Opinion ID: 2808322
Heading Depth: 2
Heading Rank: 1

Heading: Wright's Physical Condition

Text: Wright is a fifty-year-old man that suffers from back and knee pain. Wright suffered a shoulder injury and complained of low back pain after being involved in a severe car accident in 2000. The record indicates that Wright also suffered from another severe automobile accident in 1987. Wright described his pain as a stinging pain in his lower middle back and that this pain goes down both legs. Wright's obesity compounds his problems. At the time Wright applied for social security benefits, he was six-feet tall and weighed 350 lbs. As a result of his pain and obesity, Wright testified that his average day consists principally of laying on his back trying to get comfortable and spending around 30 minutes cooking basic meals for himself. Wright testified that his pain forces him to keep his movements during the day to a minimum. His limited mobility notwithstanding, Wright is able to drive and goes out [a]bout three times a month to the grocery store, the bank, and appointments with doctors. Wright's physical limitations, however, do not affect his ability to remember, concentrate, understand, follow instructions, use his hands, or get along with others. Due to his condition, Wright sought the help of several doctors over the past several years to manage his pain. After his car accident in 2000, Wright weighed 260 lbs., his C-spine series was negative, and his lumbar spine was described as unremarkable. Nearly a decade later, Wright's weight had substantially increased. On August 14, 2009, Wright began visiting Dr. Joshua Griggs, a family physician. By this date, Wright weighed 356 lbs. Dr. Griggs noted that Wright has a past medical -2- history of degenerative disc disease in the spine . . . as well as multi-level disc disease in the L4-L5 area. On top of these back issues, Dr. Griggs noted that Wright had type 2 diabetes, vitamin D deficiency, tobacco abuse, obesity, [and] bilateral knee arthritis. Wright was able to bend his back over to 90 degrees, and [e]xtension, lateral bending and twisting is all painful but normal. In addition to prescribing diabetes treatment and pain medication, Dr. Griggs counseled Wright on diet and exercise to lose weight. Dr. Griggs noted that Wright was adamantly against taking water aerobic classes because of the cost; still, Dr. Griggs advised Wright to start walking because it was free. On September 1, 2009, Wright saw Dr. William Harris, an orthopedic surgeon, to assess Wright's knee pain. Dr. Harris found that Wright's knees were tender and showed a little bit of loss with the weightbearing space but otherwise exhibited a regular range of motion and appeared to be essentially unremarkable with very minimal degenerative changes. On December 10, 2009, Wright saw Dr. Usaikimi Igbaseimokumo, a neurological surgeon. Dr. Igbaseimokumo diagnosed Wright with [l]umbar spondylosis with low back pain. Dr. Igbaseimokumo noted that Wright complained of low back pain but had no significant leg pain on that particular occasion. Dr. Igbaseimokumo also found that Wright's lumbar spine was tender, but found no obvious deformity. On February 19, 2010, Wright underwent an MRI of his lumbar spine. The MRI revealed degenerative disks at L4-L5 and L5-S1 of Wright's spine. Also, there was a moderate to severe central canal narrowing at L4-L5 with a diffuse disc bulge and a triangular appearance. There was also a mild diffuse disc bulge at L5-S1 with mild narrowing of the neural canal. Additionally, there was a possible L3-L4 left paracentral disc osteophyte. -3- Wright did not seek medical help again until eight months later on November 3, 2010. Wright saw Dr. Griggs on this date, who prescribed an anti-depressive for his [c]omplete decompensation due to major depressive disorder. On November 15, 2010, Wright visited Dr. Michael Vierra, a radiologist, who x-rayed both of Wright's knees. The results found no fracture, no joint effusion, and mild degenerative changes in the medial joint compartment. Dr. Vierra also conducted an x-ray of Wright's spine, which showed that a previous compression deformity of T12 [was] unchanged and revealed mild degenerative changes. Wright continued to see Dr. Griggs in January and February 2011 and continued to complain of back pain. Dr. Griggs reported that Wright could not lift more than 15 lbs. and could not stoop, climb, bend, or twist. When asked if Wright could stand for two hours and sit for six hours during an eight hour workday, Dr. Griggs reported that Wright could only stand for less than 10–15 minutes and could only sit for 30 min[utes] at a time before need[ing] to lay down. On March 3, 2011, Wright had another MRI of his lumbar spine. The MRI showed [b]orderline spinal stenosis at L4-L5 and posterior sublaxation of L5 on S1 with circumferential disc bulge without spinal stenosis. Interrogatories were propounded to Dr. Griggs, who described Wright as suffering from [b]ilateral knee arthritis [and] [d]egenerative [l]umbar [d]isc [d]isease, among other things. On July 8, 2011, Wright saw Dr. Tomoko Tanaka, a neurosurgeon. Dr. Tanaka found that Wright exhibited 5/5 in a motor strength test of his upper extremities and 5/5 in a motor strength test in his lower extremities with give-way to pain in the psoas [muscle] on flexion of the hip. Also, Wright exhibited 5/5 in a motor strength -4- test in bending his knees and ankles.2 Dr. Tanaka concluded that Wright suffered from lumbar spondylosis but that surgery was not a viable solution. A follow up with Dr. Tanaka on July 14, 2011, showed no abnormal movement in Wright's back. On November 28, 2011, Wright saw Dr. Garth Russell. Dr. Russell conducted a physical examination and reviewed Wright's past medical records. Dr. Russell diagnosed Wright with [d]egenerative disc disease, chronic with spinal stenosis L4-5, moderately severe, among other things. Dr. Russell also noted that Wright's knees have degenerated to the point where they are unable to tolerate [his] weight except for short periods of time. Dr. Russell concluded by stating that Wright would survive only with a significant amount of medical attention and medications. He will spend most of his time in a recumbent position because of the pain. In addition, he would be unable to sit longer than 20 to 30 minutes or to stand for about that same length of time. On several occasions, Wright admitted that he was not taking his pain medication; this was against the recommendation of his treating physician, Dr. Griggs. Wright also declined conservative treatment options, such as physical therapy, against the recommendation of several doctors.