United States District Court, D. Connecticut
RULING ON THE PLAINTIFF'S MOTION TO REVERSE AND
THE DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE
Dominic J. Squatrito United States District Judge
an administrative appeal following the denial of an
application filed by the plaintiff, Natale DiMauro
(“DiMauro”), for disability insurance benefits
(“DIB”) and supplemental security income benefits
(“SSI”). It is brought pursuant to 42 U.S.C.
§§ 405 (g) and 1383 (c)(3).
now moves for an order reversing the decision of the
Commissioner of the Social Security Administration
(“Commissioner”). In the alternative, DiMauro
seeks an order remanding his case for a rehearing. The
Commissioner, in turn, has moved for an order affirming her
issues presented are whether the ALJ: (1) properly weighed
the medical opinion evidence; and (2) properly evaluated
DiMauro's credibility with regard to his symptoms. For
the following reasons, DiMauro's motion for an order
reversing or remanding the Commissioner's decision is
granted in part and denied in part, and the
Commissioner's motion for an order affirming her decision
is granted in part and denied in part.
filed applications for DIB and SSI on November 30, 2013, and
December 18, 2013, respectively, for an alleged disability
that commenced on August 1, 2013. For purposes of DIB,
DiMauro's date last insured (“DLI”) is
September 30, 2017. His applications were denied both
initially and upon reconsideration.
April 9, 2015, DiMauro appeared with counsel for a hearing
before an ALJ. On April 23, 2015, the ALJ issued a decision
denying benefits. On August 26, 20156, the appeals council
denied DiMauro's request for review of that decision,
thereby making the ALJ's decision the final decision of
the Commissioner. This appeal followed.
who was born in 1964, has a high school education. His
relevant past work experience was as a stucco setter helper
and a tile setter. According to DiMauro, he had to stop
working in August 2013 because of constant pain in his neck
and back due to a pinched nerve.
was evaluated for lower back and neck pain by Janice Desi,
P.A.-C (Certified Physician Assistant) on January 14, 2013.
Although DiMauro indicated that he had intermittent neck
pain, his principal complaint was lower back pain that
radiated from his back down both of his legs into his feet
along with numbness and tingling. DiMauro further indicated
that increasing pain was affecting his ability to work.
Lumbar radiculopathy was diagnosed and Percocet was prescribed.
He was also scheduled for an epidural steroid injection.
was seen again by P.A. Desi on three occasions between April
and June 2013. On April 5, 2013, he indicated that he had not
gotten the epidural injection because his pain had improved.
He also stated that he had increasing pain in his right elbow
and had trouble lifting objects. He had numbness in his
fingers and had been dropping things. At that time he was
diagnosed with resolving lumbar radiculopathy, medial
epicondylitis right elbow, and ulnar
neuropathy right elbow. On May 2, 2013, he was seen
for neck pain with limited mobility and also for pain in his
upper back. Cervical spine x-rays revealed mild degenerative
disc disease and a straightening of the cervical curve. On
June 28, 2013, DiMauro reported low back and right elbow pain
and indicated that his right elbow pain worsened when he
lifted heavy loads at work. At that visit P.A. Desi diagnosed
lumbar radiculopathy and lateral epicondylitis of the right
Bruce H. Moeckel (“Dr. Moeckel”), an orthopedic
surgeon, saw DiMauro on July 26, 2013 for continued back and
right elbow pain. At that time DiMauro reported having
difficulties with day-to-day activities due to pain. Dr.
Moeckel's physical examination found tenderness across
the lower back, pain into the buttocks caused by a straight
leg raise, tenderness over the lateral epicondyle, and pain
with resisted wrist extension. Dr. Moeckel administered a
cortisone shot in the right elbow. On August 23, 2013,
DiMauro reported significant right elbow pain as well as pain
on the inside of his right arm with numbness and tingling in
his right hand. At that time, Dr. Moeckel diagnosed lumbar
radiculopathy, lateral epicondylitis of the right elbow, and
ulnar neuropathy involving the right elbow. Dr. Moeckel
stated he was concerned about DiMauro's severe elbow and
back symptoms and whether he could continue working.
September 25, 2013, Dr. Moeckel completed a Summary
Impairment Questionnaire concerning DiMauro. Dr. Moeckel
indicated diagnoses of lumbar radiculopathy, lateral
epicondylitis of the right elbow, and ulnar neuropathy. The
clinical and laboratory findings cited by Dr. Moeckel in
support of his diagnoses were tenderness across DiMauro's
lower back, decreased range of motion, and increased pain
with range of motion. DiMauro's primary symptoms were
listed as lower back pain, right elbow pain, and increased
pain when attempting to lift heavy loads. Dr. Moeckel offered
his opinion that DiMauro was able to sit less than one one
hour and stand/walk less than one hour in an eight-hour
workday. He further opined that it was medically necessary
for Dimauro to elevate both of his legs to waist level at all
times when seated, that DiMauro was incapable of lifting
and/or carrying even five pounds, and that he had significant
limitations that allowed only occasional use of his
hands/fingers for fine manipulation. The doctor indicated
that DiMauro was likely to be absent from work more than
three times a month as a result of his impairments or
treatments. According to Dr. Moeckel, DiMauro's
limitations applied at least as far back as August 1, 2013.
Moeckel evalutated DiMauro again on October 4, 2013, at which
time DiMauro indicated that his biggest problem was pain and
stiffness in his neck. He also had pain in his lower back and
trouble with day-to-day activities. Dr. Mockel ordered
cervical and lumbar MRIs and continued Percocet at a higher
dose. On November 7, 2013, DiMauro reported to Dr. Moeckel
that he continued to have right elbow, neck, and back pain.
On that occasion, a steroid injection was administered to his
right elbow and prescribed medications were continued.
December 27, 2013, the cervical and lumbar MRIs that had been
ordered by Dr. Moeckel were performed. The results of the
cervical spine MRI were interpreted as showing mild
degenerative changes of the cervical spine and no abnormal
signal in the cervical spinal cord. The results of the lumbar
spine MRI were interpreted as showing stable mild
degenerative changes of the lumbar spine.
was seen by Dr. Moeckel again on January 8, 2014, and
February 5, 2014. Dr. Moeckel continued to feel that DiMauro
was disabled. There were no changes made to prescribed
medications. Findings based on the doctor's physical
examination of DiMauro remained unchanged from previous
visits. According to Dr. Moeckel's February 5, 2014 note,
DiMauro was trying to arrange a cervical epidural steroid
saw P.A. Desi on March 6, 2014 for increased pain in his back
and down both legs. He indicated that he had been clearing
snow and experienced increased pain in his lower back and
down both legs. He complained of trouble with day-to-day
activities and was unable to lift anything. On March 26,
2014, an epidural steroid injection was administered to
April 2, 2014, DiMauro reported to Dr. Moeckel that his back
pain continued, although the epidural steroid injection gave
him some relief. Dr. Moeckel referred DiMauro for a second
lumbar injection which was administered on April 23, 2014. No
significant changes were noted at subsequent follow-up visits
through October 13, 2014.
Moeckel completed a second Summary Impairment Questionnaire
on October 13, 2014. He indicated diagnoses of lumbar
radiculopathy, cervical radiculopathy, and status post
shoulder surgery. Dr. Moeckel listed MRIs of the cervical
and lumbar spines as the clinical findings that supported his
diagnoses. DiMauro's primary symptoms were reported as
neck and back pain. According to Dr. Moeckel, DiMauro was
able to sit for up to two hours and stand/walk for no more
than one hour in an eight- hour workday. He could
occasionally lift and/or carry up to five pounds, but never
more than five pounds. He could only occasionally use his
hands and fingers for fine manipulation. Dr. Moeckel further
opined that DiMauro was likely to be absent from work more
than three times per month due to his impairments or
January 14, 2015, DiMauro reported that his neck and back
pain had worsened. Physical examination revealed tenderness
across the lower back, pain into his buttocks caused by a
straight leg raise, and neck pain radiating into his shoulder
blades caused by range of motion of his neck. At the same
time, physical examination also revealed that “upper
extremity motor strength is 5/5, sensation is intact [and]
[r]eflexes are symmetric.” (Doc. # 9-8, at 71, p.
April 11, 2015, Dr. Moeckel completed a Disability Impairment
Questionnaire in which he repeated the findings reported in
his second Summary Impairment Questionnaire. Dr. Moeckel
again listed MRIs of the cervical and lumbar spines, as well
as an x-ray, as the clinical findings that supported his
diagnoses of cervical radiculopathy and lumbar radiculopathy.
He also opined that it was medically necessary for DiMauro to
avoid continuous sitting in an eight-hour workday, and that
if seated, he would need to get up and move around every
15-20 minutes for a period of 15-20 minutes before sitting
again. DiMauro could occasionally lift and/or carry up to ten
pounds but never more. He could frequently use his hands and
fingers for fine manipulations, but could only occasionally
grasp, turn, and twist objects. According to Dr. Mocekel,
DiMauros's pain, fatigue, and other symptoms were
frequently severe enough to interfere with his attention and
concentration. He would need to take unscheduled rests at
unpredictable intervals during an eight-hour workday for
10-15 minutes each time before returning to work. Dr. Moeckel
estimated that DiMauro was likely to be absent from work two
or three times per month as a result of his impairments or
treatment. Pranav Kapoor, M.D.
Pranav Kapoor (“Dr. Kapoor”), DiMauro's
primary care physician, first saw DiMauro on December 10,
2013. At that time Dr. Kapoor diagnosed obesity, elevated
blood pressure without diagnosis of hypertension, and
gastroesophageal reflux disease (“GERD”). At a
follow-up visit on January 20, 2014, Dr. Kapoor diagnosed
hypertension and chronic back pain.
January 24, 2014, Dr. Kapoor completed a Mental Impairment
Questionnaire at the request of the Social Security
Administration. He diagnosed a prior history of depression
and listed medications that included Escitalopram, which is
used to treat anxiety and major depressive disorder.
DiMauro's mental status was reported as appropriate and
normal. According to Dr. Kapoor, DiMauro had a slight problem
using appropriate coping skills to meet the ordinary demands
of a work environment, but had a serious problem performing
work activity on a sustained basis due to his physical
limitations from chronic pain.
March 10, 2014, DiMauro reported to Dr. Kapoor that he had
experienced a little dizziness and shortness of breath.
DiMauro expressed his belief that these symptoms were
“secondary to back pain when he was replacing parts on
the ventilation unit above his range. He was twisted in an
unusual position and when he stood up straight he began to
feel symptoms and sharp pain.” (Doc. # 9-8, at 51, p.
415). During the period from March 2014 through October 2014
DiMauro saw Dr. Kapoor on three occasions. During these
visits DiMauro reported feeling anxious and depressed. He
indicated that he had tried to go back to work but had to
stop after three weeks due to unbearable pain. Dr. Kapoor
diagnosed hypertension, depression, chronic low back pain,
and being overweight. He prescribed medications that included
February 13, 2015, Dr. Kapoor completed a Disability
Impairment Questionnaire. He indicated diagnoses of GERD,
hypertension, depression, impaired fasting glucose
(pre-diabetes), and chronic low back pain. DiMauro's
primary symptoms of depression were listed as poor sleep and
increased stress. According to Dr. Kapoor, DiMauro's
symptoms and limitations applied as far back as August 1,
2013. Dr. Kapoor stated that he only treated DiMauro for his
blood pressure and impaired fasting glucose and that another
doctor treated him for his back pain. He also indicated that
he had not assessed DiMauro's capacity for work.
report dated March 23, 2015, Dr. Kapoor stated that he
believed chronic back pain was the primary basis of
DiMauro's disability. He reported that DiMauro's
hypertension and GERD were well controlled with medication.
Dr. Kapoor also indicated that DiMauro's depression had