Shiva V. Hodges United States Magistrate Judge

REPORT AND RECOMMENDATION

This appeal from a denial of social security benefits is before the court for a Report and Recommendation ("Report") pursuant to Local Civ. Rule 73.02(B)(2)(a) (D.S.C.). Plaintiff brought this action pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) to obtain judicial review of the final decision of the Commissioner of Social Security ("Commissioner") denying her claim for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI"). The two issues before the court are whether the Commissioner's findings of fact are supported by substantial evidence and whether she applied the proper legal standards. For the reasons that follow, the undersigned recommends that the Commissioner's decision be reversed and remanded for further proceedings as set forth herein. I. Relevant Background

A. Procedural History

On or about March 25, 2014, Plaintiff filed applications for DIB and SSI in which she alleged her disability began on August 9, 2013. Tr. at 300-10. Her applications were denied initially and upon reconsideration. Tr. at 199-200, 234-41, 245-49. On December 8, 2016, Plaintiff had a hearing before Administrative Law Judge ("ALJ") Thaddeus J. Hess. Tr. at 140-73. (Hr'g Tr.). The ALJ issued an unfavorable decision on February 23, 2017, finding Plaintiff was not disabled within the meaning of the Act. Tr. at 36-56. Subsequently, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner for purposes of judicial review. Tr. at 1-7. Thereafter, Plaintiff brought this action seeking judicial review of the Commissioner's decision in a complaint filed on April 2, 2018. [ECF No. 1].

B. Plaintiff's Background and Medical History

1. Background

Plaintiff was 40 years old at the time of the hearing. Tr. at 146. She completed high school. Tr. at 161. Her past relevant work ("PRW") was as a hair stylist and cashier. Tr. at 143, 169. She alleges she has been unable to work since August 9, 2013. Tr. at 145.

2. Medical History

On August 8, 2013, Plaintiff was transported by ambulance to the emergency room for chest pain. Tr. at 445, 418-29, 441-507, 883-89. Plaintiff reported having had an argument earlier in the night, but the argument was over and she was sitting on the couch when she started having chest pain in her substernal area radiating down both arms with sweating and nausea. Tr. at 445. She reported shortness of breath, chest discomfort, and arm tightness, with a strong family history of heart disease and cigarette use, but no previous history of hypertension or diabetes. Tr. at 418, 425-26. An electrocardiogram ("EKG") showed sinus rhythm with right bundle-branch block, evidence of anterior infarction, and some ST-segment changes anterolaterally. Id. She had a consultation with Francis Michael Eickman, M.D. ("Dr. Eickman"), was admitted to the hospital, and underwent an emergent catheterization. Tr. at 418-19, 425-26. A transthoracic echocardiography report ("TTE") showed mild, concentric, left ventricular hypertrophy and an ejection fraction ("EF") of 40 to 45% and moderate-to-severe apical septal or inferior and anteroseptal wall hypokinesis. Tr. at 422. Her A1c was found to be 11.4% and consistent with long-term hyperglycemia. Tr. at 425. Longinus Agors, M.D. ("Dr. Agors"), assessed diabetes mellitus type two, ST elevation myocardial infarction ("STEMI") status post-left anterior descending artery ("LAD") stenting, dyslipidemia, tobacco dependence, gastroesophageal reflux disease ("GERD"), obesity, and aspirin allergy, with a plan to adjust Plaintiff's diet and possibly initiate insulin with counseling. Tr. at 427. She was discharged on August 12, 2013, with the following diagnoses: coronary atherosclerotic heart disease; acute anterior myocardial infarction; stent; left anterior descending acutely; newly-diagnosed diabetes mellitus; hypertension; and dyslipidemia. Tr. at 441. Plaintiff was advised she could return to full employment after several weeks. Tr. at 443.

On August 19, 2013, Kimberly L. Bridges, M.D. ("Dr. Bridges"), evaluated Plaintiff to establish primary care. Tr. at 559-63. Plaintiff complained of fatigue, insomnia, anxiety, and blurred vision. Id. Dr. Bridges elicited a detailed history, including Plaintiff had quit smoking, and noted Plaintiff suffered from diabetes, hypertension, and coronary artery disease. Id. Dr. Bridges also noted Plaintiff was supposed to start cardiac rehabilitation. Id. Dr. Bridges found no edema in Plaintiff's extremities and normal mood, affect, attention span, and concentration. Id. Dr. Bridges assessed diabetes and hypertension. Id. Dr. Bridges indicated Plaintiff seemed motivated and would do well with rehabilitation. Id.

On August 22, 2013, Plaintiff received an assessment and exercise prescription for cardiac rehabilitation from the Heart Center for Cardiac and Pulmonary Rehab ("Heart Wellness Center"). Tr. at 1049-53. Plaintiff reported her symptoms included fatigue, trouble concentrating, and depression, and they made it "somewhat difficult" to do her work, take care of things at home, or get along with others. Tr. at 1050. The attending physician noted Plaintiff tolerated exercise well, as she had been walking at home, but stopped early due to heartburn. Tr. at 1053, 1057. An additional visit was reflected on August 29, 2013, but Plaintiff missed her September 16, 2013 appointment due to transportation issues. Tr. at 1058.

On September 10, 2013, Erin Nash, M.D. ("Dr. Nash"), at Dr. Bridges' office evaluated Plaintiff for complaints of swelling. Tr. at 568-71. Plaintiff reported having had shortness of breath three days prior and indicated she was propping herself up to sleep. Id. Plaintiff also reported going to cardiac rehabilitation three times per week. Id. Dr. Nash diagnosed peripheral edema likely related to increased sodium intake. Id. Dr. Nash prescribed furosemide and ordered chest x-rays that showed possible bronchitis. Id.; Tr. at 507, 607-08.

On September 19, 2013, Dr. Bridges evaluated Plaintiff for follow up of peripheral edema. Tr. at 526-30. Plaintiff reported improved shortness of breath and eagerness to return to work. Id. Plaintiff admitted to having some problems with depression and crying, but indicated her sugars had been good. Id. Plaintiff had a depressed affect, but no edema in her extremities. Tr. at 528. Dr. Bridges assessed improved hypertension and depression, prescribed Celexa, and continued other medications. Id.

On October 4, 2013, the Heart Wellness Center dismissed Plaintiff for noncompliance with the program, as she had been absent due to transportation issues and had not returned their calls. Tr. at 1054-56.

On October 21, 2013, Dr. Bridges evaluated Plaintiff for depression. Tr. at 522-25. Plaintiff reported Celexa kept her awake at night and caused abdominal bloating. Id. Dr. Bridges noted Plaintiff was working two days a week at Burger King, but she could not breathe well in the kitchen and did better at the counter. Id. Dr. Bridges indicated Plaintiff's blood sugars had been up and she started using Glipizide. Id. Plaintiff's affect was depressed, but she had no edema in her extremities. Tr. at 524. Dr. Bridges assessed improved hypertension, coronary artery disease, deteriorated diabetes, and depression, and modified Plaintiff's medications accordingly. Tr. at 524-25.

On November 6, 2013, Louis L. Martin, M.D. ("Dr. Martin"), performed an eye examination. Tr. at 414-16. Plaintiff complained of blurred vision at a distance, especially at night. Id. Dr. Martin noted Plaintiff had type two diabetes and suffered a major heart attack in August. Id. Plaintiff's visual acuity was 20/20 for oculus dextrus ("OD") and oculus sinister ("OS"). Id. The dilated fundus exam found mild non-proliferative diabetic retinopathy in OD and OS. Tr. at 416. She had mild myopia. Id.

Also on November 6, 2013, Dr. Eickman evaluated Plaintiff and performed an EKG that showed sinus rhythm with old anteroseptal infarction and a nonspecific T-abnormality. Tr. at 420, 430-32. Plaintiff reported she had done well overall and worked two days per week, but wanted to work fulltime. Id. Plaintiff complained of intermittent bloating treated with Lasix. Id. Dr. Eickman encouraged weight loss, indicated Plaintiff could return to work, and continued her treatment regimen. Id.

On November 21, 2013, Dr. Bridges evaluated Plaintiff for follow up. Tr. at 572-76. Plaintiff reported swelling in her hands or feet, muscle aches, and poor sleep due to anxiety that caused her heart to race. Id. Plaintiff also reported she had stopped taking Celexa and took Lasix once a week due to increased swelling and shortness of breath when lying down at night. Id. Plaintiff stated she checked her blood sugar three times per day, ate healthy, exercised three times per week, such as walking half a mile, and worked four days a week. Id. Dr. Bridges found no edema in her extremities, no focal deficits, and normal heart sounds, mood, affect, attention span, and concentration. Id. Dr. Bridges assessed hypertension, diabetes, and depression and switched Plaintiff from Celexa to Buspirone. Id. Dr. Bridges ordered blood work and adjusted Plaintiff's medications for anxiety and heartburn. Id.; Tr. at 508-09, 581-82, 594 (providing laboratory results), 759-66.

On December 5, 2013, Dr. Bridges evaluated Plaintiff's right arm pain that had lasted one week. Tr. at 540-42. Plaintiff reported the pain was cramp-like and had been so intense she considered taking Nitroglycerin. Id. Plaintiff indicated her symptoms had been in both arms, but moved to the right arm. Id. Plaintiff reported insomnia and muscle aches. Id. Dr. Bridges noted Plaintiff was tender in her upper extremities, but had normal mood, affect, attention span, and concentration. Id. Dr. Bridges assessed myalgia, improved hypertension, and unchanged coronary artery disease. Id. Dr. Bridges ordered blood work, advised Plaintiff to hold her Pravastatin for a week, and continued her other medications. Id.; Tr. at 510-11, 595-96, 754-58.

On January 23, 2014, Dr. Bridges evaluated Plaintiff for increased pain in her arms and legs for one month and tingling and numbness sensations. Tr. at 548-51, 751-53. Plaintiff reported she stopped Pravastatin because it had not made a difference, but Tylenol helped. Id. Dr. Bridges noted Plaintiff had returned to work part-time, but could not increase her hours due to fatigue. Id. Dr. Bridges diagnosed diabetic peripheral neuropathy. Id. Dr. Bridges added Neurontin to Plaintiff's medications, discussed the need for good diabetic control, and advised her to stay off the statin at that time. Id.

On February 10, 2014, Dr. Bridges evaluated Plaintiff for neuropathy. Tr. at 564-67, 747-50. Plaintiff had not taken a statin in two months, but took Neurontin at night, which she did not feel helped much. Id. Plaintiff reported continued problems with numbness and tingling, but that her pain and sugars had improved. Id. Dr. Bridges assessed fatigue, diabetic peripheral neuropathy, and coronary heart disease. Id. She referred Plaintiff for a cardiology evaluation, and increased her dose of Gabapentin. Id.; 577-80 (providing laboratory results), 742-45.

On March 10, 2014, Plaintiff presented to Dr. Bridges and complained of blurred vision and dizziness for two days. Tr. at 543-47. Plaintiff also reported episodes of blurred vision, a glucose level of 300, headaches, and weakness that lasted for several days and worsened when changing from sitting to standing. Id. Plaintiff's dizziness was associated with visual changes and headache. Id. Plaintiff admitted her glucose had been running higher and her diet had not been good. Id. Dr. Bridges indicated Plaintiff had decreased sensation to light touch in both feet nearly to her knees, but no edema in her extremities and normal concentration. Id. Dr. Bridges assessed blurred vision, transient ischemic attack ("TIA"), hypertension, and diabetes. Id. Dr. Bridges continued Plaintiff's medications, ordered magnetic resonance images ("MRIs"), and scheduled an appointment for the following week. Id.; Tr. at 512-15 (providing blood work), 583-84 (same), 551, 733-41.

On March 20, 2014, Dr. Bridges evaluated Plaintiff and reviewed MRIs that showed areas consistent with multiple sclerosis ("MS"). Tr. at 552-53, 516-17, 599-600, 728-32, 746, 1253-54. Dr. Bridges indicated Plaintiff needed a neurological evaluation and added Trazodone for sleep. Id.

On March 27, 2014, Plaintiff presented to Dr. Eickman and reported she tried to work for an hour at Burger King, but became so fatigued she had to quit. Tr. at 433-34, 890-96. Dr. Eickman noted Plaintiff completed cardiac rehabilitation without much complaint, but had not attended vocational rehabilitation. Tr. at 433. Plaintiff complained of visual disturbances and indicated she had an MRI and was told over the phone there may be some concern about MS that was being investigated. Id. Dr. Eickman's overall impression was Plaintiff was overweight, with no significant murmurs or edema. Id. Dr. Eickman noted Plaintiff seemed stable and should be able to maintain an active lifestyle. Id. He instructed her to check with vocational rehabilitation, continued her medications, and indicated she should consider long-term Plavix as she was aspirin-intolerant. Id. Dr. Eickman performed an EKG that showed sinus rhythm with poor R-wave progression, old anterior infarct, and a non-specific T-abnormality. Tr. at 435-39. A TTE report showed Plaintiff's left ventricle chamber was mildly dilated and an EF of 35 to 40% with septal mid-hypokinesis and severe apical hypokinesis. Tr. at 438-39.

On April 14, 2014, Plaintiff presented to C. Todd Walter, Jr., M.D. ("Dr. Walter"), for an evaluation of possible MS. Tr. at 531-36. Dr. Walter noted Plaintiff's memory was intact, and she had normal attention, concentration, fund of knowledge, gait, and coordination. Id. Dr. Walter also noted Plaintiff complained of muscle fatigue, and he scheduled various screenings and additional MRIs. Id.; Tr. at 585-93 (providing laboratory results), 718-27.

On April 21, 2014, Plaintiff's cervical spine MRI showed central disc protrusions at several levels and mild central canal stenosis at the C3-4, C4-5, and C5-6 levels, but no evidence of a demyelinating disease. Tr. at 518-19, 597-98, 1255-56. Plaintiff also had an unremarkable thoracic spine MRI and a lumbar spine MRI that showed mild degenerative disc disease ("DDD") at L3-4 and L4-5. Tr. at 519-20, 601-06, 1256-58.

On April 29, 2014, Dr. Bridges evaluated Plaintiff and reviewed her updated MRIs. Tr. at 555-58, 714-17. Plaintiff reported continued left visual field deficit and an ophthalmologist visit was scheduled. Id. Plaintiff also reported she was no longer working and had applied for disability. Id. Dr. Bridges noted Plaintiff had gained ten pounds and had decreased sensation to light touch in both feet to nearly her knees, but no edema in her extremities and a normal mood and concentration. Id. Dr. Bridges gave Plaintiff a trial voucher of Belviq for weight loss. Id.

On May 13, 2014, Plaintiff was airlifted to the hospital and admitted for chest pain. Tr. at 628, 610-700, 855-60, 864-65, 867-70. Plaintiff reported her chest pain began when she awoke that morning and was relieved by Nitroglycerin, but the pressure continued and worsened throughout the day. Tr. at 628. Plaintiff's husband reported she complained of chest pressure, vomited, passed out, and fell to the floor. Id., Tr. at 636. Plaintiff's EKG did not show any clear evidence of acute ischemia. Tr. at 630. Plaintiff continued to have chest pain at the hospital, and the doctor obtained a troponin ultra that was elevated. Id. Another EKG was performed that showed some vague inferior ST-elevation and anterior ST-depression. Id. However, this was not significant enough to meet the criteria for a STEMI. Id. Plaintiff was diagnosed with acute myocardial infarction or inferolateral STEMI and underwent catheterization that showed severe circumflex lesion. Tr. at 626. On May 18, 2014, Plaintiff was discharged with medication adjustments. Id.; Tr. at 867.

On May 21, 2014, Dr. Bridges evaluated Plaintiff for follow up. Tr. at 706-13. Dr. Bridges noted Plaintiff's EF was 25% when she left the hospital and she was on Aldactone, Coreg, and an angiotensin-converting enzyme ("ACE"). Id. Plaintiff reported pain in her left arm and neck and shortness of breath upon exertion and fatigue. Id. Dr. Bridges found Plaintiff had a few crackles in both lung bases, trace ankle edema, and decreased sensation to light touch in both feet to nearly her knees. Id. Dr. Bridges prescribed Crestor. Id.

On June 6, 2014, Larry Clanton, Ph.D. ("Dr. Clanton"), a state agency psychologist completed a psychiatric review technique ("PRT") questionnaire that indicated Plaintiff's mental impairments were non-severe and imposed minimal limitations on her ability to perform basic work-related tasks or functions. Tr. at 179-80, 191-92. Dr. Clanton opined Plaintiff only had mild difficulties in maintaining concentration, persistence, or pace. Tr. at 180.

On June 9, 2014, Dr. Bridges evaluated Plaintiff for a long-lasting cough and fatigue and noted she had lost significant weight. Tr. at 702-05. Dr. Bridges found Plaintiff had trace ankle edema and a few crackles in her lungs, diagnosed congestive heart failure, and switched her Lisinopril to Cozaar. Id.

On June 10, 2014, Plaintiff presented to the Heart Failure Center for management. Tr. at 898-904.

On June 20, 2014, Kimberly S. Wilson, N.P. ("Nurse Wilson"), at the Heart Failure Center evaluated Plaintiff. Tr. at 906-19. Plaintiff reported retaining fluid and leg pain. Id. Her lab results showed increased brain natriuretic peptide ("BNP") with a six-pound weight gain. Id. Nurse Wilson advised Plaintiff on fluid restriction and sodium intake and assessed deteriorated chronic systolic heart failure, improved hypertension and diabetes, and unchanged dyspnea, anemia, hyperlipidemia. Id. She also ordered bloodwork. Id.

On July 23, 2014, Plaintiff presented to the Heart Failure Center and reported she felt better overall, was walking and swimming, and had lost three pounds, but had not attended cardiac rehabilitation and complained of fatigue and dyspnea with exertion. Tr. at 920-26. Plaintiff also reported she stopped Losartan because it dropped her blood pressure and made her feel "bad." Id. Nurse Wilson noted Plaintiff's heart rate was elevated and she was not taking medications as prescribed. Id. Plaintiff had a steady gait and normal mood and concentration, with no edema in her extremities. Id. Nurse Wilson assessed improved chronic systolic heart failure, hypertension, and hyperlipidemia, and unchanged dyspnea, anemia, and diabetes. Id. She prescribed Cozaar and continued Plaintiff's other medications. Id. However, Plaintiff's bloodwork revealed her hemoglobin level had increased, and she was referred to hematology. Tr. at 927-32.

On July 28, 2014, Plaintiff called the Heart Failure Center to report a cough, weight gain of two pounds in twenty-four hours, edema in her legs, and chest pain. Tr. at 933. Bobbie Little, R.N. ("Nurse Little"), noted it was asymptomatic to congestive heart failure symptoms and instructed her to take an additional Lasix. Id.

On July 30, 2014, Plaintiff was admitted to the hospital after being transported by ambulance to the emergency room due to shortness of breath, heart failure, and shock. Tr. at 768-850. Plaintiff reported sitting up straight in her bed to breathe for the prior five nights and having shortness of breath for two days that worsened over three hours. Tr. at 772, 811. Plaintiff's family reported noticing she had gained ten pounds in two days. Id. Plaintiff reported having had more swelling than normal in her lower extremities and a cough that produced lightly blood-tinged sputum. Id. While in the ambulance, Plaintiff was able to shake or nod her head, but not speak. Id. She was tachypneic with a respiratory rate of 32 and tachycardic with a heart rate of 140. Tr. at 776. She exhibited expiatory rhonchi bilaterally and 1+ pitting edema of her lower extremities. Id. Her symptoms were consistent with acute pulmonary edema and acute respiratory distress. Id. Plaintiff's chest x-ray showed bilateral increased hazy lung opacities centered at the perihilar region with probable cardiomegaly. Tr. at 810, 838. The attending physician's impression was cardiomegaly probably with vascular congestion compatible with congestive heart failure. Id.

Plaintiff's lab results showed an elevated BNP of 543 and A1c of 7.7%. Tr. at 769, 796. Plaintiff was also mildly anemic, nauseas, and vomiting. Tr. at 815. The attending physician noted advising Plaintiff was having heart failure. Tr. at 816. She was diagnosed with acute systolic congestive heart failure, severe ischemic cardiomyopathy with left ventricular EF measuring 30 to 35% that was decreased compared to the prior year when it was 40 to 45%, iron deficiency anemia thought to be secondary to menorrhagia, diabetes, coronary artery disease with stent placement, chronic obstructive pulmonary disease, dyslipidemia, obesity, diabetes, stable angina, and hypertension. Tr. at 769, 841-42. Her discharge medications included Coreg, Plavix, Crestor, Lasix, Glipizide, Levemir insulin, Losartan, Metformin, Nitroglycerin, Ranitidine, and Spironolactone. Tr. at 770. Plaintiff was discharged with a LifeVest for her severe EF. Tr. at 769-70.

On August 18, 2014, Plaintiff presented to Dr. Eickman, reported her better breathing and no edema, admitted she had not taken her insulin because it was too expensive, and inquired about exercise. Tr. at 861-63, 866. Dr. Eickman noted Plaintiff was unhappy with the LifeVest, but would have to wait for an echocardiogram ("echo") in one month to determine if it could be discontinued. Id. Plaintiff was also unhappy with her morning fatigue after taking her medications, and Dr. Eickman indicated it was likely from Coreg and continued her treatment regimen. Id.

On August 19, 2014, Plaintiff presented to Dr. Bridges and reported being prescribed Levemir, but could not afford it and took Metformin and Glipizide. Tr. at 871-77. Dr. Bridges noted Plaintiff had been wearing a LifeVest, she realized how serious things were, and she wanted to take better care of herself. Id. Dr. Bridges indicated Plaintiff's biggest complaint was fatigue. Id. Dr. Bridges found Plaintiff had an A1c of 6.5%, trace ankle edema, and decreased sensation to light touch in both feet to nearly her knees, but she had normal mood, affect, attention span, and concentration. Id. Dr. Bridges assessed chronic systolic heart failure, cardiomyopathy, hypertension, and diabetes. Id. Dr. Bridges adjusted Plaintiff's medications and provided samples of Levemir. Id.

On August 26, 2014, Plaintiff presented to Nurse Wilson at the Heart Failure Center and reported fatigue, low blood pressure, and dizziness when changing positions from standing or sitting. Tr. at 935-37. Nurse Wilson noted Plaintiff was supposed to be wearing a LifeVest, but had stopped because the "alarms kept acting up." Id. Nurse Wilson encouraged Plaintiff to wear the LifeVest, noted she was not exercising, and adjusted her medications. Id.

On September 22, 2014, Plaintiff had an echo that showed global left ventricle ("LV") systolic dysfunction and an EF of 35 to 40%. Tr. at 939-40, 1120. It also showed mild LV dilation, grade 3 diastolic dysfunction, and suggested moderate pulmonary hypertension, but no significant valvular pathology. Id.

On September 24, 2014, Plaintiff presented to the Heart Failure Center. Tr. at 879-82. Her weight was reduced, her gait was steady, and she had normal attention span and concentration, but trace ankle edema. Id. The attending physician assessed unchanged chronic systolic heart failure, hypertension, anemia, tachycardia, improved diabetes and dyspnea, and unchanged hyperlipidemia. Id. However, the attending physician noted Plaintiff's blood pressure was too low and she must continue to wear her LifeVest as directed. Id.

On October 27, 2014, Judy Thomas, N.P. ("Nurse Thomas"), at the Heart Failure Center evaluated Plaintiff. Tr. at 1142-1147. Plaintiff reported feeling "pretty good overall" and medication compliance. Id. She also reported fatigue, abdominal fullness, the need to sleep on two pillows, weight gain, and dyspnea with exertion and climbing stairs, but no dyspnea with walking. Id. Plaintiff stated Dr. Eickman removed the LifeVest in August due to an improved echo. Tr. at 1142. Nurse Thomas noted Plaintiff had lost weight, a steady gait, and no edema. Tr. at 1145. Nurse Thomas increased Plaintiff's Carvedilol dose to address her blood pressure and scheduled an appointment in two months. Tr. at 1145-46.

On December 3, 2014, Dale Van Slooten, M.D. ("Dr. Van Slooten"), a state agency physician, completed a physical residual functional capacity ("RFC") assessment and concluded Plaintiff was capable of performing light work with postural and visual limitations. Tr. at 181-84, 193-96. Dr. Van Slooten opined Plaintiff could lift, carry, push, or pull twenty pounds occasionally and ten pounds frequently; walk, stand, or sit for about six hours in an eight-hour workday; stoop, kneel, crouch, or crawl frequently; climb stairs and balance occasionally; never climb ladders, ropes, or scaffolds; avoid jobs that required a full visual field for job performance or worker safety; and avoid concentrated exposure to heat, cold, humidity, and all hazards. Id.

On January 6, 2015, Dr. Bridges ordered bloodwork that found Plaintiff's hemoglobin was 10.7%. Tr. at 942, 947-49, 953, 1038-39.

On February 11, 2015, Dr. Bridges evaluated Plaintiff for fatigue and increased shortness of breath that began one week prior. Tr. at 954-59, 1036-37. Dr. Bridges noted Plaintiff gained nine pounds, had abdominal bloating, and paroxysmal nocturnal dyspnea ("PND"), and that her A1c increased from 6.5 to 6.7%. Id. Dr. Bridges evaluated Plaintiff's diabetes, noting Plaintiff reported her dietary and medication compliance, but was not exercising. Id. Dr. Bridges found Plaintiff had trace edema and decreased sensation to light touch in her feet nearly up to her knees, but had normal mood and concentration. Id. Dr. Bridges ordered updated blood work and continued Plaintiff's medications. Id.

On February 24, 2015, Susan Elliott, N.P. ("Nurse Elliott"), at the Heart Failure Center evaluated Plaintiff. Tr. at 1148-54. Plaintiff reported she had not slept well, had cramps in her legs, and required three to four pillows to breathe while sleeping. Id. Nurse Elliott indicated Plaintiff had fluid present despite her increased Lasix dosage. Id. Nurse Elliott assessed deteriorated chronic systolic heart failure, insomnia, and obstructive sleep apnea, but unchanged hypertension and coronary artery disease. Id. Nurse Elliott increased Plaintiff's Lasix dosage, added potassium, magnesium, and furosemide, ordered a sleep study, advised her on diet and weight control, and continued her other medications. Id.

On March 10, 2015, Plaintiff presented to Dr. Bridges and reported inability to sleep, shortness of breath with exertion, and increased fluid retention, but denied anxiety and depression. Tr. at 960-65. Plaintiff continued to have trace edema bilaterally and decreased sensation to light touch, but normal mood and concentration. Id. Dr. Bridges advised Plaintiff to take an extra Lasix and continued her medications. Id.

On March 27, 2015, Ruth Ann Lyman, Ph.D. ("Dr. Lyman"), a state agency psychologist, completed a PRT assessment upon reconsideration and affirmed Dr. Clanton's findings that Plaintiff's mental impairments were non-severe. Tr. at 210-12, 226-28.

On April 1, 2015, Dr. Bridges evaluated Plaintiff for increased shortness of breath the prior week and noted she slept propped up and had gained twenty pounds. Tr. at 966-69. Dr. Bridges noted Plaintiff was seen at the clinic earlier that day. Id. Plaintiff reported she "just didn't feel good" and complained of swelling and abdominal bloating, but denied chest pain and reported medication compliance. Id. Dr. Bridges found Plaintiff's abdomen was distended, she had 2+ left and 1+ right pedal edema, and decreased sensation to light touch in both feet to knees, but normal mood, affect, attention span, and concentration. Id. Dr. Bridges diagnosed chronic systolic heart failure, anemia, diabetes, and hypertension and adjusted Plaintiff's medications. Id.

On April 8, 2015, Dr. Bridges evaluated Plaintiff's congestive heart failure. Tr. at 970-73. Plaintiff reported her symptoms were improving, she had been walking, she lost twenty pounds, and Metolazone had helped. Id. Dr. Bridges noted no edema, assessed improved chronic systolic heart failure, and continued Plaintiff's treatment regimen. Id.

On April 16, 2015, Plaintiff complained of a four-day headache, sinus pressure, photophobia, and weakness. Tr. at 974-79. Dr. Bridges administered a Toradol injection, prescribed Amoxicillin, and advised Plaintiff to take Claritin daily. Id.

On April 22, 2015, Plaintiff presented to Dr. Eickman and reported she had recently moved and walking up fourteen steps to her home or half a lap around a track caused shortness of breath. Tr. at 1115-19, 1122-27. Dr. Eickman noted he had not seen Plaintiff since August 2014. Tr. at 1115. Dr. Eickman indicated Plaintiff was on good medical therapy for congestive heart failure, and an echo had showed an EF in the 25% range, which he suspected may be closer to 30%. Tr. at 1116. Dr. Eickman noted, "Nonetheless this is a concern. Raises questions about sudden death prevention." Id. He indicated being concerned about her exercise intolerance and scheduled a nuclear stress test to define her current EF. Id.

On April 25, 2015, Thomas O. Thomson, M.D. ("Dr. Thomson"), a state agency physician, completed an RFC assessment and indicated Plaintiff was capable of performing sedentary work with postural and visual limitations. Tr. at 213-15, 229-31. Dr. Thomson opined Plaintiff could lift, carry, push, or pull ten pounds; walk or stand for two hours; sit for about six hours in an eight-hour workday; could frequently balance; occasionally stoop, kneel, crouch, crawl or climb stairs; never climb ladders, ropes, or scaffolds; avoid jobs that required a full visual field for job performance or worker safety; and avoid concentrated exposure to heat, cold, humidity, and all hazards. Id.

On May 28, 2015, Plaintiff presented to Dr. Bridges and reported anxiety, fatigue, insomnia, shortness of breath, depression, decreased libido, high stress with the loss of her home, crying a lot, and no interest in pleasurable activities. Tr. at 980-84. Dr. Bridges noted Plaintiff had been denied disability again. Id. Dr. Bridges found Plaintiff had depressed affect and decreased sensation to light touch. Id. Dr. Bridges noted Plaintiff might need a defibrillator and prescribed Lexapro for anxiety and depression. Id.

On June 25, 2015, Plaintiff presented to Dr. Bridges and reported fatigue, lightheadedness, shortness of breath with exertion, swelling of her hands and feet, and that Lexapro had not helped. Tr. at 985-89. Plaintiff indicated she did not attend her appointment at the Heart Failure Center and did not understand why she needed a defibrillator. Id. Dr. Bridges provided an explanation to Plaintiff and noted she seemed to understand. Id. Dr. Bridges also noted Plaintiff's increased weight, trace edema, and decreased sensation to light touch, but normal mood and concentration. Id. Dr. Bridges agreed Plaintiff could stop Lexapro and urged her to return to the Heart Failure Center. Id.

On July 9, 2015, Plaintiff underwent a rest/stress single isotope single photon emission computed tomography ("SPECT") myocardial perfusion imaging scan that showed a moderate area of infarction at the apex and anterior wall, as well as in the septum, with a small area of ischemia in the inferior wall. Tr. at 1044-45, 1113-14, 1128-37. The left ventricular function was abnormal with regional wall abnormalities, with an EF of 29%. Id.

On September 9, 2015, Dr. Bridges evaluated Plaintiff for increased shortness of breath for one week and fatigue. Tr. at 990-93. Plaintiff reported she being unable to lie down and complained of decreased urination and cramping in her legs. Id. Dr. Bridges noted Plaintiff's weight had increased nine pounds, despite a good diet, and found trace edema bilaterally. Id. Dr. Bridges ordered blood work and advised Plaintiff to take extra Lasix that day. Id.; Tr. at 1041, 1162-63.

On September 10, 2015, Plaintiff presented to Nurse Thomas and reported fatigue, shortness of breath with steps, and retained excess fluid, despite losing six pounds overnight. Tr. at 1155-61, 1164. Id. Plaintiff admitted she was not adhering to sodium, fluid, or diet restrictions. Id. Nurse Thomas found Plaintiff had 1+ left and trace right pedal edema. Id. Nurse Thomas noted Plaintiff had a functional capacity of Class III of the New York Heart Association ("NYHA") and was comfortable at rest, but most activities resulted in fatigue, exertional dyspnea, and chest pain. Id. Nurse Thomas adjusted Plaintiff's medications, stressed the importance of compliance and weight loss, and noted her fatigue was likely multifactorial due to excess volume, anemia, uncontrolled diabetes, insomnia, and a sedentary lifestyle. Id.

On October 19, 2015, Dr. Bridges evaluated Plaintiff for complaints of chest pressure for two days, with some nausea and difficulty breathing at night. Tr. at 994-98. Plaintiff reported she missed her prior appointment with the Heart Failure Center due to transportation issues, but her sugar levels were good. Id. Dr. Bridges noted Plaintiff had gained three pounds and had trace pedal edema bilaterally, but her mood and concentration were normal. Id. Dr. Bridges provided Dexilant samples and encouraged Plaintiff to follow up with the Heart Failure Center. Id.

On December 2, 2015, Plaintiff complained of pain in her right great toe and nausea for three days, as well as fatigue, shortness of breath, and joint pain or stiffness. Tr. at 999-1004. Dr. Bridges noted Plaintiff had not been to the Heart Failure Center due to transportation issues and found she had trace edema and tenderness over her metatarsals, with decreased sensation to light touch in both feet nearly to her knees. Id. Dr. Bridges diagnosed joint pain in her ankle and foot and a B12 deficiency and administered a B12 injection. Id.

Later on December 2, 2015, Plaintiff was treated in the emergency room for "stroke-like" symptoms and slurred speech, but left before treatment was finalized. Tr. at 1173-83.

On December 3, 2015, Dr. Bridges evaluated Plaintiff for an emergency follow-up due to left-sided weakness, slurred speech, and a possible TIA or reaction to the B12 injection. Tr. at 1005-11. Plaintiff's daughter reported Plaintiff's speech was unclear, slurred, and her mouth was drooped on one side with a thick tongue. Id. Plaintiff reported she left the emergency room after waiting several hours for a full work-up to be done. Id. Plaintiff also reported fatigue, loss of strength, difficulty with concentration, poor balance, headaches, disturbances in coordination, and numbness, but that she felt better and just "a little off." Id. Dr. Bridges found Plaintiff had slowed coordination with finger-to-nose and heel-to-shin, but had other normal results, including attention, concentration, and fund knowledge. Id. Dr. Bridges assessed a personal history of TIA and cerebral infarction, without residual deficits, slurred speech, and headache and prescribed Ativan. Id. Dr. Bridges noted Plaintiff's last echo was 25 to 30% and "every echo her EF is worse," her blood pressure ran low at all times, and MS was questioned at one point, but Plaintiff reported "it was never worked up." Tr. at 1011. Dr. Bridges scheduled MRIs and an echo and referred Plaintiff to neurology. Id.

On December 7, 2015, Plaintiff underwent cardiac testing that showed her left ventricle was mildly dilated and her EF was 30 to 35%. Tr. at 1249-51. Plaintiff had moderate-to-severe global hypokinesis of the left ventricle and elevated right ventricular systolic pressure. Id.

On December 11, 2015, Plaintiff had a brain MRI that showed a new gyriform enhancement in the right frontal and parietal lobes, most suggestive of a subacute infarct and evidence of an old right posterior circulation infarct, along with a small cortical infarct in the posterior left frontal lobe. Tr. at 1042-43, 1247-48, 1260-61.

On December 14, 2015, Carol A. Kooistra, M.D. ("Dr. Kooistra"), at Carolina Neurology of Spartanburg, evaluated Plaintiff for headaches and noted she was a "rather incomplete historian" and had trouble providing her symptoms. Tr. at 1267-68. Dr. Kooistra reviewed Plaintiff's medical history and her March 2014 MRI. Id. Plaintiff reported falling in the shower two weeks prior, after her left arm and leg went numb. Id. Plaintiff reported she improved after one to two hours, but still had some incoordination with her left hand. Id. Plaintiff also reported developing a headache, but indicated she did not hit her head, and described her pain as pressure, with blurred vision. Id.

Dr. Kooistra noted Plaintiff's subsequent MRI showed new gyriform areas of abnormal enhancement involving the right parietal cortex and posterior right cortex, including the insular cortex, as well as some laminar necrosis on T1 images. Id. Dr. Kooistra indicated Plaintiff's examination showed a left homonymous hemiapsia. Id. Plaintiff's fine motor movements were slowed on the left and her reflexes were 1+ and symmetric, but there were no gait abnormalities. Id. Dr. Kooistra assessed headache and late effect cerebrovascular accident ("CVA") hemiplegia. Id. Dr. Kooistra explained she would consider Plaintiff's MRI changes "to represent either embolic CVA with known embolic source on a TTE (EF 30 to 35% and in July thrombus could not be excluded) or from a [central nervous system ("CNS")] vasculitis (considering the laminar superficial nature)." Id. Dr. Kooistra indicated she favored the cardiac source, but would need to complete a young person's strong evaluation for inflammation and coagulopathy etiologies and then coordinate with Dr. Eickman. Id. She explained both scenarios cause headaches and, in the embolic setting, it would eventually spontaneously improve or, in the vasculitis setting, it could be a part of a syndrome. Id. Dr. Kooistra continued Plavix because Plaintiff was acetylsalicylic acid ("ASA")-intolerant and ordered blood work. Id.; Tr. at 1271-73.

On January 4, 2016, Plaintiff had a head computed tomography ("CT") scan that showed small vessel disease in the distal branches of the right posterior cerebral artery and stenosis in the V3 segment of the right vertebral artery. Tr. at 1245-46, 1262-63.

On January 14, 2016, and February 2, 2016, Plaintiff underwent cardiac monitoring that showed unspecified atrial fibrillation. Tr. at 1274-75.

On February 2, 2016, Dr. Eickman evaluated Plaintiff for a follow up, noting he had not seen her since April 2015, and indicated she had no new cardiac complaints, but presented with a cardiac monitor in place. Tr. at 1106-12, 1138-40. Dr. Eickman noted Plaintiff had no edema in her extremities and her mood and affect were appropriate. Tr. at 1110-11. Dr. Eickman reviewed Plaintiff's echo that showed an estimated EF of 30% and indicated he agreed with Dr. Kooistra that embolic CVA was quite possible. Id. Dr. Eickman indicated long-term Coumadin may be reasonable and he would seek a second opinion. Tr. at 1111.

On February 17, 2016, Dr. Bridges evaluated Plaintiff for complaints of fatigue, low energy, urine frequency, and insomnia. Tr. at 1012-18. Plaintiff had been on Coumadin for ten days to prevent a stroke and her sugars had been in the 200s, which was "absolutely terrible," with an A1c over 11%. Id. Dr. Bridges noted Plaintiff had trouble following the conversation during the visit and indicated her weight had increased and she had to void twice during the visit. Id. Dr. Bridges assessed CVA, insomnia, cardiomyopathy, and deteriorated diabetes. Id. She adjusted Plaintiff's medications and ordered bloodwork. Id.

On February 22, 2016, Dr. Kooistra reevaluated Plaintiff and noted her 30-day event monitor was unremarkable and she had no additional neurologic issues. Tr. at 1269-70. Dr. Kooistra noted she spoke with Dr. Eickman and he had switched Plaintiff's Plavix to Warfarin because of her embolic risk. Id. Dr. Kooistra stated Plaintiff had two embolic CVAs that were likely cardiac-related, either to her cardiomyopathy or unrecognized atrial fibrillation, but was adequately addressed by Warfarin. Id.

On February 24, 2016, Plaintiff presented to Dr. Bridges and reported her glucose had been 252 or only reflecting "high," she was thirsty and voiding all the time, and had blurry vision. Tr. at 1019-23. Dr. Bridges assessed deteriorated diabetes, doubled her insulin, and instructed her to go to the emergency room if the glucometer read "high" again. Id.

On March 8, 2016, Plaintiff presented to Dr. Bridges and complained of weight gain, fatigue, and shortness of breath. Tr. at 1024-30. Plaintiff reported compliance with her medication and no side effects from insulin, but admitted she had not been eating well. Id. Plaintiff's physical examination was normal, and she denied diabetic issues with her feet. Id. Dr. Bridges increased Coumadin for anticoagulation. Id.

On March 16, 2016, Plaintiff had an anticoagulation check, and Dr. Bridges increased her Coumadin. Tr. at 1031. Plaintiff had additional anticoagulation checks through November 2016. Tr. at 1032-35, 1040, 1070-71, 1078, 1085-86, 1100-04 (noting visits on March 23, March 28, April 4, April 11, April 25, May 9, May 23, August 12, September 9, October 7, October 24, and November 16, 2016).

On April 18, 2016, Plaintiff presented to Dr. Bridges and reported feeling her weight was increasing due to the insulin shot, Ativan no longer helped, and she was experiencing insomnia and anxiety. Tr. at 1079-84. Dr. Bridges found no edema and normal mood and concentration. Id. Dr. Bridges explained Plaintiff would likely need to take insulin for the rest of her life and prescribed Trazodone. Id.

On April 28, 2016, Plaintiff presented to Dr. Bridges' office and reported constipation, shortness of breath, chest tightness, cough, fatigue, insomnia, and swelling. Tr. at 1072-77. Mindy Thompson, N.P. ("Nurse Thompson"), noted Plaintiff had started taking iron, which likely caused her constipation. Id. Plaintiff reported sleeping better and losing six pounds, but continued grogginess in the morning. Id. Nurse Thompson found Plaintiff had 1+ pedal edema bilaterally and a distended abdomen. Id. Nurse Thompson stated she felt Plaintiff's "edema [wa]s the best it [wa]s going to be" and noted Plaintiff had "a lot of comorbidities" and her "long-term outlook [wa]s not good." Tr. at 1077. Nurse Thompson indicated she tried to explain congestive heart failure to Plaintiff, who admitted to taking more Lasix than prescribed. Tr. at 1072-77. Nurse Thompson prescribed Miralax, substituted Belsomra for Ativan and Trazadone because they were no longer working, and continued Plaintiff's other medications. Id. Nurse Thompson indicated Plaintiff was "trying to get on disability which I agree is best for her." Tr. at 1077.

On June 30, 2016, Dr. Bridges evaluated Plaintiff for worsening diabetes. Tr. at 1087-89. Plaintiff reported worsened symptoms of chest pain, fatigue, polydipsia, polyphagia, polyuria, and weakness. Id. Dr. Bridges noted Plaintiff's diabetic complications included a CVA, heart disease, and nephropathy. Id. Dr. Bridges noted Plaintiff was compliant with treatment "some of the time," but her weight was steadily increasing. Id. Plaintiff had blood sugars in the 300s, shortness of breath, rapid heart rate over 200, and an EKG that read sinus tachycardia. Id. Dr. Bridges found Plaintiff's lungs had decreased breath sounds and she heard a tachycardic with gallup, but no real pedal edema. Id. Dr. Bridges indicated Plaintiff's A1c was "terrible" and she did not think Plaintiff was taking her insulin as prescribed. Id. Dr. Bridges increased Plaintiff's insulin dosage, discussed diet, and stressed the seriousness of her condition. Id.

On July 29, 2016, Plaintiff presented to Dr. Bridges and reported her sugars had ranged from 72 to 180. Tr. at 1090-91. Dr. Bridges noted Plaintiff had abdominal distention, shortness of breath, leg swelling, gained weight, and lacked energy. Id. Dr. Bridges also noted Plaintiff's congestive heart failure was not well-controlled, her blood pressure was low, and her heart rate and weight were up. Id. Dr. Bridges found trace ankle edema and a heart gallup, but normal rate and regular rhythm with breath sounds. Id. Dr. Bridges stressed diet and noted Plaintiff was to start cardiac rehabilitation. Id.

On August 4, 2016, Plaintiff reported to cardiac rehabilitation, but had to stop walking on the treadmill due to leg cramps. Tr. at 1059-68. Plaintiff reported noncompliance with medications, but expressed desire to follow instructions due to her declining heart function, and she was referred to Dr. Grace for depression. Id.; Tr. at 1184-1243 (reflecting various test forms and laboratory results from Heart Failure Center).

On August 15, 2016, Plaintiff presented to Dr. Bridges and complained of leg cramps, achiness in her legs and arms, and a warm sensation in her thighs for one week. Tr. at 1092-94. Dr. Bridges noted Plaintiff's potassium was low and likely caused her leg issues. Id. Dr. Bridges also noted she could not restart Ativan due to Plaintiff's other health concerns or medications and would continue insulin because Plaintiff's recent A1c was 12.1%. Id.

On August 18, 2016, Plaintiff presented to Dr. Bridges and reported shortness of breath, fatigue, leg swelling, and abdominal distention. Tr. at 1095-96. Dr. Bridges found Plaintiff had increased swelling, despite being on three diuretics, was not doing well with compliance and diet, and her blood pressure was low. Id. Dr. Bridges indicated Plaintiff needed to return to cardiac rehabilitation. Id.

On November 3, 2016, Plaintiff complained of insomnia, depression, and arm and chest pain. Tr. at 1097-99. Dr. Bridges noted Plaintiff's diabetic control was "terrible," she forgot to take her insulin, was not eating correctly, and was gaining weight. Id. Dr. Bridges "stressed proper diet and need for med[ication] compliance." Tr. at 1098. Dr. Bridges recommended exercise and added Temazepam to Plaintiff's medications. Id.

b. Medical Evidence Submitted to the Appeals Council

On April 21, 2017, Dr. Eickman provided an opinion regarding Plaintiff's conditions and limitations. Tr. at 12. Dr. Eickman's opinion consisted of a one-page questionnaire on which he noted Plaintiff would fit under Class III of the NYHA classification of heart disease due to coronary heart disease, prior myocardial infarction, and cardiomyopathy and noted his opinion was based upon her prior cardiac catheterizations in August 2013 and May 2014 and her prior echo in February 2016. Id. However, he responded "probably not" to the inquiry of whether Plaintiff would need to elevate her legs above the waist for significantly more than an hour during the working portion of the workday. Id.

On September 7, 2017, Dr. Bridges provided an opinion regarding Plaintiff's conditions and limitations. Tr. at 8. Dr. Bridges noted she had been Plaintiff's primary care physician for many years, Plaintiff's primary problems impacting her ability to work were cardiomyopathy and chronic systolic heart failure. Id. She explained Plaintiff was an insulin-dependent diabetic. Id. She noted Plaintiff's EF was "quite low" at 25% on her last echo and had been between 25 to 30% since at least April 2016. Id. Dr. Bridges also noted Plaintiff saw her cardiologist on August 24, 2017, but had not seen him for 15 months prior, and his notes summarized the cardiac history "pretty well." Id. Dr. Bridges added Plaintiff had an acute coronary syndrome with emergency stent placement in May 2014, and a nuclear stress test in July 2014 calculated her EF at 29%. Id. Dr. Bridges noted Plaintiff was noncompliant with her medications, did not take her insulin properly, did not eat appropriately, and had gained significant weight. Id. Dr. Bridges explained:

[Plaintiff] gets short of breath with any exertion, and that is consistent with her condition. On clinical examination, her edema has increased over the last 6-8 months. A couple of month[s] ago, she had to go to the emergency room for intravenous diuretics. She has increased numbness and significantly increased edema since that time. As her diabetes has gotten worse, her peripheral neuropathy has worsened. Due to edema in her extremities, she would need to rest away from the work station with her legs elevated for significantly more time than the usual breaks allow. Even the minimal amount of walking necessary to perform a sedentary job would cause her fatigue to the point where she would suffer frequent interruptions to task. She does present at time[s] with sluggish thought process. She has had these limitations on and off for years but consistently since April 2016. Her condition would improve somewhat with compliance.

C. The Administrative Proceedings

1. The Administrative Hearing

a. Plaintiff's Testimony

At the hearing on December 8, 2016, Plaintiff testified she was 40 years old, was 5'5.5", 270-275 pounds, up from 230 pounds the year prior, and completed the twelfth grade. Tr. at 146-48, 161. She stated she lived with her two teenage daughters in an apartment with fourteen stairs. Tr. at 147. She testified she goes up seven of them, then rests a minute or two before going up the rest. Id. She said she had a driver's license and drove short distances two to three times per week, but did not drive on the highway since she had a stroke because of an inability to concentrate. Tr. at 149-50. She reported her mother drove her to the hearing. Tr. at 149.

Plaintiff stated she is not able to exercise, and the extra weight makes her extremely tired. Tr. at 148-49. She related that the prior August she tried rebuilding her heart at the Heart Wellness Center, but only went one time and tried to exercise for two to three minutes before she was told to stop and was informed they could not help her. Tr. at 150. She previously attempted to attend rehab at the Heart Wellness Center in August 2013 after her first heart attack, but she began cramping badly because her potassium was out of control. Tr. at 150-51. She testified she takes Lasix, which strips her potassium, and her doctors have had trouble adjusting her potassium level. Tr. at 151. She testified she took 40 mg of Lasix early in the morning and another 40 mg in the afternoon that caused her to urinate every 15 to 20 minutes. Tr. at 152-53. Plaintiff stated she took the medications she provided on the form, in addition to Gabapentin that Dr. Bridges had added for gout. Tr. at 152. She noted she is supposed to limit her liquid intake to 64 ounces because of her congestive heart failure, but she drank more water because her medicines caused dry mouth. Tr. at 153. She testified she had a stroke in December 2015, and an MRI of the brain showed two spots, indicative of having had two strokes, not MS. Tr. at 153-54. She testified her condition had worsened since her stroke and that her mental ability has changed and caused her to be a procrastinator. Tr. at 154-55.

Plaintiff reported having worked at Burger King as a cashier prior to her heart attack and stroke, but that she would be unable to do that work again because of her inability to concentrate and difficulty with counting. Tr. at 156-57. She testified having worked as a cashier at a pizza place for seven or eight years, but she could not do that work again because she lacks the energy to check on customers and refill their water and tea. Tr. at 157-58. She worked as a cashier at another restaurant, Palmetto, and began braiding hair at her house in 2014-15. Tr. at 158-61. However, she stopped braiding hair in 2016. Id.

Plaintiff stated she also had diabetes, for which she takes 30 units of insulin by injection three times a day and 80 mgs before bed. Tr. at 161. She noted the diabetes has impaired her peripheral vision, especially on the left. Tr. at 161-62. She testified she has shortness of breath all the time and could stand for less than ten minutes because of neuropathy in her legs that causes pain and swelling. Tr. at 162-63. She testified she could walk four of five minutes before becoming fatigued and sit for ten to fifteen minutes. Tr. at 163. She stated she could not lift over 25 pounds due to heart stents. Tr. at 164. She testified she uses a motorized cart to get around grocery stores and always has at least one of her daughters accompany her to pick up heavy items. Tr. at 165. She stated she attended church, but she could not sit through an entire service because of having to use the restroom. Tr. at 165-166. Plaintiff indicated her daughters do the housework, including cooking, washing the dishes, and taking out the trash. She stated she would fold clothes if they brought them to her. Tr. at 166. She testified she takes Trazadone for help sleeping, anxiety, and depression. Tr. at 166-67. She testified she could not climb a ladder due to balance issues. Tr. at 167.

b. Vocational Expert Testimony

Vocational Expert ("VE") Kerry Washington reviewed the record and testified at the hearing. Tr. at 168-72. The VE categorized Plaintiff's PRW as a cashier as light unskilled work, specific vocational preparation ("SVP") of 2, Dictionary of Occupational Titles ("DOT") No. 211.462-010, and hair stylist as light work, SVP of 3 or 4, DOT No. 332.271-018. Tr. at 169-70. The ALJ described a hypothetical individual of Plaintiff's vocational profile who could perform sedentary work (i.e., lifting or carrying 10 pounds occasionally, 5 pounds frequently; standing and walking two hours of eight; sitting six hours of eight); never climb ladders, ropes, or scaffolds; occasionally climb ramps or stairs, balance, stoop, kneel, crouch, and crawl; avoid concentrated exposure to workplace hazards such as unprotected heights and moving machinery; avoid concentrated exposure to extreme cold and extreme heat; and could perform detailed, but not complex, tasks for two-hour blocks of time with normal rest breaks during an eight-hour workday. Tr. at 170. The VE indicated the hypothetical would not allow Plaintiff's PRW, but would allow for other sedentary, unskilled jobs with SVP of 2 such as an addresser (DOT No. 209.587-010), an inspector (DOT No. 669.687-014), or an order clerk in food and beverage (DOT No. 209.567-014), with 125,000, 150,000, and 150,000 positions available in the national economy. Tr. at 170-71. The VE testified availability of jobs would not be impacted if the hypothetical were modified to avoid jobs that required full visual fields for job performance and safety. Tr. at 171.

The ALJ proposed another hypothetical, with the following modifications: stand and walk less than two hours of an eight-hour workday and sit less than six hours of eight. Tr. at 171-72. The VE responded the modifications would preclude work on a sustained basis. Tr. at 172.

If the individual needed bathroom breaks of less than 10 to 15 minutes hourly, the VE responded it would preclude the identified jobs and any other work. Id. The VE further testified there would be no work for a person who was expected to be off task 20% of the time. Id.

2. The ALJ's Findings

In his decision dated February 23, 2017, the ALJ made the following findings of fact and conclusions of law:

1. The claimant meets the insured status requirements of the Social Security Act through December 31, 2020.
2. The claimant has not engaged in substantial gainful activity since August 9, 2013, the alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).
3. The claimant has the following severe impairments: history of myocardial infarction, diabetes mellitus, degenerative disc disease of the cervical spine, obesity, history of congestive heart

failure, left homonymous hemianopia, hyperlipidemia, high cholesterol and a history of cerebrovascular accident (20 CFR 404.1520(c) and 416.920(c)).
4. The claimant does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).
5. After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform sedentary work as defined in 20 CFR 404.1567(a) and 416.967(a) except that the claimant can occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl, but can never [c]limb ladders, ropes, and scaffolds. The claimant must avoid concentrated exposure to workplace hazards such as unprotected heights, moving machinery, and extreme cold and heat. The claimant can perform detailed, but not complex tasks for two-hour blocks of time, with normal rest breaks during an eight-hour workday. The claimant must avoid jobs that require full visual fields for job performance and safety.
6. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and 416.965).
7. The claimant was born on November 17, 1976 and was 36 years old, which is defined as a younger individual age 18-44, on the alleged disability onset date (20 CFR 404.1563 and 416.963).
8. The claimant has at least a high school education and is able to communicate in English (20 CFR 404.1564 and 416.964).
9. Transferability of job skills is not material to the determination of disability because using the Medical-Vocational Rules as a framework supports a finding that the claimant is "not disabled," whether or not the claimant has transferable job skills (See SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).
10. Considering the claimant's age, education, work experience, and residual functional capacity, there are jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1569, 404.1569(a), 416.969, and 416.969(a)).
11. The claimant has not been under a disability, as defined in the Social Security Act, from August 9, 2013, through the date of this decision (20 CFR 404.1520(g) and 416.920(g)).

Plaintiff alleges the Commissioner erred because new and material evidence was submitted to the Appeals Council that was not considered and warrants remand. The Commissioner counters that substantial evidence supports the ALJ's findings, the ALJ committed no legal error in his decision, and the Appeals Council properly handled the additional evidence

A. Legal Framework

1. The Commissioner's Determination-of-Disability Process

The Act provides that disability benefits shall be available to those persons insured for benefits, who are not of retirement age, who properly apply, and who are under a "disability." 42 U.S.C. § 423(a). Section 423(d)(1)(A) defines disability as:

inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months.

To facilitate a uniform and efficient processing of disability claims, regulations promulgated under the Act have reduced the statutory definition of disability to a series of five sequential questions. See, e.g., Heckler v. Campbell, 461 U.S. 458 (1983) (discussing considerations and noting "need for efficiency" in considering disability claims). An examiner must consider the following: (1) whether the claimant is engaged in substantial gainful activity; (2) whether she has a severe impairment; (3) whether that impairment meets or equals an impairment included in the Listings; (4) whether such impairment prevents the claimant from performing PRW; and (5) whether the impairment prevents her from doing substantial gainful employment. See 20 C.F.R. §§ 404.1520, 416.920. These considerations are sometimes referred to as the "five steps" of the Commissioner's disability analysis. If a decision regarding disability may be made at any step, no further inquiry is necessary. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4) (providing that if Commissioner can find claimant disabled or not disabled at any step, Commissioner may make a determination and not go on to the next step).

A claimant is not disabled within the meaning of the Act if she can return to PRW as it is customarily performed in the economy or as the claimant actually performed the work. See 20 C.F.R. §§ 404.1520(a), (b), (f), 416.920(a), (b), (f); Social Security Ruling ("SSR") 82-62 (1982). The claimant bears the burden of establishing her inability to work within the meaning of the Act. 42 U.S.C. § 423(d)(5).

Once an individual has made a prima facie showing of disability by establishing the inability to return to PRW, the burden shifts to the Commissioner to come forward with evidence the claimant can perform alternative work and such work exists in the national economy. To satisfy that burden, the Commissioner may obtain testimony from a VE demonstrating the existence of jobs available in the national economy that claimant can perform despite the existence of impairments that prevent the return to PRW. Walls v. Barnhart, 296 F.3d 287, 290 (4th Cir. 2002). If the Commissioner satisfies that burden, the claimant must then establish that she is unable to perform other work. Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981); see generally Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987) (regarding burdens of proof).

2. The Court's Standard of Review

The Act permits a claimant to obtain judicial review of "any final decision of the Commissioner . . . made after a hearing to which [s]he was a party." 42 U.S.C. § 405(g). The scope of that federal court review is narrowly tailored to determine whether the findings of the Commissioner are supported by substantial evidence and whether the Commissioner applied the proper legal standard in evaluating the claimant's case. See id.; Richardson v. Perales, 402 U.S. 389, 390 (1971); Walls, 296 F.3d at 290 (citing Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990)).

The court's function is not to "try [these cases] de novo or resolve mere conflicts in the evidence." Vitek v. Finch, 438 F.2d 1157, 1157 (4th Cir. 1971); see Pyles v. Bowen, 849 F.2d 846, 848 (4th Cir. 1988) (citing Smith v. Schweiker, 795 F.2d 343, 345 (4th Cir. 1986)). Rather, the court must uphold the Commissioner's decision if it is supported by substantial evidence. Richardson, 402 U.S. at 390. "Substantial evidence" is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. at 401 (citation omitted); Johnson v. Barnhart, 434 F.3d 650, 653 (4th Cir. 2005). Thus, the court must carefully scrutinize the entire record to assure there is a sound foundation for the Commissioner's findings and that her conclusion is rational. See Vitek, 438 F.2d at 1157-58; see also Thomas v. Celebrezze, 331 F.2d 541, 543 (4th Cir. 1964). "In reviewing for substantial evidence, we do not undertake to reweigh conflicting evidence, make credibility determinations, or substitute our judgment for that of the [ALJ]." Johnson, 434 F.3d at 653 (quoting Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996)). If there is substantial evidence to support the decision of the Commissioner, that decision must be affirmed "even should the court disagree with such decision." Blalock v. Richardson, 483 F.2d 773, 775 (4th Cir. 1972).

B. Analysis

1. Good Cause Exception Met Under Amended Regulations

First, the Commissioner argues the amended regulations apply and Plaintiff has failed to meet their requirements, particularly the good cause exception for failing to submit her additional evidence to the ALJ. [ECF No. 16 at 7-15]. Plaintiff replies the old regulations apply in this case because the hearing was held prior to the effective date, and, in the alternative, she has met the good cause exception. [ECF No. 17 at 3-7].

Prior to January 17, 2017, the regulations required the Appeals Council to "consider" additional evidence that was new, material, and related to the period on or before the date of the ALJ's decision and evaluate the entire record with the additional evidence to determine whether an ALJ's actions, findings, or conclusions were contrary to the weight of the evidence. 20 C.F.R. §§ 404.970, 416.1470 (eff. to Jan. 16, 2017).

As of January 17, 2017, the regulations provide the Appeals Council will only consider additional evidence if a claimant shows "good cause" for not submitting the evidence to the ALJ, or informing him of it, at least five business days prior to the hearing. 20 C.F.R. §§ 404.970, 416.1470 (2017). If good cause is shown, the Appeals Council will determine whether to review a case on the basis of additional evidence if such evidence is new, material, relates to the period on or before the hearing decision, and provides a reasonable probability the outcome of the hearing decision would change. 20 C.F.R. §§ 404.970(a)(5), 416.1470(a)(5).

As Plaintiff notes, one of the primary effects of the amended regulations was to require the claimant to inform of or submit evidence to the ALJ at least five days prior to the hearing, unless good cause was shown. 20 C.F.R. §§ 404.970, 416.1470 (2017).

The hearing in this case was held on December 8, 2016, the amended regulations took effect on January 17, 2017, and the ALJ's decision was issued on February 23, 2017. Tr. at 39, 50; 20 C.F.R. §§ 404.970, 416.1470 (2017). After receiving the ALJ's decision, Plaintiff retained new counsel and appealed her case to the Appeals Council. Tr. at 13-16. The notice granting additional time to perfect the appeal stated, "Any more evidence must be new and material to the issues considered in the hearing decision dated February 17, 2017," which reflects the prior regulations' requirements. Tr. at 9 (emphasis in original). However, in issuing their denial letter on February 15, 2018, the Appeals Council stated, "[it] applied the laws, regulations and rulings in effect as of the date [it] took this action," and provided the amended regulations' requirements. Tr. at 1-2. With regard to the additional evidence at issue, Dr. Eickman and Dr. Bridges' opinions, the Appeals Council stated, "[t]he [ALJ] decided your case through February 23, 2017. This additional evidence does not relate to the period at issue. Therefore, it does not affect the decision about whether you were disabled beginning on or before February 23, 2017." Tr. at 2.

Here, the issue concerning which version of the regulations applies need not be resolved because Plaintiff is able to satisfy both. The Commissioner argues Plaintiff is unable to show good cause for failing to submit Dr. Bridges' opinion previously. [ECF No. 16 at 7-14]. Indeed, Plaintiff's arguments that the excusable neglect standard governs this issue and evidence merely created after the ALJ's hearing is sufficient to meet the good cause exception are incorrect. [ECF No. 17 at 4-5]. However, Dr. Bridges' opinion fits two circumstances provided by the Social Security Administration ("SSA") to fulfill the good cause exception.

Due to a report by the Administrative Conference of the United States ("ACUS") and various comments, the SSA provided examples "to clarify when other unusual, unexpected, or unavoidable circumstances beyond the claimant's control prevent earlier identification of or submission of evidence." 81 Fed. Reg. 45079, 45082 (July 12, 2016). The SSA noted "our rule is not intended to prevent a claimant from submitting evidence related to ongoing treatment," rebuttal evidence "if an ALJ introduces new evidence at or after a hearing," or evidence the claimant or attorney "actively and diligently [sought] but [was] unable to obtain." 81 Fed. Reg. 90987, 90990-91 (Dec. 16, 2016). In addition, the SSA addressed a concern about prior incompetent counsel and responded, "[i]f a new representative can show that a prior representative did not adequately uphold his or her duty to the claimant, we expect that our adjudicators would find that this would warrant an exception to the 5-day requirement." Id.

In this case, Dr. Bridges' opinion is based upon Plaintiff's ongoing treatment and meets the good cause exception for "evidence related to ongoing treatment." See, e.g., Tr. at 8 (explaining Dr. Bridges was Plaintiff's primary care physician and "[o]n clinical examination, [Plaintiff's] edema ha[d] increased over the last 6-8 months" in her opinion dated less than seven months from the ALJ's decision); 81 Fed. Reg. at 90990-91. In addition, Plaintiff's current counsel did not represent her until after the ALJ's decision, which could allow her to meet another circumstance under the good cause exception, as the SSA explained, "[i]f a new representative can show that a prior representative did not adequately uphold his or her duty to the claimant, we expect that our adjudicators would find that this would warrant an exception to the 5-day requirement." 81 Fed. Reg. at 90990-91; see Tr. at 13-18 (reflecting Plaintiff's prior counsel released his file and Plaintiff's current counsel began representing her after the ALJ's decision); see also [ECF No. 17 at 6-7] (stating current counsel did not represent Plaintiff at the hearing and he is unable to explain why a treating physician's opinion was not submitted to the ALJ). Notably, Plaintiff's prior counsel did not submit any opinions from Plaintiff's treating physicians for the ALJ's consideration. Furthermore, the Appeals Council only noted the additional evidence was being denied because it did not relate to the relevant time period; it did not find she failed to show good cause for failing to produce it earlier. Tr. at 2.

2. Additional Requirements Under the Amended Regulations

Moreover, Dr. Bridges' opinion meets the other requirements posed by the amended regulations.

On May 1, 2017, the SSA updated its internal Hearings, Appeals, and Litigation Law Manual ("HALLEX") to provide a succinct explanation of how the Appeals Council will handle additional evidence under these amended regulations. See HALLEX I-3-5-20 (available at https://www.ssa.gov/OP_Home/hallex/I-03/I-3-5-20.html); see also I-3-3-6 (available at https://www.ssa.gov/OP_Home/hallex/I-03/I-3-3-6.html). In doing so, the SSA provided definitions for the terms "new," "material," and "relates to the period," regarding additional evidence. Id. (noting additional evidence is "new if it is not part of the claim(s) file as of the date of the hearing decision," "material if it is relevant, i.e., involves or is directly related to issues adjudicated by the ALJ," and "relates to the period . . . if the evidence is dated on or before the date of the hearing decision, or the evidence post-dates the hearing decision but is reasonably related to the time period adjudicated in the hearing decision").

First, Dr. Bridges' opinion is new because it was not a "part of the claim(s) file as of the date of the hearing decision" and was submitted after the ALJ issued his decision. HALLEX I-3-3-6; see Tr. at 51-56 (depicting the list of exhibits available to the ALJ at the time of his decision).

Second, Dr. Bridges' opinion is material because "it is relevant, i.e., involves or is directly related to issues adjudicated by the ALJ." HALLEX I-3-3-6. The ALJ found Plaintiff's severe impairments included myocardial infarction, diabetes, and congestive heart failure and limited her to sedentary work. Tr. 41, 44. Likewise, Dr. Bridges' opinion discusses Plaintiff's cardiomyopathy, chronic systolic heart failure, and diabetes, with symptoms of edema, shortness of breath, peripheral neuropathy, and a slowed thought process, that result in her inability to perform sedentary work. Tr. at 8.

Third, contrary to the Appeals Council's finding, Dr. Bridges' opinion relates to the period because "the evidence post-dates the hearing decision but is reasonably related to the time period adjudicated in the hearing decision." HALLEX I-3-3-6; see also Stepp v. Berryhill, No. 1:17-cv-771-MBS-SVH, 2017 WL 6806664, at *17 (D.S.C. Dec. 6, 2017), adopted by 2018 WL 294517 (D.S.C. Jan. 3, 2018) (noting Bird v. Commissioner of Social Sec. Admin., 699 F.3d 337, 345 (4th Cir. 2012), allowed for retrospective consideration of medical evidence, and courts have found medical records from a later time period may be probative and relevant to establishing disability in an earlier time period if there is linkage).

Here, Plaintiff alleged her disability began on August 9, 2013. Tr. at. 300-10. The ALJ issued an unfavorable decision finding Plaintiff was not disabled within the meaning of the Act "from August 9, 2013, through the date of [his] decision" on February 23, 2017. Tr. at 36-56. Dr. Bridges' opinion states she served as Plaintiff's primary care physician for years, and the record reflects treatment notes since August 19, 2013. Tr. at 559-63. In addition, Dr. Bridges' opinion dated September 7, 2017, discusses the time period adjudicated, as she states Plaintiff "has had these limitations on and off for years but consistently since April 2016," and "on clinical examination, her edema ha[d] increased over the last 6-8 months," which would be between January 2017 and March 2017. Tr. at 8. Therefore, Dr. Bridges' opinion is reasonably related to the adjudicated time period, and her references to Plaintiff's limitations fall between August 9, 2013, and February 23, 2017.

Finally, the only remaining requirement is whether the evidence shows a reasonable probability that it would change the outcome of the decision, which was previously described as "material" by prior regulations and decisions by the United States Court of Appeals for the Fourth Circuit ("Fourth Circuit"). See Hawks, 2018 WL 6728037, n.5 (M.D.N.C. Dec. 21, 2018), adopted by 2019 WL 359999 (Jan. 29, 2019) ("Long-standing Fourth Circuit law defined 'material' as a reasonable possibility the new evidence would have changed the outcome of the case." (citing Meyer v. Astrue, 662 F.3d 700, 704 (4th Cir. 2011)).

In Meyer, the Fourth Circuit explained the process under the prior regulations, but, even if the amended regulations were to apply, it may be used as guidance. Meyer 662 F.3d 700. The Fourth Circuit stated, after reviewing new evidence submitted to the Appeals Council, the court should affirm the ALJ's decision to deny benefits where "substantial evidence support[ed] the ALJ's findings." Meyer, 662 F.3d at 707 (citing Smith v. Chater, 99 F.3d 635, 638-39 (4th Cir. 1996)). However, if a review of the record as a whole shows "that new evidence from a treating physician was not controverted by other evidence in the record," the court should reverse the ALJ's decision and find it to be unsupported by substantial evidence. Id. (citing Wilkins v. Sec'y, Dep't of Health & Human Servs., 953 F.3d 93, 96 (4th Cir. 1991)). Yet, if the evidence is not so one-sided as to allow the court to determine, upon consideration of the record as a whole, whether substantial evidence supported the ALJ's denial of benefits, the appropriate course of action is for the court to remand the case for further fact-finding. Id. Thus, the court must consider Dr. Bridges' opinion as part of the entire record in determining whether the ALJ's decision was supported by substantial evidence. See Spencer v. Comm'r of Soc. Sec. Admin., No. 1:16-cv-1735-JMC-SVH, 2017 WL 1379605, at *10-13 (D.S.C. Jan. 31, 2017), adopted by 2017 WL 1364116 (D.S.C. Apr. 14, 2017).

The instant case differs from Meyer in that the ALJ did not specifically cite the absence of an opinion from Dr. Bridges as an evidentiary gap that supported his decision to deny Plaintiff's claim. However, the addition of Dr. Bridges' opinion reveals a chasm in the ALJ's assessment that makes it difficult for this court to determine whether his conclusions were supported by substantial evidence. See, e.g. Camper v. Colvin, No. 1:14-cv-4801-MGL-SVH, 2015 WL 7566266, at *12 (D.S.C. Oct. 16, 2015), adopted by 2015 WL 7568595 (D.S.C. Nov. 24, 2015).

The undersigned has carefully considered Plaintiff's argument in view of the language in Meyer, 662 F.3d at 706, that "analysis from the Appeals Council or remand to the ALJ for analysis would be particularly helpful when the new evidence constitutes the only record evidence as to the opinion of the treating physician" and in light of the deference the Commissioner's rules and regulations accord to treating physicians' opinions. See, e.g., 20 C.F.R. § 404.1527(c)(2) (applicable to claims filed before March 27, 2017). Unlike other cases distinguishable from Meyer, Dr. Bridges' opinion is the only treating physician's opinion in the record, provides an opinion regarding Plaintiff's limitations during the adjudicated period, and specifically addresses the impact of these limitations on her ability to perform sedentary work.

The ALJ only assigned weight to other opinions in the record that were provided by state agency psychologists and physicians by April 2015, almost two years prior to his decision. Tr. at 179-84, 191-96, 210-15, 226-31. Of note, Dr. Van Slooten initially opined Plaintiff had the RFC to perform light work on December 3, 2014, but, upon reconsideration, Dr. Thomson opined Plaintiff only had the RFC to perform sedentary work on April 25, 2015. Tr. at 181-84, 193-96. Tr. at 213-15, 229-31. This decline in Plaintiff's abilities was assessed even without the benefit of Dr. Eickman's treatment note on April 22, 2015, stating Plaintiff's EF range of 25 to 30% caused concern and "[r]aise[d] questions about sudden death prevention." Tr. at 1116.

Moreover, Dr. Bridges' opinion shows Plaintiff's further decline in 2016. In his decision, the ALJ focused upon Plaintiff's previously-improved EF rate, but Dr. Bridges' opinion relays Plaintiff's EF rate has consistently been between 25 to 30% since April 2016. Tr. at 8, 46. See Foster v. Colvin, No. 6:13-cv-926-TMC, 2014 WL 3829016, at *3 n.3 (D.S.C. Aug. 4, 2014) ("The [American Heart Association] states that a normal EF rate is between 55- 70%; an EF between 40-55% indicates damage, perhaps from a previous heart attack, but it may not indicate heart failure; and a measurement under 40 may be evidence of heart failure or cardiomyopathy." (citingwww.heart.org/HEARTORG/Conditions/HeartFailure/SymptomsDiagnosisofHeartFailure/Ejection-Fraction-Heart-Failure-Measurement_UCM_306339_Article.jsp# )). The ALJ even acknowledged during the hearing,

I know it's - the heart is the issue here, the heart condition. So one of my questions, really, the bottom line that I need to know, that I've gotta answer for myself in making the decision is can she perform sedentary work. DES, the State agency when they did their reviews at the lower level, they put her at sedentary and, I'll be honest, you don't see that very often that they'll find somebody at sedentary because usually, you know, DES is a medium - not always, but sometimes I'm at light. If they're at light, I'm at sedentary. So, you know, it's an interesting case. I know there's a lot going on heart-related and a lot of concerns and she tried to go to Burger King and, you know, didn't do too well after all that happened. But - so the question I need to answer for myself is can she perform sedentary work or not. That's kind of what it boils down to.

Other elements of Dr. Bridges' opinion are supported by some of the additional evidence submitted to the Appeals Council. See Tr. at 22 (noting Plaintiff's EF was 40 to 45% in 2013, 35% in 2014, and 25 to 30% in 2015), 103 (noting Plaintiff's chronic systolic heart failure was classified as Class III of the NYHA and Stage C-Asymptomatic of the AHA and instructing Plaintiff that her "heart has become to[o] weak to pump enough blood to [her] organ and tissues," as her heart pumped blood 30 to 35%, but the normal range was 50 to 90% on August 9, 2016), 117 (providing Plaintiff's visit to the Heart Failure Center and noting her heart pumped blood at 30% on November 8, 2016), 84 (providing Plaintiff's visit with the Heart Failure Center due to increased shortness of breath caused by just walking to her car and edema in her legs with tingling and burning sensations on January 16, 2017), 89-92 and 136 (noting Plaintiff's presentment to the Heart Failure Center and complaint of fatigue and weight gain and her heart failure treatment medication was adjusted due to chronic fatigue, weakness, and dizziness and her heart was pumping blood at 25 to 30% on February 9, 2017).

In addition, the ALJ failed to acknowledge other notes in the record that would support Dr. Bridges' opinion. For example, Nurse Thomas, at the Heart Failure Center, noted Plaintiff had a functional capacity of Class III of the NYHA and was comfortable at rest, but most activities resulted in fatigue, exertional dyspnea, and chest pain on September 10, 2015. Tr. at 1155-61, 1164. "According to the [AHA], the most commonly used classification system for heart failure is the [NYHA] Functional Classification, which places patients in one of four categories based on how much they are limited during physical activity. Under this classification, . . . Class III heart failure encompasses '[p]atients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain.'" Foster, 2014 WL 3829016, at *3 n.2 (D.S.C. Aug. 4, 2014) (citing www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-ofHeart-Failure_UCM_306328_Article.jsp#)). Furthermore, Nurse Thompson, at Dr. Bridges' office, stated she felt Plaintiff's edema was the best it was going to be, she had a lot of comorbidities, and her long-term outlook was not good on April 28, 2016. Id. Tr. at 1072-77. Nurse Thompson also noted Plaintiff was "trying to get on disability which I agree is best for her." Tr. at 1077. These records appear to support Dr. Bridges' opinion regarding Plaintiff's limitations and inability to perform sedentary work, but there still remains conflicting evidence. See, e.g., Tr. at 44-46.

The ALJ did not have the opportunity to review Dr. Bridges' opinion and, after reviewing the additional evidence presented to the Appeals Council with the entire record, the undersigned "simply cannot determine whether substantial evidence supports the ALJ's denial of benefits here," as the ALJ emphasized his need to determine whether Plaintiff was able to perform sedentary work and the updated records and Dr. Bridges' opinion appear to support a decline in Plaintiff's health that would prevent her from performing sedentary work since 2016. See Meyer, 662 F.3d at 707. In light of the foregoing, the undersigned recommends the court find the Appeals Council erred in declining to remand the case to the ALJ for consideration of Dr. Bridges' opinion and it is unclear whether the Commissioner's decision is supported by substantial evidence. III. Conclusion and Recommendation

The court's function is not to substitute its own judgment for that of the ALJ, but to determine whether the ALJ's decision is supported as a matter of fact and law. Based on the foregoing, the court cannot determine that the Commissioner's decision is supported by substantial evidence. Therefore, the undersigned recommends, pursuant to the power of the court to enter a judgment affirming, modifying, or reversing the Commissioner's decision with remand in Social Security actions under sentence four of 42 U.S.C. § 405(g), that this matter be reversed and remanded for further administrative proceedings.

IT IS SO RECOMMENDED. March 13, 2019
Columbia, South Carolina

/s/

Shiva V. Hodges

United States Magistrate Judge

The parties are directed to note the important information in the attached

"Notice of Right to File Objections to Report and Recommendation."

Notice of Right to File Objections to Report and Recommendation

The parties are advised that they may file specific written objections to this Report and Recommendation with the District Judge. Objections must specifically identify the portions of the Report and Recommendation to which objections are made and the basis for such objections. "[I]n the absence of a timely filed objection, a district court need not conduct a de novo review, but instead must 'only satisfy itself that there is no clear error on the face of the record in order to accept the recommendation.'" Diamond v. Colonial Life & Acc. Ins. Co., 416 F.3d 310 (4th Cir. 2005) (quoting Fed. R. Civ. P. 72 advisory committee's note).

Specific written objections must be filed within fourteen (14) days of the date of service of this Report and Recommendation. 28 U.S.C. § 636(b)(1); Fed. R. Civ. P. 72(b); see Fed. R. Civ. P. 6(a), (d). Filing by mail pursuant to Federal Rule of Civil Procedure 5 may be accomplished by mailing objections to:

Robin L. Blume, Clerk

United States District Court

901 Richland Street

Columbia, South Carolina 29201

Failure to timely file specific written objections to this Report and Recommendation will result in waiver of the right to appeal from a judgment of the District Court based upon such Recommendation. 28 U.S.C. § 636(b)(1); Thomas v. Arn, 474 U.S. 140 (1985); Wright v. Collins, 766 F.2d 841 (4th Cir. 1985); United States v. Schronce, 727 F.2d 91 (4th Cir. 1984).