United States District Court, D. Vermont
OPINION AND ORDER (DOCS. 14, 16)
Geoffrey W. Crawford, Chief Judge.
Melanie M. brings this action under 42 U.S.C. § 405(g)
of the Social Security Act, requesting reversal of the
decision of the Commissioner of Social Security, after a 2017
remand, denying her two consolidated applications for
disability insurance benefits (DIB). Pending before the court
is Plaintiffs motion to reverse the decision of the
Commissioner (Doc. 14) and the Commissioner's motion to
affirm (Doc. 16). Plaintiffs motion is GRANTED, the
Commissioner's motion is DENIED, and the matter is
REMANDED for further proceedings and a new decision.
was 33 years old on her alleged onset date of January 16,
2013. She testified at her November 19, 2014 hearing that she
has experienced problems since a 2008 motor vehicle accident
in which she was ejected from the vehicle and landed on her
right side. (AR 770, 777.) At her April 25, 2018 hearing,
Plaintiff stated that after the motor vehicle accident, her
ribs healed wrong and that "messed up my whole shoulder
mechanism." (AR 816.) She also states that she sustained
a traumatic brain injury (TBI) in the 2008 accident. (AR
831.) She testified to numerous other medical and mental
health difficulties, including "overbearing" and
"permanent" pain (AR 766, 815), fatigue (AR 768,
782), migraines (AR 774, 813), hip pain (AR 777), depression,
anxiety, and posttraumatic stress disorder (PTSD) (AR 779,
819, 832), short-term memory loss (AR 782), a left leg nerve
problem with numbness (AR 807, 833), a hysterectomy and
subsequent urinary problem that required surgery (AR 809-10),
and total hearing loss in her left ear (AR 814).
completed high school in three years and completed a
four-year degree in psychology, with some coursework towards
a master's degree in occupational therapy. (AR 764.)
After college she worked in accounts payable for a building
materials supplier and as a personal banker for a bank.
(Id.) She worked part-time for Turning Point (an
addiction recovery center) in 2013 and 2014 (AR 765, 826) and
at Home Depot in 2015 and 2016. (AR 805.)
testified at her 2014 hearing that in a typical day she would
wake up after sleeping poorly, get dressed, and go to work at
Turning Point at around 9:00 or 10:00 a.m. (AR 767-68.) She
would return home after working for four hours and rest until
her husband returned home. (AR 768.) If she felt well enough
she might make a five-minute car ride to visit her
grandmother. (AR 769.) At her 2018 hearing, Plaintiff
testified that she left the part-time job at Turning Point
because she physically could not do the job anymore. (AR
826.) She left the job with Home Depot on her doctor's
orders. (AR 807.) She testified that she spends most of each
day resting. (AR 823.) In good weather she tries to walk
short distances or "swim for therapy in my pool."
filed an application for DIB on February 20, 2013. (AR 94.)
That claim was denied initially on May 21, 2013
(id.) and on reconsideration on September 13, 2013.
(AR 108.) She requested a hearing, and Administrative Law
Judge (ALJ) Thomas Merrill conducted a hearing on November
19, 2014. (AR 762-800.) ALJ Merrill issued an unfavorable
decision on February 27, 2015. (AR 859.) The Appeals Council
denied her request for review on May 11, 2016. (AR1.)
filed a subsequent claim for DIB on May 30, 2016.
(See AR 891.) She also filed a complaint with this
court on July 5, 2016, appealing the denial of the claim that
she filed in February 2013. [Melanie M] v.
Berryhill, No. 2:16-cv-190 (D. Vt. July 5, 2016). Acting
on the Commissioner's assented-to motion to remand, the
court reversed and remanded for further proceedings. (AR
885.) The Appeals Council accordingly remanded with
instructions to (1) address a conflict between Plaintiffs
reaching limitations and her past relevant work; (2) give
further consideration to whether Plaintiff can perform her
past relevant work; and (3) obtain supplemental evidence from
a vocational expert to clarify the effect of the assessed
limitations on Plaintiffs ability to perform past relevant
work and, if appropriate, her occupational base. (AR 891.)
The Appeals Council noted Plaintiffs separate May 30, 2016
claim and directed the ALJ to "consolidate the claim
files, associate the evidence, and issue a new decision on
the consolidated claims." (Id.)
remand, ALJ Merrill convened a hearing on April 25, 2018. (AR
803-54.) Plaintiff appeared at the hearing and was
represented by Margaret Sayles. Vocational Expert (VE) Louis
LaPlante also testified. ALJ Merrill issued an unfavorable
decision on June 22, 2018. (AR 720-45.) Plaintiff appealed to
this court on September 14, 2018. (Doc. 3.)
Security Administration regulations set forth a five-step,
sequential evaluation process to determine whether a claimant
is disabled. Mclntyre v. Colvin, 758 F.3d 146, 150
(2d Cir. 2014). First, the Commissioner considers
"whether the claimant is currently engaged in
substantial gainful activity." Id. Second, if
the claimant is not currently engaged in substantial gainful
activity, then the Commissioner considers "whether the
claimant has a severe impairment or combination of
impairments." Id. Third, if the claimant does
suffer from such an impairment, the inquiry is "whether
the impairment meets or equals the severity of the specified
impairments in the Listing of Impairments." Id.
Fourth, if the claimant does not have a listed impairment,
the Commissioner determines, "based on a 'residual
functional capacity' assessment, whether the claimant can
perform any of his or her past relevant work despite the
if the claimant is unable to perform past work, the
Commissioner determines "whether there are significant
numbers of jobs in the national economy that the claimant can
perform given the claimant's residual functional
capacity, age, education, and work experience."
Id.; see 20 C.F.R. §§ 404.1520,
416.920. The claimant bears the burden of proving her case at
steps one through four. Mclntyre, 758 F.3d at 150.
At step five, there is a "limited burden shift to the
Commissioner" to "show that there is work in the
national economy that the claimant can do." Poupore
v. Astrue, 566 F.3d 303, 306 (2d Cir. 2009) (per
the five-step sequential analysis in his June 22, 2018
decision, ALJ Merrill first determined that Plaintiff has not
engaged in substantial gainful activity since January 16,
2013, the alleged onset date. (AR 723.) At step two, the ALJ
found that Plaintiff has only one severe impairment:
myofascial pain syndrome. (Id.) The ALJ noted other
diagnoses in the record-including hearing loss, a
vesicovaginal fistula, headaches, an affective disorder, and
"various psychiatric diagnoses"-but concluded that
none constituted a "severe" impairment. (AR
723-28.) At step three, the ALJ concluded that Plaintiff does
not have an impairment or combination of impairments that
meets or medically equals the severity of one of the listed
impairments. (AR 731.)
the ALJ determined that Plaintiff has the residual functional
capacity (RFC) to perform "light work" as defined
in 20 C.F.R. § 404.1567(b),  except as follows:
[S]he could lift and carry 20 pounds occasionally and 10
pounds frequently; stand or walk for six hours and sit for
six hours total in an eight-hour day; occasionally push
and/or pull with the right upper extremity; occasionally
reach with the right upper extremity; never climb ladders,
ropes, or scaffold but occasionally climb ramps or stairs,
balance, stoop, kneel, crouch, and crawl; and avoid even
moderate exposure to vibrations and hazards.
(AR 732.) Given that RFC, the ALJ found at step four that
Plaintiff is unable to perform any past relevant work. (AR
743.) At step five, the ALJ considered Plaintiffs age,
education, work experience, and RFC, and concluded that there
are jobs that exist in significant numbers in the national
economy that Plaintiff could perform, including companion,
usher, furniture rental clerk, and surveillance system
monitor. (AR 744.) The ALJ accordingly concluded that
Plaintiff has not been under a disability, as defined in the
Social Security Act, from January 16, 2013 through the date
of the decision. (AR 745.)
Social Security Act defines disability, in pertinent part, as
the "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 12 months." 42 U.S.C. §
423(d)(1)(A). Under the Act, a claimant will only be found
disabled if his "impairments are of such severity that
he is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage
in any other kind of substantial gainful work which exists in
the national economy." Id. § 423(d)(2)(A).
considering the Commissioner's disability decision, the
court conducts "a plenary review of the administrative
record to determine if there is substantial evidence,
considering the record as a whole, to support the
Commissioner's decision and if the correct legal
standards have been applied." Brault v. Soc. Sec.
Admin., Comm'r, 683 F.3d 443, 447 (2d Cir. 2012)
(per curiam) (quoting Moran v. Astrue, 569 F.3d 108,
112 (2d Cir. 2009)); see also 42 U.S.C. §
405(g). Substantial evidence means "more than a mere
scintilla"; it means "such relevant evidence as a
reasonable mind might accept as adequate to support a
conclusion." Biestek v. Berryhill, 139 S.Ct.
1148, 1154 (2019) (quoting Consol. Edison Co. of N.Y. v.
Nat'1 Labor Relations Bd., 305 U.S. 197, 229
(1938)). The "substantial evidence" standard is
even more deferential than the "clearly erroneous"
standard; facts found by the ALJ can be rejected "only
if a reasonable factfinder would have to conclude
otherwise." Brault, 683 F.3d at 448 (quoting
Warren v. Shalala, 29 F.3d 1287, 1290 (8th Cir.
1994)). The court is mindful that the Social Security Act is
"a remedial statute to be broadly construed and
liberally applied." Dousewicz v. Harris, 646
F.2d 771, 773 (2d Cir. 1981).
appeal, Plaintiff argues that the ALJ erred by (1) improperly
evaluating opinions and medical evidence and (2) assessing an
RFC that is unsupported by substantial evidence, particularly
with respect to limitations for migraine headaches, hearing
loss, mental health impairments, and Plaintiffs pain
syndrome. (See Doc. 14 at 17-20.) The Commissioner
maintains that substantial evidence supports the ALJ's
decision and that it complies with the applicable legal
standards. (Doc. 16 at 1.) .
The Treating Physician Rule
of her challenge to the ALJ's evaluation of opinion
evidence, Plaintiff claims that the ALJ failed to consider
treating physician opinions. The court accordingly begins
with the treating physician rule. The treating physician rule
"generally requires a measure of deference to the
medical opinion of a claimant's treating physician."
Halloran v. Barnhart, 362 F.3d 28, 31 (2d Cir. 2004)
(per curiam); see also 20 C.F.R. §
the treating physician rule, "the opinion of a
claimant's treating physician as to the nature and
severity of the impairment is given 'controlling
weight' so long as it 'is well-supported by
medically-acceptable clinical and laboratory diagnostic
techniques and is not inconsistent with the other substantial
evidence in [the] case record.'" Burgess v.
Astrue, 537 F.3d 117, 128 (2d Cir. 2008) (alteration in
original) (quoting 20 C.F.R. § 404.1527(c)(2)). Even
when a treating physician's opinion is not given
controlling weight, it is still entitled to some weight
because treating physicians are "likely to be the
medical professionals most able to provide a detailed,
longitudinal picture of [the claimant's] medical
impairment(s) and may bring a unique perspective to the
medical evidence." 20 C.F.R. § 404.1527(c)(2). If a
treating physician's opinion is not given controlling
weight, the weight to be given the opinion depends on several
factors: (1) the length of the treatment relationship and the
frequency of examination; (2) the nature and extent of the
treatment relationship; (3) the relevant evidence supporting
the opinion; (4) the consistency of the opinion with the
record as a whole; (5) whether the opinion is of a
specialist; and (6) other factors which tend to support or
contradict the opinion. Id.
Treatment and Opinions
Michael J. Welther met Plaintiff as a new primary care
patient on February 20, 2015-about two years after the
alleged onset date and Plaintiffs 2013 DIB application, and
shortly after Plaintiff concluded treatment with pain
management specialist Dr. Brian Erickson (discussed below).
(AR 3073.) Plaintiffs previous primary care physician, Dr.
Therese Dranginis, treated her between February 2013 and
January 2015. (See AR 416 (visit to establish care);
AR 1365 (last appointment with Dr. Dranginis).) At the
initial February 2015 appointment, Dr. Welther noted that
Plaintiff had a long and complicated medical history related
to an August 2008 motor vehicle accident. (Id.) He
briefly recounted that history in pertinent part as follows:
[D]irect admission to Alb Med where she had multiple
[fractures], ruptured spleen eventually removed, large scalp
laceration, then post hosp[ital] complications of bowel
obstruction and re surgery at SVMC [Southern Vermont Medical
Center.] [S]ince then she has had chronic pain syndrome
mostly of R shoulder neck R lower back, and has been to
multiple providers and on multiple meds including methadone
percocet etc[.] [M]ost recently been at pain clinic at UVM
[University of Vermont] and on fentanyl patch and prn
oxycodone with fairly reasonable control[.] [R]esulting
depression, anxiety PTSD have required counseling and doing
some cognitive relaxation counseling as well....
(Id.) Upon physical examination, Dr. Welther noted
"R shoulder decreased ROM [range of motion] winging or R
scapula, lower back tenderness not localized."
(Id.) It is undisputed that Dr. Welther treated
Plaintiff at regular appointments after the February 2015
appointment through at least January 18, 2018. (AR 3244.)
Welther wrote a letter to "Whom it May Concern"
regarding Plaintiff on October 28, 2016. (AR 3650.) The
letter appears to be in support of vocational rehabilitation
for Plaintiff. (See AR 2726.) It states:
In order for [Plaintiff] to work she would need to be
restricted to no more than 4 hours a day. She should not have
any prolonged standing or walking. She should have no
bending. There should be no strain on her back from any
activity. She should be able to sit and use her hands etc.
No. lifting anything more than 10 pounds. No. stooping down
kneeling recommended at this time. These restrictions may be
modified over time depending on how she is functioning. She
is still undergoing some testing and treatment to improve her
mechanical back problems and neuropathy.
Welther also supplied a medical opinion on April 4, 2018. (AR
3725-30.) He opined that Plaintiff is unable to work an
eight-hour day and that work-related abilities are affected
by pain. (AR 3726.) He further opined that Plaintiffs mental
health interferes with her physical and cognitive
functioning, and that she is unable to handle stressful
situations. (Id.) He explained that his opinions
regarding Plaintiffs limitations are supported by multiple
surgeries causing pain and dysfunction; multiple medications
impacting functioning; and failed attempts to work.
(Id.) Dr. Welther stated that he assessed mental
health limitations due to "anxiety," "low self
esteem," "poor coping ability, [and] poor support
system." (AR 3727.)
Welther also offered opinions on Plaintiffs concentration,
persistence, and pace. He opined that she does not have the
ability to concentrate and focus on job-related tasks for
continuous two-hour periods consistently throughout an
eight-hour workday and five-day workweek. (Id.) He
further opined that Plaintiffs impairments would interfere
with her ability to complete job-related tasks in a timely
manner or reduce her pace in performing work-related tasks.
(Id.) In particular, he opined that the effects of
Plaintiff s impairments would cause her to be off-task more
than 20% of an eight-hour workday. (Id.) He stated
that Plaintiff would need more than ordinary rest breaks
during a workday or shift. (Id.) He articulated the
following medical reasons for his opinions about
concentration, persistence, and pace: "Pain,
concentration, poor stamina, positioning difficulty."
Welther further opined that Plaintiffs medications-including
a fentanyl patch- affect Plaintiffs alertness and
concentration. (AR 3729.) He further opined that he expected
Plaintiff to be absent from work because of her impairments
"several days per month at best." (AR 3729.) In
support of his conclusion about work absences, Dr. Welther
listed Plaintiffs "previous failed attempts" at
ALJ's Failure to Explicitly Analyze Dr. Welther's
Merrill's June 22, 2018 decision refers to Dr. Welther
and some of his treatment notes between 2015 and 2017.
(See AR 726, 736, 738, 739.) According to the ALJ,
Dr. Welther's treatment notes support no more than a
"mild" mental health limitation. (AR 726-28.) As to
physical impairments, the ALJ further concluded that Dr.
Welther's notes indicate "only mild pain and
distress." (AR 736.) The ALJ's decision does not
explicitly mention Dr. Welther's October 28, 2016 letter
opinion or his opinion dated April 4, 2018. The ALJ did write
that "[e]ven though a specific exhibit may not be
mentioned, I have reviewed and considered all exhibits: 3,
729 pages." (AR 721.) Later is his decision the ALJ
stated that he considered "all opinions within the
record." (AR 743.) Introducing his analysis of opinion
evidence, the ALJ stated that the opinions of Plaintiff s
treating physicians "are not entitled to controlling
weight." (AR 740.) The ALJ went on to discuss and assign
weights to the opinions of several treating physicians and
other opinion evidence, but Dr. Welther's opinions do not
appear in that discussion.
argues that the ALJ's failure to mention Dr.
Welther's opinions is "clear reversible error."
(Doc. 14 at 28.) Relying on the portions of the ALJ's
decision stating that the ALJ considered "all
exhibits" and "all opinions," the Commissioner
maintains that the ALJ did consider Dr. Welther's
opinions. (Doc. 16 at 15.) According to the Commissioner, the
ALJ properly afforded those opinions no controlling weight on
the grounds that they were not well supported and were
inconsistent with other substantial evidence. (Id.)
Plaintiff replies that the Commissioner cannot supply a post
hoc rationalization for agency action and that the ALJ failed
to supply adequate specificity for the court to decide
whether the determination is supported by substantial
evidence. (See Doc. 17 at 1-3.)
regulations require the Social Security Administration to
"consider all evidence in [a claimant's] case record
when [making] a determination or decision whether [the
claimant is] disabled." 20 C.F.R. § 404.1520(a)(3).
Here, although the ALJ's decision does not discuss Dr.
Welther's opinions, the court can reasonably infer that
the ALJ did at least consider those opinions. The ALJ stated
that he considered "all exhibits" and "all
opinions." The ALJ admitted numerous documents into
evidence, the range of which includes Dr. Welther's
opinions. (See AR 759, 803-04.) The court therefore
concludes that the ALJ's statement that he considered all
opinions is "sufficient to establish that the ALJ
considered [Dr. Welther's opinions], even though [the
ALJ] did not address [those specific opinions]."
McKinstry v. Astrue, ~No. 5:10-cv-319, 2012 WL
619112, at *5 (D. Vt. Feb. 23, 2012).
the court can infer that the ALJ considered Dr.
Welther's opinions, the court must also analyze whether
the ALJ's failure to discuss those opinions
constitutes reversible error. The regulations dictate that,
"[r]egardless of its source, we will evaluate every
medical opinion we receive." 20 C.F.R. §
404.1527(c). In addition, the Social Security Administration
must "always give good reasons in our notice of
determination or decision for the weight we give your
treating source's medical opinion." Id.
§ 404.1527(c)(2). In light of those requirements, the
court concludes that the ALJ's failure to discuss or
otherwise evaluate Dr. Welther's opinions was error.
See Estrella v. Berryhill, 925 F.3d 90, 95 (2d Cir.
2019) (if the ALJ decides that a treating physician's
opinion is not entitled to controlling weight, then the ALJ
must "explicitly" apply the relevant factors;
failure to do so is "procedural error");
Bautista v. Berryhill, No. 3:18CV01247(SALM), 2019
WL 1594359, at *6 (D. Conn. Apr. 15, 2019) (ALJ's failure
to "discuss or otherwise evaluate" treating
physician's opinion was error).
"[f]ailure to address evidence is harmless error if
consideration of the evidence would not have changed the
ALJ's ultimate conclusion." McKinstry, 2012
WL 619112, at *5. As the Second Circuit has explained:
If "the Commissioner has not [otherwise] provided
'good reasons' [for its weight assignment]," we
are unable to conclude that the error was harmless and
consequently remand for the ALJ to "comprehensively set
forth [its] reasons." ... If, however, "a searching
review of the record" assures us "that the
substance of the treating physician rule was not
traversed," we will affirm.
Estrella 925 F.3d at 96 (brackets in original)
(quoting Halloran v. Barnhart, 362 F.3d 28, 32-33
(2d Cir. 2004) (per curiam)). The court accordingly proceeds
to conduct a harmless error analysis.
Harmless Error Analysis
specialization, the ALJ noted that Dr. Welther is a primary
care provider. (AR 736.) There is no indication that Dr.
Welther is a specialist in pain management, mental health
treatment, or any other relevant area. Plaintiff does not
the frequency, length, nature, and extent of treatment, the
ALJ's discussion of Dr. Welther's treatment notes
from 2015 through 2017 demonstrate that the ALJ was aware of
the multi-year treatment relationship. The Commissioner does
not dispute Plaintiffs assertion that Dr. Welther saw and
treated Plaintiff on at least a monthly basis. (See
AR 818 (testimony that Plaintiff sees Dr. Welther at least
once a month).) The ALJ observed that Dr. Welther made
notations relevant to Plaintiffs mental and physical health
during the course of treatment. (See AR 726, 736.)
The ALJ also recognized that Dr. Welther prescribed opioid
medications to Plaintiff. (AR 734.) At the hearing, the ALJ
heard evidence that Dr. Welther administered pressure point
injections and cortisone injections in Plaintiffs neck. (AR
808.) The ALJ further recognized that Dr. Welther referred
Plaintiff to specialists to address complaints of pain.
(See AR 736.)
Commissioner argues that there is no support for Dr.
Welther's "overly restrictive" opinions.
(See Doc. 16 at 16.) The Commissioner points to Dr.
Welther's statement in his April 4, 2018 opinion that
Plaintiff is unable to work an eight-hour day. (AR 3726.)
Somewhat similarly, Dr. Welther stated in his October 28,
2016 letter that Plaintiff was limited to working no more
than four hours per day. (AR 3650.) The Commissioner asserts
that a medical source's statement that a claimant is
unable to work is not a medical opinion and is not entitled
to any significant weight. (Doc. 16 at 16.)
Commissioner is correct that a medical source opinion that a
claimant is "unable to work" is not a medical
opinion and is not entitled to any special significance. 20
C.F.R. § 404.1527(d); see also Tanya L. v.
Comm'r of Soc. Sec, No. 2:17-cv-136, 2018 WL
2684106, at *6 (D. Vt. June 5, 2018) (treating
psychiatrist's opinion that plaintiff was unable to work
was not entitled to any significant weight because it was on
an issue reserved to the Commissioner); Savage v.
Comm'r of Soc. Sec, No. 2:13-cv-85, 2014 WL 690250,
at *5 (D. Vt. Feb. 24, 2014) (doctor's statement that
plaintiff could not work "full time" was not a
medical opinion). At the same time, the ALJ cannot discount a
medical opinion in its entirety solely because the opinion
includes a statement about the plaintiffs ability to work.
Thomas v. Berryhill, No. 1:17-CV-0042-LJV-RJA, 2019
WL 2264966, at *2 (W.D.N.Y. May 28, 2019). It is necessary to
review the support for the other statements in Dr.
Commissioner also seizes on Dr. Welther's
statement-written immediately after his statement that
Plaintiff is unable to work an eight-hour day-that Plaintiff
is "unable to stand walk lift reach." (AR 3726.) If
that statement was intended to be unqualified, the court
would agree with the Commissioner that it is unsupported.
Indeed, Plaintiff herself testified that she can walk (albeit
with a limp) for a short distance before getting "really
tired" and starting to hurt. (AR823.) She also stated
that she can lift up to five pounds. (See AR 806.) And Dr.
Welther himself opined that Plaintiff is capable of
"short lasting sit reach." (AR 3726.) There is no
support for an opinion that Plaintiff categorically cannot
stand, walk, lift, or reach.
Welther's statement about standing, walking, lifting, and
reaching was in response to a compound question that asked
about the effects of Plaintiff s impairments on those
functions and for an opinion regarding "how
long during an 8-hour day you would expect that she could
perform the function on a regular and continuing basis
consistently over 40 hour work weeks." (AR 3726.) Read
in that context, Dr. Welther's opinion about standing,
walking, lifting, and reaching is less restrictive than the
Commissioner suggests. Although Dr. Welther did not supply a
quantitative estimate of length of time that Plaintiff could
perform those functions, he plainly opined that Plaintiff is
unable to perform those functions on a regular and continuing
basis consistently over a 40-hour work week.
the Commissioner argues that Dr. Welther's opinion is
inconsistent with other opinion evidence. (Doc. 16 at 16.)
The court reviews the other opinion evidence below. For the
reasons discussed below, based on its searching review of the
record, the court is unpersuaded that the ALJ complied with
the substance of the treating-physician rule when considering
Dr. Welther's opinion.
Treatment and November 2014 Opinion
Brian Erickson-a pain management specialist with the Tilley
Pain Clinic in South Burlington, Vermont-began treating
Plaintiff on April 7, 2014. (AR 569.) At the first visit, Dr.
Erickson compiled a thorough account of Plaintiff s history
of present illness. (Id.) He noted, among other
things, that Plaintiff had previously been seen in the
clinic, initially on September 27, 2013, and that she had
been referred from her orthopedic surgeon Dr. Nathan Endres.
Erickson's impression was as follows. He noted Plaintiffs
injuries from the 2008 accident and that "[s]he
continues with significant physical pain despite a variety of
anesthetic interventions, medication regimens." (AR
571.) She reported "optimal functioning when she was on
low-dose Fentanyl patch and Percocet p.r.n."
(Id.) Dr. Erickson noted that "[c]omorbid
problems may include traumatic brain injury and possible
cognitive impairment, as she describes no longer having a
photographic memory, having short-term impairment."
(Id.) He also noted that Plaintiff "may have a
comorbid posttraumatic stress disorder history."
(Id.) He recommended a treatment plan that included