United States District Court, E.D. Missouri, Eastern Division
MICHAEL P. HILL, Plaintiff,
ANDREW M. SAUL, Commissioner of Social Security, Defendant.
D. NOCE K UNITED STATES MAGISTRATE JUDGE.
action is before the court for judicial review of the final
decision of the defendant Commissioner of Social Security
denying the applications of plaintiff Michael P. Hill for
disability insurance benefits and supplemental security
income benefits under Titles II and XVI of the Act, 42 U.S.C.
§§ 401- 434, 1381-1385. The parties have consented
to the exercise of plenary authority by the undersigned
United States Magistrate Judge pursuant to 28 U.S.C. §
636(c). For the reasons set forth below, the final decision
of the Commissioner is affirmed.
was born on August 4, 1969, and was 47 years old at the time
of his hearing. (Tr. 104.) He filed his applications on
August 2, 2015, alleging a November 7, 2014 onset date. He
alleged disability due to bipolar disorder, vascular
insufficiency, neuropathy in his feet and legs,
schizophrenia, memory loss, and learning disability.
(Tr.164.) His application was denied, and he requested a
hearing before an Administrative Law Judge (ALJ). (Tr.
January 24, 2018, following a hearing, an ALJ issued a
decision finding that plaintiff was not disabled under the
Act. (Tr. 10-24.) The Appeals Council denied his request for
review. (Tr. 1-6.) Thus, the decision of the ALJ stands as
the final decision of the Commissioner.
following is a summary of plaintiff's medical and other
history relevant to his appeal. Throughout the relevant
period, November 2014 through January 2018, plaintiff was
treated for coronary artery disease and peripheral vascular
disease, a progressive circulation disorder. (Tr. 420-64,
565-83, 616-831, 1034-60.) Plaintiff was a long time tobacco
user and had a history of alcoholism and fetal alcohol
syndrome. His treating physicians were David German, M.D., a
wound care specialist and plastic surgeon, and Vito Mantese,
M.D., a vascular surgeon, both within the Mercy Hospital St.
15, 2015, plaintiff saw Dr. Mantese for leg pain and
swelling. Examination revealed minor skin changes on both
ankles with darkened skin and induration or loss of
elasticity and pliability. He had a normal gait and station.
His motor and sensory functions were equal bilaterally. Dr.
Mantese assessed superficial venous incompetency bilaterally
and right popliteal vein incompetency with no evidence of
deep vein thrombosis or incompetency. He recommended
symptomatic treatment, continued use of support stockings and
moisturizing cream, and regular exercise. (Tr. 1049-53.)
January 26, 2016, plaintiff saw Ksenija Kos, M.D., to
establish care. Plaintiff had suffered from lower extremity
symptoms since age thirteen. On examination, he had no edema
or clubbing, but positive cyanosis or severe discoloration of
his feet from poor circulation, and diminished pulses over
the anterior tibial arteries. His motor bulk and strength
were within normal limits. Plaintiff had a mild decrease in
sensation distally in his feet up to his knees. His postural
stability was normal and his gait was steady. An
electromyography (EMG) and nerve conduction study was
“mildly” abnormal, suggesting “mild”
sensory peripheral neuropathy. Dr. Kos directed him to take
preventative measures, including 30 minutes of moderate
exercise three times per week. (Tr. 608-14.)
saw Dr. Mantese again on February 17, 2016, for leg pain and
swelling. He had minor skin changes on both ankles with
induration. He had a normal gait and station with normal
motor and sensory function. Dr. Mantese told him he needed to
continue wearing support stockings and using moisturizing
cream and discussed the importance of regular exercise. (Tr.
saw Dr. German on March 8, 2016 for assessment of his lower
leg edema. He had seen a physician in the past who ordered
him to wear compression stockings, but he had not worn them
since June 2015. On examination, plaintiff had bilateral
lower extremity edema characterized as “mild”
with chronic stasis changes with hyperpigmentation and some
lymphedema. He had small areas of hyperkeratosis (thickening
of the skin's outer layer) but no ulcers. Dr. German
instructed him to control his leg swelling by elevation and
limiting sodium. He was also instructed to wash his legs and
apply lotion daily, and to wear compression stockings and
replace them every six months. The cost of the stockings was
a problem for him, however. He was also advised to lose
weight and exercise. Plaintiff was noted to be elevating his
legs about 8 to 16 hours a day. (Tr. 623-29.)
returned to Mercy on May 4, 2016, for edema and lower
extremity pain. He was asked to bring in a photo documenting
his swelling. Notes describe his lower extremity edema as
“minimal.” He was prescribed Gabapentin, used to
treat neuropathic pain. His doctor's instructions
included leg elevation, among other things. (Tr. 659-64.)
15, 2016, plaintiff was seen again at Mercy. He was not
wearing any form of compression due to hot weather. He stated
he had been following a low sodium diet and walking.
Examination showed mild lower extremity edema and was
otherwise unchanged. He was again instructed to document his
swelling with pictures. He was not compliant with his
Gabapentin prescription and was instructed on taking it on a
routine basis. Plaintiff was again ordered to elevate his
legs. (Tr. 702-07.)
next appointment at Mercy on September 29, 2016, plaintiff
stated that he had tried to increase his walking but had
increased swelling. His examination showed mild lower
extremity edema. His swelling remained stable. He had no open
wounds or ulcers. His treatment plan included compression
stockings, weight loss, and exercise. (Tr. 738-41.) The
“discharge instructions” under “wound
care” stated to elevate the legs for 30 to 60 minutes.
In another section labeled “general wound care”
instructions stated to elevate legs as ...