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
Michael P. Shea, U.S.D.J.
an administrative appeal following the denial of Meghan
Gigliotti's application for disability insurance
benefits. Ms. Gigliotti appeals pursuant to 42 U.S.C.
§§ 405(g) and 1383(c)(3),  and moves for an order
reversing the decision of the Commissioner of the Social
Security Administration (“Commissioner”). In the
alternative, Ms. Gigliotti seeks an order remanding her case
for a rehearing. The Commissioner, in turn, has moved for an
order affirming the decision.
Gigliotti argues that the Administrative Law Judge
(“ALJ”) improperly assessed her credibility,
accorded too little weight to the opinions of her treating
physicians and too much weight to those of agency consulting
physicians, and improperly determined her residual functional
capacity (“RFC”), thereby erroneously finding
that Ms. Gigliotti could return to work. I disagree and
conclude that the ALJ's decision was supported by
substantial evidence. I therefore AFFIRM.
Gigliotti was born on February 6, 1965, and was 50 years old
at the time of her hearing. (Record page (“R.”)
45.) She most recently worked as a health unit clerk. (R.
69.) Ms. Gigliotti applied for disability benefits on January
28, 2013, claiming that she had been disabled since December
20, 2011. (R. 26, 200-03.) Her Date Last Insured was September 30,
2016. (R. 25.) Defendant initially denied her application for
benefits on March 7, 2013. (R. 102-05.)
relevant medical evidence is set forth in a Joint Medical
Chronology filed by the parties (ECF No. 16-2), which the
Court adopts and incorporates by reference herein. The
following is a summary of that chronology.
Medical Evidence Before the Alleged Onset Date
September 14, 2009, after having a neurology consultation
with Dr. Robert Thornton, who noted that Ms. Gigliotti was
experiencing paresthesias in the digits of her right hand,
Ms. Gigliotti had an MRI of her lumbar spine, which showed
right paracentral disc herniation. (R. 800, 821.) On
September 16, 2009, Ms. Gigliotti underwent an EMG study that
showed right ulnar neuropathy with evidence of a partial
conduction delay across the elbow segment, as well as
radiculopathy with features of acute and chronic
denervation. (R. 823.) She underwent a lumbar x-ray on
October 23, 2009, which showed degenerative disease and facet
arthropathy. (R. 796.) On December 21, 2009, Ms. Gigliotti
received facet joint injections for chronic low back pain.
(R. 797-98.) In a follow-up appointment with neurosurgeon Dr.
Thomas J. Arkins on December 23, 2009, Dr. Arkins recommended
that Ms. Gigliotti undergo a disc excision and fusion
procedure. (R. 783.) On January 26, 2010, Ms. Gigliotti had a
CT scan of her lumbar spine, which revealed mild left convex
scoliosis, mild loss of disc height, disc bulging, and disc
protrusion that is associated with endplate spurring and mild
encroachment of the neural foramen. (R. 780.) The same day,
Ms. Gigliotti underwent a discogram surgery for chronic
lumbar spondylosis. (R. 323, 460, 466.) On February 2, 2010,
Dr. Arkins recommended that Ms. Gigliotti undergo
decompression and discectomy surgery. (R. 792.)
February 24, 2010, Ms. Gigliotti underwent a lumbar
decompression procedure for spondylosis. (R. 454-59, 464,
763-72, 778.) Two weeks later, she complained of numbness in
her left leg but reported that her nerve pain was gone and
that she felt better than she had before the surgery. (R.
324.) On March 16, 2010, Ms. Gigliotti was admitted to the
hospital for two days for spondylosis and back pain. (R.
454.) An April 8, 2010 lumbar spine x-ray showed maintenance
of anatomic segmentation and stable positioning of hardware,
as well as no evidence of progressive disc degeneration,
following Ms. Gigliotti's lumbar decompression. (R. 757.)
That day, Ms. Gigliotti reported to Dr. Arkins complete
relief of leg pain, but increased back pain, because she was
more active. (R. 325.) Dr. Arkins asked her to try gradually
to mimic work activity for six to seven weeks before she was
due to return to work.
20, 2010, Dr. Arkins noted that Ms. Gigliotti was able to
return to work four hours per day without restrictions, and
advised as much in a letter addressed “[t]o whom it may
concern” on May 22, 2010. (R. 326-327.) On June 21,
2010, Ms. Gigliotti reported sacroiliac pain extending to the
mid-lumbar spine and deep pain in the buttock to Dr. Arkins,
but stated that she believed she could work six hours per
day. (R. 329.) Dr. Arkins wrote a letter advising that Ms.
Gigliotti could return to work as of June 28, 2010 for six
hours per day without restrictions. (R. 328.) After returning
to work, Ms. Gigliotti asked Dr. Arkins on July 26, 2010 to
be released to work fulltime, eight hours per day. (R. 331.)
Dr. Arkins advised her to stop smoking cigarettes as complete
cessation was necessary to assure solid fusion of her
hardware. (Id.) As of September 17, 2010, Ms.
Gigliotti continued to take Vicodin and Neurontin three times
a day for burning in her left foot and calf and continued to
smoke cigarettes. (R. 332.) A December 30, 2010 lumbar MRI
showed that Ms. Gigliotti's vertebral bodies were well
aligned without evidence of subluxation; the same day, Ms.
Gigliotti reported trouble when she could not get up and move
throughout the day, but that her back pain was “far,
far less than it was preoperatively and she [was] very
pleased that she had surgical treatment.” (R. 333,
January 26, 2011, Dr. Arkins completed a report for the
Connecticut Department of Labor indicating that it was
necessary for Ms. Gigliotti to leave her job because she
could not function with her hands because of numbness and
lumbar pain. (R. 689.) Dr. Arkins could not determine when
she would be able to work full time. (Id.) On
February 24, 2011, Dr. Arkins noted during a follow-up
appointment that Ms. Gigliotti's x-rays showed solid
fusion, that she had less pain after surgery and no longer
had a foot drop,  but that she had significant numbness in
her right foot and continued to take Vicodin and Neurontin.
(R. 334, 472, 681.) Dr. Arkins opined that Ms. Gigliotti was
“fully functional and active.” (R. 334.)
consultation with pain specialist Dr. David B. Glassman, Ms.
Gigliotti reported low back and leg pain but that opioid
medication gave her pain relief; on examination, her gait was
slightly antalgic and her straight leg raising was positive
on the left more than on the right while sitting. (R. 343.)
Dr. Glassman encouraged activity as tolerated, alternating
ice and moist heat as needed, and daily exercise and
stretching. (R. 344.) Ms. Gigliotti had various treatments
for pain throughout 2011, including steroid, nerve block, and
trigger point injections. (R. 349, 360-61.) A cervical MRI on
August 25, 2011 showed moderate spondylosis but no cord
compression or large herniation. (R. 526.)
Gigliotti saw Dr. Arkins for left arm symptoms and numbness
in the left hand on October 11, 2011. (R. 335.) Upon
examination, extension of the neck provoked mild numbness in
the left arm, but she showed no weakness in either arm nor
atrophy in the hand. (Id.) She had diminished
reflexes in her arms but her balance and strength appeared
normal. (R. 336.) On November 1, 2011, Dr. Arkins noted mild
weakness of abduction in the second and third fingers but
otherwise intact grasp strength, opposition, abduction, and
adduction, and no left hand paresthesias. (R. 338.) On
December 2, 2011, Dr. Arkins noted that Ms. Gigliotti
“remained clumsy in the left arm” but “not
because of weakness, ” and that he was “perplexed
diagnostically.” (R. 339.) On December 13, 2011, Ms.
Gigliotti underwent a procedure for percutaneous placement of
epidural leads and a SCS [spinal cord stimulator] trial. (R.
Medical Evidence After the Alleged Onset Date
Gigliotti had a chest MRI on December 22, 2011, which showed
reversal of the normal cervical lordosis and mild disc
bulges. (R. 467-68.) In a neurological consultation with Dr.
Samuel Bridgers on January 18, 2012, Ms. Gigliotti complained
of numbness in her left hand, paresthesia extending up to her
forearm, neck pain, loss of power in her left hand, and
inability to grip and squeeze with her left hand. (R. 699.)
Examination showed only mild limitation of cervical motion
and tenderness on the left arm and unremarkable gait. (R.
700.) Dr. Bridgers diagnosed her with radiculopathy.
Arkins opined in a follow-up appointment on January 26, 2012
that Ms. Gigliotti “is not work-capable” after
Ms. Gigliotti complained of increased lumbar pain. (R. 340.)
February 21, 2012, Ms. Gigliotti underwent a CT
myelogram of the cervical spine, which showed no
significant central canal stenosis and only minimal
degenerative changes. (R. 694-95.) A lumbar spine CT
myelography showed no significant canal or neuroforaminal
stenosis, progression of anterior osseous fusion, and only
minimal degenerative changes. (R. 681-82.) On March 2, 2012,
Dr. Arkins observed no evidence of nerve root compression or
mass, though EMGs revealed the possibility of ulnar
neuropathy; Dr. Arkins noted there was no surgical solution
to Ms. Gigliotti's left arm pain and intermittent sciatic
pain, and advised that if she increased her activities, she
might worsen her condition. (R. 341.) Ms. Gigliotti continued
to receive epidural steroid injections through 2012. (R. 381,
neurosurgical consultation with Dr. Judith Gorelick on
December 7, 2012, Ms. Gigliotti complained of leg heaviness
and weakness and numbness of the left upper extremity. (R.
615.) Dr. Gorelick saw no evidence of discrete cervical
radiculopathy or peripheral nerve entrapment and noted an
unremarkable imaging study. (R. 616.) In a December 11, 2012
neurological consultation for left arm numbness with Dr.
Joshua Hasbani, Ms. Gigliotti had a normal motor examination,
with full strength in the upper and lower extremity, normal
sensation except for diminished sensation of temperature and
light touch, normal coordination, and normal reflexes with a
bilaterally absent Babinski sign. (R. 394.) Dr. Hasbani noted
that the examination was only notable for subjective sensory
loss in the left arm in a nonspecific dermatomal
distribution; because he did not find specific dermatomal
numbness in the left upper extremity and because Ms.
Gigliotti had full strength, he elected not to repeat nerve
conduction studies at that time. (R. 395.) In a neurological
reevaluation with Dr. Hasbani on January 10, 2013, Ms.
Gigliotti had a normal motor examination with full strength
in the upper and lower extremities, normal sensation, and
normal reflexes and gait. (R. 391.) Dr. Hasbani diagnosed her
with thoracic outlet syndrome. (R. 392.)
neurological evaluation with Dr. Moshe Hasbani on February
24, 2013, Ms. Gigliotti's upper extremity muscle strength
was nearly normal in all groups and she had no radicular
symptoms. (R. 514-15.) Dr. Hasbani opined that she probably
had thoracic outlet syndrome and required further evaluation.
neurological evaluation with Dr. Gorelick on July 12, 2013,
Ms. Gigliotti demonstrated good strength in the lower
extremities bilaterally and no significant foot drop on the
left. (R. 571.) She ambulated with a steady gait.
(Id.) Dr. Gorelick opined that Ms. Gigliotti had
symptoms of increasing weakness and paresthesias of the left
lower extremity of unclear causation. (Id.)
December 12, 2013, Dr. David Kloth noted that based on an MRI
of her cervical spine, Ms. Gigliotti had multilevel disease,
which correlated with her left upper extremity and hand
problems. (Tr. 870.) Dr. Kloth noted on March 5, 2014 that
after a lumbar branch mapping procedure, Mr. Gigliotti had
increased sitting tolerance and decreased pain, but no
significant improvement on a sustained basis. (R. 866.) Ms.
Gigliotti underwent a left sacroiliac joint mapping procedure
on March 26, 2014. (R. 864.)
April 21, 2014, Dr. Kloth noted in a reevaluation that Ms.
Gigliotti's hip x-ray did not reveal significant
arthritis, despite her continuing to have deep pain within
her hip. (R. 860.) Dr. Kloth noted that Ms. Gigliotti had
chronic radiculopathy. (Id.) On June 3, 2014, Dr.
Kloth noted that Ms. Gigliotti's most recent lumbar MRI
revealed progression of disease above her fusion but did not
recommend surgery. (R. 858.) Ms. Gigliotti continued to have
epidural steroid injections through 2014, but continued to
have pain in her left lumbar region. (R. 846, 848, 849, 851,
February 23, 2015, Ms. Gigliotti reported a significant
reduction of her symptoms with an almost 80% reduction of
pain after undergoing a left cervical facet block earlier
that month. (R. 839.) Ms. Gigliotti continued to have burning
on the left side of her neck, but which did not travel down
her arm. (R. 838.) In a March 9, 2015 reevaluation, Dr. Kloth
opined that Ms. Gigliotti had had a cerebrovascular
accident (“CVA”), as she had weakness,
numbness, and tingling in her left hand. (Id.)