Moore v. Astrue

Filing 30

MEMORANDUM Opinion and Order. Signed by the Honorable Young B. Kim on 5/27/2010. (aac, )

UNITED STATES DISTRICT COURT N O R T H E R N DISTRICT OF ILLINOIS E A S T E R N DIVISION M A R S H A MOORE, P la in tif f , v. M I C H A E L ASTRUE, C o m m is s io n e r of Social Security, D e f e n d a n t. ) ) ) ) ) ) ) ) )

C a s e No. 08 CV 5180 M a g is tr a te Judge Young B. Kim

M a y 27, 2010

M E M O R A N D U M OPINION and ORDER B e f o re the court are the parties' cross-motions for summary judgment. Marsha Moore s e e k s disability insurance benefits ("DIB") and supplemental security income ("SSI") under th e Social Security Act, 42 U.S.C. §§ 416(i), 423, 1382c, claiming that her persistent severe m ig ra in e headaches and lower back pain render her disabled. The Commissioner of Social S e c u rity issued a final decision denying her claims, and Moore appeals. See 42 U.S.C. §§ 4 0 5 (g ), 1383(c). For the following reasons, Moore's motion is granted and the

C o m m is s io n e r's is denied. This case is remanded for further proceedings consistent with this o p in io n . Procedural History M o o re applied for DIB and SSI in December 2005, claiming that her disability began o n January 15, 2003. (A.R. 98, 101.) The Social Security Administration denied her claim in iti a l l y and on reconsideration. (Id. at 39-40.) Moore then requested, and was granted, a h e a rin g before an administrative law judge ("ALJ"). (Id. at 6.) The ALJ concluded that

Moore was not "disabled" as defined in the Social Security Act. (Id. at 56.) When the A p p e a l s Council denied review, the ALJ's decision became the final decision of the C o m m is s io n e r. See Schmidt v. Astrue, 496 F.3d 833, 841 (7th Cir. 2007). Moore then filed th e current suit seeking judicial review of the ALJ's decision. See 42 U.S.C. §§ 405(g), 1 3 8 3 (c ). The parties have consented to the jurisdiction of the United States Magistrate J u d g e . See 28 U.S.C. § 636(c). Facts In her applications for DIB and SSI, Moore claimed that her disability began on J a n u a ry 15, 2003, when she was fired from her job as an ophthalmology technician because o f excessive absenteeism brought on by her persistent and debilitating migraine headaches. (A.R. 14, 98, 101.) She also claimed that the side-effects of her migraine medication a d v e rs e ly impact her ability to work, and that she suffers from increasingly severe low back p a in . (Id. at 12, 32.) At her hearing before an ALJ, Moore provided both documentary and te s tim o n ia l evidence to support her claims. A. M o o re 's Evidence

M o o re testified that the most serious of her impairments are her migraine headaches, w h ic h arrive without warning up to three times per week. (A.R. 14, 21.) Her primary care p h ys ic ia n , Dr. Merrill Zahtz, prescribes Imitrex pills to treat the migraines once they appear, b u t she is unable to tolerate medicine that in some people prevents migraines. (Id. at 15-17, 2 0 .) When Moore has a migraine, she is "laid out for the day," and has to lie down in a dark

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room with white noise until the headache subsides. (Id. at 15.) It usually takes two hours for th e Imitrex to work, and even after it reduces the headache, her sensations are heightened u n c o m f o rta b ly and she feels tired and physically drained. (Id. at 15, 20.) Moore also te s tif ie d that she experiences panic attacks with every migraine, which cause a painful tig h te n in g in her chest that can last up to eight hours. (Id. at 23-24.) Dr. Zahtz prescribes K lo n o p i n to control the panic attacks. (Id. at 20.) She explained that her medications can c a u s e her to experience rapid heartbeat or sleepiness, and based on those side effects, she let h e r drivers' license lapse two years earlier. (Id. at 13, 24, 32.) Moore explained that her typ ic a l migraine lasts only a couple of hours, but stated that she has experienced headaches th a t last up to three days. (Id. at 31.) Moore testified that she cannot predict the onset of a m ig ra in e , but that bright sunlight, flashing lights, and stress are all triggers. (Id. at 14, 293 1 .) T h e ALJ questioned Moore about what additional steps she was taking to reduce the im p a c t of her migraines. Moore testified that she had cut caffeine and chocolate out of her d ie t, but she admitted that she still smokes a pack of cigarettes about every three days, despite D r. Zahtz's suggestion that quitting smoking might help reduce the migraines. (A.R. 18-19, 3 0 .) She also testified that she had seen only one neurologist about her migraines, and that w a s years before the hearing. (Id. at 15-16.) Moore explained that the neurologist had not p re s c rib e d any treatment that varied from Dr. Zahtz's, so she did not think returning would b e beneficial. (Id. at 16.) She testified that she had sought emergency-room treatment for

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a migraine only once, and the ALJ noted that there was no record of that visit in the evidence s h e submitted. (Id. at 19.) To support her testimony describing her migraines, Moore submitted medical records f ro m Dr. Zahtz and Dr. Scott Kale, an internist who performed a consultative examination. Dr. Zahtz's treatment records show that he treated Moore for migraines beginning in October 2 0 0 2 . (A.R. 239-40.) In March 2006 he noted that Moore complained that her headaches w e re occurring two to five times per week. (Id. at 246.) He prescribed Imitrex and Soma. (Id .) In 2007 he described Moore's prognosis as "very guarded" based in part on "recurrent s e v e re migraines." (Id. at 231.) Similarly, Dr. Kale noted that he examined Moore in March 2 0 0 6 and that she complained of increasingly severe and frequent migraines that occurred th re e to four times per week. (Id. at 175.) Moore told Dr. Kale that the headaches prevented h e r from concentrating or being able to tolerate light or sound. (Id.) Dr. Kale diagnosed M o o re as suffering from "uncontrolled migraines by history" and "status migrainosus." (Id. a t 178.) In addition to the evidence regarding her migraine headaches, Moore testified that she s u f f e re d from debilitating lower back, knee, and shoulder pain. (A.R. 22.) She testified that s h e has three extra vertebrae and decreased cushioning in her spine, which causes constant lo w e r back pain. (Id. at 18, 22.) She stated that her knee and shoulder pain come and go d e p e n d in g on her physical activity and stress levels. (Id. at 22-23.) She explained that her o rth o p e d ist, Dr. Patrick Schuette, prescribes Vicodin and Dr. Zahtz prescribes a muscle

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relaxant to treat her pain. (Id. at 17-18, 20.) When the ALJ asked about her daily activities, M o o re testified that she spends 80% of her day lying on a heating pad while she watches tv o r reads in short intervals. (Id. at 25-26.) She explained that she rarely cooks and does not c le a n , do laundry, or go to the grocery store (her fiancé does most of the household chores). (Id.) She testified that the last time she traveled was in January 2003, but she spent most of th e trip in bed with migraines and did not do any sight-seeing. (Id. at 27-28.) The ALJ noted th a t Dr. Schuette had advised her to exercise to increase her strength level, but Moore te s tif ie d that walking exacerbates her knee pain. (Id. at 24.) The ALJ also noted that Dr. S c h u e tte wanted her to try decreasing her Vicodin intake, but Moore explained that she takes o n ly the Vicodin dosage that Dr. Schuette prescribes. (Id. at 17.) Moore offered medical records from Drs. Schuette and Kale and from Cook County H o s p ita l in support of her testimony regarding her back, knee, and shoulder pain. The Cook C o u n ty Hospital records show that between March 2004 and October 2006 Moore was tre a te d for symptoms of sciatica, lower back pain, and left hip/lower extremity pain. (A.R. 1 9 8 -2 0 3 .) Those records also note that Moore complained of migraine headaches. (Id. at 2 0 3 .) An MRI of Moore's spine in October 2006 showed minimal degenerative disc disease. (Id. at 204.) Dr. Schuette's treatment records cover the period from July 2003 through October 2 0 0 6 . In her initial visit with Dr. Schuette, Moore complained of intermittent lower back p a in and some left hip and upper thigh pain, as well as periodic muscle pain on the left side

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of her body. (A.R. 224.) She reported that the pain grew much worse after activity, and at tim e s was severe enough to wake her from a sound sleep. (Id.) She also reported a history o f migraine headaches. (Id.) Dr. Schuette noted that Moore has rotary scoliosis and could lif t her leg to only 85, rather than 90, degrees. (Id. at 224-25.) He prescribed Bextra and S o m a to treat Moore's pain, but warned Moore that Soma could negatively impact her c o g n itiv e functioning. (Id. at 225.) In August 2003 Dr. Schuette noted that x-rays of M o o re 's lumbar spine showed no significant abnormalities, but stated that "Moore has p e rs is te n t back pain." (Id. at 221.) Dr. Schuette counseled Moore about the long-term use o f narcotics like Vicodin, but said that she was "clearly in a fair amount of pain" that needed m a n a g e m e n t. (Id.) He also noted that Moore's lack of health insurance was complicating h e r ability to get treatment. (Id.) In January 2004 Dr. Schuette noted that Moore continued to complain of back pain that radiated into her left hip and leg but that the etiology of the p a in was unclear. (Id. at 217.) He again noted that determining the etiology of her pain was " c o m p lic a te d by the inability to get an adequate workup performed given her insurance s ta tu s ." (Id.) Moore's pain persisted and in June 2005 Dr. Schuette noted that x-rays, a CAT s c a n , and an MRI of the lumbar spine did not reveal any specific abnormalities. (Id. at 213.) He diagnosed modest scoliosis with muscle pain as the etiology of Moore's back pain, and n o te d his hope that she would "push the envelope" in trying to exercise and cut back on her V ic o d in use. (Id. at 213-14.) He reduced her Vicodin dosage in 2004 and 2005. (Id. at 213, 2 1 6 .) In his last treatment notes in October 2006 Dr. Schuette noted that Moore's lower back

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pain was "quite significant" and "persistent," and that she "continues to require fairly high d o s e s of Vicodin as ongoing treatment." (Id. at 212.) Following his March 2006 consultative examination of Moore, Dr. Kale noted that M o o re complained of low back pain, but could stand and walk normally. (A.R. 175.) Dr. K a le diagnosed low back pain with "sciatic features," with "no objective abnormalities." (Id. a t 178.) A t the hearing Moore also submitted residual functional capacity assessments c o m p le te d by Drs. Zahtz and Schuette. Both doctors noted that Moore needs to lie down in te rm itte n tly throughout the day, and Dr. Zahtz opined that Moore cannot sit at all during a work day when she has a migraine. (A.R. 210, 232.) They both noted Moore's sensitivity to temperature and opined regarding limitations in her ability to reach or carry more than five p o u n d s occasionally. (Id. at 210-11, 232-33.) Both doctors also described limitations caused b y the side effects of Moore's medicine: Dr. Schuette noted that "machines would be a p ro b le m " because of her Vicodin use, and Dr. Zahtz stated that her migraine medication c a u s e s weakness, lethargy, hearing and speech impairment, and panic attacks. (Id. at 211, 2 3 3 .) Although Dr. Schuette referred to Moore's prognosis as "fair," (Id. at 209), both d o c to rs concluded that her symptoms would markedly limit her ability to: "complete a normal w o rk d a y and workweek without interruptions . . . [and] perform at a consistent pace without a n unreasonable number and length of rest periods." (Id. at 211, 233.) They agreed that

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Moore would "reasonably be expected to experience significant deficiencies in sustained c o n c e n tra tio n , persistence and pace." (Id. at 211, 233.) B. T h e Vocational Expert's Testimony

F o llo w in g Moore's testimony the ALJ called a vocational expert, James Radke, to d e s c rib e Moore's past work and to opine about other jobs she might perform, assuming c e rta in hypothetical limitations. Radke described Moore's past work as an ophthalmology te c h n ic ia n as "light and skilled." (A.R. 33.) The ALJ then asked Radke to assume an in d iv id u a l who is 43 years old (Moore's age at the time), with Moore's tenth-grade education a n d limitations of doing only light work, lifting and carrying 10 pounds frequently, and o c c a s io n a lly stooping, crawling, climbing, crouching, and kneeling, with the need to avoid " c o n c e n tra te d exposure to pulmonary irritants and temperature extremes." (Id. at 33-34.) Radke testified that a person with those limitations could work as an ophthalmology te c h n ic ia n . (Id. at 34.) Radke further opined that a person with those limitations could work in food preparation or as a mail clerk, courier, or receptionist, and that thousands of those jo b s existed in the region where Moore lived. (Id. at 34-35.) C. T h e ALJ's Decision

A f te r considering the proffered evidence, the ALJ concluded that Moore is not d is a b le d . In so finding, the ALJ applied the standard five-step sequence, see 20 C.F.R. § 4 0 4 .1 5 2 0 , which requires her to analyze: (1 ) whether the claimant is currently [un]employed; (2) whether the claimant h a s a severe impairment; (3) whether the claimant's impairment meets or 8

equals one of the impairments listed by the [Commissioner], see 20 C.F.R. § 4 0 4 , Subpt. P, App. 1; (4) whether the claimant can perform her past work; and (5 ) whether the claimant is capable of performing work in the national e c o n o m y. C liffo r d v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000) (quoting Knight v. Chater, 55 F.3d 309, 3 1 3 (7th Cir. 1995)). If at step three of this framework the ALJ finds that the claimant has a severe impairment which does not meet the listings, she must "assess and make a finding a b o u t [the claimant's] residual functional capacity based on all the relevant medical and other e v id e n c e ." 20 C.F.R. § 404.1520(e). The ALJ then uses the residual functional capacity to d e te r m i n e at steps four and five whether the claimant can return to her past work or to d if f e re n t available work. Id. § 404.1520(f), (g). It is the claimant's burden to prove that she h a s a severe impairment that prevents her from performing past relevant work. 42 U.S.C. § 423(d)(2)(A); Clifford, 227 F.3d at 868. H e re , the ALJ determined at steps one and two of the analysis that Moore had been u n e m p lo ye d since January 13, 2005, and that she had a severe combination of impairments c o n s is tin g of lower back pain, migraine headaches, "possible Vicodin abuse," and "possible a n x ie ty disorder." (A.R. 48.) At step three the ALJ determined that Moore had only mild re s tric t i o n s in daily living, social functioning, and concentration, persistence, or pace, and th u s concluded that her impairments did not meet or medically equal any listed impairment. (Id. at 49-50.) P ro c e e d in g to step four of the analysis, the ALJ determined that Moore has a residual f u n c tio n a l capacity "to perform light work except that she is limited to occasional stooping, 9

crawling, climbing, crouching and kneeling; she also must avoid concentrated exposure to p u lm o n a ry irritants and temperature extremes." (A.R. 50.) The ALJ stated that Moore's " m e d ic a lly determinable impairments" could be expected to cause some of the symptoms she c la im e d to be experiencing, but found that her descriptions of the "intensity, persistence and lim itin g effects of these symptoms are not entirely credible." (Id. at 54.) The ALJ did not s a y which of the symptoms could be caused by the impairments, nor did she explain what le v e l of intensity, persistence, or limitation she believed that the symptoms caused. Instead, th e ALJ stated that Moore's complaints were out of proportion to the prescribed treatment, w h ic h the ALJ characterized as "conservative in nature." (Id. at 54-55.) She noted that M o o re had not followed her doctor's advice to exercise, quit smoking, or reduce her Vicodin in ta k e . (Id. at 54.) The ALJ also pointed to the lack of documentation to substantiate M o o re 's testimony that she once sought emergency treatment for a migraine and visited a n e u ro lo g ist. (Id.) The ALJ further noted Moore's unwillingness to return to a neurologist o r to seek mental health treatment for her panic attacks. (Id. at 54-55.) T h e ALJ determined that the opinions of Drs. Schuette and Zahtz were not entitled to controlling weight because, she found, their opinions "contrasts [sic] sharply with the other e v id e n c e of record," and because the "doctors [sic] own treatment notes fail to reveal the type o f significant clinical and laboratory abnormalities one would expect if the claimant were, in fact, disabled." (A.R. 55.) The ALJ did not say what weight she gave their opinions re g a rd i n g her migraines and back pain, but she gave no weight to their evaluation of her

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anxiety attacks because, she said, those opinions were "outside their areas of expertise." (Id.) The ALJ said that the physicians' course of treatment was inconsistent with "what one would e x p e c t if the claimant were truly disabled." (Id.) The ALJ gave "some weight" to the re s id u a l functional capacity submitted by a nonexamining physician employed by the State D is a b ility Determination Services, who opined that Moore was not disabled. (Id.) In c ra f tin g the residual functional capacity, the ALJ did not analyze Moore's or the doctor's d e s c rip tio n of the side effects of her medication. (Id. at 54-55.) H a v in g determined Moore's residual functional capacity, the ALJ concluded that M o o re is capable of returning to her past relevant work as an ophthalmology technician. (A.R. 55.) Relying on Radke's testimony that this job consists of "skilled and light work," th e ALJ stated that working as an ophthalmology technician "does not require the p e rf o rm a n c e of work-related activities precluded by the claimant's residual functional c a p a c ity." (Id.) The ALJ thus concluded that Moore is not under a disability as defined by th e Social Security Act, and denied her applications for SSI and DIB. (Id. at 56.) A n a ly s is In Moore's current motion for summary judgment, she attacks the ALJ's decision on m u ltip le fronts. First, Moore argues that the ALJ did not give proper weight to the opinions o f Drs. Schuette and Zahtz, Moore's treating physicians. She argues that their opinions are e n title d to controlling weight, and that even if they are due less weight, the ALJ failed to e x p la in what weight she ascribed to them and improperly drew her own medical conclusions

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about Moore's condition. Next, Moore argues that the ALJ improperly evaluated the residual f u n c tio n a l capacity because, according to Moore, she ignored the frequency of Moore's m ig ra in e s and did not explain how her assessment matches up with Moore's limitations. Finally, Moore attacks both the ALJ's credibility assessment and her analysis of Moore's past re le v a n t work. In responding to Moore's motion and moving for summary judgment himself, th e Commissioner has utterly failed to respond to a number of these well-developed a rg u m e n ts. The Commissioner submitted an eight-page brief, of which just under two pages c a n fairly be described as analysis. Even then, the Commissioner defends his decision with n o t much more than blanket conclusions and recitations of the applicable burdens of proof. P e rh a p s the Commissioner's incomplete response can be chalked up to reliance on the d e f e re n tia l standard under which this court reviews the ALJ's decision. This court asks only w h e th e r the ALJ applied the correct legal standards and reached a decision that is supported b y substantial evidence. 42 U.S.C. § 405(g); Buckner v. Astrue, 680 F.Supp.2d 932, 938 (N .D . Ill. 2010). Substantial evidence means "such relevant evidence as a reasonable mind m ig h t accept as adequate to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1 9 7 1 ) (quotation omitted). This court reviews the entire record in making the substantial e v id e n c e determination, but does not "reweigh the evidence, resolve conflicts, decide q u e s tio n s of credibility, or substitute our own judgment for that of the Commissioner." Clifford, 227 F.3d at 869. On the other hand, this court "cannot uphold an administrative d e c is io n that fails to mention highly pertinent evidence, or that because of contradictions or

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missing premises fails to build a logical bridge between the facts of the case and the o u tc o m e ." Parker v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010) (internal citations omitted). B e c a u s e Moore's disability claim hinges largely on her subjective complaints about th e intensity and frequency of her migraine headaches and other pain, the ALJ's adverse c re d ib ility finding is crucial, and this court begins its review there. Challenging an ALJ's c re d ib ility determination typically is an uphill battle; this court will affirm if the ALJ gives " s p e c if ic reasons that are supported by the record for his finding." Skarbek v. Astrue, 390 F .3 d 500, 505 (7th Cir. 2004). Moore argues here that the credibility finding is improper b e c a u s e the ALJ did not explain how her testimony was inconsistent with the medical record, d id not properly evaluate the factors used to evaluate subjective pain complaints, and e rro n e o u s ly concluded that Moore was not following her treatment protocol. In response, th e Commissioner states in a conclusory manner that the credibility finding should not be d is tu rb e d because the ALJ "expressly considered appropriate factors including the lack of s u f f ic ie n t objective medical evidence, medical opinion evidence of record, Plaintiff's a c tiv itie s , and her treatment and medications." (Def.'s Mem. at 8.) In her decision denying benefits, the ALJ wrote that Moore's "medically determinable im p a irm e n ts could reasonably be expected to produce some of the alleged symptoms, but the c la im a n t's statements concerning the intensity, persistence and limiting effects of these s ym p to m s are not entirely credible." As the Seventh Circuit recently pointed out, this precise la n g u a g e is boilerplate that is regularly used in social security disability cases, and worse than

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that, "it is meaningless boilerplate." Parker, 597 F.3d at 921-22. As the Seventh Circuit e x p la in e d , an ALJ's statement "that a witness's testimony `is not entirely credible' yields n o clue to what weight the trier of fact gave the testimony." Id. (emphasis in original) ; see a ls o Zurawski v. Halter, 245 F.3d 881, 887 (7th Cir. 2001). Indeed, here the ALJ gave this c o u rt no way to discern whether she thought Moore had lied to her doctors for years about h e r symptoms in an effort to obtain benefits fraudulently, whether she merely thought Moore w a s exaggerating all of her symptoms, or whether she thought Moore overstated some but n o t all of her symptoms. If it was the latter, this court cannot discern which of Moore's s ym p to m s the ALJ disbelieved. The ALJ's finding that Moore's complaints of pain are u n s u p p o rte d by objective medical evidence is unhelpful, because "[a]s countless cases e x p la in , the etiology of extreme pain often is unknown, and so one can't infer from the in a b ility of a person's doctors to determine what is causing her pain that she is faking it." P a rk e r , 597 F.3d at 922; see also Sims v. Barnhart, 442 F.3d 536, 538 (7th Cir. 2006) (noting th a t where a claimant's pain is "severe enough to be disabling, the fact that they have no o rg a n ic cause is irrelevant"). The ALJ did not explain what objective indicators one might e x p e c t to find along with disabling migraine pain, and points to nothing in the record to s u p p o rt her assumption that the absence of such indicators means Moore was lying. See P a rk e r , 597 F.3d at 922-923. Because objective evidence often is lacking where a disability claim stems from c o m p la in ts of pain, an ALJ is required to investigate and describe "the nature and intensity

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of claimant's pain, precipitation and aggravating factors, dosage and effectiveness of any p a in medications, other treatment for the relief of pain, functional restrictions, and the c la im a n t's daily activities." Zurawski, 245 F.3d at 887 (quoting Luna v. Shalala, 22 F.3d 6 8 7 , 691 (7th Cir. 1994). It is insufficient for the ALJ to merely cite those factors; instead s h e must examine the full range of evidence that relates to them. Id. at 887-88; see also T e r r y v. Astrue, 580 F.3d 471, 477 (7th Cir. 2009). Here the ALJ points to the lack of d o c u m e n ta tio n to support Moore's testimony that she once sought treatment for a migraine in an ER and visited a neurologist, but does not explain whether she concludes from that o m is s io n that those visits never happened or that the migraines never happened. (A.R. 545 5 .) The ALJ also criticizes Moore's unwillingness to follow-up with a neurologist even if s h e could do so for free, but Moore explained that her reluctance stemmed from the fact that th e first neurologist did not provide helpful treatment. See Parker, 597 F.3d at 922 (noting th a t claimant's decision not to pursue care that she considered unhelpful explains refusal to f o llo w -u p ). The ALJ also noted Moore's failure to seek mental health treatment for her panic a tta c k s and her failure to follow her doctors' advice to quit smoking, exercise, and cut back h e r use of Vicodin. (A.R. 54.) But Moore testified that Dr. Zahtz was treating her for panic a tta c k s , and the record shows that her ability to access additional treatment was limited by h e r lack of health insurance. There is no evidence to suggest that exercise would reduce M o o re 's migraines (her main complaint in seeking benefits). Nor is there any evidence that M o o re was taking more Vicodin than her doctor prescribed (and the record shows he cut

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back on her dose over time); if anything, her persistence in taking the full dose rather than c u ttin g back lends support to her claims that her pain was severe. But even if the ALJ's re lia n c e on Moore's failure to follow treatment protocol were well-supported, this court still c a n n o t tell which symptoms the ALJ believed and which she disbelieved. Simply put, the A L J did not provide an adequate explanation of how the factors for subjective complaints o f pain stack up in this case. See Zurawski, 245 F.3d at 887. Turning to the ALJ's handling of the treating physicians' assessments, Moore asserts th a t because Drs. Zahtz's and Schuette's evaluations of her residual functional capacity are c o n s is te n t, and because there are no differing opinions from other treating physicians, their o p in io n s are entitled to controlling weight. Under the "treating physician rule," the ALJ must " g iv e controlling weight to the medical opinion of a treating physician if it is `well-supported b y medically acceptable clinical and laboratory diagnostic techniques' and `not inconsistent w ith the other substantial evidence.'" Hofslien v. Barnhart, 439 F.3d 375, 376 (7th Cir. 2 0 0 6 ) (quoting 20 C.F.R. § 404.1527(d)(2)). But that presumption disappears if the

p h ys ic ia n s ' opinions are internally inconsistent, Schmidt, 496 F.3d at 842, or well-supported c o n tra d ic tin g evidence is introduced, Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008). As th e government points out, here the ALJ found that the treating doctors' opinions regarding M o o re 's limitations were not uncontroverted; a nonexamining state physician opined that M o o re 's migraines are not severe. The ALJ also found that Dr. Schuette's and Zahtz's a s s e s sm e n ts seem inconsistent with their course of treatment and notes. Given those

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potential weaknesses in the treating physicians' assessments, the ALJ was not required to g iv e Drs. Schuette's and Zahtz's opinions controlling weight.1 See Bauer, 532 F.3d at 608. B u t the ALJ's conclusion that the treating physicians' opinions are not entitled to c o n tro llin g weight did not permit her to disregard them altogether, and here the C o m m is s io n e r has not responded to Moore's alternative argument that the ALJ erroneously f a ile d to explain what weight their opinions are due, or what evidence she relied on to get f ro m the doctors' opinions that Moore's limitations are disabling to the ALJ's conclusion that M o o re is able to perform light work. The ALJ ascribed the nonexamining physician's o p in io n "some weight,"and noted that "as a general matter" the treating physicians' opinions a re entitled to more weight, but she did not say whether in this matter she gave Drs. S c h u e tte 's and Zahtz's opinions more deference, and if so, what level. From what this court c a n tell, she may have given them no weight--the treating physicians agreed, for example, th a t Moore needs to lie down throughout the day and is unable to sit for prolonged periods. Yet the ALJ's residual functional capacity assessment does not account for those limitations. Nothing in the ALJ's analysis explains that departure or builds the requisite logical bridge f ro m her recitation of the medical evidence to her conclusion. See Terry, 580 F.3d at 475. And as Moore points out, the ALJ's conclusions rest at least in part on her own medical

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Moore's related argument that the ALJ should have recontacted the treating physicians for f u rth e r explanation requires little attention. An ALJ is only required to recontact a physician f o r additional evidence if she finds the record inadequate to make a disability determination. 20 C.F.R. § 404.1512(e); Skarbek, 390 F.3d at 504. Here the ALJ viewed the record as u n c o n v in c in g rather than inadequate. 17

judgment that Drs. Schuette's and Zahtz's course of treatment was "conservative." She gives n o explanation for the basis of that characterization, nor does she describe what more a g g re s s iv e treatment one might expect to find for a person who suffers disabling migraine h e a d a c h e s and other pain. An ALJ is not permitted to simply swap her own medical judgment f o r the treating physicians', see Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565, 570 (7th Cir. 2 0 0 3 ); Clifford, 227 F.3d at 870, but given the lack of analysis applied to the medical e v id e n c e , this court cannot rule out that the ALJ did so here. Next Moore persuasively argues that the ALJ erroneously failed to account for the lim ita tio n s caused by her migraine headaches in her residual functional capacity and c o n s tru c te d an improper middle-ground assessment between the treating physicians' and n o n e x a m in in g physician's evaluations. Specifically, Moore points out that the ALJ found s h e suffered from a history of migraine headaches, but did not explain how the migraines im p a c t Moore's ability to work. An ALJ is required to discuss how she arrived at the re s id u a l functional capacity, citing record evidence to support her conclusions. Briscoe ex r e l. Taylor v. Barnhart, 425 F.3d 345, 352-53 (7th Cir. 2005). The ALJ must discuss the e v id e n c e that does not support her conclusion as well as that which supports it. Indoranto v . Barnhart, 374 F.3d 470, 474 (7th Cir. 2004) (noting ALJ must discuss how claimant's h e a d a c h e s impact ability to work). H e re , there was record evidence from Moore, Dr. Zahtz, and Dr. Schuette explaining th a t Moore experienced migraines two to five times a week, and that when the migraines

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occurred, she had to lie down until they passed, and even then she experienced hours of h e ig h te n e d sensations and lethargy. Dr. Zahtz explained that when Moore was experiencing a migraine, she was incapable of sitting or concentrating. Moore explained that she had been f ire d from her last job because the onset of her migraines is unpredictable and because she h a d to call in sick frequently. The vocational expert testified that a person who has to lie d o w n often or miss more than two work days per month is unemployable. Yet the ALJ c o n c lu d e d that Moore can perform "light work" as long as she is limited in "stooping, c ra w lin g , climbing, crouching, and kneeling" and avoids "concentrated exposure to p u lm o n a ry irritants and temperature extremes." That assessment is devoid of any analysis th a t matches up those limitations with the evidence regarding the severity and frequency of M o o re 's migraines.2 The Commissioner's only defense of the ALJ's assessment is to remind th e court that it is Moore's burden to prove her impairments prevent her from working and to argue that the ALJ did not think the severity of Moore's headaches were disabling. The C o m m is s io n e r is correct that it is Moore's burden to supply evidence, but it remains the A L J 's burden to provide a narrative discussion that explains the basis for the residual f u n c tio n a l capacity. Briscoe, 425 F.3d at 352. That discussion is missing here. The C o m m is s io n e r cites no language to support his assertion that the ALJ disbelieved the

2

The reference to "pulmonary irritants" is especially puzzling given the dearth of reference e ls e w h e re in the ALJ's decision (or in the record, that this court can see) describing p u lm o n a ry difficulties. 19

evidence regarding the severity of Moore's migraines. The only such language this court can f in d is the meaningless boilerplate described above. Finally, Moore argues that in concluding that she could return to her past work as an o p h th a lm o lo g y technician, the ALJ improperly failed to describe the requirements of that w o rk and did not discuss how Moore could meet those requirements given her limitations. In response, the Commissioner again points to the burden of proof and argues that it was M o o re 's responsibility to demonstrate that she cannot perform that past work. But once a g a in , the Commissioner conflates the claimant's evidentiary burdens with the ALJ's duty to explain her decision. In describing past relevant work, the ALJ is required to do more than c o n s id e r whether the claimant can perform "light" or "sedentary" work in general--instead, s h e must analyze "whether she could perform the duties of the specific jobs that she had h e ld ." Smith v. Barnhart, 388 F.3d 251, 252 (7th Cir. 2004); see also Nolen v. Sullivan, 939 F .2 d 516, 519 (7th Cir. 1991). Here, the ALJ stated succinctly that Moore can work as an o p h th a lm o lo g y technician because the vocational expert testified that someone with the re s id u a l functional capacity the ALJ assigned could perform "skilled and light work activity." As far as this court can tell, the ALJ did not consider, for example, how Moore's migraine trig g e rs and medication side effects would impact her ability to perform the specific re q u ire m e n ts of her past work. That is an analysis the ALJ should develop on remand. M o o re 's disability claim may not be air-tight, but neither is it frivolous, and it is not th is court's role to substitute its judgment for the ALJ's. The court is remanding this case

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because the ALJ's heavy reliance on boilerplate language and the absence of a logical bridge b e tw e e n the evidence and many of the conclusions--coupled with the Commissioner's tepid d e f e n s e of those conclusions--are roadblocks to adequate judicial review. On remand, the A L J must explain how the credibility factors related to pain stack up in this case, what level o f deference she ascribes to the treating physicians' opinions, how Moore's symptoms match u p with the residual functional capacity, and how Moore's limitations gel with the job re q u ire m e n ts of an ophthalmology technician. C o n c lu s io n F o r the foregoing reasons, Moore's motion for summary judgment is granted and the C o m m is s io n e r's motion for summary judgment is denied. This case is remanded for further p ro c e e d in g s consistent with this opinion. ENTER:

_________________________________ Y o u n g B. Kim U n ite d States Magistrate Judge

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