Diabetes, Peripheral Neuropathy, Charcot Foot.

The claimant complained of “diabetes, degenerative discs in her back, high blood pressure, bronchial problems, arthritis, and swelling and numbness in her right foot.”  The Administrative Law Judge “found that Plaintiff suffered from diabetes, a back disorder, obesity, and chronic obstructive pulmonary disease . . . .”

In this appeal, the claimant argued that the ALJ’s residual functional capacity assessment did not include all of her limitations and that the vocational expert’s testimony was based on a hypothetical that did not include all her limitations.

The claimant testified at the hearing that she had “severe arthritis in her feet and legs such that they swell up if she stands too long; she had one disc replaced and two more degenerative discs; when she tries to walk a little distance her whole left side stiffens up on her. . . . The pain in her back from the arthritis causes her pain which goes straight down the left side of her body down to her leg and foot. . . . Plaintiff also testified that she had severe peripheral sensory neuropathy, or nerve damage, in her feet, legs, arms, and hands; she was losing feeling in her hands due to the peripheral neuropathy. . . . Plaintiff has also had issues with swelling in her feet, legs, hands, and whole body at times; arthritis in her right hand also caused swelling at times. . . . Plaintiff further testified that her diabetes was not controlled, but went from one extreme to another; she failed to take the medication because she could not always afford it. . . . She would opt not to take her insulin at night, but only take it in the morning; she would not be able to take the dose at night because she did not have enough. . . .”

The court cited medical evidence that:  “Over the following twelve months between fall of 2009 and 2010, Dr. Mason opined that the claimant was suffering from ‘severe peripheral sensory neuropathy,’ Charcot in her right foot, and ‘quiescent Charcot on the left.’”

The court also observed that: “Diabetic Charcot foot arthropathy is one of the most serious foot problems that diabetics face, and it is a result of nerve damage or neuropathy that leads to a loss of sensation in the feet; diabetes also damages blood vessels, which decreases the blood flow to the feet and poor circulation weakens bone, and can cause disintegration of the bones and joints in the foot and ankle; the combination of bone disintegration and trauma can warp and deform the shape of the foot.” (Citations omitted.)

With regard to the issue of noncompliance with medical advice, the court found that, “The ALJ went to great length to describe [the claimant’s] noncompliance, even misstating and mischaracterizing some of the evidence, and failed to discuss [the claimant’s] inability to afford the insulin medication.”

The court ruled that the ALJ erred by failing to recognize the claimant’s “peripheral neuropathy, including specifically her Charcot foot problems, as a severe impairment and include limitations from these impairments, particularly related to sitting and walking” in his residual functional capacity assessment and hypothetical.


Further the court found that “the ALJ failed to adequately discuss, in the context of Plaintiff’s noncompliance, her inability to afford her insulin and other medications, as he is required to do” and the ALJ compounded his error “by significantly mischaracterizing the records of noncompliance or citing records not in the Record at all.”
  
The case was remanded.

Smith v. Commissioner of Social Security, Case No. 6:13-cv-52-Orl-18DAB (D. M.D. Fla. Orlando Div., Mar. 4, 2014).

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