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Byron v. Saul

United States District Court, D. New Hampshire

August 14, 2019

James A. Byron
Andrew Saul, Commissioner Social Security Administration



         James Byron challenges the denial of his application for disability insurance benefits pursuant to 42 U.S.C. § 405(g). He contends that the Administrative Law Judge (“ALJ”) committed reversible errors at steps three through five of the sequential analysis required by 20 C.F.R. § 404.1520. The Commissioner, in turn, moves for an order affirming the ALJ's decision. I deny Byron's motion and affirm the Commissioner's decision.

         I. BACKGROUND

         A. Procedural Facts

         Byron is a 52-year-old man with high school education. He worked as an HVAC technician for fifteen years. He alleged disability as of October 2015, due to a torn tendon in his right arm, right ulnar nerve transposition at elbow, carpal tunnel syndrome, diabetes, a herniated disc in the neck, sleep apnea, and a brain tumor.

         Byron's application was initially denied in February 2017. On October 25, 2017, he testified at a hearing before ALJ Thomas Merrill, who ultimately denied Byron's claim. See Tr. 17-28. The Appeals Council denied his request for review in June 2018, rendering the ALJ's decision the final decision of the Commissioner. See Tr. 3-8. Byron now appeals.

         B. Medical Evidence

         In March 2015, Byron suffered a work-related injury to his right elbow while carrying a tall ladder. After doing light-duty work for the next several months, he stopped working in October 2015.

         Between July 2015 and April 2017, Byron underwent four surgeries to his right arm. After an MRI showed a partial tear of the extensor muscles in that arm, Dr. Richard Choi performed a right epicondyle debridement and partial tendon excision. Tr. 262, 298. Byron had occupational therapy post-surgery. See Tr. 380-89.

         When Byron continued to complain of pain and clicking in his right elbow, Dr. Choi performed a second surgery, a right radiocapitellar anterior capsulectomy, in October 2015. Tr. 260. Following the surgery, Byron did a second round of occupational therapy. Tr. 352-78.

         In April 2016, Dr. Choi performed a third surgery on Byron's right arm, a right ulnar nerve transposition, after an EMG showed ulnar nerve neuropathy. Tr. 258, 450. Byron again underwent occupational therapy. May and June 2016 occupational therapy records noted that he was restricted from performing heavy activities with his right arm, but that he remained independent in personal care activities, with some limitations in more demanding activities such as camping. Tr. 336.

         At a follow-up visit in June 2016, Dr. Choi noted that Byron reported pain over his right ulnar nerve, but that his sensation and elbow motion were intact. Tr. 266-67. Later that month, Dr. Choi's only clinical finding was radial tunnel pain. Tr. 264-65. Byron's elbow motion was unremarkable and there were no other sensory or motor problems. Id.

         In September 2016, Byron presented to his primary care physician, Dr. Elias Nabbout, requesting sleep medication and a referral to a second orthopedic surgeon. Tr. 309-10. Dr. Nabbout observed normal sensation and motor strength, with no abnormalities of the extremities, and full range of motion of the joints without swelling or tenderness. Id.

         The following month, Byron reported to Dr. Steven Alter a history of right arm pain and surgical treatment, but positive findings were limited to tenderness and modest loss of right grip strength, without loss of range of motion. Tr. 319-20. He was able to make a fist and demonstrated normal wrist strength. Id. An MRI of Byron's right elbow performed that same month showed mild widening the radiocapitellar joint and a mild sprain of the radial collateral ligament. Tr. 452-53, 325.

         In December 2016, orthopedic surgeon Dr. Charles Cassidy examined Byron and observed full range of motion of the right elbow and wrist, with some tenderness and decreased grip strength. Tr. 325. In light of the findings of positive ulnar nerve neuropathy and Byron's continued complaints of pain, Dr. Cassidy recommended a radial nerve release surgery. See Tr. 325-26.

         State agency physician Dr. Louis Rosenthall reviewed Byron's records in January 2017. He opined that Byron was limited to frequent reaching with his right arm, should avoid concentrated exposure to hazards such as machinery and heights, could lift and carry 25 pounds occasionally and 20 pounds frequently, and could stand, walk or sit for 6 hours in an 8hour workday. Tr. 57-61. Dr. Rosenthall noted that Byron had three surgeries and complained of persistent pain in his right elbow, but multiple clinical examinations within the past year were “very reassuring, with only abnormality being ligamentous laxity of lateral ulnar collateral ligament.” Tr. 59.

         Dr. Cassidy performed a fourth and final surgery on Byron's right arm in April 2017. After the surgery, Dr. Cassidy observed mild residual tenderness, but also improved range of motion in the right arm. Tr. 417-19, 421-23. Byron had diminished strength, but he maintained the ability to make a fist. Id. He also reported to Dr. Cassidy that his pain was well controlled, that he no longer needed prescription pain medication, and that he was taking Tylenol as needed. Tr. 423.

         In September 2017, one-time examining orthopedist Dr. Robert Pennell examined Byron. Tr. 454-59. Byron complained of continued pain, weakness, numbness, and tingling when he saw Dr. Pennell. Id. He reported that his pain felt better with prescription pain medication, Tramadol and Gabapentin. Id. On examination, he was able to raise both arms straight overhead, exhibited a range of motion between 5 and 145 degrees in his right elbow and between 0 and 150 degrees in his left elbow, had reduced grip strength in his right hand, and had good and equal abduction strength of the fingers of both hands, with mild weakness of adduction of the fingers on the right side. Tr. 457. Dr. Pennell ...

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