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Rinehart v. Berryhill

United States District Court, D. South Dakota, Central Division

June 7, 2019

DEBORAH RINEHART, Plaintiff,
v.
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.

          OPINION AND ORDER AFFIRMING DECISION OF COMMISSIONER

          ROBERTO A. LANGE UNITED STATES DISTRICT JUDGE.

         Plaintiff Deborah Rinehart (Rinehart) seeks reversal of the decision of the Commissioner of Social Security (Commissioner) denying Rinehart widow's insurance benefits. Doc. 14. The Commissioner argues for this Court to affirm the denial of benefits. Doc. 16. For the reasons explained below, this Court affirms the Commissioner's decision.

         I. Summary of Case A. Procedural History

         On May 14, 2012, Rinehart filed an application for Social Security widow's insurance benefits. Doc. 12 at 55-61. The Commissioner denied Rinehart's claim initially on June 4, 2012, on the basis that Rinehart was not married to Richard Harter (Harter) for at least nine months before the date of his death as required by the Social Security Act (Act). Doc. 12 at 65. On August 2, 2012, Rinehart requested reconsideration of her claim. Doc. 12 at 68-69. Upon reconsideration, the claim was denied. Doc. 12 at 70-73.

         Rinehart then sought a hearing before an Administrative Law Judge (ALJ), which was conducted on July 26, 2013.[1]Doc. 12 at 74, 107. At the hearing, Rinehart proceeded pro se. Doc. 12 at 110. On August 14, 2013, the ALJ issued his opinion denying Rinehart's claim for widow's insurance benefits. Doc. 12 at 107-10. The ALJ considered statements from Rinehart that Harter was healthy on the date of their marriage on August 27, 2011, and was expected to live for many years. Doc. 12 at 29, 109. The ALJ also considered Dr. Vinod Parameswaran's (Dr. Parameswaran) prediction that Harter had a median survival rate of 3.3 years from January 2012 when Dr. Parameswaran had begun his care for Harter's blood cancer. Doc. 12 at 29, 109. However, the ALJ concluded that Rinehart was not entitled to widow's benefits because Harter's death did not meet the definition of "accidental" in the Code of Federal Regulations (regulations). Doc. 12 at 29, 109. The ALJ Judge reasoned that "[n]o evidence has been submitted that definitively establishes that the insured's blood cancer did not cause or contribute to his death" to support a conclusion that his death was an "accident." Doc. 12 at 27, 109.

         Rinehart hired an attorney, Doc. 12 at 127, who appealed to the Appeals Council and submitted new material, Doc. 12 at 114-322; Doc. 12-1 at 1-25. The new material included an affidavit, medical evidence, a summary of the evidence, and a brief. Doc. 12 at 115-322; Doc. 12-1 at 1-25. The Appeals Council remanded the case to the ALJ to determine whether the preexisting condition was the proximate cause of the wage earner's death or whether his death satisfies the statutory requirements of an accidental death which would entitle Rinehart to widow's insurance benefits. Doc. 12-1 at 31.

         Rinehart provided additional evidence for the second ALJ[2] to consider on remand. Doc. 12 at 15. Before the hearing, Rinehart submitted an expert opinion from Ronald Citron, M.D (Dr. Citron). Doc. 12-1 at 77-88. After the hearing was held on June 23, 2015, Dr. Parameswaran submitted responses to interrogatories, and counsel made written argument. Doc. 12-1 at 94-98, 107-08, 112-26. On September 14, 2015, the ALJ held that Rinehart's marriage to Harter did not satisfy the nine-month durational marriage requirement and that no exception, including the accidental death exception, applied. Doc. 12 at 17. Rinehart was thus denied benefits. Doc. 12 at 19.

         Rinehart appealed the second ALJ decision to the Appeals Council. Doc. 12 at 7. On January 30, 2018, the Appeals Council affirmed. Doc. 12 at 7-9. The Appeals Council considered Rinehart's argument against the ALJ's decision, and stated "[w]e found that the reasons do not provide a basis for changing the Administrative Law Judge's decision." Doc. 12 at 7. By denying Rinehart's request for review, the decision of the ALJ became the final decision of the Commissioner. Doc. 12 at 7.

         Rinehart filed a Complaint in this Court appealing the Commissioner's final decision. Rinehart contends that the Commissioner's decision denying her benefits is not based upon substantial evidence and that substantial evidence shows she is entitled to widow's insurance benefits. Rinehart seeks reversal of the Commissioner's decision.

         B. Relevant Facts

         The second ALJ properly observed that "[t]he facts of this matter are largely undisputed" and that Rinehart's "credibility is not at issue." Doc. 12 at 16-17. Harter and Rinehart met in 2002 in Highmore, South Dakota. Doc. 12 at 45-46. Rinehart had a real estate business and was hired by Harter to sell some property. Doc. 12 at 37-38. During the course of this business relationship, Rinehart and Harter developed a close friendship. Doc. 12 at 39. They became a couple and eventually got engaged. Doc. 12 at 41, 45. On August 27, 2011, Rinehart and Harter were married in Highmore. Doc. 12 at 58, 116. The marriage was not a sham; Rinehart and Harter had a loving and close relationship for a prolonged period of time leading up to the wedding. Doc. 12 at 39-47.

         About a month before the wedding, Harter woke up with petechiae[3] all over his body. Doc. 12 at 115, 204, 312. He visited his family physician in Miller, South Dakota, who found that Harter had a very low blood platelet count. Doc. 12 at 115-16, 312. Harter was referred to Michael McHale, M.D. (Dr. McHale), a hematologist/oncologist in Sioux Falls, South Dakota. Doc. 12 at 116, 312. On August 2, 2011, Harter saw Dr. McHale for his idiopathic thrombocytopenic purpura (ITP).[4] Doc. 12 at 116, 312. Dr. McHale ordered a bone marrow biopsy. Doc. 12 at 116, 307. On August 5, 2011, a pathologist reported that the bone marrow biopsy results were not typical of ITP, but of myeloproliferative neoplasm[5] blood cancer and most likely of a type of leukemia called primary myelofibrosis.[6] Doc. 12 at 303. Harter was prescribed Prednisone.[7] Doc. 12 at 157, 296, 313.

         In September 2011, Prednisone had not succeeded in increasing Harter's platelet count, so Dr. McHale prescribed Rituximab.[8] Doc. 12 at 116, 158. On Rituximab, Harter experienced a skin reaction without improvement of his platelet counts. Doc. 12 at 116, 296. On September 13, 2011, Harter returned to Dr. McHale. Doc. 12 at 294. Dr. McHale's impression was, again, ITP and questioned whether there was myelofibrosis leukemia. Doc. 12 at 294, 296. Dr. McHale subsequently prescribed WinRho, [9] but Harter experienced a severe reaction to WinRho and stopped taking it. Doc. 12 at 117, 296.

         In October of 2011, Harter and Rinehart visited the Mayo Clinic. Doc. 12 at 117, 159. Harter was seen by specialists, including Dr. Robert Phyliky, hematologist, and Dr. Ayalew Tefferi (Dr. Tefferi), a specialist in proliferative disorders of hematic cells. Doc. 12 at 117-18, 165, 206, 215. The physicians diagnosed chronic myeloproliferative neoplasm with dysplastic features. Doc. 12 at 206, 215. Harter was placed on Danazol[10] for long-term treatment. Doc. 12 at 215. Dr. Tefferi advised Harter to connect with a hematologist close to Highmore to have access to blood and platelets for transfusions in case of bleeding. Doc. 12 at 118, 166, 221-22.

         On January 6, 2012, Harter met with Christina Gant (Gant), oncology certified nurse practitioner at St. Mary's Hospital in Pierre. Doc. 12 at 166, 312. She set up a telemedicine conference with Dr. Parameswaran. Doc. 12 at 118, 167, 312. On January 18, 2012, Gant acted as a scribe for Dr. Parameswaran, by recording:

[H]e agreed with the Mayo Clinic doctors that myeloproliferative neoplasm is incurable. However, there is some talk that sometimes it can be treated as [myelodysplastic syndrome (MDS)], [11] especially if the patient has dysplastic features within his bone marrow which this patient looked as though he did. Dr. [Parameswaran] also [wanted to] to repeat a bone marrow biopsy to check for leukemia and to see if acute leukemia is present. If the patient is more MDS than MPD [myeloproliferative disorder], Dr. [Parameswaran] discussed with him that he could possibly be started on Vidaza[12] ....

Doc. 12 at 314.

         Dr. Parameswaran ordered another bone marrow biopsy and peripheral blood test on January 23, 2012. Doc. 12 at 285-88. A pathologist deemed the results consistent with MDS, best classified as refractory anemia with excess of blasts (RAEB-1)[13] or acute myeloid leukemia. Doc. 12 at 169, 288. A Seattle laboratory performed additional studies. Doc. 12 at 290. On January 26, 2012, Dr. Parameswaran reported his diagnosis as MDS RAEB-1. Doc. 12 at 192. He reviewed the laboratory results through a telemedicine conference with Harter. Dr. Parameswaran recorded:

I have discussed the diagnosis and prognosis with him in detail. I have indicated that his median survival is in the order of three to five years at this stage of disease with the 25% AML [acute myeloid leukemia] progression in the absence of therapy at a median of 3.3 years .... Clearly, he can continue his danazol and his platelet stabilized then we can back off on danazol. I have recommended azacytidine which I will be prescribing at a dose of 75 mg/m2 IV daily for seven days repeated every month. The side effects of the drug were discussed in detail. I have told him that his disease will progress to leukemia if it is untreated. I have informed him that it may take several weeks to months for the drug to work and his counts may deteriorate in the meanwhile .... We will consult Dr. Becker to have a central venous catheter, Port-a-Cath placed.... He will start therapy this coming Monday. We will give him six units of platelets prior to placement.

Doc. 12 at 192.

         After the appointment, Harter researched Vidaza and wrote questions to ask Dr. Parameswaran. Doc. 12 at 315-18. Gant faxed Dr. Parameswaran that Harter had his port placed but "now doesn't know if he wants chemo. He has been researching and doesn't know if it is the best thing for him right now ...." Doc. 12 at 318. Dr. Parameswaran, on February 27, 2012, had a telemedicine visit with Harter, for which the notes state:

His next question was could the treatment leave him permanently worse off than he was originally. Dr. [Parameswaran] stated that no, the disease process may progress and that may leave him in a worse state than he was originally but the Vidaza will not leave his counts permanently damaged .... The next question was were there real benefits for starting the treatment now rather than waiting and watching to see how the disease develops. Dr. [Parameswaran] stated that yes, if the disease is caught prior to it becoming acute myelocytic leukemia, there are definite benefits in the form of greatly increased life expectancy of greater than 10 years as opposed to if he should develop acute myelocytic leukemia a life expectancy of 4 months to a year.

Doc. 12 at 319.

         Harter underwent infusions of Vidaza in Pierre from March 5 to March 13, 2012. Doc. 12-1 at 7. On March 18, 2012, Harter began shaking, sweating, and had a fever. Doc. 12-1 at 7. He went to the emergency room, was diagnosed with pneumonia/septicemia, and was admitted to the hospital. Doc. 12 at 177; Doc. 12-1 at 7. Pneumonia with sepsis is a known ...


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