Opinion ID: 772834
Heading Depth: 5
Heading Rank: 8

Heading: SSA Medical Expert Witness, Dr. Cox

Text: 47 Internist Dr. Frank Cox testified before the ALJ at the second hearing in September of 1998. The ALJ asked Dr. Cox to identify and evaluate Buxton's mental disorders, based on Dr. Cox's review of Buxton's medical records. Dr. Cox then explained the diagnosis of CFS and discussed the history of the medical field's development of a definition for the disease. Dr. Cox then explained that Buxton had a positive result for a human herpes virus titer, that may or may not have related to the CFS. Dr. Cox then explained that Buxton's diagnosis of multiple chemical sensitivities was not a diagnosis recognized by conventional medical centers. Dr. Cox explained that the alleged symptoms of CSS were almost identical to those associated with CFS. Dr. Cox then explained that Buxton had a diagnosis for her irritable urethra, but that the urologist had indicated it would not cause a disability. 48 The ALJ then inquired about Buxton's alleged allergies. Dr. Cox acknowledged Buxton had been evaluated, and testedpositive for, some allergies, but stated there's just nothing in her evaluation that would be accountable for her disability. The ALJ discussed with Dr. Cox that the ALJ had previously made a finding about Buxton's need to avoid exposure to a work environment with multiple chemicals, and asked Dr. Cox's opinion with regard to that finding. Dr. Cox opined: if you're asking me, is there a medical reasonable certainty that working next to or in that plant would harm her, I would have to [s]ay no. 49 Dr. Cox was then questioned by Buxton's attorney. Dr. Cox indicated that he had treated patients with CFS, and that CFS was a recognizable diagnosis. Dr. Cox further indicated that to some extent, a patient's symptoms are the primary factor used to diagnose CFS. Dr. Cox also stated that he did not quarrel with Buxton's diagnosis of CFS. Dr. Cox opined that multiple chemical sensitivities as a diagnosis was quackery, and that those associated with its treatment had not shown that these programs do a bit of good other than costing a lot of money. 50 Following questioning by Dr. Daniel Schweid (infra), the ALJ readdressed Dr. Cox for a brief moment. The ALJ asked Dr. Cox if he had reconsidered any of his testimony, and Dr. Cox said no but further explained I mean, they use bleach somewhere in the house, and her urethra immediately began to burn and she, she had to sleep... on a cot by the door for three days. I mean, that's not a physical illness. And it's not an allergy. There's no way, but -... she's been allowed to think that. 51
52 Psychiatrist Dr. Daniel Schweid testified before the ALJ at the second hearing in September of 1998. Based on Dr. Schweid's review of Buxton's medical records, the ALJ asked Dr. Schweid to identify and evaluate Buxton's psychological or psychiatric disorders that might affect Buxton's occupational abilities. Dr. Schweid first opined that his review of the records showed that none of Buxton's physicians had adequately evaluated the psychiatric component to Buxton's diagnoses of CFS and CSS, not even Dr. Bielefeld, the psychologist. 53 Dr. Schweid then discussed, at length, the medical community's debate regarding whether chronic fatigue immune dysfunction/CFS and multiple chemical sensitivities/CSS are legitimate diagnoses, and if so, what research criteria a physician should use to make the diagnosis. Dr. Schweid indicated that there was a subset of physicians who were true believer[s] who would try to treat these patients with treatments that either did not work, or would have the effect of reinforcing the patient's beliefs that she could not tolerate exposure to certain chemicals--it becomes iatrogenic, an iatrogenic illness, after a while. 54 Dr. Schweid then discussed Buxton's doctors. He noted that a couple of her physicians had advocated the CFS/CSS diagnoses, but that Dr. Salata, the infectious disease specialist, had noted that she did not quite meet the criteria for the diagnosis, although he did not affirmatively discount the diagnosis. Dr. Schweid also noted Dr. Frank's herpes virus theory as possibly being a causal element to her symptoms. 55 However, Dr. Schweid opined that what Buxton truly suffered from was depression, somatoform disorder, or both. He noted that patients such as Buxton do not want to believe that they have a psychiatric disorder, so sometimes no physicians will even entertain the idea of a psychiatric disorder. Dr. Schweid then translate[d] the parts of the record that do not seem tosupport CFS, but do support somatoform disorder, which he noted is found at 12.07 in the listings. Dr. Schweid further opined that Buxton is depressed, and evaluated her depression under the listing 12.04. 56 Dr. Schweid noted that the elements of a 12.07 somatoform disorder are present in Buxton's case: hypochondriasis,... some unrealistic interpretation of physician signs or sensations associated with the preoccupation or belief that she has a serious disease or injury,... chronic fatigue, and maybe some chronic pain. Dr. Schweid then noted the elements of a 12.04 depressive disorder that are present in Buxton's case: loss of interest, that is anhedonia,... sleep disturbance,... decreased energy,... difficulty concentrating. As to her level of impairment, Dr. Schweid opined she is moderately impaired in her activities of daily living and social functioning; often impaired in [c]oncentration, persistence, and pace, etc. Dr. Schweid opined that Buxton does not meet the listing of the impairment. However, he did suggest some limitations Buxton might have by reason of her somatoform or depressive syndromes: her situation would have to be routine, low stress, no high production quotas, and because of irritability, no situations that are intrinsically confrontational or... very intense interpersonal transactions.... She should not be in a situation where she would be responsible for the safety or welfare of others, and I think that would define it. 57 Upon questioning by Buxton's attorney, Dr. Schweid opined that Buxton was not primarily a malingerer.... She's both hypochondriacal and responsive to her doctors who say that [she should not touch certain things or be in a room where certain chemicals exist, etc.].... [S]he likes to listen to the ones that verify it. Dr. Schweid clarified that when he was assessing the impairments (see paragraph above), he was assessing for both listings 12.07 and 12.04. Dr. Schweid opined that Buxton is at least moderately impaired in all of this, but I don't think extremely impaired, and I don't think markedly impaired. Dr. Schweid concluded: I don't think this issue we're dealing with stands or falls on the diagnosis. It's more on, on the operational issues, the functional issues.