United States District Court, D. South Carolina
REPORT AND RECOMMENDATION
V. Hodges, United States Magistrate Judge.
appeal from a denial of social security benefits is before
the court for a Report and Recommendation
(“Report”) pursuant to Local Civ. Rule
73.02(B)(2)(a) (D.S.C.). Plaintiff brought this action
pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) to
obtain judicial review of the final decision of the
Commissioner of Social Security (“Commissioner”)
denying her claim for Disability Insurance Benefits
(“DIB”) and Supplemental Security Income
(“SSI”). The two issues before the court are
whether the Commissioner's findings of fact are supported
by substantial evidence and whether she applied the proper
legal standards. For the reasons that follow, the undersigned
recommends the Commissioner's decision be reversed and
remanded for further proceedings as set forth herein.
March 18, 2014, Plaintiff filed applications for DIB and SSI
in which she alleged her disability began on August 1, 2007.
Tr. at 176-79 and 180-89. Her applications were denied
initially and upon reconsideration. Tr. at 54-73 and 76-99.
On December 10, 2015, Plaintiff had a hearing before
Administrative Law Judge (“ALJ”) Edward T.
Morriss. Tr. at 36-49 (Hr'g Tr.). The ALJ issued an
unfavorable decision on February 3, 2016, finding Plaintiff
was not disabled within the meaning of the Act. Tr. at 18-35.
Subsequently, the Appeals Council denied Plaintiff's
request for review, making the ALJ's decision the final
decision of the Commissioner for purposes of judicial review.
Tr. at 1-7. Thereafter, Plaintiff brought this action seeking
judicial review of the Commissioner's decision in a
complaint filed on August 24, 2017. [ECF No. 1].
Plaintiff's Background and Medical History
was 45 years old at the time of the hearing. Tr. at 39. She
completed the twelfth grade. Id. Her past relevant
work (“PRW”) was as a cook, cashier, housekeeper
or childcare giver, bus driver, and patient transporter. Tr.
at 97-98, 678. She alleges she has been unable to work since
February 10, 2014. Tr. at 678.
Evidence Submitted to the ALJ
March 29, 2013,  Plaintiff presented to University
Hospital, part of the Medical University of South Carolina
(“MUSC”), with complaints of abdominal pain,
nausea, vomiting, and diarrhea. Tr. at 695-701. Plaintiff
reported nausea and vomiting every morning for the prior
month, as well as increased epigastric pain and unintended
weight loss over the prior few months. Tr. at 695-96, 699.
Plaintiff also reported fevers and chills in the forty-eight
hours prior to her hospital visit. Id.
Plaintiff's blood sugar was 550 with a minimal gap of 13,
her last hemoglobin A1C was 16.6, and her urine tested
positive for ketones. Tr. at 699-700. Plaintiff was given two
liters of fluid, and the gap closed. Id. Plaintiff
was diagnosed with starvation ketosis, uncontrolled diabetes,
dehydration, and hypertension. Tr. at 700-01. She responded
to medication and was placed back on her home dose of
Levemir. Tr. at 700. The treatment notes indicated that the
rapid normalization of her sugars suggested she may not have
been compliant with her home regimen of insulin. Id.
Plaintiff was instructed to follow up with the Franklin C.
Fetter Clinic (“F.C. Fetter”). Tr. at
26, 2013, Plaintiff presented to University Hospital with
abdominal pain, nausea, vomiting, diarrhea, and a syncopal
episode, reporting pain intensity of 7/10. Tr. at 691-93.
Plaintiff's children witnessed her lose consciousness for
a few seconds and fall to the floor. Tr. at 692. Plaintiff
was 5'1” and 270 pounds with a body mass index
(“BMI”) of 51.02. Id. The notes from
Plaintiff's visit indicated her syncopal event and
abdominal pain were likely secondary to her vomiting and
dehydration. Tr. at 694. Plaintiff's lab results were
within normal limits. Id. Plaintiff was given fluids
and nausea medication intravenously and was discharged with
instructions to follow up with her primary care provider.
29, 2013, Plaintiff visited F.C. Fetter. Tr. at 801-04. The
notes stated Plaintiff was a “43 year-old with
[diabetes mellitus] for several years, but poorly compliant
who comes for follow up after months of not being
seen.” Tr. at 801. Plaintiff reported her recent
syncopal episodes. Id. The notes from the visit
indicated she had symptoms of gastroparesis. Id.
Plaintiff was assessed for diabetes, diabetic gastroparesis,
obesity, and abdominal pain. Tr. at 803. Plaintiff's A1C
was 14.3. Tr. at 787.
3, 2013, Plaintiff presented to F.C. Fetter, complaining of
dizziness when her glucose was closer to normal values. Tr.
at 797-800. Charles Effiong, M.D. (“Dr.
Effiong”), explained to Plaintiff that her dizziness
was likely autonomic neuropathy. Tr. at 797. Plaintiff
weighed 265 pounds and “was applauded for weight
loss.” Tr. at 797-98. Plaintiff was assessed for
diabetic gastroparesis, diabetes, and autonomic neuropathy.
Tr. at 799. Dr. Effiong noted Plaintiff's diabetes
mellitus was not adequately controlled and increased Novolog.
Tr. at 799-800.
August 26, 2013, Plaintiff presented to F.C. Fetter for
hypertension and complained of dizziness and feeling
lightheaded for one week. Tr. at 794- 96. Dr. Effiong ordered
lab tests and the results revealed Plaintiff's A1C was
14.3. Tr. at 787.
November 6, 2013, Plaintiff presented to University Hospital
after a syncopal episode. Tr. at 688. Plaintiff reported she
had episodes of lightheadedness at work in prior months, but
had never passed out. Id. During the episode,
Plaintiff had a heavy feeling in her chest, took a few steps,
and lost consciousness, but was unsure how long she was
unconscious. Id. When she awoke, she had right hip
pain. Tr. at 691. Her electrocardiogram (“EKG”)
showed no ischemic changes and no ectopy. Id.
Plaintiff's blood sugar was in the high 200s, and it was
unclear whether she was dehydrated. Id. Plaintiff
was given intravenous fluids and felt better. Plaintiff was
advised to keep track of her blood sugar and drink plenty of
February 16, 2014, Plaintiff presented to University Hospital
with complaints of losing consciousness. Tr. at 684.
Plaintiff reported she had been passing out for over a month,
but was unsure how long she had been unconscious during those
episodes. Id. Plaintiff indicated she was
“under a lot of stress at work[.]” Id.
She had hyperglycemia with a glucose level of 487.
Id. The physical exam notes indicated Plaintiff
could walk without difficulty, but she had bilateral
paresthesia in her feet. Tr. at 685. The clinical impression
was syncope. Tr. at 687. Plaintiff was given intravenous
fluids, and her blood glucose level improved. Id.
She reported improvement and was discharged. Id.
February 17, 2014, Plaintiff presented to F.C. Fetter to
follow up on her fall. Tr. at 790-93. Plaintiff reported
numbness in both feet, an unsteady gait, and frequent falls.
Tr. at 790. Plaintiff also reported her symptoms were
aggravated by movement, resting, standing, and walking, with
no relieving factors. Id. Dr. Effiong stressed the
importance of controlling Plaintiff's diabetes mellitus.
Id. Dr. Effiong assessed diabetes mellitus, obesity,
diabetic neuropathy, and polyneuropathy in diabetes. Tr. at
March 13, 2014, Plaintiff presented to F.C. Fetter. Tr. at
788-89. Dr. Effiong noted Plaintiff was a “44-year-old
with poorly controlled [diabetes mellitus] with complications
including severe neuropathy. Comes in following a recent fall
at her home in the hallway.” Tr. at 788. Dr. Effiong
reviewed Plaintiff's lab results and scheduled a
follow-up appointment. Tr. at 789.
March 25, 2014, Plaintiff presented to F.C. Fetter Family
Health Center for a gynecologist visit. Tr. at 783-85. Sharon
Bullard, a family nurse practitioner, noted Plaintiff had
insomnia and instructed her to schedule a follow-up visit
with Dr. Effiong for diabetes mellitus in June 2014. Tr. at
April 5, 2014, Plaintiff presented to MUSC complaining of
right leg pain, which she described as sharp and constant in
the posterior aspect of her calf and up the back of her leg.
Tr. at 805-10. Plaintiff reported swelling of her leg with
numbness and tingling. Id. Plaintiff's blood
pressure was 164/104. Tr. at 806. The physical exam showed
minimal appreciable swelling of Plaintiff's right leg,
joint swelling, and a gait problem. Id.
Plaintiff's pain was exacerbated by a straight leg raise
(“SLR”) test. Id. Plaintiff's
strength was four out of five on the right. Id. Dr.
Brett W. McGary, M.D. (“Dr. McGary”), noted the
most likely cause of Plaintiff's pain was an exacerbation
of her peripheral neuropathy, as it appeared her glucose
levels were not adequately controlled due to the increased
insulin. Tr. at 807. He also noted she would likely benefit
from neuropathic modulating or receptor medications.
2, 2014, Bernard Arnold, O.D. (“Dr. Arnold”),
completed a vision exam of Plaintiff for a “South
Carolina Vocational Rehabilitation Department Disability
Determination Services Medical Summary.” Tr. at 815-18.
Plaintiff reported blurred vision and inability to drive. Tr.
at 816. In the diagnosis and prognosis section, Dr. Arnold
noted Plaintiff needed a prescription for reading glasses and
her vision was stable. Tr. at 818. Dr. Arnold opined
Plaintiff's mobility, visual activities, and fundus
photography were normal. Id. Dr. Arnold also opined
Plaintiff's work-related activities were “normal
(somewhat), ” and he recommended a “GDx or
equivalent due to CUD/DISC Rati.” Id.
5, 2014, Hugh Wilson, M.D. (“Dr. Wilson”), a
state agency consultant completed a physical residual
functional capacity (“RFC”) assessment. Tr. at
57-73. He indicated Plaintiff had the following limitations:
occasionally lift, carry, push or pull twenty pounds;
frequently lift, carry, push, or pull ten pounds; stand,
walk, or sit with normal breaks for about six hours;
frequently stoop, kneel, crouch, and crawl; and never climb
ladders, ropes, or scaffolds. Tr. at 59-60. In addition, he
opined Plaintiff should avoid concentrated exposure to
hazards, such as machinery or heights, because she
“[m]ay have dizziness from uncontrolled [blood
sugar].” Tr. at 60-61.
19, 2014, Plaintiff returned to F.C. Fetter for a follow-up
appointment with Dr. Effiong. Tr. at 824. Plaintiff reported
she quit her job because of neuropathic pain and had
difficulty standing due to pain and weakness in her leg.
Id. Plaintiff reported she had fallen twice in the
prior few weeks. Id. Plaintiff also reported having
nausea and vomiting daily, being stressed due to lack of work
and her medical conditions, and not sleeping. Id.
Dr. Effiong noted Plaintiff would need magnetic resonance
imaging (“MRI”) of her lower back, as she had a
positive SLR test, which potentially indicated ongoing disc
disease. Tr. at 827. Plaintiff was instructed to check her
blood sugar once a day, check her feet daily, and follow a
prescribed diet. Id. Dr. Effiong assessed diabetes
mellitus, gastroparesis, obesity, autonomic neuropathy, and
insomnia. Id. Dr. Effiong increased Novolog and
Reglan and started Gabapentin. Id.
18, 2014, Plaintiff presented to MUSC with complaints of
constant fatigue, abdominal pain, non-bloody vomiting, and
non-bloody diarrhea for five to six days. Tr. at 861.
Plaintiff reported she had been off her diabetic medication
since losing her job. Id. Plaintiff also indicated
she had not taken her Novolog because she had not felt like
eating. Tr. at 869. During the physical exam, Plaintiff was
tender in the epigastric area. Tr. at 863. Plaintiff's
glucose was 558, which decreased to 226 with the medications
given in the emergency room. Tr. at 863-64, 869. An x-ray of
Plaintiff's abdomen showed no acute intrathoracic or
abdominal process. Tr. at 923. The clinical impression
recorded during Plaintiff's visit was hyperglycemia,
nausea and vomiting, and diarrhea. Tr. at 869. It was noted
the primary care provider at F.C. Fetter “had utilized
social work to help [Plaintiff] pay for [L]evemir and
[N]ovolog” and she would have them “filled by
10, 2014, Angela Saito, M.D. (“Dr. Saito”), a
state agency consultant completed a physical RFC assessment
upon Plaintiff's request for reconsideration. Tr. at
82-97. She adopted the same exertional limitations as Dr.
Wilson, but opined Plaintiff had the following additional
postural and environmental limitations: occasionally climb
ramps or stairs; occasionally balance, stoop, kneel, crouch,
or crawl; and avoid all exposure to hazards, such as
“[u]nprotected hts for Endocrine imp.” Tr. at
83-84. Dr. Saito limited the RFC assessment to
the period of February 10, 2014, to February 10, 2015. Tr. at
82, 94. Moreover, Dr. Saito provided the following additional
explanation within her report:
Endo - Severe. Poorly controlled DM with evid of EOD disease.
see neuro and GI below.
Neuro - Severe. Autonomic neuropathy or other cause for
Syncope/Falling. Curious that clmt is not seen day of the
falls or syncope but a few days later. Has not had complete
evaluation or been referred to specialists yet. Neuropathic
pain in leg is a new symptom. MRI of Lumbar spine ordered
5/19/14 for positive SLT. MSK was o/w nl.
GI - Mention of Gastroparesis on 5/14. Admitted 3/13 for
“starvation ketosis”. Clmt's regular 5/13 wt
273 with BMI 40.31. Not severe.
Vision - n/s 5/2/14 Vision CE - c/o blurred vision. w/o
correction 20/30 bilat near 20/25. Mobility normal. work
related activities normal. visit normal.
Pain and limitations of leg pain are partially credible.
Atypical of diabetic neuropathy. W/u for lumbar radiculopathy
has been initiated with 5/14 order of MRI. Has not had trials
of medications for neuropathic pain as of yet.
Clmts sxs of blurred vision is credible but not to the degree
she has stated. Has 20/30 VA bilat. Could be result of high
MSS from Bernard Arnold that work related activities based on
patient's mobility and visual activities are normal
(somewhat). Great wt is given to this provider as it is not
inconsistent with the majority of objective evidence in the
file. It is unclear why Mr Arnold wrote
“somewhat”. This may be due to clmt's level
III obesity or possible blurred vision due to poorly
Clmt has a severe endocrine imp with some possible end organ
disease. She is undergoing a work up for peripheral
neuropathy v. lumbar radiculopathy. Her evaluation has
been incomplete. With further investigation and compliance
with appropriate treatment, clmt should be capable of the RFC
as outlined within one year.
Tr. at 84, 96 (emphasis added).
September 14, 2014, Plaintiff presented to Walter E.
Limehouse, M.D. (“Dr. Limehouse”), at MUSC with
complaints of blurred vision, fatigue, polydipsia, and
polyphagia for the prior week, noting she had been compliant
with treatment most of the time. Tr. at 870-80. Although
Plaintiff was taking insulin as prescribed, her blood glucose
level had been 400 or higher. Tr. at 870. The recorded
clinical impression was hyperglycemia and dehydration. Tr. at
880. Plaintiff was given fluids and medication. Id.
September 24, 2014, Plaintiff presented to MUSC with
complaints of high glucose, abdominal pain, nausea, and
vomiting. Tr. at 881-90. Plaintiff reported her gastroparesis
symptoms had been bad and she had not been eating much, so
she had not taken her Novolog in two weeks. Id. The
recorded clinical impression was hyperglycemia without
ketosis. Tr. at 889. Plaintiff's blood glucose improved
from over 500 to 282 with fluids and insulin, noting the
hyperglycemia was likely from not taking Novolog for two
November 21, 2014, Plaintiff presented to MUSC after
experiencing two syncopal events in two days. Tr. at 890-96.
Plaintiff reported her blood glucose had been in the 400s,
but as low as 60 to 80 at night. Id. Plaintiff
admitted she had stopped taking Novolog, as she had not been
eating, but she continued to take Levemir. Id.
Plaintiff's blood pressure was 160/92, and her glucose
was greater than 500. Tr. at 891-93. Plaintiff's syncope
presentation was consistent with orthostasis. Tr. at 895. She
was given fluids and insulin, and her blood glucose level
lowered to 280. Id. The recorded clinical
impressions were hyperglycemia, vasovagal syncope, type two
diabetes mellitus, nausea and vomiting, and leg pain.
Id. Results of an EKG reflected: sinus tachycardia,
possible left atrial enlargement, left ventricular
hypertrophy, nonspecific T wave abnormality, abnormal ECG,
and, “when compare[d] with ECG taken on June 18, 2014,
nonspecific T wave abnormality [was] now evident in lateral
leads.” Tr. at 926.
December 9, 2014, Plaintiff began treatment with Don A.
Schweiger, M.D. (“Dr. Schweiger”), for
uncontrolled diabetes. Tr. at 834. Plaintiff reported she had
lost over 100 pounds in the prior eight months, and Dr.
Schweiger noted she weighed 230 pounds, which was still
significantly overweight. Id. Plaintiff also
reported she had no appetite, vomited everything, had
weakness, and experienced stomach pain. Id. Dr.
Schweiger suspected diabetic gastroparesis. Id. Dr.
Schweiger's exam showed significant diabetic retinopathic
changes. Id. Dr. Schweiger's assessment was
diabetes mellitus, abdominal pain, hypertension, and diabetic
gastroparesis. Tr. at 834-35. He adjusted Plaintiff's
medications by stopping Norco; continuing Phenergan, Levemir
Flexpen, and Novolog; and starting Tramadol, Lisinopril, and
Metoclopramide. Tr. at 835. Dr. Schweiger scheduled a
follow-up appointment for Plaintiff because he needed medical
records from MUSC and F.C. Fetter. Id.
follow-up appointment with Dr. Schweiger on December 16,
2014, Plaintiff reported her nausea after meals persisted,
although she had seen some improvement after starting Reglan.
Tr. at 836-38. Plaintiff continued to report abdominal pain
after eating. Id. Her glucose was 545. Id.
Dr. Schweiger continued Lisinopril, NovoLog, Phenergan,
Metoclopramide, Tramadol; started
Lisinopril-Hydrochlorothiazide; increased Plaintiff's
Levemir; and referred her to Theodore Gourdin, M.D.
(“Dr. Gourdin”), a gastroenterologist, due to
“weight loss and poorly controlled diabetes with
gastroparesis.” Tr. at 836-37. Dr. Schweiger noted
Plaintiff was to follow up in one week because there was
“no charge until approved for Roper charity.” Tr.
December 18, 2014, Plaintiff had a computed tomography
(“CT”) scan of her abdomen and pelvis, which
showed the following: (1) small periumbilical hernia with
omentum extending into it, no associated dilatation of bowel;
(2) multiple small groundglass nodules within the right lower
lobe, which were presumed inflammatory; and (3) a small
appendicolith within a normal appearing appendix. Tr. at
December 23, 2014, Plaintiff saw Dr. Schweiger for a
follow-up appointment. Tr. at 839-40. Dr. Schweiger noted,
[H]ere for follow up patient problems or obesity hypertension
poorly controlled diabetes diabetic gastroparesis as well as
a newly identified pulmonary nodules and right lower lobe she
also has hyperlipidemia she is on a host of new medicines and
I will adjust some of her medicines as her A1c is 17-1/2. She
cannot be seen by endocrine until March. I also referred her
to surgery because of a[n] umbilical hernia noted and
abdominal pain I [am] not sure that her pain is from . . .
hernia [, ] other issues are weight loss which I believe is
related to poorly controlled diabetes.
Tr. at 839. Dr. Schweiger adjusted Plaintiff's
medications; assessed hypertension, diabetes mellitus,
diabetic gastroparesis, leg pain, hyperlipemia, and pulmonary
nodule; and ordered a CT chest imaging, without contrast, for
March 23, 2015. Tr. at 839-40; 856-57.
had two biopsies done on January 23, 2015. Tr. at 931-33. One
biopsy was of a small bowel mucosa designated duodenum, which
showed no diagnostic histologic abnormalities. Tr. at 932.
The other biopsy was of a gastric mucosa consistent with
antrum and showed inactive chronic gastritis and histologic
features consistent with reactive or chemical gastropathy.
Id. The biopsy was negative for helicobacter
organisms. Id. In addition, Plaintiff had a normal
upper endoscopy. Tr. at 931.
January 28, 2015, Plaintiff presented to Dr. Schweiger for a
follow-up appointment. Tr. at 841-44. Plaintiff reported
having headaches for three weeks, which she indicated could
be caused by her insulin. Tr. at 841. Dr. Schweiger assessed
hypertension, diabetes mellitus, diabetic gastroparesis,
pulmonary module, and hyperlipemia. Tr. at 842. Dr. Schweiger
adjusted medications and ordered several labs, including a
basic metabolic panel, hemoglobin A1C lab report, hepatic
function panel (liver), and lipid panel. Id.
February 17, 2015, Plaintiff presented to Simon Watson, M.D.
(“Dr. Watson”) at MUSC, with complaints of facial
pain on the left side of her face and full body aches. Tr. at
896-99. As to her facial pain, Plaintiff reported a sharp
pain in the upper aspect of her jaw when she opened and
closed her mouth. Id. As to her leg pain, Plaintiff
indicated her neuropathy was not well controlled, but she was
taking Tramadol for pain. Id. On exam, Plaintiff was
tender over the left temporomandibular joint, and the pain
was exacerbated by opening and closing her mouth. Tr. at 898.
Plaintiff had a normal motor exam in her bilateral lower
extremities, but reported subjective decreased sensation to
light touch. Id. Plaintiff's gait and stance
were normal. Id. The clinical impression was
peripheral neuropathy and facial pain. Tr. at 899.
February 23, 2015, Dr. Gourdin noted Plaintiff had a normal
upper endoscopy. Tr. at 931. Dr. Gourdin also noted Plaintiff
“overall states that she is doing much better
lately” and he “continue[d] her Nexium
February 26, 2015, Plaintiff saw Dr. Schweiger for a
follow-up appointment. Tr. at 845-48. Plaintiff reported pain
on the left side of her face and leg pain, which Dr.
Schweiger noted could be diabetic neuropathy. Id.
Dr. Schweiger noted his treatment options for Plaintiff had
been limited for insurance reasons, as she received Medicaid.
Id. He started Gabapentin, Amlodipine Besylate,
Crestor and Nexium. Tr. at 846.
March 5, 2015, Plaintiff became a patient of Sweetgrass
Endocrinology and saw Temple W. Simpson, P.A.
(“Simpson”) upon referral by Dr. Schweiger. Tr.
at 957-59. Plaintiff reported she had been diagnosed with
diabetes in 2007 or 2008 and felt her diabetes had never been
well controlled. Id. Plaintiff reported she started
with Metformin, which gave her gastrointestinal issues, then
placed on several insulins, and she expressed frustration
with her lack of control. Id. Simpson noted
Plaintiff had neuropathy, but her kidney function remained
intact and her diet consisted of whatever she could tolerate,
as she had abdominal pain and vomiting at times. Id.
During her examination, Simpson noted the diabetic
nephropathy screening was met by Plaintiff “currently
on ACE-I or ARE.” Id. Simpson assessed
Plaintiff for diabetes, hypertension, and hypercholesteremia.
Tr. at 958. Simpson continued Plaintiff on Levemir, Novolog,
Tradjenta, Lisinopril-Hydrochlorothiazide, Amlodipine
Besylate, and Atorvastatin Calcium. Id.
March 20, 2015, Plaintiff saw Simpson at Sweetgrass
Endocrinology for a follow-up appointment. Tr. at 960-61.
Simpson noted samples of Janumet and Invokana were given to
Plaintiff at the previous visit, but she developed
candidiasis. Tr. at 960. Simpson also noted she was not
recommending glucagon-like peptide 1 drugs due to
Plaintiff's ongoing gastrointestinal issues. Id.
Plaintiff's A1C was 10.3, down from 17. Tr. at 961.
Simpson continued Plaintiff on Levemir, Novolog, and Janumet.
March 25, 2015, Plaintiff presented to Dr. Schweiger,
complaining of pain in her feet, face, and right leg and
rating the pain intensity 10/10. Tr. at 849. Dr. Schweiger
attributed Plaintiff's facial pain to neuropathy.
Id. Plaintiff took Gabapentin and Tramadol for
neuropathic pain. Id. Dr. Schweiger noted he
believed Plaintiff's abdominal pain was “mostly
diabetic gastroparesis [as] she's had a thorough GI
April 3, 2015, Plaintiff presented to Dr. David Manning
French, M.D. (“Dr. French”) at MUSC, with
complaints of tightness in her chest, pain in her right arm
and flank, and vomiting. Tr. at 899. Plaintiff indicated the
pain had been going on for a week and continued to worsen,
despite taking Neurontin and Tramadol. Id. Plaintiff
reported her blood sugar ranged from 70 to 300 daily. Tr. at
899. Her blood pressure was 172/118 and her glucose was 308.
Tr. at 899-901. A chest x-ray showed no evidence of acute or
chronic cardiopulmonary disease. Tr. at 903, 924. Plaintiff
was given fluids, pain medication, and nausea medication. Tr.
at 904. The recorded clinical impressions were chest pain and
myalgia. Tr. at 901, 904.
April 14, 2015, Plaintiff presented to Jeffrey Paul
Caporossi, M.D. (“Dr. Caporossi”) at MUSC, with
complaints of yellow and green emesis and diarrhea. Tr. at
905-09. Plaintiff indicated a blood glucose level in the 200s
was “good for her.” Id. Plaintiff's
blood pressure was 220/137. Tr. at 906. On exam, Plaintiff
had mild ...