Walton v. Astrue (664 F. Supp. 2d 1000, 2009)

MEMORANDUM OPINION

MARY ANN L. MEDLER, United States Magistrate Judge.

This is an action under Title 42 U.S.C. § 405(g) for judicial review of the final decision of Michael J. Astrue (“Defendant”) denying the applications for Disability Insurance Benefits under Title II of the Social Security Act, 42 U.S.C. §§ 401 et seq., and Supplemental Security Income (“SSI”) under Title XVI of the Act, 42 U.S.C. §§ 1381 et seq., filed by Plaintiff Kathleen E. Walton (“Plaintiff’). Plaintiff filed a Brief in Support of the Complaint. Doc. 15. Defendant filed a Brief in Support of the Answer. Doc. 18. Plaintiff filed a Reply Brief. Doc. 19. The parties have consented to the jurisdiction of the undersigned United States Magistrate Judge pursuant to 28 U.S.C. § 636(c)(1). Doc. 8.

I.

PROCEDURAL HISTORY

Plaintiff filed an applications for Disability Insurance Benefits and SSI, alleging a disability onset date of August 1, 2004. Tr. 12, 60-67. On May 16, 2005, Plaintiffs applications were denied. Tr. 38-53. Plaintiff filed a timely request for hearing. Tr. 54-55. Hearings were held on February 26, 2007 and November 7, 2007, before an Administrative Law Judge (“ALJ”). Tr. 449-56, 469-519. On February 8, 2008, the ALJ issued a decision finding that Plaintiff was not disabled. Tr. 9-23. On August 22, 2008, the Appeals Council denied Plaintiffs request for review. Tr. 5-7. Thus, the decision of the ALJ stands as the final decision of the Commissioner.

II.

MEDICAL RECORDS

Records from Northeast Missouri Family Medical Clinic, dated July 2, 2001, reflect Plaintiff had an abdominal x-ray; that Plaintiff was “very constipated”; and that the x-ray showed that Plaintiff had DJD at L 2/3. Tr. 199.

Records from Northeast Missouri Foot Clinic, dated July 9, 2001, state Plaintiff presented “with inflamed lesion 5th digit right foot. Duration of symptoms has been off and on for the past few weeks. Patient denies any treatment.” Tr. 272-73. Records further reflect that Plaintiffs past medical history was “[p]ositive for diabetes, asthma, arthritis and heart disease; that Plaintiff had a hysterectomy; that Plaintiffs then-current medications were Avandia, Celebrex, and Glucotrol; that Plaintiff had no known drug allergies; and that Plaintiff was positive for tobacco use. Records state that the podiatric exam showed that “[n]eurolgic-intact, sharp, dull vibratory proprioception”; that an Integument-Grade I ulceration was noted to 5th digit of the right foot; that there were no signs of infection; that hyperkeratotic build up was present; that nails had clinical evidence of onychomycosis; and that nails were thick and discolored. Tr. 273. Deborah A.K. Holte, D.P.M., reported that Plaintiff had a diabetic ulcer, hammertoe, and onychomycosis; that the plan was to debride Plaintiffs nails; that shoe gear to accommodate Plaintiff was discussed; that surgical intervention for Plaintiffs hammertoes was recommended to prevent infection; and that Plaintiff was advised not to utilize over the counter corn remover medication. Tr. 273.

Records from Harry B. Young, Jr., D.O., F.O.C.O.O., dated October 9, 2001, reflect that Plaintiff presented “for open angle glaucoma” and that Plaintiffs diagnosis included open angle glaucoma, and diabetes. Tr. 281.

Dr. Young reported on November 19, 2001, that Plaintiff was diagnosed with “S/P ACT nasal 180° OS,” nuclear cataract, diabetes mellitus, and open angle glaucoma and that Plaintiff was to see Dr. Young in January to schedule cataract surgery. Tr. 282.

Records from The Family Health Center, dated December 21, 2001, reflect that Plaintiff presented with back and arm pain; that Plaintiff was sixty-seven inches tall; that Plaintiff weighed 261 pounds; that Plaintiffs blood pressure was 132/78; that Plaintiffs eyes were “alert,” “oriented,” and in “no acute distress”; that Plaintiffs “gait and station [were] normal, no edema or palpable masses, no atrophy”; that Plaintiffs “joint [was] stable without evidence of dislocation or ligamentous laxity”; that Plaintiffs “cranial nerves 2-12 intact bilat”; that Plaintiffs “DTR’s [were] normal, no sensory deficit or parasthesias”; that Plaintiffs skin had “good color and turgor, no masses or lesions”; that Plaintiff was experiencing upper back pain; that this pain had been worsening for weeks; that Plaintiffs pain went into her left shoulder; that Plaintiff was positive for joint pain and Type 2 diabetes; that it was recommended that Plaintiff have work restrictions for two weeks; and that Plaintiffs Vioxx dosage was increased. Tr. 299-300.

Records from Dr. Young, dated February 26, 2002, reflect that Plaintiff was diagnosed with “posterior subcapsular cataracts” and that the cataract surgery process was explained to Plaintiff. Tr. 283.

Records from Dr. Young, dated April 3, 2002, reflect that Plaintiff had cataract surgery. Tr. 285.

Records from Dr. Young, dated April 12, 2002, reflect that Plaintiff presented with eye pain. Tr. 287.

Records from Dr. Young, dated April 15 and 25, 2002, reflect that Plaintiff presented for re-evaluation following her cataract surgery. Tr. 288-89. Dr. Young’s records of June 19, 2002, reflect that Plaintiff stated that she quit her job at a nursing home and that her insurance was still active. Tr. 292.

Records from Dr. Young, dated October 16, 2002, reflect that Plaintiff underwent “[p]hacoemulsification with aspiration-irrigation of cataract with the insertion of a posterior chamber ... without incident.” Tr. 294.

Records from The Family Health Center, dated October 21, 2002, reflect that Plaintiff presented complaining of a “cough, congestion, [and] left ear pain.” Records further reflect that Plaintiffs blood pressure was 140/72; that Plaintiffs heart rate was 88 BPM; that Plaintiff was positive for tobacco use; that Plaintiff had a history of glaucoma and cataracts; that Plaintiff had bilateral cataract removal six days prior; that examination revealed that Plaintiffs eyes were “alert,” “oriented,” and exhibited “no acute distress”; that Plaintiff exhibited mild congestion with clear drainage; that Plaintiffs heart had normal rate and rhythm, with no murmur or extra sounds; that Plaintiff had a normal respiratory effort, with no use of accessory muscles; that Plaintiffs lungs were clear to auscultation, with no wheezes, rales or rhonchi; that Plaintiff had no gastrointestinal masses or tenderness; and that Plaintiff was diagnosed with URI/sinusitis. Tr. 301-02.

Records from Dr. Young, dated October 22, 2002, reflect that Plaintiff presented for a one week follow-up appointment and that Plaintiff reported that she was “doing well.” Tr. 295.

Records from Dr. Young, dated December 5, 2002, reflect that Plaintiff presented for an appointment and that Plaintiff had not used her drops for approximately one week. Tr. 297.

Records from Northeast Missouri Health Council, Inc. (“NMHC”), dated August 25, 2003, reflect that Plaintiff presented to obtain the results of lab work. Records further reflect that Plaintiff weighed 258 pounds; that Plaintiffs blood pressure was 130/72; that Plaintiffs heart rate was 84 BPM, with a regular rhythm and no murmurs; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no abdominal masses; that Plaintiff had epigastric tenderness; that Plaintiffs skin was normal; that Plaintiffs neurological exam was normal; and that Plaintiffs foot examination was normal. Beth Schrage, R.N.C., F.N.P., diagnosed Plaintiff with “NIDDM,” Hyperlipidemia, and GERD. Nurse Schrage recommended that Plaintiff refill her prescriptions, schedule a gallbladder ultrasound, and take Prevacid. Tr. 160.

Records from NMHC, dated September 24, 2003, state that Plaintiff presented to NMHC “coughing” and with “sinus drainage.” Tr. 161. Records further state that Plaintiff weighed 258 pounds; that Plaintiffs blood pressure was 122/72; that Plaintiff was experiencing bilateral wheezing; that Plaintiff had no edema to the extremities; and that Plaintiff was diagnosed with acute bronchitis. Tr. 161.

Records from The Family Health Center, dated December 15, 2003, reflect that Plaintiff presented with a “hurt lower back [and left] hip.” Records further state that Plaintiff weighed 263 pounds; that Plaintiffs blood pressure was 132/84; that Plaintiff was taking Lipitor, Glucovance, Effexor, Darvocet, Tylenol, and ibuprofen; that Plaintiff had a past history of fibromyalgia and Type II Diabetes; and that Plaintiffs eyes were “alert,” “oriented x 3” and exhibited “no acute distress.” Tr. 303-04.

Records from The Family Health Center, dated January 23, 2004, reflect that Plaintiff presented with “back pain”; that Plaintiff weighed 265 pounds; that Plaintiffs blood pressure was 140/76; that Plaintiffs had a history of back pain with a duration of “years”; that Plaintiff said she was in “constant pain”; Plaintiff reported that her sleep was poor due to pain; that Plaintiff was positive for tobacco use; that Plaintiffs eyes were “alert” and “oriented x 3” and exhibited “no acute distress”; that Plaintiffs “ROM [was] normal without pain, crepitation or contracture, strength 5/5 bilat”; that Plaintiffs “DTR’s [were] normal, [with] no sensory deficit or parasthesias”; and that Plaintiffs diagnosis was “LBP/L iliolumbar ligament sprain.” Tr. 305-06.

Records from NMHC reflect Plaintiff was to present on February 19, 2004, and that Plaintiff rescheduled. Tr. 162.

Records from the Family Health Center, dated February 23, 2004, reflect that Plaintiff presented with “congestion [and] low back pain”; that Plaintiff had a history of “chest congestion”; that Plaintiffs chest congestion was “persisting” and lasted approximately five days; that Plaintiff weighs 263 pounds; that Plaintiff’s blood pressure was 150/80; that Plaintiff was positive for tobacco use; that Plaintiff was “alert” and “oriented x 3” and was in “no acute distress”; that Plaintiff’s ear “canals [were] intact, tympanic membranes clear and intact bilat”; that Plaintiffs oropharynx displayed “no lesions, no erythema, teeth in good repair”; that Plaintiffs heart had a “regular rate and rhythm, no murmur or extra sounds”; that Plaintiffs “extremities reveal[ed] no evidence of edema and/or varicosities, pedal pulses equal bi-lat”; that Plaintiff exhibited a “normal respiratory effort, [with] no use of accessory muscles”; that Plaintiff’s “lungs [were] clear to auscultation, [with] no wheezes, rales, or rhonchi, breath sounds x4”; that Plaintiffs diagnosis was sinusitis; and that Plaintiff was given a work release for the evening. Tr. 307-08.

Records from NMHC, dated March 1, 2004, reflect that Plaintiff presented to review her medications; that Plaintiff was “not compliant with diet or exercise”; that Plaintiff weighed 270 pounds; that Plaintiffs blood pressure was 130/78; that Plaintiff’s lungs were clear to auscultation; that Plaintiff’s chest motion was good; that Plaintiff had no abdominal tenderness or abdominal masses; that Plaintiff had no organomegaly; that Plaintiff had no edema; and that it was recommended Plaintiff increase her dosage of Lipitor, review her diet and exercise habits, and return for further examination in two weeks. Tr. 163.

Records from NMHC, dated March 15, 2004, reflect that Plaintiff presented for a follow-up appointment; that Plaintiff weighed 270 pounds; and that Plaintiffs blood pressure was 140/80. Tr. 164.

Records from NMHC, dated March 29, 2004, state that Plaintiff reported “that she did not increase [L]ipitor; ha[d] not been watching her diet.” Records further reflect that Plaintiff weighed 270 pounds; that Plaintiffs blood pressure was 128/80; that Plaintiffs heart rate was 164 BPM with a regular rhythm; that Plaintiff was alert with no distress; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff was diagnosed with “NIDDM”; and that Plaintiff was instructed to increase her Lipitor dosage and was to have a lipid panel in thirty days. Tr. 165.

Records from the Northeast Missouri Family Health Clinic, dated March 29, 2004, reflect that Plaintiffs blood sugar was 240. Tr. 204.

Records from NMHC, dated April 28, 2004, reflect that Plaintiff presented with a “sneezing — cough—runny nose”; that Plaintiff also complained of “pain, nausea” and “heartburn”; that Plaintiffs blood pressure was 128/78; that Plaintiffs heart rate was 72 BPM with a regular rhythm; that Plaintiffs cardio-respiratory exam indicated a cough and shortness of breath; that Plaintiff an elevated blood sugar level of 214 the morning of the examination; that Plaintiff presented alert, without distress; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no abdominal tenderness; that Plaintiff had complained of leg cramps; and that Plaintiff was diagnosed with viral syndrome, “RUQ abd pain,” fatigue, and myalgia. Tr. 166. A note from Northeast Missouri Family Health Care, dated April 29, 2004, requests to “excuse [Plaintiff] due to illness.” Tr. 168.

Laboratory records from Nemo Family Health Clinic, dated April 29, 2004, state that Plaintiffs “comprehensive metabolic panel” was “in range,” with the exceptions that her glucose level was elevated and her carbon dioxide level was depressed. Tr. 205.

Records from NMHC, dated May 4, 2004, reflect that Plaintiff cancelled an appointment for that date. Tr. 167.

Records from NMHC, dated May 13, 2004, state Plaintiff “did not show” for an appointment. Tr. 169.

Records from NMHC, dated May 20, 2004, state that Plaintiff presented for “lab results and discussion”; that Plaintiff was alert with no distress; that Plaintiffs heart rate was 88 BPM, with a regular rhythm and no murmurs; that Plaintiffs blood pressure was 128/88; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no abdominal masses and no abdominal tenderness; that Plaintiff did not have a hernia; that Plaintiff was diagnosed with “abdominal pain” and “NIDDM”; and that Plaintiff was to “follow up as needed.” Tr. 170. A “Return to Work Certificate” signed by Nurse Schrage, dated May 20, 2004, requests that Plaintiffs employer “excuse [her] for 2 days [] due to illness.” The certificate further states that Plaintiff could return to work on May 24, 2004. Tr. 171.

On June 8, 2004, Henry D. Petry, D.O., certified to the Northeast Missouri Community Action Agency that Plaintiff was in need of an air conditioner due to her asthma. Tr. 172.

Records from NMHC, dated July 16, 2004, reflect that Plaintiff had an appointment for that date, which Plaintiff rescheduled. Tr. 173.

Office notes from Nurse Schrage, dated July 23, 2004, reflect that Plaintiff presented complaining of “back pain [and] feeling tired all of the time”; that Plaintiffs blood pressure was 146/98; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff was diagnosed with “fatigue” and “elevated B/P”; and that Nurse Schrage recommended Plaintiff decrease her salt intake and increase diet compliance. Tr. 174.

A laboratory report, dated July 23, 2004, from Nemo Family Health Clinic states that Plaintiffs glucose, carbon dioxide, and albumin levels and the “absolute eosinophils” were outside the reference range. Tr. 206-207.

Records from NMHC, dated July 29, 2004, reflect that Plaintiff presented to talk about blood work and pain. Records further reflect that Plaintiff reported her “chest fe[lt] tight, very stressed, emotions seem[ed] out of control. Feels depressed, defensive.” Notes of this date further state that Plaintiff complained of “generalized back and shoulder pain; some numbness on outer aspect of [illegible] leg — not always.” Upon physical examination, it was reported that Plaintiff was alert without distress; that Plaintiffs heart rate was 64 BPM, with a regular rhythm and no murmurs; that Plaintiffs blood pressure was 152/82; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; and that Plaintiff was prescribed Ultracet and referred to social services for depression. Tr. 175.

Records from NMHC, dated August 9 and 30, 2004, reflect that Plaintiff cancelled her appointments scheduled for those dates. Tr. 176,178.

Records from NMHC, dated September 1, 2004, reflect that Plaintiff presented with back pain and “back numbness in legs and fingers,” notably in the right hand; that this pain and numbness had been “present 8-9 days”; that Plaintiffs weighed 265 pounds; that Plaintiffs blood pressure was 148/78; that Plaintiffs heart rate was 76 BPM, with no murmurs; that Plaintiffs lungs were clear and her chest motion good; that Plaintiff had no abdominal masses and no tenderness in her abdomen; that Plaintiffs right shoulder was tender; that Plaintiffs left sacroiliac was tender; and that at least one of Plaintiffs ribs was tender. Records of this date further reflect that Plaintiff was to receive physical therapy on her right shoulder, and that Plaintiff had “a Joint Injection of Left Sacroiliac Joint,” performed by Henry D. Petry, D.O. Tr. 177.

Records from NMHC, dated September 8, 2004, state that Plaintiff presented for a follow-up hip examination; that Plaintiff complained of “[left] side pain in back, lots of pain”; that Plaintiff said she had “some improvement on right side, but back still hurts”; that Plaintiff weighed 264 pounds; that Plaintiffs blood pressure was 130/84; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no masses in her abdomen, nor any tenderness in her abdomen; that Plaintiffs right sacroiliac area was “painful and swollen”; and that Plaintiff underwent “a Joint Injection of [the] Right Sacroiliac Joint.” Tr. 180.

Records from NMHC, dated September 14, 2004, reflect that Plaintiff rescheduled her appointment. Tr. 182.

Records from NMHC, dated September 20, 2004, reflect that Plaintiff complained of “back discomfort” and said that she “need[ed] more meds” and that “[w]alking ma[de] her legs & feet go numb.” Records further reflect that Plaintiff weighed 271 pounds; that Plaintiffs blood pressure was 130/82; that Plaintiffs “thoracic area [was] tender with muscle spasms”; and that Plaintiffs “sacral area [was] tender with muscle spasms.” Tr. 183.

Records from NMHC, dated September 29, 2004, reflect that Plaintiff presented for a follow-up appointment; that Plaintiff reported that her “lower back [was] still bothering [her]; that Plaintiff weighed 270 pounds; that Plaintiffs blood pressure was 124/80; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; and that Plaintiffs “CN 2-12” were “intact.” Tr. 184.

Records from the NMHC, signed by Nurse Schrage, dated October 5, 2004, reflect that Plaintiff presented with “left ear pain, not feeling well” for “2-3 days,” and that Plaintiff was diagnosed with otitis ex-terna and bronchospasms. Tr. 186. A note signed by Nurse Schrage, dated October 5, 2004, states that Plaintiff “may not return to work on 10-6-2004” and to “excuse 10/4/04 due to illness.” Tr. 185.

Records from NMHC, dated October 13, 2004, reflect that Plaintiff “did not show” for a scheduled appointment. Tr. 187.

Records from NMHC, dated October 19, 2004, reflect that Plaintiff presented with “back pain/discomfort — Requesting OMT” and that she “need[ed] med refills.” Records further reflect that Plaintiff weighed 269 pounds; that Plaintiffs blood pressure was 138/88; that Plaintiff was not experiencing any tenderness in her abdomen and did not have any abdominal masses; that Plaintiffs “thoracic area [was] tender with muscle spasms”; and that Plaintiffs “sacroiliac [was] very tender.” Tr. 189. Records from October 19, 2004, further reflect that Plaintiff had “a Joint Injection of Left Sacroiliac.” Tr. 188.

Records from Quest Diagnostics, Inc., dated October 20, 2004, reflect that Plaintiff had an elevated triglycerides count, total cholesterol count, glucose level and hemoglobin count and that Plaintiffs counts were otherwise within the reference range.

Records from NMHC, dated November 1, 2004, reflect that Plaintiff cancelled a scheduled appointment. Tr. 190.

Records from NMHC, dated November 2, 2004, reflect that Plaintiff presented for a check-up and that she “complained of severe constipation [with] occasional] diarrhea — chronic situation.” Records further reflect that Plaintiff weighed 265 pounds; that Plaintiffs blood pressure was 130/80; that Plaintiff presented alert and with no distress; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no edema in her the extremities; that Plaintiffs diagnosis was “IBS — constipation”; and that it was recommended that Plaintiff “monitor diet more closely” and that Plaintiff “call [the] next week [with] blood sugars.” Tr. 191.

Records from NMHC, dated November 15, 2004, reflect that Plaintiff presented for a follow-up regarding her blood sugar levels which were “trending [between] 180-220.” Notes state that Plaintiff also presented with low back pain, thoracic pain, and IBS; that she weighed 265 pounds; that her blood pressure was 122/68; that her heart rate was 104, with no murmurs; that Plaintiffs lung auscultation was “CTAB”; that Plaintiffs chest motion was good; that Plaintiffs “thoracic area [was] very tender”; and that Plaintiffs “sacroiliac areas [were] tender with muscle spasms.” Tr. 192.

Records from NMHC, dated December 13, 2004, reflect that Plaintiff failed to appear for a scheduled appointment. Tr. 193.

Records from NMHC, dated December 22, 2004, state that Plaintiff presented “wanting] to talk about back, would like a flu shot, needs refill on Actos, sinus are bothering her, also needs refill on Zanoflex.” Records further reflect that Plaintiff weighed 274 pounds; that Plaintiffs blood pressure was 136/82; that Plaintiffs heart rate was 88 BPM, with no murmurs; that Plaintiffs sinuses were non tender; and that Plaintiffs chest motion was good. Tr. 194.

Records from NMHC, dated January 12, 2005, reflect that Plaintiff reported that she experienced a “fall New Years day, ‘everything hurts,’ also hard to breath[e], cough, runny nose started yesterday.” Records further reflect that Plaintiff weighed 264 pounds; that Plaintiffs blood pressure was 122/80; that Plaintiff was experiencing “maxillary and frontal tenderness” in the sinuses; and that Plaintiffs “sacroiliac [was] tender with muscle spasms.” Tr. 195.

Records from NMHC, dated February 2, 2005, reflect that Plaintiff had an appointment for that date, which she rescheduled. Tr. 196.

Records from NMHC, dated February 4, 2005, reflect Plaintiff presented to “talk about back problem, needs to talk about getting food stamps.” Records further state that Plaintiff weighed 264 pounds; that Plaintiffs blood pressure was 148/92; that Plaintiffs neck examination revealed no carotid bruits; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no masses nor abdominal tenderness; that Plaintiff had no organomegaly; that Plaintiff had “tenderness low back 9/10 pain”; that Plaintiffs “hands go to sleep”; and that it was recommended that Plaintiff “apply for SSI disability-totally disable[d].” Tr. 197.

Records from NMHC, dated February 10, 2005, reflect Plaintiff presented because she “want[ed] to talk about releasing her from work, need[ed] med refills, want[ed] back TX.” Records further reflect that Plaintiff weighed 266 pounds; that Plaintiffs blood pressure was 148/82; that Plaintiffs heart rate was 72 BPM; that Plaintiff had no abdominal masses or abdominal tenderness; that Plaintiff had no organomegaly; that Plaintiff was experiencing tenderness and muscle spasms in her thoracic area; that Plaintiff said that the pain in her low back was a nine on a scale of one-to-ten; that Plaintiff had no prefíbial edema; and that Plaintiffs “feet go numb.” Notes of this date also state that Plaintiff was “unable to work at all now due to upper and lower back pain, numbness in feet.” Tr. 313.

A report from Quest Diagnostics, Inc., dated April 18, 2005, states that specimens collected from Plaintiff on April 15, 2005, show that Plaintiff had elevated triglycerides, total cholesterol levels, LDL-cholesterol, CHOL/HDLC ratio, microalbumin/creatinine, and glucose levels; that Plaintiff had a depressed carbon dioxide level; that Plaintiff had an out of range hemoglobin count; and that Plaintiffs testing levels were otherwise within the normal range. Tr. 343-44.

Records from NMHC, dated April 21, 2005, reflect that Plaintiff presented for lab results; that she was “concerned that she [could] not afford any of her medications]”; and that Plaintiff “[h]as disability / McD physical today.” Records further reflect that Plaintiff “declined” to give her weight; that Plaintiffs blood pressure was 128/82; that Plaintiff presented alert and with no distress; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiffs neurologic exam was “intact”; and that Plaintiffs extremities showed no edema. Notes further state that Plaintiffs medications included C-peptide insulin and Lipitor. Tr. 314.

On April 21, 2005, Plaintiff was examined by John R. Sparks, D.O., who issued a Disability Determination Report. Dr. Sparks reported that examination showed that Plaintiff was well-developed; that she was alert and cooperative; that she was in no acute distress; that she was able to move about the office without difficulty; that Plaintiffs lungs were clear to auscultation; that her abdomen was obese with no masses or tremor; that Plaintiffs deep tendon reflexes and grip strength were normal; that, in regard to Plaintiffs complaint of pain in the upper thoracic area across the shoulders and pain in the lumbar area, Plaintiff had no muscular spasm in the paravertebral musculature of the lumbar area; and that Plaintiff had “very little” range of motion restriction. In the Report, Dr. Sparks stated, “[w]ith this examination, I find that the only real hindrance to this patient performing work-related functions would be her uncontrolled diabetes mellitus. The remaining exam shows the patient’s complaints to exceed the physical findings.” Dr. Sparks’s impressions included: type 2 diabetes mellitus, uncontrolled, hyperlipidemia, per history, Fibromyalgia, per history, carpal tunnel syndrome, per history, and thoracic and lumbar strain. Tr. 216.

An April 22, 2005 report from Quest Diagnostics, Inc., from specimens collected on April 21, 2005, states that Plaintiff had an elevated C-Peptide level and that Plaintiffs insulin level was within rage. Tr. 345-46.

On May 6, 2005, Plaintiff was seen by James L. Tichenor, Ph.D., to whom the Section of Disability Determinations referred Plaintiff “for a consultation evaluation with report.” After interviewing Plaintiff, Dr. Tichenor concluded,

Ms. Walton presented as [a] distressed and depressed individual who appears to be in very poor physical health which has impacted her psychological condition. She [is] unable to complete a questionnaire because she could not see well enough to complete it. Her ability to understand and remember instructions and to concentrate and to persist with tasks appears to be impaired at this time. Her ability to interact socially and adapt appears to be lowered but not precluded. She does appear capable of managing money. Counseling support to help her manage her physical ailments is recommended.

Tr. 211.

Dr. Tichenor’s Diagnostic Impressions included a finding at Axis I, of “Adjustment Disorder with mixed anxiety and depression, at Axis IV, “Unemployment, inadequate finances, inadequate health care,” and at Axis V, a GAF of 55. Tr. 212.

Records from NMHC, dated May 12, 2005, state that Plaintiff presented with pain in her back, neck, and shoulder; that Plaintiff reported that she could “hardly lift [her] arm” and that she had cramps in her leg; that Plaintiff weighed 267 pounds; that Plaintiffs blood pressure was 120/82; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiffs “sacral area [is] tender with muscle spasms”; that both of Plaintiffs shoulders were tender; and that, upon full flexion, Plaintiff experienced a loss of pulse to the left arm. Tr. 315.

On May 15, 2005, Paul Stuve, Ph.D., Licensed Psychologist, completed a Psychiatric Review Technique Form and reported that Plaintiff had “Affective Disorders and Anxiety-Related Disorders”; that Plaintiff had mild limitations, in regard to Restriction of Activities of Daily Living; that, in regard to Difficulties in Maintaining Social Functioning, Plaintiff had moderate limitations; that, in regard to Maintaining Concentration, Persistence, or Pace, Plaintiff had moderate limitations; and that Plaintiff had no “Repeated Episodes of Decompensation, Each of Extended Duration.” Tr. 219-32. Dr. Stuve also reported that there was no “MSS from a treating source regarding mental problems”; and that records reflected that Plaintiffs ability to socially interact and adapt were lowered “but not precluded.” Dr. Stuve also stated that:

In her Claimant Questionnaire the claimant alleges physical problems and pain, as well as difficulty concentrating. She completes self-care tasks, prepares simple meals, does light household chores, and shops. Pain interferes with these activities to a degree. She manages money adequately. She can relate adequately to others, but is socially withdrawn. She needs to reread directions. The allegations are generally consistent with the MER and are considered credible.

Tr. 231.

In a “Mental Residual Functional Capacity Assessment,” dated May 15, 2005, Dr. Stuve stated:

The evidence in the file indicates that the claimant can understand and remember simple directions. Her concentration and persistence are moderately limited. She will have moderate difficulty related to the general public. She can interact adequately with coworkers and supervisors. She will have moderate difficulty adapting to changes in the workplace.

Tr. 233-35.

Records from NMHC, dated May 20, 2005, reflect that Plaintiff presented for “blood work and allergy pills.” Notes also state that Plaintiff weighed 266 pounds; that Plaintiffs blood pressure was 121/76; that Plaintiffs heart rate was 88 BPM; that Plaintiff presented alert and with no distress; that Plaintiffs ear’s were “dull”; that Plaintiffs nose was “swollen/pale”; that Plaintiffs throat was “pink”; that Plaintiffs lungs were clear; and that Plaintiffs chest motion was good. Tr. 316.

A June 2, 2005 note, signed by Nurse Schrage, certified to the Northeast Missouri Community Action Agency that Plaintiff “[was] in need of a fan, air conditioner, or Cooling Assistance because of the following medical condition or disability: diabetes, hypertension.” Tr. 317.

Records from NMHC, dated June 27, 2005, state that Plaintiff presented “to talk [with] Beth [Nurse Schrage] about medications].” Records further state that Plaintiff weighed 262 pounds; that Plaintiffs blood pressure was 128/78; that Plaintiffs heart rate was 68 BPM; that Plaintiff was alert and in no distress; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no edema; that Plaintiff complained of foot pain; that Plaintiffs diagnosis included “IDDM” and Hyperlipidemia; that Plaintiffs medications included Lipitor and Effexor; and that Plaintiff was scheduled for diabetic education and insulin administration education. Tr. 318.

Records from NMHC, dated July 20 and 22, 2005, state that Plaintiff canceled appointments for those dates. Tr. 319-20.

Records from NMHC, dated July 28, 2005, reflect that Plaintiff presented for “more insulin, Actos, allergy meds — check on insulin.” Notes also state that Plaintiff presented with a tender left shoulder; that Plaintiff weighed 264 pounds; that Plaintiffs blood pressure was 150/87; that Plaintiffs heart rate was 80 BPM; that Plaintiffs nose and throat were both pale; that Plaintiff had no sinus tenderness; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiff had no abdominal masses, abdominal tenderness, organomegaly, or prefibial edema; and that Plaintiff was prescribed Allegra and Actos. Tr. 321.

A July 29, 2005 report from Quest Diagnostics, Inc., for specimens collected on July 28, 2005, states that Plaintiffs creatinine, glucose, and hemoglobin levels were out of range, and that test results were otherwise within range. Tr. 347-48.

Records from NMHC, dated August 12, 2005, reflect Plaintiff presented for “med check & lab work results, low back & [illegible] are very painful, feet hurt!” Notes of this date also state that Plaintiff was “turned down on disability — says she cannot work.” Records further state that Plaintiff weighed 263 pounds; that Plaintiffs blood pressure was 140/85; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiffs ears, nose, and throat were clear; that Plaintiff had no organomegaly; that Plaintiff had some hemorrhaging in the eyes (diabetic retinopathy); that Plaintiff had no masses, nor any tenderness in the abdomen; and that Plaintiff had no prefibial edema. The treating healthcare professional noted that Plaintiff “is totally disabled for gainful employment due to physical status and education (11 grade) NO GED.” Tr. 240.

Dr. Petry reported on August 12, 2005, that Plaintiff had a decreased range of motion of her lumbar spine; that Plaintiff had normal range of motion in both shoulders, with the exception of the internal rotation of both shoulders; that Plaintiff had normal range of motion in the cervical spine, in both elbows, in both forearms, in both wrists, and in both legs for straight leg raising; that Plaintiff had pain on the left side of the cervical spine upon examination; and that Plaintiffs grip was “strong” in the right hand and “moderate” in the left hand. Tr. 238, 322.

Records dated August 23, 2005, reflect that Jeffrey Harden, D.O., conducted a psychiatric evaluation of Plaintiff. Tr. 274-76. Dr. Harden’s diagnostic impressions were as follows:

Axis I: ADHD, Combined Type of Adulthood; Axis II: No Diagnosis; Axis III: Fibromyalgia, Hyperlipidemia, Insulin Dependent Diabetes Mellitus, Gastroesophageal Reflux Disease, Environmental Allergies, Rule Out Sleep Apnea (Patient complaints of snoring, awakening unrested and being tired throughout the day); Axis IV: Difficulty with Access to Health Care and Difficulty Sustaining Employment; and Axis V: Global Assessment for Functioning: Highest for the past year is assessed at a level 50. Global assessment of functioning at time of this evaluation was assessed at a level of 50.

Tr. 276.

Further August 23, 2005 records reflect that Dr. Harden recommended that Plaintiff “be evaluated for the possible presence of sleep apnea and that she pursue treatment medically for her ADHD.” Tr. 276.

Records from NMHC, dated September 9 and 16, 2005, reflect that Plaintiff failed to appear for appointments scheduled on those dates. Tr. 239, 242.

Records from NMHC, dated September 23, 2005, state that Plaintiff presented because she “need[ed] Allegra. Tired all the time — not sleeping. [Lower] back hurting. No energy.” Records further state that Plaintiffs blood pressure was 120/82; that Plaintiff weighed 267 pounds; that Plaintiffs heart rate was 80 BPM; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiffs abdomen exhibited no masses, nor any tenderness; that Plaintiff had no organomegaly; that Plaintiff experienced low back pain; that Plaintiff had no edema to the extremities; and that it was recommended that Plaintiff return for a follow-up appointment in two weeks. Tr. 241.

A September 24, 2005 report from Quest Diagnostics, Inc., from specimens collected on September 23, 2005, states that Plaintiff had an elevated glucose and hemoglobin Ale levels. The results of Plaintiffs comprehensive metabolic panel were otherwise normal. Tr. 243.

Records from NMHC, dated October 5, 2005, reflect that Plaintiff presented “need[ing] Actos, Lipitor, headache, head / [left] eye worse ... [complaining of] eye pain w/ nausea that is worse with light and better in the dark.” Notes further state that Plaintiff had a past medical history of glaucoma and cataracts and that Plaintiffs past surgical history revealed Plaintiff has had cataract surgery twice and two glaucoma surgeries. Records of this date also state that physical examination showed that Plaintiff weighed 274 pounds; that Plaintiffs blood pressure was 130/78; that Plaintiffs heart rate was 80 BPM; and that Plaintiff had no preflbial edema. Tr. 244.

Records from NMHC, dated October 28 and November 2, 2005, reflect that Plaintiff rescheduled appointments she had for these dates. Tr. 245-46.

Records from NMHC, dated November 18, 2005, reflect that Plaintiff presented “want[ing] flu shot & pneumonia — talk about social security advocate? Needs to see neurologist.” Records further reflect that Plaintiff weighed 276 pounds; that Plaintiffs blood pressure was 150/83; that Plaintiffs “lumbosacral area [was] tender”; that Plaintiff was diagnosed with “low back pain, [illegible], rotator cuff tendinitis”; and that it was recommended that Plaintiff have an MRI of the “lumbo-lumbosacral” and that she schedule an appointment with a neurologist. Tr. 247.

Records from New Concepts Open MRI, dated December 5, 2005, state that Plaintiff had a lumbar MRI without IV contrast and that the test showed that “[t]here [were] four lumbar-appearing vertebrae, with no significant finding of alignment, height or signal — and the distal spinal cord ha[d] no significant finding”; that the “L5 vertebra [was] very sacralized, appearing like an SI vertebra”; that this “probably [was] not clinically significant”; that, at L5-S1 and L4-5, there was moderate facet osteoarthritis; that, at L3-4, there was moderate facet osteoarthritis and disk degeneration; that at L4-5, the loss of disk height was mild and there was a very small right-paracentral herniation; that, at L3-4 and L2-3, there was a “subtle anteri- or annulus fissure, but no bulging, herniation, or loss of disk height”; that “[a]s a result of the above, L3-4 central canal [was] relatively narrowed, but not to the point of (absolute) spinal stenosis”; that the remaining central canal calibers were normal; that “[t]he remainder of the lumbar spine ha[d] negative findings”; that the sacroiliac joints had mild arthritic change; that the sacrum had negative findings other than arthritic change, “with no evidence of trauma related to the fall that [Plaintiff] had”; that the cause of the numbness of the thighs and feet of which Plaintiff complained was “not apparent on the examination”; and that findings were “negative for the hip joints/bursae, musculature, and remaining findings (noting pri- or hysterectomy).” Tr. 248

Records, dated January 4, 2006, from the University of Missouri Health Care reflect that Plaintiff was seen by Shahzad Khan, MD, of the Neurology Department, for an evaluation of numbness/peripheral neuropathy. Dr. Khan recorded Plaintiffs history as follows:

This is a 50-year-old poor historian female who came in for evaluation of above symptoms. She has been having intermittent numbness and tingling in her feet which began about five or six years ago. She has more symptoms in her left as compared to her right lower extremity. She also has some cramps in the evening or nighttimes. Sometimes she wakes up in the middle of the night and has to move her leg. She felt some weakness of her legs, especially during walking. She noticed worsening of her symptoms after walking. She had intermittent numbness and tingling of her hands of unclear duration.

She has a history of low back pain for the last two-to-five years which began without any preceding trauma. She has constant burning type of pain which radiates down to both lower extremities. Nothing makes it better, but she notices worsening with physical activity or walking. In the past, she had received an epidural spinal injection without any improvement in her symptoms. She also used Darvoeet and ibuprofen. She never had physical therapy and is not inclined to go for physical therapy either as she believes this will make her symptoms worse.

She has a history of snoring at nighttime for several years. She also reports having an episode of gasping for air, excessive daytime sleepiness, and excessive daytime fatigue. She has gained about 70 pounds of weight in the last one to two years, and her today [illegible] scale score was 18 out of 24.

She has a history of memory disturbance for the last several years. She denies any fever, chest pain, nausea, vomiting, passing out spells, seizure, hallucinations. All other systems were reviewed and found to be negative.

She has a history of depression, hyperlipidemia, COPD, severe infection, hysterectomy, cataract surgery and laser surgery for glaucoma. She has diabetes for the last ten years, which is poorly controlled.

Tr. 253-54 (emphasis in original).

Dr. Khan also noted in the January 4, 2006 report that Plaintiff quit smoking several years prior; that she had been unemployed for about one year; that Plaintiffs medications included Effexor, insulin, Albuteral, Advair, Nexium and Allegra; that Plaintiff was cooperative, oriented, and in no acute distress; that Plaintiff was “afibrile”; that Plaintiff had “good carotid pulsation without any carotid bruits”; that Plaintiffs heart sounds were normal; that Plaintiffs extremities did not reveal evidence of edema; and that her peripheral pulses were within normal limits. With regard to Plaintiffs neurological examination, Dr. Khan reported that:

The patient was awake, alert and oriented. The attention span and concentration was normal. The patient had adequate fund of knowledge and able to give details of recent medical history. Her immediate recall was one out of three. The patient had good spontaneous speech without any evidence of aphasia.

The pupils round and reacting to light, extraocular movements were intact without any nystagmus. Patient has normal visual fields by confrontation and clear disc margin without disc edema. The patient had normal facial sensations, strength of facial muscles, movements of tongue and palates. The Patient has normal hearing by finger rub and normal shoulder shrug.

She has minimal wasting of her distal feet muscle. The patient had normal tone and strength in all four extremities according to age and habitus. There was no pronator drift or involuntary movement. The muscle stretch reflexes were bilateral and symmetrical. They were +2/4 in upper and +2/4 in lower extremities. Planters were down going bilaterally.

She has decreased vibratory sensation distally. She has abnormal sensation distally to pinprick at her feet. The finger to nose and rapid alternate movements were within normal limits. Gait and station [ ] was within normal limits.

Tr. 255.

Dr. Khan further reported on January 4, 2006, that Plaintiff had a comprehensive metabolic panel in July 2005, which was unremarkable; that her hemoglobin Al C in September 2005 was 8.4; that Plaintiff had an MRI of the lumbar spine in December 2005, which did not reveal any significant disc herniation or spinal stenosis; that the MRI “just show[ed] arthritic changes”; and that Plaintiffs history of abnormal sensation involving her extremities could be “consistent with diagnosis of peripheral neuropathy that can be due to diabetes.” Dr. Khan’s plan included “obtaining] a CT scan of the head, sleep study, nerve conduction study of her extremities, as well as multiple labs for further evaluation of [Plaintiffs] symptoms,” starting Plaintiff on Neurontin, and having Plaintiff return to the clinic after she had tests. Tr. 255.

Records from NMHC, dated February 10, 2006, reflect that Plaintiff presented needing refills of medications; that Plaintiff reported that her voice had been coming and going for about a month after she was at a friends house where disinfectant had been sprayed; that Plaintiff weighed 273 pounds; that Plaintiffs blood pressure was 136/80; that Plaintiff was diagnosed with diabetes mellitus, COPD, obesity, and osteoarthritis; and that it was recommended that Plaintiff have smoking education and laboratory testing, including “HgBAK, lipid profile, CMP.” Tr. 249, 323.

A February 11, 2006 report from Quest Diagnostics, Inc., for specimens collected on February 10, 2006, states that Plaintiffs lipid panel revealed elevated levels of triglycerides, total cholesterol, LDL-cholesterol, and CHOL/HDLC ratio; that Plaintiffs HDL cholesterol was within the reference range; that Plaintiffs glucose level and hemoglobin count were also elevated above the reference range; that Plaintiffs sodium level was below the reference range; and that test results were otherwise within reference ranges. Tr. 251.

Records from Dr. Khan, dated March 3, 2006, reflect that Plaintiff was evaluated for peripheral neuropathy and that a nerve conduction study showed that Plaintiffs “[l]eft peroneal and right tibial motor studies were abnormal”; that Plaintiffs “[bjilateral sural sensory studies were abnormal”; that a concentric needle EMG examination “was within normal limits”; that Plaintiff had an abnormal electrophysiological study; that the findings of the study were consistent with diagnosis of sensory motor peripheral polyneuropathy; and that, given Plaintiffs history of diabetes, it could be the possible etiology in Plaintiffs case. Tr. 260. A CT scan of Plaintiffs head conducted on this same date showed no evidence of intracranial hemorrhage and mild prominence of the bifrontal extra-axial spaces and sulci, which could be “due to atrophy and less likely subdural hygroma.” Tr. 263.

Dr. Khan reported on March 16, 2006, that Plaintiff had been diagnosed with peripheral neuropathy likely due to diabetes; that Plaintiff did not notice a significant change in her symptoms while on medicine; that due to Plaintiffs history of excessive daytime sleepiness, Dr. Khan requested that Plaintiff have a sleep study; that “unfortunately she did not keep the appointment”; that Plaintiff planned to have the sleep study performed “sometime in June 2006 due to her family concerns”; that Plaintiff continued to have memory disturbance “but denie[d] any worsening of her memory disturbance since last seen in [Dr. Khan’s] clinic”; that Plaintiff was “a pleasant, well built lady without any acute distress”; that Plaintiff was alert and had good orientation; that her speech was fluent and pupils were round and reactive; that she had good extraocular movement; that Plaintiffs motor examination showed normal tone and good motor strength; that Plaintiff had decreased sensation distally to pinprick and light touch; that her muscle stretch reflexes were “+2 all over”; and that she had normal coordination and unremarkable gait. Dr. Khan further reported Plaintiffs CT scan of the head showed evidence of atrophy and no history of intracranial hemorrhage and that Plaintiffs lab results showed that “[h]er ANA panel was negative, although her FANA titer was positive at 1:160”; that she had normal vitamin B12 and TSH; that Plaintiffs “comprehensive metabolic panel was unremarkable except it showfed] elevated glucose and low albumin”; that Plaintiff had normal white cell, hemoglobin and platelet counts; and that Dr. Khan’s impression included “[peripheral polyneuropathy, likely diabetic in nature,” “[history of snoring and daytime sleepiness which can be due to obstructive sleep apnea,” “[m]emory disturbances,” and fourth, “[a]bnormal FANA titers.” Dr. Khan reported that Plaintiffs treatment plan included continuing gabapentin; that Plaintiff have the sleep study; and that Plaintiff have a neuropsychology evaluation and EEG for her memory disturbance. Dr. Khan further reported that Plaintiff requested a pain management evaluation for low back pain and ENT evaluation for hearing loss; that Plaintiff should return after she has tests; that Plaintiff was advised to take a baby aspirin a day; and that Plaintiffs “abnormal FANA cab [should] be further investigated by her PCP, if clinically indicated.” Tr. 267-69.

Records from NMHC, dated March 28, 2006, reflect that Plaintiff rescheduled an appointment scheduled for that date. Tr. 324.

Records from NMHC, dated May 19, 2006, state that Plaintiff presented with “pain in both arms and shoulder and back pain, [left] foot pain on side of foot”; that Plaintiff reported that her “blood sugar has been running high”; that Plaintiff weighed 265 pounds; that Plaintiffs blood pressure was 146/82; that Plaintiffs heart rate was 80 BPM, with a regular rhythm and no murmurs; that Plaintiff was positive for parasthesia and numbness from the waist down and in the her hands and arms; that Plaintiff has a history of irritable bowel syndrome; that Plaintiffs lungs were “clear” and “distant”; that Plaintiffs chest motion was good; that a neurologic exam showed that Plaintiff was 5/5 for strength and that Plaintiff had decreased sensation “B/L LE”; that Plaintiffs extremities exhibited no edema and were positive for pain with palpitation; that Plaintiff was experiencing pain in her left foot with inversion; and that Plaintiffs diagnoses included low back pain, “DMII,” HTN, and diabetic neuropathy. Tr. 325.

Records from NMHC, dated May 26 and May 30, 2006, reflect that Plaintiff rescheduled appointments she had for these dates. Tr. 326-27.

Records from NMHC, dated June 16, 2006, reflect that Plaintiff presented because her “legs were retaining fluid” and “[h]urt — better now”; that Plaintiff weighed 271 pounds; that Plaintiffs blood pressure was 143/83; that Plaintiffs heart rate was 80 BPM, with regular rhythm and no murmurs; that Plaintiff had headaches and shoulder pain; that Plaintiffs lungs were clear; and that Plaintiffs diagnoses included pedal edema, right shoulder tendinitis, and DMII. Tr. 328.

Records from NMHC, dated June 16, 2006, reflect that Plaintiff was “no show for MMSE.” Tr. 329.

Records from NMHC, dated June 28, 2006, reflect that Plaintiff reported that her “allergies are acting up”; that she had “leg cramps off and on”; that she was “sleeping] poorly”; and that she was “irritable, exhausted, forgets, [has] trouble concentrating, and [has] loss of interest.” Records further reflect that Plaintiff weighed 268 pounds; that Plaintiffs blood pressure was 123/85; that Plaintiff had no headache; that Plaintiffs lugs were clear; that Plaintiffs chest motion was good; that Plaintiffs “lumbosacral area very [was] tender and swollen”; that Plaintiffs extremities showed no edema; that Plaintiffs diagnosis included “fatigue, diabetes mellitus, allergic [illegible], [and] unipolar depression”; and that it was recommended that Plaintiff have a psychological evaluation. Tr. 330.

Records reflect that, on June 28, 2006, Plaintiff had a Mini-Mental State Examination (MMSE), the report of which was signed by Dr. Petry. Test results showed that out of a possible score of 30, Plaintiff scored 27; that Plaintiff lost two points in the “Attention and Calculation” section and one point in the “Language” section; and that Plaintiff had a “mild” cognitive impairment, as defined by an MMSE score of above or equal to 21. Tr. 331.

Records from NHMC, dated July 7, 2006, reflect that Plaintiff reported that she had felt dizzy, could not walk the prior Friday, and had difficulty speaking; that Plaintiff weighed 268 pounds; that Plaintiffs blood pressure was 127/80; that Plaintiff was diagnosed with Transient Ischemic Attack (“TIA”) and Diabetes; and that is was recommended that Plaintiff have a CT scan of the brain and return for a follow-up appointment after the CT scan. Tr. 332.

Records from Northeast Regional Medical Center, dated July 18, 2006, state that Plaintiff presented for a “CT head brain WW” examination and that the CT scan showed that “[t]he cerebral hemispheres and basal ganglia region [were] unremarkable”; that the cortical sulcal spaces, ventricular system and basal cisterns were normal; that there was no mass effect, midline shift or extraaxial fluid collection; that calcification was seen in the fax in the midline anteriorly; that the posterior fossa structures [were] unremarkable”; and that the radiologist’s impression was that “[t]here [was] no midline shift, hemorrhage or extraaxial fluid collection.” Tr. 349-50, 377-79.

Records from NMHC, dated July 28, 2006, reflect that Plaintiff needed more blood pressure medicine; that Plaintiff reported that she “want[ed] to sleep all of the time for the last couple of weeks”; that Plaintiff weighed 270 pounds; that Plaintiffs blood pressure was 129/81; that Plaintiff was obese; that Plaintiff was experiencing constipation; that Plaintiff had non-pitting mild edema; and that Plaintiff was diagnosed with HTN, Diabetes Mellitus, type II, and GERD. Tr. 333.

Notes from NMHC, dated August 25, 2006, reflect that Plaintiff reported that she had back pain; that she had constipation; that she needed insulin needles; and that she was not sleeping well. Records further state that Plaintiff weighed 276 pounds; that her blood pressure was 142/77; that Plaintiff had “ + 1 pretibial edema”; that Plaintiff alleged insomnia; that she “never had a sleep study”; that Plaintiff was diagnosed with constipation, insomnia, and low back pain; and that it was recommended, among other things, that Plaintiff take colase and have a sleep study. Tr. 334.

Records from Northeast Regional Medical Center, dated August 31, 2006, reflect that Plaintiff presented with a knee injury/pain; that Plaintiff was diagnosed with an acute contusion of the left knee, acute pain in the left knee, and acute foot pain with strain; that the course of therapy was a “left long-leg knee immobilizer”; and that Plaintiff was to see Dr. Petry for follow-up. Tr. 388. An x-ray report of this date states that “[t]hree views of the left knee [did] not demonstrate a definite site of acute fracture or dislocation”; that there was “[minimal degenerative change”; that the joint compartments were maintained; that discrete osseous pathological lesion was not apparent; and that the cortical margins were smooth. The x-ray report also stated that “[m]ultiple views of the toes of the left foot [did] not demonstrate a definite site of fracture or dislocation.” The radiologist’s impression was that Plaintiff had degenerative changes of the left knee and that acute fracture, dislocation, or pathologic lesion of the left knee or toes of the left foot were not apparent. Tr. 391.

Records from NMHC, dated November 6, 2006, reflect that Plaintiff stated that she had pain from the fall which she had the prior month; that she could not tolerate the pain; and that she fell because of dizziness episodes. Tr. 335.

Records from NMHC reflect that Plaintiff presented on December 12, 2006, for a follow-up; that Plaintiff requested an appointment with an orthopedic physician; and that Plaintiff reported that her dizziness had improved with Antivert. Tr. 336.

Records from NMHC reflect that, on January 15, 2007, Plaintiff requested a letter stating why she was “disabled and not able to work.” Tr. 337.

Nurse Schrage, of Northeast Missouri Family Health Clinic, prepared a letter, in collaboration with Dr. John Knudsen, providing current healthcare information for Plaintiffs Medicaid review. Tr. 270, 309. The letter, dated January 17, 2007, states as follows:

Mrs. Walton is a 51-year-old white female with multiple health concerns. Her current diagnoses include: Obesity, Hypertension, Hyperlipidemia, Type II Insulin Dependent Diabetes Mellitus, Peripheral Diabetic Neuropathy, Gastroesophageal Reflux, COPD/Asthma, Chronic Allergic Rhinitis, Fibromyalgia, Degenerative Joint Disease, Degenerative Disc Disease, Irritable Bowel Syndrome, Chronic Back Pain, Unipolar Depression/Dysthymia, Recurrent Tendinitis (Right shoulder), Glaucoma, ADHD, Probable Sleep Apnea, and History of TIA.

Her current medications include Advair 100/50 1 puff twice daily; Allegra 180 mg 1 tablet daily; Albuteral Inhaler 2 puffs every 4-6 hours as needed; Antivert 25 mg 1 tablet every 8 hours as needed for dizziness; Effexor 225 mg 1 capsule daily; Gabapentin 600 mg 1 tablet 3 times daily; Lantus 60 units daily at 7 p.m.; Lisinopril 40 mg 1 tablet daily; Metformin 500 mg 1 tablet twice daily; Ranatidine 300 mg 1 tablet twice daily; Vytorin 10/40 1 tablet daily.

Tr. 270, 309.

The letter further stated that Plaintiff had “a pending appointment for an overnight sleep study, and an additional appointment with an orthopedist for evaluation of back pain and numbness in her legs.... Many of her disease processes will not improve over time, but with proper medication and treatment they can be controlled.” Tr. 271, 310.

Records from NMHC, dated February 5, 2007, state that Plaintiff was a “no show for paps and labs.” Tr. 339-40.

Records from NMHC, dated March 14, 2007, reflect that Plaintiff presented to “go over labs, discuss pain pill/muscle relaxer”; that Plaintiff said that she was “having a lot of pain” and “unable to sleep”; that Plaintiff weighed 288 pounds; that Plaintiffs blood pressure was 141/78; that Plaintiffs chest motion was good; and that Plaintiff exhibited no edema in her extremities. Tr. 342, 408.

A March 15, 2007 laboratory report from Quest Diagnostics, from specimens collected on March 14, 2007, states that Plaintiffs microalbumin/ereatinine levels were out of range. Tr. 426.

Records from NMHC, dated March 28, 2007, reflect that Plaintiff rescheduled an appointment she had for that date due to a lack of transportation. Tr. 409.

Records from NMHC, dated April 9, 2007, reflect that Plaintiffs blood sugar readings ranged from 111-180, when Plaintiff is not fasting; that Plaintiff said that her “allergies [were] bothering her”; that Plaintiff said that corns on feet hurt; that she weighed 283 pounds; that her blood pressure was 130/80; that her heart rate was 88 BPM, with regular rhythm and no murmurs; that Plaintiffs lungs were clear; that Plaintiffs chest motion was good; that Plaintiffs “feet [were] tingling and painful”; that she had “callous[es] on each foot”; that Plaintiffs diagnoses included “Type II Diabetes mellitus, allergic rhinitis, and “diabetic neurage”; and that it was recommended that Plaintiff schedule an appointment with a podiatrist regarding her diabetes and the corns on her feet, and that she take she take a decongestant, and that she wear shoes at home. Tr. 410.

Records from NMHC, dated April 23, 2007, reflect that Plaintiff rescheduled an appointment for that date. Tr. 411.

Records from NMHC, dated April 25, 2007, reflect that Plaintiff reported that Lyrica caused her to be too sleepy and that she took this medication for “only 3 days”; that Plaintiff complained of left shoulder pain with lifting and that her right leg went numb and shook “in certain positions — especially] sitting in hard chairs”; that Plaintiff weighed 290 pounds; that her blood pressure was 132/78; that her heart rate was 80 BPM; that she presented alert and with no distress; that her lungs were clear; that her chest motion was good; that her extremities exhibited no edema; and that Plaintiff had a “thick callous” on her right foot. It was recommended on this date that Plaintiff continue her medications, stop smoking, apply Vaseline to her feet at bedtime, and conduct daily foot exams and that Plaintiff return in three months. Tr. 412.

A June 21, 2007 laboratory report from Quest Diagnostics, from specimens collected on June 20, 2007, states that Plaintiffs triglycerides, total cholesterol, LDL-cholesterol, glucose level, and Hemoglobin were elevated; and that Plaintiffs sodium, chloride, albumin, and AST levels were below range. Tr. 427-28.

A letter from Edna DeCastro, M.D., dated June 21, 2007, states that Dr. DeCastro interviewed and examined Plaintiff “for her disability determination.” Dr. DeCastro stated in this letter t