The opinion of the court was delivered by: Terrence F. McVerry United States District Court Judge
MEMORANDUM OPINION AND ORDER OF COURT
Pending now before the court are cross-motions for summary judgment based on the administrative record: PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT (Document No. 5) and DEFENDANT'S MOTION FOR SUMMARY JUDGMENT (Document No. 6). The motions have been fully briefed and are ripe for resolution.
Plaintiff, Paula Nguyen, (hereinafter "Plaintiff") brought this action pursuant to 42 U.S.C. § 405(g) to seek review of the final determination of the Commissioner of Social Security (hereinafter "Commissioner") which denied her application for Disability Insurance Benefits ("DIB") under Title II of the Social Security Act ("Act"), 42 U.S.C. §§ 401-433.
Plaintiff was born on February 16, 1960 and was within the age range of 41 to 43 years during the period at issue, March 30, 2001 to September 30, 2003. She is considered to be a "younger individual" as defined in 20 C.F.R. § 404.1563. Plaintiff's work history includes employment as a jewelry/sales clerk (classified as semi-skilled at the light level), a waitress (classified as unskilled at the medium level), and a child care provider (classified as unskilled at the medium level). R. 3, at 26.
Plaintiff alleges disability, as of March 30, 2001, due to rheumatoid arthritis and allergies to such things as perfumes and other chemicals. R. 3, at 17. Plaintiff claims that she suffers from joint warmth, joint deformity, impaired appetite, tenderness, reduced grip, crepitus, and significant limitations in reaching, handling, and fingering. Pl. Br., at 1.
Plaintiff began seeing her first primary care physician, Dr. Joseph Richetti (hereinafter "Richetti"), on January 24, 2001 and presented for evaluation using a 4-legged cane. R. 41. Richetti noted that Plaintiff's left leg was swollen to twice the size of the right leg although the right leg caused Plaintiff more pain. Id. Plaintiff had difficulty straightening her knees. Id. Richetti also observed that Plaintiff had lost 50 pounds and did not have much of an appetite. Id. Richetti diagnosed Plaintiff with left lower extremity edema and severe unintentional weight loss. Id. Richetti gave Plaintiff only two week's supply of Vioxx for her knee pain as Plaintiff did not have insurance. Id. Plaintiff again saw Richetti on February 27, 2001 and he noted that
Plaintiff continued to experience swelling in her left lower extremity and pain in her knees, hands, and elbows. R. 3, at 40. She had difficulty holding items with her hands. Id. She was taken off Vioxx as it caused her hives. Id. Results from her blood studies reflected a positive rheumatoid factor which was an indication of possible rheumatoid arthritis. Id. Richetti also saw Plaintiff a year later on June 12, 2002 and he observed that Plaintiff was stable and doing well.
Richetti had referred Plaintiff to McAuley Rheumatology Associates, Inc. ("MRA")
where she was examined by Dr. Wendy Stiles (hereinafter "Stiles") on March 20, 2001. Stiles noted that Plaintiff does have a history of rheumatoid arthritis as it was diagnosed in her wrists and shoulders when she was in her 20's. R. 3-3, at 38. Plaintiff stated that the rheumatoid arthritis was in remission and did not reappear until early 2000. Id. Stiles observed that Plaintiff's joints were warm and swollen, especially her knees. R. 3-3, at 39. Plaintiff's shoulder strength was greatly reduced and her joint range of motion was limited. Id. There was a trace of edema in the left lower extremity. Id. Stiles diagnosed Plaintiff with a high probability of having rheumatoid arthritis due to her a-positive rheumatoid factor at 1:16. Id. Stiles recommended that Plaintiff get physical and occupational therapy and have Cortisone injections in her knees bilaterally if the Prednisone did not quell the inflammation. Id.
On April 25, 2001, Plaintiff met with another MRA physician, Dr. Catherine Cunningham (hereinafter "Cunningham") who noted that Plaintiff's regimen of Methotrexate 7.5 mg and Prednisone 5mg was helping. R. 3-4, at 25. Plaintiff had much less pain and a fairly good range of motion (able to move and squeeze), although she did still have some synovitis. Id. Cunningham recommended that Plaintiff continue with Methotrexate, Folic Acid, Calcium, and Prednisone (despite Plaintiff's reluctance to use it). Id.
On June 13, 2001, Plaintiff saw a third MRA physician, Dr. David Helfrich (hereinafter "Helfrich") who continued as Plaintiff's long-term care MRA rheumatologist. R. 3-4, at 22. Helfrich noted that Plaintiff had "clear-cut improvement" in her synovitis (although it was still active at some of her PIP joints) and continued to take Methotrexate 7.5mg, Prednisone 2.5 mg, Folic Acid 1 mg and Calcium. Id. He also observed that Plaintiff still experienced morning stiffness, puffy wrists, warm knees (the right more so than the left), some pain and swelling, and a gelling phenomenon. Id. He increased Plaintiff's Methotrexate dosage to 15 mg while maintaining the other medications at the same level. Id.
Helfrich saw Plaintiff for a follow-up on August 22, 2001. R. 3-4, at 14. Plaintiff's synovitis had improved considerably with the increase in the Methotrexate dosage. Id. Her wrists were less puffy, her elbows were extending well, her ankle and subtalar joints were doing well, and her shoulders, hips, and knees were quiet. Id. Helfrich noted a "marked improvement" in Plaintiff's rheumatoid arthritis and recommended that Plaintiff stay with the same regimen.
Id. Helfrich also met with Plaintiff on May 22, 2002. R. 3-4, at 53. Plaintiff continued to do well with the Methotrexate at 15 mg, Ibuprofen at 800 mg and the Folic Acid at 1 mg. Id. Plaintiff had also gained weight and Helfrich recommended that she control her weight and exercise. Id. Plaintiff had a minimal degree of synovitis, the swelling had been reduced greatly and her wrists, elbows, and shoulders were quiet. Id. She still experienced some tenderness in her left ankle. Id.
On January 15, 2003, Helfrich declared Plaintiff's rheumatoid arthritis to be in remission. R. 3-5, at 39. Plaintiff continued with Methotrexate 15 mg, Ibuprofen 800 mg, and Folic Acid 1 mg. Id. Plaintiff no longer experienced warmth in her joints and she had a full range of motion in her shoulders, wrists, knees, hips, elbows, and ankles and a good hand grasp. Id. Plaintiff did have positive crepitus and minimal warmth to her knees bilaterally. Id. Her condition continued to remain stable as confirmed by her visitations with Helfrich on July 23, 2003 and April 24, 2004. R. 3-5, at 30 and 32.
Plaintiff's visit with Helfrich on October 20, 2004 evidenced continued progress along with some areas of noticeable regression. Plaintiff complained of sharp and stabbing knee pain and hip pain. R. 3-5, at 23. She had crepitus in her right and left knees and the morning stiffness in her hands appeared to last all day. Id. However, Plaintiff continued to have a full range of motion in her elbows, wrists, and shoulders. Id. Helfrich noted the possibility of Plaintiff's rheumatoid arthritis flaring up again. Id.
During Plaintiff's visit on February 9, 2005, Helfrich noted that Plaintiff was still experiencing day-long stiffness along with arthralgia in her hands, knees, feet, and shoulders. R. 3-5, at 55. Physical examination revealed tenderness at her PIP joints and hamstrings, her wrists were tender at the ulnar aspects, she had patellofemoral knee pain although her elbows had good extension and her shoulder motion was not restricted. Id. Helfrich recommended that Plaintiff start taking Etanercept (Enbrel) as an alternative to the Methotrexate but decided to wait before prescribing it as Plaintiff did not have insurance. Id. Helfrich's final diagnosis was that Plaintiff's rheumatoid arthritis had returned. Id.
During subsequent visits on May 4, 2005, June 29, 2005, and September 21, 2005, Helfrich observed that Plaintiff's rheumatoid arthritis had become active with joint discomfort in her hands and knees. R. 3-5, at 52-54. She still had tenderness at her PIP joints along with swelling, erythema, and warmth. Id. She continued to have good motion in her elbows, shoulders, and hips although the degree of crepitus in her joints had risen. R. 3-5, at 52. Plaintiff was able, however, to obtain samples of Enbrel and commence treatment. Id. Her Enbrel regimen was curtailed however as Plaintiff attributed her jaundiced condition to the medication. Id.
During the period of late 2005 and early 2006, Plaintiff saw Dr. Charles Calabrese (hereinafter "Calabrese") and Dr. Sarah Goodlive (hereinafter "Goodlive") for treatment of gastritis, cholestasis, colon polyps, and mild hepatitic changes attributable to Hepatitis B. R. 3-6, at 49-55; R. 3-7, at16-41. Plaintiff also underwent a series of biopsies, stent placement, an ERCP surgery with biliary stone extraction, and a colonoscopy for polyp formations. R. 3-6, at 37-49. Plaintiff saw Helfrich on January 18 and April 24, 2006 who noted that Plaintiff's jaundice had been resolved and concluded that her hepatitis was not due to the use of Methotrexate or Etanercept but stone disease. R. 3-7, at 14-15. Plaintiff was taken off both medications pending a liver biopsy. Id. While lacking full extension in her right knee, Plaintiff continued to enjoy good motion in her elbows, shoulders, and knees. Id. She was still taking 800 mg of Ibuprofen twice a day but that did little to alleviate the pain. Id. Helfrich observed that Plaintiff had positive synovitis, tenderness in the shoulders, positive edema, and positive joint line tenderness. Id.
There were a series of residual functional capacity assessments made of Plaintiff's condition. A state medical consultant ("consultant") conducted the first residual functional capacity (RFC) on April 3, 2003.*fn2 R. 3-5, at 14-21. The consultant noted that Plaintiff can occasionally lift/carry no more than 10 pounds, frequently lift/carry less than 10 pounds, stand/walk at least 2 hours in an 8-hour work day, sit for a total of about 6 hours in an 8-hour work day, and push/pull for an unlimited amount of time. Id. The consultant ...