United States District Court, E.D. Virginia, Alexandria Division
NOHA H. AHMAD, Plaintiff,
NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.
MEMORANDUM OPINION AND ORDER
D. DAVIS, UNITED STATES MAGISTRATE JUDGE
matter is before the Court on the parties' cross-motions
for summary judgment. Plf. Mot. for Summ. J., ECF. No. 17
[hereinafter Plf. Summ. J.]; Def. Mot. for Summ. J., ECF No.
22 [hereinafter Del'. Summ. J.]. Pursuant to 42 U.S.C.
§ 405(g), Noha Hussien Ahmad ("Plaintiff) seeks
judicial review of the final decision of the Commissioner of
the Social Security Administration ("Defendant")
denying her claim for disability insurance benefits
("DIB") under Title II of the Social Security Act
("the Act"), 42 U.S.C. § 423. For the reasons
stated below, the undersigned finds that Plaintiffs Motion
for Summary Judgment is DENIED and
Defendant's Motion for Summary Judgment is
filed her application for DIB on June 8, 2013, alleging
disability commencing on September 9, 2010, based on the
following severe impairments: pituitary disorder, vertiginous
syndrome, right maxillary sinus nodules/sinusitis, total
thyroidectomy with hypothyroidism/hypoparathyroidism.
vestibular disorder, cholecystectomy, appendectomy,
degenerative disc disease. Heberden nodes of the hands, C7
vertebral body hemangioma, osteoporosis/osteopenia,
osteoarthritis of the right ankle, fibromyalgia,
hypomenorrhea, continued arterial hypertension, diabetes
mellitus type II depression, and anxiety disorder.
Administrative Record ("R.") 18, 216, 234.
the state agency denied Plaintiffs claim twice, Plaintiff
requested an administrative hearing. R. 152, 165. The
Administrative Law Judge ("ALJ") held a hearing on
November 30, 2016. R. 15, 36-90. On February 21, 2017, the
ALJ issued a decision finding that Plaintiff was not disabled
within the meaning of the Act. R. 15-35.
October 3, 2017, the Appeals Council for the Office of
Disability and Adjudication denied Plaintiffs request for
review of the ALJ's decision, rendering the ALJ's
decision the final decision of the Commissioner for purposes
of review under 42 U.S.C. § 405(g). R. 1-6. Having
exhausted her administrative remedies, Plaintiff filed the
instant suit challenging the ALJ's decision on December
7, 2017. Compl., ECF No. 1. This matter is ripe for
disposition because the parties filed cross-motions for
summary judgment and oral arguments were heard on November 2,
was born on November 16, 1966, and was forty seven (47) years
old at the time of her alleged onset Dated: June 30, 2014. R.
15, 28. Plaintiff is a college graduate and worked as a
school bus attendant, retail cashier, and veterinarian at a
poultry farm. R. 41. Plaintiff is married and has a minor
daughter. R. 40-41.
September 16, 2010, Plaintiff visited the emergency room at
Inova Fair Oaks Hospital complaining of facial pain. R. 554.
Plaintiff was diagnosed with acute sinusitis, but there was
no finding of sinus opacification or acute intracranial
abnormality. R. 554. There was mild mucosal thickening within
the ethmoid sinuses and a possible mucosal retention cyst. R.
554. Plaintiffs mastoid air cells were well aerated. R. 554.
Plaintiff was prescribed Antivert, Phenergan, and Ativan. R.
556. Plaintiff was discharged on the same day in stable
condition. R. 556.
October 2010 and January 2011, Plaintiff visited the
Neurology Center of Fairfax, Ltd. ("Neurology
Center") multiple times. R. 433-36, 524, 531. During her
October 2010 visit, Plaintiff developed episodic vertigo
(triggered by head movement) with associated right-side
pulsatile tinnitus. R. 433, 530. Upon examination, Plaintiff
was described as pleasant and cooperative with a normal tone.
R. 434, 531. Doctor Marco D. Castro, M.D., also noted that
she had a normal cardiovascular system, grossly normal mental
status, speech, and language, full strength in both arms and
legs, intact coordination, and normal light touching. R. 434,
531. A visit to the Neurology Center in November 2010,
revealed no electrophysiologic evidence of a generalized
peripheral neuropathy, bilateral carpal tunnel syndrome,
right ulnar neuropathy, or right cervical or lumbosacral
radiculopathy in response to Plaintiffs complaint of tingling
sensation around her mouth, hands, and feet. R. 436, 524. In
January 2011, Plaintiff reported an improvement in her
dizziness and that her paresthesia was less frequent. R. 435.
Plaintiffs neurological evaluation and gait were normal and
she had full strength in both arms and legs. R. 435.
2011, Plaintiff reported that she has a history of motion
illness since childhood and has had transient episodes of
vertigo for years. R. 658. In June 2011, Plaintiff reported
that she had improvements in her overall function, can engage
in routine domestic tasks, and can walk her daughter to
school if she feels well enough. R. 656. Plaintiff also
indicated that she can bathe and dress herself. R. 656. An
examination on December 28, 2011, revealed that Plaintiff had
a full range of motion in her neck, no cervical adenopathy,
normal cardiovascular exam, clear lungs, normal neurological
exam, good eye contact, and depressed mood. R. 723. In April
2012, Plaintiff reported that she had been walking every day.
1, 2012, Plaintiff was evaluated at the National Institute of
Health ("NIH") for management of her endocrine
disorder R. 1067. Plaintiff complained of weight gain after
being diagnosed with type II diabetes, easy bruising,
insomnia, and proximal muscle weakness. R. 1066. Plaintiff
was instructed to discontinue Prednisone and start
hydrocortisone, and return in one (1) week for an ACTH
(adrenocorticotropic hormone) stimulation test. R. 1068.
5, 2012, Plaintiff went to a follow up visit at NIH for
management of diabetes, hypoparathyroidism, and adrenal
insufficiency. R. 1206. There were no clinical signs of
adrenal insufficiency and Plaintiff was advised to continue
her dosage of calcium and calcitriol to treat
hypoparathyroidism. R. 1208-09.
November 29, 2012, to December 2, 2012, Plaintiff was
hospitalized at NIH for partial central adrenal
insufficiency. R. 1001-03, 1055. After administering a low
dose of a cosyntropin stimulation test and metyrapone test,
it was "confidently" concluded that Plaintiff did
not have any degree of adrenal insufficiency. R. 1056.
Plaintiff was discharged in stable condition. R. 1057.
January 10, 2013, Plaintiff visited Healthworks for Northern
Virginia ("Healthworks") complaining of sinusitis,
abdominal pain, finger joint pain, right shoulder pain, and
diffuse muscle aches. R. 681. Plaintiff was diagnosed with
fibromyalgia, chronic sinusitis, osteoarthritis, a mild
tear/strain in her rotator cuff disc, diabetes, and an upper
respiratory infection. R. 683. Plaintiff was prescribed
Trazodone to treat her fibromyalgia and Omnaris spray for her
chronic sinusitis. R. 683. She was also shown isometric
strengthening exercises to treat the tear in her rotator disc
cuff. R. 684.
January 10, 2013, Dr. Glenn Tomkins, M.D., Plaintiffs primary
care physician, examined Plaintiff. R. 681. She reported pain
in her fingers for six (6) months, myalgia in her back,
chest, and shoulder, fatigue, and low energy. R. 681-82. On
examination, Plaintiff had slightly tender finger joints, but
no limitation in range of motion, pain in her right shoulder
when elevated to ninety (90) degrees, pain with
hyperextension of the right knee, and tender points in her
upper back. R. 681-83. Doctor Tomkins assessed fibromyalgia,
diabetes in good condition, osteoarthritis not generalized or
localized, and a mild rotator cuff tear. R. 683-84. Plaintiff
was prescribed new medications and some medications were
refilled. R. 683-84.
followed up with Dr. Tomkins in four (4) weeks. R. 675.
Plaintiff had not taken any of the prescribed medications and
was not following isometric strengthening recommendations for
her rotator cuff disc. R. 678. Plaintiff was given
prescription to treat her chronic sinusitis, fibromyalgia,
rotator cuff disc, and osteoarthritis. R. 679.
2, 2013, Plaintiff returned to Dr. Tomkins and complained of
a headache, swishing sounds in her right ear, arm pain and
swelling, and thigh pain. R. 778. Doctor Tomkins noted that
April 2013 x-rays did not reveal any vertebral body issues or
any other contributory findings. R. 778. Plaintiff appeared
alert, oriented, and in no distress. R. 778. She had full
strength bilaterally, 2/4 reflexes and symmetric in upper
extremities, no tremors, clear speech, and normal gait. R.
778. Doctor Tomkins continued her medications and ordered
labs for her diabetes, headache, cholesterol, and
hypoparathyroidism. R. 779. A few weeks later, Plaintiff
reported that her sinusitis was under control and most of her
headaches resolved with medications. R. 764. Plaintiff was
sleeping six (6) to eight (8) hours a night and her vertigo
improved with a vestibular program and medications. R. 765.
Doctor Tomkins assessed Plaintiffs fibromyalgia, but noted
that the labs refuted any inflammatory process. T. 768.
June 2013 examination with Dr. Tomkins, Plaintiff reported
headaches and mild tenderness to her left neck and thyroid.
R. 756. Doctor Tomkins noted fibromyalgia without
inflammatory markers and that Trazadone normalized Plaintiffs
sleep. R. 757. Later that month, Plaintiff complained that
her right-hand pain was worse, but there was no tenderness or
swelling in her finger joints. R. 739.
2013, Dr. Tomkins noted that Plaintiffs myalgia decreased
after stopping certain medications and that her fibromyalgia
was partially attributable to the use of a statin. R. 732. In
August 2013, Plaintiff reported that she received "near
total relief from the chronic headaches with use of Maxalt.
R. 931. Doctor Tomkins opined that Plaintiffs metabolic
abnormalities might explain her fibromyalgia syndrome. R.
September 2013, Plaintiff visited both Dr. Tomkins and Dr.
Andrew Demidowich, M.D. R. 923, 1327-38. Plaintiff reported
that Lyrica helped with her body aches, Nortriptyline was
helping her sleep better, and there were no specific tasks
that were impossible or difficult. R. 923-24. Plaintiff
denied anxiety, lethargy, and difficulty sleeping. R.
1327-38. Doctor Tomkins reported that Plaintiff had normal
strength. R. 926.
Tomkins wrote a letter on October 11, 2013, describing
Plaintiffs medical conditions. R. 943. Doctor Tomkins noted
that Plaintiff suffers from fibromyalgia, which limits her to
"sedentary work that does not require ambulation beyond
five minutes at a time, or lifting more than five pounds, or
lesser exertion prolonged past 10 minutes." R. 943. Also
stated was that Plaintiff suffers from inflammatory bowel
disease, which can be treated within weeks, but requires
frequent bathroom breaks. R. 944. Doctor Tomkins opined that
Plaintiff has uncontrolled headaches and vertigo with nausea,
which are severe enough to keep her from work on an
"average of 10% of days, though this is variable from
month to month, and can reach up to 25% of days some
months." R. 944.
December 28, 2013, Plaintiff had an infectious disease
consult. R. 1220. Plaintiff complained that she was
experiencing intermittent fevers and myalgia about two (2) to
three (3) times a month. R. 1220. Plaintiff stated that she
had a complete resolution of her symptoms while she was
taking Prednisone. R. 1220. She also noted improvement in her
symptoms when she discontinued Simvastatin. R. 1220. The
physician found that her basic lab results appeared within
normal limits, except with a mildly elevated ALT (a type of
liver enzyme). R. 1221. The physician also opined that her
symptoms were intermittent, which made the infectious process
less likely, and had a resolution with her symptoms while she
was on steroids. R. 1221.
April 3, 2014, Plaintiff visited Dr. Liaw Winston, M.D.,
complaining of neck, right arm, and finger pain. R. 1161.
Plaintiff was assessed with acute neck pain and prescribed
Cyclobenzaprine and Imitrex. R. 1163. A few days later, on
April 8th, Plaintiff visited Healthworks
complaining of neck, head, back, and arm pain, and a swollen
middle finger. R. 1155. Plaintiff was advised to continue
Pregabalin to treat her fibromyalgia and Naproxen and
Cyclobenzaprine to treat her muscle strain. R. 1158. Also,
during this month, Plaintiff told Dr. Tomkins that Lyrica was
providing her with relief for her diffuse muscle pain. R.
1155. Doctor Tomkins noted that Plaintiffs fibromyalgia was
responding fairly well to Pamelor. R. 1157.
2014, Plaintiff had a neuromuscular consult with the
University of Virginia Hospital. R. 1135. Plaintiff reported
a history of generalized weakness for more than six (6)
months and weakness over the last seven (7) years. R. 1135.
Doctor Sarah Jones, M.D., indicated that Plaintiff had normal
strength in her neck, giveaway weakness in her limbs with
normal bursts of strength, and decreased sensation to light
touch in the right face and leg. R. 1136. Plaintiff could
stand with arms crossed, had a normal gait, and could walk on
her heels and toes. R. 1136. Doctor Jones reported that there
were no clear neuromuscular abnormalities to explain her
symptoms. R. 1137.
Tomkins wrote another letter on May 5, 2015, stating that
Plaintiffs abilities are limited by her fibromyalgia. R.
1260. The fibromyalgia pain limits Plaintiff to
"sedentary work that does not require ambulation beyond
ten minutes at a time, or lifting more than ten pounds, or
lesser exertion prolonged past 10 minutes." R. 1260.
Doctor Tomkins also reported that Plaintiffs arthritis is
active and treatment was going to start in a few weeks,
Plaintiff started seeing a psychiatrist for possible
depression and anxiety, but her symptoms overlap with chronic
sleep deprivation. R. 1260-61. In an addendum written on May
31, 2016, a year later, Dr. Tomkins stated that Plaintiffs
fibromyalgia is unchanged and her hand arthritis is present.
September 2010, a Magnetic Resonance Imaging
("MRI") of both of Plaintiffs temporomandibular
joints revealed no evidence of disc displacement or focal
bone abnormality, and had normal range of motion. R. 558. An
MRI angiography of Plaintiff s brain, pituitary, and neck
taken on October 22, 2010, revealed no abnormal findings. R.
426-428. An MRI of Plaintiffs head and pituitary gland taken
on April 18, 2013, found a few nonspecific small FLAIR
hyperintense foci, but no restricted diffusion abnormality of
the brain. There was no definite mass in the sella turcica
and the paranasal sinuses were unremarkable. R. 1032-33,
1045-46. An MRI of Plaintiff s brain and pituitary was taken
on February 7, 2014. R. 1107, 1169. The results revealed
stable postoperative changes within the nasal fossa and sella
turcica without evidence of residual or recurrent pituitary
adenoma. R. 1107.
response to Plaintiffs complaint of neck pain and
osteoporosis, x-rays of Plaintiffs cervical, thoracic, and
lumbar spine were taken on April 3, 2013. R. 1040. The x-rays
were unremarkable. R. 1040. X-rays of Plaintiff s chest taken
on May 17, 2013, revealed clear lungs, a normal cardiac
silhouette, and no pneumothorax or pleural effusion. R. 1031.
In response to Plaintiffs complaint of lower back pain,
x-rays of her lumbar spine and thoracic spine were taken
again on June 18, 2013. R. 1028-29. Stable tiny anterior
osteophytes at ¶ 4 and L5 were found, but there were no
acute fractures or subluxation and the SI joins were
unremarkable. R. 1028. Plaintiff had a ...