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Sharon L. Allen v. Michael J. Astrue

August 1, 2011


The opinion of the court was delivered by: Magistrate Judge Michael T. Mason


Michael T. Mason, United States Magistrate Judge:

Claimant Sharon L. Allen ("Allen" or "Claimant") brings this motion for summary judgment [22] seeking judicial review of the final decision of the Commissioner of Social Security ("Commissioner"). The Commissioner denied Allen's claim for disability insurance benefits under Sections 216(i), 223(d) and 1614(a)(3)(A) of the Social Security Act (the "SSA"), 42 U.S.C. §§ 416(i), 423(d) and 1382(c). The Commissioner filed a cross-motion for summary judgment [23], requesting that this Court uphold the decision of the Administrative Law Judge ("ALJ"). This Court has jurisdiction to hear this matter pursuant to 42 U.S.C. § 405(g). For the reasons set forth below, Claimant's motion for summary judgment [22] is denied and the Commissioner's cross-motion for summary judgment [23] is granted.


A. Procedural History

Allen filed applications for period of disability, disability insurance benefits and supplemental security income on January 18, 2007. (R. 60-61). Claimant alleges that she has been disabled since October 28, 2006 due to brittle diabetes, fibromyalgia, retinopathy, hydrothryoidism, neuropathy, osteoarthritis, degenerative disc disease, cervical spine impairment, depression, hypertensive cardiovascular disease, hypertension, scoliosis, hyperlipidemia, and asthma. (R. 65). Her applications were initially denied on April 27, 2007, and again on September 20, 2007, after a timely request for reconsideration. (Id.). On October 16, 2007, Allen filed her request for a hearing. (R. 75). On September 18, 2008, she testified before Administrative Law Judge Denise McDuffie Martin (the "ALJ"). (R. 29-41). On April 7, 2009, the ALJ issued a decision denying Allen's disability claim. (R. 10-20). On April 28, 2009, Allen requested review by the Appeals Council. (R. 6). On January 7, 2010, the Appeals Council denied Allen's request for review, at which time the ALJ's decision became the final decision of the Commissioner. (R. 1-3); Zurawski v. Halter, 245 F.3d. 881, 883 (7th Cir. 2001). Allen subsequently filed this action in the District Court.

B. Medical Evidence

Claimant began receiving treatment for her diabetes mellitus from Dr. Bhavani Sivarajan, an endocrinologist, in June 2004. While many of Dr. Sivarajan's records are illegible, it is clear that Allen saw Dr. Sivarajan regularly, that she was on an insulin pump, that the doctor often checked her feet and adjusted her medication, and that she was at times off of work to regulate her blood sugar. (R. 280-305). Claimant reported episodes of low blood sugar at work as well as retinopathy, hydrothryoidism, and fibromyalgia. (Id.). On March 3, 2005, Dr. Sivarajan noted that Claimant had "brittle" or uncontrolled Type 1 diabetes mellitus. (R. 290).

On March 30, 2005, Claimant was treated in the emergency room of Provena St. Joseph Medical Center ("St. Joseph's") for a possible hypoglycemic reaction. (R. 463). Allen reported several similar episodes in the past. (Id.). Claimant's insulin pump was suspended, she was given a meal, and her condition improved after treatment and observation. (R. 462-64). Claimant was released several hours later. (462).

On April 1, 2005, Claimant followed up with Dr. Sivarajan. He noted that Claimant had recurrent hypoglycemia. (R. 292). Allen was told not to drive and to avoid working with patients. (Id.). The records indicate hypoglycemia again on May 2, 2005.

(R. 296). On May 16, 2005, Claimant reported no more hypoglycemia since she was last seen. (R. 297). Claimant stated that she wanted to return to work. (Id.).

Claimant was treated for a second time in St. Joseph's emergency room for a possible hypoglycemic reaction on July 24, 2005. (R. 469-476). She was combative and disoriented on arrival. (R. 471). Her insulin pump was removed and she improved with treatment and observation. (R. 471-473).

Claimant was treated for a third time in St. Joseph's emergency room on November 5, 2005. (R. 477-487). She had a change in behavior including an altered level of consciousness. (R. 480). The records state that Claimant reportedly has good control of her blood sugar and is compliant with prescribed medications, but has had similar episodes in the past with her insulin pump. (R.480). Allen was given lunch and intravenous medication and was discharged after two hours of observation. (R. 479-481). She was told to follow up with her personal physician. (R. 480).

Claimant saw Dr. Sivarajan next on March 16, 2006. (R. 298). Dr. Sivarajan stated that Claimant had "uncontrolled Type 1 [diabetes] certainly brittle." (Id.). On October 3, 2006, Claimant called Dr. Sivarajan's office and reported that she was told she had to take time off from work that week and would need a note from the doctor stating she is able to work. (R. 301).

On October 18, 2006, Claimant was hospitalized at St. Joseph's Medical Center following an acute hypoglycemic spell. (R. 193, 198). Her admission diagnoses indicated an acute hypoglycemic event, arteriosclerotic heart disease and mild atypical chest pain, as well as endstage complications of diabetes including neuropathy, rentinopathy, and coronary artery disease. (R. 195).

Claimant was evaluated by Dr. Sivarajan during her hospitalization. Dr. Sivarajan noted that Claimant has been a type 1 diabetic for more than forty-three years and has been on an insulin pump. (R. 198). Dr. Sivarajan stated that Claimant has multiple end organ damage, retinopathy, neuropathy, cardiovascular disease, peripheral vascular disease and possible proteinuria, microalbuminuria in the urine. (Id.). He further stated that Claimant has a history of previous multiple hypoglycemias like the one experienced on October 18, but had not experienced any in the past three months. Dr. Sivarajan also noted Claimant's history of coronary artery disease, a heart attack in 2003, angioplasties, bilateral laser surgery of the eyes for retinopathy, severe arthritis, hypertension, hyperlipidemia, gastroparesis, hypothyroidism, fibromyalgia and degenerative joint disease.

Dr. Sivarajan examined Claimant and noted that "she does have bilateral diabetic retinopathy" and "severe peripheral neuropathy on both lower extremities." (R. 199). He diagnosed Claimant with hypoglycemia likely due to gastroparesis, made extensive adjustments to Claimant's medication, and recommended short term disability until the hypoglycemia is corrected. (Id.). Dr. Sivarajan stated that Allen should be free of any hypoglycemic reaction for the next three months before re-evaluating her for work. (Id.).

Claimant also saw Dr. Andrew Wunderlich, her primary care physician, while she was hospitalized. (R. 193-197). Allen was diagnosed with an acute hypoglycemic spell, poorly controlled type 1 diabletes mellitus, arteriosclerotic heart disease, and atypical chest pain. (R. 193). Due to her complaints of chest pain, Dr. Wunderlich ordered an electrocardiogram and laboratory testing, both of which were unremarkable. (Id.). Claimant was discharged from the hospital on October 20, 2006. (Id.).

On October 24, 2006, Allen saw Dr. Wunderlich's partner, Dr. Vemareddy, for an annual physical and follow-up on benign hypertension, dyslipidemia, hypothyroidism and asthma. (R. 236-237). Dr. Vemareddy noted that Claimant was recently hospitalized for a hypoglycemic episode. (Id.) Allen reported that she gets frequent hypoglycemic episodes secondary to gastroparesis. (Id.). She complained of bilateral burning pain in the bilateral feet and right knee osteoarthritis. (Id.). Dr. Vemareddy noted that Claimant was prescribed Cymbalta by Dr. Sivarajan for chronic depression. (Id.). Dr. Vemareddy's assessment and plan noted the following: (1) Claimant suffered from "very brittle" insulin dependent diabetes mellitus that was managed by Dr. Sivarajan, that she would continue on Reglan for the diabetic gastroparesis, and that she should follow up with Dr. Sivarajan secondary to the frequent hypoglycemic events, (2) her benign hypertension was stable on Lisinoprel and Coreg, (3) Claimant's recent stress test was negative, she should continue taking Plavix and follow up with Dr. Ramaduri if she has chest pains or shortness of breath, (4) her dyslipidemia is under good control and Claimant should continue with Lipitor, (5) Claimant has peripheral neuropathy likely secondary to the diabetes and should take Neurotonin three times a day, (6) Claimant's fibromyalgia is stable on Flexeril, and (7) the annual labs that were done during Claimant's hospitalization were within normal limits. (Id.).

On November 2, 2006, Claimant followed up with Dr. Sivarajan. She reported an episode of low blood sugar when she was in a meeting. (R. 303). Dr. Sivarajan adjusted her medication. (Id.). Claimant next saw Dr. Sivarajan on February 27, 2007.

(R. 305). Her blood sugars were increased following an epidural steroid injection but she reported that they were better. (Id.).

Claimant followed up with Dr. Sivarajan on October 1, 2007, February 4, 2008 and June 2, 2008. (R. 400-405). While these records are somewhat illegible, it does not appear that Claimant reported any further hypoglycemic episodes at these office visits. (Id.).

On September 16, 2008, Claimant was treated in St. Joseph's emergency room for a hypoglycemic episode. (R. 488-504). Claimant accidentally ingested too much insulin. (R. 497). She was treated, observed and released after her condition improved. (R. 498).

In addition to receiving treatment for her diabetes, Claimant saw Dr. Murphy for left knee pain and lower back pain on a number of occasions between November 2006 and February 2007. (R. 258-274). A November 9, 2006 x-ray of Allen's left knee revealed severe osteoarthritis primarily in the medial and petellofemoral articulations.

(R. 274). Claimant received a series of Hyalgan injections in her knee in November and December 2006. (R. 262-270). On December 28, 2006, Allen complained of pain in her back radiating down her leg and numbness. (R. 262). Dr. Murphy noted Claimant's diabetic neuropathy and ordered an MRI of her back. (Id.). The MRI revealed degenerative changes at T12-L1 with some dorsal spondylosis, a bulging of the disc that extended no further dorsal than the spurs, and some flattening of the anterior surface of the conus. (R. 272). The exam was otherwise normal. (Id.).

Dr. Murphy saw Claimant again on January 17, 2007. (R. 260). He noted that while the MRI mentioned some disc space narrowing, there was no significant nerve compression or compromise. (Id.). He also noted that Claimant had good lumbar motion, pain in her lower spine with extension, negative straight leg raise, and tenderness in the upper lumbar region. (Id.). Dr. Murphy discussed therapy or an epidural as treatment options. (Id.). Allen chose to go forward with the epidural injection. (Id.). Claimant next saw Dr. Murphy on February 23, 2007. She reported that her knee was doing well and her back was getting markedly better following the epidural injection. (R. 258). Claimant had good range of motion and no tenderness. (Id.).

Claimant's medical records also document her heart condition. She had a heart attack followed by a stent placement in 2004. (R. 413, 446). However, she returned to work following that procedure. (R. 32-33). Claimant had stress tests on August 1, 2007 and April 23, 2008, both of which were within normal limits. (R. 417-422). She was stressed pharmacologically on both occasions rather than by exercise. (Id.).

The medical evidence also includes a report from a consultative examiner, Dr. Afiz Taiwo, prepared at the request of the Bureau of Disability Determination Services.

(R. 324-328). Claimant underwent the consultative exam on April 1, 2007. (R. 324). Dr. Taiwo concluded that Claimant has cervical pain, lumbar pain, tenosynovitis of the left wrist, osteoarthritis of the left knee, diabetes mellitus with diabetic retinopathy and neuropathy, and gait imbalance. (R. 327-328). He also noted that Claimant was obese.

(R. 326). Testing of Claimant's eyes reveled that she is 20/50 in the right eye and 20/40 in the left eye. (Id.). Dr. Taiwo found that Claimant had tenderness at the medial joint in the left knee, crepitus with ...

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