United States District Court, S.D. Iowa, Western Division
REPORT AND RECOMMENDATION
C. Adams Chief U.S. Magistrate Judge.
Matthew Becker seeks review of a final decision of the
Commissioner of the Social Security administration
("Commissioner") denying his claim for Supplemental
Security Income Benefits ("SSI") under Title XVI of
the Social Security Act 42 U.S.C. § 1381-1385. This
Court reviews the Commissioner's final decision pursuant
to 42 U.S.C. § 1383(c)(3). The case is before the
undersigned for report and recommendation pursuant to 28
U.S.C. § 636(b)(1)(B). The Court considers the matter
fully submitted on the briefs.
protectively filed his SSI benefits claim on February 1, 2014
alleging disability since January 4, 2010. (AR at32,
180). He alleged oppositional defiant disorder,
"social disorder, " anxiety disorder and depression
limited his ability to work. (AR at 73, 184). The Social
Security Administration denied Becker's claim initially
and on reconsideration. (AR at 72-83, 84-96). On July 21,
2014, Becker requested an administrative hearing.
Administrative Law Judge ("ALJ") David Buell
conducted an administrative hearing on November 9, 2015.
Becker appeared with his attorney Gregory Peterson;
Becker's mother, Christine Becker, and vocational expert
Stephen Schill also testified. At hearing, counsel amended
the alleged onset date to February 1, 2014. (AR at 13, 32).
The ALJ issued an unfavorable decision on December 18, 2015,
finding Becker was not disabled. (AR at 10-26). Becker
requested a review of the ALJ's decision. (AR at 8-9).
The Appeals Council denied the request for review and the
ALJ's decision became a final decision on November 4,
2016. (AR at 1-3). The Complaint  in this case was timely
filed on December 23, 2016.
Educational and Vocational Factors
was 18 years old when he filed for benefits. (AR at 166). He
had limited past work as cook/counter attendant at a fast
food restaurant and housekeeping at a hotel. (AR at 34-37).
Becker completed the eleventh grade in high school. (AR
mental health medical history begins with an admission to
Mercy Hospital in Council Bluffs, Iowa on May 27, 2010, when
he became suicidal after breaking up with his girlfriend. He
told his counselor he was thinking about killing himself and
would not contract for safety. (AR at 279, 283). He was
hospitalized until May 30, 2010. (AR at 279) Attending
physician Dr. S. Ravipati stated that Becker participated in
individual and group therapy on the unit, followed rules and
regulations, learned some coping skills and denied any
suicidal or homicidal ideation on discharge. Dr. Ravipati
diagnosed Becker with major depressive disorder current
episode and a GAF of 50. The hospital discharged Becker to
the custody of his parents with a prescription for Prozac.
was readmitted to Mercy Hospital on July 24, 2011, after an
episode at home during which he became "very violent,
very aggressive, very demanding." (AR at 295). On
intake, his parents reported he had been forcing them to give
him money so he could buy cigarettes. (Id. at 299).
Becker admitted he had been buying drugs, using marijuana and
alcohol, and reported a history of burning and cutting
himself. (Id.) On mental status exam Becker was
appropriately dressed and groomed, was compliant, cooperative
and responsive to the interview process. (Id. at
300). His mood was irritable, affect "very testy, very
demanding" and threatening. (Id.) He denied
auditory or visual hallucinations and delusions, but admitted
he was "explosive and very impulsive."
(Id.) Becker's "stream of mental
activity" was "goal directed" and appropriate;
he was alert and oriented to time, place and person, but his
impulse control relatively poor and insight and judgment fair
to poor. His medications on admission included Prozac and
Abilify which Dr. Ravipati discontinued. (Id.)
During his hospitalization, which lasted until July 29, 2011,
Becker was started on Trileptal and Risperidone.
(Id. at 295). Becker had a court hearing during his
hospitalization and it was recommended that he be committed
and follow through with outpatient psychiatric care and
treatment. (Id.) At discharge Dr. Ravipati diagnosed
him with attention deficient hyperactivity disorder (ADHD),
mood disorder not otherwise specified, oppositional defiant
disorder, and marijuana dependency with a GAF at 50.
Rodriguez, LISW, LCSW, conducted a Diagnostic Clinical
Interview with Becker on August 18, 2011. (AR at 306-309).
Becker admitted he was self-medicating with marijuana and had
started stealing to support his habit. (Id. at 307).
On mental status exam, Becker was unkempt, but alert and
oriented x4. (Id.) His attitude was irritable and
eye contact poor. (Id. at 308). His motor behavior
was normal and his speech minimally responsive with average
vocabulary. (Id.) Becker's thought process was
logical and goal-directed, his thought content
age-appropriate. (Id.) His perception was normal; he
denied suicidal or homicidal intent. (Id.)
Becker's mood was depressed and irritable, but his affect
appropriate, with poor insight and judgment. (Id.)
Ms. Rodriguez diagnosed mood disorder NOS, oppositional
defiant disorder and ADHD by history and wanted to rule out
borderline personality disorder. (Id.) She assessed
his GAF at 50. (Id.) Ms. Rodriguez believed Becker
was in need of "extensive therapy" and he agreed to
participate in outpatient therapy. He feared being removed
from home and placed at Orchard Place. (Id. at 309).
Rodriguez noted in her prognosis/discharge criteria and
Matt is a very troubled young man and has a great deal of
anger. He appears to be an over-indulged child, as evidenced
by the fact that his mother answered many questions for him
and did not appear to be interested in pushing Matt for fear
of him becoming angry. Matt has agreed to participate in the
therapeutic process, however; it appears to be coheresed
[sic]. If Matt is not engaged in therapy for the sake of
improving his level of functioning, his prognosis is guarded
treated for a time with Alegent Health Psychiatric
Associates, starting on August 18, 2011. (AR at 313-318). The
notes are handwritten but it appears Becker was seen on five
occasions through May 10, 2012, during which his mood/affect
remained consistently irritable and angry, although he
reported on occasion he was doing well. (Id. at 314,
is a gap in Becker's treatment history until October 30,
2013, when he began seeing Patrick Pucelik, ARNP, at Myrtue
Medical Center. (AR at 323). On that occasion he was brought
in by his mother to discuss anxiety, which he reported
occurred a few times a week. (Id.) Mr. Pucelik noted
Becker's mother answered most of the questions because
Becker said he was not comfortable answering them. Mr.
Pucelik could not get him to engage. Becker had dropped out
of high school and was working on his GED. He was not
employed. He could not describe his typical day to Mr.
Pucelik. (Id.) He had seen a Dr. Armbruster and been
started on Clonazepam, which he thought was helping. He
admitted smoking marijuana. (Id.) Mr. Pucelik was
told Becker had been admitted two times for psychiatric
issues. They discussed seeing a psychiatrist and doing labs
but Becker was not interested in either, just wanted to take
Clonazepam. A prescription was given and he was to follow up
in a few weeks. (Id.)
November 13, 2013, Becker returned to see Mr. Pucelik. (AR at
324). His mother was not present. Becker told Mr. Pucelik he
did not think the Clonazepam worked and never did, just
agreed with his mother. (Id.) Mr. Pucelik spent 45
minutes talking with Becker, who was noted to be "very
withdrawn and hard to get information from."
(Id.) He told Mr. Pucelik none of the medication he
had been on ever helped and he just wanted to be left alone,
stating "nobody listens to me" during the visit.
Becker was not working on his GED anymore and had been doing
it to please his mother. (Id.) Becker reported that
his mother had left him a note to ask Mr. Pucelik about
Lexapro but Becker did not want the medication.
(Id.) Becker cried a few times during their
interview, recognized he was withdrawn, and wanted people to
leave him alone. He wanted to take Xanax instead of
Clonazepam as one of his mother's friends had given him a
few. Mr. Pucelik had reservations about changing Becker's
medications and wanted to refer him to someone else, but
Becker did not want to see any more therapists or
psychiatrists. (Id.) His prescription for Clonazepam
was continued. (Id.)
one month follow-up on December 11, 2013, Becker reported he
thought his medication was helping and he was a little more
interactive. (AR at 325). Mr. Pucelik observed him to be
January 9, 2014, at a monthly check Becker reported he was
doing well and had a good Christmas. (AR at 326). He was
taking his medications although he said he was not sure he
noticed a difference. Becker smiled and laughed during the
visit and said his anger was day by day. Mr. Pucelik planned
to continue his medications and follow up in a month.
visit on February 13, 2014, Becker told Mr. Pucelik he was
doing well and had no concerns. (AR at 327). Mr. Pucelik
observed Becker had better eye contact but was still very
nonverbal. He was groomed and well dressed and had his hood
down instead of over his head as on previous occasions.
(Id.) Becker reported he was taking his medications
as prescribed. Mr. Pucelik provided a refill of his
March 12, 2014, when Becker reported for a medication check,
he told Mr. Pucelik he was doing well and had no concerns.
(AR at 328). Mr. Pucelik tried to engage him in conversation
but got "[m]any yes no answers. Not as irritable as in
the past but still not forthcoming with discussion."
visit with Mr. Pucelik on April 9, 2014, Becker was noted to
be more "interactive" than he had been. (AR at
350). Becker reported he was looking for a job. He was not
interested in restarting his GED studies. He had not done
much with making candles and tried selling them locally
without much success. They discussed other job options.
Becker said he felt the medications were working.
8, 2014, Becker met with Mr. Pucelik for routine medication
management. (AR at 351). He said he was doing well and had no
concerns. Mr. Pucelik noted Becker had been stable on his
current medications. They discussed going to every other
month visits, to which Becker agreed. (Id.)
returned to see Mr. Pucelik on July 9, 2014, for routine
medication management. (AR at 379). He reported he was
getting along well and Mr. Pucelik observed Becker was
interactive with the examination. (Id.) Becker said
he was thinking about going to therapy in Council Bluffs and
Mr. Pucelik encouraged him in that regard. (Id. at
visit on September 10, 2014, Becker said he was doing good.
(AR at 381). Becker reported that his mother wanted him to
ask about Lexapro but he was not interested in the
medication. Becker again made a comment about seeing a
therapist but was no longer interested. (Id.)
November 6, 2014, Becker appeared for a medication check. (AR
at 382). He was getting along well. At this visit he said he
was not interested in seeing a counselor or starting new
medications as the current medications were working fine.
(Id.) His only concern was night sweats he was
experiencing many nights a week. Mr. Pucelik offered lab
draws and workup but Becker declined. (Id.)
two-month medication check on January 7, 2015, Becker said he
was doing good and had an "ok" Christmas. (AR at
383). He again declined a counselor and did not want to see
anyone or try anything different. (Id. at 384).
March 6, 2015, Becker told Mr. Pucelik he was doing well, had
a new girlfriend, and things were going well. (AR at 385). He
was frustrated on this occasion because he had to wait and
was going to be late for another appointment. His hood was on
but not pulled completely over his head. They again discussed
Becker getting counseling but he declined. Mr. Pucelik
observed Becker's birthday was approaching and he had a
"self imposed deadline of having a job by" that
time, which Mr. Pucelik thought was affecting his attitude on
this occasion. (Id.)
visit on May 4, 2015, Becker said he was living in Omaha with
his girlfriend and the relationship was going well. (AR at
386). Mr. Pucelik observed Becker was more interactive and
smiled a few times. Becker needed a letter in support of his
application for social security disability. He gave Mr.
Pucelik verbal consent to talk with his parents.
6, 2015, Mr. Pucelik observed Becker was pleasant and
cooperative during his interview, with good hygiene. (AR at
387). He told Mr. Pucelik he was doing good. His medications
were discussed and refilled. (Id.)
Medical Source Opinions/Evaluations
M. Jones-Thurman, Ph.D., a licensed clinical psychologist,
undertook a psychological evaluation of Matthew Becker on
April 23, 2014, at the request of the Disability
Determination Services Bureau of Iowa. (AR at 336-340). Dr.
Jones-Thurman took a complete demographic and family history;
asked about Becker's education, family dynamics and
employment; asked about medical and addiction issues, and
Becker's mental health history. (Id. at 337). At
that time Becker reported he had treated with Karen Rodriguez
in Avoca, Iowa; Christine Schwery in Harlan, Iowa; and Dr.
Matthew Eggers in Harlan, Iowa. (Id. at 338). He
described his symptoms as not being happy, he could not be
around people and did not talk to people; when he went out in
public he got nervous and anxious. He also stated he did
leave the house and would go to Walmart or pick up his
girlfriend. He did not like to be at home and would leave and
drive around. (Id.) Becker did not think his
medications were helping and he had lost weight.
(Id.) He reported he got angry easily, yelled a lot
and would say things in public. (Id.) He said he
kept to himself but was argumentative at home. He said he had
problems with attention, concentration, and distraction but
denied being hyper or fidgety. Becker denied panic attacks
but his mother reported he would panic and shake.
(Id.) His mother also reported he did not process
emotion, worried all the time, liked the same routine, and
did not like change. Becker said he did not like loud noises
but had no other sensory integration problems. (Id.)
respect to his activities of daily living, Becker reported he
got on the computer, read email, took care of his hygiene
daily, did cooking, cleaning, laundry, ran errands and drove
around. (AR at 338). He did not like being at home but said
he was unable to be around other people. (Id. at
339). He liked to make candles and watch movies. He did not
know if he could manage money. (Id.)
mental status exam, Becker was neat in appearance and well
groomed. (AR at 339). His behavior during the interview was
appropriate; he was open and cooperative. Becker's speech
was within normal range and easily understood; it was normal
for volume, rate and tone. He was oriented to time, place and
person; could state the date and where he was; his memory,
concentration and attention were intact. His thought
organization was coherent and logical; he denied thought
process distortion and appeared to be of average intellectual
ability. (Id.) Dr. Jones-Thurman believed Becker was
"possibly demonstrating a mood disturbance" based
on his flat mood and report of vegetative signs of depression
such as sleep and appetite disturbance. He did not appear to
be a risk of danger to himself or others. (Id.)
Jones-Thurman concluded that based on her examination Becker
"would be able to remember and understand instructions,
procedures, and locations and could carry those out and
maintain attention, concentration, and pace." (AR at
339-340). She thought he might have "some difficulty
using fair judgment and responding to changes in the work
place." (Id. at 340). She
"imagine[d]" he would have "some difficulty
getting along with others." (Id.) Her
diagnostic impression was dysthymic disorder, rule out
bipolar disorder, attention deficit hyperactivity disorder,
combined type, moderate, generalized anxiety disorder, social
anxiety disorder, and cannabis dependence (although he
alleged remission and sobriety). (Id.) Her Axis II
diagnosis was schizoid and avoidant personality traits; she
assessed his GAF at 50. (Id.)
statement dated July 3, 2014, Amy Riessland, LISW, at the
Center for Healing and Hope stated she evaluated Becker on
July 1, 2014. (AR at 356). At that time he was well groomed
but had "very poor eye contact" and he was
"disengaged in the conversation." (Id.)
She observed he appeared "very anxious and
agitated" and looked down most of the interview.
(Id.) Both Becker and his mother were present and
they both reported it was difficult to get Becker to attend
the meeting because of his struggle to talk to people and his
anxiety. They reported his anxiety often presented in verbal
aggression towards others, which occurred at the interview in
response to discussion about setting up future appointments
and goals. (Id.) Becker and his mother reported he
obsessed about his future, was depressed and hopeless.
(Id.) Ms. Riessland stated Becker appeared to
understand instructions but during the interview his
immediate past recall was not good. Ms. Riessland opined that
based on the intake information Becker would "struggle
to carry out instructions, maintain attention, concentration
and pace . . . to interact appropriately with supervisors,
co-workers and especially the public due to his extreme
social anxiety." (Id.) Based on his report
about extreme anxiety in response to any change, Ms.
Riessland believed "he would not be able to use good
judgment and respond appropriately to change in the
workplace." (Id.) He did appear to have average
intelligence and she "did not see a reason" why he
could not manage any benefits he received. (Id.)
Patrick Pucelik, ARNP
Pucelik offered two statements regarding his treatment of
Becker. The first was dated May 5, 2015. Mr. Pucelik briefly
stated he had been caring for Becker since October 2013 for
social anxiety disorder, anxiety and depression. (AR at 362).
He seemed to be stable at the time of the statement.
(Id.) Mr. Pucelik gave the opinion that Becker would
not be "able to hold or maintain a job given the amount
of anxiety he has when in a public setting."
second statement dated September 29, 2015, Mr. Pucelik stated
he had treated Becker for about three years, during which his
condition "waxed and waned." (AR at 363). He noted
that in the past few months Becker seemed to be in a better
place, having met a girl and moved to Omaha with her, as well
as living in Pennsylvania with her and another friend.
(Id.) Becker told Mr. Pucelik he had some anxiety in
both places but was able to manage. (Id.) Mr.
Pucelik was hopeful Becker would get out and be more involved
but cautioned about "doing too much, too fast."
(Id.) He noted Becker had not seen a psychiatrist
for a "number of years" and was resistant to seeing
one, which Mr. Pucelik related to "past exposure to the
mental health community." (Id.) Mr. Pucelik
believed it would be "detrimental to force him to see
someone now." (Id.) Mr. Pucelik believed Becker
was "disabled by his social anxiety, general anxiety and
general depression" but hopeful that he could "work
with these disabilities and obtain employment, "
although not at the time of his report. (Id.)
Beverly A. Doyle, Ph.D.
A. Doyle, Ph.D., licensed psychologist, performed a mental
status exam on Becker on October 12, 2015, at the request of
Disability Consultants, Becker's attorney. (AR at
392-93). Dr. Doyle noted Becker was driven to the evaluation
by his mother. He was cooperative, open and honest, and
provided information to the best of his recollection.
(Id.) Dr. Doyle reviewed his personal, educational,
and work history as reported by Becker. (Id.) She
reviewed the history of his present illness with Becker and
his mother and referred to records from Mr. Pucelik.
(Id. at 392-393). On examination, Becker was
orientated and understood why he was being evaluated. He
remembered general events in his mental health treatment
history but not the exact sequence, who he saw, or what
diagnoses were made or medications given. (Id. at
393). Becker reported he was living with his girlfriend in
Omaha and tried a move to Pennsylvania. He described his
mental health problems as including feeling sad and panic
attacks, about twice a week. (Id.) During his panic
attacks, Becker said he could not breathe and
hyperventilated. He would call his mother to calm down.
(Id.) Becker said "[h]is anxiety affected his
ability to apply for jobs or go out." (Id.) He
told Dr. Doyle he played video games with a few friends and
watched TV. (Id.) Dr. Doyle made a diagnosis of
major depressive disorder, recurrent-severe and panic
disorder. (Id.) She stated his disorder caused
"him to be unable to complete his education, work and
live independently. He is unable to manage his funds and
engage in daily activities including housekeeping, shopping
and cooking." She opined that his prognosis was poor.
follow-up to this report, Dr. Doyle filled out a Mental
Residual Functional Capacity Questionnaire. (AR at 397-404).
Dr. Doyle identified Becker's signs and symptoms as
including sleep and mood disturbance; emotional lability;
recurrent panic attacks; psychomotor agitation or
retardation; feelings of guilt/worthlessness; difficulty
thinking or concentrating; suicidal ideation or attempts;
oddities of thought, perception, speech, or behavior; social
withdrawal or isolation; persistent irrational fears; and
generalized persistent anxiety. (Id. at 397). Her
clinical findings were that Becker had recurrent panic
attacks and severe depression. (Id.) Dr. Doyle
indicated Becker had been hospitalized, treated with
medications and given therapy but had not improved. She did
not believe he was a malingerer. (Id. at 398). She
expected his impairments to last at least twelve months. With
respect to whether his psychiatric condition exacerbated his
experience of pain or other physical symptom, Dr. Doyle said
he had panic attacks and could not function. (Id.)
He did not have a low I.Q. She anticipated his impairment
would cause him to be absent from work more than three times
a month. (Id.)
respect to Becker's mental abilities and aptitudes needed
to do unskilled work, Dr. Doyle rated his ability to remember
work-like procedures, understand and remember and carry out
very short and simple instructions as unlimited or very good;
sustain an ordinary routine without special supervision and
make simple work-related decisions, perform at a consistent
pace without an unreasonable number and length of rest
periods, ask simple questions or request assistance, and be
aware of normal hazards and take appropriate precautions as
good; and his ability to maintain attention for two hour
segments as fair; and as poor or none his ability to maintain
regular attendance and be punctual within customary, usually
strict tolerances or to work in coordination with or
proximity to others without being unduly distracted, complete
a normal workday and workweek without interruptions from
psychologically based symptoms, perform at a consistent pace
without an unreasonable number and length of rest periods,
accept instructions and respond appropriately to criticism
from supervisors, get along with co-workers or peers without
unduly distracting them or exhibiting behavior extremes,
respond appropriate to changes in a routine work setting, and
deal with normal work stress. (AR at 399).
respect to Becker's mental abilities and aptitudes needed
to do semiskilled and skilled work, Dr. Doyle rated his
ability to understand and remember detailed instructions and
carry out detailed instructions as good; to set realistic
goals or make plans independently of others as fair; and to
deal with stress of semiskilled and skilled work as poor or
none. (AR at 400). In support of the fair and poor ratings,