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United States District Court, W.D. Pennsylvania
July 14, 2014
CAROL ANN SWARROW, Plaintiff,v.CAROLYN W. COLVIN, ACTING COMMISSIONER OF SOCIAL SECURITY, Defendant.
TERRENCE F. McVERRY, District Judge,
I. Introduction
Plaintiff, Carol Ann Swarrow, brought this action pursuant to 42 U.S.C. §§ 405(g) and 1383 (c)(3) for judicial review of the final determination of the Commissioner of Social Security ("Commissioner") which denied her application for disability insurance benefits ("DIB") and supplemental security income ("SSI") under Titles II and XVI of the Social Security Act ("Act"), 42 U.S.C. §§ 401-403, 1381-1383(f). The parties have filed cross-motions for summary judgment (ECF Nos. 11, 13). The record has been thoroughly developed at the administrative level. (ECF No. 9). Accordingly, the motions are ripe for disposition. For the following reasons, the Commissioner's motion will be GRANTED, and Plaintiff's motion will be DENIED.
II. Background
A. Procedural History
Plaintiff protectively filed applications for DIB and SSI on July 22, 2009, in which she claimed total disability as of April 14, 2005. An administrative hearing was held on July 11, 2011, before Administrative Law Judge ("ALJ") Leslie Perry-Dowdell. Plaintiff was represented by counsel and testified at the hearing. Dr. Cohen, an impartial vocational expert ("VE"), also testified at the hearing.
On October 14, 2011, the ALJ rendered an unfavorable decision to Plaintiff, in which she found that Plaintiff retained the ability to perform sedentary work with the following additional limitations:
The claimant is limited to simple, routine, repetitive tasks that do not require fast-paced production requirements. The claimant can make simple work related decisions and adapt to routine work place changes but must be isolated from the public and have only occasional supervision and contact with co-workers. The claimant needs to alternate sitting and standing and perform jobs that can be done while using a hand held device (only used for ambulating and not just standing in place). The claimant can occasionally climb stairs, ramps and ladders but not ropes or scaffolds. In addition, the claimant can perform occasional kneeling and crawling and frequent balancing, stooping and crouching.
(R. 24). The VE testified that given all of these factors, Plaintiff would still be able to perform the requirements of the following representative occupations: surveillance system monitor (50, 000 jobs nationally), inspector (50, 000 jobs nationally), or packer with a sit/stand option (75, 000 jobs nationally). (R. 28). Accordingly, the ALJ held that Plaintiff was not "disabled" within the meaning of the Act and denied her claims for benefits. (R. 28-29).
The ALJ's decision became the final decision of the Commissioner on May 29, 2013, when the Appeals Council denied Plaintiff's request to review the decision of the ALJ. On July 29, 2013, Plaintiff filed a Complaint in this Court seeking judicial review of the ALJ's decision. On November 12, 2013, these cross-motions for summary judgment followed.
B. Facts
Plaintiff was born on June 20, 1965. She has a twelfth-grade education and previously worked as a nurse's aide and as a laborer at a metal factory. She alleges disability as of April 14, 2005, primarily due to a cracked lumbar bone from a car accident and malignant tumors in her throat. Although she worked during the relevant period, the ALJ found that she has not engaged in substantial gainful activity since her alleged onset date. (R. 22).
1. Medical Evidence
Plaintiff's claim of disability was precipitated by injuries she sustained on April 14, 2005, when she was pushed out of a vehicle by her boyfriend and then hit by the vehicle.[1] Although she did not lose consciousness, she sustained a closed head injury, a cracked lumbar spine, and other minor injuries. (R. 237-38). Plaintiff's blood alcohol content at the time of the accident was.202. (R. 237-38). An MRI showed minimal degenerative changes and a mass on the right side of the neck. (R. 251). Plaintiff was hospitalized for two days following this incident, and although she appeared in a depressed mood, she was cooperative and pleasant with no suicidal or homicidal ideation, no hallucinations, and fair judgment. (R. 239). She was assigned a global assessment of functioning score ("GAF") of 55. (R. 239).
Several months later, Plaintiff underwent a thyroid ultrasound, which revealed an enlarged left thyroid lobe with a lesion. (R. 323). A thyroid scan was ordered, but Plaintiff never followed through with it. (R. 516).
On December 6, 2005, Plaintiff saw Dr. John Martin, her primary care physician, for a check-up. (R. 516). Plaintiff reported having pain in her right ear following the accident, for which she had been prescribed antibiotics. (R. 516). She made a number of other complaints, as well, including back pain and fibromyalgia. (R. 516). Upon examination, Dr. Martin found that Plaintiff was not in acute distress, but reported finding tenderness in her lower back. (R. 516-17). Dr. Martin diagnosed her with possible otitis externa, which is an inflammation of the outer ear or ear canal. (R. 517). He further noted that he was going to refer Plaintiff back to Dr. John Lee, whom she had been seeing for back pain, and advised her to stop smoking, since that aggravated her back problem. (R. 517).
On December 15, Plaintiff was seen by Dr. Vasu Malepati, upon referral from Dr. Martin. (R. 502). Plaintiff reported that her right ear felt blocked, with pain radiating down her neck and associated hearing loss. (R. 502). Upon examination, Dr. Malepati noted a right thyroid mass and advised her to continue medicating with antibiotics. (R. 502). Dr. Malepati also advised Plaintiff to undergo an otologic exam and thyroid evaluation. (R. 502). In January, Plaintiff underwent an ultrasound, the results of which reflected a large cold nodule on Plaintiff's left thyroid lobe. (R. 322). It could not be determined whether the nodule was malignant, however. (R. 322).
Dr. Lee again examined Plaintiff after she complained of back pain in December 2005. He reported that she had a limping gait, but found active reflexes, and generally no definite focal, motor, or sensory deficits. (R. 510-11). Therefore Dr. Lee recommended intensive home exercise coupled with hot showers and hydrotherapy. (R. 212).
Plaintiff followed up with Dr. Malepati regarding her thyroid mass on January 5, 2006. (R. 501). At this point, she had not yet undergone a thyroid scan. (R. 501). Dr. Malepati told her to return after such a scan was completed, noting that if the scan revealed a cold nodule, Plaintiff might need a thyroidectomy. (R. 501). Dr. Malepati also noted that Plaintiff's otitis eternal had healed well. (R. 501).
In February 2006, Plaintiff was admitted to Washington Hospital for chest pain, shortness of breath, and sweating. (R. 762). Before having been admitted, Plaintiff disclosed that she drank six beers that day. (R. 764). Plaintiff also reported to Dr. Howard Goldberg that she had failed to follow up with her doctors regarding the thyroid growths. (R. 226). Test results from Plaintiff's inpatient stay were unremarkable, and she denied suicidal and homicidal ideation. (R. 786, 801). After three days, Plaintiff was discharged, at which time she reported her pain as three out of ten. (R. 766).
In April 2006, Plaintiff followed up with Dr. Malepati, complaining of trouble breathing, pressure and sensation on the left side of her throat, and hoarseness. (R. 320). Dr. Malepati advised her to have a left hemi-thyroidectomy and a flexible laryngoscopy exam. (R. 499).
Plaintiff next saw Dr. Malepati on June 28, 2007, at which time she complained of a sore throat and difficulty swallowing. (R. 498). Following his examination, Dr. Malepati noted that Plaintiff's pharynx was red. (R. 498). He gave her a saline gargle and a Z-pack and again advised her to undergo a hemi-thyroidectomy if the symptoms persisted. (R. 498).
In December 2007, Plaintiff was admitted to Washington Hospital after she was punched by her ex-boyfriend. (R. 746). Plaintiff was depressed and displayed rib tenderness. (R. 748-49). X-rays revealed rib fractures. (R. 749). Plaintiff was prescribed pain medication and released. (R. 749, 756-58).
More than a year later, in April 2008, Plaintiff returned to Washington Hospital, after having taken an extra prescription Xanax. (R. 725). She also admitted to having consumed beers. (R. 725). She refused any drug or alcohol treatment and was released after denying suicidal or homicidal ideation and was released later the same day. (R. 732, 740-41).
One month later, Plaintiff returned to Washington Hospital. She reported having used alcohol and verbalized suicidal ideation in the emergency room. (R. 704). Plaintiff claimed to have attempted to harm herself, and had superficial lacerations on her arms as a result. (R. 704). However, she was sober the next day and discharged after again denying any suicidal or homicidal ideation. (R. 707, 713).
In April of 2009, Dr. Oscar Urea completed an Employability Assessment form for the Pennsylvania Department of Welfare, in which he indicated that Plaintiff was temporarily disabled from April 2, 2009, through July 31, 2009. Dr. Urea listed mood disorder, not otherwise specified, and alcohol dependence as the causes of Plaintiff's disability. (R. 264-65).
The next month, Plaintiff saw Dr. Goldberg. (R. 280). She reported feeling hoarse and experiencing neck pain, which "comes and goes." (R. 280). She also noted feeling fatigued. (R. 280). Dr. Goldberg assessed Plaintiff with a thyroid nodule of several years duration. (R. 283). He noted that she did not display any stigmata or hyper-or-hypo-thyroidism at the time, but she did have mild compressive symptoms. (R. 283). To further assess Plaintiff's condition, Dr. Goldberg ordered another ultrasound, after which he would schedule an ultrasound-guided fine needle aspiration of the lesion to determine if it was cancerous. (R. 284). The results of the ultrasound showed a large hypoechoic nodule in her left thyroid and a right thyroid lobe that was asymmetrically longer than the left. (R. 677). Based upon this visit, Dr. Goldberg completed a medical source statement regarding Plaintiff's claim and found that she had no limitations in lifting, carrying, standing and walking, sitting, pushing and pulling, or engaging in postural activities or other physical functions. (R. 278-79).
The following week, Plaintiff visited the hospital two days in a row reporting symptoms such as headache, diarrhea, and throat drainage. (R. 698). The first day Plaintiff left without being seen, and the second day was observed outside smoking three times before being discharged after declaring, "I need to go." (R. 683).
Plaintiff was seen at Monongahela Valley Hospital for neck pain and mild swelling in June 2009. At that time, her overall condition was described as "good, " and the report notes that Plaintiff denied any psychiatric symptoms. (R. 301). Later that month, she returned to Monongahela Valley Hospital with complaints of abdominal pain, nausea, and vomiting. (R. 289). She again denied any psychiatric symptoms. (R. 289). A CT scan showed fatty infiltration of the liver and fecal matter throughout Plaintiff's colon, but a chest X-ray was unremarkable. (R. 298-99). Plaintiff was given a prescription after she returned to Monongahela Valley Hospital complaining of abdominal pain, nausea, and vomiting. (R. 292).
Dr. Malepati completed an Employment Assessment Form for Plaintiff in July 2009, which stated that she was temporarily disabled from July 10, 2009, to July 10, 2010, due to her thyroid mass. (R. 327).
In July 2009, Plaintiff was referred to Dr. Robert Ferris in connection with her thyroid disorder. (R. 330). Dr. Ferris noted that even though Plaintiff had known about her left thyroid mass for three years and had previously been advised to have it removed, but she had just now indicated her willingness to go forward. (R. 330). Dr. Ferris performed an ultrasound-guided fine needle aspiration biopsy, which led him to suspect that Plaintiff had a large parathyroid adenoma (or tumor). (R. 330-32, 430).
In September 2009, Plaintiff was seen at Washington Hospital for prescription drug overdose combined with alcohol use, but denied any homicidal or suicidal ideation. (R. 651, 654, 662). Two weeks later, Plaintiff was readmitted to Washington Hospital with back pain which she rated as ten out of ten. (R. 632). She appeared depressed, but her gait appeared normal and she was discharged that day. (R. 634-36). That same week Plaintiff returned to Washington Hospital after being assaulted by her ex-boyfriend. (R. 626). She rated her pain eight out of ten and was found able to perform activities of daily living. (R. 626).
In October 2009, Dr. Ferris performed a left thyroid lobectomy and prescribed antibiotics for Plaintiff. (R. 352). Two days after the surgery, Dr. Kavita Kuchipudi found the incision from the surgery was healing well. (R. 336). At that time, Plaintiff denied any psychiatric symptoms. (R. 337).
A week later, Dr. Ferris reported that pathologic examination following the last procedure confirmed the presence of a variety of papillary thyroid carcinoma in Plaintiff's left lobe, along with inflammation which was caused by her surgery. (R. 365). Dr. Ferris scheduled Plaintiff for a completion right thyroid lobectomy, followed by radioactive iodine therapy, which was performed on November 24, 2009. (R. 358). When he discharged Plaintiff the next day, Dr. Ferris instructed her not to lift more than 10 pounds. (R. 402).
On December 22, 2009, Plaintiff saw Dr. Jill Sharer for a follow up to her thyroidectomy and for right knee pain. (R. 419-21). Dr. Sharer reported finding no edema or erythema in the right knee, but did report noticing popping sounds. (R. 419). Plaintiff was assessed with thyroid cancer and joint disease. (R. 471).
In January of 2010, Dr. Sharer again followed up on the thyroidectomy. (R. 469). At the time, Plaintiff complained of head congestion and ear pain. (R. 469). Plaintiff was diagnosed with pharyngitis, a swelling of the throat. (R. 471). At this point Plaintiff weighed 205 pounds, up from the 165 pounds she weighed on July 30, 2009. (R. 422, 439).
Shortly after her visit with Dr. Sharer, Plaintiff saw John Gibbons, M.D., for right knee pain. Plaintiff was walking with a stiff gait, and the doctor's impression was early osteoarthritis and a possible degenerative meniscus tear. (R. 472-73). As a result, Gibbons administered a shot of cortisone to the knee. (R. 473).
In March 2010, Plaintiff underwent an MRI that revealed arthritis and several partial ligament tears in her right knee. (R. 525). Plaintiff was still experiencing severe pain, so Dr. Gibbons administered another injection to the knee. (R. 525).
Plaintiff underwent another MRI in May 2010. (R. 537). The results showed a variety of damage to the right knee, including joint effusion, and a large cyst. (R. 537). The MRI results also showed mild inflammation, some healing of the partial tears of the MCL, degeneration, and mild degenerative changes. (R. 537).
Dr. Sharer examined Plaintiff later that month and found her right knee had extension issues and effusion. (R. 822). Plaintiff was also noted to be walking with a limp. (R. 822). After reviewing the results of an MRI, which revealed a lateral meniscus tear, Dr. Gibbons recommended that Plaintiff undergo an arthroscopic lateral meniscectomy on her right knee. (R. 521, 524).
A month later, Dr. Sharer examined Plaintiff and found she was still using crutches, but was now drinking in moderation. (R. 818). Dr. Sharer filled out another Employment Reassessment Form and checked the box for "permanently disabled." (R. 521). Dr. Sharer noted restrictions in daily activity, but not in Plaintiff's social functioning. (R. 530).
In August 2010, Plaintiff was told that she could walk without crutches. (R. 523). Her right knee incisions were healing well, and although there was moderate swelling, the knee could fully extend. (R. 523). That month, Dr. Sharer completed medical source statements, in which she listed Plaintiff's symptoms as difficult ambulation and joint pain, with a history of thyroid cancer and knee arthrosis. (R. 527-30). Dr. Sharer listed Plaintiff's work capacity as "None, " and said she could lift only ten pounds. (R. 527). Moreover, Dr. Sharer described Plaintiff's pain as moderate to severe. She also stated that Plaintiff could not engage in any work-related postural activities, and that she had a marked restriction of her daily activity. (R. 527-30).
Dr. Goldberg reexamined Plaintiff in September 2010 and found the incision from her surgery had healed well. (R. 532-33). Moreover, she exhibited no evidence of thyroid disease. (R. 532-33). At the same time, Plaintiff began four weeks of physical therapy for her right knee. (R. 540). She reported her pain was five out of ten, and her medical records demonstrate she had a good tolerance for the treatment. (R. 540). Dr. Gibbons reported some progress in the physical therapy; that the right knee was showing good tolerance for the treatment; that it had good extension; and that overall Plaintiff seemed to be getting better with therapy and was "walking pretty well." (R. 830). Two months later, Dr. Gibbons reported that Plaintiff was walking without a limp. (R. 829). In January 2011, Dr. Sharer found that Plaintiff's back was normal, with no abdominal tenderness. (R. 812-14).
The record ends with Dr. Gibbon's examination of Plaintiff in March 2011. (R. 828-47). Dr. Gibbons found tenderness, moderate degenerative changes, and pain from arthritis in Plaintiff's right knee. (R. 828). However, he found her motor and sensation functions were intact and that she could rotate her hip without discomfort. (R. 828). An MRI analyzed at the same time revealed mild stenosis and degenerative disc disease in the Plaintiff's back. (R. 834-37). Dr. Gibbons noted it was not a normal MRI, but that it "was not overly impressive, " and that Planitiff's back "does not look too bad." (R. 847). Plaintiff was given an epidural shot to address her complaint of pain. (R. 847).
2. Hearing Testimony
Plaintiff testified that she had to quit working because the pain became too unbearable for her to be on her feet. (R. 41). She testified that she could only stand for a period of 10 minutes before having to sit down, and then she could only sit for about 5 minutes before having to stand up again. (R. 41). According to Plaintiff, the pain was in her hands, back, legs, feet, and right knee. (R. 41-45). She also described feeling numbness in her hands. (R. 42). She testified that she had been walking with a cane for about a year, as prescribed by Dr. Gibbons. (R. 44). Plaintiff also testified that she was on pain medication. (R. 45).
When asked if there was anything else that limited her ability to do things, Plaintiff testified that "[a] lot of times if my thyroid level is off, they call it, it's just where you level is off, you feel like you're under water. You can't concentrate." (R. 43-44). She testified that she had her thyroid tested every three to four weeks. (R. 44). When asked if the tumor in her neck was limiting her ability to do things, Plaintiff replied, "No." (R. 44). The ALJ specifically asked Plaintiff if there was anything else which limited her ability to do things, but she spoke only of those three impairments. (R. 43).
On examination from her attorney, Plaintiff testified that she has not had a driver's license since 2002 because of pain. (R. 46). Plaintiff's attorney also prompted her to testify about psychological issues, which she described as anxiety, forgetfulness, and depression. (R. 47.) The symptoms of her depression were crying and a lack of energy. (R. 47). She also responded to her attorney that she had side effects of fatigue from her medication. (R. 48). Plaintiff testified that she likes to be alone, but that she has no other psychological conditions. (R. 50-51).
At the conclusion of counsel's examination of Plaintiff, she asked that the record stay open for additional records, and the ALJ agreed it would remain open for ten days. (R. 51).
At the conclusion of the hearing, Plaintiff's counsel requested that the ALJ consider whether Plaintiff met or equal the thyroid cancer Listing. (R. 57). She also requested that the ALJ consider ordering a consultative examination. (R. 57). The ALJ agreed to consider "all of that" and also kept the record open for 10 days to permit Plaintiff's counsel to submit any additional medical evidence. (R. 57).
III. Legal Analysis
A. Standard of Review
The Act limits judicial review of disability claims to the Commissioner's final decision. 42 U.S.C. §§ 405(g), 1383(c)(3). If the Commissioner's finding is supported by substantial evidence, it is conclusive and must be affirmed by the Court. 42 U.S.C. § 405(g); Rutherford v. Barnhart , 399 F.3d 546, 552 (3d Cir. 2005). The United States Supreme Court has defined "substantial evidence" as "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Richardson v. Perales , 402 U.S. 389, 400 (1971) (citation omitted). It consists of more than a scintilla of evidence, but less than a preponderance. Thomas v. Comm'r of Soc. Sec. , 625 F.3d 798, 800 (3d Cir. 2010) (citation omitted).
When a claimant files concurrent applications for SSI and DIB, courts have consistently addressed the issue of a claimant's disability in terms of meeting a single disability standard under the Act. See Sullivan v. Zebley , 493 U.S. 521, 525 n.3 (1990) (holding that regulations implementing the Title II [DBI] standard, and those implementing the Title XVI [SSI] standard are the same in all relevant aspects.); Burns v. Barnhart , 312 F.3d 113, 119 n.1 (3d Cir. 2002) (citing 20 C.F.R. § 416.920 with § 404.1520) ("This test [whether a person is disabled for purposes of qualifying for SSI] is the same as that for determining whether a person is disabled for purposes of receiving social security disability benefits [DIB]."); Morales v. Apfel , 225 F.3d 310, 315-16 (3d Cir. 2000) (stating that a claimant's burden of proving disability is the same for both DIB and SSI).
When resolving the issue of whether an adult claimant is or is not disabled, the Commissioner utilizes a five-step sequential evaluation. 20 C.F.R. §§ 404.1520 and 416.920. This process requires the Commissioner to consider, in sequence, whether a claimant (1) is working, (2) has a severe impairment, (3) has an impairment that meets or equals the requirements of a listed impairment, (4) can return to his or her past relevant work, and (5) if not, whether he or she can perform other work. See 42 U.S.C. § 404.1520; Newell v. Comm'r of Soc. Sec. , 347 F.3d 541, 545-46 (3d Cir. 2003) (quoting Burnett v. Comm'r of Soc. Sec. , 220 F.3d 112, 118-19 (3d Cir. 2000)).
To qualify for disability benefits under the Act, a claimant must demonstrate that there is some "medically determinable basis for an impairment that prevents him or her from engaging in any substantial gainful activity for a statutory twelve-month period." Fargnoli v. Massanari , 247 F.3d 34, 38-39 (3d Cir. 2001) (citation omitted); 42 U.S.C. § 423 (d)(1) (1982). This may be done in two ways: (1) by introducing medical evidence that the claimant is disabled per se because he or she suffers from one or more of a number of serious impairments delineated in 20 C.F.R. Regulations No. 4, Subpt. P, Appendix 1, see Heckler v. Campbell , 461 U.S. 458 (1983); Newell , 347 F.3d at 545-46; Jones v. Barnhart , 364 F.3d 501, 503 (3d Cir. 2004); or, (2) in the event that claimant suffers from a less severe impairment, by demonstrating that he or she is nevertheless unable to engage in "any other kind of substantial gainful work which exists in the national economy...." Campbell , 461 U.S. at 461 (citing 42 U.S.C. § 423 (d)(2)(A)).
In order to prove disability under the second method, a claimant must first demonstrate the existence of a medically determinable disability that precludes plaintiff from returning to his or her former job. Newell , 347 F.3d at 545-46; Jones , 364 F.3d at 503. Once it is shown that claimant is unable to resume his or her previous employment, the burden shifts to the Commissioner to prove that, given claimant's mental or physical limitations, age, education and work experience, he or she is able to perform substantial gainful activity in jobs available in the national economy. Rutherford , 399 F.3d at 551; Newell , 347 F.3d at 546; Jones , 364 F.3d at 503; Burns , 312 F.3d at 119.
Where a claimant has multiple impairments which may not individually reach the level of severity necessary to qualify for Listed Impairment status, the Commissioner nevertheless must consider all of the impairments in combination to determine whether, collectively, they meet or equal the severity of a Listed Impairment. Diaz v. Comm'r of Soc. Sec. , 577 F.3d 500, 502 (3d Cir. 2009); 42 U.S.C. § 423(d)(2)(C) ("in determining an individual's eligibility for benefits, the Secretary shall consider the combined effect of all of the individual's impairments without regard to whether any such impairment, if considered separately, would be of such severity").
B. Discussion
As set forth in the Act and applicable case law, this Court may not undertake a de novo review of the Commissioner's decision or re-weigh the evidence of record. Monsour Med. Cntr. v. Heckler , 806 F.2d 1185, 1190 (3rd Cir. 1986), cert. denied. , 482 U.S. 905 (1987). The Court must simply review the findings and conclusions of the ALJ to determine whether they are supported by substantial evidence. 42 U.S.C. § 405(g); Schaudeck v. Comm'r of Soc. Sec. , 181 F.3d 429, 431 (3d Cir. 1999). Plaintiff raises six arguments in support of her motion, which will be discussed seriatim .
1. The ALJ Did Not Err at Step 3 of the Sequential Evaluation.
Plaintiff contends that the ALJ erred by failing to consider whether Plaintiff met or equaled the following Listings at step 3 of the sequential evaluation: 1.04A (nerve and spinal disorders), 1.08 (soft tissue injuries), 12.02 (organic mental disorders), and 13.09 (malignant neoplastic diseases). The Court finds Plaintiff's argument to be without merit.
At Step 3 of the sequential evaluation, the ALJ must determine whether a claimant's impairment or impairments meet or equal any of the listed impairments. Burnett , 220 F.3d at 119 (citation omitted). The ALJ must, in turn, "adequately explain" why a claimant's impairment(s) do or do not satisfy the requirements of the Listings. Arroyo v. Comm'r of Soc. Sec. , 155 F.Appx. 605, 607 (3d Cir. 2005). In Burnett , the Court of Appeals "held that the ALJ's bare conclusory statement that an impairment did not match, or is not equivalent to, a listed impairment [is] insufficient" to satisfy this requirement. Jones , 364 F.3d at 504 (citing Burnett , 220 F.3d 119-20). However, the Court of Appeals has since made clear that " Burnett does not require the ALJ to use particular language or adhere to a particular format in conducting his analysis." Id. Rather, the primary purpose of this requirement is to guarantee that the reasons for the ALJ's decision are set forth clearly enough to enable "meaningful review" by the district court. Albury v. Comm'r of Soc. Sec. , 116 F.Appx. 328, 330 (3d Cir. 2004). Thus, ALJs are encouraged "to specifically identify the listed impairments under consideration, " so long as the district court is "able to discern the particular listed impairments considered... based on the ALJ's discussion of the relevant evidence and his related conclusion, " remand is not required. Arroyo, 155 F.Appx. at 608.
The ALJ's explanation meets that standard. Although she did not specifically identify or cite the listed impairments under consideration, it is clear from her discussion that she had considered the requirements of the Listings cited by Plaintiff's counsel in relation to the evidence presented. First, although the ALJ did not cite Listing 13.09, she discussed Plaintiff's thyroid cancer and noted that although she allegedly experiences hoarseness and hypothyroidism, she is in Stage I, has not had any lymph nodes removed, and the cancer has not been described as invasive. Additionally, the ALJ specifically noted that physical examinations and testing had been normal since her treatment began. (R. 23). Then the ALJ described Plaintiff's knee issues, but dismissed them because her gait, strength and range of motion are normal. (R. 23). From there, she moved on to discuss Plaintiff's closed head injury and complaints of numbness, but concluded that these issues have been resolved. (R. 23). Finally, the ALJ discussed Plaintiff's low back pain and determined that because she had a normal gait, strength, and sensation - and the fact that she was not undergoing treatment - such condition did not reach listing-level severity. The ALJ also considered whether Plaintiff's mental conditions met or equaled the severity of any of the Listed Impairments in § 12.00, but determined that neither the Paragraph B or C criteria were satisfied. Accordingly, based on the ALJ's thorough discussion of the alleged impairments, it is clear to the Court the listings which she was discussing and the basis upon which she determined that Plaintiff did not satisfy any of the Listings. Substantial evidence supports that decision.[2]
2. The ALJ Did Not Err in Having Failed to Obtain an Expert Opinion or Ordering a Consultative Examination.
Plaintiff next contends the ALJ erred by having failed to address her request for additional testimony from a Medical Expert to have determined whether Plaintiff met or equaled any of the Listings and her motions for a psychological and/or psychiatric consultative examination. The Court is unpersuaded by these contentions.
"Where the record as it exists at the time of the administrative hearing fairly raises the question or is inconclusive as to whether the claimant's impairment meets or equals a Listed Impairment, courts have held that a medical expert should evaluate the issue." Horne v. Comm'r of Soc. Sec. , No. 13-00226, 2014 WL 585927, at *6 (W.D. Pa. Feb. 14, 2014) (citing Maniaci v. Apfel, 27 F.Supp.2d 554, 557 (E.D. Pa. 1998); Diehl v. Barnhart , 357 F.Supp.2d 804, 815 (E.D. Pa. 2005); Lee v. Astrue , No. 06-5167, 2007 WL 1101281, at *4 (E.D. Pa. Apr. 12, 2007)). "However, an ALJ is not required to obtain an expert opinion as to whether an impairment meets or equals a listing and is fully competent to make an equivalency determination." Id. (citing Cordovi v. Barnhart , No. 04-3742, 2005 WL 3441222, at *6 (E.D. Pa. Dec. 14, 2005); Oakes v. Barnhart , 400 F.Supp.2d 766, 774-78 (E.D. Pa. 2005)).
The record before the ALJ in this case was thoroughly developed, as Plaintiff's impairments have been laid out at length in the medical documents which she provided to the ALJ for review. That evidence was more than sufficient to demonstrate that Plaintiff did not meet or equal any of the Listed Impairments. Accordingly, the Court concludes that because the record did not fairly raise the question of whether Plaintiff's impairments met or equaled a Listed Impairment, the ALJ did not err by failing to have obtained a medical expert opinion regarding that issue.
Plaintiff also takes issue with the ALJ's decision not to order a consultative exam to assess her mental abilities and limitations. However, the decision whether to order a consultative examination of the Plaintiff is totally within the discretion of the ALJ. Thompson v. Halter , 45 F.Appx. 146, 149 (3d Cir. 2002); 20 C.F.R. §§ 404.1517, 416.917. An "ALJ's duty to develop the record does not require a consultative examination unless the claimant establishes that such an examination is necessary to enable the ALJ to make the disability decision." Id. Conversely, where, as here, there is a clear basis already present in the record for the ALJ to find there is no severe mental impairment, additional testing is not necessary. See Rosa v. Colvin, 956 F.Supp.2d 617, 623 (E.D. Pa. 2013). Accordingly, Plaintiff's second argument fails.
3. The ALJ Did Not Err in Failing to Consider Plaintiff's Hearing loss, Obesity, and Pain as "Severe" Impairments at Step 2 of the Sequential Evaluation.
At step 2 of the sequential evaluation, the ALJ must determine whether a claimant suffers from a severe impairment. If the claimant fails to show that her impairment or combination of impairments are "severe, " she is not eligible for disability benefits. See Plummer v. Apfel , 186 F.3d 422, 428 (3d Cir. 1999). Step 2 sets the bar quite low. "An impairment or combination of impairments can be found not severe only if the evidence establishes a slight abnormality or a combination of slight abnormalities which have no more than a minimal effect on an individual's ability to work." Newell , 347 F.3d at 546 (citation and quotation marks omitted). In the instant matter, the ALJ determined that Plaintiff has the following "severe" impairments: "thyroid cancer, status post thyroid mass removal, degenerative disc disease of the lumbar spine, osteoarthritis of the right knee, post-surgical hypothyroidism, status post right knee meniscus repair, depression, status post closed head injury and history of drug and alcohol abuse." (R. 23). Plaintiff contends that the ALJ erred because she failed to also consider the following alleged impairments as "severe": hearing loss, obesity, and pain. The Court again cannot agree.
With regard to Plaintiff's first claim, there is no evidence that rationally establishes that Plaintiff experienced work-related functional limitations resulting from hearing loss. The only evidence in the record related to this alleged impairment is a medical record from 2001 indicating that Plaintiff suffered from moderately-to-moderately severe hearing loss in her right ear.[3] (R. 831). Moreover, Plaintiff did not address hearing problems at all during her hearing testimony, even when prompted by the ALJ to discuss if there was anything else that "limit[ed] her ability to do things." (R. 43). Plaintiff replied by speaking only about thyroid issues. Then Plaintiff's attorney questioned her about generally the same issues as the ALJ, without mentioning anything regarding hearing loss. Plaintiff concluded her testimony regarding physical symptoms by being asked, "Do you have any other physical problems?" (R. 50). Plaintiff responded, "No." (R. 50). The transcript from the hearing also reflects that Plaintiff was able to hear all of the ALJ's questions. Not once did she ask for her to repeat anything. Accordingly, this Court finds no reason to overturn the ALJ's determination that her alleged hearing loss was not a "severe" impairment.
Plaintiff also alleges that the ALJ violated S.S.R. 02-1p by not considering her obesity as a "severe" impairment. Under S.S.R. 02-1p, an ALJ is required to consider a claimant's obesity "at various points in the five-step analysis, " including at step 2.[4] Rutherford, 399 F.3d at 553. However, an ALJ's failure to do so does not automatically require a remand, especially where a claimant has not even cited obesity as a disabling impairment at the administrative level. Id. In such case, when an ALJ fails to specifically consider a claimant's obesity in rendering a decision, "remand is not required" unless consideration of the claimant's obesity would have "affect[ed] the outcome of the case." Id. (citing Skarbek v Barnhart , 390 F.3d 500 (7th Cir. 2004)).
As in Rutherford , Plaintiff never cited her obesity as a factor that contributed to her alleged inability to work. Even assuming that the record was sufficient to put the ALJ on notice of Plaintiff's obesity, [5] she has not articulated how consideration of her obesity would have altered the ALJ's analysis at any step of the sequential evaluation, let alone how her obesity was a "severe" impairment. Nor are there any medical records to document the effects of her alleged obesity. In any event, although the ALJ's decision did not reference the word "obese, " the restrictions the ALJ adopted in her RFC sufficiently accounted for most of the limitations that could be expected to arise due to obesity. See S.S.R. 02-1p, 2002 WL 34686281, at *6 (S.S.A. Sept. 12, 2002) ("An [obese] individual may have limitations in any of the exertional functions such as sitting, standing, walking, lifting, carrying, pushing, and pulling. It may also affect ability to do postural functions, such as climbing, balance, stooping, and crouching."). Therefore, the ALJ's failure to explicitly discuss Plaintiff's obesity or consider it a "severe" impairment does not warrant a remand.
Finally, Plaintiff argues that the ALJ erred by not considering the alleged pain caused by mild stenosis in her spine, degenerative disc disease, mild neuroforamen narrowing, osteophytes, and leg problems to be a "severe" impairment. This argument is untenable. Pain is considered a symptom, not an impairment. Compare S.S.R. 96-4p, 61 Fed. Reg. 34488 (July 2, 1996) ("A symptom' is not a medically determinable physical or mental impairment' and no symptom by itself can establish the existence of such an impairment.") with id. at 34489 ("An impairment' must result from anatomical, physiological, or psychological abnormalities that can be shown by medically acceptable clinical and laboratory diagnostic techniques."). Once an ALJ determines that a claimant has a medically determinable impairment that is likely to cause pain - e.g., degenerative disc disease, in Plaintiff's case - she must go on to evaluate the intensity and persistence of the pain along with the other objective medical evidence of record, when deciding whether the impairment is severe and when assessing a claimant's RFC. Id. ; Hartranft v. Apfel , 181 F.3d 358, 362 (3d Cir. 1999). Thus, Plaintiff's complaints of pain were properly considered later in the sequential evaluation when the ALJ determined Plaintiff's RFC. At that point, "[t]he ALJ has discretion to evaluate the credibility of a claimant and... arrive at an independent judgment, in light of medical findings and other evidence, regarding the true extent of the pain alleged." Haynes v. Astrue , No. 10-1049, 2011 WL 2112530, at *4 (W.D. Pa. May 26, 2011) (citations and quotation marks omitted). The ALJ did just that, noting that Plaintiff's "medically determinable impairments could reasonably be expected to cause the alleged symptoms" but ultimately finding that Plaintiff's statements "concerning the intensity, persistence and limiting effects of these symptoms are not credible." (R. 25). The ALJ did not, therefore, err in failing to find Plaintiff's alleged pain to be a "severe" impairment, in and of itself, or more generally in having considered the effects of Plaintiff's alleged pain in determining her RFC. Regardless, the ALJ's decision to include a sit/stand option in her RFC sufficiently accounted for any functional limitations that might arise from Plaintiff' alleged pain.
4. The ALJ Was Not Required to Specify the Frequency that Plaintiff Must Alternate Between Sitting and Standing.
Plaintiff contends the ALJ committed reversible error in not having definined the frequency that Plaintiff must alternate between sitting and standing. In her RFC assessment and hypothetical to the VE, the ALJ determined that Plaintiff needed to be able to alternate between sitting and standing at will throughout the workday. According to Plaintiff, that was insufficient because S.S.R. 96-9P requires that "the RFC assessment must be specific as to the frequency of the individuals need to alternate sitting and standing." S.S.R. 96-9P, 1996 WL 374185, at *7 (S.S.A. July 2, 1996). The Court does not agree.
Courts have "held that similar limitations to the RFC in this case have satisfied the specificity requirement in Ruling 96-9P, " even though they failed to specifically delineate the exact amount of time a claimant would need to switch between sitting and standing. McGinnis v. Comm'r of Soc. Sec. , No. 12-1395, 2013 WL 6710344, at *10 (W.D. Pa. Dec. 18, 2013) (citing Ketelboeter v. Astrue , 550 F.3d 620, 626 (7th Cir. 2008); Hodge v. Barnhart , 76 F.Appx. 797, 800 (9th Cir. 2003)). If anything, allowing Plaintiff to change positions "at will" provided Plaintiff with "broad flexibility and thus has a more restrictive effect on the jobs available to [her] than the limitation [she] thinks the ALJ should have described." Ketelboeter , 550 F.3d at 626.[6]
5. The ALJ's Hypothetical Question Properly Incorporated All of Plaintiff's Credibly Established Impairments.
Relying on Podedworny v. Harris , 745 F.2d 210 (3d Cir. 1984), Plaintiff next contends that the case should be remanded because the hypothetical question the ALJ posed to the VE failed to include "all of her impairments."[7] This argument is without merit.
The Court of Appeals has cautioned that the portion of Podedworny on which Plaintiff relies "should not be misunderstood." Rutherford , 399 F.3d at 554. Notwithstanding the decision's seemingly strong language, an ALJ is not required to submit a hypothetical to the VE encompassing "every impairment alleged by a claimant." Id. (emphasis in original). Rather, "references to all impairments encompass only those that are medically established. And that in turn means that the ALJ must accurately convey to the vocational expert all of a claimant's credibly established limitations ." Id. (citing Plummer , 186 F.3d at 431) (emphasis in original). The Court of Appeals has set forth clear guidance as to when a limitation is credibly established:
Limitations that are medically supported and otherwise uncontroverted in the record, but that are not included in the hypothetical question posed to the expert, preclude reliance on the expert's response. Relatedly, the ALJ may not substitute his or her own expertise to refute such record evidence. Limitations that are medically supported but are also contradicted by other evidence in the record may or may not be found credible - the ALJ can choose to credit portions of the existing evidence but cannot reject evidence for no reason or for the wrong reason. Finally, limitations that are asserted by the claimant but that lack objective medical support may possibly be considered nonetheless credible. In that respect the ALJ can reject such a limitation if there is conflicting evidence in the record, but should not reject a claimed symptom that is related to an impairment and is consistent with the medical record simply because there is no objective medical evidence to support it.
Id. at 554 (citations and quotation marks omitted).
Plaintiff identifies several impairments that the ALJ allegedly improperly disregarded in the hypothetical which she he submitted to the VE: the side effects of her medications and treatment, fatigue, obesity, her inability to carry things because of numbness in her hands, her hearing loss, and her pain. The Court has already concluded that the ALJ did not err in addressing Plaintiff's obesity, hearing loss, and subjective complaints of pain. Insofar as the ALJ determined that these impairments were not credibly established, she did not have to include them in the hypothetical she posed to the VE. The same is true with regard to the other limitations Plaintiff has identified.
First, Plaintiff has not identified any medical evidence suggesting that the purported side effects from her medication and treatment resulted in "serious functional limitations." Burns v. Barnhart , 312 F.3d 113, 131 (3d Cir. 2002). Plaintiff did testify, upon questioning from her attorney, that "sometimes the Synthroid" renders her unable to concentrate and makes her feel as though she is under water. (R. 48). However, on direct examination from the ALJ, she testified, "[a] lot of times if my thyroid level is off, they call it, it's just where your level is off, you feel like you're under water. You can't concentrate." (R. 44). So when she was supposedly describing the side effects of her medication, she appears to have actually been describing the effects of her hypothyroidism, generally - an impairment that the ALJ certainly took into consideration in crafting her RFC assessment. In any event, since the ALJ's RFC assessment limited Plaintiff to jobs involving "simple, routine, repetitive tasks that do not require fast-paced production requirements, " (R. 24), it sufficiently accommodated the side effects allegedly caused by her medication.
Second, although the ALJ expressly noted that Plaintiff complained of fatigue, she found that Plaintiff's statements regarding "the intensity, persistence and limiting effects" of this symptom, along with Plaintiff's other alleged symptoms, were not credible. (R. 26). As was the case with the ALJ's analysis of Plaintiff's subjective complaints of pain, the ALJ's decision in this respect was supported by substantial evidence. None of Plaintiff's physicians documented serious complaints of fatigue. The only evidence to support this point is Plaintiff's own testimony, and even that does not fully support her argument that her fatigue precluded her from working. In response to questioning from her attorney, she defined "fatigue" as feeling "[j]umpy, nervous." (R. 47). And although she testified that she only slept two hours a night, she did not require naps during the day to make up for her alleged lack of sleep. (R. 48). In sum, the ALJ did not err in failing to incorporate fatigue into her RFC.
Third, the ALJ expressly acknowledged that Plaintiff experienced numbness in her hands, but decided not to credit Plaintiff's testimony about the debilitating effects of this symptom. This credibility judgment will not be disturbed. Even if the ALJ had credited this testimony, the outcome would have been the same. When the ALJ asked the VE if his response to the hypothetical would change if the hypothetical individual was restricted to gross manipulation and fine manipulation, on account of numbness in her hands, the VE testified that the individual could still perform sedentary guard jobs, of which there are more than 50, 000 in the national economy. (R. 54-55). Courts have "held that a relatively small number of positions, as low as 1, 400 jobs, can qualify as significant." Lawrence v. Astrue , 337 F.Appx. 579, 586 (7th Cir. 2009) (citing Lee v. Sullivan , 988 F.2d 789, 794 (7th Cir. 1993)). Accordingly, assuming that the ALJ erred in addressing Plaintiff's complaints of numbness, the error was harmless, and remand is not necessary.
6. The ALJ Properly Relied On the VE's In Determining Whether Jobs Are Available For Persons Requiring A Sit-Stand Option.
Lastly, Plaintiff contends "the ALJ erroneously relied on the Vocational Expert testifying about the number of jobs available with sit/stand options, since the Dictionary of Occupational Titles does not address any sit/stand options." Pl.'s Br. In Supp. of Mot. for Summ. J. at 30 (ECF No. 14). Plaintiff's four-sentence "argument, " however, never explains why it was an error for the ALJ to rely on the vocational expert's testimony. Nor can the Court make any such determination on its own. In fact, Plaintiff seems to ignore that in situations where an ALJ must decide whether a claimant can still work despite her need for a sit/stand accommodation, the S.S.A. instructs that "it may be especially useful to" consult with a vocational expert, notwithstanding the fact that the DOT does not address the sit/stand option. S.S.R. 96-9P, WL 374185, at *7. Insofar as Plaintiff is insinuating that the VE's testimony is somehow unreliable because it is in conflict with the DOT, which says nothing about sit/stand options, this argument fails:
contrary to Plaintiff's arguments, the information [provided by Dr. Cohen] and DOT in no way conflict. As a vocational expert, [Dr. Cohen] was qualified based on her education, training and experience to opine about the employment market. Plaintiff never contested these qualifications. Further, SSR 00-4P does not limit a vocational expert's opinion solely to DOT. The explanation provided by [the expert] regarding the availability of the sit/stand/walk option is therefore reasonable and the ALJ did not err by relying on it.
Cathcart v. Astrue , No. 08-00266, 2010 WL 1054049, at *17 (W.D. Pa. Mar. 22, 2010). The Court is persuaded by such reasoning, and finds that Plaintiff's argument with regard to the VE's testimony has no merit.
IV. Conclusion
It is undeniable that Plaintiff has a number of impairments, and this Court is sympathetic and aware of the challenges which Plaintiff faces in seeking gainful employment. Under the applicable standards of review and the current state of the record, however, the Court must defer to the reasonable findings of the ALJ and her conclusion that Plaintiff is not disabled within the meaning of the Social Security Act, and that she is able to perform a wide range of work present in significant numbers in the national economy.
For these reasons, the Court will GRANT the Motion for Summary Judgment filed by the Commissioner and DENY the Motion for Summary Judgment filed by Plaintiff. An appropriate Order follows.
AND NOW, this 14th day of July, 2014, in accordance with the foregoing Memorandum Opinion, it is hereby ORDERED, ADJUDGED, and DECREED that Plaintiff's Motion for Summary Judgment (ECF No. 13) is DENIED and Defendant's Motion for Summary Judgment (ECF No. 11) is GRANTED. The clerk shall docket this case CLOSED.
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|Substituted iminoacid derivatives, process for preparing them and their use as enzyme inhibitors
|Bicyclic imino acids, particularly 2-carboxylic acid derivatives of azabicycloalkanes and process for preparing them. These compounds have therapeutical activity and may be used as medicines, particularly as cardiovascular and antihypertensive drugs in human or veterinary medicine.
|Vincent; Michel (Bagneux, FR), Remond; Georges (Versailles, FR), Laubie; Michel (Vaucresson, FR)
|Science Union et Cie (Suresnes, FR)
|Filing Date:
|Dec 03, 1980
|Application Number:
|1. A compound selected from the group consisting of bicyclic iminoacids of the formula I ##STR6## wherein A, m, and n are selected to provide a perhydroquinoline or perhydroisoquinoline ring system,
q represents 0 or the number 1 or 2,
R is hydrogen, methyl, or benzyl,
R.sub.1 is hydrogen or lower-alkyl of no more than 5 carbon atoms,
R.sub.2 is hydroxyl or lower-alkoxy of no more than 5 carbon atoms, and
Z is carboxyl, cyano, hydroxyl, sulfhydryl, or amino, in racemic or optically-active form, and pharmaceutically-acceptable addition salts thereof, when R.sub.2 is hydroxy with a mineral or organic base and, when Z is amino, with an acid.
2. 2-[3-Mercapto-2-(RS)-me thylpropionyl]-cis-perhydroisoquinoline-3-carboxylic acid.
3. 1-(3-mercapto-2-(RS)-methylpropionyl)-2-(RS)-carboxyperhydroquinoline.
4. Pharmaceutical composition, useful for treatment of high blood pressure and cardiac failure, containing as active ingredient a compound of claim 1 in admixture or conjunction with an inert, non-toxic, therapeutically-compatible carrier or vehicle.
5. A pharmaceutical composition as claimed in claim 4 in which the carrier is adapted for oral, parenteral, or rectal administration.
6. A pharmaceutical composition as claimed in claim 4 containing the active principle at the dose of 25 to 250 mg.
7. A method of treating high blood pressure and cardiac failure in a subject, which consists in administering to said subject an effective amount of a compound of claim 1 or a salt thereof together with a therapeutically suitable carrier.
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Top 5 Country Songs About Football
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text:
Pegasus lists
Horse Power0
Equine comic book heroes and villains
Greek Mythology in comics1
This is a list of greek mythological characters and also of character influenced by greek legends. (It will be updated constantly)
Olympian Myth of Marvel0
Marvel Comics Character Names start with a letter "P" 0
306. need to collect more characters soon. Goal is 400 if there is any existence of those characters with a name starts with a P.Paint, Paradise, Pig, Nemesio Petri, Posterboy, Rowden Piper
My Little Pony0
Here There Be Monsters0
Heroes and villains draw their names from a number of sources and this list honors those who pick their aliases from the mythical bestiaries of the world.If anybody thinks of anymore, let me know.
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- Health Needs for Bi Men
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Health Centers About to Go High Tech
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text:
Haha just thought of a greeeeeaaat idea!
last edited by 0
Actually I've played around with this for years in my mind and it's not a novel concept. It's just not used as often as it should be!
Let's use Hamtaro actually because he's the perfect, stereo-typically innocuous paragon of child-like exuberance that I'm looking for. Replace his voice with a much deeper voice such as the voice of the narrator for Forensic Files or, better yet, the voice on Law & Order that says, "In the criminal justice system.." (Blah blah blah Law & Order sucks!).
Can you feel it now? Keep all of Hammy Ham's lines the same and we've got some funny moments.


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September 25, 2006
UNITED STATES OF AMERICAv.SHAHAWAR MATIN SIRAJ, DEFENDANT.
On April 24, 2006, I granted the government's in limine motion, made by letter dated April 20, 2006, and opposed by a defense letter of the same date, to preclude the defense from cross-examining the confidential informant, Osama Eldawoody, on certain topics, specifically, his 1993 divorce and an extramarital affair. In addition, I denied the defense's request for more information regarding the witness's 1993 divorce proceedings. After my rulings, I indicated that I would put my reasons on the record at a later time, and I do so now.
To begin with, I found that, under the relevant case law, and the discretion afforded me by Rule 608 of the Federal Rules of Evidence, neither topic was probative of the witness's truthfulness or untruthfulness at the trial. I further found, applying Rules 611 and 403, that, even if the topics had any probative value, which in my view they did not, the prejudicial impact of such topics on the jury would clearly outweigh it. See, for example, United States v. Gotti, No. S8 02-CR-743, 2005 WL 1214321 (S.D.N.Y. May 19, 2005). See also United States v. Ndiaye, 434 F.3d 1270, 1289-90 (11th Cir. 2006). As Mueller & Kirkpatrick conclude, the Rule 608 cases are "on strong ground when they disapprove questions about sexual relationships . . . ." C. MUELLER & L. KIRKPATRICK, 3 FEDERAL EVIDENCE § 264, 165 (2d ed. 1994).
In light of the significance of the witness, I gave no weight to whether the witness would be embarrassed by the cross-examination. I was concerned only with assuring that the jury not be inflamed by irrelevant matters. I was also cognizant of the fact that the defense had numerous relevant avenues of cross-examination to pursue, and indeed the trial confirmed that the defense made ample use of these opportunities. See United States v. Scarpa, 913 F.2d 993, 1018 (2d Cir. 1990). Therefore, I concluded, and continue to conclude, that the limitations which I imposed did not remotely restrict the defendant's rights to confront the witness.
NINA GERSHON United States District Judge
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Our rescue will be at the Palo Alto Pet Food Express Saturday, October 22nd from 1-4pm and Sunday, October 23rd from 12-3pm. All of our dogs are spayed/neutered, shots current (DHPP, Bordetella and Rabies where applicable), dewormed, flea and tick treated and microchipped.
* If you are interested in a dog, please first read the biography on the dog (keep scrolling down for the bio!) and then go to our website, www.dpsrescue.com for an application. * We do not have a facility. All dogs live in foster homes. Arrangements to meet dogs occur after an approved application has been accepted. * We do not ship our dogs for any reason. * Our adoption fee is $400 for each dog/puppy. * If it is on a weekend of our adoptions, follow us on @DPSRescue on Twitter to get real time updates on our adoptions. We will also post at the end of the evening the names of those dogs who have been adopted: www.facebook.com/DPSRescue
This dog will be at Palo Alto Pet Food Express on Saturday, October 22nd from 1-4pm and Sunday, October 23rd from 12-3pm or until adopted. However, we do meet with those who submit an application and are approved just prior to the event (by invitation only) and they are given the first opportunity to adopt. If you are interested in one of our dogs, we recommend filling out an application prior to the event to be considered. Applications submitted within 24 hours of the event may not necessarily be reviewed.
Karma is a 2 year old Shiba mix who we rescued off the meat trucks of Korea. She weighs just over 30 lbs. Karma is a happy go lucky gal who is more people centered than dog centered, as is typical of the Shiba breed. She is definitely playful, more so with people but she does play well with other dogs. Karma can be bossy with her pup friends and play time is on her terms! She will need further training on sharing toys and her tendency to let other dogs know that they need to leave her along when she's got a toy, bone or food.
Karma loves to cuddle with people, and she will go belly up and invite a rub down at any time. She is happy to see you when you get home or if you've been gone gone for a few minutes!
Her foster mom notes that she will need some time to warm up to anyone and is definitely adjusting to being in a new country! What a big change so she will need time to adjust but she's very sweet and loving and just needs someone to dedicate their time to making her feel at home! She says, "Karma is a transplant from Korea so I think this gives someone a wonderful opportunity to bring her into a new world filled with love and support. Karma has a bright future and has been soaking up all of the TLC since she got here and is already adapting so well and developing her own little personality with the new addition of nurturing and support from her foster. Karma is a well behaved, loyal dog who is looking for a loving/patient person to take her in and help her morph into her best puppy self!"
Karma is an option for a home that has had a dog in the last 5 years. If there are children in the home, they will need to be over the age of 10.
**Not all of our dogs go to each adoption event. We want to make sure if you are interested in a dog that we have the dog at adoptions but that can only happen if you fill out an application ahead of time and are pre-approved. (Generally this must happen prior to the weekend)
**If you are wanting to submit an application within 24 hours of an event, please print off the application and bring with you as well as submitting it. You may still submit it and if time and volunteers permit, we will contact you. Most applications submitted the weekend of adoptions are not responded to until after the adoption weekend.
Top Reviews
Very adorable! i really wish to adopt!
Melanie Farris


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|Answers (10)
Symbian Anna is the name for Symbian^3 PR2 (and PR means product release).
Symbian Belle is the name of the next update, and is a considerablylarger update than Anna, with lotsof UI changes.
Both use the same Symbian operating system, although Belle will have more updates. Most applications should be able to runon Symbian^3, Symbian Anna andSymbian Belle phones.
Symbian Anna can be updated on existing Symbian^3 phones such as the Nokia N8.
Symbian Belle can also be updatedon Symbian^3 and Symbian Anna phones.
Posted: 29-05-2012 @ 12:30:47
Symbian Anna offers an attractive new icondesign and font, a better web browser plus updates toother Nokia services, a portrait-style QWERTY keyboard and split-screen text entry whereas Symbian Belle offers a doubling of the number of homescreens you can work with, the introduction of moreflexible homescreen widgets in several different sizes, a wide range of NFC capabilities (though that will of course rely on your phoneitself being NFC-enabled, which of the current range only the Nokia C7 is), a new status bar which takes a neat drop-down approach to notifications, dynamic real-time multitasking previews and a lock screen that shows additional detail, such as incoming messages and missed calls
Posted: 30-09-2011 @ 17:03:04
Symbian Belle is the on-board Symbian^3 release on 701 while Nokia C7 has the Symbian Anna. Update to Belle is Q4 this year.
Nokia 701 has 1GHz CPU, 512MB RAM – Nokia C7 has 680MHz CPU, 256MB RAM
Nokia 701 uses LED backlit IPS display with Clear Black Display, the brightest – Nokia C7 uses AMOLED display all at 3.5″
701 has HSDPA 14.4 Mbps HSUPA 5.76 Mbps – C7 has HSDPA 10.2 Mbps HSUPA 2.0 Mbps
Posted: 02-09-2011 @ 17:57:28
Alright in reality, Symbian^3 isn't that bad of an OS; it's extremely practical, but there is hardly any eye candy. I'm running it on my N8. Symbian Anna is a faster S^3 with more eye candy. Go with Symbian Anna, and soon enough you will be able to upgrade to Symbian Belle (so says Nokia), which looks to be downright fantastic!
The only reason I would get Android would be to cover its UI with SPB Shell 3D, which is not yet available for Symbian.
Posted: 02-09-2011 @ 17:07:33
I am using belle on my N8 and frm my experience i can tell you belle is far beyond any symbian os till date. Its lot more user friendly and intuitive. Customizable home screen icons, better feed back of touch screen and most importantly a great browser(nokia 7.4.22).
Posted: 02-09-2011 @ 15:04:46
Firstly, it differs in the User Interface. The new symbian Belle will have widget supports and lots of changes are there in the homescreen and it more likely resembles the HTC homescreens whereas symbian Anna is having the old user interface of symbian phones. Secondly, symbian Belle phones are equiped with NFC(Near Field Communication) whereas symbian phones are providing with bluetooth.
Posted: 01-09-2011 @ 23:43:55
Symbian anna is the latest operating system of nokia smart phones. Symbian Anna and Belle are updates to Symbian^3. Symbian anna is the currently running update to symbian version 3 phones. Here symbian anna refers to Symbian^3 PR2 where pr is nothing but product revision 2. Symbian Anna is now available for update for current Symbian^3 phones like N8, C7, C6-01, E7, X7, E6. Now symbian Belle will be the update to symbian anna and will be in the market later. Belle will incorporate lots of updates like improved user interface and better processing capabilities compared to anna os. Other nokia os are
meego which is run on nokia n9 and there is windows7 smartphone launched by joining hands with microsoft. The phones have not been launched yet but when they will be launched it will mark the exit of nokia from symbian os.
Posted: 01-09-2011 @ 23:00:45
Symbian Anna is the name for Symbian^3 PR2. Here pr refers to product code 2. We already have lots of symbian version 3 phones available like nokia 5230, nokia n8. Anna is the next update to this list and features mobiles like nokia c7, e7, etc. On the other hand symbian belle is the update to symbian anna. Phones have not been launched yet with belle but when it is launched there will be lot of UI changes. A great deal of updates will be on the list for symbian belle. Other os by nokia are meego which is run on nokia n9 and the windows7 phone which have not been launched yet and when launched will mark the exit of nokia from symbian operating system.Symbian Anna can be updated on existing Symbian^3 phones such as the Nokia n8 on the air or by using nokia pc suite. Fancy names such as these for software updates are quite popular like the android ginger bread,honey comb and the latest ice cream sandwich.
Posted: 01-09-2011 @ 22:51:01
symbian belle is the latest os which introduce first in 3 mobiles, nokia 600,700,701.It provide better speed.Icons are chaged into round shape.
Posted: 01-09-2011 @ 21:20:20
Symbian Belle follows on from Symbian Anna in the same way belle follows the anna and both are an update built on top of the Symbian^3 operating system, which we first saw when the Nokia N8 launched towards the end of 2010.
Posted: 01-09-2011 @ 16:50:15


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Diner Rating and ReviewsBack to detail
Based on 2 reviews
Popular with the IT and student crowd from the Koregaon Park area, Punjabi Rasoi is a safe option for dependable North Indian food at affordable prices. The Kadhai Paneer, Pudina Chicken, Afghani Chicken and Palak Mutton rise to the occasion. Other safe options include Dal Makhni, Shahi Paneer and Paneer Bhurji. An Amritsari Thali is also served here. Some other dishes worth a mention are Beliram Paneer, Chicken Adraki, Chicken Lahsuni, Paneer Adraki and Paneer Lahsuni. Its a good place for an economical place.
What awesome time I and my friends had this weekend at the Punajbi Rasoi! The raw interior and the superb food option can anyone ask more than this? At least I can't. The Amritsari Thali, Chicken Lahsuni and Butter Chicken entice the soul. I had great time thanks to all my crazy friends and the food and service of Punjabi Rasoi. It seems I will be seen in this restaurant more and more with passing days..


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Recap: yuvi's friend got to know about twinkle
Taneja house,
Leela was very happy and called everyone.
All were confused and listened.
Leela has obtained a very important contract. This contract would have a great impact on her business as through this she would be able to operate at an international level.
For some procedures, she has to go to Pune.
She decided to go by road. (I know she could take the plane but you will get the reason afterwards)
She was leaving in 2 days. She wanted to talk to twinkle if she would want to come with her.
Twinkle arrived a bit later as they had an extra class.
When she arrived, leela talked to her ask her if she would accompany her.
Twinkle:"but maa, college and everything?"
Leela:"i will talk to them"
Twinkle:"and who would take care of the house when you are not here. Remember i am in charge of the house when you go out"
Leela:"when dis i say this?"
Twinkle:"when i was 10″
Leela laughed:"do you still remember?"
Twinkle nodded yes.
Leela:"ok, if you want to stay then ok"
They chat for a while then leela went to do the arrangements.
Next day,
Assessment day,
All students were worried about the test. No one had a happy face.
The teacher handed them the papers, the clock is shown it was 9:00. Their test finished an hour later.
When they got out of the class, all were discussing about the test.
Rohan, chinki and twiraj too.
Twinkle:"that test was…"
Rohan:"agree, yaar"
Yuvi:"come on guys, it already done now"
Rohan:"yuvi, yaar you, you are never afraid or tensed about any test"
Yuvi:"because i have already done now we can't change it"
By the afternoon, the teacher had already corrected the papers and left the students quite shocked as no teacher hand them that paper on the same day.
They all got their papers. Rohan, chinki and twinkle got good marks. (Around 70 over 100)
They all asked yuvi's marks. Twinkle saw his marks(yuvi was the first one with 90 over 100)
Rohan:"yaar yuvi, how do you manage to get all these good no excellent marks"
Yuvi:"i just…" (He put his hand on his chin as if thinking something)
Yuvi continued:"by studying and revising"
Twinkle:"how i wished i get such excellent marks!!"
Rohan and chinki congratulate him. Twinkle just kissed him.
After college they went home as they were all tired by the test.
Luthras house,
Anita was already at home talking to Malhotra family.
Yuvi entered and saw all of them talking and laughing.
Yuvi:"family time without me, soo unfair mom."
He dropped his bag on one couch and went next to sana.
Sana side hug him.
Sana:"how was your test?"
They talked for a while.
After dinner Anita called yuvi in her room.
They talked but all muted. (Will reveal it later on)
Next morning,
Leela was leaving for Pune today. She was leaving early in the morning.
Twinkle woke up very early (it was the first time she woke up so early-she was the first one to wake up)
She wanted to prepare the breakfast for her mom. She tried to make it.
After sometimes everyone woke up. They noticed breakfast already on the table and twinkle who was putting the plates.
Leela:"twinkle what is all this?"
Twinkle:"mom i prepared breakfast for you"
They sat down and tasted it. They all made weird faces but try to cover it. Everyone quickly ate the food.
Twinkle,surprised:"you all liked it soo much"
All nodded yes.
Twinkle:"ok now i will also taste"
Everyone try to stop her but she already ate a bite.
She felt the taste horrible.
Twinkle:"why did you all eat this? It's horrible"
Everyone smiled at her.
Twinkle:"i am zero at cooking"
Leela:"i will prepare something for you."
She went to the kitchen and saw it all messed up and servants cleaning it.
Leela:"pagal ladki"
After a proper breakfast, leela left for Pune.
Twinkle texted yuvi. She asked him if he could pick her up.
Yuvi texted her back:"sorry baby, I can't. Mom sent me out of station for some work. Really sorry and yeah i will come late in the night. There is no much network on the highway, i will call you once i reach. Love you"
Twinkle:"couldn't he say it to me"
She texted him back:"ok, take care. And do call or you will face the tigress at your return. And love you too."
Yuvi:"no i will have to call you back, I don't want to face the tigress"
Twinkle smiled and then say:"ok twinkle, no mom, no yuvi! What will you do now?
I will go to college by myself!"
And she got up to get ready.
Hey guyz hope you like it
Sorry for the mistake
Thank you for all your support
Credit to: Zai


text:
PUNJAB NATIONAL BANK RTGS HO Branch in MIRAN SAHIB (J&K) - Address, IFSC, MICR Code
PUNB0338800MICR Code
MIRAN SAHIBContact
DISTT. JAMMU (J&K)City
MIRAN SAHIB (J&K)District
MIRAN SAHIB (J&K)State
What is IFSC Code of PUNJAB NATIONAL BANK situated at MIRAN SAHIB- RTGS-HO?
IFSC Code of PUNJAB NATIONAL BANK situated at MIRAN SAHIB - RTGS-HO is
What is the meaning of IFSC Code, MICR Codes in Banking industry?
IFSC or Indian Financial System Code is the code allocated to all banks branches. Bank branches use this code to participate in RTGS and NEFT transactions.
What is the significance of IFSC Code and how we can use it?
IFSC Code is a 11 digit code and we can use this code to communicate between different branches of different banks. Upon receiving the request for fund transfer it is easy for a bank to identify the payee branch. First four characters are code of bank, last six digits are branch code and fifth character is left 0, for any future use.


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Pjur Cult for Latex 100 ml. Fetish fashion sometimes has its difficulties. And is that sheathing be all those clothes tight not always is a task simple. Pjur Cult helps you to dress yourself in minutes
16 item in stock items in stock
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Pjur Cult 100 ml
So far the most common was to use powders that leave you the body as a baby's bottom. Now prepare for a fetish session It is something more exciting from the minute zero thanks to products like Pjur Cult.
It's a liquid to dress in which no latex or rubber garment you resist. Is much more comfortable because with just apply a small amount of product you will notice how the tissue is much more slippery and are slides best by your skin even if have enough hair.
With help of this liquid to dress you will take not more than a few minutes to Ponte your garments of rubber and latex and be ready for the action.
Amount of the container: 100 ml
|Fetish and Scene
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|15 cm
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|4 cm
|Long box
|4 cm
|Box weight
|0.15 Kg
|Totally safe packing
|Unmarked package


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Download apps, toolboxes, and other File Exchange content using Add-On Explorer in MATLAB.
Join the 15-year community celebration.
Play games and win prizes!
Rate this file 10 Downloads (last 30 days) File Size: 2.03 KB File ID: #44247 Version: 1.0
Basic Three Image Stitching Code
08 Nov 2013
This is a basic code which tells how 3 images, displaced in X direction, can be stitched.


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We provide affordable housing for individuals and families in Arizona, we operate residential behavioral health group homes, and we train and monitor sponsors of the Adult Foster Care and Adult Behavioral Health Therapeutic Home programs.
Our three food pantries provide 375,000 pounds of food to needy families in Peoria, Wickenburg and Williams. We also serve or deliver almost 800 meals to Arizonans every day.
We enhance independence for Arizonans age 3 to 103 with our home- and community-based services, including adult day health, home care and home health care services.
We educate clients, caregivers and members of the community in order to maintain and increase their personal independence as well as the independence of their loved ones.
There will come a day when everyone will need to start thinking about making the hard decision to seek out adult foster care services for their elderly parents. It can be an extremely stressful time for the family and it can seem like it might be a complicated process, however, it doesn't have to be. Most people don't know where to start, where to look or who to talk to, but the Foundation for Senior Living is here to help guide you and offer support during this time for your family.
CJ has been a regular at the Glendale Adult Day Health Services (ADHS) center for nearly four years. As she makes the rounds greeting friends and newcomers alike, it's easy to see that she considers FSL a second home.
What do you do when you see your parents changing right in front of your eyes? How do you help when your beloved mother and father say, "We are fine. We don't need any help."
At FSL (Foundation for Senior Living), we have been actively improving the lives of Arizonans for over 40 years.
We have adopted the tagline Faith, Service, Life. We are a FAITH based charity that provides a wide range of SERVICEs to help people age in place throughout their LIFE.
FSL is a 501(c)(3) organization whose mission is to provide home and community-based services and develop energy-efficient, affordable housing to promote health, independence and dignity for all.


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Please contact Maumelle Animal Services for more information about this pet.
Tracy is a sweet boy who is looking for a new home. He is white with dark grey tabby markings on his ears and he has a tabby stripped tail. He's a bigger boy and he is looking for some security in his life. Would that be with you??? Date of Intake: 10/6/16.
Tracy is currently located at Maumelle Animal Services, 425 Cogdell Drive, 501-851-6219. For more information, email us at firstname.lastname@example.com. Online adoption application located at www.Maumellefoa.org. All applications received are sent a personal confirmation email.
We are always at the NLR PetSmart with our available pets on every Saturday of the month. 10:30 - 3:15 ish.
Find Maumelle Friends of the Animals on Facebook!


text: So many RPs, so little time! I'm putting them in approximate order of start date and grouping by the site on which I play for them. Dead RPs will be listed in the spoiler: Spoiler (Move your mouse to the spoiler area to reveal the content) Show Spoiler Hide Spoiler 2014 The Witch and the Slayer with Matthias Cendriollion (Dec 8) Ambassadors to Pehl-la with Chemifox (Dec 21) Crouching Student Hidden General with Ranele (Dec 31) 2015 Houses and Hobos with Guest(Janvier) (Jan 4) Enter the Witchwood with Windsong (Jan 19) When Conflict Comes to a Head with Rain of the Night (Jan 20) The Forest Witch with FiliaFlammae (Jan 27) A Mad Realm with Cassian (Feb 5) To Hell and Maybe Back with Xippix (Feb 9) The Hidden General with Nemaisare (Mar 10) Burning Embers with Aleksandar (May 6) Welcome Ambassador with Sir Pinkleton (May 6) Sleeping Dolls and Bleeding Soldiers with The Hound of Drengrheim (May 10) Of Sleeping Dolls, Old Houses, and Runaway Soldiers with Justric (May 30) Glacelieu's Secrets with EquinoxSol (Jun 3) Airships and Porcelain Dolls with The Hound of Drengrheim (Jun 29) Empire Lands with Wistful Beast (Aug 27) Into the Imperial Bedroom with Zombehs (Sept 12) A Foreign World with Myrce (Oct 16) 2016 "How Did I Get Here?" with Unknown (no posts) (Jan 22) The Farm in the Woods with Howlykin (Feb 2) "How Did I Get Here?" with Tyrannosaurus Rekt (Feb 23) Three Years' Misery with Seiji (Feb 26) Evil's Resurgence with Unknown (no posts) (Mar 2) Damn, I Need a Partner with Rain of the Night (Mar 5) The Mage and I with Royal Pain (Mar 14) A Rare Occurence with Arcadia (May 21) An Uncommon Threat with Gigi (May 23) Unusual Circumstances with Izurich (May 25) Hellspires to Hellfires with Autarch (May 29) Impulse Mission with Ezikeel (May 29) Rains of W.A.S. with Rain of the Night (May 29) Sunny Travels with Gossamer (Jun 14) Farm of Death with Iwazuma (Jun14) Thumps in the Night with RedWillow (Jun 19) A Witchwood Chronicle with Ananfel (Jun 27) Hiding from the Present with DeadAxl (Jul 1) Red Rumor with Nickboom (Jul 19) Crystal of Ending with Cassandra_Evermore (Aug 4) Escape from the World with GlassTrinity (Aug 13) Queen and Diplomat with Cordyceps Chowder (Sep 17) A Sticky Situation with LeRagester (Oct 14) Litphoria The Curious Historian Werefarm Watching a Store and Something More Group Tooth and Eye Apartments (May 20) 2014 The Fiery Glazier with ThePezCat (Dec 26) 2015 Gravity's Pull with Lstorm (Sep 22) 2016 City Girl, Fed Boy with LogicfromLogic (Apr 29) When Everyone Has Magic, Nobody Has Magic with Cerulean (May 9) Alien and Angel Addicts Anonymous with Rembrandt (May 9) Recon Mission 649b-Alpha with Patch-Work (May 14) Deep Shadows and Creaking Floors with redblood (May 16) Lost Mission with Lstorm (May 17) Roadkill with Aerylei (Jun 10) The Fox and the Hound with F0X (Jul 1) Staying Behind with Patch-Work (Jul 6) She's Gone with Shirelin (Jul 25) Black Crown Calling with Lurcolm (Aug 10) Riding Down the East Coast with Shirelin (moved Aug 19) Servants of the Multiverse with Shirelin (moved Aug 19) Pregnant Pauses with Aerylei (moved Aug 19) The Standing Stones with VeilofRain (moved Sep 10) Shattered Time Capsule with CrystineLucarnia (Sep 20) Queen among the Triple Closet with Aerylei (Sep 29) Coriander and Honey with Kitti (Oct 17) Unwinding the Immortal Coil with redblood (Oct 17) Bad Fade with Malicious Maximus (Oct 22) I DIDNT THINK IT WOULD TURN OUT THIS WAY with underpressure (Oct 22) Leathery Caverns with Karothyss (Oct 25) The Ghost in the Male Dormitories with TheScooter (Nov 2) Farm of Styx with CalamitousNag (Nov 15) The Blind Leads the Blind with Gryal (Nov 19) A Rock's Hard Place with Shirelin (Dec 1) Group Club Parasite (May 10) Homecoming (Jul 7) Recolor.me Roll of the Dice Litphoria Red Run Hide and Seek Champion: 2076 Discord/Casual The Original Multiverse with Shirelin (10-year RP) Zuri Torment with Aerylei FarmCowMoo with Shirelin and Aerylei Darcy Torment with Aerylei Age of Infinite Twiggy with LStorm Snappity Gloves save Elves with Professor Suzuki