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Sazhneva v. Commissioner of Social Security

September 30, 2009


The opinion of the court was delivered by: Craig M. Kellison United States Magistrate Judge


Plaintiff, who is proceeding with retained counsel, brings this action for judicial review of a final decision of the Commissioner of Social Security under 42 U.S.C. § 405(g). Pending before the court are plaintiff's motion for summary judgment (Doc. 15) and defendant's cross-motion for summary judgment (Doc. 16).


Plaintiff applied for social security benefits on November 8, 2005. In the application, plaintiff claims that her disability began on April 1, 2002. In her application*fn1, Plaintiff claimed her disability is caused by a combination of varicose veins, back, leg and joint pain, incontinence, numbness of feet and hands, and headaches. Plaintiff's claim was initially denied. Following denial of reconsideration, plaintiff requested an administrative hearing, which was held on August 29, 2007, before Administrative Law Judge ("ALJ") Peter F. Belli. In a September 27, 2007, decision, the ALJ concluded that plaintiff is not disabled based on the following relevant findings:

1. The claimant has not engaged in substantial gainful activity since November 8, 2005, the application date (20 CFR 416.920(b) and 416.971 et seq.).

2. The claimant has the following severe impairments: varicose veins, mild scoliosis and spondylosis of the lumbar spine, a history of bilateral carpal tunnel syndrome, left foot bone spur, and obesity (20 CFR 416.920(c)).

3. The claimant does not have an impairment or combination of impairments that meets or medically equals one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR 416.920(d), 416.925 and 416.926).

4. After careful consideration of the entire record, the undersigned finds that the claimant has the residual functional capacity to perform the full range of light work with occasional climbing, stooping, kneeling, crouching, squatting, or crawling. Light work involves lifting no more than 20 pounds occasionally, with frequent lifting or carrying of objects weighing up to 10 pounds. The full range of light work requires standing or walking a total of approximately 6 hours of an 8 hour work day with normal work breaks.

5. The claimant is capable of performing past relevant work as boiler operator. This work does not require the performance of work-related activities precluded by the claimant's residual functional capacity (20 CFR 416.965).

6. The claimant has not been under a disability, as defined in the Social Security Act, since November 8, 2005 (20 CFR 416.920(f)), the date the application was filed.

After the Appeals Council declined review on December 15, 2007, this appeal followed.


The certified administrative record ("CAR") contains the following evidence, summarized chronologically below:


August 11, 2005 -- Plaintiff was seen for a new patient physical examination. Plaintiff presented with a history of varicose veins and obesity.*fn2

August 16, 2005 -- Plaintiff had a venous ultrasound of her left lower extremity. The findings of that ultrasound were: "There is no intraluminal sound stopping material seen throughout the left lower extremity venous system. Full compressibility is achieved on the left." The impression was: "No evidence of deep venous thrombosis in the left lower extremity." (CAR 154).

August 19, 2005 -- Plaintiff had a full physical at the Sacramento Refugee Clinic. It appears she arrived in the United States in February 2005, from the Ukraine. As part of this physical, Plaintiff had a normal chest x-ray. Her history included fractures, swelling, and varicose veins in her left leg.

October 20, 2005 -- Plaintiff was seen for joint pain, ankle and hip pain, and varicose veins. She was diagnosed with obesity, osteoarthritis, and carpal tunnel syndrome. The doctor ordered x-rays of her left ankle and hips. The doctor noted she had positive Tinel's sign, positive Phalen sign, her BMI was 40.3, her carpal tunnel (confirmed by EMG) was worse on right than left, and plantar fasciitis. She was prescribed Tylenol, compressive stockings, and wrist splints.

Normal x-ray of Plaintiff's hips and pelvis. The hip x-ray showed: "The femoral heads are well located within the acetabulm. The joint spaces are well maintained. No subchondral cysts or spurs are demonstrated. The SI joints appear normal. No pelvic fractures are demonstrated." (CAR 147). An x-ray of Plaintiff's ankle found: "The mineralization is within limits of normal. The ankle mortise is well maintained. There is a very small spur along the anterior margin of the tibia at the ankle. No fractures or destructive lesions are noted. There are several soft tissue calcifications which may represent some small phleboliths. The patient has calcaneal spurs at both planter and Achilles insertion sites into the calcaneus." The impression from the ankle x-ray was: "No fracture or significant arthritic change is noted. Calcaneal spurs. Some faint soft tissue calcifications most likely representing phleboliths." (CAR 147-48).

November 16, 2005 -- Plaintiff was seen for office visit. It appears Plaintiff was complaining about pain in legs and hips, as well as back pain and bladder incontinence. She was referred to a neurologist, and for x-ray of the lumbar and cervical spine.

November 28, 2005 -- Plaintiff was assessed by a neurologist. It appears she complained about pain in ankles and cramping in her legs. She had positive Tinel's sign, and was assessed with restless leg syndrome, polyneuropathy, and mild headaches.

Plaintiff also had a nerve conduction study, conducted by Dr. Rafanov, which was abnormal. Her history was noted to include numbness, weakness in hands, and she had positive Tinel's on examination. Her baseline was "moderately severe median neuropathy at wrist, more pronounced on right." (CAR 187).


May 4, 2006 -- Consultative internal medicine evaluation by Dr. Gabriel S. Borges. During the examination, Plaintiff stated her chief complaints were varicose veins, polyarthralgia, stress incontinence, carpal tunnel syndrome, headaches and heel spurs. On examination, Dr. Borges found Plaintiff was able to walk with a non-antalgic gait, but her gait was slow and guarded. She was able to sit unassisted, but her movements were slow getting onto the examination table. She was able to lie in supine position without assistance. Plaintiff was unable to do deep knee full squats due to right hip and knee pain, and was only able to squat about 50% of the way down. She was unable to do heel-knee-shin maneuvers, heel or toe walk, Romberg, or tandem. She took short, careful, guarded steps in a straight line. Her range of motion was grossly within normal limits in the cervical spine region, as well as the knee, ankle, shoulder, elbow and wrist joints. In the lumbar spine region, her range of motion was: flexion 0-70 degrees, extension 0-10 degrees, and lateral flexion 0-15 degrees. Her hip joints range of motion on the left was: forward flexion 0-100 degrees, backward extension 0-30 degrees, rotation-interior 0-20 degrees, rotation-exterior 0-30 degrees, abduction 0-25 degrees, and adduction 0-15 degrees. On the right, her range of motion in her hip joints were: forward flexion 0-80 degrees, backward extension 0-10 degrees, rotation-interior 0-30 degrees, rotation-exterior 0-40 degrees, abduction 0-30 degrees, and adduction 0-10 degrees. Plaintiff's straight leg raising was negative bilaterally. She had positive Tinel's and Phalen's on the right, positive Tinel's on the right, negative Phalen's on the left.

Dr. Borges's general findings were as follows:

1. Right hip does reveal some crepitus and tenderness to palpation with range of motion. No dislocation, no redness or fluctuans.

2. Mild L5-S1 spinal tenderness with flattening of the lumbar lordotic curve. No scoliosis noted.

3. Bilateral heels were tender. No gross deformity.

4. Skin exam did reveal some varicose veins in the lower extremities bilaterally.

5. Hands reveal no gross deformity, no Heberden's or Bouchard's notes. (CAR 168).

Dr. Borges also found Plaintiff's muscle bulk, tone and strength equal and symmetric in the upper and lower extremities at 5/5 bilaterally. Her grip strength on the right was 15 pounds, and on the left was 22 pounds. She had good manual dexterity bilaterally. Dr. Borges's diagnosis was:

1. Carpal tunnel syndrome. Objective findings reveal positive Tinel's and Phalen's on the right and positive Phalen's on the left. Full range of motion. Good manual dexterity.

2. Hip. We cannot rule out degenerative arthritis. I did find some palpatory tenderness on the right of the trochanteric joint with some crepitus noted with decreased range of motion. ...

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