Jennifer Karr v. Andrew Saul

In the

United States Court of Appeals

For the Seventh Circuit

____________________

No. 20-1939

JENNIFER L. KARR,

Plaintiff-Appellant,

v.

ANDREW M. SAUL,

Commissioner of Social Security,

Defendant-Appellee.

____________________

Appeal from the United States District Court for the

Northern District of Indiana, Fort Wayne Division.

No. 1:19-cv-179 — Philip P. Simon, Judge.

____________________

ARGUED JANUARY 26, 2021 — DECIDED FEBRUARY 23, 2021

____________________

Before SYKES, Chief Judge, and EASTERBROOK and SCUDDER,

Circuit Judges.

SCUDDER, Circuit Judge. Jennifer Karr applied for Social Se-

curity disability benefits based on her complaints of chronic

lower-back pain and other ailments. An administrative law

judge concluded that Karr was not disabled because she still

could perform sedentary work with some restrictions. The

district court upheld that determination. On appeal Karr

2 No. 20-1939

maintains that the ALJ improperly discounted a statement

from her treating neurosurgeon that she could not sit, stand,

or walk for sustained periods. But because the ALJ’s decision

was supported by substantial evidence, we affirm.

I

A

Karr challenges only the ALJ’s evaluation of a treating spe-

cialist’s opinion regarding her back pain, so we limit our ac-

count of her medical history accordingly. Karr traces the

source of her back pain to a car accident in the late 1990s. Years

later, in 2012, she consulted neurosurgeon Isa Canavati for

pain, numbness, and weakness in her lower back and legs.

Based on the results of an MRI, Dr. Canavati diagnosed Karr

with several spinal disorders. A year later she saw a different

doctor for worsening pain, and a second MRI showed mild

degenerative disc disease. Over the next several years, Karr

tried multiple forms of treatment, including steroid injections,

physical therapy, and opioid pain medications—but none al-

leviated her back pain.

Karr applied for Social Security disability benefits in 2016.

In connection with her application, an agency consultant ex-

amined Karr and opined that, based on her chronic back pain,

she could perform “light duties with alternate sitting, stand-

ing and walking.” Two agency doctors also reviewed Karr’s

file. They determined that she could stand or sit for about six

hours in an eight-hour workday and included no sit or stand

restrictions in their report.

Meanwhile, in May 2017 Karr visited the emergency room

complaining of severe lower-back and leg pain and numbness

about a month after she spent a day lifting heavy objects while

No. 20-1939 3

helping a relative move. A physician assistant examined Karr

and observed that her walking and muscle strength were nor-

mal. Several months later, however, Karr remained in pain

and underwent another course of physical therapy that

helped some—though she still reported pain at her final ses-

sion.

In November 2017, after undergoing a third MRI, Karr saw

Dr. Canavati again. In a letter to Karr’s referring doctor,

Dr. Canavati reported that Karr was experiencing “increasing

pain across the back, buttocks, dorsal thigh and calf,” and that

she “cannot sit, stand or walk for any sustained period of time

and the pain is interrupting her sleep.” Dr. Canavati then

opined that Karr had “advanced degenerative disc protrusion

and moderate central and foraminal stenosis.” At his recom-

mendation, Karr opted to undergo spinal fusion surgery in

January 2018.

In late November 2017, Karr appeared for a hearing before

an ALJ and described the back pain that radiated down her

leg, which prevented her from staying in one position for a

prolonged period. “I can’t sit for long. I can’t stand for long. I

can’t lay for long,” she testified, adding that she needed to

change positions every 15 or 20 minutes.

B

The ALJ concluded that Karr was not disabled. The analy-

sis began with the ALJ determining that Karr suffered from

many severe impairments, including degenerative disc dis-

ease. But from there the ALJ found that Karr still had the re-

sidual functional capacity or RFC to perform sedentary work

with several limitations—though none involved restrictions

on sitting or standing. The ALJ adopted the vocational

4 No. 20-1939

expert’s conclusion that, although Karr could not return to her

past work as a laborer or product inspector, there were still

clerical jobs she could perform.

In formulating Karr’s RFC, the ALJ assigned only “partial

weight” to Dr. Canavati’s letter. Although acknowledging

that Dr. Canavati was a treating provider who had examined

Karr, the ALJ found “extreme” Dr. Canavati’s notation that

Karr could not “sit, stand or walk for any sustained period of

time” because the record contained reports of multiple phys-

ical examinations showing that Karr had full strength and

could walk normally.

The district court affirmed the denial of benefits, and Karr

now appeals.

II

We will affirm a decision on disability benefits if the ALJ

supported her conclusion with substantial evidence. See

42 U.S.C. § 405(g); Biestek v. Berryhill, 139 S. Ct. 1148, 1152

(2019). Substantial evidence is not a high threshold: it means

only “such relevant evidence as a reasonable mind might ac-

cept as adequate to support a conclusion.” Biestek, 139 S. Ct.

at 1154 (internal citations omitted).

A

Karr’s sole argument on appeal is that the ALJ improperly

discounted Dr. Canavati’s statement in his November 2017

letter that she “cannot sit, stand or walk for any sustained pe-

riod of time.” Karr contends that because Dr. Canavati is a

treating physician and specialist (a neurosurgeon), the ALJ

should have assigned his statement controlling weight under

the regulations applicable to her claim.

No. 20-1939 5

Substantial evidence supports the ALJ’s decision not to

give controlling weight to Dr. Canavati’s letter. For claims like

Karr’s filed before 2017, the opinion of a treating physician is

entitled to controlling weight if it is supported by sound med-

ical evidence and is consistent with the record. See 20 C.F.R.

§ 404.1527(c)(2); Reinaas v. Saul, 953 F.3d 461, 465 (7th Cir.

2020). Once well-supported contrary evidence is introduced,

however, a treating physician’s opinion becomes just another

piece of evidence for the ALJ to evaluate. See Bates v. Colvin,

736 F.3d 1093, 1099–100 (7th Cir. 2013).

The ALJ reasonably and adequately explained why

Dr. Canavati’s statement was not entitled to controlling

weight. For starters, it is not even clear that Dr. Canavati’s

statement reflects his own observation or medical opinion as

opposed to a recording of Karr’s own description of her con-

dition. See 20 C.F.R. § 404.1527(a)(1) (defining medical opin-

ions for claims filed before March 27, 2017 as “statements

from acceptable medical sources that reflect judgments about

the nature and severity of [a claimant’s] impairments,” in-

cluding symptoms, diagnosis and prognosis, what the claim-

ant can still do despite impairments, and physical or mental

restrictions).

To be sure, the ALJ’s decision says that Dr. Canavati opined

that Karr “cannot sit, stand or walk for any sustained period

of time.” But in reviewing Dr. Canavati’s actual letter, it is am-

biguous whether the statement represents his own clinical im-

pression of Karr’s objective limitations after reviewing the

MRI and evaluating her physical condition, or whether it

merely records and reports what Karr told him. The latter is a

real possibility, for the statement in question appears next to

other comments recording Karr’s subjective complaints. We

6 No. 20-1939

cannot know for sure what Dr. Canavati recorded—his own

opinion or Karr’s account of her condition. The difference

matters, as an ALJ does not owe any deference to the portion

of a treating physician’s opinion based solely on the claim-

ant’s subjective complaints. See Bates, 736 F.3d at 1100.

Even if Dr. Canavati’s statement represented his medical

judgment, it was inconsistent with other objective evidence in

the record. Progress report notes from Karr’s primary care

provider in late 2016 and early 2017 indicated a normal range

of motion, no back tenderness, and normal strength. The ALJ

also pointed to a physician assistant’s notes from Karr’s May

2017 emergency room visit reporting a normal physical exam.

We recognize that Dr. Canavati had the advantage of re-

viewing Karr’s third MRI in late 2017—a piece of medical ev-

idence not available to the other medical professionals who

interacted with Karr. Even so, that fact does not undermine

our conclusion that the ALJ reached her decision based on

substantial evidence. The weight of the medical record does

not support a conclusion that Karr was unable to sit or stand

for any meaningful period of time. We cannot say the ALJ

committed any error in determining that Dr. Canavati’s state-

ment was “extreme” and not supported by other evidence in

the record.

B

Karr is right to observe that the ALJ’s analysis fell short in

one respect: the ALJ failed to expressly analyze Dr. Canavati’s

statement within the multifactor framework delineated in

20 C.F.R. § 404.1527(c)(2). The ALJ should have done so. See

Gerstner v. Berryhill, 879 F.3d 257, 263 (7th Cir. 2018). But we

No. 20-1939 7

cannot conclude under these circumstances that the ALJ’s fail-

ure constitutes a legal error requiring reversal.

As a general rule, an “ALJ should explicitly consider the

details of the treatment relationship and provide reasons for

the weight given to [treating physicians’] opinions.” Yurt v.

Colvin, 758 F.3d 850, 860 (7th Cir. 2014) (citing 20 C.F.R.

§ 404.1527(c)(2)); see also Moss v. Astrue, 555 F.3d 556, 561 (7th

Cir. 2009) (“If an ALJ does not give a treating physician’s

opinion controlling weight, the regulations require the ALJ to

consider the length, nature, and extent of the treatment rela-

tionship, frequency of examination, the physician’s specialty,

the types of tests performed, and the consistency and support-

ability of the physician’s opinion.”).

The ALJ afforded Dr. Canavati’s opinion only “partial

weight” without marching through the factors referenced in

§ 404.1527(c)(2). All the ALJ said was that Dr. Canavati, while

serving as a treating provider who personally examined Karr,

offered an “extreme” opinion in light of other medical evi-

dence. But the ALJ did not mention that Dr. Canavati was a

neurosurgeon who acted as Karr’s treating specialist, re-

viewed Karr’s 2017 MRI results, or examined Karr five years

earlier in 2012.

Normally a failure to apply the correct legal standard re-

quires us to remand the case to the ALJ for further proceed-

ings. See Meuser v. Colvin, 838 F.3d 905, 912 (7th Cir. 2016). But

if the error leaves us convinced that the ALJ would reach the

same result on remand, then the error is harmless and a re-

mand is not required. See Lambert v. Berryhill, 896 F.3d 768,

776 (7th Cir. 2018). In making this determination, we look to

the record to see “if we can predict with great confidence

8 No. 20-1939

what the result on remand will be.” McKinzey v. Astrue,

641 F.3d 884, 892 (7th Cir. 2011).

We have no doubt the error here was harmless. Foremost,

the statement that Karr “cannot sit, stand or walk for any sus-

tained period of time” may not even reflect Dr. Canavati’s

medical judgment, but instead only Karr’s own account of her

symptoms. Even accepting the statement as reflecting Dr. Ca-

navati’s opinion, the ALJ stood on firm ground in finding the

opinion “extreme”—at odds with the weight of the other

medical evidence.

Remember, too, that Karr bears the burden of proving that

she is disabled. See 20 C.F.R. § 404.1512(a); Summers v. Ber-

ryhill, 864 F.3d 523, 527 (7th Cir. 2017). She failed to carry that

burden by not identifying any objective evidence in the record

corroborating Dr. Canavati’s statement. Even if reasonable

minds could differ on the weight the ALJ gave to the medical

evidence, we will not substitute our judgment for that of the

ALJ’s by reweighing the evidence. See Zoch v. Saul, 981 F.3d

597, 602 (7th Cir. 2020).

In the end, then, this appeal amounts to a failure of proof

on Karr’s part. She had every opportunity to present evidence

aligning with and reinforcing Dr. Canavati’s statement, but

she did not do so. Karr pointed, for example, to no intervening

event in the record supporting the change and discrepancy

between her May 2017 emergency room examination and her

back flare-up in late 2017 that would have corroborated the

statement in Dr. Canavati’s letter. And although Karr supple-

mented the administrative record after the ALJ hearing with

post-surgery medical records reflecting her continued com-

plaints of experiencing “the same type of pain that she was

having prior to the surgery,” she did nothing to give this

No. 20-1939 9

statement more specific content—to show that any pain she

continued to experience after her surgery left her unable to

perform even sedentary work.

Although we are sympathetic to Karr’s situation, she has

failed to muster the evidence to prove her alleged disability

and entitlement to disability benefits. Mindful of the defer-

ence underpinning the substantial evidence standard, we

therefore AFFIRM.