The following reports were used at the comparison point decision (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 medical improvement 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 medical improvement 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 residual functional capacity (RFC) is the same as that at the CPD. Therefore, medical improvement 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 medical improvement related to the ability to work in the individual's impairment, the vocational therapy exception to medical improvement 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.