The following reports were used at the comparison point decision (CPD) dated 10/05/2014 to determine disability:

• •

  Charles Hall, Jr., M.D. , report of 06/15/2014; and

• •

  Mark James, M.D., report of 06/05/2014.

The following reports were used to decide if disability continues:

• •

  Alfred Sandman, M.D., Internist, report dated 02/16/2018;

• •

  Charles Hall, Jr., M.D., report of 03/01/2018; and

• •

  Frederick James, M.D., Orthopedist, consultative examination of 03/08/2018.

The individual was found to be disabled beginning 01/05/2014 because of a combination of obesity and osteoarthritis of both knees. These impairments limited the individual to the performance of sedentary work and Vocational Rule 201.09 directed a finding of disabled. A current evaluation is necessary as medical improvement (MI) is possible. The individual has not engaged in substantial gainful activity (SGA) since onset and maintains he is unable to perform any work activity because of arthritis. He stated he seldom goes to his doctor as it's difficult for him to get around.

The individual's treating internist reported on 02/16/2018 that the individual continues to suffer from knee pain and limitation of motion in spite of a physical therapy program and medication. He noted that the individual weighed 331 pounds at the last examination on 12/04/17. Because the medical evidence of record was not complete enough to permit evaluation of current severity, the Disability Determination Services (DDS) arranged a consultative examination.

The consulting orthopedist reported on 03/08/2018 that the disabled individual was 70 inches in height and weighed 325 pounds and used a manual wheelchair for mobility. He had difficulty getting on and off the examining table and complained of constant knee pain. Range of motion studies revealed that flexion of the right knee was 80 degrees. Flexion of the left knee was limited to 75 degrees. He could not stand or walk unassisted due to severity of his knee pain with weight-bearing. X-rays were consistent with advanced osteoarthritic changes of both knees. The consulting orthopedist opined that the individual's wheelchair was medically necessary.

Since the record shows that the disabled individual's osteoarthritis of the knees meets the requirements of Listing 1.02A, he continues to be disabled.

The following reports were used at the CPD dated 01/27/2017 to determine disability:

• •

  Hillary Watson, M.D., Women's Hospital, inpatient treatment of 08/17/2016 to 09/02/2016;

• •

  William Green, M.D., report dated 10/05/2016; and

• •

  Grace Monafo, M.D., report dated 12/07/2016.

The following reports were used to determine whether disability continues:

• •

  Hillary Watson, M.D. , Women's Hospital , inpatient 08/17/2019 to 09/01/2019; outpatient 12/04/2019 and 12/18/2019;

• •

  William Green, M.D., report dated 03/20/2019; and

• •

  Grace Monafo, M.D., reports dated 03/29/2019 and 04/10/2019.

The individual was found to be disabled beginning 8/17/16 due to obesity, heart disease, and arthritis. Medical records document a myocardial infarction in August 2016. Also, the individual had pain in both knees with limitation of motion bilaterally. Due to obesity and limitation of knee motion, the individual had difficulty walking. The impairments were determined to be equivalent to the severity reflected in Listing 1.02. Current evidence is needed because MI is possible. The disabled individual states that she is still disabled because of a heart condition and arthritis. She has not worked since her established onset date.

An examination on April 10, 2019 shows she had no recurrence of angina, but complained of shortness of breath on walking 1 1/2 blocks and dependent edema at night. Her persistent knee joint pain was exacerbated by walking or prolonged standing. She also complained of generalized joint pain and morning stiffness. Her height was 62 inches, weight 249 pounds. Blood pressure with a large cuff was 150/95. She was in no acute distress. There was mild ankle edema. The knees were enlarged and crepitant, but without heat or inflammation. Range of motion of the knees was moderately decreased bilaterally. There was no jugular vein distention and the liver was not palpable. The lungs were clear, but breath sounds were somewhat distant. Heart rhythm was markedly irregular and the apical pulse was 120, with a radial pulse of 100. There was a soft systolic aortic ejection murmur. Chest film shows clear lungs. CT ratio is 53 percent, with mild left ventricular prominence. ECG tracing shows multifocal PVCs and QS complexes through lead V5. Fasting blood sugar is 130. Serum creatinine is 1.4. X-ray films show moderate osteoarthritic changes in the knees.

The DDS medical consultant's review indicates that the individual does not meet the disability criteria for Listing 1.02. However, her mobility continues to be severely limited by impairment-related shortness of breath and by joint pain. It is determined that the combination of heart disease, obesity, and osteoarthritis of the knees continues to be equivalent to the severity reflected in the criteria for Listing 1.02. Therefore, she is disabled within the meaning of the Social Security Act and disability is continued.

The following reports were used at the CPD of 01/10/15 to determine disability:

• •

  Philip Smith, M.D., report of 11/07/2014 and

• •

  St. John's Hospital, inpatient treatment 10/07/2014 to 10/27/2014.

The following reports were used to determine whether disability continues:

• •

  Philip Smith, M.D., report dated 02/25/2018;

• •

  Khalil Kashir, M.D., report dated 03/10/2018; and

• •

  Charles White, M.D., Internist, consultative examination of 03/20/2018 and Pulmonary Function Studies (PFS) of 03/26/2018.

The individual was determined to be disabled from 10/07/2014 because of multiple injuries sustained in an automobile accident. At the time of the CPD, the individual was recuperating from multiple rib fractures, internal injuries, and a compound, comminuted fracture of the left ankle. These injuries limited him to the performance of light work and Vocational Rule 202.06 directed a finding of disabled. Current evidence is needed because MI is possible. The disabled individual states that he is still unable to work due to a leg condition and shortness of breath. He is not engaging in SGA.

Current medical evidence shows complete healing of the rib and ankle fractures and healed internal injuries. The only current residual of the accident is a mild restriction of movement of his left ankle; however, he has normal gait and station. An x-ray of his left ankle reveals a healed fracture with degenerative changes. He has good range of motion of his hips and knees. There are no sensory, motor, or reflex abnormalities. Abnormal breath sounds and labored breathing were noted. A diagnosis of chronic obstructive pulmonary disease has been made.

A consultative examination was obtained since a chest x-ray and Pulmonary Function Studies (PFS) were needed to evaluate this additional impairment. PFS performed on 03/26/2018 revealed that the pulmonary disorder has resulted in reduced breathing capacity with an FEV1 of 1.6 and MVV of 67. His height is 6 feet without shoes. The impairments do not meet or equal the Listings.

Therefore, MI has occurred. This individual previously had an RFC for light work at the CPD. Considering only the impairment present at the CPD, there is currently no significant restriction of function. Therefore, the MI is related to the ability to work. The disabled individual's respiratory impairment is severe as he is limited in his ability to lift more than 20 pounds occasionally or 10 pounds frequently. He should not work in polluted environments. Therefore, based on all the current impairments, he is found to be restricted to a limited range of light work.

The disabled individual is 58 years of age with a high school education and a 25-year work history as a rigger in the shipbuilding industry (skilled work at a heavy exertional level). This work involved maintaining the weight-handling gear on ships, arranging the weight distribution of the load and organizing the movement of the gear. He cannot perform this past relevant work because of the heavy exertional requirement, as he can only do a limited range of light work. His skills are not transferable to light work. In view of his remaining occupational base translated from his RFC and considered in conjunction with his advanced age, education, and work experience, he would be unable to make the adjustment to other skilled work. Accordingly, he continues to be disabled within the framework of Vocational Rule 202.06. Therefore, although MI related to ability to work has occurred in the original impairment, the current impairment is severe and precludes the individual from performing SGA, so disability continues.

The following reports were used at the CPD of 05/12/2015 to determine disability:

• •

  Hudson Memorial Hospital, report of admission of 08/10/2014 to 09/6/2014 and outpatient records covering 10/03/2014 to 01/17/2015; and

• •

  John Masters, M.D., report of 02/05/2015.

The following reports were used to determine whether disability continues:

• •

  Daniel Jones, M.D., report dated 02/24/2018;

• •

  Thomas Doucette, M.D., report dated 03/27/2018; and

• •

  Albert Cohen, M.D., Orthopedic Surgeon, consultative exam of 04/02/2018.

The individual was found to be disabled beginning 08/10/2014 because of a fractured left femur with slow healing. At the CPD, the individual was unable to walk without crutches and x-rays did not show the expected amount of healing. The impairment met the requirements of Listing 1.06. Current evaluation is necessary since medical improvement is expected. He indicates that he is still unable to perform work activity due to a left leg problem. He has not engaged in any substantial gainful activity (SGA) since onset.

Current medical evidence reveals that the disabled individual had full weight-bearing status at an examination in February 2018. X-rays interpreted at that time revealed that the fracture was well-healed. A consultative orthopedic evaluation was secured since a current physical exam and range of motion data were needed. The consulting orthopedic surgeon reported that the individual had good range of motion of both lower extremities. He walked with a normal gait and experienced no difficulty getting on and off the examining table. His impairment does not meet or equal listing severity.

His impairment has decreased in severity since he is fully weight-bearing and an x-ray shows solid union; therefore, medical improvement has occurred. Since the individual met a listing at the CPD but currently no longer meets that listing, the medical improvement is related to the ability to work. Although he alleges a left leg problem, his current impairment is not severe as he now has good range of motion of both lower extremities and no significant restrictions on standing, walking, lifting or other work activities.

As MI has occurred and the individual is able to engage in SGA, disability ceases as of 04/02/2018 and benefits will terminate 06/30/2018.

The following reports were used on 08/15/2015, the date of the CPD, to determine disability:

• •

  Oak Ridge Hospital, reports covering admissions of 08/24/2014 to 09/15/2014 and 05/30/2015 to 06/17/2015;

• •

  Marvin Henry, M.D., report of 07/10/2015; and

• •

  Keven R. Connolly, O.D., report of 07/12/2015.

The following reports were used to determine if disability continues:

• •

  University Hospital, reports covering admission of 10/07/2018 to 10/20/2018;

• •

  Michael Wilson, M.D., report of 02/28/2019;

• •

  Marvin Henry, M.D., report of 03/04/2019; and

• •

  Keven R. Connolly, O.D., report of 03/10/2019.

The individual has been disabled since 08/24/2014. Her impairment met Listing 1.04C. as a result of a back injury with spinal stenosis. A physical exam at the time of the CPD showed the individual had markedly decreased range of motion of the spine. Muscle spasm was present. There was L5 motor weakness and hypothesia to pin prick. She was unable to heel or toe walk. Current evaluation is necessary since medical improvement was expected. The individual states she is still unable to work because of back and right leg pain. She has not worked since onset.

In October 2018, a myelogram revealed an L4-5 extradural defect. The individual underwent a right L4-5 laminectomy and excision of the nucleus pulposus. Current evidence shows that the back impairment has decreased in severity. Office notes show that her symptoms improved although she continued to experience periodic back and right foot pain. She has good range of motion of her lumbosacral spine with 80 degree forward flexion and normal lateral bending. Motor exam reveals normal mass and tone. Deep tendon reflexes and sensation are normal. She is able to heel and toe walk normally. An x-ray shows evidence of a past laminectomy and degenerative arthritis. Therefore, MI has occurred. Since the individual met a listing at CPD and now no longer meets or equals that listing, the medical improvement is related to the ability to work. Current medical findings do not establish an impairment that produces pain of such severity as to preclude the individual from engaging in any gainful work. Therefore, disability is ceased as of March 2019 and benefits will be terminated on 05/31/2019.

The following reports were used in the CPD of 12/10/2015 to determine disability:

• •

  Concord Hospital, inpatient records from 06/22/2014 to 07/04/2014 and 08/17/2015 to 08/31/2015;

• •

  Cliff Adams, M.D., report of 09/01/2015; and

• •

  Frederick Thompson, M.D., Cardiologist, consultative examination of 09/13/2015.

The following reports were used to determine if disability continues:

• •

  Concord Hospital, inpatient records from 04/04/2018 to 04/15/2018;

• •

  Cliff Adams, M.D., report dated 06/09/2018; and

• •

  Elsie Friehold, M.D., Cardiologist, report dated 04/15/2018.

This individual was found to be disabled beginning 06/22/2014 because of coronary artery disease. At the time of the CPD, medical evidence indicates the individual underwent cardiac bypass surgery in June 2014. Although she initially progressed well, she subsequently began to complain of chest pain and shortness of breath. She underwent a second bypass surgery in August 2015. The impairment equaled Listing 4.04C.

The individual has completed a 9-month trial work period. She continues to work as a telephone solicitor with earnings indicative of substantial gainful activity (SGA). Benefits have been stopped on 11/13/2018 as indicated on SSA-833. She feels she still has a severe heart condition which limits activity. A current medical decision is needed to determine impairment severity and thus, entitlement for an extended period of eligibility (EPE).

She has coronary artery disease and ischemic heart disease. Current examination revealed normal heart sounds with only occasional premature ventricular contractions. The individual experiences chest pain infrequently and only with heavy exertion. The pain is relieved with nitroglycerin or rest. The second bypass (August 2015) improved circulation to the heart and symptoms have decreased. The treating physician stated that the patient would not be able to return to work activity. The treating cardiologist hospitalized the individual in April 2018 for chest pain. The individual performed a stress test which was negative at 5 METS and showed abnormalities at 7 METS. A chest x-ray revealed only mild cardiomegaly. The treating cardiologist assessed that because of the individual's history of heart disorder, she should avoid lifting in excess of 20 pounds.

The evidence does not show current findings that meet or equal the listed impairments; therefore, MI has occurred. Since the impairment no longer meets or equals the listings, the MI is related to the ability to work.

The record reveals the individual continues to have a severe cardiovascular impairment which limits her ability to perform basic work activities. There is a current capacity to lift a maximum of 20 pounds occasionally and 10 pounds frequently.

Although the individual's treating physician stated she would not be able to return to work activity, this issue is reserved for the Commissioner. The weight given such statements depends upon the extent to which they are supported by specific and complete clinical findings and are consistent with other evidence in the individual's case. The clinical findings and other evidence do not support the conclusion that the individual is disabled from any gainful work.

Since MI has been demonstrated by a decrease in medical severity related to the ability to work and since the individual is able to engage in SGA, disability ceased in 04/2018 and benefits are terminated as of 06/30/2018.

The following report was used at the CPD) of 10/19/2014 to determine disability:

• •

  Joseph Anderson, M.D., report of 07/05/2014.

The following reports were used to determine whether disability continues:

• •

  St. John's Hospital, reports covering admission of 04/8/2018 to 04/17/2018;

• •

  Joseph Anderson, M.D., report dated 2/9/18; and

• •

  Janice Urban, M.D., Cardiologist, report of 05/25/2018.

The individual was found to be disabled beginning 05/17/2014 because of coronary artery disease and thrombophlebitis. The individual had severe inflammation of the leg veins which was persistent despite treatment. The individual had chest pain with exertion. The impairment limited the individual to the performance of sedentary work and Vocational Rule 201.10 directed a finding of disabled. New medical evidence is needed because MI is considered possible. The individual alleges that he is still disabled due to a heart condition. He has not performed substantial gainful activity (SGA) since 05/17/2014, his date of onset.

Current medical evidence from the individual's treating cardiologist indicates that the individual underwent cardiac bypass surgery in April 2018. Examination revealed normal heart sounds with only occasional premature ventricular contractions. There are infrequent episodes of angina. The treating cardiologist reported in May 2018 that the individual performed a stress test to 7 METS with no angina. A chest x-ray revealed only mild cardiomegaly. The individual has a history of thrombophlebitis, but the lower extremities show no abnormalities. The medical findings do not document an impairment that meets or equals the listings.

The evidence shows a decrease in the medical severity of his impairment; therefore, medical improvement has occurred. Based on the individual's current impairment, he has the capacity to lift 20 pounds occasionally and 10 pounds frequently with no further restrictions. Therefore, the MI is related to the ability to work.

The individual is 58 years old and has 10 years of education. He has 5 years of relevant work history as a nurse's aide which is a medium, semiskilled job. Since the individual is limited to light work, he would be unable to perform his past work due to the exertional demands involved. His skills are not transferable to jobs of a light or sedentary type of work. The individual satisfies the criteria for Vocational Rule 202.02, which directs a decision of disabled. Since the individual does not have the ability to do SGA, even though MI has occurred, disability is found to continue.

The following evidence was used at the CPD of 06/12/2014 to determine disability:

• •

  St. John's Hospital, inpatient 02/06/2014 to 03/01/2014;

• •

  Lakeside Rehabilitation Center, outpatient 03/01/2014 to 03/27/2014; and

• •

  Claude Arakari, M.D., report of 04/01/2014.

The following reports were used to determine whether disability continues:

• •

  Lakeside Rehabilitation Center, outpatient 04/05/2017 to 08/21/2017;

• •

  Robert Franklin, M.D., report dated 02/08/2018; and

• •

  Samuel Glassner, M.D., Orthopedist, consultative examination of 03/01/2018.

The individual has been disabled since 02/06/2014 because of musculoskeletal injuries sustained in a motorcycle accident. He was able to ambulate for only short distances due to his right knee impairment. X-rays of his right knee showed incomplete healing. He was found to be limited to sedentary work and Vocational Rule 201.09 directed a finding of disabled. He has not worked since his established onset date. The individual alleges he remains unable to return to any work activity because he still has knee pain. Current evaluation is needed because MI was expected.

Currently, the treating physician reported that he continued treating the individual for complaints of pain to the lower extremities. He states that he treated the individual with medication and advised him to exercise. X-rays taken at the examination on 02/08/2018 revealed only spurring in the right knee in addition to old healed fractures. A consultative examination was arranged to obtain a physical exam and range of motion. Evidence from the consulting orthopedist dated 03/01/2018 reveals the individual continues to walk with an abnormal gait. Flexion of the right knee is limited to 120 degrees. The left knee can be fully flexed. Range of motion of the hips and ankles is normal. The impairment does not meet or equal the requirements of the Listings.

Therefore, MI has occurred as there is a decrease in medical severity. He now has the ability to stand and walk 6 out of 8 hours and to lift 20 pounds occasionally and 10 pounds frequently, which is a wide range of light work. The medical improvement that has occurred is related to his ability to work, since he could only do sedentary work activity at the CPD.

Although the individual alleges pain in the right knee, the fracture is well-healed with minimal spurring and mild limitation of motion. He is restricted to light work but the clinical findings do not establish an impairment that produces pain of such severity as to prevent the individual from performing any substantial gainful activity (SGA).

The disabled individual is 53 years old, has a limited education, and has a 20-year work history as a general laborer in a foundry which is unskilled work involving heavy lifting and carrying. Since the individual is limited to light work, he would be unable to perform his past work due to the exertional demands involved. The special medical-vocational characteristics pertaining to those cases involving arduous, unskilled work or no work are not present. The facts in this case correspond exactly with the criteria of Vocational Rule 202.10 which directs a finding of not disabled. Since there is MI and the individual has the ability to do SGA, disability is ceased in 03/2018 and benefits will be terminated as of 05/31/2018.

The following reports were used at the CPD of 04/13/2015 to determine disability:

• •

  Meadeville Medical Center, inpatient treatment of 11/12/2014 to 11/21/2014; outpatient treatment of 10/19/2014 and 12/02/2014; and

• •

  Alexander Doone, M.D., report of 01/17/2015.

The following reports were used to determine if disability continues:

• •

  Renee Legere, M.D., report of 02/28/2019;

• •

  Alexander Doone, M.D., report of 03/10/2019; and

• •

  Consultative examination, John R. Smith, M.D., Internist, 03/26/2019.

The individual has been under a disability since 10/19/2014 due to rheumatic heart disease with mitral stenosis and peptic ulcer which led to an allowance in the framework of Vocational Rule 201.10. Currently the case is being evaluated as MI is possible. The individual believes he is still disabled because of his heart condition plus recent pulmonary disease. He attempted working a few years ago but had to stop after three weeks. There is no substantial gainful activity (SGA) issue.

Current medical evidence reveals a history of rheumatic heart disease that required hospitalization for congestive heart failure. According to his physician, this impairment has responded to treatment. Currently there is no chest pain and no evidence of pulmonary or peripheral edema. There are no symptoms related to peptic ulcer disease since his diet has been adjusted. Recently, shortness of breath has been increasing. He had been smoking two packs of cigarettes per day for 20 years, but has stopped because of respiratory problems. A consultative examination dated 03/26/2019 was performed for evaluation of his respiratory impairment with pulmonary function studies (PFS).

On physical examination, height was 69" and weight was 180 pounds. Breath sounds were diminished with prolonged expiration and an expiratory wheeze. The chest was otherwise clear. On examination of the heart, a diastolic rumble at the apex was noted. An ECG showed a prominent wide P-wave suggestive of left atrial enlargement, which was confirmed on the chest x-ray. The heart size otherwise was within normal limits. The lung fields were hyperaerated and diaphragms were somewhat flattened. PFS done by the consultant revealed post-bronchodilator FEV1 was 1.9 liters and MVV 76 liters per minute.

Current medical findings do not meet or equal the findings described in any listed impairment. There is no current evidence of congestive heart failure and no active peptic ulcer disease. This individual's impairment shows MI as there is a decrease in the medical severity of impairments present at the CPD. At that time the residual functional capacity (RFC) was for light work activity. The current RFC, considering only the rheumatic heart disease and peptic ulcer disease, shows full capacity to do all work activities and these impairments are now not severe. Therefore, MI is related to the ability to do work.

Although the heart and digestive impairments are not severe when considered alone, considering their effect on the ability to perform work activities in combination with a respiratory impairment, the individual would be restricted to lifting up to 50 pounds occasionally and 25 pounds frequently. The individual now has the capacity to perform a full range of medium work. He cannot perform his prior work as baker helper (heavy, unskilled work). It involved much lifting of things, such as bags of flour (up to 100 pounds), racks of baked items, and piles of unfolded boxes. Although his most recent work was arduous and unskilled, it lasted only 17 years and he previously did semiskilled work. Therefore, the special medical-vocational characteristics pertaining to arduous, unskilled work, or no work, are not present. He is of advanced age (56) with limited education (grade 6) and meets Vocational Rule 203.11, which indicates the ability to do SGA. Since there is MI demonstrated by decreased medical severity, it is related to the ability to work. Because the individual has the ability to do SGA, disability is ceased as of 03/2019. Benefits will be terminated 05/31/2019.

In making the determination on the issue of continuing disability, all of the evidence listed on the decision dated 12/31/2014 has been considered, as well as the following additional evidence:

• •

  Vocational Rehabilitation Counselor, Department of Vocational Rehabilitation, reports covering 03/10/2017 to 03/15/2018;

• •

  T. Weston, M.D., report dated 04/19/2018;

• •

  L. Lehman, M.D., report dated 04/21/2018; and

• •

  G. Robertson, M.D., report dated 05/01/2018.

The individual was allowed disability benefits from 06/07/2014 because of injuries received in a motorcycle accident. At the time of the CPD, he had a traumatic left above the knee amputation with persistent stump complications, inability to use a prosthesis, and a right recurrent shoulder dislocation. The impairment was found to meet Listing 1.05B. A current evaluation is necessary as MI was expected. The individual states he is still disabled because of a left above the knee amputation and difficulty walking with his prosthesis. He has not worked since the onset date.

The medical evidence reveals that following his left above the knee amputation in 06/14 the individual experienced persistent pain and tenderness about the stump. He underwent three stump revisions. The most recent revision was 12/2014 for excision of a bony spur and painful scar. Office notes from the individual's treating physician show that following the latest stump revision, the individual was able to wear his prosthesis over an extended period of time without much discomfort. Recent examination of the stump revealed no neuromatous changes or other abnormalities. An x-ray did not demonstrate any bony spurs or complications. Furthermore, the individual has had no recent problems with right shoulder dislocation. He had full range of motion of his shoulder without pain or instability. The individual no longer has an impairment that meets or equals the level of severity described in the Listings.

Therefore, MI has occurred. Although he alleges difficulty walking with his prosthesis, the individual has the RFC to stand and walk for 2 hours and to sit for six hours with no further restrictions. Since his current condition no longer meets or equals Listing 1.05B, his MI is related to the ability to work.

The individual received evaluation and counseling through the Department of Vocational Rehabilitation. He obtained funds to attend a 2-year program at Central University. In December 2017 he received an associate degree in computer science. The combination of education and counseling constitute vocational therapy.

The individual has a severe impairment that limits him to the performance of sedentary work. The individual is 30 years old with 16 years of education. He has 4 years of relevant work experience as a painter. This job involved standing and walking at least 6 out of 8 hours. The individual is unable to perform his past work because of limitations on standing and walking. The special medical-vocational characteristics pertaining to arduous, unskilled work or no work are not present. Additionally, his ability to perform sedentary work has been enhanced by vocational therapy; therefore, the vocational therapy exception applies. The individual meets Vocational Rule 201.28 which directs a decision of not disabled. MI is established, the vocational therapy exception applies, and the individual is able to engage in SGA. Therefore, the individual is no longer disabled and benefits are ceased as of May 02, 2018 and benefits are terminated as of July 31, 2018.

In making the determination of continuing disability, all the evidence cited in the CPD of 02/23/2015 has been considered, as well as the following:

• •

  Ervin Medical Center, outpatient treatment 12/07/2018, 12/19/2018, and 04 /12/2019;

• •

  Commonwealth Hospital, outpatient report of 09/23/2018;

• •

  Georgia Ebenezer, M.D., report of 03/02/2019;

• •

  William A. Bell, M.D., office notes from 01/03/2014 to 03/01/2018; and

• •

  Edward Burgin, M.D., report of 03/17/2019.

The individual has been under a disability since 07/29/2014 because of ischemic heart disease which met Listing 4.04C. based on the angiogram done 12/07/2014. A narrative report of the results of a treadmill exercise test done 10/12/2014 were negative at 7 METS when it was stopped due to fatigue. Actual tracings were not obtained. Cardiac bypass surgery was considered but was not done due to obesity (197 pounds). Current evaluation is needed as MI is possible. The individual says she is still as bad off as she was when she applied and she still gets bad chest pain. She also has arthritis in her hands. There is no substantial gainful activity (SGA) issue.

Current medical evidence shows that the individual continues to have crushing chest pain on exertion, such as lifting her grandson, which stops with rest or medication. Her doctor has told her to avoid strenuous activity. When she limits exercise, she rarely has angina. She has stiffness in her finger joints and a 12/19/2018 x-ray shows degenerative arthritis of her hands and wrists, greater than normal for her age. There is also evidence of an old healed fracture of her left wrist, which is her dominant hand. Limitation of motion is noted in the left wrist and thumb. Her blood pressure is 110/70 and heart sounds are normal. There is infrequent angina for which nitroglycerin has been prescribed. Current weight is 165 pounds and height is 67-1/2 inches. She still does not want to risk surgery. Further weight reduction is planned. A treadmill exercise test done 09/23/2018 was stopped due to chest discomfort at 7 METS with no ECG abnormalities present as described in the listings.

There is no evidence of decreased medical severity in relation to the individual's cardiac impairment. Therefore, no MI has been demonstrated. The evidence now shows that a treadmill exercise test, done around the time of the initial allowance but not obtained then and not considered in making that decision, was negative at 7 METS. Had the test been considered at the time of the initial decision, the case would not have met the listing since the treadmill results have precedence over the angiogram. There would have been an RFC light work. The individual's past relevant work involved mounting tissue specimens on glass plates, doing blood and urine tests, keeping laboratory test tubes and other equipment clean and in order, and other duties, a job classified as light work in the Dictionary of Occupational Titles (DOT). Therefore, a denial based on the ability to perform her past work as a medical-laboratory assistant would have been the appropriate decision. If the treadmill results had been considered at the time of the prior determination, disability would not have been found. Therefore, the error exception applies.

Currently there is an additional impairment, arthritis of the hands, which was not present at the CPD. Current RFC permits lifting 20 pounds occasionally and 10 pounds frequently based on the cardiac impairment. However, because of the limitation of the use of the left wrist and the dominant left hand, constant handling would be precluded. The current impairments are severe and restrict the individual to light work with additional non-exertional restrictions. Since constant handling was an integral part of her past work as a medical-laboratory assistant, she could not perform this work now.

The individual is 56 years old. She is a high school graduate with a background of skilled work. She no longer has full use of her hands required in her type of work and thus has no transferable skills. The framework of Vocational Rule 202.06 and 201.06 indicates she is not able to do SGA. Therefore, although the error exception applies for the time of the CPD, the individual currently has a new impairment which limits her ability to work. Therefore, disability is found to continue because the individual is not able to do SGA.

The following reports were used to determine if disability continues:

• •

  Wharton Hospital, outpatient 05/12/2018 to 01/05/2019;

• •

  Fred Josephs, M.D., report of 02/20/2018; and

• •

  Consultative examination, Constance A. Binns, M.D., Otologist, report dated 02/28/2018.

The prior folder cannot be located. The available evidence (via query) indicates the claim was allowed as equaling a listing with an onset of 09/06/2014. Current evaluation is necessary because the diary date has been reached and indicates MI was considered possible. The individual states that he continues to be disabled due to his heart condition. He also has some trouble hearing. He has not worked since he first became disabled. It is unclear whether a decision has been made since then. He remembers going for an examination set up by the DDS which he thinks was more recent than 2014.

Medical evidence reveals a history of a myocardial infarction 09/06/2014 and cardiac arrhythmia which was due to digitalis. His medication was changed and his heart symptoms decreased. A treadmill exercise test done 05/12/2015 was positive at 10 METS according to the cover sheet describing the results of the test. The tracings are not available. The individual no longer has any chest pain. A consultative examination was arranged to evaluate the severity of his hearing impairment. He has a 40 decibel loss in the right ear and 60 decibel loss in the left ear. A hearing aid was recommended. The individual's impairments do not meet or equal any listed impairment.

A current assessment of functional capacity shows the ability to lift up to 20 pounds occasionally and 10 pounds frequently with no limit on walking and standing. He should not work in a very noisy atmosphere or in a job that requires hearing perfectly. Since the individual's past relevant work was accounting, a sedentary skilled job, he would be able to perform this past work. Therefore, he is currently able to engage in SGA and reconstruction of the prior folder is required if the date of the CPD can be established. Attempts to reconstruct prior medical evidence have not been made because the CPD date is not clear. Therefore, neither MI nor any of the exceptions to medical improvement have been demonstrated and disability must be continued.

The following reports were used at the CPD of 12/22/2015 to determine disability:

• •

  St. Anthony Hospital, inpatient treatment 06/14/2015 to 06/27/2015; outpatient treatment 07/15/2015 to 10/16/2015; and

• •

  James Gregory, M.D., report dated 11/02/2015.

The following reports were used to decide whether disability continues:

• •

  St. Anthony Hospital, inpatient treatment 09/13/2018 to 09/19/2018 and 09/27/2018 to 10/14/2018;

• •

  Vincent Moberg, M.D., Cardiologist report dated 03/05/2019; and

• •

  James Gregory, M.D., reports dated 02/19/2019 and 03/15/2019.

The individual has been disabled since 06/14/2015 because of coronary artery disease. He had angina and an abnormal treadmill exercise test positive at 6 METS. A medical-vocational allowance was made because of an RFC for light work. He has not engaged in SGA since onset. Current review is necessary since MI was expected. The individual states he continues to be unable to work because of a bad heart.

Current medical records reveal that the individual was hospitalized on 09/13/2018 with complaints of chest pain and shortness of breath. He was treated conservatively and released on 09/19/2018 but again hospitalized on 09/27/2018 to undergo further evaluation. At that time, angiography revealed significant blockage of the left anterior descending artery and the right coronary artery. The individual underwent cardiac bypass surgery and although his recovery was uneventful, he continued to complain of chest pain and shortness of breath with any exertion. An electrocardiogram was interpreted as abnormal and an echocardiogram showed a decreased ejection fraction. The treating cardiologist indicated that further surgery was not anticipated and the individual would continue to be treated with conservative therapy including medication, rest, and an exercise program. The cardiologist indicated the individual would be limited in his ability to perform any strenuous activities because of the continued chest pain, shortness of breath, and easy fatigability. The cardiologist noted the possibility of further cardiac damage.

The individual's coronary artery disease does not meet or equal the requirements of the Listings. The medical record reveals that the individual has coronary artery disease for which he has undergone surgical procedure. In spite of surgery, he has shortness of breath, chest pain on exertion, and easy fatigability. He has not had a treadmill exercise test since then because of his chest pain post-surgery. The individual has not had a decrease in severity of his coronary artery disease as evidenced by the medical findings. MI has not occurred and no exception to MI applies; therefore, disability continues.

1. 1. 

   The following reports were used at the CPD of 04/22/2015 to determine disability:

• •

  Veterans Administration Hospital, admissions of 06/14/2014 to 06/22/2014 and 10/27/2014 to 11/05/2014; and

• •

  Herbert Roberts, M.D. report of 12/15/2014.

The following reports were used to determine whether disability continues:

• •

  Veterans Administration Hospital, admission of 02/25/2018 to 03/03/2018 and outpatient records covering 01/21/2016 to 03/17/2018;

• •

  John Albrecht, M.D., report of 03/27/2018; and

• •

  George Baylis, M.D., report of 04/02/2018.

The individual was initially determined to be disabled from 06/14/2014 because of uncontrollable diabetes, peripheral neuropathy, and decreased vision. He had diabetic neuropathy with mild sensory changes of his legs and feet. The left eye had a cataract with decreased vision to 20/100 best correction. The right eye had normal vision. His impairment was considered to be equivalent to Listing 9.08. Current medical evidence was obtained as MI was possible. The individual alleges that he is still disabled because of “sugar diabetes, pins and needles in his legs, and cataracts.” He has not worked since onset.

Current medical reports show that the individual's diabetes has not been well controlled by diet and insulin. He had a hospitalization in 02/2018 to assist with control of his diabetes. Subsequent office visits revealed some elevated blood sugars. The individual has never had hypoglycemic reaction or acidosis. An ECG and chest x-ray were normal. Eye grounds exam showed no retinopathy. Visual exam revealed the presence of a cataract in the left eye. Best corrected visual acuities were 20/100 OS (the left eye) and 20/25 OD (the right eye). The individual had good peripheral pulses throughout. However, exam indicated that there was bilateral hypalgesia to pinprick and diminished vibratory sense in both lower extremities. DTRs were diminished bilaterally at the ankles. The individual was ambulatory with a normal gait. The individual does not have an impairment or combination of impairments that meets or equals the Listings.

There has been no change in the medical findings to show MI. Since MI has not occurred, and none of the exceptions to MI applies, disability continues.

The following reports were used at the CPD of 09/25/2015 to determine disability:

• •

  Mark Green, Jr., M.D., report of 10/02/2014 and

• •

  Washington Community Hospital, inpatient 08/03/2014 to 09 /04/2014.

The following reports were used to determine whether disability continues:

• •

  Washington Community Hospital, inpatient 09/13/2018 to 09/23/2018;

• •

  Vocational Rehabilitation Counselor, Department of Rehabilitation Services, report of 12/17/2018;

• •

  William Jacobs, M.D., report of 02/27/2019; and

• •

  Howard Goodman, M.D., Orthopedist, consultative exam of 03/11/2019.

The individual was found to be disabled beginning 08/03/2014 due to a crush injury with fracture of his left ankle. After discharge from the hospital, the individual followed up with his treating physician. He continued to have pain and numbness in his left foot. He was restricted to the performance of light work and thereby met the requirements of Vocational Rule 202.06, which directed a decision of disabled. Current medical evidence was obtained because MI was expected. The individual states that he continues to be disabled because of left ankle pain and difficulty standing and walking. He has not worked since onset of his disability.

Recent medical information from the individual's physician shows that an ankle fusion was done in 09/2018 to provide a stable joint and to permit weight bearing. Currently, he is fully weight bearing, but walks with a prominent limp. In order to further document severity and obtain a current x-ray, the individual was examined by a consulting orthopedic physician. Clinical examination of the left ankle revealed some thickening of the heel but the fusion was stable. Ankle movements are limited to 10 degrees dorsiflexion and 20 degrees plantar-flexion. An x-ray was consistent with a healed subtalar arthrodesis and moderate traumatic degenerative changes. Neurological evaluation revealed an absent left ankle jerk and inability to walk on heels and toes. There was decreased sensation over the lateral and dorsal aspects of the left foot and decreased strength of the left extensor hallucis longus.

The individual's impairments do not meet or equal the level of severity described in the Listings. An x-ray shows that arthritis has developed at the fracture site. The individual continues to experience left ankle pain. Further, he has an abnormal gait and limitation of motion of his left ankle. However, since the ankle fusion the individual has been full weight-bearing, which is MI since the CPD. His left ankle impairment continues to restrict his ability to stand and walk to 6 hours during an 8-hour day. The individual remains limited to the performance of a wide range of light work, lifting 20 pounds occasionally and 10 pounds frequently. This RFC is the same as that at the CPD. Therefore, MI is not related to his ability to work.

Since the CPD, the individual underwent vocational counseling through the Department of Rehabilitation Services and enrolled in an 18-month training program on small appliance repair. He completed the course on 11/30/2018 after working on appliances such as radios, electrical tools, and a variety of small household appliances.

The recent completion of this specialized training course in conjunction with counseling constitutes vocational therapy. This therapy has enhanced the individual's ability to perform work since he has acquired a skill that provides for direct entry into light work.

Although the individual continues to experience left ankle pain, he is fully weight-bearing and is able to perform light work. The clinical findings do not establish an impairment that results in pain of such severity as to preclude him from engaging in any substantial gainful activity.

The individual has a severe impairment that restricts him to light work. He is 57 years old with 12 years of education. He has 6 years of relevant work experience as a truck driver that is a medium semiskilled job. The individual is unable to perform work as a truck driver because of the exertional demands of the job and there are no transferable skills. The special medical-vocational characteristics pertaining to arduous, unskilled work or no work are not present. However, as a result of vocational therapy since the CPD, the individual has obtained job skills which are useful in the performance of light work. Therefore, he meets Vocational Rule 202.08 which directs a decision of not disabled. He can do such occupations as an Electrical-Appliance Repairer (DOT 723.381-010), a Radio Repairer (DOT 720.281-010), or as an Electrical Tool Repairer (DOT 729.281-022), all skilled light work in the electrical equipment industry. According to the Labor Market Trends Bulletin and the Virginia Department of Labor and Industry, over 30,000 individuals are employed in the electrical equipment industry in Virginia; and the cited occupations are well represented throughout that industry. It can be inferred that the occupations exist as individual jobs in significant numbers in the region where the individual lives and throughout the national economy.

While there has been no MI related to the ability to work in the individual's impairment, the vocational therapy exception to MI applies and the individual is able to engage in SGA. Therefore, the individual is no longer disabled as of 11/30/2018 and benefits are terminated as of 01/31/2019.

The following reports were used at the CPD of 07/18/2015 to determine disability:

• •

  George Washington Hospital, admission of 10/22/2014 to 10/27/2014;

• •

  Nicholas Lawrence, M.D., report of 11/29/2014; and

• •

  John Webster, M.D., Cardiologist, consultative exam of 12/12/2014.

The following reports were considered to determine whether disability continues:

• •

  Nicholas Lawrence, M.D., report of 02/13/2018;

• •

  Paul Bush, M.D., report of 02/15/2018;

• •

  Richard Wilson, M.D., report of 02/21/2018; and

• •

  Bernard Parker, M.D., Vascular Surgeon, consultative exam of 03/10/2018.

The individual was previously determined to be disabled beginning 10/22/2014 by peripheral vascular disease, hypertension, and obesity. The individual had a recent history of vein ligation and stripping on the left leg. Physical findings revealed a weight of 214 pounds and a blood pressure of 180/118. There was induration and edema of the right leg and recently healed stasis ulcers. The combination of impairments was determined to be equivalent to the severity reflected in Listing 11.14. Current evaluation is necessary because MI was possible. The individual reports that she is still disabled because of poor circulation of blood in her legs and high blood pressure. She has not engaged in SGA since she became disabled.

The individual's treating physician reported that the individual continues to be overweight (232 pounds) despite adherence to a strict diet and continues to complain of left leg swelling with necessity for using an elastic stocking. A consultative exam was obtained for specific findings regarding any peripheral vascular disease. The physical exam was remarkable for weight of 232 pounds, height of 5 feet 4 inches, and blood pressure of 190/110 with an appropriate size cuff. A chest x-ray showed the heart to be at the upper limits of normal size but otherwise unremarkable. An ECG showed left axis deviation. The left leg showed evidence of prior surgery and pigmentary changes from venous stasis. There were scars over the right ankle compatible with old healed ulcers.

A comparison with present findings show that the individual's weight has increased 18 pounds, her diastolic blood pressure remains elevated to excess of 100, and there is still evidence of vascular disease.

The current physical findings do not demonstrate a decrease in severity of the impairments from those at the CPD; therefore, MI has not occurred. Exceptions to MI have been considered and do not apply in this case. The individual continues to be disabled.

The following reports were used at the CPD of 04/26/2015 to determine disability:

• •

  Thomas Noonan, M.D., report of 11/25/2014; and

• •

  University Hospital, admission of 10/22/2014 to 10/27/2014; and outpatient report of 12/20/2014 - received after CPD as trailer mail.

The following reports were used to decide whether disability continues:

• •

  Charles Miller, M.D., report of 03/15/2018; and

• •

  David Morehead, M.D., Internist Pulmonary consultative exam of 04/02/2018.

The individual was initially allowed disability benefits effective 10/22/2014 because of chronic obstructive pulmonary disease and asthma. At the CPD, she was receiving treatment from her treating physician for asthma and COPD. In October 2014 she was hospitalized for an asthma attack. Pulmonary Function Studies (PFS) were done during the hospitalization. Based on the results of the PFS, she was restricted to light work, which resulted in an allowance. Current findings were obtained because MI is possible. The individual alleges that she is still unable to work because of emphysema and has not worked since her onset.

Re-review of the October 2014 records demonstrates that PFS were done while the individual was in an acute phase of asthma. Wheezes and rales were noted but no bronchodilator was administered prior to testing. Documentation guidelines in effect at the CPD prohibit the use of PFS performed in the presence of bronchospasm. Outpatient records of 12/20/2014 sent after the CPD as trailer mail reveal that PFS were repeated. These studies show an FEV1 of 1.9 and MVV of 84. MI has not occurred. However, the error exception applies since the individual was allowed using PFS performed in the presence of bronchospasm without the administration of bronchodilators. Additional evidence that relates to the CPD shows that if the 12/20/2014 evidence had been considered in making the CPD, disability would not have been established.

Currently, a report from the individual's treating physician states that the individual has chronic obstructive pulmonary disease and complains of shortness of breath. She also has been diagnosed with asthma, allergic sinusitis, and hay fever. These conditions are controlled with medications. A consultative exam was scheduled 04/02/2018 to obtain a current physical exam and PFS. A chest x-ray revealed mild chronic obstructive pulmonary disease. PFS showed FEV1 of 1.7 and MVV of 75. A physical exam showed a height of 5 feet 2 inches and weight of 120 pounds. There were decreased breath sounds; otherwise, the chest was clear to percussion and ausculation. The impairment does not meet or equal the level of severity described in the Listings.

The individual does not have any restrictions on standing, walking, or lifting due to her breathing impairment. Her impairment is not severe. Therefore, the individual retains the capacity to do SGA.

The error exception of the medical improvement review standard (MIRS) applies, and the individual has the ability to perform SGA. Disability ceases April 2, 2018 and benefits will terminate as of June 30, 2018.

The following reports were used at the CPD of 08/07/2014 to determine disability:

• •

  Wadsworth Memorial Hospital, inpatient treatment 05/21/2014 to 06/12/2014; and

• •

  Gene Keller, M.D., report of 07/12/2014.

• •

• •

• •

  The following evidence was used to determine if disability continues:

• •

  Wadsworth Memorial Hospital, outpatient treatment 08/18/2017 to 12/08/2017.

The individual has been under a disability since 05/21/2014 due to histiocytic lymphoma of the ileum with metastasis that equaled the Listings. Current evaluation is needed as MI is possible. There has been no work since onset. The individual says he is still disabled because of stomach problems. He had chemotherapy and radiation therapy after his operation. Because he has ulcers, he must avoid certain foods.

The only current treatment source given by the individual was Wadsworth Memorial Hospital. The Oncology Clinic notes indicate he had completed chemotherapy. He was last seen 12/08/2017 at which time he was progressing satisfactorily. He weighed 170 with height of 6 feet. Lymph nodes were shotty and the liver was enlarged. Since no current medical evidence was available, a consultative examination (CE) was scheduled for 02/10/2018.

The individual failed to keep the CE. He was contacted and another appointment was scheduled which he again failed to keep. On 03/01/2018, the Field Office made contact with the individual. The FO explained the need for current medical evidence and for his cooperation in going for a CE. There was no indication of any mental impairment or other condition that would make him unable to cooperate. Since he again agreed to keep a CE, DDS scheduled another appointment for 03/18/2018. The individual did not keep the CE and the DDS was unable to contact him by telephone. On 03/18/2018 DDS sent to the individual written notice that failure to cooperate could result in termination. He did not respond.

There is no current medical evidence available to determine if MI has occurred. The individual has repeatedly failed to cooperate in efforts to obtain current medical evidence. Therefore, since there is failure to cooperate, which is a group II exception to MI, disability is ceased 03/01/2018. This month is when the individual was first notified that failure to cooperate could result in termination of benefits. Disability benefits will terminate 05/31/2018.

The following reports were used at the CPD dated 06/30/2014 to determine disability:

• •

  John Smith, M.D., report of 03/25/2014; and

• •

  General Hospital, inpatient 02/03/2014 to 03/15/2014.

The following report was used to decide if disability continues:

• •

  John Smith, M.D., report of 04/30/2018.

The individual was found to be disabled beginning 02/03/2014 due to Huntington's Chorea which met Listing 11.17. MI was not expected, but current review is required by law. The individual advises that he has not worked since he was found disabled and there is no improvement in his impairment.

Contact with the current medical source reveals that the individual is under the care of a physician. The treating physician confirmed the individual's statements and further stated that the individual's condition continues to deteriorate. He has not had recent treatment and none is planned.

The individual's impairment has shown no MI and no exception applies; therefore, disability continues.