United States District Court, W.D. Louisiana, Lafayette Division
PATRICK J. HANNA UNITED STATES MAGISTRATE JUDGE
accordance with the provisions of 28 U.S.C. § 636(c) and
Fed.R.Civ.P. 73, the parties consented to have this matter
resolved by the undersigned Magistrate Judge, and it was
referred to this Court for all proceedings, including entry
of judgment. (Rec. Doc. 6). Before this Court is an appeal of
the Commissioner's finding of non-disability. Considering
the administrative record, the briefs of the parties, and the
applicable law, the Commissioner's decision is affirmed.
claimant, Debra McCauley, fully exhausted her administrative
remedies before filing this action in federal court. She
filed applications for disability insurance benefits
(“DIB”) and supplemental security income benefits
(“SSI”), alleging disability beginning on January
17, 1997. Her application for SSI was granted, but
her application for DIB was denied. She requested a hearing,
which was held on January 19, 2017 before Administrative Law
Judge Rowena E. DeLoach. The ALJ issued a decision on March 1,
2017, concluding that the claimant was not disabled within
the meaning of the Social Security Act from the alleged
disability onset date through the date she was last insured
for Social Security disability benefits. The claimant
requested that the Appeals Council review the ALJ's
decision, but the Appeals Council found no basis for
review. Therefore, the ALJ's decision became
the final decision of the Commissioner for the purpose of the
Court's review. The claimant then initiated this action,
seeking review of the Commissioner's decision.
of Pertinent Facts
claimant was born on May 21, 1953. At the time of the ALJ's
decision, she was two months shy of her sixty-fourth
birthday. She graduated from high school in 1971,
trained as a licensed practical nurse,  and worked as a
nurse in the cardiac care department at Lafayette General
Medical Center (“LGMC”) in Lafayette,
Louisiana. She alleged that she has been disabled
since January 17, 1997 due to a back injury, right leg and
foot pain, depression, and Type 2 diabetes.Following a
workplace accident in May 1996, she was out of work for a
period of time then returned to work as a data entry clerk in
LGMC's cardiac care department for approximately six
months. She allegedly reinjured her back on
January 17, 1997 and did not return to work thereafter.
issue presented in this appeal is whether the claimant became
disabled on or before June 30, 2002, the date on which she
was last insured for Social Security disability benefits.
Because this Court concludes that there was substantial
evidence in the record supporting the Commissioner's
decision that the claimant was not disabled before her date
last insured, the medical records and treatment notes for the
time period after the date last insured are not summarized in
detail, below. However, those records were carefully reviewed
by this Court.
September 8, 1994,  the claimant was seen in the emergency
room at LGMC complaining of lower back pain with burning pain
to her right buttock and right thigh after feeling a pop in
her back while at work. She followed up with Dr. Donald C.
Harper on October 25, 1994. He diagnosed her with
sacroiliitis and prescribed physical therapy, Xanax, Lortab,
and Dilaudid. When the claimant saw Dr. Harper again on
December 5, 1994,  she complained of pain and poor
endurance. She followed up with Dr. Harper on February 9,
1995, March 23, 1995, and October 10, 1995.
claimant saw Dr. Clifton W. Shepherd, Jr., an orthopaedic
surgeon, on March 28, 1995 for complaints of lower back pain
and right leg pain. She told Dr. Shepherd she had been
injured while working as an LPN at LGMC and moving a patient.
She reported that she had been seen in the emergency room on
the date of the accident and then treated with Dr. Harper.
Her treatment had included bed rest, medications, physical
therapy, and a back brace, but no diagnostic testing. She
also complained of neck pain and headaches. She was then
taking Relafen, Premarin, Xanax, and Lortab. She had returned
to work on a light duty basis. X-rays of her lumbar spine
were normal. Dr. Shepherd noted that the claimant displayed
“a very benign, objectively normal examination.”
He disagreed with her being prescribed tranquilizers and
narcotics. He recommended an MRI and CT scan.
lumbar MRI of April 5, 1995 showed a right posterolateral
disc protrusion at ¶ 5-S1 and a mild paracentral disc
protrusion at ¶ 4-5. A CT scan of the lumbar spine
of the same date showed mild right posterolateral disc
protrusion and neural foraminal narrowing at ¶ 5-S1 and
mild paracentral disc protrusion at ¶ 4-5. After
reviewing the diagnostic test results, Dr. Shepherd
opined that the claimant could return to
“a light duty situation” without heavy lifting
and recommended that she take only anti-inflammatory
medicine. He strongly disagreed with her taking narcotic
September 27, 1995, case management consultant Noleen
Fruitticher described a meeting with the claimant regarding
her ability to return to work while taking all of the
medications she was then taking, including Relafen, Dilaudid,
Lortab, Xanax, and Amiltriptylene.
March 11, 1996, the claimant saw Dr. Wayne T. Lindemann of
Professional Rehab Services of Acadiana. The claimant
was working light duty at LGMC, working on a computer
compiling statistics for one of the units and was able to
take a break every two hours. She gave a history of having
hurt her back while transferring a patient and having had
unsuccessful physical therapy. She had discontinued taking
Dilaudid but was continuing Relafen and was taking about
twelve Lortab a month. She reported occasional pain radiating
down her right leg but denied numbness or weakness. She
reported sleeping on a heating pad and applying Tiger Balm to
her back each day. Dr. Lindemann diagnosed chronic right
multifidus triangle strain with a myofascial component. He
recommended that she continue on light to medium level duty
at work, stretching at her desk every fifteen to twenty
minutes. He refilled her Relafen, prescribed Ketoprofen
cream, and recommended a foot stool for her right foot.
the claimant returned to Dr. Lindemann on June 3, 1996, she
reported having reinjured her back at work at LGMC when an
elevator stopped abruptly, causing her to fall to her knees.
X-rays showed no acute abnormalities but noted lumbar
spondylosis. The claimant's primary complaint was low
back pain with some radiation down the left leg and
occasional numbness of a portion of the left foot. Dr.
Lindemann continued the Relafen, advised taking Lortab at
night, and planned lumbar steroid epidural injections
September 10, 1996,  Dr. Lindemann noted that the claimant
had good results from an LESI in June 1996 and was taking
Relafen and Lortab. Dr. Lindemann encouraged her to stop the
Lortab. Another LESI was scheduled.
McCauley saw Dr. Lindeman again on September 19,
1996. He continued her medications and
prescribed physical therapy and a strengthening and
the claimant saw Dr. Lindemann again, about a month later, on
October 10, 1996,  he noted that she had had two LESIs that
provided some relief. Her physical therapy was going well,
but she complained of trouble sleeping. He prescribed Desyrel
to help her sleep, continued the Relafen and Lortab, and
prescribed Ketoprofen cream to apply to her back three times
per day. Dr. Lindemann also ordered an MRI of her lumbar
spine. The MRI, obtained on October 15, 1996, showed lumbar
and lower thoracic spine spondylosis. On October
31, 1996, Dr. Lindemann noted that the MRI showed some
bulging of the disc at ¶ 4-5 and L5-S1 but no nerve root
displacement. Ms. McCauley reported that the Ketoprofen cream
was helping, she was going to physical therapy, she was doing
spinal stabilization exercises at home, and she was
continuing to do data entry work at LGMC. Dr. Lindemann noted
that “[o]verall she is doing well.”
McCauley returned to see Dr. Lindemann on December 5, 1996,
reporting a motor vehicle collision on
November 22, 1996 and complaining of neck and low back pain.
She was taking Lortab and Soma three to four times per day
and had missed four to five days of work. He replaced her
Relafen with a Medrol Dosepak and added Zantac to protect her
stomach. She was to continue physical therapy with ice and
deep heat, she was to continue using a TENS unit, and he was
referring her to Dr. Steven Staires of LGMC's Chronic
Pain Medicine Program.
claimant saw Dr. Lindemann again on January 2, 1997 with both
cervical and lumbar pain. He ordered an MRI of her
lumbar spine and renewed her medications except for Soma. He
recommended weaning her off Lortab as well. On January 14,
1997, he gave her trigger point injections in the mid region
of her upper trapezius muscles bilaterally.
scan of the lumbar spine on February 19, 1997 showed a
broad-based disc bulge at ¶ 5-S1 with mild compromise of
the neural foramina, slightly greater on the right than the
left and mild facet sclerosis bilaterally at ¶
report dated May 26, 1999,  psychiatrist Dr. James J.
Blackburn stated that he initially saw Ms. McCauley on
November 3, 1998 after referral from Dr.
Staires due to the claimant's
“histrionic personality traits, particularly as they
relate to somatization and magnification of her pain
symptoms.” Dr. Blackburn stated that Ms. McCauley had
significant depression and severe emotional turmoil. He
explained that he prescribed Oxycontin, Serazone, and Celexa,
which, together with cognitive therapy, had resulted in the
claimant becoming “less emotionally symptomatic.”
Dr. Blackburn stated that he had not observed her
exaggerating her pain complaints. He recommended continued
psychiatric outpatient therapy with appropriate medications.
It was his opinion that this would help her to better manage
her chronic pain. In July 1999,  Dr. Blackburn noted that
the claimant's depression had worsened. In August 1999,
he noted that her mood had improved with an increase in
Celexa dosage. He recommended that she see Dr. Olga Reavill
(who does not use excessive amounts of narcotic medication or
perform invasive procedures) for possible pain management and
that she have individual counseling with a psychiatric social
worker. Ms. McCauley began seeing psychiatric social worker
Simone J. Blackburn on September 22, 1999. On October 6,
1999,  Ms. Blackburn noted that the claimant
felt bad physically, was depressed and sad, and had trouble
sleeping at night but her husband was very supportive.
October 12, 1999,  Dr. Blackburn noted that Ms.
McCauley's condition was deteriorating secondary to
increased pain. He stated that she could not walk far because
her right leg would shake, become weak, and almost give way.
She had stopped hydrotherapy because she was having to pay
for it herself. Dr. Blackburn was concerned about continuing
to prescribe Oxycontin and recommended that the claimant see
a pain management specialist, particularly Dr. Reavill.
October 20, 1999, Ms. Blackburn noted that the claimant was
anxious and having suicidal thoughts. On November 19, 1999,
the claimant reported to Ms. Blackburn that a short visit to
her sister “caused her much distress and pain”
but reported that her medication helps her to function as
best she can. On November 30, 1999, Dr. Blackburn opined that
the claimant's condition would not improve unless she was
allowed to see a chronic pain management specialist and have
physical therapy. He increased the dosage of her Oxycontin.
On December 14, 1999,  Ms. Blackburn noted that the claimant
reported bad panic attacks. She was taking Serazone, Celexa,
and Ativan. On January 21, 2000,  Dr. Blackburn again
increased the dosage of Oxycontin and again recommended that
she be allowed to see a pain management specialist, have
appropriate physical therapy, and obtain updated diagnostic
studies. He noted that she was having fewer panic attacks but
had a significant increase in her level of depression due to
the fact that she cannot function as a nurse or as a whole
February 29, 2000,  Dr. Blackburn noted that the claimant
continued to have severe pain that increased with more
physical activity. He described her as discouraged,
frustrated, and angered. He recommended psychiatric therapy
for her and her husband. He also recommended pain management
April 4, 2000, the claimant was examined by clinical
psychologist F.T. Friedberg. The purpose of the examination
was to “assess psychological state relating to her
injury at work, and her ability to return to viable
vocational endeavors.” He administered several tests.
He found that she functioned in the normal range of
intelligence, emotional factors did not interfere
significantly with her cognitive functioning, her word
recognition was at a post high school level but her
arithmetic reasoning was only at a seventh grade level. No.
cognitive deficits were noted. She had no indications of any
visual perceptual difficulties. She had good concentration
and attention to visual material. The Beck Depression
Inventory reflected only minimal depressive symptomatology
with some general anhedonia, self criticism, and being
annoyed or irritated more easily than she had been. She
admitted to fatigue, sleep disturbance, and having to take
extra effort to get started doing things. She exhibited a
preoccupation with somatic difficulties but no excessive
anxiety or depression. Despite her long history of chronic
pain, Dr. Friedberg found that she appeared able to handle a
vocational endeavor that would not compromise her medical
situation or exacerbate her pain.
same day, Ms. Blackburn counseled the claimant and her
husband. On May 3, 2000, the claimant reported to
Ms. Blackburn that she had been having migraine headaches
most of her life and was having one that day.
the claimant met with Dr. Blackburn on June 14, 2000, she was
“tearful, distressed, depressed[, ] and totally
distraught.” He encouraged her to be hopeful and she
signed a no suicide contract. He increased the dosage of her
anti-depressant medication. When the claimant returned to Dr.
Blackburn on July 27, 2000,  he noted that she was
continuing to experience significant pain and was hoping to
be allowed to see an orthopedist for further evaluation of
her back condition. She had returned to aquatherapy, which
was strengthening her muscles and improving her mood. Her
depression and mood had improved with her medication.
McCauley saw Dr. Angela Mayeux, an orthopedist, on August 17,
2000.She reported that a second injury on
January 17, 1997 when she felt a catch in her back while
working on a paper jam in a copying machine. On physical
examination, the claimant was exquisitely tender from L2 to
the sacrum and tender at the right SI joint, right gluteal
notch, right trochanteric bursa, and right iliotibial
(“IT”) band. Her range of motion was limited to
forward flexion with her fingertips to the superior poles of
the patella. Extension was 75% of normal. She had to be
encouraged to rise on her toes and rock back on her heels.
Motor was 5/5 in all groups, sensory was intact, deep tendon
reflexes were 1 and symmetrical at the knees, ½ and
symmetrical at the ankles. She had no evidence of nerve root
tension but a strongly positive Fabere's test on the
right (suggesting pathology of the SI joint). Dr. Mayeux
reviewed x-rays, CT scans, and a bone scan. She found that
the claimant had marked symptom magnification with positive
Waddell signs (indicative of malingering in patients with
back pain) with skin tenderness and pain with rotation of the
trunk. Due to the physical findings, Dr. Mayeux found that
the claimant's use of pain medication was “grossly
out of proportion.” She opined that the claimant was
capable of returning to her previous employment. Her
diagnoses were sacroiliitis, piriformis syndrome, and IT band
August 30, 2000,  Ms. McCauley reported to Dr. Blackburn
that she had a negative experience with Dr. Mayeux. She told
him that Dr. Mayeux said she was taking too much pain
medication and that her condition could be treated with
injections and physical therapy.
report of October 5, 2000, Dr. Blackburn noted that he had
reviewed Dr. Mayeux's report of her examination of the
claimant as well as the rulings issued in Ms. McCauley's
workers' compensation case. He stated that Ms. McCauley
thought the judge was fair, and Dr. Blackburn said he would
be delighted to turn over management of the claimant's
physical pain to a pain management specialist, again
recommending Dr. Reavill. He noted that Ms. McCauley was
working with a vocational rehabilitation specialist to
arrange for job applications but he opined that she “is
not anywhere close to being ready to return to work.”
November 7, 2000,  Dr. Blackburn reported that the claimant
was still waiting for an appointment with Dr. Reavill and had
not returned to aquatherapy because there was a dispute over
the cost of that therapy. Her pain control was “only
fair.” She was emotionally upset because her mother had
been diagnosed with cancer and because her doctor had
recommended that she stop taking estrogen.
December 6, 2000, Dr. Blackburn reported that the claimant
had still not seen Dr. Reavill although an appointment was
scheduled. He noted that the claimant continued to complain
of pain and multiple stressors. He continued her Oxycontin
“out of necessity.” He opined that the
claimant's psychiatric condition should improve with
the claimant met with Dr. Reavill on December 12, 2000,
she complained of right-sided hip pain that was a constant,
pulling type pain that improved with traction and worsened
with standing, sitting, stooping, and climbing stairs. She
reported that her pain improved with pool therapy and
message. She stated that she was taking Oxycontin 20 mg.
every eight hours to keep her pain level at three out of ten.
Straight leg raise tests were negative as were tests of her
sensory and motor systems. Dr. Reavill diagnosed sacroiliitis
and lumbar degenerative disc disease. She noted that the
claimant would have to be detoxed from opioid pain medication
prior to pain management and that, after being detoxed, a
possible sacroiliac joint block or sacroiliac joint
cryotherapy would be attempted as well as a possible pain
January 5, 2001,  Dr. Blackburn reported that the claimant
was “significantly upset” after her appointment
with Dr. Reavill and that Dr. Reavill required that the
claimant detox from narcotic medication before treatment. Dr.
Blackburn created a detox schedule with the claimant.
the claimant returned to Dr. Blackburn on January 25, 2001,
she was experiencing significant pain and emotional distress
as well as a significant elevation in her blood pressure. Dr.
Reavill had told her that she would have to get her cardiac
condition and blood pressure stabilized before they could
continue treatment. The claimant's level of distress was
greater as she was detoxing and she required reassurance that
she would be able to do something positive with her life.
February 13, 2001,  Dr. Blackburn reported that the claimant
had tapered her Oxycontin from a dosage of 90 mg. per day to
40 mg. per day but was experiencing increased pain. He noted
that, although Ms. McCauley seemed more depressed, she was
determined to complete the program to be free of analgesic
medication and allow further treatment with Dr. Reavill.
the claimant saw Dr. Reavill on March 12, 2001,
she was completely weaned off her medication, was hurting
more, and had had an episode of supraventricular tachycardia
(“SVT”), an abnormally fast heartbeat. Dr.
Reavill diagnosed sacroiliac (“SI”) joint
illiitis with radiculopathy and scheduled SI joint blocks.
McCauley saw Dr. Blackburn the next day, March 13,
2001. Remeron had been added to her medication
regimen as she weaned off the analgesics. She reported being
in more pain and engaging in less activity. She also reported
having had a positive encounter with Dr. Reavill.
Reavill performed left and right S1, S2, S3 nerve
cryoneurolysis injections on March 23, 2001.
April 2, 2001,  the claimant reported to Dr. Blackburn
that the injections had been very painful but she was very
pleased that she could sit down and stand up without the
catch in her back she had previously experienced. She still
reported significant pain radiating down her right leg and
into her back. She was not sleeping well and was fearful that
her pain might not be relieved. Dr. Blackburn added Seroquel
to her medications.
April 9, 2001,  the claimant reported to Dr. Blackburn
that she was sleeping better with the Seroquel. She felt
positive about her visits with Dr. Reavill. Although still
concerned about future disability, she was willing to
claimant again saw Dr. Reavill that same day. She
complained about pain on the right side of her buttock going
down the leg and then crossing over right above the knee to
the front of her leg. There was no pain in her SI joints, she
had an increased range of motion, her reflexes were intact,
the facets at ¶ 1-L5 were very painful, and she had a
decreased range of motion and positive trigger points in her
back. Dr. Reavill planned to follow up with lumbar facet
April 17, 2001, the claimant saw Dr. Blackburn. He noted that
she had increased her Seroquel dosage for consistent sleep
improvement. She was waking up during the night, sometimes
due to pain and sometimes due to emotional turmoil. Some of
the pain relief she had experienced was diminishing. She was
more depressed and obsessed with feeling that she is totally
useless. He increased her Remeron dosage.
April 26, 2001, Dr. Blackburn prepared a psychiatric report
to Janet R. Istre, the case manager assigned to Ms.
McCauley's workers' compensation claim.He stated that
the claimant was continuing to experience significant pain.
He also stated that her blood pressure had been normal before
January 2001 but had increased as her pain level increased as
she was taken off Oxycontin. He explained that he was
continuing to prescribe Soma because it was a “minimal
amount of medication” to decrease physical discomfort,
muscle spasms, and overall distress. He also stated that Ms.
McCauley began to experience episodes of severe tachycardia
after getting off the Oxycontin. He further stated that Soma
did not contribute to the claimant's depression,
insomnia, or irritability and opined that the
“prolonged period of time during which she has had to
deal with her pain without access to appropriate pain
management has contributed more to all of the above symptoms
than any conceivable combination of Soma.” He stated
the claimant was likely psychologically dependent on her
medication but not addicted. Dr. Blackburn opined that the
claimant's pain aggravates her emotional distress and she
is “too depressed, distressed[, ] and experiencing too
much turmoil to function in any gainful employment
April 30, 2001,  case manager Jane R. Istre prepared a
letter to Dr. Reavill, confirming her understanding of a
rehabilitation conference held that day. She confirmed that
Dr. Reavill's diagnosis was lumbar facet syndrome, that
Dr. Reavill recommended lumbar facet blocks, and if those
were unsuccessful would recommend lumbar facet
radiofrequency. She confirmed that Dr. Reavill found that Ms.
McCauley had increased range of motion, intact reflexes, and
relief of SI joint pain following the cryotherapy. She
confirmed that Dr. Reavill prescribed Relafen for the
claimant, might occasionally prescribe Darvocet or Vicoden
for pain control but never prescribed Soma or Ativan because
they are too addictive. She confirmed that Dr. Reavill was of
the opinion that the claimant was capable of secretarial work
although she might require position changes as needed.
7, 2001,  Dr. Blackburn noted that the claimant
was depressed, distraught, tearful, and confused. Her blood
pressure was continuing to rise despite efforts to control
it. His opinion was that her increased blood pressure was
secondary to her pain level. Because of the high blood
pressure, she had increased fear and anxiety about having a
stroke. Dr. Blackburn stated that it took two hours for him
to calm her down and stabilize her mood.
30, 2001, Dr. Blackburn noted that the claimant was still
experiencing depression and pain but her blood pressure was
better. She remained distressed about what she perceived as a
bleak future. In his opinion, her blood pressure was elevated
because of her pain. He noted that Dr. Reavill would not
treat her until her blood pressure was stabilized. He
described the claimant as being in “a very fragile
emotional and physical state.”
26, 2001,  Dr. Reavill confirmed to case manager
Istre that she had not spoken with Dr. Blackburn, that she
did not share Dr. Blackburn's opinion that the
claimant's high blood pressure was elevated due to her
pain, that she did not believe the claimant was in a
treatment dilemma, that she did not believe the claimant had
significant physical limitations, that she was willing to
reevaluate the claimant's condition, and that she then
would them be willing to confer with the claimant, Dr.
Blackburn, and the case manager.
28, 2001,  Dr. Blackburn reported that the claimant
continued to have significant pain, overall discomfort, very
obvious depression, and elevated blood pressure. He
reiterated his opinion that her high blood pressure was
caused by her pain level. He was concerned about whether she
would be able to be treated by Dr. Reavill in the near
claimant saw Dr. Reavill on July 16, 2001. She was
continuing to have left hip pain radiating down to her leg,
which she rated at eight out of ten. Her blood pressure was
elevated, and she was having bouts of SVT. Dr. Reavill noted
that the claimant “subjectively cannot bend
forward.” She diagnosed intractable low back pain and
sacroiliitis. She stated that she did not prescribe pain
medication but, as an interventionalist pain management
physician, performed procedures to eliminate pain. She
further stated that she could not perform any procedures on
the claimant until her blood pressure and SVT were under
25, 2001, the claimant was seen in the emergency room at
Medical Center of Southwest Louisiana for low back and lower
extremity pain. Dr. Scott Gammel was consulted. His
impression was acute lumbar radiculopathy, not well
controlled. He noted the claimant's history of
hypertension and depression. Dr. Gammel admitted the claimant
to the hospital for pain control using a PCA
(patient-controlled analgesia) with Demerol. He planned to
obtain an MRI to rule out acute pathology. He continued her
medications for hypertension. He prescribed Baclofen and
Valium for muscle spasms. She was discharged on July 27 with
instructions to follow up with Dr. Gammel on August 2. Her
discharge medications were Baclofen, Relafen, Oxy1R,
Oxycontin, and Valium.
obtained on July 26, 2001 showed a broad posterior
annular bulge to the right at ¶ 5-S1 with accompanying
facet degeneration, bilateral lateral recess, and proximal
foraminal stenosis as well as a potential free disc fragment
abutting the S1 nerve root.
the claimant followed up with Dr. Gammel on August 2, 2001,
she reported that her symptoms were much improved although
she continued to have persistent radicular symptoms. She was
taking Oxycontin 20 mg three times a day and OxyIR three to
five times per day. She was also taking Baclofen and Valium
for muscle spasms as needed. Her ankle reflexes were absent
bilaterally. She had a significantly positive seated straight
leg testing on the right and an equivocal test on the left.
She had tenderness to palpation over the SI joints
bilaterally and increased paraspinous muscular tone in the
lumbar spine. His impression was lumbar radiculopathy
secondary to spinal stenosis and disc disease. His plan was
to have the claimant follow up with Dr. Mayeux to see if
surgery was warranted or if LESIs should be tried. He also
recommended a spinal cord stimulator.
October 25, 2001, Dr. Mayeux scheduled a myelogram to rule
out a free disc fragment in the spinal canal.
claimant followed up with Dr. Gammel on October 25,
2001. She reported very good control of her
symptoms with her current medications. Although she had some
nausea, she was “doing relatively well” with the
medical management and aquatic therapy. She had diffuse mild
low back tenderness and a positive seated straight leg test.
Dr. Gammel noted that Dr. Mayeux had seen the clamant but was
deferring any opinion until obtaining additional information
from the radiologist regarding the MRI. Dr. Gammel planned to
refer the claimant to Dr. Muldowny for another surgical
November 1, 2001,  Dr. Blackburn reported that the claimant
had had a very positive experience at the Medical Center of
Southwest Louisiana and with Dr. Gammel who had begun to
manage her chronic pain with a resumption of Oxycontin. Dr.
Blackburn also reported that the claimant had a significant
increase in emotional turmoil, depression, and general
distress because her myelogram was scheduled at LGMC. She
indicated that she did not feel safe going there. He
indicated that whether her fears were fact-based or not, it
was “unreasonable for her to be exposed to additional
psychological trauma by being forced to go to [LGMC].”
lumbrosacral myelogram and post-myelogram CT scan were
conducted by Dr. Mayeux on December 20, 2001 at Medical
Center of Southwest Louisiana.The tests revealed a mild
annular bulge with flattening of the anterior thecal sac at
¶ 4-5 with no central or foraminal stenosis. There was a
diffuse annular bulge at ¶ 5-S1 that appeared contiguous
to the right S1 nerve root, with minimal filling of what was
suspected to be an edematous right S1 nerve root sheath,
possibly due to compression by the bulging disc. No. separate
extruded disc fragment was detected.
January 2, 2002,  Dr. Mayeux wrote to the case manager,
explaining that the myelogram did not show a free disc
fragment but did show a swollen S1 nerve root. In Dr.
Mayeux's opinion, the claimant did not need surgical
intervention but would benefit from an LESI.
claimant saw Dr. Gammel again on January 16,
2002. She appeared in mild to moderate
distress, her blood pressure was 160/100, and her pulse was
92. She had tenderness diffusely in the low back, 1 patellar
reflexes, absent ankle reflexes, and an equivocal seated
straight leg raising test on the right. He refilled her
medications and referred her to spine surgeon Dr. Munshi.
January 28, 2002, Dr. Mayeux confirmed to the case manager
that the claimant was not a surgical candidate, that she was
not symptomatic with regard to the S1 nerve root findings of
the recent myelogram, that the S1 nerve root problem was
likely a chronic problem from degenerative changes, and that
she had no right leg atrophy since her right leg was actually
larger than her left leg. Dr. Mayeux further confirmed that
an LESI might alleviate swelling of the S1 nerve root but
might not relieve the claimant's pain because her
symptoms were not related to the S1 nerve root. Dr. Mayeux
confirmed that the claimant's hypertension would not
preclude the LESI. Further, Dr. Mayeux confirmed that her
opinion was that the claimant was capable of sedentary to
light duty work with frequent changes in body position and
that she had an approximate ten percent whole body impairment
February 7, 2002,  a rehab conference was held with Dr.
Gammel, the claimant's case manager, and her attorney.
That same day,  Dr. Gammel confirmed his opinion that
Ms. McCauley was a candidate for an LESI based on the recent
myelogram showing a swollen nerve root at ¶ 1. He
confirmed his referral of the claimant to Dr. Munshi, who is
a neurosurgeon, to see if she was a surgical candidate
although he admitted that Dr. Munshi was likely to agree with
Dr. Mayeux. He also confirmed his recommendation that the
claimant might benefit from a spinal cord stimulator.
Further, he confirmed his opinion that the claimant was
capable of performing sedentary to light duty work, however,
he agreed that her return to work should be evaluated after
the LESIs. He confirmed his opinion that the claimant would
not reach maximum medical improvement until she had attempted
a course of LESIs and been evaluated for a spinal cord
claimant returned to Dr. Blackburn on February 18,
2002. She was in great distress, crying, and
in a wheelchair due to an ankle injury sustained in a recent
fall. He advised her to seek an orthopedic consult for her
ankle. X-rays taken on February 19, 2002 showed an avulsed
fracture near the cuboid bone of Ms. McCauley's right
foot as well as a second avulsed fracture adjacent to the
base of the little toe on the right foot.
Gammel administered an LESI on February 20,
later, on February 28, 2001, the claimant saw Dr. David S.
Muldowny, an orthopaedic surgeon. Dr. Muldowny stated that
it was difficult to determine if the claimant's back pain
was related to the S1 dermatome because of her broken foot.
He also discussed with her the fact that she was on such a
heavy dose of narcotics that results from surgery would be
unpredictable. He suggested waiting until her foot healed to
further evaluate her problems.
McCauley returned to Dr. Blackburn on March 19,
2002. She had a walking cast for her right
foot and had seen Dr. Muldowny. She reported that the LESI
“had limited effectiveness” but she was unable to
evaluate its effectiveness due to the broken foot, which was
painful and altered her gait. Dr. Blackburn noted that Dr.
Gammel had increased her Oxycontin dosage. He noted that he
had added Wellbutrin, which was helping with her depression
although she “continued to have significant depression
and overall distress.” He increased the Wellbutrin
returned to Dr. Muldowny on March 21, 2002. Deep tendon
reflexes were diffusely decreased bilaterally but were
symmetric. A straight leg raise test was mildly positive on
the right but negative on the left. Sensation was grossly
intact. In Dr. Muldowny's opinion, the claimant likely
did have a lumbar radiculitis at ¶ 1 from whatever was
causing the nerve root abnormality. He thought that she
“could conceivably benefit from a decompression.”
He advised, however, that due to the duration of her
symptoms, surgery might not relieve her symptoms. She
indicated that she wanted to proceed. Therefore, he
recommended a microdiscectomy at ¶ 5-S1 on the right.
McCauley returned to Dr. Gammel on April 16, 2002. She rated
her low back pain and right leg pain at seven to eight on a
ten-point scale despite using Oxycontin, OxyIR, Baclofen,
Wellbutrin, Valium, Relafen, Remeron, Ativan, and TPI gel.
She was tearful and in obvious distress. He continued her
medications but added Toradol and gave her a shot of Toradol
in the office.
10, 2002,  Dr. Blackburn noted that Ms. McCauley
was still very depressed, crying, and distressed because her
workers' compensation carrier was requiring an
independent medical examination before scheduling her surgery
with Dr. Muldowny. Dr. Blackburn opined that the surgery
should have been performed years earlier. He noted that the
claimant reported problems with sleep, and he discontinued
Sonata and prescribed Seroquel.
claimant had an independent medical examination with Dr. W.
Stan Foster on June 5, 2002. Her primary complaints were
constant burning pain in her lower back and nerve pain in the
right buttock and down the right leg. She said that sometimes
her right leg would go numb and she had pain when she coughed
or sneezed. Her medical history included heart disease with
SVT, hypertension, arthritis, and depression. Dr. Foster
noted that the claimant extended both of her legs to full
extension while sitting on the table for her husband to
remove her socks. Any extension or lateral bending caused
pain. When asked to flex forward, she flexed only 10 degrees
and complained of severe pain. She had tenderness to
palpation from L2 all the way down to S1 on the right side
with no obvious muscle spasm and exquisite right sciatic
notch tenderness. When asked to stand on her heels and toes,
she did so, but Dr. Foster felt she was not putting out a
complete effort. Knee jerks and ankle jerks were and
symmetrical but she complained of severe pain when he tapped
her right ankle. A sitting straight leg raise test was
negative on the left and positive on the right, which was
inconsistent with the fact that she had extended her legs
while sitting up to have her husband remove her socks. Pulses
were and symmetrical. Fabere's test was negative on
the left but positive on the right. Sensation was decreased
over the inner right thigh, right outer calf, right outer
foot, and the right first web space as compared to the left.
Dr. Foster noted that when he reviewed the x-rays, the
claimant was sitting comfortably, turning to the right to
face him with her right leg Indian style, with her right hip
flexed more than ninety degrees with external rotation, which
was inconsistent with the positive Fabere's test. He
observed her left leg dangling off the table, she was leaning
against the wall, and she appeared to be in no pain. It
appeared that when her husband noticed Dr. Foster observing
this, the claimant immediately changed her position. Dr.
Foster watched her walk to her car with a normal gait and no
signs of pain. He opined that she needed to be weaned off her
pain medication. Dr. Foster's impression was that the
claimant had a mildly traumatic type of accident but had
psycho-social problems and significant signs of symptom
magnification. He would not recommend surgery because she
would be unlikely to have a good result given the amount of
pain medication she seemed to require and because she was
claimant saw Dr. Gammel again on August 7,
2002. Her symptoms were unchanged, and he
refilled her medications.
Dr. Muldowny on November 12, 2002 for preoperative
counseling.He saw her again on November 25, 2002,
indicating that she was scheduled for surgery on December 10,
2002. However, there is no operative report in
McCauley returned to Dr. Muldowny on January 30,
2003. She reported that her leg still hurt but
there was some positive improvement. She was to continue
increasing her activities, as tolerated, and to return in six
February 10, 2003, Dr. Gammel had a rehab conference with the
case worker. The claimant was approximately two
months post-surgery but had not been in to see Dr. Gammel.
They discussed weaning her off the pain medications.
claimant returned to Dr. Muldowny on March 13,
2003. She was about three months post-surgery
and indicated that there had not been a lot of improvement.
Her leg pain was somewhat better but still bothersome. She
was disappointed in not getting the relief she had expected.
Straight leg raise tests were negative. Dr. Muldowny
indicated that he hoped things would improve with time. She
was to return in six weeks.
the claimant returned to Dr. Gammel on April 9, 2003,
she rated her pain at ten out of ten. She had run out of her
opioid medications and reported low back pain, right lower
extremity pain radiating into the foot, and numbness in the
right outer aspect of her leg and into her foot. Dr. Gammel
noted that the claimant was quite distressed. She had absent
ankle reflexes bilaterally, a positive seated straight leg
raising test on the right, increased tone and tenderness to
the lumbar paraspinous region bilaterally, and a well healed
midline lumbar scar. He also noted skin changes consistent
with the application of a heating pad. His impressions were
ongoing lumbar radiculopathy status post decompressive
laminectomy, poor pain control without opioid management, and
depression, anxiety, and increased situational stress. Dr.
Gammel restarted her opioid medications and prescribed a
course of pool therapy.
claimant saw Dr. Muldowny on May 1, 2003. He noted that
she was doing about the same and stated “I am not sure
if there is much more that I can offer.”
record contains no treatment notes from Dr. Blackburn between
May 2002 and June 2012.
function report dated May 5, 2015,  the claimant stated that
she could not walk, sit, or stand longer than twenty minutes
without severe back pain and right leg and foot pain. She
also stated that she could not lift anything heavier than ten
pounds. She stated that she spent most of her day reading,
doing needlepoint, or watching TV in bed. She stated that
chronic pain, back spasms, anxiety, and depression interfere
with her sleep. She stated that she can no longer work,
bicycle, camp, canoe, cook, or entertain guests. She stated
that she uses a shower chair and needs assistance getting in
and out of the bathtub. While she stated that she can dress
herself, her husband brings her clothes to her. She stated
that she does no cooking, household chores, or yard work due
to severe pain and no longer drives. She explained that her
right leg does not respond all the time, making her feel
unsafe if driving. She stated that she walks with a cane and
uses a wheelchair if she has to travel a long distance. She
denied taking any prescription medications for her allegedly
January 19, 2017, the claimant testified at a hearing
regarding her symptoms and her medical treatment. She
testified that she had low back pain following the elevator
accident that resulted in her spending more than half of each
day in bed between 1997 and 2002. The medications that she
took for pain caused nausea that prevented her from being
able to read. The Oxycontin that she was prescribed
also caused increased sleepiness.
claimant stated that, following the accident, she was in pain
from her waist down to her toes on the right
side. She described the pain as
severe and testified that increased activity
would intensify the pain. She got some relief using a
heating pad and trigger point gel. She testified that she
also had trouble going to sleep. She claimed that she was
unable to cook clean, shop, or do any household chores, all
of which were taken over by her husband. She testified
that, between 1997 and 2002, she could not walk very far and
could sit for only about half an hour before having to get up
and move around. She testified that a doctor told her not
to lift more than ten pounds.
stated that she treated with Dr. Staires at LGMC's pain
clinic following the accident. However, she denied
that the pain management treatment received prior to surgery
relieved her pain. Dr. Muldowny performed surgery on the
claimant's back in December 2002. The
claimant testified that, after the back surgery, her right
leg symptoms worsened, causing her to fall. In her
opinion, her condition was worse than it was in
claimant stated that she treated with Dr. James Blackburn for
depression from January 1997 until the time of the
hearing. She described her depression as
debilitating. She stated that her depression stemmed
from her back injury resulting in her not being able to be as
active as she was before the accident. She
testified that the medication and counseling from Dr.
Blackburn had helped her symptoms in that she no longer cried
claimant now seeks to have the Commissioner's denial of
her application for Social ...