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Salinas v. Colvin

United States District Court, D. Arizona

March 8, 2016

Raymond S. Salinas, Plaintiff,
v.
Carolyn W. Colvin, Defendant.

ORDER

ERIC J. MARKOVICH, Magistrate Judge.

Plaintiff Raymond S. Salinas ("Salinas") brought this action pursuant to 42 U.S.C. § 405(g) seeking judicial review of a final decision by the Commissioner of Social Security ("Commissioner"). Salinas raises two general issues on appeal: 1) whether the Administrative Law Judge's ("ALJ") residual functional capacity ("RFC") assessment is supported by substantial evidence, and 2) whether the ALJ's Step Five finding that Salinas can perform work existing in the national economy is inconsistent with the evidence and the law. (Doc. 23 at 1-2). Salinas specifically contends that the ALJ erred in evaluating and weighing three of the medical expert opinions and that the ALJ failed to provide clear and convincing reasons for finding Salinas not credible. Id. at 2.

Before the Court are Salinas' Opening Brief and Defendant's Response. (Docs. 23 & 25). Salinas did not file a Reply. The United States Magistrate Judge has received the written consent of both parties and presides over this case pursuant to 28 U.S.C. § 636(c) and Rule 73, Federal Rules of Civil Procedure. The Court finds that the ALJ erred in assessing Salinas's activities of daily living and that she gave improper consideration to Salinas's lack of treatment. These errors impacted the ALJ's RFC assessment and the hypotheticals posed to the VE. Consequently, these errors were not harmless because they ultimately impacted the Step Five nondisability finding, and the Court finds remand for further proceedings is appropriate.

I. Procedural History

Salinas filed an application for Supplemental Security Income ("SSI") and Disability Insurance Benefits ("DIB") on February 21, 2012. (Administrative Record ("AR") 159). Salinas alleged disability beginning March 20, 2011 (AR 159) based on an injury to his back and spine in a fall at work (AR 179). Salinas's application was denied upon initial review (AR 60, 88) and on reconsideration (AR 70, 93). A hearing was held on June 6, 2013 (AR 31), after which ALJ Lauren R. Mathon found, at Step Five, that Salinas was not disabled because he was able to perform other work existing in the national economy (AR 25). On November 6, 2014 the Appeals Council denied Salinas's request to review the ALJ's decision. (AR 1).

II. Factual History

Salinas was born on January 15, 1959, making him 52 at the alleged onset date of his disability. (AR 159). Salinas has a high school education and completed one year of college. (AR 179). Salinas's last job was with Olive Garden, from February through March 2011, where he worked as a prep cook. (AR 192). From 1997 to 2009, he worked as a lab technician for Baxter Health Care. Id. Salinas indicated that he lifted up to 50 to 70 pounds at Olive Garden and walked and stood for 9-10 hours of his work day. (AR 193). At Baxter Health Care, Salinas lifted up to 100 pounds or more and walked, stood, sat, and climbed for 10 hours a day. (AR 194).

A. Treating Physicians

Salinas had a CT of the lumbar spine on March 30, 2011. (AR 402). The findings were normal paraspinal area, normal bones, and "disc space narrowing, vacuum disc phenomenon, and small partially calcified right-sided herniated nucleus pulposus at L5-S1, mildly posteriorly displacing the right S1 nerve root."

Salinas was seen by Dr. Colin Bamford on June 22, 2011 with a complaint of neck and back pain. (AR 447). He reported that his back pops up and locks, and that he was not improving and some things were worsening. Salinas stated that staying in one position and washing dishes aggravated his pain, and changing activities relieved it. He reported that his medications made him nauseated and woozy and affected his sleep, so he stopped taking them. On examination Dr. Bamford noted Salinas had marked limitation of mobility in his neck and low back. (AR 448). Dr. Bamford also noted that Salinas got onto the examination table slowly using a step stool, and that he asked to be able to stand at one point during the interview and stood for one minute. Dr. Bamford found normal strength and tone in all four extremities, normal sensation in all four extremities, ability to toe walk, normal gait, and trouble heel walking requiring balance support from the doctor. (AR 449). Dr. Bamford's impression was neck and back pain, and he noted that Salinas' "limitation of mobility is extreme and suspect." He also noted that Salinas had a small herniated disc "which is small enough that it could be asymptomatic" and that it was "partially calcified and consequently is probably old." Dr. Bamford recommended a MRI and EMG/NCV study.

Salinas had a MRI on July 21, 2011. (AR 405). The impression was:

1. L5-S1: Mild endplate degenerative changes, small Schmori's node inferior endplate L5 with minimal retrolisthesis, disc desiccation and disc bulge extending posterior 3-4 mm asymmetric to the right result in mass effect at the ventral subarachnoid space, moderate right and mild-moderate left neural foraminal narrowing.
2. L4-5: Disc desiccation and mild intraforaminal disc bulge results in mild bilateral neural foraminal narrowing.
3. L3-4: Disc desiccation present. Left asymmetric disc bulge results in mild left neural foraminal narrowing.

Salinas also had an EMG and NCV study of the lower extremities and paraspinals on July 21, 2011. (AR 407). Both tests were normal, and the impression was "no electrodiagnostic abnormalities in bilateral lower extremities." (AR 408).

Dr. Bamford saw Salinas for a follow-up appointment on October 12, 2011. (AR 444). Salinas reported he was doing the same, that nothing was working, and that he felt he was deteriorating. He complained of severe groin, knee, and back pain, and noted that activity worsened his pain and muscle relaxants relieved it. He also complained of walking awkwardly, numbness and burning spine pain, and weakness in his arms and knees. Salinas also reported he was depressed due to weight gain. He rated his pain as a 9/10. (AR 445). On examination Dr. Bamford noted Salinas had normal attention, concentration, mood, affect, speech and language. Dr. Bamford found normal strength in the upper extremities and left leg, but noted Salinas "provided a variable effort on strength testing of the right leg." Pinprick sensation was normal in all four extremities, but light touch was absent in the right leg. Dr. Bamford observed that Salinas got up from his chair slowly and walked to the examination table slowly, laid back on the table with ease, and sat up from the exam table slowly using his arms. Dr. Bamford's impression was possible neck and back pain, small herniated disc that is probably old, and symptom magnification. He recommended a physical medicine and rehabilitation consult, and that Salinas enroll in a work hardening program. (AR 446).

Salinas saw Dr. Bamford for a follow-up on October 26, 2011 with a complaint of back, groin, and leg pain. (AR 441). He reported that the severity of his pain was unchanged, that activity made it worse, and that Diclofenac relieved it. Salinas rated his pain as a 8/10. (AR 442). Dr. Bamford observed that Salinas had an unmotivated, slightly blunted affect, and normal attention and concentration. On exam, Dr. Bamford found: slightly decreased right grip strength with variable effort, variable effort of the right leg, normal strength in left arm and leg, normal tone in all four extremities, vibration sensation decreased at right ankle, pinprick and light touch absent in the right foot, and position sense decreased in both feet. Dr. Bamford observed that Salinas walked upright but slowly, and was able to get onto the exam table and remove his socks and shoes without difficulty. Dr. Bamford's impression was possible neck and back pain, small herniated disc that is probably old, and symptom magnification. He noted Liberty Mutual had approved 6 work hardening visits for Salinas.

Dr. Bamford saw Salinas for a follow-up on December 7, 2011. (AR 438). Salinas complained of burning and numbness up and down his spine and low back spasms. He reported that his symptoms were different every day, that sometimes the pain was in his low back, upper back, and neck, and that he felt a pull in his upper back, spasms and locking in his low back, and that his neck felt misaligned with his spine. Salinas rated the pain in his upper back at a 6-7/10 and a 6-8/10 in his low back. Activity, using his arms, and walking all aggravate his pain, and inactivity, medications, and popping his neck in alignment relieve his pain. Dr. Bamford observed that Salinas got onto the examination table and laid down with ease, and got up without being asked to and without asking for help. (AR 439). On examination of the back, Dr. Bamford noted: palpation of the low back revealed no spasm; Salinas could touch his ankles but had minimal movement of the low back in all other directions; when asked to rotate his low back, Salinas "instead rotated his neck with reasonable excursion;" and Salinas "exhibited no expression of pain and made no statement of pain when asked to move his low back." On examination of the neck, Dr. Bamford noted that Salinas "had a fair range of motion in all directions." Id. Dr. Bamford also observed "poor effort on extension of the right knee and plantar flexion of the right ankle, " and noted normal strength of the left leg and both arms, and normal tone in all four extremities. His impression was possible neck and back pain, small herniated disc that is probably old, symptom magnification, and somatization disorder. Dr. Bamford opined that Salinas "may return to work with the recommended work restrictions suggested by Karen Lumda which I feel are cautious and generous." Id.

On February 15, 2012 Dr. Bamford saw Salinas for a follow-up for back pain with numbness and tingling, and a new complaint of heel pain. (AR 435). Salinas reported that PT was not helping, that he tried to do his home exercises but they made his symptoms worse, and that Diclofenac temporarily relieved his pain. Salinas stated that he was doing worse and severe pain could hit him at any time, and that his pain is constantly a 5/10 but that he gets attacks twice per month lasting for a few minutes where it is a 10/10. Salinas felt the heel pain was related to putting all of his weight on his heels to protect his back. Dr. Bamford observed that Salinas got up from his chair by holding onto the side bars, and that he walked with his back stiff. (AR 436). On the back exam, Dr. Bamford noted that Salinas could touch his toes, did not attempt to extend his back because he was worried it would increase his pain, could twist ok, side bends were mildly restricted due to pain, and there was tenderness of the right paraspinal muscles. On the neck exam, Dr. Bamford noted neck flexion, extension, and rotation were ok, and tilt was moderately restricted bilaterally due to pain between the shoulder blades. Dr. Bamford's impression was neck and back pain after a fall at work, new onset of heel pain, and moderate right and mild-moderate left L5 neural formamina narrowing. (AR 437). He recommended a lumbar Velcro corset, referral to a pain clinic for a facet block, and a follow-up appointment after Dr. Ennabi's evaluation, and renewed the Diclofenac prescription.

On December 12, 2012 Salinas was seen by Dr. Michael Milazzo for a complaint of back pain, muscle spasms, and a burning sensation in the left L5-S1 area. (AR 542). Salinas reported he could not bend over or walk 50 yards, and that he was taking Diclofenac for pain. He also reported extremity weakness, gait disturbance, numbness in his extremities, and muscle weakness. (AR 543). On examination Dr. Milazzo documented "[m]oderate paravertebral muscle spasm noted [from] cervical region to lumbar area" and "[t]enderpoint left L5-S1 to palpation." (AR 544). He also documented weakness on left foot dorsiflexion and diminished bilateral achilles deep tendon reflexes, and noted Salinas would not heel walk. Dr. Milazzo assessed herniated nucleus pulposus, L5-S1, left; muscle spasm of back; and obesity. He recommended a neurology reevaluation by Dr. Banford and prescribed Flexeril and Gabapentin. (AR 544-45).

Dr. Milazzo saw Salinas on January 10, 2013 for lab results. (AR 556). Salinas reported that there was no change in his back condition and that he had not seen the neurology specialist in Tucson. Dr. Milazzo assessed hypertension, hyperlipidemia, and herniated nucleus pulposus, L5-S1, left. (AR 557). He noted Salinas never filled the Neurontin prescription because he could not afford it, and gave Salinas a refill prescription for the Flexeril.

Salinas saw Dr. Milazzo on February 20, 2013 for prescription refills. (AR 559). Salinas stated he had been summoned for jury duty but that he did not think he could not do it because he could not sit for an extended period of time. Dr. Milazzo noted Salinas complained of persistent muscle spasms in his back and pain, and on examination Dr. Milazzo indicated "[m]oderate paravertebral muscle spasm still noted" and "[t]enderness left L5-S1." (AR 560-61). Dr. Milazzo also documented "[w]eakness still noted left foot dorsiflexion" and "[d]iminished achilles still noted." (AR 561). Dr. Milazzo assessed hypertension and sciatica due to displacement of lumbar disc, and renewed Salinas' prescription for Flexeril. (AR 562). He also noted that bed rest was not a recommended treatment for back pain and that Salinas should stay as active as possible and do exercises to strengthen his back and abdominal muscles.

On April 3, 2013 Salinas saw Dr. Milazzo for prescription refills. (AR 563). Salinas reported he had been out of medication for 5 days and that he wanted to try the Gabapentin if he could afford it. Dr. Milazzo noted Salinas still had back pain and pain radiating down his left leg, and observed that Salinas "ambulates slowly because of back problems. (AR 564-65)." Dr. Milazzo documented normal deep tendon reflexes except for the left patellar, and weakness on the left foot dorsiflexion. He assessed hyperlipidemia, hypertension, and sciatica due to displacement of lumbar disc, and gave Salinas a prescription for Gabapentin. (AR 565-66). Dr. Milazzo also noted that Salinas could not afford to go see Dr. Bamford, and that he had disability and workman's compensation hearings coming up. (AR 566).

Salinas was seen on April 23, 2013 for a medication refill. (AR 568). Dr. Milazzo assessed sciatica due to displacement of lumbar disc, and noted that Salinas had not filled the Gabapentin prescription because he could not afford it. Dr. Milazzo also noted that Salinas refused to go to physical therapy. Dr. Milazzo prescribed Cymbalta.

B. Physical Therapy

Salinas was seen at Sierra Vista Regional Health Center Rehabilitation Services for a physical therapy evaluation on January 16, 2012. Salinas reported that his current pain was a 7/10, that his pain at rest was a 7/10, and that his pain with activity was a 9/10. (AR 430). He noted that his symptoms were constant and come and go, and that they were worsening and not changing. Salinas stated that the following made his symptoms worse: walking/activity, sleeping, sitting, standing, lying down, turning/twisting, reaching, bending, gripping/grasping, stress, and work duties. He reported he was unable to engage in any activities and that after about 5 minutes of doing an activity his pain would increase and his back would lock up. (AR 474). The PT noted that Salinas currently had severe pain with activities of daily living, with a therapy goal of reducing that to moderate pain, and that Salinas was unable to perform specific work activity secondary to pain or limitation, with a therapy goal of reducing pain during or after work activity to a moderate level. (AR 475). Physical findings included: bilateral lumbar back pain, mild increased lordosis of the lumbar spine with stance, normal movement, and tenderness with palpation of the soft tissues throughout the mid and lower spine. (AR 475). On the spinal assessment, the PT noted that Salinas was "able to grab both knees, [but] does not tolerate continued flexion of the spine" and "[h]e is very limited with side bending due to reported locking' of the trunk with very little pain." (AR 476). Salinas was negative for all spine tests except one straight leg raise test, indicating hamstring tightness. The PT also noted that Salinas reported pain "to radiate into the right lower extremity but there is currently no signs or symptoms of progressive radiculopathy." The PT observed that Salinas presented with impairments of: "1 weakness of the trunk and extremities, 2 decreased tolerance to sitting, standing, walking, reaching [and] 3 decreased trunk movement due to pain and reported locking'" and recommended 8 weeks of PT. (AR 476-77).

A progress note from January 19, 2012 notes that Salinas reported pain between his shoulder blades when doing chin tucks during his home exercise program. (AR 482). He agreed to continue to try to do the exercise with modifications for pain. The PT noted that exercised were modified to accommodate Salinas' pain, and that Salinas reported increased pain between his shoulders with activity.

A progress note from January 24, 2012 notes that Salinas stated his pain was getting worse and that his home exercise program was too painful. (AR 483). The PT commented that "Raymond has increased difficulty with today's exercise session, he has pain with all activities and quits halfway through exercises stating they are too painful to continue."

A progress note from January 26, 2012 notes that Salinas reported he was doing better than at his last PT session and was performing his home exercise program to tolerance. (AR 484). The PT commented that Salinas demonstrated "improved activity tolerance" but "require[s] frequent rest breaks due to pain, " and "once he rests his pain levels decrease."

A progress note from January 31, 2012 notes that Salinas reported he was doing his home exercise program and had increased pain with prone extension exercises, and that he was still having significant pain. (AR 486).

A progress note from February 20, 2012 states that "Raymond demonstrates improved activity tolerance today's visit, he has no reports of pain throughout session." (AR 487).

A progress note from February 23, 2012 states that Salinas reported "no changes in his back symptoms since the start of therapy" and that "he reports completing his home program with no results." (AR 488). Salinas also reported "he felt good prior to last session, has since been in significant pain through the back, continuing to have 6/10 pain." He further reported "getting occasional sharp pain in the back that has a stabbing pain in the past month, " that he continued to have an occasional locking sensation in his back, and that his pain is relieved with ice only. A reevaluation completed on February 23, 2012 notes that Salinas was making steady progress towards his treatment goals. (AR 490). However, Salinas had not yet met his short term goals of improving strength and range of motion or being independent with his home exercise program, nor had he met the following long term goals: stand and walk for 30 minutes with a pain level of 5/10, reach forward and place a 5 pound object in a cabinet with pain at a 4/10, stand and was dishes for 15 minutes with pain at a 4/10, and sleep for 4 hours without interruption. (AR 490-91). The PT noted that Salinas was going to see another specialist and would then contact the PT if he wanted to continue therapy, but that "[o]therwise there has not been consistent improvement to warrant continued treatment at this time." (AR 492).

A discharge summary dated April 19, 2012 notes that Salinas was seen for 8 visits for back pain, and that Salinas was to call after his last doctor's appointment if further PT was needed. (AR 495). Salinas did not call and was administratively discharged from PT because: "1. Evaluation complete and plan of care established however, the patient did not return/complete therapy program 2. The patient did not comply with plan of care attendance policy failing to show or cancelling three or more consecutive appointments."

C. State-Agency Consulting Physicians

Salinas was seen by Dr. Jeri B. Hassman, a certified independent medical examiner, for a physical medicine consultative examination ("CE") and statement of ability to do work-related activities on November 10, 2012. (AR 525). Salinas reported that he was injured on the job on March 20, 2011 and "[s]ince then, he has had constant, severe midback pain and low back pain plus pain down both legs." He also reported "worse pain in the legs, including the ankles and knees, with prolonged standing." Salinas stated "he was feeling better when he was getting some therapy and was on pain medication, but his Workmen's Compensation was closed in February 2012, and since then he has not had any treatment." Further, Salinas "was supposed to get facet joint injections and a lumbosacral corset, but he never obtained either of those."

On examination, Dr. Hassman observed the following:

His gait was very abnormal. He took very tiny steps and he was very stiff.... He hardly moved his head at all when he walked. He could not stand or walk on his toes because, he said, it caused too much back pain. The same was true for heel walking. He also refused to hop for the same reason. He performed tandem walking very carefully, holding on for balance. He could not perform bending at all.... He seemed to have an unusual response to anything I asked him to do. He sort of smiled to himself and looked around, as if he were confused and distracted, and just could not perform anything.
He also could not perform kneeling. Taking off his shirt took a lot of time.... At least three times he started to sit down, but he never really sat down during the physical examination, even when I asked him to sit down, because, he said, sitting was more painful than standing....
I asked him to perform cervical flexion. He obviously heard me but he did not move his head. Instead, he moved his eyes in all directions...
He had no tenderness over the cervical spine. However, he had moderate tenderness over the thoracic and lumbar spine....
He could not perform any trunk flexion. The most he could bend was 10 degrees. He had no trunk extension. He could not sit or get on the table for straight leg raising test.
He had normal sensation of both lower extremities....
I could not formally test hip flexion or knee extension, since he would not sit down because of too much pain.
He had full range of motion of both upper extremities without pain.

(AR 527). Dr. Hassman's diagnosis was:

Severe back injury since a twisting injury to the spine on March 20, 2011.... He has a very antalgic, abnormal gait with tiny steps and keeps his trunk very stiff, and he has essentially no ability to perform any bending or kneeling and cannot perform any cervical range of motion either because of the pain.

(AR 528). Dr. Hassman then completed a Medical Source Statement of Ability to do Work-Related Activities (Physical) ("MSS"). She opined that Salinas' condition would impose limitations for 12 continuous months, that he could occasionally[1] and frequently[2] lift and carry less than 10 pounds, stand and walk at least 2 hours but less than 6 hours in an 8 hour workday, and sit for 3 hours. (AR 528-29). She opined that Salinas had no restrictions in seeing, hearing, speaking, handling, fingering, or feeling, that he could occasionally stoop and reach, and that he could never kneel, crouch, crawl, or climb ramps, stairs, scaffolds, or ladders. (AR 530). Dr. Hassman also stated Salinas could not work around heights, moving machinery, or extremes in temperature.

Salinas was seen by Dr. Sloan King for a psychiatric CE on November 12, 2012. (AR 533). Salinas reported an unsteady gait, and requested assistance from the hotel staff and Dr. King when walking back to his car. Salinas "stood throughout his entire hour long appointment, stating that his back felt as though he were being poked with nails, ' and he chose to save his stamina so he that he could sit in his car to drive" home. Dr. King noted that Salinas was not clean shaven, and Salinas explained that his fiance was out of town and unable to assist him, and that he had difficulty lifting his arms and holding his hand steady to shave due to his pain. Salinas reported "significant pain as a result of his injury, which begins as a central pain down the middle of his back, moves to the left side of his waist, and feels as though many of his nerves are in a bundle and twisting.'" (AR 534). He also stated the pain causes swelling in his ankles and knees, especially after sitting or standing for any period of time. Salinas reported his pain was constant and that he typically lies on the couch most of the day. "He sleeps on the couch as well, rolling off' in the morning in order to wake up as the bed is too high and he cannot comfortably get in or out." Dr. King noted Salinas had no history of mental health issues, but that "he reports symptoms of depression and anxiety as a result of the onset of his disabling condition." (AR 535).

Dr. King made the following notes regarding Salinas' current level of daily functioning:

Mr. Salinas is up by 4 or 5 in the morning. He tries to monitor his movements as to prevent spasms or acute flares... He is able to cook things in the microwave if his fiance is not at home, but otherwise relies on her to do all of the cooking, yard work, chores, laundry, and driving. He has attempted to do things like wash dishes, but cannot stand longer than five minutes.... Mr. Salinas is inactive and expressed his frustration with a 30 to 40 pound weight gain since the time of his accident. Prior to his injury, he was able to play basketball, play physically with his dogs, do the dishes, and yard work.... Mr. Salinas demonstrates overall ability to independently maintain a household. He demonstrates compromised but minimally sufficient levels of concentration, persistence, and pace necessary to complete domestic chores and engage in leisure pursuits.

(AR 535-36). Dr. King noted that Salinas "presented with good interpersonal skills, although he appeared to be in significant pain, and was anxious for the appointment to be completed." (AR 536). Dr. King observed the following regarding Salinas' mental status:

Mr. Salinas presented with a painful expression, but was able to smile appropriate to context, although his range of affect was fairly restricted overall. [He] reports a depressed mood, and had daily, passive thoughts of suicidal ideation in which he wishes to avoid the pain, even if it means ending his life.... He has noticed increased irritability, which he describes as snappiness' and anger at others, based on his inability to work but desire to do so. His worries are fairly typical in nature, such as concern about finances and credit cards after his loss of income.... He reports low levels of energy, feeling drained and fatigued since the time of his accident. He had no problems with concentration in the past, but now has difficulty focusing.... Mr. Salinas has some problems with sleep since the accident, in that he is awake because of the pain and sleeps five hours on average.... Mr. Salinas demonstrated no significant problems with cognitive functioning... and appeared to be functioning in at least the average range of intelligence... Although he reports difficulty with concentration, his ability to focus appeared fairly intact as evidenced by a subtracting backwards on the serial sevens task. He demonstrated poor judgment in response to a scenario presented to him, and also appears to have a concrete thinking style.

(AR 536-37). Dr. King's diagnosis was: adjustment disorder with depressed mood (chronic), pain disorder associated with lower back injury/pain (chronic), occupational problems (unemployed since time of injury), economic problems (currently unable to pay many of his bills), inadequate access to healthcare services (uninsured since February 2012, and unable to afford prescription medications or health care appointments). (AR 537). Dr. King assessed a current GAF[3] score of 55, and a GAF score of 50 for the past year.

Dr. King also completed a Psychological/Psychiatric MSS, and indicated that Salinas had a psychological diagnosis with limitations expecting to last 12 continuous months. (AR 538). Dr. King stated that "Mr. Salinas demonstrates the ability to understand and remember detailed instructions." Regarding sustained concentration and persistence, Dr. King noted that

Mr. Salinas presents with moderate to marked limitations based on his reported level of chronic and persistent pain. Based on his reported presentation, he would have difficulty performing tasks within a normal work day due to significant interruptions and frequent rest periods. However, Mr. Salinas reports contradictory information from an independent medical examiner that apparently alleged the claimant was able to return to employment in February 2012.

Id. Dr. King also opined that Salinas "should have no difficulty getting along with others within the realm of recent superficial contact" and that Salinas "demonstrates the ability to travel in unfamiliar places as well as utilize public transportation." (AR 539).

D. Additional Medical Information

Salinas was seen by Karen Lunda, PT, for a functional capacity evaluation ("FCE") on November 28 and 29, 2011. Lunda noted that Salinas was "pleasant and cooperative and put forth good effort over the two days of testing" (AR 418), and that he "demonstrated a ...


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