Jones v. Astrue

In the

United States Court of Appeals

For the Seventh Circuit

No. 09-3282

JACKLIN L. JONES,

Plaintiff-Appellant,

v.

M ICHAEL J. A STRUE, Commissioner of

Social Security,

Defendant-Appellee.

Appeal from the United States District Court

for the Eastern District of Wisconsin.

No. 2:09 CV 0061 RTR—Rudolph T. Randa, Judge.

A RGUED A PRIL 16, 2010—D ECIDED O CTOBER 22, 2010

Before E ASTERBROOK, Chief Judge, FLAUM, Circuit

Judge, and H IBBLER, District Judge. Œ

H IBBLER, District Judge. Jacklin Jones applied for disabil-

ity benefits, but an administrative law judge denied

her claim, reasoning that her testimony about her pain-

Œ

The Honorable William J. Hibbler, District Judge for the

Northern District of Illinois, sitting by designation.

2 No. 09-3282

induced functional limitations was not credible. The

ALJ supported the credibility determination with refer-

ences to the medical evidence, the opinions of treating

physicians, and Jones’s daily activities. The district judge

affirmed the ALJ’s decision, and Jones appeals. We affirm.

I.

Jones claimed to become disabled beginning in Novem-

ber 2003 as a result of injuries she sustained in a 2001

motor vehicle accident. Jones had sought treatment for

her injuries from her physician, Dr. Susan Joseph, but

when her condition worsened, Dr. Joseph referred Jones

to an orthopedic surgeon, Dr. Richard Karr.

In March 2003, Jones complained to Dr. Karr of chronic

lower back pain with radiation down her left leg. Jones

informed Dr. Karr that she took Hydrocodone, prescribed

by Dr. Joseph, to manage her pain. During his examina-

tion, Dr. Karr noted no pain behavior, a straight spine,

normal bending, normal ability to straighten her legs,

no limping and a normal gait. As a result of the examina-

tion, he informed Jones that her condition was benign.

He advised Jones to stop taking Hydrocodone and to

instead use a combination of anti-inflammatory and a

benign analgesic to manage her pain. Dr. Karr further

advised Jones to lose weight. Finally, Dr. Karr ordered

an MRI to further assess Jones’s condition.

After reviewing the results of the MRI a month later,

Dr. Karr noted a mild disk bulge at the L4-L5 disk of the

lumbar spine and diagnosed discogenic lower back pain

No. 09-3282 3

with associated myofascial leg pain. Dr. Karr again

advised Jones to desist taking narcotic medication to

control her pain and instead use other medication and

to begin physical therapy. Dr. Karr did, however, refer

Jones to Dr. Steven Donatello for pain management.

Dr. Karr also discussed with Jones a surgical option to

treat her pain, but advised her that it would be unpredict-

able and should be used as a last resort. Jones agreed not

to proceed with surgery at that time.

When Jones saw Dr. Donatello, he reviewed her MRI

and diagnosed leg weakness, mild edema in her left foot,

a L4-L5 disk bulge with lower back pain, and a L5

radiculopathy. Dr. Donatello gave Jones a series of

epidural steroid injections, after which Jones’s coworkers

noticed that she was able to move around the office

better and had decreased outward expressions of pain.

Dr. Donatello also prescribed Percocet, a pain relief

medication containing oxycodone and acetaminophen.

Despite the epidural steroid injections, Jones continued

to complain of pain, and Dr. Joseph again referred her to

Dr. Karr. In June 2003, Jones informed Dr. Karr that she

was taking Percocet and continued to suffer severe

pain. Dr. Karr noted that she was working without restric-

tions, walking normally, and had normal straight leg

raises and muscle strength. Dr. Karr again advised her

to take a more benign pain medication and to pursue

exercise or physical therapy. Dr. Karr also reminded

Jones of surgical options.

Jones visited Dr. Joseph throughout 2003, who pre-

scribed Darvocet and Oxycontin to relieve Jones’s pain. In

4 No. 09-3282

November 2003, Jones quit her job as an accounts

payable supervisor. At the time, Jones worked only

part time and believed that other employees might be

laid off if she did not quit.

In 2004, Dr. Joseph continued to refer Jones to Dr.

Karr. In March 2004, Dr. Karr noted that she exhibited

no signs of active radiculopathy. He opined that she had

a bad back disk but that her presentation was “very

benign.” He noted that she was overweight and

deconditioned, but did not exhibit pain behavior.

Dr. Karr again advised her of surgical options to treat

her pain, though he advised her against those options.

Meanwhile, through 2005, Dr. Joseph prescribed various

pain medication, including Oxycontin, a Lipoderm

patch, Naprosyn, and Vicodin, though Jones did not

always take the prescribed dosage of some medication

because it made her dizzy. In August 2005, Dr. Joseph

diagnosed bilateral carpal tunnel syndrome, and Jones

began wearing wrist braces to alleviate her pain.

In April 2005, Dr. Richard Almonte, a non-examining

State agency doctor, completed a physical residual func-

tional capacity assessment. Dr. Almonte believed that

Jones could lift or carry 20 pounds occasionally and

10 pounds frequently. He further believed that Jones

could sit, stand, or walk for six hours in an eight-

hour day. A second State agency doctor affirmed

Dr. Almonte’s opinion in October 2005.

In January 2006, Jones underwent another MRI.

Dr. Joseph reviewed the 2006 MRI and diagnosed a

small-to-moderate protrusion at the L3-L4 disk with

No. 09-3282 5

mild bilateral foraminal narrowing and a mild disk

bulge at the L4-L5 disk of Jones’s lumbar spine. In Febru-

ary 2006, Jones began to see Dr. Michael Belete instead

of Dr. Joseph. Like Dr. Joseph, Dr. Belete referred Jones

to a specialist, neurologist Dr. Max Lee.

Dr. Lee reviewed the 2006 MRI and found a mild

amount of degenerative disease around the L4-L5 disk

and to a lesser extent at the L3-L4 disk of the lumbar

spine. Dr. Lee opined that it was difficult to attribute all

of Jones’s symptoms to the MRI and recommended that

she continue conservative pain management and ex-

plore surgery if she did not improve.

Throughout 2006 and 2007, Dr. Belete continued Jones

on various pain medications and referred her to a pain

management clinic. Jones complained to Dr. Belete that

the medication made her both dizzy and drowsy.

Dr. Belete also ordered various medical tests to deter-

mine the extent of Jones’s injury. In August 2006, a

nerve conduction study produced results consistent

with carpal tunnel syndrome. In September, Dr. Belete

noted that Jones continued to use wrist splints and

referred her to a hand surgeon. In October 2006,

Dr. Belete prescribed another epidural steroid injection.

A November 2006 bone scan revealed a 12% decrease

in bone mineral density loss, consistent with osteopenia.

At a 2007 hearing before the ALJ, Jones testified that

she had been unable to work due to the back pain associ-

ated with her 2001 accident that had worsened over time.

She testified that, before she quit her job, walking to a co-

worker’s office had been painful and often had

6 No. 09-3282

required her to take pain medication upon return to her

office. Jones further testified that she would sometimes

attempt to control her pain by lying on the floor of her

office.

When describing her lower back pain, Jones testified

that it made it difficult to sit or stand for long periods

and also that it was irritated by movement. She stated

that she could sit for an hour or stand for a half an hour

on a “good day” and that she could walk for two blocks

before needing a rest. She also testified that the pain

impairs her concentration and that pain medication

makes her dizzy, drowsy, fatigued, and nauseated. Jones

stated that she opted to forego surgery to treat her

lower back pain because her doctors informed her that

it would be “iffy.”

Jones also testified that her carpal tunnel syndrome

makes her hands go numb and makes it difficult to hold

onto things. She testified that she could lift 10 pounds

but that it would cause her pain afterwards. She stated

that she wears a brace to relieve some symptoms of her

carpal tunnel syndrome and that the brace has alleviated

some of the symptoms. Jones testified that she did not

explore other treatment options for her carpal tunnel

syndrome because her insurance did not cover either

examinations or treatments.

Despite her pain, Jones was able to complete an associ-

ate’s degree. Jones informed the ALJ that she attended

school from 2002-2006, taking classes one or two

evenings per week. She completed a two-year associate’s

degree in business management during that four-year

No. 09-3282 7

period. She testified that she would sit at the back of

classrooms and take breaks to control her pain.

Jones also testified that she does some household

chores. When she folds laundry, a family member carries

the basket to her. She occasionally washes dishes or

vacuums, but has trouble standing to do so. She uses

a computer to monitor her bank account and her

children’s internet activity. She testified that her pain

prevents her from doing activities that she used to

enjoy, such as fishing, skating, volunteering at her chil-

dren’s schools, and directing a church choir. She testi-

fied that she does not exercise, despite her doctors’ rec-

ommendations that she do so, because of the pain associ-

ated with it. Both Jones and her husband testified

that she spends much of her time lying down in her

bedroom.

In addition, a vocational expert testified at Jones’s

hearing. The ALJ posed hypothetical questions to the

vocational expert, directing him to assume an indi-

vidual with Jones’s vocational experience who was

limited to sedentary work but who could focus only on

simple, routine, unskilled and repetitive tasks. The voca-

tional expert responded that Jones’s past work was elimi-

nated, but that such a hypothetical individual could

do unskilled sedentary work, such as work as an assem-

bler, order filler or information clerk. The vocational

expert testified that there were over 15,000 such jobs in

the state of Wisconsin. The ALJ then added detail

to the hypothetical, directing the expert to assume an

individual who must sit for an hour then get up to

8 No. 09-3282

stretch for a few minutes, but who sat for at least six

hours during the day. The vocational expert re-

sponded that such a requirement would not preclude

the hypothetical individual from working in unskilled

sedentary positions. The expert also testified that a hypo-

thetical individual who wore wrist braces would not

be able to fulfill the position of assembler (6,340 jobs),

but could fill approximately half of the positions of order

filler and information clerk.

The ALJ found that Jones was not disabled, employing

the required five-step analysis prescribed by 20 C.F.R.

§ 404.1520. The ALJ found that Jones had severe impair-

ments in the form of back pain with degenerative

changes in the lumbar spine, carpal tunnel syndrome,

and obesity. Because these impairments did not meet

or equal any impairment listed in the Regulations as

automatically disabling, the ALJ determined Jones’s

residual functional capacity. The ALJ concluded that

Jones’s residual functional capacity did not allow her to

perform her past work but that it did allow her to

perform sedentary work that is simple and routine. In

reaching this decision, the ALJ believed that Jones’s

medically determinable impairments could produce the

symptoms about which she complained but that Jones’s

testimony about the intensity, persistence and limiting

effect of those symptoms was not credible. In support of

the decision, the ALJ considered in detail the objective

medical evidence, Jones’s daily activities, and Jones’s

testimony about her limitations. The district judge

found that substantial evidence supported the ALJ’s

opinion.

No. 09-3282 9

II.

Because the Appeals Council declined review, the ALJ’s

ruling is the final decision of the Commissioner. Getch v.

Astrue, 539 F.3d 473, 480 (7th Cir. 2008). We review de novo

the district court’s judgment affirming the Commis-

sioner’s final decision, meaning we review the ALJ’s

decision directly. Moss v. Astrue, 555 F.3d 556, 560 (7th

Cir. 2009). We also review de novo the ALJ’s legal deci-

sions. Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008).

We review the ALJ’s factual determinations deferentially

and affirm if substantial evidence supported the deci-

sion. 42 U.S.C. § 405(g); Craft, 539 F.3d at 673. Substan-

tial evidence is “ ‘such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.’ ”

Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007) (quoting

Richardson v. Perales, 402 U.S. 389, 401, 91 S.Ct. 1420, 28

L.Ed.2d 842 (1971)). The ALJ is not required to address

every piece of evidence or testimony presented, but

must provide a “logical bridge” between the evidence

and the conclusions so that we can assess the validity of

the agency’s ultimate findings and afford the claimaint

meaningful judicial review. Getch, 539 F.3d at 480.

The ALJ’s credibility determinations are entitled to

special deference because the ALJ has the opportunity to

observe the claimant testifying. Castille v. Astrue, ___ F.3d

___, ___, 2010 WL 3188930, at *5 (7th Cir. Aug. 13,

2010). Rather than nitpick the ALJ’s opinion for incon-

sistencies or contradictions, we give it a common-

sensical reading. Id. Accordingly, we reverse credibility

determinations only if they are patently wrong. Id.

10 No. 09-3282

III.

Jones argues on appeal that the ALJ’s credibility deter-

mination is not supported by substantial evidence and

further that the ALJ’s credibility determination taints the

conclusion regarding her residual functional capacity.

Jones points to several flaws in the ALJ’s opinion

that affected the credibility determination: (1) the ALJ

mistakenly found a gap in Jones’s pursuit of treatment;

(2) the ALJ improperly construed Jones’s daily activities

as inconsistent with Jones’s allegations of pain; (3) the

ALJ mistakenly relied upon Jones’s decision to forgo

surgery; and (4) the ALJ did not discuss all of the objec-

tive medical evidence.

Before we begin, it is important to note just how much

of Jones’s testimony that the ALJ did credit. Although the

agency physicians opined that Jones could do light work,

the ALJ stated that she was giving Jones the benefit of

the doubt. Among other things, the ALJ credited

Jones’s testimony that she could sit only for one hour

and so instructed the vocational expert to consider a

hypothetical claimant who frequently had to change

positions. The ALJ further credited Jones’s testimony

that her medication sometimes made her drowsy or dizzy

and instructed the vocational expert to consider a hypo-

thetical claimant who could focus only on simple,

routine, unskilled and repetitive tasks. Finally, the ALJ

credited Jones’s testimony that she was required to wear

a wrist brace and instructed the vocational expert to

consider a hypothetical claimant with such a limitation.

Jones first argues that the ALJ mistakenly relied upon

a “gap” in Jones’s treatment to determine her credibility

No. 09-3282 11

and that the district court erred in concluding that the

error was harmless. When making the credibility deter-

mination, the ALJ opined that there were “gaps in treat-

ment,” commenting that Jones “saw Dr. Joseph in

August 2005 and then not again until March 2007.” The

district court noted that the ALJ inaccurately described

the record, observing that Dr. Joseph treated Jones

through 2005 and even in January 2006. The district court

did state that “there does appear to be a gap in the

medical treatment from January 2006 to March 2007.”

Although Jones did not receive treatment from

Dr. Joseph through most of 2006, she received treat-

ment from Dr. Belete on a monthly basis throughout

2006. Jones also received treatment from Dr. Lee in

2006. Neither the ALJ nor the district court discussed

Drs. Belete’s or Lee’s treatment records.

Undisputedly the ALJ erred in finding that there were

“gaps” in Jones’s pursuit of treatment. That error

does not necessarily mean the ALJ’s credibility deter-

mination was patently wrong. Reading the ALJ’s

opinion as a whole, we cannot say that the ALJ’s mis-

taken finding that Jones temporarily avoided treatment

undermines the credibility determination.

The ALJ’s mistaken statement regarding a gap in treat-

ment is embedded within a lengthy discussion of ob-

jective medical evidence that directly contradicts

Jones’s allegations of disabling pain. The ALJ noted

that Drs. Karr and Joseph consistently described her

symptoms as non-debilitating, labeling them as benign,

finding a normal gait, and observing that she did not

12 No. 09-3282

exhibit pain behavior. Treating physicians’ opinions

regarding the nature and severity of a claimant’s symp-

toms normally are given controlling weight when well-

supported by medically acceptable clinical and diag-

nostic techniques, Moss, 555 F.3d at 560, and the ALJ

observed that Jones’s treating physicians diagnosed

only mild degenerative change in her spine based on the

results of the MRI. Moreover, the ALJ observed that

none of Jones’s treating physicians opined that she

was disabled.

Jones implies that the ALJ based the credibility deter-

mination on the absence of medical evidence. Although

the ALJ reported that Dr. Karr did not observe any signs

of active radiculopathy, the ALJ discussed at length

Drs. Karr and Joseph’s opinion that the objective

medical evidence demonstrated that Jones’s presentation

was benign and mild. Although an ALJ may not

ignore a claimant’s subjective reports of pain simply

because they are not supported by the medical evidence,

discrepancies between the objective evidence and self-

reports may suggest symptom exaggeration. Getch,

539 F.3d at 483. Here, the objective medical evidence

consistently revealed only mild degenerative change,

and the ALJ properly relied upon the discrepancy be-

tween the objective evidence and Jones’s self-reports.

Even if the ALJ had not mistakenly assumed that Jones

received no treatment during the bulk of 2006 and

had instead discussed Drs. Belete’s and Lee’s treat-

ment notes, those notes were consistent with those of

Drs. Karr and Joseph. Dr. Lee, for example, observed that

No. 09-3282 13

the degenerative disease around the L4-L5 disk was mild

and opined that not all of Jones’s symptoms could

be attributed to the degenerative change revealed by

the 2006 MRI. The ALJ’s mistake concerning Jones’s

pursuit of treatment does not undermine the sub-

stantial evidence that supports her credibility determina-

tion, and we cannot say that her determination is

“patently wrong” based solely on that mistake.

Jones next argues that the ALJ did not assign proper

weight to Jones’s daily activities—pointing out that

neither Jones’s completion of an associate’s degree in

four years nor her domestic activities were “inherently

inconsistent” with her allegations of disabling pain.

Thus, Jones argues, the ALJ should not have relied on

such facts to find that Jones was not credible. An ALJ

may not ignore a claimaint’s limiting qualifications

with regard to her daily activities. Moss, 555 F.3d at 562.

That is not, however, what the ALJ did here. Although

the ALJ could have discussed Jones’s daily activities in

more detail, she did not exaggerate Jones’s testimony

regarding her daily activities. The ALJ observed that

Jones did not do much housework and that her children

helped with the housework, and so did consider the

qualifications Jones placed on her daily activities. The

ALJ also noted that Jones’s daily activities were con-

sistent with her testimony that she had to change posi-

tions occasionally to alleviate her pain. Jones invites us

to reweigh the evidence and arrive at a different conclu-

sion, namely that her limited ability to do housework

confirms her allegation of disabling pain. We cannot,

however, substitute our judgment for the ALJ’s when

14 No. 09-3282

considering the weight of the evidence, and Jones must

do more than point to a different conclusion that the

ALJ could have reached to demonstrate that the credi-

bility determination was patently wrong. Ketelboener v.

Astrue, 550 F.3d 620, 624 (7th Cir. 2008).

Jones’s final two arguments merit little discussion. She

suggests that in making a credibility determination the

ALJ focused solely on a 2003 MRI and did not dis-

cuss a 2006 MRI. The ALJ need not, however, discuss

every piece of evidence in the record and is prohibited

only from ignoring an entire line of evidence that sup-

ports a finding of disability. Terry v. Astrue, 580 F.3d

471, 477 (7th Cir. 2009). The 2006 MRI does reveal some

additional degenerative change in Jones’s condition. In

addition to the mild L4-L5 disk bulge that the 2003

MRI revealed, the 2006 MRI revealed degenerative

change to the L3-L4 disk. Both Drs. Joseph and Lee,

who reviewed the 2006 MRI, described the degenerative

change as mild. Quite simply, the ALJ did not ignore

an entire line of evidence that supported a finding of

disability and her failure to discuss the 2006 MRI

matters little in light of Jones’s treating physicians’ con-

sistent description of her condition as mild or benign.

Jones also suggests that the ALJ erred in giving weight

to Jones’s decision to forgo surgery. This argument misrep-

resents the ALJ’s opinion. The ALJ did not place

any weight on Jones’s decision to forgo surgery. Rather,

the ALJ observed that Jones’s treating physician recom-

mended non-surgical alternatives and inferred from

that recommendation that her condition was not as

severe as she claimed.

No. 09-3282 15

Given the consistent objective medical opinion from

both Jones’s treating physicians and the agency

physicians that her condition was benign, we cannot say

that the ALJ’s determination that Jones exaggerated

her allegations of disabling pain was patently wrong.

Substantial evidence supports the ALJ’s decision.

We affirm.

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