United States District Court, N.D. Indiana, Fort Wayne Division
OPINION AND ORDER
Collins, United States Magistrate Judge
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”). (DE 1). For the following reasons, the
Commissioner's decision will be AFFIRMED.
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.
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
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.
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).
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.
Issa's Testimony at the Hearing
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,
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).
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. (AR 65).
Summary of the Relevant Medical Evidence
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).
February 2013, Issa underwent diagnostic imaging, the results
of which were normal as to a person who had undergone a
Whipple procedure. (AR 309).
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).
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).
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).
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).
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).
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).
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).
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).
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). ...