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Fibromyalgia Patient also Suffering from Osteomyelitis of the Right Lower Extremity: Fully Favorable Social Security Disability Decision

Fibromyalgia Patient also Suffering from Osteomyelitis of the Right Lower Extremity: Fully Favorable Social Security Disability Decision

Disabilities: fibromyalgia and osteomyelitis

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, the undersigned makes the following findings:

1. The claimant's date last insured is December 31, 2010.

2. The claimant has not engaged in substantial gainful activity since August 18, 2008, the alleged onset date (20 CFR 404.1520(b) and 404.1571 et seq.).

3. The claimant has the following severe impairments: fibromyalgia and osteomyelitis of the right lower extremity (20 CFR 404.1520(c)).

The impairments listed above have been established by the evidence of record and are "severe" within the meaning of the regulations because they impose more than a minimal limitation on the claimant's ability to perform basic work activities (20 CFR 416.920(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 and 404.1526).

The undersigned finds that the severity of the claimant's physical impairments does not meet the criteria of any listed impairments described in Appendix 1 of the Regulations (20 CFR, Subpart P, Appendix 1). The undersigned has specifically considered the criteria of section 1.06 regarding fracture of the femur, tibia, pelvis, or one or more of the tarsal bones. No treating or examining physician has proffered findings that are equivalent in severity to the criteria of these or any other listed impairment. In reaching this conclusion, the undersigned has considered the opinions of the state agency medical consultants who evaluated this issue at the initial and reconsideration levels of the administrative review process and reached the same conclusion (20 CFR 404. 1527(f) and 416.927(f); SSR 96-6p).

Further, although there is no independent listing for fibromyalgia, the undersigned has
considered the effect of that impairment in evaluating whether the claimant meets or equals a listing.

5. The claimant has the residual functional capacity to perform sedentary work as
defined in 20 CFR 404.1567(a) except for the substantial loss of ability to meet the demands of basic work related activities on a sustained basis.

In making this finding, the undersigned 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 SSRs 96-4p and 96-7p. The undersigned has also considered opinion evidence in accordance with the requirements of 20 CFR 404.1527 and SSRs 96-2p, 96-6p and 06-3p.

The claimant alleges disability primarily due to symptoms of a long-standing chronic pain syndrome, fibromyalgia, including diffuse pain of the bilateral elbows and knees that radiates through the bilateral wrists, hands, and feet (Exhibits 3E, 4E, 7E; Hearing Testimony). The claimant reports that his pain is constant, although it is somewhat dulled with the daily use of prescription medication (Id.). The claimant further reports that his pain syndrome prevents him from lifting any amount of weight, sitting or standing for prolonged periods of time, or walking for more than a very short distance (ld.). The claimant also states that he experiences significant side-effects from his medication, such as difficulty with balance, concentration, and coordination (Id.).

The medical evidence of record corroborates the claimant's allegations regarding his physical impairments. The record indicates that the claimant has experienced symptoms of a chronic pain syndrome for more than 10 years, characterized by generalized stiffness, generalized tender trigger points, and decreased functionality (Exhibits 1F, 13F). The record further indicates that a significant increase in the severity of the claimant's symptoms coincided with the development of osteomyelitis of the right lower extremity in August of 2008 (Exhibits 12F, 14F). The claimant developed osteomyelitis after two nails punctured the bones of his right foot, causing a subsequent infection (Id.). Prior to having the diagnosis of osteomyelitis, the claimant had been treating the symptoms of his chronic pain syndrome with a rheumatologist... and had been prescribed amitriptyline (Id.). After his diagnosis with osteomyelitis, he began to complain of worsening joint aches and pains... (Exhibits 9F, 17F, 18F). The claimant presented to [his doctor] complaining of generalized pain around his shoulders, upper, mid, and lower back, neck and wrists, and was prescribed Percoset in addition to his other medications (Id.). The record indicates that the claimant has also treated with a neurologist... who has added desipramine and demerol to the claimant's regimen of medication (Exhibit 18F).

After considering the evidence of record, the undersigned finds 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.

As for the opinion evidence, the undersigned has considered the opinion of primary care
physician who opined that the claimant could only sit or stand for approximately 10 minutes at one time, for a total of less than two hours out of an 8-hour day (Exhibit 22F). The primary care physician further noted that the claimant's ability to ambulate is significantly affected by his impairments, including the inability to walk a block at a reasonable pace, inability to walk on rough or uneven surfaces, inability to perform routine ambulatory activities such as shopping and banking, and the inability to climb a few steps at a reasonable pace with the use of a single hand rail (Id.). He ultimately concluded that the claimant "cannot work" (Id.). Although the ultimate determination of disability is a matter reserved to the Commissioner under the regulations, the undersigned nonetheless concurs with his opinion and gives it great weight, as it is consistent with the record as a whole. In addition, as the claimant's primary care physician for the past 3+ years, [the doctor] is in a strong position to judge his abilities and limitations.

The State agency medical consultant's physical assessment is given little weight because [the primary care physician's] opinion is more consistent with the record as a whole, and evidence received at the hearing level shows that the claimant is more limited than determined by the State agency consultant.

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

The claimant has past relevant work as a compounder at a glue company and as a restaurant cook (Exhibit 2E; Hearing Testimony). In comparing the claimant's residual functional capacity with the physical and mental demands of this work, the undersigned finds that the claimant is unable to perform his past relevant work as it is actually and generally performed.

7. The claimant was a younger individual age 45-49 on the established disability onset date (20 CFR 404.1563).

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

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

The undersigned has found that the claimant has limitations that prevent him from performing any work on a regular and continuing basis. Therefore, there is no issue with respect to transferable skills.

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(c) and 404.1566).

In determining whether a successful adjustment to other work can be made, the undersigned 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 201.21. 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 Rulings 96-8P & 96-9P.

11. The claimant has been under a disability as defined in the Social Security Act since August 18, 2008, the alleged onset date of disability (20 CFR 404.1520(g)).

DECISION

Based on the application for a period of disability and disability insurance benefits filed on March 9, 2009, the claimant has been disabled under sections 216(i) and 223(d) of the Social Security Act since August 18, 2008.