to the couch or may go directly to bed.
Dr. Caputo further observed that the plaintiff had driven herself to the appointment and was on time. Ibid. Dr. Caputo noted that the plaintiff "appeared mildly to moderately lethargic, slouching in a chair, occasionally repositioning herself for comfort. Several times she needed to stand to alleviate pain. She rose slowly but steadily from her chair and her gait was unremarkable." AR 245. The plaintiff's contact with reality was, in Dr. Caputo's assessment, "good." Ibid. The plaintiff "is independent for self-care and needs assistance with domestic chores and maintenance of her business." Ibid. During the examination, the plaintiff was "spontaneous. There were no signs of blocked emotions, pressured speech, or circumlocution. Her conversation was logical, coherent, complex, and abstract." Ibid. Emotionally,the plaintiff "was moderately labile, [became] tearful when asked about her pain, about her family, and about her experiences through the diagnostic process." Ibid. Dr. Caputo wrote that the plaintiff's mood was "depressed, and affect consistent with mood." Ibid.
Finally, Dr. Caputo performed a series of sensory and memory tests. Based on the examination and tests, Dr. Caputo diagnosed "major depressive disorder, single prolonged episode, severe without psychotic features," and "pain disorder associated with both psychological factors and a General Medical Condition." AR at 247. The plaintiff's prognosis, Dr. Caputo opined, was "currently guarded. Involvement with a pain psychologist is strongly recommended....Treatment of insomnia should be considered as much as priority as treatment of pain and depression." Ibid.
On September 13, 2004, Aetna sent the plaintiff's medical records to a