STL News reports, “The new ALJs will be brought on board in phases with the first hires reporting for duty in April, when they will begin an intensive orientation and training program.  While initially handling a reduced docket, newly hired ALJs should be scheduling a full docket of cases by the end of the year.” We can only hope so.

Social Security: Denial Of Benefits – Mental Disability – Medical Noncompliance

Pate-Fires v. Astrue (MLW No. 59069/Case No. 07-3561 – 22 pages) (U.S. Court of Appeals, Eighth Circuit, Bye, J.)

Where an administrative law judge denied the application for disability benefits and supplemental security income of a claimant with mental impairments based on his determination that she could perform her past relevant work as a retail store stocker, the medical evidence proved that the claimant suffered from a severe mental impairment and could not engage in gainful employment, and the ALJ’s contrary conclusion was not supported by substantial evidence because the claimant’s treating doctor found her to be disabled and the ALJ improperly disregarded the doctor’s opinion based on his own conclusion that the claimant’s drug use and refusal to take her medicine precluded a finding of disability.
Judgment is reversed and remanded.

‘Playing doctor’

“The ALJ’s conclusion Pate-Fires’s medical noncompliance was not justifiable and precludes a finding of disability is not supported by substantial evidence. Further, the ALJ’s determination Pate-Fires’s medical noncompliance is attributable solely to free will is tantamount to the ALJ ‘playing doctor,’ a practice forbidden by law.”

Improper basis

Dissenting opinion by Shepherd, J.: “I respectfully dissent from the majority’s conclusion that remand for an immediate award of benefits is the appropriate remedy in this case. At step four of the sequential evaluation process, the ALJ decided that Pate-Fires retained the residual functional capacity to perform her past relevant work ‘The majority finds that the ALJ reached this step-four conclusion in error. Specifically, the ALJ relied on an improper basis to reject Dr. Erby’s opinion, and substantial evidence did not support the ALJ’s conclusion that Pate-Fires’s medical noncompliance precluded a finding of disability’ To the extent the majority’s decision to reverse the judgment of the district court is based on these errors in the ALJ’s step-four analysis, I concur.”

Judgment is reversed and remanded.
y claim.

Bone is taken from the pelvic bone or obtained from a bone bank. The bone is used to make a bridge between adjacent vertebrae. This bone graft stimulates the growth of new bone.
Metal implants are secured to the vertebrae to hold them together until new bone grows between them.
What To Expect After Surgery
You will need to be watched in the hospital for a few days after spinal fusion surgery.

Bed rest is not usually necessary during your recovery period at home.

Your doctor may recommend that you wear a back brace during recovery.

Rehabilitation can be a prolonged process and includes walking, riding a stationary bike, swimming, and similar activities.

Why It Is Done
Spinal fusion may be done by itself or in combination with decompression to treat painful symptoms caused by misalignment or instability of the vertebrae, such as spondylolisthesis.

Spinal fusion may also be done as a follow-up to decompression and debridement procedures done to treat spinal stenosis, herniated discs, spinal injuries, infection, tumors, and deformities.

How Well It Works
This surgery was originally developed as a way to stabilize the spine and treat deformity or fractures of the spine. Its use has now spread to treatment of degenerative bone or disc changes and spinal stenosis. 1

Spinal fusion is often necessary to stabilize the spine after a traumatic injury, infection, or tumor. There is no solid body of research supporting the effectiveness of spinal fusion for various other spinal conditions. One study showed no clear difference between spinal fusion surgery and intensive rehabilitation for treating chronic low back pain. 2 In addition, the surgery is expensive and has significant risks. Therefore, although this type of surgery is common, it is controversial, and there is no guarantee of treatment success.

Risks
The risks associated with this procedure vary depending upon your age and overall health, diagnosis, and the type of procedure that is done.

Spinal fusion procedures frequently cause other problems. Risks include:

Pain at the bone graft site.
Failure of the fusion process and/or breakage of metal implants.
Deep venous blood clots that may also lead to pulmonary embolism.
Nerve injury.
Graft rejection.
Superficial infection.
Deep infection.
What To Think About
Because there are so many things to consider when spinal fusion is recommended, seek a second opinion before making a decision.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Citations
Deyo RA, et al. (2004). Spinal-fusion surgery-The case for restraint. New England Journal of Medicine, 350(7): 722–726.

Fairbank J, et al. (2005). Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: The MRC spine stabilisation trial. BMJ, 330(7502): 1233–1239.

Author Shannon Erstad, MBA/MPH
Editor Kathleen M. Ariss, MS
Associate Editor Pat Truman, MATC
Primary Medical Reviewer William M. Green, MD – Emergency Medicine
Specialist Medical Reviewer Robert B. Keller, MD – Orthopedics
Last Updated February 6, 2008
WebMD Medical Reference from Healthwise
Last Updated: February 06, 2008
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.