Opinion ID: 781387
Heading Depth: 2
Heading Rank: 2

Heading: Byam's Psychiatric Background and Previous Applications

Text: 7 Byam, who was born in 1950, has been unable to work since June 1, 1969, which she attributes to depression, headaches, and arthritis. According to her psychiatric records, Byam has been hospitalized three times after suicide attempts in 1969, 1974, and 1981. 8 Byam, unassisted by counsel, first applied for SSI benefits on September 13, 1993. The application included a Mental Residual Functional Capacity Assessment (MRFCA) and a Psychiatric Review Technique by Dr. Gayle Frommelt. The MRFCA form begins by explaining, Each mental activity is to be evaluated within the context of the individual's capacity to sustain that activity over a normal workday and workweek, on an on going basis. Similarly, the Psyschiatric Review Technique uses categories established by 20 C.F.R. § 416.925 and 20 C.F.R. § 404, Subpt. P, Appendix 1, which are so constructed that an individual with an impairment(s) that meets or is equivalent in severity to the criteria of a listing could not reasonably be expected to do any gainful activity. 20 C.F.R. § 404, Subpt. P, Appendix 1, 12.00 Mental Disorders, Introduction. Thus, these evaluations focus specifically on employment. 9 Dr. Frommelt noted that Byam had an affective disorder, which the regulations characterize as a disturbance of mood, accompanied by a full or partial manic or depressive syndrome, and a personality disorder, defined as typical of the individual's long-term functioning. 20 C.F.R. § 404, Subpt. P, Appendix 1, listings 12.04 and 12.08. Dr. Frommelt checked boxes indicating that Byam had [i]nflexible and maladaptive personality traits which cause either significant impairment in social or occupational functioning or subjective distress, including [p]ersistent disturbances of mood or affect, [p]athological dependence [and] aggressivity, and [i]ntense and unstable interpersonal relationships and impulsive and damaging behavior. Dr. Frommelt also checked boxes indicating that Byam was moderately limited in her ability to understand, remember, and carry out detailed instructions, her ability to maintain attention and concentration for extended periods, and her ability to set realistic goals or make plans on her own, in addition to other moderate work-related limitations. Dr. Clifford Rivers, in a separate psychological assessment, also noted that her mood disorder affects her concentration and attention, that she may be becoming more dependant and coping increasingly poorly, and that she lacks judgment and insight into many of her problems. On November 19, 1993, the Social Security Administration (SSA) denied her 1993 application initially and denied it again upon reconsideration on April 6, 1994. 10 Byam's denial notice informed her of a right to a hearing, and explained that some benefits might be lost if, instead of requesting a hearing, she filed a new application. Byam did not request a hearing; and instead, again without counsel, she filed a second claim for benefits on September 29, 1994. Five days later, she reported to the Washington County Mental Health Hospital, so that she would not act on suicidal thoughts. Byam began treatment there, although the record is unclear whether she was ever hospitalized. The staff at the hospital noted memory loss and vagueness and dissociative presentation, which is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. Dr. Rafael Garcia observed depression, suicidal ruminations, impaired concentration, and social phobia. In November 1994, the hospital staff noted the same disorders, and also PTSD [post-traumatic stress disorder] with suicidal ideation. Dr. Edward Hurley, completing Byam's MRFCA for her 1994 application, found mental conditions similar to the ones in Dr. Frommelt's 1993 evaluation: She was moderately limited in her ability to understand and carry out detailed instructions, but not significantly limited in following simple instructions; and she had slight restriction in daily living activities, moderate difficulty in social functioning, and often had deficiencies in concentration. The regional commissioner of the SSA denied her 1994 application on January 11, 1995, and she did not request reconsideration or a hearing. 11 Byam, again unaided by counsel, filed a third application on July 26, 1995. Her 1995 evaluations indicate that her depression and poor concentration continued. Dr. Hurley completed her MRFCA for the 1995 application and found some improvement over the past year, but continued to observe moderate limitations in her ability to carry out detailed instructions. The acting regional commissioner denied her 1995 application initially on September 12, 1995 and on reconsideration on November 29, 1995. As with her previous applications, she did not request a hearing. Even though at any time within a year of the denials of her 1993, 1994, and 1995 applications she could have requested that her applications be reopened, she never did so, despite the denial notices' warnings that she may lose benefits by filing a new application. 20 C.F.R. §§ 416.1487-88. 12