United States District Court, E.D. Virginia, Norfolk Division
SARA J. JOHNSON, for KLB, Plaintiff,
NANCY A. BERRYHILL, Defendant.
UNITED STATES MAGISTRATE JUDGE'S REPORT AND
J. KRASK UNITED STATES MAGISTRATE JUDGE
Sara J. Johnson ("Johnson"), proceeding pro
se, brought this action on behalf of her minor daughter,
KLB, pursuant to 42 U.S.C. §§ 405(g), 1383(c)(3),
seeking judicial review of a decision of Nancy A, Berryhill,
the Acting Commissioner ("Commissioner") of the
Social Security Administration ("SSA"), denying
KLB's claim for Supplemental Security Income
("SSI") under Title XVI of the Social Security Act.
order of reference assigned this matter to the undersigned.
ECF No. 13. Pursuant to the provisions of 28 U.S.C. §
636(b)(1)(B), Rule 72(b) of the Federal Rules of Civil
Procedure, and Local Civil Rule 72, it is hereby recommended
that Johnson's motion for summary judgment, ECF No. 15,
be DENIED, the Commissioner's motion for
summary judgment, ECF No. 17, be GRANTED,
and the decision of the Commissioner be
August 11, 2014, Johnson protectively filed an application
for SSI on behalf of her minor daughter, KLB, alleging that
KLB became disabled on October 11, 2013, due to asthma with
exacerbation, chest pain, allergic rhinitis, and
gastroesophageal reflux disorder ("GERD"). R. 22,
25, 110, 163-66, 192.The relevant time period for assessing
KLB's conditions begins 12 months before the application
date, because this is a child claim under Title XVI, and, to
be found disabling, a child's impairments must have
lasted or "can be expected to last for a continuous
period of not less than 12 months." 42 U.S.C. §
l382c(a)(3)(C)(i); see also SSA Program Operations
Manual System ("POMS") DI 25201.001(D) (Nov. 5,
denied her application initially on February 11, 2015, R. 96,
98, 111-15, and upon reconsideration on June 17, 2015,
109, 119-22. Following the state agency's denial of these
claims, KLB requested a hearing before an Administrative Law
Judge ("ALJ"). R. 124. ALJ Carol Matula held a
hearing on February 8, 2017, at which KLB was represented by
Linda Jones-Bailey, a non-attorney representative. R. 22,
42-90. KLB and Johnson testified at the hearing. R. 43. On
March 28, 2017, the ALJ denied KLB's claim for benefits,
finding that she was not disabled from August 11, 2014,
through the date of the decision. R. 22-36.
April 3, 2018, the Appeals Council denied KLB's request
for review of the ALJ's decision. R. 1-6. The Appeals
Council noted that Johnson submitted additional medical
evidence from: Dr. Cynthia Epstein, dated August 18, 2017,
and February 20, 2018; Dr. Thedia Jones Smith, dated May 22,
2017; and Chesapeake Public Schools, dated September 12,
2017. R. 2, 7-15. However, these records did not relate to
the period at issue in the ALJ's decision. R, 2. Because the
Appeals Council denied the request for review, the ALJ's
decision stands as the final decision of the Commissioner for
purposes of judicial review. R. 1; see 42 U.S.C.
§§ 405(h), 1383(c)(3); 20 C.F.R. § 416.1481.
exhausted all administrative remedies, Johnson timely filed a
motion for leave to proceed in forma pauperis with
this Court on May 23, 2018, along with her proposed
complaint. ECF Nos. 1, 1-1. The Court granted her motion on
July 5, 2018, after she submitted a corrected motion, and
filed the complaint on the same date. ECF Nos. 2, 3, 4, 5.
The pro se complaint asserts that the
Commissioner's findings were not supported by substantial
evidence in the record, and that the evidence instead
established that KLB's asthma was disabling. ECF No. 5 at
3, 5. Specifically, it alleges that KLB's asthma
prevented her from attending school on a regular basis,
resulted "in her having to be homebound," and
"caused her to become very depressed." Id.
Commissioner answered on August 29, 2018. ECF No. 11. In
response to the Court's order, ECF No. 14, Johnson filed
a letter on October 3, 2018, which the Court construed as a
motion for summary judgment, and the Commissioner filed a
motion for summary judgment and supporting memorandum on
November 8, 2018. ECF Nos. 15-18. As neither party has
indicated special circumstances requiring oral argument, the
case is deemed submitted for a decision.
Background Information and ALJ Hearing Testimony
Disability Function Reports
2002, KLB was 14 years old and attending eighth grade at the
time of the ALJ hearing in 2017. R. 46, 48, 163. She was a
school age child (between the ages of 6 and 12) in 2013, when
her disability allegedly began, and is now an adolescent
(between the ages of 12 and 18). See 20 C.F.R.
§ 416.926a(g)(2). She has never worked. R. 47. She lives
with her mother and two older sisters, one age 15 and the
other age 26. R. 51-52.
completed a "Function Report - Child Age 6 to 12"
on October 8, 2014, stating that KLB wears glasses, has no
problems hearing or communicating, and her ability to
progress in learning was not limited. R. 176-80. Although
Johnson marked that KLB's physical abilities were not
limited, she also noted that KLB could "walk but get
short [of] breath," and could not run, jump rope, or
play team sports due to asthma, R. 181-82. She noted that
KLB's impairments do not affect her "ability to help
. . . herself and cooperate with others in taking care of
personal needs," and that KLB "[h]elps around the
house" but "gets tired or short of breath" and
takes breaks. R. 183. Johnson also completed a supplemental
disability report on the same date, noting that KLB was
restricted from physical education ("PE") class,
required emergency room visits, and missed school days
because of her condition. R. 187. Another "Disability
Report" completed on the same date lists three asthma
medications, an allergy medicine, a nasal spray, a medicine
for infections, a medicine for chest pains, and an acid
reflux medication, all of which were prescribed by the
Children's Hospital of the King's Daughters
("CHKD"). R. 191, 194.
completed another disability report on March 13, 2015,
stating that KLB's "condition is getting
progressively worse in that she is having more asthmatic
attacks" and is "more short of breath with the
least amount of exertion." R. 199. She noted that KLB
"is becoming increasingly depressed due to the fact that
she is unable to do simple chores around the house or do
things as other kids do," and that she had increased
chest pain. R. 199. She explained that KLB is "very
slow" and "unable to walk very far without stopping
to catch her breath," and she could not be around fumes,
cleaning materials, perfume, or nail polish remover. R. 203.
She reported that KLB had to stop while bathing "because
the exertion causes shortness of breath," had to
"sit down to put on her clothes," and wore a
"mask when going outside due to pollen." R. 203.
August 3, 2015 disability report completed by Johnson
reiterated that KLB had shortness of breath and chest pain,
even when taking her asthma medication daily, and that she
cannot participate in PE class because of her asthma. R.
209-10. A second disability report that month stated that
KLB's medical conditions had not changed, but that, since
June 2015, she was experiencing new conditions, including
"[s]tomach illness and Vitamin D level [that] stays low
on top of her shortness of breath[, ] we[a]k lungs[, and]
chest pains." R. 212.
ALJ Hearing Testimony
ALJ hearing on February 8, 2017, KLB testified that the
school allows her an extra five minutes to move between
classes in the one-story school building; she usually only
needs two extra minutes, but sometimes takes seven minutes if
the class is far away. R. 48-49, 62. She was earning B's
to D's "[b]ecause [she is] not in school," and
she was allowed home instruction after missing at least three
days of school. R. 49-50.
waits until her 15-year-old sister comes home to do their
homework together, but she does not need a reminder to do her
homework, and she spends "[a]bout the same" amount
of time on homework as her peers, and only needs help with it
"[s]ometimes." R. 51-52. After homework, she eats
dinner and "get[s] ready for the next day" by
taking a bath, putting out her clothes, and studying "if
there's a test the next day." R. 52. She cleans up
after herself and makes her bed every morning, and does not
need reminders to take her bath. R. 55-56. For chores, she
does not vacuum because it is "too much walking,"
and does not dust "because the chemicals get to
[her]," but she helps by making grocery lists. R. 56-57.
She takes medications throughout the day that make her
"sleepy," but not to the point where has to
"lie down and close [her] eyes." R. 60-61.
testified that she "can't participate in a lot of
physical activities" because of her asthma. R. 53. She
helps her PE teacher by keeping scores of other students. R.
59. She does not see her friends on the weekends, but she
uses the telephone and social media to talk with them, and
instead reads and "hang[s] out" with her family on
the weekend. R. 53-54. She cannot "stay with" her
family when they go out, because she cannot keep up when they
are walking at a normal pace. R. 70. She is depressed about
her weight and because she "can't do what normal
kids do," although therapy was helping. R. 61. She also
feels guilty that she cannot do things with her family, such
as go to an amusement park or go outside for her sister's
birthday due to her allergy. R. 70-71.
been "dealing with" asthma for approximately three
years, and it has "[g]otten worse" in that time. R.
64. On average, she goes to the emergency room three or four
times per month for asthma, where she receives medication and
treatment on a "breather machine." R. 65-66. The
maximum number of emergency room visits in a month was four,
and she also sees Dr. Smith every month or two. R. 67. She
has been hospitalized three times in the previous three
years, each for a "couple of days," but only two
times were due to asthma. R. 71-72. She uses a dance video
program for exercise, but takes a 10-minute break to sit down
after dancing for approximately two minutes because she has
"trouble breathing." R. 55-56, 58. She has
"[c]onstant" four- or five-level pain on a scale
often in the center of her chest caused by asthma, and
"[w]alking makes it worse." R. 57. She "get[s]
out of breath" and cannot climb stairs. R. 58-59.
her GERD, KLB testified that she was taking medication, but
it was "[n]ot really" under control, and she had to
"watch what [she] eat[s]," could not eat spicy
foods, and would "direct throw up after" eating
eggs. R. 57-58. Her reflux "flares up"
"when [her] asthma acts up." R. 68.
school, KLB testified that she missed 54 days during the
previous school year, and "[a]t least" 20 days
"here and there" during the current year. R. 59.
She had to have home instruction "three or four"
times that year, and teachers put her assignments on the
internet. R. 59-60.
then testified that KLB's asthma medicine caused her to
be tired, and that KLB has a "protocol" for five-
to ten-minute nebulizer treatments every three to four hours
at home, as well as a nebulizer treatment administered by the
school nurse before PE class. R. 75-76, KLB takes a medicine
for shortness of breath every eight hours and Albuterol every
four hours. R. 77. Johnson maintains control over the
medicines and monitors KLB when she takes her medicines to
"see if she ... starts breathing better." R. 79.
explained that she and her daughters live in a duplex, and
KLB needs to take breaks and catch her breath to climb the
stairs to get to the living room and her room. R. 81. Johnson
stated that KLB was a "smart little girl" who had
been an honor roll student, but now "everything is
declining" and "[t]hey keep putting her on more and
more medicine, higher and higher dose." R. 80. She
stated that KLB has been hospitalized three times, but
"goes to the emergency room just about every week or
every other week" due to her asthma. R. 83. She
explained that the doctors offered her steroids to keep at
home for KLB, but she "didn't want to take that
responsibility" of administering that type of medication
because she was not sure when it was needed. R. 84-85.
been hospitalized three times, all of which occurred after
the alleged onset of her disability, and within the year
before her application for SSI.
October 2013, when KLB was 10 years old, she was hospitalized
for the first time at Georgia Children's Hospital for an
asthma exacerbation triggered by mold exposure. R. 269,
342-46. She was admitted on October 21, and discharged on
October 23, 2013. R. 342, 346. The hospital noted that she
"has a history of asthma that is well controlled on
daily QVAR and albuterol." R. 342. A pulmonary function
test "showed a baseline obstructive disease secondary to
asthma and remarkable improvement after albuterol
treatment." R. 346.
April 29, 2014, KLB was admitted to observation in the
Chesapeake General Hospital after being treated in its
emergency department for an allergic reaction to IVP dye
after a CAT scan for her ongoing chest pain. R. 257-58. The
admission notes state that KLB had flushed cheeks and
swelling, but no shortness of breath or difficulty breathing.
R. 260. The physical examination notes indicate that she had
no respiratory distress and had 100 percent oxygen saturation
on room air, and she was discharged the following day in
stable condition. R. 258.
evening of July 14, 2016, KLB was admitted to CHKD for severe
persistent asthma with exacerbation, rash, and hives, which
had continued for several days and had not been resolved by
clinic visits on July 9, 11, 12, and 14. R. 785. The
admission notes state that KLB had "shortness of breath
despite outpatient steroid, albuterol, and atrovent
treatment," but her respirations were unlabored and she
had 100 percent oxygen saturation on room air. R. 786. The
etiology of her rash was uncertain, but possibly due to an
egg allergy. Id. The doctors planned to continue her
on her home medications, except for Qvar because "it
does not appear that she has been taking it regularly,"
and also prescribed Albuterol, Atrovent, and Solumedrol. R.
next day, July 15, KLB "felt more comfortable and denied
pain" after Albuterol and Atrovent treatment. R. 805. On
July 16, the doctors reduced her steroid dose, and resolved
her evening episode of chest pain and tachypnea with
Albuterol treatment. R. 805, KLB was "deemed stable to
return home with follow-up" on July 17, and discharged
from the hospital on that date. R. 805, 807.
Emergency Room and Urgent Care Visits
nine emergency room or urgent care visits between late 2013
and early 2017, with three visits in 2014, no visits in 2015,
and four visits in 2016.
December 16, 2013, KLB was treated in the emergency
department of Chesapeake General Hospital for an asthma
flareup with shortness of breath, audible wheezing, and
productive cough, which occurred after she ran out of
Albuterol nebulizer solution. R. 264. The physicians noted
"[n]o respiratory distress," and that she had 100
percent oxygen saturation on room air. R. 264-65. The doctors
administered a nebulizer treatment "with much
improvement of her symptoms," and discharged her in
stable condition with instructions to "use her albuterol
inhaler and nebulizer machine at home as directed as needed
for wheezing or difficulty breathing." R. 265.
August 5, 2014, KLB was treated in the emergency department
of Chesapeake General Hospital for chest tightness and
shortness of breath. R, 250. The physicians noted "[n]o
respiratory distress," that she had 100 percent oxygen
saturation on room air, and she was "able to speak full
complete sentences without difficulty." R. 250-51. The
physician noted that she "[w]il! provide a nebulizer
treatment," and provided KLB oral ibuprofen for pain,
but concluded that further chest x-rays were not necessary
because "previous imaging studies have been
unremarkable" and the EKG to "rule out possible
arrhythmia as cause of her chest discomfort... was
unremarkable." R. 251. KLB was discharged several hours
later on the same date in stable condition, R. 250-52. KLB
returned several weeks later, on August 30, 2014, with the
same symptoms, and was discharged several hours later after
the same treatment. R. 246-47.
October 27, 2014, KLB was treated in the CHKD emergency
department for chest pain. R. 353, 412. Her "review of
systems" at that time reported no shortness of breath,
coughing, or wheezing. R. 353. Her pain "resolved"
after administration of a "GI cocktail," and she
was sent home. R. 355.
9, 2016, KLB visited the CHKD urgent care clinic for
"concerns of intermittent cough and wheezing and
hives" after exercising the previous day, and KLB was
"complain[ing] of no chest pain but states she feels
like she is wheezing and a little short of breath." R.
751-52. She was told to use her Albuterol
"aggressive[ly]," every four hours while awake,
over the next 24 to 48 hours, and 10-15 minutes before
exercise. R. 753. She was given DuoNeb during the visit,
which completely resolved her wheezing and chest pain. R.
753. KLB returned for a visit on July 12, 2016, for
difficulty breathing, and was told to follow up with her
primary care physician. R. 756-57, 766-68.
November 9, 2016, KLB visited the CHKD urgent care clinic for
asthma, after she had a "cough, chest tightness or
wheezing" for three days. R. 726. She was instructed to
take Albuterol every four to six hours for five to seven
days. R. 727. On November 21, she returned to the clinic for
"cough, wheezing and chest tightness since
yesterday." R. 818-19. She was instructed to use
Albuterol every four to six hours for five to seven days and
follow-up with her pediatrician. R. 820.
January 28, 2017, KLB was treated in the CHKD emergency
department for asthma, and told to follow up with her doctor
in two days. R. 854.
Other Doctor Visits and Medical Records
Records from 2012 and 2013
and 2013, the records reflect eight visits to CHKD and Dr.
Michelle Curry, with some asthma flare-ups when KLB was not
compliant with daily Advair medication, but improvement after
Albuterol treatment. R. 375-83. The reports from several
visits state that KLB had no new symptoms and was "doing
better." R. 377-78.
Records from 2014
2014, KLB had approximately sixteen doctor visits, of which
six were follow-up visits with no new concerns, one was an
evaluation, and two noted non-compliance with her
visit on February 12, 2014, reported that KLB complained of
"weakness and chest hurting in school exacerbated by
activity," and "mom reports child[']s SOB
[shortness of breath] is severe that school nurse has noticed
child gets [shortness of breath] with activity." R. 372.
The same report noted that KLB "[h]asn't been really
using Advair consistently," and that she was prescribed
one puff of Advair twice daily. R. 372, 374, KLB saw Dr.
Curry on March 4, 2014, for a sore throat, wheezing, stomach
ache, and headaches. R. 477-78, A CHKD follow-up visit on
March 10, 2014, reported that KLB's "spirometry
numbers [were] lower" because she was "not
compliant at this time" with her Advair prescription,
and she was given Albuterol the day before for wheezing. R.
370. A follow-up eight days later reported that KLB had
fatigue and chest pain "for a while now," and it is
"a little hard to breath[e] when there is no chest pain
but moreso with chest pain." R. 368.
April 14, 2014, KLB saw Dr. Epstein in CHKD's Pediatric
Pulmonology Clinic. R. 269-70. Dr. Epstein noted that KLB had
a "history of chest pain" since October 2013, and
"has been missing significant amount of days of school
secondary to crying associated with being in pain," and
also could not do activities at home due to pain. R. 269. She
noted that KLB was last treated with oral steroids in October
2013, and had no emergency room or hospital visits since that
time. R. 269. KLB was 11 years old at the time, and in the
97th percentile for weight and
10thpercentile for height. R. 269. She had 100
percent oxygen saturation on room air, and Albuterol
treatment produced a "statistical significant
change" in her pulmonary function. R. 270. Dr. Epstein
prescribed two puffs of Advair twice daily for her asthma and
"continuing albuterol as needed," as well as nasal
steroids and Zyrtec for allergic rhinitis and Naprosyn for
pain associated with costochondritis. R. 270. A follow-up
visit two months later reported that KLB had no new concerns,
although she needed Albuterol twice weekly "for wheezing
since it got very hot out," and she still had pain in
her chest. R. 367.
August 7, 2014, KLB saw Dr. Epstein in the CHKD Pediatric
Pulmonary Clinic, two days after an emergency room visit. R.
272-73. Dr. Epstein reported that KLB "is trying to
exercise and walk, but she is unable to do so secondary to
pain," she has "intermittent episodes of coughing
and wheezing which has been worse over the past several days
associated with her [asthma] flare," and she "has
not been on prednisone." R. 272. KLB had 100 percent
oxygen saturation on room air, and her pulmonary function
testing showed "a mild obstructive pattern with a
decline in her flows since her last effort" and
"despite her medium strength inhaled steroid
therapy." R. 272. Dr. Epstein increased KLB's Advair
dosage, but did not change the frequency. R. 273. Dr. Epstein
noted that KLB "has a history of chest pain for which
the etiology remains unclear." R. 272.
follow-up visit four days later, on August 11, 2014, reported
that KLB experienced shortness of breath that morning and
"started coughing when she got here," but she was
given Albuterol via a nebulizer "after which the lungs
were clear." R. 365-66. A follow-up two weeks later
reported that KLB complained of chest pain "but no
cough, shortness of breath or difficulty breathing," and
that she was taking the Advair as prescribed and had not
needed Albuterol since her last visit. R. 363.
Dr. Epstein again on September 4, 2014, and reported that,
since an emergency room visit several days earlier, KLB's
"significant shortness of breath has resolved and she is
back to her baseline chest pain and shortness of breath with
exertion." R. 274. Dr. Epstein further noted that KLB
had 100 percent oxygen saturation on room air, and her
pulmonary function testing showed "a significant
improvement since her last effort and best lung function she
has had;" due to that improvement in pulmonary function,
Dr. Epstein saw "no reason to take a course of oral
steroids" which had been prescribed, but not
administered, after KLB's last emergency room visit. R.
274. KLB "continues to have chest pain daily for which
she is not able to participate in activities." R. 274. A
CHKD visit on September 24, 2014 reported "[n]o new
concerns today," and that KLB was "walking
daily" with her mom "and also around the track at
school." R. 362.
October 8, 2014, KLB saw Dr. Epstein for "followup of
ongoing chest pain, severe persistent asthma, and chronic
cough." R. 278. Her pulmonary function testing showed
"a mild obstructive pattern with an improvement in her
flows since her last effort." R. 278. Dr. Epstein noted
that KLB"s "physical education remains limited and
she seems to do okay with that," and that she was using
Albuterol twice daily. R. 278. For asthma, Dr. Epstein
prescribed two puffs of Advair twice daily and Albuterol
every four hours as needed, and for possible GERD, she
prescribed a trial of Prilosec. R. 278.
October 29, 2014, Dr. David Darrow evaluated KLB at the
request of Dr. Curry. R. 413-14. He reported that KLB had an
adenotonsillectomy when she lived in Georgia, and he
"performed a flexible fiberoptic assessment of [her]
airway" and found "some residual adenoid tissue
that was nonobstructive." R. 413. He recorded that KLB
was already scheduled for a sleep study for possible apnea
and for a polysomnogram regarding possibly obstructive
residual lymphoid tissue, and further recommendations could
be made once those results were obtained. R. 413. Finally, he
observed that KLB has a "history of daytime behavioral
issues including poor school performance, inattentiveness and
irritability," and that she "gained a substantial
amount of weight in the past couple of years." R. 413.
Dr. Epstein on October 30, 2014, three days after visiting
the emergency room for severe chest pain. R. 280, 353. Dr.
Epstein noted that KLB "has severe persistent asthma
with improvement in pulmonary function over time on high dose
inhaled steroid therapy," but she "continues to
complain of shortness of breath and inability to do simple
things like walking" or "keep[ing] up with her
family in walking normal." R. 280. Dr. Epstein
recommended a trial of Carafate for KLB's chest pain and
shortness of breath "possibly related to reflux."
December 2, 2014, KLB visited Dr. Curry for a cough and
low-grade fever, as well as chest and stomach pain. R. 466.
KLB had been using Albuterol every four hours for the prior
two days. R. 466. Three weeks later, KLB visited Dr. Curry
for a follow-up on her asthma and a sinus infection the prior
week. R. 464. KLB "was using the Albuterol every 4 hours
initially after the last visit but has not needed to use it
recently," and she did not have "as much"
chest pain. R. 465. Her asthma medications remained the same.
Records from 2015
2015, KLB had approximately sixteen doctor visits. Three
visits were asthma follow-ups with no cough or wheezing, one
was a consultation with a gastroenterologist, one was a
bronchoscopy, one was an impedance probe test, one was an EGD
test, and three were GERD- related for nausea and vomiting.
Michael Konikoff, a gastroenterologist, had a consultation
with KLB on January 5, 2015. R. 417. He noted that she
complained of daily chest pain, "nausea but infrequent
vomiting," and "frequent regurgitation with
occasional acid brash." R. 417. He concluded that GERD
"could explain" her symptoms, but the lack of
improvement on Prilosec and chest pain with palpation
"would favor costochondritis or an alternative
etiology," so he planned to continue her Carafate
medication and perform an upper GI endoscopy
("EGD") to rule out possible causes of her
symptoms. R. 418. An EGD on January 19, 2015, revealed
"[s]everal small gastric erosions with normal appearing
esophageal mucosa." R. 420. KLB also underwent a
bronchoscopy with bronchioalveolar lavage on the same date,
which revealed clear mucus and produced samples to be
analyzed. R. 420-26.
20l5, KLB had a follow-up visit with Dr. Epstein. R. 428-29.
Dr. Epstein noted that KLB had a "significant episode of
wheezing about 10 days ago" that was treated with
Albuterol, she returned to using Albuterol as needed, and
"currently has no coughing, wheezing or shortness of
breath." R. 428. She had "good and bad days with
her chest pain" and "occasional reflux
symptoms." R. 428. She was not participating in PE
class, but remained an honor roll student despite missing 25
to 30 days of school. R. 428, On March 4, 2015, KLB visited
Dr. Curry and reported that she "has been coughing and
her asthma has been flaring up"; she was also
"exercising more and has been exercising 5 minutes at a
time so she is not short of breath." R. 463. She had
recently run out of her medications and refilled them two
days before the doctor visit. R. 463. She was told to
"[c]ontinue the Advair daily and Albuterol as
needed." R. 464.
April 6, 2015, KLB saw Dr. Curry for "congestion"
and reported that she recently missed a whole week of school
due to fever, chest pain and stomach ache, and "was
wheezing then as well." R. 461. She "has PE in
school but just walks," and her "[s]pirometry [was]
good except for low FEF 25-75." R. 461-62. Dr. Curry
maintained her asthma medication and ...