Opinion ID: 618491
Heading Depth: 3
Heading Rank: 2

Heading: The Evidence Supports Maher's Limitations

Text: Viewing the totality of the medical evidence in the administrative record, I am persuaded that Maher's symptoms prevent her from reliably performing the duties of a sedentary nursing job. At the fore of that evidence are the opinions of Maher's treating doctors, Dr. Cuevas and Dr. Goessling. As noted, Dr. Cuevas's assessment as of March 2007 was that Maher remains in significant disability and is unable to reliably perform duties because her pain can become so severe so quickly. Similarly, Dr. Goessling, who has followed Maher since the onset of her abdominal symptoms in late 2001, opined in a 2007 letter: In her current status, Mrs. Maher is barely able to provide for herself and her 3-year-old son during the day. She is not able to stand or walk for prolonged periods of time. She is suffering from constant nausea that is only partially relieved by her . . . medication. She has intermittent diarrhea due to malabsorption from lack of pancreatic enzymes followed by constipation caused by her high doses of narcotics medication. On top of her chronic abdominal pain, she has frequent exacerbations, [and] often this pain prohibit[s] her completely from taking any solid foods. . . . [¶] . . . [L]et me assure that I do not see any way that my patient would be able to sit or stand for prolonged period[s] of time let alone do physically or intellectually demanding work. While there is some evidence that Dr. Goessling did not actively treat Maher in 2006 and 2007, he saw her repeatedly in the -43- preceding years and she appears to have consulted with him prior to his writing the letter quoted above.20 These opinions echo Maher's own assessment of her limitations. In an affidavit, Maher stated that she cannot be counted on to do anything, because her symptoms come on unpredictably and leave her in excruciating pain that is so bad that it sucks the wind out of [her]. Though pain is subjective and thus difficult to reliably document, her characterization appears to be borne out by the record. From late 2001, she has consistently complained of intermittent and severe abdominal pain. Her complaints have been credible enough to convince the numerous doctors who have seen her that she needs serious narcotics to relieve her pain and allow her to function. While we might suspect drug-seeking tendencies in such circumstances, the record does not reveal such tendencies. An early note from Dr. Goessling indicates that Maher was quite reluctant to take pain medications, and there are multiple indications in later records of her desire to move off of the painkillers.21 Even with her regular regimen of 20 The letter, addressed to Maher's case manager at Liberty, begins, I would like to update you on [Maher's] overall condition, especially in light of the recent denial letter for her benefits that she received, implicitly suggesting that Dr. Goessling had current knowledge of Maher's condition at the time of writing. 21 Still, the record is mixed as to the sincerity of Maher's desire to discontinue narcotic use, as she has twice started treatment with a pain clinic and then failed to follow up. She ascribes her reluctance to continue treatment at the clinics to interpersonal conflict with the doctors at one clinic, and a -44- heavy narcotics, Maher's abdominal pain has repeatedly brought her to the emergency room, where she was admitted on at least two occasions for multiple-day stays to manage her pain. Maher's record of treatment thus bespeaks significant and debilitating pain. Given the number of medical professionals who have examined her and found her distress genuine, I have no reason to question the reality of this pain. As the Seventh Circuit noted in Carradine v. Barnhart, 360 F.3d 751 (7th Cir. 2004): What is significant is the improbability that [the claimant] would have undergone the pain-treatment procedures that she did, which included . . . heavy doses of strong drugs . . ., merely in order to strengthen the credibility of her complaints of pain and so increase her chances of obtaining disability benefits; likewise the improbability that she is a good enough actress to fool a host of doctors and emergency-room personnel into thinking she suffers extreme pain; and the (perhaps lesser) improbability that this host of medical workers would prescribe drugs and other treatment for her if they thought she were faking her symptoms. Such an inference would amount to an accusation that the medical workers who treated [the claimant] were behaving unprofessionally. Id. at 755 (internal citation omitted). I therefore credit Maher's reports of abdominal pain, and note as well that her gastrointestinal and food intolerance symptoms -- which are more readily verified -- find support in numerous records. feeling that the type of program offered by the other clinic was not appropriate for her. Her lack of follow-through in this regard does not diminish the overall force of the evidence of her pain. -45- I similarly find the evidence sufficient to corroborate Maher's claims that these symptoms would interfere with her ability to work. Maher's recurring acute attacks of abdominal pain would, at a minimum, result in frequent absences from work, which would be prohibitively disruptive of any attempt to maintain regular employment. Surveillance also suggests that her background level of symptoms is sufficient to keep her housebound with some frequency, or to permit only limited levels of activity. Though Maher may occasionally run errands, contribute to household chores, or even recreate with her family for short periods of time, there is a sharp difference between a person's being able to engage in sporadic physical activities and her being able to work eight hours a day five consecutive days of the week. Id. On balance, I conclude that the evidence demonstrates that Maher cannot reliably perform the duties of a full-time sedentary nursing job.