United States District Court, D. Arizona
Rebecca C. Ruiz, Plaintiff,
Andrew M. Saul,  Acting Commissioner of Social Security, Defendant.
HONORABLE BRUCE G. MACDONALD UNITED STATES MAGISTRATE JUDGE
pending before the Court is Plaintiff’s Opening Brief
(Doc. 18). Defendant filed his Responsive Brief
(“Response”) (Doc. 20), and Plaintiff filed her
Reply (Doc. 21). Plaintiff brings this cause of action for
review of the final decision of the Commissioner for Social
Security pursuant to 42 U.S.C. § 405(g). 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
March 5, 2014, Plaintiff filed a Title II application for
Social Security Disability Insurance Benefits
(“DIB”) and a Title XVI application for
Supplemental Security Income (“SSI”) alleging
disability as of March 1, 2007 due to right shoulder pain;
lower back pain, including bulging discs; right hip-bone on
bone; right ankle weakness; insulin dependent diabetes; low
blood platelet count; high blood pressure; dizziness;
anxiety; and depression. See Administrative Record
(“AR”) at 27, 29, 67–68, 76–79, 82,
84, 90–91, 102–105, 121– 22, 262, 296, 300,
323, 349. The Social Security Administration
(“SSA”) denied this application on September 4,
2014. Id. at 27, 76–101, 143–50. On
October 15, 2014, Plaintiff filed a request for
reconsideration, and on March 26, 2015, SSA denied
Plaintiff’s application upon reconsideration.
Id. at 27, 102–37, 151–52. On May 22,
2015, Plaintiff filed her request for hearing. Id.
at 27, 153–54. On January 25, 2017, a hearing was held
before Administrative Law Judge (“ALJ”) Laura
Speck Havens. Id. at 27, 41–63. On June 8,
2017, Plaintiff appeared at a supplemental hearing before ALJ
Havens. AR at 27, 64– 75. At the supplemental hearing,
Plaintiff moved to amend her onset date to March 5, 2014 and
to withdraw her Title II claim. Id. at 67–68.
On July 3, 2017, the ALJ amended Plaintiff’s onset date
to March 5, 2014, dismissed her Title II claim, and issued an
unfavorable decision. Id. at 24–34. On August
28, 2017, Plaintiff requested review of the ALJ’s
decision by the Appeals Council, and on May 15, 2018, review
was denied. Id. at 1–4, 245–49. On June
11, 2018, Plaintiff filed this cause of action. Compl. (Doc.
was forty-five (45) years old at the time of the
administrative hearings, as well as at the time of the
alleged onset of her disability. AR at 27, 29, 33–34,
45, 67–68, 76–77, 90, 102–104, 121, 173,
201, 218, 230, 251, 262, 296, 323, 349. Plaintiff obtained a
high school equivalent education (GED). Id. at 33,
76–77, 102–103. Prior to her alleged disability,
Plaintiff worked in as a caregiver and convenience store
cashier; however, the ALJ determined Plaintiff lacked
substantial gainful activity. Id. at 29, 48, 302,
January 25, 2017
administrative hearing, Plaintiff testified that she obtained
a GED. AR at 45. Plaintiff further testified that she is able
to read, but was equivocal about her ability to do simple
adding and subtracting. Id. Plaintiff testified that
she previously worked as a companion through an agency for
between ten (10) and fifteen (15) hours per week.
Id. at 46–47. Plaintiff further testified that
she had to stop working because she could no longer do the
work. Id. at 47. Plaintiff also testified that she
lives in a house with three (3) of her four (4) daughters.
Id. at 48. Plaintiff testified that she wakes up at
approximately 11:00 a.m. and for the past year she has
required help getting out of bed, showering, and getting
dressed. AR at 48. Plaintiff further testified that she does
not do any household chores, such as cooking, washing dishes,
cleaning floors, or doing laundry. Id. at 49.
Plaintiff testified that she shops for groceries if she is up
to it, but estimates that ninety-five (95) percent of the
time her daughters do the chores. Id. at 49.
Plaintiff further testified that prior to the onset of her
disability, she was able to do more, including all of the
described her typical day as getting up, showering, and
dressing with her daughter’s help, followed by sitting
in the kitchen for awhile before returning to bed.
Id. at 50. Plaintiff noted that if she needs to use
the restroom during the day, her daughter helps her get up.
AR at 50. Plaintiff testified that prior to her health
decline, she was able to walk everywhere, get up, dress
herself, and take care of her children. Id. at
50–51. Plaintiff further testified that she was able to
walk approximately three (3) blocks before taking a thirty
(30) minute break before getting up and going again.
Id. at 51. Plaintiff admitted to using cocaine when
her parents passed away. Id. at 51–52.
Plaintiff testified that she does not drive a car having
stopped in approximately 2013. Id. at 52. Plaintiff
testified that she does not go out socially and sleeps
approximately five (5) hours per night on average. AR at 52.
Plaintiff listed her current medications as two types of
insulin, metoprolol for her heart rate, blood pressure
medicine, cholesterol medicine, monophines [sic], and
lorazepam. Id. at 53. Plaintiff described the
medication side effects as including drowsiness, sleepiness,
and an inability to function. Id.
testified that she can walk or stand for approximately five
(5) to ten (10) minutes and can sit for approximately twenty
(20) minutes. Id. Plaintiff further testified that
she cannot lift her granddaughter who is approximately
twenty-five (25) pounds. Id. at 54. Plaintiff also
testified that she has constant lower back pain, rating it as
seven (7) out of ten (10). AR at 54. Plaintiff testified that
she suffers from depression and anxiety, but is not receiving
mental treatment, rather she receives pain medication for her
further testified that she had initially applied for
disability benefits in 2013 because she had hurt her back and
hip. Id. at 55. Plaintiff also testified that she
worked three (3) days per week in 2014 because she could not
tolerate more due to her pain. Id. at 55–56.
Plaintiff described that she has “blood issues”
and frequently gets dizzy and falls. Id. at
56–58. Plaintiff also testified that she goes to the
urgent care once or twice per month for her pain-not to
receive additional pain medication, but to ensure that
nothing has gotten worse. AR at 57. Petitioner testified that
she has trouble with her sinuses, as well. Id.
Plaintiff further testified that she had not sought mental
health help because she was on “too much
medication.” Id. at 58.
June 8, 2017
supplemental administrative hearing, Plaintiff testified that
her condition has gotten worse. AR at 68. Plaintiff further
testified that her hip pain has increased and she had surgery
on her foot because of Methicillin-resistant Staphylococcus
aureus (“MRSA”) that she had contracted as a
result of an infection related to her diabetes. Id.
at 69. Plaintiff also testified that her depression has also
13, 2014, Plaintiff completed a Function Report-Adult in this
matter. AR 310. Plaintiff reported that she lived in a house
with family. Id. Plaintiff described her medical
conditions as follows:
Can’t sit longer than 20-30 minutes. Can’t stand
longer than 20-30 minutes. Have to lay down 2-3x a day due to
severe back pain. Very limited in physical activity[, ] can
only do chores – dishes, putting a load of laundry in
for 10-15 minutes before having to sit down. If sugars are
not right[, ] get really dizzy.
Id. Plaintiff described her typical day as waking up
and going to work for four (4) hours per day. Id. at
311. Plaintiff reported that she is able to lay down and take
breaks as needed while working, and then goes home and is in
bed for the remainder of the day. Id. Plaintiff
further reported that she does minimal chores, watches an
elderly woman, and watches any kids at her home. AR at 311.
Plaintiff noted that her children do a lot of the chores,
because she cannot, but that she will give pets food and
water if it is not already done. Id. Plaintiff
reported that prior to her conditions, she was a very active
mother who worked full time. Id.
noted that she is awoken every couple of hours due to severe
pain and constant discomfort. Id. Plaintiff
described her clothing choices as “[v]ery simple easy
to put on” and having “to rest in the middle of
[getting dressed.]” Id. Plaintiff reported
that she wears her hair in ponytails or otherwise uses
minimal care. AR at 311. Plaintiff further reported that she
does not need special reminders to take care of personal
needs or to take her medication. Id. at 312.
Plaintiff also reported that she could cook pre-cooked meals,
sandwiches, or TV dinners, and does so once or twice per
week. Id. Plaintiff reported that cooking takes her
no more than a maximum of thirty (30) minutes, whereas prior
to the onset of her conditions she was able to cook complete
meals for her family. Id. Plaintiff described
fatigue, exhaustion, and severe pain as limiting her ability
to cook. Id.
further reported that she does some dishes and one (1) or two
(2) loads of laundry for between ten (10) and fifteen (15)
minutes, two (2) to three (3) times per week. AR at 312.
Plaintiff reported that her family helps her with these
tasks. Id. Plaintiff indicated that she goes outside
daily, either in a car or using public transportation.
Id. at 313. Plaintiff further reported that she
cannot drive regularly due to her anxiety and chronic pain.
Id. Plaintiff also reported that she shops in stores
for groceries once or twice per month for approximately one
(1) to two (2) hours, including breaks. Id.
noted that she can pay bills, count change, handle a savings
account, and use a checkbook or money orders. AR at 313.
Plaintiff described her hobbies as spending time with her
children and reading. Id. at 314. Plaintiff reported
that she tried to do these things daily, but noted that she
can no longer go on long walks due to her pain and
discomfort. Id. Plaintiff indicated that she talks
with her children and boyfriend daily, as well as watching
television. Id. Plaintiff further reported that she
goes to work daily and doctor appointments two (2) to three
(3) times per month. Id. Plaintiff again noted that
she used to work full time and was very active with her
children’s school, as well as at home. AR at 315.
Plaintiff indicated that her conditions affect her ability to
lift, squat, bend, stand, reach, walk, sit, kneel, climb
stairs, complete tasks, and use her hands. Id.
Plaintiff stated that she cannot lift more than ten (10)
pounds; squat; kneel; or use her hands, because she loses her
grip. Id. Plaintiff reported that she can walk for
one-half of a block and then must rest for ten (10) to twenty
(20) minutes before continuing. Id. Plaintiff also
reported that although she does not have trouble with written
instructions or authority figures, she needs reminders
regarding spoken instructions. Id. at 315–16.
Plaintiff further reported that stress causes her pain to
flare-up, and changes in routine take all of her energy. AR
at 316. Plaintiff noted that her diabetes is “super out
of control” and causes dizziness and faintness.
Id. at 317.
February 11, 2015, Plaintiff completed a second Function
Report-Adult. Id. at 341–48. Plaintiff again
noted that she lived in a house with family. Id. at
341. Plaintiff reported that she is unable to be on her feet
too long before they start to hurt, and she takes a lot of
medication “at all hours of the day.”
Id. Plaintiff described her day as spending most of
the time in bed. AR at 342. Plaintiff further reported that
her daughter cared for their pets. Id. Plaintiff
indicated that prior to her conditions she was able to do
“everything, ” including hanging out with friends
and family. Id. Plaintiff reported that she is up
most of the night with pain. Id.
further reported that she needs reminders to shower, and her
boyfriend reminds her to take her medicine. Id. at
343. Plaintiff noted that she does not prepare meals, because
it is too much for her to handle. AR at 343. Plaintiff also
reported that she washes dishes and folds laundry for
forty-five (45) minutes to an hour. Id. Plaintiff
indicated that she does not do other house or yard work due
to the limitations her pain causes. Id. at 344.
Plaintiff reported going out two (2) to three (3) times per
week either riding in a car or using public transportation,
and noted that she does not drive due to pain and dizziness.
Id. Plaintiff further reported constantly falling
and needing help with insulin injections. Id.
reported that she grocery shops once per month for
approximately three (3) hours. AR at 344. Plaintiff confirmed
that she can pay bills, count change, handle a savings
account, and use a checkbook or money orders. Id.
Plaintiff noted that she becomes frustrated because she
misplaces things. Id. at 345. Plaintiff described
her hobbies as sleeping and watching television, which she
does daily. Id. Plaintiff denied spending time with
others, and needing reminders to go places, as well as
someone to go with her. Id. Plaintiff further
reported that her conditions cause irritation and she does
not participate in family functions. AR at 346. Plaintiff
indicated that she can walk for approximately ten (10)
minutes before needing to stop and rest for between twenty
(20) and thirty (30) minutes. Id. Plaintiff reported
that she finishes what she starts and is generally able to
follow both written and spoken instructions. Id.
Plaintiff further reported that she gets along with authority
figures, but does not handle stress or changes in routine
well. Id. at 347. Plaintiff noted that she also
feels depressed and angry. Id.
Work History Report
13, 2014, Plaintiff also completed a Work History Report. AR
at 319–22. Plaintiff listed her prior work experience
as including being a caregiver and a cashier or store clerk.
Id. at 319. Plaintiff described the caregiver
position as staying with an elderly woman and feeding her
through a tube. Id. at 320. Plaintiff reported that
the job did not require the use of machines, tools, or
equipment, but did require technical knowledge or skills, as
well as writing or completing reports or similar duties.
Id. Plaintiff further reported that while working as
a caregiver she walked; stood; climbed; stooped; kneeled;
crouched; crawled; handled, grabbed, or grasped large
objects; reached; and wrote, type, or handled small objects
for approximately two (2) hours per day. Id.
Plaintiff noted that she sat for approximately three (3)
hours per day and the job did not entail any lifting. AR at
320. Plaintiff described the position as requiring her to
lift less than ten (10) pounds frequently, and that this was
also the heaviest weight she lifted. Id.
described her position of store clerk as keeping the store
clean, greeting customers, balancing the register, and making
sure all shelves were stocked. Id. at 321. Plaintiff
reported that she used machines, tools, or equipment for this
position, as well as technical knowledge or skills, and wrote
or completed reports, or performed other similar duties.
Id. Plaintiff further reported that the position
required her to walk and stand for approximately six (6)
hours per day; climb, stoop, crouch, and crawl for
approximately two (2) hours per day; and sit, kneel, handle,
grab, or grasp big objects, reach and write, type, or handle
small objects for approximately one (1) hour per day.
Id. Plaintiff also reported that she lifted and
carried boxes of product to and from shelves. AR at 321.
Plaintiff indicated that she would frequently lift ten (10)
pounds, and the heaviest weight she lifted was twenty (20)
pounds. Id. Plaintiff reported that she was a lead
worker. Id. Plaintiff explained that she worked off
and on at Circle K, quit to raise her daughter, and never
returned due to the deterioration of her health. Id.
had a Disability Report-Appeal completed indicating that she
was “further limited in her ability to stand, sit
upright, [and] [could not] reach at all with [her] [left]
shoulder.” AR at 325. Plaintiff further reported that
her depression and pain continued to worsen. Id.
Plaintiff also noted that she required frequent rest due to
an increase of fatigue resulting from “a combination of
a high medication regimen and chronic, severe, and worsening
pain.” Id. Plaintiff indicated that she could
not complete chores, get dressed, or make food without either
assistance or several rest periods. Id.
Plaintiffs Medical Records
March 22, 2013, Plaintiff underwent an abdominal ultrasound.
AR at 593. Jack Porrino, M.D.’s impression included
hepatomegaly with a “[c]oarsened and nodular hepatic
echotexture is highly suspicious for underlying diffuse
hepatocellular disease/cirrhosis.” Id. Dr.
Porrino further observed a nine (9) millimeter lesion within
the right lobe of the liver with features typical for a
hepatic hemangioma, but recommended further study to exclude
alternative etiologies. Id. On April 17, 2013,
Plaintiff was seen by Guillermo Gonzalez-Osete, M.D. for an
evaluation regarding thrombocytopenia. Id. at
417-19, 618-20. Treatment records indicate that Plaintiff had
blood work that indicated a low platelet count, but she
denies any bleeding, bruising, or nosebleeds. Id. at
417-18, 618-19. Dr. Gonzalez-Osete opined that
Plaintiff’s thrombocytopenia did not require immediate
treatment, but that it would be appropriate to try and
determine its cause. AR at 418, 619.
8, 2013, Plaintiff followed-up with Dr. Gonzalez-Osete
regarding her thrombocytopenia. Id. at 414-16,
615-17. Treatment records indicated Plaintiff’s
medications included metformin, glipizide, NovoLog, Lantus,
pravastatin, aspirin, oxycodone, lisinopril, and lorazepam.
Id. at 414, 615. Dr. Gonzalez-Osete reviewed an
ultrasound of Plaintiff’s liver and noted that it was
enlarged and demonstrated a nodular echotexture. Id.
Dr. Gonzalez-Osete opined that “[t]he hepatomegaly and
the nodular pattern are suspicious for diffuse hepatocellular
disease/cirrhosis.” Id. Dr. Gonzalez-Osete
also noted “a small 9-mm lesion in the right lobe that
is suspicious for a hemangioma.” AR at 414, 615. Dr.
Gonzalez-Osete further opined that Plaintiff’s
thrombocytopenia was mild and did not require treatment.
Id. at 414-15, 615-16.
August 26, 2013, Plaintiff returned to see Dr. Gonzalez-Osete
for a follow-up regarding her thrombocytopenia. Id.
at 412-13, 612-14. Plaintiff denied any bleeding, bruising,
or petechiae. Id. at 412, 612. Dr. Gonzalez-Osete
assessed that Plaintiffs thrombocytopenia was secondary to
cirrhosis and noted her increased risk for hepatocellular
carcinoma. Id. Plaintiffs thrombocytopenia remained
mild and untreated. AR at 413, 613. On January 31, 2014,
Plaintiff was seen by Dr. Gonzalez-Osete. Id. at
March 9, 2014, Plaintiff presented to the Carondelet Health
Network Emergency Department at St. Mary’s Hospital
complaining of pelvic pressure and blood when wiping after
urination. Id. at 440-47. David A. Boswell, M.D.
evaluated Plaintiff, reviewed her laboratory studies, and
found “her symptoms and diagnostic studies [were]
consistent with [a Urinary Tract Infection].”
Id. at 441. Dr. Boswell prescribed Keflex and
Pyridium and discharged Plaintiff home. Id. On March
10, 2014, 2014, Plaintiff was seen by Annette
Hernandez-Parkhurst, M.D. at El Rio Community Health Centers
regarding her pelvic pain. AR at 580-83. Dr.
Hernandez-Parkhurst’s examination was generally
unremarkable except for small genital ulcers. Id. at
582. Cultures were collected for herpes and chlamydia
testing. Id. On March 14, 2014, Plaintiff underwent
mammography screening, which was negative for malignancy.
Id. at 843.
April 11-12, 2014, Plaintiff presented to the Carondelet
Health Network Emergency Department at St. Mary’s
Hospital reporting nausea, vomiting, and diarrhea after
eating a hamburger from Circle K. Id. at 432-439,
976-79. Amy H. Vinik, PA-C’s impression indicated
“[p]robable food poisoning with nausea, vomiting and
diarrhea which has resolved spontaneously.” AR at 433.
Plaintiff was discharged and directed to follow-up with her
primary care doctor in the following two (2) to three (3)
days. Id. On April 25, 2014, Plaintiff saw Ida M.
Heath, RNP at Healthcare Southwest, Inc. for pain management.
Id. at 1209. Plaintiff reported her pain as a six
(6) out of ten (10) and indicated that she fell in mid-March,
injuring her right ankle. Id. Plaintiff also
reported increased anxiety due to family issues. Id.
NP Heath observed tenderness in Plaintiff’s right
shoulder, right ankle, and lower back and hip. AR at 1209.
12, 2014, Plaintiff was seen by Michelle Meyer, M.D. at El
Rio Community Health Center for right eye pain and a cough.
Id. at 550-54. Dr. Meyer assessed a stye and gave
Plaintiff eye ointment, as well as cough medication for her
cough. Id. at 553. Dr. Meyer’s examination was
otherwise unremarkable. Id. at 553-54. On May 28,
2014, Plaintiff saw NP Heath at Healthcare Southwest for pain
management. Id. at 1208. Plaintiff reported working
as a private duty caretaker. AR at 1208. NP Heath observed
shoulder tenderness, low back tenderness at ¶ 5-S1 and
the right paraspinals, and right hip tenderness over the
greater trochanter. Id. Plaintiff also reported that
her pain medications worked well. Id.
25, 2014, Plaintiff was seen by NP Heath at Healthcare
Southwest for pain management. Id. at 791, 1155,
1213. Plaintiff reported “[e]njoy[ing] being back to
work as a caregiver[, ] walks to and from bus stop to go to
work . . . [s]tretches back in morning every day from paper
given here[, ] but . . . is finding that she has more pain in
[right] shoulder and back since she started working.”
Id. NP Heath noted tenderness in Plaintiffs right
shoulder, lower back, and right hip. AR at 791, 1155, 1213.
NP Heath diagnosed lower back pain with pain into right leg
due to disc protrusion and impingement of the L5 nerve root,
right hip pain with minimal degenerative changes, right
shoulder pain with mild degenerative changes, anxiety, and
smoking cessation. Id.
August 7, 2014, Plaintiff was seen by Nikki G. Nakovic, NP at
El Rio Community Health Center regarding musculoskeletal pain
and diabetes. Id. at 768-73. Specifically, Plaintiff
complained of left shoulder pain. Id. at 768. NP
Nakovic’s examination was generally unremarkable,
noting tenderness over Plaintiff’s left supraspinatus
tendon only. Id. at 771. Plaintiff was referred to
physical therapy. Id. at 772. On August 25, 2014,
Plaintiff saw NP Heath for pain management. AR at 1206. NP
Heath noted that Plaintiff walked without difficulty; had
tenderness over the coracoid process of her left shoulder but
with intact range of motion; and tenderness on her spine from
L2-coccyx. Id. NP Heath increased Plaintiffs
Morphine Sulfate Extended Release and decreased her Oxycodone
immediate release to improve Plaintiffs long term pain relief
September 11, 2014, Plaintiff returned to NP Nakovic
regarding her shoulder pain and diabetes. Id. at
762-67. NP Nakovic’s examination of Plaintiff was
generally unremarkable noting continued joint tenderness.
Id. at 762, 764. Plaintiff was urged to make a
physical therapy appointment. AR at 766. On September 25,
2014, Plaintiff saw NP Heath at Healthcare Southwest for pain
management. Id. at 1205. Plaintiff reported having
decreased her work hours due to fatigue. Id.
Treatment records indicated that NP Heath’s notes
regarding this visit were destroyed or taken by Drug
Enforcement Agency (“DEA”) agents. Id.
October 2, 2014, Plaintiff had a Telemed evaluation by
Jonathan Strohl, BHP, NP at COPE Community Services.
Id. at 672, 677-715. Plaintiff reported poor
motivation and depression. AR at 672. NP Strohl reported
Plaintiffs appearance as appropriate; her concentration,
insight, and judgment as fair; affect was anxious; her speech
was normal; mood was anxious and depressed; and she denied
delusions, hallucinations, and homicidal or suicidal ideas,
intent or plan. Id. NP Strohl’s diagnostic
impression noted that Plaintiff “has depression and
anxiety worsened by financial woes and long term use of pain
medication.” Id. NP Strohl further noted
Plaintiffs global assessment of function (“GAF”)
score as 58. Id. On October 23, 2014, Plaintiff saw
NP Heath for pain management. Id. at 1154, 1207.
Plaintiff reported that she was traveling to Houston the
following day to visit family and that Zoloft “ha[d]
made a big difference in [her] mood.” AR at 1154, 1207.
NP Heath observed that Plaintiff walked without difficulty;