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Dickinson v. Colvin

United States District Court, W.D. Missouri, Southern Division

August 15, 2016

CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.



         Clinton Dickinson appeals the Commissioner of Social Security's final decision denying his application for disability insurance benefits. The Commissioner's decision is affirmed.

         I. Background

         Dickinson was born in 1974 and left high school after completing the eighth grade. He has worked as a furniture mover, lumber handler, delivery driver, and warehouse worker, but has not worked since August 1, 2011. He claims disability based on back problems, among other conditions.

         A. Medical history

         Dickinson went to the emergency room in September 2011 complaining of back pain after moving a heavy recliner chair. He reported moderate pain and stated he had never experienced similar symptoms before. On examination, he did not appear to be in any distress, and displayed normal motor strength in the arms and legs, normal gait, normal straight leg raise bilaterally, and intact cranial nerves and sensory abilities. He was diagnosed with lumbar strain, prescribed pain medicine, an anti-inflammatory and muscle relaxer.

         He saw Richard Griffith, M.D. at Jordan Valley Community Health Center in November 2011, complaining of back and knee pain after "overexert[ing] himself while deer hunting[.]" Tr. 500. Dr. Griffith noted Dickinson's general medical exam was normal and that Dickinson "OK" to search for work despite his lower back pain. Tr. 501.

         Dickinson complained to his doctor of low back pain after changing a tire in January 2012 and after washing the car in February 2012. In May 2012, a CT scan of Dickinson's spine was unremarkable, but minimal spurring suggested posterior disk bulge at L4-L5, and an MRI was recommended. He saw Dr. Griffith in June, July, September, October, and November 2012. His medications for back pain were refilled and the doctor referred him for a neurological consultation. He saw Dr. Griffith in January 2013 for follow up of pain management, reporting that the pain medication was working well.

         In July 2013, Chad Morgan, M.D., a neurologist at Springfield Neurological & Spine Institute, reviewed Dickinson's films. The doctor concluded Dickinson did "not have any surgical issues from the imaging provided [and] would likely benefit from conservative therapy." Tr. 443.

         Later the same month, Dickinson saw Randal Hamric, M.D. at Jordan Valley for medication refills and said he had had "right leg pain since 2010." Tr. 464. Dr. Hamric noted he had not yet heard from Dr. Morgan, but that the prior CT showing minimal disk bulge. Under Assessment and Plan, the doctor wrote that he would "continue [pain medications] for a few more months but did discuss weaning if no or normal MRI[.]" Tr. 466.

         Dickinson next saw Dr. Hamric on August 6, 2013, complaining of right-sided pain from shoulder to leg and that extended walking caused leg numbness. Dr. Hamric noted Dickinson's CT and x-rays had shown "essentially normal" results, and had been reviewed by a doctor at the spine clinic who concluded there were no treatable lesions. Tr. 461. Dr. Hamric noted Dickinson "kept trying to describe why he still needed pain medications." Id. The doctor further wrote that Dickinson "became agitated when it was clear I was not going to fill more narcotics. I offered to try Neurontin for his lumbar radicular pain but he declined. I ended [the] visit as I had nothing more to offer him as he refused to do exercises and did not want Neurontin." Tr. 462.

         On August 28, 2013, Dickinson saw Dr. Langguth, M.D. for medication refills. He reported his back pain as "moderate" and said Dr. Hamric had not refilled a narcotic prescription. Tr. 458. Dr. Langguth noted tenderness on palpation of the spine and lumbar region. He noted he would allow Dickinson to continue on hydrocodone and Neurontin for pain as he attempted to get insurance coverage for an MRI, but Dickinson would have to continue showing progress on that front. Tr. 459.

         At a visit with Dr. Langguth in November 2013, Dickinson reported his back pain was moderate. Dr. Langguth noted tenderness along the spine and in the lumbosacral region, with no spasm, and the Assessment was backache. Under Plan, the doctor noted he would await an x-ray report and then probably schedule an MRI. He continued Dickinson's medications.

         A November 15, 2013 x-ray of Dickinson's lumbar spine showed normal alignment and contour, "relatively mild multilevel degenerative joint and disk disease" and no loss of joint height or fracture. Tr. 511. A December 2013 MRI of Dickinson's lumbosacral spine showed focal disk protrusion at L4-5 in the central right paracentral region with mild to moderate narrowing upon the thecal sac, and a congenitally small central spinal canal.

         Dickinson followed up with Dr. Langguth in February 2014. The doctor reviewed the MRI results and noted there was also bilateral nerve impingement. Dickinson complained that his back pain had begun six years earlier and was worsening. He also said that a recent car accident had shaken him up, but had not worsened his chronic pain. On exam, Dr. Langguth found tenderness and muscle spasm in Dickinson's back. The doctor continued Dickinson on his pain medications and added a muscle relaxer. The doctor also noted he would get a neurosurgical referral to see if there was anything that could be done for the bilateral nerve impingement.

         In April 2014, Dickinson complained to Dr. Langguth that his back pain was changing in character: the pain occurred persistently, was aggravated by sitting, and caused him trouble sleeping, and the muscle relaxer was not as effective as when he first started taking it. Dr. Langguth found tenderness and muscle spasm in Dickinson's back on exam The doctor continued Dickinson's medications, added a prescription for insomnia, and directed Dickinson to return in four months or as needed. A neurological consult was scheduled for September 2014.

         In May 2014, Dickinson went to the hospital with complaints of pain in his abdomen, back, and chest. No tests were performed. He was given an injection for pain and was prescribed a steroid and muscle relaxer. He followed up with Chan Reyes, M.D. at Jordan Valley. On physical exam, the doctor noted no abdominal tenderness; normal cervical and thoracic spine; tenderness of the lumbar spine; and negative straight leg raise. The doctor continued Dickinson's medications, added Neurontin, and told him to return in four weeks for a recheck or sooner if needed.

         Dickinson saw Dr. Morgan, his neurologist, in September 2014. On physical exam, the doctor noted Dickinson's paraspinous muscles were symmetric and normal in tone without spasm; range of motion of the cervical and lumbar spine was normal; Spurling's maneuver was negative; the straight leg raise was tolerated to 80 degrees; femoral stretch was negative; gait and station were normal; bilateral upper and lower extremities on inspection were symmetric without tenderness and there was normal range of motion; no joint instability or laxity; and the upper and lower extremity strength was normal in tone. Dickinson's deep tendon reflexes in the upper and lower extremities were normal, and there was no clonus, and no Babinski or Hoffmann sign. Under Impression, the doctor noted "back pain, lumbar, with radiculopathy, " and:

1. Low back pain with associated RLE [right lower extremity] pain consistent with L5 pattern.
2. RLE weakness: EHL [extensor hallucis longus] mild
3. Conservative management: pain meds.
4. HTN [hypertension]: controlled ...

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