United States District Court, D. Connecticut
RULING ON PLAINTIFF'S MOTION FOR REVERSAL OR
REMAND AND DEFENDANT'S CROSS-MOTION FOR AN ORDER
AFFIRMING THE DECISION OF THE COMMISSIONER
CHARLES S. HAIGHT, JR. SENIOR UNITED STATES DISTRICT JUDGE
James Stango applied to the Social Security Administration
(the "SSA") for disability benefits and
supplemental security income after sustaining injuries in a
motorcycle accident on April 2, 2011. The SSA denied
Stango's application in a written decision on May 31,
2013 (Kim K. Griswold, Administrative Law Judge)
which the Defendant Commissioner affirmed on appeal.
brings this action under § 205(g) of the Social Security
Act as amended, 42 U.S.C. § 405(g), in order to obtain a
review by the Court of the Commissioner's final decision
denying his applications for benefits. Stango now moves for
an order reversing the Commissioner's
decision.Doc. 22. For its part, the Commissioner
cross-moves for an order affirming that decision. Doc. 27.
This Ruling resolves the motions.
Stango was born on May 20, 1968. On April 2, 2011, when he
was almost 43 years old, Stango was hit by an automobile
while riding his motorcycle, leading to significant injuries.
At the core of the present dispute are Stango's
allegations that those injuries -and their concomitant
symptoms-constitute a "disabling condition" that
render him "unable to work." AR. 175.
indisputable that Stango's accident set in motion a
lengthy and arduous recovery process, which started
immediately following the accident upon admission to the
emergency room at the Waterbury Hospital, in Waterbury, CT.
Waterbury later determined that Stango had suffered "a
significant contusion and abrasions of the right leg, sprains
of both ankles, sprains of both knees and a small finger
metacarpal-based fracture, nondisplaced, left hand."
Administrative Record ("AR.") 257. Waterbury provided
Stango with an orthopedic consultation and a trauma
consultation, and told Stango to follow up with an orthopedic
specialist. AR. 312. Stango was discharged from Waterbury on
April 5, 2011. However, he returned to, and was readmitted
by, the Waterbury emergency room on April 9, 2011 after
developing swelling and redness in his right leg. AR. 257.
Stango was released on April 11, 2011, but returned yet again
on April 15, 2011 after experiencing "severe pain"
due to a left leg hematoma. AR. 373-74. At that visit, Stango
was prescribed oxycodone, a pain killer. Id. On
April 18, 2011, Stango returned to Waterbury for an initial
orthopedic consultation with Dr. Robert S. Wetmore. AR. 343.
Dr. Wetmore noted the following:
[Stango] states he is in excruciating pain which he describes
as "extreme." He complains of his thumb and index
finger on the right side causing pain, he complains of his
left hand and wrist, he complains particularly of his left
knee over the medial side, he complains of less pain in the
right knee, and finally he complains of pain in both feet and
ankles. With regards to the right calf, he states he had a
hematoma and points to a red and swollen area on the medial
side of the calf.
Id. Nevertheless, Dr. Wetmore interpreted a CT scan
to show "no other abnormalities" other than
Stango's left hand fracture, that Stango's
"multiple contusions and sprains . . . appear to be
stable, " and that "there is no obvious damage to
the lower legs that should require use of a walker." AR.
345. Stango visited Dr. Wetmore again on May 16, 2011, at
which time Dr. Wetmore referred Stango to "physical
therapy for modalities and exercises for his cervical and
lumbar strain." AR. 594. On May 18, 2011, Stango
returned again to the Waterbury emergency room after falling
at home after a spout of dizziness. AR. 380. Stango
complained that he aggravated his left hand injury during the
fall, and also that "he has been having headaches and
dizziness since [the] accident, " as well as
"continued neck and back pain." AR. 381.
19, 2011, Stango began physical therapy at Access Rehab
Centers in Southbury, CT. AR. 392. Physical therapist Mary
Beth Olan's initial evaluation of Stango noted a limited
range of lumbar and cervical motion, that Stango's gait
was "guarded and slow, " and that his "lower
calf is swollen, slightly red." AR. 393. Stango also
complained of "headaches, dizziness and shooting pain
down his legs." AR. 389. Stango continued to receive
physical therapy multiple times per week at Access Rehab
through July 27, 2012 (at which time he was still complaining
about "the headaches and dizziness with stress, exercise
and changing position"). AR. 674.
27, 2011, Stango visited internist Dr. Stephen Rossner at the
Staywell Health Center in Waterbury, CT for a follow-up exam.
AR. 300. At this time, Stango was experiencing backache,
joint pain, headaches and "reactive confusion." AR.
300. Following a "review of systems, " Dr. Rossner
found minimal issues with Stango, and assessed him only with
"low back pain[, ] headaches, " and told Stango to
schedule another follow-up appointment in 6-8 months. AR.
20, 2011, Stango had a follow-up appointment with Dr.
Wetmore. Dr. Wetmore stated that Stango's leg injury-what
Dr. Wetmore determined to be a "right post tibial
degloving injury"-was "doing well at this
point." AR. 620. He also ordered physical therapy for
Stango's left ankle neuroma (nerve-swelling) and provided
for a refill of his physical therapy prescription as to his
cervical and lumbar pain, which Stango said was "helping
tremendously." AR. 621.
28, 2011, Stango visited the emergency room at the Yale-New
Haven hospital complaining of headaches, neck, and back pain
and seeking a second opinion than that of the Waterbury
Hospital. AR. 278. The hospital diagnosed Stango with
"post-concussion syndrome, " which "is marked
by the following symptoms: persistent headache, dizziness,
weakness, insomnia, and feeling nervous or depressed."
AR. 298. The hospital also performed a CT scan of
Stango's brain and cervical spine, which showed no
abnormalities. AR. 434. Stango was released the same day with
the recommendation that he seek further evaluation from a
"neurologist/headache specialist." AR.
7, 2011, Stango was seen for a neurology office visit with
Dr. Stephen P. Novella of the Yale Neurology Clinic. AR. 430.
Dr. Novella noted that Stango was "referred for
evaluation of headaches, " and stated that:
Since accident, pt has had nearly daily HAs. Pain originates
from base of skull and radiates over scalp, 10/10, throbbing,
sometimes associated with photophobia, no nausea or vomiting.
Initially, HAs were not severe or noticeable due to more
intense pain from back and knees. Now that those pains have
subsided HAs are more noticeable. He has been to Waterbury
Emergency Department about 4x for HA management. . . . Last
week he came to YNHH Emergency Department due to severe HA. .
. . Several hours later he again developed severe HA. He
realized at that point that palpation of neck muscles are
triggers for HAs. Other triggers include stress and sudden
movements. Of note, the CT head/cspine study was
AR. 430. Dr. Novella then provided his assessment:
Description of HAs is suggestive of cervicogenic HAs. This is
reinforced by pain to hypertrophied posterior neck muscles.
He only takes oxycodone sporadically within a month and so
there may not be component of analgesic overuse HA.
Nevertheless, oxycodone is not the correct treatment for this
type of pain. We will initiate Amrix 30mg QHS and recommend
to continue PT neck stretching exercises.
AR. 432. Stango visited Dr. Novella again on September 27,
2011, at which time Dr. Novella noted that Stango
"responded well to trial of Amrix, but had recurrence
[of headaches] after trial completed, " and that the
headaches "should improve with time. In the interim,
will give another prescription for amrix as well as
antiinflammatory (naproxen)." AR. 429.
July 5, 2011 physical therapy session, Stango informed his
therapist that "my head feels like its going to explode,
" and that his level of pain was a 10 out of 10. AR.
412. However, he reported "feeling better" at his
following appointment on July 7, 2011. AR. 411.
October 2, 2011, Stango had a follow-up orthopedic visit with
Dr. Wetmore. Dr. Wetmore noted that Stango:
now complains of pain over the previous fracture of the left
fifth metacarpal as well as weak hand grips and inability to
open jars, etc. due to pain in all five fingers of both
hands. He states that he feels he is doing well in physical
therapy although the therapist stated to him that he should
be moving along faster. He wishes to return to light duty
work as he has court ordered community service he needs to
AR. 628. Dr. Wetmore noted that "[w]e have given him a
note to return to light duty to look for work of that nature.
. . . He will wear TED stockings to the lower extremities to
avoid swelling while he is standing for that work time. He
otherwise will rest and attend his physical therapy."
October 17, 2011, Stango visited Dr. Mary I. Miller, an
internist in Southbury, CT. Dr. Miller noted that Stango was
in "chronic pain, " had edema on the right leg, had
issues with dizziness, was experiencing lower back pain up to
his neck, and had shooting pains in his leg. AR. 440.
November 14, 2011, Stango had another orthopedic appointment
with Dr. Wetmore, following which Dr. Wetmore stated as
Subsequent to [Stango's accident] he has had multiple
complaints in the clinic including knee pain, low back pain,
neck pain, headaches and other vague migratory symptoms. He
became very frustrated with the "system" because he
was "not getting better." He is particularly
hostile today but we have had a long talk in which I have
explained that often in musculoskeletal trauma there can be
chronic pain without obvious objective findings. . . . Based
on his diffuse and vague symptoms I would not order any
special test as this time.
AR. 630. Dr. Wetmore then provided his ultimate assessment:
Significant psychosocial disruption and disability associated
with multiple trauma, limited ability to work, and chronic
pain syndrome. I have suggested that perhaps that he add to
his armamentarium of treating clinicians a physiatrist. This
may help address the programs to deal with his vague
musculoskeletal complaints. I have suggested activity such as
exercise, stretching and yoga might be of benefit. He is
going to start seeing Dr. Mary Miller for primary care
physician and he may benefit from that management as well.
There is no further need to come to orthopedic clinic.
February 6, 2012, Stango made his first visit to podiatrist
Dr. Joel S. Segalman of the Chase Parkway Podiatry Group, who
Stango visited nine more times over the subsequent four
months. AR. 443. Dr. Segalman diagnosed Stango with
"severe achilles tendonitis and [right] equinus
deformity." AR. 446.
March 6, 2012, Stango was evaluated by Drs. Gordon Frank
Buchanan and Gioacchino Curiale, neurologists at the Yale-New
Haven Hospital. AR. 454. Their exam did not find any
neurological abnormalities. Although they documented that
Stango experienced an "exacerbation of headaches and
pain" after running out of Amrix and Nortriptyline, they
also noted that "Patient otherwise reports that he is
feeling much better with physical therapy and balance
therapy. . . . He feels that he is getting back to baseline,
but not there yet. His headaches are milder now, tolerable,
but still almost daily. He attributes his pain to his muscles
being out of alignment." AR. 454.
8, 2012, Stango had MRIs taken of his left shoulder and
cervical spine by Dr. Andrew J. Lawson of Cerner Imaging. The
only abnormality reported as to Stango's left shoulder
was that "[t]here are moderate hypertrophic degenerative
changes of the acromioclavicular joint. There is mild
narrowing of the subacromial space. There is a small amount
of fluid within the subacromial/subdeltoid bursa." AR.
642. As to the spine, the MRI showed several instances of
"mild loss of disk signal, " a "small broad
disk bulge, " and a "slight flattening of the
spinal cord anteriorly." AR. 643.
August 1, 2012, in light of a referral from Dr. Jocelyn Maw
of Alliance Medical Group in Middlebury, CT, Stango was
evaluated by Dr. Alexandru Dinu at the Gaylord Outpatient
Center in Wallingford, CT. Stango described his symptoms to
Dr. Dinu as including: cervical spine pain, headaches,
dizziness, shoulder and neck problems, difficulties with
ambulation due to loss of balance, difficulties with memory,
concentration and mood, trouble sleeping, anxiety, swelling
in his legs, intolerance to heat, and nerve pain. Dr.
Dinu's diagnostic impression was ultimately that Stango
was suffering from the following: (i) status post motorcycle
accident with postconcussion syndrome; (ii) chronic
headaches; (iii) posttraumatic stress disorder; (iv)
myofacial pain syndrome; (v) mobility defects; and (vi)
uncontrolled hypertension. Dr. Dinu concluded that
Stango's "symptoms are probably a resultant of
postconcussive syndrome and posttraumatic stress
disorder." AR. 921. Dr. Dinu also noted, however, that
Stango's "[l]ower extremities present full range of
motion. Strength is 5/5 on both sides. Deep tendon reflexes
1. No gross sensory defects. He has difficulties maintaining
balance with 1-legged standing. Gait is normal." AR.
921. Stango then underwent aquatic therapy at Gaylord, which
was deemed to be of assistance in light of the fact that
Stango's "daily activities and gait are
limited." AR. 931. On September 14, 2012, Gaylord
physical therapist Susan Goldstein reported Stango's
"Current Level of Function" as follows:
"unable to work, pain, pt does some stretches, drives,
gardens a little, diff to read, no biking due to cervical
strain." AR. 934.
October 27, 2012, Dr. Maw responded to interrogatories
regarding Stango's headaches, and stated, inter
alia, that: (i) at least twice a week Stango suffers
from severe headaches that interfere with his daily
activities (noting that he "need[s] to lie recumbent &
undisturbed until headache subsides"); (ii) that the
headaches are associated with dizziness, vertigo,
photophobia, and noise sensitivity; (iii) that Stango can
carry on a conversation and activities of daily living while
a headache is occurring; and (iv) the headaches have not been
resistant to treatment. AR. 441.
November 7, 2012, Stango again visited Dr. Dinu at the
Gaylord Outpatient Center. Dr. Dinu noted that Stango
"has been improving with physical therapy and speech,
" and that he "needs to have a functional capacity
evaluation in order to be able to work in the near
future." AR. 924.
November 26, 2012, Stango again visited Dr. Segalman at the
Chase Parkway Podiatry Group. Dr. Segalman noted that
Stango's chief complaint was "severe pain in b/l
ankle, " and noted that "Patient complains today of
discomfort in shoes, difficulty in walking and irritation.
Pain at right heel and left heel." AR. 973. Overall, Dr.
Segalman noted that Stango's "chief complaint(s) are
resolving." AR. 974. Nevertheless, on December 4, 2012,
Dr. Segalman drafted a "letter of medical
necessity" stating that Stango requires an AFO orthotic,
specifically, "long-term mechanical control of the
pathological Subtalar Joint as the primary treatment
methodology." AR. 982. Dr. Segalman stated that the
orthotic devices "represent the only practical,
long-term means by which to effectively treat [Stango's]
acute complaints, " and that without such, surgery would
be required.Stango had a further visit with Dr.
Segalman on January 28, 2013, in which Stango made the same
complaints, but after which Dr. Segalman noted that
Stango's "chief complaint(s) are improved." AR.
February 6, 2013, Stango visited Dr. Dinu at Gaylord for a
third time. Dr. Dinu noted that "a 10 review of systems
is negative, " but documented a myriad of complaints
from Stango, specifically: "dizziness, muscle spasms,
numbness, muscle pain, swelling in the legs, occasional
migraines/headaches, trouble hearing, intolerance for heat,
loss of balance, double vision, difficulties with ambulation,
difficulties with memory, concentration and falling and
staying asleep, back pain, nerve pain." AR. 926. Dr.
Dinu's ultimate diagnostic impressions were that Stango
was suffering from "[l]ate effects of traumatic brain
injury with postconcussion syndrome, "; "[c]hronic
ankle pain"; and "[m]ild cognitive defects."
February 18, and February 22, 2013, Stango again visited Dr.
Segalman, who noted that Stango's pain is "on and
off, " and that his "chief complaint(s) are
well-controlled." AR. 977-80. Finally, on March 29,
2013, Dr. Segalman responded to a series of questions,
stating that, inter alia: (i) Stango "suffer[s]
from post traumatic changes to soft or connective tissue,
vascular changes, or arthritis of a major weight-bearing
joint (1.03) [his ankles/feet]"; (ii) Stango is limited
in motion; (iii) there is no "gross anatomical
deformity"; (iv) Stango is limited in his ability to
sit, walk, and stand; (v) Stango must move, change position,
or stretch for 5 to 10 minutes when sitting with feet on the
floor for 10 to 15 minutes; (vi) Stango's gait is
unstable; (vii) a handicapped parking sticker is appropriate;
(vii) Stango experiences "chronic ankle and foot
pain"; (viii) treatment does not completely eliminate
all pain; and (ix) Stango's "complaints have been
consistent with physical examination findings & radiology
studies over time." AR. 984.
8, 2011, three months after his accident, Stango submitted
his application for DIB and SSI with the SSA. AR. 173-190.
Stango alleged the following impairments as part of his
applications: (i) broken left hand; (ii) injuries to ankles
and knees; (iii) back and neck pain; (iv) migraine headaches;
(v) right leg swelling; (vi) hips coming out of alignment;
(vii) dizzy spells; and (vii) blurry vision. AR. 65. The SSA
denied Stango's applications in a written notice on
November 17, 2011. AR. 97-100. The SSA affirmed that
decision on reconsideration in a written notice dated
February 3, 2012. AR. 103-09. On February 6, 2012, Stango
requested a hearing by an ALJ, AR. 110-11, which was
scheduled for the following March. Prior to the hearing,
Stango submitted a Pre-Hearing Memorandum. AR. 246-51.
March 26, 2013, the SSA held the hearing in front of ALJ
Griswold, at which the ALJ took the testimony of Stango and
vocational expert Dr. Steven Sachs.
hearing, Stango testified as to his past work experience,
specifically, that he had been a toolmaker for many years,
which involved a fairly high level of physicality. Stango
then discussed his injuries and their concomitant symptoms.
When asked precisely what keeps him from working, Stango
testified as follows:
On a daily basis it's a struggle. I get headaches every
day, my neck goes into spasms, my back goes into spasms. I
have severe ankle pain. There's dizziness issues, light
issues, balance issues. I have trouble maintaining my
doctor's appointments. I have trouble keeping things
organized. I used to be very, very organized and that's
not the case anymore. A great deal of difficulty even walking
around doing my household chores. If it wasn't for my son
I would need other care.
AR. 40. He testified that he can drive. AR. 40. However, he
also testified that he has been "terribly light
sensitive ever since the accident, " which was because
"the neuro pathways are damaged from the eye to the
brain, and there was a bruise on [his] eye." AR. 43. In
fact, he testified that visual focusing is difficult such
that even "[t]he wrong color Christmas paper sets [him]
off." AR. 49-50. He testified that "both ankles
swell up pretty dramatically throughout the day, and that
limits [him] severely, " requiring him to get up and
move. AR. 46. The swelling takes place "[f]rom my ankle
to the top of my foot, that pathway . . . where all the
tendons go." AR. 47. Stango also testified that he has
trouble sleeping, including having "weird dreams about
motorcycles." AR. 48. He is "very, very sensitive
to hot and cold, " which at times feels "like
somebody beat [him] with a baseball bat on [his] neck."
AR. 50. He testified that he now has an unreliable grip, as
well as pain and cramps in his left hand, which causes him to
frequently drop things and creates difficulties at times with
writing. AR. 38-39, 50-51.
compared his current level of activity with his pre-accident
level of activity. He testified that he used to be a
"very, very active, outdoors person. I did a lot of
hiking, mountain biking, knee boarding, water skiing, all of
that stuff. Right now I haven't been on my mountain bike
in about a year-and-a-half, sad to say." AR. 48. He no
longer owns a motorcycle and cannot mow the lawn as he used
to. AR. 48-49. He also claims to have gained 50 pounds since
the accident, and that he has "[t]rouble tying ...