United States District Court, D. Colorado
LEWIS T. BABCOCK, JUDGE SUZANNE GUIDRY Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
T. BABCOCK, JUDGE
Suzanne Guidry appeals the final decision of the Acting
Commissioner of Social Security (“SSA”) denying
her application for disability insurance benefits under Title
II of the Social Security Act, 42 U.S.C. § 401, et
seq. I have considered the parties' briefs (ECF Nos.
12-14) and the administrative record (ECF No. 9)
(“AR”). Oral argument would not materially assist
me in determining this appeal.
Guidry argues the Administrative Law Judge
(“ALJ”) improperly weighed the medical opinion
evidence, should have found her disabled based on SSA's
“grid rules, ” erred in evaluating her
credibility, and inadequately accounted for her mental
impairments and work absenteeism. As I describe below, I
disagree with these arguments. Accordingly, I
AFFIRM SSA's decision.
Guidry has bipolar disorder. E.g., AR 308. Her
treatments have included medication, hospitalization, various
forms of psychotherapy, and electro-convulsive treatment
(“ECT”). Despite her mental illness, Ms. Guidry
earned a college degree in computer information systems and
worked as an information technology support engineer before
filing for disability. AR 41.
Guidry was hospitalized in late November 2012, her first
psychiatric hospitalization in 20 years. AR 1540. She was
depressed, overwhelmed at work, and had passive suicidal
ideation. Id. She was seeing her primary care
physician for psychiatric medications, and he had referred
her to the hospital. AR 1540. At the hospital, she started a
new antipsychotic medication to address her paranoia, which
helped. AR 1541. When she was discharged a few days later,
she planned to request medical leave from her job so she
could work six hours a day instead of eight, a plan her
treating psychiatrist thought “quite
appropriate.” AR 1541. At discharge, she was
“feeling much better.” AR 1541.
participated in group therapy at Centennial Peaks after her
discharge. She often described her job as a significant
source of anxiety and stress. E.g., AR 1528, 1531,
1533, 1535, 1564. Despite being depressed and having mood
swings during the therapy, she was an “emotional
leader” among the group. AR 1478.
December 2012, she started seeing Dr. Susan Ryan, a clinical
psychologist, for individual psychotherapy. AR 1661. Dr.
Ryan's treatment notes reflect Ms. Guidry's struggles
at work and with anxiety during that time. Id.
Guidry saw Dr. Gerald Chitters, a psychiatrist, for
medication management beginning in March 2013. Her mood was
“bleak, ” and she was “very seriously
suicidally depressed.” AR 904, 908. He adjusted her
medications, e.g., AR 904, and she improved by late
April, AR 719, and continued to do well in May, AR 718. In
June, she took a turn for the worse. AR 717. In July, she
reported she couldn't get out of bed and was
“completely uninterested in life.” AR 715-16. She
continued to struggle in August, reporting that she
couldn't get up and was “actively suicidal.”
AR 711. In early September, her mood was unstable and she was
“sobbing” at her appointment. AR 710. Dr.
Chitters raised the possibility of electroconvulsive therapy
(ECT) treatments with Ms. Guidry. Id. ECT is a
procedure, done under general anesthesia, where electric
currents are passed through the brain, intentionally
triggering a brief seizure. See Mayo Clinic,
Electroconvulsive therapy (ECT) Definition,
(visited April 28, 2017). It “seems to cause changes in
brain chemistry that can quickly reverse symptoms of certain
mental illnesses.” Id. But Ms. Guidry started
to do much better later in September, and while she
didn't rule out ECT, she also didn't start it. AR
709. She did see a doctor at Centennial Peaks Hospital, who
believed ECT could “really help her” and that she
had “few other options.” AR 924.
her mental health declined again in November 2013, she
decided to try ECT. AR 706. In late November 2013, Ms. Guidry
saw Dr. Leon Que at Boulder Community Hospital to discuss ECT
therapy. AR 308-13. She told Dr. Que that suicide was
“an eventuality, ” that she had “continuous
passive death wishes” and that she felt as though she
had lost 30 IQ points. AR 308. After the appointment, Dr. Que
recommended inpatient admission, but Ms. Guidry refused. AR
313. Dr. Que ordered a medical work-up to confirm that Ms.
Guidry was a candidate for ECT. Id. Dr. Que also
predicted that Ms. Guidry would need to be admitted for
hospitalization in the near future. AR 312.
was right. In early December 2013, not long after her initial
consultation with Dr. Que, she was hospitalized for intrusive
suicidal ideation. AR 739. She started bilateral ECT while
hospitalized, AR 1611, and Dr. Que adjusted her medications
because one was interfering with the effectiveness of the ECT
treatments, AR 739, 1641. When discharged after about ten
days in the hospital, Ms. Guidry was apprehensive about going
back to work. AR 316, 1642. Dr. Que told her that her
“job is not to have a job” because her focus
should be on getting her depression under control before she
thought about returning to work. AR 316, 1642. Ms. Guidry
never went back to work after this first round of ECT, but
she was paid through April 2014. AR 43.
January 2014, not long after her discharge from Boulder
Community Hospital, Dr. Chitters reported that Ms. Guidry was
“terrible, ” felt “dumb, ” and
reported that the bilateral ECT did not help. AR 700. Ms.
Guidry also described the bilateral ECT treatment's
cognitive side effects as “unbearable.” AR 429,
919. However, the contemporaneous treatment records do not
record any negative cognitive side effects. See AR
Guidry was admitted as an in-patient at Centennial Peaks in
late January 2014 because she planned to kill herself. AR
502-04. She also started unilateral ECT treatment. AR 677.
Ms. Guidry reported the unilateral ECT did not have negative
cognitive side effects. AR 429. Her ECT psychiatrist
immediately reported she was “doing better, ”
with fewer obsessive thoughts, less irritability, and
“much improved” cognition. AR 678. After two
treatments, she was “belly laughing, ”
“happy, ” and her cognition improved again. AR
672. However, a physician at Centennial Peaks also noted that
Ms. Guidry was still “impulsive.” AR 1367. He
also remarked that it was “amazing she has done so well
professionally” given the severity of her mental
illness. Id. The ECT treatments continued to be
effective, AR 669, and Ms. Guidry was doing
“excellent” despite some issues at work, AR 666.
She was discharged from the hospital in early February. AR
February 2014, Ms. Guidry started dialectical behavior
therapy (in addition to the ECT) to develop more effective
coping skills. AR 429, 434. Ms. Guidry had a history of
marijuana and alcohol abuse, impulsive behavior, and
isolative behavior that she hoped the therapy would address.
AR 434. She also was stressed about losing her job, disliking
her job, and six-figure student loans. AR 429. She also
reported she was very depressed. AR 1369, 1371.
in early March 2014, Ms. Guidry's ECT psychiatrist
reported she was “doing excellent.” AR 660. He
described her as “smiling, bright, cordial, [and]
focused” and noted that he “hope[d] this
improvement lasts.” AR 1373. However, she soon had a
relapse, with suicidal ideation and rumination on loss. AR
657. Her doctor increased the frequency of the ECT,
id., and Ms. Guidry improved by late March, AR 654.
She expressed concern about the prospect of returning to
Guidry was “stable” and doing “fairly
well” in early April. AR 649. However, her ECT
psychiatrist tempered his description of her progress with an
explanation that she was “still a far cry from when
[she] was best” and was not “able to tolerate
work.” AR 645. He further explained that her last
relapse was “so severe, it may never clear to the point
of work functioning.” AR 645. But by later April, he
concluded she was doing “phenomenally.” AR 642.
She had graduated from the dialectical behavior therapy
program she started in February and reported she felt joy for
the first time in years. Id. Despite this progress,
he also concluded she needed more ECT treatments to prevent
another relapse. AR 640. Ms. Guidry continued to do well
throughout May. AR 636-39. Throughout her unilateral ECT
treatments, treatment records revealed normal memory and
cognition. See AR 605-79; AR 935-73.
early June 2014, she was doing “terribly.” AR
632. She had a “clear relapse” with suicidal
ideation, which her ECT psychiatrist believed was related to
a change in her medications. Id. After adjusting her
medications and continuing ECT, she began to do better. AR
August 2014 she had yet another relapse, and her ECT
psychiatrist concluded that she probably could not function
without weekly ETC and likely could never return to work. AR
614-15. This news upset Ms. Guidry, and it spurred her to try
and prove him wrong. AR 611. She was doing well in September
and October, AR 605-08, and told Dr. Ryan that her
“thinking was somewhat better than the months after
bilateral ECT, ” but she still was not as
“sharp” as before those treatments, AR 1676.
went to Florida for part of the winter and told Dr. Ryan that
she functioned relatively well there, despite issues with
obtaining treatment. AR 1677 (notes indicating that
“trip went pretty well” but describing problems
obtaining medications and ECT); AR 1679-82. She said that
once she returned and restarted ECT, she felt better even
though she was “zonked out” from the treatments.
Stuart Kutz, a psychologist, examined Ms. Guidry in May 2015
and reviewed some medical records. AR 849-55. He concluded
her attention, concentration, persistence and pace were
moderately to markedly impaired, and he questioned whether
her memory and “perhaps other cognitive
functions” were mildly impaired. AR 855. Dr. Kutz did
not specify where he believed she fell on the spectrum from
moderate to marked impairment. Id.
Sara Sexton, a psychologist, reviewed some of Ms.
Guidry's medical records in May 2015, as well as Dr.
Kutz's opinion. She generally agreed with Dr. Kutz's
assessment but opined that Ms. Guidry's impairments were
on the moderate end of the spectrum rather than the marked
end. AR 72, 73-75. She concluded that Ms. Guidry could do
work that did not involve significant complexity or judgment,
had limited interaction with the general public, and did not
involve prolonged contact with co-workers or supervisors. AR
August 2015, Ms. Guidry reported she was doing well, with
more energy and fewer suicidal thoughts. AR 858-61; AR
1697-98. In October 2015, she was walking daily, feeling a
“creative spark” for the first time in years, and
trying to take an online course. AR 1701.
November 2015, Dr. Chitters completed a medical source
statement. He opined that Ms. Guidry had some moderate and
some marked impairment in understanding and memory, in
sustaining concentration and persistence, and in social
interaction. AR 1703-04.
Guidry has fibromyalgia, joint pain, lower back pain related
to degenerative disc disease, and is obese. In May 2015, she
saw Laura Moran, D.O., for an agency-ordered physical
consultative examination. AR 840-45. Dr. Moran's
examination findings and the imaging she reviewed revealed no
significant abnormalities. AR 840, 842-45. Dr. Moran
concluded that Ms. Guidry could alternate sitting, standing,
and walking for eight hours a day, carry and lift about 20
pounds, bend (but not repeatedly), and do all daily self-care
activities, and perform repetitive motion and fine motor
manipulation with her hands. AR 845. At the administrative
hearing, Ms. Guidry testified that nerve pain medication
alleviated her fibromyalgia pain throughout the day. AR 45.
Guidry filed her claim for disability and disability
insurance benefits with SSA in June 2014, alleging disability
beginning May 1, 2014. AR 150-56. Ms. Guidry later amended
the onset date to December 1, 2013. AR 43. After SSA
initially denied her claim, AR 62-78, Ms. Guidry requested a
hearing, AR 88. The hearing took place on December 18, 2015,
before an ALJ. AR 37-61. On January 20, 2016, the ALJ denied
Ms. Guidry's claim, concluding that Ms. Guidry was not
disabled within the meaning of the Social Security Act. AR
17-36. Ms. Guidry asked SSA's Appeals Council to review
the ALJ's decision. AR 12. On June 23, 2016, the Appeals
Council denied review, AR 1-6, making the ALJ's decision
the final decision of SSA, see Doyal v. Barnhart,
331 F.3d 758, 759 (10th Cir. 2003). On August 19, 2016, Ms.
Guidry timely filed this appeal. (ECF No. 1.) I have
jurisdiction pursuant to 42 U.S.C. § 405(g).