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Gigliotti v. Berryhill

United States District Court, D. Connecticut

January 10, 2018

MEGHAN GIGLIOTTI, Plaintiff,
v.
NANCY BERRYHILL, COMMISSIONER, SOCIAL SECURITY ADMINISTRATION Defendant.

          RULING ON THE PLAINTIFF'S MOTION TO REVERSE AND THE DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE COMMISSIONER

          Michael P. Shea, U.S.D.J.

         This is 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), [1] 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.

         Ms. 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.

         I. FACTUAL BACKGROUND

         A. The Claimant

         Ms. 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.)[2] Her Date Last Insured was September 30, 2016. (R. 25.) Defendant initially denied her application for benefits on March 7, 2013. (R. 102-05.)

         B. Medical History

         The 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.

         1. Medical Evidence Before the Alleged Onset Date

         On 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[3] 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.[4] (R. 323, 460, 466.) On February 2, 2010, Dr. Arkins recommended that Ms. Gigliotti undergo decompression and discectomy surgery. (R. 792.)

         On 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.

         On May 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, 474.)

         On 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, [5] 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.)

         In a 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.)

         Ms. 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. 368-69, 452-53.)

         2. Medical Evidence After the Alleged Onset Date

         Ms. 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. (Id.)

         Dr. 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.)

         On February 21, 2012, Ms. Gigliotti underwent a CT myelogram[6] 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, 429, 642.)

         In a 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.[7] (R. 392.)

         In a 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. (R. 609.)

         In a 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.)

         On 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.)

         On 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, 857.)

         On 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[8] (“CVA”), as she had weakness, numbness, and tingling in her left hand. (Id.)

         C. Hearing ...


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