United States District Court, D. Arizona
J. Markovich United States Magistrate Judge
Bruce P. Murchison (“Murchison”) brought this
action pursuant to 42 U.S.C. § 405(g) seeking judicial
review of a final decision by the Commissioner of Social
Security (“Commissioner”). Murchison raises two
issues on appeal arguing that the Administrative Law
Judge's (“ALJ”) decision was not based on
substantial evidence because: 1) the ALJ did not properly
evaluate the medical evidence from Murchison's treating
physicians, Dr. Rogers and Dr. Puri; and 2) the ALJ's
hypothetical to the Vocational Expert (“VE”) did
not include all of Murchison's limitations. (Doc. 17 at
the Court are Murchison's Opening Brief, Defendant's
Response, and Murchison's Reply. (Docs. 17, 19, &
22). The United States Magistrate Judge has received the
written consent of both parties and presides over this case
pursuant to 28 U.S.C. § 636(c) and Rule 73, Federal
Rules of Civil Procedure. For the reasons stated below, the
Court finds that the Commissioner's decision should be
filed an application for Disability Insurance Benefits
(“DIB”) on September 17, 2012. (Administrative
Record (“AR”) 59). Murchison alleged disability
beginning on May 2, 2012 based on narcolepsy and chronic
fatigue. Id. Murchison's application was denied
upon initial review (AR 57, 73) and on reconsideration (AR
75, 90). A hearing was held on February 19, 2015 (AR 26),
after which ALJ Mary P. Parnow found, at Step Four, that
Murchison was not disabled because he was able to perform his
past relevant work (“PRW”) as a high school and
college teacher. (AR 22). On January 26, 2017 the Appeals
Council denied Murchison's request to review the
ALJ's decision. (AR 1).
date last insured (“DLI”) for DIB purposes is
December 31, 2016. (AR 171). Thus, in order to be eligible
for benefits, Murchison must prove that he was disabled
during the time period of his alleged onset date
(“AOD”) of May 2, 2012 and his DLI of December
was born on October 5, 1967 making him 44 at the AOD of his
disability. (AR 59). Murchison earned a Master's Degree
in Education Administration (AR 33) and completed law school
but did not pass the Arizona bar exam (AR 221). He worked
primarily as a high school teacher from 1992-2012 (AR 34,
175) and also worked as an adjunct professor at Pima
Community College and delivered pizzas part-time (AR 34).
12, 2010 Murchison was seen by Dr. Puri at Pima Lung &
Sleep for a narcolepsy evaluation. (AR 252). Murchison
reported that he had an abnormal polysomnogram during
training for the National Guard so he was told to see a sleep
specialist. Murchison stated that he had no daytime problems,
that his sleep was not restorative, and that he occasionally
felt weak and had cataplexy. He also reported trouble driving
and nearly rear-ending other cars. Dr. Puri's diagnosis
was narcolepsy-cataplexy syndrome, with extremely mild
cataplexy. (AR 253). Dr. Puri prescribed Provigil and
recommended a repeat polysomnogram with multiple sleep
latency tests and a urine toxicology screen.
December 8, 2010 Murchison saw Dr. Puri for a follow-up. (AR
249). Dr. Puri noted that Murchison had multiple sleep
latency tests on November 13, 2010 which showed an abnormal
mean sleep onset latency of 8.7 minutes. Murchison's
insurance did not cover the Provigil so it was changed to
Nuvigil; Murchison reported it worked for three or four days
and then the effect wore off. He took it for 30 days and had
no improvement in daytime sleepiness. Murchison reported that
he became drowsy at work but had not fallen asleep, and also
became drowsy while driving and would pull over. He did not
have any episodes of cataplexy or sleep paralysis. Dr. Puri
assessed narcolepsy with cataplexy syndrome and noted
Murchison was not currently having any cataplectic episodes
but was hypersomnolent. (AR 250). Dr. Puri increased the
Nuvigil dosage and noted that if it did not work, he might
have to add another medication or change the prescription to
Provigil. Dr. Puri also suggested strategic naps could help
but noted that Murchison could not nap while teaching.
February 9, 2011 Murchison saw Dr. Puri for a follow-up. (AR
245). Murchison had dizziness, headaches, and nausea from the
increased Nuvigil, so Dr. Puri stopped the medication. With
no medication, Murchison had increased hypersomnia and
difficulty driving. Dr. Puri noted that since the Nuvigil did
not work, they would petition the insurance company to cover
the Provigil. Dr. Puri assessed narcolepsy without cataplexy,
currently with significant hypersomnia. (AR 246). Dr. Puri
also completed a form for the Tucson Unified School District
noting that Murchison's condition caused him to become
“profoundly sleepy” and recommending that
Murchison be transferred to
a school closer to home so that he could either walk or drive
a shorter distance to work. (AR 244).
On March 16, 2011 Murchison saw Dr. Puri for a follow-up. (AR
242). Murchison was taking Provigil twice a day and reported
that he was doing better and was more alert, and wanted to
continue the medication. He was still occasionally sleepy
while driving but did not have any accidents. Dr. Puri
assessed narcolepsy without cataplexy and with significant
hypersomnia, improved with Provigil. (AR 243).
On June 16, 2011 Murchison had a follow-up with Dr. Puri and
reported he was not using Provigil routinely and had chronic
headaches; he thought the Provigil made the headaches worse
but also wanted to continue using it because it helped his
narcolepsy. (AR 240). Dr. Puri recommended Murchison decrease
his morning dose of Provigil and skip the afternoon dose
unless he needed it, and also noted they could try different
medications. (AR 241).
On August 4, 2011 Dr. Puri noted Murchison was doing fairly
well, was only using Provigil on an as needed basis, and did
not have any cataplexy. (AR 238). Murchison reported he was
still fighting to be transferred to a school closer to his
home. Dr. Puri assessed narcolepsy with cataplexy, well
controlled, continue Provigil. (AR 239).
On March 21, 2012 Murchison saw Dr. Puri and reported that he
was doing well but felt his narcolepsy was worsening because
he felt like he was falling asleep in class and having
trouble staying awake. (AR 236). He was taking Provigil three
to four times a week when feeling tired. The school district
would not transfer him to a school closer to his house.
Murchison also reported headaches not always associated with
Provigil. (AR 237). Dr. Puri assessed narcolepsy without
cataplexy and recommended Murchison take his Provigil
consistently and resume the afternoon dose if having
On May 1, 2012 Murchison was seen by Dr. Rogers at El Dorado
Internal Medicine with a complaint of extreme fatigue and
headaches, and requested that Dr. Rogers fill out his FMLA
paperwork. (AR 267). Murchison reported falling asleep in
class while teaching and in his car in a parking lot. Dr.
Rogers completed the forms and noted Murchison would continue
Provigil and consider a trial of Ritalin or another
medication if the Provigil was not effective.
5, 2012 Murchison saw Dr. Puri and reported that he did not
feel good; he felt like he was going to pass out when
lecturing and the Provigil was still giving him headaches.
(AR 234). Dr. Puri assessed headaches, possibly related to
Provigil but also antedate it and occur before taking the
pill, and episodes of pre syncope, not consistent with
cataplexy. Dr. Puri also assessed narcolepsy without
cataplexy and discussed other medication options with
Murchison. (AR 235).
16, 2012 Murchison saw Dr. Rogers for a physical. (AR 265).
He reported episodes of falling asleep during the day, and
noted that he applied for disability but was denied.
11, 2012 Murchison saw Dr. Puri and reported concerns with
his Ritalin and Provigil and thought there might be something
wrong with him neurologically. (AR 230). The Ritalin helped
him concentrate but the Provigil did not give him the
benefits he wanted. Murchison also reported headaches,
occasional ataxia, and hypersomnolence in class. Dr. Puri
assessed headaches and narcolepsy without cataplexy,
recommended Murchison continue with Provigil and Ritalin, and
referred him to a neurologist. (AR 231).
18, 2012 Murchison was seen at the Center for Neurosciences
for a consultation for new medications for his narcolepsy.
(AR 260). He reported difficulty staying awake starting four
years ago; Provigil helped initially but then stopped
working, Nuvigil gave him headaches, and Ritalin did not keep
him awake but allowed him to concentrate slightly better.
Murchison reported some memory loss but no depression. (AR
261). The impression was narcolepsy without cataplexy, and
Dr. Badruddoja recommended a MRI and bloodwork. (AR 262).
30, 2012 Murchison had a follow-up at the Center for
Neurosciences. (AR 258). He reported continuing difficulty
with his narcolepsy but was otherwise doing well.
Badruddoja noted Murchison did not have the MRI or lab work
completed and recommended that he still do both. (AR 258-59).
Dr. Badruddoja also recommended Pristiq as an alternate
medication. (AR 258).
October 19, 2012 Murchison was seen by Dr. Rogers and
requested disability paperwork stating that he was still
taking medication for narcolepsy. (AR 264). Murchison
reported that his medications did not provide complete relief
and that narcolepsy prevented him from driving and interfered
with his work. Findings on exam included normal mood and
March 1, 2013 Murchison saw Dr. Rogers to have disability
paperwork completed. (AR 291). Murchison stated that he could
drive short distances but someone drove him to and from
Phoenix to attend law school. He reported falling asleep
occasionally in class and often while reading, and fell
asleep while talking on the phone. Murchison also reported a
six month history of weakness in his thighs that occurred
late in the day, three times a week. He was worried about
losing his prescription benefits and not being able to afford
Provigil. Dr. Rogers assessed limb weakness, numbness, and
narcolepsy (unchanged), and recommended Murchison see Dr.
Eichling for a second opinion. (AR 292).
17, 2013 Murchison saw Dr. Rogers to have paperwork completed
for his insurance benefits. (AR 289). Murchison reported he
was on leave from his job as a teacher because he had to
drive too far to the school and the district would not
accommodate him. Murchison stopped taking Nuvigil because it
was too expensive and did not help much; he had not seen Dr.
Puri in a year.
October 24, 2014 Murchison saw Dr. Puri for a follow-up and
because he needed supportive evidence because his disability
benefits were ending. (AR 316). Dr. Puri noted Murchison was
quite upset because his insurance company would not cover the
Provigil; he was having trouble concentrating in class,
falling asleep in class, and could not finish tests in time.
Dr. Puri noted that Murchison:
has had considerable workup, demonstrating narcolepsy with
cataplexy syndrome. This is a disorder, in which patients are
quite disabled, usually with severe sleepiness. They can have
sleep/drop attacks during the day. Concentration is difficult
because of micro sleep episodes. And hence task/test
completion can be a problem. With cataplexy, patients can
have drop attacks with ...