United States District Court, E.D. Missouri, Eastern Division
MEMORANDUM AND ORDER
E'. JACKSON UNITED STATES DISTRICT JUDGE
matter is before the Court for review of an adverse ruling by
the Social Security Administration.
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). 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).
and counsel appeared for a hearing on May 30, 2012. (Tr.
74-95, 206). 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. (Tr. 1-5). Accordingly, the ALJ's
decision stands as the Commissioner's final decision.
Evidence Before the ALJ
Disability Application Documents
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, Clonidine as a “water pill,
” Pravastatin for high cholesterol,
Ranitidine for generic “stomach” issues,
and Spironolactone for blood pressure. (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,
Xanax for anxiety,  Clonidine for blood pressure,
Spironolactone as a “water pill, ” Pravastatin
for cholesterol,  and Ranitidine for acid reduction. (Tr.
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).
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.
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.
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.
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.
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).
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.
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.
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.
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.
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.
Testimony at Hearings
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.
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.
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 which caused drowsiness, but did not
mitigate her sleeping problems. (Tr. 84). Plaintiff testified
that only rest alleviated her leg swelling. Id.
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).
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.
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).
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).
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.
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.
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.
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.
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).
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.
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).
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).
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.Id.
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.
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).
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 and Doxepin for daily use.
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
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,  Citalopram,
and Flexeril. Id. A medication log from Great Mines
Health Center lists a history of plaintiff's medications,
which included Cymbalta,  Prometrium,  Lexapro,
Diclofenac,  Zantac,  Doxepin, and Prozac. (Tr.
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.
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,  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.
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
“[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.”
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.
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. (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.
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 prescription she received the previous
day. (Tr. 410). A Great Mines Health Center medication log
listed plaintiff's prior use of Cymbalta, Promethazine,
Lexapro, Diclofenac,  Zantac, Doxepin, Prozac, Trazodone,
and Flexeril. (Tr. 409). The log set out
plaintiff's current medications as Citalopram,
Pravastatin, Clonidine, Zyprexa, and Spironolactone.
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.
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.
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,  Aspirin, and
a Toradol shot. (Tr. 453). Plaintiff reported no
headache or chest pain upon discharge. (Tr. 452).
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