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STELLA M. BLEW v. MICHAEL J. ASTRUE

November 29, 2010

STELLA M. BLEW,
PLAINTIFF,
v.
MICHAEL J. ASTRUE, COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: Sandra M. Snyder United States Magistrate Judge

ORDER REMANDING MATTER TO THE AGENCY FOR FURTHER PROCEEDINGS

Plaintiff Stella M. Blew, proceeding in forma pauperis, by her attorneys, Law Offices of Lawrence D. Rohlfing, seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying her application for disability insurance benefits under Title II of the Social Security Act (42 U.S.C. § 301 et seq.) (the "Act"). The matter is currently before the Court on the parties' cross-briefs, which were submitted, without oral argument, to the Honorable Sandra M. Snyder, United States Magistrate Judge.*fn1 After fully reviewing the record and briefs in this matter, the Court determines that remand is necessary to address Plaintiff's residual functional capacity following her development of heart and circulatory problems during the pendency of her application for benefits.

I. Administrative Record

A. Procedural History

On September 11, 2006, Plaintiff filed protectively for disability insurance benefits, alleging disability beginning September 1, 2004, attributable to lymphedema following breast cancer surgery. AR 9. Her claim was initially denied on October 13, 2006, and upon reconsideration on June 5, 2007. AR 9. On July 24, 2007, Plaintiff filed a timely request for a hearing. AR 9. Plaintiff appeared and testified at a hearing on September 30, 2008. AR 18-35. On December 1, 2008, Administrative Law Judge Michael J. Haubner denied Plaintiff's application. AR 9-15. The Appeals Council denied review on February 6, 2009. AR 1-4. On June 9, 2009, Plaintiff filed a complaint seeking this Court's review (Doc. 1).

B. Factual Background

Plaintiff (born November 11, 1955) is a trained medical receptionist. AR 23-24, 116. A widow, Plaintiff lives with her sister and brother-in-law. AR 24, 96. She has never driven and gets around by public bus or rides from family members. AR 24-25.

For approximately eighteen years, Plaintiff worked full time as a receptionist in a podiatrist's office, performing office and computer work and assisting with surgery and treatments. AR 105, 111. Beginning in 2001, she had a second job as a cook at Wendy's. AR 110, 143. She left both jobs on September 1, 2004, when she was diagnosed with breast cancer and required surgery. AR 110. See Plaintiff's mastectomy surgery and hospitalization records at AR 154-167; 193-202.

On or about September 7, 2004, Plaintiff developed lymphedema in her right hand. AR 110, 168. Lymphedema is "chronic unilateral or bilateral edema of the extremities due to accumulation of interstitial fluid as a result of stasis of lymph, which is secondary to obstruction of lymph vessels or disorders of lymph nodes." Dorland's Illustrated Medical Dictionary at 968 (28th ed. 1994). In Plaintiff's case, the lymph nodes in her right armpit were removed in the course of the mastectomy. AR 110. Since October 2004, Plaintiff has worn a glove and a compression sleeve to minimize swelling of her right arm. AR 110, 124. Plaintiff's medications included furosemide (a diuretic), hydralazine (an antihypertensive), lisinopril (an ACE inhibitor), micardis (a diuretic), nifedipine (a calcium channel blocker), and toprol (a beta-blocker) for high blood pressure; Nexium® (a proton pump inhibitor) for her stomach; and Tylenol with codeine (a narcotic pain reliever) for pain. AR 115.

From January 13 through February 18, 2005, Plaintiff was treated at the Lymphedema Clinic of Community Outpatient Rehabilitation Center. AR 147-153. Treatment included ruling out venous disorders (AR 153) and training Plaintiff to manage her condition with compression and bandaging, massage, exercise, and proper skin care. AR 147-152. Plaintiff's treatment was complicated because a rash caused by her chemotherapy was irritated by the necessary compression bandaging. AR 147. Plaintiff was experiencing pain that may have been caused or aggravated by her chemotherapy, which was then ongoing. AR 147.

Records of Plaintiff's treatment at Chinatown Family Medicine and Midwifery Medical Office, her primary source of medical care, are included at AR 172-192 and AR 327-346. The May 4, 2006 report notes Plaintiff had limited use of her right hand because her hand and arm swelled "all the time." AR 184. The August 21, 2006 record also noted arm and forearm edema. AR 177. See also AR 190, 191.

On November 1, 2006, when Plaintiff completed her adult function report, she lived with her adult daughter. AR 118. Pain and swelling impaired her use of her right arm. AR 123. Nonetheless, Plaintiff cared for her cats and helped with laundry and dusting as needed. AR 119. She sometimes experienced difficulty buttoning her clothes and tying her shoes. AR 119. When the pain was severe, Plaintiff required assistance combing the back of her hair. AR 119. Because of difficulty gripping pots and pans, and sensitivity to heat following her surgery, Plaintiff no longer cooked. AR 120. Plaintiff sat outside and walked to the "little store" sometimes. AR 121. She could walk about four blocks without needing to rest for five or ten minutes. AR 123.

Plaintiff liked to read and watch television, reporting that she did them both well. AR 122. She also read and watched television with her granddaughter daily. AR 122. She had no difficulty following written or spoken instructions, and could manage her own financial affairs by paying bills, counting change, handling a savings account, and using a checkbook or money orders. AR 121, 123.

On January 24, 2007, Dr. Rustom F. Damania prepared a report evaluating Plaintiff for the California Department of Social Services. AR 210-214. He identified Plaintiff's chief complaints as lymphedema of her right hand and arm following her mastectomy and paresthesia of her fingers and feet. AR 210. Paresthesia is "an abnormal touch sensation, such as burning, prickling, or formication [sensation of crawling insects], often in the absence of an external stimulus." Dorland's Illustrated Medical Dictionary at 653, 1234 (28th ed. 1994). Damania noted that Plaintiff's right shoulder was "slightly tender" and that her entire right arm was "slightly swollen." AR 213. Specifically, Plaintiff's left forearm measured 8.4 inches; her right forearm, 8.6 inches. AR 213. Her left upper arm was 9.6 inches; the right was 10.7 inches. AR 213. Damania also noted restriction of the range of motion of Plaintiff's right shoulder and wrist joints as well as reduced motor strength in her right arm. AR 213. Damania provided the following functional assessment:

The patient is a 51-year-old female. The patient should be able to lift and carry 10 pounds occasionally and 10 pounds frequently on the right side. No lifting restrictions on the left side. The patient should be able to stand and walk without restriction. The patient does not require an assistive device for ambulation except for a compression sleeve on the right arm at all times. No postural limitations. Manipulative limitations to frequent movements of the right arm, especially above the level of the right shoulder. No relevant visual or communicative impairments.

No workplace environmental limitations.

AR 214.

In the agency's physical residual capacity assessment, medical consultant I. Ocrant opined that Plaintiff could lift twenty pounds occasionally and 10 pounds frequently; could stand and walk with normal breaks about six hours in an eight-hour workday; could sit with normal breaks about six hours in an eight-hour workday; had limited ability to push and pull with her upper extremities; should never balance, but could climb, stoop, kneel, and crouch frequently; had limited reaching and gross manipulation but unlimited fingering and feeling; and no visual, environmental, or communicative limitations. AR 215-222. Ocrant commented:

As problem is limited to one arm, and the evidence is not sufficient to reduce the [less than sedentary] on basis of pain as [client] manages her money, is not cognitively impaired, and is on less than aggressive pain [prescription], it appear[s] [client] should at most be a light one-arm impairment requiring use of [sedentary vocational] table or PRW. [Functional report] indicates [client] is able to write as it is quite detailed and in her own hand. As I read the MSO was the 10/10 lifting was only for the affected side, and the [left upper extremity] is unrestricted so this is a MDO for Light, not [sedentary]. Accordingly, appears [client] capable of [frequent] basic light handling and fingering on [right upper extremity], so Light [residual functional capacity] is appropriate.

AR 222.

Reports of Plaintiff's follow-up care at Cancer Care Associates appear at AR 223-320 and 324-326. In a report dated March 21, 2007, Plaintiff's treating physician, Dr. Rabia Parveez of noted that Plaintiff "continues to have pain in the right upper extremity because of lymphedema and she wears her sleeves on it." AR 223. Tylenol #3 relieved "bad" right arm pain. AR 223. At her appointment, Plaintiff was experiencing chest pain and shortness of breath. AR 223. Because Parveez could not reach Plaintiff's primary care physician, he sent her to the emergency room. AR 225.

In a second adult function report dated July 20, 2007, Plaintiff reported no changes in her condition. AR 133. She had begun taking allergy medications which caused drowsiness. AR 134. She was able to "care for [her] needs." AR 135.

In an additional report dated March 12, 2008, Parveez noted that Plaintiff had uncontrolled high blood pressure and was recently diagnosed with coronary artery disease. AR 324. Plaintiff's lymphedema continued, requiring her to continue wearing the sleeve. AR 324.

Plaintiff has experienced chronic hypertension since she was eighteen years old. AR 185. Her hypertension is noted as well-controlled or improved at some appointments and elevated, severe, or uncontrolled at others.*fn2 AR 176, 177, 179, 180, 181, 182, 183, 184, 186, 187, 189, 190, 191, 328, 329, 332, 333, 338, 340, 341, 342, 343, 344, 346. In 2008, Plaintiff experienced chest pain which was diagnosed as coronary artery disease. AR 328.

Records of Plaintiff's treatment at University Cardiovascular Center are included in the record at AR 347-482. Following an examination on June 3, 2008, Dr. Usman Javed and Dr. Ralph Wessel noted that Plaintiff ...


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