Ruppert v. Saul

MARY M. GIORDANO RUPPERT, Plaintiff, v. ANDREW SAUL, Commissioner of the Social Security Administration,¹ Defendant.

Case No. 18-cv-0148 (CKK)

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

January 13, 2020

MEMORANDUM OPINION

Pending before this Court are Plaintiff's [13] Motion for Judgment of Reversal (Pl.'s Mot.) and [13-1] Memorandum in support thereof ("Pl.'s Mem."); Defendant's [14] [Consolidated] Motion for Judgment of Affirmance/Opposition to Motion for Judgment of Reversal and Memorandum in support thereof ("Def.'s Mot."); and Plaintiff's [16] Reply.² Plaintiff Mary M. Giordano Ruppert ("Plaintiff" or "Ms. Ruppert") requests reversal of the decision by the Acting Commissioner of the Social Security Administration ("SSA") to deny Plaintiff disability insurance benefits. Plaintiff alleges that the Administrative Law Judge who issued the decision:

(1) ignored the time off work and time off task required for Ms. Ruppert's required medical treatment; (2) failed to state his specific reasons for deciding that Ms. Ruppert's impairments, alone or in combination, did not meet or medically equal any of the listings in 20 C.F.R. Pt. 404, Subpt. P; (3) failed to find Ms. Ruppert disabled under Listing 4.05 (recurrent arrhythmias) and Listing 12.02 (neurocognitive disorders); (4) misstated the record with regard to the frequency, duration, intensity, and severity of her disablingsymptoms; (5) having significantly misstated Ms. Ruppert's daily activities, was left with only the inaccurate and impermissible, sole rationale that her symptoms were unsupported by objective evidence; (6) failed to explain how he reached his conclusions regarding Ms. Ruppert's residual functional capacity in his question to the vocational expert, including working on a regular and continuing basis; and (7) failed to give controlling weight to the well-supported opinions of four of her treating specialists.

Pl.'s Mot. for Reversal, ECF No. 13, at 1-2 (substituting numbers (1)-(7) above for letters (A)-(G) in the original).

Upon consideration of the pleadings, and for the reasons set forth herein, the undersigned finds that some of Plaintiff's arguments warrant remand of the Defendant's decision. Accordingly, the Court DENIES IN PART AND GRANTS IN PART Plaintiff's Motion for Judgment of Reversal, DENIES Defendant's Motion for Judgment of Affirmance, and REMANDS this matter to the Social Security Administration for further proceedings.

I. Background

Plaintiff Mary M. Giordano Ruppert is a 51-year-old female who resides in Washington, D.C. (Administrative Record ("AR") [10] 50, 78.)³ She was 44 years old on her disability onset date of October 9, 2012. (AR 78.) She has a master's degree in systems engineering, AR 50, and she was a senior associate for a defense contractor — Booz Allen Hamilton — from July 1990 to October of 2012, with a one year break in 2000-2001, when she served as a vice president of public relations in a public relations firm. (AR 50-51.) On March 10, 2014, Plaintiff filed an application for benefits under Title II of the Act, alleging disability due to Postural Orthostatic Tachycardia Syndrome ("POTS"), post-concussive syndrome, migraines, vestibular cognitive deficit, low blood pressure, diabetes insipius, anxiety, depression, neuropathy, and fibromyalgia. (AR 195-196, 229). Prior to an automobile accident in April 2012, where Plaintiff suffered a concussion,Plaintiff had already been diagnosed with POTS, fibromyalgia, and small fiber neuropathy, but she was working with accommodations, including working at home one day a week and undergoing daily 2.5 hour IV saline infusions to stabilize her blood pressure (where the infusions were sometimes administered at her office). (AR 69-71, 1388.) Plaintiff attempted to return to work after the accident; however, by August 2012, her physicians recommended ceasing work due to her worsening symptoms. (AR 1389.) She continued to attempt to work, but after a possible second concussion in October 2012, she ceased working on October 10, 2012. (AR 1389.)

Plaintiff's application was denied initially and upon reconsideration. (AR 78-93, 94-110.) Thereafter, Plaintiff requested an administrative hearing, and United States Administrative Law Judge ("ALJ") Andrew M. Emerson held an administrative hearing, which lasted approximately one hour. (AR 131-133, 45-77.) At the hearing, Plaintiff was represented by a non-attorney representative. ALJ Emerson issued his Decision denying Plaintiff's application. (AR 18-37.) Plaintiff requested a review of ALJ Emerson's decision, but the Appeals Council denied Plaintiff's request for review. (AR 1-7.) As ALJ Emerson's decision constitutes a final agency decision, Plaintiff is entitled to judicial review in this Court under 42 U.S.C. § 405(g).

A. Evidence Before the ALJ

The evidence before ALJ Emerson consisted primarily of: (1) medical records spanning from April 2012 through June 2016, including medical records from doctors who treated Plaintiff and reports from state agency physicians who reviewed her records; (2) earnings records; and (3) Social Security Administration ("SSA") disability reports completed by Plaintiff and her husband. The evidence also included testimony by Plaintiff and by Charlotte Dixon, a vocational expert, during the hearing held by the ALJ.

1. Plaintiff's Medical Records⁴

Plaintiff's medical records spanning April 2012 through December 2013, from an unknown source, indicate a diagnosis of Postural Orthostatic Tachycardia Syndrome ("POTS") and Neurobehavioral Symptoms including pain, nausea, collapse, sudden fatigue with stimuli, difficulty paying attention and remembering things, slowed thinking and brain fog. (AR 391, 393.) Plaintiff was provided IV infusions, speech therapy, physical therapy and acupuncture. (AR 396-408.)⁵

In late October of 2012, after hitting and reinjuring her head twice that month, Plaintiff went to the emergency room and was diagnosed with concussive syndrome and advised to begin brain rest and to start Lorazepam and Prozac. (AR 380, 434, 698-699, 716.) She used Sumatriptan for migraines, but she could not take Lyrica because it caused dizziness. (AR 434, 699.) In November 2012, Plaintiff was advised by Dr. Rhanni N. Herzfeld, a neurologist from the Neurology Center, to schedule an MRI of her brain and cervical spine, as she had severe neck pain, and she was further advised to undergo a formal neuropsychological assessment and an EEG. (AR 330-331.) On October 23, 2012, Plaintiff reported to Dr. Weiss, her primary care physician, who listed her underlying medical conditions as POTS, diabetes and fibromyalgia, and her currentsymptoms as recurrent syncope fatigue, nausea, weakness, migraine, chronic pain, dehydration, recurrent viral infections. He indicated that her disability started on October 10, 2012, and the end date was unknown. (AR 1086.)

Dr. Weiss issued a physician recertification statement on November 27, 2012, wherein he noted that Plaintiff's expected return to work (modified duty) was January 15, 2013. (AR 1085.) Plaintiff was evaluated by Dr. Marilyn Kraus, then-Director of the Concussion Program at Medstar National Rehabilitation Hospital on December 6, 2012, with complaints of fatigue and sleep problems, blurry vision, chest pain and fainting, nausea and incontinence. She reported pain of 5/10 in the back of her head for the previous 7 months. Plaintiff was taking Prozac and Lorazepam. Dr. Kraus noted that Plaintiff was a patient with a complex prior medical history of POTS and diabetes and migraine, who sustained a concussion. Plaintiff was referred to urology and for a balance evaluation/therapy at her physical therapy; she was kept on her medication and prescribed a low dose of Gabapentin. She was scheduled for a follow-up appointment in two weeks. (AR 698-702.)

On December 6 and 7, 2012, Plaintiff was evaluated by Dr. Jessica Clark, neuropsychologist at MedStar, for possible mild traumatic brain injury. Dr. Clark noted that details provided by Plaintiff were consistent with having suffered a concussion due to a car accident in April 2012, but it was unclear whether Plaintiff's reinjury in October 2012 was a second concussive injury. During the period of August through October 2012, Plaintiff experienced a prolonged course of recovery corresponding with work stress. It was noted that Plaintiff's situation was complicated by a pre-injury history of POTS, diabetes and fibromyalgia. Plaintiff was encouraged to rest and build up to a higher activity level gradually; to follow-up with herphysicians regarding her medical issues and with a neuropsychologist who understood the psychological component of her situation; and to try relaxation techniques. (AR 378-383.)

Plaintiff had a December 18, 2012 follow-up visit with Dr. Kraus, where she reported that her mood had improved but her fatigue was still an issue, along with headache, neck pain, nausea and dizziness. Dr. Kraus recommended that Plaintiff stop Prozac and start Sertraline, continue the Gabapentin, obtain an MRI and EEG, and follow-up with her in four weeks. (AR 703-706.) Plaintiff's MRI indicated that she had mild to moderate foraminal stenosis bilaterally, which had not changed from the previous study and mild right foraminal stenosis at C4-C5 with mild unconvertebral joint arthropathy. (AR 329.) Her EEG was normal. (AR 326.)

Dr. Weiss issued a physician recertification statement in January 2013, where he noted that Plaintiff's anticipated return to work (modified duty) was September 1, 2013, and further, that Plaintiff was seeing Dr. Hertzfeld and Dr. Kraus and attending physical therapy. (AR 1084.) Plaintiff followed up with Dr. Kraus on January 17, 2013, and she reported feeling a bit better with her POTS under control unless she overdid her activity level. She had switched from Prozac to Sertraline with an improvement in mood and the Gabapentin was helping with sleep. Plaintiff had a vestibular evaluation and started...