United States District Court, N.D. Ohio, Eastern Division
MEMORANDUM OPINION & ORDER
Kathleen B. Burke United States Magistrate Judge
Michael Karanicolas (“Karanicolas”) seeks
judicial review of the final decision of Defendant
Commissioner of Social Security (“Commissioner”)
denying his application for Disability Insurance Benefits
(“DIB”). Doc. 1. This Court has jurisdiction
pursuant to 42 U.S.C. § 405(g). This case is before the
undersigned Magistrate Judge pursuant to the consent of the
parties. Doc. 15.
reasons explained below, the Commissioner's decision is
filed his application for DIB in October 2013, alleging a
disability onset date of July 26, 2013. Tr. 91, 255. He
alleged disability based on the following: neck fusion
surgery and neck injury. Tr. 258. After denials by the state
agency initially (Tr. 147) and on reconsideration (Tr. 157),
Karanicolas requested an administrative hearing (Tr. 166). A
hearing was held before Administrative Law Judge
(“ALJ”) Peter Beekman on December 2, 2015. Tr.
106-137. In his March 10, 2016, decision (Tr. 91-101), the
ALJ determined that there are jobs that exist in significant
numbers in the national economy that Karanicolas can perform,
i.e. he is not disabled. Tr. 100. Karanicolas requested
review of the ALJ's decision by the Appeals Council (Tr.
218) and, on May 23, 2017, the Appeals Council denied review,
making the ALJ's decision the final decision of the
Commissioner. Tr. 1-4.
Personal and Vocational Evidence
was born in 1966 and was 47 years old on the date his
application was filed. Tr. 255. He completed eleventh grade
and previously worked as a warehouse worker lead person,
electrician's helper, sales rep delivery driver and
carpet cleaner. Tr. 110, 131.
Relevant Medical Evidence
February 2013, Karanicolas was involved in a car accident.
Tr. 110, 328. He went to the emergency room where he was
prescribed medications and given a physician referral. Tr.
328. Shortly thereafter, he began experiencing neck,
mid-back, and left shoulder pain. Tr. 328. On February 26, he
had an x-ray of his left shoulder, which showed mild
degenerative changes involving his left acromioclavicular
joint, Tr. 365, and an x-ray of his cervical spine, which
showed mild disk space narrowing at the C4-C5 and C6-C7
levels and mild degenerative changes, Tr. 367.
21, 2013, Karanicolas saw chiropractor John R. Fortuna, D.C.,
at Parmatown Spinal and Rehabilitation Center. Tr. 328.
Karanicolas explained that he had “beg[u]n some
therapies” per his physician but that the therapies
were “too much” and were causing him increased
pain and discomfort. Tr. 328. Fortuna stated that Karanicolas
had completed a “neck disability index form” and
scored 20/50, which correlates to 40% disability with normal
performance of activities of daily living
(“ADLs”) and an Oswestry low back pain scale and
scored 23/50, which correlates to 46% disability with normal
performance of ADLs. Tr. 328. Upon exam, Karanicolas'
cervical spine range of motion was 40 degrees of flexion, 34
degrees of extension, and 36 degrees of left and right
rotation. Tr. 330. Fortuna diagnosed Karanicolas with
cervical, thoracic and lumbar strains and a right shoulder
strain and recommended further diagnostics and treatment. Tr.
24, 2013, Karanicolas had an MRI of his cervical spine, which
showed disc bulging at ¶ 3-C4, disc herniation at ¶
4-C5 and C5-6, and straightening of the normal cervical
lordosis. Tr. 363-364.
1, 2013, Karanicolas saw surgeon Mark Grubb, M.D.,
complaining of neck and upper extremity pain, right side
greater than left, and tingling, numbness and weakness,
particularly in his right upper extremity. Tr. 317. Upon
exam, he had a diminished range of motion in his neck,
particularly to the right; normal range of motion in his
shoulder; motor testing was intact in his elbows, wrists, and
fingers; distraction was “helpful”; and he had
some diminished sensation in his right hand. Tr. 316. Dr.
Grubb provided Karanicolas with some treatment options and
Karanicolas elected to have surgery. Tr. 316.
and nerve conduction velocity study dated July 18 was
suggestive of cervical radiculitis best localized at the C5
nerve root most prevalent on the right and right median upper
extremity peripheral neuropathy. Tr. 362.
26, 2013, Dr. Grubb performed fusion surgery on Karanicolas
at ¶ 4-5 and C5-6. Tr. 306-307. On September 3, 2013,
Karanicolas saw Dr. Grubb and reported that he was much
better. Tr. 314. Dr. Grubb had x-rays taken, was satisfied
with them, and recommended that Karanicolas begin physical
therapy and conditioning and increase his activity. Tr. 314.
September 6, Karanicolas saw Fortuna and stated that his
surgery was “successful and he has noticed a highly
marked reduction in the paresthesia and numbness he was
previously experiencing in the upper extremities.” Tr.
341. He began physiotherapy and electric muscle stimulation.
Tr. 341. On September 9, Karanicolas reported that he was
“definitely feeling better” after his surgery
with less pain and minimal symptoms radiating into his upper
extremities. Tr. 340. Fortuna provided manipulations,
physiotherapy and stretches and stated that Karanicolas would
transition to an “active rehab program, especially
since he is experiencing a lot of weakness in both upper
extremities.” Tr. 340. On September 13, Karanicolas
reported “ongoing pain” in his mid- and
lower-back, but he was slowly improving and the paresthesia
in his upper extremities was diminished. Tr. 339. Fortuna
noted that Karanicolas had “recently” had an
EMG/nerve conduction velocity test of his arms which showed
radiculitis at the C5 nerve root. Tr. 339.
September 16, 2013, Karanicolas reported to Fortuna that his
neck pain was “still significant” and he still
had a restricted range of motion in his neck after his fusion
surgery. Tr. 338. He was still having a lot of weakness in
his upper extremities and pain in his lower back, but his
main area of concern was his neck. Tr. 338. On September 23,
Karanicolas reported that he had some soreness radiating into
both shoulders. Tr. 336. On September 25, he reported neck
pain and “a lot of weakness in both upper
extremities.” Tr. 335. On September 27, he complained
of ongoing post-operative residual soreness and discomfort
and Fortuna recommended he continue with treatments. Tr. 334.
On September 30, Karanicolas' neck soreness was radiating
into his upper extremities. Tr. 333. On October 2, he
reported that he was “still very concerned about
returning to work this month.” Tr. 332. Fortuna opined
that it was doubtful that he will be able to return to his
physically demanding job within two weeks, his scheduled
return to work date. Tr. 332.
October 15, Karanicolas saw Dr. Grubb. Tr. 313. Dr.
Grubb's treatment note states that Karanicolas was doing
well and that he would like to return to work. Tr. 313. Upon
exam, his incision looked good and his strength
“remains intact.” Tr. 313. X-rays were taken. Tr.
313. They showed postoperative changes (Tr. 318) and Dr.
Grubb remarked that the interbody graft looked good (Tr.
313). Dr. Grubb stated that Karanicolas had “done
well” and released him to work beginning the following
week. Tr. 313.
November 21, 2013, Karanicolas returned to Dr. Grubb
complaining of difficulty swallowing and breathing. Tr. 374.
He also reported some neck stiffness. Tr. 374. Upon exam, he
had intact, normal strength. Tr. 374. Dr. Grubb suggested he
see an ear, nose, throat doctor. Tr. 374.
5, 2014, Karanicolas returned to Dr. Grubb. Tr. 455. He
revealed that he was unable to work, his disability had been
denied, and he had shortness of breath. Tr. 455. Dr. Grubb
stated that Karanicolas had a “number of complaints,
” his symptoms were “infrequent, ” and they
occurred “when he goes to work.” Tr. 455. Upon
exam, he had good head/neck alignment, good motion, and
intact strength. Tr. 455. X-rays were taken and showed
additional consolidation in the fusion at ¶ 4-C5 and
C5-C6. Tr. 455. Dr. Grubb expressed concern for
Karanicolas' overall conditioning and recommended he
undergo an evaluation for his cardiorespiratory health and a
sleep study. Tr. 455.
September 18, 2014, Karanicolas had x-rays of his cervical
spine showing postsurgical changes at ¶ 4-5 and C5-6
levels; the height of the vertebral bodies and disc spaces
were maintained. Tr. 394.
sixth of twelve visits with physical therapy on October 20,
2014, Karanicolas reported a painful, reduced cervical range
of motion. Tr. 398-399. He reported no change in the
intensity of his pain since starting physical therapy. Tr.
399. That day his pain was 8/10 and constant. Tr. 397. His
neck disability index score was 62% disability. Tr. 398. He
had difficulty washing his hair, self-care, and driving due
to pain. Tr. 398. The therapist educated Karanicolas on
breathing techniques and stretching to promote relaxation.
14, 2015, Karanicolas visited his pain management clinic and
reported “significant relief of bilateral hand symptoms
when he is wearing his wrist splints in bed.” Tr. 457.
When he did not wear the splints he had severe pain. Tr. 457.
He had not had an EMG done. Tr. 457. He was taking Cymbalta
and it was helping; he reported that when he missed a dose he
noticed that his pain was significantly worse. Tr. 458.
Physical therapy helped when he was at the physical therapist
but did not seem to help at home. Tr. 458. Upon exam, he had
full motor strength in all extremities, normal reflexes and
intact sensation. Tr. 460. It was recommended that he follow
up with an EMG for carpal tunnel syndrome, physical therapy
was reordered, and an increase in Cymbalta and gabapentin
would be considered, noting that Karanicolas had just
restarted these medications. Tr. 460.
record also shows that Karanicolas complained of shortness of
breath, joint pain, and arthritis. See, e.g., Tr. 389, 472.
Medical Opinion Evidence