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Harris v. Astrue

October 20, 2009


The opinion of the court was delivered by: Suzanne H. Segal United States Magistrate Judge



Tanieka L. Harris ("Plaintiff") brings this action seeking to overturn the decision of the Commissioner of the Social Security Administration (hereinafter the "Commissioner" or the "Agency") denying her applications for Supplemental Security Income ("SSI") and Disability Insurance Benefits ("DIB"). The parties consented, pursuant to 28 U.S.C. § 636(c), to the jurisdiction of the undersigned United States Magistrate Judge. For the reasons stated below, the decision of the Commissioner is REVERSED and the action is remanded for further proceedings consistent with this decision.


Plaintiff protectively filed applications for SSI and DIB on May 30, 2006. (Administrative Record ("AR") 8, 34-37, 99-101, 103).*fn1 She alleged a disability onset date of October 1, 2005 (AR 8, 125) due to asthma, headaches, seizures, and side effects from a stroke. (AR 125). The Agency denied Plaintiff's claims for SSI and DIB initially on December 28, 2006. (AR 8, 38-42). This denial was upheld upon reconsideration on April 26, 2007. (AR 8, 44-48).

On August 13, 2008, a hearing was held before Administrative Law Judge ("ALJ") Joseph D. Schloss.*fn2 (AR 18-27). The ALJ denied benefits in a written decision dated October 3, 2008. (AR 5-16). On October 10, 2008, Plaintiff sought review of the unfavorable decision. (AR 4). The Appeals Council declined review on December 11, 2008. (AR 1-3). Plaintiff commenced the instant action on February 4, 2009.


A. Generally

Plaintiff was born on May 30, 1972, and was 36 years old at the time of the hearing. (AR 18, 99, 392). She has three years of college education and past relevant work experience as a rural route carrier. (AR 126, 129).

B. Relevant Medical History

1. Treating Physicians

On September 19, 2000, Plaintiff presented at a Kaiser Permanente clinic with complaints of headaches. (AR 281). She reported that she had taken Vicodin earlier at home but that it did not relieve her pain. (Id.). Dr. Sugimoto noted that a recent MRI of Plaintiff's brain was normal. (Id.). Dr. Sugimoto diagnosed Plaintiff with migraine headaches and prescribed Stadol and Phenergan. (Id.).

On August 19, 2002, Dr. John Sharpe, Plaintiff's primary care physician, treated Plaintiff for complaints of wheezing at night. (AR 327). He diagnosed sinusitis and asthma. (Id.).

On January 8, 2003, Plaintiff presented with complaints of difficulty speaking (i.e., stuttering), headaches on the left side of the head, weakness in the left extremities, and numbness in the left face, arm, and leg. (AR 336). An MRI of the brain and physical and neurological examinations were all normal. (AR 337-39, 341-42). Dr. Thomas Miller, a neurologist, commented that Plaintiff had "suggestion of medication rebound-type headache" and symptoms suggesting a migraine with impaired speech and paresthesia. (AR 341). He opined that Plaintiff should limit her narcotic analgesic medications. (AR 341-42).

On January 17, 2003, Plaintiff reported that her headaches were frequent and that she could not talk properly. (AR 343). Dr. Miller referred Plaintiff for a speech therapy evaluation. (Id.). On June 4, 2003, Dr. Viera Striez, a speech and language pathologist, observed that Plaintiff's scores from the Stuttering Severity Instrument examination suggested a "moderate degree of stuttering." (AR 347). Dr. Striez also noted that Plaintiff had severe facial dystonia, eye blinking, and involuntary facial and throat muscle ticks and twitches during reading and spontaneous speech. (Id.). Dr. Striez recommended that Dr. Miller conduct further evaluation to determine the underlying cause of Plaintiff's facial dystonia and speech dysfluencies. (Id.). On June 11, 2003, Dr. Miller noted that Plaintiff was speaking "better" and that she did "better when she speaks slowly." (AR 348).

On September 8, 2003, Dr. Sharpe referred Plaintiff to Dr. Francisco Torres for neurology consultation. (AR 362). Plaintiff complained of stuttering and chronic headaches. (Id.). Dr. Torres noted that Plaintiff's neurologic examination was normal but that, at times, Plaintiff's speech had a "stuttering quality to it" and that she suffered from a "chronic headache problem." (AR 366).

On September 12, 2003, Dr. Sharpe referred Plaintiff to Dr. Joey Gee for another neurology consultation. (AR 364). Dr. Gee opined that Plaintiff's headaches were "consistent with migraine without aura" and that she had "lots of features in the initial headache secondary to medication overuse." (AR 365). Dr. Gee observed that Plaintiff's headaches transformed into "a daily continued, daily phenomenon headache." (Id.). Dr. Gee recommended that Plaintiff discontinue the use of Robaxin, Flexeril, Propranolol, Elavil, Reglan. (Id.). He further recommended that Plaintiff "taper down" the use of Ambien and "significantly cut down" the use of Vicodin. (Id.). Dr. Gee commented that he hoped that Plaintiff would eventually stop using Vicodin. (Id.). He then prescribed Depakote and Nortriptyline. (Id.). On October 8, 2003, however, Plaintiff reported that she had taken five Vicodin pills that day. (AR 377).

On February 20, 2004, Dr. Gee noted that Plaintiff was still receiving Vicodin and Darvocet. (AR 399). He commented that he wanted Plaintiff to completely discontinue the use of narcotic medications, "as this is only worsening her headache overall, causing rebound." (Id.). Dr. Gee "highly recommended" that Dr. Sharpe "withhold any further prescriptions of the narcotics medications." (Id.). He administered a series of botulinum injections over the course of the next several months to relieve Plaintiff's headaches. (AR 399, 401, 412, 414-17, 421, 423, 426-27).

On April 16, 2004, Plaintiff reported that she suffered a syncopal episode and injured her head and lower back. (AR 402, 406). A CT scan of the brain and x-rays of the back were negative. (AR 405, 408). Dr. Pierre ...

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