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Sedlak v. Saul

United States District Court, D. Nebraska

August 8, 2019

ANDREW SAUL, Commissioner of Social Security, Defendant.


          Richard G. Kopf Senior United States District Judge.

         Plaintiff William Sedlak brings this action under Titles II and XVI of the Social Security Act, which provide for judicial review of “final decisions” of the Commissioner of the Social Security Administration. 42 U.S.C. § 405(g) (Westlaw 2019).[1]


         A. Procedural Background

         Sedlak filed an application for disability benefits on January 27, 2016, under Titles II and XVI. The claims were denied initially and on reconsideration. On March 21, 2018, following a hearing, an administrative law judge (“ALJ”) found that Sedlak was not disabled as defined in the Social Security Act. (Filing No. 10-2.) On August 27, 2018, the Appeals Council of the Social Security Administration denied Sedlak's request for review. (Filing No. 10-2 at CM/ECF pp. 1-5.) Thus, the decision of the ALJ stands as the final decision of the Commissioner. Sims v. Apfel, 530 U.S. 103, 107 (2000) (“if . . . the Council denies the request for review, the ALJ's opinion becomes the final decision”).

         B. Medical & Opinion Evidence; Sedlak's Testimony

         1. Medical Evidence

         The material medical evidence related to Sedlak's impairments is undisputed and is described by the ALJ as follows[2]:

The medical evidence confirms that the claimant has been diagnosed with myasthenia gravis[3] since before the alleged onset date. In January 2016, an electromyogram was performed, which confirmed median and sensory neuropathy of the left upper extremity. Specifically, the abnormal study showed electrophysiologic evidence of: proximal subacute and active motor median neuropathy; postsynaptic neuro[muscular] junction disorder; and sensory neuropathy.
The medical evidence also confirms the claimant's left shoulder tendinosis.[4] Prior to the amended alleged onset date, in 2015, the claimant presented to the emergency department various times with complaints of left shoulder pain. The claimant was referred to an orthopedist, Matthew J. Teusink, MD, and in August 2015 and September 2015, Dr. Teusink observed some decreased strength with supraspinatus, but full 5/5 strength with external rotation and no pain with passive range of motion of the left shoulder. An MRI of the left shoulder performed August 20, 2015 indicated tendonosis of the left shoulder. The imaging revealed advanced tendinosis of the infraspinatus; advanced atrophy supraspinatus/infraspinatus; moderate to advanced tendinosis subscapularis with small distal intrasubstance tear; mild atrophy subscapularis; mild tendinosis long head biceps tendon; complex tear to anterior inferior glenoid labrum; and findings suggestive of adhesive capsulitis. The objective evidence indicates that when considered in combination with his myasthenia gravis and neuropathy, his left shoulder tendinosis impairment is severe.
During the period under review, the claimant treated for these conditions with his primary care provider, Dr. Hoeft, who he saw approximately every two to four months until June 2017. In September 2017, the claimant started treating with Tyrus S. Soares, MD, a pain specialist, who he saw three times through December 2017. The claimant also treated with a neurologist, Ezequiel A. Piccione, MD, for management of myasthenia gravis, who he saw four times from the alleged onset date through December 2017. The claimant was treated with prescribed medication, including prednisone.
. . . [O]n December 8, 2017, Dr. Piccione documented some decreased strength of the left upper extremity rated at 4 and 5-/5, along with 4 strength of bilateral ankle dorsi flexors. Dr. Piccione further observed normal muscle bulk and tone with no atrophy, along with normal coordination. . . .
The medical evidence additionally confirms that the claimant has a history of a right ankle fracturing requiring post an open reduction internal fixation surgery, which occurred prior to the alleged onset date. Dr. Soares assessed him with chronic ankle pain and osteoarthritis of the bilateral ankles.
. . . His treating examiners observed some edema and tenderness at times, along with decreased 4 strength of the ankle dorsi flexors. In January 2016 and July 2016, Dr. Piccione did not document any abnormalities with regard to the claimant's gait. In May 2017 and December 2017, Dr. Piccione noted that the claimant was unable to walk on tip-toes or heels bilaterally, but he was able to walk steps in tandem, to get out of a chair without pushing off, and was able to squat, and Romberg sign was absent. The medical evidence does not indicate that the claimant has been prescribed an assistive walking device, not has he been observed to be using one. . . .
The medical evidence shows that the claimant was prescribed opiate medication for this condition during the period under review. He was initially prescribed the opiates by his primary care provider, Dr. Hoeft, until September 2017, when Dr. Soares start[ed] prescribing it to him. In October 2017, the claimant reported to Dr. Soares that the opiate medication was “effective[”] and that his pain symptoms were “stable.” He made similar reports to Dr. Soares in December 2017 and additionally reported that his ankle pain was “generally tolerable and he is functional and mobile.” . . .
. . . [E]ven though the claimant was prescribed opiates, urine drug screen tests performed in March 2017 and June 2017 revealed negative results for opiates. . . .
The evidence of record confirms that the claimant has ptosis[5] secondary to his myasthenia gravis. Ptosis of the left eye was obvious at the hearing, and it has been documented by various medical providers. . . .

(Filing No. 10-2 at CM/ECF pp. 30-32.)

         2. Opinion Evidence

         The ALJ gave “some weight” to the opinions of Sedlak's treating physicians, Dr. Piccione, a neurologist, and Dr. Hoeft. Dr. Piccione's opinions are undisputed and described by the ALJ as follows[6]:

. . . In a letter dated August 1, 2016, Dr. Piccione stated that the claimant's symptoms vary day to day, making it difficult to maintain consistent employment. In a letter dated June 26, 2017, Dr. Piccione stated that the claimant's symptoms had become worse, he was having more diffuse muscle weakness, and he was having worsening ptosis on the right. He stated this made it difficult for the claimant to hold employment. In May 2017, Dr. Piccione opined that the claimant had “significant problems with walking from his car due to the myasthenia so will provide handicap placard.” A handicapped parking pass was approved by Dr. Piccione on May 26, 2017. . . .
Dr. Piccione provided another letter dated January 25, 2018 in which he stated he believed that consistent with the severity of his myasthenia gravis, he would be limited to standing and walking for no more than two hours of an eight-hour day due to his symptoms. He further opined the claimant would be limited to occasional use of his upper extremities for handling, reaching, or fingering. He becomes easily fatigued, which requires him to rest frequently. Due to weakness, he is unable to lift more than 10 pounds on an occasional basis. . . .

(Filing No. 10-2 at CM/ECF pp. 33-34.) The ALJ also described and considered Dr. Hoeft's opinions:

. . . In a letter dated February 27, 2017, Dr. Hoeft stated that the claimant is “unable to effectively work and hold down gainful employment due to chronic medical conditions.” He stated that his history of ankle surgery requires opiate medications, which can affect work performance. Dr. Hoeft stated that given his medical problems, especially myasthenia gravis, he would not be able to hold down any substantial employment, and Dr. Hoeft opined that the claimant is “totally disabled.” . . . [T]he claimant testified that he has not experienced side effects from the opiates, and he was previously able to work while taking them. . . .

(Filing No. 10-2 at CM/ECF p. 34.)

         3. Sedlak's Hearing Testimony

         At his hearing before the ALJ, Sedlak testified that his myasthenia gravis is “the biggest problem affecting” him and his ability to work, and this medical condition causes ptosis of his eyelids (mostly the left and sometimes the right), blurriness, and headaches from trying to force his eyes to stay open; weakness in his arms and legs; reduced strength and ability to carry things; difficulty in manipulating his hands to, for example, open a Ziploc baggie; and difficulty standing and walking such that “if somebody was walking behind me, they would probably think I was drunk.” (Filing No. 10-2 at CM/ECF pp. 75-78, 82, 90.)

         Sedlak testified that he was released from his past job as a delivery driver for an auto-part shop because he could no longer lift heavy parts, his “eyes were just getting so bad, ” his arms are weak, he struggles to “walk a distance, ” and his Department of Transportation medical certification was rescinded because “[w]ith the drooping of the eyelid and stuff, ” Sedlak “couldn't do the driving anymore.” (Filing No. 10-2 at CM/ECF pp. 67-68.) Sedlak also testified that he suffers “pain all day long” due to his 2012 surgery for a broken ankle that required the insertion of a “plate and three screws” and shoulder tendinosis. (Filing No. 10-2 at CM/ECF pp. 79, 81.)

         Sedlak takes hydrocodone for pain in his ankle, left arm, and left shoulder. (Filing No. 10-2 at CM/ECF p. 91.) When the ALJ questioned Sedlak about why he tested negative for opiates in March and June of 2017 when he had been prescribed hydrocodone, he “couldn't explain that one” and he “do[es]n't understand why.” (Filing No. 10-2 at CM/ECF pp. 91-92.)

         Due to muscle weakness from Sedlak's myasthenia gravis and his ankle pain, it is “hard to stand for a good 15, 20 minutes at a time.” (Filing No. 10-2 at CM/ECF pp. 88-89.) After standing for that length of time, Sedlak estimated he needs to sit for 45 minutes or longer before standing again. Sedlak claims he could be on his feet only two hours in an eight-hour day. (Filing No. 10-2 at CM/ECF p. 89.)

         As far as daily activities, Sedlak testified that he lives with his mother and he “sometimes” cooks, keeps his own room clean, vacuums around his bed, gets groceries, and mows with a self-propelled mower with sitting breaks every two rows. (Filing No. 10-2 at CM/ECF pp. 93-94.)

         C. The ALJ's Conclusions

         Following the five-step sequential analysis[7] for determining whether an individual is “disabled” under the Social Security Act, 20 C.F.R. § 404.1520, the ALJ concluded in relevant part (Filing No. 10-2 at CM/ECF pp. 24-36):

         1. Sedlak has not engaged in substantial gainful activity since December 15, 2015, the alleged onset date.

         2. Sedlak has the following severe impairments: median motor neuropathy of the left upper extremity; myasthenia gravis; left shoulder tendonosis; and status post right ankle open reduction internal fixation. Sedlak also has impairments that are less than severe (diabetes mellitus) and non-severe (hypertension, hyperlipidemia, sleep apnea, history of ulcerative colitis, obesity, borderline intellectual functioning).

         3. Sedlak does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1.

         4. Sedlak has the residual functional capacity to perform sedentary work as defined in 20 C.F.R. § 404.1567(a) and ...

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