Rhonda F. v. Saul
| Decision Date | 25 June 2020 |
| Docket Number | C.A. No. 19-401JJM |
| Parties | RHONDA F., Plaintiff, v. ANDREW M. SAUL, COMMISSIONER OF SOCIAL SECURITY, Defendant. |
| Court | U.S. District Court — District of Rhode Island |
REPORT AND RECOMMENDATION
On March 21, 2018, Plaintiff Rhonda F. applied for Disability Insurance Benefits ("DIB") under 42 U.S.C. § 405(g) of the Social Security Act (the "Act"). Her application alleges that an array of physical and mental impairments forced her to leave the work she had done for most of her adult life (as a teaching assistant for the Warwick school system) on October 1, 2017, when she was fifty-one years old; she asserts that she is disabled due to the limiting effects of bilateral carpal tunnel syndrome, rheumatoid arthritis, neuropathy, fibromyalgia, Crohn's disease, GERD, anxiety and depression.
In this Court, Plaintiff has raised a plethora of challenges, but her primary contentions are that (1) the Administrative Law Judge ("ALJ") erred in basing his residual functional capacity ("RFC")1 finding on the opinions of the state agency ("SA") non-examining physicians, Dr. Ricardo Ramirez and Dr. Darrin Campo, because the medical evidence does not support their conclusion that she was capable of medium work with additional limitations; (2) the ALJ erred in rejecting as unpersuasive the opinion of her treating nurse practitioner, Nurse Practitioner JoanneLowney; and (3) the ALJ improperly impugned Plaintiff's character by failing to accept and rely on her subjective statements regarding the severity of her symptoms. Plaintiff has asked the Court to remand the matter for an award of benefits; alternatively, she asks for remand to a different ALJ because, she claims, the incumbent, ALJ Mastrangelo, acted with bias when he "nefarious[ly]" suggested that she was lying. Defendant Andrew M. Saul ("Defendant") has moved for an order affirming the Commissioner's decision. The matter has been referred to me for preliminary review, findings and recommended disposition pursuant to 28 U.S.C. § 636(b)(1)(B).
Having carefully reviewed the record, I find that the ALJ's findings are consistent with applicable law and amply supported by substantial evidence. Accordingly, I recommend that Plaintiff's Motion for Reversal of the Disability Determination of the Commissioner of Social Security (ECF No. 15) be DENIED and Defendant's Motion for Entry of an Order Affirming the Decision of the Commissioner (ECF No. 16) be GRANTED.
Plaintiff's treating medical record is replete with her subjective statements to providers describing severe and disabling symptoms, including burning and stabbing pain in all extremities, feelings of imbalance, hair and weight loss, headaches, fatigue, stiff neck, sustained high fevers, night sweats, chest pain, shortness of breath, leg cramping, difficulty walking due to leg weakness and numbness, anxiety and depression. Some of these complaints were never confirmed by examination; for example, Plaintiff reported a very troubling protracted pattern of high fevers, yet no examining provider ever recorded or observed a fever. Others were contradicted by diagnostic testing or examination. For example, Plaintiff's complaint of legweakness and lower extremity neuropathy was not confirmed by clinical testing; similarly, examination based on Plaintiff's complaint of neck stiffness did not yield any finding of clinically significant stiffness in the neck. Still other complaints suggested conditions that were ruled out by objective testing; these include rheumatoid arthritis, lupus, scleroderma, any other connective tissue disease, Lyme disease and cardiac disease. And others were well founded, resulting in the diagnoses of bilateral carpal tunnel syndrome, anxiety, depression and PTSD that the ALJ found to be severe impairments. The record also reflects that, prior to the period in issue, Plaintiff had been diagnosed with fibromyalgia, Crohn's disease, migraines and GERD. However, for the period in issue, there is limited evidence either to confirm these diagnoses or to reflect treatment related to these impairments. For example, as the ALJ correctly found, fibromyalgia is noted by virtually every treating source as a "past" or "remote" diagnosis; while some questioned or assumed that it potentially was ongoing, no treating source diagnosed it during the period in issue. E.g., Tr. 264 ("Past Medical History" includes fibromyalgia); Tr. 386 (); Tr. 394 (). The ALJ nevertheless accepted it as a non-severe impairment. Tr. 15.
During the hearing, Plaintiff further described her symptoms, including that weakness in her legs causes her to fall at home three times every week; that she has headaches every day that are not migraines; that she also had seventeen migraines in the past month; that she sleeps no more than two hours a night; and that she has severe anxiety. However, some of these complaints are missing from the treating record (e.g., falling three times a week). Tr. 49-50, 53-54. Regarding her capabilities, Plaintiff testified that she cannot sit for more than ten minutes, cannot stand for more than ten to fifteen minutes, cannot lift even a gallon of milk, cannot walkmore than half a block and has stopped driving both because of anxiety and because she often cannot pivot her foot to hit the pedals. Tr. 46-49.
Noting that "complaints alone do not equate to a finding of disability," Tr. 16, the ALJ concluded that, apart from bilateral carpal tunnel syndrome, Plaintiff's many complaints of severe physical symptoms are inconsistent with a medical record containing "[d]iagnostic imaging, radiological studies, and physical examination results [that] have routinely been either mild, moderate, or unremarkable." Tr. 20. Plaintiff's appeal asks this Court to find that this conclusion is tainted by error.
Plaintiff has an associate's degree in special education and worked for twenty years as a teacher's assistant. Tr. 38, 40. Her duties included feeding, toileting, "running after" and restraining disabled children. Tr. 41-43. When she was forty or forty-one, she was diagnosed with fibromyalgia and the larger children became too much for her to monitor; she was switched to working with younger children, which she did until she stopped work on October 1, 2017, when she was fifty-one. Tr. 41-44. As performed in the latter period, this work required the ability to function at least at the medium level of exertion. Tr. 56. After Plaintiff stopped work, she collected temporary disability insurance for a year. Tr. 40.
There are no medical records reflecting Plaintiff's symptoms, diagnoses or treatment leading up to the date (October 1, 2017) of alleged onset when she stopped working. Plaintiff later told the infectious disease specialist (Dr. Hadeel Zainah) that, beginning in June 2017, she had been having headaches and neck stiffness and that she had suffered from fevers up to "102 up to 104" during September, October and into November 2017. Tr. 384. During the hearing, Plaintiff explained that she stopped work because she could no longer restrain children, whichwas an essential function of her job - "I feel it's the fibromyalgia, and the carpal tunnel with the arms, and I just can't walk or run like I used to be able to." Tr. 42-43.
The earliest treating record is from Nurse Practitioner Lowney, the nurse practitioner who acted as Plaintiff's primary care provider. At the first appointment of record, on October 19, 2017, Plaintiff complained only of a painful rash that had just started, which Nurse Practitioner Lowney tentatively diagnosed as herpes zoster (shingles); Plaintiff "also noted a headache." Tr. 352-53. Otherwise, Nurse Practitioner Lowney's examination was entirely normal. Tr. 352-55. There is no reference to a fever during the weeks leading up to this appointment and no indication that Nurse Practitioner Lowney's examination including taking a temperature. Nurse Practitioner Lowney prescribed medication (Valtrex) for shingles. Tr. 354. A week later (October 24, 2017), Plaintiff saw Nurse Practitioner Lowney a second time to follow up regarding shingles and anxiety. Tr. 356. For anxiety, Nurse Practitioner Lowney prescribed medication, "with good effect." Tr. 356. While the rash had not gotten worse, Plaintiff also complained of fatigue and headaches; for the latter, Nurse Practitioner Lowney prescribed no treatment because they were responding to Advil "with good effect." Id.
On November 7, 2017, Plaintiff returned to Nurse Practitioner Lowney, still complaining of the rash, as well as a stiff neck, and feeling unwell, anxious and weepy. Tr. 360. Nurse Practitioner Lowney continued her diagnoses of herpes zoster (shingles) and anxiety; however, her examination yielded entirely normal results. Tr. 361. There is no reference to any fever, chest pain or shortness of breath. There is no reference to any suggestion that Plaintiff should go to the emergency room.
On the same day as the appointment with Nurse Practitioner Lowney, Plaintiff went to the Rhode Island Hospital ("RIH") emergency room. Tr. 428-62. She told RIH providers therethat she had a "worsening rash" and symptoms (weight loss, hair loss and myalgia) that "been ongoing since August," as well as that she had developed chest pain and shortness of breath "while at her PCP's office today because she was very anxious, therefore was sent here." Tr. 432. Finding only elevated blood pressure, the rash, hair loss and anxiety, the RIH physician noted that chest pain and shortness of breath had resolved, that there was no fever, that range of motion was all normal with no pitting or edema, that the rash lesions "do not appear shingle-like," Tr. 433, and that the x-rays, EKG and laboratory tests results (including for Lyme disease) showed no acute...
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