The opinion of the court was delivered by: P. MICHAEL MAHONEY, Magistrate Judge
REPORT AND RECOMMENDATION
Carlene E. Jones ("Plaintiff") seeks judicial review of the
final decision of the Commissioner of the Social Security
Administration ("Commissioner"). See 42 U.S.C. § 405(g),
1383(c)(3). The Commissioner's final decision denied Plaintiff's
application for Disability Insurance Benefits ("DIB") pursuant to
Title XVI of the Social Security Act (the "Act").
42 U.S.C. § 1381(a). This matter is before the Magistrate Judge for Report
and Recommendation pursuant to Rule 72(b) and
28 U.S.C. § 636(b)(1)(B).
Plaintiff filed for DIB on May 4, 2001. (Tr. 140). Plaintiff's
application for benefits was denied on August 2, 2001. (Tr. 103).
Plaintiff filed a request for reconsideration on August 8, 2001.
(Tr. 107). Plaintiff's request for reconsideration was denied on
March 1, 2002. (Tr. 109). Plaintiff then filed a request for a
hearing before an Administrative Law Judge ("ALJ") on March 11,
2002. (Tr. 113). Plaintiff appeared, with counsel, before an ALJ
on April 15, 2003. (Tr. 26). In a decision dated April 25, 2003,
the ALJ found that Plaintiff was not entitled to DIB. (Tr. 15). On May 1, 2003, Plaintiff requested a review of the
ALJ's decision by the Appeals Council. (Tr. 8). On June 27, 2003,
the Appeals Council denied Plaintiff's request for review. (Tr.
Plaintiff was born on November 5, 1957, and was forty-five
years old at the time of her April 15, 2003 hearing before the
ALJ. (Tr. 76). Plaintiff completed her education through the
eighth grade; she did not graduate from high school or receive
her GED. (Tr. 33). At the time of the hearing, Plaintiff
testified that she lived alone in an apartment. (Tr. 31).
Plaintiff suffers from emphysema, asthma, high blood pressure,
severe headaches, depression, and is HIV positive. For these
reasons, and some others, Plaintiff claims to be disabled.
At the time of her hearing, Plaintiff's most recent employment
was with a convalescent home.*fn1 Plaintiff testified that
during the summer of 2001 she was an activities director at the
convalescent home for about 30-45 days. (Tr. 38). This job was
part-time: Plaintiff worked five hours per day, three days per
week. (Tr. 38-39). As an activities director at this convalescent
home, Plaintiff testified she was on her feet for about three
hours of her five-hour shift. (Tr. 39). Additionally, Plaintiff
pushed people in their wheelchairs and pushed game carts.
(Id.). Plaintiff testified that she made herself take breaks
while working, but would stand continuously for an average of one
to two hours. (Id.).
Prior to working at the convalescent home, Plaintiff worked at
Swiss Colony as a seasonal, third-shift assembly-line packer.
(Tr. 41). This job was full-time: Plaintiff worked eight hours per day, six days per week. (Id.). Her duties
included packing cheeses into boxes to fill orders, and involved
lifting or carrying about ten pounds. (Tr. 41-42). Plaintiff
testified that she sustained a broken nose and injured her
shoulders in an auto accident two weeks after beginning her
employment with Swiss Colony. (Tr. 43). Plaintiff chose not to
return to work following her auto accident because of her
injuries and was subsequently terminated. (Tr. 42).
In 1999, for about a month, Plaintiff worked for a nursing home
as a nurse's aide.*fn2 (Tr. 44). According to Plaintiff's
testimony, her work included lifting patients.*fn3 (Tr. 44).
Plaintiff stated she was "released" from this position because
she was unable to lift patients, unable to stay awake during her
shift, and was found sleeping during her shift. (Id.).
Prior to working as a nurse's aid, Plaintiff was employed for
approximately one month at Anderson Packing in 1997.*fn4
(Tr. 45). Plaintiff's work involved packaging medications.
(Id.). While working at Anderson Packing, Plaintiff lifted less
than ten pounds, and performed her job sitting down. (Id.).
On a typical day, Plaintiff testified that she gets up, eats a
light breakfast, and watches TV. (Tr. 46). Plaintiff stated that
she does not sweep, mop, or vacuum for herself her oldest
daughter helps with these tasks. (Id.). Plaintiff is able to
make her own bed, however, and does that daily. (Id.). From
10:00 a.m. until 1:00 p.m., Plaintiff usually sleeps. (Tr. 66).
Despite her daily mid-day naps, Plaintiff told the ALJ that she always feels
tired. (Id.). Plaintiff is able to do some cooking; she will
boil hot dogs or scramble eggs for herself. (Tr. 74). Plaintiff
occasionally will go to a store, and handles her own cash
transactions at stores. (Id.). Plaintiff does not, however, pay
her own monthly bills because the Crusader Clinic, in Rockford,
Illinois, takes care of her bills for her. (Id.). Plaintiff
testified that, as much as possible, she avoids contact with
others because she does not like people. (Tr. 45, 51, 60).
Throughout the course of a day, Plaintiff testified that she
smokes up to two packs of cigarettes, but denied any use of
illegal drugs since 1997. (Tr. 54).
Vocational Expert, Christopher Yep, appeared before the ALJ
during Plaintiff's hearing on April 15, 2003. (Tr. 77). The
vocational expert testified that Plaintiff's position at Swiss
Colony would be classified as an unskilled job requiring a light
level of exertion and that Plaintiff's position at Anderson
Packaging would be classified as "an unskilled job performed at a
sedentary level of exertion." (Tr. 78, 79). With regard to the
nurse's aid or activity director positions, the vocational expert
testified that those would both be semi-skilled positions
requiring a light level of exertion. (Id.).
The ALJ then presented the vocational expert with the following
Let's assume we have a hypothetical female individual
who's 45 years of age, has an eighth grade education
with the ability to read, write and use basic
numbers, has the same prior work history as the
Claimant in this case with the capacity to perform
work with the following and no other additional
limitations. Lifting and carrying would be limited
to up to a maximum of 20 pounds on an occasional
basis and 10 pounds frequently. Sitting, standing and
walking could be performed respectively and with
normal breaks for up to six hours each within a
normal day. Individual may not climb ladders, ropes
or scaffolds but may otherwise climb ramps or stairs,
balance, stoop, kneel, crouch and crawl on no more
than an occasional basis. The individual must avoid
concentrated exposure to fumes, odors, dust, gases
and other pulmonary irritants. Must likewise avoid
exposure to hazards such as exposed unprotected
heights or excavations and also exposed unprotected dangerous machinery. In terms of
cognitive function let's say the individual would not
have the capacity to focus upon or carry out complex
or detailed tasks or to focus on or attend to or
perform complex or detailed tasks at a sustained
workman-like pace. I think I said before unable to
carry out the complex or detailed instruction. The
individual would however retain the capacity to focus
on, attend to and carry out let's say simple
instructions as well as to focus on, attend to and
perform simple tasks at a sustained workman-like
pace. Let's also indicate that the individual should
not perform work which requires more than incidental
contact with members of the general public. Looking
at those limitations, in your opinion, would any of
the prior work fit within the parameters of those
(Tr. 80). The vocational expert stated that such a hypothetical
person could do work in hand packaging at a light level of
exertion, and assembly and sorting occupations, at both the light
and sedentary levels. (Tr. 81). The ALJ then added the following
modifications to the hypothetical:
Lifting and carrying would be limited to a maximum of
10 pounds on an occasional basis and to lighter items
such as small hand tools, individual case files on no
more than a frequent basis, standing and walking
would be limited to a combined total of two hours
within an eight hour day, and let's say for no longer
than about 15 minutes continuously at any one time.
(Tr. 83). With these changes to the hypothetical, the vocational
expert determined that the individual would still be able to work
in the sedentary assembly and sorting occupations. (Id.).
According to the Vocational Expert, at the time of the hearing
there were 26,198 sedentary assembly jobs and 9,783 sedentary
sorting jobs in the regional economy. (Tr. 81-82).
Plaintiff most often sought medical care at the Crusader Clinic
in Rockford, Illinois, but also utilized the emergency
departments at Rockford Memorial Hospital and SwedishAmerican
Hospital when she felt care was needed more urgently. Plaintiff's
medical history, as contained in her medical records, is
difficult to decipher because Plaintiff did not routinely see the
same practitioners and often failed to follow up with
practitioners as recommended. On January 7, 2000, Plaintiff was evaluated by Kersten
Alschoewski, M.D., at the Crusader Clinic. (Tr. 230). At that
time, Plaintiff complained of severe prurits*fn5 on her
lower extremities and reported that she had lesions on her hands
that had resolved. (Id.). Dr. Alschoewski's assessment of
Plaintiff stated that Plaintiff had an allergy/skin rash and was
HIV positive. (Id.). Dr. Alschoewski ordered numerous
laboratory tests, and instructed Plaintiff to return in two to
three weeks. (Id.). Numerous laboratory tests were
conducted,*fn6 but there is no indication of follow-up with
Dr. Alschoewski, or any other practitioner at the Crusader
Clinic, within the recommended time frame. (Id.).
Plaintiff next saw Syed Ali, M.D., at the Crusader Clinic, on
April 20, 2000, for a general physical evaluation a "Social
Security physical" according to Dr. Ali. (Tr. 268). At that time,
Plaintiff complained of shortness of breath for one year with
minimal exertion, being able to walk less than half a block or at
the most one block before tiring and feeling short of breath,
needing to be propped up all the time, and swelling of both feet
which decreases at night. (Id.). She also complained of
abdominal pain located in the upper abdomen with exacerbation
upon eating spicy or greasy food, some nausea but no vomiting,
and increased urination during the day. (Id.). Plaintiff
reported that she smoked three packs of cigarettes a day for
fifteen years but was down to one-half of a pack for the last
year. (Id.). Plaintiff then continued to report that she had
been eating a lot of greasy food and drinking about eight cans of
pop every day. (Id.). Dr. Ali's assessment of Plaintiff noted
that Plaintiff was HIV positive with a past history of prolonged
drug abuse and cigarette smoking. (Id.). He wanted to rule out
any congestive heart failure which could be related to cardiomyopathy*fn7
secondary to drugs or secondary ...