Ainsworth v. Commissioner

Filing 34

OPINION AND ORDER: The decision of the Commissioner is AFFIRMED. Signed by Magistrate Judge Andrew P Rodovich on 8/31/2015. (lhc)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
FORT WAYNE DIVISION
MATTHEW G. AINSWORTH,
Plaintiff,
v.
CAROLYN W. COLVIN,
Acting Commissioner of Social Security,
Defendant.

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) Cause No. 1:14-cv-255
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OPINION AND ORDER
This matter is before the court on petition for judicial review of the decision of the
Commissioner filed by the plaintiff, Matthew G. Ainsworth, on August 20, 2014. For the
following reasons, the decision of the Commissioner is AFFIRMED.
Background
The plaintiff, Matthew G. Ainsworth, filed an application for Disability Insurance
Benefits and Supplemental Security Income on November 2, 2011, alleging a disability onset
date of January 1, 2009. (Tr. 72). The Disability Determination Bureau denied Ainsworth’s
application on January 6, 2012, and again upon reconsideration on March 7, 2012. (Tr. 72).
Ainsworth subsequently filed a timely request for a hearing on May 10, 2012. (Tr. 14). A
hearing was held on February 20, 2013, before Administrative Law Judge (ALJ) Patricia Melvin,
and the ALJ issued an unfavorable decision on April 5, 2013. (Tr. 72–84). Vocational Expert
(VE) Amy Kutschbach, Charlene Elrod, Ainsworth’s mother, and Ainsworth testified at the
hearing. (Tr. 72). The Appeals Council denied review on June 24, 2014, making the ALJ’s
decision the final decision of the Commissioner. (Tr. 1–7).

The ALJ found that Ainsworth met the insured status requirements of the Social Security
Act through December 31, 2016. (Tr. 74). At step one of the five step sequential analysis for
determining whether an individual is disabled, the ALJ found that Ainsworth had not engaged in
substantial gainful activity since January 1, 2009, the alleged onset date. (Tr. 74). At step two,
the ALJ determined that Ainsworth had the following severe impairments: degenerative disc
disease of the cervical spine and hypertension. (Tr. 75). Also at step two, the ALJ determined
that Ainsworth’s other limitations were not severe, including hearing loss, chronic obstructive
pulmonary disease, arthritis, small vessel disease, and hypothyroidism. (Tr. 75).
The ALJ found Ainsworth’s chronic obstructive pulmonary disease not severe because
his spirometry reports indicated a mild obstructive lung defect, chest x-rays and breath sounds
were normal, his medications helped, and he used an inhaler only three times per week. (Tr. 75).
The ALJ found his arthritis not severe because x-rays did not reveal any arthritic changes in
Ainsworth’s shoulder and only early osteoarthritis in his right big toe. (Tr. 75). Additionally,
Ainsworth did not have arthritis in his right hip. (Tr. 75). Although he experienced chest pains
between one second and a couple of minutes, Ainsworth’s small vessel disease was not severe
because he went a couple weeks without any chest pains. (Tr. 75). Additionally, he was not
receiving any treatment for his small vessel disease. (Tr. 75). Finally, the ALJ found his
hypothyroidism not severe because his medication controlled it. (Tr. 75).
The ALJ also found Ainsworth’s mental impairments, depression and anxiety, not severe.
(Tr. 75). She noted that Ainsworth’s mental impairments did not stop him from working or
cause him to seek psychiatric care. (Tr. 75). Moreover, treatment notes demonstrated that
Ainsworth was alert and oriented with good insight and intact memory. (Tr. 75). To determine

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whether Ainsworth’s mental impairments were severe, the ALJ considered the Paragraph B
criteria. (Tr. 76).
The ALJ found that Ainsworth had no limitations in daily living activities. (Tr. 76). He
could care for his personal hygiene, prepare meals, do laundry, clean, mow the lawn, do repairs,
drive, shop, and fly RC planes. (Tr. 76). Additionally, Joseph Pressner, a State agency
psychological consultant, concluded that Ainsworth had no limitations in this area, which the
ALJ found consistent with the record. (Tr. 76). The ALJ also found that Ainsworth had no
limitations in social functioning. (Tr. 76). Ainsworth talked to friends and family and did not
report problems getting along with others or authority figures. (Tr. 76). Dr. Pressner also found
that Ainsworth did not have limitations in social functioning, which the ALJ found consistent
with the record. (Tr. 76).
The ALJ found that Ainsworth had no limitations in concentration, persistence, or pace.
(Tr. 76). Ainsworth reported difficulty with memory, concentration, and his ability to complete
tasks. (Tr. 76). However, Dr. Pressner found that he had no limitations in this area, which the
ALJ found consistent with the record. (Tr. 76). Additionally, the ALJ concluded that Ainsworth
had no limitations in sustaining focus, attention, or concentration long enough to complete tasks
in a work setting appropriately and timely. (Tr. 76). The ALJ also found that Ainsworth had not
experienced any episodes of decompensation of extended duration. (Tr. 76). Therefore,
Ainsworth’s mental impairments did not meet the Paragraph B criteria because he did not have
more than a mild limitation in any of the first three areas and had no episodes of decompensation
of extended duration. (Tr. 76).
At step three, the ALJ concluded that Ainsworth did not have an impairment or
combination of impairments that met or medically equaled the severity of one of the listed

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impairments. (Tr. 76–77). She considered Listing 1.04 for nerve root compression, spinal
arachnoiditis, and lumbar spinal stenosis and Listing 1.00(B)(2)(b) for an inability to ambulate
effectively. (Tr. 77). The ALJ stated that hypertension did not have a specific listing but that
Listing 4.00H indicated that hypertension generally caused disability through its effects on other
body systems. (Tr. 77). Therefore, she considered listings for the affected body systems such as
the heart, brain, kidneys, and eyes. (Tr. 77). However, she found that Ainsworth’s hypertension
did not meet a listing for any body system. (Tr. 77).
The ALJ then assessed Ainsworth’s residual functional capacity as follows:
the claimant has the residual functional capacity to perform light
work as defined in 20 CFR 404.1567(b) and 416.967(b) except the
claimant can never climb ladders, ropes, or scaffolds. The claimant
can occasionally climb ramps or stairs. The claimant can
occasionally balance, stoop, crouch, and kneel, but never crawl. The
claimant can frequently reach overhead bilaterally. The claimant
must avoid concentrated exposure to wetness or humidity,
specifically slippery or uneven surfaces. The claimant must avoid
concentrated exposure to excessive noise, vibration, and
unprotected heights.
(Tr. 77). The ALJ explained that in considering Ainsworth’s symptoms she followed a two-step
process. (Tr. 77). First, she determined whether there was an underlying medically determinable
physical or mental impairment that was shown by a medically acceptable clinical and laboratory
diagnostic technique that reasonably could be expected to produce Ainsworth’s pain or other
symptoms. (Tr. 77). Then, she evaluated the intensity, persistence, and limiting effects of the
symptoms to determine the extent to which they limited Ainsworth’s functioning. (Tr. 77–78).
Ainsworth alleged disability based on arthritis, right ear deafness, chronic obstructive
pulmonary disease, learning disability, high blood pressure, small vessel disease, and bone
fragments in his right foot. (Tr. 78). He used a cane for long distance because of pain in his
right foot. (Tr. 78). Additionally, he reported extreme fatigue and pain in his neck and
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shoulders. (Tr. 78). Ainsworth indicated that the pain was constant and ranged from 3-4/10 to
9/10. (Tr. 78). He noted that driving aggravated his pain and that he had difficulty looking up.
(Tr. 78). He took oxycodone and Oxycontin for pain but claimed that the side effects were
disabling. (Tr. 78). Ainsworth testified that he got short of breath after going up a couple of
steps and that he could walk or stand for ten to fifteen minutes, sit for twenty to thirty minutes,
and lift ten pounds. (Tr. 78).
The ALJ found that Ainsworth’s impairments could cause his alleged symptoms, but she
also found him incredible regarding the intensity, persistence, and limiting effects of those
symptoms. (Tr. 78). She noted that the objective medical evidence did not support Ainsworth’s
claims of disabling symptoms and limitations. (Tr. 78). On September 24, 2009, Ainsworth
went to the emergency room and had an elevated blood pressure reading of 221 over 130. (Tr.
78). However, he had no edema and no motor or sensory deficits. (Tr. 78). Dr. Mary Wilger
diagnosed him with a hypertensive emergency, but he was released the following day after a
normal MRI and echocardiogram. (Tr. 78).
In April 2010, Dr. Matthew Snyder evaluated Ainsworth for foot and left shoulder pain.
(Tr. 78). Ainsworth’s shoulder had a slightly reduced range of motion but he had negative
impingement signs for his shoulder and a normal gait. (Tr. 78). In June, Dr. Kanakapura
Venkatakrishna found that Ainsworth’s hypertension was better controlled because of his 134
over 78 reading. (Tr. 78). An MRI revealed that his left knee was normal. (Tr. 78). Also in
June, Ainsworth presented with shoulder pain to Dr. Anuradha Kollipara, who diagnosed him
with hypertension, right foot pain, and left shoulder pain. (Tr. 78). In September, Ainsworth
received a right-sided hearing implant, and in November, he informed Dr. Kollipara that he felt
good. (Tr. 78).

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In February 2011, Ainsworth went to the emergency room for drainage from his cochlear
implant site. (Tr. 79). In March, he reported to Dr. Kollipara for extremity numbness and
tenderness from the thoracic region to his shoulder. (Tr. 79). In April 2011, cervical spine xrays revealed degenerative changes, including mild disc space narrowing, an MRI suggested
possible nerve root impingement because of mild to moderate foraminal narrowing, and lumbar
spine x-rays showed degenerative changes consistent with age. (Tr. 79). In May 2011, an
electromyography test did not show any abnormalities, and an MRI showed stable changes
consistent with age or minimal small vessel ischemic disease. (Tr. 79). Additionally, a physical
examination noted normal muscle tone and strength with normal sensation, and Ainsworth could
heel, toe, and tandem walk. (Tr. 79).
In June, Dr. Venkatakrishna indicated that Ainsworth’s blood pressure was well
controlled, and in June and August, Ainsworth received epidural steroid injections to relieve
cervical stenosis pain. (Tr. 79). At an August consultation, Ainsworth declined surgical
intervention to seek conservative care. (Tr. 79). Additionally, he was referred to physical
therapy but declined because he was too busy at work. (Tr. 79). In September, Ainsworth went
to a pain management clinic, where his mood and affect were appropriate. (Tr. 79).
Additionally, Ainsworth was tender and his shoulder had a decreased range of motion. (Tr. 79).
However, he had normal strength and sensation, and his gait, tandem, toe, and heel walk were
normal. (Tr. 79). Further treatment notes indicated a decreased range of motion in the cervical
spine, but otherwise normal findings. (Tr. 79).
An October 2011 stress test had mildly abnormal findings, and in December, Ainsworth
received lumbar and cervical steroid injections for facet arthropathy. (Tr. 79). In March 2012,
he underwent a cervical spine fusion, and x-rays showed that his spine healed well, so he was

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released with no restrictions. (Tr. 79). On June 22, 2012, he underwent a left knee arthroscopy
and a limited synovectomy. (Tr. 79). Treatment notes indicated that he recovered well and
returned to work activities as tolerated. (Tr. 79). In December, Ainsworth told his pain
management clinic that he did not have any medication side effects, and his physical
examination noted similar findings of tenderness, decreased range of motion, and normal
strength, gait, and sensation. (Tr. 79).
The ALJ noted that Ainsworth could ambulate without an assistive device, despite Dr.
Kollipara prescribing one. (Tr. 79). Dr. Kollipara prescribed a cane for Ainsworth’s
degenerative disc disease, but he was not treating Ainsworth for that condition. (Tr. 79).
Additionally, his treatment notes did not indicate that Ainsworth’s gait was abnormal. (Tr. 79).
The ALJ further noted that Ainsworth did not appear to be in pain each time he reported to the
pain management center. (Tr. 79). However, in February 2012, Ainsworth did report to a pain
management clinic with his cane. (Tr. 79). During the examination, he had decreased motor
strength. (Tr. 79). That same day, Ainsworth went to the emergency room for chest pains, but
he was released later that day. (Tr. 79). A medical record from March 12, 2013 indicated that
Ainsworth was diagnosed with left carpal tunnel syndrome, but the ALJ noted that there was no
objective support for that finding. (Tr. 80).
The ALJ concluded that the objective medical evidence demonstrated significant back
issues, considering Ainsworth’s stenosis, degenerative changes, and surgery. (Tr. 80). However,
she noted that his lumbar spine did not degenerate to the same degree and that he had a normal
gait and toe, heel, and tandem walk. (Tr. 80). The ALJ found those findings inconsistent with
Ainsworth’s claims of limited standing and walking. (Tr. 80). She also noted that medication
controlled Ainsworth’s hypertension, and that Dr. Kollipara’s notes did not reveal significant

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physical findings. (Tr. 80). The ALJ also indicated that Ainsworth saw Dr. Kollipara for routine
follow-up visits or acute illness, such as acute knee pain or infections. (Tr. 80).
The ALJ further stated that Ainsworth’s pain improved with injections and that he did not
show pain constantly. (Tr. 80). However, she found that his degenerative changes with
decreased range of motion precluded him from more than light work with various limitations.
(Tr. 80). For example, he needed postural, reaching, and environmental limitations to prevent
further injury or symptom exacerbation. (Tr. 80). Furthermore, Ainsworth’s hypertension also
would preclude hazards. (Tr. 80). Although Ainsworth alleged right foot pain and a need for a
cane, the ALJ documented that the injury causing the pain occurred twenty years ago and that
Ainsworth only saw a specialist twice. (Tr. 80). Additionally, Ainsworth received no treatment
for this condition, besides wearing special shoe insoles. (Tr. 80).
The ALJ further found Ainsworth’s daily living activities inconsistent with his claims of
disabling pain and symptoms. (Tr. 80). For example, the ALJ stated that Ainsworth’s activities
were not as limited as one would expect, considering his allegations. (Tr. 80). Specifically, the
ALJ noted that Ainsworth’s ability to clean, shop, cook, and do yard work suggested an ability to
perform light work that involved lifting and standing. (Tr. 80). She commented that Ainsworth
worked consistently after the alleged onset date, which suggested greater abilities than he
alleged. (Tr. 80). Although Ainsworth’s earnings did not reach substantial gainful activity, the
ALJ mentioned that they were close and, considering that he was self-employed, he may have
qualified for substantial gainful activity. (Tr. 80). The ALJ also noted that Ainsworth declined
physical therapy because he was too busy at work. (Tr. 80). Ultimately, the ALJ found
Ainsworth partially credible because he needed multiple steroid injections and underwent
surgery. (Tr. 80).

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The ALJ then reviewed the opinion evidence. (Tr. 80–81). On January 23, 2013, Dr.
Kollipara submitted a form that found Ainsworth disabled because his attention and
concentration would be disrupted constantly. (Tr. 80). He further found that Ainsworth could
not stand, walk, or sit for eight hours during a workday and that he would miss more than four
days of work per month. (Tr. 80). Additionally, Dr. Kollipara included postural, environmental,
and reaching restrictions. (Tr. 80). The ALJ gave his opinion no weight. (Tr. 80). She noted
that Dr. Kollipara treated Ainsworth for hypertension, chronic obstructive pulmonary disease,
hypothyroidism, and other acute illnesses. (Tr. 81). Despite being a treating physician, the ALJ
found that his treating relationship did not support his opinion. (Tr. 81). Additionally, the ALJ
found his opinion inconsistent with his physical examinations, which were benign, other medical
evidence, which showed improvement and a normal gait, and Ainsworth’s daily living activities,
which suggested an ability to perform light work. (Tr. 81).
On August 25, 2011, Dr. Shugart concluded that Ainsworth did not have any restrictions
from his cervical stenosis. (Tr. 81). The ALJ gave that opinion some weight because it
suggested that Ainsworth could perform at least light work and it was consistent with Dr.
Shugart’s notes later in the record. (Tr. 81). However, the ALJ limited the opinion to some
weight because it was vague. (Tr. 81).
Dr. J.V. Corcoran, a Stage agency medical consultant, found that Ainsworth could
perform light work with limitations consistent with the RFC. (TR. 81). Dr. J. Eskonen, another
State agency medical consultant, affirmed that opinion. (Tr. 81). The ALJ gave each opinion
great weight because they were consistent with the objective medical evidence, which indicated
that Ainsworth improved with surgery, generally had benign physical examinations, and
experienced some pain due to cervical degenerative changes. (Tr. 81).

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Ainsworth submitted a letter from “Medicaid for Employees with Disabilities.” (Tr. 81).
The ALJ indicated that the program was for employees who were working, rather than Social
Security Disability, which was for employees who could not work. (Tr. 81). Therefore, the ALJ
concluded that the letter indicated that Ainsworth was not disabled. (Tr. 81). The ALJ gave the
letter some weight but mentioned that findings from other agencies were not binding on her
decision. (Tr. 81).
Ainsworth’s mother reported similar daily living activities to those discussed above. (Tr.
81). The ALJ gave her report some weight because it was consistent with the RFC and the
objective medical evidence. (Tr. 81). However, the ALJ noted that she could not give the report
more weight because Ainsworth’s mother did not have consistent contact with him. (Tr. 81).
Additionally, Ainsworth’s mother testified that he could work for only three hours a day, that he
forgot what projects he was completing, and that he could not work for a traditional employer.
(Tr. 81). The ALJ gave that testimony little weight because it was inconsistent with the RFC and
the objective medical evidence. (Tr. 81).
Ultimately, the ALJ found her RFC consistent with the objective medical evidence. (Tr.
81). She mentioned that treatment notes were inconsistent with Ainsworth’s claims of disabling
pain because they indicated a normal gait, normal sensation, and normal strength. (Tr. 81).
Additionally, the ALJ noted that Dr. Kollipara’s physical examinations did not demonstrate any
issues that supported a need for a cane. (Tr. 81). Furthermore, the State agency opinions
afforded great weight were consistent with the objective medical evidence, and Ainsworth’s
allegations were inconsistent with his daily living activities and work history. (Tr. 81). The ALJ
conceded that Ainsworth experienced some pain and limitations but only to the extent stated in
the RFC. (Tr. 82).

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At step four, the ALJ found that Ainsworth could perform his past relevant work as a
janitorial supervisor. (Tr. 82). However, the ALJ also determined that Ainsworth could perform
other jobs in the national economy. (Tr. 82). Considering Ainsworth’s age, education, work
experience, and RFC, the ALJ concluded that there were jobs in the national economy that he
could perform, including repack room worker (350-400 jobs regionally and 450,000 jobs
nationally), office helper (200-250 jobs regionally and 110,000 jobs nationally), and storage
rental clerk (100-150 jobs regionally and 475,000 jobs nationally). (Tr. 83).
Discussion
The standard for judicial review of an ALJ’s finding that a claimant is not disabled within
the meaning of the Social Security Act is limited to a determination of whether those findings are
supported by substantial evidence. 42 U.S.C. § 405(g) (“The findings of the Commissioner of
Social Security, as to any fact, if supported by substantial evidence, shall be conclusive.”);
Moore v. Colvin, 743 F.3d 1118, 1120–21 (7th Cir. 2014); Bates v. Colvin, 736 F.3d 1093, 1097
(7th Cir. 2013) (“We will uphold the Commissioner’s final decision if the ALJ applied the
correct legal standards and supported her decision with substantial evidence.”); Pepper v. Colvin,
712 F.3d 351, 361–62 (7th Cir. 2013); Schmidt v. Barnhart, 395 F.3d 737, 744 (7th Cir. 2005);
Lopez ex rel Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003). Substantial evidence has
been defined as “such relevant evidence as a reasonable mind might accept to support such a
conclusion.” Richardson v. Perales, 402 U.S. 389, 401, 91 S. Ct. 1420, 1427, 28 L. Ed. 2d 852
(1972) (quoting Consol. Edison Co. v. NLRB, 305 U.S. 197, 229, 59 S. Ct. 206, 217, 83 L. Ed.
2d 140 (1938)); see Bates, 736 F.3d at 1098; Pepper, 712 F.3d at 361–62; Jens v. Barnhart, 347
F.3d 209, 212 (7th Cir. 2003); Sims v. Barnhart, 309 F.3d 424, 428 (7th Cir. 2002). An ALJ’s
decision must be affirmed if the findings are supported by substantial evidence and if there have

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been no errors of law. Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir. 2013); Rice v. Barnhart,
384 F.3d 363, 368–69 (7th Cir. 2004); Scott v. Barnhart, 297 F.3d 589, 593 (7th Cir. 2002).
However, “the decision cannot stand if it lacks evidentiary support or an adequate discussion of
the issues.” Lopez, 336 F.3d at 539.
Disability and supplemental insurance benefits are available only to those individuals
who can establish “disability” under the terms of the Social Security Act. The claimant must
show that he is unable “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). The Social Security regulations enumerate the five-step sequential
evaluation to be followed when determining whether a claimant has met the burden of
establishing disability. 20 C.F.R. §§ 404.1520, 416.920. The ALJ first considers whether the
claimant is presently employed or “engaged in substantial gainful activity.” 20 C.F.R. §§
404.1520(b), 416.920(b). If he is, the claimant is not disabled and the evaluation process is over.
If he is not, the ALJ next addresses whether the claimant has a severe impairment or combination
of impairments that “significantly limits . . . physical or mental ability to do basic work
activities.” 20 C.F.R. §§ 404.1520(c), 416.920(c); see Williams v. Colvin, 757 F.3d 610, 613
(7th Cir. 2014) (discussing that the ALJ must consider the combined effects of the claimant’s
impairments). Third, the ALJ determines whether that severe impairment meets any of the
impairments listed in the regulations. 20 C.F.R. § 401, pt. 404, subpt. P, app. 1. If it does, then
the impairment is acknowledged by the Commissioner to be conclusively disabling. However, if
the impairment does not so limit the claimant’s remaining capabilities, the ALJ reviews the
claimant’s “residual functional capacity” and the physical and mental demands of his past work.

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If, at this fourth step, the claimant can perform his past relevant work, he will be found not
disabled. 20 C.F.R. §§ 404.1520(e), 416.920(e). However, if the claimant shows that his
impairment is so severe that he is unable to engage in his past relevant work, then the burden of
proof shifts to the Commissioner to establish that the claimant, in light of his age, education, job
experience, and functional capacity to work, is capable of performing other work and that such
work exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. §§ 404.1520(f),
416.920(f).
First, Ainsworth has argued that the ALJ failed to evaluate his medical conditions at step
two properly. At step two, the claimant has the burden to establish that he has a severe
impairment. Castile v. Astrue, 617 F.3d 923, 926 (7th Cir. 2010). A severe impairment is an
“impairment or combination of impairments which significantly limits [one’s] physical or mental
ability to do basic work activities.” 20 C.F.R. §§ 404.1520(c), 404.1521(a); Castile, 617 F.3d at
926. Basic work activities include “the abilities and aptitudes necessary to do most jobs,” such
as “walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling.” 20
C.F.R. § 404.1521(b); Stopka v. Astrue, 2012 WL 266341, at *1 (N.D. Ill. Jan. 26, 2012).
“[A]n impairment that is ‘not severe’ must be a slight abnormality (or a combination of slight
abnormalities) that has no more than a minimal effect on the ability to do basic work activities.”
Social Security Ruling 96-3p, 1996 WL 374181, at *1. Courts have characterized step two as a
de minimis screening device that disposes of groundless claims. Johnson v. Sullivan, 922 F.2d
346, 347 (7th Cir. 1990); Elkins v. Astrue, 2009 WL 1124963, at *8 (S.D. Ind. Apr. 24, 2009)
(citing Webb v. Barnhart, 433 F.3d 683, 688 (9th Cir. 2005)); see Stopka, 2012 WL 266341 at
*1 (listing cases supporting same).

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Although the ALJ found that Ainsworth had two severe impairments and continued
through the evaluation process, Ainsworth has argued that the ALJ erred by finding some of his
impairments not severe. First, he has claimed that his small vessel disease was a severe
impairment. Ainsworth noted that a neurologist concluded that he had small vessel disease, that
the disease might cover his entire body, and that it may be associated with his memory problems.
He also indicated that the ALJ failed to mention his carpal tunnel syndrome at step two, despite
concluding that the diagnosis had no objective support later in the opinion. Moreover,
Ainsworth stated that the ALJ failed to explain why his hearing loss was not severe.
The ALJ identified Ainsworth’s testimony that his small vessel disease caused chest
pains that last between one second and a couple of minutes. (Tr. 75). However, the ALJ
indicated that Ainsworth had gone a couple of weeks without any chest pains and that he did not
receive any medication for this condition. (Tr. 75). Therefore, the ALJ concluded that
Ainsworth’s small vessel disease was not severe because it did not cause more than a minimal
limitation of his physical or mental ability to do basic work activities. (Tr. 75). The ALJ did not
mention Ainsworth’s carpal tunnel syndrome or explain why his hearing loss was not severe at
step two.
Although the ALJ could have explained her findings further that Ainsworth’s small
vessel disease, carpal tunnel syndrome, and hearing loss were not severe, those conclusions did
not alter the outcome of this case because the ALJ was required to proceed through the
evaluation process. See Castile, 617 F.3d at 927 (citing Golembiewski, 322 F.3d 912, 918 (7th
Cir. 2003) (“Having found that one or more of [appellant’s] impairments was ‘severe,’ the ALJ
needed to consider the aggregate effect of the entire constellation of ailments.”)). Therefore, at
step four, the ALJ indicated that there was no objective support for Ainsworth’s carpal tunnel

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diagnosis. (Tr. 80). Additionally, she accounted for Ainsworth’s hearing loss by restricting him
from excessive noise. (Tr. 77).
Ainsworth has argued that any errors were not harmless because the ALJ was required to
consider his impairments in combination. However, he did not identify how the ALJ failed to
consider his symptoms in combination or how any errors at step two caused an error later in the
process. Moreover, he did not meet his burden to prove that the impairments were severe.
Castile, 617 F.3d at 926. Rather, the ALJ stated that she considered all of Ainsworth’s
impairments individually and in combination. (Tr. 77). Furthermore, the ALJ demonstrated that
she considered Ainsworth’s carpal tunnel syndrome and hearing loss properly by discussing
those impairments at step four. Therefore, any error at step two did not affect the ALJ’s
determination at step four.
Next, Ainsworth has argued that the ALJ failed to develop the record. The ALJ has a
duty to develop a full and fair record. Nelms v. Astrue, 553 F.3d 1093, 1098 (7th Cir. 2009)
(citations omitted). Generally, courts will uphold the Commissioner’s decision regarding how
much evidence to gather. Nelms, 553 F.3d at 1098 (citations omitted). Therefore, a claimant
must demonstrate that there was a significant omission—a prejudicial omission. Nelms, 553
F.3d at 1098. “Mere conjecture or speculation that additional evidence might have been obtained
in the case is insufficient to warrant a remand.” Binion v. Shalala, 13 F.3d 243, 246 (7th Cir.
1994). Rather, the claimant must present specific, relevant facts that the ALJ failed to consider,
such as medical evidence. Nelson v. Apfel, 131 F.3d 1228, 1235 (7th Cir. 1997).
Specifically, Ainsworth has argued that the ALJ failed to obtain sufficient evidence
regarding his mental impairments. He alleged that his depression and anxiety affected his work
functions, and his treating physician concluded that they exacerbated his physical symptoms.

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Considering those allegations, Ainsworth has claimed that the ALJ should have ordered a
consultative examination to provide some evidence from a qualified medical professional
regarding his mental limitations. He further noted that the Appeals Council failed to consider a
psychological evaluation, dated May 1, 2013, nearly one month after the ALJ issued her opinion.
However, the record does contain evidence from a qualified professional. Dr. Pressner
concluded that Ainsworth had no mental limitations, was not taking psychiatric medications, or
receiving psychological treatment. (Tr. 520–33). Additionally, the ALJ reviewed Dr. Pressner’s
opinion at step two. (Tr. 76). Furthermore, the ALJ noted Ainsworth’s testimony that his mental
limitations did not stop him from working and treatment notes that found him “alert and oriented,
with good insight and intact memory.” (Tr. 75). Ainsworth has not demonstrated that the
evidence was inadequate for the ALJ to reach a decision. Nor has he shown specific facts that
the ALJ failed to consider. Moreover, the Appeals Council was not required to consider any
evidence postdating the ALJ’s opinion. 20 C.F.R. § 404.970(b); 20 C.F.R. § 416.1470(b).
Therefore, the ALJ was not required to further develop the record.
Third, Ainsworth has claimed that the ALJ failed to evaluate his work activity properly.
This court will sustain the ALJ’s credibility determination unless it is “patently wrong” and not
supported by the record. Bates v. Colvin, 736 F.3d 1093, 1098 (7th Cir. 2013); Schmidt v.
Astrue, 496 F.3d 833, 843 (7th Cir. 2007); Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir.
2006) (“Only if the trier of fact grounds his credibility finding in an observation or argument that
is unreasonable or unsupported . . . can the finding be reversed.”). The ALJ’s “unique position to
observe a witness” entitles her opinion to great deference. Nelson v. Apfel, 131 F.3d 1228, 1237
(7th Cir. 1997); Allord v. Barnhart, 455 F.3d 818, 821 (7th Cir. 2006). However, if the ALJ
does not make explicit findings and does not explain them “in a way that affords meaningful

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review,” the ALJ’s credibility determination is not entitled to deference. Steele v. Barnhart, 290
F.3d 936, 942 (7th Cir. 2002). Further, “when such determinations rest on objective factors or
fundamental implausibilities rather than subjective considerations [such as a claimant’s
demeanor], appellate courts have greater freedom to review the ALJ’s decision.” Clifford v.
Apfel, 227 F.3d 863, 872 (7th Cir. 2000); see Bates, 736 F.3d at 1098.
The ALJ must determine a claimant’s credibility only after considering all of the
claimant’s “symptoms, including pain, and the extent to which [the claimant’s] symptoms can
reasonably be accepted as consistent with the objective medical evidence and other evidence.”
20 C.F.R. ' 404.1529(a); Arnold v. Barnhart, 473 F.3d 816, 823 (7th Cir. 2007) (“[S]ubjective
complaints need not be accepted insofar as they clash with other, objective medical evidence in
the record.”); Scheck v. Barnhart, 357 F.3d 697, 703 (7th Cir. 2004). If the claimant’s
impairments reasonably could produce the symptoms of which the claimant is complaining, the
ALJ must evaluate the intensity and persistence of the claimant’s symptoms through
consideration of the claimant’s “medical history, the medical signs and laboratory findings, and
statements from [the claimant, the claimant’s] treating or examining physician or psychologist,
or other persons about how [the claimant’s] symptoms affect [the claimant].” 20 C.F.R.
' 404.1529(c); see Schmidt v. Barnhart, 395 F.3d 737, 746–47 (7th Cir. 2005) (“These
regulations and cases, taken together, require an ALJ to articulate specific reasons for
discounting a claimant’s testimony as being less than credible, and preclude an ALJ from merely
ignoring the testimony or relying solely on a conflict between the objective medical evidence and
the claimant’s testimony as a basis for a negative credibility finding.”).
Although a claimant’s complaints of pain cannot be totally unsupported by the medical
evidence, the ALJ may not make a credibility determination “solely on the basis of objective

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medical evidence.” SSR 96-7p, at *1; see Moore v. Colvin, 743 F.3d 1118, 1125 (7th Cir. 2014)
(“‘[T]he ALJ cannot reject a claimant’s testimony about limitations on her daily activities solely
by stating that such testimony is unsupported by the medical evidence.’”) (quoting Indoranto,
374 F.3d at 474); Indoranto, 374 F.3d at 474; Carradine v. Barnhart, 360 F.3d 751, 754 (7th
Cir. 2004) (“If pain is disabling, the fact that its source is purely psychological does not disentitle
the applicant to benefits.”). Rather, if the
[c]laimant indicates that pain is a significant factor of his or her
alleged inability to work, the ALJ must obtain detailed descriptions
of the claimant’s daily activities by directing specific inquiries
about the pain and its effects to the claimant. She must investigate
all avenues presented that relate to pain, including claimant’s prior
work record, information and observations by treating physicians,
examining physicians, and third parties. Factors that must be
considered include the nature and intensity of the claimant’s pain,
precipitation and aggravating factors, dosage and effectiveness of
any pain medications, other treatment for relief of pain, functional
restrictions, and the claimant’s daily activities. (internal citations
omitted).
Luna v. Shalala, 22 F.3d 687, 691 (7th Cir. 1994); see Zurawski v. Halter, 245 F.3d 881,
887-88 (7th Cir. 2001).
In addition, when the ALJ discounts the claimant’s description of pain because it is
inconsistent with the objective medical evidence, she must make more than “a single, conclusory
statement . . . . The determination or decision must contain specific reasons for the finding on
credibility, supported by the evidence in the case record, and must be sufficiently specific to
make clear to the individual and to any subsequent reviewers the weight the adjudicator gave to
the individual’s statements and the reasons for that weight.” SSR 96-7p, at *2; see Minnick v.
Colvin, 775 F.3d 929, 937 (7th Cir. 2015) (“[A] failure to adequately explain his or her
credibility finding by discussing specific reasons supported by the record is grounds for
reversal.”) (citations omitted); Zurawski, 245 F.3d at 887; Diaz v. Chater, 55 F.3d 300, 307-08
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(7th Cir. 1995) (finding that the ALJ must articulate, at some minimum level, his analysis of the
evidence). She must “build an accurate and logical bridge from the evidence to [her]
conclusion.” Zurawski, 245 F.3d at 887 (quoting Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir.
2000)). A minor discrepancy, coupled with the ALJ’s observations is sufficient to support a
finding that the claimant was incredible. Bates, 736 F.3d at 1099. However, this must be
weighed against the ALJ’s duty to build the record and not to ignore a line of evidence that
suggests a disability. Bates, 736 F.3d at 1099.
The ALJ found Ainsworth incredible, in part, because of his work activity. (Tr. 80). She
noted that he continued to work after the alleged onset date and that his self-employment
earnings were close to substantial gainful activity. (Tr. 80). Moreover, she concluded that his
consistent work suggested “far greater abilities than alleged.” (Tr. 80). Ainsworth has argued
that the ALJ erred by drawing a negative inference based on his work activity. He has claimed
that the ALJ failed to analyze his work activity completely by not questioning him about his
impairment related expenses or considering his accommodating environment. Ainsworth has not
argued that the ALJ’s credibility finding was patently wrong but that his work activity should
have been a positive factor towards his credibility.
The ALJ noted that Ainsworth worked in his family business through late 2011 or early
2012, which was after his alleged onset date, and that he started doing less work about a year
before the hearing. Although the ALJ did not elaborate why Ainsworth’s consistent work
suggested greater abilities than he alleged, the record demonstrated that he claimed he could not
work at all starting in January 2009, despite consistently working through 2011 or early 2012.
Therefore, the record supported her negative credibility inference based on Ainsworth’s work

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activity. Moreover, the ALJ may rely on an inconsistency between Ainsworth’s allegations and
the record to find him incredible.
However, the ALJ also presented other reasons for discounting Ainsworth’s credibility.
She reviewed the objective medical evidence and determined that it did not support Ainsworth’s
claims of disabling symptoms and limitations. For example, the ALJ noted that Ainsworth had
normal physical examinations and that medication controlled some of his conditions and
symptoms. She found inconsistencies between his daily living activities and his allegations.
Specifically, she indicated that his ability to clean, shop, cook, and do yard work suggested an
ability to perform light work because they involved lifting and standing. Furthermore, the ALJ
mentioned that Ainsworth declined physical therapy because of the demands of his job.
Therefore, the ALJ built a logical bridge from the evidence to her credibility determination and
her credibility determination was not patently wrong.
Fourth, Ainsworth has argued that the ALJ erred by rejecting Dr. Kollipara’s opinion. A
treating source’s opinion is entitled to controlling weight if the “opinion on the issue(s) of the
nature and severity of [the claimant’s] impairment(s) is well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial
evidence” in the record. 20 C.F.R. ' 404.1527(d)(2); see Bates v. Colvin, 736 F.3d 1093, 1099
(7th Cir. 2013); Punzio v. Astrue, 630 F.3d 704, 710 (7th Cir. 2011); Schmidt v. Astrue, 496
F.3d 833, 842 (7th Cir. 2007). The ALJ must “minimally articulate his reasons for crediting or
rejecting evidence of disability.” Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000) (quoting
Scivally v. Sullivan, 966 F.2d 1070, 1076 (7th Cir. 1992)); see 20 C.F.R. ' 404.1527(d)(2) (“We
will always give good reasons in our notice of determination or decision for the weight we give
your treating source’s opinion.”).

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“‘[O]nce well-supported contradicting evidence is introduced, the treating physician’s
evidence is no longer entitled to controlling weight’ and becomes just one more piece of
evidence for the ALJ to consider.” Bates, 736 F.3d at 1100. Controlling weight need not be
given when a physician’s opinions are inconsistent with his treatment notes or are contradicted
by substantial evidence in the record, including the claimant’s own testimony. Schmidt, 496
F.3d at 842 (“An ALJ thus may discount a treating physician’s medical opinion if the opinion is
inconsistent with the opinion of a consulting physician or when the treating physician’s opinion
is internally inconsistent, as long as he minimally articulates his reasons for crediting or rejecting
evidence of disability.”); see, e.g., Latkowski v. Barnhart, 93 Fed. App’x 963, 970-71 (7th Cir.
2004); Jacoby v. Barnhart, 93 Fed. App’x 939, 942 (7th Cir. 2004). If the ALJ was unable to
discern the basis for the treating physician’s determination, the ALJ must solicit additional
information. Moore v. Colvin, 743 F.3d 1118, 1127 (7th Cir. 2014) (citing Similia v. Astrue,
573 F.3d 503, 514 (7th Cir. 2009)). Ultimately, the weight accorded a treating physician’s
opinion must balance all the circumstances, with recognition that, while a treating physician “has
spent more time with the claimant,” the treating physician may also “bend over backwards to
assist a patient in obtaining benefits . . . [and] is often not a specialist in the patient’s ailments, as
the other physicians who give evidence in a disability case usually are.” Hofslien v. Barnhart,
439 F.3d 375, 377 (7th Cir. 2006) (internal citations omitted); see Punzio, 630 F.3d at 713.
Dr. Kollipara concluded that Ainsworth was disabled because his attention and
concentration would be disrupted constantly. (Tr. 80). She also found that he could not stand,
walk, or sit for eight hours during a workday and would miss more than four days of work per
month. (Tr. 80). Additionally, she included postural, environmental, and reaching restrictions.
(Tr. 80). However, the ALJ gave her opinion no weight. (Tr. 80).

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The ALJ acknowledged that Dr. Kollipara was Ainsworth’s treating physician for his
hypertension, chronic obstructive pulmonary disease, hypothyroidism, and other acute illnesses,
but she found that the scope of Dr. Kollipara’s treatment did not support his opinion. (Tr. 81).
Thus, indicating that Dr. Kollipara’s treatment would not have led to the conclusions he opined.
Additionally, the ALJ found Dr. Kollipara’s conclusions inconsistent with his treatment notes,
which included generally benign physical examinations. (Tr. 81). Furthermore, she stated that
Dr. Kollipara’s conclusions were inconsistent with the objective medical evidence, such as
Ainsworth’s improvement after surgery and normal gait. (Tr. 81). Last, the ALJ found his
conclusions inconsistent with Ainsworth’s daily living activities, which suggested an ability to
perform light work. (Tr. 81).
The ALJ at least minimally articulated her reasons for rejecting Dr. Kollipara’s opinion.
She found the opinion inconsistent with Dr. Kollipara’s treatment notes, the objective medical
evidence, and Ainsworth’s daily living activities. Additionally, the ALJ indicated that Dr.
Kollipara’s conclusions exceeded the scope of his treatment. Therefore, the ALJ did not err by
rejecting Dr. Kollipara’s opinion.
Last, Ainsworth has claimed that the ALJ misconstrued his approval letter from Medicaid
for Employees with Disabilities. Ainsworth submitted the approval letter, which indicated that
he was eligible for M.E.D. Works coverage. (Tr. 245). The letter also stated that the program
was for working individuals with disabilities. (Tr. 245). The ALJ noted that the program was
for people who were working and concluded that the letter indicated that Ainsworth was not
disabled. (Tr. 81). She gave the letter some weight, but stated that findings from other agencies
were not binding on her decision. (Tr. 81).

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Ainsworth has argued that the ALJ should not have considered the approval letter to find
him disabled without reviewing the program’s approval criteria. The ALJ did not explain how
M.E.D. Works granted coverage or how it compared to the Social Security regulations.
However, the Commissioner indicated that Ainsworth failed to identify any errors with the ALJ’s
conclusion or how the letter contradicted the ALJ’s conclusion. Although the ALJ could have
further explained the M.E.D. Works program and how it granted coverage to Ainsworth,
substantial evidence supported her RFC finding.
SSR 96-8p explains how an ALJ should assess a claimant’s RFC at steps four and five of
the sequential evaluation. In a section entitled, “Narrative Discussion Requirements,” SSR 968p specifically spells out what is needed in the ALJ’s RFC analysis. This section of the Ruling
provides:
The RFC assessment must include a narrative discussion describing
how the evidence supports each conclusion, citing specific medical
facts (e.g., laboratory findings) and nonmedical evidence (e.g., daily
activities, observations). In assessing RFC, the adjudicator must
discuss the individual’s ability to perform sustained work activities
in an ordinary work setting on a regular and continuing basis (i.e., 8
hours a day, for 5 days a week, or an equivalent work schedule), and
describe the maximum amount of each work-related activity the
individual can perform based on the evidence available in the case
record. The adjudicator must also explain how any material
inconsistencies or ambiguities in the evidence in the case record
were considered and resolved.
SSR 96-8p (footnote omitted). Thus, as explained in this section of the Ruling, there is a
difference between what the ALJ must contemplate and what she must articulate in her written
decision. “The ALJ is not required to address every piece of evidence or testimony presented,
but he must provide a ‘logical bridge’ between the evidence and his conclusions.” Getch v.
Astrue, 539 F.3d 473, 480 (7th Cir. 2008) (quoting Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir.
2000)); see Moore v. Colvin, 743 F.3d 1118, 1123 (7th Cir. 2014). Although the ALJ does not
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need to discuss every piece of evidence, she cannot ignore evidence that undermines her ultimate
conclusions. Moore, 743 F.3d at 1123 (“The ALJ must confront the evidence that does not
support her conclusion and explain why that evidence was rejected.”) (citing Terry v. Astrue,
580 F.3d 471, 477 (7th Cir. 2009); Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009); Arnett v.
Astrue, 676 F.3d 586, 592 (7th Cir. 2012)). “A decision that lacks adequate discussion of the
issues will be remanded.” Moore, 743 F.3d at 1121.
The ALJ built a logical bridge between the evidence and her RFC assessment. She
reviewed the objective medical evidence and how it supported her RFC assessment. She also
discussed the opinion evidence, which included giving great weight to the State agency medical
consultants and some weight to Dr. Shugart and Ainsworth’s mother. Furthermore, the ALJ
reviewed the inconsistencies in the record by rejecting Dr. Kollipara’s opinion. Therefore, she
built a logical and accurate bridge between the evidence and her RFC assessment without relying
on the approval letter. Thus, substantial evidence supported the ALJ’s decision without
considering the approval letter.
Based on the foregoing reasons, the decision of the Commissioner is AFFIRMED.
ENTERED this 31st day of August, 2015.
/s/ Andrew P. Rodovich
United States Magistrate Judge

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