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John Santoro v. Michael Astrue

February 7, 2011

JOHN SANTORO, PLAINTIFF,
v.
MICHAEL ASTRUE, COMMISSIONER OF SOCIAL SECURITY, DEFENDANT.



The opinion of the court was delivered by: Magistrate Judge Sheila Finnegan

MEMORANDUM OPINION AND ORDER

Plaintiff John Santoro seeks to overturn the final decision of the Commissioner of Social Security ("Commissioner") denying his application for Disability Insurance Benefits under Title II of the Social Security Act, 42 U.S.C. §§ 416, 423(d). The parties consented to the jurisdiction of the United States Magistrate Judge pursuant to 28 U.S.C. § 636(c), and Plaintiff moved for summary judgment. On April 26, 2010, the case was reassigned to this Court for all further proceedings. For reasons stated below, the Court now grants Plaintiff's motion.

PROCEDURAL HISTORY

Plaintiff applied for Disability Insurance Benefits on April 7, 2006, alleging that he became disabled on March 30, 2005 from an array of ills, principally discogenic and degenerative back disorders. (R. 56, 62). The Social Security Administration ("SSA") denied the claim initially on September 5, 2006, and again on reconsideration on December 29, 2006. (R. 62-66, 70-73). Plaintiff filed a timely request for a hearing, which an Administrative Law Judge ("ALJ") held on May 6, 2008. On September 3, 2008, the ALJ issued an opinion finding that Plaintiff's impairments do not prevent him from performing light jobs that exist in sufficient number in the national economy. (R. 13-22). The Appeals Council declined Plaintiff's request for review on February 2, 2009. (R. 1-3). Plaintiff now seeks judicial review of the ALJ's decision, which stands as the final decision of the Commissioner.

STATEMENT OF FACTS

A. Plaintiff's Medical History

Plaintiff was born on October 28, 1958 and was nearly 50 years old at the time of the ALJ's decision. (R. 20). He is a high school graduate and spent most of his working life as a union carpenter setting up and dismantling trade show exhibits at McCormick Place. (R. 21, 135-36, 138). He also worked from 1995 to 1997 running small offset printing presses. (R. 135, 137). Plaintiff's work as a carpenter regularly required him to lift weights of 50 to 100 pounds. (R. 362).

In March 1993, Plaintiff suffered a work-related injury to his lower back, resulting in pain radiating down both legs. (R. 458). A July 1, 1993 MRI showed mild left foraminal narrowing at L5-S1, with mild spinal stenosis and a mild central protrusion of the L4-L5 intervertebral disc. (R. 458). Plaintiff's back pain and stiffness did not improve, prompting him to see Dr. James B. Boscardin, a board-certified orthopaedic surgeon, on April 29, 1994. After noting that a myelogram showed a central herniation, Dr. Boscardin found Plaintiff to have a positive bilateral straight leg raising test, and indicated that he might benefit from surgical intervention. (R. 475). A few months later, on August 23, 1994, Plaintiff had surgery to repair the damaged discs and to relieve lower back and leg pain.

(R. 480). By February 1, 1995, Plaintiff's neurological exam was "totally within normal limits," and on March 20, 1995, Dr. Boscardin released him to return to work with a restriction that he lift no more than 40 pounds. (R. 463-64).

Plaintiff underwent a series of additional operations in the following years, including hernia repairs in 2000 and 2002, and two arthroscopic surgeries on his left shoulder in 2001. (R. 193-94, 232-33, 242-43, 502, 511). In January 2002, Dr. Boscardin released Plaintiff to return to work with a restriction that he lift no more than 30 pounds overhead.

(R. 496-97).

More than two and a half years later, in September 2004, Plaintiff's lower back troubles returned. A September 8, 2004 MRI showed "[l]arge right and smaller left protrusions of the L5-S1 disc with severe right and moderately severe left foraminal stenosis." (R. 491). Dr. Boscardin diagnosed a new disc herniation at L5-S1 and prescribed Decadron and a Medrol Dosepak for pain. (R. 486). When Plaintiff saw Dr. Boscardin again on September 22, 2004, he exhibited "severe L5-S1 radiculopathy, on the right," "a markedly positive straight leg raising test," "decreased sensation and a markedly positive tension sign," "[d]ecreased to absent Achilles reflex on the right . . . and [d]ecreased sensation over the S1 dermatome." (R. 208-09, 485). The next day, Dr. Boscardin performed a second surgery described as a "micro laminectomy, partial diskectomy L5-S1 on the right." (R. 213-14, 489). During the surgery, Plaintiff exhibited symptoms consistent with a heart attack, and the following week, he received a coronary stent. (R. 351-52). Dr. Boscardin's treatment notes reflect that Plaintiff had experienced coronary symptoms prior to the surgery, but that he had failed to notify Dr. Boscardin because his leg pain was so severe that he did not want to risk delaying his surgery. (R. 286, 483-84).

Plaintiff experienced total relief from his symptoms after the surgery, and in November 2004, he resumed work with a lifting restriction of 10 to 15 pounds. (R. 278, 568). Shortly thereafter, in February 2005, however, he suffered another injury and the lower back and right leg pain returned. A May 24, 2005 MRI showed "recurrent right disc protrusion at the L5-S1 level with resulting spinal stenosis," "[l]eft foraminal stenosis at the L5-S1 level," and "mild central spinal stenosis at the L4-L5 level." (R. 554, 568). Through early June 2005, Plaintiff continued to exhibit symptoms of lumbar radiculopathy, including radiating pain "from the back down through the buttock down to [the] heel," markedly positive right tension sign, muscle weakness, difficulty walking, and decreased right side sensation. (R. 175, 177, 278-79). Dr. Boscardin noted that the May 2005 MRI revealed "a significant herniation at L5, S1 on the right," and scheduled a microlaminectomy to repair this new damage. During that third operation on June 16, 2005, however, Plaintiff suffered a nearly fatal anaphylactic reaction, and Dr. Boscardin abruptly terminated the surgery before performing any repairs. (R. 180-83, 265, 287, 317-18).

On June 28, 2005, Dr. Boscardin completed Plaintiff's microlaminectomy in a fourth surgical procedure. (R. 178-79, 270-71). Once again, Plaintiff experienced greatly reduced pain and neurological signs following this treatment. (R. 171-73). At follow-up visits with Dr. Boscardin through October 24, 2005, Plaintiff continued to exhibit "low-grade radicular-type symptoms in his leg on and off with activities," but he did not have "that terrible pain that he had prior to surgery." (R. 170, 172). In December 2005, Plaintiff returned to Dr. Boscardin complaining of pain going to the right and left legs. Dr. Boscardin observed that Plaintiff was "in no acute neuro crisis other than the fact he has a markedly positive tension sign." He prescribed a host of medications for the pain, including Decadron, a Medrol Dosepak, Indocin, Lyrica and Norco. (R. 169).

A couple of months later, on February 15, 2006, Plaintiff showed marked improvement in his symptoms. Dr. Boscardin found him to be neurologically intact with only occasional back pain, and advised him to "get into a good exercise program," with a goal of walking two to three miles a day. (R. 168). By May 19, 2006, however, Plaintiff's low back problems reappeared, along with achiness in his hip. Dr. Boscardin indicated that the symptoms were likely "discogenic in nature due to the fact that these discs are significantly worn." He started Plaintiff on Vicodin Extra Strength and instructed him to continue taking Lyrica at bedtime. (R. 167). A May 23, 2006 MRI showed degenerative changes at L4-L5 and L5-S1, and central disc protrusion with moderate left and mild right neural foraminal narrowing at L4-L5. The test showed no other evidence of disc herniation, extrusion or protrusion. (R. 188). Dr. Boscardin confirmed these radiological findings during a June 16, 2006 examination, and admonished Plaintiff to take his Lyrica medication on a regular basis. The doctor refilled Plaintiff's Indocin and noted, "I feel [Plaintiff] needs no further surgery on his back at this time, but we need to deal with his chronic nerve irritation." (R. 410).

In August 2006, Plaintiff lost consciousness and fell while walking to the bathroom at night, resulting in multiple broken teeth and facial bones. (R. 381-82, 416-25). The cause of Plaintiff's fainting was never definitively determined, although Plaintiff admits to having consumed four beers on an empty stomach before going to bed, and the hospital measured his blood alcohol level at 0.075%. (R. 422).

Plaintiff saw Dr. Boscardin again on November 17, 2006, and continued to complain of back pain and stiffness. He did not exhibit any radicular symptoms, and the doctor described his "immediate orthopedic problem" as involving the left elbow. (R. 409, 565). When Plaintiff returned to Dr. Boscardin more than a year later on February 21, 2008, he was "in no neurological crisis" but was "getting some cramps" and "simply trying to get by as best [h]e can." (R. 564). At Plaintiff's last visit on April 10, 2008, Dr. Boscardin noted symptoms "compatible with chronic radiculopathy," including pain radiating from his back down his legs, depressed reflexes, and positive straight-leg raising both while lying and sitting. Dr. Boscardin opined that Plaintiff "clearly sounds like he is getting a central issue," but noted that he lacked insurance and was unable or unwilling to get another MRI to confirm that diagnosis. Given Plaintiff's past near-fatal allergic reaction, Dr. ...


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