United States District Court, D. Massachusetts
MEMORANDUM AND ORDER
SOROKIN, UNITED STATES DISTRICT JUDGE.
plaintiff, Deborah Lynn Adkins, seeks reversal and remand of
a decision by the defendant, the Acting Commissioner of the
Social Security Administration (“the
Commissioner”), denying her Supplemental Security
Income (“SSI”) and Disability Insurance Benefits
(“DIB”). Doc. No. 13. The Commissioner seeks an
order affirming her decision. Doc. No. 26. For the reasons
that follow, Adkins' Motion to Reverse and/or Remand the
Decision of the Commissioner is DENIED, and the
Commissioner's Motion to Affirm the Commissioner's
Decision is ALLOWED.
February of 2014, Adkins applied for SSI and DIB, alleging
that she became disabled on June 1, 2012. A.R. at
Her applications were denied initially on April 24, 2014 and
upon reconsideration on August 11, 2014. Id On
August 19, 2014, Adkins requested a hearing before an
administrative law judge (“ALJ”). Id
Adkins appeared, represented by counsel, and testified at her
June 30, 2015 hearing, which also featured testimony by a
vocational expert Amy Vercillo. Id.
the ALJ issued a written decision denying Adkins'
applications. Id. at 12. Adkins' timely request
for review by the Appeals Council was denied, id.,
rendering the ALJ's determination the final decision of
the Commissioner. Adkins filed this action appealing the
Commissioner's decision on October 6, 2016. Doc. No. 1.
Adkins' Physical Impairments
paperwork accompanying her applications, Adkins claimed she
suffered from severe physical impairments including thoracic
outlet syndrome (“TOS”), Paget-Shroetter syndrome
(“PSS”), transient ischemic attacks, and
Raynaud's syndrome. A.R. at 234. The administrative record
contains the following relevant evidence regarding
Adkins' alleged physical impairments:
• Adkins was in a “usual state of good health
until December of 2007, ” when she began experiencing
pain in her right arm and swelling. Id at 350.
• In December of 2007, Adkins was diagnosed with TOS
with PSS resulting from it. Id at 37, 901. Adkins
underwent surgery in 2008 and again in 2009 to treat the
conditions. Id at 36, 898.
• After the surgeries, Adkins' swelling and pain
initially decreased; however, her symptoms later returned
with increased pain. Id at 350.
• From 2010 to 2012, Adkins continued to experience
swelling, pain, and muscle spasms. Id at 61, 350. To
manage these symptoms, Adkins participated in physical
therapy. Id at 62. She also used muscle relaxers,
blood thinners, and Heparin therapy. Id at 63-64.
• In May of 2012, Adkins graduated from Harvard
University with a Bachelor of Science Degree. Id at
39, 41-42. Adkins intended to continue her education with an
additional two years of study at Northeastern University but
was deterred by her daily pain. Id at 40.
• While a student, Adkins lived in Dorchester and
commuted to school. Id. at 43-44. She took many of
her classes online. Id She typically spent three
hours at a time online to complete her assignments.
Id at 44.
• During this time, Adkins lived at the Salvation Army
Jubilee House. Id A requirement of living at the
house is volunteer work. Id To fulfill this
requirement, Adkins mentored and tutored students and
performed office work “like answering the phones”
and “hosting groups.” Id
• Adkins has had difficulty finding a medication routine
that works for her. Initially, she used the muscle relaxer
Tizanidine and the blood thinner Lovenox until the
medications inflamed her liver, causing toxic hepatitis.
Id at 63-64, 316. Adkins switched to a new blood
thinner Coumadin but was unable to consistently reach proper
blood thinness levels on the drug. Id She also used
the medication Neurontin to manage her pain but developed
edema (fluid retention) as a side effect and so discontinued
its use. Id at 350. She tried a Butrans patch to
help with chest pain, but experienced headaches, nausea and
increased pain so discontinued the patch's use.
Id at 382-83, 536.
• While a student at Harvard, Adkins also underwent
Heparin therapy every three to four months to treat blood
clots. Id at 66. The typical treatment lasted
fifteen days. Id Adkins experienced side effects as
a result of the treatment, including vomiting and generally
feeling unwell. Id. at 67.
• Recently, Adkins has had “benefits with heat and
Dilaudid, ” a pain medication. Id. at 350.
• On June 4, 2012, Adkins met with Dr. Dean Donahue at
Massachusetts General Hospital (“MGH”),
complaining of swelling and pain in her right hand.
Id at 67, 453. At the visit, Adkins also reported a
general decline in her ability to function and increased pain
and muscle spasms, and expressed a fear “that she might
not be able to commit 100% to work with her ongoing pain
issues.” Id at 67-68, 453.
• At this time, Adkins increased her use of Dilaudid to
manage her pain, but then “resumed her habit of taking
[it] only  for strong pain . . . and often [not] as
• During the June 4, 2012 examination, Dr. Donahue found
Adkins' range of motion to be normal, and found that she
had five out of five in muscle strength in all major muscle
groups except her right upper extremity which Dr. Donahue
found to have four out of five strength. Id at 454.
Dr. Donahue also found that Adkins is “able to deal
with flare-up of pain . . . with limited amount of medication
and medical support” and has “the ability to
tolerate pain most days.” Id
• From 2012 to 2014, Adkins visited MGH and Beth Israel
Pain Management Center dozens of times and saw numerous
doctors, including Dr. Donahue, pain management physicians,
vascular physicians, cardiologists, a neurologist, and a
rheumatologist. Id at 68-69, 318-422, 415-19,
453-54, 529-35, 668-80, 907, 1416-19. The most significant of
these visits, for the purposes of the issues presented here,
are summarized in the paragraphs that follow.
• On November 11, 2012, Adkins visited the emergency
department at MGH after experiencing severe abdominal pain
while riding a recumbent bike at the gym. Id at 428.
All of her laboratory tests were normal, and she was
discharged. Id at 336-67.
• In March of 2013, Adkins again visited the emergency
department at MGH, complaining of chest pain and dizziness.
Id at 427-34. After she was discharged, she followed
up with her pain management physician. Id. at 421.
Her physician found her to possess full range of motion,
normal gait, and sensation. Id at 421-22. In April
of 2013, Adkins had another episode of chest pain. She
visited MGH on April 24, 2013 and was found to have a normal
MRI. Id. at 392.
• On April 29, 2013, Adkins returned to the emergency
room complaining of chronic pain, chest pain, shortness of
breath, blurred vision, and light headedness. Id at
312, 317. Her attending physician was unable to find the
source of her pain. Id at 394. She was found to have
normal range of motion, reflexes, and coordination; her
lungs, heart, and chest were found to be normal; she was
found to “abulate with steady gait;” and ...