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Stango v. Colvin

United States District Court, D. Connecticut

June 17, 2016

JAMES STANGO, Plaintiff,



         Plaintiff 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.

         Stango 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.[1]Doc. 22. For its part, the Commissioner cross-moves for an order affirming that decision. Doc. 27. This Ruling resolves the motions.

         I. Background [2]

         Plaintiff 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.

         It is 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[3] ("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.

         On May 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").[4] AR. 674.

         On May 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. 302.[5]

         On June 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.

         On June 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. 298.[6]

         On July 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 unremarkable.

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.

         At his 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.

         On 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 pay back.

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." AR. 628-29.

         On 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.

         On November 14, 2011, Stango had another orthopedic appointment with Dr. Wetmore, following which Dr. Wetmore stated as follows:

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.

AR. 630.

         On 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.

         On 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.

         On June 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.

         On 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.

         On 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;[7] and (iv) the headaches have not been resistant to treatment. AR. 441.

         On 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.

         On 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.[8]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. 976.

         On 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." AR. 927.

         On 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.

         II. Procedural History

         On July 8, 2011, three months after his accident, Stango submitted his application for DIB and SSI with the SSA.[9] 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.[10] 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, [11] Stango submitted a Pre-Hearing Memorandum. AR. 246-51.

         On 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.

         At the 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.

         Stango 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 ...

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