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Kreinbrink v. Astrue

September 14, 2009


The opinion of the court was delivered by: Matthew F. Kennelly, District Judge


Plaintiff Lisa Kreinbrink seeks to overturn review the Commissioner of Social Security's decision to deny her application for Social Security Disability Insurance benefits. Kreinbrink has moved for summary judgment, seeking a judgment awarding her benefits or a remand for further consideration, and in response, the Commissioner seeks a judgment upholding the denial of benefits. For the reasons stated below, the Court denies Kreinbrink's motion and affirms the denial of benefits.


Kreinbrink is a forty-five year old woman with a general equivalency diploma (GED) and some college course credit. She has not worked in any capacity since November 2006. From 2003 until November 2006, Kreinbrink was employed as a case manager at Sheridan Correctional Center. Before taking the position as case manager, Kreinbrink worked for five years as the manager of two liquor stores.

On April 2, 2007, Kreinbrink applied for disability insurance benefits, claiming that she became disabled on November 9, 2006. She alleged disability due to anxiety, depression, migraine headaches, fibromyalgia, rheumatoid arthritis, and mitral valve prolapse. The Social Security Administration (SSA) denied her application initially and on reconsideration. Following these denials, Kreinbrink requested a hearing before an Administrative Law Judge (ALJ). Kreinbrink, who was represented by counsel, testified at the hearing. Vocational expert Ronald Malik also testified at the SSA's request. In May 2008, the ALJ determined that Kreinbrink was not disabled denied her claim for benefits. The SSA's Appeals Council declined review, and as a result, the ALJ's decision became the Commissioner's final decision.

1. Summary of Medical Evidence

Records from Dr. Khawaja, Kreinbrink's treating cardiologist, show Kreinbrink has a history of mitral valve prolapse (MVP), a heart disorder. In 2005, Kreinbrink began complaining of stress at work and was prescribed Alprazolam (Xanax) for her symptoms. In March 2006, she reported shortness of breath and stress and requested two work release notes from Dr. Khawaja, which he provided. A stress echocardiogram in April 2006 revealed no abnormalities other than minor MVP.

Kreinbrink went to a hospital emergency room on November 9, 2006, complaining of chest pain. Emergency room physicians told her she was suffering from anxiety. When she visited Dr. Khawaja the following day, Kreinbrink's condition had improved, and she denied any other episodes or any shortness of breath. That day, Dr. Khawaja wrote a letter stating that Kreinbrink should be excused from work for an indefinite period of time due to "stress-related symptoms." There is no record of any further treatment by Dr. Khawaja.

In April 2007, Kreinbrink visited Dr. Daniel Gauthier, an osteopathic physician, because of lower back pain. Kreinbrink denied any chest pain or palpitations. Dr. Gauthier's examination revealed tenderness and muscle tightness along Kreinbrink's thoracic spine and intrascapular region, which Dr. Gauthier assessed as back strain. The rest of the examination was normal, though Dr. Gauthier noted that Kreinbrink seemed "very anxious." Dr. Gauthier recommended stretching and a physical therapy evaluation; he also prescribed Flexeril (a muscle relaxant), Ultracet (a pain reliever), and Zoloft (a depression and anxiety medication). In May 2007, Kreinbrink requested that Dr. Gauthier change the Zoloft to Effexor.

On June 1, 2007, Kreinbrink underwent a consultative psychological examination with Dr. Mark B. Langgut, a licensed clinical psychologist, as part of her disability benefits determination. Although Dr. Langgut described Kreinbrink's speech as "somewhat pressured and emotionally highly variable," he also described her speech as "clear, direct, relevant, and characterized by a normal rate of production."

Dr. Langgut's report provides historical information about Kreinbrink. Both of Kreinbrink's parents were deaf, and her siblings have a history of suicide attempts and bipolar disorder. Kreinbrink was sexually molested by her uncle as a child and beaten by her mother throughout her childhood. From 1989 to 2002, Kreinbrink was married to an alcoholic man who was physically and emotionally abusive. Kreinbrink has good relationships with her four children. Her oldest daughter has been diagnosed with bipolar disorder, and there is also a history of bipolar disorder on Kreinbrink's mother's side of the family. At the time of the examination, Kreinbrink was not undergoing any mental health therapy. Though she had been in therapy in the past, Kreinbrink stated she discontinued the therapy because it had no positive effect.

Dr. Langgut also noted that Kreinbrink reported that her sleep was impaired. She reported sleeping approximately sixteen hours per day in the weeks prior to her examination. However, Dr. Langgut described Kreinbrink as "able to complete her activities of daily living," including cleaning, laundry, shopping and cooking. Kreinbrink engaged in various hobbies and had a good social support network. Dr. Langgut described Kreinbrink's demeanor as "friendly and outgoing."

With respect to her mental and psychological state, Kreinbrink reported feeling depressed and stated that depression was her predominant emotion at certain times. Kreinbrink also reported anxiety and panic attacks. Dr. Langgut stated that it was unclear whether the panic attacks were related to mitral valve prolapse or emotional symptoms. She also expressed anger toward the family members who had abused her and said she experienced flashbacks of the physical abuse she endured. However, Dr. Langgut described Kreinbrink's short-term and long-term memory as normal. She displayed adequate abstract reasoning skills and her judgment was intact. He described Kreinbrink's thought processes as characterized by normal to rapid speed, average coherence, and normal flexibility and suggestibility. Her consciousness was clear and her orientation to time, location, place, and person was unimpaired. He described Kreinbrink as demonstrating adequate judgment, responsibility and reasoning skills. Dr. Langgut diagnosed Kreinbrink with post-traumatic stress disorder and stated in his notes, "R/O [rule out] bipolar disorder."

On June 2, 2007, Dr. Afiz Taiwo, an internal and occupational medicine specialist, administered an internal medicine consultative examination at the request of the SSA. Dr. Taiwo noted that Kreinbrink said she tired after walking three blocks and standing for fifteen minutes but reported no difficulty sitting, bathing, dressing and cooking. A physical examination revealed no irregularities. Dr. Taiwo reported good grip strength in both hands, a normal ability to grasp and manipulate objects, and normal range of motion in all joints and the spine. Dr. Taiwo described Kreinbrink as "appropriate, polite, pleasant and cooperative," with a normal affect and no signs of depression, agitation, irritability or anxiety. He identified her major problems as depression, anxiety, and a history of MVP.

On June 20, 2007, a state agency physician, Dr. Nenaber, reviewed Kreinbrink's medical records and determined that she had some exertional limitations but was capable of performing medium work. On June 25, 2007, a state agency psychologist, Dr. Leslie Fayans, reviewed Kreinbrink's medical records. Dr. Fayans opined that Kreinbrink suffered from anxiety and post-traumatic stress syndrome but was limited in only two of the twenty vocational areas related to mental functioning on the job.

Kreinbrink had several follow-up visits with Dr. Gauthier in 2007. In August 2007, Kreinbrink scheduled an appointment to discuss her medications and anxiety. Dr. Gauthier's medical records indicate that Kreinbrink reported no back pain, joint pain, joint swelling, stiffness or arthritis at this visit. Dr. Gauthier again noted that Kreinbrink was "very anxious," and he recommended psychotherapy, which Kreinbrink refused.

Dr. Gauthier also recommended daily exercise and other lifestyle changes. Kreinbrink visited Dr. Gauthier on October 31, 2007 to discuss the medication she was taking at the time, Effexor. Dr. Gauthier noted that Kreinbrink was walking sixty minutes each day and that her anxiety disorder had improved. However, Kreinbrink requested a change in her medication due to weight gain. Kreinbrink returned to Dr. Gauthier's office on November 30, 2007 later with anxiety as her chief complaint. Dr. Gauthier again advised Kreinbrink to change her eating patterns and begin exercising regularly; he also recommended light weight training.

In November 2007, Kreinbrink went to the emergency room complaining of pain in her foot after a vacuum cleaner fell on her foot. An x-ray revealed no fracture. Six days later, Kreinbrink visited Dr. Shane York, a podiatrist, for the same foot pain. Dr. York diagnosed a deep contusion on the foot. Kreinbrink was given a Cam walker boot to wear until her foot healed.

On November 27, 2007, Dr. Shirin Ahmad began treating Kreinbrink at the Midwest Orthopaedic Institute due to her complaints of increasing joint pain. Kreinbrink's symptoms suggested fibromyalgia, and Dr. Ahmad prescribed Medrol for pain relief. In December 2007, an MRI examination of Kreinbrink's right hand revealed small joint effusions on the first, second, third, fourth, and fifth metacarpal joints and small areas of bone marrow edema in, it appears, two digits. Dr. Ahmad diagnosed Kreinbrink with seronegative rheumatoid arthritis and possible fibromyalgia. On January 3, 2008, Dr. Ahmad amended his diagnosis and noted that Kreinbrink's symptoms were more likely due to fibromyalgia than arthritis. Dr. Ahmad encouraged Kreinbrink to continue taking her medication and to begin a low-grade aerobic program.

In December 2007, Dr. Gauthier noted multiple cervical, thoracic, and lumbar trigger points (hyperirritable spots). He also recorded Dr. Ahmad's recent diagnoses of fibromyalgia and seronegative arthritis. Kreinbrink returned to Dr. Gauthier twice in January. On January 8, 2008, Dr. Gauthier noted that Kreinbrink had a foot fracture that was being treated by a podiatrist. Dr. Gauthier also noted that Kreinbrink's fibromyalgia and anxiety symptoms had improved. On January 31, 2008, Kreinbrink was not wearing the walking cast the podiatrist had given her for her foot. Dr. Gauthier adjusted the dosage of Kreinbrink's current medication, Cymbalta. He again recommended psychotherapy; Kreinbrink declined.

On January 8, 2008, Kreinbrink visited Dr. York and complained of continued pain in her right foot. Despite Dr. York's orders, Kreinbrink had stopped wearing the Cam walker boot. An MRI revealed that she had a fracture on the third metatarsal of her right foot. Dr. York again advised Kreinbrink to use the Cam walker. At a January 22, 2008 visit, Dr. York noted that Kreinbrink was again non-complaint with respect to the Cam walker.

In February 2008, Kreinbrink visited Dr. Ahmad's office, reporting that her fibromyalgia symptoms had not significantly improved. Kreinbrink stated, however, that she had discontinued Plaquenil, a medication that Dr. Ahmad had prescribed at a previous visit, because of its side effects. Dr. Ahmad again noted that her current joint pain symptoms were more consistent with fibromyalgia than arthritis and ...

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