Nelson v. Colvin

          ORDER ON PLAINTIFF’S SOCIAL SECURITY APPEAL

          SHEILA K. OBERTO, UNITED STATES MAGISTRATE JUDGE

         I. INTRODUCTION

         Plaintiff, Sheri L. Nelson (“Plaintiff”), seeks judicial review of a final decision of the Commissioner of Social Security (the “Commissioner”) denying her application for Disability Insurance Benefits (“DIB”) pursuant to Title II of the Social Security Act. 42 U.S.C. § 405(g). The matter is currently before the Court on the parties’ briefs, which were submitted, without oral argument, to the Honorable Sheila K. Oberto, United States Magistrate Judge.^[1]

         II. FACTUAL BACKGROUND

         Plaintiff was born on August 11, 1960, and alleges disability beginning on March 1, 2011. (Administrative Record (“AR”) 34; 230-43.) Plaintiff claims she is disabled due to chronic back problems, depression, and fibromyalgia. (See AR 93; 253; 266.)

         A. Relevant Medical Evidence

         On March 10, 2008, a thoracic spine x-ray revealed thoracic scoliosis (AR 346) and a cervical spine x-ray revealed degenerative changes including cervical disk space narrowing at C5-C6 and C6-C7 with hypertrophic spurring most pronounced posteriorly at C5-C6, left C5-C6 and C6-C7 neural foraminal narrowing, right C5-C6 neural foraminal narrowing, arthritic changes of the lateral masses, and curvature potentially indicating muscle spasm (AR 347). On June 19, 2008, Plaintiff had a magnetic resonance imaging study done of her lumbar spine which revealed multilevel degenerative disk and facet changes without central canal stenosis, mild foraminal narrowing as several levels, and multilevel spondylolistheses. (AR 344-45.)

         On May 13, 2010, Plaintiff saw family practitioner and pain management specialist Dr. Timothy Hooper, M.D., with pain in her low back, ankle, and hip as well as depression and an anxiety disorder. (AR 383-86.) She described the back pain as constant, chronic, and moderate in intensity and described feelings of worthlessness and a tendency toward indecisiveness. (AR 383.) Dr. Hooper noted Plaintiff enjoys gardening, reading, and shopping, practices yoga, and can bathe herself, clean the house, cook meals, dress herself, feed herself, drive a car, live independently, and converse in a meaningful manner, but cannot ride in public transportation. (AR 384.) On examination, Plaintiff appeared fatigued and in moderate pain, with a slowed gait, stiffness and pain with range of motion in the neck, pain with range of motion in the shoulders, hips, and ankles, crepitus in neck and ankles, and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 385-86.) Dr. Hooper diagnosed ankle pain, hip pain, and low back pain as well as depressive disorder, for which he prescribed baclofen and Norco. (AR 386.)

         On June 9, 2010, Plaintiff told Dr. Hooper that her pain had been increasing while at work, especially with job-related repetitive lifting, bending over, twisting, throwing, and pushing heavy objects. (AR 379.) She reported relief with heat, stretching, and narcotic pain medication. (AR 379.) Examination findings were unchanged and Plaintiff also presented with new positive straight leg raises, Hoover test, pelvic rock test, and Faber test. (AR 381-82.) Dr. Hooper refilled Plaintiff’s Norco and benazepril prescriptions. (AR 382.) On July 7, 2010, Dr. Hooper noted complaints of fatigue, hip pain, and low back pain, noted positive symptoms of depression and no symptoms of anxiety, feelings of stress, difficulty concentrating, or sleep disturbance, and refilled Plaintiff’s Norco prescription. (AR 377-78.) On August 2, 2010, Plaintiff reported that work had been “stressful” and that she was “very tired from working so hard, ” her pain was a little worse, and her medication was not helping. (AR 371.) Dr. Hooper refilled Plaintiff’s Norco and methadone medications (AR 374) and on August 27, 2010, Dr. Hooper also assessed Plaintiff with chronic pain, low back pain, fatigue, and depressive disorder. (AR 369.)

         On September 22, 2010, Plaintiff saw Dr. Hooper to discuss treatment with anti-depressants, having admitted to “severe depression” despite taking Effexor, Wellbutrin, and Deplin to treat her depressive symptoms. (AR 362.) On mental status examination, Plaintiff displayed an anxious and depressed mood and affect, with pressured speech, flight of ideas, circumstantial associations, worry about everything, and only fair judgment. (AR 364.) Dr. Hooper affirmed the diagnosis of depressive disorder and refilled her Deplin. (AR 365.)

         On October 20, 2010, Plaintiff reported ongoing problems at work and complained her low back pain, upper back pain, and depression continued despite medication. (AR 358.) Dr. Hooper refilled Plaintiff’s methadone and Norco medications and prescribed the muscle relaxant Flexeril to help treat Plaintiff’s chronic pain. (AR 361.) On November 17, 2010, Plaintiff reported that her medication was keeping her pain between a 4/10 and a 6/10, and reported that the “current pain relief makes a real difference for her” and noted “improvements in physical functioning, mood, sleep patterns, and overall function.” (AR 354.) Dr. Hooper refilled Plaintiff’s methadone and Norco prescriptions. (AR 357.) On December 13, 2010, Dr. Hooper noted Plaintiff was being seen for “generalized pain and fatigue, low back pain, upper back pain, and muscle aches, and depression” and admitted she was not doing exercises. (AR 349.) Plaintiff’s pain was worst in her lumbar spine, with radiation to her thighs. (AR 349.) She characterized the pain as “constant, moderate in intensity, dull, throbbing, and aching.” (AR 349.) The diagnoses of chronic pain, muscle aches, fatigue, and depressive disorder were affirmed, with methadone and Norco again refilled. (AR 352-53.) Dr. Hooper also noted the “muscle aches” were diagnosed two years prior by “the family doctor” due to “the presence of tenderness at specified tender points when pressure to the site is applied, symptoms present continuously for over 3 months, and pain present in all four body quadrants (upper and lower, front and back).” (AR 349.) Plaintiff described the intensity of these tender points as moderate and episodic but consistently worsening. Plaintiff reported that

. . . Primary joints affected include shoulders, right wrist, and ankles. Tender spots include entire back, both scapular regions, shoulders, the left, right, upper, mid, and lower posterior neck, left posterior hip, right, inner and left, inner knee, right, lateral and left, lateral elbow, shoulders, hands, and ankles. Associated symptoms include interrupted sleep, difficulty falling asleep, and poor sleep, myalgias described as throbbing, joint stiffness (for <30 mins after arising in the AM) and “gelling” of joints after periods of inactivity. . . . [Plaintiff] has tried ibuprofen, Hydrocodone, going to a chronic pain specialist (with fair results), relaxation therapy (with mixed effectiveness), and stretching exercises (with mixed effectiveness).

(AR 349-50.)

         On January 10, 2011, Dr. Hooper noted Plaintiff’s chronic, moderate pain continued, mostly localized to the neck, back, and bilateral thighs, and was aggravated by bending, lifting, movement in general, and walking. (AR 477.) On examination, Plaintiff was in mild pain and appeared tired; and had neck stiffness with decreased range of motion and crepitus, a slowed gait, pain on shoulder ranges of motion, back pain with flexion and extension, and pain with range of motion in both hips and ankles. (AR 479-80.) Dr. Hooper affirmed his diagnoses of chronic pain as well as low- and upper back pain, and refilled Plaintiff’s methadone and Norco. (AR 480.) At her February 2011 follow-up, Plaintiff requested a decrease in the methadone and reported it was making her “very sleepy at work.” (AR 473.)

         On March 2, 2011 Ms. Nelson saw osteopathic doctor Zuhra Musherraf, D.O., and reported being “very stressed and crying most of the time, ” being unable to “function, ” and having to leave work early. (AR 483.) She had an appointment scheduled with psychiatry the following week but felt she could not wait that long. (AR 483.) Although she was on Wellbutrin and Effexor, she asked for a change in her medications and to begin counseling. (AR 483.) Plaintiff’s appointment with psychiatry was rescheduled for the next day, and she saw psychiatrist Nancy Kenyon Nelson, M.D., on March 3, 2011. (AR 483; 490.) Plaintiff reported having had “a really hard time” at work the preceding week and told Dr. Kenyon Nelson she had been unable to work at all the preceding two days. (AR 490.) Plaintiff reported ongoing difficulties with her supervisor, crying episodes, and digestive issues due to her stress. (AR 490.)

         On mental status examination, Plaintiff exhibited fidgety behavior, very soft-spoken speech, an anxious and down mood, an anxious and dysphoric affect, distractibility, impaired concentration, an only “fair” fund of knowledge, insight, and judgment, and occasional impulsive spending. (AR 489.) Her score on the Patient Health Questionnaire-9 was consistent with “severe depression, ” with one response indicating that she had moments when “she wished God would take her” but denied specific suicidal ideation. (AR 489.) Her score on the Burns Anxiety Inventory was indicative of “severe anxiety.” (AR 489.) Dr. Kenyon Nelson adjusted Plaintiff’s dosages of Effexor, Zoloft, and Wellbutrin and recommended that she attend “work stress groups” and “anxiety groups” in the following weeks. (AR 490.) Dr. Kenyon Nelson diagnosed her with Major Depressive Disorder, recurrent, and Generalized Anxiety Disorder; with a GAF^[2] of 31 to 40, 2 indicative of “some impairment.” (AR 490.) On March 8, 2011, Dr. Kenyon Nelson noted that Plaintiff had not attended the work stress group or the anxiety group and was therefore noncompliant with their agreed treatment plan. (AR 503.)

         On March 2, 2011, workers’ compensation psychologist John Paul Beaudoin, Ph.D., stated that Plaintiff had a stable medical condition “not likely to improve with active medical or surgical treatment” supported by both “subjective complaints” and “abnormal examination findings.” (AR 199.) On March 24, 2011, Plaintiff was seen at Forest Road Prompt Care by Dr. Daniel C. Meador, M.D., requesting to be taken off work secondary to severe-job related anxiety. (AR 389.) Plaintiff was tearful, stating that her supervisor was creating such stress for her that she was “unable to function in the workplace.” (AR 389.) Dr. Meador noted, however, that he had spoken with Gilbert Silva, P.A., who had confirmed that Job Care believed that her anxiety was “nonindustrial” in nature. (AR 389.) Dr. Meador diagnosed Plaintiff with “anxiety, job-related” and prescribed one-week of Ativan and excused her from work for five days, advising her to follow up with mental health services. (AR 389.)

         On March 7, 2011, Plaintiff was off work on medical leave and complained to Dr. Hooper that she was “very stressed from work” and experiencing hip pain, neck stiffness, and anxiety. (AR 469.) Physical examination findings were unchanged, and psychiatric examination showed her to have an agitated, anxious mood and affect. (AR 471-72.) Dr. Hooper diagnosed generalized anxiety and in addition to renewing her methadone and Norco prescriptions, added a prescription for the muscle relaxant Soma. (AR 472.)

         From March 30 through May 12, 2011, Plaintiff saw psychologist Arlene Giordano, Ph.D., FICPP, on an approximately weekly basis in conjunction with her worker’s compensation claim due to workplace stress. (AR 422-27.) On March 25, 2011, Dr. Giordano opined Plaintiff would need to remain on stress leave from work through May 2, 2011 (AR 427) and on April 29, 2011, Dr. Giordano opined Plaintiff would need to take an additional six weeks stress leave from work (AR 424). On May 18, 2011, Plaintiff called to cancel her appointment and future appointments because her workers’ compensation claim had been denied. (AR 452.)

         On April 4, 2011, Dr. Hooper observed a slowed gait, pain with range of motion in the neck, shoulders, back, hips, and ankles, tenderness in the low back, posterior neck, and bilateral shoulders, and intact memory, attention, and concentration. (AR 467.) Dr. Hooper refilled Plaintiff’s Norco for hip pain and methadone for chronic pain syndrome, and noted Plaintiff was taking Zoloft and Wellbutrin for her psychiatric symptoms. (AR 465; 468.) Plaintiff reported that Norco and methadone had provided meaningful pain relief, with improvements in physical function, family relationships, and overall function, but not in social relationships, mood, or sleep patterns. (AR 465.) The medications were also causing constipation and fatigue. (AR 465.) Physical examination findings remained the same, with psychiatric examination showing an anxious and depressed mood and affect, pressured speech, flight of ideas, circumstantial associations, unreasonable worry about everything, and only fair judgment. (AR 468.) Dr. Hooper diagnosed Plaintiff with chronic pain syndrome, generalized anxiety, and insomnia in addition to hip pain and neck stiffness. (AR 468.)

         In May 2011, Plaintiff reported having “[t]rue panic attacks” in addition to generalized anxiety several times per week, with triggers including occupational stressors. (AR 457; 461.) Dr. Hooper refilled Norco and methadone for low back pain (AR 464) and at the end of the month, noted Sertraline, Soma, Wellbutrin, methadone, Norco, and Effexor and as current medications (AR 459).

         On July 15, 2011, Plaintiff’s pain index was three and she presented with a slowed gait, pain with range of motion in the neck, shoulders, back, hips, and ankles, and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 451-52.) Dr. Hooper stated that Plaintiff would pick up methadone for low back pain the following week. (AR 452.) Plaintiff had gained weight and reported ongoing low back pain, stiffness, and paravertebral spasm, depression, and hypertension. (AR 449.) Plaintiff reported a positive difference in her depression with the Cymbalta and asked to discontinue Norco. (AR 449). Dr. Hooper noted Plaintiff’s primary form of exercise was walking. (AR 449.) Physical examination findings remained unchanged. (AR 451-52.)

         On August 8, 2011, clinical psychologist John-Paul Beaudoin, M.Div., Ph.D., Q.M.E., performed a qualified medical evaluation on behalf of the state agency. (AR 407-12; 528-33.) Plaintiff related a “pattern of work stress and a hostile work environment created by the dysfunctional management style of her Supervisor” while working as a receptionist. (AR 402-03.) Plaintiff reported subjective complaints of sadness, anhedonia, failure, being overwhelmed, crying, social isolation, difficulty making decisions, diminished motivation, sleep disturbance, loss of appetite, loss of libido, and experiencing “pain throughout [her] body.” (AR 403.) Plaintiff did not finish high school, as she dropped out after becoming pregnant in the 10th grade. (AR 405.)

         Dr. Beaudoin noted Plaintiff was pleasant, cooperative, and apologetic, presenting with a sad and tearful mood; a somewhat constricted, mildly depressed affect; speech somewhat elevated in rate; oriented to time, place, person, and situation; non-verbal expressions indicating anxiety, shame, and distress; intermittent tearfulness; somewhat fast speech; vagueness in her descriptions of remembered events; and reports of having been depressed since her injury, with periods of sadness, tearfulness, anhedonia, guilt, self-recrimination, social isolation, decreased appetite, somatic complaints, and disturbed sleep; goal-oriented thought processes within normal limits; and no abnormal thought content, though she described having little life energy. (AR 413.)

         Dr. Beaudoin administered the Beck Anxiety and Depression Inventories, which were consistent with moderate depression but no anxiety disorder. (AR 414.) On the Minnesota Multiphasic Personality Inventory II (“MMPI-II”), Plaintiff achieved scores that were likely valid according to validity profiles that detect maladjustment and somatic complaint. (AR 415-16.) Her scores in the clinical scales were reflective of “significant psychological difficulties, ” with elevated depression and introversion scores. (AR 416.) Dr. Beaudoin also administered a Brief Symptom Inventory (“BSI”) test, on which Ms. Nelson’s scores were consistent with a moderate level of distress with multiple symptoms, evidence of self-recrimination, poor self-esteem, self-doubt, feelings of inadequacy, elevated depression, and intense social alienation. (AR 416.) Dr. Beaudoin diagnosed Plaintiff with Major Depressive Disorder, recurrent and moderate, with Axis II diagnoses of Passive Dependent Personality Traits, difficulty making everyday decisions and expressing disagreement, and fear of confrontation, all of which affect her ability to cope with conflictual work and interpersonal situations. (AR 417.) Dr. Beaudoin assessed Plaintiff with a GAF score of 55. (AR 417.) He found that Plaintiff’s psychiatric injuries “are not predominantly or substantially caused by the actual events of employment but are the culmination of a preexisting pattern of dysfunction and concurrent stressors.” (AR 418.) He found Plaintiff “temporarily totally disabled” on a non-industrial basis since March 3, 2011, but opined that she had not yet “reached permanent and stationary” disability status. (AR 418-20.)

         On August 18, 2011, Plaintiff saw Dr. Hooper for worsening symptoms of depression and a mood stabilizer was added to her medication regimen. (AR 444-48.) On September 15, 2011, Plaintiff reported continued low back pain, neck pain, and anxiety and reported that her depression was still uncontrolled despite taking Cymbalta, Wellbutrin, Effexor, and Zoloft. (AR 44; 443.) Dr. Hooper refilled Plaintiff’s Lorazepam prescription for her anxiety and added Depakote for her depression. (AR 445.) Plaintiff’s pain index was four. (AR 443.) Examination of Plaintiff’s back was grossly normal, including normal gait, but there was also some pain elicited by palpation. Plaintiff reported upper back pain, anxiety, and depression. (AR 444.)

         On October 18, 2011, Plaintiff’s pain index was three (AR 439) and Plaintiff had a slowed gait and pain with range of motion in the neck, shoulders, back, hips, and ankles (AR 439-40).

         Plaintiff reported she was still experiencing chronic pain radiating from her left neck to her upper back and left shoulder, and described the pain as “moderate in intensity, constant, cramping, pulling, and throbbing.” (AR 437.) Dr. Hooper prescribed Baclofen for low back pain. (AR 441.) On November 15, 2011, Dr. Hooper noted a slowed gait, pain with range of motion in the neck, shoulders, back, hips, and ankles, and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 435; 546.) Dr. Hooper refilled Plaintiff’s prescription for methadone and prescribed Cymbalta for her low back pain, refilled Baclofen for her neck pain, and refilled Lorazepam for her anxiety. (AR 436; 546-47.) Dr. Hooper noted Plaintiff’s fatigue was currently “quite severe in intensity” but that there were “no problems with initiation or maintenance of sleep” and that the amount of sleep Plaintiff got each night was “quite variable.” (AR 433.) Her methadone, Cymbalta, Baclofen, and Lorazepam prescriptions were all refilled. (AR 436.)

         On December 13, 2011, Dr. Hooper noted a slowed gait, pain with range of motion in the neck, shoulders, back, hips, and ankles, tenderness in the low back, posterior neck, and bilateral shoulders, and intact memory, attention, and concentration. (AR 432; 551.) He refilled Plaintiff’s prescription for methadone for her low back pain, refilled Baclofen for her neck pain, prescribed Lorazepam and Zoloft for her anxiety, added a prescription for Doxycycline, and noted she was currently also taking Effexor. (AR 431-32.) Dr. Hooper noted Plaintiff’s physical health was contributing to her anxiety. (AR 429.) Her physical examination findings remained unchanged, and she again showed an anxious and depressed mood and affect with pressured speech, flight of ideas, circumstantial associations, abnormal worry, and fair judgment. (AR 432.)

         On January 10, 2012, Dr. Hooper noted Plaintiff was taking methadone, Norco, Flexeril, and Baclofen for pain and Zoloft, Deplin, Lorazepam, and Effexor for her mental health. (AR 599.) Plaintiff’s pain index was four and she demonstrated a slowed gait, pain with range of motion in the neck, shoulders, back, hips, and ankles, and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 599-600.) Plaintiff complained of stiffness, paravertebral spasm, leg weakness, interrupted sleep, difficulty falling asleep, throbbing myalgias, joint stiffness for up to half an hour in the mornings, fatigue, anxiety, and depression. (AR 597.) Examination revealed an anxious and tired appearance, looking to be in moderate pain; neck stiffness with decreased ranges of motion and crepitus; a slowed gait; painful ranges of neck motion; pain in the shoulder and back ranges of motion; tenderness in the low back, posterior neck, and bilateral shoulders; and an anxious mood and affect. (AR 600.) Dr. Hooper diagnosed Plaintiff with fibromyalgia, neck and low back pain, and fatigue, and continued her on methadone, Baclofen, and lorazepam. (AR 600.)

         On February 14, 2012, Dr. Hooper noted Plaintiff’s pain index was three and observed a slowed gait; pain with range of motion in the neck, shoulders, back, hips, and ankles; and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 595.) Plaintiff reported experiencing an anxious mood, appetite changes, altered sleep habits, crying spells, decreased concentration, and fatigue, all of which were frequent and present most days. (AR 592.) Examination revealed pain to palpation of several identified regions of the body; decreased deep tendon reflexes; diminished muscular strength in the quadriceps and gluteal muscles; as well as the continued findings yielded on prior examination. (AR 594-95.) Dr. Hooper refilled Plaintiff’s prescriptions for methadone for low back pain and Lorazepam for anxiety, and prescribed Zyprexa for depression. (AR 595-96.)

         On March 21, 2012, Plaintiff’s pain index was three and Dr. Hooper observed a slowed gait; pain with range of motion in the neck, shoulders, back, hips, and ankles; and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 590-91.) He refilled methadone for low back pain and Lorazepam for muscle spasms. (AR 591.) On July 24, 2012, Plaintiff complained of abdominal pain, low back pain, anxiety, and depression and reported a pain index of four. (AR 584; 586.) On examination, Plaintiff’s back was grossly normal and she had a normal gait, but palpation of the bilateral cervical, thoracic, and lumbar paraspinal muscles, bilateral gluteus muscles, and bilateral posterior superior iliac crest elicited some pain and spasm was noted in her bilateral cervical, thoracic, and lumbar paraspinal muscles. (AR 586-87.) Dr. Hooper refilled Plaintiff’s prescriptions for methadone for low back pain and Lorazepam for anxiety. (AR 587.) On August 29, 2012, Plaintiff told Dr. Hooper that she had been decreasing her methadone over the past month from five doses a day to two or three doses a day, and stated that she would like to discuss tapering off methadone entirely. (AR 583.)

         On September 18, 2012, Plaintiff presented with continued symptoms of fibromyalgia and moderate depression and anxiety, complained of a pain index of three, and was observed to have a slowed gait; pain with range of motion in the neck, shoulders, back, hips, and ankles; and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 581.) Dr. Hooper refilled Plaintiff’s methadone for her pain and added Trazadone for her fatigue. (AR 581-82.) Plaintiff reported averaging 12 hours of sleep per night. (AR 578.) On October 12, 2012, Plaintiff reported having to take an extra methadone for a couple of days “due to severe back [pain] after cleaning a friend[’]s house” and was given a new prescription. (AR 577.)

         On November 20, 2012, Plaintiff presented to Dr. Hooper with complaints of anxiety, depression, insomnia, and fibromyalgia (AR 572), and Dr. Hooper added a diagnosis of osteoarthritis of the hand (AR 576). On examination, Plaintiff’s back was grossly normal and she presented with normal gait, but there was also some pain elicited by palpation. (AR 575.) Dr. Hooper refilled methadone for fibromyalgia, Trazadone for insomnia, and Lorazepam for anxiety, and, for low back pain, recommended alternating cold packs and moist heat, massage, and home back strengthening exercises. (AR 576.)

         Dr. Hooper also completed a fibromyalgia questionnaire based on his own treatment history, Plaintiff’s past radiological and magnetic resonance imaging (MRI) findings, and her tenderness, pain, and depression complaints. (AR 554-59.) Dr. Hooper opined Plaintiff meets the American College of Rheumatology criteria for fibromyalgia and shows evidence of multiple tender points, non-restorative sleep, chronic fatigue, morning stiffness, muscle weakness, subjective swelling, irritable bowel syndrome, temporo-mandibular joint dysfunction, numbness and tingling, anxiety, panic attacks, depression, and chronic fatigue syndrome. (AR 555.)

         Dr. Hooper further opined that emotional factors contribute to the severity of her symptoms and functional limitations, that her impairments frequently interfered with her attention and concentration, and that she is not a malingerer. (AR 555-56.) Dr. Hooper opined that Plaintiff is markedly limited in her ability to handle stress and, in a competitive work environment, she could sit or stand no more than 15 minutes at a time and for less than a total of two hours each; that she needs to walk every 15 minutes for 10 minutes each time; that she needs to be able to change positions frequently for 15- to 30-minute periods; that she could lift or carry up to 10 pounds occasionally and no weight frequently; that she has significant limitations in performing repetitive reaching, handling, or fingering; that she is likely to miss work more than three times per month; and that she would be “ok to work 2 h[ou]rs per day over [an] 8-h[ou]r period.” (AR 556-58.) Dr. Hooper listed May 13, 2010, the date he began treating Plaintiff, as the earliest date the identified limitations would apply. (AR 559.) Dr. Hooper also apparently had trouble with the questionnaire, first seeming to write a date in 2010, then crossing it out and dating it instead November 20, 2012, and writing one street address, then crossing it out and listing another. (See AR 559.) The handwriting in the questionnaire itself also appears to be different than the printing used on the last page to fill in Dr. Hooper’s name and address. (Compare AR 554-58 with AR 559.)

         In a letter dated November 21, 2012, Dr. Hooper noted he had treated Plaintiff since May 2010 for osteoarthritis, fibromyalgia, and chronic pain syndrome that caused symptoms of severe joint pain, back pain, neck pain, bilateral hip pain, severe muscle spasms, and moderate depression. (AR 553.) Dr. Hooper opined that “the sum of the impairments of the above diagnoses result in a disability rating precluding most if not all work.” (AR 553.)

         On November 27, 2012, Plaintiff called to follow-up about a letter needed for her disability hearing and to report an increase in her methadone usage due to an increase in pain possibly related to stress and the fact that she was moving. (AR 571.) On January 16, 2013, Plaintiff was seen for ongoing depression, osteoarthritis of moderately severe intensity, continued low back pain with stiffness and spasm, and fibromyalgia. (AR 566.) She continued to experience impaired sleep, myalgias, and a “gelling” of her joints after periods of inactivity. (AR 566.) Plaintiff reported to Dr. Hooper that hydrocodone, administered by a pain specialist, had only impaired “fair results” and relaxation therapy and stretching had provided “mixed effectiveness.” (AR 566.) Dr. Hooper diagnosed moderate depression and generalized anxiety, low back pain, and fibromyalgia; added Seroquel to Plaintiff’s Lorazepam regimen; recommended avoidance of caffeine and stress reduction to help with Plaintiff’s anxiety; recommended alternating cold packs and moist heat, massage, and home back strengthening exercises for Plaintiff’s back pain; and recommended increased physical activity, a support group, no substance abuse, and social interaction to treat Plaintiff’s moderate depression. (AR 569-70.) For hypertension, he recommended avoiding licorice and pseudoephedrine or other stimulants/decongestants in common cold remedies; decreasing consumption of alcohol; routine monitoring of blood pressure; having someone monitor Plaintiff for loud snoring or sleep apnea; exercise; reduction of dietary salt intake; taking medication as prescribed; smoking cessation; weight loss; and stress reduction. (AR 569-70.)

         On March 13, 2013, Plaintiff saw Dr. Hooper for constipation and wrist and neck pain. (AR 562.) Dr. Hooper observed a slowed gait; pain with range of motion in the neck, shoulders, back, hips, and ankles; and tenderness in the low back, posterior neck, and bilateral shoulders. (AR 565.) Dr. Hooper prescribed Flexeril for neck pain and refilled methadone for fibromyalgia and Lorazepam for depression. (AR 565.) Plaintiff’s medications were refilled in May 2013 (AR 615-16) but in July 2013, Dr. Hooper substituted morphine for the methadone (AR 611-12). Dr. Hooper refilled Plaintiff’s morphine prescription in August 2013 for her persistent fibromyalgia and low back pain. (AR 620-21.)

         In a letter dated July 30, 2013, Dr. Hooper again reported he had treated Plaintiff for fibromyalgia, osteoarthritis, and chronic pain syndrome since May 2010. (AR 618.) Dr. Hooper reported Plaintiff experienced severe joint pain, back pain, neck pain, bilateral hip pain, severe muscle spasms, and moderate depression as a result of her impairments, and displayed multiple positive tender points, poor sleep and chronic fatigue, morning stiffness, muscle weakness, numbness and tingling, anxiety, panic attacks, and chronic fatigue syndrome. (AR 618, ) Dr. Hooper noted Plaintiff “experiences pain in the lumbosacral, thoracic, and cervical spine; left shoulder, right arm, and bilateral hands and fingers; and in the hips, legs, knees, ankles, and feet” and that the pain is worsened by “movement, overuse, stress, and specific positions.” (AR 618.)

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Dr. Hooper&rsquo;s opined limitations were largely consistent with the sitting, standing, and walking limitations of his November 2012 opinion. (AR 618; see also AR 554-59.) Dr. Hooper opined Plaintiff is unable to sit or stand for more than 15 minutes at a time, for a total of less than two hours each of sitting, standing, or walking in an eight-hour workday; that she is unable to lift more than 20 pounds; that she could lift no more than 10 pounds on an occasional basis; and that she is “significantly limited” in her ability to perform fine or gross manipulations or use her arms to reach. (AR 618.) Dr. Hooper opined Plaintiff’s pain was “severe enough to interfere with her attention and concentration on a ...