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Hilderbrand v. Berryhill

United States District Court, E.D. Missouri, Eastern Division

June 16, 2017

NANCY A. BERRYHILL[1], Acting Commissioner of Social Security, Defendant.



         This matter is before the Court for review of an adverse ruling by the Social Security Administration.

         I. Procedural History

         On December 28, 2010, plaintiff Toni Hilderbrand protectively filed an application for supplemental security income and disability insurance benefits with an alleged onset date of December 1, 2007. (Tr. 237-51).[2] Plaintiff's application was denied on initial consideration on April 1, 2011, (Tr. 107-09, 135-39), and she requested a hearing from an Administrative Law Judge (ALJ). (Tr. 140-49).

         Plaintiff and counsel appeared for a hearing on May 30, 2012. (Tr. 74-95, 206).[3] The ALJ issued a decision denying plaintiff's application on November 21, 2012. (Tr. 110-29). The Appeals Council vacated the hearing decision and remanded the case to the ALJ. (Tr. 130-34). The ALJ conducted additional proceedings, holding another hearing on July 17, 2014, and once again denied plaintiff's application on December 2, 2014. (Tr. 30-49, 50-73, 210-15). That same day plaintiff amended the onset date of disability to October 3, 2011. (Tr. 276). When the case appeared again before the Appeals Council, it denied plaintiff's request for review on February 9, 2016.[4] (Tr. 1-5). Accordingly, the ALJ's decision stands as the Commissioner's final decision.

         II. Evidence Before the ALJ

         A. Disability Application Documents

         In a December 28, 2010, Disability Report (Tr. 288-98), plaintiff listed her disabling conditions as “right hip, ” swollen knee and feet, “legs, ” depression, insomnia, and coronary eye disease. Plaintiff claimed that these conditions prevented her from working, beginning in April 2010. (Tr. 292). An updated report (Tr. 323-30), indicated that beginning in March 2011, plaintiff experienced worsening depression and anxiety, as well as increased bruising and heaviness of her legs. (Tr. 323). Plaintiff also noted that she could not stand for long periods of time or walk to her mailbox. (Tr. 327). Additionally, plaintiff stated that she had difficulties getting in and out of the bathtub; she also needed to purchase a shower chair. Id. To treat her health conditions, doctors prescribed numerous medications including Alprazolam for depression[5], Clonidine as a “water pill, ”[6] Pravastatin for high cholesterol, Ranitidine[7] for generic “stomach” issues, and Spironolactone for blood pressure.[8] (Tr. 295). Plaintiff's updated disability report reflected some changes in her prescription medication regimen. Additionally, the stated reasons for medications changed. In particular, she held prescriptions for Celexa to treat depression, [9] Xanax for anxiety, [10] Clonidine for blood pressure, Spironolactone as a “water pill, ” Pravastatin for cholesterol, [11] and Ranitidine for acid reduction. (Tr. 326).

         In a Function Report dated January 10, 2011, (Tr. 311-22), plaintiff stated that she lived in a mobile home with her husband. In response to a daily activities inquiry, plaintiff explained that she typically started each day at about 7:00 a.m. by making coffee and breakfast and giving her husband an insulin shot. Id. After completing those initial morning tasks, plaintiff performed some household chores. (Tr. 311). She intermittently sat down and rested before continuing her housework. Id. Around lunchtime plaintiff would “try” to make a sandwich; she then lay on the couch watching television, looking out the window, or talking on the phone to her children. Id. Plaintiff prepared dinner, washed dishes, and went to bed at around 11:00 p.m. Id. Plaintiff noted that she struggled with insomnia and watched television to try to fall asleep. Id. But she woke up approximately every hour during the night. Id. Plaintiff attributed her sleep issues to insomnia, depression, and headaches. (Tr. 312).

         Plaintiff stated that she did not have any problems tending to her personal care, including dressing, bathing, caring for hair, shaving, feeding herself, or using the toilet. Id. She did not require any special reminders for dressing, grooming, or taking medication. (Tr. 313). Moreover, plaintiff prepared her own meals daily, and made enough dinner for herself and her husband. Generally, she spent thirty to forty-five minutes preparing meals. Id. She reported no changes to her cooking routine since the onset of her disability. Id.

         Plaintiff recounted that she could do laundry, clean dishes, cook, vacuum, and clean the bathroom. Id. She added that she worked on these tasks “off and on” throughout the day. Id. But, she said, she had “no desire” to do these tasks. Id. She emphasized that she needed encouragement to do her chores, because she only wanted to lie around. Id. Furthermore, leg pain and swelling inhibited her ability to do yard work. (Tr. 314). Plaintiff's disability did not affect her ability to handle money - she could pay bills, handle a savings account, count change, and use a checkbook or money orders. Id.

         Plaintiff left her home about one or twice each week to get mail, go to the store, or take her husband to a doctor's appointment. (Tr. 314). She went grocery shopping for about two hours twice each month. Id. She could go out alone, and would either walk, drive, or ride in a car. Id. She also described several hobbies and interests, including bowling and crafts. (Tr. 315). Plaintiff said she did not engage in these activities often because she had “lost interest.” Id. She could no longer bowl because her “legs bother” her. Id.

         Plaintiff spoke to her children on the phone and she visited her son and granddaughter a couple of times each month. Id. She did not need reminders to go places and did not have to be accompanied by anyone. Id. She also had no problems getting along with family, friends, neighbors, or others. (Tr. 316). But, she noted, she did not “feel like getting out of the house” and was “irritable and depressed.” Id.

         Plaintiff reported that her conditions affected her memory, ability to complete tasks, and concentration. Id. She could only pay attention for twenty minutes at a time and could not finish what she started. Id. But, she could follow written instructions “pretty well” and spoken instructions “o.k.” Id. She got along with authority figures and had never been fired or laid off from a job because of problems interacting with others. (Tr. 317). She struggled to handle stress, as she was “more agitated” and “depressed all the time.” Id. Plaintiff stated that she did a “fair” job handling changes in routine. Id. Plaintiff added that she had noticed unusual behaviors or fears, and specifically described her anxiety issues, insomnia, and headaches. Id. In her narrative plaintiff stated that she had to “work hard to get up in the morning” and get “motivated.” (Tr. 318). Plaintiff felt “tired all the time, depressed, ” and “agitated.” Id. Moreover, she worried about money and family issues. Id. Plaintiff explained that her conditions inhibited her ability to squat, bend, stand, walk, kneel, and climb stairs. (Tr. 316).

         In a Work History Report plaintiff set forth the positions she held between October 2002 and April 2010. (Tr. 299-310). Plaintiff worked in housekeeping and maintenance at a nursing home from October 2002 to 2006. (Tr. 299). She worked eight hours a day, five days a week. (Tr. 302). Her duties included cleaning rooms, moving residents, doing maintenance work, cutting grass, waxing and buffing floors, cleaning the carpets, and taking out the trash. Id. Plaintiff used machines, tools, and equipment, and employed technical knowledge and skills in that role. Id. She also wrote or completed reports. Id. The physical demands of the job included eight hours of walking or standing, thirty minutes of sitting, two hours of climbing or kneeling, three hours of stooping or crouching, one hour of crawling, five hours of reaching, and eight hours of handling large or small objects. Id. Plaintiff frequently lifted twenty-five pound objects, and the heaviest objects she lifted weighed fifty pounds. Id. Although plaintiff was a “lead worker” she did not hire or fire other employees. Id.

         From February 2007 until December 2007 plaintiff worked as a deli and seafood clerk at a grocery store. (Tr. 299). She worked eight hours each day, five days every week. (Tr. 301). Her duties as a clerk included waiting on customers, cooking and cutting food, and cleaning. Id. Plaintiff also used machines, tools, or equipment; she employed technical knowledge or skills, and wrote or completed reports. Id. The job required frequent lifting of objects weighing up to ten pounds; she had to carry buckets, as well as meats and cheeses to the deli counter. Id. The heaviest objects plaintiff lifted weighed twenty pounds. Id. The job also required eight hours of walking and standing, thirty minutes of sitting, no climbing or crawling, one hour of stooping or kneeling, two hours of crouching, and seven hours of reaching or handling large or small objects. Id. This position did not entail supervisory duties and she did not fire or hire employees. Id.

         In March 2008, plaintiff worked as a housekeeper. (Tr. 299). Her job responsibilities included cleaning windows and bathrooms, vacuuming, mopping floors, and taking out the trash. (Tr. 304). In that role, she frequently lifted objects weighing twenty-five pounds or more. She spent seven hours a day handling large objects, reaching, writing or handling small objects, walking, and standing. Id. She spent one to three hours climbing, sitting, kneeling, crouching, crawling, or stooping. Id. She also used machines, tools, or equipment; she employed technical knowledge or skills; and she wrote or completed reports. Id. Plaintiff did not serve as a “lead worker” and did not supervise other people. Id. Accordingly, she did not hire or fire employees. Id.

         Plaintiff worked as a cashier at a gas station from August 2008 to October 2008. (Tr. 299). She worked for eight hours each day, five days a week. (Tr. 303). She had a host of duties including waiting on customers and answering the phone. Id. In so doing, she used machines, tools, or equipment, and employed technical knowledge or skills. Id. Also, she wrote or completed reports. Id. The physical demands of the job included about two hours of walking, eight hours of standing, one hour of climbing, stooping, or crouching, no kneeling or crawling, thirty minutes of sitting, and eight hours of reaching and handling large or small objects. Id. She frequently carried objects weighing twenty-five pounds and had also carried an object weighing fifty pounds.

         Plaintiff's last job was in April 2010 when she worked for four days as a cake decorator at a grocery store. She worked eight hours each day. (Tr. 300). She sliced and packed bread, decorated cakes, carried cakes and buckets of icing, and waited on customers. Id. The daily physical requirements of plaintiff's position involved eight hours of walking, eight hours of standing, thirty minutes of sitting, no climbing or crawling, five hours of stooping, one hour of kneeling and crouching, and seven hours of reaching and handling both large and small objects. Id. Plaintiff frequently lifted ten-pound objects in that job. Id. She did not serve in a supervisory role; she did not hire or fire employees. Id. She needed to utilize machines, tools, or equipment. Id. Her duties required that she employ technical knowledge or skills. Furthermore, she completed or wrote reports. Id.

         B. Testimony at Hearings

         May 2012 Hearing[12]

         Plaintiff was 50 years old at the time of the hearing. She had completed the eleventh grade and obtained her GED. (Tr. 80). She started attending beauty school, but quit after six months because she could not stand for extended periods of time. Id. Although plaintiff alleged a disability onset date in December 2007, she worked occasionally in the years after that. Id. She also testified that since December 2007 she had not volunteered with any organization or filed unemployment or worker's compensation claims. Id. Plaintiff testified that she did not have any insurance or income at the time of the hearing. (Tr. 80-81). Plaintiff also stated that did not receive any form of public assistance other than $262.00 per month in food stamps. (Tr. 81).

         Plaintiff testified about her duties at Fontainbleau Nursing Center, where she worked as a housekeeping employee from 2003 to 2005. Id. She testified that she fixed water leaks and cut the grass. Id. Also, she moved residents, buffed the floors, cleaned carpets, and changed light bulbs. Id. Plaintiff testified that she left this job because she got married and moved away. Id. Plaintiff stated that she never suffered from alcohol problems, used illegal drugs, or used prescription drugs that were not prescribed to her. (Tr. 82). Moreover, she testified that she has never been questioned by the police for a misdemeanor or felony. Id.

         In response to questioning by her counsel, plaintiff testified that swelling and “severe pain” below her knees prevented her from working. Id. Because of the pain, she had to “prop” up her legs every ten minutes or at least once an hour. (Tr. 83- 84). Plaintiff believed she spent about half the day with her legs propped up. (Tr. 84). She stated that it is difficult to stand for more than twenty minutes. (Tr. 83). And walking 100 yards to the mailbox was very difficult as well. Id. Plaintiff had been treated for this condition for about two and a half years by Dr. Klemm at Great Mines Health Center. (Tr. 83-84). Plaintiff testified that Dr. Klemm prescribed Flexeril[13] which caused drowsiness, but did not mitigate her sleeping problems. (Tr. 84). Plaintiff testified that only rest alleviated her leg swelling. Id.

         She also testified that she struggled with anxiety and depression. (Tr. 82). Plaintiff described her anxiety as “really bad.” (Tr. 85). Anxiety caused plaintiff to experience chest pains, racing heart, sweating, and panic attacks several times each week. Id. Plaintiff testified that crowds triggered her panic attacks; it therefore became difficult to leave the house for doctor's visits or shopping. (Tr. 86). During the course of a panic attack, which typically lasted for about twenty to thirty minutes, plaintiff had a racing heart, felt “real nervous, ” and could not breathe. (Tr. 85). She further testified that the panic attacks were unpredictable. Id. She took Xanax or Celexa to ease the symptoms of the panic attacks, but the medications had a delayed effect. Id. She had endured panic attacks of this severity for several years. (Tr. 86).

         Plaintiff also testified that depression inhibited her ability to accomplish anything. (Tr. 86). She could not get out of bed several days during the week. (Tr. 86). Her depression did not diminish her capacity to dress or bathe, and did not precipitate suicidal thoughts. (Tr. 86-87). But, she did have crying spells, lasting approximately thirty minutes, about three times a week - separate and apart from her panic attacks. (Tr. 87). Plaintiff testified that her panic attacks and crying spells interrupted her activities. Id.

         Plaintiff testified that she had suffered from insomnia for about a year and, as a result, was able to sleep for only one or two consecutive hours. (Tr. 90). Plaintiff also had nightmares (sometimes occurring during the day) and “trust issues” which she believed stemmed from a physically and emotionally abusive previous marriage. (Tr. 87-88). The experience of being abused did not affect how she felt when she went out in public. (Tr. 88).

         Plaintiff testified that she could do some chores. Id. She would “try” to vacuum, but often failed to finish. Id. She would vacuum for ten minutes, but would then require fifteen minutes of rest. (Tr. 89). Moreover, she did laundry but then needed to sit down to fold it. Id. She could not cook on a regular basis because she could not stand at the oven. (Tr. 88). Plaintiff's husband did the grocery shopping. (Tr. 90). She did not do any work outside on a lawn or garden, and did not belong to any social groups. (Tr. 90).[14]

         July 2014 Hearing

         At the time of the July 2014 hearing, plaintiff was living with her husband, who was disabled. (Tr. 37). She held a valid driver's license, but did not drive due to an outdated eyeglasses prescription. Id. She last drove about three months prior to the hearing. Id.

         Plaintiff testified about her educational and employment background. (Tr. 37-38). She had not worked since October 2011. (Tr. 38). Plaintiff testified that she worked at a nursing home for four years where she did housekeeping and later did maintenance work. (Tr. 39). Her duties included cleaning carpets, buffing floors, changing light bulbs, fixing plumbing, and cutting grass. Id. The heaviest object she lifted at that job weighed about fifty pounds. (Tr. 40). Plaintiff left that position when she moved away. Id. She testified that she could no longer fulfill the duties of that job. Id.

         Plaintiff testified that she did not have any pending worker's compensation claims or health insurance at the time of the hearing. (Tr. 38). She did, however, have a pending Medicaid claim. (Tr. 38-39). Plaintiff claimed that no medical professional in the last fifteen years told her she had an alcohol problem. (Tr. 41). And she stated that she had never used any illegal drugs or non-prescribed medications. Id.

         Plaintiff testified that she began using a cane because she tore her right ACL. (Tr. 42). She claimed that she could not stand for long periods of time because of knee swelling; she needed to prop up her legs every day to manage the swelling. (Tr. 42-43).

         Plaintiff testified that depression and anxiety prevent her from leaving the house, as she would get panic attacks. (Tr. 40-41, 43-44). Plaintiff added that she had daily panic attacks; although the attacks lasted only five minutes, it took plaintiff two hours to recover from them. (Tr. 41-42). Because of the attacks, for the last couple of years plaintiff's husband did the grocery shopping. (Tr. 43). Plaintiff also attributed her insomnia to her depression. Id. She stated that she only slept two full hours each night. (Tr. 44). She stated that she had dealt with these sleeping problems for four or five years. Id. Additionally, depression affected plaintiff's appetite and ability to prepare her meals; therefore, she generally ate only one meal each day. Id. Consequently, she testified, she lost thirty pounds over the course of two to three years. Id. Plaintiff stated that she did not take a shower every day. Id. Plaintiff also testified that her concentration suffered as a consequence of her anxiety and depression. (Tr. 40). She claimed she did not have any suicidal or homicidal thoughts. (Tr. 43).

         In response to questioning by a vocational, plaintiff testified about her prior work experience. (Tr. 45-46). Plaintiff stated that the maintenance work she did at the nursing home did not involve work on the heating or air conditioning system. (Tr. 45). She changed light bulbs but not wall sockets or wall switches. Id. Her plumbing duties were limited to plunging toilets. (Tr. 46). The vocational expert testified that plaintiff's prior work at the nursing home was best classified as a hospital cleaner. Id. The position was unskilled, medium in the DOT, and medium as described. Id.

         The ALJ asked the vocational expert about the existence of jobs in the national economy for an individual of the plaintiff's age, education, and work experience who could only perform work at or below light exertional levels; who would be unable to (1) operate foot control operations, (2) climb ladders, ropes or scaffolds, (3) kneel, (4) crouch, or (5) crawl; who could occasionally climb ramps or stairs; who would need to avoid operation or control of moving or hazardous machinery; who would need to avoid operating at unprotected heights; and who would be limited to occupations involving simple, routine, and repetitive tasks. The ALJ added that the position for that individual would need to be low-stress, with only occasional decision-making and changes in work setting. Id. Furthermore, the position would involve no contact with the public and limited, casual interaction with coworkers. (Tr. 46-47).

         In response, the vocational expert testified that there were jobs available in the national economy for such an individual. (Tr. 47). He named, for example, a hand packager position. Id. There were about 4, 000 jobs of that variety in Missouri. Similarly, such an individual could work as a small product assembler. Id. There were about 15, 000 jobs in Missouri of that variety. Id. The vocational expert testified that a mail room clerk position would also be appropriate for such an individual; there were 209 such positions in Missouri. Id. These positions would not tolerate more than two unscheduled absences in a month. (Tr. 48).

         D. Medical Records

         In March 2007, plaintiff reported to Great Mines Health Center. (Tr. 400). Visit notes indicate that plaintiff reported that she had “started a new job where she had to stand for greater than 8 hours, ” and that “her legs became swollen from the knee to the foot and had fairly significant discomfort associated with it.” Id. Phillip. R. Cummings, APRN, FNP, observed “no fevers, chills, headaches, chest pain, SOB, nausea, vomiting” or diarrhea. Id. He also remarked that plaintiff was “awake, alert and oriented times three” and that her heart, lungs, and abdomen appeared normal. Id. He further noted that her extremities showed “no cyanosis, clubbing or edema at this time.” Id. Plaintiff reported “that she had significant edema but it was resolved after elevating her legs.” Id. He diagnosed plaintiff with peripheral edema. Id. Further, Nurse Cummings noted a treatment plan, writing that “[a]s I discussed with this patient back in December, she needs to be wearing compression stockings. Now that she is working and standing in one place on concrete floors for over 8 hours it is even more important that she wear the stockings while she is working. The patient verbalized understanding and will try to obtain a pair of stockings for work.” (Tr. 400). He noted that plaintiff received a refill of Doxepin.[15]Id.

         Plaintiff had an eye exam on December 3, 2007. (Tr. 377-79). Medical records indicate that early Fuchs Endothelial Dystrophy was observed; plaintiff's mother also had that condition. (Tr. 377). Plaintiff stated that she had no endocrine, ocular, allergy, cardiovascular, respiratory, gastrointestinal, genitourinary, integumentary, neurological, hematologic, ear/nose/mouth/throat, or constitutional issues. (Tr. 378). Notably, she also indicated that she did not have any musculoskeletal issues, such as muscle aches, joint pain, or swollen joints. Id. She also signified that she did not have depression or anxiety. Id.

         Records from Parkland Health Center indicate that plaintiff took an ambulance to the emergency room on March 2, 2008, complaining of swollen legs with pain below the knees. (Tr. 382). Records indicate that she told Laong Garcia, M.D., that her symptoms had worsened in the last three days, but the condition existed for three weeks. (Tr. 382, 384). And she registered her pain as an eight out of ten. (Tr. 384). No known trauma was reported. (Tr. 382). Walking, but not standing or stair-climbing, apparently aggravated the condition. Id. Plaintiff stated that rest and elevation served as alleviating factors. Id. Dr. Garcia noted that plaintiff's appearance, skin, and neurovascular appeared normal, and edema was flagged. Id. Warmth and swelling were observed below plaintiff's knees. Id. Dr. Garcia's differential diagnoses (or preliminary diagnoses) showed that plaintiff had phlebitis or DVT (deep vein thrombosis) and cellulitis. Id. Plaintiff received lab tests and an x-ray, which showed “no acute changes.” (Tr. 383). A radiology report from that visit indicated that plaintiff presented with “bilateral lower extremity pain and swelling” as well as “shortness of breath.” (Tr. 390). The radiologist, Kenneth D. Smith, M.D., found that “[t]he lungs are clear and well expanded, ” “[t]he heart and aorta are not enlarged, ” “[t]rachea is midline, ” “mild spondylosis is seen along the vertebral column, ” and that “bone density is borderline low.” Id. Plaintiff was discharged home as stable. (Tr. 382).

         On June 9, 2008, plaintiff returned to Great Mines Health Center complaining of leg swelling. (Tr. 397). Plaintiff was diagnosed with peripheral edema. (Tr. 398). Notes indicate a plan to prescribe Fluoxetine[16] and Doxepin for daily use. Id.

         On September 2, 2008, plaintiff reported to Great Mines Health Center for a reevaluation of her sleeping issues. (Tr. 412). Nurse Cummings wrote that plaintiff had depression and insomnia. Id.

         Plaintiff called Great Mines Health Center on October 31, 2008, for refills on Doxepin and Fluoxetine. (Tr. 395). The provider noted that plaintiff had an appointment scheduled for November 24, 2008. Id. And on November 24, 2008, plaintiff visited Great Mines Health Center complaining of severe depression and insomnia. (Tr. 393). The visit note from that examination indicates that Nurse Cummings assessed that plaintiff had depression. Id. He noted a prescription plan that included Trazodone, [17] Citalopram, [18] and Flexeril. Id. A medication log from Great Mines Health Center lists a history of plaintiff's medications, which included Cymbalta, [19] Prometrium, [20] Lexapro, [21] Diclofenac, [22] Zantac, [23] Doxepin, and Prozac. (Tr. 392).

         Plaintiff received an initial well woman exam on December 17, 2008. (Tr. 476). At that time plaintiff held prescriptions for Citalopram, Flexeril, and Trazadone. Id. Notes reflect that plaintiff's primary care physician treated her for osteoarthritis and depression. Also, the records show that plaintiff cared for her two-year old granddaughter for extended periods, frequently. Id. The notes mention that plaintiff was unemployed but was looking for work. Id.

         Plaintiff underwent a disability examination on January 15, 2009, performed by Barry Burchett, M.D. (Tr. 401-07). Her chief complaint was “trouble with [her] legs.” (Tr. 402). Dr. Burchett noted that plaintiff “reports a 11/2 -year history of constant swelling of the proximal medial tibial areas, ” and “describes pain in these areas when she stands for more than 15 minutes at a time or when she is walking up steps.” Id. Plaintiff also communicated that the “pain diminishes with sitting down” and “even more with elevation of her feet.” Id. Moreover, plaintiff “state[d] that she discussed this situation with her primary care physician about two months ago and he prescribed her some Flexeril, which has not been very helpful.” Id. Plaintiff told Dr. Burchett that no x-rays had been performed. Id. Plaintiff also “describe[d] some intermittent numbness of the right anterior thigh with prolonged standing for more than approximately 15 minutes and doing such activities as washing dishes.” Id. Plaintiff denied back pain and told Dr. Burchett that she had gained about forty pounds in the last three years. Id. Plaintiff held several prescriptions: Cyclobenzaprine, [24] Trazodone, Pravastatin, and Citalopram. (Tr. 403). Dr. Burchett noted that plaintiff had smoked two packs of cigarettes per day for fifteen years and that she denied the use of alcohol and drugs. Id. Dr. Burchett observed in his general notes that plaintiff “ambulates with a normal gait, which is not unsteady, lurching or unpredictable, ” and that she did not require a handheld assistive device. Id. Dr. Burchett also wrote that plaintiff “appears stable at station and comfortable in the supine and sitting positions.” Id. Her “[a]ppearance, mood, orientation, and thinking seem[ed] appropriate.” Id. And plaintiff's “recent and remote memory for medical events [was] good.” Id. Dr. Burchett considered that plaintiff earned a GED and last worked at a gas station in September 2007. Id.

         Next, Dr. Burchett conducted an examination of each of plaintiff's systems, including her HEENT (head, eyes, ears, nose, and throat), neck, chest, cardiovascular, abdomen, upper extremities, hands, cervical spine, and dorsolumbar spine. (Tr. 403-05). No abnormalities were noted. Id. Dr. Burchett also examined plaintiff's lower extremities, and wrote “[e]xamination of the legs reveals no tenderness, redness, warmth, swelling, fluid, laxity or crepitus of the knees, ankles or feet, ” and “there is no calf tenderness, redness, warmth, cord sign or Homan's[stet] sign.” (Tr. 404). Plaintiff complained of pain in the right knee when asked to squat. (Tr. 405). Dr. Burchett indicated that his clinical impression of plaintiff was neuralgia paresthetica and obesity. Id. He also summarized his findings as follows:

“[t]he claimant is a 47-year-old female with some recurrent numbness of the right anterior thigh with prolonged standing. Neurological examination is unremarkable in the lower extremities. There is some symmetrical and bilateral fullness in the pretibial regions proximally but without any definite mass structures involved and probably consistent with her recent weight gain. There are no effusions of the knees. Range of motion of the knees was normal.” Id.

         On April 8, 2009, plaintiff reported to Great Mines Health Center complaining of sleep problems. (Tr. 416). Notes reveal that Nurse Cummings believed the sleeping issues were a symptom of menopause. Id.

         A call-in sheet indicates that plaintiff phoned Great Mines Health Center on April 20, 2009, April 24, 2009, and May 26, 2009, May 29, 2009, and June 29, 2009, requesting samples of Zyprexa.[25] (Tr. 414-15). Plaintiff also asked why she was taking the medicine. (Tr. 415). Plaintiff was told that Zyprexa was prescribed to help her sleep problems and that she could stop taking it if she didn't need it. Id.

         On November 30, 2009, records show that plaintiff called Great Mines Health Center to report that her prescribed sleep medication did not work; she requested a different prescription. (Tr. 411). Plaintiff called back the next day, on December 1, 2009, to ask whether the doctor could prescribe a less expensive medication than the Mirtazapine[26] prescription she received the previous day. (Tr. 410). A Great Mines Health Center medication log listed plaintiff's prior use of Cymbalta, Promethazine, [27] Lexapro, Diclofenac, [28] Zantac, Doxepin, Prozac, Trazodone, and Flexeril.[29] (Tr. 409). The log set out plaintiff's current medications as Citalopram, Pravastatin, Clonidine, Zyprexa, and Spironolactone. Id.

         Plaintiff attended a well-woman exam on December 21, 2009. Records show plaintiff's medications as Trazadone and Celexa, as well as “BP med” prescribed for hot flashes. (Tr. 418). Plaintiff also stated that she had not been taking her cholesterol medication due to cost. Id. She also reported difficulties sleeping. Id. The physician indicated that plaintiff had abnormal lipids and obesity. Id. Records indicate that plaintiff smoked and that she had been counseled about healthy lifestyle choices. Id.

         Plaintiff reported to Parkland Health Center on March 1, 2010, for right eye trauma. (Tr. 432). Notes indicate that a small hemorrhage in the sclera of the right eye. Id. Moderate pain was evidenced. (Tr. 435). Plaintiff also reported some headache symptoms at that time. Id.

         Plaintiff reported to Parkland Health Center on May 27, 2010, complaining of chest pain. (Tr. 438-39). The chest pain persisted for six hours prior to plaintiff's arrival at the hospital. (Tr. 439). The pain radiated down her arm. (Tr. 449). Plaintiff told Laong Garcia, M.D., that she had had headaches on and off for over a week. (Tr. 439). Dr. Garcia found no abnormalities upon examination - her eyes, ENT, neck, respiratory system, cardiovascular system, skin, neurological system, and psychiatric assessments were all normal. (Tr. 440). Dr. Garcia did note, however, plaintiff's obesity and bilateral edema. Id. Ultimately, Dr. Garcia diagnosed plaintiff with “chest pain, non cardiac.” (Tr. 441). During the visit the hospital administered Nitroglycerin, [30] Aspirin, and a Toradol shot.[31] (Tr. 453). Plaintiff reported no headache or chest pain upon discharge. (Tr. 452).

         On July 16, 2010, Dr. Burchett conducted an internal medicine assessment for plaintiff. (Tr. 463-69). Plaintiff's chief complaints included “trouble with [her] legs and [her] eyes.” (Tr. 464). Dr. Burchett summarized plaintiff's history as follows:

[Plaintiff] reports problems with both legs, right worse than left for the past 2 years. She denies any history of injury to the leg. She complains of localized swelling in the proximal anteromedial tibial areas. She also complains of pain in th[ese] areas if she walks more than approximately 1 block, especially if she walks up steps. She states that she has discussed this with her PMD, but she has never had any particular evaluation or specific treatment for this. She further ...

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