United States District Court, C.D. Illinois, Springfield Division
SCHANZLE-HASKINS, U.S. MAGISTRATE JUDGE
Julia Ringering appeals from the denial of her application
for Social Security Disability Insurance Benefits (Disability
Benefits) under Title II of the Social Security Act. 42
U.S.C. §§ 416(i) and 423. This appeal is brought
pursuant to 42 U.S.C. §§ 405(g). Ringering filed
her application for Disability Benefits on October 9, 2009.
The Commissioner denied her claim. This Court reversed and
remanded Commissioner's decision for further proceedings.
Ringering v. Commissioner of Social Security, Ill.
C. D. No. 13-3024 (Ringering I), Opinion entered
August 4, 2015 (Case 13-3024 d/e 21) (Ringering I
Opinion) included in Certified Copy of Transcript of
Proceedings (d/e 6 and d/e 7) (R.), at 528-84. The
Commissioner again denied Ringering's application on
remand. Ringering has again filed this action for judicial
parties consented to proceed before this Court. Consent
to the Exercise of Jurisdiction by a United States Magistrate
Judge and Reference Order entered August 29, 2018 (d/e
12). Ringering filed a Motion for Summary Reversal (d/e
16), and Defendant Commissioner of Social Security filed a
Motion for Summary Affirmance (d/e 21). For the reasons set
forth below, the decision of the Commissioner is AFFIRMED in
part and REVERSED in part. The decision is affirmed except
with respect to the physical RFC finding. The case is
remanded for development of additional evidence regarding
Ringering's physical residual functional capacity.
was born on January 1, 1970. Ringering completed high school.
She worked in various clerical, administrative, and sales
positions at automobile dealerships. She also worked as a
cashier and in the paint department at a Wal-Mart. She last
worked on December 26, 2007. R. 48, 57, 453, 458. Ringering
suffers from degenerative disc disease, bipolar disorder,
posttraumatic stress disorder (PTSD), and alcohol abuse. R.
29. Ringering filed her application for Disability Benefits
on October 6, 2009. She alleged that she became disabled on
December 26, 2007. Ringering worked sufficient quarters to
remain insured for Disability Benefits through March 31,
2009. R. 27. Ringering is married. Between 2007 and 2009, she
lived with her husband and their five children. R. 45.
April 23, 2007, Ringering saw psychiatrist Dr. Sanjay K.
Nigam, M.D., for a psychiatric evaluation. Ringering reported
nightmares, flashbacks, depression, thoughts of suicide and
hypersomnia. Ringering reported that she blamed herself for
the suicide of her fiancé in April 1995. She reported
that she began to seek psychiatric treatment in 1997. She
reported episodes of depression in which she experienced
increased sleep, low energy, feelings of guilt, poor
concentration, weight gain, psychomotor retardation, and lack
of motivation. She also reported suicidal ideations. She
reported having panic and anxiety attacks. She admitted
having three panic attacks on the day of the evaluation. She
denied any hallucinations or paranoid delusions. Dr. Nigam
noted that Ringering was calm, cooperative, and pleasant. Her
personal hygiene was fair. Dr. Nigam diagnosed bipolar
disorder, possibly cyclothymia. He assigned her a Global
Assessment of Functioning (GAF) score of 55. The GAF score
was a measure of a clinician's judgment of an
individual's overall level of functioning on a
hypothetical continuum of mental health and illness. American
Psychiatric Assn, Diagnostic and Statistical Manual of
Mental Disorders (4th ed. Text Rev.) (DSM
IV-TR), at 32-35. A GAF score from 51 to 60 indicated either
“moderate symptoms . . . or moderate difficulty in
social, occupational, or school functioning.”
Id. at 34. Dr. Nigam changed Ringering's
medications. R. 199-201.
continued to see Dr. Nigam throughout 2007 and into 2008. On
May 9, 2007, and May 21, 2007, Ringering complained to Dr.
Nigam of difficulty sleeping and not being motivated to clean
the house. R. 202-03. On May 9, Ringering said she was
feeling overwhelmed trying to arrange a sleep-over birthday
party. On May 9, 2007, Dr. Nigam noted that Ringering's
appearance and grooming was fair, her mood was euthymic, her
thought process was logical and goal oriented, and her
judgment and insight were good. Dr. Nigam gave her a GAF
score of 55. R. 202. On May 21, 2007, Ringering said the
party was for her son, and she had no problems with the
party. She reported that after the party she went golfing and
cleaned up the house. She said she got a job at Walmart. Dr.
Nigam again noted that Ringering's appearance and
grooming was fair, her mood was euthymic, her thought process
was logical and goal oriented, and her judgment and insight
were good. Dr. Nigam gave her a GAF score of 55-60. R. 203.
August 8, 2007, Ringering reported racing thoughts. Dr. Nigam
noted that her thought process was logical and goal oriented
and her judgment and insight were good. Dr. Nigam again gave
her a GAF score of 55. Dr. Nigam recommended counseling. R.
September 5, 2007, Ringering again reported feeling anxious
and paranoid, and having racing thoughts. Dr. Nigam noted
that she had a depressed mood, an appropriate appearance and
affect, coherent speech, logical thought processes, normal
memory, good judgment and fair insight. R. 206. Dr. Nigam
again adjusted her medications.
October 8, 2007, Ringering reported that she stopped
drinking. She reported that she was sleeping better, but
still experienced drowsiness. Dr. Nigam noted that her speech
was coherent, her thought process was logical, her memory was
normal, her insight was fair, and her judgment was good. Dr.
Nigam gave her a GAF score of 60. R. 207.
January 4, 2008, Ringering saw Dr. Nigam. Ringering reported
that the holidays were not good for her. She reported that
she had stress at work at Wal-Mart, and she quit. She
reported that she was drinking and was not taking her
medications. Dr. Nigam and Ringering discussed the adverse
interaction between alcohol and her medications and the
effect on her mental illness. Dr. Nigam noted that she was
alert and calm, she had a sad mood, her thought process was
concrete, her judgment and insight were poor, and her ability
to abstract was limited. Dr. Nigam gave her a GAF score of
45. R. 208. A GAF score of 41 to 50 indicated either serious
symptoms or any serious impairment in social, occupational,
or school functioning. DSM IV-TR, at 34.
January 4, 2008, Dr. Nigam wrote a letter To Whom It May
Concern regarding Ringering. Dr. Nigam wrote that Ringering
was suffering from bipolar disorder with episodes of manic
and depressive symptoms. He stated that she required extra
support from her family during these episodes. R. 211.
February 4, 2008, Ringering saw Dr. Nigam. Ringering reported
getting arrested for Driving Under the Influence of Alcohol
(DUI) and resisting arrest. Her driver's license was
suspended. She reported that the officer shocked her with a
Taser. Dr. Nigam stated on that date that Ringering had a
good appearance and an improved mood; her cognition was
within normal limits; and she had good judgment, fair
insight, normal affect, and a logical and goal directed
thought process.” Dr. Nigam assigned GAF score of 50 at
this visit. R. 209.
February 26, 2008, Ringering saw an orthopedic surgeon, Dr.
Lukasz Curylo, M.D. because of problems with her neck. On
examination, Dr. Curylo found limited range of motion in her
neck and decreased strength and sensation in her left arm and
fingers. An MRI showed two large disc herniations at ¶
5-6 and C6-7. The herniations caused neuro-compression and
significant canal narrowing. Dr. Curylo discussed treatment
options with Ringering, including possible surgery. R. 375.
Ringering decided to have surgery on her neck. On or about
March 4, 2008, Dr. Curylo performed a cervical fusion
operation in which he fused C5-C7 vertebrae. R.
Ringering wore a cervical collar after the operation.
March 24, 2008, Ringering saw Dr. Curylo for a postoperative
follow-up examination. Ringering reported that her numbness
was resolved. She said that she was happy with the results.
Dr. Curylo stated that Ringering had “Excellent healing
with good results.” Dr. Curylo refilled her pain
medication prescriptions. R. 370.
March 31, 2008, Ringering saw Dr. Nigam. She reported neck
pain. She reported trouble sleeping and having racing
thoughts. Dr. Nigam noted that Ringering had a better mood, a
normal affect, and a logical goal directed, and sequential
thought process.” R. 210. Dr. Nigam also stated
Ringering had fair judgment and insight. R. 210.
12, 2008, Ringering saw Dr. Curylo for a second follow-up
examination after her surgery. Ringering reported much less
pain. She reported that she was taking no pain medication.
She complained of mild occasional numbness in her left thumb
and first and second fingers. Her symptoms were intermittent.
On examination, Dr. Curylo found that the incision was
well-healed. He noted no pain in range of motion. Dr. Curylo
told Ringering that she no longer needed to wear the cervical
collar. Dr. Curylo refilled Ringering's pain
prescriptions. R. 371-72.
22, 2008, Ringering saw a psychiatrist Dr. Kapal Datta, M.D.,
for a psychiatric evaluation. Ringering rated her depression
as a “7 out of 10.” She reported that her anxiety
varied. Dr. Datta gave her a GAF score of 60. Dr. Datta
adjusted her medications. R. 213-17.
saw Dr. Datta several times from May through October 2008. On
June 16, 2008, Ringering said she was better and had been
walking and riding her bike. R. 218, 221. On July 28, 2008,
Ringering said she was doing very well and was cutting down
on caffeine. R. 222. In September 2008, Ringering reported
that she and her husband filed for bankruptcy relief. In
October 2008, Ringering reported that she could not hold a
job. Ringering stated that she had been sober since January
2008. R. 218-225, 228-229.
September 30, 2008, Ringering was hospitalized after
reporting sadness, discouragement, low self-esteem,
worthlessness, loss of pleasure, anxiety, and anger. R.
314-17. She was discharged from inpatient care on October 9,
2009. At the time of discharge, Ringering reported some
continuing depression, anxiety, and anger, but denied any
suicidal ideations. Ringering was assessed with a major
depressive disorder and alcohol abuse in initial remission.
She was given a GAF score of 60, indicating moderate symptoms
or moderate functional limitations. R. 314-17.
October 20, 2008, Ringering saw Dr. Datta. She said she was
in an intensive outpatient program (IOP). She had attended
six sessions. Dr. Datta advised engaging in physical
activity. R. 228-29.
Shazia Malik, M.D., wrote a letter To Whom It May Concern
dated November 4, 2008, stating that Ringering completed 21
hours of a dual diagnoses program for her mental problems and
her problems with substance abuse. R. 292.
November 17, 2008, Ringering saw Dr. Datta. Ringering said
the IOP sessions were helping. She said she was learning how
to cope. She was cleaning the house, biking, and taking care
of her children. R. 230. Dr. Datta also made a list in his
notes that he entitled
“Inconsistencies/Discrepancies.” R. 231. Dr.
Datta listed under this heading, among other things:
Ringering was guarded, she was not able to hold a job, her
mother and sister told her she was lazy and did not look
after her children, she lost her job in December 2007 and did
not like her manager, she stopped attending IOP, she said her
insurance would not authorize more care, she said she did not
see a psychiatrist in IOP, the IOP records showed that she
saw a psychiatrist. R. 231.
November 17, 2008, Ringering saw Dr. Curylo about her neck.
Ringering reported increasing axial neck pain. She also
reported suboccipital pain and intermittent numbness in her
left hand. Ringering denied any weakness. Dr. Curylo stated
that Ringering may have had adjacent level degeneration with
cervicalgia and possibly facet disease superior to the
location of her March 2008 fusion. Dr. Curylo referred
Ringering to a pain specialist. R. 369.
December 8, 2008, Ringering saw Dr. Datta. Dr. Datta noted
that Ringering's affect was okay, her mood was much
better, and she was sleeping better. R. 234-35. On December
29, 2008, Ringering saw Dr. Datta again. Ringering reported
having better energy. Ringering reported that her Christmas
was “great.” R. 236-37. On January 26, 2009,
Ringering told Dr. Datta that things were better. She said
her meds helped her. R. 238.
January 26, 2009, Ringering also saw a pain specialist, Dr.
Daniel Sohn, M.D. Dr. Sohn noted neck and shoulder girdle
myofascial pain. On examination, Ringering's stance,
gait, and position were “a little slow.”
Ringering was tender to palpation in the neck and shoulder
girdles. Her neck range of motion was poor to fair with
flexion limited by pain, but extension and rotation were good
without discomfort. She had decreased sensation in the upper
extremities. Dr. Sohn prescribed physical therapy and
medication. Dr. Sohn mentioned that trigger point injections
would be considered in the future. Dr. Sohn advised Ringering
to remain active with her usual activities. Dr. Sohn advised
against bed rest. R. 367-68. Dr. Sohn recommended continuing
“appropriate exercises as discussed.” R. 368.
continued to see Dr. Datta in 2008 and 2009. R. 213-50. On
March 30, 2009, Ringering reported that therapy was helpful.
Ringering reported problems at home because of the
bankruptcy. She reported negative self-esteem, but she also
reported that the medications helped, she was having no
anxiety attacks, and her eating and sleeping habits were
better. She said that she was cleaning house, visiting with
friends, and attending soccer practice with her children. R.
240-41. On May 18, 2009, Ringering reported having lots of
anxiety attacks. Ringering reported fighting and anger. R.
242. Dr. Datta listed Ringering's diagnosis as bipolar
affective disorder and an adjustment disorder (mixed). Dr.
Datta indicated that Ringering was doing much better, and her
mood was better. R. 244.
April 21, 2009, Ringering saw Dr. Sohn. Ringering reported
that the physical therapy hurt. Ringering reported that she
continued to follow through on a home exercise program. On
examination, Ringering was alert, and in a stable mood.
Ringering's head and neck appeared normal. Her range of
motion in her neck was decreased in left rotation and
extension. She was tender to palpation on the left neck and
shoulder. Her upper extremity strength was intact, but she
had some pain in her left shoulder girdle with manual muscle
testing. Dr. Sohn gave Ringering three trigger point
injections. Dr. Sohn also renewed her medications and
directed her to continue her exercises. Dr. Sohn again
advised Ringering to remain active, avoid bed rest, and
continue appropriate exercises. R. 362-63.
19, 2009, Ringering saw Dr. Sohn again. On examination,
Ringering's stance, gait, and position appeared to be
normal. She had fair range of motion with pain in the left
neck. She was tender on palpation in the left neck and
shoulder girdle. Her upper extremity strength was intact. Dr.
Sohn administered one trigger point injection. He added
valium to her medications, to be taken at night. He again
advised her to remain active with her usual activities; he
advised against bed rest; and he recommended appropriate
exercises that they had discussed. R. 359-60.
23, 2009, Ringering saw Dr. Sohn. Ringering reported that she
had been doing “a lot of travelling for family issues
to Florida and Texas.” She said she was tired due to
the trips. She reported that the trigger injections had been
helpful. She reported that her pain was much better on the
left. She reported more pain on the right at this visit. She
stated the pain in the right side may have been due to her
trips. On examination, her stance, gait, and position changes
were normal, the range of motion in her neck appeared to be
good. She was tender to palpation on the right neck, but
non-tender otherwise. Her upper extremity strength was
intact, but her upper extremity sensation was decreased. Dr.
Sohn renewed her medications. He advised her to remain active
with her usual activities; he advised against bed rest; and
he advised to continue her medications and exercises. R. 357.
August 17, 2009, Ringering saw Dr. Sohn. Dr. Sohn
administered five trigger injections. Ringering told Dr. Sohn
that she had been very active over the summer. She had
increased pain for the last three weeks. Ringering said that
she also has started having headaches and radiating pain down
her left arm to the thumb and first and second fingers of the
hand. Dr. Sohn recommended that she refrain from overactivity
and high impact sports, but also recommended that she
continue her usual activities and recommended exercises. Dr.
Sohn ordered a nerve conduction study of her left extremity.
R. 351-52, 355.
September 11, 2009, Ringering saw Dr. Sohn again. Dr. Sohn
reported that the nerve conduction study showed normal nerve
conduction with some borderline measurements. R. 351. Dr.
Sohn ordered an MRI of Ringering's cervical spine. The
MRI was conducted on November 17, 2009. The results showed
minimal disk bulging of the upper cervical segments without
obvious stenosis or cord compression. The results also showed
a congenitally narrow spinal canal. R. 378.
September 18, 2009, Ringering was admitted to another IOP.
Dr. Datta referred her to the program because of his concerns
about her manic symptoms and her cravings to drink and engage
in promiscuity. Ringering was assessed with low mood,
feelings of helplessness, hopelessness, somatic complaints,
decreased sleep, decreased appetite, excessive worry, racing
thoughts, difficulty concentrating, poor impulse control,
irritability, and outbursts of anger. She reported some
suicidal ideations. She was given a GAF score of 45,
indicating serious symptoms or serious functional
limitations. R. 309-10.
September 20, 2009, Ringering was examined by psychiatrist
Dr. Malik. On examination, Ringering was alert and oriented.
Her speech was coherent. Her thought process was logical and
goal oriented. Her remote memory was grossly intact. Her
intellect was average. Her concentration was fair. Dr. Malik
diagnosed bipolar affective disorder, depressed, and alcohol
dependence in partial remission. Dr. Malik assigned a GAF
score of 55, indicating moderate symptoms or moderate
functional limitations. R. 311-12. Dr. Malik planned to
continue the intensive outpatient program, recommended AA
meetings, and adjusted her medications. R. 313
apparently attended the IOP sessions until November 5, 2009.
R. 309. At the time of discharge, Ringering was stable
without any suicidal or homicidal ideations. She was assigned
a GAF score of 65. R. 310. A GAF score of 61 to 70 indicated
“some mild symptoms . . . or some difficulty in social,
occupational, or school functioning, but generally
functioning pretty well . . . .” DSM IV-TR, at
November 23, 2009, Ringering saw Dr. Sohn. Dr. Sohn
administered an epidural steroid injection into the cervical
spine. Ringering underwent a C4-5 Transforaminal Epidural
Steroid Injection (TFESI) on November 3, 2009. Ringering
reported about a 50% improvement in her pain, but she still
had pain in her neck and left shoulder girdle area. Ringering
still took 4 to 5 Percocet per day. On examination, Ringering
was in a calm and stable mood. Her stance, gait, and position
changes appeared normal. Her range of motion was very
decreased. Her upper extremity strength was intact. Her left
trapezius was very tender to palpation. She reported tingling
in three of her left fingers, but her sensation to light
touch was intact in those fingers. Dr. Sohn administered a
trigger point injection and ordered another C4-5 TFESI. R.
November 29, 2009, Ringering saw Dr. Datta. She reported that
she was working out on an exercise bike. Her mood was better.
Her sleep was okay. She was advised to cut down on caffeine.
January 12, 2010, Ringering saw Dr. Sohn. Ringering reported
that the C4-5 TFESI temporarily caused increased pain, but
her pain had dropped from 6/10 to 3-4/10. She reported muscle
spasms in her left shoulder girdle muscle that responded well
to her medications. On examination, her stance, gait, and
station appeared normal. Her range of motion in her neck was
decreased to the left. Her upper extremity strength was
intact. Her left shoulder active range of motion was good,
but with some pain. Her upper extremity sensation was
decreased on the left in a C6 distribution. Ringering would
not consider more shots at this time. Dr. Sohn prescribed
medications and told her to return in two months. R. 341-42.
February 21, 2010, state agency psychologist, Dr. S. Hill,
Ph.D., completed a Psychiatric Review Technique. R. 254-67.
Dr. Hill opined that Ringering's affective disorders and
anxiety related disorders were not severe. R. 254. Dr. Hill
opined that Ringering had depression. R. 259. Dr. Hill opined
that Ringering had mild difficulties maintaining
concentration, persistence or pace, but no other functional
limitations as a result of her mental condition. R. 264. Dr.
Hill noted at the end of the Technique,
Claimant stable at exam of 3/30/09.
Claimant's allegations, credible.
Impairment not severe.
March 4, 2010, Dr. Datta completed a form entitled Social
Security Administration Listing of Impairments. R. 269-71.
Dr. Datta opined that Ringering became disabled prior to
2008. Dr. Datta opined that Ringering had ongoing symptoms of
psychomotor agitation or retardation. Dr. Datta opined that
Ringering's condition resulted in marked difficulties
maintaining social functioning, and marked difficulties
maintaining concentration, persistence, or pace; and repeated
episodes of decompensation, each of extended duration. R.
270. Dr. Datta indicated that Ringering had one or two
episodes of decompensation. R. 271.
Datta checked a box indicating that Ringering's condition
met the Social Security Administration's Listing §
12.04 for Affective Disorders. R. 270. The Social Security
Administration's analysis of disability considers, at one
point, whether a person is so significantly impaired he would
be deemed disabled without regard to his age, education, or
work experience. 20 C.F.R. §§ 404.1520(d),
416.920(d). To meet this requirement, the claimant's
condition must meet or be equal to the criteria of one of the
impairments specified in 20 C.F.R. Part 404 Subpart P,
Appendix 1 Listing of Impairments. Each impairment identified
in the Listing of Impairments is referred to as a
“Listing.” Section 12.04 sets forth the Listing
for affective disorders such as depression and bipolar
April 23, 2010, a psychologist, Dr. M.W. DiFonso, Psy.D.,
completed a Psychiatric Review Technique. R. 275-88. Dr.
DiFonso opined that Ringering had a history of major
depressive disorder. R. 278. Dr. DiFonso opined that there
was insufficient evidence in the record to establish any
functional limitations from Ringering's mental condition.
R. 285. Dr. DiFonso opined that Ringering's statements
were only partially credible. Dr. DiFonso opined that Dr.
Datta's opinions on the Social Security Administration
Listing of Impairments form, R. 269-71, were inconsistent
with his treatment notes and not otherwise supported by the
record. R. 287. Dr. DiFonso stated that, “No objective
findings are presented to substantiate this claim.” R.
April 28, 2010, substance abuse counselor Jill Wright from
the Montgomery County, Illinois, Health Department conducted
a drug/alcohol assessment of Ringering. Wright concluded that
Ringering did not present sufficient evidence of current
substance abuse to warrant treatment. R. 294.
10, 2010, Dr. Datta wrote a letter “To Whom it May
Concern.” Dr. Datta stated that Ringering had been his
patient since May 22, 2008. Dr. Datta stated that Ringering
had bipolar affective disorder; major depression, recurrent;
episodic hypoglycemia; substance abuse (possibly
self-medication to deal with underlying mental issues); and
adjustment disorder, mixed. Dr. Datta listed Ringering's
medications Seroquel, Pristiq, Lamictal, and Klonopin. R.
15, 2010, Ringering saw Dr. Sohn. Ringering reported
increased neck pain and headaches. Ringering reported that
she had been moving and doing a lot of cleaning, scraping,
and painting at the new house. On examination, Ringering was
pleasant, alert, and in a stable mood. Her range of motion
was fair with pain in the neck and shoulder girdle. Ringering
was tender to palpation on the left shoulder girdle. Her left
upper extremity strength was intact. Dr. Sohn diagnosed a
flare-up due to increased activities. Dr. Sohn prescribed
Vicodin. R. 333.
September 14, 2010, Ringering saw Dr. Sohn. Ringering said
she had pain in her neck and left upper extremity. She had
still been scraping and painting the new house. On
examination, Ringering had a stable mood. Her stance, gait,
and position changes appeared normal.
head and neck were stiff with poor range of motion and pain.
Ringering was tender on palpation in her left neck and
shoulder girdle. Her upper extremity strength was intact.
Sensation was decreased in left hand and first three fingers.
She was in moderate distress due to the neck pain. Dr. Sohn
increased her dosage of Vicodin and ordered an MRI. He
recommended continuation of usual activities and appropriate
exercises. He recommended against bedrest. R. 328.
December 2, 2010, Ringering saw Dr. Datta. Ringering said
that she was doing much better. She also said that she was
depressed and her mood was not good. She said she was moving
into a new house. R. 305.
December 2, 2010, Ringering also saw Dr. Sohn. Ringering
complained of left neck, shoulder, and arm pain with some
residual numbness in the first and second fingers of the left
hand. An MRI performed in September 2010 showed the C5-C7
fusion with stenosis at ¶ 4-5 and some narrowing at
¶ 3-4. R. 324, 378. Ringering reported that she had been
busy rehabbing her new home. She had been cleaning, scraping
wallpaper and painting. Dr. Sohn stated that this activity
could be causing her discomfort. Ringering reported that she
was sleeping fairly well. R. 324.
examination, Ringering's stance, gait, and changes in
position appeared normal. She was tender to palpation of the
left neck and shoulder girdle. She had pain with flexion,
right rotation, and bilateral side bending. Her upper
extremity strength was intact. She had some weakness in her
fingers. She had some decreased light touch sensitivity in
her right thumb and first and second finger. Dr. Sohn
administered a T1-2 interlaminar epidural injection.
Ringering was also taking Norco for pain. Dr. Sohn
recommended continuing her usual activities and appropriate
exercises and advised against bedrest. R. 324-25.
February 14, 2011, Ringering saw Dr. Sohn. Ringering said
that the December 2, 2010 injection helped some with her
pain, but her pain was recurring. She reported doing
exercises and stretches at home and cutting back on heavy
work at home. On examination, Ringering's stance, gait,
and changes in position appeared normal. Her range of motion
was fair to poor with some pulling and pain in the left
shoulder. She was tender to palpation with triggering in ...