United States District Court, N.D. West Virginia, Wheeling
REPORT AND RECOMMENDATION
MICHAEL JOHN ALOI, UNITED STATES MAGISTRATE JUDGE
December 9, 2016, Plaintiff Donna Lynn Bolyard Moore
(“Plaintiff”), by counsel Brian Bailey, 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 February 10, 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 March 6, 2017, and April 5, 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. 11). 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.
September 19, 2013, Plaintiff protectively filed her first
application under Title II of the Social Security Act for a
period of disability and disability insurance benefits
(“DIB”) and under Title XVI of the Social
Security Act for Supplemental Security Income
(“SSI”), alleging disability that began on July
30, 2013. (R. 200). Plaintiff's earnings record shows
that she acquired sufficient quarters of coverage to remain
insured through December 31, 2017 (R. 222). This claim was
initially denied on December 23, 2013 (R. 105) and denied
again upon reconsideration on March 13, 2014 (R. 131). On
March 26, 2014, Plaintiff filed a written request for a
hearing (R. 158), which was held before United States
Administrative Law Judge (“ALJ”) Nikki Hall on
October 8, 2015 in Morgantown, West Virginia. (R. 39).
Plaintiff, represented by counsel Jennifer LaRosa, Esq.,
appeared and testified, as did Mary Beth Kopar, an impartial
vocational expert. (Id.). On January 12, 2016, the
ALJ issued an unfavorable decision to Plaintiff, finding that
she was not disabled within the meaning of the Social
Security Act. (R. 21). On November 2, 2016, the Appeals
Council denied Plaintiff's request for review, making the
ALJ's decision the final decision of the Commissioner.
was born on September 14, 1963, and was forty-nine (49) years
old at the time she filed her first SSI claim. (R. 200). She
completed two years of college (R. 234). Plaintiff's
prior work experience included working in advertising sales
at a newspaper. (R. 225). She was married at the time she
filed her initial claim (R. 200) and was married (R. 45) at
the time of the administrative hearing. (R. 39). She has no
dependent children. (R. 45). Plaintiff alleges disability
based on rheumatoid arthritis, psoriatic arthritis,
fibromyalgia, hearing loss, high blood pressure, diabetes,
restless leg syndrome, and severe dry eye syndrome. (R. 86).
undersigned has reviewed the entirety of this record,
including medical opinions, treatment notes, and test results
from various providers and facilities. However, as
Plaintiff's arguments do not turn on the medical
evidence, and for the sake of brevity and relevance, the
entirety of the medical evidence contained in the record is
not related at length. Rather, Plaintiff's relevant
treatment history is reviewed, with opinions specifically
Medical History Pre-Dating Alleged Onset Date of July 30,
began seeing Clifford E. Bickerton, D.C., for chiropractic
treatment of aches in her neck and upper dorsals on May 12,
1986. (R. 812). Dr. Bickerton noted crepitation in
Plaintiff's upper spine when rotating her shoulders,
limited rotation, pain when rotating her head, and left
earache. (R. 813). Plaintiff also had bad headaches, located
frontally and on the top of her head. Id. In August
of 1997, Dr. Bickerton noted Plaintiff's movement had
increased and she was doing well and working without pain.
(R. 817). Plaintiff returned to Dr. Bickerton in fall 1998
complaining again of aches in her neck, the back of her head,
and her lumbrosacral spine. Id. Dr. Bickerton did
some adjustments. Id. Plaintiff returned in 2009
complaining of cervical and upper dorsal pain. (R. 818). She
saw Dr. Bickerton a few more times in the Fall of 2009,
reporting improvement after adjustment, but also that the
aches tended to return after a while. Id. In July
2010 Plaintiff returned to Dr. Bickerton experiencing another
flare-up, including neck and back pain, back spasms,
decreased motion, joint pain, abnormal curvature, and
degenerative joint disease. (R. 823). Dr. Bickerton's
diagnoses included “thoracic or lumbosacral neuritis or
radiculitis, unspecified” and “facet
syndrome.” Id. Dr. Bickerton adjusted
Plaintiff's C2, T2, T6, L5, and upper right sacroiliac
was treated at Advantage Health and Wellness in September
2011 for psoriatic arthritis, reporting that her symptoms
worsened a few weeks prior. (R. 833). She reported pain in
her lower back after extended walking. Id. Plaintiff
returned to Dr. Bickerton in August 2012 complaining of lumps
and stiffness in her neck and shoulders. (R. 822). Diagnoses
at that visit included “closed dislocation, fifth
cervical vertebra” and “degeneration of cervical
intervertebral disc.” (R. 825). Adjustment and
interferential current were applied. Id. In January
2013, Plaintiff returned with flare-up and neck sprain, again
treated with adjustment and interferential current. (R. 828).
began seeing Neurologist Adnan Alghadban, M.D. on June 18,
2010 upon referral. (R. 473). Her complaints included pain
and numbness in upper and lower extremities for the last few
months, recently worsening. Id. Plaintiff had been
on Embrel injections previously, but stopped those “a
few years ago.” Dr. Alghadban restarted Plaintiff
Embrel injections, prescribed Hydrocodone for pain and
Voltaren (an anti-inflammatory medication), and did trigger
point injections (R. 473-77). Dr. Alghadban referred
Plaintiff to Dr. Hornsby for rheumatology, noting that she
had already been seen in orthopedics. (R. 473).
presented to Shelly Kafka, M.D. at Mountain State
Rheumatology on September 13, 2010 pursuant to referral. (R.
768). Plaintiff's demeanor was noted as
“tearful.” (R. 804). Musculoskeletal examination
revealed tenderness over cervical and lumbar joints,
shoulders, elbows, wrists, metacarpophalangeal joints, knees,
and ankles; Plaintiff's proximal interphalangeal joints
evidenced both tenderness and swelling on the right side. (R.
804). Dr. Kafka assessed psoriatic arthritis and
fibromyalgia. Id. Dr. Kafka noted that Plaintiff
“cannot afford Humera, ” so she prescribed
Naproxen, and noted “will try to [obtain]
pre-auth[orization] for Remicade. (R. 775). At follow-ups
with Dr. Kafka, Plaintiff continued to complain of severe
pain (R“9/10”) and evidenced swelling in her
metacarpophalangeal joints (R. 807, 810); and pain in the
wrist and inside joints of her left hand (R. 809).
Plaintiff's pain was treated with conservative measures
and had no significant improvement, Dr. Alghadban completed
cervical injections in September 2012 at facet joint C5-6 and
C4-5 levels bilaterally. (R. 450). In November 2012, Dr.
Alghadban completed bilateral occipital nerve block
injections for Plaintiff's headaches when more
conservative treatment failed (R. 456), and started her on
Topamax for her headaches as well. (R. 457). By February
2013, Plaintiff was prescribed Percocet for pain. (R. 458).
In April 2013 Plaintiff received additional injections in her
tendon for tendonitis (R. 459), and bilateral shoulder
injections for arthritis pain. (R. 460).
Medical History Post-Dating Alleged Onset Date of July 30,
Alghadban performed a left knee injection in August 2013. (R.
464-5). On August 27, 2013, Dr. Alghadban wrote a letter
opining that Plaintiff:
has rheumatoid arthritis, psoriatic arthritis and
fibromyalgia. She is on medications, Enbrel and
anti-inflammatory medications, and she gets a steroid
injection. She is also on pain medications. She is very
limited due to her arthritis in terms of walking, sitting or
(R. 466). Dr. Alghadban performed another tendon injection in
January 2014. (R. 492).
studies on July 3, 2014 revealed no evidence of articular
erosions of inflammatory arthritis. (R. 527). Rather, x-rays
of Plaintiff's thoracic spine showed “prominently
developed” endplate osteophytes (bone spurs) on the
right ventral aspect of the T6-T10 vertebral levels. (R.
528). Plaintiff was seen at Pinewood Medical Center on July
14, 2014 to review imaging studies. Progress notes stated
saw  rheumatology  and was told that she had DISH
[diffuse idiopathic skeletal hyperstosis] in [her thoracic]
spine, but there was no evidence of psoriatic arthritis or
rheumatoid arthritis. She does have severe osteoarthritis and
is starting to get some deformity of her fingers. . . . Since
she does not have psoriatic arthritis, she is not on her
Enbrel, which did help her psoriasis of her fingernails when
Dr. Jeffrey Jackson gave it to her in dermatology. She said
she hurts all over in every bone of her body and also in all
of her muscles and it is getting to where she cannot pick her
feet up when she walks. She said she hides this from her
husband since he was involved in a severe motorcycle accident
not long ago ..... She said FLECTOR patches do help her, but
her insurance does not cover them. . . . She has a history of
depression and RLS.
OBJECTIVE: Vital signs stable, no acute distress noted. She
does seem to have stiffer joints when moving around from the
exam table to the floor. Especially her hips seem to be
stiff. She does have psoriasis of all of her fingernails. She
has tenderness all over her body to palpation. Her hair looks
thinner than it did several months ago.
(R. 543). Certified Nurse Practitioner Judy Lipscomb's
treatment plan included diclofenac gel, calcium and magnesium
for arthralgia, referral to Dr. Jackson to restart Embrel,
increased Glucophage for diabetes, restarting on vitamin D
for deficiency, and physical therapy for DISH of thoracic
2014, Plaintiff was seen by Jeffrey Jackson, M.D. with
Mountain State Medical Specialties for psoriasis on her
fingernails. (R. 570). Dr. Jackson restarted Plaintiff's
Embrel injections (R. 567), noting they were effective in
keeping her “mostly clear.” (R. 563).
tried physical therapy at Grafton City Hospital from July 21,
2014 through August 27, 2014. (R. 514-525, 529-531, 592-626).
At initial assessment, she reported pain at nine or ten out
of ten in all areas constantly. (R. 523). She reported that
she had stopped Embrel in January per her neurologist.
Id. She reported pain with standing, sitting, and
lying; sweeping, mopping, vacuuming, reading, laundry, and
dishes; and trouble with getting in and out of a car,
climbing steps, and balance. Id. She reported relief
from medications and massage, and temporary relief with heat
or ice. Id. Plaintiff was seen by physical therapist
Rayler Mace, P.T. who noted Plaintiff had poor to fair
posture, with decreased lumbar lordosis and increased
kyphosis in the upper thoracic spine. Id. Range of
motion testing of the cervical spine revealed no loss at
flexion, maximum loss at extension, minimum loss at SB, and
moderate loss at rotation. Id. Plaintiff's
prognosis was “guarded . . . due to increased pain in
all joints and spine.” (R. 524). Muscle strength in
hips was three out of five (3/5); Plaintiff's gait was
antalgic with decreased step length and height, decreased
trunk rotation, and decreased arm swing. (R. 531). Transfers,
strength, balance, range of movement, joint mobility, and
function were all impaired. Id. Plaintiff's
treatment plan included manual therapy in conjunction with
therapeutic exercises and activities. Id.
therapist Jeff Sapp PTA noted at next visit on August 1, 2014
that Plaintiff continued to have pain “all over her
neck and back.” (R. 522). Upon exercise, Plaintiff
experienced a “steady increase in [low back pain] that
progressed to a sharp pain towards the end of the trial,
” but that subsided afterward with increased mobility.
Id. She reported feeling better after with decreased
pain overall at the next visit on August 4, 2014 (R. 521). By
August 6, 2014 she reported another flare-up, with the
physical therapist noting major loss of range of motion in
the cervical spine on retraction, major loss on extension,
moderate loss on side bend and rotation (right), and minimum
loss on flexion. (R. 520). Plaintiff's thoracic spine
evidenced moderate loss at flexion and extension, and major
loss at rotation. Id. On August 11, 2014, Plaintiff
reported improved symptoms after a recent trigger point
injection with Dr. Alghadban, but also reported a renewed
occipital headache and tightness in her shoulder blades.
Id. Plaintiff was doing “a little
better” on August 15, 2014, but continued to evidence
range of motion deficits. (R. 518). At her last visit on
August 27, 2014, she reported “hurting pretty
bad” in her upper right trapezoid region. (R. 514).
Continued decreased motion of spine was noted, with a two out
of six (2/6) on the Paris Scale. Id.
September 2014 Plaintiff returned to Pinewood for follow-up
on depression and medication refills. (R. 545). She reported
that her pain was “constant and  getting worse every
day.” Id. N.P. Lipscomb ed Lidoderm patches
and increased Plaintiff's baclofen dose to twenty
milligrams, noting that ten milligrams “was not
controlling her pain completely.” Id. At next
follow-up in December 2014, Plaintiff continued to complain
of “severe myalgia and arthralgia, ” for which
she was given Flector patches and Metanx samples for
peripheral neuropathy. (R. 546). At follow-up in April 2015,
Plaintiff reported having left her husband two days ago
because he “has permanent brain damage from a
motorcycle accident and is being verbally abusive to
her.” (R. 549). N.P. Lipscomb noted Plaintiff's
history of depression and anxiety, and that Plaintiff's
other providers had “suggested she see a psychiatrist,
” and referred her to Dr. Nugent at Summit Center for
counseling. (R. 549).
October 2014, Plaintiff returned to Dr. Alghadban for
follow-up. (R. 582). Dr. Alghadban noted that a recent
“EMG nerve conduction study was suggestive of
neuropathy, ” and started Plaintiff on Neurontin.
Id. She also received another bilateral occipital
nerve block at that visit (R. 583), and again in April 2015.
(R. 586). She continued to go to physical therapy at Grafton
City Hospital, and continued to report paint and headaches
throughout fall and winter of 2014 and into 2015. In February
2015, Plaintiff reported pain at eight out of ten (8/10),
always in the neck but now in the shoulder blades, too. (R.
603). She reported that her TENS unit relieves the pain for
about an hour after use. Id. Physical therapy
progress notes in March 2015 note “subjectively little
to no change in her overall symptoms” despite
compliance, and that “chronic pain is starting to make
her feel depressed.” (R. 600). Tom Copeland, PTA opined
that there will “little gains to note in re: decreasing
pain level or increasing functional activity.” (R.
599). Plaintiff “would benefit from a pain clinic
consult for possible trigger point injections, ” and
observed that Plaintiff was “still waiting on her
[doctor] to contact her about the pain clinic.” (R.
2015 Plaintiff reported “constant severe pain”
rated at “15/10” at times. (R. 598). Accordingly,
Plaintiff had a consult with Russell Biundo, M.D. at WVU
Neurosurgery, Spine, and Pain Center on July 31, 2015. (R.
756). Dr. Biundo reviewed imaging studies and noted
“degenerative changes and some bridging” in the
thoracic spine, degenerative disease in the lumbosacral
spine. Id. X-rays of the sacroiliac joint, hands,
and wrist were “unremarkable.” Id. Dr.
Biundo felt that Plaintiff's decreased range of motion of
all joints seems consistent with either psoriatic arthritis
or a systemic rheumatological disorder. Id. Dr.
Biundo recommended Plaintiff see Dr. Hawkinberry for pain
control, and six weeks of physical/pool therapy, after which
they could reassess. Id.
Disability Determination at the Initial
December 21, 2013, agency reviewer Subhash Gajendragadkar,
M.D. reviewed Plaintiff's records and completed physical
residual functional capacity (“RFC”) assessment.
(R. 90-92). Gajendragadkar found the following exertional
limitations: Plaintiff could frequently lift and/or carry ten
(10) pounds; occasionally lift and/or carry twenty (20)
pounds; stand and walk for about four (4) hours in an eight
(8) hour workday; sit for about six (6) hours in an eight (8)
hour workday; and could engage in unlimited pushing and/or
pulling (within her weight restrictions for lifting and
carrying). (R. 90). Gajendragadkar noted that the limitations
he articulated were supported by the “severity of
[rheumatoid arthritis and] psoriatic arthropathy.” (R.
postural limitations, Gajendragadkar found that Plaintiff
could occasionally climb ramps, and stairs; occasionally
climb ladders, ropes, and scaffolds; and occasionally
balance, stoop, kneel, crouch, and crawl. (R. 91). No
manipulative, visual, or communicative limitations were
found. Id. As to environmental limitations,
Plaintiff could have unlimited exposure to extreme heat and
noise; should avoid concentrated exposure to extreme cold,
wetness, humidity, vibration, and fumes, odors, dusts, gases,
poor ventilations, etc.; and avoid even moderate exposure to
hazards. (R. 91).
December 20, 2013, agency reviewer Paula Bickham, Ph.D.,
reviewed Plaintiff's records and completed psychiatric
review technique (“PRT”) assessment. (R. 88).
Bickham found mild difficulties in maintaining concentration,
persistence, or pace, and no significant limitations in
Plaintiff's ability to maintain social functioning and no
restriction of activities of daily living. Id. Her
narrative explanation stated that
[Plaintiff] appears credible. The claimant is being
prescribed medication from her pcp for depression although
comments in the MER indicates depression and anxiety. In the
recent ROC of 12/20/13, the claimant reported that she no
longer believes she needs the medication. She alleged limits
to concentration and memory on the AFR Claimant reported to
the examiner that she believed her memory issues were
menopause related and she is doing better since stopping work
ADLs do not reflect severe limits w[ith] functioning.
Disability Determination at the Reconsideration
March 11, 2014, agency reviewer Rogelio Lim, Ph.D. reviewed
the prior PRT assessment and affirmed it as written, adding
only the word “affirm.” (R. 116). On March 5,
2014, agency reviewer Joseph Richard, Ph.D. reviewed the
prior PRT assessment and affirmed it as written, noting
“there is no new significant [medical evidence] data to
refute the evaluation [and] conclusions of 12/23/13 and that
evaluation are [sic] affirmed as written. (R. 113).
Treating Source Statement
September 23, 2013, Adnan Alghadban, M.D. completed a Medical
Review Team (MRT) Physician's Summary pursuant to an
application for Medicaid. (R. 478-479). Dr. Alghadban's
diagnoses included lupus, psoriatic arthritis, and another
condition that was illegible. (R. 478). He opined that
Plaintiff's incapacity/disability was expected to last
for ten (10) years, and that Plaintiff's prognosis was
“guarded.” Id. Dr. Alghadban opined that
Plaintiff was limited to lifting no more than twenty-five
pounds, and could not stand for more than fifteen minutes.
Internal Medicine Consultative Examination
November 20, 2013, Himanshu Paliwal, M.D. completed a
consultative examination (R. 480-487). Dr. Paliwal noted that
due to Plaintiff's arthritis, she complained of
“various joint pains including neck, lumbrosacral,
shoulder and hand, [as well as] pain in [the] small joints of
[her] hand and wrist.” Id. Plaintiff reported
that pain and swelling in her hands made it hard for her to
work. (R. 481). Though Plaintiff seemed to be doing better
since starting on medication, she had “good and bad
days.” Id. She also reported constant dull,
aching neck and low back pain from fibromyalgia. Id.
She reported being “able to do most of [her] daily
activities except work, which requires her to bend or be on
her knees.” Id. Results of a physical
examination were generally normal, with the exception of
Plaintiff's nails. (R. 482) (“distal half of nails
are opaque white and separated from nail bed.”). Dr.
Paliwal assessed obesity, psoriasis, psoriatic nails,
rheumatoid arthritis, psoriatic arthropathy, lumbago,
cervicalgia, fibromyalgia, and chronic fatigue syndrome. (R.
Other Opinion Evidence
returned to Dr. Biundo for follow-up in September 2015. (R.
763-764). In response to Plaintiff's request for “a
letter regarding her ability to work/question about possible
disability, ” Dr. Biundo noted the following:
Regarding disability, the patient would be pain limited in
terms of her ability to work manual type labor, but she could
conceivably do a job/desk type work. I informed her if she
wished to pursue disability, she would most likely need to be
referred to an occupation medicine doctor for further
evaluation and filling out of her paperwork. She declines
that for now. She agrees to continue with physical therapy,
and we will see her in 3 months or sooner if any problems.
The patient is comfortable with these recommendations.
Treating Psychological Source
August 13, 2015, Plaintiff's treating psychologist Dr.
Dana Nugent, Ed.D. wrote a letter to “address
[Plaintiff's] ability to participate in gainful
employment.” (R. 533). Dr. Nugent stated that Plaintiff
had been diagnosed with Major Depressive Disorder, Moderate,
for which she received treatment including psychotherapy
since May 28, 2015. Id. Dr. Nugent elaborated that
remains quite depressed due to the severity of her back pain,
which is the consequence of her Psoriatic Arthritis. I have
tried to work on increasing her activity level, including
increasing social interaction and enjoyable activities.
However, even visiting a friend is often too painful for her,
because she is not able to alternate sitting and lying down
as she needs. The tremendous loss of functioning the
arthritis has caused has precipitated extended grieving over
what she can no longer do. She has difficulty replacing
former activities with new, more sedentary ones, like
reading, because she can't even look down for long,
because of her neck pain. We are addressing her mood disorder
with medication, but so far are not seeing any improvement.
If the current medical interventions she is pursuing reduce
her back pain, we will have more to work with to address her
depression, but we cannot anticipate if that will happen.
Treating Rheumatological Source
February 24, 2016, Dr. Hornsby wrote a letter stating
Plaintiff's diagnoses as “chronic low back pain,
and [imaging] of [her] thoracic spine show changes most
consisted with Diffuse Idiopathic Skeletal Hyperostosis
(DISH).” (R. 840).
ALJ hearing held on October 8, 2015,  Plaintiff testified that she
was married and had no dependent children. (R. 45). She has
no income; she and her husband subsist on his disability
payments. Id. She receives food stamps and a medical
card (Medicaid). (R. 48). She obtained an associate's
degree as a medical assistant. (R. 47).
testified that she had been working up until about a week
before she decided to apply for disability. (R. 48-49). She
found herself going home throughout the day, once or twice a
month at first. Id. Eventually, it got to the point
where she was going home a couple of days every week.
Id. Her boss told her that she could not “keep
doing that, that [she needed] to face facts, that [she was]
disabled and  can't keep  going home in the middle of
[the] day.” (R. 49). She testified that her condition
had not particularly changed in the week between leaving her
job and applying for disability. Id. Plaintiff
testified that, rather, “Mentally, I couldn't face
facts, so finally when I realized that I am in dire pain and
I can't continue that, that's whenever I just decided
I had to face facts.” Id.
testified that she had worked for the Mountaineer newspaper,
and that her work history report accurately summarized her
work there. (R. 50). Plaintiff testified in her own words
that she feels she cannot work because:
most of my day, day and night, I'm in -- I am in severe
pain. I can't hardly use my fingers, I can't hardly I
can't even fix dinner like I used to. There's a lot
of things that I used to do that I can't do anymore. And
even if I try, my body, I just can't. My back is in such
a mess and such pain that I just can't. I can't sit
at a desk, I can't look down, I can't even hardly
read a book.
(R. 51). As to her hands, Plaintiff testified that her
“knuckles are going one way and [her] fingers are going
the other [which] mak[es] it impossible to open things up or
hold a knife to peel a potato or anything like that. And they
hurt really bad.” Id. This started about a
year to a year and a half ago. (R. 52). As to her back pain,
Plaintiff testified that started getting bad around August.
Id. She described her back pain as starting
“right below the base of [her] skull, and  between
[her] shoulder blades and [her] very low tailbone.”
Id. She testified that she at times will have
limited movement and will not be able to move a certain way
or reach for things. Id. She described the pain as
“excruciating, ” stating “I'm at number
10 a lot.” Id. However, Plaintiff clarified
that “sometimes it is worse than other times, ”
and it is not always that bad. (R. 53).
testified that she had tried physical therapy for probably
three months or more, including deep tissue massage and range
of motion machines, but those did not work or give her any
more motion. Id. She was currently doing water
therapy, and had five to six visits so far; though she had
not noticed any improvement with that, either. (R. 56). She
currently takes Hydrocodone and uses Flector patches for
pain. Id. Plaintiff testified that she has discussed
going to pain management to try to manage her pain with her
doctors, but no surgeries have been recommended. (R. 57).
testified that she could walk for probably about two minutes
before she “start[ed] feeling the back pain.” (R.
56). She could stand for about five minutes and sit for about
fifteen minutes before her back bothers her. Id.
Plaintiff estimated she could lift ten pounds. Id.
noted that although her diabetes had not been controlled in
the past, it was “starting to be more controlled”
since she started taking Novolog in addition to Lantus. (R.
58). Her sugar levels are typically “high, ” but
are lower than they have been in the past. Id. When
her sugar levels get high, she feels “dizzy and spacey,
like [she] can't think;” her mouth gets dry and she
starts shaking a little bit. (R. 59). Plaintiff testified
that this has been happening more frequently, “probably
every other day.” Id. Plaintiff testified that
her acid reflux (GERD) and blood pressure are controlled with
medications. (R. 63).
sees Dr. Alghadban for both headaches and neuropathy, which
affects her most in her feet. (R. 59). Her neuropathy affects
her feet, and causes tingling and sharp pain - “feeling
like my feet are cut” - when she walks on them.
Id. She has had these symptoms for about a year.
Id. She takes Neurontin for her neuropathy, and also
walks on the sides of her feet so that the feelings are not
as intense. Id. As to her migraine headaches,
Plaintiff has a migraine “maybe once every other month,
” typically lasting for a day or more. (R. 62). Dr.
Alghadban gives her injections to treat them; he used to
prescribe medication, but Plaintiff does not take it any more
because it made her “sick.” Id. When she
has a migraine, she puts on an eye mask and lays down in a
dark room. Id. Plaintiff stated that she thinks her
migraines are exacerbated by her neck pain, for which she
gets occipital nerve blocks - most recently the previous
month. (R. 63).
gets treatment at United Summit Center for depression. (R.
60). In addition to seeing a counselor weekly and a
psychiatrist once a month, she is also prescribed Abilify,
Celexa, and Trazodone. Id. There have been a few
weeks where she has had to cancel her appointment because she
“just couldn't get dressed.” (R. 70). Her
depression symptoms include crying all of the time, feeling
like everything is at its worst, and feeling extremely
anxious and shaky. (R. 61). Plaintiff stated that
“there's times I can't even hardly get out of
bed and get dressed. I just can't do it.”
Id. From a social standpoint, Plaintiff stated her
depression causes her to not want to be around anyone and she
finds it easier to be alone. Id.
testified that she used to cook big dinners and loved to
cook, but she has no interest in cooking or eating any more.
Id. She has had these symptoms for about four
months. Id. It had been “about five
months” since she cooked a family meal; the most she
might make now is a grilled cheese. (R. 64). She no longer
cleans; her daughter has been doing it for the past couple of
years. (R. 65). She is able to “dust a little bit,
” but cannot sweep, mop, or vacuum. Id. She
goes shopping two to three times a week, close to home, for
basics like snack foods, milk, cereal, bread, and lunch meat.
Id. Her husband, daughter, and a friend help with
shopping. Id. She has a driver's license, but
does not drive much - “maybe two or three days a week,
not very much, close to home.” (R. 46). She has a
computer at home but stopped using it “probably about a
year and a half ago.” (R. 47). She checks email or gets
on Facebook with her cell phone. Id.
testified that she tries to read, but has to be on her back
because she cannot look down very well. (R. 66). She does not
go to church as much as she used to, because she cannot sit
and has to stand in the back of the church. Id. She
goes to church “probably once a month” now.
Id. She used to like to go watch movies, but she
likewise cannot sit to watch a movie any more. Id.
She used to have a “great big flower bed [she] always
worked on, ” but has not been able to for the past
couple of years because her hands are not strong enough to
pull the weeds. Id.
testifying at the hearing was Mary Beth Kopar a vocational
expert. VE Kopar characterized Plaintiff's past work at
Mountaineer newspaper as a classified ad clerk, Dictionary of
Occupational Titles (DOT) number 247.367-010; skilled work
with a specific vocational preparation of five (5), and
sedentary exertion in the DOT, but light exertion as actually
performed. (R. 72).
regards to Plaintiff's ability to return to her prior
work, VE Kopar gave the following responses to the ALJ's
Q: Let's assume a hypothetical individual with the same
age, education, and work background as the claimant who is
capable of performing work at the light level as defined in
the regulations. All posturals are occasionally, except never
climb ladders, ropes, or scaffolds. The work should not
require greater than occasional exposure to concentrated
levels of extreme cold, wetness, humidity, vibration, or
fumes, dust, odors, or pulmonary irritants. The work should
not require exposure to unprotected heights or moving
mechanical parts. Would such a person be able to perform the
claimant's past work, either as she actually performed
the work or as the work is generally performed in the
A Could do the past work, both per the DOT and as performed.
the above hypothetical, the ALJ then questioned VE Kopar
regarding Plaintiff's ability to perform other work at
varying exertional but unskilled levels.
Q Could the hypothetical individual perform any other jobs,
and if so, could you please give me a few examples with
numbers of jobs in the nation for each occupation?
A Yes, your honor. Could do that of a sorter, DOT 222.687-
014, unskilled, SVP of 2, light exertion, with over 300, 000
positions in the national economy. Could do that of an order
caller, DOT 209.667-014, unskilled, SVP of 2, light exertion,
with over 200, 000 positions in the national economy. Could
do that of a ticket seller, DOT 211.467- 030, ...