# Braden v. Commissioner of Social Security

> District Court, N.D. Indiana · January 26, 2021

URL: https://www.frixlaw.com/law-library/cases/10160395

## Case

- **Court:** District Court, N.D. Indiana
- **Decided:** January 26, 2021
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10160395

## How later opinions describe it (automated extraction)

- finding that it was improper for the ALJ to infer a claimant was not experiencing significant problems simply because specific treatment was not prescribed

## Opinion text

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
SOUTH BEND DIVISION

LAURA D. BRADEN, )
Plaintiff, )
)
v. ) Case No. 1:20-CV-056-JD
)
ANDREW M. SAUL, Commissioner of )
Social Security )
)
Defendant. )

OPINION AND ORDER
Laura D. Braden applied for supplementary security income, alleging that she is unable to
work primarily due to anxiety, post-traumatic stress disorder, depression, an auto immune
disease, fibromyalgia, chronic pain and fatigue, erythema, annulare, centrifugum, general anxiety
disorder, and panic disorder with agoraphobia. Ms. Braden was found to be not disabled in a
December 2018 decision. Ms. Braden filed this appeal, asking the Court to reverse the ALJ’s
decision and remand for further proceedings based on alleged errors with the residual functional
capacity assessment. The Commissioner filed a response in opposition, and Ms. Braden filed a
reply. As explained below, the Court remands the Commissioner’s decision.

I. Factual Background
Until she stopped working, Ms. Braden worked as a secretary. Ms. Braden suffers from
fibromyalgia, arthritic right foot, depression, anxiety, and post-traumatic stress disorder. (R. 18).
Ms. Braden applied for benefits in 2017. The ALJ issued an unfavorable decision on
December 13, 2018. In that decision, the ALJ recognized the following residual functional
capacity:
[T]he claimant has the residual functional capacity to perform light work as defined
in 20 CFR 416.967(b) except the claimant can occasionally climb ramps and stairs.
The claimant can never climb ladders, ropes, or scaffolds. The claimant can
occasionally balance. The claimant can occasionally stoop and kneel. The claimant
cannot crouch or crawl. The claimant must avoid concentrated exposure to
unprotected heights. The claimant can understand, remember, and carry out simple
instructions. The claimant can perform work that can be done at a flexible and goal
oriented pace. The claimant is limited to work within a low stress job requiring only
occasional decision-making and only occasional changes in a work setting. The
claimant can occasionally interact with the general public and can occasionally
interact with co-workers and supervisors other than what is necessary for
instruction and task completion.

(R. 20). Finding that Ms. Braden can perform other work in the economy, the ALJ found that she
is not disabled. The Appeals Council declined review, and Ms. Braden filed this action seeking
judicial review of the Commissioner’s decision.

II. Standard of Review
Because the Appeals Council denied review, the Court evaluates the ALJ’s decision as
the final word of the Commissioner of Social Security. Schomas v. Colvin, 732 F.3d 702, 707
(7th Cir. 2013). This Court will affirm the Commissioner’s findings of fact and denial of benefits
if they are supported by substantial evidence. Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008).
Substantial evidence consists of “such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401 91 S. Ct. 1420, 28
L. Ed. 2d 842 (1971). This evidence must be “more than a scintilla but may be less than a
preponderance.” Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007). Even if “reasonable minds
could differ” about the disability status of the claimant, the Court must affirm the
Commissioner’s decision as long as it is adequately supported. Elder v. Astrue, 529 F.3d 408,
413 (7th Cir. 2008).
The ALJ has the duty to weigh the evidence, resolve material conflicts, make
independent findings of fact, and dispose of the case accordingly. Perales, 402 U.S. at 399–400.
In evaluating the ALJ’s decision, the Court considers the entire administrative record but does
not reweigh evidence, resolve conflicts, decide questions of credibility, or substitute the Court’s
own judgment for that of the Commissioner. Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539

(7th Cir. 2003). Nevertheless, the Court conducts a “critical review of the evidence” before
affirming the Commissioner’s decision. Id. An ALJ must evaluate both the evidence favoring the
claimant as well as the evidence favoring the claim’s rejection and may not ignore an entire line
of evidence that is contrary to his or her findings. Zurawski v. Halter, 245 F.3d 881, 887 (7th Cir.
2001). The ALJ must provide a “logical bridge” between the evidence and the conclusions. Terry
v. Astrue, 580 F.3d 471, 475 (7th Cir. 2009).

III. Standard for Disability
Disability benefits are available only to those individuals who can establish disability
under the terms of the Social Security Act. Estok v. Apfel, 152 F.3d 636, 638 (7th Cir. 1998).

Specifically, the claimant must be unable “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 12
months.” 42 U.S. C. § 423(d)(1)(A). The Social Security regulations create a five-step process to
determine whether the claimant qualifies as disabled. 20 C.F.R. §§ 404.1520(a)(4)(i)–(v);
416.920(a)(4)(i)–(v). The steps are to be used in the following order:
1. Whether the claimant is currently engaged in substantial gainful activity;
2. Whether the claimant has a medically severe impairment;
3. Whether the claimant’s impairment meets or equals one listed in the regulations;
4. Whether the claimant can still perform past relevant work; and
5. Whether the claimant can perform other work in the community.
See Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001).
At step two, an impairment is severe if it significantly limits a claimant’s ability to do

basic work activities. 20 C.F.R. §§ 404.1522(a), 416.922(a). At step three, a claimant is deemed
disabled if the ALJ determines that the claimant’s impairment or combination of impairments
meets or equals an impairment listed in the regulations. 20 C.F.R. §§ 404.1520(a)(4)(iii),
416.920(a)(4)(iii). If not, the ALJ must then assess the claimant’s residual functional capacity,
which is defined as the most a person can do despite any physical and mental limitations that
may affect what can be done in a work setting. 20 C.F.R. §§ 404.1545, 416.945. The ALJ uses
the residual functional capacity to determine whether the claimant can perform his or her past
work under step four and whether the claimant can perform other work in society at step five. 20
C.F.R. §§404.1520(e), 416.920(e). A claimant qualifies as disabled if he or she cannot perform
such work. The claimant has the initial burden of proof at steps one through four, while the

burden shifts to the Commissioner at step five to show that there are a significant number of jobs
in the national economy that the claimant can perform. Young v. Barnhart, 362 F.3d 995, 1000
(7th Cir. 2004).

IV. Discussion
Ms. Braden offers three arguments, in support of reversal. She argues that the ALJ erred
at step two in finding many of her impairments to be non-severe; that the ALJ erred at step three
in considering the listings; and the ALJ erred in assessing Ms. Braden’s RFC. The Court finds
that the ALJ erred in finding her Sjögren’s syndrome was not severe at step two and failing to
consider relevant medical evidence in the RFC discussion.
Ms. Braden asserts that the ALJ erred at step two in finding multiple of her impairments
non-severe, and then failing to include symptoms related to those impairments in the RFC. At
step two, the ALJ must determine the severity of the claimant’s impairments. 20 C.F.R.

§404.1520(a)(4)(ii). An impairment is severe if it significantly limits the claimant’s physical or
mental ability to perform basic work activities. 20 C.F.R. §§416.920(c); 416.921(a). According
to 20 C.F.R. § 416.921(b), “basic work activities” means:
The abilities and aptitudes necessary to do most jobs. Examples of these include—
(1) Physical functions such as walking, standing, sitting, lifting, pushing, pulling,
reaching, carrying, or handling;
(2) Capacities for seeing, hearing, and speaking;
(3) Understanding, carrying out, and remembering simple instructions;
(4) Use of judgment;
(5) Responding appropriately to supervision, co-workers and usual work situations; and
(6) Dealing with changes in a routine work setting.
20 C.F.R. § 416.921(b).
At step two, the ALJ found that Ms. Braden’s autoimmune disease, Sjögren’s syndrome,
was a non-severe impairment. The ALJ based this on finding that Ms. Braden was on medication
to treat her Sjögren’s syndrome, and that the record does not reflect any emergency treatment or
ongoing treatment for flare-ups of her Sjögren’s syndrome. (R. 18). Sjögren’s syndrome is an
autoimmune syndrome that causes dry eyes and a dry mouth. It often accompanies other immune
system disorder, such as rheumatoid arthritis and lupus. Sjögren’s syndrome can also cause joint
pain, swelling, stiffness, swollen salivary glands, skin rashes or dry skin, persistent dry cough,
and prolonged fatigue.1 Ms. Braden argues that the ALJ’s indication that her condition is non-
severe shows a lack of understanding of Sjögren’s syndrome.
As an initial matter, it is improper for the ALJ to rely on a lack of emergency treatment in
finding her Sjögren’s syndrome is not severe. See Myles v. Astrue, 582 F.3d 672, 677 (7th Cir.

2009) (finding that it was improper for the ALJ to infer a claimant was not experiencing
significant problems simply because specific treatment was not prescribed). It is illogical to
assume that an impairment must require emergency treatment in order to be severe. Rather, a
severe impairment is one which significantly limit the claimant’s ability to perform basic work
activities. 20 C.F.R. §§416.920(c); 416.921(a). Nowhere in the regulations does it state that an
impairment must require emergency treatment in order to significantly limit one’s ability to
perform basic work activities. The ALJ erred in finding Ms. Braden’s Sjögren’s syndrome was
nonsevere simply because there was no emergency treatment in the record.
The ALJ also erroneously relied on a lack of treatment “for flare ups” in finding her
Sjögren’s syndrome is nonsevere. This shows a lack of understanding for Sjögren’s syndrome

and its treatment. There is no specific treatment for Sjögren’s flares, and the treatment is
continued medication.2 Ms. Braden was already taking Plaquenil and Prednisone in addition to
Celebrex. (R. 711). Plaquenil is the suggested medication for joint pain for Sjögren’s syndrome
not controlled by other medications. She also took Prednisone, which is a short-term option for
both arthritis and Sjögren’s syndrome3, but she could no longer receive steroid injections due to
her other impairments. (R. 1373).

1 https://www.mayoclinic.org/diseases-conditions/sjogrens-syndrome/symptoms-causes/syc-20353216 (last visited
January 12, 2021).
2 https://www.hopkinssjogrens.org/disease-information/sjogrens-syndrome/joint-pain/ (last visited January 20,
2021); http://info.sjogrens.org/conquering-sjogrens/what-is-a-sjogrens-flare (last visited January 20, 2021).
3 https://www.hopkinssjogrens.org/disease-information/sjogrens-syndrome/joint-pain/
The ALJ also asserts that Ms. Braden’s Sjögren’s syndrome symptoms were controlled
with the medication Pilocarpine. (R. 18). However, the record indicates that she had to start
Plaquenil in 2017 due to continued symptoms. (R. 711-15). While Plaquenil improved her
symptoms, the dosage had to be decreased due to increased anxiety and depression while on

Plaquenil. (R. 711, 715, 789, 807, 810). Even while on Plaquenil and noting that it improved her
symptoms, Ms. Braden continued to complain of tenderness and joint pain. (R. 711, 789, 807).
The ALJ’s finding that Ms. Braden’s Sjögren’s syndrome was controlled, let alone by a single
medication, is in error, as the evidence indicates that her symptoms persisted.
In fact, the ALJ ignored large portions of evidence regarding her symptoms related to her
Sjögren’s syndrome. Ms. Braden reported to her physician in June 2018 that she was having
negative side effects to her medication prescribed for symptom relief, and that she could no
longer receive steroid injections for her pain due to her conditions. (R. 1373). The ALJ relied on
both those injections and Plaquenil, the medication to which she was having negative side
effects, to find that her pain was less limiting than alleged. (R. 21). The ALJ provided very little

discussion about her pain, either with regards to her fibromyalgia, her arthritis, or her Sjögren’s
syndrome (all of which have similar symptoms). The ALJ did not discuss further reports of
recurring pain and discomfort that Ms. Braden attributed to her Sjögren’s syndrome. (R. 1373.).
She has gone through multiple medication changes, yet still complained of significant joint pain.
(R. 1373, 1379). Ms. Braden also started pain management treatment in June 2018, including a
referral to physical therapy. (R. 1006, 1012-13). During her first pain management appointment,
Ms. Braden stated that her pain is at an 8/10 on her best days, and at a 10/10 on her worst days.
(R. 1006). She further stated that her symptoms are aggravated by bending, standing, and
activity. (Id.).
The reported aggravation of symptoms and continued pain is critical, as the worsening of
symptoms occurred after the state agency physicians evaluated her claim. The ALJ provided
those state agency physician opinions “considerable weight” (R. 23), and did not consider
subsequent evidence in determining that Ms. Braden’s Sjögren’s syndrome is nonsevere. While

the ALJ mentioned this evidence as part of a string of citations to support his finding that Ms.
Braden’s fibromyalgia and right foot arthritis are less limiting than alleged, he does not discuss
the evidence showing worsening symptoms and pain. This Court is not determining that Ms.
Braden’s Sjögren’s syndrome is a severe impairment. However, the ALJ improperly found it to
be nonsevere without considering all of the evidence in the record.
The ALJ’s errors in discussing Ms. Braden’s Sjögren’s goes hand in hand with his
dismissal of her subjective symptoms regarding her fibromyalgia and right foot arthritis, which
manifest similar symptoms as Sjögren’s syndrome, including joint pain and discomfort. The ALJ
found that Ms. Braden’s symptoms of pain were less limiting than alleged, finding that pain
medication, psychotropic medication, and physical therapy manage her conditions. (R. 21-22).

The ALJ also found that Ms. Braden retains the ability to sit and read, generally gets along with
others, is able to drive, and can count money, organize her bills, pay her bills on time, and
balance a checking account independently. (R. 22). Ms. Braden asserts that the ALJ erred in
evaluating her subjective symptoms.
An ALJ’s subjective symptoms analysis is given special deference so long as the ALJ
explains his reasoning and it is supported by the record. The Court will not overturn an ALJ’s
subjective symptoms analysis unless it is “patently wrong.” Summers v. Berryhill, 864 F.3d 523,
528 (7th Cir. 2017) (internal quotations omitted); Curvin v. Colvin, 778 F.3d 645, 651 (7th Cir.
2015). The claimant bears the burden of demonstrating that an ALJ’s subjective symptom
evaluation is patently wrong. See Horr v. Berryhill, 743 F. App’x 16, 19-20 (7th Cir. 2018). The
regulations require the ALJ to look at a variety of factors in evaluating a claimant’s symptoms,
including the nature and intensity of pain, the effects of his pain on his ability to function, and
daily activities. 20 C.F.R. § 404.1529(c).

The ALJ relies on normal findings related to her “head, eyes, ears, nose, throat, neck,
back, lungs, breasts, heart, abdomen, extremities, pulses, and skin,” as well as a lack of
“musculoskeletal swelling, redness, tenderness, or joint deformity” to discredit the right foot
arthritis and fibromyalgia symptoms. However, none of these normal findings relate to any
symptoms related to fibromyalgia and arthritis in the right foot. Normal findings related to the
head, eyes, ears, etc., do not disprove joint pain or foot pain. Joint swelling or deformity is not a
symptom of fibromyalgia,4 and therefore it is improper for the ALJ to find that a lack of
swelling or deformity discredits Ms. Braden’s testimony of continued fibromyalgia pain. See
Sarchet v. Chater, 78 F.3d 305, 307 (7th Cir. 1996) (“Since swelling of the joints is not a
symptom of fibromyalgia, its absence is no more indicative that the patient’s fibromyalgia is not

disabling than the absence of headache is an indication that a patient’s prostate cancer is not
advanced.”) Joint swelling is also not a necessary symptom of arthritis, as osteoarthritis is non-
inflammatory in nature.5 The ALJ failed to discredit Ms. Braden’s complaints of fibromyalgia
and right foot pain with any medical findings related to either condition. Normal findings related
to her head, eyes, ears, nose, throat, etc., provide no indication that she isn’t suffering from pain
in her right foot or pain related to her fibromyalgia. Moreover, the ALJ improperly found that
Ms. Braden did not have any tender points. (AR 21). In June and August 2016, Ms. Braden was

4 https://www.medicalnewstoday.com/articles/321682#do-i-have-fibromyalgia-or-ra- (last visited January 14, 2021)
(showing that swelling is a symptom of rheumatoid arthritis and not a symptom of fibromyalgia).
5 https://www.pellahealth.org/services/rheumatology/arthritis-non-inflammatory-vs-inflammatory/ (last visited
January 20, 2021).
found to have “multiple fibromyalgia tender points present.” (AR 514, 526). Other medical
records show tenderness in her sternum, lower lumbar spine tenderness, tenderness in multiple
joints, (R. 807, 809). The ALJ erred in discrediting Ms. Braden’s subjective symptoms on the
basis of cherry picked evidence that does not logically relate to her impairments.

Ms. Braden also asserts that the ALJ ignored evidence related to her pain, osteoarthritis,
and gastrointestinal impairments that were added to the medical record after the state agency
medical consultants conducted their review. Ms. Braden began attending pain management,
physical therapy, and began working with a new primary care physician after the state agency
medical consultants reviewed the evidence. (AR 988, 1006-14, 1455-95, 1373-1410). Her pain
management doctor diagnosed her with osteoarthritis in both hips, as well as added chronic pain
syndrome to her already existing diagnosis of fibromyalgia. (AR 1013). The only mention of her
pain management treatment notes in the ALJ’s decision occurs in a citation of multiple medical
exhibits used to support the ALJ’s finding that Ms. Braden’s subjective symptoms were not as
limiting as alleged. (AR 21-22). Yet, after fifteen sessions of physical therapy, she was noted to

have continued pain and tenderness in her lower back, and she had started having new pain and
limited range of motion in her cervical spine. (AR 1461). Her therapist recommended continued
physical therapy and stated that Ms. Braden “requires skilled therapy to reduce signs and
symptoms and improve function.” (AR 1461-62). Moreover, neither the ALJ nor the state agency
physicians discussed Ms. Braden’s gastrointestinal issues as documented by Dr. Brianna Serbus.
Dr. Serbus noted that Ms. Braden’s abdominal and periumbilical pain was worsening, and that
she was experiencing nausea and vomiting. (AR 771-74). Other portions of the medical evidence
showed that Ms. Braden experienced diarrhea, and that her intestinal pain and issues grew worse
when her pain was worse. (AR 44-45, 379, 467-68, 608, 758, 1373). While the exclusion of any
discussion regarding these impairments or limitations on their own may not be enough for
remand, taken all together they indicate that the ALJ did not fully examine all of Ms. Braden’s
impairments or the combined effect they may have on her ability to function.
The ALJ improperly ignored evidence in evaluating Ms. Braden’s Sjögren’s syndrome

and subjective symptoms. On remand, the ALJ must properly weigh the evidence and make a
full and proper analysis of Ms. Braden’s Sjögren’s syndrome and subjective symptoms.
Accordingly, the Court reverses and remands for additional proceedings. The parties are free to
address any remaining issues on remand.

CONCLUSION
For those reasons, the Court REVERSES the Commissioner’s decision and REMANDS
for additional proceedings consistent with this opinion. The Clerk is DIRECTED to prepare a
judgment for the Court’s approval.
SO ORDERED: January 26, 2021

/s/JON E. DEGUILIO
Chief Judge
United States District Court

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10160395. Public record. Not legal advice.