Denise N. v. Saul
| Decision Date | 26 October 2020 |
| Docket Number | CASE NO.: 4:19-CV-121 |
| Court | U.S. District Court — Eastern District of Virginia |
| Parties | DENISE N., Plaintiff, v. ANDREW SAUL, Commissioner of Social Security, Defendant. |
Plaintiff Denise N. ("Plaintiff" or "Denise") seeks judicial review of the decision of the Commissioner of the Social Security Administration ("Commissioner") denying her claim for disability insurance under Title II of the Social Security Act. 42 U.S.C. §§ 401-34. Denise's pro se pleadings raise multiple assignments of error in the decision by the Administrative Law Judge ("ALJ") that heard her claim. Broadly, she claims that the ALJ improperly failed to consider relevant evidence and to apply the appropriate presumptions in her case. Pl.'s Br. (ECF No. 16). This action was referred to the undersigned United States Magistrate Judge pursuant to the provisions of 28 U.S.C. §§ 636(b)(1)(B) and (C), and Rule 72(b)of the Federal Rules of Civil Procedure. For the reasons stated below, this report recommends that the final decision of the Commissioner be affirmed.
On June 2, 2016, Denise filed an application for disability insurance benefits ("DIB"), alleging disability beginning January 1, 2009, due to Human Immunodeficiency Virus ("HIV"), obesity, osteoarthritis, patellofemoral knee syndrome, sarcoidosis, anxiety, depression, sleep apnea, and asthma. (R. 75, 135-41).2 The Commissioner initially denied her application on October 5, 2016 (R. 74-80), and upon reconsideration on March 24, 2017. (R. 81-88). Denise then requested an administrative hearing, which was conducted on August 16, 2018. (R. 41-73).
On October 19, 2018, an ALJ concluded that Denise was not disabled within the meaning of the Social Security Act, and denied her claim for disability benefits. (R. 25-40). The Appeals Council denied review of the ALJ's decision on September 26, 2019 (R. 1-6), thereby making the ALJ's decision the final decision of the Commissioner. Pursuant to 42 U.S.C. § 405(g),Denise filed this action, on December 2, 2019, seeking judicial review of the Commissioner's final decision. This case is now before the Court to resolve the parties' cross-motions for summary judgment.
At the time of her date last insured in 2009, Denise was thirty-six years old, a younger individual under Agency rules. 20 C.F.R. § 404.1563. She had a high school education and past relevant work experience as a janitor. (R. 50, 68).
Although Denise filed her claim in June 2016, she alleged disability beginning January 2009, and her date last insured was March 31, 2009. Thus, to receive DIB Denise had to establish that she experienced disability between these two dates. See 42 U.S.C. § 423(a), (c); 20 C.F.R. §§ 404.101(a), 404.131(a). Despite few medical records related to the relevant time period, the ALJ's detailed review of the medical evidence spans years on both sides of Denise's claimed period of disability.
Medical evidence in the record begins with Denise's treatment by Daniel Kluger, M.D. on March 29, 2004. (R. 908-09). Denise was referred to Dr. Kluger for evaluation of her HIV, which she had been diagnosed with in 1994. Pl.'s Compl.(ECF No. 5, at 1); (R. 908).3 At that time, she was off highly active antiretroviral therapy, but had taken Dideoxycytidine ("DDC") for a short period and was given prescriptions for combination therapy, which she did not fill. (R. 908). Overall, Denise reported feeling well and denied any symptoms of abdominal pain, nausea, vomiting, diarrhea, dysuria, or new skin rashes. (R. 908). Dr. Kluger placed Denise on antiretroviral therapy and followed-up with her two months later, at which point Denise reported she was "100% adherent" to her medications. (R. 909-10). Her HIV was "undetectable" with a viral load4 of less than 50 and a CD45 count of 430. (R. 910). Denise again reported that she was "doing well" and did not complain of any fever, chills, sweats, nausea, vomiting, ordiarrhea. (R. 910).
Dr. Kluger next saw Denise on February 28, 2005 for a follow-up HIV evaluation. (R. 912). Denise complained of "profound fatigue," which Dr. Kluger attributed to anemia. (R. 912). Denise's viral load was less than 50, her CD4 count was 570, and she "had virologic control with highly active antiretroviral therapy." (R. 912). Dr. Kluger issued her a prescription for thrush and noted that Denise's next follow-up should occur in three months. (R. 912). However, Dr. Kluger next saw Denise eight months later on October 5, 2005. (R. 913). During this visit, Denise reported "profound fatigue with weight gain" and incomplete adherence to antiretroviral therapy. (R. 913). Dr. Kluger had a long discussion with Denise about the need for "100% adherence" to medications, and ordered virologic testing and a hold on antiretrovirals. (R. 913).
Denise, who remained off antiretroviral therapy, returned to Dr. Kruger on March 22, 2006. (R. 914). She reported "feeling better" and denied fever, chills, sweats, nausea, vomiting, or diarrhea. (R. 914). Denise's viral load was 32,000 and her CD4 count was 480. (R. 914). Dr. Kluger recommended continuing to hold antiretroviral therapy as Denise's CD4 count was above the 300-350 range. (R. 914). Dr. Kluger next saw Denise in December 2006. (R. 915). Denise denied any additional complaints, but her CD4 count was 400 andshe wanted to restart antiretroviral therapy. (R. 915). Dr. Kluger placed Denise on a new combination of medications. (R. 915). He also instructed her to obtain regular follow-up appointments. (R. 915).
On January 29, 2007, Denise had another appointment with Dr. Kluger who noted that she was "adherent and tolerant to antiretroviral therapy" and ordered virologic testing. (R. 916). Dr. Kluger told Denise to follow-up in three months' time. (R. 916). But Denise did not see Dr. Kluger again until June 2007, at which point she denied fever, chills, sweats, nausea, or vomiting and reported adherence to her antiretroviral therapy. (R. 917). Her viral load quantity was "not sufficient" to note and her CD4 count was 460. (R. 917). On October 15, 2007, Denise returned to Dr. Kluger and stated that she had been nonadherent to her antiretroviral therapy for the past six weeks. (R. 927). She reported "feel[ing] well" aside from recurrent bacterial vaginosis. (R. 927). Her viral load was undetectable as of September 27, 2007 and her CD4 count was 770. (R. 927). Therefore, Dr. Kluger deferred further antiretroviral therapy. (R. 927).
In January 2008, Denise again followed-up with Dr. Kluger. (R. 928). Denise reported "doing well" and denied any symptoms including fever, chills, sweats, nausea, vomiting, or diarrhea. (R. 928). She also continued to have an undetectable viral loadand a CD4 count of 775. (R. 928). As Denise's HIV was under "[i]nnate virologic control," Dr. Kluger again deferred antiretroviral therapy. (R. 928). He ordered repeat virologic testing and told Denise to follow up in four months. (R. 928). On August 27, 2008, Denise reported "feel[ing] well" although she had some modest facial congestion. (R. 929). Her viral load was 12,000 and her CD4 count was 328. (R. 929). Dr. Kluger noted that Denise's HIV was advancing and that they would likely need to begin antiretroviral therapy again. (R. 929). He sent Denise for further lab testing and told her to follow-up in six months. (R. 929).
In April 2009, Denise returned to Dr. Kluger with continuing complaints of right lymph node swelling and weight gain, but denied fever, chills, sweats, nausea, vomiting, and diarrhea. (R. 930). Dr. Kluger noted that Denise remained clinically stable off antiretroviral therapy and ordered repeat virologic testing. (R. 930).
Denise continued to do well in January 2010. (R. 931). Her right lymph node swelling had resolved, and she did not report any fevers, chills, sweats, nausea, vomiting, or diarrhea. (R. 931). Denise's CD4 count was 424. (R. 931). But because Denise was anxious to initiate antiretroviral therapy, Dr. Kluger again prescribed medications and cautioned Denise about the need for complete adherence. (R. 931). OnJune 21, 2010, Denise stated she was "doing well" and tolerating her antiretroviral therapy. (R. 932). Her viral load at this time was less than 48 and her CD4 count was 688. (R. 932). Dr. Kluger assessed "[c]controlled viral replication" and refilled Denise's medications. (R. 932). He also noted that her recurrent bacterial vaginosis was responding to medication and that he "doubt[ed] this [was] directly related to her disease and any component of immunosuppression." (R. 932). In September 2011, May 2012, and November 2012, Denise continued to report adherence, with occasional missed doses, and tolerance to her antiretroviral therapy. (R. 933-35).
As related in the Administrative Record, from 2012 through 2016, Denise was treated for various other medical conditions. In August 2012 Denise was diagnosed with sleep apnea and began using a CPAP. (R. 570-71, 577-78, 674-76, 679-82). During this time, she was also treated for sinusitis, allergies, and asthma, which were managed using medications. (R. 269-71, 386, 419, 424, 434, 538-39, 575-78, 580-81, 651, 655, 659-64, 670-71, 713-14). Additionally, Denise sought treatment for knee pain in 2015 (R. 591-607), as well as treatment for depression and anxiety. (R. 380-81, 392-93, 429-30). Denise also reported shortness of breath after her breast reduction surgery, which medical tests revealed to be suspected sarcoidosis. (R. 244-55, 398-403, 478-80, 489-90).
In connection with her application for benefits, Denise's records were reviewed by two agency physicians, Bert Spetzler, M.D. and Wyatt Beazly, III, M.D. in October 2016 and March 2017 respectively. (R. 79, 87). Dr. Spetzler noted that the evidence in the record was "not sufficient to fully evaluate [Denise's] claim," but that the evidence needed could not be...
To continue reading
Request your trial