United States District Court, D. Connecticut
LYNNE C. WILLIAMS, Plaintiff,
NANCY A. BERRYHILL, ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.
MEMORANDUM OF DECISION DENYING PLAINTIFF'S MOTION
TO REVERSE THE DECISION OF THE COMMISSIONER (DKT. NO. 21) AND
GRANTING DEFENDANT'S MOTION TO AFFIRM THE DECISION OF THE
COMMISSIONER (DKT NO. 26)
Vanessa L. Bryant, United States District Judge
an administrative appeal following the denial of Plaintiff
Lynne C. Williams' application for Title II Social
Security Disability and Title XVI Supplemental Security
Income benefits. It is brought pursuant to 42 U.S.C.
§§ 405(g). Plaintiff has moved for an order
reversing the decision of the Commissioner of the Social
Security Administration (“Commissioner”). (Dkt.
No. 21). The Commissioner opposes this motion. (Dkt. No. 26).
For the following reasons, Plaintiff's Motion for an
Order Reversing the Commissioner's Decision (Dkt. No.
21-2) is DENIED and Defendant's Motion for an Order
Affirming the Commissioner's Decision is GRANTED.
April 8, 2014, Plaintiff applied for disability insurance
benefits and for supplemental security income. (R. 248).
Plaintiff claims that her disability began on December 16,
2013, when she began experiencing back and radiating leg
pain. Both applications were initially denied on August 19,
2014, and again upon reconsideration on May 6, 2015. (R.
134-141, 147-162). Plaintiff then requested a hearing before
an Administrative Law Judge (“ALJ”). (R.
163-165). ALJ Ronald J. Thomas heard the case on November 21,
2016. (R. 33-35). ALJ Thomas issued a decision finding that
Plaintiff was not disabled within the meaning of the Social
Security Act. (R. 10). The Appeals Council denied
Plaintiff's request for review; this action followed. (R.
was under the care of Dr. Richard R. Slater until December
23, 2010. (R. 649). Dr. Slater withdrew from treating
Plaintiff because he believed that Plaintiff was seeking
controlled substances. (R. 648-649).
September 22, 2011, Plaintiff saw nephrologists Anushree
Shirali, M.D. and Deepak Kadiyala, M.D for evaluation. (R.
405). Their treatment notes described Plaintiff as a
53-year-old female with a ten-year history of hypertension,
hyperlipidemia, remote CVA, obesity and chronic back pain. (R.
405). Plaintiff told Drs. Shirali and Kadiyala that she was
formerly an x-ray technician “but stopped due to back
pain” (R. 406). Plaintiff had been taking Percocet and
Valium for several months preceding her appointment but
switched to meloxicam and Motrin shortly before her
appointment. Plaintiff stated that her hypertension was a
side effect of the meloxicam and that she would prefer to
take Percocet. (R. 406). Dr. Kadiyala diagnosed Plaintiff
with Chronic Kidney Disease and suggested a Liboderm patch
instead of non-steroidal anti-inflammatory drugs
(“NSAIDs”) like meloxicam and Motrin. (R. 406).
presented to the Emergency Room at Yale New Haven Hospital
(“Yale”), on February 19, 2013, following a fall
on the ice. (R. 403-405). Plaintiff complained of left ankle
pain and swelling. (R. 403). An x-ray confirmed an avulsion
fracture to the left ankle. (R. 405). Plaintiff received
Tylenol for pain. (R. 405).
later, in May 2013, Plaintiff saw a physician at the General
Practitioners of Hamden and asked for a note allowing her to
“return to work at full capacity.” (R. 647).
While there, she complained of prolonged back pain and
requested something to aid sleep. The doctor she saw
prescribed Diazepam. (R. 647).
December 16, 2013, Dr. Pichamol Jirapinyo treated Plaintiff
at Yale's Primary Care Center for back pain. (R.
401-403). The doctor recorded Plaintiff's height and
weight as 5'7” and 193 pounds giving Plaintiff a
BMI of 30.25 kg/m2. (R. 402). Plaintiff complained that her
back pain had been occurring for approximately 15 years. She
described the pain as sharp, constant, and getting
increasingly worse. Plaintiff also experienced numbness and
tingling in her legs. (R. 401). She stated the pain affected
her daily activity and interrupted with her sleep. (R. 401).
Additionally, Plaintiff indicated that she had tried multiple
medications as well as several weeks of physical therapy with
no improvement. (R. 401). She refused to accept a physical
therapy referral. (R. 401). Thus, Dr. Jirapinyo prescribed
Tramadol, an opioid pain medication. (R. 402). The Plaintiff
stated that morphine, which she received from a friend,
provided the only relief. (R. 401). Plaintiff requested
morphine, but the doctor refused because alternative options
were not yet maximized. (R. 401).
the doctor's refusal to prescribe morphine, Plaintiff
returned to Yale's Primary Care Center on January 23,
2014. (R. 524-525). During this visit, Plaintiff denied the
scheduled blood work and threw lab slips at the nurse. (R.
524). Plaintiff then pushed her son who was defending the
nurse. Security was called to escort Plaintiff out of the
office. (R. 524).
next appeared at Yale in the Emergency Room on March 4, 2014
reporting suicidal ideation. (R. 516-524). She admitted to
spending her state benefits check on card games and alcohol.
(R. 517). She stated that she drank vodka from the bottle for
two days before arriving at the hospital. (R. 517). Plaintiff
also admitted to feeling bad about herself for several months
because she was unemployed and had a poor relationship with
her father. (R. 517). Plaintiff was willing to undergo
alcohol treatment. (R. 522). Her Global Assessment of
Functioning Score (GAF Score), which assesses the effect of
psychiatric illness on a person's functional skills and
abilities, was 51 out of 100. (R. 522).
weeks later, on March 28, 2014, Plaintiff returned to the
Primary Care Center. (R. 389-392). Dr. Jirapinyo met with
Plaintiff. Plaintiff informed the doctor that her pain was
still constant. (R. 390). Dr. Jirapinyo noted that Plaintiff
was in the obese range based on a recorded height of
5'6” and weight of 191 pounds. (R. 390). The doctor
noted Plaintiff's BMI to be 30.88 kg/m2. (R. 390). The
doctor was not certain whether spinal stenosis or
osteoarthritis caused the Plaintiff's back pain. (R.
391). The doctor ordered an MRI to evaluate Plaintiff's
back. (R. 391).
took place on April 22, 2014, and showed multiple bulging
discs, some with stenosis and contact with nerve roots. (R.
369). Plaintiff saw Dr. Perdigoto to review the MRI. (R.
385). Dr. Perdigoto stated the pain was likely degenerative
disease and that Plaintiff had epidural lipomatosis, which
was possibly correlated with her obesity. (R. 386). Plaintiff
stated that she was having difficulty working because she was
unable to stand or sit for prolonged periods of time due to
her pain. (R. 385). The epidural lipomatosis can lead to
progressive neurological deficits, so Dr. Perdigoto referred
Plaintiff to orthopedics. (R. 386). The doctor increased the
Tramadol prescription from 50mg to 100mg. (R. 386). Dr.
Perdigoto issued a letter following the visit stating that
Plaintiff has a degenerative disc disease and epidural
lipomatosis, rendering her unable to work. (R. 370).
24, 2014, just one month after the MRI, an ambulance escorted
Plaintiff to the Yale New Haven Emergency Room. (R. 430-439).
The ambulance arrived after Plaintiff woke up naked, in
complete disarray. Plaintiff's son indicated that she was
extremely intoxicated the night before. (R. 431). The report
showed Plaintiff was drinking two pints of vodka per day,
three days per week, and using crack cocaine. (R. 435). The
Plaintiff also admitted to taking “handfuls” of
the prescribed Tramadol. (R. 431). Plaintiff refused
detoxification. She left the hospital upon being clinically
sober. (R. 432).
returned to Yale on May 30, 2014 after making suicidal
comments. (R. 471-478). The report stated that Plaintiff
“had been drinking earlier, got into an altercation
wither her husband, and made comments about ‘blowing
her brains out.'” (R. 473). Additionally, Plaintiff
was “belligerent, combative and yelling at
staff.” (R. 473). Plaintiff ultimately denied suicidal
plans and staff decided she was non-suicidal. (R. 475).
August 13, 2014, Plaintiff presented to Yale Primary Care
Center for “pain uncontrolled on current
regiment” and refills of her anti-hypertensives and
cholesterol medications. (R. 552-555). The report indicated
Plaintiff had been using double the prescribed amount of
Tramadol and was in need of more medication. (R. 552).
Additionally, Plaintiff stated that no medication eased her
pain except morphine. The supervising physician added to the
report that Plaintiff refused to discuss any type of therapy
or medication besides narcotic treatment. (R. 554). The
supervising physician declined to prescribe morphine. (R.
returned to Primary Care Center on October 8, 2014 with
lumbar pain. (R. 555-559). Dr. Alison Romegialli assessed
Plaintiff. (R. 555). Plaintiff indicated that the pain was
better when she leaned forward, but that she laid flat the
majority of the time. (R. 556). Additionally, Plaintiff
showed significant weight gain over the past few years due to
inactivity and reported an inability to perform household
chores. (R. 556). The doctor indicated lower lumbar
tenderness and a limited range of motion, but no neurological
deficits. (R. 557). Furthermore, the doctor referred
Plaintiff to a pain specialist and a neurologist. (R. 559).
January 12, 2015, Dr. Kolene McDade assessed Plaintiff at the
Primary Care Center. (R. 570-573). The examination affirmed
the continued back pain as well as a gait problem. (R. 571).
The doctor stated that Plaintiff's description of her
pain was out of proportion to the MRI results. (R. 572).
next visit to Primary Care occurred on August 26, 2015, where
she saw Dr. Mohsin Chowdhury for “worsening back
pain” and a renewal of Tramadol. (R. 657-666). The
report showed that Plaintiff had canceled the appointments
for neurology and pain management that were previously
scheduled at Dr. Romegialli's suggestion. (R. 657).
Plaintiff also refused to try aquatherapy, stating she was
afraid of water. (R. 657). The doctor renewed the Tramadol
prescription. (R. 660).
March 29, 2016, Dr. Robert Morrison of the Connecticut Heart
Group, PC evaluated Plaintiff for a cardiovascular
consultation after an abnormal EKG. (R. 885-886).
Plaintiff's height, weight and BMI were 5'6”,
213 pounds, and 34.38 kg/m2 respectively. (R. 885). The
doctor ordered a stress test and an echocardiogram. (R. 885).
Additionally, Dr. Morrison instructed Plaintiff to
discontinue tobacco use. (R. 885).
returned to the Emergency Room at Yale on April 3, 2016,
reporting back pain and abdominal pain. (R. 737-741). The
doctor gave Plaintiff a Licodaine patch and she returned home
after her symptoms improved. (R. 741). Plaintiff came back to
the Emergency Room on April 12, 2016. (R. 742-746). Plaintiff
stated she suffered from the same back pain for years that
her pain was not changing. (R. 742).
2, 2016, Plaintiff saw Dr. Romegialli at the Primary Care
Center for follow-up. (R. 677-680). Plaintiff specified that
she needed narcotics for her back pain. (R. 680). When Dr.
Romegialli attempted to counsel Plaintiff on the best
remedies, Plaintiff interrupted and asked if the doctor would
prescribe her opioids. (R. 680). When the doctor refused to
prescribe narcotics, Plaintiff left the office. (R. 680).
had an abnormal echocardiogram at the Connecticut Heart Group
office on May 18, 2016. (R. 890-892). A stress test occurred
on June 17, 2016. (R. 889). The Plaintiff's shortness of
breath caused the test to end after two minutes. (R. 889).
The doctor noted that Plaintiff was at immediate risk for a
cardiovascular event due to her performance on the stress
test. (R. 889).
heart catheterization and coronary angiography occurred at
Yale, on July 18, 2016. (R. 887-888). A surgical consultation
for a coronary artery bypass graft with Dr. Viswa Nathan took
place on July 21, 2016. (R. 895-897). The catheterization
revealed triple coronary artery disease and Dr. Nathan
suggested coronary artery bypass x 3 to be done the following
day. (R. 895-896). Following the bypass surgery, Plaintiff
remained in the hospital until July 27, 2016. (R. 780- 784).
After being discharged, Dr. Joseph Gallego noted that
Plaintiff returned home and drank half a pint of vodka. (R.
next day, Plaintiff attempted to appear at the hearing before
ALJ Thomas but had a syncopal episode in the lobby and an
ambulance transported her to Yale. (R. 804-833). Plaintiff
remained hospitalized until August 1, 2016 due to evolving
pneumonia. (R. 826). Antibiotics were prescribed. (R. 809).
During her stay, Plaintiff discussed with Dr. Jonathan
Siegfried her ideation that the hospital was keeping her only
for the institution's and employees' financial
benefit. (R. 813).
saw Dr. Chowdhury at the Primary Care Center to follow-up on
August 12, 2016. (R. 879-882). Plaintiff stated her
dissatisfaction with some of the doctors that have evaluated
her, then began complimenting others as the “best
doctors” she has ever had. (R. 879). Dr. Chowdhury,
concerned by her split behavior, suggested a mental health
evaluation. Plaintiff refused. (R. 879). The doctor also
noted that her exercise tolerance was improving. (R. 879).
Nathan evaluated Plaintiff on August 23, 2016. (R. 899-901).
The doctor indicated Plaintiff's height, weight and BMI
were 5'5”, 218 pounds, and 36.28 respectively. (R.
900). Dr. Nathan strongly advised Plaintiff to be on a strict
diet. (R. 900). On a follow-up dated October 11, 2016, Dr.
Nathan saw Plaintiff again. At this visit, Plaintiff weighted
208 pounds and her BMI dropped to 34.78. Dr. Nathan advised
Plaintiff to “lose a few more pounds.” (R.
returned to the Primary Care Center on November 9, 2016 to
discuss back pain with Dr. Graham Taylor. (R. 916-919).
Plaintiff's weight remained at 208 pounds. (R. 917). The
doctor discussed with Plaintiff his reasons for not
prescribing her an opioid. (R. 916). Plaintiff refused all
other suggested treatments. (R. 916). On or around November
14, 2016, Plaintiff had a second lumbar MRI. (R. 910). There
was no significant change when compared to the original MRI.
(R. 907). Plaintiff then went to Yale on December 6, 2016 and
explained that narcotics remained the only medication that
could relieve her pain. (R. ...