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Bremke v. Berryhill

United States District Court, S.D. Ohio, Western Division, Dayton

March 28, 2018

AMY C. BREMKE, Plaintiff,
NANCY A. BERRYHILL, Commissioner of the Social Security Administration, Defendant.


          Sharon L. Ovington United States Magistrate Judge.

         I. Introduction

         Plaintiff Amy C. Bremke brings this case challenging the Social Security Administration's denial of her applications for Disability Insurance Benefits and Supplemental Security Income. She applied for benefits in July 2013, asserting that beginning on June 5, 2013 she could no longer work due to Pseudotumor cerebri with a surgically implanted shunt, memory loss, and hypertension.

         “Pseudotumor cerebri … occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. Symptoms mimic those of a brain tumor, but no tumor is present…..” https://www. (search for “Psuedotumor cerebri”). “Psuedotumor cerebri signs and symptoms may include … moderate to severe headaches…, ringing in the ears…, nausea, vomiting or dizziness[, ] blurred or dimmed vision…, neck, shoulder or back pain.” Id.

         According to Administrative Law Judge (ALJ) Elizabeth A. Motta, Plaintiff's Pseudotumor cerebri and her other health problems did not constitute a “disability” as defined in the Social Security Act. This conclusion led ALJ Motta to find Plaintiff ineligible for benefits.

         In the present case, Plaintiff disagrees with ALJ Motta's decision and seeks an Order reversing her decision and awarding benefits. The Commissioner seeks an Order affirming ALJ Motta's decision.

         II. Background

         Psuedotumor cerebri is an uncommon condition-the Mayo Clinic website reports that it occurs in 1 to 2 people out of 100, 000. https://www. (search for “Psuedotumor cerebri”). Given its rarity, it is worth describing in some detail:

The fluid that surrounds the spinal cord and brain is called cerebrospinal fluid or CSF. Cerebrospinal fluid supplies the brain and spinal cord with nutrients and removes impurities while protecting and cushioning these delicate structures.
Normally, after circulating, CSF is reabsorbed into the body through blood vessels. But if too much fluid is produced or not enough is re-absorbed, the CSF can build up and cause pressure within the skull, which is an enclosed space.
This pressure can cause symptoms similar to those of a brain tumor, including worsening headache and vision problems. Untreated [P]seudotumor cerebri can result in permanent problems such as vision loss.
 (search for “Pseudotumor cerebri”).

         Plaintiff was 39 years old on her alleged disability onset date. This placed her in the Social Security Administration's category of a “younger” person. 20 C.F.R. § 404.1563(c).[1] She has at least a high-school education with an additional certification as a Licensed Practical Nurse. Over the years, Plaintiff worked as an Outpatient Admitting Clerk, a Licensed Practical Nurse, a Medical Assistant, and a Resident Care Aide.

         During a hearing held by ALJ Motta, Plaintiff testified that she lives with her fiancé and her four teenage children. Id. at 62. She drives almost every day, depending on where her four children need to be. Id.

         Plaintiff explained that she began to have headaches in 2003. Her physician discovered swelling in her optic nerve and sent her to the emergency room for a spinal tap. Plaintiff also explained, “Normal pressure is up to 18 and mine was 56, so I think I was in the hospital for nine days at that time, and we tried to manage symptoms with medication, and when that wasn't working, I had the … shunt in my placed, and that wasn't keeping up with fluid production, so that's when we went with the VP [Ventriculoperitoneal] shunt, which is the one in my head.”[2] Id. at 65-66.

         Plaintiff testified that she is unable to work due to short-term memory loss after her last brain surgery (a “shunt revision”) in June 2013. Id. at 64-65, 72-73. She copes with her memory loss by writing everything down. If she does not, she will forget things. Id. at 64. Plaintiff has undergone 3 brain surgeries. Id. at 65.

         Plaintiff's last surgery, in June 2013, did not relieve her daily headaches. Id. She testified, “My body makes too much spinal fluid, so it builds up and puts the pressure on my brain, which causes headaches. It's called intracranial hypertension.” Id. at 66. When she feels like the pressure is up, she gets a spinal tap. Her last one was two months before the ALJ's hearing in June 2015.

         Plaintiff testified that she is supposed to return to see her neurosurgeon (James B. Elder, M.D.) at Ohio State University about another shunt-revision surgery. Id. at 67. She reported that the only time she does not have a headache is when she sleeps because she does not feel anything while sleeping. Id. at 67-68. She takes medication at bedtime to help her sleep. Her headache pain is better when she is upright. Id. at 68. She sleeps “a couple hours” during the day to help manage her pain. Id. at 74. She describes her pain as constant- “It's always, it's always there.” Id. at 78. Bending over worsens her pain. Id.

         Plaintiff takes medication for pain 3 times a day, and she takes medication for hypertension and hypothyroidism. Id. at 69, 74. She rated her daily headache-pain severity at a level of 2-3 on a 1-10 scale (10 being the worst pain she'd ever felt). Id. at 73. In the morning when she wakes up her pain level is at 5. Medication helps reduce her pain to the 2-3 level. Id.

         She explained that she's had procedures done including occipital nerve blocks, epidural steroid injections, and radio frequency ablation of her optical nerves. Id. . at 75. She further explained that the ablation procedure helped with the pain that would radiate up the back of her head, but she still had “a lot of pain at the base of [her] skull.” Id.

         Regarding her daily activities, Plaintiff testified that she can perform household chores, when she feels well enough to do them. Id. at 70. During a good week, this might occur about 4 days, although it does not usually occur that often. She is generally able to follow a program she watches on television, except she doesn't always remember what she watched. Id. at 77. She noted, “sometimes it's just good to have the … mindless entertainment.” Id. Sometimes she plays a game on her phone, but she does not have any hobbies. Id. at 73.

         Plaintiff does no yard work. Id. at 71. Before her daughter turned age 17, Plaintiff drove her teenagers a block and a half to school, when the weather was bad. Her fiancé drove the flock to school when Plaintiff was not feeling well. At the time of the ALJ's hearing, Plaintiff's 17-year-old daughter generally drove them to school.

         Plaintiff is able to go to the store. Id. She occasionally visits with relatives or friends. Id. She does not regularly go anywhere. She no longer reads books because she cannot remember what she read. She used to read all the time and considered herself to be an avid reader. Id. at 72, 76. She uses a weekly pillbox that her teenagers help her with. If she doesn't use the pillbox, she will not remember whether she has taken her afternoon medication. Id. at 79-80.

         III. Medical Evidence

         A vocational expert testified during the ALJ's hearing that a hypothetical person with the work limitations identified in the ALJ's assessment of Plaintiff's residual functional capacity, could not perform the work Plaintiff had done in the past, but could perform a significant number of jobs available in the national economy. Id. at 82-83.

         The vocational expert also testified that if this hypothetical person would be off task more that than 10% of the workday beyond normal breaks, “it would push this to well over an hour of being off task every day. I would be unable to identify competitive employment.” Id. at 84. She further indicated that there would ...

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