United States District Court, S.D. Texas, Houston Division
MEMORANDUM AND ORDER ON MOTIONS FOR SUMMARY
MILLOY UNITED STATES MAGISTRATE JUDGE
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.
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,  schizophrenia,  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.
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
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
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
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).
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.
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. (Id.). The ALJ then
assessed Plaintiff's residual functional capacity
(“RFC”), and found that she is capable of
performing light work,  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).
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).
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.
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).
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).
Facts, Opinions, and Diagnoses
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”). (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 (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.).
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
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).
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
GAFscore 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
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).
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).
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
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.
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.).
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
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.
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
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).
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).
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. (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).
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).
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).
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. (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).
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).
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 ...