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Nicole v. Astrue

November 20, 2009

LAURA (GODOY) NICOLE,*FN1 PLAINTIFF,
v.
MICHAEL J. ASTRUE,*FN2 COMMISSIONER OF SOCIAL SECURITY ADMINISTRATION, DEFENDANT.



The opinion of the court was delivered by: Neal P. McCURN, Senior U.S. District Court Judge

MEMORANDUM - DECISION AND ORDER

Plaintiff Laura (Godoy) Nicole ("plaintiff") brings this action pursuant to §205(g) of the Social Security Act (the "Act"), codified at 42 U.S.C. § 405(g).

Plaintiff seeks review of the final decision of the Commissioner of the Social Security Administration ("Commissioner") denying plaintiff's claim for disability insurance benefits ("DIB") under the Act. Specifically, plaintiff alleges that the decision of Administrative Law Judge ("ALJ") Joseph F. Gibbons, denying plaintiff's application for DIB, was against the weight of substantial evidence contained in the record and contrary to applicable legal standards. The Commissioner moves for judgment on the pleadings pursuant to Fed. R. Civ. P. 12(c), arguing that the ALJ's decision was supported by substantial evidence.

The ALJ found that although plaintiff has been under a total disability since January 20, 2000, submitted evidence shows that her impairments prior to December 31, 1998, the date she was last insured, failed to produce more than a minimal effect on her ability to perform basic work activities. Therefore, the ALJ concludes, the plaintiff is not entitled to Title II (disability insurance) benefits. Tr. at 24. The issue before this court is whether the case should be remanded for clarification of the plaintiff's condition prior to her date last insured. For the reasons set forth below, the court finds that the there is substantial evidence in the record to undermine the ALJ's decision, and remands the case for clarification of the plaintiff's condition prior to her date last insured.

I. PROCEDURAL HISTORY and FACTS

The following recitation of the procedural history and facts of this case are taken from the party submissions and the administrative record. Where the parties' rendering of the facts differs from the record, where facts are omitted, or in the interest of clarification, the facts will be supplemented as needed by undisputed facts from the record. Because the ALJ determined that plaintiff has been disabled since a motor vehicle accident on January 20, 2000, the court does not concern itself with events subsequent to that date, nor does the court consider the ALJ's award of Supplemental Security Income benefits ("SSI") to the plaintiff. The court does, however, include events in the time period between plaintiff's date last insured and the date of her motor vehicle accident in order to clarify this court's decision.

A. Procedural History

Plaintiff filed an application dated September 9, 2003*fn3 for Social Security Disability Benefits ("DIB"), alleging disability due to a cardiac condition, back impairment and neck impairment. Tr. at 20; 80. Plaintiff's application was denied on December 26, 2003. Tr. at 62-65. On January 12, 2004, plaintiff made a timely request for a hearing before an ALJ. Tr. at 66. The hearing was held on June 28, 2004 in Albany, New York. Tr. at 27-57. On August 18, 2004, the ALJ issued a partially favorable decision, awarding plaintiff SSI payments, but finding that although plaintiff had been under a disability pursuant to the Act since January 20, 2000, she was insured for benefits only through December 31, 1988. Tr. at 24.

On September 30, 2004, plaintiff appealed the ALJ's decision. Tr. at 15. On March 15, 2005, plaintiff supplemented her appeal with April 1988 medical records from Dr. Denton A. Cooley ("Dr. Cooley") of the Texas Heart Institute.

Tr. at 484-96. The Appeals Council denied plaintiff's request for review on June 27, 2005 (Tr. at 3-5), making the ALJ's decision the final decision of the Commissioner. Plaintiff requested court review of the ALJ's decision by filing this civil action.

B. Facts

At the time of the hearing, plaintiff was fifty-five years old (Tr. at 20), with a date of birth of August 10, 1948. Tr. at 24. Plaintiff had a four-year college degree and past relevant work as a fashion model, news assignment writer, associate television producer, research assistant and executive assistant for a real estate developer. Tr. at 20-21.

Plaintiff was diagnosed with rheumatic fever at the age of seven, and again at age ten, which caused her to develop mitral stenosis. Tr. at 441; 490. At age nineteen, after a dental procedure, plaintiff suffered an episode of subacute bacterial endocarditis, an infection in the heart valves. Tr. at 441;488;490. While ill with endocarditis, plaintiff began developing arrhythmias, which were treated with medications and, to some degree, controlled. Tr. at 441;490. Between 1968 and 1988, plaintiff's arrhythmias continued in varying degrees, and she also suffered from rheumatoid arthritis. Plaintiff was followed by physical examination and non-invasive studies serially throughout this time. Tr. at 441; 490. In August 1986, while engaged to her future husband, plaintiff entered Mt. Sinai Hospital in New York City for an abdominal abscess, where she remained for 10 days. Tr. at 441.

On April 1, 1987, plaintiff married and moved to South America with her husband, necessitating that she terminate her employment. She became seriously ill shortly thereafter. Tr. at 98. From 1986 until April of 1988, plaintiff suffered several serious arrhythmia attacks which included severe vomiting and unconsciousness (syncopal and presyncopal episodes), and approximately ten to twelve emergency room visits to hospitals in Caracus, Venezuela, and the Miami Heart Institute in Florida. Tr. at 442; 490. Plaintiff was admitted to the Miami Heart Institute on October 6, 1987. Tr. at 431. Doctors at the Miami Heart Institute conducted electrophysiologic testing and diagnosed superventricular tachycardias in association with excessory conduction pathway. Tr. at 490. Plaintiff stated that from about eight months prior to April 1988, she had increased dyspnea on exertion, and doctors noted two pillow orthopnea and exercise related chest pains of an increasing frequency. Tr. at 490.

Doctors at the Miami Heart Institute recommended that plaintiff be evaluated by Dr. Cooley in Houston, Texas, a leading specialist in cardiac valve surgery. Upon inspection of plaintiff's medical records, Dr. Cooley summoned plaintiff to the Texas Heart Institute from her home in Venezuela for evaluation of plaintiff's rheumatic valvular heart disease. Tr. at 442;487. Plaintiff was ...


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