JANE MAGNUS-STINSON, District Judge.
Plaintiff Michael Kelley applied for disability insurance benefits and supplemental security income from the Social Security Administration ("
Mr. Kelley was thirty six years old when he filed for disability insurance benefits and supplemental security income. [Filing No. 14-5 at 2.] He has previous work experience as a forklift driver, a construction worker, a tool rental clerk, and an airport worker. [Filing No. 14-2 at 33-36; Filing No. 14-2 at 48-49.]
"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, [he] will automatically be found disabled. If a claimant satisfies steps one and two, but not three, then [he] 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 his 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).
Mr. Kelley challenges the ALJ's decision on three grounds: (1) that the ALJ did not adequately analyze whether Mr. Kelley met or medically equaled Listing 1.04, [Filing No. 16 at 4-6]; (2) that the ALJ's credibility determination was flawed, [Filing No. 16 at 6-7]; and (3) that the ALJ did not adequately consider all medical evidence in connection with her RFC analysis, [Filing No. 16 at 7-10]. The Court will address the issues in turn.
Mr. Kelley argues that the ALJ "provided only a perfunctory analysis using boilerplate language during her evaluation at step three (3) of the process," and "fail[ed] to properly evaluate the evidence in comparison to the requirement to explain how exactly she concluded that [Mr. Kelley's] severe spinal conditions did not meet or equal the requirements of listing 1.04." [Filing No. 16 at 5.] Mr. Kelley argues that the ALJ only spent two sentences discussing whether he met or equaled Listing 1.04, so remand is appropriate "to insure that proper evaluation of whether or not [he] meets or equals listing 1.04 is performed." [Filing No. 16 at 5-6.] Mr. Kelley also contends that the ALJ did not address at all whether he medically equaled Listing 1.04, and also did not consult a medical expert or analyze the medical records on that issue. [Filing No. 16 at 6.]
In response, the Commissioner argues that the ALJ found that there was no indication that Mr. Kelley could not ambulate effectively or that he had a spinal disorder or lumbar spinal stenosis which are requirements for meeting Listing 1.04.
On reply, Mr. Kelley details evidence he provided which he claims shows that he has a disorder of the spine resulting in compromise of a nerve root, evidence of neuro-anatomic distribution of pain, evidence of limitation of motion in the spine, evidence of motor loss, evidence of sensory or reflex loss, and evidence of a positive straight-leg raising test. [Filing No. 23 at 2-5.] He argues that he has met his burden of showing that he meets or medically equals Listing 1.04, and that the ALJ ignored the evidence that supported this conclusion. [Filing No. 23 at 5.]
"In considering whether a claimant's condition meets or equals a listed impairment, an ALJ must discuss the listing by name and offer more than [a] perfunctory analysis of the listing." Minnick v. Colvin, 775 F.3d 929, 935 (7th Cir. 2015) (citations omitted). The listings set forth the criteria for qualifying impairments. Id. (citing 20 C.F.R. § 404.1525(a)). "A claimant may also satisfy a listing by showing that his impairment is accompanied by symptoms that are equal in severity to those described in the Listing." Minnick, 775 F.3d at 935 (citing 20 C.F.R. § 404.1526). A determination of medical equivalence requires an expert's opinion on the issue. Minnick, 775 F.3d at 935 (citations omitted); 20 C.F.R. § 404.1526(c) ("When we determine if your impairment equals a listing, we consider...the opinion given by one or more medical...consultants designated by the Commissioner"); SSR 96-6p, 1996 WL 374180, *3 ("[L]ongstanding policy requires that the judgment of a physician (or psychologist) designated by the Commissioner on the issue of equivalence on the evidence before the administrative law judge or the Appeals Council must be received into the record as expert opinion evidence and given appropriate weight").
Listing 1.04 describes spinal disorders resulting in compromise of a nerve root or the spinal cord, with evidence of nerve root compression, spinal arachnoiditis, or lumbar spinal stenosis resulting in pseudoclaudication. Minnick, 775 F.3d at 935 (citing 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 1.04). Evidence of nerve root compression is characterized by "neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test." Minnick, 775 F.3d at 935.
As to Listing 1.04, the ALJ stated "I assessed the claimant's impairments under § 1.00 Musculoskeletal System, but the medical evidence falls short of the criteria of the section. The record does not show that the claimant has...a spinal disorder characterized by nerve root compression, spinal arachnoiditis, or lumbar spinal stenosis, as required by Medical Listing 1.04." [Filing No. 14-2 at 16.] While the ALJ discussed certain medical evidence later as part of her RFC analysis, she did not tie this evidence to her Listing determination and, more significantly, ignored evidence that could have supported a finding that Mr. Kelley met or medically equaled Listing 1.04. The Court specifically notes the following medical evidence, which directly relates to the requirements of Listing 1.04:
The ALJ did not discuss any of this evidence in connection with her evaluation of Listing 1.04. When setting forth her RFC determination, the ALJ briefly discussed some of Mr. Kelley's medical providers, including stating that Dr. Taylor recommended steroid injections and physical therapy, noting that an electromyography "was within normal limits," but also stating that Mr. Kelley was still in "severe back pain" at a January 2012 visit and was limited in his movements. [Filing No. 14-2 at 18.] The ALJ ultimately gave Dr. Taylor's opinion only "some weight" because "the record does not document significant strength or sensation deficits that would suggest a need to perform only limited standing/walking in an 8-hour work day." [Filing No. 14-2 at 19.] The ALJ also stated that "given the claimant's lack of significant stretch or[ ] sensory deficits noted in the record, and given other opinions indicating the claimant can work 40 hours weekly, Dr. Gregori's opinion is given little weight." [Filing No. 14-2 at 19.]
The ALJ's analysis of this evidence is limited to Mr. Kelley's RFC determination. In other words, while the ALJ discussed some of the medical evidence in terms of whether Mr. Kelley should be limited to certain types of work, she did not first address that evidence to see whether it indicated that Mr. Kelley met Listing 1.04.
Mr. Kelley also argues that the ALJ failed to address whether he medically equaled Listing 1.04, and did not consult an expert regarding that determination. [Filing No. 16 at 6.] The ALJ did not address medical equivalency at all in her opinion, and must do so on remand. She should also ensure that she has consulted appropriate medical experts.
Given that the Court finds remand is required based on the first issue Mr. Kelley has raised — that the ALJ did not adequately evaluate whether he met or medically equaled Listing 1.04 — the Court will not discuss the other issues he has raised in detail. As to the second issue Mr. Kelley raises, that the ALJ's credibility determination is flawed, he argues that the ALJ failed to consider why Mr. Kelley was not fully compliant with all available treatment measures. [Filing No. 16 at 6-7.] The Commissioner responds that the ALJ inquired regarding Mr. Kelley's use of prescription and non-prescription medications, and adequately explained her credibility determination which was based on many other factors. [Filing No. 21 at 22-23.] In his reply, Mr. Kelley reiterates his argument that the ALJ never asked why Mr. Kelley was not fully compliant with his medications. [Filing No. 23 at 6-7.] The Court notes that a credibility determination by the ALJ is given "considerable deference." Prochaska, 454 F.3d at 738. The ALJ's credibility determination will be reversed only if she fails to base the determination on grounds that are reasonable or supported by the evidence of record. See Sims v. Barnhart, 442 F.3d 536, 538 (7th Cir. 2006). Additionally, the Court recognizes that an ALJ "must not draw any inferences about an individual's symptoms and their functional effects from a failure to seek or pursue regular medical treatment without first considering any explanations that the individual may provide." Roddy v. Astrue, 705 F.3d 631, 639 (7th Cir. 2013). On remand, the ALJ should consider whether she complied with this standard.
In connection with the third issue, the adequacy of the ALJ's RFC determination, Mr. Kelley argues that the ALJ only discussed evidence which supported her RFC determination, and misinterpreted a post-surgery MRI, ignored a CT scan indicating potential nerve impingement and decreased reflexes and sensation, and ignored records from visits with Dr. Taylor and Dr. Gregori which indicated a lack of reflexes, difficulty ambulating, weakness, pain, and an antalgic gait. [Filing No. 16 at 7-9.] The Commissioner responds that the ALJ provided adequate reasons for rejecting Dr. Gregori's opinion, including that he opined Mr. Kelley was permanently disabled which is a determination reserved for the Commissioner, that his opinion was tentative, and that his opinion was not supported by, and was inconsistent with, other medical evidence. [Filing No. 21 at 16-18.] The Commissioner also argues that the ALJ adequately explained why she gave limited weight to Dr. Taylor's findings. [Filing No. 21 at 19.] In his reply, Mr. Kelley reiterated his arguments and noted that Dr. Taylor treated him longer than any other medical professional. [Filing No. 23 at 7-9.] While the ALJ need not address every piece of evidence that has been presented, she must set forth a logical bridge between the evidence and the conclusion so that the Court can assess the validity of the ultimate findings and the claimant can obtain meaningful judicial review. Craft, 539 F.3d at 673. Additionally, the ALJ may not analyze only the evidence that supports her ultimate conclusion; if contrary evidence exists, the ALJ must confront it and explain why it was rejected. Moore v. Colvin, 743 F.3d 1118, 1123 (7th Cir. 2014) (citations omitted). On remand, the ALJ should ensure that she considers all evidence and builds a logical bridge from that evidence to her conclusion.
For the reasons detailed herein, the Court
