Opinion ID: 172071
Heading Depth: 3
Heading Rank: 1

Heading: Dr. Munhall’s Report

Text: In the Fall of 2006, as Ms. Farr’s initial two-year period of disability was coming to an end, Hartford, through the Network Medical Review Company (“NMR”), referred Ms. Farr to Dr. Michael Munhall for an independent medical examination. Dr. Munhall examined Ms. Farr on October 2 and issued his report on October 8. The report begins by listing seven doctors whose records Dr. Munhall reviewed and goes on to detail his own examination of Ms. Farr before concluding that she is capable of performing sedentary work. In summary, it is my opinion within a reasonable degree of medical probability that Janice Farr has no conclusive medical history, laboratory examination, radiology or neuromuscular/structural evidence to provide a diagnosis of autoimmune disease, Lyme disease or rheumatologic disease. Janice presents with overlapping symptoms and features consistent with any number of connective tissue and soft tissue syndromes. It is my opinion that Janice has no objective neuromuscular or structural deficit to preclude full-time employment without restriction. Nevertheless, it is my opinion that Janice does have symptomatic suggestion of a soft tissue pain syndrome such as fibromyalgia that yields, most likely, the capacity to work full time at a sedentary level. Admin. R. at 294. Dr. Munhall also completed a physical capacities evaluation (“PCE”), dated October 5, setting forth his medical opinions concerning Ms. Farr’s ability to perform certain tasks. In one section, concerning her abilities in the areas of “handling,” “fingering,” and “feeling,” Dr. Munhall checked boxes indicating Ms. Farr could perform these functions “occasionally.” Id. at 296. Just below -6- that section, he reiterated his opinion that she was capable of performing at a “sedentary full duty” level. Id. On October 11, Marcia Goodrich of NMR sent an email informing Hartford that Ms. Farr’s medical examination was complete, but that Ms. Goodrich was addressing some concerns with the doctor. On October 13, NMR faxed a copy of Dr. Munhall’s report and PCE to Hartford. Later that day, however, Ms. Goodrich faxed Hartford another copy of the PCE, which had been altered to state that Ms. Farr could handle, finger, and feel “frequently” instead of only “occasionally.” Id. at 286. Ms. Goodrich wrote on the fax cover sheet that she had “called Dr. Munhall and he OK’d the changes.” Id. at 285. Ms. Farr seizes on the revised report as an opportunity to charge Hartford with foul play, arguing Dr. Munhall’s change is so clearly advantageous to Hartford that it cannot possibly be trusted to reflect his true medical opinion. But as Hartford points out, there is no evidence to support this theory. Hartford claims Ms. Goodrich requested clarification from Dr. Munhall because his opinion regarding Ms. Farr’s ability to work full time at a sedentary level was not consistent with a finding that she can handle, finger, and feel only occasionally. Hartford claims Dr. Munhall agreed and revised the PCE to be consistent with his other findings. It is not clear from the record how the report actually came to be altered, but there is certainly nothing to indicate Hartford asked Dr. Munhall or Ms. Goodrich to make the change. What is clear, however, is that Dr. Munhall’s -7- revised opinion concerning Ms. Farr’s gross and fine motor skills is consistent with the balance of her medical records, including those of Dr. Georgia Ohlberg, whom she identified as her treating physician during the relevant time period. More importantly, Dr. Munhall’s ultimate conclusion that Ms. Farr’s fibromyalgia does not preclude her from performing full time sedentary work is wholly consistent with her medical history as set forth in the administrative record. Dr. Ohlberg treated Ms. Farr throughout the period of her disability. She completed a PCE in August 2005 in which she checked boxes to indicate Ms. Farr could handle, finger, and feel frequently. She further noted Ms. Farr’s “total body inflamatory [sic] state ha[d] improve[d] but [was] easily aggravated by prolonged activities.” Id. at 447. In February 2006, Dr. Ohlberg completed another PCE, this time indicating Ms. Farr could handle, finger, and feel “constantly.” Id. at 373. She reiterated that Ms. Farr’s inflammation was improving but quick to worsen with prolonged activities. That same month, Ms. Farr was examined by Dr. Grant Padley, an orthopedic surgeon, who noted her “[d]exterity [was] preserved,” and that there was “no evidence of osteoarthritis of the hands.” Id. at 400. Dr. Padley did note, however, that Ms. Farr exhibited discomfort during his evaluation of her low back and neck and complained of multiple joint aches. His report does not offer a diagnosis. On July 20, 2006, Dr. Ohlberg wrote to Hartford concerning Ms. Farr’s progress. She reported it was taking Ms. Farr an hour to get out of bed in the -8- morning due to inflammation and that while her walking had improved, she continued to experience joint pain. She nonetheless concluded Ms. Farr could climb stairs and reach with her arms “constantly.” Id. at 361. Dr. Ohlberg noted, however, that Ms. Farr believed her inflammation worsened with prolonged exposure to other people. On July 31, Dr. Ohlberg opined Ms. Farr could walk for up to three to four hours a day. In August, Hartford asked Dr. Joseph Tuthill for his medical opinion concerning Ms. Farr’s physical capabilities. After reviewing her medical records and speaking with Dr. Ohlberg, Dr. Tuthill issued a report, dated September 11, 2006, concluding there were no medically supported restrictions that would prevent Ms. Farr from performing full time work. Based on current medical opinions of these doctors, a review of Ms. Farr’s medical history, and his own examination, Dr. Munhall concluded in October 2006 that Ms. Farr was capable of working full time in a sedentary occupation. This ultimate determination was reached before the revisions to his PCE concerning Ms. Farr’s gross and fine motor skills, and, importantly, it is in complete harmony with the medical evidence, including the opinion of the single physician with long-term experience treating Ms. Farr’s fibromyalgia. Dr. Munhall’s conclusion is also in accord with the opinion of Dr. Phillip Marion, whom Hartford consulted during Ms. Farr’s administrative appeal. After reviewing Ms. Farr’s medical records and speaking with Dr. Ohlberg, Dr. Marion concluded: “There remains no objective physical impairment from a physical -9- medicine and rehabilitation perspective to support any specific occupational restrictions/limitations.” Id. at 141. In sum, when considered in light of the record as a whole, Ms. Farr’s challenge to Dr. Munhall’s report is simply insufficient to cast doubt as to the genuineness and reliability of his medical opinion. 2