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Barker v. Commissioner of Social Security

United States District Court, S.D. California

June 28, 2019

COREY BARKER, Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY, Defendant.

          REPORT & RECOMMENDATION RE: PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT [DOC. NO. 17] & DEFENDANT'S CROSS MOTION FOR SUMMARY JUDGMENT [DOC. NO. 22]

          HON. KAREN S. CRAWFORD, UNITED STATES MAGISTRATE JUDGE

         Plaintiff Corey Barker seeks judicial review of defendant Social Security Commissioner's determination that he is not entitled to disability insurance benefits. Plaintiff has filed a Motion for Summary Judgment and defendant has filed a Cross-Motion for Summary Judgment. (Doc. No. 17 & 22.) At issue is defendant's assessment of plaintiffs Residual Functional Capacity (“RFC”)[1] Plaintiff contends that the RFC he was assigned is not supported by substantial evidence because the Administrative Law Judge (“ALJ”) failed to properly analyze and weigh certain opinion evidence. Specifically, plaintiff argues that the ALJ improperly afforded “little weight” to the opinions of examining physician Dr. Thomas Moyad, the two State Agency consultants and plaintiffs mother and improperly relied on the opinions of examining physician Dr. Thomas J. Sabourin (Doc. No. 17, pp. 10-11.) For the reasons set forth below, the Court recommends plaintiffs Motion for Summary Judgment be DENIED and defendant's Cross-Motion for Summary Judgment be GRANTED. I. PROCEDURAL HISTORY Plaintiff filed an application for disability insurance benefits on July 21, 2014, alleging a disability onset date of March 23, 2014. (Administrative Record (“AR”) at 160.) Plaintiffs claim was denied at the initial and reconsideration stages and plaintiff, therefore, requested a hearing before an ALJ. (Id at 111-13.)

         I. FACTUAL BACKGROUND

         Plaintiff was born on May 31, 1959. (Id at 71.) He has worked in the furniture, home improvement and construction industries and as a cook. (Id at 46, 166-69.) Plaintiff reported that he has not worked since his disability onset date of March 23, 2014.[2] (Id at 44.) He went to live with and take care of his parents after he separated from his wife. (Id at 47.) Now he lives alone. He alleges that his ability to do work is limited by his back pain and anxiety. (Id at 49-50.)

         II. MEDICAL RECORDS

         Medical records that are relevant to plaintiffs argument the ALJ'sRFC assessment is not supported by substantial evidence and this Court's review thereof are summarized below.

         A. Kekoa C. Ede, M.D., Neighborhood Healthcare, Treating Psychiatric Specialist

         Plaintiff was seen by Dr. Ede on August 21, and September 18, 2013, for a psychiatric evaluation. (Id at 288-292.) On these visits, plaintiff reported that he was not able to sleep very well, he was “pretty anxious” about a job interview and was having anxiety attacks twice a week. (Id at 288.) On September 18, 2013, Dr. Ede noted that plaintiff seemed well developed and nourished with no acute distress. (Id.) Psychologically, Dr. Ede found no delusions or hallucinations and that plaintiff was cognitively alert and oriented. (Id.) Dr. Ede diagnosed plaintiff with panic disorder without agoraphobia and prescribed him Sertraline and Gabapentin. (Id at 288-91.)

         B. William Bailey, M.D., Partners Urgent Care, Treating Physician

         Dr. Bailey saw the plaintiff on April 15, 2014, for lower back pain. (Id at 351.) At that time, plaintiff reported he had terrible back pain making it difficult to walk or move. (Id.) Dr. Bailey observed plaintiff to be uncomfortable and exhibiting very antalgic position changes. (Id.) He noted plaintiff had right hip shift elevation, his back was very tender, he experienced paralumbar spasms and he had very guarded motion. (Id.) Dr. Bailey diagnosed plaintiff as having lumbar sprain and strain, prescribed him a Toradol injection as well as Norco and Cyclobenzaprine and instructed plaintiff to seek further treatment if he had no improvement. (Id at 351-52.)

         C. Shahla Ramin, M.D., Vallette and Associates, Consultative Examining Psychiatrist Specialist

         Plaintiff saw Dr. Ramin on September 30, 2014, for a consultative psychiatric evaluation. (Id at 304-06.) Dr. Ramin noted that it was difficult to render a psychiatric opinion because no psychiatric records existed at the time, so he relied on plaintiffs self-report and his brief observations during this visit. (Id at 305.) Dr. Ramin's impression was that plaintiff had adjustment disorder with depressed mood and psychological and environmental (occupational) problems. (Id at 306.) Dr. Ramin assigned plaintiff a GAF score of 65. (Id.) He found no real limits on plaintiffs mental or social abilities. (Id at 305-06.) He further noted that plaintiff is able to complete simple and detailed tasks and activities of daily living without supervision. (Id at 305.)

         D. Thomas Moyad, M.D., Orthopedic Surgery, Consultative Examining Physician

         Plaintiff first saw Dr. Moyad, an orthopedic surgeon, on October 1, 2014, for evaluation of plaintiff s chief complaint, his back problems. (Id at 309-312.) Dr. Moyad's general examination findings were: (1) the trunk and extremities demonstrated TTP [tender to palpitation] along medial scapula border on the left upper back; (2) mild TTP on lumbar spine midline; (3) positive SLR [straight leg raise] in supine position on the left side with pain radiating to thigh, negative SLR on right side; (4) pain in the right shoulder with 160 degrees flexion and positive Hawkin's sign on the right shoulder; (5) pain in left medial scapula with full left shoulder flexion at 180 degrees; (6) positive crepitus in the right Subacromial shoulder with circular motion at the GHJ [glenohumeral joint]; (7) lumbar spine is painful with radiating pain down the left leg when ranging to maximal 80 degrees of lumbar flexion; (8) pain with 30 degrees lumbar extension without radicular symptoms; (9) pain (noted with facial grimace) with lateral bending of the lumbar spine bilaterally to 30 degrees; and (10) mild lumbar spasm palpation. (Id at 310.) He also conducted a comprehensive range of motion test. (Id.) The only finding was pulses in the bilateral distal extremities. (Id.)

         Dr. Moyad ordered a spine exam which showed: (1) mild anterolisthesis of L4 and L5 with mild disc space narrowing present at ¶ 4/L5 and L5/S1; (2) mild anterolisthesis of L4 and L5 which may be related to pars defect at ¶ 4; (3) peri-apophyseal sclerosis present from L3/L4 to L5/S1; and (4) formation of anterior osteophyte at ¶ 4 and L5. (Id at 312, 321.) The impression from this exam was that plaintiff has moderative degenerative changes with anterolisthesis (mild) at ¶ 4 and L5. (Id.)

         Based on the above examinations and findings, Dr. Moyad diagnosed plaintiff with: (1) lumbar spondylosis and L4-5 Spondylosis with Stenosis; (2) mild left leg radiculopathy; (3) right thoracic back rhomboid chronic strain; and (4) left shoulder sub-acromial impingement/Bursitis. (Id at 312.)

         Dr. Moyad also completed a functional assessment for the plaintiff. (Id.) He opined that in an 8-hour workday with normal breaks, plaintiff can be expected to sit 6 hours and stand or walk no more than 6 hours and that he can lift/carry 20 pounds occasionally and 10 pounds frequently. (Id.) The main limiting factors identified were painful lumbar Stenosis, Radiculopathy, and Degenerative Spondylolisthesis with evidence of nerve root impingement. (Id.) As to postural limitations, Dr. Moyad found plaintiff could be expected to climb, stoop, bend, and crouch only occasionally due to his degenerative lumbar spine and intermittent radicular symptoms. (Id.) He further noted plaintiffs manipulative limitations, finding he should be limited in reaching with his right shoulder because of Subacromial Bursitis, which was observed during the exam with a demonstration of pain when reaching overhead. (Id.)

         E. J. Hartman, M.D., State Agency Consultant

         On November 13, 2014, Dr. Hartman conducted a consultative review of medical records relating to plaintiffs primary diagnosis of discogenic and degenerative back disorder and secondary diagnosis of affective mood disorder. (Id at 70-82.) Specifically, he reviewed the medical records from Dr. Ramin, Dr. Moyad, Dr. Ede and Dr. Bailey, which are summarized above. (Id at 72-74.) He gave great weight to the opinions of Dr. Ramin and Dr. Moyad. (Id at 78.)

         Based on these records, Dr. Hartman concluded plaintiffs back disorders were severe and his affective mood disorder was not severe. (Id at 77.) He assessed that plaintiff was mildly restricted with respect to activities of daily living, had mild difficulties in maintaining social function and mild difficulties in maintaining concentration, persistence, and pace. (Id.) He noted that one or more of plaintiff s impairments can be expected to cause his pain or other symptoms, but observed that plaintiffs statements about the intensity, persistence and limiting effects of his symptoms were not supported by the medical evidence alone. (Id at 78.) The external limitations he determined to be applicable to plaintiff are: (1) can occasionally carry/lift 20 pounds; (2) can frequently carry/lift 10 pounds; (3) can stand or walk with normal breaks for 6 hours in an 8-hour work day; (4) can sit with normal breaks for 6 hours in an 8-hour work day; and (5) can push and pull other than that shown for lift/carry. (Id at 79.) Regarding postural limitations, Dr. Hartman noted plaintiff could never climb ladders, ropes, and scaffolds, but could occasionally climb ramps, balance, stoop, crouch and crawl. (Id.) Dr. Hartman believed plaintiff frequently had manipulative limitations such as reaching in any direction, and specifically reaching left and overhead. (Id at 79-80.)

         F. A. Khong, M.D., State Agency Consultant

         On February 5, 2015, Dr. Khong performed a consultative review of plaintiff s back and affective mood disorder. (Id at 84-95.) His review was limited to the records from Dr. Ramin, Dr. Moyad, Dr. Ede and Dr. Bailey. (Id at 85-87.) He gave great weight to the opinions of Dr. Ramin and Dr. Moyad, but noted Dr. Moyad had a short relationship with plaintiff. (Id at 93.)

         Dr. Khong noted there was no change in plaintiffs condition and he had no new physical or mental limitations. (Id at 85.) He concurred with the external limitations assigned by Dr. Hartman. (Id at 91.) Dr. Khong projected improvement with physical therapy, and that plaintiff would be capable of medium lifting and carrying and occasional stooping by April 1, 2015, at which point plaintiff could perform past relevant work. (Id. at 85, 93-94.)

         G. Family Health Centers of San Diego, Treating Medical Professionals (2014-2015)

         1. Suriti Kundu, M.D. and Steven Santoyo, M.D. (October 2014 -February 2015)

         Plaintiff started receiving treatment at Family Health Centers of San Diego on October 2, 2014. (Id at 332-34, 495-497.) At his first visit he was seen by Dr. Kundu. (Id.) Plaintiff reported having recent panic attacks, which Dr. Kundu theorized may be due to mild depression. (Id.) With respect to his back problems, plaintiff reported his pain level as 7 out of 10, which he admitted was more than usual. (Id.) He denied having any weakness, numbness or tingling. (Id.) Dr. Kundu noted subjective tenderness in the left lower back to the left of the spine and ordered physical therapy, x-rays and lab work. (Id.)

         On October 16, 2014, plaintiff returned to Dr. Kundu to review the lab results and x-rays. (Id at 335-337, 498-500.) The x-rays showed plaintiff had: (1) forward subluxation of L4 and L5 with probable associated pars defect; (2) narrowing of L3, L4, and L5 with osteophyte formation, indicating degenerative disc disease at ¶ 3, L4 and L5; and (3) Grade 1 spondylolisthesis at ¶ 4. (Id at 322.) Plaintiff reported having 4 days of acute midthoracic back pain to the right of his spine in the T11-12 area, which he described as severe and burning and rated as a pain level of 9 out 10. (Id at 335.) He described the pain as being typical of other flareups. (Id.) Dr. Kundu found reduced flexion/extension and localized tenderness at the T11-12 area. (Id.) The doctor observed plaintiff had two areas of concern with respect to his back: lower back pain with asymptomatic Grade 1 spondylolisthesis; and acute thoracic spinal pain consistent with back strain. (Id at 336.) Plaintiff was prescribed Mobic and Robaxin and directed to treat his back with moist heat. (Id.) An additional x-ray was conducted on October 17, 2014, which showed degenerative disc disease from approximately T6-T9, with disc narrowing and degenerative changes in this area. (Id at 320.)

         On November 20, 2014, plaintiff was seen at the Family Health Centers by Dr. Santoyo. (Id at 338-340, 501-503.) Notes of this visit indicate the subject of the visit was primarily hypertension. (Id.) No back problems were reported at the time. On January 7, 2015, plaintiff returned to Dr. Kundu. (Id at 341-342) Dr. Kundu observed plaintiffs appearance to be well. (Id at 341.) The subject of that visit was his anxiety. He had been taking Celexa for two months and reported feeling angry and irritable, which were the same side effects he experienced when taking Zoloft. (Id.) Dr. Kundu directed him to taper off Celexa and ordered a trial for Atarax. (Id.) No back problems were reported or observed during this visit.

         On January 19, 2015, plaintiff was seen by Monica Farfan, a registered dietitian, for help with his hypertension, hyperlipidemia and weight management. (Id at 344-345.) On February 26, 2015, he had an appointment with Dr. Kundu, but left without being seen. (Id. at 493-494.)

         2. Physical Therapy Sessions (January - June 2015)

         Plaintiff underwent his first series of physical therapy sessions through Family Health Centers from January to June 2015. (Id at 355-357, 359-366, 370-372, 437-464, 469-492, 506-513.) On February 10, 2015, he reported increased pain in his lower back, which he reported he had strained while renovating a kitchen. (Id at 480.) At the February 13 and 19, 2015 sessions, he reported some improvement but was still working on the kitchen renovation, which aggravated his lower back pain. (Id at 483, 486) The stiffness and lower back pain continued in February, March, April, and May of 2015, although plaintiff showed continued steady progress towards improvement. (Id at 420, 440-441, 442-443, 448-462.)

         On April 7, 2015, it was noted good progress had been made, but plaintiff continued to report back pain limiting his functional capacity and decreased ability to lift/carry weight due to pain. (Id at 361.) Plaintiff also failed to meet certain goals such as ability to lift and carry 20 pounds or have the ability to return to work, full duty, without restrictions. (Id at 359.) It was recommended he continue physical therapy for another four weeks to address pain, work limitations, and postural deficits. (Id at 361.) On June 4, 2015, plaintiff noted increased pain in the mid-back area, which he rated as 6 out of 10. (Id at 507.)

         On June 17, 2015, plaintiff was seen for physical therapy reassessment and treatment, by which time he had attended a total of 23 sessions at a frequency of twice a week. (Id at 355-357.) He reported minimal to no lower back pain, but had aggravated pain, which he rated as 7 out of 10, in the upper thoracic area after moving a piece of heavy furniture. (Id at 355.) The physical therapist recommended plaintiff be discharged from physical therapy because all treatment goals for his lower back problems had been met, and that he be referred to a chiropractor and/or a pain management specialist for treatment of the thoracic area. (Id at 356-357.)

         3. P.A. Martini Murialdo and Dr. Sally Alassil (June - November 2015)

         On June 9, 2015, plaintiff saw Physician Assistant (“P.A.”) Murialdo for a physical. (Id at 465-468.) The symptoms which prompted that visit were an intermittent cough, depression, insomnia and back pain. (Id.) With respect to his mental health, plaintiff reported he was sometimes stressed and anxious due to responsibilities at home. (Id at 465.) He was mildly depressed and said he did not like leaving his home. (Id.) He was not interested in counseling, but said he would try Amitryiptyline. (Id at 465-466.) P.A. Murialdo noted the physical therapist's recommendation that plaintiff try chiropractic treatment and/or be referred to pain management but, because his insurance denied coverage for chiropractic treatment, she made a pain management referral. (Id at 466.) On November 18, 2015, plaintiff was seen by Dr. Alassil to review lab results. (Id at 435-436.) He did not report any back pain at that time.

         H. Hussein Abdulhadi, M.D., Treating Pain Management Specialist

         Plaintiff saw Dr. Abdulhadi on January 9, 2016. (Id at 367.) During this visit, plaintiff reported having lower back, leg and thoracic pain, which he rated as mild when resting and severe with physical activity. (Id.) Dr. Abdulhadi found lumbosacral tenderness, SLR, and thoracic tenderness and assessed plaintiff with: (1) degenerative disc disease; (2) Listhesis of L4-L5; (3) Stenosis back pain; (4) sciatica 2 degrees above; and (5) degenerative disc disease of thoracic pain/mid thoracic. (Id.) Dr. Abdulhadi noted plaintiff was unable to do activities of daily life and physical therapy due to pain and prescribed Tramadol and Neurontin. (Id.)

         I. Family Health Centers of San Diego (February - July 2016)

         1. Dr. Alassil and P.A. Randall Culler (February - May 2016)

         Plaintiff met with Dr. Allassil on February 18, 2016, at which time the doctor addressed plaintiffs hypertension and chronic pain. (Id at 432-434.) With respect to his back issues, the doctor reported increased muscle tension over the upper back, lower back, and cervical paraspinal muscles and point tenderness to palpation over scapulae. (Id at 433.) Plaintiff reported Tramadol was not helping with his back pain, and it was noted his insurance had twice denied coverage for an epidural injection. (Id.)

         On March 28, 2016, plaintiff returned to Family Health Centers after having been treated at the Grossmont Hospital Emergency Room on March 25, 2016, for pain in his left leg.[3] (Id at 373-375.) He was seen by P.A. Culler, who noted that plaintiff reported having low back pain and burning down his left leg for about 3 months, but was experiencing very minimal pain that day. (Id at 373.) He also noted decreased range of motion in forward and side flexion. (Id at 374.) PA Culler ordered an MRI of the lumbar spine, referred plaintiff for an orthopedic evaluation and for follow up with pain management. (Id.) The MRI, which was conducted on April 29, 2016, showed pars defects of L4 with grade I anterolisthesis and subsequent severe bilateral foraminal narrowing with L4 nerve root impingement, but no spinal stenosis. (Id at 376-377.)

         On April 13, 2016, plaintiff returned to see Dr. Alassil regarding his hypertension and back pain. (Id at 429-431.) He reported the physical therapy he did in 2015 yielded minimal improvement to his lower back pain and again reported that taking Tramadol for pain management did not help. (Id at 429.) Treatment notes from this visit indicate plaintiff went to the emergency room for excruciating back pain a few weeks earlier.[4] (Id.) He reported he was prescribed a Medrol dose pack, which alleviated his pain for about a week, but it had since returned. (Id.) At the time of this visit, he was suffering lower back pain and reported left lower back burning pain. (Id.) He also noted occasional left foot weakness and numbness. (Id.) The doctor observed an increase in muscle tension over plaintiffs lower back and ordered an MRI and orthopedic evaluation. (Id at 429-430.)

         On May 18, 2016, Dr. Alassil met with plaintiff again. (Id at 426-428.) With respect to his back issues, she noted he was scheduled for an orthopedic evaluation on June 8, 2016. (Id.) He had started physical therapy a few days prior and she advised him to continue with this course of treatment. (Id.)

         2. Physical Therapy Sessions (May - July 2016)

         Plaintiff underwent a second round of physical therapy from May to July of 2016. (Id at 417-425, 542-550, 561-565.) At his first visit on May 20, 2016, he was observed to have an antalgic guarded gait. (Id at 423.) He said he was not having radiating symptoms into his lower extremities because he had not been standing. (Id.) He reported he had started a new job that was more physical than expected. (Id.) On May 23, 2016, he reported some stiffness in his lower back. (Id at 420.) On May 25, 2016, the pain and stiffness in his lower back had lessened. (Id at 417.) On June 14, 2016, he reported increased pain since his last visit and said he had been lifting and carrying heavy furniture. (Id at 549.) He skipped the following visit because he was in too much pain after lifting and carrying heavy counters at the flower shop where he worked. (Id at 547.) On June 22, 2016, his pain level was low. (Id.) On June 29, 2016, he described a general increase in back pain due to lifting and moving objects at work, but his pain was not bad at that time because he had not been on his feet long. (Id at 545.) He missed his next appointment because he had the flu; however, he reported that he still worked and built a retaining wall. (Id at 542.) On July 22, 2016, it was observed that his pain was more localized, and he rated it as a 5 out of 10. (Id at 563-564.) He was advised to decrease the intensity of his activities and to take a week off of work, which was noted to be an aggravating factor for his back problems. (Id.) At his last visit on July 28, 2016, he reported his leg pain had improved and he had no significant pain in his lower back. (Id at 561-562.)

         J. Tara M. Kelly, Nurse Practitioner, UCSD Health

         On June 8, 2016, plaintiff was seen by Nurse Practitioner (“N.P.”) Kelly for an orthopedic surgery referral. (Id at 534-37) He reported low back pain into his left buttocks and down his left leg, as well as numbness on the medial foot and lower leg. (Id at 534.) An MRI of his lumbar spine revealed: (1) degenerative disc disease at ¶ 1-L4 without any central or foraminal stenosis; (2) pars defect at ¶ 4-L5 with severe bilateral foraminal narrowing; (3) grade 1 anterolisthesis; and (4) disc bulge at ¶ 5-S1. (Id at 536.) N.P. Kelly noted plaintiff appeared oriented, had good coordination and gait and did not need assistive devices. (Id.) She further noted normal results regarding the following tests: lumbar spine, range of motion, motor strength, deep tendon reflexes and straight leg raising. (Id.) N.P. Kelly further assessed him as having midline low back pain with left-sided sciatica, anterolisthesis and spinal stenosis. (Id.) She concluded that plaintiff was not a current candidate for surgery because he had not exhausted non-operative pain management options. (Id.) It was recommended that he use Lumbar ESI since he still had pain despite physical therapy and medication. (Id.) Referral to pain management was also recommended. (Id.)

         K. Family Health Centers of San Diego (July - September 2016)

         On July 29, 2016, plaintiff was seen by Dr. Alassil to follow-up on his cough and back issues. (Id at 555-557.) Noting he was not a candidate for surgery, she referred him for pain management. (Id.)

         On August 30, 2016, plaintiff was seen by Internal Resident Najwan Al Ani for lower and upper back pain, which he reported had increased over the last few months due to heavy lifting, and was worse when standing and walking. (Id at 551-553.) He also had a foot injury he incurred two weeks prior while playing sports. (Id at 551.) He had just completed twelve physical therapy sessions. (Id.) Resident Al Ani identified trigger points over plaintiffs upper back and paraspinal muscle spasms. (Id at 552.) Plaintiffs gait was noted to be normal, his strength was 5/5 in all extremities, he had full range of motion on both sides, and he was able to change position from standing, sitting and onto the exam table without evidence of pain or hesitation. (Id.) She recommended plaintiff schedule another appointment for trigger point injections and deferred pain medication, noting plaintiff had an appointment to see a new pain management specialist on September 14, 2016. (Id at 551-552.)

         On September 9, 2016, plaintiff was seen by Internal Resident Phillip So for trigger point injections to treat his back pain. (Id at 540-541.) Plaintiff reported relief after getting the injections. (Id at 541.) He was advised he may need to repeat the trigger point injections for full relief and that he should return for more injections as needed. (Id.) He was also encouraged to continue physical therapy and strengthening exercises. (Id.)

         L. Deborah Birnbaum, M.D., Treating Psychiatry Specialist

         On July 22, 2016 plaintiff visited Dr. Birnbaum for evaluation and treatment. (Id at 558-60.) Plaintiff reported he was “doing well” since discontinuing Effexor, and that he wanted to continue with taking Xanax and Trazodone. (Id at 558-559.) He reported he still had occasional panic attacks, but felt very stable overall. (Id at 558.) Dr. Birnbaum refilled his Xanax and Trazodone prescriptions and directed him to return for follow-up in three months. (Id at 559.)

         M. Thomas J. Sabourin, M.D., Consultative Examining Orthopedic Surgeon

         On September 24, 2016, plaintiff visited Dr. Sabourin for an orthopedic consultation examination. (Id at 569-574.) Dr. Sabourin examined plaintiff but did not look at any x-rays or medical records. (Id at 573.)

         At that time, plaintiff reported that when he had back pain, it was worse in the mid-back than his lower back. (Id at 569.) He told Dr. Sabourin that he first injured his back playing baseball when he was 17; in 1980 he reinjured it in a car accident; and in March 2014, while at work as a cabinet refinisher, he injured it again. (Id.) He reported that two months prior he injured his left foot while playing frisbee. (Id.) He has had physical therapy for his back problems and has seen a pain management doctor. (Id.) One month prior to his visit, he was placed on Percocet but it had not helped. (Id.) He last worked on September 27, 2016, doing flower deliveries, but stopped when he became homeless. (Id at 570.)

         Dr. Sabourin's examination notes indicate plaintiff sat and stood with normal posture and demonstrated no evidence of any tilt or list. (Id at 571.) Plaintiff sat comfortably throughout the examination, was able to rise from a chair without difficulty, and had no difficulty getting on and off the examination table. (Id.) Station and gait were satisfactory and toe and heel walking was normal, although plaintiff complained of some pain in the left metatarsal area where he had recently injured himself. (Id.)

         Dr. Sabourin observed no issues with respect to plaintiffs cervical spine. (Id.) With regard to the lumbar area, he noted an apparent apex left lumbar scoliosis, but minimal to none in the thoracic or cervical areas. (Id.) Plaintiff had minimal pain in the mid back with forward flexion and tenderness over the T8 spinous process. (Id.) There was no spasm, swelling or heat. (Id.) His range of motion was normal in all respects. (Id.)

         When examining plaintiffs extremities, the doctor observed he had grossly normal and painless range of motion in his shoulders, elbows, wrists, hands and fingers, hips, knees and ankles and satisfactory range of motion as to his toes. (Id at 571-572.) The neurological exam indicated normal motor strength and sensation to light touch and pinprick throughout the upper and lower extremities on both sides. (Id.) Deep tendon reflexes were also normal. (Id.)

         Dr. Sabourin's impression was that plaintiff had chronic thoracic and lumbar strain and sprain and mild scoliosis, apex left lumbar. (Id at 572-573.) He opined that plaintiff: (1) could lift and carry 50 pounds occasionally and 25 frequently; (2) could stand and walk 6 hours of 8-hour workday and the same for sitting; (3) could push, pull, lift and carry; (4) could climb, stoop, kneel, and crouch frequently; (5) had no manipulative limitations; and (6) had no need for assistive devices. (Id.) He further opined plaintiff could stand and walk for up to 2 hours at a time and sit for up to 6 hours at a time without interruption. (Id at 576.) He placed no limitation on plaintiffs ability to use his hands and feet, including overhead reaching motion. (Id at 577.)

         N. Douglas Engelhorn, M.D., Consultative Examining Psychiatric Specialist

         On November 16, 2016, plaintiff visited Dr. Engelhorn for a psychiatric consultation. (Id at 585-588.) Dr. Engelhorn's diagnostic impressions were that plaintiff had a recurrent type of major depression [a mild form] and panic disorder with agoraphobia. (Id at 587.) He also noted no real mental limitations from this impression. (Id at 589-90.) The doctor noted that plaintiffs physical issues, mainly chronic pain, predominate. (Id at 589.)

         III. THIRD-PARTY ...


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