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July 14, 2004.

CARLENE E. JONES, Plaintiff,

The opinion of the court was delivered by: P. MICHAEL MAHONEY, Magistrate Judge


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. 5).


  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 hypothetical situation:
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 limitations?
(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 ...

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