SUSAN E. HOUSER, Plaintiff,
MICHAEL J. ASTRUE, Commissioner, of Social Security, Defendant.
MEMORANDUM OPINION AND ORDER
JEFFREY COLE, Magistrate Judge.
The plaintiff, Susan Houser, seeks review of the final decision of the Commissioner of the Social Security Administration ("Agency") denying her application for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act ("Act"), 42 U.S.C. § 423(d)(2). Ms. Houser asks the court to reverse and remand the Commissioner's decision, while the Commissioner seeks an order affirming the decision.
Ms. Houser applied for DIB on August 18, 2008, alleging that she had been disabled since June 9, 2006 due to congestive heart failure and leg problems. (Administrative Record "R." 142, 177). Her application was denied initially on December 31, 2008, and upon reconsideration on January 10, 2008. (R. 94, 105). Ms. Houser then filed a timely request for a hearing on June 1, 2009. (R. 109).
An administrative law judge ("ALJ") convened a hearing on February 12, 2010, at which Ms. Houser, represented by counsel, appeared and testified. (R. 38-77). At the hearing, Lee Knutson testified as an impartial vocational expert. (R. 36, 78-88). On July 23, 2010, the ALJ issued an unfavorable decision, denying Ms. Houser's application for DIB because she could still engage in light work. (R. 10-27). This became the Commissioner's final decision when the Appeals Council denied Ms. Houser's request for review on November 4, 2011. (R. 1-3); Skarbek v. Barnhart, 390 F.3d 500, 503 (7th Cir. 2004); see 20 C.F.R. §§ 404.955, 404.981. Ms. Houser has appealed that decision to the federal district court under 42 U.S.C. § 405(g), and the parties have consented to the jurisdiction of a magistrate judge pursuant to 28 U.S.C. § 636(c).
II. THE RECORD EVIDENCE
A. The Vocational Evidence
Ms. Houser was born on November 20, 1960, making her forty-nine years of age at the time of the ALJ's decision. (R. 10, 142). She completed two years of college. (R. 182). Ms. Houser has not worked since 2006. (R. 177). Her last job was as an accounts payable clerk; the job is considered to be at the lower end of skilled work, and is sedentary in physical demand. (R. 78-79, 178). Prior to that, Ms. Houser worked as an accountant. (R. 178).
B. The Medical Evidence
1. The Plaintiff's Physicians
Ms. Houser has had heart issues that date back to 2008. On January 29, 2008, she was seen by Dr. William Mikaitis for pneumonia. (R. 535). A chest x-ray was taken and she was diagnosed with bilateral pulmonary infiltrate. (R. 535). The next month she was seen again, this time for difficulty breathing. (R. 545). Another chest x-ray was taken, revealing an enlarged heart. (R. 545). The imaging also revealed small bilateral pleural effusions and right perihilar air space opacity, which was noted as perhaps indicating pneumonia or edema. Dr. Micaletti, the reviewing physician, noted that the heart appeared slightly worse since her x-ray the month prior. (R. 545).
The next day, on February 23, 2008, Ms. Houser was seen at Urgent Care for worsening shortness of breath. (R. 300). At Urgent Care, an x-ray was taken revealing fluid around her heart, so Ms. Houser was transported to the emergency room for further evaluation. (R. 298, 300). At the hospital, treating physician Dr. Justyna Stengele noted that Ms. Houser had severe shortness of breath and difficulty breathing. (R. 300). Ms. Houser reported to the doctor that she had been experiencing shortness of breath on exertion and while lying down for several years, with her symptoms worsening that month. (R. 300). The doctor noted that Ms. Houser experienced shortness of breath and difficulty breathing "with any activity, just walking to the door." (R. 298). Dr. Stengele also noted Ms. Houser's history of depression, for which she was taking Cymbalta, and also her anxiety, colitis, and arthritis. (R. 300).
Dr. Stengele referred Ms. Houser to cardiology, and an echocardiogram was administered. (R. 301, 294). Dr. Muaia Martini described the echocardiogram as a "grossly abnormal study". (R. 294). Dr. Martini diagnosed poor left ventricular systolic function, with an estimated ejection fraction of 10% or less. (R. 294). The doctor also noted a small mobile apical mural thrombus, evidence of mildly elevated pulmonary systolic hypertension, and mild-to-moderate mitral and tricuspid regurgitation. (R. 294). Dr. Martini said that Ms. Houser was experiencing chronic heart failure, and Dr. Stengele also listed his final diagnosis: severe dilated cardiomyopathy with congestive heart failure, pneumonia, and depression. (R. 294, 307). In addition to the echocardiogram, an electrocardiogram was also administered. (R. 299). The test revealed a sinus tachycardia, left atrial enlargement, left axis deviation, anterolateral ST and T-wave abnormalities. (R. 299). Chest imaging also revealed increased density along the right heart border and an enlarged heart. (R. 369). The interpreting physician, Dr. Gregory Price, diagnosed cardiomegaly and questionable subtle right middle lobe infiltrate. (R. 369).
The next month, on March 7, 2008, Ms. Houser was seen again for a cardiovascular follow up. Dr. Colin Sumida noted that while Ms. Houser was doing better, she still had intermittent shortness of breath upon exertion. (R. 256). She was diagnosed with dilated cardiomyopathy, and the cardiologist increased her ACE inhibitors and noted that if her ejection fraction remained less than 30% she would be considered for a defibrillator. (R. 257). She was again diagnosed with depression and her 60mg Cymbalta was continued. (R. 512). One month later, the records show that Dr. Stengele wrote Ms. Houser a prescription, continuing her on Cymbalta and prescribing Ambien for anxiety. (R. 528).
In May of 2008, Ms. Houser was again seen by Dr. Sumida in connection with her cardiovascular issues. (R. 259). While her symptoms did not worsen, she continued to suffer shortness of breath upon exertion. (R 259). Her medications at this time were reported as being Ambien 10mg, Coreg 3.125 mg, Cymbalta 40 mg, Furosemide 20mg, Lisinopril 2.5 mg, Potassium Chloride 20 mEq, Warfarin Sodium 5 mg, Xanax.25 mg. (R. 259). Dr. Sumida again diagnosed dilated cardiomyopathy and recommended a follow-up echocardiogram to see whether her ejection fraction remained less than 30% and to determine whether she needed a defibrillator. (R. 260).
On October 17, 2008, another echocardiogram was conducted, revealing ejection fraction around 15%, showing no significant improvement in Ms. Houser's left ventricular function. (R. 565).
On December 5, 2008, Ms. Houser was referred by Dr. Sumida to Dr. Sunil Shroff to consider her for a prophylactic ICD defibrillator. (R. 565). Dr. Shroff noted that Ms. Houser remained "short of breath with only moderate exertion with what I will class II to III congestive heart failure" (R. 565). Ms. Houser, however, told the doctor that she recently began herbal medication and that did notice symptom improvement. (R. 566). Dr. Shroff then recommended the implantation of an ICD, stating that while it would not improve Ms. Houser's symptoms, she would "clearly benefit" because the device would prevent sudden cardiac death. (R. 566). Ms. Houser declined, preferring to wait for two months to see whether her condition improved. (R. 566).
Dr. Shroff noted that Ms. Houser continued to have heart failure symptoms, so he increased Ms. Houser's ACE inhibitor and beta-blocker doses. (R. 566). He also increased her lisinopril to 5 mg per day, recommending that upon follow up it again be increased to 10 mg per day. (R. 566). Dr. Shroff also increased Ms. Houser's carvedilol to 6.25 mg twice per day, recommending that upon follow up it again be increased to 12.5 mg twice per day. (R. 566).
On January 22, 2009, Dr. Stengele completed a cardiac report regarding Ms. Houser in connection with her DIB application. (R. 506-10). She diagnosed her with idiopathic cardiomyopathy and heart failure. (R. 506). She stated that her heart failure was demonstrated by a pulmonary edema, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. (R. 506). She noted that she experienced moderate left ventricular enlargement and 10% ejection fraction. (R. 506). Dr. Stengele noted that she underwent a 20-d echocardiography, ventriculography, and resting ECG, all in February 2008. (R. 509). Dr. Stengele noted that Ms. Houser demonstrated symptoms of inadequate cardiac output include dyspnea on exertion and at rest. (R. 509). She stated that dyspnea occurs upon ordinary physical activity and that Ms. Houser's condition limited her daily living activities including cleaning, cooking, making beds, and shopping. (R. 510).
In a letter dated July 22, 2009, Dr. Justyna Stengele reported that Ms. Houser "suffers from nonischemic cardiomyopathy with severe left ventricular dysfunction, which significantly limits her functional capacity including activities of daily living. She also suffers from myalgia with chronic low back and bilateral knee pain. In my opinion, Susan Houser should classify for disability." (R. 584).
On April 1, 2009, Ms. Houser underwent another echocardiogram. The results revealed that her ejection fraction was around 35%. (R 585). Dr. Martini interpreted the the exam, finding moderate left ventricular enlargement with probable moderate left ventricular systolic dysfunction, mild left atrial enlargement, borderline mitral valve prolapse, and a probable mild degree of pulmonary hypertension. (R. 585). This again lead to a clinical diagnosis of cardiomyopathy. (R. 585).
On April 7, 2010, Ms. Houser underwent another echocardiogram. The results revealed that her ejection fraction again decreased to between 20-25%. (R. 639). Dr. Martini again found moderate left ventricular enlargement. In comparison to her previous echocardiogram, her left ventricular dysfunction was found to be severe rather than moderate. Dr. Martini reported that most of the ventricular septum was akinetic and the rest of the ventricle is severely diffusely hypokinetic. He again found mild left atrial enlargement and again diagnosed cardiomyopathy and congestive heart failure. Following the results, in a letter to the ALJ, Ms. Houser reported that Dr. Sumida told her that her "heart was in pretty bad shape, that it was still enlarged and that it had gotten weaker since my last Echo". (R. 641). Additionally "he asked how I was feeling and instructed me to continue the meds as prescribed in February, and said that we would discuss my test results during my upcoming appointment." (R. 641). She also stated that in a previous appointment that February, Dr. Sumida doubled her dosage of Carvedilol in an attempt to lower her heart rate. (R 641).
On January 7, 2011, Ms. Houser again saw Dr. Sumida through a referral from her treating physician Dr. Stengele. (R. 692). Dr. Sumida stated that while Ms. Houser's shortness of breath wasn't not worsening, she still became dyspneic to one light of stars. (R. 692). Also, after walking five blocks she had to stop to catch her breath. (R. 692). She also complained of a cough, and her latest echocardiogram showed an ejection fraction of 20%. (R. 692). Under his assessment, Dr. Sumida listed dilated cardiomyopathy, fatigue/malaise, dyspnea, and cough. (693). He stated that she had severe cardiomyopathy and was still symptomatic, although she did not appear to be in any overt heart failure. He stated that she has "severe compromise in her functional capacity." He again increased her ACE inhibitors and beta blockers, and again increased her
Llisinopril to 7.5 mg. Dr. Sumida stated that Ms. Houser "understands that she is at risk for life threatening arrhythmias, worsening heart failure, ...