Wills v. Astrue, No. 6:2011cv00025 - Document 22 (W.D. Va. 2012)

Court Description: MEMORANDUM OPINION. Signed by District Judge Glen E. Conrad on September 14, 2012. (sfc)
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OLERK' OFFI :,. ST O URT . Ce : DI , ATR- x # VA FlED I THE UNI N TED STATES DI STRI COURT CT FOR TH E W ESTERN D I STRI T OF VI N I C RGI A LY N CH BUR G DI SI VI ON 1 BKUL c DUOL J . G DON NA L.W I LLS, Ci lA c i N o. 6: 1 00025 vi ton 1 CV Pl ntf , ai if M EM O M N D UM O PI I N N O M I AEL J.A STRU E, CH Com m i s one ofSoci lSec liy, si r a trt By: H onor bl Gl n E. lad a e e Corr Chi fUnied St esD i ti tJ e t at s r c udge Def nda . e nt Pl i ifhasf l d t s a ton c le ng t tna de i i oft Com m i s one of Soc a a ntf ie hi c i ha l ngi he i l c s on he si r il Se urt de nghe c a m f c iy nyi r l i orape i d ofdi a lt a diabiiy i ur ncebe i st de he Soc a ro s biiy nd s lt ns a neft m rt il Se urt Ac,asa nde 42U. C.jj41 i and423. J iditonoft sc ti esa ihe c iy t me d, S. 6() urs ci hi our s tbls d purua t 42U. C.j405() s nt o S. g. Thi c e w a or gi ly a s gne t Se orU nie St t s Di t i tJ s as s i na l s i d o ni t d a e sr c udge N o m a K .M oon. r n On N ove be 8,2011 J m r , udge M oon r f r e t c e t a U nie St t s M a sr t J e e r d he as o td ae gi t a e udge f a or Re o t ndRe o n ain p ru n t 28U. C. 6 6 b ( )B) ema itaej d eis e p ra c mme d to , u s a t o S. j 3 ( )1( .Th g srt u g su d a Re o ta d Re o n ain o J l 2 ,2 2 TheCo sin r fld o j ci n t t e p r n c mme d to n uy 5 01 . mmiso e ie b e to s o h ma itae u g ' Re r a dRe o n ai n OnAu u t 0 2 1 J g M o nta serdt e g srt j d e s po t n c mme d to . g s 2 , 0 2,ud e o r n fre h c s t t t r i d Unie St ts DititJ a e o he mde sgne t d ae src udge. The pa te pr s nt or la g e t on ris e e ed a r um n Se e be 5,201 Thus t c e i now rpe f di pos ton. pt m r 2. , he as s i or s ii Thi c t r e oft Commisone ' fna de son i lmie t ade e na i a t s our' eviw s he s i r s i l cii s i t d o t nni ton s o w het t e i s antalevi her her s ubst i dence t suppor t Com m i onersconcl on t pl ntf f l o t he ssi ' usi hat ai if aied t m eet t r r ent f enttem entt beneft l der t A ct I s subs antalevi o he equi em s or il o is m he . f uch t i dence e s s t tnal c s o oft Com m i sonerm us be a tr e La sv. e e e, F. 640 xit , he i de i i n he si t fi m d. w Cel br zz 368 2d 1 2 ( h Ci.1966 . Sttd bify,s tnile de e hasben c r cei a s h r lva 4t r ) ae rel ubsa ta vi nc e ha a trzed s uc ee nt e de ,c i rng t r c d a aw hol , m i be f vi nce ons de i he e or s e as ght ound a qua et s de t o uppor a c us on by t oncl i aras bl mi Rihads v.Peal ,402U. 389,400( 971. e ona e nd. c r on r es S. 1 ) The pl ntf,Dom a L.W il,wasbor on J 4,1 ai if l ls n une 965,a e ual co plt d t nd vent ly m e e he ee nt gr i s hool Subs que l M r .W il ea n d a GED. Pl ntf ha wor d a a lve h ade n c . e nty, s ls r e ai if s ke s m e c l e e i s a a acl r m a ge i a r t l r a y s or Shel s w or d on ar ul r di a r c ptoni t nd s e k/ na r n e ai pha m c t e. a t ke eg a a s t i d ba i i 20 nd us a ne s s n 06. One J une 1 2006,M r .W il t l d a a i a i f a pe i of 9, s ls i e n pplc ton or rod dia lt anddia lt i ur nc be ft .Pl ntf a lge t ts be media e f al f m s s biiy s biiy ns a e ne is ai if le d ha he cn s bld or 1 or ofs tntalgai ule oy e o M a 3 200 due t ps itc a t ii ,s r pan,a ubsa i nf mpl m nt n y 0, 6 o ora i rhrts eve e i nd s e lng i he a es M r . il now m a nt nst ts ha r m ai d di a e t t pr s nt i e. w li n r nkl . s W ls i ai ha he s e ne s bl d o he e e tm Ther c d r vea st tM r . il m e t i ur d s a usr quie e soft A c a a l e e nt i e e or e l ha s W ls t he ns e t t e r m nt he t t l r l va tm s co rdbyt fnalde sonoft Commisone.See42U. C.jj41 i a 423() vee he i cii he si r S. 6() nd a. M r .W il ' cl i was de ed upon i ta c ns de a i n and r ons de aton. She t n s ls a m ni nii l o i r to ec i r i he r seda rceve aX novoheai a rviw befr a Ad nitai La J eque t nd e i d rng nd e e oe n mi srtve w udge.I an n opi on da e J nua y 1 2008, heLa J ni t d a r 0, t w udge a s de e m i d t t r . il i no di a e The l o t r ne ha M s W ls s t s bl d. La J w udge f ound t t pl i tf s f r f om ps i s s w ih ps i tc a t r ts a nai di ea e, ha a n if ufe s r or a i t ora i r h ii nd l s s c m e tvets uedie e,hy r gulbl sa ec r ld on Hum iabi ogi a a ntt r py,a ol c i is s as pecoa a e t t ontole r ol c l ge he a viami D de i inc quesi bl fbr t n fce y, tona e i omyagi r c l ir nt l tplnt r f cii ,ashma,a l a, e a cta ef a a as ts t nd obest Des t t e physc lpr e s t La J iy. pie hes i a oblm , he w udge nze t tM r .W il r t i s f int ld ha s ls e ans ufk e f tona c pa iyt per o he pas r l va w or a ar e i s .Acc di l t Law J e unc i l a c t o f nn r t e e nt k s ec ptoni t or ng y, he udg uli a e y conc ud t tpl i ifi not s e a t ts i no e il d t ape i ofdi a lt tm t l l ed ha a ntf s di abl d, nd ha he s t ntte o r od s biiy o d sb lyi s r n eb n t .S e2 C. R. j4 4 1 2 ( Mr. il t e s u ht e iw b r ia ii n u a c e eks e 0 F. j 0 .5 0 9. s W ls h n o g rv e y t t So a Se urt A dm i s r ton' A ppe l Counc l he ci l c iy nit a i s as i. l a or r da e Se em be 2,20 t Appe l Counci r a d t ca e t t n n de t d pt r 09, he as l em nde he s o he Admi sr tveLa J ef f rhe c i r ton.TheAppe sCounc l de tfe s ve a is s nita i w udg or u t r onsde a i al i i n i d e r l sue t t e eu e ol d.Spe ii a l t A ppe sCounc l s i dw he he heA d i s r tveLa ha w r nr s ve c fc ly,he al i que tone t rt m nit a i w J udge ha a qua el c i r t fndi of t aldi a lt pr d de t y ons de ed he i ngs ot s biiy oduc by pl i i f s t e tng ed a ntf r a i phys c a D r M i hae D .W il The Appe l Counc lal o not t tt e de s i i n, . c l l. as i s ed ha he vi nce ugge t t t s s ha pl i if sa t ii i pa nne had r s t i m a pul tvelm ia i t t e e no i l d i t a ntf r hrtc m i nt e uled n ni a i i t tons ha w r t nc ude n he La J w udge' a s s ntofpli ifsr iualfmci lca ct ( 1 . s sesme antf esd t tona pa iy. TR 45) Upo r m a t c s wasas i d t t s m e Adm i sr tve La J n e nd, he a e sgne o he n nitai w udge f f t r or urhe de o e a c i e a i The La J vel pm nt nd ons d r ton. w udge c onduc e a s e e ala i sr tve he r ng t d uppl m nt dm ni t a i ai on J 21 201 Att the rng,Dr H.C.Alxa r 11 a boa d c riid r um aol s and une , 0. ha a i . e nde , 1, r e tfe he t ogit i em it t sii d a a me c la s . Dr Ba r He ly t sii d a t he rng asa voc tonal nt s, e tfe s dia dvior . ry nse e tfe t he a i ai e r .Folow i t he rng, n Se e be 2, 0, heLa J xpe t l ng he a i o pt m r 201 t w udger nde e a s c o ni n.On e r d e ond pi o t s oc ason, heLa J hi c i t w udge f ound t tM r . il s f r f om s ve e i pa r e son t bas s of ha s W ls uf e s r e r m i m nt he e ps ra i, o itcarhrts ose rhrtsoft kne s midde ne a i dicdiea e,i o l a, o i ss ps ra i t ii, t oa t ii he e , l ge r tve s s s fbr myagi obe iy, ol tvets uedie e, ndAddio sdiea e TheLaw J st c meci is s as a s n' s s . udger le o t t tm o of e id n he esi ny Dr Al xa r gi n a t s e e a a i s r i he rng, n c l ng t tM r . il doe . e nde , ve t he uppl m nt l dm ni tatve a i i onc udi ha s W ls s no s f r f om a i paim e , or co bi ton of i pa nne s t t m e t or equa s a ls e t uf e r n m r nt m na i m i nt , ha es l itd i panne t rAppe x 1t Subpa tP oft Admi sr tveReg ai Pa t404. Rel ng m i nt mde ndi o r he nitai ul tons r 1 yi 1I acl m a s f sf om an i r e whi meet ore sa lsed i paim e ,t cl mant f ai nt uf er r mpaim nt ch s qual it m r nt he ai i deemed t be diabl f al f msofwor w ihoutconsde aton off t s s asage,educ i or s o s ed or l or k t i r i ac or uch aton, p irwor e re e Se 2 C. R.j4 4.52 d) ro k xpeinc . e 0 F. 0 1 0( . a i i s t nta m e ur on Dr Al xa rs t tm ony,t La J gan n ubsa i l as e . e nde ' esi he w udge as es e M r .W il s s d s ls' r s dua f to lc pa iy a f l s e i l unc i na a c t s olow : A fe a e ul ons de a i of hee i er or t unde s g d fndst t hec ai an t rc r f c i r ton t ntr ec d,he r i ne i ha t l m t ha t r i ua f tona c pa iy t pe f m a lmie r nge of lght wor s he esd l unc i l a ct o ror i td a i k. Specfc ly,t cai tca lf a c ry 20 poundsoc asonal a 1 pounds ii a l he l man n it nd a r c i ly nd 0 fe nty, n sa f 20m i esa atm ef rat t lof3 hour i a 8r que l ca t nd or nut t i o o a s n n hourda y, c n wal f r1 m i esa atmef at t lof2hour i a 8 hourda c n stf an a k o 5 nut t i or o a sn n y, a i or unlm ie num be o ho s a c n pe f nn oc s onal ba a i s oo ng, i td r f ur nd a ro ca i l nc ng, t pi c ouc ng, ndi a c i bi ofs a r / a ps How e r s c nnotpe f m a r hi be ng, nd lm ng t is r m . ve , he n r or ny ca i kne i a clmbi oflddesr /caf ds(oot t o tedj a rwlng, elng nd i ng a r/opess fol f noe mit nd m us a d expos le t w or a haz r , s h a m ovi m a hi pa t a t voi t o r kpl ce a ds uc s ng c ne r s nd unpr t c e hei ht . oe td g s ( 1 ) Gi ns har sdua f nci lc pa t a ba e ont t tmonyoft voc tonal TR 8 . ve uc ei l' tona a ciy, nd s d he esi u he ai e r,t La J xpe t he w udgede e mi d t ta1 ofpli tf spa twor r e r quied pe f r a e ofa t r ne ha 1 a n if s k ol s e r r o m nc mor s tnta r ngeoflght tviya o me um e ri Thus t La J e ubsa il a i ac i t nd/ r di xe ton. ,he w udger l dt t r . u e ha M s W il i dia edf alofhe pa tr e ntwor a tvii , c us s i no l ra et pe f m ls s s bl or 1 r s elva k c i tes be a e he s onge bl o ror a f lr nge oflg w o k. How e r g ve he r i ua f tona c pac t as ou lne abo ,a ul a i ht r ve , i n r es d l unc i l a iy ti d ve nd a t rco i i ai tf sa , duc ton, ndpa t or a tviy, sw el asDr H e l y' voc tona fe nsderngpl n if ge e a i a sw k ci t a l . ns e s a i l t s i ony,t La J e tm he w udge r e t tM r .W il r t ns s t i nt f nc i na ca ciy t pe f m ul d ha s ls e ai ufk e u to l pa t o r or sd n ayj b a ar c p ins,n omain rc r scek, n o fc cek.Ac o dn l ,h La e e tr o s s e e to it if r t /e o d lr a d fie lr o c r ig y t e w J udge a n c ude t tM r .W il i no di a e a t t s i not e il t a pe i of gai oncl d ha s ls s t s bl d, nd ha he s ntted o rod dia lt o dia lt i tr ebe ft.Se 20C. R.j40 15 g) Ont soc son,heLaw sbiiy r sbiiy nslanc neis e F. 4. 20( . hi cai t J udge' opi on was a s ni dopt d a t tnal d i i of t C o m i s one by t So al Sec iy e s he i ec son he m s i r he ci urt Admi sr ton' Appe l Co l Ha ng e used a la ia e a i sr tve r m e e ,M r . nita i s a s unci. vi xha t 1 val bl dm nita i e di s s W il t appeal t t s cour . ls hen ed o hi t 4 W hie pli if m a be dia ed f c ran f r of e oyme ,t c u i l f t l a ntf y s bl or e ti o ms mpl nt he r c a acual de e naton i w he herpl i i fwasd s bl d f ra 1f m sofs t nta ga nf le pl m e . See t nni i s t a ntf i a e o 1 or ubs a i l i u m oy nt 42U. C.j423( ( .Theeaef eeme sofpr whihmus bec i r i ma ngs S. d)2) r r our l nt oof c t onsdeed n ki uch a a ayss The eee nsa es mma ie a f l ws 1 o j ci me c lf csa d ci c l n n l i. s lme t r u rz d s ol :( ) be t o ve dia a t n l a ni fn i s ( )heo i o sa dc ndu in o te tn p ysoa s ( )s b e tv e ie c o p y ia idng ;2 t pnin n o so s f raig h iin ; 3 u j cie v d n e f h sc l ma fsai ofi ime s asdesrbe t oughacama 'tsi ny'a ( t cai nt niettons mpar nt, ci d hr li nts e tmo , nd 4) he l ma ' s e to vocaina hit y,esd ls ls, nda Vie v. nc 438F. 11 1l 60( h ducain, to l sor r iua kil a ge. tk Fi h, 2d 57, 59- 4t Ci.1 ) Unde woodv.Ri c f298F. 850,851( h Ci.1 . r 971 ; r biof, 2d 4t r 962) Upo rc iigt erfra o t c s fo t p e ii gdsrc j d e t ema itae ud e n e evn h eer l fhe ae r m he r sd n itit u g ,h gsrt j g u d ro kat r ug e e f 1tee ie c o rc r .Th ma itae u g utmaeyc ncu d n e to ho o hrviwo alh vd n e f e o d e gsrt j d e li tl o lde t t D r A l nde ' t s i o a t a i s r i he r ng co tt e s t nta e de e i ha . exa r s e tm ny t he dm ni tatve a i ns iut s ubs a i l vi nc n s uppor oft Com m i s one ' de e m i ton t tpl i if s ph i li paim e s do notm e tor t he s i r s t r na i ha a ntf ysca m r nt e e lalsedi par ntunde Appe x 1 Ba edont m e c l e or adduc a t tm eoft qua it m ime r ndi . s he di a r c d ed t he i he Law J udge' s co opi on,i i be s e nd ni t s yond que to t t M r . W il does no s f r f om a s i n ha s ls t uf e r n i pa r e , or co bi ton of i pa r e s whi h m e t or eq l one of t ls i unde m i m nt m na i m im nt , c es ua s he i tngs r App n i 1 Thec u t c e t t ema itaej dg ' rc mme d d fn igt t i efc . e dx . o r a c p s h g sr t u e s e o n e i dn o hs fe t Th ma itaej g d tr ne ,ho ve,t a t La J d e e rd i rli o Dr e g srt ud e eemi d we x h t he w u g re n eyng n . A l xa r sm e c l ni t s ppo t hetndi ha pl i ifr t i s fc e fm c i lc pa t e nde ' di a opi on o u r t i ngt t a ntf e a ns uf i i nt t tona a ciy t rbr s ve a s c fclg /e nt r r o e whihe s i sg fc ntnumbe i hena i l ope t m e r l pe ii i hts de a ywo kr l s c xit n i niia r nt tona e o my. ma itaej d eh l h th La l g fie oa c r p o e weg tot me c l c no The gsrt u g edt a t e w ud e aldt c o d r p r ih t he dia r por sofone ofpl i i f st e tng phys c a , r M i ha lD . il e t a ntf r a i i i ns D . c e W l. Dr W ili a i enit who ha teaed Mr .W il snc 2005. ( 6 ) Mr.W il . l s n ntr s, sr t s ls i e TR 48 . s ls prvi l wor d i Dr W ilsofie. ( 493) .W ilce ry q lhesa oneofpl ntf e ousy ke n . l' fc TR .Dr l lal uai s ai ifs te tng physca . He haste e M r .W il f a va it ofpr e s a wih di nos of r ai i ins r atd s ls or re y obl m , nd t ag es i l m m a or arhrts ps i tc a t ii , c nfn t y t ii , ora i rhrt s onne tve ts ue diea e vin i D de i i ncy, ci is s s , tm n fce fbr ya gi ,a pe s se l f pl nt r f s ii . O n A ugus 1 2007,D r W ilr po t d t tl r . i om l a nd r i t nt e t a a a c ts t , . l e r e ha t s M W il hashadagr a de lofdifc t wih n ultona i r uii t us ofawhe lc i ls et a fiuly t mb a i nd s eq rng he e e harwhe n s hast gooutoft hous o t mo a sgnii ntditnc ' ( 648 .Dr W ilha opi d he o he e r o ve ny i fca sa e. TR ) . l s ne ' on s ver loc s onst tM r .W il i t a l a pe m ane l di a e Fore pl o Jm e 10, e a ca i ha s ls s ot ly nd r nty s bl d. xam e, n t 201 Dr W ilc m ent a f l s 0, . l om ed s olow : Mr . il c ni u swihs v r a c r n cj it i iv li mutpej it a s W ls o tn e t e ee nd h o i on pan n ovng lil on s s de i a e i t tl te .She i ve y lm ie i he aci te a r m ansuna e t lne t d n ha e tr s r i td n r tvii s nd e i bl o wor be a eoft s 1ce ti ybe ivet ti i a o it t ts r c i f la k c us hi. ranl le ha t s ppr pra e ha he e e ve ul nd penna ntdia lt lha pr vi l de c i d he physc lmia i a ha ne s biiy. ve e ousy s rbe r ial i t tons nd ve exa ne he t yand s hasc i d sgnii n pr e swih de r s d grp mi d r oda he ontnue i fca t oblm t c ea e i sr ngh a hass te t nd omet nde nes ove he m i t a s eps itc c ng a e r s r r ss nd om ora i ha es bout he fnge s a na l . She has co i d lm ia i of r nge of m oton a r i r nd is ntnue i t ton a i bout he r s de sbia e aly a s gnik a t nde ne sofhe ankl a kne bia e a l I houl r l t r l nd i t nt e r s r es nd es l t r ly. n s m a i 1bele t ts i c pl t l una e t wor a Iwoul s um ton, i ve ha he s om e e y bl o k nd d uppor he t r i he a t m pt ofobt i ng f la pe m a n di a lt n r te s a ni ul nd r ne t s biiy. ( 647 . TR ) Ass g e tda o ,h La J d erj ce Dr W ilsfn ig a do i o s Th La u g se b ve te w u g ee td . l' i dn s n pnin . e w J udgef ound t tDr W ilsc l i a enotco itntwih t eofot rmedials ur s ha . l' oncusons r nsse t hos he c o ce , i l ng s ve alot rt e tng physci ns The La J e de e m i d t gi gr a e w e g t nc udi e r he r a i ia . w udg t r ne o ve e t r i ht o Dr Al xa rsas e s e . . e nde ' s s m nt Dr A l xa rr vi wed a loft m e c le de e w hi h ha be n co pl t d asoft . e nde e e l he di a vi nc c d e m ee he tm e oft s e e a adm i sr tve he rng. H eno e t tM r . il e renc s de i t i he uppl m nt l ni ta i ai t d ha s W ls xpe i e fnie m us ul ke e alpr e s i l ng ps i tc a tlii , l t r lca pa t c os l t obl m , nc udi ora i r lrts bia e a r l unne l r l as s ose oss plnt rf s ii i t l f he ,Ac le t ndonii,ose rhrtsoft e e e , t opor i, a a a cts n he e t el hil s e ts t oa t ii he kne , nd m id de ne a i d s di e s t es a l ge r tve i c s a e hough wihoute de e ofne ' e r tc pr s i t vi nc l oo om e s on. v ( 60- ) Bas o he vareyofmusul keea pr blms Dr Al nde o ne t t TR 65 . ed n r it c os ltl o e , . exa r pi d ha pl i ifi una e t sa orwak on a s t i bass t ug he e plcty tsiid t ts i antf s bl o t nd l usaned i , ho h x i il e tfe ha he s notlmiedi he c ct f rsti a rac ng.( 66- . i t n r apa iy o itng nd e hi TR 67) A fe co t r nduc i is own r vi w oft r c d,t cour i c t a ne t conc ude t t tng t e e he e or he t s ons r i d o l ha t r i s t nta e de t s ppo t heLa J he e s ubsa il vi nce o u r t w udge' decson nott gi co r lng weghtt s ii o ve ntoli i o t fndi ,c l i , opi onsofDr W il n t c tsvi w, hemedi lr or he i ngs onc usons and ni . l.l he our ' e t ca ec d s upporst Law J e' obs r to t tD r W ils a s s m e sa e notc i t tw ih t t he udg s e va i n ha . l ' s e s nt r ons sen t he clni lfndi ofo he physca who ha r gulry teae M r .W il Fore mpl Dr Erc i ca i ngs t r iins ve e a l r td s l. xa e, . i R. nny,ar tm aol s,ha as te t d pl n ifsnc 2005.W ihoutque to Dr Ke s Ke hel t ogit s lo r a e aitf i e t si n, . nny' r por sdoc e l s sgnii a phys c tndi t n do t e ofD r W il Fore m pl o e t um nt e s i tc nt i al i ngs ha hos . l. xn e, n M a 1 2006,Dr K e r l t d a f l s y 0, . nny e a e s olow : Rhe a ol cr vi w ofs t m si nega i f ra o i phot s nstviy, yna um t ogi e e ys e s tve o l pec a, o e ii t Ra ud, dr e s d y m o h,pl ur s pe i r ts f r uni en i y ye , r ut e iy, rca dii , eve , nt tonalwei l s a m i . ght os , ne a l whie c , 1 pl tl t c , ne ol i l dior r c o tng dior r ow t ount ow ae e ount ur ogca s de , l ti s de , he a u i , o pr e nura. Pa i nt r po t oc s ona or l ul e s whi h ha no m t r a r ot i i te e r s ca i l a c r , c ve t i r a e snce sa tng me hote t She has doc nt d ps i tc na ldiea e nc e s d i t ri t r xae. ume e orai i s s w ihouts n l s onsorot rr s She ha o he i e ne tve r um a ol c r vi w t ki e i he a h. s t m s ga i he t ogi e e ofs t s. ys em M edi lhit y i aspe e ec r ni m e c lr c d d t d M a 1 2006,r vi wed, ca s or s r l t o c di a e or a e y 0, e e w ihouti e v c ng ofnot e ptasnot d i hi t y ofpr e il s . t nt r al ha e e xce e n s or es nt lne s O BJEC TI E Exa i ton r ve sw e la arng f m a e i no a ut di t e s She V m na i e al l- ppe i e l n c e sr s . i pl as nta c pe a i , e t nd ore e M us ul ke e a exa i ton r ve s s e a nd oo r tve al r a i nt d. c os l t l m na i e al no cl cuts ear ynovii She does have s ts. evere nai dys r l t ophy of m uli e fnger l tpl i nais, unc nge f om pr vi l Exa i to of t ha r ve l m e a a pa s ha d r e ousy. m na i n he nds e a s t c r l quee e z t nde ne s bia e aly.The e i t nde nes w ih pa pa i of bot wr s s Pa i nt i e r s l tr l r s e r s t l ton h it . te s s a us pos r ght c r t tt ti a pal unne r e e.Ti l sgn i pos tve on t l f s de.Grp l el as ne i s ii he e t i i sr ngt and f s f m a i a e m idl r duc d bia e a l The e i pa n w ih f l te h i t or ton r l y e e l t r ly. r s i t ul e e i oft rg ebow, t nde ne soft rgh lt r le c xtnson he i ht l and e r s he i t a e a piondyl i pr s nt e s ee wihouts li The ei pana e r t welng. r s i t xtemesr ngeofm o i of h s de swihout a ton bot houl r t s lig.Th r i tn e s o r t a tro ge o u r lj it b ltrly wel n e e s e d me s ve he n eir ln h mea on s iaeal. Exa i ton of t kne i not bl f pai wih f l fe on bia e a l a m na i he es s a e or n t u l l xi lt r ly, nd tn e so e t eme il on ln bi tr l , u n d fni s lig e f so , e d nws v r h d a j it ie l eal b t o ei t weln , fu i n a y e wa m t ore yt m a Exa na i oft a esr a ss li i vi pose i r r h, r he . mi ton he nkl eve l welng nvol ng t ro lt r l a pec s bia e a l wih core po ng r ona t nde ne s The e i a s a e a s t lt r ly, t r s ndi egi l e r s . r s lo t nde e so rt plntra pe tof helf hee andtnde ne swihhee s ez o e m s ve he a a s c t e t l e r s t l que e n t lf sde. r i pai wih doril xi a plntrfexi ofbot al es The e he e t i The e s n t ste on nd a a l on h rkl . r i m e a a s ls ez t nd m es bia e a l Ther i t a e pitng pr tbi a a e s t t r a que e e e s l t r ly. e s r c ti e i al nd nkl e m a. Exa i ton of t s n r ve s no r s Ot wi e no ne fndi on de m na i he ki e al a h. her s w i ngs m us ul ke e a e m i ton. c os l t l xp na i ( 381. TR ) Dr K e . nny a n s w M r .W il on M a c 22,2010. On t s oc ason,pl i i fls e her gai a s ls rh hi c i a ntf i t d s pt m sasf l s ym o olow : The pa i nt r po t con i d pr e s w ih w i pr ad m us ul ke e al pa n, te e r s tnue obl m t des e c os l t i c r lc urenty ompli prm a iyofpa ni vi t ne k, houl r ,e t e a l f a ns i rl i nvol ng he c s de s lf kne , nd e t a l.He mos s v r l a fce j itc re t i telf k e . S erp rspan nke r t e eey fe td on u rn l s h e t n e h e o t i y w ih w e g be rng a i t pari ul ry g ng up a dow n s a r .Sym pt s w e e t i ht a i ctviy, tc a l oi nd t is om r pa t lyr l ve wihr s. h h slc o c nfd n ei tej i t b tn d fnt ri l ei d t e t S e a a k f o i e c n h o n, u o e iie a e gi ng wa orot r i t biiy s vi y he nsa lt ympt oms. She i no sle i t r ha bee a s t tr f he e s n ny s lng.She ha not d s lng i vi t l ta e.She ha m om i s if s weli s e weli nvol ng he ef nkl s ng tf ne s of pr ong dur ton.She r pors s ha c tnued he a ihel ai t r py ol ed ai e t he s on i r ntr tm tc he a unc hange buts hasno ha a m o t i l r t yt sst thavebe n m a d, he t d ny niorng abo a or e t ha e de a ia e t m e snc Oc obe 2009. va l bl o i e t r ( 626) Dr Kemys TR. . . l ummai dhi physc fndi asf l : rze s ial i ngs olows Exa i ton r ve sa we la m na i e al l- ppea i f m a e i no a t dit e s Pa i nti a e t nd rng e l n cu e s r s . te s l r a ore e x 3.M us ul kee a e m i tonr veasbonye a ge nta tnde es int d e os lt l xa na i e l nl r me nd e m s iv l ig2 da d3 dDl oit o b t h n s T r i rd c dg i srngha dfs n o vn n n r pj ns f oh a d . hee s e u e rp te t n it f onna i biaer l The ei m eac r lco pr s i n t nde es biae aly. r ton l t aly, r s t a pa m e so e m s l tr l The e i tnde so rt CM C j i si bot ha .Thee i amidl tnde ,feey s e nws ve he ont n h nds r s l y e r r l m obienodul rt i t l t pe l ba e o The ei pa n i l t r la pos e i l a iy n he ef up r um rr gi n. r s i n a e a nd t r or r on ofbot hi w ih hi m ani aton biat l Ther i cr t i bot knees egi h ps t p pul i l eraly. e s epius n h a pa n w ih t m i fe on ofbot kne ,butno s lng. The e i t nd ne s nd i t er nal l xi h es weli r s e er s o rmedi aea j i lneoft lf kne Theei tndene saongt Ac le ve oltrl ont i he et e. r s e r s l he hils t ndon i t r on oft A c le t ndon i e ton,a a s pl t ras tofbot e n he egi he hil s e ns ri nd l o an a pec h 8 he l .The pai n i t nde i a diti uton t c f fb o y gi Ot r s es te t s e r n srb i ypial or i r m al a. he wi e biae a uppe e r miya bia e a l re r miy mus ul ke eal m nor l tr l r xte t nd lt r l owe xte t c os l t exn mal t i pec i n, a ofm oton.sr t a s a lt The e i s ve e na ldi tophy o ns t o r nge i teng h, nd t biiy. r s e r i s r ofmuli efng r l,whih i l ha d fo p e ousy,nops i ssi vi tpl i e nais c s mc nge r m r vi l ora i nvol ng t s n. he ki ( 6 ) TR 26 . l Se e rof2009,Dr Kenny a r nge f M r W il t s e Dr J e L.Hue t,a n pt mbe . ra d or s. ls o e . oyc ra n orhopa c s ci ls .Dr H ue t e ha M r . il w a c pl i ng ofl t ndi l e t edi pe a it . ranot dt t s W ls s om a ni ongs a ng ow rbac k pan t i houghwihr c ntrditoni ot lR lwe e rmiy.( 564) Shealoc anedof t e e a ai nt he e o r xte t TR . s ompli pai a num bnes i he l f kne a a e D r Hue t no ed t tpl i i f s s pt m sw e e no n nd s n r e 4 e nd nkl . . r a t ha a ntf ym o r t a f c e by a tviy. A c di t Dr H ue t M r .W il had no e ge i phys c lt r py. H e fe t d ci t cor ng o . ra, s ls t nga d n i a he a r por e t the s pt s w e e r le d b pa n m e c ton,i l ng Lorab. D r Hue t ls e e t d ha r ym om r e i ve y i di a i nc udi t . ra i t d physca fndi a f l s i l i ngs s olow : She i c l ,a e t a c pe a i i no ac e di t e s She i or e ed x4.W el s a m l r, nd oo r tve, n ut sr s . s i nt l de l veoped, l nours d.Sheha ano ma a f c . we l ihe s r l fe t Nonnalg tpat r The ei no ai te n. r s it r of he s e a De ii i i go r par She has nor unlbor d c e us r clr e. ntton s n od e i. mal a e br t ng. Ste h i 5/ i bia e al l r e r m ii f hi fe on, kne ea hi r ngt s 5 n l t r owe xt e tes or p l xi e e e i n, nkl dor il xi a e pl nt fe on e e orha l i l us M us e xt ns o a e s te on, nkl a ar l xi xt ns luc s ong . cl sr t h r l xes2+ i bia e a pa e l e a a es Toes a e dow ngoi bia e a l t e c ete n l t r l t la nd nkl . ,r ng l t r ly. The e i no a e cl r s nkl onusbia er ly. r a e no a l t a l The e r bnor als n l s ons va i ii m ki e i , rcos tes o pitng e m aoft l w e e r m ii s She i ove w e ght w e lke pt Stai r ti de he o r xte te . s r i and l m . r ght 1gr ii i negai bia e al FABER m a u ri ne tvebia e a l Howe r e a sng s tve ltr ly. ne ve s ga i lt r ly. ve , it na and e e na r ai oft hi o t l tc us butoc pai Shei quie n er l xt r l ot ton he p n he ef a es t k n. s t tn e t pap to o e t es cola j ito t elf moes t a t ef c t on s e d r o lain v r h a r iic on n h et r o h n h a e j it. N ont nde ove t pa a pi l .She ha f nc i lr nge ofm o i f te on a e r r he r s na s d u tona a ton or l xi nd e e i wihou sgnii a pa n.Extnso di ca es epan t xtnson t t i fc nt i e i n d us om i hough. ( 5 4 .Dr Huet p ro me a e dla seo dij cini t elmb rs ieo S pe e 1 , TR 6 ) . ra ef r d n pit l tr i n e to n h u a pn n e tmb r 1 r 2009.Hepef medas c e dualseoi ij ci i Ocobe of2009. ror e ond pi r tr d n e ton n t r M rs.W il w as s by D r.Jess L.St ,anot ort ls een e em her hopaedi s als ,on Sept ber24, c peci it em 201 On t toc s on, a n ifc pl i ofpr r s ve pa n i he l f a m . A n M R Ir ve l 0. ha ca i pl i tf om a ned og es i i n retr e a ed a he niton i pl i ifsce vi a s ne wih s e ne ve r i pi m e . As f pli if s r a i n antf r c l pi t om r oot m nge ntz or antf a b a o y c pa t D r St r no e t t M r .W il t t a ot d t e m i ng r m w ihou m ul t r a ciy, . e n t d ha s ls t s r m he xa ni oo ge t t dit t'a t ts ha E fui g i patr ' ( 651 . fkuly' nd ha he s t l d at ten. TR ) a ' G i n t m e c r por sf om ot rph i i ns t c tbe i vest tt r i s t tal ve he di al e t r he ys c a , he our le ha he e s ubsan i e de et s vi nc o uppor t La J t he w udge' tndi t tpli ifsmpl doesnote re t physc s i ng ha antf i y xpe ince he ial r srcto r poredby Dr W il Cl a l i pl i ifi dagr tde lofdifculy wih n e ti i ns e t . l. e ry, f antf t ha ea a fi t t mbulton ai a i r ui i t us ofaw he l ha rw he s ha t g outof hehous o t m o a s g t a nd s eq rng he e ec i n he s o o t e r o ve ny i nik nt di t nc ' a r po t d by Dr W il Augus 1 2007, uch ac r um s a ew oul havebe c i d sa e' s e re . l on t, s ic t nc d en onfnne by D r K e . nny,Dr H ue t o D r St r e t ri t w a ofm e ca hi t r ori t r sofa di c , ra, r . e n ihe n he y di l s o y n e m ni al e m i ton.l t d, a h oft es cilssr po tdt tM r . il l dwel, t ts wa xa na i nsea e c hes pe a it e re ha s W ls ooke land ha he s a e t ge a ound wih ltl difc t n t c tsviw,t er po t s bl o t r t ite fi uly.I he our' e hes e rs uppo tt La J r he w udge' s fndi t tpl ntf r t ns s fci ntf tona c pa iy f r s de a y l vel ofa tviy. i ng ha ai i f e ai uf i e unc i l a c t o e nt r e s c i t l pa sng, he c t us not t tDr K e a s qua ii a a t e tng phys c a i t s n s i t our m t e ha . nny l o lfes s r a i i i n n hi c s W hie he hasnot s e M r .W il a ofe asD r W il he ha e l t d a tea ed pl i i f a e. l e n s ls s t n . l, s va ua e nd r t a ntf wih s t ome m e s e ofr gulrt Furhe mor i tr ofpli ifs a t ii i im e ,t am e a iy. t r e, n e ms antf rhrtc mpar nt he Com m i s one m i htr a ona y ac or g ea e w e ghtt t fndi ofD r K e t n t t e of s i r g e s bl c d r t r i o he i ngs . nny ha o hos D1 W il Unde 20C. R.j4û4.5 c() i i m o de t tmor wegh ma begi nt t ' l. . z F. 1 27()5 ,t s vi d ha e it y ve o he opi on ofa s i ls a utm e c li s r l t d t t a e of s i t t n t t opi o ofa ni pec a it bo di a s ues e a e o he r a pec aly ha o he ni n s m c who i no a s eals . Stt d fe e l a ar uma ol s, . nny i be tpl c t o e s t pe i it aed ifr nty, s he t ogit Dx Ke s s a ed o c m e on t e e oflm ia i c us d by pl i if s a t ii i pa r e . om nt he xt nt i t ton a e a ntf rhrtc m im nt 2I s d be not t Dr St n' t tng a exami ton t pl afert admi sr i t houl ed hat . er s esi nd na i ook ace t he nitatve hearng a whi Dr A l i t ch . exandert tfed. es ii 10 For t r as sa e t c tbei ve t tt Admi sr tve La J he e ons tt d, he our le s ha he nita i w udge r as e onabl y a or d g e t rwei tt t a s s e pr de by D r A l xa rast pl i if sl ve ofr s dual cc de r a e gh o he s es m nt ovi d . e nde o a ntf e l e i f tona c pa t Ot rt n f D r W il a loft phys c a i t sc e pr unc i l a ciy. he ha or . l, l he i i ns n hi as oduc d r por sw hi h e e t c a e noti ons s e w ih t no i t tpl i ifm a now pe f m s dent r w or ac i te on a r nc i t nt t he ton ha a ntf y r or e a y k tvii s s t ne bass.Fo t t a t r no o he ph i a hass usai d i r ha m te , t r ysci n ugge t t tM r . il i t a l di a ed. s ed ha s W ls s ot ly s bl Howe r t c tdoesnotbelevet tt m e c r co d s ve , he our i ha he dial e r upporst La J t he w udge' fndi t t s i ng ha pl i i fi c pa e ofpe f m i a f l r nge ofs de a y w or a ntf s a bl r or ng u l a e nt r k. I esiyi a t a m i sr tvehe z ng, r Al xa rs a e ha pl i ifi no lm ia i n nt tf ng t he d ni ta i a i D . e nde t t dt t a ntf t has i t t o f grppi a fei a nolmiain f ra ng.'( 67 .I t h heialputt t or i ng nd e lng, nd i tto or e chi ' TR ) n he ypot tc o he voc tona e r,t Admi srtveLa J ei ude noma pultvelmiains ( 79) ai l xpet he nitai w udg ncl d ni ai i tto . TR . UnlkeDr Alxa rsfndi a t pl i ifsca ct f rpr onge s den a yaci t t fndi i . e nde ' i ng s o antf pa iy o ol d e t r tviy,he i ng of m a pul tve lm ia i sm pl i not u r e no ni a i i t tons i y s s ppo t dbyt e ca e de eofr c d.Thr hem di l vi nc e or oughout hi tea m e of M r . W il , Dr K e y not pr r s i y w or eni a tui i s m pt s i s r t nt s ls . nn ed og e svel s ng rl tc y om n pl i if shands Fore m pl , nN o be 30, a ntf . xa e o vem r 2009, . nny ls e Dr Ke it dphys c lfndi asf l w s: i a i ngs olo M us ul ke et le m i ton r vea sbony e a ge ent t nde nes i vol ng t c os l a xa na i e l nl r m and e r s n vi he sc n a t r DI j it o b t ha d . e ei rd c d g i srn t a d fs e o d nd hid P on s f o h n s Th r s e u e rp te g h n it f m a i n bia e a l The e i m e ac r lc m pr s i n t nde e sbia e a l The e or t o l t r ly. r s t a pa o e s o e m s l t r ly. r i tn en s o e teCM C j i i boh h n s s e d res v rh ons n t a d . ( 631. On M ac 2 201 Dr Ke y rpore Ee ed grp srngh a fs fr ton TR ) rh 2, 0, . nn e td t duc i te t nd it o mai r biae al ' ( 626) Att tmeofhea nitai he rng, sW il tsiidt ts doen' ltr ly. TR ' . he i t dmi srtve a i Mr . ls e tfe ha he s t C a v r mu h srngh a a1nmyh n , ( 45 a dt a s ei t bet p c u o j cso f l ve ey c te t t 1i h a ds' TR ) n h t h s ma l o ik p be t f ' t tbl ( 51.Shet tfe t ts doesnotha t srngt t tkeat of aj r ( 51. he a e. TR ) esiid ha he ve he te h o a op f a . TR ) I s t t c ur c l est tt r c d doe no s n hor,he o t oncud ha he e or s t uppor t fndi i i ti t La the i ng mplci n he w J e' hypot tca que to t t voc tona e r t tM r .W il e r e esno m a pul tve udg s he i l s i n o he a i l xpe t ha s ls xpe i nc ni a i lm ia i .l ed, l of hedoc o swhoha c m e t d onpl i if sm a pul tve c pa t ha i t tons nde a 1 t tr ve om n e a ntf ni a i a ciy ve s ese t ts i lm ied i t r ofbascaci teswih he ha .W ihoutquesi s h a ugg t d ha he s i t n e ms i tvii t r nds t ton, uc lmiai woul pr ntpe f ma eofm a i notal,oft s de ay wor r esf whih M r . i t ton d eve ror nc ny,f l he e nt r k ol or c s W il i ot wi e ph i ly c pabl ls s her s ysca l a e. I W ake v. n l r Bowe 88 F. 47 50 ( hCi.1 ,heUniedSttsCour ofAppe sf n, 9 2d , 4t r 989)t t ae t al or t Fourh Cic tc m e ed a f l s he t r ui om nt s olow : The pur e ofbrng ng i a voc tona e pe ti t a ss t ALJ i deer ni pos i i n a i l x r s o s it he n t mi ng whe he her i w o k a ia ei hena i nal c t rt e s r va l bl nt to e onom yw hi hi pa tc a cl m a cht s r i ul r ai nt c n pe f m . l or rf avoc tona e r' o ni t be r e ntorhepf l i a ror n de or a i l xpe t pi on o s elva l u,t mus bebas uponac i r tonofa l here de ei t r c d, nd im us be t ed onsde a i l ot vi nc n he e or a t t i r pons t pr n es e o operhy he ialquesinswhih f il s touta lofcai ' pot tc to c ary e 1 l mant s i ime s (iainsomit ) mpar nt. ctto ted . l m uc a t La J nas h s he w udge' hypot tc que ton t t voc tonale r i t sc s di s he ial si o he a i xpe t n hi a e d no i l a 1oft sg fc tphysca lm iatonsdocl e t d b t m e c lr co d,t c t t ncude 1 he i niian i li t i lm n e y he di a e r he our c l onc udes t tt La J ha he w udge' r la e o t voc to le r ' t s i ony i fndi r s dua s e i nc n he a i na xpe ts e tm n i ng e i l f nci na c pa iyf s c fc s n a ywor r es i nots u to l a ct or pe ii , ede t r k ol ,s upporedbys t nta e de e.Gi n t ubsa il vi nc ve s h cr um sa s t cour beive t tt r i ç d c us ' f r r ma oft s c s t t uc ic t nce , he t le s ha he e s t goo a e' o e nd hi a e o he Co m i s o rs t tpr r a co pr he i hy he i lque to c n be putt a qua i i m s i ne o ha ope nd m e ns ve pot tca s i ns a o lfed voc tona ex r . 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How e r t c tc l ve , he our onc udes t t t r i s t nta e de e t s ppo tt Com m i s o r s ha he e s ubs a i l vi nc o u r he s i ne ' dee mi ton t tt tndi o t teai physc a Dr M iha D. il a enotGc r lng. tr na i ha he i ngs f he r tng ii n, . c el W l, r çontoli ' ' Theco tc ude t ts tnta e de e doe nots ur oncl s ha ubsa il vi nc s uppor t La J t he w udge' de e mi tont t s t r nai ha pl i ifr t i s fci ntf t o c pac t ope f m alm ie r a ntf e a ns uf i e unc i nal a iyt r or i t d angeoflg e ri af l a i ht xe ton, ul r nge ofs de ar e ri n, ra 1 t e ri l c i tesco e pl t d w ihi he h e nt y xe to o l of he xe tona a tvii nt m a e t nt ypot tc que t o he i al s i n pos t t voc tona e pe t The c tc l ed o he a i l x r. our oncudest tM r .W il ha m e t bur n ofpr i ha s ls s t he de oof n e t bls ngt ts i dia e f a yt ngm or t n s de a ye ri n a t the ca ct f r sa ihi ha he s s bld or n hi e ha e ntr xe to nd ha r pa iy o s nt r w or i lm ie due t m a pul tve r ti to i t us ofhe ha . 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An a opra e or r ofr m a w ilbe low d o e e tona vi nc nd r um nt4 ppr i t de e nd l e er d t sda nt e hi y. 4I isor ofr a , t Appeal Counci s n t der em nd he s l uggesed t a cons t i exam i ton m i be t hat ulatve na i ght a r raei hi c s ( 1 ) Gi nalh cr u t n e , ndine e s l t c urbeiv t a s h pp op it nt s a e. TR 46 . ve lte ic msa c s a f c s ay he o t le es h t uc acour e i wel advied. s s l s 13 The Cl r i die t d t s nd c r ii co e oft s o ni t a 1c e k s r c e o e e tfed pi s hi pi on o l ouns lofr or e ec d. DA TED : s 1 t da of Se e be ,201 Thi 4 h y pt m r 2. .r' :' 7 / u ' b ' ' i : Y Y Chi fUnie S a e Di t i tJ e t d t t s sr c udge 1 4