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Boutte v. U S Commissioner Social By Consent of Parties Security Administration

United States District Court, W.D. Louisiana, Lafayette Division

October 12, 2018




         Before the Court is an appeal of the Commissioner's finding of non-disability. Considering the administrative record, the briefs of the parties, and the applicable law, the Court finds that the Commissioner's decision should be REVERSED and REMANDED.


          The claimant, Levores James Boutte, was born on January 27, 1969. Tr. 285. Mr. Boutte has a limited education (11th grade) and consistent past employment (1989 - 2010) as a mechanic. Tr. 25, 46, 59, 168-170, 179. Mr. Boutte was discharged from his position as a mechanic in April 2010 after having a hypoglycemic episode at work. Tr. 47-48 178.

         On November 23, 2014, Mr. Boutte applied for a period of disability and disability insurance benefits. On September 6, 2016 Administrative Law Judge (“ALJ”), Tamia N. Gordon, evaluated whether Mr. Boutte was disabled based on an onset date of April 20, 2013. Tr. 13-27. The ALJ issued an unfavorable decision denying Mr. Boutte's application for benefits.[1] Id. On September 23, 2017, the Appeals Council denied Mr. Boutte's request for review. Tr. 1-6.

         On July 20, 2009, Dr. Kimberly Smith diagnosed Mr. Boutte with diabetes mellitus (“DM”), type I (juvenile)[2], systolic murmur, mixed hyperlipidemia, benign essential hypertension, erectile dysfunction due to organic reasons and leg pain. Tr.71. On February 2, 2010 and May 24, 2010, Dr. Smith indicated that Mr. Boutte's diabetes required insulin and was complicated by nephropathy (kidney disease or damage). Id. Mr. Boutte began using an insulin pump and in February 2011, Dr. Smith noted no significant improvement in his condition. Tr.69-71. Dr. Smith indicated that Mr. Boutte had kidney, vision, and heart problems due to uncontrolled diabetes; she opined that his blood sugar levels were uncontrolled and were likely to cause more organ damage. Tr.72. In a letter dated February 8, 2011, Dr. Smith opined that Mr. Boutte was disabled due to uncontrolled diabetes despite the efforts of multiple physicians. Id.

         On January 3, 2012, Mr. Boutte attended a consultative evaluation (“CE”) with Scott C. Chapman, M.D. Dr. Chapman opined that Mr. Boutte's diabetes was not optimally controlled and that he needed to have further changes made to his treatment to try to improve his blood pressure and blood sugar control. Dr. Chapman noted that Mr. Boutte had poor peripheral circulation in the bilateral lower extremities. Tr.240-247.

         The 2011 initial ALJ decision provided that on March 6, 2013, Mr. Boutte's primary care physician, Dr. Kimberly Smith, issued a medical source statement (“MSS”) opining that Mr. Boutte was permanently disabled due to uncontrolled diabetes and resulting complications. Tr.86. Mr. Boutte notes that Dr. Smith's 2013 MSS is not exhibited in the instant claim file while Dr. Chapman's 2012 CE is exhibited. R. 10.

         On March 18, 2014, Dr. Smith referred Mr. Boutte to the Lafayette Arthritis and Endocrine Clinic where he was seen by rheumatologist Jennifer Malin, M.D., who noted a history of Lupus verified by positive double-stranded DNA testing. Tr.257-260.

         In 2014, following an abnormal echocardiogram which showed mild posterior left ventricular hypertrophy (“LVH”) and evidence of diastolic dysfunction, Mr. Boutte began treatment at the Cardiovascular Institute of the South (“CIS”) for coronary artery disease (“CAD”), Valvular Heart Disease (“VHD”), hypertension (“HTN”), and high cholesterol (dyslipidemia). Tr.268-288. His treatment at CIS continued throughout 2015 and 2016. 350-405. In 2016, Mr. Boutte was examined following an emergency room and hospital stay for abnormally elevated creatinine kinase (“CK”) and complaints of chest pain and bilateral edema., Records from the Acadiana Diabetes Care & Prevention Center for the period of March 2014 through December 2014 reflect that Mr. Boutte had fluctuating hemoglobin AlC ranges and glucose levels.[3] On March11, 2014, Mr. Boutte's Hemoglobin A1C was 8.2% (with normal being 4.0 - 6.0%).6 Tr.304. On July 16, 2014, Mr. Boutte's Hemoglobin A1C (three month average of a person's blood glucose level) was elevated to 10.3%. Tr.302. On October 10, 2014, Mr. Boutte's Hemoglobin A1C was slightly improved at 9.6%, Tr.299, and on December 17, 2014, it was 9.4%. Tr. 298. Mr. Boutte also had elevated levels of urine albumin (267.6 mg/L with normal being 5 - 92.1 mg/L) and an elevated albumin/creatinine ratio (98.7 mg/g with normal being 1-55 mg/g) on December 17, 2014. Tr. 298. On May 21, 2015, Mr. Boutte's Hemoglobin A1C was 11.7%. Tr. 346. In particular, on March 11, 2014, endocrinologist Ghyass Rizk, M.D., treated Mr. Boutte and noted he reported decreased energy and was positive for retinopathy and nephropathy. Tr.296. Dr. Rizk also noted decreased sensation to vibration. Id. On July 16, 2014, Dr. Rizk noted positive findings for retinopathy and nephropathy, decreased sensation to vibration, and added severe sexual dysfunction. Tr.295. On December 17, 2014, Dr. Rizk again noted positive findings for retinopathy and nephropathy as well as decreased sensation to vibration. Tr.294.

         On January 12, 2015, Mr. Boutte was transported to the emergency department via EMS after being involved in a single vehicle accident. When EMS arrived, the claimant was confused. It was determined that he had a hypoglycemic (low blood sugar) episode and his glucose level was 41. EMS gave him dextrose and his mental status improved. At the emergency department, he said that he hadn't eaten much earlier that day and was on his way to get something to eat when he apparently drove through a fence and into a field. He reported that he did not remember the accident. His blood pressure was 149/100. He was found to be uninjured from the motor vehicle accident. Tr. 329-332.

         Mr. Boutte again presented to the emergency department on January 24, 2015 with complaints of right leg muscle spasm and severe pain from his right thigh to the right side of his chest, which he stated came on suddenly when he was at rest. Blood work showed high glucose, BUN and creatinine levels. The clinical impression was dehydration and muscle cramps. Tr. 311-313.

         On February 20, 2015, Mr. Boutte's mother, Patsy Boutte, completed a Function Report - Adult - Third Party in which she reported that Mr. Boutte has frequent blood sugar level fluctuations due to uncontrolled diabetes that caused disorientation, occasional combativeness, and curling of his fingers and legs. Tr.188. She further reported that Mr. Boutte had difficulty with understanding, memory, and concentration due to his blood sugar fluctuations. Tr.188-195.

         On April 22, 2015, Mr. Boutte again experienced an episode of hypoglycemia while driving. He stated that he did not eat breakfast that day. After being treated with IV dextrose, his glucose level became elevated. His creatinine level was also elevated. Tr. 265-270.

         From May 12, 2015 through June 10, 2015, Mr. Boutte kept a personal log of his morning and evening blood sugar readings. During the thirty days his readings indicated significantly high levels of blood sugar levels. As only ten out of sixty entries indicated normal blood sugar levels, 80% of the entries indicated uncontrolled blood glucose. Also, Mr. Boutte ...

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