United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER 
L SCHENKIER UNITED STATES MAGISTRATE JUDGE
Milburga Aide Cruz applied for Social Security benefits on
September 7, 2012, alleging she became disabled on July 31,
2006; her date last insured ("DLI") was December
31, 2011 (R. 22-23). Ms. Cruz's application was denied
initially and on reconsideration. After a hearing before an
Administrative Law Judge ("ALJ"), the ALJ issued a
written opinion denying Ms. Cruz's claim for benefits.
The Appeals Council denied Ms. Cruz's request for review
of the ALJ:s decision, rendering it the final
decision of the Commissioner (R. 1). Ms. Cruz has filed a
motion to reverse or remand the ALJ's decision (doc. #
13), and the Commissioner has filed a cross-motion asking the
Court to affirm the decision (doc. # 22). For the following
reasons, we deny Ms. Cruz's motion to remand and grant
the Commissioner's motion to affirm.
Cruz was born in Mexico in 1967 and moved to the United
States when she was 23 years old (R. 49). She has a sixth
grade education, and her primary language is Spanish (R. 193-
95). After performing repetitive work on an assembly line for
more than 20 years, Ms. Cruz developed ganglion cysts, bone
spurs and carpal boss (bump) in her right wrist, which David
Norbeck, M.D., surgically removed in January 2001 (R. 738).
At a post-operative follow-up visit in May 2001, Dr. Norbeck
opined that Ms. Cruz was at maximum medical improvement after
surgery and recommended that she no longer use an "air
ram" (a pneumatic, or air powered, screwdriver) on the
assembly line and limit her lifting to no more than 10 pounds
on her right side (R. 743).
2002, Ms. Cruz returned to Dr. Norbeck and reported
"some recurrent pain in her right wrist" after
having to do a lot of repetitive activity at work (R. 744).
Dr. Norbeck noted that Ms. Cruz had some tenderness, but full
range of motion and no swelling in her wrist (Id.).
X-rays showed no abnormalities, but an MRI showed numerous
ligament tears (R. 744-45). In September 2002, Jay Pomerance,
M.D., performed surgical repair of the ligaments and an ulnar
shortening (procedure using plate and screw fixation) (R,
911). Ms. Cruz returned to working light duty by January
2003, but continued to have some pain with wrist flexion (R.
Pomerance removed the plate in March 2003 because it was
causing Ms. Cruz discomfort (R. 1013). He released Ms. Cruz
to work using her right hand "as a light assist only
while wearing the splint" (1078-79). Though x-rays
revealed normal healing, Ms. Cruz continued to report pain
and tenderness (Id.). In May 2003, Dr. Pomerance
gave Ms. Cruz a local steroid injection in her right wrist,
but she reported that the injection provided no relief (R.
1079-80). He gave her a second injection on May 15, 2003,
which gave her minimal relief, and Dr. Pomerance stated that
Ms. Cruz could continue her present duty work, avoiding heavy
grip (R. 1080-81). Ms. Cruz continued to report pain
throughout 2003, but other than some tenderness, her
examinations were normal (R. 1082-83). Dr. Pomerance
prescribed Ultram (narcotic) and opined that she could return
to work other than doing heavy lifting or gripping, with a 25
pound restriction (R. 1083-84).
2005, Ms. Cruz returned to Dr. Pomerance, reporting that her
pain continued in her right forearm, and she had experienced
intermittent numbness and tingling in her right hand for the
previous two to three months (R. 1075). Upon examination, Ms.
Cruz had tenderness and reduced range of motion in her wrist,
but her X-rays and bone scans were normal (R. 1075-76). Dr.
Pomerance opined that Ms. Cruz may benefit from a tenolysis
(surgery to release a tendon from adhesions or scar tissue
that binds tendons to surrounding tissue); however, he also
stated that Ms. Cruz "could also just simply live with
the ulnar forearm discomfort since it does not appear that
those adhesions are functionally disabling" (R. 1076).
Dr. Pomerance stated that Ms. Cruz could continue in her
present duty job, self-limiting as needed (Id.).
21, 2006, Ms. Cruz began treating with orthopedist Serafin
DeLeon, M.D., (and her colleague Dr. Meltzer) for numbness
and pain in her left thumb radiating up her forearm, which
Ms. Cruz reported had begun two months before (R. 322). In
her report of the July 2006 visit, Dr. DeLeon wrote that
since the surgeries on her right hand and forearm in 2001,
Ms. Cruz had been moved to a different place on the assembly
line at work and instructed to use only her left wrist due to
residual weakness and limited range of motion on her right
side (R. 323). On examination, Ms. Cruz had marked tenderness
and pain over her left thumb, where Dr. DeLeon felt a
palpable nodule, and she had tenderness and pain and some
limited range of motion in both wrists and hands
(Id.). Dr. DeLeon gave Ms. Cruz steroid injections
in her left wrist area and thumb and recommended that Ms.
Cruz not return to work at the assembly line (Id.).
Dr. DeLeon diagnosed Ms. Cruz with left deQuervain's
disease (painful condition affecting the tendons on the thumb
side of the wrist),  left symptomatic trigger thumb
(stenosing tenosynovitis, where fingers get stuck in a bent
position and straighten with a snap) and chronic right wrist pain
(R. 324). Dr. DeLeon opined that these conditions were the
result of Ms. Cruz's work activities involving repetitive
gripping and twisting (R. 313). Dr. DeLeon also noted that
Ms. Cruz had to be in Mexico the following week for "an
acute family problem" (R. 324). Ms. Cruz has not worked
since July 31, 2006 (R. 194-95).
Cruz had good pain relief for two weeks after the injections
(R. 324). At an examination in September 2006, Dr. DeLeon
observed that Ms. Cruz had "very minimal tenderness to
palpation" along her left thumb, with full flexion and
extension, and tenderness over a portion of her left wrist
(R. 325). Along her right wrist, Ms. Cruz had some signs of
mild tenosynovitis, but mainly signs of chronic pain and some
limited motion (Id.). In October 2006, Ms. Cruz
decided to undergo surgery on the tendons in her left thumb
and wrist because prior injections did not provide lasting
relief (R. 317). On December 22, 2006, Dr. DeLeon performed
surgery to release the pressure around the tendons in Ms.
Cruz's left thumb and wrist (R. 320).
Cruz received physical therapy, and at a follow-up
appointment with Dr. DeLeon on January 26, 2007, Ms. Cruz had
minimal pain and full flexion at her thumb, with some
residual mild tenderness over her wrist (R. 316). The next
month, Dr. DeLeon wrote that Ms. Cruz's range of motion
and grip strength were gradually improving, but she still had
a little bit of soreness in her left wrist (Id.). By
her appointment in April 2007, Dr. DeLeon wrote that Ms. Cruz
was "much improved, " with only some residual
weakness in her left hand and tightness and mild tenderness
along her wrist (Id.). Dr. DeLeon released Ms. Cruz
to full duty work (Id.).
record does not contain any medical evidence of Ms.
Cruz's hand or wrist pain for the next five years (R.
22). While the record contains medical reports during these
years of other ailments that afflicted Ms. Cruz__ such as
stomach pain, cysts in her ovaries, difficulty urinating,
irritable bowel syndrome and gastrointestinal reflux disease
("GERD") __ Ms. Cruz does not address these other
ailments in her motion to remand, and so we do not need to do
11, 2012, Ms. Cruz returned to Dr. DeLeon, stating that about
two to three years earlier, she started experiencing pain in
both wrists, worse on the right (R. 341). Examination showed
some tenderness in both wrists, and Dr. DeLeon gave Ms. Cruz
steroid injections in both wrists (Id.). At a
follow-up visit on June 15, 2012, Ms. Cruz reported that the
injections did not alleviate her pain (R. 337). Dr. DeLeon
diagnosed Ms. Cruz with bilateral DeQuervain's and
bilateral wrist synovitis (Id.). Dr. DeLeon wrote
that Ms. Cruz's options were "either to live with
the pain or undergo a surgery, " but Dr. DeLeon was
"not 100% confident" that the surgery would help
her pain (Id.). On June 18, 2012, Dr. Deleon
performed bilateral tendon release surgery and bilateral
wrist arthroscopy with synovectomy to remove certain
connective tissue and repair certain tendons in Ms.
Cruz's wrists (R. 343).
surgery, Ms. Cruz received occupational therapy (R. 755).
During July 2012, she showed mild improvement in range of
motion, pain and functional activities, but she still had
some pain and discomfort when performing activities such as
opening jars, dressing, and washing dishes (R. 755-60).
November 2012, a state agency physician found there was
"insufficient evidence" to evaluate plaintiffs
disability claim from her alleged onset date through her DLI
of December 2011 (R. 82-85). On reconsideration, Ms. Cruz
submitted additional evidence of her impairments from 2012
and 2013, but in March 2013, the state agency physician
affirmed the earlier determination, finding that there was
"insufficient evidence to support severity prior ...