United States District Court, N.D. Ohio, Western Division
MEMORANDUM OPINION AND ORDER
R. KNEPP, II UNITED STATES MAGISTRATE JUDGE
Karen Tressler (“Plaintiff”) filed a Complaint
against the Commissioner of Social Security
(“Commissioner”) seeking judicial review of the
Commissioner's decision to deny disability insurance
benefits (“DIB”). (Doc. 1). The district court
has jurisdiction under 42 U.S.C. §§ 1383(c) and
405(g). The parties consented to the undersigned's
exercise of jurisdiction in accordance with 28 U.S.C. §
636(c) and Civil Rule 73. (Doc. 21). For the reasons stated
below, the undersigned affirms the decision of the
filed for DIB in April 2014 alleging a disability onset date
of May 19, 2009. (Tr. 196). Her claims were denied initially
and upon reconsideration. (Tr. 132, 140). Plaintiff then
requested a hearing before an administrative law judge
(“ALJ”). (Tr. 147). Plaintiff (represented by
counsel), and a vocational expert (“VE”)
testified at a hearing before the ALJ on October 13, 2015.
(Tr. 27-55). On November 3, 2015, the ALJ found Plaintiff not
disabled in a written decision. (Tr. 11-24). The Appeals
Council denied Plaintiff's request for review, making the
hearing decision the final decision of the Commissioner. (Tr.
1-3); see 20 C.F.R. §§ 404.955, 404.981.
timely filed the instant action on February 27, 2017. (Doc.
1). Plaintiff then filed her Brief on the Merits (Doc. 14);
the Commissioner filed her Brief on the Merits (Doc. 15); and
Plaintiff filed her Reply (Doc. 16). Subsequently, Plaintiff
filed a Supporting Memorandum (Doc. 17), which the
Commissioner moved to strike (Doc. 18). The undersigned
granted to Motion to Strike (Doc. 20).
Background and Testimony
was born in July 1966, making her 46 years old on her amended
alleged onset date. See Tr. 196. She alleged
disability due to her leg condition. (Tr. 197). She had
completed high school. (Tr. 34). Plaintiff was married and
lived with her husband and adult children. (Tr. 32-33).
Plaintiff had previous work as a housekeeper. (Tr. 35).
testified she had last worked the year before for one month
doing housekeeping, but had to stop because her legs would
“swell up”, “get really red, and
“burn”. (Tr. 35). Plaintiff stated her leg
problems had gotten worse since the prior ALJ's decision.
(Tr. 36). The left was worse than the right. (Tr. 36). Her
knee and foot would swell, and she got “charley horses
in the back of [her] leg.” (Tr. 38).
testified she had discussed a left knee replacement, but that
her doctor did not want to do it until she was older
(“between 50 and 55”). (Tr. 40). She also stated
that she did not go through with a recommended partial knee
replacement in 2013 because she did not have insurance. (Tr.
43-44). The provider later stated he did not want to do the
partial knee replacement because Plaintiff would “have
to have it redone in five years anyway” and “if
he went in and removed the arthritis it would make it
worse.” (Tr. 44). Plaintiff had tried physical therapy,
which “didn't help either”. (Tr. 37). She
also took Mobic and Tramadol, which she testified did not
help. Id. Plaintiff stated she had improvement with
Mobic, but it only lasted a month. (Tr. 39). She was,
however, still taking it. Id.
testified she needs to elevate her legs during the day. (Tr.
40). In a normal day, Plaintiff spends “most of the
day” with her legs elevated waist-high. (Tr. 45). After
any activity, Plaintiff needs to elevate her legs.
Id. She sits in her recliner, and wraps her knees in
an electric blanket to obtain pain relief. (Tr. 40).
testified she did not have any problems taking care of
herself, and performed household chores like vacuuming,
cooking, and laundry (“as long as I can sit and fold
it”). (Tr. 41). She later testified she sometimes had
to sit down when showering, and had to take breaks while
cooking. (Tr. 45). She stated she could not do dishes because
she could not “stand there very long to do them.”
(Tr. 41). She played games on her computer, but “[n]ot
very often because [her] legs can't hang down”.
(Tr. 42). She had a driver's license and drove
approximately once per week. (Tr. 33-34).
estimated she could walk around the block, before her left
knee “kind of catches”. (Tr. 41). She could stand
for “[m]aybe five minutes” and sit “most of
the day as long as [her] legs aren't hanging down”.
Id. She could push and pull with her arms, but not
her legs. (Tr. 41-42). She could reach in all directions with
her arms, and handle and finger. (Tr. 42). She could lift
about 50 pounds, but could not bend, squat or crawl.
Id. She could climb stairs “but it hurts so
[she] take[s] [her] time”. Id.
December 2012, before her alleged onset date, Plaintiff saw
Michael Koenig, PA-C for “followup of left knee pain
and discomfort” that was “affecting her
activities of daily living”. (Tr. 674). Mr. Koenig
noted Plaintiff had previously had cortisone injections
without improvement, and that she was having trouble
“getting up and down from a seated position.”
Id. He opined she was “[u]nable to be
gainful[ly employed secondary to the pain that she [was]
experiencing.” Id. On examination, Plaintiff
had crepitus with flexion and extension, an antalgic gait,
and tenderness to the medial joint line. Id. He
assessed “[l]eft knee medial end stage
osteoarthritis”, and discussed future surgical
underwent an MRI of her left knee in March 2013. (Tr. 326).
It showed small joint effusion; tricompartmental
osteoarthritis; thinning and degeneration of both menisci
with a small radial tear of the posterior horn of the lateral
meniscus suspected; a very small anterior horn medial
meniscus; and mild prepatellar soft tissue edema.
Id. Plaintiff had a follow-up appointment with Mr.
Koenig a few days later. (Tr. 392). He noted the MRI results,
and that Plaintiff had a previous arthroscopic surgery on her
left knee in 2008 without much improvement. Id.
Plaintiff reported a pain level of 8/10 “with trouble
doing activities of daily living and [this] subsequently
affects her quality of life.” Id. On
examination, Mr. Koenig noted “[v]arus deformity seen
with ambulation”, an antalgic gait, a tight ACL, and
“severe pain with palpation in the medial
compartment.” Id. Mr. Koenig noted “due
to the severity of her arthritis and the symptoms that she is
experiencing” Plaintiff was “unable to walk for
an extended period of time, nee[ed] to consistently elevate
her leg throughout the day for pain control, [and was] unable
to kneel, crawl, twist, turn stoop, squat with her
knee.” Id. Additionally, he noted
“stairs and ladders are very difficult for her.”
Id. He also indicated “with the nature of her
knee, she is unable to be gainfully employed at a function,
which is more than seated work only.” Id. Mr.
Koenig discussed with Plaintiff a “unicompartment
medial hemiarthroplasty for pain control” and noted
Plaintiff would “contemplate our discussion.”
April 2014, Plaintiff went to the emergency room reporting
swelling, pain and redness in both legs. (Tr. 421, 430).
Examination showed some redness and petechia on both legs.
(Tr. 421, 447). She reported it started two weeks prior when
she started a new job, increased the longer she was standing,
and decreased with rest and elevation of her legs. (Tr. 421,
430). Plaintiff was prescribed medication and discharged.
(Tr. 428, 431, 450).
had a follow-up appointment two days later with Misty Slater,
M.D. (Tr. 605-07). She reported leg pain and swelling, with
an itchy red rash extending up to her knees. (Tr. 605).
Plaintiff reported “that as she stands for more days
consecutively for work the rash and pain ascend up toward her
knees.” Id. Dr. Slater noted Plaintiff was
“awaiting a left knee replacement, which she is getting
at age 50.” Id. She assessed venous
insufficiency and referred Plaintiff to vascular and
cardiology. (Tr. 606).
2014, Plaintiff saw Andrew Seiwert at VeinSolutions. (Tr.
742-46). Plaintiff reported pain, swelling, and redness in
both legs, affecting her ability to work. (Tr. 742-43).
Plaintiff reported she treated this with elevation,
compression hose, pain medication, and exercise. Id.
An examination showed no sign of thrombosis. (Tr. 743,
745-46). Plaintiff was noted to have reflux in her great
saphenous vein. (Tr. 745-46).
2014, Plaintiff saw April L. Rock, NP. (Tr. 752-53).
Plaintiff reported leg pain affecting her sleep, and swelling
during the day. (Tr. 752). Plaintiff reported
“burning” and “cramping” pain in both
legs that was “severe (when they are swelling and with
any standing an[d] any walking).” Id. On
examination, Ms. Rock noted a “[v]ery small amount of
non-pitting edema BLE feet to knees.” (Tr. 753). She
assessed venous insufficiency, and prescribed knee-high
compression stockings (to be worn all waking hours), and
recommended Ibuprofen or Tylenol. Id. She also noted
Plaintiff should elevate her legs “as much as
possible” and should follow up with vascular and Dr.
Slater “as scheduled.” Id.
returned to Dr. Seiwert at VeinSolutions in September 2014.
(Tr. 779). Dr. Seiwert noted Plaintiff's venous duplex
scan showed reflux in the left greater saphenous vein,
“but only in the peri-genicuate region” and that
this vein “connects to a large . . . cluster of
varicosities which encircle the knee.” Id. He
also noted “[t]he deep systems function normally
bilaterally.” Id. Dr. Seiwert prescribed
thigh-high compression stockings, and noted that if her
symptoms persisted, he would “likely recommend
catheter-directed ablation of the left greater saphenous
saw Jennifer Weber, M.D. in October 2014 for a physical and
medication check (related to hypertension). (Tr. 795-96). Dr.
Weber noted Plaintiff had a history of venous insufficiency,
and “since being switched off Norvasc lower edema has
resolved.” (Tr. 795). Plaintiff reported she
“only uses compression stockings because the vascular
surgeon . . . [said] she has a leaky vein in her leg that
needs it.” Id. On examination, Dr. Weber
specifically noted “[n]o lower extremity edema
bilaterally.” (Tr. 796).
2015, Plaintiff presented to Mr. Koenig with “[l]eft
knee pain since 2008” that she reported was 10/10,
burning and sharp, and intermittent. (Tr. 814). The pain
would wake her at night and she treated it with ibuprofen and
heat. (Tr. 814-15). Mr. Koenig noted Plaintiff had previously
tried ibuprofen, Kenalog injections, Visco supplementation
injections, and physical therapy without success.
Id. Plaintiff also had a brace, “that she
wears occasionally”, but reported “use of the
brace makes her pain worse.” Id. On
examination, Mr. Koenig noted Plaintiff's left knee had
“mild varus alignment”, “[m]inimal [k]nee
effusion”, an antalgic gait, crepitus with flexion and
extension, and range of motion was “0-125 degrees in
extension and flexion”. (Tr. 816). Plaintiff had
“trouble sitting down and getting up from the
chair”. Id. Mr. Koenig noted left knee x-rays
“show[ed] no fracture or dislocation”, soft
tissues [were] unremarkable”, [m]oderate medial knee
joint space narrowing”, “[m]inimal periarticular
spurs . . . along the medial from condyle, medial tibia
plateau, and . . . minimal spur along the upper pole of
patella.” Id. Mr. Koenig assessed left knee
pain and primary osteoarthritis of the left knee.
Id. Mr. Koenig noted Plaintiff had “been doing
[an] aggressive conservative treatment course” and
might benefit “from repeat course of physical therapy
for her left knee arthritis.” Id. He
prescribed anti-inflammatory medication. Id.
returned to Mr. Koenig in July 2015. (Tr. 808-10). She
reported left knee pain, which had “improved with PT
and Mobic.” (Tr. 808). Her pain level was 2/10 at rest,
and 7/10 “depending on activity.” Id.
The pain was aggravated by movement and alleviated at rest.
(Tr. 809). Plaintiff had returned to physical therapy, and
switched her previous anti-inflammatory medication to Mobic,
and was wearing an over-the-counter knee brace. Id.
She “[c]urrently note[d] ¶ 50% improvement in her
current symptoms from last visit.” Id. On
examination, Mr. Koenig noted mild varus alignment, an
antalgic gait, knee effusion, tenderness to palpation to the
medial joint line, crepitus on flexion and extension, and a
range of motion of 0-120 degrees on extension and flexion.
Id. Mr. Koenig noted that “[a]t this time she
has improved” and continued Plaintiff's medication
“along with a home ...