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Gurzenda v. Saul

United States District Court, N.D. California

September 25, 2019

ANDREW SAUL, Defendant.




         Plaintiff Angelina Gurzenda brought this action seeking judicial review of the final decision of Defendant Andrew Saul, Commissioner of Social Security (the “Commissioner”) denying Gurzenda’s application for supplemental security income under Title XVI of the Social Security Act. Gurzenda argues that an administrative law judge (the “ALJ”) committed reversible error when she failed to address Gurzenda’s psychosis within the listings, failed to fully develop the record, and failed to address non-exertional limitations. The parties have filed cross motions for summary judgment pursuant to Civil Local Rule 16-5. For the reasons stated below, Gurzenda’s motion is GRANTED, the Commissioner’s motion is DENIED, and the case is REMANDED for further administrative proceedings in accordance with this order.[1]


         A. Procedural History

         On July 6, 2016, Gurzenda applied for supplemental security income for her alleged disability beginning on May 26, 2016.[2] Administrative Record (“AR, ” dkt. 14) at 285. This is Gurzenda’s third time applying for Supplemental Security Income. She applied previously on July 31, 2005 and on October 30, 2014; both of those applications were denied. The prior unfavorable decision for Gurzenda’s 2014 application was on May 25, 2016, a day before the onset date for this current application.

         Gurzenda’s present application was initially denied on November 22, 2016, and denied upon reconsideration on January 23, 2017. Id. at 129, 146. Gurzenda filed a written request for a hearing before an ALJ on January 31, 2017. Id. at 183. A hearing was held on June 27, 2017, in San Jose, California. Id. at 30–64. Gurzenda was represented at the administrative hearing by Timothy Reed, an attorney, but Reed no longer represents her before this Court on appeal. See Id . at 30; see generally Gurzenda’s Mot. (dkt. 23). Impartial vocational expert Robert Raschke, M.Ed., (“VE Raschke”) also appeared by telephone and testified at the hearing. AR 30. On September 20, 2017, the ALJ issued an unfavorable decision, finding that Gurzenda was not disabled under § 1614(a)(3)(A) of the Social Security Act. See Id . at 15–24. Gurzenda requested review of the ALJ’s decision, which the Social Security Administration Appeals Council denied on December 20, 2017, as it “found no reason under [its] rules to review the [ALJ’s] decision.” Id. at 1–3. Gurzenda filed a complaint on January 22, 2018, seeking judicial review by this Court. Compl. (dkt. 1) at 2. Pursuant to Civil Local Rule 16-5, Gurzenda filed a motion for summary judgment, and the Commissioner filed a cross-motion for summary judgment. See Gurzenda’s Mot.; Comm’r’s Mot. (dkt. 29).

         B. Gurzenda’s Background

         1. Personal History

         Gurzenda is fifty-four years old. AR at 557. She was born and raised in Palo Alto, California, but now resides in San Jose, California. Id. at 479. Gurzenda is currently homeless. Id. at 371. She attended school until the twelfth grade and has a high school diploma. Id. at 325. Gurzenda spent three years in federal prison for “various offenses.” Id. at 479. She is currently unemployed, and her main source of income is food stamps in the amount of $150 per month. Id. at 479. Gurzenda reports that she does not take care of anyone else. Id. at 372. She has never been married, and she has five children. Id. at 465. Gurzenda’s youngest child is 17 years old and currently lives in foster care. Id.

         2. Medical History

         Gurzenda’s claim for disability is based primarily on her Morgellons Disease, which, according to her statement to a doctor, was diagnosed in 2011 at Santa Clara Valley Medical Clinic. See Id . at 436. Morgellons Disease, or “Delusional Parasitosis, ” is a mental disorder that “causes [Gurzenda] to believe that there are bugs or other microscopic pathogens [under her skin] causing her very distressing physical symptoms.” Id. at 453.[3] She believes the disease either started about seventeen years ago when her landlord “was putting black mold into her water supply, ” or that “she likely contracted [Morgellons] from a tick about [eighteen] years ago.” Id. at 432, 464. Gurzenda reports in her application that she “really ha[s] something growing on [her] head [like] a parasite, ” which feels like “its going to [her] brain” and causes constant, severe pain in her head. Id. at 378.

         Gurzenda has a history of substance abuse as well as other mental health issues. See Id . at 70, 80–81. She admitted to previously using methamphetamine but states that she has been sober since 2014. Id . at 70. Gurzenda also spent time in prison for offenses relating to controlled substances. Id. While incarcerated, she began to experience psychiatric symptoms, such as depression and post-traumatic stress. Id. at 80–81, 464. These symptoms have gotten worse due to her Morgellons and the current stressors of being homeless and unemployed. Id. at 464.

         a. Reza Kafi, M.D.

         On September 29, 2015, Gurzenda went to see Reza Kafi, M.D., for a dermatology visit for her Morgellons. Id. at 514. Dr. Kafi reported that Gurzenda requested a biopsy of her scalp and said “[i]f [she doesn’t] do the biopsy today, there will be problems.” Id. Dr. Kafi further stated Gurzenda knows she has Morgellons, but she wants “a biopsy to see what is wrong in the area.” Id. Gurzenda told Dr. Kafi “that [her] hair has [a] firm cord that wraps around [her] postauricular scalp and around [her] ear, causing [a] crease in [the] earlobe, and causing pain” and that she “feel[s] like [she’s] dying from this.” Id. Dr. Kafi concluded the results from the physical skin exam showed there were no “fibers” coming from Gurzenda’s scalp. Id. at 516. Dr. Kafi stated Gurzenda “has a fixed delusion” and that “this is NOT A PRIMARY SKIN PATHOLOGY, [she] needs mental/behavioral health help with this issue.” Id. at 517. However, before Dr. Kafi could provide her with a referral and paperwork, Gurzenda “abruptly left the clinic.” Id. at 516.

         b. Asian Americans for Community Involvement: Social Worker Visits

         Asian Americans for Community Involvement, a non-profit organization that provides healthcare services, appears to be where Gurzenda’s receives most of her medical care. Her psychiatrist and social workers are employed here. Their records also provide the strongest support for her disability claim.

         In a letter sent to social services on August 12, 2016, Jenny Kim, MSW, wrote that Gurzenda “received rehabilitation therapy twice per month since May 13, 2016 with a former therapist, and has been scheduled with bi-weekly sessions with [a] counselor since August 12, 2016.” Id. at 454. Jenny Kim sent a second letter to social services on September 2, 2016 which was co-signed by Kao Saechao, LCSW. Id. at 461. They again reiterated that Gurzenda “had received treatment” and that she was diagnosed with “[p]sychotic disorder with delusions due to known physical condition, ” “inadequate housing, ” and “problem related to social environment, unspecified.” Id.

         On April 5, 2017, Gurzenda had an appointment with Kyong Ohk Kim, ASW, and Mio Hidaka, LCSW, to talk about her goals moving forward to help her cope with her Morgellons. Id. at 540. They recorded “[f]or the next 6 months, [Gurzenda] will practice mindfulness meditation” and “attend individual therapy session[s] bi-weekly to regulate her symptoms” with the desire for Gurzenda to be “less anxious about [her] Morgellons disease and [to] enjoy[] daily activities.” Id. Kyong Kim and Hidaka stated that Gurzenda “continues . . . having pains and symptom (e.g., depressive mood and anxiety, easily tired, and agitated, and pain in her ear and body, paranoid about her disease) which are a result of her diagnosis of Morgellons disease” and that her homelessness “makes [it] difficult to manage her symptoms.” Id. They concluded that Gurzenda “has strong interests [in] taking care of her pain and [is] very independent and resilient.” Id.

         c. Leena Khanzode, M.D.

         Gurzenda has seen Leena Khanzode, M.D., who appears to be her primary doctor, several times since she applied for supplemental security income. First, on August 17, 2016, Gurzenda went to see Dr. Khanzode for a psychiatry assessment. Id. at 534. Dr. Khanzode reported Gruzenda told her she “feels a crawling and burning sensation in her head and that a dark growth matter is coming out of her head.” Id. Gurzenda also told Dr. Khanzode that she feels “‘something [is] moving around’ on [the] back of her head, and [that] something is growing inside [her] ear, its [sic] long and keeps moving.” Id. Gurzenda told Dr. Khanzode that she is “not crazy” and that the “doctors that she has gone to have not helped her.” Id. Dr. Khanzode wrote that Gurzenda believes “her case has ‘fallen through the cracks’” and that she is getting “worse and worse.” Id. Dr. Khanzode recorded Gurzenda’s symptoms as “feeling depressed because she has not been well, low energy, conc[entration] is poor, anhedonia, does not feel well to do activities, sleep is not so good, DFA, appetite is ok, no SI/HI.” Id. She also wrote that Gurzenda is under increased stress as she has “no job” and “no place to live.” Id. As Gurzenda reported running out of medication a month earlier, Dr. Khanzode prescribed Gurzenda Zyprexa and Prozac to take daily in hopes of relieving her pain and anxiety. Id. at 534, 536.

         On October 5, 2016, Gurzenda went to see Dr. Khanzode for a follow-up appointment. Id. at 537. Once again, Dr. Khanzode reported Gurzenda “has been feeling depressed because she has not been well, low energy, conc[entration] is poor, anhedonia- does not feel well to do activities, sleep is not so good, DFA, appetite is ok, no SI/HI.” Id. Dr. Khanzode also mentioned Gurzenda “stated she has bodyache, esp[ecially] her feet, ” that she “has been anxious recently, ” and that “wanted to leave early from this visit as she was in pain.” Id. Dr. Khanzode reported Gurzenda had “stopped Zyprexa as it was too sedating, ” so she increased her Prozac prescription and restarted her on Zyprexa at a decreased dosage. Id. at 537–38.

         On April 5, 2017, Gurzenda went to see Dr. Khanzode again for her “delusional parasitosis.” Id. at 543. Dr. Khanzode reported Gurzenda “is less depressed, crying less, energy is low, angry, anhedonia, sleep is restless, appetite is too good, gaining weight, no SI/HI.” Id. She noted that Gurzenda “believes she has the M[orgellons] syndrome and now wants a biopsy.” Id. Dr. Khanzode found “no significant change” in her mood, thought process, motor activity, behavior, or medical condition since her last visit. Id. Dr. Khanzode “encouraged [Gurzenda] to exercise and eat healthy, ” told her to continue Prozac, and increased her Zyprexa prescription back to its original strength. Id. at 544.

         On June 15, 2017, Dr. Khanzode reported Gurzenda was “depressed, irritable, crying easily, energy is low, angry, anhedonia, sleep is restless, appetite is too good, gaining weight, no SI/HI.” Id. at 557. Dr. Khanzode wrote there was a “notable change” in Gurzenda’s mood from her last visit and she seemed more depressed. Id. at 558. Dr. Khanzode believed this change was a result of Gurzenda feeling “overwhelmed after she lost her client who she was living with.” Id. However, Dr. Khonzode noticed “no significant change” in her thought process or behavior. Id. She increased Gurzenda’s Prozac dosage and told her to continue with Zyprexa. Id.

         On March 1, 2017, Dr. Khanzode sent a letter to the Social Security office. Id. at 554. She wrote that “Gurzenda suffers from a Psychotic Disorder and is being treated with medications for the same.” Id. Dr. Khanzode continued that “[d]ue to her psychiatric illness she may not [be] able to work fulltime and her prognosis is guarded.” Id.

         d. Ralph H. Wood, M.D.

         On October 5, 2016, Ralph H. Wood, M.D., performed an internal medicine evaluation. Id. at 473. This was a consultative examination arranged by the Department of Social Services. Id. at 472. Dr. Wood reported that Gurzenda’s chief complaints at this exam were her depression and Morgellons. Id. at 473. She told to Dr. Wood that she had “been depressed for many years.” Id. Dr. Wood also reported that Gurzenda said she has been seeing “a psychiatrist for at least five years” and that “[c]urrently she sees her psychiatrist once a month and a therapist every two weeks.” Id. In terms of physical pain, Dr. Wood wrote “she complains of numbness and tingling and itching in her head particularly in the posterior aspect”; however, “[w]hen [Dr. Wood] looked at the scalp it appeared normal to [him].” Id. Dr. Wood concluded that Gurzenda’s head pain is “probably related to her mental problems and depression” and not a physical impairment. Id.

         Dr. Wood also completed a physical examination of Gurzenda and discovered no major issues. Id. at 474. In Dr. Wood’s functional capacity assessment, he determined Gurzenda “can stand and/or walk for six hours out of an eight-hour shift” and that he found “no limitations on sitting.” Id. at 475. Dr. Wood also found that Gurzenda “can regularly lift, push, or pull up to 20 pounds and occasionally 30 pounds” and that she had “no hand movement or fine finger limitations.” Id. If she had any limitations, Dr. Wood believed they would be on a “psychiatric basis.” Id. Dr. Wood’s impression of Gurzenda from the visit was that she may have “[c]hronic psychosis with itching in scalp” and “[p]ossible Morgellons syndrome.” Id.

         e. Jeremy Blank, Psy.D.

         On October 11, 2016, Gurzenda visited Jeremy Blank, Psy.D., for a psychological evaluation. Id. at 478. This was another consultative exam arranged by the Department of Social Services. Id. at 477. Dr. Blank reported that Gurzenda stated she “had Morgellan’s [sic] disease for 17 years” and that she was “diagnosed with bipolar disorder about 10 years ago, and . . . developed PTSD from experiences while in prison several years back.” Id. at 478. He reported that Gurzenda is “currently being treated by a psychiatrist and a mental health therapist” and that she is currently taking medications and responding “positive[ly]” to them. Id. at 479. As Dr. Blank had “no medical records available for review, ” he had to rely on Gurzenda’s testimony of her medical history. Id. at 478. Dr. Blank said her current symptoms included “poor sleep, frequent worry and anxiety, and depression” and that her current homelessness “adds to her level of stress and worry.” Id.

         As part of the appointment, Dr. Blank conducted a mental status examination. Id. at 479. He reported that Gurzenda appeared “well groomed with good hygiene, ” was “cooperative, ” her motor activity was “intact, ” she had “good” eye contact, “coherent” speech, and seemed “alert.” Id. Dr. Blank also stated that Gurzenda scored a “25 out of 30” on a “mini mental status exam, ” which tests things such as “arithmetic, memory and orientation” and is normally used “to screen for dementia.” Id. at 480. This score fell within the “normal” limits and Dr. Blank reported “[s]he had no difficulty following simple or complex directions” and that her concentration and attention was “unimpaired.” Id. at 479–80. Dr. Blank also found that Gurzenda’s judgment and insight received “fair” marks, and her thought process was “intact” and “linear and logical.” Id. at 480. However, he noted Gurzenda was “impaired” with calculations as she was “unable to complete all serial 7’s, ” and that her memory was also “mildly impaired” as she “recalled 3 out of 3 items immediately and 2 of 3 words after a brief delay with inference.” Id. at 479–80. Dr. Blank also found that her mood was “hypomanic” and there was “some suggestion of delusion material.” Id. at 480. He determined she was emotionally “[m]oderately to severely impaired due to a variety of mental health struggles” and was also “[m]oderately to severely impaired” functionally. Id. at 481. Dr. Blank’s diagnostic impressions were that Gurzenda had “[b]ipolar I disorder, most recent episode manic, moderate” and he assessed “rule out” diagnoses[4] of “[p]ost traumatic stress disorder” and “unspecified schizophrenia spectrum and other psychotic disorder.” Id.

         Since this examination was requested by the Department of Social Security, Dr. Blank also completed a “work related abilities and impairments chart” where he listed what he believed Gurzenda’s level of impairment would be with respect to various work-related skills. Id. Dr. Blank’s responses were as follows: (1) Gurzenda’s ability to follow simple instructions was “unimpaired”; (2) her ability to follow complex or detailed instructions was “mildly impaired”; (3) her ability to maintain adequate pace or persistence to perform one or two step simple repetitive tasks was “unimpaired” and for complex tasks was “mildly impaired”; (4) her ability to maintain adequate attention and concentration was “moderately impaired”; (5) her ability to adapt to changes in job routine was “moderately impaired”; (6) her ability to withstand the stress of a routine workday was “mod[erately]-sev[erely] impaired”; (7) her ability to interact appropriately with co-workers, supervisors, and the public on a regular basis was “mod[erately]-sev[erely] impaired”; and (8) her ability to adapt to changes, hazards, or stressor in a workplace setting was “mod[erately]-sev[erely] impaired.” Id.

         f. Veena Gowra, M.D.

         On December 15, 2016, Gurzenda went to see Veena Gowra, M.D., for “ear pain and [for] Morgellons disease.” Id. at 517. Dr. Gowra reported that Gurzenda was “alert and oriented, no apparent distress” and had a “slightly scaly rash of the lobule, other wise . . . normal.” Id. at 518. She ran a few tests, and nothing came back physically abnormal regarding her Morgellons. See Id . at 519–26. Dr. Gowra mentioned that Gurzenda again “request[ed] a referral to Dermatology for a biopsy of her scalp” due to the pain in her head from Morgellons. Id. at 517. Dr. Gowra granted that request and gave her ointment for her ear. See Id . at 518–19.

         On June 20, 2017, Gurzenda saw Dr. Gowra for “pain” from hypertension and stress. Id. at 562–63. The medical record from the visit is rather short, but it appears Dr. Gowra may have prescribed her additional medication to help with the increased pain. Id. That same day Dr. Gowra also wrote a letter to the Social Security office. Id. at 561. It contained two sentences and stated that Dr. Gowra was “certify[ing] that Gurzenda, Angelina is eligible for permanent disability” and to contact her if there are “any other questions.” Id. Dr. Gowra also filled out a “general assistance program” form for Gurzenda as well, identifying Morgellons as the reason for Gurzenda’s disability. Id. at 560. Dr. Gowra checked boxes saying there would be a “significant restriction of activities of daily living” and “significant deficiencies of concentration, persistence or pace” because of Gurzenda’s Morgellons. Id. She also checked that Gurzenda is “incapable of low stress jobs, ” that she feels Gurzenda is “permanently disabled/ unable to work, ” and that she supports Gurzenda pursuing a disability claim. Id. Dr. Gowra wrote that the “objective evidence” of Gurzenda’s limitations was from a “physical evaluation” she had done of Gurzenda. Id.

         g. S. Khan, M.D.

         S. Khan, M.D., a state agency consultant, reviewed Gurzenda’s medical records in November 2016 and found that she suffered from the following medically determinable impairments: affective disorders (primary, non-severe); schizophrenic, paranoid and other functional psychotic disorders (secondary, non-severe); fibromyalgia (other, non-severe); and dermatitis (other, non-severe). Id. at 139. Dr. Khan considered Listing 12.03 (schizophrenic, paranoid and other functional psychotic disorders) and 12.04 (affective disorders) and found none of Gurzenda’s medically determinable impairments satisfied the “paragraph A” criteria for either Listing. Id. at 140. Dr. Khan also evaluated whether any of Gurzenda’s impairments satisfied the “paragraph B” criteria for the same Listings and determined that they did not. Id. Dr. Khan found that Gurzenda had a “mild” restriction of activities of daily living, “moderate” difficulties in maintaining social functioning, “moderate” difficulties in maintaining concentration, persistence, or pace, and no episodes of decompensation of extended duration. Id. Dr. Khan also concluded that Gurzenda’s impairments did not meet the “paragraph C” criteria for Listings 12.03 and 12.04. Id. Dr. Khan attributed “great weight” to the results from Dr. Blank’s mental evaluation. Id. at 142.

         Dr. Khan then completed a residual functional capacity assessment and found that Gurzenda had moderate limitations concerning her ability to “understand and remember detailed instructions, ” her ability to “carry out detailed instructions, ” her ability to “maintain attention and concentration for extended periods, ” her ability to “perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances, ” her ability to “work in coordination with or in proximity to others without being distracted by them, ” and her ability to “complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number and length of rest periods.” Id. at 142–43. Furthermore, in terms of social interactions and adaptations, Dr. Khan found moderate limitations in her ability to “interact appropriately with the general public, ” her ability to “accept instructions and respond appropriately to criticism from supervisors, ” her ability to “get along with coworkers or peers without districting them or exhibiting behavioral extremes, ” her ability to “maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness, ” her ability to “respond appropriately to changes in the work setting, ” her ability to “be aware of normal hazards and take appropriate precautions, ” and her ability to “set realistic goals or make plans independently of others.” Id. at 143–44. Dr. Khan concluded that Gurzenda has the “ability to do simple unskilled work with limited public contact” and that she was not disabled.[5] Id. at 139.

         h. Alan Berkowitz, M.D.

         Alan Berkowitz, M.D., a state agency consultant, completed a reconsideration analysis in January 2017. Id. at 121. He reviewed Gurzenda’s medical history and found that she suffered from: affective disorders (primary, non-severe); schizophrenic, paranoid and other functional psychotic disorders (secondary, non-severe); fibromyalgia (other, non-severe); dermatitis (other, non-severe); essential hypertension (other, non-severe); and trauma and stressor related disorders (other, severe). Id. at 122. Dr. Berkowitz considered the same listings that Dr. Khan considered, Listings 12.03 and 12.04, along with Listing 12.15 (trauma and stressor related disorders). Id. at 123. Dr. Berkowitz reached the same conclusion that Gurzenda’s impairments do not satisfy the “paragraph A, ” “paragraph B, ” or “paragraph C” criteria for any of those listings. Id. Like Dr. Khan, he attributed “great weight” to the results from Dr. Blank’s mental evaluation and found that Gurzenda suffered from the same moderate limitations as discussed above. Id. at 124–27. Dr. Berkowitz found that Gurzenda’s impairments “do not prevent [her] from performing work [she has] done in the past as a/an caregiver” and that her “condition is not severe enough to keep [her] from working.”[6] Id. at 129.

         3. Administrative Hearing on June 27, 2017

         The ALJ began her examination of Gurzenda with questions concerning Gurzenda’s employment history. Id. at 37–44. Gurzenda stated she had worked for K-Mart for “a couple months” in 2005 “unloading the truck and stocking shelves.” Id. at 37–38. She then worked at Lucky Stores in 2005 and 2006 as a courtesy bagger for “seven months” and as a checker for “two months.” Id. at 38–39. During her time as a checker, Gurzenda “ha[d] difficulty with the computers” and “couldn’t do the codes for produce and stuff, ” so her employment was cut short. Id. at 39. Next, Gurzenda worked for Dollar Tree in 2006 “unloading the truck” for a period of “maybe two months.” Id. at 39–40. These jobs were all part-time and required her to do some light lifting, between twenty and fifty pounds, by herself. See Id . at 37–40. Gurzenda then spent time in prison. After Gurzenda’s incarceration, she “helped clean the laundromat” for “a couple of months.” Id. at 41. This job was particularly stressful for her as the owner was “[s]creaming at [her] all the time.” Id. at 42. Although Gurzenda did receive some monetary payment, the main reason she cleaned the laundromat was so that she would have a place to wash up and stay for the night. Id. at 42. The ALJ asked Gurzenda whether she was currently employed, and Gurzenda testified that she was working part-time as a caregiver after filing her application, but that had ended before this hearing. Id. at 43. She received no monetary payment, and instead could “stay there like two nights a week” in return for her services. Id. Gurzenda’s 17-year-old son, who is currently in foster care, was also allowed to stay with her on those nights. Id.

         Then, the ALJ asked Gurzenda about her daily activities. Id. at 44. Gurzenda testified that she is currently staying in “a conversion van . . . a couple nights a week” with one of her friends. Id. Since her friend takes his van to work during the day, Gurzenda spends “most days” at Columbus Park. Id. at 46. She “go[es] there all the time” and “sit[s] at the park a lot.” Id. Gurzenda also spends her time “try[ing] to take care of [her] appointments, ” which she gets to through ride services set up by her doctors since her hips and feet “bother [her] a lot.” Id. at 44– 46. She also looks forward to spending time with her son. Id. at 47.

         The ALJ asked Gurzenda why she has not been able to work, and Gurzenda testified that she has trouble focusing. Id. at 47. Gurzenda explained that her “Morgellons disease has gotten extremely worse” and her “head bothers [her] real bad all the time and [her] ear, and [she] feel[s] a lot of confusion.” Id. She further stated that “[i]t’s just gotten progressively worse and all the mental health medications don’t seem to do nothing.” Id. Gurzenda testified saying she feels like she has “do[ne] nothing with [her] life, ” as she has not been able to raise her son, hold a job, or have a home for “all these years” because her Morgellons has been so extreme. Id. at 48.

         Gurzenda’s attorney, Timothy Reed, began his examination of Gurzenda by asking Gurzenda what other mental health conditions she was currently experiencing. Id. at 49. Gurzenda testified that she was “diagnosed with anxiety and depression, and traumatic stress disorder, and fibromyalgia.” Id. Her anxiety, depression, and PTSD cause her to “have trouble sleeping at night” and as a result she gets “maybe four” hours of sleep a night, making her “feel tired all-day long.” Id. at 50. The fibromyalgia causes aching throughout “all [her] joints all over [her] body” and Gurzenda feels like she has “a headache that never goes away.” Id. Reed also asked how much weight Gurzenda believed she could “lift and carry” using the example of milk gallons, to which she replied that she could pick up one full gallon and “maybe” two full gallons. Id. at 51. Besides lifting, Gurzenda also has problems walking because her feet “[r]eally hurt all the time.” Id. Gurzenda testified that it takes her “[a]t least 10 minutes” to walk one block and that she can only stand for “less than 10 minutes” as her “legs go numb a lot.” Id. at 50–51.

         The ALJ then began her examination of a vocational expert, VE Raschke, by asking him a series of hypotheticals surrounding “a hypothetical individual who has the same vocational profile as [Gurzenda’s] as far as age, education, and prior work experience.” Id. at 56. The ALJ first asked if “an individual who was limited to simple, repetitive task characteristic of unskilled work that required only routine contact with co-workers and the public” would be able to “perform any of [Gurzenda’s] prior work.” Id. VE Raschke testified that “the only two jobs that would continue to exist would be the job as a bagger . . . or a laundry worker.” Id. The ALJ then asked what jobs would be available if “contact with the co-workers and the public could be occasional” was added to the hypothetical. Id. at 57. VE Raschke answered that none of Gurzenda’s prior jobs would fit this profile as the employee is “exposed to the public on a frequent basis, ” but identified other jobs currently available in the economy that would fit this ...

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