United States District Court, D. Colorado
MEMORANDUM OPINION AND ORDER
Y. Wang United States Magistrate Judge
civil action arises under Title II of the Social Security Act
(“Act”), 42 U.S.C. §§ 401- 33 for
review of the Commissioner of Social Security
Administration's (“Commissioner” or
“Defendant”) final decision denying Plaintiff
Cynthia Szymanksi's (“Plaintiff” or
“Ms. Szymanski”) application for Disability
Insurance Benefits (“DIB”). Pursuant to the
Parties' consent [#11], this civil action was referred to
this Magistrate Judge for a decision on the merits.
See [#17]; 28 U.S.C. § 636(c); Fed.R.Civ.P. 73;
D.C.COLO.LCivR 72.2. Upon review of the Parties'
briefing, the entire case file, the Administrative Record,
and the applicable case law, this court respectfully
REVERSES the Commissioner's decision and
REMANDS for further proceedings.
Szymanksi, born January 15, 1957, alleges she became disabled
on January 2, 2015, due to bipolar disorder; she was 57
years-old on the date of alleged onset of her claimed
disability. See [#9-3 at 90,  92; #9-6 at 181,
185]. In 1988, Plaintiff suffered her first major depressive
episode, lasting approximately three months, which left Ms.
Szymanski feeling depressed most days with a lack of feeling
pleasure, energy, or desire to leave her house. See
[#9-7 at 278, 302-03, 305]. Plaintiff suffered a second major
depressive episode in 1993. See [id. at
278]. Doctors treated both episodes with Prozac, but
Plaintiff experienced hypomania and mood destabilization not
soon after starting Prozac. See [id.]. Dr.
Ken Weiner then diagnosed Plaintiff with bipolar disorder in
1994; Dr. Weiner again prescribed Prozac, which had similar
negative effects, but later prescribed Lithium that helped
stabilize Plaintiff's mood with some negative side
effects. See [id. at 278, 304, 306].
Plaintiff constantly dealt with “serious ups and
downs” while hypomanic, including severe fluctuations
in impulse control, anxiety, psychotic thoughts, suicidal
ideations, depression, insomnia, and energy. See
[id. at 278-79, 303-04].
30, 1996, Plaintiff presented to Dr. Steven L. Dubovsky for a
psychiatric evaluation. See [#9-7 at 278]. Dr.
Dubovsky noted that Ms. Szymanski's depression “has
been accompanied by hypersomnia, slowed thinking, problems
with memory and concentration, dissociative symptoms, loss of
interest in food[, ] and suicidal thoughts.”
[Id. at 278-79]. Dr. Dubovsky continued that
Plaintiff “probably had chronically elevated levels of
mood, energy and activity, ” but no significant
decrease in need for sleep while taking antidepressants; that
Plaintiff was “irritable and impatient when her mood
[was] elevated but not when her mood is depressed”;
that Plaintiff had “chronically racing thoughts during
periods of elevated mood but her thinking [was] always slowed
when she fe[lt] depressed”; and that Plaintiff
sometimes heard her named called and saw movement out of the
corner of her eye. See [id. at 279]. Upon
examination, Dr. Dubovsky reported that Plaintiff's
appearance was “somewhat subdued but [she was] clearly
capable of looking much better than she feels”, that
Plaintiff's speech was “very well organized and
perhaps very slight pressured”, that Plaintiff's
affect seemed “slight depressed”, and that
Plaintiff's sensorium “appear[ed] intact.”
[Id.]. Dr. Dubovsky opined that Ms. Szymanski was
mildly depressed, and explained that Ms. Szymanski had
“been so accustomed over the years to an abnormal mood
that she [did] not notice minor mood swings” and could
appear “well when this is not the case.”
[Id. at 280].
in 1999, Plaintiff checked herself into the hospital for a
mental health hold, where she saw Dr. Ben Green. See
[#9-2 at 78; #9-7 at 304]. Plaintiff saw Dr. Green quarterly
between 1999 and 2006, and Dr. Green prescribed Tegretol,
Zoloft, and Klonopin, which “worked ok” and were
“tolerable.” [Id.]. Plaintiff eventually
weaned herself from these medications and, in 2000, became
pregnant with her daughter-a time she “felt the best
mentally.” [Id. at 304-05]. Plaintiff managed
her bipolar well between 2006 and 2015. See
[id. at 282, 306].
began treating with Dr. Morel Laronn on July 14, 2014.
See [#9-7 at 272]. Plaintiff saw Dr. Laronn twice,
once on July 14, 2014 and again on May 15, 2015. See
[id. at 270-73]. Dr. Laronn noted Plaintiff's
treatment history for bipolar disorder, among other ailments,
assessed mild depression and generalized anxiety disorder
upon psychiatric evaluation, and prescribed Lexapro for Ms.
Szymanski's anxiety. See [id.].
October 26, 2015, Plaintiff presented to Dr. Moles and
reported that “several challenging things happen[ed] to
her in the last year”, including losing her house and
her husband's treatment for amyloidosis, and that she had
“lost interest in things she used to do for fun”
and was struggling with anxiety and depression. [#9-7 at
274]. A physical exam revealed that Plaintiff was alert and
oriented, could move all extremities, and had a normal
affect. [Id. at 275]. Dr. Moles completed a Physical
Residual Functional Capacity Questionnaire for Plaintiff, in
which Dr. Moles indicated that while Plaintiff had no
physical impairments, her psychological impairments rendered
her incapable of performing low stress jobs. [Id. at
completed a Function Report on November 8, 2015. She stated
that her mental impairment limited her ability to work
because she “won't leave [the] house, ” she
has a “lack of concentration, focus, confidence or
worth, ” and struggles with “extreme fatigue,
tearfulness & fear, no motivation, [and] memory
problems.” [#9-6 at 199]. She continued that she can
work for only short periods before her symptoms
“reappear, ” and that she has severe issues with
focus and concentration. See [id. at 199,
203-06]. As for her daily activities, Plaintiff reported that
she stays indoors for most of the day but picks up and drops
off her daughter, drives daily, that she cares for her
husband and her daughter, that she does some cooking, that
her husband does most of the housework, that she shops and
handles finances, and that she has no issues with personal
hygiene. See [id. at 200-03].
Plaintiff's husband provided a third-party Function
Report that largely mirrors Ms. Szymanski's allegations.
See [id. at 210-17].
November 9, 2015, state agency psychological consultant Mark
Suyeishi, Psy.D. reviewed Plaintiff's medical records.
Dr. Suyeishi found a severe mental impairment of anxiety
disorders, but noted that there was insufficient evidence to
evaluate this impairment because Plaintiff had not responded
with requested additional documentation. See [#9-3
2016, Plaintiff began treating with psychiatrist Dr. Randall
Buzan because she wanted “to have a more steady
mood.” [#9-7 at 301 (stating Plaintiff complained of
not knowing “if it [is] going to be a good day or a bad
day.”)]. On April 7, 2016, Dr. Buzan noted that
Plaintiff was “delightful, funning [sic], fidgety and
bounced leg most of the time, ” sarcastic with a great
sense of humor, and that Plaintiff reported that she felt
good with her depression a 3/10. See [id.
at 309]. Dr. Buzan reported that Plaintiff was “very
bright and delightful” with bipolar I disorder,
depression, and ADHD-type temperament, but was euthymic.
See [id.]. But treatment notes from April
18, 2016 indicate that Plaintiff presented crying and looking
exhausted and sad, and that Plaintiff reported feeling
“really depressed at this point”, but that she
was “not suicidal” just “quite bored with
life-no plan, ” and that she denied hypomania and
mania. See [id. at 300, 309]. Treatment
notes from May 4, 2016 indicate that Ms. Szymanski presented
on time and looked more alert and focused with no tics or
agitation, and that she reported that she felt good but
scattered, that she had no suicidal ideation, that her mood
was up and down lately but better for the most part, that she
felt overcaffeinated, and that she “fe[lt] clearly
improved on the meds so far.” [Id. at 300,
Buzan's June 14, 2016 Psychiatric Evaluation noted
Plaintiff's symptoms as sadness, anxiety, lethargy,
hopelessness, lack of motivation, not leaving the house,
paranoia, isolation, inability to concentrate or work, and
agitation. [#9-7 at 305]. A review of Plaintiff's
psychiatric symptoms indicated that Plaintiff was positive
for major depression, bipolar I disorder, panic disorder with
recent panic attacks and anxiety, agoraphobia, general
anxiety disorder, and social phobia. See
[id. at 307]. Upon examination, Dr. Buzan noted that
Plaintiff was euthymic, thoughtful, well-kempt, logical, and
coherent. [Id. at 309].
Buzan's treatment notes from September 19, 2016 indicate
that Ms. Szymanski presented on time, was pleasant,
articulate, oriented, logical, coherent, euthymic, maintained
good eye contact, and had no suicidal ideation. See
[#9-7 at 316]. Dr. Buzan reported that Plaintiff was
“doing very well” psychiatrically and
“doing very great” psychiatrically despite some
neurological symptoms. See [id. at 317].
September 30, 2016, Ms. Szymanski presented to Dr. Ralph
Round, per a referral from Dr. Buzan, to follow-up on
Plaintiff's neurological symptoms. See
[id. at 288-99]. Dr. Round's physical exam
revealed that Plaintiff was alert and oriented with intact
memory, a good amount of spontaneous speech, a broad fund of
knowledge, and normal sensation and reflexes; Dr. Round
suspected benign fasciculation syndrome. See
[id. at 289-90].
returned to Dr. Buzan on January 18, 2017, and reported that
she thought she “was ok”, that her neurological
testing came back normal, that she believed Ritalin was the
cause of her neurological issues, and that she felt irritable
and sad and like she was cycling a bit when not on Ritalin.
See [#9-7 at 322-24]. Dr. Buzan indicated that
Plaintiff was contracting for safety and denied current
suicidal ideation (with some in the past), and Dr. Buzan
requested that Plaintiff email him twice per week.
See [id. at 324].
Buzan's February 22, 2017 treatment notes reveal that
Plaintiff presented sobbing, sad, depressed; tossed a pill
bottle at Dr. Buzan while exclaiming “this is not
working anymore!”; had passive suicidal ideation; and
was too depressed to contact Dr. Buzan for medication
suggestions. See [id. at 331-32]. Dr. Buzan
implored Plaintiff to “stay in closer touch” for
safety reasons. [Id. at 332].
Szymanski had a follow-up appointment with Dr. Buzan on March
14, 2017. [#9-7 at 341]. Dr. Buzan noted that Plaintiff
emailed often and called because she was “feeling so
depressed”, and that Ms. Szymanksi stated that her mood
was “ok, better than it was”, that her
irritability was better, that she felt it was “too much
effort to go out [or] engage”, that she was not
exercising, and that she really had to work to “have
any kind of affect[.]” [Id. at 347]. In
addition to adjusting Ms. Szymanski's medications, Dr.
Buzan indicated that Plaintiff struggled with
“persisting severe depression” that improved on
lithium and Zoloft, and directed Plaintiff to text, email, or
call often to discuss how she was feeling. See
[id. at 348-49].
4, 2017, Dr. Buzan provided two Medical Source Statements.
Dr. Buzan assessed Ms. Szymanski's mental impairments as
having a significant impact on her functionality.
See [#9-7 at 355-67].
August 14, 2015, Plaintiff protectively filed an application
for DIB. [#9-3 at 149]. The Social Security Administration
denied Plaintiff's application administratively on
November 9, 2015. See [id. at 89]. Ms.
Szymanski requested a hearing before an Administrative Law
Judge (“ALJ”), see [#9-4 at 104-118],
which ALJ Thomas Inman (“the ALJ”) held on May
11, 2017, see [#9-2 at 58]. The ALJ received