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Geibig v. Commissioner of Social Security

United States District Court, E.D. Michigan, Southern Division

March 26, 2018




         Plaintiff Patricia Marie Geibig (“Plaintiff”) brings this action under 42 U.S.C. §405(g), challenging a final decision of Defendant Commissioner denying her application for Widow's or Widower's Insurance Benefits under Title II of the Social Security Act. The parties have filed cross motions for summary judgment. For the reasons set forth below, Defendant's Motion for Summary Judgment [Dock. #21] is DENIED, Plaintiff's Motion for Summary Judgment [Dock. #16] is GRANTED to the extent that the case is remanded for further administrative proceedings.


         Plaintiff applied for benefits on September 19, 2014, alleging disability as of September 19, 2009 (Tr. 123-124).[1] Upon initial denial of the claim, Plaintiff requested an administrative hearing, held May 2, 2016 in Livonia, Michigan (Tr. 20, 35). Administrative Law Judge (“ALJ”) Henry Perez, Jr. presided. Plaintiff, represented by attorney Elizabeth Warren, testified (Tr. 38-50), as did Vocational Expert (“VE”) Annette Holder (Tr. 50-54). On June 1, 2016, ALJ Perez found that Plaintiff was capable of performing her past relevant work as a cashier (Tr. 28, 30). On October 7, 2016, the Appeals Council denied review (Tr. 1-6). Plaintiff filed suit in this Court on December 8, 2016.


         Plaintiff, born August 21, 1962, was 53 at the time of the administrative decision (Tr. 30, 124). She completed 12th grade and worked as a retail clerk and laborer before the alleged onset of disability (Tr. 151). She alleges disability as a result of bipolar disorder, Post Traumatic Stress Disorder (“PTSD”), Attention Deficit Hyperactivity Disorder (“ADHD”), depression, herniated spinal discs, a hernia, asthma, vertigo, arthritis, Carpal Tunnel Syndrome (“CTS”), hypertension, prior substance abuse, and a hearing impairment (Tr. 149).

         A. Plaintiff's Testimony

         Plaintiff offered the following testimony:

         Her former work included a job as a shipping supervisor, requiring her to lift up to 35 pounds and stand or walk most of the day (Tr. 40). She also worked at a pharmacy as “a cashier and general help” worker, requiring her to work at the register and straighten shelves (Tr. 40-41). The pharmacy job required her to lift up to 35 pounds (Tr. 41).

         Plaintiff's low back and neck pain was becoming progressively worse (Tr. 41). She was unable to turn her neck to the left or raise her left arm (Tr. 42). In spite of pain medication and injections, she experienced level “six to seven” pain on a scale of one to ten (Tr. 42). The pain was exacerbated by damp and cold weather (Tr. 43). Due to the lower back condition, she experienced lower extremity symptoms (Tr. 43). Epidural injections improved the condition (Tr. 43). She otherwise coped with the condition by taking Ibuprofen, using a heating pad, icing her back, using BenGay, taking mineral baths, and stretching (Tr. 44). She spent 60 to 70 percent of her time addressing symptoms (Tr. 44). Physical therapy improved her range of neck motion (Tr. 44-45). She was unable to lift more than 10 pounds, stand for more than five minutes, sit for more than 20 minutes, or walk for more than one quarter of a mile (Tr. 45, 50). After standing or walking, she required time to sit or lie down (Tr. 46).

         Plaintiff lived in a ground floor apartment with her boyfriend, noting that she changed to a ground floor apartment because she was unable to walk up stairs (Tr. 46). Her household chores were limited to wiping off the sink, putting dishes in the dishwasher, and wiping down the shower after bathing (Tr. 47). She cooked on an occasional basis (Tr. 48). She spent most of the day watching television (Tr. 48). She experienced concentrational problems due to both pain and bipolar disorder (Tr. 48). Her bipolar episodes were characterized by depressive episodes during which she became lethargic and reclusive (Tr. 49). She became frustrated during manic phases because her desire to be productive was hampered by physical problems (Tr. 49).

         B. Medical Records[2]

         1. Treating Records

         In March, 2014, Plaintiff was advised to get wrist splints (Tr. 535). The following month, she was referred to physical therapy for chronic neck pain (Tr. 537). In June and August, 2014, Plaintiff sought urgent treatment for back pain (Tr. 529, 531). August, 2014 psychological intake records state that Plaintiff's former substance abuse and anxiety issues were complicated by chronic pain (Tr. 416). The same month, Tendai K. Thomas, M.D. noted Plaintiff's report of ongoing “aching, burning, and sharp” back pain (Tr. 513). In September, 2014, Plaintiff reported that she experienced lower extremity numbness (Tr. 376). Imaging studies of the chest were consistent with COPD (Tr. 382). Counseling notes state that her dose of Abilify was increased (Tr. 421). In October, 2014, Dr. Thomas prescribed physical therapy for cervical and lumbar spine pain and radiculopathy of the upper and lower extremities (Tr. 329, 500, 502). Plaintiff reported “pins and needles” pain of the neck and shoulders (Tr. 330). Therapy records state that she attributed the spinal problems to motor vehicle accidents, falls, domestic abuse, and manual labor (Tr. 336). The following month, Plaintiff reported an improvement of symptoms of 75 percent but noted “consistent” pain at the “seven to eight” level (Tr. 337). Plaintiff reported chronic back pain to Dr. Thomas (Tr. 497). An MRI of the cervical spine from the same month showed “mild flattening of the spinal cord” at ¶ 5-C6 and C6-C7 (Tr. 373). An MRI of the lumbar spine showed “severe disc space narrowing and degenerative end plate change of the L5-L1 level” (Tr. 374). She was diagnosed with mild to moderate lumbar spondylosis (Tr. 375).

         In March, 2015, Plaintiff reported increasing anxiety (Tr. 424). She was prescribed Neurontin along with psychotropic medications (Tr. 425). In June, 2015 epidural injections, physical therapy, and home exercises were recommended (Tr. 372). Counseling records state that Plaintiff's psychological condition had improved (Tr. 431). Dr. Thomas' records from the same month note that the back condition was “severe” and “worsening” (Tr. 490). September, 2015 records note Plaintiff's report of ongoing lumbar spine and left shoulder pain (Tr. 360, 470). The same month, she sought emergency treatment for a shoulder injury (Tr. 557). Dr. Thomas noted a history of radiating musculoskeletal back pain (Tr. 474, 479, 484). She exhibited reduced range of lumbar spine motion (Tr. 361). Epidural injections were administered without complications (Tr. 362). Counseling notes state that she was medication compliant but reported sleep disturbances (Tr. 432).

         In October, 2015, James Moravek, M.D. noted Plaintiff's report of continuing left shoulder pain despite the use of Oxycodone and Norco (Tr. 509). He recommended physical therapy, reduction of narcotic medication use, and icing (Tr. 510). October, 2015 therapy records note the diagnosis of impingement syndrome of the left shoulder (Tr. 341). Discharge records note that Plaintiff's shoulder pain was reduced to a “two” out of “ten” (Tr. 353).

         Plaintiff reported “no improvement” in a psychiatric medication review of February, 2016 (Tr. 438). In April, 2016, Dr. Thomas completed a medical source statement stating that due to chronic neck and low back pain with radicular symptoms, Plaintiff was unable to stand or walk for more than 15 minutes or sit for more than 30 (Tr. 556). Dr. Thomas found that she was limited to standing or walking for 60 minutes in an eight-hour workday (Tr. 556). He limited her to lifting only 10 pounds on an occasional basis and only occasional pushing or pulling (Tr. 556). He found that she would be required to take unscheduled work breaks due to fatigue and poor motor strength (Tr. 556).

         2. Consultative and Non-Examining Sources

         In December 2014, Thomas Martin Horner, Ph.D. performed a consultative psychological examination on behalf of the SSA, noting Plaintiff's report of a 2011 hospitalization after a drug overdose and Post Traumatic Stress Disorder (“PTSD”) as a result of her husband's 2009 suicide (Tr. 305). She reported that she last worked in 2003 at a pharmacy as a cashier and “straightening shelves” (Tr. 305). She left due to back and emotional problems (Tr. 305). She admitted to a history of alcohol and Vicodin abuse (Tr. 306). Plaintiff reported that she used braces for CTS at night (Tr. 307). Dr. Horner found that Plaintiff was “not a shirker by nature or by attitude” (Tr. 308). He found her capable of coping with ordinary work stresses but noted that her work abilities could be complicated by the physical conditions (Tr. 308).

         The same month, Adam McKenzie, D.O. examined Plaintiff on behalf of the SSA, noting Plaintiff's report of spinal disc problems diagnosed in October, 2014 (Tr. 310). Plaintiff reported that she experienced radiating pain in all extremities (Tr. 310). She reported symptoms of CTS but stated that she never wore wrist braces (Tr. 310).

         Dr. McKenzie observed a normal gait and the absence of fine manipulative limitations (Tr. 311). Plaintiff did not experience problems squatting (Tr. 311). She exhibited a limited range of spinal motion (Tr. 313). Plaintiff reported that the condition of asthma was not controlled with inhaler ...

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