United States District Court, D. Connecticut
RULING ON MOTION TO REVERSE THE DECISION OF THE
A. BOLDEN UNITED STATES DISTRICT JUDGE.
Kennedy (“Plaintiff”) filed this administrative
appeal under 42 U.S.C. § 405(g) against Carolyn Colvin,
the Commissioner of Social Security (“Defendant”
or “the Commissioner”), seeking to reverse the
decision of the Social Security Administration
(“SSA”) denying her claim for Title II disability
insurance benefits under the Social Security Act. Compl. at
1, ECF No. 1.
Kennedy moves for an order reversing the decision of the
Commissioner or, in the alternative, an order remanding her
case for rehearing. Mot. to Reverse, ECF No. 14. The
Commissioner has moved for an order affirming the decision of
the Commissioner. ECF No. 15.
reasons that follow, Ms. Kennedy's motion is
DENIED, and the Commissioner's motion is
FACTUAL AND PROCEDURAL BACKGROUND
October 16, 1959, Tr. at 26, Ms. Kennedy graduated from high
school and received no other vocational training. Tr. 35.
When she started treatment, she lived in Hartford,
Connecticut. Tr. 410.
Kennedy's medical history includes diabetes mellitus,
breast cancer, bi-polar disorder, major depressive disorder,
post-traumatic stress disorder, anxiety disorder, arthritis,
lumbar pain, and hypertension. Tr. 305, 307, 320, 334, 338,
349-50, 353, 355, 359, 361, 366, 383, 385, 401, 406-07, 413,
417-18, 420, 423-24, 427-34, 437, 442, 447, 458, 464, 476,
478, 492. Her diabetes is “poorly controlled, ”
Tr. 305, 407, 458, and her hypertension is uncontrolled, Tr.
308-10, and she is, as a result, at risk of stroke or
myocardial infarction, Tr. 310. She also has blurred vision
while reading. Tr. 325.
the spring and summer of 2010, Ms. Kennedy was diagnosed with
stage III breast cancer. Tr. 342-44 (documenting discovery of
2.5 cm mass in her left breast and diagnosing suspected
metastatic disease in lymph nodes), 392-95 (confirming
presence of stage III carcinoma with metastases in lymph
nodes), 398-99, 497-504 (confirming through MRI primary tumor
in left breast and enlarged lymph nodes in left axilla). On
June 4, 2010, she had surgery to remove a cancerous tumor and
metastases in the axillary lymph nodes. Tr. 334-35. She was
discharged the following day. Tr. 347-48. On June 17, 2010, a
radiation oncologist examined her and recommended radiation
therapy to prevent a local recurrence. Tr. 488-89. She
underwent chemotherapy for five months and radiation for two
months, and she has experienced hot flashes since that
treatment. Tr. 320, 350.
August 16, 2010, Ms. Kennedy visited Community Health
Services. Tr. 475. She explained that she had stopped taking
her blood pressure medication because it made her feel
depressed, and that she would like to switch her medication.
Id. Her blood pressure was elevated and
uncontrolled; the advanced practice registered nurse (APRN),
Rita Rivera, changed her medication, and noted that Ms.
Kennedy was undergoing chemotherapy and experiencing side
effects from the treatment. Tr. 476. She also noted that Ms.
Kennedy had “benign essential hypertension, ”
“poorly controlled” diabetes mellitus, and breast
cancer. Tr. 476.
August 21, 2010, Ms. Kennedy returned to Community Health
Services for a diabetic foot screening with podiatrist
Sherwin Tucker, DPM. Tr. 328, 474. He noted that she had
newly been diagnosed with diabetes mellitus, and had been
referred for a foot screen; he also marked that she did not
report podiatric complaints, including that she was not
experiencing tingling in her ankles, legs, or feet. Tr. 328.
Dr. Tucker counseled Ms. Kennedy about diabetes mellitus and
foot care. Tr. 329.
August 26, 2010, Ms. Kennedy met with a registered dietician,
Leila Bruno, MS, RD, CDE. Tr. 325. Ms. Bruno noted that Ms.
Kennedy had been newly diagnosed with diabetes mellitus and
that she also had breast cancer. Id. Ms. Kennedy
reported that she had lost ten pounds over the past three
months, was experiencing increased blurry vision, decreased
appetite, and nausea, especially after the chemotherapy
treatments. Id. Ms. Bruno's report also stated
that Ms. Kennedy did not lack adequate sleep, and that she
exercised regularly by walking, though less since she began
receiving chemotherapy treatment. Tr. 326. Ms. Kennedy also
reported that she was not feeling pain or numbness in her
lower body, and Ms. Bruno noted that Ms. Kennedy's
diabetes mellitus was under “fairly good
control.” Tr. 326. On September 2, 2010, Ms. Kennedy
and Ms. Bruno attended a diabetes education class. Tr.
December 22, 2010, Ms. Kennedy visited Community Health
Services to request a refill of her blood pressure medication
and met with registered nurse Everol Ennis. Tr. 322-23;
467-69. She had stopped taking her diabetes mellitus
medication because “she read about [a] side effect of
nausea and stated that chemo was already making her
nauseous.” Tr. 322. Her final round of chemotherapy was
scheduled for that week. Id. She also stated that
she stopped taking her blood pressure medication because it
made her depressed, but that she was ready to begin taking
the medication again. Id. Nurse Ennis assessed that
Ms. Kennedy had “[b]enign essential hypertension poorly
controlled” because Ms. Kennedy had not been taking
medication for months. Tr. 323. She also assessed that Ms.
Kennedy's diabetes mellitus was “poorly controlled
secondary to no medication for months.” Id.
January 24, 2011, Ms. Kennedy visited Community Health
Services for a follow-up appointment and met with Dr. Daman
Ali. Tr. 320-21; 465-66. At that point, Ms. Kennedy had
completed chemotherapy and was scheduled for radiation
therapy to begin after a few weeks. Tr. 320. Dr. Ali noted
that Ms. Kennedy's blood pressure was elevated, and that
she reported that she had been experiencing hot flashes since
finishing chemotherapy. Tr. 321.
Kennedy underwent radiation therapy until late April 2011.
Tr. 494-95. She reported having a localized skin reaction and
feeling fatigued after completing the radiation, but she
otherwise tolerated the treatment and recovered well. Tr.
492. She had a mammogram on May 11, 2011, that revealed no
evidence of malignancy. Tr. 341, 491.
18, 2011, Ms. Kennedy returned to Community Health Services
and met with Dr. Darren Martin, who checked her blood
pressure and blood sugar. Tr. 461. Dr. Martin noted that Ms.
Kennedy's blood sugar was within normal limits, and her
blood pressure was slightly elevated. Id. Dr. Martin
also noted that Ms. Kennedy reported that she was complying
with medications, but also reported that she does not like to
take medications; Dr. Martin advised her of the importance of
complying with her prescription. Id.
3, 2011, Ms. Kennedy returned to Ms. Bruno for nutrition
counseling. Tr. 318- 19; 459-60. Ms. Bruno noted that Ms.
Kennedy had elevated blood pressure and was overweight, and
that Ms. Kennedy reported that she was walking, doing
exercise, had new glasses, and that her energy was improving.
Tr. 318-19. Ms. Bruno also noted that she suspected that Ms.
Kennedy's diabetes mellitus had not improved, and that
she had hyperlipidemia. Tr. 319. Ms. Bruno counseled Ms.
Kennedy about her “medication administration and
compliance” and about her diet. Tr. 319.
7, 2011, Ms. Kennedy visited Community Health Services for a
physical. Tr. 455. She reported anxiety and depression, as
well as feeling tired. Tr. 456. She also visited Community
Health Services on June 21, 2011, and reported that she had
been feeling “weird” on her medication, and that
she had been experiencing headaches for about two weeks. Tr.
5, 2011, Ms. Kennedy returned to Community Health Services
for a blood pressure check, and met with APRN Susan Neagle.
Tr. 316. Nurse Neagle recorded that Ms. Kennedy's blood
pressure was elevated. Tr. 316-17. Nurse Neagle renewed Ms.
Kennedy's prescription, making some changes to the
medication, and told Ms. Kennedy to follow up in two weeks.
Tr. 315. Ms. Kennedy missed the next appointment; she
returned on September 8, 2011, for refills of her
prescription. Id. She also returned on October 25,
2011. Tr. 311-13. Nurse Neagle noted on that visit that Ms.
Kennedy had elevated blood pressure, and that her diabetes
was better under control. Tr. 313.
November 8, 2011, Ms. Kennedy visited Community Health
Services for a blood pressure check. Nurse Neagle noticed an
improvement since Ms. Kennedy's last visit, and also
noted that Ms. Kennedy “stated that she is not
compliant with her medications because she has a problem with
focusing because she is out of a job, ” and that Ms.
Kennedy “states that she takes the medication probably
three times out of the week.” Tr. 310. Nurse Neagle
advised Ms. Kennedy of the “importance of taking all
medications as prescribed.” Tr. 310. On December 1,
2011, Ms. Kennedy returned, and Nurse Neagle noted that her
blood pressure was “uncontrolled.” Tr. 309-10.
February 23, 2012, Ms. Kennedy had a bilateral mammogram that
revealed no malignancy. Tr. 340.
3, 2012, Ms. Kennedy returned to Community Health Services
for a refill of her prescription. Tr. 307-08; 441-42. She
also requested, and was prescribed, Effexor for depression.
Tr. 307-08. She returned on June 21, 2012, for a blood
pressure check; she reported that she had not been taking her
medication because she “felt ‘weird on
it.'” Tr. 305.
September 14, 2012, through the referral of her primary care
physician, Ms. Kennedy met with a licensed clinical social
worker, Maritza Degonzalez, because Ms. Kennedy had stopped
eating and was sleeping ten or eleven hours each day. Tr.
378. Ms. Kennedy reported to Ms. Degonzalez that she had
plans to commit suicide by overdosing on medication, and she
described a previous suicide attempt, several years earlier:
she had set her car on fire while inside it, and then was
hospitalized at Mt. Sinai Hospital. Tr. 378.
Kennedy also reported a history of alcohol abuse, a previous
boyfriend who had physically and verbally abused her, and
that she had recently lost her job and faced eviction. Tr.
379. Ms. Degonzalez recorded that Ms. Kennedy appeared
depressed, that her thought process appeared impaired, and
that her thought content appeared relatively impaired. Tr.
380. Ms. Degonzalez also referred Ms. Kennedy to go to the
emergency room “for further evaluation and possible in
patient hospitalization for safety and medication
evaluation.” Tr. 382. Ms. Kennedy was taken to the
hospital in an ambulance. Tr. 382. Once there, hospital staff
diagnosed Ms. Kennedy as having had an anxiety attack and
being depressed. Tr. 350.
September 29, 2012, Ms. Kennedy met with licensed clinical
social worker Joanne Gayeski and psychologist Margarita
Hernandez. Tr. 349-53. Ms. Kennedy reported her medical
history, described above, as well as her typical behavior:
she described that she was “independent but is not
self-motivated, ” that she “can do her own
grooming, cleaning, shopping, and cooking, ” and that
she “is able to take public transportation without
assistance.” Tr. 351. The report also stated that Ms.
Kennedy “is knowledgeable of how to pay bills, use the
telephone directory, and utilize postal and banking
services.” Id. Ms. Kennedy stated that she was
“currently working part time as a personal care
assistant, indicating that her start date was July
2012.” Id. She reported that she worked
fifteen hours bi-weekly. Id. She also reported that
before that job, she worked as a supervisor “for female
adolescents in a ...