DANIEL G. MARTIN, Magistrate Judge.
Plaintiff Mary L. Pratt (Pratt) seeks judicial review of a final decision of the Acting Commissioner of Social Security (Commissioner) denying her application for supplemental security income (SSI). The parties have consented to the jurisdiction of the undersigned United States Magistrate Judge pursuant to 28 U.S.C. § 636(c). Because the administrative law judge's decision is not supported by substantial evidence, the denial of benefits is reversed and this case is remanded for further proceedings consistent with this opinion.
Pratt applied for SSI on December 17, 2009, alleging she became totally disabled on December 1, 2007 because of asthma, arthritis in both knees, obesity, depression, and anemia (R. 169-71). She later amended her onset date to December 17, 2009. (R. 47). Pratt was born on July 31, 1967 and suffers from arthritis, back pain, asthma, hypertension, and morbid obesity. (R. 49). Pratt completed high school. (R. 49, 181). Pratt does not drive and has past work experience as a bagger at a grocery store, cashier, and babysitter. (R. 49, 50-52). Pratt last worked in 2009 as an after-school babysitter. (R. 52). Pratt's SSI application was denied at the initial and reconsideration levels. (R. 97-103, 107-110, 515-22, 530-40).
Dr. Harvey I. Friedson, Psy.D., evaluated Pratt on April 3, 2010 for approximately one hour. (R. 436-40). Pratt presented as "very cooperative" and alert with "somewhat of a sad quality." (R. 436, 438). As to Pratt's mood and affect, Dr. Friedson noted that "there was some range of affect, though she does appear depressed." (R. 438). Pratt's speech was relevant and coherent.
On April 3, 2010 Pratt underwent a consultative examination with Norbert De Biase, M.D. (R. 490-99). Dr. De Biase reviewed the medical information sent by the Bureau of Disability Determination Services and spent thirty-five minutes with Pratt obtaining her history and performing the consultative examination. (R. 490). Pratt reported having daily pain in her back and knees "for a short time."
Dr. De Biase found tenderness in both shoulders, both knees, and lower back, but Pratt's range of motion was free, full, and painless in all joints except for the lumbosacral spine, both hips and both knees. (R. 492). Pratt had a reduced range of motion in her lumbar spine-flexion to 50/90 degrees and extension/left and right lateral bending to 15/25 degrees. (R. 497). Pratt also had a reduced range of motion in her hips, exhibiting flexion of 80/100 degrees, extension of 10/30 degrees, abduction of 30/40 degrees, and adduction of 10/20 degrees. (R. 498). Dr. De Biase noted knee flexion of 100/150 degrees.
A lumbar spine x-ray taken on April 3, 2010 revealed "mild degenerative arthritic change" with "bony hypertrophy noted along the iliac crests." (R. 489). An x-ray of Pratt's left knee on the same day revealed mild degenerative changes. (R. 500). On April 16, 2010, Pratt underwent a spirometry test, which is used to assess lung function. The spirometer results showed premed testing of a "moderate restriction" and postmed testing of a "mild restriction." (R. 485).
On April 12, 2010, Pratt saw Dr. Chukwudozie Ezeokoli in connection with a follow-up for an overnight hospital admission due to a food allergic reaction on March 27, 2010. (R. 546-58, 567-80). Under the heading "Problem List," Dr. Ezeokoli listed allergic reaction to food, asthma, hypertension, osteoarthritis in knees, and overweight. (R. 546). Dr. Ezeokoli noted that Pratt's chest was clear and she was not wheezing.
On April 27, 2010, Lionel Hudspeth, Psy.D., prepared a Psychiatric Review Technique. Dr. Hudspeth diagnosed Pratt with a depressive disorder but found that her impairments were "not severe." (R. 501, 504). Dr. Hudspeth concluded that Pratt had mild restriction of activities of daily living, mild difficulties in maintaining social functioning, mild difficulties in maintaining concentration, persistence, or pace, and no episodes of decompensation. (R. 511). Dr. Hudspeth found Pratt's allegations about her symptoms "partially credible" given her history. (R. 513).
On April 28, 2010, Dr. James Madison, a non-examining state agency physician, reviewed Pratt's medical records and assessed her RFC. (R. 515-22). Dr. Madison concluded that Pratt could occasionally lift and/or carry 20 pounds and frequently lift and/or carry 10 pounds. (R. 516). He also found that Pratt could sit, stand, or walk for about six hours in an eight-hour workday and push or pull for an unlimited period.
On August 30, 2010, Dr. Marion Panepinto, another non-examining state agency physician, completed a Physical Residual Functional Capacity Assessment of Pratt and found more significant limitations. (R. 530-37). In his assessment, Dr. Panepinto concluded that Pratt could occasionally lift 10 pounds; frequently lift less than 10 pounds; stand or walk at least two hours in an eight-hour workday; sit about six hours in an eight-hour workday; and had an unlimited ability to push and pull. (R. 531). Dr. Panepinto found that Pratt could occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl. (R. 532). Dr. Panepinto determined that Pratt should never climb ladders, ropes, or scaffolds.
At a follow-up appointment with Dr. Ezeokoli on September 15, 2010, Pratt complained of pain in her knees and hips. (R. 549). Dr. Ezeokoli noted that x-rays of her knees showed arthritis.
On September 28, 2010, Dr. Ezeokoli completed a Physical Residual Functional Capacity Questionnaire for Pratt. (R. 541-45). Dr. Ezeokoli noted that Pratt has been diagnosed with asthma, osteoarthritis of both knees, high blood pressure, and as overweight and her conditions are chronic. (R. 541). Dr. Ezeokoli reported that Pratt suffers from the following symptoms: shortness of breath on exertion, bilateral knee pain with walking, wheezing, and facial swelling.
Dr. Ezeokoli concluded that Pratt was incapable of even "low stress" jobs given her constant pain.
On June 29, 2011, Pratt went to Provident Hospital's emergency room complaining of knee pain, mostly in her joints for two months, which was exacerbated by movement and weight-bearing walking and relieved by rest. (R. 635). Pratt rated her pain as 8 on a 10-point scale upon activity. (R. 649, 659). Pratt reported that she received no relief from non-steroidal anti-inflammatory drugs. (R. 635). An x-ray taken of Pratt's knees that same day showed joint space narrowing of the left knee. (R. 644-45). The emergency room physician diagnosed degenerative joint disease of the knees with osteophytes noted on the x-ray. (R. 637). The physician prescribed naproxen
On July 20, 2011, Pratt had another follow-up appointment with Dr. Ezeokoli. (R. 660-62). Dr. Ezeokoli noted that Pratt was recently seen in the emergency room for knee pain. Dr. Ezeokoli also noted that Pratt had gained 30 pounds since her last visit and weighed 402 pounds. (R. 661). Dr. Ezeolkoli indicated that x-rays of Pratt's knees showed osteoarthritis of the knees bilaterally.
At the administrative hearing before the ALJ on July 12, 2011, Pratt described the pain in her knees as feeling "like a drill" is in her knees. (R. 54). Pratt also testified that her feet and ankles have been swelling for the last two years. (R. 64). Pratt testified that her treating physician recommended lap band surgery for her obesity. (R. 66-67, 79). Pratt takes ibuprofen and naproxen for the osteoarthritis in her knees. (R. 69). Pratt stated she takes two pills every six hours for pain, even though her prescription is for one pill every six hours.
Pratt testified that she also suffers from hypertension and asthma. (R. 72-73). Pratt uses an inhaler, a nebulizer, and medication to treat her asthma. (R. 73). Pratt visited the emergency room twice last year due to asthma. (R. 74). Pratt has food and laundry detergent allergies. (R. 75-76). She was advised to use Benadryl or an EpiPen if there are signs of an allergic reaction. (R. 75-76). Pratt uses the Benadryl about twice a week which makes her drowsy. (R. 84). Pratt reported that she became depressed and gained significant weight when her mother died in May 2003. (R. 77). Pratt explained that she lost all of her hair as a result of stress. (R. 83).
In term of her physical abilities, Pratt testified that she can walk for 30 minutes to an hour but she would be out of breath and have lower back pain. (R. 59). Pratt thought she could stand for an hour or two before having to sit. (R. 60). Pratt testified that she can sit for two hours at a time.
Pratt's sister, Tracy Pratt, was not present at the hearing, but she provided two statements describing how Pratt's condition limits her daily activities. (R. 223-30, 272-73). On January 25, 2010, Tracy Pratt completed a third-party questionnaire, in which she stated that Pratt was able to prepare frozen meals in the microwave for herself. (R. 225). However, Pratt is unable to do any cleaning, laundry, ironing, or other chores.
Richard Hamersma testified at the hearing as a vocational expert ("VE"). (R. 88). He identified Pratt's past relevant work as a bagger at a grocery store and a childcare worker. (R. 89-90). The ALJ presented a hypothetical of an individual of Pratt's age, education, and work experience who could lift and carry 10 pounds occasionally and less than 10 pounds frequently, stand and walk two hours in an eight hour workday, sit six hours with normal rest periods with an inability to work at heights, climb ladders, or frequently negotiate stairs, only occasionally balance, stoop, crouch, kneel, or crawl, avoid concentrated exposure to fumes, dust, odors, gases, or poorly ventilated areas, avoid operation of moving or dangerous machinery, unable to understand, remember, and carry out detailed and complex job instructions, unable to perform work that requires intense focus and concentration for extended periods, and would be expected to be off task about five percent of the time in an eight-hour workday. (R. 91). The VE testified that such an individual would be unable to perform Pratt's past relevant work.
Next, Pratt's attorney asked the VE if the individual described in the first hypothetical could still perform the jobs identified if the time off task percent was fifteen percent instead of five percent. (R. 93). The VE testified that off task tolerance is usually 10 to 12 percent and the jobs identified could not be performed if off task fifteen percent of the time. (R. 93-94). Pratt's attorney then asked the VE if the individual described in the first hypothetical could perform the identified jobs if an additional restriction of missing work two or three days per month was added. (R. 94). The VE testified that two days a month is the maximum a person is usually allowed to miss and three days per month would eliminate all jobs.
Under the required five-step analysis used to evaluate disability, ALJ Jose Anglada found that Pratt had not engaged in substantial gainful activity since her application date of December 17, 2009 (step one); her obesity, arthritis, and asthma were severe impairments (step two); but they did not qualify as a listed impairment (step three). (R. 14-17). The ALJ determined that Pratt retained the residual functional capacity (RFC) to perform a range of sedentary work, i.e., lift/carry less than ten pounds frequently and ten pounds occasionally; stand/walk two out of eight hours and sit six out of eight hours with normal rest periods; no work at heights, climbing ladders, or frequently negotiating stairs; only occasional balancing, stooping, crouching, kneeling, or crawling; avoid concentrated exposures to fumes, dust, odors, gases or poorly ventilated areas; avoid operation of moving or dangerous machinery; unable to understand, remember, and carry-out detailed and complex job instructions; not suited for work that requires intense focus and concentration for extended periods; and would be expected to be off task five percent of the time in an eight-hour workday. (R. 17-18). Given this RFC, the ALJ concluded that Pratt was unable able to perform her past relevant work as a customer service representative, babysitter, and bagger at a grocery store (step four). (R. 21). At step five, the ALJ determined that there were jobs that exist in significant numbers in the economy that Pratt could perform considering her age, education, and residual functional capacity, such as cashier, inspector, and hand packager. (R. 21-22). The Appeals Council denied Pratt's request for review on September 27, 2012. (R. 1-6). Pratt now seeks judicial review of the final decision of the Commissioner, which is the ALJ's ruling.
Under the Social Security Act, a person is disabled if she has an "inability to engage in any substantial gainful activity by reason of a medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than twelve months." 42 U.S.C. § 423(d)(1)(a). In order to determine whether a claimant is disabled within the meaning of the Act, the ALJ conducts a five-step sequential inquiry: (1) whether the claimant is currently unemployed; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment meets or equals any of the listings found in the regulations,
Judicial review of the ALJ's decision is limited to determining whether the ALJ's findings are supported by substantial evidence, based upon a legal error, or too poorly articulated to permit meaningful review.
The ALJ denied Pratt's claim at step five, finding that Pratt retained the RFC to perform a range of sedentary work. Pratt challenges the ALJ's adverse credibility finding, failure to give controlling weight to her treating physician's opinions, and failure to account for her obesity.
Pratt disputes the ALJ's credibility assessment. "The ALJ's credibility determinations are entitled to special deference but the ALJ is still required to `build an accurate and logical bridge between the evidence and the result.'"
Pratt first objects to the ALJ's use of the boilerplate credibility language described by the Seventh Circuit as "meaningless boilerplate."
(R. 20). The first sentence of the ALJ's credibility determination is essentially boilerplate similar to language which the Seventh Circuit has repeatedly criticized "because it fails to link the conclusory statements made with objective evidence in the record."
Here, the ALJ did not properly justify his adverse credibility determination. The only specific reason provided by the ALJ for rejecting Pratt's statements about the effects of her knee pain is the nature of the treatment she received. The ALJ recognized that Pratt may "experience some discomfort or even pain," but emphasized the lack of physical therapy and a referral to a pain clinic. (R. 20). A failure to follow a recommended course of treatment can weigh against a claimant's credibility,
Further, as to the nature of Pratt's treatment, the record establishes that Pratt was referred to an orthopedic specialist for likely steroid injections and recommended for lap-band surgery to help her conditions. (R. 66, 72, 79-80, 547, 662). Pratt testified that she was seeing an orthopedic surgeon two days after the administrative hearing. (R. 68). These recommendations belie the ALJ's suggestion that the nature and level of Pratt's treatment is inconsistent with her allegations of disabling pain.
The Commissioner contends that the ALJ also reasonably discounted Pratt's credibility based on her daily activities. Pratt argues that the ALJ exaggerated the extent of her daily activities. "[A]lthough it is appropriate for an ALJ to consider a claimant's daily activities when evaluating their credibility, SSR 96-7p, at *3, this must be done with care."
At step two, the ALJ determined that Pratt's activities of daily living were only mildly limited. (R. 15). The ALJ made only passing reference to Pratt's daily activities in his decision, noting that Pratt does a "little cooking, cleaning, and laundry," "some cooking and some shopping," and "does cook, clean and do laundry." (R. 15, 16, 18). The ALJ ignored the fact that Pratt's cooking is limited to heating up frozen meals and Pratt requires assistance with laundry, shopping, and cleaning from her sister. At the administrative hearing, Pratt described very limited daily activities, noting she "lay[s] around" and "sleep[s] all day." (R. 54, 55). Pratt testified that she spends about 15 hours a day in bed. (R. 57). Her cooking consists of using the microwave or cooking frozen entrees in the oven. (R. 57-59). Pratt's activities are limited to watching television and reading. (R. 57). Pratt does not shop or do laundry. (R. 59, 61). Pratt's sister (Tracy Pratt) does the grocery shopping and laundry for Pratt.
The Commissioner argues that the ALJ accurately noted that Pratt's statements that she did "a little cooking, cleaning and laundry" or "some cooking and some shopping" were at odds with her statement that she did not do much of anything. (Doc. 22 at 6). But the evidence the ALJ cites-Dr. De Biase's April 3, 2010 consultative examination report-does not contradict Pratt's statement that she did not do much of anything. (R. 15,18). The ALJ's characterization of what Pratt told Dr. De Biase regarding her daily activities is inaccurate and misleading. For example, despite the ALJ's representation that Pratt can do laundry (R. 15 and 18), the report from Dr. De Biase does not state Pratt does laundry. (R. 490) (stating "laundry is done by her son or her sister."). Dr. De Biase's report in fact supports Pratt's testimony that she cooks meals in a microwave and she receives substantial assistance with her daily activities from her sister. Pratt told Dr. De Biase that "[c]ooking, cleaning and laundry is done by her son or her sister who help her at home. She states that she can do a little of the cooking and cleaning. She will do it just for a little bit while sitting down and using the microwave oven." (R. 490). The ALJ fails to disclose theses qualifications and limitations mentioned by Pratt regarding her household activities.
Further, the ALJ overstated the significance of Pratt's statement to Dr. Friedson on April 3,2010 that she does "some cooking and also does some shopping." (R. 16, 438). Again, Pratt testified that her cooking was limited to using the microwave or heating frozen food in the oven. (R. 57-59). As to shopping, Pratt testified that her sister does the grocery shopping. (R. 59). Pratt testified to once going grocery shopping with her sister, but she could only walk for a half-hour to an hour and then needed to sit after walking due to back pain. (R. 59-60). The ALJ failed to discuss other statements to Dr. Friedson indicating that Pratt has substantial family support. (R. 438). In sum, the ALJ erred in failing to take into account Pratt's limitations in performing household activities and did not explain how her minimal activities contradict the pain and limitations she claims.
Also troubling is the ALJ's failure to address the statements of Pratt's sister Tracy Pratt regarding the Pratt's pain and daily activities. The ALJ must consider the entire record, including statements by "other persons about the symptoms and how they affect the individual." SSR 96-7p. Although the ALJ need not discuss every piece of evidence, the Court must be able to discern the ALJ's reasoning or provide a logical bridge between the evidence and his conclusions.
The ALJ did not acknowledge or discuss Tracy Pratt's written statements about Pratt. The ALJ's opinion states generally that he carefully considered the "entire record" and "all the evidence" (R. 12, 14, 17). The Commissioner does not dispute that the ALJ failed to discuss Tracy Pratt's notes, but argues Tracy Pratt's observations were redundant of Pratt's own assertions about the extent of her limitations. An ALJ need not specifically address a lay witness statement when it is "essentially redundant" of other evidence in the record which the ALJ has otherwise addressed.
The Commissioner contends that the ALJ reasonably concluded that Pratt's complaints of extensive pain and discomfort were contradicted by the objective medical evidence, even when taking into account her morbid obesity. (Doc. 22 at 6). While the lack of objective support from physical examinations and test results is relevant, "an ALJ may not base a decision solely on a lack of objective corroboration of complaints of pain."
Pratt also argues that the ALJ inadequately evaluated Dr. Chukwudozie Ezeokoli's opinion that Pratt is unable to work. A treating physician's opinion is entitled to controlling weight if it is supported by objective medical evidence and is consistent with other substantial evidence in the record. 20 C.F.R. 416.927(c)(2). "Obviously if [the treating physician's medical opinion] is well supported and there is no contradictory evidence, there is no basis on which the administrative law judge, who is not a physician, could refuse to accept it. Equally obviously, once well-supported contradictory evidence is introduced, the treating physician's evidence is no longer entitled to controlling weight."
If a treating physician's opinion is not entitled to controlling weight, the ALJ considers several factors in determining the weight to give the opinion, including the length of the treatment relationship, frequency of examination, nature and extent of the treatment relationship, the degree to which the opinion is supported by medical signs and laboratory findings, the consistency of the opinion with the record as a whole, and whether the opinion was from a specialist. 20 C.F.R. § 416.927(c)(1)-(6). This "checklist is designed to help the administrative law judge decide how much weight to give the treating physician's evidence. When he has decided how much actual weight to give it, there seems no room for him to attach a presumptive weight to it."
On September 28, 2010, Dr. Ezeokoli, Pratt's treating physician since April 12, 2010, indicated that Pratt suffers from asthma, osteoarthritis of both knees, high blood pressure, and is overweight. (R. 541). Dr. Ezeokoli explained that Pratt's symptoms include shortness of breath on exertion, bilateral knee pain when walking, wheezing, knee swelling and tenderness.
The ALJ rejected Dr. Ezeokoli's opinion that Pratt is unable to work. (R. 19). Because controlling weight was not given to the opinion of Dr. Ezeokoli, the Court looks to whether the ALJ adequately articulated the reasoning for rejecting his opinion. The ALJ gave several adequate reasons for rejecting Dr. Ezeokoli's opinion regarding the extent of Pratt's knee pain, which he described as constant and rated as 7-9 out of 10. The ALJ first noted that Dr. Ezeokoli's statement that he had seen Pratt for 6 months, every 2 months was inconsistent with the treatment records showing that they met just twice prior to September 28, 2010, only on April 12, 2010 and September 15, 2010 for food allergy follow-up appointments. (R. 19). The length, nature, and frequency of the treatment relationship is relevant to evaluating how much weight to accord a treating physician's opinions. 20 C.F.R. § 416.927(c)(2)(i) (ii). Next, the ALJ rejected Dr. Ezeokoli's opinion of disabling pain as conflicting with the fact that Dr. Ezeokoli prescribed no pain medication for Pratt's knee pain on April 12, 2010 and September 15, 2010. (R. 19). The lack of prescription medication is inconsistent with a finding of disabling pain.
The ALJ adequately articulated why he declined to give Dr. Ezeokoli's opinion controlling weight. The problem here is that once the ALJ rejected Dr. Ezeokoli's opinion, he was left with a decision that does not support the RFC determination. The Commissioner contends that the ALJ based his analysis of Pratt's RFC on the opinion from Dr. Panepinto, the state agency reviewing physician. The Commissioner argues that "a commonsensical reading of [the ALJ's] decision makes it absolutely clear that he accepted the opinion in its entirety and give it full weight, since his RFC determination tracks the language of Dr. Panepinto's opinion almost word-for-word." (Doc. 22 at n.2). The Commissioner's argument is an impermissible post hoc rationale. The ALJ's findings regarding Pratt's ability to perform work-related physical activities do mirror Dr. Panepinto's assessments, but nowhere in the decision does the ALJ mention the state agency physician's opinion and there is no indication that he relied on it. "`What matters are the reasons articulated by the ALJ,' not the rationale advanced by the Commissioner on appeal."
Pratt next contends that when assessing her RFC and pain, the ALJ failed to adequately consider the impact of her obesity on her arthritic knees and the likely role it played in her fatigue and mobility problems. "[W]hen determining whether an individual with obesity has a listing-level impairment or combination of impairments, and when assessing a claim at other steps of the sequential evaluation process, including when assessing an individual's residual functional capacity, adjudicators must consider any additional and cumulative effects of obesity." 20 C.F.R. Pt.404, Subpt. P, App.1 § 1.00(Q). An "ALJ must specifically address the effect of obesity on a claimant's limitations because, for example, a person who is obese and arthritic may experience greater limitations than a person who is only arthritic."
Pratt is extremely obese. SSR 02-1p, 2002 WL 34686281, at *2 (Sept. 12, 2002) (stating that "BMIs greater than or equal to 40" are level III or extreme). In his step two discussion, the ALJ noted that on April 12, 2010, Pratt weighed 377 pounds, with a BMI of 55.7. (R. 16). On July 20, 2011, eight days after the administrative hearing, Pratt weighed 402 pounds and she is 5'9" tall (R. 661, 664). The ALJ found Pratt's obesity to be a severe impairment at step two but concluded at step three that Pratt's impairments, alone or in combination with her other impairments, did not meet a listed impairment. (R. 14, 17). At step three, the ALJ noted that there is no listing for obesity but stated that he had considered the cumulative effects of Pratt's obesity in finding that her impairments are not listing-level. (R. 17). The ALJ stated in cursory fashion at step three that "[a]s to the claimaint's allegations of arthritis and hypertension, the undersigned considered the criteria enunciated in Sections 1.00 and 4.00(H) and determined that, even despite the presence of obesity, the medical records do not demonstrate any chronic effects of arthritis, or any significant effects of hypertension in reference to any specific body system. Relative to claimant's history of asthma, again, even considering her obesity and hypertension, the medical evidence reflects an asthma condition that has generally remained well-controlled throughout the years, even since childhood. (R. 17).
In his RFC assessment, the ALJ used the exact same language from his step three finding above. (R. 18). Then, in summarizing the records from Pratt's emergency room visit on June 29, 2011, the ALJ noted that Pratt was described as morbidly obese and "she reported exacerbating factors consisting of movement and weight-bearing walking." (R. 19). The ALJ noted that on examination, Pratt had normal range of motion, normal strength, was neurovascularly intact in the lower extremities, and there was no joint laxity.
Although the ALJ referenced Pratt's obesity on several occasions throughout his decision in relation to her osteoarthritis, hypertension, and asthma and the objective medical findings, he offered no analysis of the effects of obesity on Pratt's subjective complaints of pain and whether her pain was exacerbated by her obesity. Pratt's complaints include back pain, knee pain, and ankle swelling. The ALJ did not specifically discuss how Pratt's extreme obesity factored into his assessment of her credibility.
The Commissioner suggests that the ALJ indirectly accounted for Pratt's obesity by relying on the most recent medical opinion of Dr. Panepinto, the state agency physician, who evaluated her height and weight. The failure to consider the effects of obesity may be harmless error when the ALJ relies on medical opinions by doctors who were aware of the claimant's obese condition.
Because the ALJ will be reassessing the effects of obesity on Pratt's complaints of pain, the ALJ shall also consider upon remand Pratt's extreme obesity in relation to her depression and fatigue, both of which can be impacted by obesity. "Obesity may also cause or contribute to mental impairments such as depression." SSR 02-1p, 2002 WL 34686281, at *3 (Sept. 12, 2002) (stating "[t]he effects of obesity may be subtle, such as the loss mental clarity and slowed reactions that may result from obesity-related sleep apnea."). The ALJ shall further consider the effect of Pratt's obesity on her difficulty sleeping and whether a consultative examination is warranted to evaluate possible sleep apnea. Pratt has complained about symptoms indicating possible sleep apnea. For example, at the hearing, Pratt testified that she had never had a sleep study but she feels like she is "going to die in her sleep." (R. 79). She stated "my breathing sometimes I feel like I can't catch my breath and I wake up, I jump up."
For the reasons and to the extent stated herein, Plaintiff's Motion for Summary Judgment [19] is granted and the Commissioner's Motion for Summary Judgment [21] is denied. The decision of the Commissioner is reversed and this case is remanded for further proceedings consistent with this opinion. The Clerk is directed to enter judgment in favor of Plaintiff Mary L. Pratt and against the Defendant Acting Commissioner of Social Security.
