Lane v. Colvin

Filing 20

MEMORANDUM OPINION. Signed by Magistrate Judge Pamela Meade Sargent on 03/28/2016. (Bordwine, Robin)

IN THE UNITED STATES DISTRICT COURT
FOR THE WESTERN DISTRICT OF VIRGINIA
BIG STONE GAP DIVISION
JESSICA D. LANE,
Plaintiff
v.
CAROLYN W. COLVIN,
Acting Commissioner of
Social Security,
Defendant

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Civil Action No. 2:14cv00023
MEMORANDUM OPINION
BY: PAMELA MEADE SARGENT
United States Magistrate Judge

I. Background and Standard of Review
Plaintiff, Jessica D. Lane, (“Lane”), filed this action challenging the final
decision of the Commissioner of Social Security, (“Commissioner”), determining
that she was not eligible for disability insurance benefits, (“DIB”), and
supplemental security income, (“SSI”), under the Social Security Act, as amended,
(“Act”), 42 U.S.C.A. §§ 423 and 1381 et seq. (West 2011 & West 2012).
Jurisdiction of this court is pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). This
case is before the undersigned magistrate judge by transfer based on consent of the
parties pursuant to 28 U.S.C. § 636(c)(1). Oral argument has not been requested;
therefore, the matter is ripe for decision.
The court’s review in this case is limited to determining if the factual
findings of the Commissioner are supported by substantial evidence and were
reached through application of the correct legal standards. See Coffman v. Bowen,
829 F.2d 514, 517 (4th Cir. 1987). Substantial evidence has been defined as
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“evidence which a reasoning mind would accept as sufficient to support a
particular conclusion. It consists of more than a mere scintilla of evidence but may
be somewhat less than a preponderance.” Laws v. Celebrezze, 368 F.2d 640, 642
(4th Cir. 1966). ‘“If there is evidence to justify a refusal to direct a verdict were the
case before a jury, then there is “substantial evidence.’”” Hays v. Sullivan, 907
F.2d 1453, 1456 (4th Cir. 1990) (quoting Laws, 368 F.2d at 642).
The record shows that Lane protectively filed her application for DIB and
SSI on February 25, 2011, alleging disability as of July 27, 2010, 1 due to ArnoldChiari malformation, 2 degenerative disc disease of her spine, bipolar disorder,
depression, severe anxiety, severe stress and problems with her knees. (Record,
(“R.”), at 256-269, 286, 291.) The claims were denied initially and on
reconsideration. (R. at 101-14, 115-28, 131-60, 171-73, 178-80, 184-87, 189-91,
192-94, 196-98.) Lane then requested a hearing before an administrative law judge,
(“ALJ”). (R. at 199-200.) A hearing was held by video conferencing on February
1, 2013, at which Lane was represented by counsel. (R. at 37-69.)
By decision dated March 5, 2013, the ALJ denied Lane’s claims. (R. at 2134.) The ALJ found that Lane met the nondisability insured status requirements of
1

Lane filed previous claims for DIB and SSI, which were denied by ALJ opinion dated
July 26, 2010. (R. at 73-89.) The Appeals Council denied her request for review, (R. at 95-99),
and Lane did not appeal that decision. (R. at 40-41.)
2

Arnold-Chiari deformity is a congenital deformity in which the cerebellum and medulla
oblongata in the brain protrude down into the spinal canal. See DORLAND’S ILLUSTRATED
MEDICAL DICTIONARY, (“Dorland’s”), 434 (28th ed. 1994).

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the Act for DIB purposes through December 31, 2012. (R. at 24.) The ALJ also
found that Lane had not engaged in substantial gainful activity since July 27, 2010,
her alleged onset date. 3 (R. at 24.) The ALJ found that the medical evidence
established that Lane suffered from severe impairments, namely generalized
anxiety disorder, social phobia, major depressive disorder, bipolar disorder,
borderline personality disorder, provisional diagnosis of somatization disorder,
post-traumatic stress disorder, status-post Chiari malformation decompression
surgery, left knee disorder, mild back disorder, history of sprained ankles and right
hand fracture, but he found that Lane did not have an impairment or combination
of impairments listed at or medically equal to one listed at 20 C.F.R. Part 404,
Subpart P, Appendix 1. (R. at 24.) The ALJ found that Lane had the residual
functional capacity to perform sedentary 4 work that would allow her to change
positions briefly between sitting and standing, that would not require walking or
standing for more than 15 minutes at a time, did not require her to climb, kneel or
operate foot controls, no more than occasional stooping or crouching and that
allowed frequent, but not constant, reaching, handling and fingering. (R. at 26.)
Therefore, Lane must show that she became disabled between July 27, 2010, the alleged
onset date, and December 31, 2012, in order to be entitled to DIB benefits. Lane must show that
she became disabled between July 27, 2010, and March 5, 2013, in order to be entitled to SSI
benefits.
3

4

Sedentary work involves lifting items weighing up to 10 pounds at a time and
occasionally lifting or carrying articles like docket files, ledgers and small tools. Although a
sedentary job is defined as one which involves sitting, a certain amount of walking or standing is
often necessary in carrying out job duties. Jobs are sedentary if walking or standing are required
occasionally and other sedentary criteria are met. See 20 C.F.R. §§ 404.1567(a), 416.967(a)
(2015).

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The ALJ also found that Lane should avoid heights and machinery and was limited
to short, simple instructions with no close proximity to crowds of unfamiliar
persons. (R. at 26.) The ALJ found that Lane was unable to perform any of her
past relevant work. (R. at 32.) Based on Lane’s age, education, work history and
residual functional capacity and the testimony of a vocational expert, the ALJ also
found that other jobs existed in significant numbers in the national economy that
Lane could perform, including jobs as an assembler and an inspector. (R. at 32-33.)
Thus, the ALJ found that Lane was not under a disability as defined by the Act and
was not eligible for DIB or SSI benefits. (R. at 33-34.) See 20 C.F.R. §§
404.1520(g), 416.920(g) (2015).
After the ALJ issued his decision, Lane pursued her administrative appeals,
but the Appeals Council denied her request for review. (R. at 1-5, 348-51.) Lane
then filed this action seeking review of the ALJ’s unfavorable decision, which now
stands as the Commissioner’s final decision. See 20 C.F.R. §§ 404.981, 416.1481
(2015). The case is before this court on Lane’s motion for summary judgment filed
January 13, 2015, and the Commissioner’s motion for summary judgment filed
April 20, 2015.
II. Facts
Lane was born in 1984, (R. at 87), which classifies her as a “younger
person” under 20 C.F.R. §§ 404.1563(c), 416.963(c). She graduated high school
and attended one year of college classes. (R. at 88, 279-84, 292.) Lane testified that
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she had an infant daughter, but her physical problems made it difficult to perform
such tasks as lifting, bathing and changing her. (R. at 45.) Lane was convicted of
theft and distribution of Lortab in 2011 and served a couple of months in jail. (R. at
46.)
Lane testified that she could not return to her past relevant work as a cashier
because her knees hurt if she stood for too long. (R. at 48.) She said that she could
not return to her past job at a call center because her hands would cramp if she
typed for too long and her eyes would hurt from looking at a computer screen for
too long.(R. at 48.) Lane testified that she suffered from a “spinning” sensation in
her head almost every day and that she would have to lie down and go to sleep to
recover from it. (R. at 51.) Lane said that these spells were often accompanied by a
headache. (R. at 51-52.) Lane said that, if she sat, her back would start hurting,
and, if she stood for too long, her left knee would swell. (R. at 52.) She also said
that her knee had given away on her causing her to fall numerous times. (R. at 5253.) Lane also testified that she had been in counseling for years for problems
sleeping, panic attacks, difficulty being around crowds and crying spells. (R. at 5356.)
Asheley Wells, a vocational expert, also was present and testified at Lane’s
hearing. (R. at 65-68.) Wells was asked to consider a hypothetical individual of
Lane’s age, education and work history, who was able to perform sedentary work
with a sit-stand option, with no climbing, kneeling and use of foot controls and no
more than occasional shifting and crouching. (R. at 66.) The ALJ also asked Wells
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to assume that this person should avoid heights and dangerous machinery, could
perform frequent, but not constant, reaching, handling and fingering, and could
follow short, simple instructions with no close proximity to crowds of unfamiliar
persons. (R. at 66.) Wells stated such a person could perform the jobs of an
assembler 5 and an inspector. (R. at 66-67.) Wells stated that these jobs would not
require a person to stand or walk more than 15 minutes at a time. (R. at 67.) Wells
stated that there would be no jobs available should the individual be absent two
times per month. (R. at 67.)
In rendering his decision, the ALJ reviewed medical records from Indian
Path Medical Center; University of Virginia Health Systems; Clinch River Health
Services; Welmont Holston Valley Medical Center; B. Wayne Lanthorn, Ph.D.;
Karen Odle, a licensed professional counselor; Mountain View Medical Center;
Heart Center; 1st Step Rehab; Dan Levesque, D.C.; Wise County Behavioral
Health Services; Clinch River Pharmacy; Wal-Mart Pharmacy; Weber City Drug
Center; Food City Pharmacy; Johnson City Medical Center; Lonesome Pine
Hospital, Frontier Health; Woodridge Hospital; Norton Community Hospital; Dr.
Felix Shepard, Jr., M.D.; Holston Valley Imaging Center; Washington County
Medical Center; Dr. Eric Parks, M.D.; Solutions Counseling, LLC; Dr. Jeffrey
Marchessault, M.D.; Kaye Weitzman, a licensed clinical social worker;
Cardiovascular Associates; and Watauga Orthopedics. Lane’s attorney also
submitted additional medical records from Robert S. Spangler, Ed.D.;
5

The hearing recording is not audible at this point, but the DOT Listing cited, 713.687018, is for an assembler job.

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Cardiovascular Associates; Watauga Orthopedics; Washington County Medical
Clinic; and Clinch River Health Services, Inc., to the Appeals Council. 6 Much of
this medical evidence is for treatment rendered before Lane’s July 26, 2010,
alleged onset date, but it is included where relevant with regard to her ongoing
impairments.
Lane presented to the Emergency Department at Lonesome Pine Hospital,
(“Lonesome Pine”), on May 2, 2007, complaining that she had “twisted knee the
other day.” (R. at 1041-42.) Lane said that she had slipped on a wet surface. (R. at
1041.) The treating physician noted a normal inspection of the knee with some
tenderness, and he diagnosed left knee sprain. (R. at 1041-42.) X-rays of Lane’s
left knee taken at Lonesome Pine on May 12, 2007, showed mild degenerative
arthritic changes. (R. at 1040.)
Lane presented to the Emergency Department at Indian Path Medical Center,
(“Indian Path”), on February 22, 2008, for complaints of cutting both wrists that
night. (R. at 1085.) Lane said that she had been depressed for years. (R. at 1085.) It
was noted that Lane had suicidal ideations and had been mutilating herself by
cutting her forearms. (R. at 1087.) Lane admitted that she had been smoking three
to four marijuana cigarettes a day. (R. at 1087.) The treating physician noted that
the cuts on Lane’s forearms were only superficial scratches. (R. at 1089.) Lane was
6

Since the Appeals Council considered and incorporated this additional evidence into the
record in reaching its decision, (R. at 1-5), this court must also take these new findings into
account when determining whether substantial evidence supports the ALJ's findings. See Wilkins
v. Sec'y of Dep't of Health & Human Servs., 953 F.2d 93, 96 (4th Cir. 1991).

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diagnosed with depression and self-mutilation. (R. at 1090.) Lane was transferred
to inpatient psychiatric treatment at Woodridge Hospital, (“Woodridge”). (R. at
1088.)
Upon admission at Woodridge on February 22, 2008, Lane told her
attending physician, Dr. Maria T. M. Liquete, M.D., that she lived with her parents
and worked at Pal’s. (R. at 1181.) Lane said that she had suffered from depression
and anxiety for years and had become increasingly more depressed over the
previous couple of months. (R. at 1181.) Lane said that she had smoked marijuana
every day that it had been available since age 19. (R. at 1181.) Lane said that she
had plans to shoot herself and recently attempted to smother herself with a pillow.
(R. at 1181.) Lane said that she would go into rages at times and break things at
home. (R. at 1181.) At other times, her mood was euphoric. (R. at 1181.) She
reported decreased appetite and energy recently, but she admitted she suffered
from insomnia for the previous two months. (R. at 1181.) Dr. Liquete’s physical
examination showed no musculoskeletal tenderness, normal range of motion in all
extremities with no weakness or atrophy. (R. at 1181.) Dr. Liquete diagnosed
bipolar disorder. (R. at 1182.) She placed Lane’s then-current Global Assessment
of Functioning, (“GAF”) 7 score at 30. 8 (R. at 1182.)

7

The GAF scale ranges from zero to 100 and “[c]onsider[s] psychological, social, and
occupational functioning on a hypothetical continuum of mental health-illness.” DIAGNOSTIC
AND STATISTICAL MANUAL OF MENTAL DISORDERS FOURTH EDITION, (“DSM-IV”), 32
(American Psychiatric Association 1994).
8

A GAF score of 21-30 indicates “[b]ehavior … considerably influenced by delusions or

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In her Psychiatric Evaluation, Dr. Liquete noted that Lane stated that she had
a long history of depression and severe mood swings. (R. at 1183.) Lane stated
that she would “fly off the handle” for very minor reasons. (R. at 1183.) Lane
complained of severe depression, restlessness, racing thoughts and difficulty
sleeping. (R. at 1183.) She admitted difficulty expressing her moods to others and
said she would often hide how she felt. (R. at 1183.) Lane admitted to smoking
marijuana, but she claimed she did so to ease her joint pains rather than because of
her moods. (R. at 1183.) Dr. Liquete said that Lane also reported some vague
auditory hallucinations. (R. at 1183.)
A February 26, 2008, Discharge Summary from Woodridge states that Lane
was admitted on February 22, 2008, from the Emergency Department at Indian
Path after cutting her wrists in a suicide gesture. (R. at 1179.) Lane complained of
increasing depression over the previous couple of months. (R. at 1179.) She stated
that she had cut her wrists on several occasions in the past. (R. at 1179.) Dr.
Liquete stated that Lane had multiple superficial scratches on the inner aspects of
both forearms. (R. at 1179.) Dr. Liquete stated that Lane had been started on
Lithium and Trazodone, was stabilized, and her hospital course was unremarkable.
(R. at 1179.) Lane denied any auditory or visual hallucinations. (R. at 1179.) Dr.
Liquete diagnosed Lane with bipolar disorder and marijuana abuse. (R. at 1179.)

hallucinations OR serious impairment in communication or judgment … OR inability to function
in almost all areas….” DSM-IV at 32.

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She stated that Lane’s GAF score was 50-559 upon discharge. (R. at 1179.)
Lane was treated at Wise County Behavioral Health from March 6, 2008, to
November 14, 2008, when she requested that her treatment continue with Karen
Odle at Clinch River Health Services, Inc., (“Clinch River”). (R. at 970-1005.)
Lane was first seen for crisis intervention by Melissa F. “Polly” Easterling on
February 29, 2008, upon her discharge from Woodridge. (R. at 1004-05.)
Easterling noted that stated that every day she seemed to feel better. (R. at 1004.)
Easterling noted that Lane denied any suicidal or homicidal ideations or auditory
or visual hallucinations. (R. at 1004.) Lane did report feeling paranoid at times,
like people were talking about her behind her back. (R. at 1004.) Lane also
admitted that she had used marijuana since her discharge. (R. at 1004.) Lane
reported a history of cutting herself and problems controlling her thoughts. (R. at
1004.) Easterling gave a provisional diagnosis of bipolar disorder and cannabis
abuse. (R. at 1005.) She assessed Lane as exhibiting paranoia, flight of ideas,
depression, anxiety, a history of suicidal ideations and head injuries, decreased
appetite and self-mutilation. (R. at 1005.)
Easterling completed an intake assessment on Lane on March 6, 2008. (R. at
994-1001.) Easterling stated that Lane had stable housing with her parents,
9 A GAF score of 41-50 indicates that the individual has “[s]erious symptoms ... OR any
serious impairment in social, occupational, or school functioning....” DSM-IV at 32. A GAF
score of 51-60 indicates that the individual has “[m]oderate symptoms … OR moderate difficulty
in social, occupational, or school functioning….” DSM-IV at 32.

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although she had no income. (R. at 994.) Easterling stated that Lane was “thinking
of applying for disability due to knee, head and back injuries from multiple car
accidents.” (R. at 994.) Lane stated that she had worked at numerous jobs since age
17, but she was unable to hold the jobs for any extended period of time. (R. at
995.) Easterling did note that Lane was a volunteer firefighter, who helped the
Dungannon Fire Department with grants and fundraisers. (R. at 995.)
Lane claimed she suffered from hyperinsulinenmia, or too much insulin in
her blood stream, which made her blood sugar levels drop, chronic pain and carpal
tunnel syndrome. (R. at 995.) Lane said that she had good support from her family
and friends and that she spent her time with friends swimming, playing with kids,
listening to music, signing and dancing. (R. at 996.) Easterling noted that Lane was
able to complete all activities of daily independent living with no intervention. (R.
at 997.) She also noted that Lane had experienced significant decompensation in
the previous three months, in that she recently had been psychiatrically
hospitalized for suicidal thoughts and gestures. (R. at 997.) Lane stated that she
was not smoking marijuana “as often as before” and that she would like to quit. (R.
at 999.)
Lane saw Dr. Jennifer Wisdom-Schepers, M.D., a psychiatrist with Wise
County Behavioral Health, on March 10, 2008, along with Easterling. (R. at 98487.) Dr. Wisdom-Schepers noted that Lane had recently been discharged for a
psychiatric hospitalization for a suicidal gesture of cutting herself. (R. at 984.)
Lane reported a history of mood swings, including anger, depression and
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happiness, lasting from a few days to a month. (R. at 984.) Lane reported feeling
better since beginning treatment with Lithium and Trazodone. (R. at 985.) Lane
reported that she drank alcohol and smoked marijuana on occasion. (R. at 984.)
She said that she smoked an average of one joint every two days for pain and to
make herself “hyper and giggly.” (R. at 984.)
Lane claimed a history of multiple suicide attempts, including one when she
was three years old when she tried to smother herself with a pillow after being
beaten by her father. (R. at 984.) Lane stated that she had cut her wrists before and
had thought of hanging or shooting herself. (R. at 984.) She stated that she had
gone as far as buying a gun. (R. at 984.) Lane said that she had treated briefly with
a therapist when she was 19. (R. at 984.) Lane said that she suffered from
hyperinsulinemia and multiple joint problems due to a history of multiple traumatic
events including motor vehicle accidents, horse accidents and physical abuse. (R.
at 984.) Lane claimed that she was physically and sexually abused as a child. (R. at
984.) She said that she was seeking disability benefits based on her physical
problems. (R. at 984.)
Dr. Wisdom-Schepers stated that Lane was alert and oriented, calm and
cooperative and made good eye contact. (R. at 984.) She noted no abnormal
mannerisms, her speech was fluent, and psychomotor activity was normal. (R. at
984-85.) Lane reported that her mood was good, and Dr. Wisdom-Schepers noted
that Lane’s affect was euthymic with no symptoms of psychosis or gross cognitive
impairment. (R. at 985.) Dr. Wisdom-Schepers diagnosed Lane with bipolar
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disorder, not otherwise specified; and cannabis abuse. (R. at 985.) She placed
Lane’s then-current GAF score at 65, 10 with her highest score in the past year
being unknown. (R. at 985.) Dr. Wisdom-Schepers “strongly encouraged” Lane to
reconsider applying for disability given her age and the fact that she was “not
psychiatrically disabled” in her opinion. (R. at 985.) Lane revealed that she was
seeking disability because her younger brother had Down Syndrome, and her
parents had requested that she assist with his care. (R. at 985.) Lane was advised to
continue taking Lithium and Trazodone, but to discontinue the use of marijuana or
alcohol while on Lithium. (R. at 985.)
Lane also saw Easterling on this date and reported that she had been doing
good. (R. at 987.) She stated that her medications were working well with no side
effects and that with each passing day she felt less depressed and teary. (R. at 987.)
Easterling noted that Lane denied any suicidal or homicidal ideations or auditory
or visual halluncinations, was alert and oriented, her thought process was clear and
goal-directed, her speech was unremarkable, her mood was euthymic with
congruent affect, her interactions were friendly and appropriate, her hygiene was
good, and she maintained good eye contact. (R. at 987.) Easterling noted that Lane
appeared to be stable. (R. at 987.)
Easterling completed a DSM-IV Assessment on March 10, 2008, which
A GAF score of 61-70 indicates that the individual has “[s]ome mild symptoms ... OR
some difficulty in social, occupational, or school functioning....” DSM-IV at 32.
10

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stated that Lane suffered from bipolar disorder, not otherwise specified; cannabis
abuse; and a borderline personality disorder. (R. at 988-89.) She noted that Lane
reported that she was unable to work. (R. at 988.) Easterling assessed Lane’s thencurrent GAF score at 50. (R. at 988.) Easterling noted that Lane had average or
above intelligence, but she was impulsive and engaged in self-sabotaging patterns.
(R. at 988-89.)
Another report from this date states that Lane claimed that she was molested
by her older sister and two neighbors from the ages of five to seven. (R. at 990.)
She also claimed that she was physically abused by her father during her
childhood, in that he beat her as a form of discipline. (R. at 990.) Lane reported a
long history of depression and anxiety, and she claimed that she had cut her wrists
six to seven times, had plans to shoot herself and once tried to smother herself with
a pillow. (R. at 990.) She stated that she would go into rages and break things at
home. (R. at 990.) She also said that she felt euphoric at times. (R. at 990.) She
reported a decrease in appetite, energy and sleep. (R. at 990.) It was noted that
Lane exhibited mild delusions and decreased appetite, moderate decrease in energy
or fatigue, academic or work inhibition, aggression or rage, anxiety, worrying,
distractibility, impaired judgment, poor attention or concentration, pressured
speech, racing thoughts, paranoid ideation, recurrent recollection of distressing
events, anger, depressed mood, feeling worthless, helplessness, hopelessness,
hostility, marked mood shifts and insomnia and severe self-injurious behavior,
irritability, low self-esteem, tearfulness and report of abuse or neglect. (R. at 991.)
It was noted that Lane had used marijuana daily for more than two years. (R. at
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991.) At another point, it was noted that Lane had used marijuana for the previous
five years. (R. at 992.)
It also was noted that Lane complained of problems with blindness or
serious vision problems, deafness or serious hearing problems, chronic physical
problems with her back/spine/limbs and a history of head injuries. (R. at 991.)
Lane stated that she would become blind at times with stabbing pain behind her
right eye that would last for five minutes. (R. at 992.) She also complained of
hearing loss with a ringing in her ears, which prevented her from hearing others
talk. (R. at 992.) It was recommended that Lane receive a psychiatric referral and
case management services. (R. at 992-93.)
Lane saw Easterling again on March 18, 2008, and reported that she was
doing well. (R. at 982.) Lane told her that she was planning to attend a CPR/First
Aid course later that night for the volunteer fire department. (R. at 982.) Lane said
that she had not smoke marijuana in the past five days and would like to quit. (R. at
982.) Lane said that she enjoyed going out with friends and that she believed that
helped her mood. (R. at 982.) She said that she was taking her medication as
prescribed with no side effects. (R. at 982.) Easterling noted that Lane was alert
and oriented, her thought process was clear and goal-directed, her speech was
unremarkable, her mood was euthymic with congruent affect, her interactions were
friendly and appropriate, and her hygiene was good. (R. at 982.) She stated that
Lane appeared to be stable. (R. at 982.)

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Lane saw Easterling again on April 8, 2008, for a routine visit. (R. at 981.)
Lane reported taking her medications as prescribed with no side effects, no
problems with sleep or appetite, no new symptoms or increase in symptoms and no
suicidal or homicidal ideations or auditory or visual hallucinations. (R. at 981.)
Lane said that she was smoking marijuana one or two times a week. (R. at 981.)
She stated that she had been babysitting her niece and nephew and a little brother
who is disabled. (R. at 981.) Easterling noted that Lane was alert and oriented, her
mood was euthymic with congruent affect, she made good eye contact, and she
was well-groomed. (R. at 981.) She noted that Lane’s speech was clear, coherent
and goal-directed, and her interactions were friendly and cooperative. (R. at 981.)
Easterling stated that Lane appeared psychiatrically stable with no evidence of
psychosis. (R. at 981.)
Lane saw Easterling for a routine visit on May 13, 2008. (R. at 980.) Lane
stated that she was taking her medication as prescribed with no side effects. (R. at
980.) Lane reported that she was volunteering, and she recently got a new dog,
which she took everywhere she went. (R. at 980.) Lane stated that she was
smoking marijuana, but only about once a week. (R. at 980.) She reported no
problems with sleep or appetite and no new psychiatric symptoms. (R. at 980.)
Easterling stated that Lane was alert and oriented, her mood was euthymic, her
affect was congruent with mood, she made good eye contact and appeared wellgroomed. (R. at 980.) She reported that Lane’s interactions were friendly and
cooperative. (R. at 980.) Easterling stated that Lane appeared psychiatrically stable
with no evidence of psychosis. (R. at 980.)
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Lane saw Easterling for routine case management services on June 6, 2008.
(R. at 979.) Lane stated that she had been doing fairly well with no new psychiatric
symptoms. (R. at 979.) Lane stated that she was taking her medication as
prescribed with no side effects. (R. at 979.) She reported no problems with sleep or
appetite, although she said that she slept only six to seven hours a night. (R. at
979.) Lane stated that she was smoking about one joint of marijuana a week. (R. at
979.) Lane said that she went out with friends and used her dog for support in an
effort to reduce the amount of marijuana she smoked. (R. at 979.) Easterling noted
that Lane was oriented, her interactions were friendly and appropriate, her mood
was euthymic with congruent affect, and there was no evidence of psychosis. (R. at
979.) She said that Lane appeared to be psychiatrically stable. (R. at 979.)
Lane saw Easterling, again, for counseling on July 24, 2008. (R. at 976.)
Lane reported that she had been doing well and had decreased the amount of
marijuana she was smoking. (R. at 976.) Lane stated that she had a new boyfriend
and was spending time with friends almost every day, which was her main coping
skill. (R. at 976.) Lane reported no new psychiatric symptoms, no auditory or
visual hallucinations, no suicidal or homicidal ideations and no problems with
sleep or appetite, despite missing a few doses of her medication recently. (R. at
976.) Easterling noted that Lane was oriented times four, her interactions were
friendly and appropriate, her mood was euthymic with congruent affect, and there
were no evidence of psychosis. (R. at 976.) Easterling stated that Lane appeared to
be psychiatrically stable. (R. at 976.)

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Lane saw Easterling again for counseling on September 11, 2008. (R. at
975.) Lane stated that she was doing fairly well, but recently got into trouble for
shoplifting. (R. at 975.) Lane said that she did not know why she did it and that
she knew it is wrong. (R. at 975.) Lane stated that she was trying to stay close to
home and away from friends who were bad influences on her. (R. at 975.) Lane
said that she was doing some volunteer work at Dungannon Elementary School.
(R. at 975.) Lane also stated that she was no longer taking her psychiatric
medication because it was causing her to feel bad. (R. at 975.) Lane reported some
suicidal thoughts, but no plan or intent. (R. at 975.) Lane stated that she continued
to smoke marijuana occasionally, but she stated that she did not smoke it as often
as she did previously because of a lack of money. (R. at 975.) Lane reported
getting eight hours of sleep a night. (R. at 975.) Easterling noted that Lane was
oriented, her interactions were friendly and appropriate, her mood was dysthymic
with tearful affect, and she showed no evidence of psychosis. (R. at 975.) She
stated that Lane appeared to be psychiatrically stable. (R. at 975.)
Lane was seen by Dr. Wisdom-Schepers on September 18, 2008, for
treatment for bipolar disorder and cannabis abuse. (R. at 972-73.) Lane stated,
“Today I’m fine,” but she reported problems with mood swings lasting hours to
days. (R. at 972.) Lane stated that she had gotten into trouble for shoplifting again.
(R. at 972.) Lane reported that she had tried to get pregnant for years, but had not
been successful, though she had been told that there was no medical reason she
could not become pregnant. (R. at 972.) Lane stated that she had stopped her
psychiatric medication because she felt sedated on it. (R. at 972.) She said that she
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was willing to restart the medication at a lower dosage. (R. at 972.) Dr. WisdomSchepers noted that Lane was alert, oriented, calm, cooperative and made good eye
contact. (R. at 972.) Lane reported her mood as “good today,” but it was noted that
she appeared mildly constricted. (R. at 972.) Dr. Wisdom-Schepers noted that Lane
presented no symptoms of psychosis or gross cognitive impairment. (R. at 972.)
Lane denied any suicidal or homicidal ideations. (R. at 972.) Lane was prescribed
Lithium and Trazodone. (R. at 972-73.)
Lane saw Easterling for routine case management services on October 14,
2008. (R. at 971.) On this date, Lane reported that she had been doing well. (R. at
971.) She stated that she had not smoked marijuana in two weeks due to not having
any, but she also said that she no longer wished to use it. (R. at 971.) Lane reported
that she was scheduled to appear in court on November 20, 2008, on shoplifting
charges. (R. at 971.) Lane reported no new psychiatric symptoms and no suicidal
or homicidal ideations. (R. at 971.) Lane stated that she was taking her medications
as prescribed with no side effects. (R. at 971.) She reported no auditory or visual
hallucinations and no problems with sleep or appetite. (R. at 971.) Easterling noted
that Lane was oriented, her interaction was friendly and appropriate, her mood was
euthymic with congruent affect, and there was no evidence of psychosis. (R. at
971.) She stated that Lane appeared to be psychiatrically stable. (R. at 971.)
Lane presented to the Johnson City Medical Center Emergency Department
on March 18, 2009, and stated “I will kill myself before I go to jail.” (R. at 103132.) The attending physician noted that Lane gave a history of depression, was
-19-

tearful and said that she had “violated probation” and she did not “want to go to
court tomorrow.” (R. at 1031, 1073.) The physician noted that Lane’s
consciousness, orientation, attention, memory, mood, affect, appearance, speech,
judgment, abstractions, general information, though content, insight, spatial
perceptions and neurological examination all were normal. (R. at 1031-32.) The
physician diagnosed anxiety and depression with suicidal ideations. (R. at 1032.)
Lane saw a crisis mental health worker and was later discharged. (R. at 1078.)
The crisis mental health worker’s notes from March 18, 2009, state that
Lane did not meet the criteria for either involuntary commitment or voluntary
psychiatric hospitalization. (R. at 1176, 1177.) The health worker’s notes state that
Lane exhibited good attention/concentration and was alert and oriented,
cooperative with appropriate affect exhibited no evidence of agitation and made
good eye contact. (R. at 1175.) Lane said that she was “stressed out.” (R. at 1175.)
While she denied experiencing any hallucinations on that day, Lane stated that she
sometimes would hear indistinguishable voices. (R. at 1175.) The worker stated
that Lane’s judgment, impulse control and insight were all fair. (R. at 1175.) She
placed Lane’s then-current GAF score at 45.
On July 16, 2009, Lane sought treatment at the Emergency Department at
Indian Path for left knee pain. (R. at 1066-67.) An x-ray of her left knee showed
joint space narrowing at the medial compartment of the knee with mild osteophyte
formation in all compartments compatible with mild osteoarthritis, particularly
involving the medial compartment. (R. at 1068.) On November 6, 2009, Lane
-20-

sought treatment at the Emergency Department at Indian Path for left knee pain.
(R. at 1059-60.) An x-ray of her left knee showed some mild narrowing of the
medial joint space consistent with osteoarthritis, which was unchanged from July
16, 2009. (R. at 1061.)
On November 25, 2009, Lane underwent surgery for a left knee medial
meniscus tear with partial anterior cruciate ligament, (“ACL”), involvement of
anterior fibers and degenerative joint disease of the medial femoral condyle. (R. at
622-24, 712-14.) Lane sought treatment at the Emergency Department at Holston
Valley Medical Center, (“Holston Valley”), on November 30, 2009, for complaints
of pain in her left knee after surgery. (R. at 465-66.) X-rays taken of Lane’s left
knee showed osteoarthritis, but no acute abnormality. (R. at 467.) A follow-up
examination on December 8, 2009, with Dr. Eric W. Carson, M.D., showed some
mild swelling with no erythema or drainage. (R. at 616.) Dr. Carson removed
Lane’s sutures. (R. at 616.) Dr. Carson noted that Lane had been ambulating
without difficulty and that her pain was “well-controlled.” (R. at 616.) Dr. Carson
advised Lane to continue to be weight bearing as tolerated, and he ordered physical
therapy to work on quad strengthening. (R. at 616.) He prescribed Vicodin and
ordered a follow-up examination in four weeks. (R. at 616.) A follow-up
examination on March 1, 2010, with Dr. Carson showed no swelling, erythema,
drainage or sign of infection. (R. at 610.) Lane had good range of motion in her
knee with no joint line tenderness. (R. at 610.) Dr. Carson noted that Lane had not
attended physical therapy as recommended and had “no interest in doing so.” (R. at
610.) Dr. Carson gave Lane an injection in her left knee. (R. at 610.)
-21-

Lane sought treatment at the Emergency Department at Mountain View
Regional Medical Center, (“Mountain View”), on January 13, 2010, for mild lower
back, left knee and right hip pain due to a fall. (R. at 763-65.) Lane was given
Lortab and Flexeril, her knee was wrapped in an Ace bandage, and she was
discharged. (R. at 765.) She returned on February 4, 2010, for an injury to her left
knee when she fell. (R. at 756, 762.) She was diagnosed with a knee contusion,
given Motrin and released. (R. at 757, 762.) Lane returned to the Emergency
Department at Mountain View for right-sided lower back pain on July 25, 2010.
(R. at 754-55.) Lane also was treated and released again on October 8, 2010, for
injuries she sustained in a motor vehicle accident. (R. at 750-53, 369-73.) X-rays of
her left ankle showed some soft tissue swelling. (R. at 752.) Lane was diagnosed
with a contusion/sprain of her ankle. (R. at 371.)
In April 2010, Lane had Chiari malformation decompression surgery with
C1 partial laminectomy. (R. at 584-85, 591-92.) On April 9, 2010, Lane presented
to the Emergency Department at Indian Path with complaints of a “vortex”
headache with pain of a 10 on a 10-point scale. (R. at 1051-55.) Lane gave a
history of brain surgery on the previous Friday. (R. at 1054.) On this hospital note,
it states that Lane admitted to illicit drug use. (R. at 1051.) At another point, the
records show that Lane stated that she smoked a marijuana “joint” daily. (R. at
1054.) On April 16, 2010, Lane presented to the Emergency Department at Indian
Path, complaining of a throbbing headache and vomiting since her recent surgery.
(R. at 1047.) Lane reported that she came to Indian Path because her surgeon
would not call her in any pain medication. (R. at 1048.) The physician
-22-

recommended that Lane return to see her surgeon and diagnosed her with chronic
headache. (R. at 1048.)
Lane returned and was hospitalized at UVA Health Systems from April 1719, 2010, for complaints of headache with persistent nausea and vomiting postsurgery. (R. at 538, 542-43, 660-72, 1185-86, 1188-1203.) On May 16, 2010, Dr.
John A. Jane, Sr., M.D., Ph.D., with the UVA Health Systems Department of
Neurological Surgery, reviewed x-rays of Lane’s spine and stated that Lane had
“some mild thoracic degenerative changes,” which could account for her midthoracic pain. (R. at 564.) He recommended physical therapy. (R. at 564.) A May
19, 2010, letter from Dr. Jane stated that he had seen Lane for neurosurgical follow
up and that she had “not gotten quite as good as she would like to be,” although Dr.
Jane noted that her headaches were “certainly much improved.” (R. at 574.) A
follow-up MRI of Lane’s brain and cervical and thoracic spine, taken on June 11,
2010, showed post-surgical changes in her brain with no evidence of disc
protrusion, spinal stenosis or cord compression in her cervical or thoracic spine.
(R. at 353-55.) The study did show mild, multilevel degenerative disc disease in
the thoracic spine. (R. at 354.)
Lane was examined by Dr. Kelly C. Gwathmey, M.D., a neurology resident
at UVA Health Systems, on July 11, 2010, (R. at 392-95.) Lane told Dr.
Gwathmey that she had suffered from headaches most of her life. (R. at 393.) She
described her headaches as sharp, shooting pain behind her right eye, and she said
that she averaged three headaches a week. (R. at 393.) She complained of her
-23-

vision “going black” on occasion with headaches, but she denied seeing an aura
with headaches. (R. at 393.) Lane admitted that she drank four to five caffeinated
sodas a day and that she smoked marijuana daily. (R. at 393-94.) Dr. Gwathmey
diagnosed Lane as suffering from migraine headaches. (R. at 394.) He advised that
she decrease her caffeine consumption. (R. at 394.)
Lane was treated at Clinch River for a number of ailments from July 2008 to
April 2013. Lane was seen by Dr. Nazia I. Shehzad, M.D., on July 7, 2008, for
problems with her left knee. (R. at 1010-11.) Lane said that she had experienced
problems with her knee for years after injuring it in a motor vehicle accident. (R. at
1010.) Lane said that, when she would bend her knee or sit, it would often swell up
and hurt. (R. at 1010.) She said her right knee hurt her, too. (R. at 1010.) Lane
claimed that bad knees “run in family,” but Dr. Shehzad noted that Lane was 5
feet, 4.5 inches tall and weighed 274 pounds. (R. at 1010.) Lane also told Dr.
Shehzad that “sometimes something pops in her belly and at times at different parts
of her body, feels like pain but not sure, goes away on [itself] and not sure [what] it
is.” (R. at 1010.)
Lane stated that she had been psychiatrically hospitalized in February 2008
for a suicide attempt and that she was in mental health treatment. (R. at 1010.) She
complained of anxiety and stressors, but denied any suicidal ideations. (R. at
1010.) Oddly, Lane denied any drug use. (R. at 1010.) Dr. Shehzad noted that Lane
was morbidly obese, alert, oriented and pleasant. (R. at 1010.) Dr. Shehzad stated
that her exam of Lane’s right knee was normal other than for positive McMurray
-24-

sign and moderate cracking and grinding when flexed. (R. at 1010.) Her report
makes no mention of any findings with regard to Lane’s left knee. (R. at 1010-11.)
Dr. Shehzad said that she would review a recent MRI of Lane’s left knee, and she
recommended that she lose weight and use ibuprofen. (R. at 1011.)
Lane saw Dr. Gary E. Michael, M.D., on July 21, 2008, for continued
complaints of knee pain, worse when standing. (R. at 1171.) Dr. Michael found no
swelling or redness in Lane’s left knee, with full range of motion with pain and
tenderness in the medial-posterior jointline. (R. at 1171.) Dr. Michael noted that an
MRI showed a meniscus tear, and he prescribed Celebrex and a Toradol injection.
(R. at 1171.) Dr. Michael said he would refer Lane to the Department of
Orthopedic Surgery at UVA. (R. at 1171.) When Lane returned to see Dr. Todd A
Cassel, M.D., on August 22, 2008, for treatment of bronchitis, her weight was up
to 256.5 pounds. (R. at 1009.)
Lane saw Dr. Michael on October 8, 2008, complaining of constant neck
pain and pressure without radiation. (R. at 1165.) Lane also complained of back
pain without radiation, tingling or numbness. (R. at 1165.) Dr. Michael found no
tenderness in Lane’s vertebral spine, in her neck or upper back or in her ribs. (R. at
1165.) He found paraspinal spasm present on the left side of her neck, limited neck
range of motion in all directions, trapezius tenderness on the left side, normal range
of motion of the shoulder joint, normal motor strength, tender rhomboid muscle,
paraspinal tenderness, negative straight leg raising tests bilaterally, normal motor
system bilaterally in her lower extremities and an unremarkable gait. (R. at 1165.)
-25-

Dr. Michael advised Lane to start exercises for her neck problems and to call her
mental health case worker. (R. 1166.)
Lane returned to see Sabrina F. Mitchell, F.N.P., a family nurse practitioner,
on October 17, 2008, complaining of pain and pressure in the back of her head. (R.
at 1162.) Lane said her head hurt constantly, and it made her dizzy. (R. at 1162.)
Lane said she also had felt weak for years, with tingling and numbness in her left
arm since 2000. (R. at 1162.) Lane denied any vision changes. (R. at 1162.) She
complained of short-term memory problems. (R. at 1162.) Lane also stated that she
had an attorney who was helping her seek disability benefits. (R. at 1162.)
Mitchell reviewed previous MRI imaging of Lane’s brain and noted that it
showed a Chiari I malformation of the posterior fossa with no evidence of
secondary hydrocephalus. (R. at 1163.) Mitchell noted that a “Chiari I
malformation is thought to be related to fetal development with a downward
displacement of more than 4mm of the cerebellar tonsils beneath the foramen
magnum into the cervical spine canal. …[S]ymptoms can include head and neck
pain with occipital headaches, vision changes, and photophobia which the patient
reports has occurred since before 2000 when the malformation was discovered.”
(R. at 1163.) Mitchell started Lane on muscle relaxers -- Baclofen of the day and
Flexeril at night. (R. at 1163.)
Lane saw Dr. Michael on November 19, 2008, and told him that she had
stopped taking her psychiatric medication. (R. at 1160.) She claimed she stopped
-26-

taking Lithium because it was making her feel nauseated. (R. at 1160.) Lane
described her mood off of her medication as “more bitchy,” agitated and irritated
by anyone making noise. (R. at 1160.) Lane stated that she was not hyper, but she
was experiencing more trouble falling and staying asleep. (R. at 1160.) Dr.
Michael prescribed Seroquel for Lane’s bipolar disorder. (R. at 1160.) Lane saw
Dr. Shehzad again on November 20, 2008, and her weight was listed as 264
pounds. (R. at 1007.)
Lane saw Mitchell on February 27, 2009, complaining of back and neck pain
with headaches in the back of her head. (R. at 1151.) Lane also complained of
tingling and numbness in her hands and, sometimes in her feet, and limited range
of motion due to pain. (R. at 1151.) Lane denied any radiation of her pain or bowel
or bladder incontinence. (R. at 1151.) Lane said that she had been in nine motor
vehicle accidents and had experienced back pain for the previous eight years. (R. at
1151.) Lane claimed that she experienced sharp stabbing pain that came and went
with a constant ache. (R. at 1151.) Mitchell noted vertebra tenderness with
palpation at the C5 through C7, T8 through L1 and L3 through sacral vertebra
levels. (R. at 1152.) Mitchell noted lumbar muscular tenderness and tightness, with
no rhomboid tenderness, with bilateral sternocleidomastoid and trapazius
tenderness, negative straight leg raising tests bilaterally and a normal gait. (R. at
1152.) Mitchell prescribed Naprosyn and Baclofen and recommended Lane
continue taking Flexeril at bedtime. (R. at 1152.) February 28, 2009, x-rays of
Lane’s spine showed mild degenerative changes in her lower thoracic spine with
no acute abnormality. (R. at 1273-74.)
-27-

On March 11, 2009, Lane told Mitchell that she had pain the night before
that felt like someone was stabbing her in her right side, then the pain went to her
foot. (R. at 1148.) Lane said that it felt like electricity ran down to her right foot.
(R. at 1148.) She said the pain occurred while she was sitting in a vehicle and that
it lasted for a few minutes and then was gone. (R. at 1148.) She complained of
limited range of motion secondary to pain, but she denied any radiation of pain,
trauma or injury or any tingling or numbness. (R. at 1148.) Lane stated that she had
suffered from headaches since age 12 after she was thrown from a horse, hit her
head and blacked out. (R. at 1148.) Lane complained of two additional head
injuries in motor vehicle accidents. (R. at 1148.) Lane stated that she experienced
spells where everything would go black, but she could still hear what was going on
around her. (R. at 1148.) She stated that this had been getting worse over the
previous few months. (R. at 1148.) Mitchell noted no vertebra tenderness upon
palpation, mild lumbar muscular tightness without tenderness and mild rhomboid
muscular tightness, extending from the trapezius and sternocleidomastoid muscles
with no tenderness. (R. at 1149.)
Lane was seen by Karen Odle, L.P.C., a licensed professional counselor,
from December 10, 2008, to March 15, 2010. (R. at 945-48.) On December 10,
2008, Lane saw Odle for individual therapy, during which they discussed Lane’s
shoplifting behavior. (R. at 948.) Lane complained of mild depression, mild
anxiety, mild insomnia, moderate irritability/anger, mild crying spells and no
suicidal or homicidal ideations. (R. at 948.) Odle noted that, based on her mental
status examination, Lane’s mood was depressed and irritable, and she was not
-28-

suffering from any paranoia or delusions. (R. at 948.) Odle noted that Lane’s
judgment/insight was fair. (R. at 948.) Lane saw Odle again on January 20, 2009,
on which date Odle noted that Lane’s participation in individual therapy was
“problematic.” (R. at 947.) Odle noted that Lane was angry and irritable toward
her, which made it difficult to discuss her current mood. (R. at 947.) On this
occasion, Lane complained only of moderate to severe irritability/anger. (R. at
947.) Odle’s impression of Lane’s mental status examination was the same as the
previous month, except that Odle noted that Lane experienced “transient” paranoia.
(R. at 947.)
Lane told Mitchell on January 6, 2010, that she had fallen coming down a
set of steps and hurt her left knee and back. (R. at 1136.) She stated that she had
immediate pain in the center of the mid- to lower back and to the left side of her
back. (R. at 1136.) Lane said her left knee was sore and throbbing. (R. at 1136.)
Lane said that she had arthroscopic surgery on her left knee the previous
November and had been able to walk and run on it since then. (R. at 1136.) Lane
stated that she had been able to walk and bear weight on her knee since the fall, but
since the surgery, she had experienced a shooting sensation when she walked. (R.
at 1136.)
On January 28, 2010, Lane saw family nurse practitioner Donna Sparks for
complaints of pain in hips and knees. (R. at 1134.) Lane said that her right lateral
knee hurt when walking. (R. at 1134.) Lane denied any trauma or injury or any
swelling, redness, warmth or locking. (R. at 1134.) Lane also denied knee
-29-

buckling/giving out, tingling and numbness or lower back pain. (R. at 1134.)
Sparks noted no tenderness, swelling, redness or warmth in Lane’s knee. (R. at
1134.) Sparks gave Lane a steroid shot in her knee. (R. at 1134.)
On February 17, 2010, Lane told Dr. Michael that she had discontinued use
of all of her psychiatric medications because they “made her feel funny.” (R. at
1132.) Lane complained that she did not want to continue counseling with “anyone
from around here.” (R. at 1132.) Lane complained of stressors, including not
having a job. (R. at 1132.) She also complained of panic attacks, mostly at night,
even when she was taking Seroquel. (R. at 1132.) Lane also complained of diffuse
muscle aches, tender to the touch in her upper and lower extremities, which were
severe at times. (R. at 1132.) Dr. Michael noted that Lane had normal range of
motion in her spine. (R. at 1132.) Lane saw nurse practitioner Mitchell on March 3,
2010, and Mitchell noted that an examination of Lane’s neck showed it was
nontender with full range of motion. (R. at 1130.) Mitchell also noted that Lane
had full range of motion in her back without pain. (R. at 1130.) Mitchell noted that
Lane’s gait was normal and that she had normal strength bilaterally with no edema
in her extremities. (R. at 1130.)
On March 5, 2010, Lane complained to Odle of mild depression, mild
anxiety, mild insomnia, variable appetite, a mild decrease in energy and attention
and concentration, moderate irritability/anger, moderate crying spells, two to three
times a week, mild panic attacks, two to three times a month, and no suicidal or
homicidal ideations. (R. at 946.) Odle noted that Lane’s affect was euthymic, her
-30-

orientation and thought process were intact, she was not experiencing paranoia or
delusions, and her judgment/insight was fair. (R. at 946.) Odle stated that Lane
requested that Odle complete “mental” papers for Lane’s disability claim. (R. at
946.) Odle noted that since Lane had not been to therapy in more than a year, she
advised Lane that she could not complete the form that day. (R. at 946.) She stated
that she could mail them to her after her appointment. (R. at 946.) On March 15,
2010, Lane complained of mild depression, moderate anxiety, moderate
irritability/anger, mild crying spells and no suicidal or homicidal ideations. (R. at
945.) Odle described Lane’s mood as irritable with intact orientation and thought
process. (R. at 945.) She stated that Lane was not experiencing any paranoia or
delusions and that her judgment/insight was fair. (R. at 945.) Odle noted that they
discussed Lane’s upcoming surgery and Lane’s problems connection and feeling
comfortable with a counselor. (R. at 945.)
Lane saw Mitchell on April 13, 2010, for removal of her surgical stitches.
(R. at 1123.) Lane stated that she had not suffered from a headache since her
surgery on April 2. (R. at 11.23.) On May 4, 2010, Lane told Mitchell that she was
no longer having any headaches in the back of her head. (R. at 1121.) Lane
reported to Mitchell, on May 18, 2010, that she had not suffered from any episodes
of bad headaches since her last hospitalization at UVA. (R. at 1119.) Lane stated
that she did experience some muscle spasms if she overexerted herself. (R. at
1119.)
Lane saw Dr. Shehzad on August 17, 2010, for complaints of left knee pain
-31-

and requested a steroid injection in the knee. (R. at 958.) She told Dr. Shehzad that
she had severe arthritis in her knee. (R. at 958.) Lane denied any illicit drug use,
although she had told Dr. Gwathmey the previous month that she smoked
marijuana daily. (R. at 958.) Dr. Shehzad noted that Lane was 5 feet, 4 inches tall
and weighed 235 pounds. (R. at 958.) He stated that both knees were positive for
crepitus. (R. at 958.) Dr. Shehzad diagnosed Lane with unspecified left knee pain
and low back pain, although his note makes no mention of Lane complaining of
low back pain. (R. at 958.) Lane was given a steroid shot in her left knee. (R. at
959.)
Lane saw Dr. Michael on August 23, 2010, for complaints of hurting all over
and feeling weak. (R. at 956-57.) Lane stated that both arms hurt when she lifted
anything. (R. at 956.) She also complained that her right leg hurt the previous week
from the outside down the leg. (R. at 956.) Dr. Michael noted that Lane was 5 feet,
4 inches tall and weighed 240 pounds. (R. at 956.) Dr. Michael diagnosed fatigue
and malaise and ordered blood tests. (R. at 956-57.)
On October 11, 2010, Lane saw Dr. Michael with complaints of a sprained
left ankle and pulled muscles in her right leg above her knee, whiplash and muscle
spasms in her back after being hit by a car recently. (R. at 952-53.) Lane claimed
that a motorist rammed his car into the back of hers and that, when she got out of
her car, the motorist attempted to run over her. (R. at 952.) Dr. Michael noted that
Lane’s lower back examination showed normal rotation with slightly tight lumbar
muscles. (R. at 952.) Straight leg raising tests were negative bilaterally. (R. at 952.)
-32-

He noted that Lane’s gait was unremarkable and that she was able to bend over and
pull her left pant leg up to show him where her ankle hurt. (R. at 952.) Dr. Michael
noted some mild swelling in her ankle with full range of motion with minimal pain.
(R. at 952.)
Lane was seen by Mitchell on February 15, 2011, for a pregnancy test,
complaints of sinus drainage and cough and a cortisone shot in her left knee. (R. at
899-901.) Lane complained of limited range of motion and pain in her left knee
with buckling. (R. at 899.) She also complained of intermittent lower back pain.
(R. at 899.) Mitchell noted crepitus and tenderness in the medial and lateral patella
of Lane’s left knee with no swelling, redness or warmth. (R. at 900.) Mitchell also
noted vertebra tenderness in Lane’s lower back at the L4 to L5 level with bilateral
lumbar muscular tenderness and tightness. (R. at 900.) Straight leg raise testing
was normal. (R. at 900.) Mitchell prescribed naproxen and Flexeril. (R. at 901.)
Lane saw Dr. Michael on April 30, 2012, for complaints of left knee pain. (R. at
878.) Dr. Michael gave Lane a steroid shot in her knee. (R. at 878.)
On June 11, 2012, Lane saw Mitchell for complaints of chest pain on the left
side with shortness of breath. (R. at 873-76.) Lane described the pain as throbbing
that lasted from a few seconds to a couple of minutes. (R. at 873.) Lane also
complained of palpitations, dizziness and fatigue. (R. at 873.) Lane was diagnosed
with unspecified chest pain and costochondritis. (R. at 874.) Lane saw Dr. Michael
on June 18, 2012, to get him to complete a form for her disability claims. (R. at
871-72.)
-33-

Dan Levesque, D.C., a chiropractor, prepared a Report of Medical
Evaluation on February 21, 2011, based on his initial examination, evaluation and
subsequent treatment of Lane on four occasions. (R. at 933-43.) According to
Levesque, Lane reported lifelong joint and back problems. (R. at 933.) Lane
complained of severe, chronic neck, mid-back and low back pain and leg pain,
weakness, numbness and tingling. (R. at 933.) Lane also complained of frequent
weakness and pain in her shoulders and arms, numbness, tingling and swelling, as
well as weakness of her grip in both hands, frequent headaches, chronic fatigue,
insomnia, fibromyalgia, frequent joint pain and swelling, weakness and pain in
both knees, depression and anxiety. (R. at 933.)
In particular, Lane complained of a constant, dull, aching pain in her lower
back across her beltline with frequent sharp, cutting, shooting pain, radiating into
the right side of her pelvis, hip and leg. (R. at 933.) Lane said that she suffered this
pain between three-quarters and all of her time awake. (R. at 933.) She claimed the
pain precluded her from carrying out activities of daily living. (R. at 933.) She
rated her back and leg pain as a nine on a 10-point scale, and she said that her back
pain limited her from sitting, standing or lying in the same position for longer than
15-20 minutes at a time and repetitive bending and lifting of objects weighing
more than five to 10 pounds. (R. at 933.) Lane also complained of a constant, dull,
aching and burning pain in her neck with frequent sharp, shooting pain in her neck
that radiated into her arms and across the tops of her shoulders. (R. at 933.) She
complained of decreased range of motion in her neck and of knots and spasms in
her neck and trapezius muscles. (R. at 933.) Lane said that she suffered from neck
-34-

pain that she ranked a seven to eight on a 10-point scale three-quarters to all of her
time awake that precluded her from carrying out activities of daily living. (R. at
933.)
Lane also complained of dull, aching, burning and stinging pain in her midback that radiated into her shoulder blades and through to her sternum, causing a
type of chest pain and shortness of breath. (R. at 934.) She said that she suffered
this pain on a level of five to six on a 10-point scale three-quarters to all of her
time awake, and it caused serious diminution in her capacity to carry out daily
activities. (R. at 934.) Lane said that this pain was aggravated by prolonged
standing, sitting and lifting and limited her ability to push, pull or work with her
arms outstretched or overhead for any length of time. (R. at 934.) Lane further
complained of frequent, dull, aching, burning pain in her hips and legs, from threefourths to all of her time awake, and traveling down to her toes with weakness,
numbness and tingling in her legs and swelling and frequent cramps in her legs. (R.
at 934.) She said that her leg pain was nearly constant and severely limited her
from standing or walking longer than 20 minutes at a time or standing still longer
than 10-15 minutes. (R. at 934.) She also complained of throbbing, dull, achy,
sometimes sharp, unstable bilateral knee pain with frequent swelling at the end of
the day or if she spent more than a few hours on her feet. (R. at 934.) Lane
complained of extreme stiffness in her knees with trouble bending them, resulting
in serious diminution in her capacity to carry out daily activities. (R. at 934.) She
claimed that she could not kneel, squat, crouch or climb. (R. at 934.) She said that
her knees were very unstable at times, especially after she had been on them for
-35-

more than a few hours at a time. (R. at 934.)
Lane also said that she suffered from a dull, aching pain, numbness and
tingling in both hands with weakness of grip that hindered her ability to perform
fine motor functions with her fingers, such as typing or writing. (R. at 934.) She
also complained of frequent stiffness and swelling in her hands. (R. at 934.) Lane
claimed that she experienced these symptoms three-fourths to all of her time awake
and that they prevented her from carrying out activities of daily living. (R. at 934.)
Lane also complained of a sharp, burning and stinging pain in her arms and
shoulders with weakness in her arms and an inability to work with her arms
outstretched in front of her or overhead for more than a few minutes. (R. at 935.)
She claimed that these symptoms occurred three-fourths to all of the time and
prevented her from carrying out activities of daily living. (R. at 935.)
Lane also complained of symptoms, which Levesque said were
characteristic of fibromyalgia, including chronic fatigue and unpredictable high
levels of pain in her joints and muscles, which moved around her body. (R. at 935.)
She also complained of frequent, throbbing temporal and suboccipital headaches,
which occurred three to five times a week, and could last up to several days,
completely debilitating her by causing her to frequently vomit. (R. at 935.) Lane
stated that a previous surgery to correct a congenital defect had not helped her
headaches. (R. at 935.) Lane said that she had headaches three-fourths to all her
time awake and that the headaches caused serious diminution in her capacity to
carry out daily activities. (R. at 935.) Lane rated her headaches at a nine on a 10-36-

point scale, and she stated that her headaches greatly affected her ability to
concentrate/focus on a particular task, pay attention or perform any physical task
whatsoever. (R. at 935.)
Levesque stated that Lane had “several herniated discs and pinched nerves in
her spine” with “advanced levels of degenerative disc disease.” (R. at 936.)
Levesque noted that Lane was 5 feet, 6 inches tall and weighed 220 pounds. (R. at
938.) Levesque stated that, upon initial presentation, Lane was in “obvious visual
physical distress and extreme pain.” (R. at 938.) He noted that she walked slightly
antalgic upon first rising from a seated position with short, guarded steps and an
overall unsteady gait. (R. at 938.) Levesque said that Lane sat for only 15-20
minutes before she had to get up and move about the room because of her low
back/leg pain. (R. at 938.)
Levesque’s examination showed that Lane had a limited range of motion in
her cervical spine with “moderate restriction” in her flexion, extension, left lateral
flexion, right lateral flexion and left rotation and “marked restriction” in her right
rotation. (R. at 938-39.) Levesque stated that Lane had “marked restriction” in her
true lumbar flexion and “mild restriction” in her left and right lateral flexion of her
lumbar spine. (R. at 939.) Levesque also stated that his grip strength evaluation
showed that Lane had a 27.29 percent strength loss index in her right hand and a
56.8 percent strength loss index in her left hand. (R. at 939.)
Levesque stated that x-rays taken of Lane’s spine showed mild to moderate
-37-

spondylosis was present with mild to moderate degenerative arthritis at several disc
levels. (R. at 942.) Levesque stated that the x-rays showed mild intervertebral disc
space narrowing at the C7/T1 and C4/5 levels and mild to moderate disc space
narrowing at the L5/S1 level. (R. at 942.) Levesque diagnosed Lane with herniated
discs at the L5, T6, C7 and C1/2 levels resulting in cervical and lumbar
neuritis/radiculitis, that was most likely causing her arm and leg pain, weakness
and numbness, osteoarthritis of the spine, degenerative disc disease, carpal tunnel
syndrome, chronic fatigue, insomnia, fibromyalgia, chronic pain and arthritis. (R.
at 942.) Levesque stated that Lane’s prognosis was poor. (R. at 942.) He stated that
Lane had “permanent and progressively accelerating disc damage in her spine.” (R.
at 942.) Levesque said that Lane’s spinal condition would not allow her to stand or
walk for more than 15-20 minutes because of extreme low back and leg pain. (R. at
942.) He also said that she could not sit longer than 20-30 minutes without
“writhing in pain/shifting” and having to stand and walk some because of her low
back, hip and leg pain. (R. at 942.) He said that weakness and pain in her hands
and arms would limit her from doing any fine motor skills such as typing or
writing. (R. at 942.)

He stated that Lane’s grip strength “disability” would

severely limit her from activities such as grasping, pinching, holding or carrying
anything more than five to 10 pounds. (R. at 942.) Levesque stated, “I have treated
her over a short period of time and concluded there is little I can do for her other
than the possibility of temporary pain relief, however she has not responded to any
of my treatments as of yet. It is my professional opinion that … Lane has lost the
ability to provide for herself or her family financially or otherwise and should
qualify for total disability assistance as soon as possible.” (R. at 942-43.)
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Lane presented to the emergency department at UVA Health Systems on
February 16, 2011, for complaints of headache and was seen by Dr. Scott Syverud,
M.D. (R. at 378-92.) Lane complained of “hurting all over [her] body.” (R. at
378.) Lane said that her headache symptoms had worsened since being rear-ended
in a motor vehicle accident and being “beat up” by three females in October 2010.
(R. at 378.) Dr. Syverud noted that Lane did not appear to be in any acute distress,
but, instead, appeared comfortable. (R. at 380.) Neurological examination was
normal except for Lane’s complaint of tingling in her right lower extremity from
knee down to toes. (R. at 380.) Dr. Syverud requested a neurological consult. (R. at
381.) A head CT scan performed on February 16, 2011, showed post-surgical
changes, but no acute intracranial abnormality. (R. at 399.)
Lane was seen by Dr. Michael Brogan, M.D., a neurology resident at UVA
Health Systems, for consultation after her presentation to the UVA Health Systems
Emergency Department on February 16, 2011, with complaints of worsening
chronic headaches. (R. at 389-92, 656-59.) Lane gave a history of suffering from
headaches starting at age 10. (R. at 389, 656.) She described these headaches as
being primarily sharp, shooting pains behind her right eye. (R. at 389, 656.) She
said that she suffered from these headaches an average of three times a week and
that the headaches lasted from 15 minutes to an entire day. (R. at 389, 656.) Lane
said that her headaches were aggravated by sunlight and were relieved by lying
down and putting a washcloth on her head. (R. at 389, 656.) She also said that her
headaches were associated with whole body aches and, occasionally, a sharp pain
down her spine. (R. at 389, 656.) She also reported that she was nauseated and
-39-

vomited on occasion with these headaches. (R. at 389, 656.)
Dr. Brogan noted that Lane had been seen previously for complaints of
headaches in July 2010, but she had failed to keep her follow-up appointments. (R.
at 389, 656.) Dr. Brogan noted that when Lane was seen originally, it was thought
that her exam and history were consistent with migraine headaches. (R. at 389,
656.) He noted that Lane had been started on Seroquel and Abilify for the “mood
issues” and that she was taking Flexeril for neck pain and spasm. (R. at 389, 657.)
Lane also admitted to taking her mother’s Lortab once or twice a month for bad
headaches. (R. at 390, 657.) Lane reported that she was involved in a motor vehicle
accident on October 10, 2010, when the car she was driving was struck from
behind. (R. at 389, 657.) She stated that, after exiting her car, she was struck by
another vehicle. (R. at 389, 657.) She also said that she was assaulted by three
women on October 31, 2010. (R. at 389, 657.) Lane reported that she also
experienced a circumferential numbness from mid-forearm down, bilaterally, as
well as mid-calf down on her legs. (R. at 389, 657.) Lane reported that she smoked
a pack of cigarettes a day, along with smoking marijuana daily. (R. at 390, 658.)
She stated that she drank three to five caffeinated beverages a day. (R. at 390, 658.)
She said that she was applying for disability benefits. (R. at 390, 658.)
Lane complained of fatigue and generalized aches, but she denied any blurry
vision. (R. at 390, 658.) She complained of occasional tinnitus. (R. at 390, 658.)
Dr. Brogan noted that Lane did not appear to be in any acute distress. (R. at 391,
658.) Lane’s back had some mild tenderness on palpation in the cervical
-40-

paraspinous muscles. (R. at 391, 658.) Lane’s neurological examination was
unremarkable, and it showed that she had normal muscle tone, bulk and strength
and normal reflexes throughout her body. (R. at 391, 658.)
Lane’s headache symptoms went from an eight on a 10-point scale to a two
with administration of Compazine and Benadryl, so Dr. Brogan recommended that
she be given prescriptions for these medications, as well as Lamictal. (R. at 39091, 657, 659.)
Lane was seen by staff members at Clinch River from May 13-18, 2011, for
complaints of persistent vomiting. (R. at 419-23.) A urine drug screen performed
on Lane on May 12, 2011, was positive for the use of marijuana. (R. at 460.) An
abdominal ultrasound performed on Lane on May 17, 2011, was normal. (R. at
457.) A test performed on May 18, 2011, determined that Lane was pregnant. (R.
at 423.) On July 27, 2011, Dr. Shehzad gave Lane a cortisone shot in the left knee
for complaints of pain. (R. at 427.)
The medical records show that Lane delivered a child by Cesarean section,
(“C-section”), on January 18, 2012. (R. at 293-94.) Lane was seen at the Holston
Valley Emergency Department on January 31, 2012, for complications with her
incision. (R. at 839-40.)
Lane saw Dr. Brogan on April 5, 2012, for follow up of complaints of
migraine headaches. (R. at 647.) Lane gave a history of chronic headaches,
-41-

consistent with migraine without aura, according to Dr. Brogan. (R. at 647.) Dr.
Brogan stated that Lane’s headaches were complicated by caffeine, tobacco and
marijuana use, poor sleep and anxiety. (R. at 647.) Dr. Brogan noted that Lane’s
symptoms were greatly improved with administration of Compazine and Benadryl
previously, and he had recommended a prescription for oral Compazine and
Benadryl to be taken every six hours as needed for migraine headaches. (R. at
647.) He also had recommended Lane use Lamictal to prevent migraine headaches.
(R. at 647.) Lane said that she had received these medications, but had stopped all
medication when she became pregnant. (R. at 648.) Lane stated that her headaches
were a little better during pregnancy, but not dramatically. (R. at 648.) Lane said
that she continued to suffer three to five headaches a week, with each headache
lasting from a couple of hours up to two days. (R. at 648.)
Lane complained of some recent spells of transient visual loss, affecting
both eyes at the same time. (R. at 648.) She reported that things went completely
black suddenly. (R. at 648.) She said this sometimes was associated with her
headaches and sometimes not, and that sometimes it was associated with
lightheadedness or dizziness, but not consistently. (R. at 648.) Lane stated that this
blindness sometimes was precipitated by a stabbing pain in her left eye. (R. at
648.) She claimed that she did not lose consciousness with these spells, although
she did report falling once. (R. at 648.)
Dr. Brogan recommended Lane again take Compazine, Benadryl and
sumatriptan for her headaches. (R. at 649.) He also recommended that she begin
-42-

taking amitriptyline to prevent her headaches. (R. at 648.) Dr. Brogan stated that he
believed that Lane’s complaints of transient blindness were “a dramatic form of
migrainous visual aura though the time course is a little brief and the relationship
to her headache is tenuous.” (R. at 649.) He also ordered an MRI of her brain and
cervical spine, and he recommended that Lane be seen again in three months. (R. at
649.)
Lane also was seen on April 5, 2012, by Dr. John A. Scanelli, M.D., an
orthopedic surgery resident at UVA Health Systems, for knee complaints. (R. at
650.) Dr. Scanelli noted that Lane recently had a baby and had gained a lot of
weight, and she stated that her knees were bothering her more now. (R. at 650.)
Otherwise, she stated that she had no repeat mechanical symptoms. (R. at 650.) Dr.
Scanelli’s examination revealed no swelling, erythema, drainage or sign of
infection with good range of motion and positive medial joint line tenderness. (R.
at 650.) Dr. Scanelli reviewed bilateral knee x-rays, which showed moderate left
and mild right knee medial compartment joint space narrowing with mild bilateral
lateral patella subluxation. (R. at 650.) Dr. Scanelli diagnosed left knee medial
femoral condyle degenerative disc disease status-post partial medial menisectomy.
(R. at 650.) Dr. Scanelli ordered physical therapy and prescribed naproxen and
Mobic. (R. at 650.)
Lane was seen at the Emergency Department at Indian Path on May 7, 2011,
for complaints of vomiting. (R. at 431-33.) A urine screen performed on May 7,
2011, showed that Lane tested positive for the use of marijuana. (R. at 434.) An
-43-

abdominal CT scan performed that day on Lane did not show anything abnormal.
(R. at 437.) Lane returned to Holston Valley and was admitted overnight on May
9-10, 2011, for complaints of nausea, vomiting and abdominal pain. (R. at 438-39,
469-73.) Lane was diagnosed with asymptomatic intermittent bradycardia and a
urinary tract infection. (R. at 438, 469.) Lane was given prescriptions for
Phenergan and Cipro upon discharge. (R. at 439, 470.)
Lane was seen at the Emergency Department of Holston Valley the next day,
May 11, 2011, for complaints of vomiting, diarrhea and epigastric pain. (R. at 47576.) Lane was given a prescription for Phenergan and discharged. (R. at 476.) She
returned to the Emergency Department on May 13, 2011, with complaints of
vomiting and diarrhea for the previous week. (R. at 477-78.) Lane was diagnosed
with gastroenteritis. (R. at 478.)
On May 2, 2011, Dr. Brian Strain, M.D., a state agency physician,
completed a physical residual functional capacity assessment on Lane. (R. at 10910, 123-24.) Dr. Strain stated that Lane was limited to occasionally lifting or
carrying items weighing 20 pounds or less and frequently lifting or carrying items
weighing 10 pounds or less. (R. at 109, 123.) He stated that Lane could stand or
walk for a total of about six hours and could sit for about six hours in an eight-hour
workday. (R. at 109, 123.) He stated that Lane also was limited to occasionally
pushing and pulling items weighing 20 pounds or less and frequently pushing and
pulling items weighing 10 pounds or less, (R. at 109, 123.) Dr. Strain stated that
Lane could frequently climb ramps, stairs, ladders, ropes and scaffolds, balance,
-44-

stoop, kneel and crouch, but should avoid concentrated exposure to extreme heat,
noise, vibration, fumes, odors, dusts, gases, poor ventilation and hazards, such as
machinery and heights. (R. at 109-10, 123-24.)
On May 9, 2011, Jo McClain, a state agency professional counselor,
completed a Psychiatric Review Technique form, (“PRTF”), indicating that Lane
suffered from an affective disorder and substance addiction disorders. (R. at 10708, 121-22.) She found that Lane had mild limitations on her ability to perform her
activities of daily living and mild difficulties in her ability to maintain social
functioning. (R. at 107, 121.) She reported that Lane had moderate difficulties in
maintaining concentration, persistence or pace. (R. at 107, 121.) She opined that
Lane had not experienced any episodes of decompensation of extended duration.
(R. at 107, 121.)
That same day, McClain completed a mental assessment, indicating that
Lane had no significant limitations in her ability to carry out very short and simple
instructions; to perform activities within a schedule, maintain regular attendance
and be punctual within customary tolerances; to sustain an ordinary routine without
special supervision; to work in coordination with or in proximity to others without
being distracted by them; to make simple work-related decisions; to ask simple
questions or request assistance; and to maintain socially appropriate behavior and
to adhere to basic standard of neatness and cleanliness. (R. at 111-12, 125-26.)
She opined that Lane was moderately limited in her ability to carry out detailed
instructions; to maintain attention and concentration for extended periods; to
-45-

complete a normal workday or workweek without interruptions from
psychologically based symptoms and to perform at a consistence pace without an
unreasonable number and length of rest periods; to interact appropriately with the
general public; to accept instructions and respond appropriately to criticism from
supervisors; and to get along with co-workers or peers without distracting them or
exhibiting behavioral extremes. (R. at 111-12, 125-26.) McClain stated that, due to
her bipolar disorder, Lane would be limited to simple, nonstressful work with
modest social demands. (R. at 112, 126.)
Lane was evaluated by Dr. Arun Rao, M.D., with Wellmont CVA Heart
Institute, for bradycardia on June 24, 2011. (R. at 448-53.) Dr. Rao noted that
Lane was nine weeks pregnant with a history of intermittent nausea and vomiting
with transient bradycardia. (R. at 448.) Lane complained of a history of frequent
numbness and shooting pains in her arms, which improved slightly following her
spinal surgery the year previous. (R. at 448.) She also complained of occasional
palpitations and intermittent dizziness associated with transient darkening of
vision, but no chest discomfort, difficulty breathing or edema. (R. at 448.) Dr. Rao
noted that Lane was 5 feet, 6 inches tall and weighed 232 pounds. (R. at 452.) Dr.
Rao stated that he believed that Lane’s bradycardia was “probably due to
heightened vagal tone in the setting of nausea.” (R. at 453.) He recommended
additional evaluation with an event monitor to make sure her dizziness was not due
to severe bradycardia. (R. at 453.) A Holter Monitor Report stated that Lane
experienced one period with her heart rate at only 40 beats per minute. (R. at 456.)
An echocardiogram, (“ECG”), performed on June 24, 2011, was essentially
-46-

normal. (R. at 454-55.)
Lane was seen in follow up on November 3, 2011. (R. at 816-18.) Dr. Rao
noted that after seeing Lane in June, she had worn an event monitor for 30 days,
which showed sinus rhythm to mild sinus tachycardia and that an ECG had shown
normal heart function. (R. at 816, 820-21.) Dr. Rao noted that Lane was in jail
from August 19 to October 13, 2011. (R. at 816.) She reported that, while in jail,
her pulse rate would drop in the teens, and her blood pressure would be elevated on
occasion. (R. at 816.) Dr. Rao noted that Lane was 27 weeks pregnant. (R. at 816.)
She complained of occasional heart palpitations with mild chest discomfort, which
would last for about 10 minutes and would resolve with rest. (R. at 816.) Dr. Rao
noted that Lane’s heart rhythm was regular and that an electrocardiogram,
(“EKG”), showed sinus rhythm. (R. at 818.)
Dr. Rao saw Lane again on December 9, 2011, for complaints of chest pain.
(R. at 813-14.) Dr. Rao noted that Lane was obese at 5 feet, 6 inches tall and
weighing 280 pounds. (R. at 814.) He noted that Lane’s cardiac rhythm was
regular, and she had no swelling in her lower extremities. (R. at 813.) An EKG
showed normal sinus rhythm. (R. at 813.) Lane also saw Dr. Rao on February 10,
2012, complaining of intermittent palpitations and “very atypical chest pain that
only occurs at rest.” (R.at 809-12.) Dr. Rao noted that Lane’s heart rhythm was
regular, and she had no swelling in her lower extremities. (R. at 811.)
On September 13, 2011, Dr. Joseph Duckwall, M.D., a state agency
-47-

physician, completed a physical residual functional capacity assessment on Lane.
(R. at 154-56.) Dr. Duckwall stated that Lane was limited to occasionally lifting or
carrying items weighing 20 pounds or less and frequently lifting or carrying items
weighing 10 pounds or less. (R. at 154.) He stated that Lane could stand or walk
for a total of about six hours and could sit for about six hours in an eight-hour
workday. (R. at 154.) He stated that Lane also was limited to occasionally pushing
and pulling items weighing 20 pounds or less and frequently pushing and pulling
items weighing 10 pounds or less, (R. at 154.) Dr. Duckwall stated that Lane could
frequently climb ramps, stairs, ladders, ropes and scaffolds, balance, stoop, kneel
and crouch, occasionally crawl and should avoid concentrated exposure to fumes,
odors, dusts, gases, poor ventilation and hazards, such as machinery and heights.
(R. at 155-56.)
On September 15, 2011, Howard S. Leizer, Ph.D., a state agency
psychologist, completed a PRTF indicating that Lane suffered from an affective
disorder and substance addiction disorders. (R. at 152-53.) He found that Lane had
mild limitations on her ability to perform her activities of daily living and mild
difficulties in her ability to maintain social functioning. (R. at 153.) He reported
that Lane had moderate difficulties in maintaining concentration, persistence or
pace. (R. at 153.) He opined that Lane had not experienced any episodes of
decompensation of extended duration. (R. at 153.)
That same day, Leizer also completed a mental assessment, indicating that
Lane had no significant limitations in her ability to carry out very short and simple
-48-

instructions; to perform activities within a schedule, maintain regular attendance
and be punctual within customary tolerances; to sustain an ordinary routine without
special supervision; to work in coordination with or in proximity to others without
being distracted by them; to make simple work-related decisions; to ask simple
questions or request assistance; and to maintain socially appropriate behavior and
to adhere to basic standard of neatness and cleanliness. (R. at 156-57.) He opined
that Lane was moderately limited in her ability to carry out detailed instructions; to
maintain attention and concentration for extended periods; to complete a normal
workday or workweek without interruptions from psychologically based symptoms
and to perform at a consistent pace without an unreasonable number and length of
rest periods; to interact appropriately with the general public; to accept instructions
and respond appropriately to criticism from supervisors; and to get along with coworkers or peers without distracting them or exhibiting behavioral extremes. (R. at
156-57.) Leizer stated that, due to her bipolar disorder, Lane would be limited to
simple, nonstressful work with modest social demands. (R. at 157.)
Lane saw Dr. Michael on June 18, 2012, in an effort to get forms completed
regarding her disability claims. (R. at 1320-21.) Dr. Michael noted that Lane had
difficulty with weight control. (R. at 1320.) Lane reported improved pain and
swelling in her left ankle. (R. at 1320.) Lane said she was not sure what she had
done to hurt her ankle, but that she had gone to an emergency department and been
given a brace to wear on it the previous Saturday. (R. at 1320.) Lane complained
of being unable to concentrate on the computer for more than 10 minutes. (R. at
1320.) She said she was not driving due to the number of speeding tickets she had
-49-

received. (R. at 1320.) The list of Lane’s medications on this date does not include
any psychiatric medication. (R. at 1321.)
Dr. Michael noted good rotation in Lane’s back and normal range of motion
in her spine, shoulders, elbows, wrists, hips, knees and right ankle. (R. at 1321.)
Dr. Michael noted that Lane was alert and oriented, and her neurologic exam was
essentially normal. (R. at 1321.) Dr. Michael diagnosed Lane with a sprained ankle
and recommended exercise and physical therapy. (R. at 1321.) Lane said that her
lawyer was sending her for a psychological evaluation. (R. at 1321.)
On July 2, 2012, B. Wayne Lanthorn, Ph.D., a licensed clinical psychologist,
evaluated Lane at the request of Lane’s attorney. (R. at 508-17.) Lane reported
that she smoked half a pack of cigarettes a day and had used marijuana and crack
cocaine in the past. (R. at 510.) Lane told Lanthorn that she had stopped using
illicit drugs “many years ago.” (R. at 510.) Lane said that she used to drink alcohol
every other day and had blackouts, as well as having developed a tolerance. (R at
510.) Lane said that she had been convicted of theft and drug distribution and was
on probation. (R. at 510.)
Lane complained of significant pain in her head, neck and lower back. (R. at
510.) She also complained of pain “all over all the time.” (R. at at 510.) Lane said
that she had been psychiatrically hospitalized on one occasion at Woodridge in
2008 for five to seven days after a suicide attempt. (R. at 511.) She stated that she
had treated with Kaye Weitzman, a licensed clinical social worker, for
-50-

approximately one year and also had been seen at Wise County Behavioral Health
Services, but was not then receiving any psychiatric or psychotherapeutic
intervention. (R. at 511.)
Lanthorn noted that, at the time of his evaluation, Lane was 5 feet, 6 inches
tall and weighed 300 pounds. (R. at 512.) Lanthorn stated that he reviewed records
showing that Lane had been diagnosed with and treated for numerous conditions
including joint pain, lower back pain, meniscus tear in the knee, bipolar disorder,
Chiari’s network, morbid obesity, chronic ACL tear, possible schizophrenia,
chronic headaches, herniated discs and pain in her thoracic and lumbar spine with
degenerative disc disease, carpal tunnel syndrome, chronic fatigue, fibromyalgia,
arthritis, possible adult attention deficit hyperactivity disorder, mood swings and
history of cannabis abuse and hypoglycemia. (R. at 511.)
Lanthorn noted that Lane walked without apparent difficulty and made good
eye contact. (R. at 512.) He stated that Lane exhibited no signs of ongoing
psychotic processes nor any evidence of delusional thinking. (R. at 512.) He stated
that Lane was adequately groomed. (R. at 512.) Lanthorn stated that Lane’s affect
was mixed, with her exhibiting the normal range of expression at times and, at
other times, her expression was flat, and she would speak in a monotone. (R at
512.) Lane told Lanthorn that she had been “depressed for as long as I can
remember.” (R. at 512.) She said that she felt constantly drained and fatigued, but
she admitted that she would sleep as little as three to four hours a night. (R. at
512.) Lane reported that she cries at times and often feels worthless and useless.
-51-

(R. at 512.)
Lane complained of short-term memory problems. (R. at 512.) Nonetheless,
Lane was able to recall three out of five words presented earlier to her. (R. at 513.)
She said that her concentration was adequate most of the time, but she said her
mind wandered at times, and she found it hard to follow through on tasks. (R. at
512.) Lane said that she was often irritable and moody and could go from relatively
calm to very angry or upset. (R. at 512.) Lane said that she was often very
anxious, worried, tense and fretted a great deal. (R. at 512.)
Based on intelligence testing, Lanthorn stated that he believed Lane’s fullscale IQ score would fall between 92-100. (R. at 513.) Lanthorn stated that Lane’s
results on the Minnesota Multiphasic Personality Inventory – 2, (”MMPI-2”),
showed that Lane was highly anxious, worried, tense, experiencing significant
emotional discomfort and easily agitated. (R. at 514-15.) Lanthorn said the test
results showed that Lane was experiencing moderate to severe personal distress
characterized by dysphoria, agitations, worry and anhedonia. (R. at 515.) He said
that the results also showed that Lane was having difficulty concentrating and
focusing her attention and was likely to have poor judgment. (R. at 515.) He said
that it also showed that she was very uncomfortable around other people and that
her behavior was likely to be unpredictable and inappropriate at times. (R. at 515.)
Lanthorn diagnosed Lane as suffering from a generalized anxiety disorder;
major depressive disorder, recurrent, moderate; polysubstance dependence in
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sustained full remission; a personality disorder; and with a need to rule out
somatization disorder, not otherwise specified. (R. at 515-16.) Regarding Lane’s
history of polysubstance abuse, Lanthorn incorrectly stated that Lane “appears to
have stopped this altogether many years ago.” (R. at 516.) He placed Lane’s thencurrent GAF score at 55. (R. at 516.) He stated that Lane’s allegations of
psychologically disabling conditions were found to have “partial validity.” (R. at
516.)
On July 2, 2012, Lanthorn completed a mental assessment, indicating that
Lane had only a fair, or seriously limited, ability to perform all occupational,
performance and personal/social adjustments. (R. at 518-20.) He stated that Lane
would be absent from work more than two days a month based on her impairment.
(R. at 520.)
Lane saw Mitchell again on July 9, 2012, and complained of chronic
headaches, but no muscle, joint, back or mental health problems. (R. at 1317-19.)
Lane saw Dr. Michael on July 26, 2012, for follow up for her bipolar disorder. (R.
at 1314-16.)

Lane complained of fatigue and weight gain. (R. at 1314.) Dr.

Michael noted that Lane weighed 318 pounds. (R. at 1315.) Lane said that she was
tolerating Lamictal, but her mood could be “all over the place,” and she wanted to
restart Seroquel. (R. at 1314.) Dr. Michael noted some trace edema in Lane’s
extremities. (R. at 1315.) Dr. Michael diagnosed hyperglycemia and bipolar
disorder. (R. at 1315.) It appeared that Lane’s blood test results showed that the
level of Lamictal in her blood was not at a therapeutic level. (R. at 1315.)
-53-

Lane returned to the UVA Neurology Clinic on July 5, 2012, and saw Dr.
Jeffrey Ratliff, M.D., for follow up for headaches. (R. at 1222-24.) Lane stated that
she had stopped taking Elavil. (R. at 1223.) Lane complained of two types of
headaches. (R. at 1223.) The more common headache she described as a feeling of
motion sickness with mild, dull, posterior pain associated with lightheadedness and
nausea. (R. at 1223.) She reported that she experienced this type of headache three
to four times a week. (R. at 1223.) The other she described as sharper with a
throbbing quality, but still in the posterior of her head with radiation into the left
side. (R. at 1223.) Lane said that both types of headaches would last for six to eight
hours and were associated with phonophobia and photophobia. (R. at 1223.) Lane
said that her headaches were helped by lying in a dark room with a damp cloth on
her head. (R. at 1223.) Lane also complained of a transient loss of vision lasting
only a few seconds approximately twice monthly, not associated with headache.
(R. at 1223.)
Dr. Ratliff stated that Lane’s examination was normal with full strength in
her extremities with no involuntary movements, sensation intact to light touch,
reflexes equal and symmetric and a normal gait. (R. at 1224.)

Dr. Ratliff

prescribed Lamictal, but recommended that Lane not become pregnant while
taking it. (R. at 1224.)
On August 2, 2012, Lane returned to Dr. Carson at UVA for complaints of
pain in her knees. (R. at 1221.) Dr. Carson noted that Lane was seen on July 5,
2012, for pain in her left knee with possible meniscus pathology. (R. at 1221.)
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Lane complained of right knee pain for the preceding few weeks that was getting
progressively worse. (R. at 1221.) Lane described pain on the anterior part of the
knee, which was worse when climbing stairs or with uphill/downhill walking with
occasional episodes of giving away. (R. at 1221.) Lane said she would take
nonsteroidal anti-inflammatory drugs on occasion for pain control. (R. at 1221.)
Dr. Carson’s examination of both knees was basically negative. (R. at 1221.) Dr.
Carson noted that an MRI of Lane’s left knee taken on July 6, 2012, showed severe
truncation of the body and posterior horn of the medical meniscus, which likely
was secondary to a combination of previous surgery and degeneration, a complete
tear of the ACL, a large area of full-thickness cartilage loss within the medial tibial
plateau, moderate tricompartmental osteophytosis and prominent patellar tilt and
subluxation. (R. at 1221-22, 1226.) Dr. Carson diagnosed left knee osteoarthritis
and recommended an injection in Lane’s knee, that she continue physical therapy
and that she lose weight. (R. at 1222.)
On March 16, 2011, counselor Odle completed a work-related mental
assessment, indicating that Lane had an unlimited ability to understand, remember
and carry out simple job instructions, a good or satisfactory ability to follow work
rules, to function independently, to understand, remember and carry out detailed
and complex job instructions, to maintain personal appearance and to demonstrate
reliability, a fair or seriously limited ability to relate to co-workers, to deal with the
public, to use judgment with the public, to interact with supervisors, to maintain
attention and concentration, to behave in an emotionally stable manner and to
relate predictably in social situations and no useful ability to deal with work
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stresses. (R. at 746-48.) Odle stated that Lane had problems with anger
management, difficulty maintaining appropriate interaction when stressed and
some difficulty with memory. (R. at 747.) Odle said that Lane had been diagnosed
with bipolar disorder and was being further evaluated for adult attention deficit
hyperactivity disorder, (“ADHD”). (R. at 748.) She said she would anticipate that
Lane would be absent from work more than two days a month. (R. at 748.)
Lane saw Kaye Weitzman, a licensed clinical social worker with Solutions
Counseling, LLC, on November 29, 2011. (R. at 1341.) Lane complained of crying
spells and being paranoid about the upcoming birth of her daughter. (R. at 1341.)
Lane said her pregnancy had brought up a lot of “stuff” from her past. (R. at 1341.)
Weitzman stated that Lane was experiencing moderate depression, moderate
anxiety, substance abuse, moderate irritability, moderate crying spells, increasing
moderate panic attacks, decreased energy, steady appetite, steady sleep and steady
attention/concentration with no suicidal or homicidal ideations. (R. at 1341.)
Weitzman noted that Lane’s mood was depressed and irritable with an anxious
affect. (R. at 1341.) She stated that Lane was oriented, with racing thought process,
transient paranoia/delusions and fair judgment/insight. (R. at 1341.)
On December 22, 2011, Lane told Weitzman that she was scheduled to
deliver her daughter by C-section on January 18, 2012. (R. at 1340.) Lane
complained of “too much stress.” (R. at 1340.) She said that her niece had been
hitting and kicking her in her belly. (R. at 1340.) Lane’s complaints and
Weitzman’s observation were consistent with those noted on November 29, 2011,
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except she denied paranoia and delusions. (R. at 1340.) On January 31, 2012, Lane
told Weitzman that she had delivered her daughter. (R. at 1339.) Lane said that
she felt bad, but she kept going. (R. at 1339.) She said that she wanted to sleep all
the time. (R. at 1339.) Lane said that she was experiencing odd pains, and she
thought that her C-section had not gone well. (R. at 1339.) Weitzman noted that
Lane was experiencing mild depression, mild anxiety, questionable substance
abuse, moderate irritability/anger, mild crying spells, mild panic attacks, decreased
energy and increased sleep. (R. at 1339.) Weitzman noted that Lane stated that she
was doing better with less depression and less panic. (R. at 1339.)
On June 19, 2012, Lane told Weitzman that she was doing “OK,” even
though her sister was near death due to kidney failure. (R. at 1338.) Lane said that
she was wearing a “boot” due to a left ankle fracture. (R. at 1338.) Weitzman noted
moderate depression, mild anxiety, mild irritability/anger, mild crying spells and
mild panic attacks. (R. at 1338.) Lane stated that her energy, appetite, sleep and
attention/concentration all were stable. (R. at 1338.) On July 18, 2012, Lane told
Weitzman that things were going well with her boyfriend, and her family was
doing well. (R. at 1337.) Lane said that she had put her infant daughter in a beauty
contest and cried when she did not win. (R. at 1337.) Lane said that her depression,
anxiety and panic attacks were stable with increased irritability/anger and crying
spells and decreased energy and sleep. (R. at 1337.)
On August 23, 2012, Lane saw Dr. Michael for allergy testing. (R. at 131013.) Lane said that whenever she would eat shrimp, she became flushed and got
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hot. (R. at 1310.) Lane saw Dr. Michael again on August 29, 2012, complaining of
right lower quadrant abdominal pain. (R. at 1307-09.) Dr. Michael gave Lane a
prescription for an antibiotic in case she had a urinary tract infection and told her to
strain her urine to see if she passed a kidney stone. (R. at 1308.) On September 4,
2012, Lane complained of low back pain, said she woke up with her kidney killing
her, but she did not pass a stone. (R. at 1304-06.) Dr. Michael noted that Lane was
able to quickly get up onto and off of the exam table, moving well. (R. at 1305.)
Lane returned to see Sparks on September 24, 2012, complaining of left knee pain
and pain in her feet. (R. at 1301-03.) Lane said that she had been walking a lot
more lately. (R. at 1301.) Sparks recommended that Lane obtain proper fitting
walking shoes and take ibuprofen for knee or foot pain as needed. (R. at 1302.) She
recommended Lane lose weight also. (R. at 1302.) X-rays of Lane’s right foot
showed no evidence of fracture, dislocation or bony destruction. (R. at 1329.)
On October 1, 2012, Dr. Michael restarted Lane on Seroquel. (R. at 1300.)
Dr. Michael noted that Lane weighed 323 pounds, and he counseled her on
working on her diet and regular exercise of walking at least 20 minutes once a day
or 10 minutes twice a day. (R. at 1298-99.) On October 11, 2012, Lane saw
Mitchell, complaining of pain in the lower abdomen and left knee with swelling
and giving out. (R. at 1293-96.) Lane complained that her left knee pain was
constantly aching and throbbing. (R. at 1293.) Lane said that she had recently
passed a kidney stone, but that her current abdominal pain started afterward. (R. at
1293.) Mitchell noted some crepitus in the left knee with tenderness, but no
erythema or warmth. (R. at 1295.) X-rays taken of Lane’s left knee on October 11,
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2012, showed moderate to severe medial compartment degenerative change with
mild progression since November 30, 2009, and mild lateral and patellofemoral
compartment degenerative change with no effusion. (R. at 1328.)
On October 17, 2012, Lane told Weitzman that she was raising money for
her sister’s kidney transplant. (R. at 1336.) Lane vented about paranoia and
unnatural fears; she said that she had lots of stress about personal and family health
issues. (R. at 1336.)

Lane complained of increasing mild depression, stable

moderate anxiety, stable moderate irritability/anger, increasing mild crying spells,
increasing panic attacks and decreased energy. (R. at 1336.) Lane said, “I am
trying to make it with all my stress but it is harder and harder.” (R. at 1336.)
Lane saw Dr. Michael on November 20, 2012, complaining of left knee pain
which worsened the previous night. (R. at 1289-90.) Lane stated that “something
happened” when she stood up the previous night. (R. at 1289.) Lane denied any
swelling, redness, warmth, locking or buckling of the knee. (R. at 1289.) Dr.
Michael noted that there was no swelling or redness in Lane’s knee and that she
had full range of motion with pain medially, no crepitus, but tenderness on
palpation on the medial collateral ligament. (R. at 1289.) Dr. Michael diagnosed a
sprained medial collateral ligament and prescribed naproxen. (R. at 1289.)
On November 27, 2012, Lane told Weitzman that she had taken her daughter
to the Santa Train but that her niece and nephew were very ill-behaved and ruined
the holiday for all of them. (R. at 1335.) Lane said that she was frustrated by lots of
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family stress. (R. at 1335.) Lane said her mother had fallen and broken her arm. (R.
at 1335.) Lane complained of moderate stable depression, increasing moderate
anxiety, increasing moderate irritability/anger, increasing moderate crying spells,
stable moderate panic attacks, decreased energy and stable appetite, sleep and
attention/concentration. (R. at 1335.)
Lane was seen by Sparks for complaints of sinus congestion and blisters on
her feet on March 20, 2013. (R. at 11-13.) On this occasion, Lane denied any
tingling or numbness in or radiation of pain to her feet. (R. at 11.) Sparks noted
that Lane weighed 326 pounds. (R. at 12.) Lane saw Mitchell on April 11, 2013,
for pain in her left foot after hitting her little toe. (R. at 8-9.) Neither of these
reports note any complaints of overall body pain or back or neck pain, other than to
note that Lane was taking Lortab for her back. (R. at 8-9, 11-13.)
Lane was treated by Dr. Felix Shepard Jr., M.D., a urologist, for kidney
stones in 2012-2013. (R. at 1250-66.)
Lane was seen by Timothy Marquell, a physician’s assistant at Washington
County Medical Clinic, on October 23, 2012, for complaints of low back pain and
pain management. (R. 1277-81.) Lane complained of pain, at rest, at a level two
on a 10-point scale that radiated into her hips bilaterally and down her legs to the
ankles. (R. at 1277.) At another point in his report, it states that Lane complained
of pain at a level eight on a 10-point scale. (R. at 1279.) Lane claimed that she had
suffered from low back pain since she was 10 years old, but she said that it had
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worsened over the years. (R. at 1277.) Lane said that she was working on a farm
and also had to lift her handicapped brother as a caregiver. (R. at 1277.) She denied
any known injury or any other chronic, long-term medical condition. (R. at 1277.)
Lane stated that standing or sitting for prolonged periods, bending and
walking caused pain. (R. at 1277.) She claimed she also had pain radiating down
her right arm. (R. at 1277.) She described the pain as constant, dull, aching,
shooting and tingling. (R. at 1277.) Lane said that, due to pain, she had avoided
work activities, yard work/shopping, recreation, exercise, housework, socializing,
sexual activity and driving during the previous month. (R. at 1277.) Lane stated
that physical therapy, exercise, muscle relaxants and aspirin provided no relief for
her pain. (R. at 1277.) She said that heat, chiropractic treatment, corticosteroid
injections and epidural injections provided moderate relief. (R. at 1277.) Lane
claimed that she was unable to walk for more than 100 feet, stand for more than 10
minutes or sit for more than 10 minutes. (R. at 1278.)
Lane complained of blurry vision, ringing in her ears, heart palpitations,
shortness of breath, nausea, abdominal pain, diarrhea, kidney stones, muscle
weakness, easy bleeding and tendency for easy bruising, hand joint swelling, lower
back pain, ankle joint swelling, muscle cramps, joint stiffness, dizziness, difficulty
walking, tingling and numbness, anxiety, depression and sleep disturbance. (R. at
1278.) Marquell noted that palpation of Lane’s thoracic and lumbosacral spine
revealed “abnormalities.” (R. at 1279.) He noted that Lane was 5 feet, 5 inches tall
and weighed 320 pounds. (R. at 1279.)
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Marquell noted that Lane’s general appearance was normal, and she was
oriented to time, place and person. (R. at 1279.) Her heart rate and rhythm were
normal. (R. at 1279.) He stated that Lane’s lumbar spine motion was abnormal,
with palpation of the left sacroiliac joint exhibiting tenderness. (R. at 1279.)
Straight leg raising tests were normal. (R. at 1279.) Valsalva and Kemp’s testing of
the lumbar spine were negative. (R. at 1279.) Lane’s muscle bulk and tone were
normal with no lumbosacral spine, lower extremity or hip weakness observed. (R.
at 1280.) Marquell noted that Lane’s gait was “shuffling.” (R. at 1280.) He
diagnosed sacroiliitis, lumbago, morbid obesity and thoracic spine pain. (R. at
1280.)
Lane saw Marquell again on November 9, 2012, (R. at 1276), and on March
29, 2013, for complaints of back pain. (R. at 15-17.) Lane denied receiving pain
medications from any other healthcare providers and denied illegal drug use. (R. at
15.) Lane reported constant, dull, aching back pain, which affected her quality of
life. (R. at 15.) Marquell noted that he found no tenderness on palpation of Lane’s
thoracic transverse process on either side, but he did note that Lane’s lumbosacral
spine exhibited tenderness on palpation of the transverse process, which he stated
was mild to moderate. (R. at 16.) He found no tenderness in Lane’s sacroiliac joint.
(R. at 16.) Marquell prescribed Flexeril, meloxicam and hydrocodoneacetaminophen. (R. at 16.)
X-rays of Lane’s right ankle taken on December 7, 2012, showed a distal
fibular fracture with probable involvement of the distal tibiofibular syndesmosis.
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(R. at 1325.) Lane saw Dr. Eric D. Parks, M.D., with Watauga Orthopaedics, on
December 10, 2012, for a right ankle fracture she sustained on December 7, 2012,
when she fell down stairs backwards. (R. at 1284-85.) Lane reported constant pain
in the seven to eight point range on a 10-point scale, swelling and numbness in her
toes. (R. at 1284.) Lane was weightbearing, and she said that prolonged walking or
standing and climbing or descending stairs made her pain worse. (R. at 1284.)
Lane saw Dr. Parks again on December 20, 2012, for follow up. (R. at
1283.) Dr. Parks noted that Lane had been weight bearing some on the ankle
despite his recommendation to be completely nonweightbearing. (R. at 1283.)
Lane stated that she was helping her mother take care of a sibling. (R. at 1283.)
Lane said that she had a fall three days earlier, with a temporary increase in pain
for which she was taking Percocet. (R. at 1283.) Dr. Parks stated that physical
examination showed normal alignment of her right ankle with improved swelling,
no obvious neurovascular deficits and tenderness at the lateral malleolus. (R. at
1283.) Dr. Parks noted that, despite Lane’s noncompliance with instructions, her
fracture had not displaced, and he stressed the need for complete compliance with
nonweightbearing. (R. at 1283.) Dr. Parks stated that he had received disability
papers from Lane’s attorney to complete, but that Lane’s injury was not the type of
injury that should result in disability. (R. at 1283.)
On December 22, 2012, Lane sought treatment at Indian Path’s Emergency
Department for hip pain, which she thought was the result of walking in the boot
placed on her fractured ankle. (R. at 1354-58.) Lane was diagnosed with bursitis.
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(R. at 1358.)
Lane saw Dr. Michael again on December 26, 2012, for pain in her right
hand from trauma. (R. at 1287.) Dr. Michael diagnosed a fracture of the fifth
metacarpal bone of the right hand. (R. at 1287.) He placed her in a wrist splint and
recommended an orthopedic referral. (R. at 1287.) X-rays of Lane’s right hand
taken on December 28, 2012, showed a boxer’s fracture of the neck of the right
fifth metacarpal. (R. at 1324.)
Lane saw Dr. Jeffrey A. Marchessault, M.D., an orthopedic physician, for
complaints of right hand pain on December 28, 2012. (R. at 1368.) Lane gave a
history of striking a friend on his knee, with immediate pain and inability to grasp
with the right hand. (R. at 1368.)

Lane stated that her pain was adequately

controlled by medication. (R. at 1368.) Dr. Marchessault noted that Lane was alert
and oriented, pleasant and cooperative. (R. at 1368.) On examination, she was
tender to palpation with moderate swelling over the dorsum of her right hand. (R.
at 1368.) She had no abrasions and no malrotation of the finger, but she was
tender to palpation over the right fifth metacarpal head with loss of metacarpal
head prominence. (R. at 1368.) Dr. Marchessault stated that x-rays showed a
volarly angulated fifth metacarpal neck fracture. (R. at 1368.) He placed a short
arm cast on Lane and asked her to return in two weeks. (R. at 1368.)
Lane returned to Dr. Marchessault for follow up on January 14, 2013. (R. at
1367.) Dr. Marchessault stated that x-rays showed no appreciable change in the
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angulation or displacement of the fracture. (R. at 1367.) Lane was able to make a
composite fist with complaints of tightness and was tender over the fifth
metacarpal head. (R. at 1367.) Dr. Marchessault placed her in another cast for two
additional weeks. (R. at 1367.)
On January 28, 2013, Weitzman completed a mental assessment of Lane’s
work-related capabilities. (R. at 1370-72.) Weitzman opined that Lane had poor to
no ability to perform all occupational, performance and personal/social
adjustments, with the exception of a fair to poor ability to understand, remember
and complete simple job instructions. (R. at 1370-71.) Weitzman stated “Jessica
has major family & health issues. She is an inadequately medicated bipolar who
also has [post-traumatic stress disorder]. Her mood/temper/concentration are all
unstable. (R. at 1372.) Weitzman stated that Lane would miss more than two days
of work a month due to swelling in her extremities and high blood pressure. (R. at
1372.) She stated that Lane’s physical and mental health were “very unstable.” (R.
at 1372.)
On Weitzman’s January 29, 2013, counseling note, she stated that Lane said
she had fallen and broken her right ankle and had broken her right hand when she
hit her nephew during a family argument. (R. at 1374.) Weitzman noted that Lane
was decompensating because of increased pain and family stress, and she
recommended referral to a psychiatrist. (R. at 1374.) Lane complained of increased
depression, anxiety, irritability/anger, crying spells and panic attacks. (R. at 1374.)
Weitzman stated that Lane’s mood was depressed and irritable, her affect was
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anxious, her orientation was intact, her thought process was racing, and she had
transient paranoia/delusions and fair judgment/insight. (R. at 1374.)
Lane was seen by Dr. Rao again on February 21, 2013, for heart
arrhythmias. (R. at 1380-82.) Lane also complained of atypical chest pains with
intermittent high blood pressure. (R. at 1380.) Dr. Rao noted that Lane weighed
324 pounds. (R. at 1381.) Her blood pressure was 121/77. (R. at 1381.) Dr. Rao
diagnosed Lane with atypical chest pain, unlikely of cardiac origin, and mild sinus
bradycardia. (R. at 1382.) Dr. Rao told Lane to keep a record of her blood pressure
and show to Dr. Michael on her next visit. (R. at 1382.) He also advised her to lose
weight. (R. at 1382.)
Dr. Parks reviewed February 28, 2013, x-rays of Lane’s right ankle and
stated that the fracture line was still visible on the lateral view, although there was
some bridging callus formation noted. (R. at 1385.) Lane saw Marquell again on
March 1, 2013, for low back pain. (R. at 1387-89.) Lane denied receiving pain
medication from other providers, taking any illegal substances or experiencing any
side effects from opiates. (R. at 1387.) Lane complained of constant, dull, aching
pain that was significantly affecting her quality of life. (R. at 1387.) Marquell
noted that Lane’s lumbar spine motion was normal, but that palpation of her
lumbosacral spine revealed “abnormalities.” (R. at 1387.) Marquell noted moderate
tenderness on the transverse process of Lane’s lumbosacral spine on both sides and
tenderness on her sacrum with palpation. (R. at 1388.) Lane’s blood pressure was
125/85, and her heart rate and rhythm was normal. (R. at 1387.) A urine drug
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screen was negative. (R. at 1388.) Marquell prescribed hydrocodoneacetaminophen 7.5-325 mg., Flexeril and meloxicam. (R. at 1388.)
III. Analysis
The Commissioner uses a five-step process in evaluating DIB and SSI
claims. See 20 C.F.R. §§ 404.1520, 416.920 (2015). See also Heckler v. Campbell,
461 U.S. 458, 460-62 (1983); Hall v. Harris, 658 F.2d 260, 264-65 (4th Cir. 1981).
This process requires the Commissioner to consider, in order, whether a claimant
1) is working; 2) has a severe impairment; 3) has an impairment that meets or
equals the requirements of a listed impairment; 4) can return to her past relevant
work; and 5) if not, whether she can perform other work. See 20 C.F.R. §§
404.1520, 416.920. If the Commissioner finds conclusively that a claimant is or is
not disabled at any point in this process, review does not proceed to the next step.
See 20 C.F.R. §§ 404.1520(a), 416.920(a) (2015).
As stated above, the court’s function in this case is limited to determining
whether substantial evidence exists in the record to support the ALJ’s findings.
The court must not weigh the evidence, as this court lacks authority to substitute its
judgment for that of the Commissioner, provided her decision is supported by
substantial evidence. See Hays, 907 F.2d at 1456. In determining whether
substantial evidence supports the Commissioner’s decision, the court also must
consider whether the ALJ analyzed all of the relevant evidence and whether the
ALJ sufficiently explained his findings and his rationale in crediting evidence. See
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Sterling Smokeless Coal Co. v. Akers, 131 F.3d 438, 439-40 (4th Cir. 1997).
Thus, it is the ALJ’s responsibility to weigh the evidence, including the
medical evidence, in order to resolve any conflicts which might appear therein.
See Hays, 907 F.2d at 1456; Taylor v. Weinberger, 528 F.2d 1153, 1156 (4th Cir.
1975). Furthermore, while an ALJ may not reject medical evidence for no reason
or for the wrong reason, see King v. Califano, 615 F.2d 1018, 1020 (4th Cir. 1980),
an ALJ may, under the regulations, assign no or little weight to a medical opinion,
even one from a treating source, based on the factors set forth at 20 C.F.R. §§
404.1527(c), 416.927(c), if he sufficiently explains his rationale and if the record
supports his findings.
Lane argues that the ALJ improperly determined her residual functional
capacity. (Plaintiff’s Memorandum In Support Of Her Motion For Summary
Judgment, (“Plaintiff’s Brief”), at 5-7.) Lane also argues that the ALJ’s finding that
a significant number of other jobs existed that she could perform is not supported
by substantial evidence. (Plaintiff’s Brief 8-9.)
The ALJ found that Lane had the residual functional capacity to perform
sedentary work that would allow her to change positions briefly between sitting
and standing, that would not require walking or standing for more than 15 minutes
at a time, that did not require her to climb, kneel or operate foot controls, that
required no more than occasional stooping or crouching and that allowed frequent,
but not constant, reaching, handling and fingering. (R. at 26.) The ALJ also found

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that Lane should avoid heights and machinery and was limited to short, simple
instructions with no close proximity to crowds of unfamiliar persons. (R. at 26.)
In her brief, Lane argues that the ALJ erred by giving less weight to the
opinions of mental health workers Odle and Weitzman, psychologist Lanthorn and
chiropractor Levesque. In his decision, the ALJ considered the opinions of each of
these health care providers. (R. at 26-32.) The ALJ noted that, in March 2011, Odle
had opined that Lane had a poor or no ability to deal with work stresses and a fair
ability to relate to co-workers, to deal with the public, to use judgment with the
public, to interact with supervisors, to maintain attention and concentration, to
behave in an emotionally stable manner and to relate predictably in social
situations. (R. at 30, 746-48.) The ALJ discounted Odle’s opinions because he
found they were inconsistent with Odle’s own progress notes and the other
evidence of record. (R. at 30.) The ALJ noted that, in January 2013, Weitzman had
opined that Lane had a poor or no ability to perform all work-related mental
activities, with the exception of understanding, remembering and carrying out
simple job instructions. (R. at 30, 1370-72.) The ALJ discounted Weitzman’s
opinions because he found that the serious limitations she placed on Lane’s workrelated mental abilities were not reflected in her counseling notes. (R. at 30.) The
ALJ noted that Lanthorn, in July 2012, opined that Lane had a fair ability to
function in all work-related areas, which was defined as the “ability to function in
this area is seriously limited resulting in unsatisfactory work performance.” (R. at
30, 517-19.) The ALJ discounted Lanthorn’s opinions contained in his assessment
because he found that they were inconsistent with his findings and opinions
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contained in his narrative report. (R. at 31.) The ALJ noted that Levesque, in
February 2011, had opined that Lane could not stand or walk for more than 15-20
minutes or sit for longer than 20-30 minutes at a time, perform any fine motor
skills, such as typing or writing, or grasp, pinch, hold or carry items weighing more
than five to 10 pounds. (R. at 31, 933-43.) The ALJ gave Levesque’s opinions little
weight because, as a chiropractor, Levesque is not an acceptable medical source,
see 20 C.F.R. §§ 404.1513(a), 416.913(a), and his opinions were based on Lane’s
subjective complaints and not supported by the objective medical evidence of
record. (R. at 31.)
The ALJ noted that he was giving some weight to the state agency
psychologists and physicians in determining Lane’s residual functional capacity.
(R. at 23.) The regulations fully permit an ALJ to rely upon the opinions of the
state agency physicians in determining a claimant’s residual functional capacity.
See 20 C.F.R. §§ 404.1527(e), 416.927(e) (2015) (providing for the consideration
of opinions of medical and psychological consultants and other nonexamining
physicians and psychologists). The ALJ’s reliance on state agency experts’
opinions is appropriate. See Chandler v. Comm’r of Soc. Sec., 667 F.3d 356, 361
(3d Cir. 2011) (explaining that the opinions of state agency medical consultants
merit significant consideration because they are experts in Social Security
disability evaluation).
Based on my review of the record, I find that substantial evidence supports
the ALJ’s weighing of the medical and psychological evidence. I also find that
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substantial evidence supports the ALJ’s findings with regard to Lane’s residual
functional capacity. I have set out the medical evidence contained in the record in
this case at length in an effort to show that that I have considered it in its entirety.
Despite seeing numerous physicians for numerous conditions, the only physical
health care provider to place any long-term restrictions on Lane’s work-related
activities was chiropractor Levesque. I agree with the ALJ that it appears
Levesque’s restrictions were based more on Lane’s subjective complaints than
reference to her voluminous medical records, which do not document severe spine
and joint problems.
To the contrary, the medical evidence shows that, some years ago, Lane
decided that she no longer wished to work because she was needed to help care for
a disabled brother at home. (R. at 985.) Since that time, Lane has attempted to
build her claims for disability benefits, despite the fact that her health care
providers have told her that they did not consider her impairments disabling. For
instance, Lane’s treating psychiatrist, Dr. Wisdom-Schepers, stated in 2008, only a
month after Lane’s discharge from inpatient psychiatric care, that Lane was “not
psychiatrically disabled.” (R. at 985.) In 2012, Lane’s treating orthopedist, Dr.
Parks, also stated that Lane was not disabled. (R. at 1283.)
Also, the record shows that Lane has repeatedly failed to follow treatment
plans that would limit the effects of her impairments. For instance, Lane continued
to smoke marijuana after being released from inpatient psychiatric treatment. (R. at
434, 658, 976, 981, 984, 999, 1051, 1054.) Despite doing well on her psychiatric
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medications, with no reported side effects, Lane often stopped her medications. (R.
at 972, 975, 1132, 1160.) Lane, on at least one occasion, also stopped taking
medication prescribed for her chronic headaches. (R. at 1223.) After surgery on her
left knee in 2010, it was recommended that Lane participate in physical therapy,
but Lane told her treating physician that she had “no interest in doing so.” (R. at
610.) After breaking her right ankle in 2012, Lane ignored medical advice not to
weightbear for a period of time. (R. at 1283.) Also, Lane has repeatedly ignored
medical advice to lose weight to improve her complaints of body and joint aches
and pains. (R. at 1011, 1299.) “If a symptom can be reasonably controlled by
medication or treatment, it is not disabling.” Gross v. Heckler, 785 F.2d 1163, 1166 (4th
Cir. 1986).

Based on these reasons, I find that substantial evidence supports the ALJ’s
weighing of the medical evidence and his finding as to Lane’s residual functional
capacity. I also find that substantial evidence supports the ALJ’s finding that other
jobs existed that Lane could perform and, therefore, Lane was not disabled. The
transcript of Lane’s hearing shows that the ALJ provided a hypothetical to the
vocational expert, which adequately set forth his findings as to Lane’s residual
functional capacity, as well as her age, education and work history. Testimony of a
vocational expert constitutes substantial evidence for purposes of judicial review where
his or her opinion is based upon a consideration of all the evidence of record and is in
response to a proper hypothetical question which fairly sets out all of a claimant’s
impairments. See Walker v. Bowen, 889 F.2d 47, 50 (4th Cir. 1989).

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An appropriate Order and Judgment will be entered.
ENTERED: March 28, 2016.
s/

Pamela Meade Sargent

UNITED STATES MAGISTRATE JUDGE

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