United States District Court, District of Massachusetts
MEMORANDUM AND ORDER
DOUGLAS P. WOODLOCK, UNITED STATES DISTRICT JUDGE.
Hasan Hejazi appeals the final decision of the Commissioner of Social Security (the “Commissioner”) denying his claim for Disability Insurance Benefits (“DIB”) and Supplemental Security Income (“SSI”). After consideration of the record before me, which I find provides substantial evidence for the denial, I will affirm the Commissioner’s decision.
A. Basic Facts
Mr. Hejazi was forty-two years old on September 1, 2008, the date of the onset of his alleged disability. He has completed high school but not attended college. Currently, he lives with his wife and four children and relies on welfare to support himself and his family.
B. Work History
Mr. Hejazi was last employed as a construction worker for his brother in 2008. Prior to his construction work, Mr. Hejazi worked in a butcher shop, until pain in his lower back made it too difficult for him to stand for long periods as required by that occupation. Consequently, he left his job as a butcher and began to help his brother with small construction jobs, such as replacing a window or installing floor tiles, in order to maintain gainful employment.
During his hearing before the administrative law judge, Mr. Hejazi testified that the back pain he was experiencing caused him to cease helping his brother with construction on August 15, 2008. Since then, he has remained unemployed and generally homebound, watching television, sitting on his couch, and lying down throughout the day. Nevertheless, he is able to accompany his wife to the grocery store once a week, assist his children with their nightly homework, and regularly attend religious services. Moreover, Mr. Hejazi was able to travel to Jordan via Frankfurt in December of 2010 and remain there for thirteen months. Although he participated in herbal therapy, he did not seek out professional medical treatment while abroad.
C. Medical History
1. Physical Impairments
a. Evaluations by Dr. Hans Kim
The administrative record includes medical reports authored by Dr. Hans Kim, who has been Mr. Hejazi’s treating physician since June 26, 2002. These reports indicate that Mr. Hejazi has suffered from lumbar and/or thoracic back pain since at least his first meeting with Dr. Kim, and that he currently suffers from lumbar back pain, sciatica, a torn spinal disc, and leg numbness. A lumbar spine MRI conducted on June 23, 2006, at the behest of Dr. Kim, revealed degenerative disc changes at L2-3 and L4-5 levels, with a small right-sided annular tear at L4-5 level. However, there was no evidence of focal disc herniation, spinal stenosis, abnormal enhancement, or intra or parapsinal mass lesions. Nonetheless, to alleviate Mr. Hejazi’s discomfort, Dr. Kim prescribed Vicodin on May 1, 2006, renewing his prescription through 2008. Dr. Kim observed in his progress notes that Mr. Hejazi responded well to the Vicodin treatment with his back pain “improv[ing] considerably.” Indeed, on October 16, 2006, Dr. Kim reported that only an hour after taking Vicodin each morning, Mr. Hejazi’s pain level was reduced by half.
In addition to his prescribing Vicodin, Dr. Kim also recommended to Mr. Hejazi that he begin physical therapy. Mr. Hajezi, however, did not find these sessions particularly helpful, and the physical therapist discharged him for noncompliance in November of 2006.
Throughout the following year, Dr. Kim continued to write in his progress reports that Mr. Hejazi suffered from lower back pain and experienced numbness and weakness in his right leg. Although Mr. Hejazi was able to go grocery shopping and perform other daily chores, lifting anything of moderate weight exacerbated his pain. For example, on June 18, 2007, Mr. Hejazi reported to Dr. Kim that he could not carry his infant son for more than ten minutes and thus found it difficult to care for his children. On April 2, 2008, Mr. Hajezi alerted Dr. Kim to an additional numbness in his left thigh which occurred during sleep and only dissipated once he had rubbed the area and moved around in bed. Dr. Kim wrote that Mr. Hejazi’s symptoms might be due to the compression of the lateral femoral cutaneous nerve or an L5 radiculopathy. Nevertheless, by May 13, 2008, Dr. Kim declared that Mr. Hejazi’s chronic lower back pain was stable and that the numbness in his right and left legs also remained unchanged. Although Mr. Hejazi complained of additional numbness in his hands during sleep, Dr. Kim reassured Mr. Hejazi that such numbness was likely due to compression of the median nerve and could be alleviated by altering his sleep position. On October 14, 2008, Dr. Kim once again documented in his medical report that Mr. Hejazi’s symptoms were stable and being managed well with four Vicodin tablets per day.
Throughout most of 2009, Mr. Hejazi’s symptoms remained unchanged. However, during Mr. Hejazi’s visit to Dr. Kim on October 6, 2009, Dr. Kim noted that Mr. Hejazi had exacerbated “lumbar back pain with persistent deficits of the right leg.” Mr. Hejazi also suffered from “a worsening of the numbness of his right leg in an L5 distribution. In addition, he continue[d] to experience a chronic loss of the right patellar reflex.” In response to deterioration in Mr. Hejazi’s symptoms, Dr. Kim recommended that his patient “avoid prolonged immobilization” and “change his position every 15 to 30 minutes to avoid [the] worsening of his symptoms.” Already using a cane to help with ambulation, Mr. Hejazi was encouraged by Dr. Kim to remain as physically active as possible without aggravating his injuries.
The following April, Mr. Hejazi reported a “severe exacerbation of his symptoms” after entering a store. In addition to taking Vicodin, Dr. Kim proposed a “gentle range of motion exercises and avoidance of prolonged immobilization” in order to alleviate Mr. Hejazi’s discomfort. By May 27, 2010, Mr. Hejazi had improved, with Dr. Kim declaring that he had returned to his “baseline symptoms.” However, after being seated on a long air flight from Jordan, Mr. Hejazi returned to Dr. Kim with exacerbated back pain. Dr. Kim renewed Mr. Hajezi’s Vicodin prescription and also provided crutches for when the pain was most severe. By December 22, 2010, the numbness in Mr. Hajezi’s right leg had gotten worse, and periodic episodes of acute pain confined him to his bed for three or four days at a time. Although Mr. Hejazi reported that the Vicodin tablets alleviated his condition, his wife still had to assist him with his daily activities whenever his symptoms flared up.
Approximately eleven months later, on December 2, 2011, Dr. Kim filled out a physical impairment capacity questionnaire. In this document, he diagnosed Mr. Hejazi with lumbar back pain and sciatica. As a result of these ailments, Dr. Kim stated that Mr. Hejazi could lift less than ten pounds and could stand or sit for less than two hours per work day. In addition, Dr. Kim stated that Mr. Hejazi could only sit for fifteen minutes before having to change position and had to walk around for five minutes at fifteen minute intervals. Dr. Kim estimated that Mr. Hejazi would have to lie down between two and four times per shift and could not be expected to twist, bend, or climb while on the job. Regarding a prognosis, Dr. Kim did not anticipate any improvement. As a result, Dr. Kim concluded that Mr. Hejazi would likely miss more than four days of work per month.
b. Evaluation by Dr. Leslie Caraceni
On January 12, 2010, Dr. Leslie Caraceni, the state agency’s non-examining consultant, filled out an assessment of Mr. Hejazi’s physical and functional capacities. In it, she concluded that Mr. Hejazi could carry up to twenty pounds occasionally and up to ten pounds frequently. She also estimated that Mr. Hejazi could stand or walk for at least two hours and sit for approximately six hours per work day. Additionally, she determined that he had an unlimited ability to push or pull objects, as long as such an activity did not involve lifting anything more than twenty pounds. In contrast to Dr. Kim, she concluded that Mr. Hejazi was occasionally capable of climbing, balancing, stooping, kneeling, crouching, and crawling. Indeed, in Dr. Caraceni’s opinion, Mr. Hejazi’s alleged pain was out of proportion to his MRI and exam findings and consequently only partially credible. On July 14, 2010, Dr. E. Montoya, a state agency reviewing physician, studied the record and agreed with Dr. Caraceni’s set of findings.
D. Administrative Proceedings
On October 22, 2009, Mr. Hejazi filed a Title II application for Disability Insurance Benefits with the Social Security Administration. The following day, October 23, 2009, he filed a Title XVI application for Supplemental Security Income. He claimed to have become disabled on September 1, 2008. Both claims were initially denied, before being denied again upon reconsideration. On August 31, 2010, Mr. Hejazi filed a written request for a hearing.
On April 6, 2012, an administrative law judge (ALJ) held a hearing on Mr. Hejazi’s claims. During that hearing, the ALJ heard testimony from Mr. ...