United States District Court, D. Arizona
J. MARKOVICH UNITED STATES MAGISTRATE JUDGE.
Cynthia Tucker (“Tucker”) 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”). Tucker raises three issues on
appeal: 1) the Administrative Law Judge (“ALJ”)
erred by failing to include limitations related to
Tucker's Crohn's disease in the residual functional
capacity (“RFC”) assessment; 2) the ALJ erred by
failing to include any manipulative limitations in the RFC;
and 3) the ALJ failed to provide clear and convincing reasons
to discount Tucker's testimony. (Doc. 18).
the Court are Tucker's Opening Brief, Defendant's
Response, and Tucker's Reply. (Docs. 18, 22, & 23).
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. For the reasons stated below, the Court
finds that this matter should be reversed and remanded for
further administrative proceedings.
filed an application for Social Security Disability Insurance
and Supplemental Security Income on December 6, 2013.
(Administrative Record (“AR”) 89). Tucker alleged
disability beginning on November 3, 2010 based on
osteoarthritis in the hands, arthritis in knees and back,
tension headaches, degenerative disc disease, degenerative
joint disease, torn meniscus right knee, possible kidney
disease, depression, and bowel issues. (AR 89-90).
Tucker's application was denied upon initial review (AR
98) and on reconsideration (AR 124). A hearing was held on
March 3, 2016 (AR 69), after which ALJ Myriam C. Fernandez
Rice found, at Step Four, that Tucker was not disabled
because she could perform her PRW as a cashier. (AR 21). On
July 10, 2017 the Appeals Council denied Tucker's request
to review the ALJ's decision. (AR 1).
date last insured (“DLI”) for DIB purposes is
June 30, 2015. (AR 111). Thus, in order to be eligible for
benefits, Tucker must prove that she was disabled during the
time period of her alleged onset date (“AOD”) of
November 3, 2010 and her DLI of June 30, 2015.
Factual History 
was born on March 7, 1958, making her 52 at the AOD of her
disability. (AR 111). She has past relevant work as a
cashier, a patient care technician, and a stocker. (AR 83).
November 6, 2008 Tucker saw Dr. Wintzer for right arm pain.
(AR 667). She said it was in her elbow but on further
questioning it was down into her hand with numbness and
tingling, worse with repetitive motions or lifting. On exam
Tucker had full ROM with somewhat decreased grip strength,
right greater than left. (AR 668). Dr. Wintzer assessed ulnar
nerve entrapment and carpal tunnel syndrome not really
improving and referred Tucker for PT and opined that Tucker
was cleared to return to work with a 5 pound lifting
limitation. (AR 666, 668).
November 13, 2008 Tucker reported continued pain in both
wrists with numbness and tingling. (AR 664). Dr. Wintzer
noted she was not taking ibuprofen on a regular basis so she
was not getting the anti-inflammatory affect. On exam she had
full ROM in the upper extremities with positive Tinel's
sign on the right. (AR 665). Dr. Wintzer assessed probable
carpal tunnel syndrome and ulnar nerve entrapment and
referred Tucker to an orthopedic hand specialist.
November 21, 2008 letter from Dr. Safdar notes that Tucker
had an unremarkable EGD and colonoscopy but that she was
found to have erosive esophagitis due to acid reflux. (AR
829). His impression was GERD well controlled with medication
and suspected irritable bowel syndrome.
December 1, 2008 Tucker saw Dr. Goode for evaluation of hand
pain and denied numbness or tingling. (AR 828). He noted
there was a question of carpal tunnel but her symptoms did
not seem consistent with that, that she had left greater than
right thumb arthritis, and that her x-rays showed some early
wear and sclerosis. (AR 827). Dr. Goode gave her a
cortisone/lidocaine injection and Tucker was not interested
in PT or a splint. (AR 828).
January 15, 2009 Tucker saw Dr. Goode for a follow up. He
noted that the injection did not make her feel better long
term, though it was unclear if it did initially, and that it
was hard to get handle on how much it was really bothering
her. (AR 328). Tucker denied tingling and reported the pain
was all day every day. On exam her grip strength was moderate
and CMC grind was positive,  and Dr. Goode recommended thumb
December 15, 2009 ultrasound of the abdomen showed no acute
disease and mild hepatomegaly. (AR 964).
December 17, 2009 Tucker reported abdominal pain and Dr.
Wintzer assessed probably GERD and gastritis. (AR 646-47).
9, 2010 letter from Dr. Safdar notes that Tucker had severe
pain and discomfort in the abdomen and that an EGD and
colonoscopy were unremarkable. (AR 812). The plan was to
evaluate Tucker for gallbladder dysfunction.
March 27, 2010 Tucker went to the ER and was diagnosed with
biliary colic.(AR 890). An ultrasound of the abdomen
showed stable mild hepatomegaly. (AR 995).
30, 2010 ultrasound of the abdomen was normal. (AR 368-69).
March 31, 2010 Tucker reported abdominal pain with no
diarrhea. (AR 639- 40). Dr. Wintzer noted change in
scan and referred her to surgery. (AR 641).
April 9, 2010 letter from Dr. Safdar notes that Tucker had a
significant history of abdominal pain, likely related to
underlying gallbladder disease. (AR 792).
April 13, 2010 Tucker presented to the ER with severe
abdominal pain; she was scheduled to have her gallbladder out
in May. (AR 788). She was admitted for pain control secondary
to probable biliary colic. (AR 789-90).
November 3, 2010 Tucker was seen for a right wrist injury
that occurred one week prior at work. (AR 361). Tucker
reported aching pain, 4/10, and had tried nothing to relieve
her symptoms. On exam she had tenderness of the right wrist,
good flexion, extension, abduction, and adduction, excellent
approximation of thumb and fifth finger, and decreased grasp
strength. (AR 363). X-rays were normal and Tucker was placed
in a splint. (AR 364, 410).
November 9, 2010 Tucker was seen for increased wrist pain
after picking up a gallon of milk; she had not seen her PCP
yet and requested a referral to a hand specialist. (AR 411).
Tucker was instructed to continue RICE and keep the splint on
until she was evaluated by her PCP or specialist. (AR 414).
November 10, 2010 Tucker saw Dr. Wintzer for her wrist
sprain. (AR 419). On exam she had tenderness, no swelling,
full ROM, good pulses, reflexes 2/4 and symmetric, and
strength 5/5 and symmetric. (AR 420). Dr. Wintzer recommended
wrist exercises, continue splint, naproxen for pain, and
referred Tucker to a specialist.
November 16, 2010 Tucker reported she had an orthopedist
appointment the following week but that she needed a work
excuse because she worked at Walgreens and there was no light
duty. (AR 422). On exam she had mild swelling and tenderness
with normal ROM. (AR 423).
November 22, 2010 note from Dr. Wintzer states that Tucker
should avoid lifting more than 5 pounds with her right arm
and avoid repetitive lifting or twisting motions with her
right wrist. (AR 426).
November 23, 2010 Tucker saw Dr. Arnold for evaluation of her
wrist injury. (AR 427). On exam she had moderate tenderness,
normal ROM, normal strength and tone, intact sensation,
negative Tinel's sign and Phalen sign, and normal x-rays.
(AR 428). The assessment was tenosynovitis with a
recommendation to use a splint and ice three times a day.
December 14, 2010 Tucker saw Dr. Arnold and reported she was
only using the splint part time. (AR 430). On exam she had
moderate tenderness, normal strength and tone, and intact
sensation and pulses. (AR 431). Dr. Arnold recommended ice
and wearing the splint full time.
December 28, 2010 Tucker saw Dr. Arnold and was no better.
(AR 432). On exam she had marked tenderness to palpation,
normal ROM, normal strength and tone, and intact sensation
and pulses. (AR 433). Dr. Arnold recommended a splint, ice,
and a MRI. The MRI on January 7, 2011 was normal. (AR 437).
January 13, 2011 Tucker saw Dr. Arnold. (AR 438). On exam she
had a volar radial 2 cm mass 2 inches proximal to wrist
joint, tenderness, normal ROM, normal strength and tone, and
intact sensation and pulses. (AR 439). Dr. Arnold assessed a
new mass on the forearm and referred her to Dr. Medlen.
March 29, 2011 Tucker saw Dr. Hayden for an IME for her
workplace injury. (AR 443). Tucker reported constant wrist
pain, 7-8/10 without the splint and 3-4/10 with the splint,
and said she wore the splint 6-8 hours a day. (AR 444).
Tucker also reported some pain in the forearm radiating into
the wrist when lifting a heavy object without her splint. She
had a history of arthritis in both thumbs, intermittent pins
and needles sensation in the forearm, and felt her right
wrist ROM was less than the left. (AR 445). The impression
Clinically, there were no objective findings and no evidence
of a right wrist/forearm mass or tenosynovitis. Her right
wrist splint was nearly pristine in appearance despite the
fact that the patient stated she wore the splints 7-8 hours
per day for the past several months. Ms. Tucker's
clinical examination findings were diffuse and
non-localizing. . . . Although Ms. Tucker's MRI scans did
show some degenerative ulnar wrist changes, these are chronic
and preexisted her industrial injury claim and would not have
been caused or aggravated by the injury she described. Her
symptoms, moreover, are not consistent with the MRI findings.
Ms. Tucker was able to freely gesture during conversation
with her right upper extremity despite her subjective
complaint of 8/10 pain. She had no loss of range of motion.
She had no weakness of the wrist . . . and did not complain
of any pain when testing.
(AR 466). X-rays of the wrists showed arthritis in the
thumbs, more severe on the left, and no acute abnormalities,
(AR 491), and an EMG nerve conduction study was normal. (AR
492). The overall impression was that Tucker's subjective
complaints were not causally related to her industrial injury
claim, and Dr. Hayden opined that she had reached maximum
medical improvement and could return to her job as a cashier
at Walgreens without restrictions. (AR 466-67).
April 7, 2011 a MRI of the right forearm and wrist showed
degenerative joint disease and a 2-3 mm cyst. (AR 736).
12, 2011 Tucker saw Dr. Wintzer for a follow up for her
wrist. (AR 501). On exam she had some pain but no swelling,
good ROM, strength 5/5 symmetric, and reflexes 2/4 symmetric.
(AR 502). Dr. Wintzer referred her to orthopedics,
recommended she get a job where she wasn't doing
repetitive motions with her wrists and repetitive lifting,
and recommended she use the wrist splint when doing
repetitive motions or lifting.
April 30, 2012 Tucker presented to the ER with abdominal
pain; she was discharged home with a ...