United States District Court, W.D. Missouri, Western Division
NANETTE K. LAUGHREY UNITED STATES DISTRICT JUDGE
Gary Perfater appeals the Commissioner of Social
Security's final decision denying his application for
disability insurance benefits under Title II of the Social
Security Act. For the following reasons, the Court affirms
the decision of the ALJ.
was born in 1957, and alleges that he became disabled
beginning on June 13, 2013. He filed his initial application
for Title II benefits on August 27, 2014. The ALJ held a
hearing on June 27, 2016, and issued a decision denying
benefits on July 19, 2016. After the Appeals Council declined
to review the ALJ's decision, Perfater appealed to this
receive disability benefits under Title II, Perfater must
establish that he was disabled before the expiration of his
insured status. See 42 U.S.C. §§ 416(i),
423(c); Pyland v. Apfel, 149 F.3d 873, 876 (8th Cir.
1998). Perfater's insured status expired on June 30,
2015. Tr. 191. However, evidence of a disability after that
date remains relevant, “in helping to elucidate a
medical condition during the time for which benefits might be
rewarded.” Pyland, 149 F.3d at 877 (citing
Fowler v. Bowen, 866 F.2d 249, 252 (8th Cir. 1989)).
claims disability based primarily on Chronic Obstructive
Pulmonary Disease (COPD), bilateral osteoarthritis of the
hands, cervical degenerative disc disease, and bilateral
carpal tunnel syndrome.
March 2010, Perfater visited the Missouri Heart Center,
reporting extreme fatigue, shortness of breath, episodes of
hypotension, sweats, and chest pain. Tr. 425. His symptoms of
fatigue and shortness of breath persisted over the next
several years, and he was ultimately diagnosed with
obstructive sleep apnea in May 2014. Tr. 261, 268, 386, and
416. Perfater's symptoms improved with the use of a CPAP
machine, but he continued to experience daytime tiredness.
October 2014, Perfater began to report pain in both of his
hands for the first time. Tr. 348. A medical examination
revealed Bouchard's nodes and Heberden's nodes, and
he was prescribed Medrol and Meloxicam. Tr. 350.
January 2015, Perfater met with Dr. Dustin Keffer, who
examined Perfater at the request of Disability
Determinations. Perfater reported experiencing symptoms of
shortness of breath, fatigue, and chest pain. Tr. 297. Dr.
Keffer found Perfater's cardiac and pulmonary exams to be
within the normal limits. Tr. 301. He also noted that
Perfater's exam results would be consistent with
rheumatoid arthritis, but Perfater had not had any laboratory
work or a formal evaluation by a rheumatologist. Id.
April 2015, Perfater returned to the Missouri Heart Center,
and reported symptoms of fatigue and dyspnea, as well as
chest pain accompanied by lightheadedness and diaphoresis.
Tr. 392. He was advised to take nitroglycerin for the chest
pain. Tr. 395. Perfater also continued to report symptoms of
numbness, tingling, and paresthesia of the hands. Tr. 331. An
April 2015 EMG revealed bilateral chronic carpal tunnel
syndrome, Tr. 336, and a cervical MRI showed degenerative
disc disease with neural foraminal encroachment. Tr. 333.
Perfater stated that neither medication nor wrist splints
helped. Tr. 331.
2015, Perfater visited Fitzgibbon Rheumatology, where he
described pain in his fingers and hands that caused
difficulty grasping or gripping. Tr. 451. An examination once
again revealed Heberden's and Bouchard's nodes on
both hands, as well as limited extension of the fingers on
Perfater's 2nd through 4th fingers
on his left hand. Tr. 454. Imaging of Perfater's hands
showed mild osteoarthritis bilaterally. Tr. 322. An
evaluation for occupational therapy revealed that
Perfater's digits were in a flexed position for neutral
position, there was redness at the joints, and swelling in
both hands. Tr. 323. Perfater had decreased range of motion
of bilateral digits and wrists and decreased strength of the
bilateral hands. Tr. 324. Perfater later reported that he was
unable to complete therapy due to his pain. Tr. 431.
2015, Perfater described worsening arthritis symptoms in his
fingers and hands, and was prescribed indomethacin. Tr. 431,
434. Still, his pain persisted.
September 2015, Perfater received an injection after
reporting that his hand pain rated a 9 on a pain scale. Tr.
446. Examination again revealed Bouchard and Heberden's