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Edwards v. Astrue

July 22, 2010


The opinion of the court was delivered by: Dennis L. Beck United States Magistrate Judge



Plaintiff Clifford L. Edwards ("Plaintiff") seeks judicial review of a final decision of the Commissioner of Social Security ("Commissioner") denying his application for disability insurance benefits pursuant to Title II of the Social Security Act. The matter is currently before the Court on the parties' briefs, which were submitted, without oral argument, to the Honorable Dennis L. Beck, United States Magistrate Judge.


Plaintiff filed his application on February 1, 2006, alleging disability since April 1, 2001, due to previously broken hips and pancreatitis. AR 71-72, 91-98. After Plaintiff's application was denied initially and on reconsideration, he requested a hearing before an Administrative Law Judge ("ALJ"). AR 39-43, 45-48, 51. On April 16, 2008, ALJ Bernard A. Trembly held a hearing. AR 18. He denied benefits on May 29, 2008. AR 10-17. The Appeals Council denied review on April 9, 2009. AR 1-3.

Hearing Testimony

On April 16, 2008, ALJ Trembly held a hearing in Bakersfield, California. Plaintiff appeared with his attorney, Rosemary Abarca. AR 18.

Plaintiff testified that he was born in 1964 and graduated from high school. He is not married and did not have children. Plaintiff last worked in June 2001 in landscaping. He had to stop working when he injured his back and neck on the job. AR 22-23. Plaintiff also fractured his hips in 1979 when he was roller skating. His hips still cause a lot of pain. AR 23. He also still has problems with his back. AR 23. Plaintiff explained that he has the most pain in his stomach from chronic pancreatitis, which began in April 2002 and required his hospitalization for 29 days. AR 24.

Plaintiff testified that he wanted to work, but he gets sick a lot. He can't go for more than a few weeks without waking up with a "real bad stomach ache and hurting." When he is in that much pain, he cannot work. AR 25. He tries to "be careful" with his pain medication, but he's in pain a lot. He explained that he cannot work because he doesn't know what brings on the pain, although he thinks it is stress related. AR 26. Plaintiff thought he would miss about three to four days a month because of his pancreatitis. AR 28.

Plaintiff also has diabetes, though he testified that for the last year and a half, when he started insulin, his sugar levels have been under control. AR 26. He sometimes has to take medication for triglycerides, and the medication makes him feel flush and itchy. AR 27.

When questioned by his attorney, Plaintiff explained that when his pancreatitis flares up, he usually won't seek treatment until he's been in pain for a week because they often can't do anything to help him. AR 28-29. The longest flare-up, which was in December, lasted about two weeks. He went to the emergency room and underwent testing. AR 29. His shortest flare-up lasts for about a day to a day and a half. During a flare-up, he stays in bed unless he has to use the restroom. He takes Vicodin for the pain. AR 30. Although surgery has been recommended, Plaintiff chose not to have surgery because of the chance that the pain could return. AR 32.

Plaintiff has had an epidural in his hip and he does swimming therapy three days a week. AR 31. He also has back pain that he tries to ignore because the pain in his stomach is greater, though he isn't sure if the pain is from his back or stomach. AR 33. Plaintiff needs to lay down everyday and testified that he spends most of the day lying down. AR 33.

Medical Record

Plaintiff was diagnosed with diabetes mellitus in early 2001. In April 2001, Jorge E. del Toro, M.D., noted that Plaintiff was placed on medication though he had not been checking his blood sugars and had not been given instructions on how to do so. AR 346.

In August 2001, Plaintiff was having hypoglycemic episodes. Dr. del Toro adjusted his medications. AR 344.

In November 2001, Dr. del Toro noted that Plaintiff's diabetes was extremely well controlled. AR 343.

In February 2002, Dr. del Toro noted that Plaintiff's diabetes was well controlled and his hypertension was well controlled with exercise. AR 343.

On April 9, 2002, Plaintiff was admitted to Mercy Hospital in Bakersfield after complaining of stomach pain with nausea, vomiting and fever. He was admitted with a diagnosis of acute pancreatitis and diabetic ketoacidosis. On the second day of hospitalization, Plaintiff was notably lethargic and confused. He was intubated secondary to respiratory failure thought to be secondary to sepsis. By the fourth day of hospitalization, his diabetic ketoacidosis and pancreatitis began to improve. Plaintiff was extubated on the ninth day, though he remained confused and feverish. A CT scan of his abdomen showed a pseudocyst. Plaintiff improved and was released after 21 days of hospitalization. He was instructed to eat a low fat, low cholesterol diet, take his medications, have a follow up CT scan, see surgeon regarding possible internal drainage and follow up with his primary care physician. AR 125-129.

On May 9, 2002, Plaintiff returned to Dr. del Toro. He continued to have weakness and bloating, as well as difficulty eating and associated nausea. His glucose appeared to be well controlled. It was very difficult to palpate Plaintiff's abdomen because of his obesity, though Dr. del Toro noted tenderness in the epigastric area. Dr. del Toro ordered additional testing. AR 341-342.

On May 20, 2002, Plaintiff saw Dr. del Toro in follow-up. He reported that his eating and strength had improved and that he was feeling much better. Dr. del Toro indicated that Plaintiff needed to see a gastroenterologist. AR 337.

On July 11, 2002, Plaintiff reported that he felt uncomfortable whenever he ate. Overall, he was eating a lot better. There was no organomegaly or tenderness in his abdomen. AR 339.

On July 25, 2002, Plaintiff told Dr. del Toro that he was feeling better than he had in a "substantial period of time." There were no masses or tenderness in his abdomen. A CT scan revealed a very large pancreatic pseudocyst extending into the left pericolic gutter. AR 338, 395.

On August 23, 2002, Plaintiff reported to Dr. del Toro that he was doing extremely well. He was eating better and feeling better. His diabetes was well controlled and his pancreatic pseudocyst was asymptomatic. AR 336.

Plaintiff underwent a Qualified Medical Examination on October 15, 2002. Plaintiff told Mohinder Nijjar, M.D., that he injured his back while he was trying to put a heavy container into a trash compacter. On examination, Plaintiff's spine showed a slightly straightened curvature and mild to moderate paraspinal muscle spasm. There was slight tenderness over the cervical spine area and range of motion was limited. There was also straightening of the lumbar spine with slight tenderness over L4-S1. Plaintiff had paraspinal muscle spasms in the lumbar spine and slight tenderness over the sacroiliac joints on both sides. He was able to walk without a limp and stand on his toes and heels. He had difficulty stabilizing in both positions, however. Plaintiff also had difficulty squatting. AR 214-219.

Dr. Nijjar diagnosed cervical strain with residual restricted range of motion and lumbar strain with residual stiffness, both of which resulted from Plaintiff's work accident in June 2001. Dr. Nijjar believed that Plaintiff was permanent and stationary. He further opined that Plaintiff could not perform heavy work and that he lost 50 percent of his pre-injury capacity to bend, stoop, lift, pull, push or climb. Dr. Nijjar believed that Plaintiff would need anti-inflammatory medication from time to time. If his symptoms greatly worsened, Dr. Nijjar noted that Plaintiff may be a candidate for physical therapy. Plaintiff was not a candidate for surgery. AR 219-220.

On November 8, 2002, Dr. del Toro noted that the CT scan showed that although the pseudocyst had decreased in size, it was still quite sizable. He recommended a surgery consultation. Plaintiff's diabetes was well controlled. AR 335.

On January 10, 2003, Plaintiff saw Dr. del Toro, who noted that his pseudocyst was stable and totally asymptomatic and his diabetes was very well controlled. Dr. del Toro noted that the surgeon did not perform surgery since Plaintiff was asymptomatic. He decided to continue to observed Plaintiff. AR 332.

On January 27, 2003, Plaintiff saw Alan Sanders, M.D., for a Qualified Medical Examination. Plaintiff reported that his neck was his worst problem, followed by his back. On examination, Plaintiff had a normal gait, could toe and heel walk and could squat fully. There was no tenderness to palpation in his lower back and he had full range of motion. Plaintiff had no tenderness to palpation in his cervical spine and had full range of motion. There was a negative response to compression/distraction tests of the cervical spine and a valsalva maneuver failed to produce symptoms. Plaintiff complained of discomfort and pain on the extremes of motion of the hips. Dr. Sanders diagnosed chronic residual cervical and lumber spondylosis as per Plaintiff's history. He had not ...

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