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Peter Dragisic v. Michael J. Astrue

March 15, 2012


The opinion of the court was delivered by: Magistrate Judge Michael T. Mason


Michael T. Mason, United States Magistrate Judge:

Plaintiff, Peter Dragisic ("Dragisic" or "claimant"), has brought a motion for summary judgment [11] seeking judicial review of the final decision of the Commissioner of Social Security ("Commissioner") denying his claim for disability insurance benefits under the Social Security Act, 42 U.S.C. §§ 416(i) and 423(d). The Commissioner filed a response [14] asking the Court to uphold the decision of the Administrative Law Judge. We have jurisdiction to hear this matter pursuant to 42 U.S.C. § 405(g). For the reasons set forth below, plaintiff's motion is granted in part.


A. Procedural History

Dragisic filed his application for period of disability and disability insurance benefits on March 19, 2008 alleging disability beginning April 15, 2007 due to right knee problems. (R. 47, 106-115.) His application was denied initially on June 24, 2008 (R. 47-52), and again after a timely request for reconsideration on October 17, 2008. (R. 53-58.) Thereafter, Dragisic requested a hearing, which was held on October 8, 2009 before Administrative Law Judge John L. Mondi ("ALJ" or "ALJ Mondi"). (R. 21-42.)

On November 5, 2009, ALJ Mondi issued a written opinion denying Dragisic's request for benefits. (R. 9-17.) Dragisic then filed a request for review of the ALJ's decision, which the Appeals Council denied on December 27, 2010. (R. 1-3.) At that time, the ALJ's decision became the final decision of the Commissioner. Zurawski v. Halter, 245 F. 3d 881, 883 (7th Cir. 2001). This action followed.

B. Medical Evidence

1. Treating Physicians

Records reveal that Dragisic visited Midland Orthopedic Association ("Midland") on May 15, 2006 complaining of a history of right knee pain. (R. 260-264.) Dragisic reported that the pain was caused by "wrestling, torn ligaments" and had been bothering him since 1974. (R. 264.) He indicated that he previously received an x-ray and "draining" from a Dr. John Sonnenberg. (Id.)

Dr. Jay M. Brooker of Midland reported that Dragisic has a history of right knee pain with "some exacerbation of symptoms." (R. 260.) He noted that "recent x-rays reveal mild to moderate degenerative changes, medial joint space narrowing, and osteophyte formation." (Id.) He also found "crepitus on range of motion but no effusion or instability." (Id.) Dr. Brooker went on to note that Dragisic has degenerative arthritis that will initially require anti-inflammatories. (Id.) If that did not work, Dr. Brooker stated he "will have [Dragisic] undergo injections." (Id.) It appears that Dr. Brooker prescribed Celebrex. (R. 263.) Dragisic did not show up for his follow-up appointment on June 6, 2006, and there is no indication he ever returned to Midland after his initial appointment.

(R. 205, 262.)

On May 22, 2009, Dragisic presented to the urgent care department of Hines VA Hospital ("Hines") complaining of chronic pain in his left hip and right knee. (R. 249.) He described his pain as "aching, nagging [and] sharp," and stated that standing and walking makes it worse. (R. 247.) Dragisic reported to Dr. Krishnamoorthi of Hines that he tore his ligaments while wrestling thirty years earlier, then "re-injured" the ligaments several times over the years. (R. 249.) Dragisic described pain on flexion and extension, but denied "clicking," "locking," or "collaps[ing]." (Id.) He explained that he saw an orthopedic doctor three to four years earlier at which time he was told he had a bone spur, and that surgery was not likely to help. (Id.) He was also told that his hip pain was a result of "over-compensating with his gait." (Id.) Dragisic stated that he had been laid off a year and a half earlier and lost his medical insurance. (Id.)

Dr. Krishnamoorthi's exam revealed crepitus and mild effusion in the right knee as well as "small pre-patellar bursal effusion." (R. 250.) Dragisic had a decreased range of motion in his right knee, and was unable to "fully extend and relax." (Id.) His gait was "limping to guard [right] knee." (Id.) Dr. Krishnamoorthi assessed chronic right knee pain, "likely significant fibrosis from old ligament/soft tissue tears," and "bony overgrowth." (Id.) He also agreed that Dragisic's chronic left hip pain "is a result of overcompensation," and noted early osteoarthritis. (Id.) Dragisic was given Toradol for the pain in the hospital and prescribed Naproxen and Acetaminophen for pain and swelling. (R. 246, 269.) Dr. Krishnamoorthi also gave Dragisic referrals to the Hines General Medical Care ("GMC") department to establish primary care and to the Hines Physical Medicine and Rehabilitation ("PM&R") clinic to be evaluated for physical therapy and the need for imaging, interventional, and surgical strategies. (R. 250.)

Dragisic saw a GMC nurse practitioner at Hines on June 23, 2009 and continued to complain of chronic right knee and left hip pain. (R. 239-240.) The nurse practitioner ordered x-rays, and referred Dragisic to Dr. Gunjan Sharma at the PM&R clinic. (R. 240.)

Dragisic saw Dr. Sharma on July 7, 2009, at which time he told Dr. Sharma that he had difficulty walking more than two blocks or standing more than ten minutes.

(R.223.) He said the pain affects his work, relationships, and hobbies. (Id.) Dr. Sharma's physical examination revealed effusion and crepitus in the right knee, as well as limited range of motion. (R. 226-227.) Dr. Sharma described Dragisic's gait as "antalgic due to pain."*fn1 (R. 227.)

Dr. Sharma also reviewed Dragisic's x-rays. (R. 225-226.) The x-ray of the right knee revealed "moderate [degenerative joint disease] of the right knee and femoropatellar joints seen with some narrowing of the medial knee joint space." (R. 254.) Osteophyte formation was evident, including in the patellar area, and there was "soft tissue ossification adjacent to the medial condyle of the femur apparently related to previous trauma." (Id.) It was noted that these findings were consistent with PellegriniStieda's disease. (Id.) There was no definite evidence of recent fracture, subluxation or bone destruction. (Id.) Small knee joint effusion was suggested in the supra-patellar bursal regions. (Id.) As for the results of the left hip x-ray, mild to moderate degenerative joint disease of the bilateral hips was suggested, but there was no evidence of recent fracture, subluxation, avascular necrosis, or metastases. (R. 255.) The sacroiliac joints appeared normal. (Id.) The reviewing radiologist also noted that Dragisic was a patient with "apparently known mild lumbar spondylosis." (Id.)

Based on the physical exam and the x-rays, Dr. Sharma assessed right knee pain due to Pellegrini-Stieda's disease. (R. 227.) He advised Dragisic to continue taking Naproxen for pain and suggested physical therapy two to three times a week for six weeks. (Id.) Dr. Sharma also ordered a MRI to rule out a meniscal tear. (Id.)

Dragisic returned to Hines for the MRI of his right knee on July 31, 2009. (R. 253.) Patello-femoral articulation showed degenerative joint disease changes and osteophytosis. (Id.) Cartilage wear of the femoral condyles was suspected. (Id.) Small to medium sized joint effusion was identified. (Id.) There were no signs of a miniscal tear. (Id.) The anterior cruciate ligament ("ACL") was poorly outlined and subchondral cysts were noted at the attachment of the ACL to the tibia. (Id.) A partial ACL tear was suspected since a few fibers were "visible coursing in the intercondylar notch." (Id.) The posterior cruciate ligament was normal in thickness and no tear was demonstrated. (Id.) Subchondral cysts were noted in the distal femur at the intercondylar notch. (Id.) The medial and lateral collateral ligaments were normal. (Id.) On September 1, 2009, Dragisic had a follow-up appointment with Dr. Sung Ahn at the PM&R clinic to review the results of his MRI. (R. 230-234.) Dr. Ahn's notes reveal that Dragisic was limping, unable to ...

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