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
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 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.
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 ...