United States District Court, E.D. Missouri, Eastern Division
D. NOCE, UNITED STATES MAGISTRATE JUDGE
action is before the court for judicial review of the final
decision of the Commissioner of Social Security that
plaintiff Dionese Dean is not disabled under Title II or
Title XVI of the Social Security Act and is thus not entitled
to disability insurance benefits (“DIB”), 42
U.S.C. §§ 401 et seq., nor supplemental security
income (“SSI”). 42 U.S.C. §§
1381-1383(f). For the reasons set forth below, the decision
of the Commissioner is affirmed.
applied for DIB and SSI in August 2012, ultimately alleging a
disability onset date of March 15, 2013. (Tr. 131-43, 167).
Her initial claims were denied on November 1, 2012. (Tr.
71-75). Plaintiff filed a timely written request for a
hearing on November 9, 2012. (Tr. 78). She testified before
an administrative law judge (“ALJ”) on April 22,
2014. (Tr. 24). On August 27, 2014, the ALJ determined
plaintiff was not disabled. (Tr. 9-19).
decided that while plaintiff has severe impairments and is
unable to perform her past relevant work (“PRW”),
considering her residual functional capacity
(“RFC”), there are jobs in significant numbers in
the local and national economies plaintiff could perform.
(Tr. 12-19). Plaintiff filed a timely request for review on
October 1, 2014, which the Appeals Council denied on December
8, 2015. (Tr. 1-7). The decision of the ALJ therefore stands
as the final decision of the Commissioner of Social Security.
Plaintiff filed for judicial review of this decision on
January 12, 2016, arguing that it is not supported by
Medical Record and VE Information
was born on March 29, 1984. (Tr. 67-68). She first complained
of low back pain at Grace Hill Health Center on August 20,
2012. (Tr. 242). At the time, she described the back pain as
an ache that was aggravated by daily activities, lying and
resting, running, sitting, and standing. (Tr. 242). While
plaintiff claimed that the pain had been worsening the past
three months, the pain was relieved by constant movement.
(Tr. 242). She weighed 174 lbs. at the time with a body mass
index (“BMI”) of 28.95. (Id.). Nurse
Practitioner Brook Strickland prescribed Flexeril for
plaintiff's back muscle spasms and Naprosyn for her pain
and inflammation. (Tr. 243). Ms. Strickland ordered an x-ray
of plaintiff's back, which showed a mild curvature of the
lumbar spine. (Tr. 243, 408). Plaintiff was diagnosed with
lumbago with sciatica. (Tr. 408).
September 13, 2012, plaintiff sought treatment at Grace Hill
for lower back pain. (Tr. 290). She was referred for a CT
scan with contrast of her lumbar spine. (Tr. 292-93).
November 15, 2012, Ms. Strickland of Grace Hill again saw
plaintiff for low back pain, gastroesophageal reflux disease
(“GERD”), allergies, and dyspnea. (Tr. 294).
Plaintiff was again diagnosed with lumbago with sciatica, for
which she was still waiting for a CT scan. (Tr. 294-96).
Plaintiff was instructed to continue taking Gabapentin, which
she reported as relieving her symptoms; Naproxen; and an
increased dosage of Flexeril. (Tr. 294-96). She reported that
the pain was an ache and throbbing feeling and was aggravated
by sitting and standing. (Tr. 294). For GERD, plaintiff was
instructed to take Ranitidine, and for the allergies
Claritin. (Tr. 296). Lastly, plaintiff's Advair
prescription was decreased, but she was instructed to
continue using it daily and to start Albuterol as a rescue
inhaler. (Id.). At the time of this visit, plaintiff
weighed 209 lbs. and had a BMI of 34.78. (Tr. 295).
February 5, 2013, plaintiff returned to Grace Hill for back
pain, GERD, asthma, allergies, tachycardia, and hypertension.
(Tr. 303-05). Plaintiff was instructed to continue the same
medications for the GERD and lumbago with sciatica. For
plaintiff's asthma, she was instructed to continue to use
Advair and use the Albuterol inhaler once a day. (Tr. 305).
Ms. Strickland referred plaintiff to an ears, nose, and
throat doctor, as the Claritin was not helping plaintiff with
her allergies. Plaintiff was prescribed hydrochlorothiazide
(“HCTZ”) for the swelling of her feet and legs
(edema) and Metoprolol for her tachycardia. (Id.).
At the time of this visit, plaintiff weighed 231.4 lbs. and
had a BMI of 38.50. (Tr. 304). Ms. Strickland set a goal for
plaintiff to abide by the DASH diet. (Tr. 302).
February 7, 2013, plaintiff visited an orthopedic doctor on
referral from Ms. Strickland. (Tr. 309). The orthopedic
doctor reported both that plaintiff had noticed
“significant improvement in pain with Gabapentin”
while also claiming that she had experienced “worsening
pain over last 6 months.” (Tr. 310). Plaintiff was
again seen at Grace Hill on February 20, 2013, for
hypertension, tachycardia, lumbago with sciatica, and a
vitamin D deficiency. (Tr. 314). Ms. Strickland prescribed
the same treatments, except she increased the Gabapentin and
educated plaintiff on her vitamin D deficiency. (Tr. 310). At
this time Ms. Strickland specifically noted plaintiff showed
no evidence of depression. (Tr. 317).
April 3, 2013, Joseph Williams, M.D., of St. Louis Connect
Care recommended plaintiff take Cymbalta for a month or two
and return for a follow-up. (Tr. 404-05). Additionally, he
noted there were no obvious abnormalities in her back visible
in an x-ray, but he recommended she obtain copies of her MRI
and CAT scans. (Tr. 404).
April 10, 2013, plaintiff was seen at Grace Hill by Vani
Pachalla, M.D., for hypertension, edema, and back pain. (Tr.
319-20). Plaintiff's instructions were to continue her
medications as prescribed, increase her activity level, and
continue with the DASH diet as a goal. (Tr. 319).
April 24, 2013, plaintiff was seen at St. Louis Connect Care,
where she had a follow-up to review the MRI of her back. At
the time, her BMI was 45.4, which Dr. Williams noted met the
Federal Government Standards for morbid obesity. (Tr. 407).
Dr. Williams opined that “there is nothing on her MRI
or [her] physical examination that would account for her back
pain.” (Tr. 407). In order for plaintiff to relieve her
back pain, Dr. Williams “recommended a diet and
exercise and doing a job where she does something 8 hours a
day instead of sitting around and eating.” (Tr. 407).
13, 2013, plaintiff went to Missouri Baptist Medical Center
with complaints of a rapid heartbeat and chest pain. (Tr.
270). She rated her pain as 7/10 but was observed giggling
and joking with her husband and the nurse while being
examined. (Tr. 280-81). Tests administered that day did not
reveal an official diagnosis, but it was noted that plaintiff
had tachycardia unspecific and chest pain atypical. (Tr.
20, 2013, at a follow-up with Grace Hill, plaintiff was
referred to both a cardiologist and a nutrition counselor by
Nurse Practitioner Judith Gallagher, with tachycardia and
weight gain listed as assessments. (Tr. 324-26). At this
visit, plaintiff weighed 249 lbs. and her BMI was 41.53. (Tr.
August 28, 2013, at a follow-up at Grace Hill, plaintiff
again complained of hypertension, allergies, asthma, GERD and
back pain. (Tr. 333). David Richards, M.D., did not change
any medication. (Tr. 334-35). Plaintiff weighed 260.80 and
had a BMI of 43.39. (Tr. 334). On September 12, 2013, Dr.
Richards restricted plaintiff's permitted activity to
walking or standing only occasionally and to alternating
between sitting and standing due to the increase in edema in
her legs. (Tr. 345). Specifically, Dr. Richards noted
plaintiff “should not stand for long periods of
time” and “may require frequent sit down periods
due to increase[d] edema in legs.” (Tr. 346).
October 17, 2013, plaintiff was referred to Washington
University in St. Louis' Multidisciplinary Sleep Medicine
Center for a sleep study, due to her snoring and difficulty
sleeping. (Tr. 396). Plaintiff was evaluated and the
suggested potential treatments for both restless leg syndrome
and obstructive sleep apnea were “positive airway
pressure, oral prosthesis, surgery, Provent adhesive nasal
valves, and weight loss.” (Tr. 398). Additionally, it
was noted that the insomnia was psychophysiological,
“likely triggered by prior shift work and caregiver
role in her mother's recent illness.” (Tr. 398).
December 2, 2013, plaintiff returned to Grace Hill with
severe back pain. (Tr. 350-51). Plaintiff then weighed 263.4
lbs. and had a BMI of 43.83. (Tr. 362). On December 31, 2013,
Dr. Richards saw plaintiff at Grace Hill for a follow-up on
her severe back pain. (Tr. 368). Dr. Richards kept all of
plaintiff's medication the same, including the goal of
the DASH diet, but also added the goal of losing 75 lbs. by
the upcoming summer. (Tr. 368-71). At this appointment,
plaintiff weighed 268.8 lbs. and had a BMI of 44.69. (Tr.
January 7, 2014, plaintiff was seen for a comprehensive eye
exam after complaining of gradually worsening blurry vision
in both eyes. (Tr. 377). Plaintiff was given a new eye
glasses prescription as well as instructed to take out her
contacts nightly to clean them instead of wearing them when
she slept, as this was likely the cause of her corneal scars
that seemed to cause her blurry vision. (Tr. 381).
January 8, 2014, plaintiff was seen at Washington University
in St. Louis School of Medicine's Cardiovascular
Division. (Tr. 399). Plaintiff was diagnosed with morbid
obesity, hypertension, asthma, possible obstructive sleep
apnea, physical deconditioning, probable diastolic congestive
heart failure, and atypical chest pain. (Tr. 399). Plaintiff
was advised to exercise lightly daily and to lose weight.
(Tr. 400, 403). At this time, plaintiff weighed 264 lbs. (Tr.
20, 2014, VE Robin A. Cook, Ph.D., CRC submitted written
answers to a written questionnaire. (Tr. 217-25). In this
document the ALJ described this hypothetical person:
7. Assume a hypothetical individual who was born on March 29,
1984, has at least a high school education and is able to
communicate in English as defined in 20 CFR 404.1564 and
416.964, and has work experience as described in your
response to Question #6 [, which listed four jobs]. Assume
further that this individual has the residual functional
capacity (RFC) to perform sedentary work as defined in 20 CFR
404.1567(c) and 416.967(c) except she can sit for
approximately 15 minutes at a time before standing briefly to
reposition before sitting back down. She would be able to
remain on task while repositioning.
stated that a hypothetical individual with plaintiff's
age, education, experience, and RFC would not be able to
perform plaintiff's previous relevant work. (Tr. 224-25).
When asked if there are jobs in the national economy this
hypothetical individual could perform, the VE replied