Barr v. Saul

CourtDistrict Court, N.D. Illinois
DecidedJune 8, 2020
Docket3:19-cv-50019
StatusUnknown

This text of Barr v. Saul (Barr v. Saul) is published on Counsel Stack Legal Research, covering District Court, N.D. Illinois primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Barr v. Saul, (N.D. Ill. 2020).

Opinion

UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF ILLINOIS WESTERN DIVISION

KARLA J.B., ) No. 19 CV 50019 ) Plaintiff, ) Magistrate Judge Iain D. Johnston ) v. ) ) ANDREW SAUL, ) Commissioner of Social Security, ) ) Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Karla J.B.1 brings this action under 42 U.S.C. § 405(g) seeking remand of the decision denying her social security benefits. For the reasons below, Plaintiff’s motion for summary judgment is denied, the Commissioner’s motion for summary judgment is granted, and the ALJ’s decision is affirmed. I. FACTUAL BACKGROUND A. Relevant Medical History Plaintiff was diagnosed with essential tremors2 in 2008. R. 311. The medical records indicate Plaintiff was treated by various providers from April 16, 2012 through May 19, 2017 for tremors, hypothyroidism, and hypertension. See R. 209-345. Because Plaintiff’s arguments focus on the ALJ’s analysis of her tremor impairment, the Court focuses on the medical evidence related to the tremors.

1 Plaintiff’s last name has been redacted in accordance with Internal Operating Procedure 22. 2 Essential tremors are defined as “[a]n action tremor of 4-8 Hz frequency that usually begins in early adult life and is limited to the upper limbs and head; called familial when it appears in several family members.” STEDMAN’S MEDICAL DICTIONARY 935180 (West 2014). Plaintiff visited the emergency room on May 27, 2014 for headache, chest pressure, and a “funny feeling” on the right side of her face. R. 215. In a follow up visit on May 29, 2014, Plaintiff reported a history of hand tremors but that they were “under good control” with Propranolol, though the tremors had worsened coincidentally with the recent ER visit. Id.

Plaintiff had normal grip and upper-extremity strength, though hand tremors were noted as present in both hands, worse in the left. R. 216. She was referred to neurology for the tremors. R. 217. Plaintiff saw Doctor Jude Perez for right eye pain on May 30, 2014. The visit report indicated Plaintiff’s history of tremors, though noted on exam that she had full range of motion in all extremities and did not note that Plaintiff exhibited tremors. R. 300-01. On another ER follow-up visit on June 5, 2014, Plaintiff reported feeling much better and that her tremor had improved, and on exam her hand tremors were noted as “stable” and “significantly improved.” R. 217-18. Plaintiff underwent three brain MRIs in June and July 2014, which revealed mostly normal results. R. 246-48, 310-11.

At a visit with Dr. Malgorzata Bach on November 7, 2014, Plaintiff was taking Klonopin for her tremors which improved them by 30%. R. 310-11. On examination Plaintiff exhibited tremors in both hands, a mild head tremor, and a voice tremor, though finger to nose testing and muscle tone was normal. R. 312. She was prescribed Primidone at 50 mg. R. 313. At another ER follow up on November 29, 2014, Plaintiff reported that her tremors were getting worse. Plaintiff was noted as experiencing tremors in both hands with gross motor movements when asked to pick up an alcohol container in the exam room, again left hand worse than right. R. 222. She was again prescribed Klonopin for the tremors. R. 223. On December 18, 2014, Plaintiff visited with Dr. Moshin Khan for evaluation of her tremors. She reported tremors aggravated by action and that the Primidone she was prescribed was not working. On examination, Plaintiff exhibited moderate left arm, head, and neck tremors. However, she exhibited normal reflexes, strength in all extremities, and gait. R. 320-22. Dr.

Khan prescribed Sinemet. R. 324. At a follow up on March 12, 2015, Dr. Khan noted Plaintiff’s tremors had improved with Sinemet, and at this appointment Plaintiff did not exhibit any tremors on examination. R. 327-28. Dr. Khan continued Plaintiff’s Sinemet regimen. R. 330. Plaintiff next visited neurologist Dr. Roland H. Brilla, who wrote in an August 14, 2015 report that Plaintiff had complained of postural and action tremors in her hands for approximately the previous 10 years and in her head for the last few months. Dr. Brilla examined Plaintiff, who exhibited action tremors “particularly marked near the end point and then are at least moderate in severity” and postural tremors, though otherwise exhibited normal senses, gait, and rapid alternating movement. R. 250-51. Dr. Brilla again diagnosed essential tremors and increased Plaintiff’s Propranolol prescription, ultimately concluding that “[g]iven the patient’s

significant impairment, she might even be a candidate for deep brain simulation if her tremors remain refractory.” Id. Dr Brilla increased the Propranolol dose to 60 mg on August 14, 2015. R. 264. Dr. Brilla noted after the next follow-up visit on December 17, 2015 that Plaintiff reported her tremors had “mildly improved with propranolol.” R. 269-70. Dr. Brilla increased the Propranolol dose from 60 to 80 mg. Id. Plaintiff then underwent a consultative examination with Dr. K.P. Ramchandani on December 22, 2015. Plaintiff complained of constant tremors in her hands and head for the past 10 years, which made it difficult to eat or write, or to lift and carry objects over 20 pounds. She reported the tremors got worse with activity, though she did not use an assistive device and could shower, eat, change clothes, and care for her personal hygiene unassisted. R. 209. On exam, Plaintiff exhibited normal strength, tremors in outstretched hands made worse with activity, and tremors when performing a finger-nose test bilaterally. However, Plaintiff was able to make a fist, pick up objects, open and close a door, oppose thumbs to fingers, and flip pages. R. 210. Dr.

Ramchandani reaffirmed a diagnosis of essential tremors. R 211. Plaintiff was in for another follow-up visit with Dr. Brilla’s office on June 17, 2016. Plaintiff reported tolerating the increased Propranolol dose and that it worked better than other drugs she had tried but wanted to better control the tremors. Dr. Brilla again increased the Propranolol dose to 120 mg. R. 274-75. At the next follow up on December 9, 2016, Plaintiff was still having “bothersome” tremors, she agreed to take a second medication to help control them, and Dr. Brilla prescribed Gabapentin at a 100 mg dose alongside the Propranolol at 120 mg. R. 277-78. At her next follow-up on May 15, 2017, Plaintiff reported the new medication was “very effective” and that she and others had noted her tremors had “definitely improved.” R. 282. Dr. Brilla noted that no tremors were present on examination and again increased the

Gabapentin dose. Id. B. Opinion Evidence The only medical opinions on record are two consultative examination reports from State agency medical experts. R. 63-66, 70-75. Dr. Prasad Kareti completed the first on March 10, 2016. He opined that Plaintiff’s December 22, 2015 exam with Dr. Ramchandani was “unremarkable” and noted her demonstrated ability to make a fist, pick up objects, use doors, flip pages, her full motor strength, and 5/5 grip strength at that examination. R. 64. As to Plaintiff’s subjective complaints, Dr. Kareti found Plaintiff partially credible because her reported activities of daily living were “excessive in degree in light of the objective findings.” R. 65. He went on to opine that Plaintiff’s tremors were not severe and that Plaintiff was not disabled. R. 64-65. Dr. Rohini Mendonca wrote the second report on June 3, 2016 and agreed with Dr. Kareti that Plaintiff’s tremors were not severe and that she was not disabled. R. 71-75. Dr. Mendonca

cited Plaintiff’s noted improvements over time using different medications, normal grip strength, reflexes, and range of motion, though noted Plaintiff’s documented tremors with outstretched hands that was aggravated with activity. R. 72. Like Dr.

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