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Santiago v. Commissioner of Social Security

August 14, 2009


The opinion of the court was delivered by: Dora L. Irizarry United States District Judge


DORA L. IRIZARRY, U.S. District Judge

Plaintiff Melvin Santiago, proceeding pro se, filed an application for disability insurance benefits ("DIB") and supplemental security income ("SSI") under the Social Security Act (the "Act") on December 26, 2002. Plaintiff's application was denied initially and on reconsideration. Plaintiff, then represented by counsel, testified at a hearing held before an Administrative Law Judge ("ALJ") on March 17, 2005. By decision dated August 17, 2005, the ALJ concluded that plaintiff was not disabled within the meaning of the Act. On November 2, 2006, the ALJ's decision became the Commissioner's final decision when the Appeals Council denied plaintiff's request for review. Plaintiff filed the instant action seeking judicial review of the denial of SSI and DIB benefits pursuant to 42 U.S.C. § 405(g) and 1383(c)(3). The Commissioner now moves for judgment on the pleadings pursuant to Federal Rules of Civil Procedure 12(c), contending that substantial evidence supports the ALJ's finding that plaintiff is not disabled and is capable of performing medium-level work. For the reasons set forth more fully below, the Commissioner's motion is granted in its entirety.


A. Non-medical and Testimonial Evidence

Plaintiff, a forty-eight year old high school graduate with one year of college, worked as a driver and courier for twenty-four years. (R. 59, 85-89.*fn1 ) Plaintiff's responsibilities included delivering packages of up to seventy-five pounds with the aid of a small hand truck. (R. 86.) Plaintiff did not need technical knowledge or skills to perform these duties. (R. 85.) According to plaintiff, the onset of his disability occurred on December 19, 2002 after he had an epileptic seizure at work, which caused him to lose consciousness.*fn2 (R. 85, 92.) Plaintiff asserts that he is entitled to DIB and SSI because of epilepsy. (Compl. ¶ 4.)

Plaintiff lives with his girlfriend who cooks for him and reminds him to take his medicine. (R. 95, 97, 103.) When plaintiff's girlfriend doesn't prepare his meals, he eats at a diner or orders pizza, because he cannot cook. (R. 96, 105.) He does not do chores. (R. 106.) Plaintiff also stated that he cannot shop, drive, or play sports due to epilepsy. (R. 98-99.) Plaintiff spends his days reading books and watching television. (R. 103, 104.) Plaintiff can handle money and visits his father's home on a regular basis, using public transportation to travel. (R. 99, 106-07.) Plaintiff can walk for about one block before needing to rest for twenty minutes. (R. 101, 109.) He does not finish what he starts due because he is constantly tired and does not feel well. (R. 98, 101.) Plaintiff stated that his condition affects his ability to lift, stand, walk, sit, kneel, squat, reach, and talk. (R. 100.)

During the March 17, 2005 hearing*fn3 before the ALJ, plaintiff testified that he had a history of poor compliance with taking his prescribed anti-seizure medication because it was "not doing the job" and could damage his liver. (R. 408.) His doctor prescribed "Keppra instead of Dilantin," and he sometimes forgets to take it. (R. 408-09.) Plaintiff testified that he had taken his medication every day for the sixty days prior to the hearing and that, during that time period, he experienced one seizure on February 28, 2005. (R. 409-10.) Plaintiff also testified that before the February 28, 2005 seizure, he experienced a seizure in July 2004. (R. 410.)

B. Medical Evidence

Plaintiff visited a neurologist, Dr. Allamprahbu Patil, in March 2000, and continued visiting him regularly until after the date of the hearing. (R. 87-88.) Dr. Patil performed various physical examinations of plaintiff, monitored any seizure activity, and prescribed medication to control plaintiff's seizures, including Dilantin. (R. 86-89.) Plaintiff has experienced seizures since age sixteen.*fn4 (R. 337.)

The alleged onset of plaintiff's disability occurred on December 19, 2002, when plaintiff experienced a seizure and lost consciousness while driving a van at work. (R. 121.) An ambulance brought him to St. Clare's Hospital and Health Center, though he had not suffered an injury. (R. 120-22.) Plaintiff was alert and not in distress. (R. 121.) A blood test revealed that plaintiff's medication, Diantin, was at a level of less than 0.1 ug/mL, which is much lower than the therapeutic range of 10.0-20.0 ug/mL. (R. 123, 125.) Doctors gave plaintiff Dilantin intravenously and discharged him with instructions to take his medication, "as directed," avoid driving, operating machinery, and drinking alcohol, and to contact Dr. Patil the following day.

(R. 124, 128.)

On December 12, 2003, Dr. Patil completed a "neurology follow up" form, stating that plaintiff's last seizure occurred on December 19, 2002. Dr. Patil reported that plaintiff's seizure disorder was stable at that time and noted that plaintiff complained of back and neck pain, but did not elaborate on how these symptoms affected him. (R. 148-49.)

Plaintiff visited Dr. Patil again on January 21, 2004, after experiencing a seizure on January 16, 2004, while making a delivery at work. (R. 150.) Plaintiff informed Dr. Patil that he was taken to Bellevue Hospital. (Id.) Plaintiff also stated that he had been experiencing stress at work and that he had not taken three pills on the day of his seizure. (Id.) Dr. Patil noted plaintiff's non-compliance with his medication and prescribed continued use of Dilantin and added doses of Keppra to control plaintiff's epilepsy. (Id.)

Plaintiff visited Dr. Patil each month for the next three months. Plaintiff did not report experiencing seizures during those visits. (R. 154-56.) During the March and April 2004 visits, Dr. Patil increased plaintiff's dosage of Keppra. (Id.) During plaintiff's April 2004 visit, Dr. Patil discontinued plaintiff's use of Dilantin. (R. 156.)

Plaintiff visited Dr. Patil again on May 16, 2004, reporting that he experienced a seizure on May 8, 2004. (R. 158.) Plaintiff also told Dr. Patil that "[h]e had been taking only 750 mg once a day of Keppra instead of 750 mg" twice daily as prescribed. (Id.) Plaintiff also complained of experiencing headaches, neck pain, and lower back pain. (R. 159.)

On June 6, 2004, plaintiff visited Dr. Patil in the company of his brother, Radames Santiago. (R. 160.) During this visit, plaintiff did not report recent seizure episodes. Plaintiff's blood pressure was 170/130 and Dr. Patil directed plaintiff to visit the emergency room at Elmhurst Hospital. (Id.) Plaintiff again complained of experiencing headaches, neck pain, and lower back pain at that time. (R. 161.) Plaintiff's brother told Dr. Patil that plaintiff consumed a six-pack of beer per day. (R. 160.)

On July 16, 2004, plaintiff was admitted to the emergency room at Wyckoff Heights Medical Center ("Wyckoff Hospital") after experiencing two seizures earlier that day. (R. 140, 204-333, 218, 221, 224.) A physical examination of plaintiff showed multiple tongue bites and an extended abdomen. (R. 218.) Plaintiff's breathing was normal, and a CT-scan of his head was negative. (R. 224, 248.) While in the examination room, plaintiff experienced another seizure, which was eventually controlled by multiple doses of Ativan. (R. 219, 220.) His heart rate became tachycardiac, and he was intubated when he went into acute respiratory failure. (R. 220, 228.) Plaintiff's girlfriend provided his medical history to doctors at that time. (R. 221.) She reported that plaintiff suffered from epilepsy since he was sixteen years old and did not take his medication as prescribed. (Id.) She also stated that plaintiff frequently abused cocaine, that he had used cocaine the day before, and that he always has seizures after cocaine use. (Id.) Emergency room records also revealed that plaintiff drinks beer daily and uses cocaine. (R. 218.)

Doctors admitted plaintiff into the intensive care unit. (R. 231, 266.) Blood tests taken on July 16, 2004 revealed a high level of cocaine and non-theraputic levels of prescribed epilepsy medication present in plaintiff's blood stream. (R. 262-63.) During his hospital stay, the level of Dilantin in plaintiff's blood increased to a therapeutic range. (R. 259.) Plaintiff's condition stabilized and he was discharged on July 26, 2004. Upon his discharge from the hospital, plaintiff ...

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