Bronson v. Colvin

Filing 26

ORDER ON MOTIONS FOR SUMMARY JUDGMENT [DEs 22, 23]: the decision of the Commissioner is AFFIRMED; denying 22 Plaintiff's Motion for Summary Judgment; granting 23 Defendant's Motion for Summary Judgment. Signed by Magistrate Judge William Matthewman on 2/26/2018. (kza)

UNI
TED STATES DI
STRI COURT
CT
SOU TH ERN D I
STRI OF FLO RI A
CT
D
CA SE N O .1 80078- V - ATTH EW M A N
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Def nt
enda .

ORDER ON M OTI
ONS FOR SUM M ARY JUDGM ENT I 22.231
DES

THI CAUSEi be o et CouruponPli if AngeaC. ons n' (ç antf ' Moton
S
s f r he
t
antf,
l Br o s s i if) i
pl
f Summay J
or
r udgme ( 221 and Dee t Na A.Ber l,Aci Commiso rof
nt DE ,
fndan, ncy
ryhil tng
sine
SocilSe urt Admi srto sCo eenda )Moton f Summay J me g 231 The
a c iy
nitain'
f nf' i or
r udg nt DE .

pat sh v c ns ne t ma itaej dg u idci n ( 1 ,1 1 Plitf h sfldaRe y
ri a e o e td o g srt u ej rs ito . DES 6 7 . an if a i
e
e
pl
g 251 a t matri now rpef r e Theis befr t Cour i whehe t rcor
DE , nd he te s
i or eviw.
sue oe he
ts t r he e d
con a ns s t i levi e t s
t i ubsanta
denc o uppor t de a of be tt t t Pl ntf a w he her t
t he ni l
ne i s o he ai if nd
t he

e r tlga sa r ha be n a id. Lambv.
orec e l tndads ve e pple
Bowen,847F. 698,701( t Ci.1 .
2d
11h r 988)
1 FA C TS
.

On J nua y 1 201 Pl ntf fld an a iaton f s e t s c iy i ome,
a r 6, 4, ai if ie
pplc i or uppl men al e urt nc
a lgi dia lt begi ng on M a c 9, 201 ( 4211 Theca m wasdenid i ta l a
le ng s biiy
nni
rh
li
e niily nd
3. R. .
upon r c i r ton.
e onsde ai

Folo ng ahe i on Se embe 3,201 t ALJis d a de ii
l wi
arng
pt
r
5 he
s ue
cson

onDe e r3,201 de ngPli ifsrques f rbe f . g 42- . A r uetf r viw
c mbe
5, nyi antf e t o nehs R. 791
eq s or e e
1Al r e e esa et t r or oft a nitai p oce di fld byt Commisi i Doc tEnty l .
l efr nc r o he ec d he dmi sr tve r e ng ie
he
s oner n ke r 4

1

wa tldwi t eAp asCo n i a dd nido No e e 21 2 6. ( 16 .
s ie t h pe l u cl n e e n v mb r , 01 R. - 1
h
A . H e r nc Tes i o
ai
tm nv

Th ALJh l ahe rn o Se tmb r3 2 5. g 8 1 Plitf tsiidt a s wa
e
ed ai g n p e e , 01 R. 6 . an if e tfe h t he s
bonzon M a 25,1
y
970,a was45 yea s ol a t tm e oft he rng. ( 9 1 S eh sa
nd
r d t he i
he a i
R. 2 . h a
drve ' lc ns ,butdoe ve y ltl drvi bec e i i ha d f hert t he nec Pl i if
i rs i e e
s r ite i ng aus t s r or
o um r k. a ntf

gr uatd fom hi s hoola t k onead te
ad e r
gh c
nd oo
ul ducai cl s I Shemos r e l wor a
ton as . d
t ec nty ked s

a mee n ie o M ac 9,2 3 rg tb f r h ra cd n . ( 93 . Th a cd n o c re
rha d sr n r h 01 , ih e o e e c ie t R. 1 e c ie t c u rd
w hie s w a pl i t l bel on a s l ,a a s r i or w ho w as a
l he s ac ng he a s
he f nd upe v s ,
bove he on a l dde ,
r
a r

dr d t s l ng a al oft equi e ont he . 1 Pli ifdi notwor fom 2000t
oppe he hevi nd 1 he
pm nt o r d. antf d
k r
o
2011 be us he c l r w e e young. 1
ca e r hid en r
d.

Pli ift tfed t t s i una e t wo k bec us s ha ditc t usng he ha
antf esii ha he s bl o r
a e he s fi uly i
r nds
be us t y a e num b and tngl ,s ha pi hed ner s i he ne s ca
ca e he r
i e he s nc
ve n r ck, he nnothol he he d up
d r a
f ve y l be or s ne t r s i,s ha w e
or r ong f e he eds o e t t he s akne s i he r ghtha t tpr ve she fom
s n ri
nd ha e nt r r
lfi t ngs t pi or w rtng,s ha ner da a i bot a m s a he nec s ne
i tng hi , y ng,
ii
he s ve m ge n h r
nd r k, he eds

s r ey o rp e tn o a d tsu i h rrg tam,a d s e h sc r ltn e . g 9 - 4 .
u g r n ip d e d ns n is e n e ih r n h a apa u n l R. 3 9 )
Pli ifalo sa e t ts c nnotlf he ha o rhe hea orbe nd hera c nnotbend
antf s tt d ha he a
it r nds ve r d
hi
nd a

fr r wiht eweg to h rh a g 1 5 . S we r ab a eo he rg twrs a dh n t
o wa d t h ih f e e d. R. 0 1 he as r c n r ih it n a d o
k e h reb w a dt u s p o td ( 9 1 P an ifi s p o e t we rab a eo h rrg t
e p e lo n h mb u p re . R. 4 . litf s u p s d o a rc n e ih
e bow i i s a t t s el orbo he he t m uch. 1 She al o w ea s a nec br ce t ke p t
l
f t t rs o w l
t r r oo
d.
s
r
k a o e he

pr s eof he nel . l A1 t eebr ce wer pr crbe by docor . 1
es ur f r wes d
1 hr
a s e es i d
t s d.
Pl ntf e a ned t ts ca
ai if xpl i
ha he nnots a f l pe i oftm e,and t ,whie s c n
t nd or ong rods i
hat
l he a

wak, hegestrde sl bec us he he dfeshe
l s t ie a iy a e r a e l avy. ( 941 Sheha ahadtmee nlfi
R. .
s r i ve itng
a gl s of w a er a c nno lf a g l ofm ik.
as
t nd a t i4 alon
l
2

A tt tm e oft hea i , Pl ntf was
he i
he rng ai i f

t ki s ver lme c tonst the pe wih he pan bu ma hertr d, c us a f r tul
a ng e a dia i ha l d t r i t de
ie onf ed, nd o gef ,

a d as su rd h rs e c . g 9 - 6 . On a tpia d y Plitf mo ty se ps g 9 1
n lo lre e p e h R. 5 9 1
y c l a , anif sl le . R. 6 .
W he s t i s t do t ngs s be om e a o a t kes a a e y pil I Pl i if al o
n he re o
hi , he c s nxi us nd a
n nxi t l. d
a ntf s

s ndss
pe
omeoft da l ngf mipl edie sa waki ar
he y ooki or s ac t m nd l ng oundt hous orouti . (
he
e
sde R.

1 . Shes t aar t hep he r membe a tvii a ts . I Pli ifspai pr ve s
001
es l ms o l r e
r ci tes nd a ks d antf' n e nt
herfom se pi t oug t ni ht I
r
le ng hr h he g . d.
e
o
s
e o
Plitf lv swihhe t rec id e ( 9 ) Onedaught rhadt behome-chool d s
anif ie t r h e h lrn. R. 6 .
t s c d hep Pl i if a d i her pl es 1 . Pl i ifs hus nd fld f lga
hat he oul l antf nd rve
ac . d
antf
ba ie or e l
s pa ai n,a Pli if a herc l en m ove f o hous t hous 1 Pli if c nnotdo
e r to nd antf nd
hidr
rm
e o
e. d. antf a
hous hol c e be aus s c nno pus a hi . 1 He chidr n c
e d hor s c e he a t h nyt ng d.
r l e ook a c e n. I
nd l a
d

Pl ntf us d t be ve y aci ,bu he physca i par e sha c us d he t go i o a de p
ai if e o
r tve t r
i l m im nt ve a e r o
nt
e
de es i a be om e s ci lbe us s ca no l r ha t s m e i veme i he
pr son nd c
ui da ca e he n
onge ve he a
nvol
nt n r

c l e slves ( 96- 1 Pl ntf ca dohe hai o tkeas rwihou he da ers
hidrn' i . R. 97 . ai if nnot
r r ra
howe t t r ught '
hep. ( .1 .
l ) 051
R
Pli ift tfedt the a e y c n makehe f llkes ca
antf esii ha r nxit a
r ee i he nnotbr t a i ha ng a
eahe nd s vi

hea ta t k. ( 97 . She ges i tbl wih he c l e a t s la t epiode of
r tac R. 1
t nia e t r hidrn, nd hi e ds o s s
de e so whe e s g st he be cre ,a t nksba t ht . I Pl i ifbe n ha ng
pr s i n
r he oe o r d, is nd hi
d houg s d. antf ga vi
s ci lt
ui da hough s a ltl ove a ye rbe or t hea i whe s be m e una et ba i he
t ite r
a f e he rng
n he ca
bl o byst r

n e e g 9 1 Plitf tsi d t ts ha be n s en aps h ars,Dr S a a o c a
ic . R. 8 . an if etfe ha he d e e i g yc itit . hid , n e
m o h f t o yea sa t tD r Buksel a t he t s e a ps hol s a w el.
nt or w
r nd ha .
t w n ed r o e
ye ogit s l

How ever,

Pli ift sii dt ts wa no c r nty s i at r pito c
antf e tfe ha he s t ur e l eeng he a s r ouns l r 1
e o . d.
Pli if saed t t be or t wor a ci nt s wasc
antf t t ha , f e he
k c de , he
omplt l he lhy a ha no
e e y at nd d

p oblmswihhe ne k orha . ( 991 Sheti physca t rpy buthadt dico i i
r e
t r c
nds R. .
red
i l hea
o s ntnue t
3

whe i ca ed ba m i r nes 1 Pl i ifalo ti d corione s sa e dur l i he ne
n t us
d g ai . d. antf s re
ts
hot nd pi a s n r ck,
butt y di notw or 1 She ha s g y i he r g a whi h hel d w ih t s e lng a
he d
k. d.
d ur er n r i ht nn, c
pe t he w li nd

tui butt ner da ag silafe t he t b. I Pl ntf sdoc orwilnotdo s ge y on
l d,
he ve m e tl f c s r hum
d
ai if
t
l
ur r
he ne k. 1 Pl i if t s ii d t the m edi tons f de es i a anxi t hel w ih he
r c
d. a ntf e t fe ha r
ca i
or pr s on nd
ey p t r

me tlis . @ 991
na sues R. .
Thers W olor t voc tonale r,e tfe a t heai ( 1 1 TheALJfrt
e a f d,he ai
xpettsiid the rng. R. 01.
is
pos d a hypot tc li w hi h a i vi
e
he i a n
c n ndi dualoft s e age e a i a pa tw or e
he am
, duc ton, nd s
k xpere e
i nc

asPl ntf c d wor a t lghte ri
ai if oul
k t he i
xe tonall l butc d ne c i ldder or s afol ,
eve ,
oul ver lmb a s c f ds

c d fe nty ( notco tnty)r c i a1 die to wih boh uppe exte te ,c d
oul rque l but
nsa l ea h n l rcins t t
r rmiis oul
fe nty ( notc tnty)peror fngei a ha i wih bot uppe exte te ,
rque l but
onsa l
f m i rng nd ndlng t h
r rmiis
ne d t a d c e r t d e
ede o voi onc nta e xpos e t ha a ds s h as unpr e t d hei s a m ovi
ur o z r uc
ot c e
ght nd
ng

m e ha ca pa t,wa lmie t unde sandi r m e rng,a c n. outsm pl i tu tons
c ni l rs s i td o
r t ng, e mbe i nd a y
i e nsr c i ,
w a lm ie t oc as ona i e a ton w ih s r i or ,c
s i t d o c i l nt r c i
t upe v s s owor r , nd t publc coul onl m a
ke s a he
i , d y ke

smpl wok-eltdde sons a c donl t eaeoc sonalc nge i wor l ai . (
i e r r ae cii , nd oul y olrt ca i
ha s n k oc tons R.

1 2 3 . Th v ai n le p r e pli e t a s c a idviu lc ul p ro t ts of
0 - 1 e oc to a x e t x an d h t u h n n i d a o d e fnn he aks
ce ne/ eke pi r i cer a malcer g 1 .
la rhous e ng, outng l k, nd i l k. R. 03j
For t s c
he e ond hypot tca , t A LJ sat t t t i vi l ha a l of t s m e
he i l he
t ed ha he ndi dua d 1
he a

lmiai nsfom t fr thypot tc ,butwoul alo ne d t t ke oneort uns hed e br ks
i t to r he is
hei al
d s e o a
wo c uld ea
pe w o kday of a o
r r
r und 1 m i e pe br k,i a ton t t t o r ul r y s he e br aks
5 nut s r ea n ddii o he w eg a l c dul d e .

( 1 . Thevoc tona e r e anedt tt DOT doesnota e sbraks s s ha t
R. 031
ai l xpet xpli ha he
ddr s e , o he d o
f m a opi on ba e on he expe i nc 1 She opi t t i t i vi lw oul ha t
or n ni
sd
r
r e e. d.
ned ha , f he ndi dua
d ve o

t ket uns hed e br a on al ng-e m and dal bass t ti vi lwoul no be a e t
a he c uld e ks
o tr
iy i , ha ndi dua
d t bl o
m a nt i e pe ii l lem pl ym e .
i a n om ttve eve
o nt
4

Pli ifs co el pos a t r hy he i l t t voca i l expe t i whi h a
antf
uns
ed
hid pot tca o he
tona
r n
c n
i vi l wa lmie t oc sonal us of t biae a ha
ndi dua
s i td o ca i
e
he lt r l nds f fne m a pul ton,co d
or i
ni ai
ul
fe nty us t bia e alha f gr sm a pulton,waslm ie t oc sonalr ii oft
r que l e he lt r nds or os ni a i
i t d o ca i
a sng he
bia e a a ms ove s ul r heght wa lm ied t oc asona lfi a c ryi ofup t t n
lt r l r
r ho de i , s i t o c i l itng nd a r ng
o e

p t s a c ud n tlf o c ry a yhn o e tn p u d . g 1 4 . Th v c to le p r
omd , nd o l o it r ar n tig v r e o n s R. 0 1 e o aina x e t
opi dt tt r woul notbeany c
ne ha he e
d
ompeii lve empl e f s h a i vi l 1
ttve e l
oym nt or uc n ndi dua . d.
B. M e c Re d Evi nc
di al cor
de e
I r ac ng hi de i i t de Pl i i f s be ft , t A LJ r vi w e t m e c
n e hi
s c s on o ny a ntf
ne is he
e e d he di al

e de eofr or t r e ntpori ofwhi h i s
vi nc
ec d, he elva
ton
c s umm a i e cl
rz d uonol c l bel
ogi aly ow.

OnJ n r 1 , 01 , an if a Dr Din Fic rrg r igh rd p e so ( 3 3 .
a uay 8 2 3 Plitf s w . a a she e a dn e e r sin. R. 7 1
Pl n ifr td t ts wa doi be tr butsils f rng fom depr s i
aitf epore ha he s ng te ,
tl ufe i r
e son. 1 Dr Fic
d. . s her
i e s d Pl ntf' medi ton.
ncr a e ai if s
cai

The ps a rc e m w asnor a . 1 D r Fi c rnot
ychi t i xa
m l d. . s he
ed

t tPl ntf s f e fom pa c dior ra obs sve- ompuli dior r ha e onom i a
ha ai if ufer d r
ni s de nd es i c
sve s de , d c
c nd

ot ps hos ila e r ntlpr e ,a ha aGAF of5160. ( 37 .
her yc oca nd nvionme a oblms nd d
R. 41

OnM ac 21 201 , anif r sn e t Dr Ral nL. e na trs es fee h rij r
rh , 3 Pli tf p e e td o . it Gre fe h u fr d e n u y
o
a wor on M ac 8,201 ( 3 . Pl ntf rpore t t sncet a ci nts ha be
t k
rh
3. R. 45j ai if e td ha, i he c de he d en
s f i fom cons a hea che and nec pa n t r di ed t bot ar s 1 Pai m e ca i
uferng r
t nt da s
k i hat a at o h m . d.
n di ton

wa nothepi he , s ha notbe n bac t wor
s
l ng r and he d
e
k o k.

Upo exa i ton,Dr Gr e no ed
n m na i
. en t

t te r hi a a e nor ale e t tPl n if sce vi lr
ha ve yt ng ppe r d m xc pt ha ai tf
r ca ange ofm oton w a de r a e t
i
s cesd o
a l a sw ih pai m idl and pa pa i oft c r c s new aspos tve f m i m a t nde ne s
l pl ne t
n l y,
l ton he e vi al pi
ii or ni l e r s

i t biaea ta zi . ( 3461 Dr Gr n di nos Pli ifwih c r ialsr i a a
n he ltrl rpe us R. . . ee ag ed antf t e vc tan nd

fc /c l c nuso ( 3 7 . He n td ta an ifs s b e tve c mpans dd n t
a es ap o t in. R. 4 1
o e h tPlitf u jci o li t i o
D r G r en t d Pl ntf t ts s d r s
. e ol ai i f ha he houl e pond

c re p ndt teo j dieciia tn n s
o rs o o h b e v lnc li dig .
5

t c e vai te t
o ons r tve r a ment a pr s rbe physc t a
nd e c i d
ial her py. I
d

Dr Gr e de e ne t t
. e n t nni d ha

Pl ntf saci t s ul bem odii d, s s d notlf ove fvepoundsorpus orpulover
ai if tviy ho d
fe and he houl
it r i
h
l
20 pounds 1
. d.

Pl ntf s w Da d Kr ek,Dr Gr e sphyscin' as itnt on Aprl1 201 f a
ai if a
vi onz
. e n'
i a s ssa ,
i 2, 3, or

r -h c oft eij r . g 3 2 . Plitf rpo td t a,wh n s e te e h rh a f r r ,i
ec e k h nu y R. 4 1 an if e re h t e h l x d e e d o wad t
c us d dizi s a s r pan i he he d.
a e z ne s nd ha p i n r a

PA Kr k' e
onze s xami ton s
na i howed no c nge
ha

fom t M a c 21 201 e m i i n. I He f
r he r h , 3 xa nato
d
ound t tPli if saci t s d bem odii
ha antf
tviy houl
ted

sn es ec udlf n mo eta 1 po n s g 3 4 .
ic h o l it o r h n 0 u d . R. 4 1
Pl n ifpr e e t Da d Kr k,Dr Gr e sphyscin' as it nt a i on M a 1
aitf es ntd o vi onze
. e n'
i a s ssa , ga n
y 3,

2 3 a drp re ta s ewa n two kn b c u et eewa n lg t u ya albl. ( 3 1
01 , n e o td h t h s o r ig e a s h r s o ih d t v i e R. 41.
a
She a s sa e t tphysc lt r py wa ma ng he sc a gi ng he bl r d vii f
lo t t d ha
i a he a
s ki
r ik nd vi
r ure son. #.
Pl ntf r pored num bnes a tnglng i he l f hand,a w e la a pa n l ve of5 outof 1 f
ai if e t
s nd i i n r e t
s l s
i e l
0. #.
The physc e i ton di nots
i al xam na i
d
how any new i s .
s ues

PA Kr nz k not d t tPl i ifhad
o e
e ha a ntf

gote a CT s a of t br i whi h w a nega i , a a el c r yog am t t a ne v
tn
cn
he a n,
c
s
tve nd n e t om
r
es nd r e

c
onduci sudy ofhe lf ha whih wee bot ne tve. ( 3421 PA Kr k a s
ton t
r e t nd, c r h gai R. .
onze dvied
Pl ntf t t y we e r ng outofteam e optons a t ts coul ge ano he opi o
ai if hat he
r unni
r t nt i
nd ha he
d t t r ni n.

I Hen tdt t anifss be tv c mp an so t ih dt eo j ciee a I
d
oe ha Plitf u j cie o lit u weg e h b e tv x m. d
On M ay 24,201 Pli ifpr s nt d t M e
3, antf e e e o dExpr s RoyalPal Be h and wa s e by
es
m ac
s en

J a ne Dar ,PA- g 3501 Pli if rpore he che a pai i he ne k and
e ni
quea
C. R. . antf e td ada s nd n n r c
s de due t he M a c 8t w or ac i nt 1 She e ai t tm edi ton a sx s s i
houl r
o r r h h k c de . d.
xpl ned ha
ca i nd i e s ons
ofphys c t r py ha notr i ve he pa n. 1 The phys c exa i ton w a nor ale pt
i al he a
d
ele d r i d.
i al m na i
s m xce
t Pl i ifha pai ulf lr nge ofm oton durng fe on a e e i n oft nec bia e aly,
hat a ntf d nf ul a
i
i l xi nd xt ns o
he k l t r l
pa nf f lr nge ofm o i durng r a i i t rghtnec lm ie r t ton i l f ne due t
i ul ul a
ton i ot ton n he i
k, i t d o a i n e t ck
o
6

pai pa a pi
n, r s noust r sand l t a t r si t ne k,a
ende nes
aer l ende nes n he c bnor r
mal ange ofm o i i t
ton n he
s de , n no e on pal ton oft pose i s de ,a t nde e sand sif s i t l f
houl r pai t d
pa i
he t ror houl r nd e m s
tfne s n he e t
sde of t ne k. I Pli if was dignos d wih r diul t of t a m ,a s ane or
i
he c
d
antf
a
e
t a c opa hy
he r
pr i d

sr ie n c ,h a a he ,a d a u s e iid h a ij r . g 35 1 S wa p e ci d
tan d e k e d c s n n n p cfe e d n u y R. 2 . he s r srbe
m e c ton.
di a i
OnJ
une 3,2013,Pl ntf had a M R Iof t c r c s ne w ihoutcontas pe f m e
ai i f
n
he e vi al pi
t
r t r or d.

( 3 1 Shewa f t ha ahenitddicwihbony rdgi a t C3- C4- andC5R. 60 .
s ound o ve r ae s t
i ng t he 4, 5,
6
l ve s a bul i di c a t C6- l l and sr i e d a i nm e s
e l,
g ng s t he 7 eve ,
t a ght ne lg nt ugge tng m us l s s . 1
si
c e pa m d.

Therdo o itas noe t a t et g n o ij r i c r nc' f .
a il gs lo td h t h t e t f nu y s h o i. #
a
'
On J
une 5, 201 Pl i if r t ne t M e
3, antf eur d o
dExpr s a wa s e by Dr Sophi
e s nd s e n
.
a

S l n Trj n g 35 1 Plitf rpo tdt a s esil dpano t elh sd o h r c a d
amo - aa . R. 3 . an if e re h t h tlha i n h e ie f e ne k n
i he lf t
n r e t humb a t tt pa nhadbec
nd ha he i
omem o ec t nt
r onsa .

Thephys c exa i ton w a
i al m na i
s

nonnale e f ltrltndenes notd on t lh sde ofPl ntf' nec ( 3541
xc pt or aea e r s e
he e i
ai ifs k. R. .

S l n Trj n c mp ee aFlrd W o k r 'Co n ai nUnf r Me ia Tr ame ts aus
amo - aa o ltd o i a r e s mpe s to io m dc l e t n/ tt
Re tngFonn g 356- a t J 5tvii. The doct opi t Pl i ifcoul perf m
pori
R. 591 t he une h st
or ned hat a ntf
d
or
û kwor onl ' ( 357,3591
t
des
k y. R.
'
.
On J 18 201 Pli tf s w Dr Gar Ac r a f he ne pai num b ha ,nec
une , 3, a n if a
. y ke m n or r ck n,
nds
k

s s ,a d h a c e . g 3 41 He e a n d Plitf a n td t a Plitf h d n r l
pa ms n e da h s R. 6 .
x mie an if nd o e h t an if a o ma
ga t i pe ton,a pal ton,pa n a de r as d r nge of m ove e oft c r i a s ne,f l
i, ns c i
nd pa i
i nd c e e a
m nt he e v c l pi u l

r ngeofm ove ti t t a i s neand l
a
men n he hor c c pi
umba s ne, a ot r s nor a e m i ton.
r pi and n he wie m l xa na i
1
d. Dr A c nna r com m ende N SA I pa n m e ca i a pos i y a e dur . 1
. ke n e
d
D
i
di ton nd
sbl n pi al d.
Pl i if s D r A c nna a ns on J y 1 201 a he r c m e d a ce vi le dur l
a ntf aw . ke n gai t
ul 5, 3, nd
e om nde
r ca pi a .

g 3631
R. .
7

On J nua y 7,201 Pli ifs w Dr Fic r who c
a r
4, a ntf a
. s he ,
onduced a ps hi rcexa i ton.
t
yc ati
m na i

( 3 7 . The e a n to wa n r l 1 Plitf rpo td t ts e p a n d t rtl t
R. 7 1
x miain s o ma. d an if e re ha h ln e o eu. o
n
c elng. I
ouns i
d
On Fe ua y 1 201 Pl ntf pr e e t Dr Da d Si on c
br r 9, 4, ai if es nt d o . vi mps ompl ni ofnec pan.
ai ng
k i

g 3 8 . Plitf e pli d ta p y ia t ea , d c to s a d e d r lij ci n h dal
R. 6 1 anif x ane h t h sc l h rpy me iain , n piu a n e to s a l
f ied t p o de sg tca r le ofhe ne k pan r di tng i o t l f a m wih num bnes a
al o r vi i nii nt ei f
r c i a ai nt he e t r
t
s nd
tnglng i t ha
i i n he nd. 1 D r Si ps e m i d Pl i i f
d.
. m on xa ne
a ntf .

The onl a
y bnor a iy w as
m lt

t nde es i t l f t a zi . I D r Si ps r vi w e Pl n i f s J
e nz s n he e t r pe us d
. m on e e d ai t f ' une 3,201 M l l a
3 t nd

no e t t s had mulie dic he nitons wih ose
t d ha he
tl vel s r a i
t tophyt f m a i ca i ce r a
e or ton usng ntal nd

fr mia n ro n g 3 9 . Be a ec n evaiete t n h dn twoke f rPlitf, e
o a n l ar wig. R. 6 1 c us o sr tv r ame t a o r d o an if h
r e r d he f ra ne os gi le l t o
ef r e r o
ur ur ca va ua i n.
On M a c 4,201 Pl i ifs w Dr Fi c r a Pl ntf sps hi t i exa wasnor a .
rh
4, a ntf a
. s he , nd ai i f yc a rc m
m l

( 3 5.
R. 7 1
On M a c 11 201 Pl n if pr en e t Dr Pe o Na f i e s d tr dnes a
r h , 4, aitf es t d o . dr
m or ncr a e ie s nd

ftg eta wa n ti r vn ( 3 2 . S eas c mp an d o d fus j ittn e s a d
aiu h t s o mp o ig. R. 8 1 h lo o lie f if e on e d me s n
mus epai ( 3831 Dr Na a s Pl ntf t c i tki he mus l rl nta
cl n. R. . . m dvied ai if o ontnue a ng r ce eaxa nd
a ii l m m a or f he ne pa n. 1 H e a s a s he t co i t ki he pr e
nt-nfa
t y or r ck i d.
l o dvi ed r o ntnue a ng r es nt

m e c ton f hera ypi lde es i dior as s was sa e on t m e c ton. 1 Dr
dia i or
t ca pr sve s der he
t bl
he di a i
d. .
N a not d t tPl i ifw a doi w el a s r l s t n a 4 on he de es i s r ni
m
e ha a ntf s ng l nd co ed es ha
r pr s on c ee ng. f
#.
O n M a c 28,201 a D i a lt De e na i Expl na i a t i tall ve w asi s
rh
4, s biiy t nni ton
a ton t he nii e l
s ued.

( 1 371 RodoloBui ,PI. ,P. ,c l t tPli ifscl m wa pa tal ce bl
R. 27- .
f gas ZD. A. oncuded ha antf ai s rily rdi e
a t tt m e ca e de eofr or c
nd ha he di l vi nc
ec d onobo aed Pl i ifsa ey,butnothe a lge PTSD
rt
antf nxi t
r le d

a de esi g 1 1 Heas not t tt e de s we i o me wihte t nt
nd pr son. R. 31 .
lo ed ha he vi nce ho d mpr ve nt t r ame ,
8

t tf to ngwasove a li ac , nd t tPl i ifha m idlm ia i i a t ofdaiy lvi and
ha unci ni
r l nt t a ha antf d l i ttons n c s
l i ng
s i lf toni
oc a unc i ng. 1 I t Diabiiy De e na i Expl ton,Cha l t Towne ,SDM ,
d. n he s lt t nni ton
anai
rote
s

c n ld dta Pli tf i n td sbld. ( 1 7 .
o cu e h t anif s o ia e R. 3 j
Plitf s w Dr Na a an o Ap i 1 ,2 4. ( 3 0 . Dr Na n tdt a Plitf
an if a . m g i n rl 1 01 R. 8 1 . m o e h t anif

wa a an c mp an n o dfu ej ittn e e s mus l p i ,ftg ea d we k s . 1 . He
s g i o lii g f if s on e d m s , ce an ai u n a ne s d
a s no e t t Pli if ha dif e ti r poi tndem e s I He r f red Pl ntf t a
lo t d ha antf d fus rgge
nt e
s . d.
eer
ai if o
r um a ol s .
he t ogit

On M ay 5,201 Pli tf pr s nt t Dr St phen Ge vn c
4, a n if e e ed o . e
r i ompli ng ofne k pan t t
a ni
c i ha

s s i wasa 6 outof1 on t pan s al g 3951 She rpore e e sve ftg ni
he ad
0 he i c e. R. .
e td xc s i aiue, ght
s t,hea c s l sofse p,de es i dior r f ge f nes ,na e a vomii a or
wea s da he , os
le
pr sve s de , or tul s us a nd
tng, nu

1gwe k e s j itp i me r i an n, fiut i s e c a is wihc o dn to i
e a n s, on an, mo y mp iue tdifc l n p e h, n sue t o r iain n
y
he a m ,a i biiy t c
r r n na lt o once r t di opi w e kne s oft f c m us es a et depr s i
nta e, pl a, a s
he a e
cl , nxi y,
e s on,
obs s i - om pul i di or ,pa c a t c , nc e ed a tt a pe s s en s olen gl nds or
e s ve c
s ve s der ni ta ks i r as ppe ie, nd r i t t w l
a

lmphn d s ( 3 59 1 Plitf t dDr Ge vnt a s eh d q i h rj b a dt a t eo l
y
o e . R. 9 -6 . anif ol . r i h t h a ut e o n h t h n y
docors wasc rntys engwa at a s. ( 396- . Pl ntf alosae t ts ha no
t he
ure l e i
s herpit R. 971 ai if s ttd ha he d
ç pr si pr e 'prort he a i nt ( 3971 Dr Ger ne mi dPl ntf a not
t e sve oblms' i o r ccde . R. . . vi xa ne ai if nd ed
de
t ts t nde t c a e he lf a m i he lp.
ha he e d o r dl r e t r n r a

H e a s not d t ts had nonnalga ta
l o e ha he
i nd

c di ton. 1 The e naton was ge rly nor l ( 397- . Dr Ge vn alo
oor nai
d.
xnmi i
neal ma. R. 981
. ri s
rviwe Pli ifsdignosi sudi . ( 3981 Hedignos d Pli ifwihbr hi ne ii
e e d antf' a tc t es R. .
a e antf t ac al urts
orrdiultsNOS, ac a ne ii,c r ial a, ne kpai ( 3991 Dr Ge vnnotdt t
a c ii
br hil urts e vc gi and c n. R. . . r i e ha
Pl ntf ' s ne w asm e ni a l i ac e e f e e i w a 1 deg e s. 1 He al o not
ai if s pi
cha c ly nt t xc pt or xt nson s 5 r e
d.
s
ed
t the m us l sw e e ver t ns butt the m ot ,s or and r f e w e e i a t a he t
ha r
ce r
y e e,
ha r or ens y,
e l xes r nt c , nd r oe

sgnswe edown. 1 Dr Ge vnor r a tonalsudis g 399- .
i
r
d
. r i deed ddii
t e . R. 4004
9

Pl nifha a M Rla a x-a oft c vials neperor d on M a 6,201 (
aitf d n
nd n ry he er c pi
f me
y
4. R.
405- . The s
61
y howed s l dic pr r i mos sg tca a C4- whee a s ll t
mal s otusons t inii nt t C5
r mal ef
pa a di n dic pr r i wasi c a twih t c d a m id de ne a i dic i e s ce
r me a s otuson
n ont c t he or nd l ge r tve s nt r pa
na r i a C4- a C5r ow ng t C5 nd
C6. 1
d.

On M a 1 201 Plitf s w Dr Ge vn f a f l u g 1 . Dr Gevi
y 2, 4, anif a
. r i or olow-p. R. 091 . r n
e nedPli ifandnot t ts siltndedt c a ehe lh ar i herlp. ( 11 . He
xami
antf
ed ha he tl e
o r dl r e m n a R. 01
alonot d t ts ha nor gata coor na i
s
e ha he d mal i nd
di ton. I Dr Ge vn deer ne t tPli tf s
d
. r i t mi d ha a n if
s ne w a i a tm e ni ly e eptt ext ns o w as l5 degr es he m us e wer ve y t ns ,
pi
s nt c cha ca l xc hat e i n
e , r
cl s e r e e

h rmoo , e s r a dr fe sweeitc, n h rt esg weed wn g 1 l . Th d co
e tr s n o y n elxe r n a t a d e o ins r o . R. 1 1 e o t r
r vi w e Pl ntf s x- a a M RI s f om M a 6, 201 I
e e d ai i f
r ys nd
' r
y
4. d. D r G e vi c l
. r n onc uded t t
ha

Pl ntf ha ve y mid s
ai if d r l pondyltc i r i i t t ca t t lf ofce e a 4- a 5- a
ii ntuson n o he nal o he e t
nt r t 5 nd 6 nd
t t i di not a a t be neur c pr sve
ha t d
ppe r o
o- om es i .

He di gnos d he wih a e ol e a dic
a
e r t nt r atr l s

h r aint t elf a C4 5 a d ds u s d te t n o to . ( 1 2 . Ir.(J r n or r d a
enito o h et t - n ic s e r ame t p ins R. 1 j ) e vi de e
c v c s ns r ne ve conduc i s udy a a c r ca br ce. 1
er i al e o y r
ton t
nd e vi l a
d.
O n J 4,201 a D i a lt D e e m i ton Expl na i a t r cons de a i l ve w as
une
4,
s biiy t r na i
a ton t he e
i r ton e l

is e ( 1 0 5 1 Tho s Co g r PAD. e pli e t t wh l Plitf alg d t a h r
su d. R. 4 - 4 .
ma n e , I. , x an d ha, ie an if le e h t e
c to ha wor e d snc t prorde a , heupda e f tonale de e di nots
ondii n d
s ne i e he i nil t
t d unc i
vi nc d
uppo t r
r he
ale ton a i t a confr t ts wasc bl ofpe f m i awi r ngeofa tvii of
lga i nd,nse d, imed ha he
apa e
ror ng
de a
c i tes

daiy lvi wihi her physca r titons g 1 . Dr
l i ng t n
i l esrci . R. 471
.Conge alo dee ne t t
r s tnni d ha
Pl ntf ' f tonali ti onl pari ly c edi e,a t ta r vi w oft e de e c im e
ai i f s unc i
npu s y ta l r bl nd ha e e
he vi nc onfr d
t ts w a prm a iy lm ied by he phys c lcondii a t r w asno i c i n ofa m e a
ha he s i r l i t
r
ia
ton nd he e
ndi ato
nt l
i pa nne t t w oul m ee or e
m i nt ha
d
t
qual a ls i
ny itng. 1 Thom a Bi e , M . . a s f
d.
s xl r D , l o ound t t
ha

Pl ntf wa onl pa tal ce bl a t tt RFC wa r duc f panandr c opahy. (
ai if s y rily rdi e nd ha he
s e ed or i
adiul t
R.
10

1 1 LyseMt o c n ld dta Plitf i n t ia ld g 1 41
51. l f wn o cu e h t anif s o d s be . R. 5 .
Plitf s w Dr Ge vno J n 1 , 01 f r r -h c g 4 3 . S erp re ta s e
an if a . r i n u e 6 2 4,o a ec e k. R. 2 1 h e o td h t h
w a di a nt d t theri lr nc ha t ne dow n s ve a tea m e s a ne vet t a br c a
s s ppoi e ha
nsza e d ur d
e r l r t nt r es , a e, nd
a nuc ea m a tc r s nc I She alo s a e t ts w a s ils f r ng f om nec pa n i o
l r gne i e ona e. d.
s t t d ha he s tl uf e i r
k i nt

he l f s ul rwih r di a s
r et ho de t a culr ympt down he l f a m a tnglng fnge son he l h ha
oms
r e t r nd i i i r
r e nd.
I Pl i ift d t doct t the e pl rr e ed he s nc s coul notlf a hi he vy
d
a ntf ol he
or ha r m oye el as
r i e he
d
i t nyt ng a
a t tt e c vi le dur l ha nothel d he .
nd ha hr e er ca pi a s d
pe r

U pon phys c e m i ton ofPl i if
i al xn na i
a ntf ,

Dr G e vi f
. r n ound t tPl ntf ha a fui ga t no s gns of s tciy,a i a tm ec ni a s ne
ha ai i f d l d i,
i
pas i t n nt c
ha c l pi

e c p f r xe inof1 d g e s a veytn emus ls ( 4 4 . Hec ui n dPlitf n t
x e t o e tnso
5 e r e , nd r e s
ce . R. 2 1
a to e anif o
t c adl orf vorapa tc a a m and dic s dt opton oft non- ove e s vie f rce vca
o r e a
riulr r
s us e he i
he
c r d er c o r i l
ne om us ul rr ur
c a e educ ton t t s ne pr a die t d a C 5 6. 1
a i o he pi
ogr m r c e t d.

On J y 1 201 Pl ntf ha e e tomyogr phy a ne v c
ul 6, 4, ai if d l cr
a
nd r e onduci veociy t t
ton l t ess

p ro e . ( 4 7 . S wa f u dt ha erg t da sns r n u o ty,ih ula moo
ef nn d R. 2 1 he s o n o v ih me in e o y e rpah rg t n r tr
a s ns y ne opa hy,evi nce of ac e l f ( 5- a ( 6- r c opa hy,a e de e of
nd e or ur t
de
ut e l 2 6 nd 2 7 adi ul t
nd vi nc
c oni rghtC 5 6 a C6- r di ul hy. 1
hr c i
- nd
7 a c opat
d.
On Se e be 8,201 Pl i ifpr e e t D r Evl Br n f a a
pt m r
4, a ntf es nt d o . yn ow or n nnualphys ca a
i l nd

rpored pan i he bac a ebow r ditng i o bot ofhe lgs ( 4921 Dr Br
e t i n r k nd l
a ai nt h
r e . R. . . own
c
onduc e a de e son s r eni and ga Pl i if a s e of 7,whih m e t t t Pl ntf
td
pr s i c e ng
ve antf
cor
c
an ha ai if
s f e fom m i de e son. 1 Dr Br
ufer d r
nor pr s i
d. . own not t tPl ntf sde es i dior rwa
ed ha ai if
pr sve s de s

sa ewihmediai . g 4941 Sheas r ildPli ifspai me cai I
tbl t
c tons R. .
lo efle antf
n di ton. d
On Se e be 1 201 Pl i if ha a M RI of t c r i al s ne w ihout con r s
pt m r 9, 4, a ntf d n
he e v c pi
t
ta t

pef med. ( 4331 Shewasf t ha mi malrve s oft cevi ll doss modeae
ror
R. .
ound o ve ni e ral he r ca or i,
rt
de ner tvedic di ea e a ( 3- t ough C5 6, nd m ulie s l di cpr t s ons di c bul
ge a i
s s s t 2 4 hr
- a
t l vel halow s o nz i / s
ge

wih a a fs urng,wor t a (4- wih m id prmarl l tsde c d compr son a
t nnulr is i
s t 2 5 t
l i iy ef- i d or
es i nd

ds lc me tb t o sg i c n c n l rn u a f r mi l tn ss g 4 4 .
ipa e n u n t i nt a t a a o e r l o a na se o i. R. 3 1
i
OnSe embe 24,201 Pl ntf pr s nt t Dr BranRetrwihrghtel pan. (
pt r
4, ai if e e ed o . i ie t i bow i R.

4 2 . S e sae t a tepan ha sa td fu mo t p i r f . Plitf as rp re n c
5 ) h ttd h t h i d tre o r nhs ro . J an if lo e o td e k
pa n.
i

Dr Ret re m i Pl ntf rghte bow a f
. ie xa ned ai ifs i l
nd ound t ts ha sgnsands
ha he d i
ympt m s
o

of t nni e bo , ne opa hy, a pos i e c r t
e s l w
ur t
nd
sbl a pal unne s
l yndr e. l
om
d

H e per onne
f
d

da n tct rp ui ij ci n f rtetn i ebo a d f rteula n r t s ei Plitf s
ig osi/ a e tc ne to s o h e ns l w n o h n r eve o e f an if
he
s pt si ove f
ym om mpr d. #.
On N ove be 5,201 Pl i i fr t ne t Dr Reier f r a r - ck of he e bow pa n.
m r
4, a ntf e ur d o . t o
e che
r l
i

( 4 5 . Plitf sae t a t e ij cin o l woke f rt d ysa d t a t e p i h d
R. 5 1 anif ttd h t h ne to s ny r d o wo a n h t h an a
rtnwd 1 . Dr Retrp ro me as c nd ij cin f rt etn i eb w a r c mme d d
eu . d
. ie e f r d e o n e to o h e n s lo nd e o n e
physc lt rpya atl sel srp. g 456)
ia hea nd emi bow ta R. .
On Nove r25,201 Pl i ifs w Dr Br
mbe
4, antf a
. own f ar h al ove herbod t ta a ed
or as l r
y ha ppe r

a trPlitf ddy r wo k ( 49 1 Dr Br wnp e ci e me iai n. ( 4 )
fe an if i a d r . R. 0 . . o rs rb d dc to R. 91 .
OnJ n ay5 2 5 Plitf rt r e t Dr Retrf rar -h c o h reb w p i. (
a u r , 01 , an if eu n d o . ie o e c e k f e l o an R.
4 7 . Plitf rpo td ta h rmo tr c n c rio eij cin h d o l o fr dh rp ril n
5 1 an if e re h t e s e e t o ts n n e to a ny fee e a t a d
a
t
empor r r i f ac eofda a t ts hadt sopphysc t r py bec us t pan wa
a y elef or oupl
ys nd ha he
o t
i alhe a
a e he i s
unbe r e.
a abl

Dr Ret r e m i Pli ifs el
. ie xa ned antf
bow a not d t t s ha s
nd e ha he d ympt
oms of

t sebow,butas s middif et mes aoundt ebow. ( 4581 Heas notd
enni l
lo ome l fus ende s r
he l
R. .
lo e
t tt t nde nes l alze overt l t r luppe c
ha he e r s oc i d
he a e a
r ondyl I The doc oro de e a M RI I
e. d.
t r rd n
. d
On J nua y 22,201 Pl i ifha a M Rloft rghte bo w ihoutc r tpe f
a r
5, a ntf d n
he i
l w t
ontas r onne
d.

( 4071 I wa deemi dt ts hadltr e c
R. . t s tr ne ha he
aeal piondyltswihtndi i a apari t rof
ii t e noss nd
talea

tec mmo e tn o tnd n a wel samids r i tpeij r o ter da c laea lg me t
h o n x e s r e o , s la
l p an y n u y f h a il o ltrl ia n .
1
2

1
d.
On J nua y 28,201 Pl n i f s w D r Re t r f a r c k of he el
a r
5, ai t f a
. ie or e- hec
r bow pai a t
n nd o

rve t eM RI ( 4 9 . Dr Retrn tdt t an ifh das me a p iieTie' sg a
e iw h
. R. 5 1 . ie oe ha Plitf a o wh t ostv n ls in t
t rghtel and dic o ton t me a sdeoft ebow. ( 4601 Heas notd t t
he i bow
s omfr he dil i
he l
R. .
lo e ha
Pl ntf ha ci c a M llfndi f lt r epi
ai if d lnial nd t i ngs or a e al condyltsandt tc er tvete t nthad
ii
ha ons vai r a me
notw o ked.
r

Dr Reie e ane t Pl ntf t ts had ca pa t mel c t lt
. tr xpli d o ai if ha he
r l ur , ubia unnel a
, nd

pos i e c r i lr di opa hy,a he s
sbl e vca a cul t
nd
ugge t d s ge y.
se ur r

Pl i ifcons nt t s ge y.
antf
e ed o ur r

1 On Febnz r 24, 5, .Ret rpe f med de i me oft e e ort ndon,rghtel
d.
a y 201 Dr ie ror
brde nt he xt ns e
i
bow,
a a i a i of a l
nd pplc ton
ong pos e i l
t ror ong a s i t te Pl i if s r ght e bow l t r l
nn plnt o r at a ntf
i
l
aea

e c
piondylts g 4441 On M ac 5,2015,Pl ntf s Dr Reie f apos- r tvevii.
ii. R. .
rh
ai if aw . tr or
tope ai st

( 4 2 . Hen tdta s ewa d igwela dt a h rs mp o we esihl i r ve . I
R. 6 )
oe h t h s on l n h t e y t ms r lg t mp o d d
y
Heas not t tPli ifwoul besa tngphysc t rpy. ( 463 .
lo ed ha antf
d tri
ialhea
R. 1
On Apr l 3, 2015, Pl i if s w Dr J e La t san i go f a e ua i of t
i
a ntf a
. os
baul- t a
or n val ton
he

numbnes a pani he ha . ( 4361 Plitf rporedt ts waslmie i hera lt t
s nd i n r nds R. . anif e t ha he
i td n biiy o
wrt a t ts ha s
ie nd ha he d omem e y l sa de r s d f us I Shealo saedt tphysca
mor os nd c ea e oc . d
s t t ha
i l
a oc upa i t r py ha i r as d he vomii a pa n. f Pl ntf s r a l ou of
nd c tonal he a
d nc e e r
tng nd i #. ai if co ed 6 t

30on ami - nt sat e m bec us ofherdece edatnton a c ntai g 4371
nime al t e xa
a e
ras te i nd once rton. R. .
A fe c pl tng a phys ca exa on Pl i i f Dr La ul- ntago not d t teve yt ng w a
t r om e i
i l m
a ntf , . ba t sa i
e ha
r hi
s

nor e e frgi a ywe s s condayt pai g 4381 Hedetr nedt tPl nif
mal xc pt o ve wa akne s e
r o n. R. .
emi ha aitf
s f r d f om r di ul hi a ca pal t w l I He s a t d Pl i if on c e va i
uf e e r
a c opat es nd r
um . d.
t re
a ntf
ons r tve
m ana m en t i l phys c loc
ge t o nc ude
i a / cupa i lt r py a pr ve a i m edi a i n f t pa n.
tona he a
nd e nt tve
c t o or he i

( 438 . The doco alo f
R. 1
tr s ound t tPl ntf sme y detci wasmos lkey c us d by
ha ai if
mor i t
ti l a e
de es i a anxi t I H e a s d Pl i i ft c i s i a ps hi ti t
pr s on nd
e y. d.
dvi e a ntf o ontnue ee ng
yc a r s .

OnAp i 1 , 01 , anifs w Dr Retr g 46 . Dr Retrn tdt twh l t ee
rl 5 2 5 Plitf a . i . R. 41 . ie o e ha, ie h r
e
had be no pos- a i c plc tons Pli ifs s pt s we e unc nge c
en
toper tve om ia i , antf ym om
r
ha d ompar d t
e o
pr pe a i s pt s I Pl i if r pored t t s w as doi oka t t s e days we e
eo r tve ym om . d. a ntf e t ha he
ng
y, ha om
r

mor pai ult n ot s pa tc a l i s wasa i and t ts ha notye sa td physc l
e nf ha her , riulry f he
ctve,
ha he d
t tre
ia
t r py.
he a

Upon e
xami to Dr Ret rnot d t tPli ifhad f lr
na i n, . ie
e ha antf
ul ange ofmoton i he
i n r

el a t r wasmidtnde e st papato g 4651
bow nd hee
l e m s o l in. R. .

OnM a 1 , 01 , . eH. k tl o ee aû ei n r Re o t' g 5 3 . The
y 1 2 5 Dr Le Bu se c mpltd ç l a y p r. R. 7 1
pr mi
'
doc ornot t Pl i ifwas c r nty beng te t by a ps hi tit butt ts ha be
t
ed hat antf
ure l i r aed
yc ars,
ha he d en

te tdb o h r y h l it a dp y harssi t ep s. k 5 4 . DrBu tl pie ta t
r ae y t e ps c oogss n s c itit n h a t R. 7 1 . kse o n d h the
a lbl e de riedc r t tPli ifc dha s ki ofc tvedior r (
vaia e vi nce as oncens ha antf oul ve ome nd ognii s de . R.

5 5 . He e pli e ta s e ma h v s san d a mi c nc s in o ta mai b an ij r
71
x an d h t h y a e u tie
l o u so r ru tc r i n u y
d
durng he 201 wor ac i .
i
r 3
k c dent

Dr Bukselopi t tçl t rs conday i l nc st t
. t ned ha solhe e
r nfue e ha

c d alo co rbut t c tve i fi inc a e anxit pan,see dit ba e,he rng l s
oul s nti e o ognii ne fce y r
e y, i l p sur nc
a i os ,
a tr dnes . I i alo difc tt know t wha extnt i a bei on muli e media i
nd ie s t s s fiul o
o
t e , f ny, ng
tpl
c tons
c dc rbut t s
oul onti e o ome c tvei tcinc ' 1 Dr Buksel ec me
ognii nefi e y. d. .
'
t r om ndedt tPl ntf be
ha ai if
e ua ed f om a l ur yc ogi als and nt' 1
val t r
i ops hol c t poi . d.
ne
'

OnM a 29, 5, . ul- tagoco et aM e c lSoureSttme ( ia)
y 201 Dr Laba tsani
mpl ed
dia
c ae nt Physc l.

( 41 41 . Henotdt tPli ifs frd fom lmiai ofmove ntoft a duet
R. 4- 51
e ha antf ufee r i tton
me
he nns
o
pan a t ts c dno sand frl pe i . g 41 . Thedocoropi d t tPl ntf
i nd ha he oul t t o ong rods R. 41
t
ne ha ai if
c d not w or on a r gul r bas s w ihout m i s ng m or t n t o da a m on h due t he
oul
k
e a
i t
si
e ha w
ys
t
o r
di a lte . 1 He al o f
s biii s d.
s ound t Pl i i fc d nots oop or clm b,coul nots a f l
hat a ntf oul
t
i
d
t nd or ong
pe i oftm e,c d onl oc as ona l lf orc l up t 1 pounds c d onl oc s onaly us
rods i
oul
y c i ly i t ar'
y
o 0
, oul
y ca i l e

he ha f rfnem a pulton,and c d onl oc asonal r s he lf and rg a m sove he
r nd o i
ni a i
oul
y c i ly aie r e4
i ht r
r r
14

s de s
houl r .

Dr Laba tsa igo a s f
.
ul- nta
lo ound t t Pl ntf s pan wa bot e r me a
ha ai if
i
s h xte
nd

s vee,hats ha t pei c l ledownduet f iue( di no s yf how l ,a t t
e r t he d o rodialy i
o atg but d t a or
ong) nd ha
s woul ne dt tkeuns he e brakpei durnga ei - wor da ( 41 .
he
d e oa
c duld e rods i n ghthour k y. R. 51
Dr La tsa i o alo complt d a s ond unda e M edial Sour e St t me
. baul- ntag
s
ee
ec
td
c
c
a e nt

( i l. ( 439- . The onl difrnce i t undae veson ae t t Dr
Physca) DE
401
y fee s n he
td ri r ha .
La tsa igo rpledt tPli ifc d fe nty (ahe t n occ i ly)us he ha
baul- nta e i ha antf oul rque l rt r ha
asonal e r nds
f fnema pulton,ha Pl ntf span lvelwassvee(ahert nextemea s vee,and
or i
ni ai t t ai if i e
e r r t ha r
nd e r)
t tPl i ifdi notha a r as
ha a ntf d
ve e onabl m e c lne d t le down. I
e di a e o i
d

OnM a 2 , 01 , . o as c mpltdaM e ia S u c Sttme t Ph sc l. (
y 9 2 5 Dr Br wn lo o ee
d c l o r e ae n ( y ia) R.
41 1 S e n td t a Plitf h d n r e d ma e t a c u e h rt h ve p i a d nu n s
6 . h oe h t an if a e v a g h t a s d e o a an n mb e s
r ditng down he rg a l f a a i o he ha a fnge s I Dr Br
a ai
r i ht nd e t nn nd nt r nds nd i r . d. . own opi t t
ned ha
Pl i ifc d notw or on a r gul rba i w ihoutm i s ng m or t n t o da am ont due t he
a ntf oul
k
e a ss t
si
e ha w
ys
h
o r
di a lte .
s biii s

She a s f und t tPl i ifhad lm ia i nss ti s a ng, al ng,soopi
lo o
ha a ntf
i t t o itng, t ndi w ki t ng

a clmbi
nd i ng. f Dr Br
#. . own c l d t tPl i ifc d feque l lf or c ry up t fve
onc ude ha antf oul r nty it a r
o i
pounds a c d onl occ s onaly lf orca r up t 1 pounds c d ne r us he ha f
nd oul
y a i l it
ry
o 0
, oul ve e r nds or
fne m a pul ton, c d onl occ i na l us he ha
i
ni a i
oul
y
as o ly e r nds f g os m a pul ton,coul onl
or r s ni a i
d y

oc asonaly r ie he lf a m o rhers de ,a coul ne r r ie he rghta ove he
c i l as r e t r ve
houl r nd
d ve a s r i
nn
r r
s de .
houl r

Dr Br
. own a s f nd t Pl i if span wa bot exte e a s r t ts
lo ou hat antf
i s h r m nd eve e, ha he

ha t e e t he l a nee d, ha s ha t le dow n due t f tgue as ne ded,and t ts
d o l va e r egs s de t t he d o i
o ai
e
ha he

woul ne dt tkeuns he e bra perodsdurnganeg - wor da g 41 .
d e oa
c duld e k i
i
ihthour k y. R. 51
On J 22,201 Pl ntf sw Dr Retr f he ebow pan. ( 4661 Plitf
une
5, ai if a
. ie or r l
i R. . anif
r po t d s e i pr
e r e om m ovem e ,buts a ed t tt pai w a e e ba e by c t n m o m e s l
nt
t t ha he n s xac r t d
erai
ve nt . d
Pl ntf ha not ye s a t d phys ca t r py. I Pl i t f s il ha s a t nde nes a
ai i f d
t t re
i l he a
d. a n if tl d on e e r s nd
15

tght s ,bu i wasbe trt n prort s ge y. 1 Upon e m i to Dr Reie no e t t
i ne s t t
te ha i o ur r d.
xa na i n, . tr t d ha

Pl ntf had f lr nge ofmoton a t r wasmid tndenes t pal ton. ( 4671 He
ai if
ul a
i nd hee
l e r s o pai
R. .
sr y r omm e d t Pli ift ts sa tphysca t r py. 1
tongl ec
nde o a ntf ha he t r
i l he a
d
On Se e r2,201 Dr Bukse c
pt mbe
5, .
tl omplt d hi iirefPr i i yNeur yc ogi a
e e s i3 i elm nar
l
ops hol c l

Re r. ( 5 6 . He n td t a Plitf h d b e s e f ra n u o y hoo ia e au to
po t' R. 7 1
'
oe h t an if a e n e n o e r ps c lg c l v l ai n
duet he me or l sa ot rcog tvei im e . 1 Dr Bukse alono e t tPl i if
o r m y os nd he
nii mpar nt d. .
t l s t d ha antf
a
ppea e quie de es ed.
rd
t pr s

He e ane t t t tng s
xpli d ha esi howe a pa t of m a i a t
d
tem
ny nt c

a lte ,ge r ly wihi t l a a t a a r ,a s e de i ist ta e ge r ly
biiis ne a l t n he ow ver ge o ver ge ange nd om
fct ha r ne al
mid. I Dr Bukse not d t tPl ntf ha s e si pe s r tve t nki t nde and
l d
.
t l e ha ai if d om lght r eve a i hi ng e ncy
s ei fcenc on s tde a fe r al a l deayr c tonr al. 1 He a s not
om nefi i y
hor l y r e ec l nd ong l e ognii ec l d.
lo ed
t tPli ifm a m uli ei r i and r pe ii e r sa ha defcisi t a e ofr di
ha antf de tpl ntuson
e tton ror nd d i t n he r as ea ng
a e es i voc bulr ve bals
nd xpr sve a a y, r
ymbolc a ta tr s ng,r hm pater pe c pton,lf
i bsr c ea oni hyt
t n re i et
ha smpl m ot s ed,biae alfne m ot dextrt sm pl viua e utve f toni
nd i e
or pe
l tr i
or
e iy, i e s l xec i unc i ng,
a t yco pr he i ofve bal a e i , r lfue y f phone i a co e ua c e , nd
udior m e nson
r m t ralve ba l nc or
m c nd nc pt l ut s a

vebalc r ain na ng. ( 577- . Dr Bukse f
r onfontto mi
R. 781 . tl ound t tt r wa as evi nc of
ha he e s lo de e
mode a e i quac of e ani a smpl sa e e hea d a mid e r s of c u i i
r t nade
y
xpl i ng i e t t m nt r nd l ror
onf son n

c lultng. ( 5781
ac ai
R. .
Dr Bukselne r po td t tps hol c ls r ni of Pli tf r ve ed e denc of
.
t xt e re ha yc ogi a c ee ng
a n if e al vi e
s ver de es i w ih s e s c de pr oc
e e pr s on t om ui i
e cupa i , s ve e a e y,a s ver hopel s s
tons e r nxit nd e e
esne s

rgadi t f ur ( 5781 Hee ane t tPl ntf ha manynotbl srs o s 1 Dr
e r ng he ut e. R. .
xpli d ha ai if d
a e te s r . d. .
Buksel nc ude t te de e s ed s l t ne ops hol c i pai nt I He f
t co l d ha vi nc how
e ec ed ur yc ogi al m nne . d
ound
t t Pl i if s ne ops hol c l i fci ncy i lkel m uli f c oral ca e by her s ve e
ha a ntf ' ur yc ogi a nef i e
s i y
t- a t i , us d
e r

d pr s i n a a ey, o cpai se p dit ba ,da i f tg a tr dnes ,a lf ea
e e so nd nxit chr ni n, le sur nce ytme ai ue nd ie s nd e4 r
16

hea i l s 1 Dr Bukse poi ed outt ts
rng os . d. .
t l nt
ha ome ofPli ifsm ot dei isc d ber lt d
a ntf
or tct oul
ea e

t h rn c ij r a ds meo h roh rd fct c udbelng tn i i n tr . f . Hesae
o e e k nu y n o f e t e eiis o l o sa dng n al e #
z
ttd
t tt M a c 201 a i ntm a ha ca ed am id c
ha he r h
3 ccde
y ve us
l oncus i whih c d a ountf s e
son, c oul cc
or om
oft i f c enc es butt tt r w a no obvi e de e ofa t ofde e i pr s 1
he nefi i i ,
ha he e s
ous vi nc
ny ype
m ntng oces . d.

Dr Bukse c uded t t Pl i ifs i ur ysc l i fc e y i lkel mosl due t
.
t l oncl
ha antf l oph i a nefi i nc s i y
ne
ty
o
non- ur ogi f t s' t tc i d ne ol c m onior ng m i be ne s a y. 1 H e
ne ol c ac or ' and ha ontnue ur ogi al
t i
ght
ce s r d.
al o r c m e
s e om nded t tPl i if c i t s e he ps a rs ,t ke he pr s i m edi a i
ha a ntf ontnue o e r ychi t i t a
r e crbed
c tons
f de e son a a et ge a r e ofherps hotopi m e ca i a s k ps hot a
or pr s i nd nxi y, t evi w
yc r c di ton, nd ee yc her py.

1 Dr Bukse opi t tPli ifwoul lkeyha to ebenggai ulyempl ed(tt
d. . tl ned ha antf
d i l ve r ubl i
nf l
oy a he
tmeofhi r por) butt t iherde e son,a eya pani ovedwihteame ,s coul
i
s e t, ha,f
pr s i nxit nd i mpr
t r t nt he d
pos i y r t m t w or 1
s bl e ul o
k. d.

Pl ntf s w Dr W o e h Saha o on muli eoc sonsi 201 a 201 f ps hiti
ai if a
. m s
de
tpl ca i n 4 nd 5 or yc arc

cae. ( 41 477- 41 W hiet ha wrten not ar genealy il bl,Dr Sa de di
r R. 3, 8 .
l he nd- it
es e
r l legi e . ha o d
tnd t t Pli if di not s f fom ps
i ha a ntf d
ufer r
ychoss s cdal i ton, homi i i ato or
i, ui i
dea i
cdal de i n,

h l cn to s ( 4 8 4 7 . The d co as fu t a Pli tf s i ule c nr a d
al iain . R. 0 , 7 1
u
o t r lo o nd h t anif mp s o tol n

i sg t u g n we e fi a d h r afc wa bu td ( 4 8 41 2 On o e oc a in t e
n ih / d me t r ar n e fe t s lne . R. 0 - 3 .
j
n c so h
docorf Pli ifsmoodt bepoor ( 478 .
t ound antf
o
. R. 1
O n J y 1 201 Pl i if pr s nt d t J M e ca Ce e r por i t s was ve y
ul 7, 6, a ntf e e e o FK
di l nt r e tng hat he
r

de e sd, ufeedfom OCD, hadt
pr se s fr r
and
hought ofdyi orkilnghe s f ( 91 I wa notd
s
ng li rel. R. . t s e
t t Pl i if was ver difcul t m a ge ps hi t i aly. f Pl i if w as ad it d t t
ha a ntf
y f i t o na
yc a r c l J. a ntf
m te o he

hos tl ( 1 . Pl ntf sae t ts ha putag t he he buts de e a physc
pia. R. 01 ai if ttd ha he d
un o r ad, he nid ny
ial
atmpta s cde. g 11 . OnJ y23,201 Pli ifwasdic r edfom t hos t ass
te
t uii
R. j
ul
6, antf
s ha g r he pial he
wa doi S
s ng t
much,muc betr' ndr sedt ts bedic r d. ( 21 . l wa noe t t
h te'a eque t ha he
s ha ge R. 1 t s td ha

Pl ntf w a no l rs ci orps hotc a ha r e he ba e i a trr c vi t r py
ai if s onge ui dal
yc i nd d ea hed r s lne fe e ei ng he a

a da ice s dd s g o Ab l y. ( 212 1
n n n ra e o a e f ii R. - 9 .
f
C.A LJ SD e s on
' ci i

The ALJis d a decson on Pl ntf cam f be ison De embe 3,201 (
sue
ii
ai ifs li or neft
c r
5. R.

4 - 9 . Th ALJe pli dt efv -tp sq e ta e au to p o e sf rd tr n n wh te
27 1 e
x ane h ie se e u n il v lain r c s o ee mii g eh r
a i vi l i dia e ( 42- . The ALJ fund t t Pl nif has no e age i
n ndi dua s sbld. R. 441
o
ha aitf
t ng d n
s tnta ganf aci t snc J nuay 1 201 t alege ons tdae. ( 441 TheALJt
ubsa il i ul tviy i e a r 6, 4,he l d e t R. .
hen
f
oundt tPli ifs f sfom t f l ngs ve ei paime s de ner tvedicdie s oft
ha antf ufer r he olowi e r m r nt : ge a i s s a e he
c r c s ne r g e bow l t r e c
e vi al pi , i ht l
a e al pi ondylts pos de i m e ,ne opa hy i t rghtupper
ii
t br de nt ur t n he i
e r m iy,a e y a depr s i
xt e t nxi t nd
e s on. l The A LJ s c fc l not t t Pl i if s ga tii i a
d
pe i i aly ed ha a ntf
s rt s s

non- e r m e c ly di
s ve e di a l agnos i i nt 1
ed mpanue . d.
The ALJ f
ound t tPl i i fdoe nothave a i pa r e orc bi ton ofi pa r e s
ha a ntf
s
n m im nt om na i
m im nt
t tm e t orm e ca l equa st s rt ofone oft lsed i pai nt i 20 CFR Pa t40
ha e s
di ly
l he eve iy
he i t m nne s n
r 4,

SubpatP,Appe x 1 g 45 . The ALJ f t detr ned t tt s veiy ofPli ifs
r
ndi . R. 1
urher emi ha he e rt
antf'
m e a i nne s c i r sngl and i combi ton di notmee orm e c ly e
ntl mpai nt , onsde ed i y
n
nai
d
t
di a l qualt
he
c ie i of ls i 1 0 a 1 06 a Pl i i fha m id r s r c i i a t vii s of da l lvi
rt ra
i tngs 2. 4 nd 2. s a ntf s l e ti tons n c i te
iy i ng,
m o a e di fc t e i s i f toni m ode a e di fc te w ih r r t co e r ton,
der t fi uli s n oc al unc i ng,
r t fi uli s t ega d o nc nt a i

p ritn e o p c ,a d n e io e o d c mpe s to ofa e tn e d r to ( 4 - 6 .
e sse c r a e n o p s d s f e o n ain n x e d d u ain. R. 5 4 1
Th ALJas f u dta telsig 1 .4l aa r p C'ciei h sn t e nme i t i c s . (
e
lo o n h th itn 20 d r ga h ' rtra a o b e t n hs a e R.
p
461
.
The A LJ f
ound t Pl ntf ha
hat ai if s
t r i ua f tonal c pa iy t pe f
he es d l unc i
a c t o r onn lght w or a de i
i
k s fned i 20 CFR
n

41 96749e e s ( )ca ne rclmbldde sa s fol ;( c nfeque l
6. 1 xc pt he 1 n ve i a r nd caf ds 2) a r nty,
butnotconsa l rac i aldieci wih bot uppe e r tes ( c n
tnty, e h n 1 r tons t h
r xtemii ; 3) a
18

fe nty,butnotconsa l tnge a ha ewih bo h uppe e r mii s a
r que l
t nty, i r nd ndl t t
r xte te ; nd

( mus avoi c nrtd e ur t ha ar s h asunpr e tdheghsand
4) t d once tae xpos e o z ds uc
otce i t
movi me hani lpat Furhe,s c n ()unde sa rme rand c ry
ng c ca rs. t r he a 1
rtnd, e mbe
ar
ou smpl i tu tons ( haveoc aso li ea to wihs r ior, r s
t i e nsr ci ;2)
c ina ntrcin t upe vs scowoker
a t publc;( onl ma smpl,wor rlt de sons a ( onl t eae
nd he i 3) y ke i e k-eaed cii ; nd 4) y olrt
oc as o lc nge i w or l a i n.
c i na ha
n
k oc t o

( 47 . Th ALJatse ta heh d c n iee a1o Pli tf ss mp o a d Sh e tn t
R. 1 e
tetd h t a o sd r d 1 f anif y t ms n ç e x e t o
t

whih t e e s mp o c n ra o by b a c p e a c n itn wih t e o j ci me ia
c h s y t ms a e s na l e c e td s o sse t t h be t
ve dc l
e de e a ot re de es aswelasaloft opi on e denc f Het n f l d t
vi nc nd he vi nc '
'
l
l he ni vi e. #.
he olowe he
t se pr s - fr t de e ni whehe t r i a unde l ng de e na e physca or
wo-t p oce s is, t nui ng
t r he e s n
ryi
t nni bl
i l
me a i im e t t co d r as bl be expe t d t pr e Pl ntf s pa n or o he
nt l mpar nt ha ul e ona y
c e o oduc ai if
i
t r
s pt s a t n evauai t i e iy, perit nc a lm ii efe t of Pl i ifs
ym om , nd he
l tng he ntnst
sse e, nd i tng f c s
antf
s pt st det nui t e e t w hi t y lm i herf tons
ym om o e ne he xt nt o
ch he i t
unc i .

The ALJ s
umm a i e Pli ifs he rng t tmony a f
rz d a ntf
a i esi
nd ound t t t Pl i ifs
ha he antf
ç e c l de e na e i panne s c d r s bl be e c e t c us t a lge
l dialy t nni bl m i nt oul ea ona y
m
xpe t d o a e he le d

s mpt ;howe r g antf lsaeme sco eni t i e iy,pe sse e and lmii
y oms
ve , pli ifs tt nt nc r ng he ntnst ritnc
i tng
ef t oft es omsa enote ieyce bl f t r s e ane i t sde ii ' E
fecs hes ympt r
ntr l rdi e or he ea ons xpli d n hi cson. R.
'

4 1 Th ALJs e iial f u dPlitf t b t a t l c e i ea s ei s b e tt ad g e o
8. e
p cfc l o n an if o e û ri l r dbl s h s u j c o e re f
y
p ay
f nc i l r ti to as a r s t of he varous i pa nne s bot phys c a m e a . To
u tona esr c i n
e ul
r i
m i nt , h
i al nd nt l

a ommodat g ai ifs vai i i nt,t r sdua f to lca ciy i r duc d
cc
e pl ntf l rous mpanne s he e i l uncina pa t s e e
a cor ngl .. 1 TheALJa s notd t tt medi lr or e denc s
c di y..' d.
'
lo e ha he
ca ec d vi e howed t Pl ntf
hat ai if
we t muli epr de sovert r l ntpe i a f l d up af w tm e ornotatal wih
nt o tpl ovi r
he eeva
rod nd olowe
e i s
1 t
e h pr de ,t t Pl i if r e ve onl cons r tve tea m e a m ana m e of her pa n
ac ovi r ha a ntf ec i d y
e va i r t nt nd
ge nt
i
s pt s and t tPl i ifdi notc i t nty a t nd phys c lt a de pie m a r f r a sf
ym om ,
ha a nt f d
ons s e l te
i a her py s t ny e e r l or
i. I
t d

The ALJ s m a i ed t m edi al r or e de e r ga di Pl ntf s phys c l
um r z he
c ec d vi nc e r ng ai if
ia

1
9

i ime t. ( 48 5 1
mpar ns R. - 1 .
The ALJ ne no e t t Pl i ifs m e al he t s
xt t d ha antf
nt
alh ympt
oms we e gene aly sa e
r
r l t bl
t
l
uoughoutt r e ntpe i
he el va
rod. ( 51 . TheALJalo saedt tt te t trc d s
R. j
s tt ha he ramen e or howe
d

onl co e vai te t e t t wa i r nt a tm e . 1 The ALJ c ude t t ihe
y ns r tve r am nt ha
s nfeque t i s d.
oncl d ha ç
t

media evi nceofr or rfe t t tg anifs s omsaenota lmii asal ed. I
c l de
ec d elcs ha plitf j ympt
r
s i tng leg ' d
'
The ALJt n s
he umm a i d t medialr cor e de e r gar ng Pl ntf smen a i i nt.
rze he
c e d vi nc e di
ai if
t l mpanne s

( 51521
R. - .
The A LJ e i il c i r t opi on e de e a ga D r Gr e s ûm uli e
xplc ty ons de ed he ni vi nc nd ve . e n' k tpl
r ti tons' itew ei ast y w e e û em por r r t i tons a i M ay 201 D r Gr n r e ed
esr c i ' lt l
ght he
r s
t
a y es rc i
nd n
3 . ee el as

g anit t rg lr ci i ' ( 5 1 Th ALJg v DrSamo - aa ' me ia rla el te
plit l o e ua a tvt ' R. 2 . e
f
y.
a e . l n Trj n s dc l ee s i l
t
weg ta Dr S l n Trjn o y te td Plitf o e tme t e p rs S e k wo k'i i o
ih s . amo - aa nl r ae an if n i , h h a e û s r ' s l t
d
n
voc tonalyrlva , andt opi onwa pr de onawor rscompens tont notas il
ai l ee nt' he ni
'
s ovi d
ke '
ai and
oca
s c iy)f
e urt onn. I TheALJas ga Dr Na sopi ont tPl ntf i rsrcedt lfi l s
d
lo ve . m' ni ha ai if s e tit o itng es
t n 1 pounds ltl w e g a t r s rcton a a s t be t m por y a notpe m a nti t
ha 0
ite i ht s he e t i i ppe r o
e
ar nd
r ne n he
c e ofa lofD r N a ' not s 1
ont xt l
. m s e . d.
The A LJ how e r ga t opi on of D r Bi e , a s a e a ncy m e c c ula ,
,
ve , ve he ni
. xl r t t ge
di al ons t nt

sg iia t i h a Dr Bi e h ss be tmatre p rie a dt o ii ni c n itn wiht e
in fc n weg t s . xlr a u j c te x e t , n he pn o s o sse t t h
s
me c e de of r or ( 5 . The ALJ e i ty not t tt ç bove r i l
dial vi nce ec d. R. 21
xplcil ed ha he ç
a
esdua
f nc i ca ciy i m or lm ii t n opi t by t s a e a nc c ula asi i p o a es
' tonal pa t s
u
e i tng ha
ned o he t t ge y ons t nt t nco r t
t e de e of t c a m a ' rght el
he vi nc
he l i nt s i
bow i paim e ,w hi h de l
m r nt
c
ve oped a t t da e of t
fer he t
he

co ula ' opi on.' g 531
ns tnts ni ' R. .
N e ,t A LJ ga Dr Br n' m edi l s ce s a e e ltl w e ght a i w a not
xt he
ve . ow s
ca our t t m nt ite i
s t s

consse wih t medial e de e of rcor g 531 The ALJ alo g ve Dr
itnt t he
c vi nc
e d. R. .
s a
.
20

La ul- tago' undaed medi ls ces ae e ltl we ghta t r or onl r fe t one
ba tsan i s
t
ea our tt m nt ite i
s he ec d y e l c s
vii wih t dodor t û hor te menthit y doe notbolt t vaue oft s sae e s''
st t he
, he s t r at
s
sor
s
ser he l
he e t tm nt ,
t doc orssa e e wa ba e on t Aprl201 vii butwa sgne overa m ont lt r t
he t ' tt m nt s s d
he
i
5 st
s i d
h a e , he
opi ons ta e c pl t d on a c ck-i t f r w ih no r tonal t s
ni
l r om e e
he ls o m
t
a i e o uppor t opi d- o
t he
ne t
r t i tons' t r i no e a to a t w hy t t o f m s a e notcons s e w ih one a he ,
esr c i , he e s
'
xpl na i n s o
he w or
r
it nt t
not r
a t opi on i notcons s e w ih t e denc ofr or
nd he ni s
i t nt t he vi e ec d.

TheALJga t opi onsofDr Bui s asa ea nc ps hol c c ula , nd Dr
ve he ni
. ga , t t ge y yc ogial ons t nt a
.
Conge ,a s a e age y ps hol ca cons t nta t r ons de a i l ve ,sgnii ntw e g a
r tt
nc yc ogi l
ula t he ec i r ton e l i tca
i ht s

t e c n ul n sh v s b e tmatre p rie a d t o ii n a e c nsse twi t e rc r
h o s t t a e u j c te x e t , n he pn o s r o itn t h e o d
a
s
h
e d n e g 5 1 Th ALJg v t eo ii n o Dr Bu tlltl weg ta i wa v g ea d
vie c . R. 3 . e
a e h pn o f . kse ite ih s t s a u n
uncla ,and a de a a i n t tPl i ifi dia e i a is r s r e t t Comm iso .
er
ny clr to ha antf s s bl d s n s ue e e v d o he
s i ner

g 5 1 Fial,h ALJc n i ee t et id p rysae n fo Plitf ss o s a d fu d
R. 4 . n ly te
o sd rd h hr - a t ttme t r m an if p u e n o n
t ti doe notes a i h t tPl ntf i di a e
ha t s
t bls ha ai i f s s bl d.

TheALJf
ound t tPl i ifsva i GAF s e i t r or s d onl be gve ltl
ha antf
rous
cor s n he ec d houl y
i n ite

weg t a GAF' i o n t d s rb s e ii wo k rltd lmiains o o j ci me tl
ih s
S t o e cie p cfc r eae i tto r be t
d
ve na
a r ltes' S ualy do notr te tf toni ove 1 c i usm ont , a l onsder
bno ma ii , û
' us l
el c unc i ng r 2 ontnuo
hs' nd t i
'
c
ps hol i al s i la oc upa i lf toni w he e Soc alSec iy i pr m a iy conc m ed
yc og c , oc a nd c tona unc i ng
r as i
urt s i r l
e

wihoc upai f toni ' ( 5 .
t c tonal unci ng. R. 41
'
The ALJ f
ound t tPl ntf s a lga i ar no çf l c edi e' a t y a e notf l
ha ai if le tons e t çuly r bl ' s he r
uly

co rbor e byt me c e de ofrcor g 5 . TheALJnoedt Dr Gr n fund
ro atd he dial vi nce e d. R. 41
t hat . ee o

t a Plitf' s be tv rpo t wee n tc ro o ae b t e o j cie e a n to ,te
h t an ifs u j cie e rs r o or b rtd y h b e tv x miains h
phys ca e m i tons ha not s n t t Pl ntf ha difculy hol ng her hea up f
i l xa na i
ve
how ha ai if s f i t
di
d
or
di i s m us e s r ngt i t ne k,t tPl i ifdi nota t nd phys c t a a t rhe rght
m nihed
cl t e h n he c ha a ntf d
te
i al her py fe r i
21

el
bow s ge y,a t m e c e denc of r or doe not s
ur r nd he dial vi e
ec d
s
uppor t alege s vert of
t he l d e iy
Pl ntf sde es i a a e y a t 'ongiudi lr or r fe t l te t e ga a t t
ai if pr son nd nxit s he t t na ec d e l c s ong r am nt ps nd ha
l

( ai if rpo td doi weland t ts wa sa eon medi tons' g 54- . TheALJ
Pl ntfl e re ng l
ha he s tbl
cai . R. 551
'
alof
s oundt tPl n if sc e biiy wasdi i s a s hasç ovi d va i a ount ofhow
ha aitf r di lt
m nihed s he
û
pr de rous cc s

s ewa ij r d a d whe t pan o e. ( 5 1 Th ALJn td ta Plitf rp re h r
h s nu e n
n he i nst' R. 5 . e
'
o e h t an if e o td e
d p e so o e a trteMa c 2 3ij r , u s eh db e te td frd p e so p irt t a
e rsin nst fe h rh 01 n u y b t h a e n rae o e r sin ro o h t
tm eand r t d i i 1
i
epore t n 995.

The A LJ f t not d t tPl i i fha r pored t c t ts
urher e ha a ntf d e t wi e ha he

coul no do ya d wor ye s was t e t d i N ove be 201 f a r s t tw as t r ul of
d t
r
k, t he
r ae n
m r 4 or a h ha
he es t
Pl i ifdoi ya dw or 1
a ntf ng r
k. d.

TheALJne f t tPli ifha nopatr lva wor g 55 . TheALJnotdt t
xt ound ha antf s
s ee nt k. R. )
e ha
Pl i if was 46 yea s o1 on t alege diabiiy ons t dae.
antf
r d
he l d s lt
e t

The A LJ e a ne t t
xpl i d ha

Pli ifhasa l s ahi s hool
antf
t ea t gh c
educ ton a i a et comm uni t i Engls 1 TheALJ
a i nd s bl o
cae n
ih. d.

as e pan dta ta fr bl yo j bs lsi n t nis eb c u ePlitf ha n p s r lv n
lo x lie h t rnsea ii f o ki s o a su e a s anif s o a t ee a t
t
l
wo k. 1 TheALJc ude t t c i i Pl ntf' ag e ton,wo k e re e, nd
r d.
oncl d ha, onsderng ai ifs e, ducai
r xpe i nc a

RFC, h r a ej bst te iti sg fc n n mb r i t en to le o o ta Plitf c n
t ee r o ha xs n iniia t u es n h aina c n my h t an if a
pef m,i udi cla r mai clr and r i clr ( 55- . TheALJf t tt
ror ncl ng e ne , l ek,
outng ek. R. 561
ound ha he

v c t n l x e tstsi n wa c n itn wi t if r to f u di teDOT. ( 5 1
o ai a e p r' e t y s o sse t t he n omain o n n h
o
mo
h
R. 6 .
The ALJc ude t tPl n ifha notbe n unde a diabiiy snc J r 1 201 t oug
oncl d ha aitf s
e
r s lt i e anua y 6, 4, hr h
t da e oft dec s on.
he t
he i i
I .M O TI N S FO R SUM M AR Y JU D G M EN T
1
O

l herM oi frSummay J
n
ton o
r udgmen,Pli ifma t man agume t. g 221
t antf kes wo i r ns DE .
Fi s , he a gue t tt ALJ e r i f lng t cont tD r B u t lf cl r fc ton ofhi fndi
r t s r s ha he
r ed n aii o
ac . ks e or a ii a i
s i ngs
o or i a c ula i ps hol c e m i i
r derng ons t tve yc ogi al xa naton. 1 a pp.1 1 Sec
d. t
3- 7.
ond,Pl ntf a g s
ai if r ue
22

t tt ALJ e r d by notgi ng c r lng wei t t opi o offve ofPli tf ste tng
ha he
re
vi ontoli
ght o he ni ns i
a n if r a i
pr de s 1 a pp.1 20. l Def nda ' M oton f r Sum ma y J
ovi r . d. t
7n
e nts
i o
r udgmentwih Su
t ppori
tng

Memorndum ofLa a Re pons t Pl ntf M oton f Summa y J me ( 231 s
a
w nd s e o ai ifs i or
r udg nt DE , he
co e t tt ALJade t l de l d t r or r ga di Pli if sm e a i imen s
nt nds ha he
qua ey veope he ec d e r ng antf
nt l mpar t
a t t s t i medial e de
nd ha ubsantal
c vi nce s
uppors t ALJ' e ua i of t medialopi on
t he
S val ton
he
c
ni
evi nc
de e.
1 1 LEG A L A NA LY SI
1.
S

J calr vi oft f ct fndi i diabiiy ca e i lm ie t detr ni whe he
udi i e ew
he a ual i ngs n s lt s s s i t d o e mi ng
t r
t Comm isone ' de son i ûs
he
s i rs cii s iuppore by s t tale de e a ba e on pr r lgal
td
ubsan i vi nc nd s d
ope e
sa r . Subsa i l e de e i mor t n a s i il a i s h r l va e de e as a
t nda ds
t nta vi nc s
e ha
c ntla nd s uc e e nt vi nc

ra ona e pe s woul a e as a quae t s
e s bl ron
d cc pt de t o uppor a c uson. 42 U. C.j 405( ;
t oncl i '
'
S.
g)

Cr w o d v Co ' o c e . 3 3 F.d 1 5 ,1 5 ( 1h Ci.2 0 )( e c ra (nena
a f r . mm r fso .S c, 6 3 1 5 1 8 1 t r 0 4 p r u im) itr l
cttonomitd)(uoi fe sv Calahan,1 F. 1 1 ( 1hCi.1 ). Coursma
iai
te q tng wi . l
25 3d 436, 439 1 t r 997)
t y

n tû e ie te fcsa e r weg t e e ie e o s bsiue (h ilj g n f rt toft e
o t cd h a t n w, e ih h vd nc , r u ttt ter ud me t o ha h
d
g mmiso e l' Phli v Ba n a t ? 7 F.d 1 3 ,1 4 n.8 ( 1h Ci.2 0 )( u tn
co sin r. il . r h r, 5 3 2 2 2 0,
'
ps
1 t r 0 4 q oig
Bl worhv He klr 703F. 1 1 ( 1hCi.1 )
oods t . c e ,
2d 233, 239 1 t r 983).
The r t i tve s a r of r vi w s t out a
esr c i t nda d
e e e
bove a i onl t fndi of f c .
pples y o i ngs
at
pr s pto of va i t a t c t t C o m i soner s conc us ons of l . Br
e um i n
ldiy ta hes o he m s i '
l i
aw
own v Suli an,
. lv

921F. 1 1 ( 1h Ci.1 ) Mari v Sulian,89 F. 1 1 ( 1h Ci.1 )
2d 233, 236 1 t r 991 ; tn . lv
4 2d 520, 529 1 t r 990 .
Sl g
û- commisone 'jf l et a y t c rc 1w ort pr det r e ng c twih
-he
si rs aiur o ppl he ore t a
o ovi he eviwi our t
s f c e r s ng f de e m i ng t pr r l ga ana ys s has be c
uf i i nt ea oni or t r ni he ope e l l i
en onduc e m a t
t d nda es

rv ra. I g a v Co ' o o . e . mi.4 6F.d1 5 , 2 0( 1hCi. 0 7 ( u tn
e es l' n r m . mm r fs c S c Ad n, 9 3 2 3 1 6 1 t r 2 0 ) q oig
'
Cor lusv Sulian, F. 11 11 46( 1hCi.1 ).
nei . lv 936 2d 43, 45- 1 t r 991)
23

Socil Se urt r ultons e t bls a fve se s que i lanayss t a ve ata fnal
a c iy eg a i
sa ih i -t p e nta
l i o ni
i

deemi ton ofdia lt 20 C. R.j40 1 20 C. R.j41 920 ()(). TheALJmus
tr nai
s biiy.
F.
4.520;
F.
6. a-t
t
fr tde e ne whe hert c a m a i pr s nty e pl d. l s a fndi of non- s biiy i
i s t nni
t he l i nt s e e l m oye
f o, i ng
di a lt s

t he
ma a t i r c l . 20 C. R.j 404.520( . l t second sep,t ALJ must
de, nd he nquiy oncudes
F.
1 b) n he
d t nui whehe t cai nts f r fom a s ver i par nto c bi ton ofi im e s
e e ne
t r he l ma ufe s r
e e m ime r om na i
mpar nt.
l t ALJ fnds t t c am a doe not s f r fom a s ve e i im e or combi i of
f he
i
ha l i nt s
ufe r
e r mpar nt
naton

i ime s t n a fndi of non- sbiiy rs t,a t i r e . 20 C. R. j
mpar nt, he
i ng
dia lt e uls nd he nquiy nds
F.

4 4.5 0 Q.
0 12 (
St t e r uiest ALJt c
ep hre eq r he
o ompa et cl mantss veei r ts t t ei t
r he ai ' e r mpaiment) o hos n he

lsi ofi ime s 20 C. R.j40 1 d) s r P,a ndi 1 Cet ni ime sa e
itng mpar nt.
F.
4.520( , ubpa t ppe x . rai mpar nt r

s sv r ,wheh rc n iee ao eo i c n u cin wih ohe i ann n s ta,i t e a e
o e ee
te o sd r d ln r n o j n to t t r mp i e t, h t f h y r
esa ihed, t r ultons r r a fndi of dia lt wihout f t r i r i t t
t bls
he eg a i
equie
i ng
s biiy t
urhe nquiy n o he

cl ma ' a lt t pef ohe wor Se Gi onv He klr, F. 1 6,1 8,n.l( 1h
ai nts biiy o ronn t r k. e bs . c e 762 2d 51 51
1t
Ci.1 . I t i nue me t ore l a lsed i ime ,dia lt i pr s d a
r 985) f he mpai nt es quas it mpar nt sbiiy s e ume nd
be ft a ea r d. 20C. R.j404. 20( .
neis r wade
F.
15 d)
Stp f i ve a de e m i ton ofwhehe t c am a ' i im e spr ve hi or
e our nvol s
t r na i
t r he l i nts mpar nt e nt m
he fom pe f mi hi orhe pas r lvantwor I t cl mantc
rr
ror ng s
r t ee
k. f he ai
annotpe f m hi orhe pa t
ror s
r s

r lv n wo k t e a i f cec s o d sbit i e tbihe . 2 C. R. 4 4.5 0 e . Th
ee a t r ,h n prma a i a e f ia l y s sa ls d 0 F. j 0 1 2 ( ) e
i
bur n t n s fst t ALJt s
de he hit o he
o how a se fve t t de piet cai
t t p i ha, s t he l mantsi
' mpai nt ,he or
nne s
s i a et pe f wor i t na i
he s bl o r onn
k n he tonale no y i lghtoft cl m a ' RFC,a e
co m n i
he ai nt s
ge, duca i n,
to

a d wok e pein e 2 C. R.j 4 4.5 0 9;Ph lls 3 7 F.3 a 1 3 l o d r t
n
r x re c , 0 F.
0 12 4
il , 5
p
d t 2 9. n r e o
d tr n wh te t ecama t a tea ii t a j s t oh rwo ki t n to a e o o ,h
eemie eh r h li n h s h blt o du to te r n he ai n l c n my t e
y
A LJ m a e t r a y t M edi alV oc tona Gui lne ,20 C . R .pt 404 s .P,a z,o
y ihe ppl he
c
a i l de i s
F.
.
ubpt
pp. r
24

utlz t a ssa eofavoc tona e r. Se Phil s 357 F.3 a 1 40.
ii e he s it nc
a i l xpe t e li ,
p
d t 239A. W he he t ALJ a qua ey de l d t r or r ga di Pli tf s m e a
t r he
de t l
ve ope he ec d e r ng a n if
ntl
i pa nue s
m i nt
Pl i ifas e t t t i t sc e, ç s biiy r l ed t m en alhe t cn
a ntf s r s ha , n hi as idi a lt e at o
t
alh nnotbe de e m i d
t r ne
on t s r c d a t r a e w i y va yi ps hol c opi ons and t A LJ s d ha done
hi e or s he e r del r ng yc ogi al ni ,
he
houl ve

hi du y t deveop t r or 'by et r r ontctng Dr Bukse or or i a c ula i
s t o
l he ec d'
ihe ec a i
.
tl
derng
ons ttve

ps hol ca exa nai g 22 a pp.1 1 . Pli ifpoi soutt tt r or c ans
yc ogi l mi ton. DE
t
4- 51 antf nt
ha he ec d onti
onl ou da e non- xn i ng ps hol ca opi ons ot t
y t td
e m ni
yc ogi l ni
her han Dr Buks e ' . 1 a p. 1
.
t l s d. t
5.

Pl n ifa gue t t heALJs dno havegi n t opi onsoft non- xa ni Stt a ncy
aitf r s ha t
houl t
ve he ni
he
e mi ng a e ge
ps chol sst m os wei , r t rs d ha a ke Dr Bukse t eabor t a t s cii
y ogit he
t ght but a he houl ve s d .
t l o l ae s o pe fc
f tona lm ia i . 1 Pl ntf a guest tt e denc s
unc i l i t tons d. ai if r
ha he vi e howst tPli tf sme al at
ha a n if
nt he lh
de e i a e o r tm e,s ol opi ons s d not ha be r i d upon. I N e ,Pl i if
t ror t d ve i
o d ni
houl
ve en ele
d
xt a ntf

a s rs t tt ALJ i ope l i er e e Dr Bukse ' r por a c ry pike i o m ai
s e t ha he
mpr ry nt pr t d .
t ls e t nd he r c d nf r ton
f om i . 1 a pp.1 1
r t d. t
5- 6.

De e nta gue t tt ALJdi m e thi ba i oblga i ofdeveopi a f land f i
f nda r s ha he
d e s sc i ton
l ng ul
ar

rcodrga di Pli ifsme ali r s g 23a p. . Dee
e r e r ng antf' nt mpaiment. DE t 51 fndanta s rst tt ALJ
s et ha he
ha e
d nough i onua i t makear as bl de e m i ton r r ngPl i ifsdia lt sa us
nf
ton o
e ona e t r na i ega di
antf
s biiy tt ,
a r quied. 1 De e ntpoit outt tt ALJ r viwe hund e of pa ofr c ds
s e r
d. f nda
ns
ha he
e e d
r ds
ges
e or ,
i udi t e t e no esf om Pl i if st e tng ps hi r s s t r por sf m D r Buks e ,
ncl ng r a m nt t r
a ntf r a i
yc ati t , he e t or
.
t l and

t r pors fom t sa e age y ps hol ca c ulan s a t n ba ed hi de son on t
he e t r he t t
nc yc ogi l ons t t , nd he s
s cii
he
a quat l de oped r or l a p.6. Def nda m a n a ns t tt onl n bi uiy t tt
de e y vel
ec d. d t
e nt i t i ha he y m g t ha he

ALJ f
ound i Dr Bukse ' opi on wa whe he Pli tf woul ha difc t wor ng orwa
n .
t ls ni
s
t r a n if
d ve fi uly
ki
s
e ie y una e t w or Def nda m ai t ns t t t s l c of cl r t w a i m a e i . 1
ntr l
bl o
k;
e nt
n ai ha hi a k
a iy s m t ral d.

25

De e ntf t a s rst tthe r gul tonss ii aly pr de t tt abs nc ofa opi on
f nda urher s e t ha t e ai
t
pectc l ovi ha he e e n ni
r ar ng f tona lm iai doe not r r a medi l r por i om plt ' a t t t
eg di unc i l i t tons
s
ende
ca e t nc
e e' nd ha he
Sdee m i ton ofwhe he t ob a n a c ulai e
t tr na i
t r o ti
ons t tve xnmi i i dicr tona y' i c s s whe e
naton s s e i r ' n a e
r
t r i s f c en e de f t A LJt m ake a i onne de i i
he e s ufi i t vi nce or he
o
n nf
d c s on. 1 a p.7.
d. t

l r pl Pl i ifa gue t tt ALJdi notde op a f land f rr c d a he l he r
n e y, antf r s ha he
d
vel
ul
ai e or s l ry
c

p c e if r to fo Plitf te tn p o ie s u j tfa y ds o n e t e mao i o
ik d n o main r m an ifs raig r vd r , nusiibl ic u td h j rt f
y
t ero ii n , n rle o saea e c o no i a i r si l wa . ( 2 a p. 1
h i pn o s a d eid n tt g n y piins n n mpemisbe y' DE 5 t 1 .
'
The ALJ hasa ibasc o i ton t de l p a f la f rr c d,and mus de l t
l i blga i o ve o
ul nd ai e or
t veop he
m e c r cor f rt t evem ont prort t cl ma ' flng ofhe a ia i f dia lt
dial e d o he w l
hs i o he ai nts ii
r pplc ton or s biiy

b n ft. S t v Co ro c Se .5 F. p' 8 5 8 8( 1hCi. 01 )(iigElio v
e e is' mi . mm' fso . c, 01 Ap x 7 , 7 1 t r2 2 ctn l n .
'
h
s
Bar t35 F. 1 1 ( 1hCi. ) TheSoca Se trt rgultonssaei r e nt
nhar, 5 3d 272, 276 1 t r2003).
il ctiy e ai tt n elva
pa tt t i t c a m a ' e denc i i om pl t or i
r ha , f he l i nt s vi e s nc
ee
ncons s e ,t ALJ m a ne t t
it nt he
y ed o ake

a tona aci ,i l ng,butnotlm ied t r c a tng t ca ma ' medi ls c or
ddii l tons nc udi
i t o, e- ont c i he li nts
ca our e

as ng t cli ntt under a cons ttve e mi ton. 20 C. R.j 404.520b. df e
ki he ama o
go
ulai xa nai
F.
1
ç'
-h

a miitai lw j d eh sad t t d v lpt er c r wheea r p it b t sn trq ie t
d n sr t a u g a u y o e eo h e o d r pp o rae u i o e urd o
ve
or r a cons ttve exa i ton as l as t r cor c ans s fcint e denc f t
de
ula i
m na i
ong
he e d ont i ufi e vi e or he

a miitai lw j d et ma a i o dd cso . I g am v Co ro c S c Ad n,
d n sr t a u g o ke n nfnne e ii n' n r . mm' fso . e . mi.
ve
'
4 6 F.d 1 5 ,1 6 ( 1h Ci.2 0 )(iigDo ghy v Ap e,2 5 F.d 1 7 ,1 81( 1h Ci.
9 3 2 3 2 9 1 t r 0 7 ctn u t . f l 4 3 2 4 2 1 t r
2001)
).
S hie t A LJ ha a ba i dut t de op a f la f rr or t c ai an be r t
t l he
W
s
s c y o vel
ul nd ai ec d, he l m t a s he
bur n ofpr ng t the i di a ed, nd he i r po i e f pr
de
ovi ha
s s bl a
s es nsbl or oduc ng e de e i s
i vi nc n uppor ofhi
t
s

cam. Bic ofv Asr e No. 7 6 9 9 C1 2 0 W L 4 41 1 , t* 8( D. a Oc. , 0 8
li ' s h f . tu n 0 - 0 6 - V, 0 8
'
5 1 8 a 1 S. Fl. t9 2 0 )
(ii Elion v Bar t355F.d 1 1 ( t Ci. ) çI e l tngt ne esiy
ctng ls . nhar,
3 272, 276 11h r2003). 'n vauai he c st
26

f a r m a we a e gui d by ç he t r or r ve l e de ir ga whi r s ti
or e nd,
r
de
whet r he ec d e a s vi nta y ps ch e ul n

u fi s o ce rp eu ie' Br wn v Sh aa,4 F.d 9 1 9 5 ( 1h Ci.l 9 )(u tn
n al s r la rj dc .' o . all 4 3 3 , 3 1 t r 9 5 q o ig
me
'
Smihv Sch i r 677F. 8 830( lhCi.1 )
t . weke,
2d 26,
1 t r 982).
H e e t A LJ ga t opi ons of Dr Bui ,a s a e a ncy ps
r , he
ve he ni
. gas t t ge
ychol c l c ula ,
ogi a ons t nt
a Dr Conge ,a s a e age y ps hol ca c ula att r c i r ton l l s gnii a
nd .
r tt
nc yc ogi l ons t nt he e onsde a i eve , i f c nt

weg ta tec ns la t h v s be tmatre p rie a d teo no aec n itn wi te
ih s h o utn s a e u j c te x e t , n h piins r o sse t t h
s
h
rc d e de e. g 531 TheALJt n g t opi onofDr Bukse ltl weg . ( 541
e or vi nv R. .
he ave he ni
. tl ite iht R. .
The A LJ e a ne t tDr Buks elsopi on ç sva asi i unc ea wha Sr ubl t c a m a
xpl i d ha .
t ' ni ç gue t s l r
i
t t o e' he l i nt

woul ha i s wase pl d. 1 Ne , heALJf
d ve f he
m oye ' d. xt t
'
ound i t beç l ri t opi oni t t
t o l ea f he ni s ha
unc
s woul ha difc t fndi wor ort ts woul notbe a e t m ant i e pl e .
he
d ve fiuly i ng
k ha he
d
bl o i a n m oym nt'
'
1 Fi l t ALJ not d t ti he opi on t tt c a m a c d notm ai a n em pl ym e i
d. naly, he
e ha l
t
ni ha he l i nt oul
nt i
o nt s
t t untt a de a a i t tt c a m a i di a e The i s whet a cl i a i di a ed
an mno
o
cl r ton ha he l i nt s s bl d.
s ue
her a m nt s s bl
i a i s r s r e t t Com m i s one and s a opi on i e il d t no s gnii a wei .
s n s ue e e v d o he
si r
uch n ni s ntte o
i fc nt ght'
'
1
d.

W hie t ALJ di not t a pe t of Dr Bukse ' opi on whi c d have be
l he
d e wo s c s
.
t ls ni
ch oul
en
c e r r t s we e not c iialambi uii s The Cour fnds t t a f 1 a f r r cor wa
l a e , he e r
rtc
g te .
ti
ha
u1 nd ai e d s

d v lpe a t a teeween e i e tayg pswh c r s le i u f in s o ce rp eu ie
e eo d nd h t h r r o v d nir a
ih e utd n n ar e s r la rj d c
t Pli if M or over t ALJ' e l ton ofPli ifsme a i par ntwass ppo td by
o antf.
e , he
S va uai
a ntf
nt l m ime
u re
s t ntalr or evi nc - t no esand opi onsofD r .Fi c r N a ,Br n,a Sa de
ubs a i ec d de e he t
ni
s s he , m
ow nd ha o,
a Pl ntf f ie t c r y hi bur t s
nd ai i f a l d o a r s den o how t t a m en a he t i paim e c us d gr t
ha
t l alh m r nt a e ea er
f tona lm ia i t n t e a s s d by t A LJ.
' i l i t tons ha hos s es e
unc
he

27

B. W he he s t i e de e s
t r ubsantal vi nc uppors t ALJ S e ua i oft m e c lopi on
t he
' val ton
he di a
ni
e de e
vi nc
Pli if a gues t t Dr Gr n,PA Kr nz k,Dr La ul- nta a Dr Br
antf z
ha . ee
o e
. ba tsa i go, nd . own a1
l
pr de o ni t tûs w ed a co i t ntl veloflm ia i nsove m uli e ye r ' a t tt
ovi d pi ons ha tho
ns s e e
i tto
r
tpl a s ' nd ha he

ALJerdi gvngal fh o i o slteweg t g 2 a p 1 - 9 . Plitf c ne s h t
re n ii l o te pnin i l ih . DE 2 t p. 8 1 1 an if o tnd t a
t
t opi o oft f doc or a elcea l c it ntwih e h ot ra t m e c le de of
he ni ns he our t s r tl ry onsse
t ac he nd he di a vi nce

rc r ' s t ALJSC ee to o s v r ls pp re o no whl fvo ig n n e n n n
e od' o he ' t j ci n f e ea u o td piins ie a rn o -x mii g
,
r
opi o i sm pl not s ppore ' l a p. 1
ni ns s i y
u
td. d t
'
9. Pli if a tonaly as e t t t t
antf ddii l s rs ha he
non- xa i ng ps hol c lopi onswe e notba e on m uc ps
e m ni
yc ogi a ni
r
sd
h ychol c evi e a t t
ogial denc nd ha
t opi ons we e gi n wihou t bene i of Dr Buksels ne ops hol ca e mi ton
he ni
r ve
t t he
ft
.
t ' ur yc ogi l xa nai
fndi
i ngs. 1
d.
Def nda a gues t t ç ubs a i l e denc s
e nt r
ha t t nta vi e uppors t ALJ S dec s on t gi gr a e
s
t he
'
i i o ve e t r

weght t t rvi ng physcin' (ij opi ons t n t t uns
i o he e ewi
i a s sc ni ha o he uppore opi ons fom
td ni r
Pli ifsteai pr des' ( 23 a p.7 . Dee
antf r tng ovi r. DE
'
t 1 fndants ii aly ase t t tt ALJS
pectc l s rs ha he '

RFC fn igi s p o tdb t e ie c a t a t ALJp o e l rj ce tec nrr o ii n
i dn s u p re y he vd n e nd h the
r p ry ee td h o tay pn o s
of Dr . Gr e Br
s e n, own, a La ul- nta
nd ba tsa igo. I a pp.
d t

D e e nt c e
f nda ont nds t t
ha

Sb e a s t eALJp o e l rj ce tec nrr o i in fo Plitf ste tn a de a nng
t lc u e h
g
r p ry ee td h o tay p no s r m an if raig n x mii
s ce ,t A LJ was f e t gi s g fca w e gh t t opi on of t s a e a nc m e ca
our s he
r e o ve i nii nt i t o he ni
he t t ge y di l

c n utn,Dr .gijTh ma Bilr' 1 .a p.1 . De e d n a g s ta t ALJ dd n t
o s l t s sc o s x e. d t 1
a
'
fn a t rue h t he
i o
blndl r l on Dr Bi e ' opi on a not s t tt A LJ' R FC was bas on t e de e of
i y ey
. xl r s ni nd e ha he
S
ed
he vi nc
rc da i l
e or nd nc uded addii llm ia i f Pl i i fsr ghte bow i pa r e , hi h a os afe
tona i t tons or a ntf i l
m i m nt w c r e t r
D r Bi e i s hi o ni
. xl r s ue s pi on.

N e ,D e e
xt f ndan a g s t t t A LJ' fndi r r ng
t r ue ha he
S i ngs ega di

Pl i if s m e a lm ia i wer pr l ba e on t r cor e de e a t o ni oft
a ntf
nt l i t tons e opery s d
he e d vi nc nd he pi ons he

28

saea e c p y h l ia c n utn sa d t a t eALJp o ry rj ce t eo no fo Dr
tt g n y s c oogc l o s la t n h t h
r pel ee td h piin r m .
Buksel t c pe ti t a is r s r e t t Comm isone . f a pp. 11 1
t , i h raned o n s ue e e v d o he
whi
s i r' J. t
'
- 2.
D ef nda a g t tt A LJ a s r le i pa t o D r Buks els r por a f ry c r c e i d
e nt r ues ha he
l o e i d, n r , n .
t ' e t nd ail ha a t rze

i i hi de ii
t n s cson. I a p.1
d. t 2.
l r pl Pl n i f a g s t t t A LJ s d no ha gi c r lng or s t i
n e y, ai t f r ue ha he
houl t ve ven ontoli
ubsantal

weihtt t non- m i ng sa ea ncyps hol ca cons t nt a onenon- xa i ngsa e
g o wo
exa ni t t ge
yc ogi l
ula s nd
e m ni t t

a e c me ia c n utn wh n t y n v rte td Plitf. g 25 a p.2 . P an ifas
g n y dc l o s la t e he e e r ae anif DE
t ) litf lo
a s r s t tt A LJ s d ha gi Dr La t san i s opi on m or w e g be us he
s e t ha he
houl ve ven . baul- tago'
ni
e i ht ca e

k d t opporuniy t pr de a m uc mor up t dae a c
ç
ha he
t t o ovi
h
e
o t nd omplt pi t e of Pl ntf'
e e cur
ai ifs
lm iatonsa dia lt ' f a p.3. Pl ntf c endst tt t ac t tDr La ul- nta
i ti
nd s biiy. #. t
'
ai if ont
ha he l t ha . ba tsa igo
f
pr de hi opi on a s twhie afe t e l ton i ir l nthe e' and t tt doc o '
ovi d s ni
hor
l l r he vaua i s reeva
r'
ha he t r s
me c l s ce saemen i s
dia our t t
t s uppo td by t doc ors fndi a Pli ifs Aprl 3,2015
re
he
t ' i ngs t a ntf
i
a nt e . 1 a pp.3- Pl i if a g t tD r Bi er s opi on i notc r a e was
ppoi m nt d. t
4. a ntf r ues ha . xl '
ni s
or obor t d,

gi n wihout a exa i ton of Pl ntf a wihout l ul e 'Of Pl ntf s r c ds a
ve
t
n
m na i
ai if nd t
s lvi w'
f
ai if e or , nd
die ty co r di t t opi ons of Pl i if s t e tng phys ci ns. f a p. 4. Fi ly, w ih
r c l nt a c s he ni
a ntf r a i
ia
J. t
na l
t
r ga d t Pl ntf ' m e a lm ia i ,Pl ntf m ai ai t the he r ng t s i ony es a i he
e r o ai if s nt l i t tons ai i f nt ns ha r a i e tm
t bls d

t ts i lm ie i he a tvii a co r di t t ALJ' fndi t s c n pa tcpae i a
ha he s i td n r c i tes nd nta c s he
S i ngs hat he a rii t n
va i t of a tvii . 1 a p. 5. Pl ntf a s as e t t D e enda ha cied t t
rey
c i tes d. t
ai if l o s r s hat f
nt s t o he

ne ops hol c l e l ton by Dr Bukselt s
ur yc ogi a vaua i
.
t o uppor he a gument i he r s
t r r
s n r e pons ,but
e
De e ntha i e Pl ntf sps hol ca s r ni and Dr Bukse ' opi on t tPl ntf
f nda
s gnor d ai if yc ogi l c ee ng
.
t ls ni ha ai if
w oul ha t oubl bei ga nf l e pl d. 1 a pp.6d ve r e ng i uly m oye
d. t
7.

Th Elv nhCic i Co r o Ap asha e p an dta a ALJç yrj c teo iin
e e e t rut u t f pe l s x lie h t n
û ee t h pn o
ma
ofa phys c a when t e de s
ny
i in
he vi nce uppor sa c r r conc us on,' t tt A LJ i r quied
t ont a y
l i ' but ha he
se r
29

S o saewih pa tc a iyt we g hegi t dif e m e c lopi onsa t r s why.
l t t t riulrt he i ht
t
ves o fer nt di a ni
nd he ea ons
'
'

Mccl v.Bar t 1 Fe Appx.41 41 41 ( 1h Ci.2006 (ii Bl s t
oud
nhar, 66 d.
0, 8- 9 1 t r
) ctng ood worh

He ke ,7 3F.d 1 3 ,1 40( 1h Ci.1 8 ) S af r v Bo n 8 F.d2 , 7 ( 1h Ci.
c lr 0 2 2 3 2 1 t r 9 3 ; h ra z . we , 25 2 78 2 9 1 t r
1 7). Theopi on ofate tngphysca i tbe gve s tntalorconsdea eweg
98 )
ni
rai
iin l
mus
i n ubsa i
i rbl iht

u ls ço d c u e i s wnt t c nrr ' fc l 5 F.d a 1 4 û Gl o c u e' x ss
n e s g o a s ' s ho o he o tay. wg, 2 3 t 4 0. t o d a s 'e it
'
g
whe t d 1 te tng physcan' opi on wa notbolt e by t evi nc ( evi nce
n he: 1 ) rai
(
ii s ni
s
serd
he de e; 2) de
s
uppore ac r yfndi or()t te tngphyscan' opi onwasc us yori onsse
td ontar i ng; 3 he r ai
ii s ni
oncl or nc itnt
w ih t doc or s own m e c l r c ds' Phil s, 357 F. a 1 . I t A LJ de i s t
t he
t '
di a e or .
'
li
p
3d t 241 f he
c de o
di r ar t opi on ofa tea i phys c an, he A LJ m us cl a l a tc a e hi orhe r as f
s eg d he ni
r tng
ii t
t e r y r i ul t s
r e ons or
doi s I
ng o. d
D r Gr n a PA K r ek
. ee nd
onz
O n M a ch 21, 201 upon e m i ton of Pl i if r Gr n not d t t e r hi
r
3,
xa na i
a ntf ,D . ee
e ha ve yt ng
a
ppea e nor a e ptt tPl i i fsce vi lr nge ofm oton was de r as d t a 1pl ne w ih
r d m l xce ha a ntf
r ca a
i
ce e o 1 a s t

pai m idl a pal ton oft ce vi a s newa postvef mi m a t r si t bia e al
n l y, nd pa i
he r c l pi
s ii or ni l ende nes n he lt r

ta zi . ( 3 1 Dr Gr n di nos Pli if wih c r c sri and a f esal
rpe us R. 46 . . ee ag ed antf t e vial tan
ac /c p

c n u in g 3 1 Hen td ta Plitf ss be tv c mplit dd no c re p n t t e
o t so . R. 47 .
o e h t anif u j ci e o an s i t o r s o d o h
o j ci eciia tndn s 1 . Dr Gre t dPlitf t ts es o l r s o dt c n e v tv
b e tv l c l i ig . d
n
. e n ol anif ha h h ud e p n o o s r ai e
t e t e a pr c i d physca t r py. 1 D r Gr n de e ne t t Pl ntf s ac i t
r a m nt nd es r be
i l he a
d. . ee
t nni d ha ai if
tviy

s d bem odii d,a s s dnotlf ove fvepoundsorpus orpul ove 20pounds 1
houl
fe nd he houl
it r i
h
l r
. d.

Plitf a ans w P Da dKr n e o Aprl1 2 3,o ar- h c o t eij r g
anif g i a A vi o z k n i 2, 01 f r ec e k f h nu y. R.
3421 PA Kr e se mi tons dno c ngefom t M ac 21 201 e mi ton. I
.
onz k' xa nai howe
ha r he rh , 3 xa nai d.
PA Kr
onze f
k ound t tPl i t f ' ac i t s d be m odii d s t t s c d lf no m or t n
ha a n i f s tviy houl
fe o ha he oul i t
e ha

1 pounds ( 3 .
0
. R. 44)
30

Pl i ifpr e e t Davi K r ek,Dr G r en' phys c a s a s s a ,on M a 1 201
a ntf es nt d o
d onz
. e s
i i n' s it nt
y 3, 3.

( 3 1 Thephysc e mi ton di nots w a new is . l PA Kr knoe t t
R. 41.
ial xa nai d
ho ny
sues d
onze td ha
Pl i ifhad gote a CT s a oft br n,whi h w as ne tve,a a e ec r m yogr m t s a
a ntf
tn
cn
he ai
c
ga i nd n l t o
a e t nd

neve c
r onduci sudy ofhe l thand,whih wasne tve. ( 3421 PA Kr k a sd
ton t
r ef
c
gai R. .
onze dvie
Pli ift tt y wer r ng outofte mentoptonsand t ts c d ge a he opi on.
antf ha he
e unni
r at
i
ha he oul t not r ni

I Hen tdta Plitf ss be t c mpan so t ih dt eo j ciee a
d
o e h t anif u jci o lit uweg e h b e tv x m.
ve
The ALJ e i ty co i rd t opi on e de a gave Dr Gr e s (nd PA
xplcil nsdee he ni vi nce nd
. e n' a
Kr k')lmuli er titons'ltl weghta t y weeée
onze s s tpl esrci ' ite i s he r t mporr rsrci a i M a
t
ay e titons nd n y

201 Dr Gr e r e ed ( antfj t r ulr a tviy. ( 521 Thus t ALJ pr ry
3 . e n elas Pli if o eg a ci t ' R. .
'
, he
opel
e ane t thewa gi ng Dr Gr n' (nd PA Kr k')opi on ltl wei ta ceal
xpli d ha
s vi
. ee s a
onze s ni ite gh nd l ry
e a ne hi r i e f t tfndi
xpl i d s atonal or ha i ng.
Thus t onl r m a ni i s i w he he t A LJ ha good c us f no gi ng Dr
, he y e i ng s ue s
t r he
d
a e or t vi
.

Gr n' (nd PA Kr k') o ni co i rbl weght The ALJ ha good c us
ee s a
onze s pi on nsdea e i .
d
a e.
Gr n' a PA Kr k' e m i tons of Pl ntf r veae onl m idl de e e ce vca
ee s nd
onze s xa na i
ai if e ld y l y cr as d r i l

rngeofmoton a mi maltnde ne si t biaea ta zi ,Dr Gr n (nd PA Kr e
a
i nd ni e r s n he ltrl rpe us . ee a
onz k)
f
ound t tPl ntf c
ha ai ifs ompli sdi notc r s
ant d
or e pond t t c i ca fndi ,Dr Gr e no e t t
o he lni l i ngs . e n t d ha
c e v tve te t
ons r a i r a ment s d be efec i a PA Kr k r om mende t t Pl ntf ge
houl
f tve, nd
onze ec
d ha ai if t
a he opi on. Gi t s fndi , ti cl a t tD r Gr n' r t i tonsw e e no i t nded t
not r ni
ven he e i ngs i s e r ha . ee s es rc i
r t ne
o
be pe ne .
nna nt
Dr Laba t sa i o
.
ul- ntag

OnAprl3,201 Pl ntf s w Dr J eLa tsa i f t frta onl tme g
i
5, ai if a . os baul- ntago or he s nd y i . R.
4364 Pli ifs r d a 1 outof30 on a mi - ntlsae e m be us ofhe de e e
. antf co e
6
nime a tt xa ca e
r crasd
atnin a co e r ton. g 4371 Afe c ei a physca e m on Pli if Dr
te to nd nc ntai
R. . tr ompltng
i l xa
antf, .
31

La ul- i no e t te r hi wasnor a e ptf gi a y wea s s onda y t
ba tsantago t d ha ve yt ng
m l xce or ve wa
kne s ec
r o

p i ( 4 8 . He d tr n d t a Plitf s fee fo rdiulp t isa d c r a tn l
an. R. 3 1
eemi e h t anif u fr d r m a c o ahe n ap l u ne.
I He sa td Pl n if on c e va i mana m e t i l physc locc tona t a
d
tre aitf
ons r tve
ge nt o ncude
i a / upa i l her py

a prvenai mediaton f t pan. g 4381 The docor as f
nd e ttve
c i or he i R. .
t lo ound t tPl ntf s
ha ai if
m e y de i i wasmos lkey ca ed by de es i a a ey. I He ad s d Pli ift
mor fct
t i l us
pr son nd nxit d.
vie antf o
con i s ei a ps hi t i t
tnue e ng
yc a rs .

OnM a 29, 5, . ba tsa igoc ee aMedi lSo c Sttment( i l.
y 201 Dr La ul- nta ompltd
ca ure ae
Physca)

( 41 - 5 . He n td t a Plitf s fe e fo lmiain o mo e n o te a sd et
R. 4 41 )
oe h t anif u f rd r m i tto f v me t f h nn u o
p i a d t a s e c ud n tsa d f rln p ro s ( 41 1 Thed co o i d ta Plitf
an n h t h o l o tn o o g ei d . R. 4 .
o t r pne h t anif
c d not w o k on a r gul r ba i w ihout m i s ng m or t n t o da a m ont due t he
oul
r
e a ss t
si
e ha w
ys
h
o r
di a lte . 1 He a s f
s biii s d.
l o ound t tPl i i fc d nots oop orclm b,c d not sand f l
ha a ntf oul
t
i
oul
t
or ong
pe i oftm e c d onl oc as ona l lf orca r up t 1 pounds c d onl occ i ly us
rods i , oul
y c i ly i t
ry
o 0
, oul
y asona l e

he ha f rfnem a pulton,a c d onl oc asona l r s herl tand rg a ove he
r nd o i
ni a i nd oul
y c i ly aie
ef
i ht nns r r
s de s I Dr Laba tsa i go alo f
houl r . d
.
ul- nta
s ound t t Pli tf s pan wa bot e r m e a
ha a n if
i
s h xte
nd

s r,t ts ha t pe i cal ledownduet ftg ( di nots f how l , ndt t
evee ha he d o rodi ly i
o aiue but d
ay or
ong)a ha
s woul ne dt tkeuns he edbra pei durnga eghthourwor da g 41 .
he
d e oa
c dul e k rods i n i k y. R. 51
Dr La ul- ntago a s c plt d a s ond unda e M edial Sou c St t nt
. ba tsa i
l o om e e
ec
td
c
r e aeme

( h sc l. g 4 9 40 . The o l dfe e c s i te u d td v rin ae t a Dr
P y ia) DE 3 - 1
n y ifrn e n h n ae eso r h t .
La tsa igo rpled t tPli ifc d fe nty (ahe t n occ sonal us he ha
baul- nta e i ha antf oul rque l rt r ha
a i ly) e r nds
f fnema pulton,ha Pl ntf span lvelwassvee(ahert nexte a svee,and
or i
ni ai t t ai if i e
e r rt ha rme nd e r)
t tPl i ifdi no ha a r as
ha a ntf d t ve e onabl m e c lne d t le dow n. f
e di a e o i
J.
The A LJga D r La t san i go' unda e m e c s ce s a e e ltl w e g ast
ve . baul- t a s
t d di al our t t m nt it e i ht he
r co d onl r tec sone vi i w ih t doc or t is t r a m enthi t y doesno bol t rt va ue
e r
y el t
s t t he t , he t hor t e t
s or
t s e he l
32

oft s sae e s't dodor ssaeme ba e on t Aprl201 vii wa sg dove am ont
he e tt m nt , he
'
' t t nt s d he i
5 st s i ne
r
h
lt ,t opi o ta e c plt d on aehe k-itf m wih no r tonae t s
aer he ni ns sr om e e
c ls or
t
ai l o uppor t opi t
t he ned-o
r s rc i ,' he e i no e a ton ast w hy t t o f m sar notc i t ntw ih one anot r
e t i tons ' t r s
xpl na i
o
he w or
e
ons s e
t
he ,

a t o ni i notc itntwih t e de ofr cor 1
nd he pi on s
onsse
t he vi nce e d. d.
Once aga n t A LJ e i il ga D r La ul- nta s opi on ltl w e ght a
i he
xplc ty ve . ba t sa i go'
ni ite i
nd

e ai d wh a r quie The Cour fnds t t ALJha good ca e t gi t doc ors
xpl ne
y, s e r d.
t i hat he
d
us o ve he t '
o ni ltl weihtf t r as saed i t ALJ Sdecson. The Coul a s not t tt
pi on ite g or he e ons t t n he
'
ii
' lo es ha he
t
M edia Sour eStt m e sa ec e ryi onsse wihone a herandar a s i nsse wih
cl
c a e nt r l a l nc itnt t
not
e lo nco it nt t
Dr La ul- ntago' not a t ot rr c d e de e.
. ba tsa i s es nd he he e or vi nc
D r Br n
. ow

On M a 29,2015,Dr Evl Br c ee a M e c lSour e Sttme ( i l.
y
. yn own ompltd
dia
c ae nt Physca)
E 41 . Shenot t tPli ifhadner da
R. 61
ed ha antf
ve maget tc us dhe t ha pai a numbnes
ha a e r o ve n nd
s
r ditng down he rg a l ta a i o he handsa fnger .
a ai
r i ht nd ef nu nd nt r
nd i s

D r Br n opi d t
. ow
ne hat

Pl i ifcoul notwor o ar ulrbasswihou mi sng mor t n t da am on h duet he
antf
d
k n eg a
i t t si
e ha wo ys
t
o r
dia ltes I She a s f
s biii . d
lo ound t tPl ntf ha lm ia i sti sa ng,waki soo ng
ha ai if d i t tons itng, t ndi
l ng, t pi
a c i ng. 1 Dr Br wn c l d t tPl i ifc d fe nty lf orca r up t fve
nd lmbi
d. . o
onc ude ha antf oul r que l it
ry
o i
po
undsa c d onl oc sona l lh orca r up t 1 pounds c d neve us he ha f
nd oul
y ca i ly i
ry
o 0
, oul
r e r nds or
fne m a pul ton,c d onl oc asonal us he ha f g os m a pulton,c d onl
i
ni ai
oul
y c i ly e r nds or r s ni a i
oul
y
oc asonaly r i e he l f a m ove he s de ,a co d ne r r i e he r ght a m over he
c i l as r e t r
r r houl r nd ul ve a s r i
r
r

s de . 1 Dr Br
houl r d. . own a s f und t tPl i ifspan wa bot e r m e a s ve e t ts
lo o
ha antf
i s h xte
nd e r , ha he
ha t e e t herl asnee d,t ts ha t 1e dow n due t f tgue asne de a t ts
d o l va e
egs
de ha he d o i
o ai
e d, nd ha he

woul ne dt tkeunshe edbr a perodsdurnganeg - wor da ( 41 .
d e oa
c dul e k i
i
ihthour k y. R. 51
The A LJ ga Dr Br n' m e c ls c s a em e ltl wei a i was no c i t
ve . ow s di a our e t t nt ite ght s t
t ons sent
33

wi t eme ia e ie eo r c r ( 5 1 Sic teALJe plcty g v teo i in l t
t h d c l vd nc f e o d. R. 3 . n e h
h
x iil a e h p no i l
te
w e ghta e a ne w hy,t onl i s i w he he D r Br n' opi on w a i ons sen w ih
i
nd xpl i d
he y s ue s
t r . ow s ni
s nc i t t t

t e o j cie me ia e d n e a d Dr Br wn' o n ts a r s e c n u td p y ia
h b e tv
dc l vie c n
. o s wn o e he h o d ce h sc l
e mi i on Pl ntf. The Cour fndst tDr Br
xa natons
ai if
ti
ha . own' o ni wasi nsse . Ta ng
s pi on
nco it nt
ki
i t ac ounta loft r or evi nce whi h i s
no c
l
he ec d de , c s umm a i e i de ala ve and i dic s
rz d n t i bo
s s us ed
t o houtt s Or r t ALJ ha good c us t gi Dr Br n' o ni n ltl w e g o t
hr ug
hi de , he
d
a e o ve . ow s pi o ite i ht n he

basst ti wascon r dit d by t o he r c d evi nc
i ha t
ta c e
he t r e or
de e.
Dr Buks e
.
tl
A s e a ned above t A LJ opt d t gi t o ni of Dr Bui s a s a e a nc
xpl i
, he
e o ve he pi ons
. ga , t t ge y
ps hol i al c ulant and Dr C o r a s a e a ncy ps hol c c ula a t
yc og c ons t ,
. nge ,
t t ge
yc ogi al ons t nt t he

r c n ieain lv lsg iia t i h a tec ns la t h v s j c matre p rie a dt
e o sd rto e e, in tc n weg t s h o utn s a e ube t te x e ts , n he
opi onsar c itntwiht r or e de e. ( 53 . TheALJt nga t opi onofDr
ni
e onsse t he ec d vi nc R. 1
he ve he ni
.
Bukselltl we g a i wasva a unclar and a declr ton t tPli ifi dia edi a
t ite i ht s t
gue nd
e ,
ny
a a i ha antf s s bl s n

is r e v t t Commisone . g 5 . Si t ALJprpel expl ne t thewas
sue esr ed o he
s i r R. 41 nce he
o ry ai d ha
g vi Dr Bukselsopi on ltl we g a clary e ai hi r tonae f t tfndi t
i ng .
t ' ni ite i ht nd e l xpl ned s ai l or ha i ng, he
o y r m ani is i whehert ALJ ha good c e f notgi ng Dr Bukse ' opi on
nl e i ng s ue s
t he
d
aus or
vi
.
t ls ni
c i r bl w e ght
ons de a e i .
Fis ,opi ons on i s r e ve t t Com m i s one a e not e il t c r lng
rt
ni
s ues es r d o he
si r r
ntted o ontoli

weihto s cilsgnii a
g r pe a i tc nce. Se 20 C. R.jj 404.527d) ) 41 927( () De mme v
e
F.
1 ( (1, 6. d)1; no
.
ef e, he
Comm ',Soc Se Admi ,51 Fe App' 875,878 ( 1h Ci.201 . Ther or t A LJw as
r . c.
n. 8 d. x
1 t r 3)
no r quied t r l on Dr Buks els c us on t tPl ntf w a di a e
t e r o ey
.
t ' oncl i ha ai if s s bl d.
Se
cond, he ALJ pr r y f
t
ope l ound t tDr Buks elsopi on w a va a unc e ra i w as
ha .
t ' ni
s gue nd l a s t
i e a l i ons s e . O n M a 11 2015, r Lee H .
nt nz ly nc i t nt
y ,
D .
Buks elc pl t d a çpr i i r Re r .
t om e e û elm na y po t'
'
34

( 5 3 . DrBu tl pn dta t ea albee ie c r ie c n enst t anifc udh v
R. 7 ) . kse o ie h t h v ia l vd n e as d o c r ha Plitf o l a e
s ki ofc tve dior r ( 5751 Dr Bukselalo opi d t tçl t rs c r
ome nd ognii s de . R. . .
t s ne ha iolhe e onday
i l e t tc d alo c rbut t c tve i fi i y a ea e y, i see dit banc ,
nfuenc s ha oul s onti e o ognii ne tcenc r nxit pan, l p sur e
he rng l s and tr dnes . l i al o di fc tt know t w ha e ent i a be ng on m uli e
a i os ,
ie
s t s s fi ul o
o
t xt , f ny, i
tpl
m e c tons c d c r but t s e cog tve i fc enc ' I D r Buks elr c m e d
di a i
oul onti e o om
nii nefi i y. d
'
.
t e om nde

t tPli ifbee ua e fom aS ops hol c sa
ha antf
val t d r
t
neur yc ogial t ndpoi .
nt'
'
On Se e r2,201 Dr Bukse c
pt mbe
5, .
t l omplt hi lBre Pr i i r N e ops
eed s ç if elm na y ur ychol ca
ogi l

Re t' ( 5761 Dr Bukselnoed t Pli if a aed quie de ese 1 He
por. R.
'
. .
t t hat antf ppe r
t pr s d. d.
e a ne t tt s i s w ed a pa t r ofm a i ac a ltes ge r ly w ihi t l a r e t
xpl i d ha e tng ho
te n
ny nt t biii , ne a l t n he ow ve ag o

a r r nge a s m edefct t ta e g r l m id. 1 Dr Bukselnot dt tPl ntf ha
ve age a , nd o
i is ha r ene aly l d. .
t
e ha ai if d
s m e si pereve a i t nki t ndenc a s
o
lght s r tve hi ng e
y nd ome i f e y on s tdeay fe r a la
ne fcinc
hor l r e ec l nd
l
ong de a r c ton r ca l
l y e ognii e l.

H e a s no e t t Pl ntf m a m uli e i r s on a
l o t d ha ai i f de
tpl nt u i nd

r pe ii e r r a had de i t i t a ea of r di a e es i voc bul r ve ba
e tton r o s nd
tcis n he r s
ea ng nd xpr s ve
a a y, r l

s bolc a ta r a oni r hm pat r pe c pton,lf ha sm pl mot s e bia e a
ym i bsr ct e s ng, hyt
te n r e i e t nd i e
or pe d, lt r l
fne m o or dextrt smpl viua e c i f toni audio y c
i
t
e iy, i e s l xe utve unc i ng,
t r ompr he i of ve ba
e nson
r l
ma e i ,ver lfue y f phone c a c
t ral ba l nc or
mi nd once ualc es a ve ba c r t ton na ng.
pt
ut , nd r l onfon a i
mi

g 5 778 . Dr Bu se fu d ta t ee wa as e d n e o mo eae ia e ua y o
R. 7 - 1
. k tl o n h t h r s lo vie c f d rt n d q c f
e ani asmpl saeme he r a mide r sofconf i i calultng. ( 5781
xpli ng i e tt nt ad nd l ror
uson n c ai
R. .
Dr Bukselnextr t t tps hol c s r ni ofPl ntf r vea e e de e of
.
t
epored ha yc ogial c ee ng
ai if e l d vi nc
s ve e de e s on w ih s e s c de pr c i , s r a e y, a s r ho l s ne s
e r pr s i
t om ui i
eoc upatons eve e nxi t nd eve e pe e s s

rgadi t f ur ( 5781 Heexpli dt tPlitf ha ma notbl sr s s I Dr
e r ng he ut e. R. .
ane ha anif d ny a e tesor. d
.
Buks e c ude t te de e s e s e e ne ops hol c li pa nue . I H e f
t l oncl d ha vi nc how d el ct d ur yc ogi a m i nt d
ound
t t Pl n if s neur ps hol ca i fc e y i lke y m ulif t r al c ed by her s ve e
ha ai tf '
o yc ogi l nefi i nc s i l
t- ac o i , aus
e r
35

de e so a a ey, hr cpai se p dit ba e, i f tg a tr dnes ,a lf ea
pr s i n nd nxit c oni n, l e sur nc daytme a i ue nd ie s nd e t r
he i l s 1 Dr Bukself
arng os . d. .
t ound t r was no obvi e de e ofa t ofdeme i
he e
ous vi nc
ny ype
ntng
pr es . 1 He c uded t tPl i ifs ine ophysca i fi e y i lkey mosl due t
oc s d.
oncl
ha antf l ur
i l ne fcinc s i l
ty
o
non- ur ogi f c or 'a t tc i d ne ol c m oniorng mi bene s r I Dr
ne ol c a t s' nd ha ontnue ur ogial
t i
ght
ces a y. d
.

Buksel ne t tPli ifwoul lkel havetoubl bei ganf l e oye (tt tmeofhi
t opi d ha antf
di y
r e ng i uly mpl d a he i
s

rpo t,butt t i he de esi a ey a pai i ovedwihteame ,s c d posi y
e r)
ha, f r pr son, nxit nd n mpr
t r t nt he oul sbl
r t ' t w or 1
e ul o
n
k. d.
l he M o i a Repl Pl ntf poi s outt pori of t r por s t t s
n r ton nd
y, ai i f nt
he tons he e t ha uppo the
r r
di abiiy a i ton. I D e e nt s Res
s lt pplca i
n f nda '
pons s poi s out po tons of t r por s t t
e, he nt
ri
he e t ha
s
uppor t ALJ' de s on. The f c t t e c pa t c n f nd pa t of t opi on t t s ppor
t he
S ci i
a t ha a h ry a i
r s he ni ha u
t

t er ag me t i s p o to s mmay j d me til tae h w itr al i c n itn Dr
h i r u ns n u p r f u r u g n l r ts o n en l n o sse t .
us
y
Buksels opi o i . For e m pl Dr Bukse f
t ' ni n s
xa e, .
tl ound t tt Pl ntf e l ton s
ha he ai ifs vaua i howe a
d
pa t of m any i a t a ltes ge r ly w ihi t l a r t a a r nge a s e
tem
nt c biii , ne a l t n he ow ve age o ver ge a , nd om
detc t t ta e ge r ly m id a t tt r w a no obvi e de of a t ofdem e i
i is ha r ne a l l nd ha he e s
ous vi nce
ny ype
ntng
pr e s Y e ,he a s f
oc s . t
l o ound t tPl i ifwoul lkel ha toubl be ng ga nf l e pl d a
ha a ntf
d i y ve r e i
i uly m oye nd
t tnon- ur ogi f c or w e e c usng he ne ophys c li tc enc
ha
ne ol c a t s r a i
r ur
i a nefi i y.

Furhe m or ,Dr Bukse ' opi on i i
t r e .
t ls ni s nconsse wiht r cor e de e. not a
it nt t he e d vi nc The es nd
o ni ofDr .Fiche , a , nd Sa de a t sa eage y ps hol ca cons tnta ea l
pi ons
s s rN m a
ha o, nd he tt
nc yc ogi l
ula r l
a oddswih Dr Bukselsopi on. l s t ALJha g ca et gi Dr Bukse ' opi on
t
t .
t ' ni
n um, he
d ood us o ve .
t ls ni
ltl w ei ht
ite g .
N on- xa i nc Phvsci
e m ni
i ans

Fi ly, t r ar t a 1oft teai physca a
nal wih eg d o 1 he r tng
i ins bove t Co tfndst tt ALJdi
, he ur i ha he
d
no er i a s gni m or w e ghtt t opi onsoft s a e e i r t n t t opi ons ofs m e
t r n s i ng
e i o he ni
he t t xam ne s ha o he ni
o
36

oft teai physcins S ne al t mor c it ntamedialopi oni wih t r or as
he r tng
i a . l r ly,he e onsse
Ge
c
ni s t he ec d

awh l,te mo e weg twe wilgvet t tme ia o i o ' 2 C. R.j 4 4.5 7 c( )
oe h r i h
l i o ha d c l pnin. 0 F.
'
0 1 2 ()4 .
The opi on of a non- m i ng r vi w i phys c a i e tted t ltl w e ghta t ken a one,
ni
exa ni e e ng
i i n s n il o ite i
nd, a
l

doe not co tt e s tntal e de
s
nsiut ubsa i vi nce t s
o uppor a ad i sr tve de i i Swi e v
t n m nita i
c son. ndl .

Sulian,91 F. 222,226n. ( 1hCi.1 .
lv
4 2d
3 1 t r 990)
Thi Cour i no pe mitd t r wegh t e de . Howe ,t Co tdoesfnd t t
s
t s t r te o e- i he vi nce
ver he ur
i ha
t A LJ S de enni ton t t t s a e e m i r ' m e ca a ps hol ca opi o a e
he
' t na i ha he t t xa ne s
di l nd yc ogi l ni ns r

c n itn wi amao iy o t e me c le ie e o rc r ,s cfc ly t e MRIsa oh r
o sse t t
h
j rt f h dia vd nc f e o d pe iial h
' nd te
o jcie tss a d te fn igs o Dr.Fic e ,Nn S h d o Samo - aa Ac r n,
be tv e t n h i dn f s sh r m, a a e , l n Trjn, kema
Si on,a Gel n a PA Dar a,dicus ed su a,i c r c . Furhe ,t ALJ explcty
mps
nd wi nd
que s s
pr s or e t
t r he
i il
not t ther vi we t en ier or a t hi RFC as es mentwa s
ed ha
e e d he tr ec d nd hat s
s s
s uppore byt r co d,
td he e r

icu igo j ci efndn sa dme ia o i in .
n ldn b e tv i ig n dc l p no s
Addii l t ALJ di no r l on t e opi ons of t non- xa i ng phys c a
tonaly, he
d t ey
hos
ni
he
e m ni
i i ns

al
one. Fore mpl ,t ALJe i il a
xa e he
xplcty dded a tona lmia i t Pl i ifsRFC i lg of
ddii l i ttons o antf
n i ht
t f c t tPli ifsrghtebow i nnen deve ope afe t dat oft c ulantsopi on.
he a t ha antf i l
mpai t
l d tr he e he ons t ' ni
Thus t A LJdi notco m i e i a s gni m or w e g t t s a e e i r 'opi onst n
, he
d
m t nor n s i ng
e i ht o he t t xam ne s
ni ha
t t t e tng phys ci ns o ni ,e pe a l i a ca e s h a t sone w he e Pl i ifs m a
o he r a i
i a ' pi ons s ci ly n
s uc s hi
r a ntf aw ny
di f e doc or a s w doc or f s f w vi is
fer nt t s nd a
t s or o e
st.
I .CO N CLU SI N
V
O

I lgh oft f eg ng,i i he e ORDERED AND ADJUDGED t tt de son of
n i t he or oi t s r by
ha he cii

t Commisone i AFFI ED. Acc di y,Pli ifsM oinf SummayJ me (
he
si r s
RM
or ngl antf
to or
r udg nt DE
221 i hee DENI a Defnda ' Moton f Summar J me ( 23 i hee
s rby
ED, nd e nts i or
y udg nt DE ! s rby
G R ANTE D .
37

O R DE RED AN D A DJU D G ED i Cha be sa W e tPa m Be h,Pa m Be h Count
n
m r t s l
ac
l
ac
y,

W

- f b u r , 8.
a
Fl i t s z /d yo Fe r a y 201
orda, hi
. # - -'
/4
-

.

W I A M M A TTH W M AN
LLI
U nie St t M a s r t J
t d a es gi t a e udge

38