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Duffy v. Colvin

United States District Court, D. Massachusetts

August 7, 2017

JOHN DUFFY, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner, Social Security Administration, Defendant.



         Plaintiff John Duffy, who suffers from neck pain, moves to reverse the final decision of the Commissioner of the Social Security Administration denying his claim for disability benefits. He argues that the Administrative Law Judge (“ALJ”) failed to properly consider the limited range of motion in his neck.

         For the reasons set forth below, the Court DENIES Duffy's motion to reverse the Commissioner's decision (Docket No. 13) and ALLOWS the Commissioner's motion to affirm (Docket No. 17).


         Duffy claims disability based on his history of neck and lower back pain. The alleged date of onset is November 1, 2011. He was forty-six years old at the alleged onset date.

         I. Treatment History

         Duffy worked as a glazer until April 2009, when he was laid off and began receiving unemployment benefits while looking for work. R. 42. He stopped looking for work after November, 2011, when he went to the emergency room for a neck injury. R. 48. Duffy resides with friends in two different houses and has had this living arrangement for about one year. R. 44. He was previously living with his sister-in-law. R. 44. He also receives food stamps. R. 44.

         On March 8, 2012, Duffy saw primary care physician Mohammed Khedr. R. 306. Duffy stated that he had not seen a doctor in twenty years and complained of neck pain radiating down his left arm. R. 306. Dr. Khedr prescribed medication and recommended an MRI of the cervical spine. R. 308.

         On April 3, 2012, Duffy saw neurosurgeon Leslie Stern for neck pain of six months. R. 338. Dr. Stern noted marked restriction of neck extension and recommended physical therapy. R. 339.

         At a June 7, 2012 follow-up appointment with Dr. Stern, Duffy reported continuing neck pain and told Dr. Stern that he had been unable to attend physical therapy because he did not have transportation. R. 337. Dr. Stern prescribed Lodine and advised that he be re-evaluated if the pain progressed. R. 337.

         On August 9, 2012, Duffy returned to Dr. Stern and reported increased neck pain and more frequent paresthesia in the left arm. R. 336. Dr. Stern found that Duffy's MRI scan showed degenerative disc disease primarily at ¶ 6-7 and also at ¶ 5-6. R. 336.

         On September 11, 2012, Duffy underwent cervical fusion at ¶ 6-C7 and C5-C6 by Dr. Stern. R. 292. Post-surgery follow up indicated that Duffy had done well for two weeks after the surgery but that after that time, his neck pain became worse. R. 333.

         A cervical spine MRI administered on March 22, 2013 revealed mild edematous changes within the C6 and C7 vertebrae, which were possibly related to recent surgery, and tiny subligamentous herniation at the C6-C7 level. R. 342. No cervical myelopathy was noted. R. 342.

         On July 25, 2013, Duffy reported continuing neck pain and stated that turning his head and extending his head caused temporary paresthesia in the left arm. R. 329. Dr. Stern prescribed Oxycodone and a hard collar. R. 19, 329.

         On October 13, 2013, Duffy reported to Dr. Stern that the hard collar helped with sleep and that he had less pain during the day. R. 357. But Duffy would not wear the hard collar if he had to do a “fair amount” of walking because it bothered him. R. 357.

         On May 8, 2014, Duffy began to see primary care physician Raanan Gilboa. R. 383. On physical examination, Duffy ambulated normally but had neck tenderness and pain with motion. R. 385. Dr. Gilboa's assessment was cervical disc disorder with radiculopathy and low back pain. R. 386.

         A cervical spine MRI administered on May 29, 2014 revealed no significant change in multilevel central canal narrowing with mild cord impingement at the C3-C4 and C6-C7 levels. R. 371. A nerve conduction study on June 13, 2014 was indicative of carpal tunnel syndrome in the wrist with the left worse than the right. R. 391.

         On July 7, 2014, Duffy saw neurologist Michael Gieger for cervical pain in the neck with radiation down the left arm and aggravation from neck extension. R. 19, 376. A physical examination showed normal range of motion and muscle strength in the upper and lower extremities. R. 378. However, flexion of the cervical spine was moderately limited and extension was severely limited due to pain. R. 378.

         On August 28, 2014, Duffy saw neurologist Steven Hwang for neck and left arm pain. R. 410. Dr. Hwang stated that Plaintiff had full strength in all extremities except for mild bilateral triceps weakness. R. 410. Duffy had pain to palpation of the neck. R. 410. Dr. Hwang recommended physical therapy and facet blocks. R. 411.

         II. Non-Examining Physician Reports

         The record contains administrative findings made by two state agency non-examining medical physicians. R. 21. State agency physician M. Douglass Poirier reviewed the medical evidence of record and rendered a residual functional capacity (“RFC”) assessment in September 2013. R. 76-84. Dr. Poirier reviewed extensive medical evidence, including the neurological examination reports from Dr. Stern and reports from the September 2012 cervical spine surgery. R. 79. Dr. Poirier found exertional limitations (only occasional pushing and pulling), postural limitations (only occasional climbing, kneeling, and crouching), and manipulative limitations (limited overhead reach). R. 80-81.

         State agency physician Jane Matthews reviewed Duffy's medical records in December 2013. R. 96-105. Dr. Matthews's RFC analysis included limitations ...

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