United States District Court, N.D. Illinois, Western Division
August 6, 2004.
PAUL W. THULEN, Plaintiff,
JOANNE B. BARNHART, COMMISSIONER OF SOCIAL SECURITY, Defendant.
The opinion of the court was delivered by: P. MICHAEL MAHONEY, Magistrate Judge
MEMORANDUM OPINION AND ORDER
Paul W. Thulen ("Plaintiff") seeks judicial review of the final
decision of the Commissioner of the Social Security
Administration ("Commissioner"). See 42 U.S.C. §§ 405(g),
1383(c)(3). The Commissioner's final decision denied Plaintiff's
application for Disability Insurance Benefits ("DIB") pursuant to
Title XVI of the Social Security Act (the "Act").
42 U.S.C. § 1381(a). This matter is before the Magistrate Judge pursuant to
consents filed by Plaintiff and Commissioner on December 3, 2003.
See 28 U.S.C. § 636(c); Fed.R. Civ. P. 73.
Plaintiff filed for DIB on September 5, 1997, alleging
disability on April 12, 1997. (Tr. 135). Plaintiffs application
for benefits was denied on January 12, 1998. (Tr. 86). Plaintiff
filed a request for reconsideration on January 29, 1998. (Tr.
90). Plaintiff's request for reconsideration was denied on March
13, 1998. (Tr. 91). Plaintiff then filed a request for a hearing
before an Administrative Law Judge ("ALJ") on May 13, 1998. (Tr.
94). Plaintiff appeared, with counsel, before an ALJ on March 15, 2001. (Tr.
38). In a decision dated April 25, 2001, the ALJ found that
Plaintiff was not entitled to DIB. (Tr. 26-33). On May 9, 2001,
Plaintiff requested a review of the ALJ's decision by the Appeals
Council. (Tr. 13). On June 17, 2001, the Appeals Council denied
Plaintiff's request for review. (Tr. 9).
Plaintiff was born on December 3, 1961, and was thirty-nine
years old at the time of his March 15, 2001, hearing before the
ALJ. (Tr. 135). Plaintiff graduated from high school. (Tr. 43).
At the time of the hearing, Plaintiff testified that he lived in
a house with his mother and three older siblings. (Tr. 42).
Plaintiff had a heart attack some time around April 12, 1997, and
suffers from coronary artery disease, high blood pressure,
shortness of breath, diabetes, and obesity. For these reasons,
and some others, Plaintiff claims to be disabled.
At the time of his hearing, Plaintiff's most recent and only
employment was with the Village of Savanna, Illinois. (Tr. 58).
Plaintiff testified that he worked 18 years for the Village of
Savanna as a "jack-of-all-trades" who would pick up garbage, fix
water leaks and sewers, and maintain walkways and
roadways.*fn1 (Tr. 58-59). This job was full-time. (Tr. 43).
While employed by the Village of Savanna, Plaintiff testified
that the most he had to lift was "a couple of hundred pounds" and
that he would frequently lift between 50 and 100 pounds. (Tr.
Plaintiff ended his full-time employment with the Village of
Savanna after his heart attack in April of 1997. (Tr. 43).
Plaintiff testified that he could not continue with his line of work because of feeling tired, fatigued, and not having "the wind
for it." (Id.) Plaintiff likewise did not pursue lighter jobs
because of feeling "tired all the time" in addition to
experiencing a painful back and not knowing how he will feel from
day to day. (Tr. 44).
On a typical day, Plaintiff testified that he sleeps and
watches TV at two hour intervals. (Tr. 54). Plaintiff stated that
he may make breakfast for himself "once in a while." (Id.)
Plaintiff testified that he does not clean, dust, vacuum, do
dishes or wash laundry for himself his 81-year-old mother does
the laundry, and someone else does the cleaning.*fn2 (Tr.
55). Plaintiff testified that he is able to make his own bed,
change his sheets, and bathe and dress himself. (Id.). Despite
his frequent, daily naps, Plaintiff told the ALJ that he always
feels tired. (Tr. 61). Plaintiff does not make trips to the
grocery store; he has someone else deliver his groceries. (Tr.
55). Plaintiff does not do any yard work including mowing the
lawn, raking leaves, or shoveling snow his younger brother
takes care of these tasks. (Tr. 55-56). Plaintiff testified that
he does, however, take small walks of up to 100 yards roughly
every other day. (Tr. 56). Plaintiff also testified that he is
able to change light bulbs or change batteries in a smoke
detector when needed. (Tr. 58).
Plaintiff does not have any hobbies, does not go out to eat or
to see movies, does not attend religious services, has not been
out of town for vacation or other reasons (for three years prior
to his hearing), and does not participate in social, church, or
volunteer activities. (Tr. 56-57). Plaintiff still has a valid
driver's license without any restrictions, and testified that he
drives two to three times per week through town or to see the
Mississippi River, which is just a two to three minute drive from
Plaintiff's home. (Tr. 43). With regard to family interactions,
Plaintiff testified that he talks to his mother but interacts with his
older siblings as minimally as possible because they are mentally
handicapped and he prefers to "avoid it." (Tr. 57-58).
At the hearing, Plaintiffs mother testified on his behalf. (Tr.
71). She stated that Plaintiff has "a lot of problems" including
his breathing and his high level of stress due to living with his
older siblings. (Tr. 72). She testified that Plaintiff sometimes
gets up during the day and makes himself some eggs before "just
[sitting] in his chair" because "that's about all he's able to
do." (Tr. 73). She added, however, that Plaintiff is able to
drive himself to the doctor because "the doctor is just uptown."
Vocational Expert, James Radke, also appeared before the ALJ
during Plaintiff's hearing on March 15, 2001. (Tr. 73). The
vocational expert testified that Plaintiff's position with the
Village of Savanna would be classified as "heavy in terms of
exertion and semi-skilled in terms of his [skill] level." (Tr.
The ALJ then presented the vocational expert with the following
If I would assume, on the basis of the record, an
individual who is 39-years-old has the work
experience and education of this claimant and has the
following exertional limitations: can sit for six
hours, stand and walk for six hours, can lift and
carry frequently up to 25 pounds, occasionally up to
50 pounds, and only can occasionally stoop, crawl,
and climb stairs and ramps, can never climb any
ladders, robes or scaffolds. Can only occasionally
crouch, kneel or balance. Further assuming someone
who must avoid concentrated exposure to activities
involving unprotected heights, being around moving
and hazardous machinery, and dust odors, fumes and
gases. [I should] assume such a person could not
perform the claimant's past work, is that correct?
(Tr. 74-75). The vocational expert stated that such a
hypothetical person could perform Plaintiff's past work as a
and could also perform work as a janitor,
cleaner, food preparation worker, and medium level packager or filler. (Tr.
75). The ALJ then added that the hypothetical person should
"avoid concentrated exposure to temperature extremes. (Tr. 75).
This modification did not change the vocational expert's answer
about what work the hypothetical person could perform. (Id.).
The ALJ further modified the hypothetical by changing the
exertional requirement to "light work, someone who can lift and
carry frequently just up to 10 pounds and occasionally up to 20
pounds." (Tr. 75-76). With these modifications, the vocational
expert opined that Plaintiff's past work as a truck driver would
be eliminated, but such a hypothetical person could still perform
packaging and filling positions, work in miscellaneous food prep
positions, or work as a cashier or assembler. (Tr. 76). The ALJ
proceeded to modify the hypothetical further by adding the
requirement that the hypothetical person be allowed to sit and
stand approximately every 45 minutes. (Id.). With this change,
the vocational expert stated that a hypothetical person with
these limitations could still work in some packaging, filling,
miscellaneous food preparation, and cashier positions. (Id.).
The vocational expert also determined that the individual would
be able to work in sedentary assembly and sorting occupations.
(Id.). According to the vocational expert, at the time of the
hearing, there were less than 1,000 packaging and filling
positions, about 7,000 miscellaneous food preparation positions,
and 24,300 cashier positions in the Northern Illinois area that
such a hypothetical person could perform. (Tr. 76).
III. MEDICAL HISTORY
On April 13, 1997, Plaintiff was taken to the Emergency
Department of the Samaritan Health System in Clinton, Iowa, via
ambulance. (Tr. 228). Plaintiff had been coughing up blood for a
couple of days before seeking treatment, and started experiencing
severe left back and rib pain which worsened with breathing and coughing. (Id.) The
History and Physical Report, by J. Gondwe, M.D., noted that
Plaintiff "[smoked] quite a bit and apparently [had] been
drinking quite a bit lately." (Tr. 230). Dr. Gondwe's physical
exam indicated Plaintiff had a "density in the left breast, maybe
pneumonia." (Id.). Dr. Gondwe's impression of Plaintiff at that
time indicated that Plaintiff suffered from pleurisy,*fn4
had an abnormal electrocardiogram*fn5 suggesting a
myocardial infarction, was obese, and had problems with nicotine
addiction and alcoholism. (Id.). Plaintiff was treated with
penicillin and heparin, and laboratory tests were ordered.
Plaintiff was admitted to the Samaritan Health System, and
underwent further testing and consultation examinations. (Tr.
226-268). At the time of a consultative examination by Q.
Rasheed, M.D., F.A.C.C., also on April 13, 1997, Plaintiff was
alert and oriented, and appeared in mild respiratory distress.
(Tr. 232). Dr. Rasheed determined that Plaintiff experienced an
acute pulmonary embolism,*fn6 had an abnormal
electrocardiogram with evidence of inferior*fn7 and
anterolateral*fn8 myocardial infarction, used tobacco, and
used alcohol with probable dependence. (Id.). With regard to
Plaintiff's tobacco use, Dr. Rasheed noted that Plaintiff smoked
two packs of cigarettes per day for fifteen years. (Id.). Dr.
Rasheed agreed with Dr. Gondwe's decision to heparinize*fn9 Plaintiff, and ordered further tests to
assess Plaintiff's cardiac functioning. (Id.). Dr. Rasheed
noted that Plaintiff was "critical at [that] time and without
treatment the potential for morbidity and mortality [was] high."
On April 14, 1997, during Plaintiff's hospitalization, he
underwent a consultative examination by Nidal Harb, M.D., who was
asked to assume Plaintiff's cardiac care. (Tr. 234). At the
beginning of the consultation notes, Dr. Harb stated that "the
patient is a poor historian and has been somewhat noncompliant
with doctor's visits." (Id.). Dr. Harb indicated that
Plaintiff's cardiac risk factors included obesity,
hypertension,*fn10 his gender,
hypercholesterolemia,*fn11 family history for coronary
artery disease, and smoking. (Id.). Dr. Harb also indicated
that Plaintiff denied affliction with diabetes mellitus. (Id.).
Dr. Harb's impression of Plaintiff was similar to the impressions
of Drs. Gondwe and Rasheed; Dr. Harb noted that Plaintiff had a
pulmonary embolus, suffered from coronary artery disease, was
morbidly obese, had hyperlipedemia,*fn12 and was addicted to
nicotine. (Id.). Dr. Harb recommended that Plaintiff continue
with heparin treatment until switching later to warfarin therapy,
and that Plaintiff use topical nitrates if his condition
permitted. (Id.). Dr. Harb also discussed with Plaintiff the
need to modify Plaintiff's cardiac risk factors, the nature of
coronary artery disease, and the possible modalities of
treatment. (Id.). Plaintiff remained hospitalized through April 21, 1997, when he
was discharged to home. (Tr. 226). Dr. Gondwe's discharge summary
of Plaintiff's hospitalization reported a final diagnosis of (1)
pulmonary embolism, (2) deep venous thrombosis involving the left
lower extremity, (3) pneumonia involving the left lower and right
middle lobes of the lungs, (4) coronary vascular disease with a
history of subacute myocardial infarction, (5) history of tobacco
abuse, (6) obesity, and (7) pleurisy caused by a pulmonary
embolus. (Id.). Dr. Gondwe commented that Plaintiff's chest
x-rays showed improvement of the lung tissue, and that
Plaintiff's echocardiogram was "technically a very difficult
study with enlargement of the left ventricle." (Id.). Further,
Dr. Gondwe stated that Plaintiff was not to work for two months
after hospitalization, should try to quit smoking, and should
follow-up with him and with Dr. Harb as scheduled. (Id.). Dr.
Gondwe offered Plaintiff nicotine patches, but reported that
Plaintiff had not committed himself to quitting smoking yet.
(Id.). Dr. Gondwe documented his concern that Plaintiff could
"force more damage to the heart" if he smoked while using
nicotine patches. (Id.).
Plaintiff followed up with Dr. Harb on May 6, 1997. (Tr. 279).
At that time, Plaintiff denied chest pain, shortness of breath,
dizziness or loss of consciousness. (Id.). Plaintiff had
dyspnea*fn13 on exertion and some palpitations,*fn14
but reported feeling "much better." (Id.). Dr. Harb noted that
Plaintiff was "rather noncompliant" and continued to smoke very
heavily. (Id.). Dr. Harb's examination of Plaintiff revealed a
morbidly obese individual with stable vital signs, clear lungs, a heart beating at a regular rate and rhythm, and no
edema*fn15 in the extremities. (Id.). Dr. Harb "strongly
advised [Plaintiff] to stop smoking and modify other risk
On May 8, 1997, Plaintiff saw Dr. Harb for a second follow-up
visit. (Tr. 278). According to Dr. Harb
. . . [Plaintiff] presented after [medical staff]
called him for follow-up and evaluation. [Staff
called] the [Plaintiff in the] evening and during the
night to have him follow-up . . . and  were not
able to get a hold of him until today.
(Tr. 278). Plaintiff's health status was relatively unchanged
compared to his May 6, 1997 examination. (Id.). Dr. Harb again
reported that Plaintiff continued to smoke heavily, in spite of
being instructed to stop smoking and modify other risk factors.
Handwritten medical records reveal that Plaintiff was seen on
May 16, 1997. (Tr. 277). The assessment and plan from this
appointment are largely illegible, and the signature of the
treating practitioner cannot be deciphered. (Id.).
Plaintiff's next medical appointment was on May 19, 1997, with
Dr. Harb. (Tr. 276). At that time, Dr. Harb dictated that
somewhat of a poor historian and difficult to assess.
He appears to have some denial problems. He is
asymptomatic at this time. The patient does feel
better since he was started on [a beta-blocker].
(Id.). Because Plaintiff continued to smoke heavily, and
because an electrophysiologist apparently documented certain
findings which Dr. Harb wanted to follow-up on, Dr. Harb switched
Plaintiff's anticoagulant medication, and advised cardiac
catheterization for that day.*fn16
declined admission at that time, and arranged admission for
cardiac catheterization at a later time. (Id.). Dr Harb again advised
Plaintiff to stop smoking and modify his other risk factors.
On May 20, 1997, Plaintiff was evaluated for admission to the
Samaritan Health System for cardiac evaluation and management.
(Tr. 293). At the time of Plaintiff's "History & Physical"
examination by Dr. Harb, Plaintiff was asymptomatic and appeared
to be in no acute distress. (Id.). Again, Dr. Harb noted that
Plaintiff was difficult to assess because he provided a poor
history of his situation and appeared to have denial problems.
(Id.). Dr. Harb's discharge summary for this hospitalization
reported the following final diagnoses:
(1) Coronary artery disease . . . on the basis of his
clinical presentation (at that time patient did not
seek medical attention) with atypical angina which
appears to be stable.
(2) Pulmonary embolism per ventilation-perfusion lung
scan in April 1997.
(3) Morbid Obesity.
(5) Nicotine Addiction.
(6) Accelerated intraventricular rhythm on Holter
monitor which [has] now improved after treatment.
(7) Latent congestive heart failure, ejection
fraction estimated around 45%.
(Tr. 295). Dr. Harb's discussion notes state that Plaintiff
"[had] only mild ischemia,*fn17
induced by exercise. His
is now rare, if any. He feels fine." (Id.).
Dr. Harb also noted that
Patient is completely asymptomatic now and
hemodynamically stable. He has been up and around and
anxious to go home. He will be discharged. . . . With
his risk factors emphasized, he was advised strongly
to stop smoking, to lose weight, etc. He will be
discharged . . .
(Tr. 296). On May 27, 1997, Plaintiff sought care at the Emergency
Department of the Samaritan Health System at approximately 2:00
a.m., chiefly complaining of a sudden onset of chest pain and
shortness of breath. (Tr. 305). Dr. Harb dictated Plaintiff's
History & Physical for Plaintiff's hospitalization and again
reported that Plaintiff "appear[ed] to be a somewhat poor
historian and [his ex-wife] could not remember the details." (Tr.
306). Further, Dr. Harb indicated that Plaintiff was "on the
boat" and "had a few beers." (Id.). By the time Dr. Harb
examined Plaintiff, he denied palpitations, dizziness, and loss
of consciousness. (Id.). Dr. Harb reported that Plaintiff was
in no acute distress. (Tr. 307). Dr. Harb indicated that
Plaintiff "did not [previously] take medication as instructed and
actually did not even buy the prescription given to him.
[Plaintiff] continues to smoke heavily although he was instructed
not to do so especially when utilizing the Nicoderm
Plaintiff submitted to x-rays and electrocardiograms on May
27-29, 1997, at the Samaritan Health System. (Tr. 309-311,
313-315). The chest x-ray taken on May 27, 1997, was reported to
be a normal exam. (Tr. 309). With regard to the x-rays taken on
May 28, 1997, it was concluded that "the dorsal spine show[ed]
some very mild degenerative changes; no other abnormalities
[were] noted." (Tr. 313). The four electrocardiograms taken on
May 27-29 were all "abnormal."*fn20 (Tr. 310, 311, 314,
315). On June 6, 1997, Plaintiff saw Dr. Gondwe for a follow-up
visit. (Tr. 275). At that time, nurse's notes for that visit
indicate that Plaintiff was still smoking one-half to one pack of
cigarettes per day. (Id.). Dr. Gondwe reported that Plaintiff's
vital signs were stable and that Plaintiff had no complaints at
that time. (Id.). Dr. Gondwe pointed out that Plaintiff's main
problem at that time was demodex folliculorum;*fn21
Plaintiff was provided with a therapeutic lotion and advised to
change his bedding. (Id.). Later that day, after Plaintiff's
appointment with Dr. Gondwe ended, Dr. Gondwe reported that
Plaintiff's laboratory results indicated a need to change
Plaintiff's Coumadin dose. (Id.). Plaintiff could not be
reached by phone, however, so Dr. Gondwe discussed the situation
with Samaritan Home Care.*fn22 (Id.).
On June 10, 1997, Plaintiff was seen by Dr. Harb for follow-up
care. (Tr. 274). Plaintiff complained of some dyspnea on
exertion, but denied chest pain, shortness of breath at rest,
palpitations, or dizziness. (Id.). Dr. Harb indicated that
Plaintiff was still smoking. (Id.). Dr. Harb again discussed
with Plaintiff the importance of modifying his risk factors. (Tr.
274). Plaintiff was advised to follow-up with his primary care
provider and to return to Dr. Harb for evaluation in a few months
or earlier as needed. (Id.).
Dr. Gondwe saw Plaintiff again on June 30, 1997. (Tr. 273).
According to Dr. Gondwe's notes, Plaintiff wanted to go back to
work. (Id.). Dr. Gondwe indicated that Plaintiff's line of work
as a garbage man would be inappropriate given Plaintiff's health
concerns. Specifically, it was stated that "the cardiologist has
spoken to [Plaintiff] and the cardiologist's opinion is that he should find a different line of
work. I do tend to concur on that issue and [Plaintiff] has been
informed." (Id.). Objectively, Dr. Gondwe reported no findings
at that time. (Id.). Nurse's notes for this appointment reveal
that Plaintiff was smoking one-half to three-fourths of a pack of
cigarettes per day at that time. (Id.). Dr. Gondwe reported
that Plaintiff should remain off work for another six weeks until
re-evaluated, and advised that Plaintiff continue with his
current medication dose. (Id.). Handwritten notes dated July
28, 1997 indicate that Plaintiff should still continue with the
same dose of medication, but do not show whether Plaintiff was
present for a visit with any practitioner. (Tr. 273).
Plaintiff was evaluated by Dr. Gondwe again on August 11, 1997.
(Tr. 272). At that time, Plaintiff was in no acute distress, and
only experienced occasional chest pain. (Id.). Nurse's notes
for this appointment show that Plaintiff was smoking one-half to
three-fourths of a pack of cigarettes per day at that time.
(Id.). Again, Dr. Gondwe expressed his opinion that Plaintiff
could not perform his work as a garbage collector because "that
[would be] putting him in extreme danger." (Id.). Handwritten
notes, dated September 22, 1997, show that Plaintiff was again
seen for a follow-up visit, but cannot be fully deciphered.
On November 5, 1997, Plaintiff was examined by V. Kuchipudi,
M.D., at the Freeport Health Network on behalf of the Bureau of
Disability Determination Services. (Tr. 316). Plaintiff's chief
complaint at the time of examination was shortness of breath, but
his examination revealed that he was in no acute distress. (Tr
316-317). Plaintiff denied chest pain, back pain, coughing, or
wheezing. (Tr 316). The social history notes from this visit
indicate that Plaintiff had been smoking one pack of cigarettes
per day for the past fifteen years. (Id.). Dr. Kuchipudi's
impression of Plaintiff indicated that Plaintiff suffered from
coronary artery disease in the past, experienced shortness of
breath on exertion, had a history of herniated disks but presently had good range of movements in the lower back, was
afflicted with hypertension, and was a smoker. (Tr. 317).
Plaintiff's medical record was reviewed on December 8, 1997, by
V. Pilapil, M.D, to determine Plaintiff's Residual Functional
Capacity ("RFC"). (Tr. 318). Based on all the evidence in
Plaintiff's file, including clinical and laboratory findings,
symptoms, observations, lay evidence, and reports of daily
activities, Dr. Pilapil determined that Plaintiff could
occasionally lift and/or carry twenty pounds, frequently lift
and/or carry ten pounds, stand and/or walk with normal breaks for
a total of about six hours in an eight-hour work day, sit with
normal breaks for a total of about six hours in an eight-hour
work day, and push and/or pull on an unlimited basis including
the operation of hand and/or foot controls. Dr. Pilapil indicated
that these exertional limitations were appropriate for Plaintiff
because of his history of coronary artery disease, deep venous
thrombosis, pulmonary embolism, herniated disks, high blood
pressure, and obesity. (Tr. 319-320). Dr. Pilapil opined that
Plaintiff could balance, stoop, kneel, crouch, or crawl
frequently, and should only occasionally climb ramps or stairs,
and never climb ladders, ropes, or scaffolds. (Tr. 320). No
manipulative, visual, communicative, or environmental limitations
were noted by Dr. Pilapil. (Tr. 321-322). Dr. Pilapil indicated
that no treating or examining source statement regarding
Plaintiff's physical capacities was found within Plaintiff's file
at that time. (Tr. 324).
Plaintiff sought care from Dr. Gondwe again on January 9, 1998.
(Tr. 270). At that time, Dr. Gondwe reported that Plaintiff
suffered from sinusitis, and noted that Plaintiff's history of
coronary artery disease, deep venous thrombosis with pulmonary
embolism, and hypertension. (Id.). Dr. Gondwe continued
Plaintiff on his previously-prescribed medication regimen, and
advised Plaintiff to lose weight. (Id.). Plaintiff told Dr.
Gondwe that he couldn't lose weight because cold weather kept him from exercising; Dr. Gondwe
responded in Plaintiff's medical record by stating that "much of
[Plaintiff's] lifestyle has been secondary to a driving
occupation in the past, and [Plaintiff] has very poor
motivational skills. At this point, [Plaintiff] has no desire to
be involved in exercise." (Id.). Dr. Gondwe instructed
Plaintiff to schedule a follow-up visit in six months. (Id.).
A second physical RFC assessment for Plaintiff was completed by
Y. Kim, M.D., on March 5, 1998. (Tr. 326). After reviewing all
the evidence in Plaintiff's medical record, Dr. Kim concluded
that Plaintiff could occasionally lift and/or carry twenty
pounds, frequently lift and/or carry ten pounds, stand or walk
with normal breaks for about six hours in an eight-hour workday,
sit with normal breaks for six hours in an eight-hour workday,
and push or pull for unlimited periods of time with the lift and
carry weight limitations. (Tr. 327). With regard to postural
limitations, Plaintiff could occasionally climb ramps or stairs,
balance, stoop, kneel, crouch, or crawl, but should not climb
ladders, ropes, or scaffolds. (Tr. 328). Dr. Kim determined
Plaintiff did not have manipulative, visual, communicative, or
environmental limitations at that time. (Tr. 329-330).
On April 15, 1998, Dr. Gondwe evaluated Plaintiff again. (Tr.
339). At that time, Plaintiff denied any chest pain and shortness
of breath without exertion. (Id.). Plaintiff was experiencing
shortness of breath with moderate exertion. (Id.). Dr. Gondwe's
notes reveal that he spoke with Plaintiff "at length" about
continuing his medication regimen. (Id.). One month later,
Plaintiff failed to show for or cancel an appointment scheduled
with Dr. Harb. (Id.).
On September 10, 1998, Plaintiff saw Dr. Harb again. (Tr. 338).
Dr. Harb diagnosed Plaintiff with coronary artery disease,
lateral wall myocardial infarction, non-compliance, pulmonary
embolism, morbid obesity, hyperlipidemia, nicotine addiction, and
congestive heart failure. (Id.). Dr. Harb noted that Plaintiff appeared healthy,
had clear lungs, and needed to discontinue smoking. (Id.).
Plaintiff's next medical record is for an appointment with Dr.
Gondwe on March 17, 1999. (Tr. 336). Dr. Gondwe's dictation at
that time indicates that Plaintiff has not been seen for
evaluations "since April of 1998, despite having been scheduled
for return visits." (Id.). Plaintiff had "no particular
complaints at this time," denied angina, and was not taking his
medications. (Id.). Plaintiff told Dr. Gondwe he quit taking
his medications because he was unable to afford them. (Id.).
Plaintiff was in no acute distress, demonstrated no adenopathy,
had clear lungs, normal musculoskeletal presentation, normal
extremities, normal integument, and good cognitive function at
that time. (Id.). Plaintiff appeared, however, to have chronic
obstructive pulmonary disease "from years of smoking." (Id.).
Dr. Rasheed evaluated Plaintiff again on May 18, 1999. (Tr.
437). At that time, Plaintiff was "well-developed,
well-nourished, and appear[ed] to be in no distress." (Id.).
Plaintiff was experiencing "no anxiety or depression." (Id.).
Nursing notes for this appointment indicate that Plaintiff was
smoking 10-15 cigarettes per day and rarely using alcohol. (Tr.
438). Dr. Rasheed noted that Plaintiff was not taking his
anticoagulant medication, and advised Plaintiff to continue with
his medications as directed. (Tr. 437). Because Plaintiff
complained of some chest discomfort at that time, Dr. Rasheed
instructed Plaintiff to seek further medical care if the
discomfort persisted. (Id.). Dr. Rasheed further instructed
Plaintiff to return in ten months, and follow with his primary
care physician as needed "in the meantime." (Id.). A Cardiac RFC Questionnaire was completed by Dr. Gondwe on May
26, 1999.*fn23 (Tr. 345). The first question of this form
asks about the nature, frequency, and length of contact the
answering physician has with the Plaintiff; Dr. Gondwe responded
that he was familiar with Plaintiff because of interactions at
the clinic and hospital, but that visits were "infrequent"
because of missed appointments and lack of follow-up. (Id.).
Dr. Gondwe indicated that Plaintiff's symptoms included chest
pain, shortness of breath, fatigue, edema, and palpitations.
(Id.). Dr. Gondwe did not indicate that Plaintiff had anginal
equivalent pain when asked to identify Plaintiff's symptoms, but
answered the next question about the frequency, nature,
location, radiation, precipitating factors, and severity of
anginal pain by stating that Plaintiff experienced angina two
to three days each week, of varying severity. (Id.). Dr. Gondwe
reported that Plaintiff was not a "malingerer," and had a "marked
limitation of physical activity," but was "unsure" about the
"role of stress" with regard to Plaintiff's symptoms. (Tr. 346).
Dr. Gondwe indicated that Plaintiff was incapable of "low stress"
jobs because of pain and dyspnea at rest. (Id.). Dr. Gondwe
also noted that Plaintiff may "possibly" experience emotional
difficulties, and added that "anyone living with a chronic,
potentially-fatal ailment is bound to have psychological effects
or depression or anxiety." (Id.). When asked if emotional
factors contributed to the severity of Plaintiff's subjective
symptoms and functional limitations, Dr. Gondwe answered, "no."
(Id.). According to Dr. Gondwe, Plaintiff could sit for about
four hours during an eight-hour work day, may need a job which
permits shifting positions at will from sitting, standing or
walking depending on the job description, should elevate his legs
if sitting for prolonged periods of time, could occasionally lift
ten pounds, and could frequently lift less than ten pounds. (Tr.
348). Dr. Gondwe also indicated that Plaintiff should avoid concentrated exposure to extreme cold or heat, high humidity,
fumes/odors/dusts/gases, soldering fluxes, solvents/cleaners, and
chemicals; no restrictions were placed on Plaintiff's exposure to
perfumes or cigarette smoke. (Tr. 349).
On September 2, 1999, David E. Hanson, M.D., completed a
Cardiac Report about Plaintiff's cardiac condition.*fn24
(Tr. 352). This report initially states that Plaintiff was seen
most recently on August 9, 1999, though no record is found within
Plaintiff's medical record to verify that statement. Dr. Hanson
reported that Plaintiff may have had end organ damage as a result
of hypertension, because Plaintiff's "myocardial infarction may
have been caused in part by hypertension." (Id.). Dr. Hanson
noted that Plaintiff did not have congenital heart disease,
arrhythmia due to cardiac disease, neurological complications as
a result of cardiovascular disease, or discomfort from ischemic
heart disease. (Tr. 352-353). Dr. Hanson indicated that Plaintiff
suffered from recurrent or persistent fatigue and dyspnea at
rest, and experienced fatigue and dyspnea with ordinary physical
activity. (Tr. 353). When asked if restrictions had been placed
on Plaintiff's ability to engage in physical activity, Dr. Hanson
indicated that Plaintiff was unable to walk one block, and had
dyspnea with his activities of daily living. (Id.). Dr. Hanson
further noted that Plaintiff lived with his mother who performed
all household duties, while Plaintiff was unable to perform
activities of daily living and spent his time "largely watching
TV." (Tr. 354).
Also on September 2, 1999, Dr. Hanson completed a Diabetic
Report on behalf of Plaintiff. (Tr. 356). This report indicates
that Plaintiff was diagnosed with diabetes mellitus on May 14, 1999.*fn25 (Id.). Per Dr. Hanson, Plaintiff's
compliance with therapy was good, and Plaintiff had no vascular
complications as a result of his diabetic condition. (Id.).
To round out his reports about Plaintiff, Dr. Hanson also
completed a Psychiatric Report for Plaintiff on September 2,
1999. (Tr. 357). In this report, Dr. Hanson indicates that
able to care for [him]self. [Plaintiff] can clean
house, but [is] unable to do yard work. [Plaintiff]
lives with [his] mother who does support and bill
payments. [Plaintiff is] able to drive. . . .
[Plaintiff] watches TV or takes drives. [Plaintiff]
can walk short distances [less than] one block."
(Id.). With regard to Plaintiff's mental status, Dr. Hanson
noted that Plaintiff operated within normal limits, and had
appropriate judgment. (Tr. 358-359). Dr. Hanson did not provide
any further remarks about Plaintiff's impairments or conditions,
and indicated that Plaintiff was able to perform work-related
activities such as understanding, carrying out and remembering
instructions, and could respond appropriately to supervision,
co-workers, and customary work pressures. (Tr. 359). Plaintiff
was limited only to the extent that he was "unable to lift,
carry, climb, or ambulate long distances." (Id.).
Plaintiff underwent a one-hour Psychiatric Evaluation by D.V.
Domingo, M.D., on September 27, 1999. (Tr. 360-362). At that
time, Plaintiff was experiencing chest pains "on and off." (Tr.
360). Plaintiff reported to Dr. Domingo that he longed to work,
but that his doctors would not "release him." (Tr. 361).
Plaintiff presented to Dr. Domingo with a normal gait,
appropriate affect, good attitude, and was cooperative and
coherent. (Id.). Dr. Domingo's diagnosis of Plaintiff was that
Plaintiff had a history of: (1) coronary heart disease, (2)
diabetes mellitus, type II, (3) disc disease of the lower back,
(4) hypertension, (5) high cholesterol level, (6) bronchial asthma, and (7) pulmonary embolism. (Tr. 361-362).
According to Dr. Domingo, Plaintiff is capable of managing
benefits in his interest. (Tr. 362).
Plaintiff was next seen on November 5, 1999, by A. Taja, M.D.
(Tr. 435). Plaintiff was experiencing hematochezia*fn26 and
gastroesophageal*fn27 reflux at that time. (Id.). The
record for this visit indicates that Plaintiff was smoking half
of a pack of cigarettes per day, down from more heavy smoking of
three packs per day in the recent past. (Id.). Dr. Taja's
impression was that Plaintiff had a chronic history of
gastroesophageal reflux disease, and had a history of lower
gastrointestinal bleed. (Id.). Dr. Taja provided samples of
medication and ordered tests as he deemed appropriate. (Id.).
On November 10, 1999, Plaintiff was evaluated by Kamlesh
Ramchandani, M.D. (Tr. 373). At that time, Plaintiff denied any
nausea, vomiting, shortness of breath, dizziness, or sweating.
(Id.). Just five days after Plaintiff reported to Dr. Taja that
he smoked half of a pack of cigarettes per day, Plaintiff told
Dr. Ramchandani that he "quit smoking one month back; used to
smoke one pack a day for twenty years." (Id.). Dr. Ramchandani
indicated that his exam revealed
an obese male in no acute physical distress. Vital
signs are stable. . . . His gait is slow and
measured. He is able to walk on the heels and toes
gingerly. He is able to squat partially and get up
from partially squatting position with support. He is
able to get on and off the examination table with
assistance. He is able to dress and undress himself
without assistance. He is right handed. His grip is
5/5 bilaterally. Able to pick up objects, open and
close the door, oppose the thumb to fingers, make a
fist, flip pages. (Tr. 374). Dr. Ramchandani's impression was that
Plaintiff had coronary artery disease with stable
anginal chest pains, lumbar arthralgia, a history of
hypertension and noninsulin dependent diabetes, and
had dyspnea. (Id.).
On November 16 and November 29, 1999, Plaintiff followed up
with Dr. Taja for evaluation and treatment of his
gastrointestinal concerns. (Tr. 440, 434). With medication,
Plaintiff was asymptomatic by the time Dr. Taja saw him on
November 29, 1999. (Tr. 434). Dr. Taja decided to continue
Plaintiff on medication and instructed Plaintiff to eat a high
fiber diet to minimize his gastrointestinal problems. (Id.).
On January 14, 2000, a third RFC was completed based on
Plaintiff's medical record. (Tr. 389). Dr. Kim, who also
completed Plaintiff's second RFC, determined that Plaintiff could
occasionally lift and/or carry fifty pounds, frequently lift
and/or carry twenty-five pounds, stand or walk with normal breaks
for about six hours in an eight-hour workday, sit with normal
breaks for six hours in an eight-hour workday, and push or pull
for unlimited periods of time with the lift and carry weight
limitations. (Tr. 390). With regard to postural limitations,
Plaintiff could occasionally climb ramps or stairs, balance,
stoop, kneel, crouch, or crawl, but should not climb ladders,
ropes, or scaffolds. (Tr. 391). Dr. Kim determined that Plaintiff
did not have manipulative, visual, or communicative limitations
at that time, but should avoid concentrated exposure to fumes,
odors, gases, poor ventilation, or hazards such as machinery and
heights. (Tr. 391-392). In this RFC, Dr. Kim commented that
[Plaintiff's] gait is slow and measured because of
his obesity. His ability to move and do daily
activities would be limited because of his obesity.
His breathing was reduced but not significantly.
Therefore, the [Plaintiff] should be able to perform
medium work with some postural limitations and also
some environmental limitations. His coronary artery
disease was stable. . . .
(Id.). Plaintiff's next contact with medical practitioners was with
Dr. Taja, on February 28, 2000. (Tr. 433). Plaintiff did not
complain of heartburn or discomfort at that time. (Id.). Dr.
Taja determined that Plaintiff had Barrett's esophagus, reflux
which was controlled with medication, and was obese. (Id.). Dr.
Taja "rediscussed with [Plaintiff] the importance of losing
weight for management of [gastroesophageal reflux disease] and
[coronary artery disease,]" and instructed Plaintiff to return in
three months for further evaluation. (Id.).
On March 1, 2000, Plaintiff followed up with Dr. Rasheed again.
(Tr. 419).*fn28 Plaintiff was in no distress at that time,
and demonstrated no anxiety or depression. (Id.). Dr. Rasheed
noted that Plaintiff was exhibiting normal respiratory efforts,
and that Plaintiff's lungs were clear to percussion and
auscultation. (Id.). Dr. Rasheed made minor changes to
Plaintiff's medication regimen, and ordered an electrocardiogram
and a stress test to assess Plaintiff's angina. (Id.). Dr.
Rasheed deferred recommending any other treatments or therapies
pending the outcome of Plaintiff's electrocardiogram and stress
test results. (Id.). Plaintiff's echocardiogram showed
Plaintiff to have probable mild left ventricular hypertrophy and
decreased left ventricular systolic function. (Tr. 450).
Plaintiff's stress test was aborted after just three minutes and
twelve seconds because of exercise intolerance. (Tr. 451). Dr.
Rasheed determined that Plaintiff had an abnormal stress test due
to exercise-induced chest pain at a low level of stress. (Id.).
Dr. Rasheed ordered cardiac catheterization because Plaintiff's
stress test was abnormal. (Tr. 429). After Plaintiff's cardiac
catheterization was completed on March 31, 2000, Dr. Rasheed
concluded that Plaintiff's left ventricular systolic function was
moderately decreased. (Tr. 449). Additionally, Dr. Rasheed noted
that Plaintiff did not have any significant stenosis except for
his chronically occluded LAD. (Id.). Dr. Rasheed recommended
treating Plaintiff medically for ischemic heart disease. (Id.).
On April 4, 2000, Plaintiff did not call or show for his
follow-up appointment with Dr. Rasheed. (Tr. 429). Dr. Rasheed's
staff sent a letter to Plaintiff to reschedule the appointment.
Dr. Rasheed finally saw Plaintiff for a follow-up examination
on May 1, 2000. (Tr. 428). Plaintiff was not taking his Coumadin
at that time, apparently because he was planning to have dental
work done. (Id.). Plaintiff denied chest pain at that time, but
was experiencing a cough and shortness of breath on exertion; Dr.
Rasheed noted that Plaintiff was in no distress. (Id.). Dr.
Rasheed's impression was that Plaintiff was "stable from a
cardiac standpoint." (Tr. 427). Dr. Rasheed discussed "risk
reduction measures" with Plaintiff again, and advised Plaintiff
to return for another examination in one year. (Id.).
On June 1, 2000, Plaintiff returned to Dr. Taja for evaluation
of his gastroesophageal reflux disease. (Tr. 426). Per Dr. Taja,
Plaintiff was "doing fine with no gastroesophageal reflux
symptoms at all." (Id.). Dr. Taja reported that Plaintiff had
not lost weight, should continue taking medications as directed,
and should return for a repeat endoscopy in November of 2000.
Dr. Hanson authored a letter to Plaintiff's attorney on
September 20, 2000, which is included in Plaintiff's medical
record. (Tr. 417). Dr. Hanson indicated that Plaintiff's
"physical condition precludes any gainful employment whatsoever"
because Plaintiff "becomes markedly winded when climbing one
flight of stairs and has neither the training [nor the] physical
condition to work even an office job. His daily activity consists
mainly of watching television." Dr. Hanson relays Plaintiff's story that he was found not
disabled because of "the combined income of Plaintiff's brother,
sister, and mother." (Id.).
Dr. Rasheed conducted a Pre-operative Cardiac
Assessment*fn29 of Plaintiff on October 9, 2000. (Tr. 424).
Plaintiff had no symptoms of anxiety or depression, normal
respiratory efforts, clear lungs, regular heart sounds, and
normal gait. (Id.). Plaintiff was noted to have a mild
increased risk for perioperative*fn30 cardiac complications,
but was cleared for his operation. (Id.).
On November 3, 2000, Dr. Taja evaluated Plaintiff again for his
gastroesophageal reflux. (Tr. 423). Plaintiff was complaining of
only infrequent heartburn at that time; Dr. Taja noted that
Plaintiff still had not lost weight as instructed. (Id.). Dr.
Taja planned to repeat an upper endoscopy and collect esophageal
biopsies for evaluation of Plaintiff's esophageal problems.
Plaintiff underwent an esophagogastroduodenoscopy*fn31
with biopsies on November 10, 2000. (Tr. 439). Dr. Taja evaluated
the results of these procedures, and recommended that Plaintiff
continue with his medication regimen as previously prescribed,
follow standard anti-reflux measures, and return to the
gastrointestinal clinic with further concerns. (Id.). Plaintiff
followed up with Dr. Taja on November 20, 2000, and was "doing
fine" at that time. Dr. Taja examined Plaintiff and found him to
be "not in acute distress, comfortable." (Id.). Because
Plaintiff experienced a day's worth of loose bowel movements, he
was advised to increase his fluid intake, utilize over-the-counter anti-diarrheal agents, and
return to the gastrointestinal clinic if his problems continued
beyond two additional days. (Id.).
Dr. Hanson returned to the scene on February 1, 2001, to
complete a second Cardiac RFC Questionnaire for Plaintiff. (Tr.
397). Dr. Hanson indicated that Plaintiff suffered from anginal
equivalent pain, shortness of breath, fatigue, and weakness.
(Id.). Dr. Hanson noted that Plaintiff was not a "malingerer"
and had a marked limitation of physical activity. (Tr. 398).
According to Dr. Hanson, "physical stress brings on [Plaintiff's]
symptoms." Dr. Hanson reported that Plaintiff was capable of low
stress jobs, did not experience emotional difficulties such as
depression or anxiety as a result of his symptoms, and stated
that Plaintiff's subjective symptoms and functional limitations
were not affected by Plaintiffs emotional factors. (Id.).
Further, Dr. Hanson noted that Plaintiff's cardiac symptoms
seldom interfere with attention and concentration. (Id.). With
regard to environmental restrictions, Dr. Hanson indicated that
Plaintiff should avoid concentrated exposure to high humidity,
fumes, odors, dusts, gases, soldering fluxes, solvents and
cleaners; Plaintiff should also avoid all exposure to extreme
cold, extreme heat, and cigarette smoke. (Tr. 400).
Dr. Hanson also completed a Diabetes Mellitus RFC Questionnaire
on February 1, 2001. (Tr. 402). On this form, Dr. Hanson
indicated that Plaintiff's symptoms included fatigue, general
malaise, extremity pain and numbness, difficulty walking, and
rapid heart beat/chest pain. (Id.). Plaintiff's symptoms
associated with diabetes were seldom severe enough to interfere
with Plaintiff's attention and concentration, and again, Dr.
Hanson indicated that Plaintiff was capable of low stress jobs
without significant physical exertion. (Tr. 403). Dr. Hanson
reported that Plaintiff could sit at one time for 30 minutes,
stand at one time for 10 minutes, and could sit for a total of at
least six hours and stand/walk for less than two hours in an eight-hour working day. (Id.). Dr. Hanson estimated that
Plaintiff would require a job which allowed shifting from
sitting, standing, and walking, and could not determine how often
Plaintiff would need to take unscheduled breaks during an
eight-hour working day. (Tr. 404). Dr. Hanson indicated that
Plaintiff should rarely lift ten pounds, and should never lift
twenty or fifty pounds; Plaintiff did not have significant
limitations in reaching, handling or fingering; Plaintiff should
avoid all exposure to extreme heat or cold and cigarette smoke,
should avoid even moderate exposure to high humidity, and should
avoid concentrated exposure to fumes, odors, dusts, and gases.
(Tr. 404-405). Dr. Hanson commented that Plaintiff's heart
disease and cardiomyopathy were Plaintiff's most significant
limiting factors with regard to his ability to work at a regular
job on a sustained basis. (Tr. 405).
On April 6, 2001, Dr. Hanson penned another letter to
Plaintiff's attorney, which is incorporated into Plaintiff's
medical record. (Tr. 452). This letter indicates that Plaintiff
is "nominally independent in activities of daily living" with
"his mother continu[ing] to do much of the heavy work around the
house including doing laundry and preparing meals." (Id.). Dr.
Hanson opined that Plaintiff
would be unable to pursue any meaningful employment
in the private sector. Because of his sedentary
condition, I do not believe that he would be able to
work even in a sheltered workshop. . . . I do not
anticipate that given [Plaintiff's] multiple
co-morbidities that he would ever be capable of
competitive employment in any capacity whatsoever.
IV. STANDARD OF REVIEW
The court may affirm, modify, or reverse the ALJ's decision
outright, or remand the proceeding for rehearing or hearing of
additional evidence. 42 U.S.C. § 405(g). Review by the court,
however, is not de novo; the court "may not decide the facts
anew, re-weigh the evidence or substitute its own judgment for that of the ALJ." Meredith v.
Bowen, 833 F.2d 650, 653 (7th Cir. 1987) (citations omitted);
see also Delgado v. Bowen, 782 F.2d 79, 82 (7th Cir. 1986). The
duties to weigh the evidence, resolve material conflicts, make
independent findings of fact, and decide the case accordingly are
entrusted to the commissioner; "where conflicting evidence allows
reasonable minds to differ as to whether a claimant is disabled,
the responsibility for that decision falls on the Commissioner
(or the Commissioner's delegate the ALJ)." Richardson v.
Perales, 402 U.S. 389, 399-400 (1971); Walker v. Bowen,
834 F.2d 635, 640 (7th Cir. 1987). If the Commissioner's decision is
supported by substantial evidence, it is conclusive and this
court must affirm. 42 U.S.C. § 405(g); also see Arbogast v.
Bowen, 860 F.2d 1400, 1403 (7th Cir. 1988). "Substantial
evidence" is "such relevant evidence as a reasonable person might
accept as adequate to support a conclusion." Richardson,
402 U.S. at 401.
The Seventh Circuit demands even greater deference to the ALJ's
evidentiary determinations. So long as the ALJ "minimally
articulate[s] his reasons for crediting or rejecting evidence of
disability," the determination must stand on review. Scivally v.
Sullivan, 966 F.2d 1070, 1076 (7th Cir. 1992). Minimum
articulation means that an ALJ must provide an opinion that
enables a reviewing court to trace the path of his reasoning.
Walker v. Bowen, 834 F.2d 635, 643 (7th Cir. 1987); Stephens
v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985). Where a witness
credibility determination is based upon the ALJ's subjective
observation of a witness, the determination may only be disturbed
if it is "patently wrong" or if it finds no support in the
record. Kelley v. Sullivan, 890 F.2d 961, 965 (7th Cir. 1989);
Stuckey v. Sullivan, 881 F.2d 506, 509 (7th Cir. 1989).
"However, when such determinations rest on objective factors of
fundamental implausibilities rather than subjective
considerations, [reviewing] courts have greater freedom to review the ALJ decision." Herron v. Shalala,
19 F.3d 329, 335 (7th Cir. 1994); Yousif v. Chater,
901 F. Supp. 1377, 1384 (N.D. Ill. 1995).
V. FRAMEWORK FOR DECISION
The Commissioner has established a sequential five-step process
to evaluate disability claims. 20 C.F.R. § 404.1520 (2003). If
disability or lack of disability is determined at any step in the
process, the evaluation ends. 20 C.F.R. § 404.1520(a). The
Commissioner begins by asking whether a claimant is presently
engaged in employment that qualifies as substantial gainful
activity ("SGA"). 20 C.F.R. § 404.1520(b). If the answer is yes,
the claimant is deemed not disabled. Id. If the answer is no,
the Commissioner next asks whether the claimant has any
impairment or combination of impairments that significantly
limits the claimant's ability to perform basic work activities.
20 C.F.R. § 404.1520(c). If the answer is no, the claimant is
found to be not disabled. Id. If the answer is yes, the
Commissioner then determines whether the claimant's impairments
meets or equals a listed impairment. 20 C.F.R. § 404.1520(d). If
the answer is yes, the Commissioner will find that the claimant
is disabled. Id. If the answer is no, the Commissioner then
inquires whether the claimant's impairments prevent him from
doing past relevant work. 20 C.F.R. § 404.1520(e). If the answer
is no, the claimant is not disabled. Id. If the answer is yes,
the Commission finally asks whether the claimant's impairments
prevent him from doing any other work. 20 C.F.R. § 404.1520(f).
If the answer is yes, a determination of disability is made. If
the answer is no, the claimant is determined not to be disabled.
Id. Plaintiff bears the burden proof in steps one through four.
Young v. Sec'y of Health & Human Services, 957 F.2d 386, 389
(1992). At step five, the burden shifts to the Commissioner.
Id. VI. ANALYSIS
The court will proceed through the five step analysis in order.
A. Step One: Is the claimant currently engaged in substantial
The ALJ found no evidence of work after the Plaintiff's
application date. (Tr. 27). Neither party disputes this first
determination by the ALJ, and there is substantial evidence to
support the determination of the ALJ.
B. Step Two: Does the claimant suffer from a severe
The ALJ then considered whether Plaintiff suffered from a
severe impairment. (Tr. 27). A severe impairment exists where an
impairment or combination of impairments significantly limits a
claimant's physical or mental ability to do basic work
activities. 20 C.F.R. § 404.1520(c). The ALJ determined that
Plaintiff possessed a severe impairment. (Id.). Specifically,
the ALJ determined Plaintiff suffers from, among other things,
coronary artery disease, obesity, diabetes, and back pain. (Tr.
32). Neither party challenges this second determination, and
there is substantial evidence to support the determination of the
C. Step Three: Does claimant's impairment meet or medically
equal an impairment in the Commissioner's listing of
The ALJ next determined whether the Plaintiff's condition met
the requirements or equaled the level of severity contemplated
for any impairment listed in Appendix 1 to Subpart P, Regulations
No. 4. (Tr. 27). The ALJ determined that Plaintiff's condition
did not satisfy the criteria under sections 4.03, 3.02, or 1.05C.
The ALJ stated:
For example, although [Plaintiff] has hypertension
and cardiac difficulties, it is not accompanied by
significant end organ damage or other abnormalities
as required to satisfy the criteria under section
4.03 of the Listing. Likewise, the record does not
reflect any pulmonary function studies with results
equivalent to that required under the tables
associated with Section 3.02. Further, [Plaintiff's] back impairment is not accompanied by the
neurological deficits required by section 1.05C, nor
does the record contain other findings of equivalent
(Id.). This thorough analysis by the ALJ allows the court to
follow the ALJ's reasoning and proceed without question to the
next step of the disability determination process. Substantial
evidence exists to support the ALJ's determination at this step,
and the court finds no reason to disturb it.
D. Step Four: Is the claimant capable of performing work which
the claimant performed in the past?
Before reaching the step-four analysis, the ALJ established
Plaintiff's RFC. (Tr. 27). The RFC is what the Plaintiff can
still do despite his limitations. See 20 C.F.R. § 416.945. The
ALJ considered Plaintiff's allegations of disabling symptoms and
limitations and the entire record. (Id.). The ALJ determined
Plaintiff's medically determinable impairments
preclude the following work-related activities:
lifting more than 20 pounds occasionally or more than
10 pounds frequently; standing and/or walking for
more than a total of 6 hours in an eight-hour
workday; climbing ropes, ladders, or scaffolds;
bending, stooping, crouching, kneeling, crawling or
balancing more than occasionally; climbing
(ascending) stairs more than occasionally; 
performing work around unprotected heights or with or
near dangerous moving machinery; concentrated
exposure to environments containing dust, odors,
gases or fumes; and concentrated exposure to
(Tr. 17). The ALJ determined that Plaintiff's medical records
"fail[ed] to provide strong support for the [Plaintiff's]
allegations of disabling symptoms and limitations." (Tr. 28).
Further, the ALJ determined that Plaintiff's "condition is
controlled by medication and does not further reduce the residual
functional capacity given to [Plaintiff] in this decision."
(Id.). The ALJ went on to state that "the description of the
symptoms and limitations, which [Plaintiff] has provided
throughout the record [have] generally been inconsistent and
unpersuasive." (Id.). To determine this RFC, the ALJ considered
Plaintiff's entire medical record, including the three RFC's in Plaintiff's medical record, numerous cardiac, diabetes, and
psychiatric RFC questionnaires, and subjective and objective data
in Plaintiff's medical record. (Tr. 30). The ALJ specifically
The stress test that [Plaintiff] could not complete
because of his low tolerance for exercise was used by
the Disability Determination Services to determine
[Plaintiff] could still do work at the medium level.
Although this determination was not adopted in this
decision, it supports the reduced residual functional
capacity assessment given to [Plaintiff] by the
The ALJ then performed the step-four analysis to determine
whether Plaintiff's severe impairments prevented Plaintiff from
engaging in past relevant work. (Tr. 31). Past relevant work is
SGA that the Plaintiff performed within the previous fifteen
years and that the Plaintiff performed for a period of time
sufficient to learn how to do the work. 20 C.F.R. §§ 404.1520(e),
404.1560(b)(1). The ALJ determined that Plaintiff could not
"perform any past relevant work, since even the [Plaintiff's]
least demanding past relevant job as a city laborer required him
to lift items weighing over 100 pounds on occasion. This work
activity is inconsistent with the [RFC] determined above."
The finding of the ALJ as to Step Four of the Analysis is not
challenged by either party and the court finds no reason to
disturb this finding.
E. Step Five: Is the claimant capable of performing any work
existing in substantial numbers in the national economy?
At Step Five, the ALJ determined that although Plaintiff's RFC
did not allow him to perform his past relevant work, Plaintiff
can perform a "limited range of light work." (Tr. 31). To make
his determination, the ALJ consulted vocational expert James
Radke, who determined that Plaintiff could still perform light
work such as packaging/order-filling, miscellaneous food
preparation, and cashier, and assembler occupations. (Id.).
According to the ALJ, and in view of the claimant's vocational characteristics and the
[RFC] reported above, Medical-Vocational rule 202.20 serves as a
framework for decision-making. Although [Plaintiff's] limitations
prevent the performance of the full range of light work, there
are still a significant number of jobs that [Plaintiff] can
perform. The undersigned's opinion is confirmed by the vocational
expert, who testified that an individual with [Plaintiff's]
vocational characteristics and residual functional capacity would
be able to perform jobs existing in significant numbers in the
(Id.). There were 12,800 packaging/order filling positions,
12,600 miscellaneous food prep position, 24,300 cashier
positions, and 32,900 assembler positions at the light level
available in the eleven-county Northern Illinois area. (Tr. 76).
After reviewing Plaintiff's medical record and the ALJ's
opinion, this court finds substantial evidence to support the
ALJ. As the ALJ pointed out in her opinion, Plaintiff's medical
records "fail to provide strong support for the [Plaintiff's]
allegations of disabling symptoms and limitations." (Tr. 28).
Plaintiff asserts that it is unclear what RFC evaluations the
ALJ relies on in her opinion. The RFC evaluations are clearly
referenced in the ALJ's opinion. Plaintiff's record includes:
three RFC Assessments (completed by non-treating physicians who
examined Plaintiff's medical record) (Tr. 318, 326, 389); two
Cardiac RFC Questionnaires, completed by Dr. Gondwe (Tr. 345) and
Dr. Hanson (Tr. 397); a Cardiac Report (Tr. 352), Diabetic Report
(Tr. 356), and Psychiatry Report (Tr. 357) completed by Dr.
Hanson; and a Diabetes Mellitus RFC Questionnaire completed by
Dr. Hanson (Tr. 402). The ALJ referenced the reports
appropriately by exhibit number throughout her opinion. The RFC
established by the ALJ is substantially supported by Plaintiff's
most recent medical records and RFC assessments, reports, and
questionnaires. The conflicts in Plaintiff's medical records arise in the
questionnaire forms and letters completed and submitted by Dr.
Hanson (Tr. 352, 356, 357, 397, 402, 417, 452). Dr. Hanson's
questionnaires and letters including the letter submitted after
Plaintiff's hearing are acknowledged by the ALJ. Dr. Hanson
reported on September 20, 2000, that denying benefits to
Plaintiff "would be to sentence him to certain death." (Tr. 417).
It is unclear to this court, as it was to the ALJ, how Dr. Hanson
arrived at this conclusion. No medical records indicate that
Plaintiff was treated or evaluated by Dr. Hanson for the
conditions or impairments Plaintiff suffers from. No other
treating practitioners indicate in Plaintiff's medical records
that he is disabled. After proclaiming work to be a death
sentence for Plaintiff, Dr. Hanson completed a Cardiac RFC
Questionnaire on February 1, 2001, which stated that Plaintiff
was "capable of low stress jobs." (Tr. 398). Further, Dr. Gondwe
stated that "the cardiologist has spoken to [Plaintiff] and the
cardiologist's opinion is that he should find a different line of
work. I do tend to concur on that issue and [Plaintiff] has been
informed." (Tr. 273). While it is true that Dr. Gondwe made this
statement in 1997, three and four years before Dr. Hanson's
letters were written, Dr. Gondwe did not make any statements
indicating his opinion about how Plaintiff had changed during
those three years. Accordingly, because substantial evidence
exists to support the ALJ's finding, this court finds no reason
to disturb it. Therefore, the ALJ's determination as to Step Five
of the Analysis is affirmed. VII. CONCLUSION
For the above-stated reasons, the ALJ's decision to deny
benefits to Plaintiff is sustained. The ALJ is affirmed at all
steps of the disability determination process as outlined above.
Plaintiff's Motion for Judgment on the Administrative Record and
Pleadings is denied; Defendant's Motion for Summary Judgment is