Coffel v. Commissioner of Social Security

Filing 26

OPINION AND ORDER: The decision of the Commissioner is REMANDED forfurther consideration and development of the record consistent with this opinion. Signed by Chief Judge Philip P Simon on 3/29/2016. (lhc)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
SOUTH BEND DIVISION
JAMES W. COFFEL,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner of Social Security,
Defendant.

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CAUSE NO. 3:14cv2067

OPINION AND ORDER
Plaintiff James W. Coffel appeals the Social Security Administration’s
determination that he is not disabled. In essence, he argues that the ALJ erred in
discounting the opinions of his treating physicians, failed to find that he met the listing
requirement for spine disorders, and erred in relying on a stale opinion from an agency
physician. Because I find that the ALJ’s opinion was not supported by substantial
evidence, I will REMAND his decision for further consideration and development of
the record consistent with the issues discussed in this opinion.
BACKGROUND
Readers looking for a more extensive discussion of Coffel’s medical record are
directed to the detailed summaries in the ALJ’s decision (R. 10-36)1 and in Coffel’s
opening brief (DE 19). Rather than simply reiterating those summaries, I will give a

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Citations to the record will be indicated as “R. ___.” and indicate the pagination found in the
lower right-hand corner of the record because the ECF pagination is mostly illegible.

brief overview of the history of Coffel’s health issues and proceedings before the Social
Security Administration.
Coffel’s Health
Since the main reason I am remanding is based on the ALJ’s discussion of
Coffel’s diabetic neuropathy, I will focus only on that condition when discussing
Coffel’s health. At the outset, diabetic neuropathy is “a common, serious complication
of diabetes” whereby nerves in the body – most commonly in the legs and feet – are
damaged by the presence of high blood sugar throughout the body. Diabetic
Neuropathy, http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/
basics/definition/con-20033336 (last visited Mar. 28, 2016). This condition can lead to
pain and numbness in the feet and legs and “can be painful, disabling and even fatal.”
Id. When diabetic neuropathy affects more than one nerve group, it’s known as
polyneuropathy. Peripheral Nerve Disorders, http://www.mayo.edu/research/
departments-divisions/department-neurology/programs/peripheral-nerve-disorders?
_ga=1.65128302.1745024633.1427398503 (last visited Mar. 28, 2016).
The record reflects that Coffel sought regular and consistent treatment from a
handful of treating physicians. Starting as early as January 2012 and extending until at
least August 2013 (when the medical record ends), Coffel’s treating physicians
diagnosed diabetes with neurological manifestations (see e.g. R. 275, 277, 284, 337, 343,
351), polyneuropathy (see e.g. R. 277, 282, 286, 290, 372), diabetic neuropathy (see e.g. R.
283, 341, 354), along with numerous findings of numbness and tingling in the lower legs
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and feet bilaterally upon exam (see e.g. R. 277, 282, 283) and decreased or absent
sensation in the bottom of his feet when a tool called a “monofilament” was dragged
across the bottom of his feet (see e.g. R. 280, 284, 290, 336, 374). Even the state agency
examining physician, who ultimately found Coffel could work, found a 25% decrease in
Coffel’s sensation at the bottom of his feet back in October 2012. (R. 266.) By April
2013, Coffel’s foot was so neuropathic that he did not have to receive local anesthesia to
perform a debridement of a foot ulcer, which involves cutting off damaged skin until
healthy skin is uncovered. (R. 355.)
In August 2013, two of Coffel’s treating physicians – his podiatrist (Dr. Papak)
and his treating physician (Dr. Lisoni) – submitted opinions stating that he was not able
to work in part due to a recurrent foot ulceration (R. 367, 426), “peripheral neuropathy”
(R. 427) and “diabetic polyneuropathy” (R. 367). Recurrent foot ulcerations are a
common result of diabetic neuropathy. (Diabetic Wound Care,
http://www.apma.org/Learn/FootHealth.cfm?ItemNumber=981 (last visited Mar. 15,
2016).) Both of these physicians had treated Coffel for a period of four or five months
prior to rendering their opinions.
Social Security Administration Proceedings
Coffel protectively applied for disability insurance benefits on August 29, 2012,
alleging a disability onset date of August 11, 2012. (R. 13.) He was denied on both
consideration and reconsideration. (Id.) After a hearing before an ALJ in which Coffel
testified, the ALJ issued a decision denying benefits. (Id. at 10-36.) The ALJ employed
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the standard five-step analysis. (Id.) At step one, the ALJ confirmed that Coffel had not
engaged in substantial gainful activity since his application date. (Id. at 15.) At step
two, the ALJ found Coffel suffered severe impairments of chronic obstructive
pulmonary disease (COPD), lumbar degenerative disc disease, the late effects of
diabetes mellitus, and an obese body habitus. (Id.) At step three the ALJ found that
Coffel’s conditions did not satisfy any listed impairment. (Id.) At step four, in
analyzing Coffel’s residual functional capacity, the ALJ found that Coffel could:
Occasionally lift 10 pounds maximum, stand and/or walk for up to 2 hours in an
8 hour work period, and sit for up to 6 hours in an 8 hour work period, however, the
work must allow alternation of position once every half-hour for a minimum of five
minutes. During this period, the claimant would not need to abandon his
workstation or lose track of his duties. The claimant can never climb ladders, ropes,
or scaffolds, but can occasionally climb ramps and stairs, balance, stoop, kneel,
crouch, and/or crawl. The claimant must avoid concentrated exposure to
pulmonary irritants such as fumes, odors, dusts, gases, and areas of poor
ventilation. The claimant must also avoid concentrated exposure to work at
unprotected heights, and he requires the use of a cane for ambulation.

(Id. at 18.) At step five, the ALJ found Coffel could not perform past relevant work but
there were a sufficiently significant number of jobs in the national economy he could
perform. (Id. at 24.)
The Appeals Council denied review, making the ALJ’s decision the final decision
of the Commissioner. (DE 19 at 2.) Coffel timely sought review of that decision by
filing this case. Coffel’s arguments on appeal are that the ALJ improperly discounted
the opinions of his treating physicians, failed to find that he met the listing requirement
for spine disorders, and erred in relying on a stale opinion from an agency physician.
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The first and third issues are intertwined – basically, Coffel argues that the ALJ erred in
accepting an out-dated consultative exam over the more recent and contradictory
reports of Coffel’s treating physicians. Because I agree with Coffel that the ALJ erred in
evaluating the treating physicians’ opinions and will remand on that basis, I need not
address whether he also erred in finding that Coffel failed to meet the listing
requirement for spine disorders.
DISCUSSION
If an ALJ’s findings of fact are supported by “substantial evidence,” then they
must be sustained. See 42 U.S.C. § 405(g). Substantial evidence consists of “such
relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.” Nelms v. Astrue, 553 F.3d 1093, 1097 (7th Cir. 2009) (quoting Richardson v.
Perales, 402 U.S. 389, 401 (1971)). Review of the ALJ’s findings is deferential. Overman v.
Astrue, 546 F.3d 456, 462 (7th Cir. 2008). In making a substantial evidence
determination, I must review the record as a whole, but I can’t re-weigh the evidence or
substitute my judgment for that of the ALJ. Id.
In reviewing the ALJ’s analysis of Coffel’s medical records, one thing that jumps
out is that the ALJ simply didn’t think that Coffel’s diabetic neuropathy was a big deal.
But what’s less clear is why or how the ALJ reached that conclusion. At bottom, the
ALJ seems to believe that Coffel was exaggerating his symptoms in that regard. And
while that may be true, his outright rejection of the condition as possibly disabling
cannot be squared with the objective test results of a handful of treating physicians and
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a state agency physician finding the presence of diabetic neuropathy. Combine those
findings with a total lack of investigation on the ALJ’s part as to what impact Coffel’s
symptoms have on his ability to work and I’m stumped as to how the ALJ arrived at
this conclusion.
Generally speaking, a treating physician’s opinion is afforded controlling weight
so long as it is well-supported and not inconsistent with other substantial evidence in
the record. Schmidt v. Astrue, 496 F.3d 833, 842 (7th Cir. 2007). But here, the ALJ
discounted the treating physicians’ opinions for primarily two reasons: (1) Coffel
sought treatment from them “not for symptom exacerbation, but for disability
paperwork” (R. 19) and (2) he believed Coffel’s record was “very benign” (R. 22) and
indicated a general improvement in his level of pain (R. 20-21). The ALJ also appeared
to weigh more heavily an opinion from the state agency physician, rendered about a
year previously. I’ll discuss each of these in turn.
First, in the Seventh Circuit, the mere fact that a claimant or his attorney has
solicited a treating physician’s opinion is not a valid basis to reject the opinion. Punzio
v. Astrue, 630 F.3d 704, 712 (7th Cir. 2011); Warren v. Colvin, 565 Fed. Appx. 540, 545 (7th
Cir. 2014). In fact, as the court in Puzio put it:
[T]he fact that relevant evidence has been solicited by the claimant or her
representative is not a sufficient justification to belittle or ignore that
evidence. Quite the contrary, in fact. The claimant bears the burden of
submitting medical evidence establishing her impairments and her residual
functional capacity. How else can she carry this burden other than by asking
her doctor to weigh in? Yet rather than forcing the ALJ to wade through a
morass of medical records, why not ask the doctor to lay out in plain
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language exactly what it is that the claimant’s condition prevents her from
doing? Indeed the regulations endorse this focused inquiry.
Punzio, 630 F.3d at 712 (emphasis added, internal citations omitted). So the mere fact
that Coffel sought treatment from these physicians to build a record for his disability
claim – if that was, indeed, his primary motivation – is not a sufficient reason to reject
these opinions or the records supporting these opinions.
The ALJ’s second reason, however, warrants more discussion. Essentially, the
ALJ found that the opinions are not consistent with the rest of the record because his
record was “very benign” and showed improvement in his pain. Generally speaking, if
a treating physician’s opinion is not well-supported or is inconsistent with other
substantial evidence in the record, an ALJ need not accept the opinion. Schmidt, 496
F.3d at 842. Here, the ALJ found that Coffel’s pain was improving based on the
following notation in the record in September 2012: “Compared to last visit, the pain is
improved, has lyrica again, able to increase activity slightly, but still has chronic pain
and numbness to legs and feet.” (R. 274.) I fail to see how the modest level of
improvement noted is inconsistent with his reports of numbness and pain in the feet
and legs. In fact, later in those same treatment notes, the physician notes that upon
examination, Coffel had “numbness and tingling from feet to knees bilaterally” and “no
sensation with monofilament” on his feet. (R. 277.) And moreover, this one notation –
about a year before the treating physician’s opinions – is the only indication of
improvement I can find in the record after the alleged onset date. In fact, the rest of the

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medical record after this point indicates continued neuropathy and diminished or nonexistent sensation in Coffel’s feet and sometimes legs. To pick this one mention of
improvement over the rest of the record strikes me as classic cherry-picking. Scott v.
Astrue, 647 F.3d 734, 740 (7th Cir. 2011). And the frequency with which his neuropathy
is discussed and tested by his treating physicians, particularly given how serious this
condition can be, hardly strikes me as “benign.”
Equally concerning is the ALJ’s reliance on the state agency examining
physician’s findings. The ALJ points to these findings as contradicting the treating
physician’s opinions. Regarding Coffel’s neuropathy, the ALJ found that the state
agency physician “noted that the claimant’s allegations of neuropathy were not
substantiated by the clinical findings.” (R. 21.) That’s actually not the case. First, the
physician never made that statement. And second, what he did find was that Coffel’s
sensation at the bottom of his feet was 25% diminished. (R. 266.2) Sure, that’s not as
much diminution as Coffel had reported, but it doesn’t mean that he didn’t find any
neuropathy present. Also, although he ultimately found that Coffel was not disabled,
he did find that “he does have two chronic progress[ive] diseases and does have some
element of disability from these.” (R. 267.) Given that this opinion was rendered about
a year before Coffel’s treating physicians rendered their opinions, I don’t see how

2

Here, the pagination in the lower right-hand corner is illegible. This report can be found at ECF
pages 268-272, corresponding to record page numbers 263-267.

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finding that his “progressive” conditions had progressed to full-blown disability a year
later is inconsistent with the state agency doctor’s findings.
Moreover, I’m troubled by the fact that the ALJ didn’t ask Coffel a single
question about the impact of his diabetic neuropathy on his daily life or ability to work
during the very short hearing his conducted with Mr. Coffel. Upon questioning by his
lawyer, Coffel reported “constant pins and needles” and numbness in his feet and legs.
(R. 40.) Although the ALJ asked generally about how Coffel spends his day, he never
once asked about his foot pain or numbness, despite that there were references to it all
over his medical record. This is particularly surprising given that the ALJ ultimately
considered Coffel’s neuropathy to be a severe impairment. (Presumably “late effects of
diabetes mellitus” includes diabetic neuropathy.) Without more information about the
impact Coffel’s diabetic neuropathy has on his ability to work, it’s hard to see how the
ALJ has built an accurate and logical bridge from the evidence to the conclusion that he
can still work. Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002). The ALJ should have
inquired of Coffel about how his diabetic neuropathy impacts his life. Although the
ALJ does not have the duty to follow every thread of evidence to its conclusion, an ALJ
has a duty to fully develop the record and he didn’t do it here. S.S.R. 96–5p; Nelms v.
Astrue, 553 F.3d 1093, 1098 (7th Cir.2009); Barnett v. Barnhart, 381 F.3d 664, 669 (7th
Cir.2004); Goins v. Colvin, 764 F.3d 677, 682 (7th Cir.2014); O’Connor-Spinner v. Astrue,
627 F.3d 614, 618 (7th Cir. 2010).

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Ultimately, I don’t know whether Coffel’s diabetic neuropathy renders him
disabled. It isn’t difficult to imagine that someone’s constant feeling of pins and needles
in their feet and/or legs and persistent pain in these areas could prevent them from
performing even sedentary work. The ALJ needed to do more to investigate the impact
of this condition on Coffel’s ability to work, particularly in the face of two treating
physicians’ opinions that Coffel couldn’t work due, at least in part, to this condition. I
will therefore remand this matter back to the ALJ for further development of the record
consistent with this opinion.
CONCLUSION
For the forgoing reasons, the decision of the Commissioner is REMANDED for
further consideration and development of the record consistent with this opinion.

SO ORDERED.

ENTERED: March 29, 2016
s/Philip P. Simon
PHILIP P. SIMON, CHIEF JUDGE
UNITED STATES DISTRICT COURT

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