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San Antonio v. Saul

United States District Court, D. Massachusetts

January 6, 2020

Kenneth Alan San Antonio, Jr., Plaintiff,
Commissioner Andrew M. Saul, Defendant.



         Kenneth Alan San Antonio, Jr (“San Antonio” or “plaintiff”) seeks judicial review of the denial of his application for disability insurance benefits by Andrew M. Saul (“the Commissioner” or “defendant”), Commissioner of the Social Security Administration (“the SSA”).[1] Pending before the Court are plaintiff's motion for an order reversing the Commissioner's decision (Docket No. 17) and defendant's motion to affirm that decision (Docket No. 21). For the reasons that follow, plaintiff's motion will be denied and the Commissioner's motion will be allowed.

         I. Background

         A. Employment History and Alleged Disability

         San Antonio was born in 1980. In 2003, He received his bachelor's degree in science and clinical laboratory sciences from Quinnipiac University. He passed two national board exams to practice as a clinical laboratory technologist and did clinical rotations at Yale Hospital in New Haven, Connecticut. After his graduation from college, plaintiff was employed as a lab technician at several hospitals.

         In August, 2012, plaintiff sought treatment for back pain after sustaining an injury while exercising. Following an MRI, he was diagnosed with recurrent disk protrusion and herniation and several other mild to moderate spinal conditions. After two months of shoulder pain, an MRI of San Antonio's right shoulder in January, 2013, revealed findings suggestive of underlying adhesive capsulitis, a condition which can cause pain and loss of range of motion in the shoulder. Plaintiff continued his employment until February, 2013, when his persistent shoulder, neck and back conditions caused him to stop working. That is the alleged onset date for purposes of his application for disability insurance benefits. He has not engaged in any substantial gainful employment since his alleged onset date.

         From February, 2013 to July, 2014, plaintiff received Long Term Disability (“LTD”) benefits through his employer. In August, 2014, the insurer determined that San Antonio could return to work and discontinued the payment of benefits. Plaintiff appealed that determination and a subsequent lawsuit was settled in February, 2017. In conjunction with those proceedings the LTD insurer obtained an independent medical examination and San Antonio underwent a disability evaluation.

         B. Medical Opinions

         Given his several conditions, San Antonio has seen a variety of medical providers and specialists. Summaries of the most relevant medical opinions, including that of Dr. Stephanos Kales, an Independent Medical Examiner (“IME”), follow.

         In April 2013, several months after he had stopped working, San Antonio received epidural steroid injections (“ESI”). His pain management doctor, Dr. Stefan Muzin, noted that he was doing “reasonably well” and referred him for physical therapy. In May, 2013, plaintiff informed his primary care doctor, Dr. Johanna Klein, that he was doing well and could complete his activities of daily living (“ADLs”). In March, 2014, San Antonio reported increased low back pain to Dr. Muzin. After an exam, he noted that plaintiff had full range of motion of the cervical and lumbar spine, with discomfort at the end ranges and normal strength in his lower extremities.

         After an April, 2014, MRI showed a variety of spinal conditions, Dr. Muzin prescribed the resumption of anticonvulsant drugs and administered an ESI. Following that treatment San Antonio reported improvement in his symptoms and an ability to exercise. In late 2014, Dr. Klein noted that San Antonio had excellent range of motion (“ROM”) in his upper extremities, no specific spinal tenderness and normal gait.

         In April, 2015, San Antonio was examined by Dr. Stephanos Kales, the Independent Medical Examiner, in conjunction with the pending LTD benefits litigation. Dr. Kales found that the plaintiff's condition was within normal limits and that his reported disability was out of proportion to the objective findings of the imaging results and physical exam. Specially, the physical exam indicated that plaintiff had 1) a normal gait; 2) slightly decreased cervical spine ROM; 3) no pain upon spine palpation; 4) slightly reduced right shoulder active ROM with normal passive ROM; 5) full sensation except for occasional numbness in right fifth digit while flexing right shoulder; and full strength in all extremities except for slightly reduced right triceps and right grip strength.

         In September 2015, plaintiff retained Dr. Walter Panis, a disability evaluator, to conduct an examination in support of his litigation against the LTD insurer. Dr. Panis opined that San Antonio had chronic pain syndrome and concluded that he was disabled for the foreseeable future even for sedentary work. Specifically Dr. Panis reported that plaintiff had 1) mild decrease in his cervical range of flexion; 2) full active range of motion in his left shoulder but lacked 10 degrees on anterior flexion in his right shoulder; 3) normal upper extremity strength except for his right hand; 4) normal lower extremity strength 5) minimal decrease of sensation in the right arm and leg and 6) normal gait.

         In January 2016, San Antonio reported that he had been able to exercise and his back and shoulder ROM had improved. In 2016 he reported periods of pain but was generally able to perform light exercise, walk and garden. In December of 2016 an exam revealed that plaintiff had pain-free ROM in his cervical spine.

         In January of 2017 San Antonio was evaluated by John Moran, an occupational therapist, who found that he was unable to return to his past work because he ...

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