United States District Court, W.D. Pennsylvania
MEMORANDUM OPINION AND ORDER OF COURT
TERRENCE F. McVERRY, District Judge.
Terri Lynn Pryborowski ("Plaintiff"), brought this action pursuant to 42 U.S.C. § 405(g), for judicial review of the final determination of the Commissioner of Social Security ("Commissioner"), which denied her applications for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Subchapter II, 42 U.S.C. §§ 401, et seq ., and Subchapter XVI, 42 U.S.C. § 1381, et seq ., of the Social Security Act ("Act"). This case is before the Court on the parties' cross-motions for summary judgment. The record was thoroughly developed at the administrative level of the proceeding. Each side filed a brief in support of its motion (ECF Nos. 9 and 12), and the Commissioner also filed a reply brief in response to the Plaintiff's motion (ECF No. 15). Accordingly, the matter is ripe for disposition. For the reasons that follow, the Commissioner's motion will be GRANTED, and Plaintiff's motion will be DENIED.
A. Factual Background
Plaintiff was born on August 27, 1971 and was thirty-eight-years-old as of her alleged onset date. (R. 34). Under the Regulations, she is considered a "younger person." 20 C.F.R. §§ 404.1563(c), 416.963(c). Plaintiff earned a high school equivalency diploma through a General Education Development ("GED") program and has past relevant work experience as a potato farm laborer, dishwasher, forklift operator, cleaner, cook, school bus driver, and delivery person for, Comtran, FedEx, and a pizza shop. (R. 35-37). Plaintiff has a twelve-year-old daughter for whom she is the primary caregiver. (R. 34). As needed, Plaintiff does laundry, cleans, shops, and drives a car. (R. 34, 209-13).
Plaintiff alleges disability as of August 7, 2010 due to a cerebral vascular accident ( i.e. , a stroke), and related symptoms such as numbness in her right arm through her hand and fingers, as well as dizzy spells, an inability to sit for long periods of time, and headaches. (R. 35, 37-39, 43, 50). The record reflects that Plaintiff has not engaged in substantial gainful activity since her alleged disability onset date.
1. History of Medical Treatment
In August 2010, Plaintiff presented to UPMC Mercy Hospital with right-sided numbness and underwent diagnostic testing. (R. 267). A CT scan revealed an old lacunar infarct cerebellum, but no acute urticarial infarct or hemorrhage. (R. 268). A MRI showed multiple new embolic strokes. (R. 268). Plaintiff's medical records reflect that she was diagnosed with a left temporal-parietal stroke with residual right hand numbness. (R. 265). Less than a week later, Plaintiff reported that she had no residual symptoms from her stroke. (R. 423).
Later that month, Plaintiff went to the emergency room at UPMC Mercy with complaints of chest pain. (R. 400). She was admitted for testing, and an electrocardiogram (ECG) showed normal sinus rhythm and no abnormalities. (R. 399, 402). Plaintiff refused any further diagnostic testing and became "belligerent" when the emergency department staff attempted to convince her to stay for additional evaluation. (R. 402-03). Moreover, Plaintiff repeatedly demanded discharge and refused to discuss diagnostic and therapeutic measures for coronary artery disease with emergency department staff. (R. 403). Plaintiff was ultimately discharged against medical advice. (R. 403). The attending physician later documented that the etiology of Plaintiff's chest pain was unclear, but that he doubted aortic dissection based on Plaintiff's normal appearance, normal vital signs, her nonfocal neurovascular examination in all four extremities, and the time course that had elapsed since symptom onset. (R. 403). He also doubted pulmonary embolus. (R. 403).
Plaintiff followed up with her primary care physician, Dr. Richard Egan, the next day at which she reported slight clumsiness and a "pins and needles" sensation in her right hand as the only residual side effects of her stroke. (R. 419, 311). Dr. Egan found that Plaintiff had intact sensation, intact motor function, normal station and gait, normal finger to nose test, negative Romberg's test, full orientation, appropriate mood and affect, normal interaction, and good eye contact. (R. 421). Dr. Egan also adjusted Plaintiff's medication at this time. (R. 419-21).
In September 2010, Plaintiff presented herself to the emergency room at UPMC Mercy with acute abdominal pain, where she was diagnosed with acute cholecystitis ( i.e. , gallbladder inflammation) with biliary obstruction with bile duct stone. (R. 348, 356). A laparoscopic cholecystectomy was performed, and Plaintiff was discharged with a two-week heavy lifting restriction. (R. 349, 385-86). The medical records also note that her medications included Coumadin, Lisinopril, Atenolol, and Simvastatin and that she smoked a half-a-pack of cigarettes per day. (R. 348).
Later that month, Plaintiff visited Dr. Egan for a follow-up appointment regarding her gallbladder inflammation. (R. 415). The exam showed that she had intact sensation, intact motor function, normal station and gait, full orientation, appropriate mood and affect, normal interaction, and good eye contact. (R. 417).
In October 2010, Plaintiff returned to Dr. Egan with complaints of dizziness and balancing trouble. (R. 410). Dr. Egan noted that she had no new stroke symptoms, intact motor function, normal station and gait, a normal finger to nose test, full orientation, appropriate mood and affect, normal interaction, and good eye contact. (R. 410-12). Dr. Egan also added Meclizine to her medications. (R. 413).
In December 2010, Plaintiff met with Dr. Charles Diederich who performed a consultative examination. (R. 21 n.1, 452-455). The exam showed that while Plaintiff had loss of pinprick sensation on her right forearm, she maintained full strength in all muscle groups, full range of motion, negative straight leg raise tests, normal radial, ulnar, pretibial, and dorsalis pedis pulses, normal deep tendon reflexes, negative Romberg's test, and a normal gait. (R. 454, 458-61). Dr. Diederich did not restrict Plaintiff in lifting, carrying, standing and walking, sitting, pushing and pulling, postural activities, or environmental restrictions, but he did note her impairments with fingering and feeling. (R. 456-57). Dr. Diederich ultimately assessed that Plaintiff's stroke was still recent, that her sensory deficit in her right hand and forearm may improve, and that her strength was normal. (R. 455).
In January 2011, Plaintiff met Dr. Egan for a follow-up examination where she reported on-and-off left trapezious numbness as well as right hand numbness for the past month. (R. 653). Dr. Egan noted that he planned to stop prescribing Plaintiff Coumadin and to switch Plaintiff to an aspirin regimen. (R. 656). At this exam, Plaintiff had intact cranial nerves, intact sensation, intact motor function, normal station and gait, full orientation, appropriate mood and affect, normal interaction, and good eye contact. (R. 655).
In February 2011, Plaintiff returned to the emergency room at UPMC Mercy with complaints of vertigo spells. (R. 802-03). Plaintiff once again refused admission for further evaluation and testing. (R. 803). Plaintiff was discharged after the attending physician contacted Dr. Egan who agreed with the hospital's initial assessment that Plaintiff's symptoms did not represent a stroke. (R. 830, 803).
On March 14 2011, Plaintiff met with Dr. Egan for another follow-up visit at which she reported that her vertigo was going away and that she had no other neurological, cardiac, or respiratory symptoms. (R. 659). Dr. Egan noted that Plaintiff appeared depressed and tearful during the exam due to her boyfriend of four years walking out on her four months ago with no recent contact. (R. 659). The records further reflect that Plaintiff denied any suicidal ideation and that Dr. Egan prescribed her Bupropion. (R. 659, 662). Dr. Egan also found that Plaintiff had full orientation, good eye contact, normal interaction, intact cranial nerves, sensation, motor function, and normal station and gait. (R. 661).
Later that month, on March 18, 2011, Plaintiff presented herself to UPMC Mercy for what was diagnosed as a non-painful, easily reducible ventral hernia. (R. 813). Plaintiff was discharged home in good condition that day. (R. 813). Two days later, Plaintiff presented herself to UPMC for what was diagnosed as gastroenteritis. (R. 808). She was given a liter of saline, 4 mg of Zofran, and 1 mg of Dilaudid, and underwent at CT scan and urinalysis. (R. 807-08). The CT scan was negative, and the urinalysis showed hematuria but no leukocyte esterase or nitrite. (R. 808). Afterward, Plaintiff did not require any further anti-nausea medication or pain medication. (R. 808).
On November 11, 2011, Plaintiff presented to Sharon Regional Health System with numbness of the body. (R. 1132-34). She underwent a CT scan of her head and a MRI of her brain. Neither revealed acute pathology. (R. 1157). Plaintiff also received a carotid ultrasound, which showed carotid artery stenosis. (R. 1163). An ECG revealed Plaintiff had a left ventricle diastolic relaxation abnormality. (R. 1167). Plaintiff's neurological examination, performed by Dr. K. Donald Stoudt and Dr. John Moore, showed that she had full orientation, intact cranial nerves, no sensory changes, no motor weakness, normal reflexes, coordination, and gait, intact cognitive function, and clear speech. (R. 1133-34). A consulting physician, Dr. Robert Salcedo, noted that Plaintiff had a possible transient ischemic attack or simply an anxiety attack because she thought that she was experiencing another stroke. (R. 1158). Dr. Salcedo recommended Plaintiff continue taking baby aspirin, attend physical and occupational therapy, and undergo a speech evaluation. (R. 1158).
The following day, Plaintiff followed-up with Dr. Scott Morgan at the Mercer Clinic. (R. 986). Dr. Morgan noted the lack of objective findings, observing that Plaintiff's minor numbness complaint did not match any neurological ailment. (R. 986). Dr. ...