United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER 
I. SCHENKIER MAGISTRATE JUDGE.
October 17, 2012, Mary Anne Gulik filed for disability
benefits, claiming an onset date of December 18, 2011 (R.
151), later amended to December 15, 2010 (R.
160). After her application was denied initially
and on reconsideration, Ms, Gulik received a hearing before
an Administrative Law Judge ("ALJ"). On December
17, 2014, the ALJ issued a written decision denying her
request for benefits. The Appeals Counsel denied Ms.
Gulik's request for review, making the ALJ's opinion
the final decision of the Commissioner (R. 1). Presently
before this Court is Ms. Gulik's motion to reverse and
remand the ALJ's decision (doc. # 14). The motion is now
fully briefed. For the reasons that follow, we grant Ms.
Gulik's motion to remand.
Gulik has complained to physicians of pain in her upper
(cervical) back or neck, lower (lumbar) back radiating down
her right leg and right knee since late 2010, when she was 38
years old (R. 260-65). MRIs at that time showed only minimal
degenerative changes (Id.), but her pain continued.
On February 4, 2011, Ms. Gulik had one visit with a
rheumatologist, Richard M. Keating, M.D. (R. 431). Dr.
Keating's report stated that the physical examination
showed "numerous myofascial tender points with minimal
palpation, " and he opined that Ms. Gulik had
fibromyalgia syndrome (R. 430-31).
February 28, 2011, Ms. Gulik began treatment for her pain
with Faris Abusharif, M.D., of Pain Treatment Centers of
Illinois; she described her lower back pain as radiating down
her right lower extremity, particularly in her hip (R.
270-71). In March and April 2011, Dr. Abusharif administered
lumbar, cervical and hip epidural injections to treat Ms.
Gulik's pain, and prescribed her medications including
Lyrica (nerve pain medication), Flexeril (muscle relaxant),
and Norco (narcotic) (R. 272, 275). This treatment provided
little lasting relief, and in June 2011, Dr. Abusharif
administered another lumbar injection and increased Ms.
Gulik's prescription for Norco, discontinued the
prescription for Lyrica, and added a prescription for
Neurontin (nerve pain medication and anti-convulsant) (R.
277-79). In July and August 2011, Dr. Abusharif administered
another cervical injection and an injection into Ms.
Gulik's right knee (R. 281, 285). In October 2011,
Neurontin was discontinued due to side effects, and Ms. Gulik
was prescribed amitriptyline (an anti-depressant used to
treat fibromyalgia pain) (R. 287).
a visit to Dr. Abusharif in December 2011, Ms. Gulik reported
that her lower back and right lower extremity pain had
escalated to a constant, stabbing level of 9 out of 10 and
was exacerbated by sitting, standing or walking (R. 288). Dr.
Abusharif administered a right sacroiliac joint steroid
injection and added a prescription for Savella (nerve pain
medication and antidepressant) (R. 289). His report of that
visit also stated that Ms. Gulik consulted with a surgeon,
Dr. Tony Rinella, who felt surgery was not a "necessary
option" and recommended that Ms. Gulik continue with
non-surgical treatment for her pain (R. 288). That month, Ms.
Gulik stopped working as a certified nursing assistant
because the pain in her legs made her unable to lift patients
records from the Pain Treatment Centers indicate that Ms.
Gulik's pain did not abate in the first half of 2012. A
record of a February 2012 call indicated that Ms. Gulik's
pain was so severe - despite taking Norco - that she did not
want to wait four days for her steroid injection (R. 496).
And, in April 2012, Ms. Gulik asked for and received a refill
of Flexeril (Id.).
and August 2012, Ms. Gulik had additional imaging of her
lumbar spine, which showed early degenerative disc disease,
annular tears and some disc protrusion (R. 297-98, 300). On
August 21, 2012, Dr. Abusharif performed a lumbar discogram -
an invasive test to evaluate the cause of back pain - because
despite repeated epidural injections, Ms. Gulik's pain
recurred (R. 301). Dr. Abusharif determined that at ¶
4-L5, there was a broad-based posterior disc protrusion
abutting L5 nerve roots and bilateral foraminal extensions of
the disc abutting L4 nerve roots, as well as a grade IV
radial tear in the posterior aspect of the disc (R. 305). The
next month, September 2012, Ms. Gulik reported continuing
sharp pain in her low back radiating down her right lower
extremity, and her pain medication was listed as Savella,
Percocet (narcotic) and Lyrica (R. 306), with a refill of
Flexeril approved in December 2012 (R. 495).
January 3, 2013, Ms. Gulik reported a partial decrease of
pain symptoms in the cervical region after an injection, but
she had severe low back pain radiating down the right leg
causing periods of weakness, tingling and numbness in her
lower extremities (R. 381). Dr. Abusharif prescribed Medrol
(anti-inflammatory), and changed Ms. Gulik's narcotic
prescription from Percocet to OxyContin (R. 381-83). On
January 9, 2013, Ms. Gulik consulted with Daniel Troy, M.D.,
at the Midwest Bone Joint Spine Institute on a referral from
Dr. Abusharif to see if there was "anything further that
[he] could possibly do to entertain and relieve her symptoms,
" which had not resolved with injections (R. 294). Dr.
Troy recommended that Ms. Gulik continue with non-surgical
treatment options at that time (R. 294-95).
January 2013, Ms. Gulik also reported increasing pain over
her right saroiliac ("SI") joint (joint between
lower spine and pelvis), lateral hip and anterior thigh (R.
332). On January 15, 2013, Benjamin Domb, M.D., of Hinsdale
Orthopaedics, ordered an MRI, which showed a tear in the
right hip labral (cartilage) (R. 330). On January 24, 2013,
Ms. Gulik complained to Dr. Domb of worsening SI joint pain
and right hip pain and associated radiculopathy from her
lumbar spine; examination showed decreased range of motion,
pain, and tenderness (R. 328-29). Dr. Domb gave her a
lidocaine injection in the hip and recommended physical
therapy for "a last trial of non-operative
treatment" (R. 330-31). The next day, Dr. Abusharif
administered a right sacroiliac joint injection for her low
back, right buttock and right leg pain (R. 386). On February
22, 2013, Ms. Gulik reported that although she had some pain
relief since her injection, she still had severe pain in her
low back radiating down her right lower (R. 387).
March 13, 2013, a non-examining state agency physician opined
based on the medical record that Ms. Gulik could perform
sedentary work - lift up to ten pounds occasionally, stand or
walk for a total of two hours, and sit for a total of about
six hours in an eight-hour workday (R. 80-82). This opinion
was affirmed on reconsideration on September 27, 2013, after
consideration of additional evidence submitted by Ms. Gulik
April 8, 2013, Dr. Abusharif administered another lumbar
epidural steroid injection, and Ms. Gulik continued to take
OxyContin, Flexeril, Savella and Lyrica for her pain (R.
391). The next day, Ms. Gulik returned to Dr. Domb, reporting
no relief in her hip, low back and SI joint pain (R, 366-68).
Dr. Domb determined that because Ms. Gulik "failed to
improve with conservative measures of physical therapy,
activity modification and treatment of her SI joint and back,
" she was a candidate for right hip arthroscopy to
repair her labral tear (R. 368). Dr. Domb performed the right
hip arthroscopy on April 17, 2013 (R. 326-27). After the
surgery, Ms. Gulik had physical therapy through July 2013 to
help decrease pain and improve her range of motion (R. 335,
357). She also exercised, including riding her bike two hours
per day (R. 335). On July 25, 2013, Dr. Domb reported that
Ms. Gulik's hip was 80 percent improved from the surgery
but that she still experienced weakness and occasional
soreness with prolonged standing and decreased range of
motion in her hip (R. 362).
Gulik continued to visit the Pain Treatment Center. On July
18, 2013, Dr. Abusharif administered a right SI joint
injection and bilateral neck trigger point injections, and
Ms. Gulik continued to take Flexeril, Lyrica, OxyContin and
Savella (R. 392). On August 15, 2013, Ms. Gulik reported 80
percent pain reduction since the injection, but described
continued pain her lower back with radiation into the right
buttock and hip (R. 393). On October 3, 2013, Dr. Abusharif
administered a cervical epidural steroid injection for Ms.
Gulik's neck pain, which radiated down her arms (R. 490),
but on November 4, 2013, Ms. Gulik reported that she had no
reduction in pain after that injection (R. 488). Later that
month, Dr. Abusharif administered a lumbar epidural steroid
injection (R. 504), However, Ms. Gulik reported that her pain
relief from that injection lasted only one week, and in
December 2013 and January 2014, she continued to have severe
pain in her lower back and hips, radiating down her legs (R.
November 14, 2013, James T. Niemeyer, D.O., reported that Ms.
Gulik had an adverse reaction to the October 2013 cervical
injection; after the injection, she had trouble breathing (R.
451). Ms. Gulik also reported that her neck pain
and headaches were getting worse, as was her thoracic
(mid-back) pain (Id.), Dr. Niemeyer reported that
examination revealed "chronic tissue texture changes in
the cervical paraspinal, " and he performed osteopathic