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Nature of Suit Code: 863
Nature of Suit: Social Security - DIWC/DIWW (405(g))
Cause of Action: 

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United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois  60604

Argued April 13, 2010

Decided August 4, 2010

Before

ANN CLAIRE WILLIAMS, Circuit Judge

DIANE S. SYKES, Circuit Judge

JOHN DANIEL TINDER, Circuit Judge

No. 09‐3019

PATRICK J. TURNER,

Plaintiff‐Appellant,

v.

MICHAEL J. ASTRUE,

Commissioner of Social Security,

Defendant‐Appellee.

Appeal from the

United States District Court

for the Northern District

of Illinois, Eastern Division.

No. 07‐C‐1520

Michael T. Mason,

Magistrate Judge.

O R D E R

Patrick Turner appeals a district court decision affirming the denial of his claim for

disability insurance benefits under the Social Security Act.  We conclude that substantial

evidence supports the administrative law judge’s determination that Turner was not

entitled to disability insurance benefits and therefore affirm.

I. Background

NONPRECEDENTIAL DISPOSITION

 To be cited only in accordance with Fed. R. App. P. 32.1

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Turner is 51 years old and lives in Streator, Illinois.  He is married and has five

children.  He left high school at the start of his senior year, but earned his GED shortly

thereafter.  For the bulk of his professional life, he worked as a unionized painter—mostly at

nuclear power plants.  In 1998 while working at the LaSalle nuclear plant, Turner injured

his lower back transporting two 100‐pound buckets of paint.  As a result of this accident,

Turner’s back popped and pain radiated down his left leg.  Turner was able to perform

light‐duty work for the following year until his neurologist advised him to stop working

because he was on his feet too long.  Turner ultimately received a workers’ compensation

settlement in the amount of $175,000.

Turner filed his application for disability insurance benefits on December 5, 2002.

His claim was denied initially and again upon reconsideration.  Turner then requested an

administrative hearing, which was held on December 1, 2005, before an Administrative Law

(“ALJ”).  The ALJ denied Turner’s claim.  

A. The ALJ’s Ruling

The Social Security Act defines a disabled individual as one who is unable “to

engage in any substantial gainful activity by reason of any medically determinable physical

or mental impairment which . . . has lasted or can be expected to last for a continuous

period of not less than 12 months.”  42 U.S.C. § 423(d)(1)(A).  Under the regulations

promulgated by the Commissioner of Social Security for evaluating disability claims, an

individual is not considered disabled if his residual functioning capacity—along with the

individual’s age, education, and work experience—allows him to perform a significant

number of jobs.  20 C.F.R. § 404.1520(a)(4)(v).  Based on these statutory and regulatory

standards, the ALJ denied Turner’s claim for disability benefits.  

The ALJ was confronted with conflicting medical evidence concerning the precise

nature of Turner’s physical condition.  The ALJ received medical reports from several

doctors—some based on personal examinations of Turner, others based solely on a review

of Turner’s medical files—including three who prepared reports at the request of Disability

Determination Services (“DDS”).  The ALJ also received a residual functional‐capacity

report (“RFC”) from a nurse‐practitioner and heard testimony from Turner himself.  Some

of the medical evidence indicated that Turner could not perform even sedentary work due

to persistent pain in his back, but the prevailing view was that Turner’s physical limitations

were less severe than he claimed.

After reviewing and weighing the available evidence, the ALJ ultimately found that

Turner “has the residual functional capacity to perform the physical exertional and

nonexertional requirements of work except that he is limited to lifting no more than ten

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1 Section 405(g) does provide a mechanism for courts to compel the Commissioner to

(continued...)

pounds at a time.  He requires the option to alternate between sitting and standing.”  While

acknowledging that Turner could no longer perform his past work as a painter, the ALJ

concluded that Turner’s capacity for sedentary work, in addition to his age, education, and

work experience, directed a finding of “not disabled” given the applicable regulations and

the number of jobs available to a person in Turner’s condition.

B. Subsequent Procedural History

Turner administratively appealed the ALJ’s decision to the Appeals Council.  As part

of this appeal, Turner submitted additional evidence for review.  The Appeals Council

incorporated these additional documents into the administrative record but agreed with the

ALJ’s decision.  Turner then sought judicial review.  The parties agreed to conduct the

proceedings before a magistrate judge who granted the Commissioner’s motion for

summary judgment.  Turner now appeals.

II.  Discussion

The Social Security Act provides that “[t]he findings of the Commissioner of Social

Security as to any fact, if supported by substantial evidence, shall be conclusive.”  42 U.S.C.

§ 405(g).  “Evidence is substantial if it is sufficient for a reasonable person to accept as

adequate to support the decision.”  Johansen v. Barnhart, 314 F.3d 283, 287 (7th Cir. 2002)

(quotation marks omitted).  “In addition to relying on substantial evidence, the ALJ must

also explain his analysis of the evidence with enough detail and clarity to permit

meaningful appellate review.”  Briscoe v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005).

Ultimately however, the issue before us is not whether Turner is disabled, but whether the

findings of the ALJ were supported by substantial evidence.  Jens v. Barnhart, 347 F.3d 209,

212 (7th Cir. 2003).

Furthermore, we can only consider evidence that was actually before the ALJ.

42 U.S.C. § 405(g); Rice v. Barnhart, 384 F.3d 363, 366 n.2 (7th Cir. 2004) (“Although

technically a part of the administrative record, the additional evidence submitted to the

Appeals Council . . . cannot now be used as a basis for a finding of reversible error.”).  This

is important because Turner’s brief improperly includes multiple references to evidence that

was never presented to the ALJ.1

  With this framework in place, we now turn to the merits

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1

(...continued)

consider new evidence, “but only upon a showing that there is new evidence which is material and

that there is good cause for the failure to incorporate such evidence into the record in a prior

proceeding.”  Turner asked the magistrate judge to grant a remand on this basis, but this request

was denied on the grounds that the additional evidence could not be considered “material” to

Turner’s disability claim.  Turner did not challenge this holding on appeal, so we have no need to

consider this issue any further.

of Turner’s appeal.  Turner attacks the validity of the ALJ’s findings on four separate

grounds.

A. “Playing Doctor”

Turner’s first argument is that the ALJ impermissibly “played doctor” by

substituting his personal observations for the considered judgments of medical

professionals.  See Rohan v. Chater, 98 F.3d 966, 970 (7th Cir. 1996) (“ALJs must not succumb

to the temptation to play doctor and make their own independent medical findings.”).  In

particular, Turner takes issue with the ALJ’s interpretation of an MRI taken on June 30,

1999.  Turner claims that the MRI (which itself is not in the administrative record) indicates

more extensive physical damage than the ALJ credited. We are satisfied that the ALJ

considered the MRI through the perspective of the various doctors who reviewed the MRI

report.  

In particular, the ALJ specifically recounted Dr. Matthew Ross’s review of the results

of Turner’s MRI.  Dr. Ross personally examined Turner on two separate occasions as part of

Turner’s then‐pending workers’ compensation claim.   In 2000 Dr. Ross reviewed the MRI in

question and concluded that it showed degenerative disk changes and only a minimal

left‐sided L5‐S1 disk herniation.  Dr. James Graham, who conducted the first review of

Turner’s medical files for the DDS, reached the same conclusion regarding the MRI, and he

further determined that Turner was capable of frequently lifting items weighing up to

10 pounds (a limitation mirrored in the ALJ’s ultimate findings).  The ALJ was critical of

Dr. Aftab Khan, a doctor who conducted a personal examination of Turner at the direction

of the DDS and who prepared the medical report that is most supportive of Turner’s claim

for disability benefits.  The ALJ noted that Dr. Kahn apparently did not consider the MRI at

all and instead relied on his observations about Turner’s physical limitations.  After

reviewing this medical evidence, the ALJ ultimately decided that the results of the MRI

were not consistent with Turner’s claim that he was incapable of performing even sedentary

work.  This finding is well supported by the medical evidence; the ALJ did not substitute

his own judgment for that of the medical experts.

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B. Dr. Khan

Turner’s second argument is that the ALJ improperly discounted Dr. Khan’s

conclusion—following a personal examination of Turner in 2003 at the behest of the

DDS—that Turner could lift but not carry five pounds.  Turner argues that this opinion is

entitled to great weight because Khan was the only DDS doctor who examined him

personally.  To support this claim, Turner relies on Whitney v. Schweiker, 695 F.2d 784, 789

(7th Cir. 1982), but that case concerned the weight to be given the opinions of a treating

physician, and Dr. Khan was not Turner’s treating physician.  He examined Turner only

once, and thus was not as intimately familiar with his medical history or course of treatment

as a treating physician.

Importantly, the ALJ was quite clear in explaining why he was not persuaded by

Dr. Khan’s report.  The ALJ determined that Dr. Khan’s medical conclusions were based on

Turner’s own reporting and responses in the examination room rather than on objective

medical evidence.  “An ALJ may properly reject a doctor’s opinion if it appears to be based

on a claimant’s exaggerated subjective allegations.”  Dixon v. Massanari, 270 F.3d 1171, 1178

(7th Cir. 2001).  Indeed, Turner does not dispute that Dr. Khan’s findings were heavily

influenced by Turner’s self‐reporting of his physical limitations.  

The ALJ also specifically explained the reasons why he suspected Turner of

exaggerating his physical limitations to Dr. Khan.  First, Turner was obviously aware that

this DDS‐directed examination would factor prominently in any subsequent disability

hearing, so there was a clear motive for Turner to understate his physical capacity and

overstate his limitations.  Second, Turner “demonstrated significantly less functional

ability” during his 2003 evaluation with Dr. Khan than he did in 2001 when he met for the

second time with Dr. Ross.  Following that 2001 visit, Dr. Ross had concluded that it was

“realistic” that Turner could lift at the 25‐pound level.  The three other DDS physicians who

reviewed Turner’s medical files also found that Turner was capable of much greater

physical movement than he seemed to acknowledge during his visit with Dr. Khan.

Turner notes that his examination by Dr. Khan occurred two years after his last

examination by Dr. Ross, and so his condition could have deteriorated by then.  But there is

no objective medical evidence that Turner’s physical condition actually worsened after 2001,

and he does not identify any subsequent developments that could have plausibly

exacerbated his condition.  “An ALJ must only ‘minimally articulate his or her justification

for rejecting or accepting specific evidence of a disability.’” Berger v. Astrue, 516 F.3d 539,

545 (7th Cir. 2008) (quoting Rice, 384 F.3d at 371).  Here, the ALJ exceeded this standard, and

Turner has identified nothing in the record that undermines the ALJ’s explanation for

discounting Dr. Kahn’s opinions.

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C. Nurse‐Practitioner Duffield

Turner next argues that the ALJ erred by refusing to credit a 2005 RFC prepared by

Patricia Duffield, a nurse‐practitioner.  Starting in 2002, Duffield performed annual

examinations of Turner.  Her primary purpose was to help Turner manage his pain, and to

that end she regularly secured refills for his prescriptions for Vicodin and Ultram.  In 2005

Duffield completed an RFC on Turner’s behalf.  Duffield described Turner’s prognosis as

“poor.”  She also stated that Turner was not a malingerer, and that on a 1‐10 scale, Turner

self‐rated his pain at 7‐10 daily.  Duffield noted that Turner could not fully flex his back and

had an abnormal gait, sensory loss, reflex changes, muscle spasm, muscle atrophy, muscle

weakness, and reported impaired sleep.  Based on these findings, Duffield concluded that

Turner would need to shift positions at will from sitting, standing or walking, and would be

unable to do any of these three activities for more than two hours out of an eight‐hour

workday.  Duffield also concluded that Turner could not stay seated for more than five

minutes at a time and would require unscheduled breaks of between five and ten minutes

every half hour in order to manage his pain.  

Duffield’s assessment of Turner’s physical limitations is sharply at odds with the

ALJ’s holding, and Turner contends that the ALJ erred in not giving Duffield’s account

“controlling weight.”  This argument falls short on multiple fronts.  The Social Security

Administration’s regulations provide that the opinion of a “treating source” will be given

controlling weight only if “well‐supported by medically acceptable clinical and laboratory

diagnostic techniques and . . . not inconsistent with the other substantial evidence in your

case record.”  20 C.F.R. § 404.1527(d)(2).  A nurse‐practitioner, moreover, is not a “treating

source.”  See 20 C.F.R. § 416.902 (“Treating source means [a claimant’s] physician,

psychologist, or other acceptable medical source . . . .”); id. § 416.913(d)(1) (listing

nurse‐practitioner among occupations that are not “acceptable medical sources”).  

Turner attempts to get around this problem by claiming that Duffield completed the

2005 RFC in collaboration with a supervising doctor, a Dr. Podzamsky.  But there is no

evidence that Podzamsky ever examined Turner—let alone treated him.  Contrary to

Turner’s assertions, Podzamsky never “signed” the 2005 RFC.  The last page of the RFC

contains only a stamp bearing Podzamsky’s name; the report was completed and signed by

Duffield.  Turner insists that Duffield might have transcribed Podzamsky’s own

observations.  This is pure speculation; Duffield’s notes do not indicate that Podzamsky

personally examined Turner.  In sum, the ALJ had very solid reasons for concluding that

Duffield alone was responsible for the 2005 RFC.

Furthermore, the ALJ concluded that “the limitations set forth in the report are

dramatically inconsistent with the x‐ray and MRI evidence as well as the clinical findings,

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2 Turner claims in passing that the ALJ should have asked the vocational expert how a

sit/stand/lie restriction would have altered Turner’s job prospects.  This unsupported argument does

not appear to have been raised below, so it is forfeited.  Skarbek v. Barnhart, 390 F.3d 500, 505 (7th Cir.

2004).

and findings of Dr. Ross, the treating neurosurgeon, and would still be entitled to little

weight.”  In order to be entitled to controlling weight, a treating source’s opinion cannot be

“inconsistent with the other substantial evidence [in the record],” § 404.1527(d)(2), and here,

the ALJ carefully identified the ways in which the 2005 RFC was not in line with the bulk of

the medical evidence in the record.

Turner correctly notes that the ALJ erroneously described Ross as a “treating

neurosurgeon.”  Ross examined Turner but was not in fact a treating physician.  This error

was harmless, however.  There is absolutely no indication that the ALJ gave Ross’s opinion

the “controlling weight” of a treating physician’s—on this matter or any other.  Indeed, the

point of the ALJ’s “dramatically inconsistent” statement is that the 2005 RFC is inconsistent

with a host of other indicators regarding Turner’s physical condition.  Every doctor who

reviewed the MRI found only “minimal” herniation.  Also, although Duffield recorded that

Turner experienced muscle atrophy, no other doctor observed this phenomenon.  Similarly,

Duffield noted greater sensory loss and reflex changes in Turner than did any of the

doctors.  Finally, the ALJ noted that Duffield’s treatment notes were inconsistent with the

significant and constant pain she attributed to Turner in her RFC.  The ALJ’s decision to

give Duffield’s opinion “little weight” was amply justified.

D. Turner’s Daily Activities

Turner’s final argument is that the ALJ erred in concluding that Turner’s daily

activities revealed that he was less physically impaired than he claimed to be.2

  The ALJ

observed that Turner was capable of vacuuming, sweeping, dish‐washing, cooking, grocery

shopping, yard work, and fishing.  Turner claims that the ALJ failed to acknowledge that he

performs these activities slowly and with great pain and discomfort.  This is essentially a

challenge to the ALJ’s credibility determination, which is entitled to “special deference” on

appeal.  Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000).  We will only reverse an ALJ’s

credibility determination if the claimant can show that it is “patently wrong,” id., and

Turner has not satisfied this high burden.  Turner’s daily activities—even if accompanied by

pain—can fairly be construed as inconsistent with his claim that he is physically unable to

perform even sedentary work.

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In short, substantial evidence supports the ALJ’s determination that Turner can

perform sedentary work and thus is not disabled.

   AFFIRMED.

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