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Taylor v. Berryhill

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

June 11, 2019

Denise Taylor, Plaintiff,
Nancy A. Berryhill, acting Commissioner of Social Security. Defendant.


          Elaine E. Bucklo United States District Judge

         Plaintiff Denise Taylor (“Taylor”) brought this action against Nancy A. Berryhill, Acting Commissioner of the Social Security Administration (the “Commissioner”), for review of the denial of her applications for disability insurance benefits (“DIB”) under Title II of the Social Security Act, and supplemental security income benefits (“SSI”) under Title XVI of the Social Security Act. Taylor now moves to reverse the Commissioner's decision. She claims that the Commissioner's determination that she is not disabled, and thus is not entitled to DIB or SSI, was not supported by substantial evidence and is contrary to the law. For the following reasons, Taylor's motion is granted in part and denied in part. This case is remanded to the Social Security Administration for proceedings consistent with this opinion.


         On April 15, 2015, Taylor filed her applications for DIB and SSI. R. 21. In these two applications, Taylor claimed that she had been disabled since February 14, 2015, around when she underwent surgery and developed a spinal epidural abcess. Id. at 21, 71. Taylor's medical records indicated that she also had neuropathy, a fractured toe, osteoarthritis of the thumb, an ACL tear, hypertension, anemia, and depression. Id. at 24. Taylor worked as an operating room technician for approximately 23 years before her February 2015 surgery. Id. at 21, 51. During 2016, she worked part-time in a medical sterile processing department. Id. at 50-54.

         Taylor's applications were denied on November 4, 2016, and upon reconsideration on January 29, 2016. R. 21. Taylor thereafter requested a hearing, which took place on January 26, 2017 before an administrative law judge (the “ALJ”). Id. She testified at that hearing as did a vocational expert. Id. The ALJ denied Taylor's claims on June 22, 2017, finding she was not disabled as defined in the Social Security Act. Id. at 31.

         In reaching her decision, the ALJ employed the five-step inquiry set out in 20 C.F.R. §§ 404.1520 and 416.920. That inquiry requires a determination of “(1) whether the claimant is currently employed; (2) whether the claimant has a severe impairment; (3) whether the claimant's impairment is one that the Commissioner considers conclusively disabling; (4) if the claimant does not have a conclusively disabling impairment, whether he can perform his past relevant work; and (5) whether the claimant is capable of performing any work in the national economy.” Kastner v. Astrue, 697 F.3d 642, 646 (7th Cir. 2012) (citation omitted). These steps are applied sequentially. Craft v. Astrue, 539 F.3d 668, 673-74 (7th Cir. 2008). The claimant bears the burden of proof on steps one through four; the burden of proof shifts to the Commissioner for step five. Young v. Barnhart, 362 F.3d 995, 1000 (7th Cir. 2004). To reach a finding that the claimant is disabled, the ALJ must reach an affirmative answer at step three or step five. Craft, 539 F.3d at 673-74.

         At step one, the ALJ determined that Taylor had not engaged in substantial gainful activity since February 14, 2015, her claimed onset date. R. 23. Taylor had some earnings in 2016 but was not then employed as defined in 20 C.F.R. § 404.1571 et seq. and § 416.971 et seq. Id.

         At step two, the ALJ found that Taylor had one severe impairment: status post spinal cord injury. R. 23-24. Taylor's other physical impairments were found to be non-severe: neuropathy, status post fractured toe, joint osteoarthritis, an ACL tear, hypertension, and anemia. Id. at 24. The ALJ further determined that Taylor's depression was not severe and caused no more than minimal limits on Taylor's ability to perform basic mental work activities. Id.

         In assessing Taylor's depression at step two, the ALJ considered four functional areas, also known as the four “Paragraph B” criteria for mental functioning. See 20 C.F.R. § Pt. 404, Subpt. P, App. 1. The ALJ determined that Taylor had: (1) “no limitations in understanding, remembering, or applying information”, (2) “no limitations in interacting with others, ” (3) “no limitations in concentrating, persisting, or maintaining pace, ” and (4) “mild limitations in adapting or managing oneself.” R. 24. The ALJ explained that these determinations were not themselves an assessment of Taylor's residual functional capacity (“RFC”) to perform her past work, but that her assessment at step four would reflect these determinations. Id. at 25.

         The ALJ supported these functional area determinations with a summary of Taylor's reported symptoms and relevant medical opinions. In June 2015, Taylor reported that she finished things she started to do, followed written instructions well, followed spoken instructions very well, and read three times a week. Id. at 24, 267-73. In September 2015, Taylor reported that she did not finish things she started to do or follow instructions well, but she also reported external stressors at that time, including financial issues. Id. at 24, 283. Taylor “had never been hospitalized for mental health treatment, never been in individual therapy, and had never taken psychotropic medications, ” and, on examination, Taylor “was alert and oriented to person, place and time.” Id. Taylor was diagnosed with “major depression, severe, single episode” on October 22, 2015. Id. at 24, 2363. Taylor's subsequent psychiatric examinations in April, May, June, and September 2016, “showed mostly a normal mood and affect.” Id. at 24, 2392, 2519, 2523, 2527.

         At step three, the ALJ determined that Taylor did not have an impairment or combination of impairments that were conclusively disabling. Id. at 25.

         At step four, the ALJ concluded that Taylor could perform light work: frequent lifting of up to 10 pounds, maximum lifting of not more than 20 pounds, and a good deal of walking or standing. Id. at 25-30 (citing 20 CFR §§ 404.1567(b) and 416.967(b)). To reach this conclusion, the ALJ analyzed evidence of Taylor's physical abilities and her depression. The ALJ considered that Taylor reported she used a walker and cane in 2015 and 2016 and reported using her cane consistently in 2017. Id. at 26, 28. November 2016 physical therapy progress notes from the Rehabilitation Institute of Chicago stated that Taylor's ambulation status was “complete independence, ” Taylor had met all goals on her release from physical therapy, she reported she was “80% back to normal, ” and “her functional gait status revealed 30/30 with no apparent defects and 5/5 strength in the bilateral lower extremities.” Id. at 28 (citing R. 2424, 2476).

         The ALJ assigned partial weight to the March 30, 2016 opinion of Dr. Bakhtiar Yamini, Taylor's neurosurgeon, that Taylor could return to work part-time with limits on the weight she was lifting. The ALJ listed four reasons for giving Dr. Yamini's opinions partial weight. Id. at 29. First, November and December 2015 progress notes from Taylor's family medicine practitioner, Dr. Andi Arnautovic, stated that Taylor's “anemia results were all within normal limits, ” her “peripheral neuropathy was controlled with Gabapentin, ” and her left knee pain was doing well. Id. (citing R. 2495, 2515). Second, Dr. Yamini's March 2016 notes also stated that Taylor was ready to go back to work, she moved her extremities well, and was significantly improving. Id. (citing R. 2552). Third, the ALJ noted Taylor's substantial gainful activity earnings from June 2016 through September 2016. “Id. (citing R. 224-25). Fourth, November 2016 physical therapy records from the Rehabilitation Institute of Chicago show Taylor's ambulation status was “complete independence.” Id. (citing R. 2424).

         In assessing Taylor's RFC, the ALJ stated that she gave “great weight” to the state agency psychologists' “assessments for no more than mild limitations in the paragraph B criteria.” Id. The ALJ noted that these reports' assessment of a severe mental impairment was not consistent with the reports' narratives, which listed no more than mild limitations for Taylor. Id. The ALJ also contrasted these reports against Taylor's lack of history of psychiatric or mental health treatment and consistent reports of normal mood from other medical examiners. Id.

         The ALJ recognized that, in September 2015, Taylor reported her medications made her drowsy, caused memory loss, and frequent urination. Id. at 26. The ALJ later noted that Taylor's October 2015 psychiatric examination showed that she was alert, could relate recent news events, and perform simple memory tests. Id. at 28-29. And, in March 2016, Taylor denied having bladder problems. Id. at 29.

         At step five, the ALJ concluded that Taylor can perform her past job as an operating room technician and that that job was not precluded by Taylor's RFC. Id. at 30.

         Taylor requested review of the ALJ's decision. The Appeals Council denied her request on January 25, 2018. The ALJ's decision then became the final decision of the Commissioner. Haynes v. ...

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