RAMONA L. SOPKO, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security,  Defendant.
MEMORANDUM OPINION AND ORDER
MICHAEL T. MASON, Magistrate Judge.
Plaintiff Ramona L. Sopko ("Sopko" or "claimant") brings this motion for summary judgment  seeking judicial review of the final decision of the Commissioner of Social Security (the "Commissioner"). The Commissioner denied Sopko's claim for disability insurance benefits ("DIB") under the Social Security Act (the "Act"), 42 U.S.C. §§ 416(i) and 423(d). The Commissioner has filed a cross-motion for summary judgment  asking this Court to uphold the decision of the Administrative Law Judge (the "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 is granted in part and denied in part, and the Commissioner's cross-motion for summary judgment is denied. This case is remanded for further proceedings consistent with this Opinion.
A. Procedural History
Sopko filed her application for DIB on October 19, 2009. (R. 172-75.) Sopko alleges that she has been disabled since September 11, 2009 due to seizures, stroke, enlarged liver, Addison's disease, and urinary incontinence. (R. 125.) Sopko's date last insured is December 31, 2014. (R. 180.) Sopko's claim was denied initially on February 11, 2010, and again on June 3, 2010 after a timely request for reconsideration. (R. 109-13, 117, 122-25.) Sopko filed a timely request for a hearing, which was held before ALJ Curt Marceille on May 25, 2011. (R. 75-103.) In addition to testimony from claimant, the ALJ heard testimony from a vocational expert.
The ALJ issued a decision denying Sopko's claim for benefits on June 9, 2011. (R. 21-34.) Sopko then filed a timely request for review. (R. 20.) The Appeals Council denied Sopko's request for review on June 29, 2012, at which time the ALJ's decision became the final decision of the Commissioner. (R. 1-6.) Sopko subsequently filed this action and the parties consented to the jurisdiction of this Court pursuant to 28 U.S.C. § 636(c) .
B. Medical Evidence
1. Treating Physicians
The record reveals that Sopko may have suffered a mini-stroke in February 2009, resulting in left-sided weakness, for which she underwent physical therapy. (R. 293, 362.) She suffered a similar episode in mid-September 2009, when she was hospitalized at Provena St. Joseph Medical Center ("St. Joseph") and complained of lower and upper extremity weakness, dizziness, left-sided facial droop, and headaches. (R. 338, 348.) An echocardiogram during her hospitalization showed an atrial septal aneurysm, but an MRI and CT of the brain revealed unremarkable results. (R. 329, 338, 348.)
Following Sopko's episode in September 2009, Dr. R.W. Schubert, Sopko's primary care physician, referred her to neuropsychologist Michael Gelbort. (R. 353.) Sopko reported that she suffers anxiety attacks, which gave rise to a variety of physical symptoms. ( Id. ) Sopko explained that she "fired" one of her doctors and intended to "fire" another because they say there is nothing wrong with her. (R. 354.) She described a history of migraines, but had not had one in the past three years. ( Id. ) Though she has never had a seizure, she said her doctors warned her against driving following her most recent episode. ( Id. ) She acknowledged having received psychological treatment in the past for an eating disorder. ( Id. ) She explained to Dr. Gelbort that she often feels edgy, irritable, stressed, and depressed. ( Id. )
Upon testing by Dr. Gelbort, Sopko earned a verbal IQ of 70, which is on the cusp between borderline deficient and mildly impaired, a performance IQ of 79, which is on the cusp between low average and borderline deficient, and a full scale IQ of 72, which is at the lower end of the borderline deficient range of functioning. (R. 355.) Dr. Gelbort also found deficiencies in Sopko's vocabulary skills, and verbal attention and concentration, among other things. ( Id. )
In addition, Sopko was observed as strongly right-side dominant with fine motor speed and dexterity in the low average range on the right, and in the borderline deficient range on the left side. (R. 355.) In his assessment, Dr. Gelbort stated that Sopko's "clinical scales which were significantly elevated... measure a tendency to take emotional upset and convert it into complaints of physical problem[s]." (R. 356.) Dr. Gelbort reported that Sopko does not respond well to doctors who have suggested that her symptoms are more functional than organic, and concluded that it would be beneficial to focus on improving her treatment for depression. ( Id. )
A few weeks later, Sopko was admitted to St. Joseph again complaining of dizziness and left-sided weakness, as well as incidents of low blood pressure. (R. 293.) On September 30, 2009, claimant saw Dr. Ramesh Patel for these symptoms. (R. 293-96.) Dr. Patel noted a history of degenerative disc disease, headaches, fibromyalgia, anxiety, and left foot drop with knee pain. (R. 294.) Dr. Patel's examination revealed "definite weakness in the left upper and lower extremities." ( Id. ) Among other things, Dr. Patel assessed a "cerebrovascular accident that was sustained in February of 2008 with recurrence about two weeks ago." (R. 296.) The MRI and CT scan of the brain were normal, as was the chest x-ray. (R. 324, 327-28.)
On October 10, 2009, Dr. Patel performed a tilt table study. (R. 290-91.) Initially, the study was negative for induction of neurocirculatory insufficiency. (R. 291.) However, following the introduction of nitroglycerin, claimant's heart rate and blood pressure dropped and she lost consciousness. ( Id. ) Dr. Patel recommended that Sopko maintain good hydration, avoid extremes in temperature, and join an exercise program. ( Id. ) He also advised claimant to take her medications with something in her stomach, and not to take them all at one time. ( Id. )
Sopko returned to see Dr. Patel on October 28, 2009. (R. 411.) Sopko reported feeling reasonably well following her discharge from the hospital. ( Id. ) She still suffered from left-sided weakness, had fallen a few times, and was using a walker. ( Id. ) She denied chest pain, dizziness, or palpitations. ( Id. ) A physical examination was unremarkable. ( Id. ) On November 3, 2009, Sopko saw Dr. Schubert. (R. 307.) Dr. Schubert noted a history of two CVAs and hypotension. ( Id. ) Sopko reported that she was attending physical therapy two times a week for two hours each day and that overall she was "coming along better." ( Id. )
On January 15, 2010, Sopko returned to the emergency room at St. Joseph complaining of weakness and fatigue, as well as gastrointestinal issues. (R. 436.) She reported she had fainted the previous day. ( Id. ) Sopko was discharged in stable condition and advised to follow up with her personal physician. (R. 437.)
Sopko continued to complain of low blood pressure and episodes of dizziness at her February 3, 2010 appointment with Dr. Schubert. (R. 373.) The following day, Sopko saw Dr. Patel and reported multiple TIA episodes, which she described as "seizure like, " and which were accompanied by confusion and disorientation. (R. 410.) During this visit with Dr. Patel, Sopko experienced a period of low blood pressure, during which she felt like she was going to pass out. ( Id. )
On February 18, 2010, Sopko consulted with neurologist Dr. Mary Monaco regarding her episodes of loss of consciousness. (R. 388.) Dr. Monaco noted a diminished sensation of the left arm and leg and that Sopko ambulates with a cane. ( Id. ) She prescribed Florinef for hypotension and ordered an MRI of the brain, as well as an ambulatory EEG. ( Id. ) The results of those tests were normal. (R. 391, 394.) On March 25, 2010, Sopko began wearing a cardiac event monitor for a thirty day recording. (R. 418-21.) That test yielded heart rate variations within normal range, despite Sopko's notations of lightheadedness, dizziness, and palpitations. ( Id. )
In a general letter dated April 9, 2010, Dr. Schubert stated that Sopko, who had been his patient since November 2007, suffered from hypotension, syncopal episodes, which occur even when seated, and was being evaluated for seizure symptoms. (R. 430.) He explained that Sopko is not allowed to drive and described her history of TIA/CVA incidents with resultant paresthesias of her left arm, leg, and foot. ( Id. ) He stated that Sopko uses a walker or a wheelchair and has been unable to work since September 13, 2009. ( Id. )
On April 14, 2010, claimant presented to the emergency room at Silver Cross Hospital complaining of left-sided facial droop and weakness accompanied by a migraine headache. (R. 397.) A CT scan of the brain, chest x-ray, and ECG were normal. (R. 404-06) The examining physician assessed a possible CVA and Sopko was transferred to St. Joseph, where she saw Dr. Monaco for a neurology consultation. (R. 398, 401.) Dr. Monaco observed a diminished sensation on the left side of Sopko's face and in her left extremities. (R. 390.) The MRI of the brain was unremarkable. (R. 392.) Dr. Monaco did not recommend any further stroke work-up because Sopko had undergone multiple evaluations in the past with no evidence of an acute stroke. ( Id. )
Also on April 14, 2010, Sopko saw Dr. Wajid Khan for an examination regarding her history of mood disorder. (R. 514-15.) Claimant reported a history of an eating disorder, but denied any current symptoms of depression, sadness, irritable mood, or hopelessness. (R. 514.) She explained that Zoloft helps her anxiety and she had not been having panic attacks. ( Id. ) Dr. Khan recommended an increase in Sopko's Zoloft dosage and that she see a psychiatrist and therapist. (R. 515.) Sopko was discharged from St. Joseph on April 16, 2010 and advised to "follow-up at a university setting for a possible TIA." (R. 521.)
At an appointment with Dr. Patel on April 19, 2010, Sopko was feeling reasonably well and denied chest pain, dizziness, or palpitations. (R. 409.) A June 7, 2010 MRI of the cervical spine showed a mild degree of degenerative disc disease. (R. 463.) On June 19, 2010, Sopko complained of back problems to Dr. Patel. (R. 490.) An unsigned record dated June 21, 2010 reveals Sopko was seen at the Joliet Headache and Neuro Center for a history of migraine headaches. (R. 533.) At this time, Sokpo was advised to continue taking Topamax for prevention of headaches. ( Id. )
Claimant saw Dr. Elsy Devassy on July 21, 2010 for a psychiatric evaluation. (R. 580-84.) She complained of marital problems, depressed mood, and anxiety. (R. 580.) Dr. Devassy observed a depressed mood and affect. (R. 583.) She assessed major depression and panic disorder. ( Id. ) She recommended that claimant continue to take Klonopin and Xanax, and increased her dosage of Zoloft. (R. 584.) Dr. Devassy saw claimant on ...