United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
E. JACKSON, UNITED STATES DISTRICT JUDGE
matter is before the Court for review of an adverse ruling by
the Social Security Administration.
November 25, 2013, plaintiff Michelle Knichel protectively
filed an application for supplemental security income with an
alleged onset date of July 10, 2010. (Tr.
272-75). After plaintiff's application was
denied on initial consideration on December 31, 2013, (Tr.
149-52; 128-36), she requested a hearing from an
Administrative Law Judge (ALJ). (Tr. 153).
and counsel appeared for a hearing on November 20, 2014 (Tr.
86- 120, 169). The ALJ issued a decision denying
plaintiff's application on January 9, 2015. (Tr. 63-70).
The Appeals Council denied plaintiff's request for review
on March 21, 2016. (Tr. 1-7). Accordingly, the ALJ's
decision stands as the Commissioner's final decision.
Evidence Before the ALJ
Disability Application Documents
November 25, 2013, Disability Report,  (Tr. 276-85),
plaintiff listed her medical conditions as (1) anxiety with
panic attacks, (2) arthritis “throughout whole body,
” (3) left ankle with pins, screws, and plates, (4) a
left knee that she could not walk on, (5) “nerve damage
throughout body from car wreck, ” (6) “right
shoulder messed up, ” (7) “right rib keeps
popping out of place, ” and (8) depression. (Tr. 277).
Plaintiff reported that in July 2010, these conditions became
so severe that they prevented her from returning to work
following her lay-off. (Tr. 277-78). Plaintiff reported that
she had completed the eleventh grade and did not obtain a
GED. She did not attend special education classes, and did
not complete any type of specialized training, trade, or
vocational school. Id. She listed her prior work
experiences as a caregiver (2000-2001), housekeeper
(2009-2010), and waitress (1999-2000). (Tr. 279). Plaintiff
listed her medications as Buspirone for anxiety,
Diclofenac for advanced arthritis,
indecipherable pain medication, and prenatal vitamins. (Tr.
November 25, 2013, Disability Field Report (Tr. 272-75)
listed plaintiff's prior Social Security income
application decision dates as August 12, 1999, March 31,
2006, September 9, 2009, and March 31, 2011. (Tr. 273).
Social Security Administration official K. Braswell indicated
that she did not observe plaintiff experiencing difficulties
in hearing, reading, breathing, understanding, coherency,
concentrating, walking, or answering. (Tr. 274). She further
described plaintiff as “friendly and easy to interview,
” “pleasant throughout the interview, ” and
as having “clear speech.” Id.
updated Disability Report, dated April 5, 2014, plaintiff
reported that some changes in her condition had developed in
January 2014. (Tr. 317-22). Plaintiff did not specifically
identify the changes, but noted her recent doctors'
visits and the reasons for them. Plaintiff saw Craig Ruble,
M.D., on January 20, 2014 (among other unlisted dates) for a
consultation, x-rays, surgery, and post-surgery check-up.
(Tr. 318). She stated that she also had an appointment at
Resolutions Behavioral Health on February 24, 2014, to treat
her anxiety, depression, and bipolar disorder; she also
sought to obtain prescription refills. (Tr. 318). She also
had a blood test and x-rays on her left knee and ankle in
2013. (Tr. 319). Plaintiff listed her medications as Latuda
for anxiety and depression,  Meloxicam for arthritis,
Norco for pain,  Ranitidine for acid reflux,  Risperidone for
panic attacks and anxiety,  and Trazodone for
insomnia. Id. Plaintiff reported that she
had anxiety and bipolar disorder and that her short- and
long-term memory were “bad.” (Tr. 320).
She noted that her hands and arms were “all messed
up” and that her left leg and arthritis were in
“bad shape.” Id. Finally, plaintiff
complained of migraine headaches. Id. Despite these
problems, she stated that there had been no alterations in
her daily activities since her last report. Id.
Function Report dated December 10, 2013, (Tr. 298-308),
plaintiff stated that she lived in a house with her mother,
son, and daughter. In response to a daily activities inquiry,
plaintiff stated that she arose at around 7:00 a.m. and took
her sixteen-year old son to school. Plaintiff noted that her
son did not require much care, but she did his laundry and
took him to school and to his sports activities. Plaintiff
reported that taking care of her three-month old daughter
took up most of her time. According to plaintiff, her
daughter had been sick since birth and plaintiff had to
“hold her a lot.” (Tr. 298). Plaintiff also
watched television or took a nap with her daughter. In the
evening, plaintiff helped her mother with laundry and dishes.
She explained that her mother took care of most of the
household chores. Plaintiff went to bed around 9:30 or 10:00
stated that since her automobile accident in 1999, she had
experienced serious difficulties with her left leg and foot.
Id. She added that she had problems with her left
arm and right shoulder, and that she does not know how many
surgeries she will require. Plaintiff also reported that she
had broken her ribs, and that they would not “stay when
Dr. Greenlee work[ed] on her.” (Tr. 299). Additionally,
plaintiff claimed that had been in “constant
pain” since the onset of her disabling conditions.
stated that she could generally tend to her personal care.
She expressed no difficulties in dressing, bathing, shaving,
feeding herself, or using the toilet. Id. But, she
explained that sometimes she needed assistance with her hair
because her wrists would be “messed up.”
Id. She did not require any reminders to tend to her
personal needs and grooming. (Tr. 300). But, she stated that
she needed reminders from her mother to take her medications.
could also prepare her own meals every day. Id. She
cooked “complete meals” about three or four times
each week, but otherwise made sandwiches or other “easy
stuff.” Id. Meal preparation took anywhere
from ten to twenty minutes or, occasionally, as much as two
hours. Id. Plaintiff noted that her left leg and
foot were sometimes too swollen for prolonged standing.
Id. Also, she stated that her left knee and ankle
sometimes buckled and she would fall. Id. Plaintiff
stated that she could do some household chores. She reported
that she could accomplish a little at a time until her arms
or left leg gave out. Id. Outdoor chores were not
possible because plaintiff's body was “very
arthritic”; she also noted her scoliosis and bulging
discs. (Tr. 301).
reported that went outside every day. Id. She could
drive a car, ride in a car, or use public transportation.
Id. And she could do so alone. Id.
Plaintiff went to the store about two times each week, for
about thirty to forty-five minutes, to shop for food and
necessities. Id. In addition, plaintiff went to
doctors' appointments. (Tr. 302). Plaintiff did not need
reminders to go places. Id. She stated that she
would have severe panic attacks and anxiety around crowds.
(Tr. 301, 304).
could also manage money in most respects. She could pay
bills, count change, and use a checkbook or money orders.
(Tr. 301). Plaintiff also had several hobbies and interests,
including reading, watching television, resting, and spending
time with her children. (Tr. 302). She stated that she used
to “do everything with [her] son, ” until 2010.
Id. Since then, she said, “everything has
progressively gotten worse.” Id. She
specifically mentioned her frequent falls. Id.
Plaintiff also engaged in social activities, and spent time
with others. Id. She talked to her family on the
phone, or spent time with them at her house. Id.
Plaintiff seldom used the computer, and if she did, it would
only be for a few minutes. Id. Plaintiff stated that
she sometimes had problems getting along with others, as she
could not handle “all the people”; she would get
nervous and her heart would race. (Tr. 303).
stated that her conditions inhibited her abilities to (1)
lift more than ten pounds, (2) squat, (3) bend, (4) stand for
more than ten to fifteen minutes, (5) reach, (6) walk for
more than ten to fifteen minutes, (7) sit,  (8) kneel,
and (9) climb stairs. Id. When walking, plaintiff
required ten to fifteen minutes of rest, every ten to fifteen
minutes. Id. She could only use her hands for a
short time. Id. Plaintiff also expressed
difficulties with her memory, concentration, completion of
tasks, and handling of stress. (Tr. 303-04).
Testimony at Hearing
testified that the medical conditions preventing her from
maintaining employment included left ankle pain, nerve
compression in her left leg, locking of her left knee, right
shoulder pain and arthritis, double vision, migraine
headaches, and anxiety. (Tr. 96-97).
testified that she received treatment for her ankle from Dr.
Craig Ruble, an orthopedic surgeon. (Tr. 97). Dr. Ruble
removed hardware from plaintiff's ankle earlier in 2014,
but she testified that her ankle “still hurts”
and “still locks.” Id. According to
plaintiff, standing increased her pain though she still
experienced left leg pain while sitting down. Id.
She testified that she walked with a limp. Id. She
could only stand for twenty minutes before her knee or ankle
would lock and cause her to fall. (Tr. 98). And plaintiff
could walk for about fifteen minutes before she would need to
stop and rest to preventing locking. (Tr. 99).
also testified about her right shoulder pain. She stated that
sitting for long periods caused intense shoulder pain.
Id. Specifically, she could only sit for about
fifteen to twenty minutes before she needed to stand.
Id. She also had pain while extending or reaching
her arm. (Tr. 100). Dr. Ruble performed a surgery on
plaintiff's right shoulder in June 2014. (Tr. 111). She
stated that during her follow-up visit, she reported
continuing pain, and was told that the recovery process could
take up to a year and another surgery could possibly be
testified about her left leg injury. (Tr. 101). She
specifically told the ALJ that she received a nerve
decompression surgery on that leg. Id. She continued
to experience tingling and numbness after the surgery.
also described her left knee injury and condition. (Tr. 102).
She stated that she shattered her knee in several places in a
car accident. Id. After the accident, doctors
implanted metal hardware in her knee. Plaintiff later
required surgery on her knee to “remove a lot of the
arthritis in it.” Id. Plaintiff testified that
because her knee locked, it would often give out and she
would collapse. Id. This would occur if she walks
for about twenty to thirty minutes without resting or sitting
testified about her rheumatoid arthritis condition. Plaintiff
testified that she could not use a computer or type due to
her rheumatoid arthritis. (Tr. 100). She specifically stated
that the condition caused hand cramping, and she could not
grip. Id. Plaintiff had not seen a rheumatologist to
diagnose the condition at the time of the hearing. (Tr.
112). Furthermore, the medication she required
for treatment of her hepatitis C inhibited her ability to
take medication for her rheumatoid arthritis. Id.
reported to Midwest Health Group, LLC, for an appointment
with Gina Heberlie, N.P., on December 13, 2012. (Tr. 469).
The notes indicate that plaintiff presented with
“ganglion of tendon sheath, ” which began one
year prior to this visit. Id. Notes further state
that the pain was “of moderate intensity, ” and
that plaintiff experienced symptoms several times daily.
Id. Plaintiff stated that nothing relieved her
symptoms. Id. Notes on plaintiff's
musculoskeletal system state that plaintiff was
“positive for myalgias, ” secondary to the metal
in plaintiff's left knee. Id. Plaintiff also
reported chronic pain since 2002, which affected her lower
back. Id. A musculoskeletal exam showed a
“normal gait, ” “decreased range of
motion” in plaintiff's left knee flexion and
extension, “pain with range of motion” in left
shoulder adduction, and a two-centimeter “ganglion type
nodule of the dorsal left wrist. (Tr. 471). Nurse Heberlie
prescribed Flexeril to treat plaintiff's myalgia. (Tr.
472). She also referred plaintiff to a general surgeon
regarding her ganglion of tendon sheath. Id. A visit
on January 14, 2013, reported nearly identical notes on
plaintiff's musculoskeletal system. (Tr. 464-66).
April 21, 2013, Craig R. Ruble, M.D., noted plaintiff's
shoulder joint pain and impingement syndrome of the shoulder
region. (Tr. 547).
presented to Washington County Memorial Hospital on October
2, 2013, for treatment of hepatitis C, among other issues.
(Tr. 524-26). Angie DeClue, F.N.P., observed no edema or
musculoskeletal abnormalities. (Tr. 525).
October 18, 2013, plaintiff received an evaluation of her
left knee and ankle from Daniel J. Martin, Jr., M.D. (Tr.
514). In his summary of plaintiff's history, he wrote
that plaintiff had undergone open reduction internal fixation
of “her left ankle several years ago with a severe
trauma as well as an injury to her left knee, ” and
that she “had the hardware removed from her left
knee.” Id. He then noted that
“[r]adiographs of the left knee show a varus alignment,
” but she had “good maintenance of the joint
space.” Id. Dr. Martin explained that
plaintiff's “ankle has advanced degenerative
arthritis with post-traumatic changes.” Id.
His examination of plaintiff's left knee also showed a
“varus alignment, ” intact neurocirculatory exam,
stable collateral ligaments, and negative results on the
Anterior Drawer and Lachman tests. Id. He observed
crepitus with range of motion of the left ankle and
well-healed surgical scars. Id. He ordered an MRI of
plaintiff's left knee. Id.
visited Washington County Memorial Hospital complaining of
shoulder pain, among other issues on November 15, 2013. (Tr.
520-23). Plaintiff told Shelley Lee, D.O., that she had
experienced shoulder pain for some time. (Tr. 520). Plaintiff
told Dr. Lee that heat and over-the-counter medications did
not ease her pain. Id. No musculoskeletal
abnormalities were noted after her physical exam. (Tr. 522).
presented to Washington County Memorial Hospital on November
25, 2013, complaining of worsening anxiety. (Tr. 516). She
claimed that her right shoulder pain exacerbated her anxiety.
Id. A review of plaintiff's musculoskeletal
system showed right shoulder tenderness and mild pain with
motion. (Tr. 517-18). The prescribed plan included an
orthopedic evaluation. Id.
November 26, 2013, plaintiff received a right shoulder x-ray
at Washington County Memorial Hospital, pursuant to
plaintiff's complaints of pain. (Tr. 528). Gaspar
Fernandez, M.D., the reading physician, found that plaintiff
had (1) an intact clavicle, (2) a normally aligned
acromioclavicular joint, (3) no evidence of fracture,
dislocation, focal osteolytic or osteoblastic lesions of the
proximal humerus, (4) no hypertrophic or erosive changes, and
(5) intact ribs. He concluded that no acute osseous
abnormalities were identified and that “if internal
derangement is suspected, ” an MRI could be conducted.
December 17, 2013, plaintiff visited Jefferson County
Orthopaedic Surgery and Sports Medicine for left medial and
lateral knee pain, as well as medial and lateral ankle pain.
(Tr. 631). Plaintiff stated that she began experiencing
“problems after she had fractured her knee and ankle
after being involved in a motor vehicle crash back in
1999.” Id. Plaintiff also reported surgeries
on both her left knee and left ankle. Id. Plaintiff
indicated several ongoing symptoms in her left knee,
including a constant ache of the anteromedial and lateral
knee, occasional swelling, popping, catching, locking, a
sensation of instability, and some numbness over the lateral
fibular region. Id. She added that walking and other
activity aggravated her pain, while sitting alleviated her
pain. Id. Dr. Craig Ruble conducted a detailed
physical exam, which showed well-healed incisions in
plaintiff's knee, with no obvious swelling, erythema, or
heat. (Tr. 632). Further, Dr. Ruble noted that she
“demonstrated 0 degrees of extension and 125 degrees of
flexion with obvious crepitus palpated.” Id.
Her ligaments were stable and she had a positive Tinel sign
at the left common peroneal nerve at the fibular neck.
Id. She showed no calf tenderness.
Ruble also examined plaintiff's ankle. He noted
well-healed scars and mild soft tissue swelling, with
tenderness to palpation over the medial ankle. Id.
“She had slightly decreased flexion and decreased
rotation of the left ankle.” Id. He described
plaintiff's right lower extremity as “within normal
limits, ” “unremarkable, ” and
“neurovascularly intact.” Id. A
diagnostic study of plaintiff's ankle showed
“plates and screws laterally with a sutured anchor in
the medial ankle”. (Tr. 632, 634). Imaging also
revealed bone-on-bone degenerative joint disease.
Id. Images of plaintiff's left knee showed
“previous fractured lateral tibial plateau” with
removed hardware. Id.
Ruble concluded that plaintiff had ankle pain arising from
post-traumatic degenerative joint disease, painful orthopedic
hardware in the left ankle, and knee pain from
“questionable medial and lateral meniscus tearing and
probable compressed common peroneal nerve [in the] left
knee.” Id. Dr. Ruble recommended several
treatments including (1) icing and elevating the knee and
ankle frequently, (2) taking a Mobic prescription with
intermittent doses of Tylenol, (3) stopping smoking, (4)
beginning a home ...