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Cheuvront v. Commissioner of Social Security

United States District Court, N.D. Ohio, Eastern Division

December 23, 2019

BRIAN CHEUVRONT, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          MEMORANDUM ORDER AND OPINION

          THOMAS M. PARKER MAGISTRATE JUDGE.

         I. Introduction

         Plaintiff, Brian Cheuvront, seeks judicial review of the final decision of the Commissioner of Social Security, denying his applications for disability insurance benefits (“DIB”) and supplemental security income (“SSI”) under Titles II and XVI of the Social Security Act. This matter is before me pursuant to 42 U.S.C. §§ 405(g), 1383(c)(3) and the parties consented to my jurisdiction under 28 U.S.C. § 636(c) and Fed.R.Civ.P. 73. ECF Doc. 11. Because the Administrative Law Judge (“ALJ”) applied proper legal standards and reached a decision supported by substantial evidence at Steps Two, Four, and Five, and because any error at Step Three was forfeited or harmless, the Commissioner's final decision denying Cheuvront's applications for DIB and SSI must be AFFIRMED.

         II. Procedural History

         On August 6, 2015, Cheuvront applied for DIB and SSI. (Tr. 367-76).[1] Cheuvront alleged that he became disabled on June 27, 2015 due to “multiple sclerosis, heart condition (stents), diabetes, back (surgery), numbness in leg as result, club[bed] foot, sleep apnea, [and a] blood disorder.” (Tr. 397). The Social Security Administration denied Cheuvront's applications initially and upon reconsideration. (Tr. 224-75). Cheuvront requested an administrative hearing. (Tr. 311-12). ALJ Gregory Beatty heard Cheuvront's case on August 31, 2017, and denied the claim in a November 8, 2017, decision. (Tr. 17-34, 174-211). On October 17, 2018, the Appeals Council granted Cheuvront's request for review, proposed that it would adopt the ALJ's finding that Cheuvront was not disabled, and invited Cheuvront to submit additional evidence and comments. (Tr. 362-66). Cheuvront submitted additional evidence but did not submit any comments. (Tr. 4). On December 19, 2018, the Appeals Council reviewed Cheuvront's case, adopted the ALJ's decision in full, with additional commentary, and denied Cheuvront's claims. (Tr. 4-8). On February 18, 2019, Cheuvront filed a complaint to seek judicial review of the Commissioner's decision.[2] ECF Doc. 1.

         III. Evidence

         A. Personal, Educational and Vocational Evidence

         Cheuvront was born on May 20, 1974. (Tr. 26). He was 41 years old on the alleged onset date and 43 years old on the date of the ALJ's decision. (Tr. 26, 28). Cheuvront graduated from high school, and he was able to communicate in English. (Tr. 27). He had previous work as a bending machine operator; however, the he was no longer able to perform any of his past relevant work and transferability of skills was irrelevant to the Commissioner's decision. (Tr. 26-27).

         B. Relevant Medical Evidence

         On September 9, 2013, Cheuvront saw Toni King, MD, for a diabetes checkup. (Tr. 688-90). Dr. King noted that Cheuvront was compliant with his treatment, which gave him good control of his symptoms. (Tr. 688). Cheuvront denied any extremity pain or numbness, but said that he had back pain, joint stiffness, decreased memory, headaches, poor balance, tremors, weakness, and tingling. (Tr. 689). On examination, Dr. King noted that Cheuvront had normal gait, station, and posture. (Tr. 690). He had resting hand tremors, but no tremors with an outstretched hand. (Tr. 690). Dr. King directed Cheuvront to continue monitoring his blood sugars and using insulin. (Tr. 690). At follow-ups on February 3, June 30, and October 27, 2014, Dr. King did not note any significant changes in Cheuvront's condition or treatment, except that in October he had an additional diagnosis of deep vein thrombosis and reported feeling tired. (Tr. 675-77, 680-82, 684-86). On April 13, 2015, Dr. King noted that she was concerned about Cheuvront's ability to control his glucose levels and recommended taking an insulin dose at lunchtime. (Tr. 671). Cheuvront reported difficulty breathing on exertion, decreased exercise tolerance, back pain, decreased memory, and some numbness/tingling. (Tr. 672). Nevertheless, Dr. King's examination findings remained generally the same, she continued his medications, and she recommended physical therapy and dieting for weight loss. (Tr. 673-74). At follow-ups on May 11, August 18, and November 11, 2015, and March 8, 2016, Dr. King noted some improvement in Cheuvront's ability to control his glucose levels, but also noted that he continued to have periods of hypoglycemia. (Tr. 662-67, 788-90, 792-94). Dr. King recorded that Cheuvront had gained 20 pounds following the March 2016 examination, but his condition otherwise remained generally the same. (Tr. 789-90). On July 6, 2017, Dr. King noted that Cheuvront reported neurological tingling and weakness and said that he had been taking his insulin 2 hours after his meals without explanation. (Tr. 1019). On examination, he had no noted cardiovascular or musculoskeletal issues, normal memory, and well-controlled hypertension. (Tr. 1022). Dr. King recommended regular aerobic exercise, continued his medications, and directed him to take his insulin with his meals. (Tr. 1022).

         From November 4, 2013, through June 5, 2017, Cheuvront saw Laura Zelasko, CD, for a total of 44 chiropractic sessions to treat his back pain. (Tr. 724-32, 912-18, 1089-93). On October 10, 2015, Dr. Zelasko wrote a letter, stating that she had treated Cheuvront for acute pain in his back, numbness in his leg, multiple sclerosis, diabetes, club foot, and neck pain. (Tr. 722). Dr. Zelasko said that Cheuvront's “response to treatment has been favorable in the respect that he receives relief from symptoms and improved function.” (Tr. 722). Nevertheless, Dr. Zelasko said that Cheuvront's relief was only temporary, and that she did not think he would recover from his permanent conditions. (Tr. 722).

         On November 27, 2013, Cheuvront told Miriam Zidehsarai, DO, that he'd had diabetes mellitus for nine years, six cardiac stents placed in 2009, blood in his urine, and kidney stones. (Tr. 477). On examination, Dr. Zidehsarai noted that Cheuvront was alert, oriented, well-nourished, and well-developed. (Tr. 478). She diagnosed Cheuvront with chronic kidney disease. (Tr. 478). At follow-ups on March 10, 2014, and March 12, 2015, Dr. Zidehsarai noted that Cheuvront's kidney disease was stable, and that he was alert, oriented, and had a normal gait. (Tr. 478, 483).

         On March 17, 2014, Roswell Dorsett, DO, noted that Cheuvront's multiple sclerosis was stable, he had diabetic neuropathy, and he was in stage one renal failure but had no new symptoms or exacerbations. (Tr. 472). On examination, Dr. Dorsett noted that Cheuvront was alert and oriented; had no tremors; and had normal attentiveness, memory, muscle tone, strength, coordination, gait, reflexes, and sensation. (Tr. 472).

         On May 28, 2014, Cheuvront saw Heather Thomas, MD, for treatment of his hypertension and diabetes. (Tr. 492). Cheuvront told Dr. Thomas that he was working on his diet, described himself as “active, ” and said that he regularly walked for exercise. (Tr. 492-93). Cheuvront complained of fatigue, but denied any dizziness, weakness, gait disturbance, and imbalance. (Tr. 492-93). On examination, Dr. Thomas noted that Cheuvront had a normal gait and normal station, and she prescribed Crestor for Cheuvront's high cholesterol. (Tr. 496).

         On June 19, 2014, Howard Minott, MD, treated Cheuvront for a kidney stone. (Tr. 612). Cheuvront said that he did not have any pain, including no back pain, and that he had a history of passing kidney stones. (Tr. 612). Dr. Minott noted that Cheuvront's hypertension was well-controlled, his diabetes was stable, and his kidney stones were stable. (Tr. 612). On examination, Dr. Minott noted that Cheuvront's back appeared within normal limits and he had normal gait, station, range of motion, muscle strength, and digits. (Tr. 614). Dr. Minott did not recommend any medical interventions and scheduled a follow-up appointment. (Tr. 616). At a follow-up on August 4, 2015, Cheuvront reported a kidney stone, without abdominal or low back pain. (Tr. 619). Dr. Minott again noted that all of Cheuvront's conditions were stable and recommended continued observation without intervention. (Tr. 620, 622).

         On July 5, 2014, Cheuvront went to the emergency room due to “redness” and pain in his left leg. (Tr. 634). Cheuvront rated his pain as a 5/10 and said that it lasted throughout the day. (Tr. 634). On examination, John Robinson, DO, noted that Cheuvront had inflamed hematoma or varicosity, but his muscle strength, sensation, and reflexes were intact. (Tr. 635). Dr. Robinson diagnosed Cheuvront with phlebitis and possible cellulitis and gave Cheuvront a rule-out diagnosis of deep vein thrombosis. (Tr. 635). He prescribed Ultram, Naprosyn, Keflex, and Lovenox. (Tr. 635).

         On July 6, 2014, Saneka Chakravarty, MD, took a venous duplex image of Cheuvront's left leg. (Tr. 525, 568, 644). Dr. Chakravarty found that there was an acute thrombosis in Cheuvront's left leg, but his other veins were patent and there was no evidence of deep vein thrombosis. (Tr. 525, 568, 644).

         On July 9, 2014, Dr. Thomas noted that Cheuvront's symptoms had not improved or worsened since his July 5 emergency room visit. (Tr. 497). Cheuvront told Dr. Thomas that he was active and regularly walked for exercise, and Dr. Thomas noted that Cheuvront's various medical conditions were controlled through medication. (Tr. 498-99). On examination, Dr. Thomas noted that Cheuvront had a normal gait and station. (Tr. 499). Dr. Thomas recommended that Cheuvront take 600mg of ibuprofen 3 times per day, use a warm compress and elevation on his leg, and go to the emergency room if he had chest pain, dyspnea, or hemoptysis. (Tr. 500).

         On July 10, 2014, Cheuvront went to the emergency room because pain and “redness” in his left leg had spread and gotten worse. (Tr. 636). Katherine Bulgrin, DO, noted that a venous doppler study showed increasing thrombophlebitis, which could develop into deep vein thrombosis, but there was no deep vein thrombosis at the time. (Tr. 636-37). Dr. Bulgrin schedule Cheuvront for an ultrasound of his leg, from which Badr Ghumrawi, MD, later determined that there was no evidence of deep vein thrombosis but there was a thrombus in Cheuvront's left saphenous vein. (Tr. 527-28, 570-71, 642-43).

         On July 17, 2014, Dr. Thomas noted that Cheuvront had a large blood clot in his leg and pain in his leg and back, for which he was taking ibuprofen. (Tr. 501). Cheuvront denied dizziness, weakness, and gait issues, and he said that he was active and walked regularly for exercise. (Tr. 502). On examination, Dr. Thomas noted that Cheuvront's gait and reflexes were normal, and she prescribed him Mobic for his pain. (Tr. 504).

         On August 4, 2014, Cheuvront told Saif Ur Rehman, MD, that he had swelling in his left leg and was diagnosed with deep vein thrombosis. (Tr. 563). Dr. Rehman noted that Cheuvront was “not very active, ” overweight, and ‘sometimes” had “lower back pain.” (Tr. 563). On examination, Dr. Rehman noted that Cheuvront had stable vitals, normal heart rhythm, and some swelling in his extremities, but he did not have any tenderness and he had normal neurological functioning. (Tr. 563). Dr. Rehman prescribed coumadin and indicated that Cheuvront might not need Lovenox. (Tr. 567). On December 5, 2014, Cheuvront followed-up with Dr. Thomas, who noted that Cheuvront would likely be on Coumadin for the rest of his life and also prescribed him a statin for hyperlipidemia. (Tr. 505, 511). At a follow-up on August 18, 2014, Dr. Rehman noted that Cheuvront was functioning within normal limits. (Tr. 567). On November 10, 2014, and January 19, April 13, July 6, and September 24, 2015, Dr. Rehman noted that Cheuvront was “doing very well, ” denied complaints, had stable vitals/cardiac function, and no longer had swelling or edema in his extremities. (Tr. 560, 567, 855).

         On December 10, 2014, Roger Tsai, MD, noted that Cheuvront had five coronary stents placed in 2010, took coumadin for deep vein thrombosis, and complained of intermittent chest pain with activity, but he had stable blood pressure and a normal EKG. (Tr. 556-57). Cheuvront also said that he had occasional, intermittent tingling in his hand and arm, that he saw a chiropractor for back pain, and that he had pain and memory issues due to multiple sclerosis. (Tr. 556-57). On examination, Dr. Tsai noted that Cheuvront had regular heart rhythm and sounds, no motor or sensory deficits, no swelling, and appropriate mood, memory, and judgment. (Tr. 557). Dr. Tsai diagnosed Cheuvront with arteriosclerotic heart disease, continued his medications, and scheduled a stress test to determine if additional cardiac catheterization was necessary. (Tr. 557). Khaled Sleik, MD, conducted the stress test on December 12, 2014, and found normal results, no significant chest pain, and normal blood pressure; however, there was a “small area of ischemia” with normal left ventricular function. (Tr. 536-37, 639, 648). Dr. Sleik also found “excellent perfusion” in all major segments, except the apex which had a mild reversible perfusion defect. (Tr. 648). A follow-up EKG on December 18, 2014, showed no significant changes in Cheuvront's condition. (Tr. 538).

         On January 7, 2015, Heather Cope, CNP, treated Cheuvront for hyperlipidemia, hypertension, and deep vein thrombosis. (Tr. 539). Cheuvront told Cope that his chest pain had persisted for two months despite medication, but it resolved with rest. (Tr. 539-40). Cheuvront also said that he had some tingling in his left arm and dyspnea when climbing stairs, but he did not have any dizziness or extremity swelling. (Tr. 540). Cheuvront also reported nerve pain, memory issues, and back pain. (Tr. 540). Cheuvront said the he followed a heart-healthy, low-sodium diabetic diet, exercised for 20 minutes on a stationary bike every 3 to 4 days, and walked on occasion. (Tr. 540). On examination, Cope noted a regular heart rhythm, no edema, appropriate mood and memory, and no gross motor or sensory deficits. (Tr. 540). Cope diagnosed Cheuvront with coronary artery disease, recurrent deep vein thrombosis, hypertension, and hyperlipidemia. (Tr. 540-41). She prescribed medications for all of Cheuvront's conditions and recommended that he continue a healthy diet and exercise. (Tr. 541). On April 7, 2015, Cope did not note any significant changes in Cheuvront's condition and noted that different medications might be needed if his chest pain continued. (Tr. 542-44). On June 8, 2015, Cheuvront complained that his medication gave him headaches and he continued having chest pain, and Cope added Ranexa to his medications. (Tr. 517-23).

         On March 28, 2015, Cheuvront told Robert Eberlein, MD, that he had pain in his left thumb due to over-use from holding a comb and other objects while cutting hair. (Tr. 640, 742). Cheuvront said that his thumb sometime swelled, but he had no tingling in his other fingers, no tenderness in his wrist/hand, and good sensation in all fingers. (Tr. 640-41, 742-43). He had some pain in his hand on palpation. (Tr. 640-41, 742-43). Dr. Eberlein diagnosed Cheuvront with de Quervain's tenosynovitis, recommended NSAIDs and decreased use, and recommended that Cheuvront follow up with his primary care doctor about his high blood pressure. (Tr. 641, 743). Cheuvront followed-up with Dr. Thomas on April 3, 2015. (Tr. 511-17). Dr. Thomas noted that Cheuvront's thumb pain and swelling got worse, but that Norco helped. (Tr. 512). Dr. Thomas noted “slightly limited” range of motion in his hand due to discomfort, prescribed tramadol, and referred Cheuvront to an orthopedist. (Tr. 516). Cheuvront saw orthopedist Matthew Kay, MD, on April 20, 2015. (Tr. 714-18). He said that his thumb pain radiated through his wrist, rated it as a 3/10, and said that his prescription medication from the emergency room had helped. (Tr. 714). On examination, Dr. Kay noted that Cheuvront's range of motion was intact, his wrist was stable and nontender, and he had a mildly tender thumb. (Tr. 716). He said that Cheuvront's exam was inconsistent with a de Quervain's diagnosis, prescribed a thumb splint, and said that medications could be necessary if symptoms recurred. (Tr. 716).

         On June 5, 2015, Cheuvront told Dr. Thomas that he continued to have cardiac issues and chest pain, and that he had to switch medications due to his insurance coverage. (Tr. 518). He told Dr. Thomas that he was active and walked regularly for exercise, and Dr. Thomas noted that he had a normal gait, station, and cardiac exam. (Tr. 519, 521). Dr. Thomas continued Cheuvront's treatment through medication. (Tr. 523).

         On August 25, 2015, Cheuvront told Erin Dean, MD, that he had pain in his left foot, related to his clubbed foot, and asked to be fitted or brace shoes. (Tr. 708). Cheuvront denied numbness, tingling, swelling, and weakness. (Tr. 708). On examination, Dr. Dean found that Cheuvront had a normal gait on the right side and antalgic gait on the left side, his midfoot was collapsed, and he had normal alignment in his ankle and hindfoot. (Tr. 710-11). Dr. Dean fit Cheuvront for a brace and discussed a steroid injection. (Tr. 712). On October 6, 2015, Cheuvront told Dr. Dean that he felt good support and no pain with his foot/ankle brace; however, he said that he felt his brace was pulling on the side of his foot. (Tr. 703). Dr. Dean recommended a fluoroscopic guided injection and educated Cheuvront on stretching for Achilles tightness. (Tr. 707).

         On October 9, 2015, Cheuvront went to the emergency room because he had aching back pain after doing some yard work the day before. (Tr. 740, 863). Cheuvront told Michael Baumgardner, DO, that he had generalized muscle pain in his upper extremities with movement, but he denied headaches and chest pain. (Tr. 740, 863). Cheuvront said that he was compliant with his medications and that he was able to control his back pain for years by seeing a massage therapist and a chiropractor. (Tr. 740, 863). On examination, Dr. Baumgardner noted that Cheuvront had full range of motion, could walk heel-to-toe, had an antalgic gait without foot drop or weakness, had normal muscle strength and reflexes, and had appropriate judgment. (Tr. 741, 864). Dr. Baumgardner diagnosed Cheuvront with acute exacerbation of chronic lumbar back pain and prescribed tramadol. (Tr. 741, 864). Cheuvront followed up with Dr. Thomas on October 16, 2015. (Tr. 751-57). Cheuvront said that he had intermittent tingling in his arms, did not improve with tramadol, and his insurance no longer covered his massage therapy. (Tr. 751). On examination, Dr. Thomas noted some limited range of motion in his back, referred him for physical therapy, and extended his tramadol prescription. (Tr. 756).

         On October 16, 2015, Cheuvront went to the emergency room for low blood sugar and vomiting. (Tr. 737-39, 861-62). After his arrival in the emergency room, Cheuvront told Dr. Bulgrin that he felt improved, and he was able to answer questions appropriately. (Tr. 738, 861). On examination, Cheuvront's back and legs were nontender, he had no swelling in his legs, and he had full strength and sensation in all his extremities. (Tr. 738, 861). Cheuvront was discharged in a stable condition, with instructions to hold his insulin for the rest of the day and resume his normal schedule the next day. (Tr. 738, 862).

         On December 8, 2015, Cheuvront told Dr. Thomas that physical therapy did not help and requested that his medications be refilled. (Tr. 758, 824). Dr. Thomas continued Cheuvront's medications and ordered a lumbar x-ray. (Tr. 763, 830). Yun Sheu, MD, took the x-ray on December 11, 2015, and found no acute fracture or listhesis of the lumbar spine; however, there were lateral marginal osteophytes at ¶ 2-L3 and facet arthrosis at ¶ 5-S1. (Tr. 868).

         On December 14, 2015, Cheuvront told Dr. Tsai that his chest pain had totally resolved with low-dose Ranexa and that he felt well. (Tr. 767). Cheuvront said he sometimes had back problems, for which he saw a chiropractor. (Tr. 767). On examination, Dr. Tsai found that Cheuvront had no edema in his extremities and appropriate mood, memory and judgment. (Tr. 768). Dr. Tsai continued Cheuvront's medications. (Tr. 768). On December 20, 2016, Dr. Tsai noted that an AK showed no changes from Cheuvront's previous visit and that Cheuvront denied chest pain, shortness of breath, feeling poorly, tiredness, and joint pain/stiffness. (Tr. 1102, 1105). He also denied any tingling, numbness, headaches, confusion, memory loss, and anxiety. (Tr. 1105). On examination, Dr. Tsai found that Cheuvront's recent and remote memory were intact and he continued Cheuvront's medications. (Tr. 1106).

         On January 12, 2016, Cheuvront told Dr. Rehman that he had chronic pain (chest and lower back) and anxiety. (Tr. 852). On examination, Dr. Rehman found no edema or tenderness, normal heart rhythm, deep vein thrombosis, and hypertension. (Tr. 853). Dr. Rehman prescribed medication to better control Cheuvront's symptoms and recommended that Cheuvront take aspirin and dietary supplements. (Tr. 853). At follow-ups on June 14, 2016, and June 27, 2017, Dr. Rehman noted that Cheuvront was “doing very well” with his treatment and had no complaints, and Dr. Rehman continued his medications. (Tr. 847-48, 1160-62).

         On January 13, 2016, Douglas Ehrler, MD, evaluated Cheuvront's lower back pain. (Tr. 777). Cheuvront said that he had stabbing pain in his lower back, which radiated down his legs, and that he had a history of failed physical therapy sessions. (Tr. 777). Cheuvront said his symptoms were worse with lifting, bending, walking, sitting, standing, changing positions, and extended inactivity. (Tr. 777). On examination, Dr. Ehrler found that Cheuvront had a normal gait on his left and right, did not use assistive devices, and had a balanced and upright posture. (Tr. 779). Dr. Ehrler diagnosed Cheuvront with degenerative disc disease of the lumbar spine with radiculopathy to the leg, recommended “nonoperative treatment, ” and scheduled Cheuvront for an MRI. (Tr. 780). Radiologist William Taylor, MD, took Cheuvront's MRI on January 29, 2016, and found normal alignment with some “large marginal osteophytes” indicating early degenerative changes in the lumbar spine. (Tr. 867, 940).

         On March 20, 2016, Cheuvront went to the emergency room for low blood sugar. (Tr. 859-60, 931-32). Cheuvront said that he woke up with blood sugar in the 120s to 130s, took insulin, ate, went to church, and then his blood sugar dropped to 33. (Tr. 859, 931). Cheuvront was discharged in a stable condition and Dr. Baumgardner prescribed him Zofran and recommended follow-up with Dr. Thomas. (Tr. 860, 932).

         On June 7, 2016, Dr. Thomas noted that Cheuvront did not get blood work/labs done as he was supposed to do, and that he requested a referral to a new neurologist to treat his multiple sclerosis. (Tr. 805). Cheuvront denied any cardiovascular issues, dizziness, headaches, weaknesses, or gait disturbances. (Tr. 806). On examination, Dr. Thomas noted that Cheuvront had a normal heart function, gait, and station. (Tr. 809-10). Dr. Thomas refilled Cheuvront's medications and referred him to a neurologist. (Tr. 811). At a follow-up on October 28, 2016, Cheuvront said that he had hip pain and depression, and Dr. Thomas referred him to physical therapy and prescribed Zoloft. (Tr. 973-79). At a follow-up on December 14, 2016, Cheuvront told Dr. Thomas that his Zoloft had helped him a lot. (Tr. 965).

         On June 29, 2016, Cheuvront told Martha Passek, CNP, that he took aspirin and Eliquis for deep vein thrombosis, and that he had ongoing chronic chest pain especially when doing yard work. (Tr. 796, 1097). Passek noted that Cheuvront had improved since starting Ranexa and Imdur, and that he denied feeling poorly or tired. (Tr. 796, 798, 1197, 1199). On examination, Cheuvront had a normal gait and heart function. (Tr. 799-800, 1100-01).

         On August 31, 2016, Stacy Martin, DPM, found that Cheuvront had a painful left hallux, unmanageable toenails, and swelling in his toes. (Tr. 1219). Cheuvront denied weakness, joint swelling, difficulty walking, pain after inactivity, stiffness, numbness, tingling, headaches, memory loss, and chest pain. (Tr. 1220). On examination, Dr. Martin noted an “abnormal” range of motion in his right and left feet. (Tr. 1220-21). She prescribed physical activity and diet to promote weight loss. (Tr. 1220).

         On September 27, 2016, Cheuvront told Charles Zollinger, MD, that he'd had numbness for a year, which he treated with massage therapy, and that he had trouble with his left side due to cerebral palsy, vertigo, and chronic back pain. (Tr. 922). On examination, Cheuvront was alert and oriented and had a regular heart rhythm, normal memory, abnormal strength in his extremities, spastic hemiplegia, left side weakness, no tremors/involuntary movements, normal sensation, and a limp. (Tr. 924). Dr. Zollinger diagnosed Cheuvront with multiple sclerosis and numbness, continued his medications, and ordered an MRI. (Tr. 925-26). Mike Coffey, MD, took the MRI on November 3, 2016, and noted a dumbbell shaped lesion on the T2-T3 area, suggesting a nerve sheath tumor. (Tr. 933-34, 988-89, 1031-32). Dr. Coffey also noted “scattered white matter changes” in Cheuvront's brain. (Tr. 935-36, 990-91, 1032-33). Dr. Zollinger reviewed the MRI results on November 4, 2016. (Tr. 1007-10). Dr. Zollinger determined that Cheuvront had mild to moderate periventricular white matter disease in his brain, which had remained unchanged over 15 years, and a tumor on his spine. (Tr. 1007). Dr. Zollinger referred Cheuvront for spine surgery and continued his medications. (Tr. 1009-10).

         On November 7, 2016, Nicholas Bambakidis, MD, evaluated Cheuvront for spinal surgery, and noted that Cheuvront did not have any pain or numbness in his back. (Tr. 1226). Dr. Bambakidis recommended a debulking surgery and performed the surgery on November 21, 2016, without complications. (Tr. 955-56, 960-61, 1037-40, 1095, 1227, 1229-31). Dr. Bambakidis sent the removed portion of the tumor for testing. (Tr. 955-56). On November 24, 2016, Dr. Bambakidis noted that Cheuvront showed expected post-operative changes, and that his pain remained controlled and that his course of recovery was uncomplicated. (Tr. 952, 1044, 1236). Dr. Bambakidis discharged Cheuvront with instructions to drive and bear weight only as tolerated; slowly increase activity level; and avoid pushing, pulling, or lifting objects greater than 10 pounds until the follow-up visit. (Tr. 952). On January 5, 2017, Dr. Bambakidis referred Cheuvront to radiology for further treatment of the remaining portion of his tumor. (Tr. 1051, 1208, 1239). Cheuvront told Dr. Bambakidis that he was doing well, but his shoulder was sore. (Tr. 1051, 1208, 1239). On examination, Cheuvront had a normal gait and station, intact sensation, normal reflexes, normal range of motion, and full strength. (Tr. 1051-52, 1208-09, 1239-40). Dr. Bambakidis said that Cheuvront was “Ok to return to work and exercise.” (Tr. 1052, 1209, 1240).

         On January 6, 2017, Christine Suchan, CNP, noted that Cheuvront was not taking his insulin appropriately and recommended that he take it 20 to 30 minutes before his meals. (Tr. 1013). Cheuvront told Suchan that he did not have any chest, back, neck, or joint pain, but he had some dizziness, tingling and headaches. (Tr. 1013). On examination, Suchan found that Cheuvront had a normal heart rate and sounds, no edema, no deformities in his feet, a normal gait, and a normal memory. (Tr. 1016). Suchan continued Cheuvront's medications and recommended regular aerobic exercise. (Tr. 1017).

         On January 13, 2017, Cheuvront told David Mansur, MD, that he did not have any back pain or weakness, but he had some numbness in his hands from his multiple sclerosis and left-side weakness from cerebral palsy. (Tr. 1054, 1166). Cheuvront said that he had some stiffness in his back after his surgery. (Tr. 1054, 1166). He denied swelling, memory changes, and gait issues. (Tr. 1055, 1167). On examination, Dr. Mansur noted that Cheuvront had full strength in his upper and lower extremities and intact sensation. (Tr. 1055, 1167). Dr. Mansur recommended that Cheuvront continue with radiotherapy for his tumor and monitor his condition with MRIs. (Tr. 1156, 1168). On February 28, 2017, Cheuvront had an MRI that showed an unchanged mass in his spine. (Tr. 1058-62, 1163-65). Cheuvront reported numbness in his ...


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