United States District Court, D. Massachusetts
MEMORANDUM & ORDER
NATHANIEL M. GORTON UNITED STATES DISTRICT JUDGE
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”). 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.
Employment History and Alleged Disability
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.
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.
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.
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”),
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
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.
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.
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.
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
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 ...