The opinion of the court was delivered by: Spatt, District Judge.
MEMORANDUM DECISION AND ORDER
The plaintiff, Nadine M. Minsky ("Minsky" or the "plaintiff"),
commenced this action pursuant to the Social Security Act,
42 U.S.C. § 405(g) (the "Act"), seeking review of a final
administrative determination of the Commissioner of the Social Security
Administration (the "Commission"), denying her application for Social
Security Disability Insurance Benefits. At issue are the parties'
cross-motions for judgment on the pleadings pursuant to Fed.R.Civ.P.
This case is notable in that it involves the ALJ's rejection of a
finding of disability by all four of Minsky's treating physicians. With
regard to three of the four treating doctors, the ALJ rejected their
opinions, in large measure, on his perception that these licensed
physicians practiced "outside the mainstream of medicine" and used
unconventional methods of treatment. The ALJ rejected the opinion of the
fourth treating physician on the theory that his views were "unsupported"
and "contradicted" by his contemporaneous notes, even though this
physician clearly operated "within the mainstream" of medicine, a fact
evidenced by his impressive résumé: a Clinical Professor of
Medicine at New York University School of Medicine; the Medical Director
at Lenox Hill Hospital in Manhattan; the Chief of Rheumatology at Lenox
Hill Hospital; and formerly the Chief of Lupus Erythematosus and Related
Diseases at Bellevue Hospital in Manhattan. Surprisingly, the
Commissioner never had the plaintiff examined by a Social Security
consulting physician, and therefore there were no contrary opinions
offered from a single examining doctor.
On October 28, 1994, Minsky filed an application for Social Security
Disability Insurance benefits. Her application was denied, both initially
and on reconsideration. Minsky's request for an administrative hearing
was granted. The hearing was held on June 5, 1996 before an
Administrative Law Judge (the "ALJ"). The plaintiff and her attorney
attended the hearing, at which a medical advisor and a vocational expert
testified on behalf of the Commissioner. The ALJ found that the plaintiff
was not disabled because she was able to perform light work subject to
certain non-exertional limitations prior to December 31, 1994, the date
when her insured status expired. On February 5, 1998, the Appeals Council
denied the plaintiff's request for review. This action followed.
The sole issue before the Court is the Commissioner's finding that
Minsky was not disabled between May 15, 1994, her alleged onset date,
through December 31, 1994, when her insured status expired. Although
Minsky originally stated that her impairment was lupus, at the hearing,
Minsky and her attorney claimed that her sole medically-determinable
impairment was mixed connective tissue disease. Minsky and her counsel
conceded that she did not ever meet the diagnostic criteria for any
particular specific connective tissue disease, such as lupus. Connective
tissue disease is a group of diseases including rheumatoid arthritis,
systemic lupus erythematosus, rheumatic fever, scleroderma
and others, that are sometimes referred to as rheumatic diseases. Mixed
connective tissue disease is a syndrome with overlapping clinical
features of systemic lupus erythematosus, scleroderma, polymyositis, and
The plaintiff states in an affirmation that her condition went into
remission in March 1997 and she was able to work after that time.
Therefore, the plaintiff seeks only a brief and closed period of
B. The Plaintiff's Testimony at the Hearing
Minsky testified that she was 47 years old at the time of the hearing
held on June 5, 1996.
1. Minsky's Testimony Regarding Her Work History
Between 1980 and 1987, Minsky, who has three years of college
education, worked for Dunn & Bradstreet doing outside sales of credit
contracts. From 1988 to 1993, she operated a small show and boarding
kennel. She stopped when she sold her home, where the kennel was
located. Beginning in February 1993, Minsky began working at what
eventually became a full-care animal facility. In October 1993, she
became a partner in the business with its original owner. She used to
work about 60 hours a week. The business operated 24 hours a day, seven
days a week, and required that Minsky live on the premises. Minsky
testified that she last worked full-time there in May 1994, at or about
the time of her alleged onset date.
2. Minsky's Testimony Regarding Her Medical Condition
Minsky testified that she first became sick in May 1994. She felt
exhausted, had a rash on her face, and could not concentrate. She
experienced pain in her back and muscles. She had no energy, and was
short of breath all the time, even without exertion. In addition, she
developed a rash on her face, and her eyes felt tired Her lower back
started to hurt, and she noticed swelling of her ankles, hands, and the
side and back of her neck, along with headaches, The plaintiff testified
that her level of pain varied, with the worst being in her back at a
level of "more than moderate" 50% of the time. She also experienced
problems with balance, and fell down approximately 10 times. In addition,
she experienced hair loss, frequent and severe colds, coughs, and sore
throats. She had difficulty sleeping, and was only able to do so with the
aid of medication. Even with medication, however, she was only able to
sleep for a few hours.
Minsky's usual weight before her illness was 130 pounds. After she got
sick, her weight at one point increased to 218 pounds. At the hearing,
she weighed 190 pounds.
According to the plaintiff, after May 1994, on some days she worked an
hour or two a day, some days she spent in bed, and approximately six days
a months she would have a "great" day and be able to work three to four
hours. Her symptoms gradually worsened.
According to the plaintiff, she was at her worst from May 1994 to
October 1994. From January 1995 through August 1995, she was in bed most
of the time, and she felt better in September 1995 through October 1995,
but in November 1995 again felt worse, although not as badly as she felt
the prior year. Minksy testified that on some days, she could not get out
of bed because her vision would "be blurry and my back would be killing
me and I just, I just couldn't function. And, I'd sleep the entire day."
Minsky told the ALJ that on good days, she can sit for a half an hour
before her back starts to hurt and she becomes stiff on trying to stand.
On bad days, she cannot do any sitting at all. She finds it difficult to
hold a pen because she cannot grasp, and at best can do so only for 10
minutes. She can lift about 5 or 6 pounds, at most. During periods of
slight improvement, Minsky could walk a half a block to the store. At
best, she could concentrate
on a computer for 10 to 15 minutes; at worst, she could not concentrate
at all. On a good day, Minsky could stand for 10 minutes, but on a bad
day, only for 30 seconds. On the bad days, she usually stayed in bed.
Most of her days were spent laying down.
At the time of the hearing, Minsky and her husband had moved in with
her mother. The plaintiff's mother, son or husband did all of the
cleaning and shopping while she was ill. Tasks such as bathing,
dressing, and washing her hair were all difficult, and she occasionally
did not do them. She had no social activities. She had to give up dog
breeding, because she could no longer pick up the animals. She could not
sit long enough to go to a movie.
Psychologically, Minsky testified that she often cries; she cried
during the hearing. Stress made her pain worse; as did the weather.
C. The Medical Evidence Presented at the Hearing
On July 25, 1994, Dr. Jesse Stoff, M.D., evaluated Minsky. During the
evaluation, Minsky described a history of an adverse reaction to dental
implants and viral infections. She tested positive for Coxcackie B.
virus, Epstein-Barr virus and cytomegalovirus, and tested negative for
lupus. Dr. Stoff concluded that Minsky suffered from mixed connective
tissue disease. Following the initial evaluation, the plaintiff primarily
was treated by Dr. Stoff by telephone.
In a report dated November 30, 1994, Dr. Stoff stated that Minsky
"complains of severe fatigue, migratory myalgias and arthralgias, night
sweats, recurrent lowgrade fevers, insomnia, and dyslogia with a
secondary reactive depression to her chronic illness which has rendered
her totally disabled." He further noted that the "symptoms that she
suffers with i.e. the severe fatigue, muscle weakness, myalgias,
arthralgias, insomnia, and dyslogia have rendered her totally disabled in
that she is usually totally bed bound unable to complete even minimal
activities of daily living and relying upon the help of friends and
family in order to accomplish her daily activities." Her "blood tests
indicate a systemic response to her autoimmune disease." In Dr. Stoff's
view, her "illness is likely to leave her permanently disabled or worse
it if does not stop and reverse soon."
On December 7, 1994, the plaintiff told Dr. Stoff over the telephone
that she was "doing well" and her back pain was gone. However, her hands
and feet were still swollen.
In January 1995, after Minsky's insured status expired, Minsky spoke
with Dr. Stoff four times because she was having trouble obtaining the
intravenous treatments he prescribed. That same month, Dr. Stoff reported
that he made a diagnosis of autoimmune syndrome and lupus. Her symptoms
included severe fatigue, insomnia, myalgias, arthralgias, mallar rash,
dyslogia, sore throats, swollen glands, muscle weakness, hypotoxia,
headaches, night sweats, and blurred vision. He prescribed Prednisone,
DHEA IV nutrients/amino acid supplements, and nutrient supplements.
Clinical findings included lupus mallar rash, recurrent edema, recurrent
joint symptoms and one episode of kidney failure. He reported that her
fatigue was a disability, and that the condition was exacerbated by
stress. Once fatigue began, she generally was in bed for several days.
She was limited to lifting 2 to 4 pounds; her ability to stand and walk
was less than 2 hours a day; she was able to sit less than 6 hours a
day; and her pushing and pulling was limited, due to severe fatigue,
myalgias, arthralgias, and muscle weakness.
Toward the end of the year, on December 15, 1995, Dr. Stoff reported
that Minsky continued to suffer from and be debilitated by severe
fatigue, multiple migratory myalgia and arthralgia, night sweats,
recurrent low-grade fevers, insomnia, dyslogia with depression. Also, she
suffered an episode of kidney failure which responded to diuretic therapy
and intravenous medications. At that time, in Dr. Stoff's opinion, Minsky
was "totally disabled," and was "often house and bed bound due to severe
insomnia, fatigue, myalgia, arthralgias and dyslogia. She required help
to complete her basic ADL [activities of daily living]." While the doctor
stated that "she continues to try to work as much as she can in order to
maintain her business . . I do not believe it is in her best interest
physically to work part time as she does . . . I know, from talking with
her husband and close friends, that there are many days where in she is
unable to complete even basic minimal activities of daily living and must
rely on their help in order to do so. Her disease process is severe."
Further, the doctor opined that her "pronosis for recovery is guarded
because of the multiplicity of organs and systems involv[ed]."
The following year, in May 1996, Dr. Stoff again reported that the
plaintiff was under his care for progressive mixed connective tissue
disease, which rendered her disabled.
Minsky was treated on a weekly basis by Dr. Uluis Popylansky, M.D.,
from October 28, 1994 through December 1994. In a Residual Functional
Capacity Assessment Report dated February 6, 1995, Dr. Popylansky's
diagnosis was mixed connective tissue disorder and lupus. He noted that
her symptoms included fatigue, headaches (cephalagia), muscle aches
(myalgia), skin rash, insomnia, swollen lymph nodes and recurrent sore
throat. Dr. Popylansky's examination revealed that the patient was 5 feet
tall and weighed 200 pounds. Dr. Popylansky found no neurological
deficits. He found she had limited motion in her upper and lower
extremities due to pain and edema. He proscribed Prednisone in tapering
doses and non-steroidal anti-inflammatory medication. Dr. Popylansky's
Residual Functional Capacity Assessment stated that Minsky could sit up
to 6 hours a day, stand and walk less than 2 hours a day, and could not
lift or carry any weight. Dr. Popylansky stated that "when exacerbation
any movement extremely painful." In his assessment, Minsky was "unable to
concentrate," and had "memory impairment." He noted that her fatigue was
brought on by minimal exertion and activities of daily living, and she
had to rest for several hours once the fatigue began. The plaintiff also
suffered from depression, secondary to fatigue.
Dr. Ronald Hoffman, M.D., provided Minsky with weekly nutritional
support treatment between January 1995 and June 1995, immediately
following the insured period. In a report dated July 13, 1995, he made a
diagnosis of mixed connective tissue disease. He noted that she suffered
from fatigue, joint pain and a butterfly rash. Although his physical
examination of her was "not significant," Dr. Hoffman stated that her
"fatigue limits [her] ability to function in a work setting." Dr. Hoffman
was of the opinion that Minsky suffered from decreased focus and
concentration; limited understanding and memory; and limited sustained
concentration and persistence. He found that her ability to lift and
carry was limited to 5 pounds; her ability to stand and/or walk was
limited to up to 2 hours a day; her ability to sit was limited to up to 6
hours a day; and she had no limitation on her ability to push and pull.
In his January 1995 report, Dr. Argyros stated, "Minsky notes that she
looks as if she has a clear cut case of lupus." His report further states
that during the previous year, in April 1994, when she sat for a time she
had aching in her knees and it was hard to get up. At that time, her
joints were swollen, and she had to be taken off Prednisone because "she
could not function." Dr. Argyros observed that Minsky was "emotional and
cried a lot." Minsky was experiencing "chest pain and shortness of
breath." Testing revealed that the plaintiff's ANA (anti-nuclear
antibody), rheumatoid factor and complement levels all were normal. Her
C3 level was above normal. Dr. Argyros diagnosed undifferentiated
connective tissue disorder. The doctor noted that she was feeling better
and did not need systemic treatment.
On February 15, 1995, Minsky reported to Dr. Argyros that she was "ok"
except that she was very stiff in the morning. Later that year, in August
1995, Dr. Argyros reported that Minsky had been weaned off the adrenal
cortex injections Dr. Stoff ...