United States District Court, W.D. Missouri, Central Division
TROY W. ARCHER, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
NANETTE K. LAUGHREY, District Judge.
Plaintiff Troy W. Archer appeals the Commissioner of Social Security's final decision denying his application for disability insurance benefits and supplemental security income. The decision is affirmed.
Archer was born in 1970 and alleges he became disabled beginning April 1, 2008.
A. Medical history and opinion evidence
On March 15, 2011, Archer had an appointment with Nathan Byam, D.O., for complaints of mild chest tightness of gradual onset over the previous three weeks, but left the doctor's office without being seen. Archer returned three days later. He said he had not seen a doctor for over five years, and he requested a referral for occasional chest tightness and shortness of breath. Dr. Byam's physical examination showed no abnormalities.
On May 2, 2011, William Schlegel, D.O., examined Archer for complaints of increased fatigue and occasional chest discomfort with exertion. The physical examination noted no cardiac abnormalities. Dr. Schlegel stated that Archer, who was ten years status-post bypass surgery, "continues to do reasonably well[.]" [Tr. 395, 399, 422, 441.] Dr. Schlegel encouraged Archer to "continue with his present level of activity and continue to pursue lifestyle modifications" and adjusted Archer's medication [Tr. 395, 399, 422, 441.]
Later in May 2011, an echocardiogram showed moderate left ventricular hypertrophy, and a cardiac perfusion study showed findings consistent with ischemia. Dr. Schlegel performed an angiography on June 2, 2011, which showed diffuse coronary artery disease, and a cardiac catheterization. A coronary stent was successfully placed.
At an appointment on June 14, 2011, Dr. Schlegel noted Archer was having difficulty paying for medications and "[w]ants me to get him declared for disability." [Tr. 380, 384, 409.] A physical examination showed no cardiac abnormalities. Dr. Schlegel noted Archer "continue[d] to remain stable without any recurrent angina symptoms, " was "maintaining his usual level of activity[, ] and states he is doing reasonably well." [Tr. 382, 386, 411.] Dr. Schlegel encouraged Archer to increase his activity as tolerated.
Three months after the cardiac catheterization and stent placement, on September 13, 2011, Archer returned to Dr. Schlegel. Archer said he had been out of medication for one month. He reported "no chest pain or discomfort[.]" [Tr. 451.] Physical examination showed no cardiac abnormalities. Dr. Schlegel noted Archer "continue[d] to remain stable without any recurrent angina symptoms[, ]" was "maintaining his usual level of activity and... is doing reasonable well[, ]" and was "without any recurrent symptoms." [Tr. 454.]
Dr. Schlegel completed a cardiac questionnaire form on March 20, 2012. Where asked on the form to identify clinical findings, laboratory and test results to support Archer's diagnoses, Dr. Schlegel stated "[a]ngina whenever I get upset.'" [Tr. 456.] Dr. Schlegel indicated Archer could not perform even "low stress" jobs due to a combination of "low exercise tolerance and easily frustrated[, ]'" and that Archer's cardiac symptoms frequently interfered with attention and concentration. [Tr. 456.] The doctor noted Archer had "occasional chest pain." [Tr. 457.] He also noted Archer had difficulty obtaining medications. The doctor stated Archer could frequently and occasionally lift ten pounds; should avoid all exposure to extreme temperatures, humidity, and pulmonary irritants; and should avoid moderate exposure to hazards, such as machinery and heights. Dr. Schlegel estimated Archer would be absent from work more than four days per month.
Archer returned to Dr. Schlegel in January 2013 with symptoms of recurrent angina. Dr. Schlegel recommended Archer have a stress test and echocardiogram, but Archer refused for financial reasons.
In May 2013, Archer applied for financial assistance through Dr. Schlegel's office and was approved. Archer had a cardiac stress test on May 23, 2013,  which showed findings consistent with ischemia. An echocardiogram on May 29, 2013, showed moderate left ventricular hypertrophy. Following review of this testing, Dr. Schlegel recommended cardiac catheterization, and this procedure was performed the morning of June 5, 2013. Dr. Schlegel's impressions included severe 3-vessel coronary artery disease. Under the "Plans" portion of the report, Dr. Schlegel stated he would order a treadmill stress test, and:
Then, depending on findings, I may consider talking to a surgeon about a redo bypass versus just continued medical management. At this time I do not see any clear indications for actual surgical revascularization again, although I am sure he is having symptoms. Will increase his medications for now. He certainly needs better diabetic and lipid control.
The same day as Archer's cardiac catheterization, at lunchtime after the procedure, Archer "suddenly noted he was not able to feel the left side of his face. [His] condition evolved to left-sided weakness." [Tr. 475.] He was admitted for further assessment and seen by Ahmad Hooshmand, M.D., a neurologist. A chest x-ray showed no acute cardiopulmonary process. [Tr. 476.] An MRI showed "acute mildly hemorrhagic infarction involving the frontal lobe... [and] a small acute lunar infarct involving the left cerebellar hemisphere. ...