Kohlhaas v. Commissioner of Social Security

Filing 26

MEMORANDUM AND OPINION affirming the final decision of the Commissioner of Social Security. The Clerk of Court is directed to enter judgment in favor of defendant. Signed by Magistrate Judge Clifford J. Proud on 6/5/2014. (jmt)

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
SARAH L. KOHLHAAS,

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Plaintiff,
vs.
CAROLYN W. COLVIN,
Acting Commissioner of Social
Security,
Defendant.

Civil No. 13-cv-382-CJP 1

MEMORANDUM and ORDER
PROUD, Magistrate Judge:
In accordance with 42 U.S.C. § 405(g), plaintiff Sarah L. Kohlhaas seeks
judicial review of the final agency decision denying her application for Disability
Insurance Benefits (DIB) and Supplemental Security Income (SSI) benefits
pursuant to 42 U.S.C. § 423.
Procedural History
Plaintiff applied for benefits in April, 2010, alleging disability beginning on
April 10, 2010.

(Tr. 22).

After holding an evidentiary hearing, ALJ Rebecca

LaRiccia denied the application in a written decision dated December 2, 2011.
(Tr. 22-33).

The Appeals Council denied review, and the decision of the ALJ

became the final agency decision. (Tr. 1). Administrative remedies have been
exhausted and a timely complaint was filed in this Court.
Issues Raised by Plaintiff
1

This case was referred to the undersigned for final disposition on consent of the parties, pursuant
to 28 U.S.C. §636(c). See, Doc. 13.

1

Plaintiff raises the following points:
1.

The ALJ erred in not giving appropriate weight to the opinions of
plaintiff’s treating physician, Dr. Elvira Salarda.

2.

The ALJ’s determination of plaintiff’s residual functional capacity
(RFC) was erroneous because she failed to account for plaintiff’s sleep
apnea and headaches, and failed to consider the collective effects of all
impairments.
Applicable Legal Standards

To qualify for DIB or SSI, a claimant must be disabled within the meaning of
the applicable statutes. 2 For these purposes, “disabled” means the “inability to
engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period of not less than 12
months.” 42 U.S.C. §423(d)(1)(A).
A “physical or mental impairment” is an impairment resulting from
anatomical, physiological, or psychological abnormalities which are demonstrable
by medically acceptable clinical and laboratory diagnostic techniques. 42 U.S.C.
§423(d)(3).

“Substantial gainful activity” is work activity that involves doing

significant physical or mental activities, and that is done for pay or profit. 20
C.F.R. §§ 404.1572.
2

The statutes and regulations pertaining to Disability Insurance Benefits (DIB) are found at 42
U.S.C. § 423, et seq., and 20 C.F.R. pt. 404. The statutes and regulations pertaining to SSI are
found at 42 U.S.C. §§ 1382 and 1382c, et seq., and 20 C.F.R. pt. 416. As is relevant to this case, the
DIB and SSI statutes are identical. Furthermore, 20 C.F.R. § 416.925 detailing medical
considerations relevant to an SSI claim, relies on 20 C.F.R. Pt. 404, Subpt. P, the DIB regulations.
Most citations herein are to the DIB regulations out of convenience.

2

Social Security regulations set forth a sequential five-step inquiry to
determine whether a claimant is disabled. The Seventh Circuit Court of Appeals
has explained this process as follows:
The first step considers whether the applicant is engaging in
substantial gainful activity. The second step evaluates whether an
alleged physical or mental impairment is severe, medically
determinable, and meets a durational requirement. The third step
compares the impairment to a list of impairments that are considered
conclusively disabling. If the impairment meets or equals one of the
listed impairments, then the applicant is considered disabled; if the
impairment does not meet or equal a listed impairment, then the
evaluation continues. The fourth step assesses an applicant's residual
functional capacity (RFC) and ability to engage in past relevant work. If
an applicant can engage in past relevant work, he is not disabled. The
fifth step assesses the applicant's RFC, as well as his age, education,
and work experience to determine whether the applicant can engage in
other work. If the applicant can engage in other work, he is not
disabled.
Weatherbee v. Astrue, 649 F.3d 565, 568-569 (7th Cir. 2011).
Stated another way, it must be determined: (1) whether the claimant is
presently unemployed; (2) whether the claimant has an impairment or combination
of impairments that is serious; (3) whether the impairments meet or equal one of
the listed impairments acknowledged to be conclusively disabling; (4) whether the
claimant can perform past relevant work; and (5) whether the claimant is capable of
performing any work within the economy, given his or her age, education and work
experience. 20 C.F.R. §§ 404.1520; Simila v. Astrue, 573 F.3d 503, 512-513
(7th Cir. 2009.
If the answer at steps one and two is “yes,” the claimant will automatically be
found disabled if he or she suffers from a listed impairment, determined at step
three. If the claimant does not have a listed impairment at step three, and cannot
3

perform his or her past work (step four), the burden shifts to the Commissioner at
step five to show that the claimant can perform some other job. Rhoderick v.
Heckler, 737 F.2d 714, 715 (7th

Cir. 1984). See also Zurawski v. Halter,

245 F.3d 881, 886 (7th Cir. 2001) (Under the five-step evaluation, an “affirmative
answer leads either to the next step, or, on Steps 3 and 5, to a finding that the
claimant is disabled…. If a claimant reaches step 5, the burden shifts to the ALJ to
establish that the claimant is capable of performing work in the national
economy.”).
This Court reviews the Commissioner’s decision to ensure that the decision
is supported by substantial evidence and that no mistakes of law were made. It is
important to recognize that the scope of review is limited. “The findings of the
Commissioner of Social Security as to any fact, if supported by substantial
evidence, shall be conclusive. . . .” 42 U.S.C. § 405(g). Thus, this Court must
determine not whether Ms. Kohlhaas was, in fact, disabled at the relevant time, but
whether the ALJ’s findings were supported by substantial evidence and whether
any errors of law were made. See, Books v. Chater, 91 F.3d 972, 977-78 (7th
Cir. 1996) (citing Diaz v. Chater, 55 F.3d 300, 306 (7th Cir. 1995)).
The Supreme Court has defined “substantial evidence” as “such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion.”
Richardson v. Perales, 91 S. Ct. 1420, 1427 (1971).

In reviewing for

“substantial evidence,” the entire administrative record is taken into consideration,
but this Court does not reweigh evidence, resolve conflicts, decide questions of
credibility, or substitute its own judgment for that of the ALJ. Brewer v. Chater,
4

103 F.3d 1384, 1390 (7th Cir. 1997).

However, while judicial review is

deferential, it is not abject; this Court does not act as a rubber stamp for the
Commissioner. See, Parker v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010), and
cases cited therein.
The Decision of the ALJ
ALJ LaRiccia followed the five-step analytical framework described above.
She determined that plaintiff had not worked at the level of substantial gainful
activity since the alleged onset date and that she was insured for DIB through
December 31, 2014. She found that plaintiff had severe impairments of sleep
apnea, degenerative joint disease, degenerative disc disease, headaches, and
irregular heartbeat. She further determined that these impairments do not meet
or equal a listed impairment.
The ALJ found that Ms. Kohlhaas had the residual functional capacity (RFC)
to perform work at the light exertional level, with a number of limitations. Based
on the testimony of a vocational expert, the ALJ found that plaintiff was not able to
do her past relevant work as a farmworker.

She was, however, not disabled

because she was able to do other jobs which exist in significant numbers in the local
and national economies.
The Evidentiary Record
The Court has reviewed and considered the entire evidentiary record in
formulating this Memorandum and Order. The following summary of the record
is directed to the points raised by plaintiff and is confined to the relevant time
period.
5

1.

Agency Forms

Plaintiff was born in 1967, and was 43 years old on the alleged onset date of
April 10, 2010. (Tr. 182).
In her initial Disability Report, plaintiff said she was unable to work because
of a heart condition, sleep apnea and thyroid problems. She was 5’3” tall and
weighed 194 pounds. She said she stopped working on April 10, 2010, because of
her condition and because her employer died. (Tr. 163-164). She had worked as
a farmhand on a dairy farm since 1995. (Tr. 165).
Ms. Kohlhaas submitted a Function Report in June, 2010, in which she said
she got headaches when she was in the heat, and she became sleepy during
activities such as driving and reading. She used a CPAP machine and woke up a
lot during the night. She had no difficulties with personal care and was able to do
some housework such as making easy meals, laundry, gathering eggs and sweeping.
She had no difficulty in handling her personal finances. She said she could lift
about 25 pounds, sit for an hour and walk for about 500 feet. (Tr. 172-179).
About four months later, after the initial denial of her claim, plaintiff
submitted another report in which she stated that she lived with her disabled
husband, 22 year old daughter, 3 year old granddaughter, and 2 sons, ages 20 and
18. The granddaughter was in day care. The family had chickens, goats, cats and
dogs. Plaintiff’s husband and son took care of the animals. Ms. Kohlhaas said
she was able to do light household chores such as folding laundry and making the
bed, but was unable to do heavier chores such as mopping and scrubbing. She
had a “lack of focus” and had to take frequent breaks. She claimed difficulty in
6

activities such as lifting, walking, sitting, reaching, etc., because of “fatigue,
weakness and overall aching pain throughout [her] body.” (Tr. 191-199).
2.

Evidentiary Hearing

Ms. Kohlhaas was represented by an attorney at the evidentiary hearing on
October 4, 2011. (Tr. 41).
Plaintiff testified that she stopped working as a dairy farmhand in April,
2010, because she had heart trouble and back pain which went down her leg.
After further questioning, she testified that she stopped working because the owner
of the farm died, but she said she would have stopped working even if he were still
alive. (Tr. 46-47).
Plaintiff had no health insurance, but was still able to see Dr. Salarda. She
was taking Gabapentin for back pain, but it did not help. She was taking medicine
for headaches, but she still had headache pain all day, every day. The medicine
had helped her headaches for a while, but she became “immune” to it. At least 3 or
4 times a month she had a headache so bad that she had to lie down in a dark room
for several hours. She had not gone to the emergency room for any of these severe
headaches. (Tr. 48-50). She also had pain in her low back which radiated into
her left leg. (Tr. 50-51). She took medication for an irregular heartbeat and for
her thyroid. (Tr. 51-52). She had no side effects from her medications. (Tr. 57).
She used a CPAP machine at night, but still had sleepiness during the day. (Tr.
53).
Ms. Kohlhaas testified that, on an average day, she did not do much. She sat
in a recliner and watched TV. (Tr. 53). Her children did the household chores.
7

She was unable to do chores because of “so much pain in the back and legs.” (Tr.
54). She could walk for maybe 50 feet and stand in one place for 10 minutes. She
could sit for about 30 minutes. She could lift only 20 pounds. (Tr. 55-56).
A vocational expert (VE) testified that plaintiff’s past work was performed at
the medium exertional level.

The ALJ asked the VE to assume a person of

plaintiff’s age and work history who was able to do work at the light exertional level,
limited to standing/walking for a total of 1 hour a day, no foot controls with the left
leg, only occasional climbing and kneeling, frequent reaching above shoulder level,
and no stooping, crouching or crawling. She should avoid concentrated exposure
to environmental irritants and extreme temperatures, and should not work at
unprotected heights or around dangerous moving machinery. (Tr. 59-60).
The VE testified that this person could not do any of plaintiff’s past work, but
there were other jobs in the economy which she could do. Examples of such jobs
are hand packer, assembler and sorter. (Tr. 60).
3.

Medical Treatment

Ms. Kohlhaas saw Dr. Amar Sawar for headaches in May, 2009. He noted a
history of hypothyroidism and sleep apnea.
unremarkable.

He prescribed Naprosyn.

An MRI of the brain was

She returned in August, 2010, still

complaining of constant right-sided headache unrelieved by Naprosyn.

He

prescribed Indocin. (Tr. 358-361).
In May, 2010, a cardiac work-up was done because plaintiff complained of
chest “fluttering” and tightness. She had been seen for palpitations in the past.
She also complained of fatigue. She said that she was no longer working because
8

her employer had died. She denied any painful muscles or joints, weakness, loss
of sensation, and leg or buttock pain while walking. Dr. Chiu noted that she had
palpitations secondary to premature ventricular contractions in the past, but her
present complaints seemed to be different.

The cardiac work-up was not

remarkable, so Dr. Chiu suggested an event monitor. She also suggested that
plaintiff check with Dr. Sudholt to see if her CPAP machine was working properly.
(Tr. 239-240).
In June, 2010, Dr. Sudholt found nothing amiss with the CPAP machine
setting. (Tr. 249-250).
The earliest record from primary care physician Dr. Elvira Salarda is dated
July 23, 2010. Plaintiff complained of intermittent left hip pain for the past 2
months. Dr. Salarda noted she had “filed for disability for heart.” Plaintiff also
said she had headaches, occasional shortness of breath, palpitations and fatigue.
Dr. Salarda found tenderness over the left hip on exam.

She prescribed

medication and an x-ray. (Tr. 267-268).
In August, 2010, the cardiologist recorded no specific findings except for the
previously-diagnosed

palpitations

secondary

to

premature

ventricular

contractions, and increased her Beta-blocker. (Tr. 261-264).
Plaintiff saw Dr. Salarda for her annual check-up on September 15, 2010.
She complained of headaches, irregular heartbeat and pain in her left hip. She
walked for exercise. Range of motion of the back was normal, and range of motion
and strength in the legs was normal. (Tr. 265-266).
On the same day, September 15, 2010, Ms. Kohlhaas reported to Dr. Sawar
9

that the frequency of her headaches was “dramatically improved” by Indocin. The
doctor noted a diagnosis of chronic hemicranias continua, clinically improving.
(Tr. 357).
Dr. Vittal Chapa performed a consultative physical examination on
September 30, 2010. Plaintiff told him she had daily headaches which lasted all
day. She said she could not sit for a long time or walk very far. The physical
examination was essentially unremarkable. Lumbosacral spine flexion was full
and she had no muscle spasms.

The range of motion of the joints was full.

Straight leg raising was negative bilaterally. Neurological examination was normal.
(Tr. 277-280).
Ms. Kohlhaas saw her sleep specialist, Dr. Sudholt, in December, 2010.
She admitted that she had not been using her CPAP machine regularly.

Dr.

Sudholt discussed sleep hygiene measures to improve her compliance with CPAP.
There were no structural or physical issues with the equipment. (Tr. 305).
In December, 2010, she reported to Dr. Sawar that her headache had
“subsided” and Dr. Sawar wrote that her headache was “clinically in remission.”
(Tr. 356).
Plaintiff was evaluated by Dr. Tony Chien, a pain management specialist, for
left hip pain on December 10, 2010.
heat/cold intolerance.

She denied headaches, chest pain and

She had pain to palpation in the lumbar spine, and

paraspinal muscle spasms. She had pain with flexion and extension of the lumbar
spine. X-rays showed disc space narrowing at L4-5 and L5-S1. The assessment
was degenerative joint disease and degenerative disc disease of the lumbar spine
10

with left lower extremity radiculopathy. (Tr. 315-317). Dr. Salarda saw plaintiff
on December 15, 2010.

She was still having back pain and was to have an

injection in a few days. (Tr. 327-328). Dr. Chien administered epidural steroid
injections in December, 2010, and January, 2011. (Tr. 320, 309).
The last visit with Dr. Salarda was in January, 2011. Ms. Kohlhaas had
pain in her finger which occurred while she was doing dishes. (Tr. 323-324). A
Doppler ultrasound showed no arterial occlusion of the right upper extremity. (Tr.
325).
Dr. Chien examined her again in February, 2011. She reported that she had
gotten little relief from the injections. He noted that she had severe headaches in
August, 2010, but she denied current headaches. She complained of low back
pain radiating to both buttocks and the left leg, worse with activity. She again had
pain in the lumbar spinal region on palpation and muscle spasms. (Tr. 340-341).
Dr. Chien administered another epidural steroid injection. (Tr. 344-345).
The last visit with Dr. Chien was on March 11, 2011. Ms. Kohlhaas said she
continued to have constant dull aching pain in her back with intermittent sharp
pain. Her symptoms were worsening and she had no relief from injections. On
exam, she again had pain in the lumbar spinal region on palpation and muscle
spasms. She had pain with flexion and extension of the lumbar spine. There was
positive straight leg raising on the left. Muscle strength was full. She had no
sensory deficit. Dr. Chien noted that a recent MRI showed multi-level spondylosis
dominating disease at the L4-5 interval which created low grade impingement on
the left L5 nerve root. She was started on Neurontin and told not to do any heavy
11

lifting, pushing or pulling. (Tr. 336-337).
On March 16, 2011, she again reported to Dr. Sawar that her headache had
improved with Indocin. However, she now complained of low back pain radiating
into the left leg. (Tr. 355).
4.

Dr. Salarda’s Opinions

The last documented office visit with Dr. Salarda was on January 27, 2011.
(Tr. 323). In June, 2011, Dr. Salarda completed a form in which she assessed
plaintiff’s physical capacities. Dr. Salarda opined that Ms. Kohlhaas was able to
frequently lift up to 20 pounds, occasionally climb and kneel, and frequently reach
above shoulder level. She felt that plaintiff could never stoop, crouch or crawl.
Plaintiff should avoid “severe” exposure to unprotected heights, moving machinery
and driving because she fell asleep easily. She could not use her left foot to operate
foot controls. She was able to sit for 6 or more hours a day, but was able to
stand/walk for less than 1 hour a day, and she required a sit/stand option. (Tr.
363-365).
In October, 2011, Dr. Salarda wrote a letter addressed “To Whom It May
Concern,” in which she stated that plaintiff had been unable to work for the past
year because of medical problems. The doctor stated that plaintiff had persistent,
worsening low back pain radiating to her left leg that was aggravated by prolonged
walking, standing and sitting. In addition, sleep apnea caused excessive daytime
sleepiness, and she was sometimes unable to use her CPAP machine because it was
uncomfortable.

She also had COPD which was aggravated by irritants and

allergens in the environment. The doctor stated that the combination of these
12

problems caused her to be unable to work. (Tr. 366).
5.

RFC Assessment

In June, 2010, a state agency consultant evaluated plaintiff’s physical RFC
based upon a review of the records. Dr. B. Rock Oh concluded that plaintiff could
do work at the light exertional level, i.e., frequently lift 10 pounds, occasionally lift
20 pounds, sit for a total of 6 hours a day, and stand/walk for a total of 6 hours a
day.

She had no other limitations except that she should avoid exposure to

unprotected heights and dangerous machinery. (Tr. 253-260).
Analysis
Ms. Kohlhaas first argues that the ALJ erred in not giving greater weight to
Dr. Salarda’s opinions. With respect to the first report, ALJ LaRiccia said that she
considered Dr. Salarda’s treatment notes, and she accepted the doctor’s opinion
“except to the extent it is internally inconsistent with the doctor’s own treatment
notes and with other medical evidence in the record.” She rejected Dr. Salarda’s
second report because it advocated more severe limitations without any new
evidence to support them. (Tr. 30-31).
The opinions of treating doctors are not necessarily entitled to controlling
weight. Rather, a treating doctor’s medical opinion is entitled to controlling weight
only where it is supported by medical findings and is not inconsistent with other
substantial evidence in the record. Clifford v. Apfel, 227 F.3d 863 (7th Cir.
2000); Zurawski v. Halter, 245 F.3d 881 (7th Cir. 2001).
The version of 20 C.F.R. §404.1527(d)(2) in effect at the time of the ALJ’s
decision states:
13

Generally, we give more weight to opinions from your treating sources,
since these sources are likely to be the medical professionals most able
to provide a detailed, longitudinal picture of your medical
impairment(s) and may bring a unique perspective to the medical
evidence that cannot be obtained from the objective medical findings
alone or from reports of individual examinations, such as consultative
examinations or brief hospitalizations. If we find that a treating
source's opinion on the issue(s) of the nature and severity of your
impairment(s) is well-supported by medically acceptable clinical and
laboratory diagnostic techniques and is not inconsistent with the other
substantial evidence in your case record, we will give it controlling
weight. [Emphasis added] 3
Obviously, the ALJ is not required to accept a treating doctor’s opinion; “while the
treating physician’s opinion is important, it is not the final word on a claimant’s
disability.”

Books v. Chater, 91 F.3d 972, 979 (7th Cir. 1996)(internal

citation omitted).

If is the function of the ALJ to weigh the medical evidence,

applying the factors set forth in §404.1527. Supportability and consistency are
two important factors to be considered in weighing medical opinions. See, 20
C.F.R. §404.1527(d). In a nutshell, “[t]he regulations state that an ALJ must give a
treating physician's opinion controlling weight if two conditions are met: (1) the
opinion is supported by ‘medically acceptable clinical and laboratory diagnostic
techniques[,]’ and (2) it is ‘not inconsistent’ with substantial evidence in the record.”
Schaaf v. Astrue, 602 F.3d 869, 875 (7th Cir. 2010), citing §404.1527(d).
The ALJ must be mindful that the treating doctor has the advantage of having
spent more time with the plaintiff but, at the same time, she may “bend over
backwards” to help a patient obtain benefits. Hofslien v. Barnhart, 439 F.3d
3

The Court cites to the version of 20 C.F.R. §§ 404.1527 that was in effect at the time of the ALJ’s
decision. The agency subsequently amended the regulation by removing paragraph (c) and
redesignating paragraphs (d) through (f) as paragraphs (c) through (e). 77 Fed. Reg. at 10656–57
(2012).

14

375, 377 (7th Cir. 2006). See also, Stephens v. Heckler, 766 F.2d 284, 289
(7th Cir. 1985) (“The patient's regular physician may want to do a favor for a
friend and client, and so the treating physician may too quickly find
disability.”).
When considered against this backdrop, the Court finds no error in the ALJ’s
weighing of Dr. Salarda’s opinions. With regard to the second report, written in
October, 2011, the ALJ correctly observed that nothing had occurred since her first
report to support the imposition of more restrictive limitations. As far as the
record reflects, Dr. Salarda did not see plaintiff after she wrote her first report. In
fact, the record reflects no treatment at all after the March 16, 2011, visit with Dr.
Sawar. Thus, the ALJ did not err in rejecting those opinions on the basis that they
were not supported by Dr. Salarda’s treatment notes or by the medical evidence in
general. Plaintiff does not seriously argue otherwise.
Plaintiff implicitly recognizes that the ALJ accepted the limitations suggested
by Dr. Salarda in her first report except for her opinions that plaintiff could
stand/walk for less than 1 hour a day and that she needed to alternate between
standing and sitting. See, Doc. 19, pp. 18-19. Plaintiff suggests that the ALJ
rejected the doctor’s limitation of never carrying more than 20 pounds, but this is
incorrect. The ALJ limited her to light work. “Light work involves lifting no more
than 20 pounds at a time with frequent lifting or carrying of objects weighing up to
10 pounds.” 20 C.F.R. §404.1567(b)
Plaintiff argues that the ALJ was required to accept all of Dr. Salarda’s
limitations because no other doctor offered an opinion. Plaintiff cites Smith v.
15

Massanari, 2002 WL 480955 (N.D.Ill., 2002), in support of her argument.
That argument is simply incorrect. In the first place, Smith is a district court case
and is therefore not precedential.
F.3d 799, 806 (7th Cir. 2007).

Harzewski v. Guidant Corporation, 489

The fact that plaintiff had to resort to a district

court case illustrates the weakness of her argument. Secondly, plaintiff’s reliance
on Smith ignores the crucial fact that the doctor’s opinion in that case was
“consistent with other medical evidence.”

Smith, 2002 WL 480955 at *7.

Further, Smith cites Wilder v. Chater, 64 F.3d 335, 337 (7th Cir. 1995),
wherein the Seventh Circuit observed, “Of course the administrative law judge is
not required or indeed permitted to accept medical evidence if it is refuted by other
evidence—which need not itself be medical in nature—and of course our review is
deferential . . . .”
ALJ LaRiccia undertook a detailed review of the medical evidence. The
record documents only 4 visits with Dr. Salarda. As the ALJ noted, the last visit
was for a finger injury, which is unrelated to her disability claim. Her first visit
was 3 months after the alleged onset of disability. On that visit, although she was
tender over her left hip, Dr. Salarda documented a full range of motion and an x-ray
was negative. While she complained of headaches, she later reported to Dr. Sawar
that her headaches were dramatically improved on Indocin. In December, 2010,
she told Dr. Salarda that medication was helping her back pain. Further, the ALJ
noted that Dr. Chien, the pain management specialist, found that Ms. Kohlhaas
walked with a normal gait and had full strength throughout. Dr. Chien observed
that a lumbar MRI showed only mild spondylosis and low-grade impingement of the
16

left L5 nerve root.

Despite these MRI results, Dr. Chien documented normal

findings on sensory exam on his last visit. And, the ALJ noted that Dr. Vittal
Chapa examined plaintiff and reported essentially unremarkable findings. (Tr.
27-29).
An ALJ can properly give less weight to a treating doctor’s medical opinion if
it is inconsistent with the opinion of a consulting physician, internally inconsistent,
or inconsistent with other evidence in the record.

Henke v. Astrue, 498

Fed.Appx. 636, 639 (7th Cir. 2012); Schmidt v. Astrue, 496 F.3d 833, 842
(7th Cir. 2007).

Further, in light of the deferential standard of judicial review, the

ALJ is required only to “minimally articulate” her reasons for accepting or rejecting
evidence, a standard which the Seventh Circuit has characterized as “lax.” Berger
v. Astrue, 516 F.3d 539, 545 (7th Cir. 2008); Elder v. Astrue, 529 F.3d 408,
415 (7th Cir. 2008).

The Court finds that ALJ LaRiccia more than met the

minimal articulation standard here. Plaintiff has not demonstrated that she erred
in not accepting all of the limitations proposed by Dr. Salarda.
Plaintiff also suggests that remand is required because the ALJ did not
specifically discuss the factors set out in §404.1527 after deciding not to give
controlling weight to Dr. Salarda’s opinion. However, the ALJ is not required to
set forth a formal analysis of the factors where is it clear from her decision that she
has considered the relevant factors and has explained why she rejected the doctor’s
opinion. See, Sawyer v. Colvin, 512 Fed. Appx. 603, 609 (7th Cir. 2013);
Henke v. Astrue, 498 Fed. Appx. 636, 640 (7th Cir. 2012).

It is manifestly

clear that ALJ LaRiccia considered supportability and consistency. She was also
17

obviously aware of the nature and extent of the treatment relationship. The only
other factor specified in the regulation, specialization, undermines plaintiff’s
position, as she does not contend that Dr. Salarda was a specialist.
Plaintiff’s only other point is that the ALJ erred in not including additional
limitations based on headaches and sleep apnea, and in not considering the
collective effects of all of plaintiff’s impairments.
RFC is “the most you can still do despite your limitations.”

20 C.F.R.

§1545(a). In assessing RFC, the ALJ is required to consider all of the claimant’s
“medically determinable impairments and all relevant evidence in the record.”
Ibid. Obviously, the ALJ cannot be faulted for omitting alleged limitations that are
not supported by the record.
Plaintiff’s argument on this point relies heavily on the believability of her
subjective complaints, and is therefore doomed from the outset. The ALJ found
that plaintiff’s allegations were not credible, and plaintiff has not challenged that
finding. For the reasons set forth above, the ALJ’s analysis of the medical evidence
was not erroneous. Her RFC determination was substantially supported by the
medical evidence.
In the final analysis, plaintiff’s arguments are a plea to the Court to cast aside
the ALJ’s weighing of the evidence and to substitute its own analysis for that of the
ALJ. This is, however, far beyond this Court’s proper role. The most that can be
said is that reasonable minds might differ as to whether Ms. Kohlhaas was disabled
during the relevant time period. In that event, the ALJ’s decision must be affirmed
if it is supported by substantial evidence.
18

The Court cannot make its own

credibility determination or substitute its judgment for that of the ALJ in reviewing
for substantial evidence.

Shideler v. Astrue, 688 F.3d 306, 310 (7th Cir.

2012); Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008).
Conclusion
After careful review of the record as a whole, the Court is convinced that ALJ
LaRiccia committed no errors of law, and that her findings are supported by
substantial evidence. Accordingly, the final decision of the Commissioner of Social
Security denying Sarah L. Kohlhaas’ application for disability benefits is
AFFIRMED.
The Clerk of Court shall enter judgment in favor of defendant.
IT IS SO ORDERED.
DATE:

June 5, 2014.
s/ Clifford J. Proud
CLIFFORD J. PROUD
UNITED STATES MAGISTRATE JUDGE

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