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Nickerson v. Berryhill

United States District Court, S.D. Texas, Houston Division

March 24, 2017




         On March 23, 2016, the parties consented to proceed before a United States magistrate judge for all purposes, including the entry of a final judgment under 28 U.S.C. § 636(c). (Docket Entry #13). The case was then transferred to this court. Cross-motions for summary judgment have been filed by Plaintiff Jacqueline Nickerson (“Plaintiff, ” “Nickerson”) and Nancy Berryhill (“Defendant, ” “Commissioner”), in her capacity as Acting Commissioner of the Social Security Administration (“SSA”). (Plaintiff's Motion for Summary Judgment [“Plaintiff's Motion”], Docket Entry #22; Defendant's Motion for Summary Judgment and Memorandum in Support of Defendant's Cross-Motion for Summary Judgment [“Defendant's Motion”], Docket Entry #19). In addition, Defendant filed a reply. (Defendant's Response in Opposition to Plaintiff's Motion for Summary Judgment [“Defendant's Response”], Docket Entry #23). After considering the pleadings, the evidence submitted, and the applicable law, the court ORDERS Defendant's motion GRANTED, and Plaintiff's motion DENIED.


         On June 5, 2012, Plaintiff Jacqueline Nickerson filed an application for Supplemental Security Income benefits (“SSI”), under Title XVI of the Social Security Act (“the Act”). (Transcript [“Tr.”] at 121). In her application for benefits, Nickerson claimed that she has been unable to work since May 6, 2011, because she has bipolar disorder, [1] schizophrenia, [2] diabetes, high blood pressure, accompanied by headaches, back pain, and ovarian cysts. (See Tr. at 141). She concedes, however, that her previous temporary employment ended on January 15, 2009. (Tr. at 141). On October 3, 2012, the SSA found that Nickerson was not disabled under the Act, and so her application was denied. (Tr. at 57-58). Plaintiff petitioned for a reconsideration of that decision, but her claim was again denied on January 25, 2013. (Tr. at 65-67, 60). She then successfully requested a hearing before an administrative law judge (“ALJ”). (Tr. at 71-75). That hearing took place on November 25, 2013, before ALJ Mark Dowd. (Tr. at 28). Plaintiff testified at the hearing and was assisted by an attorney, Hubert Lassiter. (Tr. at 28-47). Sheryl Lynn Swisher, a vocational expert witness, testified as well at the hearing. (Tr. at 47-52). No medical experts testified at the hearing.

         On March 11, 2014, the ALJ engaged in the following five-step, sequential analysis to determine whether Plaintiff was capable of performing substantial gainful activity or was, in fact, disabled:

1. An individual who is working or engaging in substantial gainful activity will not be found disabled regardless of the medical findings. 20 C.F.R. §§ 404.1520(b) and 416.920(b).
2. An individual who does not have a “severe impairment” will not be found to be disabled. 20 C.F.R. §§ 404.1520(c) and 416.920(c).
3. An individual who “meets or equals a listed impairment in Appendix 1” of the regulations will be considered disabled without consideration of vocational factors. 20 C.F.R. §§ 404.1520(d) and 416.920(d).
4. If an individual is capable of performing the work he has done in the past, a finding of “not disabled” must be made. 20 C.F.R. §§ 404.1520(f) and 416.920(f).
5. If an individual's impairment precludes performance of his past work, then other factors, including age, education, past work experience, and residual functional capacity must be considered to determine if any work can be performed. 20 C.F.R. §§ 404.1520(g) and 416.920(g).

Newton v. Apfel, 209 F.3d 448, 453 (5th Cir. 2000); Martinez v. Chater, 64 F.3d 172, 173-74 (5th Cir. 1995); Muse v. Sullivan, 925 F.2d 785, 789 (5th Cir. 1991); Wren v. Sullivan, 925 F.2d 123, 125 (5th Cir. 1991); Harrell v. Bowen, 862 F.2d 471, 475 (5th Cir. 1988). It is well-settled that, under this analysis, Nickerson has the burden to prove any disability that is relevant to the first four steps. Wren, 925 F.2d at 125. If she is successful, the burden then shifts to the Commissioner, at step five, to show that she is able to perform other work that exists in the national economy. Myers v. Apfel, 238 F.3d 617, 619 (5th Cir. 2001); Wren, 925 F.2d at 125. “A finding that a claimant is disabled or is not disabled at any point in the five-step review is conclusive and terminates the analysis.” Lovelace v. Bowen, 813 F.2d 55, 58 (5th Cir. 1987).

         It must be emphasized that the mere presence of an impairment does not necessarily establish a disability. Anthony v. Sullivan, 954 F.2d 289, 293 (5th Cir. 1992) (quoting Milam v. Bowen, 782 F.2d 1284, 1286 (5th Cir. 1986)). Under the Act, a claimant is deemed disabled only if she demonstrates an “inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or which has lasted or can be expected to last for a continuous period of not less than twelve months.” Selders v. Sullivan, 914 F.2d 614, 618 (5th Cir. 1990) (citing 42 U.S.C. § 423(d)(1)(A)). Substantial gainful activity is defined as “work activity involving significant physical or mental abilities for pay or profit.” Newton, 209 F.3d at 452. A physical or mental impairment is “an impairment that results from anatomical, physiological or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.” Hames v. Heckler, 707 F.2d 162, 165 (5thCir. 1983) (citing 42 U.S.C. § 423(d)(3)). Further, the impairment must be so severe as to limit the claimant so that “she is not only unable to do her previous work but cannot, considering her age, education, and work experience, engage in any kind of substantial gainful work which exists in the national economy.” Greenspan v. Shalala, 38 F.3d 232, 236 (5th Cir. 1994) (citing 42 U.S.C. § 423(d)(2)(A)).

         Based on these principles, as well as his review of the evidence presented at the hearing, the ALJ found that Plaintiff “has not engaged in substantial gainful activity since June 5, 2012, the application date.” (Tr. at 11). The ALJ further concluded that Nickerson suffers from the severe impairments of low back pain, obesity, a major depressive disorder, and polysubstance abuse. (Id.). The ALJ found that Plaintiff also suffers from diabetes and hypertension, but that those conditions are not severe, because each is controlled by medication. (Id.). He considered Plaintiff's complaint of left leg numbness, and tingling and decided that these are not severe impairments, because they are recent complaints, and are not expected to persist for 12 months, and are not supported by any clinical or diagnostic evidence. The ALJ further found that Plaintiff's impairments do not meet, or equal in severity, the medical criteria for any disabling impairment in the applicable SSA regulations.[3] (Id.). The ALJ then assessed Plaintiff's residual functional capacity (“RFC”), and found that she is capable of performing light work, [4] but is limited to simple, routine and repetitive 1-2-3 step tasks that do not require fast-paced production. (Tr. at 14-15). Nickerson is also limited to only occasional interaction with the public and co-workers, and she needs a supervisor to check her work four times a day. (Tr. at 15). With these limitations, the ALJ found that Nickerson is able to work as an office cleaner, a mail clerk, and a housekeeper. (Tr. at 18). For that reason, he concluded that Nickerson is “not [] under a disability, as defined in the Social Security Act, ” and he denied the application for benefits on March 11, 2014. (Tr. at 47-48).

         On May 8, 2014, Plaintiff requested an Appeals Council review of the ALJ's decision. (Tr. at 5). SSA regulations provide that the Appeals Council will grant a request for a review if any of the following circumstances is present: “(1) there is an apparent abuse of discretion by the ALJ; (2) an error of law has been made; (3) the ALJ's actions, findings, or conclusions are not supported by substantial evidence; or (4) there is a broad policy issue which may affect the public interest.” 20 C.F.R. §§ 404.970 and 416.1470. On August 21, 2014, the Appeals Council denied Plaintiff's request for a remand, finding that no applicable reason for review existed. (Tr. at 1-3). With this ruling, the ALJ's decision became final. See 20 C.F.R. §§ 404.984(b)(2) and 416.1484(b)(2).

         On September 16, 2015, Plaintiff filed this lawsuit, pursuant to section 205(g) of the Act (codified as amended at 42 U.S.C. § 405(g)), to challenge that decision. (Complaint, Docket Entry #1). The parties have filed cross-motions for summary judgment. (Docket Entries 19, 22). Having considered the pleadings, the evidence submitted, and the applicable law, Plaintiff's motion for summary judgment is denied, and Defendant's motion for summary judgment is granted.

         Standard of Review

         Federal courts review the Commissioner's denial of disability benefits only to ascertain whether the final decision is supported by substantial evidence and whether the proper legal standards were applied. Newton, 209 F.3d at 452 (citing Brown v. Apfel, 192 F.3d 492, 496 (5th Cir. 1999)). “If the Commissioner's findings are supported by substantial evidence, they must be affirmed.” Id. (citing Martinez, 64 F.3d at 173). “Substantial evidence is such relevant evidence as a reasonable mind might accept to support a conclusion. It is more than a mere scintilla and less than a preponderance.” Ripley v. Chater, 67 F.3d 552, 555 (5th Cir. 1995); see Martinez, 64 F.3d at 173 (quoting Villa v. Sullivan, 895 F.2d 1019, 1021-22 (5th Cir. 1990)). On review, the court does not “reweigh the evidence, but . . . only scrutinize[s] the record to determine whether it contains substantial evidence to support the Commissioner's decision.” Leggett v. Chater, 67 F.3d 558, 564 (5th Cir. 1995); see Fraga v. Bowen, 810 F.2d 1296, 1302 (5th Cir. 1987). If no credible evidentiary choices or medical findings exist that support the Commissioner's decision, then a finding of no substantial evidence is proper. Johnson v. Bowen, 864 F.2d 340, 343 (5th Cir. 1988).


         Before this court, Nickerson contends that the ALJ applied the wrong legal standard in weighing the credibility of her subjective complaints. (Plaintiff's Motion at 11, 18). Plaintiff insists that this error then caused the ALJ to overlook the overwhelming evidence that she is disabled. (Plaintiff's Motion at 12-18). Because of that error, she complains that the Commissioner's findings are not supported by substantial evidence. (Id.). Defendant insists, however, that the ALJ properly considered all of the available evidence, and followed the applicable law, in determining that Nickerson is not disabled. (Defendant's Motion at 4).

         Medical Facts, Opinions, and Diagnoses

         On December 19, 2010, the Houston Police Department was called to Plaintiff's home to intervene in an altercation between Nickerson and her stepfather. (Tr. at 204). The police found her aggressive and disruptive, and so Plaintiff was taken to the NeuroPsychiatric Center, the emergency treatment center for the Harris Center for Mental Health and IDD (“HCMH”).[5] (Tr. at 204). She was verbally aggressive, loud, profane, and difficult to understand, so she was then transferred to the Harris County Psychiatric Center (“HCPC”) on an involuntary admission. (Tr. at 211). That admission was due to her expressed desire to commit assault, and her exhibited deterioration in her ability to function. (Tr. at 209). The medical records show that Nickerson had been previously hospitalized at HCPC, in 2005, for an alcohol induced mood disorder, and on one other occasion for treatment of schizoaffective[6] (bipolar type) disorder. (Tr. at 204). In addition to the prior hospitalizations, Plaintiff reported a suicide attempt at age 20, in which she drank a bottle of Nyquil. (Id.).

         Although the 2010 hospitalization was involuntary, Plaintiff was calm and cooperative during her initial examination. (Id.). She told Dr. Ashley Toutounchi, a psychiatrist, that she was irritable and needed assistance to control her anger. (Id.). She reported feeling depressed, with episodes of crying for no reason. (Id.). Overall, however, she described only minor symptoms such as irritability, “a little” depression, and an inability to control her anger. She denied hallucinations, memory or concentration problems, or feelings of hopelessness or worthlessness. (Id.). Plaintiff told Dr. Toutounchi that she had never taken psychiatric medication and was not currently receiving any psychiatric treatment. (Id.).

         Nickerson described heavy alcohol use on weekends, and told the doctor that she drinks more than two six packs of beer each day. (Id.). She also admitted to marijuana use during the months that led up to her hospitalization, a habit that began when she was a teenager. (Id.). Dr. Toutounchi's psychiatric evaluation showed that Plaintiff had a concrete thought process with no delusions or suicidal thoughts, but that her insight and judgment were poor. (Tr. at 206). Nickerson reported moderate to severe anxiety, moderate tension and hostility, and moderate excitement. (Tr. at 209-210). Plaintiff was diagnosed as suffering from an unspecified mood disorder, and alcohol and marijuana abuse. (Tr. at 208).

         Plaintiff was hospitalized for three days, and was discharged on December 22, 2010. (Tr. at 211). During her hospitalization, she tested positive for marijuana and cocaine metabolites. (Tr. at 212). She was prescribed Risperdal, an anti-psychotic medication, which is used to treat schizophrenia and bipolar disorder. She also participated in some group therapy sessions while at the hospital. (Tr. at 213). Plaintiff initially blamed the events leading to her hospitalization on her mother and step-father, but eventually revealed that she has heard voices, intermittently, since she was sixteen years old. She reported that these voices cause her distress. (Tr. at 213). Her condition improved almost immediately when she began taking the Risperdal. (Id.). She was given a GAF[7]score of 30, at the time of her admission. That score was increased to 45 at the time of her discharge. (Tr. at 213). On discharge, Dr. Tounoutchi was unsure if Plaintiff should be diagnosed as suffering from schizophrenia, or whether she had a mood spectrum disorder. (Tr. at 213). Plaintiff was advised to schedule an appointment at the Community Clinic for further psychiatric treatment, and she was encouraged to begin drug and alcohol rehabilitation. (Tr. at 214-215). Nickerson was much improved when she was released from the hospital, but she was told that she was in need of substance abuse treatment. (Tr. at 218, 216).

         On May 6, 2011, Plaintiff sought treatment at the Psychiatric Emergency Services center of HCMH. (Tr. at 229). Plaintiff acknowledged that this was her first treatment since leaving the psychiatric hospital five months earlier. (Tr. at 229). She had run out of medication and wanted to take Risperdal again, because it had helped with her symptoms. She did not want to be hospitalized, however. (Tr. at 229, 337). She admitted to heavy alcohol use in the months before this visit. (Tr. at 229). Plaintiff also believed marijuana helped to calm her, and she continued to use it. (Id.). Plaintiff said that she had tried to kill herself three weeks earlier, because she was upset with a friend. However, she had stopped herself, and no was no longer contemplating suicide. (Tr. at 229). She complained that she heard voices telling her to look at herself in the mirror, and she claimed to see shadows of people who spoke to her. (Tr. at 337).

         Dr. Charles Kopecky examined Plaintiff during this visit, and found her well dressed, and neatly groomed. (Tr. at 230-231). Her thought process was logical and clear, and she had fair insight and judgment. (Tr. at 231). She denied delusions, but did express a belief that she would be better off dead, and said that she felt helpless and hopeless. (Tr. at 231, 337). Dr. Kopecky described her as depressed and subject to mood changes. (Tr. at 230-231). He was uncertain if Plaintiff was suffering from a major depressive disorder, or if she had bipolar disorder. (Tr. at 232). He gave her a GAF score of 39. (Tr. at 232). He prescribed Risperdal, Celexa and Trazodone to treat her depression. (Tr. at 231). She was asked if she wanted to check in to the crisis stabilization unit voluntarily, and she declined to do so. (Tr. at 231). She was then referred to the mobile crisis outreach team, and told to schedule an appointment for additional treatment. (Tr. at 232).

         Over the following three weeks, the outreach team contacted Plaintiff on several occasions to encourage her to continue her psychiatric treatment. (Tr. at 323-325). Nickerson missed several appointments at HCMH, and did not follow advice to see a doctor for her overall health care. (Tr. at 221). When she was finally contacted at her home, Plaintiff explained that she was doing much better on the medications, that her hallucinations were greatly reduced, and that she no longer wanted to die. (Tr. at 325-326, 224). On June 14, 2012, Nickerson was discharged from the mental health program because she was not participating in the treatment. (Tr. at 221).

         On August 4, 2013, Nickerson was examined by Christina Gamez-Galka, Ph.D., a psychologist acting on behalf of the state. (Tr. at 264). Plaintiff was accompanied by her mother, and both women were asked to describe Nickerson's history of psychiatric problems. (Tr. at 264). Dr. Gamez-Galka believed that Plaintiff was a poor and unreliable historian, because her statements and explanations of symptoms were inconsistent and contradictory. (Tr. at 264-265). Plaintiff told Dr. Gamez-Galka that she has heard voices and experienced hallucinations since she was fourteen years old. (Tr. at 265). She said that the voices alternate between positive and negative statements. Sometimes the voices tell her she is beautiful, while at other times the voices tell her to hurt herself. (Id.). Plaintiff explained that the voices occur more often when she is alone, and that they last for several hours. (Id.). She also told Dr. Gamez-Galka that there are times when she awakens and thinks she sees someone standing at the end of her bed. (Id.). This happens at least once a month, and sometimes happens even when she is fully awake. (Id.).

         Dr. Gamez-Galka detailed several instances of irrational behavior by Plaintiff. (Id.). Nickerson's mother said that Plaintiff will walk to her aunt's house, a significant distance, for no reason. (Id.). Plaintiff will talk for hours nonstop. At other times, she will cook all of the food in the house. (Id.). Plaintiff explained that she feels as if her mood is constantly changing between happy and sad, and she is restless, with difficulty in concentrating. (Id.).

         Dr. Gamez-Galka questioned Plaintiff's reliability, in part, because she was not able to remember specific details about her past treatment. (Id.). Nickerson brought a copy of the court order for her December 2010 commitment, but neither she nor her mother could remember what led to the hospitalization. (Id.). Plaintiff also told Dr. Gamez-Galka that she had been hospitalized at Ben Taub Hospital, then transferred to a facility in Montgomery County, in 2011. (Id.). Nickerson's mother was unsure whether such a hospitalization had, in fact, occurred, and it is not mentioned in any other record. (Id.). Plaintiff also said that she had attempted suicide on more than ten occasions. She said that she had tried to kill herself, at age fourteen, by hanging, but that the rope fell down. (Id.). She then tried to cut herself but was interrupted by her sister. (Id.). Her mother was unaware of either of those attempts. (Id.). Nickerson had also attempted to kill herself by taking pills with alcohol and NyQuil, and said that at least one attempt lead to a hospital admission. (Id.). She told Dr. Gamez-Galka that she had recently thought about hurting herself, but she called her daughter for support. (Tr. at 266).

         Plaintiff told Dr. Gamez-Galka that she had stopped drinking a year ago, but had used marijuana within the last two months. (Tr. at 267). She said that she had last worked in the 1990's, but had stopped, because she worried about how her co-workers would respond to her criminal history and substance addictions. (Tr. at 264, 266). Dr. Gamez-Galka reported that Plaintiff's thoughts were coherent and logical, but her memory was very poor, and she was unable to do basic math. (Tr. at 266-267). Dr. Gamez-Galka did not provide a diagnosis for Plaintiff, because she found Nickerson's statements too unreliable, and the reported symptoms and clinical observations were not consistent enough to support a conclusive diagnosis. (Tr. at 268). Plaintiff's prognosis was said to be “guarded, ” because of her inconsistent use of medication and the absence of treatment that would help her cope with her symptoms. (Id.). Plaintiff was given a GAF score of 41. (Id.). Although Nickerson understood what it meant to file a claim for Social Security benefits, Dr. Gamez-Galka did not believe she could manage benefits on her own, because she was not consistent in taking medication and was still using drugs. (Id.).

         Five days after the psychiatric examination by Dr. Gamez-Galka, Plaintiff returned to the NeuroPsychiatric Center (“NPC”) to be voluntarily admitted. (Tr. at 275-276). She was struggling with suicidal thoughts and asked to be hospitalized. (Tr. at 280). Although Plaintiff had told Dr. Gamez-Galka a week earlier that she was taking her medications, she told the nurse at NPC that she had been without medication for two months. (Tr. at 405). Plaintiff was transferred to the Crisis Stabilization Unit for admission. (Tr. at 290). She told the nurse that she was depressed and seeing shadows. (Tr. at 290). She admitted to using alcohol and marijuana the day before. (Tr. at 284). She complained of abdominal pain, lower back pain, and leg pain, and she was found to have high blood sugar levels. (Tr. at 290, 300).

         During this hospitalization, Plaintiff resumed anti-depressant and anti-psychotic medications, and attended group therapy sessions led by the NPC staff. (Tr. at 317- 321). During these sessions, Nickerson set goals to be more positive and healthy, to continue to take her medications, and to show respect for herself and others. (Tr. at 317, 320-321). Although the drugs were effective in treating her depression, Nickerson complained of a number of side effects, including headaches, vision changes, drowsiness, rashes, nausea, anxiety, nervousness, lightheadedness upon standing, and impaired concentration. (Tr. at 315). Nickerson complained of these side effects in the group sessions, but her medical care providers recorded no such complaints to them during her hospitalization. (Tr. at 315, 278).

         Plaintiff was discharged from the Crisis Stabilization Unit, on August 15, 2012, six days after admission. (Tr. at 299). At that time, she was diagnosed as suffering from a major depressive disorder with psychotic features. (Tr. 299). Nickerson was told to continue taking her medications, and to continue psychiatric treatment through HCMH. (Tr. at 299). An outpatient drug test was positive for marijuana on August 22, 2012. (Tr. at 429).

         Three weeks later, on September 4, 2012, she returned to the Harris County Psychiatric Center for treatment and was seen by Shakeel Raza, M.D., a psychiatrist. (Tr. at 398). Plaintiff said that she had experienced no hallucinations since her last treatment. (Tr. at 398). She was counseled to continue taking her medications, and to continue her outpatient treatment. (Tr. at 428). Plaintiff agreed to discontinue drug and alcohol use, and to attend Alcohol and Narcotics Anonymous meetings. (Tr. at 430). Dr. Raza, confirmed that Plaintiff was suffering from a major depressive disorder with psychotic features, and that she also had an intermittent explosive disorder, and unexplained academic problems.[8] (Tr. at 424). Dr. Raza gave Nickerson a GAF score of 55. Plaintiff then met with Gerald Hanson, a qualified mental health professional, as part of her outpatient psychiatric treatment through the Northwest Community Services Center (“NWCSC”). (Tr. at 465). Plaintiff discussed with Mr. Hanson strategies for identifying and communicating her symptoms to her medical and mental health care providers. (Tr. at 465). She was encouraged to record her symptoms, and to seek emergency assistance if she thought about suicide. (Tr. at 465).

         On September 9, 2012, Nickerson was examined by Paul Dibble, M.D., a family doctor acting on behalf of the state, to assess her complaints of back pain, diabetes, hypertension, headaches, and ovarian cysts. (Tr. at 362). Plaintiff told Dr. Dibble that her low back pain began when she was pregnant with her daughter twenty three years earlier. (Tr. at 362). She complained of almost constant pain, which she rated at a “10, ” on a scale of 1 to 10. (Tr. at 362). She told Dr. Dibble that the pain radiates down her legs to both ankles, and causes her to take frequent breaks while doing household chores. (Tr. at 363). She said that her legs occasionally “give out, ” and she has fallen as a result. She does not use any assistive device to help her walk. (Tr. at 363). Over the counter medications like aspirin and Advil provide little relief from this pain. (Tr. at 363). A physical examination showed that Plaintiff did not have a full range of motion in her knees and hips. (Tr. at 364). Dr. Dibble attributed the diminished range of motion to her obesity. (Tr. at 364). He found no deformities or tenderness in any area of Plaintiff's back, and she was able to walk normally, without assistance. (Tr. at 364).

         Dr. Dibble briefly discussed Plaintiff's diabetes and hypertension, stating that she has received no treatment and taken no medication since those conditions were diagnosed in 2011. (Tr. at 363). She told Dr. Dibble that she suffers headaches every couple of days and that these can last from an hour to all day. (Tr. at 363). She also told him that ovarian cysts were discovered in May 2012, and that they cause constant pain in her lower abdomen. (Tr. at 363). Finally, she complained of poor vision, but admitted that she can read and watch television. (Tr. at 363). During the examination, Dr. Dibble found that she could read from a small calendar without trouble, even though she scored poorly on the eye exam. (Tr. at 364). She told Dr. Dibble that she had not consumed any alcohol or marijuana in over a month. (Tr. at 364).

         Dr. Dibble discussed the effect of each of these conditions on Nickerson. (Tr. at 365). He said that, subjectively, her back pain limited her ability to stand or walk for long periods. Although she said that her back caused her almost constant pain, there was no objective evidence to show that her mobility was impaired. (Tr. at 365). He did order an X-ray of her lower spine, but he completed his report before the results were available to him.[9] (Tr. at 365). Dr. Dibble did not find any impairments due to Plaintiff's diabetes or hypertension, because there were no complications or evidence of organ damage. (Tr. at 365). Dr. Dibble concluded that Plaintiff's subjective pain from headaches and her ovarian cysts, if severe, could affect her ability to function, but that those conditions do not directly impact an ability to work. (Tr. at 365). He offered no opinion on whether Nickerson has a visual impairment, because he found the results from her eye examinations to be inconsistent. (Tr. at 365).

         Nickerson continued her outpatient treatment with NWCSC on September 11, 2012. (Tr. at 464). On that date, she met with Mary Vallesteros. (Tr. at 364). Ms. Vallesteros counseled her on the importance of taking her medications, as well as the possible side effects from those drugs. (Tr. at 464). They discussed the symptoms of depression, and developed a crisis plan should Plaintiff begin to think about suicide. (Tr. at 464). Ms. Vallesteros expressed concern that Nickerson was not showing any progress in her treatment. (Tr. at 464). Ms. Vallesteros helped Plaintiff to apply for health insurance so that she could be seen by a family physician. (Tr. at 463).

         Ms. Vallesteros next met with Plaintiff two weeks later, on September 20, 2012. (Tr. at 462). Nickerson was reminded to take her medications as prescribed. (Tr. at 462). Plaintiff complained to Ms. Vallesteros that the medications made her drowsy, stiff, and gave her tremors, although they did improve her mood. (Tr. at 462). She said that she had suffered no hallucinations between sessions. Ms. Vallesteros believed that Plaintiff was now showing progress, because she was able to recognize and explain the benefits of taking her medication. (Tr. at 462). When Plaintiff met with Ms. Vallesteros on October 9, 2012, they discussed ways to prevent relapses and repeated hospitalizations. (Tr. at 461). On that day, Plaintiff reported that she ...

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