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Adam D. Nichols v. Michael J. Astrue

June 14, 2012


The opinion of the court was delivered by: Joseph A. DiClerico, Jr. United States District Judge

Opinion No. 2012 DNH 107


Adam D. Nichols seeks judicial review, pursuant to 42 U.S.C. § 405(g), of the decision of the Commissioner of the Social Security Administration, denying his application for social security disability insurance benefits under Title II and supplemental security income under Title XVI. Nichols contends that the Administrative Law Judge ("ALJ") erred in failing to find that Nichols met or equaled Listing 1.04A under 20 C.F.R. Part 404, Subpart P, Appendix 1. The Commissioner moves to affirm the decision.


Nichols applied for social security benefits on December 18, 2008, alleging a disability since September 5, 2007, due to a ruptured disc with nerve impingement and atrophy of his left calf. Nichols reported that he injured his back by lifting a heavy object at work. After that incident, he had low back pain that radiated to his left leg and that was made worse by bending or lifting.

Nichols had an MRI done at Exeter Hospital that was reviewed on September 25, 2007, by Dr. Manuel Sanchez, a pain specialist at Interventional Spine Medicine. Dr. Sanchez recorded that the MRI showed "degenerative changes at L4-5, L5-S1 with disc protrusion to the left, resulting in compression of the nerve root of the lateral recess and annular tears at the 4-5 and 5-S1." On physical examination, Dr. Sanchez found that Nichols had positive signs for pain limitation with straight raising of his left leg and sensory changes in his left thigh and calf.

At an appointment with Dr. Stefan Kim in October of 2007, Nichols reported that he continued to have back pain and had tried physical therapy and five epidural steroid injections. Through a physical examination, Dr. Kim found that Nichols was not in acute distress, had full motor strength, and showed no evidence of sensory deficits. An MRI of Nichols's back showed degenerative disc disease at L4-5 and L5-S1. Dr. Kim concluded that Nichols's symptoms were consistent with mechanical back pain and recommended physical therapy.

On December 14, 2007, Dr. Peter J. Dirksmeier, an orthopedic surgeon, examined Nichols and noted his obvious discomfort, very limited ability to walk and change positions, and extraordinarily stiff range of motion in the lumbar region. Dr. Dirksmeier also noted that straight leg raising caused back pain and exacerbated Nichols's left leg pain and that he had decreased sensory reaction to pin prick in the left L4, L5, and S1 areas. In March of 2008, Dr. Dirksmeier reported the same examination results, noted that Nichols's gait was slow and shuffling, and gave his opinion that Nichols probably suffered from an acute annular tear in at least one of his lower lumbar discs.

Nichols was treated at the Pain Care Center from January of 2008 through October of 2008. During that time, his symptoms improved. Nichols was also treated at Access Sports Medicine and Orthopedics beginning in March of 2008. Dr. Gary Fleischer found that Nichols was in no acute distress and retained full motor strength in his legs and recommended physical therapy.

From March to May of 2008, Nichols was also treated at Massachusetts General Hospital. He was diagnosed with lumbosacral disc disease. An MRI of Nichols's lumbar spine done on May 6, 2008, showed mild disc space narrowing at L4/5 and L5/S1 with spine alignment maintained. The radiologist wrote that Nichols had degenerative changes with disc protrusion at L4-5 and L5-S1, abutting the nerve roots. Dr. Kirkham Wood, an orthopedic surgeon, evaluated Nichols on May 6, 2009, and noted that Nichols was able to do only twenty degrees of lumbar flexion and extension, with significant pain, could do heel to toe walking but gingerly, and had positive result on straight left leg raising. In the discharge note, Dr. Elizabeth Temin wrote that the MRI showed a normal spinal cord but also showed discs bulging at L4-5 and L5-S1 with impingement on the nerve root.

On July 7, 2009, Nichols was evaluated by Dr. Sandra K. Vallery, a state agency psychiatric consultant. Nichols told Dr. Vallery that after he hurt his back he began to experience panic attacks. Dr. Vallery did a mental status examination and found that Nichols was able to interact normally, understand and remember instructions, tolerate work stress, but had some difficulty with task completion. Dr. Vallery diagnosed back problems, panic disorder without agoraphobia, and an adjustment disorder. She noted that Nichols was taking Ativan for anxiety and that his prognosis was good.

On July 17, 2009, Dr. Burton Nault, a state agency physician, reviewed Nichols's medical records and completed a physical residual functional capacity assessment. Dr. Nault found that Nichols could occasionally lift and/or carry ten pounds, could frequently lift and/or carry less than ten pounds, could stand or walk for at least two hours in an eight-hour work day, could sit for six hours, and was not limited in his ability to push or pull. He also found that Nichols was limited to doing postural activities only occasionally but had no limitations in manipulative and communicative activities. Dr. Nault found no environmental limitations.

On September 30, 2009, Dr. Fleischer examined Nichols and found slight abnormalities and some weakness but full strength in his legs. Following an examination on January 11, 2010, Dr. Fleischer made the same physical findings and also concluded that Nichols could return to work but was restricted from lifting more than twenty pounds, could do only limited bending and twisting, could not drive, and could stand up to forty-five minutes in an hour. In February, Dr. Fleischer found that Nichols's straight leg raising test was negative. Dr. Fleischer's examination notes through 2010 show that Nichols's back was normal and do not include any significant symptoms.

On October 31, 2010, Dr. Dennis Rork, a physician with Londonderry Family Practice, completed a lumbar spine residual functional capacity assessment for Nichols. Dr. Rork diagnosed degeneration of lumbar discs with radiculopathy and wrote that Nichols was totally disabled by back and leg pain. He assessed that Nichols could only sit, stand, or ...

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