United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
CATHERINE D. PERRY, District Judge.
This is an action for judicial review of the Commissioner's decision denying Christine Young's application for disability insurance benefits under Title II of the Act, 42 U.S.C. §§ 401 et seq. Section 205(g) of the Act, 42 U.S.C. §§ 405(g), provides for judicial review of a final decision of the Commissioner. Young claims she is disabled because of lupus, diabetes, fibromyalgia, high blood pressure, high cholesterol, high liver enzymes, and arthritis. Because I find that the decision denying benefits was supported by substantial evidence, I will affirm the decision of the Commissioner.
Young filed her application for benefits on November 11, 2010. She alleges disability beginning April 19, 2009. On August 13, 2012, following a hearing, an ALJ issued a decision that Young was not disabled. The Appeals Council of the Social Security Administration (SSA) denied her request for review on September 3, 2013. Therefore, the decision of the ALJ stands as the final decision of the Commissioner.
Evidence Before the Administrative Law Judge
Application for Benefits
In her application for benefits, Young stated that she was born in 1965 and has a high school education, plus one year of college. (Tr. 129, 163-64). She is 5'2" tall and at the time Young applied for benefits, she weighed 124 pounds. (Tr. 163). However, at the time of the hearing Young weighed 165 pounds. (Tr. 31). In her disability report, Young reported that she stopped working not only because of her condition, but because "the company was doing poorly due to the economy." (Tr. 163). Young also completed an Adult Function Report in conjunction with her application for benefits on December 14, 2010. (Tr. 174). In it, she described her daily activities as getting her children up for school, taking a bath and medication, eating meals, watching television, napping, letting the dog outside, and visiting with her family before going to bed. She takes care of her husband and two children by cooking, doing laundry, and taking them to doctor's appointments. She feeds her pets and lets them outside. Her husband, children, and friends help her cook, clean, do laundry, and go shopping. Young claims that she can no longer work, clean house, shop, drive, do yard work, go for long walks, dance, ride a bike, go to happy hour, host parties, and open jars. She wakes up in pain and with night sweats, and has a hard time lifting her legs, getting out of the tub, and using the bathroom. She makes sandwiches and frozen dinners on her own and full meals with the help of her family. It takes Young about two hours to do one to two loads of laundry and two to three hours to clean one room of the house. Young needs help dusting baseboards, mopping, and scrubbing floors. She goes out one or two times a week, but never alone due to pain and dizzy spells. Her husband usually takes her shopping. Young can pay bills, count change, handle a savings account, and use a checkbook. She reads, attends church weekly, talks on the phone, and visits with friends. Young does not need reminders to go places. Young stated that she gets along with others and follows instructions "very well." She has trouble lifting, squatting, bending, standing, walking, sitting, kneeling, climbing stairs, and using her hands. Young can walk five minutes before needing to rest for 10 minutes. She has a hard time gripping and her hands are always cold and tingly. Young gets along with authority figures and handles stress "very well." Young fears "that I'll never have a normal life and do the things with my children I used to be able to do. Afraid of dying and leaving them alone." (Tr. 174-80).
Young also completed a disability report in conjunction with her appeal on April 4, 2011. In it, she reported having pneumonia and gallbladder surgery since she last completed a disability report. Young also responded affirmatively to the question asking whether she had any new limitations, stating that she was "very depressed." Young reported that she "can handle [her] personal needs." (Tr. 190-97).
Young reported to DePaul Health Center on June 27, 2008, for swelling on her jaw. She thought she had been bitten by a spider. Examination revealed no lymphadenopathy or jugular venous distention, and her chest, heart, abdomen, and extremities were normal. The examining physician, Imran A. Hanafi, M.D., diagnosed Young with local cellulitis and continued her course of antibiotics along with anti-inflammatories. (Tr. 438-39).
On June 28, 2010, Young went to DePaul Health Center complaining of generalized weakness, fatigue, and neck and groin lumps. Young reported weight loss, muscle cramps, night sweats, occasional chest pain and shortness of breath, and tiredness over several months. She noticed lumps on her neck and in her groin the month before. Young denied any diarrhea, constipation, blood in her stool, back pain, neck pain, headache, vision problems, weakness in her extremities, or trouble walking. Physical examination revealed posterior cervical lymphadenopathy with groin lymphadenopathy with bilateral inguinal lymphadenopathy and bilateral axillary lymphadenopathy. A CT of the chest was done which showed bilateral lymphadenopathy and splenic enlargement suggesting lymphoma. The assessment was generalized weakness and muscle cramps with fatigue, generalized lymphadenopathy with night sweats, and splenomegaly. Attending physician Radhika Jaladi, M.D., noted, "Rule out lymphoma. Obtain oncology consultation. Consider lymph node biopsy... Also, check HIV." Dr. Jaladi also assessed leukocytopenia and thromnocytopenia, smoking and alcohol, uncontrolled diabetes mellitus, abnormal liver function tests "likely related to her generalized hemat/oncologic process, " and deep venous thrombosis prophylaxis. (Tr. 253-54). An x-ray of Young's chest taken the same day was normal. (Tr. 248).
The next day Young reported to Giancarlo A. Pillot, M.D., for an oncology consultation. Dr. Pillot was asked to see Young for a lymphadenopathy. Young reported a severe, 100 pound weight loss over the past four to five months, along with decreased energy and easy fatigability. Young denied fevers but claimed she had drenching sweats. Dr. Pillot noted that Young was positive for diabetes, with poor recent control and non-adherence to therapy for financial reasons. Dr. Pillot's examination revealed a small posterior occipital node, shotty cervical lymphadenopathy, a few axilla LN palpable, and firm bilateral groin nodes, one centimeter or less. Otherwise Young's examination was within normal limits. Dr. Pillot assessed lymphadenopathy and an enlarged spleen, with lymphoma as a possible differential diagnosis, as well as inflammatory disorders, and recurrence of cervical and vulvar carcinoma. Dr. Pillot ordered a biopsy of the most accessible lymph node, imaging scans, and tissue diagnosis. (Tr. 250-52).
Young had a follow-up visit with Dr. Pillot on July 8, 2010. She reported still feeling somewhat poorly. Dr. Pillot noted that the biopsy of Young's lymph node revealed only a reactive lymphadenopathy with follicular hyperplasia. Flow cytometry did not note any obvious malignancy or primary hematologic issue. Young's remaining lab results showed nonreactive HIV tests, a normal IgM level, HgbA1c of 13.0, white blood cell count of 3.5, hemoglobin of 12.2, and platelets at 76, 000. Coagulation studies were normal, her uric acid was low, but the hepatitis panel was negative. Her urinalysis showed large amounts of glucose. Dr. Pillot also reviewed Young's imaging tests again and noted gallstones but no obvious mass, a normal ultrasound of the pelvic and transvaginal regions, a normal CT scan of the abdomen, and bilateral axillary lymphadenopathy of the chest. Examination was within normal limits except for shotty lymphadenopathy noted in the axilla and neck. Dr. Pillot determined those lymph nodes were all less than one centimeter in size and fairly mobile. Dr. Pillot concluded that Young had a cluster of symptoms of "unclear etiology." He noted that Young's lymph node biopsy did not support the possibility of lymphoma, and her other scans did not support a recurrence of cervical or vulvar carcinoma either. Dr. Pillot recommended a PET scan to evaluate the character of her lymph nodes and to rule out any obvious bony lesions. He also advised rechecking her CBC, CMP, and LDH to rule out iron, B12, or folate deficiencies, checking her ANA to screen for lupus, and checking her TSH to screen for thyroid disease. The possibility of a bone marrow biopsy was also discussed. Young was advised to make an appointment with her primary care physician and to follow up with him in one week. (Tr. 221-23). Young's ANA test taken the same day was positive at a titre of greater than 1:1, 280 (Tr. 218). Her liver enzymes were also elevated. (Tr. 218).
Young presented to the emergency room at DePaul Health Center on July 25, 2010, for body pain, headaches, nausea, and vomiting. She reported that she had been diagnosed with lupus by Dr. Poetz two weeks ago. Young complained of a sudden onset of lower thoracic and lumbar pain radiating to the right side, with severe and constant cramping. Young's physical examination revealed no tingling, focal weakness, or loss of consciousness, but was positive for myalgias, back pain, nausea, and vomiting. Her examination was otherwise within normal limits. Young was diagnosed with leukopenia, back pain, and diabetes mellitus uncontrolled. (Tr. 330-34). The next day, Young was discharged and had a bone marrow biopsy, which revealed a low white blood cell count, hypercellular marrow with erythroid hyperplasia and dyserythropoiesis, and increased stainable iron. The flow cytometry was negative for lymphoma or acute leukemia. (Tr. 224-26).
On August 5, 2010, Young went back to Dr. Pillot to discuss her test results. Dr. Pillot noted that Young had been to see her primary care physician, but had not yet had an appointment with a rheumatologist. Dr. Pillot reviewed Young's lab data with her, which included the positive ANA test, a negative protein electrophoresis and immunofixation, a polyclonal increase in immunoglobin, a normal T4 and B12, minimally increased TSH, and a mild elevation of liver enzymes. Dr. Pillot also informed Young that her bone marrow biopsy did not reveal any obvious lymphoma, leukemia, myeloma, or obvious myeloproliferative disorder or malignancy, although it did show some degree of dyserythropoiesis and a hypercellular marrow of approximately 95%. Young's physical examination was generally within normal limits, with no change in her musculoskeletal systems and only some shotty lymphadenopathy in the axilla, which appeared less notable and palpable than before. Her back and spine were nontender to percussion and palpation, her extremities showed no edema, erythema, ecchymoses or cyanosis, and her neurologic exam revealed no focal weakness. Dr. Pillot's impression was mild leukopenia and thrombocytopenia in the setting of lymph nodes and slight elevation of the spleen, positive ANA, and "multiple other medical issues as noted." Dr. Pillot believed that Young's positive ANA test suggested that she had a rheumatologic disorder, although he still considered myelodysplasia a possible diagnosis. He suggested a follow-up visit in a couple of weeks. (Tr. 218-20).
Young saw Dr. Poetz on July 23, 2010, and August 23, 2010, for pain in her back and legs, fingertips turning blue and white, vomiting, loss of appetite, nausea, diarrhea, fatigue, heartburn, and sleeplessness. It was noted on her records that she was diagnosed with lupus on July 10, 2010, and that she was awaiting examination by a rheumatologist. (Tr. 418-19).
On September 16, 2010, Young went to Barnes Jewish Hospital complaining of severe diarrhea and pain. Young reported a throbbing headache, slurred speech, nausea, vomiting, diarrhea, loose stool with blood, and "smelling tin." Her diagnosis of lupus was noted as "questionable." Physical examination upon admission revealed two palpable lymph nodes in the right neck, a soft abdomen with normal bowel sounds, some tenderness on the ankles and knees but no swelling, effusion, or erythema at the joints, and multiple bruise-like lesions on her thighs, buttocks, and left elbow. She had no neurological deficits, was intact to light touch, had a normal gait and motor strength, and good insight and judgment. Extensive lab work was ordered, and the CT scan of the chest, abdomen, and pelvic region was remarkable for enhancing, enlarged bilateral axillary lymph nodes. In her discharge summary, Benjamin Voss, M.D., elaborated on Young's questionable lupus diagnosis by stating that her multiple symptoms were thought to fit several different processes. For this reason, Young was advised to follow up with the rheumatology clinic to discuss a diagnosis and treatment options. However, it was noted that Young's symptoms improved during her hospital stay. Her pain was alleviated by Percocet. Dr. Voss prescribed Young lisinopril, Zocor, insulin, and Percocet and instructed her to follow a diabetic diet. She was discharged on September 23, 2010. (Tr. 280-84).
Young reported to the Washington University rheumatology department on October 13, 2010, as instructed by Dr. Voss for treatment of an autoimmune disease. Young's symptoms were fatigue, weight loss, night sweats, fevers, rash, dry mouth, diabetes, early menopause, headaches, and nausea. It was noted that Young was diagnosed with lupus at DePaul Hospital in June of 2010 "with no lab confirmation of that diagnosis." Physical examination revealed no tenderness in Young's joints, no edema, no palpated lymph nodes, and a reddish brown rash on her upper and lower extremities. Young's tests from her recent hospital stay revealed likely lymphadenopathy. The treating physician, Richa Gupta, M.D., noted that "many of her symptoms are consistent with lupus." Young was prescribed prednisone and advised to return for a follow-up visit in three months. (Tr.310-13).
On October 29, 2010, Young returned to DePaul Health Center for high blood sugars in the 300-500 range. Her physical examination was within normal limits. The attending physician diagnosed Young with hyperglycemia. Young was told to resume her normal dose of Novolog with each meal and discharged the same day. (Tr. 387-403). A liver biopsy performed on November 30, 2010, revealed that Young had chronic grade one hepatitis. (Tr. 320). Another liver biopsy performed December 13, 2010, showed no evidence of autoimmune hepatitis and the presence of lesional tissue, either an adenoma or an FNH. (Tr. 318-19). A CT scan of ...