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Blumenstein v. Berryhill

United States District Court, M.D. Pennsylvania

November 15, 2017

NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.

          Chief Judge, Conner



         I. Introduction

         Social Security Administrative Law Judges face a singularly demanding task. They are required to make a series of legal, medical and factual judgments in the course of adjudicating disability claims. They perform this task against the backdrop of a five-step sequential analytical paradigm. Oftentimes, the ALJ's task is complicated by the fact that a claimant submits only sparse and sporadic medical records in support of a disability claim, or the ALJ is presented with a case in which there is no competent medical opinion describing a claimant's functional capacity.

         So it is in this case. In the instant case we are called upon to review a decision by a Social Security Administrative Law Judge (“ALJ”) that found that the plaintiff, Cheryl Blumenstein, could perform a limited scope of light work, and concluded that she was not disabled. Blumenstein now challenges this determination arguing that the ALJ erred in failing to treat some doctors' diagnoses as tantamount to a medical opinion regarding disability. Blumenstein also asserts that the ALJ erred in failing to give greater credence to her claims of on-going disabling impairments, even though the medical records only demonstrated that Blumenstein received conservative treatment for chronic conditions. Finally, Blumenstein argues that the ALJ erred in formulating a residual functional capacity in her case based upon the fragmentary information that she presented to that ALJ.

         Given the deferential standard of review that applies to Social Security Appeals, which calls upon us simply to determine whether substantial evidence supports the ALJ's findings, we conclude that substantial evidence exists in this case which justified the ALJ's decisions that led to the denial of this particular claim. Therefore, for the reasons set forth below, we recommend that the district court affirm the decision of the Commissioner in this case.

         II. Statement of Facts and of the Case

         Cheryl Blumenstein applied for supplemental security income benefits on July 24, 2013, alleging an onset of disability some four years earlier, in March of 2009. (Tr. 64.) According to Blumenstein, she was disabled due to degenerative disc disease of the lumbar spine and the effects of arthroscopic surgery. (Tr. 66.) At the time of the alleged onset of her disability in March of 2009, Blumenstein was a younger worker, approximately 42 years old.

         Blumenstein's disability application was unusual in several respects. First, Blumenstein's employment history was notable in its lack of detail and consistency. Blumenstein reported that she had a high school educational equivalency, but had reported no employment or earnings until she was approximately 30 years old. (Tr. 218.) Once Blumenstein began working, she then displayed an erratic and uneven employment history spanning from 1996 through 2014, an employment history marked by years in which she did not work or was employed only for brief and fleeting periods. (Id.)

         This enigmatic employment history was matched in some respects by Blumenstein's medical history, which also contained unexplained gaps in care and treatment. For example, while Blumenstein reported that she was totally disabled beginning in March of 2009, she did not apply for SSI until July 2013, more than four years later. (Tr. 178.) Moreover, although Blumenstein alleged that her disability was based on lumbar back problems, she presented no medical treatment records whatsoever spanning between 2008, the year before she alleged disability, and September 2012, the year before she applied for disability benefits. (Tr. 178.)

         Furthermore, with respect to her principal medical complaint, low back pain, the records that Blumenstein provided to the ALJ came from several treating sources, her primary care physician Dr. Varkey, and two pain management specialists, Drs. Malayil and Sandhu, but did not disclose totally disabling medical conditions. On this score, in September 2012, Blumenstein presented to Dr. Varkey, requesting narcotic medication[1] for right knee pain and swelling that started only four-to-six weeks earlier. (Tr. 333-42.) Notwithstanding her pain, Blumenstein reported that she was able to play with her adopted kids and go up and down a great deal; her routine walking was “not too bad.” (Tr. 348.) Dr. Varkey referred Blumenstein to an orthopedist to care for her knee, and continued to treat Blumenstein for a series of routine medical matters, as well as addressing Blumenstein's complaints of chronic back pain.

         In the course of this treatment, in 2013, shortly after she applied for disability benefits, Blumenstein was seen by Dr. Varkey complaining of low back pain. (Tr. 403.) Dr. Varkey initially treated this condition in a conservative fashion, referring Blumenstein to physical therapy. While Blumenstein underwent some physical therapy sessions, she discontinued this therapy because she reported that she did not find it to be beneficial. (Tr. 301-02, 397, 403.) Instead, Blumenstein returned to Dr. Varkey, seeking narcotic pain killers. In response to these requests, Dr. Varkey warned Blumenstein of the addiction potential of these drugs and advised her that narcotic pain medication would not be “ongoing.” (Tr. 397.)

         Given Blumenstein's complaints, in the summer of 2013, at Dr. Varkey's referral, John P. Malayil, M.D., a pain management physician, met with Blumenstein and scheduled ablation treatment, a procedure used to reduce pain, for her lumbar condition. (Tr. 287, 292-96, 322.) Dr. Malayil also prescribed Percocet and naproxen for Blumenstein. (Tr. 299, 372, 476.) By the end of 2013, Blumenstein was reporting that she was initially pleased with the results of this treatment and was doing “quite well” on her medications. (Tr. 299.) Dr. Varkey and Dr. Malayil both noted that physical examinations of Blumenstein indicated that she had intact strength of the bilateral lower extremities with normal motor and sensory functioning. (Tr. 299, 368, 374, 379, 473.) Blumenstein also reported an ability to perform activities of daily living. (Tr. 292.) When Blumenstein reported some continued discomfort in early 2014, Dr. Malayil diagnosed her with findings suggestive of moderate-to-severe facet arthropathy, a degenerative condition of the lumbar spine. Dr. Malayil then repeated ablation treatments in April of 2014, and advised Blumenstein that he would discontinue Percocet for long-term use. (Tr. 290, 471, 474, 476, 509.)

         In the Spring of 2015, Dr. Varkey referred Blumenstein to a second pain management physician, Amanpreet Sandhu, M.D., for treatment of what Blumenstein described as an exacerbation of her low back and leg pain. (Tr. 499, 504, 515, 519, 525.) Dr. Sandhu prescribed oxycodone and other pain medications, but otherwise found that Blumenstein experienced no tenderness, full lower extremity strength and range of motion, also noting normal sensation, gait, and deep tendon reflexes. (Tr. 500.)

         As for Blumenstein's second presenting medical concern, her arthroscopic surgery, in September of 2012, Dr. Varkey referred Blumenstein to an orthopedist, Robert N. Richards, M.D., for treatment. (Tr. 341.) Approximately one month later, in October of 2012 Blumenstein underwent arthroscopy on her right knee. (Tr. 282.) The records of this treatment were unremarkable. Dr. Richards noted that Blumenstein was in “good health, ” had no significant medical problems other than minimal arthritic changes with good bone quality, and indicated that she could be active for four-to-six hours at a time post-surgery. (Tr. 285, 354, 363.) Dr. Varkey likewise noted at most minimal or trace edema and advised Blumenstein that she should wear a pressure stocking, lower her salt intake, and ask her surgeon for ...

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