IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

LISA A. ESQUIVEL, )

)

 Plaintiff, )

) 

)

) No. 11 C 9200

v. )

) Judge John A. Nordberg

MICHAEL J. ASTRUE, Commissioner of )

Social Security, )

)

 Defendant. )

MEMORANDUM OPINION AND ORDER

Before the Court is plaintiff Lisa A. Esquivel’s motion seeking reversal of the ALJ’s

decision denying her social security disability benefits. 42 U.S.C. § 405(g). The ALJ found that

plaintiff suffered from impairments of migraine headaches, multiple sclerosis, degenerative disc

disease of the lumbar spine, anxiety, and depression but found that she was not disabled because,

despite these impairments, she could perform light work subject to certain limitations.

The ALJ’s decision will be upheld if it is “supported by substantial evidence, meaning

evidence a reasonable person would accept as adequate to support the decision.” Kastner v.

Astrue, 697 F.3d 642, 646 (7th Cir. 2012). The ALJ does not have to “address every piece of

evidence or testimony presented, but must provide ‘an accurate and logical bridge’ between the

evidence and her conclusion that a claimant is not disabled.” Id. Moreover, “[i]f a decision

‘lacks evidentiary support or is so poorly articulated as to prevent meaningful review,’ a remand

is required.” Id. 

Plaintiff has raised a number of arguments as to why the ALJ’s decision is not supported

by substantial evidence. After reviewing the parties’ briefs and the administrative record, we

conclude that more explanation is needed from the ALJ and that a remand is therefore

appropriate. Here are the key reasons for this conclusion.

Evidence After Plaintiff’s Last Date Insured. One issue lurking throughout the ALJ’s

opinion is the extent to which medical evidence generated after the date last insured (September

30, 2006) can be relied upon to reach conclusions about her condition before that date. Plaintiff

complains that although the ALJ summarized the medical evidence from after the date last

insured, the ALJ failed to explain why no weight was given to this evidence. (Pl. Mem. 7-8.) We

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agree. In particular, plaintiff’s MS, which was formally diagnosed after the date last insured, is a

progressive disease that may not be definitively diagnosed until later stages when certain

abnormalities only first become apparent in clinical findings. (Pl. Reply 4.) In reading the ALJ’s

opinion, we are unclear as to how she viewed this argument. Her opinion states: “The

progressive nature of MS exacerbates the ability to demonstrate earlier limitations.” (AR 33-34.)

This statement is vague, and the ALJ does not go on to explain what she means, nor how it

relates to the specific pieces of evidence submitted by plaintiff. Moreover, while the ALJ seemed

to discount medical evidence from after the date last insured, the ALJ at other places cited to this

evidence to support her ruling. See Scott v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011) (“The ALJ

was not permitted to ‘cherry-pick’ from those mixed results to support a denial of benefits.”).

For example, as pointed out by plaintiff, the ALJ stated that in February 2008 an MRI showed a

decrease in the size of plaintiff’s brain lesions. (Pl. Repl 5; AR 32.) But the ALJ did not

acknowledge that later that same month a new MRI showed that plaintiff had two new brain

lesions. (AR 553.) On remand, the ALJ should consider all the evidence and should provide

more explanation about how she views the connection between the later symptoms and how they

may or may not provide evidence regarding plaintiff’s condition before the date last insured

(regarding among other things her MS onset date and headaches, as discussed below).

Dr. Freeman’s Expert Opinion. During the administrative hearing, the ALJ indicated

that she needed additional evidence. Plaintiff submitted a report from Dr. Freeman, a neurologist

who works for the SSA, who reviewed plaintiff’s records and concluded that her impairments

during the relevant period were presumptively disabling and would have precluded her working

before the date last insured. (Pl. Mem. 9; AR 409-16.) The ALJ discounted Dr. Freeman’s

report, finding that he failed “to provide a logical or thorough nexus from the medical evidence”

to his conclusions. (AR 37.) However, the ALJ did not explain why she reached this conclusion

nor did she adequately analyze the specific evidence in Dr. Freeman’s report. Plaintiff asserts

that Dr. Freeman’s report was based on a “thorough review” and “comprehensive analysis” of all

the medical evidence. (Pl. Mem. at 10; AR 409-11.) Specifically, in concluding that plaintiff’s

MS had reached a significant level of severity by January 2004, Dr. Freeman relied on “a

constellation of findings including magnetic resonance imaging scan results, the waxing and

waning of neurological symptoms, the development of optic neuritis, and spinal fluid studies.”

(Pl. Mem.10.) The ALJ should address this specific evidence. Plaintiff further argues that, if the

ALJ believed Dr. Freeman’s opinion did not contain enough detail, the ALJ should have

recontacted Dr. Freeman to obtain additional testimony. (Id. 11.) As a second reason for

discounting Dr. Freeman’s report, the ALJ stated that she was relying on certain state agency

physicians who thought plaintiff’s evidence was insufficient. However, the ALJ did not further

discuss the reasons for why she gave more weight to the agency physicians than to Dr. Freeman.

In sum, we agree with plaintiff and find that the ALJ should address the specific evidence in Dr.

Freeman’s report.

 

Migraine Headaches. Plaintiff complains that the ALJ failed to sufficiently analyze her

claim that she suffered from debilitating migraine headaches. (Pl. Mem.2.) We agree. Dr.

Chronopoulos reported that plaintiff experienced four to five migraines monthly, improving to

three monthly, and that these headaches were severe. (Pl. Reply 2; AR 805.) Plaintiff argues that

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having three severe headaches a month is consistent with missing three days of work a month. 

(Pl. Reply 2.) The ALJ never made any finding about the frequency of her headaches. (Id.)

The ALJ discounted the evidence because she concluded that plaintiff sought “very little

medical treatment” for her headaches, and when she did, she was treated effectively with

medication. (AR 33.) As an example of the latter, the ALJ noted that plaintiff went to Christ

Hospital in January 2005 for an “intractable headache” and was later discharged, after taking

medication, with a “pain level of zero at discharge.” (Id.) As an example of the former, the ALJ

noted that plaintiff on two occasions went to the hospital (one time for foot pain and another for

a kidney stone) and did not mention that she was suffering from a headache. (AR 31.)

This analysis fails to adequately address plaintiff’s headache evidence. First, the ALJ

seems to assume that plaintiff claimed to have had a continuous headache when she only claimed

to have intermittent headaches. (Pl. Reply 13.) Given her claim that she had 3 to 5 headaches a

month, it is not surprising that on two hospital visits, when being treated for other acute

conditions, she did not report having a migraine. Second, the ALJ, in our view, wrongly assumes

that if there is a medication that eventually eliminates a particular headache, then plaintiff suffers

no limitations from those headaches. Consider for example the January 2005 headache. (AR 31,

33.) Although it is true that the headache went away, it did so only after plaintiff had first visited

her obstetrician who prescribed Vicodin and Valium, which provided only partial relief, and only

after she then went to the emergency room and was given two other medications – Compazine

and Toradol. Even if this treatment could be considered effective on some level, it still required

multiple doctor visits and multiple medications over a number of days before it was eventually

resolved. This would not be an easy treatment regimen on a daily basis for someone trying work

a regular job. See Scott, 647 F.3d at 740 (“There can be a great distance between a patient who

responds to treatment and one who is able to enter the workforce”). Moreover, the record

suggests that the headache medications did not work consistently. At various points, plaintiff

was given the following medications for migraines: Vicodin, Valium, Compazine, Toradol,

Propanalol, Inderal, Maxalt, Verapamil, and Bexta. (AR 31-33.) Third, the ALJ failed to

consider plaintiff’s financial difficulties as a possible explanation for why she did not go to the

doctor more often for her headaches. (Pl. Mem. at 18-19; AR 68, 79, 94-97, 103; Shauger v.

Astrue, 675 F.3d 690, 696 (7th Cir. 2012) (“Although a history of sporadic treatment or the

failure to follow a treatment plan can undermine a claimant’s credibility, an ALJ must first

explore the claimant’s reasons for the lack of medical care before drawing a negative inference,”

and one of those reasons is “an inability to afford treatment”).) On remand, the ALJ should

“develop a full and fair record” regarding this migraine evidence. Id. at 698. 

Post Hearing Evidence. In addition to seeking a remand to address these and other

issues, plaintiff has also asked for a remand to consider new evidence. Specifically, after the

record closed, plaintiff submitted a letter from a neurologist named Jeffrey Curtin who had been

treating plaintiff since 2009. (Pl. Mem. 19-20.) Dr. Curtin reviewed an MRI brain scan of

plaintiff from 2005 and concluded that it showed several brain lesions, thus supporting an onset

date of MS in at least 2005. The written summary of the same scan, which is all Dr. Freeman and

the ALJ had to rely on, indicated that the scan was normal and plaintiff had no brain lesions.

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Plaintiff argues that this evidence from Dr. Curtin satisfies the criterial for a sentence six remand

under 42 U.S.C. § 405(g) because it is new, material, and good causes exists for not submitting it

earlier. Evidence is considered material under this provision if there is a “reasonable

probability” the ALJ would have reached a different result if the evidence had been considered.

Schmidt v. Barnhart, 395 F.3d 737, 742 (7th Cir. 2005).

The Commissioner does not question the newness or good cause requirements, but does

argue that the evidence is not material. (Def. Resp.15.) The Commissioner states that Dr. Curtin

reviewed the MRI several years later, suggesting that his review was therefore less relevant. But

we fail to see how a review of an MRI scan would be less accurate if done several years after the

taking of the scan. The Commissioner also argues that the ALJ could still have concluded,

despite this new information, that plaintiff was not disabled in 2005. While perhaps true, we find

that there is a reasonable probability this scan could make a difference because, as plaintiff

correctly notes, the ALJ relied heavily on plaintiff’s alleged failure to provide corroborating

medical evidence. (Pl. Reply 15.)

In conclusion, we find that the ALJ’s opinion does not fully explain the basis for the

ruling and does not contain a full and fair summary of the evidence, as discussed above and as

further articulated in plaintiff’s opening and reply briefs. Accordingly, plaintiff’s motion for

summary judgment [Dkt. # 18] is granted. The ALJ’s decision is reversed, and this case is

remanded to the Social Security Administration for further proceedings consistent with this

opinion.

ENTER:

____________________________________

JOHN A. NORDBERG

Senior United States District Court Judge

 June 13, 2013

DATED: ______________________________

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