Monier v. Apfel (22 F. Supp. 2d 1035, 1998)

MEMORANDUM AND ORDER

MEDLER, United States Magistrate Judge.

This is an action under Title 42 U.S.C. § 405(g) for judicial review of defendant Kenneth Apfel’s (“Defendant”) final decision denying Plaintiff Marilyn Monier’s (“Plaintiff’) applications for Social Security benefits under Title II and Title XVI of the Social Security Act. Both parties have moved for summary judgment [21, 25] and the parties have consented to the jurisdiction of the undersigned United States Magistrate Judge for appropriate disposition pursuant to 28 U.S.C. § 636(c). [12]

I.

PROCEDURAL HISTORY

On September 25, 1992, Plaintiff filed an application for disability insurance benefits pursuant to Title II of the Social Security Act, 42 U.S.C. § 401, et seq. (Tr. 120-123), and an application for supplemental security income benefits pursuant to Title XVI of the Social Security Act, 42 U.S.C. § 1381, et seq. (Tr. 84 — 96), alleging a disability beginning March 2, 1990, due to carpal tunnel in both wrists and hands, disc problems with her back, arthritis in the wrist and hands and vein damage in her arms and legs. (Tr. 120, 138). The applications were denied initially (Tr. 79-83, 114-118) and upon reconsideration. (Tr. 75-78, 98-102).

Plaintiff requested a hearing (Tr. 97) which was held on September 8, 1993, before Administrative Law Judge (“ALJ”) H. Lloyd Kelley. (Tr. 26-74). The ALJ determined that Plaintiff was not under a disability at any time through the date of his decision. (Tr. 10-20). The Appeals Council denied review of the ALJ’s determination (Tr. 3-5), and the decision of the ALJ stood as the final determination of the Commissioner.

Plaintiff then brought a civil action before the United States District Court for the Western District of Missouri, Central Division. In an order dated May 7, 1996, the District Court reversed the Commissioner’s decision and remanded the case to the Commissioner for further proceedings. (Tr. 329-339). In an order dated July 1, 1996, the Appeals Council vacated the previous decision and remanded this case for further proceedings. (Tr. 340-341).

A second and supplemental hearing was held on December 2, 1996, before ALJ Phyllis Weber. (Tr. 289-328). Judge Weber determined that Plaintiff was not under a disability at any time through the date of the decision. (Tr. 269-282). The Appeals Council again denied review of the ALJ’s determination (Tr.262-263), and the decision of Judge Weber now stands as the final determination of the Commissioner.

II.

TESTIMONY BEFORE THE ALJ IN THE INITIAL HEARING

Plaintiff testified before the ALJ on September 8, 1993. She stated that she was 39 years old, graduated from high school, was divorced and had two children, ages 15)6 and 14, neither of whom lived with her. Plaintiff reported that she was 5'2" tall and weighed approximately 170 pounds. (Tr. 29, 43, 47). She lived in Belle, Missouri. She had no income at the time of the hearing and did not receive general relief or food stamps. (Tr. 44).

Plaintiff testified that she was a registered medical assistant which required completing a special one-year course. (Tr. 29). Plaintiffs training included office procedures, medical transcription training, laboratory work using a microscope, and phlebotomy work. (Tr. 50). Plaintiff stated she completed her training in 1991 and then worked as a personal care attendant for approximately three months. Her job was very flexible and permitted her to work around her physical therapy appointments. (Tr. 29-20). Plaintiff stated that medical transcription was difficult for her because she was clumsy at it; however, she was able to pass with the minimum speed required, with fifty one words per minute. (Tr. 50-51). Plaintiff also stated that in the past fifteen years, she worked as a stitcher and top-stitcher in the shoe manufacturing business. She operated a sewing machine and primarily sat, but also did some walking and standing. (Tr. 30-31).

Plaintiff reported that she received treatment from two or three different doctors. One was Dr. James Leslie, an orthopedic surgeon, who performed Plaintiffs carpal tunnel surgery and supervised Plaintiffs post-operative course of treatment. Dr. Leslie performed the surgery on Plaintiffs left hand in 1990. Plaintiff testified that after the surgery she never regained full use of her hand and never regained all of the strength back. She said it left her approximately B3]é% disabled in the left hand after the surgery and physical therapy. (Tr. 31).

Plaintiff wears a brace on her left hand. (Tr. 31). Plaintiff testified that she began wearing a brace on her left hand before her surgery. She wears it on an as-needed basis, like when she needs to drive a vehicle or lift something. (Tr. 32). Other than wearing a brace, Plaintiff reported that she also used Arthrocare cream, she takes hot showers or puts her hand in warm water and she does hand exercises. (Tr. 34). Plaintiff stated she needs to rest her hands depending on how much she uses them. If she is using them a lot, she needs to stop frequently for ten-minute breaks. (Tr. 34). No one has ever recommended to Plaintiff that she participate in a work hardening program, attend a pain management clinic or use a TENS unit. (Tr. 46).

Plaintiff stated that she was approximately fifteen percent disabled in her right hand. Dr. Leslie informed her that if it did not get any worse than that, he would rather not operate because he was not pleased with the way the left hand responded to the surgery. Plaintiff is right handed. (Tr. 32-33). Dr. Leslie told Plaintiff that she could no longer go into production work, factory work or manufacturing. (Tr. 33).

Plaintiff reported that every morning when she wakes up, she has numbness with tingling in her right hand. The left hand has a dead feeling to it with no strength. Plaintiff reported that as the day progresses, the tingling and numbness diminishes, but she always has the sensation as if her fingers are going to sleep. (Tr. 33-34).

Plaintiff stated that she often drops things; she is always scratching herself or hurting herself when she tries to grab the things she drops. When she tries to cook, she often burns herself. She is very clumsy. She has difficulty opening cans and she takes a long time to write letters. (Tr. 33).

Plaintiff testified that she has been treated by Dr. Curtis Cox, a neurosurgeon. She began seeing Dr. Cox for her low back injury. Dr. Cox had Plaintiff undergo an MRI and then treated her with physical therapy. He said he would prefer not to operate until her condition worsened. He believed that if Plaintiff walked, took care of herself and tried to get stronger, her back situation would improve. (Tr. 34-35). She said her pain worsens when she rides in a vehicle, sits on the floor and then tries to stand up, and in cold weather. She said she tries to alleviate the pain with warm showers, medication, and Arthrocare cream. She usually takes a hot shower every day but, when her back is especially painful, she takes up to three showers a day. She needs to take three showers a day about three times a week. (Tr. 36-37). She also lays on her stomach on the floor to alleviate the pain. She usually has to lay on the floor twice a day for about ten to fifteen minutes. (Tr. 36).

Plaintiff testified that she takes Ibuprofen 600 for pain, which is prescribed by Dr. Cox and Dr. Leslie. She said it does not alleviate the pain, which is a dull ache all the time. However, the medication does relieve some of the pressure build-up, especially at night. Plaintiff stated that she takes the medication three to four times a week and only takes it when the pain gets unbearable. (Tr. 37)

Plaintiff reported that she sees Dr. Joyce Reed for her high blood pressure. Her hypertension is controlled with medication. (Tr. 47).

Plaintiff goes to bed around 9:30 in the evening and rises around 6:30 in the morning. She usually wakes up on average of three times a night due to her back pain. (Tr. 37-38). Plaintiff reported that she drives her car about three times a week. (Tr. 38). She lives by herself in an apartment. However, she has a number of people around so she has help if she needs it and her living space is small so she does not have a large area to take care of. (Tr. 38). She said she does the dishes and cooks for herself. (Tr. 38). She does not dust very often. She tries to get someone else to vacuum. If she has to do the vacuuming, she usually needs to lay down afterwards. Plaintiff said she does the grocery shopping but someone needs to go with her to carry the groceries. (Tr. 29). She reads a lot, watches a lot of television, and picks things up around her apartment. (Tr. 42).

Plaintiff stated that she tries to walk every day, weather permitting. She usually walks two times a day anywhere from two to five miles, total. (Tr. 39-40). Plaintiff reported that she can stand in one area for about ten to fifteen minutes before she gets uncomfortable. Plaintiff said she can sit for ten to fifteen minutes before her back starts aching. (Tr. 40). According to Plaintiff, she can lift five pounds with her left hand and she can lift approximately ten pounds with the right hand. (Tr. 40-41).

Plaintiff testified that she did not attend church and did not belong to any clubs or organizations. Prior to her injury, she was active in Girl Scouts and in school activities. (Tr. 47). She visits her parents once every two weeks. One a week, Plaintiff visits a friend. She goes to the post office every other day. (Tr. 48).

III.

TESTIMONY BEFORE THE ALJ AT THE SUPPLEMENTAL HEARING

Plaintiff testified before Judge Weber on December 2, 1996. She stated that she was divorced and lived by herself. She had no source of income. However, she reported that she receives general relief in the amount of $80 per month and has been receiving that since her injury in 1992. In addition, she is in FHA housing which does not require her to pay rent. She pays for her food with food stamps. She receives a utility cheek in the amount of $48 per month which helps her with her utilities. She also receives energy assistance one time per year. (Tr. 292-293, 295). Plaintiff testified that she graduated from high school and completed one year of college where she studied medical assistance. She stated she was a registered medical assistant. (Tr. 293).

Plaintiff reported that she was employed with Brown Shoe Company from 1981 to 1990. She stopped work there due to her carpal tunnel syndrome in her left hand. She applied for and received Worker’s Compensation. (Tr. 294). She received a lump-sum payment in the approximate amount of $5,000. (Tr. 295). Plaintiff testified that after she received her Worker’s Compensation settlement, she tried to work as a personal care attendant but had difficulty doing so because of her back. She last worked in June 1992 and has not worked since. (Tr. 295).

Plaintiff reported that she had surgery on her left hand. (Tr. 308). The doctor told Plaintiff that the surgery was not as successful as he had hoped. (Tr. 309). Plaintiff stated that she has not had surgery on her right hand and surgery on the right hand is not anticipated. (Tr. 308). The doctor told Plaintiff that laser surgery might possibly help Plaintiff but the doctor could not guarantee it. (Tr. 308-309). She does, however, do exercises on a daily basis to strengthen her right hand in order to correct her problem. (Tr. 296).

Plaintiff stated that she is clumsy and often drops things, like frying pans, water glasses, pencils, and ink pens. She cannot carry things well, she cannot sit very long and she cannot stand for very long at one time. The doctor told Plaintiff that she drops things because of her carpal tunnel in her hands which has caused nerve damage. The nerve damage has caused her to lose feeling in her fingers. Her fingers feel numb and tingle. (Tr. 299). Plaintiff stated that she wears splints approximately three to four times a week, normally. The splints give her more strength. (Tr. 300).

Plaintiff testified that she has pain in both wrists and both hands. When she goes to sleep at night, her hands tingle, go to sleep and are numb. Her hands have no strength in them. She also has times during the day when her hands tingle or are numb. She testified that the pain level in her hands on a scale of one to ten is about a five. She said that if she holds onto something for very long, like five minutes, her hands will go to sleep and will go numb. Likewise, if she writes for very long, her hands go numb. (Tr. 303).

Plaintiff stated that she has problems with her back because she has “several discs that are messed up.” (Tr. 298). She also has bulging discs. She follows Dr. Cox’s advice and walks a lot and takes medication for her back. She said she tries to walk at least two and a half miles twice a day when the weather permits. She also takes warm baths, uses a heating pad and uses Arthrocare cream. She said she lays down approximately twice a day for five to ten minutes and elevates her feet. This relieves the pain in her back. (Tr. 298, 310-311). Plaintiff testified that the pain level in her back is a six, on a scale of one to ten. (Tr. 303). She described the pain as an aching, nagging pain that wears her down. She also has stiffness. (Tr. 309). Sitting definitely makes her pain worse, as well as riding in a vehicle. (Tr. 309). Plaintiff reported that Dr. Cox has not recommended surgery and believed that what Plaintiff was presently doing to take care of her back was all she needed to be doing. (Tr. 307). Other than the problems with her wrists and back, Plaintiff testified that there was nothing else that kept her from working. (Tr. 298).

Plaintiff stated that sometimes she goes to the grocery store and sometimes a friend goes for her. She is able to cany her groceries in small amounts. She said she drives her own truck but does not take long trips. She will drive approximately fifteen miles one way. (Tr. 305). Plaintiff takes care of some of her household chores. If she has a chore which is of a heavy nature, like moving furniture, she has friends help her. Her apartment is small, so she does not have trouble dusting and other such things. (Tr. 306). Plaintiff said she likes to watch television, she likes to read and she likes to walk. (Tr. 306). Plaintiff said she attends church. She has a boyfriend and they go out to eat. (Tr. 308). She is clumsy when she eats, however. She often drops her fork and has trouble cutting with a knife. (Tr. 308).

Plaintiff said she has trouble standing in one position after fifteen minutes. (Tr. 306). She can lift five pounds with the left hand and ten pounds with the right hand. She can lift approximately fifteen pounds using both hands. (Tr. 307). She has trouble sitting because she gets stiff and achy, which requires her to change her position. (Tr. 307). She can sit for about fifteen minutes before she needs to move around. As long as she can stretch or change her position, she feels relief. (Tr. 309).

Plaintiff reported that she goes to bed at night between 10:00 and .10:30. She wakes up between.4:00 and 7:00 in the morning. She wakes up approximately three times during the night because of the pain. (Tr. 312-313). Plaintiff stated that she takes Ibuprofen three times a day, usually in the morning when she wakes up, around noontime and then again before she goes to bed. (Tr. 316).

John F. McGowan, a vocational expert, also testified before the ALJ. Dr. McGowan indicated that he had looked at the record and had listened to Plaintiffs testimony. He then classified Plaintiffs past relevant work. He stated that her work as a personal attendant for four months in 1992 is generally considered to be unskilled direct entry work. If she had to lift people, then her work would be classified as heavy. The expert testified that Plaintiffs past work with Brown Shoe as a sewing machine operator, specifically a top stitch operator, is classified as semiskilled and requires a full range of reaching and handling using both arms, hands and feet to do the work. It is classified as light. (Tr. 318-319).

The ALJ then asked Dr- McGowan the following hypothetical question:

I want you to assume a woman who is 42 years of age with a similar work background and education level of the claimant, that would be 12 years plus training in, I think, medical technology through Voc Rehab and that this person has — because of back problems and pain at a mild level, however, is limited in bending and that this individual has been diagnosed with carpal tunnel syndrome in both hands but is able to lift ten pounds with the right, five pounds with the left, presumably in combination 15 pounds, but should not do any vigorous repetitive work with the hands and would be limited to a sit/stand option. Are there any jobs for such an individual?

(Tr. 319). The expert responded that this individual could perform the jobs of information clerk, security monitor, and dispatcher. (Tr. 320-321).

The ALJ then asked the expert to assume that the individual needed to lie down approximately two times a day for brief periods. The expert testified that the individual would not necessarily be precluded from doing any of the jobs he identified; however, the problem would be whether facilities would be available where the claimant could lay down, and that is not a predictable factor. (Tr. 322).

Upon cross-examination, Plaintiffs attorney asked the expert to assume the restrictions identified by Dr. Cox in his report of July 1993. Specifically, he asked the expert to assume that the individual was limited to a total of four hours standing per day (one hour at a time) and sitting a total of three hours per day (fifteen minutes at a time). Based on this report, the expert testified that the individual would be unable to perform the three jobs he identified. He further stated that the limitation of sitting for only fifteen minutes at a time would preclude the individual’s ability to engage in the jobs requiring a sit/stand option. (Tr. 324-326).

IV.

MEDICAL AND OTHER RECORDS BEFORE THE ALJ

On January 6, 1989, Plaintiff sprained her right ankle. Plaintiff was examined by Dr. Joyce Reed, Plaintiffs general physician. The doctor’s assessment was a significant right ankle sprain most probably a grade III. On that same date, Plaintiff also had complaints of numbing paresthesia of the hands. There was positive Tinel’s sign over the medial nerve with significant numbing paresthe-sia noted. Dr. Reed felt Plaintiff should be ■worked up for carpal tunnel syndrome. (Tr. 211-212).

On April 19, 1989, Plaintiff was seen again by Dr. Reed. Plaintiff stated that she was feeling well although she continued to have some intermittent pain in the right ankle. (Tr. 212). Plaintiff displayed positive Tinel’s sign of the median nerve bilaterally. The doctor again indicated that Plaintiff should be worked up for carpal tunnel syndrome. (Tr. 212).

Plaintiff received no further medical treatment until February 15, 1990, when James Leslie, M.D., examined Plaintiff for the Division of Vocational Rehabilitation. Plaintiff complained to Dr. Leslie of pain in her neck, low back, both hands and the right ankle. Physical examination revealed that Plaintiff had full range of motion in the cervical spine. The lumbar spine showed forward flexion fully performed with the finger tips reaching the floor. There was tenderness to palpation at the base of the cervical spine and there was some prominence of the spinous processes and soft tissue in this region. Straight leg raising was negative. There was no evidence of limitation of spine movement and no evidence of muscle spasm. (Tr. 200-201).

Plaintiffs hands showed the ability to make a full fist although Plaintiff expressed some feeling of weakness of grip. There was tenderness to palpation along the flexor tendon of the long finger of the right hand but no specific tenderness in the left palm. Forearm supination and pronation was fully performed as was wrist flexion, extension, ulnar and radial deviation. Sensation testing to pinprick stimulation of the arms indicated glove type decrease in sensation from the wrist down, bilaterally. (Tr. 200-201).

Multiple x-rays were taken of the hands, neck and back. X-rays of the cervical spine did not show specific evidence of degenerative intervertebral disc change, nor of significant arthritic change. Lumbar spine x-rays did not look remarkable other than for some anterior marginal early arthritic spurring and perhaps some narrowing of the L5-S1 intervertebral area. X-rays of the hands did not show significant findings that would be considered abnormal other than possibly some very mild early arthritic changes. (Tr. 200-201).

Dr. Leslie diagnosed Plaintiff with possible early osteoarthritic changes of some of the fingers with associated flexor tendonitis. He also stated that the possibility of impending or early carpal tunnel type symptoms must be considered. He believed that, in order to rule out these possibilities, a bilateral upper extremity EMG study should be conducted. (Tr. 201). Dr. Leslie’s suggested therapy was to attempt a job category change to eliminate the heavy use of the hands, right foot and right ankle in work performance. He also suggested that repetitious movements be avoided. (Tr. 201). He concluded that he saw no reason not to proceed with assessment for vocational potential and training. (Tr. 202).

On March 7, 1990, Plaintiff complained to Dr. Reed of numbness, tingling and some swelling with both hands. She said she was unable to grip with the right hand. Physical examination revealed mild edema of the right hand. Phalen’s sign was positive, bilaterally. The doctor diagnosed Plaintiff with paresthe-sia, bilaterally, and tenosynovitis. Plaintiff was prescribed Naprosyn and was given splints for her hands. (Tr. 224).

On March 9, 1990, Plaintiff was seen by Brenda Guenther, D.O., at the Charles E. Still Osteopathic Hospital, with complaints of right hand pain. She stated that she had pain in her left arm as well. Examination revealed a slight decrease in flexion and extension of her wrists bilaterally. She had full range of her digits, however, the right digits were somewhat stiff in movement. Manual muscle testing showed strength to be essentially 5/5 throughout with the exception of the dorsiflexion. Findings were consistent with bilateral carpal tunnel with the left hand showing more evidence of carpal tunnel than the right. The doctor also believed that Plaintiff had a significant amount of tenosyn-ovitis with some overuse type syndromes causing a significant amount of pain in her right arm and hand. (Tr. 220-223).

On March 14, 1990, Dr. Reed examined Plaintiff, who returned for a checkup still complaining of her right wrist being sore. Examination revealed a positive Phalen’s sign, bilaterally, and a negative Tinel’s sign, bilaterally. Dr. Reed diagnosed Plaintiff with bilateral carpal tunnel syndrome and tenosynovitis of the right hand. The doctor recommended that Plaintiff continue splinting her hands and taking medication. The doctor also discussed with Plaintiff the possible need for surgery. The doctor instructed Plaintiff to avoid repetitive activities, gripping and pulling with the hands. (Tr. 209, 224).

On March 28, 1990, Plaintiff continued to report marked pain in the right hand and paresthesia to both hands. Dr. Reed noted that Plaintiffs nerve conduction studies were consistent with bilateral carpal tunnel syndrome. She instructed Plaintiff to continue taking Naprosyn- and to continue wrist splinting at all times. (Tr. 207).

On April 11,1990, Plaintiff reported to Dr. Reed that her symptoms had improved somewhat. She still experienced some paresthe-sia in the left hand and considerable pain in the right hand. However, Plaintiff told the doctor that she had been more active at home and was doing household chores. The doctor noted that there was palpable tenderness along the mid aspect of the right wrist and right hand. Plaintiff also still had a positive Phalen’s sign in both hands. Plaintiff was again instructed to continue taking Naprosyn and to continue with the splints and the warm soaks. (Tr. 207).

On April 25, 1990, Plaintiff complained of occasional paresthesia in the left hand. She also continued to complain of pain in the right hand, which limited her gripping and occasionally caused her to drop things. Phalen’s sign was only mildly positive, bilaterally. The doctor assessed Plaintiff with bilateral carpal tunnel syndrome and teno-synovitis of the right hand, which was gradually improving. The doctor instructed Plaintiff to wear her splints only at nighttime, to continue with warm soaks and to begin exercises with the hands. (Tr. 207).

Plaintiff returned to Dr. Reed on May 9, 1990. She reported continuing intermittent paresthesia to the left hand but reported that the right hand was improved as far as pain is concerned. Phalen’s was positive on the left side and negative on the right side. There was no tenderness with palpation to the right hand and thumb. The doctor assessed Plaintiff with bilateral carpal tunnel syndrome and tenosynovitis of the right thumb. Plaintiff was instructed to wear the left wrist splint on a continual basis and to continue with warm soaks. She was also instructed to splint her right wrist at bedtime. (Tr. 207).

On May 14, 1990, Dr. Reed completed a “General Medical Examination Record” for the Division of Vocational Rehabilitation. The doctor noted that Plaintiff had been unable to work since March 6, 1990 due to paresthesia and pain in both hands. The doctor reported that Plaintiff had positive Phalen’s and Tinel’s signs bilaterally together with tenderness along the right thumb. She diagnosed Plaintiff with bilateral carpal tunnel syndrome, tenosynovitis of the right thumb, and a history of Achilles tendon strain. She indicated that Plaintiff should avoid repetitive activities, gripping and pulling with the hands. (Tr. 208-209).

On May 23, 1990, Plaintiff still reported a problem with paresthesia to her left hand, with occasional paresthesia to her right hand. Positive Phalen’s signs were noted bilaterally, worse on the left. Dr. Reed continued to diagnose Plaintiff with bilateral carpal tunnel syndrome, worse on the left, and resolving tenosynovitis of the right hand and thumb. Dr. Reed referred Plaintiff to Dr. Leslie regarding possible carpal tunnel release surgery. (Tr. 206). Carpal tunnel release was performed by Dr. Leslie on July 26, 1990. (Tr. 191,198).

On December 6, 1990, Dr. Leslie issued a report to Vocational Rehabilitation. He reported that on July 26, 1990, a carpal tunnel release was performed on Plaintiffs left hand and thereafter Plaintiff received a regular program of rehabilitation physical therapy. The doctor believed she had progressed satisfactorily with the program. Examinations since her surgery indicated satisfactory progress with the return of strength to a satisfactory level for ordinary activity in the left hand. The doctor noted that Plaintiff persisted with some mild symptoms in the right hand but he did not feel that surgery was required at that time. Dr. Leslie reported that he last examined Plaintiff for the status of her hands on November 14,1990, at which time Plaintiff indicated that she was doing fairly well with the use of the left hand. She did report that there was still a slight amount of soreness and occasional tingling in the right hand. The doctor believed that Plaintiff could be released from active treatment and could return to work. However, she would probably need some form of schooling to prepare her for a less physically demanding type job. The doctor did not believe that she should return to the work that she was performing at Brown Shoe Company due to the repetitious nature of that work. He believed that Plaintiff’s symptoms would either return or persist if she returned to work of that nature. In summary, the doctor stated that Plaintiff was considered disabled as far as physical repetitious work activities were concerned but she should be considered capable of returning to schooling for training for some other type vocation. (Tr. 191-192).

On January 4, 1991, Plaintiff was seen again by Dr. Leslie with neck and back complaints. She apparently had been involved in a motor vehicle accident in October 1990. She indicated that she was feeling better and had started school in December. Straight leg raising was negative. X-rays showed no definite fracture. The doctor diagnosed Plaintiff with persisting lumbar sprain and instructed Plaintiff to do back exercises. (Tr. 189).

Dr. Jerome Levy examined Plaintiff on January 18, 1991. Plaintiff reported to Dr. Levy that her left hand had not improved much since the surgery. The numbness and tingling were gone, but her hand was still weak. She also said she had sharp pains in the left hand when turning it in certain directions. (Tr. 215). As for her right hand, she complained of weakness and of intermittent numbness and occasional tingling. Physical examination revealed equal strength in both extremities. However, Plaintiff was unable to squeeze the dynamometer with either hand. There was no measurable muscle atrophy or motor weakness. Sensory examination showed diminished sensation to pin prick in a stocking distribution of the entire left hand without relation to dermatome pattern. Tinel’s sign was not present. There was slight discomfort on motion of both wrists. Deep tendon reflexes were equal and active bilaterally. Circulation was normal. All joints moved through a full range of motion. The doctor’s diagnosis was status post left carpal tunnel release, chronic strain of the left wrist, carpal tunnel syndrome of the right wrist and chronic strain of the right wrist. In Dr. Levy’s opinion, Plaintiff had a permanent partial disability which he would rate at thirty percent of the left upper extremity at the wrist and twenty percent of the right upper extremity at the wrist. He indicated that the combination of the impairments created a greater disability than the simple total of each. (Tr. 216-217).

On February 8, 1991, Plaintiff returned to see Dr. Leslie with complaints of some aching in the low back. She indicated that the exercises helped some. The doctor’s diagnosis remained the same as of January 4, 1991, ie., persisting lumbar strain, and he instructed Plaintiff to continue with the exercises. (Tr. 189).

On March 27, 1991, Plaintiff reported to Dr. Leslie that she felt better. She said she only had some aching in her back in bad weather. She was diagnosed with persistent lumbar strain and was instructed to continue with exercises. (Tr. 190).

On May 17, 1991, Dr. Reed examined Plaintiff and noted that Plaintiff suffered from increased blood pressure. Her blood pressure reading was 148/100. (Tr. 205). On May 17th, Plaintiff was also examined by Dr. Leslie to whom she continued to report that her back felt better. She reported that her hands have been sore during the bad weather. She told the doctor that she was still in business school and would finish in December. Physical examination revealed that Plaintiff had full range of motion in her back. Straight leg raising was negative bilaterally. (Tr. 190).

On June 3, 1991, Plaintiff returned to Dr. Reed for a routine examination. Her blood pressure reading was 168/100. (Tr. 205). On June 7, 1991, Plaintiffs blood pressure was 158/100. Dr. Reed noted that Plaintiffs blood pressure was still elevated and she discussed with Plaintiff the need for increased exercise and weight loss to avoid the need to take anti-hypertensive medication. On July 31, 1991, Plaintiff returned to Dr. Reed with a blood pressure reading of 142/98. (Tr. 205). Plaintiff was started on blood pressure medication. (Tr. 204-205).

On July 9, 1991, Plaintiff returned to Dr. Leslie. He noted that Plaintiff had good range of motion in the back. Straight leg raising was negative bilaterally. He continued to diagnose Plaintiff with lumbar strain. (Tr. 187).

On August 5, 1991, Plaintiffs blood pressure reading was 124/84. On August 7th, her blood pressure reading was 120/82. Dr. Reed noted at that time that Plaintiffs hypertension was much improved. Plaintiff was to continue with a regimen of anti-hypertensive medication. (Tr. 204).

Plaintiff returned to Dr. Leslie for a routine follow-up examination of her back on October 16,1991. She indicated that she still had pain. It was not constant, however, and mostly occurred when she was riding in a truck or had been sitting for a long period of time. She said it was not unbearable but is was an ache. Straight leg raising was negative. The doctor continued to diagnose Plaintiff with lumbar sprain. (Tr. 187).

On November 19, 1991, Plaintiffs blood pressure reading was 144/96. Plaintiff had apparently stopped taking her blood pressure medication. Dr. Reed noted that Plaintiffs blood pressure was well-controlled with medication and instructed Plaintiff to begin taking her medicine again. (Tr. 204).

On December 17, 1991, Plaintiff reported to Dr. Reed that she was having wrist pain in her right wrist in the area where she had previously had problems with tendonitis. There was some mild palpable tenderness along the dorsal medial aspect of the right wrist. The doctor believed Plaintiff had ten-osynovitis of the right hand and wrist. Dr. Reed instructed Plaintiff to splint the area again, to use warm soaks and to take Napro-syn. (Tr. 203-204).

On February 26, 1992, Plaintiff was seen by a neurosurgeon, Curtis Cox, M.D., at the Jefferson City Bone and Joint Clinic, Inc. (Tr. 183). Plaintiff was referred to Dr. Curtis by Dr. Leslie. Plaintiffs main complaint was pain in the low back and numbness and pain down the right lower extremity to the foot. Plaintiff underwent an MRI which was positive for a herniated disc on the right side and was negative on the left side. She had moderate paraspinal muscle spasms. She could walk on her heels and toes, with pain evident while heel walking. The doctor’s impression was lumbar, radiculopathy from a herniated disc at L4-5 and L5-S1 on the right. (Tr. 183). The doctor recommended an Epidural DepoMedrol Injection to be followed by a program of physical therapy. If this failed, the doctor believed that Plaintiff would be a candidate for lumbar laminotomy and diskectomy at both levels, L4-5 and L5-S1 on the right. (Tr. 183).

On March 25, 1992, Plaintiff indicated that she had improved following her epidural injection. She also stated that the therapy was helping. Plaintiff told Dr. Cox that she was doing a lot of walking at home and some exercises. The doctor believed that as long as therapy and conservative care was working, there was no need to proceed with operative intervention. (Tr. 184).

On April 29, 1992, Dr. Cox noted that Plaintiffs low back pain had improved. She stated that the traction at therapy really seemed to make a significant difference. She still had some soreness in the back and soreness down the right ankle, but otherwise she was doing fine. Plaintiff reported that she was walking about five miles a day. The doctor told her that she needed to lose weight to improve her back. He also instructed her that she needed to avoid heavy lifting and prolonged sitting. The doctor’s impression was lumbar radiculopathy from herniated disc at L5-S1 with slight asymmetric bulging on the right side at L4-5 as well and disc desiccation at all three levels in the low back. She was to continue her home therapy and see the doctor again in August for a final evaluation. (Tr. 185).

On July 7, 1992, Plaintiff was seen at the Phelps County Regional Medical Center with complaints of swollen ankles. (Tr. 149). Plaintiff underwent a bilateral lower extremity venous duplex scan. The impression of William W. Cottingham, D.O., who reviewed the scan, was: (1) normal bilateral lower extremity Doppler arterial screening examination; (2) no evidence of venous thrombosis; and (3) probable venous insufficiency of the left lower extremity. Plaintiff was discharged from the emergency room in stable condition. (Tr. 149). She was instructed on discharge to decrease her use of salt and to elevate her legs. (Tr. 154).

On August 3,1992, Plaintiff was seen again by Dr. Cox who noted that Plaintiff was doing very well. She had minimal discomfort in the low back without any radiation into the legs. She had negative straight leg raising bilaterally. She had soft paraspinal muscles and normal ankle jerks bilaterally. The doctor noted that although Plaintiff had some structural abnormalities in her low back, in light of the fact that she was doing very well and was largely asymptomatic, the doctor believed there was no need for surgical intervention. Plaintiff was discharged from Dr. Cox’s care. (Tr. 186).

On November 5, 1992, Plaintiff was examined by John Demorlis, M.D., for a disability physical. Physical examination revealed no swelling of Plaintiffs joints. There was no atrophy and no deformities. Plaintiff did not have varicosities. Tinel’s sign was negative. She had stocking glove decreased sensation of the left forearm to include the wrist, hand and fingers. She had upper and lower motor strength of+5/+5. She could do two-thirds of a squat and could heel and toe walk. She had a normal gait. She had complete range of motion in the shoulders, elbows and wrists. Plaintiff could fully extend her hands and could make fists. She had full range of motion in her hips, ankles, cervical spine and lumbar spine. The doctor’s impressions were: (1) subjective hypoparesthesia left forearm, wrist, hand and hyperparesthesia right wrist and hand (apparently due to carpal tunnel and possibly failed left carpal tunnel surgery); (2) arthralgias; (3) history of a probable lumbar disc herniation; (4) no significant venous insufficiency found; and (5) exogenous obesity. The doctor indicated that there was no evidence of incompetency or obstruction of the deep venous return. (Tr. 170-176).

On December 4, 1992, Plaintiff underwent a “Comprehensive Functional Capacity Evaluation” by Rusk Rehabilitation Center to assist the Division of Vocational Resources in vocational placement. (Tr. 155). When Plaintiff was asked to indicate how a typical 24-hour day was divided among the activities of sitting, standing/walking and sleeping/lying down, Plaintiff gave the following profile: sleeping or lying down, 9.0 hours; standing or walking, 7.5 hours; and sitting, 7.5 hours. The doctor’s objective findings included the following with respect to Plaintiffs back. She had an independent gait requiring no 'assistive device. Speed, symmetry and rhythm were normal. There was poor correlation between Plaintiffs movement patterns and her pain rating of 7/10+ . Plaintiffs sitting posture was unremarkable. Lumbar lordosis appeared normal to slightly increased. Plaintiff could heel-toe walk. Initially, Plaintiff claimed she could not squat; however, with coaxing, she was able to squat and return to standing without much difficulty. (Tr. 159). When tested for repetitive forward bending of the lumbar spine, it was noted that Plaintiff performed ten repetitions in 45 seconds. There was no over-reaction or end-stretch noted. Her range of motion remained consistent and her lumbosacral rhythm was normal. Her pain rating of 5/10+ did not correlate with the doctor’s observed movement patterns. During the fast repetitive bending test, Plaintiff performed 25 repetitions in 65 seconds. Her range of motion remained consistent with repetitions and her lumbo-sacral rhythm remained smooth. She continued to rate her pain as 5/10 +; however, her movement patterns did not correlate well with this pain rating. (Tr. 160).

As for Plaintiffs upper extremities, the doctor noted that there was no edema, especially in the hands. Phalen’s sign was positive in the right hand after twelve seconds and in the left hand after two seconds. Range of motion in the upper extremities was within normal limits. (Tr. 161-162). She scored within normal function on the right hand in six of seven subtests, testing fine manipulatory skills. However, she had poor fine manipulatory skills of the left hand. She scored at the 14th percentile in performing assembly tasks. (Tr. 162-163).

Plaintiff attempted seven material handling tests. Although Plaintiffs results were low, the doctor noted several inconsistencies. For instance, at first Plaintiff said she could only carry an empty milk crate weighing two pounds. However, she demonstrated an ability to carry a sandbag weighing ten pounds over a distance of fifteen feet. She gave the clinical appearance of exerting a great deal of effort and on one occasion let the object fall to the floor and began dragging it to complete the task. However, on another occasion she was able to carry it the full fifteen feet. On another occasion, Plaintiff attempted to push an empty sled requiring 18 ft.-lbs of force and reported being unable to complete the task. However, this did not correlate with the doctor’s observations of Plaintiffs demonstrated ability to easily push open the clinic door at the time of departure, which required 32 ft.-lbs. of force. (Tr. 164). The doctor noted that Plaintiffs results did not correlate with her demonstrated strength during the musculoskeletal examination. (Tr. 165).

In summary, the doctor noted that there appeared to be discrepancies between Plaintiffs perception of her functional abilities, her results of the musculoskeletal and hand evaluations and self reports of specific activities. The doctor believed that Plaintiff could increase her functional abilities if she continued her prescribed home exercise program on a daily basis, if she utilized work simplification and energy conservation techniques, if she wore splints on her wrists during repetitive use and if she continued with her walking program on a daily basis to promote cardiovascular fitness and weight loss. The doctor also believed that Plaintiff would benefit from instruction on proper body mechanics and lifting techniques .to decrease the amount of stress to the low back. Finally, the doctor noted that Plaintiff would benefit from participation in a work tolerance program focusing on improvement of functional abilities. (Tr. 168-169).

On July 7, 1993, Dr. Leslie completed a Physical Medical Source Statement. With respect to Plaintiffs ability to lift, carry, stand, walk, sit, push and pull, Dr. Leslie deferred to the reports of Dr. Cox. He also deferred to Dr. Cox’s reports with respect to climbing, balancing, stooping, kneeling, crouching and bending. Dr. Leslie found that Plaintiff was limited in her ability to reach, handle, finger and feel. He believed that she was limited because of her past history of bilateral carpal tunnel syndrome. In the doctor’s opinion, resuming work of a rapid hand use could cause reactivation of Plaintiffs carpal tunnel syndrome. (Tr. 245-247).

On July 19, 1993, Plaintiff was examined by Dr. Cox for an evaluation for social security disability. Plaintiff complained to the doctor of occasional aching and nagging backache as well as some numbness down her left leg. Plaintiff told the doctor that walking tended to decrease her pain, but sitting tended to increase it. She said she could stand for thirty minutes whereas sitting tended to bother her and cause some numbness in her left leg. (Tr. 235). Physical examination revealed Plaintiffs blood pressure to be 125/85. Plaintiff was able to walk on her toes and heels bilaterally. She had decreased sensation at L5-S1 on the left side. Straight leg raising was negative on the right at 90 degrees, but 80 degrees on the left caused back pain. She had mild paraspinal muscle spasms. Plaintiff had some limited range of motion of the thoracolumbar spine with some back discomfort. She was able to stoop. (Tr. 235).

Dr. Cox reported that Plaintiff could frequently lift and/or cany twenty-five pounds, she could stand and/or walk a total of four hours in an eight-hour day and could continuously stand or walk for one hour. She could sit for a total of three hours in an eight hour day and could continuously sit for fifteen minutes. Her ability to push and/or pull was limited because of her back pain. He believed she could occasionally balance, stoop, kneel, crouch and bend. (Tr. 236-237). Dr. Cox believed that rest would be helpful for Plaintiff, specifically, assuming a reclining position for up to thirty minutes one to three times a day, assuming a supine position for up to thirty minutes one to three times a day and elevating her legs one to three times a day while sitting. (Tr. 238).

On October 24, 1994, Dr. Cox examined Plaintiff at the request of the Maries County Family Services. Her complaints included low back pain primarily on the left side and tingling and numbness down the left lower extremity involving essentially all the toes. She also complained of weakness, numbness and aching of both hands, worse on the left side. Physical examination revealed that Plaintiff was able to walk on her heels and toes, although both tended to cause pain in her low back. She had positive straight leg raising on the right at 70 degrees and at 40 degrees on the left. The doctor noted that a positive MRI in 1992 suggested Plaintiff to have problems in her back on the right. However, her symptoms on October 24,1994, were primarily on the left, which the doctor found to be inconsistent. The doctor believed that Plaintiff’s disc herniation which was in evidence in the 1992 MRI was probably therefore no longer significant. He reached this conclusion based on the fact that ruptured discs naturally tend to improve on their own in 70 to 90 percent of cases. (Tr. 352). Tinel’s and Phalen’s signs at the wrists were negative bilaterally. When Plaintiff told the doctor, however, that her hands wake her up from sleep and she tends to drop things from her hands, the doctor believed this suggested carpal tunnel syndrome bilaterally. The doctor believed that, in order to better evaluate Plaintiff, a repeat bilateral nerve conduction velocity study should be obtained to check for any peripheral entrapment neuropathy or any residual carpal tunnel syndrome. He also believed it would be appropriate to do a myelogram and post myelogram CT on the low back. (Tr. 351).

On October 25, 1994, Plaintiff was examined by A.M. Hooshmand, M.D., a neurologist, for complaints of pain and numbness of both hands. Examination revealed that Plaintiffs motor power was normal and symmetrical in both arms and both legs. Deep tendon reflexes were 1+ in both arms and both legs. Tinel’s sign was positive bilaterally. No Phalen’s sign was elicited. Coordination and all sensory modalities were completely within normal limits. Plaintiff had nerve conduction velocity studies of both motor medial nerves and both motor ulnar nerves. She also had an EMG conducted. The doctor believed that the results of the tests were compatible with left carpal tunnel syndrome and evidence of borderline to early stage of right carpal tunnel syndrome. (Tr. 355-356).

Plaintiff underwent a lumbar myelogram on October 28,1994. (Tr. 342-347). Dr. Cox noted that same date that the lumbar myelo-gram and post myelogram CAT scan were positive for a protruding disc centrally and leftwards at the level of L5-S1. He believed this to be consistent with her symptoms. The doctor believed that Plaintiff would get better with the passage of time. The doctor also noted that Plaintiffs nerve conduction velocity study showed an increased distal latency on the left side and slightly increased distal latency on the right median nerve. It was possible that the entire nerve was not thoroughly decompressed with Plaintiffs pri- or left carpal tunnel release and Plaintiff might have to have another surgery. The doctor believed Plaintiffs carpal tunnel problem and low back problem were both potentially correctable problems if her pain became significantly bothersome to the point where it was preventing her from working. (Tr. 350).

On April 28,1995, Dr. Cox evaluated Plaintiff for Family Services. He had not seen Plaintiff since October 1994. Plaintiff presented with symptoms primarily in the right low back and she continued to have the numbness and tingling in both hands. Physical examination revealed a negative Tinel’s sign and a negative Phalen’s sign bilaterally showing no objective evidence of carpal tunnel syndrome. However, based on her EMG/NCV studies of October 25, 1994, the doctor found her to have left carpal tunnel syndrome and borderline to early stage right carpal tunnel syndrome. She was able to walk on her heels and toes. Her ankle and knee jerks were normal. Reflexes in the upper extremities were also normal. Straight leg raising with Plaintiff lying on her back at caused some discomfort in her back both on the left and the right at ninety degrees. Using a dynamometer to check the grip strength of the hands, the doctor noted some inconsistency of the right hand. The first time Plaintiff did it, it registered thirty pounds and the second time it registered only ten pounds, which indicated to the doctor that perhaps Plaintiff was not fully cooperating. On the left side it was ten pounds on both occasions. With range of motion of the thoracolumbar spine, Plaintiff was able to flex but at all times complained of pain in the low back. (Tr. 349). The doctor noted that Plaintiff had no radiculopathy of the lumbar region which was an improvement compared to when he saw her in October 1994. She had symptoms consistent with bilateral carpal tunnel syndrome but no signs. The doctor opined as follows:

Because I find no significant objective evidence of neurologic impairment, I think it will be appropriate to have this patient evaluated by a physiatrist for the determination of incapacity. At this time, I will have to say that I do not find her objectively to have any significant incapacity for gainful employment. However, I would say that perhaps she should be given 2 months during which time a physiatrist should be able to evaluate her and conclude whether there any [sic] incapacity is present.

(Tr. 349).

On July 10,1996, Dr. Cox wrote a letter to Plaintiffs attorney in which he stated:

I have reviewed my various notes as well as the Medical Source Statement that I prepared on 7/19/93. The last time I saw Mrs. Monier was on 4/28/95 while I was employed at the Jefferson City Bone & Joint Clinic. I saw her then for an evaluation of her back for Family Services. When I compare my notes of that evaluation of 4/28/95 and the Medical Source Statement that I prepared on 7/19/93, I could see no significant change in that the patient has not improved to any significant degree clinically over that period of time. I really don’t know how she’s doing now since it has been over one year since I have last seen her. I have no reason to believe that she should be better. She did call my office on 5/2/96 for some anti-inflammatory medications which I prescribed for her. They were Motrin, 600 mgs, 50 tablets, one t.i.d.

(Tr. 357).

On August 9, 1996, Plaintiff was examined by Dr. Cox, who was now with Neurosurgery-Spine Specialists, Inc. He stated that the last time he saw her prior to this was on April 28, 1995. He evaluated her on August 9th because Plaintiff had been requesting medications and the doctor thought it appropriate to re-evaluate her. Plaintiff complained to him of generalized aches and pains, and generalized tiredness and fatigue, primarily stiffness, achiness, and numbness in the low back and down both lower extremities, but worse on the left side. Dr. Cox was not able to elicit Tinel’s or Phalen’s with either wrist so, clinically, he acknowledged that he did not have any evidence of carpal tunnel syndrome. However, based on Plaintiffs EMG and nerve conduction velocity studies and Plaintiffs clinical symptoms, the doctor nonetheless found Plaintiff to have bilateral carpal tunnel syndrome. Plaintiff told the doctor that her symptoms in the back and legs were aggravated by bending, by sitting for longer than 10-15 minutes and by prolonged standing in one place. Also, vacuuming increased her low back pain. Plaintiff said she gets relief by walking and taking Ibuprofen, having hot baths and using a heating pad. (Tr. 359). Physical examination revealed that Plaintiff was able to walk on her heels and toes. Her reflexes were normal. Straight leg testing was negative on the right at 90 degrees and on the left it was positive at 60 degrees causing pain in the low back, both on the left and on the right. (Tr. 359). The doctor noted that on previous evaluations, there was evidence of protruding disc, leftward and centrally at L5-S1, and a bulging disc at 3-4 and 4-5 in the lumbar region. The doctor’s impression was; (1) chronic low back and bilateral lower extremity pain from lumbar spondylosis; (2) chronic bilateral upper extremity discomfort, numbness and weakness from bilateral carpal tunnel syndrome; and (3) post-left carpal tunnel syndrome release. (Tr. 358). The doctor concluded that Plaintiff does have some chronic discomforts. She continues to be moderately obese and her walking and general exercises tend to keep her flexible and keep the pain tolerable. She is not at the point where she would require surgical intervention at this time. (Tr. 358).

V.

DETERMINATION OF THE ALJ

After considering the evidence of record, the ALJ concluded that Plaintiff was not under a “disability,” as that term is defined in the Social Security Act, at any time through the date of the decision. (Tr. 282). She found that Plaintiff met the disability insured status requirements as of March 2, 1990, and noted that Plaintiff has not engaged in substantial gainful activity since at least March 2,1990. (Tr. 282).

The ALJ assessed the medical records and set forth Plaintiffs medical history. She determined that the medical evidence established that Plaintiff had a herniated disc at L5-S1, bulging discs at L3-4 and L4-5, lumbar spondylosis, and bilateral carpal tunnel syndrome. However, she did not have an impairment or combination of impairments listed in, or medically equal to one listed in Appendix 1, Subpart P, Regulations No. 4. (Tr. 281).

The ALJ next determined whether Plaintiff could perform her past relevant work and, if not, whether there was other work she could perform. In making this determination, the ALJ assessed Plaintiffs residual functional capacity. The medical evidence and Plaintiffs subjective complaints were considered in determining her residual functional capacity.

The ALJ found that Plaintiffs testimony, insofar as it related to disabling and debilitating subjective complaints, was not credible and therefore not entitled to significant weight and consideration. Considering Plaintiffs allegations pursuant to Polaski v. Heckler, 739 F.2d 1320, 1321-22 (8th Cir.1984), the ALJ listed the following factors which detracted from Plaintiffs credibility; (1) the objective medical evidence did not support Plaintiffs complaints; (2) there were numerous inconsistencies portrayed by Plaintiff during the functional assessment in December 1992; (3) Plaintiff sought limited medical attention after receiving her medical source statement from Dr. Cox in July 1993; (4) Plaintiffs pain appeared to be controlled with medication; (5) Plaintiff has not required surgery or prolonged hospitalization since the date of her left carpal tunnel release; nor has she required the prolonged use of an assistive device such as a cane or brace for the purpose of ambulation or motion due to back pain; (6) Plaintiffs daily activities were not indicative of a disabling impairment; (7) Plaintiff was able to complete a forty-week program at a metropolitan business college, attaining a certification as an Administrative Medical Assistant; (8) Plaintiff has looked for work since her alleged onset date which suggests that she believes she can work; (9) Plaintiff failed to comply with prescribed remedial treatment without good cause; (10) despite allegations of disabling physical pain, there is no presence of persistent and progressive atrophy; (11) Plaintiffs lack of use of strong pain medication is inconsistent with one suffering from disabling pain; and (12) Plaintiff appears to be motivated to qualify for benefits. For all of these reasons, the ALJ concluded that Plaintiff was not a credible witness and was exaggerating her complaints in an attempt to qualify for benefits.

The ALJ found that the evidence establishes that Plaintiffs impairments preclude, at most, repetitive bending, lifting more than ten pounds on the right, lifting more than five pounds on the left, lifting more than fifteen pounds with both hands, performing work activity requiring vigorous repetitive use of the upper extremities, and performing work activity that does not allow for the ability to alternate between sitting and standing, with half of the work time devoted to each postural position. The ALJ found that the medical evidence did not establish the existence of any other persistent, significant and adverse limitation of function due to any other ailment, Plaintiff could perform prolonged walking. Ordinary movement at the work site, as well as breaks and a meal period, provide Plaintiff with further opportunity to change positions. (Tr. 280).

Judge Weber found that Plaintiff was a “younger individual,” had more than a high school education, and did not have transferable work skills outside of the sewing industry. The ALJ found that Plaintiff could not perform her past relevant work. Thus, the ALJ shifted the burden to the Commissioner to show that there were other jobs existing in significant numbers in the national economy which Plaintiff could perform consistent with Plaintiffs medically determinable impairments, functional limitations, age, education and work experience. To meet this burden, the ALJ relied on the evidence of a vocational expert. The ALJ asked the expert whether a hypothetical individual of Plaintiffs age, education and prior work history, with the functional restrictions set forth above, could perform a significant number of jobs in the local and state economies. The expert responded that such an individual could perform work as a receptionist and information clerk. These jobs require use of the hands but not to the extent precluded by Plaintiffs ailments. Plaintiff may need to use a pen or make change in such positions, but would not utilize her hands in a fashion similar to the manner in which she had used them within the sewing industry. These jobs were noted to exist in the numbers of 720 in Plaintiffs local area, and 12,000 in Plaintiffs state. Thus, the ALJ concluded that there were a significant number of jobs in Plaintiffs local and state economies that Plaintiff could perform.

The ALJ therefore concluded that Plaintiff was not disabled. Plaintiff was not entitled to a period of disability or disability insurance benefits under sections 216(1) and 223, respectively, of the Social Security Act. In addition, Plaintiff was not eligible for supplemental security income under section 1614(a)(3)(A) of the Social Security Act. (Tr. 281-282).

VII.

LEGAL STANDARDS

Under the Social Security Act, the Commissioner has established a five-step process for determining whether a person is disabled. 20 C.F.R. §§ 416.920, 404.1529. First, the claimant cannot be engaged in “substantial gainful activity.” 20 C.F.R. §§ 416.920(b), 404.1520(b). Second, the claimant must have a severe impairment. 20 C.F.R. §§ 416.920(c), 404.1520(c). The Social Security Act defines “severe impairment” as “any impairment or combination of impairments which significantly limits [claimant’s] physical or mental ability to do basic work activities .... ” Id. Third, the ALJ must determine whether the claimant has an impairment which meets or equals one of the impair