Opinion ID: 2747890
Heading Depth: 3
Heading Rank: 2

Heading: Ponder's Medical History After March 31, 2010

Text: On July 1, 2010, Dr. Yelvington evaluated Ponder and noted certain degenerative changes, although he did not specify what those changes were. Ponder -3- returned on September 13, 2010, and complained to Dr. Yelvington of joint pain, indigestion, and shortness of breath. Dr. Yelvington ordered an x-ray of Ponder's chest and, on September 23, 2010, found some scarring in [Ponder's] left lung and significant degenerative disc disease. Notwithstanding these findings, Dr. Yelvington again issued no work restrictions, and Ponder once again left ambulatory in no acute distress. On January 13, 2011, James Abraham, III, M.D., provided Ponder with a rheumatology consultation. Dr. Abraham noted that Ponder had full range of motion in her wrists, shoulders, hips, and knees. He also noted that her spine, ankles, and feet had no deformities. Dr. Abraham opined that Ponder may have sleep apnea and fibromyalgia. He recommended, among other things, 30 to 40 minutes of aerobic exercise three to four times per week. He also recommended Ponder undergo a sleep study, but Ponder was reluctant to submit to it. On February 22, 2011, Robert Searcy, M.D., performed a pulmonary consultation and ordered two x-rays of Ponder's chest. Those x-rays indicated that Ponder may have sarcoidosis. On March 16, 2011, state agency physician Judith Forte, M.D., completed a Physical Residual Functional Capacity Assessment and opined that Ponder could occasionally lift ten pounds and frequently lift less than ten pounds; could stand and/or walk for at least two hours in an eight-hour workday; and could sit for about six hours in an eight-hour workday. Dr. Forte opined that, even giving Ponder the benefit of the doubt and assuming Ponder was morbidly obese, had osteoarthritis in her right knee, and suffered from degenerative disc disease before March 31, 2010, Ponder could nevertheless perform sedentary work as of that date. On April 5, 2011, David G. Davila, M.D., consulted with Ponder regarding her lack of sleep. Ponder denied having chronic back pain, rheumatoid arthritis, -4- osteoarthritis, and degenerative disc disease. In fact, Ponder's chief complaint was snoring. Dr. Davila recommended a sleep test and continuous positive airway pressure (CPAP) therapy. The CPAP therapy ultimately improved both the quality and quantity of Ponder's sleep. Similarly, Ponder reported on August 5, 2011, that she did not regularly need to use an albuterol inhaler, and that Advair controlled her cough, wheezing, and shortness of breath.2 On November 22, 2011—approximately 20 months after Ponder's insured status expired—Dr. Yelvington completed a Physical Residual Functional Capacity Questionnaire for Ponder. Dr. Yelvington indicated on the form that Ponder's diagnoses included COPD, sarcoidosis, and osteoarthritis, and that Ponder's symptoms included light headedness, dyspnea, chronic fatigue, chronic pain, and insomnia. He separately listed fibromyalgia under clinical findings and objective signs. He opined that emotional factors did not contribute to Ponder's symptoms and functional limitations, yet he also opined that Ponder could perform only low stress jobs. Dr. Yelvington estimated that Ponder could walk only up to one city block before resting, could neither stand nor sit for more than 30 minutes at a time, and could sit, stand, or walk for less than two hours in an eight-hour workday. He also opined that, if Ponder attempted employment, she would need to take up to two 15-minute breaks per day and miss as many as four workdays per month. Dr. Yelvington further indicated that Ponder could never lift 20 pounds or more. Dr. Yelvington estimated that Ponder's limitations were [that] severe as of no later than January 2009.