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Kim M. Puleo v. Michael J. Astrue

March 4, 2011

KIM M. PULEO , PLAINTIFF,
v.
MICHAEL J. ASTRUE, COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: Magistrate Judge Martin Ashman

MEMORANDUM OPINION AND ORDER

Plaintiff Kim M. Puleo ("Puleo") seeks judicial review of a final decision of Defendant Michael J. Astrue, Commissioner of Social Security ("Commissioner"), denying her claim for disability insurance benefits ("DIB") under Title II of the Social Security Act, 42 U.S.C. §§ 401-431. Before this Court are Puleo's Motion for Summary Judgment and the Commissioner's Cross Motion for Summary Judgment. The parties have consented to have this Court conduct all proceedings in this case, including the entry of final judgment pursuant to 28 U.S.C. § 636(c) and N.D. Ill. R. 73.1(c). For the reasons set forth below, this Court affirms the Commissioner's decision.

I. Procedural History

On August 29, 2006, Puleo filed an application for DIB claiming that she became disabled on March 20, 2005 due to ongoing treatment for a left elbow injury and Crohn's disease.*fn1 (R. at 97, 133.) The Social Security Administration ("SSA") denied Puleo's application initially on December 19, 2006, and upon reconsideration, on May 23, 2007. (R. at 59, 66.) Puleo then submitted a timely request on July 23, 2007 for a hearing before an administrative law judge ("ALJ"). (R. at 72.) The administrative hearing was held on March 20, 2008 before ALJ Maren Dougherty, who issued a decision on April 16, 2008 finding that Puleo was not disabled. (R. at 58.) The SSA Appeals Council denied Puleo's request for review of the ALJ's decision, and the ALJ's decision became the final decision of the Commissioner. (R. at 1.) Plaintiff now appeals from that decision.

II. Factual Background

A. Medical History

Ms. Puleo was born on July 6, 1966, and is married with two children. (R. at 158, 166.) After completing high school, she has worked for the last fifteen years primarily in clerical positions such as an office clerk, customer service representative, or order entry clerk. (R. at 44, 112-15.) Unfortunately, Puleo suffered a serious fall at work in March 2004 and severely fractured her left elbow. On March 19, 2004, Dr. Thomas Karnezis performed the first of several surgeries on Puleo's elbow, this time to repair the fracture by an open reduction and internal fixation, and Puleo entered a program of physical therapy. (R. at 250-55, 296-302.) While in therapy, however, Puleo began experiencing pain in her left elbow, and an examination noted a metallic pin projecting medially from the joint. (R. at 235, 250-55, 296-305.) Accordingly, Puleo underwent another surgery on September 17, 2004 to remove the painful hardware and bone spurs around her left elbow. (R. at 278.) In the operative report, Dr. Karnezis noted that despite the pain Puleo was experiencing, the bone was well-healed and in full union. (R. at 279.)

Several problems arose after Puleo's first follow-up surgery, and she was required to undergo yet another surgical procedure on June 24, 2005 to remove painful plates and screws in her left elbow, to clean out fragments around the joint area, and to perform a bone graft. (R. at 310.) Puleo tolerated the new surgery well but had to be readmitted six days later when the bond holding her surgical wound separated. (R. at 315.) In the physical therapy that followed, Puleo reported pain of about a three on a ten point scale, with ten being the most painful. (R. at 213-17.) She also continued to experience a limited range of movement and difficulty lifting heavy objects with her left arm. (R. at 215.)

Puleo endured another setback in January 2006 when she reinjured her elbow while going through a revolving door. (R. at 238.) A CT scan on January 19, 2006 found a chronic humeral fracture as well as some angulation in the healing of the medial portion of the fractured fragments. (R. at 233.) Dr. Karnezis also noted severe degenerative changes involving the left-elbow joint space. (Id.) Accordingly, Puleo underwent another operation on June 24, 2006 to repair and stabilize the new fracture. (R. at 238.) In his operative report, Dr. Karnezis stated that the original 2004 injury had healed both laterally and medially prior to the re-injury, and x--rays taken after the surgical procedure revealed that the new fracture appeared to be well-aligned. (R. at 243, 333.)

From June to August of 2006, Dr. Karnezis recommended that Puleo not attend work and that she concentrate on slowly increasing her range of motion. (R. at 329-31.) Dr. Karnezis allowed her to return to work on September 11, 2006, but Puleo was cautioned not to use her left arm. (R. at 327.) After gradually increasing the use of her left arm, Dr. Karnezis cleared Puleo to return to full duty at work in November 2006, noting that her left elbow post-malunion appeared to be healing nicely. (R. at 325-27.)

Puleo, however, continued to report pain and physical limitations in using her left elbow. On November 16, 2006, Dr. Ahmari M. Shaikh conducted a consultative examination for the Bureau of Disability Determination Services, and Puleo reported constant pain of a seven on a ten point scale, with ten being the most painful. (R. at 334.) Dr. Shaikh also noted considerable deformity in Puleo's left elbow, reported a grip strength of four out of five, and found that Puleo had abnormal functioning with her left hand. (R. at 335-36.)

In April 2007, Dr. Karnezis opined that Puleo was at maximum medical improvement and could function and perform her activities overall. (R. at 400.) He did note, however, that the elbow continued to cause her pain on an intermittent basis, sometimes reaching an eight on a ten point scale. (Id.) Dr. Karnezis' again noted that Puleo could return to full-time work, now with only a twenty pound weight restriction and limited extension when using her left arm.

(R. at 401.) A consulting physician for Puleo's insurance company, Dr. Gregory Nicholson, also conducted an examination on May 15, 2007. Contrary to Dr. Karnezis' conclusion, Dr. Nicholson found that Puleo had not reached maximum improvement, (Plt's. Mot., Ex. 1), and determined that she suffered significant loss of function due to post-traumatic arthrosis and soft-tissue contracture. (R. at 405) As a result, Dr. Nicholson recommended further advanced surgery to restore Puleo's range of motion and recommended that she be restricted to desk work and use of a keyboard, although Puleo felt that even this work would be too painful. (Plt's. Mot., Ex. 1.)

By July 2007, Dr. Karnezis believed that Puleo could now work without any restrictions.

(R. at 402.) He reported that she was no longer experiencing pain or discomfort, although she still had a limited range of motion. (Id.) Dr. Karnezis presented Puleo with some options for further surgery, such as a partial or total elbow replacement should she desire to regain the full range of motion of her left elbow, but he did not recommend undergoing further surgical procedures since she appeared functional and was not complaining of pain. (R. at 403.)

B. Puleo's Testimony at the Administrative Hearing

On March 20, 2008, Puleo appeared at an administrative hearing before the ALJ to testify about her employment history, alleged disability, and the symptoms affecting her ability to work. She claimed that she had to leave her previous employment because of pain in her left arm.

(R. at 17.) Puleo testified that she is left-hand dominant and described constant pain in her left elbow that radiates to her hand when writing or typing. (R. at 17, 20.) According to her testimony, pain can also result from prolonged, repetitive use of her left arm while using a keyboard, writing, reaching, and lifting. (R. at 17-18.) Puleo physically demonstrated for the ALJ the limited flexion and extension of her left elbow, which the ALJ noted for the record was consistent with the medical reports about her range of motion. (R. at 18-19.)

Puleo testified that the last time she took prescription pain medication was in February 2007. (R. at. 21) For pain relief, Puleo relies on heating pads and almost daily use Advil or Ibuprofen (typically 1500 mg). (R. at 21, 30.) She dislikes taking anti-inflammatories, however, because she claims they can aggravate her Crohn's disease. (Id.; R. at 232.) With regard to her daily activities, Puleo stated that she is primarily in charge of the household chores, but requires assistance with activities like mopping the floors or folding large laundry. (R. at 19, 22, 29.) She conducts the majority of the grocery shopping, but requires help carrying heavy groceries ...


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