Opinion ID: 6316378
Heading Depth: 2
Heading Rank: 1

Heading: Initial Treatment History

Text: Sebranek was in a car accident in 2010. She received some treatment for chronic pain as well as depression and anxiety after the accident, but more details appear in a mid-2013 consultation report with Dr. Sara Christenson Holz, a spine specialist with the University of Wisconsin Spine Clinic. Dr. Holz recorded her impressions that Sebranek had a biomechanical dysfunction of the thoracic spine with a rotated rib on the right side, as well as low back pain consistent with facet arthropathy (painful arthritis of the joints) and maybe lumbar-disc herniation. Dr. Holz noted Sebranek’s complaint that her pain was quite severe, particularly around the right shoulder blade. Dr. Holz also noted that MRIs from 2010 confirmed herniations in both her neck (C5-C6 vertebrae) and lower back (L5-S1 vertebrae). Dr. Holz referred Sebranek to a physical therapist to reduce her pain and strengthen her back. Sebranek reported having headaches, severe shoulder pain, and “subtle” lower back pain. She continued physical therapy through November 2013, making some progress, but she reported that she still experienced pain (which she measured as six out of ten) and that being active for long periods aggravated her symptoms. In late 2013, Sebranek received from Dr. Holz several “facet injections” (injections of anesthetics directly into the impaired spinal joints) to relieve her back pain. She reported that the injections helped “quite a bit,” and she would continue receiving these injections for several years. As for restrictions, Dr. Holz mentioned that Sebranek should not lift more than twenty pounds and must change positions every half hour for five to ten minutes. B. Initial Application and Subsequent Treatment History Sebranek applied for disability benefits in May 2015, identifying an array of conditions that she said limited her ability to work (neck and back pain, disc herniation, depression, anxiety, and fibromyalgia). She specified an onset date of mid-2013. In her application, she reported working full-time as an administrative assistant in 2013 and part-time as a real estate agent beginning in 2014. Sebranek filed several reports detailing how her pain limited her from working and engaging in daily-living activities. In a 2015 Function Report, she said her back pain flared and caused her to adjust positions or take breaks while working on her computer. No. 20-3399 Page 3 To manage her pain, she reported taking hydrocodone (an opioid) six times a day. She noted that she prepared dinner and helped with household cleaning and yardwork, though less than she used to. In another report, Sebranek stated that she could sit and stand for seven hours throughout the day and sit for an hour at a time. In mid-2015, in connection with her application, Sebranek underwent a consultative exam with psychologist Michael Goldstein for an assessment of her depression and anxiety. Dr. Goldstein opined that Sebranek’s behaviors indicated chronic pain, depression, and anxiety, but that her functioning was otherwise normal. He did, however, note moderate limitations in her ability to remember and follow simple instructions, maintain concentration and work pace, and withstand routine work stresses and changes. Around the same time, two non-examining, state-agency consultants reviewed Sebranek’s application and prepared reports of her residual functional capacity. Pat Chan, M.D., who submitted a physical capacity assessment, opined that Sebranek should be restricted to lifting no more than ten pounds and sitting for at least six hours per day and that she could be expected to sustain at least sedentary work despite her chronic pain. Deborah Pape, Ph.D. submitted a mental capacity assessment, opining that Sebranek had moderate restrictions in understanding and carrying out detailed instructions, maintaining attention and concentration, acting within a schedule, completing a normal workday, and adapting to changes. The agency concluded that Sebranek was not disabled and denied her claim. C. Reconsideration and Subsequent Treatment History In early 2016, Sebranek sought reconsideration, noting increasing pain and worsening depression. In a second Function Report, she said that her pain increased when sitting, standing, driving, or working on the computer, and that her depression affected her work stamina. She noted that she still cooked, cleaned, and visited friends out-of-state, but that her pain often prevented her from leaving the house. Sebranek underwent a second psychological exam, this time with psychologist Steven Benish. Dr. Benish opined that Sebranek had major depressive disorder (“severe”) and panic disorder. He noted that Sebranek had mild difficulty with interpersonal skills, adapting to change, concentration and maintaining attention, and moderate difficulty with responding to stress and recalling basic instructions. He also opined that these difficulties would not support a finding of disability: Sebranek’s mental-status exam was “essentially normal.” No. 20-3399 Page 4 Around this time, new residual functional capacity assessments were prepared by non-examining, state-agency consultants. Syd Foster, D.O., submitted a physicalcapacity report and, like Dr. Chan the year before, opined that Sebranek could do at least sedentary work, adding that Sebranek should avoid “even moderate exposure” to workplace hazards. As for the mental-capacity assessment, Mary Menken, Ph.D., determined that Sebranek had moderate restrictions in understanding and carrying out detailed instructions, maintaining attention and concentration for extended periods, and completing a normal workday. The agency again denied Sebranek’s claim. ALJ Hearing and District Court Proceedings Sebranek received a hearing in early 2018 with an administrative law judge. Sebranek testified to working after the accident in several short-term, part-time jobs. She said that her back pain flared up every few weeks, limiting her to lifting ten pounds at most. As for her mental impairments, Sebranek generally described her depression as severe and her medications as helpful, and she eschewed therapy. A vocational expert then answered hypothetical questions about the availability of work for someone with Sebranek’s background and limitations. The expert testified that this individual—if limited to light work—could perform Sebranek’s past work as an administrative assistant. The expert also testified that if this individual were further limited to sedentary work, she could still work as an administrative assistant. And if additional mental limitations were imposed (relating to understanding, remembering, and carrying out only simple instructions, tolerating occasional changes in a routine setting, and not interacting with the public), the expert testified that the individual could not work as an administrative assistant but could perform thousands of unskilled jobs (such as bench worker, inspector, or office helper). The ALJ began the requisite five-step analysis, 20 CFR §§ 404.1520(a), 416.920(a) by finding that Sebranek met several threshold requirements but fell short of having a disability per se. At step one, the ALJ found that Sebranek had not engaged in substantial gainful activity since her alleged onset date. At step two, the ALJ found that Sebranek had a severe impairment: degenerative disc disease. But at step three, the ALJ found that Sebranek’s impairment was not a disability per se under 20 CFR Part 404,