is -I: self -harm - Organized Mobbing
is -I: self -harm - Organized Mobbing
is -I: self -harm - Organized Mobbing
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3ATE OF ADMSSSION: 01/0E/OR<br />
DATE OF DISCIYLRGE: 01./11 ./38<br />
- PSYCRIATRIC DIgCRARGE SUMMARY<br />
KISTORY OF THE PRESEm ,ILLNESS: 'I'hc patient <strong>is</strong> a >'/-yeii~.'-uld Akrican--<br />
A[ner.ican f ernale br-ouyh[ i1;t.o the hospital a?l..r.r xecellt ly al i eyedly cuttir-y<br />
her wr<strong>is</strong>ts bilaterall;,- and tkcn L.iikinc a hos~ alci dLt;ac.hiilg it t~; ller. rJar<br />
exha!~sl. anri taping it ro ho~' wiridow and was fo~lild unconscious by security<br />
car. in her cntn~>lcx. Tile patient at th i ;q t1rr.e very dcprci-z~sd for s lorly klre<br />
and thi F: L.~.III~ just felt ovcl.-w>;eln~ed and clid not care about d'ylrlg. kt thi~<br />
I-. i at. patier-t meet:: l ilgm;ient. crite-ri a ne(:ondar;~ to ila [:?*I. tc <strong>self</strong> cj~le to<br />
mental 7 1 [less with litt.1 r. i i::c: the conncqilcs:ices of her a::!..iurls. ??!~c!n I<br />
r;pnke aboct why s h ~ <strong>is</strong> -I: the il3~~'1:T..dL Y~LE just fi?..dt...d, "I'll hr:, [i~i~, I'li<br />
:i~-~st i~cs ho~o. " I stated abo'ut. :;iedizatian foi. itepr~ssinn wllicfl she i,er.l:<br />
crl arrtidrgres~arl~. ~nedicatio~l I;c!l'i>rr and very y~.iar.ded abcllt. tier st+r.?chr..s 11;<br />
her lire an well ns hcr 1 ife in gea?ral. At tn<strong>is</strong> t-j:ne. patient_ ~l;r::(:.:L.s<br />
:i f~patient critcri 3 a?cc~~ry to darlgsr ta pel f due to rr.enre 1 illness.<br />
KEDICATIQNS: Ativan I. 7r.y per day as well as a~ather- meciicinc which oh^.<br />
(:loex cot remamber. -LntLcieprt;!,c:sa_1+, and h-Aeral mainly For. blood pveenure<br />
MEDICAL ELSTORY:<br />
H':,.l;~r.r.':ensio~:<br />
MWAL STATUS EXAMINATIDN: kf f ecL : Somewllat flat . She Icok.~ her sr,ll..ec', a?;e<br />
wixh fair. elre contsc~ . She <strong>is</strong> ozitnte~? timen thuGa with .I dr?pressec! ;nocsd.<br />
M~rl'liir.:~ : Fai:: . Specr:!il: IJor-;nsl rat;c, rlormal aulglitudc . 11;t.elliuencc : .&varacye.<br />
Tr:~ight : Lilni l.e:.l insinht i n!..o her currC:rtl_ p~ychoLog l cal condit. i v11. Tho.dgh(.<br />
conkeat: "T kr~u:.~ I put I : . h huse to t-hc window. A. l..riuw I war-: -ur:conscio~ia i r ~<br />
rl-ir car.. " T!lo-~ght. processes t Nc:) delusions but sornevrha L. bizarrc Lhought<br />
p r.ucesf. ;J~lfiyn;erit : Pgor . Perceptual d i t.urbclncr:~ ~ : There i :; <strong>self</strong> -<strong>harm</strong><br />
sit~~i1t.i on, rncect a l.!-amnt, no llcs1nicid~t1 icicdtixt. 2'her.e asr 1-10 auditory<br />
hal.lucination~. 1Ju ~rina,ll Fallucinzti of<strong>is</strong>.<br />
AXIS II NO32 ,<br />
AXIS 111<br />
AXIS IV<br />
!IYPEIC'l'h:NS~Oj4.<br />
F'CYCIIOSOC~XA'I t<br />
ST?XESSOR.L; : XUUZPATE TG SEVERE,<br />
AXIS V GTOSllL hC'Sh':;CMENT OF' . ~ ~ ~ C ' TAT I ~ THE N l 'TTME ~ ~ QF mMISSIoN\rl 75,<br />
G;CDfiL A:iSGI;SMZ>T" Oh' FTJNCTIONING I1i TXE PAST YEAL : 73.<br />
HOSPITAL COURSE: Trlitit~l 5i;iqrlus<strong>is</strong> v?aw aajvr dc:plession. 3etox proto,zg~<br />
per rncd.1 cal dsctor . ~~icide pr rcautions in niac!e due to depressi V?<br />
~p~pi.o~r~at~l~g.i. Zcjlcft :!!J tllg p.0. CI ?.8; 3C ti;.rr;ke to c! .inicr~~ .C:ymptaac.<br />
Page I<br />
COLLEGE HQSPYTAL<br />
PATIENT NAME : GPACiA, DSNIELLX<br />
CEWITOS HOSPITAL NUMBER: '1: 136<br />
PSYCHIATRYC DISCHARGE, AGE : 3 7 SEX : b'cnlalc<br />
SVKMARY<br />
ATTENDING PBYSICIFN: Lralg W~oncki, D.O.
irll>i? Vivtaril because of lailk of ecficacy ar.d then rr:s:.nr.tecl brcnuse<br />
of some anxiety, and starr.ed it q 8 hcurs p.i7.n, anxiety. The pati!:!nc did<br />
well with rnedicati.on tiErat1c.n to I-1inir.n. sy.;ptorne., iacresr;~ in ir?slqht<br />
Into her illness but wa: di.sc-.:haegcd % court on 1 /! 1 j38 and at th,>t. I.. i roc+<br />
did IX-~I.. war! t the medication. No otFcl:. madicizc was give?^ aild foliowup r:art:!<br />
will be on the out.pati(::-t:. f:au<strong>is</strong>. Ile will he. d'sc::harged h2* cnurt ar:~fi that<br />
happened (311 1 /J ;/08. The patie:lt tn fol low up with ourr;it-!cr providers. T::r.<br />
pa Lierlt prefers tzi arrn?lyc? 8 f bercare with Cia~3.0H I(agar? and she za.ic3. she<br />
will do rh;: by he~:.aal.f.<br />
~<strong>is</strong>tcor.~~..<br />
LABOKATORY : SiQ"i- 25, CEi' an? thy'r'0ir.3. f.uctio11 vrcxq within 11orly.al 1 .i n1i.t~<br />
H&H a little low ale 10.3 and 31.3. Bcta HCG negative. Qr.i rre drug screcn<br />
positivc for, benzodiazepines .<br />
--<br />
KISTORY AND PBYSTCAL EXAMINATION! H<strong>is</strong>t.wr)~ arlrl pl~fsical c;irnir:zt iol wa::<br />
dole by TI' . r,!elchor .?.~xi zhi>~?A t;yp2~+-~11~i~:l, !:,!VITO;I~C h~-adachc, l.il.cesatia11<br />
IcFl-. forearm, . sacunda~-~v r.o r:a,r.i>c:)r~ rrlon3xide 2Ci.i ?:::cling.<br />
AXIS I1<br />
AXIS v<br />
:DISCHARGE PUB: '1-lie patierit ~rc~ttssd ally nicdication at t;ili;-i time, b:,?j.~l~es to<br />
~LIGL. do hol<strong>is</strong>=ic~l!y on the cst:l.gatlent bas<strong>is</strong>. Was d<strong>is</strong>cha~yed by cou.:..::<br />
T.il:>uyl'~. At r.hi..c: L.i~qcr I .;lad sp:>kari wit3 thc: ~!iotl-ler abol~t.. need Tvr succni<br />
sl-~~purr. well as il:c!rv?asin(? fupprsr L on the olll.~,atient baw i a. Mother 1 ives<br />
out 0.F Late, starcs t'.:~? underst.c~c,ci th<strong>is</strong>. ':hc pat Fent <strong>is</strong> 1.1gt o~lic:j gal,<br />
homicidal, or. gsyc5otlc at. 1.Fia time of d.i.scharqe ac::ording to l,Ilc court drld<br />
wan di.c;c:harged and p;i::i =nt. not wi.:;hi~ly to okay .ji~lwtaz-j.l y.<br />
-. .-<br />
Craig i+Jrorski , D. 9.<br />
C!W/crn d: 01/%3jOa t: C'L./25/08 doh t CC462iG<br />
--<br />
lJagr: Z<br />
COLLEGE HOSPITAL<br />
PATIENT NAME: CARCIA, D;iPI TELLE<br />
CERRITOS HOSPITAL NUMBER: "12175<br />
PSYCHTATRIC DISCHARGE AGE : 3 7 SEX: Female<br />
SUMMARY ATTENDING PHYSICIAN: Craig lh'r.uilski, D. 0.
PSYCB'TATR'IC AND MENTAL STATUS EYAMINATION --<br />
DATE QF ADMISSION;<br />
01/08/C8<br />
HISTORY OF THE PRESENT ILLNES!. The pa1.i e ~t. in a 3?-\;f!a~.-olci Africnnhlnerican<br />
female brnughr inko the hospital af~.cr recently allc~gadly curting<br />
her wr<strong>is</strong>ts b3.laterall:j and tk~en 'caking a haze ai~d el-t-aching it to ?J,:?T. car<br />
exl.-au9 !, arid tapillq it to he:r ihl i nciurv and v!as f ounA ~.~~icnnscious hy H B C U ~ ~ ~ Y<br />
car in her coc~lplnx. The patient at Ckl..i~ time veq ddepreaaad for a lcmy tinie<br />
aria rl~ia Lint! just fclt oirervht:ln~ed and did ~:ct csre about Cying. Rt: th<strong>is</strong><br />
L.inia patient meets 'i a;>?tierit criteria ~ccoridary :o d;irgcr Lo elf due fn<br />
mental Llll~i':;?~ 'with little ii:.to r.h~: ~orlae-ensrs af wctions. l W : ~ ~ ~<br />
:;~:c.)habo:lt wily she <strong>is</strong> I r1 1.1.1a hcspita; shr:: just stated, ''1' 11 be fii:~, 1, 7 7.<br />
just qo hnmc." I stated 3bcv.t mcdic2Liun for bepressicn vrhicn shs was very<br />
t.t:!a~ I.Lil i:.!le~ I tail~cd abo~t her 19 .jca.r. (>id daugl1:er. Tfle patien? ?1;i(.3 heell<br />
on s n r i c i o ~ rlledicat ~ i ion bcl;orc: arld ..rery guarded about hi:^: alzetches
MEDICBL<br />
-<br />
HISI'ORY AND PHYSICAL EXAMINATION<br />
DATE OF ADMISSION:<br />
ol/oa/os<br />
CHIEF COMPLAINT: "P.?..c~mpt.ed sLiciQe. "<br />
BRIEF HISTORY OF TRE PRESENT ILLNESS: Tile patierlt ie a 37-year-nld Af r:! car.(-<br />
.z;\ne.r,i.car~ feir~alr, who at.tenpted -Lo commit suicide by eai.horl ~rirj.ncr:.;ide<br />
po<strong>is</strong>oning in he- car. The pa5ic.n~ Lad tvxic ezczphalopath as a<br />
col:aequcm!i:. T~c: pl,ie:~L WRB adnlitted at Wozt Pnahein~ i"lcdica7. Center on<br />
3./'5!CE1. She also made laceratioils x two ancl silt :~uge.r~ficial cut in the lcft.<br />
f oresl-n~ with LL kxif @. 'l'hc l.&ccr-at.ioriz wex'e suture? and these wt::yc irila(:,r,,<br />
'J.'hc gal.ienld iier~ieu any pair1 f rorn her lecLonn . Shc: i s co~,:plsil-~:~:; of chronic<br />
l?ead:~che, ~I:JVJ it <strong>is</strong> 11c~r: a:; bad, 5/1.0, aching, fronrral, :~or~-xarj.i 31.. i.115. .She<br />
riurlizs ariy cb-x-qe in v<strong>is</strong>ion or aeui-clog? c F:)??gl:.orua,<br />
PAST MEDICAL HISTORY: Hyye~ l.e:leion, cr.sential trr:rro:*s, i:!br.(;r~ii: headache<br />
fforkcp was newt ive . She was j u:;t. l>l aced or propra;loloi ;~ncl At..ivar~.<br />
PAST SURGICAL HISTORY:<br />
Ucremarkable<br />
PAST CHILDHOOD ILLNESSES2<br />
Chickrnp.jx.<br />
OB/GYN HISTORY: G 1, P 1. N o m<strong>is</strong>carriagcs<br />
MAJOP. INJOR3ES : ;done .<br />
ALLERGIES: No know^ rlril'g a1 1.e rg<strong>is</strong>s .<br />
MEDICATIONS<br />
Ativar, propranolcl.<br />
sOCIAL HISTORY: ~h4 pa~ient li.ren wf th :let daughter on and c~ff, she dc:ni c:s<br />
arT: drug use. Sht-: :;molt c:; three zigaret ;es a day j ~1st recently, ~1:e rJrir~~<br />
..in:[,:s a week, sbcut 1-2 b~cr's i)ar sesrio:~.<br />
2 . .-<br />
.<br />
FAMILY HTSTORY:<br />
Iln.r'c:~~rd r.kablr?.<br />
AEVLEW OF SYSTEMS: GENEML: The patient rlc?riieu aq suddcr: i~i~igilt. loss,<br />
i.iri.gI-:r_ gain, 3vnco~al e:+sodes, n\ala<strong>is</strong>r, ~FT-er, ~ r . c;~s of sppet-ir.c. HEENT:<br />
1 CARDIORESPIFA'I'ORY: patient. :ic:rli.as any chest pa i ~ i ,.hc>rtnec:;<br />
of breath, gi~ 01- whe ?zing. GA9TROINTESTINA.L : ':he pi; ti.ent denies ar.:y<br />
ahdon:inal pain, -nailsea, vorr.itillcj, diarrhea, or conr;;ipa!-:ior?. The paticr~i,<br />
does not have any me:!ex.3. or h:matrmcsi.s. GENITOURINARY: The pltient d~!iiies<br />
fiysuria, rIrqrllcy, f reyl.~~ncy, :nasitancy, &r,d herr.at,uria cr flank pain.<br />
EXTREMITIES: The patl.or.c:. dent.2~ any ankle ywelli~g or joi~it pin.<br />
NEUROLOGICAL: The patie,.lt delllee SIIY dizzf ~les.c;, weakness, or. :iumhness of<br />
3i:Y extremities . SKIN: Sae IIPI .<br />
PHYSICAL EXAMINATION:<br />
-<br />
COLLEGE HOSPITAL PATIENT N-ME ; GIirtCIA,<br />
Pqe 1<br />
UA1;ITELLC<br />
CERRITDS ROSPITAL NUMBER: /2:36<br />
XeDICAL HISTORY AND AGE : 2 ' I SEX: bctn-lle<br />
PfIYSICAL EXAMINATION ATTENDING PWSLCLAN: C. Aro~lsX~, D.O.
VITAL GIGNS ... : Tetllperat~rre: 98.2, Blood prengure: 14D,/$i. pulse : 65<br />
Respi cator-f rate: 30, Height 5' SN, weiqht 13 R pounds.<br />
Slc.lN: Tll~ patientpi.. :%kin iz warm Ar16 intact. The patient. has no raa!st:kt.<br />
Pr..esence of 1 aceratiuns, 5 cm Cn the proxiinai left. f(:>r-earm anc? 2.5 cm mi<br />
the d<strong>is</strong>l:el left forc:a?-111 with zuturea, clean, dr-y, intacr., nn2 inonrcr~[lnr to<br />
p.ilpa!.-iuE. In addi:::iorl there <strong>is</strong> a sup~rf ici a1 cut z.So~lT. 0 . 5 cm n?i l:.kie left.<br />
Eurearn~.<br />
-4EEP:T; Iiracl <strong>is</strong> ~'~oznoc:egl~al~.r: and atracn~atic. Eyes! Ftigils a-rc! eq;~al,<br />
-<br />
ṙ c~urid, a~lri :t:.eactive tcr 1 iyllc . Extraocular movcnlerl:. s a:-e i ntact . Sc? erne<br />
anir,t ,.r.r<br />
-.. .- I.(.!. Earn! 3xLes-nal audi.l.ory ca~m<strong>is</strong> iire patect'.. Ty?maaic rrtenbranes<br />
i :~l:.azt. Mosi! : Normal rLasd.1 passagca . ?Joutll s~?d thrcat : Huccal mllcor;a <strong>is</strong><br />
pink and mo<strong>is</strong>t . De:~r. i L.ivn ; Fair. TmqLe <strong>is</strong> pin^ 2nd i.r:. tte miciline . Nn<br />
ph;l r'yrlgeal exvdaLes.<br />
ED3.T: Regular rat-~: ?rid rhyth~~n. 51 and S2 rlvrmal. Nu nlurmurg, 1-ubs, a:<br />
gal 3 r.ip5.<br />
I.-. \E~CIV:E~I : Ssf t a?ld 7orlt erdez- . 3ewel so~inde are pr-caext rt:-.c! rlcrrnoact.ivc.<br />
E~~XAST/PELV~S.'/RECTAL:<br />
. lhc! examinstjcri was deferred sct:!vndarl; t:r: the<br />
patient's x'afusal, She had a. Pap smear 3rd breasd axax dor'ie in 9/07 which<br />
we-ce i;c.)l.F~ ~?cjr-malimi Ls .<br />
k:XTF.:,LMITI k:S ;<br />
-<br />
Nn clubbirlq, c\r.anos<strong>is</strong>, =IX sdcma . Hjll railqc uf moti 011 all<br />
t.hro~lg.:j:~ut .<br />
NPIJROT,~GICZAL<br />
- EXP,MI>lA'II':jK: 'She patic!rir, <strong>is</strong> awske, .~lc:r.l;, z1ld c:lsiei:ted >: 3.<br />
P. .. --<br />
iruar~ial nerve I: Sot axamined. Cranial ?:crve I:: 1ilurrr.al viouai 1:~elds to<br />
cnntxnn!.:ation. P'llniiu,~~~:~pi?l ezaminatior <strong>is</strong> hor~ign. I:::,-tinial ncsrves LIT, Ii.;,<br />
'JI: Pupils are cqual, round, and :'cacti-.re Co light, . Extraaculsr :nosrene::t.a<br />
are intact. and frill. T?re par.ii.rit doe..: not rep3c.t. anif r>y~taqmus. Cr;lri.ial<br />
nerve V: Sensory exam rc gi-r~rick a112 corncal reflcxes arc e?r.etricsl.<br />
il'xaui.al Iservc! VIi; No 'I ORS of riafi~labial fold. Xc! ptos<strong>is</strong>. Bil,~t.r.!r.~.lly<br />
syrnrr.etr5 cal wrLnkl. ing ';t tf?e f orencad. Crani.nl nerve ~111: ,fl~,2rill~ i,~<br />
illt2cb. Craliia.1 rien7cs XX, X: C&G retier. <strong>is</strong> inract. LTvula elev;t.c!s in t.l.le<br />
m:j dline . Pharynqeal se>:satio:rts are in tact . Cranial nctve XI I :?o wea It mess r?~<br />
atrophy uf trancsi~s 01: alernoclf:'~.ilomast~id muscle,, Gono shoulder shrug.<br />
i:.c*rlial xcr ve XI1 ! 'ror~:.n~e proLr.udes i. ti the n1.i dlire . No inotor or se~~s:,ry<br />
3- Lic:.i,,,<br />
L c- , Reflcxes arc :?+ 'uiia;erally ir I~tit!~ uppc?r and lower ~txt:.cemitica.<br />
Cter.sbellar%: Piilger k:o-ilose [.tr?8t <strong>is</strong> iritac", Rapid ali-arnatinq mo-~encrit.5 ar?.<br />
alsc! inl.act. Cai :. <strong>is</strong> norir~ai.<br />
PAIN -<br />
ABSk;SSKENT: .- See IIPI.<br />
-,. -<br />
Pirg- 2<br />
COLLEGE EIOSPITAL PATIENT NAME;; G-XqC'lA, DXYTZLTE<br />
CERRITOS HQSPLTAL NUMBER: 72196<br />
MEDICAL HISTORY AND AGE : 'J 7 SEX: Fenale<br />
PHYSICAL EXAMINATION ATTENDING PHYSICTAN: C. Nronsk.;. 13.0.
LABOFATORY STUDIES: L,>h:: are still pendi~ig at of dictation. ?T scan<br />
nf the head dorie. at th? hnspit.al 1/6/09 was negative.<br />
ASSESSMENT:<br />
I. LACERRYIONS O'J TI-IE LEFT POREAPJ4<br />
PLAN:<br />
- - ~diui t; pal ... i enl. L.c.l:i t.k:e ur~it -;r;_d~r tl:~ r~z-e of 137- . Wr'uiwki who will<br />
1.3rrf :jrm a rnental status exacin~~ion, pr;yr:!h .i.al.r.iu evalaation,<br />
m~aagcmcilt on83 LrPa l.~rrw 1.lla patient nr a medi.ca1 i>ani:3 and aidress<br />
EI ny "I:)r":)~~1'fi1 1.abs .<br />
?hark yori for. al:ow.i;'ig<br />
ma to participate in t.hc c.:*-r.e 2f th<strong>is</strong> n;ttie:ir.<br />
F!~/rnIi d; 01/09/C9 t: 21/39/08 Juh 4 DD266i.9<br />
-<br />
Rosemarie Melchor, M .D.<br />
.-<br />
COLLEGE HOSPITAL PATIENT NAME : G.WCI3,<br />
Page 3<br />
3>1JIEsi,4:<br />
CERRITOS HOSPITAL NUMBER : '/ 2 1 96<br />
MEDICAL HISTORY AND AGE: 3 7 SEX: Female<br />
PHYSICAL EXAMINATION ATTENDING PHYSICIAN: C. Wro:~~ki, D.O.
03, i 3 finr~~nni<br />
US1 1 I U'73VUVI UI<br />
j:.<br />
.,<br />
..,.<br />
Licensed<br />
? ,<br />
., ,<br />
':'$<br />
-:. :<br />
Daniel Brown, M.A.<br />
Clinical Mental Health Counselor<br />
3 Main St., Suite 2 16 75 Fairfield St.<br />
i"<br />
;$ Burlington, VT 05401 St. Albans, VT 05478<br />
.:.;I (802) 65 1-75 15 (802) 524-2002<br />
-.:I<br />
State of Vermont<br />
D<strong>is</strong>ability determination services<br />
93 Pilgrim Park Rd., Suite 6<br />
Waterbury, VT 05676<br />
October 1,20 1 1<br />
Dear d<strong>is</strong>ability services,<br />
Th<strong>is</strong> letter <strong>is</strong> in response to your request for information concerning Ms. Danielle<br />
Garcia's application for d<strong>is</strong>ability services (case #: 0 1 508 19). Ms. Garcia entered into<br />
counseling with me on 8/21 I and we have continued meeting for sessions once a week.<br />
A total of eight sessions have occurred to date.<br />
Ms. Garcia <strong>is</strong> a single 41 year old woman who presently lives in a homeless shelter in<br />
Burlington, VT. She reports that she has felt "very shaky" since 1995-96 or so. Her<br />
childhood years involved serious chaos, including sexual exploitation, and she had a<br />
daughter at age 17. She describes her family as "not good people" and presently <strong>is</strong> cut<br />
off from them with no contact. Her present symptoms are cons<strong>is</strong>tent with PTSD (309.81)<br />
and involve serious impairment in the ability to trust anybody. She also describes being<br />
harassed and persecuted in a series of different job settings which she refers to as<br />
"workplace mobbing". Needless to say these experiences have made matters<br />
considerably more overwhelming for her. Looking for a safer place to live has led her to<br />
Sweden and she ha. sought asylum in Cuba. None of these attempts worked out.<br />
I have not done any psychological testing with Ms. Garcia and have not received any<br />
reports of testing from anybody else. She presents normal in regards to memory and<br />
shows some impairment in regards to concentratiodattention. Her affect and mood<br />
present as anxious and depressed. Her insight and judgment, stemming from her trauma,<br />
present as having been comprom<strong>is</strong>ed. Her ability to trust and relate with others <strong>is</strong><br />
significantly impaired. Ms. Garcia does not drink or smoke, presents her<strong>self</strong> in an<br />
articulate and appropriate manner and has been very conscientious in keeping all of her<br />
scheduled appointments. In my opinion in her present condition she <strong>is</strong> not capable of<br />
holding down a job. I do not see that changing in the near term. The long term prognos<strong>is</strong><br />
for Ms. Garcia <strong>is</strong> not known at th<strong>is</strong> point. I hope th<strong>is</strong> report <strong>is</strong> useful to you as you<br />
consider her request for d<strong>is</strong>ability services.<br />
Sincerely,<br />
?&*/I 4w--,<br />
Daniel Brown, LCMHC<br />
Vermont Lic. #: 068-0000090<br />
*c,y/tc
FROM :CERRITOS PSYCHTJLOGICRL CENTER FRX NO. :562 860 1154 Nov. 03 2011 08: 53PM P2<br />
Cerrltos Psychological Center<br />
1721 5 Studebskar Road Suite 119<br />
Cerritos, Califorr.ia 90703<br />
1582) 860-2219 Vcica Mall 3<br />
Fax (562) 860-1 ? 54<br />
Lester A. Mindus, Ph,C<br />
CCI-Dlrectar<br />
November 3,2011<br />
State of Vermont<br />
D<strong>is</strong>ability Determination Sewices<br />
93 Pilgrim Park Rd. Ste 6<br />
Waterbury, VT 05676<br />
Re: Danielle Garcla<br />
Case # 0150819<br />
DOB 7/30/1970<br />
Brlef Narrative Report<br />
Danlelle Garcia was in individual psychotherapy with me for 9 v<strong>is</strong>its on 6/15,7/6,7/13,7/23,8/3,8/10,<br />
8/17,8/31, and 9/7/10.<br />
Her diagnos<strong>is</strong> was 296.33, major depression recurrent, severe with pers<strong>is</strong>tent features of persecution.<br />
In my opinion she was unable to tolerate work related pressures and relationships and was probably too<br />
severely impaired to work.<br />
~?jAf?f~~fld/&f<br />
Lester A. Mindu Ph,D,<br />
Clinical ~s~cho(o~<strong>is</strong>t #PSY5564
VERMONT DISABILITY DETERMINATION SERVICES<br />
TELEDICT.4TION<br />
CONSUI>TATIVE EXLAM<br />
PSYCHOLOGICAL REPORT<br />
PROVIDER'S NAME/ADDRESS:<br />
Benjamin Skolnik, Psy .D.<br />
RE: Danielle Garcia<br />
2 C.hurcl~ Street, Suite 2B CLAIM$: 0150819<br />
Burlington, VT 05401<br />
DATE OF BIRTH: 07:'30/1970<br />
DATE ESL4IMINED: 1 lR3/2011<br />
D14TE DICTATED: 1 li30!2011<br />
DIStU3ILITY ES.4,b11NER: Bryan Civalier<br />
GENERAL OBSERVATIOT\I:S:<br />
Danielle Garcia <strong>is</strong> a 41-year-old fernale \ T~O presents to th<strong>is</strong> examiner as part of her<br />
application for d<strong>is</strong>ability benefits. She states that she walked to my office today for her<br />
appointtnent from a shelter. which <strong>is</strong> only a few blocks away. She states that shr: has a<br />
driver's license but no vehicle. Ms. Garcia dates that she <strong>is</strong> presently staying in a<br />
hollieless shelter and has bee11 doi~lg so since June of th<strong>is</strong> year. She states that she has<br />
been homeless since March of 2010 and that she has been in the Burlington area since<br />
June of th<strong>is</strong> year. Most recently, prior to moving here, she lived in California.<br />
Ms. Garcia przsentsd as a casually but neatly dressed woman who appeared<br />
approximately her stated age. Her affect was flat and her mood appeared irritable, but she<br />
was agreeable and forthcorning througho~lthe interview. There was nothing notably<br />
~rnusual about her posture, gait or nlotor behavior.<br />
INFORMAIT:<br />
Information for th<strong>is</strong> report was gathered from the itlterview with Ms. Garcia as well as<br />
from some ~s~edical and psychological notes forwarded to th<strong>is</strong> exanliner. The first of these<br />
notes dated 01/11i2008 related to a psychiatric hospitalization followitlg a <strong>self</strong>-reported<br />
suicide attempt. The report explained that Ms. Garcia was d<strong>is</strong>charged by the court likely<br />
because she was in the hospital against her will and that she refi~sed medications upotl<br />
d<strong>is</strong>charge. It appears that the duration of her stay was 3 days. The second note was dated<br />
10/0112011 and was by psychotherap<strong>is</strong>t Daniel Brown. Mr. Bronin's note cons<strong>is</strong>ted ofa<br />
letter in support of Ms. Garcia's d<strong>is</strong>ability application and described Ms. Garcia as<br />
meeting the criteria for posttraumatic stress d<strong>is</strong>order. The note also reported that Mr.<br />
Brown felt that Ms. Garcia was not in a position to function well in the workplace. The<br />
final note was dated 11!03:'2011 and was an evaluation by a Dr. Lester Mingus, a clinical<br />
psycholog<strong>is</strong>t, I believe, in California. Th<strong>is</strong> no indicated that Ms. Garcia met criteria for<br />
ma-lor depressive d<strong>is</strong>order, recurrent and severe with "pers<strong>is</strong>tent fantasies of persecution."<br />
It <strong>is</strong> interesting lo note that nons of the notes forwarded to ths exanliner indicated the<br />
possibility that Ms. Garcia met criteria for a psychotic d<strong>is</strong>order.<br />
It appeared to th<strong>is</strong> examiner that Ms. Garcia was answering ques?ions honestly and to the<br />
best of her ability. There was no evidence gathered today that ~varranted questioning the<br />
possibility of intentional falsehood, malingering, exaggeration or mninimizaliotl. The only<br />
Page 1 of 7
Claimant: Danielle Garcia<br />
Claim #: 01 50819<br />
puzzling thing was that Ms. Garcia's presentation appeared quite acutely del~~sional and<br />
none of the medical notes forwarded to th<strong>is</strong> examiner indicated that R~ls. Garcia had rnet<br />
criteria for delusional d<strong>is</strong>order or for any other psychotic d<strong>is</strong>order. While there Lyas no<br />
evidence that Slfs. Garcia was malingering, there was some d<strong>is</strong>crepancy betwleal th<strong>is</strong><br />
examiner's observation and the apparent observations of these previous notes. The only<br />
hint in previous notes of th<strong>is</strong> specific sort of difl>culty \vas the report by Dr. bIing<strong>is</strong> that<br />
Ms. Garcia experienced pers<strong>is</strong>tent fantasies of persecution.<br />
CHIEF COMPLAINT:<br />
M'hen asked what it <strong>is</strong> that caused her to appllr for d<strong>is</strong>ability. hls. Garcia stated, ".A<br />
nunibzr of factors, mostly on that nrebsite." The website she was referring to was a<br />
website she had IcA me a. message a few days prior to the interview to check out and <strong>is</strong><br />
one of her own creations. The website; ktiown as organizedn~ohbing.co~~i was not clearly<br />
pronounced in her message, so th<strong>is</strong> examiner did not have a chance to read the website<br />
until R few mitl~ltes prior to the inter\:ic\v when I revieived her medical records which<br />
also referenced the website. From lvhat th<strong>is</strong> examiner saw ofthe website it was a general<br />
treat<strong>is</strong>e on Ms. Garcia's belizf system about the way tliat she and other people have been<br />
the victims of w11at she described as "government d<strong>is</strong>integration." Ms. Garcia explained<br />
to th<strong>is</strong> examiner that there were other parts of the uiebsite that were more autobiographical<br />
in nature though th<strong>is</strong> examiner did not have a chance to check these parts out.<br />
Garcia veti it on lo slaborate that the reason she was applying for d<strong>is</strong>ability was because of<br />
th<strong>is</strong> "gowt-timent d<strong>is</strong>inteyation?' and stated that '7hrough government d<strong>is</strong>integration you<br />
have an ~nlraveling of your life." She then referenced "COINTELPRO." When th<strong>is</strong><br />
examiner asked what th<strong>is</strong> was she looked at hitn somewhat cluizzically surpr<strong>is</strong>ed that he<br />
did not how that she was referring to counter intelligsnce progamning. She s-tates that<br />
th<strong>is</strong> <strong>is</strong> the agent or the d<strong>is</strong>integration and that it <strong>is</strong> brought about by the government.<br />
When asked to elaborate, she slates that she believes the government <strong>is</strong> causing her to<br />
lose jobs and <strong>is</strong> otkerw<strong>is</strong>e trying to ilnravel her life and in her words "d<strong>is</strong>integrate" her.<br />
She states emphatically that she does not believe tliat th<strong>is</strong> <strong>is</strong> the case "I ktlo\v that th<strong>is</strong> <strong>is</strong><br />
tlic case."<br />
I-IISTOKY OF PRESENT ILLNESS:<br />
Ms. Garcia reports that she grew up in Rochester, New York with both parents. She states<br />
that she was an only child and that she suf'fered an extremely diff~cult childhood. She<br />
states that licr fathcr was hostile and physically abusive to her mother frequently and to<br />
her, her<strong>self</strong>, occasionally. She states that she \vitncssed ller father's abuse to her mother<br />
on multiple occasions and that tthere was generally an atmosphere of fear and hostility in<br />
the home. She states that she had to walk around "tiptoeing." Slle states that her father<br />
was not an alcoholic.<br />
.At some point around the ,zgc of 14 or 15. hls. Garcia reports that she became "connected<br />
to the wrong individual and became a child prostitute." She states that she left home<br />
around the same age and dropped o~lt of ~cliool and began living with the person that<br />
appears. essentially. to have beet1 pimping her. She states that her dropping out of school<br />
Page 2 of 7
Claimant: Danielle Garcia<br />
Claitn #: 0150819<br />
was the wlnter of 1 lth grade. She states that she stayed there for a year and that it mas an<br />
extsemely abusive and difficult environment. Approximately 1 year later, she was able to<br />
get out, lived down the street for a ~vhile and then went to stay with her grandmother She<br />
states that she returned to school at th<strong>is</strong> tixne and managed to graduate with her previous<br />
classmates by consolidating her junlor and senior year into I year. She states that she was<br />
very successful acadenlically when she wanted to be and that she never had trouble with<br />
conlprehenslon or with academic performancs. She also states that she was an athlete,<br />
playing softball. She denies any h<strong>is</strong>tory of si gnificant itlvolven~ent with alcohol or drugs.<br />
She states that during th<strong>is</strong> period of her life she felt socially coriilected and comfortable,<br />
though she does feel there was a lot of rac<strong>is</strong>m in the school that she went to. Ms. Garcia<br />
<strong>is</strong> African-hericar~ and she stiites that she went to a mostly Caucasian school.<br />
Ms. Garcia does recall intense periods of sadness during her adolescence including 3<br />
suicide anetnpts. She states that these attempts each cons<strong>is</strong>ted of her cutting her wr<strong>is</strong>ts,<br />
though she states that she did not lalovi~ how to do so effectiti~:ely. She states that she still<br />
w<strong>is</strong>hes that she had been successful in killing her<strong>self</strong> either during these ep<strong>is</strong>odes or in<br />
ep<strong>is</strong>odes that occursed later. In spite of the abuse that she was experiencing, Ms. Garcia<br />
denied ally h<strong>is</strong>ton; of nightnlares at the time. She states that she actually had dreams and<br />
a sense of optim<strong>is</strong>m when slle was not in one of her acute periods of sadness. After<br />
fin<strong>is</strong>hing high school, Ms. Ciarcia states that she went to community college then<br />
transfersed to the State University of h'ew York \arith one of the cainpuses near Rochester.<br />
She states that she got her bachelor's of science in Engl<strong>is</strong>h.<br />
h4s. Garcia states that. she believes that at some point during her undergraduate or<br />
graduate school career that she believes that she began being a target of the govermnent<br />
d<strong>is</strong>integration described above. She states that she <strong>is</strong> uncertain why th<strong>is</strong> <strong>is</strong> the case and<br />
that she <strong>is</strong> frequently persecuted by a desire to unders$and. She states that she believes?<br />
perhaps. that she has been targeted for being anti-Semitic, although she denies tl<strong>is</strong> being<br />
the case. She relates a couple of stories ~~lhere people saw things that she had beer1<br />
doodling and referred lo them as swastikas or other anti-Semitic slogans even though Ms.<br />
Garcia dznies that th<strong>is</strong> <strong>is</strong> the case. She states that she believes that these are the kinds of<br />
mind gallles that people play with you when you are a target of govelntnent<br />
d<strong>is</strong>integration, trying to tnake you feel like you are crazy. She states that in the years<br />
since college she has had a great deal oftrouble holding down jobs or relationships arid<br />
that she has moved a numbsr of times in an attempt to escape the government<br />
d<strong>is</strong>integration. She also states that until recently she did not really have a sense of what<br />
was happening to her, and it <strong>is</strong> only in the last couple of years that she states that she has<br />
scad thir~gs and gathered information that she has become very clear about the nature of<br />
her persecution. She does state that she has moved around a number of times in an<br />
attempt to escape it even though she was not entirely certain what it was and relates one<br />
story where she feels that she came close to doing so in a foreign countsy but that they<br />
ca~~ght up to her. She states that everybody in hzr life, including her family, are 01.1 board<br />
with the government d<strong>is</strong>integration. She went so fhr as to report a. sensz of surety that<br />
even th<strong>is</strong> examiner was involved with the govemnlent d<strong>is</strong>integration and that the whole<br />
Page 3 of 7
Claitnant: Danielle Garcia<br />
Claim &: 01 50819<br />
process <strong>is</strong> simply one that has managed to either it~doctritiate everyone in her life or get<br />
them to look the other way. She states that as a result, "I'm totally <strong>is</strong>olated.''<br />
Ms. Garcia's system of very bizan-e thinking appears very tight and impenetrable. She<br />
appears entirely convinced of the reality of her situation and appears to zxperience<br />
ambiguous situations as filrther cotfirmation tl~athe government <strong>is</strong> trying to unnerve<br />
her. She also feels that she has been dniggsd and surveilled by helicopters. She denies<br />
any fatnil? h<strong>is</strong>tory of schizoplrenia or other psychotic d<strong>is</strong>orders. She denies<br />
hallucinations or other bizarre sa<strong>is</strong>ot-y espesiences. She does report that she feels so<br />
hopeless about hat <strong>is</strong> being done to her that she has attempted to kill hersclf on 4<br />
separate occasions. She states that the most recent of tl~ese was an attelllpt at carbon<br />
monoxide po<strong>is</strong>oning which led to her hospitalization in 2008, referenced in the note<br />
described in the beginning of th<strong>is</strong> report.<br />
It \tias .very clear to th<strong>is</strong> esaminer at the time of the intenrie~v that it4s. Garcia was acutely<br />
delusional. It was itllpossiblc to assess, given a one-time intervie\v and the absence of any<br />
longitudinal information, the e~qent to which th<strong>is</strong> perception comes and goes. Ms. Garcia<br />
was asked about th<strong>is</strong> and states that she <strong>is</strong> always clear at ths point about what <strong>is</strong><br />
happening to her, but she also states that th<strong>is</strong> clarity has onlv ar<strong>is</strong>en in the last ycar or<br />
two. Because ofths it <strong>is</strong> difficult to ktlo\v whetha Ms. Garcia goes in and out of these<br />
bizarre delusiotlal periods or \vhether it <strong>is</strong> a pers<strong>is</strong>tent esperience for her. There <strong>is</strong> also a<br />
vet?.; slim chance, as it should be noted. that Ms. Garcia was exaggerating or fabricating<br />
her presentation hr th<strong>is</strong> cxaminds benefit. Again, there n7as no evidence of th<strong>is</strong> effect,<br />
but the contrast between th<strong>is</strong> exanliner's observation and that of the previous people rvho<br />
have known Ms. Garcia in a clinical context \was striking.<br />
Ms. Garcia reports that she has not ~rorkcd since Sovember 2010. Prior to that, she<br />
worked for approximately 3 years as an eligibility worker for welfare benefits in Los<br />
-4ngeles County in California. She states that she left that job because she began to<br />
pcrceive "workplace mobbing." basically a sense of the in\:olvement of her co~vorkers<br />
and superv<strong>is</strong>ors in the go~~ernment d<strong>is</strong>integration. It was very difficult to get a sense from<br />
S~ls. Garcia of e-mctly what was occurring interpersonally between she and her coworkers<br />
and employers as her tight delusional system made her perceive every&hing as people<br />
persecutitlg her and tqing to make Iier feel she was crazy. Prior to th<strong>is</strong> job- Ms. Garcia<br />
states that she has done a number of dif'fcrent things over the ycars gctierally \vorking in<br />
jobs for 3 or 4 years before the government d<strong>is</strong>integration and the workplace mobbing<br />
within it catch up to her arid make her have to leave.<br />
13s. Garcia reports that she receives primary care services from a Dr. Miller at Fletcher<br />
,Allen Health Care. She states that she recently saw therap<strong>is</strong>t Dan Brown but after reading<br />
the note that he sent to the d<strong>is</strong>ability people did not tn~st him anymore. She states that the<br />
note in its absence of reference to the workpla.ce mohbing or go.r~nment d<strong>is</strong>integ a t' lot1<br />
itidicated to her that TvIr. Rro\vtl was hitn<strong>self</strong> attempting to obscure the reality of what she<br />
<strong>is</strong> going through.<br />
Page 4 of 7
Claimant: Danielle Garcia<br />
Claim if: 01 5081 9<br />
She hopes to connect with a new therap<strong>is</strong>t probably through Fletcher ,Ulen.<br />
.4t the present time, Ms. Garcia reports that the only medication that she takes <strong>is</strong><br />
lo raze pan^ for anxiety. She states that she did take R<strong>is</strong>perdal, an antipsychotic, at some<br />
point in the late 90s though has not taken any antipsychotics other than th<strong>is</strong>. It does<br />
appear to th<strong>is</strong> examiner that antipsychotic medication may be of great benefit to her but<br />
she <strong>is</strong> likely at th<strong>is</strong> point to be m<strong>is</strong>trustfi~l of anybody that trizs to prescribe it,<br />
14s. Garcia reports that she has been psychiatrically hospitalized on 3 occasions. The<br />
tnost recent of these was in 2008 following thc carbon monoxide po<strong>is</strong>oning. She reports<br />
that she tv<strong>is</strong>hes she had succeeded but that she was found unconscious by a security<br />
guard. She states that she was hospitalized at Cerritos Com~minity I-Iospital in California.<br />
Slie appea.rs to have left on cout-t order without accepting any medication prescriptions.<br />
Prior to th<strong>is</strong>, she reports that she was hospitalized 2 times in 1996. She states that onz of<br />
these was for 24-hour evaluation follo~ving a referral from jail, where she had been<br />
arrested and incarcerated briefly for some sort of bizarre behavior which she statzs did<br />
not result in criminal charges. Following the 24-hour evaluation, she was transfetred to<br />
another unit at Lindemann Hospital in Boston. She states that she was there for<br />
approximately 1 month. Slie <strong>is</strong> unable to remember the specific circumstances that lcd to<br />
these hospitalizations except to say that sotnething occurred vilule she was in jail that led<br />
her to be referred for psychiatric evaluation and hospitalizatioti.<br />
Ms. Garcia rcports no major impair~nent with activities of daily living. Socially. she<br />
reports that she <strong>is</strong> extremely <strong>is</strong>olated because she believes that everybody in her life <strong>is</strong><br />
involved in the government d<strong>is</strong>integration.<br />
LIFE HISTORY:<br />
As mentioned previously. Ms. Ciarcia grew up in Rochester, New York. She states that<br />
her parents are still living and that "hly mother has nly things and I'm tqing to get tthetn<br />
away Srom her." :.Zs tnentioned abo\:e? shc has corne to believe that her mother <strong>is</strong><br />
in\:olved in thz government d<strong>is</strong>integration so s112 feels that she cannot rely on her for<br />
support. She did not have any siblings.<br />
Ms. Garcia reports that she has a bachelor's of science in Engl<strong>is</strong>h fioru the State<br />
IJnivzrsity of Nev 1-ork. She states she began but never completed a mastcr's program in<br />
library science.<br />
h,ledically, Garcia reports that she suffers wit11 neuropathy, ~rhich she describes as a<br />
feeling of pressure in her head which <strong>is</strong> not entirely painful but <strong>is</strong> somewhat unpleasant.<br />
She states that it has been diagnosed as neuropathy at the present time though it <strong>is</strong> unclear<br />
what exactly <strong>is</strong> happening medically hzre. Ms. Garcia denied arly h<strong>is</strong>tory of ~xinlinal<br />
charges. She states that she has never been in the military. She has been married 1 time<br />
and has 2 childrn~, a 17-year-old boy and a 22-year-old girl. Ms. Garcia reports that she<br />
<strong>is</strong> estranged from both of her children and that her 17-year-old was gven up at the age of<br />
Page 5 of 7
Claimant: Da~iielle Garcia<br />
Claim #: 0150819<br />
2 for adoption. She states that th<strong>is</strong> was voluntar> but she felt coerced into doing it and in<br />
retrospect feels that th<strong>is</strong> was yet another eesarilple of her being persecuted.<br />
11s. Garcia reports that she likes to dl-itik alcohol but that she catuiot afford to buy it and<br />
that it <strong>is</strong> against the reg~~lations of the homeless sheller wherc sl<strong>is</strong> lives. Shs denies any<br />
significant h<strong>is</strong>tory with alcohol abuse or with any other recreational drugs. She denies the<br />
present use of any other recreational dn~gs.<br />
\,IENTAT, STATUS:<br />
>Is. Garcia presented as a casually but neatly dressed woman who appeared<br />
approximately her stated age. Her affect was somewhat flat and her mood was generally<br />
irritable and extremely suspicious. She was fidly oriented to time. person and place.<br />
though she had sotne d<strong>is</strong>orientation related to sinlation, related. 1 think, to her delusional<br />
system. She evidetlced significant thought d<strong>is</strong>turbance, specifically ideas of reference and<br />
persecutory delusions. There was no evidence of perceptual d<strong>is</strong>turbance. Judgment and<br />
insight appeared poor rclatulg to the acuity of her delusional d<strong>is</strong>order and, given thls,<br />
there <strong>is</strong> some reason to question her capacity to capably handle her own finances.<br />
14s. Garcia was admiri<strong>is</strong>tered the Mini-Mental State Esatn and received 29 out of a<br />
possible 30 points. Th<strong>is</strong> would indicate tlo overt d<strong>is</strong>turbance with atte~~tiotl.<br />
concentration. immediate or short-term memory.<br />
DIAGNOSES:<br />
As<strong>is</strong> I: DIFFERENTIATE BET\.'i'EEN:<br />
297.1 Delusional d<strong>is</strong>order.<br />
295.30 Schizophrenia. paranoid type.<br />
Ax<strong>is</strong> TI: 799.9 Deferred.<br />
ib<strong>is</strong> 111: No diagnos<strong>is</strong>.<br />
Av<strong>is</strong> TV: Homelessnzss, occupational pt-ohlems, ecotiomic problzms.<br />
Av<strong>is</strong> V: GAF 50.<br />
Page 6 of 7
Claimant: Danielle Garcia<br />
Claim fi: 015081 9<br />
FOR;LlUI.,ATION:<br />
It seemed very clear fiom Ms. Garcia's presentation today that she <strong>is</strong> acutely psychotic,<br />
specifically extremely delusional. She does not appear to evidence any h<strong>is</strong>tory of<br />
hallucinations though it <strong>is</strong> hard to ktlow for sure. Additionally, it <strong>is</strong> hard to know the<br />
duration or pattern of her delusional thinking which tnakes it difficult to diflerentiate<br />
between a delusional d<strong>is</strong>order and more full blown schizophrenia. It <strong>is</strong> also, as mentioned<br />
2 times previously, pilzzling to th<strong>is</strong> examiner that tlo~lz of her previous treatment<br />
providers have described her as meeting criteria for a psychotic d<strong>is</strong>order. It <strong>is</strong> at th<strong>is</strong> point<br />
an unknowable contrast but does appear to warrant fi~rther consideration.<br />
Benjamin D. Skolnk, Psy.D.<br />
Yern~ont Psycholog<strong>is</strong>t $9 12<br />
BSlczeitls<br />
nn: 12!01!2011<br />
DT: 11,'30!2011<br />
10-02575293<br />
LC: 129<br />
Page 7 of 7
D<strong>is</strong>ability Determination Explanation<br />
CLAIMANT INFOFth4ATION<br />
Th<strong>is</strong> D<strong>is</strong>ability Determination Explanation <strong>is</strong> for the Dm claim at the In itid level.<br />
CLAIh3ANT INFORMATION<br />
Name: Claniillle S Gari:ia<br />
SSN.<br />
Phone Number 802-683-1 138<br />
Secondary Phone Number<br />
.Address:<br />
Claimant Gender: F<br />
Self Reported Height: 65 inches<br />
Self Reported Weight. 140.01bs<br />
Special Indications: None.<br />
RELEVANT DATES<br />
Below table represents the Relevant Dates<br />
Date of Birth Current Age BOD Age at AOD DFI DL1<br />
41 years 4 40 :real's 3<br />
Age at<br />
DLI<br />
person)<br />
person)<br />
Does the individual have an attorney lappointed representative? Yes<br />
Representative's name, address and phone number:<br />
Craig Anthony jarv<strong>is</strong><br />
353 STONE CUTTERS WAY<br />
MONTFELIER., VT 05602<br />
802-229-5146<br />
ALLEGATIONS OF IMPAIRMENTS<br />
The individual filed for Initial claim for d<strong>is</strong>ability on 05/29/201I due to the following illnesses, injuries,<br />
or conditions:<br />
Fast-tfaurnatic stress<br />
Post T1'3umatic Stress<br />
FJeusopathg<br />
The individual alleges inability to function andlor work as of<br />
11 / 1512010<br />
TECHNICAL ISSUES
Is the individual working?<br />
No<br />
Prior Electronic Filing<br />
There are no prior electronic filings.<br />
Alleged Onset Date:<br />
llj15(201C)<br />
Has the individual performed work after the Alleged Onset Date(.4OD)?<br />
No<br />
Has any period(s1 of work been determined to be an Unsuccessful 'Mrork Attempt, S~~bsidizedlSheltered<br />
Work or involved Impairment-Related Work Fxpenses, or other technical <strong>is</strong>sue?<br />
No<br />
The following initial evidence has been received<br />
EVIDENCE OF RECORD
The following evidence has been requested:<br />
Source of Evidence<br />
DR. GREENEUR-G; UCL4<br />
-<br />
.-cnr,rr~~ nr~rrunru~n n~r r~hr-ror,. A rr r cc-rcn nsrh~r~rrc<br />
EF Request Date<br />
loj07/20ll<br />
i rT,<br />
1~,713r,i i<br />
Level<br />
IPJ<br />
T ~ T
~~nn.1 I 'JJ r A ILI IV I I LL~LL-.~ L LLIY I ~;n> r.1 I LLA I Ln LVIIIVUUJ<br />
DR GREEMRURG; UCLA<br />
CERRITQS PSYCHOTHERAPY CENTER; P.TT LESTER MIMDUS<br />
ICIJLJI (LLJIL<br />
09/23/2011<br />
09/23/2011<br />
11'4<br />
I P.J<br />
IN<br />
CLAIM COMFlUNICATIONS<br />
No Clam Cofmunications 1-lave been created.<br />
Is a Cqs) required?<br />
Yes<br />
CONSULTATIVE EX4MINATION(S) (CE)<br />
Select the reason(s) for which a CE(s) <strong>is</strong> required:<br />
c--<br />
~~~~cialized ~r~edical e~idence that <strong>is</strong> needed <strong>is</strong> not available from the individual's treating or other<br />
medical sources.<br />
Was the beating source(s) contacted to perform the CE(s)?<br />
No<br />
Indicate which of the following apply:<br />
Specific exa,m neerfed<br />
Were all of the CE(s) kept?<br />
T?<br />
r es<br />
Analys<strong>is</strong><br />
dib 11115110-dlif<br />
FINDINGS OF FACT AND ANALYSIS OF EVIDENCE<br />
Neuopathy :<br />
"Neuropathy" vms used as a dia.gflos<strong>is</strong> regarding the clairnarit in 1989 to explairl a reactior~ to Elavil which<br />
involved a sense of pressure within her head, twitching dovm her spine and jerking ml.).lverrlents of her a,rm<br />
and legs. These sympto~~<br />
have gradually refitted spontaneously, and clairm.nt does not consider them to<br />
present any irrlpairnlent.<br />
Neurological CE dated 12 101 11 1 included a norma,l neurological exarmnation aad the conclusion that "Th<strong>is</strong><br />
patient has no neurologic irnpairr-nent."<br />
Rerriew of the Func. Rprt. corlfirrns that clairnent <strong>is</strong> not alleging any physical inipairfnent. Nu, MDI<br />
Mental:<br />
41 jrr old fe~mle with 4 years college alleges PTSD. She has h<strong>is</strong>tory of admin<strong>is</strong>trative jobs, leavif~g last job as<br />
eligibility worker due to ~n,~orkpla.ce reorganization, fnobbing, harrass~nent, d<strong>is</strong>crirr~ination and d<strong>is</strong>parate<br />
treatrlerlt.<br />
She rem.rks that she was vrongfully terminated. JSQ from 06-07 notes rlo ciifficulties, and further sta.tes she<br />
vos good viorker and pleasure to ha.77~ on staff Clrr~t had 4 day ps:;ch hospitalization in 2006 fi~ll~~i~firig<br />
serious suicide atternpt by cutting wr<strong>is</strong>ts and carbon n-lo~loxide po<strong>is</strong>onif~g. Diagnos<strong>is</strong> %as Major Depressiof~<br />
and d<strong>is</strong>charge GAF ~ ms 70. She was d<strong>is</strong>charged by court, refused meds Clrr~t seen for 9 outpatient<br />
psychotherapy appointments from 6110-91 10.. with diagnos<strong>is</strong> of hlDD, reimrrer~t, severe, with pers<strong>is</strong>tent<br />
features of persecution Treating source opined that clmt vm.s unable to tolerate work-related pressures and<br />
rhras probably too severely impaired to vark. Th<strong>is</strong> opinion <strong>is</strong> appreciated af~d given significa~it weight as source<br />
<strong>is</strong> specialty and treating. Letter frorn tr~ating counselor dated If31 11 notes clmt seen at that point for 8<br />
sessions since Ej 11. He reports she <strong>is</strong> presently homeless, has a, h<strong>is</strong>tory of sexual exploitation, and currently<br />
resides in a shelter. Current symptoms are ~loted to be cons<strong>is</strong>tent with PTSD. She has serious impairment in<br />
ability to trust anybody. She reports being harrassed at rrlultiple jobs, and has sought safer places to live,<br />
including Sweden and seelung asplunl in Cuba. Affect and ~nood are anxious and depressed. Insight and<br />
judgment are comprom<strong>is</strong>ed, ability to relate and trust others <strong>is</strong> severely impaired. Memory <strong>is</strong> norrnal,<br />
attentionjconcentration ShOm sofne impairment. Treating Source opines that in current condition, dmt <strong>is</strong> not<br />
capable of holdi~ig dmm a job now in the near tern1 Long term prognos<strong>is</strong> <strong>is</strong> unkno~m~. Th<strong>is</strong> opinion <strong>is</strong><br />
appreciated and given appropriate {eight, but not contr-olling weight as source <strong>is</strong> not program-acceptable. At<br />
PCP to establ<strong>is</strong>h care, clmt had normal speech, full affect, thought appeared to be goal-directed. She r~po~ted<br />
hdnm d;=nnn.?crA r~"+h DTCPt ;r1 3nl-IQ Cha ra-n+tc h;.?tnr,r ,-,$ r~nsclrnl
past 10 years, ~fi.qtl1 recent a.ttempt to seek asyli-~rn in Sn~den. Her only rned was lorazeparn, used infrequent1;r.<br />
kt neuro1og:i CE, she reported that d<strong>is</strong>abiling condition <strong>is</strong> PT SD. MSE vias norrnal. There r~~ias no neurologic<br />
irnpairrnent. At psych (3E in 11 ( 11, clmt reported being prostitluted as teen. She reports 3 suicide attempts by<br />
cutting during her adolescence. She reported that during undergra.d school, she becarne target of "gorrrmrrlrnt<br />
d<strong>is</strong>integration" and d<strong>is</strong>cussed counter intelligence programming. She has a :~,~bsite that further explains these<br />
<strong>is</strong>sues. She has had difficulty holding jobs and has moved a number of tin-~es in order to escape government<br />
progranming. She reported that her family and everyone in her life, including examining psycholog<strong>is</strong>t, mere<br />
invl2lued with th<strong>is</strong> government d<strong>is</strong>integration. Diagnos<strong>is</strong> u.as Delusiona.1 D<strong>is</strong>order, noted to be extensive and<br />
impenetrable. It was unclear to psycholog<strong>is</strong>t whether th<strong>is</strong> vms co~ltinuous v@rsus ep<strong>is</strong>odic condition. GAf T~a.s<br />
50. Psycholog<strong>is</strong>t noted tha.t there vn.s no diagnos<strong>is</strong> of th<strong>is</strong> from other- providers, but did note remark by one<br />
treating source about "persecution fanta.siesU. MSE noted that affect v,ms some7,vhat fat, mood was generally<br />
irritable arid extreme1:~ suspicious. She ?QIT~S generally oriented, although somevihat d<strong>is</strong>oriented to situation,<br />
rela.ted to delusional system. She had significant thought d<strong>is</strong>turbance, specifically ideas of reference and<br />
persecutory delusions. There TOL~S 110 evidence of perceptual d<strong>is</strong>turbance. Judgment a1x1 insight appeared poor<br />
due to acuity of delusional d<strong>is</strong>order, thus ra<strong>is</strong>ing question about capability. MMSE of 29/30 does not indicate<br />
frank cognitive irnpairrnent. Psycholog<strong>is</strong>t noted that clrnt h8.d read treating counselor's note to d<strong>is</strong>a.bility, no<br />
longer trusted him, and had dropped out of counseliag. Per function report, clrnt resides in shelter, avoids<br />
people in order to avoid "rnclbbing". She reports she tries to stay al$m.ke tto keep an eye on the people in the<br />
shelter clue to concerns ahout rnobbing. She reports she ~fi,vuld not be able to trust refrigerator, does not<br />
prepare meals, But feels she could. She reports she uses public t~'ansporta.tion, shops, marlages finances. She<br />
reports difficulty with memory, concentration, getting a.long with others, but states she can follow instructions<br />
r~rell. She does not do ?$Ell with authority figures. She reports her fears are justified, people are up to things.<br />
The total evide~lce suggests a lengthy rie11ta.l health h<strong>is</strong>tory, with at least one documented serious suidde<br />
a.tternpt and refusal to participate in rrledication treatrrler~t in 200%. Clmt briefly participated in outpatient<br />
psychotherapy just prior to A13L in 2010, with diagnos<strong>is</strong> of MDi3 nith pers<strong>is</strong>tent feature of persecution and<br />
opinion tha.t she 5hms probably too irr~paired to ~mmrk. She apparently traveled to Swden and then relocated ts<br />
Ver~nont follo7,ving th<strong>is</strong>. More r'ecently, she participated in brief ep<strong>is</strong>clde of outpatlent psychothera.py, wth<br />
counselor noting she <strong>is</strong> unable to trust anybodv. Clmt d<strong>is</strong>cussed "rnobblng" there as well, and ~zounselor<br />
offered opinion that cl~rlt 1s not capable of holding dortvn a job in current condition. There <strong>is</strong> no diagnos<strong>is</strong> of<br />
FTSD from acceptable source. Hotever, there are diagnoses of MDD, severe., and Delusional D<strong>is</strong>orcier. Basd on<br />
the available evidence, clmt's persecutory clelusional system appears to have pers<strong>is</strong>ted from kLQD to present.<br />
Cofldition equals 12.03, 2,3. Not capable. Recomnd 18 fnonth dlary.<br />
416 - CASE ANALYSES<br />
Indicate whether th<strong>is</strong> 416-Case .4nalgs<strong>is</strong> <strong>is</strong> for:<br />
Other Period(sj: 11 / 15/2010 - Fresent<br />
Details:<br />
The claimant has no medically determinable irrlpairment.<br />
These findings complete the medical portion of the d<strong>is</strong>ability determination.<br />
MC /PC or SDM Sipnature<br />
Donald Sv,artz, M.D. 12/05/2011<br />
MEDICALLY DETERMINABLE IMPAIRMENTS AND SEVERITY<br />
MEDICALLY DETFRMIN.4BLE IMPAIRMENTS (A4l3I)<br />
- . . . .. .. q.<br />
,, , . . .. . - -
uoes me Inmviaua have one or more memca~~y aeterrmnable lmparments r<br />
< .-rn<br />
?I=;,<br />
IMPAIRME?Tf DIAGNOSIS<br />
2950 - Schizophrenic, Paranoid and Other Functiona.l<br />
Psychotic D<strong>is</strong>orders<br />
2902 - Affective D<strong>is</strong>orders Secondary<br />
SECTERITY<br />
Severe<br />
PSYCHIATRIC REVIEIV TECHNIOLTE (PRT]<br />
PRTl<br />
Indicate whether th<strong>is</strong> Psychiatric Review Technique (PRT) assessment <strong>is</strong> for:<br />
Other Periud(z): 11) 15i2010 - Present<br />
'A' CRITERIA OF THE LISTINGS<br />
12.03-Schizophrenic,Paranoic~,anc~ Other Psychotic D<strong>is</strong>orders<br />
A medically determinable impairment <strong>is</strong> present that does not prec<strong>is</strong>ely sat<strong>is</strong>fy the diagnostic criteria above<br />
12.04-Affective D<strong>is</strong>orders<br />
A nledicallg determinable impairxlent <strong>is</strong> present tha.t does not prec<strong>is</strong>ely sat<strong>is</strong>fy the diagnostic criteria above<br />
'B' CRITERIA OF THE LISTINGS<br />
12.03-Scllizophr~ic,Pa1'a1loid,and Other Psychotic D<strong>is</strong>orders<br />
12.04-Affective D<strong>is</strong>ordefs<br />
Restriction of Activities of Daily Living: Moderate<br />
Difficulties in Maintaining Social Functioning: Mar-Ired<br />
Difficulties in Maintaining Concentration, Pers<strong>is</strong>tence or Pace: B~1ark.ed<br />
Repeated Ep<strong>is</strong>odes of Deconlpensation, Each of Extended Duration: None<br />
PRT - ADDITIONAL JXPLANATION<br />
Delusional Dlsorder and MDD, severe<br />
Not capable<br />
Recommend 18 rnor~th dia.ry<br />
equal 12.03<br />
MC IPC or SDM Sinnature<br />
Ellen Atkns, Ph.D 12107/2011<br />
LISTINGS CONSIDEREI)<br />
L<strong>is</strong>ting Descriation Subsection PRT Assessment
Schizophrenia and Other Psychotic<br />
D<strong>is</strong>orders<br />
Affective D<strong>is</strong>orders<br />
PRT 1<br />
PRT 1<br />
MEDIC.4L DISPOSITION<br />
Medically Equals L<strong>is</strong>ting - The severity of one or more of the MDI(s) medically equals current l<strong>is</strong>ting criteria.<br />
12.03 Schizophrenia and Gther Ps~/chotir, D<strong>is</strong>orders<br />
SYMPTOMS AND CREDIBILITk'<br />
ASSESSMENT OF POLICY ISSCTES<br />
Th<strong>is</strong> section has been considered but does not apply to th<strong>is</strong> claim.<br />
MTEIGHING OF OPINION EVIDENCE<br />
There <strong>is</strong> no indication that there <strong>is</strong> medical or other opinion evidence.<br />
RESIDUAL FUNCTIONAL CAPACITY<br />
hIc, P-FC IIvIR-FC assessments are associated with th<strong>is</strong> claim.<br />
RECONCILING OF SOUFKE OPINION<br />
ASSESSMENT OF POLICY ISSUES - CONTINUED<br />
There 1s no 111dicatlon that there IS oplnlon eolcfence from any source.<br />
DETERMINATION<br />
Based on the documented findings, select the determination:<br />
D<strong>is</strong>abled<br />
~ndicate which of the f ollowillg Acquiescence Rulings are applicable<br />
None of the kRs considered apply to th<strong>is</strong> cla.im<br />
Is there medical evidence of DAN<br />
No medical evidence of DAA<br />
REGULATION BASIS CODE<br />
Regulation Bas<strong>is</strong> Code;<br />
E 1 -2OCFK404.1520~1)-DIE CLP,II\?<br />
Alleged onset date:<br />
11,f15(2010<br />
Enter the establ<strong>is</strong>hed onset date:<br />
llj1512010<br />
Is th<strong>is</strong> a closed period?<br />
No<br />
Diary type and reason code:<br />
Medical 11-nprovernent Expected (MIE) k,
Diary date:<br />
05j0112r313<br />
Assess the individual's capability:<br />
Capability un~'esolvecl.<br />
Review of the followir~g r~~edical evider-~ce suggest@):<br />
Individual <strong>is</strong><br />
Incapable<br />
MC /PC or SDM Signature<br />
Ellen Atpins, Ph.D 12(07(2011<br />
D<strong>is</strong>ability Adjudicator/Examiner Signature:<br />
Bryan Civalier 12/138/2011<br />
?CAT version: 7.1.06
~ ~ -<br />
SCICIAL SECURIlY ADMINISTRATION<br />
1 3EE'IbI.RTlOi.l<br />
2 CDS T3CE<br />
DDs uD0 DRS DUB ll.17~P;X<br />
s51<br />
HUr-JrJ<br />
DANIELLE S GARCIA<br />
PO BOX 1485<br />
BURUNGTON VT 05402<br />
u<br />
5. :lih:EiHC AOC:ESS OF CLAlb:Al.:T ,irc!uda Z li Code,<br />
DISABILITY DETERMINATION AND TRANSMlllAL<br />
5 -1LlPlG ATE<br />
08/29/2011<br />
J SS:,!<br />
5 '!;xE's ~.IF:..IE j~i CC? 3, CWB CL~IM)<br />
~<br />
3 C jP CO? sr D1,'9? C?.AlM)<br />
7 "i3E CLilh,; (-lUe .,I<br />
DIE '2 D\;iB CDE-R CCE-D RDR RD-D RD P-R P-D MQFE<br />
mnu I? oonocln<br />
00<br />
9 DhTE OF 2 s'H<br />
07/30/1970<br />
'2 DISiPIC7-EQrbICH CLFICE ADOFiSS nrl~dc<br />
BURLINGTON DISTRICT OFFIC~.SSA<br />
56 PEARL STREET<br />
BURUNGTON, VT 05401<br />
i3 'PIC;<br />
PD<br />
ZIP Cnca,<br />
hCT13I<br />
FT<br />
DO-I30<br />
CODE<br />
-<br />
'1 'C_\';pI. S<br />
Clmt Phone: 602-683-1138<br />
DDS Rece~ved 09/22/2011<br />
-Ti<br />
D<strong>is</strong>ability<br />
DETERMINATION PURSUANT TO THE SOCIAL SECURITY ACT, AS AMENDED<br />
'5 CLOllAAH 7 jlS23LEC<br />
1:; P?lYiP- 3I.;G~4CSl.~ E73','SYS.<br />
CODE t:C<br />
:EE SICO'l:CF 1 :I;C;VCSIS<br />
12<br />
2950<br />
Dlssbl;t~<br />
a 3rg35 / ll/l5/2010 SCHIzOpHRENLA, pAMNoIA 8<br />
AFFECTNEiMOOD DISORDERS<br />
OTHER PSYCHO~IC DISORDERS<br />
B. [7 Ceased<br />
17 C>l4,9'i 7 iP; ' 8 REASON<br />
CJDE h:>IS ;,:.IE<br />
- .<br />
01<br />
2: '.*:,<br />
012.03C2 F.<br />
??A gH&S/Jb.3 0" t4E I 2DCr Lt!E !S!ZTO, 3:inI cr Yype)<br />
8atecJ !5)@8~0kl<br />
12/08/2011 ELLEN ATKINS, PH.D. 38<br />
I I I<br />
j2Z S?EC CODE<br />
38<br />
CRAIG ANTHONY JARVIS<br />
453 STONE CUTER5 WAY<br />
MONTPELIER VT 05602<br />
I<br />
I<br />
3s E;CI?Y;I:IT:I MULTIPLE<br />
t(3NC6'itCi<br />
35 Bi91S CODE 136 YE+ D l i 137 $5.4 PEF=ECE;4T,hil'>.'E<br />
I I<br />
( SSA 132 DLTi<br />
CODES<br />
CODE<br />
b:Q'iE5i'EBt<br />
Form SSA-831-C3 (5189)<br />
Oper B3C Date 12/08/2011 Case # 0150819 Dec AL [7 DECISION CASE TOhlTROL
JOB SCREENING QUESTJON AIRE<br />
111 11 (~1-1rn%uhum<br />
mloyerr S m A MONICA LIBRARY<br />
mloyee namex DANIELLg S GARCIA CASE NUMBER: 0150819<br />
JOB TITLE:<br />
LIARA~~,' FAGE<br />
1. Name of individual cornplctbg form: JANGT-<br />
2. Work relationship to employee:<br />
3. How long did you work with or observe<br />
4. Why did the employee leave the job?<br />
5. Please rate the individual on the items below:<br />
DATES OF EMPLOYMENT CfN THIS JOB<br />
Generally Could Had Some Had Great Not Applicable<br />
Do Without Difficulty with Difficulty with<br />
Problems jh<strong>is</strong> Function th<strong>is</strong> Function<br />
a. Could learn job duties in expected<br />
amount of time. Comments or<br />
Examples if a problem:<br />
0<br />
b. Accepts instructions and reasonable<br />
critic<strong>is</strong>m. Comments or Example if a<br />
problem:<br />
0<br />
c. Asks questions and requests help.<br />
Comments or Examples if a problem:<br />
17 17 0<br />
. -<br />
d. Has acceptable grooming and dress for<br />
the job. Comments or examples if a<br />
problem:<br />
f7<br />
e. Cooperates with coworkers as required.<br />
'Comments or Examples if a pmblem:<br />
%<br />
0 0<br />
f. Avoids d<strong>is</strong>rupting others. Comments or<br />
examples if a problem:<br />
17 0 0
g. Adapts to work changes such as hours,<br />
equipment, location. Comments or<br />
Examples if a problem:<br />
Generally Coulq 1 IHad *$! 0 (;I 6 FJajXdGreat Not Applicable<br />
Do Without Difficulty with Difficulty with<br />
Probtems th<strong>is</strong> Function th<strong>is</strong> Function<br />
h. Performs repetitious tasks.<br />
Comments or Examples if a problem:<br />
0 0<br />
i. Understands and carries out simple<br />
directions in reasonable amount of time.<br />
Comments or Examples if a problem:<br />
j. Start. work on time. Comments or<br />
Examples if a problem:<br />
k. Has acceptable attendance. Comments<br />
or Examples if a problem:<br />
0 0<br />
1. Understands and follows safety<br />
guidelines. Comments or Examples if a<br />
problem:<br />
rn. Needs ordinary amount of<br />
superv<strong>is</strong>ion and attention.<br />
Comments or Examples if a problem:<br />
CI<br />
a<br />
6. Please provide any other information which you feel would help us evaluate the individual's work activities:<br />
Date *<br />
/g