Brinkman v. Astrue
Filing
26
MEMORANDUM Opinion and Order Signed by the Honorable Daniel G. Martin on 1/9/2013.Mailed notice(lxs, )
IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
PATRICIA BRINKMAN
Plaintiff,
v.
MICHAEL J. ASTRUE
Commissioner of Social Security,
Defendant.
)
)
)
) Case No. 12 C 1397
)
) Magistrate Judge Daniel G. Martin
)
)
)
)
)
MEMORANDUM OPINION AND ORDER
Plaintiff Patricia Brinkman ("Plaintiff" or "Brinkman") seeks judicial review of a final
decision of Defendant Michael J. Astrue, the Commissioner of Social Security
("Commissioner"). The Commissioner denied Plaintiff's application for Disability Insurance
Benefits ("DIB") and Supplemental Security Income Benefits ("SSI") under Title II of the
Social Security Act, and Brinkman filed a Motion for Summary Judgment. The parties have
consented to have this Court conduct all proceedings in this case, including an entry of
final judgment. 28 U.S.C. § 636(e); N.D. Ill. R. 73.1(c). For the reasons stated below,
Plaintiff's motion is denied.
I. Legal Standard
A. The Social Security Administration Standard
In order to qualify for DIB, a claimant must demonstrate that he is disabled. An
individual does so by showing that he cannot "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. § 4243(d)(1)(A). Gainful activity is defined
as "the kind of work usually done for pay or profit, whether or not a profit is realized." 20
C.F.R. § 404.1572(b).
The Social Security Administration ("SSA") applies a five-step analysis to disability
claims. See 20 C.F.R. § 404.1520. The SSA first considers whether the claimant has
engaged in substantial gainful activity during the claimed period of disability. 20 C.F.R. §
404.1520(a)(4)(i). It then determines at Step 2 whether the claimant's physical or mental
impairment is severe and meets the twelve-month durational requirement noted above.
20 C.F.R. § 404.1520(a)(4)(ii).
At Step 3, the SSA compares the impairment (or
combination of impairments) found at Step 2 to a list of impairments identified in the
regulations ("the Listings"). The specific criteria that must be met to satisfy a Listing are
described in Appendix 1 of the regulations. See 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the
claimant's impairments meet or "medically equal" a Listing, the individual is considered to
be disabled, and the analysis concludes; if a Listing is not met, the analysis proceeds to
Step 4. 20 C.F.R. § 404.1520(a)(4)(iii).
Before addressing the fourth step, the SSA must assess a claimant's residual
functional capacity ("RFC"), which defines his exertional and non-exertional capacity to
work. The SSA then determines at the fourth step whether the claimant is able to engage
in any of his past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). If the claimant can do so,
he is not disabled. Id. If the claimant cannot undertake past work, the SSA proceeds to
Step 5 to determine whether a substantial number of jobs exist that the claimant can
perform in light of his RFC, age, education, and work experience. An individual is not
disabled if he can do work that is available under this standard.
2
20 C.F.R. §
404.1520(a)(4)(v).
B. Standard of Review
A claimant who is found to be "not disabled" may challenge the Commissioner's final
decision in federal court. Judicial review of an ALJ's decision is governed by 42 U.S.C. §
405(g), which provides that "[t]he findings of the Commissioner of Social Security as to any
fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C. § 405(g).
Substantial evidence is "such evidence as a reasonable mind might accept as adequate
to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). A court
reviews the entire record, but it does not displace the ALJ's judgment by reweighing the
facts or by making independent credibility determinations. Elder v. Astrue, 529 F.3d 408,
413 (7th Cir. 2008). Instead, the court looks at whether the ALJ articulated an "accurate
and logical bridge" from the evidence to her conclusions. Craft v. Astrue, 539 F.3d 668,
673 (7th Cir. 2008). This requirement is designed to allow a reviewing court to "assess the
validity of the agency's ultimate findings and afford a claimant meaningful judicial review."
Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002). Thus, even if reasonable minds could
differ as to whether the claimant is disabled, courts will affirm a decision if the ALJ's opinion
is adequately explained and supported by substantial evidence. Elder, 529 F.3d at 413
(citation omitted).
II. Background Facts
A.
Medical History
Brinkman was diagnosed with discoid lupus erthyematosus ("DLE") as early as June
1993, when cutaneous rashes were noticed on her face and hands. (R. 395). DLE "is a
3
set of skin changes that can occur as part of lupus, with or without systemic involvement."
The Merck Manual 269 (18th ed., 2006). The record is unclear on what treatment steps
she took after her 1993 diagnosis other than taking an oral steroid to alleviate her rashes.
A treatment note dated April 21, 1999 states that Brinkman had been encouraged to see
a specialist for her condition, but the record is not clear whether she did so at that time.
(R. 377). By March 2002, treating physician Dr. Evan Geissler noted that Brinkman had
lupus sun rashes and advised her to wear a protective sunscreen. (R. 373).
A treatment note in October 2005 by Dr. Kevin Joyce states that Brinkman had
consulted two rheumatologists about her lupus and had been treated with courses of oral
corticosteroids and topical creams. (R. 299). Dr. Joyce, who was seeing Brinkman due
to swelling in her legs, stated that it was "possible" that her lupus had become systemic.
However, little evidence supported a finding of "active lupus" at that time. (R. 300-01).
Nevertheless, Dr. Joyce ordered two antibody tests that are used to diagnose lupus, an
antinuclear antibody test ("ANA") and an anti-La antibody test ("SSB"). The results showed
that Brinkman's ANA and SSB levels were both 296, significantly over the high normal
range of 99. (R. 314).
The record is not clear on what course of treatment Brinkman underwent
immediately after these tests. Brinkman told Dr. Joyce on October 27, 2009 that she had
discontinued topical treatments for her lupus and that she managed her condition by
avoiding exposure to the sun. (R. 299). Blood tests performed earlier in September 2009
indicated an abnormal level of ANA antibodies, and the report states that Brinkman was
again encouraged to consult a rheumatologist.
(R. 405).
A treatment note dated
November 2009 also states that she was referred to a specialist for lupus. (R. 565). A
4
February 2010 progress note completed by a medical assistant indicates that Brinkman did
consult a rheumatologist, though the physician's name is not clear from the record. (R.
425). Brinkman continued to see her rheumatologist throughout 2010 and early 2011, and
tests showed that her antibodies remained in the high level. (R. 571-79). She was
prescribed Plaquenil to treat her condition. (R. 626).
Brinkman's physical discomfort was enhanced during this period by joint pain
stemming from her arthritis. An x-ray of her left hand on September 24, 2009 indicated
normal joint structures with smooth cortical margins. (R. 418). A follow-up x-ray in
February 2010 showed only "minimal degenerative changes" in each of Brinkman's hands
and "unremarkable" changes in her spine. (R. 440, 442). A treatment note states that she
was taking 10mg daily of prednisone, though it is not clear if that oral steroid was
prescribed for her lupus, arthritis, or for both conditions. (R. 574).
Brinkman was also treated for a variety of other physical and emotional conditions,
though there are few records for these treatments. Tests performed in May 2004 showed
that her thyroid stimulating hormone ("TSH") level was 12.85, more than double the
maximum normal range of 4.67, and a thyroid nuclear scan was ordered in June 2004. (R.
349, 351). She was diagnosed with thyroiditis and placed on the synthetic hormone
Synthroid by April 2009. (R. 539, 566). Thyroid tests done in February 2010 also
suggested continued high TSH levels. (R. 526-27).
As the ALJ noted, Brinkman also suffered from high blood pressure and was treated
with the medication Lisinopril. In addition, she was treated for depression from at least
2004 and was prescribed various antidepressant medications, particularly Zoloft. (R. 172,
353, 566). The Court notes that the record concerning Brinkman's mental health treatment
5
is sparse, and at times she denied feeling depressed. (R. 459).
B.
Consulting and Examining Physicians
The record contains the reports of several physicians who either examined
Brinkman or reviewed her records in order to determine the extent of her physical and
mental impairments.
1.
Dr. Muhammad Rafiq
On June 5, 2010, internal medicine specialist Dr. Muhammad Rafiq examined
Brinkman in LaGrange, Illinois. Brinkman told Dr. Rafiq that she required at least two naps
a day and experienced pain throughout her body. Notwithstanding, she also reported that
she could sit up to one hour, lift up to ten pounds, and stand for thirty minutes at a time.
Dr. Rafiq noted a lupus-related rash on her face, arms, and legs. He also found that
Brinkman could walk more than fifty feet without support and had a normal range of motion
in her shoulders, hips, knees, lumbar spine, and ankles. She had a normal ability to grasp
and grip with both hands. Dr. Rafiq noted that Brinkman was obese and weighed 194
pounds with a height of under five feet and five inches. He stated that Brinkman showed
no signs of depression at the examination, but Dr. Rafiq included depression as one of her
disorders, together with lupus, hypothyroidism, osteoarthritis, hypertension, dyslipidemia,
and CREST syndrome.1 (R. 468-71).
2.
Dr. Alan Jacobs
Brinckman was also examined by psychologist Dr. Alan Jacobs on the same day as
1
CREST syndrome is a limited cutaneous form of systemic scleroderma that
involves changes in the skin, blood vessels, muscles, and internal organs. See The Merck
Manuel 270 (18th ed. 2006).
6
she saw Dr. Rafiq. Dr. Jacobs noted that Brinkman had not received "formalized mental
health treatment" for her depression, although she was currently taking the antidepressant
medication Sertraline. Brinkman stated that her symptoms ebbed and flowed and that she
believed her depression was associated, at least in part, with her lupus. Dr. Jacobs noted
that she displayed some self-consciousness about her lupus-related skin rashes. After
consulting with her, Dr. Jacobs diagnosed Brinkman as suffering from major depression
associated with her lupus and hypothyroidism, bereavement, and anxiety. (R. 474-76).
3.
Dr. Virgilio Pilapil
On June 18, 2010, Dr. Virgilio Pilapil issued a physical RFC assessment for the
SSA. Dr. Pilapil found that Brinkman could work at the medium exertional level and had
the ability to lift fifty pounds occasionally and twenty-five pounds frequently. She could sit,
stand, and walk for up to six hours during a workday and had an unlimited capacity to push
and pull. Nevertheless, Dr. Pilapil did impose some non-exertional limits on her RFC.
These include findings that she could only occasionally climb stairs and should never be
required to balance due to obesity and hypertension. (R. 486-93).
4.
Dr. Lionel Hudspeth
The record also contains a Psychiatric Review Technique ("PRT") assessment
issued by Dr. Lionel Hudspeth on July 6, 2010. Dr. Hudspeth found that Brinkman suffered
from a major depressive disorder and anxiety. Under the Paragraph B criteria of Listing
12.04, he found that she had mild limitations in her activities of daily living and social
functioning, a moderate limitation in concentration, persistence, and pace, but that she had
not experienced any episodes of decompensation. No Paragraph C criteria were met. Dr.
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Hudspeth then assessed Brinkman's mental RFC by finding that she had moderate
limitations in her ability to accept instructions, set realistic goals, maintain attention, and
perform activities within a regular schedule. All other functional areas were found not to
be significantly limited. (R. 494-510).
C. Hearing Testimony
Brinkman testified at the June 29, 2011 hearing that she was forty-two years old and
lived with her husband and five-year old son. (R. 35). She last worked as a receptionist
for an insurance company from 1997 through 2004, when she left her job due to pain and
stress. (R. 37-41). Brinkman described her physical condition as including spasms in her
legs while driving, swelling in her feet, headaches, and skin rashes from her lupus. She
treats the pain in her feet with the medication Tramadol and various over-the-counter pain
relievers. (R. 42). Brinkman also stated that she must frequently stay indoors because of
her depression. (R. 43, 47).
Brinkman described her daily life as involving small tasks such as watching
television, engaging in activities with her son, and napping in the afternoon. (R. 46). Her
husband helps with cooking and laundry, and her mother assists in caring for her child
when Brinkman's symptoms prevent her from doing so. (R. 46-47). Brinkman testified that
she can stand for thirty minutes and is only able to walk a few blocks without experiencing
back pain. She can sit for up to an hour at a time and is able to lift no more than a gallon
of milk. (R. 48-49).
Vocational expert ("VE") Lee Knutson also testified at the hearing. The ALJ posed
six hypothetical questions to the VE about Brinkman's ability to work. She first asked the
VE to assume a person limited to light work who also had a number of non-exertional
8
limitations. These included a limited ability to climb stairs, and the capacity to perform only
routine tasks with simple instructions. The VE responded that a substantial number of jobs
existed that could be performed by a person with such a RFC. The ALJ then asked the VE
to assume a person limited to sedentary work. Again, the VE stated that work existed for
such a person.
Finally, the ALJ proposed four variations for a person who could only perform light
work. The first involved a claimant limited to frequent but not constant bilateral fingering.
The VE found that work was available for such a person. When bilateral fingering was
reduced from frequent to occasional, the VE responded that it would eliminate the jobs he
earlier identified if the restriction involved a claimant's dominant hand. However, jobs at
the sedentary level would be available. Third, if the additional limitation of fatigue were
added, the VE stated that no work could be performed. Finally, if a person needed to be
off task for thirty percent of the time, the VE again stated that work would not be available.
(R. 54-60).
D.
The ALJ's Decision
ALJ Sayon issued a written decision on August 23, 2011 and found that Brinkman
was not disabled. She determined at Step 1 that Brinkman had not engaged in substantial
work since her alleged onset date of June 1, 2004. (R. 15). At Step 2, the ALJ found that
Brinkman's
severe
impairments
included
lupus,
osteoarthritis, obesity, depression, and anxiety.
hypothyroidism,
(R. 16).
hypertension,
Brinkman's lupus and
osteoarthritis did not meet or medically equal a Listing at Step 3. (Id.). The ALJ also
applied at Step 3 the "special technique" required under 20 C.F.R. § 1520(a) for assessing
the severity of mental disorders. She determined that Brown had mild restrictions in her
9
activities of daily living and social functioning, together with a moderate restriction in her
concentration, persistence, and pace. (R. 16-17). No episodes of decompensation
existed, and the ALJ found that no Paragraph C criteria had been met. (R. 17).
Before moving to Step 4, the ALJ reviewed the medical record and Brinkman's
testimony in order to assess her RFC. With the exception noted below, the ALJ found that
Brinkman's statements about the limitations imposed by her symptoms were not credible.
Her RFC was assessed at light work with a variety of exertional and non-exertional
limitations. (R. 17-18). The ALJ then determined at Step 4 that Brown could not perform
her past relevant work. (R. 22). Based on the testimony of the VE, the ALJ concluded at
Step 5 that a substantial number of jobs existed in the national economy that Brinkman
could perform and that, as a result, she was "not disabled." (R. 23-24).
III. Discussion
Brinkman challenges the ALJ's decision on three grounds. She argues that the ALJ
erred by: (1) finding at Step 3 that her lupus did not meet or medically equal Listing 14.02
(systemic lupus erthyematosus); (2) finding that her statements were not credible; and (3)
not properly considering her RFC. The Court addresses each of these arguments in turn.
A.
Substantial Evidence Supports the ALJ's Step 3 Finding
Systemic lupus erthyematosus is "a chronic inflammatory disease that can affect
any organ or body system," including an individual's respiratory, cardiovascular, renal,
blood, skin, neurologic, mental, or immune systems. 20 C.F.R. Pt. 404, Subpt. P, App. 1
at § 14.00D1. Listing 14.02 states that a claimant can meet or medically equal the
requirements for SLE by demonstrating the existence of lupus accompanied by the:
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A. Involvement of two or more organs/body systems, with:
1. One of the organs/body systems involved to at least a moderate level
of severity; and
2. At least two of the constitutional symptoms or signs (severe fatigue,
fever, malaise, or involuntary weight loss).
or
B. Repeated manifestations of SLE, with at least two of the constitutional
symptoms or signs (severe fatigue, fever, malaise, or involuntary weight
loss) and one of the following at the marked level:
1. Limitation of activities of daily living.
2. Limitations in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in
concentration, persistence, or pace.
20 C.F.R. Pt. 404, Subpt. P, App. 1 at § 14.02.
The Court agrees with the Commissioner that substantial evidence supports the
ALJ's finding that Brinkman did not meet or medically equal either of these alternatives.
Listing 14.02A requires a claimant to show two things. She must first demonstrate that two
of her organs or body systems are moderately affected by SLE. Brinkman does not
address this point fully, but the record suggests that she met these criteria. Several
treating sources stated that Brinkman suffered from lupus-related skin rashes, and
examining psychologist Dr. Jacobs concluded that her depression was "associated with
lupus/hypothyroidism." (R. 476).
However, the record does not show that Brinkman satisfied Listing 14.02A's second
requirement that she suffer from at least two of the constitutional symptoms identified in
the Listing as severe fatigue, fever, malaise, or involuntary weight loss. Brinkman again
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does not address how the record relates to this portion of Listing 14.02A, but she argues
in other portions of her motion that she suffered from significant fatigue. Even if this were
sufficient to meet the fatigue element of Listing 14.02A.2, the record does not show that
Brinkman suffered from one of the other listed symptoms of malaise, fever, or involuntary
weight loss. Brinkman points out that her anitibody counts were elevated at times, but
antibody counts are not part of Listing 14.02A's criteria. She also claims that a person with
SLE should be expected to have the symptoms identified in Listing 14.02. See Doc. 16 at
12. Having a disorder, however, does not mean that a claimant necessarily experiences
all the symptoms that could be associated with it. See Boyd v. Astrue, No. 09 C 1217,
2009 WL 5149136, at *9 (N.D. Ill. Dec. 28, 2009) ("[A] condition that can cause certain
symptoms does not mean that the condition has caused those symptoms in a particular
case."). A claimant always bears the burden of showing that the evidence supporting her
condition meets or equals the criteria of a specific Listing. Maggard v. Apfel, 167 F.3d 376,
379-80 (7th Cir. 1999).
The record also fails to show how Brinkman can meet or medically equal Listing
14.02B. That Listing again contains two-prongs. First, Brinkman must show two of the
constitutional symptoms like fatigue and fever, and she has not done so. Second, she
must demonstrate that she has a "marked" limitation in at least one of the functional areas
of activities of daily living, social functioning, or concentration.
Brinkman does not
challenge the ALJ's findings as part of the special technique that she only experienced
"mild" limitations in the first two categories and had a "moderate" restriction in her
concentration. (R. 16-17). Brinkman claims in other parts of her motion that she has
"severe" limitations in her activities of daily living, but she fails to identify any part of the
12
record that supports this claim. In particular, Brinkman fails to address that Dr. Hudspeth's
PRT reached the same conclusions as the ALJ concerning her daily life, social functioning,
and concentration. In the absence of any argument on why the ALJ's findings fail to
properly account for the medical evidence, Brinkman has not shown how the record could
support a conclusion that she meets the requirements of Listing 14.02A or 14.02B. The
Motion for Summary Judgment is denied on the Listing issue.
B.
Substantial Evidence Supports the ALJ's Credibility Assessment
Brinkman next argues that the ALJ erred in finding that her statements concerning
the limiting effects of her symptoms were not credible. If an ALJ finds that a medical
impairment exists that could be expected to produce a claimant's alleged condition, he
must then assess how the individual's symptoms affect his ability to work. SSR 96-7p.
The fact that a claimant's subjective complaints are not fully substantiated by the record
is not a sufficient reason to find that he is not credible. The ALJ must consider the entire
record and "build an accurate and logical bridge from the evidence to his conclusion."
Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir. 2000). Factors that should be considered
include the objective medical evidence, the claimant's daily activities, allegations of pain,
any aggravating factors, the types of treatment received, any medications taken, and
functional limitations. Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir. 2006); see also
20 C.F.R. § 404.1529(c)(3); SSR 96-7p. A court reviews an ALJ's credibility decision with
deference and overturns it only when the assessment is patently wrong. Jones v. Astrue,
623 F.3d 1155, 1162 (7th Cir. 2010).
Brinkman presents a limited credibility argument that relies primarily on a comment
13
the ALJ made at Step 1. The ALJ noted that a 2005 treatment note from Dr. Kevin Joyce
stated that "she is continuing to work as a bartender," but that Brinkman had testified at the
hearing that she worked as a bartender for only two days in 2005. (R. 15, 37, 300). The
ALJ speculated that "'continuing to work' sounds more like an ongoing job, as opposed to
a two-day attempt at work." (R. 16). The ALJ then stated that the apparent contradiction
between Brinkman's testimony and Dr. Joyce's comment would be considered in her
credibility assessment. (Id.). Brinkman argues that the ALJ was not entitled to discount
her credibility due solely to Dr. Joyce's use of the word "continuing."
The Court agrees that the ALJ laid undue stress on Dr. Joyce's note, which appears
to be little more than a passing comment the physician made while interviewing Brinkman.
However, Brinkman overstates the ALJ's reliance on the note to reach her credibility
decision. The ALJ did not find Brinkman's testimony to be non-credible based only on Dr.
Joyce's comment, and she considered many of the factors required by SSR 96-7p. The
relevant question is whether substantial evidence supports the ALJ's finding based on her
discussion of those factors.
The ALJ gave considerable attention to the objective medical record, including the
results of Brinkman's x-rays and blood tests, and Brinkman fails to challenge many of her
key findings. The ALJ noted, for example, that x-rays of Brinkman's joints showed only
minimal degenerative changes, that her treating physician found little evidence of active
lupus, and that Brinkman had discontinued lupus treatment altogether at one point and
considered it to be inactive. (R. 21). The ALJ also reviewed Brinkman's tests and medical
consultations in detail and concluded that both her physical and mental treatment histories
were inconsistent with Brinkman's allegations of severe limitations. In particular, the ALJ
14
stated that the record did not provide evidence of the pain or mental distress that Brinkman
alleged had caused her to stop working in 2004.
Brinkman also fails to challenge the ALJ's finding that her pain-related claims were
inconsistent with comments she made to her doctors. The ALJ noted that Brinkman did
not report any pain in May and September 2009. (R. 19). She claimed a pain level of 5
out of 10 on November 12, 2009, but once again stated that her pain was at a 0 level only
ten days later. (R. 19, 456, 458). In early February 2010, Brinkman stated that her pain
was an 8 or 9 out of 10, but it was at the 0 level once more by February 26, 2010. (R. 19).
Brinkman briefly attempts to support her credibility by pointing out that 20 C.F.R. §
404.1529 requires a medical condition to exist that could be expected to produce a
claimant's symptoms. Social Security Ruling 96-7p elaborates on this requirement by
stating:
[O]nce an underlying physical or mental impairment(s) that could reasonably
be expected to produce the individual's pain or other symptoms has been
shown, the adjudicator must evaluate the intensity, persistence, and limiting
effects of the individual's symptoms to determine the extent to which the
symptoms limit the individual's ability to do basic work activities. For this
purpose, whenever the individual's statements about the intensity,
persistence, or functionally limiting effects of pain or other symptoms are not
substantiated by objective medical evidence, the adjudicator must make a
finding on the credibility of the individual's statements based on a
consideration of the entire case record.
SSR 96-7p. The basis of Brinkman's reliance on this provision to support her credibility is
unclear. She appears to be arguing that, because she was diagnosed with lupus and
arthritis, all of her pain-related allegations should be construed as credible because they
are the "expected" consequences of her conditions.
The Court finds this reasoning unpersuasive. As noted above, the existence of a
15
medical condition does not mean that all of a claimant's pain allegations must be accepted
as true. Social Security Ruling 96-7p makes clear that a credibility assessment is required
only after a medical condition is established. That does not mean, however, that all
"expected" symptoms of a condition will always be present in a particular case, or that a
claimant's allegations must be taken as true just because she has a specific medical
condition. If Brinkman's claim were correct, the ALJ's credibility assessment would not be
necessary at all because Brinkman's diagnosed conditions would themselves verify her
claims. That is clearly not the case, and the ALJ properly turned to the requirements for
assessing credibility under SSR 96-7p once she determined that Brinkman suffered from
medical conditions that could reasonably be expected to give rise to her symptoms.
Part of this analysis was based on the ALJ's consideration of Brinkman's activities
of daily living. As discussed above, Brinkman fails to address the basis for the ALJ's
conclusion that she only experienced mild limitations in this functional area. The ALJ also
considered the side effects of Brinkman's medications to some degree. She noted that
Brinkman took oral and topical corticosteroids for lupus-related rashes; Wellbutrin, Zoloft,
and Effexor for depression; Methotrexate for headaches; and Ultram for foot pain.2 The
ALJ noted that Brinkman experiences nausea from both Methotrexate and steroids. (R.
18). Brinkman objects that the ALJ did not consider all the side effects of her medications,
but remand is not required just because the ALJ did not discuss every aspect of her
medication in full. See Clay v. Apfel, 64 F. Supp.2d 774, 781 (N.D. Ill. 1999) (stating that
an ALJ is not necessarily required to discuss all of the seven credibility factors, even
2
The ALJ failed to note that Brinkman took Synthroid for her thyroiditis and took
Lisinopril to control her blood pressure.
16
though she is obligated to "consider" them).
Finally, Brinkman contends that the ALJ failed by not considering her testimony that
she often feels tired and is required to take naps during the day. This argument fails on
several grounds. It is not true that the ALJ rejected Brinkman's claims out of hand, as she
states. To the contrary, the ALJ explicitly restricted the RFC to "routine" work with no
exposure to heights because Brinikman "testified that she is always tired." (R. 22). The
ALJ also did not fail to take account of Brinkman's testimony on this issue. The ALJ
considered the complaints of fatigue Brinkman made to her consulting physicians, her
testimony at the hearing, and even statements about tiredness that Brinkman made as
early as 2003. (R. 18-22). The ALJ simply did not find that Brinkman's fatigue was as
severe as she alleged. Brinkman claims that the ALJ failed to consider that the combined
effect of her many medications was "likely" to cause this tiredness. (Doc. 16 at 12).
However, Brinkman did not testify that she was tired because of her medicine, and she has
not cited any evidence on what effects could result from a combination of her medications.
The Court recognizes that the ALJ's credibility discussion is not without flaws. She
could have discussed the reasons for her decision in greater detail and should have
provided a more thorough explanation of her reasoning. However, the Court cannot say
that the ALJ's credibility assessment as a whole is patently incorrect. Brinkman's motion
is denied on the credibility issue.
C.
Substantial Evidence Supports the RFC
Finally, Brinkman argues that the ALJ's hypothetical question to the VE at Step 5
was flawed because it failed to include limitations that would have reduced her RFC from
the light exertional level to the less onerous level of sedentary work. As discussed earlier,
17
the ALJ posed an initial question to the VE that reflected Brinkman's RFC. She then added
increasingly restrictive limitations to this hypothetical. Brinkman cites several of these
restrictions, including the ability to handle and finger objects, the need to take naps, and
the possibility that she might need to be off-task for portions of each day. Brinkman
appears to claim that if the RFC had included these extra limitations, the ALJ would have
been required to find her disabled.3
Brinkman fails to cite any part of the record that supports her claim that the ALJ
should have accommodated her fatigue more than limiting her to routine work without
exposure to heights. The Court has carefully reviewed the record and finds that substantial
evidence supports the ALJ's finding that Brinkman did not need extensive work breaks.
Dr. Hudspeth found that she had "moderate" restrictions in persistence and pace and had
no significant limitations in the ability "to perform at a consistent pace without an
unreasonable number and length of rest periods." (R. 504, 509). Dr. Pilapil's physical RFC
determined that Brinkman could perform work at the medium exertional level and could sit,
stand, and walk for up to six hours a day with only normal breaks. (R. 487). The RFC did
not include any finding that Brinkman needed additional break periods during the workday.
As for her ability to handle objects, Dr. Pilapil found that Brinkman had no manipulative
limitations, including both gross and fine manipulation. (R. 489).
3
The exact nature of Brinkman's claim is not clear. She appears to be contesting
the RFC assessment itself, not the ALJ's Step 5 decision. See Arnett v. Astrue, 676 F.3d
586, 591 (7th Cir. 2012) (noting that claimant's "contention that at Step 5 the ALJ
constructed a hypothetical built around a flawed RFC adds nothing to her challenge to the
RFC"). The Commissioner interprets Brinkman's argument in this manner, and she does
not state otherwise in the reply brief. In the absence of any argument to the contrary, the
Court agrees with the Commissioner that Brinkman's primary concern is whether the ALJ
should have included the additional restrictions she identifies as part of the RFC.
18
Brinkman has not challenged these findings or argued that the ALJ erred by relying
on these conclusions to reach her RFC. As a result, Brinkman has not shown why the
RFC should have included additional limitations concerning fingering, handling, and rest
periods. Brinkman's motion is denied on this issue.
IV. Conclusion
For these reasons, the Court denies Brinkman's Motion for Summary Judgment [16]
and affirms the Commissioner's final decision. The case is closed.
ENTERED:
__________________________________
DANIEL G. MARTIN
United States Magistrate Judge
Dated: January 9, 2013
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