Commissioner’s Mem. 8 argues that ALJ Bretthauer’s decision
restricting Crenshaw to a limited range of light rather than
medium work, as recommended by the reviewing medical consultants,
suggests that the ALJ did take the diagnostic test results into
account. But that argument just demonstrates the problem: It
cannot be known on what basis ALJ Bretthauer reached her RFC
conclusion, because she failed to articulate her reasoning.
Further, Commissioner’s attempts to persuade this Court to
discredit the tests as inconclusive are misdirected. As already
described, a reviewing court's role is a limited one in which
“[wle have no authority to supply a ground for the agency’s

decision” (Q'Connor v. Sullivan, 938 F.2d 70, 73 (7% Cir.

1991)).

It is after all taught by such cases as Smith, 231 F.3d at

437 that it is the ALJ's duty to develop a full and fair record,
including the ordering of any added medical evidence necessary to
make the disability determination (accord, Clifford, 227 F.3d at
873). Although Luna v. Shalala, 22 F.3d 687, 692 (7 Cir, 1994)
explains that courts “generally respect the Secretary's reasoned
judgment” on how much evidence is needed to make a disability
determination, it remains true that the ALJ’s duty may be best
served by obtaining some expert medical assessment of how the
conditions shown by Crenshaw’s diagnostic tests impact her

functional abilities.

19


depressive disorder not otherwise specified and borderline
intellectual functioning, she was not “disabled” under the
prescribed framework. Although those conditions were “severe,”
the ALJ held that they did not meet or medically equal any of the
listed impairments (R. 65).

In light of Crenshaw's impairments, the ALJ found that she
was unable to perform her past relevant work but that she
retained the capacity to perform a significant range of light
work (R. 70). Specifically ALJ Bretthauer found that Crenshaw
had the RFC* to perform work that did not require
‘“lifting/carrying more than 20 pounds occasionally and 10 pounds
frequently; performing repetitive leg movements; grasping
repetitively; and understanding, remembering and carrying out
other than simple, routine work tasks” (R. 65). Relying on
Hoiseth's testimony that such a claimant would be capable of
performing a significant number of jobs existing in the economy,

the ALS coneluded that Crenshaw was not under a “disability” (R.

70).

In explaining her decision ALJ Bretthauer stated that the

®* RFC denotes what a claimant can still do despite her
physical and mental limitations (Hickman v. Apfel, 187 F.3d 683,
689 (7th Cir. 1999); Reg. §416.945(a)). In reaching that

determination the ALJ considers the claimant's ability to meet
various physical demands, such as lift weights, sit, stand, walk,
push and pull among other things (Reg. §416.945(b)). RFC is used
to determine the claimant's ability to engage in various levels
of work (sedentary, light, medium, heavy or very heavy) (Reg.
§416.967}.

13


ee

evidence, including whether a physician is a treating or

examining physician; the length, nature and extent of the
treatment relationship; the physician's specialty; and the
consistency and supportability of the physician's opinion.

Here the record before the ALJ contained conflicting
assessments of Crenshaw's depression and her mental functional
capacity. Crenshaw does not dispute the ALJ's authority to
resolve those conflicting medical opinions. Instead she argues,
without a single case citation for support, that ALJ Bretthauer
did not adequately explain her decision because she failed to
address the specifics of Dr. Krakowski's report.

In resolving conflicts in medical opinion evidence, the ALJ
must minimally articulate the reasons for her decision (Clifford,
227 F.3d at 870). But it also remains true that no written
evaluation of every piece of evidence, or in this instance of
every finding in an extensive medical report, is required (Dixon
vy. Massanari, 270 F.34 1171, 1176 (7th Cir. 2001)).

Here ALJ Bretthauer addressed Dr. Krakowski's opinion
thoroughly. At the outset of her decision the ALJ listed
Crenshaw’s impairments, adopting Dr. Krakowski's medical finding
that Crenshaw had “borderline intellectual functioning” (R. 67,
65). Turning explicitly to Dr. Krakowski’s report, the ALJ
summarized its findings and conclusions and explained her reasons

for giving them little weight in substantial detail. Because it

23



was prescribed medication for her hypertension, diabetes and pain
(R, 206).

On December 11, 1998 Dr. Margaret Stronska performed an
internal medical evaluation of Crenshaw (R. 186-88). At that
session Crenshaw related to pr. Stronska that she had suffered
from hypertension for ten years and diabetes mellitus for five
years but did not have complications from those conditions (R.-
486). Crenshaw said that for five years she had experienced back
pain that arose on walking more than two blocks or on standing
more than ten minutes {id.). Lung, cardiac, abdominal, vascular
and neurological examinations revealed no problems (R. 187).
During that examination Dr. Stronska observed that Crenshaw had a
normal range of motion in both upper and lower extremities and
that her bilateral hand grip and fine and gross manipulations
were normal. Crenshaw was able to do tandem walking, heel
walking, toe walking and squatting, and she could walk with a
normal gait without assistance for more than 50 feet (id.).
Although Crenshaw had some limited spinal flexion, her extension
wag normal, Spinal x-rays taken that day showed mild
degenerative changes (R. 189). Dr. Stronska concluded that
Crenshaw's hypertension and diabetes mellitus were well
controlled by her medication and that her low back pain could be
associated with Crenshaw's moderate obesity (R. 188).

on the same day Dr. Mahim Kamakant Vora performed a


According to vocational expert Hoiseth, there were no jobs
available for a claimant analogous to Crenshaw who had to be
allowed to sit and stand every 45 minutes (R. 107). Hence a
determination that Crenshaw was unable to stand or walk for
sustained periods of time would have had a significant impact on
the disability determination. Yet the ALJ'S decision fails to
articulate even minimally why she dismissed Crenshaw's claimed
standing and walking difficulties, so it is impossible to trace
the steps that she took to determine that crucial aspect of
Crenshaw's RFC. ALJ Bretthauer's failure to address the evidence
related to those symptoms leaves this Court “unable to evaluate
and determine whether substantial evidence existed to support the
ALJ's finding” (Herron, 19 F.3d at 334).

What has been said up to this point bars judgment as a
matter of law in favor of Commissioner. Instead a remand is
necessary to gee whether or not a full analysis and articulation
in the respect that this opinion has found wanting will produce
the same conclusion that the ALJ reached. But what of the other
side of the coin--the possibility that Crenshaw can prevail at
this stage of the dispute? On that score no protracted
discussion is needed, for the already discussed uncertainty as to
the effect of the diagnostic test results bars Crenshaw from a
current victory when reasonable inferences are drawn, as they

must be on Crenshaw's Rule 56 motion, in Commissioner's favor.

20


EE

sit/stand restriction--is really the same argument that has
already been discussed here as calling for a remand rather than a
pro-Crenshaw decision now.

Crenshaw's remaining (and really the only new) argument on
the same subject is that the ALJ should not have relied on
Hoiseth’s testimony about available light jobs because it was
inconsistent with descriptions in the Dictionary of Occupational
Titles (4% ed. 1991). But whether or not Hoiseth miscategorized
some of those jobs, Crenshaw failed to point out the discrepancy

at the Hearing and cannot do so now (Donahue v. Barnhart, 279

F.3d 441, 447 (7 Cir. 2002)). Donahue, id. at 446 established
the rule in our Circuit that when such a conflict is not
identified at a hearing, “an ALJ is entitled to accept the
vocational expert’s conclusion, even if that conclusion differs
from the Dictionary'’s.”

Lastly Crenshaw contends that ALJ Bretthauer failed to
adequately state her reasons for rejecting Dr. Krakowski's
opinion of Crenshaw’s depression and mental capacity. As the
finder of fact an ALJ is required to resolve evidentiary
conflicts (Diaz v, Chater, 55 F.3d 300, 308 (7th Cir, 1995)).
And that role applies when the ALdg is faced with conflicting
medical opinions (Books vy. Chater, 91 F.3d 972, 979 (7th Cir.
1996). Reg. §416.927(d) sets out a variety of factors that the

ALJ must consider in assessing conflicting medical opinion

22



sustained basis. That failure prevents any informed review of
the ALJ’s decision, thus alone mandating a remand (Smith v.
Apfel, 231 F.3d 433, 438 (7 Cir. 2000), citing Herron, 19 F.3d
at 334),

Throughout the record Crenshaw repeatedly complained that
she was unable to stand or walk for long periods due to her back
pain (R. 88, 161, 180, 186). Those complaints were not addressed
at all by the ALJ, whose stated reasons for generally discounting
Crenshaw’s complaints failed to speak to Crenshaw’s claim of
standing/walking difficulties. Crenshaw’s testimony about that
problem was not contradicted by her statements elsewhere in the
record, nor are her reported daily activities inconsistent with
her claimed inability to walk and stand for long periods of time.
At least equally problematic, the ALJ's discussion of Crenshaw's
asserted lack of treatment for her pain said that she did not
take pain medication--but to the contrary, the record shows that
Crenshaw had taken prescription level ibuprofen for the last four
years (R. 221, 239).

Admittedly most of the objective medical evidence cuts
against Crenshaw's contention that she has a limited ability to
sit, stand or walk on a sustained basis. Dr. Stronska found that
Crenshaw could walk more than 50 feet without an assistive
device, and she did not find significant abnormalities in

Crenshaw’s vascular or musculoskeletal examinations. Crenshaw's

17


depressed about four days a week (R. 93-94, 104). She took her
medication for her insulin and hypertension as well as
prescription level ibuprofen for her back pain (R. 95-98). Due
to pain in her feet and back, Crenshaw said that she could walk
less than a plock, stand for less for less than 30 minutes, sit
for less than an hour, lift less than 5 pounds and grab and hold
only light objects (R.- 98-99). She described her typical day as
taking care of her grandchildren, reading the Bible and just
peing at home (99-100). She testified that she was able to
concentrate on what she was reading when it was quiet in the
house (R. 104). Crenshaw's grandchildren and other relatives did
most of the housework, although she herself was able to do some
light cooking and dishwashing and sometimes made her own bed (R.
101). Crenshaw stated that she went to church every week but was
unable to sit without pain through the entire service.
vocational Expert's Testimony

Vocational expert Cheryl Hoiseth (“Hoiseth”) testified at
ALJ Bretthauer's request. In principal part she responded to a
series of hypothetical questions posed by the ALJ.

In the first hypothetical ALJ Bretthauer asked Hoiseth to
assume (R- 105-06):

an individual who is 52 years old, has the work

experience and education of this claimant, and has the

following exertional limitations: can sit for six

hours, stand and walk for six hours, lift and carry

frequently up to 25 pounds, occasionally up to 50
pounds, with no other limitations except is Limited to

9

—————————— i=


Other cognitive tests suggested the possibility of an organic
impairment (R. 223-24). After administering psychological
testing, Dr. Krakowski diagnosed major depression, severe,
without psychotic features; “atypical organic disorder (rule
out)";? and borderline intellectual functioning (R. 225).

Dr Krakowski also prepared a psychiatric review technique
assessment and mental residual functional capacity (“RFC”)
assessment for Crenshaw (R. 226-37). Dr. Krakowski found that
Crenshaw met listing 12.04 of Req. Part 404, Subpt. PB, App. 1 for
Affective Disorder, with depression characterized by anhedonia,
appetite disturbance, sleep disturbance, psychomotor agitation or
retardation, decreased energy, feelings of guilt or
worthlessness, and difficulty in concentrating or thinking (R.
226, 229). Dr. Krakowski further found that Crenshaw’s mental
functional capacity was markedly limited for the majority of
understanding, memory, concentration, persistence, social
interaction and adaptation activities (R. 235-36).

Both initially and on reconsideration, Crenshaw's records
were reviewed by non-treating medical consultants who assessed
her physical and mental functional capabilities (R. 192-203). In

January and again in April 1998 such non-treating physicians

? This Court has no idea whether that listing in the
portion of the psychiatrist's opinion meant that she found
Crenshaw did or did not suffer from that disorder--and none of
the parties' memoranda has cast any light on the subject.

6


consultative psychological examination of Crenshaw (R. 183-985).
Crenshaw told Dr, Vora that she felt depressed on and off and for
up to a few hours at a time (R- 183). She also reported having
crying spells, difficulty in sleeping and appetite fluctuations
and that she lacked motivation (id.). Describing her daily
activities, Crenshaw said that she did cooking, cleaning and all
household chores as well as shopping (id.}). She sometimes
socialized with friends and attended church once a week (id.)-
Dr. Vora observed that Crenshaw's general appearance was normal
but that her affect was depressed and tearful. she performed
well on all cognitive functioning tests except for serial sevens
(R. 184). Dr. vora diagnosed major depressive disorder, single
episode and aysthymic disorder (R. 185).

In February 1999 Dr. Antoinette Krakowski examined Crenshaw
and prepared a psychological report at the request of Crenshaw's
representative (R. 217-25). During the examination Crenshaw said
that she had been depressed since her father died in 1987 and
that her condition had worsened since 1993 with the death of
three of her children (R. 224). She told Dr. Krakowski that she
spent most days at home reading her Bible when she was not caring
for her grandchildren, who helped with the cooking, cleaning and
laundry (R. 222). Crenshaw's Weschler Intelligence Scale results
placed her in the borderline range of intellectual functioning,

and she performed at a low level on academic testing (R. 223).


December 1998 lumbosacral x-ray showed mild degenerative changes.
Two medical consultants who reviewed the record found that
Crenshaw could perform medium level work, and their completed
assessments stated that she could stand/walk and sit for about 6
hours in an 8 hour work day.

But it is critical to note that every one of the medical
evaluations on which the ALJ relied for her determination
preceded the post-Hearing December 1999 diagnostic tests. And
thus every hypothetical posed to the vocational expert, other
than the one that produced an answer of Crenshaw's total
nonemployability (and hence her disability), necessarily omitted
any consideration of whether the diagnostic tests buttressed Dr.
Shah's opinion as to Crenshaw's major sit/stand limitation. Yet
Crenshaw's standing and sitting limitations as found by Dr. Shah
can be symptoms of occlusive arterial disease in her lower right
extremity and bilateral lumbosacral radiculopathy, and those
conditions--accepted by ALJ Bretthauer as “significant physical
findings” --were supported by objective medical evidence:
Crenshaw’s diagnostic test results. All of that being so, the
ALJ was not free to dismiss out of hand Dr. Shah's confirmation
of Crenshaw's standing and walking difficulties without
explaining why the diagnostic test results could not constitute
the objective support that the ALJ said was missing from Dr.

Shah's opinion standing alone (Herron, 19 F.3d at 334).

18


included the results of diagnostic testing done in late November
and December 1999 plus treatment notes from Dr. Shah (R. 108).
Results of Doppler (peripheral vascular) testing showed decreased
pressure of the right lower extremity that suggested inferior
popliteal artery occlusive disease (R. 292-95).* Blectro-
myography (EMG) /nerve conduction study (NCS) done on Crenshaw's
lower extremities and the corresponding paraspinal muscles showed
bilateral lumbosacral radiculopathy, suggestive of spinal
stenosis (R. 297).° Although progress notes for Crenshaw's
treatment by Dr. Shah in late 1999 and early 2000 are also
largely illegible, radiculopathy and peripheral vascular disease
of the lower limbs were among the medical problems that he listed
on January 21, 2000 (R. 300).
Crenshaw's Hearing Testimony

Crenshaw testified that she could not work because of
numbness in her hands and back pain that prevented her from
standing for too long at one time (R. 88). Although she had not

sought psychological counseling, Crenshaw stated that she felt

* Inferior popliteal arterial occlusive disease is a
condition that results from a narrowing of the artery running
along the back of the leg at the level of the knee and below
(Stedman's Medical Dictionary (“Stedman's”) 144, A20, 1250 (27th
ed. 2000)).

5 Lumbosacral radiculopathy is a disease of the spinal
nervé roots along the lower region of the spinal cord (Stedman's
at 1034, 1503). Spinal stenosis is a condition that results from
a narrowing of the spinal canal (id. at 1695)).

8


is plain that the ALJ considered this important evidence and
explained her reasoning in discounting it, that aspect of her
opinion meets the minimum articulation standard.”

Conclusion

In sum, ALJ Bretthauer did not err in relying on the
vocational expert's testimony, and she adequately explained her
reasons for resolving the conflicting psychiatric opinions in the
record. But neither party has demonstrated entitlement to a
judgment as a matter of law, because genuine issues of material
fact remain regarding the extent to which Crenshaw’s impairments
limit her ability to function.

Accordingly both motions for summary judgment are denied.
Because the ALJ failed to address an important aspect of the
evidence in her decision, it cannot be said that substantial
evidence supported her denial of benefits as a matter of law, nor

ean the opposite result prevail as a matter of law. Hence

? Although this is not argued by Crenshaw, the Aid's
explanation is somewhat troublesome to the extent that she failed
to mention expressly the conflicting medical opinions in the
record, leaving open the possibility that she improperly
substituted her own judgment for a physician's opinion (Clifford,
227 F.3d at 870; Rohan, 98 F.3d at 970). But in those cases the
ALd failed to address relevant evidence and rejected
uncontradicted medical opinions, while here the record contained
conflicting medical opinions that required resolution (see Dixon,
270 F.3d at 1177-78). Earlier in the ALJ's decision she
discussed and accepted Dr. Vora's contradictory opinion of
Crenshaw's depression, and although the ALJ's reference to Dr,
Vora's finding of a higher level of functioning is somewhat
oblique, it suffices to trace her reasoning.

24


Minute rife Form (0077)

ec United States District Court, Northern District of Illinois
“[Prttemmtinge | iton .siudur | Sea
CASE NUMBER 02 C 3543 DATE 2/13/2003
CASE Rosalind Crenshaw vs. Jo Anne Barnhart
L TITLE

Tla the fiallowing box (a) indicate the party tiling the motion, e.g. plaintiff, defemdant, 3rd party pluiuititf, und (b) state briefly tlhe nature

MOTION: of the motion being presented, |

DOCKET ENTRY:

qd) a Filed motion of [ use listing in “Motion” box above.]

(2) oO Brief in support of motion due

(3) a Answer brief to motion due_ ___, Reply to answer brief due_

(4) Oo Ruling/Hearing on ss setfor_ at,

(5) oO Status hearing[held/continued to] [set for/re-set for}on_ sel for at

(6) oO Pretrial conference[held/continued to] [set for/re-set for]on_ __seset for, at
(7) Oo Trial[set for/re-set for]on. __— at.

(8) 0 {Rench/Jury trial] [Hearing] held/continued to __al .

(9) Qo This case is dismissed [with/without] prejudice and without costs[by/agreement/pursuant to)

CFRCP4(m) =O) Local Rule 41.1 OPRCP41(ay(l) CO FRCP41(a)(2),

(0) (Other docket entry] Enter Memorandum Opinion and Order. Both motions for summary judgment
are denied. (12-1) Because the ALJ failed to address an important aspect of the evidence in her decision,
it cannot be said that substantial evidence supported her denial of benefits as a matter of Jaw, nor can the
opposite result prevail as a matter of law. Hence Crenshaw’s alternative request for a remand must be

and is granted.

dl [For further detail see order attached to the original minute order.|

Ty No nolices required, advised in open court. Document

— a
No notices required, sumbet uf nati Numbe
Notices mailed by juclge’s stulf FEB aan
Notified counse! by telephone, ale 18 200:

a7 | Docketing to mail notices: (,
¢ | Mail AO 450 form, doekcum dene ine
Copy to judge/magistrate judge. ye
courtoorn dete aie) ice
SN deputy’s ;
initials —
Date/time teceived in
central Clerk's Office ning deputy otras



Standard of Review and Applicable Law

Judicial review of Commissioner's decision, authorized by
Section 405(q), requires that her findings of fact must be upheld
if they are supported by substantial evidence. Such review is
therefore limited to determining (1) whether Commissioner applied
the correct legal standards in reaching the decision and (2)
whether there is substantial evidence in the record to support
the findings (Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir.
2000)).

Substantial evidence means “such relevant evidence as a

reasonable mind might accept as adequate to support a conclusion”

(Kepple v. Massanari, 268 F.3d 513, 516 (7th Cir. 2001), quoting
(ag always) Richardson v. Perales, 402 U.S. 389, 401 (1971)). In

reviewing Commissioner's determination this Court must look at
the entire administrative record, but it may not reweigh the
evidence, resolve conflicts, decide credibility questions or
substitute its own judgment for Commissioner’s (Clifford, 227
F.3d at 869), That does not however call for an uncritical
rubber-stamping of Commissioner's decision (id.).

To be eligible for benefits, Crenshaw must suffer froma
“disability,” defined in pertinent part as (Section
423 (a) (1) (A)):

inability to engage in any substantial gainful activity

by reason of any medically determinable physical or

mental impairment which can be expected to result in
death or which has lasted or can be expected to last

al


jobs that are simple, routine. Could such a person
perform claimant's past work?

Hoiseth testified that such a claimant could not perform
Crenshaw's past work, but she could do three other jobs that were
classified at a simpler level: bagger (25,000 jobs), hand
packager (5,800 jobs) and maid or cleaner (9,200 jobs) (R. 106).
When the ALJ added a limitation of no repetitive grasping to the
hypothetical, Hoiseth responded that the first two of those three
jobs would be ruled out (id.).

Next the ALJ posited that the hypothetical claimant was
capable of a light exertion level: “someone who could lift and
carry 10 pounds frequently, and 20 pounds occasionally” (id.).
Hoiseth responded that available jobs included kitchen helper
(3,000 jobs), cleaner (6,100 jobs) and laundry worker (8,000
jobs) (id.). In response to the ALJ's questioning Hoiseth
testified that those jobs would remain available if the claimant
had limited ability to grasp repetitively or could not use her
legs or foot controls for repetitive movements (R. 106-07).

Finally the ALJ added to that hypothetical that the claimant
would also have to sit and stand every 45 minutes (R. 107).
Hoiseth responded that adding that sit/stand restriction would
preclude performance of all of the jobs that she had earlier
identified. She concluded that no jobs would be available for
that hypothetical claimant because even sedentary jobs would be

ruled out by the grasping restrictions (id.).

10


completed a physical residual capacity assessment of Crenshaw's
back pain and hypertension, concluding that she was capable of
medium work (R. 281). Crenshaw's January 1998 psychological
assessment from a non-treater, based on the report from Dr. Vora,
noted her deficiencies in concentration and social functioning
but identified no significant limitations in her ability to
perform the mental aspects of simple tasks (R. 193), That
assessment was seconded in March 1998 by psychological consultant
Carl Herksmeyer, who reviewed the record including Dr.
Krakowski's February 1998 report (R. 250-62). In particular Dr.
Herkameyer found that although Crenshaw suffered from major
depression and had borderline intelligence, in his view the
record did not support Dr. Krakowski's conclusion that she met
the Reg. 12.04 listing (R. 252).

In November 1999 Crenshaw's treating physician Dr. Jagdish
Shah completed a physical capacities evaluation (R. 284-90).
Although much of that form is illegible, Dr. Shah limited
Crenshaw to sedentary work (R. 284). Dr. Shah found that
Crenshaw could neither stand nor sit continuously for 6 of 8
hours and that she could lift and carry less than 5 pounds on a
frequent basis (R. 288). Dr. Shah did not indicate the basis for
his opinion (R. 285).

After the Hearing Crenshaw submitted additional medical

records that had been requested by the ALJ. Those documents


Those test results also do not demonstrate conclusively that
Crenshaw's RFC prevents her from sustained standing and walking.
That the diagnostic tests were not interpreted in the record by
any physician and were not factored into any medical assessments
of Crenshaw’s functioning pose equivalent problems for her effort
to gain judgment as a matter of law. In that reapect the need

for further input is underscored by Whitney vy. Schweiker, 695

F.2d 784 (7th Cir. 1982):

{[Blecause an Administrative Law Judge as a rule is not

a doctor, [she] should avoid commenting on the meaning

of a test or clinical x-ray when there has been no

supporting expert testimony.

That then would also appear to call for a remand in response
to Crenshaw's motion as well. But before a definitive conclusion
can be reached in that regard, it is necessary to see whether any
of Crenshaw's remaining arguments proves persuasive.

First Crenshaw contends that ALJ Bretthauer did not properly
rely on vocational expert Hoiseth's testimony in concluding that
Crenshaw could perform a significant number of jobs. Cass v.
Shalala, 8 F.3d 552, 555-56 (7° Cir. 1993), the single case
cited by Crenshaw, does confirm the legal rule that an ALJ must
pose a hypothetical to the vocational expert that fully sets
forth the claimant's medically supported impairments. But as
Commissioner points out, the main thrust of Crenshaw's

contention--that the ALJ should have relied on Hoiseth’s

testimony in response to the hypothetical that included the

21


eighth and tenth grade and has not obtained her GED (R. 86, 221,
33). Crenshaw's only past work experience was as a paid hospice
care worker for her son from August 1997 until October 1997, when
he died of AIDS (R. 221). Although she never married, Crenshaw
had five children, three of whom have died since 1993, and she
cares for four of her grandchildren in her home (R. 220).

Crenghaw's initial application for disability benefits
asserted that her medical conditions prevented her from working.
Specifically she reported that she had difficulty with her hands
due to her arthritis and that at times her feet were so swollen
that she could not stand (R. 152). Crenshaw's February 5, 1999
request for reconsideration reiterated her impairments,
emphasizing that she had considerable back pain and also suffered
from depression (R. 164-65).

Medical Evidence

Numerous physicians who evaluated Crenshaw's physical and
psychological condition created documentation that was submitted
for ALJ Bretthauer's consideration. Given the nature of that
evidence and the ALJ's ultimate decision, a detailed review is in
order.

Crenshaw was seen on several occasions in 1998 and 1999 by
Dr. Lilia De Leon at the HealthFirst treatment center (R. 205-14,
238-49, 264-73). Records from those visits indicate that her

serum glucose level was elevated (R. 208, 214, 240) and that she



objective medical evidence in the record provided support for her
findings (R. 65), For that support she relied on Dr. Stronska's
internal medical examination and the psychiatric evaluation by
Dr. Vora. She mentioned that diagnostic results from the Doppler
and EMG/NCS testa were “(tlhe only significant physical findings”
(R. 66). Lastly, she noted the consistent findings of the
medical consultants who reviewed the record (R. 66-67).

ALJ Bretthauer found that Crenshaw's assertions as to her
limitations were not credible because her daily activities belied
her complaints of disabling symptoms and limitations. In
addition, Crenshaw's hearing testimony was said to contradict
what she had told examining psychiatrists about caring for her
grandchildren and her home (R. 66). ALJ Bretthauer alao stated
that Crenshaw's failure to seek “treatment was not what one would
expect from a disabled person” (R. 67). Crenshaw was unable to
explain why she had not sought treatment for her depression (R.
68). And the ALJ found that although Crenshaw had complained of
back pain for several years, she did not take pain medication and
had not sought treatment for her back pain (R. 67).

Although the ALJ noted that a treating physician's medical
opinion should be afforded special significance, she found that
Dr. Shah's opinion could not be accepted because he provided “no
basis for his finding such restrictive limitations” (id.). ALJ

Bretthauer noted that Dr. Shah's involvement in Crenshaw's care

14


Commissioner is charged by Social Security regulations with
making the ultimate determination of disability (Reg.
§416.927(e) (2)). But in making that determination an ALJ (whose
decision typically becomes that of Commissioner herself) “must
minimally articulate [her] reasons for crediting or rejecting
evidence of disability” (S¢ivally v. Sullivan, 966 F.2d 1070,
1076 (7th Cir. 1992)) and “build an accurate and logical bridge

between the evidence and the result” (Sarchet v. Chater, 78 F.3d

305, 307 (7th Cir. 1996)). As Herron, 19 F.3d at 333 (internal
citation omitted) teaches:

Although a written evaluation of each piece of evidence

or testimony is not required, neither may the ALJ

select and discuss only that evidence that favors his

ultimate conclusion.

Finally, *ALJs must not succumb to the temptation to play doctor
and make their own independent medical findings” (Rohan v.
Chater, 98 F.3d 966, 970 (7th Cir. 1996)).

In assessing a claimant's RFC an ALJ must consider all of
the claimant‘'s symptoms, including pain, that can reasonably be
found to be consistent with the available evidence (Reg.
§§416.929, 416.945). As already described, ALJ Bretthauer
determined that Crenshaw was capable of work at a light level of
exertion with no restrictions on her standing or walking (R, 65).
But in reaching that determination she simply failed to make any

assessment of the testimony and medical evidence that bore on

Crenshaw's inability to tolerate standing or walking on a

16


Procedural Background’

On November 4, 1998 Crenshaw filed an application for SSI
disability benefits due to her high blood pressure, diabetes,
depression, stress, arthritia and back pain (R. 145, 152). That
application was denied both initially and on reconsideration (R.
112-15, 118-20). Crenshaw then requested and received a hearing
{the "Hearing"), which took place before Administrative Law Judge
("ALJ") Cynthia M. Bretthauer on December 1, 1999 (R. 24).

On February 22, 2000 ALJ Bretthauer issued a decision
denying Crenshaw’s request for disability benefits (R. 13). That
denial was based on the ALJ's finding that although Crenshaw was
incapable of performing her past relevant work due to the
limitations caused by her impairments, she was able to perform a
significant number of jobs in the economy and was therefore not
disabled (R. 68-69).

Crenshaw's timely request for review before the Appeals
Council was denied on March 28, 2002 (R. 7-8). On July 29, 2002
Crenshaw filed this action pursuant to Section 405 (g).

General Background
Crenshaw, born on December 10, 1946 (R. 145), was 53 years
old at the time of ALJ Bretthauer’s decision, She is 5'4" tall

and weighs 223 pounds (R. 300). She left school between the

2 What followa in the next sections of the text is drawn
from the administrative record (cited “R. --").

2



Crenshaw's alternative request for a remand must be and is

granted.

Milton I. Shadur
Senior United States District Judge

Date: February 13, 2003

25



IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS

JO ANNE B. BARNHART, Commissioner,
Social Security Administration,

EASTERN DIVISION BOTS

ROSALIND CRENSHAW, ) FEB 18 2003
SSH#332-40-1836, )
)
Plaintiff, )
)

v. ) No. 02 C 3543

)
)
)
)
)

Defendant.

MEMORANDUM OPINION AND ORDER

Rosalind Crenshaw ("Crenshaw") seeks judicial review
pursuant to the Social Security Act (“Act”) ,' more specifically
Sections 405(g) and 1383(¢) (3), of the final decision of
Commissioner of Social Security Jo Anne Barnhart ("Commissioner")
denying Crenshaw's claim for supplemental security income ("SSI")
disability benefits. Both sides have moved for summary judgment
under Fed. R. Civ. P. ("Rule") 56, and Crenshaw has alternatively
moved to remand for further proceedings. For the reasons stated
in this memorandum opinion and order, poth parties' Rule 56
motions for summary judgment are denied, but Crenshaw's

alternative motion to remand is granted.

lal] further statutory references will take the form

sgection --,” using the Title 42 numbering rather than the Act’s
internal numbering. All portions of 20 C.F.R. will be cited
‘Reg. § ---" Finally, citations to Crenshaw's and Commigsioner’s

respective memoranda take the form “Cr. Mem. --” and “Comm. Mem.

a



for a continuous period of not less than 12 months.
Knight v. Chater, 55 F.3d 309, 313 (7th Cir.1995) (citations
omitted) sets out the customary five-step inquiry prescribed by
Reg. §416.920 to determine whether a claimant is disabled:
(1) whether the claimant is currently employed;
(2) whether the claimant has a severe impairment;
(3) whether the claimant's impairment meets or
equals one of the impairments listed by the SSA, see 20

C.FLR. §404, Subpt. P, App. 1;

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

(5) whether the claimant is capable of performing
work in the national economy.

If a claimant satisfies steps one, two, and three, she
will automatically be found disabled. If a claimant
satisfies steps one and two, but not three, then she
must satisfy step four. Once step four is satisfied,
the burden shifts to the SSA to establish that the
claimant is capable of performing work in the national
economy .

If a disability determination reaches step five, the ALJ must
discharge Commissioner's burden of proof either by applying the
Medical Vocational Guidelines (the "grid") or through the use of

a vocational expert (Herron v. Shalala, 19 #.3d 329, 336-37 (7th

Cir. 1994)).

ALJ _ Bretthauer's Opinion

ALJ Bretthauer reviewed the submitted evidence and found
that while Crenshaw had multiple impairments, including diabetes

with neuropathy, mild degenerative disc disease, obesity,

12



was actually quite limited and that there was no evidence that
his opinion was grounded in anything other than Crenshaw's
subjective account of her impairments (id.).

Finally the ALJ also discredited Dr. Krakowski's opinion of
Crenshaw's mental functioning because she “lacked the
longitudinal perspective to fully assess this claimant” (id.).
ALJ Bretthauer found Dr. Krakowski's assessment to be
inconsistent with evidence in the record as a whole. Noting that
Crenshaw cared for her grandchildren, took care of the household,
regularly went to church and was capable of concentrating well
enough to read and understand the Bible, the ALJ concluded that
those “functional abilities are simply not consistent with a
person who is disabled by depression” (R. 67-68).

Analysis of the ALd's Decision

Crenshaw argues that the ALJ's decision was not based on
substantial evidence because she (1) failed to address the
diagnostic test results in her determination of Crenshaw's RFC,
(2) improperly relied on the vocational expert’s testimony and
(3) did not adequately articulate her reasons for rejecting Dr.
Krakowski's opinion. Because ALJ Bretthauer’s decision rejected
on a purely conclusory basis the evidence of Crenshaw's symptoms
that was consistent with the diagnostic test results--her
inability to stand or walk on a sustained basis--this action must

indeed be remanded for further proceedings.

15