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Jennifer Lawton v. Michael Astrue

July 24, 2012


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

Opinion No. 2012 DNH 126


Jennifer Lawton seeks judicial review of the denial of her application for Social Security Disability Benefits. See 42 U.S.C. § 405(g). Lawton contends that the administrative law judge ("ALJ") incorrectly found that despite her severe impairments due to ACL strain of the left knee, obesity, post-traumatic stress disorder, and panic disorder, she retained the residual functional capacity to perform light work with certain additional limitations. The Commissioner moves to affirm the decision. For the reasons that follow, the decision is affirmed.


The background information is taken from the parties' joint statement of material facts, augmented, as necessary, by the administrative record. See LR 9.1(b).

Lawton filed an application for disability insurance benefits on June 30, 2009, alleging a disability that began on July 17, 2008, when she was thirty-five years old. At that time, Lawton worked as a cook at a restaurant, Bagel Works, where she fell on a wet floor, injuring her hip and knee. Her other past work included jobs as a waitress, a cook, a restaurant manager, a personal care assistant, and a production assembler at a factory. At the time of her application, she was taking online college classes at Franklin Pierce University toward a Bachelor's Degree in criminal justice.

A. Medical Records of Physical Impairments After the fall on July 17, 2008, Lawton was examined at Cheshire Medical Center by Dr. Karoline Kimball who noted a superficial abrasion on her left knee but no swelling or other deformity. The x-ray was "perfect," showing no evidence of degenerative change or fracture. Dr. Kimball assessed Lawton with a bruised left knee and a strained left hip. Vicodin was prescribed for pain, and Lawton was given crutches. During subsequent treatment visits, Lawton continued to report knee pain and continued to use crutches. Dr. Kimball wrote in her medical notes that Lawton's complaints of tenderness and pain were "a little over reactive." Dr. Kimball stated that Lawton "certainly could work doing a sit-down job only."

Lawton did physical therapy to strengthen her knee. On August 8, 2008, Dr. Kimball reported that an MRI of Lawton's knee showed evidence of an ACL strain. Dr. Kimball instructed Lawton to be more active and released her to work at her job at Bagel Works but only three to four hours each day. Because Bagel Works did not have light duty work Lawton could do, Dr. Kimball restricted her from working.

On August 29, 2008, Dr. Kimball referred Lawton to an orthopedic surgeon, Dr. Wade Penny. Lawton had a consultative examination with Dr. Penny on September 11, 2008. Dr. Penny concluded that Lawton's MRI scans and x-rays suggested a minor strain-type injury with very mild inflammation. On examination, Dr. Penny concluded that Lawton's bruise was not significant. He concurred with Dr. Kimball's opinion that Lawton was capable of sedentary work.

Lawton sought a second opinion from Dr. Shawn Harrington on September 16, 2008. Dr. Harrington also found no basis from his examination and Lawton's scans that would indicate chronic difficulty with her left knee. Dr. Harrington stated that Lawton could do sedentary full-time work. On October 3, 2008, Dr. Harrington reported that Lawton had improved and cleared her for light duty work with certain limitations. Dr. Harrington again cleared Lawton for light duty work with certain restrictions on October 31, 2008. An MRI of Lawton's knee done on December 3, 2008, was negative except for a possible small increase in fluid in the joint. Dr. Harrington suggested injections for knee pain. Dr. Harrington restricted Lawton to avoid kneeling, squatting, and climbing and gave her a temporary limitation to standing and walking for no more than thirty minutes each hour. Her ability to sit, reach, and drive was unrestricted.

In January of 2009, Lawton reported considerable improvement and that she was looking for work. Dr. Harrington stated that Lawton could lift and carry weight at the light exertional level and could frequently stand and walk. She was limited in kneeling, squatting, and climbing but not restricted in sitting, bending, reaching, or driving.

Dr. Sachin Dave did a neurological examination on February 27, 2009, because of Lawton's complaints of numbness in her left foot. Lawton denied any symptoms or pain in her back, arms, or her right leg. On examination, Lawton had normal strength in her left leg and foot muscles, normal reflexes, normal sensory responses, and normal gait. An additional test showed no significant abnormalities.

Dr. Pamela Deberghes, examined Lawton on March 31, 2009, at Dr. Harrington's request, because of Lawton's continued complaints of pain in her left knee. She noted that Lawton's complaints of pain were out of proportion to the minimal objective findings, suggesting that Lawton's pain might be exaggerated because of secondary gains. She concluded that Lawton probably had patellar chondromalacia, which was exacerbated by her bruise and her obesity.*fn1 Dr. Deberghes stated that losing weight might be the best option but also recommended arthroscopic surgery.

Lawton had arthroscopic surgery on her left knee with resection of the symptomatic medial plica on April 28, 2009.*fn2 At her postoperative examination, Lawton complained of difficulty with pain control. Dr. Ronald E. Michalak stated that Lawton's chronic use of narcotics for "benign musculoskeletal pain" had increased her tolerance for pain medication. Although Lawton was walking without crutches or medication in May of 2009, in August of 2009 she reported to Dr. Harrington that she had global pain throughout her left leg. Dr. Harrington found that Lawton's complaints of pain were out of proportion to his findings on examination and stated that Lawton's obesity worked against her recovery. On September 16, 2009, Lawton had a left lumbar nerve block and reported that she was doing better by October 1 although she continued to complain of left knee and hip pain. X-rays and bone scans were normal.

In January of 2010, Dr. Yulan Wang, a pain specialist, prescribed a low dose of Hydrocodone, a pain medication, and a trial of Topamax, a medication used to treat seizures. An MRI done on March 10, 2010, of Lawton's hip produced normal results, and a radiological examination of her left ankle in April showed that her ankle was normal.

Dr. Burton Nault, a state agency consultant, reviewed Lawton's medical records on October 21, 2009. Dr. Nault assessed Lawton's residual functional capacity in light of Lawton's knee problem and obesity since July 17, 2008. He concluded that Lawton could lift, carry, push, or pull twenty pounds occasionally and ten pounds frequently; that she could stand or walk for about six hours during an eight-hour work day, and that she could sit for about six hours in an eight-hour work day. Dr. Nault found no other limitations.

On August 26, 2010, Joan Van Saun, a licensed occupational therapist, did a functional capacity evaluation of Lawton. Van Saun concluded that Lawton could only do part-time sedentary work and could not return to her job as a cook at Bagel Works.

B. Medical Evidence of Mental Impairments Lawton had an appointment with her primary care provider on July 7, 2008, for assessment of her mood symptoms. Lawton discussed having felt depressed for years and the sources of stress in her life. The nurse practitioner suggested psychotherapy and prescribed medication for depression and anxiety.

On October 13, 2009, Lawton had a consultative examination done by Richard W. Root, Ed.D., to assess her anxiety. Root concluded that Lawton experienced post traumatic stress disorder ("PTSD"), panic attacks with agoraphobia, and a mood disorder related to her knee problem. Root found that Lawton's impairments did not impact her ability to perform activities of daily living, allowed her to remember simple instructions and to concentrate on and complete normal work tasks.

Nicholas Kalfas, Ph.D., completed a Psychiatric Review Technique form on October 20, 2009, based on his review of Lawton's records pertaining to mental impairment. Dr. Kalfas concluded that Lawton's mood disorder, PTSD, and panic disorder with agoraphobia caused a mild degree of limitation in Lawton's daily activities and her ability to maintain concentration, persistence, or pace. Her impairments caused a moderate degree of limitation in her ability to maintain social functioning. Dr. Kalfas concluded that Lawton was able to understand, remember, and carry out simple instructions; to maintain attention and complete a normal work week; to make simple work decisions; and to interact appropriately with peers and supervisors. Dr. Kalfas also noted that Lawton could adapt to a work setting when supervisors were not overly critical and when she could avoid the general public and large groups of people.

From November 5, 2009, to June 29, 2010, Lawton was treated at Antioch Psychological Services Center. The final diagnosis made there was PTSD. Lawton was assessed as having a Global ...

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