United States District Court, D. Arizona
ORDER
BRIDGET S. BADE UNITED STATES MAGISTRATE JUDGE
Plaintiff
Elaine Quintana seeks judicial review of the final decision
of the Commissioner of Social Security (the
“Commissioner”) denying her application for
benefits under the Social Security Act (the
“Act”). The parties have consented to proceed
before a United States Magistrate Judge pursuant to 28 U.S.C.
§ 636(b) and have filed briefs in accordance with Rule
16.1 of the Local Rules of Civil Procedure. As discussed
below, the Court vacates the Commissioner's decision and
remands for further proceedings.
I.
Procedural Background
In
October 2013, Plaintiff applied for Social Security
Disability Insurance (“SSDI”) alleging a
disability onset date of October 19, 2011.[1] (Tr.
145-46.)[2] Plaintiff alleged disability based on
neuropathy in her hands and feet, weakness in her wrists,
chronic joint pain in her fingers, wrists, elbows, knees and
hips, shoulder pain, blurry vision, and teary eyes. (Tr.
211.) Plaintiff alleged that all of these conditions were
caused by the medication she took during chemotherapy.
(Id.) She also alleged fatigue. (Tr. 27.) After
Plaintiff's application was denied on initial review, and
on reconsideration, she requested a hearing before an
administrative law judge (“ALJ”). (Tr. 22.)
Following a hearing the ALJ issued a decision finding
Plaintiff not disabled under the Act. (Tr. 22-38.) Plaintiff
requested review of the ALJ's decision. (Tr. 1-7.) The
Social Security Appeals Council denied Plaintiff's
request for review and Plaintiff now seeks judicial review of
the Commissioner's decision pursuant to 42 U.S.C. §
405(g).
II.
Administrative Record
The
administrative record includes medical records pertaining to
the history of diagnoses and treatment of Plaintiff's
alleged impairments. The record also includes several medical
opinions. The Court discusses the relevant records and
opinions below
A.
Medical Treatment Records
In
December 2011, Plaintiff was diagnosed with breast cancer.
(Tr. 366-67.) Oncologist Ian K. Komenka, M.D., prescribed six
cycles of intravenous chemotherapy. (Tr. 367.) Plaintiff was
also treated with radiation. (Tr. 673.) In February 2012, a
liver biopsy revealed that Plaintiff had severe liver
disease. (Tr. 401-02.) In April 2012, Plaintiff's
treating gastroenterologist, Abdul Nadir, M.D., noted that
Plaintiff was currently receiving chemotherapy and had
several side effects including fatigue. (Tr. 468.) In May
2012, Colan Kennelly, M.D., noted that Plaintiff had
“puffy eyes with excess tearing for 3 weeks, ”
which was a symptom of conjunctivitis but was also a side
effect of the chemotherapy drug Taxotere. (Tr. 311.) In June
2012, Plaintiff reported that she was exhausted from
chemotherapy and wanted to postpone breast surgery for a
month. (Tr. 504.)
In July
2012, Plaintiff had surgery, including a right wire-guided
lumpectomy. (Tr. 522.) In February 2013, after Plaintiff
completed chemotherapy, Dr. Nadir prescribed hepatitis
treatment. (Tr. 607, 661.) After her chemotherapy treatment
ended, Plaintiff also continued to receive Herceptin
intravenously for one year. (Tr. 458-59, 519.) In March 2013,
while Plaintiff was undergoing hepatitis treatment, Charlotte
Gurule, M.D., noted that Plaintiff had chronic abdominal
pain, lymphedema of the right arm, right shoulder and middle
back pain, and ongoing numbness in the hands and feet. (Tr.
304.) Plaintiff reported that she frequently dropped things
due to numbness in her hands. (Id.) In May 2013,
Plaintiff told Dr. Gurule she felt weak and lightheaded and
had severe skin itching and fatigue. (Tr. 300.) That same
month, Plaintiff was hospitalized and had a blood transfusion
for severe anemia. (Tr. 328-31.) In May 2013, Dr. Nadir
decreased Plaintiff's dose of hepatitis medication,
Ribavivrin, due to dizziness, shortness of breath, and
weakness. (Tr. 686-90.) In August 2013, Dr. Nadir noted
Plaintiff had had 21 shots of the hepatitis medication
Pegasys, and was “still experiencing nausea, vomiting
and headache and fatigue.” (Tr. 724.)
In
October 2013, Sabrina Pojar, D.O., noted that Plaintiff had
joint pain “most likely from osteoarthritis, ”
but medications used to treat hepatitis “have a side
effect of arthritis and arthralgia.” (Tr. 953.) On
examination, Dr. Pojar observed Plaintiff had bilateral
finger joint swelling and bilateral knee crepitus. (Tr. 956.)
In November 2013, Dr. Nadir noted Plaintiff was no longer
receiving treatment for hepatitis, but she had abdominal pain
and elevated liver function levels on laboratory testing.
(Tr. 748-49.)
In
January 2014, rheumatologist Stuart Posner, M.D., noted that
Plaintiff had ongoing “generalized joint pain, ”
“general fatigue, ” and an x-ray suggested
probable degenerative arthritis in the knees. (Tr. 779.) Dr.
Posner noted that Plaintiff had mild compression tenderness
of the finger joints, mild crepitation in both knees, and a
restricted range of motion of the left shoulder.
(Id.) In April 2014, Dr. Pojar noted that
Plaintiff's pain was “uncontrolled.” (Tr.
976.) Plaintiff reported muscle cramps in her jaw, right
foot, arms, and back. (Id.) She reported that muscle
cramps were worse with stretching or walking. (Id.)
She also had continued polyarthalgias. (Id.) In May
2014, Plaintiff reported to Duane Mitzel, M.D., that she had
tearing, eye discharge, burning eyes, and blurred vision.
(Tr. 826-27.) In July 2014, Plaintiff reported to Dr. Pojar
that she had “diffuse pain, muscle cramping, and
occasional numbness and tingling in hands and feet.”
(Tr. 966.) Dr. Pojar noted that Plaintiff had undergone
chemotherapy and that paraesthesias was a side effect.
(Id.) Plaintiff reported decreased activity.
(Id.)
In
December 2014, Zachary Ortiz, M.D., noted that Plaintiff
reported pain in the groin, legs, arms, stomach, and back,
that “appears consistent with neuropathy of unclear
etiology, chemo side effect, depression.” (Tr. 887.) In
May 2015, Dr. Pojar noted Plaintiff had a normal vision
screen and eye examination but had “nonspecific color
and flashes of light in both eyes.” (Tr. 979.) In
August 2015, Dr. Nadir noted that Plaintiff had stopped
treatment for hepatitis over one year ago but she continued
to report fatigue and joint pain. (Tr. 1002.) In October
2015, an abdominal ultrasound revealed that Plaintiff had
hepatic cirrhosis. (Tr. 1092.)
B.
Medical Opinion Evidence
1.
Non-Examining Physicians
As part
of the initial state agency determination, in February 2014,
Allen Radkowsky, M.D., opined that Plaintiff retained the
physical abilities to perform light work with some
restrictions, including occasionally climbing ladders, ropes,
and scaffolds, and occasionally crawling. (Tr. 65-67.) As
part of the reconsideration determination, in October 2014,
Michael Keer, D.O., assessed the same physical abilities and
restrictions. (Tr. 82-85.)
2.
Treating Physician Opinion
In
October 2015, Dr. Nadir completed a Medical Assessment of
Ability to do Work-Related Physical Activities. (Tr. 984-85.)
Dr. Nadir opined that Plaintiff could sit, stand, or walk
less than two hours in an eight-hour day. (Tr. 984.) Dr.
Nadir opined that Plaintiff needed to change positions and
rest every ten to fifteen minutes. Dr. Nadir opined that
Plaintiff's “symptoms” caused moderately
severe limitations, defined as limitations that would result
in being “[o]ff task 16-20% of an 8-hour day.”
(Tr. 985.) The form asked Dr. Nadir to identify those
symptoms by “(circl[ing] all that apply) pain, fatigue,
dizziness, headaches, other.” (Id.) Dr. Nadir
did not circle any of the listed symptoms or identify any
“other” symptoms. (Id.) Dr. Nadir opined
that Plaintiff's “medical condition” would
cause her to miss work four to five days per month.
(Id.) Dr. Nadir indicated that he had provided or
supervised Plaintiff's treatment and that he has
considered and reviewed his treatment notes, records from
other providers, laboratory reports, and Plaintiff's
responses to treatment. (Id.) He indicted
“no” in response to whether “the
limitations result from objective, clinical, or diagnostic
findings which have been documented either by [him], or
elsewhere in the patient's medical records.”
(Id.)
III.
The Administrative Hearing
Plaintiff
was fifty-five years old at the disability onset date and
fifty-nine years old as of the date of the administrative
hearing. (Tr. 41, 43.) Plaintiff had a high school education
and her past relevant work included work as a “clerk,
” a light, skilled job. (Tr. 30-31.)
Plaintiff
testified at the administrative hearing, but the ALJ did not
call a vocational expert to testify. (See tr. 39.)
At the administrative hearing Plaintiff testified that while
undergoing treatment for breast cancer, she was
“constantly sick, very fatigued, ” and “had
issues with walking.” (Tr. 45.) Plaintiff also had
“problems with [her] legs and [her] hands.”
(Id.) Plaintiff stated that a few months after her
breast cancer treatment ended, she started treatment for
advanced liver fibrosis. (Tr. 46-47.) Plaintiff completed
five months of that treatment but could not finish the whole
course of treatment. (Tr. 47.) Plaintiff continued to have
significant fatigue following her treatment for breast cancer
and liver problems. (Tr. 47-48.) Plaintiff testified that the
fatigue was “like somebody took all [her] energy. [She
couldn't] function [and] need[ed] to just go lay
down.” (Tr. 48, 49.) Plaintiff stated that she
experienced daily fatigue that required her to nap for two to
three hours. (Id.)
Plaintiff
testified that she also had joint pain in her hands,
knuckles, shoulders, knees, and feet. (Tr. 50.) Plaintiff
stated that the pain in her hands caused her to drop objects.
(Tr. 51.) Plaintiff also had ductal tearing as a result of
chemotherapy and “it look[ed] like [she was] always
crying, ” and made her vision blurry. (Tr. 52.)
Plaintiff testified that three or four times a month she got
headaches that usually lasted four hours and that made her
need to lie down. (Tr. 53-54.)
IV.
The ALJ's Decision
A
claimant is considered disabled under the Social Security Act
if she is unable “to engage in any substantial gainful
activity by reason of any 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 12 months.” 42 U.S.C. §
423(d)(1)(A); see also 42 U.S.C. §
1382c(a)(3)(A) (providing a nearly identical standard for
supplemental security income disability insurance benefits).
To determine whether a claimant is disabled, the ALJ uses a
five-step sequential evaluation process. See 20
C.F.R. §§ 404.1520, 416.920; see, e.g.,
Garrison v. Colvin, 759 F.3d 995, 1010 (9th Cir.
2014).
A.
The Five-Step Sequential ...