United States District Court, W.D. Missouri, Southern Division
NANETTE K. LAUGHREY DISTRICT JUDGE.
Dickinson appeals the Commissioner of Social Security's
final decision denying his application for disability
insurance benefits. The Commissioner's decision is
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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,
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 ...