JANE MAGNUS-STINSON, District Judge.
Plaintiff Sondra K. Owens applied for disability insurance benefits and supplemental security income in August 2012. [
"The Social Security Act authorizes payment of disability insurance benefits and Supplemental Security Income to individuals with disabilities." Barnhart v. Walton, 535 U.S. 212, 214 (2002). "The statutory definition of `disability' has two parts. First, it requires a certain kind of inability, namely, an inability to engage in any substantial gainful activity. Second it requires an impairment, namely, a physical or mental impairment, which provides reason for the inability. The statute adds that the impairment must be one that has lasted or can be expected to last . . . not less than 12 months." Id. at 217.
When an applicant appeals an adverse benefits decision, this Court's role is limited to ensuring that the ALJ applied the correct legal standards and that substantial evidence exists for the ALJ's decision. Barnett v. Barnhart, 381 F.3d 664, 668 (7th Cir. 2004) (citation omitted). For the purpose of judicial review, "[s]ubstantial evidence is such relevant evidence as a reasonable mind might accept as adequate to support a conclusion." Id. (quotation omitted). Because the ALJ "is in the best position to determine the credibility of witnesses," Craft v. Astrue, 539 F.3d 668, 678 (7th Cir. 2008), this Court must afford the ALJ's credibility determination "considerable deference," overturning it only if it is "patently wrong," Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir. 2006) (quotations omitted).
The ALJ must apply the five-step inquiry set forth in 20 C.F.R. § 404.1520(a)(4)(i)-(v), evaluating the following, in sequence:
Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000) (citations omitted) (alterations in original). "If a claimant satisfies steps one, two, and three, [she] will automatically be found disabled. If a claimant satisfies steps one and two, but not three, then [she] 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).
After Step Three, but before Step Four, the ALJ must determine a claimant's 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). In doing so, the ALJ "may not dismiss a line of evidence contrary to the ruling." Id. The ALJ uses the RFC at Step Four to determine whether the claimant can perform her own past relevant work and if not, at Step Five to determine whether the claimant can perform other work. See 20 C.F.R. § 416.920(e), (g). The burden of proof is on the claimant for Steps One through Four; only at Step Five does the burden shift to the Commissioner. Clifford, 227 F.3d at 868.
If the ALJ committed no legal error and substantial evidence exists to support the ALJ's decision, the Court must affirm the denial of benefits. Barnett, 381 F.3d at 668. When an ALJ's decision is not supported by substantial evidence, a remand for further proceedings is typically the appropriate remedy. Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 355 (7th Cir. 2005). An award of benefits "is appropriate only where all factual issues have been resolved and the record can yield but one supportable conclusion." Id. (citation omitted).
Ms. Owens was forty-nine years old at the time she applied for disability benefits. [
In support of her claim of disability, Ms. Owens cites the combined effects of various medical problems, including asthma, headaches, diabetes with neuropathy, and lower back pain.
The ALJ followed the five-step sequential evaluation set forth by the Social Security Administration in 20 C.F.R. § 404.1520(a)(4) and ultimately concluded that Ms. Owens is not disabled. [
Ms. Owens requested that the Appeals Council review the ALJ's decision, but that request was denied on September 4, 2015, making the ALJ's decision the Commissioner's "final decision" subject to judicial review. [
Ms. Owens' appeal focuses on the ALJ's alleged failure to adequately address evidence of her back pain, arguing that the ALJ should have ordered a consultative examination to determine Ms. Owens' functional limitations from a February 2014 MRI. [
In response, the Commissioner maintains that there is substantial evidence in the record to support the ALJ's decision. [
In reply, Ms. Owens again contends that substantial evidence does not support the ALJ's RFC determination. [
It is well established that the ALJ must provide `an accurate and logical bridge' between the evidence and her conclusion that a claimant is not disabled." Kastner v. Astrue, 697 F.3d 642, 646 (7th Cir. 2012) (quoting Craft, 539 F.3d at 673). In doing so, the ALJ should take into account all of the relevant evidence, including both medical and nonmedical evidence. Diaz v. Chater, 55 F.3d 300, 306 (7th Cir. 1995). The ALJ is not required to address every piece of evidence that has been presented, but she must explain the bridge between the evidence and the conclusion sufficiently enough to allow the reviewing court to assess the validity of the ultimate findings and afford the claimant meaningful judicial review. Craft, 539 F.3d at 673 (citing Young v. Barnhart, 362 F.3d 995, 1002 (7th Cir. 2004)). Additionally, "an ALJ may not ignore an entire line of evidence that is contrary to her findings," and, if conflicting evidence exists, she must explain why the conflicting evidence was overcome by the evidence on which she relied. Zurawski v. Halter, 245 F.3d 881, 888 (7th Cir. 2001) (quoting Henderson v. Apfel, 179 F.3d 507, 514 (7th Cir. 1999)).
The ALJ also has a duty to develop a full and fair record to facilitate a determination of disability. Nelms v. Astrue, 553 F.3d 1093, 1098 (7th Cir. 2009). As a general matter, an ALJ is not required to order a consultative examination, but she may do so if medical evidence of a claimed impairment is not sufficient or if a consultative examination is otherwise necessary. 20 C.F.R. §§ 416.912(f), 20 C.F.R. § 416.917, 20 C.F.R. § 416.945(a)(3); Skinner v. Astrue, 478 F.3d 836, 844 (7th Cir. 2007). Generally, the "court gives deference to an ALJ's decision about how much evidence is sufficient to develop the record fully and what measures (including additional consultative examinations) are needed in order to accomplish that goal." Poyck v. Astrue, 414 F. App'x 859, 861 (7th Cir. 2011) (citing Nelms, 553 F.3d at 1098).
The Seventh Circuit has held, however, that "[a] consultative examination is normally required if the evidence is ambiguous, if specialized medical evidence is required but missing from the record, or if there is a change in a condition but the current severity of the impairment is not established." Poyck, 414 F. App'x at 861. Thus, failure to submit new and potentially decisive medical evidence to medical scrutiny can constitute reversible error because it allows the ALJ to impermissibly play doctor, which the Seventh Circuit has emphasized is a "clear no-no." Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014). The burden is on the claimant to introduce some objective evidence that further development of the record is necessary, particularly if the claimant is represented by counsel. Poyck, 414 F. App'x at 861 (citing Skinner, 478 F.3d at 844). "Mere conjecture or speculation that additional evidence might have been obtained in the case is insufficient to warrant a remand[;] . . . [i]nstead, a claimant must set forth specific, relevant facts— such as medical evidence—that the ALJ did not consider." Nelms, 553 F.3d at 1098 (quoting Binion v. Shalala, 13 F.3d 243, 246 (7th Cir. 1994)).
In support of her argument that the ALJ erred by not ordering a consultative examination, Ms. Owens points to an MRI she had in February 2014 indicating that she has "[s]ignificant degenerative disc disease and degenerative changes of posterior facets within the lumbar spine." [
The Court agrees with Ms. Owens that the February 2014 MRI is sufficient objective evidence to meet her burden to show that the ALJ erred by not further developing the record. Instead of ordering a consultative examination for Ms. Owens based on the recent, objective MRI evidence to determine any resulting functional limitations, the ALJ impermissibly played doctor by concluding without a medical opinion that it did "not support significant limitations." [
The Court is also guided by the Seventh Circuit's decision in Goins. 764 F.3d at 680. In that case, two consulting state-agency physicians reviewed the claimant's medical records and concluded that the claimant was able to work full time. Id. at 678-79. A subsequent MRI revealed degenerative disc disease, stenosis, and a Chiari I malformation that had not appeared on the earlier MRI that was submitted to the state-agency physicians as part of the medical records they were asked to review. Id. The ALJ did not seek the opinion of an additional physician regarding the results of the second MRI, and found that the claimant was not disabled, thereby denying the requested benefits. Id. at 679. The Seventh Circuit Court reversed and remanded the case, stating that "[t]he administrative law judge's critical failure, however, was the failure to obtain a medical report on the results of the [most recent] MRI," because the results of the MRI were otherwise unaccounted for in the records that formed the basis of the expert opinions on which the ALJ relied. Id. at 681. The Seventh Circuit concluded that this was reversible error because the failure to submit new and potentially decisive medical evidence to medical scrutiny allowed the ALJ to impermissibly play doctor, which is a "clear no-no." Id. at 680.
In sum, the Court agrees with Ms. Owens that, under these circumstances, the ALJ's failure to obtain a consultative examination to determine any functional limitations from Ms. Owens' significant degenerative disc disease is reversible error. Alternatively, the ALJ's decision must be reversed because she so significantly downplayed the results from Ms. Owens' February 2014 MRI, such that the ALJ failed to build a logical bridge from the evidence to her conclusion by ignoring contrary evidence. Thus, the ALJ's decision must be reversed and remanded.
For the reasons detailed herein, the Court
