Summary
In Orender v. Barnhart, 2002 WL 1747501 (D.Kan. July 16, 2002), the Court considered a similar claim of disability based on fibromyalgia.
Summary of this case from Shumate v. BarnhartOpinion
Civil Action No. 01-2369-KHV
July 16, 2002
MEMORANDUM AND ORDER
Claron Sue Orender brings suit under 42 U.S.C. § 405(g) and 1383(c)(3) seeking judicial review of the Commissioner's decision to deny disability insurance benefits under Title II of the Social Security Act ("SSA"), 42 U.S.C. § 401 et seq. This matter is before the Court on plaintiff's request for relief. See Brief Of Plaintiff (Doc. #14) filed April 15, 2002. For reasons set forth below, plaintiff's motion is sustained.
Procedural Background
On July 7, 1998, plaintiff filed an application for disability insurance benefits, claiming that she had been disabled since October 16, 1996. Tr. 68-71. Plaintiff alleges that she became disabled due to back pain, leg pain, pelvic bone pain, neck pain, loss of strength in hands, headaches and stomach problems. Tr. 92. The Commissioner denied plaintiff's application initially and upon reconsideration. Tr. 55-64. On May 25, 1999, Administrative Law Judge Byron A. Samuelson ("the ALJ") held an administrative hearing at plaintiff's request. Tr. 19. On July 27, 1999, he found that plaintiff was not disabled. Tr. 16-25. On August 11, 1999, plaintiff requested review of the decision by the Appeals Council. Tr. 12-15. On May 30, 2001, the Appeals Council denied plaintiff's request for review, thereby rendering the ALJ decision the final decision of the Commissioner. Tr. 5-6.
Factual Background
The following evidence was presented to the ALJ:
Plaintiff, Claron Sue Orender was 52 years old at the time of the administrative hearing. Tr. 36. She is five feet two inches, weighs 181 pounds and is right handed. Tr. 116, 41. She has a tenth grade education, certified nurses aid ("CNA") training and a CNA certificate. Tr. 20, 36. Plaintiff lives with her husband, Dwight Orender, and her son, daughter-in-law and two grandchildren. Tr. 43-44, 69.
• Medical And Work History
From September 1988 through August 1992, plaintiff worked as a CNA at Shields Adult Care Home. Tr. 78, 85, 123. From October 1992 through December 1992, she worked as a CNA at Sunset Manor and from February 1994 through October 1996, she worked as a CNA at Medical Lodge North. Tr. 79, 85, 123. Her duties as a CNA included caring for the elderly by giving them showers, making beds, feeding clients, lifting clients from their beds to their chairs and helping clients walk. Tr. 86. She monitored daily behavior and daily diet intake of clients. Id. At one of the CNA jobs, she supervised other CNAs two days a week. Id. In 1997, plaintiff started working for Olsten Staffing where she was assigned to work as a general laborer at Superior Industries. Tr. 85. Her duties included reading an X-ray machine, carrying wheels from one spot to another and filling out reports. Tr. 89. After three days, however, she had to quit due to the lifting involved. Tr. 50.
On March 4, 1997, Dr. Gellender diagnosed plaintiff with irritability and spasm in the lower half of the esophagus and evidence of gastroesophageal reflux. Tr. 155. On March 17, 1997 plaintiff started seeing Dr. Herbert Sisk for gastroesophageal reflux. Tr. 128. Dr. Sisk noted irritability of the lower esophagus and prescribed Zantac and Reglan. Id. On March 28, 1997, Dr. Sisk noted that medications helped limit the tenderness in the upper middle portion of the abdomen. Tr. 127. On April 18, 1997, Dr. Sisk noted that plaintiff still had peptic acid type symptoms but that her stomach was much improved. Tr. 126. On May 15, 1997, Dr. Sisk diagnosed hiatal hernia and referred plaintiff to Dr. Lane Lee for surgery. Tr. 125. Dr. Sisk also noted that plaintiff complained of fatigue, blacking out and chest pain that increased with belching. Id.
Gastroesophageal reflux is a condition that causes backflow of the contents of the stomach into the esophagus, which is also known as reflux esophagitis. See Stedman's Medical Dictionary ("Stedman's") 1520 (26th ed. 1995).
A hiatal hernia is a protrusion of a part of the stomach through the esophageal opening of the diaphragm. See Stedman's at 788.
On May 19, 1997, Dr. Lee ordered a 24 hour pH study to measure the level of acid in the esophagus and an esophageal manometry to measure the pressure of gasses in the esophagus. Tr. 145. Dr. Lee used these tests to determine if plaintiff's pain was due to esophageal spasm or gastroesophageal reflux. Id. The study revealed that plaintiff had severe refluxes. Tr. 134. Dr. Lee ordered a laparoscopic nissen fundoplication to diminish her reflux disease. That surgery, which was performed on June 17, 1997, eliminated reflux and allowed pain to be controlled without narcotics. Tr. 145.
A laparoscopic nissen fundoplication is an operation where the fundus (lowest part) of the stomach is sutured around the esophagus to prevent reflux in repair of hiatal hernia. See Stedman's at 694.
In July 1997, plaintiff went to Mt. Carmel Medical Center for a breathing treatment due to pneumonia. Tr. 94.
A year later, on July 23, 1998, plaintiff completed a daily activities form. Tr. 112-17. Plaintiff stated that she cooks meals, does dishes and laundry, takes out trash, dusts and vacuums. Tr. 107. She cares for her grandchildren by fixing meals and bathing and dressing them. Id. Plaintiff shops several hours a week, but requires help to get in and out of the car. Tr. 108. Sometimes she plays cards, Bingo or watches a movie. Tr. 109. She likes to fish, camp and garden, but has not been able to do that recently due to pain. Tr. 106-117. Also on July 23, 1998, plaintiff completed a fatigue questionnaire. Tr. 118. Plaintiff stated that her fatigue had gotten worse over the past two years and that she became tired due to heat and household activities. Id. Due to fatigue, she had to lie down for 30 minutes to an hour every day. Id.
The record contains another daily activities form dated November 20, 1998, which is very similar to the July form. Tr. 106-11. For purposes of brevity, the Court will only set forth the information on the initial form.
On September 23, 1998, the Social Security Administration referred plaintiff to Dr. Robert Thomen. Plaintiff complained to Dr. Thomen of low back pain that started when she fell on ice 14 years earlier, in 1984, and became worse in subsequent months. Tr. 148. She described the pain as sharp, shooting and aching. Id. She also reported headaches, neck, shoulder and occasional chest pain. Id. The pain started after the laparoscopic nissen fundoplication surgery. Id. She also complained of pelvic pain which she had developed in the last two months. Tr. 148. Plaintiff stated that she could sit for only 10 minutes and that she had difficulty with repetitive walking or lifting. Id. She took aspirin for the pain, but had not tried other pain medication. Id. Dr. Thomen took X-rays of plaintiff's pelvis and left hand. Tr. 146-147. The pelvic X-ray revealed a mild narrowing of the interspace of the lower spine. Tr. 146. The left hand X-ray showed mild degenerative joint disease involving the end joints of the second through the fifth fingers. Tr. 147. During the exam, Dr. Thomen noted that plaintiff's range of motion in her neck, back, leg and wrists was normal. Tr. 149. After a musculoskeletal exam he found 11 trigger points in the low back, neck, shoulder blade region, upper back, chest and left elbow. Tr. 149. Dr. Thomen assessed plaintiff as having chronic low back, neck and pelvis pain and obesity. Id. He suspected fibromyalgia and found that due to pain, plaintiff was limited in daily activities such as sitting, walking, lifting and traveling. Id.
Several times, in February of 1999, plaintiff saw Dr. Gellender for treatment of pain and fatigue. Tr. 153. Dr. Gellender prescribed Celebrex for pain in March of 1999. Id. On April 9, 1999, plaintiff visited Dr. Gellender because Celebrex had not relieved her pain. Dr. Gellender diagnosed plaintiff with fibromyalgia and referred her to Dr. Michael Joseph. Tr. 152.
On June 16, 1999, Dr. Joseph examined plaintiff and found multiple trigger points in her neck, back, chest, arms and legs. Tr. 162. He also noted tenderness and limitation of motion when plaintiff extended her left wrist. Id. He diagnosed plaintiff with fibromyalgia that caused muscle aches, malaise, fatigue, insomnia and multiple trigger points. Id. He also found that plaintiff had moderately severe muscle contraction headaches and believed that she suffered from osteoarthritis of her spine, hands, knees and feet. Id.
Osteoarthritis is characterized by erosion of the cartilage in the joints. See Stedman's at 1267.
Upon re-examination on September 4, 1999, Dr. Joseph thought that plaintiff might have an undifferentiated autoimmune disorder or Sjogren type syndrome. Tr. 170. On November 29, 1999, Dr. Joseph again examined plaintiff and found a limitation of motion when she flexed and extended her left wrist. Tr. 168. He found that she had developed arthritis in her left wrist, so he prescribed Ibuprofen. Id.
Sjogren type syndrome is a condition associated with inflammation of the cornea, dryness of the mouth, and connective tissue disease like rheumatoid arthritis. See Stedman's at 1741.
In February of 2000, plaintiff developed bursitis of her left shoulder. This prevented plaintiff from raising her arm above her head or lying on her left side. Tr. 167.
In May of 2000, Dr. Joseph noted that there was tenderness in the middle and end joints of the fingers, wrists, shoulders, lower spine and right hip, as well as loss of strength in the shoulders and limitation of motion in the wrist. Tr. 164. He felt that these symptoms related to plaintiff's osteoarthritis. Id.
• Administrative Hearing
At the administrative hearing on May 25, 1999, plaintiff testified about her disability and daily activities. Tr. 35-52. Plaintiff described her pain as severe — particularly with her headaches, neck and wrist pain. Tr. 38. Twice a week or more often, the pain was so bad that she would have to go to bed for the day. Id. Occasionally, the pain stopped if plaintiff took aspirin or Tylenol. Tr. 38-39. Plaintiff also testified that she occasionally has pain in her left wrist, but her doctors do not know what is causing it. Tr. 39. When the pain flares up, she can not pick up a coffee mug with her left hand. Tr. 40. Taking aspirin or putting heat or cream on her hand helps with the pain. Tr. 40. When the pain recedes, she does activities like washing dishes or dusting. Tr. 40-41. Plaintiff said that she also has leg and foot pain that emanates from her left foot when she walks or stands. Tr. 41. Once or twice a day, she will get relief from this pain by rubbing her foot or soaking it in hot water. Id. Plaintiff has back pain that starts when she reaches, bends over or lifts heavy things. Tr. 42. She can only sit in a chair about 10 to 20 minutes before she needs to get up and move around and she can only stand for about 10 to 20 minutes without pain. Tr. 45. In the past, plaintiff suffered from stomach pain, but it was alleviated by surgery in 1998. Tr. 47, 51.
Plaintiff usually gets up at 5:30 a.m. to fix coffee for her husband and then lays back down until 8:00 or 8:30 a.m. Tr. 43. When plaintiff gets up again, she tries to straighten up the house and fix breakfast for her grandchildren. Id. Plaintiff does most of the cooking but requires help with draining water or using a heavy skillet. Tr. 44. Her daughter-in-law normally helps her. Id. Plaintiff can take care of her own personal needs, but she requires help getting out of the bathtub. Tr. 42. She can drive, but not very far. Tr. 43. Plaintiff can lift about ten pounds with her right hand, but, she can hardly lift anything with her left hand. Tr. 45-46. Plaintiff goes to the grocery store, but requires help carrying the groceries and putting them away. Tr. 49. She watches television in the afternoon and usually falls asleep for 15 to 20 minutes. Tr. 46. Plaintiff does not recall falling asleep; she thinks such episodes are more like "blackouts." Id. Plaintiff normally visits one of her sons for 10 to 15 minutes on the weekend. Tr. 48-49. Plaintiff said that she has not been employed since October 16, 1996 because of pain in her back, neck and hands and a hiatal hernia. Tr. 37.
In his order of July 27, 1999, the ALJ made the following findings:
1. The claimant met the disability insured status requirements of the Act on October 16, 1996, the date the claimant stated she become unable to work, and has acquired sufficient quarters of coverage to remain insured through at least March 31, 2001.
2. The claimant has not engaged in substantial gainful activity since October 16, 1996.
3 The claimant has gastroesophageal reflux disease and possible fibrositis.
4. The claimant's statements concerning her impairments and their impact on her ability to work are not entirely credible.
5. The claimant does not have any impairment which significantly limits her ability to perform basic work-related functions; therefore, the claimant does not have a severe impairment.
6. The claimant has not been under a disability, as defined in the Social Security Act, at any time through the date of this decision.
Tr. 24-25.
Standard Of Review
The ALJ's decision is binding on the Court if it is supported by substantial evidence. See 42 U.S.C. § 405(g); Dixon v. Heckler, 811 F.2d 506, 508 (10th Cir. 1987). The Court must determine whether the record contains substantial evidence to support the decision and whether the ALJ applied the proper legal standards. See Castellano v. Sec'y of HHS, 26 F.3d 1027, 1028 (10th Cir. 1994). While "more than a mere scintilla," substantial evidence is only "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). Evidence is not substantial "if it is overwhelmed by other evidence — particularly certain types of evidence (e.g., that offered by treating physicians) — or if it really constitutes not evidence but mere conclusion." Knipe v. Heckler, 755 F.2d 141, 145 (10th Cir. 1985) (citation omitted).
Analysis
Plaintiff bears the burden of proving disability under the SSA. See Ray v. Bowen, 865 F.2d 222, 224 (10th Cir. 1989). The SSA defines "disability" as the inability to engage in any substantial gainful activity for at least twelve months due to a medically determinable impairment. See 42 U.S.C.A. § 423(d)(1)(A) (1996). To determine whether a claimant is under a disability, the Commissioner applies a five-step sequential evaluation: (1) whether the claimant is currently working; (2) whether the claimant suffers from a severe impairment or combination of impairments; (3) whether the impairment meets an impairment listed in Appendix 1 of the relevant regulation; (4) whether the impairment prevents the claimant from continuing her past relevant work; and (5) whether the impairment prevents the claimant from doing any kind of work. 20 C.F.R. §§ 404.1520, 416.920 (1996). If a claimant satisfies steps one, two and three, she will automatically be found disabled; if a claimant satisfies steps one and two, but not three, then she must satisfy step four. If step four is satisfied, the burden shifts to the Commissioner to establish that the claimant is capable of performing work in the national economy. See Williams v. Bowen, 844 F.2d 748, 751 (10th Cir. 1988).
The ALJ found that plaintiff met step one of the analysis because she has not engaged in substantial gainful activity since October 16, 1996. At step two, however, he found that plaintiff's impairment or combination of impairments were not "severe." Because the ALJ found that plaintiff did not have a severe impairment, the ALJ did not proceed to step three and denied plaintiff's claim for benefits.
Plaintiff argues that the ALJ erred by (1) improperly determining that plaintiff does not have a severe impairment at step two of the analysis, (2) failing to give proper weight to plaintiff's treating physicians, (3) failing to give full weight to the testimony of the plaintiff, and (4) not basing his decision on substantial evidence.
Plaintiff argues that the ALJ made an improper step two determination when he found that she did not suffer from a severe impairment. Plaintiff argues that there is substantial evidence in the record to support a finding of sufficient medical severity which requires the ALJ to continue the five step analysis.
If the evidence makes a de minimis showing of medical severity at step two, the ALJ must proceed to step three. See Francis v. Chater, 974 F. Supp. 1361, 1365 (10th. Cir. 1997). The Secretary has given guidance as to the proper use of step two of the evaluation process.
If an adjudicator is unable to determine clearly the effect of an impairment or combination of impairments on the individual's ability to do basic work activities, the sequential evaluation process should not end with the not severe evaluation step. Rather, it should be continued. In such a circumstance, if the impairment does not meet or equal the severity level of the relevant medical listing, sequential evaluation requires that the adjudicator evaluate the individual's ability to do past work, or to do other work based on the consideration of age, education, and prior work experience.
Social Security Ruling 85-28. Only claimants with slight abnormalities that do not significantly limit any "basic work activity" can be denied benefits without undertaking a vocational analysis. See Bowen v. Yuckert, 482 U.S. 137, 157 (1987).
A severe impairment is one that interferes with basic work activities. See 20 C.F.R. § 404.1521, 416.921. Examples of these activities include walking; standing; sitting; the capacity to see, hear and speak; the understanding and ability to carry out simple instructions; use of judgment; and dealing appropriately with supervision, co-workers and changes in a routine work setting. See 20 C.F.R. § 404.1521. An impairment is not severe if it is only a slight abnormality with a minimal effect on the ability to work. See Soc. Sec. Ruling 85-28.
Plaintiff relied on her testimony and that of her treating doctors to establish that she suffers from a "severe impairment." The Court will examine this testimony to determine whether it supports a conclusion that plaintiff does not have such an impairment.
• Weight Given To The Testimony Of Plaintiff's Doctors
Plaintiff alleges that in determining whether she had a severe impairment, the ALJ failed to give proper weight to the testimony of her treating doctors. Specifically, she argues that the ALJ erred in discrediting Dr. Gellender's opinion because he did not refer to trigger points. She contends that Dr. Gellender's opinion is supported in the record by the opinions of other doctors and is not contradicted by medical evidence. Plaintiff also argues that the ALJ erred in ignoring the medical findings of Dr. Joseph.
Before the ALJ considers any subjective evidence of pain, plaintiff must first "prove by objective medical evidence the existence of a pain-producing impairment that could reasonably be expected to produce the alleged disabling pain." Thompson v. Sullivan, 987 F.2d 1482, 1489 (10th Cir. 1993) (citations omitted). Plaintiff need only establish "a loose nexus between the impairment and the pain alleged." Luna v. Bowen, 834 F.2d 161, 164 (10th Cir. 1987). "If an impairment is reasonably expected to produce some pain, allegations of disabling pain emanating from that impairment are sufficiently consistent to require consideration of all relevant evidence." Id. at 164. Three doctors have diagnosed plaintiff with fibromyalgia. Each doctor acknowledged that plaintiff experienced some pain with this condition. Therefore, all relevant evidence must be considered. Dr. Gellender diagnosed plaintiff with fibromyalgia, but the record contains no evidence of medical tests. The ALJ considered Dr. Gellender's opinion since he was the main treating physician, but the ALJ discounted that opinion because it was not supported by medical tests or reference to positive trigger points.
A medical opinion based on a physician's evaluation of the patient's medical history, observations of the patient, and an evaluation of the credibility of the patient's subjective complaints of pain, is medical evidence supporting a claim of disabling pain, even if objective test results do not fully substantiate the claim. See Nieto v. Heckler, 750 F.2d 59, 61-62 (10th. Cir. 1984); Gatson v. Bowen, 838 F.2d 442, 447-448 (10th Cir. 1988) (medical doctor's clinical assessment is objective medical evidence of disabling pain). Dr. Gellender's opinion does not contradict the other physicians' diagnoses and can be supported by their findings. Therefore his opinion should not be discredited solely for lack of medical tests.
On June 15, 1999, after a musculoskeletal examination, Dr. Joseph noted (1) multiple trigger points in plaintiff's neck, back, chest, arms and legs; and (2) tenderness and limitation of motion in her left wrist. He diagnosed plaintiff with fibromyalgia that manifested itself as diffuse muscles aches, malaise, fatigue, insomnia and multiple trigger points. He opined that plaintiff had muscle contraction headaches that were moderately severe with osteoarthritis of her spine, hands, knees, and feet. Upon re-examination, Dr. Joseph stated that plaintiff remained symptomatic of fibromyalgia and osteoarthritis and had tenderness in several joints and limitation of motion in her left wrist.
The ALJ did not appear to consider Dr. Joseph's opinion. Dr. Joseph treated plaintiff several times. He diagnosed plaintiff with fibromyalgia and multiple trigger points. An ALJ cannot determine that an individual does not have a disability without a full evaluation of all subjective and objective evidence of pain. See Huston v. Bowen, 838 F.2d 1125, 1130 (10th Cir. 1988). The ALJ must consider assessments of subjective pain, at least where they have been made by treating physicians. Id. at 1130. If the ALJ disregards the opinion of the claimant's physician, specific, legitimate reasons for this action must be given. See Byron v. Heckler, 742 F.2d 1232, 1235 (10th Cir. 1984). The record does not show that the ALJ considered Dr. Joseph's opinion. Nor does it give any specific reason why Dr. Joseph's opinion should be disregarded. Dr. Joseph's opinion must be considered before a determination of no disability can be found.
In addition, the record reveals that the ALJ discounted the opinion of Dr. Thomen because he based his findings on subjective information which plaintiff provided. Dr. Thomen took an X-ray of plaintiff's back, however, that showed a mild narrowing of interspace in the spine. An X-ray of her left wrist showed a narrowing of the end finger joints and mild degenerative joint disease. Dr. Thomen also completed a musculoskeletal exam which revealed multiple trigger points. After a musculoskeletal exam, Dr. Thomen found 11 trigger points in plaintiff's low back, shoulder blade region, upper back, chest (both sides), and left elbow. He diagnosed plaintiff with low back, neck and pelvic pain as well as obesity. He also said that plaintiff was limited in activities due to pain, and he suspected fibromyalgia.
The ALJ noted that Dr. Thomen's opinion contradicts information which plaintiff provided in a daily activities questionnaire. In the questionnaire, plaintiff reported caring for her grandchildren four to eight hours a day, doing laundry, washing dishes, cooking, dusting, vacuuming and taking out trash. She said that she shopped for groceries and went to thrift stores and that she enjoyed fishing, camping and gardening. Plaintiff did note that she needed help doing these daily activities. She testified that she cannot lift heavy pots while cooking or heavy bags when shopping. She needs help getting in and out of a car, carrying heavy baskets of laundry and hanging up clothes. In addition, she said that she has not been able to go fishing or camping or do gardening due to pain. Even if plaintiff's testimony of pain during these activities is not considered, "the ALJ may not rely on minimal daily activities as substantial evidence that a claimant does not suffer disabling pain." Thompson v. Sullivan, 987 F.2d 1482, 1490. The "sporadic performance [of household tasks or work] does not establish that a person is capable of engaging in substantial gainful activity." Thompson, 987 F.2d at 1490 (10th Cir. 1993) (citing Fry v. Bowen, 816 F.2d 508, 516 (10th Cir. 1987).
The record therefore reveals testimony from three doctors that plaintiff suffered from a severe impairment. Based on this evidence, the ALJ should have determined that plaintiff had a severe impairment and considered plaintiff's subjective complaints of pain.
• Credibility Of Plaintiff's Testimony
Plaintiff argues that the ALJ failed to make proper credibility findings regarding her testimony about the limitations caused by her pain. The Tenth Circuit has set forth the proper framework for analyzing evidence of disabling pain. The relevant factors are: (1) whether claimant proves with objective medical evidence an impairment that causes pain; (2) whether a loose nexus exists between the impairment and the subjective complaints of pain; and (3) whether the pain is disabling based upon all objective and subjective evidence. See Glass v. Shalala, 43 F.3d 1392, 1395 (10th Cir. 1994); Luna v. Bowen, 834 F.2d 161, 163-164 (10th Cir. 1987). In the final step, the ALJ should consider the levels of medication and their effectiveness, the extensiveness of the attempts (medical or nonmedical) to obtain relief, the frequency of medical contacts, the nature of daily activities, subjective measures of credibility that are peculiarly within the judgment of the ALJ, the motivation of and relationship between the claimant and other witnesses and the consistency or compatibility of nonmedical testimony with objective medical evidence. See Huston v. Bowen, 838 F.2d 1125, 1132 (10th Cir. 1988).
The determination of credibility is left to the observations of the ALJ and are generally considered binding on the reviewing court. See Broadbent v. Harris, 698 F.2d 407, 413 (10th Cir. 1983). The ALJ found that plaintiff's statements concerning her impairments and ability to work were not entirely credible. The record contains sufficient evidence to support this finding. The ALJ noted inconsistencies in the record. Plaintiff testified that aspirin was her only pain reliever, and the absence of stronger pain medication contradicts her statement of disabling pain. The ALJ also noted that plaintiff did not seek medical treatment from June 30, 1997 until February 11, 1999. Plaintiff's failure to seek medical attention supports a finding that plaintiff's statements were not entirely credible.
While plaintiff's testimony may not be entirely credible, her allegations of pain are supported by physicians who have treated her over time. Therefore, the ALJ's credibility determination should not have ended the analysis of disability at stage two of the analysis.
IV. Conclusion
The record contains insufficient evidence to support the ALJ's finding that plaintiff does not suffer from a severe impairment or combination of impairments. Plaintiff satisfied the initial burden of showing objective medical evidence that she has an impairment that more than minimally affects her ability to do basic work functions. Three physicians diagnosed plaintiff with fibromyalgia that produces pain and limits her range of motion in her wrist. The ALJ's credibility determination at this stage is not sufficient to end the analysis. This case is remanded to proceed through the sequential evaluation.
IT IS THEREFORE ORDERED that plaintiff's request for relief, (see Brief of Plaintiff (Doc. #14)) filed April 15, 2002 be and hereby is SUSTAINED.
IT IS FURTHER ORDERED that the Commissioner's decision to deny plaintiff social security benefits is REVERSED AND REMANDED.