United States District Court, W.D. Louisiana, Lake Charles Division
REPORT AND RECOMMENDATION
H.L. PEREZ-MONTES UNITED STATES MAGISTRATE JUDGE
Paul Guillory ("Guillory") filed an application for
disability insurance benefits ("DIB") on May 28,
2015, alleging a disability onset date of November 1, 2014
(Doc. 6-1, p. 139/495) due to reactive airway disease,
tinnitus, post-traumatic stress disorder ("PTSD"),
and a skin disorder (Doc. 6-1, p. 167/495). That application
was denied by the Social Security Administration
("SSA") (Doc. 6-1, p. 87/495).
de novo hearing was held before an administrative
law judge ("ALJ"), at which Guillory appeared with
his attorney and a vocational expert ("VE") (Doc.
6-1, p. 42/495). The ALJ found that, although Guillory has
severe impairments of eczema, asthma, and anxiety/PTSD, he
has the residual functional capacity to do sedentary work
that is unskilled, does not entail exposure to heat, odors,
gases, fumes, or poorly ventilated areas, and does not
require him to interact or communicate with the public (Doc.
6-1, pp. 16, 19/495). The ALJ also found there are jobs
existing in significant numbers in the economy that Guillory
can perform, such as document specialist (DOT 249.587.018,
sedentary, SVP 2, 73, 000 jobs in the national economy) (Doc.
6-1, p. 26/495). The ALJ concluded that Guillory was not
disabled, as defined in the Social Security Act, from
November 1, 2014 through the date of her decision on July 25,
2016 (Doc. 6-1, pp. 25-26/495).
requested a review of the ALJ's decision, but the Appeals
Council declined to review it (Doc. 6-1, p. 4/495). The
ALJ's decision became the final decision of the
Commissioner of Social Security ("the
next filed this appeal for judicial review of the
Commissioner's final decision. On appeal, Guillory
contends the Appeals Council erred in declining to review the
ALJ's decision because Guillory submitted new and
material medical evidence that created doubt as to whether
the ALJ's decision was supported by substantial evidence
Commissioner filed a response to Guillory's appeal (Doc.
12) Guillory's appeal is now before the Court for
served in the United States Navy, the United States Navy
Reserve, and the National Guard (Doc. 6-1, p. 185/495).
Beginning April 1, 2012, Guillory received VA benefits for
service-connected PTSD and unspecified depressive disorder,
which were found to be 70% service- connected (Doc. 6-1, pp.
March 2012, the VA listed Guillory's problems as: dyspnea
(shortness of breath); asthma, unspecified; depression, NOS;
anxiety disorder; nicotine dependence; PTSD; and unspecified
housing or economic circumstance (Doc. 6-1, pp. 258/495).
December 2012, Guillory's blood pressure was 133/81, he
was 71 inches tall, and he weighed 216 pounds (Doc. 6-1, pp.
274, 451/495). Guillory was treated for PTSD, asthma, and an
itchy rash on his arms and face (Doc. 6-1, p. 449/495).
Guillory reported smoking half a pack of cigarettes per day
(Doc. 6-1, p. 450/495). Guillory was taking Albuterol,
Budesonide, Doxepin, Prazosin, and sertraline (Doc. 6-1, p.
450/495). Guillory had cracking on both palms and fingers due
to eczema (Doc. 6-1, p. 453/495). Guillory also had a
two-week old, diffuse, red rash on his face and arms, with
some lichenification (Doc. 6-1, pp. 450, 453/495).
Guillory's rash was believed to be an allergic reaction
and he was prescribed betamethasone and a Decadron Dose Pak
(Doc. 6-1, p. 451/495). Guillory was strongly urged to stop
smoking due to his asthma (Doc. 6-1, p. 451/495).
January 2013, Guillory reported his rash had resolved with
the medication, but returned on his back, wrist, buttocks,
and both legs, and he developed boils (Doc. 6-1, p. 448/495).
By February the rash was widespread and inflamed (Doc. 6-1,
p. 442/495). Guillory was prescribed Cipro (Doc. 6-1, p.
442/495). A week later, the rash was improved but not
completely gone (Doc. 6-1, p. 437/495). It was determined the
rash was probably a reaction to exposure to some chemical at
work (Doc. 6-1, p. 437/495).
February 2013, during counseling, Guillory reported his PTSD
and anxiety medications were not working; he was under a lot
of stress; he was not able to relax or enjoy things: he had
quit his job because he was allergic to something in that
workplace; he was struggling with school and his grades were
not good; and he had filed for bankruptcy (Doc. 6-1, p.
442/495). Guillory had also signed up for another 6 years
with the National Guard (Doc. 6-1, p. 442/495). Guillory
showed continued improvement in his PTSD symptoms (Doc. 6-1,
p. 443/495). His appearance, speech, eye contact, posture,
orientation, thoughts, affect, memory, concentration,
judgment and insight were good, but his mood was anxious
(Doc. 6-1, p. 443/495).
mental status exam in March 2013 showed Guillory was so
hypervigilant at night that he fought against his sleep meds,
so his medications were changed (Doc. 6-1, p. 433/495).
Guillory's mood was irritable, and his affect was
restricted in range (Doc. 6-1, p. 434/495). Guillory was
diagnosed with depression, anxiety, and PTSD at Axis I, and a
GAF of 65 at Axis V (Doc. 6-1, p. 434/495). Guillory's
Zoloft was increased, his Prazosin and Doxepin were
continued, and Klonopin was started (Doc. 6-1, p. 434/495).
2013, Guillory again reported anxiety due to life-changing
events: his grandfather, which whom he was very close, passed
away; his home had burned down the month before! he and his
family stayed in several different places for a month until
they found a new place! and he was dismissed from school for
failure to complete assignments due to lack of a computer for
that month (Doc. 6-1, p. 430/495). However, Guillory said he
would be able to resume classes (Doc. 6-1, p. 430/495). It
was noted that Guillory was coping adequately with these
challenges (Doc. 6-1, p. 430/495).
2013, Guillory reported stress due to moving and problems
sleeping, and admitted he had been out of Zoloft and Klonopin
for a week and had not been taking his sleep medicine
(Doxepin) because there was so much going on and it made him
tired (Doc. 6-1, p. 426/495). Klonopin was helping
Guillory's irritability (Doc. 6-1, p. 426/495).
Guillory's mood was "down" and his affect was
constricted (Doc. 6-1, p. 426/495). Dr. Victor B. Bush, a
psychiatrist, found Guillory had not been compliant with his
medications, he was still dealing with the loss of his home
in a fire, and his relationship with his wife was strained
(Doc. 6-1, p. 427/495). Guillory was then 30 years old (Doc.
6-1, p. 428/495). Dr. Bush diagnosed depression, PTSD, and
anxiety at Axis I; and a GAF of 60 at Axis V (Doc. 6-1, p.
427/495). Dr. Bush decreased Guillory's Doxepin and
continued his other medications (Doc. 6-1, p. 427/495).
August 2013, Guillory's mood was still a little down and
his affect constricted, he was compliant with treatment, he
continued to have poor sleep and a depressed mood, and his
anxiety was triggered by financial stressors (Doc. 6-1, p.
423/495). Dr. Bush again found Guillory's GAF was 60
(Doc. 6-1, p. 423/495). Guillory's Doxepin was
discontinued and Hydroxyzine was prescribed (Doc. 6-1, p.
September 2013, Guillory's restrictive lung disease and
reactive airway dysfunction (diagnosed in April 2012) were
evaluated (Doc. 6-1, p. 418/495). It was noted that Guillory
had childhood asthma, was a current half-pack per day smoker,
and had been exposed to dust, smoke, and other irritants in
the Gulf War (Doc. 6-1, p. 418/495). Due to his lung disease,
Guillory required intermittent inhalational bronchodilator
therapy, intermittent use of inhalational anti-inflammatory
medication, intermittent use of an oral bronchodilator, and
antibiotics (Doc. 6-1, p. 418/495). Guillory's pulmonary
function report was normal (pre-bronchodilator FEV-1/FVC of
80% and post-bronchodilator FEV-1/FVC of 84%) (Doc. 6-1, pp.
418-19/495). Guillory's mid-expiratory flow rates FEF
were 25-75%, 62% suggestive of small airway disease (Doc.
6-1, p. 419/495). Guillory's small airway disease was
found likely to be related to exposure events in Southwest
Asia, since the onset of his respiratory symptoms was during
his Gulf War deployment (Doc. 6-1, p. 419/495). Meter-dose
inhalers were recommended (Doc. 6-1, p. 419/495).
October 2013, Guillory's mood and affect were anxious
(Doc. 6-1, p. 416/495). Guillory explained he draws and
paints, and plans to get an airbrush (Doc. 6-1, p. 416/495).
Guillory lives with his wife and her four children, and his
wife recently began working, which helped with the family
finances "tremendously" (Doc. 6-1, p. 416/495).
Guillory reported medication compliance (Doc. 6-1, p.
November 2013, Guillory's mood and affect were anxious,
but he showed improvement in his ability to manage his anger
and his PTSD symptoms (Doc. 6-1, p. 415/495). Guillory
reported stress and anger which appeared to emanate from
family issues and the holiday season (Doc. 6-1, p. 414/495).
Guillory admitted he had not been taking his medications, in
part because they had been changed and he was waiting for the
new ones to arrive (Doc. 6-1, p. 414/495). Guillory and his
wife agreed to take the children in for counseling, also
(Doc. 6-1, p. 414/495), which they did in December (Doc. 6-1,
January 2014, Guillory said he was discouraged about his
children's behavior and felt misunderstood by his wife
(Doc. 6-1, p. 411/495). Guillory admitted he had never
receive his medications and had not taken any in about 6
weeks, so the doctor's office re-ordered them (Doc. 6-1,
p. 411/495). When he still had not received his medications
two weeks later, it was discovered they were being mailed to
his old post office box and the Post Office had the packages
(Doc. 6-1, p. 410/495).
February 2014, Guillory's blood pressure was 124/82 and
he weighed 221 pounds (BMI 35) (Doc. 6-1, pp. 267, 399/495).
In his PTSD reassessment, Guillory reported having repeated
disturbing memories, thoughts, or images "quite a
bit;" repeated disturbing dreams-a little bit; suddenly
feeling as if the stressful experience was happening
again-moderately; feeling very upset when something reminds
him of the stressful experience-quite a bit; having physical
reactions when something reminds him of the stressful
experience-quite a bit; avoiding thinking about or having
feeling related to the stressful experience-extremely;
avoiding activities of situations that remind him of the
stressful experience-extremely; loss of interest in
activities he used to enjoy-quite a bit; feeling distant or
cut off from others-moderately; feeling emotionally
numb-moderately; feeling as hit his future will somehow be
cut short-moderately; trouble falling or staying
asleep-extremely; feeling irritable or having angry
outbursts-extremely; having difficulty concentrating-quite a
bit; being "super-alert, " watchful, or on
guard-extremely; and feeling jumpy or easily
startled-extremely (Doc. 6-1, pp. 401-02/495). These things
had made it very difficult for Guillory to work, take ...