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Barrett v. Berryhill

United States District Court, N.D. West Virginia, Clarksburg

January 22, 2018

NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.

          (JUDGE KEELEY)




         On February 27, 2017, Plaintiff Kevin Dwayne Barrett (“Plaintiff”), by counsel Brian Bailey, Esq., filed a Complaint in this Court to obtain judicial review of the final decision of Defendant Nancy A. Berryhill, Acting Commissioner of Social Security (“Commissioner” or “Defendant”), pursuant to Section 205(g) of the Social Security Act, as amended, 42 U.S.C. § 405(g). (Compl., ECF No. 1). On May 8, 2017, the Commissioner, by counsel Helen Campbell Altmeyer, Assistant United States Attorney, filed an answer and the administrative record of the proceedings. (Answer, ECF No. 6; Admin. R., ECF No. 7). On June 2, 2017, and June 28, 2017, Plaintiff and the Commissioner filed their respective Motions for Summary Judgment. (Pl.'s Mot. for Summ. J. (“Pl.'s Mot.”), ECF No. 9; Def.'s Mot. for Summ. J. (“Def.'s Mot.”), ECF No. 11). Following review of the motions by the parties and the administrative record, the undersigned Magistrate Judge now issues this Report and Recommendation to the District Judge.


         On August 13, 2013, Plaintiff protectively filed his first application under Title II of the Social Security Act for a period of disability and disability insurance benefits (“DIB”) and under Title XVI of the Social Security Act for Supplemental Security Income (“SSI”), alleging disability that began on January 9, 2013. (R. 207). Plaintiff's earnings record shows that he acquired sufficient quarters of coverage to remain insured through December 31, 2016; therefore, Plaintiff must establish disability on or before this date. (R. 226). This claim was initially denied on September 24, 2013 (R. 100, 74) and denied again upon reconsideration on November 19, 2013 (R. 130, 102). On December 2, 2013, Plaintiff filed a written request for a hearing (R. 158), which was held before United States Administrative Law Judge (“ALJ”) Regina Carpenter on May 19, 2015 in Morgantown, West Virginia. (R. 38). Plaintiff, represented by counsel Brian Bailey, Esq., appeared and testified, as did Larry Bell, an impartial vocational expert. (Id.). On July 27, 2015, the ALJ issued an unfavorable decision to Plaintiff, finding that he was not disabled within the meaning of the Social Security Act. (R. 18-35). On February 7, 2017, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner. (R. 1).


         A. Personal History

         Plaintiff was born on October 28, 1974. (R. 44). Although the hearing transcript lists Plaintiff as stating he was forty-nine (49) years old at the time of the hearing, (R. 44), his date of birth indicates he was thirty-nine (39) years old at the time, and thirty-eight (38) when he filed his first SSI claim. (R. 207). He completed seventh grade (R. 46). Plaintiff's prior work experience included painter for a pipeline company, delivery truck driver/retail sales, rig hand, lottery machine service technician/installer, golf course maintenance worker. (R. 42-58). He was single at the time he filed his initial claim (R. 207) and was single at the time of the administrative hearing. (R. 45). He has no dependent children. (R. 45). Plaintiff alleged disability based on inability to strain due to his feeding tube, “must clean tubes out because of no nose, trouble speaking, dizzy spells, reconstructive surgeries are needed.” (R. 102). His impairments were considered at the initial level and determined to be amputation of the nose, depression, and anxiety (severe), as well as obesity and alcohol addiction disorder (non-severe). (R. 106).

         B. Relevant Medical History

         On January 9, 2013, Plaintiff was “watching TV with [his] family, when [he] promptly stood and walked out.” (R. 379). Approximately thirty (30) minutes later, police contacted the family to advise that Plaintiff had shot himself. Id. Plaintiff was taken to Stonewall Jackson Hospital Emergency Department with multiple self-inflicted gunshot wounds to the face. (R. 331-355). Dr. Snuffer noted that the injury was from a .243 caliber rifle, and that Plaintiff's “nose [and] whole lower face [we]re absent.” (R. 331). Plaintiff was transferred to WVU (Ruby Memorial) Hospital, where he was admitted to the Intensive Care Unit. (R. 366). Alison Wilson, M.D. related that the report stated Plaintiff “shot himself in the face twice, shot up from his chin, ” which resulted in extensive injury to his lower and mid-face. (R. 365).

         Plaintiff underwent surgeries to repair extensive mid-face lacerations and a feeding tube was placed for nutrition and medication. (R. 362). Operation revealed complete traumatic amputation of the nose (R. 361) and complete loss of half of the upper lip; complex facial lacerations to the soft palate and labial mucosa, extending into the upper cheeks bilaterally. (R. 370). There were also “extensive comminuted fractures [] involving the nasal bones, hard palate, bilateral maxilla and ethmoid bones, ” anterior subluxation of the right temporomandibular joint. (R. 361). Fragments of metal and tooth/bone were scattered throughout. Id. Plaintiff was directed to follow up with Opthamology, ENT and Trauma following his discharge on January 21, 2013 and to continue psychological therapy as an outpatient. (R. 504).

         Plaintiff followed up with WVU Opthamology on January 28, 2013, noting excessive tearing from his eyes daily and numbness in his cheeks. (R. 596-97). At that time it was noted that after ENT consult Plaintiff's doctors “d[id] not feel that there are options for repair of the bony structure of the face at this time [because] there is no significant bone of the mid-face which could be used to anchor an orbital fracture repair.” (R. 599). Progress notes noted no significant visual deficits and no significant pain. (R. 602). Plaintiff reported “drainage from his nose [] nearly continuously since the [injury which has] caus[ed] a significant amount of crusting;” also, that occasionally, food regurgitates from his mouth into his nose. Id. Overall, Plaintiff was doing well. Id. He was directed to follow up with Dr. Armeni in four weeks, and advised that a nose prosthesis was a more viable option for him than nasal reconstruction surgery, given the extensive nature of his wounds. Id.

         At follow-up with Trauma on February 5, 2013, Plaintiff reported no problems at that time and declined a referral to psychiatry. (R. 604). At a follow-up with ENT on February 13, 2013, Plaintiff reported worsening nasal obstruction on both sides, but much worse on the right. (R. 607). Dr. Armeni dilated the left nasal passage due to partial obstruction and trouble breathing. (R. 608). He thought Plaintiff would likely need to have his right nose reopened if possible, and a stent placed in it. Id. Although Plaintiff was initially breathing well following the procedure, he reported back to the Emergency Room later that day because he felt his nasal passage was closing. Id. Plaintiff was discharged to home with directions to be seen at the ENT clinic. (R. 610). On February 19, 2013, Dr. Armeni placed a nasal trumpet into Plaintiff's left nasal cavity to prevent any further stenosis (narrowing) and discussed having surgery to create a new nasal opening. (R. 616). Plaintiff decided to hold off on surgery for the time being. Id.

         At follow-up on March 15, 2013, Dr. Armeni noted that Plaintiff's “right nasal cavity is completely scarred and occluded anteriorly.” (R. 617). He removed and cleaned the nasal trumpet, then sutured it back in place. Id. At follow-up with Otolaryngology on March 29, 2013, significant swelling over his piriform aperture, complete closure of the right-sided nasal passage, and the development of granulation tissue around his left nasal trumpet were observed. (R. 618). On May 2, 2013, Plaintiff underwent surgery for recavitation of the right nasal cavity. (R. 623). At follow-up with otolaryngology on June 24, 2013, Dr. Armeni instructed Plaintiff he could start leaving the splints out of his nose more frequently, for about half an hour daily, and reinsert the nasal trumpets if he notices any narrowing of the passage. (R. 641). Plaintiff was scheduled for follow-up in two months, at which point Dr. Armeni noted it would be appropriate to start discussing prosthetics. Id.

         Robert Snuffer, D.O., treated Plaintiff as his primary care physician and saw him at regular intervals. Progress notes from October 16, 2013, note Plaintiff was “about the same.” (R. 710). Plaintiff “still ha[d] a lot of problems going out in public;” Dr. Snuffer hoped this would improve once Plaintiff obtained a nose prosthesis. (R. 710-11). He was breathing better after having surgery to remove most of the septum the previous month. Id. On November 12, 2013, Plaintiff's family called Dr. Snuffer's office for a referral “ASAP” because Plaintiff was threatening to harm himself again and they were concerned. (R. 709). They were instructed that Plaintiff should go to United Summit Center (“USC”) as a “walk-in for crisis.” Id.

         On November 14, 2013, Plaintiff reported to USC seeking treatment for depression, anxiety, and panic attacks. (R. 763). He presented as withdrawn, with a depressed mood and blunted affect. Id. He reported “feeling very depressed and experiencing mood swings . . . [and] crying episodes that seem to happen for no reason.” Id. He also reported feeling very anxious in public places and having panic attacks “nearly every time he leaves his home;” as a result, he only leaves his house to attend doctor's appointments. Id. Plaintiff reported getting only a few hours of sleep each night, but has gone up to a couple of days without any sleep. Id. Plaintiff stated that symptoms began in January 2013 after he went to his girlfriend's house to “gather some of his things because they had gotten into a fight and were breaking up.” Id. He stated that his girlfriend told police that he had shot himself and the incident reported as an attempted suicide, but he “does not believe that he actually shot himself” because he remembers boot marks on his face from being kicked, and money being stolen from his wallet and truck. Id. He reported continuing paranoia about seeing “the people who attacked him.” Id. Plaintiff's symptoms included “excessive anxiety that is difficult to control, ” fatigue, difficulty concentrating, and trouble sleeping. (R. 764). He was diagnosed with Major Depressive Disorder (single episode, moderate) and Generalized Anxiety Disorder. Id. Plaintiff exhibited mild dysfunction in self care (Domain I) and activities of community life (Domain II), and moderate dysfunction in social, interpersonal and family relationships (Domain III) and concentration and task performance (Domain IV). Id.

         On December 4, 2013, Plaintiff returned to USC presenting with a depressed mood and congruent affect, and fair hygiene and grooming; he was alert and oriented. (R. 768). Plaintiff reported that his depression and anxiety had been “much worse the last five months.” Id. His anxiety, panic attacks, and insomnia had not improved. Id. He was to discontinue Prozac, Amitriptyline and Buspar, and start taking Zoloft and Vistaril instead. (R. 769).

         Dr. Snuffer noted at follow-up on December 19, 2013 that Plaintiff had “a lot of drainage from posterior nasal passages, ” was still anxious, and was not going out much. (R. 708).

         On March 10, 2014, Plaintiff reported to USC for follow-up. He reported that therapy had been helpful for him and his depression had improved with medication, but he still occasionally felt hopeless and helpless, occasionally had suicidal thoughts, and was still experiencing a lot of anxiety. (R. 765). He was still getting only two to three hours of sleep per night. Id. His symptoms included depressed mood, loss of interest, insomnia, fatigue, guilt, excessive anxiety, and difficulty concentrating. (R. 766). His symptoms continued to “cause significant distress in social functioning.” Id.

         On April 15, 2014, Plaintiff reported to Dr. Snuffer that he was “less anxious [and] getting out a little better by himself.” (R. 705). Dr. Snuffer noted that Plaintiff “took a trip to Mississippi to see a girl and did well.” (R. 704).

         At follow-up with USC on June 16, 2014, Plaintiff appeared more talkative than before. (R. 761). He reported that his depression had been improving; he was sleeping more (about six hours per night) and his energy had “somewhat improved.” Id. Anxiety was still a problem, however, especially around people; he had had one panic attack recently. Id. He reported that he had been getting out more, had gone to Mississippi to visit a friend, and was working at a friend's car detailing shop. Id. Therapist notes from that session indicate his GAF score was still at 50, and he was still exhibiting depressed mood and excessive anxiety with associated symptoms and distress in social functioning. Id.

         On August 14, 2014, Dr. Snuffer noted that Plaintiff was “still having occasional drying and closure of nasal septum, ” but was otherwise doing okay with his facial wounds. (R. 702). As to anxiety, Plaintiff was “still anxious about going [out] in public.” Id.

         At follow-up at USC on July 27, 2015, however, Plaintiff reported increased depression and withdrawal, suicidal thoughts, and “some fleeting homicidal thoughts.” (R. 783). He stated that he had gotten a prosthetic nose, but that “the glue will not hold it on appropriately.” (R. 783). He reported he was no longer “working at his friend's detailing shop due to the amount of people that come and go and the level of his anxiety.” Id. “He still experiences some anxiety, especially around people . . . he has not left the house very often . . . his energy ‘comes and goes.'” Id. By October 25, 2015, Plaintiff presented with “mild symptoms of panic, agitation, oppositional behavior, moderate symptoms of depression, anxiety, hopelessness, helplessness, apathy, change in energy, distractibility, loss of interest, sleep disturbance, motivation, engagement, poor concentration, suspiciousness, obsessive/intrusive thoughts, and severe withdrawal.” (R. 785). He reported a slow decrease in depression and anxiety, and less frequent suicidal and homicidal thoughts - most recently, a “couple weeks ago.” Id. He reported that he tries to avoid leaving the house if at all possible. Id.

         1. Medical Reports/Opinions

         a. Consultative Psychological Examination

         On August 20, 2013, Morgan D. Morgan, M.A. completed a consultative psychological examination of Plaintiff consisting of a mental status examination and a clinical interview. (R. 642-648). Plaintiff was cooperative, but presented as “rather tentative and self-conscious, especially frustrated.” (R. 646). Morgan noted having reviewed “eight pages of medical documents from WVU Healthcare System [relating] to [Plaintiff's] facial injuries from shooting and treatment of [same].” (R. 643). Morgan also noted that he was “unclear as to whether [Plaintiff] just could not remember shooting himself, or was in denial, or actually did not shoot himself in the face.” (R. 646).

         Morgan found Plaintiff's immediate and recent memory to be within normal limits; his remote memory was mildly deficient. (R. 647). Plaintiff's insight was mildly deficient, and his judgment poor. (R. 644). His mood was dysphoric and anxious; his affect restricted. Id. Morgan found Plaintiff's social functioning and persistence to be moderately deficient; his concentration within normal limits; and his pace mildly deficient. (R. 647). Morgan diagnosed Major Depressive Disorder (single episode, severe, without psychotic features, with anxiety features), and Alcohol Use Disorder (mild, in remission). (R. 646). Morgan opined that Plaintiff's prognosis was “poor.” Id.

         b. Disability Determination at the Initial Level

         On July 16, 2013, agency reviewer Caroline Williams, M.D. reviewed Plaintiff's records and completed a physical residual functional capacity (“RFC”) assessment. (R. 80). Williiams found the following exertional limitations: Plaintiff could occasionally lift and/or carry fifty (50) pounds; frequently lift and/or carry twenty-five (25) pounds; stand, walk, and/or sit for about six (6) hours in an eight (8) hour workday; and unlimited pushing and/or pulling. (R. 81). As to postural limitations, Williams found Plaintiff could frequently climb ramps, stairs, ladders, ropes, and scaffolds; and frequently balance, stoop, kneel, crouch, and crawl. (R. 81). No manipulative, visual, or communicative limitations were found. Id. As to environmental limitations, Plaintiff could have unlimited exposure to wetness, humidity, noise, vibration, and extreme heat; but should avoid concentrated exposure to hazards and extreme cold, and avoid even moderate exposure to fumes, odors, dusts, gases, and poor ventilations. (R. 82). The narrative explanation accompanying these limitations noted, in relevant part, that otolaryngist records indicated normal examination results and “excellent” breathing with nasal trumpets, and that Plaintiff “appears to be recovering without complications since most recent surgery on [May 2, 2013] . . . Should [claimant] cont[inue] to recover [without] complications, it is expected that he should be able to, at least, perform activities as described in this RFC.” Id.

         On September 23, 2013, agency reviewer Paula Bickham, Ph.D. reviewed Plaintiff's records and completed a psychiatric review technique (“PRT”) and Mental Residual Functional Capacity (“MFRC”) assessment. (R. 79, 83). Bickham found Plaintiff had mild limitations in activities of daily living; moderate difficulties in maintaining social functioning; moderate difficulties in maintaining concentration, persistence, or pace; and no episodes of decompensation. (R. 80). As to concentration and persistence limitations, Plaintiff was moderately limited in his ability to work in coordination with or in proximity to others without being distracted, and moderately limited in his ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. (R. 83). As to social functioning limitations, Plaintiff was markedly limited in his ability to interact appropriately with the general public and moderately limited in his ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness. (R. 84). As to adaptation limitations, Plaintiff was moderately limited in his ability to respond appropriately to changes in the work setting. Id. The following narrative explanation accompanied these limitations:

The claimant is being evaluated under 12.04, 12.06 and 12.09.
He appears mostly credible. The recent CE observed moderate limits [with social functioning] and persistence. IQ and Cognistat did not reflect memory or concentration deficits. Recent [office visit] with his new [primary care provider] indicated increased anxiety in public and isolation at home. The claimant did not allege limits based on cognitive or [social functioning] on the [Adult Function Report]. He completed the form independently.
Please see the PRTF for the initial case discussion.
The claimant retains the ability to learn and perform work-like activity with no contact [with] the general public.

(R. 84).

         c. Disability Determination at the Reconsideration Level

         On November 15, 2013, agency reviewer Narendra Pankshak, M.D. reviewed the prior RFC assessment and affirmed it as written. (R. 111). Pankshak noted in the narrative explanation, in part, that there was “no new [medical evidence of record] to suggest increased functional limitations, [and that claimant's] gunshot injury [] seems to be healing and he is awaiting prosthesis.” (R. 110). On November 12, 2013, agency reviewer Philip Comer, Ph.D. reviewed the prior PRT and MFRC assessments and affirmed them as written. (R. 112). Comer noted in the narrative explanation, in part, that he had “reviewed evidence in [the] file, [and that] new [medical evidence of record] does not indicate additional significant mental/emotional limitations.” (R. 113).

         d. Psychological Evaluation

         On April 24, 2015 Tony Goudy, Ph.D. conducted a psychological evaluation of Plaintiff, including a Clinical Interview, Mental Status Examination, and psychological testing. (R. 770-776). Dr. Goudy reviewed Plaintiff's medical records from United Summit Center, Morgan's consultative examination report, and progress notes from Dr. Snuffer. (R. 772).

         Dr. Goudy observed that Plaintiff's appearance was striking pursuant to his missing nose, long beard, and mustache. (R. 773). Hygiene and personal care appeared “fair.” Id. Plaintiff was cooperative, but “somewhat reserved.” Id. His speech was relevant and coherent, but he did not generate any spontaneous conversation during the interview. Id. Plaintiff was generally oriented to time, place, person, and circumstance. (R. 774).

         Dr. Goudy observed that Plaintiff's affect was blunted, and he described his mood as “nervous.” (R. 773). Dr. Goudy noted a history of suicidal ideation, in addition to Plaintiff's gunshot wound being self-inflicted according to witnesses and the police report, though Plaintiff does not remember it. (R. 774). As to perception, Plaintiff denied hallucinations but admitted a history of paranoid ideation especially in public. Id. Immediate memory was intact; recent memory was moderately to markedly impaired, and recent memory was not significantly impaired. Id. Concentration was markedly impaired, based on serial sevens and other task performance. Id. Intellectual functioning was in the low average range, based on the interview, academic history, and prior test results. Id. Judgment was significantly impaired, based on hypothetical assessment and further supported by a history of same, including “the incident where he shot his nose off.” Id.

         Dr. Goudy administered the Beck Depression Inventory-II (BDI-II), on which Plaintiff's score of 52 indicated severe levels of depression. (R. 774). Plaintiff highest-rated symptoms included sadness, pessimism, feeling like a failure, guilt, feeling as though he is being punished, self-criticalness, difficulty making decisions, feelings of worthlessness, irritability, and fatigue. Id. On the Beck Anxiety Inventory (BAI), Plaintiff's score of 44 indicated severe levels of anxiety. Id. Plaintiff's highest-rated symptoms included inability to relax, fear of the worst happening, heart racing, feeling terrified, nervousness, feelings of choking, shakiness, fear of losing control, and fear of dying. (R. 774-75).

         Dr. Goudy diagnosed Major Depressive Disorder, Recurrent, Severe; Generalized Anxiety Disorder, and Panic Disorder without Agoraphobia. (R. 775). He considered Plaintiff's treatment records which showed a “steadily declin[ing]” emotional state since January 2013, a continued inability to maintain emotional control despite ongoing psychological treatment and medication, continuing severe psychiatric impairment reflected in low GAF scores, continued severe depression and anxiety, moderate to marked impairment in recent memory and marked impairment in concentration. Id. Dr. Goudy opined that Plaintiff had mild impairment in activities of daily living, marked impairment in social functioning due to panic attacks and paranoia, marked impairment in concentration, persistence, and pace (particularly around groups of people), and one episode of decompensation (attempted suicide by gunshot in January 2013). (R. 776). Dr. Goudy opined that in considering 12.04 A.1.A, 12.06 A.1, and 12.06 A.3, “Mr. Barrett meets a listing based on a combination of psychological factors.” (R. 775). Goudy also provided an explanation for differences in his findings compared to the prior consultative examination:

It is important to note here that although the Morgan evaluation did not find marked impairment in concentration, Mr. Barrett's severe anxiety and paranoia around others would likely render his ability to concentrate as markedly impaired in the workplace. Moreover, as he feels intense paranoia in public and has increasingly isolated himself because of it, his social functioning would also be markedly impaired. Mr. Barrett's inability to maintain emotional stability has been consistently and longitudinally documented in the records from United Summit Center. Consequently, he would be expected to miss multiple workdays per week due to that instability.

(R. 775).

         e. Statement from Treating Physician Dr. Snuffer

         On June 4, 2015, Dr. Snuffer wrote a letter to Plaintiff's counsel responsive to the issues of “any information or opinion [he] may have regarding [Plaintiff's] ability to make visits or trips out of the State of West Virginia and as to his capacity for employment.” (R. 777). Dr. Snuffer opined that Plaintiff's facial injury has “certainly created or perhaps aggravated a preexisting extremely severe anxiety disorder[, and that Plaintiff] continues to have extreme difficulty adjusting to his post injury features.” Id. Dr. Snuffer noted that Plaintiff appears to be in some denial about the self-inflicted nature of his injury, as he continues to maintain that he is not sure what happened. Id. Dr. Snuffer advised that he has no personal knowledge of Plaintiff taking any trips; only that Plaintiff had said that he made a trip to Mississippi to see a girl. Id. However, Dr. Snuffer added he now doubts that Plaintiff ever made such a trip because he has observed in subsequent visits that Plaintiff claims to participate in activities or events that the people who accompany him indicate are not in fact occurring. Id. Dr. Snuffer believed Plaintiff may be attempting to appear to be more “normal.” Id.

         Dr. Snuffer noted that Plaintiff's attempts to repair his teeth and obtain a prosthetic nose had been unsuccessful. (R. 778). As a result, Plaintiff's appearance gives him “extreme anxiety, ” to the point of “moderate to severe agoraphobia, and usually not going out in public” alone. Id. Dr. Snuffer further noted that a “near 40 pound weight gain from September 2013 to the end of 2014” led him to suspect Plaintiff is “quite depressed and inactive.” Id. Dr. Snuffer concluded:

Overall, in spite of his assertions to me of engaging in activities, I find Kevin to be extremely impaired and limited from a psychological standpoint. His facial features and difficulty with swallowing and breathing only add to his misery. I do not believe he can sustain any type of employment at this time.


         f. Psychiatric Review Technique

         On April 4, 2016, Dr. Jourdan Aromin, a treating psychiatrist, completed a Psychiatric Review Technique form with accompanying narrative explanation. (R. 791). His opinion was based on his own longitudinal psychological treatment of Plaintiff, which he began in October 2015 at Dr. Snuffer's request, as well as his review of Plaintiff's medical records. (R. 803). Aromin observed that Plaintiff “has presented with significant levels of anxiety and depression at all sessions.” Id. Moreover, he “continues to be in denial” about the fact that his gunshot wound was self-inflicted, maintaining that he was shot by some other unknown person. Id. Aromin opined that Plaintiff was “faced with an extremely unfortunate incident and residual emotional condition for which he ha[s] only a minimal, immature coping capacity.” Id. Aromin pointed to Plaintiff's tendency to “deal[] with stress by creating and voicing fantasy activities” such as visiting friends in other states, or participating in hunting or traveling activities - none of which he has actually done. Id. Rather, “these proved to be activities he had only observed on television and [] fantasized himself into.” Id. Aromin explained that “[b]y using this primitive coping defense, Kevin is able to push away or obtain some escape from his traumatic and intrusive thoughts surrounding the gunshot wound to his face.” Id.

         Dr. Aromin opined that Plaintiff met listings 12.04 and 12.06. (R. 791). As to listing 12.04, Affective Disorders, Dr. Aromin noted mood disturbance accompanied by anhedonia, appetite disturbance with change in weight, sleep disturbance, difficulty concentrating or thinking, thoughts of suicide, and delusions or paranoid thinking. (R. 794). As to listing 12.06, Anxiety-Related Disorders, Dr. Aromin noted generalized persistent anxiety accompanied by motor tension, autonomic hyperactivitiy, apprehensive expectation, vigilance and scanning; a persistent irrational fear of a specific activity or situation resulting in a compelling desire to avoid it; recurrent obsessions or compulsions that are a source of marked distress; and recurrent and intrusive recollections of a traumatic experience that are a source of marked distress. (R. 796). Dr. Aromin opined that Plaintiff had moderate to marked restriction of activities of daily living; marked difficulties in maintaining social functioning; marked difficulties in concentration (and particularly) persistence and pace; and one or two episodes of decompensation, each of extended duration. (R. 801). Dr. Aromin further opined that Plaintiff's chronic mental conditions had lasted at least two years, caused more than a minimal limitation of ability to do any basic work activity (with symptoms or signs currently attenuated by medication or psychosocial support), and were accompanied by such marginal adjustment that even a minimal increase in mental demands or change in the environment would be predicted to cause the individual to decompensate. (R. 802). Dr. Aromin's narrative explained that:

Kevin continues to have marked difficulties in maintaining his social functioning. He prefers to isolate himself and avoids contact with others as much as possible. Continues social contact and interaction aggravates his anxiety and depression. Kevin is additionally somewhat limited in his activities of daily living, even within his home. He often demonstrates poor hygiene and comes to his sessions in soiled clothes. His limitation in activities can approach marked limitation if those activities require him to be outside the sphere of his home. His discomfort around other[s], due to the physical deformity of his face, makes activities such as shopping, banking, or other types of even minimal public interaction quite difficult for him. In areas of useful concentration, persistence and pace, I would note that in session with Kevin he has demonstrated adequate concentration, but from his descriptions of his activities, he has markedly limited persistence and page. I would predict that, given his difficulty in other areas, with even minimal additional pressure, his concentration would be expected to deteriorate into markedly limited.

(R. 803). Dr. Aromin also agreed with and endorsed Dr. Goudy's opinion, including his findings of severe emotional disturbance in anxiety and depression, that the severity of Plaintiff's conditions met listings 12.04 and 12.06. (R. 804). Dr. Aromin additionally felt Plaintiff's situation was “quite fragile” and demonstrated that “even minimal increase in mental demands or other changes would likely cause him to further withdraw and compensate.” Id. While Dr. Aromin has continued to encourage Plaintiff to try return to work, there has been “some slow progress” to date. Id. Ultimately, Dr. Aromin opined that Plaintiff has not been able to work since his injury in 2013, and is not yet prepared to return to a work environment at this time. Id.

         C. Testimonial Evidence

         At the ALJ hearing held on May 19, 2015, Plaintiff testified that he was single and had no children. (R. 45). He lives with his parents. Id. He has a driver's license and has no difficulty driving. (R. 45-46). He completed seventh grade in high school and does not have a GED or any other type of schooling or training. (R. 46). He has no income at this time, but receives food stamps and a medical card. Id.

         Plaintiff testified that he has not worked since January 2013. (R. 47). The ALJ questioned Plaintiff about information in the file that indicated that he had “been working for a detail shop owned by a friend.” Id. Plaintiff testified that he had not worked there, but had “[gone] over there a couple of times, ” as his friend was trying to help Plaintiff with social issues. Id. Plaintiff testified that he “went over there about three or four times and hung out with him [but] that was it.” Id. Plaintiff testified that he did not earn any money for being at his friend's shop, and he does not know why his doctor's notes stated that he was “working when he is needed at his friend's car detailing shop in Clarksburg.” (R. 48).

         As to his work history, Plaintiff testified that he last worked in 2012 at Pro-Guard Eastern Division, a pipeline company, at which he painted above-ground pipeline pad assemblies. (R. 48-49). Prior to that he was employed from 2009 to 2011 at Home Warehouse of Clarksburg, where he drove a delivery truck and did in-store retail sales. (R. 49). In this job, Plaintiff operated a forklift and lifted siding and windows between one hundred to one hundred and fifty (100 - 150) pounds. (R. 54). Prior to that, he worked for Maximum Well Service as a rig-hand on a service rig. (R. 50). In 2006 Plaintiff was employed through Winan's, a temp agency through which he worked at Home Warehouse. (R. 50-51). In 2003, Plaintiff worked for Woodward Video as a service technician and installer of the West Virginia Lottery machines and video poker machines. (R. 51). In this job, Plaintiff lifted a hundred pounds, and it required 40 hours of training to get the necessary technician certificate. (R. 53). In 2001 and 2002, Plaintiff worked for Morgan Development Corporation doing golf course maintenance. (R. 52).

         In response to questions from his attorney, Plaintiff testified that his psychological diagnoses included depression and anxiety. (R. 55). He testified that these conditions affect him in that he “pretty much ha[s] no social activities [and] can't make [him]self function to contribute to social activity.” Id. He rarely leaves his house; “usually the only time [he] do[es] is if some of [his] famiy is with [him], and that's not very often.” Id. Plaintiff testified that he lives with his parents because “[he] do[es]n't trust [him]self to be alone” as a result of suicidal and homicidal thoughts he has. (R. 56). Plaintiff further testified that these pervasive thoughts affect his ability to concentrate:

Q Why do you live with your mom and dad?
A I myself, I don't trust myself to be alone.
Q And why don't you trust yourself to be alone?
A Because I do have suicidal thoughts.
Q And have you ever had thoughts about killing other people?
A Yes, sir.
Q These types of thoughts that's coming from this anxiety, what - how do these thoughts affect your ability to concentrate, say on a 30-minute television program?
A I can, I can watch 30 minutes of TV and tell you nothing about it.
Q Why can't you tell me anything about it?
A I'll just, it's just like I'll watch it, but ...

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