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November 30, 1989

LOUIS W. SULLIVAN, M.D., Secretary of Health and Human Services, Defendant

The opinion of the court was delivered by: REVERCOMB


 This matter is before the Court pursuant to Plaintiff's Motion for Reversal or Remand and Defendant's Motion for Affirmance of the decision by the Secretary of Health and Human Services (Secretary) denying Plaintiff's application for Supplemental Security Income benefits under Title XVI of the Social Security Act. 42 U.S.C. §§ 405(g), 1383(c)(3).

 On July 3, 1985, Plaintiff went to D.C. General Hospital for treatment for carpal tunnel syndrome in her left hand and wrist. In December 1985 Plaintiff again went to D.C. General complaining of left hand pain and weakness. The results of diagnostic testing were consistent with carpal tunnel syndrome of the left wrist. *fn1" In April 1986 D.C. General physicians performed a carpal tunnel release which is a surgical procedure to relieve the symptoms of carpal syndrome. After the operation, plaintiff complained of some pain and stiffness in her hand but by September 1986 she had no complaints.

 From December 1985 Plaintiff had been seen as an outpatient for rheumatoid arthritis with complaints of pain and stiffness in her hands, fingers, feet and ankles. There was swelling in her fingers and she was unable to flex them and had a weak grip. There was no marked swelling or gross deformity with her hands, feet and ankles and flexion and extension were fine. Plaintiff took Naprosyn and Tylenol for relief of pain.

 In January 1988 Plaintiff visited D.C. General's rheumatology clinic complaining that her feet and ankles were painful and that her ankles and heels were swollen. Plaintiff also complained of pain in her hands and wrists although the pain was primarily in her right hand and wrist, the carpal tunnel release she had previously undergone having relieved her of the pain in her left wrist. She related that she achieved temporary relief of her pain with the medication Indocin. Physical examination of the Plaintiff revealed that there was some decreased range of motion in the right wrist. There was mild tenderness in Plaintiff's feet but the soles and digits were normal and had full range of motion. Plaintiff's shoulders and elbows were also normal and there was a full range of motion in Plaintiff's knees which were nonedementous, or in other words, not swollen. A D.C. General physician concluded that Plaintiff had nonspecific rheumatologic complaints which needed further evaluation. He prescribed Indocin, referred plaintiff for x-rays of her hands, feet, ankles, and knees, instructed her in exercises, and asked her to return to the clinic in two weeks.

 Plaintiff returned to the clinic in February 1988. Physical examination revealed that Plaintiff had swollen wrists with no tenderness but with slightly decreased range of motion. Her elbows were also swollen but she had full range of motion. Her feet were swollen and her ankles were slightly tender on lateral motion. She had a full range of motion of the shoulders and knees and there was no swelling of the knees. The treatment plan was to continue Plaintiff on Indocin and see her back in the clinic in three months.

 Dr. Franklin Garmon performed an orthopedic examination of Plaintiff in July 1987 for consultative purposes at the request of the Secretary. Plaintiff complained to him of pain in her hands and feet and stated that since the onset of her impairments in 1985 her joint pains have increased in severity. She stated that her medication tends to help but does not cure the pain. She stated that she can only walk for one and a half blocks before she has to stop because of the pain.

 Dr. Garmon reported that Plaintiff was in no acute distress and walked with an erect gait but with some guarding. There was no atrophy of the musculature of Plaintiff's legs. Ankle range of motion was normal but reportedly painful and they were mildly swollen. Toe motions were also normal but there was some tenderness. Range of motion in the hands, fingers and wrists was essentially normal although there was mild enlargement of one of the joints of plaintiff's right index finger with tenderness. Grip strength was marginal but strength in the other muscle groups in Plaintiff's arms and legs was essentially normal.

 At the hearing before the Administrative Law Judge (ALJ) the Plaintiff testified that on a typical day she is so tired after being out of bed for only half an hour that she can hardly walk. Plaintiff said she can stand no longer than twenty minutes before the bottom of her feet begin to burn. She walks to the shopping center and to the mail box. Walking at times frightens her because if she steps on something on the ground that she didn't see it hurts her feet. Once while walking her ankle simply gave way after having been on her feet for too long and she fell and knocked out two bottom teeth. Sometimes her feet swell so much that she cannot wear shoes. She testified that she spends most of the time sitting with her feet elevated watching TV or reading a book.

 She testified that she prepares her own lunch and dinner but sometimes it is almost too much of an effort to do more than open a can of soup. She cannot lift anything over five pounds because she has no strength in her hands. She testified that she has very little stamina and tires easily.

 Plaintiff testified that she has a home and has a young couple and an elderly gentleman living with her. The young woman helps her with most of the housework and often cooks for the Plaintiff. The elderly gentleman does the yard work, minor repairs and most of the driving for Plaintiff. Plaintiff occasionally drives her car to the store about ten minutes away from her ...

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