Searching over 5,500,000 cases.

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Perfater v. Berryhill

United States District Court, W.D. Missouri, Western Division

June 19, 2018

NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.



         Plaintiff 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.

         I. Background

         Perfater 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 Court.

         To 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)).

         A. Medical history

         Perfater claims disability based primarily on Chronic Obstructive Pulmonary Disease (COPD), bilateral osteoarthritis of the hands, cervical degenerative disc disease, and bilateral carpal tunnel syndrome.

         In 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. Tr. 278.

         In 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.

         In 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.

         In 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.

         In May 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.

         In June 2015, Perfater described worsening arthritis symptoms in his fingers and hands, and was prescribed indomethacin. Tr. 431, 434. Still, his pain persisted.

         In 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 nodes, ...

Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.