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Grugett v. Colvin

United States District Court, C.D. Illinois, Peoria Division

October 28, 2016


          ORDER AND OPINION[1]


         The Plaintiff, John Judson Grugett, appeals the Defendant-Commissioner's denial of his application for Supplemental Security Income benefits, wherein he alleged he was disabled. He asks this Court to remand this matter back to the Commissioner for further administrative proceedings, arguing that the Administrative Law Judge (“ALJ”) erred by failing to provide adequate reasons for rejecting the opinions of a treating physician and making an erroneous determination regarding Grugett's credibility.[2]

         In his application for benefits filed on June 19, 2012, Grugett alleged onset of disability beginning on April 21, 2012. (Tr. 25).[3] The ALJ found that Grugett's degenerative joint disease of the left shoulder, hypertension, and obesity were “severe impairments.” (Tr. 27). However, she also found that Grugett had the residual function capacity (“RFC”) to perform light work as defined in 20 C.F.R. § 416.967(b), with the following additional limitations:

[H]e cannot climb ladders, ropes, or scaffolds; he can occasionally climb ramps and stairs; he can only occasionally balance, stoop, kneel, crouch, and crawl; he can occasionally reach in any direction with the non-dominant upper extremity; he can only occasionally push/pull with the non-dominant upper extremity; and he is limited to frequent but not constant handling (grasping) with the non-dominant upper extremity.

(Tr. 28-29). Although this RFC would not allow Grugett to perform any of his “past relevant work, ” there were jobs in the national economy that he could perform, thereby precluding a finding of disability. (Tr. 31-32).

         Regarding Grugett's left shoulder issue -- the only impairment he really discusses on appeal -- the objective medical evidence reveals as follows. On April 21, 2011, Grugett saw for the first time nurse practitioner, Holly Killion. (Tr. 303). Her treatment note lists the reason for the encounter as, “WANTS TO GET SS DISABILITY-SHOULDER PAIN.” Id. He complained of shoulder pain which started over three years before the visit, after he picked something up at work and “felt a pop.” Id. He characterized his pain as sharp and stabbing which lasted all day, but was worse at night when trying to sleep. He had not had an x-ray or MRI, but did occasionally take Ibuprofen and his sisters' Vicodin. Id. Killion noted a full range of motion with all extremities, although with pain. Id. She started Grugett on naproxen and Vicodin, ordered an x-ray, and scheduled a follow-up visit six weeks later. Id. The x-ray revealed “mild left should osteoarthritis.” (Tr. 314).

         At that follow-up visit on June 10, 2011, Killion again noted a full range of motion of the shoulder, but with pain. (Tr. 303). She changed the naproxen prescription to piroxicam because the naproxen made Grugett sick and increased the Vicodin prescription from 60 to 90 pills a month, per his request. Id. Finally, she ordered an MRI and scheduled a follow-up a month later to discuss the results. Id.

         The July 14, 2011 MRI revealed a partial thickness articular and bursa surface tear of the supraspinatus tendon; severe AC joint degenerative change; advanced glenohumeral joint osteoarthritis with full thickness cartilage loss, tearing, and paralabral cysts; and a visualized lesion (later found to be non-cancerous) in the proximal humeral diaphusis. (Tr. 311).

         Grugett next saw Killion on July 21, 2011, to discuss his MRI results. (Tr. 298). She noted no changes in the physical exam of Grugett's shoulder since her last exam, noted that the MRI revealed multiple injuries in his left shoulder, and noted his need to see an orthopedic surgeon for surgery. Id. She discontinued his piroxicam but kept him on the Vicodin. Id.

         On October 27, 2011, Grugett saw physician's assistant Danielle Johnson for a three month check-up. (Tr. 293). Her treatment note indicated that Grugett was still in the process of finding an orthopedic surgeon for a consult. Id. She kept him on his Vicodin and scheduled him for another follow-up in three months. Id.

         At that follow-up visit on January 27, 2012, Johnson noted Grugett had limited movement in his shoulder due to pain.[4] (Tr. 286). She also repeated the findings of the previous MRI and noted that Grugett requested that she complete paperwork for his disability claim. Id.

         At Grugett's next office visit on October 3, 2012, he saw Dr. Holden for the first time. (Tr. 368). Dr. Holden noted the reason for the visit was “disability papers.” Id. He noted Grugett's symptoms were “unchanged, ” and that he still complained of left shoulder pain, it being an 8 out of 10. (Tr. 369). He also noted tenderness in the shoulder with weakness and decreased range of motion. Id. Dr. Holden noted a prescription for hydrocodone, with no other plans for treatment. Id.

         At this same visit, Dr. Holden also completed a “Residual Functional Capacity Questionnaire.” (Tr. 328). He opined Grugett could sit 60 minutes at one time and for eight hours total, stand or walk for 30 minutes at one time and for four hours total, lift and carry ten pounds occasionally and less than ten pounds frequently, and shift positions at will between sitting, walking, and standing. (Tr. 328-29). Dr. Holden opined Grugett could use his left arm for handling and fingering for ten percent of the workday with no ability to reach with that arm. (Tr. 329). Dr. Holden also opined Grugett would likely be absent more than four times per month due to impairments and treatment. Id. Dr. Holden did not provide, nor does the form have a space for, any explanation regarding how or why Dr. Holden reached these conclusions.

         Grugett saw Dr. Holden only one other time, on November 29, 2011. (Tr. 363). The visit was a follow-up and medication renewal visit, at which Dr. Holden noted Grugett was still waiting on his “disability, ” ...

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