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Crocker v. Colvin

United States District Court, E.D. Virginia, Alexandria Division

April 21, 2016

CAROLYN W. COLVIN, Acting Commissioner, Social Security Administration, Defendant.


John F. Anderson United Stales Magistrate Judge

This matter is before the court on cross-motions for summary judgment. Plaintiff seeks judicial review of the final decision of Carolyn W. Colvin, Acting Commissioner of the Social Security Administration ("Commissioner"), denying plaintiffs claim for Disability Insurance Benefits ("DIB") and Supplemental Security Income ("SSI") under Titles II and XVI of the Social Security Act. See 42 U.S.C. §§ 423, 1382. The Commissioner's final decision is based on a finding by the Administrative Law Judge ("ALJ") and Appeals Council for the Office of Disability Adjudication and Review ("Appeals Council") that claimant was not disabled as defined by the Social Security Act and applicable regulations.[1]

On January 28, 2016, plaintiff filed a motion for summary judgment (Docket no. 14) and memorandum in support (Docket no. 15). Thereafter, the Commissioner submitted a cross-motion for summary judgment (Docket no. 16), memorandum in support (Docket no. 17), and memorandum in opposition (Docket no. 18). The two briefs submitted on behalf of the Commissioner are identical. (Docket nos. 17, 18). Plaintiff submitted her reply brief on March 11, 2016. (Docket no. 22). For the reasons set forth below, plaintiffs motion for summary judgment (Docket no. 14) will be denied; the Commissioner's cross-motion for summary judgment (Docket no. 16) will be granted; and the Commissioner's final decision will be affirmed.


Plaintiff applied for DIB and SSI on February 13, 2012 and February 28, 2012, respectively, with an alleged onset date of November 17, 2009. (AR 78-79, 180-92). The Social Security Administration denied plaintiffs claims initially (AR 57-79, 114-35) and on reconsideration (AR 80-109, 138-51). After receiving the notices of denial, plaintiff requested a hearing before an ALJ.[2] (AR 152-53). The Office of Disability Adjudication and Review acknowledged receipt of plaintiff s request (AR 154-58) and scheduled the matter for a hearing on April 21, 2014.

On April 21, 2014, ALJ Timothy Wing held a telephonic hearing in Wilkes Barre, Pennsylvania. (AR 28). Plaintiff appeared telephonically with her representative Megan Dawson.[3] (Id). On June 9, 2014, the ALJ issued a decision denying plaintiffs claims for disability under the Social Security Act. (AR 10-22). In reaching this decision, the ALJ concluded that plaintiff was not disabled under either Title II (sections 216(i) and 223(d)) or Title XVI (section 1614(a)(3)(A)) of the Social Security Act.

On July 9, 2014, plaintiff filed a request for review with the Appeals Council. (AR 8-9). On July 28, 2014, the Appeals Council granted plaintiffs request for more time to provide additional information or argument. (AR 6-7). On August 18, 2014, plaintiff provided a brief on her behalf to the Appeals Council, objecting on a number of grounds to the ALJ's decision. (AR 264-68). On July 23, 2015, the Appeals Council denied plaintiffs request for review. (AR 1-5). As a result, the decision rendered by the ALJ became the final decision of the Commissioner. See 20 C.F.R. §§ 404.981, 416.1481.

On September 23, 2015, plaintiff filed a complaint in the U.S. District Court for the Eastern District of Virginia, seeking judicial review pursuant to 42 U.S.C. § 405(g). (Docket no. 1). Thereafter, the parties agreed to refer this matter to the undersigned magistrate judge for resolution. (Docket no. 23). This case is now before the court on cross-motions for summary judgment. (Docket nos. 14, 16).


Under the Social Security Act, the court's review of the Commissioner's final decision is limited to determining whether the decision was supported by substantial evidence in the record and whether the correct legal standard was applied in evaluating the evidence. See 42 U.S.C. § 405(g); Hays v. Sullivan, 907 F.2d 1453, 1456 (4th Cir. 1990). Substantial evidence means "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Hays, 907 F.2d at 1456 (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). While the standard is high, where the ALJ's determination is not supported by substantial evidence on the record, or where the ALJ has made an error of law, the district court must reverse the decision. See Coffman v. Bowen, 829 F.2d 514, 517 (4th Cir. 1987).

In determining whether the Commissioner's decision is supported by substantial evidence, the court must examine the record as a whole, but may not "undertake to re-weigh the conflicting evidence, make credibility determinations, or substitute [its] judgment for that of the Secretary." Mastro v. Apfel, 270 F.3d 171, 176 (4th Cir. 2001) (alteration in original) (citing Craig v. Chater, 76 F.3d 585, 589 (4th Cir. 1996)). The Commissioner's findings as to any fact, if the findings are supported by substantial evidence, are conclusive and must be affirmed. See Perales, 402 U.S. at 390. Moreover, the Commissioner is charged with evaluating the medical evidence and assessing symptoms, signs, and medical findings to determine the functional capacity of the claimant. See Hays, 907 F.2d at 1456-57. Overall, if the Commissioner's resolution of conflicts in the evidence is supported by substantial evidence, the district court must affirm the decision. See Laws v. Celebrezze, 368 F.2d 640, 642 (4th Cir. 1966).


A. Plaintiffs Age, Education, and Employment History

Plaintiff was born in 1962 and was fifty-one years old at the time of the ALJ's decision. (AR 20, 22, 180). Plaintiff left school in 1976, having completed the eighth grade (AR 217), her highest level of schooling (AR 36). Plaintiff reports that she did not complete any additional training or specialized schooling. (AR 217). Plaintiff identifies working as a feeder on a pig farm from the summer of 1995 through the winter of 1996, from 1998 through 1999, and again from March 2005 through January 2006. (AR 205, 257). Subsequently, plaintiff identifies working in a warehouse as a packager from September 2006 through December 2006, September 2007 through January 2008, September 2008 through January 2009, and September 2009 through November 2009.[4] (AR 205, 258). Plaintiffs last day of employment was November 6, 2009. (AR257).

Plaintiff currently resides in Virginia with her husband and grandson. (AR 37).

B. Summary of Plaintiffs Medical History[5]

Plaintiffs submitted medical records contain treatment notes beginning in 2009. (AR 456). On February 9, 2009, plaintiff presented at the Horizon Health Services, Waverly Medical Center ("Waverly Medical Center") for a refill of her blood pressure medication. (Id). Plaintiff indicated that she was doing well and had no complaints of shortness of breath, chest pain, dizziness, or headaches. Plaintiff stated that she was taking her medications as prescribed, but continued to have some arthritic pain in her hands and knees. (Id). Treatment notes indicate that plaintiff had a history of rheumatoid arthritis and was having some stiffness and pain. (Id.). Further, plaintiff indicated that she was concerned about her right thumb because it was very swollen and painful. (Id). Plaintiff stated that naproxen works well for her arthritis, but that the medication can upset her stomach. (Id.). Finally, plaintiff indicated that her blood pressure medication did not cause her to experience any side effects. (Id). Valeri L. Jaskowski, N.P. ("Nurse Jaskowski") examined plaintiff and indicated that her right thumb was very swollen on the first and second joint, was warm to the touch, red, tender, and had limited range-of-motion due to pain and swelling. (AR 457). Nurse Jaskowski assessed the plaintiff with benign hypertension and rheumatoid arthritis and recommended that plaintiff continue amlodipine and captopril for her hypertension and that she continue taking Tylenol and Ultram, stop naproxen, and start prednisone to treat her rheumatoid arthritis. (Id). Nurse Jaskowski recommended that plaintiff follow up in four months with George C. Coleman, MD ("Dr. Coleman") for routine follow-up regarding her hypertension. (Id.).

On November 6, 2009, plaintiff sought treatment at Sentara Obici Hospital ("Sentara Obici") in Suffolk, Virginia for significant rectal bleeding and was transferred and admitted to Sentara Norfolk General Hospital ("Sentara Norfolk") in Norfolk, Virginia. (AR 546). Plaintiff underwent a bleeding scan upon arrival, which showed a source of the bleeding in her right colon. (AR556). The bleeding appeared to resolve itself. (Id.). However, on plaintiff s third into fourth day at Sentara Norfolk, she developed further rectal bleeding. (Id.). After additional testing, an embolization angiography was performed, after which, plaintiffs bleeding appeared to again resolve. (Id.). Plaintiff was discharged on November 13, 2009 with no activity restrictions and with directions to follow up with her primary-care provider.[6] (AR 558).

Plaintiff next followed up with Dr. Coleman at Waverly Medical Center on January 6, 2010. (AR 459). Plaintiff represented to Dr. Coleman that she was not taking her prescribed medications because she had none, but did indicate that she was exercising one to three times per week. (Id.). Dr. Coleman assessed that the plaintiff was continuing to suffer from hypertensive disease and had an acute respiratory infection at multiple sites. (Id.). Dr. Coleman prescribed a treatment regime of Lisinopril for plaintiffs hypertension and medication for plaintiffs respiratory infection. (AR 459-60). Treatment notes also indicate an order to stop taking captopril, prednisone, Ultram, Tylenol, and amlodipine, and finally, to follow up in four months. (AR 460). Following additional testing, Dr. Coleman indicated that plaintiffs lipid panel was okay and indicated that plaintiff should adhere to a heart-healthy diet and be as physically active as she could be, that plaintiffs blood count showed no anemia, and that plaintiffs blood chemistry was okay. (AR 462-63).

A little over six months later, plaintiff followed up with Dr. Coleman at Waverly Medical Center on July 20, 2010. (AR 461). Plaintiff reported that she was taking her medications- Lisinopril and cough and cold medications-as prescribed and reported that she checks her blood pressure at home once per day. (Id). Plaintiff also reported that she was engaging in exercise and physical activity five times per week. (Id). Dr. Coleman assessed plaintiff with hypertensive disease, gastrointestinal vessel anomaly ("GVA"), and menopausal and postmenopausal disorder ("MPD"), and indicated that plaintiff should continue Lisinopril for her hypertension and ordered lab work to assess plaintiffs GVA and MPD. (AR 463). Dr. Coleman also indicated that plaintiff should stop taking the cough and cold medications and that plaintiff would be next due for a routine follow-up visit in January 2011. (Id.).

Plaintiff appeared at her follow-up appointment with Dr. Coleman on January 21, 2011. (AR 468). Plaintiff reported that she was doing well and that she exercised at home using a stationary bike and treadmill, but that she did not do so regularly. (Id.). Treatment notes further indicate that plaintiff reported no problems with her knees or back. (Id). Plaintiff reported that she continued to take Lisinopril for hypertension. (Id.). A physical examination indicated that plaintiff experienced some pain when her hip was moved into a flexion position, but none when the hip joint was rotated-the range of motion was full. (AR 469). Plaintiff also did not report any pain upon examination of her knees. (Id.). Dr. Coleman assessed plaintiff as having hypertension and benign neoplasm large bowel, and treatment notes indicate that Lisinopril was to be refilled and a basic metabolic panel, cholestech lipid, and cholestech ALT/AST labs were run. (AR 470). Also listed under "treatment" was information regarding exercising at a training heart rate of 65-75% of plaintiff s maximum heart rate. (Id). Plaintiff was advised to return in May 2011 for a routine follow-up appointment.

Plaintiff next followed up with Waverly Medical Center for hypertension on July 8, 2011. (AR 472). Plaintiff reported that she was doing very well and was going to a gym, which seemed to help with stress and controlling her hypertension. (Id.). Plaintiff complained, however, of a very heavy menstrual cycle, which left her with significantly decreased energy upon occurrence. (Id). Plaintiff also indicated that she was taking Lisinopril and a multivitamin. (Id.). Dr. Coleman described plaintiff as well-appearing. (AR473). Dr. Coleman assessed plaintiff as continuing to suffer from hypertension and refilled her Lisinopril prescription and also ordered a metabolic panel. (AR 474). Plaintiff and Dr. Coleman also discussed the issues concerning her menstrual cycle, and Dr. Coleman indicated that they should be evaluated. To that end, plaintiff indicated she preferred to have her follow-up with Sussex Health Department and would make an appointment. (Id.). Plaintiff was again advised to return in six months for a follow-up appointment.

Plaintiff next presented at the Waverly Medical Center on October 24, 2011 for pain in her right foot. (AR 475). Plaintiff indicated that when she was playing with children in July 2011, she stepped in a hole and twisted her ankle. (Id.). Lois Brown, N.P. ("Nurse Brown") examined plaintiff and advised that she should start taking Naprosyn for her ankle pain, have varying labs drawn, and have an x-ray taken of her right foot. (AR 476). An x-ray of plaintiff s right foot was negative for fracture or dislocation and showed minimal hallux valgus of the great toe and degenerative plantar calcaneal spurring, but was otherwise normal. (AR 645).

On November 13, 2011, plaintiff presented at Sentara Norfolk Emergency Department with rectal bleeding and was admitted that day. (AR 570). Plaintiff underwent a colonoscopy, which found pancolonic diverticulosis with an active bleed in the ascending colon. (AR 571). Plaintiff reported that she had no prior instances of rectal bleeding between her prior 2009 hospital admittance and this occasion. (AR 594). Plaintiff was treated with an epinephrine injection and two clips. (AR 571). Plaintiff also began to experience heavy menstrual bleeding during her hospital admission, and as a result, her hemoglobin and hematocrit levels were monitored. (Id.). Plaintiff indicated that she was short of breath and had experienced shortness of breath upon exertion over the past two years. (Id.). Plaintiff was transfused three units of packed red-blood cells, which improved her hemoglobin and hematocrit levels and overall symptoms. (Id.). Electrocardiogram and echocardiogram tests were benign. {Id). On November 18, 2011, plaintiff was discharged following normal bowel movements and the absence of any bleeding or symptomatic anemia. (Id.). Plaintiff was advised about a high-fiber diet and a healthy lifestyle and was told to follow up with Dr. Coleman in two weeks. (Id.). Plaintiff was not put on any activity restrictions upon discharge (AR 573), but was advised to start taking omeprazole, along with continued use of Tylenol and Lisinopril (AR 628).

Plaintiff presented at Waverly Medical Center on December 8, 2011 for a follow-up visit. (AR 478). Nurse Brown examined plaintiff. Plaintiff stated that she felt fine, but that she tires quickly and always feels tired. (Id.). Nurse Brown indicated that plaintiff had no dyspnea on exertion and no shortness of breath. (Id.). Plaintiff identified that she was taking a multivitamin, Lisinopril, omeprazole, and Tylenol arthritis. {Id.). Nurse Brown assessed plaintiff as suffering from anemia due to acute blood loss, gastrointestinal vessel anomaly, hypertensive disease, and menometrorrhagia. (AR 479). Nurse Brown's plan to treat these ailments included plaintiff starting ferrous sulfate tablets and vitamin C and continuing to take a multivitamin to treat plaintiffs anemia, continue omeprazole to treat plaintiffs gastrointestinal vessel anomaly, continue Lisinopril to treat plaintiffs hypertensive disease, and a referral to a gynecologist to treat plaintiffs menometrorrhagia. (Id). Plaintiff was to follow up in one week, which she did on December 15, 2011. (AR 481). On that date, plaintiff again indicated that she was feeling very fatigued and that her menstrual cycle came on when she was stressed and ceased when she rested. (Id). Nurse Brown assessed plaintiff as again suffering from anemia due to acute blood loss, and ordered that she continue taking ferrous sulfate tablets, Vitamin C, and a multivitamin with folic acid. (AR 482). Nurse Brown indicated that plaintiff should continue taking Lisinopril and follow up in four weeks. (Id.).

On January 23, 2012, plaintiff presented at Waverly Medical Center for her four-week follow-up. (AR 483). She reported that she was a little off balance and that after sitting for a while, she is unsteady on her feet upon standing. (Id.). Plaintiff indicated that these symptoms had been present since she left the hospital in November 2011. Again, a review of plaintiff s symptoms revealed no dyspnea on exertion and no shortness of breath. (Id.). Nurse Brown assessed plaintiff as continuing to suffer from anemia due to acute blood loss and hypertensive disease and ordered that a complete blood count ("CBC") with differential be performed on plaintiff. (AR484). Plaintiff was to follow up in two months.

Two months later, on March 19, 2012, plaintiff presented at Waverly Medical Center for her follow-up. (AR 485). Plaintiff indicated that she was experiencing numbness and tingling in her left hand, had been having shortness of breath and palpitations on and off since 2009, and finally, had been under a lot of stress over the last month. (Id.). A physical examination by Nurse Brown identified that plaintiff had a full range of motion without pain in her back and spine. (AR 486). Plaintiff also had a full range of motion throughout her upper- and lower-extremity joints. (Id). Plaintiff s gait was also normal. (Id.). Nurse Brown assessed that plaintiff had anemia due to acute blood loss, hypertensive disease, tingling in extremities, palpitations, edema, and anxiety. (Id.). Nurse Brown ordered various blood-work labs, as well as a referral to neurology for the numbness in plaintiffs left side. (AR 486-87). Plaintiff was also referred to counseling services for anxiety and ordered to return for a follow-up in two months. (AR487).

Also on March 19, 2012, Nurse Brown completed a "residual functional capacity questionnaire."[7] (AR 270). In this questionnaire, Nurse Brown identified that plaintiff suffered from palpitations, numbness, tingling, and edema. (Id.). Nurse Brown opined, inter alia, that plaintiff could walk less than one city block without rest or significant pain; could sit for 60 minutes at a time; could stand/walk for 15 minutes at a time; could sit for eight hours a day; and stand/walk for four hours a day. (Id.). Nurse Brown also opined that plaintiff could occasionally lift and carry less than 10 pounds, but never 20 pounds. (AR 271). She also identified that plaintiff could use her right hand, right-hand fingers, and right arm for 100% of an eight-hour workday for grasping, turning, and twisting objects; fine manipulation; and reaching, respectively. She identified, however, that plaintiff could only use her left hand, left-hand fingers, and left arm for 10% of the time during an eight-hour workday for the same categories of function. (Id). Also, Nurse Brown concluded that plaintiff was likely to be absent from work more than four times per month as a result of her impairments. (Id.). Plaintiff was also identified as needing a psychological evaluation. (Id.).

On March 22, 2012, plaintiff sought treatment at Central Virginia Health Services ("CVHS") after being referred for psychological services. (AR 275). Plaintiffs Lisinopril was increased to 20 mg per day and she was given a prescription for Celexa for depression, as well as trazodone for insomnia. (275-76). A physical examination showed that plaintiff had a full range of motion in her back and a straight-leg raise was negative. (AR 275).

On March 29, 2012, plaintiff presented at VCU Medical Center ("VCU") in Richmond, Virginia for menometrorrhagia. (AR 311). An endometrial biopsy was performed (AR 299) and was negative for endometrial cancer (AR 297). Plaintiff was started on Provera for the first ten days of the month and blood work was also ordered. (AR 311). A physical exam showed a normal range of motion and strength in plaintiffs musculoskeletal system. (Id.). Plaintiff followed-up with VCU on April 19, 2012 and reported that she was doing well, with much improvement and minimal bleeding. (AR 294, 297).

On May 3, 2012, plaintiff presented for follow-up treatment at CVHS for hypertension and depression. (AR 272). Plaintiff indicated that she had been compliant in taking her medications and that she had no chest pain, shortness of breath, or dizziness. (Id). Plaintiff also reported that she had no numbness or tingling of lower extremities. (Id.). Plaintiff also stated that the joint pain she experiences in the morning in her hands and knees had gotten worse and indicated that when she rests, the pain resolves, but exacerbates with activities throughout the day. (Id.). Plaintiff finally reported that she takes Tylenol arthritis, but had not currently found any and that her insomnia had improved. (Id.). A physical examination indicated that plaintiff had a full range of motion in her back and in her knees, with no edema. (Id.). Plaintiff also had a full range of motion in her wrists, which were nontender on palpation. (Id.). Treatment notes indicate that plaintiffs hypertension was stable with her current medication and that she was to monitor the amount of salt in her diet and exercise as tolerated. (Id). Plaintiff was also to continue her current medication for insomnia and was given a trial of diclofenac for her joint pain. (Id.). Finally, plaintiff identified that her depression was much improved, and treatment notes indicate that she was to continue with her current medications. (AR 273).

On May 18, 2012, plaintiff presented at VCU for her annual exam. (AR 288). She represented that she was doing well and that her bleeding had greatly improved. (AR 285, 288). Treatment notes indicate that plaintiffs hypertension was controlled with Lisinopril, her diabetes was controlled with diet, her gastro-esophageal reflux was controlled with omeprazole, and her diverticulosis was stable. (AR 288).

On May 30, 2012, plaintiff followed up with Nurse Brown at Waverly Medical Center. (AR 488). Nurse Brown's progress notes indicate that plaintiff complained of right-hand pain that had been present for one week. (Id). Plaintiff stated that for three days, she could not close her hand and that the pain radiates up her right arm to her head. She also indicated that she used an arm brace to help with the discomfort and had been taking Tylenol arthritis and diclofenac, which helped somewhat with the pain. (Id.). Nurse Brown's physical examination showed that plaintiff had a limited range of motion with pain on left lateral bending and flexion and the right side of her back was tender to palpation. (489). Nurse Brown assessed plaintiff with neck pain and numbness and tingling in her right hand and indicated that plaintiff should begin taking Flexeril and undergo an x-ray of her spine and back. (Id.).

The following day, May 31, 2012, plaintiff underwent an x-ray of her spine. (AR 315, 539). The x-ray showed "no malalignment" and "[n]o fracture." (AR 315, 539). The x-ray report further identified that "[t]here are prominent partially bridging anterior osteophytes at C5-C-6" and "mild disc narrowing at C5-C6." (AR 315, 539). Also, the report stated that "[t]he neural foramina are patent, " "[f]acet joints are maintained, " and "[t]he odontoid is normal." (AR 315, 539). The overall impression showed "[c]ervical spondylosis with mild disc narrowing at C5-C6." (AR 315, 539).

Dr. Coleman's progress notes indicate that plaintiff next followed up at Waverly Medical Center on June 8, 2012 for her hypertension and anemia. (AR 491). Plaintiff indicated that she was taking her medications as prescribed. Dr. Coleman's physical examination does not appear to note any abnormal findings; Dr. Coleman noted that plaintiff was well-appearing. (AR 493). Dr. Coleman assessed plaintiff as continuing to have hypertensive disease, anemia due to acute blood loss, gastrointestinal vessel anomaly, and anxiety associated with depression. (Id.). Plaintiff was instructed to continue taking 20 mg of hydrochlorothiazide-lisinopril, omeprazole, trazadone, diclofenac enteric, medroxyprogesterone, cyclobenzaprine, and additional blood work was ordered. (493-94). Plaintiff was further instructed to stop taking Flexeril and the lower dose of Lisinopril. (Id.).

Plaintiff next sought treatment from Waverly Medical Center on June 28, 2012. (AR 495). Nurse Brown's treatment notes indicate that plaintiff presented for right-hand pain that had been present since May 2012 and indicated that pain radiates from her finger tips to her right shoulder, back of neck. (Id.). Plaintiff further indicated that neck exercises help, but the pain returns. Nurse Brown assessed plaintiff as having arm pain, weakness of muscles, gait abnormality, spondylosis, and numbness and tingling of her right arm. (AR 496). Nurse Brown instructed that diagnostic imaging, consisting of an EMG, electromyogram, and nerve conduction study, be conducted for plaintiffs weakness of muscles. Nurse Brown further instructed plaintiff to begin using a cane as directed and have a CT scan conducted of her head, with and without contrast. (Id.).

ACT scan was performed on June 29, 2012 by Southside Regional Medical Center ("SRMC"). (AR 321, 540). The report indicates that "axial images from the skull base to the vertex were obtained prior to and following intravenous contrast administration." The impression notes that there was a "[s]ubtle area of low density in the left parietal lobe deep to the gray matter. This could be artefactual. Possibility of old ischemia cannot be excluded. Amass is felt to be less likely. Recommend follow[-]up as clinically warranted." (AR 321, 540-41).

Plaintiff next presented at Waverly Medical Center on July 9, 2012 for right-arm pain and numbness. (AR 498). Plaintiff identified that she had some paresthesia on the right side of her face, but that it had resolved. (Id). She also identified that she had chronic intermittent weakness in her legs. (Id.). Dr. Coleman assessed that plaintiff should have an MRI done of her brain, with and without contrast, to assess the right-sided muscle weakness. (AR 500). Dr. Coleman also indicated, after conducting a Phalen's sign test that was positive, that findings suggested that plaintiff had carpal tunnel syndrome, but this was uncertain. (Id.). He further instructed plaintiff to start taking aspirin, as well as continuing her other medications. (Id.).

On July 10, 2012, plaintiff underwent a nerve-conduction study at SRMS. (AR 319, 529-30, 534-35). The report indicated that plaintiffs study was "normal." (AR 319, 529-30).

On July 19, 2012, plaintiff also underwent an MRI. (AR 322, 528, 533). The report noted that it was a "normal exam" and identified plaintiff as suffering from chronic pansinusitis. (AR 322, 528, 533).

On August 1, 2012, plaintiff was seen by Dr. Pavani Guntur ("Dr. Guntur") at VCU Health System, Neurology ("VCU Neurology") in Richmond, Virginia. (AR 429-32). Dr. Guntur reviewed plaintiffs MRI and nerve-conduction study. (AR 432). Dr. Guntur assessed plaintiff as having "peripheral neuropathy ... in the setting of longstanding [diabetes mellitus] with diet control" and indicated that an EMG of plaintiffs lower extremities would be beneficial. (Id.). Dr. Guntur's attending physician, Dr. James Bennett, assessed that plaintiff "likely has non-painful diabetic neuropathy" and agreed with the ordering of an EMG. (AR 428).

On August 10, 2012, plaintiff was seen by Dr. Sari Eapen ("Dr. Eapen"), at the request of the Virginia Department of Rehabilitative Services, for a complete medical evaluation "due to rheumatoid arthritis, carpal tunnel [syndrome], diabetes[, ] and hypertension." (AR 324). A physical examination revealed, inter alia, that plaintiff had "[f]ull range of motion of the cervical spine, both shoulders, elbows[, ] and wrists. Grip strength 4/5 on right, 5/5 on left side. Tinel sign negative at right wrist for median nerve. Phalen['s] sign negative on right." (AR 326). The examination also ...

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