Opinion ID: 791178
Heading Depth: 2
Heading Rank: 1

Heading: Haynes's Medical History

Text: 3 Since at least December 1996, when he smoked a pack and a half of cigarettes each day, Haynes has suffered from chronic obstructive pulmonary disease. In March 1997, Haynes underwent pulmonary function testing, which indicated that he suffered from severe airway obstruction—a perhaps unsurprising result, given that Haynes by then had increased his cigarette consumption to about two packs a day. At any rate, Haynes received bronchodilator treatment for his condition, and this course of treatment was apparently successful. Despite his ongoing smoking habit, Haynes exhibited only scattered wheezes with good air exchange by December 1998. The record does not disclose further medical treatment for any pulmonary problems since then, despite the fact that Haynes continued to smoke more than a pack a day through January 2001. 4 This was not the end of Haynes's medical problems, however. On June 1, 1998, while working a construction job, Haynes suffered a fractured right heel—a comminuted displaced right calcaneus fracture, in medical jargon. Haynes underwent surgical debridement, reduction, and splinting for this injury. After surgery, Haynes undertook a regimen of whirlpool and wound debridement treatment, to which he responded well. Medical treatment notes from several months after the injury indicated that Haynes's surgical site was healing extremely well, although Haynes indicated that he still suffered some discomfort when attempting to move about on his fractured heel. 5 In September 1998, x-rays indicated that Haynes's fracture was showing improvement, but there was significant soft tissue swelling of the affected area. On the advice of Dr. Daniel Lochmann, Haynes's treating orthopedic surgeon, Haynes underwent physical therapy. Haynes experienced some success with this therapy, which apparently reduced pain and brought great improvements to Haynes's range of motion and strength. In November 1998, however, Haynes reported continued difficulty with the range of motion of his right ankle. Dr. Lochmann instructed Haynes to stay the course with his physical therapy and to remain off work until June 1999, the one-year anniversary of his injury. 6 In January 1999, Haynes reported significant difficulty standing longer than 15 to 20 minutes at a time. In addition, Haynes reported some weakness and pain in his foot and had difficulty bearing weight on it. Dr. Lochmann examined Haynes and discovered that his right ankle had a limited range of motion. Dr. Lochmann expressed doubt that Haynes could return to his previous work and activity level, although Haynes indicated that several prescription drugs helped to reduce the severity of the pain to a more moderate and bearable level. Haynes sought no further medical followup or treatment for his heel pain after January 1999. 7 In a March 1999 report, Dr. Lochmann recorded that Haynes was unable to stand or walk longer than 30 minutes at a time, nor could he walk for more than three hours in an eight-hour workday. The surgeon also noted, however, that Haynes could perform work in which he occasionally lifted 20 pounds or frequently lifted 10 pounds. In addition, Dr. Lochmann determined that Haynes could do work that involved unrestricted sitting, occasional climbing and balancing, and no exposure to heights. 8 Over a year later, in September 2000, Dr. Nina Gilberg conducted a consultative examination of Haynes's heel and reported that the calcaneus fracture had healed for the most part. Haynes's right foot remained tender and swollen, but Haynes showed some range of motion and could bear his full weight on the foot, although he had a slight limp. Haynes could also rise from a chair and could get on and off an examination table without difficulty. 9 Dr. Gilberg concluded that Haynes could not perform any work requiring significant standing, walking, or carrying. Nevertheless, she concluded that Haynes could perform tasks while seated, if permitted to adjust his position while doing so. Dr. Gilberg also opined that Haynes could perform work requiring occasional lifting and carrying of between 10 and 20 pounds. In addition, Dr. Gilberg believed that Haynes could stand and walk a total of three to four hours a workday (for five to ten minutes at a time) and could sit for most of the workday with position changes every 20 to 30 minutes. She specified, however, that any such work should require no use of ladders, balancing, stooping, or crouching. Moreover, Haynes's work should entail no more than occasional kneeling or crawling, limited pushing and pulling, limited work at heights, and limited exposure to moving machinery (if balance is involved), temperature extremes, or vibration. 10 Unfortunately, Haynes's medical problems were not confined to the physical ailments described above. As documented in the record, Haynes also has a long history of chronic alcohol abuse. He has been arrested repeatedly for driving while intoxicated, and has been fired or otherwise disciplined for problems arising from his alcohol dependence. Haynes has been committed to detoxification programs on multiple occasions. Although he has benefitted from periods of remission, Haynes has engaged in repeated episodes of binge drinking on and off through late 2000. Over the years, Haynes was prescribed various medications for his alcohol dependency, but he only took these medications erratically. 11 Haynes has also been diagnosed with a mild form of depression and bipolar disorder. He received ongoing therapy and took Prozac and other prescription drugs for these disorders. As of December 1998, Haynes's depression was in marked remission, and his bipolar disorder was in full remission as of October 1999.