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At a Glance:
Title:
Baker v. Colvin
Date:
April 20, 2015
Citation:
4:14-CV-0231
Status:
Unpublished Opinion

Baker v. Colvin

United States District Court, S.D. Texas, Houston Division.

Donna BAKER, Plaintiff,

v.

Carolyn W. COLVIN, Acting Commissioner of the Social Security Administration, Defendant.

Civil Action No. 4:14-CV-0231

|

Signed 04/20/2015

Attorneys & Firms

Howard David Olinsky, Olinsky Law Group, Syracuse, NY, for Plaintiff.

Corey Stephen Fazekas, US Social Security Administration, Dallas, TX, for Defendant.

ORDER

VANESSA D. GILMORE, UNITED STATES DISTRICT JUDGE

*1 Pending before the Court is Plaintiff Donna Baker(“Plaintiff” or “Baker”)’s Motion for Summary Judgment. (Instrument No. 9). Also pending before the Court is Defendant Carolyn W. Colvin (“Defendant” or “Commissioner”)’s Motion for Summary Judgment. (Instrument No. 10).

I.

A.

Plaintiff Baker brings this action to review a final order from the Commissioner of the Social Security Administration (“Administration”), pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). (Instrument No. 1, at 1). Baker seeks a reversal of the Commissioner’s final decision denying Baker disability benefits under the Social Security Act (“SSA”). (Instrument No. 1, at 2). In the alternative, Baker seeks a remand of the case for additional administrative proceedings. (Id.).

B.

Baker filed for disability insurance benefits and supplementary security income under Titles II and XVIII of the SSA on August 3, 2011. (Instrument No. 7-6, at 2). In her application, Baker alleged a period of disability beginning on October 2, 2008. (Id.). Baker’s claim was initially denied on January 11, 2012, and denied again upon reconsideration on March 5, 2012. (Instrument No. 7-5, at 4, 20). Baker requested an administrative hearing, which was held before Administrative Law Judge (“ALJ”) Richard A. Gilbert on December 13, 2012. (Instrument No. 7-3, at 40). On February 8, 2013, the ALJ found that Baker was not disabled. (Instrument No. 7-3, at 24-35). On February 27, 2013, Baker requested a review of the ALJ’s decision by the Appeals Council. (Instrument No. 7-3, at 20). On March 14, 2014, the Appeals Council denied Baker’s request, making the ALJ’s decision the Commissioner’s final decision. (Instrument No. 7-3, at 4-6). Pursuant to her right to judicial review, Baker filed this action under 42 U.S.C. §§ 405(g) and 1383(c)(3). (Instrument No. 9-1, at 6).

C.

Baker was born on August 1, 1968, and was 40 years old at the onset of her alleged disability. (Instrument No. 7-6, at 2). Baker testified that she completed the eleventh grade and that she does not have a General Equivalency Diploma. (Instrument No. 7-3, at 44). From September 2005 to November 2008, Baker worked as a server in a school cafeteria. (Instrument No. 7-7, at 23). Prior to that, Baker worked in various secretarial and customer service positions. (Instrument No. 7-7, at 23).

D.

Baker suffers from the following severe impairments: cervical and lumbar disease, radiculitis,1 mild L5 root irritation,2 spondylosis of the cervical spine,3 degenerative disc disease (DDD) and disc protrusion of the lumbar spine,4 hypertension,5 fibromyalgia,6 carpal tunnel syndrome,7 obesity, depression, and anxiety. (Instrument No. 7-3, at 26). Baker alleges that the injury leading to her back problems occurred in 2008. (Instrument No. 7-3, at 45).

*2 On December 18, 2007, Baker complained of back pain to her treating physician, Charles Schuhmacher, M.D. (“Dr. Schuhmacher”). (Instrument No. 7-11, at 3). Baker stated that the pain began the preceding day when she heard and felt a pop in her back while she was pushing a cart carrying a five-pound crate of milk. (Instrument No. 7-11, at 3). Dr. Schuhmacher prescribed Baker medication for her pain. (Instrument No. 7-11, at 3). Baker returned to Dr. Schuhmacher for follow-up visit for her back pain in December 2007 and January 2008. (Instrument No. 7-11, at 3). On such a visit on January 16, 2008, Dr. Schuhmacher completed a Texas Workers’ Compensation Work Status Report (“TWC report”) and reported that Baker’s injury prevented her from working from January 16, 2008 through January 23, 2008, but that she could return to work after that period in a limited form. (Instrument No. 7-12, at 2). On January 28, 2008, Dr. Schuhmacher recommended “restricted duty” on Baker’s medical report and TWC report and cleared her to return to limited work on January 24, 2008. (Instrument No. 7-11, at 27). Dr. Schuhmacher wrote in Baker’s TWC report that in an 8-hour workday, Baker may stand for 1-3 hours, walk for 3-5 hours, lift up to 10 pounds, and occasionally bend, climb, kneel, and push/pull. (Instrument No. 7-11, at 23).

On January 29, 2008, Baker underwent an MRI scan of her lumbar spine. (Instrument No. 7-8, at 92). On February 6, 2008, Dr. James Bonnen, M.D., reviewed the MRI and determined that Baker had a bulging disc at L4/5 and L5/S1 with some degenerative changes and minimal stenosis.8 (Instrument No. 7-11, at 26). He diagnosed Baker with low back pain and recommended a course of physical therapy. (Instrument No. 7-11, at 26). On February 7, 2008, Baker visited Dr. Schuhmacher, who wrote on Baker’s TWC report that her injury would prevent her from working between February 7, 2008 and March 6, 2008. (Instrument No. 7-11, at 22). On March 5, 2008, Dr. Schuhmacher completed another TWC report indicating that Baker’s injury would prevent her from working between March 5, 2008 and April 3, 2008. (Instrument No. 7-11, at 18). On March 12, 2008, Baker followed up with Dr. James Bonnen who reported that Baker’s persistent lower back pain had not improved with physical therapy. (Instrument No. 7-11, at 20). Dr. Schuhmacher saw Baker again in 2008 on March 18, April 16, May 8, June 9, and July 22, and each time wrote on Baker’s TWC report that her injury would prevent her from returning to work. (Instrument No. 7-11, at 11-12, 14, 16). During Baker’s final visit with Dr. Schuhmacher on July 22, 2008, Dr. Schuhmacher wrote on Baker’s TWC report that Baker’s injury would prevent her from working from October 18, 2007 through July 22, 2008. (Instrument No. 7-11, at 9). However, Dr. Schumacher’s Report of Medical Evaluation dated July 22, 2008 finds that Baker did not suffer from any impairment. (Instrument No. 7-11, at 8).

On November 24, 2010, Baker was admitted to Clear Lake Regional Medical Center for chest pain. (Instrument No. 7-12, at 22). Baker was diagnosed with chest pain, uncontrolled hypertension, chronic back pain syndrome, and nicotine abuse. (Instrument No. 7-12, at 22). Baker told the medical staff that she stopped taking her blood pressure medicines because she could not afford them, and that she was smoking about half a pack to one pack of cigarettes a day and had done so for several years and was not ready to quit. (Instrument No. 7-12, at 22). Baker received treatment and was discharged the following day. (Instrument No. 7-12, at 22).

On February 9, 2011, Baker visited Stephen I. Esses, M.D., (“Dr. Esses”) for low back pain radiating down both legs. (Instrument No. 7-9, at 42). Dr. Esses noted that Baker sustained a work-related injury in 2008 and had experienced low back pain since. (Instrument No. 7-9, at 42). Baker reported that she had received an epidural steroid injection9 one month prior to her first visit with Dr. Esses. (Instrument No. 7-9, at 42). Dr. Esses concluded from his physical examination that Baker’s flexion was 40 degrees, and that she experienced pain on her right and left sides when performing the straight-leg raising test. (Instrument No. 7-9, at 42). Dr. Esses also found normal strength in the iliopsoas and quadriceps, but marked weakness in the right tibialis anterior and right extensor hallucis longus. (Instrument No. 7-9, at 42). Dr. Esses ordered an updated MRI scan, which took place on February 14, 2011. (Instrument No. 7-9, at 42, 40). On February 23, 2011, Dr. Esses reviewed the MRI scan taken on February 14, 2011 and diagnosed Baker with stenosis at L4-5 with a superimposed right-sided disc herniation, a clear nerve root, and thecal sac compression.10 (Instrument No. 7-9, at 39). After conducting a physical exam, Dr. Esses found that Baker had decreased range of motion and continued weakness in the right tibialis anterior and right hallucis longus. (Instrument No. 7-9, at 39). Dr. Esses started Baker on a prescription for Lyrica11 and noted that if Baker did not respond to the medication that she would be an “excellent candidate” for surgery. (Instrument No. 7-9, at 39). On March 11, 2011, Baker spoke to Dr. Esses over the phone and told him that the Lyrica was not helping her and that she would like to schedule surgery. (Instrument No. 7-9, at 38). The record does not indicate that Baker further spoke to or met with Dr. Esses after this telephone conversation.

*3 On March 21, 2011, Baker went to Houston Spine and Neurosurgery for a neurosurgical consultation. (Instrument No. 7-8, at 6-8). Baker was referred to Gulf Coast MRI & Diagnostic for another MRI scan of her spine (Instrument No. 7-8, at 9, 19-21). A manual muscle test was performed on Baker. (Instrument No. 7-8, at 7). The results were recorded using a scale of zero (0) to five (5), with zero as having no contraction and five as having normal power. (Instrument No. 7-8, at 7). For her right and left upper extremities, Baker received zeroes, indicating that she had no contraction in those areas. (Instrument No. 7-8, at 7). Baker received a zero for her right lower extremity, which indicated no contraction in that region, and a one for her left lower extremity, which indicated only a flicker or trace of contraction on her left lower extremity. (Instrument No. 7-8, at 7).

On March 30, 2011, Baker had a third MRI scan taken at Gulf Coast MRI & Diagnostic. (Instrument 7-8, at 19-21). Dr. James P. Caplan, M.D., observed on Baker’s total body bone scan a degenerative change bilateral T11-12 with possible disc disease at L4-5, and a loss of lordosis in the cervical spine consistent with a soft tissue process. (Instrument No. 7-8, at 21). Frank Cavallo, M.D., reported that the MRI of the cervical spine indicated spondylosis, degenerative disc disease, and mild spinal stenosis, C3-C4 and C5-C6. (Instrument No. 7-8, at 19). Dr. Cavallo noted that the MRI of Baker’s cervical spine was otherwise unremarkable. (Instrument No. 7-8, at 20). It appears that Baker’s physician at the Houston Spine and Neurosurgery Center reviewed the images on April 20, 2011; however, the physician’s comments on the report are illegible. (Instrument No. 7-8, at 4).

On April 6, 2011, Baker returned to the Houston Spine and Neurosurgery Center to undergo lower extremity electromyography12 and nerve conduction velocity testing13 for the lumbar pain radiating to her lower legs. (Instrument No. 7-8, at 15). The lower extremity electromyography showed that there was increased insertional activity for the L5 paraspinal muscles on the right. (Instrument No. 7-8, at 15). The lower extremity nerve conduction velocity study showed that the findings were “consistent with mild right L5 root irritation consistent with radiculitis.” (Instrument No. 7-8, at 15-16). Baker was directed to return to her treating physician for further consultation. (Instrument No. 7-8, at 16). On April 20, 2011, the Houston Spine and Neurosurgery Center performed a bilateral upper extremity electromyography and a nerve conduction velocity test on Baker to assess the cervical pain radiating to both of her arms. (Instrument No. 7-8, at 11). The electromyography showed no evidence of spontaneous activity, positive sharp waves, and/or fibrillations. (Instrument No. 7-8, at 11). The nerve conduction velocity test indicated findings consistent with mild right distal mononeuropathy of the median nerve consistent with irritation at the wrist (carpal tunnel syndrome affecting primarily sensory components). (Instrument No. 7-8, at 11). The test also indicated no definitive electromyographic evidence recorded of cervical radiculopathy at that time. (Instrument No. 7-8, at 11).

*4 On April 27, 2011, Baker sought treatment from Barbara Barnett, D.O., at the Texas Pain Consultants. (Instrument No. 7-9, at 49). Dr. Barnett observed that Baker’s neck was stiff and guarded with limited range of motion. (Instrument No. 7-8, at 28). She also noted that the cervical facets were tender to palpation bilaterally at C5-6, and that the paracervical muscles spasmed bilaterally. (Instrument No. 7-9, at 49). Dr. Barnett also reported intact sensory function to light touch and that Baker’s motor function was full and equal in all muscle groups. (Instrument No. 7-9, at 49). Dr. Barnett diagnosed Baker with cervicalgia, cervical radiculitis, and low back pain. (Instrument No. 7-9, at 49). She recommended Baker receive a Cervical Epidural Steroid Injection (ESI)14 and prescribed Neurontin,15 Amrix,16 and Norco17. (Instrument No. 7-9, at 50).

On May 11, 2011, Dr. Robert W. Sickler, M.D., (“Dr. Sickler”) administered the Cervical ESI to Baker. (Instrument No. 7-9, at 55). In a follow-up visit with Dr. Barnett on May 18, 2011, Dr. Barnett noted that Baker’s pain had improved by 10% since the procedure. (Instrument No. 7-9, at 47). Dr. Barnett noted that Baker was deriving benefit from the prescribed medication, and renewed the prescriptions. (Instrument No. 7-9, at 48). Dr. Barnett recommended a second cervical ESI procedure, which was performed by Dr. Sickler on June 1, 2011. (Instrument No. 7-9, at 47, 53). On June 8, 2011, Baker saw Dr. Sickler again, who noted that Baker’s pain had not improved since the procedure, but that her pain had been relieved by taking Neurontin, Amrix, and Norco. (Instrument No. 7-9, at 45). Dr. Sickler referred Baker to consult with Dr. Mavis Fujii, M.D. (Instrument No. 7-9, at 46).

On June 23, 2011, Baker sought treatment from Sonia Shantilal Bhatt, M.D., at the University of Texas Medical Branch for ear pain. (Instrument No. 7-8, at 47). Dr. Bhatt diagnosed Baker with ear pain most likely caused by radiation of neck pain. (Instrument No. 7-8, at 49). Dr. Bhatt also diagnosed Baker with depression and hypertension. (Instrument No. 7-8, at 49). Dr. Bhatt prescribed Wellbutrin 18 to help Baker with depression. (Instrument No. 7-8, at 47).

*5 On June 27, 2011, Baker saw Dr. Mavis Fuji, M.D., (“Dr. Fuji”) at Egret Bay Neurology for low back pain, insomnia, depression, paresthesias19, and muscle spasms. (Instrument No. 7-8, at 72). While conducting the physical examination, Dr. Fuji observed that Baker was in moderate distress. (Instrument No. 7-8, at 47). Dr. Fuji noted marked spasms in the trapezius and cervical paraspinal musculatures with trigger points in the upper broader of the trapezius. Dr. Fuji also noted trigger points in the heads of pectoralis over Baker’s forearms and calves, as well as marked spasms over the thoracic, lumbar, sacral muscles with bilateral sciatic notch tenderness. (Instrument No. 7-8, at 73). Dr. Fuji tested Baker’s muscle, wrist and finger strength (Instrument No. 7-8, at 47). Baker received a 5/5 for her wrist flexors, wrist extensors, finger flexors, and finger extensors. (Instrument No. 7-8, at 73). Dr. Fuji diagnosed Baker with proximal and upper lower extremities weakness, fibromyalgia, migraines, peripheral neuropathy based on impaired vibration, cervical spondylosis, lumbar spondylosis, bilateral sciatica20, severe depression, and hypertension. (Instrument No. 7-8, at 73-74). Dr. Fuji ordered labs to look for other causes of neuropathy and weakness, ordered further EMG and nerve conduction studies, and referred Baker to specialists for pain and depression. (Instrument No. 7-8, at 74).

On June 30, 2011, Baker sought treatment from Alan H. Silverblatt, Ph.D., a clinical psychologist recommended by Dr. Fuji. (Instrument No. 7-12, at 12). Dr. Silverblatt examined Baker’s mental status and reported that Baker was crying, appeared sad, and showed a poor ability to cope with pain. (Instrument No. 7-12, at 16). Dr. Silverblatt also observed that Baker’s judgment was fair, her eye contact was good, and her concentration was fair. (Instrument No. 7-12, at 16). Dr. Silverblatt assessed that Baker had moderate restrictions on daily activities, marked difficulties in maintaining social function, and marked difficulties in maintaining concentration, persistence, or pace. (Instrument No. 7-12, at 16). Dr. Silverblatt also administered a Beck Depression Inventory – II, Beck Anxiety Scale, and Beck Hopelessness Scale, and found that “all three were significantly elevated!” (Instrument No. 7-12, at 12)(emphasis in original). On this test, Baker scored a 44 on the anxiety scale, which indicated severe generalized anxiety. (Instrument No. 7-12, at 16). Baker scored 19 on the hopelessness scale, which indicated a pervasive sense of hopelessness. (Instrument No. 7-12, at 16). Finally, Baker scored 52 on the depression inventory, which indicated severe depression, including: pervasive sadness, pessimism, past failure, excessive guilt punishment feelings, self-dislike/criticism, frequent crying episodes, agitation, indecisiveness, worthless feelings, fatigue, sleeping very little, irritability, decreased appetite, concentration difficulties and decreased libido. (Instrument No. 7-12, at 16). Dr. Silverblatt had Baker sign a suicide contract for her suicidal ideations. (Instrument No. 7-12, at 18). Dr. Silverblatt immediately referred Baker to Dr. Mohamed Ahmed, a psychiatrist. (Instrument No. 7-12, at 18). On the same day, Baker saw Dr. Bhatt for a follow-up visit, and Dr. Bhatt noted that Baker was “not doing well.” (Instrument No. 7-8, at 43). Dr. Bhatt stopped the Wellbutrin and switched Baker to Celexa.21 Dr. Bhatt reiterated the suicide precautions Dr. Silverblatt had given Baker earlier that day. (Instrument No. 7-8, at 43).

*6 Baker followed up with Dr. Silverblatt on July 6, 2011. (Instrument No. 7-12, at 8). Dr. Silverblatt conducted a mental status examination and noted that Baker was sad, crying, focused on chronic pain/somatic ailments, showed a poor ability to cope with pain, showed psychomotor retardation, and was socially withdrawn. (Instrument No. 7-12, at 9). Dr. Silverblatt also observed that Baker’s judgment was good, her eye contact was good, and her concentration was adequate. (Instrument No. 7-12, at 9). Dr. Silverblatt reported that Baker no longer showed signs of suicidal ideation. (Instrument No. 7-12, at 8).

On July 11, 2011, Baker returned to Dr. Fuji, who conducted an examination and found that Baker had bruising, point tenderness, spasms, twitching, depression, anxiety, insomnia, and that she appeared fearful. (Instrument No. 7-8, at 69). Dr. Fuji’s recommendations are illegible. (Instrument No. 7-8, at 69). On July 11, 2011, Baker also met with Dr. Mohamed Ahmed, M.D. (“Dr. Ahmed”), a psychiatrist at PsyClinic Clear Lake. (Instrument No. 7-9, at 65). Dr. Ahmed diagnosed Baker with generalized anxiety, and recommended stress reduction and avoiding caffeine. (Instrument No. 7-9, at 66). Dr. Ahmed noted that Baker did not show signs of hopelessness or safety concerns. (Instrument No. 7-9, at 66). Dr. Ahmed also diagnosed Baker with a depressive disorder, recommended that Baker increase physical activity, contact a support group, avoid substance abuse, and resume social interaction. (Instrument No. 7-9, at 64). Dr. Ahmed further recommended that Baker continue Celexa and also begin Atarax22. (Instrument No. 7-9, at 67). Dr. Ahmed reported that Baker was not suicidal and that her mood was of an appropriate demeanor. (Instrument No. 7-9, at 66). On a follow-up visit on July 19, 2011, Dr. Ahmed reiterated the same findings as the prior visit with the additional remark that Baker’s mood was anxious and depressed. (Instrument No. 7-9, at 63). On July 20, 2011, Baker returned to Dr. Silverblatt, who conducted another current mental status examination, reported many of the same findings as on July 6, 2011, but also remarked that Baker did not exhibit psychomotor retardation, nor did she appear socially withdrawn. (Instrument No. 7-12, at 7).

On August 18, 2011, Baker returned to Dr. Fuji for a follow-up visit. (Instrument No. 7-8, at 65). Dr. Fuji conducted an examination and found that Baker had muscle weakness, spasms, twitching, and joint pain, as well as anxiety, depression, and insomnia. (Instrument No. 7-8, at 66). Dr. Fuji’s recommendations and orders are illegible. (Instrument No. 7-8, at 67). On October 17, 2011, Dr. Fuji conducted another examination and observed many of the same findings as she did on August 18th. (Instrument No. 7-8, at 63). Baker sought treatment from Space City PainSpecialists on July 21st, August 22nd, and November 17th of 2011. (Instrument No. 7-8, at 110-112). She was diagnosed with cervical radiculitis, lumbar radiculitis, and myasthenia gravis, and received pain medication. (Instrument No. 7-8, at 110-112).

On December 28, 2011, Robert B. White, Ph.D., (“Dr. White”) performed a Psychiatric Review Technique as part of Baker’s disability determination. (Instrument No. 7-9, at 2). Dr. White assessed that Baker had no severe impairments, that she had a coexisting nonmental impairment that required referral to another medical specialty, and that she suffered from affective disorder which included disturbance of mood accompanied by depressive syndrome characterized by sleep disturbance and decreased energy. (Instrument No. 7-9, at 2, 5). Dr. White diagnosed Baker with Major Depressive Disorder, and found that Baker had no restrictions on daily living activities, but did experience mild difficulties in maintaining social functioning and in maintaining concentration, persistence, or pace. (Instrument No. 7-9, at 12). Dr. White opined that Baker showed a euthymic 23 mood, reactive affect, and that the remainder of the exam was within normal limits. (Instrument No. 7-9, at 14). Dr. White noted that Baker engaged in a relatively wide range of activities despite her symptoms and complaints, and that many of Baker’s restrictions were secondary to physical symptoms and complaints. (Instrument No. 7-9, at 14). Dr. White concluded that the exam did not indicate that Baker’s degree of mental and/or emotional symptoms would significantly or consistently compromise her work-related abilities or activities. (Instrument No. 7-9, at 14).

*7 On January 10, 2012, Dr. Nancy Childs, M.D., (“Dr. Childs”) performed a Physical Residual Capacity Assessment as another part of Baker’s disability determination. (Instrument No. 7-9, at 16). Dr. Childs concluded that Baker could occasionally lift and/or carry 20 pounds, frequently lift and/or carry 10 pounds, stand and/or walk (with normal breaks) for a total of at least 2 hours in an 8-hour workday, sit (with normal breaks) for a total of about 6 hours in an 8-hour workday, and did not face restrictions for pushing and/or pulling, including in operation of hand and/or foot controls. (Instrument No. 7-9, at 17). Dr. Childs found that Baker’s diagnosis of myasthenia gravis to be unconfirmed by clinical and lab findings. (Instrument No. 7-9, at 17). Dr. Childs recommended that Baker may occasionally climb ramp/stairs, balance, stoop, kneel, crouch, or crawl, but may never climb a ladder, rope, or scaffold. (Instrument No. 7-9, at 18). Dr. Childs determined that Baker’s alleged limitations from symptoms were partially supported by the medical evidence on record. (Instrument No. 7-9, at 21).

E.

On August 3, 2011, Baker applied for disability insurance benefits and supplementary security income under Titles II and XVIII of the SSA. (Instrument No. 7-6, at 2). In her application, Baker sought to establish a period of disability beginning on October 2, 2008. (Instrument No. 7-6, at 2). Baker’s claim was initially denied on January 11, 2012, and denied again upon reconsideration on March 5, 2012. (Instrument No. 7-5, at 4, 20). Baker requested an administrative hearing before an Administrative Law Judge (“ALJ”), which was held before Judge Richard A. Gilbert on December 13, 2012. (Instrument No. 7-3, at 40). Attorney Vicki Skidmore (“Ms. Skidmore”) represented Baker. (Instrument No. 7-3, at 42). Charles Poore (“Poore”) testified as a vocational expert (“VE”). (Instrument No. 7-3, at 42). Albert Owijifor, M.D., (“Dr. Owijifor”) and Robert Border, Ph.D., (“Dr. Border”) testified as medical experts. (Instrument No. 7-3, at 42).

On February 8, 2013, the ALJ found that Baker was not disabled. (Instrument No. 7-3, at 24-35). In determining whether Baker was disabled under the Act, the ALJ applied the five-step sequential evaluation process required by the SSA. (Instrument No. 7-3, at 25). At step 1, the ALJ found that Baker had not engaged in substantial gainful activity since October 2, 2008. (Instrument No. 7-3, at 26). At step 2, the ALJ determined that Baker had the following severe impairments: cervical and lumbar disease, radiculitis, mild L5 root irritation, spondylosis of the cervical spine, degenerative disc disease (DDD) and disc protrusion of the lumbar spine, hypertension, fibromyalgia, carpal tunnel syndrome, obesity, depression, and anxiety. (Instrument No. 7-3, at 26). At step 3, the ALJ concluded that Baker did not have any impairment or combination of impairments that met or medically equaled the severity of one of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Instrument No. 7-3, at 27).

The ALJ first noted that Baker’s cervical and lumbar disease, radiculitis, mild L5 root irritation, spondylosis of the cervical spine, degenerative disc disease, and disc protrusion of the lumbar spine “failed to meet the criteria of section 1.04 in that there is no compromise of a nerve root or the spinal cord with (A) evidence of nerve root compression characterized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss accompanied by sensory or reflex loss, and positive straight-leg raising test (sitting and supine); (B) spinal arachnoiditis.... or (C) lumbar spinal stenosis resulting in pseudoclaudication24” (Instrument No. 7-3, at 27).

*8 Second, the ALJ found that Baker’s hypertension is “controlled or controllable with medication” and that it had not resulted in the limitations required for a presumptive disability under the medical listings. (Instrument No. 7-3, at 27).

Third, the ALJ found that Baker’s fibromyalgia condition did not meet or equal “listing 11.00, et seq., concerning neurological impairments and listing 14.01, generally, concerning immune system disorders.” (Instrument No. 7-3, at 28). The ALJ stated that to be considered a medically determinable impairment, the fibromyalgia “must have: (1) a history of widespread pain in all quadrants of the body that has persisted for at least 3 months; (2) at least 11 positive tender points on physical examination bilaterally and above and below the waist; and (3) evidence that other disorders that could cause the symptoms or signs were excluded.” (Instrument No. 7-3, at 27).

Fourth, the ALJ stated that Baker’s carpal tunnel syndrome did not meet the listing severity under section 11.14 because she did not have “peripheral neuropathies with disorganization of motor function as described in 11.04B in spite of prescribed treatment.” (Instrument No. 7-3, at 28).

Fifth, the ALJ stated that Baker’s obesity was not of the “severity to meet or equal the criteria of any impairment listed in Appendix 1,” nor did the records document any “neurological deficits, significant musculoskeletal abnormalities, or any serious dysfunctioning of the bodily organs.” (Instrument No. 7-3, at 28).

Finally, the ALJ concluded that Baker’s mental impairments did not meet or medically equal the criteria of listings 12.04 and 12.06 which require at least two of the following: “marked restriction of activities of daily living; marked difficulties in maintaining social functioning; marked difficulties in maintaining concentration, persistence, or pace; or repeated episodes of decompensation, each of extended duration.” (Instrument No. 7-3, at 29). The ALJ found that Baker only had mild restrictions in activities of daily living, moderate difficulties in social functioning and with regard to concentration, persistence or pace, and no episodes of decompensation. (Instrument No. 7-3, at 29).

Prior to reaching step 4, the ALJ determined that Baker had the residual functional capacity (“RFC”) to perform sedentary work as defined in 20 CFR §§ 404.1567(a) and 416.697(a) with the following additional limitations:

“can occasionally climb ramps and stairs, balance, stoop, kneel crouch, and crawl; can never climb ladders, ropes, or scaffolds; can understand, remember, and carry out short and simple instructions; maintain attention and concentration for extended periods on simple tasks; is limited to simple, routine, repetitive tasks and a low stress work environment, defined as occasional decision making required and occasional changes in work settings; and can have superficial contact with the general public and occasional contact with coworkers and supervisors.”

(Instrument No. 7-3, at 30). In determining the RFC, the ALJ found that Baker’s impairments could reasonably be expected to cause her symptoms. (Instrument No. 7-3, at 30). However, the ALJ found that Baker’s statements concerning the intensity, persistence, and limiting effects of her symptoms were not entirely credible to the extent that they were inconsistent with the medical record. (Instrument No. 7-3, at 30-32).

*9 At step 4, the ALJ found that Baker was unable to perform any of her past relevant work. (Instrument No. 7-3, at 33). At step 5, the ALJ considered Baker’s age, education, work experience, and RFC, and found there were jobs that existed in significant numbers in the national economy that Baker could perform despite her limitations. (Instrument No. 7-3, at 34). The ALJ relied on the testimony of vocational expert Charles Poore, who reported that Baker could perform the jobs of sorter, optical goods worker, and bench worker. (Instrument No. 7-3, at 35). Based on the foregoing, the ALJ found Baker not disabled under the Act. (Instrument No. 7-3, at 35).

II.

Summary judgment is appropriate if no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Fed. R. Civ. P. 56. A fact is “material” it its resolution in favor of one party might affect the outcome of the suit under governing law. Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986). “Factual disputes that are irrelevant or unnecessary will not be counted.” Id. at 248. An issue is “genuine” if the evidence is sufficient for a reasonable jury to return a verdict for the nonmoving party. Id. If the evidence rebutting the motion for summary judgment is only colorable or not significantly probative, summary judgment should be granted. Id. at 249-50.

Under Fed. R. Civ. P. 56(c), the moving party bears the initial burden of “informing the district court of the basis for its motion, and identifying those portions of [the record] which it believes demonstrate the absence of a genuine issue for trial.” Matsushita Elec. Ind. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986); Leonard v. Dixie Well Serv. & Supply, Inc., 828 F.2d 291, 294 (5th Cir. 1987).

Where the nonmoving party has met its Rule 56(c) burden, the nonmovant “must do more than simply show that there is some metaphysical doubt as to the material facts...the nonmoving party must come forward with specific facts showing there is a genuine issue for trial.” Matsushita, 475 U.S. at 586-87 (quoting Fed. R. Civ. P. 56(c)). To sustain the burden, the nonmoving party must produce evidence admissible at trial. Anderson, 477 U.S. at 255. In deciding a summary judgment motion, “[t]he evidence of the nomovant is to be believed, and all justifiable inferences are to be drawn in his favor.” Id. at 255. If reasonable minds can differ regarding a genuine issue of material fact, summary judgment should not be granted. Id. at 250-51.

When applying the summary judgment standard to the ALJ’s decision to deny benefits, the Court may only inquire into: (1) whether the proper legal standard was applied; and (2) whether substantial evidence supports the decision. Joseph v. Astrue, 231 Fed. Appx. 327, 329 (5th Cir. 2007) (unpublished). If the Commissioner’s findings are supported by substantial evidence, they are conclusive and must be affirmed. Anthony v. Sullivan, 954 F.2d 289, 292 (5th Cir. 1992) (citing 42 U.S.C. § 405(g)); Richardson v. Perales, 402 U.S. 389, 390 (1971).

Substantial evidence requires “more than a mere scintilla” of evidence. Joseph, 231 Fed. Appx. at 329 (citing Richardson, 402 U.S. at 401). Alternatively, substantial evidence “means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Id. A determination as to whether there is substantial evidence in the record to support the findings of the Commissioner does not involve reweighing the evidence, trying the issues de novo, or substituting the judgment of this Court for that of the Commissioner. Greenspan v. Shalala, 38 F.3d 232, 236 (1994) (citing Haywood v. Sullivan, 888 F.2d 1463, 1466 (5th Cir. 1989)). Instead, this Court must scrutinize the record in its entirety to determine whether substantial evidence supports the Commissioner’s findings. Id.

III.

*10 A claimant is entitled to disability benefits if she establishes that she is unable to engage in, “any substantial gainful activity by reason of any medically determinable physical or mental impairment... which has lasted or can be expected to last for a continuous period of not less than twelve months.” 42 U.S.C. §§ 416(i)(1), 423(d)(1)(A) (2008). In determining whether a claimant is capable of engaging in any substantial gainful activity, the Commissioner applies a five-step sequential evaluation process.

The rules governing the steps of this evaluation process are: (1) a claimant who is working, engaging in a substantial gainful activity, will not be found to be disabled no matter what the medical findings are; (2) a claimant will not be found to be disabled unless he has a severe impairment; (3) a claimant whose impairment meets or is equivalent to an impairment listed in Appendix 1 of the regulations will be considered disabled without the need to consider vocational factors; (4) a claimant who is capable of performing work that he has done in the past must be found not disabled; and (5) if the claimant is unable to perform his previous work as a result of his impairment, then factors such as his age, education, past work experience, and RFC must be considered to determine whether he can do other work. Boyd v. Apfel, 239 F.3d 698, 704-05 (5th Cir. 2001); Villa v. Sullivan, 895 F.2d 1019, 1022 (5th Cir. 1990).

“A finding that a claimant is disabled or is not disabled at any point in the five-step review is conclusive and terminates the analysis.” Boyd, 239 F.3d at 705 (quoting Greenspan v. Shalala, 38 F.3d 232, 236 (5th Cir. 1994)). When a claimant’s impairments do not meet the requirements of step 3, the Commissioner will still evaluate the claimant’s RFC to determine if she can do her past work. 20 C.F.R. § 404.1520 (2012). The burden of proof is on the claimant for the first four steps, but shifts to the Commissioner at step five. Newton v. Apfel, 209 F.3d 448, 453 (5th Cir. 2000).

Following the hearing in this case, the ALJ found that Baker was not disabled at step 5 of the evaluation process. (Instrument No. 7-3, at 35). The Appeals Council denied Baker’s request for reconsideration on March 14, 2014, making the ALJ’s decision the final decision of the Commissioner. (Instrument No. 7-3, at 4-6). Baker asserts three errors in support of her motion for summary judgment. (Instrument No. 9-1). Baker argues that the ALJ’s RFC determination is not supported by substantial evidence, that the ALJ improperly assessed her credibility, and that the ALJ erred at step 5 when he failed to inquire into the inconsistencies between the VF’s testimony and the regulations. (Instrument No. 9-1, at 8-15).

The Commissioner argues in her cross-motion for summary judgment that the ALJ’s determination is supported by substantial evidence because the ALJ properly considered Baker’s failure to seek treatment as weighing against her allegations of disability, and because the ALJ properly considered Baker’s activities of daily living when determining her RFC. (Instrument No. 11, at 5-6). The Commissioner further argues that despite some clinical studies demonstrating some abnormalities, Baker continued to function “at a level inconsistent with total disability.” (Instrument No. 11, at 4).

A.

In her first claim of error, Baker asserts that the ALJ’s RFC determination is unsupported by substantial evidence for two distinct reasons. First, Baker argues that the ALJ failed to properly consider the opinion of Dr. Silverblatt in evaluating Baker’s mental impairments. (Instrument No. 9-1, at 14). However, Fifth Circuit jurisprudence holds that the ALJ is free to assign little or no weight to the opinion of any physician for good cause. Newton v. Apfel, 209 F.3d 448, 455-456 (5th Cir. 2000). Good cause arises where the treating physician’s evidence is conclusory, is unsupported by medically acceptable clinical, laboratory, or diagnostic techniques, or is otherwise unsupported by the evidence. Id., at 456. Treating physicians’ opinions are not conclusive, Perez, 415 F.3d at 466, and may be rejected when the evidence supports a contrary conclusion. Martinez v. Chater, 64 F.3d 172, 176 (5th Cir. 1995).

*11 In this case, Baker argues that the ALJ “failed to assign weight or even mention the opinion provided by Dr. Silverblatt,” and that the “ALJ relied only on Dr. Borda’s opinion when evaluating Plaintiff’s mental limitations.” (Instrument No. 9-1, at 14). Baker cites to Dr. Silverblatt’s June 20, 2011 medical report, in which he noted that Baker had moderate restrictions on daily activities, marked restriction in maintaining social functioning, and marked restrictions in maintaining concentration, persistence, or pace. (Instrument No. 9-1, at 14). Baker argues that the ALJ’s failure to “weigh, discuss, articulate, or otherwise explain” why this opinion was not adopted into the RFC is an error requiring remand. (Instrument No. 9-1, at 14).

Conversely, the Commissioner argues that in evaluating Baker’s mental impairments, the ALJ cited to records from July 2011 “revealing intact memory, intact attention and concentration, normal thought processes, good abstract reasoning, normal language, fair fund of knowledge, fair insight, and no abnormal thoughts.” (Instrument No. 11, at 5). The Commissioner cites to Baker’s medical records from August 2011, which indicate that Baker demonstrated “normal mood and affect, normal orientation, and good judgment.” (Instrument No. 11, at 5). The Commissioner further cites to Baker’s medical record from November 2011, in which her treating physician “noted no psychological symptoms”. (Instrument No. 11, at 5). The Commissioner states that the ALJ “actually gave Plaintiff the benefit of the doubt by including significant functional limitations in the RFC assessment, as the medical record supports few, if any, functional limitations attributable to a mental impairment.” (Instrument No. 11, at 5).

Baker’s claim that the ALJ failed to mention Dr. Silverblatt’s opinion is not supported by the record. While Dr. Silverblatt’s initial impression was that Baker experienced marked mental restrictions, Dr. Silverblatt made a contrary finding in his assessment the following month. The ALJ cited to Dr. Silverblatt’s meetings with Baker on July 6th and July 20th of 2011, where Dr. Silverblatt noted Baker’s “judgment was good and concentration was adequate.” (Instrument No. 7-3, at 32). The ALJ also cited to Dr. Silverblatt’s Global Assessment of Functioning (“GAF”) evaluation, stating that “GAF scores, while certainly evidence to be considered, do not directly correlate to a determination of whether an individual is or is not disabled.” (Instrument No. 7-3, at 32). The ALJ determined that little to no weight would be given to the GAF score in this case because it was “not consistent with other substantial evidence.” (Instrument No. 7-3, at 32). Dr. Borda testified at the hearing that a GAF score of 40 or 50, was “almost contradictory” to Baker’s condition, which was “mostly intact at that time.” (Instrument No. 7-3, at 58). In fact, Dr. Borda opined that Baker’s “functional limitations in a work setting are going to be primarily physical” and that her “activities of daily living would be impaired to a mild degree, social functioning to a moderate degree, concentration, persistence and pace to a moderate degree.” (Instrument No. 7-3, at 58).

In addition to considering Dr. Silverblatt and Dr. Borda’s opinions, the ALJ also cited to medical reports by Baker’s psychiatrist, Dr. Ahmed. In July 2011, Dr. Ahmed found that Baker was “fully oriented” and that “[h]er recent and remote memory were intact, attention and concentration were intact, thought process was normal, she had good abstract reasoning, her thought associations were intact, and insight and judgment were fair.” (Instrument No. 7-3, 31). The ALJ also noted that on August 22, 2011, Dr. Cannella noted Baker’s judgment was good and her mood was normal, and that on August 31, 2011, Dr. Earle found that Baker’s mood was euthymic, her cognition was grossly intact, and her behavior showed no unusual movements or psychomotor changes. (Instrument No. 7-8, at 54). Numerous reports on Baker’s mental limitations made by treating physicians substantiate the ALJ’s conclusion that Baker’s mental limitations did not warrant a finding of total disability. Conflicts in the evidence are for the Commissioner and not the courts to resolve.” Masterson v. Barnhart, 309 F.3d 267, 272 (5th Cir. 2002). Therefore, the Court concludes that substantial evidence supports the ALJ’s evaluation of Baker’s mental impairments.

*12 Second, Baker argues that the ALJ erred by failing to account for her severe carpal tunnel syndrome when determining her RFC. (Instrument No. 9-1). However, Baker’s argument is unsupported by the record, which reflects that the ALJ considered both the medical record and Baker’s own statements when evaluating her RFC.

On April 20, 2011, Baker’s underwent an electromyography study and nerve condition velocity test. (Instrument No. 7-8, at 11). The ALJ cites to the electroneurographic findings, which were “most consistent with mild right distal mononeuropathy of the median nerve consistent with irritation of the wrist (carpal tunnel syndrome)” with “no definitive electromyographic evidence reflective of cervical radiculopathy.” (Instrument No. 7-3, at 31). The ALJ notes that there was no follow-up evidence of record on Baker’s carpal tunnel syndrome findings. (Instrument No. 7-3, at 31). Additionally, on June 27, 2011, Dr. Fuji tested Baker’s muscle, wrist and finger strength, and observed that Baker showed full “5/5” strength in her wrist flexors, wrist extensors, finger flexors, and finger extensors. (Instrument No. 7-8, at 73).

On November 28, 2011, Baker submitted a Function Report to the SSA in connection with her disability claim. (Instrument No. 7-7, at 2). In the report, Baker stated that she took care of her daughter, cooked, did laundry, fed and played with pets, crocheted, and liked to hot-glue crafts. (Instrument No. 7-7, at 15-18). Baker also testified to being able to peel potatoes, button her shirt, and tie her shoes. (Instrument No. 7-3, at 48, 53-54). While Baker testified that she had learned to do a lot more with her left hand, the ALJ found that Baker’s ability to engage in the foregoing activities indicated “that she was not totally precluded from all work related activities.” (Instrument No. 7-3, at 32). Therefore, the Court concludes that substantial evidence supports the ALJ’s determination of Baker’s RFC.

B.

Great deference is accorded to the ALJ’s assessment of a claimant’s credibility. Newton v. Apfel, 209 F.3d 448, 459 (5th Cir. 2000); See Falco v. Shalala, 27 F.3d 160, 163-64 (5th Cir. 1994) (observing that credibility conclusions are “precisely the kinds of determinations that the ALJ is best positioned to make”). However, when an ALJ finds that a claimant lacks credibility, the ALJ must articulate reasons for discrediting the claimant’s complaints. See Abshire v. Bowen, 848 F.2d 638, 642 (5th Cir. 1988).

In her second claim of error, Baker states that the ALJ improperly assessed her credibility for two reasons. Baker first argues that it was improper for the ALJ to discredit Baker because she was not able to afford treatment after November 2011. (Instrument No. 9-1, at 16). The ALJ noted the lack of medical evidence of treatment after November 2011, and that “claimant’s failure to seek medical treatment suggests that the symptoms may not be as serious as was alleged in connection with this application and detracts from the persuasiveness of her allegations.” (Instrument No. 7-3, at 32). However, the Fifth Circuit has held that if a “claimant cannot afford prescribed treatment or medicine, and can find no way to obtain it, ‘the condition that is disabling in fact continues to be disabling in law.’ ” Lovelace, 813 F.2d at 59 (5th Cir. 1987) (citing Taylor v. Bowen, 782 F.2d 1294, 1298 (5th Cir. 1986)). An ALJ “must not draw any inferences about an individual’s symptoms and their functional effects from a failure to seek or pursue regular medical treatment without first considering any explanations that the individual may provide... for example...[t]he individual may be unable to afford treatment and may not have access to free or low-cost medical services.” SSR 96-7p, 1996 WL 374186, at *7-8.

*13 In this case, Baker testified at the hearing that she was not currently seeing a doctor because she did not have medical insurance or money to pay for care out-of-pocket. (Instrument No. 9-1, at 17). Baker testified that she was limited to over-the-counter medications because she did not have a doctor to prescribe her medication. (Instrument No. 9-1, at 17). However, Lovelace requires that a claimant show she cannot “afford prescribed treatment or medicine, and can find no way to obtain it.” 813 F. 3d at 59 (emphasis added). Because Baker has not shown that she could not gain access to free or low-cost medical services, the ALJ did not err in assessing her credibility based on her claimed inability to afford medical care. See Lovelace, 813 F.2d at 59.

Second, Baker argues that the ALJ’s credibility assessment is not supported by substantial evidence because the ALJ failed to consider the limitations on her daily activities as well as other methods used by Baker to alleviate pain. (Instrument No. 9-1, at 17). Baker contends that the ALJ “failed to consider the extent of time and conditions associated with these daily activities.” (Instrument No. 9-1, at 17). For instance, Baker testified that she does do some of the cooking, but that she mostly cooks with a crockpot and must alternate positions while cooking. (Instrument No. 9-1, at 17). Baker also testified that while she can clean, she does so slowly, and requires consistent breaks while doing so. (Instrument No. 9-1, at 17). Baker stated that she did not leave home often, and had fallen many times in the shower. (Instrument No. 9-1, at 17). Baker testified to using heating pads multiple times a day, exercising every day, and taking non-prescription pain medicine to help her sleep through the pain. (Instrument No. 9-1, at 17-18). Baker asserts that while she is able to complete daily functions and activities, she has had to adjust those activities around her severe pain, and that her efforts to adapt to her pain should not detract from her credibility regarding the existence of such pain. (Instrument No. 9-1, at 17).

In contrast, the ALJ found that although Baker’s impairments could produce the alleged symptoms, Baker’s statements concerning the intensity, persistence, and limiting effects of those symptoms were not entirely credible. (Instrument No. 7-3, at 30). The ALJ cited to electromyographic studies conducted in April 2011 which do not indicate any follow-up evidence of record, and the June 2011 records which showed Baker had full “5/5” muscle strength in all major muscle groups and overall tone. (Instrument No. 7-1, at 31). The ALJ also cited Dr. Oguejifor’s testimony, which concluded from examinations and radiological investigation that Baker could perform a light range of work despite her back pain. (Instrument No. 7-3, at 32). In addition, the ALJ determined, after a review of Baker’s Function Report and Baker’s testimony, that Baker was able to participate in many daily living activities, and that her impairments did not warrant a finding of total disability. (Instrument No. 7-3, at 32). Accordingly, the Court finds that the ALJ articulated adequate reasons for discrediting Baker’s testimony regarding the extent of her limitations and that these reasons were based on substantial evidence.

C.

In her third claim, Baker asserts that the ALJ’s Step Five analysis is unsupported by substantial evidence for two reasons. (Instrument No. 9-1, at 18). First, Baker states that the ALJ erred in determining her RFC and evaluating her credibility without substantial evidence. (Instrument No. 9-1, at 18). The Court has above addressed these two issues and found that both of the ALJ’S findings were supported by substantial evidence. Second, Baker argues that the Vocational Expert’s testimony was inconsistent with 20 C.F.R. § 404.1567(a), and that the ALJ failed to inquire into this inconsistency.

*14 At the hearing, the ALJ asked Vocational Expert Charles Poore to “assume a hypothetical individual [of] claimant’s age and educational background that [sic] can perform the exertional demands of a sedentary work as defined in the Commissioner’s regulations.” (Instrument No. 7-3, at 60). 20 C.F.R § 404.1567(a) defines sedentary work as:

“lifting no more than 10 pounds at a time and occasionally lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is defined as one which involves sitting, a certain amount of walking and standing is often necessary in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and other sedentary criteria are met.”

The ALJ asked Poore to specifically assume that “the individual can occasionally lift and carry ten pounds, frequently lifting and carrying five pounds. The individual could stand and walk about two hours out of an eight-hour workday with normal breaks, sit for about six hours out of an eight-hour workday with normal breaks.” (Instrument No. 7-3, at 60). In posing the hypothetical, the ALJ included Baker’s additional non-exertional limitations on her ability to perform sedentary work. (Instrument No. 7-3, at 60-61). Poore testified that “essentially as I consider the details of your hypothetical, we’re left with the category of work that would be labeled as sedentary and unskilled.” (Instrument No. 7-3, at 61). Therefore, Baker’s argument that Poore’s testimony is inconsistent with the language of § 404.1567(a) is not supported by the record. The ALJ incorporated the definition of sedentary work, as well as Baker’s additional non-exertional limitations, into the hypothetical he posed to Poore. After considering the details of the ALJ’s hypothetical question, Poore then testified to various jobs that Baker could perform given these limitation. Therefore, the Court concludes that the Vocational Expert’s testimony is consistent with the regulations, and that substantial evidence supports the ALJ’s Step Five determination.

For these reasons, the Court concludes that substantial evidence supports the Commissioner’s ultimate finding that Baker was not disabled.

IV.

Based on the foregoing, IT IS HEREBY ORDERED THAT Plaintiff’s Motion for Summary Judgment (Instrument No. 9) is DENIED and Defendant’s Motion for Summary Judgment (Instrument No. 10) is GRANTED.

The Clerk shall enter this Order and provide a copy to all parties.

SIGNED on this the 20th day of April, 2015, at Houston, Texas.

Footnotes

1

Radiculitis, or radicular pain, is a type of pain that radiates into the extremity directly along the course of a spinal nerve root. Spine-health, Radicular Pain and Radiculopathy Definition, SPINE-HEALTH.COM, http://www.spinehealth.com/glossary/radicular-pain-and-radiculopathy (last visited Mar. 10, 2015).

2

The L5 nerve supplies the nerves to the muscles that raise the foot and big toe, and consequently, impingement of this nerve may lead to weakness in these muscles. Numbness for L5 runs over the top of the foot. Spine-health, Spinal Cord and Spinal Nerve Roots, SPINE-HEALTH.COM, http://www.spine-health.com/conditions/spine-anatomy/spinal-cord-and-spinal-nerve-roots (last visited Mar. 10, 2015).

3

Cervical spondylosis, also called cervical osteoarthritis, is a condition involving changes to the bones, discs and joints of the neck, caused by the normal wear-and-tear of aging usually in middle-aged and elderly people. The discs of the cervical spine gradually break down, lose fluid, and become stiffer. Symptoms include: neck stiffness and pain, headaches, pain in the shoulder or arms, inability to fully turn the head or bend the neck, or grinding noise or sensation when the neck is turned. WEBMD, Cervical Osteoarthritis (Cervical Spondylosis), http://www.webmd.com/osteoarthritis/guide/cervical-osteoarthritis-cervical-spondylosis (last visited Feb. 24, 2015).

4

Degenerative disc disease is not really a disease but a term used to describe the normal changes in spinal discs with age. Degenerative disc disease can take place throughout the spine, but most often occurs in the lower back (lumbar region) and neck (cervical region). The changes in the discs can result in back or neck pain. WEBMD, Degenerative Disc Disease – Topic Overview, http://www.webmd.com/back-pain/tc/degenerative-disc-disease-topic-overview (last visited Feb. 24, 2015).

5

Hypertension is high blood pressure. MAYO CLINIC, High Blood Pressure (hypertension), http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/basics/definition/con-20019580 (last visited Feb. 24, 2015).

6

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Symptoms may sometimes begin after a physical trauma, surgery, infection, or significant psychological stress. MAYO CLINIC, Fibromyalgia, http://www.mayoclinic.org/diseases-conditions/fibromyalgia/basics/definition/con-20019243 (last visited Feb. 24, 2015).

7

Carpal tunnel syndrome is a hand and arm condition that causes numbness, tingling, and other symptoms. Carpal tunnel syndrome is caused by a pinched nerve in your wrist. MAYO CLINIC, Carpal tunnel syndrome, http://www.mayoclinic.org/diseases-conditions/carpal-tunnel-syndrome/basics/definition/con-20030332 (last visited Feb. 24, 2015).

8

Spinal stenosis is the narrowing of the spaces in the spine which causes pressure on the spinal cord and nerves. Spinal stenosis may result in low back pain as well as pain in the legs. WEBMD, Pain Management and Spinal Stenosis, http://www.webmd.com/back-pain/guide/spinal-stenosis (last visited Mar. 10, 2015).

9

Epidural steroid injections contain drugs that mimic the effects of the hormones cortisone and hydrocortisone. When injected near irritated nerves, these drugs many temporarily reduce inflammation and help relieve pain. MAYO CLINIC, Why are epidural steroid injections for back pain limited to only a few a year?, http://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/epidural-steroid-injections/faq-20058277 (last visited Feb. 26, 2015).

10

A herniated disc, also known as a slipped or ruptured disc, occurs when the soft center of a spinal disc pushes out through a crack. MAYO CLINIC, Herniateddisk, http://www.mayoclinic.org/diseases-conditions/herniateddisk/basics/definition/con-20029957 (last visited Mar. 2, 2015).

11

Lyrica is a medication used to treat pain caused by nerve damage due to diabetes or to shingles infection. It may also be used to treat nerve pain caused by spinal cord injury or fibromyalgia. WEBMD, Lyrica, http://www.webmd.com/drugs/2/drug-93965/lyrica-oral/details (last visited Mar. 10, 2015).

12

Electromyography is a diagnostic procedure to assess the health of muscles and the nerve cells that control them. MAYO CLINIC, Electromyography (EMG), http://www.mayoclinic.org/tests-procedures/electroconvulsive-therapy/basics/definition/prc-20014183 (last visited Mar. 2, 2015).

13

Nerve conduction velocity is a test to see how fast electrical signals move through a nerve. This test is used to diagnose nerve damage or destruction, and sometimes may be used to evaluate diseases of nerve or muscle, including myopathy, Lambert-Eaton syndrome, or myasthenia gravis. MEDLINE PLUS, Nerve conduction velocity, http://www.nlm.nih.gov/medlineplus/ency/article/003927.htm (last visited Mar. 2, 2015).

14

Cervical ESI deliver steroids into the epidural space surrounding spinal nerve roots to help alleviate pain in the upper spine and neck caused by irritated nerves. SPINE-HEALTH, Cervical EpiduralSteroid Injection Video, http://www.spine-health.com/video/cervical-epidural-steroid-injection-video (last visited Mar. 2, 2015).

15

Neurontin is a medication used with other medications to prevent and control seizures. It is also used to relieve nerve pain following shingles. It may be used to treat other nerve pain conditions such as diabetic neuropathy, peripheral neuropathy, trigeminal neuralgia, and restless legs syndrome. WEBMD, Neurontin, http://www.webmd.com/drugs/2/drug-9845-8217/neurontin-oral/gabapentin-oral/details (last visited Mar. 10, 2015).

16

Amrix is a medication used usually along with rest and physical therapy to treat muscle spasms in the short term. WEBMD, Amrix, http://www.webmd.com/drugs/2/drug-148753/amrix-oral/details (last visited Mar. 10, 2015).

17

Norco is a combination medication containing narcotic and non-narcotic pain relievers used to treat moderate to severe pain. WEBMD, Norco, webmd.com, http://www.webmd.com/drugs/2/drug-63/norco-oral/details (last visited Mar. 10, 2015).

18

Wellbutrin is a medication used to treat depression. Wellbutrin can improve your mood and feelings of well-being by helping to restore the balance of certain natural chemicals in the brain. WEBMD, Wellbutrin, http://www.webmd.com/drugs/2/drug-13509/wellbutrin-oral/details (last visited Mar. 31, 2015).

19

Parasthesia refers to a burning or prickling sensation that is usually felt in the hands, arms, legs, or feet. It is usually described as tingling or numbness, skin crawling, or itching. NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE, NINDS Paresthesia Information Page, http://www.ninds.nih.gov/disorders/paresthesia/paresthesia.htm(last visited Mar. 10, 2015).

20

Sciatica refers to pain that radiates along the path of the sciatic nerve which branches from your lower back through your hips and buttocks and down each leg. Sciatica most commonly occurs when a herniated disk or a bone spur on the spine compresses part of the nerve. MAYO CLINIC, Disease and Conditions-Sciatica, http://www.mayoclinic.org/diseases-conditions/sciatica/basics/definition/con-20026478 (last visited Mar. 10, 2015).

21

Celexa is a medication used to treat depression. Celexa works by helping to restore the balance of serotonin in the brain. WEBMD, Celexa, http://www.webmd.com/drugs/2/drug-8603/celexa-oral/details (last visited Mar. 10, 2015).

22

Atarax is sued to treat itching caused by allergies and may also be used short-term to treat anxiety. WEBMD, Atarax, http://www.webmd.com/drugs/2/drug-5511/atarax+oral/details (last visited Mar. 10, 2015).

23

Euthymic is a moderate or peaceful state of mind. DICTIONARY.COM, Euthymia, http://dictionary.reference.com/browse/euthymia (last visited Mar. 10, 2015).

24

Pseudoclaudication causes leg pain while standing or walking, can be a symptom of lumbar spinal stenosis. Pseudoclaudication pain is usually relieved by sitting or lying down. MAYO CLINIC, What is the difference between pseudoclaudication and claudication, http://www.mayoclinic.org/diseases-conditions/spinal-stenosis/expertanswers/pseudoclaudication/faq-20057779 (last visited Mar. 10, 2015).

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