Opinion ID: 705923
Heading Depth: 2
Heading Rank: 2

Heading: Factual/Medical History

Text: 3 Travis Ripley injured his back while building a shed. 2 After the injury, Ripley began making frequent trips to the Olin E. Teague VA Medical Center complaining of back pain which radiated down his right leg and numbness in the sole of his right foot. The pain allegedly increased with sitting or standing. 3 The results of a CT scan revealed that Ripley had a herniated L5-S1 disc with compression of the right S1 nerve root. On September 30, 1988, Dr. Kirby Hitt, an orthopedic surgeon, performed a partial hemilaminectomy and a discectomy at L5-S1, with a partial right medial facetectomy on Ripley. At the time of his discharge, Ripley was able to move freely, but he reported numbness over his right fifth toe. 4 Ripley returned to the VA clinic on many occasions after his surgery. Initial reports indicated that his condition was improving. But later, Ripley complained about the pain and numbness returning. The medications and physical therapy were not relieving his symptoms. On April 23, 1990, Dr. Clark took x-rays of Ripley's back which revealed that the lumbosacral disc space is questionably narrowed today whereas it appeared normal previously and that there were signs of questionable degenerative disc disease at the lumbosacral level. On May 31, 1990, X-rays showed a mild retrolisthesis at L5 on S1, but were otherwise negative. On November 29, 1990, Ripley was diagnosed with chronic lower back pain after his condition had not improved. A second CT scan, taken on August 16, 1991, indicated, according to the record, that Ripley had a herniated disc centrally and to the right which encroaches upon the fecal [sic] sac. The possibility of a second surgery was raised. 5 On November 7, Ripley received caudal block injections which relieved some of his back pain, but not all of his other symptoms. The doctor who testified concluded that Ripley was suffering from a recurrent herniated disc, and scheduled an appointment with Ripley to discuss the possibility of additional surgery. 6 On December 11, 1991, Ripley was sent for more physical therapy where he was taught back strengthening exercises. X-rays were also taken which revealed a mild narrowing of the L5-S1 disc space, but no significant change in his condition. 7 On July 29, 1992, Ripley returned to the clinic complaining of pain which resulted from sitting or standing. A myelogram revealed a mild anterior extradural impression on thecal sac at L4-L5 consistent with mild bulging of L4-L5 disc ... No definite evidence of encroachment upon nerve roots at L4-L5 or L5-S1 noted. The post-myelogram CT scan indicated that there is a small herniated nucleus pulpous at L4-L5, but no encroachment upon the thecal sac. 8 At his hearing on November 5, 1992, Ripley testified that he is unable to do most of the work around his house because he cannot sit or stand for more than thirty or forty minutes at a time. In addition, he can sleep only for three to four hours a night. Ripley also testified that he participates in limited outside activities. He attends church on Sundays, but is unable to sit through the entire service. He is able to drive or ride in a car, but only for short periods of time. 4 Despite his complaints, the ALJ denied Ripley's claim for disability. 9 In October 1993, after the Appeals Council refused to review Ripley's claim, MRI studies revealed that Ripley had a central and right herniated disc at the L5-S1 which affected the L5 nerve root and may have affected the S1 nerve root. On February 2, 1994, Ripley underwent additional surgery. 5 The operation revealed the presence of significant scar tissue from the original L5-S1 discectomy on the right and scarring of the nerve root to the lateral wall of the canal. Despite this new evidence, the district court denied Ripley's claim by granting summary judgment in favor of the Commissioner on September 13, 1994.