United States District Court, C.D. Illinois, Springfield Division
TAMMY L. SHARPE, Plaintiff,
NANCY A. BARRYHILL, Acting Commissioner of Social Security Defendant.
SCHANZLE-HASKINS UNITED STATES MAGISTRATE JUDGE.
Tammy L. Sharpe, appeals from the Defendant Commissioner of
Social Security's final decision on her application for
Social Security Disability Insurance Benefits under Title II
of the Social Security Act. 42 U.S.C. §§ 416(i) and
423 (Disability Benefits). This appeal is brought pursuant to
42 U.S.C. § 405(g). Sharpe has filed a Brief in Support
of Motion for Summary Judgment (d/e 13), and Defendant
Commissioner has filed a Motion for Summary Affirmance (d/e
16). The parties consented, pursuant to 28 U.S.C. §
636(c), to proceed before this Court. Consent to the
Exercise of Jurisdiction by a United States Magistrate and
Reference Order entered November 30, 2016 (d/e 8). For
the reasons set forth below, the decision of the Commissioner
was born on June 18, 1969. Sharpe completed high school,
although she took special education classes in high school.
She previously worked as an assistant manager/cashier at a
gas station and store. She last worked on October 27, 2011.
She lived with her husband. She suffers from tremors,
degenerative disc disease, asthma, history of possible
sensory stroke, obesity, attention deficit hyperactivity
disorder (ADHD), and borderline intellectual functioning.
Certified Transcript of Proceedings before the Social
Security Administration (d/e 11) (R.), at 14, 63-65,
From Before the First Evidentiary Hearing
February 2, 2012, Sharpe saw Dr. Walid Hafez, M.D., for a
tremor in her hands and lower jaw. R. 369-72. Sharpe reported
that the tremor leveled off after a procedure on her thyroid.
Sharpe reported that her tremor became worse in the last
month. She reported that she was having trouble writing and
buttoning her clothes. She reported that she occasionally had
a jaw tremor. Dr. Hafez noted, “However, overall she is
very happy and adjusted to her condition.” R. 370. On
examination, Dr. Hafez noted that Sharpe gained weight.
Sharpe was 5 feet 3 inches tall and weighed 230 pounds 4.8
ounces. On examination, Sharpe's motor strength was good.
Sharpe had cogwheeling at the neck, fine tremors in her hands
and tension in her fingers. Dr. Hafez noted that Sharpe had
no tremor when totally at rest. Sharpe had a mild intention
tremor when she moved her hand. Sharpe's sensation was
preserved. She had mild tremor placing a finger to her nose.
Her handwriting also demonstrated a tremor. Dr. Hafez planned
to recheck her thyroid hormone T4 level and prescribed
Primidone. Dr. Hafez discussed tremor medication with Sharpe.
He also discussed ways to improve Sharpe's tremor
including using “weights at the wrists, relaxation,
physical fitness, and ‘defocusing' off the
tremor.” Dr. Hafez also scheduled Sharpe for physical
therapy. R. 371.
March 5, 2012, Sharpe saw Dr. Hafez. R. 365-68. She reported
no change in her tremors, but sudden mood changes and sudden
anger at others since she started taking the Primidone. Dr.
Hafez discontinued the medication. Sharpe reported that her
tremor was gradually worsening. Sharpe reported having
problems picking up a glass of tea. Sharpe was “now
very self-conscious about the tremor and worries that people
are looking at her.” R. 367. On examination, Sharpe had
normal strength with preserved sensation. She was impaired on
taking her finger to her nose with a mild intention tremor.
Dr. Hafez concluded that Sharpe “has most likely an
essential tremor.” He changed her medications. Dr.
Hafez stated that Sharpe had a “fairly benign tremor
and is not a candidate for deep brain stimulation.” Dr.
Hafez encouraged Sharpe to engage in a fitness program and
reduce her caloric intake. R. 367.
April 27, 2012, Sharpe saw nurse practitioner Jane Peterson,
CNP. R. 420-23. Sharpe reported that she experienced an ice
water sensation from her waist to her knee on the right side
since the day before. Sharpe also reported bilateral pain in
her feet for the last two weeks. Sharpe also reported back
pain for over a month. R. 420. On examination, Sharpe was
alert, oriented, cooperative, and her memory function was
normal. Her breathing was normal, her gait was normal, and
she could move all extremities. Peterson assessed possible
peripheral neuropathy. She ordered an MRI of the lumbar
spine. R. 422-23.
4, 2012, Sharpe was admitted to Blessing Hospital in Quincy,
Illinois, for paresthesis, and possible stroke. A CT scan of
her head showed no intracranial hemorrhage, mass, or mass
effect. The CT scan showed no acute intracranial abnormality.
The CT scan report states that Sharpe had a clinical history
of right-sided leg weakness, right-sided facial numbness, and
lightheadedness. R. 332. An ultrasound of her carotid
arteries showed no significant carotid artery stenosis. She
was discharged on May 5, 2012. R. 334.
8, 2012, Sharpe saw Dr. Hafez. R. 361-64. Sharpe reported
numbness from her right hip to her right knee, with a feeling
of ice water and warm water running over it. Sharpe reported
that the sensation moved up to her arm and right face. She
reported tremors, weakness, difficulty urinating with
leakage, dizziness, tingling and numbness in her right ear,
and problems swallowing. R. 361. On examination, Sharpe's
motor strength seemed good and symmetrical. Sharpe felt
stimuli to the right side of her face as a tingling
sensation. Sharpe had less perception of sharp and dull
stimuli in the right lower extremity and less so over the
right upper extremity. Dr. Hafez noted that Sharpe's
coordination was “definitely impaired.”
Sharpe's gait was good. She limped because of the pain in
her right knee. Dr. Hafez concluded that Sharpe could have a
mild sensory stroke, except the May 4 and 5 CT scan and
carotid artery ultrasound were normal. R. 364.
18, 2012, Sharpe underwent an echocardiogram. The test showed
normal heart function and an ejection fraction of 60 percent.
1, 2012, Sharpe underwent a lumbar puncture for a biopsy of
spinal fluid. The procedure report noted that Sharpe had a
clinical history of paresthesia and urinary incontinence. R.
341. The results of the lumbar puncture biopsy was negative.
12, 2012, Sharpe went to see Peterson. Sharpe had multiple
questions regarding recent test results. Sharpe reported that
she was feeling better but continued to have numbness in her
right leg and tremors. Sharpe reported that she had twitching
in her right eyelid and fatigue. Peterson did not conduct a
physical examination during this visit. The same day Sharpe
underwent an MRI of her thoracic spine. The MRI showed
left-side bulging disk at ¶ 6-7 of doubtful clinical
significance. The scan was otherwise normal. R. 342.
21, 2012, Sharpe saw Dr. M. Ali, M.D., for a hypercoagulable
state. R. 402-05. Dr. Ali noted that Sharpe had heterozygous
factor V Leiden gene mutation and history of sensory stroke.
Dr. Ali noted that Sharpe had undergone MRIs of her carotid
artery, brain, and thoracic spine. He noted that the scans
were all normal except for the bulging disc at ¶ 6-7,
which he said was “probably insignificant.” Dr.
Ali also noted that the lumbar puncture results were
negative. Dr. Ali stated that Sharpe's
“hypercoagulable state revealed heterozygous factor V
gene mutation.” She took aspirin for this condition.
Sharpe reported the she still had some numbness in her right
lower extremity, but the rest of the numbness “actually
has been somewhat resolved.” R. 402.
examination, Sharpe's strength was symmetrical in all
extremities. She had somewhat decreased sensation in the
right lower extremity. Dr. Ali noted “some impairment
of coordination with questionable positive finger-nose-finger
test on right side.” Sharpe's gait was normal. Dr.
Ali assessed hypercoagulable state. Dr. Ali recommended
continuation of the aspirin and additional testing. R.
2, 2012, Sharpe saw Dr. Hafez for a follow up visit. R.
357-60. Sharpe reported that the numbness in her right side
had subsided except “outer aspect of strip knee up to
thigh still numb.” Dr. Hafez noted that the MRI, lumbar
puncture and other testing was generally negative except for
the factor V Leiden mutation and mild bulging of a thoracic
disc without cord compression. Dr. Hafez noted that
Sharpe's condition “if anything has
improved.” Dr. Hafez summarized:
The patient's condition if anything has improved. She is
left now with a patch of numbness from the proximal part of
the thigh laterally down to the right knee, down to the
mid-leg laterally. There is no pain. She is fairly
comfortable and she is capable of doing things the way she
does without problem. She, however, still has issues with
Her review of systems apart from these two issues is
negative. She is trying to eat healthy foods.
R. 359. Dr. Hafez performed a formal SLUMS mental status
examination. Sharpe scored 27 out of 30. Dr. Hafez said
concerning the test results.
This may be an expression of mild cognitive impairment the
test, but her score which was 27 out of 30 is still in the
normal range. Most likely this problem is related to
R. 306. Dr. Hafez could not diagnose any cause of
We reviewed all those results with the patient. At the
present time I am unable to apply a specific diagnosis to the
patient's complaint. This could have been the result of
her minor vascular event or viral infection. I do not have
evidence for strokes, ongoing inflammatory disease like MS,
18, 2012, Sharpe saw Dr. Ali for a follow up. R. 373-74. Dr.
Ali noted that he completed the additional testing for
Sharpe's hypercoagulable state. The additional testing
was negative. Sharpe reported that she still had some
shooting pain in her right lower extremity. Sharpe reported
no other new symptoms. R. 373. Dr. Ali recommended
continuation of the daily aspirin. R. 374.
August 1, 2012, Sharpe completed a Function Report-Adult
Form. R. 242-49. Sharpe reported that she had a hard time
walking down stairs due to her tremors and partial numbness
in her right leg. She said that the heat “makes my
asthma act up.” She said she got dizzy bending over due
to vertigo. She said she had no strength on her right side
due to a lumbar puncture test. R. 242. Sharpe reported that
she let the dogs out and did laundry during the day.
Otherwise, she sat and rested. She did not drive due to her
vertigo, numbness, and tremors. R. 243. She reported that she
had problems sleeping due to lower back pain, leg pain, and
severe headaches. R. 243. She said she had trouble
remembering to take her medications. She said she made
sandwiches and heated leftovers. She did not cook more
extensively because she could not stand for long periods. R.
said she did not do yardwork because of her asthma. She went
outside once a day, but more often in cool weather. She went
grocery shopping once a month. R. 245. She opined that she
could lift five pounds, walk 10 yards, pay attention for five
minutes or less. She could not follow spoken instructions but
could follow written instructions, but demonstrations worked
best. R. 247.
September 28, 2012, Sharpe saw psychologist Dr. Frank Froman,
Ed.D., for a consultative examination (CE) and mental status
examination (MSE). R. 375-84. Dr. Froman stated that,
“Tammy presented as a somewhat anxious individual who
appeared to put forth a very strong effort, trying to do
better each time, and became angry with herself when she did
not know what to say or do. Anxiety definitely interfered
with her performance.” R. 376. Dr. Froman administered
a Wechsler Memory Scale-Fourth Edition test. Dr. Froman
stated that the test results showed “unusually poor
memory virtually ‘across the boards.'” R.
383. Dr. Froman diagnosed probable dementia of unknown
origin, borderline intellectual functioning by interview, and
a current Global Assessment of Functioning (GAF) of
R. 383. Dr. Froman opined:
CONCLUSIONS: Tammy does not appear able to
perform one or two step assemblies at a competitive rate. She
is able to understand simple oral and written instructions,
but will not be able to retain them without "writing
them down or looking at them." She can get along with
other people adequately, and seems to be able to manage her
own benefits. I strongly doubt that she would be able to
withstand the stress associated with customary employment
until such time as we have a more clear understanding as to
what might be causing her memory loss.
October 5, 2012, state agency physician Dr. Richard Lee
Smith, M.D. prepared a Physical Residual Functional Capacity
Assessment. Dr. Smith opined that Sharpe could lift and carry
20 pounds occasionally and 10 pounds frequently; stand and/or
walk about six hours in an eight-hour workday; sit about six
hours in an eight-hour workday; never climb ladders, ropes,
or scaffolds; occasionally climb stairs and ramps; and
frequently balance, stoop, kneel, crawl, and crouch. Dr.
Smith opined that Sharpe had no manipulative limitations. R.
October 5, 2012, state agency psychologist Dr. Joseph Mehr,
Ph.D., prepared a Mental Residual Functional Assessment. R.
98-100. Dr. Mehr opined that Sharpe was markedly limited in
understanding and remembering detailed instructions; not
significantly limited in remembering locations and work-like
procedures; and not significantly limited in understanding
and remembering short and simple instructions. R. 99. Dr.
Mehr opined that Sharpe was not significantly limited in her
ability to carry out simple and short instructions. He opined
that she was moderately limited in carrying out detailed
instructions. He opined that Sharpe was moderately limited in
her ability to maintain attention and concentration for
This woman performs very poorly on cognitive tests at a MSE
which is in direct contrast to her capacity when assessed by
her treating physician. She is oriented times three, presents
as mentally impaired at a CE MSE but is fairly independent in
activities of daily living. Her issue at the CER (sic) MSE
may be the result of ADHD which is diagnosed by her treating
source. She retains enough mental capacity necessary for
remembering work locations and work related procedures and
she has the cognitive capacity to understand and remember
instructions for simple one and two step work of a routine
and repetitive type.
She also retains sufficient attention and concentration to
persist at and complete work activities for the periods of
time required in the general work force. This lady retains
the capacity for adequate pace and perseverance to maintain a
schedule and on time attendance, and to complete a normal
work day and work week on a consistent basis. She is able to
perform at minimally acceptable rates, requiring only the
common frequency and lengths of rest ...