United States District Court, N.D. Texas, Dallas Division
MEMORANDUM OPINION AND ORDER
CARRIILLO RAMIREZ UNITED STATES MAGISTRATE JUDGE
Cavett Williams (Plaintiff) seeks judicial review of a final
decision by the Commissioner of Social Security
(Commissioner) denying her claim for a period of disability
and disability insurance benefits (DIB) under Title II of the
Social Security Act. (See docs. 1; 16.) Based on the
relevant filings, evidence, and applicable law, the
Commissioner's decision is AFFIRMED.
February 5, 2015, Plaintiff filed her application for DIB,
alleging disability beginning on March 27, 2014.
(Id. at 54.) Her claim was denied initially on May 20,
2015, and upon reconsideration on September 27, 2015.
(Id. at 77, 82.) On September 28, 2015, Plaintiff
requested a hearing before an Administrative Law Judge (ALJ).
(Id. at 85-86.) She appeared and testified at a
hearing on May 30, 2017. (Id. at 32-53.) On August
28, 2017, the ALJ issued a decision finding her not disabled
and denying her claim for benefits. (Id. at 14-31.)
timely appealed the ALJ's decision to the Appeals Council
on September 21, 2017. (Id. at 155-56.) The Appeals
Council denied her request for review on June 22, 2018,
making the ALJ's decision the final decision of the
Commissioner. (Id. at 5-11.) Plaintiff timely
appealed the Commissioner's decision under 42 U.S.C.
§ 405(g). (See doc. 1.)
Age, Education, and Work Experience
was born on July 28, 1974, and was 42 years old at the time
of the hearing, (doc. 12-1 at 35.) She had an eleventh grade
education, could communicate in English, and had past
relevant work as a school bus driver. (Id. at 36.)
March 27, 2014, Plaintiff presented to Stanley B. Cohen,
M.D., with musculoskeletal complaints. (Id. at 339.)
She had pain in her left thigh with numbness and tingling all
the way down her left leg that bothered her while driving a
bus and sitting for a long period. (Id.) A
rheumatologist had seen her and felt that she had
fibromyalgia and possibly lupus. (Id.) Her physical
examination showed no evidence of synovitis, but she had
severe valgum deformity in her knees. (Id. at 341.)
Straight leg raising was positive on the left, but Plaintiff
had a range of motion that was good in all upper extremity
joints, normal in the cervical spine, and excellent in both
hips. (Id.) She had a positive Taber Patrick
maneuver, and her lower extremities were unremarkable.
(Id.) Dr. Cohen assessed her joint pain as
potentially a component of sciatica and recommended imaging
studies of her spine, left hip, and knees. (Id.) He
noted that her lupus was stable with creatinine, and that he
had discussed the necessity of weight reduction.
(Id.) He was uncertain whether Plaintiff could
continue working as a bus driver because of her obesity and
"mechanical issues." (Id.)
following day, Plaintiff presented to Maria Carmin Perez,
M.D., for lupus treatment. (Id. at 300.) Her
creatinine was stable, and she had been tolerating her lupus
medication. (Id.) She continued to experience left
leg pain, but her hyperkaimenia, recurrent skin abscesses,
and abdominal pain were noted as resolved. (Id. at
303.) She weighed approximately 287 pounds with a BMI of
56.08, and Dr. Perez discussed weight loss strategies.
(Id. at 303-04.)
April 1, 2014, Plaintiff underwent MRIs of her lumbar spine
and left hip to rule out nerve entrapment and avascular
necrosis (AVN). (Id. at 341.) Her lumbar spine
showed a 1.8 mm central protrusion with epidural lipomatosis
and mild facet hypertrophy at L5-S1, but no significant
foraminal narrowing. (Id. at 357.) It also showed
minor degenerative disc disease (DDD) and epidural
lipomatosis, but was not considered significant by the
examining neurologist. (Id. at 333.) Bilateral lower
quadrant/pelvic cystic lesions were observed, and a
sonographic correlation was recommended for possible adnexal
tumors. (Id. at 358-59.) Plaintiffs left hip showed
bilateral symmetric avascular nacrosis of the femoral heads
without articular surface collapse or disruption, as well as
mild left gluteus minimus and medius insertional
tendinopathy. (Id. at 359.) It also showed
borderline bilateral external iliac symmetric lymphadenophy,
and a correlation for systemic cause was recommended.
(Id.) A septated left adnexal cystic focus measuring
at least 4.2 x 4 cm was observed, and the radiologist opined
that stability of this finding could be confirmed through a
follow-up pelvic ultrasound. (Id.). A right knee
X-ray was unremarkable. (Id. at 356.)
20, 2014, Plaintiff returned to Dr. Cohen for pain in both
her lower back and lumbosacral junction. (Id. at
333.) She weighed approximately 283 pounds with a BMI of
52.60. (Id. at 335.) Dr. Cohen recommended physical
therapy and continued weight reduction, and referred her for
pain management. (Id. at 336.) He noted that she
should remain on short-term disability because her situation
prevented her from working as a bus driver. (Id.) On
May 28, 2014, Plaintiffs hip X-ray showed mild degenerative
changes of the right hip, and her pelvic ultrasound was
normal. (Id. at 353-54.)
June 2014 through September 2014, Plaintiff completed eleven
physical therapy sessions for sacroilitis, trochanteric
bursitis, and lumbar radiculopathy. (Id. at 266-67.)
Her compliance with physical therapy was noted as
"fair"; she discharged herself on September 29,
3, 2014, Plaintiff saw Dr. Cohen for a follow-up.
(Id. at 327.) She weighed 277 pounds with a BMI of
51.49. (Id. at329-30.) She had responded well to
epidural steroid injections, and Dr. Cohen opined that the
source of her pain appeared to be from her hips and back.
(Id. at 329.) Her lupus nephritis (LN) and aseptic
necrosis femur (ANF) symptoms were noted as stable, and the
results from her musculoskeletal examination remained
unchanged. (Id. at 329-30.) Dr. Cohen opined that
she should not drive a bus and would be better off in a
sedentary job. (Id. at 327.)
August 18, 2014, Plaintiff returned to Dr. Perez for a lupus
follow-up.(Id. at 287.) Her renal function and
creatinine remained stable, but she continued showing
proteinuria and hematuria. (Id.) She weighed
approximately 273 pounds with a BMI of 53.47. (Id.
follow-up with Dr. Cohen on September 2, 2014, Plaintiff
reported lower back pain during prolonged sitting or weight
bearing. (Id. at 406.) Prior injections provided
some relief, but her symptoms returned. (Id.) She
did not have any radicular complaints or hip issues, and her
weight remained the same. (Id.) Dr. Cohen noted that
her DDD was being aggravated by her obesity and severe lumbar
lordosis, and recommended core strengthening, another
injection, and aggressive weight reduction. (Id. at
following day, Plaintiff presented to Irving Orthopedics and
Sports Med (Orthopedics) for evaluation of her bilateral
hips. (Id. at 271.) Her bilateral hip pain had
started gradually months before, was most severe in the left
hip, and would radiate to the lower leg. (Id.) She
described it as constant "sharp, aching, and numbness of
moderate intensity" that would become more severe with
standing and sitting. (Id.) She previously received
two left sacroiliac joint injections that had moderately
improved her pain, and she was administered another
September 25, 2014, she returned to Orthopedics with
"throbbing" pain in her low back and left leg that
she rated as an eight out often, worse than in her previous
visit. (Id. at 268.) It was noted that her recent
cortisone injection was "not effective," her
lumbosacral spine range of motion was "mildly
reduced," and her straight leg raise test was positive
on the left. (Id. at 268, 270.) She agreed to the
recommended lumbar medical branch block injection under
fluoroscopy to relieve pain. (Id. at 270.).
November 25, 2014, Plaintiff saw Dr. Cohen for a routine
appointment. (Id. at317.) She had been in a motor
vehicle accident earlier in the month that had aggravated the
pain in her cervical and lumbar spine. (Id.) She
weighed approximately 266 pounds with a BMI of 49.44.
(Id. 317-19.) She denied photosensitivity and did
not have eye pain or changes in vision, but reported some
episodic paresthesia in her hands that worsened after lying
down. (Id. at 317.) Dr. Cohen released Plaintiff
back to work despite her being symptomatic, but she stated
that she was unable to continue in her current position and
would be looking for alternative employment. (Id. at
319.) Plaintiff returned to Dr. Cohen on December 2, 2014;
her ANF was considered stable and she was not experiencing
significant discomfort. (Id. at 312-14.)
February 6, 2015, Plaintiff saw Dr. Perez for her lupus.
(Id. at 279.) She continued showing proteinura and
hematuria, and reported that she had not been to pain
management and was no longer working. (Id. at 280.)
18, 2015, Roberta Herman, M.D., a state agency medical
consultant (SAMC), reviewed Plaintiffs medical records as
part of her disability determination. (Id. at 54.)
She identified Plaintiff s medically determinable impairments
as DDD and systemic lupus erythematosus (SLE), but noted that
a consultative examination was not required. (Id. at
56.) While partially credible, she found that "the
statements made by the claimant regarding symptom-related
functional limitations and restrictions cannot reasonably be
accepted as consistent with the objective medical evidence
and other evidence in the case record." (Id. at
56-57.) She assessed Plaintiff as having the physical
residual functional capacity (RFC) to lift/carry and
push/pull 20 pounds occasionally and 10 pounds frequently,
stand and/or walk for 2 hours, and sit for 6 hours in an
8-hour workday. (Id. at 57-58.) She identified no
postural, manipulative, visual, communicative, or
environmental limitations. (Id. at 58.) Dr. Herman
found that Plaintiff was not disabled, and her RFC
demonstrated the maximum sustained work capability for
sedentary work. (Id. at 59-60.) Amita Hedge, M.D.,
reviewed and affirmed Dr. Herman's assessment on August
19, 2015. (Id. at 62-69.)
September 14, 2015, Plaintiff saw Dr. Perez for a routine
appointment. (Id. at 466.) She continued showing
proteinuria and hematuria, and was still experiencing joint
pain. (Id. at 467.) She was off steroids and had
been unable to see Dr. Cohen for her SLE because she did not
have insurance. (Id.) She weighed approximately 252
pounds with a BMI of 49.22; her eyes were normal.
September 29, 2015, Plaintiff was seen by a physician
assistant (PA) at Parkland Hospital (Parkland). (Id.
at 560.) She reported a "band-like" headache for
three days, myalgias (or muscles aches), and tingling in the
toes with constant pain. (Id.) The PA noted that her
generalized myalgias were typical to her lupus pain, but she
had been out of her lupus medication for 4 months.
(Id.) Plaintiff reported bilateral eye pain with
hard red nodules, and that her "eye doctor" advised
her to use a warm compress. (Id. at 561.) She was
referred to a primary care physician who would organize a
follow-up with a rheumatologist and nephrologist treatment
and provide her with her medications. (Id. at 563.)
November 12, 2015, Plaintiff returned to Parkland to
establish care for her SLE and lupus nephritis (LN).
(Id. at 589.) She had recently been diagnosed with
Shingles and had a rash that was still painful but less
erythematous. (Id.) She reported occasional sharp
stabbing and shooting pains in her bilateral toes that
worsened upon standing and walking. (Id. at589.) She
would sit to improve her pain, and had to limit her ibuprofen
intake due to her LN. (Id.) Plaintiff denied any
current arthralgias or myalgias, but complained of persistent
lower back pain that was exacerbated by activity.
(Id.) She weighed approximately 246 pounds with a
BMI of 48.3. (Id. at 591.) The examining physician
noted that Plaintiff s SLE and LN was currently a "quiet
disease [with] no flare up," and her coronary artery
disease (CAD) appeared normal with no signs of clinical heart
failure and a normal cardiovascular (CV) exam. (Id.
at 592.) She was advised to lose weight and to continue
taking the medication prescribed for her shingles,
neuropathic pain, CAD, SLE, LN, and hypertension.
(Id. at 592-93.)
January 21, 2016, Plaintiff saw Dr. Perez and reported ankle
and back pain, but no arthralgias, joint swelling, or joint
stiffness was observed. (Id. at 472-74.) She weighed
approximately 256 pounds with a BMI of 50.02. (Id.
at 474.) She was still unable to see Dr. Cohen due to
insurance issues, but stated she would establish care for her
SLE with another rheumatologist the following week.
(Id. at 475.) She was instructed to continue losing
weight and to follow a low sodium diet. (Id.)
February 26, 2016, Plaintiff returned to Dr. Perez,
complaining of back and arm pain. (Id. at 480.)
There were no significant changes in her weight and BMI, and
her renal function was "stable with same
proteinuria." (Id.) She did not report any
problems with her eyes, and they showed no erythema,
swelling, or discharge with equal, round, and active pupils.
(Id. at 481.) On July 11, 2016, Plaintiff returned
to Dr. Perez with back and joint pain and some tingling in
her lower extremities. (Id. at 488.) Her weight and
BMI increased to approximately 266 pounds and 51.95
respectively, but she was noted as being otherwise stable.
(Id. at 488-89.)
18, 2016, Plaintiff presented to rheumatology at Parkland to
establish care for her SLE. (Id. at 605.) She
reported body aches, pains "jumping all over [her]
body," fatigue, and difficulty with getting off the
couch and driving, but her kidneys felt unaffected.
(Id. at 607.) Her eyes were positive for blurry
vision and negative for irritation and redness, and she
denied photosensitivity or dry eyes. (Id. at
607-08.) She once lost eyesight in her right eye in 1998, but
the cause was unclear. (Id. at 607.) Plaintiff had
arthralgias of the shoulders, lower back, and hips, pain in
the legs and knees, and some discomfort of the ankles and
toes. (Id. at 607.) She weighed approximately 263
pounds, and her musculoskeletal examination was unremarkable.
(Id. at 609.) The examining physician's
assessment was "SLE with mildly active disease at
present," "Lupus nephritis with CKD stage 3b with
currently stable renal function," and fibromyalgia was
"contributing to much of her current symptoms."
(Id. at 609-10.) Exercise was recommended, and she
was referred to ophthalmology for a baseline eye examination.
(Id. at 610.)
November 14, 2016, Plaintiff returned to Dr. Perez and was
primarily concerned with her weight gain. (Id. at
495.) She weighed approximately 262 pounds with a BMI of
51.21. (Id. at 499.) Her renal function was noted as
stable with minimal proteinuria. (Id. at 495.) Dr.
Perez found "no erythema, swelling or discharge" of
her eyes and noted that the pupils were equal, round and
reactive to light. (Id. at 496.) It was noted that
she had missed her last rheumatology appointment at Parkland.
December 12, 2016, Plaintiff went to Parkland for a routine
appointment; she weighed approximately 277 pounds.
(Id. at 616.) She had lower back pain, bilateral hip
and ankle pain, and numbness in both arms and legs, and
complained that "[p]ain just travel[ed] through [her]
body." (Id. at 617.) Ibuprofen was no longer
effective, and her pain was sometimes so severe that she was
unable to even brush the side of her body with a sheet.
(Id.) She did not know if the cause of pain was
fibromyalgia or lupus, but her prior "lupus
attacks" had caused her chest pain. (Id.)
Plaintiff was reportedly unable to be active because she was
"in too much pain," but admitted that she drank
"a lot of Dr. Pepper and other regular sodas," ate
"a lot of fried food," and frequently went out to
eat. (Id.) The examining physician noted that
"sometimes there is no treatment for fibromyalgia
despite  best efforts," and advised her to "work
on losing weight" by "cutting down on regular sodas
and eat[ing] 1 less fried meal per week," eating a
healthy and balanced diet, and exercising 15 to 30 minutes
for 3 to 5 times a week "or as tolerated."
(Id. at 620, 622.)
March 7, 2017, Plaintiff returned to Parkland and reported
that she hurt her thumb "playing around."
(Id. at 633.) She had been diagnosed with a strain
and wore a wristband that made her wrist feel better.
(Id.) She weighed approximately 292 pounds with a
BMI of 57.2, was noted to have gained over 30 pounds in less
than a year, and was morbidly obese, but "continue[d] to
drink regular sodas, eat fried foods, and eat out."
(Id. at 632-33.) Her lupus nephritis was stable, but
her urinary protein/creatinine ratio was elevated.
(Id. at 635.) Plaintiff reported being told that she
had DDD with possible spinal stenosis, but the examining
physician observed no radicular symptoms. (Id.) She
was urged to lose weight, particularly since she had
"gained almost 50 lbs in [the] past 2 years."
March 14, 2017, Plaintiff presented to rheumatology at
Parkland for a follow-up. (Id. at 641.) She reported
chronic hip, back, and joint pain that she attributed to the
deterioration of her hip bone from chronic steroid use.
(Id. at 642.) It was noted that her
"generalized pain [was] secondary to fibromyalgia,"
and that she should continue taking her prescribed medication
for it. (Id. at 641.) She weighed approximately 292
pounds, and her musculoskeletal examination showed tenderness
and normal range of motion of the upper and lower
extremities. (Id. at 643-44.) Her eyes were
"positive for blurred vision" and "negative
for phobophobia," and she was again referred to
ophthalmology for a baseline eye examination. (Id.
at 642, 644.) Her chest X-ray was unremarkable and showed no
acute cardiopulmonary disease. (Id. at 679.) Her
lumbar spine X-ray showed diminutive or absent ribs at T12,
and L5 partially sacralized on the left with a pseudarthrosis
potentially symptomatic. (Id. at 680.) The vertebral
body heights were maintained with no subluxation, and there
was mild facet arthrosis at multiple levels. (Id.)
30, 2017, Plaintiff and a vocational expert (VE) testified at
a hearing before the ALJ. (Id. at 32-53.) Plaintiff