United States District Court, S.D. Ohio, Western Division, Dayton
AMY C. BREMKE, Plaintiff,
NANCY A. BERRYHILL, Commissioner of the Social Security Administration, Defendant.
DECISION AND ENTRY
L. Ovington United States Magistrate Judge.
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.
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. mayoclinic.org
(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.”
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.
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.
cerebri is an uncommon condition-the Mayo Clinic website
reports that it occurs in 1 to 2 people out of 100, 000.
https://www. mayoclinic.org (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”).
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). 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.
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.
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.” Id. at
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
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
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.
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.
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.
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.
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.
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.
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
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 ...