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May 6, 2003


The opinion of the court was delivered by: Gabriel W. Gorenstein, United States Magistrate Judge

REPORT AND RECOMMENDATION To the Honorable Loretta A. Preska
Plaintiff Enid Ramos brings this action on behalf of her daughter pursuant to section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), to obtain judicial review of the final decision of the Commissioner of Social Security (the "Commissioner") denying her claim for supplemental security income ("SSI") benefits. The Commissioner has moved for judgment on the pleadings pursuant to Fed.R.Civ.P. 12(c). Ramos opposes the motion and has cross-moved for judgment on the pleadings. In the alternative, Ramos requests the matter be remanded to the Commissioner for a new hearing and decision. For the reasons below, the Commissioner's motion should be denied. Ramos' motion should be granted in part and denied in part.


A. Insulin-Dependent Diabetes Mellitus and Hyper/Hypoglycemia

Diabetes is a medical condition that affects the manner in which the body handles glucose — a sugar derived from food that appears in the bloodstream. In the typical case of juvenile or "Type I" diabetes, the pancreas fails to produce sufficient insulin, which is the hormone necessary to allow the cells of the body to use the glucose in the bloodstream. In the absence of insulin, and particularly after eating, glucose remains in the blood in abnormally high concentrations, resulting in the condition known as "hyperglycemia." See Stedman's Medical Dictionary 489-91, 849 (27th ed. 2000). If the patient requires insulin injections to control his or her blood glucose levels, the condition is known as insulin-dependent diabetes mellitus ("IDDM").

Diabetics using insulin may at times also experience "hypoglycemia," which occurs where the glucose level is abnormally low. See id. at 861. Although medical authorities apparently do not agree what constitutes a normal glucose level, Ramos has alleged — and the Commissioner does not dispute — that hypoglycemia in children occurs where their glucose level falls below 50 — 80 mg/dL. See Plaintiff's Memorandum of Law in Opposition to the Commissioner's Rule 12(c) Motion for Judgment on the Pleadings and in Support of Plaintiff's Rule 12(c) Motion for Judgment on the Pleadings, dated January 7, 200[3] ("Pl. Mem."), at 7-9 (citing authorities).

B. Ramos' Claim for Benefits and Procedural History

Ramos filed for SSI disability benefits on behalf of her daughter, Michelle Soto-Ramos, on February 22, 2000. R. 67-69.*fn1 Ramos alleged that Michelle was disabled due to IDDM. R. 67-69, 84-94. The application was denied initially and again on reconsideration. R. 39-44, 47-50. Ramos thereafter requested a hearing before an administrative law judge ("ALJ"), R. 51, which was held on March 12, 2001. R. 18-38. Ramos and Michelle appeared at the hearing before ALJ Mark Sochaczewsky and were represented by counsel. R. 18-38. Dr. Sree Devi T.N. Chandrasekhar, a medical expert, also attended and testified at the hearing. R. 29-36.*fn2

On August 22, 2001, ALJ Sochaczewsky ruled that Michelle was not disabled. R. 11-17. This decision became final on February 7, 2002, when the Appeals Council denied Ramos' request for review. R. 3-4. On April 23, 2002, Ramos filed the instant complaint on behalf of Michelle seeking review of the denial of her claim.

C. Evidence Presented at the Hearing before the ALJ

1. Testimony

Michelle testified at the hearing. At that time, she was fifteen years old and in the tenth grade in school. R. 21-22. Michelle was diagnosed with diabetes when she was six years old and living in Puerto Rico. See R. 22. As a consequence of her condition, she was required to take daily medication, including administering insulin injections three times each day, and to follow a "very careful diet." R. 22, 24. However, when asked if her blood sugar level was under control even when she adhered to her diet and took her medication Michelle replied "[s]ometimes it's kind of good and sometimes it doesn't." R. 23. When questioned further, she testified to having hyperglycemic attacks approximately two or three times per week during which her sugar level would get as high as 250 or 300 mg/dL, despite following her regimen. R. 23-24. She explained that when her sugar level was high she would take an "extra dose" of insulin. R. 24.

Michelle testified further that her diabetes prevented her from participating in certain activities. R. 25-28. She testified that she also suffered hypoglycemic attacks two or three times per week and that it took 20 to 25 minutes to stabilize her blood sugar level on each occasion. R. 25-26. Because of these attacks, she was unable to ride a bicycle or participate in "any kind of running activities" and had limited ability to play basketball. R. 25-28. However, she was able to take part in at least some activities in gym class and testified that she had friends in school, would sometimes go to the park with her family, and would often study at night and on weekends. R. 26-27.

When asked if she ever "cheat[ed]" on her diet, Michelle replied "maybe sometimes." R. 28. However, she stated that she still had two or three hypoglycemic attacks per week even when she adhered to her diet and did "what [she was] supposed to do." R. 28.

Dr. Chandrasekhar, an independent medical expert, was also present at the hearing. After Michelle's initial testimony, the ALJ asked Dr. Chandrasekhar if Michelle should be asked further questions. R. 28-30. Dr. Chandrasekhar requested that Michelle describe the hypoglycemic attacks and asked whether and to what extent she was having problems with abdominal pain and bloating. R. 30. Michelle stated that she "[s]ometimes" experienced abdominal pain and that she had headaches "[e]very time" her blood sugar level "is too low" and "when it's high." R. 30. When her sugar level is low, she testified that she gets "dizzy," "don't know what [she is] doing," and "cannot do nothing." R. 31. When her sugar level is high, she stated that "I get a lot of headaches and my mind wants to explode. I have a lot of pain." R. 31. Michelle further testified that when she is in school and feels a hypoglycemic attack coming, she has to leave the classroom in order to get something to eat. R. 32. She acknowledged, however, that the teacher allowed her to eat at her desk. R. 32-33.

Dr. Chandrasekhar then asked more specific questions about the hypoglycemic attacks. He asked whether Michelle checked her sugar level with each attack, to which she replied "[s]ometimes I check the sugar, sometimes I just eat." R. 33. When asked if her sugar level was low on the occasions she checked her blood, Michelle answered "yes." R. 33. Michelle then testified that she had told her doctors the previous month about the attacks and accompanying "dizziness" and that they had changed her regimen, R. 33-34, after which the following exchange took place:

Q. Do you still have incidences where it's too high or too low?
A. Yes.

Q. But not as frequently?

A. No.

Q. How often has it happened in the ...

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