United States District Court, D. Oregon
MELANIE J. MEDFORD, Plaintiff,
NANCY A. BERRYHILL,  ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.
OPINION AND ORDER
Yim You United States Magistrate Judge.
Melanie Medford (“Medford”), seeks judicial
review of the final decision by the Commissioner of Social
Security (“Commissioner”) denying her application
for Disability Insurance Benefits (“DIB”) under
Title II of the Social Security Act (“SSA”), 42
USC §§ 401-33. This court has jurisdiction to
review the Commissioner's decision pursuant to 42 USC
§ 405(g). Both Medford and the Commissioner have
consented to allow a Magistrate Judge to enter final orders
and judgment in this case. ECF #6; FRCP 73; 28 USC §
636(c). For the reasons set forth below, the
Commissioner's decision is REVERSED and this case is
REMANDED for further proceedings.
protectively filed for DIB on December 17, 2012, alleging a
disability onset date of November 23, 2012. Tr. 20,
175-80. Her application was denied initially on
August 9, 2013 (Tr. 77, 91-92), and on reconsideration on
September 18, 2013 (Tr. 93, 108-09). On October 20, 2014, a
hearing was held before Administrative Law Judge
(“ALJ”) Luke Brennan. Tr. 40-76. The ALJ issued a
decision on January 28, 2015, finding Medford not disabled.
Tr. 20-33. The Appeals Council denied a request for review on
June 8, 2016. Tr. 1-4. Therefore, the ALJ's decision is
the Commissioner's final decision subject to review by
this court. 20 CFR § 404.981.
July 1960, Medford was 54 years old at the time of the
hearing before the ALJ. Tr. 45. Medford is a high school
graduate and previously worked as a house cleaner. However,
the ALJ concluded that Medford's past work did not reach
the level of “substantial gainful activity, ” and
she therefore had no past relevant work for purposes of her
DIB application. Tr. 31. Medford alleges she is unable to
work due to a history of aneurysmal coiling, anterior
communicating artery (brain) aneurysm with intracranial
hemorrhage (stroke), hydrocephalus with shunt, hypertension,
and depression. Tr. 22, 94.
November 23, 2012, Medford was admitted to an emergency room
with left leg weakness, was observed to have facial droop,
and was diagnosed with an intracranial hemorrhage. Tr.
294-95. Ten years earlier, Medford underwent aneurysmal
coiling treatment for a brain aneurysm, which eventually
developed a hydrocephalus that required a right parietal
shunt. Tr. 294-95, 322. Treating physician Bruce J. Andersen,
M.D., felt the hemorrhage was due to Medford's
hypertension, and she was discharged after two days. Tr. 294.
was again admitted to the emergency room less than two weeks
later, on December 4, 2012, experiencing disorientation and
significant weakness in her left leg. Tr. 302. She was
diagnosed with an anterior communicating artery aneurysm,
hydrocephalus with shunt placement, hypertension, anxiety,
and depression. Id. Medford was advised not to drive
or return to work, and the attending physician's
assistant felt she might require 24hour supervision when
released from the hospital. Tr. 464. After three days in the
hospital, Medford was transitioned into acute inpatient
rehabilitation. Tr. 459, 461.
showing improvement in self-care and mobility over the next
two weeks, she was discharged to her home on December 20,
2012. Tr. 457-58. She was advised to attend occupational
therapy, physical therapy, speech therapy, and
neuropsychological therapy. Tr. 457.
D. Gage, Ph.D., performed a neuropsychological assessment on
January 15, 2013. Tr. 384-85. Medford's memory was
improving, though still impaired, and she continued to have
difficulty concentrating, organizing, planning, and
multitasking. Tr. 384. Dr. Gage diagnosed a cognitive
disorder secondary to thalamic bleed, and found Medford to
have a lot of difficulty with attention and concentration, as
well as processing speed. Tr. 384. She scored in the
“borderline range at the 5th percentile” for both
attention and processing speed. Tr. 385.
months later, on March 11, 2013, Medford was again admitted
to the hospital because she could not open her left hand and
had general weakness throughout the left side of her body.
Tr. 535, 540. Mary E. River, M.D., evaluated Medford, and
indicated it was unclear if she had suffered another
seizure/stroke event or if her symptoms were the result of
her prior aneurysm. Tr. 533. By the next day, Medford
reported feeling that she was “back to her
baseline.” Tr. 520. Following an MRI, she was diagnosed
with “acute ischemic stroke, ” prescribed Plavix,
and discharged on March 13, 2013. Tr. 512.
Cox, M.D., examined Medford on March 18, 2013. Tr. 456. Dr.
Cox felt Medford had suffered a recurrent stroke the week
before, and noted continuing symptoms in her left arm and
right leg. Id. At a follow-up appointment on April
8, 2013, Dr. Gage noted “significant improvement with
regard to processing speed.” Tr. 476. Although Medford
still showed “significant deficits regarding
visuospatial skills and attention, ” she was doing well
enough to attempt a driving test. Id. The following
month, Dr. Cox noted that Medford was driving again and was
doing “reasonably well.” Tr. 566. Dr. Cox
observed continuing “discoordination” in
Medford's left upper extremity, gave Medford some
exercises, and encouraged her to begin using her hand more
for “fine motor hobbies such as jigsaw puzzles.”
Id. Also in May 2013, Medford's speech
pathologist indicated that Medford had met all of her
long-term treatment goals and she was therefore discharged.
2013, Dr. Gage noted that Medford was “driving during
the day . . . without any problems.” Tr. 570. Although
she had made improvements in some areas, she continued to
have difficulty with visual attention and memory.
Id. Dr. Gage explained that Medford should be able
to resume nighttime driving once she had shown some mild
improvement in visuospatial skills. Id.
27, 2013, Ralph D. Heckard, M.D., performed a consultative
neurological examination. Tr. 620-23. At that exam, Medford
displayed “[e]vident memory and executive function
impairments” and “asymmetrical sustained
dyscoordination of dexterity.” Tr. 621. Although
Medford had mild left-sided weakness, she had normal range of
motion and strength, and no other deficits of motor, sensory,
or reflex functions of any extremity. Tr. 623. With regard to
her mental condition, Dr. Heckard concluded that Medford
presented with “mental status features which could
significantly impair her ability to make reasonable workplace
decisions and occupational adjustments, ” was
“easily confused at time, ” and displayed
“alterations of affect and cognition.”
follow-up appointment in mid-August 2013, Dr. River noted a
slight loss of motor strength on the left side and that
Medford had one more week of Plavix before switching to
aspirin once daily. Tr. 626-27. The doctor noted that Medford
asked her to complete some disability paperwork, stating,
“this may or may not get her disability, [s]he may need
to undergo neuropsychological testing . . . [, ] actual
physical and neurologic difficulties are not profound.”
a day of the initial and reconsideration denials of
Medford's application, two state agency doctors reviewed
Medford's record, including Martin Seidenfield, Ph.D.
(Tr. 87-90, Aug. 9, 2013) (followed by initial denial the
same day) and Mack Stephenson, Ph.D. (Tr. 104-07, Sept. 17,
2013) (followed by reconsideration denial the following day).
Dr. Seidenfield found Medford to have “some confusion
and difficulty with stress, ” as well as moderate
limitations in her ability to: (1) understand and remember
detailed instructions; (2) carry out detailed instructions;
(3) maintain attention and concentration for extended
periods; and (4) respond appropriately to changes in the work
setting. Tr. 88-89. Dr. Stephenson found these same
limitations. Tr. 105-06. With regard to the paragraph B
criteria, the opinions of Drs. Seidenfield and Stephenson
differ: Dr. Seidenfeld assessed moderate limitations in both
ADLs and social functioning, while Dr. Stephenson assessed
merely mild limitations in ADLs and moderate limitation in
social functioning. Tr. 83-84, 100. However, in the separate
section for assessing Medford's mental RFC, Drs.
Seidenfeld and Stephenson both declined to assess any social
limitations. Tr. 89, 106.
had another follow-up appointment with Dr. River on January
22, 2014. Tr. 706-07. At that appointment, Medford reported
an abrupt onset of bilateral hand numbness, which Dr. River
found “concerning for paraneoplastic neuropathy.”
Tr. 706. Dr. River ordered a nerve conduction study, to look
for peripheral neuropathy, followed by an MRI of the cervical
spine to rule out spinal stenosis if the nerve conduction
study proved negative. Tr. 707.
February 27, 2014, Medford again saw Dr. River, who noted
that the nerve conduction study was normal in both the upper
and lower extremities. Tr. 711. Dr. River opined that
Medford's reported neuropathy might be musculoskeletal
rather than neurological, and suggested Medford wear an elbow
later, on March 20, 2014, Dr. Andersen reviewed a catheter
angiogram of Medford's aneurysm site, which revealed no
unprotected aneurysmal wall. Tr. 704. He indicated he would
continue the annual surveillance of the issue as scheduled in
a few months. Id.
7, 2014, at a follow-up appointment with Dr. River, Medford
reported no new complaints and that her peripheral numbness
had improved with avoidance of prolonged positioning and the
use of elbow ...