United States District Court, D. Massachusetts
MEMORANDUM AND ORDER
Patti B. Saris Chief U.S. District Judge
Nirlande Augustin brings this action under 42 U.S.C. §
405(g) for judicial review of a final decision denying her
applications for Social Security Disability Insurance and
Supplemental Security Income benefits. She claims that the
Administrative Law Judge (“ALJ”) erred by failing
to find that she has a listed impairment, misweighing the
medical opinions, and improperly concluding she can perform
light office work.
following reasons, the Court ALLOWS
Plaintiff's motion to reverse the Commissioner's
decision (Docket No. 12) and DENIES
Defendant's motion to affirm the Commissioner's
decision (Docket No. 13).
following facts are taken from the administrative record.
Plaintiff is a single, 62-year-old female. R. 40. She lives
with one of her children in Everett, Massachusetts.
Id. Her claim for disability benefits is based on
her sickle cell disease, breast cancer, and left shoulder
subtotal tear/ avascular necrosis. R. 19-20.
Educational and Work History
earned a high school diploma and received some vocational
training. R. 40. She worked as a legal secretary at New
England Life until the mid-1980s. R. 165. She stopped working
due to her sickle cell disease, moved to Florida, and
received disability benefits for ten years. Id. She
worked from 2000 to 2010 as a legal secretary at a Miami law
firm. Id. During 2011, 2012, and 2014, she was
self-employed as a part-time French translator and personal
care attendant and companion for elderly clients. R. 45-46,
165. After her diagnosis of breast cancer in 2015, she moved
from Miami back to Boston for her medical care. R. 426.
sixteen, Plaintiff was diagnosed with sickle cell disease.
Id. She began taking folic acid and iron around this
time, though not consistently. R. 440. During the twenty-nine
years she lived in Miami, she was hospitalized about ten
times. Id. For example, in February 2015, she was
hospitalized for chest, back, knee, and arm pain associated
with her sickle cell disease. R. 426.
March 2015, Plaintiff was diagnosed with breast cancer. R.
342. On April 29, 2015, she underwent a right modified
radical mastectomy to remove the cancer. R. 374-75. There
were no immediate complications from the procedure, and her
surgeon indicated one week later that she exhibited full
range of motion of her entire arm. R. 340-41.
27, 2015, after moving to Boston, Plaintiff went to the
Lawrence Memorial Hospital emergency room complaining of
shortness of breath and right-sided chest pain. R. 382, 384.
She informed the attending physician that she had been doing
reasonably well since her surgery two months earlier. R. 386.
The physician found that she was severely anemic. R. 382. Her
symptoms improved after she was rehydrated and transfused
with two units of blood. Id. She remained in the
hospital for three days. Id. Plaintiff met with
oncologist Dr. Dejan Juric at the Massachusetts General
Hospital (“MGH”) on July 17, 2015 to discuss her
breast cancer. R. 405-06. She reported some fatigue and
intermittent tightness in her right chest wall, but denied
any frank pain, shortness of breath, dyspnea on exertion,
bone pain, or joint pain. R. 405. She declined chemotherapy
to reduce her risk of recurrence because she worried that, in
conjunction with her sickle cell disease, the chemotherapy
would render her completely unable to function. R. 51, 406.
Plaintiff saw a hematologist at MGH, Dr. Rachel Rosovsky, on
December 7, 2015 for her sickle cell disease. R. 440-43. She
told Dr. Rosovsky that her energy levels were
“okay” but had decreased over the past two years.
R. 441. She reported no pain. R. 441-42. Plaintiff said she
was not consistently taking her folic acid and iron to treat
her sickle cell disease and did not know how many sickle cell
crises she had per year. Id.
weeks later, Plaintiff returned to Dr. Rosovsky. She reported
that she had been taking her iron and folic acid daily since
the last visit and that she was okay but felt fatigued often.
R. 436. Plaintiff refused to take any pain medication
stronger than Motrin. R. 439. Dr. Rosovsky encouraged
Plaintiff to start taking a prescription drug called Hydra
for her sickle cell disease, which she said she would
January 4, 2016, Plaintiff met with Dr. Anne Moulton, her
primary care physician at MGH. R. 434-35. Plaintiff reported
no pain, though she appeared tired. R. 434. She also saw Dr.
Rosovsky the same day. R. 426-30. She reported feeling weak
all over and had taken 600mg of Motrin the evening before to
prevent a sickle cell crisis. R. 427. She stated that she was
taking folic acid and iron more regularly. Id. Dr.
Rosovsky again recommended that Plaintiff start taking
Hydrea. R. 430. Plaintiff was transferred to the
emergency department to receive a transfusion of one unit of
red blood cells, but she left later that night before
receiving the transfusion. R. 423, 431.
February 29, 2016, she visited a nurse practitioner
complaining of fatigue, feeling like she was going to pass
out after basic tasks, and right arm numbness. R. 462. The
nurse practitioner noted that Plaintiff was inconsistently
taking her folic acid. R. 463-64. She arranged for Plaintiff
to receive a blood transfusion. R. 463.
April 1, 2016, Plaintiff visited Dr. Juric to discuss her
breast cancer. R. 452-54. She reported significant fatigue
and intermittent chest wall tightness but no pain. R. 452-53.
Dr. Juric counseled her to take Hydrea regularly for her
sickle cell and advised her to undergo chemotherapy to reduce
the risk of cancer recurrence; again, she declined both. R.
454. Plaintiff met with Dr. Rosovsky the same day. R. 455-60.
She told her she was tired all the time and took naps a lot
but her fatigue was better than before. R. 456. She noted
that she was still inconsistent in taking her folic acid and
Rosovsky strongly encouraged her again to take Hydrea, but
Plaintiff decided not to do so. R. 460. Plaintiff returned to
Dr. Juric on July 15, 2016. R. 477-80. He again tried to
convince Plaintiff to undergo chemotherapy to reduce her risk
of breast cancer recurrence, but she declined. R. 477. He
also emphasized the importance of taking Hydrea daily for her
sickle cell disease. Id. At the appointment, she
reported significant fatigue and intermittent chest
tightness. R. 478. Dr. Juric noted that Plaintiff was
restricted in her ability to perform physically strenuous
activity but that she was ambulatory and able to carry out
work of a light or sedentary nature, such as light house work
and office work. Id.
days later, Plaintiff followed up with Dr. Rosovsky. R.
469-75. She said she was feeling “quite well, ”
although she was still not consistent with her medications.
R. 470. She reported occasional back or neck pain and said
she took Motrin when this occurred, which helped the
flare-ups subside within three days. Id. She said
she was still tired, though not all the time, and that her
fatigue was better. Id. She said that she took
occasional naps during the day, but not as often as before.
Id. She denied any pain, except for an occasional
slight twinge in her left shoulder with movement.
Id. She reported shortness of breath with one flight
of stairs only when her sickle cell disease flared up.
Id. Dr. Rosovsky again strongly recommended that
Plaintiff take Hydrea. R. 475. Plaintiff saw Dr. Moulton on
August 23, 2016 for left arm pain she first noticed while
putting on coats in the late winter. R. 476. She told Dr.
Moulton that her arm hurt whenever she reached for anything
and that she had been unable to sleep on her left side for a
month. Id. Her arm hurt much more when she was
moving than when she was at rest. Id. She was not
dropping anything because of the pain, and ibuprofen helped
“a little.” Id. Dr. Moulton ordered an
MRI of Plaintiff's left shoulder. Id. The MRI
revealed avascular necrosis of the humeral head and a
subtotal tear of the anterior fibers of the supraspinatus. R.
465. At an appointment a few months later, Plaintiff reported
pain at an eight out of ten but refused medication and did
not want to see orthopedics. R. 484. She stated that she had
a similar issue with her other shoulder twenty years ...