United States District Court, W.D. Louisiana, Alexandria Division
REPORT AND RECOMMENDATION
H.L. Perez-Montes United States Magistrate Judge.
the Court is Douglas Bruce Holly's
(“Holly's”) appeal of the denial of
disability insurance benefits (“DIB”) by the
Commissioner of Social Security (“the
Commissioner”). Because substantial evidence does not
support the ALJ's findings that Holly and his physicians
are not credible, the Commissioner's decision should be
reversed and Holly should be awarded benefits.
filed an application for DIB, alleging a disability onset
date of December 28, 2014 (Doc. 10-1, p. 139/421), due to
“hole in heart, asthma, sleep apnea, bone spur in left
heel, heart murmur, acid reflux, and shortness of
breath.” (Doc. 10-1, p. 57/421). That application was
denied by the Social Security Administration
(“SSA”). (Doc. 10-1, p. 66/421).
novo hearing was held before an Administrative Law Judge
(“ALJ”) on March 23, 2016, at which Holly
appeared with his attorney and a vocational expert
(“VE”). (Doc. 10-1, p. 37/421). The ALJ found
Holly has not engaged in substantial gainful activity since
December 28, 2014, the alleged onset date. (Doc. 10-1, p.
25/421). The ALJ further found that, although Holly has
severe impairments-chronic obstructive pulmonary disease
(“COPD”) and obesity-he has at least a high
school education and has the residual functional capacity to
perform the full range of light work. (Doc. 10-1, pp. 25, 27,
31/421). The ALJ found Holly is unable to do his past
relevant medium and heavy work as a laborer, deckhand,
corrections officer, and green chain off-bearer (at a plywood
plant). (Doc. 10-1, pp. 30-31/421). Because a finding of
“not disabled” was directed by § 202.20 of
the Medical-Vocational Guidelines, 20 C.F.R. Part 404,
Subpart P, Appendix 2, the ALJ found Holly was not disabled
at any time through the date of his decision on December 28,
2014. (Doc. 10-1, p. 31/421).
requested a review of the ALJ's decision, but the Appeals
Council declined to review it (Doc. 10-1, p. 4/421), and the
ALJ's decision became the final decision of the
then filed an appeal for judicial review, with the following
grounds for relief (Docs. 15, 16):
1. The ALJ's reasons for not crediting the opinion of Dr.
Davis, Holly's treating cardiologist, are not supported
by substantial evidence.
2. The ALJ's findings as to Holly's credibility are
not supported by substantial evidence.
3. The ALJ's finding that Holly retains the residual
functional capacity to perform the full range of light work
is not supported by substantial evidence.
Holly's medical records.
Gregory Ardoin, a pulmonologist, first saw Holly in May 2014
on referral from Dr. Karson. (Doc. 10-1, p. 371/421). Holly
complained he had been progressively shorter of breath for
years but was markedly worse in the last “many
months”; his shortness of breath was aggravated by
exertion, relieved by rest, and accompanied by coughing and
wheezing, and he had been very tried for the last year. (Doc.
10-1, p. 371/421). Dr. Ardoin noted Holly's history of a
bilateral heart catheter, pulmonary hypertension, and severe
dyspnea on exertion, with progressively worsening shortness
of breath for years, markedly worse in the last several
months. (Doc. 10-1, p. 371/421). Dr. Ardoin noted that Holly
has significant left ventricle hypertension and hypertrophic
cardiomyopathy with normal left ventricle function, asthma
with wheezing, hypersomnolence, and snoring. (Doc. 10-1, p.
371/421). Holly could not make it up and down stairs at work
without severe distress. (Doc. 10-1, p. 271/421). Dr. Ardoin
diagnosed pulmonary artery hypertension, atrial septal defect
(“ASD”), hypertrophic cardiomyopathy, dyspnea on
exertion, morbid obesity, asthma, and hypertension. (Doc.
10-1, p. 372/421).
then 42 years old, underwent an echocardiogram in June 2014.
(Doc. 10-1, pp. 333-334/421). Holly's left ventricle
ejection fraction was about 59% and the wall thickness was at
the upper limits of normal; there was mild regurgitation in
the pulmonic valve; there was mild to moderate regurgitation
in the tricuspid valve; and everything else was normal. (Doc.
10-1, p. 334/421). Cardiopulmonary tests and pulmonary
function studies revealed pulmonary hypertension. (Doc. 10-1,
pp. 335-345/421). Dr. Ardoin stated Holly's case was very
unusual due to a right heart catheter, documented in August
2013. (Doc. 10-1, p. 368/421). Holly's cardiothoracic
surgeon recommended trying medications for a while before
trying to close the atrial septal defect, so Dr. Ardoin
prescribed PDE5 inhibitors to help his hypertrophic diastolic
dysfunction. (Doc. 10-1, p. 370/421). Dr. Ardoin diagnosed
pulmonary artery hypertension, atrial septal defect,
hypertrophic cardiomyopathy, dyspnea on exertion, morbid
obesity asthma and hypertension. (Doc. 10-1, p. 368/421).
2014, Holly had an abnormal pulmonary function study. (Doc.
10-1, pp. 346-/421). Dr. Ardoin noted that Holly said he felt
markedly better since treating his asthma with Advair and
Spiriva, but was not at normal exercise capacity at work, and
his cardiopulmonary exercise test was “remarkably
abnormal for both ventilatory limitation…and from his
hypoxemia”. (Doc. 10-1, p. 265/421). Dr. Ardoin
diagnosed shortness of breath, exercise hypoxemia, pulmonary
artery hypertension, COPD, atrial septal defect, asthma,
dyspnea on exertion, morbid obesity, and hypertension. (Doc.
10-1, p. 266/421).
study in July 2014 showed Holly has severe obstructive sleep
apnea syndrome. (Doc. 10-1, p. 347/421). Holly was prescribed
a positive airway pressure therapy titration trail study.
(Doc. 10-1, p. 347/421). A second sleep study in September
2014 showed his obstructive sleep apnea was controlled by
CPAP and he was prescribed home CPAP therapy. (Doc. 10-1, p.
echocardiogram in September 2014 showed Holly's left
ventricle had mildly increased wall thickness, his left and
right atriums were mildly dilated, and his pulmonic and
tricuspid valves had mild to moderate regurgitation. (Doc.
10-1, pp. 349-50/421). Holly's left ventricle ejection
fraction was 62 %. (Doc. 10-1, p. 350/421).
had another abnormal spirometry report in October 2014. (Doc.
10-1, p. 352/421). Holly was called to undergo a repair of
his atrial septal defect, but he refused it. (Doc. 10-1, p.
362/421). Holly stated he was able to do his work with mild
to moderate compromise, which was a marked improvement. (Doc.
10-1, p. 362/421). Dr. Ardoin noted Holly still had trace
edema and had started CPAP therapy. (Doc. 10-1, p. 362/421).
Dr. Ardoin diagnosed Holly with atrial septal defect,
exercise hypoxemia, pulmonary artery hypertension, shortness
of breath, pulmonary artery hypertension (“PAH”),
chronic obstructive pulmonary disease (“COPD”),
asthma, hypertrophic cardiomyopathy, dyspnea on exertion,
morbid obesity, hypertension, and obstructive sleep apnea on
CPAP. (Doc. 10-1, pp. 262-63/421).
December 2014, Holly had a blood vessel pop (Doc. 10-1, p.
244/421). Holly's history of benign hypertension was
noted (Doc. 10-1, p. 244/421), and he was diagnosed with
varicose veins and morbid obesity. (Doc. 10-1, p. 245/421).
saw Dr. Ardoin three times in January 2015. Holly was treated
for an upper respiratory infection, and a heart murmur was
noted (systolic grade III/IV in LUSB), as well as edema and
morbid obesity. (Doc. 10-1, pp. 248-49/421). Holly reported a
long history of heart murmur since age 4 after having open
heart surgery. (Doc. 10-1, p. 249/421). Holly underwent an
EKG, lab work, x-rays, a cardiopulmonary, and pulmonary
function studies at the request of Dr. Gregory Ardoin, a
pulmonologist. (Doc. 10-1, pp. 267-284, 297-302/421). Holly
was 5'10” tall and weighed 289 pounds. (Doc. 10-1,
p. 258/421). Dr. Ardoin diagnosed shortness of breath;
gastroesophageal reflux disease (“GERD”); ASD;
hypertrophic cardiomyopathy; obstructive sleep apnea on CPAP;
asthma; morbid obesity; dyspnea on exertion; pulmonary artery
hypertension; and exercise hypoxemia. (Doc. 10-1, p.
258/421). Dr. Ardoin found Holly's asthma, reactive
airways disease, and obstructive lung disease had improved
markedly, and his pulmonary hypertension “may have
improved somewhat.” (Doc. 10-1, p. 259/421). Dr. Ardoin
noted that Holly's primary limiting factor is hypoxemia
with exercise, and his second most limiting factor is
hypertrophic cardiomyopathy/diastolic dysfunction. (Doc.
10-1, p. 159/421). Dr. Ardoin found Holly was unable to do
physical labor (his usual work requirements) without
respiratory distress due to hypoxemia. (Doc. 10-1, p.
258/421). Dr. Ardoin recommended that Holly stop working,
since he was doing physical labor, but Holly said he could
not. (Doc. 10-1, p. 359/421).
was referred to Dr. Wesley W. Davis, a cardiologist, in April
2015. (Doc. 10-1, p. 402/421). Holly was 42 years old,
69” tall, weighed 310 pounds, and his blood pressure
was 118/63. (Doc. 10-1, p. 402-404/421). After Holly
underwent tests, Dr. Davis diagnosed primary pulmonary
hypertension, obesity, hypertension, and asthma. (Doc. 10-1,
2015, Dr. Davis noted Holly's “leaking valve”
(since open heart surgery in1976) and asthma. (Doc. 10-1, pp.
406-407/420). Dr. Davis found Holly had pitting edema in both
lower extremities (more om the right) and varicose veins.
(Doc. 10-1, p. 408/421), and is disabled due to hypertension,
chronic stasis changes (right leg more than left), obesity,
his ASD repair at age 4, edema, and moderate primary
pulmonary high blood pressure. (Doc. 10-1, p. 406/420). Dr.
Davis diagnosed venous insufficiency of both lower
extremities, primary pulmonary hypertension, hypertension,
asthma, and obesity. (Doc. 10-1, p. 406/420). Dr. Davis
recommended that Holly elevate his feet one hour in the
morning and one hour in the afternoon, and continue taking
his medications (Lasix, potassium chloride, omeprazole,
Advair, Spiriva, Ventolin, and Inderal). (Doc. 10-1, p.
Ardoin evaluated Holly in August 2015 and found shortness of
breath, dyspnea on exertion, pulmonary artery hypertension,
atrial septal defect, asthma, and chronic obstructive
pulmonary disease. (Doc. 10-1, p. 353/421). Dr. Ardoin noted
that, given Holly's hypertrophic cardiomyopathy and
pulmonary hypertension, complicating obesity, and obstructive
sleep apnea, Holly's condition could be made worse if the
ASD was closed since it could be acting as a “pop off
valve.” (Doc. 10-1, p. 354/421). Dr. Ardoin prescribed
a PDE5 inhibitor for his pulmonary hypertension. (Doc. 10-1,
p. 349/421). Dr. Ardoin also stated that Holly is
“completely disabled and unemployable at this
time.” (Doc. 10-1, p. 355/421).
September 2015, Dr. Ardoin wrote that Holly is unable to
perform physical labor due to severe exercise hypoxemia
caused by a combination of pulmonary hypertension, atrial
septal defect, hypertrophic cardiomyopathy, and severe
persistent asthma. (Doc. 10-1, p. 410/421). A cardiopulmonary
stress test documented severe hypoxemia with mild to moderate
exercise. (Doc. 10-1, p. 410/421). Dr. Ardoin noted that