February 28, 2018
from the United States District Court for the Eastern
District of Wisconsin. No. 15-C-1548 - William C. Griesbach,
Manion, Sykes, and Hamilton, Circuit Judges.
Lambert appeals the denial of Disability Insurance Benefits
for chronic back pain. The Social Security Administration
denied his application initially and on reconsideration, and
an administrative law judge ("ALJ") concluded that
Lambert suffers from degenerative disc disease that is
severely impairing but not disabling. Lambert challenges the
ALJ's decision to give little weight to the most recent
opinions of his treating neurosurgeon and to discredit his
own testimony about the severity of his pain and extent of
his limitations. We reverse and remand for further agency
applied for benefits in 2012 at age 41 alleging disabling
lower back pain since 2011, an onset date that he later
amended to 2013. Yet his back problems started long before
then. In 2004 discs in his lumbar spine were surgically fused
with a rod. In 2008 surgeons repaired the rod. Still, Lambert
held several jobs over the years.
Lambert began experiencing back pain "most of the
time" and thereafter also had "intermittent"
pain down his left leg that often caused him to fall. By late
2012 Lambert had tried various treatments, including steroid
injections in his spine and pelvis, chiropractic care,
medication, and physical therapy. Nothing produced lasting
relief, though hydrocodone helped ease the pain. Medical
imaging revealed no postsurgical complications or other
explanation for his persistent pain. Several neurosurgeons
found the cause unclear; three said further surgery was not
September 2012 a pain specialist attributed Lambert's
pain to degenerative disc disease or joint disease of the
lower lumbar spine. Months later he diagnosed Lambert with
failed back syndrome (meaning he experienced continuous pain
despite surgeries) and recommended that he accept his chronic
pain and proceed with a pain-management program instead of
seeking a surgical cure. The pain specialist also recommended
that Lambert consider behavioral therapy to learn coping
skills. Lambert followed this advice, but in early 2013 the
pain specialist referred him to a neurosurgeon to find the
source of the left-leg pain that by this time was causing
Kamajit Paul began treating Lambert in June 2013 and
initially recommended a conservative course of steroid
injections to determine if his pain was caused by dysfunction
in the left sacroiliac joint. (The sacroiliac joints connect
the pelvis to the lower spine and support the weight of the
upper body when a person stands. Sacroiliac Joints,
(last visited June 28, 2018).) The pain specialist
administered three injections but continued advising Lambert
to accept his chronic pain and moderate his activities.
Because the injections provided only several hours of relief,
Dr. Paul believed Lambert had dysfunction in his left
sacroiliac joint and recommended surgery to fuse it. But he
cautioned that the surgery offered no guarantee of
improvement and that Lambert would still experience some back
and leg pain and would "never be 100%."
Paul performed the left-joint fusion in October 2013, and
Lambert's condition initially started to improve. In
November Lambert reported minimal pain. After a month of
physical therapy, he underwent a functional assessment in
January 2014. He was able to walk without an assistive device
and reported "improved function at home and in the
community." His physical therapist recommended allowing
him to return to work with some lifting restrictions, and Dr.
Paul released Lambert to light-duty work.
Lambert's relief was short-lived. In February 2014 he
returned to Dr. Paul, now reporting pain on his
right side. Dr. Paul was "not sure what [was]
happening" and sent Lambert back to his pain specialist.
Testing revealed potential dysfunction in the right
March 2014, Dr. Paul completed an assessment of Lambert's
functional abilities. He diagnosed bilateral joint
dysfunction and stated that Lambert experienced continued
pain in his right sacroiliac joint and lower back. He opined
that in a competitive work situation, Lambert could sit for
at least six hours out of eight, stand for 30 minutes at a
time (up to two hours total), and walk one block at a time
(if allowed to shift between these positions at will). Dr.
Paul also noted, however, that Lambert's prognosis was
guarded and that he "may develop problems in the upper
April 2014 Dr. Paul surgically fused Lambert's right
sacroiliac joint. Lambert returned to physical therapy and in
early June reported that his preoperative pain had resolved.
But later that month Lambert told his physical therapist that
the pain on the left side of his lower back had returned; he
said it was minimal but interfered with sleep. A week later
Lambert said the pain had worsened and now prevented him from
walking as far as he could just weeks before. In July 2014
Lambert told Dr. Paul that he had been experiencing
pain-exacerbated by activity-for as long as four weeks.
X-rays revealed intact surgical hardware ...