Helping the people of Massachusetts, New Hampshire and Rhode Island with Social Security Disability

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Cervical and Lumbar Degenerative Disc Disease with Lumbar Spine Stenosis Patient also Suffering from Right Hip Osteoarthritis and Bursitis: Fully Favorable Social Security Disability Decision

Cervical and Lumbar Degenerative Disc Disease with Lumbar Spine Stenosis Patient also Suffering from Right Hip Osteoarthritis and Bursitis: Fully Favorable Social Security Disability Decision

Disabilities: degenerative disc disease, osteoarthritis, and bursitis

Notice of Decision: Fully Favorable

Office of Disability Adjudication and Review (ODAR): Boston, Massachusetts

FINDINGS OF FACT AND CONCLUSIONS OF LAW

After careful consideration of the entire record, I make the following findings:

1. The claimant's date last insured is June 30, 2013.

2. The claimant has not engaged in substantial gainful activity since January 12, 2009, the alleged onset date (20 CFR 404.1520(b), 404.1571 et seq., 416.920(b) and 416.971 et seq.).

3. The claimant has the following severe impairments: cervical and lumbar degenerative disc disease with lumbar spinal stenosis; and right hip osteoarthritis and bursitis (20 CFR 404.1520(c) and 416.920(c)).

The claimant is a forty-one-year old woman who presently resides in... Massachusetts. The claimant has a longstanding history of lower-back and neck pain. The
claimant's lumbar MRI's reveal significant degenerative changes at the L4/5 level with a
moderately large disc herniation and endplate changes at L5/S1 with an annular tear and bilateral S1 nerve root encroachment (Ex. 14F). In November of 2009, the claimant underwent electromyography (EMG) testing that showed evidence of an "L5 and S1 root injury with active and chronic denervation with reinnervation changes" (Ex. 25F). With respect to the claimant's neck impairment, her cervical MRI's reveal cervical spondylosis with a right-sided osteophyte effacing the ventral thecal sac and cord at C4/5 (Ex. 10F). The claimant has tried multiple treatment modalities for her neck and back pain with limited success, including physical therapy, narcotic pain medications, and epidural steroid injections (Ex. 8F). Based upon the ineffectiveness of these conservative treatments, the claimant's physicians are now evaluating more aggressive treatment options, such as decompression surgery (Id.).

The claimant has also begun to experience persistent bilateral hip pain. The claimant's hip pain was previously primarily right-sided, but she reports that her left hip has become increasingly painful in recent months. The claimant's September 2010 right hip x-rays revealed bursitis and osteoarthritis with a superolateral osteophyte at the femoral head (Ex. 23F). [The claimant's doctor] indicated that the claimant may be a candidate for hip replacement if her arthritis continues to progress over time (Id.).

The claimant testified that she is no longer able to work because of her constant back and hip pain. She stated that she is required to lie down for two to three hours per day to alleviate her severe pain. She indicated that she has begun to experience numbness in her hands and fingers secondary to her spinal conditions. The claimant also testified that she can only walk for about ten minutes at time and is limited to lifting and carrying less than a gallon of milk. The claimant's multilevel degenerative disc disease and right hip osteoarthritis and bursitis constitute severe impairments in that they significantly limit her ability to do basic work-related activities (20 CFR 404.1520(c)).

4. The claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1(20 CFR 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).

The claimant's spinal impairments do not meet or equal the criteria of Section 1.04 (Disorders of the Spine) of the Listings of Impairments (Listings). Although the record contains some diagnostic evidence of nerve root compression, it is not characterized by neuro-anatomic distribution of pain, motor loss, or reflex loss as required by Section 1.04A of the Listings. Similarly, the claimant does not have any confirmed spinal arachnoiditis diagnosis as required by Section 1.04B of the Listings and does not lack the ability to ambulate effectively as required by Section 1.04C of the Listings.

5. The claimant has the residual functional capacity to perform sedentary work as
defined in 20 CFR 404.1567(a) and 416.967(a) except that the claimant: can only sit for one hour at a time and for a total of less than two hours in an eight-hour workday; can only stand for one hour at a time and for a total of less than two hours in an eight-hour workday; requires the ability to freely alternate between sitting and standing throughout the workday; requires the ability to take unscheduled breaks throughout the workday; can only frequently lift/carry less than ten pounds and can never lift/carry more than ten pounds; cannot perform any work-related stooping or crouching; must avoid concentrated exposure to cold temperatures; and will likely incur in excess of four unscheduled absences per month on account of her impairments.

In making this finding, I considered all symptoms and the extent to which these symptoms can reasonably be accepted as consistent with the objective medical evidence and other evidence, based on the requirements of 20 CFR 404.1529 and 416.929 and SSRs 96-4p and 96-7p. I have also considered opinion evidence in accordance with the requirements of 20 CFR 404.1527 and 416.927 and SSRs 96-2p, 96-6p and 06-3p.

In finding that the claimant is limited to less than the full range of sedentary work, I have given controlling weight to the January 18, 2010 residual functional capacity assessment of her primary care physician ...(Ex. 27F). [The doctor's] opinion that the claimant has the limitations detailed in the above finding is well-supported by the objective medical evidence surrounding the claimant's neck, back, and hip impairments and is not inconsistent with other substantial evidence in the case record (SSR 96-2P). Specifically, [her] opinion is well supported by the claimant's: lumbar MRI's revealing significant degenerative changes at the L4/5 level with a moderately large disc herniation and endplate changes at L5/S1 with an annular tear and bilateral S1 nerve root encroachment (Ex. 14F); cervical MRI's revealing spondylosis a right-sided osteophyte effacing the ventral thecal sac and cord at C4/5 (Ex. 10F); and EMG test evidencing an L5 and SI root injury (Ex. 25F). Moreover, her opinion is consistent with the claimant's hearing testimony regarding her symptoms and limitations, which I find to be credible.

After considering the evidence of record, I find that the claimant's medically
determinable impairments could reasonably be expected to produce the alleged symptoms, and that the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are generally credible.

I have given, the State agency medical consultants' physical assessments little weight because [the primary care physician's] opinion is more consistent with the record as a whole. Furthermore, the State agency consultants did not adequately consider the claimant's subjective complaints, which I find to be credible in light of the supporting objective medical evidence.

6. The claimant is unable to perform any past relevant work (20 CFR 404.1565 and
416.965).

As the claimant presently lacks the ability to perform even the full range of sedentary
work, the demands of the claimant's past relevant work exceed her residual functional capacity.

7 . The claimant was a younger individual age 18-44 on the established disability onset date (20 CFR 404.1563 and 416.963).

8. The claimant has at least a high school education and is able to communicate in
English (20 CFR 404.1564 and 416.964).

9. The claimant's acquired job skills do not transfer to other occupations within the
residual functional capacity defined above (20 CFR 404.1568 and 416.968).

Transferability of skills is not an issue in this appeal as the claimant's impairments
preclude her from performing work at any exertional level.

10. Considering the claimant's age, education, work experience, and residual functional capacity, there are no jobs that exist in significant numbers in the national economy that the claimant can perform (20 CFR 404.1560(e), 404.1566, 416.960(e), and 416.966).

In determining whether a successful adjustment to other work can be made, I must
consider the claimant's residual functional capacity, age, education, and work experience in conjunction with the Medical-Vocational Guidelines, 20 CFR Part 404, Subpart P, Appendix 2. If the claimant can perform all or substantially all of the exertional demands at a given level of exertion, the medical-vocational rules direct a conclusion of either "disabled" or "not disabled" depending upon the claimant's specific vocational profile (SSR 83-11). When the claimant cannot perform substantially all of the exertional demands of work at a given level of exertion and/or has nonexertional limitations, the medical-vocational rules are used as a framework for decisionmaking unless there is a rule that directs a conclusion of "disabled" without considering the additional exertional and/or nonexertional limitations (SSRs 83-12 and 83-14). If the claimant has solely nonexertional limitations, section 204.00 in the Medical-Vocational Guidelines provides a framework for decisionmaking (SSR 85-15).

If the claimant had the residual functional capacity to perform the full range of sedentary work, considering the claimant's age, education, and work experience, a finding of "not disabled" would be directed by Medical-Vocational Rule 201.28. However, the additional limitations so narrow the range of work the claimant might otherwise perform that a finding of "disabled" is appropriate under the framework of this rule. This conclusion is supported by Social Security Ruling(s) 96-8p and 96-9p.

11. The claimant has been under a disability as defined in the Social Security Act since January 12, 2009, the alleged onset date of disability (20 CFR 404.1520(g) and 416.920(g)).

DECISION

Based on the application for a period of disability and disability insurance benefits filed on July 13, 2009, the claimant has been disabled under sections 216(i) and 223(d) of the Social Security Act since January 12, 2009.

Based on the application for supplemental security income filed on July 13, 2009, the claimant has been disabled under section 1614(a)(3)(A) of the Social Security Act since January 12, 2009.

The component of the Social Security Administration responsible for authorizing supplemental security income will advise the claimant regarding the nondisability requirements for these payments and, if the claimant is eligible, the amount and the months for which payment will be made.

Medical improvement is expected with appropriate treatment. Consequently, a continuing
disability review is recommended within 8 to 12 months.