IN THE UNITED STATES DISTRICT COURT 

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

PAMELA S. KOKOS, )

 )

Plaintiff, )

 )

 v. ) No. 12 C 5271

)

CAROLYN W. COLVIN,

1 ) Magistrate Judge Finnegan

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Pamela S. Kokos seeks to overturn the final decision of the 

Commissioner of Social Security (“Commissioner” or “Defendant”) denying her

application for Disability Insurance Benefits (“DIB”) under Title II of the Social 

Security Act. 42 U.S.C. §§ 416(i), 423(d). The parties consented to the 

jurisdiction of the United States Magistrate Judge pursuant to 28 U.S.C. § 636(c), 

and filed cross-motions for summary judgment. After careful review of the 

record, the Court now grants the Commissioner’s motion, denies Plaintiff’s 

motion, and affirms the decision to deny disability benefits.

PROCEDURAL HISTORY

Plaintiff applied for DIB on October 20, 2009, alleging that she became 

disabled on January 17, 20092 due to: fibromyalgia; arthritis in the knees, neck 

 

1 Ms. Colvin became Acting Commissioner of Social Security on February 14, 

2013, and is substituted in as Defendant pursuant to Federal Rule of Civil Procedure 

25(d)(1).

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and shoulders; bursitis in the hip; tendinitis in the elbow; and “back surgery and 

pain.” (R. 177, 201). The Social Security Administration denied the applications 

initially on December 29, 2009, and again upon reconsideration on April 21, 

2010. (R. 103-15). Plaintiff filed a timely request for hearing and appeared 

before Administrative Law Judge Roxanne J. Kelsey (the “ALJ”) on February 4, 

2011. (R. 63). The ALJ heard testimony from Plaintiff, who was represented by 

counsel, as well as from vocational expert Pamela J. Tucker (the “VE”). Shortly 

thereafter, on April 15, 2011, the ALJ found that Plaintiff is not disabled because 

there are a significant number of light jobs she can perform in the national 

economy. (R. 20-31, 40-51). The Appeals Council denied Plaintiff’s request for 

review on May 4, 2012, (R. 1-3), and Plaintiff now seeks judicial review of the 

ALJ’s decision, which stands as the final decision of the Commissioner.

Plaintiff raises multiple arguments in support of her request for remand, 

including that the ALJ: (1) failed to properly consider the combined effects of 

Plaintiff’s obesity together with her other impairments; (2) erred in weighing the 

physician opinion evidence; (3) made a flawed RFC determination; and (4) erred 

in assessing Plaintiff’s credibility. As discussed below, the Court finds that the 

ALJ’s decision is supported by substantial evidence and does not require 

reversal or remand.

 

2 Plaintiff initially alleged on onset date of January 7, 2009 but amended it to 

January 17, 2009 at the administrative hearing. (R. 20).

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FACTUAL BACKGROUND

Plaintiff was born on July 15, 1958, and was 52 years old at the time of the 

ALJ’s decision. (R. 65, 177). She has a high school diploma and worked at 

various times as a bartender, hostess/office worker and waitress. (R. 65-66, 

202). Though Plaintiff says she did not become disabled until January 2009, it 

appears that she stopped working as of January 2007. (R. 218).

A. Medical History

Plaintiff had back surgery in 1985 and again in late 2005. (R. 459, 572). 

Throughout 2006, she routinely sought treatment with Patrick S. Cosgrove, D.O., 

at the Hammond Clinic for various conditions including a bleeding ulcer. In 

December 2006, she first started complaining of constant joint pain and stiffness. 

(R. 784). At appointments with Dr. Cosgrove in June and October 2007, Plaintiff 

said that she had been experiencing severe pain all over her body for the past 

year, including constant numbness in the shoulders, hands, hips and feet. (R. 

773, 776). Dr. Cosgrove prescribed Lyrica and by November 1, 2007, Plaintiff 

was feeling 75% better. (R. 772).

1. 2008

Plaintiff reported “feeling ok” when she saw Dr. Cosgrove on January 25, 

2008, and he increased her dosage of Lyrica. (R. 770). The Lyrica was still 

helping on February 28, 2008, but Plaintiff complained of continued diffuse joint 

pain in the shoulders, wrists and hips. (R. 769). Dr. Cosgrove referred her to 

Anita M. Zachariah, M.D., at the Hammond Clinic for evaluation of muscle pain. 

At that initial visit on March 3, 2008, Plaintiff told Dr. Zachariah that she had been 

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experiencing diffuse pain in both hips and shoulders for 1 1/2 years, and suffers 

from osteoarthritis (“OA”) in her knees. She complained that her arms were 

falling asleep, her hands felt stiff in the morning, and she had an aching pain in

her hips and legs. Plaintiff said that she cannot take non-steroidal antiinflammatory drugs (“NSAIDs”) due to a history of gastric ulcers but was getting 

mild pain improvement from the Lyrica. (R. 763). On examination, Dr. Zachariah 

noted tenderness in Plaintiff’s hands and hips with full range of motion and 

normal strength in both legs. (R. 764). She diagnosed trochanteric (hip) bursitis,

prescribed Lidoderm patches and Tramadol for the pain, and referred Plaintiff to 

physical therapy (“PT”). (R. 765).

At Plaintiff’s Initial Evaluation for PT on March 13, 2008, she noted her 

history of shoulder and wrist pain but said she wanted to prioritize her hip pain at 

that time. (R. 365). The next day, on March 14, 2008, Plaintiff had an X-ray of 

the cervical spine to evaluate the numbness in her hands. The test showed

intervertebral disc space narrowing and neural foramina stenosis at C2-C3, 

intervertebral disc space narrowing at C5-C6, and mild narrowing at C4-C5. (R. 

343). Plaintiff had PT on March 21 and 28, 2008, and reported “doing good” with

a pain level of 2/10. (R. 363, 364).

When Plaintiff returned to Dr. Zachariah on April 2, 2008, she said that the 

PT, Lyrica and Lidoderm patches had been helpful for her hip bursitis, but she 

still had pain in her right arm radiating down to the hand, and she complained of 

joint pain and stiffness. (R. 361). Dr. Zachariah opined that the cervical X-rays 

showed “significant” OA in the neck, (id.), and diagnosed shoulder bursitis. (R. 

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362). She referred Plaintiff for more PT and gave her cortisone injections to help 

with the shoulder pain. (Id.). Plaintiff attended PT sessions on April 4 and 9, 

2008, and reported that she was “doing good” and her symptoms were better. 

(R. 358, 359).

On May 12, 2008, Plaintiff had bilateral wrist and hand X-rays. The results 

were normal with no evidence of fracture, dislocation, osseous destruction, 

erosions, or abnormal calcifications. (R. 339). X-rays of both knees taken the 

same day showed “bilateral narrowing in the medial joint compartments right 

greater than left, mild severity.” (R. 340-41). At a follow-up visit with Dr. 

Zachariah on May 15, 2008, Plaintiff reported that her shoulder and right hip 

were bothering her again, and she complained of joint pain and swelling. (R. 

766). Dr. Zachariah diagnosed hip bursitis that was not improving, and OA of the 

lower leg, including the fibula, knee, patella and tibia. She gave Plaintiff 

cortisone injections in the hip and knee to assist with the pain. (R. 767).

Plaintiff next saw Dr. Zachariah on June 19, 2008 for an established 

follow-up appointment. She was still struggling with the hip bursitis and OA of 

the knees, and indicated that the injections had only helped for 2 or 3 weeks. (R. 

760). Dr. Zachariah gave Plaintiff a Synvisc injection in her right knee and said 

she would consider giving Plaintiff another hip injection when she returned the 

following week. (R. 761). At that June 26, 2008 visit, Plaintiff’s hip bursitis was 

better and Dr. Zachariah decided against another injection. She also noted that 

Plaintiff was reporting only minimal hand symptoms. (R. 758). As for the knee 

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pain, Plaintiff confirmed that the Synvisc had helped so Dr. Zachariah gave her a 

second injection as scheduled. (R. 759).

Plaintiff reported continuing improvement when she saw Dr. Zachariah 

again on July 3, 2008. The pain in her hip, shoulder and hand was better and 

she had no joint swelling or stiffness. (R. 756). Dr. Zachariah gave Plaintiff a 

third Synvisc injection in the knee and said she could return only as needed. (R. 

757). More than two months later, on September 29, 2008, Plaintiff saw Dr. 

Zachariah for a follow-up evaluation of her knee pain. She did not have any joint 

swelling or stiffness, but she requested additional injections to help with 

increased symptoms in the right knee and hip. (R. 749). Dr. Zachariah 

described Plaintiff’s OA in the lower leg as “improving,” gave her cortisone shots

in the knee and hip, and instructed her to continue using the Lidoderm patch and 

Lyrica. (R. 750).

2. 2009

A few months later, on January 14, 2009, Plaintiff was admitted to the 

Munster Community Hospital after her husband found her unconscious from

alcohol intoxication. (R. 659-60). She was prescribed Librium to help with the 

withdrawal symptoms and discharged three days later on January 17, 2009. (R. 

662-64). Plaintiff claims that she became disabled the day of her discharge.

When Plaintiff saw Dr. Cosgrove on May 19, 2009, she was “feeling well” 

with no edema or varicosities of the extremities, and was regularly attending 

Alcoholics Anonymous (“AA”) meetings. Dr. Cosgrove diagnosed her with stable 

diabetes mellitus and noted that she weighed 231 pounds at a height of 5’8”. (R. 

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733, 831, 967-68). Plaintiff next saw Dr. Cosgrove for a routine visit and 

medication refill on August 12, 2009. She was “[f]eeling great” at that time, once 

again presenting with no edema or varicosities of the extremities. (R. 727, 972). 

Dr. Cosgrove diagnosed benign hypertension (“HTN”) and scheduled a follow-up 

visit for November 2009 to obtain updated lab tests. (R. 728, 972).

On October 27, 2009, Plaintiff had an appointment with Dr. Zachariah to 

assess her knee pain. Dr. Zachariah noted Plaintiff’s history of OA, HTN, 

bursitis, fibromyalgia, obesity, and gastrointestinal (“GI”) ulcers from NSAID use. 

Plaintiff had no joint swelling or stiffness but she did present with joint pain that 

was disturbing her sleep, and she requested additional injections. (R. 839). Dr. 

Zachariah observed that Plaintiff’s gait was intact and her knee was “normal to 

inspection and palpation.” Since Plaintiff reported that the Lidoderm patches 

were “really not helping,” however, Dr. Zachariah gave her a Synvisc injection for 

the knee pain and a cortisone shot in the hip for the bursitis pain. (R. 840).

Plaintiff returned to Dr. Zachariah on November 3, 2009 for a follow-up 

evaluation. She continued to complain of joint pain but there was no swelling or 

stiffness and her sleep had improved. Plaintiff’s hip bursitis and knee pain were

also better following the injections, though she did experience one day of knee 

pain over the previous week. (R. 836). On examination, Plaintiff’s gait remained 

intact and her knee was normal. Dr. Zachariah gave her another Synvisc 

injection and instructed her to return in one week. (R. 837). At that November 

11, 2009 visit, Dr. Zachariah noted that Plaintiff’s BMI was 36.49 and confirmed 

her history of: diffuse OA of knees, helped by Synvisc; right hip bursitis “which is 

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better after injection”; obesity; fibromyalgia; and GI ulcer. Plaintiff said that she 

was “[s]tarting to exercise again,” had no joint swelling, stiffness or pain, and was 

still sleeping well. (R. 831). Dr. Zachariah gave Plaintiff another Synvisc

injection in the right knee, (R. 832, 1065), and instructed her to return in six 

months. (R. 833).

The following day, on November 12, 2009, Plaintiff saw Dr. Cosgrove for a 

check of her blood pressure and lab results. (R. 965). Plaintiff was “motivated to 

start diet and exercise” at that time and Dr. Cosgrove diagnosed her with stable 

diabetes. (R. 829, 966). Plaintiff’s next two visits with Dr. Cosgrove in November 

and December 2009 related solely to her complaints of tonsillitis and a 

subsequent tonsillectomy. (R. 1050-51, 1053-55).

On December 21, 2009, Charles Wabner, M.D., completed a Physical 

Residual Functional Capacity (“RFC”) Assessment of Plaintiff for the Bureau of 

Disability Determination Services (“DDS”). (R. 903-10). Dr. Wabner found that 

Plaintiff can occasionally lift 20 pounds; frequently lift 10 pounds; stand, walk and 

sit for about 6 hours in an 8-hour workday; and push/pull without limitation. (R. 

904). Plaintiff can occasionally climb, balance, stoop, kneel, crouch, and crawl

and has no other limitations. (R. 905-07).

3. 2010

On January 28, 2010, Plaintiff saw Elisa Rhodes, NP, at the Hammond 

Clinic with complaints of right foot pain. Plaintiff admitted to injuring her foot two 

years prior while walking up stairs and never having it examined. Now, she was 

experiencing shooting pain to the bottom of her foot and up the ankle, with 

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throbbing at times. She rated the pain as a 7/10 with standing, and described 

trying to walk on the side of her foot to compensate for the pain. (R. 924). Nurse 

Rhodes reported that Plaintiff had a normal gait, station and posture, and the 

sensation in her foot was intact. There was trace edema (swelling) in the right 

ankle, however, and decreased range of motion in both the ankle and foot, 

especially with flexion. Nurse Rhodes gave Plaintiff a “cam” (controlled ankle 

motion) walker to help her avoid further injury, prescribed Ultram and Darvocet, 

and scheduled her for a follow-up visit in one week. (R. 925). The same day, 

Plaintiff went for X-rays of her right foot and ankle. The tests showed spurring at 

the superficial aspect of the medial malleolus compatible with old trauma, as well 

as mild degenerative findings of the first metatarsal phalangeal joint, but was 

otherwise unremarkable. (R. 922, 993).

Plaintiff returned to Nurse Rhodes on February 3, 2010, for a recheck of 

her right foot. She said that she had used only one Darvocet since her last visit

and was not wearing the cam boot often, i.e., only a “couple times in past week.” 

Plaintiff also denied having severe pain at that time. (R. 920, 956). Nurse 

Rhodes noted that Plaintiff had a normal gait, station and posture, and told her to 

wear the cam walker as directed and follow-up with a podiatrist. (R. 920-21, 

956). It does not appear from the record that Plaintiff in fact consulted with a 

podiatrist.

When Plaintiff saw Dr. Cosgrove on February 12, 2010 to check her blood 

pressure, she complained of continued right foot pain that felt like “pins and 

needles.” (R. 917, 959). Dr. Cosgrove diagnosed diabetes with possible 

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neuropathy and benign HTN, indicated that Plaintiff would likely need an EMG

and a consultation with a neurologist, and asked her to return in three months. 

(R. 918, 959). On February 23, 2010, Plaintiff went for a follow-up visit with Dr. 

Zachariah. The doctor noted that Plaintiff’s BMI was 36.79, the diffuse OA of her 

knees was “now better” with Synvisc, her hip bursitis was also “better after 

injection,” and she had no joint swelling, pain or stiffness. (R. 915, 1058). 

Plaintiff reported that after shoveling snow, however, she was now having pain in 

her neck and cervical muscles, as well as numbness in the right foot. (Id.). On 

examination, Plaintiff had normal range of motion in her spine but 

paramusculature tightness and tenderness on the right side. To help with 

Plaintiff’s “muscle spasm after activity,” Dr. Zachariah prescribed Flexeril and 

Limbrel. (R. 916).

Plaintiff returned to Dr. Zachariah for a routine follow-up on March 16, 

2010. The treatment note was largely unchanged from the previous visit, except 

that Plaintiff reported improvement in her neck and cervical pain with the Limbrel 

and Flexeril. (R. 912, 1062). Dr. Zachariah instructed Plaintiff to return as 

needed. (R. 913). The following month, on April 14, 2010, Plaintiff had a nerve 

conduction EMG study performed on her legs. The findings were “most 

consistent with mild right chronic L5-S1 radiculopathy.” (R. 1178).

Five days later, on April 19, 2010, Vidya Madala, M.D., affirmed Dr. 

Wabner’s December 29, 2009 RFC assessment. Dr. Madala considered new 

treatment records showing that Synvisc had helped with Plaintiff’s knee pain 

symptoms, and that her bursitis had likewise improved following injections. He 

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also cited to Dr. Zachariah’s March 16, 2010 treatment note indicating that 

Plaintiff exhibited no joint swelling, stiffness or pain, as well as documentation of 

normal range of motion in the spine on February 23, 2010. Though Plaintiff 

alleged that her conditions had worsened, Dr. Madala found no evidence of this 

in the record and thus affirmed that Plaintiff is capable of performing light work. 

(R. 938).

The next day, on April 20, 2010, Plaintiff had an MRI of the lumbar spine. 

The test showed: persistent central disc herniation at T11-12 resulting in 

“moderate compression of the ventral thecal sac with mild central canal stenosis 

suspected”; diffuse disc bulging at L3-4 with degenerative facet change resulting 

in mild central spinal canal narrowing; postoperative changes at L4-5 and L5-S1 

with disc bulging and degenerative facet changes; and “[r]esidual narrowing of 

the inferior proximal right neural foramen at L5-S1.” (R. 941).

When Plaintiff saw Dr. Cosgrove on May 14, 2010 for a check of her 

cholesterol, her BMI was 38.16. (R. 974). Dr. Cosgrove started her on 

simvastatin to help lower her cholesterol, recommended that she focus on diet 

and exercise, and instructed her to return in three months. (R. 975). Five days 

later, on May 19, 2010, Plaintiff called Dr. Cosgrove and Dr. Zachariah because 

her application for disability benefits had been denied and her lawyers told her 

“she needs to make sure her physicians will support her in this action.” Plaintiff 

said that she was seeking disability “with diagnosis of fibromyalgia and history of 

back surgery in 2005,” and noted that she was a waitress and could “no longer 

lift, or even do yard work on her knees anymore.” (R. 976). Dr. Zachariah 

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responded by email that she “can’t support this as a reason for disability.” Dr. 

Cosgrove responded by email that “I would say she could still work, maybe not 

her current job, or with restrictions. I would say she is not completely disabled.” 

(Id.).

Plaintiff subsequently started treating with Vijay Gupta, M.D., of the 

Hammond Pain Clinic for lower back pain radiating to the right leg. At an initial 

June 29, 2010 visit, Plaintiff reported having more pain with walking and standing 

for long periods of time, and complained of numbness and tingling in her foot. 

(R. 1160). Straight leg raise tests were negative but a Patrick’s sign, a test used 

to determine the presence of arthritis, was positive on the right side. Dr. Gupta 

diagnosed status post laminectomy at L4-5 and L5-S1, bulging disc at L5-S1 

causing central canal stenosis, and right foraminal stenosis. (R. 1161). He 

recommended that Plaintiff have a transforaminal epidural steroid injection to 

help with the pain, (R. 1162), and Plaintiff underwent that procedure on July 2, 

2010. (R. 1156-57).

Between August 18 and October 18, 2010, Plaintiff attended 19 physical 

therapy sessions at St. Margaret Mercy Rehabilitation Services. (R. 945-46). At 

her last visit, the therapist noted that she had achieved four of six goals but not 

the ones relating to standing and walking. (R. 983). The initial assessment 

identified those two goals as: being able to stand for 10-15 minutes without 

increased complaints of pain; and being able to walk short distances for exercise. 

(R. 1171). The therapist indicated that Plaintiff needed to continue exercising, 

(R. 983), and gave her an Exercise Referral to the Omni Health & Fitness 

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Connection, an affiliate of St. Margaret Mercy. (R. 1176). The referral stated 

that Plaintiff should not jog, stair climb, cross country ski, take high impact dance 

exercise classes, or bend too much, but she otherwise had no restrictions in her 

ability to engage in activities. (Id.).

In the meantime, Plaintiff returned to Dr. Cosgrove on August 25, 2010 to 

review lab test results. (R. 979). Dr. Cosgrove noted that Plaintiff’s BMI was 

38.31, and diagnosed her with stable diabetes, stable cholesterol disorder and

benign HTN. (R. 979-80). He instructed her to return in six months. (R. 981). 

At a follow-up appointment with Dr. Gupta on September 7, 2010, Plaintiff 

indicated that the epidural steroid injection had “helped her enormously,” as had 

the PT, though the walking in water made her feet “very sore.” In addition, some 

of the pain had returned at a level of 5-6/10, which rendered her unable to do her 

day-to-day chores. (R. 1151). Dr. Gupta noted that straight leg raise tests and 

Patrick’s signs were negative on both sides, and he diagnosed bulging disc at 

L5-S1, central canal stenosis and right foraminal stenosis. (R. 1152). He 

recommended a second transforaminal epidural steroid injection at L5, (id.)., 

which Plaintiff had on September 10, 2010. (R. 1149).

The following month, on October 28, 2010, Plaintiff started treating with 

Sadiq Altamimi, M.D., at the Hammond Clinic for her lower back pain. (R. 1000-

04). Plaintiff said that the epidural steroid injection she had received in July 2010

had not helped, but that a second injection in September did. She complained of 

sharp pain radiating to the right leg, weakness of the lower extremities, muscle 

cramps in her calf muscles, and neck pain. She reported sleeping in a recliner 

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for the previous 5 years, gaining 80 pounds, and responding well to Lyrica, 

Ultram and Flexeril. (R. 1000). Dr. Altamimi noted that Plaintiff’s BMI was 39.38,

(R. 1002), and observed that her gait, stability, reflexes and sensation were all 

abnormal. (R. 1003). He diagnosed lower back pain, foot pain and ataxia (lack 

of muscle coordination), and instructed her to add Lidoderm patches to her 

medication regimen. (Id.).

4. 2011

Plaintiff next saw Dr. Altamimi on January 10, 2011, at which time he 

diagnosed her with lower back pain, cervical spondylosis and peripheral 

neuropathy. A straight leg raise test was positive on the right at 45 degrees, but 

her stability and muscle strength were normal. Dr. Altamimi recommended that 

Plaintiff continue with her same medications but decrease the dosage of Lyrica. 

He also referred her for an MRI and EMG. (R. 1187-88). The January 19, 2011 

MRI of Plaintiff’s cervical spine showed degenerative changes at C5-8 with a 

small right paracentral disc protrusion, but no significant central spinal or 

foraminal stenosis. (R. 1183). An EMG of both arms taken the same day was 

described as abnormal, with evidence of a “mild sensorimotor polyneuropathy 

involving the bilateral upper and right lower extremity,” but no evidence of 

radiculopathy. (R. 1196).

On February 3, 2011, Dr. Altamimi completed a Physical Residual 

Functional Capacity Questionnaire for Plaintiff based on treatment he said he 

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provided on four occasions in four months.

3 (R. 1190-94). He stated that 

Plaintiff has constant sharp back pain radiating to the right foot that worsens with 

standing. The clinical findings he cited included the positive straight leg raise test 

on the right at 45 degrees and decreased vibration “more on right foot.” (R. 

1190). Dr. Altamimi opined that Plaintiff is capable of a low stress job that allows

her to: shift positions at will from sitting, standing or walking; take unscheduled 

breaks every hour throughout the day; and elevate her legs 12 inches for 60% of 

the workday. (R. 1191-92).

With respect to Plaintiff’s exertional and postural limitations, Dr. Altamimi 

stated that she can: occasionally lift 10 pounds; frequently lift less than 10 

pounds; walk one city block without rest or severe pain; sit for one hour at a time; 

stand for 5 minutes at a time; sit for less than 2 hours in an 8-hour workday; 

occasionally look down, look up and turn her head; frequently hold her head in a 

static position; rarely twist or crouch/squat; occasionally stoop and climb stairs; 

and never climb ladders. (R. 1191-93). Dr. Altamimi checked “Yes” in response 

to the question whether Plaintiff has significant limitations with reaching, handling 

and fingering, and opined that she can grasp with her hands 50% of the workday, 

and perform fine manipulation and reach for 30% of the workday. (R. 1193). 

According to Dr. Altamimi, Plaintiff is likely to have good days and bad days, and 

to be absent from work more than four days per month. (Id.).

 

3 The record contains only the two treatment notes from Dr. Altamimi dated 

October 2010 and January 2011. (R. 1000-04, 1187-88).

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B. Plaintiff’s Testimony

On November 19, 2009, Plaintiff completed a Function Report in 

connection with her application for disability benefits. (R. 209-16). She stated 

that she sleeps in a recliner and needs to be up for two hours before she feels 

physically ready to shower. Each day she feeds and lets the dogs out and tries 

to do one cleaning chore depending on how she feels. (R. 209). This includes 

dusting, laundry, limited cleaning, very limited yard work, and limited vacuuming 

as long as she does not lift any heavy objects or kneel. (R. 209, 211-12). 

Plaintiff is able to drive herself places, and stated that once a day she visits either

her grandmother, her parents or her in-laws. (R. 209, 212). She also attends 

nightly AA meetings, (R. 209), prepares frozen dinners or sandwiches, (R. 211), 

shops for clothes and food for short periods of time “if having a good day,” (R. 

212), and enjoys scrapbooking and watching television. (R. 213). With respect 

to physical abilities, Plaintiff stated that lifting 20 pounds is “pushing it” and 

squatting is “almost impossible.” Bending is very painful, she can only stand in 

one spot for 5 minutes, and reaching is painful when her arthritis is “acting up.” 

She estimates that she can walk about 5 to 10 minutes before needing to rest for 

another 5 to 10 minutes. (R. 214).

Plaintiff completed a second Function Report on April 8, 2010 that was 

essentially identical to the previous report. (R. 241-48). She indicated that 

sometimes her kids come over and help with the vacuuming and cleaning, and if 

she tries to “take advantage of” a good day by doing more chores, she “will pay 

for it” later. (R. 243). Plaintiff stated that her husband now does the grocery 

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shopping and she only shops in places where she can sit. (R. 244). Since she is 

unable to kneel and lift, her gardening consists of putting flowers into pots that 

her husband has filled with dirt. (R. 245). Otherwise, Plaintiff remains very 

active in AA and close to her family. (Id.). She mentioned the cam walker 

prescribed in December 2009 but says she does not use it “because of my back.” 

(R. 247).

In a Physical Impairments Questionnaire completed the same day, Plaintiff 

stated that she can push a cart at the grocery store, but her husband has to take 

out the trash and do any other heavy lifting. (R. 250). She can only sit for about 

15 minutes before needing to get up and move around, and she sometimes has 

trouble getting out of the recliner where she sleeps. On a normal day, Plaintiff 

needs to rest for 70% of the day; if her fibromyalgia is bad, however, she needs 

to rest for 80% of the day. (R. 251).

At the February 4, 2011 hearing before the ALJ, Plaintiff testified that she 

is most bothered by her lower back and right leg, but also suffers from OA in the 

knees, hip bursitis, fibromyalgia and slight peripheral neuropathy. (R. 66-67). 

She had epidural steroid injections in October 2010 that “[d]efinitely helped [her] 

foot,” but they did not help her back and she continues to have shooting pain and 

numbness in the right leg. (R. 66-67). Plaintiff said that as long as her foot is not 

bothering her, she is able to drive at least 30 minutes to attend appointments, go 

to the store, and visit family, though she does have some back and hip pain 

getting in and out of the car. (R. 69). With respect to other physical activities, 

Plaintiff testified that she: cannot lift more than 10 pounds; can only walk a block 

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without stopping; can sit for an hour before needing to get up and move around; 

can stand for 5 minutes at a time; and can use her hands without trouble “for 

awhile,” but they “start to go numb.” (R. 81-84).

Plaintiff said that on a typical day, she often visits her grandmother, does 

some light chores, including laundry, and makes light meals such as frozen 

dinners or soup. (R. 75-76). She goes to the grocery store once every two 

weeks and is very active in AA, attending meetings between 7 and 10 times a 

week. (R. 76-77). Plaintiff confirmed that she is able to plant flowers in pots if 

someone else adds the soil, and that she does “a lot of” scrapbooking with her 

sister, though she only works for about half an hour and completes one page at a 

time due to her problems looking down and pain and numbness in her wrists and 

hands. (R. 78-79, 85). Other hobbies include reading and watching television. 

(R. 80). Plaintiff stated that her pain is typically at a 7/10, (R. 81), and she has 

bad days 7 times a month when she does not want to even get out of bed. (R. 

84). The medications help “somewhat” in that regard, as do hot showers and PT. 

(R. 70). Nevertheless, the back pain is “always there,” radiating down her right 

leg, and the neck pain emerges if she looks down or turns her head too much. 

(R. 81).

C. Vocational Expert’s Testimony

Pamela Tucker testified at the hearing as a VE. The ALJ asked her to 

consider a hypothetical person of Plaintiff’s age, education and past work 

experience who can perform light work with only occasional climbing, balancing, 

stooping, crouching, crawling and kneeling. The VE testified that such a person 

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would be able to perform Plaintiff’s past work as a waitress, bartender and office 

helper, which she characterized as light and semi-skilled. (R. 90-91). The same 

jobs would be available if the person could not stand in one spot for more than 10 

minutes without being allowed to sit or walk a short distance. In addition, the 

person could work as a dining room attendant (3,100 jobs available), laundry 

worker (2,400 jobs available), and parking lot attendant (1,900 jobs available). 

(R. 92). None of these jobs would be available, however, if the person would 

miss two or more days of work per month, would be off task 15% or more of the 

workday, or could only use her hands to grasp for half an hour before needing to 

stop using them for an hour. (R. 93-94). If the same hypothetical person were 

limited to sedentary work, then she would not be able to perform her past work 

and would “grid out” due to an absence of transferrable skills. (R. 93).

D. Administrative Law Judge’s Decision

The ALJ found that Plaintiff’s “low back impairment with continued 

difficulties following two surgeries,” OA in both knees, right hip bursitis, 

degenerative disc disease of the cervical spine, obesity, and right ankle 

impairment are all severe impairments, but that they do not meet or equal any of 

the listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1. (R. 42-46). 

After reviewing the medical records in detail, the ALJ determined that Plaintiff has 

the capacity to perform light work involving occasional lifting of 20 pounds; 

frequent lifting of 10 pounds; standing, walking and/or sitting for 6 hours in an 8-

hour workday; no prolonged standing in one spot longer than 10 minutes without 

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being permitted to sit or walk a short distance; and occasional climbing, 

balancing, stooping, crouching, crawling and kneeling. (R. 46).

In reaching this conclusion, the ALJ gave very little weight to the opinion of 

Dr. Altamimi, explaining that it was based on only four examinations over a fourmonth period, was “quite conclusory, providing little explanation of the evidence 

relied on in forming that opinion,” and was inconsistent with laboratory findings 

and Plaintiff’s course of treatment. (R. 49). At the same time, the ALJ gave 

significant weight to Dr. Wabner’s opinion that Plaintiff is capable of light work, 

(R. 45), as well as controlling weight to the opinions of long-term treaters Dr. 

Cosgrove and Dr. Zachariah, which she found to be supported by the “objective 

medical evidence and the overall record.” (R. 49). The ALJ acknowledged 

Plaintiff’s testimony that she is completely unable to work, but noted that 

medication has been relatively effective in controlling her symptoms. (R. 48). In 

addition, despite claims of disabling hand pain and numbness, Plaintiff engages 

in activities requiring “frequent use of her hands and wrists” such as 

scrapbooking and gardening. (Id.).

Based on the stated RFC, the ALJ accepted the VE’s testimony that 

Plaintiff remains capable of performing her past work as a bartender, waitress, 

and office helper, as well as a significant number of other light jobs available in 

the regional economy, including laundry worker, dining room attendant, and 

parking lot attendant. (R. 50). The ALJ thus concluded that Plaintiff is not 

disabled within the meaning of the Social Security Act, and is not entitled to 

benefits.

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DISCUSSION

A. Standard of Review

Judicial review of the Commissioner’s final decision is authorized by § 

405(g) of the Social Security Act. See 42 U.S.C. § 405(g). In reviewing this 

decision, the Court may not engage in its own analysis of whether Plaintiff is 

severely impaired as defined by the Social Security Regulations. Young v. 

Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004) (citation omitted). Nor may it 

“displace the ALJ’s judgment by reconsidering facts or evidence or making 

credibility determinations.” Castile v. Astrue, 617 F.3d 923, 926 (7th Cir. 2010) 

(quoting Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007)). The court’s task 

is to determine whether the ALJ’s decision is supported by substantial evidence, 

which is “‘such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.’” McKinzey v. Astrue, 641 F.3d 884, 889 (7th 

Cir. 2011) (quoting Skinner, 478 F.3d at 841).

In making this determination, the court must “look to whether the ALJ built 

an ‘accurate and logical bridge’ from the evidence to [his] conclusion that the 

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

(quoting Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008)). Where the 

Commissioner’s decision “‘lacks evidentiary support or is so poorly articulated as 

to prevent meaningful review,’ a remand is required.” Hopgood ex rel. L.G. v. 

Astrue, 578 F.3d 696, 698 (7th Cir. 2009) (quoting Steele v. Barnhart, 290 F.3d 

936, 940 (7th Cir. 2002)).

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B. Five-Step Inquiry

To recover DIB under Title II of the Social Security Act, a claimant must 

establish that she is disabled within the meaning of the Act. Crawford v. Astrue, 

633 F. Supp. 2d 618, 630 (N.D. Ill. 2009). A person is disabled if she is unable to 

perform “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 period of not less than 12 

months.” 42 U.S.C. § 423(d)(1)(A); Crawford, 633 F. Supp. 2d at 630; Strocchia 

v. Astrue, No. 08 C 2017, 2009 WL 2992549, at *14 (N.D. Ill. Sept. 16, 2009). In 

determining whether a claimant suffers from a disability, the ALJ conducts a 

standard five-step inquiry: (1) Is the claimant presently unemployed? (2) Is the 

claimant’s impairment severe? (3) Does the impairment meet or equal one of a 

list of specific impairments enumerated in the regulations? (4) Is the claimant 

unable to perform her former occupation? and (5) Is the claimant unable to 

perform any other work? See 20 C.F.R. § 404.1520; Clifford v. Apfel, 227 F.3d 

863, 868 (7th Cir. 2000).

C. Analysis

Plaintiff claims that the ALJ’s decision must be reversed because she (1) 

failed to properly consider the combined effects of Plaintiff’s obesity together with 

her other impairments; (2) erred in weighing the physician opinion evidence; (3) 

made a flawed RFC determination; and (4) erred in assessing Plaintiff’s

credibility.

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1. Obesity

Plaintiff first argues that the ALJ failed to properly analyze how her obesity 

impacts her ability to work. The Seventh Circuit has made it clear that “[a]n ALJ 

must factor in obesity when determining the aggregate impact of an applicant’s 

impairments.” Arnett v. Astrue, 676 F.3d 586, 593 (7th Cir. 2012). As SSR 02-

1p explains, “the combined effects of obesity with other impairments may be 

greater than might be expected without obesity. For example, someone with 

obesity and arthritis affecting a weight-bearing joint may have more pain and 

limitation than might be expected from the arthritis alone.” SSR 02-1p, 2000 WL 

628049, at *6. See also Tolbert v. Astrue, No. 10 C 7940, 2012 WL 1245611, at 

*10 (N.D. Ill. Apr. 13, 2012).

Here, the ALJ found Plaintiff’s obesity to be a severe impairment at step 

two of the analysis, (R. 42), and noted that Dr. Zachariah diagnosed her with 

“obesity (238 pounds)” in October 2009. (R. 43). She also discussed Dr. 

Altamimi’s finding that Plaintiff had gained 80 pounds after becoming sober. (R. 

45). At step four of the analysis, the ALJ cited Plaintiff’s testimony that she 

weighed 260 pounds, (R. 47), but then made no further mention of her obesity. 

Plaintiff says this constitutes reversible error because an ALJ must affirmatively 

explain why obesity either does or does not cause functional limitations. (Doc. 

18, at 7) (citing SSR 02-1p, 2000 WL 628049, at *7).

The Court agrees that on the facts of this case, the ALJ erred in failing to 

explicitly consider the combined effects of Plaintiff’s obesity along with her back, 

hip, knee and foot pain. Though the ALJ referenced Plaintiff’s weight and obesity 

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on several occasions throughout the decision, “she never explained how the 

obesity affected or did not affect [Plaintiff’s] other conditions,” all of which may be 

exacerbated by excessive weight. Ulloa v. Barnhart, No. 01 C 9229, 2003 WL 

22388992, at *12 (N.D. Ill. Oct. 20, 2003). As the Arnett court has explained, “[i]f 

the ALJ thought that [Plaintiff’s] obesity has not resulted in limitations on her

ability to work, [s]he should have explained how [s]he reached that conclusion.” 

676 F.3d at 593.

Defendant argues that the ALJ’s error was harmless because she

considered Plaintiff’s obesity indirectly by adopting limitations suggested by 

doctors who were aware of that condition. (Doc. 23, at 14). See Prochaska v. 

Barnhart, 454 F.3d 731, 736-37 (7th Cir. 2006); Skarbek v. Barnhart, 390 F.3d 

500, 504 (7th Cir. 2004); Zenka v. Astrue, 904 F. Supp. 2d 884, 899 (N.D. Ill. 

2012). To be sure, Plaintiff’s obesity has been well-documented by all of her 

treating and reviewing physicians. Dr. Zachariah and Dr. Cosgrove routinely 

noted her high BMI, and Dr. Zachariah started including obesity as an official 

diagnosis in October 2009. (R. 839, 974, 979). Dr. Wabner similarly cited to 

Plaintiff’s BMI in making his December 2009 RFC assessment, which Dr. Madala 

affirmed in April 2010. In June 2010, Dr. Gupta recorded Plaintiff’s weight as 248 

pounds, (R. 1161), and in October 2010 and January 2011, Dr. Altamimi noted 

that her BMI was 39.38 and described her as obese. (R. 1002, 1187-88). The 

ALJ fully discussed these opinions throughout her decision. (R. 43-45, 49).

Plaintiff notes that only two of these physicians provided evidence as to 

her functional ability: Dr. Wabner and Dr. Altamimi. (Doc. 24, at 3). The Court 

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agrees that since the ALJ gave very little weight to Dr. Altamimi’s opinion, it 

cannot support Defendant’s harmless error argument. See Arnett, 676 F.3d at 

593 (declining to find harmless error based on opinions that the ALJ either 

discounted or ignored). The ALJ afforded significant weight to Dr. Wabner’s 

opinion, but Plaintiff says this is irrelevant because “significant evidence came 

into the record after [his] review . . . including: magnetic imaging showing 

additional spinal degeneration; positive straight leg raising, abnormal reflex, 

abnormal sensory, and abnormal gait and station clinical findings; and 

electromyogram results showing upper extremity and lower right extremity 

polyneuropathy.” (Doc. 24, at 3-4) (citing R. 941, 1003, 1183, 1188).

Plaintiff does not explain why these tests negate the fact that Dr. Wabner 

considered her obesity in assessing her RFC. The only case Plaintiff cites for 

this proposition, Arnett v. Astrue, involved a situation where the ALJ credited an 

opinion from a physician who knew about the plaintiff’s obesity, but who assigned 

work limitations based solely on her chronic obstructive pulmonary disease 

without mentioning another key impairment, osteoarthritis. 676 F.3d at 593. The 

court declined to find harmless error under such circumstances. Id. Here, there 

is no dispute that at the time Dr. Wabner completed his December 2009 RFC 

assessment, he had access to medical records addressing Plaintiff’s OA of the 

knees and neck, hip bursitis, shoulder bursitis, low back pain, obesity diagnosis, 

fibromyalgia, and pain in the hands and wrists. The only new impairment that 

emerged after that date was foot pain and numbness dating to January 2010, 

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and Dr. Madala had access to that information when he affirmed Dr. Wabner’s 

opinion in April 2010.

Plaintiff may believe that she has greater functional limitations than those 

set forth by Dr. Wabner, but that has no bearing on whether the ALJ indirectly 

considered her obesity by adopting Dr. Wabner’s opinion. See Kittelson v. 

Astrue, 362 Fed. Appx. 553, 559 (7th Cir. 2010) (finding harmless error where 

the ALJ “based his RFC on the limitations identified by doctors . . . who 

specifically noted [the plaintiff’s] obesity, so it was ‘factored indirectly’ into his 

analysis.”). For similar reasons, the mere fact that Plaintiff told her physical 

therapist in August 2010 that she “feels” her weight “contributes to the pain” is 

irrelevant to the harmless error analysis. (R. 1170).

On the record presented, Plaintiff’s request that the case be reversed or 

remanded because the ALJ failed to consider the combined effects of her obesity

and other impairments is denied.

2. Physician Opinion Evidence

Plaintiff next argues that the ALJ erred in rejecting Dr. Altamimi’s opinion 

and granting controlling weight to the opinions of Dr. Cosgrove and Dr. 

Zachariah. A treating source opinion is entitled to controlling weight if it is “wellsupported by medically acceptable clinical and laboratory diagnostic techniques 

and is not inconsistent with the other substantial evidence” in the record. 20 

C.F.R. § 404.1527(c)(2); see Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011);

Campbell v. Astrue, 627 F.3d 299, 306 (7th Cir. 2010). An ALJ must offer “good 

reasons” for discounting a treating physician’s opinion, Scott, 647 F.3d at 739, 

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and then determine what weight to give it considering (1) the length of the 

treatment relationship and frequency of examination, (2) the nature and extent of 

the treatment relationship, (3) the degree to which the opinion is supported by 

medical signs and laboratory findings, (4) the consistency of the opinion with the 

record as a whole, and (5) whether the opinion was from a specialist. 20 C.F.R. 

§ 404.1527(c)(2)-(5). See, e.g., Simila, 573 F.3d at 515.

a. Dr. Altamimi

Plaintiff first objects that the ALJ committed reversible error when she 

stated that “the record does not contain any opinions from treating or examining 

physicians indicating the claimant is disabled or even has limitations greater than 

those determined in this decision.” (R. 49). As Plaintiff notes, Dr. Altamimi 

opined that she in fact has several additional limitations that would preclude 

competitive work, including a need to take unscheduled breaks every hour and to

elevate her legs for 60% of the workday. (R. 1191-92). Regardless, the Court 

agrees with Defendant that this misstatement is harmless in light of the ALJ’s 

very next sentence confirming that she “is well aware of Dr. Altamimi’s 

assessment of February 3, 2011.” (R. 49). The ALJ discussed that opinion in 

detail earlier in the decision, (R. 45), and explained here why she did not give it 

much weight. (R. 49). In the Court’s view, this is not the type of “inconsistent 

statement” that warrants remand. Compare Parker v. Astrue, 597 F.3d 920, 924-

25 (7th Cir. 2010) (remanding case where the ALJ first stated that the plaintiff 

suffered from depression and PTSD as of her date last insured, but then 

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concluded that all of her psychiatric impairments had surfaced after the date last 

insured).

Plaintiff next argues that the ALJ should have given Dr. Altamimi’s opinion 

more weight. Dr. Altamimi’s February 3, 2011 RFC assessment indicates that 

Plaintiff is incapable of working because she: must be able to take unscheduled 

breaks every hour throughout the day; must elevate her legs 12 inches for 60% 

of the workday; can sit for less than 2 hours in an 8-hour workday; can only walk 

one block before needing to rest; can only stand for 5 minutes at a time; can only 

grasp with her hands for 50% of the workday; and would be absent from work 

more than 4 days per month. (R. 1191-93). The only “clinical findings and 

objective signs” Dr. Altamimi cited in support of this assessment were a positive 

straight leg raise test at 45 degrees on the right, and decreased vibration in 

Plaintiff’s feet, more pronounced on the right. (R. 1190). As the ALJ noted, Dr. 

Altamimi provided no explanation as to how these two relatively minimal findings 

translate into such severe functional limitations. (R. 49).

The same can be said of the other diagnostic evidence of record, which

similarly reflects essentially mild abnormalities of the neck, hands, knees and 

back. For example, an X-ray of Plaintiff’s cervical spine in March 2008 showed

intervertebral disc space narrowing at C2-C3, C4-C5 and C5-C6, as well as 

stenosis at C2-C3. (R. 43, 343). Dr. Zachariah gave Plaintiff cortisone injections 

in her shoulders in April 2008 to address what she described as significant OA of 

the neck, but never repeated that procedure. (R. 362). Plaintiff did not complain 

of neck pain again until February 2010, when she experienced a “muscle spasm” 

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after shoveling snow. She exhibited normal range of motion in her spine at that 

time, and by March 2010 the pain had improved with medication. (R. 44, 912, 

915). An MRI of Plaintiff’s cervical spine taken nearly a year later on January 19, 

2011, moreover, showed no central spinal or foraminal stenosis and only a small 

right paracentral disc protrusion, along with degenerative changes at C5-8. (R. 

45, 1183).

Dr. Zachariah diagnosed Plaintiff with OA of the knees and hip bursitis in 

March 2008. Knee X-rays taken in May 2008 revealed only mild bilateral 

narrowing in the medial joint compartments, greater on the right. (R. 340-41). 

Dr. Zachariah treated Plaintiff with injections and medication through March 16, 

2010, at which time Plaintiff’s knees and hip were both “better” and she had no 

joint pain, stiffness or swelling. (R. 44, 912, 915). She also exhibited a normal 

gait in October and November 2009, and in January and February 2010. (43, 

837, 840, 920, 925). Plaintiff complained of foot pain stemming from an old, 

untreated injury in early 2010, but X-rays showed only mild degenerative 

changes and spurring consistent with old trauma. (R. 43-44, 922).

The findings from an April 2010 nerve conduction EMG study of Plaintiff’s 

legs were “most consistent with mild right chronic L5-S1 radiculopathy,” and an

MRI of the lumbar spine showed: persistent central disc herniation at T11-12 

resulting in “moderate compression of the ventral thecal sac with mild central 

canal stenosis suspected”; diffuse disc bulging at L3-4 with degenerative facet 

change resulting in mild central spinal canal narrowing; postoperative changes at 

L4-5 and L5-S1 with disc bulging and degenerative facet changes; and “[r]esidual 

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narrowing of the inferior proximal right neural foramen at L5-S1.” (R. 44, 941). 

To address Plaintiff’s back pain that radiated to the right leg, Dr. Gupta gave her

epidural steroid injections in July and September 2010, which “helped her 

enormously.” At the September appointment, straight leg raise tests and 

Patrick’s signs were all negative. (R. 44, 1149, 1151, 1156-57).

The following month, on October 18, 2010, Plaintiff’s physical therapist 

stated that she failed two of six PT goals relating to standing and walking, but an 

exercise referral precluded only jogging, stair climbing, cross country skiing, high 

impact dance exercise classes, and bending too much. (R. 44, 1176). Allowed 

activities included walking, rowing, stationary biking, recumbent biking, aqua 

aerobic classes, and low impact dance exercise classes. (R. 1176). Ten days 

later, on October 28, 2010, Dr. Altamimi concluded that Plaintiff’s gait, stability, 

reflexes and sensation were all abnormal, and he added Lidoderm patches to her 

medication regimen. (R. 45, 1003). When Dr. Altamimi saw Plaintiff again in 

January 2011, she had a positive straight leg raise test on the right and abnormal 

reflexes, but her stability and muscle strength were normal. Dr. Altamimi 

instructed Plaintiff to continue her current medications but decrease her dosage 

of Lyrica. (R. 1188). Finally, an EMG from January 2011 showed mild 

sensorimotor polyneuropathy involving both arms and the right leg, but there was 

no evidence of radiculopathy. (R. 45, 1196).

Plaintiff does not address most of the above-cited tests and treatment 

notes, much less explain how they support Dr. Altamimi’s assessment. Instead, 

she argues that the ALJ committed reversible error by failing to acknowledge that 

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Dr. Altamimi observed “abnormal gait and station, with abnormal stability and an 

inability to tandem walk; positive straight leg raising at forty-five degrees; 

abnormal reflexes; and abnormal sensation.” (Doc. 18, at 14; Doc. 24, at 11). In 

Plaintiff’s view, this evidence refutes the ALJ’s determination that Dr. Altamimi’s

opinion lacks medical substantiation. (Id.). The Court disagrees. An ALJ “need

not discuss every piece of evidence in the record” as long as she builds “an

accurate and logical bridge from the evidence to [her] conclusion.” Murphy v. 

Barnhart, 417 F. Supp. 2d 965, 970 (N.D. Ill. 2006). Dr. Altamimi is the only 

physician who ever found a positive straight leg raise test, and that occurred in 

January 2011, some two years after Plaintiff’s alleged disability onset date. Dr. 

Altamimi provided no explanation as to why this finding translates into the 

significant functional restrictions set forth in his RFC assessment. This is 

particularly troubling since Dr. Gupta reported negative straight leg raise test 

results just three months earlier on September 7, 2010, and Dr. Altamimi himself 

reported normal range of motion on October 28, 2010. (R. 1003, 1152).

Dr. Altamimi is also the only physician who ever reported abnormal gait, 

sensation and reflexes, again with no explanation as to why these symptoms 

require Plaintiff to, among other things, take unscheduled breaks every hour, 

raise her legs for 60% of the workday, walk no more than one block, sit for less 

than 2 hours, and miss work more than 4 days per month. Notably, Plaintiff 

ignores the fact that Dr. Altamimi himself said that her stability and strength had 

returned to normal in January 2011. See Schmidt v. Astrue, 496 F.3d 833, 842 

(7th Cir. 2007) (“[t]he patient’s regular physician may want to do a favor for a 

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friend and client, and so the treating physician may too quickly find disability.”) 

(internal quotations omitted).4

 Viewing the record as a whole, the ALJ built a 

logical bridge between the medical evidence and her conclusion that Dr. 

Altamimi’s assessment is not supported by objective testing or his own treatment 

notes.

As required by the Social Security regulations, the ALJ went beyond the 

objective tests and provided additional reasons for discounting Dr. Altamimi’s 

opinion. She first noted that Dr. Altamimi had treated Plaintiff only four times in 

four months so his records did “not show [her] longitudinal condition.” (R. 49). 

Plaintiff claims that this was improper because the ALJ simultaneously gave 

significant weight to “the state agency physician who never examined” her at all. 

(Doc. 18, at 14). Plaintiff cites no authority for this proposition, likely because it is 

well-established that “it is up to the ALJ to decide which doctor to believe – the 

treating physician who has experience and knowledge of the case, but may be 

biased, or that of the consulting physician, who may bring expertise and 

knowledge of similar cases – subject only to the requirement that the ALJ's 

decision be supported by substantial evidence.” Micus v. Bowen, 979 F.2d 602, 

608 (7th Cir. 1992). See also Scheck v. Barnhart, 357 F.3d 697, 700 (7th Cir. 

2004) (“The ALJ may properly rely upon the opinion of [state agency] medical 

experts.”); Mont v. Chater, 114 F.3d 1191, at *7 (7th Cir. 1997) (“[T]he law does 

 

4 It is worth noting that Dr. Altamimi also limited Plaintiff to “low stress jobs” even 

though she does not claim to have any mental impairments. In the space provided for 

an explanation of this finding, Dr. Altamimi left the form blank. (R. 1191).

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not require an ALJ to accord a treating source’s opinion more weight than a 

consulting physician’s opinion.”).

The ALJ fairly observed that Dr. Altamimi’s treatment history with Plaintiff 

was quite limited, as the record contains only two treatment notes from him. By 

comparison, Dr. Cosgrove and Dr. Zachariah both had a “lengthy treatment 

relationship with [Plaintiff]” extending over the course of two years or more. (R. 

49). Plaintiff argues that the only “opinions” provided by Dr. Cosgrove and Dr. 

Zachariah are the email messages declining to support her application for 

disability benefits. She describes those responses as “perfunctory and vague 

statements” that are no less “conclusory” than any opinion offered by Dr. 

Altamimi. (Doc. 18, at 13-14; Doc. 24, at 10). This argument ignores the fact 

that the ALJ discussed all of the treatment notes from Dr. Cosgrove and Dr. 

Zachariah in great detail, (R. 43-44), found them to be consistent with “objective 

medical evidence and the overall record,” and concluded that they did not 

evidence greater restrictions than those set forth by Dr. Wabner. (R. 45, 49).

Dr. Altamimi’s RFC largely contradicts these medical findings but, as 

noted, there is no explanation for why the positive straight leg raise test, 

decreased foot vibration, or any other objective test results require Plaintiff to

take unscheduled breaks every hour, raise her legs for 60% of the workday, walk 

no more than one block, sit for less than 2 hours, and miss work more than 4 

days per month. Notably, Plaintiff does not identify any treatment records from 

Dr. Cosgrove or Dr. Zachariah that confirm the necessity of such limitations. The 

Court is satisfied that the ALJ did not err in considering Dr. Altamimi’s short 

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treatment history with Plaintiff, as well as the conclusory nature of his RFC 

assessment as factors in discounting his opinion. See Ridinger v. Astrue, 589 F. 

Supp. 2d 995, 1005-06 (N.D. Ill. 2008) (if treating physician opinion is not given 

controlling weight, ALJ must consider what weight to give it in light of several 

factors, including “length of treatment relationship, frequency of treatment, [and] 

nature and extent of treatment relationship.”); Gildon v. Astrue, 260 Fed. Appx. 

927, 929 (7th Cir. 2008) (“An ALJ is not required to accept a doctor’s opinion if it 

is brief, conclusory, and inadequately supported by clinical findings.”) (internal 

quotations omitted).

The ALJ also gave little weight to Dr. Altamimi’s opinion because “the 

course of treatment [he] pursued . . . has not been consistent with what one 

would expect if [Plaintiff] were truly disabled.” (R. 49). The ALJ posited that if 

Plaintiff really had the severe limitations identified by Dr. Altamimi, “further 

treatment and testing would have been expected.” (Id.). Citing Myles v. Astrue, 

582 F.3d 672 (7th Cir. 2009), Plaintiff first objects that the ALJ “does not set forth 

a supported rationale of what she deems appropriate treatment.” (Doc. 18, at 14; 

Doc. 24, at 11). The ALJ in Myles improperly “played doctor” by concluding that 

the plaintiff’s diabetes was not a significant problem because his treating 

physicians did not prescribe insulin. Id. at 677. The Seventh Circuit explained 

that since “no doctor gave any reason why insulin was not prescribed,” the ALJ’s 

inference that it signified a small problem was “wholly unsupported by the 

record.” Id. at 677-78.

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In this case, the ALJ did not speculate about why Plaintiff either did or did 

not receive certain treatments. The record reflects that Plaintiff’s medication and 

treatment regimen remained essentially constant while she was seeing Dr. 

Zachariah and Dr. Cosgrove, neither of whom would support her application for 

disability benefits. Though Dr. Altamimi’s restrictive RFC assessment suggested 

that Plaintiff’s condition had significantly worsened, this was not reflected in the 

objective medical tests, or in the fact that he barely changed her medication 

regimen at all aside from adding Lidoderm patches and decreasing her dosage of 

Lyrica. Plaintiff claims that the ALJ should have considered the possibility that 

Dr. Altamimi declined to alter her medication due to her history of addiction and 

stomach ulcers that limit her ability to take NSAIDs. (Doc. 18, at 14; Doc. 24, at 

11). Of course, this is mere speculation on Plaintiff’s part as Dr. Altamimi in no 

way indicated that he wanted to prescribe more medication but was unable to do 

so. As for the ALJ’s statement about further testing, the Court agrees that it is 

neither instructive nor appropriate in this context. Nevertheless, since the ALJ

expressly considered the MRI and EMG ordered by Dr. Altamimi in January 2011 

along with all of the other evidence of record, this is not sufficient to render the 

ALJ’s decision so unsupported as to require reversal or remand. (R. 45).

Plaintiff’s final argument that the ALJ should have recontacted Dr. 

Altamimi rather than simply rejecting his opinion requires little attention. (Doc. 

18, at 15). “An ALJ need recontact medical sources only when the evidence is 

inadequate to determine whether the claimant is disabled.” Skarbek, 390 F.3d at

504. The ALJ in this case “viewed the record as unconvincing rather than 

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inadequate,” making it unnecessary for her to recontact Dr. Altamimi. Moore v. 

Astrue, No. 08 C 5180, 2010 WL 2166629, at *8 n.1 (N.D. Ill. May 27, 2010).

In sum, the ALJ’s decision to afford little weight to the opinion of Dr. 

Altamimi is supported by substantial evidence.

b. Dr. Cosgrove and Dr. Zachariah

Turning to Dr. Cosgrove and Dr. Zachariah, Plaintiff argues that the ALJ

erred in giving both of their opinions controlling weight. As noted, the ALJ 

discussed the physicians’ extensive treatment notes in detail, (R. 43-44), and 

then “emphasized that [they] refused to support [Plaintiff’s] allegations that she 

was completely and totally disabled.” (R. 49). Specifically, on May 19, 2010, 

Plaintiff called Dr. Cosgrove and Dr. Zachariah because her lawyers told her that 

she “needs to make sure her physicians will support her” claim for disability 

benefits. Plaintiff explained that she was seeking these benefits “with diagnosis 

of fibromyalgia and history of back surgery in 2005,” and noted that she was a 

waitress and could “no longer lift, or even do yard work on her knees anymore.” 

(R. 976). The treatment note reflects that Dr. Zachariah responded by email 

stating that she “can’t support this as a reason for disability.” Dr. Cosgrove also 

responded with an email stating that “I would say she could still work, maybe not 

her current job, or with restrictions. I would say she is not completely disabled.” 

(Id.).

Plaintiff insists that neither email message undermines her claim of 

disability. She first notes that Dr. Zachariah was not treating her for fibromyalgia 

or back pain, the only conditions cited in the May 19, 2010 message, and that the 

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doctor “did not say that she could not support other reasons for disability,” such 

as hip, knee and “leg difficulties.” (Doc. 18, at 12; Doc. 24, at 8). Of course, the 

inverse is also true – Dr. Zachariah in no way indicated that Plaintiff actually has 

any other disabling conditions. This is significant because Dr. Zachariah had 

been treating Plaintiff for more than two years at the time, and though Plaintiff 

clearly wanted the doctor to say that she is unable to work, Dr. Zachariah 

declined the opportunity to do so. See, e.g., Scott v. Sullivan, 898 F.2d 519, 523 

(7th Cir. 1990) (ALJ properly relied on certain “negative inferences” in the record 

indicating that the plaintiff did not meet a Listing, including the fact that his doctor 

“declined to give his opinion” on that issue). Moreover, Plaintiff concedes that Dr. 

Cosgrove, who has been treating her since at least 2006, likewise refused to 

support her application for disability benefits based on his belief that she remains 

capable of working. (R. 976).

Plaintiff argues that the ALJ still had no basis for giving controlling weight 

to these opinions because neither Dr. Zachariah nor Dr. Cosgrove identified her 

specific functional abilities, much less stated that she is capable of performing 

light work consisting of standing and walking for 6 hours in an 8-hour workday. 

(Doc. 18, at 12-13; Doc. 24, at 9). Regardless, Dr. Wabner found that Plaintiff 

can engage in light work, and she points to nothing in the treatment notes from

Dr. Zachariah or Dr. Cosgrove that contradicts this assessment. See Elder v. 

Astrue, 529 F.3d 408, 413 (7th Cir. 2008) (“[E]ven if reasonable minds could 

differ concerning whether [the plaintiff] is disabled, we must nevertheless affirm 

the ALJ’s decision denying her claims if the decision is adequately supported.”) 

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(internal quotations omitted). Plaintiff’s mere speculation that the doctors may 

believe she is capable of only sedentary work appears nowhere in the record and 

cannot support a remand in this case. (Doc. 24, at 9).

Citing SSR 96-5p, Plaintiff finally objects that statements from a treating 

physician that a person is or is not disabled can never receive “controlling weight”

as a matter of law. (Doc. 18, at 13; Doc. 24, at 9-10). To be sure, the 

Commissioner bears the final responsibility for determining whether a person is 

“disabled” under the Act, and a treating physician’s blanket assertion in that 

regard is not dispositive. SSR 96-5p, 1996 WL 374183, at *2. As noted, 

however, a treating source opinion is entitled to controlling weight if it is “wellsupported by medically acceptable clinical and laboratory diagnostic techniques 

and is not inconsistent with the other substantial evidence” in the record. 20 

C.F.R. § 404.1527(c)(2); SSR 96-2p, 1996 WL 374188, at *1. Here, the ALJ 

explained that Dr. Zachariah and Dr. Cosgrove had a “lengthy treatment 

relationship with [Plaintiff],” and that their opinions, found not only in the email 

messages but also in their extensive treatment notes, are supported by “objective 

medical evidence and the overall record.” (R. 49). On this record, the ALJ did 

not err in giving controlling weight to the opinions of Dr. Zachariah and Dr. 

Cosgrove.

3. RFC Determination

Plaintiff next seeks reversal or remand based on the ALJ’s allegedly 

flawed RFC determination. A claimant’s RFC is the maximum work that she can 

perform despite any limitations, and is a legal decision rather than a medical one. 

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20 C.F.R. §§ 404.1527(d)(2), 404.1545(a)(1); SSR 96-8p. “When determining 

the RFC, the ALJ must consider all medically determinable impairments, . . . 

even those that are not considered ‘severe.’” Craft, 539 F.3d at 676.

Plaintiff claims that “Seventh Circuit decisions . . . do not support that [she] 

retained the ability to perform light work . . . given her many musculoskeletal 

problems combined with her obesity.” (Doc. 18, at 8). She first directs the Court 

to Gentle v. Barnhart, 430 F.3d 865 (7th Cir. 2005), where the plaintiff suffered 

from “disk disease, which causes her pain in sitting, standing, etc.” Id. at 868. 

The Seventh Circuit held that the ALJ erred in finding the plaintiff capable of light 

work without also considering the fact that she was obese. As the court 

explained, “[t]he effect of the disk disease . . . is likely to be different [for an 

obese and non-obese person] by virtue of the difference in weight.” Id. Plaintiff 

says she “arguably presents an even more compelling case for inability to 

perform light work because in addition to her severe back impairment interacting 

with obesity, her musculoskeletal impairments also include severe impairments 

of the knee, hip, and ankle.” (Doc. 18, at 8).

The problem for Plaintiff is that unlike in Gentle, the ALJ’s RFC 

determination is based directly on findings from Dr. Wabner, affirmed by Dr. 

Madala, that despite Plaintiff’s obesity and other impairments she remains

capable of standing and walking for 6 hours in an 8-hour workday. Compare 

Barrett v. Barnhart, 355 F.3d 1065, 1068 (7th Cir. 2004) (where no physician 

stated that the plaintiff, who was grossly obese with arthritic knees, could stand 

for two hours at a time, the ALJ’s determination in that regard “borders on the 

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fantastic.”). Plaintiff disagrees with this assessment and believes she should be 

restricted to sedentary work, which would make her disabled under the MedicalVocational Guidelines given her age (over 50), high school education and lack of 

transferrable skills. (Doc. 18, at 9-10; Doc. 24, at 5-6) (citing 20 C.F.R. § 404, 

Subpt. P, App. 2, Rule 201.14). Of course, no physician actually limited Plaintiff 

to sedentary work. Dr. Altamimi found her capable of less than sedentary work, 

but as explained earlier, the ALJ reasonably discounted this assessment, leaving 

uncontroverted the RFC for light work from Dr. Wabner.

Plaintiff finds it significant that despite achieving four out of six physical 

therapy goals, she failed her goals relating to standing for 10-15 minutes without 

increased complaints of pain, and walking short distances for exercise. (R. 

1171). In Plaintiff’s view, these failures are not “essentially consistent” with the

stated RFC, as suggested by the ALJ, and she questions “the basis for [this] 

finding.” (R. 49; Doc. 18, at 16; Doc. 24, at 12). On the issue of standing, 

Plaintiff’s argument is unavailing because at the September 9, 2010 therapy 

session, she herself reported that she could stand in one place for 10 minutes. 

(R. 1168). She ultimately did not achieve her goal of standing in one place for 

longer than 10 minutes, but the RFC does not require her to do so. (See Doc. 

24, at 12) (arguing that Plaintiff’s “therapist found that [she] could stand for no 

more than ten minutes at a time.”) (emphasis added).

Plaintiff’s next claim, that even Dr. Wabner limited her standing to 5 

minutes at a time, reflects a misreading of his report. (Doc. 18, at 16). Dr. 

Wabner stated that Plaintiff can stand for 6 hours in an 8-hour workday without 

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further limitation. (R. 904). The citation to standing for 5 minutes was drawn 

from Plaintiff’s own Activities of Daily Living Questionnaire, and used as evidence 

of her partial credibility. (R. 908). As for Dr. Altamimi’s opinion that Plaintiff can 

only stand for 5 minutes, the ALJ reasonably rejected this position for the 

reasons explained earlier. Given that the ALJ found Plaintiff more limited in her 

ability to stand than Dr. Wabner, the Court cannot say that she made an 

improper independent medical assessment. Compare Suide v. Astrue, 371 Fed. 

Appx. 684, 690 (7th Cir. 2010) (RFC improper where no physician indicated that 

the plaintiff was capable of standing and walking for 6 hours in an 8-hour 

workday). It is less clear that the PT notes support Plaintiff’s ability to walk for 6 

hours in an 8-hour workday, but any misstatement in that regard is harmless 

given that the ALJ adopted this limitation directly from Dr. Wabner’s RFC, which 

she found consistent with treatment notes from Dr. Cosgrove and Dr. Zachariah.

Compare Scott, 647 F.3d at 740 (ALJ erred in finding the plaintiff capable of 

standing for 6 hours where no physician supported this view).

On the record presented, the ALJ adequately explained how she arrived at 

her RFC determination and Plaintiff’s motion for summary judgment on this basis 

is denied.

4. Credibility Determination

Plaintiff finally argues that the ALJ’s credibility determination is flawed. In 

assessing a claimant’s credibility, an ALJ must first determine whether the 

symptoms are supported by medical evidence. See SSR 96-7p, at *2; Arnold v. 

Barnhart, 473 F.3d 816, 822 (7th Cir. 2007). If not, SSR 96-7p requires the ALJ 

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to consider “the entire case record, including the objective medical evidence, the 

individual’s own statements about symptoms, statements and other information 

provided by treating or examining physicians or psychologists and other persons 

about the symptoms and how they affect the individual, and other relevant 

evidence in the case record.” Arnold, 473 F.3d at 822. See also 20 C.F.R. § 

404.1529; Carradine v. Barnhart, 360 F.3d 751, 775 (7th Cir. 2004). Because 

hearing officers are in the best position to evaluate a witness’s credibility, their 

assessment should be reversed only if “patently wrong.” Castile, 617 F.3d at 

929; Elder, 529 F.3d at 413-14.

The ALJ first observed that “the objective medical evidence does not 

document the existence of impairments of sufficient severity to be totally workpreclusive.” (R. 48). The Court need not reiterate these extensive findings, as 

the only error Plaintiff identifies in this regard is the ALJ’s assertion that she 

“reported numbness in her wrists, which is not supported by objective findings.” 

(R. 48). Plaintiff insists that this is inaccurate because “upper extremity 

electromyogram findings were abnormal.” (Doc. 18, at 17). The ALJ 

acknowledged the January 2011 EMG results, but prior to that time, Plaintiff had 

not complained to any physician about hand or wrist numbness since July 2008, 

at which time the pain was better and she had no joint swelling or stiffness. (R. 

756). Moreover, the ALJ observed that Plaintiff “has reported she enjoyed 

scrapbooking and gardening, without kneeling[,] and these activities involved 

frequent use of her hands and wrists.” (R. 48). Plaintiff does not dispute this 

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characterization of her hobbies, and the ALJ was not patently wrong in 

discounting Plaintiff’s claims of disabling wrist and hand pain.

The ALJ went on to consider other factors that affect credibility as required 

by 20 C.F.R. § 404.1529. She stated, for example, that while Plaintiff’s use of 

appropriate medications and injections weighs in her favor, those treatments

have “been relatively effective in controlling [her] symptoms.”5 (R. 48). Plaintiff 

concedes that “some treatment modalities provided temporary relief,” but says 

that the pain was nonetheless “recurring and persistent.” (Doc. 18, at 20). In 

fact, the record supports the ALJ’s finding that the treatments were generally 

quite helpful. Dr. Zachariah gave Plaintiff cortisone injections in her hip and knee 

in September 2008, (R. 750), and when Plaintiff saw Dr. Cosgrove nearly a year 

later in August 2009, she was “[f]eeling great.” (R. 727). Plaintiff received further 

injections in October and November 2009, by which time she reported “[s]tarting 

to exercise again.” (R. 831, 837).

At a February 2010 appointment with Dr. Zachariah, Plaintiff’s hip and 

knee pain were both “better,” and in March 2010, her snow shoveling-induced 

neck and cervical pain had improved with Limbrel and Flexeril. (R. 912, 915). 

The epidural steroid injections Plaintiff received from Dr. Gupta in July and 

 

5 Given the ALJ’s extensive discussion of the nature and effectiveness of what she 

described as Plaintiff’s “appropriate” treatment history, including surgeries, PT, 

injections, epidurals and pain medications, (R. 43-45, 47-49), her credibility finding is not 

patently wrong merely because she stated in passing that Plaintiff “has not generally 

received the type of medical treatment one would expect for a totally disabled individual.” 

(R. 48). Compare Hughes v. Astrue, 705 F.3d 276, 278 (7th Cir. 2013) (ALJs concern 

about “lack of aggressive treatment” identified as but one of many problems with the 

credibility finding).

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September 2010 for back pain also “helped her enormously.”

6

 (R. 1149, 1151, 

1156-57). See Molnar v. Astrue, 395 Fed. Appx. 282, 288 (7th Cir. 2010) (“[T]he 

ALJ was permitted to consider the effectiveness of treatment, including surgery 

and epidural injections, in making her credibility determination.”); Skinner, 478 

F.3d at 845 (affirming ALJ’s credibility finding where “the record medical 

evidence established that [the plaintiff’s] symptoms are largely controlled with 

proper medication and treatment.”).

Looking next to Plaintiff’s daily activities, the ALJ determined that they “are 

not the activities and abilities of an individual who is completely unable to engage 

in any substantial gainful activity.” (R. 48). In that regard, the ALJ noted that 

Plaintiff can care for her own personal needs and those of her two dogs; prepare 

simple meals; do light housekeeping chores, including laundry, light 

housecleaning and light yard work; drive; shop; visit her grandmother; attend 

daily AA meetings, chair two of them and host a home group; watch television; 

play computer games; and read. (Id.). Plaintiff faults the ALJ for failing to 

consider the fact that she “performed these tasks in small increments and with 

assistance.” (Doc. 18, at 19). Specifically, Plaintiff testified that her husband 

buys the heavy groceries (R. 77); her son puts the soil into flower pots for her (R. 

78); she only does one scrapbooking page at a time because she cannot look 

down for very long (R. 79); and she does not lift heavy loads of laundry and has 

to lean while folding the clothes. (R. 85, 87).

 

6 Plaintiff does not dispute that “she had no side effects from her prescribed 

medications.” (R. 48, 69).

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The Seventh Circuit has “cautioned that a person’s ability to perform daily 

activities, especially if th[ey] can be done only with significant limitations, does 

not necessarily translate into an ability to work full-time.” Roddy v. Astrue, 705 

F.3d 631, 639 (7th Cir. 2013). Here, the ALJ “did not overstate [Plaintiff’s] ability 

to perform daily activities” or place undue weight on them. Molnar, 395 Fed. 

Appx. at 288. Rather, the ALJ clearly noted that Plaintiff could only do “light” 

chores and prepare “simple” meals, and cited this as but one of the factors 

undermining Plaintiff’s credibility. Roddy, 705 F.3d at 639 (“[I]t is appropriate for 

an ALJ to consider a claimant’s daily activities when evaluating their credibility, 

SSR 96-7p, at *3,” as long as it is “done with care.”). For this reason, the ALJ’s 

statement that Plaintiff’s activities “clearly reflect the ability to perform her past 

relevant light work,” (R. 48), is not sufficient to justify a reversal or remand. 

Viewing the decision as a whole, the Court is satisfied that notwithstanding this 

remark, the ALJ considered appropriate evidence in discounting Plaintiff’s 

testimony and did not simply equate her daily activities with an ability to work.

In sum, the ALJ’s credibility determination is not patently wrong, and 

Plaintiff’s motion for summary judgment on this basis is denied. Elder, 529 F.3d 

at 413-14; Simila, 573 F.3d at 517 (an ALJ’s credibility determination is entitled to 

“deference, for an ALJ, not a reviewing court, is in the best position to evaluate 

credibility.”).

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CONCLUSION

For the reasons stated above, Plaintiff’s Motion for Summary Judgment is 

denied, and Defendant’s Motion for Summary Judgment (Doc. 22) is granted.

The Clerk is directed to enter judgment in favor of Defendant.

ENTER:

Dated: December 13, 2013 _____________________________

SHEILA FINNEGAN

United States Magistrate Judge

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