UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

HECTOR LORENZO, )

 )

Plaintiff, ) No. 12-cv-2475

 )

 ) Magistrate Judge Susan E. Cox

MICHAEL J. ASTRUE, Commissioner of )

Social Security, )

 )

Defendant, )

MEMORANDUM OPINION AND ORDER

Plaintiff, Hector Lorenzo, seeks judicial review of a final decision of the Commissioner of

the Social Security Administration (“SSA”) denying his application for disability insurance benefits

(“DIB”) and Supplemental Security Income (“SSI”) under the Social Security Act (“the Act”).1 Mr.

Lorenzo has filed a motion for summary reversal, seeking to reverse the Commissioner’s final

decision or remand the case for consideration of the issues raised herein. The Commissioner has also

filed a cross motion for summery of judgment. For the reasons set forth below, Mr. Lorenzo’s

motion for summary judgment is denied [dkt. 19] and the Commissioner’s motion is granted [dkt.

27]. 

I. Procedural History

 Mr. Lorenzo applied for DIB and SSI on June 22, 2009, alleging disability beginning

October 1, 2006.2

 On November 3, 2009, Mr. Lorenzo requested a hearing before an Administrative

Law Judge (“ALJ”), which was granted on August 11, 2010.3

 A hearing took place before ALJ

1

 42 U.S.C. §§416(I), 423, and 1381 et seq. 2

 R. at 131-141. 

3

 R. at 94-100.

Page 1 of 31
Roxanne J. Kelsey in Orlando Park, Illinois, on September 20, 2010.4

 Following the hearing, the

ALJ issued an unfavorable decision on October 27, 2010, concluding that Mr. Lorenzo was not

disabled under sections 206(i) and 223(d) of the Act through December 31, 2007, the last date

insured.5

 The Appeals Council denied Mr. Lorenzo’s request to review the ALJ decision on February

1, 2012, meaning the ALJ’s decision is the final decision of the Commissioner.6

II. Factual Background

The facts set forth under this section are derived from the administrative record. Mr. Lorenzo

was born October 3, 1958, and was forty-nine years old on December 31, 2007, the date last

ensured.7 At 5'8" inches tall and 228.2 pounds at the time of the hearing,8 Mr. Lorenzo was

considered obese with a body mass index of 34.7.9 Mr. Lorenzo alleged disability beginning October

1, 2006 and remained insured through December 31, 2007.10 Mr. Lorenzo must establish that he

became disabled during this period.11

Mr. Lorenzo listed several ailments in his application for benefits; the ALJ found only Mr.

Lorenzo’s congestive heart failure, hypertension, degenerative disc disease and obesity to be severe

impairments.12 We will limit our review to these four severe impairments.

A. Congestive Heart Failure and Hypertension

It is well documented in the record that Mr. Lorenzo has suffered from, and been treated for,

4

 R. at 96.

5

 R. at 22.

6

 R. at 1.

7

 R. at 233.

8

 R. at 258.

9

 R. at 13.

10R. at 10.

11Id.

12R. at 12.

Page 2 of 31
congestive heart failure and hypertension since 2006.13 According to the record, Mr. Lorenzo had

four echocardiograms, and one stress test during the period in question.14 The primary method of

calculating Mr. Lorenzo’s heart function was the ejection fraction of his left ventricle, which can

be approximated from an echocardiogram, and more exactly measured during a stress test.15 Philip

Liebson, M.D., of the Rush University Heart Institute (“Heart Institute”), noted on October 6, 2006

that Mr. Lorenzo had an enlarged left ventricle, reduced heart contraction speed and efficiency.16

As a result, Dr. Liebson estimated Mr. Lorenzo’s ejection fraction, the portion of blood ejected from

the left ventricle at the end of each heart contraction, to be ten to fifteen percent.17 The normal,

healthy, range for left ventricle ejection fraction is approximately between fifty-five to sixty-five

percent.18

Mr. Lorenzo returned to the Heart Institute for a stress test ordered by Richard Abrams,

M.D., an internist at Rush University, on October 16, 2006.19 The test noted: (1) normal heart rate

response to stress, (2) no chest pain, (3) a moderately reduced left ventricular ejection fraction of

thirty-one percent, and (4) the symptoms were not reproduced under light activity.20

In a report to Dr. Abrams dated November 7, 2006 by Christian Spies, M.D., and R. Jeffrey

Snell, M.D., the Director of Interventional Cardiology at the Heart Institute and Mr. Lorenzo’s

13R. at 280-281.

14R. at 246, 252, 280, 283, 287, 289, 291, 293.

15R. at 280-281.

16R. at 246, 252, 291 (finding moderately dilated left ventricle, markedly reduced systolic function, severe

diffuse hypokinesis and an ejection fraction estimated in the range of 10-15 percent); Stedman’s Medical Dictionary

934, 1929, 2114-2115 (Lippincott, Williams & Wilkins eds., 29th ed.). 17R. at 291; J.E. Schmidt, M.D., Attorney’s Dictionary of Medicine and Word Finder E-38 (Cumulative

Supplement December 2005). 18Pfisterer ME, Battler A, Zaret BL, Range of normal values for left and right ventricular ejection fraction

at rest and during exercise assessed by radionuclide angiocardiography, (June 6, 2013),

http://www.ncbi.nlm.nih.gov/pubmed/4054134. 19R. at 280, 293.

20R. at 249-250, 293-294.

Page 3 of 31
treating cardiologist, noted that Mr. Lorenzo was diagnosed with New York Heart Association Class

II (“heart classification”).21 Mr. Lorenzo’s heart classification means that he has “slight limitation

of physical activity,” is “comfortable at rest,” and “ordinary physical activity results in fatigue,

palpitation, dyspnea, or anginal pain.”22 On November 17, 2006 Mr. Lorenzo underwent another

exam; Dr. Snell estimated a below average ejection fraction of thirty-five percent.23 Mr. Lorenzo’s

estimated ejection fraction had improved from the ten to fifteen percent estimate on October 6,

2006.24

The following year, on March 26, 2007 Mr. Lorenzo visited the Rush University Emergency

Room complaining of lower back pain which was aggravated by movement or bending.25 During

a physical exam, Anthony Zelazny, M.D., the attending clinician, noted a history of cardiac disease

but found no heart murmurs, rubs or gallops.26 On May 3, 2007, Mr. Lorenzo underwent a

consultative examination with Norbert De Biase, M.D., who noted (1) uncontrolled hypertension

but current medical treatment; and (2) his congestive heart failure was stable with current medical

treatment.27 Dr. Snell ordered another echocardiogram on May 22, 2007, which found a normally

functioning left ventricle with an estimated ejection fraction within normal range, which was a

marked improvement from his October 6, 2006 echocardiogram.28 Mr. Lorenzo had a minor

impairment of his left ventricle causing it to not fully relax and expand, which resulted in a smaller

21R. at 281.

22Classification of Functional Capacity and Objective Assessment, (June 1, 2013),

http://my.americanheart.org/professional/StatementsGuidelines/ByPublicationDate/PreviousYears/Classification-ofFunctional-Capacity-and-Objective-Assessment_UCM_423811_Article.jsp. 23R. at 246, 283.

24R. at 246, 252, 291.

25R. at 243-244.

26R. at 243-245.

27R. at 259.

28R. at 289, 291.

Page 4 of 31
amount of blood pumped through the circulatory system with each contraction of the heart.29 On

December 4, 2007, in the last exam before the period in question ended, Dr. Snell found normal

heart function, an ejection fraction within the normal range, and a mild asymmetric enlargement of

his heart.30

In a residual function capacity assessment for the Social Security Administration on August

27, 2009, Frank Jimenez, M.D., noted that medical evidence supported the existence of congestive

heart failure and hypertension.31 Dr. Jimenez also noted Dr. Biase’s consultive examination on May

3, 2007 that found both congestive heart failure and hypertension to be stable.32 Finally, Dr. Jimenez

noted that there was no evidence in the record of organ damage as a result of any of Mr. Lorenzo’s

heart conditions.33

B. Degenerative Disc Disease

As noted in the previous section, on March 26, 2007, Mr. Lorenzo was admitted to the Rush

University Emergency Room complaining of lower back pain which was aggravated by movements

such as bending.34 Mr. Lorenzo described to Dr. Zelazny how he had fallen a few weeks earlier and

injured his lower back.35 Prior to March 2007, there is no medical evidence in the record of back

pains.36 Dr. Zelazny’s examination noted mild compression of three vertebrae in the lower back

29 R. at 289 (grade I diastolic dysfunction); Schmidt, Attorney’s Dictionary of Medicine and Word Finder,

supra, at D-114. 30R. at 287 (mild asymmetric hypertrophy involving focal basal segments);Schmidt, Attorney’s Dictionary

of Medicine and Word Finder, supra, at B-37, F-132-133, H-258. 31R. at 273.

32Id.

33Id.

34R. at 243-244.

35R. at 244.

36R. at 16.

Page 5 of 31
which was considered temporary in nature37 and bone spurs between vertebrae causing pain.38 Mr.

Lorenzo was prescribed Norco for his pain and the record noted that the maximum severity was

mild, and that his back was tender but he appeared comfortable.39

Mr. Lorenzo underwent a consultive examination with Dr. Biase for the Bureau of Disability

Determination Services on May 3, 2007. Dr. Biase noted significant decreased range of motion in

his lower back and tenderness in his lower back and shoulders.40 A spinal x-ray revealed growing

bone spurs which caused pain.41 Mr. Lorenzo was able to walk fifty feet unassisted at a slow pace

but was unable to perform toe, heel, tandem, and squatting maneuvers because of pain in his back.42

Dr. Biase concluded his examination by noting both Mr. Lorenzo’s limited motion43 and his

uncontrolled and unmedicated back pain.44

In Mr. Lorenzo’s residual function capacity assessment for the Social Security

Administration on August 27, 2009, Dr. Jimenez considered Dr. Biase’s consultative examination

in determining Mr. Lorenzo’s exertional and postural limitations.45 Dr. Jimenez also noted normal

grip strength, reflexes and feeling.46 Dr. Jimenz found medical evidence for some of Mr. Lorenzo’s

37Schmidt, Attorney’s Dictionary of Medicine and Word Finder, supra, at F-113, S-245; Human Vertebral

Column, Enclyclopaedia Britanica Online, (June 10, 2013), http://www.britannica.com/EBchecked/topic/626589/

vertebral-column. 38R. at 243 (mild anterior wedging of the T11-L1 vertebral bodies considered temporary in nature, mild

narrowing and small anterior osteophytes); Schmidt, Attorney’s Dictionary of Medicine and Word Finder, supra, at

O-122, E-246. 39R. at 244-225.

40R. at 16, 258-259 (decreased range of motion in lumbosacral spine); Schmidt, Attorney’s Dictionary of

Medicine and Word Finder, supra, at L-196-197 . 41R. at 265 (degenerative osteophyte); Schmidt, Attorney’s Dictionary of Medicine and Word Finder, supra,

at O-122.42R. at 258.

43R. at 261.

44R. at 259.

45R. at 267-268, 273.

46R. at 273.

Page 6 of 31
complaints and determined him able to perform light work.47 Dr. Jimenez found Mr. Lorenzo to be

“partially credible” because of the inconsistencies between his complaints of back pain and the

medical record.48

C. Obesity

During the period at issue, Mr. Lorenzo was between 222.6 to 245 pounds.49 While Mr.

Lorenzo’s weight is noted throughout the medical record, he is never referred to as obese nor are

there notations regarding his weight and how that affected his other impairments.50 It is unclear

which record the ALJ relied on in noting Mr. Lorenzo’s BMI to be 34.7.51 An individual with a BMI

over 30.0 is considered obese.52

III. ALJ Hearing and Decision

 The hearing before the ALJ occurred on September 20, 2010 in Orland Park, Illinois.53 Mr.

Lorenzo was present and represented by Agustin G. Garcia, an attorney.54 Also present was Richard

T. Fisher, a vocational expert (“VE”).55 On October 27, 2010, the ALJ concluded that Mr. Lorenzo

was not disabled, “as defined in the Social Security Act, at any time from October 1, 2006, the

alleged onset date, through December 31, 2007, the date last insured.”56

47Id. 48Id.

49R. at 246, 251.

50R. at 257-258 (noting claimant weighed 228.2 pounds on May 3, 2007), 278-279 (finding Mr. Lorenzo

unable to work full time in Dr. Snell’s retrospective opinion, which does not mention weight), 281-282 (describing

Mr. Lorenzo as a “well nourished gentleman”), 291 (noting claimant weighed 245 pounds on October 6, 2006), 293

(noting claimant weighed 226 pounds on October 16, 2006). 51R. at 13; see About BMI for Adults, (June 8, 2013), www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/

(explaining the calculation of BMI as “dividing weight in pounds by height in inches squared and multiplying by a

conversion factor of 703"). 52R. at 13; About BMI for Adults, supra. 53R. at 10.

54Id.

55Id.

56R. at 22 (citation omitted).

Page 7 of 31
A. Mr. Lorenzo’s Testimony

Mr. Lorenzo began his testimony by confirming that he became disabled in October 2006,

and that he lived with his parents and sister during the time in question.57 Mr. Lorenzo also

confirmed that he had a high school education and could read and write.58 Mr. Lorenzo testified that

before becoming ill in 2006, he had a number of jobs, the last of which was as a drywall installer.59

From approximately 2004 to 2006, Mr. Lorenzo worked as a stock clerk and supervisor.60 Mr.

Lorenzo also worked part time for Avon sales throughout most of this time period.61

 Mr. Lorenzo testified that between 2006 and 2007, he was diagnosed with congestive heart

failure, high blood pressure, high cholesterol, and gout, as well as back problems.62 Mr. Lorenzo

testified that he believed he was prescribed hydrocodone for his back pain.63 When Mr. Lorenzo

became ill, he stopped drinking64 and moved in with his parents and sister who helped take care of

him.65 Mr. Lorenzo testified that he was able to dress himself66 but he suffered from shortness of

breath, weakness in his hands and fingers,67 and could not bend or squat.68 Mr. Lorenzo testified that

he was told his breathing was hindered due to his heart condition, which also caused him to become

easily fatigued.69 Mr. Lorenzo testified that he was dependant on his parents and sister for

housework, laundry, groceries and transportation.70 Mr. Lorenzo also testified that he became tired

57R. at 35-36.

58R. at 40, 57-58.

59R. at 41.

60R. at 43; see also R. at 219 (worked for Logan Foods Inc. from August 1, 2004 to October 5, 2006). 61R. at 44.

62R. at 45.

63R. at 48.

64R. at 45-47.

65R. at 34-36, 59.

66R. at 56-57.

67R. at 57-58.

68R. at 48-49.

69R. at 49-50.

70R. at 38, 50.

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after only short walks, and spent most of his time watching television or napping.71

 Next, the ALJ asked about Mr. Lorenzo’s memory during the time in question, he testified

that it was “pretty good,” but his heart medication caused him to have difficulty following news

stories.72 As a followup, the ALJ told Mr. Lorenzo that she was trying to assess his mental

functioning and asked if he was “unable to understand, or just not interest.”73 Mr. Lorenzo testified

that he was “not interested” and “not paying attention,” television was “just something to see till [he]

fall back asleep.”74

Finally, Mr. Lorenzo testified that his back injury made sitting uncomfortable.75 After a

“couple of minutes,” he would need to move around, or lay down and that he could not stand for

long periods of time.76

B. Letters from Mr. Lorenzo’s Parents and Sister

 Mr. Lorenzo’s family was not present at the hearing. But pursuant to the ALJ’s request, two

signed letters explaining his condition during the time period Mr. Lorenzo was under their care were

entered into the record.77

 Mr. Lorenzo’s parents, Hilario and Ana Lorenzo, describe in their letter dated September 27,

2010, that while Mr. Lorenzo was ill from 2006 to 2008, they assisted him with his medication,

showering, and feeding.78 Also, Mr. Lorenzo was assisted in and out of his bed.79

71R. at 50-54, 56. 

72R. at 53-54.

73R. at 54.

74Id.

75R. at 55.

76R. at 55-56.

77R. at 34-35.

78R. at 224-225.

79R. at 225.

Page 9 of 31
 Mr. Lorenzo’s sister, Nancy Lorenzo, also included a letter dated September 27, 2010.80

Nancy wrote that Mr. Lorenzo moved from his third floor apartment to the first floor because his

condition did not allow him to walk up the stairs.81 During 2007 and 2008, the family assisted Mr.

Lorenzo by cooking, and helping him move from one place to the next in the house.82 Nancy also

noted that Mr. Lorenzo required assistance using the restroom and the shower because he would

become “dizzy, short of breath, and weak.”83

C. VE’s Testimony

 Lastly, the VE testified.84 The ALJ asked the VE two hypotheticals.85 The last hypothetical

provided for an individual between the age of forty-five and forty-nine and had a high school

education similar to Mr. Lorenzo.86 The hypothetical person had the residual functional capacity to

lift ten pounds occasionally or frequently, could stand for no more than two hours in an eight hour

work day, and sit for six hours in an eight hour work day, could occasionally climb ramps or stairs,

and could occasionally balance, stoop, crouch, crawl, or kneel, and could never climb ladders, ropes,

or scaffolds.87 The VE testified that the hypothetical individual would not be able to perform all of

the claimant’s past work.88 When asked if that individual could perform any occupation, the VE

testified that the individual would be able to perform sedentary, unskilled work such as ticket taker,

order clerk or telephone quote clerk.89 Finally, the VE testified that all three positions existed in

80R. at 227.

81Id.

82Id.

83R. at 228.

84R. at 60.

85R. at 78.

86Id.

87Id.

88Id.

89R. at 78-79.

Page 10 of 31
Illinois.90

D. ALJ’s Decision

 In an opinion issued on October 27, 2010, the ALJ concluded that Mr. Lorenzo was not

disabled within the meaning of the Act from October 1, 2006, through December 31, 2007, the last

date insured.91 The Social Security Administration has prescribed a sequential five-step evaluation

process for determining whether a claimant is disabled.92 The ALJ’s first step is to consider whether

the claimant is engaged in substantial gainful activity, which would preclude a disability.93 In the

present case, the ALJ determined that Mr. Lorenzo was “not engaged in substantial gainful activity

during the period from his alleged onset date of October 1, 2006 through his date last insured of

December 31, 2007.”94

The second step is for the ALJ to consider “whether the claimant has a medically

determinable impairment that is severe or a combination of impairments that is severe.”95 In the

present case, the ALJ concluded that Mr. Lorenzo had the medically determinable severe

impairments of congestive heart failure, hypertension, degenerative disc disease and obesity.96 The

ALJ also found that Mr. Lorenzo’s alcohol abuse was not a severe impairment because he was clean

and sober during the period at issue.97 Finally, the ALJ found that Mr. Lorenzo’s gout was not severe

because the medical evidence did not support significant limitations as a result of gout in 2007, and

the first medical evidence indicating swelling and pain appears in the record in 2009.98

90R. at 79.

91R. at 22.

92R. at 10; 20 C.F.R. 404.1520(a).

93R. at 11; 20 C.F.R. 404.1520(b).

94R. at 12.

95R. at 11; 20 C.F.R. 404.1520(c).

96R. at 12.

97Id.

98R. at 12-13.

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

impairments meets or medically equals the criteria of an impairment listed in the regulations as

being so severe as to preclude gainful activity.”99 In the present case, the ALJ determined that Mr.

Lorenzo’s impairments did not meet or medically equal a listed impairment under 20 CFR Part 404,

Subpart P, Appendix 1.100 The ALJ considered listing 1.04 for disorders of the spine, which

considers a person disabled if there is “evidence of nerve root compression” that results in pain,

limited motion, and lack of reflex.101 Mr. Lorenzo failed to meet the requirement for this listing

because he lacked nerve root compression and he was still able to ambulate effectively.102 Next, the

ALJ also considered 4.02 for chronic heart failure, which requires medically documented evidence

of systolic failure or distolic failure and (1) persistent symptoms of heart failure which very seriously

limit the ability to complete daily living activities, (2) three or more separate episodes of acute

congestive heart failure within a consecutive twelve month period, or (3) an inability to perform on

an exercise tolerance test.103 Mr. Lorenzo did not display the necessary symptoms, functional

limitations and evidence necessary to meet or equal the listing.104 Last, the ALJ considered Social

Security Ruling 02-1p for the evaluation of obesity.105 Mr. Lorenzo is considered to have level I

obesity according to the Clinical Guidelines and his BMI, calculated by the ALJ.106 The ALJ found

that Mr. Lorenzo failed to meet or equal the listing because of his ability to ambulate without

99R. at 11, 13; 20 C.F.R. 404.1520(d), 404.1525, 404.1526.

100R. at 13. 10120 C.F.R. § 404 app. 1, 104(A). 102R. at 13. 10320 C.F.R. § 404 app. 1, 402. 104R. at 13. 105Titles II & XVI: Evaluation of Obesity, SSR 02-1P (S.S.A. Sept. 12, 2002). 106Id.

Page 12 of 31
assistance.107 However, she considered his obesity and its effects in later steps.108

In the event that no impairments are found to meet the Social Security Ruling listing

requirements, the ALJ proceeds to the fourth step of the test, in which the ALJ must first determine

the claimant’s residual functional capacity (“RFC”).109 The RFC is an assessment of the maximum

work-related activities a claimant can perform despite his limitations.110 The claimant's RFC is used

to determine whether he is able to perform his past relevant work.111 This involves evaluating the

claimant’s RFC based on the record of his testimony and comparing it to the requirements of his past

work.112

If determining the claimant's RFC requires the ALJ to assess subjective complaints, then the

ALJ follows a two-step process.113 First, the ALJ must determine whether there is an underlying

medically determinable impairment, which can be shown by medically acceptable clinical and

laboratory diagnostic techniques, that could reasonably be expected to produce the claimant’s

symptoms.114 If so, the ALJ then evaluates the intensity, persistence, and limiting effects of the

claimant’s symptoms to determine the extent to which they limit the claimant’s functioning and

ability to do basic work.115 When making determinations about the credibility of the claimant’s

subjective complaints, the ALJ must consider the entire record.116 The ALJ need only consider the

107R. at 13, 258. 108R. at 13. 10920 C.F.R. 404.1520(e). 110R. at 14. 11120 C.F.R. 404.1520(f), 404.1565. 112Titles II & XVI: Assessing Residual Functional Capacity in Initial Claims, SSR 96-8P (S.S.A. July 2,

1996). 113Id. 114Id. 115Id. 116Titles II & XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of Individual’s

Statements, SSR 96-7P (S.S.A. July 2, 1996).

Page 13 of 31
subjective symptoms to the extent that they can reasonably be accepted as consistent with the

objective medical evidence and other evidence.117 If the ALJ determines that the claimant’s RFC

makes him capable of performing his past work, the claimant is not disabled.118

Here, the ALJ decided that Mr. Lorenzo had the RFC to perform sedentary work as defined

in 20 CFR 404.1567(a).119 The ALJ added additional limitations that he could not climb ladders,

ropes, or scaffolds, and that Mr. Lorenzo’s medications and fatigue would limit him to simple,

routine and repetitive tasks.120 In support of the RFC, the ALJ then moved to an analysis of the

claimant’s subjective complaints, symptoms and Mr. Lorenzo’s credibility.

In her credibility determination, the ALJ pointed to inconsistent statements concerning the

intensity, persistence and limiting effects of Mr. Lorenzo’s symptoms and “the medical evidence and

other evidence of record that supported that he was able to work in another capacity within the

confines of the residual functional capacity.”121 The ALJ found Mr. Lorenzo and his family members

were not fully credible in their testimony describing extreme limitations, and the medical evidence

does not support the inability to function for a period of one year or longer.122

The ALJ began by considering Mr. Lorenzo’s complaint that his back pain was one factor

which prevented him from working.123 The ALJ noted some diagnostic and clinical findings that

referenced back impairment and pain, but the ALJ found that there was very little medical treatment

for Mr. Lorenzo’s back pain.124 The ALJ reasoned that Mr. Lorenzo’s “lack of ongoing treatment

117Id. 118SSR 96-8P. 119R. at 13. 120Id. 121R. at 17-18. 122R. at 19. 123R. at 18. 124Id.

Page 14 of 31
suggest[ed] that the claimant’s back pain and resulting limitations were not as debilitating as he and

his family members have suggested.”125 The ALJ noted Dr. Zelazny’s findings on March 26, 2007,

describing Mr. Lorenzo’s back issues as “mild” and “presumably transitional in nature.”126 The ALJ

also noted that despite Dr. Biase’s determination that the claimant’s back condition was uncontrolled

the claimant failed to seek additional treatment.127 The ALJ concluded that Mr. Lorenzo’s “lack of

treatment for his back condition and pain [did] not support an inability to work.”128

Next, the ALJ considered Mr. Lorenzo’s complaint that in addition to back pain, his

congestive heart failure, high cholesterol and high blood pressure prevented him from working.129

The ALJ noted that Dr. Biase indicated that in May 2007, Mr. Lorenzo’s congestive heart failure

was stable. He also refrenced his hypertension and hypercholesterolemia were both being treated

by medication.130 As a result, the ALJ discredited Mr. Lorenzo’s testimony that he was unable to do

anything but lie around and watch television.131

The ALJ also discredited Mr. Lorenzo’s testimony that his memory was affected by his

medication, noting the lack of support in the medical record.132 The ALJ noted a lab report in

November 2006,133 a consultative examination for the Bureau of Disability Determination Services

in May 2007134 and Mr. Lorenzo’s Adult Functioning Report,135 all of which supported normal

125Id. 126R. at 18, 243. 127R. at 18. 128Id. 129Id. 130R. at 18, 259. 131R. at 18. 132Id. 133R. at 245. 134R. at 259. 135R. at 213.

Page 15 of 31
memory and no side effects from medication.136 Thus, the ALJ concluded that the medical record

did not support Mr. Lorenzo’s memory complaints.137

Last, the ALJ considered Mr. Lorenzo’s complaints of shortness of breath and fatigue.138 The

ALJ examined the opinion of Dr. Snell, who opined that Mr. Lorenzo’s condition was mild and

caused slight limitation during physical activity according to his heart classification.139 Dr. Snell

further opined that Mr. Lorenzo was unable to work full time.140 The ALJ found Dr. Snell’s two

opinions to be inconsistent and discredited Dr. Snell’s opinion that Mr. Lorenzo was unable to work

as conclusory and lacking medical support.141 The ALJ concluded that Mr. Lorenzo’s heart

classification was consistent with sedentary work.142 The ALJ noted and gave some weight to Dr.

Jimenez’s opinion in August 2009, who found that Mr. Lorenzo was capable of light exertional work

during the relevant period.143

The ALJ found the claimant able to perform sedentary work with the limitations set forth in

the RFC and was capable of sustaining competitive work consistent with the RFC.144 In reaching this

conclusion, the ALJ considered Mr. Lorenzo’s fatigue, shortness of breath, obesity and pain.145 The

ALJ noted the VE’s opinion that Mr. Lorenzo was unable to perform past relevant work.146 The ALJ

considered the testimony of the VE who opined that Mr. Lorenzo could perform three positions

136R. at 18. 137Id. 138Id. 139R. at 20. 140R. at 19-20. 141R. at 20. 142Id. 143R. at 20, 267, 273. 144R. at 20. 145R. at 19. 146R. at 20.

Page 16 of 31
including: ticket checker, order clerk and telephone quote clerk.147 The ALJ concluded that based

on the VE’s testimony, Mr. Lorenzo “was capable of making a successful adjustment to other work

that existed in significant numbers in the national economy.”148

IV. Standard of Review

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

substantial evidence and are free of legal error.149 Substantial evidence is relevant evidence that a

reasonable mind might accept as adequate to support a conclusion.150 The standard of review is

deferential, but the reviewing court must conduct a critical review of the evidence before affirming

the Commissioner’s decision.151 Where conflicting evidence allows reasonable minds to differ, the

responsibility for determining whether a plaintiff is disabled falls upon the Commissioner and not

the Court.152 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.153 The Court will conduct a critical review of the evidence and will not uphold the ALJ’s

decision if it lacks evidentiary support or “if the Commissioner applied an erroneous legal

standard.”154

V. Analysis

147R. at 21. 148R. at 21-22. 14942. U.S.C. § 405(g). 150McKenzey v. Astrue, 641 F.3d 884, 889 (7th Cir. 2011) (citing Skinner v. Astrue, 478 F.3d 836, 841 (7th

Cir. 2007); Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003)). 151Eichstadt v. Astrue, 534 F.3d 663, 665 (7th Cir. 2008) (citing Briscoe ex rel. Taylor v. Barnhart, 425 F.3d

345, 351 (7th Cir. 2005)). 152Herr v. Sullivan, 912 F.2d 178, 181 (7th Cir. 1990) (citing Walker v. Bowen, 834 F.2d 635, 640 (7th Cir.

1987)). 153Jones v. Astrue, 623 F.3d 1155, 1160 (7th Cir. 2010); McKinzey, 641 F.3d at 889. 154Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000) (citing Rohan v. Charter, 98 F.3d 966, 970 (7th Cir.

1996)).

Page 17 of 31
Mr. Lorenzo proffers four principal arguments for remand: (1) the ALJ improperly weighed

the opinion of Dr. Snell, his primary treating physician; (2) the ALJ failed to sufficiently account

for the limitations stemming from his obesity; (3) the ALJ’s credibility analysis was patently wrong

because the ALJ dismissed his complaints of frequent, severe pain; and (4) the ALJ erred in

determining his RFC because she found that Mr. Lorenzo was able to lift, perform simple tasks even

when confused and drowsy, and did not account for his need to lie down.

A. The ALJ Properly Weighed the Opinion of Dr. Snell

Mr. Lorenzo argues that the ALJ gave improper weight to the opinion of his treating

cardiologist, Dr. Snell.155 The Commissioner contends that Dr. Snell’s opinion lacked objective

medical evidence and was inconsistent with other substantial medical evidence in the record,

warranting the ALJ’s decision to not give Dr. Snell’s opinion controlling weight.156

Generally, the claimant’s treating physician is given more weight, but the opinion will only

be given controlling weight if it is “well-supported by medically acceptable clinical and laboratory

diagnostic techniques and is not inconsistent with the other substantial evidence in the medical

record.”157 The ALJ will determine which treating and examining doctors’ opinions should receive

weight in a Social Security DIB and SSI case and, in doing so, she must explain the reasons for her

finding.158 If the ALJ decides not to assign this weight to the treating physician, she will consider

factors such as length of treatment, nature of treatment, supportability, consistency, specialization,

155Pl. Mem. at 11, dkt. 20. 156Def. Mem. at 8-10, dkt. 23. 15720 C.F.R § 404.1527(c); S.S.R. 96-5P; Hofslien v. Barnhart, 439 F.3d 375, 376 (7th Cir. 2006 ) (finding

that the treating physician's evidence is no longer entitled to controlling weight once well-supported contradicting

evidence is introduced). 15820 C.F.R § 404.1527(d), (f), 416.927(d), (f); Craft v. Astrue, 539 F.3d 668, 678 (7th Cir. 2008).

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and additional factors to determine how much weight to allocate to the opinion of each physician.159

The ALJ must articulate why particular statements or reports are necessarily inconsistent.160 The ALJ

need not address every piece of evidence or testimony present but, rather, must provide a “logical

bridge” between the evidence and the ALJ’s conclusion.161

In this case, the ALJ gives Dr. Snell’s opinion some weight, as opposed to the controlling

weight sometimes given to the treating physician, for two reasons.162 First, the ALJ noted the

medical questionnaire submitted by Dr. Snell, which stated that prior to December 2007, Mr.

Lorenzo had an ejection fraction of ten to fifteen percent.163 The ALJ further noted that while Mr.

Lorenzo did have an ejection fraction in the range of ten to fifteen percent by October 6, 2006,164 his

ejection fraction rose considerably during the period in question to be within the normal range

according to an echocardiogram performed at Heart Institute on December 3, 2007.165 Therefore, Dr.

Snell’s opinion was inconsistent with Mr. Lorenzo’s considerable improvement, into the normal

range for left ventricle ejection fraction, before December 31, 2007, the last date insured.166

Second, the ALJ found Dr. Snell’s opinion regarding the claimant’s heart classification

15920 C.F.R § 404.1527(c). 160Clifford, 227 F.3d at 871 (explaining that in order to adequately articulate her reasoning for discounting a

treating physician’s opinion, the ALJ must explain why the treating physician’s statements were inconsistent with

others in the record). 161Jones, 623 F.3d at 1160; see also Rohan v. Chater, 98 F.3d 966, 971 (7th Cir. 1996) (citing Carlson v.

Shalala, 999 F.2d 180, 181 (7th Cir. 1993) (finding that the ALJ must sufficiently articulate her assessment of

evidence to create a traceable path of reasoning and to provide assurance that she considered the important

evidence).162R at 20. 163R at 20, 278. 164R. at 246, 252, 291. 165R. at 287; see R. at 249-250 (noting on October 16, 2006: moderately reduced left ventricular ejection

fraction of thirty one percent), 246, 283 (noting on November 17, 2006: estimated ejection fraction of thirty five

percent), 289 (noting on May 22, 2007: estimated ejection fraction range of fifty five to sixty five percent). 166Pfister et al., Range of normal values for left and right ventricular ejection fraction, supra.

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inconsistent with his own conclusion that Mr. Lorenzo was unable to work.167 Initially, the ALJ

noted “that a statement by a medical source that the claimant is disabled or unable to work is

conclusory and an issue reserved for the Commissioner.”168 While the ALJ must consider medical

opinion evidence about any issue, “treating source opinions on issues that are reserved to the

Commissioner are never entitled to controlling weight or special significance.”169 The ALJ then

discounted Dr. Snell because the heart classification he determined Mr. Lorenzo to have is actually

defined as “denot[ing] mild symptoms and slight limitation during physical activity.”170 The ALJ,

therefore, concluded that this would not prohibit him from performing sedentary work.171 For the

purpose of this review, we acknowledge that there is no description or definition of Mr. Lorenzo’s

heart classification in the record, but the description given by the ALJ, the definition noted above,

is similar to the description found on the American Heart Association website.172 Despite the

classification denoting only slight limitation during physical activity, Dr. Snell opined that Mr.

Lorenzo could not work because of his heart classification.173 Those two positions could reasonably

be considered inconsistent. The ALJ’s decision to give Dr. Snell’s opinion less weight, then, was

supported by this inconsistent evidence.174

167R. at 20. 168Id. 169Titles II and Xvi: Med. Source Opinions on Issues Reserved to the Commr., SSR 96-5P (S.S.A July 2,

1996); see Bjornson v. Astrue, 671 F.3d 640, 647-48 (7th Cir. 2012) (finding that the ALJ must not ignore a doctor’s

opinion that a claimant cannot work, though no special significance is owed to the statement). 170R. at 20; see Classification of Functional Capacity and Objective Assessment, supra, (Class II: “Patients

with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical

activity results in fatigue, palpitation, dyspnea, or anginal pain.”). 171R. at 20. 172Id.; see also Classification of Functional Capacity and Objective Assessment, supra. 173R. at 279; see Classification of Functional Capacity and Objective Assessment, supra. 174 20 C.F.R § 404.1527(c); S.S.R. 96-5P; Hofslien v. Barnhart, 439 F.3d 375, 376 (7th Cir. 2006 ) (finding

that a the treating physician's evidence is no longer entitled to controlling weight once well-supported contradicting

evidence is introduced).

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These reasons - the lack of objective medical evidence and inconsistencies with other

medical evidence - sufficiently explain why the ALJ did not give Dr. Snell’s opinion controlling

weight.175 Thus, we conclude that the ALJ’s decision was supported by substantial evidence,176 and

the ALJ created the necessary “logical bridge” connecting the evidence with her conclusion.177 

B. The ALJ Properly Accounted for Mr. Lorenzo’s Obesity

Mr. Lorenzo argues that the ALJ did not properly consider his obesity in combination with

his other impairments.178 Specifically, he claims that the ALJ did not offer a detailed analysis

regarding how obesity might have impacted the “severity of [his] respiratory, cardiovascular, and

musculoskeletal impairment.”179 In response, the Commissioner first asserts that the failure to

consider Mr. Lorenzo’s obesity in certain circumstances, when obesity is indirectly connected to the

decision, is a harmless error. The Commissioner also claims that the ALJ, in fact, repeatedly

referenced Mr. Lorenzo’s obesity.180

The ALJ must factor obesity into the determination of the claimant’s RFC by assessing what

the effect obesity, in combination with other impairments, has upon the individual's ability to

work.181 The ALJ must also evaluate all limitations that arise from medically determinable

175R. at 19. 176McKenzey, 641 F.3d at 889 (citing Skinner, 478 F.3d at 841) (“such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.”). 177Jones, 623 F.3d at 1160 (holding that an ALJ must provide a “logical bridge” from evidence to the

conclusions so the finding can be reviewed); see Lopez ex rel. Lopez, 336 F.3d at 539 (holding that the ALJ must

construct an “accurate and logical bridge from the evidence to his conclusion”). 178Pl. Mem. at 13-14, dkt. 20 (citing Villano v. Astrue, 556 F.3d 558, 563 (7th Cir. 2009)). 179Id. at 13. 180Def. Mem. at 11, dkt. 23 (citing Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir.2006); Richards v.

Astrue, 320 Fed.Appx. 727, 733 (7th Cir. 2010)). 181Id.

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impairments and may not dismiss a line of evidence contrary to the ruling.182

Mr. Lorenzo first asserts that similar to Villano v. Astrue, “the ALJ failed to analyze the

combined effect of [his] obesity and [his] other impairments.”183 In that case, the ALJ was reversed

in part because he failed to create the required logical bridge between the evidence and his

conclusion that the claimant was not credible.184 The ALJ also had failed to consider all of the

claimant’s impairments in his RFC determination that found him able to sit for six hours in an eight

hour work-day without considering the combined effects of the claimant’s obesity and other

impairments.185

But here, in accordance with the clinical guidelines, the ALJ calculated Mr. Lorenzo’s BMI

to be 34.7 and classified him as obese.186 The ALJ also considered SSR 02-1p and concluded that

Mr. Lorenzo did not meet or equal the listing when she considered obesity in conjunction with his

other severe impairments.187 The ALJ stated that she would “consider his obesity in the sequential

evaluation process and in assessing his RFC.”188 Finally, the ALJ noted Mr. Lorenzo’s obesity,

fatigue, shortness of breath and pain in her determination that he was limited to sedentary work.189

Mr. Lorenzo’s shortness of breath limited his ability to climb stairs, which the ALJ acknowledged

when she limited climbing ramps and stairs to “occasional.”190 Finally, the ALJ noted that she

182S.S.R. 96–8p; Villano, 556 F.3d at 563 (citing Golembiewski v. Barnhart, 322 F.3d 912, 917 (7th

Cir.2003)). 183556 F.3d at 563. 184Id. at 562. 185Id. at 563. 186R. at 13; see SSR 02-1P. 187R. at 13. 188Id. 189R. at 19. 190Id.

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considered Mr. Lorenzo’s obesity when making the additional postural limitations in Mr. Lorenzo’s

RFC finding.191 Considering each of these notions, we find that unlike in Villano, the ALJ

adequately considered Mr. Lorenzo’s obesity and the effect it may have had on his other limitations

in making her RFC conclusion, and explained how his obesity effected her postural limitation

analysis.192

C. The ALJ Properly Assessed Mr. Lorenzo’s Credibility

Mr. Lorenzo argues that the ALJ improperly assessed his credibility and erred in dismissing

his complaints of pain.193 The Commissioner argues that the ALJ provided an adequate explanation

of Mr. Lorenzo’s credibility by considering the “lack of ongoing treatment, the absence of regular

pain medication, the treating physician’s opinion, the medical evidence, and Mr. Lorenzo’s

allegations.”194

According to SSR 96-7p, the ALJ must base her credibility finding on the entire record and

must sufficiently explain her conclusion of the claimant’s credibility.195 The ALJ may consider, for

the purposes of her credibility analysis, the claimant’s pursuit of treatment, so long as she also

considers any argument the claimant might offer such as over-the-counter medication or debilitating

side effects.196 In analyzing inconsistencies between a claimant’s statements and medical evidence,

an ALJ must investigate “all avenues” presented that relate to pain, including the observations by

191Id. (finding the claimant able to occasionally balance, stoop, kneel, crouch and crawl). 192S.S.R. 02-1P; 42 U.S.C. § 405(b)(1); Villano, 556 F.3d at 563; Prochaska, 454 F.3d at 738. 193 Pl. Mem. at 15, 17, dkt. 20. 194Def. Mem. at 13, dkt. 23. 195Titles II and XVI: Evaluation of Symptoms in Disability Claims: Assessing the Credibility of an

Individual's Statements, SSR 96-7P (S.S.A July 2, 1996). 196Id.

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treating and examining physicians.197 While the ALJ may not reject subjective complaints of pain

solely because they are not supported by medical evidence, the ALJ may consider this conflict as

probative of the claimant’s credibility.198 Last, this Court grants deference to the ALJ’s credibility

assessment, and will only overturn it if it is “patently wrong.”199

In this case, the ALJ found Mr. Lorenzo to be not fully credible because the “medical

evidence, physical examination and treatment provided” were inconsistent with the degree and

severity of his subjective complaints. Specifically, the ALJ explained that: (1) he failed to pursue

ongoing treatment for back pain that he testified was debilitating; (2) there was a lack of medical

support for the severity of his shortness of breath, fatigue, and chest pain; and (3) there was a lack

of medical support for his memory complaints.200 

Consistent with SSR 96-7P, the ALJ noted that Mr. Lorenzo had “very little medical

treatment for his back pain,” and he did not use “any pain medication on a regular basis.”201 The ALJ

also noted the lack of any “physical therapy, steroid injections, or any other type of therapy or

treatment to support his limitations with regard to back pain.”202 Such inconsistencies between

subjective complaints and medical evidence “casts doubt on [his] credibility.”203

Next, the ALJ noted that the record contained some complaints of shortness of breath and

fatigue, but that the diagnostic testing and procedures showed that Mr. Lorenzo’s heart condition

197Luna v. Shalala, 22 F.3d 687, 691 (7th Cir. 1994). 198Powers, 207 F.3d at 435. 199Jones, 623 F.3d at 1160; see also Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000) (finding that an

ALJ’s credibility determinations must have been “patently wrong” in order to be overturned). 200R. at 18-19. 201R. at 18. 202Id. 203Powers, 207 F.3d at 435 (finding “the discrepancy between the minimal impairment expected from her

conditions and her testimony of debilitating pain casts doubt on her credibility”).

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improved and that he reported no side effects from his medication.204 The ALJ supported her

conclusion further by noting that Mr. Lorenzo did not “have frequent trips to the doctor or hospital

with severe complaints of shortness of breath and fatigue” that would support his complaint that he

was unable to do anything besides lie around.205

Last, the ALJ noted that the medical record did not support Mr. Lorenzo’s testimony that his

memory was affected by his medication, and his testimony was contradicted by his Adult Function

Report, where he claimed to have no side effects from his medication.206 Therefore, while the ALJ

may not completely ignore Mr. Lorenzo’s complaints of poor memory because they are not

supported by medical evidence, the lack of support is probative of his credibility.207

As a result, the ALJ gave partial credit to Mr. Lorenzo’s reports of pain and functional

limitations in assessing her RFC, despite his physical examination that revealed inconsistences

between the medical record and his testimony.208 The ALJ also limited Mr. Lorenzo to simple,

routine, and repetitive tasks because of his complaints of fatigue and confusion from his heart

medication, even though he reported no side effects from his medication in his Adult Function

Report.209 The ALJ also considered the opinion of Dr. Snell, giving him some weight because he was

Mr. Lorenzo’s treating physician and a cardiovascular specialist,210 and noted the reports from Mr.

Lorenzo’s family members in her RFC finding, despite not finding them completely credible in

204R. at 18. 205R. at 19. 206R. at 18, 213; see R. at 245, 259; see Powers, 207 F.3d at 435 (finding that discrepancies between

testimony and objective medical evidence can cast doubt on the claimant’s credibility). 207See Powers, 207 F.3d at 435. 208R. at 19. 209R. at 18-19, 180. 210R. at 20.

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reducing Mr. Lorenzo’s RFC to sedentary work.211 Thus, the ALJ considered both Mr. Lorenzo’s

testimony, and the testimony of others, when she determined that Mr. Lorenzo had a more restrictive

RFC than even Dr. Jiminez’s findings supported.212

D. The ALJ Properly Determined Mr. Lorenzo’s RFC

Mr. Lorenzo’s final argument is that the ALJ erred in her determination of his RFC by: (1)

failing to provide medical support for her conclusion, (2) failing to consider Mr. Lorenzo’s fatigue

and confusion, and (3) failing to properly consider Mr. Lorenzo’s back pain and his inability to sit

or stand for prolonged periods.213

When assessing a claimant’s RFC, the ALJ must consider all limitations that arise from

medical impairments, regardless of the severity of the limitation.214 The ALJ’s RFC assessment must

be based on all of the relevant evidence, including, but not limited to, medical history, side effects

of medication, reports or daily activities, lay evidence, and effects of symptoms.215 Lastly, the ALJ

must base her RFC determination in evidence, and explain how she reached her conclusions.216

1. The ALJ Supported Her RFC Conclusion With Medical Evidence

Mr. Lorenzo’s first argument is that the ALJ failed to adequately explain her RFC

conclusion, and that the ALJ filled in the evidentiary gaps in the record without adequate

evidence.217 The Commissioner counters by arguing that the ALJ is not required to cite direct

211R. at 19-20. 212R. at 19. 213Pl. Mem. at 7-11, dkt. 20. 214Villano, 556 F.3d at 563. 215Title II & XVI: Assessing Residual Functional Capacity in Initial Claims, SSR 96.8P (S.S.A. July 2,

1996). 216Scott v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011) (citing Moss v. Astrue, 555 F.3d 556, 561 (7th Cir.

2009); Briscoe ex. rel Taylor, 425 F.3d at 352). 217Pl. Mem. at 7, dkt. 20 (citing Suide v. Astrue, 371 Fed.Appx. 684, 690 (7th Cir. 2010)).

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evidence to support her RFC determination. Instead, the ALJ need only “provide that the RFC

finding is based on all the evidence of record.”218

The ALJ found that the medical evidence supported that Mr. Lorenzo was able to work

within the confines of the RFC.219 The ALJ noted that Mr. Lorenzo believed he was unable to work

primarily because of back pain and congestive heart failure.220 As discussed in the credibility

analysis above, the ALJ noted that Mr. Lorenzo’s failure to pursue treatment and medication did not

support his complaint of debilitating back pain.221 Next, the ALJ noted that Mr. Lorenzo’s heart

condition improved over the period in question, and was noted as stable with his current medication

therapy.222 Finally, the ALJ noted that Mr. Lorenzo’s heart classification is defined as mild and

would not prevent him from performing sedentary work.223 In her conclusion, the ALJ referenced

the opinions of both Dr. Jimenez and Dr. Snell, the medical record, the testimony of Mr. Lorenzo,

and his family’s reports.224 The ALJ “made additional restrictions and reduced [Mr. Lorenzo] to

sedentary work” based on the aforementioned factors.225 Therefore, the ALJ based her RFC

conclusion upon the evidence in the record and the hearing testimony, and explained how she

reached her determination that Mr. Lorenzo is able to perform sedentary work.226

2. The ALJ Properly Accounted for Mr. Lorenzo’s Fatigue and Confusion

in Determining His RFC.

218Def. Mem. at 6, dkt. 23 (citing 20 C.F.R. §§ 404.1527(d)(2), 404.1545(a)(3)). 219R. at 18. 220Id. 22118, 244, 258-9, 273. 222R. at 18, 259, 273, 287. 223R. at 19. 224R. at 18-19. 225R. at 19. 226Scott, 647 F.3d at 740 (citing Moss, 555 F.3d at 561; Briscoe ex. rel Taylor, 425 F.3d at 352).

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Next, Mr. Lorenzo argues that the limitations created by his fatigue and confusion were not

properly considered in the ALJ’s RFC analysis.227 He argues that without support from the record,

the ALJ found that fatigue and confusion limited him to simple, routine, and repetitive tasks, but

were not considered as more limiting.228 The Commissioner argues that Mr. Lorenzo failed to submit

medical evidence that would “prevent him from performing simple, routine, repetitive tasks, and the

ALJ reasonably found that he could.”229

The ALJ explicitly considered both fatigue and memory in her determination that Mr.

Lorenzo could perform sedentary work.230 Mr. Lorenzo’s fatigue stemmed from his congestive heart

failure, and the ALJ examined the record regarding the state of his heart condition, as well as his

independent complaints of shortness of breath.231 The ALJ noted that during an exam in May 2007,

Mr. Lorenzo’s congestive heart failure was determined to be stable, and nothing in the medical

evidence supported that his fatigue made him unable to do anything but lie around.232 Mr. Lorenzo

argues that the ALJ failed to properly analyze his fatigue and need to lie down.233 However, the ALJ

supported her finding by noting that Mr. Lorenzo had no side effects from his medication, according

to his Adult Function Report.234 Additionally, during the period at issue, Mr. Lorenzo’s heart

227Pl. Mem. at 7, dkt. 20. 228Pl. Mem. at 7, dkt. 20 (citing O’Conner-Spinner v. Astrue, 627 F.3d 614, 620 (7th Cir. 2010)). 229Def. Mem. at 7-8, dkt. 23 (citing Shideler v. Astrue, 688 F.3d 308, 311 n.1 (7th Cir. 2012) (finding that

the ALJ may discredit subjective complaints if they are not supported by objective medical evidence)). 230R. at 18-19. 231Id. 232R. at 19, 259. 233Martinez v. Astrue, 2009 WL 4611415 *12 (N.D. Ind. 2009) (finding that an ALJ must connect the

evidence and the claimant’s credibility determination);Cuevas v. Barnhart, 2004 WL 1588277, *15 (N.D. Ill. 2004)

(holding that the ALJ must explain her reasoning and may not ignore evidence that is contrary to her ultimate

conclusion); Holland v. Barnhart, 2003 WL 22078383, *9 (N.D. Ill. 2003) (holding that the ALJ must discuss

relevant evidence adequitely so that it is possible to review her conclusion). 234R. at 18.

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condition, primarily measured through ejection fraction, improved from ten to fifteen percent, below

normal, to fifty-five to sixty-five percent, within the normal range.235 An ALJ may discredit

subjective complaints if they are not supported by objective medical evidence and if she created the

necessary logical connection between the evidence and the conclusion.236 Thus, the ALJ did not err

when she ascribed partial credibility to Mr. Lorenzo’s subjective complaints because they were

inconsistent with the objective medical evidence.237

Similarly, the ALJ noted that all of the medical evidence presented showed Mr. Lorenzo’s

memory as normal.238 The ALJ considered Mr. Lorenzo’s Disability Report Appeal in which he

claimed to have no side effects from any of his medications.239 The ALJ’s dismissal of Mr.

Lorenzo’s complaints of memory issues because there was no objective medical evidence to support

his subjective complaints does not constitute an error.240 As a result, the ALJ sufficiently articulated

her analysis of the record and the evidentiary support for her RFC assessment.241

3. The ALJ Properly Considered Mr. Lorenzo’s Back Pain When

Determining His RFC

Finally, Mr. Lorenzo argues that his back pain was improperly dismissed and the ALJ erred

in finding him capable of sitting for six hours in an eight hour work-day.242 Mr. Lorenzo argues that

the ALJ failed to consider his need to lie down, and cited a number of cases where courts within the

235R. at 287, 291. 236Shideler, 688 F.3d at 311-12; see Martinez, 2009 WL 4611415 *12. 237Id. 238R. at 19, 243-259; 239R. at 19, 213. 240Shideler, 688 F.3d at 311-12 (finding that the ALJ may discredit subjective complaints if they are not

supported by objective medical evidence). 24120 C.F.R. §§ 404.1527(d)(2), 404.1545(a)(3); Title II & XVI: Assessing Residual Functional Capacity in

Initial Claims, SSR 96.8P (S.S.A. July 2, 1996); see Briscoe ex rel. Taylor, 425 F.3d at 352. 242Pl. Mem. at 10, dkt. 20.

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Seventh Circuit have reversed the ALJ on similar grounds.243 Citing Villano, the ALJ found him able

to sit for six hours each day despite objective evidence of back pain.244 But the Commissioner

responds by arguing that the ALJ sufficiently addressed Mr. Lorenzo’s back pain and need to lie

down, and that the ALJ exceeded the minimum level of analysis necessary to allow the reviewing

court to follow her reasoning.245

We agree with the Commissioner that the ALJ sufficiently considered the record in making

her assessment of Mr. Lorenzo’s RFC.246 Unlike Villano, as we have already discussed, the ALJ

specifically considered Mr. Lorenzo’s other impairments along with his complaints of pain when

discussing his postural limitations.247 In Villano, the Court stressed the “cursory analysis” and failure

to consider the claimant’s combination of impairments;248 in this case, the ALJ articulated her

analysis of both.249 In addition, the ALJ noted Mr. Lorenzo’s first treatment in March 2007, and that

he was given Norco for his pain.250 The ALJ also noted that the record showed no pursuit of any

“physical therapy, steroid injections, or any other type of therapy or treatment.”251 The ALJ

concluded that Mr. Lorenzo’s failure to obtain treatment or regular pain medication does not support

243Pl. Mem. at 8-9, dkt. 20 (citing Martinez, 2009 WL 4611415 *12 (N.D Ind. 2009) (needing to lie down

several times a day undermines finding the claimant capable of sedentary work); Cuevas, 2004 WL 1588277, *15

(N.D. Ill. 2004) (failing to consider the claimant’s need to take a nap each day); Holland, 2003 WL 22078383, *9

(N.D. Ill. 2003) (failing to consider affect of fatigue on the claimant’s job performance)). 244R. at 18, 55-56; Villano, 556 F.3d at 563 (finding the ALJ erred improperly drawing inferences about the

claimant’s ability to sit based solely on a lack of objective medical evidence without consideration of the claimant’s

other impairments). 245Def. Mem. at 8, dkt. 23(citing R. at 14-15, 18-19; Johnsen v. Barnham, 214 F.3d 283, 287 (7th Cir.

2002)(citation omitted)). 246Id.; see R. at 16-19. 247R. at 19. 248556 F.3d at 563. 249R. at 18-19. 250R. at 18. 251Id.

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his claims of debilitating pain.252 The Seventh Circuit has found that the failure to pursue treatment

and medication can be used by the ALJ to consider the claimant’s subjective complaints.253 Further,

the ALJ considered the conclusion of the March 2007 examination describing the maximum and

current symptoms as mild.254 The ALJ considered both inconsistencies in the record and Mr.

Lorenzo’s failure to pursue relief for his symptoms and, therefore, adequately considered the record

in her assessment of his RFC.255

IV. Conclusion

For the reasons set forth above, Mr. Lorenzo’s motion for summary judgment is denied [dkt.

19] and the Commissioner’s motion is granted [dkt. 27]. 

IT IS SO ORDERED.

Date: July 2, 2013 ____________________

Susan E. Cox

U.S. Magistrate Judge 

252Id. 253Orlando v. Heckler, 776 F.2d 209, 214 (7th Cir. 1985) (finding that failure to take strong pain medication

and a lack of any regular treatment for the claimant’s condition can be considered when weighing subjective

complaints). 254R. at 18, 244. 255R. at 18-19.

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