SIDNEY I. SCHENKIER, Magistrate Judge.
In this social security appeal, Wanda Morgan ("Ms. Morgan") seeks judicial review under 42 U.S.C. § 405(g) of a final decision of the Defendant, Commissioner of the Social Security Administration ("SSA"), denying her application for Supplemental Security Income ("SSI") benefits. We presently consider Ms. Morgan's motion to reverse or remand the Commissioner's decision (doc. # 17), and the Commissioner's motion for summary judgment (doc. # 27). Ms. Morgan has also filed a reply to the Commissioner's motion (doc. # 29). For the reasons that follow, Ms. Morgan's motion for remand is granted. The Commissioner's motion for summary judgment is denied.
We begin with the procedural background of this case. Ms. Morgan filed an application for SSI on February 26, 2010, alleging that she was disabled due to Carpal Tunnel Syndrome ("CTS"), diabetes, high blood pressure, and asthma, with an onset date of October 3, 2002 (R. 186).
We next summarize the medical record. Ms. Morgan was born on May 13, 1961; she was 50 years old at the time of her hearing. On September 13, 2009, Ms. Morgan visited the Adventist Bolingbrook Hospital emergency room complaining of shortness of breath caused by asthma (R. 251-69). The attending physician noted that Ms. Morgan's lungs were clear and that a chest x-ray was normal (R. 257). She was discharged the same day with a prescription for the inhaled medication Albuterol; the discharge notes state "lungs clear, feels well" (R. 254-257).
Outside of the visit to the Bolingbrook Hospital emergency room, the majority of Ms. Morgan's medical treatment was provided by the Will County Community Health Center ("Will County"); she visited there twelve times between July 2009 and December 2010. Most of Ms. Morgan's visits to Will County related to obtaining prescription refills for her asthma and hypertension medications as well as follow up appointments after her October 2009 diabetes diagnosis (R. 276-281). In February 2010, a doctor at Will County recommended that Ms. Morgan undergo a bilateral MRI of her hands and wrists (R. 275).
On May 17, 2010, Agency physician Dr. Ravikiran Tamragouri examined Ms. Morgan in connection with her application for benefits (R. 286-88). He noted that Ms. Morgan took the medication Metformin for diabetes, was watching her diet to control her high blood pressure, and used an inhaler to control her asthma (Id.). With respect to Ms. Morgan's hands, wrists, and arms, Dr. Tamragouri noted that Ms. Morgan complained of CTS bilaterally and tendonitis in her right shoulder, and alleged that she continued to experience CTS symptoms, despite her having surgery in 2002 (R. 286, 288). On examination, Dr. Tamragouri noted that Ms. Morgan's range of motion for all joints was normal and there were no joint swellings, deformities, or tenderness (R. 287). Dr. Tamragouri further noted that Ms. Morgan's grip strength was 4/5 on her right hand and 5/5 on her left hand (Id). When tested, she reported decreased touch sense in her fingers, more in her right hand than her left hand (Id.). Ms. Morgan "performed alternating movements of her hands normally and without pain" (Id). In addition, "she [was] able to touch her fingers to the thumbs without difficulty" and "performed fine and gross hand movements normally" (Id).
On May 21, 2010, Dr. Francis Vincent completed a physical Residual Functional Capacity ("RFC") assessment of Ms. Morgan, based on Dr. Tamragouri's examination (R. 290-97). Dr. Vincent opined that Ms. Morgan could occasionally lift and carry 50 pounds and frequently lift and carry 25 pounds (R. 291).
In September 2010, Ms. Morgan visited Will County for a follow up on her diabetes condition; in addition, this visit marks the first recorded evidence of Ms. Morgan complaining of knee pain (R. 330). She had an x-ray of her knees in October 2010 that revealed mild arthritic changes (R. 349); in December 2010, Ms. Morgan visited Will County to request stronger pain medication for her knees (R. 329). The examining doctor added a prescription for the pain reliever Vicoprofen to the Tramadol Ms. Morgan was already taking (Id.).
The record contains no evidence that Ms. Morgan received any medical treatment at all in 2011. In January 2012, she returned to Will County for a checkup; the "assessment plan" from this visit discussed continuing her asthma medications, her need for bloodwork related to her diabetes and high cholesterol, and that she was taking Vicopofen for her arthritis in her knees (R. 322). There was a recommendation that Ms. Morgan exercise and continue to take medication for her arthritis; there is no mention of CTS or pain in her hands or wrists (Id.).
The ALJ held a hearing on March 2, 2012. At the hearing, Ms. Morgan testified that she has not worked since August 2004, when she worked for Trinity Services providing cleaning, cooking and physical assistance to disabled individuals (R. 39). Prior to that time, Ms. Morgan worked at Meijer Stores as a cashier (R. 40). Ms. Morgan testified that was injured in October 2002 when a box of oil fell on her hand (R. 40-41).
Ms. Morgan testified that she had surgeries in 2002 and 2003 on both of her hands, but the surgery did not improve her CTS (R. 43). With regard to her asthma, Ms. Morgan testified that she was taking Advair and Pro-Air to alleviate her asthmatic symptoms (R. 44). She further testified that her doctor prescribed "little steroid pills" to help restore her breathing (Id). Ms. Morgan treats her diabetes with medication but she testified that it does not help keep her sugar levels under control (R. 45). She testified that she requires juice or candy about ten to twelve times a day in order to ensure her blood sugar levels do not drop (R. 51). Ms. Morgan testified that she does not have any side effects from her medication (R. 47).
Ms. Morgan testified that because of her CTS, she feels a lot of aching pain throughout her hand joints (R. 47). She described the pain as a "numbness, like pin sticking, and then there's a real sharp like knife piercing pain" (R. 48). Ms. Morgan testified that her thumbs will lock up at least two or three times a week, and that her left hand is slightly better than her right hand but it is still weak (R. 47, 51). Ms. Morgan testified that she can lift around five pounds with each hand (R. 47-48). In addition to her CTS, Ms. Morgan stated she has arthritis in both knees and it has been a problem for more than a year and a half; she testified that on certain mornings she cannot straighten her legs (R. 48).
Ms. Morgan testified that her typical daily activities include reading the Bible and praying, as well as taking care of her adult son with Downs Syndrome and performing some housework with the help of her daughter; both her son and daughter live with her (R. 50). In a March 2010 function report that she completed as part of her application for benefits, Ms. Morgan reported that she could do a load of laundry on the days she was feeling well, that she prepared food twice a week, and that she needed assistance doing her hair and dressing because it hurt to lift her hands over her head (R. 196). Ms. Morgan has not been able to get a medical card despite numerous applications because, she says, she has not been "legally diagnosed disabled," although she was able to have dental work performed at Will County (R. 54).
A Vocational Expert ("VE") testified that Ms. Morgan's previous jobs at Trinity Health Services and Meijer were at the light, semi-skilled level (R. 56). The ALJ asked the VE to consider a hypothetical individual who can lift and carry twenty pounds occasionally, ten pounds frequently, can stand, walk, and sit for six hours out of the eight-hour workday, can frequently handle and finger with both hands, cannot be exposed to concentrated pulmonary irritants, and should not work with hazardous machines (R. 58-59). The VE opined that such an individual would be able to perform Ms. Morgan's previous duties of unskilled cashier at the light level, as well as at least sixty percent of available maid or house-keeping positions, as those are also unskilled and light exertion jobs (Id). Ms. Morgan could also perform the duties of a non-postal service mail sorter or mailroom clerk, another unskilled position considered to be at a light exertion level (R. 60).
On August 28, 2012, the ALJ issued a written decision denying Ms. Morgan's application for SSI benefits (R. 17-30). At Step One of the sequential evaluation, the ALJ found that Ms. Morgan has not engaged in substantial gainful activity ("SGA") since her SSI application date of February 26, 2010 (R. 22). At Step Two, the ALJ found that Ms. Morgan's severe impairments were diabetes, arthritis,
Before moving to Step Four, the ALJ found that Ms. Morgan had an RFC that matched the hypothetical she gave the VE, that is, Ms. Morgan could perform light work, except that she can lift or carry twenty pounds occasionally and ten pounds frequently, can stand, walk, or sit for six hours in an eight-hour workday, and can frequently handle and finger (R. 24). The ALJ also established further limitations in the RFC: avoiding concentrated exposure to pulmonary irritants, working directly with hazardous machines, and working in high-exposed places (Id). In support of the RFC, the ALJ explained that she considered Ms. Morgan's symptoms, and the extent to which those symptoms were consistent with the objective medical evidence and other evidence, as well as the medical opinions in the record (R. 24). After detailing both the subjective and objective evidence, the ALJ explained that, although she gave Ms. Morgan's testimony some weight, "the mostly normal clinical findings, mild diagnostic findings and minimal complaints in the treatment record with consistent medication management did not support a finding of total disability" (R. 27).
Specifically, in explaining her RFC determination and finding that Ms. Morgan retained the ability to work, the ALJ pointed to: (1) Ms. Morgan's various daily activities (driving, preparing simple meals, taking care of her adult son with Downs Syndrome, taking her grandchildren to the park); (2) the fact that she returned to her cashier's job after her 2002 CTS surgery; (3) the infrequency of her asthma attacks, and successful management of the condition with medication; (4) the "relative stability" of her symptoms for all her impairments with medication, without side effects; (5) her minimal complaints of pain or documentation of problems with her right hand; (6) the fact that her medical treatment for her various conditions was periodic and sporadic; and (7) essentially normal physical examinations and diagnostic tests (R. 25). In addition, the ALJ also considered the entirety of Ms. Morgan's treatment at Will County and determined that many of her treatments were not related to aggravated chronic symptoms but were visits to seek help for medication refills, to obtain lab results, or to complete necessary paperwork (R. 24-25).
In addition, the ALJ stated that she also considered the opinion of the state agency medical consultant, and gave it some weight (R. 28). The ALJ found the opinion of Dr. Vincent, and confirmation by Dr. Bilinsky, that Ms. Morgan could perform medium work to be "reasonable" in light of the minimal treatment and clinical findings (Id). The ALJ discussed Dr. Tamragouri's examination of Ms. Morgan, first recognizing that, "notably, she [Ms. Morgan] failed to report any ongoing medications for pain" (R. 26).
With respect to Ms. Morgan's complaints of arthritis in her knees, the ALJ noted that Ms. Morgan first began complaining of problems with her knees in September 2010, and that she refused a referral for occupational therapy. The ALJ also noted that Ms. Morgan's knee x-ray revealed mild arthritic changes and that Ms. Morgan returned to Will County in December 2010 for stronger pain medication for her knees, but did not follow up on any of her medical treatments until January 2012.
The ALJ stated that despite a lack of support in the objective medical evidence, she nevertheless relied on Ms. Morgan's subjective complaints of pain from arthritis and CTS to reduce her RFC from the medium level recommended by Dr. Vincent to the light work level (Id). The ALJ further stated that the reduced exertional level and additional environmental limitations took into consideration Ms. Morgan's obesity and asthma, despite the fact that the record provided no proof of frequent asthma exacerbations (Id).
With respect to Ms. Morgan's credibility, the ALJ recognized that some of Ms. Morgan's failure to obtain treatment may have stemmed from an inability to afford particular tests or medical specialists (R. 26). After acknowledging Ms. Morgan's financial difficulties, the ALJ determined that, in any event, Ms. Morgan was not taking significant medications for her pain and alleged limitations (Id). Moreover, the ALJ found that despite Ms. Morgan's inability to afford additional CTS testing or a pain specialist, the overall record suggested that Ms. Morgan rarely visited Will County for pain management, although she went there regularly for other medication refills, paperwork assistance, and follow-up tests for her diabetes (R. 25, 27).
At Step Four, the ALJ concluded that Ms. Morgan has never engaged in SGA and therefore does not have past relevant work (Id).
We review the ALJ's decision deferentially, and will affirm if it is supported by substantial evidence. Thomas v. Colvin, 745 F.3d 802, 806 (7th Cir. 2014). Substantial evidence is "such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Pepper v. Colvin, 712 F.3d 351, 361-62 (7th Cir. 2013) (quoting McKinzey v. Astrue, 641 F.3d 884, 889 (7th Cir. 2011) (internal citations omitted). We do not reweigh evidence or substitute our own judgment for that of the ALJ. Shideler v. Astrue, 688 F.3d 306, 310 (7th Cir. 2012). In rendering a decision, the ALJ "must build a logical bridge from the evidence to his conclusion, but he need not provide a complete written evaluation of every piece of testimony and evidence." Pepper v. Colvin, 712 F.3d 351, 361 (7th Cir. 2013).
Ms. Morgan argues that the ALJ failed to properly consider her hand limitations stemming from her CTS, that the ALJ's adverse credibility determination was flawed, and that the RFC was unsupported by substantial evidence in the record because the ALJ rejected the only medical opinion in the record (Pl. Mot. at 6-15). We disagree with many of plaintiff's arguments. For example, plaintiff argues that because the only medical opinion in the record (Dr. Vincent's) assessed Ms. Morgan as having a "medium" RFC, by giving Ms. Morgan an RFC that was "light" with additional restrictions, the ALJ rejected Dr. Vincent's opinion outright and then independently — and impermissibly — "played doctor" by determining Ms. Morgan's RFC herself (Pl. Mem. at 7-8).
The bulk of the ALJ's opinion allows us to trace her reasoning from the medical opinions to her RFC determination. With respect to Ms. Morgan's hand limitations, the ALJ noted that Dr. Vincent opined that plaintiff was able to lift 25 pounds frequently and 50 pounds occasionally and did not include any manipulative limitations. She compared this to plaintiff's testimony that she was able to lift only five to eight pounds and that she dropped things, and found that the record did not support Ms. Morgan's claim because the "mild diagnostic findings and minimal complaints in the treatment record with consistent medication management" were inconsistent with the plaintiff's alleged lifting abilities.
However, we cannot say the same with respect to limitations based on Ms. Morgan's knee condition. We remand because the medical opinions on which the ALJ relied for her RFC determination were rendered before Ms. Morgan was diagnosed with arthritis in her knees, and the ALJ failed to explain the path by which she determined the evidence shows that Ms. Morgan could perform light duty work. Dr. Vincent's medical opinion, and Dr. Tamragouri's examination on which Dr. Vincent's opinion is based, both predate Ms. Morgan's diagnosis of arthritis in her knees, which the ALJ found was a severe impairment. Both the medium and light exertion levels assume the ability to stand or walk for six hours in an eight hour work day.
We find that the ALJ here has not built an "accurate and logical bridge" from the evidence about Ms. Morgan's knee condition to the RFC determination that she could perform at the light exertion level. While the medical records concerning Ms. Morgan's other impairments reveal that they were well-controlled by medication and that she seldom complained of pain in her hands and wrists, the medical record is less clear with respect to Ms. Morgan's knees. Her arthritis was diagnosed through x-ray and the record suggests that pain medication may not have been sufficient to control her symptoms. We note that the ALJ partially discredited Ms. Morgan's complaints of pain because of her gaps in treatment and the fact that she rarely requested pain medication (R. 25, 27). However, we read this analysis as being more targeted towards Ms. Morgan's CTS than to her arthritis. Although the record does not support a finding that Ms. Morgan sought additional medication for her hands, it does show her returning to Will County for better pain control for her knees in late 2010 and then again in early 2012.
In remanding this case, we are mindful that in Trammell v. Colvin, 12 C 6780, 2014 WL 1227565 at *7, (N.D.Ill. March 25, 2014), the district court declined to remand for an additional medical opinion concerning a diagnosis rendered after the date of the medical expert's RFC. But in that case, the ALJ considered a number of more recent test results "at length," including several doctors' evaluations of the plaintiff's impairment, and there was no indication that the RFC was contradicted by the more recent diagnoses. Trammell, 2014 WL 1227565 at *6. In contrast, the record here contains notes of Ms. Morgan's complaints of knee pain and diagnostic test results, but no medical analysis of the limitations (if any) resulting from that condition. Further, the ALJ did not describe how she determined that Ms. Morgan was able to stand and walk for up to six hours a day, given that the ALJ found Ms. Morgan's knee impairment to be severe. The ALJ's treatment of Ms. Morgan's arthritis does not meet the Seventh Circuit's standards for a "logical bridge" from the evidence to her RFC.
For the foregoing reasons, Ms. Morgan's motion (doc. # 17) is granted. The Commissioner's motion for summary judgment (doc. # 27) is denied. This case is remanded for further consideration consistent with this opinion.
