United States District Court, W.D. Louisiana, Lafayette Division
B. WHITEHURSTUNITED STATES MAGISTRATE JUDGE
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
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
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. Id. On September 23, 2017, the
Appeals Council denied Mr. Boutte's request for review.
20, 2009, Dr. Kimberly Smith diagnosed Mr. Boutte with
diabetes mellitus (“DM”), type I
(juvenile), 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.
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
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.
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.
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. 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.
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.
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.
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.
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.
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.