Ellis v. Saul

Filing 30

MEMORANDUM Opinion and Order: Claimant's Motion to Reverse the Decision of the Commissioner of Social Security [ECF No. 13] is denied and the Commissioner's Motion for Summary Judgement [ECF No. 19] is granted. See attached Memorandum Opinion and Order for further details. Civil case terminated. Signed by the Honorable Jeffrey T. Gilbert on 9/9/2021. Mailed notice(ber, )

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IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
JOHN E.,
Claimant,
No. 19 CV 1883
v.
Magistrate Judge Jeffrey T. Gilbert
KILOLO KIJAKAZI, Acting
Commissioner of Social Security,
Respondent.
MEMORANDUM OPINION AND ORDER
Claimant John E.1 (“Claimant”) seeks review of the final decision of
Respondent

Kilolo

Kijakazi,2

Acting

Commissioner

of

Social

Security

(“Commissioner”), denying Claimant’s application for Disability Insurance Benefits
(“DIB”) under Title II of the Social Security Act (“Act”). Pursuant to 28 U.S.C. § 636(c)
and Local Rule 73.1, the parties have consented to the jurisdiction of a United States
Magistrate Judge for all proceedings, including entry of final judgment. [ECF No. 6].
This Court has jurisdiction pursuant to 42 U.S.C. §§ 405(g) and 1383(c), and the
parties have filed cross-motions for relief [ECF Nos. 13, 19] pursuant to Federal Rule
of Civil Procedure 56. For the reasons discussed below, Claimant’s Motion to Reverse

Pursuant to Northern District of Illinois Local Rule 8.1 and Internal Operating Procedure
22, the Court will identify the non-government party by using his or her full first name and
the first initial of the last name.
1

Kilolo Kijakazi became the Acting Commissioner of Social Security on July 9, 2021.
Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, the Court has substituted
Acting Commissioner Kijakazi as the named defendant.
2

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the Decision of the Commissioner of Social Security [ECF No. 13] is denied and the
Commissioner’s Motion for Summary Judgement [ECF No. 19] is granted.
PROCEDURAL HISTORY
On August 28, 2014, Claimant filed a Title II application for DIB alleging
disability beginning on January 18, 2013. (R. 107-109, 236-37). His claim was denied
initially and upon reconsideration, after which Claimant requested a hearing before
an Administrative Law Judge (“ALJ”). (R. 85-106, 120-21). On November 2, 2016,
Claimant appeared at a hearing before ALJ Diane S. Davis. (R. 76-84). The hearing
was continued so that Claimant could obtain representation and a second hearing, at
which Claimant testified, was held on March 7, 2017. (R. 40-75). ALJ Davis also heard
testimony on that date from impartial vocational expert (“VE”) Edward P. Steffan.
(R. 68-74). On May 18, 2017, ALJ Davis denied Claimant’s claim for DIB. (R. 24-34).
In finding Claimant not disabled, the ALJ followed the five-step evaluation
process required by Social Security regulations for individuals over the age of 18. See
20 C.F.R. §§ 404.1520(a), 416.920(a). At step one, the ALJ found that Claimant did
not engage in substantial gainful activity during the relevant period from January
18, 2013, his alleged onset date, through March 31, 2017, his date of last insured. (R.
26). At step two, the ALJ found that Claimant had a severe impairment or
combination of impairments as defined by 20 C.F.R. 404.1520(c). (R. 26). Specifically,
Claimant suffered from cardiomyopathy; atrial fibrillation; hypertension; sleep
apnea; chronic obstructive pulmonary disease (COPD); and obesity. (R. 26-27). The

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ALJ also acknowledged a non-severe complaint, diabetes mellitus, but concluded that
it did not cause work-related limitations. (R. 26-27).
At step three, the ALJ determined that Claimant 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. 27). In
particular, the ALJ considered listings 3.02, 4.02, and 4.05, but concluded that
Claimant did not meet or medically equal the severity of those listings, nor did any
“acceptable medical source [mention] findings equivalent in severity to the criteria of
any listed impairment, individually or in combination.” (R. 27). Regarding listing
3.02A, the ALJ noted that Claimant’s single pulmonary function study in 2014 did
not constitute proof of listing level severity, in that the record did not provide evidence
of at least three forced expiratory maneuvers performed during the same test session,
which the regulations require. (R. 27). Nor did the ALJ see any pulmonary function
tests in the medical record beyond the single study in 2014, meaning that even if
Claimant had demonstrated listing level scores on that one occasion, there was no
evidence of ongoing significant severity. (R. 27). With respect to listing 4.02, the ALJ
concluded that Claimant did not meet numerous listing requirements, (R. 27-28), and
in particular, had a recent echocardiogram that showed left ventricular ejection
fraction of 60%, which is in a normal range, as was Claimant’s earlier testing that
showed 55%-60%. (R. 28). Finally, the ALJ substantively discussed listing 4.05 but
noted that Claimant’s arrhythmia did not meet the listing requirements for a number
of reasons, including that Claimant had not presented adequate documentary

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evidence to substantiate those listing requirements. (R. 28). The ALJ also touched on
Claimant’s obesity but noted that there was no evidence of record that Claimant’s
obesity contributed to any other severe impairment such that, in combination, those
impairments would meet listing level severity. (R. 28).
The ALJ then found Claimant had the RFC,3 through his date last insured, to:
“perform light work, as defined in 20 CFR 404.1567(b). The claimant can lift
and/or carry 20 pounds occasionally and 10 pounds frequently. He can stand
and/or walk for about six hours total in an 8-hour workday, and sit for about
six hours total. He can occasionally balance, stoop, kneel, crouch, crawl, and
climb ramps and stairs, but cannot climb ladders, ropes, and scaffolds. He
should avoid concentrated exposure to temperature extremes, pulmonary
irritants, and hazards, such as unprotected heights.”
(R. 28).
Based on this RFC, the ALJ found at step four that Claimant had past relevant
work as a construction worker but that work, which was very heavy, exceeded
Claimant’s residual functional capacity and could no longer be performed. (R. 32). At
step five, the ALJ concluded that, considering Claimant’s age, education, past work
experience, and residual functional capacity, he is capable of performing other work
within the national economy and that those jobs exist in significant numbers. (R. 3233). Specifically, the VE’s testimony, on which the ALJ relied, identified jobs
including unskilled light occupations such as office helper, cashier, and cleaner
housekeeper that Claimant could perform and that are available in significant
numbers in the national economy. (R. 33). The ALJ then found Claimant was not

Before proceeding from step three to step four, the ALJ assesses a claimant’s residual
functional capacity. 20 C.F.R. § 416.920(a)(4). “The RFC is the maximum that a claimant
can still do despite [her] mental and physical limitations.” Craft v. Astrue, 539 F.3d 668, 675–
76 (7th Cir. 2008).
3

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under a disability from January 18, 2013, the alleged onset date, through March 31,
2017, the date last insured. (R. 33).
The Appeals Council granted Claimant’s request for review on April 23, 2018
and issued a written decision on June 27, 2018 explaining that Claimant was not
entitled to benefits but that Claimant last met the insured requirements of the Social
Security Act on June 30, 2017, meaning the hearing decision left an unadjudicated
period from April 1, 2017 through May 18, 2017. (R. 9-11). Substantively, however,
the Appeals Council adopted the ALJ’s “statements regarding the pertinent
provisions of the Social Security Act, Social Security Administration Regulations,
Social Security Rulings and Acquiescence Rulings, the issues in the case, and the
evidentiary facts, as applicable.” (R. 9). Because there were no changes and no new
evidence submitted,4 the Appeals Council also adopted the ALJ’s findings or
conclusions from January 18, 2013 through March 31, 2017 and the previously
unadjudicated period from April 1, 2017 and May 18, 2017. (R. 9-10). The Appeals
Council adopted all of the ALJ’s findings from Steps 1 through 5 of the sequential
evaluation and agreed that Claimant had the RFC “perform a reduced range of light
work with occasional balancing, stooping, kneeling, crouching, crawling and climbing
ramps or stairs, but can never climb ladders, ropes, or scaffolds. The claimant should
avoid concentrated exposures to temperature extremes, pulmonary irritants and
hazards such as unprotected heights.” (R. 10). Ultimately, the Appeals Council agreed

Although Claimant’s attorney did request, and was granted, more time to submit additional
information to the Appeals Council, it appears that Claimant ultimately did not submit a
statement or any additional evidence for the Appeals Council to review. (R. 9, 14-19).
4

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with the ALJ that Claimant’s “limitations do not significantly erode the light,
unskilled, occupational base” and that there were a significant number of jobs
Claimant is capable of performing despite his limitations. (R. 11). A finding of “not
disabled,” the Appeals Council reasoned, was thus appropriate under the Act. (R. 11).
“[B]ecause the Secretary has delegated its authority to make final decisions to
the Appeals Council,” it is the Appeals Council’s decision that constitutes the
Secretary’s final decision for purposes of judicial review under 42 U.S.C. § 405(g).
Bauzo v. Bowen, 803 F.2d 917, 921 (7th Cir. 1986) (citations omitted). The decision of
the Appeals Council is therefore final and reviewable by this Court. Id.
STANDARD OF REVIEW
The Court’s analysis begins with the well-established principle that federal
courts may review only the Secretary’s final decisions. White v. Sullivan, 965 F.2d
133, 136 (7th Cir. 1992) (citing Califano v. Sanders, 430 U.S. 99, 108 (1977)). The
Appeals Council granted review in this case and, with a few modifications, adopted
the ALJ’s factual and legal conclusions in their entirety. Therefore, the Court must
review both the Council’s decision and the ALJ’s underlying opinion as modified in
timeframe only. 20 C.F.R. § 404.981; see, e.g., Arbogast v. Bowen, 860 F.2d 1400, 142003 (7th Cir. 1988) (“We therefore review the decision of the Appeals Council rather
than the decision of the ALJ. However, in this case, the Appeals Council explicitly
adopted, as modified, the opinion of the ALJ. Accordingly, we must review the
decision of the ALJ as modified by the Appeals Council.”).

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The Appeals Council is held to the same standard as the ALJ. Sanford v.
Berryhill, 2018 WL 539804, at *3 (N.D. Ill. 2018) (citing Bauzo, 803 F.2d at 923).
Judicial review is limited to determining whether the ALJ’s decision – adopted by the
Appeals Council here – is supported by substantial evidence in the record and
whether the ALJ applied the correct legal standards in reaching her decision. Nelms
v. Astrue, 553 F.3d 1093, 1097 (7th Cir. 2009). This Court may enter a judgment
“affirming, modifying, or reversing the decision of the Commissioner of Social
Security, with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g).
Substantial evidence “means – and means only – such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Biestek v.
Berryhill, 139 S. Ct. 1148, 1154 (2019) (internal quotations omitted); see also,
Richardson v. Perales, 402 U.S. 389, 401 (1971). “[W]hatever the meaning of
‘substantial’ in other contexts, the threshold for such evidentiary sufficiency is not
high.” Biestek, 139 S. Ct. at 1154. But even where there is adequate evidence in the
record to support the decision, the findings will not be upheld if the ALJ does not
“build an accurate and logical bridge from the evidence to the conclusion.” Berger v.
Astrue, 516 F.3d 539, 544 (7th Cir. 2008) (internal quotations omitted). In other
words, if the Commissioner’s decision lacks evidentiary support or adequate
discussion of the issues, it cannot stand. See Villano v. Astrue, 556 F.3d 558, 562 (7th
Cir. 2009). Though the standard of review is deferential, a reviewing court must
“conduct a critical review of the evidence” before affirming the Commissioner’s
decision. Eichstadt v. Astrue, 534 F.3d 663, 665 (7th Cir. 2008) (internal quotations

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omitted). The reviewing court may not, however, “displace the ALJ’s judgment by
reconsidering

facts

or

evidence,

or

by

making

independent

credibility

determinations.” Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008). “[O]nly if the
record compels a contrary result” will the court reverse the ALJ’s decision. Borovsky
v. Holder, 612 F.3d 917, 921 (7th Cir. 2010) (internal quotation marks and citation
omitted).
ANALYSIS
I.

The ALJ’s Assessment of Claimant’s Subjective Symptom
Statements

The Court first turns to the ALJ’s5 evaluation of Claimant’s subjective
symptom statements, which will be upheld unless it is “patently wrong.” Burmester
v. Berryhill, 920 F.3d 507, 510 (7th Cir. 2019); Murphy v. Colvin, 759 F.3d 811, 816
(7th Cir. 2014) (patently wrong “means that the decision lacks any explanation or
support.”). In this case, the ALJ discounted Claimant’s testimony regarding the
intensity, persistence, and limiting effects of his symptoms because this testimony
was, in the ALJ’s view, inconsistent with the objective medical evidence and
Claimant’s activities of daily living, course of treatment, and functional limitations.
Still, Claimant argues that the ALJ's credibility determination was patently wrong
for two reasons. First, he argues that the ALJ erred by finding that some of his daily
activities, including painting and riding a bicycle, contradicted the alleged intensity
of his symptoms. Second, he charges that the ALJ improperly played doctor when she

Because the Appeals Council adopted the substance of ALJ’s opinion in its entirety, the
Court will predominantly refer and cite to the ALJ’s reasoning.
5

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focused on his “normal” examination findings in his medical records to the exclusion
of other evidence – in particular, the records of his treating cardiologist Dr. Parag
Jain. Neither argument is availing.
The regulations6 provide a two-step test for adjudicators to follow when
evaluating a claimant’s symptoms such as pain. Maske v. Astrue, 2012 WL 1988442,
at *11 (N.D. Ill. 2010). First, the ALJ “must consider whether there is an underlying
medically determinable physical or mental impairment(s) that could reasonably be
expected to produce the individual's symptoms, such as pain.” SSR 16-3p, 2017 WL
5180304, at *2 (Oct. 25, 2017); see also 20 C.F.R. § 404.1529. “Second, once an
underlying physical or mental impairment(s) that could reasonably be expected to
produce the individual's symptoms is established, we evaluate the intensity and
persistence of those symptoms to determine the extent to which the symptoms limit
an individual’s ability to perform work-related activities [...].” Id. The ALJ must
justify her subjective symptom evaluation with “specific reasons supported by the
record,” Pepper v. Colvin, 712 F.3d 351, 367 (7th Cir. 2013), and in doing so, must
consider several factors, including the objective medical evidence, the claimant’s daily
activities, his level of pain or symptoms, aggravating factors, medication, course of
treatment, and functional limitations. 20 C.F.R. § 404.1529(c); SSR 16-3p, 2017 WL

SSR 16-3p supersedes SSR 96-7p for disability determinations issued on or after March 28,
2016 and eliminates the use of the term “credibility” to “clarify that subjective symptom
evaluation is not an examination of an individual’s character.” See SSR 16-3p, at *1. However,
the factors to be considered in evaluating symptoms under either SSR 96-7p and SSR 16-3p
are the same, and so the Court also is bound by case law concerning former SSR 96-7p.
Compare SSR 96-7p, 1996 WL 374186 (July 2, 1996), with SSR 16-3p, 2017 WL 5180304, at
*7-8 (Oct. 25, 2017).
6

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5180304, at *5, *7-8. A claimant's assertions of pain, taken alone, are not conclusive
of disability. See 42 U.S.C. § 423(d)(5)(A).
The ALJ summarized Claimant’s subjective symptom testimony as follows:
“The claimant testified that he could not sit for four hours because his legs will
swell, so he has to get up and move around. He can sit for two hours before
elevating his legs, and then he has swelling in his legs and feet and his legs
hurt. He elevates his legs a couple of times during the day and at night to avoid
swelling. His energy levels are not good, and he starts falling asleep sitting
upright. He has shortness of breath throughout the day, and uses Advair when
needed. He has difficulty with temperature extremes. When it is very cold, he
cannot feel his feet because of circulation, and he cannot breathe in cold or hot
temperatures. With regard to breathing, he testified that he uses a BiPap
machine with oxygen during the day, otherwise his hands and ankles will
swell.”
(R. 29); see also (R. 42-68).
In order to cohesively assess Claimant’s subjective complaints, the ALJ
separated those complaints into three general categories: Claimant’s cardiac
symptoms, his need to elevate his feet, and his respiratory issues. (R. 28-31). She then
tackled whether each category was consistent with the objective medical evidence,
activities of daily living, course of treatment, and functional limitations. In so doing,
the ALJ considered the necessary factors under 20 C.F.R. § 404.1529(c) and
adequately justified her subjective symptom evaluation with “specific reasons
supported by the record,” Pepper, 712 F.3d at 367, as discussed below.
a. Cardiovascular Symptoms
First, regarding Claimant’s cardiac symptoms, the ALJ cited specific pieces of
medical evidence that, in her opinion, did not support the degree of limitation
Claimant described. “[D]iscrepancies between the objective evidence and self-reports

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may suggest symptom exaggeration.” Jones, 623 F.3d at 1161; Getch v. Astrue, 539
F.3d 473, 483 (7th Cir. 2008); Sienkiewicz v. Barnhart, 409 F.3d 798, 804 (7th Cir.
2005). And here, the records provided by Claimant’s cardiologist, Dr. Jain, revealed
that in the four visits Claimant had between 2015 and 2017, Claimant presented with
normal cardiovascular findings that stood in stark contrast to the subjective
complaints Claimant sometimes reported to Dr. Jain during those visits and
reiterated during his testimony. (R. 680-81) (3/24/15) (“CV: no chest pain,
palpitations, fatigue, or syncope…CV: AUSC: regular rhythm, normal S1, S2; no
pathological murmurs, CAROTIDS: no carotid bruit, EXT: no edema.”); (R. 682-83)
(9/29/15) (same); (R. 684-85) (7/22/16) (same); (R. 686-87) (2/2/17) (“CV: no chest pains
and palpitations...CV: AUSC: regular rhythm, normal S1, S2; no pathological
murmurs, CAROTIDS: no carotid bruit, EXT: no edema.”). Examinations performed
by Claimant’s pulmonologist Dr. Alexander Sosenko were similarly uneventful. (R.
701) (7/7/14) (“HEART: Regular rhythm. No obvious ectopy. No JVD (jugular venous
distension).”); (R. 692-93) (8/18/14) (“Cardiac: Good heart tones with no murmurs with
occasional ectopic beats.”); (R. 695) (2/19/15) (“Cardiac: Irregular rhythm. No obvious
JVD.”). And Claimant’s primary care physician, Dr. Rick Singh,7 regularly credited
and monitored Claimant’s multiple diagnoses but, as relevant here, documented
cardiac symptoms that were at odds with Claimant’s testimony. (R. 705-06) (4/19/13)
(“Patient denies any cardiovascular, respiratory, or genitourinary complaints
today…HEART: regular rate and rhythm, normal S1S2, no murmurs, click or rubs.”);

Dr. Singh’s records are sometimes signed “Dr. Jitinder Singh,” and on other occasions, “Dr.
Rick Singh.” The Court assumes based on context that these are the same person.
7

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(R. 708) (7/17/13) (“[Patient] denies any chest pain, pressure, no shortness of
breath…HEART: regular rate and rhythm, normal S1S2, no murmurs, click, or
rubs.”); (R. 711-713) (11/6/13) (“Patient denies any cardiovascular, respiratory,
genitourinary complaints today…HEART: regular rate and rhythm, normal S1S2, no
murmurs, click or rubs.”); (R. 715) (12/24/13) (“HEART: regular rate and rhythm,
normal S1S2, no murmurs, click or rubs.”); (R. 716-17) (1/10/14) (“[Patient] denies
any chest pain, pressure, no heart palpitations…HEART: regular rate and rhythm,
normal S1S2, no murmurs, click or rubs,”); (R. 408-410); (R. 719-21) (10/8/15)
(“Patient

denies

any

cardiovascular,

respiratory,

genitourinary

complaints

today…HEART: regular rate and rhythm, normal S1S2, no murmurs, click or rubs.”);
(R. 649-51) (4/10/15) (“Patient denies any cardiovascular, respiratory, genitourinary
complaints today…HEART: regular rate and rhythm, normal S1S2, no murmurs,
click or rubs.”); (R. 725) (6/16/16) (“Patient is a very nice 49-year-old gentleman who
presents today for general annual checkup he denies any complaints he does have a
past medical history is difficult for atrial fibrillation, hypertension, hyperlipidemia,
diabetes mellitus he continues to follow up with his cardiologist on a regular basis.
Patient

denies

any

cardiovascular,

respiratory,

genitourinary

complaints

today…HEART: regular rate and rhythm, normal S1S2, no murmurs, click or rubs.”).
These consistently normal examination findings belied Claimant’s testimony that his
cardiovascular symptoms were entirely disabling.
Claimant correctly argues that an ALJ cannot ignore evidence that conflicts
with her conclusion, Briscoe, 425 F.3d at 354, but the ALJ did not do so here. The ALJ

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specifically took note of many of the facts that Claimant now argues on appeal should
have been dispositive; for example, that there was a single sentence in Dr. Jain’s
medical notes in February of 2017 that because Claimant was likely in “severe
diastolic heart failure,” Dr. Jain would be “placing him at New York Heart
Association [C]lass IV” and “will even consider cardiac transplant in this individual.”
(R. 687). [ECF No. 13] at 11-12. The ALJ went to great lengths to articulate why she
was not swayed in her credibility assessment by the aforementioned isolated medical
findings, particular given the longitudinal evidence of record. (R. 30) (“Dr. Jain
suggested Claimant may require a transplant, but again ordered no additional
testing to support this extreme statement. Instead of ordering further tests or
recommending changes in cardiac treatment, Dr. Jain referred the claimant to a new
primary care physician so that the claimant could continue to see Dr. Jain in
network.”). At the end of the day, the ALJ specifically considered the facts upon which
Claimant now asks this Court to base its remand. (R. 30). She simply did not afford
them the significance Claimant prefers. And if the ALJ’s credibility assessment finds
“some support” in the record, Berger, 516 F.3d at 546, it will not be disturbed –
regardless of how this Court of review might have looked at the matter or weighed
the evidence itself in the first instance. The ALJ was not simply required to accept
Claimant’s subjective complaints to the extent they clashed with other, objective
medical evidence in the record. Arnold v. Barnhart, 473 F.3d 816, 823 (7th Cir. 2007).
And as the ALJ explained, isolated references in the medical record to the
“possibility” of a heart transplant and a Class IV NYHA Classification with nothing

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else to support those statements and no follow-up did not, in her view, overcome a
medical record replete with normal examination findings and relatively conservative
courses of treatment for Claimant’s cardiovascular issues.
So too did the ALJ find that Claimant’s activities of daily living were largely
incompatible with Claimant’s testimony that his cardiovascular limitations were
entirely work preclusive. And the ALJ was correct to consider these activities as one
factor in her subjective symptom assessment. SSR 96–7p recognizes “the fact that an
individual’s symptoms can sometimes suggest a greater level of severity of
impairment than can be shown by the objective medical evidence alone,” which is why
the ALJ should also consider other evidence “when assessing the credibility of an
individual’s statements.” 20 C.F.R. §§ 404.1529(c), 416.929(c). In that vein, the ALJ
identified activities of daily living that she believed were inconsistent with the degree
of disability Claimant alleged. See. e.g, Adams v. Astrue, 880 F. Supp. 2d 895, 907
(N.D. Ill. 2012) (the ALJ properly considered the claimant’s daily activities, which
included performing household chores and using public transportation, in
determining the extent of Claimant’s alleged symptoms); see also, 20 C.F.R. §
404.1529(c)(3)(i) (explaining that other evidence, including daily activities, is an
“important indicator of the intensity and persistence of [claimants] symptoms.”). In
2013, Claimant told Dr. Jain, his cardiologist, that he tries to stay active and Dr. Jain
recommended that he continue to exercise at that time, without apparent limitation.
(R. 423). In 2014, Dr. Jain documented – and the ALJ cited – the fact that Claimant
“does not get any chest pain with exertion and he stays very active. He likes to go

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biking but he cannot do any manual heavy labor.” (R. 421). Dr. Jain similarly noted
in 2014 that Claimant was going out to eat a lot, “he says with the Bears games.” (R.
419). In 2015, Dr. Jain noted that Claimant was moving boxes and drywall, which
the ALJ characterized as significant activity far beyond the limitations contained in
the RFC in this case and acknowledged that the medical records noted caused
Claimant “a little bit [of] shortness of breath.” (R. 682). Claimant also testified that,
throughout the relevant period, he cared for his children, drove them to and from
school as necessary, and occasionally went shopping. (R. 30).
The ALJ weighed the above-described activities of daily living and reasonably
concluded that, on balance, they undercut Plaintiff’s own subjective testimony about
his symptoms and impairments. Burmester, 920 F.3d at 510 (“The ALJ did not equate
[the claimant’s] ability to perform certain activities of daily living with an ability to
work full time. Instead, he used her reported activities to assess the credibility of her
statements concerning the intensity, persistence, or limiting effects of her symptoms
consistent with the applicable rules.”). It was permissible, and even encouraged by
the regulations, for the ALJ to do so. Hostetter v. Saul, 841 F. App’x 983, 987 (7th Cir.
2021) (“Based on records reflecting that, between 2015 and 2017, Hostetter worked
as a carpenter, and testimony that he did housework, shopped, and cared for a young
child, the ALJ could reasonably infer that his daily activities were “‘somewhat greater
than he has generally reported.’”). That the ALJ did not fully accept Claimant’s
proffered explanations for the apparent contrast between the activities of daily living
documented in the medical records and those Claimant described in his testimony –

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for example, Claimant’s response that he would not say he enjoyed the bicycle and
only did it briefly, as a form of rehabilitation – is not indicative of error. The ALJ was
in the best position to make credibility determinations about the explanations
Claimant offered for the statements contained in the medical records, particularly
where, unlike this Court, the ALJ “had the opportunity to observe the claimant
testifying, and, as Justice Jackson rightly observed more than a half-century ago, ‘a
few minutes observation…in the courtroom is more informing than reams of cold
record.’” Brenda L. v. Saul, 392 F. Supp. 3d 858, 864 (N.D. Ill. 2019) (quoting Ashcraft
v. State of Tenn., 322 U.S. 143, 171 (1944) (Jackson, J., dissenting)).
Claimant may have preferred the ALJ assign different weight to pieces of
evidence in the record to support his subjective symptom testimony that he had
entirely work preclusive limitations. But the ALJ saw the longitudinal record
differently and explained as much in her opinion, which is enough to satisfy this
Court under the deferential standard of review afforded to credibility decisions made
by administrative law judges.
b. Elevated Legs
The ALJ next tackled Claimant’s testimony that he must elevate his feet for
an hour at least two or three times a day. (R. 30, 59-60). As required by the 20 C.F.R.
§ 404.1529(c) factors, the ALJ first evaluated Claimant’s subjective testimony in light
of the objective medical evidence and concluded that the two were incongruous. The
ALJ credited the truth of Claimant’s statements about elevating his legs but
explained that such a severe limitation was not borne out by the medical evidence.

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(R. 30). As the ALJ emphasized, Claimant’s treatment providers never recommended
that he elevate his legs at all, let alone for the frequency and duration that Claimant
reported. See, e.g., Anders v. Saul, 2021 WL 2396236, at *4 (7th Cir. 2021). Although
Claimant makes a valiant effort to characterize the record in his favor and suggest
that Claimant’s treatment providers did in fact recommend Claimant elevate his legs,
this argument is unsupportable. [ECF No. 13] at 9 (arguing that Claimant “was
following his doctors’ instructions regarding elevating his legs” because “Dr. Singh
“instructed [Claimant] to elevate his legs 45 degrees for 20 minutes once or twice
during the day” and Dr. Jain “wrote in his notes…that he needed to elevate his legs
70% of the time during an 8 hour work day”). Neither Dr. Singh nor Dr. Jain ever
“recommended” to Claimant that he elevate his legs during the course of their
treatment or wrote about the need for such treatment in their “notes.” Instead, those
doctors mentioned for the first time in the medical opinions they generated for the
Social Security Administration that Claimant’s work limitations may include the
need to elevate his legs to reduce swelling during the workday. (R. 655) (“Based on
your medical expertise, medical findings and treatment history please state the
patient’s ability to do sustained work-related physical activity throughout an eighthour workday…Does the patient’s leg(s) need to be elevated to reduce swelling during
the daytime? Yes…45˚…once or twice.”); (R. 676-77) (“Please answer the following
questions concerning your patient’s impairments…With prolonged sitting, should
your patient’s leg(s) be elevated? Yes…over his head…70% [of an 8-hour working
day].”). These opinions generated in connection with a patient’s application for social

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security benefits are a far cry from a doctor-patient recommendation as part of a
regular course of treatment or diagnosis, and the ALJ considered them appropriately.
The ALJ also noted that Claimant’s assertion of swelling in his lower
extremities was not substantiated by any independent observations of edema, or
swelling, in Claimant’s legs during his medical visits. In fact, after he presented with
some “[t]race edema” during a hospital visit in 2013, (R. 30, 393-94), and described
“increasing lower extremity edema” to his doctor in 2014 (which the doctor concluded
may be a result of his “weight gain and by the fact that he also has some issues with
his salt intake”), Claimant was prescribed a diuretic medication, (R. 394, 419), that
largely resolved his edema, at least according to the medical record after that point.
And although Claimant counters with the sweeping generalization that the “record
does, in fact, show periodic edema” and that this “support[s] [Claimant’s] alleged need
to elevate his legs,” that is not a fair reading of the medical evidence. [ECF No. 24] at
3. No physical examination after Claimant’s initial complaint documented any
notable occurrences of edema. (R. 419, 420, 423, 425-26, 429, 432, 681, 683, 685, 687,
706, 708, 713, 715, 717, 721, 725-26). In fact, physician notes from many
examinations specifically and affirmatively disclaimed that Claimant had swelling in
his extremities. And the single mention of edema in the record upon which Claimant’s
argument rests is Dr. Jain’s February 2, 2017 treatment note, which already stands
in stark contrast to the longitudinal medical evidence. Indeed, while that note does
reference, without apparent support, that Claimant has a medical history of “periodic
edema on exam,” it also states that Claimant had no edema on that date, as was the

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case on every other date Dr. Jain examined Claimant. (R. 686-87) (“EXT: no clubbing
or cyanosis…EXT: no edema.”).
Although the argument that a lack of edema is not necessarily inconsistent
with Claimant’s need to elevate his legs has some merit, Anders, 2021 WL 2396236,
at *4, the Court is unwilling to say that the ALJ was patently wrong in deciding not
to fully credit Claimant’s testimony about his leg elevation limitation. See also,
McKinzey v. Astrue, 641 F.3d 884, 890–91 (7th Cir. 2011) (concluding “that the ALJ's
credibility determination was adequately supported by evidence in the record” even
though the “credibility determination was not without fault”). Dispositively, no
medical provider ever recommended as part of Claimant’s treatment that he needed
to do so. On balance, the ALJ considered the appropriate factors, of which objective
medical evidence was one, and concluded that Claimant’s testimony could not be
reconciled with the record as presented. This Court will not substitute its judgment
for that of the ALJ by reweighing the evidence. Zoch v. Saul, 981 F.3d 597, 602 (7th
Cir. 2020) (“[E]ven if reasonable minds could differ on the ALJ’s rejection of [the
claimant’s] testimony, we will not reweigh evidence or substitute our judgment for
the ALJ’s.”).
c. Respiratory Symptoms
Finally, the ALJ touched on Claimant’s subjective reports that he was
experiencing work-preclusive shortness of breath during the day and had difficulty
breathing in cold or hot temperatures. (R. 29-30). Claimant does not directly
challenge the ALJ’s assessment of his subjective respiratory complaints, and so this

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Court is reluctant to wade into an undeveloped argument. Suffice it to say that the
ALJ supported her conclusion that Claimant’s respiratory issues appeared to be wellcontrolled by Claimant using his inhalers as needed, an Advair disc as a rescue
inhaler, and his being compliant with his BiPap machine with substantial evidence.
(R. 30-31). She reviewed the objective medical evidence and noted that Claimant’s
mostly normal examination findings were consistent with well-controlled respiratory
symptoms. (R. 30-31); (R. 680-81) (3/24/15) (“RESP: dyspnea and occasional uses
inhaler…RESP: clear to auscultation and percussion”); (R. 682-83) (9/29/15) (same);
(R. 684-85) (7/22/16) (same); (R. 686-87) (2/2/17) (same). So too did she consider
Claimant’s infrequent need to see a pulmonologist to address his shortness of breath
and sleep-related breathing issues, as discussed further below.
d. Other Issues
In evaluating Claimant’s subjective symptom reports, the ALJ also vaguely
mentioned that Claimant’s “conservative course of treatment” was not consistent
with the degree of limitation alleged. Claimant argues that the ALJ committed
reversible error with this line of reasoning, as the regulations state that an ALJ “must
not draw any inferences about an individual’s symptoms and their functional effects
from a failure to seek or pursue regular medical treatment without first considering
any explanations that the individual may provide.” SSR 96–7p, 1996 WL 374186, at
*7 (Jul. 2, 1996); see also, Moss v. Astrue, 555 F.3d 556, 562 (7th Cir. 2009). “[T]he
agency has expressly endorsed the inability to pay as an explanation excusing a
claimant's failure to seek treatment.” Roddy v. Astrue, 705 F.3d 631, 638 (7th Cir.

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2013). And other than a few references to Claimant being specifically referred to
physicians that were “in network,” the ALJ did little in her written opinion to discuss
the references in the record to Claimant’s insurance concerns and how that may have
affected his chosen course of treatment or failure to seek more aggressive
interventions for his conditions.
Although the ALJ did not explicitly discuss, in her written opinion, the impact
of Claimant’s shifting insurance coverage on her characterization of Claimant’s care
as relatively “conservative,” it clearly was on her mind at Claimant’s hearing. The
ALJ and Claimant engaged in a lengthy back and forth about Claimant’s insurance
coverage and possible financial hardships that would have precluded Claimant from
pursuing more aggressive treatment, had it been recommended or required. (R. 5154). During that exchange, Claimant provided some context for the notes in Dr. Jain’s
records that suggested he was having insurance struggles, (R. 682), and explained
that at a singular point in time, he experienced some insurance issues because he
moved “from his union insurance to [his] buy-off-the-exchange insurance.” (R. 52). It
was not, as Claimant now suggests the Court should infer from Dr. Jain’s medical
records, as if Claimant did not have insurance to help defray his medical costs.
Rather, Claimant needed a new primary care doctor who, in turn, needed to make
new referrals for his new insurance to cover his treatment. (R. 52-53). And although
Claimant expressed some frustration that his new insurance, Blue Cross Blue Shield,
could not preauthorize certain tests and confirm to Claimant that those tests would
be covered, that is a far cry from cases in which courts in this district have chastised

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an ALJ for failing to consider a claimant’s financial difficulties and how that may
affect a course of treatment. See, e.g., Sabo D. v. Saul, 2021 WL 1315630, at *6 (N.D.
Ill. 2021) (where the record showed that the claimant had significant financial
difficulties, i.e. he lost his job, went bankrupt, and had no insurance whatsoever, the
ALJ erred in not discussing these barriers to treatment during his assessment of the
claimant’s subjective symptom testimony).
Certainly, it would have been better for the ALJ to specifically mention
whether Claimant’s change in insurance from a union-based plan to an open
marketplace plan affected the type of treatment he sought and/or received during the
relevant time period. But, on balance and taking into account the extensive colloquy
between Claimant and the ALJ at the hearing on that subject, it is clear to the Court
that the ALJ was aware of Claimant’s shifting insurance coverage and that she
considered its impact on Claimant’s care when she commented on the relatively
conservative nature of that care in her written opinion. The Court sees no reversible
error based on the facts of this case, especially where the Seventh Circuit recently
described that where an ALJ’s “analysis surely could have been better, but [it] is not
a circumstance where an ALJ altogether missed a medical opinion, ignored important
testimony, or reasoned in terms lacking coherence,” affirmance is warranted. Anders,
2021 WL 2396236, at *2-3.
In sum, the ALJ and the Appeals Council considered Claimant’s subjective
complaints and evaluated the relevant evidence of record, including the objective
medical evidence and Claimant’s activities of daily living. But after considering this

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evidence, the ALJ simply did not believe Claimant’s pain was as debilitating as he
claimed. Nor was she required to do so. Sarchet v. Chater, 78 F.3d 305, 307 (7th Cir.
1996) (The “administrative law judge did not have to believe [Claimant’s
testimony].”). Instead, her obligation was “to rationally articulate the grounds
for…decision,” Steele v. Barnhart, 290 F.3d 936, 941 (7th Cir. 2002), which she did
here. Particularly given that credibility determinations are due special deference as
factual findings, Matthews v. Saul, 833 F. App’x 432, 438 (7th Cir. 2020), Claimant
offers no meaningful reason the ALJ’s subjective symptom assessment should not be
upheld, nor does this Court believe the ALJ was patently wrong in this case.
II.

The Medical Opinions of Record
a. The State Agency Physicians
Claimant’s first claim of error regarding the medical opinion evidence is that

the ALJ relied on outdated opinions from the state agency physicians when she
formulating the RFC and discounted Dr. Jain’s opinion. The Court is unpersuaded.
Claimant filed his Title II application for DIB on August 28, 2014. The state
agency physicians rendered their opinions on December 10, 2014, (R. 85-94), and
June 11, 2015, (R. 96-105), after which Claimant appeared at his first hearing with
the ALJ on November 2, 2016. That hearing was continued so that Claimant could
obtain representation and a second hearing was held on March 7, 2017. The ALJ
ultimately rendered her opinion on May 18, 2017. According to Claimant, in the gap
between the state agency physician’s June 2015 opinion and the ALJ’s May 18, 2017
opinion, new and significant medical evidence arose that should have been evaluated

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by an independent medical expert. Specifically, Claimant points to Dr. Jain’s note in
September of 2015 that Claimant had elevated blood pressure (R. 682), Dr. Jain’s
note in July of 2016 that he was classifying Claimant as NYHA Class III, and Dr.
Jain’s February 2017 note that a heart transplant might be considered for Claimant.
[ECF No. 13] at 13-14. Because of these new medical findings, it was incumbent on
the ALJ, in Claimant’s view, to order an independent medical evaluation to fill in the
gap in time between the state agency opinions and the ALJ’s opinion.
The Court measures the sufficiency of the record differently. “It is common for
there to be a lag between the state agency physicians’ reviews and the ALJ's decision,
so the fact that new medical records came in after the state agency physicians
conducted their reviews, is not, by itself, problematic.” Shelia M. v. Saul, 2021 WL
1784775, at *6 (N.D. Ill. 2021) (citing Keys v. Berryhill, 679 F. App’x 477, 481 (7th
Cir. 2017); Scheck v. Barnhart, 357 F.3d 697, 702 (7th Cir. 2004) (“If an ALJ were
required to update the record any time a claimant continued to receive treatment, a
case might never end.”)). Instead, the dispositive question is whether there is
“evidence containing new, significant medical diagnoses” postdating the state agency
physician’s opinion that could reasonably have changed the outcome of that opinion.
Stage v. Colvin, 812 F.3d 1121, 1125 (7th Cir. 2016) (remanding where state agency
physician did not have access to later medical evidence containing “significant, new,
and potentially decisive findings” that could “reasonably change the reviewing
physician's opinion”). Here, there were no significant medical findings that the ALJ
failed to the consider, nor was it incumbent on the ALJ to seek an updated medical

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review based on isolated notes from a treating physician to whom the ALJ ultimately
afforded little weight, as described in Section II of this opinion.
Moreover, Claimant failed to articulate how the records he references would
have changed the state agency physicians’ opinion and offered only conclusory
statements that because those opinions were “old opinions from doctors who had an
incomplete view of the record,” it was improper for the ALJ to rely on them. [ECF No.
13] at 14. Not only is this undeveloped argument problematic, but it also ignores the
fact that the ALJ clearly reviewed, considered, and then discussed at length the
records Claimant now emphasizes would have changed the outcome of the case, or at
least the opinions of the state agency physicians. The ALJ took care to evaluate and
distinguish, where necessary, Dr. Jain’s records and other post-2015 treatment
records when she concluded that Claimant could perform light work with some
additional restrictions. See, e.g., Keys, 679 F. App’x at 480-81. This reviewing Court
will not overstep its limited role and, as Claimant requests, “reweigh the evidence,
resolve debatable evidentiary conflicts, determine credibility, or substitute our
judgment for the ALJ's determination so long as substantial evidence supports it.”
Gedatus v. Saul, 994 F.3d 893, 900 (7th Cir. 2021) (citing Burmester, 920 F.3d at 510;
Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000)).
b. Claimant’s Treating Physician Dr. Jain
Claimant’s second concern with the medical opinion evidence is that the ALJ
misjudged Claimant’s treating physician’s opinion. In fact, although Claimant
dedicates a comparatively small section of his brief to the argument that the ALJ

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erred when she afforded Dr. Jain’s opinion little weight, the accusation that the ALJ
did not correctly evaluate Dr. Jain’s opinion pervades Claimant’s entire
memorandum, as Claimant relies on Dr. Jain’s notes and opinions in support of
almost every other claim of error. Claimant would have this Court weigh Dr. Jain’s
opinion differently and reach a different conclusion that the ALJ on the evidence
before her, but that is not this Court’s role. Rather, the inquiry is limited to whether
the ALJ sufficiently accounted for the factors in 20 C.F.R. § 404.1527 and built an
“accurate and logical bridge” between the evidence and her conclusion. See Elder, 529
F.3d at 415-16 (affirming denial of benefits where ALJ discussed only two of the
relevant factors laid out in 20 C.F.R. § 404.1527). The ALJ did what she was supposed
to do under that deferential standard, and the Court has no grounds to disturb her
conclusion as to the weight to be given Dr. Jain’s opinion on the facts of this case.
An ALJ must “minimally articulate” her reasons for crediting or rejecting
evidence of disability. Clifford, 227 F.3d at 870 (quoting Scivally v. Sullivan, 966 F.2d
1070, 1076 (7th Cir. 1992)). Claimant filed his disability claims before March 27,
2017, meaning the ALJ was required to evaluate the treating physician opinion in
two steps. At the first step, the ALJ must give a treating source’s opinion controlling
weight if the “opinion on the issue(s) of the nature and severity of [the claimant's]
impairment(s) is well-supported by medically acceptable clinical and laboratory
diagnostic techniques and is not inconsistent with the other substantial evidence” in
the record. 20 C.F.R. § 416.927(c)(2); see Bates v. Colvin, 736 F.3d 1093, 1099 (7th
Cir. 2013); Punzio v. Astrue, 630 F.3d 704, 710 (7th Cir. 2011); Schmidt v. Astrue, 496

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F.3d 833, 842 (7th Cir. 2007). Then, at the second step, if the ALJ decides a treating
physician’s opinion should not be given controlling weight, she must determine what
weight to afford the opinion in light of the factors in 20 C.F.R. § 404.1527(c)(2).
Scrogham v. Colvin, 765 F.3d 685, 697 (7th Cir. 2014). These factors include the
nature of the examining relationship, the length of the treating relationship, whether
the medical evidence supports the opinion, whether the opinion is consistent with the
record, the physician's specialization, and any other factors that relate to the opinion.
Schmidt, 496 F.3d at 842 (“An ALJ thus may discount a treating physician’s medical
opinion if the opinion is inconsistent with the opinion of a consulting physician or
when the treating physician’s opinion is internally inconsistent, as long as he
minimally articulates his reasons for crediting or rejecting evidence of disability.”);
see also, Latkowski v. Barnhart, 93 F. App’x 963, 970-71 (7th Cir. 2004); Jacoby v.
Barnhart, 93 F. App’x 939, 942 (7th Cir. 2004). Once contrary evidence is introduced,
a treating physician’s opinion becomes just one piece of evidence for the ALJ to
evaluate. Ray v. Saul, 2021 WL 2710377, at *2 (7th Cir. 2021).
Although an ALJ must consider all the factors set forth in 20 C.F.R. §
404.1527(c), she need not expressly discuss each factor in her written opinion.
Schreiber v. Colvin, 519 F. App’x 951, 959 (7th Cir. 2013) (rejecting claimant's
argument that the ALJ erred by not specifically addressing each factor). As long as
she otherwise explains why the treating physician's opinion is not supported by the
medical record and is inconsistent with the rest of the record, that usually will suffice.
Henke v. Astrue, 498 F. App'x 636, 640 n. 3 (7th Cir. 2012) (“The ALJ did not explicitly

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weigh every factor [in 20 C.F.R. § 404.1527] while discussing her decision to reject
[the treating physician’s] reports, but she did note the lack of medical evidence
supporting [the treating physician’s] opinion...and its inconsistency with the rest of
the record...This is enough”); see also, Loveless v. Colvin, 810 F.3d 502, 507 (7th Cir.
2016) (“treating physician's opinion is entitled to controlling weight unless it is
‘inconsistent with the other substantial evidence.’ ”). Ultimately, the weight accorded
to a treating physician's opinion must balance all the circumstances and recognize
that while a treating physician “has spent more time with the claimant,” the treating
physician may also “bend over backwards to assist a patient in obtaining
benefits...[and] is often not a specialist in the patient's ailments, as the other
physicians who give evidence in a disability case usually are.” Hofslien v. Barnhart,
439 F.3d 375, 377 (7th Cir. 2006) (internal citations omitted).
Here, the ALJ followed the two-step process prescribed by the regulations and
explained that, although Dr. Jain did have a treating relationship with Claimant, she
could not afford controlling weight to his opinion because it was overwhelmingly
based on Claimant’s subjective reports and was inconsistent with Dr. Jain’s own
records of Claimant’s treatment, other medical evidence in the record, Claimant’s
activities of daily living, and Claimant’s longitudinal course of treatment. (R. 29-31).
Specifically, the ALJ was aware of the nature and extent of Claimant’s
relationship with Dr. Jain, Larson v. Astrue, 615 F.3d 744, 751 (7th Cir. 2010), and
substantively discussed many of Claimant’s visits with Dr. Jain throughout the
relevant period. But, she explained Dr. Jain’s opinion was entitled to only “little

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weight” because it was contradicted by other evidence and unsupported by objective
tests.

(R. 30-31). Dr. Jain’s opinion also was, in the ALJ’s view, internally

inconsistent with Dr. Jain’s own notes of his visits with Claimant. Knight, 55 F.3d at
314 (“Medical evidence may be discounted if it is internally inconsistent or
inconsistent with other evidence” in the record). Almost every time he examined
Claimant, Dr. Jain noted normal examination findings; or at least, examination
findings that were significantly less limiting than those Dr. Jain ultimately provided
in his opinion. (R. 418-474, 678-89). And as described in detail in Section I of this
opinion, the ALJ also clearly considered Claimant’s activities of daily living in the
context of Dr. Jain’s opinion, (R. 29-31), and ultimately concluded that they did not
align with the comparatively severe limitations Dr. Jain propounded. Finally, the
ALJ considered that Dr. Jain’s increased 2017 NYHA classification and single
reference to “possibility” of a heart transplant were not consistent with the nature of
Dr. Jain’s treatment during at that time, which largely consisted of medication
management and periodic testing. The record evidence, as the ALJ noted, did not
document any recent emergency care visits or anything else to support Dr. Jain’s
isolated notes that Claimant’s condition had rapidly deteriorated in February of 2017.
(R. 30). Because the record supports these conclusions, the ALJ provided “‘an accurate
and logical bridge’ between the evidence and her decision” to discount Dr. Jain’s
opinion. See Jeske v. Saul, 955 F.3d 583, 593 (7th Cir. 2020) (quoting Roddy v. Astrue,
705 F.3d 631, 636 (7th Cir. 2013)).

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As the Seventh Circuit has cautioned, Claimant bears the burden to prove he
is disabled by producing medical evidence. Ray, 2021 WL 2710377, at *3; see also,
Castile v. Astrue, 617 F.3d 923, 927 (7th Cir. 2010). Claimant did not do so here, where
his disability claim rises and falls almost entirely on Dr. Jain’s opinion. That opinion
is, in turn, based largely on Claimant’s subjective reports and is inconsistent with Dr.
Jain’s own medical notes. Claimant did little to support that opinion with other
evidence, and so the ALJ’s decision on this issue stands. Id.
III.

The ALJ’s Assessment of Claimant’s Residual Functional Capacity
and Claimant’s Obesity

Finally, Claimant next challenges the ALJ’s RFC assessment and postulates
that the ALJ overlooked the impact of his obesity on the severity of his other
impairments. As discussed below, the Court is unconvinced by Claimant’s rote legal
citations and undeveloped factual argument on this point and finds that the ALJ did
adequately consider Claimant’s obesity in combination with his other impairments
when she formulated the RFC.
The RFC is a measure of what an individual can do despite the limitations
imposed by his impairments. 20 C.F.R. § 404.1545(a). It is “a function-by-function
assessment based upon all of the relevant evidence of an individual's ability to do
work-related activities,” Id., and must be supported by substantial evidence. Clifford,
227 F.3d at 870. An “ALJ has the obligation to consider all relevant medical evidence
and cannot simply cherry-pick facts that support a finding of non-disability while
ignoring evidence that points to a disability finding.” Denton v. Astrue, 596 F.3d 419,
425 (7th Cir. 2010). However, it is also true that “an ALJ need not mention every
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piece of evidence, so long as [she] builds a logical bridge from the evidence to [her]
conclusion.” Id. (citing Getch, 539 F.3d at 480). An ALJ’s analysis of a claimant’s RFC
“must say enough to enable review of whether the ALJ considered the totality of a
claimant’s limitations.” Lothridge v. Saul, 984 F.3d 1227, 1233 (7th Cir. 2021).
In formulating the RFC here, the ALJ determined that Claimant was capable
of performing light work, as defined in 20 CFR 404.1567(b), with some additional
restrictions. (R. 28). Specifically, Claimant can “lift and/or carry 20 pounds
occasionally and 10 pounds frequently. He can stand and/or walk for about six hours
total in an 8-hour workday, and sit for about six hours total. He can occasionally
balance, stoop, kneel, crouch, crawl, and climb ramps and stairs, but cannot climb
ladders, ropes, and scaffolds. He should avoid concentrated exposure to temperature
extremes, pulmonary irritants, and hazards, such as unprotected heights.” (R. 28).
As this Court discussed in Sections I and II of opinion, the ALJ conducted a
thorough review of all the objective medical evidence, Claimant’s subjective
testimony, and his activities of daily living. After considering this evidence, together
with other non-medical evidence in the record, the ALJ concluded that Claimant’s
severe impairments – cardiomyopathy, atrial fibrillation; hypertension, sleep apnea,
COPD, and obesity – did limit Claimant's ability to work, but not to the extreme
degree propounded by Claimant and his treating physician, Dr. Jain. The ALJ also
paid particular attention to Claimant’s obesity in this case and noted that Claimant’s
weight and BMI have fluctuated during the relevant period, with Claimant weighing,
at various times, between 230 and 282 pounds and his BMI similarly fluctuating

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between 32.1 and 39.3. (R. 31). And although Claimant accuses the ALJ of “fail[ing]
to mention” this significant increase in his BMI and apply it to his combination of
impairments, the ALJ in fact did so at length. She explained that she found
“substantial medical support that the claimant’s medically diagnosed obesity
significantly limits his ability to engage in work activity,” and that the “combined
effects of the claimant’s heart disease, chronic obstructive pulmonary disease,
hypertension, and obstructive sleep apnea results in greater physical and mental
limitations than might be expected without the obesity.” (R. 31). The ALJ
accommodated Claimant’s obesity by limiting him to work “at light exertion level with
additional restrictions.” (R.31). The ALJ’s analysis and reasoning throughout her
opinion supports her determination concerning the limiting effects of Claimant’s
obesity. Claimant certainly would have preferred the ALJ conclude that his obesity
functionally limited him in more significant ways, but the ALJ’s decision not to do so
is not reversible error on this record. Collins v. Barnhart, 114 F. App'x 229, 234 (7th
Cir. 2004). The ALJ adequately considered the totality of the medical evidence in
formulating the RFC, including Claimant’s obesity, and supported her decision with
substantial evidence.
At the end of the day, even if the ALJ could have reached a decision in
Claimant's favor on the record before her, which is what Claimant contends she could
and should have done, the ALJ’s failure to do so is not reversible error as long as the
decision the ALJ actually made is supported by substantial evidence in the record
and the Court can follow the ALJ's rationale in concluding that Claimant is not

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disabled. Brenda L., 392 F. Supp. 3d at 862 (“If the ALJ’s decision is supported by
“substantial evidence,” the court on judicial review must uphold that decision even if
the court might have decided the case differently in the first instance.”) (citing 42
U.S.C. § 405(g)); see also, Zoch, 981 F.3d at 601 (“we ask whether the ALJ’s decision
is supported by substantial evidence – evidence that ‘a reasonable mind might accept
as adequate to support a conclusion.’”) (quoting Biestek, 139 S. Ct. at 1154). The Court
agrees with the Commissioner that the ALJ’s decision in this case passes muster
under the applicable legal standards.
CONCLUSION
Claimant’s Motion to Reverse the Decision of the Commissioner of Social
Security [ECF No. 13] is denied and the Commissioner’s Motion for Summary
Judgement [ECF No. 19] is granted.
It is so ordered.

____________________________
Jeffrey T. Gilbert
United States Magistrate Judge
Dated:

September 9, 2021

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