Brundige v. Commissioner of Social Security

Filing 28

OPINION AND ORDER: The decision of the ALJ is reversed and remanded for further consideration consistent with this Opinion. Signed by Judge Theresa L Springmann on 8/23/2016. (lhc)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
FORT WAYNE DIVISION
PATRICIA M. BRUNDIGE,

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Plaintiff,
v.
CAROLYN COLVIN,
Acting Commissioner of the Social
Security Administration,
Defendant.

CAUSE NO.: 1:15-CV-222-TLS

OPINION AND ORDER
The Plaintiff, Patricia M. Brundige, seeks review of the final decision of the
Commissioner of the Social Security Administration denying her application for Disability
Insurance Benefits. The Plaintiff alleges that her disability began on March 20, 2012. An ALJ
conducted a one-hour hearing in December 2013, at which the Plaintiff—who was represented
by an attorney—her husband, and a vocational expert (VE) testified. On April 22, 2014, the ALJ
found that the Plaintiff has the following severe impairments: degenerative disc disease, mild
carpal tunnel syndrome, history of bilateral rotator cuff repair, depression, pain disorder,
asthma/COPD/allergies, plantar fasciitis, and gastrointestinal disorders including alcoholic
pancreatitis, irritable bowel syndrome, diverticulosis/diverticulitis, and history of multiple hernia
repairs. However, the ALJ ultimately concluded that the Plaintiff is not disabled. On June 24,
2015, the Appeals Council denied the Plaintiff’s request for review, making the ALJ’s decision
the Commissioner’s final decision. The Plaintiff then initiated this civil action for judicial review
of the Commissioner’s final decision.

BACKGROUND
The Plaintiff was 48 years old at the time of her alleged onset date, and she turned 50
during the pendency of her claim. The Plaintiff has a high school education and a beauty college
certificate. Her past relevant work includes cafeteria attendant, which was unskilled and light per
the Dictionary of Occupational Titles (DOT) and medium as performed; cashier, which was light
as performed as part of the cafeteria attendant job, and; food worker, which was an unskilled
light job per the DOT and medium as she performed it.

A.

The Plaintiff’s Testimony
The Plaintiff believes she cannot work because of pain from head to toe. (R. 51.)
My stomach is the worst. I can get really sharp pains. What’s worse now is the
swelling and the pain in there that it’s causing, and it goes through to my back,
which initially will set off my back problems and my hips, and which initially will
go down my legs to me knees, once in a while to my toes. I have the sciatic pains.
Plantar fasciitis, which is very painful in my feet.

(Id.) The Plaintiff also testified about her concern with “trigger thumb” on her right hand. (Id.)
The Plaintiff admitted that her pain medications, Neurontin and Bentyl, “take the worst of the
pain out,” but that she continued to have pain. (R. 52.) Side effects included sleepiness,
dizziness, and forgetfulness. (R. 53.) The Plaintiff testified that she had to take a nap “[a]lmost
every day,” because she did not sleep more than four hours at a time, but also stated that Zoloft
helped her sleep at night. (R. 61–62.) She did not take more heavy-duty narcotics because she
had become “hooked on them” in the past. (R. 58.)
In describing a typical day, the Plaintiff stated that she got up in the morning, tried to do
her stretches, and fed the dog. “And basically I’m up and down off of the sofa. I try to do—I visit

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the restroom often, very often. Most of the time I’m down, either sitting or laying.” (R. 56–57.)
On a good day, she would visit the restroom about six times over a period of about six hours. On
a bad day, when she was experiencing diarrhea, she would use the restroom at least 10 to 12
times. (R. 57.) According to the Plaintiff, she had more bad days than good days in a week. A
bad day involved “staying in bed, going back and forth to the restroom, when everything’s
hurting. When you hurt so bad you can’t get up and go take your medicines and make it feel a
little bit better.” (Id.)
The Plaintiff had not had any recent emergency room visits, but wanted to go about a
month earlier for “a real bad bout of vomiting and diarrhea for four hours straight,” but decided
to stay home when it subsided. (R. 53.)
For household chores, the Plaintiff did dishes, but did not finish the job if there were a lot
of them. She also dusted. Vacuuming hurt her back too much. The Plaintiff did some grocery
shopping, but her husband did the majority of the shopping.

B.

Testimony from the Plaintiff’s Husband
Mr. Brundige testified that he worked from 7 a.m. to 3:15 p.m., and that when he arrived

home, his wife was usually laying down in bed, he would fix his own dinner. Mr. Brundige
thought that his wife had more bad days than good days. He stated that he did all of the chores
outside the house, and everything inside except dusting and the dishes.

C.

Treating Sources
In December 2013, the Plaintiff obtained opinions from two of her treating physicians,

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Gastroenterologist Imad Horani, and pain specialist Jon Karl.

1.

Dr. Horani
In a Medical Source Statement, Dr. Imad Horani listed the Plaintiff’s diagnoses to

include chronic alcoholic pancreatitis, diverticulosis, acute pancreatitis, irritable bowel
syndrome, abdominal pain, and diarrhea reflux. (R. 774.) His prognosis was that this was a
chronic disease. Dr. Horani cited abnormal blood work values, abnormal imaging studies, and
distended small bowel in the left upper quadrant as the clinical findings and objective signs for
her medical conditions. Dr. Horani described her pain as abdominal and epigastric “occurring
daily with bouts of increasing pain waxing and waning.” (R. 775.) With respect to her functional
limitations at full time employment, he indicated that she “may need day off from time to time”
for “abdominal pain not controlled by medication.” (R. 776.) He opined that she would miss
work more than three times per month, and that she would be able to stay on task in unskilled
work for 80% to 84% of a workday.

2.

Dr. Karl
Dr. Karl’s Medical Source Statement (R. 795–99) included diagnoses of lumbar

spondylosis, cervical sprain/strain, cervical pain, lumbar radiculitis, lumbar pain, lumbar
degenerative disc disease, rotator cuff tear, and myalgia. He thought that her prognosis for her
medical conditions was “chronic pain lifelong.” (R. 795.) The clinical findings and objective
signs included limited range of motion with pain in her upper extremities; limited flexion,
extension, and rotation in the cervical/lumbar region; and shoulder pain with range of motion.

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Dr. Karl reported that the Plaintiff’s symptoms were pain, muscle tightness, numbness, and right
thumb catching and locking. He characterized her pain as sharp and deep in the neck, low back,
lower extremities, shoulders, and both hands, which increased with activity. The pain was treated
with neurontin, which caused drowsiness and difficulty in concentration. With respect to the
Plaintiff’s functional limitations, Dr. Karl states that she could walk one block, sit for fifteen
minutes before needing to get up, and stand for ten minutes.
Dr. Karl estimated that the Plaintiff could work ten hours per week, and that if she
worked an eight-hour day, she would need to take unscheduled breaks two to three times per day
for an average of thirty minutes due to pain, fatigue, and medication side effects. The most
weight she could lift, and then only rarely, was ten pounds. According to Dr. Karl, the Plaintiff
could never reach with her left arm or perform fingering with her left hand, but could
occasionally perform handling with her left hand. For her right extremities, she could never
perform handling with the right hand, but could occasionally reach with her right arm and
perform fingering. Dr. Karl opined that the Plaintiff would be absent from work as a result of her
impairment more than three days per month.

D.

Non-Treating Sources
The Plaintiff had a consultative physical exam with Dr. H.M. Bacchus on July 27, 2012.

Also in July, Dr. Corcoran, a non-examining State Agency physician found that the Plaintiff was
limited to light exertional work with additional non-exertional limitations related to climbing,
stooping, and concentrated exposures to wetness and hazards. Dr. Sands, a nonexamining
State Agency physician, reviewed these findings and agreed.

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The Plaintiff had a consultative psychological exam with Dr. Sherwin Kepes on July 26,
2012. He diagnosed major depressive disorder that was recurrent, and moderate and pain
disorder associated with a general medical condition, specifically her low back. He also
diagnosed “Abdominal.” (R. 440.) In August and October 2012, non-examining State Agency
psychologists found no severe mental impairment.

E.

ALJ Decision (Five-Step Evaluation)
The Social Security regulations set forth a five-step sequential evaluation process to be

used in determining whether the claimant has established a disability. See 20 C.F.R.
§ 404.1520(a)(4)(i)-(v); 42 U.S.C. § 423(d)(1)(A) (defining a disability under the Social Security
Act as being 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”);
§ 423(d)(2)(A) (an applicant must show that his “impairments are of such severity that he is not
only unable to do his previous work but cannot, considering his age, education, and work
experience, engage in any other kind of substantial gainful work which exists in the national
economy”). The first step is to determine whether the claimant is presently engaged in
substantial gainful activity (SGA). Here, the ALJ found that the Plaintiff was not engaged in
SGA, so she moved on to the second step, which is to determine whether the claimant had a
“severe” impairment or combination of impairments. An impairment is “severe” if it
significantly limits the claimant’s physical or mental ability to do basic work activities. 20
C.F.R. § 404.1521(a). The ALJ determined that the Plaintiff’s severe impairments are

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degenerative disc disease, mild carpal tunnel syndrome, history of bilateral rotator cuff repair,
depression, pain disorder, asthma/COPD/allergies, plantar fasciitis, and gastrointestinal disorders
including alcoholic pancreatitis, irritable bowel syndrome, diverticulosis/diverticulitis, and
history of multiple hernia repairs. The ALJ concluded that the Plaintiff’s right “trigger thumb”
was not a severe impairment.
At step three, the ALJ considered numerous impairment listings to determine whether the
Plaintiff had an impairment, or combination of impairments, that meets or medically equals the
severity of one of the impairments listed by the Administration as being so severe that it
presumptively precludes SGA. See 20 C.F.R. Pt. 404, Subpt. P, App. 1. The ALJ concluded that
the Plaintiff’s impairments did not to meet or equal a listed impairment.
Next, the ALJ was required, at step four, to determine the Plaintiff’s residual functional
capacity (RFC), which is an assessment of the claimant’s ability to perform sustained
work-related physical and mental activities in light of her impairments. SSR 96–8p. The relevant
mental work activities include understanding, remembering, and carrying out instructions;
responding appropriately to supervision and co-workers; and handling work pressures in a work
setting. 20 C.F.R. § 404.1545(c). The ALJ concluded that the Plaintiff had the RFC to perform
light work as defined in 20 C.F.R. § 404.1567(b), except that she was not able to climb ladders,
ropes, or scaffolds and could only occasionally climb ramps and stairs, balance, stoop, kneel,
crouch, and crawl. She was not able to reach overhead, but could frequently reach in other
directions and could frequently finger. The Plaintiff’s RFC required that she avoid concentrated
exposure to wetness and hazards of slick surfaces and unprotected heights, and to irritants. The
ALJ found that the Plaintiff was unable to engage in complex or detailed tasks but could perform

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simple, routine, and repetitive tasks consistent with unskilled work, and was able to sustain and
attend to tasks throughout the workday.
Once the RFC is established, the ALJ uses it to determine whether the claimant can
perform her past work and, if necessary, whether the claimant can perform other work in the
economy. 20 C.F.R. § 416.920. At this final step of the evaluation, the ALJ determined that, in
light of the Plaintiff’s age, education, and RFC, there were unskilled jobs that existed in
significant numbers in the national economy that she could perform. These included usher, rental
consultant, and bakery production worker. The VE testified that most employers would provide
two breaks of a 5 to 15 minute duration, and a lunch break. Most employers would also allow an
additional 2 to 3 breaks a week of the 5 to 15 minute duration, but that anything more than that
would not be tolerated. Additionally, an individual who missed 2 to 3 days a month or more
would not be able to maintain competitive employment. According to the VE, employers require
employees to be on task at least 85% of the time.

STANDARD OF REVIEW
The decision of the ALJ is the final decision of the Commissioner when the Appeals
Council denies a request for review. Liskowitz v. Astrue, 559 F.3d 736, 739 (7th Cir. 2009). A
court will affirm the Commissioner’s findings of fact and denial of disability benefits if they are
supported by substantial evidence. Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008). Substantial
evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971). It must be “more than a scintilla
but may be less than a preponderance.” Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007).

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Even if “reasonable minds could differ” about the disability status of the claimant, the court must
affirm the Commissioner’s decision as long as it is adequately supported. Elder v. Astrue, 529
F.3d 408, 413 (7th Cir. 2008).
It is the duty of the ALJ to weigh the evidence, resolve material conflicts, make
independent findings of fact, and dispose of the case accordingly. Perales, 402 U.S. at 399–400.
In this substantial-evidence determination, the court considers the entire administrative record
but does not reweigh evidence, resolve conflicts, decide questions of credibility, or substitute the
court’s own judgment for that of the Commissioner. Lopez ex rel. Lopez v. Barnhart, 336 F.3d
535, 539 (7th Cir. 2003). Nevertheless, the court conducts a “critical review of the evidence”
before affirming the Commissioner’s decision, and the decision cannot stand if it lacks
evidentiary support or an inadequate discussion of the issues. Id.
The ALJ is not required to address every piece of evidence or testimony presented, but
the ALJ must provide a “logical bridge” between the evidence and the conclusions. Terry v.
Astrue, 580 F.3d 471, 475 (7th Cir. 2009). If the Commissioner commits an error of law, remand
is warranted without regard to the volume of evidence in support of the factual findings. Binion
v. Chater, 108 F.3d 780, 782 (7th Cir. 1997).

ANALYSIS
On appeal, the Plaintiff contends that the ALJ improperly evaluated the opinions of her
treating pain specialist, Dr. Karl, and her treating Gastroenterologist, Dr. Horani; failed to
consider her mental and physical impairments in combination; improperly evaluated the
Plaintiff’s credibility, and; failed to incorporate the moderate degree of limitation in

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concentration, persistence, or pace into her hypothetical to the vocational expert.

A.

Credibility Determination
An ALJ is in the best position to determine the credibility of witnesses, and a credibility

determination will be overturned only if it is patently wrong. Craft, 539 F.3d at 678; 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 his opinion to great
deference. Nelson v. Apfel, 131 F.3d 1228, 1237 (7th Cir. 1997); see also Allord v. Barnhart, 455
F.3d 818, 821 (7th Cir. 2006). However, when “the determination rests 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.’” Indoranto v.
Barnhart, 374 F.3d 470, 474 (7th Cir. 2004) (brackets omitted) (quoting Clifford v. Apfel, 227
F.3d 863, 872 (7th Cir. 2000)). Additionally, if the ALJ does not make explicit findings and does
not explain them “in a way that affords meaningful review,” the ALJ’s credibility determination
is not entitled to deference. Steele v. Barnhart, 290 F.3d 936, 942 (7th Cir. 2002). To evaluate
credibility, an ALJ must “consider the entire case record and give specific reasons for the weight
given to the individual’s statements.” SSR 96-7p. The ALJ should look to a number of factors to
determine credibility, such as the objective medical evidence, the claimant’s daily activities,
allegations of pain, aggravating factors, types of treatment received and medication taken, and
functional limitations. Simila, 573 F.3d at 517 (first citing 20 C.F.R. § 404.1529(c)(2)–(4); and
then citing Prochaska, 454 F.3d at 738).

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The ALJ accurately cited the testimony provided by the Plaintiff and her husband
regarding the restrictions that were caused by pain and frequent diarrhea. The ALJ listed the
Plaintiff’s severe impairments, and noted that they could reasonably be expected to cause the
alleged symptoms. However, she found that the statements by the Plaintiff and her husband
concerning the intensity, persistence, and limiting effects of those symptoms were not entirely
credible. She wrote:
Several factors, especially when considered in conjunction with each other,
support a finding that the allegations made by the claimant and her husband are
not entirely credible; they also do not support a more restrictive assessment of the
claimant’s residual functional capacity. First, the record reflects that the claimant
is able to drive, go out alone, pay bills, count change, handle bank accounts, care
for her personal needs independently, take her medications without reminders,
and prepare simple foods (such as sandwiches and green beans). In addition, she
is able to feed her dog, wash dishes (although she reportedly must take breaks),
dust, use a telephone, stay in contact with her friends, and watch television. Both
she and her husband stated prior to the hearing that the claimant had no difficulty
getting along with others and that she was able to follow instructions. Next, there
is no evidence in the record that the claimant has been hospitalized on an inpatient
basis for a psychiatric reason or that she sought counseling since March 20, 2012.
Furthermore, it is noted that she tested positive for THC in February 2013.
Moreover, the record indicates that the claimant has a somewhat sparse work
history. A review of her earnings record indicates that she never earned more than
about $15,000.00 per year and that most of her annual earnings were less that
$8,000.
(R. 25 (citations omitted).)
Next, the ALJ discussed the medical evidence that she believed supported a finding that
the allegations were not entirely credible and made a more restrictive assessment of her residual
functional capacity implausible. The ALJ devoted considerable time to a discussion of the
Plaintiff’s mental condition, stating that the Plaintiff’s presentation with regard to her mental
functioning was largely within normal limits. Turning to the Plaintiff’s physical condition, the
ALJ noted that the physical examinations were also largely within normal limits, except for the
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following:
decreased bowels sounds at times, abdominal tenderness, decreased range of
motion in her shoulders, tenderness over her shoulders . . . back[,] and SI joints,
an antalgic gait at times, clumsiness with tandem walking, difficulty walking on
her heels and toes, difficulty squatting, slow movements, mild wheezing at times,
and decreased range of motion in her neck, right hip, knees, and back.
(R. 26.) She noted that upper extremity muscle strength had, at the worst, been graded at 4 out of
5 for any 12-month consecutive period of time, and that there was no evidence of significant
deficits in reflexes or sensation. The ALJ highlighted the fact that there was no evidence of
muscle atrophy, “which might be reasonably expected bases on the allegations by the claimant
and her husband.” (R. 26.) Further, the Plaintiff did not use an assistive device to ambulate.
The ALJ cited other medical evidence that supported her determination that the
allegations by the Plaintiff and her husband were not entirely credible. First, she cited the lack of
evidence of any bowel obstruction during the time the Plaintiff was hospitalized for a few days
for abdominal pain. And although the Plaintiff had been diagnosed with recurrent pancreatitis,
the doctor who performed the EGD in late 2013 stated that the Plaintiff should not need to take
pancreatic enzyme replacement. Additionally, the Plaintiff had actually gained weight since
March 2012, despite having severe gastrointestinal impairments. The ALJ noted a MMPI-2
profile, which indicated that the Plaintiff was “‘extremely’ sensitive to changes in her bodily
functions, which could result in some degree of symptom exaggeration.” (R. 27.)
A claimant’s “subjective complaints need not be accepted insofar as they clash with
other, objective medical evidence in the record.” Arnold v. Barnhart, 473 F.3d 816, 823 (7th Cir.
2007). However, the absence of objective medical evidence is just one factor to be considered
when considering subjective complaints of pain. Knight v. Chater, 55 F.3d 309, 314 (7th Cir.

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1995). An individual’s statements about the intensity and persistence of pain, or about the effect
the pain has on her ability to work, may not be disregarded solely because they are not
substantiated by objective medical evidence. Moore v. Colvin, 743 F.3d 1118, 1125 (7th Cir.
2014) (citing SSR 96-7p); see also Johnson v. Barnhart, 449 F.3d 804, 806 (7th Cir. 2006)
(“Even when . . . the claimant attributes her pain to a physical rather than a psychological cause,
the administrative law judge cannot disbelieve her testimony solely because it seems in excess of
the ‘objective’ medical testimony.”); Schmidt v. Barnhart, 395 F.3d 737, 746–47 (7th Cir. 2005)
(“[The governing] 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.”);
Carradine v. Barnhart, 360 F.3d 751, 753 (7th Cir. 2004) (An ALJ may not “discredit the
claimant’s testimony as to subjective symptoms merely because they are unsupported by
objective evidence.”) (citation omitted); Clifford v. Apfel, 227 F.3d 863, 871–72 (7th Cir. 2000).
With respect to the other factors to consider, the Seventh Circuit has instructed that:
If the allegation of pain is not supported by the objective medical evidence in the
file and the claimant indicates that pain is a significant factor of his or her alleged
inability to work, then the ALJ must obtain detailed descriptions of 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 claimant’s pain, precipitation and aggravating factors,
dosage and effectiveness of any pain medications, other treatment for the relief of
pain, functional restrictions, and the claimant’s daily activities.
Luna v. Shalala, 22 F.3d 687, 691 (7th Cir. 1994) (citation omitted).
Here, the ALJ solicited details of the Plaintiff’s activities and the extent to which the
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Plaintiff could perform those activities without experiencing pain. The ALJ also recounted the
medications that the Plaintiff took, and inquired into treatment she received. However, the ALJ
did not link any of this testimony to a specific allegation the Plaintiff made about her restrictions.
In other words, the ALJ did not indicate which of the Plaintiff’s statements were or were not
credible. See Chase v. Astrue, 458 Fed. Appx. 553, 558 (7th Cir. 2012) (stating that ALJ’s use of
phrase “not entirely credible” was “meaningless boilerplate” and remanding case so ALJ could
fully assess the plaintiff’s credibility as part of the RFC determination). “The statement by a trier
of fact that a witness’s testimony is ‘not entirely credible’ yields no clue to what weight the trier
of fact gave the testimony.” Parker v. Astrue, 597 F.3d 920, 922 (7th Cir. 2010), as amended on
reh’g in part (May 12, 2010).
The Plaintiff alleged restrictions that were not all related to the same impairment. Some,
such as experiencing 5 to 6 bad days per week where she was in the restroom 10 to 12 times in
the morning for 15 to 20 minutes each time, were related to her gastrointestinal impairments.
Others, such as not being able to pick up a gallon of milk or perform most household chores,
related to the issues with her rotator cuff, degenerative disc disease, carpal tunnel, or other like
impairments. Still others, such as needing to nap for several hours a day, stemmed from poor
sleep, depression, or a combination of the two. Although the ALJ did not clarify which
statements or symptoms she found credible and which she did not, the Court can assume, based
on the RFC and questions to the VE, that the ALJ did not credit the Plaintiff’s testimony that she
experienced 5 to 6 bad days per week where she needed to be in the restroom for a bulk of the
morning, or her testimony that she needed to nap for several hours almost daily. However, the
ALJ does not explain how the Plaintiff’s limited daily activities undermined these claims. See,

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e.g., Roddy v. Astrue, 705 F.3d 631, 639 (7th Cir. 2013) (criticizing ALJ’s reliance on claimant’s
ability to perform household tasks because inability to get through the day without lying down
every hour does not indicate ability to work even sedentary job). An ALJ should explain
inconsistencies between daily living activities, the medical evidence, and the individual’s
complaints of pain. Zurawski, 245 F.3d at 887 (finding the ALJ’s listing of daily activities was
not sufficient to undermine claims of disabling pain, without explaining the inconsistencies); see
also Jelinek v. Astrue, 662 F.3d 805, 812 (7th Cir. 2011) (“An ALJ may consider a claimant’s
daily activities when assessing credibility, but ALJs must explain perceived inconsistencies
between a claimant’s activities and the medical evidence.”) (internal citation omitted). Moreover,
even if the ALJ had articulated a basis for disbelieving 5 to 6 bad days or the need for daily naps,
the RFC does not account for any bad days; it provides that the Plaintiff would be able to sustain
and attend to tasks throughout the workday.
Neither does the ALJ’s decision explain how testing positive for THC lowered the
Plaintiff’s credibility or was inconsistent with the pain and limitations she claimed. The same is
true of the other factors the ALJ cited in her Decision—a sparse work history and lack of
treatment for psychiatric issues. There is no connection drawn between these factors and the
Plaintiff’s credibility or the specific limitations she alleged. The ALJ notes the Plaintiff’s MMPI2 profile indicating an extreme sensitivity to changes in her bodily functions, which could result
in some degree of symptom exaggeration, but does not discuss what this means with respect to
her functional limitations. “If pain is disabling, the fact that its source is purely psychological
does not disentitle the applicant to benefits.” Carradine v. Barnhart, 360 F.3d 751, 754 (7th Cir.
2004) (“The question whether the experience is more acute because of a psychiatric condition is

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different from the question whether the applicant is pretending to experience pain, or more pain
than she actually feels. The pain is genuine in the first, the psychiatric case, though fabricated in
the second.”).
The ALJ also notes that the Plaintiff gained weight despite having severe gastrointestinal
impairments: she weighed 157 pounds in February 2012; 165 pounds in August 2012; and 186
pounds in December 2013. This was presumable intended to be evidence that the Plaintiff’s
statement about the frequency of bad days was not credible. But without a medical opinion on
the issue, the ALJ may not properly draw the inference that, because the Plaintiff has gained
weight, it is unlikely that her stomach pain and bouts with diarrhea are as severe as she claims.
See Schmidt v. Sullivan, 914 F.2d 117, 118 (7th Cir.1990) (“Common sense can mislead; lay
intuitions about medical phenomena are often wrong.”).
The ALJ’s determination was not “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. Without an adequate explanation, the ALJ’s
Decision does not evidence that she considered factors outside the lack of objective medical
evidence to find that the Plaintiff exaggerated the limiting effect of her impairments. While the
lack of objective medical evidence is certainly relevant, according to governing standards, it
cannot be the sole reason for discrediting the Plaintiff. See, e.g., Castille v. Astrue, 617 F.3d 923,
929–30 (7th Cir. 2010) (stating that, although lack of objective evidence was cited in the ALJ’s
credibility determination, the ALJ also discussed a report casting doubt on the plaintiff’s
credibility, the plaintiff’s failure to adhere to prescribed treatment, her daily activities, and
inconsistencies in the plaintiff’s own testimony).

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On remand, the ALJ must articulate which of the statements from the Plaintiff and her
husband the ALJ finds to be unworthy of credence, and the basis for those findings.

B.

Opinions of Treating Physicians
An ALJ is tasked with evaluating opinion evidence when making a determination of

disability. A treating physician’s opinion is entitled to controlling weight if it is well-supported
by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent
with other substantial evidence. 20 C.F.R. § 404.1527(c)(2). An ALJ must offer good reasons for
discounting a treating physician’s opinion. Id. Even when the treating physician’s opinion does
not deserve “controlling weight,” the ALJ must consider certain factors—namely, (1) the length
of the treatment relationship and the frequency of examination, (2) the nature and extent of the
treatment relationship, (3) how supportable the doctor’s medical opinion is, (4) how consistent
the doctor’s opinion is with the record, (5) the doctor’s specialization, and (6) other factors that
might support or contradict the doctor’s opinion—to determine what weight to give the opinion.
Id. Thus, an ALJ may discount a treating source’s medical opinion if it is internally inconsistent
or inconsistent with other evidence in the record. Clifford v. Apfel, 227 F.3d 863, 871 (7th Cir.
2000). An ALJ may also discount a treating physician’s opinion if it reveals bias due to
sympathy for the patient. See Dixon v. Massanari, 270 F.3d 1171, 1177 (7th Cir. 2001). The ALJ
must give “good reasons” to support the weight he ultimately assigns to the treating source’s
opinion. § 404.1527(c); Larson v. Astrue, 615 F.3d 744, 749 (7th Cir. 2010).
The ALJ assigned less weight to the opinions of Dr. Horani and Dr. Karl than to the
earlier opinions of the State Agency physicians. She noted that Drs. Horani and Karl had the

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benefit of examining and treating the Plaintiff, but that the State Agency physicians had the
benefit of reviewing more of the record as a whole, and were specifically trained in evaluating
disability for the Social Security Administration. The ALJ concluded that the objective medical
evidence and the Plaintiff’s activities were more supportive of the State Agency opinion.
Specifically, the Plaintiff did not use an assistive device to ambulate, there was no evidence that
she had reflex or sensory deficits, muscle atrophy, loss of grip strength, or more than relatively
mild loss of muscle strength in her extremities. Also, the Plaintiff was able to care for her
personal needs, drive, and go out alone.
The ALJ has not offered a sound explanation for rejecting the opinions of Dr. Horani and
Dr. Karl and adopting, instead, the State Agency physicians’ conclusion that the Plaintiff was
able to perform light work with some environmental and postural limitations. With respect to the
amount of the record reviewed, and the specific training in evaluating disabilities for the SSA,
those are statements that would apply to every state agency doctor and thus do not provide a
logical bridge. The ALJ could have just as easily said that “[m]ore weight is given to the opinion
of treating physicians because of their greater familiarity with the claimant’s conditions and
circumstances.” Gudgel v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003); see also 20 C.F.R. §§
404.1527(c)(1), 416.927(c)(1) (“Generally, we give more weight to the opinion of a source who
has examined you than to the opinion of a source who has not examined you.”). It is not even
clear why the ALJ thought it was important that the State Agency physicians reviewed “more of
the record as a whole.” Neither of the treating physicians suggested that they were offering an
opinion about the Plaintiff’s limitations for all her impairments—only those that they treated.
The amount of the record reviewed, and the specific training State Agency physicians receive are

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not factors that are pertinent to whether the opinions are well-supported by medically acceptable
clinical and laboratory diagnostic techniques or inconsistent with other substantial evidence.
Moreover, as the Plaintiff points out, the State Agency physicians last reviewed the Plaintiff’s
records in October 2012, but she had major surgery on her left shoulder in December 2012, and
continued to seek medical treatment thereafter.
The remaining rationale, that the State Agency physicians deserved more weight because
they were supported by the objective medical evidence and the Plaintiff’s activities, is not
supported by substantial evidence. In rendering this conclusion, the ALJ does not discuss any
objective medical evidence that even touches on Dr. Horani’s opinion that the Plaintiff was
likely to be absent from work more than three times per month for abdominal, epigastric pain.
Nor does the ALJ indicate how caring for personal needs, driving, or going out alone is
inconsistent with Dr. Horani’s opinion. The State Agency Assessments do not even purport to
address functional limitations that might be brought about by abdominal pain. Dr. Karl indicated
that the Plaintiff would need to take 2 to 3 unscheduled breaks lasting 30 minutes or longer in an
8-hour period for pain, fatigue, and medication side-effects related to impairments in her lumbar
region and shoulder. He also thought that she would be absent from work more than 3 days per
month. Dr. Karl did not indicate that the Plaintiff needed an assistive device to walk, or that she
would be so incapacitated that should would have suffered muscle atrophy, so his opinion cannot
be said to be unsupported or inconsistent based on those reasons as cited by the ALJ.
Final decisions of the Social Security Administration must be upheld if they are
supported by substantial evidence. 42 U.S.C. § 405(g). The decision must construct a logical
bridge between the facts in the record and its ultimate conclusions. McKinzey v. Astrue, 641 F.3d

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884, 889 (7th Cir. 2011); Villano v. Astrue,556 F.3d 558, 562 (7th Cir. 2009). The ALJ’s
decision, while quite thorough in certain regards, does not construct that bridge when it comes to
the credibility of the Plaintiff or to the medical opinions of her treating physicians. Accordingly,
the Court cannot say on this record that the ALJ’s decision was supported by substantial
evidence.

C.

Hypothetical to Vocational Expert
In Step 2 of her analysis, the ALJ found that the Plaintiff had moderate difficulties with

regard to concentration, persistence, or pace. (R. 22.) The Plaintiff argues that the ALJ was thus
required, under O’Connor-Spinner v. Astrue, 627 F.3d 614 (7th Cir. 2010), to supply the VE
with hypothetical that included the terms “concentration, persistence, or pace.” Although the
ALJ stated that the Plaintiff would be limited to simple, routine, and repetitive tasks consistent
with unskilled work, and could not engage in complex or detailed tasks, this was not found to be
sufficient in O’Connor-Spinner. 627 F.3d at 620 (“limiting a hypothetical to simple, repetitive
work does not necessarily address deficiencies of concentration, persistence and pace”).
Although the Seventh Circuit noted that it had not insisted “on a per se requirement that this
specific terminology (‘concentration, persistence and pace’) be used in the hypothetical in all
cases,” the exceptions the court cited do not appear applicable in this case. In any event, because
the Court is remanding this matter for further consideration, the ALJ should additionally
consider whether the VE was adequately advised of all of the Plaintiff’s limitations.

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CONCLUSION
For the reasons stated above, the decision of the ALJ is reversed and remanded for
further consideration consistent with this Opinion.
SO ORDERED on August 23, 2016.
s/ Theresa L. Springmann
THERESA L. SPRINGMANN
UNITED STATES DISTRICT COURT

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