Shramek V. Apfel by Seventh Circuit U.S. Court of Appeals on iBooks Apfel Thrombophlebitis

The focus of her claim for benefits was her history of frequent superficial phlebitis and repeated deep venous thrombophlebitis, for which she received approximately forty treatments over a fifteen year period.

In doing so, the ALJ found that: See Kni ght v. In reaching his conclusions at Step 5, the ALJ found that she was capable of doing sedentary work with some restrictions, and that a sufficient number of such positions existed in the economy. The Appeals Council and the district court affirmed that determination, and she now appeals to this Court. Shramek raised a number of issues in this Court as she did in the district court, but unfortunately there is little overlap between the two.

Many-if not most-of the issues raised in this appeal were not raised in the district court. Although the failure to assert an argument at the Appeals Council does not operate as a waiver of that claim, Johnson v. Secretary of Health and Human Services, F. A generous reading of the briefs before the district court and this Court yields a few issues that Varizen in den Beinen Kribbeln been preserved, which we will address.

Shramek contends that the ALJ erred in crediting the opinion of the medical examiner, Dr. Eckman, Apfel Thrombophlebitis, who had reviewed the record but had Apfel Thrombophlebitis examined her, over Apfel Thrombophlebitis of her treating physician, Dr.

Quenan, who had ministered to her for over 10 years. Shramek also asserts that the ALJ improperly discredited Shramek's testimony regarding her disability. Apfel Thrombophlebitis agree with most of these arguments, but affirm because they ultimately did not affect the outcome. We turn first to the ALJ's assessment of Shramek's credibility, Apfel Thrombophlebitis. A credibility assessment is afforded special deference because the ALJ is in the best position to see and hear the witness and determine credibility.

A glance at only a one-year period reveals the following history:. Far from refuting her allegations of swelling and discomfort, those medical records provide significant support for it.

In fact, the Apfel Thrombophlebitis contains at least 13 separate instances in which elevation is recommended, thus affirming her claims of swelling and clotting. It is unclear what frequency of visits he would deem sufficient, but physician visits every months for fifteen years is hardly insubstantial, and is an unsound basis on which to reject testimony of swelling and discomfort that is consistent with the complaints regularly made to the physician during those visits.

Another reason provided for the ALJ's credibility assessment is her purported failure to comply with the prescribed medical treatment. The alleged non-compliance identified by the ALJ included her failure to quit smoking despite evidence that smoking could worsen the condition. That is a misuse of the non-compliance Apfel Thrombophlebitis. In Rousey, we reversed an ALJ's denial of benefits premised in part on the claimant's failure to quit smoking where the claimant suffered from chronic obstructive pulmonary disease, Apfel Thrombophlebitis.

We held that no evidence demonstrated that she would be restored to a non-severe condition if she quit smoking, Apfel Thrombophlebitis. We Apfel Thrombophlebitis denounced the ALJ's conclusion that her smoking rendered incredible her allegations of pain because no medical evidence linked her chest pain directly to her smoking.

As in Rousey, Apfel Thrombophlebitis, the ALJ here made no finding that the prescribed Apfel Thrombophlebitis would restore her ability to work, and the record would not in fact support such a finding. In addition, no medical evidence directly linked her pain or swelling to her smoking. Therefore, the ALJ erred in relying on her failure to quit smoking as evidence of noncompliance and as a basis to find her incredible.

We note that even if medical evidence had established a link between smoking and her symptoms, Apfel Thrombophlebitis, it is extremely tenuous to infer from the failure to give up smoking that the claimant is Apfel Thrombophlebitis when she testifies that the condition Apfel Thrombophlebitis serious or painful. Given the Drogen Thrombophlebitis unteren Extremitäten nature of smoking, the failure to quit is as likely attributable to factors unrelated to the effect of smoking on a person's health.

One does not need to look far to see persons with emphysema or lung cancer-directly caused by smoking-who continue to smoke, Apfel Thrombophlebitis, not because they do not suffer gravely from the disease, Apfel Thrombophlebitis, but because other factors such as the addictive nature of the product impacts their ability to stop, Apfel Thrombophlebitis.

This is an unreliable basis on which to rest a credibility determination. The record also provides scant support for the other allegations of non-compliance raised.

For instance, the ALJ decries Shramek's failure to wear prescribed elastic stockings, Apfel Thrombophlebitis, stating that she testified that she declined to Apfel Thrombophlebitis these stockings because it caused too much swelling in her legs. That is not an accurate recitation of her testimony. It indicates that the hospital personnel discontinued the stockings because of the swelling, and does not support even an inference of non-compliance on her part.

The remaining allegations of non-compliance are no more convincing, Apfel Thrombophlebitis. Moreover, her testimony that she was significantly limited in performing prolonged sitting, standing and walking is not contradicted by her ability to care for the house and her children. Such work by its nature provides the type of flexibility to alternate standing, sitting and walking, and to rest and Apfel Thrombophlebitis the legs when necessary, that she, Dr, Apfel Thrombophlebitis.

Quenan, and even Dr. Eckman testified was necessary, Apfel Thrombophlebitis. It is therefore not a basis to find her incredible. Accordingly, the factors used by the ALJ in rejecting Shramek's credibility are not supported by the record. Shramek also challenges the ALJ's failure to credit the testimony of her treating physician over that of the medical examiner, Apfel Thrombophlebitis.

In his decision, the ALJ expressly adopted the functional capacity assessment of Dr, Apfel Thrombophlebitis. Eckman limiting her to carrying no more than 20 pounds, Apfel Thrombophlebitis, walking no further than blocks, and sitting and standing no more than 4 hours out of an 8-hour day. The ALJ's determination was erroneous for a number of reasons, not the least of which is it did not accurately reflect the functional capacity assessment actually tendered by Dr, Apfel Thrombophlebitis.

In addition to the above limitations, Dr. Eckman opined that she could sit or stand for only minutes at a time before she would have to move. The ALJ fails to acknowledge that in his opinion. That limitation by Dr. Apfel Thrombophlebitis in fact tracks a similar requirement imposed by Dr. Quenan, who maintained that Shramek could not perform any work requiring prolonged sitting, standing or walking, with prolonged defined as lasting between 30 and 45 minutes.

Quenan also stated that Shramek needed to rest and elevate her legs after 30 minutes of activity. The ALJ erred in rejecting the opinion of Dr, Apfel Thrombophlebitis. Quenan, who treated her for over 10 years Apfel Thrombophlebitis this condition. A physician's opinion regarding the nature and severity of an impairment will be given controlling weight if Apfel Thrombophlebitis is well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence in the case.

Nothing in the record contradicted Dr, Apfel Thrombophlebitis. Quenan's conclusions, and Apfel Thrombophlebitis medical Apfel Thrombophlebitis in the record supports his opinion, Apfel Thrombophlebitis.

Eckman was asked whether Dr. Quenan's assessment but was open to agreeing with it if there was any documented deep vein thrombosis. Later in his testimony, he acknowledged that the record in fact contained Apfel Thrombophlebitis evidence of deep vein thrombosis. Eckman thought that Dr, Apfel Thrombophlebitis. The ALJ thus mischaracterized Dr.

Eckman's opinion in his decision, and improperly discounted the testimony of Shramek and the opinion of Dr. None of those errors, however, ultimately impacted Apfel Thrombophlebitis outcome. See Sarchet, 78 F. At the hearing, the ALJ in fact submitted a hypothetical to the vocational expert VE that included all of the functional limitations set forth by Dr.

Quenan and was consistent with Shramek's own testimony regarding her limitations. Quenan's opinion was that Shramek:. She has difficulty at this time in even completing her own housework and has to rest and elevate her legs after only 30 min, Apfel Thrombophlebitis. In response to that assessment, Apfel Thrombophlebitis, the ALJ asked the VE whether sufficient work existed for a claimant with her age, education and work history, who could stand only four out of eight hours and sit four out of eight hours with the Apfel Thrombophlebitis to sit or stand every half hour and with the option to elevate her feet.

The VE testified that there would be a number of sedentary employment positions that fall within those parameters. Thus, even accepting the limitations set forth by Shramek and Dr. Quenan, she is not disabled under the statute. Quenan's report at face value, with the exception of the need to rest and elevate her lower extremities after 30 minutes of activity, the vocational expert testified that the claimant was still capable of performing all of Apfel Thrombophlebitis above cited jobs.

The VE's testimony, however, Apfel Thrombophlebitis, was not so limited. The VE accepted Dr. Quenan's limitations and declared that sufficient work still existed that met those parameters with one caveat.

The VE testified that if Shramek would need to rest after every 30 minutes of activity, as opposed to simply elevating her legs, then she would not be capable of working, Apfel Thrombophlebitis. A plain reading of Dr. Quenan's assessment, Apfel Thrombophlebitis, however, belies such a limitation, Apfel Thrombophlebitis.

When discussing her ability to complete her housework, he states that she needs to rest and elevate her legs after 30 minutes of activity. That statement does not indicate that she cannot engage in any other activity while she is elevating her legs. The reference to resting clearly refers to taking a break from the housework and getting off her feet. In fact, his later statement that she could perform work if it could be done Apfel Thrombophlebitis a lounge chair with her legs elevated establishes his belief that she could engage in work activity while elevating her legs.

Moreover, if his statement were interpreted as imposing a rest break from any work every 30 minutes, the ALJ was justified in disregarding that opinion because it is unsupported by any evidence in the record, Apfel Thrombophlebitis.

Therefore, the ALJ propounded a hypothetical to the VE that included all of the supportable limitations identified by Dr. Quenan, and the VE stated that work existed in Apfel Thrombophlebitis national economy in this region that would fall within those parameters. On that basis, the decision of the ALJ denying benefits because she was capable of performing Apfel Thrombophlebitis in the regional economy was supportable. Shramek did not challenge in the district court the validity of the VE's conclusion and thus waived any such challenge on appeal.

Accordingly, the decision of the district court is affirmed. Erythema is inflammatory redness of the skin. Stasis dermatitis is erythema and scaling of the lower extremities due to impaired circulation and other factors. Varicosity is a varix or varicose condition. Varix is a dilated vein, or an enlarged and torturous vein, artery or lymphatic vessel, Apfel Thrombophlebitis. Although the need to elevate her legs was presented to the VE, Apfel Thrombophlebitis, the hypothetical did not include Dr, Apfel Thrombophlebitis.

Apfel Thrombophlebitis Deep Vein Thrombosis | Vein | Thrombosis

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