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Julia A. Oawster v. Michael J. Astrue

September 12, 2011


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



Julia A. Oawster ("Plaintiff") brings this action seeking to overturn the decision of the Commissioner of the Social Security Administration (the "Commissioner") denying her application for disability insurance benefits and Supplemental Security Income ("SSI") benefits. The parties consented to the jurisdiction of the undersigned United States Magistrate Judge, pursuant to 28 U.S.C. § 636(c). For the reasons stated below, the decision of the Agency is AFFIRMED.


Plaintiff filed an application for SSI on July 18, 2003, alleging a disability onset of March 30, 2001, due to diabetes, coronary artery disease, double bypass surgery, spondylolisthesis at L4-5, and a suspicion of breast cancer. (Administrative Record ("AR") 210-19). The agency denied Plaintiff's claim on November 18, 2003. (AR 85-89). On January 12, 2004, Plaintiff requested a hearing before an Administrative Law Judge, which was held on October 21, 2004. (AR 90, 130-65). On January 10, 2005, the ALJ issued an unfavorable decision. (AR 70-84). Plaintiff requested review of the ALJ's decision and the Appeals Council remanded the case for further proceedings on October 20, 2005. (AR 43, 179-80). A second hearing with Administrative Law Judge James Goodman (the "ALJ") was held on February 13, 2007. (AR 41-68). On April 7, 2008, the ALJ issued an unfavorable decision. (AR 20-35). Plaintiff again requested review of the ALJ's decision. (AR 18-19). The Appeals Council denied her request for review on July 15, 2010, and the ALJ's decision became the final decision of the Commissioner. (AR 8-10, 18). Plaintiff's Complaint, filed on September 27, 2010, seeks review of the ALJ's decision denying her disability benefits.


Plaintiff was born on October 31, 1960. (AR 133, 187). Plaintiff is a high school graduate. (AR 133). She previously held certificates as a medical assistant and an emergency medical technician. (Id.). Her application alleges disability beginning on March 30, 2001 due to diabetes, coronary artery disease, double bypass surgery, spondylolisthesis at L4-5, and a suspicion of breast cancer. (AR 211). Plaintiff testified that she worked as a "dispatcher" of ambulances and medical vans for a company now known as "Krippens" since 1984, but stopped working in March of 2001 after she suffered a neck injury in a non-work related car accident. (AR 134-36). Plaintiff stated that "[she] was still willing to come in and work [after the accident]. But a couple days later is when [her employer] decided to lay [her] off." (AR 136). According to Plaintiff, her employer was "downsizing" and, when she told her employer she could not come back in, the employer "laid [Plaintiff] off." (AR 135).

A. Plaintiff's Medical History

1. ALJ Hearings

Plaintiff testified that her heart condition began in October 2002. (AR 136). Although Plaintiff's test results in 2001 were normal, she required bypass surgery on October 24, 2002. (AR 136-37). Plaintiff stated that after the surgery she had "[l]ess chest pain [and it was] easier to breathe." (AR 137). As of the date of her first administrative hearing on October 21, 2004, Plaintiff noted that she continued to have chest pain "[o]nce a week" and it lasted about "a half-an-hour." (Id.). Plaintiff stated that when she felt chest pain and took nitroglycerine the pain "goes away within about 10 minutes." (AR 138). After taking nitroglycerine Plaintiff testified that she "get[s] tired afterward" and "rest[s] for about an hour." (Id.).

A "treadmill test" completed just prior to the first hearing indicated that Plaintiff had "no new blockages" and Plaintiff's doctor "wanted to keep [her] on the nitroglycerine to see if that would keep the chest pains away." (AR 148).

In 2004, Plaintiff stated that she has been diabetic for 14 years and takes "two different insulin tablets." (AR 139). Plaintiff further noted that she suffers from hypothyroidism, but it is controlled with medication. (AR 140). Plaintiff also suffers from elevated cholesterol, but is controlling her cholesterol with diet. (Id.). Further, Plaintiff noted in 2004 that she has neck, shoulder, and lower back pain and suffers from spondylolisthesis. (Id.). Plaintiff testified that the pain "come[s] and go[es]" and that her shoulder pain was monthly, while her neck and lower back pain were daily. (AR 141). Plaintiff took non-prescription Tylenol which gave her some relief. (Id.). Plaintiff stated that she had difficulty sitting and walking when her back pain was severe. (Id.). She noted that she could only walk for about fifteen minutes and also had discomfort when sitting. (AR 141-42). When Plaintiff has back pain, she stated that she has difficulty bending at the waist, so she usually squats down instead. (AR 142). Plaintiff indicated that her shoulders hurt "just about [every] day depending on what . . . [she] tried to lift." (Id.). Plaintiff also takes Tylenol for her shoulder pain. (AR 143).

The medical expert ("ME"), Dr. Thomas Maxwell, present at Plaintiff's first hearing stated that he disagreed with Plaintiff's treating physician, who concluded that Plaintiff is in a permanent state of incapacity. (AR 153). The ME stated:

I just reach a different opinion simply because I don't really have a lot of details as to how they [INAUDIBLE] opinion. So my own opinion based on the record [INAUDIBLE] would be the ability to lift and /or carry both frequently and occasionally 10 pounds, to sit for six hours with the ability to stand at will to relieve discomfort, to stand and/or walk for two hours, and then postural limitations as far as [INAUDIBLE] crouching, crawling, stooping to occasional but no climbing of ladders, ropes, or scaffolds, other climbing to be occasional. And then manipulative limitation as far as reaching overhead in both upper extremities to occasional. And then just environmental as far as excessive exposure to temperature and other things such as humidity and [INAUDIBLE].

(AR 153-54). Dr. Maxwell further noted that no pulmonary function *fn1 tests were completed and that while Plaintiff did have "moderate cardiomegaly" after her surgery, the condition was not ongoing. (AR 154-55).

At the February 13, 2007 hearing, Plaintiff testified that her "physical limitations, [her] heart, [her] back, [her] shoulders, [and] her hands" continued to prevent her from working. (AR 49). Plaintiff noted that if she "exert[s] herself too much by lifting, doing anything heavy, pushing a vacuum sweeper too far, too long, [her] chest starts hurting. It feels like something's sitting on [Plaintiff's] chest." (AR 50). Plaintiff most recently visited the emergency room in August 2006 because her chest pain did not stop after taking nitroglycerin at home. (AR 51). Plaintiff noted that starting six months before the second hearing, her chest pain occurred "monthly" and prior to that period the frequency of her chest pain was "[a]bout every six months." (AR 52). Plaintiff attributed the increased frequency to her performance of more household chores and "stress of the bills." (AR 53).

Plaintiff also noted that after the surgery she "was put on Lipitor to lower [her] cholesterol, and one of the side effects [was] muscle pain and it go to where [Plaintiff] couldn't walk or sit up, and they did an MRI, and they found out that [Plaintiff has] arthritis in [her] lower back." (AR 55). She experiences a "sharp pain" that "radiates down to [her] legs" as a result of the arthritis. (Id.). Plaintiff noted that the severe pain occurs "every three or four days" depending on how much she walks and sits. (Id.). In addition to the severe pain, Plaintiff testified that the symptoms pertaining to her back pain have become worse, and she feels less severe, "like a soreness," pain daily. (AR 56).

Plaintiff also described a "sharp" pain in her left shoulder. (Id.). The symptoms in her left shoulder first arose in 2000. (AR 57). She noted that she has "a torn ligament" in that shoulder. (AR 56). Plaintiff testified that she has limitations reaching with her left arm, reaching out in front of her, to the side, and behind her, as well as reaching overhead. (AR 57). Plaintiff also testified as to having pain emanating from her hands. She "had carpal tunnel surgery in '94 and '95." (AR 58). Plaintiff noted that she underwent two procedures on her left hand, as well as one procedure to her right hand in 1993." (Id.). Additionally, Plaintiff has also been taking insulin, Glucophage and Glyburide, since 2000 for diabetes. (AR 58-59).

Because of the Plaintiff's symptoms resulting from her heart and back, she testified that she requires periods of rest during the day. (AR 59). Plaintiff noted that she lies down, "twice a day," (id.), for "[a]bout an hour." (AR 60). Plaintiff also noted that over the course of the past year, the need to lie down is "more frequent now than what it was." (Id.). Her overall energy levels are "lower than what it used to be" and there are periods of time she feels fatigued. (Id.). Plaintiff testified that "[t]rying to do too much housework, or take care of [her] daughter," cause the fatigue. (Id.). Finally, Plaintiff does not wear a back brace of any sort and attributes a weight loss from 250 pounds at the time of the August 2001 hearing to 180 pounds during the February 2007 hearing to a cut down "on eating, and trying to do a lot more walking." (AR 65).

2. Treatment Records

On her "Disability Report," Plaintiff stated that a car accident in March of 2001 had caused her to stop working. (AR 210-19). As part of her worker's compensation claim, Plaintiff visited Dr. Ralph Steiger in December 2001. (AR 423). At the request of Dr. Steiger, Plaintiff had a magnetic resonance imaging (MRI) scan of her cervical spine and left scapula, which showed a two to three millimeter disc bulge at C5-6 and a normal left scapula. (AR 28, 423-29).

Later, in October 2002, after complaining of chest pains, Plaintiff was referred to Dr. Dandekar at Citrus Valley Medical Center for coronary bypass graft surgery. (AR 301-03, 455-57). By January of 2003, doctors noted that Plaintiff was "Feeling well. Active. Ambulatory. No chest pains." (AR 359). Further reports in April 2003 and July 2003 also confirmed that Plaintiff was feeling well. (AR 346, 355, 357).

In October 2003, Tina Moy, a non-physician State Agency Disability Analyst, reviewed Plaintiff's prior medical records and determined that Plaintiff could lift or carry twenty pounds occasionally, and ten pounds frequently. (AR 223-38). Ms. Moy also concluded that Plaintiff could stand or walk for a total of about six hours in an eight-hour workday. (AR 229-35, 382). Later, in April 2004, Dr. Bhupinder Bains, Plaintiff's treating physician, found Plaintiff incapacitated from work because of coronary artery disease status post coronary artery bypass graft, diabetes mellitus, and hypothyroidism. (AR 420). He also concluded that the date for this incapacity was October 2002, and that this incapacity was permanent. (Id.).

On August 17, 2004, Plaintiff returned to Dr. Gadgil, who had examined Plaintiff before her surgery. (AR 489-91). In contrast to Dr. Bains's findings, Dr. Gadgil determined that Plaintiff's overall cardiac status was "normal" and advised her to continue her current activities and medications. (AR 490). In a later visit to Dr. Gadgil in September 2004, he also noted that Plaintiff's echocardiogram was "unremarkable." (Id.). After Plaintiff underwent a stress test in October 2004, there was no evidence of hemodynamically significant coronary artery disease and no significant perfusion abnormality. (AR 430). It was also discovered in that stress test that Plaintiff had normal left ventricular size, global function, and ejection fraction at rest. (Id.). Further, in January 2005, Dr. Roy Kaku, assessed her as "asymptomatic and hemodynamically stable." (AR 503).

Plaintiff also had an x-ray taken of her lumbar spine after complaining of back pain in May 2003. (AR 552). The x-ray showed very slight anterolisthesis of L5 on S1 with a subtle irregularity suggestive of a pars defect. (AR 28, 552-54). In September 2003, Plaintiff was diagnosed with ...

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