The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
MESHELLA T.,1
Plaintiff,
v. Case No. 3:21-CV-314-NJR
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.
MEMORANDUM AND ORDER
ROSENSTENGEL, Chief Judge:
In accordance with 42 U.S.C. § 405(g), Plaintiff Meshella T., through counsel, seeks
judicial review of the final agency decision denying her application for Supplemental
Social Security (SSI) benefits pursuant to 42 U.S.C. § 423.
PROCEDURAL HISTORY
On September 11, 2014, Plaintiff’s mother applied for SSI benefits on her behalf.
(Tr. 120.) Plaintiff’s claim for disability was based on ADHD, depression, mood disorder,
bipolar disorder, anxiety disorder, and mild intellectual disability. (Id.) The application
initially was denied on January 20, 2015, and was denied upon reconsideration on
September 24, 2015. (Tr. 42.) Plaintiff timely requested a hearing, and a video hearing was
held before Administrative Law Judge Jason R. Yoder on June 20, 2017. (Tr. 42, 67.)
The ALJ issued an unfavorable decision on January 9, 2018, finding that Plaintiff
1 Plaintiff’s full name will not be used in this Memorandum and Order due to privacy concerns. See FED.
R. CIV. P. 5.2(c) and the Advisory Committee Notes thereto.
had not been disabled as a child under Section 1614(a)(3)(C) and was not disabled as an
adult under Section 1614(a)(3)(A) of the Social Security Act. (Tr. 39-61.) The Appeals
Council denied Plaintiff’s request for review, rendering the ALJ’s decision the agency’s
final decision for purposes of judicial review. (Tr. 30-34.) Plaintiff now appeals that
decision directly to this Court, pursuant to 42 U.S.C. § 1383(c) and 20 C.F.R. § 404.984.
ISSUES RAISED BY PLAINTIFF
Plaintiff raises four issues:
1. Whether the ALJ improperly evaluated Plaintiff’s functional
equivalency as a child where the ALJ failed to consider or address
evidence that supports a finding of greater functional limitations.
2. Whether the ALJ’s analysis of Plaintiff’s functioning as an adult is
fundamentally flawed where the ALJ failed to reach a finding regarding
the consistency of Plaintiff’s allegations of the nature, severity, and
limiting effects of her subjective symptoms.
3. Whether the ALJ improperly rejected the opinion of Gabe Martin, PA,
where the ALJ’s rationale was factually incorrect and legally
insufficient.
4. Whether the ALJ’s Step Five finding is not supported by substantial
evidence where it is based on an incomplete and inadequately
supported RFC assessment.
LEGAL STANDARD
To qualify for SSI, a claimant must be disabled within the meaning of the
applicable statutes. Under the Social Security Act, a person is disabled 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 twelve
months.” 42 U.S.C. § 423(d)(1)(a).
A “physical or mental impairment” is an impairment resulting from anatomical,
physiological, or psychological abnormalities demonstrated by accepted diagnostic
techniques. 42 U.S.C. § 423(d)(3). “Substantial gainful activity” is work activity that
involves doing significant physical or mental activities and that is done for pay or profit.
20 C.F.R. § 404.1572.
Social Security regulations set forth three sequential steps used to determine
whether a child is disabled. 20 C.F.R. § 416.924. First, the ALJ considers whether the child
is doing substantial gainful activity. Id. If so, the child is not disabled, and the claim will
not be reviewed further. Id. Second, if the child does not have a severe medical
impairment or combination of impairments, then the child is not disabled, and the claim
will be denied. Hopgood ex rel. L.G. v. Astrue, 578 F.3d 696, 699 (7th Cir. 2009). Third, if the
impairments are severe, the ALJ determines whether the impairments meet, medically
equal, or functionally equal any of the Listings of Impairments contained in 20 C.F.R.
pt. 404, subpt. P, App. 1. Id.
For adults, there are five questions for the ALJ to consider in assessing whether a
claimant is disabled: (1) Is the claimant presently unemployed? (2) Does the claimant
have a severe impairment? (3) Does the impairment meet or medically equal one of a list
of specific impairments enumerated in the regulations? (4) Is the claimant unable to
perform his or her former occupation? and (5) Is the claimant unable to perform any other
work? See 20 C.F.R. § 404.1520.
An affirmative answer at either step three or step five leads to a finding that the
claimant is disabled. A negative answer at any step, other than at step three, precludes a
finding of disability. The claimant bears the burden of proof at steps one through four.
Once the claimant shows an inability to perform past work, the burden then shifts to the
Commissioner to show the claimant’s ability to engage in other work existing in
significant numbers in the national economy. Zurawski v. Halter, 245 F.3d 881, 886 (7th
Cir. 2001).
Once an assessment has been made and a claimant appeals a denial, the Court may
only review the Commissioner’s decision to ensure it is supported by substantial
evidence and that the Commissioner made no mistakes of law. Lopez ex rel. Lopez v.
Barnhart, 336 F.3d 535, 539 (7th Cir. 2003). “The findings of the Commissioner of Social
Security as to any fact, if supported by substantial evidence, shall be conclusive. . . .”
42 U.S.C. § 405(g). The Supreme Court defines substantial evidence as “more than a mere
scintilla, and means only such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (internal
citations omitted). “Even if reasonable minds could differ as to whether plaintiff was
disabled at the relevant time, the ALJ’s decision must be affirmed if it is supported by
substantial evidence, and the Court cannot substitute its judgment for that of the ALJ in
reviewing for substantial evidence.” B. v. Comm’r of Soc. Sec., No. 17-cv-1243-DGW, 2020
WL 230594, at *4 (S.D. Ill. Jan. 15, 2020).
In reviewing for “substantial evidence,” the entire administrative record is taken
into consideration, but the Court will not reweigh the evidence, assess credibility, or
otherwise substitute its own judgment for that of the ALJ. Burmester v. Berryhill, 920 F.3d
507, 510 (7th Cir. 2019). The ALJ need not discuss every piece of evidence in the record.
Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). Where an ALJ ignores a whole line
of evidence contrary to the ruling, however, it makes it impossible for a district court to
assess whether the ruling rested on substantial evidence and requires the court to remand
to the agency. Golembiewski v. Barnhart, 322 F.3d 912, 917 (7th Cir. 2003).
EVIDENTIARY RECORD
The Court has reviewed and considered the entire evidentiary record in preparing
this Memorandum and Order. The following summary of the record is directed to the
points raised by Plaintiff.
I. Evidentiary Hearing
Plaintiff was represented by an attorney at the hearing on July 20, 2017. Plaintiff’s
mother and an impartial vocational expert also appeared and testified. (Tr. 67-119.)
Plaintiff, age 19 at the time of the hearing, testified that she graduated from high
school about a month before the hearing. (Tr. 73.) Plaintiff was held back in kindergarten
for being “too slow to move on,” and she started special education in first grade. (Id.)
Throughout elementary, middle, and high school, Plaintiff had an individualized
education program (IEP). (Tr. 95.) While Plaintiff can read and write, she testified that
she cannot read very well. (Id.) She can do simple math with the use of a calculator.
(Tr. 74.) Plaintiff testified she was never prepared for any kind of job, never learned how
to write a resume, and never learned how to interview. (Tr. 95-96.) She had a job in junior
high but “it didn’t work out.” (Tr. 72-73.)
Plaintiff had some months where she got along with her teachers, but there were
more months where she did not. (Id.) Plaintiff felt the teachers were not doing their job
correctly, and she would have to teach herself what she already knew from previous
years in school. (Tr. 75.) Plaintiff had some friends in school but mostly hung around with
her sister, who was two years younger. (Tr. 76.)
At the time of the hearing, Plaintiff testified that she had her driver’s license, but
she did not have a car to drive. (Tr. 77.) She also was nervous to drive, but stated that
when she moved out on her own, she would work her way up to driving. (Id.)
Plaintiff takes medication for her depression and anxiety. (Tr. 83.) She testified that
the medications help her but that she gets anxious when doing something outside her
normal routine. (Tr. 83.) Plaintiff’s dog also helps her through days where she is feeling
depressed or anxious. (Tr. 79.) The dog warns her before her depression and anxiety
becomes severe and lets her know it’s okay. (Tr. 80.) Plaintiff’s dog was not trained for
that specific reason, but he “picked it up” on his own. (Id.)
Plaintiff can shower, bathe, brush her teeth, and otherwise attend to her personal
care needs. (Id.) Sometimes her mom has to remind her to brush her teeth. (Id.) She started
cooking at age 14 and can make easy items like macaroni, hot dogs, and baked beans.
(Tr. 81.) She goes to the grocery store with her family. (Tr. 84.) Plaintiff testified that she
enjoys drawing and writing in a journal. (Id.) Plaintiff also testified that most days she
lays around the house, picks up after herself, and plays with her dog. (Tr. 88.)
On January 28, 2017, Plaintiff had a baby. (Tr. 90.) Plaintiff testified that she is not
left alone with the baby; usually her siblings or cousin are home with her. (Tr. 91.) Plaintiff
changed the baby’s diapers, but her mother would bathe the baby. (Id.)
Plaintiff testified that the number one issue keeping her from working is her
ADHD and anxiety. (Tr. 97.) Because of her ADHD, Plaintiff cannot focus or concentrate
on something for more than a matter of minutes. (Id.) Plaintiff also has “a little of both”
depression and bipolar disorder. (Tr. 98.) Her manic episodes last an hour, while her lows
last 10 to 30 minutes, though some days her lows last a few hours. (Tr. 98-99.) Plaintiff
explained she knows she’s depressed because she feels a knot in her chest and
experiences negative thoughts about not being good enough or nobody wanting her here.
(Tr. 99.) She also has thought about self-harming. (Tr. 100.) When having a manic or
depressed moment, Plaintiff cries it out or hugs her dog. (Tr. 101.) Plaintiff also testified
that she has night terrors every night of the week and needs a light on in order to sleep.
(Tr. 101-02.) According to Plaintiff, there are three to four nights a week where she gets
no sleep at all. (Tr. 102.)
Plaintiff’s mother, Sherisa, also testified at the hearing. Sherisa testified Plaintiff
has seen Gabe Martin, a psychiatric Physician’s Assistant, since the age of six. (Tr. 108.)
PA Martin changed Plaintiff’s medication or dosage four times between 2014 and 2017
due to behavioral, anxiety, and concentration issues. (Tr. 108-09.) Sherisa further testified
that Plaintiff cannot complete simple chores around the house like dusting, vacuuming,
laundry, and dishes because she loses focus. (Tr. 109-10.) They also have to remind her to
take her medicine, brush her teeth, and take out her dog. (Tr. 110.)
With regard to Plaintiff’s child, Sherisa testified that Plaintiff initially took care of
the baby but would constantly call Sherisa, saying she “can’t do this” and expressing
frustration that she didn’t understand why the baby was crying. (Tr. 106.) After two
weeks, Sherisa took temporary guardianship over the child until she could finish the
process of legal guardianship. (Tr. 106-07.) When asked what the difference was between
Plaintiff and any other teenager who has a baby, Sherisa said Plaintiff has “to put a lot of
focus and a lot of time into trying to figure out what time she fed last and things like that,
whether or not she burped her, whether she’s burping her right. And it just becomes too
overwhelming, more so than she even knows what to deal with.” (Tr. 108.)
According to Sherisa, Plaintiff cannot work because she has no sense of time.
(Tr. 111.) She also cannot focus and stay on task, and her short-term memory prevents
her from remembering what her job is to do. (Tr. 113.) Sherisa testified that she does not
allow Plaintiff to drive because she gets too excited, which breaks her concentration. (Id.)
Vocational witness Robert Breslin also testified at the hearing. Breslin testified that
Plaintiff could perform some occupations that exist in the national economy including
industrial cleaner, kitchen helper or dishwasher, or hand packager. (Tr. 116-17.) When
asked if an individual could perform these jobs if they were off task 15 to 20 percent of
the workday due to an inability to focus or remember instructions, Breslin testified that
no employer would find that level of productivity acceptable. (Id.) Breslin also was asked
whether an employee could perform these jobs if they required significant additional
supervision or if they were off task when not being supervised. (Tr. 118.) Breslin testified
that most employers would find this unacceptable in the competitive employment
environment, and that this level of supervision was more characteristic of supported
employment or sheltered employment. (Id.)
Melodee Garner, Plaintiff’s special education teacher, provided a Teacher
Questionnaire dated December 19, 2014. (Tr. 253.) As for acquiring and using
information, Garner reported that Plaintiff needs a lot of assistance from teachers and
directions must be repeated multiple times. (Tr. 254.) According to Garner, Plaintiff
struggles with all math concepts including basic addition and subtraction, as well as
counting money. (Id.) She also has serious problems with expressing ideas in written form
and applying previously learned material, and she has very serious problems with
providing oral explanations and adequate descriptions, as well as with applying
problem-solving skills. (Id.)
For attending and completing tasks, Garner reported that Plaintiff has a very
serious problem with carrying out multi-step instructions, and serious problems with
refocusing to task and completing work accurately without careless mistakes. (Tr. 255.)
Garner stated that Plaintiff struggles to stay focused in class and will interrupt the teacher
to tell a story that is unrelated to the lesson. (Id.)
Garner reported that Plaintiff has no issues with interacting and relating with
others and no issues with moving about and manipulating objects. (Tr. 256-57.) Garner
also reported that Plaintiff has no serious or very serious problems with caring for herself.
(Tr. 258.) Plaintiff does, however, have obvious problems with handling frustration
appropriately, being patient, asserting her emotional needs, and knowing when to ask
for help. (Id.) According to Garner, Plaintiff does not handle frustration in an appropriate
way, but rather becomes loud and vocal. (Id.)
II. Relevant Medical Records
Plaintiff was treated by PA Martin for her ADHD, depression, mood disorder,
bipolar disorder, and anxiety disorder. Throughout 2014 and 2015, Plaintiff often
reported hyperactivity, impulsivity, inability to focus and finish tasks, agitation, and
having very few friends. (See, e.g., Tr. 399.) Plaintiff was hospitalized in May 2014 for
suicidal ideations and cutting. (Tr. 462-68.)
Upon physical examination, PA Martin, many times, found Plaintiff to be well-
groomed, cooperative, oriented to situation, time, and place, alert, and memory intact.
(Id.) Her mood was euthymic and her affect was pleasant. (Id.) Her intelligence was below
average. (Id.) A January 31, 2014 Progress Note by PA Martin states that Plaintiff is “doing
well in school” and getting all As and Bs. Her mood was stable, and she had “no
complaints.” (Tr. 323.) In May 2015, however, PA Martin found Plaintiff to be agitated,
irritable, angry and tearful. (Tr. 546.) Her insight and judgment were impaired, and her
through processes were tangential. (Id.) But by June 2015, PA Martin performed another
exam and found Plaintiff once more to be cooperative, calm, oriented, pleasant, and
euphoric. Her insight and judgment were intact. (Tr. 543.) Her intelligence was, again,
below average. (Id.)
Dr. Fred Klug performed a psychological consultation upon request of the ALJ on
July 27, 2017. (Tr. 720.) Dr. Klug found that Plaintiff’s reasoning was poor, abstract
thinking was poor, and judgment and insight were poor. (Tr. 720-21.) Plaintiff also
underwent intelligence testing at the request of the ALJ. (Tr. 722.) Plaintiff attained a
verbal comprehension IQ score of 72, a perceptual reasoning IQ score of 69, a working
memory IQ score of 71, a processing IQ score of 79, and a full-scale IQ score of 67, which
falls within the mild range of intellectual disability. (Id.) Her full-scale IQ score indicates
she is functioning at a level below that of 99% of her peers. (Tr. 723.) It was Dr. Klug’s
opinion that Plaintiff should not manage her own funds. (Id.)
III. School Records
The ALJ considered Plaintiff’s IEP review from October 2014, which noted that
Plaintiff was functioning below the average range in all academic areas. (Tr. 326.) As part
of her IEP review, Plaintiff was observed in her biology class. (Id. at 327.) A “momentary
time sampling of attention to task” found that Plaintiff remained on task for 97% of the
observation time. (Tr. 326.) She exhibited appropriate social interaction, appropriate eye
contact, and an appropriate sense of humor. (Id.) She was able to follow directions and
complete activities. (Id.)
Plaintiff’s teachers completed the Behavior Rating Inventory of Executive Function
(BRIEF). (Id.) The results indicated Plaintiff could control her impulses and consider the
possible consequences of her actions, although she had trouble with emotional control.
(Id.) She also needed prompting to begin activities, she had difficulty planning and
organizing, and she had difficulty checking her work for accuracy. (Id.) With regard to
cognitive functioning, Plaintiff was in the low average range in overall cognitive ability.
(Tr. 327.) Her verbal comprehensive was average, her perceptual reasoning and
processing speed were low average, and her working memory was significantly below
average. As to her emotional status and social functioning, Plaintiff’s anxiety continued
to be a concern for the staff at her high school. (Tr. 329.) She had difficulty getting along
with other students in the past, but stated that “people don’t bug me this year.” (Id.)
Plaintiff was described as a hard-working student who wants to do well and tries
her best the majority of the time. (Tr. 334.) She likes to help others and makes efforts to
keep herself organized. (Id.) She also asks for help when she needs it, has a positive
attitude, and participates in class. (Id.) At the time of the IEP renewal, Plaintiff was
passing all of her classes and completing her homework the majority of the time, but
teachers were concerned with her ability to comprehend test questions. (Id.) Although
she was in 10th grade, she was reading at a 5th grade level. (Id.)
In October 2016, during Plaintiff’s senior year of high school, another IEP review
was performed. Plaintiff was found to have a 9th grade level in vocabulary and an 8th
grade level in reading comprehension. (Tr. 621.) Plaintiff was “aware of her deficit areas
and work[ed] hard to compensate for them.” (Id.) She had As and Bs in her classes, with
the exception of a C in Art III. (Id.) At the time of the IEP review, Plaintiff was pregnant
and only attending school part-time. (Id.)
IV. State Agency Examiners
In January 2015, David Voss, Ph.D., reviewed the record for a childhood disability
evaluation. (Tr. 120-30.) Dr. Voss found that Plaintiff’s impairments or combination of
impairments were severe, but did not meet, medically equal, or functionally equal the
listings. (Tr. 126.) Specifically, the mental allegations were only partially consistent with
the medical records and, therefore, were only partially credible. (Id.) He found that the
extent of the limitations alleged exceeded that supported by the weight of the overall
findings. (Id.) Accordingly, Dr. Voss determined Plaintiff was not disabled. (Tr. 127.)
In September 2015, M. W. DiFonso, Psy.D., reviewed the record upon
reconsideration of the disability determination. (Tr. 131-43.) Dr. DiFonso noted that while
Plaintiff reported a worsening of conditions, the medical evidence of record did not show
any significant changes, and her allegations were still considered to be only partially
credible. (Tr. 138.) Accordingly, affirmation of the original determination of not disabled
was appropriate. (Id.)
DECISION OF THE ALJ
In reaching his decision, the ALJ considered hearing testimony from Plaintiff, her
mother, and the impartial vocational expert. The ALJ also considered Plaintiff’s medical
records, her school records, including a statement from Plaintiff’s special education
teacher, and the opinions of Dr. Voss and Dr. DiFonso.
Because Plaintiff was in the “Adolescents (age 12 to attainment age of 18)” age
group on the date the application was filed, the ALJ first considered whether Plaintiff met
the disability standard for child’s benefits under the three-step sequential evaluation set
forth in 20 C.F.R. § 416.924. (Tr. 46-55.)
At step one, the ALJ determined that Plaintiff had not engaged in substantial
gainful activity. (Tr. 46.) At step two, the ALJ determined that Plaintiff’s ADHD,
depression, mood disorder, bipolar disorder, anxiety disorder, and mild intellectual
disability constituted severe impairments. (Tr. 47.) At step three, the ALJ determined that
Plaintiff’s impairments, alone or in combination, did not meet, or medically or
functionally equal, the criteria of a listed impairment. (Id.) Specifically, the ALJ found
there were not two marked or one extreme limitation in the six domains of function:
(1) acquiring and using information; (2) attending and completing tasks; (3) interacting
and relating with others; (4) moving about and manipulating objects; (5) caring for
yourself; and (6) health and physical well-being. (Tr. 47-55.) Therefore, she had not been
disabled prior to her 18th birthday.
Plaintiff reached age 18 on November 24, 2015; thus, the ALJ also considered
whether Plaintiff met the adult standard for disability from that date through the AL]’s
decision on January 9, 2018. (Id.) Applying the adult disability standard to the period after
Plaintiff's 18th birthday, the ALJ again found that Plaintiff's impairments do not meet or
equal a listed impairment. (Tr. 56.) The ALJ found that Plaintiff had only moderate
limitations in the four broad “paragraph B” areas of functioning: (1) understanding,
remembering, or applying information; (2) interacting with others; (3) concentrating,
persisting, or maintaining pace; and (4) adapting or managing themselves. (Tr. 55-56.)
The ALJ found that, since reaching age 18, Plaintiff has had the residual functional
capacity (RFC) to perform a full range of work at all exertional levels, with the following
non-exertional limitations:
° Plaintiff can understand and remember simple instructions and
carry out simple, routine, and rote type tasks that require little
independent judgment or decision making;
° Plaintiff can perform this work for two-hour segments at a time with
a short 10- to 15-minute rest break between the two-hour segments;
° Plaintiff can perform tasks at an average production rate but never
perform tasks with stringent speed or strict rate-based production
requirements involving few, if any, daily changes in work tasks or a
work environment;
° Change, when necessary, is introduced gradually; and
° Only occasional interaction with others, including the public,
coworkers, and supervisors. (Tr. 57.)
Page 14 of 24
Further, based on the testimony of the vocational expert, the ALJ found that
Plaintiff was able to perform a significant number of jobs in the national economy,
including the three representative jobs of industrial cleaner, kitchen helper/dishwasher,
and hand packager. (Tr. 60, 114-17.) Thus, Plaintiff is not disabled as defined in the Social
Security Act.
DISCUSSION
I. The ALJ’s Functional Equivalency Analysis
Plaintiff argues that the ALJ erred in finding that her impairments as a child did
not functionally equal a listing. Plaintiff first asserts the ALJ ignored evidence that
supports greater functional limitations in the domain of attending and completing tasks.
Specifically, the ALJ did not consider evidence that Plaintiff required accommodations in
order to achieve and advance in school. Plaintiff asserts that the evidence of
accommodations and academic support show that, while she was able to graduate high
school, she needed substantial amounts of support, social work, and medication to do so.
Second, Plaintiff argues the ALJ failed to discuss her medical records from prior
to the age of 18, which show she routinely struggled at school with hyperactivity,
impulsivity, irritability, anger, anxiety, the inability to finish tasks, agitation, and the
inability to maintain friendships and relationships. Plaintiff claims this evidence must be
considered in assessing the domain of interacting and relating with others, and the ALJ’s
failure to do so was error.
A. Attending and Completing Tasks
Attending and completing tasks refers to how well the child is able to focus and
maintain his attention, and how well he begins, carries through, and finishes his activities,
including the pace at which he performs activities and the ease with which he changes
them. 20 C.F.R. § 416.926a(h); Hopgood, 578 F.3d at 700-01. Adolescents should be able to
pay attention to increasingly longer presentations and discussions, maintain
concentration while reading textbooks, independently plan and complete long-range
academic projects, organize materials and plan time to complete school assignments.
20 C.F.R. § 416.926a(h)(2)(v). They should also be able to maintain attention on a task for
extended periods of time and not be unduly distracted by peers or unduly distracting to
them in a school or work setting. Id.
While Plaintiff claims the ALJ ignored evidence demonstrating a greater limitation
in her ability to attend to and complete tasks, the Court disagrees. In finding that Plaintiff
had a less than marked limitation in attending and completing tasks prior to reaching the
age of 18, the ALJ relied on evidence from PA Martin that Plaintiff had no complaints and
was making As and Bs in school in January 2014. He also relied on the IEP annual review
from October 2014 in which Plaintiff remained on task for 97 percent of the observation
time, demonstrated age-appropriate social interactions, paid attention, and followed
directions. She also was noted to be a hard-working student who tried her best and made
all efforts to stay organized. The ALJ also referred to the Teacher Questionnaire
completed by Plaintiff’s special education teacher, Melodee Garner, in which Ms. Garner
reported that Plaintiff struggled to stay focused in class. Ms. Garner noted Plaintiff had a
very serious problem carrying out multi-step instructions, an obvious problem with
single-step instructions, and only slight problems with paying attention when spoken to
directly. In addition, both Plaintiff and Plaintiff’s mother reported that medication helped
her to focus and stay on task. Her IEP review from October 2016 showed she was an
excellent student who stayed on task, followed directions, and completed her homework.
Finally, the reviewing psychologists, Dr. Voss and Dr. DiFonso, assessed a less than
marked limitation in this domain based on Plaintiff’s ADHD diagnosis, difficulty with
attention, and the teacher questionnaire.
In determining Plaintiff had a less than marked limitation in attending and
completing tasks, the ALJ noted and considered the evidence that was more favorable to
Plaintiff, but then explained why that was outweighed by other evidence noted above.
For these reasons, the Court finds that substantial evidence supports the ALJ’s
conclusion.
B. Interacting and Relating with Others
Interacting and relating with others refers to how well the child initiates and
sustains emotional connections with others, cooperates with others, complies with rules,
responds to criticism, and respects and takes care of the possessions of others. 20 C.F.R.
§ 416.926a(i). An adolescent should be able to initiate and develop friendships with same-
aged children, relate appropriately to other children and adults, and begin to be able to
solve conflicts between himself and peers or family members or other adults. 20 C.F.R.
§ 416.926a(i)(2)(v). The child should be able to express his feelings and follow social rules
for interaction and conversation. Id.
The ALJ found Plaintiff had a less than marked limitation in this domain. The ALJ
relied on Plaintiff’s IEP reviews in 2014 and 2016, in which it was noted that Plaintiff was
able to appropriately interact with other students, initiate conversations, help other
students and teachers, and participate in class discussions. The ALJ also referred to Ms.
Garner’s finding that Plaintiff did not have any problems interacting and relating with
others. Finally, the ALJ relied on the State agency examiners’ finding that Plaintiff had a
less than marked limitation in this domain.
Plaintiff argues the ALJ ignored evidence from PA Martin’s medical records,
which indicate Plaintiff had very few friends and was unable to keep or maintain
relationships. Plaintiff claims the failure to consider this evidence was error.
The Court disagrees. The records Plaintiff refers to are her own subjective
complaints contained in PA Martin’s records, which themselves are inconsistent. For
example, on September 25, 2014, and October 23, 2014, Plaintiff reported being well
connected with her peers. (Tr. 399, 401.) Thus, this is not an instance where an ALJ
ignored a whole line of evidence contrary to the ruling. Golembiewski v. Barnhart, 322 F.3d
912, 917 (7th Cir. 2003). The ALJ’s decision was supported by substantial evidence.
II. The ALJ’s Evaluation of Plaintiff’s Subjective Symptoms
Plaintiff next argues ALJ erred as a matter of law by failing to reach an explicit
finding regarding the consistency of Plaintiff’s allegations of the nature, severity, and
limiting effects of her subjective symptoms. That is, while the ALJ discussed Plaintiff’s
testimony regarding her subjective symptoms, the ALJ did not make an explicit finding
regarding the weight he placed on those allegations. Plaintiff also argues the ALJ failed
to weigh Sherisa’s testimony regarding Plaintiff’s functioning after her 18th birthday.
Specifically, Plaintiff alleges, the ALJ failed to consider Sherisa’s testimony that Plaintiff
needed to frequently be redirected, prompted, or reminded on how to perform basic tasks
in order for her to complete those tasks.
“When evaluating credibility, the ALJ must ‘consider the entire case record and
give specific reasons for the weight given to the individual’s statements.’” Shideler v.
Astrue, 688 F.3d 306, 311 (7th Cir. 2012) (quoting Simila v. Astrue, 573 F.3d 503, 517 (7th
Cir. 2009)). Here, the ALJ specifically stated that, “[a]fter considering the evidence of
record, the undersigned finds that the claimant’s medically determinable impairments
could reasonably be expected to produce the alleged symptoms; however, the claimant’s
statements concerning the intensity, persistence and limiting effects of these symptoms
are not credible to the extent they are inconsistent with the residual functional capacity
assessment for the reasons explained below.” (Tr. 48.) Thus, the Court finds that the ALJ
did make an explicit finding regarding the weight he placed on Plaintiff’s testimony
regarding her subjective symptoms.
With regard to the ALJ’s consideration of Sherisa’s testimony about Plaintiff’s
functioning as an adult, the ALJ specifically noted Sherisa’s testimony that Plaintiff has
difficulties remembering how to play games and finishing chores, like dusting or doing
the dishes. (Tr. 57.) Thus, the ALJ clearly considered Sherisa’s testimony regarding
Plaintiff’s functioning since attaining the age of 18.
III. The ALJ’s Consideration of PA Martin’s Opinions
Plaintiff next asserts the ALJ erred in giving Physician Assistant Gabe Martin’s
opinions “little weight” and finding that his opinion is not supported by objective
treatment records.
First, Plaintiff argues that PA Martin specializes in mental health despite the ALJ’s
statement that PA Martin “is a general primary care provider physician’s assistant and
not a specialist in the field of mental health.” (Tr. 59.) Moreover, the ALJ favored Dr.
Klug’s opinion because he believed PA Martin was not a behavioral health specialist.
Thus, the ALJ’s factual error also undermines his analysis of Dr. Klug’s opinions. Second,
she argues, the ALJ failed to explain how PA Martin’s opinion is inconsistent with his
own objective treatment notes. Third, Plaintiff argues, the ALJ essentially cherrypicked
exam findings from six of Plaintiff’s 27 visits with PA Martin. Thus, it is unclear why the
ALJ believed PA Martin’s treatment records are inconsistent with his opinion. And
fourth, Plaintiff contends, the ALJ’s rationale is opaque with regard to his reliance on
Plaintiff’s daily activities and how those activities undermine PA Martin’s opinion.
Again, the Court disagrees. As an initial matter, as the Commissioner points out,
the regulations distinguish between “acceptable medical sources,” medical sources who
are not “acceptable medical sources,” and “non-medical sources,” for applications filed
before March 27, 2017. 20 C.F.R. § 416.913. Only “acceptable medical sources,” such as
licensed physicians, can be characterized as treating sources whose opinions are
generally entitled to controlling weight, while Physician Assistants are considered “other
medical sources.” 20 C.F.R. § 404.1513(a); SSR 06–03p. “Although the opinions of other
medical sources are important and should be considered when evaluating ‘key issues
such as impairment severity and functional effects,’ their findings cannot ‘establish the
existence of a medically determinable impairment.’” Phillips v. Astrue, 413 F. App’x 878,
884 (7th Cir. 2010) (quoting SSR 06–03p)). Thus, even if the ALJ considered PA Martin to
be a mental health specialist, he did not err in giving more weight to the opinion of
psychiatrist Fred Klug, Ph.D.
The Court also finds that the ALJ properly considered PA Martin’s opinions from
his “Medical Source Statement,” in which he found Plaintiff has only moderate
limitations in understanding and remembering short, simple instructions and marked
limitations in carrying out short, simple instructions; interacting appropriately with the
public; responding appropriately to work pressures in a usual work setting; and
responding appropriately to changes in a routine work setting. (Tr. 599-600.)
The ALJ also properly considered records and treatment notes from Plaintiff’s
medical visits in finding that this opinion was not supported by his objective treatment
records. The ALJ noted that Plaintiff received her mental health treatment for anxiety
disorder, bipolar disorder, and ADHD from PA Martin. His mental status exams
throughout 2015 and 2016 revealed she was well groomed, cooperative, her memory was
intact, her mood was euthymic, and she had a pleasant affect. (Tr. 58.) While she began
to complain of worsening mood swings in May 2016, PA Martin’s exam showed she was
cooperative, and her memory was intact. (Id.) Even when she stopped taking all
medications due to her pregnancy, she continued to be cooperative, euthymic, and
pleasant, and she maintained an intact memory and thought process. (Id.) Thus, the ALJ
explained why he found PA Martin’s opinion to be inconsistent with his objective
treatment records.
The Court also is not convinced that the ALJ only reviewed or considered six of
Plaintiff’s 27 visits with PA Martin; a review of the entire record demonstrates that PA
Martin often found Plaintiff to be well groomed, cooperative, oriented to situation,
euthymic, pleasant, and happy, with intact judgment.
The ALJ also was not opaque with his explanation as to why Plaintiff’s activities
of daily living undermined PA Martin’s opinion. PA Martin found that Plaintiff had
marked limitations in the ability to carry out short, simple instructions and the ability to
make judgments on simple work-related decisions. Yet, Plaintiff testified that she takes
care of her own personal care needs, cooks simple foods, and cares for her dog. (Tr. 81,
84, 88.) Thus, the ALJ did not err in finding PA Martin’s opinion regarding Plaintiff’s
ability to carry out short, simple instructions and the ability to make judgments on simple
work-related decisions to be unsupported.
IV. The ALJ’s Step Five Finding
Lastly, Plaintiff argues the ALJ’s RFC assessment was not based on all relevant
evidence in the record. Plaintiff claims the ALJ failed to account for Plaintiff’s
documented need for frequent and ongoing prompts, guidance, and redirection to
complete assigned tasks. In addition to Plaintiff’s IEPs, which clearly identified her need
to be prompted and guided while working on assignments, Plaintiff’s mother testified
that she needs to be reminded how to perform simple chores. Plaintiff asserts the ALJ
also failed to discuss the hypothetical he gave the vocational expert regarding an
individual who needed additional daily supervision and failed to discuss any testimony
regarding Plaintiff’s functioning as an adult.
The ALJ found Plaintiff has the RFC to perform a full range of work at all
exertional levels but with a number of non-exertional limitations. He found she can
understand and remember simple instructions and carry out only simple, routine, and
rote-type tasks that require little independent judgment or decision making, in two-hour
segments with a short 10- to 15-minute break between each segment. He also found she
can perform tasks at an average production rate, but cannot handle tasks requiring
stringent speed or strict rate-based production requirements or daily changes in a work
task or work environment. He found that change must be introduced gradually, and
there should be only occasional interaction with others, including the public, coworkers,
and supervisors.
This RFC assessment is supported by substantial evidence. Plaintiff’s subjective
complaints, her mother’s testimony, Plaintiff’s IEPs, Ms. Garner’s Teacher Questionnaire,
PA Martin’s examination notes, and Plaintiff’s ADHD diagnosis all support the ALJ’s
conclusion that Plaintiff can perform simple, routine work that requires short, simple
instructions and little independent judgment or decision making.
In making her argument, Plaintiff herself ignores evidence that she was able to
stay on task for 97 percent of the time during her 2014 IEP evaluation, she exhibited
appropriate social interaction, and she was able to follow directions and complete
activities. (Tr. 487.) Her 2016 IEP also noted that Plaintiff completed all of her assignments
when they were due, worked well with other students, participated in class discussion,
and was “aware of her deficit areas and work[ed] hard to compensate for them.” (Tr. 621.)
She was noted to “sometimes” have difficulty staying on task and to “sometimes” need
prompting. (Id.) In other words, while Plaintiff accuses the ALJ of only considering one
side of the evidence, her own arguments do the same.
CONCLUSION
After careful review of the record as a whole, the Court finds that ALJ committed
no errors of law, and his findings are supported by substantial evidence. Accordingly,
the final decision of the Commissioner of Social Security denying Plaintiff's application
for disability benefits is AFFIRMED, and this action is DISMISSED with prejudice.
The Clerk of Court is DIRECTED to enter judgment accordingly and close this
case.
IT IS SO ORDERED.
DATED: October 13, 2022 7 g 7)
NANCY J. ROSENSTENGEL
Chief U.S. District Judge
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