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Guetschow v. Colvin

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

January 23, 2017

Tina Guetschow Plaintiff,
Carolyn W. Colvin, Acting Commissioner of Social Security, Defendant.


          Iain D. Johnston, United States Magistrate Judge

         Plaintiff Tina Guetschow brings this action under 42 U.S.C. §405(g), challenging the denial of social security disability benefits. The appeal raises one issue, which can be stated as follows: whether the administrative law judge (“ALJ”) properly rejected the opinions of two treating physicians and relied instead on the ALJ's own layperson analysis to find that plaintiff's problems from multiple sclerosis and spinal degeneration had improved to the point where she could work full time. The answer to this question, not surprisingly, leads to this outcome: the case is remanded.


         Plaintiff filed for disability benefits in August 2012, soon after being diagnosed with multiple sclerosis. She was then 41 years old. Her medical care was coordinated through Dr. Jack-ky Wang at the Beloit Clinic. Plaintiff first visited the clinic in May 2012, complaining about a diffuse list of problems. After various tests and measurements (including an MRI and a test of her CSF fluid), doctors at the Beloit Clinic tentatively diagnosed her with multiple sclerosis and then referred her to Dr. Christopher Luzzio at the University of Wisconsin for a second opinion. After reviewing plaintiff's medical records and examining her, Dr. Luzzio confirmed that she had multiple sclerosis-specifically “relapsing-remitting” multiple sclerosis. Over the next two years or so, plaintiff was seen multiple times by both Dr. Wang and Dr. Luzzio and was also referred to other doctors to address specific issues, such as vision problems.

         Both Dr. Wang and Dr. Luzzio completed two-page checkbox-style questionnaires about plaintiff's limitations. Dr. Luzzio completed a form on July 5, 2013. See Ex. 10F. He opined that plaintiff's medical problems would allow her to stand (with breaks) three hours a day on a job, sit (with breaks) for three hours, and walk for one hour. In response to a question about expectations for the future, he checked the box “Unknown” (the other possible answers were “Improvement, “No Change, ” or “Deterioration”) and then wrote the following: “Chronic unpredictable disease - can have ups and downs.” In response to a question asking about plaintiff's treatment, he wrote the following: “Meds: Neurontin, Avonex injections weekly, Zoloft. Neuropsych testing being scheduled, routine visits, has had MRI, L.P.” In response to the last question, asking for additional comments, he wrote the following: “[Patient] also has dysthymia. Her extreme fatigue, balance, weakness of lower extremities are all contributing to her disability related to this disease.” Dr. Wang completed a similar two-page form about a year later, on July 1, 2014. See Ex. 9F. He wrote that plaintiff had suffered from fatigue, unsteady gait, and blurry vision, the latter condition was labelled “now resolved.” He opined that she could sit for about four hours a day on a job, could stand and walk for about an hour, and would need unscheduled breaks every 30 minutes. He stated that, in a normal work day, plaintiff could use her right hand 20% of the day, her right fingers 20% of the day, and her right arm could be raised overhead 50% of the day. He estimated that she would be off task more than 30% of the day and would miss approximately five days a month.

         On July 30, 2014, a hearing was held before the ALJ. Plaintiff testified that she received a weekly injection for her multiple sclerosis, which usually led to headaches and flu-like symptoms requiring her to lie around the next day. She had been taking the injections for a year and half, but was still experiencing problems despite them. Her multiple sclerosis caused vision problems; “a lot of pain, ” particularly in her hip, back, right arm, right foot, and neck; sleep problems; fatigue; headaches (both “shooting pains” and “normal” lighter headaches); and urinary problems. She also had a lump on her thumb that would swell up and hurt badly when used too much. She was married and lived with her husband and 11-year old son. A vocational expert testified after plaintiff. No medical expert testified.

         On August 19, 2014, the ALJ found plaintiff not disabled in a 7-page decision (about half of which was boilerplate found in all ALJ decisions). The ALJ found that plaintiff had as severe impairments of multiple sclerosis and degenerative disc disease but that she was able to do sedentary work subject to certain limitations.


         As noted, the sole issue is whether the ALJ was justified in rejecting Dr. Wang's and Dr. Luzzio's opinions. This issue requires consideration of the treating physician rule. Under this rule, a treating physician's opinion is entitled to controlling weight if it is supported by medical findings and consistent with other substantial evidence in the record. 20 C.F.R. §404.1527(c)(2); Moore v. Colvin, 743 F.3d 1118, 1127 (7th Cir. 2014). If the ALJ does not give the treating physician's opinion controlling weight, the ALJ cannot simply disregard it without further analysis. Campbell v. Astrue, 627 F.3d 299, 308 (7th Cir. 2010). Instead, the ALJ must determine what specific weight, if any, the opinion should be given. Moss v. Astrue¸ 555 F.3d 556, 561 (7th Cir. 2009). To make this determination, the ALJ must apply the checklist of six factors set forth in 20 C.F.R. §404.1527(c)(2). Campbell, 627 F.3d at 308 (referring to the factors as a “required checklist”). Failure to apply the checklist is reversible error. Larson v. Astrue, 615 F.3d 744, 751 (7th Cir. 2010) (ALJ disregarded checklist).

         Here, the ALJ did not follow this two-step process. The ALJ did not refer to the treating physician rule, did not apply the requirements in the first step, and did not apply the checklist factors in the second step. Specifically, under the first step, the ALJ did not analyze whether these opinions were “well-supported by medically acceptable clinical and laboratory diagnostic techniques” or consistent with “other substantial evidence.” 20 C.F.R. §404.1527(c)(2). As plaintiff summarized in her opening brief, these two doctors reached their conclusions only after multiple tests, such as brain MRIs, had been performed. Neither the ALJ, nor the Government, has suggested that any important test or measurement was not performed. As for whether the doctors' opinions were consistent with other evidence, this question also was not analyzed in a consistent way. The ALJ made a general assertion that Dr. Wang's opinion was “not supported by the medical evidence of record, ” but this statement was not followed by any explanation or citation to specific evidence. And, of course, Dr. Wang's opinion was supported by medical evidence in the record; specifically, it was supported by Dr. Luzzio, plaintiff's other treating physician. Significantly, there were no medical opinions in the record from other doctors or consultants contradicting or casting doubt on these two opinions. The ALJ chose not to call an expert at the hearing, and gave no weight to the opinions of the agency doctors.

         As for Step Two, the ALJ did not analyze the six checklist factors. As for the first two- length and nature of treatment-the ALJ made no determination about the specific number of visits nor the precise length of the treating relationship. The ALJ gave no weight to the fact that these doctors saw plaintiff multiple times over several years. To the contrary, as discussed below, the ALJ inexplicably concluded that Dr. Wang's opinion deserved little weight because he did not see plaintiff enough. However, plaintiff's treating doctors had a close and collaborative relationship. As plaintiff summarized, Dr. Wang coordinated plaintiff's referrals to multiple specialists in the Beloit Clinic network, including rheumatology visits, an orthopedic evaluation, an ophthalmology exam, and a GI evaluation. Dkt. #24 at 2. Dr. Wang and Dr. Luzzio also kept each other informed about plaintiff's condition and test results. In short, the first two checklist factors support these doctors' opinions. The ALJ also completely ignored the fifth factor, which asks about the doctor's degree of specialization. This factor weighs in favor of these doctors' opinions, particularly that of Dr. Luzzio. He was a neurologist who worked at a University clinic specializing in the treatment of multiple sclerosis. The ALJ did not acknowledge this important fact nor give it any weight.

         The only argument offered by the Government in response is that one of the ALJ's specific criticisms of Dr. Luzzio's opinion, which is discussed below, invokes the fourth factor concerning the consistency of the opinion. Dkt. #23 at 6. But the Government does not address the other factors, especially the ones discussed above. In sum, if the ALJ had explicitly applied these checklist factors, it is possible that she would have reached a different result, but more importantly, she at least would have been forced to provide a greater explanation.

         It is true that the ALJ did not completely ignore the two opinions, and discussed each in a paragraph. However, despite this fact, the Court takes the view that an explicit analysis is still required. See Duran v. Colvin, 2015 U.S. Dist. LEXIS 101352, *8-9 (N.D. Ill. Aug. 4, 2015). But even if the Court allowed an implicit analysis, it would still remand because too many questions are unresolved.

         The Court first considers the ALJ's analysis of Dr. Wang's July 2014 opinion, which was given “little weight.” The ALJ gave two reasons for the conclusion. The first is that the opinion supposedly “contrasts with his earlier December 2012 opinion that [plaintiff] ‘may need to be on temporary disability until meds are straightened out and [she is] having no issues with them.'” R. 15. To clarify, the earlier referenced opinion is not a formal opinion nor is it even clear it was made by Dr. Wang himself. The statement is in Dr. Wang's December 21, 2012 office notes, but he appears to be ...

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