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King v. Commissioner of Social Security Administration

United States District Court, D. South Carolina

March 31, 2017

Teresa Ann King, Plaintiff,
v.
Commissioner of Social Security Administration, Defendant.

          REPORT AND RECOMMENDATION

          SHIVA V. HODGES UNITED STATES MAGISTRATE JUDGE.

         This appeal from a denial of social security benefits is before the court for a Report and Recommendation (“Report”) pursuant to Local Civ. Rule 73.02(B)(2)(a) (D.S.C.). Plaintiff brought this action pursuant to 42 U.S.C. § 405(g) and § 1383(c)(3) to obtain judicial review of the final decision of the Commissioner of Social Security (“Commissioner”) denying her claim for Disability Insurance Benefits (“DIB”) and Supplemental Security Income (“SSI”). The two issues before the court are whether the Commissioner's findings of fact are supported by substantial evidence and whether she applied the proper legal standards. For the reasons that follow, the undersigned recommends that the Commissioner's decision be affirmed.

         I. Relevant Background

         A. Procedural History

         On November 30, 2012, Plaintiff protectively filed an application for DIB in which she alleged her disability began on May 6, 2012. Tr. at 79 and 137-41. Her application was denied initially and upon reconsideration. Tr. at 80-83 and 89-94. Plaintiff subsequently filed an application for SSI on August 27, 2014. Tr. at 11. On September 26, 2014, Plaintiff had a hearing before Administrative Law Judge (“ALJ”) Jerry W. Peace. Tr. at 28-59 (Hr'g Tr.). The ALJ issued an unfavorable decision on December 9, 2014, finding that Plaintiff was not disabled within the meaning of the Act. Tr. at 8-27. Subsequently, the Appeals Council denied Plaintiff's request for review, making the ALJ's decision the final decision of the Commissioner for purposes of judicial review. Tr. at 1-6. Thereafter, Plaintiff brought this action seeking judicial review of the Commissioner's decision in a complaint filed on July 12, 2016. [ECF No. 1].

         B. Plaintiff's Background and Medical History

         1. Background

         Plaintiff was 45 years old at the time of the hearing. Tr. at 34. She completed high school. Id. Her past relevant work (“PRW”) was as a convenience store manager. Tr. at 55. She alleges she has been unable to work since May 6, 2012. Tr. at 137.

         2. Medical History

         On July 29, 2009, Plaintiff presented to Michael Kilburn, M.D. (“Dr. Kilburn”), and Carrie A. Turner, PA-C (“Ms. Turner”), for a neurological consultation. Tr. at 321- 22. They observed Plaintiff to have full range of motion (“ROM”), to be non-tender to palpation and percussion, and to have no paraspinal spasm in her lumbar spine. Tr. at 322. On motor testing, they found Plaintiff to have full, symmetric strength throughout with normal bulk and tone. Id. They indicated Plaintiff's sensation was intact to pinprick, light touch, vibration, and position sense. Id. Plaintiff had normal bilateral deep tendon reflexes (“DTRs”). Id. Dr. Kilburn and Ms. Turner indicated an L5-S1 central and left-sided disc bulge was giving rise to some of Plaintiff's low back and hip discomfort. Id. They noted Plaintiff weighed 150-190 pounds over her normal body weight and was experiencing resultant trouble with her right knee and low back. Id. They recommended Plaintiff consult a bariatric surgeon and indicated they would reevaluate her if she reduced her weight below 200 pounds and continued to have problems with her back and leg. Id.

         Plaintiff presented to Connie D. Abbott, N.P. (“Ms. Abbott”), with severe right leg pain on January 18, 2011. Tr. at 289. She described her pain as sharp and shooting and indicated it was worsened by sitting and pressing the accelerator pedal in her car. Id. She indicated the pain radiated from her posterior right buttock down her right leg. Id. Ms. Abbott indicated Plaintiff had been diagnosed with a disc bulge, facet narrowing on the right, and mild impingement in 2009. Id. She stated the neurosurgeon was unwilling to perform surgery until Plaintiff lost some weight. Id. Ms. Abbott observed Plaintiff to have asymmetric DTRs in her lower extremities and to be hyper-reflexive on the right. Id. She noted tenderness in Plaintiff's right hip and sacroiliac joint. Id. She described Plaintiff as being unable to lie down and having a positive straight leg raising (“SLR”) test on the right at 30 degrees while standing. Id. She prescribed Naproxen and Lortab and instructed Plaintiff to obtain magnetic resonance imaging (“MRI”) and to avoid lifting and bending. Id.

         On January 26, 2011, an MRI of Plaintiff's lumbar spine showed a bulging and protruding disc at ¶ 5-S1 that combined with degenerative changes and hypertrophy at the posterior elements to cause mild central canal stenosis, moderate bilateral neural foraminal narrowing, and central S1 nerve root compression that was greater on the left than the right. Tr. at 293. The findings were unchanged from a July 2009 MRI. Id.

         Plaintiff followed up with Ms. Abbott to discuss the MRI report on February 2, 2011. Tr. at 287. She continued to complain of severe right leg pain and right foot numbness, but stated her pain was improved by 80% with use of Lortab. Id. Ms. Abbott observed Plaintiff to have asymmetric reflexes in her lower extremities and to be hyper-reflexive on the right. Id. She noted tenderness in Plaintiff's right sacroiliac joint and stated Plaintiff was unable to lie down because of her pain. Id. She indicated Plaintiff had a positive SLR test on her right side at 30 degrees while standing and was tender in her right hip. Id. She referred Plaintiff for a neurosurgical consultation. Tr. at 288.

         Plaintiff presented to Sybil Reddick, M.D. (“Dr. Reddick”), with a complaint of low back pain and right lower extremity radicular pain on February 8, 2011. Tr. at 367. Dr. Reddick observed Plaintiff to have decreased left patellar, right patellar, right Achilles, and medial hamstring reflexes. Tr. at 368. She observed mild generalized weakness and restricted movement in Plaintiff's lumbar spine and reduced strength in her abdominal muscles. Id. She noted no tenderness, crepitation, or edema in Plaintiff's bilateral lower extremities. Id. Plaintiff demonstrated 5/5 muscle strength, normal tone, and normal muscle bulk in her bilateral lower extremities. Id. She ambulated with an antalgic gait favoring the right side and had a positive SLR test on the right at 45 degrees with leg pain. Tr. at 369. An SLR test was negative on the left. Id. Dr. Reddick prescribed Neurontin and recommended nerve conduction velocity (“NCV”) and electromyography (“EMG”) studies of Plaintiff's lower extremities. Id.

         On February 22, 2011, Plaintiff reported her medication regimen was working well, but complained of increased swelling in her left foot. Tr. at 364. Dr. Reddick observed no edema in Plaintiff's spine or lower extremities. Tr. at 365. She noted decreased reflexes in Plaintiff left patella, right patella, right Achilles, and medial hamstring. Id. She noted mild generalized tenderness and restricted movement in Plaintiff's lumbar spine. Id. Plaintiff had no tenderness or crepitation, normal tone, 5/5 motor strength, normal muscle bulk/no atrophy, and no fasciculations in her bilateral lower extremities. Id. An SLR test was positive for leg pain at 45 degrees on the right, but was negative on the left. Id. Plaintiff ambulated with an antalgic gait favoring the right. Id. Dr. Reddick instructed Plaintiff to follow up after the NCV and EMG testing was completed. Tr. at 366.

         On May 10, 2011, Plaintiff complained of bilateral knee pain, but indicated Naproxen was working well. Tr. at 360. She complained of a little swelling in her left foot and requested that Naproxen be refilled. Id. Dr. Reddick observed Plaintiff to have 1 left patellar, right patellar, and right Achilles reflexes. Tr. at 361. She was unable to elicit Plaintiff's hamstring reflexes. Id. She noted mild generalized tenderness in Plaintiff's lumbar area; restricted movement in all directions; and reduced strength in her abdominal muscles. Id. An SLR test was positive for leg pain at 45 degrees on the right, but negative on the left. Tr. at 361-62. Plaintiff demonstrated no edema or crepitation, and she had normal tone, 5/5 muscle strength, and normal muscle bulk/no atrophy. Tr. at 361. She had some medial joint line tenderness in her left knee and walked with an antalgic gait favoring the right. Tr. at 362. Dr. Reddick reviewed the EMG report and indicated it was normal. Id. She refilled Plaintiff's prescription for Naproxen, discontinued Neurontin, and recommended she obtain orthopedic shoes with support. Id.

         Plaintiff presented to Brian Henry, M.D. (“Dr. Henry”), with a complaint of back pain that radiated to her right thigh and posterior knee on November 28, 2011. Tr. at 285. Dr. Henry indicated Plaintiff had asymmetric DTRs in her lower extremities and was hyper-reflexive on the right. Id. He noted Plaintiff had 4-5/5 strength in her right lower extremity and was tender at her right sacroiliac joint. Id. Plaintiff was unable to lie down and had a positive SLR test. Id. She was tender in her right hip. Id. Dr. Henry assessed degenerative disc disease, not otherwise specified (“NOS”), and radiculopathy. Id. He refilled Plaintiff's prescription for Lortab and prescribed Naproxen. Id.

         On February 9, 2012, Plaintiff indicated to Ryan Groth, PA-C (“Mr. Groth”), that she experienced aching pain in her knees and buttocks. Tr. at 214. She stated she had been unable to afford to follow up for pain management treatment and had received prescriptions for Naproxen and Hydrocodone from Dr. Henry in November. Id. Plaintiff reported balance problems and difficulty walking. Tr. at 217. Mr. Groth observed Plaintiff to be 5'5” tall and to weigh 330 pounds. Id. He noted Plaintiff had 1 left patellar, 1 right patellar, and 1 right Achilles reflexes. Id. He was unable to elicit medial hamstring reflexes. Id. Plaintiff demonstrated mild generalized tenderness in her lumbar area. Id. Her movement was restricted in all directions, and she had reduced strength in her abdominal muscles. Id. An SLR test was positive for leg pain at 45 degrees on the right. Tr. at 218. Plaintiff walked with an antalgic gait and favored the right. Id. Mr. Groth recommended Plaintiff obtain orthopedic shoes and refilled her prescription for Naproxen and Tramadol. Tr. at 218 and 219. He referred Plaintiff for bilateral knee x-rays. Tr. at 219.

         Plaintiff followed up with Dr. Reddick on March 15, 2012. Tr. at 220. She reported that her medications were ineffective and that her right knee pain had worsened. Id. Dr. Reddick observed Plaintiff to have 1 right patellar, left patellar, and right Achilles reflexes. Tr. at 221. She was unable to elicit medial hamstring reflexes. Id. Plaintiff demonstrated mild generalized tenderness in her lumbar area, restricted movement in all directions, and reduced strength in her abdominal muscles. Tr. at 221- 22. An SLR test was positive for leg pain at 45 degrees. Tr. at 222. Dr. Reddick indicated Plaintiff was tender to palpation and had mild swelling over her medial joint line. Id. She refilled Lortab, discontinued Tramadol, and referred Plaintiff for an MRI of her left knee. Id.

         On March 22, 2012, x-rays of Plaintiff's left knee showed three-compartment knee joint degeneration that was most prominent in the medial compartment. Tr. at 233. An MRI indicated medial tibial plateau bone contusion, medial meniscal degeneration, and moderate osteoarthritis. Tr. at 234.

         On March 29, 2012, Plaintiff reported Lortab provided some relief, but did not take away all her pain. Tr. at 227. Dr. Reddick indicated Plaintiff weighed 350 pounds. Tr. at 228. She observed Plaintiff to have reduced reflexes, mild generalized tenderness in the lumbar area, restricted movement in all directions, and reduced strength in the abdominal muscles. Tr. at 228-29. She noted Plaintiff demonstrated an antalgic gait favoring the right and had a positive SLR test at 45 degrees for leg pain. Tr. at 229. She noted Plaintiff had experienced a negative reaction to the previous steroid joint injection. Id. She scheduled Plaintiff for a Hyalgan injection in her left knee and instructed her to take one-and-a-half Lortab pills at a time. Id.

         Plaintiff received Hyalgan injections in her left knee on April 18, April 25, May 2, May 9, and May 16, 2012. Tr. at 238, 239, 244, 247, and 254. She tolerated the injections without complications. Id.

         On August 7, 2012, Plaintiff complained of bilateral knee pain that worsened when she stood for long periods. Tr. at 281. She reported swelling in her left lower leg. Id. Ms. Abbott observed edema in Plaintiff's left leg after she removed a knee brace. Id. She noted medial tenderness, pain with flexion and extension, and 2 pitting edema in Plaintiff's left foot. Id. She referred Plaintiff to Lakelands Orthopedics for an evaluation of knee pain and prescribed Lasix for edema. Id.

         On August 27, 2012, John H. Cathcart, III, M.D. (“Dr. Cathcart”), indicated Plaintiff had no obvious swelling in her knees, but had pitting edema in her bilateral lower extremities. Tr. at 265. He noted Plaintiff was able to extend her left knee and flex to about 120 degrees. Id. Plaintiff complained of pain medially and laterally and had patellofemoral grinding on both sides. Id. She demonstrated adequate ROM in her hip and had a negative SLR test. Id. Dr. Cathcart assessed end-stage arthritis of the left knee and obesity. Id. He indicated Plaintiff needed a knee replacement, but that his partners would be reluctant to perform the surgery based on her age and weight. Tr. at 266. He stated Plaintiff would need to demonstrate an ability to lose weight to be a candidate for surgery and may be a candidate for gastric weight loss procedures. Id.

         Plaintiff followed up with Ms. Abbott on September 4, 2012. Tr. at 279. She reported consuming many high-fat meals and indicated she was unable to exercise because of pain in her joints. Tr. at 279. Ms. Abbott indicated Plaintiff weighed 367 pounds. Id. She noted edema when Plaintiff removed her knee brace. Id. Plaintiff demonstrated tenderness medially, pain with flexion and extension, and 2 pitting edema. Id. Ms. Abbott discussed possible weight reduction options with Plaintiff, and Plaintiff opted to use Phentermine. Tr. at 280. Ms. Abbott refilled a prescription for Lasix for swelling and prescribed Phentermine for weight loss. Id.

         Plaintiff presented to Charles Gray, M.D. (“Dr. Gray”), on September 10, 2012. Tr. at 262. She reported a constant, sharp pain in her left knee. Id. She also endorsed pain in her right knee, but indicated it was not as severe. Id. She reported a history of reactions to both Cortisone and Hyalgan injections. Id. Dr. Gray observed that Plaintiff's knee had near-full extension and flexed to 90 degrees. Id. He noted Plaintiff had no instability. Id. He observed medial and lateral tenderness, but indicated he could not determine if there was an effusion. Id. He discussed with Plaintiff the procedure and possible complications of knee replacement, and Plaintiff opted not to pursue it. Id. Plaintiff indicated she would try to reduce her weight. Id. Dr. Gray recommended she join a water exercise program and use Osteo Bi-Flex. Id. He prescribed a trial of Mobic. Id.

         On October 2, 2012, Plaintiff reported decreased appetite and having made dietary changes. Tr. at 277. She indicated she intended to participate in a water therapy program. Id. After Plaintiff removed her brace, Ms. Abbott observed Plaintiff to have some edema in her left knee. Id. She indicated Plaintiff had some tenderness medially, pain with flexion and extension, and 2 pitting edema in her left foot. Id.

         On November 6, 2012, Plaintiff reported having lost four pounds over the prior month despite the fact that she ate fatty foods while vacationing in Texas. Tr. at 276. Ms. Abbott indicated that Plaintiff was wearing a knee brace and that edema was evident when she removed it. Id. She observed Plaintiff to be tender medially, to have pain with flexion and extension, and to demonstrate 2 pitting edema in her left foot. Id. She noted Plaintiff was using Lortab sparingly. Tr. at 276.

         Plaintiff followed up with Ms. Abbott regarding her weight loss efforts on December 4, 2012. Tr. at 273. Ms. Abbott noted that Plaintiff had lost five pounds over the last month. Id. She observed Plaintiff to have no clubbing or edema and full ROM of her extremities, but noted some crepitus with knee flexion and extension. Id. Ms. Abbott indicated Plaintiff was no longer seeing her pain management provider and was taking Lortab sparingly. Tr. at 274.

         Plaintiff reported some improvement with use of anti-inflammatory medications on January 2, 2013. Tr. at 306. She complained of morning stiffness, but indicated she had lost approximately 20 pounds. Id. Dr. Gray encouraged Plaintiff to continue with weight reduction and exercise. Id. He refilled Meloxicam and advised Plaintiff to return in six months. Id.

         On January 4, 2013, Plaintiff indicated she had indulged over the holidays, but had not gained weight. Tr. at 271. She stated she intended to join a weight loss program, but was unable to afford it. Id. She continued to report knee pain. Id. She stated Meloxicam was helpful, but she could only take it at night because it made her sleepy. Id. She indicated she took Lortab only when her pain was “really bad.” Id. Ms. Abbott observed that Plaintiff weighed 348.60 pounds. Id. She noted Plaintiff had normal dorsalis pedis pulses, no clubbing or edema in her extremities, and full ROM. Id. However, she indicated Plaintiff demonstrated some crepitus with flexion and extension. Id. She continued Plaintiff's prescriptions for Phentermine, Lortab, and Meloxicam. Tr. at 272.

         On February 9, 2013, state agency medical consultant Frank Ferrell, M.D. (“Dr. Ferrell”), determined Plaintiff had the residual functional capacity (“RFC”) to occasionally lift and/or carry 10 pounds; frequently lift and/or carry 10 pounds; stand and/or walk for a total of two hours in an eight-hour workday; sit for a total of about six hours in an eight-hour workday; occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl; never climb ladders, ropes, and scaffolds; and should avoid concentrated exposure to hazards. Tr. at 63-65.

         On March 4, 2013, Plaintiff reported she was no longer able to tolerate Phentermine and had discontinued it during the prior month. Tr. at 297. Plaintiff weighed 350 pounds. Id. Ms. Abbott observed Plaintiff to demonstrated 5/5 motor strength in her bilateral upper and lower extremities; no clubbing; no edema; full ROM; crepitus with flexion and extension of her knee; a diffusely tender right trapezius; and pain in the anterior aspect of her right shoulder. Tr. at 297-98. She assessed tachycardia, morbid obesity, knee pain, depression, and shoulder pain. Tr. at 298. However, she noted that Plaintiff's tachycardia had resolved since she stopped taking Phentermine. Id. Ms. Abbott advised Plaintiff to control her portions and to continue positive dietary changes. Id. She noted Plaintiff continued to use Lortab sparingly, but refilled the medication. Id. She increased Plaintiff's dose of Meloxicam. Id. Plaintiff declined a prescription for an antidepressant medication. Id.

         On April 11, 2013, state agency medical consultant James Upchurch, M.D. (“Dr. Upchurch”), completed an RFC assessment and found that Plaintiff could occasionally lift and/or carry 20 pounds; could frequently lift and/or carry 10 pounds; could stand and/or walk for a total of two hours; could sit for a total of six hours during an eight-hour workday; could occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl; could never climb ladders, ropes, or scaffolds; should avoid concentrated exposure to extreme cold, extreme heat, and vibration; should avoid concentrated exposure to fumes, odors, dusts, gases, poor ventilation, etc.; and should avoid all exposure to hazards. Tr. at 73-76.

         On July 1, 2013, Plaintiff complained of pain in her knee and stated she was taking Meloxicam daily. Tr. at 305. Dr. Gray indicated Plaintiff had not lost any additional weight. Id. He observed Plaintiff to have edema in her legs and prescribed support stockings. Id. He advised Plaintiff to visit her family doctor for possible diuretics and to determine the effect of anti-inflammatory medications on her edema. Id. He encouraged Plaintiff to continue to work on losing weight. Id.

         Plaintiff presented to Courtney Burton, F.N.P. (“Ms. Burton”), on October 23, 2013, for a six-month follow up. Tr. at 318. She reported pain in her knee and lower back and difficulty with weight loss. Id. She indicated she took Lortab only when her pain was “really bad.” Id. She denied edema. Id. Ms. Burton observed Plaintiff to demonstrate 5/5 motor strength in her bilateral upper and lower extremities, 2 peripheral pulses bilaterally, no clubbing, trace edema to the bilateral lower extremities, full ROM, and crepitus with flexion and extension of the knee. Tr. at 319. She encouraged Plaintiff to maintain a healthy diet and to pursue water therapy. Id. She noted that Plaintiff continued to use Lortab “very sparingly.” Id. Plaintiff denied an exacerbation of depressive symptoms and indicated she felt like she was managing well. Id.

         On January 9, 2014, Plaintiff reported that her right knee was giving way and her left knee was locking more often. Tr. at 304. Dr. Gray noted some varus deformities and medial and lateral tenderness, but stated Plaintiff had good ROM and no instability. Id. He refilled Plaintiff's prescription for Meloxicam and indicated that her only option for relief was knee replacement. Id.

         On April 23, 2014, Plaintiff reported she had started Weight Watchers and was using a stationary bike for exercise. Tr. at 357. She continued to complain of low back and knee pain, but indicated that Meloxicam was helpful and that she took Lortab only when her pain was “really bad.” Id. She reported problems with increased thirst and facial hair, and Ms. Burton noted that her A1c was slightly elevated at her last visit. Id. Ms. Burton observed Plaintiff to have 5/5 motor strength in her bilateral upper and lower extremities; no clubbing; trace edema in the bilateral lower extremities; and normal peripheral pulses. Tr. at 358. She assessed non-insulin dependent diabetes mellitus and hirsutism. Id. She prescribed Cyclobenzaprine and Norco for back pain. Id.

         On May 6, 2014, Plaintiff requested that Ms. Burton complete disability forms. Tr. at 355. She complained of pain in her back and knees. Id. She stated she had recently attempted to clean her bathroom and was unable to move the next day. Id. Ms. Burton observed Plaintiff to have 5/5 motor strength in her bilateral upper and lower extremities; normal peripheral pulses; no clubbing; trace edema to the bilateral lower extremities; tenderness to palpation in the lumbar region; negative SLR test bilaterally; normal motor functioning; normal reflexes; and slowed gait. Tr. at 356. She continued Plaintiff's prescriptions for Lortab and Meloxicam and encouraged Plaintiff to lose weight and to engage in mild exercise. Id. Ms. Burton indicated work-preclusive restrictions in a medical source statement. Tr. at 323-25. She also indicated Plaintiff's impairments met the requirements for a finding of disability under Listing 1.02. Tr. at 326.

         Plaintiff presented to the emergency room at Self Regional Healthcare on June 8, 2014, with a complaint of back pain that radiated to her chest and neck. Tr. at 329. She was diagnosed with a gallbladder obstruction. Tr. at 332.

         On June 16, 2014, Plaintiff indicated she was still experiencing some nausea, but that Zofran was helpful. Tr. at 352. She complained of knee and low back pain, but indicated Meloxicam helped her knee pain and that she only took Lortab when her back pain was “really bad.” Id. Ms. Burton recorded Plaintiff's weight to be 324 pounds. Tr. at 353. She observed Plaintiff to have 5/5 motor strength in her bilateral upper and lower extremities; normal peripheral pulses; no clubbing; trace edema in the bilateral lower extremities; tenderness to palpation in the lumbar spine; negative SLR test; normal motor functioning; normal reflexes; and slowed gait due to weight and knee pain. Id. She refilled Plaintiff's prescriptions for Lortab and Meloxicam and encouraged her to engage in “mild exercise such as walking.” Id.

         On August 15, 2014, Plaintiff underwent laparoscopic surgery to remove her gallbladder. Tr. at 379.

         Plaintiff presented to Ronald M. Tollison, M.D. (“Dr. Tollison”), for an independent medical evaluation on August 29, 2014. Tr. at 390-91. She reported chronic pain in her back and knees, as well as swelling in her left knee. Tr. at 390. Dr. Tollison observed Plaintiff to ambulate with a limp favoring her left leg. Id. He stated she required assistance in getting on and off the exam table. Id. He noted Plaintiff had full ROM of her shoulders, elbows, fingers, and wrists. Id. He observed mild tenderness to palpation in her lower back. Id. Dr. Tollison indicated Plaintiff was unable to touch the floor with her hands or to do a knee squat. Id. He stated she had full ROM of her hips. Id. He observed her to have crepitation and swelling in both knees and noted her left knee was more swollen than her right with 1 edema. Id. Dr. Tollison indicated Plaintiff had 1 and symmetrical DTRs. Id. His diagnostic impressions were osteoarthritis of the knees with history of meniscal degeneration, morbid obesity, degenerative disc disease, polycystic ovarian disease, and status post-cholecystecomy. Id. He completed a medical source statement. Tr. at 392-94.

         C. The Administrative Proceedings

         1. The Administrative Hearing

         a. Plaintiff's Testimony

         At the hearing on September 26, 2014, Plaintiff testified that she had worked as a store manager at The Pantry for 18 years. Tr. at 36. She indicated she had stopped working because of problems with her knees and back and had been unable to return to work. Id. She stated she initially received short-term disability benefits and had subsequently withdrawn money from an individual retirement account (“IRA”) to cover living expenses. Tr. at 36-37. She testified she had stopped seeing her pain management physician because she could no longer afford the visits. Tr. at 51.

         Plaintiff stated she was unable to work because of problems with her lower back, bilateral knees, swelling in her legs, and obesity. Tr. at 37. She testified she was 5'5” tall and weighed 322 pounds. Tr. at 34. She stated that she had weighed as much as 362 pounds, but indicated her weight was generally around 320 pounds. Id. She described her knee pain as constant. Tr. at 37. She stated her pain was reduced, but was not completely relieved by elevating her legs. Id. She indicated she had previously been treated with Cortisone injections, but had experienced a severe allergic reaction and could no longer be treated with Cortisone. Tr. at 38. She stated she had received Silicone injections in her knees, but that they had only exacerbated her symptoms. Id.

         Plaintiff testified she experienced swelling in her lower extremities. Tr. at 47. She indicated she had to buy a larger shoe size and was unable to wear shoes with heels or laces because of swelling. Id. She stated her providers had prescribed compression stockings, but denied that they reduced her swelling. Id.

         Plaintiff testified that her medications lessened her pain, but did not eliminate it. Tr. at 42. She stated the medications reduced her concentration and that she ...


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