United States District Court, N.D. Illinois, Eastern Division
For Maria C. Katsigiannis, Plaintiff: Barry Alan Schultz, LEAD ATTORNEY, Law Offices of Barry Schultz, Evanston, IL.
For Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant: LaShonda Annette Hunt, LEAD ATTORNEY, AUSA-SSA, United States Attorney's Office (NDIL), Chicago, IL.
MEMORANDUM OPINION AND ORDER
MAGISTRATE JUDGE MICHAEL T. MASON.
This case is before the Court on the parties' cross motions for summary judgment. Plaintiff Maria Katsigiannis seeks a remand or an outright reversal of the Commissioner's decision to deny her request for benefits. The Commissioner seeks summary judgment affirming the decision to deny benefits. For the reasons set forth below, Katsigiannis' motion  is denied, and the Commissioner's motion  is granted.
Maria Katsigiannis applied for disability insurance benefits (" DIB") on May 17, 2010, alleging that she became disabled and unable to work as of August 29, 2007 due to lupus. R. 138-139. Her application was denied initially and on reconsideration. She requested a hearing before an Administrative Law Judge (" ALJ"), and the case was assigned to Rebecca LaRiccia, who held the requested hearing in Oak Brook, Illinois on February 8, 2012.
1. Witness Testimony
At the hearing, the ALJ heard first from Katsigiannis' attorney, who emphasized that his client worked as a pre-school teacher even after being diagnosed with lupus, but that her symptoms got progressively worse, to the point where she was no longer able to work. He noted that she was diagnosed with lupus, which is accompanied by severe joint pain and stiffness, primarily in her hands, hips, knees, ankles, feet and lower back. R. 38. She was also diagnosed with membranous lupus nephritis, which affects her kidneys; this seems to be in remission, but still causes frequent urination and accidents. R. 38. In addition, her attorney represented, she has decreased bilateral hand strength, respiratory issues (chronic cough and shortness of breath), a compromised immune system and chronic pain and fatigue. R. 38-39. He noted that she has two small children, that her pregnancies complicated her symptoms, that she gets a lot of help from her mother and her family, and that she is unable to work. R. 39. He concluded by saying to the ALJ, " I think it would be up to you to determine if you feel the 14.02 lupus listing could apply. She has the documentation that might be sufficient for that or looking at a less than sedentary RFC, Your Honor." R. 39. Katsigiannis' attorney argued that, ultimately, the case would turn on credibility. R. 39, 66.
Next, the ALJ heard from Katsigiannis, who testified that she was 35 years old at the time, and married with two small children, Kylie, who was five at the time of the hearing, and George, who was 18 months at the time. R. 40. She testified that she completed high school and earned an associates degree in early childhood education; she worked as a pre-school teacher for the Veteran Park District until 2007, when she stopped working because of her condition. R. 40. She testified that, before becoming a teacher, she worked for Sears. R. 41.
Katsigiannis testified that she quit working in 2007, after being diagnosed with lupus, because she was suffering from terrible fatigue and because, with her compromised immune system, it was a bad idea for her to be working around small children. R. 42. She testified that she gets sick easily, has a chronic cough and a constant cold. R. 42.
She testified that she currently takes Plaquenil (hydrocloro), salsept, prednisone, Ultram, Zoloft, baby aspirin, Claritin and an inhaler. R. 43. She testified that the medication makes her nauseous and tired and gives her frequent headaches. R. 44. She testified that she is in constant pain, though some days are worse than others. R. 45. She testified that her pain has gotten progressively worse in her hands and back and that, on a scale of zero to ten, it's about a seven, even with the Ultram. R. 45. She testified that the Ultram helps somewhat, but some days it feels as if it isn't working at all. R. 45. Without the medication, she testified that her pain would be at a 9 or a 10. R. 45. She testified that she has noticed decreased grip strength in her hands and is just constantly fatigued, to the point where some days she can't get up at all and other days, when she does get up, she has to lie down or nap again in an hour. R. 46. She testified that her mother comes to her house five days a week and helps her a lot; her mother's help allows her to nap even when her son is not napping. R. 46-47.
She testified that the fatigue keeps her from doing the things she needs to do -- like taking care of her kids, cooking and cleaning the house; she testified that, when she is in the middle of a flare up, she is unable to do anything about 90% of the time. R. 49. She testified that she planned to talk to her doctors at the next appointment about upping her Ultram to try to address her severe joint pain so that she is not so incapacitated. R. 49-50.
She testified that she is treated by Dr. Katz, a rheumatologist, and by Dr. Gashti, a renal specialist. R. 47. She sees both doctors every three to six months. R. 47. She also sees Dr. Kecala, her primary care doctor, regularly. R. 50. She testified that Dr. Kecla prescribed Zoloft for anxiety and depression; she also testified that she recently started counseling for her anxiety and depression because she just gets overwhelmed so easily. R. 50.
She testified that she used to take medication for osteopenia, but stopped because she experienced such bad side effects -- namely nausea and bad headaches. R. 51-52. She also testified that she suffers from allergies, which she believes are weather-related; she experiences sneezing, coughing and watery eyes; the cough is the worst, however, because it lasts for months and the coughing attacks are frequent and debilitating. R. 53.
She testified that, in any given week, five days out of seven are bad; on a bad day, she rarely gets up, doesn't get dressed and doesn't do much physical activity. R. 54. She testified that, if she is feeling okay, she might be able to do some physical tasks around the house for about an hour and then she has to stop and take a nap; then she may be able to go back and do a little more, but would need a break every 20 or 25 minutes or so. R. 60.
She testified that she still has her driver's license, but doesn't drive much. R. 55. She will drive her daughter to school occasionally, but does not drive long distances because she gets stiff and experiences lots of pain in her lower back and hands. R. 55. She testified that she really does not get out much, except to go to doctor appointments and maybe to her mom's house " for like a birthday or something." R. 55. She testified that she has no hobbies but does have friends, one in particular who comes over for regular visits. R. 56. She testified that she is able to dress and bathe herself. R. 56. She testified that she has to use the bathroom frequently (about 6 to 8 times during the day), and that, if she tries to wait, she will have an accident. R. 60-61.
She testified that she is able to walk, that she does not use a wheelchair or other assistive device, but that sometimes it takes her a while to get going because of the stiffness and the joint pain. R. 56. She has to stretch and try to loosen up for a little while first -- as much as 10 to 15 minutes on a bad day. R. 58. She testified that she has pain and decreased strength in her hands, that she is able to write for about 10 or 15 minutes before her fingers get numb and tingly -- the same is true for gripping a vacuum or the stroller. R. 57. She testified that she also has trouble lifting heavy things and that the most she can lift is about 24 lbs. R. 57. She testified that she can't hold things for very long and that, on days when her fingers are more sensitive and tingly, it is difficult to work buttons or zippers, but generally she can do that. R. 58.
She testified that she gets general tension headaches and also gets headaches that are more migraine-like, more piercing and shooting in the temple; when she gets the latter, she has to be in the dark because the light makes it worse and makes her feel nauseous. R. 61. She testified that she gets one of the bad headaches about 3 or 4 times a week and that they generally last for about an hour, but can last as long as four hours. R. 62.
When asked whether there was anything else she wanted the ALJ to know, Katsigiannis stated that
my condition, since I've been diagnosed, has progressively gotten worse, and it's an autoimmune disease, and I'm just susceptible of getting sick easier. Like, I had a virus set into my face which went into Bell's Palsey, which was just a virus, but for me, it attacks me differently, and it affects me differently and just weird things that you wouldn't think that could happen to you, different viruses that people get colds. If I get a cold, it can affect me differently because of my immune system.
I can't fight off things like a regular person can, and that's why honestly in my position and being around people, it's a higher risk for me getting sick all the time because I'm always exposed to germs, and with my job and being around people, I would be out sick more than working, and honestly, I don't think any employer would hold me with a job if I was out sick more than working.
Next, the ALJ heard from Ward Kinise, who testified as a Vocational Expert (" VE"). Kinise testified that Katsigiannis' past work as a preschool teacher would be classified as SVP 7, skilled work at the light physical demand level; her past work as a receptionist would be classified as SVP 4, semi-skilled, sedentary physical demand level; and her past work as a sales attendant would be classified as SVP 2, unskilled, light physical demand level. R. 63. The ALJ asked the VE to consider a person who is 35 years old, has an associate's degree in early childhood education and a work history identical to Katsigiannis', is capable of performing work at the light exertional level, needs the ability to alternate between sitting and standing at will, cannot climb ladders, ropes or scaffolds and can only occasionally climb ramps and stairs, can occasionally stoop, kneel, crouch and crawl, and must avoid extreme heat, cold and humidity. R. 63-64. The ALJ asked the VE whether such a person could perform any of Katsigiannis' past work; the VE testified that the sales attendant position would still be feasible, as would other work existing in the national economy, such as a route aide, a messenger, and a page. R. 64.
Next, the ALJ asked the VE to consider the same hypothetical person, but with the added limitation that the person would have only occasional use of her hands for handling; the VE testified that the page position would still be available, but the messenger position would be eliminated with that additional limitation. R. 64.
Finally, the ALJ added the limitation that the person would need to take a break every hour for a period of time lasting up to an hour; the VE testified that adding this limitation would preclude all work. R. 64. The VE also testified that the acceptable level of absenteeism is one day every three months; beyond that, work would be precluded. R. 65. Additionally, the VE testified that, if an individual is off task 20% of the workday, she would not be able to perform competitive employment. R. 65-66.
2. Medical Records
In addition to the witness testimony, the ALJ had before her medical records documenting Katsigiannis' treatment. Katsigiannis was diagnosed with lupus in May or August of 2007, although the original documents reflecting that diagnosis are not included in the record. R. 445, 446. Katsigiannis saw Dr. Ruth Kadanoff and her fellow, Dr. Richard Hariman, on August 3, 2007. R. 269. At that time, she reported that, since her pregnancy and delivery, she felt very fatigued, started getting more severe headaches and is constantly thirsty; she reported that her legs occasionally cramp and her joints occasionally hurt, and that her eyes were sensitive to the sun. R. 269. Katsigiannis had a renal ultrasound on August 3, 2007, which was unremarkable. R. 280. But Dr. Hariman recommended that she get a renal biopsy, which she did on August 24, 2007. R. 271, 248. According to the report from that procedure,
[t]he kidney biopsy is membraneous GN Stage 3 without any subendi othelial deposits. There were some non impressive meg sangial expansion but not the usual picture you se[e] in Lupus. The serology for lupus is either negative or borderline ANA. There is only one cardiolipin [antibody] present that too in minimal conc. She could be Lupus but possibility may be Phospholipid syndrome and or pure membranous. Without our input she has been started on Cellcept and prednisone by the rheumatologist/. Since her renal functions are normal and the BP is normal at this p[o]int there is no reason for her to see us. Therefore we will d/c her from renal clinic and if there are problems or if rheumatologist so desires we will be happy to see her.
R. 264. She had another renal ultrasound on August 29, 2007, which was also normal. R. 279.
The record includes a December 12, 2007 final pathology report from the Department of Pathology at Rush University Medical Center indicating the pathology findings and indicating that " [a]lthough these findings are not sufficient to make a diagnosis of lupus glomenular nephritis, this possibility should be excluded on clinical grounds." R. 480.
Katsigiannis saw Dr. Robert Katz, a rheumatologist, on January 19, 2009; at that time, she had already been diagnosed with lupus and was complaining about low back pain. R. 409. She reported being treated recently for Bell's palsy. R. 409. According to Dr. Katz, " [h]er review of systems is negative except for poor sleep, stress and nervousness." R. 409. Dr. Katz noted that she was feeling better on prednisone, but otherwise reported no changes. R. 409, 411. Katsigiannis reported feeling stiffness in the morning for about an hour, rated her fatigue at a 4, indicating that it was worse since her last appointment, and she reported bruising. R. 412. She reported having some difficulty getting in and out of bed, getting a good night's sleep and dealing with feelings of anxiety, but otherwise reported no difficulty in her activity level. R. 413. She rated her pain at a 3 on a scale of 1 to 10 and reported that it interfered significantly with her energy, her normal work and her sleep, and to a lesser extent her mood, her general activity, her concentration, her enjoyment of life and her relations with other people. R. 414. She described her pain as " aching, " " exhausting, " and " tiring" and noted it was in her mid to low back; she also noted that it was alleviated somewhat with rest and medicine. R. 414.
Katsigiannis saw Dr. Katz again on February 16, 2009 and reported feeling " a lot better" and reported that she was considering getting pregnant in the summer. R. 405. She reported being fatigued and having some difficulty sleeping, some bruising and an elevated but " better" stress level, but generally rated herself as " better" compared to her last visit. R. 406. She reported experiencing pain, on average, at a 3, on a scale of 1 to 10; reported that her condition interfered with her activities at a level of 3, on a scale of 1 to 10; and she reported that her condition interfered with her ability to sleep (5 on a scale of 1 to 10) and with her energy level (4 ...