George B. Meuser, Plaintiff-Appellant,
Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant-Appellee.
July 7, 2016
from the United States District Court for the Southern
District of Indiana, Evansville Division. No. 3:15-cv-32 -
William G. Hussmann, Jr., Magistrate Judge.
Wood, Chief Judge, and Bauer and Kanne, Circuit Judges.
Meuser suffers from schizophrenia and applied for Disability
Insurance Benefits principally because of that impairment.
But an administrative law judge concluded at Step 2 of the
5-step disability analysis that Meuser's schizophrenia
was not a severe impairment and denied benefits on that
basis. A magistrate judge presiding by consent, see
28 U.S.C. § 636(c), upheld that ALJ's decision, but
Meuser argues that it rests on a profound misunderstanding of
the medical evidence and thus is not supported by substantial
evidence. We agree.
who is 46 years old, was diagnosed with schizophrenia in
1996, and for 15 years he managed his symptoms with the
antipsychotic drug Zyprexa. Throughout that time, from 1995
through March 2012, Meuser worked in the mail-room at a
publishing company. Although he described himself as
"socially impaired somewhat, " he generally got
along well with his coworkers.
Meuser's health began deteriorating in late 2011 after
his pharmacist gave him the generic version of Zyprexa.
Before that switch, as evidenced by nearly two years of
physicians' progress notes, Meuser was sleeping eight to
ten hours per night, was not experiencing side effects from
his medication, and was showing "good" and
"euthymic" mood and affect, meaning neither
elevated nor depressed, see Dorland's Medical
Dictionary 655 (32d ed. 2012). But after the drug
substitution, Meuser started having insomnia and would sleep
only four to six hours per night. He said that he could not
focus at work. He told clinicians that an increased work load
over the preceding six or seven months was causing him
stress. Hoping that a break would improve his symptoms,
Meuser took a leave of absence from his job in December 2011.
He apparently was living with his parents at the time, and he
continues to live with them.
changed psychiatrists in January 2012. At that time he began
seeing Dr. Charles Rhoton, who rediagnosed Meuser's
schizophrenia from "undifferentiated" to
"paranoid type/' which involves "prominent
delusions or auditory hallucinations/' see Am.
Psychiatric Ass'n, Diagnostic and Statistical Manual of
Mental Disorders 313 (4th ed. text revision 2000)
(DSM-IV-TR). Dr. Rhoton also noted "[p]roblems related
to social environment" and assessed Meuser's Global
Assessment of Functioning (GAF) score as 61 to 70 with "mild
symptoms." Dr. Rhoton switched Meuser back to the
brand-name Zyprexa he was taking previously and increased his
dosage, but Meuser did not fully improve. Two weeks after Dr.
Rhoton's initial assessment, Meuser reported that the
increased dosage was causing him to sleep at least 12 to 14
hours a night. Meuser started taking a lower dosage, which
helped, but still his sleep was "erratic." Dr.
Rhoton noted that Meuser's mood was "mildly
dysthymic, " or mildly depressed, and his affect was
"blunted, " meaning that Meuser exhibited a severe
reduction in the intensity of his external expression of
emotion, see Dorland's Medical Dictionary at
582, 655. Dr. Rhoton now revised his diagnosis to be
schizophrenia, undifferentiated type.
next month Meuser reported to Dr. Rhoton that he was
"doing pretty well, " had more energy, was falling
asleep easier, and had "been getting out of the house a
little more." Dr. Rhoton noted that Meuser was
responding well to his medication and that his mood and
affect were normal. Nevertheless, Meuser said, he was not
feeling well enough to return to work. Faced with the choice
of returning to work or being fired, Meuser decided to quit
his job. At his next appointment with Dr. Rhoton at the end
of March 2012, Meuser said he was doing "okay, "
and Dr. Rhoton assessed his mood as dysthymic.
had applied for DIB on February 27, 2012, and based on
medical records through March 2012, psychologist F. Kladder,
an agency consultant, opined that Meuser's schizophrenia
was not a severe impairment. He noted that Meuser's
symptoms had been well controlled for over 15 years and that,
although his symptoms were not well controlled with generic
medication, Meuser was again "doing well' after
switching back to Zyprexa. Dr. Kladder checked boxes
indicating only mild difficulties in activities of daily
living, social functioning, and concentration, persistence,
and pace. A month later William Shipley, an agency consultant
with a Ph.D. in an unspecified field, agreed with Dr.
Kladder's assessment without explanation.
application for benefits then was denied initially and on
reconsideration. For the next year and a half, until his
hearing before the ALJ, Meuser visited Dr. Rhoton six times
as his symptoms waxed and waned. Although at each visit
Meuser reported to Dr. Rhoton that he was "well, "
"stable, " "fairly well, " or "okay,
" Dr. Rhoton noted during four of those visits that
Meuser was exhibiting a blunted affect, and on a fifth visit
that he was dysthymic. Meuser continued to complain about
erratic sleep. In November 2012, for example, Meuser reported
that sleep was "an issue" but said he did not want
to change his medication. Then in February 2013 he reported
sleeping only three or four hours some nights and other
nights twelve to fourteen hours. And as late as August 2013
he reported sleeping "poorly" and having difficulty
"falling asleep and staying asleep." But Meuser did
not report "psychotic symptoms" or "positive
symptoms" such as hallucinations, paranoia, or
"thought broadcasting/insertion, " see Am.
Psychiatric Ass'n, Diagnostic and Statistical Manual of
Mental Disorders 94 (5th ed. 2013) (DSM-V). At Meuser's
last appointment before the September 2013 hearing, Dr.
Rhoton noted that his "negative symptoms" (i.e.,
limited emotional expression and disinterest in work or
social activities) "remain prominent, "
see DSM-V at 88.
after this appointment, Dr. Rhoton completed a mental
residual functional capacity assessment, marking boxes for
the degree of Meuser's limitations in various categories.
Dr. Rhoton opined that Meuser, in addition to being
"moderately" limited in many areas, was
"markedly" limited in his abilities to (1) maintain
attention and concentration for extended periods, (2)
regularly attend scheduled activities and be punctual, (3)
"sustain an ordinary routine without special
supervision, " (4) "make simple work-related
decisions, " (5) "ask simple questions or request
assistance, " (6) accept instructions and criticism, and
(7) set realistic goals and make plans. Dr. Rhoton further
opined that Meuser was experiencing "extreme"
limitations in the abilities to (1) "work in
coordination with or proximity to others without being
distracted, " (2) "complete a normal workday and
workweek without interruptions from psychologically based
symptoms and ... perform at a consistent pace without an
unreasonable number and length of rest periods, " and
(3) "respond appropriately to changes in the work
setting." Dr. Rhoton wrote that these limitations had
been present for over a year and a half, since February 2012.
to the hearing Meuser submitted reports completed by himself
and his parents describing his functional limitations.
Meuser's mother described how Meuser's sleep "is
a major problem." She reported that he "only sleeps
a couple of hours at a time/' which "causes great
anxiety." She said that Meuser's chores included
doing laundry taking out the trash, caring for their two
cats, and doing "odd jobs as needed around the
house." Weekly he also prepares meals such as canned
pasta or soup, frozen pizza, burgers, and cereal. She said
that he "only goes out to eat or out in public about
every two weeks when he sees his psychiatrist" and, even
then, needs someone with him. And, his mother noted, Meuser
had "become extremely reclusive" and "more
obsessed with TV and with NASCAR" since his symptoms
returned. She said that Meuser respects authority and
"gets along with others when with them, but hardly ever
goes near them." Meuser's father echoed these
observations, saying that Meuser spends no time with others
and has become more withdrawn. In ...