The opinion
IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS
ANITA MARIE B.,1 )
Plaintiff, )
)
vs. )
) Case No. 23-CV-2768-SMY
MARTIN O’MALLEY, Commissioner of )
Social Security, )
Defendant. )
)
)
MEMORANDUM AND ORDER
YANDLE, District Judge:
In accordance with 42 U.S.C. § 405(g), Plaintiff Anita Marie B. seeks judicial review of
the final agency decision denying her application for Disability Insurance Benefits (DIB) pursuant
to 42 U.S.C. § 423 (Doc. 1).
Procedural History
Plaintiff applied for DIB on February 11, 2020 (Tr. 182). Plaintiff’s initial alleged
disability onset date was August 5, 2019. Id. Plaintiff’s claims were denied on November 9,
2020 (Tr. 104-106). Her request for reconsideration was also denied on February 1, 2021 (Tr.
109-111). Plaintiff then requested a hearing with an ALJ (Tr. 112-113).
After conducting an evidentiary hearing, the ALJ denied the application on October 26,
2021 (Tr. 35-60). The Appeals Council denied Plaintiff’s request for review, making the ALJ’s
decision the final agency decision subject to judicial review. (Tr. 26-31).
1 Plaintiff’s full name will not be used in this Memorandum and Order due to privacy concerns. See, Fed. R.
Civ. P. 5.2(c) and the Advisory Committee Notes thereto.
1
Issues Raised by Plaintiff
Plaintiff raises the following issues:
1. The ALJ failed to comply with applicable regulations in evaluating
Plaintiff’s subjective complaints.
2. The ALJ failed to seek development of the record despite the RFC’s
significant departure from the available opinion evidence.
Legal Standards
To qualify for DIB, a claimant must be disabled within the meaning of the applicable
statutes. Under the Social Security Act, a person is disabled if he or she has an “inability to engage
in any substantial gainful activity by reason of any medically determinable physical or mental
impairment which can be expected to result in death or which has lasted or can be expected to last
for a continuous period of not less than twelve months.” 42 U.S.C. § 423(d)(1)(a).
In determining whether a claimant is disabled, the ALJ considers the following five
questions in order: (1) Is the claimant presently unemployed? (2) Does the claimant have a severe
impairment? (3) Does the impairment meet or medically equal one of a list of specific impairments
enumerated in the regulations? (4) Is the claimant unable to perform his or her former occupation?
and (5) Is the claimant unable to perform any other work? See 20 C.F.R. § 404.1520. An
affirmative answer at either step 3 or step 5 leads to a finding that the claimant is disabled. A
negative answer at any step, other than at step 3, precludes a finding of disability. The claimant
bears the burden of proof at steps 1–4. Once the claimant shows an inability to perform past work,
the burden then shifts to the Commissioner to show the claimant's ability to engage in other work
existing in significant numbers in the national economy. Zurawski v. Halter, 245 F.3d 881, 886
(7th Cir. 2001).
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“The findings of the Commissioner of Social Security as to any fact, if supported by
substantial evidence, shall be conclusive....” 42 U.S.C. § 405(g). Thus, the Court is not tasked
with determining whether Plaintiff was disabled at the relevant time, but whether the ALJ's
findings were supported by substantial evidence and whether any errors of law were made. Lopez
ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003). Substantial evidence is “such
relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”
Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (internal citations omitted).
In reviewing for substantial evidence, the Court considers the entire administrative record,
but does not reweigh evidence, resolve conflicts, decide questions of credibility, or substitute its
own judgment for that of the ALJ. Burmester v. Berryhill, 920 F.3d 507, 510 (7th Cir. 2019). At
the same time, judicial review is not abject; the Court does not act as a rubber stamp for the
Commissioner. See Parker v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010).
Decision of the ALJ
The ALJ followed the five-step analytical framework described above (Tr. 35-55). She
found that Plaintiff had not engaged in substantial gainful activity during the period from her
alleged onset date of August 5, 2019 through her date last insured of June 30, 2020 (Tr. 37). She
found that Plaintiff had the following severe impairments: Raynaud’s phenomenon, degenerative
disc disease of the lumbar spine, mixed connective tissue disease, chronic headache and/or
migraine headaches, irritable bowel syndrome, mild left axonal peroneal mononeuropathy, mild
bilateral carpal tunnel syndrome (CTS), early osteoarthritis of the bilateral knees and left hand,
peripheral neuropathy, anxiety, and angina and left anterior descending coronary artery stenosis
with stent placement (Tr. 37-38) The ALJ found that these severe impairments significantly limit
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the ability to perform basic work activities (Tr. 38). The ALJ also found that Plaintiff had other
impairments including hypothyroidism, insomnia, and hypertension. Id. Based on these
impairments, the ALJ concluded that Plaintiff did not have an impairment or combination of
impairments that met or medically equaled the severity of one of the listed impairments listed in
the Commissioner’s list of presumptively disabling impairments, 20 CFR Part 404, Subpart P,
Appendix 1 (Tr. 38-44).
The ALJ determined that Plaintiff had the RFC to do the following:
Sedentary work as defined in 20 CFR 404.1567(a) except she can never climb ladders,
ropes, or scaffolds but can occasionally climb ramps and stairs. She can engage in
occasional stooping, kneeling, crouching, and crawling and can perform frequent fine
and gross manipulation. She cannot work at unprotected heights or around moving
mechanical parts or other such hazards. She can have no concentrated exposure to
extreme heat, cold, humidity, wetness, dust, fumes or other pulmonary irritants such as
toxic or caustic chemicals. She can maintain the concentration required to perform
simple routine tasks, remember work procedures, and make simple work-related
decisions. She cannot work at a fast pace such as an assembly line but can stay on task
and meet reasonable production requirements in an environment that allows her to
maintain a flexible and goal-oriented pace. She is further limited to work that requires
only occasional changes in the work setting which are introduced gradually (Tr. 44-45).
The ALJ concluded that Plaintiff was not able to perform her past relevant work, but there were
other jobs in significant numbers in the national and local economy that Plaintiff could perform,
such as order clerk, circuit board screener, and optical goods assembler (Tr. 54-55). As such, the
ALJ ultimately concluded that Plaintiff was not disabled within the meaning of the Act (Tr. 55).
The Evidentiary Record
The Court has reviewed and considered the entire evidentiary record in formulating this
Memorandum and Order. The following summary of the record is directed to the points raised
by Plaintiff.
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Agency Forms
Plaintiff was 45 years old at the time of the ALJ’s decision. (Tr. 54). She claimed she was
disabled due to mixed connective tissue disease, borderling lupus, Hashimoto’s disease, Raynaud’s
phenomena, carpal tunnel, neuropathy, arthritis, irritable bowel syndrome, memory loss, and
migraines (Tr. 201). Plaintiff took numerous medications for her conditions (Tr. 204). Plaintiff
had worked in the past as a general manager of a pizza place (Tr. 733-734), photography assistant
manager, a front desk clerk/laundry in hospitality, a receptionist at a community college, a school
bus driver, and as a trustee in local government (Tr. 203). She indicated she stopped working on
November 20, 2018, because of her conditions (Tr. 202).
Plaintiff completed a function report on May 12, 2020 (Tr. 217-225). She stated that she
has difficulty lifting, squatting, bending, standing, reaching, walking, sitting, kneeling, stair
climbing, with memory, with completing tasks, with concentration, with understanding, with
following instructions, and with using her hands (Tr. 222). She has trouble doing both physical
and mental tasks on her bad days (Tr. 217, 222). A second function report dated December 18,
2020 was submitted as well(Tr. 244-251). Plaintiff’s complaints remained unchanged, and she
stated that she has bad days 2 times a week where she cannot do anything other than dress herself,
use the bathroom, and eat (Tr. 244).
Evidentiary Hearing
Plaintiff was represented by Attorney Brent Matthew Gaines at the September 14, 2021
hearing (Tr. 49-81). She testified that she has been diagnosed with back pain, lupus, migraines
with visual aura, peripheral neuropathy, a B12 deficiency, thyroid problems, and cardiac issues
(Tr. 737, 742, 743). Her husband has to do the chores in the household because if she is on her
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feet doing chores then her legs will swell (Tr. 736-737). She spends the majority of her days
sleeping (Tr. 744). She cannot handle cold temperatures (Tr. 739) and has migraines at least once
or twice a week that leave her debilitated (Tr. 740). She also struggles with memory issues from
her thyroid condition (Tr. 742).
Plaintiff testified that the conditions that preclude her from working are the swelling in her
feet and her inability to use her hands because of the Raynaud’s, the lupus swelling, and the carpal
tunnel (Tr. 743). Her hands cramp and she will sometimes have difficulty buttoning, zipping,
grabbing and holding items (Tr. 744). She could not do a job where she sat most of the day
because sitting would cause her legs to swell, the arthritis in her back keeps her from being able to
sit too long, and she would have to constantly be moving to deal with her irritable bowel syndrome
or trying to alleviate the pressure in her back, knees or feet (Tr. 745).
A vocational expert (VE) testified that Plaintiff’s past work as a fast-food manager was
classified as light with an SVP of 5 and performed at the medium work demand (Tr. 748). The
ALJ posed a hypothetical to the VE that comported with the ultimate RFC assessment – a person
of Plaintiff’s age and education (four years of college) and past work as described – that cannot
climb ladders, ropes or scaffolds – can only occasionally use ramps and stairs – can occasionally
stoop, kneel, crouch and crawl – with frequent fine and gross manipulation – with no work at
unprotected heights around moving mechanical parts or other such hazards – and with no
concentrated exposure to extreme heat, cold, humidity, wetness, dust, fumes or other pulmonary
irritants like toxic or caustic chemicals (based upon Plaintiff’ testimony regarding hot and cold
and her cardiac condition) (Tr. 748-749). The VE testified that this person could not perform
Plaintiff’s past work (Tr. 749). However, there are other light and unskilled work in the national
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economy that the hypothetical could perform: dining attendant, retail clerk, or housekeeper. Id.
The ALJ added to the hypothetical person one that can maintain the concentration required
to perform simple, routine tasks, remember work procedures and make simple work-related
decisions – cannot work at a fast pace, such as an assembly line, but can stay on-task and meet
reasonable production requirements in an environment that allows the individual to maintain a
flexible and goal-oriented pace – but limited to work that requires only occasional changes in the
work setting, which are introduced gradually (Tr. 749-750). The VE testified that this person
could not perform Plaintiff’s past work (Tr. 750). However, the same light and unskilled jobs
previously referenced could still be available. Id.
The ALJ changed the hypothetical to a sedentary hypothetical – without mental limitations
but at the sedentary work demand (Tr. 750). The VE testified that this person could not perform
Plaintiff’s past work. Id. However, such a person would have available work classified as
sedentary and unskilled like an order clerk, a circuit board screener, or an optical goods assembler
(Tr. 750-751). The ALJ changed the hypothetical to sedentary with mental limitations as
previously indicated (Tr. 751). The VE testified again that while this person could not perform
Plaintiff’s past work, the same sedentary and unskilled jobs previously referenced could still be
available. Id.
The ALJ questioned the VE regarding additional limitations. (Tr. 752). The VE testified
that no jobs would be available at the sedentary work demand level if the work demanded
occasional handling and fingering; if the individual had to elevate their legs at waist level for about
15 minutes every hour; if the individual could not, even occasionally, lift ten pounds; if the
individual had to alternate sitting and standing and walking every 15 minutes; and, if the individual
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was off-task 20 percent of the workday or absent two or more days per month (Tr. 751-752). The
VE further testified that at either light or sedentary unskilled work, if the hypothetical individual
needed additional breaks throughout the day, employment would require an accommodation for
any extra breaks (Tr. 753).
Relevant Medical Records
Plaintiff began treating with Dr. Allan Morton, a rheumatologist, in 2014 when she resided
in Michigan (Tr. 276-281). His notes and letter indicate that Plaintiff suffered from primary
connective tissue disease with significant joint pain, fatigue, and other symptoms; significant
degenerative arthritis of the lumbar spine with significant pain and fatigue; and, an abnormal MRI
of her brain identifying decreased mental acuity (Tr. 276). Dr. Morton was also the first in the
records to indicate that some of Plaintiff’s symptoms were compatible with Raynaud’s (Tr. 277).
Plaintiff also treated with Dr. Lawrence Eilender, a neurologist, starting in 2016 (Tr. 290-
303). Plaintiff’s complaints to Dr. Eilender related to memory loss and chronic headaches. Id.
Dr. Eilender prescribed her medications to aid with her complaints. Id.
While in Michigan, Plaintiff was also under the care of Dr. David Pawloski (Tr. 306-462).
At her office visit on May 13, 2019, Plaintiff had no complaints, had good energy levels and was
sleeping well (Tr. 456). Dr. Pawloski’s records indicate that Plaintiff was diagnosed with
hypertension, hypothyroidism, Raynaud’s phenomenon, positive antinuclear antibody, BMI,
chronic anemia, and menopause (Tr. 458). Dr. Pawloski treated Plaintiff with prescriptions. Id.
After moving to the Southern Illinois area in late 2019, Plaintiff began treating with Dr.
Amar Sawar with the Neurology & Arthritis Clinic in Carbondale, Illinois (Tr. 559-582). Plaintiff
advised Dr. Sawar that she had been diagnosed with mixed connective tissues disease, Raynaud’s
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phenomenon with discoloration of her fingers when exposed to cold weather, and Hashimoto
thyroiditis (Tr. 563). She complained about puffy hands; excessive daytime sleepiness; loud
snoring; arthralgia in small joints of her hands, wrists, feet, and ankles; dry eyes, mouth and skin;
diffuse myalgia and stiffness with fatigue and leg cramps; neck pain that was dull, occasional, and
non-radiating; low back pain that was dull, constant, and radiated into her left leg; numbness and
tingling of both hands and feet; headaches with nausea twice a week on average; and, memory loss
for recent events. Id. Dr. Sawar ordered nerve conduction studies, x-rays, MRI, and continued
medication treatment (Tr. 566).
The nerve conduction studies showed electrodiagnostic evidence of mild left axonal
peroneal mononeuropathy with no evidence of lumbosacral radiculopathy or large fiber peripheral
neuropathy, and electrodiagnostic evidence of mild bilateral median neuropathy at the wrist (carpel
tunnel) with the right side worse but no evidence of ulnar neuropathy or cervical radiculopathy
(Tr. 578, 582). X-rays were done of Plaintiff’s feet, ankles, knees, hands, and wrists (Tr. 585-
594). Generally, there were no acute abnormalities or evidence of inflammatory arthritis. Id.
Plaintiff’s knees and left hand showed only early osteoarthritic changes. Id. The MRI of
Plaintiff’s lumbar spine showed mild disc desiccation with left lateral disc protrusion and mild left
foraminal stenosis (Tr. 495).
Dr. Sawar’s continued treatment of Plaintiff in 2020 involved medication and the ordering
of a wrist splint to be worn at night (Tr. 559-562). In 2021, Dr. Sawar saw Plaintiff again for the
same general complaints but more complaints with headaches and resulting nausea (Tr. 692-693,
710-715). Dr. Sawar continued to treat Plaintiff with medication. Id.
Plaintiff also began treating with a new primary care physician in Illinois, Dr. Michael
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Ambrose (Tr. 499-544, 627-638). Dr. Ambrose’s examination of Plaintiff in January 2020
identified that Plaintiff had mixed connective tissue disorder since 2015; that Plaintiff reported
pain and discoloration in her hands especially with temperature and weather changes; that Plaintiff
had Raynaud’s phenomenon, hypothyroidism, Hashimoto’s syndrome, daily migraines, irritable
bowel syndrome, and hormone related symptoms (Tr. 499-502). Plaintiff complained of bilateral
knee pain that was worsening with activity and bending. Id. She also complained of lower back
pain with radiculopathy and weakness in her right leg. Id. Plaintiff indicated her back pain was
worse with activity and with sitting, and she was unable to perform tasks at home. Id.
Physical examination by Dr. Ambrose identified restriction and tenderness in C-spine
palpation; restricted in movement of upper extremities like trapezius and shoulder muscles;
hypertonic, tight restricted muscles in the lumbar area (especially L4-L5); hypertonicity and
restrictions in movement in the thoracic area; and restriction in movement and tightness in the SI,
pelvis, and lower extremities. Id. Dr. Ambrose treated Plaintiff with medication, orders for
physical therapy, orders for a back brace, and various injections in her knees. (Tr. 499-544, 627-
638). Throughout 2020 and her treatment with Dr. Ambrose, Plaintiff reported that both her knee
and back pain seemed to be getting better even though she still had some right leg radiculopathy.
Id.
In late 2020, Plaintiff went back to Dr. Ambrose and indicated that her knee pain was better
but that her back pain was worse after spending time working in her yard (Tr. 627-629). In early
2021, Plaintiff again went back to Dr. Ambrose and reported that her knee, lower back and neck
pain were somewhat better and tolerable – the focus was then on her hormone treatments (Tr. 630-
632). In March 2021, Plaintiff again visited Dr. Ambrose to discuss her new migraine medication
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and complained of heart palpitations (Tr. 633-635). Dr. Ambrose referred Plaintiff to cardiology.
Id.
Plaintiff also treated with various specialists. Dr. Shadab Bhutto, an internal medicine
specialist, tested and treated Plaintiff for hypothyroidism due to Hashimoto’s, lupus, palpitations,
anemia, fatigue, fatty liver, shortness of breath, hypertension, thrush and migraines (Tr. 646-656).
Dr. Muhammad Jaffer Ansari, a cardiologist, treated Plaintiff in 2021 for her cardiac palpitations
and chest pain (Tr. 674-689). Plaintiff had a cardiac cath procedure completed with a drug-eluting
stent. Id.
Opinions of Treating Physicians
On August 5, 2021, Dr. Amar Sawar completed a medical source statement on behalf of
Plaintiff (Tr. 703-709). He indicates that Plaintiff was diagnosed with lupus, chronic migraines,
carpal tunel syndrome, nerve damage, and arthritis (Tr. 703). He identifies Plaintiff’s symptoms
to include migraines; pain and swelling in the legs, knees, feet and hands; vertigo; fatigue; memory
loss; back pain; and, hair loss. Id. Dr. Sawar indicates that plaintiff’s pain increases with activity
or use. Id. He identified Plaintiff’s reduced range of motion in her fingers and knees, reduced
grip strength, impair sleep, weight change, impaired appetite, tenderness, redness, swelling,
muscle spasms, and muscle atrophy. Id. Dr. Sawar indicated that anxiety affected Plaintiff’s
pain (Tr. 704). He opined that Plaintiff’s pain is frequently severe enough to interfere with her
attention and concentration; and, that Plaintiff is severely limited in her ability to deal with work
stress. Id.
Dr. Sawar also opined about Plaintiff’s ability to perform regular and continuous activity
during an 8-hour workday (Tr. 705-708): Plaintiff could sit for 15 minutes maximum before
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needing to walk about for 15 minutes (Tr. 705); Plaintiff would need to elevate both legs to at least
waist level while sitting to minimize pain; Plaintiff could only spend less than 1-hour cumulative
sitting during an 8-hour workday; Plaintiff could only stand or walk about for less than 15 minutes
before needing to lie down or recline in a supine position for at least 30 minutes (Tr. 705-706);
Plaintiff could only stand or walk about for less than 1-hour in an 8-hour workday (Tr. 706). In
summary, Dr. Sawar opined that Plaintiff would spend a cumulative 5-hours resting or lying down,
1 hour sitting, and 1 hour standing or walking about (Tr. 707).
Additionally, Dr. Sawar opined: Plaintiff could rarely or not at all lift or carry any weight
from 1-50 pounds, balance when standing or walking on level terrain, stoop or bend over, look
down at a table or desk, look upward at the ceiling or sky, look sideways to the right or left (Tr.
707); Plaintiff could rarely (if at all) reach, handle, or finger anything with her right or left hand,
except that he believed Plaintiff could occasionally reach with her left hand (Tr. 708); Plaintiff
was not in need of an assistive device for ambulating; and Plaintiff would have both “good days”
and “bad days”, but he believed she would be absent from work more than 3 times per month (Tr.
709).
Consultative Examinations
Dr. Adrian Feinerman conducted an internal medicine examination of Plaintiff on October
2, 2020 (Tr. 601-609). He noted that Plaintiff was able to ambulate 50 feet without an assistive
device and was able to get on/off the exam table, stand on toes, stand on heels, and squat and rise
(Tr. 606). Plaintiff’s muscle strength was normal; her fine and gross manipulation was normal
(including fingers and thumbs); she was able to dress and undress herself. Her deep tendon
reflexes were normal and equal bilaterally. She was oriented to person, place and time, and her
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appearance, behavior, memory and concentration were normal. Id. His diagnostic impressions
were systemic lupus erythematosus (diagnosed in January 2020); hypothyroidism, degenerative
joint disease, and hypertension; mixed connective tissue disease, Raynaud’s phenomenon, irritable
bowel syndrome, bilateral carpal tunnel syndrome (since January 2020); knee pain, low back pain,
and vertigo (Tr. 606-607). He concluded that Plaintiff is able to sit, stand, walk, hear, and speak
normally and is able to lift, carry, and handle objects without difficulty (Tr. 607).
Plaintiff underwent a psychological consultative examination with Dr. Linda L.
Collinsworth, Ph.D. on September 8, 2020 (Tr. 597-600). The examination was conducted by
video. Id. Dr. Collinsworth found no errors in Plaintiff’s answers to questions and the exams
and did not assign a DSM 5 diagnosis. Id. She found that Plaintiff was capable of managing her
own funds. Id.
State Agency Consultants’ Opinions
Dr. James Hinchen MD reviewed the evidence and opined that Plaintiff has exertional
limitations: Plaintiff could only occasionally lift and/or carry 20 pounds, could frequently lift
and/or carry 10 pounds, could only stand and/or walk for a total of 6 hours in an 8-hour workday,
and could only sit for a total of 6 hours in an 8-hour workday (Tr. 70-71). Plaintiff was limited
to work consistent with light exertional level with occasional climbing of ladders/ropes/scaffolds
and occasional stooping, kneeling, crouching, and crawling (Tr. 71). Plaintiff should avoid
concentrated exposure to extreme cold, extreme heat, and hazards like machinery and heights (Tr.
72).
Dr. Bharati Jhaeri MD also reviewed the evidence and opined that Plaintiff had exertional
limitations: Plaintiff could occasionally lift and/or carry 20 pounds, could frequently lift and/or
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carry 10 pounds, could only stand and/or walk about 6 hours in an 8-hour workday, and could only
sit about 6 hours in an 8-hour workday (Tr. 90); Plaintiff was limited to work consistent with light
exertional level with occasional climbing of ladders/ropes/scaffolds and occasional stooping,
kneeling, crouching and crawling (Tr. 91); Plaintiff should avoid concentrated exposure to extreme
cold, extreme heat, and hazards like machinery and heights (Tr. 92).
Discussion
Plaintiff asserts that the ALJ erred by failing to comply with applicable regulations in
evaluating Plaintiff’s subjective complaints and by failing to seek development of the record
despite the RFC’s significant departure from the available opinion evidence. The Court disagrees.
The RFC is a measure of what an individual can do despite the limitations imposed by her
impairments. 20 C.F.R. §404.1545(a). It is a “function-by-function assessment based upon all
of the relevant evidence of an individual’s ability to do work-related activities,” Id., and must be
supported by substantial evidence. Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000). “As a
general rule, both the hypothetical posed to the VE and the ALJ’s RFC assessment must
incorporate all of the claimant’s limitations supported by the medical record.” Yurt v. Colvin, 758
F.3d 850, 857 (7th Cir. 2014).
The ALJ bears “the ‘final responsibility’ for determining a claimant’s residual functional
capacity.” Fanta v. Saul, 848 Fed. Appx. 655, 658 (7th Cir. 2021) quoting 20 C.F.R.
§404.1527(d)(2). The Court’s “role is to determine whether the ALJ applied the right standards
and produced a decision supported by the substantial evidence.” Jeske v. Paul, 955 F.3d 583,
595-596 (7th Cir. 2020). An “ALJ has the obligation to consider all relevant medical evidence
and cannot simply cherry-pick facts that support a finding of non-disability while ignoring
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evidence that points to a disability findings.” Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010).
However, “an ALJ need not mention every piece of evidence, so long as he builds a logical bridge
from the evidence to his conclusion.” Id. citing Getch v. Astrue, 539 F.3d 473, 480 (7th Cir. 2008).
In this case, the ALJ supported her RFC determination with substantial evidence and
accurately characterized both Plaintiff’s subjective complaints and the medical evidence. The
ALJ did not dispute that Plaintiff had impairments that caused her difficulties, but questioned
Plaintiff’s statements concerning the intensity, persistence and limiting effects of her symptoms.
She engaged in a detailed discussion of the medical records and Plaintiff’s testimony and was
entitled to rely on the totality of the objective medical evidence and Plaintiff’s subjective
statements in the record.
Plaintiff argues that the ALJ should have found that she needed to elevate her legs due to
swelling in her lower extremities. The record demonstrates that the ALJ considered Plaintiff’s
complaints of swelling in light of the objective medical evidence that showed no swelling in
Plaintiff’s lower extremities. The ALJ found the medical evidence more persuasive. There is no
indication in the objective medical evidence and records that Plaintiff reported to any of her
treating physicians with swelling in her lower extremities. Nor did she not seek any treatment by
her physicians for swelling in the lower extremities.
The only indication that Plaintiff needed to elevate her lower extremities because of
swelling was in Dr. Sawar’s medical opinion. However, his opinion is not consistent with his
own medical records and examinations of Plaintiff. Supportability and consistency are “the most
important” factors, and the only factors that must be explained by the ALJ, in weighing the medical
opinions that are provided by a plaintiff. See 20 C.F.R. §404.1520c(a) and (b)(2). The ALJ fairly
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and accurately relied on the totality of the objective medical evidence and ultimately found the
state agency consultants’ opinions more consistent and persuasive. Further, the ALJ’s reduced
sedentary RFC accurately accounted for the physical impairments that Plaintiff’ complaints of –
even any potential swelling of lower extremities.
Plaintiff also argues that the ALJ should have found that she was unable to work in
temperatures below 60 degrees because of the medical symptoms and complications she had with
her extremities (specifically hands and fingers). The ALJ did in fact include in her RFC that
Plaintiff was to be precluded from concentrated exposure to extreme cold. That assessment is
consistent with the state agency consulting physicians’ evaluations and is more detailed than the
opinions provided by Plaintiff’s treating physicians. None of Plaintiff’s treating physicians
identified a specific temperature or threshold at which Plaintiff’s symptoms increased or became
worse. Plaintiff has failed to identify with any specific medical evidence that shows at what
temperature those conditions and symptoms begin. Thus, the ALJ’s RFC that precluded Plaintiff
from concentrated exposure to extreme cold accurately and adequately considers the need to
minimize her symptoms associated with temperature and weather changes.
Plaintiff also disagrees with the ALJ’s findings with respect to fine and gross manipulative
restrictions of her hands and fingers. The ALJ’s RFC identifies the issue of fine and gross
manipulation of the hands and fingers, but the RFC indicates that the limitation is minimal. There
is no objective medical evidence in the record that Plaintiff’s fine and gross manipulation is so
limited or hindered so as to require a greater limitation than that imposed by the ALJ. Rather, the
objective medical evidence indicates that Plaintiff has no (or very limited) fine and gross
manipulation limitations other than her own complaints. Examinations and imaging results by
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treating and consulting physicians confirmed that Plaintiff was capable of significant fine and gross
manipulation of her hands and fingers. Plaintiff never sought separate or specific treatment or
therapy as it related to any fine and gross manipulative symptoms. The ALJ went beyond the
scope of what any treating or consulting physician recommended because she recognized the
potential impact of Plaintiff's underlying diagnosed conditions, like carpal tunnel syndrome.
In sum, the ALJ identified and referenced the evidence and weight she ascribed to various
portions of the evidence in supporting her opinion and decision — logically building a bridge to her
ultimate conclusions. She took great detail in evaluating and weighing every treating physician,
consulting physician, and Plaintiff's own testimony. While Plaintiff may disagree with the ALJ’s
ultimate conclusions, the Court does not find that the ALJ committed reversible error in any
respect.
Conclusion
After careful review of the record, the Court concludes that the ALJ committed no errors
of law, and that her findings are supported by substantial evidence. Accordingly, the final
decision of the Commissioner of Social Security denying Plaintiff's application for disability
benefits is AFFIRMED. The Clerk of Court is DIRECTED to enter judgment in favor of
Defendant.
IT IS SO ORDERED.
DATED: March 29, 2025 Aoth )
STACIM.YANDLE ————iis—‘—s~S
United States District Judge
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