United States District Court, N.D. Illinois, Eastern Division
November 9, 2004.
NICOLE GENTLE, Plaintiff,
JO ANNE BARNHART, COMMISSIONER OF SOCIAL SECURITY, Defendant.
The opinion of the court was delivered by: SIDNEY SCHENKIER, Magistrate Judge
MEMORANDUM OPINION AND ORDER
Plaintiff, Nicole Gentle, seeks judicial review of a final
decision denying her application for disability insurance
benefits, under Sections 405(g) and 416(i) of the Social Security
Act. 42 U.S.C. §§ 405(g), 416(i) (2004). Ms. Gentle filed an
application for Disability Insurance Benefits and Supplemental
Security Income payments on September 18, 2001, alleging she
became disabled on September 4, 2001 due to asthma, back pain and
leg pain (R. 96-98). Ms. Gentle's application was denied and, on
February 19, 2003, an administrative hearing was held before the
Administrative Law Judge (the "ALJ"). During the hearing, Ms.
Gentle, who was represented by counsel, testified to suffering
from depression in addition to the above-listed conditions, and
further claimed that her conditions are exacerbated by her
obesity (R. 26-51). Linda Gels, a vocational expert, also
testified at the hearing (R. 51-58).
Ms. Gentle's benefits claim was denied by the ALJ in a written
decision dated October 31, 2003 (R. 16-21). The ALJ determined
that Ms. Gentle was not disabled because she retained the ability
to perform her past work as either a lunchroom attendant or deli
worker. Ms. Gentle, through her attorney, sought review of the
ALJ's decision on December 5, 2003 (R. 269-274). The Appeals Council denied Ms. Gentle's request for review on February 3,
2004 (R. 9-11), making the ALJ's decision the final decision of
the Commissioner. This lawsuit followed.
Ms. Gentle now seeks summary judgment reversing the
Commissioner's decision or, in the alternative, remanding the
case for further proceedings (doc. # 18). The Commissioner has
filed a cross-motion for summary judgment to affirm the decision
below (doc. # 19). For the reasons stated below, the Court grants
the Commissioner's motion for summary judgment and denies Ms.
Gentle's motion for summary judgment.
The following facts are taken from the administrative record,
the administrative hearing transcript, and the ALJ's written
decision. The Court will discuss Ms. Gentle's personal and
medical history, followed by a summary of the hearing testimony
and the ALJ's written decision.
Ms. Gentle was born on October 1, 1976, making her 26 years old
at the time of the hearing (R. 28). Ms. Gentle is single and
lives with her two children (R. 28). She is 5'11" tall and weighs
approximately 275 pounds (R. 39). Ms. Gentle graduated from high
school, during which time she was enrolled in special education
classes (R. 32-33). Her previous work experience includes
positions held as a deli worker, childcare worker, and school
lunchroom attendant (R. 28-30, 102). Ms. Gentle has not been
employed since she left her job as a lunchroom attendant on
September 4, 2001, but continues to care for her children and
perform general housekeeping duties such as cooking, cleaning,
and grocery shopping (R. 31-32).
The medical records relevant to Ms. Gentle's back and leg pain
date from July 31, 2001, when she complained to her obstetrician,
Dr. Collingham, about shooting pains in her right leg that had
been getting worse over the previous three weeks (R. 180). At the
time, Ms. Gentle was pregnant with her second child. Dr. Collingham referred Ms.
Gentle to a physical therapist and to a neurologist, noting that
she may have either a compressed nerve or lumbar disk syndrome
(R. 180). On September 6, 2001, Ms. Gentle saw Dr. Lee Ann Myers,
a neurologist at Evanston Hospital (R. 170-71). Dr. Myers'
treatment notes indicate that Ms. Gentle reported feeling
shooting pain in her right hip and leg, which she had been
experiencing off and on since November 1998, when she delivered
her first child (R. 170). Ms. Gentle had previously taken
Celebrex for the pain, but it was not effective (R. 170). Dr.
Myers recommended Ms. Gentle find a different job for the
duration of her pregnancy that did not involve standing (R. 169).
Ms. Gentle was working as a lunchroom attendant at the time (R.
On September 24, 2001, Ms. Gentle saw a physician at Evanston
Northwestern Hospital who noted that Ms. Gentle may have multiple
slipped discs, but concluded that nothing could be done about her
condition until after her pregnancy (R. 179). Ms. Gentle was
scheduled for physical therapy three times in November and
December 2001 (R. 182). Ms. Gentle gave birth to her second child
on February 28, 2002 (R. 29). In April 2002, Ms. Gentle had an
MRI of her lumbar spine, revealing a small disc protrusion at the
L5-SI level (R. 246, 252). A letter from Dr. Pamela McShane,
dated April 11, 2002 states that this condition prevents Ms.
Gentle from lifting heavy objects (R. 246). Ms. Gentle's
outpatient psychiatric notes from May 2002 indicate that Dr.
McShane stated that Ms. Gentle's MRI showed "no significant
physical abnormality requiring additional treatment or
disability" (R. 241). The outpatient psychiatric notes also state
that Ms. Gentle's pain symptoms may be related to stress (R.
Ms. Gentle's problems with depression and anxiety were first
documented at age six, when a teacher requested that she be
evaluated by a psychiatrist due to behavioral concerns (R. 163).
Ms. Gentle continued to have emotional problems and received
periodic mental health evaluations while in school (R. 163-164). After graduating from high school, Ms.
Gentle does not appear to have sought treatment for depression
until May 2002, when she was diagnosed with major depression and
received a prescription for Celexa (R. 227). At that time, Ms.
Gentle reported to her doctors that she had been sexually abused
by her mother's boyfriends from ages five through fourteen (R.
227-229). She also reported feeling overwhelmed by the task of
caring for her children and that she experienced episodes of
anxiety or panic (R. 227-229). The treatment notes indicate that
Ms. Gentle's obesity is a factor related to her depression (R.
From May 2002 through January 2003, Ms. Gentle continued to
seek regular psychiatric treatment and her doctors made some
adjustments to her medication prescriptions (R. 227-240). As of
January 2003, Ms. Gentle's treatment notes indicate that her
symptoms had improved, although she was still experiencing some
depression, feelings of being overwhelmed, and reluctance to
leave her house (R. 240). Her attending psychiatrist noted that
Ms. Gentle experienced mild constipation and a decreased ability
to concentrate as side-effects of taking Prozac (R. 240, 245). On
April 8, 2003, Dr. Robert Burton wrote a letter stating that Ms.
Gentle had been diagnosed with recurrent major depression, that
her symptoms (decreased energy, depressed mood, panic/anxiety,
and feeling easily overwhelmed) were disabling, and prevented her
from caring full-time for her children, and that Ms. Gentle
should be permitted to have childcare assistance (R. 254).
At the administrative hearing, Ms. Gentle testified that she
has not performed any paid work since she left her position as a
school lunchroom attendant on September 4, 2001, the alleged
onset date of her disabilities (R. 28). The ALJ asked Ms. Gentle
several questions about her employment history. Ms. Gentle stated
that she left her job as a school lunchroom attendant which was
during her second pregnancy because the position required too
much standing, moving around, and lifting, which caused her to experience pain in her back (R.
28-29). She also testified to having experienced difficulty
filling out all the paperwork for the lunchroom attendant
position, which she attributed to her difficulty reading and
writing and maintaining the requisite level of attention (R. 35).
However, there was no evidence that these difficulties rendered
Ms. Gentle's job performance unacceptable to her employer.
At the hearing, Ms. Gentle's attorney claimed that Ms. Gentle
is disabled and that, due to a combination of her impairments,
she is unable to sustain substantial gainful activity (R. 26,
27). Her attorney stated that Ms. Gentle's has low back syndrome,
as indicated by obstetrician's notes (R. 26, 179-181); that she
experiences shooting pain in her right leg, especially when
standing or walking for prolonged periods (R. 26); that she
experiences pain in her back and stiffness in her right leg when
sitting for extended periods of time (R. 26); that she suffers
from asthma, which is triggered by dust, smoke, mold, and hot
weather (R. 26); that she would probably be considered obese,
which exacerbates her pain symptoms (R. 27); that she takes
Prozac for depression, experiences crying spells and is reluctant
to leave her home (R. 27); that she has difficulty keeping up
with her children and household cleaning (R. 27); that, as a
result of taking Prozac and Benadryl, she feels drowsy and must
lie down during the day and also has problems with mental focus
and functioning (R. 27).
Ms. Gentle brought a brace with her to the hearing that she
received from her physical therapist (R. 39). Her physical
therapist instructed Ms. Gentle to wear the brace at all times,
but since Ms. Gentle finds the brace uncomfortable, she only
wears it when she is bending over frequently or when she needs to
lift something (R. 39). She finds it difficult to lift her
daughter, who weighed 25 pounds at the time of the hearing (R.
47). Ms. Gentle stated that she experiences shooting pains on a
daily basis, starting in her lower back, going through both hips,
and down the back of her right leg to her knee (R. 40). Ms. Gentle stated that
she started experiencing this pain several years prior to the
hearing, when she was working at the grocery store (R. 36). She
testified to experiencing this pain when she walks and that the
pain lasts for hours (R. 40-42). Ms. Gentle stated that if she
sits to rest, her leg stiffens, making the pain worse (R. 41).
She takes Vicodin or Extra Strength Tylenol about three times a
week for that pain, but tries to avoid taking Vicodin more often
than three times per week due to the fact that she is nursing her
daughter and also because it causes blurry vision and drowsiness
(R. 41). Ms. Gentle can stand in one place approximately ten or
fifteen minutes before she starts to experience leg or back pain,
after which time she usually lays down (R. 42). She can usually
sit about twenty minutes before she starts to experience pain or
discomfort in her back, at which point she usually stands up (R.
Ms. Gentle testified that she was not certain when she started
seeing a psychiatrist for her depression (R. 34). Although she
was taking Prozac as of the date of the hearing, she was still
experiencing some symptoms of depression (R. 43). She stated that
she regularly experiences crying spells (R. 44) and has
difficulty focusing and keeping appointments (R. 45). Ms. Gentle
testified that she has anxiety attacks about twice a week, during
which her stomach twists, her chest tightens, her head spins, and
she has difficulty breathing (R. 46). When she takes Prozac, Ms.
Gentle experiences dry mouth, upset stomach, and sleepiness (R.
48). She feels especially sleepy when she takes other medication
along with Prozac, such as allergy and sinus medications (R. 48).
She usually takes her medication at 9:00 a.m., and needs to sleep
every day around 11:00 a.m. for three or four hours (R. 49-50).
She experiences difficulty sleeping at night, with which the
Prozac is somewhat helpful (R. 49).
Ms. Gentle takes care of her infant daughter during the day,
although she is sometimes assisted by an elderly female
acquaintance (R. 30). Her son, who was four at the time of the hearing, goes to day care (R. 30). In addition to caring for her
children, Ms. Gentle also tries to clean her house (R. 31-32).
She mostly prepares microwaveable meals for herself and her
children (R. 32). Ms. Gentle says that she does not leave the
house except to go to the public assistance office, to see her
psychiatrist, or to go to the grocery store (R. 31-32). She rests
intermittently throughout the day (R. 36). She also testified to
having difficulty keeping up with her day-to-day activities (R.
Ms. Gentle testified that she can barely read (R. 32), and that
she has difficulty reading children's books to her children (R.
33). Ms. Gentle did graduate from Evanston Township High School,
during which time she was enrolled in special education courses
(R. 32-33). At the hearing, Ms. Gentle testified that her
learning problems are the biggest hindrance to her engaging in
sustained gainful activity (R. 34-35) a problem she did not
identify in her original application for benefits and that her
next most significant problem is her back condition (R. 35-36).
Ms. Gentle stated that she takes steroids and uses an inhaler
for her asthma condition, which she has had since birth (R. 37).
She stated that her asthma symptoms are triggered by smoke, dust,
extreme temperatures, her allergies (to animal hair, dust, and
mold), and when she has a cold (R. 37). She testified that she
went to the hospital several times for her asthma symptoms during
the year she was pregnant (R. 38). Ms. Gentle stated that when
she went to the hospital on those occasions, the staff put her on
an IV with steroids, but did not recall whether she received any
injections (R. 38). Ms. Gentle also went to the emergency room
when her carbon monoxide detector went off, but that visit was
not asthma-related (R. 38).
The ALJ also received testimony from Linda Gels, a vocational
expert ("VE"), who heard Ms. Gentle's testimony and reviewed her
file (R. 50). The VE testified that, based on the definitions in
the Dictionary of Occupational Titles, Ms. Gentle's previous
positions as a lunchroom attendant and as a deli worker are considered to be both "light and
unskilled" (R. 51, 52). The ALJ asked the VE, hypothetically,
whether those jobs could be performed by a 26-year-old claimant,
with past relevant work experience and education equivalent to
Ms. Gentle's, who is (a) unable to lift, carry, push, or pull
more than ten pounds frequently and twenty pounds occasionally,
(b) unable to perform certain postural movements (e.g.,
bending, twisting, crouching, crawling, turning) more than
occasionally, and (c) unable to maintain the attention and
concentration necessary for detailed or complex tasks (R. 52).
The VE testified that someone with the limitations listed by the
ALJ could perform "light and unskilled" work, which would include
work as a lunchroom attendant or deli worker (R. 52). The VE said
that such work could be performed by an individual who could not
perform detailed tasks (R. 54).
The VE further testified that her opinion would not change if
the hypothetical were modified to include a need to avoid
temperature and humidity extremes and areas with moderate amounts
of pulmonary irritants (R. 53). The VE stated that such an
individual could perform light and unskilled work, and would not
be precluded from that kind of employment if that person needed
to miss work due to illness one day per month; however, the VE
said a person likely could not perform such work if that person
needed to miss two or more days each month due to illness (R.
The VE testified that if a hypothetical individual with the
limitations listed by the ALJ also was limited to sedentary work,
that person could do "bench work" (e.g., work as a hand packer
or assembly line worker), and that approximately 3,000 such jobs
exist in the Chicago market (R. 57). If a hypothetical individual
needed to alternate his or her position between sitting and
standing every 30 minutes, the vocational expert said that such
an individual could not sustain any gainful activity, even
sedentary work, as it is necessary for an individual to maintain
one position for 45 minutes to an hour to maintain a productive
work pace (R. 58). If an individual needed to sleep one or two hours during the workday, the vocational expert thought that such
a person would not be able to sustain any gainful activity, even
sedentary work (R. 56).
The ALJ issued his decision on October 31, 2003, which applied
the standard five-step sequential evaluation pursuant to
20 C.F.R. §§ 404.1520 and 416.920 (2004). At Step 1, the ALJ found
that Ms. Gentle had not engaged in substantial gainful activity
since the alleged onset date of her disability (R. 20). At Step
2, the ALJ found that Ms. Gentle suffers from asthma, low back
pain syndrome, hypertension and depression, which are "severe"
impairments within the meaning of the Regulations (R. 17, 20). At
Step 3, the ALJ found that Ms. Gentle's impairments do not meet
or medically equal any of the impairments listed in the
regulations as so severe as to preclude substantial gainful
activity (R. 17, 20).
At Step 4, the ALJ determined that Ms. Gentle's residual
functional capacity ("RFC") did not preclude her from performing
her past relevant work as a lunchroom attendant or as a deli
worker and that she was, therefore, not entitled to Disability
Insurance Benefits or Supplemental Security Insurance Benefits
(R. 21). Specifically, the ALJ found that Ms. Gentle retained the
RFC "to lift, carry, push and pull ten pounds frequently and
twenty pounds occasionally; to crouch, bend, twist, turn and
crawl only on an occasional basis; and to maintain attention and
concentration necessary for tasks which are not detailed or
complex" (R. 19). The ALJ also found Ms. Gentle to be restricted
from working "in areas of moderate amounts of pulmonary irritants
and temperature and humidity extremes" (R. 19). The ALJ found
that Ms. Gentle's allegations at the hearing regarding pain, lack
of interest in activities and medication side-effects were not
fully credible (R. 19). He found that those allegations were
either not supported by objective medical evidence in her records
or by the presence of aggressive treatment (R. 19). The ALJ also
found that Ms. Gentle's allegations were contradicted by the fact that she had only
experienced mild limitations in her daily living activities (R.
In assessing Ms. Gentle's RFC, the ALJ evaluated Ms. Gentle's
medical records regarding her right hip and lower back pain,
mental health problems with depression and anxiety attacks,
medical history of low back pain, asthma, migraine headaches, and
noted obesity (R. 18). The ALJ noted that Ms. Gentle's treating
physician interpreted the results of her MRI of her lower back to
prevent her from lifting heavy objects (R. 18) and that she had
received conservative treatment for her back pain (R. 19). The
ALJ also noted that Ms. Gentle had received conservative
treatment for her asthma (R. 19). With regard to Ms. Gentle's
mental impairments, the ALJ found that she experiences mild
limitations in her daily activities, mild restrictions in
maintaining social functioning, moderate limitations on her
ability to maintain concentration, persistence or pace, and that
she has experienced no episodes of decompensation in a work-like
setting (R. 19). The ALJ noted that Ms. Gentle had been given
effective medication for her depression and anxiety symptoms and
that, by December 2002, she reported to her psychiatrist that she
was feeling better, with her only medication side-effects being
the occasional loss of concentration and intermittent
constipation (R. 18, 19). The ALJ also noted that the VE
testified that, based on the ALJ's assessment of Ms. Gentle's
RFC, Ms. Gentle could return to her past relevant work as a
lunchroom attendant or deli worker (R. 20). The ALJ concluded
that Ms. Gentle could return to her past relevant work, since
those jobs did not require the performance of work-related
activities precluded by her RFC or her medically determinable
impairments (R. 21).
The ALJ considered the April 8, 2003 letter from a
psychiatrist, Dr. Burton, asking that Ms. Gentle be allowed
childcare assistance on the ground that she was "disabled" by her
symptoms of decreased energy, depressed mood, panic/anxiety, and
feelings of being overwhelmed (R. 19,254). The ALJ found that Dr. Burton's opinion was not controlling on
the issue of disability, explaining that the disability
determination can only be made by the Social Security
Commissioner and her delegees; that Dr. Burton's opinion was not
accompanied by any objective medical evidence; and that his
opinion was contradicted by Ms. Gentle's medical records (R.
We begin with a brief overview of the relevant legal standards.
To establish a "disability" under the Act, a claimant must show
an "inability to engage in any substantial gainful activity by
reason of any medically determinable physical or mental
impairment which can be expected to result in death or which has
lasted or can be expected to last for a continuous period of not
less than twelve months." 42 U.S.C. §§ 423(d)(1)(A)(2004). A
claimant must demonstrate that her impairments prevent her from
performing not only her past work, but also any other work that
exists in significant numbers in the national economy. See
42 U.S.C. §§ 423(d)(2)(A). The social security regulations prescribe
a sequential five-part test for determining whether a claimant is
disabled. See 20 C.F.R. §§ 404.1520 (2004). Under this test,
the ALJ must consider: (1) whether the claimant is presently
unemployed; (2) whether the claimant has a severe impairment or
combination of impairments; (3) whether the claimant's impairment
meets or equals any impairment listed in the regulations as being
so severe as to preclude substantial gainful activity; (4)
whether the claimant is unable to perform her past relevant work;
and (5) whether the claimant is unable to perform any other work
existing in significant numbers in the national economy. See
20 C.F.R. §§ 404.1520; see also Young v. Sec'y of Health and Human
Services, 957 F.2d 386, 389 (7th Cir. 1992). A finding of
disability requires an affirmative answer at either Step 3 or 5.
A negative answer at any step other than Step 3 precludes a
finding of disability. Id. The claimant bears the burden of
proof at Steps 1 through 4, after which the burden of proof
shifts to the Commissioner at Step 5. Id. In reviewing the Commissioner's (here the ALJ's) decision, this
Court may not decide facts anew, reweigh the evidence, or
substitute its own judgment for that of the Commissioner. Herron
v. Shalala, 19 F.3d 329, 333 (7th Cir. 1994). The Court must
accept the findings of fact which are supported by "substantial
evidence" (42 U.S.C. §§ 405(g) (2004)), defined as "such relevant
evidence as a reasonable mind might accept as adequate to support
a conclusion." Herron, 19 F.3d at 333 (quotations omitted).
Where conflicting evidence allows reasonable minds to differ, the
responsibility for determining whether a claimant is disabled
falls upon the Commissioner (or the ALJ), not the courts. See
Herr v. Sullivan, 912 F.2d 178, 180 (7th Cir. 1990); see also
Stuckey v. Sullivan, 881 F.2d 506, 509 (7th Cir. 1989) (the ALJ
has the authority to assess medical evidence and give greater
weight to that which the ALJ finds more credible). The Court is
limited to determining whether the Commissioner's final decision
is supported by substantial evidence and based upon proper legal
criteria. Ehrhart v. Sec'y of Health and Human Services,
969 F.2d 534, 538 (7th Cir. 1992). A finding may be supported by
substantial evidence even if a reviewing court might have reached
a different conclusion. See Delgado v. Bowen, 782 F.2d 79, 83
(7th Cir. 1986) (per curiam).
That said, the Commissioner (or ALJ) is not entitled to
unlimited judicial deference. The ALJ must consider all relevant
evidence, and may not select and discuss only that evidence which
favors his or her ultimate conclusion. See Herron,
19 F.3d at 333. Although the ALJ need not evaluate in writing every piece of
evidence in the record, the ALJ's analysis must be articulated at
some minimal level and must state the reasons for accepting or
rejecting "entire lines of evidence." Id.; see also Young,
957 F.2d at 393 (ALJ must articulate reason for rejecting evidence
"within reasonable limits" if there is to be meaningful appellate
review). The written decision must provide a "logical bridge from
the evidence to [the] conclusion" that allows the reviewing court
a "glimpse into the reasoning behind [the] decision to deny
benefits." See, e.g., Zurawski v. Halter, 245 F.3d 881, 887, 889 (7th Cir. 2001) (quoting Clifford v. Apfel,
227 F.3d 863, 872 (7th Cir. 2000)). This is especially true regarding
credibility determinations, since both the case law and the
regulations require an ALJ to minimally articulate the specific
reasons for the credibility finding. Zurawski, 245 F.3d at 887.
Specific reasons are required so that the reviewing Court can
ultimately assess whether the ALJ's determination was supported
by substantial evidence or, if not, was "patently wrong." Id.
(quoting Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000)).
Ms. Gentle challenges the ALJ's findings on several grounds.
First, Ms. Gentle asserts that the ALJ failed to consider all
of her impairments, or the aggregate effect of these impairments,
when he assessed her RFC. Second, Ms. Gentle claims the ALJ, in
assessing her RFC, discredited her subjective complaints on an
insufficient basis. Third, Ms. Gentle claims that the ALJ
failed to consider whether she could perform the specific demands
of her past jobs. We address these challenges in turn.
Ms. Gentle first asserts that the ALJ did not adequately assess
all her impairments. In his opinion, the ALJ found that Ms.
Gentle suffers from asthma, low back pain syndrome, hypertension,
and depression (R. 17, 21). Ms. Gentle finds fault with this
determination, arguing that the ALJ did not include obesity and
migraine headaches in considering the severity of Ms. Gentle's
impairments (Pl.'s Mem. 5). She also contends that the ALJ
improperly failed to consider the aggregate effect of Ms.
Gentle's impairments (Id. at 5).
We begin with the question of obesity. The Social Security
Administrator has provided the following guidance on whether or
not a claimant's obesity is a "severe" impairment: As with any other medical condition, we will find
that obesity is a "severe" impairment when, alone or
in combination with another medically determinable
physical or mental impairment(s), it significantly
limits an individual's physical or mental ability to
do basic work activities. . . . There is no specific
level of weight or BMI that equates with a "severe"
or a "not severe" impairment. Neither do descriptive
terms for levels of obesity (e.g., "severe,"
"extreme," or "morbid" obesity) establish whether
obesity is or is not a "severe" impairment for
disability program purposes. Rather we will do an
individualized assessment of the impact of obesity on
an individual's functioning when deciding whether the
impairment is severe.
Social Security Ruling, SSR 02-1p; Titles II and XVI: Evaluation
of Obesity, 67 Fed. Reg. 57,859, 57,862 (Sept. 12, 2002).
Ms. Gentle stands 5'11" tall, and weighed 275 pounds at the
time of the hearing (R. 39). The ALJ observed in his opinion that
Ms. Gentle's psychiatric records note she is obese (R. 18). In
his opening statement at the administrative hearing, Ms. Gentle's
attorney argued that her obesity exacerbates her pain symptoms
(R. 27). However, at no point in the hearing did Ms. Gentle
testify to any symptoms or any limitations on her ability to do
basic work activities resulting from her obesity. The burden to
prove that Ms. Gentle's obesity constitutes a "severe" impairment
was Ms. Gentle's. See 20 C.F.R. § 404.1512. Ms. Gentle's
medical records contain a notation stating that she appears to be
obese, but those records do not indicate that Ms. Gentle's weight
standing alone significantly limits her physical or mental
ability to work. Given the lack evidence relevant to this
question, the ALJ's conclusion that Ms. Gentle's obesity is not a
"severe" impairment is supported by substantial evidence.
An ALJ must consider the disabling effect of a claimant's
obesity in combination with her other impairments, regardless of
whether that condition alone would be considered "severe," when
the evidence in the case fairly raises the issue. Clifford,
227 F.3d at 873. In Clifford, the claimant's medical records
contained numerous references to her "excessive" weight problem,
reports that her microvascular brain stem disease was aggravated by her high fat
diet, and recommendations by her treating physician that she lose
weight because of her condition. Id. In the case at hand, the
record contains no evidence of any disabling effects directly
attributable to Ms. Gentle's obesity, or any way in which that
condition combines with Ms. Gentle's other impairments to create
a disabling effect.
An ALJ is not required to address every piece of evidence in
the record, so long as he provides "some glimpse into [his]
decision to deny benefits." Zurawski, 245 F.3d at 889. Although
the ALJ did not provide a detailed discussion of Ms. Gentle's
weight problem, he did discuss Ms. Gentle's other impairments
that could potentially be exacerbated by that condition (back/leg
pain, asthma, and depression) (R. 18-20); see 20 C.F.R. Pt.
404, Subpt. P, App. 1 (2004). He noted that Ms. Gentle's treating
physicians used only conservative methods to treat her asthma and
pain (R. 19). The ALJ's opinion remarked upon the fact that Ms.
Gentle's psychiatrist noted her obesity in the context of her
depression, but also noted that, according to the most recent
psychiatric records available at the time of the hearing, Ms.
Gentle reported feeling better and experienced minimal side
effects from her medication (R. 18, 19). The ALJ's opinion
provides the information necessary to discern how he concluded
that Ms. Gentle's obesity did not combine with other impairments
to disable her, and to conclude that his opinion was supported by
With regard to Ms. Gentle's assertion that the ALJ erred when
he failed to consider evidence that Ms. Gentle suffers from
frequent severe headaches, the ALJ need only consider impairments
that a claimant actually claims or of which the claimant offers
enough evidence to fairly raise the impairment as a basis for a
claim. See 20 C.F.R. §§ 404.1512(a), 404.1516 (2004); see also
Clifford, 227 F.3d at 873 (ALJ should evaluate the severity of
all impairments (including those not claimed) fairly raised by the evidence). In her application for disability
benefits, Ms. Gentle did not state that her migraine headaches
were an impairment contributing to her alleged disability (R.
101). Neither Ms. Gentle nor her attorney raised any claims
regarding headaches at the administrative hearing (R. 26-58).
Moreover, while the ALJ did note in his opinion that Ms. Gentle's
records indicate that she has a history of migraine headaches (as
noted by her obstetrician) (R. 18), the record contains no
medical evidence that Ms. Gentle's migraine headaches are
impairing. The ALJ was therefore not required to make any
determinations regarding Ms. Gentle's migraine headaches.
Ms. Gentle argues that the ALJ failed to adequately assess all
factors relevant to her RFC. We are not persuaded by the
criticisms leveled by Ms. Gentle.
First, Ms. Gentle argues that the ALJ erred in rejecting the
medical opinion of Dr. Burton regarding whether or not Ms. Gentle
is disabled (Pl.'s Mem. 8). It is true that "a treating
physician's opinion is entitled to controlling weight if it is
well supported by medical findings and not inconsistent with
other substantial evidence in the record." Dixon v. Massanari,
270 F.3d 1171, 1177 (7th Cir. 2001). However, it is the sole
province of the Commissioner to determine whether a claimant is
disabled: a claimant is not entitled to disability benefits just
because her doctor has offered the opinion that she is
"disabled." Id. Dr. Burton's letter simply applied the
conclusory label of "disabled" to Ms. Gentle without providing
as the ALJ noted (R. 19) an explanation of what medical
evidence led him to that conclusion. The ALJ gave Dr. Burton's
opinion that Ms. Gentle is "permanently disabled" reduced weight
in his assessment of her RFC, noting that Dr. Burton's April 2003
letter was "not accompanied by objective medical findings or
consistent with other evidence of record"*fn1 (R. 19). And, indeed, Dr.
Burton himself observed in January 2003 that Ms. Gentle was
"feel[ing] better in general" (R. 238), and concluded that she
did not require further medical consultation for two months (R.
239). The ALJ's treatment of Dr. Burton's statement was supported
by substantial evidence. See Jens v. Barnhart, 347 F. 3d 209,
212 (7th Cir. 2003).
Second, Ms. Gentle contends that the ALJ erred in that he did
not assess her ability to "respond appropriately to co-workers,
supervisors and work pressures" in determining her RFC (Pl.'s
Mem. 8). An ALJ must consider all a claimant's impairments,
supported by substantial evidence in the record, which might
limit a claimant's RFC. See Young v. Barnhart, 362 F. 3d 995,
1002 (7th Cir. 2004). Ms. Gentle relies on this proposition
from Young for her assertion that the ALJ was required to
assess the above factors in making his determination of her RFC.
In Young, the claimant allegedly suffered from problems
involving his temper and poor social judgment and, although the
ALJ there found that Young suffered from those and other related
impairments, the ALJ failed to reference those impairments in
determining the claimant's RFC. See id. In Young, the appeals
court held that the ALJ failed to adequately "connect the dots"
between the claimant's impairments and the ALJ's RFC findings.
Id. In contrast, Ms. Gentle never offered any evidence or made
any claims that she lacks the ability to respond appropriately to
co-workers, supervisors and work pressures (R. 101, 28-58). The
ALJ was not required to make any determinations regarding these
Third, Ms. Gentle claims that the ALJ erred in finding that
her alleged need to sleep during the day caused by the
side-effects of Prozac, Benadryl, and Vicodin was not credible,
and did not affect her RFC (Pl.'s Mem. 9). Ms. Gentle did not claim to be
disabled by her sleep requirements in her application for
benefits (R. 101). At the hearing, Ms. Gentle stated that she
becomes very sleepy upon taking anti-depressants and her allergy
medication (R. 48-50). While Ms. Gentle's medical records
indicate that she was prescribed Benadryl for her allergy
symptoms in September 2001 (R. 179) and Prozac for depression
symptoms in December 2002 (R. 238), those records do not contain
any notation of a prescription for Vicodin for any medically
necessary purpose. The ALJ found that Ms. Gentle's claims
regarding "medication side-effects" were not credible as she told
her treating psychiatrist that she only experienced mild
constipation and occasional loss of concentration as side-effects
of her anti-depressant medication (R. 19). Dr. Burton's April
2003 letter upon which Ms. Gentle relies in part does not
cite day-time sleepiness as a basis for disability (or as a
problem at all) (R. 254), and the medical evidence from January
2003 shows that she was not feeling as tired as she had in the
past (R. 245) and that she was "sleeping less" and feeling "less
sedated" (R. 238). The ALJ's determination that Ms. Gentle's
claims that she must sleep during the day due to her medication
were not credible, and thus did not limit her RFC, is supported
by substantial evidence.
Ms. Gentle also claims that the ALJ did not properly consider
her claims that she suffers from regular crying spells and
anxiety attacks (Pl.'s Mem. 9). In her initial application for
benefits, Ms. Gentle did not list either problem as contributing
to her claimed disability (R. 101). However, at the hearing, Ms.
Gentle testified to suffering from both of these problems (R.
44-46). In his discussion of Ms. Gentle's medical history, the
ALJ noted that, shortly after delivering her second child, Ms.
Gentle sought psychiatric treatment for her depression symptoms
and anxiety attacks, and that Dr. Burton listed Ms. Gentle's
"depressed mood" and "panic/anxiety" as contributing to Dr.
Burton's opinion that Ms. Gentle is "permanently disabled" (R.
18). The ALJ did not make any specific findings as to whether Ms. Gentle's crying spells and
anxiety attacks created additional limitations on her residual
functional capacity. Rather, the ALJ made general findings
regarding the functional limitations created by all of Ms.
Gentle's mental impairments (R. 19). The ALJ found that Ms.
Gentle has mild limitations on her daily living activities and
social functioning, that her ability to maintain concentration,
persistence, or pace is "moderately limited," and that she has
not experienced any decompensation or any exacerbation of
symptoms that has caused her to withdraw from situations while in
a work-like setting (R. 19). These four broad functional areas
have been identified by the Social Security Administration as
contributing to the severity of a claimant's mental impairments.
See 20 C.F.R. §§ 404.1520a; Subpt. P, App. 1, 12.00 (C) (2004).
The ALJ found that Ms. Gentle's mental impairments do not create
functional limitations beyond the inability to maintain the
attention and concentration necessary for detailed or complex
tasks (R. 19). See 20 C.F.R. §§ 404.1520a; Subpt. P, App. 1,
12.00(c) (2004). This finding encompasses all of Ms. Gentle's
alleged mental impairments, including her crying spells and
The ALJ also observed that Ms. Gentle's allegations that she
cannot perform any sustained work activity due to a "lack of
interest in activities" (presumably referring to depression) are
not fully credible because her symptoms have responded to
prescribed medication, have not required aggressive treatment,
and "have not been documented by medical findings to be so severe
as to produce the symptoms as alleged [at the hearing]" (R. 19).
From these two findings, we can "glimpse" the ALJ's reasoning
with regard to the evidence of crying spells and anxiety attacks
Ms. Gentle presented at the hearing and how that evidence
factored into his opinion of Ms. Gentle's RFC. See Zurawski,
245 F.3d at 889. Thus, the conclusion that Ms. Gentle's problems
with crying spells and anxiety attacks did not create additional
limitations on her RFC is supported by substantial evidence. Fourth, Ms. Gentle also asserts that the ALJ inadequately
articulated his reasons for finding that Ms. Gentle's subjective
complaints of pain were not credible (Pl.'s Mem. 10). Ms. Gentle
asserts that the ALJ erred in failing to make a specific finding
regarding how her impairments affect her ability to sit and
stand. Ms. Gentle's application for benefits states that she has
difficulty standing for long periods of time due to her leg and
back pain (R. 101). At the administrative hearing, in addition to
testifying to being unable to stand for long periods of time, Ms.
Gentle also testified to being unable to sit or walk for extended
periods due to leg and back pain (R. 40-43).
The ALJ did not specifically address Ms. Gentle's ability to
sit and stand (R. 16-21). However, the ALJ's opinion does discuss
Ms. Gentle's allegations regarding her back and leg pain which,
according to her claims, are the factors that contribute to her
inability to sit or stand for extended periods (R. 19). The ALJ
found that Ms. Gentle's subjective complaints of pain were not
credible because they were contradicted by objective medical
evidence, the absence of more aggressive treatment, and her
normal daily activities (R. 19). The ALJ's opinion states, ". . .
these symptoms have not required hospitalization, surgical
intervention or other aggressive treatment . . . have not been
documented by medical findings to be so severe as to produce the
symptoms as alleged and do not prevent the claimant from
performing an extensive range of daily activities including
taking care of two small children, cooking, cleaning, and
shopping." (R. 19). We also note that the April 2002 report of
Dr. McShane found that Ms. Gentle's back condition "prevents her
from lifting heavy objects," but did not cite any effect on her
ability to sit or stand (R. 246). Moreover, the consultative
reports from December 2001 and March 2002 cited by the ALJ (R.
20) find no significant limit on Ms. Gentle's ability to sit or
stand (R. 198-99). While the ALJ's credibility finding was not
accompanied by an extensive discussion of the specific medical
evidence contradicting her claims, the body of the ALJ's opinion
does refer to such evidence (that she received conservative treatment for her hip pain and that her
MRI revealed a small disc protrusion that only prevents her from
lifting heavy objects) (R. 18).*fn2 We find the ALJ's
credibility finding is supported by substantial evidence.
Ms. Gentle claims that the ALJ should not have relied on the
vocational expert's testimony in order to conclude that Ms.
Gentle is capable of performing her past work. We do not find
persuasive the arguments Ms. Gentle asserts in support of this
First, Ms. Gentle claims that the hypothetical question the
ALJ posed to the VE did not include all her impairments.
Specifically, she claims that the ALJ should have stated that Ms.
Gentle has "mild restrictions" in social functioning and is
"moderately limited" in her ability to maintain concentration,
persistence and pace (Pl.'s Mem. 11). When an ALJ poses a
hypothetical question to a VE, that question should reflect a
claimant's work-related impairments. See Cass v. Shalala,
8 F. 3d 552, 555 (7th Cir. 1993). The question the ALJ posed to
the VE was based on the ALJ's determinations regarding Ms.
Gentle's RFC, and contained a clause limiting the hypothetical
claimant's ability to maintain attention and concentration to
that level necessary to perform tasks that are neither detailed
nor complex (R. 21, 52-53). Thus, the hypothetical question did
incorporate Ms. Gentle's limitations on concentration,
persistence, and pace. See 20 C.F.R. § 404.1520a (2004); 20
C.F.R. Pt. 404, Subpt. P., App. 1, 12.00 (C) (3) (2004). With
regard to Ms. Gentle's limitations on "mild restrictions" on social functioning, it is generally
proper to consider any "mild" limitations to have a minimal
effect on a claimant's ability to do basic work activities. See
20 C.F.R. § 404.1520a (2004). With regard to Ms. Gentle's claims
that the ALJ should have included Ms. Gentle's anxiety attacks,
crying spells, and need to sleep for several hours during the
day, again, for the reasons stated above, the ALJ's finding that
these alleged ailments are not "severe impairments" is supported
by substantial evidence. Thus, the ALJ was not required to
include these factors in the hypothetical question posed to the
VE as they were not relevant to the determination of whether Ms.
Gentle could perform her previous jobs. See Cass,
8 F. 3d at 555.
Second, Ms. Gentle also claims that the ALJ's hypothetical
question to the VE did not properly take into account Ms.
Gentle's previous participation in special education courses.
Although it is unclear from her brief exactly how she believes
her educational experience has been misrepresented, vocational
factors such as education are not relevant to the question of
whether or not a claimant can perform her past relevant work.
20 C.F.R. § 404.1560 (b)(3)(2004). Moreover, while Ms. Gentle
indicated difficulty in reading, the record shows that she
received "Bs" and "Cs" in her high school reading and English
courses (R. 147-49). In any event, Ms. Gentle's education
deficits were addressed in the portion of the hypothetical
limiting the available work to that which did not require
performance of "detailed or complicated tasks" (R. 52).
Third, Ms. Gentle claims that the ALJ failed to evaluate Ms.
Gentle's current capacity to perform the specific physical
requirements of her past jobs. In determining whether a claimant
can perform her past relevant work, an ALJ may rely on a
vocational expert's testimony in response to "a hypothetical
question about whether a person with the physical and mental
limitations imposed by the claimant's medical impairment(s) can
meet the demands of the claimant's previous work, either as the
claimant actually performed it or as generally performed in the
national economy." 20 C.F.R. § 404.1560 (b) (2) (2004). "The issue is not whether the
applicant for benefits can return to the precise job [she] held,
which is hardly likely to have been held open for [her], but
whether [she] can return to a "job" [she] held that exists at
other employers." Smith v. Barnhart, No. 03-3498 slip op. at 4,
2004 WL 2382142, *2 (7th Cir. Oct. 26, 2004).
Here, the ALJ presented the VE with a hypothetical question
based on Ms. Gentle's RFC (R. 52-53). In response, the VE
testified that Ms. Gentle's work as a lunchroom attendant and a
deli worker would both be considered "light and unskilled," work
that could be performed by a person with Ms. Gentle's limitations
(R. 52). The hypothetical question the ALJ posed to the VE
specifically referred to Ms. Gentle's physical and mental
abilities (R. 52-53). The VE was present while Ms. Gentle
testified regarding the specific details of Ms. Gentle's previous
jobs. (R. 28-30, 35, 50). Since Ms. Gentle offered no evidence
indicating that her physical impairments were more severe at the
time of the hearing in comparison to when she last worked, the
ALJ's hypothetical question to the vocational expert was
sufficient to elicit the expert's opinion as to whether Ms.
Gentle could perform her previous relevant work. See Nolen v.
Sullivan, 939 F. 2d 516, 519 (7th Cir. 1991). Moreover,
there is no evidence that the specific requirements of Ms.
Gentle's previous jobs as a lunchroom attendant or deli worker
would require any physical or mental abilities beyond those of
which the ALJ found Ms. Gentle to be in possession. See Smith,
No. 03-3498, slip op. at 4.
We have little doubt as did the ALJ that Ms. Gentle is
afflicted with impairments and other circumstances that create an
unfortunate life situation. But not every set of impairments
meets the statutory definition of disability, and to Ms. Gentle's
misfortune, the ALJ's conclusion that Ms. Gentle's condition did
not meet that statutory definition was supported by substantial
evidence and thus must be affirmed. For the foregoing reasons, Ms. Gentle's
motion (doc. # 18) is denied and the Commissioner's motion
summary judgment (doc. # 19) is granted.