United States District Court, E.D. New York
KAREN A. INGRASSIA, Plaintiff,
CAROLYN W. COLVIN, Acting Commissioner of Social Security, Defendant.
Offices of Harry J. Binder and Charles E. Binder, P.C.
Attorneys for the Plaintiff By: Charles E. Binder, Esq., Of
States Attorney's Office for the Eastern District of New
York Attorneys for the Defendant By: Rukhsanah L. Singh,
Assistant United States Attorney
MEMORANDUM OF DECISION & ORDER
D. SPATT United States District Judge
February 29, 2016, the Plaintiff Karen Ingrassia (the
“Plaintiff” or the “claimant”)
commenced this civil action pursuant to the Social Security
Act, 42 U.S.C. § 405 et seq. (the
“Act”), challenging a final determination by the
Defendant Acting Commissioner of Social Security Carolyn W.
Colvin (the “Commissioner”), that she is
ineligible to receive Social Security disability insurance
before the Court are the parties' cross motions, pursuant
to Federal Rule of Civil Procedure (“Fed. R. Civ.
P.” or “Rule”) 12(c) for judgment on the
pleadings. For the reasons that follow, the Plaintiff's
motion is granted in its entirety and the Commissioner's
motion is denied in its entirety.
February 5, 2013, the Plaintiff filed for Social Security
disability benefits. She alleged that she had been disabled
since August 10, 2008. The Plaintiff's application was
denied, and she requested an administrative hearing.
15, 2014, Administrative Law Judge Andrew S. Weiss
(“ALJ Weiss” or the “ALJ”) conducted
an administrative hearing. The Plaintiff was represented by
counsel. At the hearing, the Plaintiff amended her alleged
onset date of disability to February 2, 2009.
August 14, 2014, the ALJ issued a written decision denying
the Plaintiff's claim. The Plaintiff requested a review
from the Social Security Appeals Council (the “Appeals
Council”). On January 6, 2016, the Appeals Council
denied her request and the ALJ's decision became the
Commissioner's final decision.
The Administrative Record
Relevant Medical Evidence
Before the Relevant Period (Prior to February 2,
August 21, 2008, the Plaintiff underwent arthroscopic surgery
of her left knee with reconstruction of the anterior cruciate
ligament (the “ACL”) and hamstring autograft and
medial meniscal repair. The surgery was conducted by
orthopedic surgeon Dr. Jeremy Idjadi (“Dr.
Idjadi”). After the operation, the Plaintiff was
diagnosed with a left knee ACL tear with a grade 3 sprain;
left knee medial meniscus tear; and chondromalacia of
multiple compartments, medial and lateral.
August 28, 2008, the Plaintiff followed up with Dr. Idjadi.
She reported to him that she had gone to the emergency room
due to a brief period of redness in her leg. An examination
revealed numbness laterally and distally to the tibial
incision; a trace amount of warmth; mild to moderate
effusion; loss of 3 to 5 degrees from straightening her knee;
flexion limited to 45 degrees; pain and guarding with range
of motion; and some edema around her ankle. A venous duplex
scan was negative for deep vein thrombosis
(“DVT”). The Plaintiff stated that she had not
yet started physical therapy because she had transportation
issues. Dr. Idjadi prescribed physical therapy, Percocet, and
OxyContin, and told the Plaintiff not to bear any weight on
her left leg.
September 4, 2008, the Plaintiff, who arrived to the
appointment in a wheelchair, told Dr. Idjadi's
physician's assistant (“PA”) that she was
experiencing significant discomfort; that she needed home
health physical therapy because of the level of her pain; and
that she was primarily isolated to the upper floor of her
home. The Plaintiff's sutures were removed without
significant difficulty. Two-view X-rays of the left knee
demonstrated appropriate ACL fixation components. Dr.
Idjadi's PA assessed a reasonably good course post left
ACL reconstruction and lateral meniscus repair. The PA
advised the Plaintiff to remain in a Bledsoe Brace at zero
degrees with partial weight bearing on the operative side. He
further prescribed Vistaril.
patient progress report dated September 30, 2008 notes that
the Plaintiff had six total physical therapy sessions as of
that date, but only one of those visits occurred after her
operation. She had begun physical therapy on July 17, 2008.
The Plaintiff was unstable when descending stairs and had a
tender knee, with poor control and tone.
October 2, 2008, the Plaintiff stated that she had made great
progress with physical therapy. The Plaintiff was using a
crutch to walk, and her hinged knee brace for
“protection.” She said that she only took
Percocet at night. Her left leg was neurovascularly unchanged
mild-to-moderate swelling in the ankle extending up to the
calf; decreased muscle tone; and weakness graded as 4.
Flexion of the knee was 105º to 110º, passively,
and extension was about 180º. Dr. Idjadi prescribed a
duplex scan to rule out DVT and recommended home exercises
and PT. A lower extremity venous duplex scan conducted on
October 2, 2008 revealed no evidence of DVT.
November 5, 2008, the Plaintiff told Dr. Idjadi's staff
that she felt like her improvement had hit a plateau. On
examination, the left leg exhibited trace effusion. Dr.
Idjadi instructed her on additional home exercises and
completed a form for modified duty.
the Plaintiff returned for a follow-up on November 26, 2008,
she reported that her pain was progressively worsening
following aggressive physical therapy. She further stated
that she experienced pain when she shopped or ran errands for
more than 90 minutes. Physical examination revealed minimal
inflammation in and around the knee joint; no joint effusion;
point tenderness near the point of surgery; flexion to
approximately 120 degrees; some “marked” atrophy
compared to the right side; and weakness with knee extension.
X-rays of the left knee revealed a well-seated staple in the
proximal tibia and a well-seated transfix pin in the distal
femur, without evidence of lysis or failure of the
components. The Plaintiff was advised to decrease her
physical therapy from four days a week to three; and to limit
running errands to two to three hours per day. She was
prescribed Voltaren and Ultram.
December 4, 2008, Dr. Idjadi's physical examination of
the Plaintiff revealed that flexion was 5 degrees short of
full activity; and a hamstring popliteal angle about
50º, with tightness posteriorly. Dr. Idjadi noted trace
effusion again. The Plaintiff's ACL was solid and there
no sign of a meniscal problem. Dr. Idjadi prescribed Voltaren
gel. The Plaintiff attended physical therapy that day as
December 23, 2008, the Plaintiff told Dr. Idjadi that she had
been fired from her job, but she believed that she had
“turned the corner.” On examination, her left leg
was neurovascularly intact, with the incisions well healed;
she had almost full flexion; she had solid stability and her
ligaments were not tender; she had inflammation and moderate
tenderness in her knee and hamstring. There was no erythema,
warmth, effusion, or pain with movement. She received an
injection of Marcaine with epinephrine in her left knee. Dr.
Idjadi prescribed Voltaren gel, icing, and physical therapy.
January 2, 2009, the Plaintiff saw a PA in Dr. Idjadi's
office who gave her a second Marcaine injection. The
Plaintiff told the PA that the last injection had caused a
decrease in her pain. The PA Noted tenderness in the
Plaintiff's hamstrings, and that her range of motion was
a well-preserved zero degree of extension to 125 degrees of
January 20, 2009, Plaintiff returned to Dr. Idjadi. She
reported that the steroid injection had helped. She further
told Dr. Idjadi that she had obtained a new job and believed
she was capable of performing all the job's duties. She
had no complaints. On examination, she had full strength and
range of motion in her left knee.
During the Relevant Period (February 2, 2009 through August
February 2, 2009, a physical therapy report noted that the
Plaintiff's range of motion had increased, and that she
had met her physical therapy goals.
the Plaintiff returned to Dr. Idjadi on February 24, 2009,
she told him that her knee had buckled less than a week
earlier, and that her pain had returned. A physical
examination revealed trace effusion; mild global tenderness
in the areas of the joint capsule and lateral joint line;
mild opening at 15 degrees; a painful patellofemoral
compression test; and mild patellofemoral crepitus. Her ACL
was stable. Dr. Idjadi did not know the reason for the
setback, but diagnosed her with a mild MCL sprain. He
recommended that she wear a hinged knee brace, treat with
ice, and take Celebrex.
11, 2009 MR Arthrogram of the Plaintiff's left knee
showed a vertical re-tear of the medial meniscus; a small
horizontal tear in the lateral meniscus; and a moderate sized
chondral flap in the weight-bearing portion of the medial
femoral condyle with small focus of moderately severe
cartilage loss in the weight bearing portion of the lateral
tibial plateau. The ACL repair was intact.
March 13, 2009, the Plaintiff told Dr. Idjadi that she had
another episode of buckling, which had preceded the MR
Arthrogram. The Plaintiff said that her knee had gotten
progressively worse, that it was quite painful, and that the
pain was limiting her daily activities and job functions to a
great degree. The Plaintiff listed her daily pain as an 8 or
9 out of 10. Exam revealed mild to moderate left knee
effusion, “exquisite” medial joint line
tenderness, mild medial collateral ligament tenderness and
pes region tenderness, and flexion to 120 degrees. Dr. Idjadi
recommended further arthroscopic surgery, and instructed the
Plaintiff to wear the knee brace and modify her activities.
He prescribed Tramadol and Percocet.
March 26, 2009, the Plaintiff underwent a second arthroscopic
surgery for medial meniscectomy; removal of a loose body; and
shaving chondroplasty and debridement. The surgery was
performed by Dr. Idjadi.
30, 2009 venous duplex scan of the Plaintiff's left leg
showed no evidence of DVT or superficial thrombophlebitis.
April 9, 2009, the Plaintiff followed up with Dr.
Idjadi's office. She said that she had started physical
therapy, that she was taking oxycodone only at night for
pain. Her range of motion was 0º of extension and
115º of flexion. There was tenderness to palpation
around the incision sites, mild effusion, and a slight
antalgic gait. The Plaintiff was directed to continue
physical therapy three times a week, and she was prescribed
April 14, 2009, the Plaintiff reported to Dr. Idjadi that the
sharp pain in her knee was worsening. Physical examination
revealed mild tenderness along the hamstrings; moderate to
severe tenderness along the medial joint line; extension 5
degrees short of full extension; flexion over 130 degrees.
Dr. Idjadi administered another steroid injection. There was
an increased range of motion following the injection.
April 16, 2009 physical therapy report noted that the
Plaintiff had tolerance for activity and walking, but had
difficulty with endurance and descending stairs. A report
from May 5, 2009 noted that the Plaintiff had improved in her
tolerance for walking and performing errands.
6, 2009, the Plaintiff reported that the steroid injection
had helped and that she felt she was progressing. Dr. Idjadi
noted that the Plaintiff's patella was “somewhat
socked in with decreased medial lateral mobility, . . . with
inability to bring the tilt to neutral even passively.”
(R. at 347).
21, 2009, the Plaintiff told Dr. Idjadi that she had
experienced another buckling episode. She complained that she
could not walk for long periods of time. An exam revealed
peripatellar tenderness of the distal aspect of the patella
and femoral and lateral facets; positive patellofemoral grind
test with mild patellofemoral crepitus; medial joint line
tenderness; and tightness with deep flexion of the knee. Dr.
Idjadi noted that there was no evidence of ongoing meniscal
injury, although there was some tenderness. Dr. Idjadi
recommended that the Plaintiff receive a second opinion from
his partner, Dr. Peter Mandt (“Dr. Mandt”).
26, 2009, Dr. Mandt examined the Plaintiff. He believed that
the Plaintiff's pain was related to some arthrofibrosis,
with possible notch impingement. The doctor noted her
prognosis was not good because of her body weight. He
suggested another steroid injection.
4, 2009, Dr. Idjadi administered another steroid injection.
The Plaintiff's physical examination on that date was
unchanged from May 21st, except that Dr. Idjadi
emphasized the tenderness in the Plaintiff's knee.
16, 2009, Ms. Ingrassia stated that the injection helped the
sense of “fullness” in her knee, but did not
decrease her pain at all. She continued to wear a knee brace
and ice her knee, but had an increase in pain following a
session of physical therapy. An examination revealed pain
with full hyperextension of the knee, anteromedial joint line
tenderness adjacent to the patellar tendon and nearby the
previous anteromedial incision, and joint effusion. Dr.
Idjadi noted that the Plaintiff's pain may have been due
to arthrofibrosis and some notch impingement. After a
discussion, the Plaintiff intimated that she wanted another
arthroscopic surgery. A physical therapy report three days
later on June 19, 2009 noted that the Plaintiff felt
frustrated with her lack of progress and her inability to
return to work.
14, 2009 x-ray showed degenerative changes in her right knee.
Dr. Idjadi assessed possible rheumatologic or systemic joint
problems, likely aggravated by overuse and being overweight
On August 4, 2009, the Plaintiff reported that she had an
independent medical examination performed by Dr. Bradley
Billington who mentioned possibly debriding the pes bursitis,
and noted decreased range of motion of some 8 degrees of
flexion. Dr. Idjadi noted no significant changes from the
June 16, 2009 examination, other than moderate tenderness
with some soft tissue swelling. Her range of motion was a few
degrees of hyperextension.
Plaintiff underwent a third arthroscopic surgery on August
10, 2009, which included lysis of adhesions in the knee;
chondroplasty of the medial femoral condyle; and an open pes
August 24, 2009, the Plaintiff told a PA at Dr. Idjadi's
office that she had some foot swelling and tenderness, but
did not go to the emergency room. The Plaintiff was
September 15, 2009, the Plaintiff told Dr. Idjadi that her
hamstrings were bothering her and she had some numbness. On
examination, there was subjective decreased sensation distal
to an incision point, but sensation was grossly intact. She
had almost full flexion and extension strength. The doctor
assessed possible nerve inflammation; prescribed Neurontin;
and recommended vitamins.
October 2, 2009, the Plaintiff reported that she had an onset
of pain the previous night. An examination showed
subjectively decreased sensation in her left knee near the
incision but it was otherwise grossly intact. Dr. Idjadi
recommended a gradual resumption of activities with the
physical therapist; a knee brace; icing; and continued
medications. He cautioned against deep knee squatting and
deep knee bending with any resistance.
physical therapy report from October 13, 2009 noted that the
Plaintiff walked for ...