United States District Court, D. South Carolina
REPORT AND RECOMMENDATION OF MAGISTRATE JUDGE
KAYMANI D. WEST FLORENCE JUDGE
This appeal from a denial of social security benefits is before the court for a Report and Recommendation (“Report”) pursuant to Local Civil Rule 73.02(B)(2)(a) (D.S.C.). Plaintiff, appearing through counsel, brought this action pursuant to 42 U.S.C. § 405(g) to obtain judicial review of the final decision of the Commissioner of Social Security (“Commissioner”) denying her claim for Disability Insurance Benefits (“DIB”) pursuant to the Social Security Act (“the Act”). For the reasons that follow, the undersigned recommends that the Commissioner’s decision be reversed and remanded for further administrative proceedings.
I. Relevant Background
A. Procedural History
On June 24, 2011,  Plaintiff filed an application for DIB alleging a disability onset date of July 29, 2008. Tr. 275. After being denied both initially and on reconsideration, Tr. 100, 133, Plaintiff requested a hearing before an Administrative Law Judge (“ALJ”), Tr. 179-80. On July 23, 2013, the ALJ conducted a hearing in Fresno, California,  taking testimony from Plaintiff and from a vocational expert (“VE”). Tr. 48-86. The ALJ issued a decision on August 15, 2013, denying Plaintiff’s claims. Tr. 36-47. The Appeals Council subsequently denied Plaintiff’s request for review, thereby making the ALJ’s decision the Commissioner’s final administrative decision for purposes of judicial review. Tr. 1-4. Plaintiff brought this action seeking judicial review of the Commissioner’s decision in a Complaint filed on November 18, 2014. ECF No. 1.
B. Plaintiff’s Background
Plaintiff, born on November 11, 1958, was 49 years old as of her alleged onset date of July 29, 2008. Tr. 309. She completed high school and four or more years of college. Tr. 288. In 2002 Plaintiff also completed training to become a Certified Breastfeeding Consultant. Id.
Plaintiff’s prior work history includes work as a Clinical Coordinator, Labor & Delivery Registered Nurse for a hospital, and as a Labor & Delivery staff RN travel nurse for a nursing agency. Tr. 289. In her July 2011 Disability Report Plaintiff indicated the following conditions limit her ability to work:
(1) Spondilosis/spondilothesis (sic), upper extremety (sic) damage; (2) spondylolsis (sic)/spondylolisthesis L5-S1; (3) multilevel degenerative disease of lumbosacral spine; (4) multilevel degenerative disc disease; (5) severe bilateral facet/ligamentous arthropathy; (6) posterior fracture of the right inferior facet of L5; (7) difuse (sic) disc bulge L5 over S1; (8) acute stress fractures bilat. L5 & right S1 pedicles; (9) ADHD; (10) bilateral cubital tunnel syndrome; [and] (11) bilateral carpal tunnel syndrome.
Tr. 287. In this same report Plaintiff further explained why she stopped working as follows:
The injuries incurred to my upper extremities bilaterally and subsequent surgeries left me with significant physical limitations and weakness. The required further surgeries for Carpal Tunnel Syndrome and Cubital Tunnel Syndrome require significant time for healing and rehabilitation. My Neck [is] currently being assessed for further nerve damage involved in this [workers compensation] case. My MDs state that I cannot return to the work I did. Additionally, MRIs, CT Scan, & Xrays of my Lumbar spine from 2007 to 2011 shows significant deterioration and explains the intensity of the pain I live with. I cannot walk, stand, bend, kneel, squat or even sit for short periods of time without experiencing debilitating pain. I have been advised that I will not heal from the fractures in my spine and that surgical intervention will not make things better and could make my back worse. As a result I require significant doses of narcotic medications to get thru the day. I am not able to return to work.
Tr. 288. In a December 26, 2011 letter to the Social Security Administration seeking reconsideration of her claim, Plaintiff provided the following information regarding her injuries:
On July 29, 2008 I suffered an injury at work that left me torn muscles and nerve damage to both my arms, elbows, wrists and hands. The injury was in fact a result of cumulative trauma to my upper extremities sustained over time while working in the Labor & Delivery unit of Hanford community hospital. This particular hospital did not enforce safety regulations with respect to the use of stirrups during the pushing phase of vaginal deliveries. Instead, most of the doctors and midwives insisted that the nurse assisting the patient hold and support the patient’s legs by holding the leg up, putting the patient’s foot against the nurse’s shoulder while she pushed with each contraction.
C. The Administrative Hearing
1. Plaintiff’s Testimony
Plaintiff and her counsel appeared at her administrative hearing held in Fresno, California on July 23, 2013. See Tr. 48-86. In response to questions from the ALJ Plaintiff testified that she was divorced with three adult children ages 30, 25, and 21. Tr. 52-53. Plaintiff stated that she lived in a house with a roommate and she possessed a driver’s license but only drove once or twice a month because she did not own a vehicle. Tr. 53. Plaintiff testified that she borrowed a car and drove herself to the hearing. Tr. 54. Plaintiff confirmed that she had a high school education plus four years of college. She stated that she received a degree in nursing and her license was in good standing. Id. Plaintiff testified that she has not done any type of work since her alleged onset date of July 29, 2008. Tr. 55. Plaintiff testified that she worked previously for Geneva General Hospital as a labor and delivery nurse. In 2000 she also worked part-time for Professional Choice as a nurse in a nursing home. Id. Plaintiff testified that she later worked for Millennium Medical Services as a travel nurse and went to California. Tr. 56. Plaintiff stated that in 2006, 2007, and 2008 she worked as an independent contractor travel nurse. Id. When asked by the ALJ what prevented her from working, Plaintiff testified that in 2008 she tore muscles in both her arms and shoulders and was still having difficulty with her hands. Tr. 57. Plaintiff stated that she drops items inadvertently and “[does not] have the strength to open like a bottle or whatever.” Id. Plaintiff testified that her job as a labor and delivery nurse put a lot of stress on her body and her back and the problems with her back “became significantly worse to the point where [she is] in constant pain and just trying to deal with that.” Id. Plaintiff stated that she has fractures in her back but has been told that surgery to repair the fractures will leave her more disabled. Id. Plaintiff testified that she had a worker’s compensation claim that determined she was 35 percent disabled and she received payments for two-and-a-half years, however she kept open the medical portion of the claim. Tr. 58. Plaintiff testified that she takes her prescribed medications on a regular basis and the pain medicine makes her pain “somewhat tolerable if [she is] not over stressing or putting stress on, specifically [her] lower back and the neck.” Tr. 58-59. Plaintiff testified that the Cymbalta somewhat controlled her depression symptoms but doctors were still adjusting the dosage. Tr. 59. Plaintiff stated that she has side effects from the medication, including “nausea and inability to sleep.” Id. Plaintiff testified that she has had surgery on both shoulders but surgery has not been recommended for her back because doctors felt “that the outcome of the surgery would be more debilitating and more pain that what [she is] experiencing currently.” Tr. 60. Plaintiff stated that she had three epidural steroid injections in the past three years but they did not help. Tr. 60-61. Plaintiff testified that she was continuing to do physical therapy and she also wore a back brace that was given to her by a doctor. Tr. 61. Plaintiff stated that the brace “just seems to help for maybe a couple of hours, but then it seems that position of [her] back, whatever, starts hurting even more.” Id. Plaintiff testified that she had also used a TENS unit but was not getting any results with it and used it only periodically. Id.
Plaintiff stated that she did not use a cane or other assistive device. Tr. 61-62, Plaintiff testified that she sees a psychiatrist “who is mainly involved with [her] ADHD” but she also talks to her about “depression, memory loss, [and] difficulty organizing things.” Tr. 62. Plaintiff testified that she is in pain “[e]very day, 24 hours a day, seven days a week.” Id. She stated the pain is located in her lower back and shoulders; she has residual pain from the surgeries and pain in her wrists, her hands, and her elbows. Id. She stated that she also has pain in her joints, her knees, and her ankles and if she walks for more than 10 or 15 minutes her “feet start really hurting significantly.” Tr. 62-63. Plaintiff stated she has had issues with swelling and taking medication. Tr. 63. To help with the pain Plaintiff testified that besides taking pain medication and doing stretching exercises she tries to get off her feet and limit what she does on a daily basis. Id. Plaintiff stated that any kind of activity-such as lifting, carrying, walking, twisting, sitting, and bending-made her pain worse. Id. Plaintiff described the pain in her lower back as a “tightening knot” that was a constant, achy, throbbing pain. Tr. 64. Plaintiff testified that the pain radiated down her arms to her hand and down her legs to her feet-particularly down her right leg. Id. Plaintiff stated that if she sat in one spot for an hour the pain would start affecting her back and she would “have to get up, walk around, [and] maybe lay down.” Tr. 65. Plaintiff stated she could stand for 30 minutes before needing to sit down, and could walk for “maybe a block” before needing to stop. Id. Plaintiff stated that she did not know whether she could continue walking because the pain in her foot and her legs and hips did not stop at that point. Id. Plaintiff testified that she could lift a gallon of milk with two hands but could not lift a case of soda with two hands. Tr. 66. Plaintiff stated that she could bend over and pick an item up that was dropped, but not without pain. Id. Plaintiff testified that she has problems reaching overhead with both arms and avoids reaching. She stated that she also has issues with her hands that cause her to inadvertently drop items and if she writes continuously for more than 10-or-15 minutes her wrists ache and her hand starts to become numb. Tr. 66-67. Plaintiff testified that if she tried to type for more than 15 minutes her hands would start to cramp and she would have a lot of pain and numbness. Tr. 67. She stated that she is able to use fasteners such as buttons or zippers to put on her clothes. Id. Plaintiff testified that her ...