“[T]he ALJ must consider the combined effect of all impairments, ‘even those that would not be considered severe in isolation.’ “
How later courts described this case
- “[T]he ALJ must consider the combined effect of all impairments, ‘even those that would not be considered severe in isolation.’ “
- “An error is harmless only if we are convinced that the ALJ would reach the same result on remand.”
Written by the judges who cited it.
The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
SARAH M.,1 )
)
Plaintiff, )
)
vs. ) Case No. 3:22-cv-1852-DWD
)
COMMISSIONER OF SOCIAL )
SECURITY, )
)
Defendant. )
MEMORANDUM & ORDER
DUGAN, District Judge:
Under 42 U.S.C. § 405(g), Plaintiff seeks judicial review of the final agency decision
of Defendant, which denied Plaintiff’s application for Disability Insurance Benefits
(DIBs). For the reasons explained below, the Court AFFIRMS the final agency decision.
I. Procedural History
Plaintiff was born on September 17, 1979. She protectively applied for DIBs on
April 15, 2015. Plaintiff initially alleged a disability onset date of November 1, 2012, but
that date was later amended to June 30, 2013. Plaintiff’s date of last insured was December
31, 2017. The alleged disability was related to cervical radiculopathy, scoliosis, migraines,
fibromyalgia, bone degeneration, nerve damage, sphincter dysfunction, chronic fatigue
syndrome, anxiety, asthma, and severe memory loss. (Doc. 14-9, pg. 24). The claim was
denied initially and on reconsideration. Plaintiff sought a hearing, which was held in
October 2017 before an Administrative Law Judge (“ALJ”). In July 2018, Plaintiff received
1Plaintiff’s full name will not be used due to privacy concerns.
an Unfavorable Decision. The Appeals Council denied review, so Plaintiff appealed to
this Court. Before the Court could resolve the appeal, however, the parties agreed to a
remand of the case to the agency. A second hearing was held on October 1, 2020. On
November 25, 2020, Plaintiff received another Unfavorable Decision. Plaintiff filed
written exceptions to that Unfavorable Decision, which were rejected by the Appeals
Council in June 2022. Plaintiff has now exhausted her administrative remedies.
Accordingly, the most recent Unfavorable Decision is final and ripe for judicial review.
II. General Legal Standards
To qualify for DIBs, a claimant must be disabled. To assess a disability, the ALJ
employs a “five-step sequential evaluation process.” See 20 C.F.R. § 404.1520(a)(1), (2), (4).
The ALJ asks whether: (1) the claimant is doing substantial gainful activity; (2) the
claimant has a severe medically determinable physical or mental impairment that meets
certain duration requirements or a combination of impairments that is severe and meets
the duration requirements; (3) the claimant has an impairment that meets or equals an
impairment listed in the regulations and satisfies the duration requirements; (4) in view
of the RFC and past relevant work, she can perform past relevant work; and (5) in view
of the claimant’s RFC, age, education, and work experience, she can adjust to other work.
See 20 C.F.R. § 404.1520(a)(4)-(g); Young v. Barnhart, 362 F.3d 995, 1000 (7th Cir. 2004).
If the claimant is doing substantial gainful activity under step 1, does not have an
impairment or combination of impairments as described at step 2, can perform past
relevant work under step 4, or can adjust to other work under step 5, then the claimant is
not disabled. See 20 C.F.R. § 404.1520(a)(4)(i),(ii), (iv), (v). If the claimant has an
impairment that meets the requirements of step 3 or is incapable of adjusting to other
work under step 5, then she is disabled. See 20 C.F.R. § 404.1520(a)(4)(iii), (v). The claimant
has the burden of proof at steps 1 to 4. See Mandrell v. Kijakazi, 25 F.4th 514, 516 (7th Cir.
2022). At step 5, however, the burden shifts to Defendant to show that the claimant can
adjust to other work existing in “a significant number of jobs…in the national economy.”
See Young, 362 F.3d at 1000; accord Brace v. Saul, 970 F.3d 818, 820 (7th Cir. 2020).
Impairments and related symptoms may cause physical and mental limitations
that affect the ability to work. See 20 C.F.R. § 404.1545(a)(1). Steps 4 and 5 assess the most
a claimant can do at work despite those limitations. See 20 C.F.R. § 404.1545(a)(1);
accord SSR 96-8p, 1996 WL 374184, *2; Clifford v. Apfel, 227 F.3d 863, 872-73 n. 7 (7th Cir.
2000). As such, a residual functional capacity (“RFC”), which the ALJ completes after step
3 but before steps 4 and 5, assesses the ability to perform sustained physical and mental
activities in a work setting on a regular and continuing basis, i.e., for eight hours a day
and five days a week or an equivalent schedule. See Tenhove v. Colvin, 97 F. Supp. 2d 557,
568 (E.D. Wisc. 2013); SSR 96-8p, 1996 WL 374184, *2; accord Moore v. Colvin, 743 F.3d 1118,
1121 (7th Cir. 2014). An RFC must be based on the relevant medical and other evidence
contained in the record. See 20 C.F.R. § 404.1545(a)(3); SSR 96-8p, 1996 WL 374184, *2-3, 5.
In the RFC, the ALJ must identify the claimant’s functional limitations and assess
his work-related abilities on a function-by-function basis. See Tenhove, 97 F. Supp. 2d at
569; SSR 96-8p, 1996 WL 374184, *1, 3; accord Lechner v. Barnhart, 321 F. Supp. 2d 1015,
1036 (E.D. Wisc. 2004). The ALJ considers all impairments, including those that are
nonsevere, and the claimant’s ability to meet physical, mental, sensory, and other
requirements of work. See 20 C.F.R. § 404.1545(a)(2), (4); see also Alesia v. Astrue, 789 F.
Supp. 2d 921, 933 (N.D. Ill. 2011) (“[T]he ALJ must consider the combined effect of all
impairments, ‘even those that would not be considered severe in isolation.’ “). “An
impairment or combination of impairments is not severe if it does not significantly limit
[the] physical or mental ability to do basic work activities.” 20 C.F.R. § 404.1522(a). And,
importantly, while a claimant’s statements of pain or other symptoms are considered,
they alone are not conclusive evidence of a disability. See 20 C.F.R. § 404.1529.
As to physical abilities, the ALJ assesses the nature and extent of physical
limitations, then determines the RFC for work activity on a regular and continuing basis.
See 20 C.F.R. § 404.1545(b). A limited ability to perform physical demands, such as sitting,
standing, walking, lifting, carrying, pushing, pulling, reaching, handling, stooping, or
crouching may reduce the ability to do “other work” at step 5. See 20 C.F.R. § 404.1545(b);
see also SSR 96-8p, 1996 WL 374184, *5-6. After identifying a claimant’s functional
limitations and assessing his work abilities on a function-by-function basis, the RFC may
be expressed by exertional category, such as “sedentary.”2 See Tenhove, 97 F. Supp. 2d at
569; accord Lechner, 321 F. Supp. 2d at 1036; SSR 96-8p, 1996 WL 374184, *3. To do a full
range of work in an exertional category, the claimant must be able to perform
substantially all of the functions at that level. See SSR 96-8p, 1996 WL 374184, *5-6.
Further, in the RFC, the ALJ must address medical source opinions. See SSR 96-8p,
2Sedentary work involves “lifting no more than 10 pounds at a time and occasionally lifting or
carrying articles like docket files, ledgers, and small tools.” 20 C.F.R. § 404.1567(a). A sedentary job involves
sitting but often has walking and standing that is necessary to related duties. See 20 C.F.R. § 404.1567(a).
Jobs are sedentary if walking and standing are required occasionally, and the other sedentary criteria are
satisfied. See 20 C.F.R. § 404.1567(a).
1996 WL 374184, *7. If the RFC assessment conflicts with a medical source opinion, then
the ALJ must explain why the opinion was not adopted. See id.; accord Smith v. Colvin, 9
F. Supp. 3d 875, 887 (E.D. Wisc. 2014). Medical opinions are considered with the following
factors: (1) supportability; (2) consistency; (3) the relationship with the claimant;
(4) specialization; and (5) other factors supporting or contradicting the opinion, including
evidence showing familiarity with other evidence in the claim or an understanding of
disability policies and evidentiary requirements. See 20 C.F.R. § 404.1520c(c). The most
important factors to the persuasiveness of a medical opinion, however, are supportability
and consistency. See 20 C.F.R. § 404.1520c(a), (b)(2).3 The ALJ may, but is not required to,
explain how the other factors were considered. See 20 C.F.R. § 404.1520c(c)(3)-(5).
III. The ALJ’s Decision
The ALJ noted, on remand, the Appeals Council directed it to consider medical
source opinion evidence and the claimant’s maximum RFC, to acquire evidence from a
vocational expert, and to offer Plaintiff the opportunity for a new hearing. (Doc. 14-9, pg.
16). Further, the ALJ recognized that Plaintiff was required to establish a disability
between the amended onset date of disability, June 30, 2013, and the date of last insured,
December 31, 2017. (Doc. 14-9, pg. 17). For the reasons discussed below, the ALJ found
Plaintiff was not under a disability between those dates. (Doc. 14-9, pg. 17).
3The more relevant the objective medical evidence and supporting explanations presented by a
medical source are to support his or her medical opinions, the more persuasive the medical opinions will
be. See 20 C.F.R. § 404.1520c(c)(1). The more consistent medical opinions are with the evidence from other
medical sources and nonmedical sources in the claim, the more persuasive the medical opinions will be.
See 20 C.F.R. § 404.1520c(c)(2).
At step 1, the ALJ found Plaintiff had not engaged in substantial gainful activity
during the relevant period. (Doc. 14-9, pg. 19). At step 2, the ALJ found Plaintiff suffered
from severe impairments through the date of last insured, including left trochanteric
bursitis, mild scoliosis, facet arthropathy, asthma, migraines, fibromyalgia, obesity,
depression, anxiety, somatic symptom disorder, and posttraumatic stress disorder. (Doc.
14-9, pg. 19). Those impairments were severe, as they limited Plaintiff’s ability to perform
basic work activities. (Doc. 14-9, pg. 19). Certain other conditions were found to be
nonsevere, as there was no persuasive evidence suggesting they caused more than
minimal limitations in the ability to perform basic work activities. (Doc. 14-9, pg. 19). Still,
the ALJ considered the effect that those nonsevere impairments had on Plaintiff’s ability
to function. (Doc. 14-9, pg. 20). At step 3, the ALJ found she did not have an impairment
or combination of impairments that met or medically equaled the severity of impairments
listed in the regulations through the date of last insured. (Doc. 14-9, pg. 20).
Before proceeding to step 4, the ALJ assessed Plaintiff’s RFC, finding as follows:
[T]hrough the date [of] last insured, the claimant had the…[RFC] to
perform sedentary work as defined in 20 CFR 404.1567(a) except that she
cannot climb[] ladders, ropes, or scaffolds and can only occasionally climb
ramps and stairs. The claimant cannot engage in tasks requiring balancing
on slippery or unexpectedly uneven surfaces or moving walkways. She
can engage in no more than frequent stooping, kneeling, crouching and
crawling and can perform no overhead reaching, pushing, or pulling
bilaterally. The claimant can perform tasks requiring no more than
frequent handling and fingering, and she must work in an environment
where the noise level would be no more than 3-moderate. She cannot
work at unprotected heights, around moving mechanical parts or other
such hazards, and she can have no concentrated exposure to extreme heat,
cold, humidity, wetness, dust, fumes[,] or other pulmonary irritants. The
claimant is limited to performing simple, routine tasks and can perform
work with production expectations, but the work must not be at a fast
pace such as an assembly line. She cannot engage in work that requires
tandem tasks, where other work functions would be dependent on her
completion of a task. She is limited to work that requires only occasional
changes in the work setting and she can have no more than occasional
interaction with the public.
(Doc. 14-9, pg. 23).
In assessing the above RFC, the ALJ noted that, “[a]t the hearing…the claimant
testified that she has an 8-year history of dominant right upper extremity nerve damage
resulting in things flying out of her hand.” (Doc. 14-9, pg. 24). Further, Plaintiff “claimed
her hand jerks and she has difficulty writing her name, getting dressed, brushing her hair,
holding a coffee cup, and carrying a water bottle.” (Doc. 14-9, pg. 24). However, while
Plaintiff’s medically determinable impairments could reasonably cause her alleged
symptoms, the ALJ found her statements concerning the intensity, persistence, and
limiting effects of those symptoms were not entirely consistent with the medical evidence
and the other evidence of record. (Doc. 14-9, pg. 24). More specifically, Plaintiff’s
allegations of severe symptoms and limitations were inconsistent with the conservative
treatment, objective diagnostic testing results, and observations of the treating medical
sources. (Doc. 14-9, pg. 24). Likewise, there was no evidence of significant worsening
symptoms since the date of last insured. (Doc. 14-9, pg. 25).
In support of these findings, the ALJ engaged in a thorough discussion of the
medical evidence. The ALJ stated the physical examinations throughout the relevant
period were found to be “essentially unremarkable as related to the claimant’s neck and
back impairment.” (Doc. 14-9, pg. 25). Treatment notes referenced complaints of chronic
pain, but the ALJ found the objective imaging revealed only mild scoliosis. (Doc. 14-9, pg.
25). Further, radiographs showed early degenerative disc disease, some degenerative
arthritis of the sacroiliac joints, and facet arthropathy, but there was no canal stenosis or
foraminal stenosis. (Doc. 14-9, pg. 25). Plaintiff reported muscle spasms around the
amended alleged onset date of disability, June 30, 2013, but she was also “staying active”
at that time. (Doc. 14-9, pg. 25). As a result, the ALJ noted that Plaintiff’s normal to mild
examination findings were inconsistent with her extreme complaints. (Doc. 14-9, pg. 25).
The ALJ noted, during a neurological examination on April 7, 2015, Plaintiff
reported chronic neck pain caused by automobile accidents. (Doc. 14-9, pg. 25). Plaintiff
also reported, inter alia, episodic reduced function of the right arm and shaking hands.
(Doc. 14-9, pg. 25). However, the ALJ believed it was significant that the neurologist
found a CT of the neck was normal, as that finding was inconsistent with Plaintiff’s claim
of cervical radiculopathy. (Doc. 14-9, pg. 25). Further, the neurologist’s examination
found no skeletal abnormalities, no joint deformity, no tenderness or swelling, normal
strength throughout, normal motor tone with no spasticity or rigidity, no muscle atrophy,
and normal sensation with no cervical radiculopathy. (Doc. 14-9, pg. 25).
In a consultative examination on August 26, 2015, Plaintiff complained of, inter
alia, cervical radiculopathy attributable to an automobile accident. Plaintiff indicated to
Dr. Austin Montgomery that she had neck pain, arm issues, and uncontrollable tremors.
(Doc. 14-9, pg. 25). However, although Plaintiff had one or two tender spots in the back
and the right shoulder, with right upper extremity atrophy, “the overall examination was
otherwise normal.” (Doc. 14-9, pg. 25). The ALJ noted Dr. Montgomery observed some
limitation in the right shoulder range of motion and cervical range of motion, but
otherwise observed a normal range of motion in the lumbar spine. (Doc. 14-9, pg. 25). The
ALJ also stated: “when noted, the remainder of the record documents…normal
musculoskeletal range of motion. (Doc. 14-9, pg. 25). Therefore, despite Plaintiff’s
testimony of significant limitations from neck and back pain, the ALJ found the
“treatment notes regularly show essentially normal musculoskeletal examinations with
no significant tenderness or swelling.” (Doc. 14-9, pg. 26). Likewise, the ALJ found the
treatment notes indicated “generally normal physical examinations with a normal gait
and station.” (Doc. 14-9, pg. 26). Also, as to the alleged uncontrollable tremors, the ALJ
noted “the record first indicated the tremor was psychogenic…[and] claims of any such
tremor were not featured later in the record.” (Doc. 14-9, pg. 27).
The ALJ noted that Plaintiff’s treatment notes referenced fibromyalgia without
evidence of specific trigger points. (Doc. 14-9, pg. 27). The ALJ discussed Plaintiff’s
examination by a rheumatologist on July 6, 2016. (Doc. 14-9, pg. 27). At that time, Plaintiff
complained of chronic pain and fatigue, including pain in her hands and right shoulder.
(Doc. 14-9, pg. 27). Plaintiff also reported the worst pain was in her cervical spine. (Doc.
14-9, pg. 27). The ALJ noted Plaintiff’s physical examination by the rheumatologist
showed no acute distress and no edema in the extremities. (Doc. 14-9, pg. 27). Also, a
musculoskeletal examination revealed no synovitis in a standard 28 joint count. (Doc. 14-
9, pgs. 26-27). There was some tenderness to palpation of the PIP joints, but the
rheumatologist noted no myofascial trigger points present on examination. (Doc. 14-9,
pg. 27). The ALJ stated that was inconsistent with a diagnosis of fibromyalgia. (Doc. 14-
9, pg. 27). Radiographs of the right hand were normal. (Doc. 14-9, pg. 27).
Further, the ALJ noted objective imaging of, inter alia, facet arthropathy. (Doc. 14-
9, pg. 27). Plaintiff’s testimony of severely limited ability to lift, walk, and perform other
activities, such as manipulative activities, was found to be extreme when compared to
that objective imaging, which the ALJ found showed only mild abnormalities. (Doc. 14-
9, pg. 27). The ALJ stated clinical signs were also limited and, despite references to back,
neck, and joint pain, there was not an indication of inflammatory signs, significant or
persistent range of motion problems, persistent or frequently recurring muscle spasms,
nerve root impingement, or motor, sensory, or reflex loss. (Doc. 14-9, pg. 27). Plaintiff
received only conservative medication management, without any specific or ongoing
indications of side effects, and achieved general pain relief. (Doc. 14-9, pg. 27).
Although the ALJ found the record evinced adequate control of symptoms related
to Plaintiff’s physical conditions through conservative treatment modalities, such as
longitudinally decreased dosages of narcotic pain medication, the ALJ accommodated
Plaintiff’s ongoing symptoms to the extent that they caused functional limitations. (Doc.
14-9, pg. 27). This was done in light of Plaintiff’s testimony. (Doc. 14-9, pg. 27). The ALJ
limited Plaintiff to work performed at the sedentary exertional level with additional
postural and environmental restrictions. (Doc. 14-9, pg. 27). The ALJ stated its RFC
assessment “more than accommodate[d]” Plaintiff’s allegations in consideration of her
physical condition, as “the totality of the medical records[,] including observations of
treating and examining sources[] and the claimant’s own statements[,] fail[ed] to provide
convincing objective evidence to support” greater limitations. (Doc. 14-9, pg. 27).
Next, the ALJ discussed the medical opinion evidence. The ALJ noted the March
20, 2015, statement of Plaintiff’s primary care physician, Dr. Gregory Climaco. (Doc. 14-
9, pg. 28). Dr. Climaco opined that Plaintiff could not stand or walk up to 2 hours per day,
sit six hours or more per day, occasionally lift 10 pounds, or work 40 hours a week due
to anxiety, fibromyalgia, and migraines. (Doc. 14-9, pg. 28). The ALJ gave this opinion
little weight because, despite Plaintiff’s longitudinal history with Dr. Climaco, the severe
limitations were inconsistent with the objective imaging and mild clinical signs discussed
above. (Doc. 14-9, pg. 28). According to the ALJ, Dr. Climaco regularly noted that Plaintiff
had normal examinations without debilitating symptoms that resulted in an inability to
work. (Doc. 14-9, pg. 28). Further, Dr. Climaco “provide[d] very little in the way of actual
functional limitations…instead provid[ing] a conclusory statement.” (Doc. 14-9, pg. 28).
As to the consultative examination of Dr. Montgomery, which was conducted on
August 26, 2015, the ALJ noted Plaintiff claimed her shoulder swelled, fingers locked,
and she was unable to use one hand. (Doc. 14-9, pg. 29). The ALJ gave Dr. Montgomery’s
opinion partial weight. (Doc. 14-9, pg. 29). The ALJ noted that Dr. Montgomery
conducted testing that was supportive of the objective findings and the shoulder and
hand limitations assessed in the RFC. (Doc. 14-9, pg. 29). He noted shoulder range of
motion deficits and reduced grip strength, but the ALJ found other records showed
normal right shoulder range of motion and normal right and left hands without
significant abnormalities shown on imaging. (Doc. 14-9, pg. 29). Dr. Montgomery’s
observations were normal other than Plaintiff’s alleged distress from tremors, right hand
dexterity, and numbness in the “right 5th finger and 4th - ulnar nerve.” (Doc. 14-9, pg.
29). Also, Dr. Montgomery’s clinical impressions were based on Plaintiff’s statements,
and the note Plaintiff could not contain fasciculations or tremors was inconsistent with
the treating neurologist’s opinion. (Doc. 14-9, pg. 29). The ALJ noted Dr. Montgomery’s
findings of 11 tender points, mild range of motion deficits in the shoulder, 2/5 right upper
extremity strength, and 3/5 upper right grip strength. (Doc. 14-9, pg. 29). The ALJ stated,
“[o]verall, while the generally normal physical examination supports a finding of the
claimant’s ability to engage in each of these activities, Dr. Montgomery’s opinion is vague
and does not provide limitations on a function-by-function basis.” (Doc. 14-9, pg. 29).
The ALJ also discussed the initial assessment of the non-examining state medical
consultant, Dr. Kenneth R. Smith, M.D., from September 2015, and the reconsideration
assessment of the non-examining state medical consultant, Dr. James L. Greco, M.D.,
from May 2016. (Doc. 14-9, pgs. 29-30). The ALJ noted Dr. Smith “assigned less than the
full range of the light exertional level,” while Dr. Greco “assigned less than the full range
of the sedentary exertional level.” (Doc. 14-9, pg. 30). The ALJ noted that Dr. Greco
limited Plaintiff to frequent climbing of ramps and stairs, balancing, stooping, kneeling,
crouching, and crawling, as well as occasional climbing of ladders, ropes, and scaffolds.
(Doc. 14-9, pg. 30). Further, Plaintiff was to avoid concentrated exposure to extreme cold,
extreme heat, humidity, fumes, odors, dusts, gases, and poor ventilation. (Doc. 14-9, pg.
30). Drs. Smith and Greco’s opinions were given partial weight by the ALJ, as they were
generally consistent with the medical evidence and other evidence of record. (Doc. 14-9,
pg. 30). However, the ALJ found the record did not support additional manipulative and
environmental accommodations. (Doc. 14-9, pg. 30). The ALJ emphasized, though, “I
have accommodated the claimant’s subjective complaints to the greatest extent possible
consistent with the objective evidence of record.” (Doc. 14-9, pg. 30).
The ALJ noted its consideration of the response to interrogatories of Dr. Olivia M.
Bajor, D.O., from January 29, 2018. (Doc. 14-9, pg. 31). The ALJ gave that opinion partial
weight. (Doc. 14-9, pg. 31). The ALJ noted that Dr. Bajor assessed Plaintiff as capable of
sedentary work, as Plaintiff could stand and walk for 1 hour each and could sit for 8 hours
in an 8-hour workday. (Doc. 14-9, pg. 31). Further, Plaintiff could lift and carry 10 lbs
frequently and do the same with 20 pounds occasionally. (Doc. 14-9, pg. 31). Dr. Bajor
“specifically noted” reports in the medical record were inconsistent. (Doc. 14-9, pg. 31).
For example, “[c]linical consultative exam [of Dr. Montgomery] in Exhibit 10F reported
diminished strength and dexterity in the right hand and shoulder, but subsequent exams
(Exhibits 13F-14F) do not report similar findings.” (Doc. 14-9, pg. 31). Further, Plaintiff’s
primary care provider examinations were consistently normal to mild. (Doc. 14-9, pg. 31).
The ALJ noted that Dr. Bajor limited Plaintiff to mostly occasional postural maneuvers,
consistent with Plaintiff’s complaints. Overall, the ALJ stated, “Dr. Bajor…explained her
opinion with reference to specific medical signs and findings, and her opinions [we]re
generally consistent with the evidence as a whole.” (Doc. 14-9, pg. 31).
In sum, based on the objective medical evidence and Plaintiff’s course of
treatment, clinical signs, medications, level of daily activity, and work history, the ALJ
found Plaintiff retained the above-described RFC. (Doc. 14-9, pg. 32). Plaintiff’s subjective
reports, including the limitations on her ability to perform activities of daily living, found
minimal support in the objective medical evidence of record. (Doc. 14-9, pg. 32). While
Plaintiff suffered from severe impairments, the ALJ noted conservative treatment
provided symptom relief and stabilization. (Doc. 14-9, pg. 32). Further, the clinical
findings were generally mild throughout the period at issue, as providers documented
normal examinations without significant changes to or worsening of symptoms. (Doc. 14-
9, pg. 32). When considered in totality, the ALJ found Plaintiff’s statements of limitations
supported the exertional and non-exertional accommodations outlined in the RFC, which
appropriately accommodated her subjective restrictions. (Doc. 14-9, pg. 32).
At step 4, the ALJ found Plaintiff was unable to perform past relevant work, which
included work as a dental assistant. (Doc. 14-9, pg. 33). The ALJ noted Plaintiff had a high
school education and one year of college education. (Doc. 14-9, pg. 33). Further, the
transferability of jobs skills was not material to the determination of disability, as a
finding of not disabled would be appropriate regardless of whether Plaintiff had
transferable job skills. (Doc. 14-9, pg. 33). At step 5, the ALJ indicated, if Plaintiff had the
RFC to perform the full range of sedentary work, a finding of “not disabled” would be
directed. (Doc. 14-9, pg. 34). However, Plaintiff’s ability to perform all or substantially all
of the requirements of sedentary work was impeded by additional limitations. (Doc. 14-
9, pg. 34). Therefore, to determine the extent to which those limitations eroded the
unskilled sedentary occupational base through the date of last insured, the ALJ relied on
the testimony of a vocational expert. (Doc. 14-9, pg. 34). The vocational expert testified
that, given Plaintiff’s age, education, work experience, and RFC, she would have been
able to perform “sedentary, unskilled, SVP 2 occupations.” (Doc. 14-9, pg. 34).
Accordingly, at step 5, the ALJ found there were jobs existing in significant numbers in
the national economy that Plaintiff could have performed through the date of last
insured. (Doc. 14-9, pg. 33). For these reasons, the ALJ found Plaintiff was not disabled
between June 30, 2013, and December 31, 2017. (Doc. 14-9, pg. 34).
IV. Analysis4
The Court’s review of the ALJ’s decision is “extremely limited” and “very
deferential.” See 42 U.S.C. § 405(g); Jarnutowski v. Kijakazi, 48 F.4th 769, 773 (7th Cir. 2022)
(quoting Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008)). Findings of fact, supported by
substantial evidence, are conclusive. See 42 U.S.C. § 405(g); accord Clifford, 227 F.3d at 869.
The Court will reverse the ALJ’s decision only if the findings of fact were not supported
by substantial evidence or the ALJ applied the wrong legal standard. See Clifford, 227 F.3d
at 869; accord Martin v. Saul, 950 F.3d 369, 373 (7th Cir. 2020). “Substantial evidence means
‘such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion.’ ” See Clifford, 227 F.3d at 869 (quoting Richardson v. Perales, 402 U.S. 389, 401
(1971)); accord Jarnutowski, 48 F.4th at 773. If reasonable minds could differ about the
alleged disability and the ALJ’s decision is supported by substantial evidence, then the
Court will affirm the ALJ. See Jarnutowski, 48 F.4th at 773 (quoting Elder, 529 F.3d at 413).
The Court reviews the entire record, but does not reweigh the evidence, resolve conflicts,
decide credibility, or substitute its judgment for that of the ALJ. See Clifford, 227 F.3d at
869; accord Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003). However, an
ALJ must build a logical bridge between the evidence and the conclusions.
4The Court reviewed the entire evidentiary record. The portions of the evidentiary record that are relevant
to Plaintiff’s present arguments and the Court’s resolution of the case are incorporated into the analysis below.
See Jarnutowski, 48 F.4th at 773 (quoting Butler v. Kijakazi, 4 F.4th 498, 501 (7th Cir. 2021)).
1. Opinion of Dr. Bajor
On January 23, 2018, the SSA requested the professional opinion of Dr. Bajor in
relation to Plaintiff’s claim. (Doc. 14-7, pg. 631). Dr. Bajor was provided exhibits that were
selected for inclusion in the record, as well as interrogatories that were to be completed
based on that evidence and her professional knowledge. (Doc. 14-7, pg. 631).
Dr. Bajor opined that Plaintiff could frequently lift up to 10 lbs and occasionally
lift 11 to 20 lbs. (Doc. 14-7, pg. 632). Plaintiff could frequently carry up to 10 lbs and
occasionally carry 11 to 20 lbs. (Doc. 14-7, pg. 632). When asked to identify the particular
medical or clinical findings that supported these assessments, Dr. Bajor noted Plaintiff’s
diagnosis of facet arthropathy in the cervical spine at Exhibit 12F. (Doc. 14-7, pg. 632).
Further, Dr. Bajor opined that, at a given time, Plaintiff could sit for 6 hours, stand
for 1 hour, and walk for 30 minutes. (Doc. 14-7, pg. 633). In an 8-hour workday, Plaintiff
could sit for 8 hours, stand for 1 hour, and walk for 1 hour. (Doc. 14-7, pg. 632). When
asked to identify the particular medical or clinical findings that supported these
assessments, Dr. Bajor noted “exam…by orthopedic surgeon, claimant has only slight
limp without assistive device and may continue regular activity.” (Doc. 14-7, pg. 633).
As to the right hand, Dr. Bajor opined that Plaintiff could continuously feel and
push/pull, frequently reach (all but overhead), and occasionally reach (overhead),
handle, and finger. (Doc. 14-7, pg. 634). When asked to identify the particular medical or
clinical findings that supported these assessments, Dr. Bajor noted the “[r]eports in
medical record are inconsistent. Clinical exam in 10F reports diminished strength and
dexterity in Rt. Hand, shoulder, but subsequent exams (13F, 1/14/17) do not report
similar findings.” (Doc. 14-7, pg. 634).
Dr. Bajor answer “yes” when asked whether there was sufficient objective medical
and other evidence to allow her to form opinions about the nature and severity of the
impairments during the relevant timeframe. (Doc. 14-7, pg. 639). Dr. Bajor identified the
following impairments, among others, established by the evidence and supported with a
citation: chronic neck pain and facet arthropathy (12F); tremors, possibly psychogenic in
etiology (7F); and arthritis/arthralgia (13F). (Doc. 14-7, pg. 639).
Now, with her first argument, Plaintiff states the ALJ did not “specifically
acknowledge” Dr. Bajor’s opinion that Plaintiff could only occasionally handle and finger
with the dominant right upper extremity. (Doc. 18, pg. 8). Further, the ALJ allegedly
“incorrectly cited the handwritten notes [of Dr. Bajor] below th[at] limitation.” (Doc. 18,
pg. 8). As such, Plaintiff argues the ALJ “objectively misstated” Dr. Bajor’s opinion and
suggested she “discount[ed] her own opinion by the handwritten notes.” (Doc. 18, pgs.
8-9). Plaintiff argues it cannot be assumed Dr. Bajor meant anything other than Plaintiff
could occasionally handle and finger with the right upper extremity. (Doc. 18, pg. 9).
Defendant responds that the ALJ noted Dr. Bajor, in her opinion on Plaintiff’s
ability to use her hands, cited Exhibit 10F to show diminished strength and dexterity in
Plaintiff’s right hand and shoulder. (Doc. 24, pg. 7). The ALJ also noted, incorrectly, that
Dr. Bajor cited Exhibits 13F and 14F to show contrary findings. However, according to
Defendant, a review of Dr. Bajor’s opinion shows that she did rely upon Exhibit 13F,
which included a report of an examination from January 4, 2017. (Doc. 24, pg. 7). The
examination allegedly showed no diminished strength or dexterity in Plaintiff’s right
hand and shoulder. (Doc. 24, pg. 7). The fact the ALJ miscited to Exhibits, in Defendant’s
view, does not undermine its decision to give Dr. Bajor’s opinion partial weight, as the
ALJ reasonably compared Dr. Bajor’s opinion to primary care provider examinations that
consistently showed Plaintiff’s normal to mild use of the hands. (Doc. 24, pg. 7).
Defendant also argues the ALJ did not find Dr. Bajor discounted her own opinion
through handwritten notes. (Doc. 24, pg. 7). Defendant argues the ALJ accurately quoted
Dr. Bajor’s handwritten comments. (Doc. 24, pg. 7). However, based on the whole record,
including the treatment notes and objective test results, Defendant argues the ALJ
declined to adopt the opinion that Plaintiff could only occasionally handle and finger
with the right hand. (Doc. 24, pg. 8). Therefore, Defendant indicates the Court should not
reweigh the evidence or substitute its judgment for that of the ALJ. (Doc. 24, pg. 7).
Here, it is undisputed that the ALJ considered Dr. Bajor’s opinion, which was
requested by the SSA. (Doc. 14-9, pg. 31). Plaintiff does not make a contrary argument;
instead, she suggests the ALJ did not “specifically acknowledge” a particular aspect of
Dr. Bajor’s opinion, namely, that Plaintiff could only occasionally handle and finger with
the right hand. (Docs. 14-9, pg. 31; 18, pg. 8). The Court finds Plaintiff’s argument is overly
technical and flawed for the reasons discussed below.
The ALJ discussed the handwritten notes that “identif[ied] the particular medical
or clinical findings…[that] supported…[Dr. Bajor’s] assessment of any limitations and
why the findings support[ed] the assessment.” (Docs. 14-7, pg. 634; 14-9, pg. 31). It is
obvious to the Court that Dr. Bajor’s handwritten notes, as well as the ALJ’s discussion
of those handwritten notes, contemplated Plaintiff’s ability to occasionally handle or
finger with the right extremity. (Docs. 14-7, pg. 634; 14-9, pg. 31). Immediately below the
area where Dr. Bajor found, inter alia, Plaintiff could occasionally finger and feel with the
right hand, she stated: “Reports in medical record are inconsistent. Clinical exam in 10F
reports diminished strength and dexterity in Rt. Hand, shoulder, but subsequent exams
(13F, 1/14/17) do not report similar findings.” (Doc. 14-7, pg. 634). The ALJ referenced
those handwritten notes, then added its belief that “primary care provider examinations
are consistently normal to mild.” (Doc. 14-9, pg. 31). The ALJ also noted, generally, Dr.
Bajor “limited the claimant to mostly occasional postural maneuvers, consistent with the
claimant’s complaints,” and Dr. Bajor explained her opinion with reference to specific
medical signs and findings. (Doc. 14-9, pg. 31). Dr. Bajor’s opinions were “generally
consistent with the evidence as a whole.” (Doc. 14-9, pg. 31). For these reasons, the Court
finds Plaintiff is incorrect that the ALJ failed to consider, i.e., failed to “specifically
acknowledge,” Dr. Bajor’s opinion on Plaintiff’s right hand. (Docs. 14-9, pg. 31; 18, pg. 8).
Further, the Court finds no error in the ALJ’s decision to find, contrary to Dr.
Bajor’s opinion, that Plaintiff could “perform tasks requiring no more than frequent
handling and fingering.” (Doc. 14-9, pg. 23) (Emphasis added.). As noted above, Dr. Bajor
and the ALJ both acknowledged the inconsistency of the evidence with respect to the
strength and dexterity of the right hand and shoulder. (Docs. 14-7, pg. 634; 14-9, pg. 31).
Ultimately, the ALJ expressly stated that it was granting Dr. Bajor’s opinion “partial
weight.” (Doc. 14-9, pg. 31). The ALJ added that “provider examinations [we]re
consistently normal to mild.” (Doc. 14-9, pg. 31). In doing so, the Court finds the ALJ did
not misstate Dr. Bajor’s opinion, as argued by Plaintiff, but described its consideration of
that opinion in light of the medical and other evidence of record. (Doc. 14-9, pg. 31).
Similarly, the ALJ did not commit error by indicating Dr. Bajor, in her opinion,
cited to both Exhibits 13F and 14F rather than to only Exhibit 13F. (Docs. 14-7, pg. 634; 14-
9, pg. 31). The bottom line is that Dr. Bajor cited to Exhibit 13F, which details a date of
visit of January 4, 2017, for the proposition that subsequent examinations, i.e.,
examinations after that of Dr. Montgomery on August 26, 2015, did not indicate Plaintiff
suffered from diminished strength and dexterity in the right hand and shoulder. (Doc.
14-7, pgs. 348-59, 420-32, 634). Exhibit 13F, which documents no such diminished strength
or dexterity but includes normal x-rays of the right shoulder and hand from July 6, 2016,
reasonably stands for that proposition. (Doc. 14-7, pgs. 420-32). Therefore, it is irrelevant
that the ALJ included an extra citation to Exhibit 14F, presumably by mistake.
Notably, the ALJ’s decision to limit Plaintiff to frequent handling and fingering is
supported by the provider examinations of record, as the ALJ noted. For example, in
February and March 2016, Plaintiff had no musculoskeletal symptoms and, on
examination, there was “normal movement of extremities.” (Doc. 14-7, pgs. 223, 225, 227,
230, 277, 279). On examination in April 2016, Plaintiff was observed to have normal
musculoskeletal symptoms and “[n]o skeletal abnormalities or deformities.” (Doc. 14-7,
pgs. 265, 273). Likewise, as to Plaintiff’s joints, there was “no deformity or dislocation, no
tenderness or swelling, normal…[range of motion], no pain.” (Doc. 14-7, pg. 265). In
February 2017, despite some cervical tenderness and decreased range of motion, Plaintiff
had 5/5 strength in the right upper extremities and was intact to gross touch to bilateral
upper extremities. (Doc. 14-7, pg. 379). From April to October 2017, despite “arthralgias
and joint pain” on one occasion, Plaintiff’s musculoskeletal symptoms and examinations
were normal. (Doc. 14-7, pgs. 565, 568, 570, 574-75, 578-79, 585, 588, 590, 593, 596, 599, 603,
606, 615). Therefore, the ALJ’s findings here were supported by substantial evidence.
2. Opinion of Dr. Montgomery
Plaintiff presented to Dr. Montgomery on August 26, 2015. (Doc. 14-7, pg. 348).
Based on the medical information available for review, Dr. Montgomery noted, inter alia,
Plaintiff had cervical radiculopathy and a transient paralysis of a limb. (Doc. 14-7, pg.
348). He also identified a prior diagnosis of fibromyalgia. (Doc. 14-7, pg. 349).
Dr. Montgomery noted Plaintiff’s chief complaints were, among other things,
cervical radiculopathy, bone degeneration, and nerve damage in the neck, upper back,
and right arm. (Doc. 14-7, pg. 348). Dr. Montgomery also noted Plaintiff’s history of
present complaints. (Doc. 14-7, pg. 348). Plaintiff was in separate severe motor vehicle
accidents in 2007 and 2013. (Doc. 14-7, pg. 348). Since that time, she had neck pain and
arm issues. (Doc. 14-7, pg. 348). Plaintiff described uncontrollable tremors on the right
side of her body, degeneration in the bones around her shoulder and upper arm and neck
on the right, right arm and upper back pain, and “she obviously ha[d] nerve damage in
the neck involving different nerves, even in her right hand.” (Doc. 14-7, pgs. 348-49).
Some limitations pointed to ulnar nerve dysfunction and other limitations pointed to
radial nerve dysfunction. (Doc. 14-7, pg. 349). Plaintiff’s tremors caused distress and were
“a big problem,” as Dr. Montgomery noted “she had constant tremors in her right arm
and right leg as well as other uncontrollable movements” during the interview. (Doc. 14-
7, pgs. 349-50). Plaintiff’s “right shoulder swells and her fingers lock on the right side.”
(Doc. 14-7, pg. 349). Plaintiff’s fingers and hands also got feverish. (Doc. 14-7, pg. 349).
On examination, Plaintiff’s neck was supple, but she could not turn to the right
very well. (Doc. 14-7, pgs. 350-51). Plaintiff had tender spots in the back, especially over
the scapulae and the entire right shoulder area. (Doc. 14-7, pg. 351). Plaintiff’s right upper
arm was hypertrophied compared to the left upper arm, and “it apparently [wa]s due to
the constant tremors and contraction of the[] muscles…[that] she is not able to control.”
(Doc. 14-7, pg. 351). Further, Plaintiff’s right hand was not very dexterous. (Doc. 14-7, pg.
351). Plaintiff had numbness in the 5th finger and the medial half of the 4th finger,
implying some involvement of the ulnar nerve. (Doc. 14-7, pg. 351). However, Plaintiff’s
numbness in the thumb also suggested radial involvement. (Doc. 14-7, pg. 351).
In terms of a clinical impression, Dr. Montgomery noted Plaintiff had been in two
severe motor vehicle accidents, one with a concussion and the other “with multiple
injuries involving the central nervous system.” (Doc. 14-7, pg. 351). The latter accident
resulted in constant tremors, fasciculations, and jerking spastic motions that were painful
and, according to Plaintiff’s doctors, were probably causing degeneration of the bone
around the right shoulder. (Doc. 14-7, pg. 351). Plaintiff could not “contain the constant
fasciculations and tremors in her body.” (Doc. 14-7, pg. 348).
With respect to her second argument, Plaintiff notes Dr. Montgomery observed
that the dominant right upper extremity, when compared to the left upper extremity, was
hypertrophied. (Doc. 18, pg. 9). Plaintiff argues this observation, as well as the fact that
Dr. Montgomery observed numbness in the thumb, was “completely absent from the
ALJ’s discussion.” (Doc. 18, pg. 9). Further, Plaintiff argues the imaging relied upon by
the ALJ for the proposition that Plaintiff had a normal right extremity would not have
shown the ulnar and radial nerve issues noted by Dr. Montgomery. (Doc. 18, pgs. 9-10).
In response, Defendant argues the ALJ found Dr. Montgomery’s findings
supported the limitations assessed because “other records show[ed] normal right
shoulder range of motion and normal right and left hands without any significant
abnormalities seen on imaging.” (Doc. 24, pgs. 8-9). Therefore, rather than ignoring Dr.
Montgomery’s findings as to the right shoulder and hand limitations, “[t]he ALJ
reasonably weighed Dr. Montgomery’s findings against other record evidence and
explained her reasons for giving his opinion partial weight.” (Doc. 24, pg. 9).
Here, the Court disagrees the ALJ failed to observe Plaintiff’s “right upper arm
[wa]s hypertrophied compared to the left,” as found by Dr. Montgomery. (Docs. 14-7, pg.
351; 18, pg. 9). The ALJ stated, “[w]hile the claimant had one or two tender spots in the
back and especially over the scapulae and the right shoulder, with right upper extremity
atrophy [sic]…the overall examination was otherwise normal. (Docs. 14-7, pg. 351; 14-9,
pg. 25) (Emphasis added.). The ALJ also noted Plaintiff complained to Dr. Montgomery
of “arm issues…and uncontrollable tremors,” the latter of which were found by Dr.
Montgomery to be the cause of the hypertrophy. (Docs. 14-7, pg. 351; 14-9, pg. 25). Aside
from these specific statements, though, the ALJ also noted that Dr. Montgomery observed
some limitation in the right shoulder and cervical ranges of motion, but no abnormal
range of motion relating to the lumbar spine. (Doc. 14-9, pg. 25). Further, the ALJ noted
Dr. Montgomery found 11 tender points, including two in the right shoulder and one in
the right arm, and 2/5 right upper extremity strength. (Docs. 14-7, pg. 354; 14-9, pg. 29).
Similarly, it is not clear to the Court that the ALJ “ignored the statement [of Dr.
Montgomery] about numbness in the thumb.” (Doc. 18, pg. 9). The ALJ noted Dr.
Montgomery found Plaintiff’s “right hand was not very dexterous, numbness right 5th
finger and 4th—ulnar nerve.” (Doc. 14-9, pg. 29). Dr. Montgomery attributed the
numbness in the thumb to the radial nerve, and the ALJ did not note that finding.
However, the ALJ did note Dr. Montgomery, in the neurological section of his opinion,
which discussed all right-hand numbness, found “[p]inprick and vibratory sensation
were intact” on examination. (Docs. 14-7, pg. 351; 14-9, pg. 25). Likewise, the ALJ noted
Dr. Montgomery’s finding that Plaintiff had a right-hand grip strength of 3/5. (Docs. 14-
7, pg. 356; 14-9, pg. 29). It must be remembered, in light of these arguments, “an ALJ ‘need
not provide a complete written evaluation of every piece of testimony and evidence.’ ”
See Curvin v. Colvin, 778 F.3d 645, 651 (7th Cir. 2015). Regardless, though, the ALJ
recognized Dr. Montgomery “conducted testing supportive of some of the objective
findings and supportive of shoulder and hand limitations in the” RFC. (Doc. 14-9, pg. 29).
Further, the Court rejects Plaintiff’s contention that the ALJ erred by noting, in a
discussion of Dr. Montgomery’s opinion, “other records show[] normal right shoulder
range of motion and normal right and left hands without any significant abnormalities
seen on imaging.” (Doc. 14-9, pg. 29). Plaintiff suggests the ALJ’s statement was improper
because the impairment related to her right extremity stems from nerve, rather than bone,
damage. However, the imaging was referenced after the ALJ noted Dr. Montgomery’s
testing was supportive of the shoulder and hand limitations in the RFC. (Doc. 14-9, pg.
29). Further, the imaging was referenced in the context of Dr. Montgomery’s noted
“shoulder range of motion deficits and reduced grip strength,” which seems to render
the imaging relevant. (Doc. 14-9, pg. 29). Therefore, in a case where Plaintiff is alleging
impairments related to the right extremity, the Court finds it entirely unsurprising that
the ALJ would note the way in which that imaging assisted in determining the
functionality of the right extremity, even if Plaintiff alleges nerve damage. For these
reasons, the Court finds the ALJ did not err when considering Dr. Montgomery’s opinion.
3. The Treating Source Statement Regarding Plaintiff’s Right Hand
On March 20, 2015, Plaintiff was assessed by her primary care physician, Dr.
Climaco. (Doc. 14-7, pg. 176). He diagnosed Plaintiff with chronic pain and cervical
radiculopathy. (Doc. 14-7, pg. 176). Dr. Climaco marked the box “no” when asked
whether Plaintiff, in an 8-hour workday and 40-hour workweek, could stand and/or
walk up to 2 hours, sit for 6 or more hours, occasionally lift and/or carry up to 10 lbs, or
frequently lift and/or carry up to a few lbs. (Doc. 14-7, pg. 176). Dr. Climaco described
the objective and clinical findings that supported his opinions by stating, inter alia,
Plaintiff had pain and muscle spasms with prolonged sitting or standing, difficulty
turning her head to the right, and numbness in the right hand. (Doc. 14-7, pg. 176).
Now, as to her third argument, Plaintiff admits the ALJ discussed the above
medical source opinion of her primary care physician, Dr. Climaco, which was accorded
little weight, but states the ALJ “omit[ted] any reference to Dr. Climaco’s statement about
the Plaintiff’s right upper extremity” and right-hand numbness. (Doc. 18, pg. 10). Plaintiff
states this would usually be unimportant; however, here, “errors and omissions in the
analysis of the…right hand function are a theme in the ALJ decision.” (Doc. 18, pg. 10).
In response, Defendant points out that Plaintiff is not challenging the decision to
give Dr. Climaco’s opinion little weight. (Doc. 24, pg. 9). Defendant further notes the
ALJ’s decision is replete with references to subjective reports of nerve damage and
medical records documenting, inter alia, right hand numbness. (Doc. 24, pg. 9).
Here, the ALJ gave the entire 1-page opinion of Dr. Climaco “little weight”
because, although he was Plaintiff’s primary care doctor, Dr. Climaco provided a
“conclusory statement” with “very little in the way of actual functional limitations.” (Doc.
14-9, pg. 28). Indeed, the 1-page opinion provides two “check box” questions with little
room for meaningful comments. Therefore, even if the Court were to find error and
remand the case for consideration of the comment identified by Plaintiff, the ALJ would
likely find Dr. Climaco’s entire “conclusory statement” is still entitled to “little weight.”
See Lambert v. Berryhill, 896 F.3d 768, 776 (7th Cir. 2018) (“An error is harmless only if we
are convinced that the ALJ would reach the same result on remand.”). And, regardless of
the claimed omission to consider that statement, the ALJ found Dr. Climaco “regularly
note[d] normal examinations,” including as to the musculoskeletal system, “without
anything supportive of such debilitating symptoms resulting in an inability to work
(Exhibit 1F).” (Doc. 14-9, pg. 28). Plaintiff’s alleged severe limitations were inconsistent
with the objective evidence. (Doc. 14-9, pg. 28). Indeed, the Court made similar findings
as to Plaintiff’s right hand and shoulder with respect to Dr. Bajor. As such, the Court finds
the ALJ did not ignore or otherwise error in its consideration of Dr. Climaco’s opinion.
4. The Failure to Mention Physical Therapy Records
On April 24, 2015, Plaintiff presented for physical therapy. (Doc. 14-7, pg. 185). The
primary and rehabilitative diagnosis was, inter alia, fibromyalgia and generalized
weakness. (Doc. 14-7, pg. 185). Plaintiff presented with decreased range of motion,
decreased strength, and increased pain that was scaled at 7/10 during resting and 10/10
during activity. (Doc. 14-7, pg. 185). Plaintiff reported “extreme neck pain and [an]
inability to turn head to…[the right, right upper extremity] weakness, tremors, and
occasional ‘locking.’ ” (Doc. 14-7, pg. 185). The physical therapist observed a guarded
right upper extremity and hypertonicity throughout “B UT and paraspinals.” (Doc. 14-7,
pg. 185). Plaintiff had gross limitations into all planes with the right upper extremity, and
the pain and weakness reportedly limited her range of motion. (Doc. 14-7, pg. 185).
Plaintiff argues the above-noted physical therapy notes describe hypertonicity in
the right upper extremity. (Doc. 18, pg. 11). Plaintiff argues the ALJ failed to discuss that
evidence, which “describe[es] abnormality with neurologic origin that pertains to the
right dominant upper extremity.” (Doc. 18, pg. 11). Plaintiff notes, again, such an
omission, by itself, would be unimportant. (Doc. 18, pg. 11). In this case, though, “errors
and omissions in the analysis of the…right upper extremity function are a theme in the
ALJ decision.” (Doc. 18, pg. 11). In response, Defendant argues the ALJ was not required
to summarize or discuss every piece of evidence in the record. (Doc. 24, pgs. 9-10).
Defendant stresses, even though that is the case, the ALJ did not ignore the line of
evidence related to Plaintiff’s right arm and hand problems. (Doc. 24, pg. 10).
Here, Plaintiff takes issue with the ALJ’s failure to discuss an isolated observation
of a physical therapist that was made on a single date of service in April 2015. As noted
above, however, “an ALJ ‘need not provide a complete written evaluation of every piece
of testimony and evidence.’ ” See Curvin, 778 F.3d at 651. This is especially true where, as
here, the ALJ did not otherwise ignore the evidence related to Plaintiff’s right upper
extremity. Indeed, the ALJ’s decision thoroughly discusses the issues related to Plaintiff’s
right upper extremity, including, inter alia, Plaintiff’s hearing testimony and written
statements relating to nerve damage, Plaintiff’s statements in the neurological
examination in April 2015, Plaintiff’s statements and Dr. Montgomery’s comprehensive
observations in August 2015, Plaintiff’s complaints of right shoulder pain and
examination in July 2016, and the findings of Dr. Bajor in January 2018. (Docs. 14-7, 631;
14-9, pgs. 24-25, 29). Dr. Bajor indicated the evidence was inconsistent as to the
diminished strength and dexterity in the right hand and shoulder. (Doc. 14-7, pg. 634).
However, the ALJ indicated its RFC and other findings were based on the entire record
of objective medical and other evidence. (Doc. 149, pgs. 12, 15, 23-25). And, as noted above
with respect to Dr. Bajor’s opinion, the findings related to Plaintiff’s right hand and
shoulder are supported by substantial evidence. Accordingly, the Court rejects Plaintiff’s
argument that the ALJ erred by failing to mention the above-discussed treatment record.
5. The Impermissible Playing of Doctor
On April 7, 2015, Plaintiff presented to Dr. Roula Al-Dahhak, M.D., of St. Louis
University. (Doc. 14-7, pg. 161). At that time, Dr. Al-Dahhak noted a prior CT of the neck
was “NL.” (Doc. 14-7, pg. 165). Plaintiff noted neck pain, joint pain, and tremors in the
past 90 days. (Doc. 14-7, pg. 167). On examination, Dr. Al-Dahhak noted Plaintiff’s neck
was symmetric and she had no skeletal abnormalities or deformities, scoliosis or
kyphosis, or contractures. (Doc. 14-7, pg. 167). Further, in terms of her joints, Plaintiff had
normal range of motion and no deformities or dislocations, tenderness or swelling,
edema in the lower extremities, or pain. (Doc. 14-7, pg. 167). Plaintiff also had normal
muscle tone with no spasticity or rigidity, normal muscle bulk with no atrophy or
hypertrophy, no contractures, 5/5 muscle strength in all categories, and 2/2 muscle
stretch reflexes in three categories. (Doc. 14-7, pg. 168).
Plaintiff argues, even if there was a normal CT of the neck from an unknown time,
the ALJ “improperly played doctor when she stated ‘a normal cervical spine CT is
inconsistent with her claim of cervical radiculopathy.’ ” (Doc. 18, pg. 12). Plaintiff notes
her pain from cervical radiculopathy was treated with a steroid injection at a time when
she was already taking methadone, lyrica, and oxycodone. (Docs. 14-7, pg. 396; 18, pg.
12). The doctor added baclofen and noted an MRI showing cervical indentation of the
thecal sac and facet arthropathy. (Docs. 14-7, pg. 396; 18, pgs. 12-13). Plaintiff states the
ALJ did not discuss this evidence, and “[t]he individual assessments of cervical
radiculopathy…are too numerous to cite.” (Doc. 18, pg. 13).
In response, Defendant argues Plaintiff’s characterization of the CT is incomplete.
(Doc. 24, pg. 10). In particular, Defendant notes a neurologist reviewed a CT scan of
Plaintiff’s neck and noted the results were normal. (Doc. 24, pg. 10). Further, on
examination, the neurologist observed that Plaintiff had normal muscle tone and
strength, sensation, and range of motion in the hands and feet. (Doc. 24, pg. 10).
Here, the ALJ noted, on April 7, 2015, Plaintiff complained of chronic neck pain.
(Doc. 14-9, pg. 25). The ALJ also correctly noted the neurologist’s observation that a CT
scan of the neck was normal. (Doc. 14-9, pg. 25). It is true the ALJ indicated “[a] normal
cervical spine CT is inconsistent with her claim of cervical radiculopathy,” but that was
not the end of the analysis. (Doc. 14-9, pg. 25). After making this statement, the ALJ noted
the neurologist’s examination indicated: “no skeletal abnormalities, no joint deformity,
no tenderness or swelling, normal speech and mentation…5/5 strength throughout,
normal motor tone with no spasticity or rigidity, no muscle atrophy, and normal
sensation with no cervical radiculopathy.” (Doc. 14-9, pg. 25). It does not appear the ALJ’s
findings as to Plaintiff’s cervical radiculopathy were based solely, or even primarily, on
the CT of the neck. (Doc. 14-9, pg. 25). The neurologist’s examination clearly informed
the ALJ’s immediate analysis. (Doc. 14-9, pg. 25). And, more broadly, the ALJ indicated
“[p]hysical examinations throughout the relevant period were essentially unremarkable
as related to the claimant’s neck…impairment.” (Doc. 14-9, pg. 25). The ALJ further
stated, “[d]espite the claimant’s testimony of such significant neck…pain and limitation,
treatment notes regularly show essentially normal musculoskeletal examinations with no
significant joint tenderness or swelling.” (Doc. 14-9, pg. 26). Also, “Dr. Montgomery
observed some limitation in…cervical range of motion…[but] the remainder of the record
documents…normal musculoskeletal range of motion.” (Doc. 14-9, pg. 25). Similar
findings have been noted by the Court above. As such, the ALJ did not improperly play
doctor, did not ignore evidence, and its findings were supported by substantial evidence.
V. Conclusion
For these reasons, the Court AFFIRMS the final agency decision. The Clerk of the
Court is DIRECTED to enter judgment for Defendant and against Plaintiff.
SO ORDERED.
Dated: September 29, 2023.
s/ David W. Dugan
__________________________
DAVID W. DUGAN
United States District Judge