IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

THERESA TALOFF, )

)

Plaintiff, )

)

v. ) No. 1:12-cv-01696

)

MICHAEL J. ASTRUE, ) Magistrate Judge Susan E. Cox

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff, Theresa Taloff, seeks judicial review of a final decision of the Commissioner of

the Social Security Administration (?SSA”) denying her application for Supplemental Security

Income and Social Security Disability Insurance benefits under the Social Security Act, 42

U.S.C. §§416(1), 423, and 1381 et seq. (“the Act”). Ms. Taloff has filed a motion for summary

judgment, seeking to reverse the Commissioner’s final decision or remand the matter for

additional proceedings. For the reasons set forth below, Ms. Taloff’s motion is granted and the

case is remanded to the SSA for further proceedings [dkt. 19].

I. PROCEDURAL HISTORY

Ms. Taloff filed a Title II application for a period of disability and disability insurance

benefits on October 12, 2007.1

 She also protectively filed a Title XVI application for

supplemental security income on September 14, 2007.2

 In each of these applications, Ms. Taloff

alleged she had been unable to work since April 1, 2007, due to fibromyalgia, arthritis of the

1

R. at 263-66, 267-76.

2

R. at 126-27.

Page 1 of 29
back, and thyroid disease.3

 Ms. Taloff also stated in her application that she could not lift or

carry anything, that she had migraines between two and three times per week, that she had back

pain, and that she could only sit or stand ?for so long.”4

 Ms. Taloff’s applications were denied

after the SSA determined that although Ms. Taloff ?may have some discomfort,” she was able to

move around sufficiently to perform light work activity.5

 On February 9, 2009, Ms. Taloff

requested a hearing before an Administrative Law Judge (“ALJ”).6 This request was granted on

January 25, 1010.7

A hearing on Ms. Taloff’s claims began on March 3, 2010; however, after discussion

with the ALJ, Ms. Taloff requested to postpone her hearing so she could obtain representation.8

On August 10, 2010, a second hearing where Ms. Taloff was represented by counsel took place

before ALJ Sylke Merchan.9

 Following the hearing, the ALJ issued an unfavorable decision.10

The Appeals Council denied Ms. Taloff’s request to review the ALJ decision on January 13,

2012,11 making the ALJ’s decision the final decision of the Commissioner. Ms. Taloff filed a

complaint in this Court on March 8, 201212

II. STATEMENT OF FACTS

The facts set forth in this section are derived from the administrative record. We begin

with an overview of Ms. Taloff’s medical conditions both before and after the alleged onset date.

We then summarize the ALJ hearing testimony and the ALJ’s decision. 

3

R. at 286, 291; see R. at 263-64, 269. 

4

R. at 291. 

5

R. at 128, 138. 

6

R. at 144-46. 

7

R. at 162.

8

R. at 117. 

9

R. at 35. 

10R. at 18-27. 

11R. at 1-5.

12Dkt. 1.

Page 2 of 29
A. Ms. Taloff’s Background and Medical Records

Ms. Taloff was born on August 7, 1959, and at the time of the ALJ’s decision she was 51

years old. Since at least 2003, she has been treated for a wide variety of medical conditions,

including: migraine headaches;13 carpal tunnel syndrome;14 back pain;15 radiculopathy in her

lower extremities;16 fibromyalgia;17 hypothyroidism;18 sleep apnea;19 stomach pain,20 and other

gastrointestinal ailments, including irritable bowel syndrome,21 dyspepsia,22 gastroesophogeal

reflux disease,23 hepatitis,24 pancreatitis,25 and hepatic cysts;26 and osteoarthritis of the left knee.27

At 5’1” tall and 248 pounds at the time of the hearing,28 Ms. Taloff had a body mass index of

47,29 rendering a condition of ?extreme obesity.”30 Here, we will briefly review the medical

conditions Ms. Taloff claims were not properly assessed by the ALJ. 

1. Migraine Headaches

It is well documented that Ms. Taloff has suffered from and been treated for migraines

since at least 2003, when she sought treatment from Armita Bijari, M.D., at Neurological Care

Specialists, S.C.31 Dr. Bijari treated Ms. Taloff for common migraine headaches and tension

13See R. at 336, 380, 776.

14R. at 767, 792.

15R. at 780.

16R. at 787, 790.

17See R. at 361, 767.

18R. at 703.

19R. at 442.

20R. at 520, 704.

21R. at 717.

22R. at 398.

23R. at 383.

24R. at 519.

25R. at 736.

26R. at 682-83.

27R. at 408.

28R. at 403.

29NHLBI, Obesity Guidelines - Body Mass Index Table 2, National Institutes of Health,

http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl2.htm (last visited Feb. 13, 2013).

30SSR02-1p (stating that BMIs greater than 40 constitute extreme obesity). 31 R. at 330, 334-58.

Page 3 of 29
headaches with a variety of different medications, and it appears that generally Ms. Taloff saw

Dr. Bijari approximately one time per month.32 Although the effect of the prescribed medications

on Ms. Taloff’s migraines varied widely,33 many if not all of them stopped working at one point

or another. For example, between August 2003 and January 2004, Ms. Taloff’s migraines

appeared to be mostly controlled by Zomig and Topamax, which reduced their frequency and

severity;34 however, by March and April of 2004 they had increased in frequency35 (although

they subdued again in May).36 This type of fluctuation continued from 2004 through 2006, with

Ms. Taloff reporting some months that she was doing well,37 and at other times that her

headaches had increased in duration and/or frequency.38 By May 2006, Dr. Bijari reported that

“Naprosyn, Elavil, Flexeril and Topamax [had] not helped” Ms Taloff.39

Although it appears from the record that Ms. Taloff stopped seeing Dr. Bijari in 2006,40

she continued to receive treatment for her migraines, and remained on medication for them.

After the alleged onset date of April 1, 2007, Ms. Taloff received additional, though limited,

treatment for her migraines.41 For example, in February and April 2008, Ms. Taloff received

follow-up treatment from Cindy Mangene, FNP for her migraines (among other issues), and was

again prescribed Zomig.42 Additionally, when Ms. Taloff was treated for generalized pain in

March 2010, she also complained of headaches.43

32 See R. at 335, 336, 361.

33 See R. at 330, 334-58.

34 R. at 353-58.

35 R. at 352-53.

36 R. at 350.

37 See R. at 335, 338-41, 344, 346, 349.

38 See R. at 330, 336-37, 342, 345, 347-48.

39 R. at 336.

40 See R. at 335, dated May 16, 2006, which appears to be the last update from Dr. Bijari. 41 See R. at 759, 777-79 (discussing Ms. Taloff’s treatment for migraines in August and September 2010). 42 R. at 380-81.

43 R. at 696.

Page 4 of 29
2. Carpal Tunnel Syndrome

Although Ms. Taloff’s carpal tunnel syndrome is not as well documented as her

migraines, references to it are scattered throughout her medical records. In December 2002, Ms.

Taloff was diagnosed with “possibly severe” bilateral carpal tunnel syndrome.44 At that time, she

reported “numbness and tingling in both hands for quite a number of years progressively

worsening.”45 Nerve conduction studies indicated “[m]ild right median nerve compression at the

wrist with a mild slowing of motor and sensory conduction and a normal needle examination,”

and “[n]ormal sensory nerve conduction studies for the left upper extremity with no evidence to

suggest median nerve compression at the wrist.”46 In August 2004, Ms. Taloff received treatment

for pain in her hands, back and feet; however, Thomas F. Morris, D.O, the treating physician,

made no note of carpal tunnel syndrome.47 After the alleged onset date, in September 2010, she

received an MRI of the bilateral wrists, which was negative;48 however, an electromyographic

and electrodiagnostic consultation showed “electrodiagnostic evidence of a moderate right

sensory motor median mononeuropathy at the wrist (carpal tunnel syndrome) with associated

denervation.”49

3. Fibromyalgia and Other Pain

In May 2003, Ms. Taloff was diagnosed with fibromyalgia by Sherine Parimanath,

M.D.50 Dr. Parimanath noted that Ms. Taloff had “multiple diffuse tender points,”51 and that she

reported “increased fatigue with concomitant weight gain and increased diffuse pain involving

44 R. at 750.

45 Id.

46 R. at 752.

47 R. at 532.

48 R. at 790.

49 R. at 792.

50 R. at 753-60.

51 R. at 758.

Page 5 of 29
her muscles and joints” for the past four years.52 Dr. Parimanath also discussed Ms. Taloff’s

sleep apnea.53 She informed Ms. Taloff that proper sleep helps improve and control symptoms of

fibromyalgia, and that she should be sure to use the continuous positive airway pressure machine

she had been prescribed to treat her sleep apnea (which she had not been using at that time

because the mask did not fit her properly54).55

Ms. Taloff was also treated at various times for pain in her feet, hands, and back. She

was treated for arthralgias and swelling in her ankles as early as September 2003,56 and in March

2003 she was treated for chronic low back pain, which she stated she had been experiencing for

about eighteen years.57 Ms. Taloff also told Dr. Morris that the pain was worse when she was at

work or doing any housework, that bending over at the waist seemed to worsen it, and that days

she had to work were “hell.”58 She was again treated for pain in March 2004 due to an injury to

her left knee,59 and in August 2004 for pain in her hands, back, and feet.60 In January 2009, Ms.

Taloff went to the emergency room, complaining of body numbness, body aches, and

“generalized pain, all over.”61 She initially ranked her pain level at 6 out of 10, but after being

prescribed Toradol, rated her pain level at 0 out of 10 by the time of her discharge.62 She was

again treated for pain in March 2010, where she rated her pain at 10 out of 10 and also

52 R. at 752.

53R. at 755.

54 Id.

55 R. at 758.

56 R. at 542.

57 R. at 550.

58 R. at 542.

59 R. at 539.

60 R. at 532.

61 R. at 507, 503.

62 R. at 508.

Page 6 of 29
complained of headaches,63 and experienced left-side abdominal pain in May 2010, when she

was diagnosed with irritable bowel syndrome.64

4. Consultative Examinations

On February 22, 2008, Ms. Taloff underwent her consultative examination with Phong T.

Dao, D.O., an examiner for the Department of Social Services Disability and Adult Programs.65

Dr. Dao noted that Ms. Taloff was able to drive to the office.66 Ms. Taloff reported that she had

“had back pain since after she gave birth to her son in 1985,” and described her lower back pain

as “an aching dull pain that worsens with prolonged standing or sitting.”67 Ms. Taloff also stated

that taking pain medication helps her back pain, and that when she is at home, “she tries to avoid

bending down to lift objects because of the back pain.”68 She also noted that she had experienced

left knee pain since 2004, which she described as “an aching pain” which worsened “with

squatting down to pick up objects or cleaning the floor.”69

Dr. Dao assessed Ms. Taloff with the following: low back pain and left knee pain due to

osteoarthritis; obesity with excess fat tissue, likely contributing to the left knee pain and low

back pain; fibromyalgia, contributing to the generalized pain throughout Ms. Taloff’s body,

especially her shoulder joints, posterior neck area, upper back, lower back, arms, knees and

buttocks; bilateral wrist pain, likely due to carpal tunnel syndrome; a history of hyperlipidemia;

and a history of Hashimoto’s thyroid disease.70 Dr. Dao’s functional assessment was that Ms.

Taloff can ?lift or carry, push or pull 20 lbs. occasionally and 10 lbs. frequently,” ?can stand or

63 R. at 696.

64 R. at 717.

65 See R. at 401-7.

66 R. at 401.

67 Id.

68 R. at 401-2.

69 R. at 402.

70R. at 406.

Page 7 of 29
walk for up to six hours in an 8-hour workday,” and ?can sit for up to six hours in an 8-hour

workday.”71 He also found that Ms. Taloff’s ?[c]limbing, stooping, kneeling and crouching

should be limited to occasionally.”72

On March 12, 2008, F. Kalmar, M.D. conducted a physical residual functional capacity

assessment of Ms. Taloff for the Social Security Administration.73 Dr. Kalmar’s findings were

nearly identical to Dr. Dao’s findings, and he stated that Ms. Taloff complained of headaches

and has had back pain, left knee pain, carpal tunnel, and fibromyalgia. He also determined that

Ms. Taloff had pain on 12 of 18 trigger points, tenderness to palpation in the back, mild disc

degeneration, early osteoarthritis, and a history of thyroid disease.74 Dr. Kalmar found that Ms.

Taloff could lift 20 pounds occasionally and 10 pounds frequently, can stand or walk for up to 6

hours in an 8-hour workday, can occasionally climb, stoop, kneel or crouch, and that her

credibility was partially supported by her conditions.75

B. The ALJ Hearing and Opinion

1. Summary of Testimony at the ALJ Hearing

Ms. Taloff’s hearing before the ALJ took place on August 10, 2010, in Orland Park,

Illinois.76 Ms. Taloff,77 her sister,78 and a vocational expert (?VE”)79 were all present and

testified. Ms. Taloff was represented and questioned by Roger Hutchinson, her attorney.80

71Id.

72Id.

73 See R. at 390-96.

74 R. at 396.

75 Id.

76R. at 35. 

77R. at 49.

78R. at 83.

79R. at 89.

80R. at 38.

Page 8 of 29
a. Ms. Taloff’s Testimony

Ms. Taloff began her testimony by discussing problems with her memory, and said when

she speaks about her medical history, she has problems explaining which doctors she saw

when.81 She stated her memory had gotten worse over the last 10-15 years.82 Mrs. Taloff next

testified that her migraines began when she gave birth to her daughter in 1986, and that she

started seeing doctors for her migraines between 2002 and 2005.83 She stated that since 2007, her

migraines had gotten worse, and that by the time of the hearing she could have three or four per

day.84 She testified that Zomig had helped to stop her migraines, but that she was currently on

Topomax, which did not work as well, because her doctor would not prescribe Zomig.85 Ms.

Taloff additionally said that she had migraines for more than half of each month, particularly

around her menstrual time.86 When she had migraines, Ms. Taloff testified that she had to stay in

bed and try to sleep because they hurt so badly.87 She also stated that she has a difficult time

concentrating when she is having a migraine, and that she cannot think or talk.88

Ms. Taloff additionally testified that she had pain all over her body from fibromyalgia,

including on her neck and her back.89 She had tested positive for arthritis, but not rheumatory

arthritis, and was on pain medication for that but not for her back pain or fibromyalgia.90 She

stated that because she has to take Synthroid on an empty stomach, but has to take her migraine

medication on a full stomach, she would often have to eat when she woke up in order to take her

81R. at 49-50.

82R. at 50.

83R. at 50-51.

84R. at 51.

85R. at 51-52.

86R. at 53.

87R. at 54.

88R. at 55.

89R. at 55-56.

90R. at 56.

Page 9 of 29
migraine medication, and forego the pain medication for her fibromyalgia.91 With regard to her

carpal tunnel syndrome, Ms. Taloff testified that she cannot write because her fingers go numb,

and that she used to cut hair but no longer can because of the numbness.92

Upon examination by the ALJ, Ms. Taloff testified that her sister and daughter did the

cooking, cleaning, and laundry at her house.93 She said that she could not hold her arms up or do

her hair because of her fibromyalgia, but that otherwise she was able to take care of her personal

needs, such as showering, brushing her teeth, and putting her clothes on.94 She testified that

unless she was seated in a ?good position,” she could not sit for very long, ?[a]t the most, maybe

10 minutes if that.”95 She was unable to guess how long she could stand in one position without

moving, but said that on some days she is able to walk down the block.96 While being questioned

by her lawyer, Ms. Taloff additionally testified that she thought she could lift one gallon of milk,

but did not think she could lift two.97 She stated that she sometimes wakes up at 4:00 a.m.

because of pain in her back, legs, neck, and colon spasms, and that even if she is not having

migraines, she feels tired and “wiped out” during the day.98 She had recently undergone physical

therapy at Oak Forest Hospital, and stated that she was also doing exercises at home, but that

they were not helping.99

Ms. Taloff additionally testified about the inflammation in her hands and feet. She said

that her feet often swell, and that it is very painful.100 She stated that when her feet swell,

91R. at 59.

92R. at 61. 

93R. at 61.

94R. at 63.

95R. at 65.

96R. at 66.

97R. at 67.

98R. at 73.

99R. at 73. 

100R. at 76.

Page 10 of 29
normally she lays down to put them up, and that helps them feel better.101 She noted that she has

told her doctors about the swelling, but that she has not been treated for it.102 Ms. Taloff also

testified that she had hand swelling due to her arthritis.103

In terms of her living situation, Ms. Taloff testified that she had moved to California for a

short period of time to live with her mother, but had returned to Illinois because her condition

had deteriorated and she needed her sister to take care of her.104 She said that she had previously

moved to California to try to help her mother, but was unable to meet her needs.105

b. Patricia Altipeter’s Testimony

Next, Ms. Taloff’s sister, Patricia Altipeter, testified.106 She testified that she saw her

sister between three and four times per week, and accompanied her to doctors’ appointments.107

She stated that she went with her sister to appointments because her sister’s memory is not very

good, and she does not always remember what the doctors tell her.108 Ms. Altipeter also testified

that because of her fibromyalgia, Ms. Taloff ?wakes up and goes to bed completely inflamed,”

and that although both she and her sister have fibromyalgia, Ms. Taloff’s is more severe.109 Ms.

Altipeter also stated that Ms. Taloff has migraines for about half of each month, and that when

she has migraines she cannot focus and most of the time would ?just rather lay down and be in a

dark place because they hurt so bad.”110 She testified that she had noticed her sister get ?[m]uch

101R. at 76.

102R. at 77.

103R. at 77. 

104R. at 81.

105R. at 81-82.

106R. at 83.

107R. at 84.

108R. at 84-85.

109R. at 85.

110R. at 87.

Page 11 of 29
worse” over the last couple of years.111 Ms. Altipeter also noted that her sister was not taking

medication for her fibromyalgia because she did not have insurance.112

c. VE’s Testimony

Lastly, the VE testified.113 She had reviewed Ms. Taloff’s past relevant work, from 1995

through the date of the hearing, and stated that Ms. Taloff had previously worked a ?combination

billing clerk and collections clerk,” and as a telemarketer, and that both are sedentary

positions.114 She stated that a hypothetical person of Ms. Taloff’s age, education and work

experience, who was able to do work at the light exertional level but was limited to sedentary

work with only occasional postural limitations, and unable to use ladders, ropes or scaffolds may

be able perform her past relevant work.115 She elaborated that if there was a sit/stand option, it

was important that the person be able to stay on task while standing, stating ?[t]hat’s the key. If

they can remain on task, stay on the phone, type, take notation, do documentation, file, whatever

is required and they’re not off task while standing, then they could do the past relevant work.”116

When asked if in her experience, a billing clerk, collections clerk or telemarketer could remain

on task while standing, the VE responded that “[i]t depends on how long they have to stand, and

it depends on if they’re off task, because you can stand while talking on the phone.”117

However, the VE additionally testified that if this hypothetical person would have to be

off work at least three days per month due to symptoms from their impairments or side effects

from the individual’s medications, ?[t]here would be no work that would be full-time

111R. at 89.

112 R. at 87.

113R. at 89.

114R. at 91.

115R. at 93-94.

116R. at 93.

117R. at 94.

Page 12 of 29
competitive work.”118 She also stated that if the person could only use his or her hands on an

occasional basis, that would preclude past relevant work, and ?substantially erode the

occupational base,” and that if the person were off task for more than fifteen percent of the day,

that would preclude past relevant work and all other jobs.119

2. ALJ’s Decision 

In an opinion issued October 28, 2010, the ALJ concluded that Ms. Taloff had not been

disabled from April 1, 2007 until the date of the decision within the meaning of the Act, both in

terms of a period of disability and disability insurance benefits, and supplemental security

income.120 The ALJ concluded that although Ms. Taloff had the severe impairments of obesity,

fibromyalgia, thyroid disease, lumbar degenerative disc disease, sleep apnea, and carpal tunnel

syndrome,121 she had the residual functional capacity (“RFC”) to perform sedentary work with

certain restrictions,122 and was capable of performing past relevant work.123

SSA regulations prescribe a five-step sequential evaluation process for determining

whether an individual is disabled.124 The steps are followed in order, and if it is determined that

the claimant is or is not disabled at any step, the evaluation does not go on to the next step. The

ALJ’s first step is to determine whether the claimant is presently engaged in substantive gainful

activity, which would preclude a finding of disability.125 In the present case, the ALJ determined

that Ms. Taloff had not engaged in substantial gainful activity since April 1, 2007, the alleged

118R. at 95.

119R. at 95, 97. 

120R. at 26-27.

121R. at 20.

122R. at 21.

123R. at 26.

12420 C.F.R. §§ 404.1520(a), 416.920(a). 

12520 C.F.R. §§404.1520(b), 416.920(b).

Page 13 of 29
onset date.126 The second step is for the ALJ to consider whether the claimant has a severe

impairment or combination of impairments.127 In this case, the ALJ found that Ms. Taloff has the

following severe impairments: obesity, fibromyalgia, thyroid disease, lumbar degenerative disc

disease, sleep apnea, and carpal tunnel syndrome.128

The ALJ’s third step is to consider whether the claimant’s impairment or combination of

impairments meets or medically equals any impairment listed in the regulations as being so

severe as to preclude gainful activity.129 In the present case, the ALJ determined that Ms.

Taloff’s impairments did not meet or medically equal a listed impairment under 20 C.F.R. Part

303, Subpart P, Appendix 1.130 She considered Ms. Taloff’s lumbar degenerative disc disease

under section 1.04 of the Listing (Disorders of the Spine), and determined that Ms. Taloff had

not established all of the required criteria, and particularly had ?not established a disorder of the

spine resulting in compromise of a nerve root or spinal cord with evidence or nerve root

compression accompanied by sensory or reflex loss and positive straight-leg raising.”131

The ALJ next considered Ms. Taloff’s carpal tunnel syndrome and degenerative joint

disease under section 1.02 of the Listing (Major Dysfunction of a Joint), finding that Ms. Taloff

had ?not established a major dysfunction of a joint resulting in an inability to ambulate or

perform fine and gross movements effectively.132 The ALJ additionally considered Ms. Taloff’s

sleep apnea under section 3.10 (Sleep-Related Breathing Disorders), and found that Ms. Taloff

did ?not have cor pulmonale, and [had] not established” any of the listing criteria.133 Finally, the

126R. at 20.

12720 C.F.R. §§ 404.1520(c), 416.920(c).

128R. at 20.

12920 C.F.R. §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925, 416.926. 

130R. at 20-21.

131R. at 20.

132R. at 21.

133Id. 

Page 14 of 29
ALJ considered Ms. Taloff’s thyroid disorder under section 9.02 of the Listing (Thyroid

Disorders), and found that Ms. Taloff had ?not established the criteria for any other body

system.”134

In the event that no impairments are found to meet SSA listing requirements, the ALJ

proceeds to the fourth step of the test, which is to determine whether the claimant is able to

perform her past relevant work.135 This involves evaluating the claimant’s RFC based on the

record and her testimony, and comparing it to the requirements of her past work.136 If

determining the claimant’s RFC requires the ALJ to assess subjective complaints, then she

follows a two-step process.137 First, she determines whether there is an underlying medically

determinable impairment, determinable by medically acceptable clinical and laboratory

diagnostic techniques that could reasonably be expected to produce the claimant’s symptoms.138

If so, the ALJ then evaluates the intensity, persistence, and limiting effects of a claimant’s

symptoms on her ability to do basic work activities.139 If, after this process, the ALJ determines

that the claimant’s RFC makes her able to perform her past work, she is not found to be

disabled.140

In the present case, the ALJ found that Ms. Taloff had the RFC ?to perform sedentary

work” as defined in 20 C.F.R. Section 404, Part 1567, Subpart A and Section 416, Part 967,

Subpart A, except that Ms. Taloff ?should never climb ladders, ropes, or scaffolds, and only

occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl.”141 In terms of Ms.

134Id.

13520 C.F.R. § 404.1520(a)(4)(iii).

136Id. 

137Id. § 1529. 

13820 C.F.R. § 404.1529(b). 

139Id. § 404.1529(c).

140Id. § 404.1520(a)(4)(iv).

141R. At 21.

Page 15 of 29
Taloff’s subjective complaints, although the ALJ found that her ?medically determinable

impairments could reasonably be expected to cause the alleged symptoms,” she also found that

Ms. Taloff’s statements ?concerning the intensity, persistence and limiting effects of these

symptoms are not credible to the extent they are inconsistent” with her RFC assessment.142

In assessing Ms. Taloff’s credibility, the ALJ relied heavily on her ability to engage in

daily activities.143 The ALJ specifically noted that Ms. Taloff ?reported that she could do light

chores such as light laundry and cleaning . . . assists her elderly mother with care, cooks, and

does light housework.”144 She additionally noted that Ms. Taloff ?drives and goes grocery

shopping, and spends time in the community pool and hot tub.”145 The ALJ also recognized Ms.

Taloff’s testimony ?that her daughter and sister clean and cook, and that she is unable to lift her

arms to care for her hair.”146 On that basis, the ALJ determined that Ms. Taloff’s ?reported

activities of daily living are not inconsistent with” her RFC assessment.147

The ALJ also found that the objective evidence of record did not support the extent and

severity of Ms. Taloff’s subjective complaints.148 In this assessment, the ALJ stated that although

fibromyalgia had been documented since the alleged onset date, it was not clear as to the

severity.149 Additionally, the ALJ stated that Ms. Taloff had ?received only limited treatment for

her carpal tunnel syndrome and back pain” since the alleged onset date, ?generally presented

with transient complaints or whole body pain,” and had only received additional treatment for

142R. At 22.

143See R. At 24.

144Id.

145Id.

146Id.

147Id.

148Id.

149Id.

Page 16 of 29
pain in August 2010.150 While noting additional treatments Ms. Taloff had undergone, the ALJ

nonetheless did not include any additional manipulative limitations, stating ?the record does not

establish limitations in grip strength, and the claimant exhibited 5/5 strength in all extremities on

consultative examination. Moreover, the claimant reported that she is able to read, cook, perform

some light household chores, and grocery shop, all of which would require the use of her

hands.”151

With regard to opinion evidence, the ALJ noted that she gave great weight to the

opinions of the State agency physicians and the consultative examiner, because their opinions

were ?consistent with the evidence of record that was before them at the time.”152 However, she

found that evidence submitted after the date of the state examinations further limited Ms. Taloff

and, therefore, limited her to sedentary work with occasional postural limitations.153 The ALJ

also discredited Ms. Taloff’s headache RFC questionnaire,154 because it was unclear whether the

person who completed the form was a physician, and the individual who signed the form had

only treated Ms. Taloff twice in three months before completing it.155 Additionally, the ALJ

stated that Ms. Taloff ?has received only limited treatment for headaches,” and that although Ms.

Taloff has received ?frequent treatment for headaches prior to her alleged onset date . . . these

were generally controlled on medication.”156

The ALJ also took note that a physician had ?opined that the claimant had an impairment

that limited her ability to perform full-time work from February 2, 2008 through August 1,

150R. at 25.

151Id.

152Id.

153Id.

154R. at 770-75

155R. at 25.

156Id.

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2008.”157 However, the ALJ then went on to state that ?[t]his opinion [was] based simply on her

diagnosis of fibromyalgia,” and there was ?no explanation as to why the claimant could not

perform full time work, or what her function-by-function limitations were.”158 She gave this

opinion little weight.159

The ALJ additionally determined that Ms. Taloff was ?capable of performing past

relevant work as a billing clerk, collections clerk, and telemarketer,” and that this work did ?not

require the performance of work related activities precluded by” Ms. Taloff’s RFC.160 The ALJ

additionally noted that each of these jobs were sedentary, with specific vocational preparations

between 3 and 5.161 In comparing Ms. Taloff’s RFC ?with the physical and mental demands of

this work,” the ALJ found that Ms. Taloff was ?able to perform it as actually and generally

performed.”162 Because the ALJ found that Ms. Taloff could perform her past relevant work, she

did not proceed to the fifth step of the analysis.

III. STANDARD OF REVIEW

This Court must sustain the Commissioner’s findings of fact if they are supported by

substantial evidence and are free of legal error.163 Substantial evidence is “such relevant evidence

as a reasonable mind might accept as adequate to support a conclusion.”164 To be supported by

substantial evidence, the findings must be such that a reasonable mind might accept them as

adequate to support the conclusion.165 The standard of review is deferential, but the reviewing

157Id; see R. at 421.

158R. at 25.

159R. at 26.

160Id.

161Id.

162Id.

16342 U.S.C. § 405(g); Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir. 2002).

164Scheck v. Barnhart, 357 F.3d 697, 699 (7th Cir. 2004); Kepple v. Massanari, 268 F.3d 513, 516 (7th Cir.

2001).

165Zurawski v. Halter, 245 F.3d 881 (7th Cir. 2001); Richardson v. Perales, 402 U.S. 389, 401 (1971).

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court must conduct a critical review, considering both evidence that supports and evidence that

detracts from the Commissioner’s decision.166 Where conflicting evidence allows reasonable

minds to differ, the responsibility for determining whether a plaintiff is disabled falls upon the

Commissioner, not the court.167 Although the ALJ need not address every piece of evidence or

testimony presented, she must adequately discuss the issues and build an accurate and logical

bridge from the evidence to the conclusion.168 The court will conduct a critical review of the

evidence, and will not uphold the ALJ’s decision if it lacks evidentiary support or an adequate

discussion of the issues.169

IV. ANALYSIS

Ms. Taloff argues that the ALJ erred: (1) when she failed to properly analyze Ms.

Taloff’s migraines and failed to explain why no limitations from migraines were established;170

(2) when she found that Ms. Taloff’s carpal tunnel syndrome was a severe impairment but failed

to include any limits affecting her hands in her RFC analysis;171 (3) by failing to consider the

effects of the combination of Ms. Taloff’s impairments;172 and (4) by not analyzing Ms. Taloff’s

pain as required by SSR 96-7p.173 Though we only find error with respect to the analysis of Ms.

Taloff’s migraines, we briefly review all of Ms. Taloff’s arguments.

166Eichstadt v. Astrue, 534 F.3d 663, 665 (7th Cir. 2008).

167Herr v. Sullivan, 912 F.2d 178, 181 (7th Cir. 1990); quoting Walker v. Bowen, 834 F.2d 635, 640 (7th

Cir. 1987).

168Jones v. Astrue, 623 F.3d 1155, 1160 (7th Cir. 2010); Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008).

169Clifford v. Apfel, 227 F.3d 863, 839 (7th Cir. 2000).

170Dkt. 18 at 6-9.

171Id. at 9-12.

172Id. at 12-17.

173Id. at 18-19.

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A. Migraine Headaches

Despite extensive evidence in the record regarding the fluctuating severity of Ms.

Taloff’s migraines going back to 2003, the ALJ minimally disposed of the issue, stating in

relevant part:

I give little weight to the headache Residual Functional Capacity Questionnaire at

Exhibit 30F as it is not supported by the record. It is unclear whether the person

completing this form is a physician, and this individual had treated the claimant

only twice in three months before completing this form. At the claimant’s initial

complaints, she reported many complaints, however headaches were not reported.

At a follow-up in June 2010, the claimant did report headaches, however the

frequency and intensity were not noted. Most recently, the claimant has received

only limited treatment for headaches. The claimant did receive frequent treatment

for headaches prior to her alleged onset date, but these were generally controlled

on medication.174

Although the ALJ was “not required to mention every piece of evidence” in the record, she was

required to ?provide <an accurate and logical bridge’ between the evidence and the conclusion” to

allow this Court to provide Ms. Taloff a “meaningful judicial review.”175 Despite the ALJ’s

statement that Ms. Taloff’s migraines were ?generally controlled on medication,” she did not

address the evidence in the record showing a fluctuation in the severity of Ms. Taloff’s

migraines going back to 2003. Ms. Taloff’s migraines were apparently severe enough for her to

seek treatment from Dr. Birjari, a neurologist, and yet the ALJ did not note that Dr. Birjari 

reported several times that various medications failed to reduce the severity or frequency of Ms.

Taloff’s headaches.176 In fact, Ms. Taloff sought additional treatment for her migraines since the

onset date, including medication refills,177 generalized treatment,178 and treatment at an

174R. at 25 (internal citations omitted).

175 Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008) (quoting Young v. Barnhart, 362 F.3d 995, 1002 (7th

Cir. 2004)).

176R. at 336.

177 R. at 380-81.

178 R. at 696.

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emergency room.179 At the hearing before the ALJ, Ms. Taloff testified that her migraines had

been getting progressively worse, and that by the date of the hearing she often experienced three

or four each day,180 and suffered from migraines for more than half of each month.181 She also

stated that when she was suffering from migraines, she would have to lay down in a dark

room.182 All of this testimony was corroborated by Ms. Taloff’s sister, Ms. Alitpeter, who

testified that Ms. Taloff suffered from migraines for half of each month,183 frequently woke up

with migraines and would have to go back to bed,184 and that when Ms. Taloff was suffering

from a migraine, she was unable to focus and wanted to lay down in a dark room.185

The ALJ’s statement that Ms. Taloff’s migraines ?were generally controlled on

medication” failed to take the full record and the testimony from Ms. Taloff’s hearing into

account. An ALJ is ?required to evaluate whether [a claimant’s] statements about the intensity

and persistence of his pain [are] consistent with the available evidence,”186 and ?an ALJ may not

disregard a claimant’s testimony about the severity of her symptoms without providing careful

analysis.”187 In this case, the only analysis the ALJ provided of Ms. Taloff’s testimony was with

regard to her daily activities.188 The ALJ provided no assessment of Ms. Taloff’s or Ms.

Altipeter’s testimony, and no discussion of Ms. Taloff’s prior substantial treatment for migraines

179 R. at 776-77.

180R. at 51

181R. at 53.

182R. at 54.

183R. at 87.

184Id.

185R. at 88. 

186Briscoe v. Barnhart, 425 F.3d 345, 354 (7th Cir. Ill. 2005).

187Phillips v. Astrue, 601 F. Supp. 2D 1020, 130 (N.D. Ill. 2009) (citing Briscoe, 425 F.3d at 353-55).

188 See R. at 24.

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by Dr. Birjari. Although it is possible that the ALJ could have found, based on the record, that

Ms. Taloff’s testimony was not credible, she was required to weigh the evidence and discuss

why she came to this finding.189 From this analysis, the Court is unable to determine whether the

ALJ considered the record as a whole.190

B. Carpal Tunnel Syndrome

The ALJ determined that Ms. Taloff’s carpal tunnel syndrome was a severe impairment,

but did not include any limitations on Ms. Taloff’s use of her hands.191 However, a severe

limitation does not necessary require any limitations,192 and in this case the ALJ’s discussion of

why she did not include any limitations is sufficient. Although the guidelines for evaluating a

disability state that a severe impairment ?significantly limits [a person’s] physical or mental

ability to do basic work activities,”193 simply having a severe impairment is not determinative of

whether limitations exist in that circumstance. 

In addition to finding that Ms. Taloff had “received only limited treatment for her carpal

tunnel syndrome” since the alleged onset date,194 the ALJ also stated the following:

An electromyographic and electrodiagnostic consultation revealed

electrodiagnostic evidence of a moderate right sensory motor median

mononeuropathy at the wrist (carpal tunnel syndrome) with associated

189 See Zurawski v. Halter, 245 F.3d 881, 887-88 (7th Cir. 2001)(finding that An ALJ must not ignore

entire lines of evidence that are contrary to her findings, and must at least minimally articulate her analysis of the

evidence in order to produce an informed review). 190Zurawski, 245 F.3d at 889 (?[w]hile we have never required an ALJ to address every piece of evidence or

testimony in the record, the ALJ’s analysis must provide some glimpse into the reasoning behind her decision to

deny benefits.”). 191 R. at 20.

192See 20 C.F.R. § 404.1520(c) - (e) (if a claimant has a severe impairment that does not meet the listing

requirements, it is up to the ALJ to determine whether any limitations exist). 19320 C.F.R. § 404.1520(c).

194R. at 25.

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denervation. However, I do not include any additional manipulative limitations as

they are not supported by the record. The record does not establish limitations in

grip strength, and the claimant exhibited 5/5 strength in all extremities on

consultative examination. Moreover, the claimant reported that she is able to read,

cook, perform some light household chores, and grocery shop, all of which would

require the use of her hands.195

It is true that the ALJ did not explicitly take note of Ms. Taloff’s testimony regarding limitations

of the use of her hands, such as being unable to write196; however, explicit discussion of every

piece of evidence in the record is not required for an ALJ’s determination to stand.197

An ALJ “must provide particular reasons for discrediting . . . testimony concerning the

severity, persistence, and limiting effect of her symptoms.”198 Here, the ALJ satisfied this

requirement. In describing her reasoning for finding no additional limitations, the ALJ cited to

several pieces of the record, including Ms. Taloff’s consultative examination, where Dr. Dao

found that Ms. Taloff did not exhibit any signs of limitations.199 She also cited to Ms. Taloff’s

own testimony regarding her daily activities, which supported her determination.200 This is

sufficient to build a logical bridge between the record and the ALJ’s finding of no limitations

related to carpal tunnel syndrome.

C. Ms. Taloff’s credibility

Ms. Taloff has been treated for both full-body and localized pain,201 and has been

195Id. (internal citations omitted).

196R. at 61.

197See Clifford v. Apfel, 227 F.3d 863, 872 (7thCir. 2000).

198Phillips, 601 F. Supp. at 1020. 199R. at 25.

200Id.

201R. at 55-56, 65, 68, 402, 406, 507, 520, 704, 766-67, 780.

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diagnosed with fibromyalgia,202 irritable bowel syndrome,203 degenerative disc disease,204

osteoarthritis of the knee,205 carpal tunnel syndrome,206 and migraines.207 These were recognized

by the ALJ in her decision.208 After a physical impairment “that could reasonably be expected to

produce the individual's pain or other symptoms has been shown, the adjudicator must evaluate

the intensity, persistence, and limiting effects of the individual's symptoms to determine the

extent to which the symptoms limit the individual's ability to do basic work activities.”209 When

the claimant’s statements regarding the “intensity, persistence, or functionally limiting effects of

pain or other symptoms are not substantiated by objective medical evidence, the adjudicator

must make a finding on the credibility of the individual’s statements based on a consideration of

the entire case record.”210 An ALJ is required to provide a detailed analysis of how she

determines whether a claimant’s allegations of pain are credible.211 The ALJ must ?carefully

evaluate all evidence bearing on the severity of pain and give specific reasons for discounting a

claimant's testimony about it” when making her decision.212

202R. at 361.

203R. at 717.

204R. at 787.

205R. at 402.

206R. at 792.

207R. at 776.

208See R. at 20-25. 

209 SSR 96-7p. 210 Id.

211Steele,290 F.3d at 942; Zurawski, 245 F.3d at 887. 

212Martinez v. Astrue, 630 F.3d 693, 697 (7th Cir. 2011) (citing Social Security Administration, "How We

Evaluate Symptoms, Including Pain," 20 C.F.R. § 404.1529; "Policy Interpretation Ruling Titles II and XVI:

Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an Individual's Statements," Social

Security Ruling 96-7p, 1996 SSR LEXIS 4; Lopez v. Barnhart, 336 F.3d 535 (7th Cir. 2003) (per curiam);

Lingenfelter v. Astrue, 504 F.3d 1028, 1035-38 (9th Cir. 2007); Patrice Rusconi et al., "Taking into Account the

Observers' Uncertainty: A Graduated Approach to the Credibility of the Patient's Evaluation," 33 J. Behav. Med. 60,

68 (2010)).

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The analysis here could be more specific because it does not state why any of Ms.

Taloff’s representations are discredited; rather, it merely states that Ms. Taloff’s “reported

activities of daily living are not inconsistent with” the ALJ’s RFC assessment.213 The Seventh

Circuit also requires that a judge “consider the difference between a person’s being able to

engage in sporadic physical activities and her being able to work eight hours a day five

consecutive days of the week.”214 If Ms. Taloff’s pain allegations are not supported by the

record, such analysis must be explicit.215 An ALJ ?must consider a claimant's subjective

complaint of pain if supported by medical signs and findings.”216 And even if a claimant’s

complaint is not fully supported by objective medical evidence, the ALJ must nonetheless

?investigate all avenues presented that relate to pain, including claimant's prior work record

information and observations by treating physicians, examining physicians, and third parties.”217

Here, the ALJ noted that Ms. Taloff’s testimony included that she does light chores and

housework, drives, goes grocery shopping, and spends time in the community pool and hot

tub.218 The ALJ also referenced Ms. Taloff’s testimony that her sister and daughter do the

cleaning and cooking, and that she is not able to lift her arms to style her hair.219 Then the ALJ

determined that this testimony was “not inconsistent with” her RFC assessment.220 Though this

213 R. at 24.

214 Carradine v. Barnhart, 360 F.3d 751, 755-57 (7th Cir. 2004).

215 Id.

216Clifford v. Apfel, 227 F.3d 863, 871 (7th Cir. 2000) (citing Scivally v. Sullivan, 966 F.2d 1070, 1077 (7th

Cir. 1992); 20 C.F.R. § 404.1529).

217Clifford, 227 F.3d at 871-72 (citing Luna v. Shalala, 22 F.3d 687, 691 (7th Cir. 1994)). This should

include an analysis of factors such as the nature and intensity of the pain, potentially aggravating factors, dosage and

effectiveness of pain medication, other treatment for pain relief, functional restrictions, and daily activities. Id.

218 R. at 24.

219 Id.

220 Id.

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may be sufficient, it would be prudent for the ALJ to more fully explain how she considered Ms.

Taloff’s claims that she had significant pain that worsened with prolonged sitting or standing,

tried to avoid bending down to lift objects because of the pain, and that she did not do much

housework.221 Or that Ms. Taloff expressed that cooking was difficult, and that holding a cup of

water makes her hands hurt and feel weak.222

The ALJ further noted that Ms. Taloff was only taking pain medication for her arthritis

and not fibromyalgia;223 however, she did not reference Ms. Altipeter’s testimony that she was

not taking additional medication for her fibromyalgia and related pain because she did not have

health insurance.224 This avenue, unexplored by the ALJ, could provide not only the reason that

Ms. Taloff was not taking medication for her fibromyalgia, but also why she had not received

significant recent treatment for her migraines or carpal tunnel syndrome. A claimant’s inability

to pay for treatment should be considered when determining credibility.225

Finally, we acknowledge that the ALJ stated that “the objective evidence of record [did]

not support the extent and severity” of Ms. Taloff’s subjective complaints.226 But the ALJ’s

opinion merely states that, although “fibromyalgia [had] been documented since the alleged

onset date, it [was] not clear as to the severity.”227 There was no further discussion of Ms.

Taloff’s fibromyalgia or pain allegations, except where the ALJ discredits the opinion of a

221 R. at 401-2.

222 R. at 402.

223 R. at 22.

224 R. at 87.

225 See Alesia v. Astrue, 789 F. Supp. 2d 921, 934 (N.D. Ill. 2011) (holding that “[t]he ALJ erred by

drawing negative inferences from the lack of treatment without first addressing Claimant's ability to pay”). 226 R. at 24.

227 Id.

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physician who opined that Ms. Taloff “had an impairment that limited her ability to perform fulltime work. . . .”228 This may benefit from further review. 

D. Full combination of Ms. Taloff’s impairments

The ALJ noted that Ms. Taloff had the following severe impairments: obesity,

fibromyalgia, thyroid disease, lumbar degenerative disc disease, sleep apnea, and carpal tunnel

syndrome.229 But there was no analysis of how these impairments, while not debilitating on their

own, might work together to create a disability. After an ALJ determines that a claimants

impairments are ?severe,” she must ?consider the aggregate effect of this entire constellation of

ailments--including those impairments that in isolation are not severe.”230 ?In determining an

individual’s RFC, the ALJ must evaluate all limitations that arise from medically determinable

impairments, even those that are not severe, and may not dismiss a line of evidence contrary to

the ruling.”231 This rule has best been applied in the context of arthritis, where the Seventh

Circuit found that ?[e]ven if [claimant’s] arthritis was not particularly serious in itself, it would

interact with her obesity to make standing for two hours at a time more painful than it would be

for a person who was either as obese as she or as arthritis as she but not both.”232

228 See R. at 25 (discrediting the doctor’s opinion because it was “based simply on her diagnosis of

fibromyalgia, and there [was] no explanation as to why the claimant could not perform full time work, or what her

function-by-function limitations were”). 229R. at 20.

230Golembiewski v. Barnhart, 322 F.3d 912, 917 (7th Cir. 2003) (quoting 20 C.F.R. § 404.1523; Sims v.

Barnhart, 309 F.3d 424, 432 (7thCir. 2002); Green v. Apfel, 204 F.3d 780, 782 (7th Cir. 2000); Cunningham v.

Apfel, 222 F.2d 296, 501 (8th Cir. 2000)) (emphasis in original). See also Gentle v. Barnhart, 430 F.3d 865, 868 (7th

Cir. 2005) (ordering remand where the ALJ ?failed to consider [the claimant’s] disabilities in combination, as the

cases require”) (internal citations omitted). 231Villano v. Astrue, 556 F.3d 558, 563 (7th Cir. 2009). See also Barrett v. Barnhart, 355 F.3d 1065, 1068

(7th Cir. 2004) (an ALJ is required ?to consider the applicant’s medical situation as a whole”). 232Barrett, 355 F.3d at 1068.

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The Commissioner supports the ALJ’s finding by citing to an unpublished case from the

Sixth Circuit,233 Essary v. Commissioner of Social Security, where the court found that the

claimant failed to present evidence of functional limitations due to obesity.234 There, the ALJ

was not required to consider any additional limitations.235 But the Seventh Circuit does not

require that a claimant present evidence of functional limitations due to obesity for it to be a

relevant factor (although it has determined that an ALJ’s failure to explicitly address a

claimant’s obesity may be harmless error where it is factored indirectly into her decision).236

Here, because the ALJ determined that Ms. Taloff suffers from the severe impairment of

obesity,237 the ALJ may want to more specifically note the “‘functional limitations resulting from

the obesity,’” in conjunction with her other impairments.238 Though we acknowledge that this

may be unnecessary “when the RFC is based on limitations identified by doctors who

specifically noted obesity as a contributing factor....”239

233 Dkt. 23, at 7.

234114 F. App’x 662, 667 (6th Cir. 2004). 235Id.

236Prochaska v. Barnhart, 454 F.3d 731, 736 (7th Cir. 2006).

237R. at 20.

238See Pepper v. Colvin, 2013 WL 1338123, *11 (7th Cir. 2013)(citing SSR 02-01p); see also Villano, 556

F.3d at 562; see also Barrett, 355 F.3d at 1068. 

239Pepper, 2013 WL 1338123 at *11. 

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V. CONCLUSION

For the reasons set forth above, Ms. Taloff’s motion for summary judgment is granted

[dkt. 19] and the case is remanded to the SSA for proceedings consistent with this opinion.

IT IS SO ORDERED.

Date: April 11, 2013 ___________________

Susan E. Cox 

U.S. Magistrate Judge 

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