Nunez found that the plaintiff was suffering from acute "sprain and strain of the myoligamentous supporting structures of the lumbosacral spines"; "low back pain with radicular symptoms of the left lower extremity"; "diffuse congenital spinal stenosis, presence of the central to left herniated disc of L4-5 increasing the spinal stenosis"; "myositis of the left periscapular musculatures"; and obesity. (R. 98.) Dr. Nunez recommended ongoing chiropractic treatment, and he commented that since plaintiff's job as a carpet installer requires heavy physical activity, plaintiff "may need ongoing work hardening and back strengthening exercises." (Id.)
After the September 18, 1991, examination, Dr. Nunez reported to Dr. Zweibaum that plaintiff "still showed pain and tenderness in the periscapular area as noted previously. There is also tenderness noted again over the lumbosacral spine and the related paraspinal muscles." (R. 130.) Dr. Nunez recommended that plaintiff continue chiropractic care, exercise regularly, and lose weight. (Id.) Dr. Nunez opined that Mr. Schonewolf would be unable to return to his job as a carpet installer and that his long-term prospects of recovery were undetermined as of the date of his latest examination. (R. 128, 129.)
5. Dr. M. Felt, M.D.
The next physician to examine Mr. Schonewolf was a neurologist, Dr. Felt, who examined plaintiff on September 4, 1991. (R. 104.) Dr. Felt found the plaintiff to be mentally alert and coherent, but suffering from a "post-traumatic cervical sprain"; a "post-traumatic reflex cephalalgia secondary to the cervical sprain"; a herniated disc in the lumbar region with signs and symptoms that suggested an L5 radiculopathy; tenderness to palpation of the left shoulder; weakness in the arms, hands and fingers; and spasms and tenderness in the lumbar region. (R. 105.) Dr. Felt also found that plaintiff had normal deep tendon reflexes and no sensory deficit. (Id.) Based on these findings, Dr. Felt recommended that Mr. Schonewolf consult an orthopedic or neurological surgeon. (Id.)
6. Dr. Elisabeth M. Post, M.D.
Mr. Schonewolf consulted a neurological surgeon, Dr. Post, on October 31, 1991, and again on December 23, 1991. (R. 108, 110.) Upon the initial examination, Dr. Post concluded that plaintiff suffered from a "degenerated disc at the L4-5 level with small herniation on the left." (Id.) She recommended a "strict course of bed rest, along with Robaxin and Darvocet." (R. 109.) Dr. Post also concluded that Mr. Schonewolf "may need surgery." (Id.) After the plaintiff's return visit on December 23, 1991, Dr. Post concluded that the bed rest "did not help" and that the plaintiff should lose forty to fifty pounds before an operation is considered.
7. Dr. Martin Swiecicki, M.D.
Dr. Zweibaum next referred Mr. Schonewolf to Dr. Swiecicki, a neurologist, who examined plaintiff on March 30, 1992. (R. 132.) Dr. Swiecicki found plaintiff to be suffering from L5 radiculopathy as well as a lumbar disc herniation at L4-5. (R. 133.) He noted that Mr. Schonewolf alleges that he is not able to exercise and that his weight increased from 220 pounds to 285 pounds after he injured his back on July 5, 1991. (Id.) He further noted evidence of weakness of the left foot. (Id.) Dr. Swiecicki concurred with Dr. Post that plaintiff is a candidate for surgical intervention, but that plaintiff must lose weight before surgery is considered. (Id.)
8. Dr. Armando Montiel, M.D.
Dr. Montiel examined Mr. Schonewolf on April 13, 1992, and concluded that Mr. Schonewolf's full range of motions was intact; that plaintiff was suffering from no limitations or restrictions; and that there was "no evidence of radiculopathy or any focal neurological deficits." (R. 116.) Dr. Montiel found that "palpation of the thoratic spine and paraspinal musculature revealed no evidence of pain or tenderness"; that the lumbar paraspinal musculature was "unremarkable"; that "backward extension, abduction, as well as adduction symmetrically were appreciated to be normal"; and that with the plaintiff standing, "flexion, extension and lateral flexion of the lumbar region were noted to be normal." (R. 115.) Although Dr. Montiel mentioned the EMG testing, he noted that the results were "unavailable," so he did not consider them. (R. 115.) Likewise, Dr. Montiel makes no mention of the MRI test results. (Id.)
9. Dr. Karen Scardigli, M.D.
Finally, Mr. Schonewolf was examined by Dr. Scardigli, a neurologist, on June 21, 1995, in a consultation "set up by the ALJ after the Appeals Council remand." (Pl. Br. at 23.) Dr. Scardigli observed that plaintiff was in "obvious distress with any particular moving as far as standing up or lying on the table." (R. 162.) Plaintiff weighed 348 pounds, had blood pressure of 140/92, and a pulse of 108. (Id.) Dr. Scardigli reviewed plaintiff's EMG report, which demonstrated "acute L5 radiculopathy" in her opinion. (R. 162.) Similarly, she reviewed his MRI which indicated an L4-5 herniated disc "located centrally and to the left." (R. 163.) Further, Dr. Scardigli found that plaintiff was suffering from a herniated disc at L4-5; that his cervical spine examination was unremarkable; that his lumbosacral spine examination revealed limited range of motion; that his mental status was normal; that "motor examinations revealed normal tone"; and that "deep tendon reflexes were and symmetrical throughout." (R. 163.)