Greggs v. Berryhill

Filing 23

MEMORANDUM Opinion and Order Signed by the Honorable Maria Valdez on 7/13/2018: Mailed notice (lp, )

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
ALLAN D. GREGGS,
Plaintiff,
v.
NANCY A. BERRYHILL, Deputy
Commissioner for Operations,
Social Security Administration,
Defendant.

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No. 17 C 0671
Magistrate Judge
Maria Valdez

MEMORANDUM OPINION AND ORDER
This action was brought under 42 U.S.C. §§ 405(g) and 1383(c) to review the
final decision of the Commissioner of the Social Security Administration
(“Commissioner”) denying Plaintiff Allan D. Greggs’s (“Plaintiff”) claims for
Disability Insurance Benefits (“DIB”) and Supplemental Security Income (“SSI”)
under Titles II and XVI of the Social Security Act (the “Act”). The parties have
consented to the jurisdiction of the United States Magistrate Judge pursuant to 28
U.S.C. § 636(c). For the following reasons, Plaintiff’s memorandum, which this
Court will construe as a motion for summary judgment [Doc. No. 14] is granted in
part, and the Commissioner’s motion for summary judgment [Doc. No. 15] is denied.
The case is remanded for further proceedings consistent with this Opinion.

BACKGROUND
I.

Procedural History
In March 2013, Plaintiff filed an application for SSI and, the following month,

an application for DIB. (R. 140–141.) Plaintiff’s applications alleged a disability
onset date of March 5, 2013 due to HIV, bipolar disorder, diabetes, morbid obesity,
hypertension/high blood pressure, hepatitis B and C, herpes, anxiety, and mania.
(R. 177, 262.) His applications were initially denied and then again upon
reconsideration. (R. 173–185.)
Represented by counsel, Plaintiff appeared and testified at a hearing before
an Administrative Law Judge (“ALJ”) on September 30, 2015. (R. 34–84.) A
vocational expert (“VE”) also appeared and testified at the hearing. (R. 84–93.) On
November 20, 2015, the ALJ issued an unfavorable decision finding that Plaintiff
was not disabled. (R. 14–33.) The Appeals Council denied review on November 29,
2016. (R. 1–6.)
II.

ALJ Decision
In determining that Plaintiff was not disabled, the ALJ analyzed Plaintiff’s

claim according to the five-step sequential evaluation process established under the
Act. (R. 18–19.) At step one, the ALJ concluded that Plaintiff met the insured status
requirements of the Act through December 31, 2016, and that Plaintiff had not
engaged in substantial gainful activity since March 5, 2013, his alleged onset date.
(R. 19.) At step two, the ALJ found that Plaintiff suffered from the following severe
impairments: diabetes mellitus, hepatitis C, hypertensive vascular disease, renal

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disease, anxiety disorder, HIV, and obesity. (Id.) At step three, the ALJ determined
that Plaintiff did not have an impairment or combination of impairments that met
or medically equaled the severity of one of the listed impairments in 20 C.F.R. Part
404, Subpart P, Appendix 1. (R. 20–22.)
Next, the ALJ determined Plaintiff’s residual functional capacity (“RFC”). (R.
22–27.) The ALJ found that Plaintiff had the RFC to perform medium work: he
could lift/carry 50 pounds occasionally and 25 pounds frequently, stand/walk about
six hours in an eight-hour workday with normal rest periods, and sit about six
hours in an eight-hour workday with normal rest periods. (R. 22.) Plaintiff’s RFC,
however, was subject to the following limitations: he was unable to work at heights
or frequently climb ladders; he was limited to simple routine tasks involving no
more than simple, short instructions and simple work-related decisions with few
workplace changes; and he could only have casual interaction with the general
public and superficial or casual contact with coworkers. (Id.)
Moving to step four, the ALJ relied upon the VE’s testimony about Plaintiff’s
RFC and determined that Plaintiff could perform his past relevant work as a
kitchen helper. (R. 27.) Because of this determination, the ALJ found that Plaintiff
was not disabled under the Act. (Id.)
DISCUSSION
III.

ALJ Legal Standard

Under the Act, a person is disabled if he has an “inability to engage in any
substantial gainful activity by reason of any medically determinable physical or

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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 twelve months.” 42
U.S.C. § 423(d)(1)(A). To determine disability, the ALJ considers five questions in
the following order: (1) Is the plaintiff presently unemployed? (2) Does the plaintiff
have a severe impairment? (3) Does the impairment meet or medically equal one of
a list of specific impairments enumerated in the regulations? (4) Is the plaintiff
unable to perform his former occupation (i.e., past work)? and (5) Is the plaintiff
unable to perform any other work? See Young v. Sec’y of Health & Human Servs.,
957 F.2d 386, 389 (7th Cir. 1992); 20 C.F.R. § 416.920(a)(4).
An affirmative answer at either step three or step five leads to a finding of
disability. Young, 957 F.2d at 389. A negative answer at any step, other than at step
three, precludes a finding of disability. Id. The plaintiff bears the burden of proof at
steps one through four. Id. If the plaintiff meets this burden, the burden then shifts
to the Commissioner to show the plaintiff’s ability to engage in other work existing
in significant numbers in the national economy. See Weatherbee v. Astrue, 649 F.3d
565, 569 (7th Cir. 2011).
IV.

Judicial Review
Because the Appeals Council denied review, the ALJ’s decision becomes the

final decision of the Commissioner, which is reviewable by this Court. 42 U.S.C. §§
405(g), 1383(c); Haynes v. Barnhart, 416 F.3d 621, 626 (7th Cir. 2005). “The findings
of the Commissioner of Social Security as to any fact, if supported by substantial
evidence, shall be conclusive.” § 405(g). Thus, judicial review of the ALJ’s decision is

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limited to determining whether the ALJ’s findings are supported by substantial
evidence or based upon legal error. Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir.
2000). “Substantial evidence means ‘such relevant evidence as a reasonable mind
might accept as adequate to support a conclusion.’” Id. (quoting Richardson v.
Perales, 402 U.S. 389, 401 (1971)). This Court may not substitute its judgment for
that of the ALJ, reweigh evidence, resolve conflicts, or decide questions of
credibility. Id.
Although the ALJ need not “address every piece of evidence or testimony in
the record, the ALJ’s analysis must provide some glimpse into the reasoning behind
her decision to deny benefits.” Zurawski v. Halter, 245 F.3d 881, 889 (7th Cir. 2001).
This requires the building of “an accurate and logical bridge from the evidence to
[the ALJ’s] conclusion.” Clifford, 227 F.3d at 872. The ALJ must explain the
“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); see also Murphy v. Astrue, 496 F.3d 630, 634 (7th Cir. 2007) (“An ALJ has a
duty to fully develop the record before drawing any conclusions and must
adequately articulate his analysis so that we can follow his reasoning.” (internal
citations omitted)).
Where conflicting evidence would allow reasonable minds to differ, the
responsibility for determining disability falls upon the ALJ, not the Court. See Herr
v. Sullivan, 912 F.2d 178, 181 (7th Cir. 1990). Nonetheless, an ALJ must consider

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all relevant evidence, and it cannot “select and discuss only that evidence that
favors his ultimate conclusion.” Herron v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994).
V.

Analysis
On appeal, Plaintiff argues that: (1) the ALJ improperly excluded certain

moderate limitations in Plaintiff’s social functioning from his RFC assessment; (2)
the ALJ failed to incorporate Plaintiff’s moderate limitations in concentration,
persistence, or pace into his hypothetical questions to the VE; (3) the ALJ erred in
assessing the opinions of Plaintiff’s treating psychiatrist, Joe Sangster, M.D.; (4) the
ALJ did not properly analyze Plaintiff’s impairments in combination; and (5) the
ALJ failed to assess Plaintiff’s subjective complaints in accordance with the
applicable regulations. Because the Court agrees with Plaintiff regarding the ALJ’s
assessment of his treating psychiatrist’s opinions, remand is appropriate.
A. The ALJ Did Not Properly Evaluate Dr. Sangster’s Opinion
In evaluating a claim of disability, “[a]n ALJ must consider all medical
opinions in the record.” Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir. 2013). The
opinion of a treating physician is afforded controlling weight if it is both “wellsupported” by clinical and diagnostic evidence and “not inconsistent with the other
substantial evidence” in the case record. 20 C.F.R. § 404.1527(c)(2); see Scott v.
Astrue, 647 F.3d 734, 739 (7th Cir. 2011). Because of a treating physician’s “greater
familiarity with the claimant’s condition and circumstances,” Gudgel v. Barnhart,
345 F.3d 467, 470 (7th Cir. 2003), “[a]n ALJ must offer good reasons for discounting
a treating physician’s opinion.” Campbell v. Astrue, 627 F.3d 299, 306 (7th Cir.

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2010) (internal quotations omitted). Those reasons must be “supported by
substantial evidence in the record.” Gudgel, 345 F.3d at 470.
If a treating physician’s opinion is not given controlling weight, the ALJ must
still determine how much weight to give it. Scrogham v. Colvin, 765 F.3d 685, 697
(7th Cir. 2014). To do this, the ALJ must, by regulation, consider a variety of
factors, including: (1) the length of the treatment relationship and frequency of
examination; (2) the nature 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; and (5) whether the physician was a specialist
in the relevant area. Id.; 20 C.F.R. § 404.1527(c)(2)–(5). The ALJ should address
these factors so the Court can properly review whether the ALJ followed the correct
methodology in weighing the medical opinion evidence. See, e.g., Scrogham, 765
F.3d at 697–98.
As the ALJ acknowledged, Dr. Sangster had been Plaintiff’s treating
physician since September 2013. (R. 25.) From September 2013 to October 2014, Dr.
Sangster saw Plaintiff during at least five 30-minute sessions and one 60-minute
session. (R. 635–638, 642–643, 924–929.) On January 2, 2014, Dr. Sangster
completed a psychiatric/psychological impairment assessment of Plaintiff. (R. 621–
628.) In this assessment, Dr. Sangster opined that Plaintiff’s illness—bipolar
disorder, mixed—caused marked difficulties in maintaining social functioning;
marked deficiencies of concentration and persistence; and repeated episodes of
deterioration or decompensation in work or work-like situations. (R. 621, 626.)

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Although the ALJ considered these findings as those “of a treating and
examining medical source,” he gave them “little weight.” (R. 25.) The ALJ gave
three reasons for this assessment. The first two reasons were based on alleged
inconsistencies with the record, namely, that Dr. Sangster’s findings were
inconsistent “with the longitudinal treatment records showing only conservative
and routine treatment” and “with the clinical examination findings of record
showing that while the claimant has some symptoms and limitations, his severe
impairment does not result in any marked limitations.” (Id.) For his third reason,
the ALJ asserted that exacerbations in Plaintiff’s symptoms were “often correlated
with non-compliance with medication.” (Id.)
The Court concludes, however, that none of these reasons, as articulated by
the ALJ, are “good reasons” supported by substantial evidence. Moreover, in giving
Dr. Sangster’s opinion less than controlling weight, the ALJ failed to analyze the
appropriate factors under 20 C.F.R. § 404.1527(c). Accordingly, remand is
appropriate. See Campbell, 627 F.3d at 306–09 (remanding where the ALJ did not
give “good reasons” for discounting a treating physician’s assessment and did not
“explicitly address the checklist of factors” from § 404.1527 to determine the weight
to give to the assessment); see also Scrogham, 765 F.3d at 697 n.48 (indicating that
the ALJ’s failure to address the factors set forth in § 404.1527(c) was not harmless).
i. The ALJ’s Reasons for Discounting Dr. Sangster’s Opinion
With respect to his first line of reasoning, the ALJ failed to identify the
treatment records (or any other evidence) that he believed demonstrated that

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Plaintiff was undergoing “conservative and routine” treatment. (R. 25.) As such, the
Court cannot determine whether this assertion is supported by substantial evidence
in the record. Nor is the ALJ permitted to make this assertion based on a
reasonable, “common-sense” inference, as the Commissioner contends. (Def.’s Mem.
at 7.) What may seem reasonable or common sense to a lay person may not make
much sense in the medical world. See Schmidt v. Sullivan, 914 F.2d 117, 118 (7th
Cir. 1990) (“Common sense can mislead; lay intuitions about medical phenomena
are often wrong.”). As such, an ALJ cannot “play doctor” and make inferences about
medical treatments without any supporting medical evidence. See, e.g., Myles v.
Astrue, 582 F.3d 672, 677–78 (7th Cir. 2009); Rohan v. Chater, 98 F.3d 966, 970 (7th
Cir. 1996) (“ALJs must not succumb to the temptation to play doctor and make their
own independent medical findings.”). Yet that is what the ALJ did here when he
determined, without any medical evidence, that Plaintiff’s treatment regimen was
conservative and routine.
Moreover, the ALJ failed to explain how conservative and routine treatment
undermined Dr. Sangster’s opinion. An ALJ cannot assume that symptoms or
mental limitations are less serious based solely on his or her lay opinion as to the
treatment given. For example, in Myles, the Seventh Circuit found that the ALJ
improperly diminished the severity of the plaintiff’s symptoms based on his
unsupported belief that the plaintiff would have been prescribed insulin had her
diabetes been more serious. 582 F.3d at 677–78. Similarly, the ALJ could not
permissibly reason (without medical evidence to back it up) that simply because

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Plaintiff was undergoing conservative treatment, his difficulties with social
functioning, concentration, and persistence were not as bad as Dr. Sangster
believed.
For his second line of reasoning, the ALJ similarly failed to identify the
“clinical examination findings of record” that purportedly showed that Plaintiff’s
“severe impairment does not result in any marked limitations.” (R. 25.) Again,
without such an identification, the Court cannot determine whether the ALJ’s
reasoning is supported by substantial evidence. Although the Commissioner asserts
that the ALJ was referring to the medical records discussed in the prior paragraph
of the ALJ’s opinion, Def.’s Mem. at 6–7, the ALJ’s opinion itself does not indicate
that this is the case. (R. 25.) This Court’s review is limited to what is articulated in
the ALJ’s opinion. Jelinek v. Astrue, 662 F.3d 805, 812 (7th Cir. 2011); Scott, 647
F.3d at 739.
Even if the Court accepts the Commissioner’s assertion, the ALJ’s discussion
of these records does not support his reasoning. In the paragraph at issue, the ALJ
discussed: (1) a July 2013 psychological consultative examination conducted by
Harvey Friedson, Psy.D; (2) a March 2014 internal medicine consultative
examination conducted by Rochelle Hawkins, M.D.; and (3) an April 2014 treatment
record from Deborah Killingsworth, M.D., Plaintiff’s primary care physician. (R. 24–
25, R. 611.) 2 The ALJ noted that Dr. Friedson found Plaintiff to be “alert without
evidence of psychotic or schizophrenic process and reported no current suicidal or
Although the ALJ’s discussion did not refer to Dr. Hawkins or Dr. Killingsworth by name,
the exhibits he cited correspond to the identified examinations. (See R. 611–620 (Ex. 11F);
R. 914–919 (pages 7–12 of Ex. 21F).)
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homicidal ideation”; that Dr. Hawkins found Plaintiff to be “alert and fully oriented
with intact memory and judgment”; and that Dr. Killingsworth found Plaintiff to be
“fully oriented with appropriate mood and affect, normal insight and normal
judgment.” (Id.)
These findings, however, fail to show that Plaintiff’s limitations in social
functioning, concentration, or persistence were not, in fact, marked. Notably, none
of these findings addresses Plaintiff’s concentration or persistence, or how well
Plaintiff can function socially. Instead, they address findings about the Plaintiff’s
alertness, orientation, memory, judgment, insight, and/or mood. Although there
could be some relationship between these findings and Plaintiff’s limitations, the
ALJ did not explain (or identify any evidence explaining) what this relationship is.
Put simply, there is no “accurate and logical bridge” leading from these findings to
the ALJ’s conclusion regarding Plaintiff’s ability to concentrate, persist, or function
socially. See Clifford, 227 F.3d at 872.
As for the ALJ’s third line of reasoning, the ALJ cited a single instance when,
on February 27, 2014, Plaintiff reported “racing thoughts” to Dr. Sangster after
being out of medication for three weeks. (R. 25, 930.) Based on this instance, the
ALJ then concluded that there was a correlation between exacerbations in
Plaintiff’s symptoms and his non-compliance with medication. (R. 25.)
Again, there is no “accurate and logical bridge” leading from the cited
evidence to the ALJ’s conclusion. See Clifford, 227 F.3d at 872. Correlation does not
constitute causation, and the ALJ cannot simply assume that a lack of medication

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caused the racing thoughts that Plaintiff reported to Dr. Sangster in February 2014.
See Steele v. Barnhart, 290 F.3d 936, 941 (7th Cir. 2002) (an ALJ may not assume
that non-compliance with medication caused seizures to become uncontrollable in
the absence of record evidence establishing a causal link between non-compliance
and ongoing seizure episodes). To the contrary, other evidence in the record
indicates that Plaintiff experienced racing thoughts even when he was taking his
medication. (See, e.g., R. 79 (hearing testimony indicating that despite taking
Trileptal, Plaintiff had racing thoughts); R. 1111–12 (December 2013 treatment
record indicating that Plaintiff reported racing thoughts despite taking Fluoxetine
and Trileptal).)
What’s more, the ALJ provides no explanation as to why Plaintiff’s noncompliance with medication in February 2014 would impact the findings that Dr.
Sangster offered in January 2014. If Plaintiff’s symptoms were exacerbated by noncompliance, as the ALJ reasoned, those symptoms would have only been
exacerbated during the month of February; specifically, the three-week period prior
to February 27, 2014. Dr. Sangster, however, rendered the assessment at issue on
January 2, 2014, based on symptoms he observed before Plaintiff ran out of
medication. The symptoms Dr. Sangster observed in rendering his January 2014
assessment could not have been exacerbated by Plaintiff’s non-compliance with
medication a month later.
In conclusion, it is undisputed that Dr. Sangster was Plaintiff’s treating
psychiatrist. As such, the ALJ was required to give good reasons supported by

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substantial evidence to justify his decision to give Dr. Sangster’s January 2014
opinion “little weight.” The ALJ did not do so. Accordingly, remand is appropriate.
ii. The ALJ’s Failure to Address 20 C.F.R. § 404.1527(c)
Remand is also appropriate because, in determining the amount of weight to
give Dr. Sangster’s opinion, the ALJ failed to address or otherwise consider many of
the factors set forth in 20 C.F.R. § 404.1527(c). For instance, the ALJ did not
account for Dr. Sangster’s specialty, see § 404.1527(c)(5), which is psychiatry. (R.
628.) This factor favors crediting Dr. Sangster’s opinion over that of Dr. Friedson,
who is a psychologist (R. 606); Dr. Hawkins, who performed an internal medicine
examination (R. 23–24), indicating that she is neither a psychiatrist nor a
psychologist; and Dr. Killingsworth, who is Plaintiff’s primary care physician (R.
611). See Scott, 647 F.3d at 740 (fact that treating physician was a psychiatrist
favored crediting her over a psychologist); Kelly v. Colvin, No. 14 C 1086, 2015 WL
4730119, at *6 (N.D. Ill. Aug. 10, 2015) (indicating that a psychiatrist’s opinion
should be given greater weight than an internal medicine specialist’s opinion).
Nor did the ALJ consider the frequency and nature of the examinations by
the different doctors, which favors crediting Dr. Sangster’s opinion. See 20 C.F.R. §
404.1527(c)(2)(i)–(ii). Dr. Sangster examined Plaintiff twice before submitting his
January 2014 opinion—in September and November 2013, for a total of 90
minutes—and four times afterwards, from February 2014 to October 2014, for a
total of 120 minutes. (R. 635–638, 642–643, 924–929.) Dr. Friedson, on the other
hand, only examined Plaintiff once, in July 2013, for 60 minutes. (R. 602–606.) Dr.

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Hawkins also only examined Plaintiff once, in March 2014. (R. 611–620.) Notably,
Dr. Hawkins’s internal medicine examination only lasted 23 minutes, and most of
the examination was focused on Plaintiff’s physical condition, not Plaintiff’s mental
state. (Id.) Similarly, the April 2014 observation from Dr. Killingsworth that the
ALJ relied upon was made in the context of a routine follow-up examination that
was not focused on Plaintiff’s mental impairments. (R. 914–919.)
Lastly, the ALJ did not address the supportability of Dr. Sangster’s opinion
or properly analyze the consistency of Dr. Sangster’s opinion with the entire record.
See 20 C.F.R. § 404.1527(c)(3)–(4). The ALJ did not, for example, examine whether
the notes and records from Dr. Sangster and other treating and examining
providers and observers supported the findings in Dr. Sangster’s January 2014
assessment. And, as discussed above, the ALJ’s determination that Dr. Sangster’s
January 2014 opinion was inconsistent with the clinical examination findings of
record was flawed.
Ultimately, the ALJ failed to adequately justify his decision to give the
opinion of Plaintiff’s treating psychiatrist, Dr. Sangster, “little weight,” and remand
is appropriate. To be clear, the Court is not finding that, on remand, the
Commissioner must give controlling weight to Dr. Sangster’s January 2014 opinion,
or any other opinion of Dr. Sangster. Rather, if the Commissioner determines that
Dr. Sangster’s opinion is not entitled to controlling weight, she must support this
determination with good reasons supported by substantial evidence. And if Dr.
Sangster’s opinion is given less than controlling weight, the Commissioner must

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sufficiently explain the rationale underlying the amount of weight given to this
opinion, in accordance with the factors set forth in 20 C.F.R. § 404.1527(c).
B. Plaintiff’s Remaining Arguments
Because remand is required, the Court need not address Plaintiff’s remaining
arguments. The Court expresses no opinion about the decision to be made on
remand but encourages the Commissioner to use all necessary efforts to build a
logical bridge between the evidence in the record and her ultimate conclusions,
whatever those conclusions may be. See, e.g., Myles, 582 F.3d at 678 (“On remand,
the ALJ should consider all of the evidence in the record, and, if necessary, give the
parties the opportunity to expand the record so that he may build a ‘logical bridge’
between the evidence and his conclusions”). The Commissioner should not assume
that any other claimed errors not discussed in this Order have been adjudicated in
her favor.
CONCLUSION
For the foregoing reasons, Plaintiff’s motion for summary judgment is
granted in part, and the Commissioner’s motion for summary judgment [Doc. No.
15] is denied. The Court finds that this matter should be remanded to the
Commissioner for further proceedings consistent with this Order.
SO ORDERED.

ENTERED:

DATE:

___________________________
HON. MARIA VALDEZ
United States Magistrate Judge

July 13, 2018

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