Full opinion text
ORDER RICHARD H. KYLE, District Judge. Based upon the Report and Recommendation of United States Magistrate Judge Raymond L. Erickson, and no objections having been filed with respect thereto, IT IS ORDERED: 1. The Report and Recommendation (Doc. No. 17) is ADOPTED; 2. Plaintiffs Motion for Summary Judgment (Doc. No. 10) is DENIED; and 3. Defendant’s Motion for Summary Judgment (Doc. No. 11) is GRANTED. LET JUDGMENT BE ENTERED ACCORDINGLY. REPORT AND RECOMMENDATION RAYMOND L. ERICKSON, United States Chief Magistrate Judge. I. Introduction The Plaintiff commenced this action, pursuant to Section 405(g) of the Social Security Act, Title 42 U.S.C. § 405(g), seeking a judicial review of the Commissioner’s final decision which denied her application for Disability Insurance Benefits (“DIB”). The matter is now before the Court upon the parties’ cross-Motions for Summary Judgment. The Plaintiff has appeared pro se, and the Defendant has appeared by Lonnie F. Bryan, Assistant United States Attorney. For reasons which follow, we recommend that the Defendant’s Motion for Summary Judgment be granted, and that the Plaintiffs Motion be denied. II. Procedural Background The Plaintiff protectively filed for Social Security Disability Benefits (“DIB”) on September 30, 2004, and alleged an onset date of December 1, 2000, with a date last insured of December 31, 2000. [T. 74]. Her application was initially denied on January 12, 2005, and upon reconsideration on May 25, 2005. Id. The Plaintiff requested a Hearing, which was held before an Administrative Law Judge (“ALJ”) on August 12, 2006, at which time, the Plaintiff appeared and testified, and was represented by legal counsel. Id.; [T. 448-75]. The Plaintiff was also represented by another, who did not appear at the Hearing, but who submitted additional documents thereafter. Id. William Rutenbeck (“Rutenbeck”) appeared at the Hearing as Vocational Expert (“VE”). Id. After the supplemental documents were submitted, the ALJ held a supplementary Hearing, on September 26, 2006. [T. 440-47]. The Plaintiff appeared at the supplementary Hearing and was represented by legal counsel, but only the VE, who was Mitchell J. Norman (“Norman”), testified. Id. The ALJ issued her decision on January 10, 2007, and found that the Plaintiff was not disabled as of her date last insured — December 31, 2000. [T. 84], The Plaintiff filed a request for review of the ALJ’s decision, and submitted additional records for consideration by the Appeals Council, in addition to several letters. [T. 5, 409-439], However, on August 27, 2008, the Appeals Council denied the request for further review. [T. 6-9]. As a consequence, the ALJ’s determination became the final decision of the Commissioner. See, Sims v. Apfel, 530 U.S. 103, 106-07, 120 S.Ct. 2080, 147 L.Ed.2d 80 (2000); Grissom v. Barnhart, 416 F.3d 834, 836 (8th Cir.2005); Steahr v. Apfel, 151 F.3d 1124, 1125 (8th Cir.1998); Johnson v. Chafer, 108 F.3d 942, 943-44 (8th Cir.1997); Title 20 C.F.R. § 404.981. III. Administrative Record A. Factual Background. The Plaintiff was forty-five (45) on the date last insured. [T. 83]. The Plaintiff completed college in 1977, [T. 146], and according to her reports to the Social Security Administration (“SSA”), her impairments began in January of 2000, and she stopped working on December 1, 2000. [T. 119, 141]. In her application for DIB, the Plaintiff alleged that she was unable to work due to her depression, and “considerable ADD,” which limited her ability to concentrate. [T. 140-41]. In addition to those impairments, the ALJ found severe impairments of obesity, chronic sinusitis, and bilateral chondromalacia/patellofemoral syndrome. [T. 76], 1. Medical Records as to Physical Impairments On January 5, 1994, the Plaintiff was seen at the North Suburban Family Physicians Clinic (“North Suburban”) with nasal congestion, and facial pain for the preceding ten (10) days. [T. 405]. The Plaintiff was assessed with sinusitis and a left ear canal lesion, and was prescribed Amoxicillin. Id. On February 11, 1994, the Plaintiff was seen at the Mid-West Ear, Nose, and Throat Clinic (“Mid-West”), for choanal atresia, and reported constant pain in her left ear, and a recent bout of bad sinusitis. [T. 202, 323, 343]. Upon examination, the physician noted that the Plaintiff had difficulty breathing through her nose, and a significant septal deformity. Id. The Plaintiff and the physician discussed surgery for the septal deformity. Id. On March 4, 1994, MidWest canceled the surgery, because of congestion, and the Plaintiff was referred for RAST allergy testing. Id. On March 14, 1994, the Plaintiff was seen at North Suburban for sinus symptoms which were not being fully resolved with antibiotics. [T. 404]. The physician observed that the Plaintiffs “TM” was mildly inflamed, and that the nasal mucosa on the left side was fairly boggy and inflamed, with a purulent discharge. Id. The physician assessed chronic and recurring sinusitis, and the Plaintiff was prescribed Augmentin, and Nasalide nose spray. Id. On March 23, 1994, the Plaintiff was seen at MidWest, where her RAST results returned negative for all antigens tested, and the Plaintiff was referred to Dr. Carley for further direction. [T. 201, 321, 342], On March 29, 1994, the Plaintiff was still experiencing a marked amount of problems with her nose, and examination revealed deflection of the septum to the left. Id. A CT scan from March 30, 1994, revealed mild mucoperiosteal thickening; bilateral maxillary sinuses that were markedly hypoplastic, and showed small atretic appearing infundibula; a complex septal deviation to the left at one part, and to the right at another; and patent appearing sphenoethmoidal recesses and nasofrontal ducts. Id. On March 31, 1994, the physician assessed the Plaintiff with hypoplastic sinuses, with problems mostly occurring intranasally, and septal surgery was recommended. Id. The Plaintiff not was seen again until November 17, 1994, when she reported good health, and decided to have the septal surgery, [T. 200, 322, 341], which she underwent in December of 1994. In a medical note from December 29, 1994, it was related that the Plaintiff was healing nicely. [T. 199, 320, 340]. However, a few months later, on March 27,1995, the Plaintiff was seen at North Suburban for weakness, aches, and slight nasal congestion, [T. 402], and on July 10, 1995, the Plaintiff returned to MidWest with complaints of sinus infections, nasal infections, and excessive drainage. [T. 198, 319, 339], Examination revealed “some swelling in the nose bilat[erally]” and drainage, and the physician prescribed Biaxin. Id. A CT scan, from July 11, 1995, revealed an interval increase in the mucoperiosteal thickening in the left maxillary sinus, bilateral nasofrontal ducts, and bilateral sphenoethmoidal recesses; an interval decrease in mucoperiosteal thickening in the left maxillary sinus, with apparent widening of atretic infundibulum; the right maxillary sinus was improved in pneumatization; the septal deviation had decreased; and there was an appearance of interval onset of nasofrontal duct opacification. Id. The Plaintiff was seen again on August 3, 1995, when she reported that she was feeling much better, but the CT scan showed “some chronic ethmoid disease,” and that she “bilaterally ha[d] hypoplastic maxillary sinuses,” and the physician opined that the Plaintiffs problems were “probably [ ] due to vasomotor rhinitis that causes a secondary ethmoiditis.” [T. 197, 318, 338]. The physician recommended bilateral endoscopic ethmoidectomies, id., but there are no records which document that the Plaintiff underwent that second recommended surgery. The Plaintiff returned to North Suburban on March 8, 1996, with symptoms of a cold that had lasted three (3) days, with a minimal amount of sinus congestion, but clear drainage, and she related that she was concerned because she was going to take an airplane the next day, in order to go skiing. [T. 397]. The physician assessed viral “URI” with probable eustachian tube dysfunction, and recommended Afrin and Sudafed for the air travel, and for skiing. Id. A year later, the Plaintiff returned to North Suburban on March 21, 1997, with complaints of a sore throat, congestion, a runny nose, and weepiness, but she had nontender sinuses, [T. 391], and the physician recommended fluids, and alternating Tylenol and Advil. [T. 392], Almost one (1) year later, on February 13, 1998, the Plaintiff was seen for a sinus infection by Dr. William G. Jones, [T. 191— 92], and he observed a thick discharge and recommended acidophillus. [T. 192], On February 16, 1999, Dr. Jones completed an employment health form, for the United States Postal Service, in which he stated that he had treated the Plaintiff for acute sinusitis in early 1999, and had also treated her for acute sinusitis in February of 1998, and possibly in November of 1998, from which she had recovered. [T. 193]. Those treatments are reflected in Dr. Jones’s brief notations, which list the Plaintiffs complaints as nasal congestion and coughing, on February 13, 1998, November 12, 1998, November 23, 1998, and February 9, 1999. [T. 192], In addition, Dr. Jones opined that the Plaintiffs acute sinusitis was “temporary,” and that she was recovering with a good prognosis, and that she did not require any physical restrictions, in February of 1999. [T. 193]. Dr. Jones also completed a Patient History Sheet on January 16, 1998. [T. 194-196]. The history relates that the Plaintiff had previously undergone a tonsillectomy, a broken ankle, a caesarean section, and repair of a deviated septum, and reports a diagnosis of depression, as well as of chronic sinus infections, which were reported to have been occurring for the previous ten (10) years. [T. 194], The history also relates the Plaintiffs report, that she had previously taken Prozac for approximately four (4) months, but had stopped because of its side-effects. Id. Dr. Jones noted that the Plaintiff “dulled easily,” and was wordy, and the Plaintiff related that she loved to read and rollerblade. [T. 195]. The Plaintiff weighed 170 pounds at that time. Id. On June 12, 1998, the Plaintiff was seen at North Suburban for pain in her left great toe joint, and she reported that she was not taking any medications except progesterone. [T. 390], The physician diagnosed acute arthritis of that joint, and prescribed Indocin, but did not place the Plaintiff on any restrictions. Id. During the year 2000, the Plaintiff was seen for a gynecological exam on March 14, 2000, [T. 218], for the treatment of a bunion, hammertoes, and an ingrowing right toenail, on May 19, 2000, [T. 345], and had an office visit with her gynecologist, who did not examine the Plaintiff, at her request, on September 12, 2000. [T. 217]. On January 9, 2001, the Plaintiff was treated at the Stillwater Medical Group for painful hammertoes, which had become very sore while she was cross-country skiing. [T. 344]. The physician discussed surgical options with the Plaintiff, but she requested treatment with toe pads instead. Id. On August 10, 2001, the Plaintiff was treated at the Fairview Lakes Medical Center for pain in her right foot, [T. 379], and on August 6, 2001, the Plaintiff reported a history of medial knee pain, which had been exacerbated by increased activity. [T. 380]. The Plaintiff reported that she was biking regularly, had not reduced that activity because of her knee pain, and had also been rollerblading earlier in the season. Id. The physician noted some laxity of the collateral ligaments, and some tenderness with palpation, and diagnosed right medial plica syndrome. Id. The physician recommended a reduction in activities, such as biking, and treatment with ibuprofen and ice, and possible physical therapy. Id. On February 7, 2002, the Plaintiff was seen at the Fairview-University Medical Center by Dr. Jyonouchi, for an evaluation of her chronic sinus infections, or “CRS”. [T. 233]. The Plaintiff related that her sinusitis had lasted for three (3) to four (4) weeks, and that she had last had sinusitis in August of 2001, id., and the physician recommended preventative measures for her sinus infections, including Singulair, an inhaler of Nasonex, and a humidifier, as well as an illegible medication, for one (1) month. [T. 235, 337]. The physician recommended that the Plaintiff return in one (1) month for a follow-up. Id. On February 27, 2002, the Plaintiff was seen at the Joint Replacement & Arthritis Center by Richard C. Reut, D.O. [T. 326-27], The Plaintiff reported that she was experiencing some knee pain, after having fallen during a snowboarding lesson, and she asked Dr. Reut if she would be able to attend another lesson that afternoon. [T. 326]. The Plaintiff also complained of aches when she climbed stairs, but denied locking, swelling, or instability, and reported that she was currently using ibuprofen for pain. Id. Dr. Reut completed a physical exam, and observed that the Plaintiff had a normal gait, and no obvious effusion, but that the left knee seemed slightly swollen, with quite a bit of patellofemoral crepitation, in both the left and right knees. Id. Dr. Ruet also noted that the Plaintiffs active flexion was 0/140 degrees, that the knees were “ligamentously lax,” and that there was excessive movement in the knee joints in all four (4) planes, but that there was a solid end joint, with no joint line tenderness. Id. The weight bearing x-rays showed some increased joint space narrowing of leftside medial compartment, some irregularities in the articular surface of the patellofemoral joint, and patellar compression caused some discomfort, patellar mobilization was 2 + medially and laterally, with good quad tone, fair VMO tone fair, and good hamstring flexibility. [T. 327]. Dr. Reut diagnosed ehondromalacia/patellofemoral pain, which had been aggravated by the snowboard fall, in a stable joint with no signs of internal derangement, and he recommended Physical Therapy, Celebrex samples, activities as tolerated, and a follow-up visit if needed. Id. On April 2, 2003, the Plaintiff was restricted from leg extensions, and squatting below parallel. [T. 330], The Plaintiff participated in physical therapy on March 8, 2002, and Physical Therapist Meghan M. Reistchel (“Reistchel”) noted that the Plaintiff reported bilateral knee pain with ambulation, sporting activities, and while using stairs. [T. 229]. Reistchel placed the Plaintiff on no work restrictions, and opined that the overall rehabilitation potential was good. [T. 228]. The Plaintiff participated in physical therapy, again, on March 12, 2002, with mild pain and difficulty. [T. 227], In a Discharge Summary dated April 17, 2002, Reistchel noted that the Plaintiffs overall condition had not significantly changed, and that the Plaintiff had been doing her home exercise program once per day, but had cancelled her physical therapy appointments three (3) times, without calling to reschedule, and that the Plaintiff had reported that the sessions would not fit into her schedule. [T. 222-23 (Discharge Summary); 224 (cancellation on April 15, 2002); 225 (cancellation on April 10, 2002); and 226 (cancellation on March 15, 2002) ]. On March 21, 2002, the Plaintiff returned to the Fairview-University Medical Center for CRS, fatigue, and depression. [T. 232]. The physician noted that the Plaintiff was taking Celebrex for knee pain, Singular and Nasonex, and another medication which is illegible. [T. 231]. During the physical exam, the physician noted no abnormalities, except that the Plaintiffs nose had “more patent nasal passages,” and another notation, that is illegible. Id. The physician further noted that, overall, the Plaintiffs nasaocular symptoms had improved, but that she was still experiencing fatigue and depression. [T. 232], More than two (2) years later, on April 15, 2004, the Plaintiff was seen at the Fairview Lakes Medical Center for sinusitis and environmental allergies. [T. 376]. The physician prescribed Nasonex and Singulair. Id. Several months later, on February 1, 2005, the Plaintiff was seen at the Fairview Lakes Medical Center for influenza, including symptoms of cough, sinus pain, and sore throat. [T. 374]. On April 26, 2005, the Plaintiff was seen by Dr. Joseph Campanelli, with complaints of acute maxillary sinusitis, and hypertrophic turbinates. [T. 258, 316]. The Plaintiff reported a twenty (20) year history of sinus problems, and stated that she experienced one (1) to three (3) “severe episodes” per year. Id. The Plaintiff reported that her most recent infection was in February of 2005, and she also related that she was filing a disability claim, due to her chronic sinusitis, but had come to see him because she was going out of town for her fiftieth (50th) birthday, had started to develop a sinus infection, and did not want to miss the trip. Id. The Plaintiff related that she was taking Nasonex and Singulair, as well as Trazodone and Celexa, and that her last treatment with antibiotics had been approximately two (2) years before. Id. Dr. Campanelli completed a physical exam, in which he noted that all systems were negative, except for pain, weakness, and numbness in her knees. Id. Dr. Campanelli also noted the Plaintiffs reports of depression and decreased immunity, id., and observed that the Plaintiff was cooperative, in no significant distress, and had appropriate communication skills. [T. 259, 317]. He also observed that the Plaintiffs maxillary and frontal sinuses were non-tender to palpation, but that the left ear canal showed a ineudomyringostapediopexy, the nose showed some erythema of the skin, the right side of the nose was clear, with some mucoid drainage, and that the left side showed an edematous turbinate. Id. Dr. Campanelli diagnosed acute maxillary sinusitis, prescribed Augmentin, and suggested a sinus rinse kit for when Plaintiff returned from her trip, and a good regimen of preventative care. Id. Dr. Campanelli also noted that “the hypertrophic turbinates that she has which are affecting her nasal breathing should be addressed” as well. Id. There is no evidence that the Plaintiff returned to Dr. Campanelli to follow up on the recommended preventative care. On February 23, 2005, the Plaintiff was seen by Dr. Richard Bae at the Abbot Northwestern Minneapolis Heart Institute, for a “jabbing feeling” in her heart. [T. 309]. Dr. Bae observed that the Plaintiff was pleasant, and related her report that she had been experiencing some chest symptoms and arm pain, but that this had not affected her activity level, and she was able to bike ten (10) miles without exertional symptoms. Id. Dr. Bae assessed chest pain with some atypical features, and recommended an exercise echocardiogram to rule out any significant ischemia. [T. 311-12], The echocardiogram revealed no ischemia. [T. 268]. On June 20, 2006, the Plaintiff was seen by Dr. Kent Wilson, in order to obtain an assessment for her upcoming DIB Hearing. [T. 260, 315]. The Plaintiff reported that she was not feeling ill at the time, but that she experienced five (5) to fifteen (15) episodes of rhinonasal infections per year, that she was weak, tired, and without energy, for two (2) to three (3) weeks after each infection, and that she was currently taking Nasonex, Ambien, Wellbutrin, and Singulair. Id. Upon a physical examination, Dr. Wilson observed that the Plaintiff was alert and cooperative, with a mild left septal deflection with minimal edematous nasal mucosa, and slight mucous in the nasopharynx, but that all else was normal. Id. Dr. Wilson noted that he “indicated to [the Plaintiff] that at this point I could not find evidence of advanced sinus disease, so I recommended CT study of the paranasal sinuses and a recheck in 1-2 weeks.” Id. On June 27, 2006, the Plaintiff followed up with Dr. Wilson to review her CT scan, [T. 48], and Dr. Wilson reported that the scan demonstrated moderate right septal deflection, with normal turbinal structures and sinuses, but small maxillary sinuses with congestion of the right nasal mucosa, which was compatible with normal function. Id. Dr. Wilson concluded that the findings were normal, and that no surgical or medical intervention was required at that time. Id. In addition, Dr. Wilson completed a short questionnaire, which was sent to him by the Plaintiffs representative, on August 2, 2006, in which he circled the answer that the Plaintiff would not be able to tolerate more than minimal fumes, odors, dusts, gases, and the like, for full time work, and that this would appear to have been the case since December of 2000. [T. 408]. On December 8, 2006, the Plaintiff was seen by Dr. Eric T. Becken, for an upper respiratory infection, chronic rhinitis, and acute serous otitis media. [T. 49]. The Plaintiff related that she had been taking antibiotics for a sinus infection, which were not helping. Id. The nasal exam showed mild erythema of the mucosa, no significant drainage, and no purulence, but some thicker drainage. Id. At that time, the Plaintiff expressed interest in surgery to decrease the likelihood of sinus infections, and Dr. Becken recommended she follow up in two (2) weeks. Id. On January 8, 2007, the Plaintiff was seen by Dr. Bradley D. Johnson, D.O., at the Oakdale Ear, Nose, and Throat Clinic (“Oakdale”), for chronic sinusitis. [T. 45-46]. The Plaintiff reported symptoms for the past fifteen (15) years, and that she was looking into surgery, because antibiotics and other medications had not improved her symptoms. [T. 46]. Dr. Johnson’s examination revealed no acute distress, communication without difficulty, and that the Plaintiffs other systems were normal, with the exception of the slight deflection in her nasal .septum, “with inferior turbinate hypertrophy and marked congestion within the middle meatus bilaterally.” Id. Dr. Johnson prescribed Clindamycin for two weeks, discussed surgery, and recommended a follow-up appointment. [T. 45]. The Plaintiff followed up with Dr. Johnson on January 25, 2007, and related no improvement on the Clindamycin. [T. 44]. Dr. Johnson noted that a CT scan revealed “inferior turbinate hypertrophy with a slight deviation of her nasal septum,” and “hypoplastic maxillary sinuses with moderate mucosal thickening to severe mucosal thickening on the right,” and “an obstruction of her left ostiomeatal complexes.” [T. 42, 44], The Plaintiff agreed to surgical intervention, [T. 44], but the Record does not contain any records related to any such surgery. On September 24, 2007, Dr. Rick Bosacker sent a letter to the SSA, in which he related that he had been treating the Plaintiff for the last year, which pertained to colitis resulting from antibiotic use from her chronic rhinitis and sinusitis, and that, although he did not treat her for her mental health concerns, that it appeared to him that she had fairly significant depression, which made it difficult for her to stick to plans, and to work. [T. 15,16]. On December 22, 2007, the Plaintiff was admitted to Unity Hospital with complaints of chest pain. [T. 19]. The Plaintiff appeared very anxious, [T. 20], and Dr. Raza A. Khan observed that the Plaintiff was tangential in her speech, and reported that she could not work due to her chronic sinusitis. [T. 19]. Dr. Khan ordered testing, in order to rule out a myocardial infarction, and also ordered a psychiatric consultation, so as to assist with the possible anxiety attack, or a possible personality disorder. [T. 21], The Plaintiffs chest x-ray was normal, [T. 27], and all of her other tests were normal, except that the EKG revealed some “nonspecific ST abnormalities as 98 beats per minute.” [T. 33, 37]. The diagnoses on discharge were chest pain due to anxiety, anxiety disorder with panic attacks and agoraphobia, depression, probable histrionic personality disorder, and elevated blood pressure. [T. 17]. As to the Plaintiffs obesity impairment, on July 25, 1997, the Plaintiffs gynecologist recommended that the Plaintiff, who weighed 178 pounds at that time, reduce her weight. [T. 242]. At an exam, on March 14, 2000, the Plaintiff weighed 196 pounds, [T. 218], and her weight remained stable, around 200 pounds, thereafter. [T. 234 (2002), 238 (2004), 309 (2005), 374 (2005) ]. The Plaintiff was treated for obesity with Meridia, in March of 2002, [T. 377], and on March 5, 2002, the Plaintiff reported that she was a member of the Y, and that she was “swimming regularly,” but that it was not helping as much as she had hoped. [T. 378]. With respect to medications, there are notes in several medical records which indicate that the Plaintiff was taking Zoloft at various times, [T. 217, 345], which is also reflected in the pharmacy records from 1998, 1999, and 2000. [T. 175-76], In addition, in a medication list from the Target Pharmacy, between July 1, 2002, and June 26, 2006, the Plaintiff filled prescriptions for the following medications, in addition to Singulair and Naxonex: clindamycin, Celexa, Trazodone, doxycycline, tetracycline, Differin, zoderm, Elidel, citalopram, amox tr-k, Ambien, bupropion, Concerta permethrin, and cephalexin. [T. 172-73]. Another pharmacy record, from August 1, 2006, to August 21, 2007, shows that the Plaintiff had filled prescriptions for Ambien, Differin, Prednisone, “amox,” avelox, metronidazol, proctofoam, lidocaine, and zolpidem. [T. 47]. 2. Medical Records as to Mental Impairments. The Record contains a letter from Barbara A. Hanson, Ph.D., at the Arden Woods Psychological Services, P.A., (“Arden Woods”) dated November 26, 2003, [T. 215], in which Dr. Hanson relates that she treated the Plaintiff from January 10, 1996, to June 12, 1996, for diagnoses of Attention-Deficii/Hyperactivity Disorder (“ADHD”), Predominantly Hyperactive-Impulsive Type, and that some unspecified testing was completed on January 17, 1996, and February 26,1996. Id. Dr. Hanson also relates that all of the clinical records had been destroyed by the clinic, and that the only records available on the computer were the Plaintiffs identifying information, diagnosis, and the dates and types of services provided. Id. On March 27, 1996, Dr. Hanson referred the Plaintiff to the Roseville Clinic-Mental Health Services (“Roseville Clinic”) for assessment of ADHD and depression. [T. 409]. The Plaintiff was seen by Dr. Paul F. Goering, at which time, she related a “long and complicated history of inattentiveness and depression.” Id. Specifically, the Plaintiff related trouble with restlessness, fidgeting, waiting, a tendency to blurt things out, difficulty completing tasks, poor motivation, aggravation because she could not finish tasks, frequent forgetfulness, moving from one task to another without finishing, inattentiveness in conversation, irritability, and job conflict. Id. The Plaintiff also described symptoms of depression, since college, and for the past nine (9) years, with a loss of enjoyment, sadness, tearfulness, ruminating on the past, disturbed sleep, and poor concentration due to the sleep issues. Id. In addition, the Plaintiff reported that her interests in reading, skiing, tennis, and rollerblading continued, but that she did them somewhat less, and tended to isolate herself. Id. The Plaintiff denied any suicidal ideation. Id. The Plaintiff stated that she felt that she was making slow progress with Dr. Hanson, and related her history of sinusitis and septal surgery. [T. 410]. Dr. Goering completed a mental status exam, in which he observed that the Plaintiff was casually kempt, in no acute distress, and that, while the Plaintiff made an initial impression of being irritable, gruff, or unpolished, she was pleasant and cooperative. [T. 411]. Dr. Goering noted that the Plaintiffs voice was of normal rate and rhythm, her eye contact was normal, and there was no motor disturbance. Id. In addition, the Plaintiff exhibited a logical thought process that was goal directed, but frequently overinclusive of detail, and Dr. Goering observed that the Plaintiff told her story in a very controlling and obsessive fashion, but that there was no evidence of delusion, paranoia, or other psychotic symptoms. Id. Dr. Goering also observed that the Plaintiff was cognitively intact, well-oriented, with a good fund of knowledge, and normal impulse control, from the exam and from the history she related, and above average in intelligence, but he noted that her insight into her illness was somewhat limited. Id. Dr. Goering diagnosed Depressive Disorder NOS, R/O Atypical Major Depression; Dysthymia; ADD; passive aggressive and narcissistic traits; chronic sinus infections; and a Global Assessment Function (“GAF”) score of 70. Id. Dr. Goering recommended a screening EKG, individual therapy with Dr. Hanson, the initiation of imipramine, and a followup appointment in six (6) weeks. [T. 412], The Plaintiff saw Dr. Goering for a follow-up appointment on May 28, 1996, in which she reported some dry mouth from the imipramine, and related that she was not sure if she felt better on the medication, but also reported a more stable mood, less irritability, less anger, better sleep, less crying, less ruminating, improved emotional resiliency, and improved focus and comprehension, but that she continued to isolate herself, had poor optimism, and still procrastinated, was distractible, and forgetful. [T. 413]. The EKG had returned normal results and, in the mental status exam, Dr. Goering noted that the Plaintiff was fifteen (15) minutes late, had many questions, and appeared to have an improved mood. Id. Dr. Goering adjusted his diagnoses slightly, to ADD, Depressive Disorder NOS, Dysthymia, and he recommended continuing with the imipramine at a higher dosage, with a followup appointment in four (4) weeks, and continued therapy. Id. The Plaintiff did not seek treatment with Dr. Goering again until October 24, 1996, when she related that she had failed to come to an appointment in July because she had been traveling. [T. 414]. The Plaintiff reported that she continued to take imipramine, and that she felt better, had improved sleep, energy, and mood, reduced tearfulness, and improved attention, but not completely, and that she was still sensitive to the opinions of other people. Id. The Plaintiff also related that she was no longer seeing Dr. Hanson for therapy. Id. Dr. Goering noted that the Plaintiff was pleasant and cooperative, in no acute distress, her affect was full-ranging, her mood was “good,” and there was no evidence of psychosis or cognitive disturbance. Id. Dr. Goering noted his diagnoses of Depressive Disorder NOS, which was improved on imipramine; ADD, which was also improving; and Dysthymia, which was his primary diagnosis. Id. Dr. Goering recommended that the Plaintiff return to therapy, and they discussed the addition of Prozac to imipramine, with a level of medication to be taken in two (2) weeks, and a follow up in four (4) to (6) weeks. Id. The Plaintiff was seen for the final time by Dr. Goering on December 2, 1996. [T. 415]. The Plaintiff reported that she had begun taking Prozac, but that she was inconsistent with her medications, due to forgetfulness. Id. However, the Plaintiff related that she generally felt more optimistic, with improved mood, sleep, energy, and frustration tolerance, but also related that she continued to be sensitive and to procrastinate. Id. Dr. Goering noted that the Plaintiff related no other symptoms consistent with ADHD at that time. Id. In the mental status exam, Dr. Goering observed that the Plaintiff was pleasant, in no acute distress, with no evidence of anxiety or depression, and that she was cognitively intact. Id. He diagnosed Depressive Disorder NOS, which was improved; ADD, which was improving; Dysthymia, primary type; and partial noncompliance with medication. Id. Dr. Goering recommended a decrease in the imipramine, because the Plaintiff had failed to get her medication level checked, and also recommended that the Plaintiff return to therapy, but the Plaintiff declined. Id. Almost three (3) years later, on August 30, 1999, the Plaintiff was seen by Dr. J. Green, at North Suburban, for a left eye irritation. [T. 386-87]. During that visit, the Plaintiff reported her history of depression, and that she had previously received a prescription for Zoloft, from her gynecologist, but related that she inconsistently took Zoloft, had been in therapy, but ceased because she did not like her therapist. [T. 387]. Dr. Green discussed depression with the Plaintiff, encouraged her to seek out a new therapist, and suggested a new Zoloft prescription, but cautioned the Plaintiff that she would need to consistently take the medication. Id. The Plaintiff did not take a Zoloft prescription at that time, agreed to return for further discussion with Dr. Green if necessary, id., but did not return. The Plaintiff sought therapy approximately four (4) years later, in 2003, and was treated by Elaine K. Johnson, who is a Licensed Psychologist, from September 9, 2003, to February 3, 2004, for a total of eighteen (18) hour-long sessions. [T. 213]. In a letter dated November 29, 2004, Dr. Johnson informed the ALJ that she had treated the Plaintiff for significant depressive, interpersonal sensitivity, obsessive-compulsive, and paranoid ideation symptoms. Id. Johnson related that she had completed the Symptom Checklist, [T. 216], Beck Depression Inventory, and the Millón Clinical Multiaxial Inventory, and that the Axis I diagnoses were Delusional Disorder, Generalized Anxiety Disorder, and Adjustment Disorder with Depressed Mood. [T. 213]. Johnson reported that the Plaintiff was treated with medication, and cognitive/behavioral techniques, with the goal of, among other things, “authoring and pursuing career ambitions.” Id. In her letter, Johnson explained that, from her clinical observations, the Plaintiff “was able to sit, stand, walk, hear, speak, understand, had sustained concentration and persistence, along with good memory skills,” but that “[s]he struggled with social interaction and adaptation, especially in difficult interpersonal situations,” id., and that the Plaintiffs “diagnosis are [sic] best addressed over a long term, on-going psychotherapeutic relationship,” with a good prognosis, but that Johnson had ceased treating the Plaintiff, due to financial concerns. [T. 214], The Plaintiff was treated by Dr. Thomas Fox, at the North Metro Psychiatry Clinic (“North Metro”), from October 14, 2003, to January 11, 2005, to whom she had been referred by her therapist, who was Johnson at that time, for the evaluation and treatment of depression. [T. 256]. In her intake interview with Dr. Fox, the Plaintiff reported that, over the past year, she had been more depressed, more socially sensitive, more weepy and emotional, and had been withdrawing and ruminating, experiencing a reduction in enjoyment of life, and some anxiety symptoms, but she denied suicidal ideation. Id. The Plaintiff reported that she had never seen a psychiatrist, or been hospitalized for psychiatric reasons, but that she had taken Zoloft years before, and had experienced some dry-mouth. Id. Dr. Fox noted that the Plaintiffs past medical history was unremarkable, and that she was in good medical health, and was not taking medications. Id. Dr. Fox completed a mental status exam, during which he observed that the Plaintiff was alert, oriented, cooperative, appeared her age, and maintained good eye contact, with no evidence of a major thought disorder, and no hallucinations or delusions. Id. Dr. Fox observed that the Plaintiff cried throughout the interview, and that her mood was depressed, but that her affect was appropriate, and she was cognitively intact, with average to above average intelligence, some dependency issues, and “clearly looked depressed.” Id. Dr. Fox diagnosed Major Depressive Disorder, id., and encouraged the Plaintiff to continue her participation in therapy, started her on Celexa, and told her to return in one month. [T. 257]. The Plaintiff returned to Dr. Fox on November 12, 2003, and reported that she was feeling better, but that she did not believe it was because of the medications. [T. 255]. Dr. Fox noted that the Plaintiff was very agreeable, and noted her concerns of ADD, because of her reports that she “just flit[s] around, etc.” Id. The Plaintiff reported no side effects from the medications, and Dr. Fox observed that her affect was brighter, which may have been a response to the medications. Id. The Plaintiff completed the MCMI-II Test on December 11, 2003, in which the examiner observed that there was reason to believe that “at least a moderate level of pathology characterizes the overall personality organization” of the Plaintiff, with a less than satisfactory hierarchy of coping strategies, and that her foundation for intrapsychic regulation and socially acceptable interpersonal conduct was deficient or incompetent. [T. 352]. The examiner opined that the Plaintiff was subject to the flux of her own enigmatic attitudes and contradictory behavior and, “[although she is usually able to function on a satisfactory basis, she may experience periods of marked emotional, cognitive, or behavioral dysfunction.” Id. In addition, the examiner opined that it was likely that her depression, loneliness, and isolation, were worsening. Id. In his discussion of her Axis I diagnosis, the examiner reported that the Plaintiffs thinking “includes a number of delusional facets (e.g. transient ideas of reference, mixed jealousy, and persecutory beliefs) that interweave with other features to constitute a mini-paranoid episode.” [T. 353]. In addition, on the MCMI-II Test, the Plaintiff responded that she sleeps poorly, does not have the energy to concentrate, feels shaky, and has trouble falling asleep because painful memories run through her mind. [T. 354]. The Plaintiff also reported a fear of making friendships, that she avoids most social situations, often criticizes people strongly if they annoy her, and that people have said that she becomes too interested and too excited about too many things. Id. The examiner concluded that the Plaintiffs possible diagnoses were as follows: Delusional (Paranoid) Disorder; Generalized Anxiety Disorder; Adjustment Disorder with Depressed Mood; Avoidant Personality Disorder, of long-term or chronic duration; low self-confidence, and job or school problems. [T. 355]. As for treatment, the examiner felt that, “[i]f additional clinical data are supporting of the MCMI-II’s hypotheses, it is likely that this patient’s difficulties can be managed with either brief or extended therapeutic methods.” [T. 356]. On January 8, 2004, Dr. Fox referred the Plaintiff to Joe House, but the Plaintiff reported that she was feeling fine, but could not sleep, and wanted to wait on the Joe House referral. [T. 255]. The Plaintiff reported no problems with Celexa, and was prescribed a medication for her insomnia. Id. The Plaintiff next saw Dr. Fox on February 16, 2004, when she reported that she was feeling better, experiencing no problems with her medications, and Dr. Fox noted a brighter mood, and improvement in her symptoms. Id. The Plaintiffs next appointment with Dr. Fox took place eleven (11) months later, on January 11, 2005, when the Plaintiff reported irregular use of medications, and that she felt more depressed, sad, ruminative, negative, and irritable. [T. 254]. Dr. Fox referred the Plaintiff for neuropsychological testing, due to her reports of cognitive difficulty. Id. On March 1, 2005, the Plaintiff completed a neuropsychological examination with Charlaine J. Skeel, Psy.D. [T. 209], Dr. Skeel noted the Plaintiffs diagnoses for anxiety and depression, and noted that the Plaintiff endorsed significant stress and difficulty maintaining attention, losing things, proneness to interrupt others, and difficulty sitting still. Id. The Plaintiff reported her current medications as Celexa and Trazodone, but she could not recall their dosages. Id. Dr. Skeel administered the following tests: WAIS-R; Bender-Gestalt; Trail Making Test; Wechsler Memory Scale-Revised; Boston Naming Test; Controlled Oral Word Association Test; Test of Variables of Attention (TOVA); WRAT-R; WIAT; Gray Silent Reading Test; GORTIII; Beck Depression Inventory; Beck Anxiety Inventory; MMPI (2"60487'3-9/15: 0.2.15.8.); and the Self-Rating Behavior Checklist. Id. Dr. Skeel concluded that the Plaintiff was cooperative and invested in the testing, so the testing was likely a reasonable estimate of her then present capabilities. [T. 211]. In interpreting the raw data, Dr. Skeel concluded that the Plaintiff was within the average range intellectually, and had adequate abstract and logical reasoning, an extensive vocabulary, and average general knowledge, and that there was “no apparent concern for intellectual deficits and gross-level cerebral organic impairment is not evident.” Id. With respect to the Plaintiffs ADHD, Dr. Skeel observed that the “TOVA results are valid and the ADHD score positive for attention problems,” but that “omission errors of one or two are often statistically more significant than clinically relevant,” and the Plaintiffs “slow response time appears due to a cautious test-taking stance.” Id. Dr. Skeel also noted that the “Beck Inventories index moderate depression without acute panic features,” and that the Plaintiff endorsed the listed symptoms. Id. Further, Dr. Skeel concluded that “[t]he MMPI appears a valid profile suggesting situational turmoil in an individual who feels readily overwhelmed in the face of psychiatric upheaval,” and that the “[c]linical scales index mild to moderate depression with mild anxiety in a woman who may exhibit obsessive-like neurotic defenses.” Dr. Skeel diagnosed Depressive Disorder NOS; R/O Major Depressive Disorder; and Axis II Deferred, and recommended that the Plaintiff continue with her medications, and that they discuss the Plaintiffs willingness to participate in individual support psychotherapy. [T. 212], The Plaintiff began treatment for her mental impairments with Dr. Richard Lentz on May 5, 2005. [T. 265]. In her initial visit, Dr. Lentz noted that the Plaintiff was “dissatisfied with her prior psychiatrist, stating she thinks she has a valid case for Social Security Disability and he does not think they will accept depression and ADHD.” Id. In his mental status exam, Dr. Lentz observed that the Plaintiff was somewhat obese, coughed constantly, with a loose, hacking cough, which the Plaintiff attributed to sinusitis, and that the Plaintiff fidgeted constantly, her psychomotor activity was generally increased, she interrupted frequently, her affect was of a full range and appropriate, her mood was anxious and depressed, she had normal speech, judgment and adequate abstraction, and moderate insight. [T. 266]. Dr. Lentz also noted that the Plaintiffs associations were intact, with no hallucinations or delusions, no paranoia, and no suicidal ideas, she was alert and oriented on all three (3) axes, with normal attention and concentration, memory and cognition, fund of information and language skills. Id. Dr. Lentz assessed Major Depressive Disorder, Dysthmic Disorder, from a prior diagnosis, some symptoms of ADHD, and assessed a GAF of 45-50. [T. 266-67]. Dr. Lentz recommended an increase in the Plaintiffs dosage of Citapram to the maximum, with the possible addition of Wellbutrin, and suggested that the Plaintiff see Lynn Jacobs. [T. 267]. In supplementary notes, Dr. Lentz related that the Plaintiff had complained to his receptionist that Dr. Lentz did not spend enough time with her, though their appointment lasted over an hour, which he opined was the kind of behavior that was clinically relevant, and was of the type that gets her into trouble with others. Id. Dr. Lentz saw the Plaintiff again on June 14, 2005, when she reported improvement from her last visit, and no side effects from Celexa. [T. 264]. On July 22, 2005, Dr. Lentz observed that the Plaintiff continued taking Celexa and Trazodone as directed, and that all of her symptoms had improved since her previous visit, and he prescribed Wellbutrin SR, and Ambien as well. [T. 263]. The Plaintiff did not see Dr. Lentz again until October 14, 2005, when she reported that she was taking the medications as prescribed, and the only side effect was some sluggishness in the morning from the Ambien. [T. 262]. Dr. Lentz recommended continuing the medications, but changed the timing of the dosages, and noted that the Plaintiffs Major Depressive Disorder was “in partial remission,” but that she reported difficulty with her short-term memory, with attending to tasks, and with concentration. Id. On November 18, 2005, Dr. Lentz reported that the Plaintiffs depression was now controlled, and “symptoms attributable solely to depression have resolved.” [T. 261]. During that visit, the Plaintiff reported trouble doing tasks around the house, endorsed symptoms of combined ADHD, related problems sustaining attention, including that people had informed her that she did not listen to them, procrastination, difficulty organizing, avoidance of tasks that take prolonged mental effort, forgetfulness, and she reported that she was easily distracted and restless. Id. The Plaintiff also related that she talked excessively, blurted out answers before questions were finished, and had problems with waiting. Id. Dr. Lentz’s physical exam of the Plaintiff revealed a full affect range, neutral mood, a tendency to answer questions before completely asked, but denial of suicide ideation, and adequate judgment. Id. Dr. Lentz assessed the Plaintiff with Major Depression, Dysthymic Disorder, and ADHD, and recommended that the Plaintiff continue with her current medications, and add Concerta. Id. Dr. Lentz did not assign any GAF scores, in his clinical notations, after the initial intake assessment. The Plaintiff began to see M. Charmoli, Ph.D., on March 20, 2006. [T. 361]. During her initial appointment, Dr. Charmoli observed that the Plaintiff was on time, neatly dressed and groomed, alert, oriented, coherent, not responding to internal stimuli, and had a speech rate and amplitude within the normal range. Id. Dr. Charmoli also observed that the Plaintiff was articulate, with a depressed affect, and appeared to be high average to above average in intelligence. Id. The Plaintiffs primary concern was depression and getting along with people, and she related that she lost her job with American Airlines in 1992, and had never been the same since. Id. The Plaintiff reported experiencing insomnia, chronic sinus infections, seasonal affective disorder, anxiety, and ADHD, and also related that SSA had lost her file, making it difficult for her to get benefits. Id. The Plaintiff reported that she was seeing Dr. Lentz, taking Citalopram, Wellbutrin, and Ambien, and had taken Trazodone, and that the sleep aides helped, but the antidepressants were variably effective. Id. Dr. Charmoli informed the Plaintiff that she did not perform DIB evaluations, but that the Plaintiff was still open to completing the intake, and Dr. Charmoli assessed Major Depressive Disorder, single episode, Axis II deferred, and ADHD per the Plaintiffs report. Id. Dr. Charmoli also noted that the Plaintiff appeared quite depressed, cried throughout the interview, her energy appeared to be low, and that the prognosis was guarded to fair. Id. Dr. Charmoli recommended that their next appointment should be in three (3) weeks. [T. 362], The Plaintiff also completed a BSI Test on March 20, 2006, [T. 363], and the results qualified her “as a positive clinical case,” and suggested that a more intensive and detailed evaluation of mental status should be completed. [T. 365]. In particular, the examiner noted that extremely high levels of obsessive-compulsive symptoms were in evidence, as well as marked feelings of inferiority, and an extremely high level of depression, with a moderate level of anxiety. Id. The Plaintiff reported extremely high levels of anger, frustration, and intensely hostile feelings, and she exhibited extremely high levels of paranoid ideation, which were “almost certainly associated with a formal psychiatric disorder which possesses clear paranoid overtones.” Id. In addition, the examiner noted the Plaintiffs extremely high psychoticism score, which would normally be associated with either a formal thought disorder or intense confusion and a sense of marked alienation arising from the presence of another psychiatric disorder. Id. The Plaintiff also related that she was easily annoyed, blocked on completing tasks, lonely, that her mind was often blank, and that she had trouble concentrating. [T. 366]. The Plaintiff saw Dr. Charmoli, again, on June 6, 2006, and she reported trouble with focus and concentration, and feeling lonely, discouraged, and easily distressed. [T. 358]. The Plaintiff also recounted that she rode a bike ten (10) miles per day, enjoyed rollerblading, and used to enjoy swimming laps, but no longer swam. Id. The Plaintiff also disclosed a history of sexual and physical abuse. Id. Dr. Charmoli discussed day treatment, referred the Plaintiff to United Hospital and FairviewUniversity, and discussed using “EMDR/brainspotting to address mood.” [T. 359]. Dr. Charmoli assessed Major Depressive Disorder, mixed Personality Disorder with problems with relationships, authority figures and impulsivity, and observed that the Plaintiff was thirty (30) minutes late for the appointment and had a depressed affect. Id. Dr. Charmoli planned to see the Plaintiff again in one (1) to two (2) weeks. Id. Dr. Charmoli’s next record is from June 13, 2006, wherein she notes that the Plaintiff had cancelled their next appointment, and had asked for a referral to a psychologist who would complete a DIB evaluation. [T. 360]. Dr. Charmoli opined that the Plaintiff was not very motivated to address her emotional difficulties, but might have been hoping to obtain DIB. Id. On August 10, 2006, the Plaintiff was seen by Dr. Bosacker for sleep problems, and she related that she was taking Ambien. [T. 58]. Dr. Bosacker noted that the Plaintiff “[m]aybe worries a bit more than the average person,” but that she denied fatigue, weakness, weight change, fever, night sweats, polyphagia, polydipsia, or polyuria, and hair growth changes. Id. Dr. Bosacker also observed that the Plaintiff was pleasant and interactive, alert and oriented, in no acute distress, with coherent speech, normal rate and volume, and was able to articulate logical thoughts, and able to engage in abstract reasoning, without tangential thoughts, hallucinations or delusions. [T. 59]. The Plaintiff was seen by Dr. Buddy Lile for a psychiatric consultation on December 23, 2007, which was related to her anxiety attack, and she reported her history of depression and ADHD. [T. 23]. Dr. Lile observed that the Plaintiff was in no apparent distress, [T. 24], that she was cooperative, with appropriate eye contact, unremarkable activity and speech, but had excessive and overinclusive speech, with a rambling thought process, a normal mood, and a slightly labile affect. [T. 25]. The Plaintiff was alert and oriented, with normal attention and concentration, no memory impairment, knowledge of current events and calculations, average intelligence, fair judgment, fair insight, and fair control of impulsivity. Id. Dr. Lile diagnosed generalized anxiety disorder, tobacco use disorder, suspect histrionic personality traits, and hypertension, but he did not assign a GAF. Id. Dr. Lile recommended that the Plaintiff begin therapy again, and cease the Wellbutrin prescription, because it increased anxiety. [T. 25-26], 3. Other Records. A. Hearing Testimony. The ALJ held the first Hearing on July 12, 2006, [T. 448], at which time, the Plaintiff appeared and was represented by legal counsel, [T. 450], and Rutenbeck testified as the YE. [T. 470]. The Plaintiff made no objection to the exhibits, [T. 450], and, when the ALJ asked if all documents had been disclosed, her lawyer responded that some treatment notes from Dr. Charmoli were not yet in the Record, and notes from a therapist, named Rita Stanoch, would also be added. [T. 450-51]. The ALJ held the Record open for ten (10) additional days for the submission of those records. [T. 451], The ALJ questioned the Plaintiff, who testified that she had a degree in Liberal Arts, [T. 452], and that she was not able to work for a variety of conditions, primarily because her emotions were “pretty out of control,” with “a lot of negativity, frustration, disappointments,” and emotional instability. Id. The Plaintiff testified that she had never been hospitalized, [T. 452], and had been seeing her current therapist for about six (6) months, and has been going to therapy since 1995, although she has “switched [therapists] quite a few times.” [T. 453]. The Plaintiff testified that she was currently not taking Celexa or Trazodone, but was taking medications for sinus infections, and Nasonex and Singulair, as well as Bupropion for depression, and Concerta, for ADHD, as prescribed by Dr. Lentz, but that she was not sure if the medications were helping, and she was dissatisfied with Dr. Lentz’s care. [T. 454-55], She also testified that she was very reliant on Ambien, [T. 458], but that it does not always work. [T. 459]. The Plaintiff testified that her ADHD causes her mind to work in “zigzag,” such that she gets lost, and sometimes requires more than two (2) hours at the grocery store, even when she has a list, and can feel overwhelmed at other stores as well. [T. 456-57], The Plaintiff testified she requires very strong antibiotics for her sinuses, [T. 463], and that her sinus infections are triggered by cold weather, being run down, and being near people, and that the antibiotics have weakened her immune system, [T. 464], which also prevents her from working. With respect to her daily activities, the Plaintiff testified that she tries to keep house, and that her daughter was very self-sufficient, [T. 457], and that she drives her daughter places, but is very inefficient, cannot remember what she is doing, gets confused and frustrated, and has to call her husband for assistance. [T. 458]. The Plaintiff related that she sometimes does laundry and cooking, but that her family helps a lot. Id. The Plaintiff testified that she bikes ten (10) miles daily, for half of the year, goes to church weekly, enjoys watching courtroom television shows, and enjoys reading “meaty” literature, but that she now she finds it difficult to stay focused on reading. [T. 459-60]. With respect to her work experience, the Plaintiff testified that her last gainful employment was with American Airlines, [T. 462], and that she had had approximately ten (10) different jobs since 1992, and did not leave any of them voluntarily. [T. 465]. With respect to her most recent job, the Plaintiff testified that she was fired after seeing a note, that was written by her supervisor, and that said that she did not get along with others, needed many instructions, could not keep concentration for long, and was high strung. [T. 465-66]. The Plaintiff testified that she would not be able to do customer service work, because she is always agitated, unable to stick with tasks, is not reliable, and has been that way since 2000. [T. 467], The Plaintiff testified that she has few friends, [T. 467], cannot sustain frequent contact with her family, [T. 468], and that people find her annoying. [T. 469]. The ALJ next examined Rutenbeck, and posed a hypothetical person, who is forty-five (45) years of age, with a college education, and the Plaintiffs work experience, who is on medications which cause side effects of some insomnia and irritability, and who is impaired with obesity, chronic sinusitis, depression, longstanding dysthymia, osteoarthritis of the knees, and ADHD, and who can lift 50 pounds occasionally, and 25 pounds frequently, who cannot work at heights or on ladders or scaffolds, and who must work in a low stress environment, with few distractions, low to moderate standards for production and pace, only incidental contacts with the public, and brief and superficial contacts with co-workers and supervisors, and with no exposure to temperature or humidity extremes. [T. 470-71]. Rutenbeck testified that the hypothetical person would not be able to perform any of the Plaintiffs past relevant work, [T. 471], but that, at the unskilled medium or light occupational level, the Plaintiff would be able to work as a cleaner, in an industrial setting, or as a housekeeper or maid. [T. 471-72]. The ALJ then posed another hypothetical, with a similar individual, but a person who would be overwhelmed at times, and have to leave work, and who would be absent from work more than two (2) days per month, and Rutenbeck testified that such an individual would not be able to work in the regional or national economy. [T. 472], Upon examination by the Plaintiffs attorney, Rutenbeck testified that the Plaintiff would not be able to work as a cleaner if she could not tolerate even minimal contact with others, [T. 472], or if she could not be exposed to any dust. [T. 473]. Upon reexamination by the ALJ, Rutenbeck testified that, if the Plaintiff could not be exposed to concentrated dust or fumes, then she could still work as a cleaner, but not if she could not tolerate any exposure. [T. 474]. In closing, the ALJ asked the Plaintiff if she had anything else to add, which the Plaintiff did not. [T. 475]. At the second Hearing, which was held on September 26, 2006, the Plaintiff also attended with her attorney, and Norman testified as the VE. [T. 440]. The Plaintiff made no objection to the Exhibits, [T. 442], but objected to Norman testifying, and asserted that Rutenbeck had answered all of the relevant questions. [T. 443]. The ALJ overruled the objection, and posed a hypothetical individual, who was forty-five (45) years old, with a college education, the Plaintiffs work experience, who was taking medications that cause some insomnia and irritability, and with the impairments of obesity, chronic sinusitis, depression, dysthymia, ADHD, and osteoarthritis of knees, who is limited to lifting 50 pounds occasionally, 25 pounds frequently, and who can perform all functional aspects of medium work, except work at heights, or on ladders or scaffolds, and who would need to work in a low stress environment, with few distractions, low to moderate standards for production and pace, with only incidental contact with the public, and brief and superficial contact with others, no exposure to temperature, humidity, and no concentrated exposure to dust fumes, chemicals, gases, odors or airborne irritants. [T. 444-45]. Norman testified that the individual could not do the Plaintiffs prior work, but could be a hospital cleaner, or a semiconductor lead tester. [T. 445]. The ALJ then posed a second hypothetical, with the same criteria, except that the individual could only be exposed to chemicals, fumes, and dust for less than one-sixth (1/6) of the day. [T. 445-46]. Norman testified that the individual would not be able to work at any jobs. [T. 446]. In addition, Norman testified that his testimony was based upon Dictionary of Occupational Titles (“DOT”), but that, to the extent that the DOT did not account for exposure to particles, he based his testimony on his experience over the last 25 years, and that he had placed individuals, with such limitations, in job positions. Id. The Plaintiffs attorney did not question Norman. [T. 447], B. Employment Records. The Plaintiffs earnings statement demonstrates that, from 1985 to 1989, the Plaintiff earned between $15,000 and $16,000 per year, which then dropped to approximately $8,000 in 1990, increased