Coventry v. HHS

CourtDistrict Court, D. New Hampshire
DecidedMarch 27, 1995
DocketCV-94-72-JD
StatusPublished

This text of Coventry v. HHS (Coventry v. HHS) is published on Counsel Stack Legal Research, covering District Court, D. New Hampshire primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Coventry v. HHS, (D.N.H. 1995).

Opinion

Coventry v . HHS CV-94-72-JD 03/27/95 UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE

Jeffrey Coventry

v. Civil N o . 94-72-JD

Secretary, Health and Human Services

O R D E R

The plaintiff, Jeffrey Coventry, brings this action pursuant to section 205(g) of the Social Security Act, 42 U.S.C. § 405(g), seeking review of a final determination of the secretary of Health and Human Services ("Secretary") denying his claim for disability insurance benefits. Before the court are the plaintiff's motion to reverse the decision of the Secretary and remand for further proceedings (document n o . 10) and the defendant's motion to affirm the decision of the Secretary (document n o . 7 ) .

Background

The plaintiff was thirty-five years old at the time of the

administrative hearing. Transcript of Administrative Record

("Tr.") 3 9 . He has completed fourteen years of education

including an associates degree. T r . 4 2 . He formerly worked as an electrical drafter, Tr. 4 3 , a computer drafter, Tr. 46-47, and

a construction equipment operator. Tr. 9 2 .

I. Medical History1

The medical record indicates that treatment began August 2 2 , 1990, for pain resulting from a back injury occurring on August 2 1 , 1990. T r . 1 9 1 , 195. D r . Neil J. Markwith prescribed medica- tion, and interpreted test results from August 2 3 , 1990, and August 2 8 , 1990, as compatible with a bulging or herniated disc at L5-S1 on the left. The plaintiff was referred to an orthopedic surgeon, D r . David G. Publow.

On September 5 , 1990, D r . Publow examined the plaintiff, reviewed x-rays and a CT scan, and diagnosed the plaintiff with sciatica from a disc bulge, which, in his opinion, was probably resolving. Supportive care and physical therapy were recom- mended. T r . 203. On September 1 9 , 1990, D r . Publow noted that the plaintiff exhibited an improved condition from therapy, and opined that improvement would continue. Notes from October 2 , 1990, describe some tightness and soreness in the plaintiff's low back, aggravated by long driving. However, the plaintiff exhibited great improvement as to muscle spasm and leg pain. The

1 The court's recitation of the plaintiff's medical condition is drawn largely from the stipulation of facts filed jointly by the parties.

2 doctor recommended continued therapy including use of a transcutaneous electrical nerve stimulator ("TENS unit"), and indicated that the plaintiff's condition should gradually improve over time. T r . 203. Notes from October 2 4 , 1990, disclose gradual improvement due to therapy, exercises, and the TENS unit. Dr. Publow noted further improvement after a November 2 8 , 1990, evaluation. Tr. 204.

Progress notes from the Chiropractic Association of Bedford, New Hampshire, ("CABNH") document treatment of the plaintiff beginning on January 3 , 1991, for complaints of soreness in the ribs and back. T r . 206-208. An interim report dated August 2 6 , 1991, indicates a diagnosis of sacroiliac dysfunction and lumbar radiculopathy. T r . 213. The plaintiff was receiving chiro- practic spinal manipulative therapy, and reported a thirty percent overall improvement and an eighty to ninety percent improvement of the mid back.

Progress notes from CABNH dated February 5 , 1992, indicate the plaintiff's low back was sore, but the upper back was reported as "o.k." Tr. 207.

Progress notes from CABNH dated February 2 8 , 1992, through June 1 0 , 1992, disclose that the plaintiff continued to ex- perience soreness and low back pain, and that the plaintiff received treatment in the form of exercises and medication. T r .

3 230-34. The plaintiff's upper back improved through use of a back brace, T r . 2 3 1 , while the low back continued to be sore, aggravated by leaning or lying on the floor. T r . 232. Notes from May 2 2 , 1992, disclose that the plaintiff was more active at home and was exercising daily for fifteen to twenty minutes. The notes through June 1 0 , 1992, indicate that the plaintiff con- tinued to complain of back and hip soreness. T r . 234.

Dr. David J. Nagel, a specialist in physical medicine and rehabilitation, referred the plaintiff to D r . Albert Drukteinis, a psychiatrist. On August 1 3 , 1992, D r . Drukteinis prepared a psychological back profile, which consisted of evaluation and testing to determine if psychological or emotional factors were aggravating the plaintiff's pain condition. T r . 274-81. The testing also included counselling sessions to develop coping skills for mastering a chronic pain condition. T r . 274. D r . Drukteinis reports that the plaintiff was pleasant, talkative, and cooperative, although he exhibited considerable pain behavior (e.g., guarding, bracing and grimacing). According to D r . Drukteinis, "there is still a great deal of pain behavior, depression and other emotional aspects to his problem." T r . 275. The doctor stated the plaintiff's sporadic use of Elavil made him susceptible to side effects. T r . 275.

4 According to Dr. Drukteinis, the battery of tests he administered showed the plaintiff to be a person with a capacity for marked somatization,2 moderately marked anxiety and significant depression. T r . 276. The doctor considered the plaintiff to be moody and unpredictable. Tr. 278.

D r . Drukteinis reports that the plaintiff's score on the Beck Depression Inventory ("BDI") indicated a mild to moderate degree of depression. Tr. 279. The doctor noted that the plaintiff reported moderate to marked endogenous anxiety on the Patient Anxiety Scale ("PAS"). The doctor stated that patients with endogenous anxiety "frequently have spontaneous, autonomous, clonic, phasic episodes with one or more accompanying somatic complaints." T r . 279. The doctor reported the plaintiff registered a tendency to hysteriam depression and hypochondriasis indicative of a poor prognosis using the Minnesota Multiphasic Personality Inventory-2 ("MMPI-2"). Tr. 280-81. D r . Drukteinis noted that the plaintiff's depressed mood is accompanied by physical complaints and fatigue.

David B . Lewis, D.O. reviewed the plaintiff's medical records, examined the plaintiff on April 1 0 , 1991, and summarized his findings in a report dated April 1 1 , 1991. Tr. 235-36.

2 Somatization is the conversion of anxiety into physical symptoms. Stedman's Medical Dictionary 1434 (25th Ed. 1990).

5 According to D r . Lewis, the plaintiff's plain lumbar x-rays from

August 2 3 , 1990, appeared normal except for slight decreased disc

space at L5-S1, and a CT scan dated August 3 1 , 1990, resembled a

mild disc herniation at L5-S1 to the left. T r . 235. D r . Lewis

diagnosed probable lumbar radiculopathy, bilateral piriformis

syndrome, chronic pain, sleep disturbance and probable

depression. T r . 236. The plaintiff experienced "some good

immediate effect" upon treatment with Marcaine and Celestone.

Id. The plaintiff received prescriptions "for Prednisone at a

decreasing dose, as well as Elavil to be used at night for sleep

disturbance and pain." Id. An EMG test dated May 3 , 1991,

indicated improvement following the Marcaine and Celestone

injections, and improved sleep from the Elavil. T r . 239. The

Prednisone provided no significant relief, although the physical

therapy alleviated some leg symptoms. Id. D r . Lewis found no

evidence of significant neuropathic problems. Id. An addendum

notes that an April 1991 MRI showed mild bulging "at L34 and

L45," T r . 238-39, which was later confirmed. T r . 241.

Dr.

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