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Disabilities: Severe osteoarthritis of the bilateral knees, hypertension, status post left ankle fracture, and obesity
Notice of Decision: Fully Favorable
Administrative Law Judge: D. Kevin Dugan
Office of Disability Adjudication & Review (ODAR): Fort Lauderdale, Broward County, Florida & Palm Beach County, Florida
The claimant followed with the orthopedic department at Broward Medical Center for a large left knee effusion with valgus deformity and tri-compartmental arthritis of the left knee. The orthopedist noted in February 2008 that the claimant's left knee pain was worsening, particularly with standing and walking and that she had difficulty sleeping due to pain. She had to use a cane to ambulate. Her physical examination demonstrated swelling, valgus deformity, and crepitance with range of motion. She was assessed with advanced osteoarthritis of the left knee. She failed conservative treatment with NSAlDs and corticosteroid injection with little if any relief and physical therapy was contraindicated due to the severity of the valgus deformity. Total knee arthroplasty was therefore recommended. The claimant returned to the orthopedist in September 2008, at which time her condition remained the same (Ex. 11F).
The claimant was seen in the emergency department in July 2008 with chest pain without radiation. She was admitted to telemetry due to cardiac risk factors and hypertension, which was as high as 189/100. She was administered nitroglycerin and Lisinopril (Ex. 11F).
After considering the evidence of record, the undersigned finds that the claimant's medically determinable impairment could reasonably be expected to produce the alleged symptoms and that the claimant's statements concerning the intensity, persistence and limiting effects of these symptoms are generally credible. The claimant testified that her condition has progressed and is getting worse all the time. She fell and broke her ankle in May 2006 and never recovered from that point forward.
When examined by a consultative physician in March 2007, there was evidence of positive swelling and tenderness of the left knee and valgus deformity on the left. The claimant's reflexes were normal, but she was ambulatory without assistance for only a few steps, and her gait was unstable and antalgic. She was unable to perform tandem walk, heel to toe walking, or partial squatting (Ex 2F). Moreover, active joint inflammation of the left knee with swelling and pain and valgus deformity of both knees was again observed by a different consultative physician in October 2007, and the claimant was assessed with hypertension and inflammatory arthropathy, consistent with degenerative joint disease, active on therapy (EX. 6F). These findings were confirmed at the claimant's subsequent emergency room visit for right knee pain in October 2007, as well as her follow up orthopedic visits, which concentrated primarily on her left knee tri-compartmental osteoarthritis.
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