Starnes v. Kijakazi

Filing 23

MEMORANDUM Opinion and Order: For the reasons stated in the attached Memorandum Opinion and Order, the Commissioner's motion for summary judgment 18 is denied, and this case is remanded to the Social Security Administration for further proceedings consistent with this opinion. Signed by the Honorable Thomas M. Durkin on 11/21/2022. Mailed notice. (ecw, )

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UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
ANGIE S.,
Plaintiff,

No. 21 C 5978

v.

Judge Thomas M. Durkin

KILOLO KIJAKAZI, Acting Commissioner
of Social Security,
Defendant.
MEMORANDUM OPINION AND ORDER
Angie S. (“Claimant”) brings this action under 42 U.S.C. §§ 405(g) and 1383(c)
for judicial review of the final decision of the Commissioner of Social Security denying
her claim for disability insurance benefits, widow’s insurance benefits, and
supplemental security income. The Commissioner filed a motion for summary
judgment [18]. For the following reasons, the Commissioner’s motion is denied.
Background
I.

Procedural History
Claimant filed Title II applications for widow’s insurance benefits and

disability insurance benefits on July 31, 2019 and August 29, 2019, respectively. 1 R.
15. She also filed a Title XVI application for supplemental security income on
December 18, 2019. Id. All applications pertain to a disability beginning on July 30,
2019. Id. The claims were denied initially on April 13, 2020 and again upon

1

References to the Administrative Record (ECF No. 12) are cited as “R. #.”
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reconsideration on September 21, 2020. Id. Claimant filed a request for a hearing
before an Administrative Law Judge (ALJ) on November 9, 2020 and attended and
testified at a telephone hearing on March 2, 2021. Id. The ALJ issued a decision
denying benefits on March 31, 2021. Id. at 12. Plaintiff sought review from the
Appeals Council, which denied her request on September 3, 2021. Id. at 1. Claimant
then filed a timely request for review in this Court. 2
II.

Factual Background
A. Medical Record Evidence
Claimant had a kidney transplant in 2005 and was diagnosed with dyspnea on

exertion 3 (DOE) in 2016. Id. at 354, 380. At a July 2019 nephrology visit, her physical
examination was normal with noted blood pressure issues. Id. at 386. In August 2019,
Claimant visited a cardiologist regarding increased DOE, and her physical
examination showed clear lungs, normal heart function, mild lower extremity edema,
and “stable class II symptoms.” 4 Id. at 356-58. At a second cardiology visit in

Claimant recognizes that she “cannot be found disabled under the Widow’s claim
because her alleged onset of disability began on July 30, 2019, and the prescribed
period for the Widow’s benefits ended on February 28, 2006.” ECF No. 15 at 1 n.1
(citing 20 C.F.R. § 404.335); see also R. 40-41.
3 Dyspnea on exertion refers to “shortness of breath [that] is present with exercise
and improves with rest.” Sandeep Sharma et al., Dyspnea on Exertion, Nat’l Library
of Med. (Aug. 18, 2022), https://www.ncbi.nlm.nih.gov/books/NBK499847/.
4 Per the New York Heart Association (NYHA) Classification, an individual with
“class II” symptoms has a slight limitation of physical activity, is comfortable at rest,
and ordinary physical activity results in fatigue, palpitation, and/or dyspnea. See
American
Heart
Association,
“Classes
of
Heart
Failure”
https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/classes-ofheart-failure.
2

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November, the provider observed Claimant’s DOE was stable and had improved with
medication. Id. at 362. Claimant’s echocardiogram that month showed normal
findings, consistent with the prior year. Id. at 730-31.
In January 2020, Claimant visited her primary care physician, Dr. Iram
Ahmed, who observed that she had normal motor strength, no edema, and obesity.
Id. at 414. Around that time, Claimant presented with normal heart function and
range of motion at her nephrology visit, and a bone density scan showed osteoporosis.
Id. at 743, 1004-05. Claimant had a consultative examination in March 2020, where
she reported shortness of breath, back pain, and other joint pain. Id. at 688. The
internist observed that Claimant had morbid obesity, normal range of motion of her
cervical spine, shoulders, elbows, wrists, knees and ankles, normal motor and grip
strength, an ability to walk unassisted with “a slow waddling type of gait,” normal
respiratory rate, and no edema. Id. at 690-91. Additionally, she showed a reduced
range of motion in the lumbar spine and hips, and an x-ray revealed degenerative
changes in her lumbar spine. Id. at 690-91, 93. That month, Claimant began physical
therapy for back and knee pain and was also hospitalized for COVID-19. Id. at 834,
1278-1326.
In August 2020, Claimant visited Dr. Ahmed complaining of worsening back
and knee pain. Id. at 1231. He observed normal motor strength and no edema. Id.
Claimant was discharged from physical therapy in September 2020 with continued
impaired core strength, lumbar spine soft tissue mobility, lumbar range of motion,
and hip and knee strength and range of mobility. Id. at 1266-67. The discharge

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summary noted her improved standing and walking tolerance, lumbosacral range of
motion, core and hip strength, and knee strength and range of motion. Id.
In October 2020, Claimant’s cardiologist observed that she had DOE with
stable class II symptoms. Id. at 1173. Pulmonary function testing revealed a “mild
obstructive ventilatory defect” and that “the decreased diffusing capacity suggests
the presence of emphysema.” Id. at 1145. Her pulmonologist subsequently reported
that Claimant had DOE with a suspected “mild degree of diastolic failure” and normal
gait and muscle tone. Id. at 1116, 1117, 1119. Imaging that month also revealed
degenerative changes in her left knee and lumbar spine. Id. at 1248-52. And in
November, Claimant presented with “episodic DOE” but an otherwise normal
physical examination at her nephrology visit. Id. at 1213.
At a follow up in January 2021, her pulmonologist observed normal gait and
muscle tone with some edema, “chronic diastolic heart failure,” and spoke to Claimant
about the need to walk and exercise. Id. at 1049, 1052. That month, Claimant also
visited an orthopedic surgeon regarding her left knee pain. Id. at 1074. The provider
found that Claimant showed a good range of motion, normal strength, and intact
sensation with no gross motor weakness of the hip, ankle, and knee. Id. at 1078-79.
An x-ray of her knee revealed some degenerative changes, joint space narrowing, and
mild osteoarthritis, and the provider spoke to Claimant about lifestyle changes
including low impact exercise. Id. at 1079-80. Claimant also visited Dr. Ahmed that
month regarding back, knee, and chest pain, and he observed that she had normal
motor strength, no edema, and morbid obesity. Id. at 1223.

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B. Medical Opinion Evidence
Dr. Ahmed submitted two medical source statements. In the first statement
dated January 31, 2020, Dr. Ahmed noted Claimant’s ability to ambulate without an
assistive device and 5/5 bilateral grip strength, with no limitations in her ability to
handle objects or reach overhead. Id. at 372. He opined that she could stand for 1020 minutes, walk for 5-10 minutes, and needed to stand for 10-20 minutes after sitting
for 30 minutes. Id.
In the second statement dated August 18, 2020, Dr. Ahmed opined that
Claimant could only walk half a block, sit for 20 minutes and stand for 45 minutes at
one time, and sit for about 2 hours and stand or walk for less than 2 hours in a normal
working day. Id. at 1028-29. He stated that Claimant needed to walk for 15 minutes
every 45 minutes and take unscheduled 30-minute breaks as often as every hour or
two due to muscle aches, fatigue, joint pain, adverse effects of medication, and her
history of lupus and kidney transplant. Id. at 1029. He further noted that she should
elevate her leg at least 45 degrees during prolonged sitting and must use a cane
during occasional standing or walking. Id. Dr. Ahmed also opined that she could lift
less than 10 pounds rarely, use her hands and fingers for handling objects 25-40% of
the time, and use her arms for reaching overhead 10-25% of the time. Id. at 1029. He
opined that she would likely be absent more than four days per month. Id. at 1030.
State medical consultants also submitted opinions at the initial and
reconsideration levels, finding Claimant capable of light work with postural
limitations. Id. at 69-94, 98-128.

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C. Hearing Testimony
At the hearing before the ALJ, Claimant testified that she left her job as a bus
driver due to shortness of breath, knee, neck, and shoulder pain, arthritis in her
fingers, and grip weakness. Id. at 57-58. She stated that she could not stand or walk
for more than 30 minutes because of back, knee, and hip pain, and that she could not
sit for more than one hour before her knees start hurting. Id. at 59. She further stated
that her legs and feet swelled with significant walking, so she elevated her legs when
seated, and that her medication caused fatigue. Id. at 60-61.
Dr. Joseph Gaeta, an impartial medical expert, testified at the hearing
regarding Claimant’s limitations. Dr. Gaeta stated that based on his review of the
record, Claimant had a history of lupus, kidney disease and transplant, and
hypertension, with no significant recent changes. Id. at 43. Dr. Gaeta further testified
as to Claimant’s recent history of back and knee pain, stating, “I don’t see that, you
know, significantly evaluated.” Id. He noted the March 2020 finding of normal
bilateral strength, some “abnormal” limitation in range of motion of the hip and back,
and a report of an x-ray which showed “not . . . significant changes.” Id. at 42-44. Dr.
Gaeta further testified that Claimant was morbidly obese. Id. Dr. Gaeta discussed
the listings he considered, and opined that Claimant, due to her obesity and back and
knee issues, would be limited to light level work with postural but no environmental
limitations. Id. at 45-46. On cross-examination, when Dr. Gaeta stated he would have
liked to see more imaging studies and an orthopedic evaluation, counsel pointed out
Claimant’s visit with the orthopedic surgeon and the x-rays in the record. Id. at 50-

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51. After review of the record, Dr. Gaeta explained that he was focused on the physical
examination showing normal strength and range of motion and the lack of a “severe
abnormality” in the knee. Id. at 51-52.
Vocational expert Gary Wilhelm also testified at the hearing. He described
Claimant’s past work and cited the comparable positions from the Dictionary of
Occupational Titles for reference. Id at 62. The ALJ asked Wilhelm to consider a
hypothetical individual of Claimant’s age, education, and work experience with a
specific set of limitations:
This person could lift 20 pounds occasionally, 10 pounds frequently.
Stand and walk six hours in an eight-hour day, sit for up to six hours in
an eight-hour day with normal breaks. This person could never climb
ladders, ropes or scaffolds. Could never crawl. Could only occasionally
climb ramps or stairs, balance, stoop, crouch and kneel. This person
must avoid concentrated exposure to respiratory irritants such as
fumes, odors, dust and gases. Must avoid concentrated exposure to
dangerous moving machinery. And must avoid all exposure to
unprotected heights.
Id. at 63. Wilhelm stated that such a person could not perform Claimant’s past work
because bus driving is not conducive to the environmental limitations. Id. Wilhelm
further testified that other jobs that such a person could perform existed in
substantial number in the national economy. Id. at 64.
D. The ALJ’s Decision
To determine whether an individual is entitled to disability insurance benefits,
an ALJ must follow the five-step analysis set out at 20 C.F.R. § 404.1520(a)(4). At
step one, if the ALJ determines that the claimant is “doing substantial gainful
activity,” then the claimant is not disabled, and no further analysis is necessary. If
the claimant is not engaged in gainful activity, at step two, the ALJ must determine
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whether the claimant has a “severe” impairment or combination of impairments. If
the ALJ finds that the claimant has such a severe impairment, and the impairment
is one provided for in the Social Security regulation listings, then at step three, the
ALJ must find that the claimant is disabled. If the ALJ finds that the impairment is
not in the listings, then at step four, the ALJ must assess the residual functional
capacity (“RFC”) the claimant continues to possess despite the claimant’s
impairment. If the claimant’s RFC enables the claimant to continue his or her “past
relevant work,” then the ALJ must find that the claimant is not disabled. But if the
claimant cannot perform past relevant work, at step five, the ALJ must determine
whether the claimant “can make an adjustment to other work.” If the claimant cannot
make such an adjustment, then the claimant is disabled.
The ALJ first found that Claimant had not engaged in substantial gainful
activity since July 30, 2019, and that Claimant had severe impairments of lupus
controlled with plaqunil/steroid therapy, history of kidney transplantation in 2005
with stable hypertension, obesity, degenerative joint disease of the left knee,
degenerative disc disease of the lumbar spine, and osteoporosis. R. 18. The ALJ
concluded that the impairments did not meet or medically equal the severity of one
of the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R. §§
404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925, and 416.926). Id.
The ALJ then determined that Claimant had the RFC to:
[P]erform light work as defined in 20 C.F.R. 404.1567(b) and 416.967(b)
except the claimant can never crawl nor climb ladders, ropes, or
scaffolds[;] can no more than occasionally climb ramps or stairs, balance,
stoop, crouch, and kneel[;] [and] must avoid concentrated exposure to
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respiratory irritants, such as fumes, odors, dusts and gases[,] . . .
concentrated exposure to dangerous moving machinery and all exposure
to unprotected heights.”
Id. at 20. The ALJ stated that Claimant’s “medically determinable impairments could
reasonably be expected to cause the alleged symptoms,” but concluded that her
“statements concerning the intensity, persistence and limiting effects of these
symptoms are not entirely consistent with the medical evidence and other evidence
in the record[.]” Id. at 26.
In support of his RFC assessment, the ALJ reviewed Claimant’s testimony and
the medical evidence and opinions. The ALJ first summarized Claimant’s testimony
regarding her back, knee and hip pain; difficulty walking, standing, sitting, kneeling,
lifting, and climbing stairs; leg swelling; forgetfulness; and fatigue from her lupus
medication. Id. at 21. He pointed to her reported back and joint pain and shortness
of breath in assessing an RFC with limited physical maneuvers, frequency of
movement, and exposure to respiratory irritants, dangerous moving machinery, and
unprotected heights. Id. at 23-24.
In determining that more restrictive limitations were not warranted, the ALJ
emphasized Claimant’s generally normal physical examinations, absence of edema
except for some instances, exercise recommendations from two providers, the lack of
support for the physical therapy discharge summary in the form of treatment notes,
the “essentially” normal strength and range of motion in her knee, hip, and ankle
reported by the orthopedic surgeon, and the lack of a significant abnormality in the
x-ray of her knee. Id. at 24. The ALJ also pointed to her well-controlled lupus and
hypertension and stable kidney function and absence of “medically determinable
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impairments

to

explain”

Claimant’s

reported

DOE,

citing

the

normal

echocardiograms from 2018 and 2019, normal lung examinations, normal stress test
from 2018, and mild obstruction. Id. The ALJ further stated that Claimant’s obesity
could reasonably be expected to limit her mobility and tolerance for exertion. Id. at
25.
The ALJ found that Dr. Gaeta’s opinion was persuasive because it was
“supported by the record, as Dr. Gaeta is familiar with the disability program and its
rules and had the opportunity to review the claimant’s record in its entirety.
Therefore, Dr. Gaeta’s opinion is the most informed and consistent with the overall
record.” Id. at 26. The ALJ also found the state medical consultants’ opinions
persuasive because they were consistent with the treatment records and Dr. Gaeta’s
opinion. Id. at 25. Nevertheless, the ALJ determined that additional limitations as to
respiratory irritants, dangerous moving machinery, and unprotected heights were
appropriate given Claimant’s reported shortness of breath and any instability or
limited mobility. Id. at 26.
The ALJ further found that Dr. Ahmed’s January 2020 opinion was of some
persuasive value because it was consistent with the record regarding the use of upper
extremities and gross manipulation, but inconsistent with the relatively normal
physical examinations. Id. Additionally, the ALJ found that Dr. Ahmed’s August 2020
opinion was unpersuasive because it was not supported by the treatment notes or
consistent with the evidence as a whole. Id. The ALJ explained that the restrictive
limitations were inconsistent with the physical examinations, Dr. Ahmed did not

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explain the need for unscheduled breaks or a high rate of absence, and the record did
not include a recommendation for leg elevation but instead generally showed no
edema. Id.
Although the ALJ determined that Claimant’s RFC did not enable her to
perform the full range of light work, he concluded—based on the vocational expert’s
testimony—that jobs existed in significant numbers in the national economy that she
could perform. Id. at 27-28. Accordingly, the ALJ found that Claimant was not
disabled. Id. at 28.
Legal Standard
Judicial review of a final decision of the Social Security Administration is
generally deferential. The Social Security Act requires the court to sustain the ALJ’s
findings if they are supported by substantial evidence. See 42 U.S.C. § 405(g).
Substantial evidence means “such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401
(1971). The court should review the entire administrative record, but must “not
reweigh the evidence, resolve conflicts, decide questions of credibility, or substitute
[its] own judgment for that of the [ALJ].” Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir.
2000). “However, this does not mean that [the court] will simply rubber-stamp the
[ALJ’s] decision without a critical review of the evidence.” Id. A decision may be
reversed if the ALJ’s findings “are not supported by substantial evidence or if the ALJ
applied an erroneous legal standard.” Id.
In addition, the court will reverse if the ALJ does not “explain his analysis of
the evidence with enough detail and clarity to permit meaningful appellate review.”
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Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005). “Although a
written evaluation of each piece of evidence or testimony is not required, neither may
the ALJ select and discuss only that evidence that favors his ultimate conclusion.”
Herron v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994); see also Scrogham v. Colvin, 765
F.3d 685, 698 (7th Cir. 2014) (“This ‘sound-bite’ approach to record evaluation is an
impermissible methodology for evaluating the evidence.”). Additionally, the ALJ “has
a duty to fully develop the record before drawing any conclusions,” Murphy v. Astrue,
496 F.3d 630, 634 (7th Cir. 2007), and deference in review is “lessened . . . where the
ALJ’s findings rest on an error of fact or logic,” Thomas v. Colvin, 745 F.3d 802, 806
(7th Cir. 2014). In oft-quoted words, the Seventh Circuit has said that the ALJ “must
build an accurate and logical bridge from the evidence to his conclusion.” Clifford,
227 F.3d at 872.
When the ALJ has satisfied these requirements, the responsibility for deciding
whether the claimant is disabled falls on the Social Security Administration, and if
“conflicting evidence allows reasonable minds to differ as to whether a claimant is
disabled,” the ALJ’s decision must be affirmed. Herr v. Sullivan, 912 F.2d 178, 181
(7th Cir. 1990).
Analysis
Claimant asserts the ALJ failed to support his findings with substantial
evidence on three fronts: (1) the ALJ improperly credited Dr. Gaeta’s opinion and
discounted Dr. Ahmed’s August 2020 opinion; (2) the ALJ failed to evaluate
Claimant’s subjective symptoms; and (3) the ALJ included additional limitations in

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the RFC that did not accommodate Claimant’s symptoms. The Court will examine
each argument in turn.
I.

Evaluation of Medical Opinion Evidence
Claimant first argues that the ALJ failed to offer a specific reason for finding

Dr. Gaeta’s opinion persuasive or examine discrepancies and inaccuracies in his
testimony. Claimant further argues that the ALJ failed to pinpoint records showing
that Dr. Ahmed’s August 2020 opinion was not supported by treatment notes or the
evidence as a whole and ignored the consistency between the opinion and other
evidence.
For claims filed after March 27, 2017, the old “treating physician rule” has been
replaced by 20 C.F.R. § 404.1520c. Accordingly, treating physicians’ opinions are no
longer entitled to presumptive controlling weight; the ALJ “will not defer or give any
specific evidentiary weight, including controlling weight, to any medical opinion(s) or
prior administrative medical finding(s), including those from [a claimant’s] medical
sources.” 20 C.F.R. § 404.1520c(a). Rather, the ALJ considers the persuasiveness of
the medical opinions using several factors: supportability, consistency, relationship
with the claimant, specialization, and other factors that tend to support or contradict
the opinion. Id. at §§ 404.1520c(a)-(c). Supportability and consistency are the most
important factors and the only factors that must be articulated in the final decision.
Id. at §§ 404.1520c(a), (b)(2). “Supportability measures how much the objective
medical evidence and supporting explanations presented by a medical source support
the opinion,” whereas “consistency assesses how a medical opinion squares with other

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evidence in the record.” Michelle D. v. Kijakazi, No. 21 C 1561, 2022 WL 972280, at
*4 (N.D. Ill. Mar. 31, 2022) (citing 20 C.F.R. §§ 404.1520c(b)(1), (2)). While the ALJ
generally need only minimally articulate his reasoning for how he assessed a medical
opinion, he must still consider the regulatory factors and build a “logical bridge” from
the evidence to his conclusion. See Evonne R. v. Kijakazi, No. 20 C 7652, 2022 WL
874650, at *5 (N.D. Ill. Mar. 24, 2022) (citing Grotts v. Kijakazi, 27 F.4th 1273, 1277
(7th Cir. 2022)).
Here, the ALJ did not adequately analyze the supportability and consistency
of Dr. Gaeta’s opinion. The ALJ explained that Dr. Gaeta’s opinion was “supported
by the record” because he was familiar with the disability program and had the
opportunity to review the record. R. 26. On that basis, the ALJ stated that Dr. Gaeta’s
opinion was the “most informed and consistent with the overall record.” Id. But these
are “conclusion[s], not a reason (or reasons)” for them. Mueller v. Astrue, 493 F. App’x
772, 776 (7th Cir. 2012). On supportability, while Dr. Gaeta’s knowledge of the
disability program was certainly a valid consideration, see § 404.1520c(c)(5), it says
nothing about the objective medical evidence or explanations underlying Dr. Gaeta’s
opinion. Further, the fact that Dr. Gaeta had access to the record does not necessarily
mean he reviewed it or his opinion was supported by it. On consistency, the ALJ
deferred to boilerplate and provided “no indication of which portions of the record
might actually be consistent.” See Schmidt v. Colvin, 545 F. App’x 552, 557 (7th Cir.
2013) (rejecting similar language as “entirely unhelpful” boilerplate); Patrice W. v.
Kijakazi, 20 C 02847, 2022 WL 2463557, at *3 (N.D. Ill. July 6, 2022) (finding that an

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ALJ’s statement that agency consultants’ opinions were “consistent with the record
as a whole,” without more, was insufficient).
The Commissioner urges that when read as a whole, the ALJ’s opinion satisfies
the regulations. To be sure, the ALJ recounted Dr. Gaeta’s testimony on Claimant’s
impairments, listings for consideration, and limitations. But, in reviewing the opinion
in its entirety, the Court cannot piece together how the ALJ reasoned that Dr. Gaeta’s
testimony was supported by and consistent with the overall record. Instead, parts of
the ALJ’s opinion call into question the supportability and consistency of Dr. Gaeta’s
opinion. For example, the ALJ cites Dr. Gaeta’s testimony that the record was “devoid
of any significant evaluation” of Claimant’s back and knee pain, yet several pages
earlier, summarizes Claimant’s visit to an orthopedic surgeon and imaging that
showed degenerative changes in her lumbar spine and osteoarthritis in her knee. R.
23, 25. The ALJ must “articulate adequately the bases for his conclusions” as to the
persuasiveness of medical opinions so that the Court can “trace the path of [his]
reasoning.” Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002). The ALJ failed to do
so with respect to Dr. Gaeta.
However, the ALJ sufficiently evaluated the supportability and consistency of
Dr. Ahmed’s August 2020 opinion. Though the ALJ began with boilerplate
conclusions that Dr. Ahmed’s opinion was “not supported by the treatment notes” or
“consistent with the evidence as a whole,” R. 26, he did not end his analysis there.
The ALJ explained that the limitations were “contrary to physical examinations.” Id.
Claimant asserts that this brief reference to “physical examinations” does not pass

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muster. But here, unlike with Dr. Gaeta’s opinion, the “earlier section contained the
missing analysis.” Cf. Evonne, 2022 WL 874650, at *4. The ALJ previously clarified
that more restrictive limitations were not appropriate because notwithstanding
“some instances of decreased range of motion,” Claimant’s “physical examinations
have generally been normal with no neurological deficits including normal strength
and intact sensation,” citing extensively to treatment notes from both Dr. Ahmed and
Claimant’s other providers between April 2019 and January 2021. R. 24. This is not
“mere summary” but rather “meaningful analysis” that bears directly on the
supportability and consistency of Dr. Ahmed’s more restrictive limitations on
standing, walking, sitting, lifting, and handling. Jennifer S. v. Kijakazi, No. 3:20-CV50239, 2022 WL 279554, at *6 (N.D. Ill. Jan. 31, 2022). That the ALJ did not repeat
these details in the paragraph discussing Dr. Ahmed’s August 2020 opinion is not
fatal. See Gedatus v. Saul, 994 F.3d 893, 903 (7th Cir. 2021) (“An ALJ need not rehash
every detail each time he states conclusions on various subjects.”).
Additionally, even though an ALJ is not required to “march through each
opined limitation to explain whether it was consistent with or supported by the
record,” the ALJ addressed other aspects of Dr. Ahmed’s opinion as well. Cf. Gary R.
v. Kijakazi, No. 20 C 6109, 2022 WL 4607581, at *12 (N.D. Ill. Sept. 30, 2022). He
pinpointed specific treatment notes from Dr. Ahmed and other providers regarding
Claimant’s more frequent presentation without edema and the lack of any leg
elevation recommendations. R. 26. Though the ALJ incorrectly stated that Dr. Ahmed
did not explain the need for unscheduled breaks or absences, given the other analysis

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of gaps in supportability and consistency, this factual error is not so serious as to
warrant remand. See Beardsley v. Colvin, 758 F.3d 834, 837 (7th Cir. 2014).
Still, remand is necessary for the ALJ to properly analyze and sufficiently
explain the persuasiveness of Dr. Gaeta’s opinion. The ALJ is directed to more clearly
articulate how Dr. Gaeta’s opinion is supported or not supported by his own
explanations and objective medical evidence and is consistent or inconsistent with
the other evidence in the record.
II.

Subjective Symptom Evaluation
Claimant next argues that the ALJ’s discussion of her symptoms violated SSR

16-3p because he did not evaluate her reported back and knee pain, difficulty
standing and walking, shortness of breath, and other symptoms for consistency. In
evaluating a claimant’s subjective symptom allegations, an ALJ assesses the
objective medical evidence and several other factors, including the claimant’s daily
activities, effectiveness and side effects of any medication, treatment, other methods
to alleviate symptoms, and factors that precipitate and aggravate pain. SSR 16-3p,
2017 WL 5180304, at *5, *7-8 (Oct. 25, 2017); 20 C.F.R. § 404.1529(c). “‘An ALJ need
not discuss every detail in the record as it relates to every factor,’ but an ALJ may
not ignore an entire line of evidence contrary to [his] ruling.” Benito M. v. Kijakazi,
No. 20 C 5966, 2022 WL 2828741, at *8 (N.D. Ill. July 20, 2022) (quoting Grotts, 27
F.4th at 1278). “As long as an ALJ gives specific reasons supported by the record, [the
Court] will not overturn a credibility determination unless it is patently wrong.”

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Grotts, 27 F.4th at 1279; Murphy v. Colvin, 759 F.3d 811, 816 (7th Cir. 2014) (patently
wrong “means that the decision lacks any explanation or support.”).
The ALJ adequately showed how Claimant’s symptoms were consistent and
inconsistent with the medical evidence. After summarizing Claimant’s testimony
regarding her pain, difficulty walking and standing, shortness of breath, and fatigue,
he described inconsistent evidence such as treatment records showing Claimant’s
generally normal range of motion, sensation, strength, and lack of edema, normal
lung examinations and echocardiograms, mild rather than significant knee and
pulmonary abnormalities, and alertness, along with providers’ recommendations that
she exercise. R. 21, 23-25. Further, the ALJ recognized evidence that supported her
reported symptoms, such as her degenerative disc and joint disease, osteoporosis, and
obesity. Id. at 24-25; Gedatus, 994 F.3d at 900-01.
But the ALJ did not meaningfully address Claimant’s daily activities. The ALJ
“noted” Claimant’s testimony regarding her challenges in performing certain daily
activities such as driving and shopping, but “never said what he made of them.” Sam
K. v. Saul, 391 F. Supp. 3d 874, 881 (N.D. Ill. 2019). He did not “explain how plaintiff’s
testimony regarding her daily activities lacked credibility or conflicted with the
record” or “describe how these difficulties were not as severe as alleged.” Evonne, 2022
WL 874650, at *6. The Commissioner asserts that the ALJ did not have to address
every daily activity. That is true. But here, the ALJ did not engage with any of them.
See Villano v. Astrue, 556 F.3d 558, 562 (7th Cir. 2009) (remanding where the ALJ
“briefly described” the claimant’s testimony about her activities but did not explain

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whether her “daily activities were consistent or inconsistent with the pain and
limitations she claimed”). Therefore, the ALJ’s decision must be remanded for
consideration of Claimant’s limitations in her daily activities.
III.

RFC Assessment
Claimant lastly argues that the RFC finding was not supported by substantial

evidence because it included additional environmental limitations beyond what Dr.
Gaeta and the state medical consultants recommended. As other district courts have
recognized, this argument is a “prime example of nitpicking that does not help her
claim.” See David C. v. Kijakazi, No. 20 C 3891, 2022 WL 602520, at *9 (N.D. Ill. Mar.
1. 2022) (citing Patrick C. v. Saul, 2020 WL 6287370, at *8 (N.D. Ill. Oct. 27, 2020)).
If the ALJ was wrong and the Claimant has no issue with exposure to respiratory
irritants, dangerous moving machinery, or unprotected heights, it is not at all clear
how such an error would further her cause or warrant remand. Surely Claimant is
not asking the Court to remand so that an ALJ can find her capable of greater workrelated activities.
Nevertheless, as part of the required remand for analysis of Dr. Gaeta’s
opinion, the ALJ will have to reconsider the RFC. Therefore, for the sake of
completeness, the Court addresses whether these restrictions are supported by
substantial evidence. The ALJ sufficiently tied the restriction on moving machinery
and unprotected heights to the evidence indicating instability or limited mobility,
such as her reported difficulty standing and walking, degenerative changes in the

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spine and knee, instances of decreased range of motion, and obesity. 5 But it is unclear
how the ALJ construed the record to mean that Claimant’s shortness of breath upon
exertion is related to environmental factors. R. 24; Tepper v. Colvin, No. 14 C 2848,
2015 WL 7351692, at *7 (N.D. Ill. Nov. 20, 2015). Neither Claimant’s complaints
about shortness of breath after walking or any treatment notes or medical opinions
provide the missing link. It could be that the ALJ added this limitation to avoid
exacerbating Claimant’s shortness of breath upon exertion, but he did not say so. On
remand, to the extent a restriction on exposure to respiratory irritants is included in
the newly considered RFC, the ALJ should more clearly articulate its evidentiary
basis.
Conclusion
For the reasons stated above, the Commissioner’s motion for summary
judgment is denied, and this case is remanded to the Social Security Administration
for further proceedings consistent with this opinion.

ENTERED:

______________________________
Honorable Thomas M. Durkin
United States District Judge

Dated: November 21, 2022

Claimant’s assertion that she did not complain of instability is puzzling considering
her argument that the ALJ did not credit her complaints of difficulty walking and
standing. Compare ECF No. 15 at 12 with id. at 13.
5

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