United States District Court, N.D. Indiana, Hammond Division
OPINION AND ORDER
P. SIMON, JUDGE
Wayne Gibson, Jr. appeals the Social Security
Administration's decision to deny him Social Security
disability insurance benefits. An administrative law judge
found Gibson was not disabled within the meaning of the
Social Security Act. As explained below, I find the ALJ erred
by disregarding the opinion of one of Gibson's treating
physicians. A remand is necessary so that the ALJ may fully
address that physician's opinion.
is not to determine from scratch whether or not Gibson is
disabled and entitled to benefits. Instead, my review of the
ALJ's findings is deferential, to determine whether the
ALJ applied the correct legal standards and whether the
decision is supported by substantial evidence. Shideler
v. Astrue, 688 F.3d 306, 310 (7th Cir. 2012);
Castile v. Astrue, 617 F.3d 923, 926 (7th Cir.
2010); Overman v. Astrue, 546 F.3d 456, 462 (7th
Cir. 2008). If substantial evidence supports the
Commissioner's factual findings, they are conclusive. 42
U.S.C. §405(g). “Evidence is substantial if a
reasonable person would accept it as adequate to support the
conclusion.” Young v. Barnhart, 362 F.3d 995,
1001 (7th Cir. 2004). “Substantial evidence” is
more than a “scintilla” of evidence, but it's
less than a preponderance of the evidence. Richardson v.
Perales, 402 U.S. 389, 401 (1971). As such, the review
is a light one. But of course, I cannot “simply
rubber-stamp the Commissioner's decision without a
critical review of the evidence.” Clifford v.
Apfel, 227 F.3d 863, 869 (7th Cir. 2000).
addition, the ALJ does not have to review every piece of
evidence, but must provide a “logical bridge”
between the evidence and conclusions. Terry v.
Astrue, 580 F.3d 471, 474 (7th Cir. 2009). When an ALJ
denies disability benefits but fails to adequately support
his conclusions, the decision must be remanded. Jelinek
v. Astrue, 662 F.3d 805, 811 (7th Cir. 2011).
Specifically, the ALJ's reasoning must be sufficiently
articulated to permit meaningful review. See Steele v.
Barnhart, 290 F.3d 936, 940 (7th Cir. 2002). I must only
consider the evidence pointed out by the ALJ in his written
decision. See Jelinek, 662 F.3d at 811
(“[W]hat matters are the reasons articulated by the
Gibson's treating physicians was Dr. Chetan Puranik, an
anesthesiologist and pain management specialist. Gibson and
Dr. Puranik had a long-term treating relationship spanning
from 2011 through 2014. Unquestionably, Dr. Puranik was a
treating physician. Dr. Puranik treated Gibson for cervical
spondylosis, which is age- related wear and tear affecting
the spinal disks in the neck. See
uses/syc-20370787 (last visited Mar. 19, 2018). Dr. Puranik
also diagnosed Gibson with myelopathy and cervicalgia, both
of which are diseases of the spinal cord. [A.R. at
certainly true that on a couple of occasions noted in the
medical records, Dr. Puranik said that Gibson
“ambulates without difficulty.” [Id. at
408, 426, 428.] Indeed, the ALJ picked up on that point in
his discussion of Dr. Puranik. The ALJ pointed out that
“on November 2, 2012, Dr. Puranik noted that the
claimant's medication regimen was working adequately,
he ambulated without difficulty, and he had mild to
moderate pain on range of motion in his cervical
spine.” [Id. at 33 (emphasis added).] These
couple of references to Gibson being able to ambulate without
problem were early on in Gibson's treatment relationship
with Dr. Puranik. Nothing more was said by the ALJ in his
review of Dr. Puranik's medical records relating to
Gibson's ability to ambulate.
reading the ALJ's opinion one would be left with the
impression that Gibson's ability to get around-that is,
his ability to “ambulate”-was not at all an issue
for him. But that would be a totally misleading impression.
What Dr. Puranik's records actually show is that on
no less than 13 visits, Dr. Puranik made a special note
that Gibson “ambulates with difficulty and exhibits
guarding and antalgic behavior.” An antalgic gait is
one which develops as a way to avoid pain while walking.
(last visited Mar. 19, 2018). None of there references to
Gibson's difficulty moving around, however, found their
way into the ALJ's opinion.
first reference to Gibson having difficulty walking is in a
note in the medical records from a visit by Gibson to Dr.
Puranik in March 2012. [A.R. at 416.] And then nearly every
month thereafter, Dr. Puranik repeats that same mantra-that
Gibson is having difficulty ambulating, that he walks in a
“guarded” way, and that there are signs of
antalgic behavior. See Gibson's May 2012 visit
with Dr. Puranik [Id. at 420]; June 2012
[Id. at 422]; March 2013 [Id. at 529];
April 2013 [Id. at 599]; May 2013 [Id. at
97.]; June 2013 [Id. at 595]; July 2013
[Id. at 593]; August 2013 [Id. at 591];
September 2013 [Id. at 589]; October 2013
[Id. at 587]; November 2013 [Id. at 585];
December 2013 [Id. at 583]; early January 2014
[Id. at 581]; late January 2014 [Id. at
579]. In other words, there was a drumbeat of evidence that
Gibson had a substantial and prolonged problem with pain and
with ambulating. Yet, the ALJ plucked out one visit from 2012
and relied on that one visit to find that Gibson
“ambulates without difficulty.” [Id. at
reference by the ALJ to the one of the few times that Dr.
Puranik said that Gibson walks without difficulty-while
ignoring the 13 times that Dr. Puranik said something to the
contrary-is a classic case of cherry-picking from a medical
record to support a denial of benefits. Such cherry-picking
of evidence is improper. Scott v. Astue, 647 F.3f
734, 740 (7th Cir. 2011).
more, at no time does the ALJ assign any weight to the
opinion of Dr. Puranik. This is a problem. A treating
physician's opinion is entitled to controlling weight if
it is “well supported by medically acceptable clinical
and laboratory diagnostic techniques and is not inconsistent
with other substantial evidence“ in the record. 20
C.F.R. § 404.1527(d)(2); see White v. Barnhart,
415 F.3d 654, 658 (7th Cir. 2005); Bauer v. Astue,
532 F.3d 606, 608 (7th Cir. 2008); Hofslien v.
Barnhart, 439 F.3d 375, 376 (7th Cir. 2006). This rule
takes into account the treating physician's advantage in
having personally examined the claimant and developed a
rapport, while controlling for the bias that a treating
physician may develop with the patient. Dixon v.
Massanari, 270 F.3d 1171, 1177 (7th Cir. 2001). If an
ALJ decides not to give controlling weight to a treating
physician's opinion, however, he must explain her reasons
for doing so. Scott v. Astrue, 647 F.3d 734, 740
(7th Cir. 2011). Failure to do so is cause for remand.
problem in this case is not that the ALJ gave little weight
to the opinion of Dr. Puranik. The problem is that he
assigned it no weight at all. A reader of the ALJ's
opinion is left to guess what the ALJ thinks about Dr.
Puranik's opinion regarding Gibson's ability to
ambulate. This is especially problematic given the long term
relationship that Gibson had developed with Dr. Puranik and
the number of times that Dr. Puranik noted that Gibson had a
hard time ambulating. An ALJ should state what weight, if
any, he is assigning to the opinion of a treating physician
in order to permit meaningful review. See 20 C.F.R.
§404.1527; Zurawski v. Halter, 245 F.3d 881,
889 (7th Cir. 2001). While a treating physician's opinion
regarding the nature and severity of a medical condition is
entitled to controlling weight if it is well supported by
medical findings and not inconsistent with other substantial
evidence in the record, it is in the ALJ's purview to
discount the treating physician's opinion, but she must
provide “good reasons” to explain the weight
given to the opinion and support these reasons with evidence.
SSR 86-2p, 1996 WL 374188 (July 2, 1996); Scott v.
Astrue, 647 F.3d 734, 739 (7th Cir. 2011). The ALJ must
also consider such factors as the length, nature, and extent
of the treatment relationship, frequency of examination, the
physicians's specialty, and the types of tests performed.
E.g., Moss v. Astrue, 555 F.3d 556, 561
(7th Cir. 2009). I must allow the ALJ's decision to stand
“so long as the ALJ minimally articulated his reasons-a
very deferential standard that we have, in fact, deemed
lax.” Elder v. Astrue, 529 F.3d 408, 415 (7th
Cir. 2008) (internal quotation and citation omitted).
the ALJ did not indicate how much weight, if any, he was
giving Dr. Puranik's opinion, let alone his reasons for
doing so. This is particularly problematic given the
long-term treatment relationship between Gibson and Dr.
Puranik and Dr. Puranik's numerous notations that Gibson
has difficulty ambulating. Yet at no time did the ALJ say
what weight he was giving to that opinion. While the ALJ need
not discuss every piece of evidence, he cannot ignore
significant evidence supporting a claimant's claim.
See Golembiewski v. Barnhart, 322 F.3d 912, 917 (7th
Cir. 2003). Failure to discuss an entire line of evidence
makes it “impossible for a reviewing court to tell
whether the ALJ's decisions rests upon substantial
evidence.” [Id.] The ALJ's failure to
indicate what weight he assigned to Dr. Puranik's
opinions prohibits meaningful review of the ALJ's
decision to deny benefits.
this is not a case where the failure of the ALJ to properly
weigh Dr. Puranik's opinions is harmless. See,
e.g., Shramek v. Apfel, 226 F.3d 809, 814 (7th
Cir. 2000). The ability to ambulate without difficulty is
important to this case because of the residual functional
capacity that the ALJ assigned to Gibson. According to the
ALJ, “[a]fter careful consideration of the entire
record” he determined that Gibson could “stand
and/or walk for 20 minutes at one time for a total of 2 hours
during an 8-hour workday.” He went on to include in the
RFC that Gibson could “occasionally climb ramps and
stairs, balance, kneel, stoop, crouch, and crawl, but he
could never climb ladders or scaffolds.” [A.R. at 30.]
It is unclear from the record what effect Dr. Puranik's
opinions would have had on the RFC had those opinions been
accepted, or even considered, by the ALJ.
the ALJ cherry-picked the evidence from Gibson's medical
records to support the denial of benefits. Gibson had a long
term relationship with Dr. Puranik. The ALJ left the
impression that, based on Dr. Puranik's records, Gibson
has no problem at all getting around. Yet a review of all of
Dr. Puranik's records suggest something quite to the
contrary. On remand, the ALJ must properly consider all of
Dr. Puranik's records and then assign a weight to his
opinions. If the ALJ still believes that he should discount
the opinions of Dr. Puranik-and that is of course the
ALJ's prerogative-then he must explain why he is doing so
and build a logical bridge between the evidence and his
decision. As it stands now, I am not permitted to conduct a
meaningful review ...