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Burr v. Saul

United States District Court, D. Massachusetts

December 16, 2019

ROBYN L. BURR, Plaintiff,
v.
ANDREW SAUL, Commissioner, Social Security Administration, Defendant.

          MEMORANDUM AND ORDER ON PLAINTIFF'S MOTION FOR ORDER REVERSING THE COMMISSIONER'S DECISION

          F. Dennis Saylor IV, United States District Judge

         This is an appeal from the final decision of the Commissioner of the Social Security Administration denying an application for social security disability insurance (“SSDI”) and supplemental security income (“SSI”) benefits. Plaintiff Robyn Burr alleges that she became disabled on December 27, 2015, after various impairments worsened and rendered her unable to work. She submitted medical records indicating that she suffers from various ailments, including arthritis, degenerative joint disease of the knees, fibromyalgia, chronic obstructive pulmonary disease (“COPD”), and asthma. She now disputes the Commissioner's holding that she is not “disabled” within the meaning of the Social Security Act.

         Pending before the Court is Burr's appeal and the Commissioner's motion to affirm. For the reasons stated below, Burr's motion to reverse and remand will be granted and the Commissioner's motion to affirm will be denied.

         I. Background

         The following is a summary of the relevant evidence in the administrative record (“A.R.”).

         A. Education and Occupational History

         Robyn Burr was born on July 20, 1958, and is approximately 61 years old. (A.R. (Dkt. No. 13) at 108). She has completed high school and has attained both a college and master's degree. (Id. at 66-67, 301).

         At the administrative hearing, Burr testified that she worked from approximately October 1988 to December 2009 as a seamstress (id. at 120); from approximately January 2001 to September 2005 as a full-time transcriptionist and/or data-entry clerk for State Farm Mutual Insurance (id. at 68, 119, 329); from approximately March 2006 to December 2008 as a computer-aided design (“CAD”) designer and/or project document administrator for LPE Enterprises Ltd. and Custom Staffing (id. at 68-69, 119, 329); and from approximately July 2010 to March 2016 as a primary care attendant (“PCA”) to her mother for Cerebral Palsy of Massachusetts, Inc. (now, Tempus Unlimited, Inc.) (id. at 67, 70, 119).[1] She has not worked since March 2016. (Id. at 300, 323, 328).[2]

         B. Medical History

         Burr alleges that she suffers from numerous impairments, including arthritis, fibromyalgia, degenerative joint disease of the hand, osteoarthritis of the knee, COPD, and asthma. (Id. at 137, 152, 350, 407-08).

         On January 18, 2016, while she was still working, Burr saw Dr. Slawomir Pajak to follow up on prior diagnoses of proteinuria and fibromyositis. (Id. at 472). She reported “arthralgias/joint pain” and reported no muscle weakness, back pain, swelling in the extremities, fatigue, arm pain on exertion, shortness of breath, cough, wheezing, shooting pain, headache, dizziness, or depression. (Id. at 474). Dr. Pajak noted that she was a daily smoker, ambulated normally, and was “healthy-appearing, well-nourished, and well-developed.” (Id. at 474-75). He also noted that she had no dyspnea, her breathing sounded normal, and she had good air movement. (Id. at 475). For her proteinuria, he recommended she take Lisinopril and avoid non-steroidal anti-inflammatory drugs (NSAIDs). (Id.). As to her fibromyositis, he noted that she experienced chronic left knee pain and was “stable on camphor patches” but did not tolerate Cymbalta because of sedative effects. (Id.).

         On January 27, 2016, Burr saw Dr. Daniel Martin, her primary-care physician. (Id. at 516). He noted that she ambulated normally, she had no dyspnea, her breathing sounded normal, and she had good air movement. (Id. at 519). He assessed that she had asthma, for which he prescribed albuterol and Advair; hyperglycemia; and multiple nodules of the lung, which he noted were stable and produced no symptoms. (Id. at 519-520).

         Spirometry testing from April 15, 2016, indicated mild obstructive pulmonary impairment, no restrictive ventilatory defect, and mild diffusion defect. (Id. at 513-15). The testing also suggested that Burr may not benefit from bronchodilator therapy. (Id. at 515).

         During a follow-up visit with Dr. Martin on April 27, 2016, Burr reported a cough, wheezing, shortness of breath, foot and joint pain, chronic pain, and an inability to stand or sit for prolonged periods. (Id. at 499, 505, 508-09). She stated that her fibromyositis was “doing okay” but that her COPD worsened with activity. (Id. at 505). Dr. Martin noted that her pulmonary nodules and emphysematous changes were stable and that she ambulated normally. (Id. at 506, 508). She had rhonchi sounds and diminished air movement. (Id. at 508). He assessed that she had COPD, hyperglycemia, multiple nodules of the lung (which were non-symptomatic), and joint pain in her hands, knees, and feet. (Id. at 508-09). For COPD, he prescribed albuterol and Advair, and noted that her respiratory symptoms included cough and dyspnea. (Id. at 508, 510).[3] For joint pain, he referred her to an orthopedist for a gel injection. (Id. at 509).

         On May 20, 2016, Burr saw Dr. Edward Klein for knee pain. (Id. at 722). She reported pain in both knees, beginning in November 2015, and that the pain was worse on the left. (Id.). She reported that the pain was occasional, of moderate severity, minimally improved by ice, improved by elevation, temporarily relieved by patches, and aggravated by long periods of activity. (Id.). A cortisone injection from November 2015 also relieved the pain, but for only two months. (Id. at 723). She reported no weakness, numbness, tingling, swelling, catching/locking, popping/clicking, instability, or radiation down her leg. (Id.). Dr. Klein determined from a physical examination that she had normal flexion and extension strength in both legs and no laxity or ligamentous instability. (Id. at 725). Neither knee had any deformity, mass, warmth, erythema, or abnormal axial alignment. (Id.). Her left knee, however, had moderate tenderness along the medial joint line and mild swelling. (Id.). Dr. Klein assessed that she had derangement of the left knee. (Id.). Based on an x-ray, he concluded that there were no signs of arthritis but that she appeared to have a meniscal tear on her left knee. (Id.). He referred her for an MRI. (Id.).

         On June 16, 2016, Burr saw Dr. Michael Egan to follow up on her knee osteoarthritis and fibromyalgia. (Id. at 558). She reported pain when sitting and in her lower back, tailbone, hands, wrists, neck, and knee. (Id. at 561). She also reported that she was in physical therapy and that she used a knee brace. (Id.). She reported no exercise intolerance, fatigue, cough, wheezing, shortness of breath, weakness, or shooting pain. (Id.). Dr. Egan conducted a physical examination and found her to be “healthy-appearing, well-developed, and thin.” (Id.) (emphasis omitted). She ambulated normally, had no dyspnea, breathed normally, and had good air movement. (Id.). She had normal motor strength and tone and no contractures, tenderness, or bony abnormalities in her joints, bones, or muscles. (Id.). She had bony swelling of the knee, limited range of motion of the lumbar spine, and tender range of motion of the cervical spine. (Id.). Dr. Egan assessed that she had osteoarthritis of the knee, fibromyalgia (which he noted was “still a problem” with “very limited” medication options), lower back pain, cervical spondylosis, and hand pain. (Id.).

         On June 28, 2016, Burr saw Dr. Andrew Spongberg for ear discomfort. (Id. at 575). She reported fatigue, depression, anxiety, and that she occasionally felt a little unsteady. (Id. at 578-79). She reported no weakness, wheezing, dyspnea on exertion, shortness of breath, or cough. (Id.). Dr. Spongberg noted that her ear discomfort was probably related to her fibromyalgia. (Id.).

         On September 9, 2016, Burr again saw Dr. Klein. (Id. at 718). She reported that the pain in her left knee had worsened due to physical therapy and had become severe. (Id. at 720). The pain was occasional, throbbing, and sharp. (Id.). It was aggravated by sitting, standing, lying down, walking, bending/squatting, weight-bearing, driving, moving from sitting to standing, and going upstairs or downstairs. (Id.). She also reported weakness, swelling, and radiation down the leg. (Id.). Dr. Klein determined that she had normal flexion and extension strength in both legs and no laxity or ligamentous instability. (Id. at 721). Neither knee had any deformity, mass, warmth, or erythema. (Id.). Her left knee, however, had moderate tenderness along the medial joint line, mild swelling, and moderate pain at extreme limits of range of motion. (Id.). Dr. Klein again assessed that she had derangement of the left knee and noted that he still recommended an MRI. (Id.).

         On September 15, 2016, Burr had a follow-up appointment with Dr. Egan for knee osteoarthritis, cervical spondylosis, and pain in her hands and lower back. (Id. at 733-34). She reported that her hand and knee pain had worsened. (Id. at 736). She also reported exercise intolerance, muscle aches, and arthralgias/joint pain, but reported no fatigue, weakness, or shooting pain. (Id.). Dr. Egan noted that she appeared to be in moderate distress but “healthy-appearing, well-nourished, [] well-developed, ” and ambulated normally. (Id.). She had normal motor strength and tone and normal movement of her extremities. (Id. at 737). She had no contractures, tenderness, bony abnormalities, or abnormal movement of the extremities in her joints, bones, or muscles. (Id.). Dr. Egan observed that she had positive trigger points; left knee pain; and pain in, and limitation of, the lower back. (Id.). He assessed that she had degenerative joint disease of the hand, for which he recommended that she apply heat and gentle range of motion; derangement of the knee; and fibromyositis, which he noted remained active and for which medication treatment was limited. (Id.).

         On September 24, 2016, an MRI of Burr's left knee indicated medial and lateral tears, as well as “[s]ome degenerative intrasubstance signal . . . in the body of the medial meniscus.” (Id. at 738).

         On October 5, 2016, Burr had a follow-up appointment with Dr. Klein for her knee pain. (Id. at 713). She reported left knee pain and total body pain, but reported no weakness, numbness, swelling, catching/locking, popping/clicking, or instability. (Id. at 713-14). The pain was constant, of moderate severity, minimally improved by ice, and improved by elevation and rest. (Id. at 713-14). It was aggravated by walking, bending/squatting, range of motion, weight-bearing, getting out of bed, moving from sitting to standing, goings upstairs or downstairs, and nighttime. (Id.). Dr. Klein noted that she had no deformity, mass, warmth, or erythema in either knee. (Id. at 716). She had an antalgic gait, swelling, moderate tenderness, and moderate pain at extreme limits of range in the left knee. (Id.). Dr. Klein assessed that she had medial/lateral meniscal tears in the left knee, for which he recommended arthroscopy because “conservative measures” had not been successful. (Id.).

         On January 17, 2017, Burr had her one-year follow-up appointment with Dr. Pajak. (Id. at 726). She reported that her condition had not changed, her fibromyalgia was stable, she was experiencing chronic knee pain and awaiting knee replacements, and she was experiencing stress due to her daughter's death and her brother's deployment to Syria. (Id.). She also reported “arthralgias/joint pain” in both knees, but reported no muscle weakness, back pain, swelling in the extremities, fatigue, arm pain on exertion, cough, wheezing, shortness of breath, weakness, tingling, shooting pain, or depression. (Id. at 728). On examination, she ambulated normally and appeared healthy, well-nourished, and well-developed. (Id.). She had normal breathing, good air movement, and no dyspnea. (Id. at ...


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