The opinion of the court was delivered by: David Stewart Cercone United States District Judge
Plaintiff, Carmenlita Ridout ("Ridout"), brings this action pursuant to 42 U.S.C. § 405(g), seeking judicial review of the final determination of the Commissioner of Social Security ("Commissioner") denying her applications for Supplemental Security Income ("SSI") and disability insurance benefits ("DIB") under Title II and Title XVI of the Social Security Act ("Act")[42 U.S.C. § § 401-433,1381-1382f]. Before this Court are cross-motions for summary judgment filed pursuant to Rule 56 of the Federal Rule of Civil Procedure. The record has been developed at the administrative level. For the foregoing reasons, this Court will DENY Commissioner‟s Motion for Summary Judgment (Doc. No. 10) and will GRANT Plaintiff‟s Motion for Summary Judgment (Doc. No. 8). The case will be remanded for further proceedings consistent with this opinion.
Ridout proactively filed for DIB and SSI on October 2, 2006, alleging disability as of July 17, 2006. (Record of Ridout v. Astrue, 09-1073, 62, 78)( herein after "R."). Ridout alleged disability due to hip bursitis, migraines and injuries from a motor vehicle accident. (R. 12). The applications were administratively denied on February 28, 2007. (R. 41, 46). Ridout responded by filing a timely request for an administrative hearing. (R. 114). On July 31, 2008, a hearing was held before Administrative Law Judge John T. Porter ("ALJ"). (R. 25-37). Ridout, who was not represented by counsel, appeared and testified at the hearing. (R. 26-37). There was no vocational expert ("VE") present. (R. 25-37).
In a decision dated September 2, 2008, the ALJ determined that Ridout was not "disabled" within the meaning of the Act. (R. 10-16). The Appeals Council denied Ridout‟s request for review on November 2, 2008, thereby making the ALJ‟s decision the final decision of the Commissioner in this case. (R. 1-3). Ridout commenced the present action on December 18, 2009, seeking judicial review of the Commissioner‟s decision. (Doc. No. 1). Ridout and the Commissioner filed motions for summary judgment on May 12, 2010, and June 11, 2010, respectively. (Doc. Nos. 8 & 10). The motions are now before the Court.
III. STATEMENT OF THE CASE
The documentary evidence indicates that Ridout suffers from multiple impairments. On July 17, 2006, Ridout‟s alleged disability onset date, she was involved in a motor vehicle accident. (R. 82, 130). Ridout was the driver of one of the vehicles involved in the accident. (R. 129). As a result of her injuries, Ridout was hospitalized for four days and treated for fractured ribs, fracture of the third metacarpal base in the left hand and right pneumothorax. (Id.). A CT scan of her chest, abdomen, and pelvis showed a pneumothorax on the right anterior basilar and two lateral lower rib fractures. (Id.). Ridout complained of left hand pain and an x-ray showed subtle lucency at the base of the third metacarpal fracture. (R. 137, 130). Ridout tested positive for cocaine at the time of the accident. (R. 137).
On December 28, 2006, at the request of the state agency, Ridout underwent a consultative medical examination by Lawrence Rahall, D.O.. (R. 144, 148). Ridout was not observed to be in acute distress, but "walked to and from the examination office with a slight waddle to her gait favoring her right groin." (R. 146). Dr. Rahall observed that Ridout had normal internal and external rotation of the flexion and extension of the left hip and the knees.
(R. 147). Ridout complained to Dr. Rahall of continued "discomfort in the right side of her chest, the upper portion of her back, at the base of her neck and right groin pain." (R. 144). Dr. Rahall noted that Ridout‟s rib pain was "gradually subsiding" and that her collapsed lung had "completely healed." (R. 144, 146). However, Dr. Rahall noted that Ridout‟s rib and right groin pain limited her ability to stand. (R. 144). Dr. Rahall concluded that Ridout‟s pain limited her to standing for 30 minutes. (R. 144-45).
Dr. Rahall observed abnormalities in Ridout‟s left arm and hand. Dr. Rahall noted that Ridout had left hand pain and weakness and was attending physical therapy once a week. (R. 144). Ridout had "some decreased extension to 45 degrees" in her left hand. (R. 147). Her left hand grasp was approximately 50% of normal and her left forearm strength was fifty percent in comparison to her right forearm. (Id.). Specifically, Dr. Rahall noted that Ridout had difficulty lifting anything greater than ten pounds or holding any object that has weight in her left hand.
(R. 145). Ridout was noted to have "normal opposition of her fingers" and "no localized pain to palpation in the wrist area or in the bones of the hand." (Id.). However, Dr. Rahall noted that Ridout has "a difficult time lifting objects with her left arm due to left hand pain." (R. 145).
Dr. Rahall completed a medical source statement which noted that Ridout should be limited to only minimal pushing and pulling. (R. 149). Dr. Rahall also indicated that Ridout could only occasionally bend, kneel, stoop, crouch, balance or climb. (R. 149-50). Ridout was also noted to have "affected" reaching, handling, fingering, and feeling. (R. 150). Furthermore, Dr. Rahall expressed that Ridout should avoid heights, moving machinery, and vibration. (Id.).
On January 10, 2007, Ridout was examined by William Greer, M.D.. (R. 154). Dr. Greer noted that Ridout ambulated "with some antalgia favoring the right lower extremity." (R. 154). Ridout continued to complain of right groin pain, thigh pain, and a "minimal amount of back pain." (R. 154). Ridout‟s lumbar spine examination revealed a full range of motion. (Id.). X-rays did not show evidence of acute injury and showed adequate maintenance of the joint space. (Id.). Dr. Greer noted "some right-sided paraspinal tenderness." (Id.). Dr. Greer assessed "right hip pain" and planned to offer a steroid injection if an upcoming MRI-arthogram didn‟t show intra-articular pathology. (R. 155).
On January 30, 2007, Ridout was seen by Mark Baratz, M.D., a treating physician at the Human Motion Center. (R. 155). Dr. Baratz noted "no lifting, no carrying", "no pushing or pulling", "no balancing" and "no climbing" because of Ridout‟s impairments. (R. 165). Dr. Baratz was awaiting results of the ordered MRI-arthrogram as he noted next to these limitations, "MRI-arthrogram needed & ordered." (Id.). Dr. Baratz noted that Ridout could frequently perform all postural activities except for climbing and didn‟t assess any other physical or environmental limitations. (R. 166).
Ridout was seen by Dr. Greer a second time on April 25, 2007, to review the results of her MRI-arthogram. (R. 181). Dr. Greer described the results as reflecting "some evidence of labral fraying" but "no occult fracture or frank labral tear. (Id.). Dr. Greer diagnosed Ridout with hip bursitis and proceeded to treat her with injections. (Id.). On October 15, 2007, Ridout told Dr. Greer the injection in April helped her for approximately three months, but the pain had been increasing. (R. 180). Since Ridout indicated that she was having renewed difficulty with hip pain, Dr. Greer administered another injection. (Id.).
On February 23, 2007, Brian Geho, a non-physician disability adjudicator found that Ridout was limited to an occasional ability to climb stairs, balance, stop, kneel, crouch and crawl. (R. 170-71). Mr. Geho also noted Ridout‟s limited ability to push and pull in the upper extremities, handle with the left hand, or finger with the left hand. (Id.). He also concluded that Ridout had no ability to climb ropes or scaffolds. (R. 170).
Ridout was also treated by physiatrist John A. Magnotta, M.D. On October 2, 2007, Dr. Magnotta performed an upper extremity neurologic examination. (R. 185). Dr. Magnotta‟s examination revealed "grasp, hand intrinsic, wrist extensors, elbow flexion extensors, and shoulder abductors to be 5/5." (Id.). Ridout had tenderness along the right medial scapular border, full bilateral shoulder abduction and forward elevation but no cervical spine motion restrictions. (R. 184-85). Dr. Magnotta‟s impression was that Ridout "may have a component of right scapulothoracic dysfunction, perhaps in relationship to her rib fractures, also a component of myofascial pain." (R. 185).
On October 25, 2007, Dr. Magnotta noted normal radiographs of Ridout‟s right shoulder.
(R. 184). Dr. Magnotta‟s impression was that his "evaluations have demonstrated left thumb CMC joint arthritis and right trochanteric bursitis. It is my impression that she may have a component of right scapulothoracic dysfunction with some secondary myofascial pain." (R. 183). Dr. Magnotta planned to send Ridout to physical therapy for ...