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Lucy Ann Londono v. Michael J. Astrue

July 26, 2012


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

Opinion No. 2012 DNH 127


Lucy Ann Londono seeks judicial review, pursuant to 42 U.S.C. § 405(g), of the decision of the Commissioner of the Social Security Administration, denying her application for social security disability insurance benefits under Title II. Londono contends that the Administrative Law Judge ("ALJ") erred in his assessment of her impairments and their combined effects, in his evaluation of the medical opinion evidence, and in finding medical improvement. The Commissioner moves to affirm.


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).

Lucy Ann Londono filed an application for disability insurance benefits on January 8, 2009, alleging a disability since September 13, 2007, due to fibromyalgia, back pain, diabetes, anxiety, and depression. She was thirty-nine years old when she filed her application. Londono has an Associate Degree and training as a medical transcriptionist. Her past jobs included working as a medical transcriptionist, retail sales attendant, production team leader for an electronics manufacturer, and customer service representative.

A. Medical Records of Physical Impairments Before her application for benefits, Londono had been diagnosed with diabetes and received treatment for the disease. Her medical records show that she was inconsistent in controlling her diabetes, which caused repeated episodes of diabetes symptoms, including high blood sugar levels and depression. Her diabetes remained uncontrolled through much of the relevant period.

At an appointment with ARNP Tamara Tello on August 21, 2008, Londono reported that she had been in a car accident on July 28, 2008. ARNP Tello noted lower back pain and strain along with prior chronic low back pain. On examination, ARNP Tello found normal responses. An x-ray of the lumbar spine showed no acute bony issue and only minimal left curvature of the spine.

On September 5, 2008, Londono's primary care physician, Dr. Maria Velazquez-Evans, noted Londono's back pain. Londono began physical therapy on September 17. She reported left-sided sacroiliac joint pain with radiating pain down her left thigh. By November 20, Londono had completed four physical therapy treatments and reported 60% to 70% improvement in her pain.

On April 16, 2009, Dr. Hugh Fairley, a state agency consultant, completed a residual functional capacity evaluation based on a review of Londono's records. Dr. Fairley assessed the effects of Londono's sacroiliac joint disease, obesity, and fatigue. He concluded that Londono had the residual functional capacity to do work at the light exertional level, that she could occasionally do certain postural activities, and that she should avoid extreme temperatures and other environmental conditions. Dr. Fairley noted that the record did not include a medical source statement of Londono's physical capacities.

On June 16, 2009, PA-C Anne Riemer assessed Londono with a lumbar muscle spasm and prescribed medication. In July, PA-C Riemer found that Londono's back range of motion was limited and her straight leg raise was limited to forty-five degrees on the right. On August 14, 2009, PA-C Riemer assessed Londono with "myalgia/polyarthralgia with a question of fibromyalgia." Londono reported ongoing musculoskeletal pain which was increased by standing. An x-ray of the lumbar spine showed mild left-sided degenerative changes of the sacroiliac joints.

On September 2, 2009, PA-C Riemer noted that Londono's depression was worse and that her fibromyalgia pain had increased. She added that depression might be contributing to Londono's perception of pain. She was referred to a rheumatologist. Londono was discharged from physical therapy with a prognosis of fair after she missed scheduled visits and follow-up communication. On September 28, 2009, Dr. Leslie M. Dionne noted that Londono's diabetes was under better control and that Londono reported that she was feeling much better.

Londono was diagnosed with breast cancer on September 16, 2009, following a biopsy. The lesion was surgically removed. An MRI in November showed no sign of malignancy and follow-up examinations have all been benign.

On December 11, 2009, Dr. Dionne wrote that Londono's diabetes was very poorly controlled but her fibromyalgia had improved. In January of 2010, Londono reported that she was doing well, despite ongoing high blood sugars, that her fibromyalgia pain was well managed although she continued to have low back pain. PA-C Ronald Carson ordered an MRI of Londono's lumbar spine because of ongoing pain. The MRI was done in March of 2010 and showed "grade I anterolisthesis of L5 relative to S1 causing bilateral neuroforaminal encroachment." Based on that result, PA-C Carson and Dr. Dionne decided ...

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