United States District Court, N.D. Ohio, Eastern Division
MEMORANDUM OF OPINION AND ORDER
M. ParkerJ United States Magistrate Judge
Polly Anne Ferris seeks judicial review of the final decision
of the Commissioner of Social Security
(“Commissioner”) denying her application for
disability insurance benefits (“DIB”) under Title
II of the Social Security Act. The parties have consented to
my jurisdiction. (ECF Doc. 15.) Because the
Commissioner's decision is supported by substantial
evidence, it must be AFFIRMED.
2013, Ferris filed an application for DIB, alleging
disability beginning on September 30, 2009. (Tr. 283-89).
After the Social Security Administration denied her
application, she attended a hearing before Administrative Law
Judge Joseph G. Hajjar (“ALJ”). (Tr. 141-191,
244-247, 249-251) On July 23, 2015, the ALJ denied
Ferris' claim for benefits. (Tr. 121-135)
Appeals Council declined to review the case, rendering the
ALJ decision the final decision of the Commissioner. (Tr.
treated with Dr. James Cannatti at Summit Ophthalmology from
2007 through 2014. She was diagnosed with ocular migraine
headaches in November 2012. (Tr. 724, 726, 735)
October and November 2011, Ferris complained of diarrhea and
hemorrhoids. (Tr. 424) On November 29, 2011, she complained
of joint pain and swollen hands to Dr. James Johnston. (Tr.
426) On December 16, 2011, Ferris presented to the emergency
room complaining of joint pain and stating that she had a
question regarding her hemorrhoids. (Tr. 813) On December 19,
2011, Dr. Johnson prescribed Percocet for her pain and
diagnosed irritable bowel syndrome (“IBS”). (Tr.
January 13, 2012, Ferris visited her primary care physician,
Dr. David Kimbell, MD, with complaints of constipation,
bloody stool, joint pain, sleep disturbance, and fatigue.
(Tr. 509-511) Dr. Kimbell noted bony deformity and synovitis
in Ferris's wrists and hands. (Tr. 510) He noted normal
muscle tone, strength, respiratory functions, gait and
station. (Tr. 510)
met with rheumatologist, Dr. Andrew Raynor, M.D., on January
20, 2012. (Tr. 434) Ferris reported that her joint pain and
swelling had responded well to steroid treatment but that she
had recently discontinued it. (Tr. 434) Dr. Raynor observed
small joint polysynovitis, but normal range of motion of the
upper and lower extremities, normal gait, and normal
respiratory function. (Tr. 436) He diagnosed inflammatory
arthritis and administered injections to Ferris's left
wrist and right shoulder. (Tr. 436, 439) X-rays showed mild
degenerative changes of the big toes with a small left
calcaneal spur, and soft tissue swelling around the fingers
and wrists bilaterally (Tr. 437). Her hip joint spaces were
well maintained. (Tr. 437) At a follow-up appointment on
February 7, 2012, Dr. Raynor diagnosed rheumatoid arthritis
(“RA”). (Tr. 443) He observed normal gait, normal
respiratory function, and normal range of motion in the upper
and lower extremities. (Tr. 443) A chest X-ray performed on
February 7, 2012 returned normal findings. (Tr. 609) Dr.
Raynor prescribed an anti-rheumatic/immunosuppressant,
methotrexate, and advised Ferris of other treatments for
rheumatoid arthritis including biologic response modifiers.
(Tr. 441, 573)
met with Dr. Reynaldo Gacad, a gastroenterologist, on
February 3, 2012. (Tr. 399) Ferris complained of excessive
bowel movements (five times daily, at times with urgency) who
initially diagnosed chronic diarrhea and GERD. (Tr. 399-401)
A colonoscopy revealed no abnormalities and samples were
biopsied for pathology. (Tr. 402-405) At a follow-up
appointment in April 2012, Ferris continued to complain of
excessive bowel movements and diarrhea. (Tr. 396-398) Dr.
Gacad diagnosed IBS and prescribed medication to treat
Ferris's symptoms. (Tr. 398)
returned to Dr. Kimbell on February 8, 2012 complaining of
constipation, blood in stool and pain in joints. (Tr.
Raynor prescribed Enbrel, a biologic, in March 2012. (Tr.
445) On March 23, 2012, a bone density/DEXA scan revealed T
scores consistent with osteopenia in the left side of
Ferris's hip. (Tr. 473) At a visit in May 2012, Dr.
Raynor observed normal gait, normal respiratory function, and
normal range of motion of the upper and lower extremities.
2012, Dr. Kimbell noted that he was treating Ferris for RA
with MTX and Enbrel. He observed hand wrist deformity,
synovitis and limited range of motion. Dr. Kimbell diagnosed
IBS and anxiety and considered prescribing Lexapro, an
antidepressant. (Tr. 504-506)
September 2012, Dr. Raynor noted that Ferris continued to
have RA activity in her hands and feet but also noted that
she was much improved since she started taking Enbrel. Dr.
Raynor noted that he would consider a different biologic if
Ferris continued to have RA activity at her next visit. (Tr.
453) Dr. Raynor noted pain in Ferris's muscles and
joints. Ferris was no longer displaying full range of motion;
Dr. Raynor noted “smoldering small joint synovitis
wrists and metatarsals.” (Tr. 455) However, he
continued to observe normal gait and respiratory function.
(Tr. 455) Dr. Raynor adjusted Ferris's medications. (Tr.
office visit with Dr. Kimbell in November 2012, Ferris
complained of joint pain and swelling throughout her
extremities, but no fatigue, sleep disturbance or depression.
(Tr. 502) Dr. Kimbell observed synovitis of the right index
finger and limited range of motion of both hands. He noted
normal muscle tone and strength, normal respiratory function
and normal gait. (Tr. 503)
followed-up with Dr. Raynor in December 2012. He continued to
note smoldering arthritis activity in Ferris's hands and
feet. (Tr. 458) He discontinued Enbrel and prescribed Humira.
February 2013, Dr. Kimbell noted that Ferris continued to
suffer from anxiety, IBS and RA. (Tr. 499) He observed
synovitis of the right index finger and limited range of
motion of both hands. He again observed normal muscle tone
and strength, normal respiratory findings and normal gait.
March 2013, Dr. Raynor noted that Ferris was having recurrent
respiratory infections and that she continued to smoke. He
ordered a chest X-ray and referred her for a pulmonary
assessment. (Tr. 463) Ferris continued to complain of muscle
and joint pain. Dr. Raynor noted “smoldering”
small joint synovitis of the wrists and fingers. Ferris had
normal respiratory findings and gait. (Tr. 465) The chest
X-ray revealed stable findings compared to imaging performed
in February 2012 with no acute cardiopulmonary process. (Tr.
met with Dr. Charles Fuenning for a respiratory evaluation on
April 25, 2013. (Tr. 419) Dr. Fuenning noted dry inspiratory
crackles at end inspiration and end expiratory wheezing. He
also observed rheumatoid arthritic changes in the hands. (Tr.
419-420) Dr. Fuenning diagnosed rheumatoid lung
(“RL”), chronic obstructive pulmonary disease
(“COPD”), and personal history of tobacco use,
presenting hazards to health. (Tr. 420) He stressed that
Ferris must stop smoking and discussed strategies to
accomplish that. He also prescribed an inhaler to treat
Ferris's COPD. (Tr. 420) Dr. Fuenning ordered testing
which revealed moderate small airway disease with mild
restrictive ventilator defect. (Tr. 550) A CT scan of
Ferris's chest showed severe emphysema. (Tr. 551)
2013, Ferris experienced persistent smoldering joint
synovitis in her wrists and hands. Dr. Raynor wanted to
restart Humira but could not because Ferris continued to
smoke. He said he would reevaluate after she met with Dr.
Fuenning again. (Tr. 467)
returned to Dr. Fuenning on June 27, 2013. She continued to
have respiratory difficulty, including coughing and dyspnea.
(Tr. 512) Dr. Fuenning noted that Ferris had not quit smoking
but had cut back to ½ pack per day. Dr. Fuenning
diagnosed small airway disease, emphysema, RA, COPD with
exacerbation and RL. (Tr. 514)
September 2013, Dr. Raynor noted that Ferris could resume
Humira if she stopped smoking and that he would wait to hear
from her. Raynor noted continued small joint synovitis, and
he felt that she needed a biologic. Ferris received
injections in her left shoulder and wrists. (Tr. 619)
received physical therapy for her hands in October and
November 2013. (Tr. 626-628) At the end of her therapy,
Ferris still had pain but indicated that she was more able to
manage. (Tr. 627)
followed-up with Dr. Raynor in December 2013 and January
2014. (Tr. 648) Ferris still exhibited smoldering small joint
synovitis in her wrists and metatarsals, but could not resume
Humira because of her smoking. Ferris continued taking
prednisone and Methotrexate Sodium. (Tr. 649-651, 647)
Raynor restarted Humira in April 2014 even though Ferris had
not stopped smoking. Ferris discontinued Humira after one
use. Dr. Raynor indicated that she would
“rechallenge” and resume the biologic if she
stopped smoking. (Tr. 679)
returned to Dr. Fuenning on June 26, 2014. She reported that
her breathing had improved with medications. (Tr. 866) Dr.
Fuenning continued to advise smoking cessation and diagnosed
emphysema and COPD. He no longer diagnosed rheumatoid lung.
He ordered additional imaging and testing. (Tr. 866-867)
2014, Dr. Kimbell noted that Ferris was still smoking a pack
of cigarettes each day. (Tr. 754) He also noted anxiety and
depression with symptoms of sleep disturbance. He observed
bony deformity and limited range of motion of the hands
without edema. (Tr. 755)
returned to Dr. Raynor on July 28, 2014 and reported that she
had taken three months of Humira with little benefit. She was
advised to take it for an additional six weeks but if no
significant improvement she would discontinue and try
Rituximab. Dr. Raynor noted continued small joint synovitis.
met with Dr. Kimbell in October 2014. He noted abdominal pain
and treatment for bronchitis. Ferris continued to take
Percocet for pain and Enbrel, MTX, and prednisone for RA.
October 2014 through December 2014, Dr. Raynor noted that
Ferris had stopped taking Humira in September. She continued
to experience pain in her eye, right shoulder, muscles and
joints. Dr. Raynor noted smoldering synovitis in her wrists
and hands and positive RA factors. Her gait and respiratory
findings were normal. Ferris continued to smoke. (Tr.
January 7, 2014, Ferris returned to Dr. Kimbell who adjusted
her medications. He observed limited range of motion in her
hands and wrists and diagnosed acute bronchitis and RA and
noted that she was “immunocompromised.” (Tr.
January 20, 2014, Ferris followed-up with Dr. Raynor. Dr.
Raynor administered another dose of Rituximab. Dr. Raynor
continued to observe smoldering small joint synovitis of the
wrists and fingers, now with “multiple rheumatoid
nodules.” Ferris had a normal gait and respiratory
function. (Tr. 809)
State Agency Non-Examining Sources
Kourosh Golestany reviewed Ferris's medical records on
August 2, 2013. He opined that Ferris could: lift twenty
pounds occasionally and ten pounds frequently; stand/walk for
about six hours in an eight-hour workday; sit for about six
hours in an eight hour workday; occasionally crawl; never
climb ladders, ropes or scaffolds; and occasionally finger
with the hangs bilaterally. Dr. Golestany also opined that
Ferris must avoid all exposure to unprotected heights and
should only work in well-ventilated areas due to her COPD.
John L. Mormol reviewed Ferris's records on December 4,
2013 and rendered the same opinions as Dr. Golestany. (Tr.
August 7, 2013, Mel Zwissler, Ph.D., reviewed records from
Ferris's psychiatric treatment. (Tr. 218-219) Dr.
Zwissler opined that Ferris had mild restrictions of
activities of daily living and mild difficulties in
maintaining social functioning. He opined that she had
moderate difficulties in maintaining concentration,
persistence or pace, but no repeated episodes of
decompensation. (Tr. 219) Dr. Zwissler felt that Ferris's
ability to carry out detailed instructions and her ability to
perform activities within a schedule, maintain regular
attendance and be punctual were moderately limited. (Tr. 223)
He further opined that her ability to complete a normal
workday and workweek without interruptions from
psychologically based symptoms and her ability to perform at
a consistent pace without an unreasonable number of length of
rest periods were moderately limited. (Tr. 223)
Goldsmith, Ph.D., reviewed Ferris's records on December
3, 2013 and affirmed the opinions of Dr. Zwissler. (Tr.
State Agency Examining Source
26, 2013, Joshua Magleby, Ph.D., conducted a psychological
examination of Ferris. (Tr. 486-492) Dr. Magleby did not
review any of Ferris's medical records. (Tr. 486) Dr.
Magleby diagnosed persistent depressive disorder, unspecified
anxiety disorder, maladaptive behavior (smoking), IBS, COPD
and RA. (Tr. 490) He opined that Ferris's ability to
understand and carry out simple instructions were similar to
other adults of the same age. He felt that her comprehension
seemed fair; her memory - fairly average; and her ability to
follow more complex instructions - “fairly average for
age expectations.” (Tr. 491) Dr. Magleby opined that
Ferris's ability to perform simple repetitive tasks
appeared good but her ability to perform multi-step tasks
seemed “somewhat impaired for age expectation.”
(Tr. 491) Finally, he opined that Ferris had never had any
significant incidents suggesting that her ability to relate
to others was impaired. He also noted that social relating
during the examination was appropriate. However, he noted
that emotional distress observed during the evaluation might
impair her social interactions at times. (Tr. 491)
treating ophthalmologist, Dr. James Cannatti, completed a
medical questionnaire on June 20, 2013. (Tr. 478 - 481) Dr.
Cannatti diagnosed arthritis, dry eye syndrome, and ocular
migraines. (Tr. 480) Dr. Cannatti opined that Ferris did not
have any limitations from an ophthalmic standpoint except
that she would need time to take her drops and must avoid dry
or dusty environments. (Tr. 481)
treating physician, Dr. David Kimbell, completed a medical
questionnaire on July 11, 2013. (Tr. 494-495) He indicated
that Ferris had a history of a mental impairment and that he
had treated her by prescribing Lexapro. (Tr. 494) He opined
that she had functional restrictions including poor coping
and trouble with concentration. (Tr. 494)
Kimbell completed a second medical questionnaire on October
14, 2013. (Tr. 616-618) In it, he diagnosed rheumatoid
arthritis, depression with anxious features and irritable
bowel syndrome. (Tr. 617) He indicated that IBS and RA where
chronic conditions and that RA was a progressive disease,
“with progressive debilitation and chronic pain despite
treatment.” (Tr. 618) In describing Ferris's
limitations, resulting from her conditions, Dr. Kimbell
stated, “chronic pain hands, wrists, worse with
activity, requiring narcotic pain medications. New lung
involvement with increase dyspnea ...