Opinion ID: 20701
Heading Depth: 3
Heading Rank: 1

Heading: Medical Opinions Presented to ALJ

Text: 22 Newton's treating physician, Dr. Pertusi, is an Assistant Professor of Medicine and Rheumatology at the Texas College of Osteopathic Medicine. Pertusi submitted an assessment, dated January 30, 1995, stating that Newton could occasionally lift up to ten pounds; stand or walk less than two hours per regular work day; sit continuously for thirty minutes at a time, for a total of two hours out of an eight-hour work day; and stand, walk and sit for a combined total of three hours out of an eight-hour work day. Pertusi also found Newton was able to reach and handle items and occasionally balance, stoop, kneel, crouch, crawl, reach or drive, but she could not climb or perform repetitive operations of foot controls. Pertusi also stated that Newton should avoid temperature extremes. Pertusi asserted that Newton had been under these restrictions since December 1989 through the date of his assessment. Pertusi based his assessment on diagnoses of SLE, polyarthritis, fatigue and anemia. He stated that Newton suffered from impairments that couldreasonably be expected to produce pain or other symptoms. 23 Pertusi also responded to interrogatories from Newton's attorney. In the responses, Pertusi asserted that the diagnosis of SLE was supported by documented episodes of fatigue, fever, pleuritic chest pain and cognitive changes; findings of synovitis, polyarthritis, and a malar rash; and laboratory results consistent with lupus. He noted that the clinical records showed at least three months of active disease despite prescribed treatment, and further noted that the disease had remained active or was expected to remain active for at least 12 months. He indicated that Newton had exhibited symptoms of severe fatigue, fever, malaise, and weight loss. In addition, her lupus resulted in the moderate involvement of her joints; mild involvement of the muscles in the form of myalgias; moderate to marked pleuritic chest pain; mild renal involvement in the form of persistent proteinuria; mild skin involvement because of a recurring malar rash; and mild or subtle decline in cognitive function. He stated that the degree of fatigue that could reasonably be expected to result from SLE would prevent Newton from performing sustained work activities, even of a sedentary nature. 24 Medical expert Otto Willbanks also testified before the ALJ. Willbanks noted that Newton's SLE was well established and was documented in the record. Based on his review of the medical records, Willbanks stated that Newton experienced intermittent joint and muscle pain, intermittent chest pain, and a rash characteristic of SLE. He observed that there was some interference with kidney function as well, but he could not determine the extent. 25 Willbanks testified that the record did not contain sufficient information regarding the degree of severity of any of the complicating factors, although he noted that many of Newton's problems were denoted as mild at various points in the record. He testified that the record did not indicate that Newton's lupus (or the related complications) met the criteria for any listed impairment. Willbanks stated that Pertusi's office notes failed to document the frequency of Newton's lupus flare ups and the extent or degree of severity of her symptoms. Willbanks observed that the record showed Newton suffered from relapses of arthralgias, possibly arthritis, and swelling, but that he saw no records indicating that Newton's condition was, at any time, totally non-responsive to medication. 26 Willbanks reviewed Pertusi's interrogatory responses. He criticized Pertusi for listing the complications that occurred from time to time without providing the frequency, degree, or manner they interfered with Newton's activities. Willbanks testified that he did not see medical evidence to suggest that Newton's flare ups would prevent her from performing a job that involved sitting six to eight hours a day, but admitted that he also saw no evidence that she could perform such a job.