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Winfred D. Ramey v. Michael J. Astrue

September 26, 2011


The opinion of the court was delivered by: Magistrate Judge Young B. Kim


Plaintiff Winfred Ramey ("Ramey") seeks review of the final decision of the Commissioner of Social Security ("Commissioner") denying his application for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act ("Act"), 42 U.S.C. § 423(d)(2), and Supplemental Security Income ("SSI") under Title XVI of the Act, 42 U.S.C. § 1382c(a)(3)(A). Before the court are the parties' cross-motions for summary judgment. Ramey asks the court to reverse the Commissioner's decision and award benefits, or in the alternative, to remand the case for further proceedings. The Commissioner seeks an order affirming the decision. For the following reasons, Ramey's motion for summary judgment is granted insofar as it requests a remand and the Commissioner's motion is denied:

I. Procedural History

Ramey applied for DIB and SSI on June 2, 2005, alleging that he became disabled on January 26, 2005, due to diabetes, kidney failure, poor circulation, and back problems. (Administrative Record ("A.R.") 16, 87-89, 394-99, 410.) His applications were denied initially on August 30, 2005, (id. at 40-44), and again on reconsideration on January 6, 2006, (id. at 49-52, 407-10). Thereafter, Ramey requested and received a hearing before an administrative law judge ("ALJ"). (Id. at 54, 575-612.) One month after the hearing, on January 12, 2007, the ALJ issued a decision finding Ramey not disabled. (Id. at 415-23.) The Appeals Council granted Ramey's request that it review the ALJ's decision, and on September 28, 2007, it vacated the ALJ's decision and remanded the case for further proceedings and a new decision. (Id. at 427-28.)

The ALJ held a second hearing in February 2009, and on March 3, 2009, the ALJ issued a second decision again finding Ramey not disabled. (Id. at 16-25.) This time the Appeals Council denied Ramey's request for review, making the ALJ's decision the final decision of the Commissioner. (Id. at 5-7.) See Getch v. Astrue, 539 F.3d 473, 480 (7th Cir. 2008). Pursuant to 42 U.S.C. § 405(g), Ramey initiated this civil action for judicial review of the Commissioner's final decision. The parties have consented to the jurisdiction of this court pursuant to 28 U.S.C. § 636(c).

II. Background

A. Summary of Medical Evidence

Ramey, who is now 54 years old, suffers from insulin-dependent diabetes mellitus, hypertension, cerebrovascular disease with residual left-sided weakness as a result of a stroke, chronic obstructive pulmonary disease, chronic lower back pain, and chronic left leg pain and swelling. (A.R.19, 638-39, 647.) His problems began in January 2005, when he was injured in a car accident and sought emergency medical treatment for left-sided neck and lower back pain. (Id. at 160, 162.) An x-ray evaluation of the cervical and lumbar spines showed mild narrowing of the intervertebral disc space, minimal degenerative changes, and mild spurring. (Id. at 170.) Ramey was diagnosed with acute cervical spine and lumbosacral spine contusions and prescribed pain medication. (Id. at 163.)

In June 2005, Ramey suffered a stroke. He reported to an emergency room with left-sided weakness and blurry vision, and he complained that he was dropping things. (Id. at 182-84, 190.) Following an initial examination, Ramey was hospitalized for a two-week period. He had numerous diagnostic tests-including chest x-rays, electrocardiograms, Doppler testing, and CT and MRI scans-which produced abnormal results. (Id. at 215-23, 302, 304-06.) In particular, MRI scans of Ramey's brain showed atrophy and "[w]hite matter findings consistent with chronic ischemia" (restriction in blood flow). (Id. at 216-17, 221.) Furthermore, an MRI of the cervical spine confirmed the earlier diagnosis of mild intervertebral disc degenerative changes. (Id. at 223.) Other tests showed that Ramey had an enlarged heart and markedly reduced lung capacity. (Id. at 207, 215.)

Ramey's doctors also diagnosed him as suffering from multiple problems in his lower extremities likely related to his stroke and diabetes. For example, he was experiencing significant venous stasis (slow blood flow in the veins) with varicose veins and edema on the left side and poor peripheral pulses in the feet. (Id. at 184-85.) He exhibited decreased strength in his left leg, causing a lack of coordination of movement. (Id. at 188.) Ramey underwent physical therapy in an attempt to strengthen his left leg. (Id. at 201.) While hospitalized, he was diagnosed with diabetes mellitus, hypertension, peripheral vascular disease (obstruction of large arteries not within the heart or brain), probable stroke, and baseline chronic obstructive pulmonary disease due to smoking. (Id. at 185, 208.)

Shortly after Ramey was released from the hospital, a state agency physician, Dr. Stanley Rabinowitz, evaluated Ramey. (Id. at 309-11.) Ramey complained to Dr. Rabinowitz that for fifteen years he had suffered from diabetes, which caused intermittent blurred vision and required him to take insulin. (Id. at 309.) He also complained of persistent balance difficulties stemming from his recent stroke. (Id.) Dr. Rabinowitz observed a number of impairments on Ramey's left side. (Id. at 310.) He noted that Ramey had moderate to severe varicose veins, particularly in his left leg. (Id.) He also noted that Ramey's left hand grip strength was 70 percent of normal strength and that his digital dexterity was mildly impaired. (Id.) Ramey displayed mild motor weakness, and decreased light touch and pinprick sensation in the left upper and left lower extremities. (Id. at 311.) Gait testing indicated a left antalgic gait (a limp used to avoid pain on weight-bearing structures). (Id.) Because of his left-sided weakness, Ramey walked with a cane for support. (Id.) Dr. Rabinowitz diagnosed a history of exertional dyspnea (breathlessness) and chronic cigarette dependency, a stroke with mild residual left hemiparesis (weakness) and a left hemisensory (loss of sensation) deficit, and insulin-dependent diabetes mellitus. (Id.)

About a month later, in August 2005, Dr. Patey Robert, a state agency physician, reviewed Ramey's medical file and completed a Physical Residual Functional Capacity ("RFC") Assessment form. (Id. at 317-24.) Dr. Robert opined that Ramey can occasionally lift and carry 20 pounds, frequently lift and carry 10 pounds, stand and walk for about six hours in an eight-hour workday, sit for about six hours in an eight-hour workday, and occasionally climb, balance, stoop, kneel, crouch, and crawl. (Id. at 318-19.) A state agency medical consultant agreed with this assessment. (Id. at 325-26.)

Throughout the first half of 2006, Ramey sought treatment for symptoms related to his diabetes. For example, in January, Ramey had emergency medical treatment for swelling in his left lower leg that had persisted for seven to eight months. (Id. at 19, 565.) He complained that for several weeks he had endured pain in his toes that went up into his thigh. (Id. at 565.) His discharge diagnoses included chronic swelling and pain in the left leg with dilated superficial veins in his left calf. (Id. at 565-66.) That same month Ramey had diabetic foot care to treat swelling and varicosity of his left foot. (Id. at 559-60.) In May, he suffered other diabetes-related conditions, including retinopathy (damage to retina of the eye), nephropathy (disease of the kidneys), and neuropathy (nerve damage of the extremities). (Id. at 557.) And in July, a physical examination confirmed swelling of the left lower leg. (Id. at 345.)

In the fall of 2006 Ramey injured himself when he fell out of bed and hurt his left hip and head. (Id. at 346-47.) He went to the emergency room complaining of a headache and lower back pain that radiated to his left leg. (Id. at 346-47, 350.) A CT scan of the head showed normal results, (id. at 391), and an x-ray of the left hip showed no dislocation or bony destruction, (id. at 389), but an x-ray of the left knee showed sclerosis and spurring, (id. at 390). The diagnoses included left hip and left knee contusion, lower back pain with left sciatica, and contusion to the head. (Id. at 347.)

About a year later in November 2007, Ramey sought emergency medical treatment due to dizziness caused by high blood sugar levels. (Id. at 484, 490.) The emergency room doctor gave Ramey insulin and diagnosed him with uncontrolled diabetes mellitus. (Id. at 483, 490.) Later that same month, Ramey reported to the emergency room with chest pain and acute respiratory distress. (Id. at 492, 503.) He was admitted into the hospital and underwent a number of diagnostic tests showing abnormal results. (Id. at 503-06.) For example, a chest x-ray indicated that Ramey had an enlarged heart and bilateral infiltrates of the lungs, which were worse than a prior study. (Id. at 505.) The discharge diagnoses included acute chronic respiratory failure, interstitial lung disease, dilated cardiomyopathy (heart muscle disease), diabetes mellitus, and hypertension. (Id. at 503.)

In March 2008, Ramey underwent a psychological evaluation with Dr. Mary Gardner, a licensed clinical psychologist, at the request of his attorney. (Id. at 545-49.) Dr. Gardner administered a number of diagnostic tests, which showed that Ramey has an IQ score of 69. (Id. at 547.) She assessed Ramey's IQ score as being far below what would be expected of someone with a high school education. (Id. at 549.) Ramey's reading score placed him at a fifth through seventh grade reading level and his arithmetic score placed him at a sixth through ninth grade level. (Id. at 548.) Dr. Gardner assessed Ramey as having a cognitive disorder not otherwise specified and a depressive disorder not otherwise specified. (Id. at 549.) She opined that it is unlikely that Ramey would be able to "sustain meaningful employment given the nature of his medical and cognitive problems." (Id.) Dr. Gardner determined that Ramey meets Listing 12.02 for Organic Mental Disorders and Listing 12.04 for ...

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