Opinion ID: 584559
Heading Depth: 4
Heading Rank: 3

Heading: Dr. Thomas W. McNeill, M.D.

Text: 18 On Dr. Elyea's recommendation, Ms. Scivally was examined by Dr. McNeill, an orthopedic consultant on March 25, 1987. He reported some limitation in the motion of her spine at the extremes. He discovered tenderness and spasms in her lower back and a flattening of her normal lumbar lordosis. Dr. McNeill received X-rays which revealed a multi-level degenerative disease in the lower lumbar spine with disc bulging. He noted that Ms. Scivally's reflexes, motor power and sensation were normal, and that there were no protrusions or significant neuroforaminal stenosis. He diagnosed osteoporosis, arteriosclerotic peripheral vascular disease involving feet, secondary to smoking, and degenerative disease at multi-levels of the lumbar spine. He recommended the use of anti-inflammatory medication, physical therapy with heat, ultrasound and massage and the use of a LS corset. Dr. McNeill did not think surgery would be a reliable treatment at the present time. Dr. McNeill also administered a low back pain evaluation profile. He concluded that Ms. Scivally exhibited an atypical pain profile, but that the pain score was within normal limits, consistent with the organic findings. 19 Dr. McNeill saw Ms. Scivally again on May 3, 1987. He completed a spinal disorder report for the BDDS. He reported motion limitations in both her cervical spine and lumbrosacral spine with a paravertebral muscle spasm in the cervical spine. With reference to the patient's ability to perform work-related activities, Dr. McNeill stated that Ms. Scivally needed physical therapy for acute spinal pain and that she was unable to repeatedly bend, lift or twist.d. Dr. Robert A. Stone, M.D. 20 Dr. Stone, an orthopedic surgeon, examined the claimant on March 11, 1988. He reported that flexion was 75 degrees and that the straight leg lift was limited to 70 degrees for the right leg and 65 degrees for the left leg, causing back pain at these limits. He also detected tenderness and palpitation associated with muscle spasms. He examined X-rays and noted arthritic changes, a narrowing of the disc spaces, bony spurring and sclerosis. He also detected a disc herniation. He advised taking anti-inflammatory medication and an exercise program. He also recommended conservative management noting that Ms. Scivally would continue to experience residual difficulties with her lumbar spine. 21 e. Dr. William G. Fischer, Ph.D. 22 Dr. Fischer testified at the hearing, at the ALJ's request, as a vocational expert. Dr. Fischer stated that he had listened to Ms. Scivally's testimony and reviewed the exhibits. The ALJ asked the following question: Assume the claimant were capable of a level of light work, but that she should bend only occasionally, and she should not work in a noisy environment. Okay. Would this reduce the number of these jobs [1,600 separate sedentary and light unskilled occupations in the national economy] or these occupations? Dr. Fischer responded that he did not think that those limitations would significantly reduce the number of jobs available. Dr. Fischer named several categories of jobs that he thought would be available within the limitations noted by the ALJ: sorting, assembly, inspection and packing jobs. He also testified that in most of these jobs, the individuals are confined to one work station and are not allowed to leave for significant periods of time. Finally, Dr. Fischer stated that all jobs require some degree of bending, so that if an individual were completely precluded from bending, all jobs would be eliminated.