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Hosea M. v. Saul

United States District Court, N.D. Illinois, Eastern Division

November 1, 2019

Hosea M., [1] Plaintiff,
ANDREW SAUL, Commissioner of Social Security, [2] Defendant.



         Hosea M. (“Claimant”) brings a motion for summary judgment to reverse or remand the final decision of the Commissioner of Social Security (“Commissioner”) denying his claim for Child's Disability Insurance Benefits (“CDIBs”) and Supplemental Security Income (“SSI”). The Commissioner brings a cross-motion seeking to uphold the decision to deny benefits. The parties have consented to the jurisdiction of a United States Magistrate Judge pursuant to 28 U.S.C. § 636(c). This Court has jurisdiction to hear this matter pursuant to 42 U.S.C. § 405(g). For the reasons that follow, Claimant's motion for summary judgment (Dkt. 17) is denied and the Commissioner's motion for summary judgment (Dkt. 25) is granted.

         I. BACKGROUND

         A. Procedural History

         On September 3, 2014, Claimant (then 19-years old) filed for SSI, alleging disability beginning July 1, 2014 (when he was 18) due to narcolepsy. (R. 15.) Claimant filed for CDIBs on the same basis on October 17, 2014. (Id.) Claimant's applications were denied initially and upon reconsideration. (R. 66-115.) Claimant filed a timely request for a hearing, which was held on December 7, 2016 before an Administrative Law Judge (“ALJ”). (R. 32-65.) Claimant appeared with counsel and offered testimony at the hearing. A vocational expert and a medical expert also offered testimony.

         On April 21, 2017, the ALJ issued a written decision denying Claimant's applications for benefits. (R. 15-26.) Claimant filed a timely request for review with the Appeals Council. (R. 199-200.) On February 21, 2018, the Appeals Council denied Claimant's request for review, leaving the decision of the ALJ as the final decision of the Commissioner. (R. 1-4.) This action followed.

         B. Medical Evidence in the Administrative Record

         Claimant seeks disability benefits for narcolepsy. The administrative record contains the following evidence that bears on Claimant's claim:

         1. Evidence from Claimant's Treating Physicians

         On May 12, 2014, at the age of 18, Claimant presented to nurse practitioner Linda Hushaw complaining of excessive daytime sleepiness. (R. 426-28.) Claimant reported that he had an accident after he fell asleep while driving the day before. (R. 426.) A physical examination yielded normal results. (R. 427.) Nurse Hushaw recommended that Claimant avoid driving or operating dangerous machinery and referred him for a sleep consultation. (R. 428.)

         Claimant began treatment with pulmonologist Dr. Ahmad Agha in June 2014 when he presented for a sleep consultation. (R. 342-43.) Claimant complained of excessive daytime sleepiness, weight gain, snoring, witnessed apnea, and decreased energy. (R. 342.) Claimant told Dr. Agha that he sleeps from 10:00 p.m. to 4:00 a.m. and takes a daily nap. (Id.) He denied cataplexy.[3] (Id.) A physical examination was unremarkable. (Id.) Dr. Agha referred Claimant for a sleep study because his symptoms were “suggestive of obstructive sleep apnea.” (R. 343.)

         In August 2014, Claimant underwent a full night polysomnography (“PSG”) and a multi-latency sleep test (“MLST”). The PSG revealed no evidence of obstructive sleep apnea, but did show severe bradycardia (i.e., low heart rate) and mild periodic limb movements. (R. 349, 387.) Dr. Agha recommended further evaluation with a cardiologist. (R. 387.) The MLST revealed severe hypersomnia indicative of narcolepsy. (R. 385.) Dr. Agha also noted sleep talking and hallucinations. (R. 347.) Dr. Agha prescribed Provigil and advised Claimant to avoid driving. (Id.) Claimant followed up with Nurse Hushaw in September 2014 and reported that his insurance did not cover Provigil.[4] (R. 423-25.)

         By November 2014, Dr. Agha had started Claimant on Ritalin, but he was “still sleepy.” (R. 349.) According to Dr. Agha's notes, Claimant wakes up at 8 a.m., takes Ritalin, takes a nap for 30 minutes, goes back to sleep at 5:00 p.m., and then is “jumping at night.” (Id.) Dr. Agha again recommended Provigil. (Id.) In February 2015, Dr. Agha indicated that Claimant was “very limited with medication choices due to insurance” and again noted that Claimant had been denied coverage for Provigil. (R. 361.) Claimant continued to complain that Ritalin only helped for a couple of hours, after which he would get “sleepy again.” (Id.) On physical exam, Dr. Agha noted decreased breath sounds. (362.) Dr. Agha recommend Nuvigil, which “should be approved per insurance.” (Id.) Dr. Agha advised Claimant to “stick to routine, ” exercise, and to avoid driving, alcohol, and nicotine. (Id.) Dr. Agha did not add any notable treatment notes at a follow-up visit in April 2015. (R. 390-92.)

         Claimant did not return to see Dr. Agha again until February 29, 2016. (R. 393-94.) Claimant was still taking Nuvigil. (R. 394.) Claimant told Dr. Agha he usually goes to bed at 10:00 p.m., wakes up at 7:00 a.m., takes Nuvigil, and then “sleep[s] in the car.” (Id.) He gets home at 5:00 p.m. and takes another nap at 7:00. (Id.) Dr. Agha increased Claimant's Nuvigil dosage, prescribed Effexor for hallucinations, and recommended that Claimant try not to nap. (Id.) In October 2016, Claimant told Dr. Agha the Effexor had helped and he was “doing better.” (R. 397.)

         2. Evidence from Claimant's School Records

         Claimant's high school records reveal he took general education classes but received special education services for a “learning disability [that] adversely affects basic reading skills, reading comprehension, math calculation, math problem solving and written expression.” (R. 225.) The special education services included sitting with a peer tutor when a teacher presented new material, the ability to retake tests in the resource room, and a reduced number of homework problems. (R. 320.) In ninth grade, Claimant took the Wide Range Achievement Test and earned the following grade equivalent scores: Word Reading 2.4, Sentence Comprehension 4.1, Spelling 2.8, Math Computation 4.5. (R. 304.) Claimant obtained a composite score of 98 on the Reynolds Intellectual Assessment Scales, placing his cognitive abilities within the average range.[5] (R. 286.) In tenth grade, Claimant failed all five sections of the Alabama high school graduation exam. (R. 314.) Some of Claimant's twelfth grade teachers commented that he had difficulty staying awake in class. (R. 229.) Notwithstanding his challenges, Claimant graduated from high school. (R. 51-52.)

         3. Evidence from Agency Consultants

         State agency medical consultant Dr. Richard Bilinsky completed a residual functional capacity assessment on January 15, 2015. (R. 66-79.) After reviewing the record, Dr. Bilinsky concluded that although Claimant had no exertional limitations, he could only occasionally climb ramps and stairs, never ladders, ropes, and scaffolds, and must avoid even moderate exposure to hazardous machinery and unprotected heights due to his narcolepsy. (R. 69-70, 76-77.) On July 24, 2015, at the reconsideration level, Dr. Leah Holly affirmed Dr. Bilinsky's findings, but added that Claimant must avoid driving in the workplace. (R. 80-91, 100-02.)

         Also at the reconsideration level, psychologist Erika Gilyot-Montgomery conducted a psychiatric review technique to determine the effects of Claimant's mental impairments, if any. (R. 87-88, 98-99.) After reviewing Claimant's medical and school records, Dr. Montgomery concluded that Claimant did not have a medically determinable mental impairment, and further noted that Claimant had not alleged any such impairment in his applications. (R. 88, 99.) In Dr. Montgomery's opinion, Claimant's documented learning disability resulted in a mild cognitive impairment, “improving with academic support, ” which caused no more than mild limitations in sustained concentration, pace, stress tolerance, and adaptability. (Id.)

         On January 22, 2015, Claimant's counsel submitted a request for a consultative psychological evaluation due to a history of special education services. (R. 322.) Counsel reiterated this request in his pre-hearing brief to the ALJ. (R. 327-29.) The Social Security Administration never conducted a psychological evaluation and the ALJ expressly denied the renewed request in her opinion. (R. 15.)

         C. Evidence from Claimant's Testimony

         Claimant appeared with counsel at the December 7, 2016 hearing and testified as follows. Claimant is a high school graduate who, at the time of the hearing, resided with his grandparents and younger cousins. (R. 49, 51-52.) Claimant confirmed that his narcolepsy was the only health impairment he wished to discuss at the hearing. (R. 44.)

         When asked about his narcolepsy, Claimant testified that he “always had problems with sleeping, ” but that his symptoms “got bad” in 2014 during his senior year of high school. (R. 45.) He explained that he fell asleep “multiple times a day, ” sleeping through most of his classes, on the bench during basketball games, and once while driving in May 2014, which led to an accident. (Id.) It was at that point Claimant saw a doctor and was put on medication. (R. 46.) At the time of the hearing, Claimant was taking Provigil, though he had started “to get immune to it.” (Id.) He had similar problems in the past with Ritalin and Adderall. (R. 52.) His doctor tried to start him on Nuvigil, but Medicaid would not cover it.[6] (R. 48.) Other than trying different medications, Claimant's doctors did not have any other plans for treatment. (R. 52-53.)

         On a typical day, Claimant wakes up around 7:00 a.m., helps get his younger cousins ready for school, and then takes a walk outside, at times up to 20 blocks. (R. 47, 51.) After about an hour of being awake, Claimant gets drowsy and needs to take a nap. (Id.) He'll wake up after an hour and then the cycle continues. (Id.) He usually falls asleep about six times a day. (R. 49.) Apart from getting his cousins ready for school, Claimant also sweeps and vacuums the floors, cleans the bathrooms, cleans up after his cousins, and cares for the family dogs. (R. 50-51.) Claimant typically goes to bed at 9:00 p.m. and sleeps through the night. (R. 49.)

         According to Claimant, now that he's on medication, he can usually tell when he's going to fall asleep, because he starts to shake, and his eyesight gets blurry. (R. 47-48.) In Claimant's words, it's as if his “body is shutting completely down; like [he] can't do anything.” (R. 48.) Claimant testified that he has fallen asleep while engaged in activities. (R. 53.)

         Claimant also described his past work. For two to three months during the summer of 2016, Claimant worked for a friend's landscaping company performing general yard work. (R. 39-40.) Although he worked eight-hour days, Claimant testified that a lot of those hours were spent sleeping in the car. (R. 40.) Claimant was fired after he fell asleep while putting a lawn mower on a truck. (R. 42, 53.) Next, Claimant worked part-time (five hours, three days a week) at a local tire shop. (R. 41-42.) Business was slow so Claimant spent “most of the time” asleep in the back of the shop. (R. 41.) Claimant only worked at the tire shop for three weeks ...

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