United States District Court, N.D. Illinois, Western Division
MEMORANDUM OPINION AND ORDER
D. Johnston, United States Magistrate Judge
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
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
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.
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.
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.
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).
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
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
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
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.
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