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Stephanie Simpson On Behalf of Z.J.M v. Comm'r of Soc. Sec

August 3, 2012


The opinion of the court was delivered by: Hon. Glenn T. Suddaby, United States District Judge


Plaintiff Stephanie Simpson ("Plaintiff") commenced this action against the Commissioner of Social Security ("Defendant") pursuant to 42 U.S.C. § 405(g) seeking Supplemental Security Income ("SSI") benefits on behalf of her son, Z.J.M. Currently pending before the Court are Plaintiff's motion for judgment on the pleadings (Dkt. No. 11), and Defendant's motion for judgment on the pleadings (Dkt. No. 13). Generally, in her motion, Plaintiff argues that Z.J.M., who suffers from hypertrophic cardiomyopathy, was disabled from birth, on April 14, 2006, until August 26, 2007, and that a contrary finding by an administrative law judge ("ALJ") is not supported by substantial evidence in the record and resulted from the ALJ's failure to fully develop the record. Generally, in his motion, Defendant argues that the Commission's decision that Z.J.M. was not disabled during the relevant period was supported by substantial evidence. For the reasons set forth below, Plaintiff's motion is granted, Defendant's motion is denied, and this matter is remanded to the Social Security Administration for further proceedings consistent with this Decision and Order.


A. Factual Background

Z.J.M. was born on April 14, 2006, after an unremarkable pregnancy. His newborn physical was normal. (See Administrative Transcript ["T."] at 142-143.) During a well-child visit on May 17, 2006, pediatrician Dr. Jana Shaw detected a systolic heart murmur and referred Z.J.M. for an echocardiogram and a pediatric cardiology consultation. (T. 151.)

On June 15, 2006, pediatric cardiologist Dr. Frank Smith diagnosed Z.J.M. with familial hypertrophic cardiomyopathy with obstruction after an examination and review of results of an electrocardiogram and echocardiogram. Dr. Smith noted that Z.J.M.'s "ventricular septum is at least moderately hypertrophied and there is subaortic stenosis with a variable subaortic stenosis gradient of 64-100 mmHg." Dr. Smith notified Plaintiff that there is a risk of sudden arrhythmia or sudden death with this diagnosis, although relatively rare in young children. Dr. Smith recommended no restrictions on Z.J.M.'s activity, but started him on four milligrams daily of Propranolol, a beta blocker, due to a dynamic obstruction of his outflow. (T. 177-178.)

On July 6, 2006, Dr. Smith repeated Z.J.M.'s echocardiogram and noted that "his LV outflow tract obstruction was, if anything, a little better." Due to Z.J.M.'s weight gain, his prescription for Propranolol was increased to six milligrams daily. Again, Dr. Smith placed no restrictions on Z.J.M.'s activity. (T. 174-175). On August 3, 2006, Dr. Smith noted no changes in Z.J.M.'s cardiac exam, but again, due to weigh gain, increased his dosage of Propranolol, and provided Plaintiff with a schedule for further increases based on Z.J.M.'s weight. Also, Dr. Smith continued to place no restrictions on Z.J.M.'s activity. (T. 171-172.)

On September 19, 2006, Z.J.M. presented to Dr. Sandra Crane, a pediatrician, with coughing, wheezing and a runny nose. Dr. Crane diagnosed Z.J.M. with asthma and prescribed Xopenex, a bronchodilator. (T. 188.) On September 22, 2006, Dr. Crane saw Z.J.M., who presented with Plaintiff's complaint that his cough was rattling. Dr. Crane reduced the Xopenex dosage and conferred with Dr. Smith regarding the possible interference between the bronchodilator and Propranolol. (T. 187.) On September 25, 2006, Z.J.M. saw Dr. Smith for examination to investigate whether Xopenex might be interfering with the effect of Propranolol. Dr. Smith changed Z.J.M.'s prescription to another beta blocker, Atenolol. Also, during that visit, Z.J.M.'s echocardiogram revealed that the subaortic stenosis gradient was up to 144 mmHg. Dr. Smith noted that Z.J.M. "has remained free of any significant symptoms" but that "it may be reasonable to perform a cardiac catheterization to determine just how high [his] intracardiac pressures are" and that "[s]urgical intervention of subaortic stenosis can be performed." Dr. Smith concluded that in Z.J.M.'s case "there may be a reason to proceed with some type of surgical procedure if the hemodynamic data were significant enough." Again, Dr. Smith placed no restrictions on Z.J.M.'s activity. (T. 167-169.)

On October 17, 2006, Dr. Smith noted that although Z.J.M.'s wheezing had improved, his subaortic stenosis "has remained significant and has actually progressed over the last month or so." Also, Z.J.M.'s father reported that Z.J.M. was coughing during the night. Concerned that he "might be developing some mild degree of pulmonary edema related to increased ventricular filling pressures," Dr. Smith prescribed Z.J.M. a small dose of Lasix. Dr. Smith also noted that he discussed Z.J.M.'s case at the cardiac case conference and "it was agreed that he might be a candidate for surgical therapy in the future to reduce his subaortic stenosis gradient, if he has significant signs of congestive heart failure related to this." Still, no restrictions were placed on Z.J.M.'s activity level. (T. 164-165.)

Although Dr. Smith's last treatment note indicated that an appointment was scheduled for Z.J.M. to see him on November 20, 2006, the next treatment note in the record is for August 23, 2007. (T. 165, 219.) On that date, Dr. Smith noted that he was following up with Z.J.M. "post resection of the hypertrophied septum and placement of a VSD patch to relieve the subaortic stenosis on April 26, 2007 at about one year of age with good result." Dr. Smith also noted that Z.J.M.'s only medication is Atenolol. Again, no restrictions were placed on Z.J.M.'s activity.

(T. 219-220.)

The next of Dr. Smith's treatment notes in the record is April 10, 2008. At that point, there were no changes to Z.J.M.'s cardiac history, physical exam or ECG. Dr. Smith recommended Z.J.M. remain on Atenolol, and placed no restrictions on his level of activity. (T. 197-198.) Six months later, Dr. Smith noted that Z.J.M.'s ventricular function was good and that there was no residual outflow tract obstruction. Dr. Smith continued the dosage of Atenolol, because Z.J.M.'s heart rate was slow and because he appeared to have episodes of tiredness. However, Dr. Smith noted that because Z.J.M. "is doing so well," he would only need to be seen every 12 months and "he requires no activity restrictions at the present time." (T.195-196).

On August 18, 2009, Dr. Smith wrote a letter in response to a request to "comment upon [Z.J.M.'s] cardiac health and, in particular, his cardiac status during the first 18 months of life." Dr. Smith explained Z.J.M.'s condition and noted that because it was so severe and did not respond to medical therapy, Z.J.M. underwent surgery on April 26, 2007, and that it took about four months for him to recover. Dr. Smith went on to opine that

[w]ere [Z.J.M.] to be an adult with this heart condition he would definitely have been unable to do any significant strenuous activity and would probably have had great difficulty finding employment through the entire time of his cardiac diagnosis and at least 3-4 months beyond the time of his operation. Fortunately, [Z.J.M.'s] condition has improved since then.

(T. 221.)

On December 18, 2006, R. Mohanty, a pediatric consultant, reviewed the record for Defendant and concluded that while Z.J.M.'s impairment is severe, it does not meet, medically equal or functionally equal the Listings. The consultant found that Z.J.M. has no limitation in the following domains: Acquiring and Using Information, Attending and Completing Tasks, Interacting and Relating with Others, and Moving About and Manipulating Objects. The consultant found that Z.J.M. has marked limitation in the domain of Health and Physical Well-Being, and failed to indicate which level of ...

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