United States District Court, D. New Hampshire
A. DICLERICO JR. UNITED STATES DISTRICT JUDGE.
Gruhler seeks judicial review, pursuant to 42 U.S.C. §
405(g), of the decision of the Acting Commissioner of Social
Security, denying her application for disability benefits
under Title II the Social Security Act. Gruhler moves to
reverse on the grounds that the Administrative Law Judge
(“ALJ”) erred in weighing opinion evidence, in
considering her impairments, and in failing to find that she
is disabled. The Acting Commissioner moves to affirm.
reviewing the final decision of the Acting Commissioner in a
social security case, the court “is limited to
determining whether the ALJ deployed the proper legal
standards and found facts upon the proper quantum of
evidence.” Nguyen v. Chater, 172 F.3d 31, 35
(1st Cir. 1999); accord Seavey v. Barnhart, 276 F.3d
1, 9 (1st Cir. 2001). The court defers to the ALJ's
factual findings as long as they are supported by substantial
evidence. § 405(g); see also Fischer v. Colvin,
831 F.3d 31, 34 (1st Cir. 2016). Substantial evidence is
“more than a mere scintilla.” Richardson v.
Perales, 402 U.S. 389, 401 (1971). When the record could
support differing conclusions, the court must uphold the
ALJ's findings “if a reasonable mind, reviewing the
evidence in the record as a whole, could accept it as
adequate to support his conclusion.” Irlanda Ortiz
v. Sec'y of Health & Human Servs., 955 F.2d 765,
769 (1st Cir. 1991) (internal quotation marks omitted).
applied for social security benefits in June of 2014 when she
was sixty-one years old. She completed the twelfth grade in
school and had previously worked as an electronics inspector
fall in August of 2012, Gruhler was examined in the emergency
room at Concord Hospital. Despite tender spots along her
spine, Gruhler's strength, sensation, and gait were
normal. A CT scan and xrays showed were negative. A second
review of her xrays showed “a non-displaced proximal
scaphoid wrist fracture.”
began physical therapy in September of 2012, because of
constant head and neck pain, back pain, and short-term memory
problems. At an appointment in October of 2012, Gruhler's
right ankle was swollen after a two-mile walk. Gruhler was
referred to a foot doctor because of right ankle pain.
Ronald Resnick noted swelling in Gruhler's foot and
ankle. Gruhler explained that when she hurt her wrist in the
August fall she also injured her ankle. Dr. Resnick noted
that x-rays did not show a fracture but put Gruhler in a
removable cast boot. A CT scan of Gruhler's ankle on
October 11, 2012, “showed a tiny avulsion type fracture
at the tip of the lateral malleolus with focal soft tissue
swelling.” At subsequent appointments Gruhler continued
to complain of right ankle pain.
also began physical therapy for her ankle. The physical
therapist noted that Gruhler had exceeding hypersensitivity
in the ankle and was concerned about potential Complex
Regional Pain Syndrome (“CRPS”). Dr. Resnick
referred Gruhler to pain management.
continued to have pain in her wrist following the fall. Dr.
Mollano recommended that she use a stimulator and wrist
November of 2012, Gruhler continued to complain of pain in
her ankle and continued to wear the boot, although she was
told she did not need the boot. Dr. Resnick told Gruhler to
take off the boot and “to push through the pain.”
Dr. Resnick believed that Gruhler's pain was due to CRPS
because nothing was structurally wrong with her ankle.
occupational therapist, Paul Bonzani, evaluated Gruhler's
wrist pain in November of 2012. He concluded that her pain
suggested CRPS and planned a therapy program to control pain
and increase her function.
saw Dr. James Mirazita in December of 2012 for pain
management related to her ankle. Dr. Mirazita diagnosed
myofascial pain syndrome and scheduled a right lumbar
sympathetic block. Dr. Resnick saw Gruhler in January of 2013
for reevaluation of her ankle. Dr. Resnick noted that there
was no structural cause for the pain Gruhler claimed.
Davis Clark evaluated Gruhler's back pain in January of
2013. He found that Gruhler had tenderness at some spinal
points but not others and that her range of motion in her
legs and hips was limited. Gruhler's neurological
examination of her legs was normal.
Mirazita did nerve blocks in February and March of 2013,
which improved Gruhler's pain level and mobility. During
his examinations between January and July of 2013, Dr.
Mirazita found that Gruhler was not in acute distress, her
neck and back ranges of motion were normal, no evidence of
spasms, and no pain due to facet joint disease. Her arm and
leg ranges of motion were also normal, except for a reduced
range of motion in her right ankle. Gruhler's ankle pain
reduced to two out of ten by July of 2013.
Clark found minimal lumbar spine tenderness in April of 2013.
During physical therapy, the therapist noted that Gruhler
continued to be very limited in her functioning because of
her “right ankle fracture.” Dr. Mirazita noted
that Gruhler had increased ankle pain with walking.
September of 2014, Gruhler reported worsened ankle pain. Dr.
Russell Brummett noted that Gruhler had a difficult time
standing and walking but was in no acute distress, her
cervical range of motion was intact, motor testing on her
legs was normal and she was walking with a stable upright
gait. Dr. Mollano diagnosed Gruhler with bilateral carpal
tunnel syndrome in October of 2014.
Peter Loeser did a consultative examination of Gruhler on
October 2, 2014. Based on Gruhler's records, Dr. Loeser
noted early degenerative disease in the lumbar spine. He
found on examination that Gruhler was in no apparent
distress, had normal cervical range of motion, no tender
points on spinal palpation, and no spasms. The examination of
her thoracic spine was also normal. Gruhler had mild
tenderness in the lower lumbar areas. Dr. Loeser found that
Gruhler had normal range of motion and strength in her arms
and legs with no pain. She had mild pain in her right ankle.
Dr. Loeser found that Gruhler had a normal ability to sit,
stand, get on and off the examination table, squat, and walk.
had an MRI of the lumbar spine the week after her examination
with Dr. Loeser. Dr. Brummett examined Gruhler in mid-October
and found that the MRI indicated only mild degenerative
changes. He noted that it would be reasonable for Gruhler to
try exercise and therapy, although Gruhler found it
exacerbated her issues. Dr. Brummett recommended chiropractic
treatment and a physiatrist.
John MacEachran assessed Gruhler's functional capacity on
October 21, 2014. He found that Gruhler could do work at the
light exertional level and could occasionally do postural
activities. Gruhler saw Dr. Sarah Glover on October 25, 2014,
who found on examination that Gruhler was tender over lower
back muscles but had normal strength in her ...