Hartline v. Commissioner of Social Security

Filing 31

MEMORANDUM AND ORDER, The Commissioner's final decision denying application for social security disability benefits is REVERSED and REMANDED to the Commissioner for rehearing and reconsideration of the evidence, pursuant to sentence four of 42 U.S.C. § 405(g).The Clerk of Court is DIRECTED to enter judgment in favor of plaintiff. Signed by Judge J. Phil Gilbert on 6/6/2017. (jdh)

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
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TERRI L. HARTLINE,
Plaintiff,
vs.
NANCY A. BERRYHILL,
Acting Commissioner of Social Security,
Defendant.1

Case No. 16-cv-00509-JPG-CJP

MEMORANDUM and ORDER
In accordance with 42 U.S.C. § 405(g), plaintiff Terri L. Hartline (plaintiff), represented
by counsel, seeks judicial review of the final agency decision denying her application for
Disability Insurance Benefits (DIB) pursuant to 42 U.S.C. § 423.
Procedural History
Plaintiff filed for DIB on May 15, 2012, alleging disability beginning on August 1, 2009.
(Tr. 11).

After holding an evidentiary hearing, Administrative Law Judge (ALJ) Patricia

Witkowski Supergan denied the application on September 15, 2014. (Tr. 11-19). 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
Plaintiff raises the following points:
1.

The ALJ erred by not giving the opinion of plaintiff’s treating physician
controlling weight.

2.

The ALJ erred in finding plaintiff not credible.

1

Nancy A. Berryhill is now the Acting Commissioner of Social Security. See, Casey v. Berryhill, 853 F.3d 322 (7th
Cir. 2017). She is automatically substituted as defendant in this case. See Fed. R. Civ. P. 25(d); 42 U.S.C. §405(g).

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Applicable Legal Standards
To qualify for DIB, a claimant must be disabled within the meaning of the applicable
statutes. 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.
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).

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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, 512513 (7th Cir. 2009); Schroeter v. Sullivan, 977 F.2d 391, 393 (7th Cir. 1992).
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 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 plaintiff 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,

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55 F.3d 300, 306 (7th Cir. 1995)). This Court uses the Supreme Court’s definition of substantial
evidence, i.e., “such relevant evidence as a reasonable mind might accept as adequate to support
a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (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, 103 F.3d 1384,
1390 (7th Cir. 1997); Moore v. Colvin, 743 F.3d 1118, 1121 (7th Cir. 2014). 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 Supergan followed the five-step analytical framework described above.

She

determined that plaintiff had not been engaged in substantial gainful activity since the alleged
onset date and that plaintiff had the following severe impairments: obesity, degenerative disk
disease, degenerative joint disease, irritable bowel syndrome, and headaches. (Tr. 13). ALJ
Supergan then found that plaintiff had the RFC to perform sedentary work, with the exception
that she could occasionally climb ramps and stairs, but never ladders, ropes, or scaffolds;
occasionally balance, stoop, crouch, and crawl; tolerate occasional exposure to extreme cold and
heat, wetness, humidity, vibration, fumes, and other pulmonary irritants; tolerate occasional
exposure to hazards such as moving machinery or unprotected heights; perform unskilled work
tasks that could be learned by demonstration or in thirty days or less if simple, repetitive, and
routine nature; and that she would need to change positions every thirty minutes or hourly, for
one to two minutes. (Tr. 14). Finally, the ALJ found that plaintiff could not perform past
relevant work, but nonetheless was not disabled because jobs existed in significant numbers in

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the national economy that plaintiff could perform. (Tr. 17-18).
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.
1.

Agency Forms.

Plaintiff was born on September 26, 1975. (Tr. 181). She worked as an admitting clerk
at a hospital from 1995 until 2003, and as a legal secretary from 2003 until 2009. (Tr. 186).
Before this, plaintiff also held positions as a receptionist and a sales clerk. (Tr. 200). She
claimed she was unable to work due to her inability to stand or sit for long periods of time, and
occasional diarrhea that could last for multiple days. (Tr. 208). She was also unable to read for
long periods. Id.
Plaintiff stated that she cared for her husband, daughter, stepdaughter, and two small dogs
by doing what she could to assist with everyday living. (Tr. 209). Her husband cleaned, cooked,
and did laundry when she was unable to. Id. She prepared family meals approximately once or
twice per week. (Tr. 210). Plaintiff needed assistance with vacuuming, sweeping, and laundry,
but could dust. Id. According to plaintiff, everyday chores were very difficult and took extra
time to complete. (Tr. 215).
2.

Evidentiary Hearing.

Plaintiff was represented by counsel at the hearing on April 8, 2014. (Tr. 26). She
testified that she was last employed as a legal secretary, and was laid off on either April 1 or
April 11 of 2009. (Tr. 31, 43). Plaintiff attended college fulltime in 2011 for criminal justice,
but did not complete her degree due to back pain, headaches, and stomach issues. (Tr. 32).

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Plaintiff was one year and one semester shy of earning her degree. (Tr. 42).
Plaintiff alleged an onset date of April 1, 2009, because this is when her issues worsened.
(Tr. 32). She had back pain and irritable bowel syndrome (IBS), which caused cramping. Id.
Plaintiff did not file for DIB until May of 2012, when her primary care physician advised her to
pursue benefits. (Tr. 43). Plaintiff began occasionally wearing protective undergarments in
2012 whenever she experienced diarrhea. Id. Plaintiff was five foot and four inches tall, and
204 pounds at the time of the hearing. (Tr. 33).
Plaintiff had been married for fourteen years and had one biological child and three
stepchildren. (Tr. 34). Plaintiff attended two of her child’s sporting games the year of the
hearing. (Tr. 35). She was unable to attend the others because she could not sit for the whole
time. (Tr. 45-46). Plaintiff occasionally cooked, but had to perform some tasks sitting down.
Id. Her husband did most of the grocery shopping. Id. Plaintiff had a driver’s license at the
time of the hearing. (Tr. 36). She rarely used the computer. (Tr. 39). Plaintiff often helped her
twelve-year-old daughter with homework. Id. However, severe headaches that affected her
vision sometimes prevented her from helping. (Tr. 46). These headaches generally lasted two
days and occurred twice to three times per month. Id. Plaintiff mainly socialized with friends
and family over the phone and did not belong to any social groups. (Tr. 40). Plaintiff attended a
parent-teacher conference that past February. Id. Plaintiff could not do laundry. (Tr. 42). Her
only hobby was watching television. Id.
Dr. William Ribbing had been plaintiff’s primary care physician for fourteen years. (Tr.
44). Plaintiff’s medications made her nauseous, dizzy, and tired. Id. Consequentially, she took
daily naps that lasted for, at least, an hour-and-a-half. Id. Plaintiff also used hot showers and ice
to alleviate pain. (Tr. 45).

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Plaintiff had difficulty bathing and sometimes did not bathe at all because of pain. Id.
She experienced cramping and diarrhea at least one week per month.

Id.

Plaintiff had

experienced lower back pain that traveled into her hips and legs for eight years. (Tr. 46). The
pain had become increasingly worse with time and she rated it at an eight out of ten. (Tr. 47).
Plaintiff’s back problems made it difficult for her to work because she could only stand for
fifteen to twenty minutes and sit for about ten to fifteen minutes. Id. Additionally, plaintiff
could not squat or lift more than five pounds. (Tr. 47, 48). Dr. Ribbing imposed those lifting
restrictions on plaintiff on multiple occasions. (Tr. 48-49).
Plaintiff missed many workdays during her last period of employment due to headaches,
IBS, and back pain. (Tr. 47-48). The pain impaired plaintiff’s concentration and memory. (Tr.
48). Plaintiff did not believe she could work a job that required her to sit for six hours out of an
eight-hour workday. Id. Plaintiff experienced IBS flare-ups approximately five days per month,
during which she would have twelve or more bowel movements per day. (Tr. 49).
Dr. Sherrill Nimagadda, a medical expert, testified next. (Tr. 50). She opined that
plaintiff did not have an impairment that met a listing. (Tr. 51). Dr. Nimagadda further opined
that plaintiff’s RFC was that of the ALJ’s ultimate finding. Id. Dr. Nimagadda did not examine
or observe plaintiff in any way. Id.
Mr. Bose, a vocational expert (VE), then testified that a hypothetical person with
plaintiff’s characteristics and restrictions could not perform her past relevant work, but there
were other sedentary, unskilled positions that plaintiff could perform. (Tr. 52-57).
3.

Medical Records.

Plaintiff received injection therapy from Pain Management Center of Paducah from 2008
to 2013. (Tr. 348-83, 599-607, 621-23). Throughout treatment, plaintiff complained of back,

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leg, and neck pain, as well as headaches. Id. She was prescribed MS Contin, Doxepin, Xanax,
Phenergan, Zanaflex, Fioricet, Medrol, Glucosamine, and Neurontin at various points throughout
treatment. Id.
Plaintiff presented to Union County Hospital on January 8, 2009, with lower back pain,
which she rated at a ten out of ten. (Tr. 463). A CT scan of her abdomen revealed bilateral
spondylolysis at L5 without spondylolisthesis. (Tr. 467). On February 15, 2009, plaintiff
received an x-ray of her lumbar spine, which identified bilateral spondylolysis at L5 with grade
one spondylolisthesis of L5 on S1. (Tr. 458).
Plaintiff presented to Union County Hospital on April 3, 2009, with a headache that she
rated at a ten out of ten. (Tr. 453). On December 28, 2009, plaintiff, again presented to Union
County Hospital with pain in her forehead, which she rated at an eight out of ten. (Tr. 443). A
CT scan of her brain revealed no remarkable findings. (Tr. 448). She received Dilaudid and
Phenergan. (Tr. 444).
On May 2, 2010, plaintiff was admitted to Union County Hospital upon complaints of
abdominal pain, nausea, vomiting, and diarrhea.

(Tr. 405).

She was diagnosed with

gastroenteritis and received Dilaudid, Zofran, Rocephin, an oral replacement of potassium, and
sent home with Phenergan. (Tr. 407). On August 2, 2010, plaintiff presented to Dr. James
Edwards, who suspected lateral patellar dislocation in her left knee. (Tr. 329). Dr. Edwards
recommended an MRI. (Tr. 330). On August 5, 2010, Dr. Edwards diagnosed plaintiff with left
knee lateral patellar compression syndrome, chondromalacia of the patella, and a stress fracture
of the proximal aspect of the fibula. (Tr. 332). He recommended crutches. Id. On August 23,
2010, Dr. Edwards and plaintiff planned a left knee arthroscopy with arthroscopic lateral release
repair of the MPFL.

(Tr. 333).

On September 1, 2010, plaintiff underwent a left knee

8

arthroscopy, arthroscopic lateral release, chondroplasty of the patella, major debridement
tricompartmental and MPFL plication.
On January 25, 2011, Dr. Tibrewala noted that plaintiff had experienced abdominal pain,
diarrhea, and constipation since 2010. (Tr. 284). Dr. Tibrewala recommended a colonoscopy,
advised plaintiff to take OsmoPrep, and also prescribed her Dexilant and Bentyl. (Tr. 285-86).
On February 25, 2011, plaintiff reported abdominal pain and diarrhea. (Tr. 278). She
underwent a colonoscopy, which revealed GERD, internal hemorrhoids, a GE junction, polypsessile, and possible IBS. (Tr. 291-92). She also tested positive for c-dif. (Tr. 289). Her final
diagnosis was duodenal mucosa with congestion, mild chronic active gastritis, mild acute ileitis
with lymphoid hyperplasia, rectal mucosa with hemorrhage, and hyperplastic polyps. (Tr. 291).
On March 23, 2011, plaintiff presented to Herrin Hospital with rectal bleeding and abdominal
pain, which she rated at a six out of ten. (Tr. 253). She received a CT scan of her abdomen
pelvis that revealed no evidence of bowel obstruction, fluid collections, or acute inflammatory
changes. (Tr. 251). On March 29, 2011, plaintiff complained of bad headaches and abnormal
cramping. (Tr. 302). She was diagnosed with DUB2 and USI.3 (Tr. 303).
On April 7, 2011, plaintiff presented to Union County Hospital with complaints of a
headache. (Tr. 478). She was given Zofran and SC Sumatriptan. (tr. 481). On May 11, 2011,
plaintiff presented to Union County Hospital with a headache, which she rated at an eight out of
ten. (Tr. 487). A CT scan of her brain revealed no acute intracranial process. (Tr. 490). She
was given Dilaudid and Phenergan. (Tr. 487). On May 26, 2011, plaintiff presented to Dr. Liu
with abdominal pain, vomiting, and diarrhea. (Tr. 531). Dr. Liu noted mild tenderness in the
epigastric area in the left upper quadrant.

2
3

Id.

On June 7, 2011, plaintiff complained of

“DUB” is defined in Dorland’s Medical Dictionary as dysfunctional uterine bleeding.
“USI” is not defined in Dorland’s Medical Dictionary.

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abdominal cramping. (Tr. 529). On June 20, 2011, plaintiff received a pelvic ultrasound, which
returned no significant findings.
endometrial biopsy.

(Tr. 306).

(Tr. 476).

On June 21, 2011, plaintiff underwent an

On August 4, 2011, plaintiff saw Dr. Beyer-Nolen for a

gynecologic consultation for not having menses since January, leaking of urine, urinary
incontinence at times, abdominal cramping, and bleeding with urination. (Tr. 310). Plaintiff was
prescribed Diflucan. (Tr. 312).
On December 1, 2011, plaintiff received an MRI of the left knee after presenting with
complaints of lateral knee pain. (TR. 493). The MRI found patellar chondrosis, edema adjacent
to lateral patellar retinaculum, small joint effusion, and minimal thinning of the anterior cruciate
ligament. (Tr. 494). On December 15, 2011, Dr. Edwards opined that plaintiff had a lateral
meniscus tear, and recommended knee arthroscopy with possible partial lateral meniscectomy.
(Tr. 338). On December 23, 2011, plaintiff underwent a left knee arthroscopy with debridement.
(Tr. 340). There was no evidence of any lateral meniscal tear. Id.
On April 9, 2012, plaintiff presented to Cape Girardeau Urology Associates with
hematuria. (Tr. 496). She reported abdominal pain, constipation, occasional diarrhea, and a
history of hematuria and vaginal bleeding. Id. A urine NMP22, cystoscopy, CT of her abdomen
and pelvis, and renal ultrasound were ordered. (Tr. 499). Plaintiff presented to Union County
Hospital with flank pain on April 28, 2012. (Tr. 393). A CT scan revealed no significant
findings. (Tr. 401). She was given Toradol, Zofran, and Dilaudid. (Tr. 397). On May 14, 2012,
plaintiff underwent a cystourethroscopy, which found no abnormalities. (Tr. 504). On August
10, 2012, plaintiff received a complete abdomen sonogram for complaints of abdomen pain,
nausea, and vomiting. (Tr. 391). On September 24, 2012, plaintiff underwent an optometric
examination at Marion Eye Centers and Optical. (Tr. 616). A history of Pseudotumor Cerebri

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was noted, as well as pseudophakia ou, posterior capsular opacifications os, and astigmatism ou.
(Tr. 617). On November 12, 2013, plaintiff received a CT scan of her abdomen and pelvis,
which revealed no acute intra-abdominal or pelvic abnormality. (Tr. 651). A possible cyst or
hemangioma was noted in her upper posterior right hepatic lobe. (Tr. 652). On March 26, 2014,
plaintiff underwent a fluoroscopically guided lumbar puncture for her pseudotumor cerebral eye.
(Tr. 640).
4.

Dr. Ribbing’s Treatment.

Plaintiff presented to Dr. Ribbing with a headache on June 3, 2010, and received Nubain
and Phenergan. (Tr. 539). Plaintiff presented with knee pain on July 29, 2010, and was referred
to physical therapy. (Tr. 538). Dr. Ribbing reported some effusion in plaintiff’s left knee joint
and knee tenderness. Id. On October 10, 2010, plaintiff presented with a left thoracic back
sprain, for which Dr. Ribbing prescribed a Lidoderm patch. (Tr. 537). Dr. Ribbing noted
tenderness in plaintiff’s back. Id. Plaintiff reported heavy menstrual bleeding, a migraine,
nausea, dizziness, and photosensitivity on November 10, 2010. (Tr. 536). Dr. Ribbing noted
mild suprapubic tenderness and gave plaintiff Nubain, and hydrozyline for nausea. Id. He also
gave plaintiff Provera for menorrhagia. Id. Plaintiff complained of intermittent abdominal
cramping and diarrhea that had occurred for several months on December 8, 2010. (Tr. 535).
Dr. Ribbing noted epigastric and midabdominal tenderness. Id. He placed plaintiff on Dexilant
for epigastric discomfort, Lomotil for diarrhea and cramping, and noted she had Phenergan at
home for nausea. Id. Plaintiff presented with severe headaches and nausea on December 10,
2010. (Tr. 534). Dr. Ribbing referred her to Union County Hospital Emergency Room for
further evaluation and treatment option. Id. Plaintiff also reported depression and severe
situational anxiety to Dr. Ribbing in March 2010. (Tr. 540, 552). Dr. Ribbing started plaintiff

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on Cymbalta. Id.
On August 26, 2011, Dr. Ribbing switched plaintiff to Benazepril for hypertension. (Tr.
523). On November 28, 2011, plaintiff presented to Dr. Ribbing with a left knee injury and
difficulty ambulating. (Tr. 521). He noted left knee tenderness and decreased range of motion
secondary to pain, with some joint effusion. Id. He placed her in a knee brace and prescribed
Percocet. Id. He also scheduled an MRI of plaintiff’s left knee. Id.
Plaintiff presented to Dr. Ribbing on February 4, 2012, with complaints of a migraine,
nausea, and vomiting. (Tr. 520). Dr. Ribbing gave plaintiff Nubian and Phenergan. Id. On
February 7, 2012, plaintiff presented with a migraine that had lasted for four to five days. (Tr.
519).

She stated that her pain injections made her drowsy and that her current headache

medications were not helping. Id. Dr. Ribbing placed plaintiff on a trial of Tramadol. Id. On
February 28, 2012, Dr. Ribbing refilled plaintiff’s prescriptions for colestipol, Lomotil, and
Bentyl. (Tr. 518). On April 10, 2012, plaintiff complained of lower abdominal pain. (Tr. 517).
Dr. Ribbing noted suprapubic and lower abdominal tenderness, and a urinalysis showed a large
amount of blood. Id. Dr. Ribbing referred plaintiff to an urologist for evaluation and sent
plaintiff’s urine for culture and sensitivity. Id. He advised plaintiff to continue her Bentyl. Id.
Plaintiff presented on August 1, 2012, with abdominal cramping, epigastric discomfort,
right upper quadrant discomfort, generalized malaise and fatigue, occasional emesis, and nausea.
(Tr. 571). Dr. Ribbing gave plaintiff a trial of Nexium and scheduled a CT scan of her abdomen.
Id. He also advised her to continue Bentyl, Lomotil, and Colestipol for her IBS, and Neurontin,
MS Contin, doxepin, Xanax, and Robaxin for her chronic pain. Id. Dr. Ribbing advised plaintiff
to continue VESIcare for her spastic bladder. Id. On August 20, 2012, plaintiff complained of a
migraine, for which Dr. Ribbing gave her Nubian and Phenergan. (Tr. 570). He recommended

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IV medication if the symptoms did not resolve within twelve hours. Id. On November 20, 2012,
plaintiff presented to Dr. Ribbing, who noted nonspecific generalized tenderness. (Tr. 614). He
advised plaintiff to continue Bentyl, Lomotil, and cestipol for her IBS, and continue pain
management, epidural injections, MS Contin Neurontin, dozepin, Xanac, Robaxin, and Fioricet
for her chronic back pain. Id.
On January 1, 2013, Dr. Ribbing noted that plaintiff had symptoms consistent with
fibromyalgia and depression. (Tr. 613). He placed her on a trial of Cymbalta. Id. Plaintiff
presented on February 10, 2012 for a follow-up of hypertension, migraine, pseudotumor cerebri,
IBS, back pain, tobacco use, and obesity. (Tr. 624). Dr. Ribbing increased plaintiff’s losartan
for hypertension, continued her Lomotil, Bentyl, and colestipol for IBS, and continued plaintiff’s
Fioricet, doxepin, Xanax, MS Contin, and Neurontin for migraines and back pain. Id. On
November 12, 2013, plaintiff reported some nausea and vomiting associated with pain. (Tr.
626).

Dr. Ribbing noted that her symptoms were consistent with choledocholithiasis or

ascending cholangitis, and referred plaintiff to Memorial Hospital for immediate evaluation. Id.
On September 6, 2013, plaintiff was diagnosed with a UTI and placed on Cipro and Pyridium.
(Tr. 628). On August 23, 2013, Dr. Ribbing continued plaintiff’s losartan for hypertension,
advised plaintiff to continue her pain management and medications, and continued plaintiff’s
Lomotil, Bentyl, and colestipol for her IBS. (Tr. 629).
5.

Dr. Ribbing’s RFC Assessment.

On April 4, 2014, Dr. Ribbing completed a “Medical statement regarding physical
abilities and limitations for Social Security disability claim.” (Tr. 643). He opined that plaintiff
could stand for less than fifteen minutes at a time, sit for less than fifteen minutes at a time, and
occasionally lift five pounds. Id. Dr. Ribbing also opined that plaintiff could not bend, stoop,

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balance, or work around dangerous conditions. Id.
Dr. Ribbing stated,
Patient has been following with neurologist and pain . . . physician.
She receives multiple injections and pain medications (high doses)
to try to control pain and dysfunction. She is in constant pain that
severely limits her ability to perform her ADLS. Due to these
debilitating illnesses, she is incapable of working or being
employed by anyone.
(Tr. 644).
6.

State Agency Consultant RFC Assessments.

Dr. B. Rock Oh performed an RFC assessment in October 2012 and opined that plaintiff
could occasionally lift twenty pounds, frequently lift ten pounds, stand and/or walk six hours in
an eight-hour workday, sit for a total of six hours in an eight-hour workday, and push and/or pull
and unlimited amount. (Tr. 66).
Dr. Lenore Gonzalez also assessed plaintiff’s RFC in March 2013. (Tr. 70-81). She
opined plaintiff could frequently lift ten pounds, stand and/or walk for two hours, sit for about
six hours in an eight-hour workday, and push and/or pull an unlimited amount. (Tr. 78). She
further opined that plaintiff could frequently climb ramps and stairs, occasionally climb ladders,
ropes, and scaffolds, and could frequently balance, stoop, kneel, crouch, and crawl. Id. Also
according to Dr. Gonzalez, plaintiff should avoid concentrated exposure to extreme cold and
heat, wetness, humidity, noise, vibration, and fumes, odors, dusts, gases, poor ventilation. (Tr.
79).
7.

Other RFC Assessments.

Dr. Adrian Feinerman evaluated plaintiff in September 2012 and noted no limitations.
(Tr. 576-86). Dr. James Peterson conducted a mental status examination of plaintiff, also in
September 2012, and opined that plaintiff had a mood disorder. (Tr. 589-592).
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Plaintiff’s previous employer submitted a letter on March 31, 2014, stating that plaintiff
was absent from work on numerous occasions due to headaches and back problems. (Tr. 642).
He also stated, “It appears to me that she does have a case for being unable to maintain a job
because of all of her illnesses.” Id.
Analysis
Plaintiff first argues that the ALJ erred in not giving controlling weight to the opinions of
plaintiff’s primary care physician, Dr. Ribbing.
Pursuant to 20 C.F.R. § 404.1527(c), the Social Security Commission generally gives
more weight to a medical opinion from the plaintiff’s treating source, so long as it is “wellsupported by medically acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with the other substantial evidence in [plaintiff’s] case record.” Medical opinions,
as defined in 20 C.F.R. § 404.1527, “reflect judgments about the nature and severity of
[plaintiff’s] impairment(s), including . . . symptoms, diagnosis and prognosis, what [plaintiff] can
still do despite impairment(s), and [plaintiff’s] physical or mental restrictions.”
If the ALJ determines that the treating physician’s opinions are not entitled to controlling
weight, she must offer “good reasons” for her determination and then evaluate the opinion in
consideration of the factors set forth in 20 C.F.R. § 404.1527(d). Campbell v. Astrue, 627 F.3d
299, 308 (7th Cir. 2010).
Here, the ALJ gave plaintiff’s treating doctor no weight because “the opinion is based
upon the claimant’s subjective complaints, the function limitations appear to be a sympathetic
opinion, and the opinion is not supported by the doctor’s own objective clinical or laboratory
findings.” (Tr. 17). The ALJ also noted that a finding of disability is a decision reserved to the
Social Security Administration. Id.

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Dr. Ribbing did conclude in his April 2014 report that plaintiff was unable to work, (Tr.
644), which, under 20 C.F.R. § 404.1527(d), is not a medical opinion entitled to deference.
Therefore, the ALJ did not err in rejecting Dr. Ribbing’s ultimate disability finding. However,
the report contains other opinions regarding plaintiff’s symptoms, diagnosis, and physical
limitations, which the ALJ cannot summarily dismiss.
The ALJ gave three reasons for discounting Dr. Ribbing’s opinions: (1) they were
sympathetic to plaintiff; (2) they were unsupported; and (3) they were based on plaintiff’s
subjective complaints. (Tr. 17). Because the ALJ failed to even minimally articulate why Dr.
Ribbing’s opinions appeared sympathetic or were unsupported, the ALJ’s opinion cannot be
upheld on these grounds. “If a decision lacks evidentiary support or is so poorly articulated as to
prevent meaningful review, a remand is required.” Kastner v. Astrue, 697 F.3d 642, 646 (7th
Cir. 2012) (internal quotations omitted).
The ALJ also disregarded Dr. Ribbing’s assessment because it was based on plaintiff’s
subjective complaints. (Tr. 17). The Seventh Circuit has held that the ALJ may discount a
treating physician’s opinion when it is largely based on the plaintiff’s subjective complaints.
Ketelboeter v. Astrue, 550 F.3d 620, 625 (7th Cir. 2008).
Dr. Ribbing regularly treated plaintiff for several years prior to completing the
assessment.

He occasionally utilized objective tests such as urinalysis (Tr. 517, 626), a

sonogram (Tr. 574), and an x-ray (Tr. 625), which returned insignificant findings. Although he
did note objective findings such as abdominal tenderness (Tr. 517, 535), suprapubic tenderness
(Tr. 517, 536), tenderness in plaintiff’s back and knee (Tr. 537, 538, 521), decreased range of
motion in plaintiff’s knee (Tr. 521), and joint effusion (Id.), Dr. Ribbing’s assessment was based
almost entirely on plaintiff’s subjective complaints. Therefore, the ALJ did not err in refusing to

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give Dr. Ribbing’s opinions controlling weight.
However, the ALJ did err in failing to consider, at all, the other factors set forth in 20
C.F.R. § 404.1527(c). “Even if an ALJ gives good reasons for not giving controlling weight to a
treating physician’s opinion, she has to decide what weight to give that opinion.” Campbell, 627
F.3d at 308.
Plaintiff next argues that the ALJ improperly found plaintiff’s subjective complaints not
credible. “An ALJ is in the best position to determine the credibility of witnesses, and we review
that determination deferentially.” Craft v. Astrue, 539 F.3d 668, 678 (7th Cir. 2008).

A

credibility determination will only be disturbed if it is “patently wrong.” Id. However, the
finding must still be “supported by the evidence” and “specific enough to enable the claimant
and a reviewing body to understand the reasoning.” Id.
The ALJ, here, found plaintiff’s complaints were not credible because she indicated that
she could care for her personal hygiene, her family, and her pets, and could attend school
meetings, sporting events, and classes. Id. The ALJ also found it suspect that plaintiff watched
television, did chores, and helped her daughter with homework. Id.
A review of the record shows the ALJ grossly mischaracterized this evidence. Plaintiff
stated, in regards to caring for her family, “I do what I can do for just everyday living.” (Tr.
209). She alleged she prepared family meals once or twice a week and dusted. (Tr. 210).
Plaintiff claimed she needed help with other household chores such as vacuuming, sweeping, and
laundry, and ultimately found house and yard work “very difficult.” (Tr. 211). Plaintiff also
testified that she sometimes did not bathe because it was too painful. (Tr. 45). In regards to
attending sporting events, plaintiff testified she had only attended two that year because she was
unable to sit for the entirety of the event. (Tr. 45-46). She also testified that she dropped out of

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school because of her symptoms (Tr. 32) and was unable to help her child with homework
sometimes due to headaches (Tr. 46). Plaintiff did testify that she attended a single parentteacher conference that year. (Tr. 40).
Moreover, the Seventh Circuit has “remarked the naiveté of the Social Security
Administration’s administrative law judges in equating household chores to employment.”
Hughes v. Astrue, 705 F.3d 276, 278 (7th Cir. 2013). The Seventh Circuit stated:
The critical differences between activities of daily living and
activities in a full-time job are that a person has more flexibility in
scheduling the former than the latter, can get help from other
persons . . . and is not held to a minimum standard of performance,
as she would be by an employer. The failure to recognize these
differences is a recurrent, and deplorable, feature of opinions by
administrative law judges in social security disability cases.
Id. (quoting Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012). Thus, the ALJ cannot rely on
plaintiff’s ability to complete household chores as the basis for discrediting plaintiff’s subjective
complaints, let alone a mischaracterized summary of her daily activities. Although the ALJ also
opined that plaintiff’s “subjective complaints are not consistent with the medical evidence of
record,” the ALJ offered no more explanation.

Because the credibility determination was

unsupported and insufficiently articulated, it is patently wrong.
In sum, the ALJ improperly equated plaintiff’s ability to perform household chores with
an ability to maintain employment, and failed to offer any other support for the adverse
credibility determination. The ALJ also erred in failing to assign any weight to the opinion of
plaintiff’s treating doctor, Dr. Ribbing, or articulate her reasons for not doing so.
Conclusion
The Commissioner’s final decision denying application for social security disability
benefits is REVERSED and REMANDED to the Commissioner for rehearing and

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reconsideration of the evidence, pursuant to sentence four of 42 U.S.C. § 405(g).
The Clerk of Court is DIRECTED to enter judgment in favor of plaintiff.
IT IS SO ORDERED.
DATED: 6/6/2017
s/J. Phil Gilbert
J. PHIL GILBERT
U.S. DISTRICT JUDGE

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