Opinion
18-CV-04065 (LDH)
2019-09-30
Dana FAZIO, Plaintiff, v. COMMISSIONER OF SOCIAL SECURITY, Defendant.
Dana Fazio, Brooklyn, NY, pro se. Social Security Administration, Social Security Administration, Candace Scott Appleton, United States Attorneys Office Eastern District of New York, Brooklyn, NY, for Defendant.
Dana Fazio, Brooklyn, NY, pro se.
Social Security Administration, Social Security Administration, Candace Scott Appleton, United States Attorneys Office Eastern District of New York, Brooklyn, NY, for Defendant.
MEMORANDUM AND ORDER
LaSHANN DeARCY HALL, United States District Judge:
Plaintiff Dana Fazio, proceeding pro se, appeals Defendant the Commissioner of Social Security's denial of her application for disability insurance benefits ("DIB") under Title II of the Social Security Act (the "Act"). (Compl., ECF No. 1.) Defendant moves pursuant to Rule 12(c) of the Federal Rules of Civil Procedure for judgment on the pleadings. (ECF No. 16.) BACKGROUND
The following facts are taken from the administrative transcript, cited herein as "Tr." (ECF No. 8.)
I. Relevant Non-Medical Evidence
To be eligible for DIB, a claimant must establish that she was disabled by the date she was last insured. Banyai v. Berryhill , 767 F. App'x 176, 179 (2d Cir. 2019) (summary order). Here, Plaintiff was last insured on June 30, 2000. (Tr. 17, 307.) Thus, the relevant evidence of her disability pertains to the period prior to that date.
Plaintiff, who was born in 1974, completed one year of college and worked full-time as an administrative assistant from June 1995 to October 1997. (Tr. 250, 268, ECF No. 8.) Plaintiff reported that she has experienced migraines since 1993 and that the pain first began to affect her activities in October 1997. (Tr. 290.) She described the migraines as causing "stabbing pain" and pressure on different sides of her head—sometimes radiating to her eyes, cheekbones, and jaw—and she stated that "sometimes all of the pain causes numbness." (Tr. 290–91.) Plaintiff reported undergoing a brain MRI in March 1996 and gynecological surgeries for endometriosis in October 1997 and July 1998. (Tr. 100, 290.) At the hearing, Plaintiff testified that her gynecological issues (including severe bleeding and pelvic pain) and migraines (about 20 per month) caused her to frequently leave work early or take days off, leading to her termination in October 1997. (Tr. 42, 44–45, 48.)
Plaintiff also reported developing pre-eclampsia after the January 2000 birth of her first child. (Tr. 100–01.)
II. Medical Evidence
Plaintiff's treatment records from November 2, 1995, indicate that she had normal thyroid condition, normal breast skin and nipples, and dense breast tissue with no secondary signs of malignancy. (Tr. 344–45.) A January 3, 1996 record indicates that she had an unspecified history of migraines. (Tr. 1109.) A March 20, 1996 record indicates a clinical observation of severe headaches but a normal MRI impression. (Tr. 345–46.) A March 29, 1996 breast sonogram revealed no cystic densities. (Tr. 346–47.) A July 24, 1996 abdominal sonogram revealed no recognizable abnormalities in Plaintiff's kidneys, liver, or spleen. (Tr. 347–48.) A December 17, 1996 echocardiogram revealed that Plaintiff's heart condition and activity were within normal ranges. (Tr. 348.) A December 27, 1996 treatment record from Dr. Donald Zarou indicates that Plaintiff had a history of moderate to severe cervical dysplasia and describes Dr. Zarou's laser removal of a lesion from Plaintiff's cervix. (Tr. 1118–19.)
The medical record includes several gynecological treatment notes relating to the relevant time period. An October 17, 1997 treatment report describes Dr. Rosemary Ruggiero's laser vaporization of endometrial lesions on Plaintiff's left ovary, biopsy of an endometriotic lesion in Plaintiff's cul-de-sac, and operative laproscopy. (Tr. 388–89.) Dr. Ruggiero's notes from one week later indicate that Plaintiff was "doing well" and had "no specific complaints." (Tr. 926.) On January 9, 1998, Dr. Ruggiero noted Plaintiff's complaint of pelvic pain, especially during menses, and frequent urination. (Tr. 924.) A pelvic exam revealed mild internal and abdominal tenderness, but no abdominal masses and a normal uterus size. (Id. ) Dr. Ruggiero's February 19, 1998 treatment notes indicate Plaintiff's continuing complaint of on-and-off pelvic pain; a pelvic and abdominal examination revealed mild tenderness to palpitation. (Tr. 923.) On May 17, 1998, Dr. Ruggiero noted Plaintiff's complaint that her pelvic pain was severe and debilitating. (Tr. 922.) A June 12, 1998 transabdominal and transvaginal sonogram showed that both ovaries appeared normal in size and sonic architecture, and revealed no evidence that any adnexal mass or abnormal fluid was present in the pelvis. (Tr. 1006.) A June 19, 1998 pelvic exam by Dr. Ruggiero revealed severe tenderness to palpitation of Plaintiff's uterus and abdomen. (Tr. 922.) Dr. Ruggiero's July 1998 postoperative report indicates that Plaintiff was diagnosed with pelvic adhesions, mild endometriosis, and a cyst on her left ovary. (Tr. 386–87.) Dr. Ruggiero's March 30, 1999 treatment notes indicate an "unremarkable" pelvic exam. (Tr. 920.) Plaintiff's prenatal treatment notes from June 1999 to January 2000 do not describe gynecological issues like those set forth above. (See Tr. 956–62.) On January 19, 2000, Plaintiff complained of a headache since the previous day. (Tr. 959.) Dr. Ruggiero's February 2, 2000 pelvic examination revealed mild bleeding from the cervix, which had ceased by February 16. (Tr. 918.) A March 22, 2000 pelvic exam was normal. (Tr. 917.) A May 8, 2000 pelvic exam revealed some tenderness. (Tr. 916.)
In May 2012, Plaintiff began seeing a neurologist, Dr. Nada Abou-Fayssal, for treatment for chronic migraine headaches. (Tr. 538.) A June 24, 2016 letter from Dr. Abou-Fayssal states that Plaintiff has "suffer[ed] from severe and debilitating [h]eadaches since 1993." (Tr. 795.) The letter further states that Plaintiff has "upwards of 15 headaches per month causing her to be bedridden when the migraine headaches occur.... When she experiences a migraine, the throbbing pain is so intense that she needs to take medication and lay down in a dark room in silence. When this happens, she cannot sit, stand, walk or even talk." (Id. ) Dr. Abou-Fayssal noted that Plaintiff's "migraines have lasted for many years and are not expected to improve." (Id. )
III. Plaintiff's DIB Application
Plaintiff applied for DIB on September 23, 2014, alleging disability since October 10, 1997, due to chronic migraine headaches, hypertension, arrhythmia, high cholesterol, gastroesophageal reflux disease, irritable bowel syndrome, twisted colon, bilateral prophylactic mastectomy, ovarian cysts/endometriosis, and vertigo. (Tr. 250–51, 267.) The application was denied on November 18, 2014, and Plaintiff requested a hearing before an administrative law judge ("ALJ"). (Tr. 92–107.)
On December 28, 2016, Plaintiff appeared with counsel before the ALJ, who adjourned the hearing in order to ensure the availability of a testifying medical expert and permit Plaintiff's recently retained counsel to further develop the record. (Tr. 78, 81–84.) On March 2, 2017, the hearing was again adjourned to permit the medical expert to review recently submitted evidence. (Tr. 72–73.) The hearing was ultimately held on June 8, 2017. (Tr. 35–64.)
Plaintiff disputes Defendant's characterization of the basis for the adjournments. (Notice Mot. 1, ECF No. 18.) The Court's description of the adjournments is based on its own review of each hearing's transcript.
In a decision dated June 26, 2017, the ALJ found that Plaintiff had not engaged in substantial gainful activity during the period from her alleged disability-onset date of October 10, 1997, through the date she was last insured, June 30, 2000. (Tr. 19.) The ALJ further found that Plaintiff had the severe impairments of chronic pelvic pain, stage I endometriosis, ovarian cysts, and status post-prophylactic bilateral mastectomy, and that Plaintiff did not have an impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Id. ) The ALJ determined that Plaintiff had the residual functional capacity ("RFC") to perform the full range of sedentary work as defined in 20 C.F.R. § 404.1567(a). (Tr. 20–22.) Considering Plaintiff's age, education, and work experience through the date last insured, the ALJ determined that jobs existed in significant numbers in the national economy that Plaintiff could have performed. (Tr. 22–23.) Accordingly, the ALJ determined that Plaintiff was not disabled under the Act at any time between October 10, 1997, and June 30, 2000. (Tr. 23.)
The ALJ mistakenly dated Plaintiff's bilateral prophylactic mastectomy as having taken place in March 2000. (Tr. 20.) In fact, the operation took place in March 2010, well after Plaintiff's date last insured. (Tr. 382–83.)
On May 7, 2018, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision final. (Tr. 1–8.) This action followed.
STANDARD OF REVIEW
Under the Act, a disability claimant may seek judicial review of the Commissioner's decision to deny her application for benefits. 42 U.S.C. § 405(g). In conducting such a review, the Court is tasked only with determining whether the Commissioner's decision is based upon correct legal standards and supported by substantial evidence. 42 U.S.C. § 405(g) ; Burgess v. Astrue , 537 F.3d 117, 127 (2d Cir. 2008).
The substantial-evidence standard does not require that the Commissioner's decision be supported by a preponderance of the evidence. Schauer v. Schweiker , 675 F.2d 55, 57 (2d Cir. 1982). Instead, the Commissioner's decision need only be supported by "more than a mere scintilla" of evidence and by "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Burgess , 537 F.3d at 127 (quoting Halloran v. Barnhart , 362 F.3d 28, 31 (2d Cir. 2004) ).
In deciding whether substantial evidence supports the Commissioner's findings, the Court must examine the entire record and consider all evidence that could either support or contradict the Commissioner's determination. Snell v. Apfel , 177 F.3d 128, 132 (2d Cir. 1999). Still, the Court must defer to the Commissioner's conclusions regarding the weight of conflicting evidence. Cage v. Comm'r of Social Sec. , 692 F.3d 118, 122 (2d Cir. 2012). If the Commissioner's findings are supported by substantial evidence, then they are conclusive and must be affirmed. Ortiz v. Comm'r of Soc. Sec. , No. 15-CV-3966, 2016 WL 3264162, at *3 (E.D.N.Y. June 14, 2016) (citing § 405(g) ). Indeed, if supported by substantial evidence, the Commissioner's findings must be sustained, even if substantial evidence could support a contrary conclusion or where the Court's independent analysis might differ from the Commissioner's. Rosado v. Sullivan , 805 F. Supp. 147, 153 (S.D.N.Y. 1992) (citing Rutherford v. Schweiker , 685 F.2d 60, 62 (2d Cir. 1982) ).
DISCUSSION
To be eligible for disability benefits under 42 U.S.C. § 423, [a claimant] must establish [her] "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which ... has lasted or can be expected to last for a continuous period of not less than twelve months," and the impairment must be of
"such severity that [she] is not only unable to do his previous work but cannot, considering [her] age, education, and work experience, engage in any kind of substantial gainful work which exists in the national economy."
Balsamo v. Chater , 142 F.3d 75, 79 (2d Cir. 1998) (quoting §§ 423(d)(1)(A), 423(d)(2)(A) ). Additionally, "an applicant must be ‘insured for disability insurance benefits’ " at the time of onset. Kohler v. Astrue , 546 F.3d 260, 265 (2d Cir. 2008) (quoting §§ 423(a)(1)(A), 423(c)(1) ; Arnone v. Bowen , 882 F.2d 34, 37 (2d Cir. 1989) ).
The Commissioner's regulations prescribe the following five-step framework for evaluating disability claims:
First, the Commissioner considers whether the claimant is currently engaged in substantial gainful activity. If [she] is not, the Commissioner next considers whether the claimant has a "severe impairment" which significantly limits [her] physical or mental ability to do basic work activities. If the claimant suffers such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment which is listed in Appendix 1 of the regulations. If the claimant has such an impairment, the Commissioner will consider [her] [per se ] disabled .... Assuming the claimant does not have a listed impairment, the fourth inquiry is whether, despite the claimant's severe impairment, [she] has residual functional capacity to perform [her] past work. Finally, if the claimant is unable to perform [her] past work, the burden of proof shifts to the Commissioner to determine whether there is other work which the claimant could perform.
Talavera v. Astrue , 697 F.3d 145, 151 (2d Cir. 2012) (quoting DeChirico v. Callahan , 134 F.3d 1177, 1179–80 (2d Cir. 1998) ).
The parties do not dispute the ALJ's finding that Plaintiff last met the Act's insured-status requirements on June 30, 2000. (See Tr. 17, 307.) Accordingly, the Court's review is limited to whether substantial evidence supports the ALJ's finding that Plaintiff was not disabled at any time between her alleged disability-onset date, October 10, 1997, and June 30, 2000.
I. Dr. Ruggiero's Opinion
Plaintiff first argues that the ALJ failed to grant controlling weight to the treating opinion of Dr. Ruggiero regarding the severity of Plaintiff's pelvic pain, endometriosis, vaginal bleeding, and migraines. (Notice Mot. ("Opp.") 1, ECF No. 18.) In other words, Plaintiff argues that the ALJ violated the treating-physician rule.
The treating-physician rule is a series of regulations set forth in 20 C.F.R. § 404.1527 (for claims filed before March 27, 2017) detailing the weight to be accorded to a treating physician's opinion. An ALJ is to consider each and every medical opinion in a claimant's administrative record. Id. § 404.1527(c). But an ALJ must generally give the medical opinion of a treating physician "controlling weight if it is well supported by medical findings and not inconsistent with other substantial evidence." Smith v. Berryhill , 740 F. App'x 721, 724 (2d Cir. 2018) (summary order) (quoting Rosa v. Callahan , 168 F.3d 72, 78-79 (2d Cir. 1999) ). The reason for preferring the findings of a treating physician is plain: the treating physician is in a more capable position to provide a detailed picture of a claimant's impairments than consultative physicians who may see the claimant on just one occasion or not at all. Estela-Rivera v. Colvin , No. 13-CV-5060, 2015 WL 5008250, at *13 (E.D.N.Y. Aug. 20, 2015) (citing 20 C.F.R. § 404.1527(c)(2) ). The Second Circuit has described circumstances under which an ALJ may properly disregard the opinion of a treating physician:
[T]he ALJ may set aside the opinion of a treating physician that is contradicted by the weight of other record evidence. Snell v. Apfel , 177 F.3d 128, 133 (2d Cir. 1999) ; 20 C.F.R. § 404.1527(c)(2). A treating physician's opinion may also be rejected if it is internally inconsistent or otherwise uninformative. Halloran , 362 F.3d at 32 (2d Cir. 2004) ; see also Micheli v. Astrue , 501 F. App'x 26, 28 (2d Cir. 2012) (summary order) ("A physician's opinions are given less weight when his opinions are internally inconsistent."). An ALJ must provide "good reasons" for affording limited weight to the treating-source's opinion and more weight to a non-treating-source. Schaal v. Apfel , 134 F.3d 496, 505 (2d Cir. 1998) ; see 20 C.F.R. § 404.1527(c)(2).
Smith , 740 F. App'x at 724.
Where the ALJ does not give controlling weight to the opinion of the treating physician, the Second Circuit has "mandate[d] specific procedures that an ALJ must follow in determining the appropriate weight to assign" their opinion. Estrella v. Berryhill , 925 F.3d 90, 95 (2d Cir. 2019). The ALJ must " ‘explicitly consider’ the following, nonexclusive ‘ Burgess factors’: ‘(1) the frequen[cy], length, nature, and extent of treatment; (2) the amount of medical evidence supporting the opinion; (3) the consistency of the opinion with the remaining medical evidence; and (4) whether the physician is a specialist.’ " Id. at 95–96 (quoting Selian v. Astrue , 708 F.3d 409, 418 (2d Cir. 2013) (per curium) (citing Burgess , 537 F.3d at 129 )). "An ALJ's failure to ‘explicitly’ apply the Burgess factors when assigning weight at step two is a procedural error." Id. at 96. Where an ALJ procedurally errs, "the question becomes whether ‘a searching review of the record ... assure[s] [the court] ... that the substance of the treating physician rule was not traversed." Id. (quoting Halloran , 362 F.3d at 32 ). Remand is appropriate "when the Commissioner has not provided ‘good reasons’ for the weight given to a treating physician[']s opinion." Halloran , 362 F.3d at 33.
Here, Dr. Ruggiero's December 21, 2016 medical-source statement indicates that she treated Plaintiff since 1997, though it does not indicate the frequency of treatment. (Tr. 1056.) The statement indicates that Plaintiff was diagnosed with a fibroid uterus, chronic pelvic pain, endometriosis, and chronic migraine headaches. (Id. ) The opinion lists the following symptoms during Plaintiff's prior treatment: chronic pelvic pain, which was exacerbated by menses; fatigue; and heavy vaginal bleeding. (Id. ) Dr. Ruggiero indicates that Plaintiff's treatment included hormonal therapy with concomitant side effects of nausea and the exacerbation of her headaches. (Id. ) As Dr. Ruggiero is an obstetrician and did not treat Plaintiff for migraines, her opinion as to Plaintiff's migraines is not entitled to controlling weight. Dr. Ruggiero states that Plaintiff's impairments had lasted at least twelve months and opined that Plaintiff was not a malingerer, that Plaintiff frequently experienced symptoms severe enough to interfere with her attention and concentration, and that Plaintiff had a moderate limitation in her ability to deal with work stress. (Tr. 1057.) Based on the date she had last examined Plaintiff, Dr. Ruggiero opined that Plaintiff could walk only one city block without rest; sit for only ten minutes at a time; stand for only fifteen minutes at a time; and sit, stand, or walk for less than two hours in an eight-hour workday. (Tr. 1057–58.) Dr. Ruggiero further opined that Plaintiff would need to take thirty-minute breaks every two hours during an eight-hour workday; would need to keep her legs elevated for half of each workday; could lift less than ten pounds occasionally; could engage in repetitive arm, hand, and finger movements for only ten percent of each workday; and could bend and twist at the waist for half of each workday. (Id. ) Finally, Dr. Ruggiero opined that Plaintiff's impairments would likely cause her to be absent from work either about two days or more than three days per month. (Tr. 1059–60.)
The same question is repeated twice on the form medical-source statement, and no explanation is given for Dr. Ruggiero's inconsistent answers.
The ALJ summarized Dr. Ruggiero's opinion but committed procedural error by not explicitly considering all of the Burgess factors, including the amount of evidence supporting the opinion, the consistency of the opinion with the remaining medical evidence, and whether Dr. Ruggiero is a specialist. Nor did the ALJ indicate the specific weight accorded to Dr. Ruggiero's opinion. The ALJ simply stated that, although Dr. Ruggiero's statement indicates "that the earliest date that this description of symptoms and limitations applies is 1997, ... the sparse evidence prior to June 30, 2000[,] fails to document evidence of impairments that would cause these limitations prior to that date." (Tr. 21.)
Nonetheless, upon a searching review of the record, the Court is satisfied that the ALJ did not traduce the substance of the treating-physician rule with respect to Dr. Ruggiero's opinion. Importantly, the ALJ's determination that Plaintiff had the severe impairments of chronic pelvic pain, stage I endometriosis, and ovarian cysts is consistent with Dr. Ruggiero's opinion and the medical expert's testimony. (See Tr. 19, 52, 386–87.) With respect to the functional limitations assessed by Dr. Ruggiero in 2016, the medical expert testified that the evidence does not support the existence of such limitations arising out of Plaintiff's gynecological impairments between 1997 and 2000. (Tr. 53–54.) The medical expert's conclusion is consistent with Dr. Ruggiero's treatment notes from this period, which indicate that Plaintiff experienced symptoms associated with mild endometriosis, including intermittent pelvic pain, which was exacerbated by menses. (E.g. , Tr. 922–24.) Thus, the ALJ's determination to discount Dr. Ruggiero's opinion as to the severity of Plaintiff's functional limitations did not run afoul of the treating-physician rule.
II. Plaintiff's History of Migraines
Plaintiff next argues that the ALJ erred in failing to infer that her migraines began in 1993 and were severe enough to constitute a disability during the relevant time period. (Opp. 2–4.) Plaintiff notes that her previous neurologists and primary-care physicians with knowledge of her history of migraines either died, retired, or moved away, and that her records from that time period are not available. (Opp. 2.) Nonetheless, she argues, the ALJ should have looked to the opinions of Dr. Ruggiero, Dr. Abou-Fayssal, and the medical expert to determine that her migraines sufficiently limited her functional capacity during the relevant time period. (Opp. 3.) The Court agrees, in part.
As noted above, Dr. Ruggiero was Plaintiff's obstetrician and did not treat Plaintiff for migraines, so her opinion as to Plaintiff's migraines is not entitled to controlling weight. Instead, the relevant opinions regarding Plaintiff's migraines are those of Dr. Abou-Fayssal and the medical expert. Dr. Abou-Fayssal is a neurologist who began treating Plaintiff for migraines in May 2012. (Tr. 538.) As such, Dr. Abou-Fayssal's opinion regarding Plaintiff's migraines during the relevant period from June 1995 to October 1997 is not entitled to controlling weight. See Monette v. Astrue , 269 F. App'x 109, 112–13 (2d Cir. 2008) (summary order) (holding that physician who first saw claimant in 2000 was not treating physician under the Act with respect to claimant who was last insured in 1997); Arnone , 882 F.2d at 41 (holding that physician who treated claimant in 1973–74 and 1987–88 was not treating physician under the Act with respect to claim requiring a showing of continuous disability in 1977–80). "However, the fact that a treating physician did not have that status at the time referenced in a retrospective opinion does not mean that the opinion should not be given some, or even significant weight." Monette , 269 F. App'x at 113. As the Second Circuit has noted, the "diagnosis of a claimant's condition may properly be made even several years after the actual onset of the impairment." Dousewicz v. Harris , 646 F.2d 771, 774 (2d Cir. 1981) (citations omitted). "Indeed, claimants have won reversal of adverse decisions by the Secretary even where their condition is degenerative, making retrospective evaluation of their ability to work somewhat speculative, and even where some non-physician testimony or evidence suggests a possible ability to work at the relevant time." Rivera v. Sullivan , 923 F.2d 964, 968 (2d Cir. 1991).
District courts in this circuit have reversed and remanded the Commissioner's decisions where the ALJ failed to properly consider the possibility of retrospective diagnosis by a treating physician. For example, in Rogers v. Astrue , the plaintiff sought DIB for post-traumatic stress disorder ("PTSD") for the relevant period of June 1984 through December 1989. 895 F. Supp. 2d 541, 543 (S.D.N.Y. 2012). The plaintiff's medical evidence included a July 2001 letter from his psychologist stating that his PTSD diagnosis was "directly related" to his 1969 combat experience in Vietnam. Id. at 545–46. The ALJ determined that the plaintiff was not disabled primarily because there was a lack of medical evidence of disability during the relevant time period, but the ALJ did not discuss the psychologist's 2001 opinion. Id. at 551. The district court held that it was legal error for the ALJ to rely on the plaintiff's lack of evidence from the relevant time period to deny benefits without, among other things, considering the possibility of retrospective diagnosis based on the psychologist's opinion or those of other treating physicians. Id. at 552. The Rogers court found Martinez v. Massanari , 242 F. Supp. 2d 372 (S.D.N.Y. 2003), to be "instructive." 895 F. Supp. 2d at 550. In Martinez , the plaintiff applied for DIB arising out of her back and leg pain. 242 F. Supp. 2d at 373. The medical evidence included treatment records beginning seventeen months after her date last insured, and the treating physician noted that the plaintiff had a history of back pain extending back into the relevant period. Id. at 373–74. However, the ALJ discounted the treating physician's opinion as unsupported by any clinical or diagnostic findings that were contemporaneous to the relevant period. Id. at 377. As in Rogers , the Martinez court held that the ALJ had committed legal error by failing to pursue and consider the possibility of retrospective diagnosis based on the treating physician's subsequent tests and treatments. Id. at 378. A similar outcome is warranted here.
In this case, Dr. Abou-Fayssal noted that Plaintiff has "suffer[ed] from severe and debilitating [h]eadaches since 1993" and underwent a brain MRI in 1996. (Tr. 795.) After summarizing Plaintiff's symptoms and current treatments, Dr. Abou-Fayssal concluded that her "migraines have lasted for many years and are not expected to improve." (Id. ) The ALJ's opinion does not discuss Dr. Abou-Fayssal's opinion, so the Court cannot determine whether the ALJ considered it at all or discounted it for some unknown reason. Moreover, the medical expert testified that "it's highly likely that [Plaintiff's migraines] were present and the same in 1997." (Tr. 55.) Based on the evidence of Plaintiff's migraines since 2012, the medical expert opined that the ALJ could "extrapolate" similar symptoms during the relevant time period. (Tr. 60.) The medical expert reasoned that migraines are typically "much more present and severe earlier in people's lives. Generally they start around the time of puberty, or a little bit later, and then as folks get older, they tend to improve." (Tr. 59.) The medical expert further reasoned that "it's not uncommon when people, for example, with severe headaches, that MRIs are done to rule out something more serious, like a brain tumor or, or so forth, so this is why that [1996] MRI was done, and it does bolster the case that she had some very severe headaches prior to '97." (Tr. 62.) The ALJ rejected the medical expert's proposed extrapolation because it "involve[d] a substantial amount of conjecture." (Tr. 22.) Specifically, the ALJ noted that "there is no indication that the [1996] MRI of the brain was taken to rule out tumors or the like, something to which the medical expert testified, and additionally there is only one progress note written contemporaneously to the 1997–2000 period that addresses migraines." (Id. ) However, the ALJ's basis for discounting the 1996 MRI misconstrues the import of the medical expert's testimony on the subject. The medical expert indicated that an MRI reflects a concern that some "more serious" medical issue is causing "severe headaches." (Tr. 62.) The 1996 MRI and the additional treatment note during the relevant period identified by the ALJ, coupled with Plaintiff's self-described history of symptoms, Dr. Abou-Fayssal's opinion, and the medical expert's testimony, create at least some ambiguity regarding Plaintiff's disability during the relevant time period. Accordingly, the ALJ committed reversible error by failing to consider the possibility of a retrospective diagnosis of migraines.
CONCLUSION
For the foregoing reasons, Defendant's motion for judgment on the pleadings is GRANTED in part and DENIED in part. The final decision of the Commissioner is reversed and remanded for further proceedings in accordance with this ruling. On remand, the ALJ must consider the possibility that Dr. Abou-Fayssal's opinion constitutes a retrospective diagnosis of Plaintiff's migraines during the relevant period.
SO ORDERED.