United States District Court, W.D. Missouri, Southern Division
NANETTE K. LAUGHREY, District Judge.
Plaintiff Gregory Owens appeals the Commissioner of Social Security's final decision denying his application for disability insurance benefits and supplemental security income. 42 U.S.C. §§ 401, et seq., and 1381, et seq. The Commissioner's decision is reversed for further proceedings.
This appeal arises after a second hearing of Owens' claims by an administrative law judge and second decision denying his claims. After the first hearing and decision in 2011, the Appeals Counsel directed that the ALJ obtain additional evidence; obtain evidence from a medical expert if needed to clarify the nature and severity of Owens' impairments, give further consideration to Owens' maximum RFC during the entire period at issue and provide the rationale with specific references to evidence of record in support of assessed limitations; evaluate treating and nontreating source opinions and explain the weight given such evidence; and obtain supplemental evidence from a vocational expert if necessary. [Tr. 14; 135-137.] The Appeals Council also discussed Owens' treating physicians' opinions and stated that recontact appeared necessary for clarification. [Tr. 22; 135.]
Owens alleges he became disabled beginning December 8, 2009. His impairments include bronchiectasis; asthma; borderline obesity; diabetes mellitus; and a history of leukemia and lower left lung lobectomy. In this appeal, he claims that his impairments result in fatigue requiring him to rest, and the need for frequent medical appointments and treatments, requiring him to be away from the workplace, to such extent that he is not employable.
A. Medical evidence
Owens was born in 1981. When he was 16, he was diagnosed with acute myelogenous leukemia (AML). His treatments included an initial round of extensive chemotherapy and a second one after relapse; bone marrow transplants; and removal of a portion of a lung. Medical records from 1998 to 2003 reflect hospitalizations and treatment for recurrent pneumonia, graft-versus-host disease, recurrent fungal lung infection, ear infections, eye infections, pancreatitis, and bronchitis. Owens also had borderline test results suggesting cystic fibrosis.
In 2009, Owens saw Brian Kim, M.D., three times. Dr. Kim diagnosed recurrent pneumonia and bronchitis with mucus plugging, history of AML in remission, immunocompromised status with steroid usage, and asthmatic bronchitis. Owens had a CT scan of his chest, and Dr. Kim performed a lung procedure to clear mucus.
In 2010, Owens had a pulmonary function study. He was also hospitalized for three days and diagnosed with diabetes, for which he was prescribed insulin. He subsequently had seven doctor appointments that year, relating to diabetes management, recurrent pneumonia, fatigue, and breathing problems. He complained of fatigue. One of his doctor visits was in December 2010 with Kristina Kauffman, D.O., to whom Owens went after his endocrinologist, James Bonucchi, D.O., refused to continue to treat him due to his attempts to qualify for Medicaid. Dr. Kaufman's assessment was uncontrolled diabetes mellitus and chronic obstructive pulmonary disease (COPD).
In 2011, Owens had a total of eleven doctor appointments, the majority with Dr. Kaufman, relating to diabetes management; chronic obstructive pulmonary disease (COPD); follow up for his AML; pneumonia; colitis; recurrent bronchitis due to asthma; atelactic changes in the lower left lobe of the lung; and mucus plugging. He complained of fatigue. Testing included two chest x-rays and an echocardiogram. In 2011, he also had two emergency room visits relating to gallstones, and then had surgery to remove his gallbladder.
In 2012, he had a total of at least 20 doctor visits, almost half with Dr. Kaufman, relating to COPD; bronchiectasis; chronic bronchitis; asthma; upper respiratory infection; acute otitis media and bloody discharge from the ears; sinusitis; pseudomonas; coughing and breathing problems; daily sputum production, often purulent; diabetes management, including issues related to taking steroids; and cystic fibrosis symptoms. He complained of fatigue. Testing included several pulmonary function studies, showing moderate lung disease, sometimes improving and sometimes worsening; a six-minute walk test, showing drop in blood oxygen saturation; and CT scan of his sinuses, showing chronic sinus disease. One of his doctor visits took place in August 2012, with James Hargis, M.D., a pulmonologist, who examined Owens for bronchiectasis and asthma, and performed a pulmonary function test. The doctor opined that Owens has significant asthma, requiring frequent treatment and occasional hospitalizations.
Owens was hospitalized for 11 days in April 2012 for cystic fibrosis exacerbation. During the hospitalization, a CT scan was indicative of cystic fibrosis and possible developing pneumonia. He received aggressive antibiotic therapy and aggressive airway clearance therapy. Tubes were placed in both ears. Results of genetic testing following his hospitalization showed a significantly decreased likelihood of cystic fibrosis, notwithstanding his clinical picture.
In 2013, through August, he had seven doctor visits, including three in February and two in March, relating to cough, diabetes management, and acute sinusitis, among other things. He complained of fatigue. Testing included a pulmonary function study, showing lower limits below normal and restrictive lung pattern. One of Owens' visits was with Uzma Khan, M.D., an endocrinologist, who examined him in March on referral by his primary care doctor, Kristina Kauffman, D.O. Dr. ...