JOSEPH H.L. PEREZ-MONTES, Magistrate Judge.
Before the Court is Douglas Bruce Holly's ("Holly's")
Holly filed an application for DIB, alleging a disability onset date of December 28, 2014 (Doc. 10-1, p. 139/421), due to "hole in heart, asthma, sleep apnea, bone spur in left heel, heart murmur, acid reflux, and shortness of breath." (Doc. 10-1, p. 57/421). That application was denied by the Social Security Administration ("SSA"). (Doc. 10-1, p. 66/421).
A de novo hearing was held before an Administrative Law Judge ("ALJ") on March 23, 2016, at which Holly appeared with his attorney and a vocational expert ("VE"). (Doc. 10-1, p. 37/421).
Holly requested a review of the ALJ's decision, but the Appeals Council declined to review it (Doc. 10-1, p. 4/421), and the ALJ's decision became the final decision of the Commissioner.
Holly then filed an appeal for judicial review, with the following grounds for relief (Docs. 15, 16):
Dr. Gregory Ardoin, a pulmonologist, first saw Holly in May 2014 on referral from Dr. Karson. (Doc. 10-1, p. 371/421). Holly complained he had been progressively shorter of breath for years but was markedly worse in the last "many months"; his shortness of breath was aggravated by exertion, relieved by rest, and accompanied by coughing and wheezing, and he had been very tried for the last year. (Doc. 10-1, p. 371/421). Dr. Ardoin noted Holly's history of a bilateral heart catheter, pulmonary hypertension, and severe dyspnea on exertion, with progressively worsening shortness of breath for years, markedly worse in the last several months. (Doc. 10-1, p. 371/421). Dr. Ardoin noted that Holly has significant left ventricle hypertension and hypertrophic cardiomyopathy with normal left ventricle function, asthma with wheezing, hypersomnolence, and snoring. (Doc. 10-1, p. 371/421). Holly could not make it up and down stairs at work without severe distress. (Doc. 10-1, p. 271/421). Dr. Ardoin diagnosed pulmonary artery hypertension, atrial septal defect ("ASD"), hypertrophic cardiomyopathy, dyspnea on exertion, morbid obesity, asthma, and hypertension. (Doc. 10-1, p. 372/421).
Holly, then 42 years old, underwent an echocardiogram in June 2014. (Doc. 10-1, pp. 333-334/421). Holly's left ventricle ejection fraction was about 59% and the wall thickness was at the upper limits of normal; there was mild regurgitation in the pulmonic valve; there was mild to moderate regurgitation in the tricuspid valve; and everything else was normal. (Doc. 10-1, p. 334/421). Cardiopulmonary tests and pulmonary function studies revealed pulmonary hypertension. (Doc. 10-1, pp. 335-345/421). Dr. Ardoin stated Holly's case was very unusual due to a right heart catheter, documented in August 2013. (Doc. 10-1, p. 368/421). Holly's cardiothoracic surgeon recommended trying medications for a while before trying to close the atrial septal defect, so Dr. Ardoin prescribed PDE5 inhibitors to help his hypertrophic diastolic dysfunction. (Doc. 10-1, p. 370/421). Dr. Ardoin diagnosed pulmonary artery hypertension, atrial septal defect, hypertrophic cardiomyopathy, dyspnea on exertion, morbid obesity asthma and hypertension. (Doc. 10-1, p. 368/421).
In July 2014, Holly had an abnormal pulmonary function study. (Doc. 10-1, pp. 346-/421). Dr. Ardoin noted that Holly said he felt markedly better since treating his asthma with Advair and Spiriva, but was not at normal exercise capacity at work, and his cardiopulmonary exercise test was "remarkably abnormal for both ventilatory limitation . . . and from his hypoxemia". (Doc. 10-1, p. 265/421). Dr. Ardoin diagnosed shortness of breath, exercise hypoxemia, pulmonary artery hypertension, COPD, atrial septal defect, asthma, dyspnea on exertion, morbid obesity, and hypertension. (Doc. 10-1, p. 266/421).
A sleep study in July 2014 showed Holly has severe obstructive sleep apnea syndrome. (Doc. 10-1, p. 347/421). Holly was prescribed a positive airway pressure therapy titration trail study. (Doc. 10-1, p. 347/421). A second sleep study in September 2014 showed his obstructive sleep apnea was controlled by CPAP and he was prescribed home CPAP therapy. (Doc. 10-1, p. 348/421).
An echocardiogram in September 2014 showed Holly's left ventricle had mildly increased wall thickness, his left and right atriums were mildly dilated, and his pulmonic and tricuspid valves had mild to moderate regurgitation. (Doc. 10-1, pp. 349-50/421). Holly's left ventricle ejection fraction was 62 %. (Doc. 10-1, p. 350/421).
Holly had another abnormal spirometry report in October 2014. (Doc. 10-1, p. 352/421). Holly was called to undergo a repair of his atrial septal defect, but he refused it. (Doc. 10-1, p. 362/421). Holly stated he was able to do his work with mild to moderate compromise, which was a marked improvement. (Doc. 10-1, p. 362/421). Dr. Ardoin noted Holly still had trace edema and had started CPAP therapy. (Doc. 10-1, p. 362/421). Dr. Ardoin diagnosed Holly with atrial septal defect, exercise hypoxemia, pulmonary artery hypertension, shortness of breath, pulmonary artery hypertension ("PAH"), chronic obstructive pulmonary disease ("COPD"), asthma, hypertrophic cardiomyopathy, dyspnea on exertion, morbid obesity, hypertension, and obstructive sleep apnea on CPAP. (Doc. 10-1, pp. 262-63/421).
In December 2014, Holly had a blood vessel pop (Doc. 10-1, p. 244/421). Holly's history of benign hypertension was noted (Doc. 10-1, p. 244/421), and he was diagnosed with varicose veins and morbid obesity. (Doc. 10-1, p. 245/421).
Holly saw Dr. Ardoin three times in January 2015. Holly was treated for an upper respiratory infection, and a heart murmur was noted (systolic grade III/IV in LUSB), as well as edema and morbid obesity. (Doc. 10-1, pp. 248-49/421). Holly reported a long history of heart murmur since age 4 after having open heart surgery. (Doc. 10-1, p. 249/421). Holly underwent an EKG, lab work, x-rays, a cardiopulmonary, and pulmonary function studies at the request of Dr. Gregory Ardoin, a pulmonologist. (Doc. 10-1, pp. 267-284, 297-302/421). Holly was 5'10" tall and weighed 289 pounds. (Doc. 10-1, p. 258/421). Dr. Ardoin diagnosed shortness of breath; gastroesophageal reflux disease ("GERD"); ASD; hypertrophic cardiomyopathy; obstructive sleep apnea on CPAP; asthma; morbid obesity; dyspnea on exertion; pulmonary artery hypertension; and exercise hypoxemia. (Doc. 10-1, p. 258/421). Dr. Ardoin found Holly's asthma, reactive airways disease, and obstructive lung disease had improved markedly, and his pulmonary hypertension "may have improved somewhat." (Doc. 10-1, p. 259/421). Dr. Ardoin noted that Holly's primary limiting factor is hypoxemia with exercise, and his second most limiting factor is hypertrophic cardiomyopathy/diastolic dysfunction. (Doc. 10-1, p. 159/421). Dr. Ardoin found Holly was unable to do physical labor (his usual work requirements) without respiratory distress due to hypoxemia. (Doc. 10-1, p. 258/421). Dr. Ardoin recommended that Holly stop working, since he was doing physical labor, but Holly said he could not. (Doc. 10-1, p. 359/421).
Holly was referred to Dr. Wesley W. Davis, a cardiologist, in April 2015. (Doc. 10-1, p. 402/421). Holly was 42 years old, 69" tall, weighed 310 pounds, and his blood pressure was 118/63. (Doc. 10-1, p. 402-404/421). After Holly underwent tests, Dr. Davis diagnosed primary pulmonary hypertension, obesity, hypertension, and asthma. (Doc. 10-1, p. 404/421).
In June 2015, Dr. Davis noted Holly's "leaking valve" (since open heart surgery in1976) and asthma. (Doc. 10-1, pp. 406-407/420). Dr. Davis found Holly had pitting edema in both lower extremities (more om the right) and varicose veins. (Doc. 10-1, p. 408/421), and is disabled due to hypertension, chronic stasis changes (right leg more than left), obesity, his ASD repair at age 4, edema, and moderate primary pulmonary high blood pressure. (Doc. 10-1, p. 406/420). Dr. Davis diagnosed venous insufficiency of both lower extremities, primary pulmonary hypertension, hypertension, asthma, and obesity. (Doc. 10-1, p. 406/420). Dr. Davis recommended that Holly elevate his feet one hour in the morning and one hour in the afternoon, and continue taking his medications (Lasix, potassium chloride, omeprazole, Advair, Spiriva, Ventolin, and Inderal). (Doc. 10-1, p. 408/421).
Dr. Ardoin evaluated Holly in August 2015 and found shortness of breath, dyspnea on exertion, pulmonary artery hypertension, atrial septal defect, asthma, and chronic obstructive pulmonary disease. (Doc. 10-1, p. 353/421). Dr. Ardoin noted that, given Holly's hypertrophic cardiomyopathy and pulmonary hypertension, complicating obesity, and obstructive sleep apnea, Holly's condition could be made worse if the ASD was closed since it could be acting as a "pop off valve." (Doc. 10-1, p. 354/421). Dr. Ardoin prescribed a PDE5 inhibitor for his pulmonary hypertension. (Doc. 10-1, p. 349/421). Dr. Ardoin also stated that Holly is "completely disabled and unemployable at this time." (Doc. 10-1, p. 355/421).
In September 2015, Dr. Ardoin wrote that Holly is unable to perform physical labor due to severe exercise hypoxemia caused by a combination of pulmonary hypertension, atrial septal defect, hypertrophic cardiomyopathy, and severe persistent asthma. (Doc. 10-1, p. 410/421). A cardiopulmonary stress test documented severe hypoxemia with mild to moderate exercise. (Doc. 10-1, p. 410/421). Dr. Ardoin noted that Holly's cardiothoracic surgeon, cardiologist, and pulmonary hypertension specialist all concurred in his opinion. (Doc. 10-1, p. 410/421).
In November 2015, Dr. Ardoin found Holly still had significant dyspnea on exertion but his asthma had improved. (Doc. 10-1, p. 411/421). A transthoracic echocardiogram showed: a mildly dilated left ventricle with increased wall thickness and an estimated ejection fraction
At his administrative hearing in March 2016, Holly testified he was 43 years old, 5'9" tall, and weighed 310 pounds. (Doc. 10-1, p. 41/421). Holley testified he last worked on a land oil rig in December 2014. (Doc. 10-1, p. 41/421). Prior to that, Holly worked as a deckhand on a riverboat; worked in corrections; and worked at a plywood plant. (Doc. 10-1, p. 42/421).
Holly testified that his primary doctors are Dr. Ardoin (a pulmonologist) and Dr. Davis (a cardiologist). (Doc. 10-1, p. 48/421).
Holly testified he has COPD and asthma. (Doc. 10-1, p. 51/421). Holly takes Tudorza, Spiriva, and Albuterol inhalers, and Adcirca for pulmonary hypertension. (Doc. 10-1, p. 42/421). Holly testified those medications help. (Doc. 10-1, pp. 42-43/421). Holly testified he can walk for 10 to 15 minutes, stand for 15 to 30 minutes, and sit for up to 30 minutes. (Doc. 10-1, p. 43/421). Holly can lift 15 to 20 pounds. (Doc. 10-1, p. 43/421). If Holly walks too long or exerts himself, he suffers shortness of breath and fatigue and has to stop. (Doc. 10-1, pp. 46, 48/421). Holly also has trouble bending over, which makes it difficult to get dressed in the mornings. (Doc. 10-1, pp. 48-49/421). The problems that prevent Holly from working are fatigue and shortness of breath on exertion. (Doc. 10-1, p. 48/421). Sometimes he has "fairly severe" problems getting dressed in the morning, particularly when bending over. (Doc. 10-1, pp. 48-49/421). He had the same problems at work. (Doc. 10-1, p. 49/421). His medications have helped with the fatigue and shortness of breath. (Doc. 10-1, p. 49/421).
Holly's right leg swells occasionally around his ankle. (Doc. 10-1, p. 51/421). Holly elevates his legs (above his heart) every day for an hour in the morning and an hour in the afternoon, as prescribed by Dr. Davis (Doc. 10-1, pp. 49-50/421), and when his leg swells. (Doc. 10-1, p. 52/421). Holly testified that elevating his legs helps (Doc. 10-1, p. 49/421). Holly testified that his heart is overworked, one side is enlarged from working too hard, and the heart valve that was repaired still leaks. (Doc. 10-1, pp. 50-51/421). His doctors have talked to him about having another surgery on his heart. (Doc. 10-1, p. 52/421).
Holly testified that he cooks, washes dishes, makes beds, sweeps, mops, does laundry, and goes shopping. (Doc. 10-1, pp. 44-45/421). Holly's 12-year-old son does the yard work. (Doc. 10-1, pp. 44-45/421). Holly watches about two hours of TV daily, goes to bed about 9:00 or 10:00 p.m., and gets up at 6:00 a.m. (Doc. 10-1, p. 45/421). Holly testified his three children, who are 12, 9, and 6 years old, live with him. (Doc. 10-1, pp. 45-46/421). Holly testified he does not have any income except food stamps and is insured by Medicaid. (Doc. 10-1, p. 46/421).
Holly testified he cannot do sedentary work because it would involve sitting too long, which would make him stiff and sore and causes his right leg to swell. (Doc. 10-1, p. 53/421).
The VE testified that Holly's past work as a: laborer was very heavy work with SVP 1; correction officer was medium work with SVP 4; deckhand was heavy work with SVP 4, and green chain off bearer was medium work with SVP 2. (Doc. 10-1, p. 54/421). The VE further testified that a claimant who is 43 years old, with 12 years of education, and with the ability to perform light work but must elevate his legs at least two times a day would not be able to do Holly's past work. (Doc. 10-1, p. 55/421). The VE also testified that that if such a person were to elevate his legs for only 30 minutes twice a day, he still would not be employable. (Doc. 10-1, p. 55/421).
In considering Social Security appeals, the Court is limited by 42 U.S.C. §405(g) to a determination of whether substantial evidence exists in the record to support the Commissioner's decision and whether there were any prejudicial legal errors.
A court reviewing the Commissioner's decision may not retry factual issues, reweigh evidence, or substitute its judgment for that of the fact-finder.
Holly contends the ALJ's reasons for not crediting the opinion of Dr. Davis, Holly's treating cardiologist, are not supported by substantial evidence. Specifically, Holly contends Dr. Davis advised him to elevate his legs for one hour twice a day, in the morning and evening to help with swelling. Holly argues the ALJ erred in finding Dr. Davis's opinion was not consistent with the evidence showing a normal ejection fraction, symptom improvements, and normal to mild findings that indicate no significant limitations. (Doc. 10/1, p. 26/421). Holly also contends the ALJ's finding that he has the residual functional capacity to perform the full range of light work is not supported by the medical evidence.
Because the treating physician is most familiar with the claimant's impairments, his opinion should be accorded great weight in determining disability.
An ALJ "may reject the opinion of the treating physician only if the ALJ performs a detailed analysis of the treating physician's views under" the factors set out in 20 C.F.R. 404.1527 and 416.972.
Both of Holly's treating physicians-Dr. Davis, the cardiologist, and Dr. Ardoin, the pulmonologist-have emphatically stated that Holly cannot do labor-intensive work. Dr. Davis also stated that Holly cannot climb stairs. That limitation is supported by Dr. Ardoin's pulmonary function studies. Dr. Davis further told Holly to elevate his legs twice a day for an hour due to swelling and chronic stasis changes with pitting edema in his right leg. Neither physician stated whether Holly can or cannot do light or sedentary work. The ALJ did not request physical residual functional capacity findings from either treating physician. Nor did the ALJ order a consultative examination.
Instead, the ALJ rejected the opinions of both physicians as to Holly's medical condition, and substituted his own opinion that, although Holly has respiratory impairments and obesity: (1) he does not have an atrial septal defect or hypertrophic cardiomyopathy; (2) his pulmonary hypertension, chronic stasis changes in the lower extremities, and obesity are not disabling; and (3) he has only "trivial" regurgitation in the mitral valve and tricuspid valve.
(Doc. 10-1, p. 29/421). The ALJ then found Holly has the residual functional capacity to do the full range of light work, without citing any supporting medical or other evidence for that finding.
A person's "residual functional capacity" is determined by combining a medical assessment of an applicant's impairments with descriptions by physicians, the applicant, or others of any limitations on the applicant's ability to work.
"Light work" is defined in 20 C.F.R. § 404.1567(b) and § 416.967(c) as follows: "Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities."
An ALJ is free to reject a physician's opinion when good cause exists.
In this case, Dr. Ardoin and Dr. Davis both agree on the nature and extent of Holly's medical problems, and their opinions are supported by substantial medical evidence. There is no medical (or other) evidence contradicting their opinions.
The ALJ erred in reinterpreting the medical test results and disagreeing with Holly's two treating specialist-physicians' findings as to the nature, extent, and effects of Holly's medical problems. The medical evidence does not support the ALJ's finding that Holly can walk and/or stand for up to six hours in an eight-hour day, as required for light work. The ALJ's findings as to Holly's residual functional capacity, based on only some of his medical problems, are not supported by substantial evidence.
Therefore, substantial evidence does not support the ALJ's/Commissioner's findings that Holly can perform the full range of light work and is not disabled. Substantial evidence does not support the conclusions of the ALJ and the Appeals Council, their decision is incorrect as a matter of law. Since the VE testified there are no jobs that Holly can do if he must elevate his legs twice a day, the evidence of record shows Holly is entitled to DIB.
Because there is no issue as to Holly's entitlement to DIB, Holly's case should be remanded to the Commissioner to determine the amount of his DIB.
Holly also contends the ALJ's findings as to his credibility are not supported by substantial evidence.
The evaluation of a claimant's subjective symptoms is a task particularly within the province of the ALJ who has had an opportunity to observe whether the person seems to be disabled.
The ALJ made the following findings as to Holly's credibility (Doc. 10-1, pp. 26, 28-30/421):
The ALJ then reviewed the medical evidence though April 2015. The ALJ did not review the medical evidence of June, August, September, and November of 2015.
The ALJ found Holly's physical complaints are non-severe because he did not visit the doctor often.
Therefore, the ALJ's reasoning and finding that Holly was not credible are not supported by substantial evidence.
Because the ALJ/Commissioner erred in finding Holly is not disabled, IT IS RECOMMENDED that the final decision of the Commissioner be VACATED, that Holly be AWARDED DISABILITY INSURANCE BENEFITS, and that Holly's case be REMANDED to the Commissioner for a determination as to the amount of his benefits.
Under the provisions of 28 U.S.C. § 636(b)(1)(c) and Fed. R. Civ. P. 72(b), parties aggrieved by this Report and Recommendation have fourteen (14) calendar days from service of this Report and Recommendation to file specific, written objections with the Clerk of Court. A party may respond to another party's objections within fourteen (14) days after being served with a copy thereof. No other briefs (such as supplemental objections, reply briefs, etc.) may be filed. Providing a courtesy copy of the objection to the undersigned is neither required nor encouraged. Timely objections will be considered by the District Judge before a final ruling.
Failure to file written objections to the proposed findings, conclusions, and recommendations contained in this Report and Recommendation within fourteen (14) days from the date of its service, or within the time frame authorized by Fed. R. Civ. P. 6(b), shall bar an aggrieved party from attacking either the factual findings or the legal conclusions accepted by the District Judge, except upon grounds of plain error.
To be entitled to benefits, an applicant bears the initial burden of showing that he is disabled. Under the regulations, this means that the claimant bears the burden of proof on the first four steps of the sequential analysis. Once this initial burden is satisfied, the Commissioner bears the burden of establishing that the claimant is capable of performing work in the national economy.
It is well-documented in the record that Holly was laid off from his work offshore and lost his medical insurance. (Doc. 10-1, p. 26/421). On January 27, 2015, Dr. Ardoin stated that the loss of insurance would affect Holly's medical care. (Doc. 10-1, pp. 259, 292, 357/421). In June 2015, Dr. Davis also noted the fact that Holly had been laid off from work. (Doc. 10-1, p. 312/421). The ALJ did not discuss this when he stated Holly had not seen his doctors very often.