Johnson v. Commissioner of Social Security
OPINION AND ORDER: The decision of the Commissioner of Social Security is AFFIRMED. Clerk DIRECTED to enter judgment in favor of Defendant Commissioner of Social Security and against Plaintiff Tamera S Johnson. Signed by Magistrate Judge Susan L Collins on 2/2/17. (cer)
UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
FORT WAYNE DIVISION
TAMERA S. JOHNSON,
COMMISSIONER OF SOCIAL
CAUSE NO. 1:15-cv-00310-SLC
OPINION AND ORDER
Plaintiff Tamera Johnson appeals to the district court from a final decision of the
Commissioner of Social Security (“Commissioner”) denying her application under the Social
Security Act (the “Act”) for Disability Insurance Benefits (“DIB”) and Supplemental Security
Income (“SSI”).1 (DE 1). For the following reasons, the Commissioner’s decision will be
I. PROCEDURAL HISTORY
Johnson applied for SSI in September 2012 and for DIB in October 2012, alleging
disability as of March 3, 2011. (DE 11 Administrative Record (“AR”) 167-75). The
Commissioner denied Johnson’s application initially and upon reconsideration. (AR 110-25).
After a timely request, a hearing was held on March 13, 2014, before Administrative Law Judge
Patricia Melvin (“the ALJ”), at which Johnson, who was represented by counsel, and a
vocational expert, Micha Daoud (the “VE”), testified. (AR 33-65). On June 3, 2014, the ALJ
rendered an unfavorable decision to Johnson, concluding that she was not disabled because
All parties have consented to the Magistrate Judge. (DE 17); see 28 U.S.C. § 636(c).
despite the limitations caused by her impairments, she could perform her past relevant work as a
sales clerk, cleaner, and telemarketer. (AR 17-27). The Appeals Council denied Johnson’s
request for review (DE 5-9), at which point the ALJ’s decision became the final decision of the
Commissioner. See 20 C.F.R. §§ 404.981, 416.1481.
Johnson filed a complaint with this Court on October 23, 2015, seeking relief from the
Commissioner’s final decision. (DE 1). In this appeal, Johnson argues that the residual
functional capacity (“RFC”) assigned by the ALJ is not supported by substantial evidence
because it purportedly was based on the ALJ’s improper lay interpretation of the medical
evidence. (DE 16 at 3-7).
II. FACTUAL BACKGROUND2
At the time of the ALJ’s decision, Johnson was 53 years old (AR 27, 167); was a high
school graduate and had attended some college (AR 38, 192); and possessed past work
experience as a retail sales clerk, warehouse worker, and security guard (AR 193, 229). At the
time of her application, Johnson alleged disability due to a back injury, degenerative disc
disease, fibromyalgia, and abdominal issues. (AR 191). Johnson advances an alleged onset date
of March 3, 2011—the date she was terminated from her last job for “other reasons.”3 (AR 192).
A. Johnson’s Testimony at the Hearing
At the hearing, Johnson, who was five feet, five inches tall and weighed 200 pounds,
testified that she lived alone. (AR 37). She was receiving financial help from her two adult sons
In the interest of brevity, this Opinion recounts only the portions of the 371-page administrative record
necessary to the decision.
Curiously, despite advancing an alleged onset date of March 3, 2011, Johnson states in her Disability
Report that it actually was not until August 1, 2012, that her conditions became severe enough to keep her from
working. (AR 192).
and her friends, as she was not insured, had no income, and was not receiving public assistance
at the time. (AR 37). She drives herself to appointments and had driven herself to the hearing.
(AR 56). She performs her bathing and dressing independently. (AR 56). She adequately
performs household tasks such as cooking, doing dishes, laundry, vacuuming, and shopping, but
her neighbor helps her by maintaining the lawn and taking out the garbage. (AR 57-58). Her
hobbies are surfing the internet and watching crime shows on television. (AR 56-57). When
asked to describe a typical day, Johnson stated that she sits in a recliner in the living room, surfs
the internet, prepares light meals, watches television, and lies in bed and tries to sleep. (AR 5859).
When asked why she thought she could not work, Johnson cited headaches and constant
pain in her low back, legs, feet, shoulders, and chest. (AR 44). She stated that she experiences
numbness in her legs if she walks or sits too long; several times a week, her leg numbness causes
her to start to fall, and she has to catch herself on furniture. (AR 44, 47-48, 56). She rated her
back pain on a 10-point scale as an “eight” on an average day with medication; she feels
“extreme pain” and “can’t move” when without medication (AR 45-46). Her fibromyalgia
causes constant dull pain in her shoulders, which she rated as a “five” or a “six,” as well as sharp
pains several times a week in her chest, shoulders, and head. (AR 49, 51-52). She told her
doctor about the sharp pains, but she has not been treated for them due to her lack of insurance.
(AR 52). Her fibromyalgia makes just putting her feet on the floor very painful; she rated her
constant foot pain as a “six” with Cymbalta 30 and a “10” without. (AR 49-50). Using her arms
intensifies her pain, so she “just do[es]n’t use them.” (AR 50). She also has constant neck pain,
which she believes causes her headaches. (AR 51-53). Her neck issues cause intermittent
numbness in her hands and elbows on a daily basis; if she stops using her hands, the numbness
subsides. (AR 51).
Johnson stated that she has undergone only “[m]inimal treatment” for her conditions,
including consulting a pain management clinic and a free clinic when available, participating in
physical therapy, receiving spinal injections, and taking medications. (AR 45-46). She was
taking Cymbalta and Opana at the time, which “take the edge off” her pain, but did not eliminate
it (AR 46, 49); she was not taking any medications specifically for her headaches (AR 53).
Cymbalta 30 causes her side effects of extreme fatigue, so she had just been prescribed Cymbalta
20. (AR 46, 49). Lying down in one position, sitting too long, walking, and standing all
aggravate her pain; nothing she can do at home, other than using a heating pad, relieves or
reduces her pain. (AR 46-47, 50).
Johnson estimated that she could walk 70 feet, stand for 10 minutes, sit in one position
for five minutes, and lift from three to five pounds. (AR 54). She stated that she has problems
with her balance and often feels lightheaded. (AR 55-56). She has difficulty reaching overhead
with her left arm and pushing the gas and brake pedals while driving. (AR 54-55). She stated
that she could not climb stairs without assistance, but conceded that she could climb the three
stairs to her porch when using a railing. (AR 55). She claimed that she drops items every day,
such as glasses of water and the remote control, and has difficulty with buttons, zippers, and
shoelaces. (AR 53, 55).
B. Summary of the Relevant Medical Evidence
On January 10, 2011, Johnson presented to the emergency room with a one-week history
of left-sided chest pain. (AR 239-40). All cardiac and pulmonary tests were normal. (AR 241,
246). She was treated with aspirin and Percocet. (AR 241).
On April 13, 2011, Johnson returned to the emergency room for a headache. (AR 24849). She stated that Aleve was helping but that she felt lightheaded. (AR 248). She believed
that she needed blood pressure medication, but the free clinic was closed and the urgent care
center sent her to the emergency room. (AR 248-49, 277). A head CT, chest X-ray, and cardiac
exam were normal. (AR 250). A preliminary drug screen was positive for methamphetamine or
ecstasy, which she could not explain. (AR 250). She was given a prescription for blood pressure
medication and directed to follow up at the free clinic. (AR 250).
On May 18, 2011, Johnson visited the Faith Community Health Clinic for a four-month
history of headaches and neck pain. (AR 280). She reported a history of fibromyalgia. (AR
280). She returned to the Faith Community Health Clinic on August 24, 2011, for a bee sting,
and she requested documentation of degenerative disc disease and fibromyalgia. (AR 280). On
September 21, 2012, Johnson visited the clinic for soreness in her right ankle and back of her left
leg, stating that she wanted to try Lyrica for her pain. (AR 279). She requested paperwork for
her disability application. (AR 279).
On October 5, 2012, Johnson went to the emergency room for right flank pain. (AR 26263). The physician could find no clear etiology for her symptoms. (AR 264). She was given
pain medication and directed to follow up at the free clinic. (AR 264). The following month,
Johnson returned to the Faith Community Health Clinic; she was able to move all four
extremities when talking with the doctor, demonstrated full strength in all extremities, and
ambulated without difficulty when leaving the exam room. (AR 278). She was assessed with
right flank pain and fibromyalgia and was prescribed Flexeril. (AR 278).
On November 20, 2012, Johnson presented to Vijay Kamineni, M.D., for a disability
physical. (AR 296-300). Her chief complaint was upper and lower back pain and multiple
painful joints, reporting that her pain was “10/10” at times. (AR 296). She told Dr. Kamineni
that she had been diagnosed with degenerative disc disease in 1993 and fibromyalgia in 2008.
(AR 296). On physical exam, she had tenderness to palpation in the lumbosacral spine, but no
muscle pain or weakness; her muscle strength and grip strength were “5/5.” (AR 298). She had
normal range of motion in sitting, but said she could not move her legs in supine. (AR 300).
Although she complained of fine motor difficulties, no fine motor deficiencies were observed
during the examination. (AR 299). At the end of his report, Dr. Kamineni articulated the
following medical source statement:
The patient states she cannot sit for 30 minutes. She states she cannot stand for
30 minutes. She states she can carry 20 pounds. She is able to walk 6 minutes.
She states she cannot lift 10 pounds over her head. She can step up an 8 inch
step. [She] has normal fine motor skills with normal handling of fine objects.
Normal concentration and social interaction. Remote and recent memory intact.
Normal hearing, speech and vision.
X-rays of Johnson’s lumbar spine in December 2012 showed disc height loss at L4-5 and
L5-S1, but alignment was maintained and there was no compression deformity. (AR 307). Xrays of her hands were normal. (AR 307).
On December 20, 2012, R. Bond, M.D., a state agency physician, reviewed Johnson’s
record and concluded that she could lift 10 pounds frequently and 20 pounds occasionally; stand
or walk six hours in an eight-hour workday; sit for six hours in an eight-hour workday;
frequently balance and climb ramps and stairs; occasionally stoop, kneel, crouch, crawl, and
climb ladders, ropes, or scaffolds; must avoid concentrated exposure to fumes, odors, dusts,
gases, and poor ventilation; and must avoid even moderate exposure to hazards such as
dangerous machinery and unprotected heights. (AR 71-73).
On February 13, 2013, Johnson began seeing Thomas Miller, M.D., for complaints of
back pain. (AR 308-09). A straight-leg raising test on the left was positive; she had no
tenderness on palpation or spasms of the lumbosacral spine, but she did exhibit left thigh
weakness. (AR 308-09). Dr. Miller assessed sciatica, and he ordered an MRI of her spine,
which revealed a Schmorl’s node of the L4 inferior endplate with adjacent marrow edema and
mild-to-moderate spondylosis of the lower lumbar spine with narrowing of the inferior foraminal
recesses at the L4-5 and L5-S1 levels. (AR 309, 314). On February 25, 2013, Johnson returned
to Dr. Miller to follow up on her MRI results. (AR 310-11). She complained of tingling in both
legs and numbness from the waist down; however, her gait and stance were normal. (AR 310).
Dr. Miller assessed lumbar spondylosis and peripheral neuropathy, and referred her to a
neurologist. (AR 310-11). On March 8, 2015, Johnson returned to Dr. Miller for abdominal
pain. (AR 312-13). On exam, musculoskeletal system findings were normal other than some
tenderness on the plantar aspect of both feet. (AR 312). Dr. Miller assessed degenerative disc
disease. (AR 313).
On March 27, 2013, J. Sands, M.D., another state agency physician, reviewed Johnson’s
record and articulated the same conclusions as Dr. Bond. (AR 105-07).
Johnson received a lumbar epidural in both May and June 2013. (AR 346). She
experienced 40% pain improvement for one week with the first epidural and 50% pain
improvement for one week with the second epidural. (AR 346).
On June 18, 2013, Johnson saw Kelly Anderson, a nurse practitioner at the Centers for
Pain Relief, reporting low back pain and insomnia, but no numbness or tingling. (AR 360-64).
Johnson rated her constant low back pain as an “8/10,” describing it as “burning, shooting and
stabbing.” (AR 360). She also reported constant pain in all of her joints, rating it as a “4/10” at
the time, but stating that it increases to “7/10.” (AR 360). Her pain was aggravated by any
movement and reduced by prescription medications. (AR 360). On examination, Johnson had
pain with flexion; bilateral sacroiliac joint, lumbar facet, and myofascial tenderness; positive
straight-leg raising, torque, and Patrick’s tests; and a slow, wide-based gait. (AR 362). She was
able to sit comfortably on the examination table without difficulty or evidence of pain. (AR
362). Ms. Anderson prescribed Baclofen and Percocet. (AR 363).
Johnson returned to Ms. Anderson on July 16, 2013, reporting that the Percocet gave her
migraines and made her feel “loopy.” (AR 355-59). Her examination results were similar to her
previous visit. (AR 356-58). Ms. Anderson discontinued the Percocet and prescribed Opana and
Baclofen. (AR 359). Johnson returned to Ms. Anderson on August 27, 2013, reporting low back
and joint pain, but no numbness or tingling. (AR 350-54). She denied any side effects from her
current medications. (AR 351). She stated that her pain had improved by 40%, as well as her
ability to walk, do housework, and sleep. (AR 351). Examination results were similar as at her
last visit. (AR 352-53). Ms. Anderson discontinued the Baclofen, but continued the Opana.
On November 1, 2013, Johnson saw William Hedrick, M.D., at the Centers for Pain
Relief, reporting an overall percentage of improvement of 40%. (AR 345-49). She denied any
side effects from her current medications, Opana and Cymbalta (20 mg). (AR 346).
Examination results were similar to those documented by Ms. Anderson. (AR 345-48). Dr.
Hedrick assessed lumbar pain, lumbar/thoracic radiculopathy, unspecified joint pain, and chronic
pain syndrome. (AR 348). He prescribed Cymbalta and Nucynta, and instructed Johnson to
begin a regular low impact exercise program. (AR 349). Dr. Hedrick indicated that Johnson was
tolerating her medications and that they helped her to maintain her activities of daily living and
her ability to work. (AR 348). He expressed an ultimate goal of further reduction of opioids as
Johnson improved with positive lifestyle changes. (AR 348-49).
On November 12, 2014, Johnson saw Dr. Hedrick for spinal injections. (AR 343). She
was seen several days later by Gay Watson, another nurse practitioner at the Centers for Pain
Relief. (AR 338-42). Examination findings were similar to Ms. Anderson’s previously. (AR
338-41). Johnson had normal reflexes but decreased sensation to light touch in her left lower
leg. (AR 340). She denied experiencing any side effects from her current medications,
including any excessive drowsiness. (AR 339). Ms. Watson prescribed Opana and Cymbalta.
(AR 342). The following month, Ms. Anderson saw Johnson again, making similar observations
and diagnoses. (AR 333-37). Johnson again denied experiencing any medication side effects.
(AR 334). Ms. Anderson continued Johnson’s prescriptions of Opana and Cymbalta. (AR 337).
On March 11, 2014, Dr. Hedrick completed a questionnaire regarding Johnson’s
functional capacity. (AR 368-71). He opined that Johnson could lift and carry 10 pounds
occasionally and less then 10 pounds frequently; stand for less than two hours in an eight-hour
period; sit for about two hours in an eight-hour period; occasionally twist, stoop, and bend, but
never crouch or climb ladders or stairs; must change position after sitting for five to 10 minutes
and after standing for five minutes; must walk around for five minutes every 15 minutes; must be
able to shift at will from sitting, standing, or walking; and must lie down at unpredictable
intervals during an eight-hour period. (AR 368-69). Dr. Hedrick also found limitations in
kneeling, balancing, and crawling, stating that Johnson becomes lightheaded at times. (DE 369).
Additionally, he stated that Johnson had limitations in reaching, fingering, handling, feeling, and
pushing/pulling, indicating that she frequently drops items and had decreased sensation in her
left thumb. (AR 369). He wrote that Johnson’s symptoms were severe enough that they would
constantly interfere with the attention and concentration needed to perform simple work-related
tasks. (AR 369). He estimated that she would miss more than four days per month as a result of
her impairments. (AR 360). He indicated that the foregoing symptoms and limitations had
begun in 1980 after a fall from a porch. (AR 369). Dr. Hedrick cited the following medical
findings in support of these limitations: lumbar radiculopathy; lower back pain; multiple
abdominal surgeries; sacroiliitis; and carpel tunnel syndrome, together with positive Phalen’s
and Tinel’s tests, in her left hand. (AR 368-701).
III. STANDARD OF REVIEW
Section 405(g) of the Act grants this Court “the power to enter, upon the pleadings and
transcript of the record, a judgment affirming, modifying, or reversing the decision of the
[Commissioner], with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The
Court’s task is limited to determining whether the ALJ’s factual findings are supported by
substantial evidence, which means “such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Schmidt v. Barnhart, 395 F.3d 737, 744 (7th Cir. 2005)
(citation omitted). The decision will be reversed only if it is not supported by substantial
evidence or if the ALJ applied an erroneous legal standard. Clifford v. Apfel, 227 F.3d 863, 869
(7th Cir. 2000) (citation omitted).
To determine if substantial evidence exists, the Court reviews the entire administrative
record but does not reweigh the evidence, resolve conflicts, decide questions of credibility, or
substitute its judgment for the Commissioner’s. Id. Rather, if the findings of the Commissioner
are supported by substantial evidence, they are conclusive. Jens v. Barnhart, 347 F.3d 209, 212
(7th Cir. 2003) (citation omitted). “In other words, so long as, in light of all the evidence,
reasonable minds could differ concerning whether [the claimant] is disabled, we must affirm the
ALJ’s decision denying benefits.” Books v. Chater, 91 F.3d 972, 978 (7th Cir. 1996).
A. The Law
Under the Act, a claimant is entitled to DIB or SSI if she establishes an “inability to
engage in any substantial gainful activity by reason of any medically determinable physical or
mental impairment which can be expected to . . . last for a continuous period of not less than 12
months.” 42 U.S.C. §§ 416(i)(1), 423(d)(1)(A), 1382c(a)(3)(A). A physical or mental
impairment is “an impairment that results from anatomical, physiological, or psychological
abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic
techniques.” 42 U.S.C. §§ 423(d)(3), 1382c(a)(3)(D).
The Commissioner evaluates disability claims pursuant to a five-step evaluation process,
requiring consideration of the following issues, in sequence: (1) whether the claimant is
currently unemployed; (2) whether the claimant has a severe impairment; (3) whether the
claimant’s impairment meets or equals one of the impairments listed by the Commissioner, see
20 C.F.R. § 404, Subpt. P, App’x 1; (4) whether the claimant is unable to perform her past work;
and (5) whether the claimant is incapable of performing work in the national economy.4 See
Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001) (citations omitted); 20 C.F.R. §§
404.1520, 416.920. An affirmative answer leads either to the next step or, on steps three and
five, to a finding that the claimant is disabled. Zurawski v. Halter, 245 F.3d 881, 886 (7th Cir.
2001) (citation omitted). A negative answer at any point other than step three stops the inquiry
and leads to a finding that the claimant is not disabled. Id. (citation omitted). The burden of
proof lies with the claimant at every step except the fifth, where it shifts to the Commissioner.
Clifford, 227 F.3d at 868 (citation omitted).
B. The Commissioner’s Final Decision
On June 3, 2014, the ALJ issued the decision that ultimately became the Commissioner’s
final decision. (AR 17-27). At step one of the five-step analysis, the ALJ found that Johnson
had not engaged in substantial gainful activity since her alleged onset date. (AR 19). At step
two, the ALJ found that Johnson’s degenerative disc disease and fibromyalgia were severe
impairments. (AR 19). At step three, the ALJ concluded that Johnson did not have an
impairment or combination of impairments severe enough to meet or equal a listing. (AR 2123).
Before proceeding to step four, the ALJ determined that Johnson’s symptom testimony
was not entirely credible, and the ALJ assigned her the following RFC:
[T]he claimant has the [RFC] to perform less than a full range of light work . . . .
She can lift/carry 20 pounds occasionally and 10 pounds frequently; stand/walk
for six hours in an eight hour workday; sit for six hours in an eight hour workday;
Before performing steps four and five, the ALJ must determine the claimant’s RFC or what tasks the
claimant can do despite her limitations. 20 C.F.R §§ 404.1520(e), 404.1545(a), 416.920(e), 416.945(a). The RFC is
then used during steps four and five to help determine what, if any, employment the claimant is capable of. 20
C.F.R. §§ 404.1520(e), 416.920(e).
occasionally climb ladders/ropes/scaffolds, stoop, kneel, crouch, and crawl; and,
frequently climb ramps/stairs and balance. She must avoid concentrated exposure
to fumes, odors, dust, gases, poorly ventilated areas, use of/work in close
proximity to hazardous machinery, and work at unprotected heights.
(AR 22). Based on the RFC and the VE’s testimony, the ALJ concluded at step four that
Johnson could perform her past relevant work as a sales clerk, cleaner, and telemarketer, both as
the jobs were generally performed and as Johnson actually performed them. (AR 26).
Therefore, Johnson’s applications for DIB and SSI were denied. (AR 27).
C. The Assigned RFC Is Supported by Substantial Evidence
In this appeal, Johnson challenges the RFC assigned by the ALJ, contending that it “lacks
evidentiary support as it was based solely on the ALJ’s lay interpretation of the medical evidence
submitted after [the state agency physicians] reviewed the file.” (DE 16 at 4). In tandem,
Johnson asserts that the RFC assigned by the ALJ is flawed because she “erroneously rejected
the only up-to-date opinion of record”—that of Dr. Hedrick from the Centers for Pain Relief.
(DE 16 at 7). Having considered the record and the parties’ arguments, the Court finds
Johnson’s arguments unpersuasive and concludes that the RFC assigned by the ALJ is supported
by substantial evidence.
The Seventh Circuit Court of Appeals has explained that “more weight is generally given
to the opinion of a treating physician because of his greater familiarity with the claimant’s
conditions and circumstances.” Clifford, 227 F.3d at 870 (citations omitted); see 20 C.F.R. §§
404.1527(c)(2), 416.927(c)(2). However, this principle is not absolute, as “a treating physician’s
opinion regarding the nature and severity of a medical condition is [only] entitled to controlling
weight if it is well supported by medical findings and not inconsistent with other substantial
evidence in the record.” Clifford, 227 F.3d at 870 (citation omitted); see Johansen v. Barnhart,
314 F.3d 283, 287 (7th Cir. 2002); 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2).
In the event the treating physician’s opinion is not well supported or is inconsistent with
other substantial evidence, the Commissioner applies the following factors to determine the
proper weight to give the opinion: (1) the length of the treatment relationship and frequency of
examination; (2) the nature and extent of the treatment relationship; (3) how much supporting
evidence is provided; (4) the consistency between the opinion and the record as a whole; (5)
whether the treating physician is a specialist; and (6) any other factors brought to the attention of
the Commissioner. See Books, 91 F.3d at 979; 20 C.F.R. §§ 404.1527(c), 416.927(c). The
Commissioner must always give good reasons for the weight ultimately applied to the treating
source’s opinion. 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2); see Clifford, 227 F.3d at 870.
Although an ALJ may decide to adopt the opinions in a medical source statement
concerning the ability of a claimant to perform work-related activities, the RFC assessment is an
issue reserved to the ALJ. 20 C.F.R. §§ 404.1545(e), 416.945(e); SSR 96-5p, 1996 WL 374183,
at *2 (July 2, 1996) (“[A] medical source statement must not be equated with the administrative
finding known as the RFC assessment.”). The RFC is a determination of the tasks a claimant can
do despite her limitations. 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). The RFC assessment:
is based upon consideration of all relevant evidence in the case record, including
medical evidence and relevant nonmedical evidence, such as observations of lay
witnesses of an individual’s apparent symptomology, an individual’s own
statement of what he or she is able or unable to do, and many other factors that
could help the adjudicator determine the most reasonable findings in light of all
SSR 96-5p, 1996 WL 374183, at *5 (July 2, 1996); see 20 C.F.R. §§ 404.1545, 416.945. Thus, a
medical source opinion concerning a claimant’s work ability is not determinative of the RFC
assigned by the ALJ. See Thomas v. Colvin, 745 F.3d 802, 808 (7th Cir. 2014) (“[T]he
determination of a claimant’s RFC is a matter for the ALJ alone—not a treating or examining
doctor—to decide.” (citing 20 C.F.R. § 404.15279d)); see SSR 96-5p, 1996 WL 374183, at *5
(July 2, 1996).
Here, the ALJ considered all of the medical source opinions of record—that of Dr.
Kamineni on November 20, 2012; Dr. Bond on December 20, 2012; Dr. Sands on March 27,
2013; and Dr. Hedrick on March 11, 2014. (AR 20, 25-26). The ALJ ultimately assigned “great
weight” to the opinions of Drs. Bond and Sands, the reviewing state agency physicians, who
found that Johnson could perform a limited range of light work. (AR 26). In doing so, the ALJ
explained that these opinions were “consistent with totality of the evidence, including
examinations, diagnostic imaging, and the conservative nature of treatment in this case.” (AR
As a general principle, “[i]t is appropriate for an ALJ to rely on the opinions of
physicians and psychologists who are also experts in social security disability evaluation.”
Flener ex rel. Flener v. Barnhart, 361 F.3d 442, 448 (7th Cir. 2004) (citing 20 C.F.R. §
416.927(f)(2)(i)). “State agency medical and psychological consultants and other program
physicians, psychologists, and other medical specialists are highly qualified physicians,
psychologists, and other medical specialists who are also experts in Social Security disability
evaluation.” 20 C.F.R. §§ 404.1527(e)(2)(ii), 416.927(e)(2)(ii).
The ALJ, in contrast, assigned “no significant weight” to the medical source statement of
Dr. Kamineni, an examining physician. (AR 26). In doing so, the ALJ explained that Dr.
Kamineni’s medical source statement was “obviously based on the claimant’s own statements.”
(AR 26 (citing AR 298 (“The patient states that she cannot sit for 30 minutes. She states she
cannot stand for 30 minutes. She states she can carry 20 pounds . . . .”))). The ALJ’s proffered
rationale has support in the law. The Seventh Circuit has repeatedly explained that “ALJs may
discount medical opinions based solely on the patient’s subjective complaints[.]” Filus v.
Astrue, 694 F.3d 863, 868 (7th Cir. 2012) (citing Ketelboeter v. Astrue, 550 F.3d 620, 625 (7th
Cir. 2008)); see also Dixon, 270 F.3d at 1177 (“An ALJ may properly reject a doctor’s opinion if
it appears to be based on a claimant’s exaggerated subjective allegations.” (citing Diaz v. Chater,
55 F.3d 300, 308 (7th Cir. 1995))).
The ALJ also assigned “little weight” to the medical source statement of Dr. Hedrick, the
pain management physician who saw Johnson twice, both times in November 2013. (AR 25-26).
The ALJ explained that Dr. Hedrick’s opinion was inconsistent with his own treatment notes and
the treatment notes of his nurse practitioners, and was also inconsistent with other evidence of
record, including Dr. Miller’s treatment notes and Dr. Kamineni’s examination findings. (AR
25-26). As explained earlier, an ALJ may discount a treating physician’s opinion for the reason
that it is internally inconsistent or inconsistent with other substantial medical evidence of record.
See Henke v. Astrue, 498 F. App’x 636, 639 (7th Cir. 2012) (“[T]he ALJ need not blindly accept
a treating physician’s opinion—she may discount it if it is internally inconsistent or contradicted
by other substantial medical evidence in the record.” (citation omitted)); Ketelboeter, 550 F.3d at
625 (noting that an ALJ can discount a treating physician’s opinion if it is internally
inconsistent); Skarbek v. Barnhart, 390 F.3d 500, 503 (7th Cir. 2004) (“An ALJ may discount a
treating physician’s medical opinion if it is inconsistent with the opinion of a consulting
physician, or when the treating physician’s opinion is internally inconsistent, as long as he
minimally articulate[s] his reasons for crediting or rejecting evidence of disability.” (alteration in
original) (citation omitted)).
In challenging the ALJ’s consideration of the medical source opinions, Johnson first
argues that the ALJ rejected Dr. Hedrick’s opinion “[w]ithout specifying any actual
inconsistencies.” (DE 16 at 7). But that argument has no traction, as the ALJ sufficiently
explained how Dr. Hedrick’s opinion was inconsistent with his own treatment notes and the
documentation of other providers. At the outset, the ALJ observed that Dr. Hedrick had seen
Johnson just two times—November 1, 2013, and November 12, 2013—before issuing his March
11, 2014, medical source statement. (AR 26, 343, 345, 368-71). The ALJ explained that Dr.
Hedrick’s medical source statement of severe limitations was inconsistent with his November 1st
note indicating that: (1) Johnson experienced an 40% overall improvement in her ambulation,
housework, and sleep; (2) she was tolerating her medications without any side effects; (3) her
medications helped to maintain her activities of daily living and her ability to work; and (4) she
should perform a regular low impact exercise program. (AR 26 (citing AR 345, 348-49);
compare AR 370 (indicating that Johnson could stand for only five minutes), with AR 349
(instructing her to perform regular, low impact exercise)).
The ALJ further observed that Dr. Hedrick’s medical source statement was also
inconsistent with other substantial evidence of record. For example, the ALJ observed the
contrast between Dr. Hedrick’s opinion of severe limitations and the less severe findings in Dr.
Miller’s treatment notes. (See AR 20 (citing AR 309 (Dr. Miller’s observation of no tenderness,
spasm, or acute distress, but some left thigh weakness), AR 310 (Dr. Miller’s documentation of
some tingling and numbness in the legs); AR 312 (Dr. Miller’s documentation of normal
musculoskeletal findings except for some foot tenderness))). Similarly, the ALJ noted the
contrast between Dr. Hedrick’s severe limitations and Dr. Kamineni’s examination results. (AR
25-26 (compare AR 369 (Dr. Hedrick’s statement that Johnson’s condition affected her reaching,
fine and gross manipulation, and pushing/pulling), with AR 298-299 (Dr. Kamineni’s finding
that Johnson had normal fine motor skills))). As such, the ALJ satisfied her duty of minimal
articulation when explaining her reasoning for discounting the severe limitations in Dr.
Hedrick’s medical source statement. In that regard, “an ALJ need not address every piece of
evidence in [her] decision. The ALJ need only build a bridge from the evidence to [her]
conclusion.” Sims v. Barnhart, 309 F.3d 424, 429 (7th Cir. 2002) (citations and internal
quotation marks omitted); see Elder v. Astrue, 529 F.3d 408, 415 (7th Cir. 2008) (describing the
minimal articulation standard as “a very deferential standard that we have, in fact, deemed ‘lax’”
Next, Johnson argues that the ALJ inappropriately “played doctor” by considering the
records from the Centers for Pain Relief without soliciting an updated opinion from an
independent medical expert. More pointedly, Johnson states that the ALJ could not rely on the
opinions of Drs. Bond and Sands because they were issued in December 2012 and March 2013,
respectively, before Johnson began her treatment in June 2013 at the Centers for Pain Relief. As
Johnson sees it, her treatment at the Centers for Pain Relief revealed significant new evidence of
decreased strength and sensation in her left leg, positive physical examination findings, steroid
injections, and pain management treatment—evidence which Drs. Bond and Sands never
reviewed. (DE 16 at 4 (citing AR 308-09, 314, 334-35, 343-48, 355-58, 362)).
It is true that “[a]n ALJ cannot play the role of doctor and interpret medical evidence
when he or she is not qualified to do so.” Murphy v. Astrue, 496 F.3d 630, 634 (7th Cir. 2007)
(citations omitted). Here, however, the ALJ did not “play doctor” by improperly interpreting
medical evidence. Rather, the ALJ considered the limitations opined by Dr. Hedrick and the
other evidence from the Centers for Pain Relief for purposes of determining Johnson’s RFC—a
responsibility which is reserved to the Commissioner. 20 C.F.R. §§ 404.1545(e), 416.945(e).
“The ALJ is charged with making an RFC determination that reflects the entire record, not just
one doctor’s opinion.” Lemere-Jackson v. Colvin, No. 3:13-cv-912-CAN, 2014 WL 4656567, at
*8 (N.D. Ind. Sept. 17, 2014) (emphasis added). Accordingly, an ALJ does not impermissibly
“play doctor” when defining what limitations should be included in and excluded from a
claimant’s RFC. Id.; see Rudicel v. Astrue, 282 F. App’x 448, 453 (7th Cir. 2008) (rejecting the
claimant’s argument that the ALJ impermissibly “played doctor” by affording more weight to the
limitations opined by the state agency physicians than the limitations opined by her treating
specialist); Jones v. Colvin, No. 11 C 1608, 2014 WL 185087, at *11 (N.D. Ill. Jan. 13, 2014)
(concluding that the ALJ did not “play doctor” by failing to adopt physicians’ opinions of the
claimant’s RFC, where the ALJ offered adequate reasons for rejecting their conclusions).
To the extent that Johnson suggests that the ALJ should have sought an updated opinion
from a state agency physician to review the records from the Centers for Pain Relief, the ALJ did
not err in declining to do so. The ALJ has discretion to consult a medical expert, but she
certainly is not required to do so. 20 C.F.R. §§ 404.1527(e)(2)(iii), 416.927(e)(2)(iii)
(“Administrative law judges may also ask for and consider opinions from medical experts . . . . ).
The applicable regulations and Seventh Circuit case law clearly leave it to the discretion of the
ALJ to consult a medical expert when the evidence received is inadequate for the ALJ to
determine whether the claimant is disabled. See Poyck v. Astrue, 414 F. App’x 859, 861 (7th
Cir. 2011); Similia v. Astrue, 573 F.3d 503, 516 (7th Cir. 2009); Skinner v. Astrue, 478 F.3d 836,
843 (7th Cir. 2007); Skarbek, 390 F.3d at 504; 20 C.F.R. §§ 404.1512(e), 416.1512(e). Here,
there was no evidentiary deficit. The opinions of Drs. Bond and Sands were issued in December
2012 and March 2013, respectively—well after Johnson’s alleged onset date of March 3, 2011.
See, e.g., Miller v. Colvin, No. 12 CV 50440, 2015 WL 1915658, at *5 (N.D. Ill. Apr. 27, 2015)
(rejecting claimant’s argument that the ALJ improperly relied on the opinions of the state agency
doctors, explaining that there was no evidentiary deficit, and thus, that no additional medical
expert was necessary). “[H]ow much evidence to gather is a subject on which [the] court
generally respect[s] the [ALJ’s] reasoned judgment.” Smith v. Apfel, 231 F.3d 433, 443 (7th Cir.
2000) (third and fourth alteration in original) (citation and internal quotation marks omitted).
Moreover, “[w]hen an applicant for social security benefits is represented by counsel the
administrative law judge is entitled to assume that the applicant is making [her] strongest case
for benefits.” Glenn v. Sec’y of Health & Human Servs., 814 F.2d 387, 391 (7th Cir. 1987).
Johnson was represented by counsel at the hearing, and counsel did not suggest that a medical
expert or additional evidence was necessary to decide Johnson’s claim. (AR 34-65); see
Buckhanon ex rel. J.H. v. Astrue, 368 F. App’x 674, 679 (7th Cir. 2010) (stating that a claimant
who is represented by counsel is presumed to put on her best case, and counsel’s failure to
request an additional medical opinion supports the inference that it would not have made a
In sum, “when the record contains conflicting medical evidence, the ALJ has an
affirmative responsibility to resolve that conflict.” Bailey v. Barnhart, 473 F. Supp. 2d 842, 849
(N.D. Ill. 2006) (citing Stephens v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985)). Here, the ALJ
confronted, and then resolved, the conflict between the medical source opinions of record. The
ALJ articulated several “good reasons” for assigning greater weight to the opinions of Drs. Bond
and Sands and for discounting the more severe restrictions opined by Dr. Hedrick. See 20 C.F.R.
§§ 404.1527(d)(2); 416.927(d)(2). The Court will not accept Johnson’s plea to reweigh the
evidence at this juncture. See Clifford, 227 F.3d at 869 (“The Court does] not reweigh the
evidence, resolve conflicts, decide questions of credibility, or substitute [its] judgment for that of
the Commissioner’s.” (citations omitted)). The Commissioner’s final decision will be
For the foregoing reasons, the decision of the Commissioner is AFFIRMED. The Clerk
is directed to enter a judgment in favor of the Commissioner and against Johnson.
Entered this 2nd day of February 2017.
/s/ Susan Collins
United States Magistrate Judge
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