Orstead v. Commissioner of Social Security

Filing 18

ORDER and OPINION entered by Senior District Judge Joe Billy McDade on 9/23/2024. The relief sought in Plaintiff's Brief (doc. 12 ) is DENIED, while the relief sought in the Commissioner's Brief (doc. 16 ) is GRANTED. The decision of the ALJ is AFFIRMED. SEE WRITTEN ORDER. (JPL)

E-FILED

Tuesday, 24 September, 2024 09:39:08 AM
Clerk, U.S. District Court, ILCD

UNITED STATES DISTRICT COURT
CENTRAL DISTRICT OF ILLINOIS
PEORIA DIVISION

REBECCA O.,
Plaintiff,
v.
MARTIN J. O’MALLEY, Commissioner
of Social Security,
Defendant.

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Case No. 1:23-cv-1362

ORDER & OPINION
This matter is before the Court on motion of Plaintiff Rebecca O. (“Plaintiff”)
to reverse or remand the final decision of the Social Security Commissioner
(“Commissioner”) denying her benefits. (Doc. 12). Defendant Commissioner provided
a Brief in opposition (doc. 16), seeking to uphold the decision to deny benefits, and
Plaintiff replied (doc. 17). The matter is therefore ripe for review. For the following
reasons, the Court affirms the decision of the Administrative Law Judge (“ALJ”).
PROCEDURAL BACKGROUND
Plaintiff Rebecca O. filed an application for Supplemental Security Income
(“SSI”) on August 10, 2018, and for Childhood Disability Benefits (“CDB”) on August
23, 2018, alleging an onset date of January 1, 2009. (R. at 15). 1 The Social Security
Administration denied Plaintiff’s application initially on October 17, 2018, and again
on reconsideration on February 5, 2019. (R. at 15, 100–28). Plaintiff requested a
Citation to “R. at __” refers to the page in the certified transcript of the record of
proceedings provided by the Social Security Administration.

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hearing before an ALJ, which took place on December 4, 2019. (R. at 35–82). On April
29, 2020, the ALJ issued a decision concluding Plaintiff was not disabled and,
therefore, ineligible for disability benefits. (R. at 12–34). The Social Security
Administration Appeals Council denied Plaintiff’s request for review, rendering the
ALJ’s decision final. (R. at 1). Plaintiff appealed her case to this Court, which granted
a joint motion for remand on January 5, 2022. (R. at 3456–62). On remand, the ALJ
was instructed to give further consideration to the medical source opinions and
Plaintiff’s maximum residual functional capacity. (R. at 3463–68). After a hearing on
December 22, 2022, the ALJ issued a decision that again concluded Plaintiff was not
disabled. (R. at 3388–426, 3362–87). Plaintiff filed the instant Complaint on
September 22, 2023. (Doc. 1).
FACTUAL BACKGROUND
On her alleged onset date, Plaintiff was seventeen years old; therefore, she had
only marginal education and no past relevant work. (R. at 3371). The following is a
summary of Plaintiff’s medical records 2 submitted to the ALJ, the hearing before the
ALJ on February 7, 2023, and the decision of the ALJ dated February 20, 2023. While

As stated, Plaintiff has applied for two types of benefits: SSI and CDB. In order to
qualify for CDB, Plaintiff must establish that she was disabled between the ages of
eighteen and twenty-two. 20 C.F.R. 404.350(a). That would require Plaintiff to submit
medical evidence for the period of April 2009 to April 2013. However, there were no
records submitted for this period, and Plaintiff makes no explanation in her Brief as
to why this Court should find her entitled to CDB despite the lack of medical evidence.
Plaintiff has the burden to provide medical evidence establishing her disability; as
she has not done this, the Court affirms the ALJ’s decision to deny her CDB claim.
See Courtney F. v. Kijakazi, No. 1:21-CV-02943, 2023 WL 110232, at *9 (S.D. Ind.
Jan. 4, 2023) (“It remains a claimant’s burden of submitting medical evidence
establishing her impairments.”) (citation and internal quotation marks omitted).
2

2

Plaintiff submits medical evidence dating back to 2015, her first month of eligibility
is September 2018. See 20 C.F.R. 416.335 (setting the earliest date of eligibility as
“the month following the month” of application for Title XVI claims requesting SSI).
The Court has reviewed the record in its entirety but will focus on the relevant period.
I.

Summary of Plaintiff’s Medical History
The medical record reveals Plaintiff has diagnoses for various mental

impairments like affective disorder, anxiety disorder, post-traumatic stress disorder
(“PTSD”), attention deficit hyperactivity disorder (“ADHD”), and substance use
disorder. She has sought medical treatment for some physical ailments, like general
back pain. During the period at issue, Plaintiff saw various medical providers,
including and of note, Sherri Bowald (“NP Bowald”), a psychiatric mental health
nurse practitioner, Briana Flori (“APN Flori”), an advanced practice nurse, and
Megan Amdor (“Case Manager Amdor”), a social services provider.
When Plaintiff began seeing NP Bowald in September 2017, she had several
recent trips to the emergency room for an intentional overdose, suicidal ideations,
panic attacks, anxiety, and depression. (See, e.g., R. at 3813, 2698, 1472, 1388–89,
1351, 1931). Some of Plaintiff’s trips to the emergency room required her to stay at
the hospital for a period of time. (R. at 1470, 2485, 1369–70). NP Bowald took over
Plaintiff’s medication management at the Institute for Human Resources; however,
she did not treat Plaintiff again until July 2018. (R. at 2571, 2572). At that time,
Plaintiff informed NP Bowald of her relationships with family members, and was
anxious with rapid speech. (R. at 2572). Later that year, in October, NP Bowald noted
Plaintiff’s similar presentation but greater impulse control demonstration. (R. at
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2574). While she presented as well-groomed and displayed appropriate coping skills,
she also had increased depression due to a family matter. (R. at 2574). Her next visit
to NP Bowald in December 2018 followed an emergency room visit, where she
reported anxiety due to her children being removed from her care. (R. at 2575).
In April 2019, Plaintiff visited NP Bowald and reported difficulty with
activities of daily living, such as performing chores. (R. at 2576). Around the same
time, Plaintiff began court-mandated therapy with a different provider. (R. at 2577).
She next spoke to NP Bowald in July and was documented to have loud and rapid
speech. (R. at 2579). Less than a week after, Plaintiff visited an emergency room,
complaining of panic attacks, but reported improvement after receiving medication.
(R. at 2464–67). In October 2019, NP Bowald completed medical opinion forms and
wrote an additional letter where she provided her opinion on Plaintiff’s functionality.
(R. at 2476–78, 2605).
In January through March of 2020, Plaintiff attended case management
services with Paige Sveda (“Case Manager Sveda”) where she reported feeling well,
and was taking her medications, but also reported family issues, like a physical
altercation with her mother and concerns over her boyfriend’s health. (R. at 3656–
61). Plaintiff spoke with NP Bowald in June 2020 and reported increased anxiety due
to losing parental custody of her daughter; in response, NP Bowald modified her
prescriptions. (R. at 3663). In July 2020, NP Bowald recorded Plaintiff had decreased
symptoms and no panic attacks in over a month. (R. at 3672). A few months later, in
October, Plaintiff again reported being in a good mood. (R. at 3682). After a series of

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cancellations, Case Manager Sveda complained of Plaintiff’s failure to attend her
appointments, and advised Plaintiff that she needed the sessions to develop her social
skills. (R. at 3668). Plaintiff saw Case Manager Sveda frequently throughout the next
few months, and the sessions consisted of social activities or discussing Plaintiff’s life.
(R. at 3669–71, 3673–81, 3683–89). Case Manager Sveda recorded Plaintiff’s positive
moods, appropriate interactions with the public, and consistency taking her
medications. (R. at 3685, 3686, 3687).
In January 2021, both Case Manager Sveda and NP Bowald started to discuss
finding an apartment with Plaintiff. (R. at 3689–90). The next month, Case Manager
Sveda noted that Plaintiff had difficulty acting appropriately during the meeting. (R.
at 3693). In March 2021, Case Manager Sveda told Plaintiff that she was leaving her
role, and while Plaintiff displayed some manic behaviors, she “took this news well.”
(R. at 3696). When Plaintiff was transferred to Case Manager Amdor, she presented
with rapid speech and was acting inappropriately. (R. at 3698). However, a week after
the transfer, Plaintiff reported her mood as stable to NP Bowald. (R. at 3699). During
their first session in April 2021, Case Manager Amdor noted that Plaintiff did well in
public, needing only “minimal instructions and advisement.” (R. at 3700). In May,
Plaintiff reported to NP Bowald that her mood improved after adopting a kitten. (R.
at 3701). NP Bowald adjusted Plaintiff’s medications. (R. at 3701). In her sessions
with Case Manager Amdor, Plaintiff reported calling a suicide hotline over the
previous weekend but denied having suicidal ideations at the time of their
appointment. (R. at 3702–06).

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Case Manager Amdor attended Plaintiff’s first appointment with APN Briana
Flori (who replaced NP Bowald) to help Plaintiff vocalize her needs. (R. at 3708). At
the meeting, Plaintiff complained of hypersomnia and anxiety but declined the
majority of APN Flori’s medication adjustments. (R. at 3708). Later, in July and
August 2021, Plaintiff informed Case Manager Amdor about her decision to move out
of her boyfriend’s home and was initially upset when she learned that a different
patient was prioritized in housing placement, but presented as stable at the following
appointment. (R. at 3715, 3718, 3720). During a visit with APN Flori in October 2021,
Plaintiff reported increased energy due to an iron supplement, although she
continued to experience symptoms of anxiety and depression due to her current living
situation. (R. at 3729). The next month, Plaintiff reported a poor mood to Case
Manager Amdor; however, during a follow-up appointment a week later, Plaintiff was
engaged and talkative. (R. at 3730, 3731).
In December 2021, Case Manager Amdor helped Plaintiff move into her new
apartment. (R. at 3734, 3735). This required Plaintiff to complete paperwork,
interview with the apartment complex, and perform other various tasks—Case
Manager Amdor noted that while Plaintiff easily gets overwhelmed and anxious in
public, she expressed a sense of accomplishment in being able to remove herself from
the difficult living situation. (R. at 3724, 3734, 3736). Throughout January 2022, Case
Manager Amdor and Plaintiff worked on coping strategies so Plaintiff could feel more
comfortable staying in her apartment alone. (R. at 3738). That same month, Plaintiff
informed APN Flori that she did not receive her medications and that her worsened

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anxiety was improved at the time of her visit. (R. at 3794). Plaintiff reported staying
in her apartment alone at the end of the month. (R. at 3741).
From February to April 2022, Plaintiff worked with Case Manager Amdor to
cope with moving the last of her possessions into her apartment, incidents with her
family members, and her cat passing away. (R. at 3744, 3745). Plaintiff reported
anxiety, depression, and an unstable mood, and admitted not taking her full dose of
medication. (R. at 3746, 3747). However, by July 2022, Plaintiff reported an increased
mood and decreased symptoms. (R. at 3762). At that time and onward, Plaintiff’s
symptoms were manageable with medication and case management, and she ended
her relationship with her previous boyfriend, which significantly decreased her
anxiety symptoms. (R. at 3747, 3762). She reported attending church and
volunteering at the Humane Society and was documented as being less manic. (R. at
3750–69). Case Manager Amdor reported Plaintiff was able to interact with others
appropriately and could “accomplish what she needed to do with minimal impact to
functioning.” (R. at 3749). APN Flori completed a medical opinion form on December
16, 2022, while Case Manager Amdor provided her opinion in an undated form. (R.
at 3802–04, 3805–07).
II.

Hearing before the ALJ
On December 22, 2022, Plaintiff appeared via telephone before an ALJ to

testify about her mental impairments. (R. at 3388–426). She was represented by an
attorney, and a vocational expert (“VE”) was present to testify. (R. at 3390). Case
Manager Amdor was present for moral support. (R. at 3391).

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To begin, Plaintiff provided general information—she lives on her own but has
never had a driver’s license or completed her high school diploma. (R. at 3395–96).
Plaintiff testified about how her appointments with Case Manager Amdor have
helped her remain stable. (R. at 3402–03, 3410–11). Plaintiff spoke about her
previous boyfriend, and her past drinking and substance abuse problems. (R. at 3406–
07). She adopted a cat, has a friend in her apartment building, and volunteers at the
animal shelter—activities she reported to help with anxiety. (R. at 3410–11).
As to her cognitive abilities, Plaintiff testified that she can read but has
difficulty with comprehension; she can add and subtract but is unable to do
multiplication or division. (R. at 3397). She explained how she is unable to retain
employment due to panic attacks and answered questions related to the few jobs she
attempted to work. (R. at 3397, 3402–03). With respect to physical difficulties,
Plaintiff spoke about back pain and how she is unable to lift more than thirty pounds.
(R. at 3397–98). Plaintiff testified about how her weight contributes to pain in her
ankle. (R. at 3399). She then detailed how she experiences mood swings, panic
attacks, bipolar disorder, anxiety, and PTSD, and the medications she takes to
manage each. (R. at 3400–02). Plaintiff confirmed that her medications are “very
effective” for her symptoms, and that she experiences few side effects. (R. at 3401).
After Plaintiff testified, the VE provided testimony consistent with the
Dictionary of Occupational Titles. (R. at 3416–22). The VE was asked by the ALJ to
provide examples of medium and light work appropriate for a hypothetical person
with the same characteristics as Plaintiff, who can understand and remember simple

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instructions, who is limited to performing simple, routine tasks on a sustained basis
with only routine breaks, whose work involves no more than ordinary or routine
changes, and who should only have occasional contact with supervisors, coworkers,
or the public. (R. at 3416). For medium work, the VE stated that this hypothetical
person would be able to perform the job of a warehouse worker and that 67,000 of
those jobs were available in the national economy. (R. at 3416–17). For light work,
the VE suggested an assembler, and roughly 30,000 of those jobs were available in
the national economy. (R. at 3417).
The ALJ next asked the VE to consider further limitations—such as avoiding
climbing, stooping, kneeling, and other postural activities no more than occasionally,
avoiding reaching overhead no more than occasionally, avoiding exposure to vibration
or hazards such as dangerous machinery, and avoiding interaction with the public
with no more than an occasional interaction. (R. at 3417–18). The VE replied that
this hypothetical person could still perform work as an assembler, but also as a
commercial cleaner or housekeeper, and suggested that the number of those available
jobs is 50,000. (R. at 3419). However, the VE opined that if the person had a level of
unexcused absences, lateness, leaving work early, or being off task, there would likely
be no competitive employment in the national economy. (R. at 3420). The ALJ next
asked the VE of any light, unskilled jobs that would not require the hypothetical
person to have any contact with coworkers or the public, and the VE responded that
there are no such jobs. (R. at 3421).

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Plaintiff’s attorney then asked the VE whether any job would exist if the
hypothetical person was unable to tolerate standard forms of instructions or
criticisms, and the VE stated that there would be no jobs in a competitive workplace
for this person. (R. at 3422). Plaintiff’s attorney then inquired about further
considerations, such as the person having a panic attack or crying outbursts that
could cause a distraction for coworkers, and whether such would be tolerated in an
unaccommodated work setting; the VE responded in the negative. (R. at 3422).
Finally, when asked whether an emotional-support companion would be tolerated in
an unaccommodated work setting, the VE also responded in the negative. (R. at 3422).
III.

Decision of the ALJ
A five-step sequential analysis is employed to determine whether a plaintiff is

disabled. 20 C.F.R. § 404.1520; Bowen v. Yuckert, 482 U.S. 137, 137 (1987). At step
one, the ALJ determines whether the plaintiff is engaged in substantial gainful
activity. 20 C.F.R. § 404.1520(a)(4)(i). At step two, the ALJ determines whether the
plaintiff’s impairments are severe. 20 C.F.R. § 404.1520(a)(4)(ii). An impairment is
“severe” if it significantly limits the plaintiff’s ability to perform basic work activities.
20 C.F.R. § 404.1520(c). At step three, the ALJ determines whether any of the
plaintiff’s impairments, alone or in combination, meet or equal one of the Listings in
Appendix 1 to Subpart P of Part 404 of C.F.R. 20 C.F.R. § 404.1520(a)(4)(iii). At step
four, the ALJ evaluates the plaintiff’s residual functional capacity (“RFC”) and
determines whether the plaintiff can perform past relevant work based on the RFC.
20 C.F.R. § 404.1520(a)(4)(iv). The RFC represents the most a plaintiff can do given
his limitations. 20 C.F.R. § 404.1545(a). An RFC includes limitations for all medically
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determinable

impairments,

including

non-severe

impairments.

20

C.F.R.

§ 404.1545(a)(2). Finally, at step five, the ALJ determines whether the plaintiff can
perform other work. 20 C.F.R. § 404.1520(a)(4)(v). The ALJ may require the
testimony of the VE to make a step-five determination. The burden of proof is on the
plaintiff for the first four steps; it then shifts to the Commissioner for the fifth step.
Young v. Sec’y of Health & Human Servs., 957 F.2d 386, 389 (7th Cir. 1992).
Applying the five-step inquiry, the ALJ here concluded Plaintiff was not
disabled from January 1, 2009, through the date of the decision. (R. at 3366). The
ALJ did find Plaintiff’s affective disorder, anxiety disorder, PTSD, and history of
ADHD and substance use disorder as medically determinable severe impairments
under 20 C.F.R. § 404.1520(c). (R. at 3368). However, all other impairments were
found to be “non-severe or non-medically determinable as they have been responsive
to treatment [and] cause no more than minimal vocationally relevant limitations.”
(R. at 3368). The ALJ found none of Plaintiff’s impairments, individually or in
combination, met the requirements listed in 20 C.F.R. Pt. 404, Subpt. P, App. 1. (R.
at 3369). While Plaintiff has no relevant past work experience, the ALJ found that
she could adjust to work that exists in significant numbers in the national economy.
(R. at 3378). In making this finding, the ALJ discounted the work-preclusive opinions
from NP Bowald, APN Flori, and Case Manager Amdor, and made the following RFC
determination:
After careful consideration of the entire record, the undersigned finds
that the claimant has the residual functional capacity to perform a full
range of work at all exertional levels but with the following nonexertional limitations. She can understand and remember simple
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instructions and due to deficits in memory, concentrated, persistence
and pace, she is reasonably limited to performing simple and routine
tasks on a sustained basis with only routine breaks. Any work should
not involve more than ordinary or routine changes in work setting or
duties. Any work should not require more than occasional contact or
interaction with the general public, supervisors, or co-workers.
(R. at 3370).
LEGAL STANDARD
The Court has the “power to enter, upon the pleadings and transcript of the
record, a judgment affirming, modifying, or reversing the decision of the
Commissioner of Social Security, with or without remanding the cause for a
rehearing.” 42 U.S.C. § 405(g). In reviewing the ALJ’s decision, this Court must
uphold the ALJ’s findings of fact if the findings are supported by substantial evidence
and no error of law occurred. Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001).
“Substantial evidence means such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Id. The Court is obligated to “review the
entire record, but [does] not replace the ALJ’s judgment with [its] own by
reconsidering facts, re-weighing or resolving conflicts in the evidence, or deciding
questions of credibility.” Jeske v. Saul, 955 F.3d 583, 587 (7th Cir. 2020).
The ALJ “need not evaluate in writing every piece of testimony and evidence
submitted.” Carlson v. Shalala, 999 F.2d 180, 181 (7th Cir. 1993). It is the ALJ’s
responsibility to “build an accurate and logical bridge from the evidence to her
conclusion,” and the ALJ “may not ignore evidence that undercuts her conclusion.”
Spricher v. Berryhill, 898 F.3d 754, 757 (7th Cir. 2018) (citations and internal
quotation marks omitted). The ALJ is required to articulate only a minimal, but
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legitimate, justification for her acceptance or rejection of specific evidence of
disability. Scheck v. Barnhart, 357 F.3d 697, 700 (7th Cir. 2004). At the same time,
judicial review is not abject; the Court does not act as a rubber stamp for the
Commissioner. Parker v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010).
DISCUSSION
Plaintiff raises numerous arguments to explain how the ALJ erred in
determining her not eligible for disability benefits. The dispute centers on whether
the ALJ properly evaluated the medical opinion evidence and assessed Plaintiff’s
work-related limitations. (Doc. 12 at 20–22). Additionally, Plaintiff contends that the
ALJ should have sought clarification from the medical providers before dismissing
the opinions as inconsistent and unsupported. (Doc. 12 at 23–24). Plaintiff’s primary
relief requested is to remand this case for further consideration. (Doc. 12 at 24). The
Commissioner, in opposition, argues Plaintiff has not demonstrated error on the part
of the ALJ. Instead, the Commissioner states the ALJ used substantial evidence to
support his evaluation of the record and opinion evidence. (Doc. 16 at 2–8). The
remaining arguments asserted by Plaintiff lack merit and are not supported by
relevant case law, according to the Commissioner. (Doc. 16 at 8). For relief, the
Commissioner seeks affirmance. (Doc. 16 at 8).
I.

Evaluation of the Medical Opinion Evidence
Plaintiff argues that the ALJ did not meaningfully address the supportability

and consistency of the medical opinions provided by NP Bowald, APN Flori, and Case
Manager Amdor, instead dismissing them as “check-box responses without specific

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citations to the record.” (Doc. 12 at 22). The Commissioner, in response, argues that
the ALJ sufficiently met the requirements under the Act. (Doc. 16 at 2).
A “medical opinion” is a statement from a medical source about what the
claimant can still do despite her impairments and whether she has impairmentrelated limitations in her ability to perform the physical or mental demands of work
activities. 20 C.F.R. § 404.1513(a)(2). The ALJ will not defer or give any specific
evidentiary weight, including controlling weight, to any medical opinions or prior
administrative medical findings, including those from the claimant’s treating
providers. 20 C.F.R. § 404.1520c(a). Instead, the ALJ will articulate how “persuasive”
he finds all of the medical opinions and prior administrative medical findings in the
case record. The factors of “supportability” (the more support the source offers, the
more persuasive the opinion will be) and “consistency” (the more consistent the
opinion is with the other evidence, the more persuasive it will be) are the most
important in determining how persuasive the ALJ finds a source’s medical opinions
or prior administrative medical findings to be. 20 C.F.R. § 404.1520c(b)(1), (c)(1).
ALJs are required to consider the objective medical evidence when evaluating the
supportability and consistency of a medical opinion. 20 C.F.R. § 404.1520c(c)(1)–(2).
NP Bowald provided her medical opinion in three check-box questionaries and
one letter. (R. at 3374). The first survey related to anxiety, dated October 7, 2019,
indicated that Plaintiff demonstrated restlessness, irritability, panic attacks,
difficulty concentrating, persistent worry, and disproportionate anxiety in leaving the
home and attending appointments. (R. at 2478). NP Bowald opined that these

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findings, along with an involuntary, time-consuming preoccupation with intrusive
thoughts due to anxiety, caused marked limitations in understanding, interacting
with others, concentrating, and adapting or managing herself. (R. at 2478).
On October 8, 2019, NP Bowald completed two additional questionnaires
related to Plaintiff’s trauma, stress, depression, and bipolar disorder. (R. at 2476,
2477). She marked that Plaintiff had clinical findings of depression, including
depressed mood, diminished interest in activities, sleep and appetite disturbance,
psychomotor agitation, decreased energy, difficulty concentrating, and thoughts of
suicide or death. (R. at 2476). Plaintiff’s clinical findings related to her bipolar
disorder included pressured speech, flight of ideas, irritability, decreased need for
sleep, and distractibility. (R. at 2476). The form provides that Plaintiff’s depression
caused mild or moderate impairment in understanding, remembering or applying
information, and marked limitation in interacting with others, concentrating,
persisting and maintaining pace, and adapting or managing herself. (R. at 2476). The
questionnaire form related to trauma and stress indicated Plaintiff had a mild or
moderate impairment in understanding, remembering, or applying information, and
marked impairments in interacting, concentrating, and adapting or managing
herself. (R. at 2477).
NP Bowald also wrote a letter dated October 28, 2019. (R. at 2605). It detailed
Plaintiff’s diagnoses of Unspecified Bipolar and Related Disorder and PTSD, and her
symptoms including racing thoughts, depression, and anxiety. (R. at 2605). NP
Bowald went beyond Plaintiff’s medical history, and discussed her financial and legal

15

issues, as well. (R. at 2605). Her opinion was that Plaintiff’s mental health condition
cause her issues with sleep and controlling her anger and described recent medication
changes to assist with these ongoing issues. (R. at 2605).
A few years later, on December 16, 2022, APN Flori completed a questionnaire
as to Plaintiff’s functional capacity. (R. at 3802–04). APN Flori described Plaintiff’s
symptoms as progressive anxiety and difficulty with focus, concentration, and
memory, and executive dysfunction. (R. at 3802). She indicated that Plaintiff would
not be able to consistently maintain attention for two hours and would require a break
every thirty minutes due to her mental impairments. (R. at 3802). APN Flori opined
that Plaintiff would miss two to four days of work per week and would be late two
days per week. (R. at 3802). The form shows that APN Flori is of the opinion that
Plaintiff would be incapable of understanding, remembering, and carrying out
detailed instructions, accepting instructions and responding appropriately, and
dealing with stress. (R. at 3803).
The last questionnaire was completed by Case Manager Amdor. (R. at 3805–
07). She described Plaintiff’s anxiety as moderate to severe and opined that Plaintiff’s
mental impairments would cause her to consistently be distracted, need a break every
fifteen minutes, miss three to four days of work per week, and be late every day. (R.
at 3805). She checked boxes to indicate that Plaintiff would be incapable of
understanding, remembering, and carrying out instructions, having an ordinary
routine, working in proximity to others, interacting appropriately with others,

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accepting instructions or criticism, responding to change, and setting goals. (R. at
3806).
The ALJ ultimately found the opinions of Ms. Bowald, APN Flori, and Case
Manager Amdor to be unpersuasive, labeling them as generalizations, and finding
the opinions to be unsupported by the objective medical evidence and inconsistent
with the record in general. (R. at 3375). In his decision, the ALJ noted that while all
three providers had an established relationship with the Plaintiff, they provided
“relatively generic” answers to the questionnaires and listed the Plaintiff’s symptoms
without citing specific objective evidence. (R. at 3375). The ALJ found the opinions
that Plaintiff would be unable to meet workplace standards of neatness to be
inconsistent with the treatment records describing how Plaintiff presented with good
hygiene. (R. at 3375). Further, according to the ALJ, the record did not support the
contention that Plaintiff exhibited suicidal thoughts or struggled with focus,
concentration, memory, executive functioning, or startle responses. (R. at 3375).
Relatedly, the ALJ found “Ms. Bowald’s assessment of marked limitations or Ms.
Flori and Ms. Amdor’s opinions that [Plaintiff] would need frequent breaks or have
frequent interference in several areas of work-related abilities and aptitudes” to be
inconsistent with and unsupported by the record. (R. at 3375).
In the end, the ALJ concluded that the totality of the treatment record—
including the providers’ treatment notes, Plaintiff’s clinical presentations, and her
reported and observed functionality—did not support the significant work-preclusive
limitations in the opinions. (R. at 3375). Instead, the ALJ pointed out that the

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treatment records showed Plaintiff maintained stability and functionality with
medication and case management. (R. at 3375). Even when Plaintiff encountered
stressors, the ALJ found that she utilized coping mechanisms, managed her personal
business, and did not experience “exacerbation of her symptoms or interference in her
functioning.” (R. at 3375).
Plaintiff takes issue with this analysis for various reasons. She first suggests
that the ALJ repeated the same errors found in his first decision. (Doc. 12 at 21–22).
Plaintiff recounts what the ALJ wrote, summarizes it as a “longer way of saying” that
the medical opinions were unpersuasive because the check-box forms lacked
specificity, and argues that this is the same reasoning the Appeals Council found
insufficient. (Doc. 12 at 21–22). She describes how the ALJ’s reasoning failed to
consider how the opinions were consistent with one another and Plaintiff’s selfreports—in other words, according to Plaintiff, the ALJ did not adequately explain
the lack of supportability or consistency in his decision. (Doc. 12 at 22). The ALJ is
accused of offering “an evaluation that is simply unreasonable and incompatible with
the medical record” and ignoring the part of the record which supported a finding of
disability. (Doc. 12 at 22–23).
The Court generally disagrees with Plaintiff’s arguments. When reviewing,
“[t]he court applies a common-sense reading to the entirety of [the] decision.” Winsted
v. Berryhill, 923 F.3d 472, 478 (7th Cir. 2019). This means the decision is read “as a
whole.” Rice v. Barnhart, 384 F.3d 363, 370 n.5 (7th Cir. 2004). Specifically responsive
to the remand order, the ALJ focused on analyzing NP Bowald’s medical opinion, and

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reviewed the additional record evidence provided by Plaintiff. (R. at 3371). The ALJ
cited evidence from over three years’ worth of medical appointments between Plaintiff
and the her providers before explaining why he found the respective opinions
inconsistent with and unsupported by the record. He referenced the treatment
records in which the providers documented Plaintiff’s symptoms to be controlled by
medication, how she remained able to function in the face of stressors, and that she
generally presented as stable. (R. at 3372–74). The ALJ described how Plaintiff was
able to overcome the stressors related to moving into her own apartment. (R. at 3371–
74).
As an ALJ may not “ignore an entire line of evidence contrary to its ruling[,]”
Grotts v. Kijakazi, 27 F.4th 1273, 1278 (7th Cir. 2022), the decision also summarizes
treatment notes describing Plaintiff’s anxiety, depression, low energy, and
inappropriate behavior, (R. at 3372–73). He discussed Plaintiff’s history with her
previous boyfriend, alcohol use, substance abuse, and parental custody, and how
those factors contributed to her anxiety and other symptoms. (R. at 3372–74). He
explained how Plaintiff’s providers connected psychosocial stressors to her symptoms
in their treatment notes. (R. at 3373). If Plaintiff complains that the ALJ failed to
mention every last symptom Plaintiff experienced over the past few years, the Court
reminds her that an ALJ “need not address in writing every shred of evidence.”
Winkelman v. Saul, 835 F. App’x 889, 891 (7th Cir. 2021). There is no requirement
that an ALJ must “fully summarize the record” or provide “support for every
proposition or chain of reasoning.” Warnell v. O’Malley, 97 F.4th 1050, 1053 (7th Cir.

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2024) (citations omitted). If Plaintiff takes issue with the analysis, she must do more
than simply ask this Court to reweigh the evidence in her favor. See Dzafic v.
Kijakazi, No. 22-2090, 2023 WL 2536340, at *5 (7th Cir. Mar. 16, 2023) (“[C]laimants
cannot simply point to evidence the ALJ considered and rejected and ask this court
to infer greater limitations from it. Instead, they must engage with the ALJ’s analysis
and show why it was either illogical or unsupported.”).
After recounting the record, the ALJ explained what each provider (NP
Bowald, APN Flori, and Case Manager Amdor) indicated in the opinion
questionnaires. (R. at 3374–75). Each opinion contained significant work-preclusive
limitations without objective supporting evidence, and in discounting them, the ALJ
provided examples as to how the opinions were inconsistent with and unsupported by
their own treatment notes with citations to the record. 3 (R. at 3375). His analysis was

Although, Plaintiff’s issue with the ALJ’s discussion on suicidal ideations has some
merit. His conclusion that the medical opinions were inconsistent with the record as
it relates to Plaintiff’s history of suicidal ideations was not supported by substantial
evidence. It seems the ALJ ignored that in May 2021, Plaintiff reported calling a
suicide hotline for assistance after she experienced thoughts of ending her life, and
that Case Manager Amdor encouraged her to call the hotline when this happened. (R.
at 3702). Additionally, NP Bowald’s notes chronicle that Plaintiff experienced suicidal
ideations that same month, but that Plaintiff denied any lingering thoughts at the
time of their appointment. (R. at 3701). Plaintiff’s Brief references a hospitalization
related to suicidal ideations around this time. (Doc. 12 at 12). However, Plaintiff and
her attorney were informed that the ALJ did not have the medical records related to
the incident and were told to submit documentation. (See R. at 3422, 3366). The ALJ
granted four extensions of time to file such documentation; Plaintiff instead filed a
letter confirming that no such records existed. (R. at 3366).
3

The ALJ’s conclusion that Plaintiff did not exhibit suicidal ideations during the period
at issue is incorrect; however, this is error is harmless. An error is harmless “if the
error leaves us convinced that the ALJ would reach the same result on remand.”
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supported by substantial evidence, as this Court can trace the ALJ’s reasoning from
the evidence to his conclusion. See Grotts, 27 F.4th at 1278 (writing that a court does
“not review medical opinions independently but rather review[s] the ALJ’s weighing
of those opinions for substantial evidence,” and only “overturn[s] that weighing if no
reasonable mind could accept the ALJ’s conclusion”). Here, the ALJ complied fully
with what the remand order required of him. See 20 C.F.R. § 404.977(b) (“The
administrative law judge shall take any action that is ordered by the Appeals Council
and may take any additional action that is not inconsistent with the Appeals
Council’s remand order[.]”). Plaintiff’s first arguments related to the ALJ’s
supportability and consistency analysis are meritless.
Plaintiff also takes issue 4 with the ALJ’s finding that her stable functioning
was not a mark of needing serious limitations—she argues that the “lack of

Lambert v. Berryhill, 896 F.3d 768, 776 (7th Cir. 2018). If this Court can “predict with
great confidence what the result on remand will be,” then it may decline to remand.
McKinzey v. Astrue, 641 F.3d 884, 892 (7th Cir. 2011). As this was one of many of the
ALJ’s considerations made when weighing the consistency and supportability factors,
the Court concludes the ALJ would more than likely reach the same result if
remanded.
4 In the same line of reasoning, Plaintiff points out that the three medical opinions
were consistent with each other and her own self-reports. (Doc. 12 at 22). However,
she does not provide the Court with a developed argument as to either point. That is
likely because courts reject her first contention, writing that the “medical opinions
are consistent with each other does not, in and of itself, establish that any of the
opinions were entitled to great weight or that the ALJ erred.” Hughes v. Kijakazi, No.
21-CV-367, 2022 WL 4103194, at *12 (W.D. Wis. Sept. 8, 2022). In other words,
multiple “flawed opinions do not equal a good one.” Cassens v. Saul, No. 19-cv-912,
2020 WL 3316094, at *3 (W.D. Wis. June 18, 2020). As to Plaintiff’s self-reports, the
ALJ did consider them—but to Plaintiff’s dismay, found them to be inconsistent with
the opinions rather than in support of. (See R. at 3375) (“Overall, the opinions
rendered . . . are not supported by . . . the claimant’s reported . . . functionality.”). As
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exacerbation does not indicate that baseline functioning is not seriously limited.”
(Doc. 12 at 22). She complains that the ALJ distorted evidence and reached an
“absurd result.” (Doc. 12 at 23). The Seventh Circuit has directed ALJs to consider
that individuals suffering from mental illness may have “good days and bad days, and
possibly good and bad months.” Bauer v. Astrue, 532 F.3d 606, 609 (7th Cir. 2008).
An ALJ should remember that symptoms may fluctuate when evaluating
inconsistencies. Quinones v. Colvin, No. 15 CV 6072, 2017 WL 337993, at *4 (N.D. Ill.
Jan. 23, 2017) (citing SSR 16-3p). The entire record must be considered, including
those parts that do not support the ultimate determination. Scrogham v. Colvin, 765
F.3d 685, 697 (7th Cir. 2014). As discussed, the ALJ cited both evidence that
supported his conclusion and undermined it, acknowledging Plaintiff’s worsened
symptoms and inappropriate displays of behavior. (R. at 3371–74). This means that
the ALJ did not run afoul of what was required of him under the regulations and
relevant caselaw. This Court finds it difficult to construe Plaintiff’s argument as
anything more than an impermissible request to reweigh the medical evidence in her
favor.
As the Seventh Circuit recently explained, “[a]ll we require is that ALJs
provide an explanation for how the evidence leads to their conclusions that is
sufficient to allow us, as a reviewing court, to assess the validity of the agency’s
ultimate findings and afford [Plaintiff] meaningful judicial review.” Warnell, 97 F.4th

this Court’s role does not include reweighing the evidence, it must find this argument
unpersuasive, as well. See Butera v. Apfel, 173 F.3d 1049, 1055 (7th Cir. 1999)
(rejecting an invitation to reconsider medical evidence).
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at 1054 (citation and internal quotation marks omitted). This Court can readily
observe that the ALJ considered the relevant factors and can follow his path of
reasoning. Plaintiff’s arguments to the contrary are not convincing. Therefore, the
ALJ did not err in his analysis of the medical opinions and remand is not warranted
on this issue.
II.

Clarification of Medical Opinions
Plaintiff’s final argument is that the ALJ failed to seek further clarification

from the medical providers, and especially from NP Bowald. (Doc. 12 at 23–24). She
puts forth that if the ALJ “was so convinced that the nature of the forms was simply
insufficient to provide him enough information,” he could have contacted NP Bowald
to ask for clarification. (Doc. 12 at 24). In support, she cites Barnett v. Barnhart for
the contention that “although a medical opinion on an ultimate issue such as whether
the claimant is disabled is not entitled to controlling weight, the ALJ must consider
the opinion and should recontact the doctor for clarification if necessary.” 381 F.3d
664, 669 (7th Cir. 2004) (citation omitted).
An ALJ is required to develop the record only when there is insufficient
evidence to determine whether Plaintiff is disabled under the Act. 20 C.F.R.
§ 416.920b. Evidence is insufficient “when it does not contain all the information we
need to make our determination or decision.” 20 C.F.R. § 416.920b(b). Here, the ALJ
complained that the medical opinions lacked specifics beyond mere generalizations,
not that the providers failed to provide information necessary to the determination.
See, e.g., Lisa M.F. v. Comm’r of Soc. Sec., No. 122CV01419, 2023 WL 9511468, at *6
(C.D. Ill. Aug. 30, 2023) (cleaned up) (rejecting an argument that an ALJ should have
23

sought clarification when he only indicated a medical opinion lacked specificity);
Joseph M. v. Saul, No. 18 C 5182, 2019 WL 6918281, at *15 (N.D. Ill. Dec. 19, 2019)
(“What is more, an ALJ is generally under no ‘affirmative duty’ to contact a claimant’s
physician to obtain a medical opinion.”). Because the ALJ could have contacted NP
Bowald, but was not required to under the regulations, Plaintiff’s final argument is
unpersuasive.
For all these reasons, the ALJ provided sufficient analysis for finding the
opinions of NP Bowald, APN Flori, and Case Manager Amdor as inconsistent with
and unsupported by the objective medical record. As all of Plaintiff’s arguments are
rejected, the relief requested in her Brief (doc. 12) is denied. Although this Court is
sympathetic to Plaintiff’s situation, it must remain mindful of the deference
underpinning the substantial-evidence standard and affirm a decision if it is
adequately explained and supported. Elder v. Astrue, 529 F.3d 408, 413 (7th Cir.
2008).
CONCLUSION
IT IS THEREFORE ORDERED that the relief sought in Plaintiff’s Brief (doc.
12) is DENIED, while the relief sought in the Commissioner’s Brief (doc. 16) is
GRANTED. The decision of the ALJ is AFFIRMED. As all issues have been disposed
of, this matter is TERMINATED.

SO ORDERED.
Entered this 23rd day of September 2024.

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s/ Joe B. McDade
JOE BILLY McDADE
United States Senior District Judge

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