The opinion of the court was delivered by: SIDNEY SCHENKIER, Magistrate Judge
MEMORANDUM OPINION AND ORDER*fn1
The plaintiff, Rosa Pickett, brings this action pursuant to
42 U.S.C. § 405(g) to review a final decision of the Commissioner
("Commissioner") of the Social Security Administration ("Agency")
denying her Disability Insurance Benefits ("DIB") and
Supplemental Security Income ("SSI") under the Social Security
Act ("Act"). Ms. Pickett filed an application for DIB and SSI on
August 22, 2001, with a protective filing date of July 31, 2001
(Administrative Record ("R.") at 14, 80-82, 265-267). Ms. Pickett
alleged that she became disabled on January 24, 2001, due to
bilateral carpal tunnel syndrome, asthma, numbness in her hands,
and chest pain (R. 76-79). Her application was denied at the
initial levels of administrative review (R. 76-79, 268-69), and
she requested an administrative hearing (R. 39-40). On April 15,
2003, an administrative law judge ("ALJ") conducted a hearing at
which Ms. Pickett, represented by counsel, appeared and testified
(R. 41-75). In addition, Elizabeth Clem testified as a vocational
expert (R. 69-73). In a decision dated October 24, 2003, the ALJ
found that Ms. Pickett was not disabled because she retained the
ability to perform her past work as either a nurse's aid or a packager in a greeting
card factory (R. 14-20). This became the final decision of the
Commissioner when the Appeals Council denied Ms. Pickett's
request for review of the decision on June 12, 2003 (R. 4-5).
Ms. Pickett now seeks summary judgment reversing the
Commissioner's decision denying her DIB and SSI or, in the
alternative, remanding the case for further proceedings (Doc. #
18). The Commissioner has filed a cross-motion for summary
judgment to affirm her decision below (Doc. # 20). For the
reasons stated below, the Court grants Ms. Pickett's motion for
summary judgment and, remands the case for further proceedings;
the Court denies the Commissioner's motion for summary judgment.
Ms. Pickett was born on January 30, 1961, making her forty-two
years old at the time of the ALJ's decision (R. 80). She is
single and has two children (R. 49). She is right-handed (R. 57),
is 5' 9" tall, and weighs 245 pounds (R. 50, 185). Ms. Pickett
attended school through the eleventh grade, and was in some
special education classes (R. 23). She later obtained a nurse's
assistant certificate after completing a vocational school course
(R. 49-50). From the year 2000 through 2001, Ms. Pickett worked
in a greeting card factory, where she performed various jobs
among several departments, including packaging greeting cards and
driving a forklift (R. 70, 118). She has briefly held several
other similar factory jobs, as well as a few other short-lived
positions (R. 45-47, 118). In addition, Ms. Pickett worked as a
certified nurse's assistant the position she held the longest
at a mental health facility, from 1993 until 1996 (R. 71, 118).
She traces the onset of her disability to January of 2001 when, in addition to her carpal tunnel
syndrome, she "started having problems with everything" (R.
The relevant medical record in this case begins on January 24,
2001, when Ms. Pickett was hospitalized at the Baptist Memorial
Hospital in Osceola, Arkansas, for two days with complaints of
chest pains (R. 198). There is apparently no record of this
hospitalization, but shortly thereafter, on February 6, 2001, Ms.
Pickett followed up with Dr. D.V. Patel at the Northeast Arkansas
Clinic, and related her experience (Id.). The pains were sharp,
and radiated from the left side of her chest to her left arm and
back (Id.). Ms. Pickett also experienced shortness of breath,
diaphoresis, and nausea (Id.). She was treated with aspirin,
and it took two to three hours for the pain to subside (Id.).
Ms. Pickett told Dr. Patel that she was in constant pain
(Id.). At that time, she was taking Celebrex for
osteoarthritis, and Propo-N/APAP and Tylenol as needed for pain
(Id.). Ms. Pickett stated she had asthma, but smoked four or
five cigarettes a day (Id.). She complained of joint pain and
depression (R. 199). An EKG showed normal sinus rhythm, but also
demonstrated anterolateral ischemia (Id.).*fn3 Dr. Patel
diagnosed asthma, and chest pain of questionable etiology (R.
200). On Dr. Patel's recommendation, Ms. Pickett underwent a
stress echocardiagram the following day with normal results, and
demonstrated a fair exercise tolerance (R. 196).
On March 7, 2001, Ms. Pickett underwent a nerve conduction
study of her upper extremities at the Northeast Arkansas Clinic
(R. 194-95). The results were consistent with mild carpal tunnel syndrome bilaterally (R. 195). On March 21, 2001, Ms. Pickett was
told she could return to work at the greeting card factory by
March 26, but was instructed to wear braces on both wrists (R.
162). On March 23, however, she was noted to have limited
repetitive use of both hands (Id.). The following week, Ms.
Pickett returned to the clinic to inquire about carpal tunnel
surgery, and she was referred for an orthopedic evaluation
On April 3, 2001, Dr. James Marvel evaluated Ms. Pickett's
carpal tunnel syndrome at the clinic (R. 167). Ms. Pickett
reported that she had been unable to work from January 24 through
March 26, 2001 (Id.). Dr. Marvel characterized the results of
the nerve conduction study as revealing bilateral carpal tunnel
syndrome, which was "quite mild" on the left side (Id.). He
noted that Ms. Pickett was taking Celebrex, Tylenol with codeine,
Prevacid for stomach acid, and using an Albuterol inhaler for
asthma (Id.). Upon examination, Dr. Marvel found that clinical
signs were positive for carpal tunnel syndrome on the right side
(R. 168). In addition, there was tightness in the muscles on the
left side of the base of Ms. Pickett's neck (Id.). He
recommended physical therapy for this, and carpal tunnel release
surgery for Ms. Pickett's right hand (Id.). Ms. Pickett also
had a chest x-ray at the clinic that day, the results of which
were consistent with asthma or bronchitis (R. 153).
Ms. Pickett underwent carpal tunnel release surgery on her
right hand on April 19, 2001 (R. 147). By April 26, she reported
that her right hand was feeling much better (R. 165). Her right
hand continued to heal well and, while not at full strength, it
was making progress through July 9, 2001 (R. 160-61, 163-64). At
that time, Dr. Marvel noted that Ms. Pickett's right hand was
"doing fine," but felt she had become a candidate for carpal
tunnel release surgery on her left hand (R. 160). The doctor next
saw Ms. Pickett on July 16, 2001, at which time he found her
surgical scar was well-healed (R. 145). As for her left hand, Dr. Marvel reported that there
was good thenar*fn4 strength, although clinical signs were
mildly positive for carpal tunnel syndrome (R. 145).
Ms. Pickett had carpal tunnel release surgery on her left hand
on July 27, 2001 (R. 142-43). On August 16, 2001, Dr. Marvel
reported that Ms. Pickett's left hand had healed, but that she
had decreased sensory function in the ulnar side of her right
hand (R. 158). This additional problem involved a different nerve
than the one that had been freed by the surgery (Id.). By
September 28, 2001, the doctor felt Ms. Pickett's hands were
"doing relatively well" (R. 181). There continued to be decreased
ulnar nerve sensation in her right hand, however, and Dr. Marvel
thought she might benefit from ulnar nerve surgery (Id.).
In connection with Ms. Pickett's August 21, 2001 application
for DIB and SSI, a state disability agency physician reviewed the
preceding medical records and, on October 5, 2001, found that Ms.
Pickett could occasionally lift or carry up to fifty pounds,
frequently lift or carry up to twenty-five pounds, stand or walk
about six hours of an eight-hour workday, sit about six hours of
an eight-hour workday, and push or pull hand or foot controls
without limitation (R. 173-78). On December 12, 2001, a second
state disability agency physician conducted a similar review, and
concurred in that assessment (R. 178).
On January 17, 2002, Ms. Pickett sought an assessment of her
mental state at Mid-South Health Systems, and had an interview
with a social worker there, Barbara Weaver (R. 221-24). Ms.
Pickett reported that she had experienced depressive symptoms
since 1993, including depressed mood; crying spells; decreased
sleep, appetite, and energy; hopelessness; and anhedonia (Id.).
The symptoms had become worse since she had been diagnosed with
carpal tunnel syndrome (Id.). According to Ms. Pickett, that condition had precipitated the
loss of her job due to "improper medical leave" (R. 224). Ms.
Pickett stated she had thought about suicide a week prior to the
assessment, and had been hearing voices in her head arguing as to
whether she should kill herself (R. 221). Ms. Pickett related
that she had been a marijuana and cocaine user in the past, but
had not used any in the last eight years after going through
rehabilitation (R. 222). Ms. Weaver's impression was that Ms.
Pickett had a major recurrent depressive disorder and a mild
anxiety disorder, and that malingering needed to be ruled out
(Id.). Ms. Pickett was admitted as an outpatient on a voluntary
basis for a course of individual therapy sessions (Id.).
Ms. Pickett had a session with a psychiatrist, Dr. David Erby,
on February 11, 2002 (R. 216-217). Dr. Erby noted Ms. Pickett had
a ten-year history of depression but had not previously sought
treatment (R. 216). Dr. Erby stated the timing of Ms. Pickett's
request for treatment might be related to her "unsuccessful quest
to obtain disability" (Id.). Ms. Pickett exhibited good
grooming and hygiene, and a serious, business-like affect
(Id.). While her mood was depressive and anxious, there was no
overt anxiety behavior and Ms. Pickett was not suicidal (Id.).
Dr. Erby diagnosed major depression, anxiety disorder, not
otherwise specified, and noted a need to rule out malingering (R.
217). He assigned Ms. Pickett a Global Assessment of Functioning
("GAF") score of 57 (Id.).*fn5 He started her on a
prescription for Celexa for depression, and Remeron as a sleep
At her next therapy session with Ms. Weaver, on February 15,
2002, Ms. Pickett reported a positive change in her depression
and sleep within two days of beginning her medication (R. 215). Ms. Weaver noted that Ms. Pickett was laughing and smiling
(Id.). On March 11, 2002, Dr. Erby substituted Zoloft for
Celexa, due to side effects Ms. Pickett reported (R. 214). It
would appear that Ms. Pickett continued her therapy until May of
2002, when she "dropped out" (R. 209). She was officially
discharged as an outpatient on July 16, 2002, at which time Ms.
Weaver indicated that the initial goal of decreasing depression
and anxiety was only "partially met" (R. 207-08).
On February 13, 2002, Ms. Pickett returned to Dr. Marvel with
complaints of tenderness in the skin of her left hand and pain in
both hands (R. 180). Although Ms. Pickett claimed that the carpal
tunnel had returned, Dr. Marvel was skeptical, especially since
she had not been working or overusing her hands (Id.). There
was good functioning in the thenar ...