United States District Court, D. Vermont
MEMORANDUM AND ORDER (DOCS. 10, 13)
J. Garvan Murtha United States District Judge
Tracy Lawlor (Lawlor) brings this action under 42 U.S.C.
§ 405(g) of the Social Security Act, requesting review
and reversal of the Commissioner of Social Security's
(Commissioner) denial of her application for disability
insurance benefits. Pending before the Court are Lawlor's
motion seeking an order reversing the Commissioner's
decision (Doc. 10 (Doc. 10-1 Memorandum)), and the
Commissioner's motion seeking an order affirming her
decision (Doc. 13). Lawlor filed a reply. (Doc. 16.) For the
reasons set forth below, Lawlor's motion to reverse is
granted and the Commissioner's motion to affirm is
13, 2012, Lawlor filed an application for disability
insurance benefits alleging she became disabled as of January
1, 2008. (A.R. 149-55.) On November 1, 2012, her application
was denied, id. at 87-89, and, on March 22, 2013,
was denied again on reconsideration, id. at 99-101.
Lawlor filed a timely request for an administrative hearing,
id. at 103-04, which was held by Administrative Law
Judge (“ALJ”) Thomas Merrill on April 14, 2014,
id. at 27-56. Lawlor appeared with a representative
at the hearing and testified. Id. On July 14, 2014,
the ALJ issued a decision concluding Lawlor was not disabled
from the alleged disability onset date of January 1, 2008,
through the date of the decision. Id. at 11-21. The
Appeals Council denied her timely request for review on
December 8, 2015, and the ALJ's decision became the final
decision of the Commissioner. Id. at 1-3.
February 2016, Lawlor timely filed this action. (Docs. 1-3.)
She raises four challenges to the ALJ's decision: (1) the
ALJ failed to properly consider her fatigue; (2) he failed to
make findings regarding the effects of her medications and
treatment on her functional abilities; (3) the ALJ erred in
his determination of her residual functional capacity
(“RFC”); and (4) he erred in evaluating the
medical opinions of Dr. Tietz, her treating psychiatrist.
was born July 23, 1968. (A.R. 149.) She has a high school
education (GED), an LNA, and some college. Her past relevant
work is as a warehouse worker and LNA. Id. at 31-32.
She worked part-time as an LNA from 2008 until June 2012.
Id. at 36. In November 2011, Lawlor was diagnosed
with hepatitis C. Id. at 37. She alleges disability
as a result of anxiety and her hepatitis treatment.
Id. at 32-33, 37-40.
at least 1998, Lawlor has treated with psychiatrist Judith
Tietz, M.D. (A.R. 917.) In February 2000, Lawlor asked Dr.
Tietz to hospitalize her. Dr. Tietz assessed major depressive
episode, severe, recurrent, without psychotic features,
attention deficit disorder, and generalized anxiety disorder.
She noted Lawlor's current medications of Ritalin and
Klonopin, her prior trials of Prozac, Paxil, Zoloft, Effexor,
and Serzone, and prescribed Wellbutrin. Id. at 894.
April 2005, Dr. Tietz noted Lawlor had begun working at
Maplewood Nursing Home. In July, Lawlor reported she had felt
overwhelmed but was doing better and Dr. Tietz provided
counseling regarding vocational issues. (A.R. 857-58.) In
August, her Ritalin prescription was increased from 5mg to
10mg. Id. at 856-57. In October 2006, Lawlor
reported she was doing well but her anxiety was “so
bad.” Id. at 851. In April 2008, Lawlor
reported her panic was at a low level but had been high three
weeks prior, she was not depressed, and restarted taking
Ritalin she had discontinued while pregnant. Id. at
April 2009, Dr. Tietz noted Lawlor was generally doing well,
anxiety was even, and she was working per diem. She thought
Lawlor's generalized anxiety disorder (“GAD”)
could benefit from a low dose of clonazepam. (A.R. 847.) In
February 2010, Lawlor reported she was sober. Id. at
January 2011, Dr. Tietz noted she was less anxious though she
had an episode of panic, felt fatigued on clonazepam so the
dose was lowered, and was prescrbed Xanax. (A.R. 845.) On
March 17, Lawlor was very anxious, overwhelmed, and tearful.
She had taken more of her clonazepam and ran out early, so
Dr. Tietz doubled her Xanax. Dr Tietz's mental status
exam noted she was very tearful, upset, agitated, but
goal-directed and no evidence of psychosis. She assessed her
GAD as “quite severe at this time, as she has pulled
the rug out from under herself by stopping the
Klonopin.” She directed Lawlor to restart Klonopin.
Id. at 843. By March 31, she was feeling better,
restarted clonazepam so was less anxious, and continued on
Xanax and Ritalin. In May, her anxiety was up. Id.
at 843. In July, she called Dr. Tietz reporting she was
panicky and had run out of Klonopin because she was taking
too much. Id. at 842. In September, she reported she
felt overwhelmed at times but was not depressed and had
social anxiety. Lawlor cancelled her December appointment.
Id. at 381.
January 2012, Dr. Tietz noted Lawlor had discontinued taking
clonazepam and had been diagnosed with hepatitis C. Her mood
was good and GAD stable. (A.R. 381.) In July, Lawlor reported
she was very anxious, fearful, and could not leave the house.
Dr. Tietz assessed GAD with panic disorder and agoraphobia.
Id. at 380. In August, she was anxiously
anticipating very bad side effects from her hepatitis
treatment and would stay on lorazepam which was working well.
Id. at 502. In October, Lawlor reported she was
responding to her treatment, was moody but denied feeling
depressed, and had increased her lorazepam dose to 8mg per
day. Dr. Tietz discussed the risk of this behavior and the
importance of using another agent to lower her anxiety. She
assessed the irritability may be a mood disorder and
instructed she limit her lorazepam to 4mg per day.
Id. at 501. In November, Lawlor reported using more
lorazepam than prescribed and running out. Id. In
December, she denied depression but was very anxious and in
excruciating pain. She had lowered interest and was fearful
and overwhelmed. Dr. Tietz assessed GAD worsened by hepatitis
treatment and mood disorder. Id. at 500.
March 2013, Dr. Tietz and Lawlor spoke by phone. Lawlor
reported she was not sleeping, was extremely anxious, and
felt overwhelmed. The plan was to consider Seroquel. (A.R.
809.) In May, Lawlor reported her anxiety was “sky
high, ” Seroquel knocks her out but makes it hard to
breathe, she had a short fuse and was agitated. Dr. Tietz
noted she had fair judgment and insight, was oriented with
intact memory and focused attention and concentration, low
mood and unstable, tearful affect. She diagnosed mood
disorder, GAD and panic, and noted her anxiety was worsened
by hepatitis treatment. Id. at 804-05. In September,
Lawlor reported she continued to struggle with sadness and
grief following her father's death, her anxiety was high,
she did not like to leave the house, and her husband did most
of the shopping because of her panic attacks. Dr. Tietz noted
psychomotor agitation, fair judgment and insight, was
oriented with intact memory and focused attention and
concentration, low mood and anxious affect, and was overusing
lorazepam and clonazepam. Dr. Tietz added Valium to her
prescriptions. Id. at 802-03. In December, Lawlor
reported her anxiety had been very high, she used marijuana
to lower her anxiety but then does not get out, rarely leaves
the house, and was sleeping all day. Dr. Tietz noted she had
good judgment and insight, was oriented with intact memory
and focused attention and concentration, unstable mood. She
diagnosed GAD, ADD, and cannibus abuse, recommended
considering medical marijuana, and noted current medications
were Valium and Seroquel. Id. at 800-01.
February 13, 2014, Dr. Tietz noted Lawlor continued to deal
with panic and agoraphobia, rarely leaving the house except
for appointments, does not attend to activities of daily
living, and spends most of the day in bed. She reported she
was easily overwhelmed by people and activity. (A.R. 840.) Dr
Tietz noted obesity and hepatitis C, fair judgment and
insight, oriented, intact memory, scattered attention and
concentration, low mood and tearful affect. She assessed ADD,
panic disorder, agoraphobia. Her current medications were
Valium, Seroquel and Ritalin. Dr. Tietz noted her lifelong
anxiety and panic and that she was very limited in her
ability to leave the home. Id. at 840-41. On March
10, 2014, Lawlor reported her anxiety was “sky
high.” She does not walk her children to the bus, her
husband does all the grocery shopping, and she spends much of
her day in bed. ...