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Woman with Pineal Gland Cyst and Unproven Pain Employable


 A 43-year-old woman applied for Social Security disability benefits claiming to be disabled by a cyst in her pineal gland, a small endocrine gland in the brain that produces melatonin, which regulates sleep. The woman’s cyst caused her to experience vertigo, blurred vision, and headaches. She argued that in combination the symptoms disabled her from full-time gainful employment.

 

While her application for disability benefits was pending, the woman underwent brain surgery to remove the cyst. An MRI following the operation showed that the cyst had been removed and the site of the operation in the brain with healing normally. Her vertigo and vision problems had been resolved. However, within weeks she complained about pain and numbness in her head. Her surgeon referred her to a physician with expertise in anesthesiology, who prescribed drugs, and also referred her to two pain specialists. One pain specialist suggested an occipital nerve injection, which is an injection of a steroid at the back of the head to relieve pain. The woman rejected this treatment. She declined to consult the other pain specialist. Her primary physician then referred her to a third specialist, who recommended that she seek ongoing care at a hospital. She declined saying she would be unable to travel to the hospital, which was a two hour drive from her home, on a regular basis.

 

Though continuing to complain about pain, the woman ran long distances in preparation for participating in a marathon. She ran for an hour daily. She ran a 5000 meter race. She flew to Australia.

 

In support of her application for disability benefits she submitted documents from two chiropractors. One chiropractor said that on the basis of what the woman had told him he thought that if employed she would need 15 minute breaks every 30 minutes and would miss work more than four times a month, which would preclude full-time gainful employment and thus render her totally disabled within the meaning of the Social Security Act.

 

At her hearing before the administrative law judge (ALJ), the woman testified that her activities were severely limited by her pain and the side effects of the narcotic medications that she took for it, which included drowsiness and diarrhea. She said that she experienced constant pain in her head that traveled down her neck to her shoulders; that she slept most of the day and had trouble sleeping at night because of the pain; and that she drives only on back roads, does not read, watches only some television because it hurts her eyes, and uses her computer for only 20 minutes at a time. She submitted a note from her mother, which stated that the woman was mostly homebound, had memory problems, and was unable to drive long distances or do laundry.

 

The woman’s treating physician’s treatment notes largely list her subjective reports of pain, with almost no attempt to evaluate their severity. Her treating physician wrote that “she still feels she has modest pain” and “overall, her description of symptoms is essentially unchanged, but she does have improved pain control overall.” His own observations were optimistic: “She actually appears to be in a better mood and more jovial than I have noted in the past” and “I did discuss with the patient that at this point, I am uncertain in regards to what her opportunities are for further pain control and feel that she would be best served being evaluated by a pain physician that is involved in a tertiary setting.” The treatment notes indicated a belief not that the applicant had disabling pain but that she was reporting pain symptoms and that he was not competent to treat her condition. While noting her reports of “persistent, chronic, severe neck pain,” he did not explain how the pain limited her activities.

 

The ALJ found that the woman was exaggerating the severity of her pain. The ALJ did not deny that she had pain, specifically muscle pain (myofascial pain) in her neck and arthritis and inflammation in her neck joints (bilateral facet arthropathy). However, the ALJ did not believe that the pain was severe enough to disable her to the extent she claimed.

 

Based on the ALJ’s finding that the woman was exaggerating the severity of her pain, the vocational expert who testified at the hearing opined that someone with the woman’s limitations as determined by the ALJ would not be totally disabled. She would be able to perform sedentary, unskilled work as a production inspector or bench assembly worker.

 

After the hearing, the Commissioner of Social Security denied the woman’s application for disability insurance benefits. The United States District Court for the Eastern District of Wisconsin upheld the Commissioner’s decision.

 

The Seventh Circuit United States Court of Appeals affirmed. The court held that substantial evidence supported the ALJ's determination that the woman was capable of full-time employment.

 

Substantial evidence supported the ALJ's determination that the woman was capable of full-time employment. The court noted that the woman ran one hour every day, completed a 5000 meter race, and flew round-trip coach class to Australia. The court reasoned that the ALJ could reasonably conclude that the combination of these activities was inconsistent with having pain severe enough to preclude full-time employment. The court found that the ALJ could reasonably conclude that the woman was exaggerating her symptoms because she turned down three different treatment opportunities: the occipital nerve injection, the consultation with a second pain specialist, and ongoing care at a hospital. The court noted that the woman’s primary physician and chiropractor recited the woman’s subjective complaints of pain as the sole basis for their conclusions that she had pain severe enough to preclude full-time employment. The court also discounted the two chiropractors’ conflicting assessments of how far she could walk without pain given her completion of a 5000 meter race, which was far longer than the higher of the two assessments.

 

The Seventh Circuit United States Court of Appeals affirmed the district court’s upholding of the commissioner’s denial of the woman’s application for disability insurance benefits.

 

See: Mitze v. Colvin, 2015 WL 1570153 (C.A.7 (Wis.), April 9, 2015) (not designated for publication).

 

See also Medical Law Perspectives, December 2011 Report: When Pain is the Only Proof: Subjective Impairments

 

See also Medical Law Perspectives, August 2012 Report: Anesthesiology Errors: Complications, Malpractice, and Catastrophe

 

See also Medical Law Perspectives, January 2014 Report: Prescription Painkillers: Risks for Patients, Pharmacists, and Physicians

 

 

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