The opinion of the court was delivered by: Paul Barbadoro United States District Judge
Joy Fogg seeks judicial review of the decision by the Commissioner of the Social Security Administration denying her applications for supplemental security income, disability insurance, and disabled widow's benefits. Fogg alleges that the decision of the Administrative Law Judge ("ALJ") who considered her applications is not supported by substantial evidence and that the ALJ improperly discounted both the medical opinions of her treating physicians and her subjective pain complaints. For the reasons provided below, I grant Fogg's motion to reverse the Commissioner's decision.
Fogg is fifty-three years old, and discontinued her education after graduating from high school. Tr. 28. Fogg's past relevant work included electronics parts assembly, as well as work as a stenciler, garment folder, and hand packager in the textile industry. Tr. 46-47. She stopped working to care for her ill husband who died in May 2005. Fogg alleges that degenerative disc disease of her lower back, kidney disease, dizzy spells, depression, hypertension, blurred vision, diarrhea, diabetes, female stress incontinence, migraines, and gastric reflux caused her to become disabled as of December 31, 2006. Pl's Mem. Of Law in Support of Mot. for Order Reversing the Decision of the Comm'r. (Doc. No. 8-1).
On June 11, 2008, Fogg filed applications for supplemental security income, disability insurance and disabled widow's benefits. Following the initial denial of her claim, Fogg requested an administrative hearing before an ALJ, which she attended on September 27, 2010. At the hearing, Fogg and a vocational expert testified, and she was represented by counsel.
The ALJ issued a decision dated October 26, 2010, denying Fogg's applications. The Decision Review Board ("DRB") selected her claim for review, but did not complete its review of Fogg's claim within the allotted time, thereby leaving the ALJ's decision as the final decision of the Commissioner.
Fogg alleges various medical conditions that, in combination, cause her to be disabled. Doc. No. 8-1 at 2. I begin by discussing the evidence that pertains to her renal and urologic conditions and then turn to her complaints of low back pain, depression, and dizziness.*fn2
1. Renal and Urologic Conditions
Fogg has consulted various physicians for renal and urologic problems. On January 11, 2006, Fogg presented to Manchester Urology Associates for stress incontinence and kidney stones. She returned on February 27 complaining of another kidney stone and pain, for which she was prescribed Percocet and sent for a CT study that showed multiple stones.
During a May 30, 2006 appointment with Dr. Karen Calegari, her primary care physician ("PCP") at the time, Fogg reported that Percocet was helping her pain and that she continued to pass kidney stones. On July 6, Fogg saw Dr. Rick Phelps, a urologist, for kidney stones and pain.
After two urinalyses showed protein, Fogg was referred to Dr. David Friedenberg, a nephrologist. On September 6, Dr. Friedenberg noted evidence of vascular disease and recommended discontinuation of Fogg's anti-steroidal medications. Later that month, following a renal ultrasound and other lab work, Dr. Friedenberg became concerned that Fogg's left kidney was shrunken and her blood sugar was elevated. He ordered a kidney biopsy, prescribed Lisinopril and referred Fogg to an ophthalmologist to confirm vessel damage.
Fogg underwent a kidney biopsy on October 16, which showed significant inflammation and a moderate degree of chronic kidney damage. On November 7, Dr. Friedenberg discontinued Renitidine, because he suspected that the renal problems were caused by an allergic reaction to the prescription. The biopsy also revealed sclerosis of the glomerulus and blood vessels. Fogg was instructed on medication and lifestyle changes to manage vascular disease risk. On January 12, 2007, Fogg's renal and urologic issues were stable. Tr. 480.
An x-ray of Fogg's kidneys on May 15, 2007, showed the possibility of small stones. Two days later, Dr. Friedenberg determined that Fogg's renal failure was stable. Tr. 444.
On June 5, 2007, Fogg was seen by Dr. Sarah McAleer, a urologist. Fogg noted frequently passing stones and continuing problems with incontinence when coughing or sneezing. Although she stated that physical therapy was helping, Fogg reported wearing five pads a day to absorb the urine. Dr. McAleer diagnosed her with female stress incontinence without spontaneous leakage and recommended physical therapy.
Later that month, Fogg complained of kidney stones and pressure in her back to Dr. Calegari, who prescribed Percocet. In a follow-up on August 16, Fogg reported passing multiple stones and requested more Percocet, which Dr. Calegari prescribed.
An abdominal x-ray on December 4, and an ultrasound the next day showed kidney stones in both kidneys. On December 10, Fogg underwent a urologic examination with Dr. McAleer. Fogg had blood and protein in her urine and a kidney stone. She stated that she was not bothered by her stress incontinence. An abdominal x-ray performed on December 18 showed a cluster of between four and five kidney stones in her left kidney, and another, separate stone in the same kidney.
On December 24, Dr. Stephen Smith of Manchester Urology Associates prescribed Percocet for Fogg's back pain and recommended that she increase her water intake.
Fogg presented to Catholic Medical Center on May 31, 2008, for nausea and diarrhea that had lasted one week. Fogg was diagnosed with acute, chronic renal failure, and was hospitalized for four days. Tr. 349. Her renal ultrasound, abdominal x-rays, and EKG were all unremarkable. On June 10, Dr. Calegari noted that her renal condition had improved.
A few days later, Fogg reported to Dr. McAleer that she was wearing between one and two pads a day to absorb urine, and had passed stone fragments. On September 9, however, Fogg denied experiencing incontinence to her new PCP, Dr. Peter Kiprop.
On December 30, Fogg saw Dr. Alfred Bertagnoll for pain, and an abdominal x-ray showed a stone in Fogg's right kidney. Fogg returned on January 9, 2009, reporting that she had passed the stone, but tests showed an increased risk for kidney stone formation and suboptimal urine volume.
Due to a concerning lab result, on March 12 Dr. Kiprop instructed Fogg to follow up with Dr. Friedenberg, who informed her that her renal function was deteriorating. Tr. 616. He suspected it was caused by renal artery stenosis in one or both kidneys. An April 7 ultrasound showed an atrophic left kidney, which Dr. Friedenberg concluded was evidence of renal artery stenosis, putting her at risk for progression of renal issues and renal failure even though her lab work showed her current kidney functioning at baseline.
Fogg returned to Dr. McAleer on June 22, 2009, complaining of bladder pressure and stress incontinence with moderate improvement. Although an abdominal x-ray did not clearly show a uretal stone, Dr. McAleer concluded that a stone was present, and prescribed Flomax and Percocet. After another abdominal xray confirmed the stone's presence, Fogg underwent surgery to remove it on July 8. During her post-surgery visit on July 31, Fogg was doing well.
Dr. Bijoy Kundu, Fogg's new PCP, noted her history of kidney stones in his office notes from January 7 and February 4, 2010. Tr. 749, 751. On April 29, 2010, Fogg's labs showed a rising creatinine level. When the level continued to rise, several of her prescriptions were stopped.
During her appointment on June 2, Dr. Richmond noted that Fogg's major issue was renal, but on July 7, he noted that her test results were at baseline. An abdominal CT scan on September 2 showed a renal stone, moderate atrophy of ...