WILLIAMS v. COMMISSIONER OF SOCIAL SECURITY

Filing 23

ENTRY ON JUDICIAL REVIEW: For the reasons set forth above, the decision of the Commissioner is REVERSED and REMANDED for further consideration consistent with this Entry ***SEE ENTRY FOR ADDITIONAL INFORMATION***. Signed by Judge William T. Lawrence on 9/10/2012.(DW)

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
INDIANAPOLIS DIVISION
JEWEL A. WILLIAMS,
Plaintiff,
vs.
MICHAEL J. ASTRUE, COMMISSIONER
OF SOCIAL SECURITY,
Defendant.

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) Cause No. 1:11-cv-1150-WTL-DKL
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ENTRY ON JUDICIAL REVIEW
Plaintiff Jewel A. Williams (“Williams”) requests judicial review of the final decision of
Defendant Commissioner of the Social Security Administration (“Commissioner”), denying her
applications for Supplemental Security Income (“SSI”) and Disability Insurance Benefits
(“DIB”) under Titles II and XVI of the Social Security Act (the “Act”). The Court rules as
follows.
I. PROCEDURAL BACKGROUND
Williams filed for SSI and DIB on August 3, 2007, alleging that she became disabled on
April 17, 2007, primarily due to symptoms associated with strokes. After her applications were
denied initially on November 5, 2007, and upon reconsideration on December 13, 2007,
Williams requested and was granted a hearing before an Administrative Law Judge (“ALJ”). On
January 11, 2010, Williams appeared and testified at a hearing in Indianapolis, Indiana before
ALJ Albert J. Velasquez. At the hearing, Williams was represented by counsel. On May 19,
2010, the ALJ issued his decision in which he found that Williams was not disabled under the
Act because she was able to perform work that existed in significant numbers in the national

economy. On June 23, 2011, the Appeals Council denied Williams’ request for review of the
ALJ’s decision. Williams then filed this timely civil action for review of the ALJ’s decision.
II. SUBSTANTIVE BACKGROUND
A. Medical Records
Williams is a fifty-one year old woman who worked as a grocery store cashier prior to the
alleged onset of her disability. Williams was forty-six years of age on the date of the alleged
onset of her disability.
On February 5, 2007, Williams was admitted to the emergency department of
Community Hospital – Anderson with an acute onset of left hemisensory deficit that occurred
earlier that day. At admission, she stated that the numbness started in her face and worked its
way down to her arm and her leg. She also reported experiencing facial pain. Dr. Larry
Blankenship, a neurologist, stated that his impression of Williams on admission was that she was
experiencing a sensory stroke, likely secondary to right thalamic infarct with risk factors
including hypertension, diabetes, and hyperlipidemia, all leading to intracranial occlusive
disease. An MRI conducted the following day revealed no evidence of an acute intracranial
abnormality or infarct.
On February 21, 2007, Williams was seen at Central Indiana Neurology following her
discharge from the hospital. She reported that she felt better but still had weakness in her left
arm. On examination, the neurologist found that her head, neck, cranial nerves, gait, speech, and
cognition were all within normal limits. The neurologist stated that his impression of Williams
was that she had suffered a stroke.
On April 2, 2007, Williams was admitted to the emergency department of St. Vincent’s
Hospital with complaints of weakness. The admitting papers noted that Williams was

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experiencing new weakness, impaired speech, decreased ability to stand/walk, confusion, and
trouble concentrating or thinking. The attending physician, Dr. Brad L. Hayes, stated that his
clinical impression was “somatic hemiplegia mental stress inducer.” Record at 214. A CT scan
of Williams’ brain performed during the visit was normal. Dr. Hayes’ discharge diagnosis was
“stress induced plegia of left arm and psychosomatic stroke symptoms.” Id. at 219.
Two weeks later, on April 17, 2007, Williams was admitted to the emergency
Department of Community Hospital – Anderson complaining of headaches associated with loss
of vision over the left hemifield and numbness and tingling on the left side of her body. Dr.
Christopher Melin, a neurologist, completed the admitting examination. Dr. Melin noted that
Williams appeared clumsy and was experiencing dyspraxia on her left side. Dr. Melin’s clinical
impression was a lacunar infarct, which is a stroke in a deep area of the brain, hypertension,
coronary artery disease, and marked family history of vascular disease at a young age. An MRI
taken that day showed no evidence of an acute infarct. Williams was discharged from the
hospital four days later with a diagnosis of possible stroke. After her discharge, Williams did not
return to work.
On May 7, 2007, Williams followed up with Central Indiana Neurology in an office visit.
She told the neurologist that she had memory problems, constant left occipital headaches and
trouble feeling her left leg. She also indicated that she was nervous, short of breath, and tired.
The neurologist’s clinical impression was stroke, possible obstructive sleep apnea, rule out
conversion disorder, and occipital neuralgia.
On October 12, 2007, Williams was examined by a state agency physician, Dr. Elpidio
Feliciano. On examination, Williams’ gait was normal and she could get up and down from the
examining table. Williams became unsteady when walking on heels and toes. Williams’ cranial

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nerves 5 and 11 were diminished on the left side of her face. Williams’ muscle strength was 4/5
in the upper extremities and 3/5 in the lower extremities. Williams’ grip strength was 3/5 on the
left and 5/5 on the right. Although Williams had diminished sensation to light touch on the left
upper and lower extremities, she could pick up coins with both hands. Dr. Feliciano found that
she had left-sided weakness, fatigue, and receptive aphasia, which is damage to a language
center located in a rear portion of the brain.
On October 16, 2007, Williams underwent a mental status evaluation by Robert B.
Fischer, Ph.D. Dr. Fischer noted that Williams reported being forgetful, having comprehension
and spatial relationship problems, easily becoming disoriented even in familiar surroundings, and
having persistent headaches, prosopagnosia, some word-finding difficulty, and slurring of
speech. He also noted that Williams reported feelings of depression, generalized anxiety,
feelings of foreboding, and constant worry. Dr. Fischer noted that Williams’ performance on the
Wechsler Memory Scale – III was “clearly in the deficient range.” Id. at 452. He summarized
her diagnoses as Amnesiac Disorder, Major Depressive Disorder, and Generalized Anxiety
Disorder.
On November 3, 3007, Joseph A. Pressner, Ph.D., completed a Mental Residual
Functional Capacity Assessment of Williams based upon his review of her medical records. Dr.
Pressner stated that some of Williams’ scores on the Wechsler Memory Scale – III administered
by Dr. Fischer suggested that Williams may have intentionally distorted her test results. Dr.
Pressner further stated that the reports of functioning in Williams’ file suggest that she is capable
of understanding, remembering, and carrying out simple instructions. In addition, Dr. Pressner
stated that he believed Williams capable of making simple work related decisions, remembering
locations, and remembering simple work-like procedures. Dr. Pressner further noted that

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Williams would have problems with tasks requiring intensive or prolonged concentration.
Ultimately, Dr. Pressner concluded that “although [Williams] has a severely limiting condition, it
appears that [Williams] retains the ability to perform simple, repetitive tasks on a sustained basis
without extraordinary accommodations.”1 Id. at 477.
On September 18, 2008, Dr. Frank Campbell, Williams’ treating physician, completed a
physical residual functional capacity questionnaire. His diagnoses included hypertension,
anxiety, and cerebral vascular accident. Dr. Campbell noted that Williams’ symptoms included
loss of memory, dizziness, and fatigue. He stated that he believed that Williams’ depression and
anxiety affected Williams’ physical condition.
On July 10, 2009, Williams was examined by consultative examiner Carrie Dixon, Ph.D.
Dr. Dixon conducted an Adult Mental Status Examination, a Wechsler Memory Scale – III test, a
clinical interview, a review of available records, and behavioral observations. Dr. Dixon stated
in her report that Williams approached the evaluation in a “semi-cooperative fashion”. Id. at
783. Dr. Dixon considered the scores that Williams obtained in the Wechsler Memory Scale –
III “an invalid representation of [Williams’] true memory skills.” Id. at 784. It was Dr. Dixon’s
impression that Williams exhibited a “fake-bad” response style. Id. Dr. Dixon included a
diagnosis of Depressive Disorder, not otherwise specified, in her report.
B. Hearing Testimony
Williams testified regarding her impairments during her hearing before the ALJ on
January 11, 2010. At the time of the hearing, Williams was forty-eight years old and had not

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The Court notes that this opinion is not particularly helpful to the Commissioner or the
Court, inasmuch as there is no way to know what Dr. Pressner believes are “extraordinary
accommodations” and thus no way of knowing whether there are accommodations that he
believes Williams would need that he views as non-extraordinary but that would nonetheless
prevent Williams from performing substantial gainful activity.
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worked since April 17, 2007. She testified that she stopped working after she had the last of
three strokes. Williams stated that she could not return to her job as a grocery store cashier
because she could not “concentrate long enough to even do anything.” Id. at 36. She testified
that she had trouble sleeping at night and had to nap during the day.2 She stated that she had
headaches every day and the headaches required her to lay down two or three times a week,
sometimes all day. She stated that her headache medication made her dizzy.
On a “good day” Williams stated that she will try to make her bed, do some cleaning, and
do some laundry. Id. at 39. Williams also stated that she cooks for herself, drives to the grocery,
drives to medical appointments, and visits friends on good days. On bad days, Williams testified
that she had to stay in bed or on her couch.
Williams testified that in addition to her physical difficulties she had some depression,
but her medication helped. Williams stated that her depression would “at times” affect her
ability to work, but that there were times when it would not affect her at all. Id. at 44.
C. Opinion of the Vocational Expert
On January 19, 2010, the ALJ submitted interrogatories to vocational expert Ray O.
Burger (“Burger”) in which he asked Burger to consider a hypothetical individual who was
Williams’ age and had the same education and work experience as Williams. The hypothetical
individual was able to lift and carry twenty pounds occasionally and ten pounds frequently, and
could stand and walk for six out of eight hours and sit for about six out of eight hours. She could
only occasionally balance, stoop, kneel, crouch, crawl, or climb stairs and ramps, and she could
never climb ropes, ladders, or scaffolds, or work at unprotected heights, around dangerous
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Curiously, the ALJ states in his decision that Williams “seems to be able to watch TV
during the day uninterrupted by daytime sleepiness.” Record at 17. In fact, when asked at the
hearing if she sleeps during the day, Williams testified that “I’ll take a nap. I’ll be sitting
thinking I’m just fine and just doze off and go to sleep.”
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moving machinery, or around open flames and large bodies of water. She also could not operate
a motor vehicle. Work she performed had to be simple and repetitive and could not require more
than occasional pushing and pulling with the lower left extremity or more than frequent feeling
with the left, non-dominant, hand. Burger responded that the hypothetical worker could perform
work as a stocker, food preparation worker, and mail clerk.
III. APPLICABLE STANDARD
Disability is defined as “the inability to engage in any substantial gainful activity by
reason of a medically determinable mental or physical impairment which can be expected to
result in death, or which has lasted or can be expected to last for a continuous period of at least
twelve months.” 42 U.S.C. § 423(d)(1)(A). In order to be found disabled, a claimant must
demonstrate that his physical or mental limitations prevent him from doing not only his previous
work, but any other kind of gainful employment that exists in the national economy, considering
his age, education, and work experience. 42 U.S.C. § 423(d)(2)(A).
In determining whether a claimant is disabled, the Commissioner employs a five-step
sequential analysis. At step one, if the claimant is engaged in substantial gainful activity, she is
not disabled, despite her medical condition and other factors. 20 C.F.R. § 404.1520(b).3 At step
two, if the claimant does not have a “severe” impairment (i.e., one that significantly limits her
ability to perform basic work activities), she is not disabled. 20 C.F.R. § 404.1520(c). At step
three, the Commissioner determines whether the claimant’s impairment or combination of
impairments meets or medically equals any impairment that appears in the Listing of
Impairments, 20 C.F.R. pt. 404, subpt. P, App. 1, and whether the impairment meets the twelve-

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The Code of Federal Regulations contains separate sections relating to DIB and SSI that
are identical in all respects relevant to this case. For the sake of simplicity, this Entry contains
citations to DIB sections only.
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month duration requirement; if so, the claimant is deemed disabled. 20 C.F.R. § 404.1520(d). At
step four, if the claimant is able to perform her past relevant work, she is not disabled. 20 C.F.R.
§ 404.1520(f). At step five, if the claimant can perform any other work in the national economy,
she is not disabled. 20 C.F.R. § 404.1520(g).
On review of the ALJ’s decision, the ALJ’s findings of fact are conclusive and must be
upheld by this Court “so long as substantial evidence supports them and no error of law
occurred.” Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). “Substantial evidence
means such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion,” id., and this Court may not reweigh the evidence or substitute its judgment for that
of the ALJ. Overman v. Astrue, 546 F.3d 456, 462 (7th Cir. 2008). The ALJ “need not evaluate
in writing every piece of testimony and evidence submitted.” Carlson v. Shalala, 999 F.2d 180,
181 (7th Cir. 1993). However, the “ALJ’s decision must be based upon consideration of all the
relevant evidence.” Herron v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994). The ALJ is required to
articulate only a minimal, but legitimate, justification for his acceptance or rejection of specific
evidence of disability. Scheck v. Barnhart, 357 F.3d 697, 700 (7th Cir. 2004). The ALJ must
articulate his analysis of the evidence in his decision; while he “is not required to address every
piece of evidence or testimony,” he must “provide some glimpse into his reasoning . . . [and]
build an accurate and logical bridge from the evidence to his conclusion.” Id.
IV. THE ALJ’S DECISION
The ALJ found that Williams met the disability insured status requirements of the Act at
all times relevant to the decision and that Williams had not engaged in substantial gainful
activity since April 17, 2007, the alleged onset date. The ALJ further found that Williams’
depression “does not cause more than minimal limitation” in Williams’ ability to perform basic

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mental work activities. Accordingly, the ALJ concluded that Williams’ medically determinable
mental impairment of depression was not severe.
In finding that Williams’ depression was not a severe medically determinable mental
impairment, the ALJ examined the four functional areas set out in the disability regulations for
evaluating mental disorders and in section 12.00C of the Listing of Impairments. See 20 C.F.R.
pt. 404, subpt. P, appx. 1. The ALJ found that in the functional areas of daily living, social
functioning, and concentration, persistence or pace, the ALJ found that Williams had mild
limitations. In the fourth functional area of episodes of decompensation, the ALJ found that
Williams had not experienced any episodes of decompensation of extended duration. The ALJ
concluded that because Williams’ medically determinable mental impairment caused no more
than “mild” limitation in any of the first three functional areas and she had experienced no
episodes of decompensation of extended duration in the fourth area, her medically determinable
mental impairment was nonsevere.
The ALJ found that Williams had the following severe impairments: obstructive sleep
apnea, hypertension, late effects of a mild cerebral vascular accident (“CVA”), occipital
neuralgia, and obesity. The ALJ found that Williams did not have an impairment or combination
of impairments that met or medically equaled any of the impairments included in the Listing of
Impairments.
The ALJ then concluded that Williams had the residual functional capacity (“RFC”) to
perform light work with the following restrictions:
lift/carry twenty pounds occasionally and ten pounds frequently; sit/stand/walk
for six of eight hours; occasional climbing stairs/ramps; no climbing
ropes/ladders/scaffolds; no more than occasional balancing, stooping, kneeling,
crouching, crawling; no work at unprotected heights, around dangerous moving
machinery, operating motor vehicle [sic.], being around open flames and large
bodies of water; only simple, repetitive tasks; no more than occasional pushing
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and pulling with the lower left extremity and no more than frequent feeling with
the left (non-dominant) hand.
Record at 14. The ALJ then found that, given her RFC, Williams could not perform any of her
past work, but that she could perform other jobs that existed in significant numbers in the
national economy and, therefore, was not disabled.
V. DISCUSSION
Williams advances several objections to the ALJ’s decision. Each is addressed below.
A. ALJ’s Treatment of Williams’ Mental Impairments
Williams contends that the ALJ erred in failing to find that she suffers from the severe
impairments of organic mental disorder, anxiety related disorder, and depression. The ALJ
found that she suffered from depression but that it was not “severe” as defined by the Act, and he
did not acknowledge the fact that Williams has been diagnosed with organic mental disorder and
anxiety related disorder.
The Commissioner correctly notes that whether the ALJ considers a particular
impairment “severe” at step two is not reversible error as long as he continues to step three. See
Arnett v. Astrue, 676 F.3d 586 (7th Cir. 2012) (holding that as long as the ALJ finds at least one
severe impairment at step two, omission of other severe impairments is harmless because “Step 2
is a threshold issue only”). This is because even if the ALJ determines that an impairment is not
severe, he must include any limitations caused by that impairment in his determination of the
claimant’s RFC. See SSR 96-8p.
In this case, Williams argues that the ALJ failed properly to consider the effect of her
mental impairments on her RFC. Specifically, she notes that consultative examiner Dr. Fischer
and non-examining consultant Dr. Pressner both concluded that she suffered from memory
difficulties, major depressive disorder, and generalized anxiety disorder. Dr. Pressner found that
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she had a “severely limiting [mental] condition” and opined that as a result she was moderately
limited in her ability to maintain attention and concentration for extended periods, that she had
moderate restrictions in her activities of daily living, that she had moderate difficulties in
maintaining concentration, persistence, and pace, and that she was markedly limited in her ability
to understand, remember and carry out detailed instructions. Record at 461-77. Dr. Fischer
similarly opined that she had memory problems and that “difficulties are expected pretty much
across the board with employment, access to healthcare, social group, quality of life.” Id. at 452.
The ALJ did not mention Dr. Pressner’s report in his decision. He acknowledged Dr.
Fischer’s findings, but rejected them in favor of the other consultative examiner, Dr. Dixon, who
opined that Williams’ score on the Wechsler Memory Scale test she administered indicated a
“fake-bad” response style; in other words, Williams was intentionally trying to make her
impairments appear worse than they really were. The problem is that the ALJ rejected Dr.
Fischer’s findings because he found them to be “based on subjective complaints” when, in fact,
Dr. Fischer administered the same Wechsler Memory Scale test that Dr. Dixon administered.
The ALJ also opined that Dr. Dixon’s finding that Williams exaggerated her symptoms when she
examined her “certainly suggests that this could have been present in the first examination as
well.” Record. at 17. Unfortunately, the ALJ points to nothing other than his own gut instinct
that indicates that this is the case.4
There may well be substantial evidence on the record to support the ALJ’s determination
that Williams’ mental impairments affect her RFC only to the extent the she is limited to simple,

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The Court is troubled by the ALJ’s statement that Williams “alleges that she is easily
disoriented, has comprehension problems, word finding difficulty and slurring of speech, but I
note these symptoms are not alluded to in any of the number of examinations reviewed here.”
Record at 17. That statement is false; as the ALJ acknowledges in the very next sentence, many
of those symptoms were acknowledged by Dr. Fischer.
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repetitive tasks. As noted above, however, the ALJ is required to “provide some glimpse into his
reasoning . . . [and] build an accurate and logical bridge from the evidence to his conclusion.”
Scheck, 357 F.3d at 700. With regard to Williams’ mental impairments, the ALJ failed to do so
in this case. Remand is thus required.
B. Credibility Determination
Williams argues that the ALJ erred in evaluating the credibility of her allegations
regarding her symptoms. The Court agrees.
In assessing a claimant’s credibility, an ALJ must consider several factors, including
daily activities; the location, duration, frequency, and intensity of symptoms; precipitating and
aggravating factors; medications taken; and treatment. SSR 96-7p. In assessing the credibility
of the claimant, the ALJ need not cite findings on every factor, but the ALJ must articulate the
reasons for her decision in such a way as 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.” Brindisi v. Barnhart, 315 F.3d 783, 787-88 (7th Cir. 2003) (citing SSR 96-7p). In other
words, the ALJ is required to “build and accurate and logical bridge between the evidence and
the result.” Shramek v. Apfel, 226 F.3d 809, 811 (7th Cir. 2000). “In analyzing an ALJ’s
opinion for such fatal gaps or contradictions, [the court] give[s] the opinion a commonsensical
reading rather than nitpicking at it.” Id. Accordingly, an ALJ’s credibility finding is entitled to
“considerable deference” and will be overturned only if it is “patently wrong.” Prochaska v.
Barnhart, 454 F.3d 731, 738 (7th Cir. 2006) (internal quotations omitted).
The “commonsensical” reading of the ALJ’s credibility determination is that he placed
great weight on the fact that Williams’ MRI and CT scan were normal. He mentions that fact six
times in his decision. Absent from his decision is any reference to any medical evidence that a

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person with the symptoms alleged by Williams would have abnormal MRI or CT scan results.
The ALJ apparently is satisfied that Williams actually suffered strokes and symptoms as a result
of the strokes, inasmuch as he found “late effects of a mild cerebral vascular accident” as one of
her severe impairments. If the strokes themselves failed to show up as abnormalities on MRI and
CT scans that were taken immediately after she suffered them, it is unclear why the ALJ believes
that the lack of such abnormalities is inconsistent with the symptoms alleged by Williams.
Given the centrality of this unsupported assumption to the ALJ’s credibility finding, the Court
agrees with Williams that the ALJ should reassess that finding on remand, applying the
appropriate factors as set forth in SSR 96-7p.
C. Weight Accorded to Williams’ Treating Physician’s Opinion
Williams argues that the ALJ erred in his treating of the opinion of Williams’ treating
physician, Dr. Campbell. Pursuant to the “treating physician rule,”
A treating physician’s opinion that is consistent with the record is generally
entitled to “controlling weight.” 20 C.F.R. § 404.1527(d)(2); Schaaf v. Astrue,
602 F.3d 869, 875 (7th Cir. 2010). An ALJ who chooses to reject a treating
physician’s opinion must provide a sound explanation for the rejection. 20 C.F.R.
§ 404.1527(d)(2); Campbell v. Astrue, 627 F.3d 299, 306 (7th Cir. 2010); Schmidt
v. Astrue, 496 F.3d 833, 842 (7th Cir.2007).
Jelinek v. Astrue, 662 F.3d 805, 811 (7th Cir. 2011). “‘If an ALJ does not give a treating
physician’s opinion controlling weight, the regulations require the ALJ to consider the length,
nature, and extent of the treatment relationship, frequency of examination, the physician’s
specialty, the types of tests performed, and the consistency and supportability of the physician’s
opinion.” Scott v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011) (quoting Moss v. Astrue, 555 F.3d
556, 561 (7th Cir.2009) (citing 20 C.F.R. § 404.1527(d)(2)). However, the ultimate
determination of disability is a legal matter reserved to the Commissioner, and “[a] statement by

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a medical source that [a claimant] is ‘disabled’ or ‘unable to work’ does not mean that [the
Commissioner] will determine that [the claimant is] disabled.” 20 C.F.R. § 404.1527(e).
The ALJ notes that Dr. Campbell, Williams’ treating physician twice stated that Williams
was unable to work. However, the ALJ also correctly notes that Dr. Campbell gave no basis for
that opinion. Indeed, it is entirely unclear what symptoms Dr. Campbell believes Williams has
that prohibit her from working. In fact, in the most recent report from Dr. Campbell in the
record, a June 10, 2009, Physical Residual Capacity Questionnaire, he answered “not known” to
virtually all of the questions regarding Williams’ ability to engage in various work activities. Dr.
Campbell’s opinion simply does not have enough substance to it to be entitled to controlling
weight, or any weight. The ALJ did not err in his consideration of it.
VI. CONCLUSION
For the reasons set forth above, the decision of the Commissioner is REVERSED and
REMANDED for further consideration consistent with this Entry.
SO ORDERED: 09/10/2012

_______________________________
Hon. William T. Lawrence, Judge
United States District Court
Southern District of Indiana

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