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Nature of Suit Code: 864
Nature of Suit: Social Security - SSID Title XVI
Cause of Action: 

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United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Argued November 19, 2024 

Decided November 26, 2024 

Before

AMY J. ST. EVE, Circuit Judge

JOHN Z. LEE, Circuit Judge 

JOSHUA P. KOLAR, Circuit Judge

No. 24-1583 

BRITNY N. CASTEN,

Plaintiff-Appellant, 

v. 

MARTIN J. O’MALLEY, Commissioner 

of Social Security, 

Defendant-Appellee.

Appeal from the United States District 

Court for the Central District of Illinois.

No. 22-cv-02250 

Colin S. Bruce, 

Judge. 

O R D E R

Britny Casten, a young woman who experiences low back pain, appeals the 

denial of her application for disability insurance benefits. An Administrative Law Judge 

(ALJ) found that Casten did not have a disability and denied her application. Casten 

sought review in the district court, which upheld the ALJ’s ruling. Because the ALJ’s 

decision was supported by substantial evidence, we affirm.

In December 2019, Casten (then 29) stopped working as a customer-complaint 

clerk at AT&T, and a month later she filed for disability insurance benefits. She had a 

NONPRECEDENTIAL DISPOSITION

To be cited only in accordance with FED. R. APP. P. 32.1

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wide range of medical issues, but her principal symptom was low back pain, which she 

had complained about for approximately ten years. Her back pain had been attributed 

to fibromyalgia, obesity, degenerative disc disease, and sacroiliac joint arthritis. The 

pain worsened after a fall in 2018 and again after several falls in 2020. Doctors 

prescribed her various pain medications and referred her to surgeons, specialists, and 

physical therapists. In early 2021, a pain-management specialist administered 

bilateral-sacroiliac-joint injections, which relieved some of her pain. She received 

additional injections in early 2022.

Casten also experienced wrist and finger pain. In March 2021, she received 

cubital-tunnel-release surgery, which seemed to have removed most of the discomfort.

But later that year, the pain in her right wrist returned. She reported that the pain 

diminished after she received a steroid injection and completed four weeks of 

immobilization.

Casten also had chronic migraines, for which she was prescribed various 

medications, including an anticonvulsant, periodic trigger-point injections, and 

butalbital (a barbiturate drug used to treat tension headaches). In August 2021, she 

reported that her migraines had generally been “doing pretty well,” that she 

experienced two to four migraines per month, and that she was satisfied with her 

current medications. 

In connection with Casten’s application, in July and September 2020, two state 

agency physicians, Dr. Vidya Madala and Dr. Bharati Jhaveri, respectively, reviewed 

Casten’s medical records, and opined that she could perform “light work” with certain 

restrictions. See 20 C.F.R. § 404.1567(b). 

Those opinions differed from that of a physical therapist, Madison Bayler, who 

opined after a one-time evaluation in January 2021 that Casten could work only at a 

sedentary level of exertion or below. Bayler conducted a physical-therapy evaluation, 

which incorporated Casten’s reports of her own functional ability and pain. Bayler 

concluded that Casten had limited range of motion in her spine and shoulders, 

significant weakness in her upper and lower extremities, weak grip strength, and 

problems with her endurance, balance, and gait. Dr. Steven Gentry, Casten’s primary 

care physician, endorsed Bayler’s conclusions the following day, and relayed the 

findings on a pre-printed Physical Residual Functional Capacity Questionnaire.

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No. 24-1583 Page 3 

An ALJ conducted a hearing in February 2021 and denied Casten’s application 

for benefits. The ALJ found that Casten could perform sedentary work, and that Casten 

was not disabled because she could perform her past relevant work as a customer 

complaint clerk. The Appeals Council, however, remanded the case for a new hearing 

because the ALJ had abused her discretion when she discounted Bayler’s opinion after 

finding, without support, that Casten did not provide full effort at Bayler’s examination.

Another ALJ held a hearing on remand in January 2022 and again denied 

Casten’s application. Applying the five-step disability analysis, see 20 C.F.R. 

§ 416.920(a)(4), the ALJ determined that (step 1) Casten had not engaged in substantial 

gainful activity during the relevant period; (step 2) her obesity, fibromyalgia, migraines, 

supraventricular tachycardia, status post ablation surgery, degenerative disc disease of 

the cervical and lumbar spine, and sacroiliac joint arthritis were severe impairments; 

but (step 3) none of these equaled a listed impairment; (step 4) she could perform light 

work with postural, manipulative, and environmental restrictions; and (step 5) she 

could perform her past relevant work as a customer complaint clerk. 

In finding that Casten had the residual functional capacity (RFC) to perform light 

work with certain restrictions, the ALJ explained that the state physicians’ opinions 

were better supported and more consistent with the medical evidence than the opinions 

of Bayler and Dr. Gentry. The ALJ explained that Bayler had assessed several of 

Casten’s functional abilities based on Casten’s subjective reports of pain, and Bayler’s 

one-time evaluation did not reflect Casten’s longitudinal functioning. The ALJ also 

found Bayler’s opinion at odds with reports from other medical providers who had 

examined Casten and had not reported significantly reduced strength in her upper and 

lower extremities. As for Dr. Gentry’s opinion, the ALJ found it unpersuasive because 

he had used a pre-printed form and provided little narrative, relying for support only 

on Bayler’s evaluation, and his opinion was inconsistent with his previous treatment 

notes and other medical evidence. 

This time, the Appeals Council declined further review.

Casten sought review in the district court and argued that the ALJ’s findings 

regarding the medical opinions were illogical and not supported by substantial 

evidence. The court upheld the ALJ’s decision, deferring to the ALJ’s stated reasons for 

crediting the opinions of the state physicians’ opinions over those of Dr. Gentry and 

Bayler.

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We will affirm an ALJ’s decision denying disability benefits if it is supported by 

substantial evidence—a low threshold. Warnell v. O'Malley, 97 F.4th 1050, 1052 (7th Cir. 

2024). “[W]e will not reweigh the evidence, resolve debatable evidentiary conflicts, 

determine credibility, or substitute our judgment for the ALJ’s determination so long as 

substantial evidence supports it.” Id. at 1052–53 (quoting Gedatus v. Saul, 994 F.3d 893, 

900 (7th Cir. 2021)). 

Casten first argues that the ALJ glossed over recent developments in her medical 

record and failed to explain how they were consistent with the state agency physicians’ 

earlier opinions (from mid-2020). Casten points, for example, to evidence that she had 

surgery on her wrist in March 2021, reported wrist pain in December 2021 and January 

2022, had frequent migraines throughout 2021, and received bilateral-sacroiliac-joint 

injections to treat ongoing back pain. According to Casten, the ALJ merely recited this 

evidence without explaining how it could be reconciled with the earlier opinions.

This argument shortchanges the ALJ’s analysis. The ALJ explained how this 

more recent evidence influenced her ultimate decision. The ALJ noted, for example, that 

Casten’s low back pain improved after she received sacroiliac injections in April 2021, 

and she received another round of injections a couple of weeks before the hearing in 

January 2022, after she complained that her back pain had returned; her symptoms in 

her right wrist had improved after her cubital tunnel release in 2021; and her migraines 

were “well managed with treatment” and had improved after she began receiving 

injections in October 2020. Further, in light of these recent developments, the ALJ 

included additional manipulative, reaching, and environmental limitations in Casten’s 

RFC. The ALJ’s analysis here was sufficient. Warnell, 97 F.4th at 1053 (ALJs “are subject 

to only the most minimal of articulation requirements”). 

Casten relatedly argues, for the first time, that the medical opinions from the 

state agency physicians were “stale” and that the ALJ should have accounted for 

subsequent developments by having them evaluated through an additional medical 

opinion. We agree with the Commissioner that Casten waived this argument by failing 

to raise it before the district court. See Milhem v. Kijakazi, 52 F.4th 688, 693 (7th Cir. 2022). 

Regardless, the argument lacks merit because the ALJ was not required to seek an 

additional medical opinion beyond those already in the record. An additional medical 

opinion would be necessary only if new, significant medical diagnoses reasonably could 

have changed the physicians’ medical opinions. See Pavlicek v. Saul, 994 F.3d 777, 783–84 

(7th Cir. 2021). Here, the developments in the medical evidence were not new: they 

concerned diagnoses and treatment for conditions—low back pain, wrist pain, and 

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migraines—that Casten had experienced long before the state physicians submitted 

their opinions. Further, the ALJ accounted for these developments by explaining that 

Casten’s treating physicians had observed improvements in her back pain, wrist pain, 

and migraine frequency that were consistent with the state agency physicians’ opinions 

that she could perform light work. To the extent Casten disagrees with the ALJ’s 

weighing of the state physicians’ opinions and subsequent medical evidence, we will 

not reweigh the evidence or resolve debatable evidentiary conflicts. See Warnell, 97 F.4th 

at 1052. 

Casten next argues that the ALJ wrongly discounted Bayler’s medical opinion as 

not well supported simply because it was based on a single examination and included 

assessments of subjective reports of pain. But an ALJ may discount a medical opinion 

that is based primarily upon a patient’s subjective complaints. Prill v. Kijakazi, 23 F.4th 

738, 751 (7th Cir. 2022). And substantial evidence—namely, Bayler’s notes from her 

examination—supports the ALJ’s determination to discount Bayler’s assessments of 

Casten’s ability to stand, sit, or lift to the extent they were based on Casten’s subjective 

reports of pain during the examination.

Casten also challenges the ALJ’s finding that Bayler’s opinion was inconsistent 

with the medical evidence. The ALJ referred to exams performed by other treatment 

providers showing that Casten had normal motor strength, no other neurological 

abnormalities, and no deficits in her range of motion or grip strength. Casten disputes 

the ALJ’s characterization of the evidence and points to select findings from the record 

that she says are consistent with Bayler’s opinion.

∗

Substantial evidence also supports the ALJ’s finding that Bayler’s assessment, 

which showed significantly reduced motor strength in Casten’s upper and lower 

extremities, was inconsistent with the medical evidence. As the ALJ explained, other 

treatment providers consistently found that Casten was not as physically limited as 

Bayler opined. When treating physicians present conflicting evidence, the ALJ may 

∗The findings identified by Casten include diminished light touch sensation on the left side, 

reduced strength in the hips and knees, pain in the back, moderate instability on left single leg stand, and 

a wide-based, antalgic, slow gait in January 2019; trigger points in the back in April 2019; discomfort with 

light tapping on the lumbar spine, limited ability to bend forward and backward, and discomfort while 

walking in February 2020; positive provocative testing in the right cubital tunnel and at the Guyon’s canal 

in May 2020; decreased range of motion of the cervical spine, tenderness in the back, and decreased range 

of motion in the shoulders in August 2020; poor posture, tenderness in the spine, limited lumbar range of 

motion, shaking throughout all manual motor testing, and a slow and waddling gait in September 2020.

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decide whom to credit, so long as substantial evidence supports the decision. 

See Warnell, 97 F.4th at 1053. In light of the reports from other treatment providers who 

contradicted Bayler’s opinion, we conclude that substantial evidence supports the ALJ’s 

decision to reject it. 

Casten next argues that the ALJ did not provide a logical explanation for finding 

Dr. Gentry’s opinion unpersuasive. According to Casten, the ALJ should not have 

devalued Dr. Gentry’s opinion merely because he used a pre-printed form and 

provided “very little narrative explanation” for his opinion. In her view, the ALJ’s 

reasoning was unfair because the opinions from the state agency physicians, which the 

ALJ found persuasive, were similarly issued on pre-printed forms and contained 

comparable narrative explanations.

Casten’s focus on the nature of the forms, however, ignores the ALJ’s broader 

conclusion that Dr. Gentry’s opinion was inconsistent with his prior examination notes 

that did not mention any gait abnormalities, motor-strength deficits, or range-of-motion 

deficits. We will not disturb an ALJ’s decision to discount a medical opinion that is 

contradicted by medical evidence in the record that the ALJ relied upon. See id. The ALJ 

here appropriately explained that the record evidence consistently contradicted Dr.

Gentry’s opinion that Casten could not stand, walk, or sit for more than minutes at a 

time. The ALJ also observed that Dr. Gentry’s opinion about Casten’s severely limited 

ability to use her hands or reach was inconsistent with the medical evidence, which 

showed no abnormalities in her hands or arms on a consistent basis other than 

immediately before and after her surgery in March 2021. 

AFFIRMED

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