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Shoulders v. Berryhill

United States District Court, N.D. West Virginia, Elkins

January 16, 2018

NANCY A. BERRYHILL, Acting Commissioner of Social Security, Defendant.

          BAILEY, JUDGE.




         On February 17, 2017, Plaintiff Susan Ann Shoulders (“Plaintiff”), by counsel Jan Dils, Esq., filed a Complaint in this Court to obtain judicial review of the final decision of Defendant Nancy A. Berryhill, Acting Commissioner of Social Security (“Commissioner” or “Defendant”), pursuant to Section 205(g) of the Social Security Act, as amended, 42 U.S.C. § 405(g). (Compl., ECF No. 1). On April 26, 2017, the Commissioner, by counsel Helen Campbell Altmeyer, Assistant United States Attorney, filed an answer and the administrative record of the proceedings. (Answer, ECF No. 6; Admin. R., ECF No. 7). On May 25, 2017, and June 30, 2017, Plaintiff and the Commissioner filed their respective Motions for Summary Judgment. (Pl.'s Mot. for Summ. J. (“Pl.'s Mot.”), ECF No. 9; Def.'s Mot. for Summ. J. (“Def.'s Mot.”), ECF No. 13). Following review of the motions by the parties and the administrative record, the undersigned Magistrate Judge now issues this Report and Recommendation to the District Judge.


         On January 22, 2013, Plaintiff protectively filed her first application under Title II of the Social Security Act for a period of disability under Title XVI of the Social Security Act for Supplemental Security Income (“SSI”), alleging disability that began on August 17, 2011. (R. 181). Plaintiff's earnings record has no date last insured listed (R. 194). This claim was initially denied on July 31, 2013 (R. 112) and denied again upon reconsideration on November 13, 2013 (R. 120). On January 3, 2014, Plaintiff filed a written request for a hearing (R. 123), which was held before United States Administrative Law Judge (“ALJ”) Karen Kostol on June 17, 2015 in Morgantown, West Virginia. (R. 31-72). Plaintiff, represented by Ambria Adkins at the hearing, appeared and testified, as did Casey Vass, an impartial vocational expert. (Id.). On July 2, 2015, the ALJ issued an unfavorable decision to Plaintiff, finding that she was not disabled within the meaning of the Social Security Act. (R. 15-25). On December 21, 2016, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner. (R. 1-4).


         A. Personal History

         Plaintiff was born on January 27, 1964, was forty-nine (49) years old when she filed her claim (R. 181), and fifty-one (51) years old at the time of the hearing. (R. 40). She completed eleventh grade, and never obtained a GED; Plaintiff further testified that she was in special education classes for the duration of her schooling. (R. 42). Plaintiff's prior work experience included video attendant, telemarketer, waitress, and short order cook. (R. 24). She was divorced at the time she filed her initial claim (R. 181) and was divorced at the time of the administrative hearing. (R. 33). She has four children, none of whom are dependent or live with her. (R. 222, 696). Plaintiff alleges disability based on major depressive disorder (severe with psychotic features), generalized anxiety disorder, polyneuropathy, memory impairment, chronic lower extremity edema, peripheral arterial disease, partial amputation of second and third left toes, and exogenous obesity. (R. 289).

         B. Relevant Medical History

         At issue on appeal is the ALJ's treatment of psychological evidence; no arguments are raised as to Plaintiff's physical conditions or limitations. Accordingly, review of evidence is limited to psychological evidence only for relevance and brevity.

         1. Medical History Post-Dating Alleged Onset Date of August 17, 2011

         Plaintiff began receiving mental health treatment from Community Mental Health Center (“CMHC” - Upshur County) in July of 2013. (R. 681). At her initial intake assessment, Plaintiff reported that she was “seeking treatment for depression.” (R. 681). Plaintiff was referred for mental health treatment by her primary care doctor; she noted that “[h]er family physician has prescribed her anti-depressant medication, ” but she had never attended therapy. Id. At that appointment, it was noted that “Susan experiences moderate to severe depressive symptoms daily.” Id. Plaintiff reported that she “does not return phone calls and has no desire to spend time with other friends or family members.” Id. Although she “used to make an effort to spend time with her grandchildren, [] she has not seen [them] in several months.” Id. She has also not visited her son, who is institutionalized “in the State hospital” as a result of schizophrenia, in several months. (R. 682). She reported “that she could be verbally aggressive, ” and as a result, she tried to avoid “situations that she knew would turn volatile.” Id.

         At this intake appointment, Plaintiff appeared “somewhat disheveled, ” but she was clean and appropriately dressed. (R. 683). She reported being unable to sit still. Id. Plaintiff was cooperative and communicative, and appeared to be relaxed. Id. Plaintiff's speech was observed to be “slow, ” and she appeared to have “a hard time recalling events.” (R. 683). Her mood was observed as “depressed and irritable, ” and her affect “flat.” Id. She reported significant problems with concentration and being “quite forgetful.” Id. Plaintiff reported experiencing both auditory and visual hallucinations. Id. Plaintiff's insight and judgment were deemed “fair.” Id. She reported suicidal ideations three to five (3-5) times per week, but denied any plans or means to follow through with them. Id.

         On September 17, 2013, Plaintiff was seen for a psychiatric intake evaluation at United Summit Center by Linda McPherson (“USC” - Buckhannon). (R. 694). Plaintiff stated “I just can't stand being around people.” Id. She reported that her moods worsened after her mother's death in 2009, around which time she also got divorced - there was “a lot of drama going on at th[at] time.” Id. She reported that she would just “rather sleep” - sometimes all night and all day the next day. Id. She “doesn't want to be bothered, ” does not want to talk on the phone, and does not like to be around anyone. Id. “Things are getting progressively worse.” Id. Plaintiff continued to report passive suicidal thoughts. Id. She reported feeling hopeless and useless. Id. She noted a family history of mental conditions, including her mother (schizophrenic), son (schizophrenic, bipolar, mood disorder), her daughter (attempted suicide), and her other son (suicidal and homicidal). Id. Plaintiff was diagnosed with Major Depressive Disorder, recurrent, severe, with psychotic features, and assigned a Global Assessment of Functioning (“GAF”) score of 50. (R. 695). Plaintiff was directed to continue taking Prozac, discontinue Paxil, take Tegretol, and do therapy. Id.

         On December 3, 2013, Opal Fox with CMHC completed a mental status assessment. Plaintiff was dressed appropriately with good hygiene, cooperative, and maintained good eye contact. (R. 692). Speech and thought processes were normal. Id. Plaintiff's affect was normal and her mood congruent. Id. Although Plaintiff admitted having auditory hallucinations, she did not appear to be having any hallucinations at that time. Id. She denied having any delusions. Id. Plaintiff complained again of memory problems, though Fox noted both appeared to be intact during the interview. Id. Fox also administered the Adult Functional Assessment and Plaintiff's scores were as follows (R. 692): Domain I - mild self care dysfunction (R. 685); Domain II - moderate dysfunction; Domain III - moderate social, interpersonal, and family dysfunction (R. 685); Domain IV - marked concentration and task performance dysfunction, moderate hallucinations, moderate poor concentration, moderately suspicious (R. 684); and Domain V - mild maladaptive, dangerous, and impulsive behaviors dysfunction. (R. 685).

         Plaintiff was diagnosed with Major Depressive Disorder, recurrent, severe with psychotic features, and a GAF score of 50. Id. By the next review scheduled for March 2014, the treatment plan listed the following outcome objectives: Plaintiff will 1) “reduce her moderate symptoms of hallucinations, poor concentration and suspiciousness as evidenced by the Comprehensive Clinical Assessment to a targeting rating of mild or not present;” (R. 684); 2) “reduce her severe symptoms of agitation as evidenced by the Comprehensive Clinical Assessment to a targeted rating of moderate or mild, ” (R. 685); and 3) “reduce her mild symptoms of suicidal ideations as evidenced by the Comprehensive Clinical Assessment to a targeting rating of not present.” (R. 686).

         Plaintiff's case manager referred her for an evaluation because Plaintiff had “been experiencing a significant level of symptoms and expressed concern over her diagnosis due to family history of mental illness and medication inefficacy.” (R. 696). On February 10, 2014, psychologists Laura Wilson, M.A. and Dennis Kojaza, Ph.D. completed a psychological evaluation of Plaintiff at USC. Id. Wilson reviewed Plaintiff's chart, conducted a clinical interview and mental status examination, and administered the Weschler Abbreviated Scale of Intelligence (WASI-II) and the Minnesota Multiphasic Personality Inventory (MMPI-2). Id.

         In the clinical interview, Plaintiff again reported a worsening of her symptoms following her mother's death in 2009. (R. 697). She reported having “difficulty interacting with others and can become verbally abusive towards them.” Id. She reported that she “remains isolated at home so that she does not have to interact with others.” Id. She reported having “to be prompted to take showers and to leave [her] home.” Id. She complained of memory problems and complained that tasks took “longer than they should, either because she gets off track or because she does not care to complete them.” Id. She reported being “easily frustrated with everything” and experiencing “rapid mood changes where she will be happy and then snap to anger.” Id. She reported sleeping much of the day, and prefers being asleep to being awake. Id. “[A]t time she feels as though someone is talking to her and she is answering . . . she hears voices in her head and it feels as though she is telling herself a story and prompting her throughout the day.” Id.

         As to the mental status assessment, Wilson noted that Plaintiff was clean and dressed appropriately. (R. 698). She was cooperative, and motor skills appeared intact. Id. Plaintiff “presented with depression and some irritability, ” described her mood as “sad, ” and evidenced an “average” range of emotional expression. Id. Speech was normal; Plaintiff was appropriately oriented. Id. Although immediate memory was intact, “delayed” memory was “impaired as evidenced by her ability to only recall one of the four items previously presented after a short delay.” Id. Plaintiff also had “some difficulty” providing specific details about her personal history, indicative of remote memory issues. Id. Insight and judgment were deemed “fair.” Id. Plaintiff again reported passive suicidal thought with no plan or intent. Id.

         As to the WASI, Wilson noted that although Plaintiff's IQ scores were “Borderline” or “Extremely Low, ” that was “not likely truly representative of Susan's intellectual ability, as she exhibited some resistance towards clarifying answers on certain subtests and admitted that she often becomes easily frustrated with tasks.” (R. 698).

         As to the MMPI-2, Wilson noted that Plaintiff's “MMPI-2 profile was invalid due to significantly elevated validity scales.” (R. 699). “Possible explanations for her high response rate (on the deviant scale items) include: reading problems, a plea for immediate help for significant symptoms, and to derive secondary gains.” Id. Wilson was able to eliminate one of those options - reading problems - because Plaintiff's “functional abilities and scores on the VRIN and TRIN validity scales rule out reading problems as a contributing factor.” Wilson did not eliminate either of the two remaining possible explanations for the invalidity of the MMPI-2 results. Id. Wilson also observed that regardless of the issues with the personality inventory (MMPI), she believed that Plaintiff nonetheless “[wa]s likely experiencing a significant level of depression.” Id. (emphasis added). Like consultative examiner Morgan, Wilson also noted that Plaintiff's “history of tumultuous relationships and aggressive interpersonal skills may be a result of a specific personality disorder that is not evident at this time.” (R. 699-70). Wilson also noted that Plaintiff's “symptoms of consistent sadness, irritability, loss of interest, self-neglect, fleeing suicidal ideation, and concentration problems support” the Major Depressive Disorder diagnosis (severe) Plaintiff was regularly assigned. (R. 699). Wilson recommended that Plaintiff continue medication management and could also benefit from individual therapy to address angry outbursts. (R. 700).

         At a review assessment at CMHC on March 26, 2014, Plaintiff continued to report “mild suicidal thoughts and stated that she does not ‘want to be in this world anymore.'” (R. 687). She reported that she and her boyfriend broke up “because she always ‘snapped' at him.” Id. She complained of frequent mood swings and not sleeping much at night. Id. She reported not feeling like doing much lately, having no energy, and needed to be told to take a shower. Id. She reported anxiety and “picking at her fingernails due to [the anxiety].” Id. She does not like being around people and stated she would like “to run away to Utah.” Id. She continued to experience suicidal thoughts with no plan or intent. She continued to experience suicidal thoughts with no plan or intent. Id. Her diagnosis of Major Depressive Disorder, recurrent, severe, with psychotic features - “as evidenced by her suicidal ideations, withdrawal, impulsivity, verbal aggression, hallucinations, poor concentration, suspiciousness, depression, guilt, anxiety, hopelessness, agitations, hyperactivity, distractibility, loss of interest, change in appetite and sleep difficulties.” (R. 688). She was assigned a GAF score of 50. Id.

         Plaintiff began treating at Bridgeport Behavioral with Dr. Salman in May of 2014. (R. 820). Her intake evaluation noted chief complaints were depression and anxiety since 2004 and worsening over the years. Id. She complained of difficulty remembering things, irritability (“'snaps' at people”), racing thoughts, insomnia, mood swings, crying spells, and paranoia (“always feels like people are talking about her.”). Id. Plaintiff was oriented, her speech was clear, and hallucinations was marked “? Unsure.” Id. Mood was described as “okay, ” and affect was reactive. Id. Occasional passive suicidal ideations were noted. Id. A GAF score of 45 was assigned. (Axis V). Id.

         Subsequent visits spanning June 2014 - May 2015 continue to document the same - repeated complaints of poor sleep, feeling emotional, mood swings, crying spells, and racing thoughts. Though Plaintiff was generally cooperative, had good eye contact, and clear speech, she also regularly evidenced a depressed or anxious mood and labile or blunted affect, and delusions or hallucinations were sometimes noted. On July 30, 2014 Plaintiff reported that she “no longer feels like jumping out of [her] skin, ” but “still [was] not [doing] good, ” and continued to complain of racing thoughts, and feeling depressed and hopeless. (R. 817). In August 2014 she complained of mood swings and feeling emotional (reporting she would cry when watching television). (R. 816). In October 2014 Plaintiff again complained of mood swings and feeling emotional; she was frustrated with weight gain and her medication, and wanted Risperdal switched to something else. (R. 815).

         On January 13, 2015, Plaintiff “admit[ted] that she continues to feel easily provoked [and] irritated, ” experienced anxiety attacks, and reported a confrontation in which she felt “agitated” and “got in in [a] man's face and yelled at him.” (R. 814). In February 2015 she reported sleeping better, but in terms of moods and behaviors she was “about the same . . . irritated by ‘people' in general, mood swings . . . paranoia [she felt like people are talking about her], racing thoughts, ” feeling isolated and withdrawn, and still “snapping quickly at family and friends.” (R. 813). By March 2015 her sleep was worse again, and her “mood swings and anxiety [we]re continuing problems.” (R. 812). In April 2015 Plaintiff was “not feeling good” and continued to feel depressed and have mood swings, and reported that she “feels more anxious lately.” (R. 811). On May 1, 2015, Plaintiff reported visual hallucinations (“having a vivid vision of her son and the police coming in”), feeling overwhelmed, and continued mood swings. (R. 810). On May 29, 2015, Plaintiff reported improvement in her restless leg syndrome, but her sleep was still “poor, ” she was still irritable. (R. 809).

         2. Medical Reports/Opinions

         a. Disability Determination at the Initial Level

         i. Mental Limitations

         On July 8, 2013, agency reviewer Jim Capage, Ph.D. reviewed Plaintiff's records, evaluated listings 12.04 (affective disorders and 12.06 (anxiety disorders), and completed a psychiatric review technique (“PRT”) and Mental Residual Functional Capacity (“MRFC”) assessment. (R. 78). In his PRT, Capage found mild limitations of Plaintiff's activities of daily living, moderate difficulties in maintaining social functioning, and moderate difficulties in maintaining concentration, persistence or pace. (R. 79). As to sustained concentration and persistence limitations, Capage found Plaintiff had moderate limitations in her ability to 1) carry out detailed instructions, 2) maintain attention and concentration for extended periods, 3) work in coordination with or in proximity to others without being distracted by them, and 4) complete a normal workday and workweek without interruptions from psychologically-based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods. (R. 81-82). As to social interaction limitations, Capage found Plaintiff was moderately limited in the ability to 1) accept instructions and respond appropriate to criticism from supervisors, and 2) get along with coworkers or peers without distracting them or exhibiting behavioral extremes. Id. (R. 82). As to adaptation limitations, Capage answered “Yes” to the question, “Does the individual have adaptation limitations?” but went on to list that Plaintiff was “not significantly limited” or had “no evidence of limitation” in each category of adaptive limitations. Id. Capage added that Plaintiff's “impairments are severe, but do not meet nor equal these listings, ” (R. 78), and that:

MRFC assessment indicates that the [Plaintiff] can learn and perform at least routine 2-3 step work-related activities. Tasks should be low stress with no fast-paced production quotas, no supervisory responsibilities, and no complex decision making. She can sustain basic work interactions, but is best suited to work at tasks that do not require cooperative endeavors in a setting that calls for no more than occasional and superficial social interaction.

(R. 82-83). Plaintiff was found partially credible as to her mental complaints because her “statements concerning her [symptoms] and related functional limitations appear to exceed that supported by the [medical evidence of record] and are deemed not fully credible.” (R. 79). Under “Weighing of Opinion Evidence, ” the determination stated “[t]here is no indication that there is medical or other opinion evidence” (R. 79); and under “Reconciling of Source Opinion, ” “[t]here is no indication that there is opinion evidence from any source.” (R. 83).

         b. Disability Determination at the Reconsideration Level

         Plaintiff's disability determination at reconsideration indicated additional psychological records dated July 8, 2013 and September 17, 2013. (R. 91). On October 30, 2013, agency reviewer Ann Logan, Ph.D. reviewed the prior PRT and MFRC assessments and affirmed them. (R. 93). Logan noted only that the “[n]ew evidence [was] received and reviewed. No change in assessment.” Id.

         c. Consultative Examination - Mental Assessment

         On June 29, 2013, Morgan D. Morgan, M.A. completed a consultative mental assessment of Plaintiff at the Commissioner's request, including a mental status examination and clinical interview. (R. 505). Morgan noted that he reviewed records from the Tri-County Health Clinic, Southern Upshur County, and United Hospital Center. (R. 506). Morgan recounted Plaintiff's subjective complaints as follows:

SUBJECTIVE SYMPTOMS: The client reported history of recurrent depressive episodes. She described her current mood as typically depressed. She reported problems with attention, concentration, and recall. The client reportedly frustrates easily and displays irritability. She reported symptoms of anhedonia, as well as a diminished libido. She reported guilt feelings. She is an anxious individual who readily ruminates over problems. She sometimes feels restless and apprehensive. The client reportedly paces or picks at her nails. She has a history of poor anger control. Relationships have often been highly tempestuous and problematic. Her sleep is reportedly disturbed. Her appetite is diminished. She has been losing weight. The client reported occasional crying spells. Her energy level is diminished. She denied any past suicide attempts or any current plan of suicide. She denied a history of mania, PTSD, or psychosis.

(R. 505-06). Objective symptoms observed by Morgan included that Plaintiff appeared “somewhat tense” and “somewhat irritated” at times, with restricted affect. (R. 508). Her mood was dysphoric and occasionally anxious. Id. Morgan also noted that Plaintiff was cooperative and compliant, and her eye contact was good, with no abnormalities noted as to posture or gait. (R. 507). Speech and verbal responses were within normal limits. Id. Morgan noted that Plaintiff was oriented to time, name, and place, but was uncertain of the date. Id. Plaintiff's insight was mildly deficient; her judgment was within normal limits. Id. Plaintiff's immediate and remote memory were mildly deficient, based on results of recall tests. (R. 507-08). Plaintiff's recent memory was moderately deficient. (R. 509). Her social functioning was moderately deficient, based upon the assessment. Id. Her concentration was moderately deficient, based on the Digit Span subtest of the WAIS-IV. (R. 508). Persistence was deemed mildly deficient, based upon presentation. (R. 509).

         Morgan diagnosed Major Depressive Disorder, recurrent, moderate; Generalized Anxiety Disorder, and “probable Personality Disorder” with a history of Borderline Personality features. (R. 508). Social functioning was deemed moderately deficient, based on the results of Morgan's assessment. (R. 509). Morgan opined that Plaintiff's prognosis was “poor.” (R. 508).

         d. Verification of Disability Form

         Primarily at issue here, on November 11, 2014, Dr. Salman completed a Verification of Disability form for Plaintiff pursuant to an application for her to reside at Weston Arbors, subsidized housing for the elderly and disabled. (R. 821-823). Unlike a Medical Source Statement form as is typically completed by treating physicians for the Commissioner, this “check box”-style form solicited only a few basic questions. (R. 822). Dr. Salman checked “Yes” to indicate that Plaintiff had “a disability, as defined in 42 U.S.C. 423, which means [an] inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment that . . . has lasted or can be expected to last for a continuous period of not less than 12 months.” Id. He also checked “Yes” to indicate that Plaintiff had “a physical, mental, or emotional impairment that is expected to be on long-continued and indefinite duration.” Id. This form did not solicit or provide any space for the completing physician to indicate functional limitations or explain his answers to the checkbox questions, noting that information requested included “only the minimum information necessary to determine whether you meet the applicable definition of disability . . . Any other request for information about you is not relevant and may not be asked (e.g., diagnosis, treatment plan). (R. 823).

         C. Testimonial Evidence

         At the ALJ hearing held on June 17, 2015, Plaintiff testified that she was divorced and lived alone. (R. 41). She received food stamps and a medical card. (R. 43).

         She worked in 2011 for a month or two at Jane Lew Trucking; she left that job because she felt the people around her were talking about her, and she could not handle the pace. (R. 45). She worked at the sports grill from November to February of 2011. Id. She occasionally cooked and waitressed at this job, but the majority of the time, she handled the video game machines. (R. 49). She testified that she had to count money and pay out money to customers, and “made a lot of mistakes.” Id. She left that job because her manager yelled at her, though she also had problems with stress, anxiety and sitting still with that job. (R. 46). Plaintiff worked for Crestview Manor Nursing and Rehab doing housekeeping. (R. 47). She quit after two weeks, again because she “couldn't handle the people.” Id. Plaintiff worked for the Tele Response Center doing telemarketing for a number of years. Id.

         The ALJ asked Plaintiff what conditions she had the led her to believe she could not work. Plaintiff testified that she “wouldn't be able to remember” or operate a register any longer, and cannot stay focused for long. (R. 51). She also finds it difficult to stay in one place and has to walk constantly. Id. Moreover, she cannot be around people as she cries a lot and “snap[s] real easy.” Id.

         Plaintiff's attorney then questioned Plaintiff further about her impairments. Plaintiff testified that after her toes were amputated, she has difficulty staying balanced, both when walking or standing still. (R. 52). She does not use any assistive devices to walk. Id. She testified that when she has trouble with her balance, “people make fun of [her] because [she] look[s] like [she is] drunk, ” and sometimes staggers. (R. 53). She continues to have problems with edema (swelling) in her legs, which she notices “at least once a day.” Id. She takes Lasix for that, which her doctors took her off for a few months due to complications with her kidneys, but she was subsequently put back on. (R. 54). She testified that the Lasix was helping some, but she still has to prop her legs up every night and sometimes during the day due to the swelling. Id. Plaintiff testified that her kidneys were being monitored and checked every six months. (R. 55). She is also having visual hallucinations “a few times a month, ” for which her dosage of Abilify was recently increased. Id.

         As to mental health treatment, Plaintiff testified she has seen Dr. Salman monthly for the past year for psychological issues and also sees a therapist named Amy at the same office. (R. 56, 58). Prior to that, she was receiving counseling at United Summit Center with Opal Fox. (R 56). Dr. Andrews also prescribed her Prozac as well. Id. Plaintiff currently lives in housing for senior citizens or the disabled. Id. Although she did not meet the age requirements, she was able to obtain housing there pursuant to a statement from Dr. Salman that she was disabled. (R. 58).

         As to daily activities, Plaintiff testified that she rarely sees or talks to her friend Faye any more. (R. 59). Now, her daughter goes to the store with her approximately once a week, as she “do[es not] like the people.” Id. Plaintiff also goes out to the grocery store by herself when she can borrow her daughter's car. (R. 60). She also goes for walks on her own, to the store and back. Id. When Plaintiff goes to Walmart by herself, she cannot stay very long because she gets upset easily by the people there. (R. 61). She has problems sleeping and takes a sleeping aid, but still wakes up through the night and her mind races for “about an hour.” Id. During the day, Plaintiff testified that she spends some time with a friend or watches television, though she “zone[s out]” and cannot focus on what she is watching. (R. 62). She does do some reading, and although she can read, she has problems concentrating on what she is reading and loses her place. Id. She tries to knit a blanket but it is taking a long time because she can typically work on it for about half an hour before she stops. (R. 63).

         Plaintiff does not have problems lifting and carrying things, but does have problems sitting for an extended period of time. (R. 63). She was prescribed medication to “make [her] more relaxed” that helps her sit longer. (R. 63-64). She can walk for about ten (10) minutes in one direction and ten (10) minutes back. (R. 64). How long she can stand “depends; [her] toes don't hit flat . . . so [she] fluctuates on [her] standing.” Id. For that reason, she cannot stand “even 20 minutes in one place.” Id.

         D. Vocational Evidence

         Also testifying at the hearing was Casey Vass, a vocational expert (“VE”). VE Vass characterized Plaintiff's past work as:

1. Video Attendant, DOT Code 342.667-014, unskilled, light work with a specific vocational preparation (“SVP”) of two (2); (R. 66).
2. Telemarketer, DOT Code 299.357-014, semi-skilled sedentary work with an SVP of three (3); Id.
3. Waitress, DOT Code 311.477-030, semi-skilled light work with an SVP of three (3); Id., and
4. Short Order Cook, DOT Code 313.374-014, semi-skilled light work with an SVP of three (3). (R. 67).

         VE Vass clarified that the video attendant, waitress, and short order cook work was a combination job. Id.

         With regards to Plaintiff's ability to return to her prior work, VE Vass gave the following responses to the ALJ's hypothetical:

Q I ask that you assume an individual with the same, age, education and past work experience as the claimant with the following abilities. There are no exertional limitation in this case. Said individual is capable of simple, routine, and repetitive tasks in a low stress job, defined as having only occasional decision making required, and occasional changes in the work setting and no strict production quotas. Said individual is capable of occasional interaction with the general public, co-workers and supervisors. Can an individual with these limitations perform any of the claimant's past work?
A That's out. That's out. That's out. Would only be the - - [INAUDIBLE] No.

(R. 67). Incorporating the above hypothetical, the ALJ then questioned VE Vass regarding Plaintiff's ability to perform other work at varying exertional but unskilled levels:

Q Okay. Is there other work this individual can perform?
A No exertion -- yeah, heavy, unskilled jobs?
Q Yes.
A I would list a laborer. DOT number is 914.687-010, 94, 000 jobs in the nation; 1, 400 in the region. A lumber handler. The DOT code is 922.687-070, 245, 000 jobs in the nation; 6, 200 in the region. Bakery worker. The DOT code is 520.585-010, 123, 800 in the nation; 3, 700 in the region. These are unskilled, heavy jobs.

(R. 68). Finally, the ALJ questioned VE Vass about Plaintiff's ability to work if she is completely credible as to the severity of her condition:

Q Now, the second hypothetical. If you add a limitation that said individual is capable than no more than medium exertional level work. Can never climb ladders, ropes or scaffolds. Can occasionally climb ramps or stairs, and occasionally balance. Also, said individual must avoid concentrated ...

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