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Flores v. Colvin

United States District Court, D. Minnesota

October 6, 2014

Leticia P. Flores, Plaintiff,
Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant.

David F. Chermol, Esq., Chermol & Fishman, LLC, counsel for Plaintiff.

Ann M. Bildtsen, Esq., Assistant United States Attorney, counsel for Defendant.


JEFFREY J. KEYES, Magistrate Judge.

Pursuant to 42 U.S.C. §§ 405(g) and 1383(c), Plaintiff Leticia P. Flores seeks judicial review of the final decision of the Commissioner of Social Security ("the Commissioner"), who denied Plaintiff's applications for disability insurance benefits and supplemental security income. The parties have filed cross-motions for summary judgment. (Doc. Nos. 15, 17.) This matter has been referred to the undersigned for a Report and Recommendation pursuant to 28 U.S.C. § 636 and D. Minn. LR 72.1. For the reasons stated below, this Court recommends that Defendant's motion be denied; that Plaintiff's motion be granted; and that this matter be remanded to the Commissioner for consideration consistent with this Report and Recommendation.


I. Procedural History

Plaintiff filed a Title II application for a period of disability and disability insurance benefits and a Title XVI application for supplemental security income on August 4, 2010, alleging a disability onset of June 1, 2010. (Tr. 194-201.)[1] The Social Security Administration ("SSA") denied the applications initially and on reconsideration. (Tr. 84-89, 100-02.) Plaintiff requested a hearing before an Administrative Law Judge ("ALJ"), which was held on May 23, 2012. (Tr. 40.) On June 27, 2012, the ALJ issued a decision unfavorable to the claimant. (Tr. 10-22.) Plaintiff sought review of the ALJ's decision, but the Appeals Council denied her request for review on September 20, 2013. (Tr. 1-3.) The Appeals Council's denial made the ALJ's decision the final decision of the Commissioner. See 20 C.F.R. § 404.981.

On November 22, 2013, Plaintiff filed the instant action with this Court seeking judicial review pursuant to 42 U.S.C. §§ 405(g) and 1383(c). (Doc. No. 1.) The parties thereafter filed cross-motions for summary judgment. (Doc. Nos. 16, 18.)

II. Factual Background

Ms. Flores was born on January 31, 1975. (Tr. 44.) On the alleged disability onset date of June 1, 2010, she was 35 years old. ( Id. ) Plaintiff has an eleventh grade education and has not received her GED. (Tr. 46, 249.) Ms. Flores has taken English as a Second Language classes to improve her English skills. (Tr. 47, 300.) She was licensed as a Certified Nursing Assistant ("CNA") in 2001. (Tr. 249.) She has also worked as a CNA for Evangelical Lutheran Good Samaritan Center and Pelican Valley Health Center. (Tr. 204, 262-266.) Additionally, Ms. Flores was previously employed as a factory line worker at a turkey processing plant. (Tr. 249.) In her applications for disability and supplemental income, Plaintiff alleged disability due to obesity, bilateral carpal tunnel syndrome, reactive airway disease, headaches, elbow degenerative joint disease, anemia, diabetes mellitus, hysterectomy, and hypercholesterolemia. (Tr. 15-16.)

Medical History

The following is a summary of the relevant medical records found in the administrative record before the court.

Bilateral Carpal Tunnel Syndrome

In January 2010, Ms. Flores saw Dr. Julia Spina for pain in her right hand and wrist. (Tr. 354-56.) An examination of Plaintiff's hand and wrist did not reveal a specific cause or site of the discomfort. (Tr. 354.) In December 2010, Ms. Flores had her first carpal tunnel evaluation with Dr. Alan Williams. (Tr. 433.) During this evaluation, Dr. Williams recommended that Plaintiff get an electromyography ("EMG").[2] ( Id. ) The EMG was conducted on January 26, 2011 and showed moderately severe compression of the median nerve on the right hand and mild compression on the left. (Tr. 484-86.) On February 1, 2011, Ms. Flores complained of limited grip strength in both hands. (Tr. 486.)

On March 7, 2011, Plaintiff had open carpal tunnel surgery on her right hand. (Tr. 492.) Immediately following the surgery, Ms. Flores' hand was comfortable. ( Id. ) On March 17, 2011, Plaintiff had her sutures removed. (Tr. 522-25.) At that appointment, Ms. Flores reported pain at a level of 6 on a scale of 10. (Tr. 522.) During a follow-up appointment on April 5, 2011, Plaintiff had no complaints about her right hand, though she did state that she was experiencing some pain in her left wrist which interfered with her housekeeping, and she also had bilateral limitations on elbow movement. (Tr. 452.) Eight months after her right-hand surgery, Ms. Flores indicated to Dr. Williams that she was pleased with the results of the carpal tunnel surgery and that her tingling and nocturnal symptoms had disappeared, but she experienced shooting pains in her hand when driving, possibly a result of a very arthritic elbow condition. (Tr. 450.)

In January 2012, Carrie Affield, a physician's assistant and Plaintiff's primary care provider, opined, for the purposes of Ms. Flores' disability application, that Ms. Flores "will have difficulty with repetitive tasks, lifting, or fine movements" with her left hand due to "chronic arm issues and carpal tunnel on the left which cannot be repaired." (Tr. 549.) Chronic uncontrolled migraines were also referenced. ( Id. ) In a Physical Residual Functional Capacity Assessment conducted by way of medical records review in September 2010, a state agency consulting physician, Dr. Dan Larsen, stated that the claimant "should not do frequent pushing, pulling, gripping, grabbing, etc. with either upper extremity." (Tr. 391.)

In March 2012, Dr. Williams saw the Plaintiff with regard to left hand pain. He noted that she had a congenital deformity in both elbows that restricted forearm rotation, but for which no surgery was recommended. (Tr. 552.) She had symptoms in her left hand that troubled her daily, and carpal tunnel surgery was scheduled. ( Id. ) In April 2012, Ms. Flores had open carpal tunnel release surgery on her left hand. (Tr. 654.) During a follow-up appointment eight days after surgery, Ms. Flores' hand was comfortable and Dr. Williams did not anticipate any problems. ( Id. ) Further, Dr. Williams' noted that Plaintiff was gradually going to mobilize herself and realized it would take a few months to get her grip strength back. ( Id. )

On May 23, 2012, during her hearing with the ALJ, Ms. Flores stated that her left hand was the worse hand and that some puffiness and pain on the top of her hand were the primary problems with her right hand. (Tr. 49, 53-54.) Two days later on May 25, 2012, during a visit with Ms. Affield, Plaintiff complained of right hand pain and swelling. (Tr. 622-23.) On June 15, 2012, Ms. Flores again complained to Ms. Affield about right hand pain and swelling. (Tr. 629, 632.)

On July 16, 2012, Ms. Flores saw Dr. Stacey Smith with a primary complaint of severe left hand pain, but also reporting right hand pain, and daily migraines. (Tr. 640.) Dr. Smith's notes from that appointment indicate that Plaintiff's physical therapy for her right hand was helping, and accordingly, Dr. Smith prescribed physical therapy on both hands. ( Id. ) On July 24, 2012, Plaintiff again saw Ms. Affield, presenting complaints of continued swollen hands, bilateral hand pain, and loss of hand strength. (Tr. 645.) Pain medications were providing no relief. ( Id. )

Degenerative Elbow Joint Disease

In Plaintiff's December 9, 2010, visit to Dr. Williams in regards to carpal tunnel issues, Dr. Williams reviewed x-rays taken on July 20, 2010, which revealed advanced degenerative changes in both elbows. (Tr. 433.) The condition resulted in a loss of range of forearm rotation, but was diagnosed as a genetic joint malformation rather that degenerative arthritis. ( Id. ) Examination of Ms. Flores's elbows at the University of Minnesota Medical Center on April 5, 2011, revealed osteophytic spurring on the right elbow with otherwise no osseous abnormality. (Tr. 456.) The examination revealed some degenerative changes of her ...

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