Burka v. Colvin

Filing 23

MEMORANDUM (Order to follow as separate docket entry)For the reasons discussed above, the Court concludes Plaintiffs appeal is properly granted. This case is remanded to the Acting Commissioner for further consideration consistent with this Memorandum. An appropriate Order is filed simultaneously with this MemorandumSigned by Honorable Richard P. Conaboy on 9/25/17. (cc)

UNITED STATES DISTRICT COURT
FOR THE MIDDLE DISTRICT OF PENNSYLVANIA
JOSEPH JOHN BURKA,

:
:CIVIL ACTION NO. 3:16-CV-2443
Plaintiff,
:
:(JUDGE CONABOY)
v.
:
:
NANCY A. BERRYHILL,
:
Acting Commissioner of
:
Social Security,
:
:
Defendant.
:
:
________________________________________________________________
MEMORANDUM
Pending before the Court is Plaintiff’s appeal from the
Commissioner’s denial of Disability Insurance Benefits (“DIB”)
under Title II of the Social Security Act and Supplemental Security
Income (“SSI”) under Title XVI.

(Doc. 1.)

Plaintiff filed

applications for benefits on December 15, 2014, alleging a
disability onset date of April 11, 2014.

(R. 19.)

After he

appealed the initial denial of the claims, a hearing was held on
March 29, 2016, and Administrative Law Judge (“ALJ”) Gerard W.
Langan issued his Decision on June 14, 2016, concluding that
Plaintiff had not been under a disability during the relevant time
period.

(R. 19, 34.)

Plaintiff requested review of the ALJ’s

decision which the Appeals Council denied on October 13, 2016.
1-6, 14-15.)

(R.

In doing so, the ALJ’s decision became the decision

of the Acting Commissioner.

(R. 1.)

Plaintiff filed this action on December 12, 2016.

(Doc. 1.)

He asserts in his supporting brief that the Acting Commissioner’s

determination should be reversed or remanded for the following
reasons: 1) the ALJ failed to explain the weight he assigned to the
opinion of Plaintiff’s treating pain management specialist; 2) the
ALJ failed to explain the weight he assigned to the opinion of
Plaintiff’s treating orthopedic surgeon; 3) the ALJ erroneously
failed to assign great weight to the opinion of Plaintiff’s
treating psychologist; and 4) the ALJ omitted credibly established
limitations from the hypothetical question posed to the Vocational
Expert.

(Doc. 18 at 3.)

After careful review of the record and

the parties’ filings, the Court concludes this appeal is properly
granted.
I. Background
Plaintiff was born on August 23, 1974, and was thirty-nine
years old on the alleged disability onset date.

(R. 32.)

He has a

high school education and past relevant work as an electrician and
carpet cleaner.
A.

(Id.)

Medical Evidence
The Court focuses on the medical evidence most relevant to

Plaintiff’s objections, that is evidence from his treating pain
management specialist and associates, his treating orthopedic
surgeon, and his treating psychologist.
1.

Pain Management Specialist

a.

Office Notes
Plaintiff was seen by Mikhail Artamonov, M.D., of Premier
2

Pain, Spine and Sports Medicine (“Premier”) from December 2013
through March 2016.

(R. 323-41, 422-65, 633-717.)

He was also

seen by Faizal Quereshi, P.-A.C., and other Premier providers
during this time.

(Id., R. 625-32.)

At his initial appointment on

December 3, 2013, Plaintiff explained to Dr. Artamonov that he
suffered a work injury in April 2010 when he fell off a platform
and into a hole.

(R. 323.)

He was immediately taken to the

hospital and examined but went back to work a week later.

(Id.)

His back pain continued to increase, he took some time off, and he
went back to lighter work until he was laid off in December 2011.
(Id.)

In September 2013, Plaintiff had a lumbar fusion at L5-S1

which took care of the pain that had radiated into his legs but he
continued to report mid-thoracic pain that radiated into his chest.
(Id.)

He told Dr. Artamonov that he gets occasional flare-ups of

the pain and he rated the spasms at 10/10 in pain.

(Id.)

In

general, he described his pain generally to be constant
stabbing/burning which was aggravated by prolonged walking,
standing, exercise, or stress.

(Id.)

Plaintiff reported that in

the past he had cortizone injections which helped minimally,
medication had helped moderately as had physical therapy and
chiropractic treatment, and he used a TENS unit at home which
helped.

(Id.)

His primary care provider had prescribed pain

medications, and Plaintiff said he visited Dr. Artamonov to take
over the management of his pain.

(Id.)
3

Physical examination

revealed the following:
Thoracic Spine: Increased tone in thoracic
paravertebral musculature. Tenderness to
palpation in thoracic spine. No masses,
scars, lesions noted.
Lumbar Spine: Well healed scar noted.
Palpation the lumbar facet reveals pain on
both sides at L3-S1 region. There is pain
noted over the lumbar intervertebral spaces
on palpation. Palpation of the bilateral
sacroillitis joint area reveals right and
left-sided pain, with slight hypermobile SI
joint. Palpation of the greater
trochanteric bursa on both sides reveals
mild tenderness. Lumbar paraspinal area
moderately tender to palpation. Anterior
flexion the lumbar spine is noted to be 50'.
Anterior lumbar flexion does not cause pain.
Extension of the lumbar spine is noted to be
10'. There is pain noted with lumbar
extension.
(R. 324.)

Dr. Artamonov diagnosed lumbago, thoracalgia, facet

joint syndrome, chronic thoracalgia (S/P work injury), history of
thoracalgia without having immediate residual pain, and secondary
myofascial pain syndrome.

(Id.)

Dr. Artamonov noted that he had a

lengthy discussion with Plaintiff and set out the following plan,
explaining that
[t]he patient will be a candidate for a
series of interventional diagnostic
procedures, including facet joint and nerve
blocks to identify the underlying pain
source. Once diagnosis is confirmed, the
patient will be a candidate for therapeutic
radiofrequency ablation of the appropriate
structure for long-lasting improvement. All
these options were discussed with the
patient. If the patient fails to respond to
the above approach, a series of therapeutic
epidural steroid injections can be performed
4

for palliative pain relief.
(Id.)

Dr. Artamonov prescribed OxyCodone and Diazepam.

(Id.)

On December 16, 2013, Dr. Artamonov decided to perform

facet

blocks due to Plaintiff’s presentation with severe mid-dorsal pain
and examination which showed severe tenderness over the T8-T10
facet levels.

(R. 325.)

On December 23, 2013, Plaintiff reported sixty percent midback pain improvement after the facet blocks but he complained of
severe low-dorsal pain.

(R. 326.)

Physical examination showed

severe tenderness with pain reproduction so Dr. Artamonov decided
to perform additional levels of facet blocks.

(Id.)

On December 30, 2013, Plaintiff noted improvement after the
December 23rd procedure but he continued to have severe tenderness
with pain reproduction.

(R. 327.)

confirmative facet blocks.

Dr. Artamonov performed

(Id.)

On January 7, 2014, Plaintiff reported to Dr. Artamonov that
the physical therapy and thoracic facet injections he had received
over the preceding month had helped to decrease his pain but he
continued to have mid thoracic pain that radiated into his chest
with occasional flare-ups and spasms that he rated at 10/10 on a
pain scale.

(R. 328.)

low back pain.

(Id.)

Plaintiff also complained of intermittent
Physical examination showed tenderness to

palpation of the thoracic and lumbar spine, anterior flexion of the
lumbar spine ten degrees and extension ten degrees with pain noted

5

on lumbar extension.

(R. 329.)

Plaintiff was directed to continue

physical therapy, compound cream, and TENS unit, and he was
scheduled for follow-up testing.

(Id.)

January 2013 EMG of thoracic spinal muscles showed evidence of
T5-T6 and T11-T12 thoracic radiculopathy.

(R. 701.)

In late January Plaintiff was seen by Mr. Quereshi and Dr.
Artamonov and reported that he had mostly mild mid-thoracic pain
with some low back pain and flare-ups with over-exertion.
332.)

Plaintiff wanted to decrease his pain medication.

(R. 330,
(Id.)

The plan was to decrease medication and continue multidisciplinary
pain management including interventional, pharmacological, and
physical therapies.

(R. 333.)

At his March 2014 appointment with Dr. Artamonov, Plaintiff
reported that he continued to go to physical therapy three days a
week and he believed it was helping.

(R. 336.)

He said he

continued to have flare-ups and muscle spasms occasionally as well
as some burning and tingling in his left leg hat could last for
days.

(R. 336.)

for pain.

Dr. Artamonov prescribed Gabapentin and Flexeril

(R. 337.)

On April 8, 2014, Plaintiff reported to Mr. Quereshi that he
continued to have flare-ups and muscle spasms in his lumbar and
thoracic regions mostly with activity, and the burning and tingling
his left leg could last for a few days.

(R. 338.)

He said the

Gabapentin made him feel tired and “like a zombie” and the over-

6

the-counter medications he had tried did not help to alleviate his
pain.

(Id.)

Plaintiff said he was otherwise doing fine.

(Id.)

Office records from this visit indicate that the CT of the lumbar
spine done in January 2014 showed mild central disc bulging at L5S1 and CT of the thoracic spine showed small osteophyte vs.
ossification of anterior longitudinal ligament at left paracentral
region of T8-9, contacting the ventral thecal sac.

(Id.)

In his

Review of Systems, Mr. Quereshi noted that Plaintiff admitted to
joint swelling of the left lower extremity, he denied muscle
wasting but admitted muscle weakness, pain, tenderness, night
cramps, and limitation of joint movements in the left lower
extremity.

(R. 338.)

Mr. Quereshi also noted pain to palpation of

the thoracic and lumbar spine and pain with lumbar extension.
339.)

(R.

Plaintiff was directed to continue his formal physical

therapy and rehabilitation program with subsequent transition to a
home exercise program, continue Flexeril but discontinue
Gabapentin, and he was prescribed a Butrans patch for pain.

(Id.)

On April 25, 2014, Pravin Patel of Premier saw Plaintiff for
extreme pain in the right forearm and he administered a lateral
epicondyle tendon injection.

(R. 441.)

On April 28th, Plaintiff saw Mr. Quereshi for follow-up of his
lumbar and thoracic pain.

(R. 442.)

Plaintiff reported continuing

muscle spasms in his thoracic spine as well as burning and tingling
in his right leg at times that could last for a few days but other

7

than that he was doing fine.

(Id.)

He said the Butrans patch

helped to take the edge off his pain and physical therapy was also
helping.

(Id.)

Physical examination showed pain on palpation in

the thoracic and lumbar spine and pain was noted on lumbar
extension.

(R. 443.)

Mr. Quereshi planned a continuation of

medications and therapy and noted that a function capacity test
would be scheduled.

(Id.)

In May 2014 Plaintiff had several diagnostic tests.

Dr.

Artamonov performed a nerve conduction study of the upper
extremities due to Plaintiff’s complaints of neck pain with
radiation to both upper extremities.

(R. 444.)

The study showed

no evidence of cervical radiculopathy or peripheral neuropathy.
(R. 445.)

X-rays done to assess right shoulder pain showed a

normal right shoulder.

(R. 446.)

Studies of the cervical spine

showed minimal 2mm retrolisthesis of C5 on C6 that did not change
with flexion or extension though flexion was slightly limited.

(R.

447.)
Mr. Quereshi saw Plaintiff for follow-up of his right elbow
epicondylitis on May 21, 2014.

(R. 448.)

He reported that he had

some relief from the injection but he still had pain.

(Id.)

Mr.

Quereshi noted that the repetitive movement performed in
Plaintiff’s work as an electrician was the cause of his problem.
(Id.)

He also noted that Plaintiff continued to wear a tennis

elbow brace and had been taking NSAIDs but had minimal relief.

8

(Id.)

Examination showed excruciating tenderness over the lateral

epicondyle above and below the elbow with painful pronation and
supination.

(Id.)

Mr. Quereshi’s recorded plan included

intraarticular injection if the pain worsened, formal physical
therapy once the pain was better controlled, and follow up with an
orthopedic surgeon.

(R. 449.)

On June 14, 2011, Plaintiff reported to Mr. Quereshi that he
continued to have muscle spasms in his thoracic spine but he felt
it was not as bad with the combination of medication and physical
therapy.

(R. 450.)

Plaintiff commented that although he had some

relief from pain, he thought it was partially due to “not doing
anything.”

(Id.)

Physical examination continued to show

tenderness to palpation in the thoracic and lumbar spine as well as
gait dysfunction.

(R. 451.)

On June 25, 2014, Plaintiff saw Dr. Artamonov with the chief
complaint of lumbar and thoracic pain.
to have disability forms filled out.

(R. 452.)
(Id.)

He also wanted

On exmamination Dr.

Artamonov found increased tightness and tone in the thoracic
paravertebral musculature and moderate tenderness to palpation,
pain with lumbar extension, and non-antlagic gait, (R. 453.)

He

assessed severe chronic cervical thoracic spinal pain, cervical
radiculopathy due to HNP, secondary myofacial pain syndrome, spinal
facet joint syndrome, lumbar post-laminectomy syndrome, and
significant functional disability.

9

(R. 453.)

August office visit notes indicate similar problems (R. 45455) and September notes show that Plaintiff reported a hard time
sitting for fifteen to thirty minutes but he felt his knee and
shoulder were better.

(R. 456.)

Mr. Quereshi found increased

tightness in thoracic paraertebral musculature T6-T10 with moderate
tenderness to palpation and palpation of the lumbar facet joint
produced pain.

(R. 457.)

was non-antalgic.

(Id.)

He also reported that Plaintiff’s gait
The plan included continuing to use the

lumbar support and TENS unit.

(Id.)

In October 2014, Plaintiff reported to Mr. Quereshi that he
had continuing pain in the thoracic and lumbar region, his pain
limited his daily activities, and his pain increased with extra
movement.

(R. 458.)

Plaintiff also said he had “intolerable

muscle spasms” in his thoracic spine.

(Id.)

Physical examination

showed increased tightness in the thoracic spine, anterior flexion
of thirty degrees, anterior flexion did not cause pain, lumbar
flexion of ten degrees with pain, positive slump test in right leg,
and slightly antalgic gait.

(R. 459.)

Mr. Quereshi noted that

Plaintiff may benefit from a function test to determine his level
of ability.

(Id.)

He opined “[a]t this time the patient is 100%

permanently partially disabled in terms of lumbar and thoracic
injuries.”

(Id.)

At his November follow up appointment, Plaintiff reported he
was no longer able to do activities such as sit and read to his

10

daughter and go for car rides because he had to take breaks to move
around after ten minutes.

(R. 460.)

Plaintiff also reported

muscle spasms in his thoracic spine “all the time,” and medication
and physical therapy made the pain more tolerable.

(Id.)

Plaintiff identified an increased pain level: where it was
ordinarily recorded to be 4-5/10 with medication (R. 442, 448, 451,
452-53, 455, 459), he reported a pain level of 6-8 with medication
(R. 461).

For the first time, Plaintiff reported depression due to

pain which he identified as 2/10.

(R. 461.)

Physical examination

was much the same as recorded in November but Plaintiff’s gait was
noted to be antalgic.

(Id.)

Plaintiff’s subjective reporting was the same in December and
Mr. Quereshi said the physical examination was unchanged from
November.

(R. 462-63.)

Mr. Quereshi’s plan included scheduling

Plaintiff for treatment with consideration towards disc
decompression, physiotherapy, soft tissue mobilization, active
release technique and/or acupuncture as indicated.

(R. 463.)

Plaintiff was to continued physical therapy and medication
management.

(Id.)

On January 7, 2015, Plaintiff reported to Dr. Artamonov that
he was experiencing “unbearable pain” in his left elbow as well as
low and mid-back pain.

(R. 464.)

He said he had not been able to

continue with massage and decompression due to insurance coverage
problems.

(Id.)

Mr. Quereshi ordered MRI of the lumbar spine and

11

elbow “to delineate any soft tissue pathology which could account
for the patient’s persistent and otherwise refractory pain
symptomatology.”

(R. 464.)

January 26, 2015, MRI of the lumbar spine showed postoperative
changes of prior posterior fusion of L5 and S1, minimal
degenerative changes of the lumbar spine with no significant spinal
canal stenosis or neuroforaminal narrowing.

(R. 703.)

At his February 4, 2015, office visit with Mr. Quereshi,
Plaintiff reported radiating pain in his low back that extended
into his right leg and caused numbness at times.

(R. 683.)

Lower

extremity sensory examination showed decrease on the right leg to
light touch and pinprick sensation using a pinwheel and antalgic
gait.

(R. 684.)

Examination of the lumbar spine showed bilateral

moderate tenderness, pain from the level of L2-L5, paraspinal
muscle spasm, positive slumb test bilaterally, and decreased range
of motion for flexion and extension (flexion of twenty degrees and
extension of ten degrees).

(Id.)

scheduling Left SIJ injections.

Mr. Quereshi’s plan included

(Id.)

February 17, 2015, EMG and Nerve conduction studies of the
lower extremities showed no peripheral neuropathy or lumbosacral
radiculopathy. (R. 695.)

An electrodiagnostic study of the same

date revealed no evidence of delayed nerve conduction throughout
the spinal nerve roots, spinal cord, or brain stem.

(R. 693.)

In April 2015, Plaintiff told Mr. Quereshi that his pain had

12

gotten worse over the preceding few weeks and he had constant pain
rated at 7/10 on average, which was aggravated by bending, lifting,
standing and sitting for prolonged periods and improved with
resting and medications.

(R. 677.)

In addition to the thoracic

and lumbar region pain, Plaintiff complained of excruciating pain
in his left elbow.

(Id.)

Mr. Quereshi noted that Plaintiff

appeared uncomfortable and moved constantly to find a more
comfortable position, he had bilateral moderate tenderness of he
lumbar spine with pain from L2-S1, paraspinal muscle spasm and
position slump test bilaterally.

(R. 678.)

Examination of the

thoracolumbar spine showed diffuse tenderness over the lower
thoracic and upper lumbar paraspinals, tenderness over the lower
thoracic facets at the T8-T12 and over the upper lumbar facet at
the L1 level bilaterally.

(Id.)

Mr. Quereshi also noted that

extension, lateral bending, and rotation of the thoracolumbar spine
appeared painful and limited, and range of motion of the
lumbosacral spine appeared to be restricted in all planes,
particularly in extension, lateral bending, and rotation.

(Id.)

Sensory exam was normal to light touch and gait was antalgic.
(Id.)

In his plan, Mr. Quereshi noted that Plaintiff presented

with pain that was axial in nature and facet loading testing was
positive on physical exam.

(Id.)

He commented that because of

Plaintiff’s severity of pain and failure to respond to more
conservative modalities he recommended Plaintiff to proceed with

13

right and left T8-L2 facet joint injections “as diagnostic
maneuvers toward delineating facetogenic pain generators . . . with
the intent to proceed with radiofrequency if these diagnostic
injections successfully offer the patient temporary relief.”

(R.

679.)
After receiving the facet blocks, Plaintiff reported on April
29, 2015, that he got 50% relief for a short period of time.
673.)
April.

(R.

Physical examination was similar to that recorded earlier in
(R. 674.)

After receiving additional injections, Plaintiff

reported on May 26, 2015, that he had 60% improvement afterwards
but he had severe pain the mid-dorsal area.

(R. 671.)

Physical

examination showed severe tenderness over identified facet levels
with pain reproduction so the decision was made to perform
additional facet blocks.

(Id.)

In June 2015, Plaintiff said the he had significant pain
reduction after the May 26th injections but that only lasted for a
few days and the symptoms gradually returned.

(R. 668.)

Plaintiff

requested that the procedures be repeated so he could continue with
daily functioning and decrease in pain.

(Id.)

Plaintiff noted a

different type of radicular pain that was excruciating and he had
been having great difficulty performing daily activities.
He also noted he had right elbow pain.

(Id.)

Physical examination

was similar to that recorded previously.

(R. 66.)

injections and testing were recommended.

(Id.)

14

(Id.)

Further

June 19, 2015 CR of the lumbosacral area showed straightening
of normal lordotic curve and orthopedic fusion at L5-S1.

(R. 689.)

On July 20, 2015, Plaintiff continued to report severe lumbar
and radicular leg pain as well as right elbow pain.

(R. 665.)

Plaintiff expressed a fear that he was regressing–-his ability to
function and complete activities of daily living had declined, he
was not sleeping well due to pain, the pain was aggravated by
movement and sitting for extended periods.

(Id.)

He said his

thoracic pain was severe due to spasms during which he was unable
to move.

(Id.)

Plaintiff also said he did not like the way he

felt when he took higher doses of pain medication and he got some
relief from medication but not enough to function properly.

(Id.)

While many aspects of the physical examination were similar to
those recorded previously, sensory exam was again decreased to
light touch and pinprick sensation on the right lower extremity,
gait was antalgic and Plaintiff was using a single point cane to
assist with ambulation, and he had swelling over the posterior
aspect of the right elbow with moderate pain to palpation and
decreased range of motion.

(R. 666.)

Mr. Quereshi recommended a

spinal cord stimulator trial because he had failed to respond to
interventional epidural injections, facet joing injections as well
as nerve blocks, and he had not responded with much relief of pain
with the use of non-opioid and opioid medications.

(R. 666-67.)

Mr. Quereshi also recommended further testing for his back and

15

radicular symptoms as well as PRP treatments for his elbow.

(R.

667.)
In August 2015, Dr. Artamonov noted that Plaintiff’s working
diagnosis and comorbidities of concern had been established and
documented in treatment reports and notes.

(R. 661.)

He also

commented on the need for a functional capacity evaluation to base
care on an evidence and outomes based approach.

(Id.)

On September 9, 2015, Plaintiff was seen by PA Joel Paradis of
Premier.

(R. 656.)

He recommended radiofrequency ablation of the

nerves for long-term pain relief.

(R. 657.)

Plaintiff saw Dr. Artamonov on October 29, 2015.

(R. 651.)

Physical examination showed severe tenderness over the T9-T12 facet
levels with pain reproduction.

(R. 651.)

administered facet joint nerve blocks.

Dr. Artamanov

(Id.)

He did so after

explaining Plaintiff’s previous treatment history.
The . . . patient has been treating in our
facility in the comprehensive pain management
program including interventional pain
management. To this point, the patient has
experienced significant dorsal pain that is
felt to be originating and in large part
associated with the listed diagnosis of disc
pathology, inflammatory radiculopathy, facet
syndrome and resultant inflammation and facet
imbridation.
(Id.)

Dr. Artamonov added that the decision to administer facet

blocks was based on a “reasonable degree of medical certainty and
in consideration of previous examinations and diagnostic workups.”
(Id.)
16

On November 2, 2015, Plaintiff reported to Dr. Armanotov that
he experienced 60% improvement after the nerve blocks but he had
severe mid-dorsal pain slightly higher than before.

(R. 650.)

Because physical examination showed severe tenderness with pain
reproduction over identified facet levels, Dr. Artamonov decided to
perform additional nerve blocks.

(Id.)

He repeated the history

and treatment rationale set out at the previous visit.

(R. 650,

651.)
On November 5, 2015, Plaintiff told Mr. Quereshi that the
blocks had helped his pain–-although he still felt “electrical
spasms” across his low back the overall pain was reduced by 50%.
(R. 647.)

He requested that the procedure be repeated.

(Id.)

Physical examination showed that Plaintiff was wearing a lumbar
brace; he had bilateral moderate tenderness in the lumbar region,
positive slump test bilaterally, and pain to palpation over the
lower thoracic and upper lumbar paraspinal muscles; multiple
trigger points were identified in the thoracic region; extension,
lateral bending, and rotations of the thoracolumbar spine appeared
painful and limited; and there was pain reproduced with lumbar
extension and positive lumbar facet loading.
assessment was similar.

(Id.)

December

(R. 644-46.)

On January 18, 2016, Plaintiff had radiofrequency ablation of
left T8-T11 facet joints.
reasons for the procedure.

(R. 643.)
(Id.)

17

Notes include Dr. Artamonov’s

The patient noticed good (over 75%) but
temporary improvement after the confirmative
Dx facet block. Therefore, the decision to[]
perform RF was made. . . . To this point, the
patient has experienced significant dorsal
back pain that are cyclic felt to be
originating and in large part associated with
the listed diagnosis of facet syndrome and
resultant inflammation and central symptoms.
RFA has been prescribed for the
treatment of axial (non-radicular) dorsal
pain and the following conditions exist:
- Severe pain limiting activities of daily
living for at least 3 months despite
conservative treatments (structured exercise,
physical therapy including active muscle
conditioning, activity modifications,
including lumbar orthotics, nonpharmacological managment - TENS and garment
application, pharmacological management,
etc.);
- Skeletal and neuro imaging studies confirm
that the principal cause of the axial low
back pain is not disc herniation, spinal
instability, fracture, malignancy, or spinal
stenosis;
- Within 6 months prior to the procedure, two
trials of diagnostic facet block injections
under flouroscopic guidance have been
performed and temporarily relieved at least
70% of the axial mid-back pain.
This determination is based on a reasonable
degree of medical certainty and in
consideration of previous examinations and
diagnostic workups. Medical necessity and
efficacy have been established.
(Id.)
On February 25, 2016, Plaintiff reported to Mr. Quereshi that
he experienced 50% pain reduction after the January 18th treatment
but the pain gradually returned and he again reported severe lumbar
and radicular leg pain.

(R. 637.)

18

Physical examination findings

were similar to those recorded previously.

(R. 638.)

Plaintiff

was informed that maximum efficacy of radiofrequency ablation may
take as long as six to eight weeks.

(R. 639.)

He was encouraged

to use ice packs, heating pads, gentle stretching and other
conservative modalities.

(Id.)

Plaintiff also received a left

lateral epicondyle injection for treatment of elbow pain.

(Id.)

On March 9, 2016, Dr. Artamonov again performed radiofrequency
ablation.

(R. 636.)

He identified the need for the procedure and

noted that he would repeat the procedure on the opposite side in
two to three weeks.

(Id.)

On March 16, 2016, Dr. Artamonov administered paravertebral
muscle injections to treat Plaintiff’s severe residual pain and
numbness as indicated by physical examination.
b.

(R. 635.)

Opinion Evidence
On April 29, 2014, Dr. Artamonov completed a Medical Source

Statement in which he opined that Plaintiff could sit for zero to
two hours with the need for “micro breaks every fifteen minutes”;
he could stand/walk for a total of two to three hours with
alternating between sitting and standing every fifteen minutes; he
could rarely lift less than ten pounds, occasionally lift ten
pounds, and never lift more than that; he could rarely use his
upper and lower extremities for pushing/pulling; pain from his
treatments that was occasionally severe enough to interfere with
concentration needed to perform even simple work tasks; he would

19

likely be absent from work more than four days per month due to his
impairments; he experienced fatigue due to treatment which could
have implications for work activity; and his assessment was
supported by MRI, CAT, radiculopathy, and chronic exacerbations.
(R. 429-30.)
In a Pain Assessment form dated June 11, 2014, Mr. Quereshi
identified Plaintiff’s diagnoses, the sources of his pain, the
clinical and laboratory findings which supported the diagnoses, and
measures taken to alleviate pain.

(R. 705-08.)

He noted that

Plaintiff’s impairments were expected to last more than twelve
months, he was not a malingerer, and his physical symptoms were not
greater than what would be expected for the known physiological
mechanisms.

(R. 705, 708.)

He assessed limitations similar to

those found by Dr. Artamonov in April.

(See R. 709-11.)

In October 2014, Mr. Quereshi opined “[a]t this time the
patient is 100% permanently partially disabled in terms of lumbar
and thoracic injuries.”

(R. 459.)

Mr. Quereshi’s March 23, 2016, Medical Source Statement of
Ability to Do Work-Related Activities (Physical) found similar
lifting restrictions as well as findings that Plaintiff could
sit/stand/walk for ten minutes at a time and he could sit for a
total of three hours, and stand/walk for a total of two hours each;
he needed a cane to ambulate; and he could occasionally climb
stairs and balance but he could never climb ladders or scaffolds,

20

stoop, kneel, crouch, or crawl.
2.

Orthopedic Specialist

a.

(R. 626-30.)

Office Notes
Paul L. Kuflik, M.D., was Plaintiff’s treating orthopedic

specialist at Mount Sinai in New York.

(See, e.g., R. 376.)

Prior

to the September 2013 fusion surgery, Dr. Kuflik noted that he had
made clear to Plaintiff that the surgery would not change his
thoracic spine pain where he had multiple disc herniations and he
thought Plaintiff would have a hard time getting back to work after
surgery.

(Id.)

At a post-surgery follow-up visit in November 2013, Dr. Kuflik
recorded that Plaintiff was doing well with regard to his surgery
but he continued to have spasms in the thoracic spine probably
related to disc herniations and degenerative disc disease.
371.)

(R.

He recommended that Plaintiff follow up with a pain

management doctor.

(Id.)

In February 2014, Dr. Kuflik noted good surgical results but
found numerous other problems including thoracic pain, neck pain,
and tennis elbow.

(R. 370.)

In May he again recorded Plaintiff’s

complaints of thoracic spine pain and noted that Plaintiff was
continuing with pain management.

(R. 369.)

In October 2014, Plaintiff reported to Dr. Kuflik that he
continued to have thoracic pain and some right lower extremity
numbness which Dr. Kuflik though could be related to the disease at

21

4-5.

(R 368.)

Dr. Kuflik noted that Plaintiff was to continue

with his pain management doctor.
b.

(Id.)

Opinion Evidence
In a May 29, 2014, Medical Source Statement of Ability to Do

Work-Related Activities, Dr. Kuflik assessed that, in an eight-hour
day, Plaintiff could sit for zero to two hours, stand/walk for two
hours; he could occasionally lift less than ten pounds, rarely lift
ten pounds, and never lift more than that; he could rarely use
upper and lower extremities for pushing/pulling; his pain would
occasionally interfere with focus and concentration to perform even
simple tasks; and he would be absent more than four days per month
due to his impairments.

(R. 420-21.)

On June 23, 2014, Dr. Kuflik completed a Spinal Impairment
Questionnaire.

(R. 414-19.)

found previously.

His assessments were similar to those

(R. 416-17.)

He noted that Plaintiff’s symptoms

would frequently interfere with attention and concentration and he
would need to take unscheduled breaks two to three times a day.
(R. 418.)

Dr. Kuflik opined that Plaintiff’s symptoms would likely

increase if he were placed in a competitive work environment, he
noted that Plaintiff was not a malingerer, he would likely be
absent from work more than three days a month due to his
impairments and his assessments applied as far back as June 3,
2013.

(R. 418-19.)

22

3.

Mental Health Specialist
Plaintiff was treated by Christopher Barker, Ph. D., who

provided an opinion regarding Plaintiff’s Mental Abilities and
Aptitudes Needed to Do Unskilled Work on March 21, 2016.
24.)

(R. 623-

Dr. Barker opined that Plaintiff was unable to meet

competitive standards in his ability to perform at a consistent
pace without an unreasonable number and length of rest periods.
(R. 623.)

He also found Plaintiff seriously limited in the

following abilities/aptitudes: maintain attention for two-hour
segment; sustain an ordinary routine without special supervision;
complete a normal work day or work week; accept instructions and
respond appropriately to criticism from supervisors; and deal with
normal work stress.

(Id.)

Dr. Barker explained that Plaintiff

would have difficulty working at a regular job on a sustained
basis: “Medication and pain, complicated by depression, will result
in distractibility and irritability[;] [l]imited movement creates
frustration and difficulty focusing.”

(R. 624.)

He opined that

Plantiff would miss more than four days per month due to his
impairments or treatments.

(Id.)

B. ALJ Decision
ALJ Langan issued his Decision on June 14, 2016.

(R. 19-34.)

He found that Plaintiff had the severe impairments of status-post
lumbar fusion, degenerative disc disease of the lumbar spine,
lumbar stenosis, bilateral epicondylitis, depression, and anxiety

23

which did not alone or in combination meet or equal the severity of
a listed impairment.

(R. 21-22.)

ALJ Langan assessed Plaintiff to have the residual functional
capacity (“RFC”) to perform sedentary work except that he had to be
afforded the opportunity to alternate between
sitting and standing every thirty minutes.
He must avoid unprotected heights and
dangerous moving machinery. The claimant can
never climb ladders, ropes, and scaffolding.
He can frequently climb ramps and stairs.
The claimant can occasionally tolerate
exposure to extreme cold temperatures,
wetness, and vibration. He is limited to
simple, repetitive tasks with few workplace
changes. The claimant can have occasional
interaction with the public, co-workers, and
supervisors.
(R. 23.)
Regarding the providers identified above, ALJ Langan
recognized that Dr. Artamonov stated in a Medical Source Statement
essentially that Plaintiff was not able to work due to significant
limitations.

(R. 24-25.)

He noted that Mr. Quereshi’s Medical

Source Statement limited Plaintiff to less than a full range of
sedentary work.

(R. 25.)

He did not identify the weight due Dr.

Artamonov’s opinion in that he did not mention the opinion in his
review of opinion evidence.

(R. 31.)

ALJ Langan assigned no

weight to Mr. Quereshi’s opinion in the treatment records that
Plaitniff is temporarily or totally disabled and his Medical Source
Statement, stating that
his statement that the claimant is
temporarily or totally disabled are not a
24

full functional analysis and not supported by
the objective physical findings including no
neurological deficits. Further, he is not an
acceptable medical source and while he is
another source deserving of consideration,
his exertional demands regarding
sitting/standing/walking and the postural
activities are too restrictive given the lack
of neurological deficits.
(R. 31.)
ALJ Langan assigned some weight to Dr. Kuflik’s June 2014
opinion, finding it “too restrictive for the exertional demands
regarding functions involving sit/stand/walk given his full motor
strength.

The remainder of the opinion is fairly consistent with

the residual functional capacity.
by the record.”

(R. 31.)

Absenteism is also not supported

The ALJ also gave some weight to Dr.

Kuflik’s May 2014 opinion but stated that “the exertional
limitations again are far too restrictive based on the overall
clinical picture.”

(Id.)

Regarding Dr. Barker’s opinion, ALJ Langan gave it no weight
because it was not consistent with the overall record of rather
benign mental status examinations in his own examinations and
records.

(Id.)

Because ALJ Langan found that Plaintiff had the RFC to perform
jobs that were available in significant numbers in the national
economy, he concluded that Plaintiff had not been disabled during
the relevant time.

(R. 32-34.)

25

II. Disability Determination Process
The Commissioner is required to use a five-step analysis to
determine whether a claimant is disabled.1

It is necessary for the

Commissioner to ascertain: 1) whether the applicant is engaged in a
substantial activity; 2) whether the applicant is severely
impaired; 3) whether the impairment matches or is equal to the
requirements of one of the listed impairments, whereby he qualifies
for benefits without further inquiry; 4) whether the claimant can
perform his past work; 5) whether the claimant’s impairment
together with his age, education, and past work experiences
preclude him from doing any other sort of work.

20 C.F.R. §§

404.1520(b)-(g), 416.920(b)-(g); see Sullivan v. Zebley, 493 U.S.
521, 110 S. Ct. 885, 888-89 (1990).

1

“Disability” is defined as the “inability to engage in any
substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for
a continuous period of not less than 12 months . . . .” 42 U.S.C.
§ 423(d)(1)(A). The Act further provides that an individual is
disabled
only if his physical or mental impairment or
impairments are of such severity that he is not
only unable to do his previous work but cannot,
considering his age, education, and work
experience, engage in any other kind of
substantial gainful work which exists in the
national economy, regardless of whether such
work exists in the immediate area in which he
lives, or whether a specific job vacancy exists
for him, or whether he would be hired if he
applied for work.
42 U.S.C. § 423(d)(2)(A).
26

If the impairments do not meet or equal a listed impairment,
the ALJ makes a finding about the claimant’s residual functional
capacity based on all the relevant medical evidence and other
evidence in the case record.

20 C.F.R. § 404.1520(e); 416.920(e).

The residual functional capacity assessment is then used at the
fourth and fifth steps of the evaluation process.

Id.

The disability determination involves shifting burdens of
proof.

The initial burden rests with the claimant to demonstrate

that he or she is unable to engage in his or her past relevant
work.

If the claimant satisfies this burden, then the Commissioner

must show that jobs exist in the national economy that a person
with the claimant’s abilities, age, education, and work experience
can perform.

Mason v. Shalala, 993 F.2d 1058, 1064 (3d Cir. 1993).

As set out above, the instant decision was decided at step
five of the sequential evaluation process when the ALJ found that
Plaintiff could perform jobs that existed in significant numbers in
the national economy.

(R. 32-33.)
III. Standard of Review

This Court’s review of the Commissioner’s final decision is
limited to determining whether there is substantial evidence to
support the Commissioner’s decision.

42 U.S.C. § 405(g); Hartranft

v. Apfel, 181 F.3d 358, 360 (3d Cir. 1999).
means “more than a mere scintilla.

Substantial evidence

It means such relevant evidence

as a reasonable mind might accept as adequate to support a

27

conclusion.”

Richardson v. Perales, 402 U.S. 389, 401 (1971); see

also Cotter v. Harris, 642 F.2d 700, 704 (3d Cir. 1981).

The Third

Circuit Court of Appeals further explained this standard in Kent v.
Schweiker, 710 F.2d 110 (3d Cir. 1983).
This oft-cited language is not . . . a
talismanic or self-executing formula for
adjudication; rather, our decisions make
clear that determination of the existence vel
non of substantial evidence is not merely a
quantitative exercise. A single piece of
evidence will not satisfy the substantiality
test if the Secretary ignores, or fails to
resolve, a conflict created by countervailing
evidence. Nor is evidence substantial if it
is overwhelmed by other evidence–particularly certain types of evidence (e.g.,
that offered by treating physicians)–-or if
it really constitutes not evidence but mere
conclusion. See [Cotter, 642 F.2d] at 706
(“‘Substantial evidence’ can only be
considered as supporting evidence in
relationship to all the other evidence in the
record.”) (footnote omitted). The search for
substantial evidence is thus a qualitative
exercise without which our review of social
security disability cases ceases to be merely
deferential and becomes instead a sham.
Kent, 710 F.2d at 114.
This guidance makes clear it is necessary for the ALJ to
analyze all probative evidence and set out the reasons for his
decision.

Burnett v. Comm’r of Soc. Sec., 220 F.3d 112, 119-20 (3d

Cir. 2000) (citations omitted).

If he has not done so and has not

sufficiently explained the weight given to all probative exhibits,
“to say that [the] decision is supported by substantial evidence
approaches an abdication of the court’s duty to scrutinize the

28

record as a whole to determine whether the conclusions reached are
rational.”
1979).

Dobrowolsky v. Califano, 606 F.2d 403, 406 (3d Cir.

In Cotter, the Circuit Court clarified that the ALJ must

not only state the evidence considered which supports the result
but also indicate what evidence was rejected: “Since it is apparent
that the ALJ cannot reject evidence for no reason or the wrong
reason, an explanation from the ALJ of the reason why probative
evidence has been rejected is required so that a reviewing court
can determine whether the reasons for rejection were improper.”
Cotter, 642 F.2d at 706-07.

However, the ALJ need not undertake an

exhaustive discussion of all the evidence.

See, e.g., Knepp v.

Apfel, 204 F.3d 78, 83 (3d Cir. 2000).
A reviewing court may not set aside the Commissioner’s final
decision if it is supported by substantial evidence, even if the
court would have reached different factual conclusions.

Hartranft,

181 F.3d at 360 (citing Monsour Medical Center v. Heckler, 806 F.2d
1185, 1190-91 (3d Cir. 1986); 42 U.S.C. § 405(g) (“[t]he findings
of the Commissioner of Social Security as to any fact, if supported
by substantial evidence, shall be conclusive . . .”).

“However,

even if the Secretary’s factual findings are supported by
substantial evidence, [a court] may review whether the Secretary,
in making his findings, applied the correct legal standards to the
facts presented.”

Friedberg v. Schweiker, 721 F.2d 445, 447 (3d

Cir. 1983) (internal quotation omitted).

29

Where a claimed error

would not affect the outcome of a case, remand is not required.
Rutherford v. Barnhart, 399 F.3d 546, 553 (3d Cir. 2005).

Finally,

an ALJ’s decision can only be reviewed by a court based on the
evidence that was before the ALJ at the time he or she made his or
her decision.

Matthews v. Apfel, 239 F.3d 589, 593 (3d Cir. 2001).
IV. Discussion

Plaintiff asserts that the Acting Commissioner’s determination
should be reversed or remanded for the following reasons: : 1) the
ALJ failed to explain the weight he assigned to the opinion of
Plaintiff’s treating pain management specialist; 2) the ALJ failed
to explain the weight he assigned to the opinion of Plaintiff’s
treating orthopedic surgeon; 3) the ALJ erroneously failed to
assign great weight to the opinion of Plaintiff’s treating
psychologist; and 4) the ALJ omitted credibly established
limitations from the hypothetical question posed to the Vocational
Expert.
A.

(Doc. 18 at 3.)

Treating Physician Opinions
Plaintiff contends the ALJ erred by not reviewing Dr.

Artamonov’s opinion, by failing to explain the weight assigned Dr.
Kuflik’s opinions, and by assigning no weight to Dr. Barker’s
opinion.

(Doc. 18 at 5-12.)

Defendant responds that substantial

evidence supports the ALJs assessments of medical source opinions.
(Doc. 19 at 17-26.)

The Court concludes this claimed error is

cause for remand.

30

Under applicable regulations and the law of the Third Circuit,
a treating medical source’s opinions are generally entitled to
controlling weight, or at least substantial weight.2

See, e.g.,

Fargnoli v. Halter, 247 F.3d 34, 43 (3d Cir. 2001) (citing 20
C.F.R. § 404.1527(c)(2); Cotter v. Harris, 642 F.2d 700, 704 (3d
Cir. 1981)).

Sometimes called the “treating physician rule,” the

principle is codified at 20 C.F.R. 404.1527(c)(2), and is widely
accepted in the Third Circuit.

Mason v. Shalala, 994 F.2d 1058 (3d

Cir. 1993); see also Dorf v. Brown, 794 F.2d 896 (3d Cir. 1986).
The regulation addresses the weight to be given a treating source’s
opinion: “If we find that a treating source’s opinion on the
issue(s) of the nature and severity of your impairment(s) is wellsupported by medically acceptable clinical and laboratory
diagnostic techniques and is not inconsistent with the other
substantial evidence in your case, we will give it controlling
weight.”

20 C.F.R. § 404.1527(c)(2).3

“A cardinal principle

2

A new regulation regarding weight attributed to a treating
source affects claims filed after March 27, 2017. For claims filed
after March 27, 2017, 20 C.F.R. § 404.1520c eliminates the treating
source rule. In doing so, the Agency recognized that courts
reviewing claims have “focused more on whether we sufficiently
articulated the weight we gave treating source opinions, rather
than on whether substantial evidence supports our decision.” 82 FR
5844-01, 2017 WL 168819, *at 5853 (Jan. 18, 2017). This case,
based on claims filed on December 15, 2014 (R. 19), is not affected
by the new regulation and is to be analyzed under the regulatory
scheme cited in the text.
3

20 C.F.R. § 404.1527(c)(2) states in relevant part:
Generally, we give more weight to opinions from
31

guiding disability eligibility determinations is that the ALJ
accord treating physicians’ reports great weight, especially when
their opinions reflect expert judgment based on continuing
observation of the patient’s condition over a prolonged period of
time.”

Morales v. Apfel, 225 F.3d 310, 317 (3d Cir. 2000)

(citations omitted); see also Brownawell v. Commissioner of Social
Security, 554 F.3d 352, 355 (3d Cir. 2008).

In choosing to reject

the treating physician’s assessment, an ALJ may not make
“speculative inferences from medical reports and may reject a
treating physician’s opinion outright only on the basis of

your treating sources, since these sources are
likely to be the medical professionals most
able to provide a detailed, longitudinal
picture of your medical impairment(s) and may
bring a unique perspective to the medical
evidence that cannot be obtained from the
objective medical findings alone or from
reports of individual examinations, such as
consultative examinations or brief
hospitalizations. If we find that a treating
source's opinion on the issue(s) of the nature
and severity of your impairment(s) is wellsupported by medically acceptable clinical and
laboratory diagnostic techniques and is not
inconsistent with the other substantial
evidence in your case record, we will give it
controlling weight. When we do not give the
treating source's opinion controlling weight,
we apply the factors listed in paragraphs
(c)(2)(i) and (c)(2)(ii) of this section, as
well as the factors in paragraphs (c)(3)
through (c)(6) of this section in determining
the weight to give the opinion. We will always
give good reasons in our notice of
determination or decision for the weight we
give your treating source's opinion.
32

contradictory medical evidence and not due to his or her own
credibility judgments, speculation or lay opinion.”

Morales, 225

F.3d at 317 (citing Plummer v. Apfel, 186 F.3d 422, 429 (3d Cir.
1999); Frankenfield v. Bowen, 861 F.2d 405, 408 (3d Cir. 1988)).
The review of ALJ Langan’s Decision set out above indicates
that he did not provide any explanation for not assigning
controlling weight to Dr. Artamonov’s opinion.

Pursuant to the

legal framework within which the analysis of opinion evidence is to
be assessed, it was error for the ALJ not to review the opinion
and/or explain weight assigned.

Defendant’s attempt to minimize

this error is unavailing (see Doc. 19 at 18-19 & n.6) in that she
cannot do what the ALJ was obligated to do in the first instance.
See, e.g., Fargnoli v. Massanari, 247 F.3d 34, 42, 44 n.7 (3d Cir.
2001).
To the extent Defendant argues that the opinions of Dr.
Artamonov and Mr. Quereshi are the same and the ALJ properly
discounted Mr. Quereshi’s opinion (id. at 19 & n.6), the Court
cannot conclude that ALJ Langan properly discounted the opinions of
Mr. Quereshi.

The ALJ does not point to any medical support for

his conclusion that the lack of neurological deficits undermines
treating source findings.

(See R. 31.)

Particularly given Dr.

Artamonov’s detailed explanation of findings supporting the need
for radiofrequency ablation and consistent problems noted on
physical examination by all Premier providers, it appears that ALJ

33

Langan substituted his lay opinion for that of providers.

In the

face of treating source opinions based on “continuing observation
of the patient’s condition over a prolonged period of time,” see
Morales, 225 F.3d at 317, the type of speculative inferences found
in the ALJ’s decision could not be considered substantial evidence
in support of his conclusion that Premier providers opinions are
due no weight.

Id.

On this basis, remand is required for further consideration of
Premier treating provider opinions.

In the course of the

assessments, recognition that Mr. Quereshi provided valuable
treatment and evaluation is required although he was not an
acceptable medical source at the time Plaintiff filed this claim.4

4

For claims filed prior to March 27, 2017, CRNPs and PA-Cs
were not “acceptable medical sources.” See 20 C.F.R. § 404.1502.
The importance of information from CRNPs and PA-Cs is indicated in
the definitional change for claims filed on or after March 27,
2017, which includes these practitioners in the definition of an
“acceptable medical source.” See 20 C.F.R. § 404.1502(a).
Importantly, at the relevant time Mr. Quereshi was considered a
medical source, and, as such, evidence related to his treatment and
physical examinations are to be considered in evaluating the
opinion of a medical source and in making the determination as to
whether the individual is disabled. SSR 06-03p, 2006 WL 2329939,
at *4. Earlier, SSR 06-03p highlighted the relevance of evidence
from these practitioners in evaluating impairment severity and
functional effects:
With the growth of managed health care in
recent years and the emphasis on containing
medical costs, medical sources who are not
‘acceptable medical sources,’ such as nurse
practitioners[, and] physician assistants,
have increasingly assumed a greater
percentage of the treatment and evaluation of
functions previously handled primarily by
34

Similarly, further evaluation of Dr. Kuflik’s opinions is
required because the cursory assessments of the opinions, which are
consistent with those of the treating pain specialist, do not
satisfy the ALJ’s obligation of explaining his analysis.
Finally, upon remand the ALJ should consider Dr. Barker’s
opinion in conjunction with the opinions of treating sources.

Dr.

Barker based his assessed limitations on problems associated with
Plaintiff’s pain and medications.

(R. 624.)

Thus, just as the

Court has concluded the ALJ’s determinations regarding treating
providers Kuflik, Artamonov, and Quereshi are deficient, further
explanation is needed for the rejection of the consistent opinion
of Dr. Barker.
B.

Credibly Established Limitations
Plaintiff avers that the ALJ erroneously failed to include

limitations assessed by treating providers and a consultative
examiner in the hypothetical questions posed to the Vocational
Expert.

(Doc. 18 at 14-16.)

Defendant responds that the ALJ

included all credibly established limitations.

(R. 26-28.)

The

Court concludes that this claimed error is cause for remand,
particularly in light of the findings regarding the ALJ’s
consideration of treating source opinions.
The Third Circuit Court of Appeals has held that to accurately

physicians and psychologists.
SSR 06-03p, 2006 WL 2329939, at *3.
35

portray a claimant’s impairments, the ALJ must include all
“credibly established limitations” in the hypothetical.

Rutherford

v. Barnhart, 399 F.3d 546, 554 (3d Cir. 2005) (citing Plummer v.
Apfel, 186 F.3d 422, 431 (3d Cir. 1999)).
Insofar as the providers whose records are set out above were
specialists (and their associates) who treated Plaintiff over an
extended period, the ALJ must do far more than he has done to show,
by substantial evidence, that the limitations identified by them
were not credibly established within the legal framework provided
by the regulations and the Third Circuit Court of Appeals.
The reconsideration required regarding treating source
opinions which are clearly based on extended and extensive
treatment of Plaintiff’s back impairments and his elbow impairment
must encompass a thorough explanation of what limitations
identified by them are found not to be clearly established and what
medical evidence supports the finding.

Therefore, further

consideration of this claimed error is not warranted at this time.
V. Conclusion
For the reasons discussed above, the Court concludes
Plaintiff’s appeal is properly granted.

This case is remanded to

the Acting Commissioner for further consideration consistent with
this Memorandum.

An appropriate Order is filed simultaneously with

this Memorandum.
S/Richard P. Conaboy
RICHARD P. CONABOY
United States District Judge
DATED: September 25, 2017
36