Sarah P. v. Kijakazi

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SARAH P., Plaintiff, v. KILOLO KIJAKAZI, Acting Commissioner, Social Security Administration, Defendant.

No. 1:22-cv-313-MSM

United States District Court, D. Rhode Island

July 21, 2023

MEMORANDUM & ORDER

MARY S. MCELROY, UNITED STATES DISTRICT JUDGE

Sarah P. is a 46-year-old woman who has experienced severe headaches since she suffered a traumatic brain injury at the age of six.^[1] At the age of 14, she passed out at a school dance and woke up in a hospital, having lost the ability to walk and talk as well as her memory. She was hospitalized for three months with what she believed was diagnosed as a major TIA.^[2] (ECF No. 5-2, 48.) In 2019, at the age of 42 she applied for Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”), alleging an onset of disability date of March 29, 2014. Ultimately, after an internal Social Security Administrative denial, the Administrative Law Judge (“ALJ”) denied disability benefits, finding her not disabled. See ALJ Decision, ECF No. 5-2, 15-38.

Sarah's major complaint is that she suffers from debilitating migraine headaches which leave her unable to function for lengthy periods of time several days per week and therefore unable to work.^[3] Explained in more detail below, she testified that she suffers from “[e]xtreme head pain” on average more than 4 times per week (about 18 times per month), lasting two to four hours at a time and requiring her to lie down until the episode passes. (ECF No 5-2, 64-65.) On top of these episodes which she characterized as “migraines,” she experiences frequent milder headaches and, once or twice per month, “really bad” TIAs when she cannot get out of bed. (ECF No. 5-2 76-77.)

Sarah's other physical impediments are many. The ALJ accepted her previous diagnoses of celiac condition, thyroid disorder rheumatoid arthritis, obesity and conjunctivitis.^[4] In addition, she suffers from myriad mental health conditions, including what the ALJ characterized as “severe” bipolar disorder, depressive disorder, anxiety disorder, impulse control disorder, attention deficit hyperactivity disorder, learning disorder, memory loss status post TIA. (ECF No. 5-2, 21.) He acknowledged that these conditions “significantly limit [her] ability to perform basic work activities” but ultimately concluded that while they stopped her from resuming her previous work as a personal attendant, they did not preclude her employment in such jobs as housekeeping cleaner, kitchen helper, hand packer, dining room attendant, and deli cutter. (ECF No. 5-2, 32.) For that reason, the ALJ concluded that Sarah was not disabled.

The ALJ appropriately followed the analytic steps required by his level of review. The five-part process is well-established.

The ALJ must follow five steps in evaluating a claim of disability. See 20 C.F.R. § 404.1520(a). First, if a claimant is working at a substantial gainful activity, the claimant is not disabled. Id. § 404.1520(a)(4)(i). Second, if a claimant does not have any impairment or combination of impairments that significantly limit physical or mental ability to do basic work activities, then the claimant does not have a severe impairment and is not disabled. Id. § 404.1520(a)(4)(ii). Third, if a claimant's impairments meet or equal an impairment listed in 20 C.F.R. Part 404, Appendix 1, the claimant is disabled. Id. § 404.1520(a)(4)(iii). Fourth, if a claimant's impairments do not prevent doing past relevant work, the claimant is not disabled. Id. § 404.1520(a)(4)(iv). Fifth, if a claimant's impairments (considering RFC, age, education and past work) prevent doing other work that exists in the local or national economy, a finding of disabled is warranted. Id. § 404.1520(a)(4)(v). Significantly, the claimant bears the burden of proof at Steps One through Four, but the Commissioner bears the burden at Step Five. Sacilowski v. Saul, 959 F.3d 431, 434 (1st Cir. 2020); Wells v. Barnhart, 267 F.Supp.2d 138, 144 (D. Mass. 2003) (five step process applies to DIB claims).

James F v. Kijakazi, No. C. A. No. 22-230JJM, 2023 WL 3223790, at *2 (D.R.I. May 3, 2023).

In reviewing the record, “[t]he findings of the Commissioner of Social Security as to any fact, if supported by substantial evidence, shall be conclusive....” 42 U.S.C. § 405(g). Questions of law are reviewed de novo. Seavey v. Barnhart, 276 F.3d 1, 9 (1st Cir. 2001) (citing Ward v. Comm'r Soc. Sec., 211 F.3d 652, 655 (1st Cir. 2000)).

Although Sarah testified to many years of suffering from myriad physical and mental health conditions, the most debilitating were her headaches, and it is on that complaint that this Court focuses. Because in the Court's opinion the ALJ may have misunderstood the thrust of Sarah's testimony, and failed to find her disabled as a result, the matter must be remanded for reconsideration.

A close reading of Sarah's testimony, as well as the medical records after the onset date, reveals that she categorized her headaches in three separate types.^[5] The most severe were the migraines, which were described as “hemiplegic migraines.”^[6] Sarah described these episodes as follows: “I can't see. I get little [sic] blurriness in my eyes. I don't feel very good. I feel kind of weak.” “[I have] horrible light sensitivity.” (ECF No. 5-2, 65.) She described having to lie down in a dark room and simply rest until the episode passes, a duration of “two to four hours each.” (ECF No. 5-2, 64-65.) Sarah's migraines are treated by her primary care physician, Dr. Monica Gross, with whom she has been treating for many years, and who she sees four or five times per year. She has been consistently prescribed medication for these migraines but made it clear that while the medication helped, it neither prevented the episodes nor reduced their frequency. (ECF No. 5-2, 64-65.) The claimed frequency of these episodes, in which all she could do was sleep, was consistent with her description to the ALJ that a typical day included a nap, sleeping if she had a migraine. (ECF No. 5-22, 74.)

A second type of headache is what Sarah referred to as “TIA's.” She does not get them very often she testified, perhaps one or two per month, but when she does, “sometimes [she doesn't] get out of bed.” (ECF No. 5-2, 76.) Finally, she gets what she refers to simply as “headaches.” Medical records as far back as December 2, 2014, record her as reporting “complicated migraine[s]” (ECF No. 5-8), as do records from 2016 (ECF 5-12). That she considers these different types of pain is evidenced by the number of records in which she refers to them as either migraines, headaches or TIA's. Eg., records from MedOptions of June 2, 2015, reporting “f/u of migraines, no recent headaches”; records from Kent Hospital ER of Dec. 19, 2018 “patient with a hx of migraines that result in TIA,s [sic] c/o having one last Friday and having a headache x5 days now, that won't go away.” On that day, she reported left-side weakness that resolved after about three hours, leaving a “headache” persisting; that “headache is similar to prior migraines but is lasting much longer than her typical migraine.” She described these different events to Saima Chaudhry, M.D., of the Neurology Foundation at Brown University's Alpert Medical School: “located unilaterally on her head (can alternate sides), is throbbing in quality, and associated with photophobia, phonophobia, nausea, visual aura, and sometimes gets garbled speech with this and other times gets, hemibody weakness (she calls the hemibody weakness plus headaches TIAs.').” These occurred at least three times per week, “triggered by flashing lights, stress, food.” The second type is a “vice-like headache, [with] upper back tightness,” occurring about 12 times per month. (ECF No. 5-14). Sometimes Sarah characterized the different types of head pain by the medication she took for them. Some - the ones that occurred three or four times per week - were “Excedrin migraine[s].” (ECF No. 5-14). Dr. Chaudhry confirmed that Sarah experienced different types of pain:

The patient's clinical symptoms this visit appear consistent with a mixed type headache disorder including chronic migraine headaches with a complex component (unilateral head pain, throbbing in quality, associated with photophobia, nausea, visual auras, garbled speech, and at times hemibody weakness - this is reminiscant [sic] of a hemiplegic migraine and are less frequent per parient [sic]) and tension type head pain (vice like head pain with upper back tenderness).^[7]

Id. Sarah was sometimes imprecise in describing the different types of headaches, but she clearly distinguished between the types: explaining to a provider that she had just started a new migraine medication, she reported, “These headaches don't prevent me from doing things but they are bad; the migraines prevent me from doing things.” She described tension headaches that turned into “overall head pain.” A later note in this series reports that the tension headaches had decreased in number, and the migraines, while continuing, had decreased some. Id.^[8]

The medical records here “'show the existence of a medical impairment . . . which could reasonably be expected to produce the pain . . . alleged . . .'” Avery v Sec'y of Health and Human Serv., 797 F.2d 19, 20-21 (1st Cir. 1986) (quoting 42 U.S.C. § 423(d)(5). The ALJ, however, found, despite Sarah's testimony about suffering migraines which required her to take to her bed for hours at a time, several times per week, that her symptoms were minimal and that her condition was a non-severe” impairment. In doing so, he grouped together and treated as one condition her migraines, her tension headaches, and her stress headaches. He addressed only migraines in his decision, failing to discuss the...