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Warren v. Colvin

United States District Court, N.D. Illinois, Eastern Division

January 4, 2017

Crystal D. Warren, Plaintiff,
Carolyn Colvin, Acting Commissioner of Social Security, Defendant.


          Honorable Thomas M. Durkin United States District Judge

         Plaintiff Crystal D. Warren appeals from the final decision of the Acting Commissioner of Social Security (“Commissioner”) denying her application for disability insurance benefits. For the reasons that follow, the Commissioner's decision is vacated and the case is remanded for further proceedings.


         Warren filed an application for disability benefits on August 17, 2011, alleging that, as a result of her illnesses, she has been unable to work since March 14, 2011. (AR 121).[1] Warren later amended the date of the onset of her disability to April 1, 2012. (AR 211). Warren's application was denied initially on March 9, 2012, (AR 124), and upon reconsideration on July 2, 2012, (AR 128, 131). On July 18, 2012, Warren filed a request for a hearing before an Administrative Law Judge (“ALJ”). The hearing took place on February 18, 2014 (AR 51-117), and the ALJ issued a written decision denying Warren's application on May 30, 2014 (AR 20-44). The ALJ's findings on steps 1, 2 and 3 of the five-part sequential evaluation process used to determine whether a claimant seeking Social Security disability benefits is disabled, [2] are not in dispute. Instead, Warren's appeal focuses on the ALJ's determination on step 4, that she has the residual functional capacity (“RFC”) to perform her past relevant work as a mailroom attendant, and, on step 5, that she also can perform other “light work” jobs[3] in the national economy such as hand packager, cleaner, and laundry sorter. Warren filed a request for review of the ALJ's decision with the Social Security Administration Appeals Council on August 1, 2014. (AR 15). The Appeals Council denied her request on August 26, 2015. (AR 1). Warren then filed the present action. R. 1. This Court has jurisdiction to review the Commissioner's final decision denying Warren's application for disability benefits pursuant to 42 U.S.C. § 405(g).

         Standard of Review

         Judicial review of a final decision of the Social Security Administration is generally deferential. The Social Security Act requires the reviewing court to sustain the ALJ's findings if they are supported by substantial evidence. See 42 U.S.C. § 405(g). Substantial evidence means “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 (1971). The court should review the entire administrative record, but must “not reweigh the evidence, resolve conflicts, decide questions of credibility, or substitute [its] own judgment for that of the [ALJ].” Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000). “However, this does not mean that [the court] will simply rubber-stamp the [ALJ's] decision without a critical review of the evidence.” Id. A decision may be reversed if the ALJ's findings “are not supported by substantial evidence or if the ALJ applied an erroneous legal standard.” Id. In addition, the court will reverse if the ALJ does not “explain his analysis of the evidence with enough detail and clarity to permit meaningful appellate review.” Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005). In addition, the ALJ “has a duty to fully develop the record before drawing any conclusions, ” Murphy v. Astrue, 496 F.3d 630, 634 (7th Cir. 2007), and deference in review is lessened when the ALJ has made errors of fact or logic, Thomas v. Colvin, 745 F.3d 802, 806 (7th Cir. 2014). When the ALJ has satisfied these requirements, the responsibility for deciding whether the claimant is disabled falls on the Social Security Administration, and, if conflicting evidence would allow reasonable minds to differ as to whether a claimant is disabled the ALJ's decision must be affirmed. Herr v. Sullivan, 912 F.2d 178, 181 (7th Cir. 1990) (internal quotation marks and citation omitted).


         The ALJ found that Warren suffered from several severe impairments, including systemic lupus erythematous (“SLE”), depression, anxiety, and alcohol abuse. (AR 22). SLE is an autoimmune disease where the body's immune system mistakenly attacks healthy tissue. See 435.htm (last visited on 1/3/2017). It can affect the skin, joints, kidneys, brain, and other organs, with symptoms varying from person to person depending on which body parts are most affected in that person. Id. Almost everyone with SLE, however, has joint pain and swelling in the fingers, hands, wrists, and knees. Id. In addition to her joints, Warren's SLE symptoms in the past have primarily affected her skin, a condition known as discoid lupus. See http://www.aocd. org/?page=DiscoidLupusErythe (last visited on 1/3/2017). A person with discoid lupus can experience chronic skin sores, inflammation, and scarring on the face, ears, scalp and other parts of the body. Id.

         According to her medical records, Warren is being treated by a team of doctors at Northwestern Medical Facility. Her primary care provider is Dr. Tang, and her treating rheumatologist is Dr. Hsieh. Warren also has received treatment from a psychiatrist (Dr. Dinwiddie), an ophthalmologist (Dr. Schmidt), a dermatologist (Dr. Laumann), and another internist (Dr. Dolan). To control her lupus symptoms, Warren has been prescribed a medication called hydroxychloroquine, also known as Plaquenil. (AR 342). The possible side effects of Plaquenil include headaches, dizziness, nausea, and vision problems. See https://www.nlm.nih. gov/medlineplus/druginfo/meds/a601240.html (last visited on 1/3/2017). In addition to taking Plaquenil to control her lupus symptoms, Warren is taking medications for pain (methotrexate, prednisone, and ibuprofen), for skin irritations, lesions, and hair loss (clindamycin lotion and clobetasol propionate), for chronic coughing (albuterol inhaler), and for depression (Paxil). (AR 342).

         Warren reports that her symptoms from lupus include constant pain, swelling, weakness, numbness, and tingling in her hands, legs, ankles, and/or back. (AR 253). She also reports “severe throbbing pain” in her left eye, blurred vision, lesions on her scalp that ache at times, shortness of breath with physical activity, and “burning pain in [her] back after sitting for longer periods of time.” (Id.). She states that she (1) has “difficulty getting up from a seated position due to muscle spasms in [her] back, ” (2) “cannot lift and carry objects that weigh more tha[n] a gallon of milk, ” (3) “experience[s] lightheadedness and dizziness, ” and (4) is “sensitive to the light, sit[s] in the dark a lot, ” and has “to avoid being in the sun due to doctor[']s orders.” (Id.). She also reports that she has feelings of “hopelessness and helplessness, ” “nervousness and frustration, ” and “self-hate, guilt and worthlessness, ” and that she is “easily angered, ” “lack[s] motivation to do most things, ” has “mood swings” and “crying spells a few times per day, ” “has difficulty concentrating, ” and “lacks energy and is fatigued most of the time.” (Id.). She states that she avoids being around others, does not talk on the phone, isolates herself at home, and needs to be reminded to care for her personal needs such as showering and combing her hair. (Id.).

         Warren repeated these symptoms at the administrative hearing, where she testified that the pain she experiences has increased significantly since she was first diagnosed with lupus, that her back hurts, her hands hurt, and her head throbs daily (AR 76), that she had a pain shooting down to her kneecap and around to her abdomen as she was testifying right then (AR 82), that four days out of the week the pain is “excruciating (id.), that she does not sleep well because of the pain (AR 83), that she stopped driving because her leg no longer functions comfortably (id.), and that she frequently does not wear underwear at home because the pain in her fingers prevents her from putting them on (id.). She wears splints on her hands “24/7” to help with the wrist pain, but neither the splints nor ibuprofen help with the pain in her fingers (AR 83-84). She gets headaches at least three to four times during the week, which she experiences as a throbbing pain over her left eye (AR 85-86), and she sees a psychiatrist to talk about her depression from having lupus and how it changed her life and forced her to take all kinds of medicine that make her feel sick (AR 86-87). She reports that she has tried a number of antidepressants, but experiences negative side effects from them (AR 87-88), and that she has not been able to obtain continuous psychiatric treatment because her insurance does not cover it and she cannot always afford to pay for the appointments (AR 88). She testified that, although she had tried in early 2012 to return to work on a part-time basis, she was fired in May 2012 because her employer could no longer accommodate her part-time work schedule. (AR 71-72). She estimated she could lift four pounds, stand about fifteen minutes at a time, walk about a half block, and sit twenty to thirty minutes continuously without exacerbating her pain. (AR 103-105).

         A person is disabled under the Social Security Act if she has 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 12 months.” 42 U.S.C. § 423(d)(1)(A). Warren's description of her symptoms makes a compelling case that she is disabled from gainful employment, which “normally requires an ability to work a 40-hour week without missing work more than twice a month.” Allensworth v. Colvin, 814 F.3d 831, 833 (7th Cir. 2016). The ALJ, however, rejected both Warren's testimony concerning the nature and extent of her impairments and the medical opinion evidence that supported a finding that she was disabled. After a thorough review of the record, the Court concludes that the reasons given by the ALJ for her rejection of this evidence are either legally insufficient or not supported by substantial evidence, thus requiring a remand for reconsideration of Warren's disability application in accord with the principles discussed below.

         A. The ALJ's Rejection Of The Opinion Of Warren's Treating Primary Care Physician

         The ALJ rejected the opinion of Warren's treating primary care physician, Dr. Tang, who stated in a letter dated April 30, 2012 that, “[b]ecause of [Warren's] multiple medical conditions, ” she “recommended that it not be in [Warren's] best interest to work full-time.” (AR 709). Dr. Tang further stated that, “[d]ue to the uncertain course of [Warren's] medical condition and the necessary ongoing changes in medication management, [she is] unable to supply a concrete date for [Warren's] return to work on a full-time basis.” (Id.). “[T]o the extent a treating physician's opinion is consistent with the relevant treatment notes and the claimant's testimony, it should form the basis for the ALJ's determination.” Bates v. Colvin, 736 F.3d 1093, 1100 (7th Cir. 2013) (citation omitted). But the ALJ accorded Dr. Tang's opinion only “slight weight” because (1) it was “conclusory”; (2) it did “not contain any functional capacity assessment”; (3) it was “not consistent with or supported by Dr. Tang's contemporaneous progress and examination notes, or with the objective imaging studies and laboratory reports”; and (4) it “seem[ed] to be affected by her sympathy for the claimant, and claimant's reported need for frequent visits to manage her treatment and medication.” (AR. 38) None of these reasons justify the ALJ's rejection of Dr. Tang's opinion.

         To begin with, the asserted conclusory nature of Dr. Tang's opinion is not an adequate basis to reject it. To be sure, the ALJ was not bound by Dr. Tang's conclusion in her letter that Warren should not work full-time. See Garcia v. Colvin, 741 F.3d 758, 760 (7th Cir. 2013) (the ALJ “was not bound” by the claimant's doctor's statement in a letter that the claimant “‘will be unable to return to any form of employment, ' because a doctor may not be acquainted with the full range of jobs that a person with [the claimant's] ailments could fill”). Nevertheless, it appears from Dr. Tang's letter and Warren's medical records that Warren's ability to work full-time was severely diminished by the overall impact of her many symptoms, by the side-effects of her various medications taken for those symptoms, by the uncertainties caused by sudden onset and fluxuating symptoms, and by the practical and emotional difficulties she understandably was having managing all of those things. The impact of these things on Warren's RFC are matters “to which medical testimony is relevant and if presented can't be ignored.” Id. (citing Bjornson v. Astrue, 671 F.3d 640, 647-48 (7th Cir. 2012), and Ferguson v. Commissioner of Social Security, 628 F.3d 269, 272-73 (6th Cir. 2010)). If the ALJ thought that it was possible there were jobs in the economy that Warren could perform despite her lupus diagnosis and the difficulties that diagnosis presented for her, as alluded to in Dr. Tang's letter, she “should have asked [Dr. Tang] to specify more exactly what ‘functions' [Warren] is incapable of performing, ” Garcia, 741 F.3d at 760, before rejecting Dr. Tang's opinion as conclusory and according it only slight weight for that reason.[4]

         Similarly, the ALJ should not have discounted Dr. Tang's opinion based on the absence of a functional capacity assessment. Presumably, the ALJ was referring to Warren's physical functional capacity when she mentioned Dr. Tang's failure to provide such an assessment. Again, the ALJ should have asked Dr. Tang to clarify her physical functional capacity assessment of Warren if the ALJ desired more information about that before deciding what weight to give Dr. Tang's opinion. Moreover, a claimant's RFC can be affected by both exertional impairments and non-exertional impairments. “Exertional impairments are those that affect the claimant's ‘ability to meet the strength demands of jobs (sitting, standing, walking, lifting, carrying, pushing, and pulling), '” while “[n]onexertional impairments-such as depression, anxiety, difficulty concentrating or remembering-are defined as all other impairments that do not affect a claimant's ability to meet the strength demands of jobs.” Fast v. Barnhart, 397 F.3d 468, 470 (7th Cir. 2005) (quoting 20 C.F.R. § 404.1569a(b) and 20 C.F.R. § 404.1569a(c)(1)). Dr. Tang's opinion appears to reflect primarily non-exertional impairments related to the uncertainties and difficulties in managing a medical diagnosis of lupus, and her opinion regarding these non-exertional matters is not rendered irrelevant simply because she does not also state an opinion regarding the extent to which Warren's RFC is affected by exertional impairments caused by her illness. The ALJ had a duty to consider both exertional and non-exertional impairments in deciding whether Warren was disabled.

         Third, the ALJ failed to provide an explanation of the ways in which Dr. Tang's opinion was inconsistent with or not supported by her contemporaneous progress and examination notes or the objective imaging studies and laboratory reports. While the Court could speculate about what the ALJ had in mind based on the ALJ's description of the medical records in another part of her decision, it would not be appropriate to do so. Instead, the ALJ “must build an accurate and logical bridge from the evidence to [her] conclusion, ” Beardsley v. Colvin, 758 F.3d 834, 837 (7th Cir. 2014), and the ALJ did not make any attempt to do that here.

         Finally, the ALJ's speculation that Dr. Tang's opinion might have been affected by her sympathy for Warren is not supported by substantial evidence in the record. While the Seventh Circuit has said that the ALJ has the ability as a trier of fact to consider a treating physician's possible sympathy bias, see, e.g., Reynolds v. Bowen, 844 F.2d 451 (7th Cir.1988); Stephens v. Heckler, 766 F.2d 284 (7th Cir. 1985), it also has stated that:

Reynolds and Stephens do not create a presumption of bias in a treating physician's disability opinion; the cases recognize only the ALJ's ability as a trier of fact to consider a physician's possible bias. The ability to consider bias, however, is not synonymous with the ability to blithely reject a treating physician's opinion or to discount that physician's opportunity to have observed the claimant over a long period of time. Reynolds and Stephens, moreover, do not change the requirement that the ...

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