# CROUCH v. SAUL

> District Court, S.D. Indiana · February 25, 2022

URL: https://www.frixlaw.com/law-library/cases/10168814

## Case

- **Court:** District Court, S.D. Indiana
- **Decided:** February 25, 2022
- **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/10168814

## How later opinions describe it (automated extraction)

- affirming where the ALJ adopted the limitations suggested by the reviewing doctors, who were aware of the claimant's obesity
- holding that mere speculation about the impact of obesity is insufficient for remand

## Opinion text

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
TERRE HAUTE DIVISION

SCOTT C. 1, )
)
Plaintiff, )
)
v. ) No. 2:20-cv-00501-DLP-JRS
)
KILOLO KIJAKAZI, )
)
Defendant. )

ORDER
Plaintiff Scott C. requests judicial review of the denial by the Commissioner
of the Social Security Administration ("Commissioner") of his application for Social
Security Disability Insurance Benefits ("DIB") under Title II of the Social Security
Act. See 42 U.S.C. §§ 405(g), 423(d). For the reasons set forth below, this Court
hereby AFFIRMS the ALJ’s decision denying the Plaintiff benefits.
I. PROCEDURAL HISTORY

On August 27, 2018, Scott proactively filed his application for Title II DIB
benefits. (Dkt. 12-2 at 20, R. 19). Scott alleged disability resulting from blind or low
vision, irritable bowel syndrome, tremors, high blood pressure, carpal tunnel,
arthritis, depression, restless leg syndrome, high cholesterol, and rheumatoid
arthritis. (Dkt. 12-3 at 3, R. 79). The Social Security Administration ("SSA") denied

1 In an effort to protect the privacy interests of claimants for Social Security benefits, the Southern
District of Indiana has adopted the recommendations put forth by the Court Administration and
Case Management Committee of the Administrative Office of the United States Courts regarding the
practice of using only the first name and last initial of any non-government parties in Social Security
opinions. The Undersigned has elected to implement that practice in this Order.
Scott's claim initially on February 15, 2019, (Dkt. 12-3 at 2-12, R. 78-88), and on
reconsideration on May 2, 2019. (Id. at 13-26, R. 89-102). On May 21, 2019, Scott
filed a written request for a hearing, which was granted. (Dkt. 12-2 at 20, R. 19).

On December 10, 2019, Administrative Law Judge ("ALJ") Stuart T. Janney
conducted a hearing, where Scott appeared in person and vocational expert
Christine Fontaine appeared telephonically. (Dkt. 12-2 at 44-78, R. 43-77). On
January 16, 2020, ALJ Janney issued an unfavorable decision finding that Scott
was not disabled. (Dkt. 12-2 at 20-39, R. 19-38). On January 17, 2020, Scott
appealed the ALJ's decision. (Dkt. 12-4 at 74-76, R. 175-77). On September 1, 2020,

the Appeals Council denied Scott's request for review, making the ALJ's decision
final. (Dkt. 12-2 at 2, R. 1). Scott now seeks judicial review of the ALJ's decision
denying benefits pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3).
II. STANDARD OF REVIEW
To qualify for Title II DIB, a claimant must be disabled within the meaning
of the Social Security Act. To prove disability, a claimant must show he is 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 twelve
months." 42 U.S.C. § 423(d)(1)(A). To meet this definition, a claimant's impairments
must be of such severity that he is not able to perform the work he previously
engaged in and, based on his age, education, and work experience, he cannot engage
in any other kind of substantial gainful work that exists in significant numbers in
the national economy. 42 U.S.C. § 423(d)(2)(A). The SSA has implemented these
statutory standards by, in part, prescribing a five-step sequential evaluation
process for determining disability. 20 C.F.R. § 404.1520(a). The ALJ must consider

whether:
(1) the claimant is presently [un]employed; (2) the claimant has a
severe impairment or combination of impairments; (3) the
claimant's impairment meets or equals any impairment listed in
the regulations as being so severe as to preclude substantial
gainful activity; (4) the claimant's residual functional capacity
leaves him unable to perform his past relevant work; and
(5) the claimant is unable to perform any other work existing in
significant numbers in the national economy.

Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351-52 (7th Cir. 2005) (citation
omitted). An affirmative answer to each step leads either to the next step or, at
steps three and five, to a finding that the claimant is disabled. 20 C.F.R. § 404.1520;
Briscoe, 425 F.3d at 352. If a claimant satisfies steps one and two, but not three,
then he must satisfy step four. Once step four is satisfied, the burden shifts to the
SSA to establish that the claimant is capable of performing work in the national
economy. Knight v. Chater, 55 F.3d 309, 313 (7th Cir. 1995); see also 20 C.F.R.
§ 404.1520. (A negative answer at any point, other than step three, terminates the
inquiry and leads to a determination that the claimant is not disabled.).
After step three, but before step four, the ALJ must determine a claimant's
residual functional capacity ("RFC") by evaluating "all limitations that arise from
medically determinable impairments, even those that are not severe." Villano v.
Astrue, 556 F.3d 558, 563 (7th Cir. 2009). The RFC is an assessment of what a
claimant can do despite his limitations. Young v. Barnhart, 362 F.3d 995, 1000-01
(7th Cir. 2004). In making this assessment, the ALJ must consider all the relevant
evidence in the record. Id. at 1001. The ALJ uses the RFC at step four to determine
whether the claimant can perform his own past relevant work and if not, at step

five to determine whether the claimant can perform other work in the national
economy. See 20 C.F.R. § 404.1520(a)(4)(iv)-(v).
The claimant bears the burden of proof through step four. Briscoe, 425 F.3d
at 352. If the first four steps are met, the burden shifts to the Commissioner at step
five. Id. The Commissioner must then establish that the claimant – in light of his
age, education, job experience, and residual functional capacity to work – is capable

of performing other work and that such work exists in the national economy. 42
U.S.C. § 423(d)(2); 20 C.F.R. § 404.1520(f).
Judicial review of the Commissioner's denial of benefits is to determine
whether it was supported by substantial evidence or is the result of an error of law.
Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). This review is limited to
determining whether the ALJ's decision adequately discusses the issues and is
based on substantial evidence. Substantial evidence "means – 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); Rice v. Barnhart, 384
F.3d 363, 369 (7th Cir. 2004). The standard demands more than a scintilla of
evidentiary support but does not demand a preponderance of the evidence. Wood v.
Thompson, 246 F.3d 1026, 1029 (7th Cir. 2001). Thus, the issue before the Court is
not whether Scott is disabled, but, rather, whether the ALJ's findings were
supported by substantial evidence. Diaz v. Chater, 55 F.3d 300, 306 (7th Cir. 1995).
Under this administrative law substantial evidence standard, the Court

reviews the ALJ's decision to determine if there is a logical and accurate bridge
between the evidence and the conclusion. Roddy v. Astrue, 705 F.3d 631, 636 (7th
Cir. 2013) (citing Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008)). In this
substantial evidence determination, the Court must consider the entire
administrative record but not "reweigh evidence, resolve conflicts, decide questions
of credibility, or substitute its own judgment for that of the Commissioner." Clifford

v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000). Nevertheless, the Court must conduct a
critical review of the evidence before affirming the Commissioner's decision, and the
decision cannot stand if it lacks evidentiary support or an adequate discussion of
the issues. Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003); see
also Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir. 2002).
When an ALJ denies benefits, he must build an "accurate and logical bridge
from the evidence to his conclusion," Clifford, 227 F.3d at 872, articulating a

minimal, but legitimate, justification for the decision to accept or reject specific
evidence of a disability. Scheck v. Barnhart, 357 F.3d 697, 700 (7th Cir. 2004).
The ALJ need not address every piece of evidence in his decision, but he cannot
ignore a line of evidence that undermines the conclusions he made, and he must
trace the path of his reasoning and connect the evidence to his findings and
conclusions. Arnett v. Astrue, 676 F.3d 586, 592 (7th Cir. 2012); Clifford, 227 F.3d at
872.
III. BACKGROUND

A. Factual Background
Scott was fifty-three years old as of his July 30, 2018 alleged onset date. (Dkt.
12-3 at 2, R. 78). He is a high school graduate who has past relevant work as an
operator and road boss in the construction industry. (Dkt. 12-6 at 7-8, R. 211-12).
B. ALJ Decision
In determining whether Scott qualified for benefits under the Act, the ALJ

employed the five-step sequential evaluation process set forth in 20 C.F.R.
§ 404.1520(a) and concluded that Scott was not disabled. (Dkt. 12-2 at 20-39, R. 19-
38). At Step One, the ALJ found Scott had not engaged in substantial gainful
activity since his alleged onset date of July 30, 2018. (Id. at 22, R. 21).
At Step Two, the ALJ found that Scott suffered from the following severe
impairment: bilateral knee degenerative joint space loss. (Dkt. 12-2 at 22, R. 21).
The ALJ found Scott had non-severe physical impairments of bilateral cubital and

carpal tunnel syndrome, essential tremor, low vision, hypertension, hyperlipidemia,
gastroesophageal reflux disease, irritable bowel syndrome, and obesity. (Id. at 22-
23, R. 21-22). The ALJ concluded that Scott's medically determinable mental
impairments of major depressive disorder, moderate, recurrent, with anxious
distress; anxiety; and post-traumatic stress disorder, considered singly and in
combination, were nonsevere impairments. (Id. at 24, R. 23). Additionally, when
considering the "paragraph B" criteria, the ALJ found that Scott had no limitation
in interacting with others but mild limitations in understanding, remembering, or
applying information, concentrating, persisting, or maintaining pace, and adapting

or managing oneself. (Dkt. 12-2 at 24-29, R. 23-28).
At Step Three, the ALJ found that Scott's impairments or combination of
impairments did not meet or medically equal the severity of one of the listed
impairments in 20 C.F.R. §§§ 404.1520(d), 404.1525, 404.1526. (Dkt. 12-2 at 30, R.
29).
After Step Three but before Step Four, the ALJ found that Scott had the

residual functional capacity ("RFC") to perform the full range of medium work as
defined in 20 C.F.R. § 404.1567(c). (Dkt. 12-2 at 30-37, R. 29-36).
At Step Four, the ALJ concluded that Scott is capable of performing past
relevant work as an Operating Engineer, medium exertion as generally performed,
very heavy exertion as actually performed, skilled with an SVP of 6; and Truck
Driver, Heavy, medium exertion as generally performed, very heavy exertion as
actually performed, semi-skilled with an SVP of 4. (Dkt. 12-2 at 37-39, R. 36-38).

The ALJ concluded that Scott was not disabled. (Id. at 39, R. 38).
IV. ANALYSIS

Scott challenges the ALJ's decision on two bases: (1) the ALJ erred by failing
to recognize his obesity as a medically determinable impairment, and (2) the ALJ's
residual functional capacity assessment is not supported by substantial evidence.2
(Dkt. 15 at 4).
A. Obesity

Scott contends that the ALJ committed reversible error when he failed to
recognize Plaintiff's obesity as a medically determinable impairment at Step Two
and when he failed to consider it when assessing Scott's RFC. (Dkt. 15 at 5-7). In
response, the Commissioner maintains that the ALJ found Plaintiff's obesity to be a
non-severe impairment at Step Two, and accurately considered this impairment
when factoring an appropriate RFC. (Dkt. 18 at 9-10). In his reply, Scott concedes

that the ALJ did find Plaintiff's obesity to be a non-severe, medically determinable
impairment, at Step Two. (Dkt. 19 at 1). Scott continues to maintain, however, that
remand is necessary because of the ALJ's failure to consider Plaintiff's obesity in
crafting Scott's RFC. (Id. at 1-2). This will be addressed in the next section.
At Step Two of the sequential process, ALJs are required to determine
whether the claimant has an impairment or combination of impairments that are
"severe." 20 C.F.R. § 404.1520(a)(4)(ii).3 Here, as the Plaintiff concedes in his Reply

2 Plaintiff's Opening Brief technically raises four issues for review. (Dkt. 15 at 4). Because Scott
concedes his Step Two argument in the reply brief, the Court will address Scott's RFC arguments
under one subheading.
3 A severe impairment is one that "significantly limits [one's] physical or mental ability to do basic
work activities." 20 C.F.R. § 404.1520(c). When considering whether an impairment is severe, an
ALJ is to consider whether the impairment significantly limits the claimant's physical or mental
ability to do basic work activities, such as walking, standing, sitting, pushing, pulling, use of
judgment, or dealing with changes in a routine work setting. 20 C.F.R. § 404.1522. Impairments are
found to be "not severe" when the medical evidence establishes only a slight abnormality which
would have no more than a minimal effect on an individual's ability to work even if the individual's
age, education, or work experience were specifically considered. SSR 85-28.
brief, the ALJ found Scott's obesity to be a non-severe, medically determinable
impairment. (Dkt. 12-2 at 22-23, R. 21-22). Thus, the ALJ did not err at Step Two.
B. Residual Functional Capacity

Scott's remaining arguments relate to the ALJ's residual functional capacity
assessment. The Seventh Circuit has defined the RFC as "the claimant's ability to
do physical and mental work activities on a regular and continuing basis despite
limitations from [his] impairments." Moore v. Colvin, 743 F.3d 1118, 1121 (7th Cir.
2014). It is the most the claimant can do despite his limitations. 20 C.F.R. §
404.1545(a)(1). When determining the RFC, an ALJ "must consider all medically

determinable impairments, physical and mental, even those that are not considered
severe." Craft v. Astrue, 539 F.3d 668, 675-76 (7th Cir. 2008). And, while an ALJ
"must consider the entire record," the ALJ "is not required to rely entirely on a
particular physician's opinion or choose between the opinions [of] any of the
claimant's physicians." Schmidt v. Astrue, 496 F.3d 833, 845 (7th Cir. 2007). Rather,
it is the ALJ's role to resolve conflicts in the evidence and to formulate an
appropriate RFC based on consideration of the entire record. Diaz v. Chater, 55 F.3d

300, 306 n.2 (7th Cir. 1995) (the determination of RFC "is an issue reserved for the
[Commissioner]," based on "the entire record, including all relevant medical and
nonmedical evidence" and "if conflicting medical evidence is present, the SSA has
the responsibility of resolving the conflict."). The Court will address each of Scott's
arguments in turn.
1. Obesity
Where a claimant suffers from obesity, the ALJ must consider the limiting
effects of obesity with the claimant's underlying impairments when formulating the

RFC. SSR 19-2p. As noted above, the ALJ found Scott's obesity to be a non-severe
impairment. The ALJ failed, however, to explicitly address Scott's obesity
impairment in the RFC. (Dkt. 12-2 at 30-37, R. 29-36). Scott maintains that the
ALJ's failure to properly consider his obesity or to include limitations in the RFC
warrants. (Dkt. 19 at 1-2). Because Scott has failed to cite to any medical evidence
demonstrating that his weight affected his ability to work, (Dkt. 15 at 5-7; Dkt. 19

at 1-3), the Court finds this error harmless.
Courts often find harmless error where the claimant fails to "specify how his
obesity further impaired his ability to work." Prochaska v. Barnhart, 454 F.3d 731,
736-37 (7th Cir. 2006) (affirming where the ALJ adopted the limitations suggested
by the reviewing doctors, who were aware of the claimant's obesity); see Skarbek v.
Barnhart, 390 F.3d 500, 504 (7th Cir. 2004) (holding that mere speculation about
the impact of obesity is insufficient for remand); Rennaker v. Saul, 820 F. App'x.

474, 481 (7th Cir. 2020) (finding the ALJ's failure to consider claimant's obesity
harmless were claimant failed to explain how her obesity hampered her ability to
work). Scott fails to point to any medical records to support his contention that his
obesity required limitations in the RFC assessment or that it limited his ability to
work. Givens v. Colvin, No. 4:12-cv-44-WGH-RLY, 2013 WL 1102754, at *4 (S.D.
Ind. Mar. 15, 2013); see also Clark v.
Kijakazi, No. 20-CV-1363, 2021 WL 5905942, at *3 (E.D. Wis. Dec. 14, 2021)
(finding ALJ's error in failing to specifically address the effects of the claimant's
obesity on her mental limitations harmless where the claimant did not explain how

her obesity – in combination with either her physical or mental impairments –
impacted her ability to work); Stepp v. Colvin, 795 F.3d 711, 720 (7th Cir. 2015)
("An ALJ's failure to explicitly consider an applicant's obesity is harmless if the
applicant did not explain how [his] obesity hampers [his] ability to work."). Scott did
not seek treatment for obesity or testify that obesity affects him in any way. Mere
speculation that obesity should or could have affected other impairments is not

enough. Reid v. Berryhill, No. 1:17-cv-02933-RLY-DLP, 2018 WL 3422128, at *4
(S.D. Ind. June 14, 2018), R. & R. adopted, No. 1:17-cv-02933-RLY-DLP, 2018 WL
3416621 (S.D. Ind. July 13, 2018). Because any consideration of obesity by the ALJ
would have been speculative, the Court finds remand to be inappropriate on this
issue.
2. Ability to perform "medium work"
Next, Scott asserts that the ALJ failed to build an accurate and logical bridge

from the evidence to his conclusion when he determined that Scott had the residual
functional capacity to perform medium work. (Dkt. 15 at 8). Scott argues that the
ALJ never explains how he came up with assigning a "medium" RFC. (Id). The
Commissioner maintains that the ALJ sufficiently explained his RFC finding,
in accordance with SSR 96-8p. (Dkt. 18 at 7-8). The Commissioner also asserts that
the ALJ's discussion of Plaintiff's medical records and the medical source opinions
constitute substantial evidence supporting the finding that Scott could perform

medium work. (Id.).
By finding that Scott had the residual functional capacity to perform medium
work, (Dkt. 12-2 at 30, R. 29), the ALJ concluded that Scott could "[lift no more than
50 pounds at a time with frequent lifting or carrying of objects weighing up to 25
pounds." 20 C.F.R. § 404.1567(c). In reaching this conclusion, the ALJ followed a
two-step process. (Dkt. 12-2 at 30-31, R. 29-30). The ALJ first determined that

Scott's impairments could reasonably be expected to cause Scott's alleged symptoms.
(Id. at 30-32, R. 29-31). The ALJ then evaluated the intensity, persistence, and
limiting effects of Scott's symptoms to determine the extent to which they limit
Scott's work-related activities. (Id. at 31-32, R. 30-31).
In making this evaluation, the ALJ considered the statements by Scott and
his wife that Scott could lift 50 pounds. (Dkt. 12-2 at 34, R. 33). The ALJ noted Scott
consistently demonstrated normal gait, normal strength in bilateral upper and lower

extremities, normal range of motion, and normal coordination. (Id. at 33-34, R.
32-33). The ALJ noted that in May 2018, Scott denied having limited use of his
arms, hands, fingers, legs, feet, and toes; Scott also denied having neck and back
problems. (Dkt. 12-2. at 33, R. 32). The ALJ pointed to Scott's consultative
examinations with Dr. Soufi in which he had a steady and symmetric gait; did not
use an assistive device; exhibited 5/5 muscle strength throughout his bilateral lower
extremities; was able to lift, carry and handle light objects; and exhibited grossly
normal fine and gross manipulative abilities. (Dkt. 12-2. at 33, R. 32; Dkt. 12-7 at
56-58, 65-67, R. 371-73, 380-82). The ALJ also pointed to Scott's ability to rise from

a sitting position without assistance; get up and down from the exam table with
ease; squat and rise from that position with ease; walk on heels and toes with ease;
no joint swelling, effusion, erythema, or deformity; his ability to stand and hop on
one foot bilaterally; and his full range of motion. (Dkt. 12-2 at 33-34, R. 32-33; Dkt.
12-7 at 57-58, 66, R. 372-73, 381). The ALJ also considered Scott's and his wife's
statements regarding Scott's activities of daily living, which included Scott walking

his dogs, washing dishes, shopping, and his ability to perform some yardwork. (Dkt.
12-2 at 34, R. 33; Dkt. 12-6 at 19-21, 31-33, R. 223-25. 235-37; Dkt. 12-7 at 54, 63,
71, 98, R. 369, 378, 386, 413).
It is important to note that much of Scott's testimony at the hearing sharply
contrasted with his early statements contained in the record limiting his subjective
symptom reliability. See Masters v. Astrue, 818 F. Supp. 2d 1054, 1065 (N.D. Ill.
Aug. 19, 2011) ("[A]n ALJ may reasonably disbelieve a claimant's testimony when,

for example, it is contradicted by medical records or other medical evidence, by
conduct inconsistent with the claim, by prior inconsistent statements, or other
conduct or statements that tend to render the testimony doubtful."); Summers v.
Berryhill, 864 F.3d 523, 528 (7th Cir. 2017) (affirming the ALJ's credibility
determination where the claimant's allegations conflicted with prior statements to
medical providers). While acknowledging a range of daily activities in
his Social Security application paperwork, Scott testified at the disability hearing
that he does not shop, wash dishes, or walk his dogs. (Dkt. 12-2 at 65, 67, R. 64, 66).
The ALJ noted these inconsistencies in his opinion. (Dkt. 12-2 at 34-35, R. 33-34).

The ALJ then considered the medical opinions of the state agency
consultants, the consultative examiners, and Scott's physician. (Dkt. 12-2 at 35-37,
R. 34-36). The ALJ first considered the opinions of state agency medical consultants
Dr. B. Whitley and Dr. J. Sands, who opined that Scott was capable of light work.
(Dkt. 12-2 at 35, R. 34). The ALJ found these opinions less persuasive because the
doctors failed to provide sufficient rationale for their postural limitations and the

inconsistencies of the opinions with the evidence from other medical sources. (Id.).
Scott does not contest this finding. The ALJ found the opinions of Dr. Soufi most
persuasive because Dr. Soufi's physical exam findings did not differ markedly from
those from other providers. (Id. at 35-36, R. 34-35; Dkt. 12-7 at 52-59, 61-67; R.
367-74, 376-82). The ALJ also considered the post-operative limitations imposed by
Dr. Terry Fenwick related to Scott's carpal tunnel surgery but found the opinion
unpersuasive because the limitations were intended to be in place for only a few

weeks, not a continuous period of 12 or more months. (Dkt. 12-7 at 36, R. 35).
In formulating Scott's RFC, the ALJ sufficiently weighed Scott's medical
history, physicians' opinions, the effects of claimant's subjective symptoms, the
statements made by Scott and his wife regarding his activities of daily living, and
other record evidence, to build a logical bridge between the evidence and his
conclusion. The ALJ's determination that Scott's physical limitations limited him to
performing the full range of medium work is supported by substantial evidence in
the record, thus remand is not warranted on this issue.

3. Need for Updated Medical Opinion
Scott next argues that the ALJ erred in failing to obtain an updated medical
expert opinion to review his October 2019 x-rays which demonstrated that he had
"mild degenerative joint space loss in both knees" and "small right knee joint
effusion." 4 (Dkt. 15 at 8-9). In response, the Commissioner contends that Scott has
failed to demonstrate how these x-rays constituted new, significant evidence that

reasonably could have changed the ALJ's decision. (Dkt. 18 at 11).
As Scott argues, Dr. Soufi, who examined the claimant in February and April
2019, did not review his bilateral knee x-rays taken on October 21, 2019. (Dkt. 12-7
at 104-05, R. 419-20). Because of this new medical evidence diagnosing "mild
degenerative joint space loss in both knees," Scott maintains that the ALJ was
required to submit the x-rays to medical scrutiny. (Dkt. 15 at 9). The Court
disagrees.

"It is common for there to be a lag between the state agency physicians'
reviews and the ALJ's decision, so the fact that new medical records came in after
the state agency physicians conducted their reviews, is not, by itself problematic."

4 "Joint effusion" refers to a swollen joint that happens when extra fluids flood the tissues around a
person's joints. Joint Effusion (Swollen Joint), CLEVELAND CLINIC,
https://my.clevelandclinic.org/health/symptoms/21908-joint-
effusion#:~:text=What%20is%20joint%20effusion%3F,compared%20to%20your%20other%20joints
(last visited Feb. 22, 2022).
Shelia M. v. Saul, No. 20 C 664, 2021 WL 1784775, at *6 (N.D. Ill. May 5, 2021).
Instead, the dispositive question is whether there is evidence containing new,
significant medical diagnoses postdating the state agency examining physician's

opinion that reasonably could have changed the physician's opinion. Stage v. Colvin,
812 F.3d 1121, 1125 (7th Cir. 2016) (remanding where a later diagnostic report
contained "significant, new, and potentially decisive findings" that could
"reasonably change the reviewing physician's opinion"). Under those circumstances,
the ALJ should not rely on the outdated state agency assessment, but submit the
new evidence to medical scrutiny. Moreno v. Berryhill, 882 F.3d 722, 728 (7th Cir.

2018); see also Kemplen v. Saul, 844 F. App'x 883, 887 (7th Cir. 2021); Keys v.
Berryhill, 679 F. App'x 477, 481 (7th Cir. 2017); Charles B. v. Saul, 2:19-cv-00084-
JPH-DLP, 2020 WL 1163924, at *14 (S.D. Ind. Mar. 11, 2020) ("The Seventh Circuit
has repeatedly held that an ALJ may not 'play doctor' and interpret 'new and
potentially decisive medical evidence' without medical scrutiny.").
Here, there were no significant medical findings that the ALJ failed to
consider, nor was there any new and significant evidence that reasonably could

have changed Dr. Soufi's opinion. First, the ALJ's RFC determination suggests that
the ALJ was aware of Scott's October 2019 x-rays generated after Dr. Soufi's
consultative examinations. As the ALJ noted, Scott's primary care provider, Nurse
Practitioner Kathy Brinkman ordered Scott's X-rays, during his October 21, 2019
examination, in response to Scott's complaints about knee pain. (Dkt. 12-2 at 34, R.
33; Dkt. 12-7 at 92-93, R. 407-08). Ms. Brinkman's treatment notes documented
that she had reviewed and discussed the x-rays with Scott, found him to be stable
and doing well, and advised Scott to remain as active and mobile as possible. (Dkt.
12-2 at 34, R. 33; Dkt. 12-7 at 93, R. 408). Next, the ALJ acknowledged Scott's

December 4, 2019 visit with Nurse Practitioner Ann Vash for IBS. (Dkt. 12-2 at 34,
R. 33; Dkt. 12-7 at 127-30, R. 442-45). Citing directly to Ms. Vash's evaluation, the
ALJ noted that Scott had no joint pain, swelling, redness, or limited mobility; and
on physical exam, normal range of motion in his extremities. (Dkt. 12-2 at 34, R. 33;
12-7 at 130, R. 445). Thus, contrary to the Plaintiff's contention, the ALJ did not
impermissibly play doctor interpreting Scott's x-rays. Instead, the ALJ simply

acknowledged the October 2019 x-rays and their findings. (Dkt. 12-2 at 34, R. 33).
Scott has failed to demonstrate how his October x-rays "changed the picture
so much" that the ALJ erred by continuing to rely on Dr. Soufi's earlier assessment.
Kemplen v. Saul, 844 F. App'x at 887 (citing Stage v. Colvin, 812 F.3d 1121, 1125
(7th Cir. 2016)). Scott's complaints regarding his knees were well documented in
records and statements and known by the agency prior to the October 2019 x-rays.
In his December 2018 Adult Function Report, which was reviewed by the agency,

Scott stated that it was rough for him going up stairs because it hurt and that it was
rough for him to get up from a squat. (Dkt. 12-6 at 35, R. 239; Dkt. 12-3 at 4, R. 80).
Following this report, Scott presented to Dr. Soufi on February 9, 2019 for his
consultation. The Plaintiff's musculoskeletal physical exam showed Scott was able
to squat, rise from a sitting position without assistance, and get up and down from
the exam table with ease. (Dkt. 12-7 at 57, R.
372). Dr. Scoufi also noted that Scott had a normal range of motion – bending and
straightening – in both knees. (Dkt. 12-7 at 58, R. 373).
In support of the reconsideration of his disability application, on February 26,

2019, Scott informed the agency that he felt he could no longer do his job because it
was painful for him to get in and out of the machines. (Dkt. 12-6 at 61, R. 265).
Scott specifically noted in his March 2019 Adult Function Report, which was also
reviewed by the agency, that he hurt when he knelt and struggled to get out of his
bathtub. (Dkt. 12-6 at 66, 70, R. 270, 274). Following this, on April 27, 2019, Scott
presented to Dr. Soufi for a second consultative examination. (Dkt. 12-7 at 61-67, R.

376-82). Scott's musculoskeletal physical exam revealed tenderness in the hands,
elbows and ankles. (Dkt. 12-7 at 66, R. 381). Dr. Soufi noted that Scott was able to
squat, rise from a sitting position, get up and down from the exam table with ease,
and stand and hop on one foot bilaterally. (Id.). Dr. Scoufi also noted that Scott had
a normal range of motion – bending and straightening – in both knees, and no joint
swelling or effusion. (Id.). As noted above, Scott took bilateral x-rays of his knees in
October 2019. After examining Scott and reviewing the x-rays, Scott's primary care

provider, Ms. Brinkman did not identify any specific limitations in Scott's abilities.
Here, the ALJ clearly reviewed, considered, and then discussed at length Scott's
medical history, including his October 2019 x-rays. The Plaintiff has failed to
present any significant medical findings that the ALJ failed to consider.
Moreover, Scott offers no explanation or argument of how his x-rays from
October 2019 showing "mild degenerative joint space loss" and "small right knee
joint effusion," could have altered Dr. Soufi's opinion. Courts have generally not found
new evidence showing only mild changes in a claimant's condition to be potentially
decisive. Shelia M. v. Saul, No. 20 C 664, 2021 WL 1784775, at *6 (N.D. Ill. May 5,

2021); see also Keys v. Berryhill, 679 F. App'x 477, 481 (7th Cir. 2017)
(finding that it was not error for the ALJ to rely on the opinions of the state agency
doctors where the plaintiff did not explain how the findings on plaintiff's two spinal
MRIs would have changed the doctors' opinions); Natasha M. v. Saul, No. 2:19-
cv-002520JRS-DLP, 2020 WL 5640529, at *6-7 (S.D. Ind. Sept. 2, 2020) (finding that
the consultant psychological assessments were not critically outdated relative to the

completed record where the plaintiff failed to show that there was significant evidence
that postdated the consultants' assessments); Bond v. Berryhill, No. 16 C 2018, 2017
WL 1398656, at *3 (N.D. Ill. Apr. 18, 2017) (finding that the ALJ did not need to get a
medical opinion to interpret a CT scan showing mild degenerative changes).
Plaintiff has not established that his October 2019 x-rays "changed the picture"
so much that the ALJ abused his discretion by failing to consult a medical expert
before making an RFC determination. These x-rays show only mild changes to Scott's

knees problems, which were issues documented at some level in the records provided to
the state agency physicians. Further, Scott's own primary care provider, Ms. Brinkman,
who reviewed the x-rays, failed to find that his knee pain affected his functional
limitations. See Frank R. v. Kijakazi, No. 19 CV 3223, 2021 WL 4264386, at *11 (N.D.
Ill. Sept. 20, 2021) ("In these circumstances, where plaintiff cannot
show that his treaters themselves opined that the more recent medical evidence
affected his work-related limitations, the Court finds that plaintiff has not shown
that it was an abuse of the ALJ's discretion to evaluate plaintiff's knee impairment

without requesting an updated medical opinion."). Because Scott failed to develop
any argument of how these x-rays could have changed the state agency physicians'
opinions, Scott is unable to demonstrate prejudice from the ALJ's decision to not
submit these records for medical review. Accordingly, the Court finds the ALJ did
not commit reversible error by declining to submit Scott's October 2019 x-rays for
medical scrutiny.

4. Paragraph B Criteria
Finally, Plaintiff maintains that the ALJ failed to properly incorporate all of
Scott's limitations in the RFC. (Dkt. 15 at 10-11). Specifically, the claimant argues
that while the ALJ found mild limitations in three of the four Paragraph B criteria,
there is no evidence that the ALJ included these limitations in the RFC. (Id.). In
response, the Commissioner maintains that the ALJ sufficiently considered the
combined effects of Plaintiff's impairments throughout the decision, including the

RFC, and that the ALJ's consideration was supported by the record. (Dkt. 18 at
12-17).
The Seventh Circuit has held that an ALJ must consider a claimant's RFC by
evaluating "all limitations that arise from medically determinable impairments,
even those that are not severe." Christina B. v. Kijakazi, No. 1:20-cv-01936-DLP-
JRS, 2022 WL 178606, at *2 (S.D. Ind. Jan. 20, 2022) (quoting Villano v. Astrue,

556
F.3d 558, 563 (7th Cir. 2009)). If, after consideration, the ALJ determines that a mild
limitation does "not merit a non-exertional limitation in the RFC, he is obligated to
explain that conclusion so that [the Court] can follow the basis of his reasoning."

Muzzarelli v. Astrue, No. 10 C 7570, 2011 WL 5873793, at *23 (N.D. Ill. Nov. 18, 2011)
(citing Haynes v. Barnhart, 416 F.3d 621, 626 (7th Cir. 2005)).
Here, at Step Two, the ALJ found that Scott had no more than mild limitations
in the first functional area of understanding, remembering, or applying information5;
no limitations in the second functional area of interacting with others; no more than
mild limitations in the third functional area of concentrating, persisting, or

maintaining pace6; and no more than mild limitations in the fourth functional area of
adapting or managing oneself7. (Dkt. 12-2 at 24-29, R. 23-28). The ALJ, however,
imposed no non-exertional limitations in the RFC. (Dkt. 12-2 at 30, R. 29).
Reading the ALJ's opinion as a whole,8 the Court finds the ALJ sufficiently
explained his reasoning for not including mental limitations in the RFC. At Step Two,
the ALJ noted Scott's assertion that he needed reminders to take his medication

5 Understanding, remembering, or applying information refers to the ability to learn, recall, and use
information to perform work activities. Examples include identifying and solving problems; following
one- or two-step oral instructions to carry out a task; and sequencing multi-step activities. 20 C.F.R.
§Pt. 404, Subpt. P, App. 1, 12.00(E)(1).
6 Concentrating, persisting, or maintaining pace refers to the ability to focus on work activities and
stay on task at a sustained rate. Examples include initiating and performing a task and working at
an appropriate and consistent pace. 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 12.00(E)(3).
7 Adapting or managing oneself refers to the ability to regulate emotions, control behavior, and
maintain well-being in a work setting. Examples include responding to demands, adapting to
change; and maintaining personal hygiene. 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 12.00(E)(4).
8 "[I]t is proper to read the ALJ's decision as a whole." Jenkins v. Saul, No. 18 C 7031, 2020 WL
7771142, at *13 (N.D. Ill. Dec. 29, 2020) (citing Rice v. Barnhart, 384 F.3d 363, 370 n. 5 (7th Cir.
2004) ("[I]t would be a needless formality to have the ALJ repeat substantially similar factual
analysis at both steps three and five.")).
and to go to appointments but did not need reminders for personal care; and that
Scott handled stress "fair" but did not handle change well. (Dkt. 12-2 at 24, R. 23).
The ALJ also acknowledged that Scott testified that he could pay attention for 10

minutes but that he did not finish what he starts. (Dkt. 12-2 at 24, 27, R. 23, 26).
During Scott's January and April 2019 psychological consultative
examinations, the ALJ noted that the claimant was able to interpret proverbs, note
similarities and differences, and perform simple calculations. (Dkt. 12-2 at 24-25, R.
23-24; Dkt. 12-7 at 46-49, 69-72, R. 361-64, 384-87). The examiner, Dr. Scott
Duncan, found Scott's immediate, recent, and remote memory functions to be intact.

(Id.). The reports also indicated that Scott was attentive and cooperative during the
examination and that he exhibited a logical and sequential thought process. (Dkt.
12-7 at 46-49, 69-72, R. 361-64, 384-87). Dr. Duncan determined that Scott had
adequate comprehension, memory, and complexity of endeavors. (Id.). The ALJ
acknowledged that no ambulatory or behavioral concerns were noted, and Scott's
hygiene and grooming were fairly meticulous. (Dkt. 12-2 at 28-29, R. 27-28). The
ALJ also recognized that during Scott's physical consultative examinations, Scott's

concentration was good. (Id. at 27, R. 26).
In the RFC assessment, the ALJ considered the opinions of reviewing
psychological consultants, Dr. Amy S. Johnson and Dr. Kari Kennedy, and
psychological consultative examiner, Dr. Duncan. The ALJ found the opinions of
Drs. Johnson, Kennedy, and Duncan persuasive. (Dkt. 12-2 at 30, 36-37, R. 29, 35,
36). Drs. Johnson and Kennedy opined that Scott did not have any severe mental
impairments, and Dr. Duncan opined that Scott did not have any work-related
limitations that would affect his ability to perform the mental demands of work-
related activity. (Dkt. 12-2 at 36-37, R. 35-36). Scott has not challenged the ALJ's
weighing of the state agency consultants’ opinions, and thus the Court accepts the
ALJ's finding. As support for finding these opinions persuasive, the ALJ
summarized Scott's mental health treatment records noting that Scott had failed to
offer many symptom allegations to his providers; engage in expansive mental health
treatment; or to have been referred for dedicated outpatient treatment, crisis
stabilization, or inpatient stays by his providers. (Id.). Through the development of
the record and extensive analysis, the ALJ has built a logical bridge between the
evidence and his decision to not include additional mental limitations in the RFC.
Because substantial evidence supports the ALJ's decision, remand is not warranted.
V. CONCLUSION
For the reasons detailed herein, this Court AFFIRMS the ALJ’s decision
denying the Plaintiff benefits. Final judgment will issue accordingly.
So ORDERED.
Date: 2/25/2022

United States Magistrate Judge
Southern District of Indiana

Distribution:
All ECF-registered counsel of record via email

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10168814. Public record. Not legal advice.