UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF ILLINOIS 

EASTERN DIVISION 

JANICE DOUGLASS, 

 Plaintiff, 

 v. 

CAROLYN W. COLVIN, Acting 

Commissioner, Social Security 

Administration,1 

 Defendant. 

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No. 12 CV 504 

Magistrate Judge Young B. Kim 

April 30, 2013 

 

MEMORANDUM OPINION and ORDER

 Janice Douglass has documented physical and mental impairments, 

including back pain, depression, and post-traumatic stress disorder (“PTSD”). She 

applied for disability benefits in 2005, and in the eight intervening years she has 

watched her claim wend its way through a slow-moving administrative and judicial 

review process. Her claim has twice been denied by an administrative law judge 

(“ALJ”), and is now before this court at the summary judgment stage for a second 

time. After all of this time in legal limbo, Douglass finds herself in front of a court 

whose task it is not to decide whether the evidence suggests that she is disabled, 

but only to ensure that the ALJ who reviewed her claim gave reasons for denying it 

that are supported by substantial record evidence. See Pepper v. Colvin, 

___F.3d___, 2013 WL 1338123, at *8 (7th Cir. Apr. 4, 2013). Although this is a case 

 

1 Pursuant to Federal Rule of Civil Procedure 25(d), Carolyn W. Colvin—who 

became the Acting Commissioner of Social Security on February 14, 2013—is 

automatically substituted as the named defendant. 
2

where reasonable minds could disagree over whether Douglass can perform 

substantial gainful work despite her impairments, at the end of the day, this court 

finds that the ALJ discharged his duty to explain, using reasons supported by the 

record, why he does not believe that her impairments are as limiting as she claims 

they are. See Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008) (noting that the 

court must affirm an ALJ’s adequately supported decision “even if reasonable minds 

could differ concerning whether [the claimant] is disabled” (internal quotation 

omitted)). Accordingly, and for the following reasons, this court is bound to deny 

Douglass’s motion for summary judgment and to grant the Commissioner’s crossmotion for summary judgment: 

Procedural History

 Douglass applied for disability insurance benefits and supplemental security 

income on July 22, 2005, claiming that she had been disabled since 2003 by a 

combination of back pain, carpel tunnel syndrome, depression, and anxiety. 

(Administrative Record (“A.R.”) 66-68.) After her applications were denied initially 

and upon reconsideration, Douglass was granted a hearing before an ALJ. (Id. at 

47-53.) Following the hearing, the ALJ issued a decision finding that Douglass is 

not disabled. (Id. at 11-23.) After the Appeals Council denied her request for 

review, (id. at 4-6), Douglass sought judicial review before this court. At the 

summary judgment stage, this court determined that the ALJ had not given 

adequate reasons for his credibility determination, and on June 29, 2010, it 

remanded the case for further proceedings. (Id. at 716-51.) 
3

 Following this court’s decision, the ALJ held a new hearing at which 

Douglass testified and presented supplemental medical evidence. (Id. at 1038-81.) 

On October 28, 2011, the ALJ issued a decision again finding that Douglass is not 

disabled. (Id. at 697-712.) The Appeals Council did not assume jurisdiction over 

the case, so the ALJ’s decision became the final decision of the Commissioner. See

20 C.F.R. § 416.1484. On January 23, 2012, Douglass filed the current civil action 

for judicial review of the Commissioner’s final decision. (R. 1.) The parties have 

consented to the jurisdiction of this court. See 28 U.S.C. § 636(c). 

Facts 

This court provided a detailed recitation of the record evidence from 2003-

2008 in its June 2010 decision, and incorporates those facts by reference for 

purposes of the current opinion. (A.R. 718-33.) What follows below is a description 

of the record developed during the proceedings on remand. 

A. Medical Evidence

In 2008 Douglass sought mental health services at North Central Behavioral 

Health Systems (“NCBHS”). (Id. at 993.) (She also sought services there in 2007 

but stopped attending because of car problems. (Id. at 983.)) At her March 2008 

intake appointment, Douglass described herself as depressed due to the 

combination of her untreated physical pain and grief stemming from the loss of her 

daughter, who was killed in a car accident in January 2007. (Id.) She underwent a 

psychiatric evaluation in May 2008 with Dr. Mark McVay, who described her as 

having “[h]uge and unresolved grief issues,” as experiencing “marked health 
4

impairment” in the form of back pain, and as having lingering issues connected to 

her history of being abused as a child. (Id. at 983-85.) Dr. McVay prescribed 

Trazodone and Celexa to treat Douglass’s depression and what he described as her 

“sleep disturbances.” (Id. at 993-94.) Later that month Dr. McVay evaluated 

Douglass again and found that her symptoms were “significantly improved globally” 

and she was not experiencing any medication side effects. (Id. at 977-78.) Douglass 

also began individual counseling, although by September 2008 she was discharged 

“due to non-participation.” (Id. at 969-72.) The discharge note states that Douglass 

has a history of “poor engagement in services.” (Id. at 972.) 

In December 2008 Douglass returned to NCBHS to resume treatment, 

reporting that she was experiencing an increase in her depression and anxiety as 

the anniversary of her daughter’s death approached. (Id. at 945.) She re-engaged 

in individual therapy, where she reported that she had gone off of her depression 

medication because she could not afford it. (Id. at 940-41.) In March 2009 Douglass 

reported sleeping for an hour or two but then being unable to fall back to sleep. (Id. 

at 918.) She was given new prescriptions for Celexa and Trazodone for depression 

and sleep disturbances. (Id. at 923-24.) A month later she reported that her 

symptoms had improved and that she was not experiencing any medication side 

effects. (Id. at 907-08.) In July 2009 Douglass again reported no medication side 

effects, but said that she was sleeping very poorly, although “a little better on 

Trazodone.” (Id. at 896-97.) 
5

In the fall of 2009 Douglass reported having some improvement in her moods 

and depression when she was on medication, which included Cymbalta and 

Zyprexa, but said that she had ongoing anxiety and stress over financial worries 

and her disability case. (Id. at 869.) Douglass denied any medication side effects. 

(Id. at 890.) She reported having back pain at a level of four out of ten and said that 

she was under a doctor’s care for the pain. (Id. at 870.) The staff person who filled 

out a psychological assessment form checked all of the boxes pertaining to 

Douglass’s functional areas for daily activities, noting that she is able to maintain a 

residence, cook, drive or use public transportation, take care of her home, shop, and 

care for her own hygiene. (Id. at 871.) They discussed a treatment goal of 

improving Douglass’s anxiety, depression, grief, mood swings, and symptoms of 

PTSD. (Id. at 874.) 

On December 11, 2009, an NCBHS clinician filled out a diagnostic review 

form, stating that Douglass had reported experiencing constant pain in her neck 

and back. (Id. at 855.) The clinician rated her Global Assessment of Functioning 

(“GAF”) score as 52 (it had been as low as 45 in 2008).2 (Id. at 856, 975.) A month 

later Douglass was evaluated by Dr. Mohammad Sami, who noted that she had 

been dealing with back pain for years but could not afford treatment. (Id. at 863.) 

He wrote that she was “waiting for disability.” (Id.) Dr. Sami noted that she 

 

2 A GAF score is used to measure an individual’s overall functional capacity. A GAF 

score in the 41-50 range indicates serious impairments in social, occupational, or 

school functioning. A score in the 51-60 range indicates moderate difficulties in 

those areas. Diagnostic and Statistical Manual of Mental Disorders, 32-34 (4th ed. 

2000). 
6

reported having no side effects from her medications, but that she was anxious and 

depressed. (Id. at 864-65.) 

Progress notes show that between December 2009 and March 2010, Douglass 

attended only one of her ten scheduled group therapy appointments. (Id. at 852-54, 

903.) For eight of the nine times she did not attend, the notes reflect that she did 

not call to cancel. (Id.) During that time she was scheduled to attend four 

individual therapy sessions, but she only attended two. (Id. at 852, 902-03.) The 

notes from individual therapy state that Douglass reported not taking her anxiety 

medication because of “funding problems.” (Id. at 852.) She also said she was 

having difficulty with transportation and discussed with the therapist using a 

minibus to get to group sessions. (Id.) But after she repeatedly missed the group 

sessions, on March 4, 2010, NCBHS again closed her file and canceled her 

scheduled appointments “due to lack of engagement.” (Id. at 853.) 

In 2009 and 2010 Douglass pursued treatment for her back pain through the 

Health Center of Eastern LaSalle County in Ottawa, Illinois (“the pain clinic”). The 

hand-written notes from those visits are difficult to read, but they convey that she 

reported having back and neck pain for “years.” (Id. at 1003.) They also reflect that 

she was a “no show” for several scheduled appointments. (Id. at 1000-03.) The 

notes also show that she began taking Seroquel, a medication that treats depression 

and bipolar disorder, but it is unclear from the record when that prescription began. 

(Id. at 999.) 
7

During this period Douglass went to an emergency room seeking treatment 

for her back pain on three occasions. On February 27, 2009, she told E.R. personnel 

that her then-current pain level was at a nine out of ten. (Id. at 841.) The doctor 

who examined her noted that she was ambulatory upon arrival and did not appear 

to be in any distress from pain. (Id. at 842-43.) Forty minutes after her arrival 

Douglass described her pain as being at a two or three out of ten. (Id. at 844.) She 

was discharged with a prescription for Vicodin. (Id. at 839, 846.) 

Douglass again sought E.R. treatment in August 2010, where the intake form 

describes the intensity of her pain as mild. (Id. at 1010.) She was discharged with 

another Vicodin prescription and described her pain level as a two out of ten at 

discharge. (Id. at 1008, 1013.) Two months later Douglass again reported to an 

E.R. with back pain. (Id. at 1005.) She was ambulatory on arrival and reported 

being at six out of ten on the pain scale. (Id.) She was given a shot of morphine and 

discharged in good condition. (Id. at 1005-06.) 

B. Hearing Testimony

At her hearing on remand, which took place on September 19, 2011, Douglass 

again described her pain, depression, and other symptoms to the ALJ. Douglass 

said that on a good day her pain level is at a four or five out of ten, but that on a bad 

day it can be at a nine or ten. (A.R. 1055.) She stuck to that assessment even when 

the ALJ asked her to consider ten as representing “the most excruciating pain 

imaginable.” (Id. at 1062-63.) Douglass testified that her pain level during the 

hearing was at “about a four.” (Id. at 1063.) When the ALJ asked her to explain 
8

how her pain had changed over time, Douglass estimated that her typical pain level 

in 2005, 2007, and 2009 was about an eight or nine. (Id. at 1063-64.) But she also 

testified that her back pain had gotten “a little bit worse” since her July 2008 

hearing. (Id. at 1048.) 

The ALJ asked Douglass to explain what kind of treatment she was getting 

for her pain, and she explained that because she did not have medical insurance she 

was pursuing treatment at a free clinic. (Id. at 1050.) Douglass said that she often 

missed appointments because of transportation problems. (Id.) Douglass explained 

that she relies on a bus to get her to the clinic, and it does not always run at the 

time of her appointments. (Id. at 1050-51.) When the ALJ pressed her to explain 

why she had not called to cancel her appointments when she could not get there, 

she testified that she “probably didn’t have a phone at the time.” (Id. at 1060.) 

Douglass said that she did not go to the emergency room more often for treatment 

because she did not know anyone who could take her and because she was too 

embarrassed to call an ambulance when she could not afford to pay for it. (Id. at 

1066.) 

Douglass also described her attempts to get medical attention for her mental 

health issues, which she said include depression and PTSD. (Id. at 1053.) She 

testified that those conditions sometimes cause her to stay in bed for days. (Id.) 

Douglass said that a counselor at NCBHS recommended that she attend group 

therapy for her PTSD, but that she found the sessions overwhelming. (Id. at 1049-

50.) Douglass explained that after she was discharged from the program for not 
9

attending, she made numerous attempts to get back in but was told that there were 

not any government programs available to help potential patients who do not have 

insurance or a state medical card. (Id. at 1050.) 

When asked if she has any lingering effects of carpal tunnel syndrome, 

Douglass testified that her hands often feel numb or she has a “pins and needles” 

sensation. (Id. at 1052.) She said that the effects cause her to drop things often, 

and that she recently dropped a cigarette without even noticing because her hands 

were so numb. (Id. at 1052-53.) 

In describing her medications, Douglass testified that Seroquel, which is a 

sleep aid that she had been taking for three or four months, causes her to sleep for 

long periods of time. (Id. at 1046.) She said that it sometimes makes her sleep “for 

two or three days at a time,” but that this effect “varies.” (Id. at 1046-67.) When 

the ALJ asked whether she had discussed this side effect with her doctor, she 

replied, “he knows it makes me sleep.” (Id. at 1046.) 

C. The Vocational Expert’s Testimony

The ALJ also took testimony from Vocational Expert (“VE”) Ronald Malik, 

who testified that a person who is limited to light work involving only occasional 

overhead reaching and postural activities, moderately complex tasks, and occasional 

contact with the public, supervisors, and coworkers would not be able to perform 

Douglass’s past job as a laundry laborer. (A.R. 1074.) The VE testified that a 

person with those limitations could perform a number of other jobs, including 

supply clerk, grain clerk, loading checker, and shipping checker. (Id. at 1075-76.) 
10

He testified that all of those jobs exist in significant numbers in the regional 

economy. (Id.) When asked by Douglass’s attorney whether she could perform 

those jobs if she had to miss three to four days per month because her medications 

make her drowsy, or if she had to lay down with a heating pad for a couple of hours, 

the VE said those limitations would preclude employment. (Id. at 1078.) 

D. The ALJ’s Decision 

After hearing the proffered evidence, the ALJ concluded that Douglass is not 

disabled under sections 216(i) and 223(d) of the Social Security Act. (A.R. 712.) In 

so finding, the ALJ applied the standard five-step sequence, see 20 C.F.R. 

§ 404.1520(a), which requires him to analyze: 

(1) whether the claimant is currently [un]employed; (2) whether the 

claimant has a severe impairment; (3) whether the claimant’s 

impairment meets or equals one of the impairments listed by the 

[Commissioner], see 20 C.F.R. § 404, Subpt. P, App. 1; (4) whether the 

claimant can perform her past work; and (5) whether the claimant is 

capable of performing work in the national economy. 

Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000) (quoting Knight v. Chater, 55 

F.3d 309, 313 (7th Cir. 1995)). If at step three of this framework the ALJ finds that 

the claimant has a severe impairment that does not meet the listings, he must 

“assess and make a finding about [the claimant’s] residual functional capacity based 

on all the relevant medical and other evidence.” 20 C.F.R. § 404.1520(e). The ALJ 

then uses the residual functional capacity (“RFC”) to determine at steps four and 

five whether the claimant can return to her past work or to different available work. 

20 C.F.R. § 404.1520(f), (g). 
11

The ALJ’s post-remand decision largely tracks the original decision at steps 

one and two of the analysis; he found that Douglass has not engaged in substantial 

gainful activity since October 29, 2003, and that she has severe impairments in the 

form of a back disorder, depression, and PTSD. (Id. at 703.) He explained that he 

does not consider Douglass’s carpal tunnel syndrome to qualify as a severe 

impairment because she had not reported any manipulative difficulties to her 

doctors since 2008 and her smoking habit requires her to constantly grasp small 

objects. (Id.) At step three the ALJ determined that none of Douglass’s 

impairments individually or in combination meet or medically equal any listed 

impairment. (Id.) In evaluating Douglass’s mental impairments at this stage, the 

ALJ found that she has only mild restrictions in activities of daily living and 

moderate restrictions in social functioning and with regard to concentration, 

persistence, or pace. (Id. at 704.) 

The ALJ’s assessment of Douglass’s RFC at step four of the analysis also 

echoed his original decision. The ALJ determined that Douglass has an RFC to 

perform light work involving only occasional overhead reaching and postural 

activities, moderately complex or detailed tasks, and occasional contact with the 

public, co-workers, or supervisors. (Id. at 705.) In reaching that determination, the 

ALJ incorporated by reference his original analysis of the pre-September 2008 

medical record and then engaged in a lengthy credibility analysis incorporating his 

review of the more recent medical evidence. (Id. at 706-10.) The ALJ found 

Douglass’s credibility to be lacking and so discounted her testimony and gave little 
12

weight to any medical reports that are based only on her subjective statements. (Id. 

at 706.) The ALJ gave a long list of reasons for his dim view of Douglass’s 

credibility, pointing to what he sees as inconsistencies between her testimony and 

the medical record, discrepancies in her testimony, her lack of compliance with 

recommended treatment, and her presentation during the hearing. (Id. at 706-08.) 

He also noted that several recent medical records described her mental 

impairments as being only moderately severe and as improving with medication. 

(Id. at 708-09.) For those reasons, the ALJ found that although Douglass’s RFC 

leaves her incapable of performing her past work, he nonetheless determined at 

step five that there are a number of jobs that exist in significant numbers in the 

national economy that she remains able to perform. (Id. at 710-11.) Accordingly, 

the ALJ found that Douglass is not disabled, and denied her applications for 

benefits. (Id. at 712.) 

Analysis

 In reviewing the ALJ’s decision to deny Douglass’s application for benefits, 

this court is limited to ensuring that it is supported by substantial evidence, 

meaning “such relevant evidence as a reasonable mind might accept as adequate to 

support a conclusion.” See Getch v. Astrue, 539 F.3d 473, 480 (7th Cir. 2008) 

(quotation and citation omitted). The court’s role under this standard of review is 

“extremely limited,” in that it is “not allowed to displace the ALJ’s judgment by 

reconsidering facts or evidence, or by making independent credibility 

determinations.” Elder, 529, F.3d at 413. Instead, this court asks “whether the 
13

ALJ built an ‘accurate and logical bridge’ from the evidence to her conclusion that 

the claimant is not disabled.” Simila v. Astrue, 573 F.3d 503, 513 (7th Cir. 2009) 

(quoting Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008)). In applying that 

standard, this court must bear in mind that the ALJ “‘need not provide a complete 

written evaluation of every piece of testimony and evidence’” to survive judicial 

review. See Pepper, 2013 WL 1338123, at *8 (quoting Schmidt v. Barnhart, 395 

F.3d 737, 744 (7th Cir. 2005)). 

A. Law of the Case Doctrine 

 Douglass’s first challenge to the ALJ’s decision consists of her argument that 

his decision to adopt by reference his original analysis of the pre-September 2008 

medical evidence into the current opinion violates the law of the case doctrine. The 

law of the case doctrine—which applies to administrative agency proceedings, see 

Key v. Sullivan, 925 F.2d 1056, 1060 (7th Cir. 1991)—requires the ALJ “to conform 

any further proceedings on remand to the principles set forth in the appellate 

opinion unless there is a compelling reason to depart,” Wilder v. Apfel, 153 F.3d 799, 

803 (7th Cir. 1998) (quotation omitted). According to Douglass, in its July 2010 

opinion this court “already made a finding that the objective medical evidence 

supports Douglass’s pain allegations and establishes that she suffers from a myriad 

of physical and mental impairments.” (R. 17, Pl.’s Br. at 57.) She argues that in 

light of the ALJ’s decision not to reexamine the preexisting medical records on 

remand, the law of the case doctrine binds him to what she characterizes as the 

court’s finding that the objective evidence supports her allegations. 
14

 Douglass’s law of the case argument misreads both the court’s original 

decision and the scope of the doctrine itself. In the context of social security cases, 

the law of the case doctrine only applies to issues that the reviewing court fully 

decided. Key, 925 F.3d at 1061. It does not apply where an issue is left open, such 

as where the ALJ remains “free to reinterpret the evidence or to take new 

evidence.” See Wilder, 153 F.3d at 804. In its July 2010 opinion, this court left open 

the question of whether the medical evidence supports Douglass’s claim that her 

impairments are disabling. If this court had resolved that question in Douglass’s 

favor, as she now suggests, the court would have remanded the case for an award of 

benefits rather than for further proceedings. Instead, this court found the ALJ 

erred in discounting Douglass’s credibility based on a blanket statement that “the 

medical record is not wholly consistent with” her allegations, without explaining the 

nature of those inconsistencies. (A.R. 740.) This court noted that there is medical 

evidence which “supports Douglass’s pain allegations and establishes she suffers 

from a myriad of physical and mental impairments.” (Id. at 740-41.) But that 

statement reflects a matter not in dispute. The ALJ acknowledged in both of his 

decisions that Douglass has severe mental and physical impairments. (Id. at 13, 

703.) The point the court made in its original decision is that given the objective 

evidence of severe impairments, before discounting Douglass’s credibility based on 

perceived inconsistencies with the objective evidence, the ALJ was required to 

“explain why the medical evidence was inconsistent with the level of pain and 

limitation Douglass described.” (Id. at 742.) That explanation was especially 
15

important because this court found that the other reasons that the ALJ gave for his 

original credibility assessment lacked support in the record or were insufficiently 

explained. (Id. at 743-50.) The court explicitly left open the question of whether the 

medical record supports the extent of the symptoms and impairments Douglass 

describes. Nothing in this court’s decision bound the ALJ on remand to accept 

Douglass’s characterization of the limiting effects of her impairments. 

B. The ALJ’s Credibility Assessment 

 The heart of Douglass’s argument on appeal is her contention that the ALJ’s 

credibility determination is unsupported by substantial evidence. An ALJ is 

required to give specific reasons for finding that a claimant’s description of her 

symptoms lacks credibility. See Steele v. Barnhart, 290 F.3d 936, 942 (7th Cir. 

2002). But once the ALJ provides those reasons, his credibility assessment is 

entitled to particular deference and will be overturned only if it is “patently wrong.” 

Castile v. Astrue, 617 F.3d 923, 929 (7th Cir. 2010). In other words, as long as the 

credibility assessment is reasonable and supported, see Getch, 539 F.3d at 483, and 

does not ignore or mischaracterize relevant evidence, see Myles v. Astrue, 582 F.3d 

672, 676 (7th Cir. 2009), this court will not disturb it. 

 Even Douglass acknowledges that this is not a case in which the ALJ failed to 

give any reasons for discounting her credibility. In her opening brief she highlights 

twelve distinct reasons that the ALJ gave to explain why he disbelieved her 

allegations. (R. 17, Pl.’s Br. at 58-68.) Douglass instead attempts to show that each 

individual reason is either unsupported by or based on a mischaracterization of the 
16

record. (Id.) Her argument approaches the border of requiring the kind of 

“nitpicking” of the ALJ’s credibility analysis in which this court is not supposed to 

engage, see Castile, 617 F.3d at 929, but out of deference to the long road Douglass 

has traveled to reach this point in her disability proceedings, this court will address 

each contention head on. 

 Douglass first attacks the ALJ’s treatment of her testimony that her Seroquel 

prescription sometimes causes her to sleep for two to three days at a time and that 

she is sometimes so depressed she stays in bed for up to seven days at a time. The 

ALJ considered that testimony to be exaggerated, explaining that the medical 

records reflect that Douglass repeatedly denied to her health care providers that her 

medication caused any side effects and that there is no evidence in those records 

that she ever reported extended sleep patterns or prolonged depressive episodes. 

(A.R. 707.) Douglass correctly points out that the only medical records reflecting 

that she denied having medication side-effects predate her Seroquel prescription 

and therefore have no bearing on whether she is exaggerating that medication’s 

effects. But the ALJ’s credibility decision is not required to be flawless, see Berger v. 

Astrue, 516 F.3d 539, 545 (7th Cir. 2008), and he correctly found that there are no 

medical records documenting her complaints of being so depressed she would stay 

in bed for up to seven days at a time. Douglass points to records notating that she 

has “sleep problems,” fatigue, and “sleep disturbance,” and argues that this 

evidence “may corroborate” her testimony. (R. 17, Pl.’s Br. at 59-60.) But this court 

is not empowered to overturn an ALJ’s credibility determination just because the 
17

evidence is subject to differing interpretations. See Elder, 529 F.3d at 413. It is the 

ALJ’s role to interpret the evidence, id., and Douglass has not highlighted any 

record that contradicts the ALJ’s finding that she never reported the kind of 

prolonged episodes of total incapacity that she described at the hearing. 

 Next Douglass argues that the ALJ should not have viewed her descriptions 

of her past and present pain levels as being contradictory. In discounting her 

credibility, the ALJ noted that Douglass testified at one point that her back pain 

had gotten worse since July 2008, but later contradicted herself by saying that her 

average pain level from 2005 through 2009 was an eight or nine while in 2011 it 

was only a seven or eight. (A.R. 707.) The ALJ found that this contradiction made 

it harder to trust Douglass’s overall description of her pain levels. Douglass argues 

that the discrepancy in her testimony only amounts to a contradiction “in a strict 

sense,” and thus faults the ALJ for holding it against her. (R. 17, Pl.’s Br. at 61.) 

But it is up to the ALJ to weigh the importance of inconsistencies in the claimant’s 

testimony, and this court’s role is not to second-guess the balance he struck. See 

McKinzey v. Astrue, 641 F.3d 884, 889 (7th Cir. 2011). Even Douglass admits that 

she contradicted herself, and the ALJ was entitled to view that contradiction as one 

of the many reasons he gave for discrediting her testimony. 

 Douglass also argues that the ALJ should not have discredited her based on 

her testimony that she had last visited an E.R. six months before the hearing, when 

in fact her last visit occurred eleven months earlier. According to Douglass, her 

answer was just “really uncertain, vague, indefinite,” but “[d]efinitely not” 
18

dishonest. (R. 17, Pl.’s Br. at 62.) Again, Douglass wants this court to ascribe less 

weight to her error than the ALJ did, but it is not this court’s role to “reweigh the 

evidence or substitute [its] judgment for that of the ALJ’s.” See Pepper, 2013 WL 

1338123, at *8. The ALJ was entitled to view Douglass’s inability to provide 

accurate information about her treatment history as a reason to find her less 

credible overall. 

 Douglass also faults the ALJ for finding unconvincing her testimony that she 

did not seek E.R. treatment for her back pain more often because she lacked 

transportation and was too embarrassed to call an ambulance when she could not 

afford to cover its costs. Douglass challenges the ALJ’s statement that she had told 

her healthcare providers that “she can provide her own transportation,” asserting 

that there is no evidence of such reports in the record. But that statement is only 

one of the reasons the ALJ gave for disbelieving that transportation was a barrier to 

Douglass seeking E.R. treatment. The ALJ was skeptical of her testimony that 

embarrassment would prevent someone whose pain level is a ten out of ten—a state 

the ALJ had asked her to consider “the most excruciating pain imaginable,” (A.R. 

1062)—from seeking emergency care, (id. at 707). He also pointed out that 

Douglass has been able to find transportation to accomplish things like going to the 

post office, shopping, and getting various forms of government assistance. (Id.) 

Because the ALJ gave at least two supported reasons for disbelieving Douglass’s 

testimony regarding her hesitation to seek E.R. care, this court will not overturn his 

decision to discount her explanation for her failure to seek more frequent care. See 
19

Berger, 516 F.3d at 545 (noting that an ALJ’s decision need not be flawless to 

survive judicial review). 

 Turning to the ALJ’s treatment of her testimony describing her daily 

activities, Douglass argues that the ALJ should not have credited over her hearing 

testimony the answers she gave to a counselor at NCBHS who asked about her 

daily activities. (R. 17, Pl.’s Br. at 63-65.) The ALJ wrote in his decision that 

Douglass had “provided inconsistent information regarding daily activities,” noting 

that she had testified that she performs few daily activities but told a counselor at 

NCBHS that she is able to “maintain her own residence, care for her own personal 

hygiene, pay bills, cook, and drive or use public transportation.” (A.R. 707.) He also 

considered inconsistent with her description of her limited daily activities the 

evidence that she has been able to obtain for herself various other forms of 

assistance, including free eyeglasses, subsidized housing, and Wal-Mart vouchers. 

(Id.) Douglass does not now deny that there is a discrepancy between the testimony 

and the responses recorded on the form, but argues that it is the form, not her 

testimony, that the ALJ should have discounted because there is no way to know 

what specific questions the counselor asked. According to Douglass, the responses 

she gave the NCBHS counselor are of limited value because, she says, they are 

subject to differing interpretations. 

 Again, Douglass has not explained why this court should (or how it could, 

given the standard of review) credit her interpretation of the form over the ALJ’s. 

See McKinzey, 641 F.3d at 889 (noting that court’s role does not include reweighing 
20

evidence). To the extent Douglass argues that the daily activities recorded in the 

form do not equate with the ability to perform full-time work, her argument misses 

the point of the ALJ’s discussion. The ALJ did not find her able to perform light 

work because she said she can do things like shop and use the post office. Instead, 

he found that the inconsistencies between what she told her caregiver and how she 

testified at the hearing make her testimony regarding the extent of her symptoms 

harder to believe overall. (A.R. 707.) With respect to the ALJ’s comments 

regarding Douglass’s ability to obtain other benefits, it is unclear why the ALJ 

believed that securing public assistance is inconsistent with her description of her 

symptoms. There is no detail in the record to support the ALJ’s assessment of 

whether someone with Douglass’s claimed symptoms could have completed the 

steps required to access needed resources. But again, the main thrust of the ALJ’s 

assessment—that Douglass gave different descriptions of her limitations to her 

caregiver than she gave to him—is supported by the record. The reasons the ALJ 

gives for discrediting a claimant need not all be valid, as long as enough of them 

are. See, e.g., Simila, 573 F.3d at 517. 

Moving on to the question of Douglass’s compliance with prescribed 

treatment, Douglass argues that the ALJ failed to give sufficient consideration to 

the causes of her noncompliance, including her on-going financial difficulties, 

transportation problems, and the nature of her mental health problems. (R. 17, 

Pl.’s Br. at 65.) Although the ALJ mentioned evidence that Douglass had not 

consistently taken prescribed medications, his main concern with respect to her 
21

treatment compliance is the extensive evidence that she repeatedly failed to attend 

scheduled appointments. (A.R. 707-10.) In fact, the supplemental record shows 

that between 2008 and her second hearing, Douglass was discharged from mental 

health services at least twice “due to non-participation” or “lack of engagement.” 

(Id. at 853, 972.) Notes from the free pain clinic also reflect that she was a frequent 

“no show” for scheduled appointments. (Id. at 1000-02.) In contrast to the ALJ’s 

original decision where he failed to explore the reasons behind Douglass’s 

noncompliance, (see id. at 747-48), this time the ALJ acknowledged Douglass’s 

transportation difficulties, but found her explanation “without merit where she is 

capable of utilizing public transportation to obtain services” and other necessities. 

(Id. at 707.) At the hearing and in his written decision, the ALJ also expressed 

concern about Douglass’s failure to call to cancel appointments, noting that if 

transportation—rather than lack of motivation—were truly the barrier to keeping 

appointments, she could have kept her caregivers informed of that problem. (Id. at 

710.) In short, this is not a situation where the ALJ failed to explore or ignored the 

claimant’s explanation for her failure to comply with treatment. See, e.g., Shauger 

v. Astrue, 675 F.3d 690, 696 (7th Cir. 2012). The ALJ considered Douglass’s 

transportation (and inherently, her financial) difficulties, but found that barrier 

insufficient to explain the extent of her failure to attend scheduled treatment or her 

lack of diligence in calling to cancel or reschedule appointments. 

 Douglass also asserts that her noncompliance should not be a factor in the 

ALJ’s decision because “there is no reason to believe that if Douglass had been more 
22

diligent in her treatment, she would have been able to return to work.” (R. 17, Pl.’s 

Br. at 66.) But again this argument misses the mark. Douglass has pointed to no 

evidence to show that her symptoms did not improve with prescribed treatment. In 

fact the record reflects the opposite; doctors often noted that her symptoms 

improved with medication. (A.R. 869, 907-08.) The ALJ found that if Douglass’s 

depression and PTSD were as severe as she claims, she would have made a greater 

effort to attend therapy sessions, or at least would have informed her caregivers 

when she could not attend to avoid being discharged from treatment. Similarly, to 

the extent Douglass faults the ALJ for not explicitly exploring the impact her 

mental health issues have on her ability to follow through with treatment, the ALJ 

did implicitly address that point in repeatedly discussing her daily activities and 

ability to obtain other necessary benefits. (Id. at 707.) It is clear that the ALJ 

considered her capable of advocating for herself when she is motivated to do so. 

(Id.) Thus the ALJ was entitled to view Douglass’s apparent apathy toward 

treatment as one of the many reasons he gave for discounting her credibility with 

respect to the severity of her symptoms. 

 Next Douglass points out that her back pain is a chronic condition that 

improves only temporarily with pain medication and argues that accordingly, it was 

unfair for the ALJ to note that she was always discharged from E.R. visits in stable 

condition. (R. 17, Pl.’s Br. at 67.) But it is not just the discharge notes that the ALJ 

considered in finding that the E.R. records do not support Douglass’s description of 

the severity of her pain. The ALJ noted that none of the E.R. notes support a 
23

finding that she was in severe pain upon arrival. As he points out, the notes from 

her February 2009 E.R. visit reflect that while she reported a pain level of nine out 

of ten, she did not appear to be in acute distress and there were no abnormal 

findings during her examination. (Id. at 708, 841-43.) The records from her August 

2010 E.R. visit show that she arrived in only “mild distress” and the notes from her 

October 2010 E.R. visit show that she was ambulatory upon arrival and reported 

her pain level as being at six out of ten. (Id. at 710, 1005, 1010-11.) The ALJ was 

entitled to conclude, as he did here, that even on the few occasions that Douglass 

sought treatment for her back pain, the treating physicians’ observations of her 

condition do not support her claimed level of discomfort. 

 Douglass next argues that the ALJ erred in discounting her testimony based 

on her GAF score and reports that her symptoms improved over time. (R. 17, Pl.’s 

Br. at 68.) According to Douglass, the fact that she reported improvements to her 

doctors supports rather than undercuts her credibility. But the ALJ’s point in 

discussing this evidence is that she presented herself to the counselors at NCBHS 

in a different way than she described her condition to him at the hearing. He noted 

that her mood improved with therapy to make the point that if her symptoms were 

interfering with her life to the extent she claimed, she would not have “stopped 

attending without calling.” (Id. at 710.) Even if this evidence is subject to varying 

interpretations, Douglass has not demonstrated that the ALJ’s view is “patently 

wrong.” See Castile, 617 F.3d at 929. 
24

 Finally, at least with respect to the credibility determination, Douglass 

argues that because she had testified that her pain level on the day of the hearing 

was only at a four out of ten, the ALJ should not have discounted her credibility 

based on his observations of her demeanor. (R. 17, Pl.’s Br. at 61.) The Seventh 

Circuit has acknowledged that what it refers to as the “sit and squirm” test is 

problematic because a claimant can easily manipulate his or her demeanor to 

display discomfort. See Powers v. Apfel, 207 F.3d 431, 436 (7th Cir. 2000). 

Nonetheless, it has “repeatedly endorsed the role of observation in determining 

credibility.” Id. (collecting cases). Here the ALJ noted that Douglass “betrayed no 

evidence of pain or discomfort while testifying,” but he acknowledged that the 

hearing was “short-lived,” and so in assessing her credibility he gave only “some 

weight” to her lack of obvious discomfort. (A.R. 707.) This is precisely the kind of 

subjective assessment that requires substantial deference, because it is based on 

the kind of intangible elements that only the ALJ is in a position to observe. See 

Butera v. Apfel, 173 F.3d 1049, 1055 (7th Cir. 1999); see also Diaz v. Chater, 55 F.3d 

300, 308 (7th Cir. 1995). Because the ALJ’s observations are entitled to 

considerable weight, see Butera, 173 F.3d at 1055, and because the ALJ gave a 

number of supported reasons to explain his decision, his credibility assessment 

survives judicial review. 

C. The ALJ’s Treatment of Third-Party Statements 

 Douglass also challenges the ALJ’s decision not to credit letters submitted by 

her son and two friends in support of her claims. (A.R. 830-36.) As she 
25

acknowledges, the ALJ wrote that he considered those letters but found that their 

description of Douglass’s condition lacks support. (Id. at 710.) Significantly, 

Douglass has not pointed to any medical evidence in her brief that she considers 

supportive of the witness’s descriptions. (R. 17, Pl.’s Br. at 69-70.) The ALJ is not 

required to discuss in detail every bit of evidence in the record, and because he has 

sufficiently articulated his reasons for finding that Douglass’s symptoms are not as 

severe as she claims, he did not err in failing to discuss the third-party statements 

in more detail. See Books v. Chater, 91 F.3d 972, 980 (7th Cir. 1996); see also 

Limberopoulos v. Shalala, 17 F.3d 975, 979 (7th Cir. 1994) (overruled on other 

grounds) (noting that an ALJ may discredit the input of interested witnesses). 

D. Douglass’s Combination of Impairments 

 Douglass’s final argument is that the ALJ failed to consider the combination 

of her bipolar diagnoses, “complaints of dropping things,” and headaches together 

with her other symptoms in determining her RFC. Her argument is premised on 

the rule mandating that where “an applicant has several medical problems, the ALJ 

must consider her condition as a whole.” See Sienkiewicz v. Barnhart, 409 F.3d 798, 

802 (7th Cir. 2005). In other words, once the ALJ identifies a severe impairment, 

he must take into account the claimant’s “entire constellation of ailments—

including those impairments that in isolation are not severe.” Golembiewski v. 

Barnhart, 322 F.3d 912, 918 (7th Cir. 2003). But an ALJ may discharge this duty 

by noting that the claimants’ health problems are not severe enough “either singly 
26

or in combination” to be disabling and by emphasizing that he has considered all of 

the symptoms together. See Getch, 539 F.3d at 483. 

 In crafting Douglass’s RFC the ALJ explicitly said that he “has considered all 

symptoms” and that he considered the severity of her mental impairments “singly 

and in combination.” (A.R. 704-05.) The ALJ considered Douglass’s testimony 

regarding her difficulties grasping things, but found those complaints unpersuasive 

in light of her admission that she smokes cigarettes. (Id. at 703.) He noted that a 

smoker has to grasp small objects and concluded that her grasping problems are not 

as severe as she describes. (Id.) The ALJ considered her headaches but noted that 

she had not reported the problem to any healthcare provider since 2008. (Id. at 

703.) Douglass calls that a “mistake,” but pointedly, she points to no records to 

support her contention that she complained of headaches to a doctor. (R. 17, Pl.’s 

Br. at 69.) She also overlooks the ALJ’s additional statement that there is no 

objective evidence that her headaches “affect the claimant’s ability to sustain basic 

work activity.” (A.R. 703.) Again, Douglass cites no evidence to refute that 

statement. As for her bipolar diagnosis, Douglass points to no evidence showing 

how any symptoms attached to that diagnosis impact her differently than the 

diagnoses of depression and PTSD that the ALJ explicitly considered. (Id. at 703-

04.) The ALJ engaged in a detailed examination of how her mental impairments 

limit her in various areas of functioning, and Douglass makes no attempt to argue 

that this assessment would have been different using the bipolar diagnosis. As the 

government points out, the Social Security regulations treat depression and bipolar 
27

syndrome under the same category of mood disorders for purposes of evaluating 

their impact on a claimant’s ability to work. 20 C.F.R. Pt. 404, Subpt. P, App. 1 

§ 12.04. In sum, Douglass has made no attempt to argue that her non-severe 

impairments exacerbate her struggles with back pain or her mental health issues, 

despite her burden to show that the combination is disabling. See Castile, 617 F.3d 

at 927. Accordingly, this court finds no reversible error in the ALJ’s handling of the 

totality of Douglass’s impairments.

Conclusion

 For the foregoing reasons, Douglass’s motion for summary judgment is denied 

and the Commissioner’s cross-motion for summary judgment is granted. 

 ENTER:

 

 ____________________________________ 

 Young B. Kim 

 United States Magistrate Judge