The opinion of the court was delivered by: Conti, District Judge
Pending before this court is an appeal from the final decision of the Commissioner of Social Security ("Commissioner" or "defendant") denying the claims of Nora Croyle ("plaintiff" or "claimant") for disability insurance benefits ("DIB") under Title II of the Social Security Act ("SSA"), 42 U.S.C. §§ 423 et. seq. Plaintiff argues that the decision of the administrative law judge (the "ALJ") should be reversed and remanded for further consideration because the ALJ's determination is not supported by substantial evidence. Specifically, plaintiff argues that a remand is warranted because the ALJ misconstrued or ignored relevant evidence of record and based his decision instead on his own speculative inferences. Defendant argues that the decision of the ALJ is supported by substantial evidence and, therefore, should not be reversed and remanded. The parties filed cross-motions for summary judgment pursuant to Rule 56(c) of the Federal Rules of Civil Procedure. The court will deny the motions for summary judgment filed by plaintiff and defendant and the case will be remanded for further proceedings consistent with this opinion.
Plaintiff protectively filed for DIB on August 24, 2004, (R. at 12), claiming that she became disabled and unable to work on May 31, 2000, which was amended to January 2002. (R. at 72, 92, 644). Plaintiff asserted in her application that she became unable to work as a result of the effects of an artery bypass in her leg, clogged arteries and mini-strokes. (R. at 72). Plaintiff's claims were initially denied on October 14, 2005. (R. at 12, 33). A timely written request for a hearing before an administrative law judge was filed by plaintiff, (R. at 7), and a hearing was held on April 24, 2006. (R. at 634). Plaintiff appeared at the hearing with counsel and testified.
(R. at 628-82). A vocational expert (the "VE") also testified at the hearing. (R. at 629).
At the time of the hearing, plaintiff was fifty-nine years old. (R. at 634). She testified that she has a high school education. (Id). She has past relevant work experience as a title clerk and office cleaner. (R. at 639-43). At the time of her application, plaintiff worked part-time as a notary approximately seven hours a day, two days a week. (R. at 72). Plaintiff alleges that she began working as a self-employed notary in 2001, did not work in 2002, and returned to her work in August 2003. (Id.) The VE testified about the availability of positions for an individual with medium exertion, light exertion and a sedentary work level in the national and regional economies. (R. at 672- 78).
The ALJ ordered a consultative examination after the hearing with respect to plaintiff's complaints of pain and weakness in her legs. (R. at 21, 680). A consultative evaluation was performed by Dr. Lloyd Richless in September 2005. (R. at 18). In June 2006, additional consultative examinations were performed by Dr. Anna Mathew and Dr. Eliot Michel. (Id.)
In the decision, dated October 26, 2006, (R. at 12-20), the ALJ determined that plaintiff is not under a disability within the meaning of §§ 216(i) and 223(d) of the SSA. (R. at 20). Plaintiff filed a timely request to review the ALJ's decision, (R. at 7), which the Appeals Council denied on December 7, 2007. (R. at 4). On February 26, 2008, plaintiff filed a complaint seeking judicial review of the ALJ's determination by this court.
Plaintiff's Medical History
Plaintiff's Medical History Pertaining to her Cardiac Complaints Plaintiff was admitted to Mercy Hospital in Pittsburgh, Pennsylvania on January 7, 2002 (R. at 153), after complaints of headaches and tingling in her left upper extremities. (Id.). She was diagnosed with a right carotid stenosis.*fn1 (R. at 158). An angiogram was performed that showed a tight stenosis in the right internal carotid artery. (Id.). A right carotid endarterectomy*fn2 was performed on that date. The records from Mercy Hospital indicate that, after the surgery, plaintiff experienced numbness and heaviness in the left arm. (R. at 153). An examination after the procedure revealed no blood clots or plaques in the right carotid artery. (Id.) A doppler study*fn3 and ultrasound revealed that plaintiff's carotid was normal. (Id.). At the time of her discharge, plaintiff's records indicate that she was stable, had no recurrent symptoms and left arm numbness and heaviness had improved to the point that it was nearly nonexistent. (Id.).
Plaintiff was discharged with instructions to follow up after two weeks with her surgeon, to refrain from smoking and was ordered occupational therapy as an outpatient for her left arm. (Id.) She was prescribed aspirin and plavix and was directed to continue her previous medicines, which included hydrochlorothiazide and Prilosec. (R. at 154-55).
On May 24, 2002, plaintiff was admitted to Mercy Hospital with occlusion (blockage) of the superficial femoral artery on the right side and peripheral vascular disease.*fn4 (R. at 176). Prior to her admission, plaintiff had complaints of severe pain in her left lower extremities. (R. at 309). A femoropopliteal (above the knee) bypass graft of the saphenous vein was performed.
(R. at 178). The records indicate that post-operation plaintiff had a palpable dorsalis pedal pulse*fn5 and that procedure was uneventful. ( R. at 181). Plaintiff had some edema and was directed to elevate her legs and to follow up with her surgeon after a week. (Id.).
On June 4, 2002, plaintiff was seen at Mercy Hospital for an infection in her leg following the May 24, 2002 femoropopliteal bypass. (R. at 183). Plaintiff was diagnosed as having cellulitis in the area of the incision. (Id.) She was admitted to Mercy Hospital for IV antibiotics. (R. at 185). She was discharged on June 10, 2002, with instructions to continue medications, antibiotics and to refrain from lifting anything over ten pounds for two weeks. (R. at 188).
On follow-up examination in August 2002, plaintiff's vascular surgeon, Dr. Villella, noted that plaintiff had a palpable right dorsalis pedis pulse and a strong left femoral pulse. (R. at 308). According to the records, plaintiff had complaints of swelling in her right leg and left hip pain while walking. (Id.). Dr. Villella opined that these conditions were not due to lack of circulation or arterial insufficiency, but more likely due to arthritis. (Id.).
Plaintiff was admitted to the emergency room at Armstrong County Memorial Hospital ("ACMH") on December 21, 2003, with complaint a chief complaint of dizziness. (R. at 199). A CAT scan was performed, which was normal. (Id.) The treating physician's impression was that plaintiff suffered from probable TIA.*fn6 (Id.) He ordered plaintiff to follow up with Dr. Villela. (R. at 205).
On December 30, 2003, plaintiff was admitted to ACMH. (R. at 212). She complained that the symptoms of numbness on her left side, dizziness and slurring of speech sustained after the fem/prop bypass had worsened. (R. at 213). A CT scan of plaintiff's brain was performed on December 21, 2003, for complaints of dizziness. (R. at 207). The results were normal. (Id.). "Her initial cardiac workup was negative." (R. at 213). Her physician questioned whether she suffered from TIA and not "cardiac related symptoms." (R. at 214). CT scans of her head and chest were performed, which were normal. (R. at 230-31). An angiography was also performed and showed no evidence of aneurysms or occluded vessels. (R. at 233). An angiography of the neck performed on December 31, 2003, however, showed a high grade stenosis of the distal common carotid artery and the adjacent carotid blub. (R. at 234). The physician's notes indicate that he did not find this to be significant. (Id.). Doppler samplings were normal. (R. at 238-39). She was given antivert for vertigo and Tylenol for headaches. (R. at 220).
Plaintiff was seen by Dr. Villella on December 31, 2003 while she was in Mercy Hospital regarding her complaints of dizziness. (R. at 244). On January 3, 2004, Dr. Frederick Crock, a cardiologist, examined her. (R at 247). Dr. Crock's impression was that plaintiff had either previous cerebrovascular accident with residual scarring and ischemia or benign positional vertigo. (R. at 248). He prescribed Lisinopril for control of her high blood pressure. (Id.). He wanted her lipid profile checked and to see the results of an echocardiogram. (R. at 248). A doppler study was performed on January 2, 2004, which was normal. (R. at 258-59). A stress test was performed on January 4, 2004, and was also normal. (R. at 260-61).
Plaintiff underwent an echocardiogram on March 12, 2004. (R. at 286). The results of this test were normal. (Id.). Another stress test was performed in May 2005, which was normal and showed no evidence of changes suggesting ischemia. (R. at 473).
Plaintiff was seen at ACMH on March 10, 2006. (R. at 604). On March 28, 2006, plaintiff was treated for "focal high grade stenosis in the proximal right common femoral to popliteal artery bypass graft." (R. at 599). The stenosis was successfully ballooned and dilated "with good angiographic results." (Id.). The records state that there was ...