Opinion ID: 569210
Heading Depth: 2
Heading Rank: 1

Heading: Donna Jones' Ailment

Text: 4 The prognosis of Jones' condition was long in coming. At first, Jones' personal physician, Dr. Apte, thought she suffered a minor sprain. On December 31, 1984, her first visit to Dr. Apte after the injury, he noted no bones were broken, and recommended heat compresses and bed rest. 1 However, in subsequent weekly visits, Jones asserted that her back pain was so great that she could no longer comfortably bend, sit, or stand. 2 When, on February 3, 1985, Jones' ability to flex had dwindled to six degrees, Dr. Apte referred her to an orthopedic surgeon, Dr. Robert Kepley. 5 Jones reiterated her complaint that she has pain with any prolonged standing or sitting, during her first examination with Dr. Kepley, on February 19, 1985. After re-examining the x-rays taken at the time of Jones' fall, Dr. Kepley determined that there was a fifty percent compression fracture of the fourth thoracic vertebrae of her spine. He prescribed a back brace and a cane to keep the spine in an upright and rigid position until the fracture healed. After this treatment, the x-rays showed good consolidation of the fracture. 6 Dr. Kepley did not take new x-rays until February 22, 1988. In the interim three-year period, Jones continued to complain of back pain. Nonetheless, Dr. Kepley assumed Jones' problem was now postural in origin. When she complained that she could not bear to sit at a typewriter for more than one and one-half hours, Dr. Kepley reassured her that it would merely take more time for her to build up tolerance for an eight hour day. When her complaints continued, Dr. Kepley prescribed a physical fitness and strengthening program. Afterward, when Jones still complained of back pain, Dr. Kepley prescribed only a mild pain reliever, Motrin. It was only after Dr. Kepley took new x-rays in 1988 that he recognized that her fracture had never healed. 7 Meanwhile, she tried to return to secretarial work. She went back to Superior Staffing, her employer at the time of her injury. The temporary secretary agency accommodated Jones, assigning her to an office where she could set her own hours, not carry objects, bend, or stand for an extended period of time. Despite these accommodations, Jones found that she could not meet even the lenient demands of this position: [F]or every 4 hrs worked, I spent 18 on ice & flat on back, and spasms got worse. On December 3, 1986, she stopped working altogether. 8 For the next year, Jones led a sedentary life, resting in her apartment. She continued to assert that she was experiencing back pain. Even climbing the stairs to her second-floor bedroom had become an ordeal. 3 By the end of the year, her savings had dwindled to $20 in her bank account, and she turned to her daughter for financial support. 4 On December 7, 1987, she filed for disability benefits with the Secretary. She explained: 9 I tried, and wanted to work, but condition seemed to worsen. I can still not sit for more than 2 hrs. in a straight position--Must recline. Bending or reaching to file even causes much pain.... 10 While awaiting the Secretary's decision on her disability claim, she returned to Dr. Kepley on February 22, 1988. Dr. Kepley took the first x-rays of Jones' spine in nearly three years. On this basis, he determined that 60 to 70 percent of her fourth thoracic vertebrae had collapsed in the interim. Moreover, he found that her upper back was contorted by thoracic kyphosis into a hunchback. He noted that any flexion of the spine was very painful. 11 While Dr. Kepley informed the Secretary of his new diagnosis, it still denied the application on March 9, 1988. On April 15, 1988, Jones moved for reconsideration of the decision, explaining: 12 [T]he pain in my upper back is so severe I could not hold a full time job. A fracture in the spine was misdiagnosed & mistreated--healed improperly. 13 Her request was denied; she then moved for an administrative hearing.