United States District Court, D. Connecticut
TRACY L. EDMONDS
ANDREW SAUL, COMMISSIONER OF SOCIAL SECURITY
RULING ON THE PLAINTIFF'S MOTION FOR JUDGMENT ON
THE PLEADINGS AND ON THE DEFENDANT'S MOTION FOR AN ORDER
AFFIRMING THE DECISION OF THE COMMISSIONER
M. SPECTOR UNITED STATES MAGISTRATE JUDGE
action, filed under § 205(g) of the Social Security Act,
42 U.S.C. § 405(g), seeks review of a final decision by
the Commissioner of Social Security [“SSA”]
denying the plaintiff disability insurance benefits
[“DIB”] and Supplemental Security Income
October 7, 2013, the plaintiff filed applications for DIB and
SSI, claiming she had been disabled since June 1, 2007, due
to endometriosis, fibromyalgia, arthritis, COPD, high blood
pressure, diabetes and a heart murmur. (Certified Transcript
of Administrative Proceedings, dated December 6, 2018
[“Tr.”] 343-58, 271). The plaintiff's
application was denied initially (Tr. 271-78) and upon
reconsideration. (Tr. 283-89). On June 30, 2015, a hearing
was held before Administrative Law Judge [“ALJ”]
Eskunder Boyd, at which the plaintiff and a vocational expert
testified. (Tr. 182-223). The plaintiff was represented by
two attorneys at the hearing. (Id.). On September
14, 2015, the ALJ issued an unfavorable decision denying the
plaintiff's claim for benefits. (Tr. 7-24). On November
3, 2015, the plaintiff filed a request for review of the
hearing decision (Tr. 39), and on December 16, 2016, the
Appeals Council denied the request, thereby rendering the
ALJ's decision the final decision of the Commissioner.
August 17, 2018, the plaintiff filed her complaint in this
pending action (Doc. No. 1), and on October 30, 2018, the
defendant filed his answer and administrative transcript.
(Doc. Nos. 22, 23). On December 5, 2018, the parties
consented to the jurisdiction of a United States Magistrate
Judge; the case was transferred to Magistrate Judge Donna F.
Martinez. (Doc. No. 27). On December 6, 2018, the defendant
filed an amended administrative transcript. (Doc. No. 28).
The plaintiff filed her Motion for Judgment on the Pleadings
on December 27, 2018, (Doc. No. 29), and brief in support.
(Doc. No. 30 [“Pl.'s Mem.”]). On February 19,
2019, the defendant filed his Motion to Affirm (Doc. No. 31),
and brief in support. (Doc. No. 31-1 [“Def.'s
Mem.”]). The plaintiff filed a Reply to the
defendant's Motion to Affirm on February 25, 2019. (Doc.
No. 33). On October 10, 2019, this case was reassigned to
this Magistrate Judge. (Doc. No. 34).
reasons stated below, the plaintiff's Motion for Judgment
on the Pleadings (Doc. No. 29) is denied, and the
defendant's Motion to Affirm (Doc. No. 31) is
the date of her hearing in 2015, the plaintiff was forty-four
years old, living with her husband, two sons, sister, and her
sister's children in a first-floor apartment in Danbury,
CT. (Tr. 189). Her average weight was 196 pounds. (Tr. 190).
The plaintiff testified that she used a prescribed cane to
“keep [her] stable” and “help her 
walk.” (Id.). At the time of the hearing, she
had been using the cane for “about a year and a
plaintiff's last job was as a substitute teacher's
aide. (Tr. 192). For that job, which she held in 2013, she
worked “about 20” hours per week. (Id.).
Her last full-time position was in 2012, at which time she
worked as a “teacher's aide, and also a gas station
clerk.” (Id.). Her normal day, at the time of
the hearing, consisted of staying in the house unless she had
a doctor's appointment. (Tr. 195). She testified that she
could manage her own money, keep a bank account, and pay her
bills. (Tr. 191-92). She could groom and bathe herself,
although she had difficulty standing in the shower. (Tr.
193). She also tried to perform household chores, such as
washing dishes and cooking, but she could only stand for
“about two minutes.” (Tr. 193-94). She testified
that she wears glasses, but that they did not help with her
vision. (Tr. 191). According to the plaintiff, she was in the
process of scheduling cataract surgery. (Tr. 205). She was
able to see street signs but not the print on a newspaper.
(Tr. 190-91). The plaintiff testified that she only drove
“maybe about ten miles” a week, (Tr. 194), and
could be “behind the wheel” no longer than thirty
minutes at a time. (Tr. 195). The plaintiff's sister
accompanied her to the grocery store. (Id.). She
would remain in the “mobile cart” while her
sister pushed the cart of groceries. (Id.).
to the plaintiff, she was disabled due to diabetes,
neuropathy, and fibromyalgia. (Tr. 196). She testified that
her medications made her very tired, and that
“everything” aggravated her pain. (Id.).
She rated an average day's pain as a nine out of ten, or
an eight out of ten with medication. (Tr. 197). The plaintiff
testified that she could not sit for a long time, could not
stand for a long time, could not walk for a long time without
getting shortness of breath, and could not lift.
(Id.). She testified that, “on a good day,
” she could lift “maybe a pound, ” (Tr.
200), and that she could carry “maybe about five
pounds.” (Tr. 201). She testified that she could not
carry a half gallon of milk from the cooler in the grocery
store to the cashier. (Id.). According to the
plaintiff, she could walk one city block before getting short
of breath. (Id.). She could stand for only two
minutes at a time and could sit for “maybe twenty
minutes” at a time. (Tr. 202). After sitting for twenty
minutes, she would have to lay down, and when laying down,
would have to wait for fifteen minutes before adjusting her
position. (Id.). The plaintiff could not bend over
to touch her toes, but she could bend over to touch her
knees. (Id.). She could not squat. (Tr. 203). She
could climb stairs or ramps with the help of a guardrail.
(Id.). She could reach her arms over her head and
directly in front of her, as well as use her fingers for both
smaller things, i.e., buttons, zippers, and larger
things, i.e., an orange. (Id.). She could
not shuffle and deal a deck of cards. (Id.). The
plaintiff also testified that temperatures, both hot and
cold, aggravated her symptoms, as did humidity and rain. (Tr.
203-04). She was also sensitive to odors, fumes and dusts.
vocational expert (“VE”) testified at the
plaintiff's hearing that the plaintiff's past work as
a customer service representative in a call center
corresponded with a “hybrid” of both order clerk
and telephone solicitor, occupations performed at the
sedentary exertional level, (Tr. 213), and that her past work
as a teacher's aide corresponded with teacher aide II, an
occupation typically performed at the light exertional level
but performed at the medium exertional level as reported by
the plaintiff. (Tr. 214). The ALJ then asked the VE to assume
the following hypothetical individual: an individual of the
plaintiff's age, education, and vocational background,
limited to performing light work, but with limits of standing
and walking for two to four hours and sitting for up to six
hours. (Id.). Such individual would also require an
option where she would be able to sit for thirty minutes,
alternate to a standing position for five minutes, and then
resume sitting. (Id.). Such individual would have
the additional limitations of never climbing ladders, ropes,
or scaffolds, never kneeling or crawling, occasionally
climbing stairs and ramps, and occasionally balancing,
stooping and crouching. (Tr. 215). She could frequently
handle and finger, but could not work with exposure to
temperature extremes, humidity or wetness. (Id.).
response to questioning, the VE testified that the
hypothetical individual described above could perform the
plaintiff's past work in the call center. (Id.).
The ALJ then asked the VE whether the hypothetical
individual, if she required a cane for ambulation, could
perform the plaintiff's past work. (Id.). The VE
again testified that such an individual could perform the
plaintiff's past work in the call center. (Id.).
For the next hypothetical, the ALJ kept all the limitations
described above, but instead of light work, limited the
hypothetical individual to sedentary work. (Id.).
The VE testified that such an individual could perform the
plaintiff's past work in the call center. (Tr. 216).
However, if the hypothetical individual, limited to sedentary
work, with all the other limitations described above, could
only occasionally handle and finger, that individual could
not perform the plaintiff's past work or other jobs in
the national economy. (Tr. 216-17). Similarly, the VE
testified that if the hypothetical individual had to
alternate to a reclining position for fifteen minutes after
thirty minutes of sitting, the individual could not perform
the plaintiff's past relevant work or any other jobs in
the national economy. (Tr. 216). Finally, the ALJ asked the
VE whether an individual limited to frequent close visual
acuity and occasional far visual acuity would be able to
perform the plaintiff's past work in the call center.
(Tr. 219). The VE answered in the affirmative. (Tr. 220). The
VE testified, however, that, if the individual was limited to
occasional close visual acuity and occasional far visual
acuity, his “understanding . . . is that your near
acuity is going to be required at least on a frequent
level.” (Tr. 221).
Court presumes the parties' familiarity with the
plaintiff's medical history, which is discussed in the
parties' Joint Statement of Facts. (Doc. No. 30-1).
Though the Court has reviewed the entirety of the medical
record, it cites only the portions of the record that are
necessary to explain this decision.
record reflects that the plaintiff frequently visited the
Danbury Hospital Emergency Room (“ER”) and the
Seifert & Ford Family Community Health Center, which
appears to be affiliated with Danbury Hospital. The first
medical record is from the plaintiff's visit to the ER on
March 23, 2007. (Tr. 494). Treatment notes indicate that she
presented “very lethargic” with a history of
uncontrolled diabetes. (Id.). Her glucose level was
460. (Tr. 496). Over the next three years, the plaintiff
presented at the Danbury Hospital ER on multiple occasions,
complaining of abdominal pain, (Tr. 502, 523), pain under her
left arm and right groin, (Tr. 515), and a yeast infection
and cold. (Tr. 549). Her next visit related to her alleged
impairments appears to have been on February 2, 2011, at
which time she presented with low blood sugar, blurred
vision, tingling fingers, headache, neck pain, abdominal pain
and nausea. (Tr. 559). Treatment notes reflect that her chief
complaint was abdominal pain. (Tr. 561).
plaintiff thereafter returned to the ER for various
treatments. She was treated for eye redness in April 2011,
(Tr. 571), underwent an endoscopy in May 2011, (Tr. 577),
received a gynecological ultrasound in June 2011, (Tr. 580),
was treated for chest pain in August 2011, (Tr. 587, 597),
and was treated for a benign laryngeal cyst in September and
November 2011. (Tr. 612, 703). At her visit to the Seifert
& Ford Family Community Health Center on November 4,
2011, the plaintiff did not have any chest or abdominal pain.
(Tr. 705). Treatment notes reflect that she had not been
compliant with her diabetes medication. (Id.). Due
to her complaints of continuing chest pain, the plaintiff had
a coronary angiography and LV angiography in January 2012.
(Tr. 614). She returned to the Seifert & Ford Family
Community Health Center in March 2012 due to chest, knee,
abdominal, and pelvic pain. (Tr. 709-10).
April and May 2012, the plaintiff went to the ER with
complaints of head congestion, (Tr. 618), swelling of her
hands and feet, and a sore throat, which she believed might
be coxsackie disease. (Tr. 626-27). Treatment notes from the
plaintiff's May 21, 2012 visit to Seifert & Ford
Family Community Health Center indicate that the
plaintiff's fibromyalgia had improved but her diabetes
remained uncontrolled. (Tr. 716 (“Poor DM
remainder of the plaintiff's medical records from 2012
are for other conditions. In May 2012, the plaintiff had a
colonoscopy. (Tr. 635). In July 2012, she twice went to the
ER with complaints of chest pain, (Tr. 638, 649), and she had
an x-ray, which revealed no evidence of active
cardiopulmonary disease. (Tr. 654). In August 2012, she
presented to Dr. Jason Gajraj with complaints of a headache
and neck ache. (Tr. 753). At that appointment, treatment
notes indicate her history of being “fatigued with
prolonged activities.” (Tr. 754). In August 2012, she
complained of an abscess and chest pressure. (Tr. 666). In
September 2012, she reported (and was treated) for a sinus
infection, congestion, and chest pain. (Tr. 724). Finally, in
October 2012, she again indicated she was experiencing chest
pain. (Tr. 728). Treatment notes reflect a diagnosis that the
chests pains were likely musculoskeletal and a referral for
physical therapy. (Tr. 730).
the medical records from October 2012, there is a gap in the
plaintiff's treatment until a visit to the Danbury
Hospital ER on September 17, 2013. (Tr. 733). At that
appointment, the plaintiff presented for evaluation and
treatment of “generalized point tenderness over her
cervical spine, lumbar spine, knees and ankles.” (Tr.
733-34). Treatment notes indicate her history of fibromyalgia
and that she had been maintained on Cymbalta, but that she
had not been on that medication for one year after moving to
South Carolina in October 2012. (Tr. 734). The treatment
notes also reflect that the plaintiff had been off her
diabetes and anti-hypertensive medications except for
Lisinopril for the past year. (Tr. 734). Dr. Jason Gajraj
prescribed medication. (Tr. 735).
endocrine consultation for the plaintiff's diabetes with
Dr. Guillermo Pons, M.D., on September 30, 2013, the
plaintiff complained of foot pain while walking. (Tr. 487).
Treatment notes reflect that the plaintiff “is afraid
of needles and is reluctant to start on insulin.”
(Id.). The plaintiff had blurred vision but no
dryness, no neck pain, no chest pain, no back pain, no muscle
weakness, no muscle aches, no headache, no tremors, no
numbness, and no burning sensation. (Id.). An
examination revealed that she had normal muscle strength and
no arthropathy. (Tr. 489). Her “[feet were]
onychomycosis, but not swollen, not tender, not
erythematous” and had “no ulcerations.”
(Id.). A “sensory exam [for both feet] showed
normal vibratory sensation at the level of the toes and
normal position sense at the level of the toes.”
(Id.). The plaintiff's motor exam was also
normal, with normal deep tendon reflexes and no tremors.
(Id.). Dr. Pons noted that “leg pain is
unusual in a patient who does not exhibit any signs of
peripheral neuropathy”; “[i]n fact there is no
evidence to suggest pseudo claudication syndrome.” (Tr.
same day, the plaintiff presented at the Danbury Hospital ER
complaining of chest pain, beginning in her left chest area
and radiating to her left arm. (Tr. 695). On examination, the
plaintiff had no myalgia, muscle weakness, joint pain, back
pain, or abdominal pain. (Tr. 697). She had a regular heart
rate and rhythm, no murmurs, positive reproducible tenderness
to her left mid to lower sternal border, and no edema in her
bilateral lower extremities. (Tr. 697, 701).
one week later, the plaintiff saw Dr. Gajraj for her
diabetes. (Tr. 743-44). Treatment notes reflect that the
plaintiff has a severe phobia of needles and had not taken
the Lantus Solostar, an insulin pen, prescribed to her.
(Id.). Dr. Gajraj recommended that the plaintiff try
using the Novolog Flexpen, a different insulin pen; the
Diabetes Education department also recommended alternative
medications, but the record does not reflect whether their
recommendations also required needles. (Tr. 744). Treatment
notes indicate that the plaintiff had generalized body aches
related to fibromyalgia that had improved with use of
Robaxin. (Tr. 744). The plaintiff returned to Dr. Gajraj on
October 22, 2013, complaining of bilateral leg, knee, and
ankle pain. (Tr. 738-39). Treatment notes indicate her
history of fibromyalgia, which had been maintained on
Cymbalta; the plaintiff discontinued her use of Robaxin due
to drowsiness. (Tr. 738). As to the plaintiff's diabetes,
her cousin had been administering her Novolog Flexpen twice
daily. (Tr. 739). The plaintiff rated her pain level at ten
out of ten; her hips, ankles, knees and feet were tender upon
examination. (Tr. 740).
November 12, 2013, the plaintiff presented to Dr. Gajraj with
bilateral lower extremity pain, numbness and tingling. (Tr.
133-34). The plaintiff reported decreased sensation of both
feet. (Id.). Treatment notes indicate that the
plaintiff had issues administering insulin due to needle
phobia but did well with a trial of Auto Shield pen needles.
(Tr. 134). Because those needles were not covered by the
plaintiff's insurance, however, the physician recommended
that the plaintiff start back on Lantus Solostar. (Tr. 135).
The plaintiff returned to the ER on December 3, 2013, for
weakness, (Tr. 865), and again on December 30, 2013, for
severe pain and buckling of her right knee. (Tr. 100). An
x-ray revealed “mild mexlial tibiofemoral joint
2014, the plaintiff continued to visit the Danbury Hospital
ER and Seifert & Ford Community Health Center. On January
30, 2014, the plaintiff reported bilateral knee pain, which
radiated to her right calf and ankle; she rated her pain as a
ten out of ten. (Tr. 108-09). Treatment notes reflect that
the plaintiff reported she was still able to walk
independently but had to change position “all the
time.” (Tr. 108). The pain interfered with her sleep,
was worse with movement, and was mildly relieved with rest.
(Id.). On examination, the “appearance”
of the plaintiff's knees was normal, with no swelling or
warmth. (Tr. 109). The plaintiff's knees were tender upon
palpation, and her range of motion was restricted, though
“hard to tell as the patient ...