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

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Right Total Hip Replacement Patient, also Suffering from Diabetes Mellitus with Neuropathy and Amputation of the Toes of the Right Foot: Fully Favorable Social Security Disability Decision

Right Total Hip Replacement Patient, also Suffering from Diabetes Mellitus with Neuropathy and Amputation of the Toes of the Right Foot: Fully Favorable Social Security Disability Decision

Disabilities: total hip replacement and diabetes mellitus

Notice of Decision: Fully Favorable

Office of Disability Adjudication and Review (ODAR): Providence, Rhode Island

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, 2013.

2. The claimant has not engaged in substantial gainful activity since November 3, 2008, the alleged onset date (20 CFR 404.1520(b) and 404.1571 et seq.).

3. The claimant has the following severe impairments: right total hip replacement status post fracture, diabetes mellitus with neuropathy and amputation of the toes of the right foot (20 C:FR 404.1520(c)).

4. The severity of the claimant's impairments medically equals the criteria of Section 1.03 of 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525 and 404.1526).

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's impairments medically equal Listing 1.03 Reconstructive surgery of a major weight-bearing joint. [A Medical Expert], testified that the claimant sustained
a fracture of the femoral neck on the right hip with a subsequent right hip replacement. He further testified that the claimant has brittle diabetes with balance problems due to the loss of his toes on the right foot. He has significant ambulatory and balance problems due to the hip replacement and loss of the toes. [The Medical Expert] concluded that the claimant equals Section 1.03 of the listed impairments due to an inability to ambulate effectively.

The medical evidence reveals that the claimant sustained an injury to his right hip in November of 2008 after a fall. He underwent right hip replacement on November 7, 2008. Postoperatively, he became septic and it was discovered that the source of the sepsis was a gangrenous gallbladder. On November 13, 2008, he underwent laparoscopic cholecystectomy (Exhibit IF). Following surgery, he was transferred to a rehabilitation program for physical therapy (Exhibit 4F).

[A doctor] evaluated the claimant in January of 2009. He observed that the claimant
was using crutches for ambulation. He had difficulty getting in and out of the chair and he did not fully extend his knee when he walked. An x-ray of the right hip showed ectopic calcification superior to the prosthesis, which was present before the surgery (Exhibit 2F). By March of 2009, the claimant presented with increased edema in the legs. He was advised to wear stockings and elevate legs as needed (Exhibit 4F).

[Another doctor] evaluated the claimant at the request of the state agency in October of 2009 for right hip pain and ambulating with a cane due to balance problems. Examination revealed that he clearly favored his right hip. [The doctor] opined that the claimant could not perform his past work due to limitations in lifting because of the right hip (Exhibit l0F). Following this evaluation, the claimant presented to the emergency [room] with right hip pain after falling (Exhibit 16F).

In July of 2010, an EMG revealed evidence of severe axonal sensorimotor polyneuropathy and severe distal median neuropathy with evidence of denervation consistent with carpal tunnel syndrome (Exhibit 19F). The claimant presented a few months later with complaints of bilateral leg numbness. He continued to ambulate with a cane and a slow and steady gait (Exhibit 19F).

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.

The Undersigned affords great weight to the opinion of [the Medical Expert] as he had the advantage of reviewing the entire medical record, including the testimony of the claimant at the hearing.

The State agency medical consultants' physical assessments are given little weight because other medical opinions are 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 consultants.

5. The claimant has been under a disability as defined in the Social Security Act since November 3, 2008, the alleged onset date of disability (20 CFR 404.1520(d)).

DECISION

Based on the application for a period of disability and disability insurance benefits filed on November 13, 2008, the claimant has been disabled under Sections 216(i) and 223(d) of the Social Security Act since November 3, 2008.