United States District Court, Western District of Pennsylvania
NORA BARRY FISCHER, DISTRICT JUDGE
Adriane Tameko Johnson (“Plaintiff”) brings this action under 42 U.S.C. §§ 405(g) and 1383(c), seeking review of the final determination of the Commissioner of Social Security (“Defendant” or “Commissioner”) denying her application for disability insurance benefits (“DIB”) under Title II of the Social Security Act, 42 U.S.C. §§ 401-402 (“the Act”) and supplemental security income (“SSI”) under Title XVI.
II. PROCEDURAL HISTORY
Plaintiff applied for both DIB and SSI on July 30, 2010, claiming an amended disability onset date of February 14, 2009. (R. at 18). Both claims initially were denied on October 14, 2010. (R. at 13, 115, 120). Plaintiff requested an administrative hearing as to the DIB determination on November 24, 2010. (R. at 13, 128). This hearing was conducted on December 2, 2011 in Mars, Pennsylvania at which Plaintiff, represented by Katrine M. Erie, Esq., and an impartial vocational expert testified. (R. at 13).
On June 12, 2012, the Administrative Law Judge (“ALJ”), Brian W. Wood, issued his ruling, which was unfavorable to Plaintiff. (R. at 29). On July 25, 2012, Plaintiff initiated a request for review of the ALJ’s decision regarding DIB to the Appeals Council. (R. at 9). Plaintiff’s attorney also submitted a letter to the Appeals Council, dated October 11, 2012, arguing that the ALJ’s decision should be reversed, and the Council should either remand the case back to the ALJ for further analysis of the record or find the claimant disabled and, therefore, unable to engage in substantial gainful activity. (R. at 263-87). On November 14, 2013, the Appeals Council denied Plaintiff’s request for review, thereby making the decision of the ALJ the Commissioner’s final decision. (R. at 1). Plaintiff filed her Complaint on January 9, 2014. (Docket No. 1). Defendant filed her Answer on April 3, 2014. (Docket No. 4). The parties then filed cross-Motions for Summary Judgment. (Docket Nos. 10, 14). The matter, having been fully briefed (Docket Nos. 11, 15), is now ripe for disposition.
III. STATEMENT OF FACTS
A. General Background
Plaintiff was born on December 20, 1972 and was thirty-eight years old at the time of her administrative hearing. (R. at 45). Plaintiff is not married and lives with her three children. (R. at 47). Her income consists of County assistance and unemployment extension. (Id.). She does not have problems getting along with others, and has never been fired from a job due to problems with coworkers. (R. at 18).
Plaintiff earned a high school diploma. (R. at 48, 252). In October 2009, she began at Sanford-Brown Institute, pursuing an associate’s degree in anesthesia technology, but withdrew in September 2011 due to an excess of absences caused by medical impairments. (R. at 48-49, 252). Plaintiff’s most recent employment was at Holy Cross Hospital in Silver Spring, Maryland, working as a Tech Assistant, until she was terminated in April 2008. (R. at 52-53). This job consisted of setting up for contrast injections, turning over the room for the next procedure, and helping with biopsies. (R. at 53). Previously, Plaintiff held the job of a child care worker from 2000-2002. (R. at 97). From 2001-2002, she was a shipper for Mail Boxes Etc., where she was required to lift more than 50 pounds. (R. at 55, 98, 249). She then worked as a child development teacher for preschoolers at the C.H.I.L.D Center in 2002. (R. at 55, 97, 249). For seven months in 2004, she worked part-time at Holy Cross Hospital as an in-house transporter, a job which entailed moving patients from one place to another. (R. at 54, 98, 249). From 2004-2008, she was a radiology technician at Holy Cross. (Id.).
In her application for DIB and SSI, Plaintiff claimed that she has been unable to work since the amended onset date of February 14, 2009 due to the following health conditions: bilateral carpal tunnel syndrome (CTS),  tendinopathy of the left shoulder, mild degenerative disc disease (DDD) of the thoracic and lumbar regions, chronic otitis externa,  obstructive sleep apnea, Marfan Syndrome,  the residual effects of a thoracic aortic aneurysm with repair, abdominal aortic aneurysm, gastroesophageal reflux disease (GERD), goiter, diabetes mellitus, polycystic ovary syndrome,  hypertension, obesity, and major depression. (R. at 15).
Plaintiff takes care of her children, prepares meals, is able to manage her finances, reads, plays board games, uses a computer, finishes what she starts, and is independent in personal care. (R. at 18, 212-215). Her partner helps out with household chores and caring for Plaintiff’s children. (R. at 75, 78-79). She cannot go outside the home alone, because she gets dizzy and falls. (R. at 215). The dizziness also affects her ability to lift, squat, bend, walk, sit, kneel, climb stairs, and use her hands. (R. at 217). In her Self-Report, Plaintiff described her daily activities as including: getting up at 4:30 a.m. to watch TV; making breakfast for herself and her children; reading a book for school; playing computer games; making lunch for her children; preparing dinner; watching TV; and then going to bed. (R. at 212). She occasionally needs to be reminded to take her medication. (R. at 214). She denied problems with personal care. (R. at 213). Plaintiff reported that she does not handle stress well, but rather shuts down and does not talk. (R. at 218). Furthermore, Plaintiff avers that she can walk “a couple of blocks” before needing to rest for 20 minutes. (R. at 217). Otherwise, Plaintiff reports that her level of social activities has not changed since her alleged disability onset because she “never had any activities.” (Id.).
Plaintiff has developed multiple aneurysms, likely due to Marfan syndrome, which cause chest, back, and stomach pain, daily palpitations, and dizziness. (R. at 252). Plaintiff takes pain medications to cope with the pain. (R. at 59). The Court notes the discrepancies in the record relative to the quantity and frequency of pain medication used by Plaintiff. In her Supplemental Functional Questionnaire, Plaintiff indicated that she does not take pain medicine. (R. at 221). However, in her testimony in front of the ALJ, Plaintiff stated that she “feel[s] addicted to pain medicine.” (R. at 91).
In 1999, Plaintiff went to the emergency room for chest pain where doctors discovered her first thoracic aortic aneurysm. (R. at 726). Plaintiff was five months pregnant, and the aneurysm was stable at that time. (R. at 56-57, 726). Plaintiff lived with the thoracic aortic aneurysm for over ten years, and the pain affected her almost daily. (R. at 58). On a few occasions the pain became so intolerable that she thought her aneurysm was leaking. (Id.). Consequently, she went to the emergency room, where it was determined that it only had slightly grown. (Id.).
In August 2009, Dr. Chris Cook began monitoring the size and growth of the aneurysm. (R. at 22). In September 2011, the thoracic aortic aneurysm grew to 6.5 centimeters, so Dr. Robert Rhee performed an endovascular repair of the descending thoracic aneurysm. (R. at 57, 253, 982). Plaintiff initially reported that she had some back pain after the surgery, but it was under control with pain medication, so she was discharged. (R. at 982). Dr. Rhee completed a follow-up after the aneurysm repair surgery on October 24, 2011 and reported that Plaintiff was doing well with no complications. (R. at 1373). Since having the surgery, Plaintiff has experienced back pain and breathing problems. (R. at 61). She testified that she thinks these problems are due to lying flat on her back for 10 hours and being intubated the entire time. (Id.) She has completed breathing treatments to improve her breathing. (Id.). Plaintiff’s back pain is between her shoulders, and she takes oxycodone approximately four times per week to deal with same. (R. at 62).
Plaintiff’s second aneurysm is a “mild aneurysmal dilation of the abdominal aorta.” (R. at 443-45). Her doctors routinely conduct CAT scans every six months in order to check the size of the aneurysm, but it has not yet grown to an operable size. (R. at 63). In a July 2009, Dr. Iozzi performed a CT of the abdomen with contrast. (R. at 443). The CT showed a mild aneurysmal dilation of the brachiocephalic artery and a mild aneurysmal dilation of the right common iliac artery. (R. at 443-445). Plaintiff’s doctors plan to continue to monitor the size of the aneurysms, but in the meantime, she was prescribed metoprolol to regulate her heart rate. (R. at 65-66).
2. Ear Problems
Plaintiff was diagnosed with acute infection otitis externa and chronic bilateral otitis externa (“swimmer’s ear”), which cause ear pain, minor loss of hearing, itchiness, drainage, infection, dizziness, and MRSA boils. (R. at 254). Plaintiff’s ear problems began in June 2008 after contracting swimmer’s ear at her daughter’s pool party. (R. at 88). Since the pool party, Plaintiff’s chronic ear problems have affected her everyday life by way of requiring daily pain management and preventing her from completing her associate’s degree. (R. at 56, 83). Plaintiff had to miss numerous classes at Sanford-Brown Institute because of pain and doctor’s visits to acquire antibiotics for episodes of boils. (R. at 83-86).
Plaintiff has been treated in the emergency room for her ear pain and drainage. (R. at 85-86). She was admitted to hospitals on the following occasions: Providence Hospital from June 22 through June 26, 2008; Passavant Hospital on December 7, 2008 and September 17, 2009; and Butler Memorial Hospital on December 25, 2009. (R. at 288, 387, 413, 421). Hospital doctors performed ear examinations with an otology binocular microscope, all of which produced normal results, so Plaintiff was discharged with a prescription for antibiotics. (R. at 791, 798, 809, 815). Dr. Mariann McElwain (“Dr. McElwain”) has been the primary doctor treating Plaintiff’s ear problems from 2009-2011. (R. at 21, 455). Dr. McElwain routinely performed ear examinations and provided treatment of Plaintiff, vis-à-vis antibiotics, ear plugs, and follow-up examinations. (R. at 460). Dr. McElwain saw Plaintiff in her office on the following dates: January 2009 (R. at 455); February 2009 (R. at 460); May 2009 (R. at 466); September 2009 (R. at 470); three visits in October 2009 (R. at 474, 478, 482); November 2009 (R. at 486); February 2010 (R. at 505); July 2010 (R. at 513); August 2010 (R. at 517); January 2011 (R. at 789); July 2011 (R. at 782); and August 2011 (R. at 776). According to Dr. McElwain’s records, Plaintiff’s visits to her office have decreased in frequency over the years. (R. at 455-776). At the time of the ALJ hearing, Plaintiff still had ear problems, and she was in the middle of treatment for an abscess that needed to be lanced. (R. at 85). She continues to have flare-ups, sometimes three times per month, during which she experiences tremendous head and ear pain that leave her unable to function. (R. at 83-84).
3. Lung Disease
In November 2010, Plaintiff started seeing Dr. David Rice for obstructive sleep apnea and shortness of breath from activities such as walking up steps. (R. at 275). Dr. Rice examined an abnormal CT scan and diagnosed Plaintiff with probable emphysema. (R. at 726). He was unsure of the exact diagnosis and needed more testing. (R. at 89, 728). Because of Plaintiff’s shortness of breath and emphysema, Dr. Rice strongly recommended that she quit smoking. (R. at 728). Plaintiff had smoked approximately half a pack of cigarettes per day for the last 19 years. (R. at 726). She attempted to quit on numerous occasions, but she claims that she officially quit approximately two weeks before her September 2011 endovascular repair of her descending thoracic aneurysm. (R. at 68-69, 726).
Plaintiff’s brief argues that her serious side effects of chronic lung disease are “shortness of breath and chest pain upon exertion.” (R. at 276). According to Plaintiff’s testimony, her emphysema diagnosis does not cause chest pain or coughing, but she was prescribed an inhaler to help with shortness of breath. (R. at 68, 728-729). She did not have chest pain or shortness of breath during the following doctor’s visits: February 2009; August 2009; September 2009; November 2009; January 2010; April 2010; July 2010; August 2010; and November 2010. (R. at 522-528, 609, 611, 613, 726). Plaintiff claims that her breathing troubles have worsened. (R. at 277). She further alleges that her breathing worsened after the endovascular repair of the descending thoracic aneurysm. (R. at 68). She does not know if it is worse specifically from the surgery or if it is a result of her COPD. (Id.).
Plaintiff’s obstructive sleep apnea has led to insomnia, which she alleges the ALJ failed to mention or even classify as a severe impairment. (R. at 275). Plaintiff uses a Continuous Positive Airway Pressure machine (“CPAP machine”) to help her sleep. (R. at 278). In August 2010, Plaintiff’s Self-Report states that she goes to bed at 12:00 a.m. and wakes up at 4:30 a.m. (R. at 212). During his evaluation in November 2010, Plaintiff reported to Dr. Rice that she sleeps early in the morning until noon and then takes naps throughout the day. (R. at 726). At the ALJ hearing in December 2011, Plaintiff testified that she goes to bed every night at 3:30 a.m. and ...