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Hill v. Saul

United States District Court, E.D. Missouri, Eastern Division

August 21, 2019

MICHAEL P. HILL, Plaintiff,
ANDREW M. SAUL, [1]Commissioner of Social Security, Defendant.



         This 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.

         I. BACKGROUND

         Plaintiff 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. 208-09.)

         On 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.


         The 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. Louis system.

         On July 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.)

         On 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.)

         Plaintiff 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. 1043-47.)

         Plaintiff 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.)

         Plaintiff 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.)

         On June 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.)

         At his 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 ...

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