United States District Court, M.D. Pennsylvania
Deborah E. Knoblauch, Plaintiff,
CAROLYN W. COLVIN, ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.
MEMORANDUM Docs. 1, 8, 9, 10, 11, 13, 14, 15
GERALD B. COHN, Magistrate Judge.
I. Procedural Background
On July 16, 2010, Deborah E. Knoblauch ("Plaintiff") protectively filed an application as a claimant for disability insurance benefits, with an alleged disability onset of October 31, 2009. (Administrative Transcript, hereinafter, "Tr." at 12, 83). After Plaintiff's claim was denied at the initial level of administrative review, at Plaintiff's request, on February 4, 2012, an administrative law judge ("ALJ") held a hearing at which Plaintiff, who was represented by an attorney, and a vocational expert ("VE") appeared and testified. (Tr. 55-82). On February 23, 2012, the ALJ found that Plaintiff was not disabled and not entitled to benefits. (Tr. 9-23). On April 18, 2012, Plaintiff filed a request for review with the Appeals Council (Tr. 6-8), which the Appeals Council denied on August 19, 2013, thereby affirming the decision of the ALJ as the "final decision" of the Commissioner. (Tr. 1-3).
On October 18, 2013, Plaintiff filed the above-captioned action pursuant to 42 U.S.C. § 405(g) and pursuant to 42 U.S.C. § 1383(c)(3), to appeal a decision of the Commissioner of the Social Security Administration denying social security benefits. Doc. 1. On March 19, the Commissioner ("Defendant") filed an answer and an administrative transcript of proceedings. Doc. 8, 9. On April 3, 2014, Plaintiff filed a brief in support of the appeal ("Pl. Brief"). Doc. 10. On April 30, 2014, the Court referred this case to the undersigned Magistrate Judge. On May 8, 2014, Defendant filed a brief in response ("Def. Brief"). Doc. 11. Both parties consented to the referral of this case to the undersigned Magistrate Judge, and an order referring the case to the undersigned Magistrate Judge was entered on August 1, 2014. Doc. 13, 14, 15.
II. Relevant Facts in the Record
Plaintiff was born on December 3, 1957, and thus was 54 years old and classified by the regulations as a person closely approaching advanced age through the date of the decision rendered on February 23, 2012. (Tr. 18); 20 C.F.R. § 404.1563(d). Plaintiff graduated high school. (Tr. 18, 130). Plaintiff worked as a weaver in a textile mill for 33 years until the plant closed on April 15, 2009. (Tr. 129-30). On October 8, 2009, Plaintiff completed a ten week course of basic computer, basic math, and basic English. (Tr. 72).
A. Relevant Treatment History and Medical Opinions
1. Hospital Treatment
On October 31, 2009, Plaintiff went to St. Joseph Medical Center emergency room ("ER"). (Tr. 228, 242). Plaintiff reported shortness of breath with ambulation and cold air, as well as a productive cough. (Tr. 242). Plaintiff stated that she was a one-and-a-half pack per day smoker, but that she "has felt so sick that she has only been smoking about a half pack per day." (Tr. 229, 242). On examination, Plaintiff was in moderate respiratory distress, with a productive and loose cough. (Tr. 229). Plaintiff received a breathing treatment, and, within an hour, Plaintiff was speaking easier with no cough. (Tr. 230-31). Within four hours of her arrival at the ER, Plaintiff reported that she was feeling much better. (Tr. 233). Plaintiff was admitted to the hospital for two days. (Tr. 230, 235).
Hospital records indicate that Plaintiff was suffering from acute hypoxemic respiratory failure as well as chronic obstructive pulmonary disease ("COPD") exacerbation. (Tr. 244). Hospital records also indicate that Plaintiff had an extensive 40-year smoking history in which she smoked one to one-and-a-half packs of cigarettes each day; she had never previously been hospitalized for shortness of breath. (Tr. 244, 251). Chest x-rays revealed no active disease, that Plaintiff's heart was normal in size, and that her lung fields were "satisfactorily aerated without evidence of active inflammatory or neoplastic disease." (Tr. 237). Plaintiff received antibiotics, additional nebulizer treatments and Heparin. (Tr. 244).
By the second day, Plaintiff reported to physicians that she "fe[lt] better, " and hospital records indicate that Plaintiff was coughing less, eating fine, and that she was in no acute distress. (Tr. 246). Plaintiff was discharged on November 3, 2009. (Tr. 251). The discharge summary reports that Plaintiff's respiratory failure secondary to COPD exacerbation had been resolved and that Plaintiff had been counseled regarding smoking cessation. (Tr. 251).
On February 24, 2010, Plaintiff returned to the ER for complaints of respiratory distress and shortness of breath. (Tr. 277). Upon examination, Plaintiff was in mild respiratory distress and her lung sounds were diminished. (Tr. 278). After receiving oxygen, Plaintiff reported that she felt much better (Tr. 278). A chest x-ray revealed no active disease in Plaintiff's chest and that her "lung fields [we]re satisfactorily aerated without evidence of active inflammatory or neoplastic disease." (Tr. 284). Plaintiff was not admitted to the hospital and was discharged from the ER within seven hours. (Tr. 282).
On June 7, 2010, Plaintiff was admitted to Schuylkill Medical Center for complaints related to shortness of breath. (Tr. 300). The admission diagnosis was "left lower lobe pneumonia, " "acute exacerbation of COPD, " and "tobacco use disorder." (Tr. 300). A chest x-ray showed "[m]ild diffuse bilateral pulmonary interstitial prominence, which is most likely chronic, without specific evidence of acute cardiopulmonary disease." (Tr. 309). Plaintiff was treated with antibiotics, nebulizers, an anti-inflammatory drug and "her usual medications." (Tr. 301). She was discharged on June 10, 2010. (Tr. 300).
On December 26, 2010, Plaintiff returned to the ER complaining of an asthma attack after going outside into cold air. (Tr. 473). Upon examination, Plaintiff showed no respiratory distress but her lung sounds were diminished. (Tr. 474). Chest x-rays indicated no active disease, Plaintiff's heart appeared normal in size, and her lungs were satisfactorily aerated with no evidence of active inflammatory or neoplastic disease. (Tr. 478). Plaintiff was not admitted to the hospital and was discharged within several hours. (Tr. 474).
2. Harwinder S. Ahluwalia, M.D., Pulmonologist
On March 17, 2010, Dr. Ahluwalia examined Plaintiff for complaints relating to shortness of breath, wheezing, coughing and tightness in her chest. (Tr. 323). Dr. Ahluwalia noted that Plaintiff's "clothes reek[ed] of cigarette smoke, " that Plaintiff started smoking when she was 12, and that she had been smoking one-and-a-half packs of cigarettes every day for the past 40 years. (Tr. 323-24). Dr. Ahluwalia explained that Plaintiff "knows she needs to quit and has been told to quit by every physician that she sees." (Tr. 324). Dr. Ahluwalia noted that Plaintiff had chest pain and tightness in the past year, and that she had a "chronic cough especially first thing in the morning when she awakens." (Tr. 324). Dr. Ahluwalia recommended that Plaintiff discontinue her use of Lisinopril to ease her coughing spells, and "strongly emphasized that she should quit smoking completely"; he noted that "she is not at all motivated to quit smoking at this time." (Tr. 326).
On April 5, 2010, Dr. Ahluwalia again noted that Plaintiff smelled like cigarettes and that she smoked a pack of cigarettes per day. (Tr. 321-22). On examination, Dr. Ahluwalia reported that Plaintiff's coughing spells were less noticeable and that her mild COPD "should not be causing as much symptoms as the patient seems to be having at this time." (Tr. 321-22). On May 5, 2010, Dr. Ahluwalia reported that Plaintiff's coughing spells were less noticeable since she "cut down her use of Lisinopril." (Tr. 319). Moreover, Dr. Ahluwalia reported that although Plaintiff "does tend to cough first thing in the morning... and has to use an inhaler... [a]fter approximately 5 minutes, she does better and does not have as much distress." (Tr. 319). Dr. Ahluwalia stated that Plaintiff continued to report shortness of breath on minimal exertion and explained, "I have suggested once again that she should quit smoking completely as the trachea bronchitis is contributing to her coughing spells and shortness of breath." (Tr. 319-20).
On July 5, 2010, Plaintiff returned to Dr. Ahluwalia, who indicated that Plaintiff had mild COPD, nicotine addiction, and possible bronchial asthma. He also noted that Plaintiff's "PFTs do not reveal significant improvement with inhaled bronchodilators." (Tr. 317). Dr. Ahluwalia reported that Plaintiff's "coughing spells are diminished since she is off the ace-inhibitors. She is currently feeling better." (Tr. 317, 318). Dr. Ahluwalia also noted that Plaintiff was willing to consider quitting ...