United States District Court, W.D. Missouri, Western Division
NANETTE K. LAUGHREY, District Judge.
Plaintiff Constance Harper appeals the Commissioner of Social Security's final decision denying her application for disability insurance benefits. The decision is affirmed.
A. Work history
Harper was born in 1954 and has a high school education. The vocationally-relevant years for purposes of her application are April 1998 to April 2013. Except for 2001, Harper's work history reflects substantial gainful activity every year from 1998 to when she stopped working in March 2011.
Specifically, Harper worked as a Building Permit Tech for the City of Lenexa from August 1984 to January 2000, a position including in-office clerical and administrative responsibilities such as scheduling inspections, doing paperwork and filing, and answering general questions from the public. She also worked as a Building Permit Tech for the City of North Platte from April 2002 to May 2005. There, she reviewed plans and issued permits, and went into the field by car to do residential inspections.
From November 2005 to May 2006, Harper worked for the City of Fairway, Kansas as an office clerk for the "Police Building/Court Office." [Tr. 27.] The job included data entry, working at the front desk to collect money for traffic tickets and dog licenses, making daily reports of collections, and working with new inspectors. Harper also worked part-time in 2006 as a hostess at an Olive Garden restaurant.
At the end of 2006, Harper went to work as a "nanny-house manager" for a family with three children, ages six months to four years old, 50-55 hours per week (five days per week, ten to eleven hours per day). [ Id. ] Harper left the job in July 2010 to work for a family with two small children, 25 hours per week (five days per week, five hours per day). Her last day of substantial gainful activity was March 25, 2011, when she quit the second nanny job in March 2011 to have surgery for breast cancer.
When Harper filed her application for benefits on January 31, 2011, she alleged disability beginning January 1, 2004, based on vision issues and peripheral neuropathy. At her hearing in January 2013, she amended the alleged onset disability date to July 1, 2010, and claimed disability due to vision problems; breast cancer; diabetes; neuropathy; diarrhea; pain in her limbs, neck and lower back; depression; and side effects of medications.
B. Medical record
Harper had laser eye surgery in 2003, which made her left eye worse. She was diagnosed with bilateral diabetic retinopathy in 2006 and her left eye was treated for cystoid macular edema with a steroid injection. In April 2007, Harper had 20/300 corrected vision in the left eye and 20/20 in the right. In 2011, Harper underwent a cosmetic blepharoplasty. [Tr. 898.] At the end of 2012, Harper had 20/200 corrected vision in the left eye and 20/40 in the right. A consultative ophthalmologic examination, performed in early 2013 at the request of the ALJ, showed 20/400 corrected vision in the left eye and 20/40 corrected vision in the right eye. The consultant's impression was bilateral diabetic retinopathy, related to type 2 diabetes.
2. Breast cancer
Harper had a left total mastectomy and sentinel node biopsy in March 2011. At an April 2011 follow up, review of her symptoms was negative except for report of pain at a level of 2 out of 10 at the surgical site. At a May 2011 follow up, Harper declined chemotherapy, and began anti-hormonal therapy. She had reconstructive surgery in June 2011. At an August 2011 follow up, she had mild generalized weakness, and mild dry heaves and gagging. Her pain rating was zero and her Eastern Cooperative Oncology Group (ECOG) status was "0, fully active, able to carry on all pre-disease performance without restriction." [Tr. 18.] At a September 2011 follow up, Harper complained of left side chest soreness. In October 2011, there was no evidence of recurrence. She complained of pain rated at the level of 4. The physician noted her status was "fully active, able to carry on all pre-disease performance without restriction." [ Id. ] At a March 2012 doctor visit, Harper was noted to be "doing well." [ Id. ] A physical exam showed she had normal upper and lower extremity strength; and her neurological exam was grossly intact. In April 2012, Harper found a mass in her right breast; a biopsy was negative. At August and October 2012 follow ups, Harper's pain rating was zero and ECOG status was "fully active, able to carry on all pre-disease performance without restriction." [ Id. ]
3. Type 2 diabetes
Harper had gastric bypass surgery in 2004 to help address her type 2 diabetes, and lost 100 pounds. In November 2012, Harper's primary care physician, Danielle Stebbins, M.D., noted Harper's diet and compliance were good most of the time, she had sporadic home glucose monitoring, she had had no hypoglycemic reactions, and her diabetes was under good control.
4. Neuropathy, carpal tunnel syndrome, and other complaints of pain
Harper was examined by Dr. Stebbins in October 2009 and had no complaints of neuropathy. At a February 2011 visit with Dr. Stebbins, Harper complained of a 10-year history of leg neuropathy, and the recent development of neuropathy in her arms. Harper told the doctor she was unable to feel heat, tripped when walking, dropped things she was holding, and had some weakness and numbness. The doctor assessed peripheral neuropathy, with sensation impaired below the knees and elbows bilaterally.
Harper was referred to Mamatha Pasnoor, M.D. and had a nerve conduction study in November 2011 to evaluate possible neuropathy. The results were normal. At a follow up with Dr. Pasnoor in October 2012, Harper complained of an increased burning sensation in her right thigh. A skin biopsy performed on the right leg suggested small fiber neuropathy. Dr. Pasnoor's assessment was painful diabetic peripheral neuropathy, presently stable on pain medications, and bilateral meralgia parasthetica. Under "Plan, " the doctor included continuing to do exercise. [Tr. 947.] The doctor also noted having talked to Harper about participating in an exercise study, but that "[Harper] takes care of her grandchildren during the day and therefore will have difficulty coming in for the visits." [ Id. ] The doctor instructed Harper to return in six months or sooner if symptoms progressed.
Harper saw Steven Bormann, M.D., for a cardiology follow up in March 2012. The physical assessment included examination of Harper's upper and lower extremities, which the doctor noted had "normal strength, alignment and mobility, [and] no deformity." [Tr. 933.] Harper's neurological assessment was noted as "grossly intact." [ Id. ] The doctor noted Harper was "doing well." [ Id. ]
In June 2012, Harper, who is right handed, saw a surgeon, Bruce Toby, M.D., about carpal tunnel syndrome. She reported having had surgery for carpal tunnel syndrome on the right side five years earlier, with good results, and that she had been having symptoms on the left side for a year. Electrodiagnostic studies were performed and Dr. Toby diagnosed left-hand carpal tunnel syndrome. Harper underwent a left endoscopic carpal tunnel release. At an August 2012 follow-up, she reported that her symptoms were completely resolved. Dr. Toby noted on physical examination that her incisions were healing well.
The medical record also showed Harper was treated after two accidents in 2010. In March 2010, Harper had a car accident and sustained whiplash, for which she received chiropractic treatment. In May 2010, she fell when she was getting out of a truck, and went to the emergency room with complaints of abdominal injury and severe pain including lower back pain. Her x-rays and a CT scan showed no acute abnormalities, except a hemangioma. She had some chiropractic treatments.
A May 2011 bone scan, related to Harper's breast cancer treatment, showed severe osteopenia, placing Harper at moderate to high risk for fracture. Exercise and Vitamin D and calcium supplements were recommended.
In January 2013, Harper complained to Dr. Stebbins of neck pain, relating it to the March 2010 accident. An x-ray was normal and the doctor ...