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Goin v. Berryhill

United States District Court, D. Nevada

February 15, 2019

JUANITA JOAN GOIN, Plaintiff,
v.
NANCY A. BERRYHILL, Acting Commissioner of Social Security Administration, Defendant.

          REPORT & RECOMMENDATION OF UNITED STATES MAGISTRATE JUDGE RE: ECF NOS. 14, 15

          WILLIAM G. COBB UNITED STATES MAGISTRATE JUDGE.

         This Report and Recommendation is made to the Honorable Howard D. McKibben, Senior United States District Judge. The action was referred to the undersigned Magistrate Judge pursuant to 28 U.S.C. § 636(b)(1)(B) and the Local Rules of Practice, LR 1B 1-4.

         Before the court is Plaintiff's Motion for Reversal and Remand. (ECF No. 14.) The Commissioner filed a Cross-Motion to Affirm and Response to Plaintiff's motion. (ECF Nos. 15, 16.)

         After a thorough review, it is recommended that Plaintiff's motion be granted; the Commissioner's cross-motion to affirm be denied; and, that this matter be remanded for further administrative proceedings consistent with this Report and Recommendation.

         I. BACKGROUND

         On January 18, 2015, Plaintiff completed an application for disability insurance benefits (DIB) under Title II of the Social Security Act alleging disability beginning September 16, 2013. (Administrative Record (AR) 166-167.) The applications were denied initially and on reconsideration. (AR 94-106.)

         Plaintiff requested a hearing before an administrative law judge (ALJ). (AR 109-110.) ALJ Craig Denney held a hearing on November 18, 2016. (AR 30-63 .) Plaintiff, who was represented by counsel, appeared and testified on her own behalf at the hearing. Testimony was also taken from a vocational expert (VE). On February 23, 2017, the ALJ issued a decision finding Plaintiff not disabled. (AR 10-22.) Plaintiff requested review and the Appeals Council denied the request, making the ALJ's decision the final decision of the Commissioner. (AR 1-4.)

         Plaintiff then commenced this action for judicial review under 42 U.S.C. § 405(g). Plaintiff argues: (1) the ALJ erred at step three in failing to consider whether Plaintiff's impairments met or equaled Listed Impairments 1.02 or 1.04; (2) the ALJ did not properly evaluate the medical opinion evidence of the treating and examining medical providers; and (3) the ALJ did not properly consider her subjective claims.

         The Commissioner, on the other hand, argues that the ALJ properly: (1) did not consider Listed Impairments 1.02 and 1.04; (2) evaluated the medical opinion evidence; and (3) discounted Plaintiff's subjective complaints.

         II. STANDARDS

         A. Disability Process

         After a claimant files an application for disability benefits, a disability examiner at the state Disability Determination agency, working with a doctor(s), makes the initial decision on the claimant's application. See 20 C.F.R. §§ 404.900(a)(1); 416.1400(a)(1). If the agency denies the claim initially, the claimant may request reconsideration of the denial, and the case is sent to a different disability examiner for a new decision. See 20 C.F.R. §§ 404.900(a)(2), 416.1400(a)(2). If the agency denies the claim on reconsideration, the claimant may request a hearing and the case is sent to an ALJ who works for the Social Security Administration. See 20 C.F.R. §§ 404.900(a)(3), 416.1400(a)(3). The ALJ issues a written decision after the hearing. See 20 C.F.R. § 404.900(a)(3). If the ALJ denies the claim, the claimant may request review by the Appeals Council. See 20 C.F.R. §§ 404.900(a)(4), 416.1400(a)(4). If the Appeals Council determines there is merit to the claim, it generally remands the case to the ALJ for a new hearing. If the Appeals Council denies review, the claimant can file an action in the United States District Court. See 42 U.S.C. § 405(g); 20 C.F.R. §§ 404.900(a)(5), 416.1400(a)(5).

         B. Five-Step Evaluation of Disability

         Under the Social Security Act, "disability" is the inability to engage "in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 1382c(a)(3)(A). A claimant is disabled if his or her physical or mental impairment(s) are so severe as to preclude the claimant from doing not only his or her previous work but also, any other work which exists in the national economy, considering his age, education and work experience. 42 U.S.C. § 1382c(a)(3)(B).

         The Commissioner has established a five-step sequential process for determining whether a person is disabled. 20 C.F.R. §404.1520 and § 416.920; see also Bowen v. Yuckert, 482 U.S. 137, 140-41 (1987). In the first step, the Commissioner determines whether the claimant is engaged in "substantial gainful activity"; if so, a finding of nondisability is made and the claim is denied. 20 C.F.R. § 404.152(a)(4)(i), (b); § 416.920(a)(4)(i); Yuckert, 482 U.S. at 140. If the claimant is not engaged in substantial gainful activity, the Commissioner proceeds to step two.

         The second step requires the Commissioner to determine whether the claimant's impairment or combination of impairments are "severe." 20 C.F.R. § 404.1520(a)(4)(ii), (c) and § 416.920(a)(4)(ii), (c); Yuckert, 482 U.S. at 140-41. An impairment is severe if it significantly limits the claimant's physical or mental ability to do basic work activities. Id. If the claimant has an impairment(s) that is severe, the Commissioner proceeds to step three.

         In the third step, the Commissioner looks at a number of specific impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1 (Listed Impairments) and determines whether the claimant's impairment(s) meets or is the equivalent of one of the Listed Impairments. 20 C.F.R. § 404.1520(a)(4)(iii), (d) and § 416.920(a)(4)(iii), (d). The Commissioner presumes the Listed Impairments are severe enough to preclude any gainful activity, regardless of age, education or work experience. 20 C.F.R. § 404.1525(a), § 416.925(a). If the claimant's impairment meets or equals one of the Listed Impairments, and is of sufficient duration, the claimant is conclusively presumed disabled. 20 C.F.R. § 404.1520(a)(4)(iii), (d), § 416.920(a)(4)(iii), (d). If the claimant's impairment is severe, but does not meet or equal one of the Listed Impairments, the Commissioner proceeds to step four. Yuckert, 482 U.S. at 141.

         At step four, the Commissioner determines whether the claimant can still perform "past relevant work." 20 C.F.R. § 404.1520(a)(4)(iv), (e), (f) and § 416.920(a)(4)(iv), (e), (f). Past relevant work is that which a claimant performed in the last 15 years, which lasted long enough for him or her to learn to do it, and was substantial gainful activity. 20 C.F.R. § 404.1565(a) and § 416.920(a).

         In making this determination, the Commissioner assesses the claimant's residual functional capacity (RFC) and the physical and mental demands of the work previously performed. See id.; 20 C.F.R. § 404.1520(a)(4)(v), § 416.920(a)(4)(v); see also Berry v. Astrue, 622 F.3d 1228, 1231 (9th Cir. 2010). RFC is what the claimant can still do despite his or her limitations. 20 C.F.R. § 404.1545 and § 416.945. In determining the RFC, the Commissioner must assess all evidence, including the claimant's and others' descriptions of the limitation(s), and medical reports, to determine what capacity the claimant has for work despite his or her impairments. 20 C.F.R. § 404.1545(a)(3) and 416.945(a)(3).

         A claimant can return to previous work if he or she can perform the "actual functional demands and job duties of a particular pat relevant job" or "[t]he functional demands and job duties of the [past] occupation as generally required by employers throughout the national economy." Pinto v. Massanari, 249 F.3d 840, 845 (9th Cir. 2001) (internal quotation marks and citation omitted).

         If the claimant can still do past relevant work, then he or she is not disabled. 20 C.F.R. § 404.1520(f) and § 416.920(f); see also Berry, 62 F.3d at 131.

         If, however, the claimant cannot perform past relevant work, the burden shifts to the Commissioner to establish at step five that the claimant can perform other work available in the national economy. 20 C.F.R. §§ 404.1520(e), 416.920(e); see also Yuckert, 482 U.S. at 141-42, 144. This means "work which exists in significant numbers either in the region where such individual lives or in several regions of the country." Gutierrez v. Comm'r of Soc. Sec. Admin., 740 F.3d 519, 528 (9th Cir. 2014). If the claimant cannot do the work he or she did in the past, the Commissioner must consider the claimant's RFC, age, education, and past work experience to determine whether the claimant can do other work. Yuckert, 482 U.S. at 141-42. The Commissioner may meet this burden either through the testimony of a VE or by reference to the grids. Tackett v. Apfel, 180 F.3d 1094, 1100 (9th Cir. 1999).

         If at step five the Commissioner establishes that the claimant can do other work which exists in the national economy, then he or she is not disabled. 20 C.F.R. § 404.1566(b), § 416.966(b). Conversely, if the Commissioner determines the claimant unable to adjust to any other work, the claimant will be found disabled. 20 C.F.R. § 404.1520(g), § 416.920(g); see also Lockwood, 616 F.3d at 1071; Valentine v. Comm'r of Soc. Sec. Admin., 574 F.3d 685, 689 (9th Cir. 2009).

         C. Judicial Review & Substantial Evidence

         The court must affirm the ALJ's determination if it is based on proper legal standards and the findings are supported by substantial evidence in the record. Gutierrez, 740 F.3d at 522 (citing 42 U.S.C. § 405(g)). "Substantial evidence is 'more than a mere scintilla but less than a preponderance; it is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. at 523-24 (quoting Hill v. Astrue, 698 F.3d 1153, 1159 (9th Cir. 2012)).

         To determine whether substantial evidence exists, the court must look at the record as a whole, considering both evidence that supports and undermines the ALJ's decision. Gutierrez, 740 F.3d at 524 (citing Mayes v. Massanari, 276 F.3d 453, 459 (9th Cir. 2001)). The court "'may not affirm simply by isolating a specific quantum of supporting evidence.'" Garrison v. Colvin, 759 F.3d 995, 1009 (9th Cir. 2014) (quoting Lingenfelter v. Astrue, 504 F.3d 1028, 1035 (9th Cir. 2007)). "'The ALJ is responsible for determining credibility, resolving conflicts in medical testimony, and for resolving ambiguities.'" Id. (quoting Andrews v. Shalala, 53 F.3d 1035, 1039 (9th Cir. 1995)). "If the evidence can reasonably support either affirming or reversing, 'the reviewing court may not substitute its judgment' for that of the Commissioner." Gutierrez, 740 F.3d at 524 (quoting Reddick v. Chater, 157 F.3d 715, 720-21 (9th Cir. 1996)). That being said, "a decision supported by substantial evidence will still be set aside if the ALJ did not apply proper legal standards." Id. (citing Bray v. Comm'r of Soc. Sec. Admin., 554 F.3d 1219, 1222 (9th Cir. 2009); Benton v. Barnhart, 331 F.3d 1030, 1035 (9th Cir. 2003)). In addition, the court will "review only the reasons provided by the ALJ in the disability determination and may not affirm the ALJ on a ground upon which he did not rely." Garrison, 759 F.3d at 1010 (citing Connett v. Barnhart, 340 F.3d 871, 874 (9th Cir. 2003)).

         III. DISCUSSION

         A. Medical Records Summary

         Plaintiff was working as a caregiver in September of 2013, when she was transferring a patient from a wheelchair and felt a pop in her back and significant back pain. (AR 420.) She was transported to the emergency room via ambulance, and on examination had significant tenderness to palpation in the L4-5 region as well as along the lumbosacral region. (AR 420.) An x-ray of the lumbar spine was unremarkable for any acute abnormality. (AR 426.) She was given Vicodin and valium which gave her some relief. She was assessed with lumbosacral strain and was advised to follow up with her doctor. (AR 422.)

         On December 2, 2013, after initiating a workers' compensation claim, she established care with physiatrist Dr. Dallin DeMordaunt of the Nevada Occupational Health Center. She reported worsening back pain, and difficulty walking because her cane had broken. She had pain that radiated to mid-calf when she was standing, and right above the knee while sitting. She had limited range of motion, limited functional ability, limited sensation, and an antalgic gait. She was assessed with lumbar radiculopathy and central sensitization. (AR 350.) She was restricted as follows: bending was limited to five hours per day; no kneeling; no lifting or pulling greater than 10 pounds; no squatting; she should alternate sitting and standing as tolerated. (AR 354.)

         She saw Dr. DeMordaunt again on December 12, 2013, for low back pain and referred pain in the lower extremities, which was greater on the right side. She had begun physical therapy, which gave her some short-term relief but then led to increased pain and a return to her baseline amount of pain. She reported aching pain across the low back and buttocks, and aching, burning, numbness and tingling down the right lower extremity to the ankle. She was taking Percocet and Flexeril three times a day. (AR 352.) On examination, she had tenderness to palpation in the midline lumbar spine, mid and lower lumbar spine, right upper-mid and lower lumbar paraspinals and a little on the left side as well. As for range of motion, her trunk flexion was reduced with her hands reaching not quite to her knees. She had pain across her back with the two-point straight leg test and Patrick's test bilaterally. She had an antalgic gait on the right. She reported decreased sensation throughout the right lower extremity. She was diagnosed with lumbar strain and sprain and agreed to proceed with trigger point injections. (AR 353.) It was noted that she was making minimal/modest gains, and that if she did not respond to the trigger point injections, they would consider facet injections, and if that provided no relief a second opinion would be considered. (AR 354.)

         At physical therapy a few days later, she still had pain, and she had maximum limitation in her spinal flexion, and her overall improvement was described as poor. (AR 355.)

         Notes from her remaining December 2013 and January 2014 appointments reflect that her pain, tenderness, numbness and tingling, decreased sensation and limited range of motion continued. (AR 357-364.) She had no relief from physical therapy or the trigger injections. (Id.) She had an EMG, which was negative for radiculopathy. (AR 364.) She was referred to an orthopedist. On December 19, 2013, Dr. DeMordaunt said she could not lift or pull more than 10 pounds; she was limited to bending five times per hour; and she should alternate between sitting and standing as tolerated. (AR 358.) The restrictions were the same after her January 9, 2014 appointment, with the added restrictions that she could not squat or kneel. (AR 364.)

         She saw orthopedist Dr. James R. Rappaport of Sierra Regional Spine Institute for an initial consultation on January 15, 2014, for continuing low back pain radiating to the entire right lower extremity. On examination, she had: “exquisite” tenderness to the lightest palpation of the lumbar spine; significant tenderness over all lumbar facet joints and spinous processes; significant tenderness over both SI joints; limited range of motion with pain; mild muscle spasm; positive SI area testing; and, decreased sensation in the right lower extremity. Her diagnoses at that point included: facet mediated low back pain; lumbar spondylosis; foraminal stenosis; sacroiliitis; lumbar radiculopathy; myofascial pain; and, positive Waddell signs. Dr. Rappaport suggested diagnostic selective nerve root blocks at ¶ 4, L5, and S1 on the right side, with a note she may be a candidate for decompression surgery. (AR 547.) He assessed her as being limited to lifting 10 pounds or less; she should have the ability to change positions as needed; and she should avoid bending, twisting the waist, reaching above shoulder height, and climbing. (AR 543.)

         She saw both Dr. DeMordaunt and Dr. Rappaport in January through April of 2014, with continued complaints of sharp and aching pain, and numbness and burning down the lower right extremity. She was extremely tender to palpation in the lower lumbar spine and had minimal lumbar range of motion. Dr. DeMordaunt administered the right L-5 selective nerve root block, which provided her with no relief, and if anything, resulted in a worsening of her symptoms. (AR 365-67, 541543.) She subsequently underwent selective nerve root blocks at L-4 and S-1, which also gave her no relief. (AR 368, 541, 369, 370, 538.) Having no success with non-operative treatment, an updated EMG to attempt to localize the radiculopathy as well as an MRI were ordered as Plaintiff wished to proceed with surgery. (AR 540.) At her February 27, 2014, appointment with Dr. DeMordaunt, he included the following work restrictions: limited bending; no kneeling; no lifting, pulling or pushing greater than 10 pounds; no squatting; alternate sitting and standing as tolerated. (AR 368.) At her March 27, 2014, appointment with Dr. DeMordaunt, he restricted her to no lifting, pushing or pulling more than 10 pounds; only occasional bending; no squatting; and alternating between sitting and standing as tolerated. (AR 370.)

         The EMG study was normal. (AR 538.) The April 29, 2014 MRI showed: lumbar disc herniation at ¶ 5-S1 and L4-5; loss of signal at 5-1 with disc space narrowing and loss of signal at 4-5; subarticular recess stenosis at 5-1; foraminal stenosis left greater than right at 5-1; facet arthropathy at 5-1; disc herniation at 4-5, left greater than right foraminal stenosis and moderately severe arthropathy. (AR 536.) When she saw Dr. Rappaport on May 15, 2014, she still had severe pain, decreased sensation, limited range of motion, and positive bilateral sciatic tension signs. She was assessed with lumbar internal disc disruption syndrome at ¶ 4-5, L5-S1; lumbar facet arthrosis; lumbar subarticular recess stenosis, with lumbar radiculitis. It was noted that she had failed with non-operative treatment, and her symptoms prevented her from doing activities of daily living and her work. (AR 536.) Dr. Rappaport recommended a lumbar discectomy, laminectomy and fusion at ¶ 4-S1. Due to her body habitus and severity of the MRI findings, he opined this would be best accomplished through a two-stage approach: a posterior laminectomy followed by the anterior discectomy. (AR 537.)

         At her May 29, 2014, appointment with Dr. DeMordaunt, she still had pain and tenderness in the lumbar spine, reduced range of motion with increased pain, and decreased sensation in the right lower extremity. She had a slow gait. She was restricted to no lifting, pushing or pulling more than 10 pounds; occasional bending; no squatting; and alternating between sitting and standing as tolerated. (AR 372.)

         Her pain and other symptoms worsened as she awaited authorization for surgery. In fact, when she saw Dr. Rappaport on July 2, 2014, they were described as “intolerable” and had significantly increased. (AR 372, 534-35.) She had a very difficult time ambulating, and Dr. Rappaport's office loaned Plaintiff a wheelchair. (AR 534.) On August 13, 2014, Dr. Rappaport still had not received authorization for the surgery, and he noted that Plaintiff's condition appeared to be deteriorating. (AR 532.) When she saw Dr. DeMordaunt the next day, she reported doing worse with significant pain. She required a wheelchair because she would fall over when standing due to pain and weakness. The pain now stretched up into the thoracic spine, and continued in the lumbar spine, radiating to the lower extremities. (AR 373.) At that point, he restricted her to no lifting, pushing or pulling over 10 pounds; no squatting; and, she was to alternate between sitting and standing as tolerated. (AR 374.) Nothing was said about bending. He recommended she see a pain management physician and pain psychologist. (AR 374.)

         It appears she was approved for surgery when she saw Dr. Rappaport on August 27, 2014. (AR 379.) She was still using a wheelchair, and while she was able to get up and take a few steps and get on and off the exam table, it was quite slow and with obvious pain. She still had significant tenderness to palpation in the lumbar spine as well as over both SI joints, limited range of motion, and decreased sensation in the right leg. (AR 381.)

         Plaintiff underwent the first phase of the surgery-lumbar decompression and fusion from L4 to S1-with Dr. Rappaport on September 2, 2014. At that time, he noted she had been using a wheelchair, as well as a walker to get around the house and was not driving. (AR 383.) In her initial follow up appointment, she indicated her radicular symptoms improved. (AR 527-28.) On September 17, 2014, it was noted that her radicular symptoms, while somewhat improved, continued to varying degrees. (AR 549.)

         Plaintiff underwent the second phase of the surgery-the anterior discectomy-with Dr. Rappaport and vascular surgeon Dr. Thomas E. Rembetski, on September 23, 2014. (AR 432-473.) When she saw Dr. Rappaport following the second surgery on October 1, 2014, she reported continued back pain with some radicular symptoms to the left leg. A neurological examination showed continued weakness in the right leg. (AR 522.) When she saw Dr. Rappaport on October 15, 2014, he noted her radicular pain had improved only mildly. She was also having abdominal wall pain near the incision site. (AR 521.) She went to the emergency room for the abdominal pain, and eventually had an incisional hernia repair, which had its own complications and required another procedure to remove pressure that a stitch was putting on a nerve. (AR 424-29, 477-94, 495-96, 508, 578, 580-584, 626-31, 677-79, 690, 693.)

         When she saw Dr. Rappaport on November 5, 2014, she had right leg pain. (AR 520.) At that point he classified her work status as temporarily totally disabled. (AR 520.) On December 10, 2014, she was still using a walker for ambulation. She continued to report weakness in both lower extremities, though he noted it was improving. (AR 518.) he remained at temporary totally disabled work status. (AR 518.)

         On January 9, 2015, she reported to Dr. Rappaport that she had increasing low back pain directly above the fusion site at the thoracolumbar junction and again over the right SI joint. She had burning and numbness and pain in the anterior and posterior thigh. He noted that prior to surgery she had decreased ambulating and was using a wheelchair, and after surgery she continued to use a walker. On examination, she had mild tenderness at the surgical site, and exquisite tenderness over the SI joint. She had moderate muscle spasm with trigger point formation noted at the thoracolumbar junction. Her diagnoses included: status post lumbar decompression/fusion; low back pain; lumbar spondylosis; sacroiliitis; and, myofascial pain with trigger point formation. (AR 516.)

         Dr. DeMordaunt gave her a right SI joint injection, but it provided no relief. On February 19, 2015, she reported increased back pain at the thoracolumbar junction and over the right SI joint. She still had difficulty walking. (AR 622.) Dr. DeMordaunt performed an EMG and nerve conduction study on March 13, 2015, which was normal on the right side but abnormal as to the left lower extremity, which curiously was asymptomatic. Dr. DeMordaunt felt this may suggest development of left L5 radiculopathy, which he felt was concerning and should be monitored. (AR 621.)

         She saw Michael J. Lewandowski, Ph.D., of Behavioral Medicine Consultants for a behavioral medicine and psychological intake evaluation on March 18, 2015. She was using a walker and back brace and reported falling frequently. She indicated that sitting, standing and walking all aggravated her pain, and that she frequently had to drag her right leg due to pain. (AR 634-35.) She reported a significant reduction in her activity levels as a result of her injury.

         She saw Dr. Rappaport again on March 19, 2015. She walked with a stiff right hip and had tenderness over the right SI joint. She was advised to initiate physical therapy for core stabilization and right SI joint work. He assessed her work status at that point as sedentary only, and it was noted she could not drive. (AR 619.) She followed up with Dr. Rappaport the following month, and still had pain with radicular symptoms in the right leg as well as SI joint pain. Physical therapy had been making her symptoms worse, and she was advised to stop. He assessed her as having significant sacroiliitis and referred her to a SI joint specialist and for pain management. She was to continue taking Percocet, though he discussed with her the importance of weaning off from ongoing narcotic use. Her work status was still described as sedentary. At that point, he stated her prognosis was somewhat guarded secondary to the development of significant sacroiliitis. (AR 618.)

         She had a follow up with Dr. Rappaport on May 13, 2015, and workers' compensation had denied her treatment for the SI joint pain. On examination, she still had pain over the right SI joint; was walking with a limp on the right side; and used a walker. She was going to try to transition from Percocet to Ultram or Meloxicam. There was no change in her sedentary work assessment. (AR 616.)

         By June 10, 2015, she had weaned herself off the opioids. (AR 651.) When she saw Dr. Rappaport that day she indicated she was ready to proceed with closure of her workers' compensation claim. She still had back pain and radicular symptoms. She was advised to follow up with her primary care provider. (AR 614.) He assessed her work status as follows at that time: she could not lift greater than 20 pounds, with no repetitive lifting greater than 10 pounds; she could bend at the hips but should not bend at the lumbar spine; standing and sitting were unlimited, but she should change between positions for five minutes every hour. He indicated that these were permanent restrictions. (AR 614.)

         She initiated care with Dr. Cesar Udani of Sierra Nevada Health Center on July 6, 2015. She still had piercing, sharp and shooting back pain, and was using a walker to ambulate. (AR 554.) She had lumbar spine tenderness and moderate pain with range of motion. (AR 556.)

         On July 8, 2015, Michael A. Glick, D.O., examined Plaintiff and subsequently completed a permanent partial disability evaluation report. He concluded she had a 32 percent whole person impairment attributed to her occupational injury. (AR 601-02.) At that point, she complained of pain bilaterally in her back, that was shooting in the legs, back and hips; she had numbness and tingling in the legs and buttocks, and weakness in her legs; she had shooting pain while walking; and was using a walker. She rated her sitting tolerance as 15-20 minutes, her walking tolerance as 10 minutes, and her standing tolerance depended on how her legs were doing. (AR 605.)

         She described her daily activities as follows: she used adaptive tools such as a long-handled sponge for bathing; with grooming she needed help shaving her legs; she was limited with dressing, and needed assistance with her socks; she could not bend or reach, and had an extended grabber to help with dressing; she had problems concentrating due to being unable to get comfortable; she had problems standing, sitting, reclining, walking, stooping, squatting, kneeling, reaching, bending, twisting and carrying, which all caused her pain; she could lift maybe 10 pounds; driving was difficult; and she had difficulty sleeping.

         On examination, she had tenderness in the lumbar spine; some give-way weakness in the right lower extremity with flexion and extension of the leg; decreased sensation in the entire right leg to pin prick and light touch; and limited range of motion. She tended to drag her right leg. (AR 608.)

         She continued to complaint of back pain in her visits with Dr. Udani between October 6, 2015 and November of 2016. (AR 735-38, 740-43, 761, 96.) She went to physical therapy, but was discharged with her goals unresolved as she experienced severe pain with therapy. (AR 655-69.) She reported to her physical therapist she could sit for 10 to 15 minutes; she could stand for one minute; and she could walk half a block. She described significant functional limitations due to her pain and weakness, including difficulty sitting, standing, walking, with housework and dressing, and doing the wash. (AR 659, 663, 665.)

         She was assessed with chronic low back pain and bilateral sciatica. (AR 796.) She was referred to orthopedics for a re-evaluation, though there are no additional records from an orthopedist in the record. (AR 739.)

         B. Hearing Testimony

         Plaintiff testified at the hearing that she was living with her cousin, and she was no longer driving so her mother drove her to the hearing. (AR 37.) She could not drive because she could not feel the pedals with her ...


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