Opinion
Case No. 00 C 6839
October 26, 2001
MEMORANDUM OPINION AND ORDER
This cause coming on to be heard on Plaintiff's Motion for Summary Judgment or for Remand, the Court having reviewed and studied the briefs, the record and the relevant authorities, and being duly advised in the premises, orders as follows:
STATEMENT OF THE CASE AND FACTS
The background and case facts are, essentially, not in dispute. See Plaintiffs memorandum, pp. 1-6 and Defendant's memorandum, pp. 1-4, both of which are thus incorporated herein by reference.
ISSUE
The initial, threshold dispute is whether or not the Administrative Law Judge ("ALJ") erred in not considering Plaintiffs congestive heart failure as a severe impairment under Step 2 (and, consequently, also at Step 3) of the requisite sequential disability analysis.
APPLICABLE LEGAL STANDARD(S)
Step 2 of the requisite sequential analysis requires a determination of whether the claimant has a "severe" impairment or impairments. If the impairment is severe then the combined effect of all of the "severe" impairments must be considered, at Step 3, in assessing the claimant's residual functional capacity.
A disability claimant can be considered as not suffering from a severe impairment only if the impairment is a slight abnormality having only a minimal effect on a person's ability to perform the full range of work related activities. Anthony v. Sullivan, 954 F.2d 289 (5th Cir. 1992); see also McDonald v. Secretary of Health and Human Services, 795 F.2d 1118 (1st Cir. 1986); Stone v. Heckler, 752 F.2d 1099 (5th Cir. 1985).
Stated otherwise, a "severe" impairment is any medically determinable impairment that would interfere with a person's ability to perform the full range of exertional and non-exertional work related activities.
THE ALJ's DECISION
The ALJ found that Plaintiff had not engaged in substantial gainful activity since the onset date of her alleged disability and that she had severe impairments, including residuals of a brain aneurysm and a history of drug abuse, depression, and mixed personality disorder; her impairments were not, however, among those included in the Listing of Impairments at 20 C.F.R. Pt. 404, subpt. P, app. 1, nor did they, singly or in combination, medically equal any of those listed (Tr. 22). The ALJ further found that Plaintiff had the residual functional capacity (RFC) to lift 50 pounds occasionally or 25 pounds frequently, that she was further limited to performing low-stress, simple, repetitive tasks that required no significant memory or anything more than one to two step processes, and that Plaintiff had no relevant past work history, but she could perform a significant number of jobs in the economy.
Accordingly, the ALJ ruled that Plaintiff was not disabled under the terms of the Act, during the relevant time period.
DISCUSSION AND ANALYSIS
The Court finds that, respectfully, the ALJ erred in not considering Plaintiffs congestive heart failure as a severe impairment.
The record discloses that Plaintiff had a significant history of reduced systolic function on both the left and right sides of the heart causing both left and right sided congestive heart failure. She has clinically exhibited peripheral edema, hepatomegaly, jugular vein distension, dyspnea and orthopnea. The chest k-ray(s) showed cardiomegaly. The echo cardiogram confirmed reduction in left and right systolic performance, hypertrophy, aortic insufficiency, dilated left and right atrium, mitral and tricuspid regurgitation. Her left ventricular ejection fraction measured only 15%. Her cardiologist, Dr. Krauss, deemed her condition to be HYHA- functional Class II, meaning, in essence, she would experience symptoms of congestive heart failure on engaging in exertional activity.
In short, the ALJ did not consider bilateral congestive heart failure causing cardiomegaly reducing the ejection fraction to 15% and producing clinical signs of bi-ventricular congestive heart failure to be a "severe impairment." The evidence shows, however, that the condition meets all the laboratory evidence required under Section 4.02 of the applicable Listings. The ALJ noted Dr. Krauss' New York Heart Association class rating but effectively rejected the rating, instead relying on Dr. Krauss' indication that claimant can perform her activities of "daily living" without limitation due to her congestive heart failure (R. 17). The problem with the ALJ's analysis is that the activities of daily living refer to things like bathing, dressing, cooking and walking a short distance. This does not equate with the ability to perform the full range of exertional and non-exertional work related activities that would be required.
The cardiac "Listings of Impairments" at Appendix 1 to Subpart P requires a ejection fraction measured at 30 percent or less to meet the listings at Section 4.02(B) (Congestive Heart Failure) Section 4.04 (B) (Ischemic Heart Disease) as well as Section 4.08 (Cardiomyopathies). As stated, according to Dr. Krauss, the Plaintiffs ejection fraction was measured by echocardiogram to be approximately 15%.
It bears noting that the state agency reviewing doctors are required to list the medical conditions upon which they base their RFC's so that one can weigh the opinions contained therein. Neither reviewing doctor considered Plaintiffs bi-ventricular congestive heart failure in determining an REC in Exhibits 23 and 27.