Spencer v. Berryhill

• Decision Date: 26 June 2019
• Docket Number: Civil No. 3:18-CV-2006
• Parties: KIMBERLY CAROL SPENCER, Plaintiff v. NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant
• Court: U.S. District Court — Middle District of Pennsylvania

KIMBERLY CAROL SPENCER, Plaintiff v. NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant

Civil No. 3:18-CV-2006

UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF PENNSYLVANIA

June 26, 2019

(Judge Mariani)

(Magistrate Judge Carlson)

REPORT AND RECOMMENDATION

I. Introduction

Kimberly Spencer's Social Security appeal presents us with a striking set of facts. For the past 17 years, Spencer has been plagued by random fainting spells. These episodes are preceded by moments of severe vertigo before Spencer descends into brief unconsciousness. When she emerges from this unconscious state, Spencer frequently endures migraine attacks, coupled with profound emotional distress. For many years, these attacks have occurred on an intermittent, but frequent basis, with Spencer collapsing into an unconscious state on average once a week. Due to these attacks, Spencer's former employer came to deem her disabled, and later discharged her, concluding that they could not accommodate these episodes of unconsciousness in the workplace. Spencer, who was now unemployed due to this disability, sought disability benefits, but those benefits were denied.

The decision to deny Spencer's disability claim rested upon a rationale which was both simple, and simply inadequate. The ALJ found that Spencer could perform a range of light work with some additional functional limitations. Specifically, the ALJ found that, although Spencer suffers from syncope, which causes her to pass out on average once per week, Spencer could perform light work as long as she was able to take one unscheduled five-minute break per week. The accommodation of one unscheduled five-minute break per week was presumably the ALJ's way of accounting for those frequent, inevitable instances in which Spencer would collapse, unconscious, at work.

In our view, more is needed here to in order to fairly assess this claim. After a review of the record, including the extensive medical history of the plaintiff's fainting spells, we find that the ALJ's RFC determination is not supported by substantial evidence. Accordingly, we recommend that this case be remanded for further consideration.

II. Factual Background

A. Spencer's Medical History

Ms. Spencer filed for disability insurance benefits on September 9, 2015 and filed an application for supplemental security income on September 25, 2015. (Tr. 15.) She was 42 years old as of the alleged onset date of July 31, 2014 and had a high school education and past work as a sales representative. (Tr. 15, 160.) Spencer alleged impairments of syncope, or fainting, severe migraines, low blood pressure, anxiety, depression, and sleep disorder. (Tr. 159.)¹

With respect to her syncope, Spencer was seen and treated by several medical professionals over the course of almost two decades. Treatment notes from Dr. Turner, M.D., from March 2015 reveal that Spencer had a 17-year history of intermittent syncope. (Tr. 567.) Before 2011, it had occurred only when Spencer was standing, but after 2011, it occurred unprovoked or while Spencer was sitting down, as well. (Id.) In April of 2014, Spencer reported recurring dizziness to her treating physician, Dr. Straub. (Tr. 1023.) Dr. Straub's assessment was that Spencer suffered from vertigo and suggested she see a specialist. (Tr. 1023-24.)

In June 2014, Spencer was brought to the emergency room after she had fainted during work. (Tr. 625-26.) Spencer's coworkers reported that she had fallen from her chair and was unresponsive for a few minutes, and that she had similar episodes in the past. (Id.) Then, during a visit to Dr. Straub in July of 2014, Spencer fainted in the waiting room. (Tr. 1019.) Dr. Straub's treatment notes state: "Patient sitting in chair in waiting room and suddenly feeling dizzy and faint. Daughter reports pt was leaning forward then falling out of chair onto carpeted floor. Pt was unresponsive for several seconds, then responded to verbal stimuli." (Tr. 1019.) Spencer was admitted to the hospital after the incident, (Tr. 600), and during a follow up with Dr. Straub on July 16, 2014, was referred to a specialist for her syncope. (Tr. 1018.)

Spencer was seen by Trent Shultz, CRNP, at Danville Cardiology in July 2014. (Tr. 596.) She was diagnosed with vasovagal syndrome, which may lead to syncopal events. (Tr. 598.) Spencer was advised to recognize the warning signals and to lay down in order to prevent injury from falling. (Id.) In August 2014, it was reported that Spencer continued to have fainting spells and suffered from daily headaches. (Tr. 591.) Spencer was also seen at Geisinger Medical Center in September 2014 after she had another episode of unconsciousness. (Tr. 585.) She had reported that she had chest pain and noted that it could have been from fallingon the floor during one of her syncopal episodes. (Id.) On September 17, 2014, Spencer was again seen at Geisinger when she fell face-first onto the ground during an episode and reported having similar episodes twice per week since January. (Tr. 579.) Then in October 2014, Spencer reported to the Balance Center that she became dizzy while in the shower and fell. (Tr. 574.)

In October 2014, it was noted that Spencer was seeing a neurologist, and that her syncope was "triggered by prolonged sitting/standing/walking and emotional stressors." (Tr. 1016.) In November, Spencer was being evaluated by cardiology for her frequent syncope, and it was noted that she was experiencing side effects despite the medications she was taking. (Tr. 1014.) In December 2014, Spencer was seen at Geisinger after complaining of nausea and a headache, and she was diagnosed with right posterior canal BPPV. (Tr. 570.) Additionally, at a visit to Dr. Straub in December 2014, Spencer was taken to the emergency room after complaining of dizziness and feeling as if she was going to pass out. (Tr. 1013.)

Spencer's symptoms and episodes continued into 2015. Thus, in January 2015, Spencer was discharged from physical therapy treatment due to "[i]ncreased episodes of unconsciousness." (Tr. 362.) In March, Spencer was seen by Danville Neurology and it was noted that her spells had continued, and that her episodes were unprovoked. (Tr. 567.) In May 2015, it was reported that Spencer was stillexperiencing syncope every couple of weeks, and that there was no apparent cause. (Tr. 565.) Treatment notes indicate that Spencer experienced lightheadedness and dizziness prior to her episodes, and that emotional stress seemed to exacerbate her symptoms. (Id.)

CRNP Shultz filled out a cardiac medical source statement in 2016. He diagnosed Spencer with vasovagal syncope with a good prognosis. (Tr. 992.) He indicated that Spencer's symptoms included chest pain, weakness, syncope, dizziness, and chronic fatigue, and noted that she was incapable of even low stress work. (Tr. 992-93.) Shultz stated that Spencer's symptoms caused emotional difficulties, and that emotional factors contributed to Spencer's symptoms and limitations. (Tr. 993.) Ultimately, he opined that Spencer would likely be absent from work at least 4 days per month, that she would be off task twenty-five percent of the time, but stated that she would not need unscheduled breaks during the day. (Tr. 993-94.)

Dr. Turner of Geisinger Neurology, whom the plaintiff saw beginning in 2010, also wrote a letter on her behalf in 2016. (Tr. 991.) In this letter, Dr. Turner opined that Spencer's ongoing migraines and syncope will affect her ability to work, and that her symptoms may not completely resolve. (Id.)

Dr. Straub also filled out a medical source statement related to Spencer's disability application in 2017. Dr. Straub indicated that he had treated Spencer for dizziness since 2009 and diagnosed her with orthostatic hypotension. (Tr. 1836.) He opined that Spencer's episodes typically last 30 minutes, and that she has about a 5-minute warning before the episode begins. (Id.) He also identified symptoms associated with the dizziness, including falling, fatigue/exhaustion, and mental confusion/inability to concentrate. (Tr. 1837.) Ultimately, he concluded that Spencer was incapable of even low stress work, and that she would need an unscheduled break every two hours, lasting at least 15 minutes. (Tr. 1838.) He additionally noted that she would likely be absent from work at least 4 days per month and would be off task twenty percent of the time. (Id.)

At the administrative hearing, Spencer testified that she gets dizzy and passes out at least one time per week. (Tr. 44.) She stated that she gets symptoms about four minutes before she passes out, including headaches, clamming up, achiness and fatigue. (Tr. 42.) She indicated that she tries to prepare for it by either sitting or lying down. (Id.) Once she passes out, she is out for anywhere between 20 seconds to one minute. (Tr. 43.) Spencer stated that once she comes to, she has a major headache that sometimes turns into a migraine, and that she is embarrassed and cries. (Id.) Additionally, she testified that her doctors have not been able to determine the causeof her passing out. (Id.) In addition to her passing out, Spencer also testified that she suffers from dizzy spells, which she gets two or three times per week. (Tr. 45.) She has similar warning signs before she gets dizzy and tries to sit or lay down when she feels the dizzy spell beginning. (Id.)

Despite her passing out and dizzy spells, Spencer was able to retain her driver's license, as she stated she is able to pull over to the side of the road if she feels herself getting dizzy. (Id.) However, she indicated that she was placed on short-term disability by her employer in July of 2014, and eventually terminated from her employment in April 2015 due to her employer's inability to accommodate her passing out. (Tr. 51-52.)

A Vocational Expert also testified at the administrative hearing. The ALJ posed a hypothetical to the VE, which asked the expert to identify jobs that an individual of the...