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Ernesto Azada Mangat v. Michael J. Astrue

April 4, 2013


The opinion of the court was delivered by: Hon. Gonzalo P. Curiel United States District Judge


Plaintiff Ernesto Azada Mangat (hereinafter "Plaintiff") brings this action pursuant to § 405(g) of the Social Security Act (hereinafter "Act") to obtain judicial review and remedy of the final decision of the Commissioner of the Social Security Administration (hereinafter "Defendant") in a claim for disability insurance benefits under Title II of the Act. 42 U.S.C. § 405(g). Before the Court are the parties' cross motions for summary judgment. On January 2, 2013, Magistrate Judge Skomal filed a report and recommendation granting Plaintiff's motion for summary judgment and denying Defendant's motion for summary judgment. (ECF No. 23.) The Magistrate Judge recommended that the matter be remanded to the Commissioner for further proceedings. (Id.) On January 18, 2013, Defendant filed objections to the report and recommendation. (ECF No. 24.) Plaintiff filed a reply to Defendant's objections on February 5, 2013. (ECF No. 26.) Based on the reasoning below, the Court ADOPTS the report and recommendation granting Plaintiff's motion for summary judgment and denying Defendant's motion for summary judgment. The Court REMANDS the matter to the Commissioner of Social Security for further proceedings.


The Magistrate Judge's report and recommendations provides a factual background that is not objected to by the parties. Accordingly, the Court adopts the factual background of the Magistrate Judge and recites them below.*fn1

Plaintiff filed an application for a period of disability and disability insurance benefits on January 22, 2009, alleging disability beginning on December 10, 2008. (Administrative Record ("AR") 18, 41.) Plaintiff's application was based on, but not limited to, insulin-dependent diabetes mellitus, back pain from kidney stones, chest pain and gout. (AR 24, 42.) Plaintiff's application was denied initially and upon reconsideration. (AR 18.) Thereafter, he requested a hearing before an ALJ. (Id.) ALJ Parker held a hearing on November 10, 2010. (Id.) Plaintiff appeared and testified at the hearing, represented by his attorney Harold O. McNeil, Esq. (Id.) John

R. Morse, M.D., a medical expert, and Gloria J. Lasoff, M.A., a vocational expert, also appeared and testified. (Id.)

A. Relevant Medical Records / Diagnoses Submitted to ALJ Prior to Hearing

1. Insulin Dependent Diabetes Mellitus With Mild Sensory Neuropathy

Plaintiff has a ten year history of treatment for diabetes: originally being treated with oral medications, and later, in approximately 2008, being treated with insulin. (AR 337.) Throughout these ten years, Plaintiff "has never been hospitalized for out of control blood sugar . . . ", and has never suffered from diabetic ulcers or lesions. (AR 337, 480.)

Yet, on November 30, 2009 the consultative examiner, ("CE"), Phong T. Dao, D.O., noted that Plaintiff's glucose level was high, and that his blood sugar was not controlled. (AR 341-342.) Further, progress notes from Operation Samahan, a community health clinic, show that, as of April 2, 2010, Plaintiff's diabetes was in fair to poor control with an elevated blood sugar level at 130 mg/dL. (AR 443.) In addition, various medical records evidence that Plaintiff has never complied with his diet restrictions or medication instructions. (AR 231, 246, 264, 268, 280, 281, 387.)

2. Renal Insufficiency

Plaintiff has renal insufficiency. On December 18, 2009, Sharp Chula Vista Medical Center noted that after Plaintiff's bypass surgery his renal symptoms were not significantly changed from before. (AR 363.) Further, medical records from Plaintiff's treating physician, Dr. Elena Maria Bautista-Sacamay ("Dr. Sacamay"), at Balboa Nephrology Medical Group on March 31, 2010 and May 27, 2010, show that although Plaintiff did not require hemodialysus or peritoneal dialysis, Plaintiff received specialty care for his renal insufficiency. (AR 405-413.) Also, lab results from June 9, 2010 and September 25, 2010, establish that Plaintiff's creatinine levels were elevated. (AR 475-476.) Most recently, in a discharge summary from March 3, 2010, Paradise Valley Hospital confirmed Plaintiff's chronic kidney disease, as well as the presence of hematuria (presence of red blood cells) in his urine. (AR 450-451.)

3. Polyarticular Gouty Arthritis ("Gout")

As a consequence of his diabetes, Plaintiff suffers from gout. For example, signs of gout and accompanying pain were evidenced at the outset of Plaintiff's medical records, namely in the Kaiser medical records from March 3, 2008 to October 18, 2008. (AR 236-237.) Specifically, the Kaiser medical records state: (1) on October 9, 2009, "[l]eft hand mild tenderness in his hand with TOM no edema or erythema present," (AR 247), (2) on September 14, 2008, left hand and left finger numb, and wrist pain "likely due to uncontrolled gout," (AR 274, 276), and (3) on December 10, 2008, "[n]umbness and tingling of bilateral feet" but no foot lesions." (AR 280.)

Moreover, on November 30, 2009, the CE noted that Plaintiff "has a history of diabetic peripheral neuropathy [and] [o]n today's examination, his sensation to light touch in the extremities was in tact." (AR 342.) The CE also acknowledged that Plaintiff "has intermittent burning pain in the feet." (AR 338.) Further, Samahan Medical Center noted on February 5, 2010, that Plaintiff suffered from joint swelling with pain for a week. (AR 374.) And, between May 21, 2009 and August 25, 2010, Operation Samahan indicated in its progress notes that Plaintiff complained of: (1) arm swelling on February 5, 2010, (AR 436), (2) right foot and shoulder pain on February 25, 2010, (AR 433), (3) left elbow and right foot pain on April 16, 2010, (AR 429), and (4) left knee swelling on September 16, 2010. (AR 430.)

More recently, on March 3, 2010, the Paradise Valley Hospital stated that Plaintiff was admitted to the Emergency Room in February for polyarthralgias (pain in two or more joints). (AR 450-451.) During his admittance, Plaintiff had an elevated blood cell count and a positive antinuculear antibody ("ANA") test, but negative RH factor. (Id.) A positive ANA test is an indication of an autoimmune disorder. Consequently, Plaintiff was provided a steroid taper, responded positively, and was discharged with referrals for follow-up care. (Id.) Last, in its progress notes from September 3, 2010 to September 25, 2010, Operation Samahan noted that both of Plaintiff's feet were swollen and as a result, Plaintiff suffered from left leg pain. (AR 480-81.)

4. Coronary Artery Disease, Bypass Surgery, and Congestive Heart Failure

Plaintiff has coronary artery disease and underwent three-vessel coronary artery bypass surgery in November 2009. On November 30, 2009, the CE wrote:

The claimant has no history of stroke but he did have a history of myocardial infarction recently, on November 12, 2009. His myocardial infarction was so severe that he had to have a three vessel cardiac bypass. Since the bypass, about two weeks ago, he continues to have midsternal chest pain especially with coughing, sneezing, deep breaths or bending down to pick up objects. The pain can also occur while he is sitting or lying down resting. He can now only walk about one block before getting shortness of breath and experience midsternal chest pain. When pain occurs, he denies any pain radiation and denies any nausea or vomiting. The pain can last anywhere from a few minutes to several hours. He is currently taking pain medication to help with the chest pain.

(AR 338.)

Since the bypass surgery, Plaintiff has experienced intermittent chest pain. For instance, at Sharp Chula Vista Medical Center on December 18, 2009, after bypass surgery, Dr. Ali noted "no shortness in breath or chest pain." (AR 362.) And on March 31, 2010 and May 27, 2010, Dr. Sacamay indicated that Plaintiff "denies chest pain nor [sic] shortness or breath." (AR 405, 408.) Yet, between May 21, 2009 and August 25, 2010, Operation Samahan wrote in its progress notes that Plaintiff complained of chest pain three times. (AR 417, 419, 427.) Moreover, on March 3, 2010, Paradise Valley Hospital's discharge summary stated that Plaintiff was admitted to the Emergency Room for polyarthralgias, but emphasized Plaintiff had an "atypical chest pain episode during his hospital stay." (AR 450-451.)

Last, Dr. Fernandez's progress notes about Plaintiff's recovery from December 31, 2009 to September 14, 2010, noted that Plaintiff (1) recovered but continued to receive follow up care, (AR 464), (2) stabilized, (AR 464), and (3) experienced the occasional chest pain, (AR 464), but his lungs were clear and there were no episodes of arrhythmia. (AR 464-469.)

5. Relevant "Lesser" Diagnoses

Plaintiff has also ...

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