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Streater v. Berryhill

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

December 28, 2017

NANCY A. BERRYHILL, Acting Commissioner of Social Security, [1] Defendant.


          Young B. Kim, United States Magistrate Judge

         Willie Streater seeks supplemental security income (“SSI”) based on his claim that he has disabling back pain. After the Commissioner of the Social Security Administration denied his application, Streater filed this suit seeking judicial review. See 42 U.S.C. § 405(g). Before the court are the parties' cross-motions for summary judgment. For the following reasons, Streater's motion is denied and the government's is granted:

         Procedural History

         Streater filed his application for SSI in January 2013, claiming a disability onset date of September 15, 2010. (Administrative Record (“A.R.”) 126-31.) After his claim was denied initially and upon reconsideration, (id. at 66, 73), Streater sought and received a hearing before an Administrative Law Judge (“ALJ”) which took place on March 24, 2015, (id. at 34-49). On June 17, 2015, the ALJ issued a decision concluding that Streater is not disabled and therefore not entitled to SSI. (Id. at 17-33.) When the Appeals Council denied Streater's request for review, (id. 1-7), the ALJ's decision became the final decision of the Commissioner, see Minnick v. Colvin, 775 F.3d 929, 935 (7th Cir. 2015). Streater filed this lawsuit seeking judicial review of the Commissioner's final decision, see 42 U.S.C. § 405(g); (R. 1), and the parties have consented to this court's jurisdiction, see 28 U.S.C. § 636(c); (R. 6).


         Streater worked two hours per week as a self-employed auto mechanic from 1986 until 2009, after which he reported doing “clean up” work two hours a week through the date of his SSI application in 2013. (A.R. 163.) Streater asserts that beginning in September 2010, at the age of 48, he began suffering from back pain that prevented him from working on a full-time basis. During the March 2015 hearing, Streater presented medical and testimonial evidence in support of his claim.

         A. Medical Evidence

         The medical record shows that Streater went to the emergency room in November 2012 complaining of back pain and left leg pain. (A.R. 340.) Records from that visit include x-ray results showing degenerative disc disease at ¶ 5-S1 and joint disease at ¶ 4-L5 and L5-S1 with suggested neuroforaminal stenosis. (Id. at 254.) An examination showed normal alignment in his back, normal patellar reflexes bilaterally, intact sensation in his lower extremities, normal strength in his upper and lower extremities, and a negative straight-leg raise test bilaterally. (Id. at 346.) Streater's lumbar region was negative for obvious deformities, but there was tenderness to palpation of the left sacroiliac joint and pain with forward flexion and hip rotation to the right. (Id.) Streater was given pain medications, which he said helped alleviate his back pain. (Id.) He was also able to stand and walk with a normal gait. (Id.)

         The following month in December 2012, Streater began seeing Dr. Muhammad Rafiq for routine primary care. (Id. at 248.) Streater complained of sometimes having lower back pain radiating to his left leg. (Id.) Dr. Rafiq noted that a physical examination of Streater's back showed it was within normal limits. (Id. at 249.) Dr. Rafiq prescribed ibuprofen and methocarbamol to treat Streater's pain and ordered an MRI, which was completed in January 2013. (Id. at 250, 256-57.) The MRI showed multilevel degenerative disc disease and degenerative facet arthropathy. (Id. at 256-57.)

         In February 2013 state agency consultant Dr. Phillip Galle reviewed the MRI results along with Streater's other records and determined that Streater is still capable of performing light work because he had a normal musculoskeletal exam in December 2012. (Id. at 50-55.) In October 2013 Dr. Charles Wabner, another state agency consultant, affirmed Dr. Galle's initial assessment that Streater is capable of light work. (Id. at 57-64.)

         Meanwhile, Streater went back to see Dr. Rafiq in March 2013 for a routine visit. (Id. at 290.) Upon examination Streater had a positive straight-leg raise test in his right leg and complained of pain during a range-of-motion test. (Id. at 291.) Dr. Rafiq again prescribed ibuprofen and methocarbamol and gave Streater a handout with physical therapy exercises. (Id. to 293.) During subsequent visits in July and December 2013 and July 2014, Dr. Rafiq refilled Streater's medications and prescribed Tramadol and a back brace for his pain. (Id. at 285, 308, 310, 331.) A second MRI performed in June 2014 showed no significant interval changes from the first MRI taken in January 2013. (Id. at 357.)

         Dr. Rafiq completed a questionnaire in December 2014 in which he opined that Streater can only sit for two to three hours and stand and/or walk for less than one hour in an eight-hour workday. (Id. at 328.) He also opined that Streater has to get up from a seated position every 20 minutes to move around and must return to a seated position after 5 minutes. (Id.) Dr. Rafiq noted that Streater's symptoms would be severe enough to frequently interfere with his attention and concentration throughout the workday, and that Streater would also need to take five- to ten-minute unscheduled breaks every one to two hours. (Id. at 329.) Finally, Dr. Rafiq determined that Streater would likely be absent from work more than three times a month because of his impairments, and that his symptoms go as far back as October 2010. (Id. at 330.) Dr. Rafiq wrote that his opinion was based on MRI findings, lumbar flexion of 80 degrees, a positive straight-leg raise test on the left, and 4/5 weakness in Streater's lower extremity. (See Id. at 326.) In January 2015 Dr. Rafiq prescribed Streater a walking cane. (Id. at 317.)

         B. Streater's Hearing Testimony

         Streater described his symptoms and medical treatment at the March 2015 hearing. He testified that he started having back pain about four years before the hearing and that it has gotten progressively worse since then. (A.R. 40, 43.) He said that he is in constant pain, has numbness in his left leg all the time, suffers from imbalance, and cannot sleep well. (Id. at 43, 45-46.) Streater also explained that he has been taking Tramadol and a muscle relaxer and wearing a back brace to address his pain. (Id. at 41.) He said that because of his medications he suffers from diarrhea, chronic nose bleeds, migraines, and stomach cramps. (Id. at 43.) According to Streater, with the help of a cane he can only walk for half a block. (Id. at 42.) Before he used a cane, he relied on walking sticks to ambulate. (Id. at 42-73.) He also testified that he might fall three or four times ...

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