Opinion ID: 3011442
Heading Depth: 1
Heading Rank: 1

Heading: introduction

Text: This matter is before the court on an appeal by Durwood B. Knepp in this social security disability benefits case. Knepp filed an application for disability benefits on March 25, 1994, alleging that he had been disabled as a result of an accident on October 23, 1984. Knepp last had been insured for benefits on June 30, 1991, and therefore must show that he was disabled on or before that date to obtain the benefits. There was a hearing held before an administrative law judge on April 3, 1997, following which on May 6, 1997, the ALJ rendered her decision denying Knepp's application. Knepp filed a request for review of the decision of the ALJ 2 on May 9, 1997, with the Appeals Council which denied his request on November 18, 1997. Thus, the decision of the ALJ became the final decision of the Commissioner of Social Security. Thereafter, Knepp filed his complaint in the district court on January 20, 1998, seeking review of the Commissioner's final decision. The parties filed cross-motions for summary judgment that were assigned to a magistrate judge for a report and recommendation. On January 26, 1999, the magistrate judge recommended that the district court affirm the decision of the ALJ. On February 8, 1999, Kneppfiled an objection to the magistrate judge's report and recommendation, but by a comprehensive memorandum opinion and order entered March 31, 1999, the district court granted the Commissioner's motion for summary judgment. The evidence in the case, as developed before the ALJ, is as follows. Knepp sustained severe injuries as a result of a high voltage electrocution on October 23, 1984, at his place of work. See app. at 73. Knepp testified that the electrocution took off my left arm, my shoulders, down my back, blew both cheeks off my butt, the calves off my legs, the heels off my feet, toe off my left foot, and here on the abdomen. Id. at 25. At the time of the accident Knepp had been moving a welding machine when it came into contact with an overhead 17,000 volt power source. See id. at 94. Knepp required immediate hospitalization at North Carolina Memorial Hospital, and later continued treatment and rehabilitation at the Geisinger Medical Center in Pennsylvania. See id. at 94-99 (North Carolina Memorial Hospital report); id. at 100-141 (Geisinger Medical Center reports). As a result of the injuries, Knepp was awarded disability insurance benefits from October 23, 1984 to May 31, 1986. In the application for benefits at issue now, Knepp alleged that he continued to be disabled as a result of the injuries he sustained in his October 1984 accident through his last insured date. These injuries included: 1) loss of his non-dominant left arm (amputated above the elbow joint); 3 2) loss of body mass in numerous areas, including the stomach, shoulder, back, buttocks, calves and heels of both feet; 3) loss of the fifth toe on his left foot; 4) burns to 34% of his body (with third degree burns over 20% of his body); and 5) residual pain associated with the electrocution. See Admin. Tr. at 106 (disability report). Knepp explained that these injuries prevented him from working because the loss of his left arm has affected balance and the ability to do any sort of construction work. Back injury with accident causes daily pain. Skin grafts on feet and calves crack and bleed. Id. Knepp testified at the hearing before the ALJ that he had not worked since his accident on October 23, 1984. See app. at 12. He stated, I've tried several things and it just don't [sic] work. Id. Knepp's last effort at working involved chores related to his family cattle farm. Knepp testified that, in particular, he was able to feed some of the cattle by filling a feed cart and pushing it. See id. at 13. Knepp did state, however, that there were times when he would need assistance. See id. Knepp spent approximately half of his day doing work on the farm. Knepp testified that since 1989 he has experienced pain in his lower back. See id. at 15-16. Knepp stated that this pain affected his ability to walk. Well, there's time when you just can't hardly walk, you know, from the pain in the back, hip and, and legs. You, you got trouble walking, you got trouble sitting, you can't stand, I, even today, I can't stand at any period of time at all. I, you know, have to move a little or sit down or do something. Id. at 16-17. Knepp stated that he started treating his back pain in earnest in 1989 and 1990 with Dr. Bainey, a chiropractor, and Dr. Langton, a physician. See id. at 26. Knepp continues to see Dr. Langton and Dr. Rhodes, another 4 chiropractor. See id. Knepp stated that he has a constant, stabbing pain in his back. See id. Knepp testified that he attempted to help with housework, but his wife did 90 percent of it. See id. at 19. Knepp also stated that he was capable of cooking meals and dressing and bathing himself without assistance. See id. Knepp was able to drive, and his automobile did not require any special adjustments to accommodate his injuries. See id. Knepp stated that on some days, however, he could drive only a couple of miles, although on other days he could drive for a half hour. See id. at 28. Knepp's ability to drive depended upon the state of his back and hip pain. See id. For relaxation, Knepp would take walks, sit somewhere, or watch television. See id. at 20. Knepp also stated that he was able to hunt and visit friends. During the relevant time period Knepp took approximately three Tylenol 3, Motrin or ibuprofen 600s pills daily for his pain. See id. at 20. Knepp stated that while he was not perfectly fine while taking the medication, it sure help[ed] .... it makes a big difference. Id. at 20-21. Knepp also testified that during the relevant time period he visited Dr. Langton three times per week for ultrasound therapy for his back. See id. at 21. The ALJ called Dr. Peter G. Decker (Dr. Decker), a board certified internist, as a medical expert. Dr. Decker testified based upon his review of Knepp's medical records as he did not treat Knepp. See id. at 31. Dr. Decker testified that Knepp's impairments arose from his accident on October 23, 1984, and that the injuries Knepp sustained were the result of exit wounds caused by the high voltage electrocution. See id. at 32. Dr. Decker outlined Knepp's injuries, including the amputation of the left arm above the elbow, the trauma to the lower extremities, and the burns of the abdomen, lower and upper back, buttocks, left shoulder, and right leg. See id. at 32. In response to the ALJ's question of whether Knepp's impairments met or equaled any condition specified in the Listing of Impairments contained at 20 C.F.R., Subpart P, App. 1 (1999) (Listed Impairments), Dr. Decker stated that no specific listing described Knepp's injuries. See id. at 3435. 5 Dr. Decker testified that the most applicable listing of impairments was 1.13 and that 1.10 C was also relevant to Knepp's injuries. See id. at 35-38. Listing 1.10 C and 1.13 read as follows: 1.10 Amputation of one lower extremity (at or above the tarsal region): . . . C. Inability to use a prosthesis effectively, with out obligatory assistive devices, due to one of the following: 1. Vascular disease; or 2. Neurological complications (e.g., loss of posit ion sense); or 3. Stump too short or stump complications persiste nt, or are expected to persist, for at least 12 months from onset; or 4. Disorder of contralateral lower extremity which markedly limits ability to walk and stand. 1.13 Soft tissue injuries of an upper or lower extremity requiring a series of staged surgical proceedings within 12 months after onset for salvage and/or restoration of major function of the extremity, and such major function was not restored or expected to be restored within 12 months after onset. 20 C.F.R., Subpart P, App. 1 (1999) (emphasis added). Dr. Decker testified that Knepp's burn injuries were analogous to the soft tissue injury requirement of Listed Impairment 1.13. See app. at 35. Dr. Decker explained that he considered the debridements and skin grafting procedures that Knepp underwent to be staged surgical procedures from which major functioning of the left arm never was restored because, even with the surgical procedures, Knepp could not be fitted with a functioning prosthesis. See id. at 34-35. Dr. Decker further testified that Knepp's heels could not be restored to major function because of severe tissue loss from burns. See id . at 35-36. Dr. Decker noted that in view of the combination of Knepp's injuries to his left arm and both feet, he would not expect Knepp to be able to walk or stand for long periods of time, and because of the injuries to the buttocks, he would not 6 be able to sit for prolonged periods of time. See id. at 3537. Dr. Decker stated that he would expect Knepp to suffer chronic pain in both heels, back, and phantom pain in the arm. See id. at 33. Based upon his conclusions, Dr. Decker stated that Knepp's condition equaled Listed Impairment 1.13 and that Listed Impairment 1.10 was applicable because of the number of factors present in that listing consistent with Knepp's condition. See id. Dr. Decker's testimony was limited to the application of the Listed Impairments. Dr. Decker did not make a determination as to Knepp's actual ability to perform light work that did not require use of the non-dominant upper extremity. The ALJ also elicited testimony from a vocational expert concerning the availability of jobs for someone with Knepp's limitations. The ALJ asked the vocational expert to consider the situation of a younger individual, aged 47 to 49, with a high school education and history of semi-skilled labor, capable only of using his dominant right hand, and who had to alternate between sitting and standing. See id. at 41. It was further assumed that this individual was capable of lifting 10 pounds. See id. The vocational expert concluded that there would be a significant number of jobs available to a person with the limitations provided by the ALJ. For example, the vocational expert testified that such a person would be able to perform jobs such as inspector, gate guard, cashier, or telephone solicitor. See id. at 43-44. The vocational expert did note, however, that the number of jobs available in the area of Pennsylvania where Knepp lived was likely to be significantly less than the number of jobs available in the state as a whole. See id. at 44-45. As we mentioned, the ALJ issued her opinion on May 6, 1997. See app. at 71. She began her opinion by noting that Knepp already had received disability benefits between October 23, 1984, the date of his injury, and May 31, 1986. See id. at 71. Accordingly, the ALJ focused her inquiry on the period beginning June 1, 1986, and ending on June 30, 1991, the date Knepp last met the insured status requirements. See id. 7 Pursuant to her application of the required five-step analysis under the applicable regulations, the ALJfirst determined that Knepp had not been engaged in substantial gainful activity since June 1, 1986. See id. at 72. Second, the ALJ determined that the injuries resulting from Knepp's electrocution constituted a severe impairment. See id. at 73. The third step of the regulation required the ALJ to determine whether Knepp suffered from an impairment, or combination of impairments, that either met or equaled a Listed Impairment. See id. The ALJ determined that, despite the testimony of Dr. Decker, Knepp did not suffer from an impairment or combination of impairments that either met or equaled a Listed Impairment. See id. The ALJ determined that Dr. Decker had not understood properly the scope of the provisions he cited as establishing disability on the part of Knepp. See id. at 74. The ALJ then proceeded to the fourth and fifth steps of the analysis. At the fourth step, the ALJ determined that Knepp was unable to perform his past relevant work as a boilermaker. See id. at 75. At the fifth step, the ALJ concluded that Knepp had the residual functional capacity to perform work that does not require bi-lateral dexterity or use of the left arm; does not require lifting more than 10-20 pounds; allows for a sit/stand option; and does not require prolonged sitting, standing, or walking. See id . The ALJ determined that Knepp was not disabled because there were sufficient jobs available in the national economy within the limitations described above. See id . The ALJ, in making her determination that Knepp was not disabled, took note of the scope of Knepp's injuries. See id. at 76-78. She observed that the treatment notes for Knepp through 1986 reflected that Knepp had healed well, began to regain body weight, and had begun to increase his activity level. See id. at 76. Further, the ALJ noted that while Knepp had received treatment for lower back pain beginning in 1990, such treatment consisted of conservative ultrasound pain management in 1990 and 1991 with virtually no medical intervention of any type from 1992 through 1995. See id. Accordingly, the ALJ determined that the evidence in the record did not support 8 a conclusion that Knepp was disabled before June 30, 1991. See id. at 76-77. The ALJ found that Knepp's subjective complaints of pain were generally credible, but overstated to the extent Knepp claimed he had been unable to perform any work since June 1, 1986. See id. at 77. She noted that Knepp had received only conservative treatments during the period at issue, and no diagnostic testing or physical examinations were conducted prior to 1996. See id. Further, Knepp's daily activities supported the conclusion that he was capable of working during the period at issue. See id. Accordingly, Knepp was found not to have been disabled during the period beginning June 1, 1986 and ending June 30, 1991. See id. at 80. Thus, the ALJ denied the benefits.