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Teschner v. Colvin

United States District Court, N.D. Illinois, Eastern Division

December 6, 2016

CAROLYN W. COLVIN, Acting Commissioner, Social Security Administration, Defendant.


          Young B. Kim, Magistrate Judge

         Heather Teschner seeks Supplemental Security Income (“SSI”) based on her claim that she is unable to work because of impairments including asthma, migraine headaches, obesity, chronic pain, depression, and anxiety. After the Commissioner of the Social Security Administration denied her application, Teschner filed this lawsuit seeking judicial review. See 42 U.S.C. § 405(g). Before the court are the parties' cross-motions for summary judgment. For the following reasons, Teschner's motion is denied, the government's is granted, and the Commissioner's final decision is affirmed:

         Procedural History

         Teschner filed her SSI application in May 2010 claiming a disability onset date of October 21, 2001. (Administrative Record (“A.R.”) at 229-31.) After her claim was denied initially and upon reconsideration, (id. at 148-57), Teschner sought and was granted a hearing before an administrative law judge (“ALJ”), which took place on December 8, 2011, (id. at 46-92). On February 14, 2012, the ALJ issued a decision concluding that Teschner is not disabled and therefore not entitled to SSI. (Id. at 105.)

         Teschner then sought and was granted review by the Appeals Council. On May 8, 2013, the Appeals Council vacated the ALJ's decision and remanded the case for the resolution of several issues. The Appeals Council directed the ALJ to: (1) obtain additional evidence including a consultative examination; (2) give additional consideration to Teschner's asthma; (3) apply the special technique for mental disorders set out in 20 C.F.R. § 416.920a; (4) re-evaluate the credibility of Teschner's subjective complaints; (5) reconsider her residual functional capacity (“RFC”); and (6) obtain additional evidence from a vocational expert (“VE”). (Id. at 112-14.) The ALJ held a new administrative hearing on November 21, 2013, and issued a decision on January 31, 2014, again concluding that Teschner was not disabled. (Id. at 14-45, 120-39.) When the Appeals Council declined review, (id. at 1-5), the ALJ's decision became the final decision of the Commissioner, Schomas v. Colvin, 732 F.3d 702, 707 (7th Cir. 2013). Teschner filed this lawsuit seeking judicial review of the Commissioner's final decision, (R.1); see 42 U.S.C. § 405(g), and the parties consented to this court's jurisdiction, (R. 6); see also 28 U.S.C. § 636(c).


         In support of her application for SSI, Teschner presented documentary and testimonial evidence.

         A. Medical Records

         Teschner began receiving treatment for migraine headaches from her primary care physician, Dr. Massarat Bala, and other doctors at the Partners in Primary Care Center starting in 2008. One of her physicians there first noted headaches in February 2008 and prescribed Topomax to prevent the onset of migraine attacks. (A.R. 371.) Imitrex was added several weeks later after Teschner appeared at the Northwest Community Hospital complaining of a two-day headache. (Id. at 352-54, 459.) A CT scan of Teschner's brain performed at the hospital showed normal results. (Id. at 351.) In April 2008, Dr. Bala noted that Teschner's headache symptoms had stabilized, and the remaining 2008 treatment notes do not reflect any further complaints of migraines. (Id. at 357-67.) Dr. Bala discontinued Imitrex in 2009, and treatment notes from that year do not reflect any headache complaints except for a May 2009 entry that Teschner's pain was worse. (Id. at 436.) Otherwise, Dr. Bala merely noted that Teschner's migraines were stable. (Id. at 423-43.)

         The next significant episode of migraine pain came in July 2010, when Teschner complained of a three-day headache and stated that she was weaning off Topomax because it caused memory loss. (Id. at 565-66.) In response, Dr. Bala prescribed the pain medication Ultram instead. (Id.) Three weeks later, Teschner presented at Northwest Community Hospital complaining of a five-day headache. (Id. at 543.) She was placed on topiramate, a generic version of Topomax, and by September 2010 Teschner stated that her head pain was “mild to none.” (Id. at 561, 563.)

         During her August 2010 hospital visit, Teschner was diagnosed with cervicalgia (pain in the neck). (Id. at 654.) A cervical spine x-ray was taken in May 2011 to examine the causes of her neck and head pain. The results showed no abnormalities in the neck. (Id. at 625.) An August 2011 MRI of the cervical spine was also normal. (Id. at 654.) Teschner told Dr. Bala in April 2012 that she was again having headaches combined with photophobia and phonophobia. (Id. at 773.) Dr. Bala's treatment notes show that Teschner otherwise denied headache pain at all of her other 2012 appointments and never complained of memory loss. (Id. at 767-83.) By contrast, Teschner told another medical provider throughout much of 2012 that topiramate was not helping to relieve her migraines and that she wanted to return to Topomax. (Id. at 848-49.) She stopped taking either topiramate or Topomax at some point after April 2013, which is the last mention of medication in Dr. Bala's notes. (Id. at 761.) The notes from July through November 2013 state that Teschner denied memory loss and had no headaches, with one exception in August 2013. (Id. at 755.)

         In addition to headaches, Teschner was also treated for asthma. The record is not clear on when that treatment began, and Dr. Bala's notes from 2008 and 2009 do not mention asthma. (Id. at 423-43.) In December 2009, however, Dr. Mahesh Shah examined Teschner at the request of the Illinois Bureau of Disability Determination Services. (Id. at 398-402.) He diagnosed her with bronchial asthma that was under “good control.” (Id. at 401.) Dr. Shah did not note that Teschner was taking any medication to control her symptoms, but by January 2010, she was using an inhaler six times daily. (Id. at 416.) Treatment notes from 2010 do not reflect any asthma-related complaints, although they show that Teschner's inhaler prescription was changed in February 2010. (Id. at 415.)

         In August 2010, state-agency expert Dr. Calixto Aquino completed a physical RFC assessment concerning Teschner's asthma. (Id. at 510-17.) Dr. Aquino opined that Teschner could work at all exertional levels with no postural or manipulative limitations, but should avoid concentrated exposure to fumes, odors, dusts, and gases. (Id. at 514.) Another agency expert, Dr. Ernest Bone, considered both Teschner's asthma and migraine pain and affirmed Dr. Aquino's RFC assessment in December 2010. (Id. at 576.)

         By February 2011, Dr. Bala was prescribing albuterol sulfate as Teschner's asthma inhaler. (Id. at 613.) Teschner experienced breathing problems related to bronchitis at that time, and she developed a respiratory infection in September 2011. (Id. at 613, 696.) But Dr. Bala's notes do not reveal any asthma-related complaints throughout 2011. (Id. at 591-613, 696-98, 783-84.) Teschner experienced an asthma flare-up in March 2012 following a pulmonary embolism caused by hormonal supplements. (Id. at 836.) Dr. Bala and his associates did not note any other exacerbations of her symptoms, though Teschner was treated for pneumonia in February 2012. (Id. at 779.) By 2013, Dr. Bala had added Symbicort to the inhaler that Teschner was using to control her asthma symptoms. (Id. at 747.) The medical notes show that Teschner did not complain of any asthma at that time.

         While Teschner was being treated for her physical problems, she also sought treatment for depression and anxiety which primarily consisted of periodic counseling visits and medication management. Dr. Bala prescribed and then discontinued treatment with Wellbutrin in 2008, when he referred Teschner to psychiatrist Dr. Jonathan Gamze. (Id. at 370, 374, 491.) Dr. Gamze's handwritten notes are, as the ALJ stated, indecipherable, (id. at 134-35), but his office provided typed transcripts of multiple entries. These notes reveal that Teschner was “very mildly dysthymic” at her initial consultation in January 2008. (Id. at 408.) Even though Teschner was never diagnosed with bipolar disorder, Dr. Gamze prescribed a trial course of Lamictal because one of Teschner's relatives had been diagnosed as having the disorder, and Dr. Gamze speculated that a family history of bipolar disorder might be present. (Id.) His one treatment note for 2009 states that her depression was mild. (Id.) In the first half of 2010, Dr. Gamze prescribed Sonata to help Teschner sleep, and prescribed Klonopin, a tranquilizer, for anxiety. (Id. at 688-89.) The antidepressant medication Abilify was briefly added to Teschner's regimen in July 2010. (Id. at 689.) Teschner was euthymic in May 2010 and only mildly dysthymic in December 2010. (Id. at 689-90.)

         Teschner received additional care through counseling with social worker Michelle McCullough at the Salvation Army. McCullough submitted a letter dated December 21, 2010, stating that she had held six individual and four family sessions with Teschner and her daughter. (Id. at 582.) She found that Teschner was easily overwhelmed by simple tasks and had not consistently appeared for her appointments. (Id.) A letter submitted on October 25, 2011, echoed the same observation. (Id. at 634.) Despite McCullough's concerns, Dr. Gamze did not note significant difficulties in Teschner's functioning. She was euthymic in March 2011, had no depression in May 2011, and showed no symptoms in December 2011. (Id. at 689-90, 848.) In March 2012, Dr. Gamze discontinued Abilify in favor of Klonopin, noting that Teschner was euthymic in June, July, and October 2012. (Id. at 849.) He also did not note any side effects with Klonopin. (Id. at 850.) Teschner expressed distress in May 2013 but was once again euthymic in July. (Id.)

         Several examining and non-examining experts evaluated Teschner's depression and anxiety. Psychologist Randy Kettering, Ph.D., interviewed Teschner on July 20, 2010. Dr. Kettering found her to be euthymic with a broad affect. (Id. at 493.) She could repeat series-seven numbers forward and series-four numbers backwards. (Id.) Based on his observations, Dr. Kettering diagnosed Teschner with a cyclothymic disorder and a personality disorder, NOS (not otherwise specified). (Id. at 494.) State agency psychologist Howard Tin, Psy.D., then reviewed Dr. Kettering's report and completed a Psychiatric Review Technique evaluation on August 6, 2010. (Id. at 496-509.) Dr. Tin also assessed an affective disorder and a personality disorder, NOS, but he concluded that neither condition constituted a severe impairment. (Id. at 496.) He found that Teschner had mild limitations in her activities of daily living and concentration, no restrictions in social functioning, and had not experienced any episodes of decompensation. (Id. at 506-07.)

         Dr. Gamze also provided a mental RFC assessment on March 22, 2011. (Id. at 587-88.) He opined that Teschner's symptoms were triggered by stress and that she was unable to remain focused on her tasks up to 15 percent of an ordinary workday. (Id. at 588.) He further opined that Teschner would also need to miss more than three work days each month because of her symptoms. (Id.) Dr. Gamze then assessed the limitations imposed by Teschner's depression and anxiety, respectively. He found that her depression imposed moderate restrictions in her activities of daily living, social functioning, and concentration, persistence, and pace. (Id. at 589.) He also stated that Teschner had experienced four or more episodes of decompensation in the past two years. (Id.) Dr. Gamze found Teschner's anxiety-related restrictions to be greater, opining that she was markedly restricted in all functional areas and that she had suffered repeated episodes of decompensation. (Id. at 589-90.)

         Finally, Teschner underwent another mental status exam in July 2013 after the Appeals Council remanded her case to the ALJ. Dr. Chirag Raval, a consulting psychiatrist, found among other things that Teschner could immediately recall three out of three words posed to her and could recall two of them five minutes later. (Id. at 707.) He did not provide a written narrative of his conclusion, but Dr. Raval diagnosed Teschner with dysthymia and an anxiety disorder, NOS. (Id. at 708.)

         B. Hearing Testimony

         Teschner testified at both the December 2011 and November 2013 hearings. She stated that she last worked in 2007 in a scrap-booking store, but had to quit her position because of migraine headaches. (A.R. 50-52.) She explained that her headaches could be caused by minimal activities such as bending down, could last for days or even weeks at a time, and were accompanied by significant sensitivity to light and sound. (Id. at 52.) Teschner said at the first hearing that she went to the emergency room between five and six times within the previous two years for uncontrolled headache pain. (Id.) She also testified that she has headaches several times a month, and she later asserted that they are “almost constant.” (Id. at 54, 67.) At the first hearing, Teschner said that she was experiencing a migraine that had lasted for three weeks. (Id. at 54.) At the second hearing, Teschner stated that she had headaches three to five times a week, but that her longest migraine had lasted only four days. (Id. at 20.) Teschner explained that she used to take Topomax to treat her migraines, but she switched to Excedrin Migraine because ...

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