After examining Ms. Bosley on May 1, 1991, Dr. Simmons noted that a bone scan had been done, and had revealed no abnormalities. A.R. 169. Ms. Bosley continued to do well in regard to her lower back, though she was still experiencing some pain in the left hip area and over the groin. Physical therapy was to be resumed. Dr. Simmons noted that he would see Ms. Bosley again in two months, and expressed the view that at that time she would most likely be ready to return to work. Id.
On July 1, 1991, Dr. Simmons again examined Ms. Bosley. A.R. 168. She was continuing to do well, and had no problems with lower back pain. However, she was experiencing a sensation of weakness in her lower left extremity. On physical examination she had very slight decreased power of dorsiflexion and plantar flexion of the left compared to the right side, revealed by repetitive toe raises and heel walking. She felt that she was unable to stand long enough to do her former job. Dr. Simmons recommended that she undergo vocational rehabilitation counseling, and opined that "she would be best suited for a desk type job where she doesn't have to stand for long periods of time." Id.
After a further examination on October 7, 1991, Dr. Simmons reported that Ms. Bosley was "doing quite well with regard to her lower back pain with good improvement compared to her pre-operative state. She still has some sensation of weakness in her left lower extremity and as well, has described some flushing sensations and pain radiating up into her upper thoracic spine and upper extremities occasionally." A.R. 167. He noted that she was undergoing vocational rehabilitation, and stated that "I think she should have reasonable prospects in terms of getting some form of work not requiring prolonged standing." Id.
The record contains the report of a neurologist, Kailash C. Lall, M.D., dated October 23, 1991. AR. 164-66. Dr. Lall's examination of Ms. Bosley apparently revealed no neurological problems. However, he noted that there was tenderness in the midlumbar region, and that "she still has chronic low back pain which usually gives rise to the pain going down into the left lower extremity." He expressed the view that she was "still partially disabled." A.R. 165.
2. After October 31, 1991
Ms. Bosley's family physician, John C. Stubenbord, M.D., examined her on November 21, 1991. A.R. 184-91, 195. On a report to the Workers' Compensation Board, he noted that she had numbness of her legs and cold feet. A.R. 195. She was experiencing pain, mainly in her lower back, left hip area, and left leg. She had weakness in her left leg, and a tender left sciatic notch. She could flex her back to 150 degrees with pain. Dr. Stubenbord marked a box on the report form indicating that Ms. Bosley was totally disabled at that time. Id. In a report for the New York State Department of Social Services, Office of Disability Determinations, based upon the same examination, Dr. Stubenbord noted that Ms. Bosley had a healed scar in her lumbrosacral region, that there was tenderness in both the left and the right paravertebral areas lateral to the scar, and that she experienced left sciatic notch tenderness. A.R. 184. He noted that wearing a brace helped Ms. Bosley in both standing and sitting. A.R. 185. In his opinion, she was unable to lift or carry any weight. A.R. 188. She could stand and/or walk for less than two hours per day, and should not stand for more than 15 minutes, or stoop. She could sit for less than six hours per day, and should not push or pull. Id.
In a workers' compensation report based on an examination on January 8, 1992, Dr. Stubenbord noted numbness of the left leg, and cold feet. A.R. 194. He indicated that Ms. Bosley was still experiencing pain in her lower back and left hip, and that her left sciatic notch was still tender. She was able to flex her back to 90 degrees with pain. The doctor again marked a box indicating that Ms. Bosley remained totally disabled. Id.
On April 1, 1992, Dr. Stubenbord submitted a further report to the New York State Department of Social Services, Office of Disability Determinations, based on an examination carried out on that day. A.R. 208-17. Ms. Bosley's current symptoms were described as persistent low back pain, to left hip. A.R. 208. She still had left sciatic notch tenderness. A.R. 209. She was able to straight leg raise to 70 degrees on the right and to 60 degrees on the left, with pain. Id. Dr. Stubenbord again indicated that she could lift and carry no weight, that she could stand and/or walk for less than two hours per day, that she could sit for less than six hours per day, and that she should not push or pull. A.R. 216-17.
In a letter dated August 9, 1992, Dr. Stubenbord noted that Ms. Bosley continued to experience numbness in her left leg and pain in her left hip and lower back. A.R. 222-23. She had pain on extension of her left leg, diminished reflexes of her left leg, and tender left sciatic notch. The doctor indicated that her prognosis was guarded until the results of an epidural injection were known. He expressed the view that Ms. Bosley was unable to return to her former work, and that she had been "totally disabled from 9/18/89 until the present." It was, however, possible that she could do a desk job if properly trained, and if the epidural injection helped her back. He noted that at that time, Ms. Bosley was using Tylenol for pain, as needed. This helped her "only to a certain extent." Id.
Also in the record is a psychiatric report prepared by Mary T. Spinks, M.D., and Kathy McCadden, R.N., dated January 22, 1992, based on Ms. Bosley's treatment at the Southtowns Counseling Center between October 14, 1991, and January 20, 1992. A.R. 196-205. The report noted that Ms. Bosley had been visiting the Center "off and on" for depression and anxiety. She had returned for treatment on October 14, 1991, due to recurrence of depression, with symptoms of insomnia, extreme tearfulness, low energy, poor concentration and motivation, and subjective dysphoria and fear. A.R. 196. She was treated with medication, received individual supportive psychotherapy weekly, and attended a weekly support group. Her mood and level of functioning had improved by January 22, 1992, but at that time she continued to experience fear and anxiety. Id.
In an undated report, identified by the ALJ as having been made in June 1992, A.R. 21, Ms. McCadden stated that:
Mrs. Bosley's current mental status would not seriously affect her vocational functioning. She is prone to anxiety when subjected to high levels of stress (e.g. multiple or conflicting demands, unclear expectations). It is much more likely that her physical limitations would impact on her ability to do certain kinds of work for extended periods of time.
C. Ms. Bosley's Testimony
At her administrative hearing on August 17, 1992, Ms. Bosley testified that she could neither sit nor stand for extended period of time, and could not lift. A.R. 50. She described shooting pains going from her lower back into her buttocks, and radiating down into her left leg and foot. A.R. 51. She experienced these pains daily. Id. To obtain relief, she would get up and walk around, or sometimes lie down on her bed for a few minutes. A.R. 52. The pain would sometimes recur within 30 minutes. Id. She described being extremely depressed and lacking in energy. Id. She was very limited in her activities. She cooked only two or three times a week for her family, did not sweep, mop, make beds, vacuum, do the laundry, or do any grocery shopping. A.R. 58. She spent much of her time watching television, and working on hand crafts. Id. She could walk for short distances -- two to three city blocks -- but could stand for only five to ten minutes without support. A.R. 61. She could not bend at her waist to pick an object up from the floor, and had difficulty kneeling. Id. She was able to carry books, and lift and carry a gallon of milk, but she stated that her doctor had recommended not lifting any weights. Id. She could climb stairs, but doing so would bring on pain in her hip. A.R. 62.
A. Standard for Entitlement to Benefits
A claimant is considered disabled under the Act if she can demonstrate an "inability to engage in any substantial gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous period of not less than 12 months." 42 U.S.C. § 423(d)(1)(A); White v. Secretary of Health and Human Services, 910 F.2d 64, 65 (2d Cir. 1990). Her impairment must be "of such severity that she is not only unable to do [her] previous work but cannot, considering [her] age, education, and work experience, engage in any other kind of substantial gainful work which exists in the national economy." 42 U.S.C. § 423(d)(2)(A); White, 910 F.2d at 65. The claimant has the initial burden of proving that her impairment prevents her from returning to her past work, but thereafter the burden shifts to the Secretary to prove that she can engage in alternative employment. White, 910 F.2d at 65 (citing Bluvband v. Heckler, 730 F.2d 886, 891 (2d Cir. 1984); Ferraris v. Heckler, 728 F.2d 582, 586-88 (2d Cir. 1984)).
In evaluating disability claims, the Secretary generally employs the five-step sequence described in 20 C.F.R. § 404.1520. The Second Circuit has described the procedure as follows:
"First, the Secretary considers whether the claimant is currently engaged in substantial gainful activity. If she is not, the Secretary next considers whether the claimant has a "severe impairment" which significantly limits [her] physical or mental ability to do basic work activities. If the claimant suffers such an impairment, the third inquiry is whether, based solely on medical evidence, the claimant has an impairment which is listed in Appendix 1 of the regulations. If the claimant has such an impairment, the Secretary will consider [her] disabled without considering vocational factors such as age, education, and work experience; the Secretary presumes that a claimant who is afflicted with a 'listed' impairment is unable to perform substantial gainful activity. Assuming the claimant does not have a listed impairment, the fourth inquiry is whether, despite the claimant's severe impairment, she has the residual functional capacity to perform [her] past work. Finally, if the claimant is unable to perform [her] past work, the Secretary then determines whether there is other work which the claimant could perform."