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May 12, 2004.

JO ANNE B. BARNHART, Commissioner of Social Security, Defendant

The opinion of the court was delivered by: JAMES MORAN, Senior District Judge


After moving up to the Seventh Circuit Court of Appeals and back down to the Social Security Administration (SSA), Corrinda Spaulding's action seeking Social Security disability insurance benefits is once again before this court. Plaintiff's claim for benefits was first denied by the SSA over seven years ago. After a requested hearing, Administrative Law Judge James Horn (ALJ Horn) issued a decision on June 26, 1998, finding that plaintiff was not disabled under the Social Security Act. The Appeals Council denied review of the ALJ's decision, and plaintiff filed a complaint in federal court, requesting review under 42 U.S.C. § 405(g). This court affirmed the decision of the ALJ in August 2000. Seven months later the Seventh Circuit Court of Appeals reversed the decision, stating that the ALJ's determination was based on factual errors, failures to pursue lines of evidence, and inadequate analysis to support the conclusion. The case was remanded to the SSA, where the Appeals Council vacated the previous decision and ordered the ALJ to conduct further proceedings. Plaintiff, a medical expert, and a vocational expert testified at a supplemental hearing. On April 25, 2003, ALJ Horn issued a second decision, in which he once again found that plaintiff was not disabled. The Appeals Council did not take jurisdiction of the case and so plaintiff sought judicial review of the ALJ's decision. Now, both plaintiff and defendant, Jo Anne Barnhart, Commissioner of Social Security, have filed motions for summary judgment on plaintiff's claim for benefits.


  Corrinda Spaulding has a long history of stomach-related medical problems. On September ll, 1996, she applied for disability benefits. She alleged that December 16, 1993, marked the onset of her disability. To be eligible for disability benefits plaintiff needed to prove that she was disabled before December 31, 1998, the date after which she was no longer insured under the special earnings requirement of Title II of the Social Security Act See 42 U.S.C. § 423(c).

  Plaintiff's medical records and the testimony from her hearings establish the history of her illness. In 1988, at the age of 21, plaintiff met with Dr. Michael Colligan after stomach pains forced her to the emergency room. Dr. Colligan reported that plaintiff had a two-year history of burning epigastric pain and nausea, which was symptomatic of hyperacidity. She also experienced bouts of alternating constipation and diarrhea. Dr. Colligan's tests of her upper gastrointestinal tract evidenced duodenitis, with possible erosions. He prescribed medication and set a follow-up by phone.

  Plaintiff did not return to see Dr. Colligan until 1992. Though her treatments initially improved her condition, she reported that once again she suffered from recurrent nausea, vomiting, and irregular bowel movements. She had also gained 50 to 60 pounds. Dr. Colligan diagnosed a combination of irritable bowel syndrome and gastroparesis, and prescribed Zantac and Reglan. Though the medication alleviated some of her symptoms, plaintiff experienced flare-ups. In July 1992, Dr. Colligan wrote that plaintiff's nausea and dry heaves had persisted, despite compliance with her prescribed medication regimen. A few months later, plaintiff called Dr. Colligan to inform him that she was feeling better and that "the problem was milk products."

  Due to an unpaid balance owed to Dr. Colligan, and new insurance coverage, plaintiff sought the services of another doctor the following year. On December 7, 1993, she met with Dr. Eugene Loftin, complaining that her hiatal hernia was acting up. Once again, her symptoms were nausea, vomiting, and stomach pain. Dr. Loftin narrowed his diagnosis to either gastroesophageai reflux disease (GERD) or pancreatic inflammation. He prescribed Reglan and Pepacid and ordered more tests. A week later, at plaintiff's behest, Dr. Loftin wrote a note stating that plaintiff was under his care for "`severe stomach pain* but may continue to work her usual job." After missing her next two scheduled appointments, plaintiff did not see Dr. Loftin again until May 1995, when he refilled her Zantac prescription. A year later, in April 1996, she contacted Dr. Loftin's office to get another refill of her prescription. When informed that she would first have to return for an office visit, she became upset, explaining that she could not afford a visit given that both she and her husband were out of work.

  Instead of making an appointment with Dr. Loftin, plaintiff returned to Dr. Colligan. In his notes from plaintiff's July 17, 1996 appointment, Dr. Colligan noted that he had previously seen plaintiff for "chronic dyspepsia" and that her prior esophagogastroduodenoscopy revealed a hiatal hernia and erosive gastritis. Plaintiff informed Dr. Colligan that Dr. Loftin had prescribed Zantac, which was working. She reported that she had been off work for three years and felt as well as she ever had, experiencing only minimal dyspepsia, occasional episodes of nausea and dry heaves. Dr. Colligan's examination revealed that plaintiff's abdomen was soft and non-tender with no masses. He continued her on Zantac and Reglan and scheduled a follow-up appointment for six months later.

  In September 1996, plaintiff filed for disability benefits. The next month, Dr. Colligan completed a form sent by the Bureau of Disability Determination Services as part of its inquiry into plaintiff's eligibility for benefits under the Social Security Act. Dr. Colligan wrote that plaintiff's current diagnosis was duodenitis and hiatal hernia. He stated that her endoscopy found erosive gastritis and a hiatal hernia. He reported that she had not lost weight and had no other impairments or conditions. In response to the request that he describe plaintiff's ability to perform a variety of work-related activities, Dr. Colligan wrote, "Employment-related stress cause G.I. symptoms to become intolerable according to patient She should not bend over or lift objects greater than 20# because of hiatal hernia." Plaintiff returned to Dr. Colligan on January 6, 1997, for a physical examination. In a general medical report requested by the SSA, and under the heading "Physical Findings," Dr. Colligan reported that plaintiff had GERD and a hiatal hernia. He advised that she continue medical management of these conditions.

  After plaintiff's disability claim was denied, she received a requested hearing before the ALJ on March 3, 1998. Plaintiff, the only witness who testified, recounted her employment history, including her last position as a bank teller. She explained that she was fired from her last job due to her absences and breaks resulting from the symptoms of her condition. Her employer did not believe plaintiff was suffering from conditions beyond her control. Though plaintiff had not been employed since 1993, she had volunteered a few days a month at her daughter's school. She testified that since she stopped working "her system has just calmed down." And, while she still experienced symptoms, she was able to control them to a degree. She stated that before being fired, she had attempted to reduce her symptoms by changing her job responsibilities and rearranging her schedule, but that these efforts had no effect

  Plaintiff reported that Dr. Colligan directed her to avoid both physical and mental stress to control her vomiting and nausea. She explained that she took both Reglan and Zantac on an as-needed basis, though she tried not to take more than two Reglan per day, given their tranquilizing effect Plaintiff described her bouts of diarrhea and chest pain. She stated her weight had fluctuated over the years and that two years earlier she was 30 to 35 pounds heavier. Though doctors had told her to quit smoking, she still smoked a half-pack to a pack of cigarettes per day. Three months after the hearing, on June 2, 1998, the ALJ issued a decision finding that plaintiff was not disabled.

  Additional medical evidence was added to the administrative record following the Seventh Circuit's remand to the SSA. In February 1999, plaintiff was examined by Dr. Loren White at Northwest Gastroenterologists. The assessment on her examination form included GERD, hlatal hernia, motility disorder, irritable bowel syndrome, and first term pregnancy. A test revealed an abnormal presence of heliob acter pylori in her stomach. On May 26, 1999, when plaintiff returned to Northwest Gastroenterologists, the doctor noted that she was "still having reflux." Plaintiff cancelled two other appointments in 1999, but continued to see Dr. White through 2002. On a form dated September 28, 2000, Dr. White diagnosed plaintiff with esophagitis and nausea with vomiting. In October 2000, she underwent an esophagogastroduodenoscopy, a biopsy, and a clotest, due to the abdominal pain and nausea she was experiencing. Following the tests, Dr. White diagnosed: grade I-II esophagitis with small erosions, moderate proximal gastritis, duodenal erosion, antral erosion, and chronic duodenitis. Despite continuing treatment with various medication, which proved effective, plaintiff did experience recurring abdominal pain, nauseau, and bowel irregularity in 2001 and 2002. An upper gastrointestinal and small bowel study performed on plaintiff in November 2001 found no abnormalities.

  The ALJ held a second hearing in plaintiff's case in November 2002, after the remand. This time, in addition to plaintiff, Dr. Walter Miller, a medical expert, and James Breen, a vocational expert, testified. Though plaintiff's testimony was not as extensive as during the first hearing, the ALJ and her attorney posed a few questions. When asked why she had not sought new employment since 1993, plaintiff asserted that she could not keep a job because her vomiting, diarrhea and nausea caused her to take frequent breaks and kept her from being able to serve customers. She stated that her current medical treatment included taking Reglan and Zantac daily. Plaintiff was also taking Effexor for depression. At the time of the hearing, she smoked about a pack of cigarettes a day.

  The next witness at the hearing was Dr. Miller, who had reviewed plaintiff's medical documents and her testimony from the previous hearing. When asked whether the record established that plaintiff had any physical impairments, Dr. Miller replied that he did not think so because her condition did not compare with the impairments of the digestive system listed in the Social Security Regulations, 20 C.F.R. § 404, subpt. P, app. 1. According to Dr. Miller, plaintiff's tests revealed no more than gastric erosion and duodenal erosions. He pointed out that she had not been diagnosed with ulcerative colitis, Crohn's disease, or regional enteritis. While Dr. Miller acknowledged plaintiff's symptoms, he found that they persisted "without any basis, anatomical, pathological basis" and that she had "received symptomatic treatment all these years without any actual physical pathological diagnosis." When asked again whether plaintiff had any impairments, Dr. Miller replied, "Not according to the list of impairments, no." Addressing limitations that plaintiff might experience, the doctor found that she could occasionally perform light lifting, up to twenty pounds, and could frequently lift ten pounds. He found no evidence of limitations with regards to standing, walking, sitting, balancing, or bending. Dr. Miller testified that the record provided no explanation for plaintiff's frequent bathroom ...

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