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PREDKI v. HECKLER

September 10, 1985

EMILIA PREDKI, PLAINTIFF,
v.
MARGARET HECKLER, SECRETARY OF HEALTH AND HUMAN SERVICES, DEFENDANTS.



The opinion of the court was delivered by: Rovner, District Judge.

MEMORANDUM OPINION AND ORDER

For the reasons set forth below, this Court reverses the decision of the Secretary and remands the case for further fact findings.

I. History of Proceedings

On November 3, 1981, the plaintiff applied to the Social Security Administration ("SSA") for a period of disability and for disability insurance benefits. Plaintiff claims that she suffers from lupus syndrome, ventricular tachycardia, and Barlow's Syndrome, and that she lives under the threat of severe ventricular arhythmias and the possibility of sudden death. The plaintiff's application was denied initially on March 9, 1982 (R. 65), and again on reconsideration on April 28, 1982. A hearing was conducted on January 10, 1983 before an administrative law judge ("ALJ"). The ALJ denied plaintiff's claim on February 22, 1983.

In his decision denying disability benefits, the ALJ determined initially that the claimant is unable to perform her past relevant work. The ALJ also found, however, that the plaintiff was not under a disability and that she maintains the capacity to perform a full range of light work. The plaintiff sought review of the ALJ's decision by the Social Security Administration Appeals Council. The Appeals Council denied review, which renders the ALJ's opinion the final decision of the Secretary. The plaintiff then filed a timely request for federal judicial review pursuant to 42 U.S.C. § 405(g) (1982).

II. Review of the Evidence

The plaintiff, Emilia Predki, was fifty years old at the time of the hearing. She was born in Poland and received a high school education in Africa. The plaintiff came to the United States in 1952 and thereafter learned English by listening. Although she can read and write, the plaintiff testified that she misses a few words and that she has trouble spelling. The plaintiff was employed first in quality control at a television factory and later she worked as a bindery worker. The defendant's vocational expert characterized these jobs as semi-skilled (R. 9).

Plaintiff claims that she has been disabled since April of 1981 because she suffers from several serious diseases. First, plaintiff claims that she has lupus syndrome, because she suffers pain and swelling in her arms and hands. Systemic lupus erythematosus is an inflammatory connective tissue disorder. The Merck Manual at 1207 (14th ed. 1982). As the medical evidence shows, however, plaintiff does not suffer from systemic lupus erythematosus but rather she suffers only from drug-induced lupus syndrome (R. 104, 112, 133, 134, 137). Next, plaintiff complains that she suffers from Barlow's syndrome, or mitral prolapse syndrome. Prolapse of the mitral valve is a chronic heart valve disease "now recognized as a common and sometimes serious and progressive lesion." The Merck Manual at 526 (14th ed. 1982). Plaintiff also suffers from ventricular tachycardia. This disease is defined as "an abnormal rapid beat of the heart, from 150 to 200 beats per minute, associated with minor irregularities of the rhythm." 3 Schmidt's Attorney's Dictionary of Medicine at V-50 (1979). Finally, plaintiff claims that she lives "under the threat of severe ventricular arhythmias and the incidence of sudden death." Arhythmia is the loss of or variation in the normal rhythm of the heart beat, resulting in, inter alia, fast beats. 3 Schmidt's Attorney's Dictionary of Medicine at A-274 (1979).

The medical evidence begins with the records of Memorial Hospital of Elmhurst. The plaintiff was hospitalized on January 16, 1979. She complained of syncope (fainting) preceded by moments of dizziness. An electrocardiogram given to the plaintiff confirmed the presence of ventricular tachycardia. The plaintiff was released on January 23, 1979, put on medication, and advised to avoid excessive activity (R. 130).

The plaintiff was again hospitalized at Memorial Hospital in July of 1979 due to complaints of syncope (R. 126). The treating physician at Memorial Hospital, Dr. J.M. Stoker, M.D., diagnosed the plaintiff as having ventricular tachycardia, documented at a rate of 210, and possibly having Barlow's Syndrome. Dr. Stoker then advised that the plaintiff be transferred to the Arhythmia Unit of Northwestern University Medical Center for evaluation and therapy by Dr. Martin Grais, M.D., a cardiologist (R. 126-127, 129).

The records at Northwestern Hospital noted that the plaintiff continued to have persistent syncopal episodes while on antiarhythmic therapy. She was suffering from paroxysmal ventricular tachycardia (R. 98). While at Northwestern Hospital, the plaintiff underwent an echocardiographic test which showed that plaintiff also suffered from Barlow's syndrome (R. 101). In a letter to Dr. Stoker, dated August 9, 1979, Dr. Grais reported that the plaintiff remains asymptomatic and has no augmentation of arhythmia (R. 101). Dr. Grais also noted the possibility of lupus in view of the plaintiff's intake of Pronestyl. Dr. Grais determined that the plaintiff could be discharged for outpatient follow up. The plaintiff subsequently was discharged but remained on medication, including Pronestyl and Inderal, in order to control her tachycardia (R. 99).

The plaintiff was hospitalized again at Northwestern Hospital on April 5, 1981, complaining of transient joint symptoms in the knees, wrists, and shoulders (R. 103, 112). Dr. Grais determined that the plaintiff had a reaction to the drug Pronestyl, which caused the plaintiff to develop a lupus-like syndrome (R. 104). This lupus-like syndrome was documented by a positive ANA test. Consequently, she was taken off Pronestyl in April of 1981 (R. 103).

In November of 1981, Dr. Stoker reported that the plaintiff had been free of significant syncope episodes (R. 104). Furthermore, Dr. Stoker noted that the plaintiff had tolerated the omission of the drug Pronestyl but "subsequently has had a general fatigue feeling and has some residual arthritic symptoms although the Lupus status is gradually clearing". He also noted, however, that plaintiff carries a continual long-term risk of syncope or serious cardiac arhythmia. She is on high doses of Inderal which has a sedative and depressing effect, but the use of adequate medication is extremely important. Dr. Stoker also noted that there is a potential risk that heavy physical or stressful situations would subject plaintiff to serious arhythmias. In his November, 1981 letter, Dr. Stoker concluded that "the only practical employment situation for her would be near her home . . . in situations of strictly office or clerical and minimum stress activity" (R. 104).

In December of 1981, the Illinois Bureau of Disability Adjudication Services referred plaintiff to a Dr. Bacalla, M.D. (R. 105). After examining plaintiff, Dr. Bacalla reported that the heart rate was normal and that there were no gross cardiomegaly or murmurs (R. 107). Dr. Bacalla did find sinus bradycardia, which is a slowness of the heart beat due to a disturbance in the right atrium of the heart; 3 Schmidt's Attorney's Dictionary of Medicine at B-76 (1979). While he observed some soft tissue swelling and tenderness of the hands, there were no joint deformities noted. Dr. Bacalla did not diagnose arhythmia. Moreover, Dr. Bacalla did not offer any evidence or make any statements regarding the plaintiff's functional capacity to work.

The administrative record also includes a letter written by Dr. Stoker on January 18, 1983, which the ALJ did consider in making his determination (R. 135-136). For four years, Dr. Stoker was plaintiff's treating physician. Dr. Stoker reported that the plaintiff is subject to increasing or changing susceptibility to ventricular irritability even though at times in the past her condition has been under control. Dr. Stoker further reported:

  At this time, she is manifesting increased ventricular
  extrasystoles and the history strongly supports an episode of
  fainting with symptoms compatible with a return of at least
  short bouts of tachycardia. Mrs. Predki continues on extremely
  high doses of the beta-blocker medication called . . . Inderal,
  and this continues to have a sedative effect and has a slowing
  effect on her basic heart rate and a tendency to drop her blood
  pressure. All of the above side effects must be accepted in the
  treatment program and contribute to her reduced functional
  status (R. 135).

Dr. Stoker further advised that the only kind of work situation of which plaintiff is capable would be clerical-type work in her home. The basis of this evaluation is that the plaintiff lives under the threat of severe ventricular arhythmias and the incidence of sudden death (R. 135). The risk of sudden death is enhanced by increased heart irritability "which could be a result of unusual physical activity, increased metabolic changes such as high fever or even the stress of mental aggravation or strain" (R. 135). In other words, in order to prevent and control the risk of these serious illnesses, not only does the plaintiff have to be on high dosages of medication, but her physical environment must be strictly controlled. Finally, Dr. Stoker also stated that the plaintiff's condition "has to do with a possible gradual degeneration of the collagen disease in the heart muscle and valves," and that with the passage of time, the plaintiff will need regular follow-up examinations and "possibly the use of more and newer suppressive medication" (R. 135).

In addition, the plaintiff testified regarding her symptoms and diseases at the administrative hearing. The plaintiff stated that she was unable to work after April of 1981 (R. 38). She testified that she had pain in her chest and that her arm was swollen. She was unable to walk because her entire body was in pain. She stated that although she could move her arm, if she reached for too long a period of time, she would get dizzy (R. 39). Plaintiff also testified that she suffered fatigue because of her chest pains. In a period of six months, the plaintiff stated that she had fainted twenty times.

With regard to her residual functional capacity, the plaintiff testified that she was told by her doctor not to lift heavy articles or shovel snow and that she was to rest (R. 45). Plaintiff also stated that she can do only some housework for ten to fifteen minutes before she becomes fatigued and must sit or lie down. Furthermore, during the summertime, she can do housework for only five minutes at a time (R. 46). Plaintiff testified that she cannot work at all because she gets tired very fast ...


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