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Issa v. Commissioner of Social Security

United States District Court, N.D. Indiana, Fort Wayne Division

September 29, 2016



          Susan Collins, United States Magistrate Judge

         Plaintiff Lacey Janine Issa appeals to the district court from a final decision of the Commissioner of Social Security (“Commissioner”) denying her application under the Social Security Act (the “Act”) for Supplemental Security Income (“SSI”).[1] (DE 1). For the following reasons, the Commissioner's decision will be AFFIRMED.


         Issa applied for SSI on August 26, 2013, alleging disability as of May 15, 2012. (DE 14 Administrative Record (“AR”) 173-78). SSI, however, is not payable prior to the month following the month in which the application was filed. 20 C.F.R. § 416.335. Because Issa filed her application in August 2013, the first month in which she was eligible to receive SSI benefits was September 2013.

         The Commissioner denied Issa's application initially and upon reconsideration, and Issa requested an administrative hearing. (AR 89, 103, 108-14). On July 31, 2014, a hearing was conducted by Administrative Law Judge Terry L. Miller (“the ALJ”), at which Issa, who was represented by counsel at the time; her mother; and Robert Barkhaus, a vocational expert (the “VE”), testified. (AR 32-77).

         On October 20, 2014, the ALJ rendered an unfavorable decision to Issa, concluding that she was not disabled since August 26, 2013, the date her application was filed, because despite the limitations caused by her impairments, she could perform a significant number of unskilled, light occupations in the economy. (AR 15-26). The Appeals Council denied Issa's request for review (AR 1-4), at which point the ALJ's decision became the final decision of the Commissioner. See 20 C.F.R. § 416.1481.

         Issa filed a complaint with this Court on February 18, 2015, seeking relief from the Commissioner's final decision. (DE 1). Issa argues in this appeal that the ALJ: (1) improperly discounted the credibility of her symptom testimony, and (2) failed to account for her limitations caused by her gastrointestinal (“GI”) symptoms when assessing her residual functional capacity (“RFC”). (DE 19 at 6-13).


A. Background

         At the time of the ALJ's decision, Issa was 35 years old (DE 204); had a tenth grade education (DE 209); and had prior work experience as a grinder/cleaner in a factory and at a ticket booth at a drive-in theater. (AR 209). Issa represented in her SSI application that she was seeking disability due to problems with her pancreas, removal of a tumor, nausea, and stomach pain (AR 208); she subsequently cited mental impairments as well (AR 22). Issa does not challenge the ALJ's consideration of her mental impairments, and thus, the Court will focus on the evidence pertaining to her physical conditions.

         B. Issa's Testimony at the Hearing

         At the hearing, Issa testified that since her divorce, she lives in a house with her mother and her three-month old daughter. (AR 37-39). Issa was receiving food stamps and Medicaid benefits; she performs her self care independently and drives a car. (AR 40, 59-60). In a typical day, Issa gets up every three hours to care for her baby. (AR 59-60). She stated that if she is having a good day, she goes out to visit friends and family, but if she is not feeling well, she spends most of her time lying in bed. (AR 59). She estimated that she has four or five bad days a week. (AR 67). On a bad day, Issa's mother cares for the baby. (AR 68). Issa grocery shops occasionally, but her mother usually does the cooking; Issa helps out with household chores and does her own laundry. (AR 60-61). She enjoys sewing blankets, spending time on social media, and watching television. (AR 59, 61-62).

         Issa identified her primary physical problem as intraductal papillary mucinous neoplasm of the pancreas, stating that she underwent surgery to remove the benign tumor in October 2012. (AR 46-47). She experienced abdominal pain and vomiting in the month before the surgery. (AR 47). Since the surgery, she has been on a strict diet. (AR 47-50). She testified that even though she takes medications, she experiences nausea, vomiting, and diarrhea every day, and she has pain every time she eats. (AR 47-50). She rated her abdominal pain as a “seven or eight” on a scale of one to 10. (AR 50). She stated that she keeps a trash can beside her bed and carries bags with her in the car in case she needs to vomit. (AR 63, 66). She asserted that she can never finish her shopping before needing to use a restroom. (AR 63). She estimated that she had four urinary or fecal accidents in the week before the hearing, commenting that this was a typical week for her. (AR 63-64).

         Issa testified that her GI problems are aggravated by stress and by bending over, sitting, or standing too long. (AR 50-54). She stated that the only time she does not experience GI symptoms is when she is lying down, and thus, she spends about 70 percent of her day lying down on a bed or the floor. (AR 52-53). She avoids climbing stairs because she gets lightheaded and dizzy; she can lift up to 20 pounds. (AR 50, 52-54). Her symptoms worsened during her recent pregnancy. (AR 57). She smokes cigarettes, but has reduced from one-half pack to three cigarettes a day; she uses marijuana to help control her nausea when medications fail to do so. (AR 57-58). Issa stated that her medications sometimes make it difficult for her to sleep and that her nausea medication sometimes make her sick.[3] (AR 65).

         C. Summary of the Relevant Medical Evidence

         Issa sought emergency room treatment in June 2012 for abdominal pain and vomiting. (AR 336). In September 2012, Issa underwent an esophagogastroduodenoscopy with biopsy and endoscopic ultrasound due to repeated episodes of pancreatitis. (AR 264-66). The procedure revealed an intraductal papillary mucinous neoplasm in the head of her pancreas. (AR 264). Due to the malignant potential of such tumors, Alan M. Yahanda, M.D., recommended that Issa undergo a pancreaticoduodenectomy, referred to as a “Whipple” procedure. (AR 382). Dr. Yahanda performed the surgery on October 30, 2012. (AR 305-08). Issa's postoperative course was notable for a slow return of GI function, and she was started on a feeding tube, which she used through mid-December 2012. (AR 287, 324).

         In February 2013, Issa underwent diagnostic imaging, the results of which were normal as to a person who had undergone a Whipple procedure. (AR 309).

         In July 2013, Issa reported to a nurse at St. Martins Healthcare that she had lost her health insurance and needed medications. (AR 335). She complained of frequent stomach cramps, liquid stools, and that she was vomiting bile three to four times a day. (AR 335). The following month, Issa was again having difficulty with food, reporting that she was vomiting every day. (AR 334). She complained of feeling sluggish, tired, and dizzy upon standing; she asked for a nutritional consult. (AR 334). She had not seen Dr. Yahanda in four months and was not sure what medications she should be taking. (AR 334).

         In September 2013, Issa complained to Dr. Yahanda of recurrent nausea with any oral intake and stated that she had to force herself to eat. (AR 386). Her abdomen was soft, tender, and non-distended. (AR 386). Dr. Yahanda prescribed several medications, including Sucralfate, which had helped Issa in the past. (AR 386).

         In October 2013, Issa visited the emergency room due to leg cramping for the past 24 hours. (AR 357-58). In a review of systems, the examiner documented that Issa had “[p]retty standard intermittent and diffuse waxing and waning abdominal pain, which [was] nothing new or concerning to her at all, ” and that her “[b]owel and bladder habits [had] not been compromised recently.” (AR 357). Upon exam, Issa's abdomen was diffusely and mildly tender, but without rebound or guarding; Issa indicated that this was “pretty much her normal level.” (AR 357).

         In November 13, 2013, Issa reported to Dr. Yahanda that she was unable to eat any large amount and had been maintaining her nutrition by consuming baby food. (AR 388). Her bowel movements were slightly constipated. (AR 388). Dr. Yahanda noted that Issa's postoperative course had been complicated by persistent nausea and vomiting, which was thought to be due to bile reflux gastritis. (AR 388). On examination, Issa appeared healthy, in no acute distress, and no thinner than at her previous visits. (AR 388). Her abdomen was soft, non-tender, and non-distended; her bowel sounds were normal. (AR 388). Dr. Yahanda noted that the Carafate seemed to be helping Issa's complaints, although it did not completely relieve her gastric irritation. (AR 388). Dr. Yahanda referred her to gastroenterology for management of her gastritis and for follow-up endoscopies. (AR 388). The next day, November 14, 2013, a urine screen revealed that Issa was pregnant. (AR 390).

         On November 25, 2013, Issa was evaluated by Neil Sharma, M.D., upon request by Dr. Yahanda for evaluation of her nausea and vomiting. (AR 554-55). She was in her first trimester of pregnancy and was experiencing morning sickness. (AR 554). Her obstetrician had approved her taking Zofran, Creon, and Carafate for her GI problems during her pregnancy. (AR 554). Dr. Sharma found that Issa's nausea and vomiting were “currently well-controlled, ” and that she had not lost any weight. (AR 554). Her abdomen was non-distended and non-tender, and her bowel sounds were normal. (AR 555). The following month, Dr. Sharma again noted that Issa's nausea and vomiting were “currently well-controlled.” (AR 443-44).

         On December 2, 2013, Issa was seen at the office of Lindsay Coda, D.O., to begin her prenatal care. (AR 507). Issa told Dr. Coda that she had been “doing well” since undergoing the Whipple procedure in October 2012. (AR 507). She was taking her pancreatic enzymes. (AR 507). She denied any nausea or vomiting, but stated that she was having difficulty taking prenatal vitamins due to stomach pain. (AR 507). Issa appeared well-nourished, her abdomen was soft without tenderness, and her bowel sounds were normal. (AR 508). She was counseled to stop smoking tobacco and marijuana. (AR 509).

         On December 15, 2013, H.M. Bacchus, M.D., evaluated Issa at the request of Social Security. (AR 413-15). She reported that she had to stop many of her medications due to her pregnancy, but was still taking Zofran. (AR 413). She complained of severe constipation or diarrhea, vomiting bile, severe pain with movement, daily nausea, that she has to maintain a strict diet, and that she has to lie down after she eats. (AR 413). She estimated that she could sit for 90 minutes, stand for 45 minutes, and walk for 30 minutes, but that she could not carry any weight while walking. (AR 413). Upon physical exam, Issa moved on and off of a chair without difficulty, and her gait and station were steady and upright. (AR 414). She was unable to hop on both feet, but she could walk on heels and toes, squat, and tandem gait. (AR 414). Her range of motion and upper extremity strength were normal; her lower extremity strength was 4/5. (AR 414). Her abdomen was soft, non-tender, and without guarding. (AR 414). Dr. Bacchus's impression was a tumor removed from her pancreas and bile duct, surgery in October 2012; and stomach problems secondary to the surgery in October 2012. (AR 414).

         On December 26, 2013, M. Brill, M.D., a state agency physician, reviewed Issa's record and completed a physical RFC assessment. (AR 83-85). Issa was nine weeks pregnant at the time. (AR 85). Dr. Brill found that Issa could lift and carry 10 pounds frequently and 20 pounds occasionally; stand or walk six hours in an eight-hour workday; sit for six hours in an eight-hour workday; perform unlimited pushing or pulling within her lifting limitations; occasionally balance, stoop, kneel, crouch, crawl, and climb ramps and stairs, but never climb ladders, ropes, or scaffolds; and must avoid concentrated exposure to wetness and hazards such as machinery or heights. (AR 84-85).

         On January 3, 2014, Issa was seen for a follow-up visit by a nurse practitioner working with Bret Kueber, M.D. (AR 417). Issa had been without her GI medications and was experiencing severe nausea and vomiting. (AR 417). (AR 417). ...

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