Johnson v. Colvin

Filing 21

MEMORANDUM Opinion and Order Signed by the Honorable Mary M. Rowland on 8/23/2017. Mailed notice. (dm, )

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
SARAH L. JOHNSON,
Plaintiff,
v.
NANCY A. BERRYHILL, 1 Acting
Commissioner of Social Security,

No. 16 C 8850
Magistrate Judge Mary M. Rowland

Defendant.
MEMORANDUM OPINION AND ORDER
Plaintiff Sarah Johnson filed this action seeking reversal of the final decision of
the Commissioner of Social Security denying her application for Disability
Insurance Benefits and Supplemental Security Income under Titles II and XVI of
the Social Security Act (Act). 42 U.S.C. §§ 405(g), 423 et seq. The parties have
consented to the jurisdiction of the United States Magistrate Judge, pursuant to 28
U.S.C. § 636(c), and filed cross motions for summary judgment. For the reasons
stated below, the case is remanded for further proceedings consistent with this
Opinion.
I. THE SEQUENTIAL EVALUATION PROCESS
To recover Disability Insurance Benefits (DIB), a claimant must establish that
he or she is disabled within the meaning of the Act. 2 York v. Massanari, 155 F.
Nancy A. Berryhill is substituted for her predecessor, Carolyn W. Colvin, pursuant to
Federal Rule of Civil Procedure 25(d).
1

Supp. 2d 973, 977 (N.D. Ill. 2001). A person is disabled if he or she is unable to
perform “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.” 20 C.F.R. § 404.1505(a). In determining whether a claimant suffers from a
disability, the Commissioner conducts a standard five-step inquiry:
1. Is the claimant presently unemployed?
2. Does the claimant have a severe medically determinable physical
or mental impairment that interferes with basic work- related
activities and is expected to last at least 12 months?
3. Does the impairment meet or equal one of a list of specific
impairments enumerated in the regulations?
4. Is the claimant unable to perform his or her former occupation?
5. Is the claimant unable to perform any other work?
20 C.F.R. §§ 404.1509, 404.1520; see Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir.
2000). “An affirmative answer leads either to the next step, or, on Steps 3 and 5, to
a finding that the claimant is disabled. A negative answer at any point, other than
Step 3, ends the inquiry and leads to a determination that a claimant is not
disabled.” Zalewski v. Heckler, 760 F.2d 160, 162 n.2 (7th Cir. 1985). “The burden of
proof is on the claimant through step four; only at step five does the burden shift to
the Commissioner.” Clifford, 227 F.3d at 868.
The regulations governing the determination of disability for DIB are found at 20
C.F.R. § 404.1501 et seq. The SSI regulations are set forth at 20 C.F.R. § 416.901 et seq.
The standard for determining DIB is virtually identical to that used for SSI. Craft v. Astrue,
539 F.3d 668, 674 n.6 (7th Cir. 2008) (“Although the Code of Federal Regulations contains
separate sections for DIB and SSI, the processes of evaluation are identical in all respects
relevant to this case.”). Accordingly, this Court cites to both DIB and SSI cases.
2

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II. PROCEDURAL HISTORY
Plaintiff protectively applied for Disability Insurance Benefits (DIB) and
Supplemental Security Income (SSI) on April 1, 2013, alleging that she became
disabled on March 1, 2013, due to a history of chronic discoid lupus, cognitive delay,
and dyslexia. (R. at 64). These claims were denied initially and upon
reconsideration, after which Plaintiff filed a timely request for a hearing. (Id. at 16,
122–23). On November 17, 2014, Plaintiff, represented by counsel, testified at a
hearing before Administrative Law Judge (ALJ) David R. Bruce. (Id. at 16, 30–63).
The ALJ also heard testimony from Tricia Oakes, a vocational expert (VE). (Id.).
The ALJ denied Plaintiff’s request for benefits on May 12, 2015. (R. at 16–24).
Applying the five-step sequential evaluation process, the ALJ found, at step one,
that Plaintiff had not engaged in substantial gainful activity since her alleged onset
date of March 1, 2013. (Id. at 18). At step two, the ALJ found Plaintiff’s discoid
lupus to be a severe impairment. (Id. at 18–19). At step three, the ALJ determined
that Plaintiff does not have an impairment or combination of impairments that
meet or medically equal the severity of any of the listings enumerated in the
regulations. (Id. at 19).
The ALJ then assessed Plaintiff’s Residual Functional Capacity (RFC) 3 and
determined that Plaintiff has the RFC to perform a full range of work at all
exertional levels but with the following non-exertional limitations:

Before proceeding from step three to step four, the ALJ assesses a claimant’s residual
functional capacity. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). “The RFC is the maximum
3

3

[Plaintiff] should avoid all exposure to unprotected heights; moving
mechanical parts, or operat[ing] a motor vehicle as part of the job.
[She] must avoid concentrated exposure to weather including sunlight
and extremes of heat.
(R. at 19). The ALJ determined at step four that Plaintiff had no past relevant
work. (Id. at 23). At step five, based on Plaintiff’s RFC, her vocational factors, and
the VE’s testimony, the ALJ determined that there are jobs that exist in significant
numbers in the local economy that Plaintiff can perform, including small parts
assembler, mail clerk, and plastic product assembler. (Id. at 23–24). Accordingly,
the ALJ concluded that Plaintiff was not under a disability, as defined by the Act,
from the alleged onset date through the date of the ALJ’s decision. (Id. at 24).
The Appeals Council denied Plaintiff’s request for review on July 21, 2016.
(R. at 1–3). Plaintiff now seeks judicial review of the ALJ’s decision, which stands as
the final decision of the Commissioner. Villano v. Astrue, 556 F.3d 558, 561–62 (7th
Cir. 2009).
III. STANDARD OF REVIEW
Judicial review of the Commissioner’s final decision is authorized by § 405(g) of
the Act. In reviewing this decision, the Court may not engage in its own analysis of
whether the plaintiff is severely impaired as defined by the Social Security
Regulations. Young v. Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004). Nor may it
“reweigh evidence, resolve conflicts in the record, decide questions of credibility, or,
in general, substitute [its] own judgment for that of the Commissioner.” Id. The
that a claimant can still do despite his mental and physical limitations.” Craft v. Astrue,
539 F.3d 668, 675-76 (7th Cir. 2008).

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Court’s task is “limited to determining whether the ALJ’s factual findings are
supported by substantial evidence.” Id. (citing § 405(g)). Evidence is considered
substantial “if a reasonable person would accept it as adequate to support a
conclusion.” Indoranto v. Barnhart, 374 F.3d 470, 473 (7th Cir. 2004); see Moore v.
Colvin, 743 F.3d 1118, 1120–21 (7th Cir. 2014) (“We will uphold the ALJ’s decision
if it is supported by substantial evidence, that is, such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.”) (citation
omitted). “Substantial evidence must be more than a scintilla but may be less than
a preponderance.” Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007). “In addition
to relying on substantial evidence, the ALJ must also explain his analysis of the
evidence with enough detail and clarity to permit meaningful appellate review.”
Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005).
Although this Court accords great deference to the ALJ’s determination, it “must
do more than merely rubber stamp the ALJ’s decision.” Scott v. Barnhart, 297 F.3d
589, 593 (7th Cir. 2002) (citation omitted). “This deferential standard of review is
weighted in favor of upholding the ALJ’s decision, but it does not mean that we
scour the record for supportive evidence or rack our brains for reasons to uphold the
ALJ’s decision. Rather, the ALJ must identify the relevant evidence and build a
‘logical bridge’ between that evidence and the ultimate determination.” Moon v.
Colvin, 763 F.3d 718, 721 (7th Cir. 2014). Where the Commissioner’s decision “lacks
evidentiary support or is so poorly articulated as to prevent meaningful review, the
case must be remanded.” Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir. 2002).
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IV. RELEVANT MEDICAL EVIDENCE
On October 19, 2012, Plaintiff presented to the emergency department at
Regions Hospital with complaints of scalp itchiness, sores, and pus pockets. (R. at
306). Plaintiff reported a history of scalp sores secondary to discoid lupus
erythematosus (DLE) for several years. (Id.). The sores were located over the back
of her head. (Id.). Plaintiff stated the sores were improving with steroid shots and
prescription strength steroid creams in 2006, but she could no longer afford them
and had to switch to over-the-counter hydrocortisone cream and triple antibiotic
cream only. (Id.). She indicated that her sores worsen intermittently due to stress or
colds. (Id.). Plaintiff stated that lately her sores were the worst they had ever been,
despite no increase in stress level, and the over-the-counter creams were no longer
providing relief. (Id.). A physical examination by Dr. Bradley Hernandez revealed a
“tender, pink, balding patch of inflamed skin the size of a Yamaka located at the
same location of a Yamaka.” (Id. at 307). (Id.). There was a second, small 2.5 cm
sore located posteriorly to the left ear. (Id.). Dr. Hernandez assessed alopecia and
discoid lupus, and discharged Plaintiff home with a prescription of Lidex cream.
(Id.).
Plaintiff returned to Regions Hospital on March 18, 2013, for an evaluation of a
“pus pocket” on the top of her head, and expressed concern that her discoid lupus
was spreading. (R. at 324). She reported that the lesions were restricted to her
scalp, but that she had “dry patches” on her forearms. (Id.). She was taking the
Lidex twice daily. (Id.). Upon physical examination, Dr. Joel Holger noted
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atraumatic lesions in the midline anterior scalp with multiple areas of hair loss,
inflammatory areas on occiput and the crown of the head, and a firm, hard lesion of
chronic discoid lupus erythematosus. (Id. at 325). Plaintiff was prescribed Percocet
and instructed to follow up with a dermatologist within the week. (Id.).
On March 28, 2013, Plaintiff sought treatment from Michelle Ovando, PA-C, at
Dermatology Associates. (R. at 344). Plaintiff reported flaring for the past six
months, particularly in recent weeks. (Id.). Plaintiff noted pus lumps, sore flares,
and achy joints. (Id.). A physical examination revealed multiple 1–2 cm cysts, 2–3
positive diffuse pink “A2” patches, and a left infected abscess with drainage. (Id.).
PA Ovando ordered routine labs and prescribed Bactrim. (Id.). The following week,
Plaintiff’s scalp cyst was noted to be resolving, although two or more discoid lesions
were still present. (Id. at 351). Plaquenil 4 was initiated at this time. (Id.). When
Plaintiff returned for a follow-up visit in May, Plaintiff reported she was “doing ok,”
and one or two active patches were noted on the scalp. (Id. at 352). Bactrim was
discontinued due to side effects. (Id.).
On August 10, 2013, Plaintiff presented to internal medicine physician David
Ellens, M.D., 5 for an evaluation. (R. at 394). Plaintiff gave a history of systemic
lupus, and reported she was presently seeing a dermatologist concerning her
alopecia due to scarring from her lupus, and that she was receiving injections in her

Plaquenil is an antirheumatic medicine and is used to treat symptoms of rheumatoid
arthritis and discoid or systemic lupus erythematosus.
<https://www.drugs.com/plaquenil.html>
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5

The ALJ and both parties erroneously referred to Dr. Ellens as “Dr. Ellen.”

7

scalp areas for treatment. (Id.). She reported occasional fatigue and tiredness. (Id.).
Dr. Ellens observed multiple areas of balding scarring on the scalp and assessed
alopecia and systemic lupus erythematosus. (Id. at 395). Plaintiff was given a
referral to a rheumatologist for further evaluation. (Id.).
Plaintiff returned to PA Ovando on August 13, 2013. (R. at 358, 405). Three or
more erythematous patches with alopecia were noted. (Id. at 358). Plaquenil was
continued, and betamethasone dipropionate cream (Beta Dip) 6 was prescribed for
the scalp. (Id. at 358, 405). A few days later, Plaintiff reported having a flare up on
her scalp, which seemed to be related to using the Beta Dip. (Id. at 357). The
following week, Plaintiff reported feeling “a little better” and less sore. (Id. at 360).
However, the patches on the scalp remained. (Id. at 360, 403).
On September 13, 2013, Plaintiff returned to Dr. Ellens for a complete physical
and public aid evaluation. (R. at 393). Physical examination was relatively normal;
Dr. Ellens again noted the multiple areas of balding scarring on the scalp area. (Id.
at 394). Plaintiff’s complaints of occasional fatigue and tiredness persisted. (Id. at
393).
Plaintiff presented to Raymond Kazmar, M.D., a rheumatologist with South
Suburban Arthritis Group, for an initial evaluation on October 16, 2013. (R. at 488–
89). Dr. Kazmar assessed severe discoid lupus causing loss of hair, along with skin
thinning, areas of induration and severe tenderness and infected blisters requiring
Betamethasone dipropionate cream is a topical corticosteroid used for reducing itching,
redness, and swelling associated with many skin conditions. <
https://www.drugs.com/cdi/betamethasone-dipropionate-cream.html>
6

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antibiotic treatment. (Id. at 488). Similar lesions were noted on the left ear, right
eye, and facial area. (Id.). Dr. Kazmar noted that Plaintiff needed chronic use of
Prednisone, Plaquenil, and steroid cream. (Id.). He indicated that a reduction in
medications caused a flare up of skin lesions. (Id.). Dr. Kazmar further assessed
arthritis pain in the knees and spine, and ordered x-rays of both knees. (Id.).
At a routine check-up with Dr. Ellens on November 13, 2013, Plaintiff reported
no flares of her lupus but continued to complain of occasional tiredness and fatigue.
(R. at 392). The next day, Plaintiff followed up with Dr. Kazmar. (Id. at 486–87). Dr.
Kazmar noted scattered areas of redness and tenderness on the scalp and
recommended continued use of the Prednizone and Plaquenil. (Id.). On December
28, 2013, Plaintiff’s DLE appeared to be controlled with medications, although
Plaintiff reported occasional scalp tenderness and itchy, dry patches on her arms
and legs. (Id. at 381). PA Ovando assessed “eczematous dermatitis, legs and arms.”
(Id. at 402). By February 2014, the eczematous dermatitis had spread to the face
and shoulders. (Id. at 380, 401). Cephalexin was prescribed and Allegra was
recommended. (Id.).
In January 2014, Plaintiff returned to Dr. Kazmar with complaints of bilateral
knee pain, especially when ascending/descending stairs and when squatting. (R. at
483, 485–86). A physical examination revealed tenderness of the medial patellar
joint line. (Id. at 485). X-rays of the knees performed on January 20, 2014, were
unremarkable, with no evidence of significant joint degeneration. (Id. at 484).

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Plaintiff next followed up with Dr. Ellens on January 31, 2014, requesting
assistance with completing her disability packet. (R. at 391). Plaintiff expressed
concern about intermittent chest pain and reported pain in her legs for the past few
months. (Id.). She also stated that the medicated lotion prescribed by dermatology
was causing her to itch. (Id.). Plaintiff reported occasional fatigue and tiredness and
occasional swelling of the extremities, but denied shortness of breath. (Id.). Dr.
Ellens completed Plaintiff’s disability packet and instructed Plaintiff to discontinue
use of the medication lotion and switch to Vaseline. (Id.).
Plaintiff consulted with Kelly Rychter, D.O., with South Suburban Cardiology
Associates, on March 3, 2014, regarding her complaints of chest pain and dyspnea.
(R. at 374–76). Plaintiff indicated that in the past few months, she had been
experiencing sharp chest pains lasting only a few seconds unrelated to exertion, and
shortness of breath when walking. (Id. at 374). Plaintiff additionally reported joint
aches, fatigue, and dizziness, and a rash was noted on physical examination. (Id. at
374, 376). Dr. Rychter recommended a cardiac stress test for further evaluation of
Plaintiff’s symptoms. (Id. at 376). The stress test was inconclusive and had to be
stopped due to generalized fatigue. (Id. at 425). The impression was a severe
reduced exercise tolerance for Plaintiff’s age and gender. (Id.). When Plaintiff
followed up with Dr. Rychter on April 7, 2014, she again reported complaints of
chest pain, shortness of breath with exertion, joint aches, fatigue, and dizziness. (Id.
at 371). Plaintiff stated that she had been feeling more fatigued than usual, and her
rash was still present on physical examination. (Id. at 371–72).
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Dr. Kazmar noted continued bilateral patellofemoral knee pain and a new onset
of lumbar spine pain on April 10, 2014. (R. at 482). Plaintiff had contacted Dr.
Kazmar in February and reported calf and posterior thigh pain. (Id. at 483). She
indicated that this pain had increased in intensity since that time. (Id. at 482). Dr.
Kazmar prescribed Mobic 7 and ordered x-rays of the lumbar and thoracic spines,
which were negative. (Id. at 480–82). On June 12, 2014, at Plaintiff’s final visit of
record with Dr. Kazmar, Plaintiff reported scalp tenderness, severe knee pain with
squatting and climbing stairs, and spinal discomfort at thirty degrees lumbar
flexion. (Id. at 479). Subsequent x-rays of the hips and pelvis were normal. (Id. at
426).
Plaintiff continued to complain of feeling tired and fatigued at her next two
visits with Dr. Ellens in August and September 2014. (R. at 387–89). On September
3, 2014, Plaintiff reported a scalp “flare” and continued joint pain. (Id. at 379).
Mupiricin ointment was prescribed for multiple “crusty” spots on Plaintiff’s scalp.
(Id. at 379, 400). In October 2014, Plaintiff reported shortness of breath with
exertion. (Id. at 388).
Plaintiff testified that she experiences pain every day in her back and her knees.
(R. at 45). She described the pain as a “dull ache” that is constantly present. (Id.).
Getting up and moving around makes the pain worse. (Id.). Plaintiff stated that she
can stand for about five minutes, and usually lays down for about an hour during
Mobic (meloxicam) is a nonsteroidal anti-inflammatory drug (NSAID). Mobic is used to
treat pain or inflammation caused by rheumatoid arthritis and osteoarthritis in adults.
https://www.drugs.com/Mobic.html.
7

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the day. (Id. at 47). She estimated that she can walk past only two or three houses
before having to stop and catch her breath. (Id.). In addition, her sores cause severe
pain and migraine headaches. (Id. at 52). Plaintiff has difficulty concentrating at all
times because of the pain, the rashes, the itching, and the migraines. (Id.).
Plaintiff typically has three or four bad days a week. (R. at 50). On her bad days,
she is unable to do much at all. (Id.). She has trouble sleeping at night because of
her pain and her medications. (Id. at 48). Plaintiff testified that, although her
current medications help to a certain extent, she feels like the medications also
make “different things” act up, and seem to make things worse. (Id. at 42–43). She
stated that her skin breaks out, and she gets rashes on her face, chest, shoulders,
legs, and stomach. (Id. at 43). Other side effects from her medications include
nausea, migraines, and dizziness. (Id. at 53). They also occasionally make her
emotional (i.e., stressed out and worried). (Id.).
She is able to care for herself and perform minor household tasks, such as
folding clothes, cooking, and washing dishes. (R. at 48). Plaintiff reported challenges
in caring for her three year-old son, including being unable to lift him or play with
him because he moves too fast. (Id. at 48–49). Plaintiff indicated that Dr. Ellens
instructed her not to lift her son because it exacerbates her back pain. (Id. at 49).
V. DISCUSSION
Plaintiff contends that the ALJ’s decision contains errors of law and is not
supported by substantial evidence because (1) the ALJ failed to consider Listing
14.02 (systemic lupus erythematosus) and Listing 12.05(C) (intellectual disability);
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(2) the ALJ improperly weighed the medical opinions regarding Plaintiff’s mental
and physical impairments, and (3) the ALJ improperly assessed Plaintiff’s
credibility and subjective symptoms. (Dkt. 15 at 4–15).
A. The ALJ Did Not Properly Evaluate the Treating Physician’s Opinion
Plaintiff first argues that, in light of Dr. Ellens’s opinion that Plaintiff met or
equaled Listing 14.02, 8 it was error for the ALJ to omit consideration of that issue.
(Dkt. 14 at 7–8). In general, the claimant bears the burden of proving her condition
meets all the criteria of a listing. Ribaudo v. Barnhart, 458 F.3d 580, 583 (7th Cir.
2006). However, an ALJ’s listing determination “must discuss the listing by name
and offer more than a perfunctory analysis of the listing.” Barnett v. Barnhart, 381
F.3d 664, 668 (7th Cir. 2004) (citing Brindisi ex rel. Brindisi v. Barnhart, 315 F.3d
783, 786 (7th Cir. 2003)); Scott, 297 F.3d at 595–96; Steele, 290 F.3d at 940. If
evidence exists in the record that might establish that a listing’s criteria have been
met, as is the case here, an ALJ cannot simply ignore it without explanation.
Ribaudo, 458 F.3d at 583. Thus, the ALJ’s failure to provide any analysis of why
Plaintiff's impairments did not satisfy Listing 14.02 is particularly problematic

8

Listing 14.02, systemic lupus erythematosus (SLE), requires:

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. Limitation in maintaining social functioning.
3. Limitation in completing tasks in a timely manner due to deficiencies in concentration,
persistence, or pace.

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considering that the medical evidence of record suggests that Plaintiff may be
disabled under either or both of two subsections of Listing 14.02. Accordingly,
Plaintiff contends that the ALJ ran afoul of the treating physician rule by not
affording controlling weight to Dr. Ellens’s opinion that she met or equaled Listing
14.02.
By rule, “in determining whether a claimant is entitled to Social Security
disability benefits, special weight is accorded opinions of the claimant’s treating
physician.” Black & Decker Disability Plan v. Nord, 538 U.S. 822, 825 (2003). The
opinion of a treating source is entitled to controlling weight if the opinion “is wellsupported by medically acceptable clinical and laboratory diagnostic techniques and
is not inconsistent with the other substantial evidence.” 20 C.F.R. § 404.1527(d)(2);
accord Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008). A treating physician
typically has a better opportunity to judge a claimant’s limitations than a
nontreating physician. Books v. Chater, 91 F.3d 972, 979 (7th Cir. 1996); Grindle v.
Sullivan, 774 F. Supp. 1501, 1507–08 (N.D. Ill. 1991). “More weight is given to the
opinion of treating physicians because of their greater familiarity with the
claimant’s conditions and circumstances.” Gudgel v. Barnhart, 345 F.3d 467, 470
(7th Cir. 2003). Therefore, an ALJ “must offer ‘good reasons’ for discounting a
treating physician’s opinion,” and “can reject an examining physician’s opinion only
for reasons supported by substantial evidence in the record; a contradictory opinion
of a non-examining physician does not, by itself, suffice.” Campbell v. Astrue, 627

14

F.3d 299, 306 (7th Cir. 2010) (citing 20 C.F.R. § 404.1527(d)(2); other citation
omitted).
Furthermore, even where a treater’s opinion is not given controlling weight, an
ALJ must still determine what value the assessment does merit. Scott v. Astrue, 647
F.3d 734, 740 (7th Cir. 2011); Campbell, 627 F.3d at 308. In making that
determination, the regulations require the ALJ to consider a variety of factors,
including: (1) the nature and duration of the examining relationship; (2) the length
and extent of the treatment relationship; (3) the extent to which medical evidence
supports the opinion; (4) the degree to which the opinion is consistent with the
entire record; (5) the physician’s specialization if applicable; and (6) other factors
which validate or contradict the opinion. 20 C.F.R. § 404.1527(d)(2)–(6). In sum,
“whenever an ALJ does reject a treating source’s opinion, a sound explanation must
be given for that decision.” Punzio v. Astrue, 630 F.3d 704, 710 (7th Cir. 2011)
(citing 20 C.F.R. § 404.1527(d)(2)).
The ALJ’s opinion must build an “accurate and logical bridge from the evidence
to [the] conclusion so that [the] reviewing court[ ] may assess the validity of the
agency’s ultimate findings and afford a claimant meaningful judicial review.”
Young, 362 F.3d at 1002 (citations omitted). To build a logical bridge, the ALJ must
“sufficiently articulate his assessment of the evidence to assure [the court] that he
considered the important evidence and to enable [the court] to trace the path of his
reasoning.” Hickman v. Apfel, 187 F.3d 683, 689 (7th Cir. 1999) (citation omitted).

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Here, Dr. Ellens opined that Plaintiff met or equaled Listing 14.02, systemic
lupus erythematosus (SLE), in that Plaintiff had at least two of the constitutional
symptoms or signs (severe fatigue, fever, malaise, or involuntary weight loss) and
she has limitations in maintaining social functioning and completing tasks in a
timely manner due to deficiencies in concentration, persistence, or pace. (R. at 365).
Additionally, Dr. Ellens opined that Plaintiff would have difficulty lifting more than
ten pounds occasionally and five pounds frequently. (Id. at 366). She could walk less
than one hour in an eight-hour workday and sit less than two hours of an eight-hour
workday. (Id.). He further limited Plaintiff to occasional pushing/pulling with
hands, frequent balancing, and prohibited any climbing of ramps/stairs, ladders or
ropes. (Id.). He opined she should never crouch or crawl and could occasionally
reach and handle. (Id.). She would have frequent ability to fingering and feeling.
(Id.).
The ALJ rejected Dr. Ellens’s opinion for several reasons. First, the ALJ
concluded that, because Plaintiff requested Dr. Ellens’s assistance with her
disability paperwork, there was evidence of “pecuniary gain” and a “bias on the
doctor’s part” to help Plaintiff by “painting her in an unflattering light.” (R. at 22).
Second, the ALJ referenced Plaintiff’s activities of daily living, such as caring for
her young child, going shopping, and performing light household tasks, and
concluded that such activities were “not limited to the extent one would expect,
given the complaints of disabling symptoms and limitations.” (Id. at 21–22). Third,
the ALJ noted that Dr. Ellens is “not a specialist in Lupus but in internal
16

medicine.” (R. at 22). Fourth, the ALJ concluded that Dr. Ellens’s opinion was “not
consistent with the record as a whole.” (Id.). Finally, the ALJ concluded that
Plaintiff’s condition was controlled with medications. (Id.). The Court concludes that
the ALJ’s decision to give Dr. Ellens’s opinion only little weight is legally
insufficient and not supported by substantial evidence.
1. Pecuniary Gain and Bias
First, the ALJ offered no support for his finding of “pecuniary gain” or his
contention that the opinion of Dr. Ellens may have been biased because Plaintiff
requested his assistance in completing a disability packet. (R. at 22). True, the ALJ
has the ability, as the trier of fact, to consider a physician’s possible bias. Edwards
v. Sullivan, 985 F.2d 334, 337 (7th Cir. 1993). However, “[t]he ability to consider
bias . . . is not synonymous with the ability to blithely reject a treating physician’s
opinion or to discount that physician’s opportunity to have observed the claimant
over a long period of time.” Micus v. Bowen, 979 F.2d 602, 609 (7th Cir. 1992). The
ALJ must have a substantial evidentiary basis for finding bias by the treating
physician. Moss v. Astrue, 555 F.3d 556, 560 (7th Cir. 2009). Here, the ALJ merely
stated, “I find pecuniary gain that means there was a bias on the doctor’s part to
help the claimant by painting her in an unflattering light,” yet offered no
evidentiary basis for this conclusion. (R. at 22). This is error. See White ex rel. Smith
v. Apfel, 167 F.3d 369, 375 (7th Cir. 1999) (“a decision based on speculation is not
supported by substantial evidence.”). Furthermore, the ALJ’s assertion that Dr.
Ellens’s opinions were not generated through course of treatment is equally
17

unsupported and erroneous. Dr. Ellens saw and examined Plaintiff on four separate
occasions prior to completing the disability paperwork, and continued to treat
Plaintiff long after the paperwork was completed. (R. at 385–95). Simply put, the
mere fact that Plaintiff was seeking assistance with her disability paperwork is not
an appropriate reason to discredit Dr. Ellens’s opinions. See McClinton v. Astrue,
No. 09 C 4814, 2012 WL 401030, at *12 (N.D. Ill. Feb. 6, 2012) (“[S]imply because
[the plaintiff] was seeking disability and required such paperwork does not mean
that the doctor’s treatment was any less legitimate. The ALJ simply fails to explain
how the completion of necessary paperwork for a patient . . . mitigates the
credibility or accuracy of a treating doctor’s medical opinion.”).
2. Activities of Daily Living
Next, the ALJ cited Plaintiff’s ability to care for her young child, go shopping,
and perform simple household tasks as an additional basis for discrediting Dr.
Ellens’s opinion. (R. at 22). However, the ALJ failed to articulate how Plaintiff’s
reported daily activities contradicted Dr. Ellens’s findings. See Clifford, 227 F.3d at
871 (finding that the ALJ did not provide any explanation for his belief that the
claimant’s activities were inconsistent with the treating physician’s opinion and his
failure to do so constitutes error). Without such a logical bridge, the Court cannot
trace the path of the ALJ’s reasoning.
As the Seventh Circuit has explained on numerous occasions, an ALJ may not
equate the ability to perform basic household work and child care with the ability to
hold a job. This is because “extrapolating from what people do at home, often out of
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necessity, to what they could do in a 40-hour-a-week job is perilous . . . and sheer
necessity may compel one to perform tasks at home no matter how painful.”
Forsythe v. Colvin, 813 F.3d 677, 679 (7th Cir. 2016); see also Gentle v. Barnhart,
430 F.3d 865, 867 (7th Cir. 2005) (holding that the ALJ’s “casual equating of
household work to work in the labor market cannot stand,” especially because the
ALJ attached great significance to the fact that the claimant was “able to care for
her personal needs and those of her two small children.”).
The ALJ, in placing particular emphasis on Plaintiff’s ability to care for her
young child, completely disregarded and/or ignored Plaintiff’s testimony and other
evidence in the record that suggests Plaintiff is significantly limited in her ability to
care for her son. For example, Plaintiff testified that she has extreme difficulty
lifting her son up, cannot take him for walks, and is unable to move as quickly as
necessary to keep up with him. (R. at 48–49, 250, 369). In fact, Plaintiff stated that
Dr. Ellens specifically told her not to pick up her son. (Id. at 49). Plaintiff
additionally reported the she receives significant assistance from her mother and
two sisters in caring for her son. (Id. at 208).
Further, the ALJ did not properly take into account the limitations Plaintiff
described in performing basic daily activities such as bathing, minor household
chores, and preparing simple meals. For instance, Plaintiff has indicated, in
function reports and disability reports, that while she is able to prepare meals for
herself, she is limited to quick, simple meals such as “microwave foods.” (R. at 209,
241). In performing household tasks, Plaintiff is limited to making her bed and
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doing laundry, although she is unable to carry the laundry up and down the stairs.
(Id. at 209, 241, 250). She has also reported difficulty getting in and out of the
bathtub, and an inability to take long showers due to leg pain and weakness. (Id. at
246, 250). Plaintiff additionally indicated that it is difficult for her to do daily
activities because she tires so quickly. (Id. at 242). Moreover, the ALJ also failed to
consider the written statement of Plaintiff’s mother, Ina Jackson, which confirmed
many of the limitations Plaintiff testified to. (Id. at 219–26). “An ALJ cannot
disregard a claimant’s limitations in performing household activities.” Moss, 555
F.3d at 562.
In sum, the ALJ did not “build a logical bridge between the evidence and his
conclusion” when he failed to discuss these limitations when finding that Plaintiff’s
activities are inconsistent with the limitations recommended by her treating
physician. Pratt v. Colvin, No. 12 C 8983, 2014 WL 1612857, at *8–10 (N.D. Ill. Apr.
16, 2014).
3. Physician’s Specialty
As for the ALJ’s suggestion that Dr. Ellens’s opinion deserves less weight
because he is an internal medicine physician and not a specialist in Lupus, this
factor is only relevant if the doctor’s opinion is not given controlling weight for
proper reasons. See 20 C.F.R. § 404.1527 (explaining that it is only when the
treating source’s opinion is not given controlling weight that factors including
specialization are considered). Assuming, arguendo, that the ALJ had proper
reasons for not giving controlling weight to Dr. Ellens’s opinion, it was perfectly
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acceptable for him to consider the doctor’s lack of expertise. In this case, the ALJ
discounted Dr. Ellens’s opinion because of his area of expertise, but did not do the
same for the state agency consultants in his evaluations of their opinions. Instead,
the ALJ simply concluded that the consultants were “well qualified by reason of
training and experience in reviewing an objective record and formulating an opinion
as to limitations,” despite having the same lack of specialization as Dr. Ellens. (R. at
22).
Indeed, the Court is troubled, and frankly somewhat puzzled, by the ALJ’s
explanation of the weight given to the opinions of the state agency consultants. The
ALJ assigned “great weight” to the assessments of the state agency consultants, “as
the assessment [sic] with the medical record in its entirety.” (R. at 22). However,
upon review of the record, it is clear that this is an inaccurate assertion by the ALJ.
Instead, the record indicates that the agency consultants arrived at their
determinations without considering Dr. Ellens’s opinion and listing equivalence
form or the records from Plaintiff’s treating rheumatologist (and thus a specialist in
Lupus), Dr. Kazmar. The ALJ attempted to side-step this issue by concluding,
without any explanation, that “the evidence received into the record after the
reconsideration determination concerning the claimant’s physical status did not
provide any credible or objectively supported or new material information that
would significantly alter the State agency findings.” (R. at 22–23). It is not clear
how the ALJ could arrive at such a conclusion in light of the nature of this laterreceived evidence.
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In any event, because neither of the state agency physicians reviewed records
from Drs. Ellens and Kazmar, the state agency physicians’ assessments do not, by
definition, take into account all of the medical evidence in the record. In this
situation, the ALJ could have sent Plaintiff for a consultative exam, requested that
the state agency physicians render supplementary opinions based on a review of the
entire record, or brought in a medical expert to testify at the hearing. But the ALJ
did none of those things. Therefore, the medical opinions relied upon by the ALJ to
contradict the opinion of Plaintiff’s treating physician were not based on a complete
review or an accurate summary of all the relevant medical evidence. See
Bellinghiere v. Astrue, No. 10 C 6184, 2011 WL 4431023, at *7 (N.D. Ill. Sept. 22,
2011); Ivey v. Astrue, No. 11 CV 083, 2012 WL 951481, at * 13 (N.D. Ind. Mar. 20,
2012) (an ALJ’s decision to give more weight to a reviewing state agency physician’s
opinion “cannot stand where it lacks evidentiary support and is based on an
inadequate review of [the claimant’s] subsequent medical record”); Staggs v. Astrue,
781 F. Supp. 2d 790, 794–95 (S.D. Ind. 2001) (remanding with instructions to obtain
and consider an updated medical opinion based on all of the evidence in the record
where the ALJ relied upon the state agency physicians’ opinions that did not take
subsequent medical records into account and therefore were not based on the entire
medical record). As a result, without sufficient medical evidence to support his
decision to reject Dr. Ellens’s opinions, the Court concludes that the ALJ
impermissibly substituted his judgment for that of Plaintiff’s treating physician.

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Moreover, the Court notes that, although the state agency consultants
considered only Listing 8.04 (chronic infections of skin or mucous membranes), and
despite Plaintiff’s requests for consideration of Listing 14.02, the sole listing
considered by the ALJ at step three was, inexplicably, Listing 14.09 (inflammatory
arthritis). (R. at 19, 68, 76, 87, 96). And, apart from stating that he “considered”
Listing 14.09, the ALJ did not mention the requirements of Listing 14.09, or provide
any analysis as to why Plaintiff’s impairments did not satisfy the listing. In fact, the
word “arthritis” does not appear once in the remaining five pages of the ALJ’s
opinion.
4. Opinion Not Consistent With the Record as a Whole
Next, although the ALJ found that “the record as a whole” does not support Dr.
Ellens’s opinion, the ALJ never explained how or where the record is inconsistent
with Dr. Ellens’s findings. The Court is left guessing as to which part of the record
the ALJ relied. It is vital that the ALJ support his findings with substantial record
evidence. “The statement that [Dr. Ellens’s] opinion is not supported by the record
as a whole, without more, does not suffice.” Thunberg v. Astrue, 2014 WL 971458, at
*11 (N.D. Ill. Mar. 12, 2014). The ALJ has not built a logical bridge to support his
opinion. Other than a blanket citation to the records from Dermatology Associates,
the ALJ provided no actual, specific medical evidence for discounting Dr. Ellens’s
opinion, particularly as it relates to Listing 14.02.
True, the ALJ provided a summary of some (but not all) of Plaintiff’s medical
records earlier in his opinion. (R. at 20–21). But “summarizing a medical history is
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not the same thing as analyzing it, in order to build a logical bridge from evidence to
conclusion.” Chuk v. Colvin, No. 14 C 2525, 2015 WL 6687557, at *8 (N.D. Ill. Oct.
30, 2015); see also Edge v. Berryhill, No. 15 CV 50292, 2017 WL 680365, at *4 (N.D.
Ill. Feb. 21, 2017).
The ALJ ignored much of the evidence that does support Dr. Ellens’s findings.
For instance, the record is replete with evidence of Plaintiff’s continuous complaints
of fatigue (see, e.g., R. at 242, 246, 371, 374, 387–89, 391–94, 433, 502, 556), yet the
ALJ’s opinion is devoid of any reference to fatigue. Similarly, the ALJ barely
mentioned Plaintiff’s frequent complaints of muscle aches and joint pain. (See, e.g.,
id. at 238, 240–42, 246, 344, 371, 374, 479, 481–82, 485–86, 488–89). The ALJ also
referenced the normal findings on x-rays taken of Plaintiff’s knees, lumbar spine,
and thoracic spine, and asserted that the “objective imaging studies do not support
the degree of limitations or severity as alleged” and “the relative normalcy of the
above noted findings does not suggest a severe impairment as defined by the Act.”
(Id. at 21–22). The ALJ’s discounting of Dr. Ellens’s opinion “based on the ALJ’s
perception that joint findings would be markedly profound if [Dr. Ellens’s] opinion
were accurate highlights the danger of the ALJ making a medical determination for
which [he] is not qualified.” Warren v. Colvin, No. 15 C 8987, 2017 WL 36404, at *7
(N.D. Ill. Jan. 4, 2017) (emphasis in original).
Arthritis or synovitis is common in SLE, with up to 90% of patients experiencing
it at some point in time. See Warren, 2017 WL 36404, at *7 (citing
https://www.hss.edu/conditions_joint-pain-lupus-really-arthritis.asp). The pain is
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usually more severe than expected based on the appearance of the joint on
examination, and there can be pain without swelling or even tenderness in the joint,
known as arthralgia. Id. “The Court is not attempting to inject its own factual
findings into the matter but is only using this information to illustrate why it was
inappropriate for the ALJ to reject [Dr. Ellens’s] medical opinion regarding
[Plaintiff’s] functional limitations based on an unstated medical assumption the
ALJ apparently was making without evidentiary support in the record to back it
up.” Id.; see also Martin v. Sullivan, 750 F. Supp. 964, 970 (S.D. Ind. 1990)
(rejecting Appeal Council’s finding that claimant’s testimony regarding his
symptoms was inconsistent with medical finding that claimant “had a full range of
motion with no swelling, erythema, or increased warmth in the joint area” on the
ground that “the ALJ’s own medical advisor” stated that “lupus is a medical
impairment that results from physical abnormalities reasonably expected to
produce pain” and that “[l]upus patients may develop joint pains . . . that are not
accompanied by inflammatory changes”).
In sum, the ALJ’s “analysis” merely refers to “the record as a whole.” (R. at 22).
He does not directly connect the evidence—or build a “logical bridge”—to his
findings. This prevents the Court from assessing the validity of the ALJ’s findings
and providing meaningful judicial review. See Scott, 297 F.3d at 595.
5. Condition Controlled with Medications
Lastly, the ALJ discounted Dr. Ellens’s opinion by asserting that Plaintiff’s
condition was “controlled with medication.” (R. at 22). However, the record indicates
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that her symptoms were not controlled with medication. For instance, new
symptoms arose, old symptoms worsened and new medications were tried. New
symptoms included chest pain and shortness of breath, while complaints of fatigue,
joint pain, and back pain continued. For example, PA Ovando’s September 3, 2013,
correspondence to Dr. Ellens included a new diagnosis of “seborrheic dermatitis, left
inframammary,” and a prescription for Minocycline. (Id. at 404). On December 28,
2013, PA Ovando assessed “eczematous dermatitis, legs and arms.” (Id. at 402). In
February 2014, the eczematous dermatitis had spread to the face and shoulders.
(Id. at 380, 401). Cephalexin was prescribed and Allegra was recommended. (Id.).
On September 3, 2014, Plaintiff reported a scalp “flare” and continued joint pain.
(Id. at 379). Mupiricin ointment was prescribed for multiple “crusty” spots on
Plaintiff’s scalp. (Id. at 379, 400). Treatment records from October 2013, November
2013, January 2014, March 2014, April 2014, and June 2014 all contain reports of
joint pain. (Id. at 371–75, 479–89). Dr. Kazmar specifically noted in April 2014 that
Plaintiff was not responding to Mobic. (Id. at 481). These records were never
addressed by the ALJ in his analysis.
The ALJ also disregarded Plaintiff’s numerous reports of adverse side-effects
from her medications, including rashes on her face, chest, shoulders, legs, and
stomach, headaches, nausea, fatigue, dizziness, blurry vision, and joint pain. (See,
e.g., R. at 43, 53, 212, 214, 226, 240, 249, 277, 352, 357, 372, 374, 391). Thus, in
reaching his conclusion, the ALJ committed the same error the Seventh Circuit has
so frequently warned against: he “focused solely on the reports of stability and
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ignored the many complaints of persisting symptoms.” Roth v. Colvin, N. 14 C
04406, 2016 WL 890750, at *9 (N.D. Ill. March 9, 2016) (citing Campbell v. Astrue,
627 F.3d 299, 306 (7th Cir. 2010). Accordingly, the ALJ erred in concluding that
because the record evidence reflected some improvement and response to
medications, it did not support Dr. Ellens’s opinion.
In sum, the ALJ provides no “good reasons” for discounting the treating
physician’s opinion. The ALJ failed to build a “logical bridge” between the facts of
the case and the outcome. Parker v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010). This
prevents the Court from assessing the ALJ’s findings and providing meaningful
judicial review. See Scott, 297 F.3d at 595. For the reasons set forth herein, the
ALJ’s decision is not supported by substantial evidence.
On remand, the ALJ shall reevaluate the weight to be afforded to the opinion of
Dr. Ellens. If the ALJ finds “good reasons” for not giving the opinion controlling
weight, see Campbell, 627 F.3d at 306, the ALJ shall explicitly “consider the length,
nature, and extent of the treatment relationship, frequency of examination, the
physician’s specialty, the types of tests performed, and the consistency and
supportability of the physician’s opinion,” Moss, 555 F.3d at 561, in determining
what weight to give the opinion.
B. Other Issues
Because the Court is remanding to reevaluate the weight to be given to the
treating physician’s opinion, the Court chooses not to address Plaintiff’s other
arguments. However, on remand, after determining the weight to be given the
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treating physician’s opinion, the ALJ shall then reevaluate Plaintiff’s physical and
mental impairments and RFC, considering all of the evidence of record, including
Plaintiff’s testimony, and shall explain the basis of his findings in accordance with
applicable regulations and rulings. “In making a proper RFC determination, the
ALJ must consider all of the relevant evidence in the record, even limitations that
are not severe, and may not dismiss a line of evidence contrary to the ruling.”
Murphy v. Colvin, 759 F.3d 811, 817 (7th Cir. 2014) (citation omitted). Finally, with
the assistance of a VE, the ALJ shall determine whether there are jobs that exist in
significant numbers that Plaintiff can perform.
VI. CONCLUSION
For the reasons stated above, Plaintiff’s motion for summary judgment [14] is
GRANTED. Defendant’s motion for summary judgment [18] is DENIED. Pursuant
to sentence four of 42 U.S.C. § 405(g), the ALJ’s decision is reversed, and the case is
remanded to the Commissioner for further proceedings consistent with this
Opinion.

Dated: August 23, 2017

E N T E R:

MARY M. ROWLAND
United States Magistrate Judge

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