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Amy Crandall v. Michael J. Astrue

October 5, 2011


The opinion of the court was delivered by: Yohn, J.


Plaintiff, Amy Crandall, seeks judicial review under 42 U.S.C. § 405(g) of the final decision of the Commissioner of Social Security (the "Commissioner") denying her claim for disability insurance benefits under Title II of the Social Security Act (the "Act"). I referred the matter to Magistrate Judge Timothy R. Rice, who submitted a report and recommendation recommending that I affirm the Commissioner's decision to deny plaintiff disability benefits. Plaintiff has filed objections to the report and recommendation. For the following reasons, I will adopt the magistrate judge's report and recommendation and affirm the final decision of the Commissioner.

I. Factual Background

At the time of the decision denying disability benefits, plaintiff Amy Crandall was thirty years old. (R. 81-82.) She has more than a high-school education, speaks English, and worked most recently as a licensed practical nurse. (R. 81.) She lives with her husband and daughter, who was three years old at the time of the hearing. (R. 79.)

Crandall alleges that she became disabled on November 17, 2005, as a result of autonomic nervous system dysfunction ("ANSD")*fn1 and vasodepressor syndrome with labile hypertension.*fn2 (R. 43, 117, 139.) Her medical records show a history of treatment for hypertension and ANSD beginning in 2005. (R. 236-37.) In October of that year, Crandall began seeing her current primary-care physician, Dr. Karen E. Fox. (R. 141-42.) Dr. Fox noted at that time that Crandall had a history of venous insufficiency,*fn3 "trace edema"*fn4 in her legs and hands, and ankle swelling. (R. 226-27.) At a follow-up visit on November 2, 2005, Crandall reported that her legs were tired and hurt but that elevation or Tylenol sometimes provided relief. (R. 225.) Dr. Fox prescribed hydrochlorothiazide*fn5 and ordered an ultrasound of Crandall's legs, which showed no evidence of blood clots. (R. 225, 229.) Crandall also underwent an electrodiagnostic evaluation of her legs in December 2005 at Dr. Fox's recommendation. (R. 205-06.) The test results were normal. (R. 205.)

In December 2005, Crandall began seeing Dr. Ramesh K. Adiraju, a cardiologist, for leg edema and labile hypertension. (R. 261.) He recorded that Crandall had a history of leg swelling, cramps, numbness, and tingling, but noted "no peripheral edema." (R. 261.) In order to rule out ANSD, Dr. Adiraju ordered an autonomic nervous system ("ANS") test. (R. 261.) The test revealed "evidence of parasympathetic abnormality, which was very mild." (R. 256.) On the basis of these results, Dr. Adiraju switched Crandall from hydrochlorothiazade to Coreg.*fn6 (R. 256.)

Dr. Adiraju continued to monitor Crandall throughout 2006 and noted her improvement with treatment on several occasions. In April, Dr. Adiraju wrote that "[r]epeat ANS tests show significant improvement," and in May, he noted "stable and improved ANS status." (R. 250-51.) In July, Dr. Adiraju added Elavil*fn7 and ProAmatine*fn8 to Crandall's medications in response to continued leg cramps and fatigue and the results of an additional ANS test. (R. 248.) In October, Dr. Adiraju observed that "leg edema is completely resolved on ProAmatine." (R. 241.) By November, Crandall's ANS test showed "mild paradoxic parasympathetic activity but improved parameters." (R. 242.)

Crandall's medical records from 2007 catalog her continued symptoms and complaints despite improvement in her test results. In January 2007, Dr. Adiraju wrote that Crandall's leg cramps had "significantly improved" and that he was "encouraged . . . [because] a repeat ANS test in the office [a] couple of weeks ago showed significant improvement." (R. 236.) But Dr. Fox's notes from April 19, 2007, report edema, and Dr. Adiraju recorded symptoms of fatigue, leg swelling, and cramping on May 24, 2007. (R. 218, 235.) An ANS test performed in August 2007 showed "significant improvement," and an ultrasound in September 2007 showed no plaque deposits in the arteries of either of Crandall's legs. (R. 265, 303.) But by November, Crandall again reported experiencing cramps and fatigue, for which Dr. Adiraju recommended circulator boot treatment.*fn9 (R. 264.) These treatments were conducted in October and November 2007, and produced improvement for the first few days followed by the return of pain and edema.

(R. 304.)

II. Procedural Background

Plaintiff filed an application for disability insurance benefits on July 13, 2006. (R. 117-21.) She alleged that she has been disabled since November 17, 2005, because she suffers from ANSD and vasodepressor syndrome with labile hypertension. (R. 139.) In her agency submissions, Crandall reported that her symptoms include shortness of breath; burning, tingling, and swelling of her legs and hands; and pain with extreme temperatures, sitting, standing, or walking continuously for longer than half an hour. She claimed that these symptoms limit her ability to concentrate at times; to drive for longer than half an hour; to climb more than six stairs; to carry more than 20 pounds; to sit, stand, or walk continuously for longer than half an hour at a time; and to sleep through the night. (R. 139, 147-53.) She also claimed that her conditions caused her to be absent from work, work fewer hours, and be let go by her employer. (R. 139.) Elsewhere in her submissions, Crandall described her daily activities as including bathing her daughter; preparing meals for her family; changing her daughter's diapers; playing with her daughter; paying bills; taking out "light" trash; doing household chores such as vacuuming or laundry for half an hour at a time; unloading light groceries from the car; swimming; reading; and watching television. (R. 147-50.)

Dr. Leland Patterson, an agency reviewer, evaluated Crandall's case. (R. 213.) In a report dated August 29, 2006, Dr. Patterson wrote that Crandall "had objective tests confirming autonomic nerve dysfunction." (R. 213.) Nevertheless, he noted that "treatment produced normalization" and concluded that the medical evidence did not support the severity of Crandall's subjective complaints. (R. 213.)

On September 16, 2007, Dr. Adiraju submitted a medical source statement that was considerably more bleak. (R. 266-70.) While characterizing Crandall's prognosis as fair, he nevertheless opined that her condition caused symptoms severe enough to interfere with her concentration frequently; that she could walk three city blocks without rest; she could sit for 45 minutes continuously at one time and stand for 15 minutes; that she could stand less than two hours in an eight-hour workday and sit for about two hours in that time; that she must walk for 15 minutes twice during an eight-hour workday; that she needs one or two unscheduled breaks per shift; that her legs must be elevated during 30% of an eight-hour workday; that she can lift 10 pounds frequently and 50 pounds occasionally; and that her symptoms would cause her to miss three days of work a month. (R. 266-70.)

Crandall's application was denied on August 30, 2006, and she filed a timely request for a hearing on September 29, 2006. (R. 75.) In her appeal form, Crandall noted no change in her condition. (R. 157.)

Plaintiff was represented by counsel at her hearing before the administrative law judge ("ALJ"), which took place on October 2, 2007, and November 28, 2007. (R. 19, 42.) At the hearing, Crandall testified about her daily life and physical limitations. She testified that she is the primary caregiver of her three-year-old daughter because her husband works long hours as a truck driver. (R. 48-49.) On a typical day, Crandall will complete range-of-motion exercises for twenty minutes after waking up; bathe and dress herself and her daughter without resting; make her daughter breakfast; make beds and complete light housework; play with her daughter; take her daughter outdoors; pay bills; make dinner; clean up after meals; elevate her legs at night while watching television; and repeat her range-of-motion exercises before bed. (R. 51-55.) She sometimes has difficulties with these activities and experiences tingling and numbness, which will cause her to stop and rest. (R. 55.) Crandall testified that her mother comes over most days from 11:00 in the morning until 4:00 in the afternoon and helps watch her daughter. (R. 51-52.) Crandall tries to minimize the physical strain of her daily life by making dinner with a Crockpot, using paper dishware, and allowing her daughter to bathe herself and wash her hair under Crandall's supervision. (R. 51-52, 62.) Crandall drives with her daughter locally to run errands and lifts her 41-pound daughter to see herself in the mirror about twice a week, and occasionally takes out the trash. (R. 49-50, 55, 57.) Although she testified that she can drive for 20 minutes, her sister drives when she needs to go grocery shopping. (R. 45, 50.) Her sister also helps with housework on weekends. (R. 51.) On weekends, Crandall will accompany her husband and daughter to a nearby park or to her cousin's house, where she goes swimming. (R. 53, 56.)

Crandall also testified before the ALJ about her medical history, condition, and symptoms. According to Crandall, her edema is not a problem until she walks. (R. 57.) When swelling does occur, she will sit down and elevate her legs for 15 minutes. (R. 58.) She experiences numbness and tingling in her lower legs, feet, and hands throughout her waking hours. (R. 58.) Her medications can cause fatigue and a rapid heartbeat, and decrease her ability to concentrate. (R. 58, 60.) Crandall experiences leg cramps lasting 15 to 20 minutes four or five times a day. (R. 61.) Crandall also testified that her doctor had mentioned the possibility that she may have primary lymphedema, which Crandall opined could lead to elephantitis or require vascular surgery.*fn10 (R. 32-33.)

Marlene Hychalk, Crandall's mother, also testified before the ALJ. (R. 64-69.) Hychalk corroborated Crandall's testimony in many respects; she testified to observing Crandall struggle with heavy housework, to helping Crandall with child care regularly, and to witnessing Crandall's sister help with household cleaning and grocery shopping. (R. 64-69.)

Dr. Brad Rothkopf testified as a medical expert after having reviewed the medical evidence. (R. 21.) He provided the ALJ with an explanation of Crandall's ANSD, diagnostic tests that could have been and had been performed, and possible treatments. (R. 22-25.) He testified that ANSD is not a "listed impairment," and that Crandall's symptoms were not analogous to any listing. (R. 26-27.) He opined that the limitations he would apply for Crandall are "less than the limitations from, from the doctor," and he advised against sitting or standing for six hours at a time. (R. 26, 30.) With respect to Crandall's edema, Dr. Rothkopf testified that the condition would "always come back," but that it is a problem that can be treated and managed. (R. 31.) He also testified that there was nothing in Crandall's medical records to suggest lymphedema or vascular surgery. (R. 33-34.)

Finally, Dr. Carolyn Rutherford testified before the ALJ as a vocational expert. The ALJ inquired about the employment prospects of "an individual of this claimant's age, education and past work history . . . [who] is capable of performing a range of light work that affords the opportunity to sit or stand in 15 to 20-minute [intervals]." (R. 37.) In response to this hypothetical, Dr. Rutherford testified that the individual would not be able to ...

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