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Milliken v. Astrue

November 9, 2009


The opinion of the court was delivered by: Magistrate Judge P. Michael Mahoney


I. Introduction

Patricia Milliken seeks judicial review of the Social Security Administration Commissioner's decision to deny her application for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act. See 42 U.S.C. § 405(g). This matter is before the Magistrate Judge pursuant to the consent of both parties, filed on September 30, 2008. See 28 U.S.C. § 636(c); Fed. R. Civ. P. 73.

II. Administrative Proceedings

Claimant first filed for DIB on or about July 13, 2005. (Tr. 55.) She alleges a disability onset date of December 28, 1996. (Tr. 55.) Claimant's last date insured for DIB was March 31, 2002. (Tr. 153.) Her claim was denied initially and on reconsideration. (Tr. 76--79.) The Administrative Law Judge ("ALJ") conducted a hearing into Claimant's application for benefits on August 13, 2007. (Tr. 4.) At the hearing, Claimant was represented by counsel and testified. (Tr. 6--36.) Claimant's daughter also testified at the hearing. (Tr. 36--42.) A medical examiner, Joseph Cools, and a vocational expert, Susan Entenberg, also testified at the hearing. (Tr. 42--54.) The ALJ issued a written decision denying Claimant's application on March 28, 2008, finding that jobs existed in significant numbers in the national economy that Claimant could perform. (Tr. 59--66.) Because the Appeals Council denied Claimant's Request for Review regarding the ALJ's decision, that decision constitutes the final decision of the Commissioner. (Tr. 539--41.)

III. Background

Claimant was born on March 3, 1950, making her 57 years old at the time of her hearing and 52 years old on her date last insured. (Tr. 7, 10.) She graduated high school. (Tr. 10.) From 1981 to 1996, Claimant worked on the assembly line at Philips Electronics. (Tr. 11, 160, 199--201.) Claimant testified that she would stand about half the day when she worked on the assembly line. (Tr. 12.) She constantly used her hands. (Tr. 18.) Occasionally, she would have to do packing for the company. (Tr. 12.) Claimant testified that as a packer, she would have to lift up to 20 pounds at a time. (Tr. 12.)

Around March 2002, Claimant's daughter was put on bed rest due to complications in her pregnancy. According to Claimant's testimony, Claimant's condition made it difficult to help her daughter during this period. (Tr. 14.) She testified that she had problems doing things with her hands because they would go numb and stiff. (Tr. 14.)

Claimant also testified that she has been "tired all the time" for the past ten years. (Tr. 15.) Her condition affects her ability to baby-sit her grandchildren. (Tr. 21.) Claimant testified that she can "keep an eye on them," but cannot do any lifting. (Tr. 21.)

Claimant testified that she does the dishes during the day, but has to take breaks to sit down because her legs "feel like they're going to give out." (Tr. 25.) She testified that she watches television and reads, but that reading is hard because of her eye problems. (Tr. 25.) She testified that her eyes pull to the side and "bounc[e] up and down." (Tr. 25.) She also has a hard time comprehending books. (Tr. 30.) Claimant cooks light meals once or twice a week, cleans the bathroom on rare occasion, dusts once a week, and does laundry every other day. (Tr. 26.) Claimant testified that she can do laundry because she is able to sit while she is doing it. (Tr. 26--27.)

About once per week, Claimant visits with friends. (Tr. 31.) They will sometimes go to the fitness center, where Claimant enjoys being in the pool. (Tr. 31.) She testified that the pool helps her condition. (Tr. 31.) She also testified that she does not go out as often when it is really hot outside because the heat makes her sick. (Tr. 31.) She stated that she has had a problem with the heat since 2005. (Tr. 32.)

Claimant stated that she is able to drive, but avoids heavy traffic. (Tr. 34.) She also has an easier time driving in the summer time than during the winter. (Tr. 34.)

IV. Medical Evidence

Claimant's relevant medical history begins on May 23, 1995 when she visited Dr. Donovan at Rockford Memorial Hospital for a physical. (Tr. 500.) At that time, Claimant had some leg numbness and pain. (Tr. 500.) Dr. Donovan attributed the numbness to an injury that occurred when a big dog hit Claimant a year prior. (Tr. 500.) He thought the pain to be related to sciatica.*fn1 (Tr. 500.)

On August 31, 1995, Claimant saw Dr. Maynard at the Monroe Clinic after Dr. Donovan was unsuccessful at treating her leg pain. (Tr. 522.) She complained that her feet were numb and tingled, and that her legs had been giving out on her since the end of March 1995. (Tr. 522.) Claimant indicated that stress caused her legs to give out. (Tr. 522.) She also complained of being tired. (Tr. 522.) He started her on Pamelor, an antidepressant. (Tr. 521.)

Claimant returned to Dr. Maynard on October 10, 1995. (Tr. 520.) At that time, she complained of low back pain which went into her legs. (Tr. 520.) Claimant told Dr. Maynard that she had not yet tried the Pamelor. (Tr. 520.) Dr. Maynard wrote that Claimant had "alpha/delta intrusions on sleep study, consistent with fibromyalgia type symptomatology." (Tr. 520.)

On November 8, 1996, Claimant returned to see Dr. Donovan. (Tr. 501.) Claimant told Dr. Donovan that she had aches, pains, and numbness in her lower extremities. (Tr. 501.) She also told Dr. Donovan that she had poor sleep habits and woke up achy. (Tr. 501.) Claimant expressed hesitance at trying an antidepressant for sleep at night, but Dr. Donovan prescribed her the antidepressant Doxepin. (Tr. 501.) Claimant saw Dr. Donovan on November 19, 1996, at which time he discussed her depression and continued Doxepin. (Tr. 501.) He also noted that she complained of neck aches and pains. (Tr. 501.)

Dr. Donovan referred Claimant to Dr. Shah for a neurological consultation, which took place on April 15, 1997. (Tr. 503.) Claimant complained that she got pain between her shoulder blades which climbed up to her neck and then went into the left side of her head. (Tr. 503.) She also complained of an "electric-like sensation" that went into her head, and intermittent tingling and numbness starting from her feet up to her waist. (Tr. 503.) She also stated that she got foot drop on her left side. (Tr. 503.) Advil was the only medication that she acknowledged taking. (Tr. 503.)

An MRI showed changes in brain white matter, and Dr. Shah found that Claimant's symptoms indicated possible multiple sclerosis ("MS") and possible transient ischemic attacks. (Tr. 503.) He also found that Claimant had headaches and musculoskeletal pain. (Tr. 503.) He noted that she complained of being nervous and anxious. (Tr. 503.) He prescribed her Paxil, which is an antidepressant and anti-anxiety medication. (Tr. 503.)

On June 17, 1997, Claimant saw Dr. Srivastava seeking a second opinion regarding the numbness and tingling sensations in her lower extremities, and her difficulty walking. (Tr. 296.) She stated that she was not taking any medication at that time. (Tr. 297.) Dr. Srivastava noted that Claimant's sense of position and vibration was somewhat impaired in the lower extremity, and that heel-knee ataxia was present, especially on the left side. (Tr. 297.) He noted the presence of mild ataxia and subjective paresthesia with questionable posterior column involvement, and suggested that Claimant undergo an MRI of her spine. (Tr. 297.) She did, and on June 22, 1997, Dr. Srivastava noted that Claimant's MRI showed a protruded disc at C5--C6. (Tr. 298.) It also showed bony spur at T6--T7--T8--T9 with "some degeneration of the spine disc spines." (Tr. 298.) Bony spurs were also found at L3--L4 and L4--L5, with the most at L4--L5. (Tr. 298.)

Dr. Srivastava continued to treat Claimant for subjective paresthesia and gait difficulty, and prescribed her Zenoflex on July 22, 1997 to treat her spasms and cramps in her lower extremities. (Tr. 299.) On August 12, 1997, Claimant told Dr. Srivastava that she was still taking Zenoflex, along with Relafen, a drug used to treat arthritis. (Tr. 300.) She reported that the pain in her upper extremities had improved, but that she still had some "vague symptoms of lower extremities associated with some 'popping sensation' and being somewhat nervous." (Tr. 300.) Her gait was markedly better and her overall condition had improved. (Tr. 300.) Dr. Srivastava felt that her symptoms might have been anxiety induced, so he discontinued her Zenoflex prescription and prescribed her Paxil. (Tr. 300.) By September 9, 1997, Claimant reported that her symptoms were somewhat better than before, but that she felt tired and fatigued. (Tr. 300.)

Dr. Srivastava referred Claimant to a rheumatologist at the Freeport Clinic, Dr. Singh, who examined her on November 13, 1997. (Tr. 303.) Claimant reported numbness and tingling in both her legs, and difficulty walking. (Tr. 303.) She stated that if she sat down, the numbness and tingling in her feet went away, but if she walked, it got worse. (Tr. 304.) She also reported that she occasionally experienced numbness in her hands. (Tr. 304.) She had some pain in her neck going down her upper back when she flexed her neck. (Tr. 304.) Also, her joints popped and cracked. (Tr. 304.) She reported not sleeping well. (Tr. 304.)

Dr. Singh noted that Claimant was tired looking. (Tr. 304.) He found that her neck movements were limited at extremes due to tightness. (Tr. 304.) He also found that she had diminished vibration sense up to the knees and that she had a questionable Romberg test.*fn2 (Tr. 305.) He noted that Claimant had some difficulty in doing heel to toe testing on both sides. (Tr. 305.) Claimant had follow-up exams with Dr. Singh on November 18 and December 18, 1997.

(Tr. 306--07.) Her symptoms remained essentially the same. (Tr. 306--07.)

Claimant underwent a comprehensive evaluation at the Mayo Clinic from November 29, 1999 to December 3, 1999, which consisted of exams by multiple doctors. (Tr. 212.) Dr. Kennedy, an endocrinologist, found that Claimant was experiencing right shoulder and back pain. (Tr. 225.) He noted symptoms of a possible peripheral neuropathy because of the numbness in her feet bilaterally. (Tr. 226.) He stated that the symptoms did not sound like typical MS. (Tr. 226.) He wrote that Claimant's symptoms sounded more musculoskeletal in nature than anything else, with the exception of the radiation of pain down the arm. (Tr. 226.) He also noted that Dr. Oh of the Mayo Clinic's Department of Physical Medicine and Rehabilitation felt that Claimant had multifactorial myofascial pain, right shoulder arm and axial low-back pain, and complicating factors of psychosocial issues in addition to deconditioning. (Tr. 218.)

Dr. Daube, a neurologist also at the Mayo Clinic, found "mild sensory deficit that appear[ed] to be in the distribution of the S1 sensory root." (Tr. 220.) Reflexes were minimally reduced bilaterally, and she had pain with straight leg raising. (Tr. 220.) Dr. Daube wrote that Claimant had "significant pain and tenderness over her cervical paraspinal muscles, particularly on the right." (Tr. 220.) She also had sharp pain with deep palpation over the trapezius muscle on the right. (Tr. 220.) Claimant had "some pain over the lumber spine area as well as the paraspinal and gluteus on the left." (Tr. 220.) Dr. Daube concluded that Claimant's primary problem was that of a musculoskeletal pain syndrome. (Tr. 220.) He diagnosed her with ...

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