United States District Court, N.D. Ohio, Eastern Division
MEMORANDUM ORDER AND OPINION
M. PARKER MAGISTRATE JUDGE.
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
August 6, 2015, Cheuvront applied for DIB and SSI. (Tr.
367-76). 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. ECF Doc. 1.
Personal, Educational and Vocational Evidence
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).
Relevant Medical Evidence
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).
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.
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).
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).
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.
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).
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).
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,
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).
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,
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).
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).
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).
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).
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.
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.
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).
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).
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).
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).
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).
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).
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).
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).
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).
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,
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).
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).
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).
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).
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 ...