IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

PATRICIA BRINKMAN )

)

 Plaintiff, )

) Case No. 12 C 1397

)

v. ) Magistrate Judge Daniel G. Martin

)

MICHAEL J. ASTRUE )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Patricia Brinkman ("Plaintiff" or "Brinkman") seeks judicial review of a final

decision of Defendant Michael J. Astrue, the Commissioner of Social Security

("Commissioner"). The Commissioner denied Plaintiff's application for Disability Insurance

Benefits ("DIB") and Supplemental Security Income Benefits ("SSI") under Title II of the

Social SecurityAct, and Brinkman filed a Motion for Summary Judgment. The parties have

consented to have this Court conduct all proceedings in this case, including an entry of

final judgment. 28 U.S.C. § 636(e); N.D. Ill. R. 73.1(c). For the reasons stated below,

Plaintiff's motion is denied.

I. Legal Standard

A. The Social Security Administration Standard

In order to qualify for DIB, a claimant must demonstrate that he is disabled. An

individual does so by showing that he cannot "engage in any substantial gainful activity by

reason of any medically determinable physical or mental impairment which can be

expected to result in death or which has lasted or can be expected to last for a continuous

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period of not less than 12 months." 42 U.S.C. § 4243(d)(1)(A). Gainful activity is defined

as "the kind of work usually done for pay or profit, whether or not a profit is realized." 20

C.F.R. § 404.1572(b). 

The Social Security Administration ("SSA") applies a five-step analysis to disability

claims. See 20 C.F.R. § 404.1520. The SSA first considers whether the claimant has

engaged in substantial gainful activity during the claimed period of disability. 20 C.F.R. §

404.1520(a)(4)(i). It then determines at Step 2 whether the claimant's physical or mental

impairment is severe and meets the twelve-month durational requirement noted above. 

20 C.F.R. § 404.1520(a)(4)(ii). At Step 3, the SSA compares the impairment (or

combination of impairments) found at Step 2 to a list of impairments identified in the

regulations ("the Listings"). The specific criteria that must be met to satisfy a Listing are

described in Appendix 1 of the regulations. See 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the

claimant's impairments meet or "medically equal" a Listing, the individual is considered to

be disabled, and the analysis concludes; if a Listing is not met, the analysis proceeds to

Step 4. 20 C.F.R. § 404.1520(a)(4)(iii). 

Before addressing the fourth step, the SSA must assess a claimant's residual

functional capacity ("RFC"), which defines his exertional and non-exertional capacity to

work. The SSA then determines at the fourth step whether the claimant is able to engage

in any of his past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). If the claimant can do so,

he is not disabled. Id. If the claimant cannot undertake past work, the SSA proceeds to

Step 5 to determine whether a substantial number of jobs exist that the claimant can

perform in light of his RFC, age, education, and work experience. An individual is not

disabled if he can do work that is available under this standard. 20 C.F.R. §

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404.1520(a)(4)(v). 

B. Standard of Review

A claimant who is found to be "not disabled" may challenge the Commissioner's final

decision in federal court. Judicial review of an ALJ's decision is governed by 42 U.S.C. §

405(g), which provides that "[t]he findings of the Commissioner of Social Security as to any

fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C. § 405(g). 

Substantial evidence is "such evidence as a reasonable mind might accept as adequate

to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). A court

reviews the entire record, but it does not displace the ALJ's judgment by reweighing the

facts or by making independent credibility determinations. Elder v. Astrue, 529 F.3d 408,

413 (7th Cir. 2008). Instead, the court looks at whether the ALJ articulated an "accurate

and logical bridge" from the evidence to her conclusions. Craft v. Astrue, 539 F.3d 668,

673 (7th Cir. 2008). This requirement is designed to allow a reviewing court to "assess the

validity of the agency's ultimate findings and afford a claimant meaningful judicial review." 

Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002). Thus, even if reasonable minds could

differ as to whether the claimant is disabled, courts will affirm a decision if the ALJ's opinion

is adequately explained and supported by substantial evidence. Elder, 529 F.3d at 413

(citation omitted). 

II. Background Facts

A. Medical History

Brinkman was diagnosed with discoid lupus erthyematosus ("DLE") as early as June

1993, when cutaneous rashes were noticed on her face and hands. (R. 395). DLE "is a

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set of skin changes that can occur as part of lupus, with or without systemic involvement."

The Merck Manual 269 (18th ed., 2006). The record is unclear on what treatment steps

she took after her 1993 diagnosis other than taking an oral steroid to alleviate her rashes. 

A treatment note dated April 21, 1999 states that Brinkman had been encouraged to see

a specialist for her condition, but the record is not clear whether she did so at that time. 

(R. 377). By March 2002, treating physician Dr. Evan Geissler noted that Brinkman had

lupus sun rashes and advised her to wear a protective sunscreen. (R. 373). 

A treatment note in October 2005 by Dr. Kevin Joyce states that Brinkman had

consulted two rheumatologists about her lupus and had been treated with courses of oral

corticosteroids and topical creams. (R. 299). Dr. Joyce, who was seeing Brinkman due

to swelling in her legs, stated that it was "possible" that her lupus had become systemic. 

However, little evidence supported a finding of "active lupus" at that time. (R. 300-01). 

Nevertheless, Dr. Joyce ordered two antibody tests that are used to diagnose lupus, an

antinuclear antibody test ("ANA") and an anti-La antibody test ("SSB"). The results showed

that Brinkman's ANA and SSB levels were both 296, significantly over the high normal

range of 99. (R. 314). 

The record is not clear on what course of treatment Brinkman underwent

immediately after these tests. Brinkman told Dr. Joyce on October 27, 2009 that she had

discontinued topical treatments for her lupus and that she managed her condition by

avoiding exposure to the sun. (R. 299). Blood tests performed earlier in September 2009

indicated an abnormal level of ANA antibodies, and the report states that Brinkman was

again encouraged to consult a rheumatologist. (R. 405). A treatment note dated

November 2009 also states that she was referred to a specialist for lupus. (R. 565). A

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February 2010 progress note completed by a medical assistant indicates that Brinkman did

consult a rheumatologist, though the physician's name is not clear from the record. (R.

425). Brinkman continued to see her rheumatologist throughout 2010 and early 2011, and

tests showed that her antibodies remained in the high level. (R. 571-79). She was

prescribed Plaquenil to treat her condition. (R. 626).

Brinkman's physical discomfort was enhanced during this period by joint pain

stemming from her arthritis. An x-ray of her left hand on September 24, 2009 indicated

normal joint structures with smooth cortical margins. (R. 418). A follow-up x-ray in

February 2010 showed only "minimal degenerative changes" in each of Brinkman's hands

and "unremarkable" changes in her spine. (R. 440, 442). A treatment note states that she

was taking 10mg daily of prednisone, though it is not clear if that oral steroid was

prescribed for her lupus, arthritis, or for both conditions. (R. 574). 

Brinkman was also treated for a variety of other physical and emotional conditions,

though there are few records for these treatments. Tests performed in May 2004 showed

that her thyroid stimulating hormone ("TSH") level was 12.85, more than double the

maximum normal range of 4.67, and a thyroid nuclear scan was ordered in June 2004. (R.

349, 351). She was diagnosed with thyroiditis and placed on the synthetic hormone

Synthroid by April 2009. (R. 539, 566). Thyroid tests done in February 2010 also

suggested continued high TSH levels. (R. 526-27). 

As the ALJ noted, Brinkman also suffered from high blood pressure and was treated

with the medication Lisinopril. In addition, she was treated for depression from at least

2004 and was prescribed various antidepressant medications, particularly Zoloft. (R. 172,

353, 566). The Court notes that the record concerning Brinkman's mental health treatment

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is sparse, and at times she denied feeling depressed. (R. 459). 

B. Consulting and Examining Physicians

The record contains the reports of several physicians who either examined

Brinkman or reviewed her records in order to determine the extent of her physical and

mental impairments.

1. Dr. Muhammad Rafiq

On June 5, 2010, internal medicine specialist Dr. Muhammad Rafiq examined

Brinkman in LaGrange, Illinois. Brinkman told Dr. Rafiq that she required at least two naps

a day and experienced pain throughout her body. Notwithstanding, she also reported that

she could sit up to one hour, lift up to ten pounds, and stand for thirty minutes at a time. 

Dr. Rafiq noted a lupus-related rash on her face, arms, and legs. He also found that

Brinkman could walk more than fifty feet without support and had a normal range of motion

in her shoulders, hips, knees, lumbar spine, and ankles. She had a normal ability to grasp

and grip with both hands. Dr. Rafiq noted that Brinkman was obese and weighed 194

pounds with a height of under five feet and five inches. He stated that Brinkman showed

no signs of depression at the examination, but Dr. Rafiq included depression as one of her

disorders, together with lupus, hypothyroidism, osteoarthritis, hypertension, dyslipidemia,

and CREST syndrome. (R. 468-71). 1

 2. Dr. Alan Jacobs

Brinckman was also examined by psychologist Dr. Alan Jacobs on the same day as

CREST syndrome is a limited cutaneous form of systemic scleroderma that

1

involves changes in the skin, blood vessels, muscles, and internal organs. See The Merck

Manuel 270 (18th ed. 2006).

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she saw Dr. Rafiq. Dr. Jacobs noted that Brinkman had not received "formalized mental

health treatment" for her depression, although she was currently taking the antidepressant

medication Sertraline. Brinkman stated that her symptoms ebbed and flowed and that she

believed her depression was associated, at least in part, with her lupus. Dr. Jacobs noted

that she displayed some self-consciousness about her lupus-related skin rashes. After

consulting with her, Dr. Jacobs diagnosed Brinkman as suffering from major depression

associated with her lupus and hypothyroidism, bereavement, and anxiety. (R. 474-76). 

3. Dr. Virgilio Pilapil

On June 18, 2010, Dr. Virgilio Pilapil issued a physical RFC assessment for the

SSA. Dr. Pilapil found that Brinkman could work at the medium exertional level and had

the ability to lift fifty pounds occasionally and twenty-five pounds frequently. She could sit,

stand, and walk for up to six hours during a workday and had an unlimited capacity to push

and pull. Nevertheless, Dr. Pilapil did impose some non-exertional limits on her RFC. 

These include findings that she could only occasionally climb stairs and should never be

required to balance due to obesity and hypertension. (R. 486-93). 

4. Dr. Lionel Hudspeth

The record also contains a Psychiatric Review Technique ("PRT") assessment

issued by Dr. Lionel Hudspeth on July 6, 2010. Dr. Hudspeth found that Brinkman suffered

from a major depressive disorder and anxiety. Under the Paragraph B criteria of Listing 

12.04, he found that she had mild limitations in her activities of daily living and social

functioning, a moderate limitation in concentration, persistence, and pace, but that she had

not experienced any episodes of decompensation. No Paragraph C criteria were met. Dr.

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Hudspeth then assessed Brinkman's mental RFC by finding that she had moderate

limitations in her ability to accept instructions, set realistic goals, maintain attention, and

perform activities within a regular schedule. All other functional areas were found not to

be significantly limited. (R. 494-510).

C. Hearing Testimony

Brinkman testified at the June 29, 2011 hearing that she was forty-two years old and

lived with her husband and five-year old son. (R. 35). She last worked as a receptionist

for an insurance company from 1997 through 2004, when she left her job due to pain and

stress. (R. 37-41). Brinkman described her physical condition as including spasms in her

legs while driving, swelling in her feet, headaches, and skin rashes from her lupus. She

treats the pain in her feet with the medication Tramadol and various over-the-counter pain

relievers. (R. 42). Brinkman also stated that she must frequently stay indoors because of

her depression. (R. 43, 47). 

Brinkman described her daily life as involving small tasks such as watching

television, engaging in activities with her son, and napping in the afternoon. (R. 46). Her

husband helps with cooking and laundry, and her mother assists in caring for her child

when Brinkman's symptoms prevent her from doing so. (R. 46-47). Brinkman testified that

she can stand for thirty minutes and is only able to walk a few blocks without experiencing

back pain. She can sit for up to an hour at a time and is able to lift no more than a gallon

of milk. (R. 48-49). 

Vocational expert ("VE") Lee Knutson also testified at the hearing. The ALJ posed 

six hypothetical questions to the VE about Brinkman's ability to work. She first asked the

VE to assume a person limited to light work who also had a number of non-exertional

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limitations. These included a limited ability to climb stairs, and the capacity to perform only

routine tasks with simple instructions. The VE responded that a substantial number of jobs

existed that could be performed by a person with such a RFC. The ALJ then asked the VE

to assume a person limited to sedentary work. Again, the VE stated that work existed for

such a person. 

Finally, the ALJ proposed four variations for a person who could only perform light

work. The first involved a claimant limited to frequent but not constant bilateral fingering. 

The VE found that work was available for such a person. When bilateral fingering was

reduced from frequent to occasional, the VE responded that it would eliminate the jobs he

earlier identified if the restriction involved a claimant's dominant hand. However, jobs at

the sedentary level would be available. Third, if the additional limitation of fatigue were

added, the VE stated that no work could be performed. Finally, if a person needed to be

off task for thirty percent of the time, the VE again stated that work would not be available. 

(R. 54-60).

D. The ALJ's Decision

ALJ Sayon issued a written decision on August 23, 2011 and found that Brinkman

was not disabled. She determined at Step 1 that Brinkman had not engaged in substantial

work since her alleged onset date of June 1, 2004. (R. 15). At Step 2, the ALJ found that

Brinkman's severe impairments included lupus, hypothyroidism, hypertension,

osteoarthritis, obesity, depression, and anxiety. (R. 16). Brinkman's lupus and

osteoarthritis did not meet or medically equal a Listing at Step 3. (Id.). The ALJ also

applied at Step 3 the "special technique" required under 20 C.F.R. § 1520(a) for assessing

the severity of mental disorders. She determined that Brown had mild restrictions in her

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activities of daily living and social functioning, together with a moderate restriction in her

concentration, persistence, and pace. (R. 16-17). No episodes of decompensation

existed, and the ALJ found that no Paragraph C criteria had been met. (R. 17).

Before moving to Step 4, the ALJ reviewed the medical record and Brinkman's

testimony in order to assess her RFC. With the exception noted below, the ALJ found that

Brinkman's statements about the limitations imposed by her symptoms were not credible. 

Her RFC was assessed at light work with a variety of exertional and non-exertional

limitations. (R. 17-18). The ALJ then determined at Step 4 that Brown could not perform

her past relevant work. (R. 22). Based on the testimony of the VE, the ALJ concluded at

Step 5 that a substantial number of jobs existed in the national economy that Brinkman

could perform and that, as a result, she was "not disabled." (R. 23-24). 

III. Discussion

Brinkman challenges the ALJ's decision on three grounds. She argues that the ALJ

erred by: (1) finding at Step 3 that her lupus did not meet or medically equal Listing 14.02

(systemic lupus erthyematosus); (2) finding that her statements were not credible; and (3)

not properly considering her RFC. The Court addresses each of these arguments in turn.

A. Substantial Evidence Supports the ALJ's Step 3 Finding

Systemic lupus erthyematosus is "a chronic inflammatory disease that can affect

any organ or body system," including an individual's respiratory, cardiovascular, renal,

blood, skin, neurologic, mental, or immune systems. 20 C.F.R. Pt. 404, Subpt. P, App. 1

at § 14.00D1. Listing 14.02 states that a claimant can meet or medically equal the

requirements for SLE by demonstrating the existence of lupus accompanied by the:

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A. Involvement of two or more organs/body systems, with:

 1. One of the organs/body systems involved to at least a moderate level 

 of severity; and

2. At least two of the constitutional symptoms or signs (severe fatigue,

 fever, malaise, or involuntary weight loss).

or

B. Repeated manifestations of SLE, with at least two of the constitutional 

symptoms or signs (severe fatigue, fever, malaise, or involuntary weight 

loss) and one of the following at the marked level:

 1. Limitation of activities of daily living.

 2. Limitations in maintaining social functioning.

3. Limitation in completing tasks in a timely manner due to deficiencies in 

 concentration, persistence, or pace.

20 C.F.R. Pt. 404, Subpt. P, App. 1 at § 14.02. 

The Court agrees with the Commissioner that substantial evidence supports the

ALJ's finding that Brinkman did not meet or medically equal either of these alternatives. 

Listing 14.02A requires a claimant to show two things. She must first demonstrate that two

of her organs or body systems are moderately affected by SLE. Brinkman does not

address this point fully, but the record suggests that she met these criteria. Several

treating sources stated that Brinkman suffered from lupus-related skin rashes, and

examining psychologist Dr. Jacobs concluded that her depression was "associated with

lupus/hypothyroidism." (R. 476). 

However, the record does not show that Brinkman satisfied Listing 14.02A's second

requirement that she suffer from at least two of the constitutional symptoms identified in

the Listing as severe fatigue, fever, malaise, or involuntary weight loss. Brinkman again

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does not address how the record relates to this portion of Listing 14.02A, but she argues

in other portions of her motion that she suffered from significant fatigue. Even if this were

sufficient to meet the fatigue element of Listing 14.02A.2, the record does not show that

Brinkman suffered from one of the other listed symptoms of malaise, fever, or involuntary

weight loss. Brinkman points out that her anitibody counts were elevated at times, but

antibody counts are not part of Listing 14.02A's criteria. She also claims that a person with

SLE should be expected to have the symptoms identified in Listing 14.02. See Doc. 16 at

12. Having a disorder, however, does not mean that a claimant necessarily experiences

all the symptoms that could be associated with it. See Boyd v. Astrue, No. 09 C 1217,

2009 WL 5149136, at *9 (N.D. Ill. Dec. 28, 2009) ("[A] condition that can cause certain

symptoms does not mean that the condition has caused those symptoms in a particular

case."). A claimant always bears the burden of showing that the evidence supporting her

condition meets or equals the criteria of a specific Listing. Maggard v. Apfel, 167 F.3d 376,

379-80 (7th Cir. 1999). 

The record also fails to show how Brinkman can meet or medically equal Listing

14.02B. That Listing again contains two-prongs. First, Brinkman must show two of the

constitutional symptoms like fatigue and fever, and she has not done so. Second, she

must demonstrate that she has a "marked" limitation in at least one of the functional areas

of activities of daily living, social functioning, or concentration. Brinkman does not

challenge the ALJ's findings as part of the special technique that she only experienced

"mild" limitations in the first two categories and had a "moderate" restriction in her

concentration. (R. 16-17). Brinkman claims in other parts of her motion that she has

"severe" limitations in her activities of daily living, but she fails to identify any part of the

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record that supports this claim. In particular, Brinkman fails to address that Dr. Hudspeth's

PRT reached the same conclusions as the ALJ concerning her daily life, social functioning,

and concentration. In the absence of any argument on why the ALJ's findings fail to

properly account for the medical evidence, Brinkman has not shown how the record could

support a conclusion that she meets the requirements of Listing 14.02A or 14.02B. The

Motion for Summary Judgment is denied on the Listing issue.

B. Substantial Evidence Supports the ALJ's Credibility Assessment

Brinkman next argues that the ALJ erred in finding that her statements concerning

the limiting effects of her symptoms were not credible. If an ALJ finds that a medical

impairment exists that could be expected to produce a claimant's alleged condition, he

must then assess how the individual's symptoms affect his ability to work. SSR 96-7p. 

The fact that a claimant's subjective complaints are not fully substantiated by the record

is not a sufficient reason to find that he is not credible. The ALJ must consider the entire

record and "build an accurate and logical bridge from the evidence to his conclusion."

Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir. 2000). Factors that should be considered

include the objective medical evidence, the claimant's daily activities, allegations of pain,

any aggravating factors, the types of treatment received, any medications taken, and

functional limitations. Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir. 2006); see also

20 C.F.R. § 404.1529(c)(3); SSR 96-7p. A court reviews an ALJ's credibility decision with

deference and overturns it only when the assessment is patently wrong. Jones v. Astrue,

623 F.3d 1155, 1162 (7th Cir. 2010).

Brinkman presents a limited credibility argument that relies primarily on a comment

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the ALJ made at Step 1. The ALJ noted that a 2005 treatment note from Dr. Kevin Joyce

stated that "she is continuing to work as a bartender," but that Brinkman had testified at the

hearing that she worked as a bartender for only two days in 2005. (R. 15, 37, 300). The

ALJ speculated that "'continuing to work' sounds more like an ongoing job, as opposed to

a two-day attempt at work." (R. 16). The ALJ then stated that the apparent contradiction

between Brinkman's testimony and Dr. Joyce's comment would be considered in her

credibility assessment. (Id.). Brinkman argues that the ALJ was not entitled to discount

her credibility due solely to Dr. Joyce's use of the word "continuing." 

The Court agrees that the ALJ laid undue stress on Dr. Joyce's note, which appears

to be little more than a passing comment the physician made while interviewing Brinkman.

However, Brinkman overstates the ALJ's reliance on the note to reach her credibility

decision. The ALJ did not find Brinkman's testimony to be non-credible based only on Dr.

Joyce's comment, and she considered many of the factors required by SSR 96-7p. The

relevant question is whether substantial evidence supports the ALJ's finding based on her

discussion of those factors.

The ALJ gave considerable attention to the objective medical record, including the

results of Brinkman's x-rays and blood tests, and Brinkman fails to challenge many of her

key findings. The ALJ noted, for example, that x-rays of Brinkman's joints showed only

minimal degenerative changes, that her treating physician found little evidence of active

lupus, and that Brinkman had discontinued lupus treatment altogether at one point and

considered it to be inactive. (R. 21). The ALJ also reviewed Brinkman's tests and medical

consultations in detail and concluded that both her physical and mental treatment histories

were inconsistent with Brinkman's allegations of severe limitations. In particular, the ALJ

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stated that the record did not provide evidence of the pain or mental distress that Brinkman

alleged had caused her to stop working in 2004.

Brinkman also fails to challenge the ALJ's finding that her pain-related claims were

inconsistent with comments she made to her doctors. The ALJ noted that Brinkman did

not report any pain in May and September 2009. (R. 19). She claimed a pain level of 5

out of 10 on November 12, 2009, but once again stated that her pain was at a 0 level only

ten days later. (R. 19, 456, 458). In early February 2010, Brinkman stated that her pain

was an 8 or 9 out of 10, but it was at the 0 level once more by February 26, 2010. (R. 19). 

Brinkman briefly attempts to support her credibility by pointing out that 20 C.F.R. §

404.1529 requires a medical condition to exist that could be expected to produce a

claimant's symptoms. Social Security Ruling 96-7p elaborates on this requirement by

stating:

[O]nce an underlying physical or mental impairment(s) 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. For this

purpose, whenever the individual's statements about 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.

SSR 96-7p. The basis of Brinkman's reliance on this provision to support her credibility is

unclear. She appears to be arguing that, because she was diagnosed with lupus and

arthritis, all of her pain-related allegations should be construed as credible because they

are the "expected" consequences of her conditions. 

The Court finds this reasoning unpersuasive. As noted above, the existence of a

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medical condition does not mean that all of a claimant's pain allegations must be accepted

as true. Social Security Ruling 96-7p makes clear that a credibility assessment is required

only after a medical condition is established. That does not mean, however, that all

"expected" symptoms of a condition will always be present in a particular case, or that a

claimant's allegations must be taken as true just because she has a specific medical

condition. If Brinkman's claim were correct, the ALJ's credibility assessment would not be

necessary at all because Brinkman's diagnosed conditions would themselves verify her

claims. That is clearly not the case, and the ALJ properly turned to the requirements for

assessing credibility under SSR 96-7p once she determined that Brinkman suffered from

medical conditions that could reasonably be expected to give rise to her symptoms. 

Part of this analysis was based on the ALJ's consideration of Brinkman's activities

of daily living. As discussed above, Brinkman fails to address the basis for the ALJ's

conclusion that she only experienced mild limitations in this functional area. The ALJ also

considered the side effects of Brinkman's medications to some degree. She noted that

Brinkman took oral and topical corticosteroids for lupus-related rashes; Wellbutrin, Zoloft,

and Effexor for depression; Methotrexate for headaches; and Ultram for foot pain. The 2

ALJ noted that Brinkman experiences nausea from both Methotrexate and steroids. (R.

18). Brinkman objects that the ALJ did not consider all the side effects of her medications,

but remand is not required just because the ALJ did not discuss every aspect of her

medication in full. See Clay v. Apfel, 64 F. Supp.2d 774, 781 (N.D. Ill. 1999) (stating that

an ALJ is not necessarily required to discuss all of the seven credibility factors, even

The ALJ failed to note that Brinkman took Synthroid for her thyroiditis and took

2

Lisinopril to control her blood pressure.

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though she is obligated to "consider" them). 

Finally, Brinkman contends that the ALJ failed by not considering her testimony that

she often feels tired and is required to take naps during the day. This argument fails on

several grounds. It is not true that the ALJ rejected Brinkman's claims out of hand, as she

states. To the contrary, the ALJ explicitly restricted the RFC to "routine" work with no

exposure to heights because Brinikman "testified that she is always tired." (R. 22). The

ALJ also did not fail to take account of Brinkman's testimony on this issue. The ALJ

considered the complaints of fatigue Brinkman made to her consulting physicians, her

testimony at the hearing, and even statements about tiredness that Brinkman made as

early as 2003. (R. 18-22). The ALJ simply did not find that Brinkman's fatigue was as

severe as she alleged. Brinkman claims that the ALJ failed to consider that the combined

effect of her many medications was "likely" to cause this tiredness. (Doc. 16 at 12). 

However, Brinkman did not testify that she was tired because of her medicine, and she has

not cited any evidence on what effects could result from a combination of her medications. 

The Court recognizes that the ALJ's credibility discussion is not without flaws. She

could have discussed the reasons for her decision in greater detail and should have

provided a more thorough explanation of her reasoning. However, the Court cannot say

that the ALJ's credibility assessment as a whole is patently incorrect. Brinkman's motion

is denied on the credibility issue.

C. Substantial Evidence Supports the RFC

Finally, Brinkman argues that the ALJ's hypothetical question to the VE at Step 5

was flawed because it failed to include limitations that would have reduced her RFC from

the light exertional level to the less onerous level of sedentary work. As discussed earlier,

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the ALJ posed an initial question to the VE that reflected Brinkman's RFC. She then added

increasingly restrictive limitations to this hypothetical. Brinkman cites several of these

restrictions, including the ability to handle and finger objects, the need to take naps, and

the possibility that she might need to be off-task for portions of each day. Brinkman

appears to claim that if the RFC had included these extra limitations, the ALJ would have

been required to find her disabled. 

3

Brinkman fails to cite any part of the record that supports her claim that the ALJ

should have accommodated her fatigue more than limiting her to routine work without

exposure to heights. The Court has carefully reviewed the record and finds that substantial

evidence supports the ALJ's finding that Brinkman did not need extensive work breaks. 

Dr. Hudspeth found that she had "moderate" restrictions in persistence and pace and had

no significant limitations in the ability "to perform at a consistent pace without an

unreasonable number and length of rest periods." (R. 504, 509). Dr. Pilapil's physical RFC

determined that Brinkman could perform work at the medium exertional level and could sit,

stand, and walk for up to six hours a day with only normal breaks. (R. 487). The RFC did

not include any finding that Brinkman needed additional break periods during the workday. 

As for her ability to handle objects, Dr. Pilapil found that Brinkman had no manipulative

limitations, including both gross and fine manipulation. (R. 489). 

The exact nature of Brinkman's claim is not clear. She appears to be contesting 3

the RFC assessment itself, not the ALJ's Step 5 decision. See Arnett v. Astrue, 676 F.3d

586, 591 (7th Cir. 2012) (noting that claimant's "contention that at Step 5 the ALJ

constructed a hypothetical built around a flawed RFC adds nothing to her challenge to the

RFC"). The Commissioner interprets Brinkman's argument in this manner, and she does

not state otherwise in the reply brief. In the absence of any argument to the contrary, the

Court agrees with the Commissioner that Brinkman's primary concern is whether the ALJ

should have included the additional restrictions she identifies as part of the RFC. 

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Brinkman has not challenged these findings or argued that the ALJ erred by relying

on these conclusions to reach her RFC. As a result, Brinkman has not shown why the

RFC should have included additional limitations concerning fingering, handling, and rest

periods. Brinkman's motion is denied on this issue. 

IV. Conclusion

For these reasons, the Court denies Brinkman's Motion for Summary Judgment [16]

and affirms the Commissioner's final decision. The case is closed.

ENTERED:

__________________________________

 DANIEL G. MARTIN

 United States Magistrate Judge

Dated: January 9, 2013

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