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Melissa Day Proulx v. Michael J. Astrue

October 11, 2012


The opinion of the court was delivered by: Paul Barbadoro United States District Judge

Opinion No. 2012 DNH 180


Melissa Day Proulx seeks judicial review of a ruling by the Commissioner of the Social Security Administration denying her application for disability insurance benefits. Proulx contends that the Administrative Law Judge ("ALJ") who initially denied her claim failed to properly evaluate the expert medical evidence. Proulx urges this court to either reverse the Commissioner's ruling or remand the case for further hearing. For the reasons set forth below, I deny Proulx's request.


Proulx was 33 years old when she applied for disability insurance benefits. She obtained her high school diploma in 1993 and completed a licensed nursing assistant's course in 1995. Her work experience includes jobs as a retail cashier and a licensed nursing assistant. Proulx alleged a disability onset date of October 15, 1999 in her original application for benefits, but she later amended the date to December 11, 2002. She claimed disability due to ankylosing spondylitis,*fn2 injuries from a car accident in 1998, and memory issues.

On December 24, 2009, the Social Security Administration denied Proulx's claim. She requested a hearing, and after appearing and testifying on March 3, 2011, the ALJ issued a decision denying her request for benefits. This decision became final on August 30, 2011 when the Appeals Council declined to review it.

A. Medical History

1. Medical Conditions and Treatment Summary

On August 31, 2001, Proulx began receiving treatment from Dr. Margaret Tilton, a physiatrist, for chronic neck, shoulder, arm, and hand pain. Proulx explained that her symptoms were sporadic and began after a car accident on July 23, 1998. Dr. Tilton's exam revealed soft tissue trigger points and reduced range of cervical motion. Dr. Tilton diagnosed Proulx with chronic cervical and thoracic myofascial pain superimposed on cervical and thoracic sprain/strain.

Dr. Tilton recommended a series of trigger point injections which Proulx began receiving on September 6, 2001. At her second treatment on October 4, 2001, Proulx reported that the injections provided significant, but temporary, relief. Proulx received trigger point injections every few weeks until April 23, 2002, at which point treatment was suspended because Proulx was due to give birth. She gave birth via Caesarean section on April 26, 2002. The hospital released her three days later.

On August 23, 2002, Proulx visited Dr. Tilton for the first time after giving birth. Proulx reported that her pain management had improved since delivery.*fn3 Dr. Tilton examined her and reported that she looked "quite good," but noted trigger points on her trapezius and left scapulae. Accordingly, Dr. Tilton ordered another series of trigger point injections.

Dr. Tilton continued to administer trigger point injections to Proulx every few weeks from August 2002 through June 2003 and also in November and December 2003. In her clinical notes from several visits with Proulx, Dr. Tilton reported that Proulx was exercising, including pushing her children outside for a walk, and participating in water therapy, swim, and yoga. Tr. 531, 559, 569.

On December 11, 2002, Dr. Tilton drafted a "Permanent Medical Impairment Report," which summarized Proulx's treatment and explained how the relatively low impact collision and resulting soft tissue injury of July 23, 1998 precipitated her symptoms. Dr. Tilton concluded that Proulx could not perform her past relevant work as a certified nurse's assistant, but "has a capacity for full-time sedentary work, or work in the light category, that would allow her to change position frequently, and not involve any sustained or repetitive cervical motion, or lifting."

On February 12, 2003, Proulx began treatment with Dr. Bruce Samuels, a rheumatologist, for chronic myofascial pain syndrome. Dr. Samuels observed tenderness in her neck, shoulders, deltoids, trapezius, elbows, and lower back. He opined in his treatment notes that Proulx appeared to have fibromyalgia, or at least a chronic myofascial pain syndrome. Dr. Samuels noted that Proulx was receiving trigger point injections and, more recently, Botox for her stiff neck and discomfort. Dr. Samuels commented that a low dose of steroids could help to alleviate her pain. Thus, on May 15, 2003, Proulx started taking Prednisone. In June,*fn4 Dr. Samuels noted that Prednisone helped to eliminate pain in Proulx's lower extremities, but not her upper extremities and neck.

On June 30, 2003, Proulx reported severe pain and cried during her exam with Dr. Samuels. Proulx explained that she was now taking four Percocet pills each day for pain. Dr. Samuels noted that he was "at a loss of what to do" or where to send Proulx for treatment. He provided Proulx with OxyContin and ordered a bone scan. On July 21, 2003, the bone densitometry report indicated normal bone mineral density.

On August 5, 2003, Proulx was feeling better during her exam with Dr. Samuels, but her complaints remained the same.

Tr. 596. Dr. Samuels noted that Proulx had a cervical epidural steroid injection, with minimal relief, but was going back for a second injection.

On August 27, 2003, a cervical MRI revealed mid-cervical spondylotic change with mild spinal stenosis at C3-4 and C4-5 as a result of disc-osteophyte complex.*fn5 A ...

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