endorphin, but cortisol levels is key in reducing fibromyalgia symptomatology." Ibid.
On April 8, 2004, Dr. Bleiberg again met with the plaintiff. He wrote in his notes that "she did see the infectious disease doctor, the ear physician, and the neurologist." Ibid. At the time, the plaintiff reported to Dr. Bleiberg that the ear specialist had diagnosed Menier's disease "and had some hearing loss in the right ear." Ibid. The plaintiff was undergoing further work-up and was to call the infectious disease doctor to set up testing. On April 23 and 28, 2004, Dr. Bleiberg performed "trigger point injection in an attempt to get her some relief of her pain symptoms there." AR at 211. On April 28, 2004, Dr. Bleiberg noted that the plaintiff
continues with pain and palpabletrigger points in the lumbar paraspinal musculature which has been resistant to conservative treatment to date, including medication and therapy. She underwent trigger point injections about the scapula/shoulder on 4/23/04 and had a good response with substantial improvement in pain. These injections are indicated in order to improve her pain and improve her overall function.
AR at 212. After the procedure on April 28, 2004, the plaintiff "noted a substantial *601 improvement in her pain, not only in the lumbar region, but also radiating down the limbs after the injection." Ibid.
In addition to Dr. Blieberg's records, the plaintiff submitted the records of Dr. Michael J. LaRouere, her ear specialist, for consideration on appeal. The plaintiff treated with Dr. LaRouere on February 11, 2004. His notes record:
The patient gives approximately