UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

MANDEEP G.,

Plaintiff,

v.

KILOLO KIJAKAZI,

 ACTING COMMISSIONER OF

 SOCIAL SECURITY,

1

Defendant.

No. 20 CV 3645

Magistrate Judge McShain

MEMORANDUM OPINION AND ORDER

Plaintiff Mandeep G. brings this action for judicial review of the Social Security 

Administration’s (SSA) decision denying her application for benefits. For the 

following reasons, plaintiff’s request to reverse and remand the SSA’s decision [19]2

is denied, defendant’s motion for summary judgment [20] is granted, and the SSA’s 

decision denying plaintiff’s application is affirmed.

Background

A. Procedural Background

In July 2017, plaintiff filed a Title II application for a period of disability and 

disability benefits, alleging a disability onset date of May 26, 2017, due to multiple 

sclerosis (MS). [18-1] 10. Plaintiff’s claim was denied initially and on reconsideration. 

[Id.]. Plaintiff requested a hearing, which was held before an administrative law 

judge (ALJ) on March 19, 2019. [Id.]; [id.] 27-60. In a decision dated April 24, 2019, 

the ALJ found that plaintiff was not disabled and denied her application. [Id.] 10-17. 

The Appeals Council denied review on April 20, 2020, [id.] 1-5, making the ALJ’s 

decision the agency’s final decision. See 20 C.F.R. §§ 404.955 & 404.981. Plaintiff 

1 In accordance with Fed. R. Civ. P. 25(d), Kilolo Kijakazi, the Acting Commissioner of Social 

Security, is substituted as the defendant in this case in place of the former Commissioner of 

Social Security, Andrew Saul.

2 Bracketed numbers refer to entries on the district court docket. Referenced page numbers 

are taken from the CM/ECF header placed at the top of filings, except for citations to the 

administrative record [18], which refer to the page numbers in the bottom right corner of 

each page.

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timely appealed to this Court [1], and the Court has subject-matter jurisdiction to 

review the Acting Commissioner’s decision under 42 U.S.C. § 405(g).3

B. ALJ’s Decision

The ALJ reviewed plaintiff’s disability claim in accordance with the SSA’s fivestep sequential evaluation process. At step one of her decision, the ALJ found that 

plaintiff had not engaged in substantial gainful employment since her alleged onset 

date. [18-1] 12. At step two, the ALJ determined that plaintiff suffered from one 

severe impairment: multiple sclerosis. [Id.] 12-13. At step three, the ALJ ruled that 

plaintiff does not have an impairment or combination of impairments that met or 

equaled the severity of one of the listed impairments. [Id.] 13. Before turning to step 

four, the ALJ found that plaintiff had the residual functional capacity to perform 

“medium work,” though the ALJ also found that plaintiff could only frequently 

push/pull with the non-dominant left upper and lower extremities and must avoid 

concentrated exposures to hazards, including dangerous moving machinery and 

unprotected heights. [Id.] 13-17 (emphasis in original). Later in her analysis of 

plaintiff’s physical RFC, the ALJ reiterated that plaintiff was “capable of performing 

work involving the reduced range of medium exertion” before also stating that 

plaintiff was capable of only “sedentary work.” [Id.] 15, 16. At step four, the ALJ 

determined that plaintiff could perform her past relevant work as a software 

engineer. [Id.] 17. Because that ruling meant that plaintiff was not disabled, the ALJ 

did not proceed to step five and consider whether other jobs existed in substantial 

numbers in the national economy that plaintiff could perform.

Legal Standard

Under the Social Security Act, disability is defined as the “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 for a continuous period of not less than 12 months.” 42 

U.S.C. § 423(d)(1)(A).

To determine whether a claimant is disabled, the ALJ conducts a sequential 

five-step inquiry: (1) whether the claimant is unemployed; (2) whether the claimant 

has a severe impairment or combination of impairments; (3) whether the claimant’s 

impairment meets or equals any listed impairments; (4) whether the claimant is 

unable to perform her past relevant work; and (5) whether the claimant is unable to 

perform any other available work in light of her age, education, and work experience. 

See 20 C.F.R. §§ 404.1520(a)(4) & 416.920(a). “An affirmative answer leads either to 

the next step, or, on Steps 3 and 5, to a finding that the claimant is disabled. A 

negative answer at any point, other than Step 3, ends the inquiry and leads to a 

3 The parties have consented to the exercise of jurisdiction in this case by a United States 

Magistrate Judge. [10].

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determination that a claimant is not disabled.” Clifford v. Apfel, 227 F.3d 863, 868 

(7th Cir. 2000). 

The Court reviews the ALJ’s decision deferentially to determine if it is 

supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is “not a 

high threshold: it means only ‘such relevant evidence as a reasonable mind might 

accept as adequate to support a conclusion.’” Karr v. Saul, 989 F.3d 508, 511 (7th Cir. 

2021) (quoting Biestek v. Berryhill, 139 S. Ct. 1148, 1152 (2019)). But the standard 

“is not entirely uncritical. Where the Commissioner’s decision lacks evidentiary 

support or is so poorly articulated as to prevent meaningful review, the case must be 

remanded.” Brett D. v. Saul, No. 19 C 8352, 2021 WL 2660753, at *1 (N.D. Ill. June 

29, 2021) (internal quotation marks and citation omitted).

Discussion

Plaintiff argues that the ALJ’s decision should be reversed for four reasons.

First, plaintiff contends that the ALJ was required to assess her mental limitations 

by using the “Psychiatric Review Technique” (PRT), a method that plaintiff claims an 

ALJ must use “to determine severity at step two,” to determine “whether a listing is 

satisfied at step three,” and to “shap[e] the RFC.” [19] 10. Because the ALJ either 

failed to apply the PRT at all, or failed to document the findings that the PRT 

generated, plaintiff contends that the ALJ’s decision cannot be meaningfully 

reviewed. [Id.] 11-13. Second, plaintiff argues that the ALJ’s decision is internally 

contradictory because (a) the ALJ allegedly recognized that plaintiff’s MS caused 

some mental limitations but did not state whether plaintiff suffered from a mental 

impairment, and (b) the ALJ purported to limit plaintiff to both medium work and 

sedentary work. [Id.] 13-15. Third, plaintiff argues that the ALJ did not meaningfully 

evaluate the medical opinions in the record. [Id.] 15-16. Fourth, plaintiff maintains 

that the ALJ’s subjective symptom evaluation was patently erroneous. [Id.] 16-21.

A. The ALJ Was Not Required To Use The Psychiatric Review 

Technique.

Plaintiff first argues that the ALJ either failed to apply the supposedly 

required “Psychiatric Review Technique” to determine the extent of her mental 

limitations or, having applied the PRT, did not adequately explain what conclusions 

she drew from the PRT. [19] 10-12. Plaintiff maintains that this error undermined 

the ALJ’s analysis at steps two and three, as well as the ALJ’s determination of 

plaintiff’s RFC, and prevents the Court from meaningfully reviewing the ALJ’s 

decision. The Court rejects this argument. Because plaintiff introduced no evidence 

that she suffers from a mental impairment, the ALJ was not required to apply the 

PRT to determine the severity of such impairment or the extent to which such

impairment caused work-related limitations.

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Under the applicable SSA regulations, “when a mental impairment is found to 

be a medically determinable impairment, it must be reviewed using ‘a special 

technique at each level of the administrative review process.’” Lisa G. v. Kijakazi, No. 

21-cv-3732, 2022 WL 4272782, at *2 (N.D. Ill. Sept. 15, 2022) (quoting 20 C.F.R. 

§ 404.1520a); see also Sheila M. v. Saul, Case No. 20 C 664, 2021 WL 1784775, at *3 

(N.D. Ill. May 5, 2021) (stating that the “psychiatric review technique” that is 

“described in 404 CFR 404.1520a” “requires adjudicators to assess an individual’s 

limitations and restrictions from a mental impairment(s) in categories identified in 

the paragraph B and paragraph C criteria of the adult mental disorders listings”).

“This special technique includes rating the degree of limitation in four areas: (1) 

understanding, remembering, and applying information; (2) interacting with others; 

(3) concentrating, persisting, and maintaining pace; and (4) adapting or managing 

oneself.” Lisa G., 2022 WL 4272782, at *2 (citing 20 C.F.R. § 404.1520a(c)(3)). 

Limitations in these areas are measured on a five-point scale: none, mild, moderate, 

marked, and extreme. 20 C.F.R. § 404.1520a(c)(4). Case law and SSA regulations

refer to this “special technique” as the “Psychiatric Review Technique.” See, e.g., 

Carly M. v. Kijakazi, No. 20 C 2995, 2022 WL 2237132, at *4 (N.D. Ill. Jun. 22, 2022) 

(describing psychiatrist’s completion of “an agency form entitled ‘psychiatric review 

technique’ in which he concluded that Plaintiff met the criteria” for two listed 

impairments); Ronning v. Colvin, 555 F. App’x 619, 621 (7th Cir. 2014) (describing 

consulting psychologist’s conclusion, “[i]n a form labeled ‘Psychiatric Review 

Technique,’” that plaintiff did not have a medically determinable impairment).

The ALJ was not required to apply the PRT in this case because plaintiff does 

not suffer from a mental impairment. Plaintiff has not offered evidence or argued that 

she suffers from a mental impairment; rather, plaintiff sought disability benefits 

based on her diagnosed multiple sclerosis, a condition that the Listings characterize 

as a neurological disorder. See Grace E. B. v. Comm’r of Soc. Sec., Case No. 19-cv1136-MAB, 2020 WL4747697, at *7 (S.D. Ill. Aug. 17, 2020) (“The 11.00 series of the 

Listings covers neurological disorders,” including MS). At step two, moreover, the 

ALJ agreed that plaintiff’s multiple sclerosis was a severe impairment, and later in 

her decision the ALJ crafted an RFC determination after considering the extent to 

which plaintiff’s MS limited her ability to work. See [18-1] 12-13, 14-16. Because 

plaintiff does not suffer from a mental impairment, the ALJ’s “failure” to apply the 

PRT–a key purpose of which is to establish the severity of a mental impairment–at 

step two was not an error. See Angie R. v. Saul, Case No. 20-cv-1442, 2021 WL 

2950152, at *9-11 (D. Minn. Jul. 14, 2021) (ALJ not required to use PRT in case where 

plaintiff alleged that her multiple sclerosis caused work-related mental limitations).

And while plaintiff faults the ALJ for not applying the PRT at step three, this 

argument fails because, again, plaintiff does not contend that she has a mental 

impairment, and plaintiff does not argue (or cite any evidence that would support an 

argument) that she meets or equals Listing 11.09, which addresses multiple sclerosis. 

See [19] 10-13.

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B. The Inconsistencies In The ALJ’s Decision Identified By 

Plaintiff Did Not Affect The Denial Of Benefits.

Plaintiff next argues that the Court cannot meaningfully review the ALJ’s 

decision because it is logically inconsistent. [19] 13-14. In support, plaintiff contends 

that the ALJ “did not commit to whether [she] had mental impairments of some 

degree or had no mental impairments.” [Id.] 14. Plaintiff also notes that the ALJ’s 

physical RFC determination is internally inconsistent because the ALJ purported to 

limit plaintiff to medium work but also stated that she was capable of only sedentary 

work. [Id.] 14-15. These contentions provide no basis for reversing or remanding the 

ALJ’s decision.

First, regarding the supposed inconsistencies concerning mental impairments, 

the Court reiterates that plaintiff has offered no evidence that she suffers from any 

mental impairment, whether severe or non-severe. None of the agency doctors who 

evaluated plaintiff diagnosed her with a mental disorder or found that plaintiff 

suffered from a mental impairment of any severity. See, e.g., [18-1] 337-38 

(psychological evaluation prepared by Dr. Shannon Doyle on September 11, 2017); 

[id.] 367-69 (mental status examination prepared by Dr. Randy Kettering on March 

13, 2018); (internal medicine consultative evaluation prepared by Dr. Debbie Weiss 

on March 14, 2018). The ALJ’s decision could not be any clearer that the ALJ did not 

believe that plaintiff had a mental impairment, and plaintiff has not cited any 

evidence that is even arguably inconsistent with that decision.

Plaintiff’s argument that the ALJ’s decision on this point is somehow internally 

inconsistent appears to rest on the following passage, which appears during the ALJ’s 

discussion of plaintiff’s ability to complete certain activities of daily living (ADLs):

The claimant admits she performs self-care, prepares meals, drives a 

car, performs household chores, goes grocery shopping. In addition, she 

reads, uses a computer, manages her finances, has friends, goes out for 

dinner, and watches television. The performance of such activities on a 

regular and continuing basis indicates that the claimant’s level of pain 

and mental impairment does not seriously interfere with her ability to 

maintain attention and concentration, perform routine tasks, 

understand and follow simple instructions, adapt or manage herself and 

interact with others.

[18-1] 15 (emphasis added); see also [19] 14 (plaintiff’s brief citing this portion of ALJ’s 

decision).

Plaintiff’s argument seems to be that, if the ALJ had actually decided that she

did not have a mental impairment, there was no reason for the ALJ to consider 

whether plaintiff had any limitations in these areas of mental functioning. Stated 

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another way, because the ALJ considered plaintiff’s ability to function in these four 

areas–areas that an ALJ must consider when applying the PRT, see 20 C.F.R. 

§ 404.1520a(c)(3)–the ALJ must have found that plaintiff had a mental impairment. 

This argument lacks merit. In the Court’s view, the ALJ focused on these areas of 

mental functioning because they were relevant to whether plaintiff met or equaled

Listing 11.09. Under Listing 11.09, a claimant’s multiple sclerosis may be found to be 

presumptively disabling under two sets of criteria: the “paragraph A” criteria, which 

focus on extreme limitations resulting from disorganized motor function in the 

extremities; and the “paragraph B” criteria, which focus on marked limitations in 

physical functioning and in the four areas of mental functioning addressed by the 

ALJ: understanding, remembering, or applying information; interacting with others; 

concentrating, persisting, or maintaining pace; and adapting or managing oneself. 

See 20 C.F.R. Pt. 404, Subpt. P, App, 1, Listing 11.09. Thus, when the ALJ said that 

plaintiff’s “level of pain and mental impairment does not seriously interfere with” 

these four areas of mental functioning, the ALJ was providing support for her 

conclusion that plaintiff did not have a marked limitation in these areas and, 

consequently, did not meet the “paragraph B” criteria of Listing 11.09. See 20 C.F.R. 

Pt. 404, Subpt. P, App 1, Listing 11.00G2b (“a marked limitation means that, due to 

the signs and symptoms of your neurological disorder, you are seriously limited in the 

ability to function independently, appropriately, effectively, and on a sustained basis 

in a work setting”) (emphasis added). Contrary to plaintiff’s argument, there is no 

inconsistency in the ALJ’s handling of plaintiff’s undocumented and–as far as the 

record before the Court shows–nonexistent mental impairments, let alone an 

inconsistency warranting a remand.

Second, the Court agrees with plaintiff that the ALJ’s physical RFC 

determination is internally inconsistent. The ALJ initially concluded that plaintiff 

could perform medium work. [18-1] 17. The ALJ reiterated that point later in her 

decision, [id.] 15, before concluding, near the end of her RFC analysis, that plaintiff 

only had “the residual functional capacity to perform sedentary exertional work.” [Id.] 

16. This is a meaningful inconsistency because limiting plaintiff to sedentary work is 

more restrictive than limiting her to medium work. E.g., Joy B. v. Kijakazi, No. 20 C 

3238, 2023 WL 415544, at *5 (N.D. Ill. Jan. 25, 2023) (“The only opinions from the 

relevant period limited Claimant to medium work, but the ALJ went further and 

restricted Claimant to sedentary work.”).

That said, the Court also finds that the ALJ’s error was harmless. See Karr, 

989 F.3d at 513 (“But if the error leaves us convinced that the ALJ would reach the 

same result on remand, then the error is harmless and a remand is not required.”).

At step four, the ALJ found that plaintiff could perform her past relevant work as a 

software engineer. During the hearing, the vocational expert (VE) testified without 

objection that the software engineer position was classified as a “sedentary” position 

and “appeared to be really sedentary as performed” [18-1] 60, and the ALJ’s decision 

reflects that she accepted this characterization. Accordingly, even if the ALJ should 

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have limited plaintiff to sedentary work only, such a limitation would have been 

consistent with the ALJ’s finding that plaintiff could perform her past relevant–and 

sedentary–work as a software engineer.4 Accordingly, no remand is warranted.

C. The ALJ’s Handling Of The Opinion Evidence Was Not 

Reversible Error.

Plaintiff also argues that the ALJ erred in evaluating the opinion evidence. 

[19] 15-16. Plaintiff contends that the ALJ “did not find any opinion persuasive or 

give any opinion particular weight.” [Id.]. While the Court agrees that the ALJ did 

not follow the SSA’s regulations for weighing opinion evidence, this error was 

harmless because none of the opinion evidence was favorable to plaintiff’s claim. See 

Karr, 989 F.3d at 513.

“An ALJ has an obligation to evaluate every medical opinion and explain the 

weight given to the opinion.” Georgios A. v. Kijakazi, No. 20-cv-2729, 2022 WL 

1004249, at *5 (N.D. Ill. Apr. 4, 2022) (internal quotation marks omitted). In cases 

like this one, where the disability claim was filed after March 27, 2017, the ALJ was 

not required to give controlling weight to the opinions of a treating physician. See 20 

C.F.R. § 1520c. “Instead, the most important factors are a medical opinion’s 

‘supportability’ and ‘consistency’ with the evidence in the record.” Albert v. Kijakazi, 

34 F.4th 611, 614 (7th Cir. 2022). Similarly, “[w]hen evaluating a non-treating 

source’s opinion, the ALJ is required to determine the weight to assign the opinion 

by considering certain regulatory factors, including the claimant’s examining and 

treatment relationship with the source of the opinion; the physician’s specialty; the 

support provided for the medical opinion; its consistency with the record as a whole; 

and any other factors that tend to support or contradict the opinion.” Michael G. v. 

Kijakazi, No. 19 CV 6017, 2022 WL 4119775, at *12 (N.D. Ill. Sept. 9, 2022) (internal 

quotation marks omitted).

The ALJ in this case did not follow this process for weighing the various 

opinions in the record. Rather, the ALJ simply summarized the contents of the 

doctors’ opinions and did not expressly indicate whether, the extent to which, or why 

she found these opinions to be well-supported and consistent with other evidence in 

4 Plaintiff suggests in passing that her past relevant work was not a sedentary position 

because her employer described that job as requiring travel fifty percent of the time. See [19] 

20 (citing [18-1] 185). But plaintiff (who was represented by counsel at the hearing, see [18-

1] 29) did not object to the VE’s testimony that the software engineer position was a sedentary 

job either during the hearing, see [18-1] 55-56, or in her post-hearing brief, see [id.] 159-60. 

Accordingly, plaintiff has forfeited any objection to the classification of her past relevant work 

as sedentary. See Todd B. v. Kijakazi, No. 20 C 6888, 2022 WL 2132542, at *3 (N.D. Ill. Jun. 

14, 2022) (plaintiff’s failure to object to VE’s testimony that he acquired skills from past 

relevant work that were transferrable to sedentary work resulted in forfeiture of “any 

objection or claimed deficiency with respect to the ALJ’s consideration of the . . . VE’s 

testimony concerning transferability of skills”). 

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the record. No remand is warranted, however, because the opinion evidence simply 

did not support plaintiff’s claim to be disabled. The opinion evidence summarized by 

the ALJ reflected only that:

• Plaintiff could perform medium exertional work. See [18-1] 52-53 (opinion of 

testifying medical expert Dr. Sai Nimmagadda); [id.] 67 (opinion of Dr. Charles 

Kenny during initial disability determination); [id.] 90-91 (opinion of Dr. Lisa 

McMullan during reconsideration-level disability determination).

• Plaintiff was alert and oriented, displayed a normal range of comprehension 

and concentration, and could handle her own finances. [18-1] 387 (March 14, 

2018 opinion of consultative examiner Dr. Debbie Weiss).

• Plaintiff did not meet the criteria for any psychiatric diagnosis. [18-1] 338

(September 11, 2017 opinion of consultative examiner Dr. Shannon Doyle).

• Plaintiff exhibits “spotty judgment in some common situations,” but did not 

meet the criteria for any mental or psychiatric disorder. [18-1] 369 (March 13, 

2018 opinion of consultative examiner Dr. Randy Kettering).

Although the ALJ did not follow the relevant regulations for weighing this 

evidence, it is implicit from the ALJ’s discussion of this evidence–none of which 

reflects that plaintiff’s MS imposed meaningful work-related limitations–that the 

ALJ believed it was consistent with her ruling that plaintiff was not disabled. Indeed, 

while plaintiff accuses the ALJ of cherry-picking the evidence, see [19] 15, plaintiff 

has not identified any favorable opinion evidence that the ALJ failed to discuss, see

[id.] 15-16. And while plaintiff contends that “[t]he examining doctors noted mental 

problems,” [id.] 16, plaintiff notably fails to cite any part of the record to support that 

claim. In any event, and as the ALJ’s accurate recounting of the opinion evidence 

demonstrates, nothing in the record suggests that any “mental problem” was caused 

by plaintiff’s MS–let alone that it imposed a meaningful limitation on plaintiff’s 

ability to work.5

For these reasons, the ALJ’s failure to adhere to the SSA’s regulations for 

evaluating and weighing opinion evidence was harmless. Karr, 989 F.3d at 513.

5 Plaintiff faults the ALJ for “misstat[ing] the opinions of the non-examining, non-treating 

physicians as medium work ‘with constant pushing/pulling with the left upper and lower 

extremities.’” [19] 15 (citing [18-1] 16). Plaintiff is correct that the ALJ’s summary of this 

opinion evidence overstated the frequency with which plaintiff could push and pull with her 

left upper and lower extremities, but plaintiff does not explain how this error undermines 

the ALJ’s finding that plaintiff could perform her past relevant work. Nor does plaintiff’s 

employer’s description of plaintiff’s job duties suggest that any pushing or pulling with the 

left extremities was required. See [18-1] 185. Accordingly, the Court finds that this error, too, 

was harmless. Karr, 989 F.3d at 513.

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D. The ALJ’s Evaluation Of Plaintiff’s Subjective Allegations Was 

Not Patently Erroneous.

Finally, plaintiff argues that the ALJ erred in evaluating whether her 

subjective allegations were consistent with the record. [19] 16-21. Plaintiff contends 

that the ALJ rejected her allegations about the severity of her symptoms for nine 

reasons, but “[q]uantity does not equal quality.” [Id.] 16.

“When assessing a claimant’s subjective symptom allegations, an ALJ must 

consider several factors, including the objective medical evidence, the claimant’s daily 

activities, his level of pain or symptoms, aggravating factors, medication, course of 

treatment, and functional limitations.” Charles B. v. Saul, Case No. 19 C 1980, 2020 

WL 6134986, at *6 (N.D. Ill. Oct. 19, 2020). “[T]he ALJ must explain her subjective 

symptom evaluation in such a way that allows the Court to determine whether she 

reached her decision in a rational manner, logically based on her specific findings and 

the evidence in the record.” Id. (internal quotation marks and brackets omitted). “The 

Court will overturn an ALJ’s evaluation of a claimant’s subjective symptom 

allegations only if it is patently wrong.” Id. (internal quotation marks omitted).

The ALJ concluded that plaintiff’s “statements concerning the intensity, 

persistence and limiting effects of [her] symptoms are not entirely consistent with the 

medical evidence and other evidence in the record[.]” [18-1] 14. In support, the ALJ 

noted that (1) plaintiff’s allegation that she could not work after the disability onset 

date “is not supported by objective medical evidence”; (2) plaintiff was taking 

medication that “was working well” and had “tolerable side effects,” but also had 

“elected not to start medication for fatigue”; (3) plaintiff’s condition was stable and 

“has actually improved since the alleged onset date”; (4) plaintiff was noncompliant 

with her treatment regimen; (5) plaintiff’s description of her ADLs was “inconsistent 

with her complaints of disabling symptoms and limitations”; (6) the record 

consistently showed that plaintiff “had full recall and attention”; (7) plaintiff gave 

inconsistent reasons for her alleged inability to work; (8) there was no medical 

evidence indicating that plaintiff’s MS impeded her ability to walk or caused 

weakness in her left arm and leg; and (9) plaintiff’s “presentation and demeanor at 

the hearing,” during which she “closely and fully attend[ed] the hearing proceedings,” 

was “inconsistent with her allegations of disabling symptoms.” [Id.] 14-16.

Plaintiff makes several valid arguments against the ALJ’s subjective symptom 

determination. For example, the ALJ drew a negative inference from plaintiff’s 

failure to attend a recommended neuropsychological consultation and to follow up

with a referral to an ophthalmologist. [18-1] 14-15. But as plaintiff correctly observes, 

see [19] 18, the ALJ never explored plaintiff’s reasons for not pursuing this treatment. 

See James C. v. Kijakazi, No. 20 CV 6592, 2023 WL 3886106, at *5 (N.D. Ill. Jun. 8, 

2023) (“An ALJ may consider noncompliance with recommended treatment 

modalities when evaluating the severity of a claimant’s symptoms,” but “must first 

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explore the claimant’s reasons for the lack of medical care before drawing a negative 

inference[.]”) (internal quotation marks omitted). The ALJ also emphasized that 

plaintiff “performs self-care, prepares meals, drives a car, performs household chores, 

[ ] goes grocery shopping[,] reads, uses a computer, manages her finances, has friends, 

goes out for dinner, and watches television.” [18-1] 15. “Although an ALJ should 

consider a plaintiff’s daily activities in assessing the severity of a plaintiff’s 

symptoms, an ALJ must be careful not to equate a plaintiff’s ability to perform 

activities of daily living with an ability to work full time.” Latina W. v. Kijakazi, No. 

21 C 5344, 2023 WL 4273663, at *3 (N.D. Ill. Jun. 29, 2023). In this case, however, 

the ALJ appears to have considered plaintiff’s ability complete a handful of ADLs as 

direct evidence of her ability to work without mental or physical limitations: “Such 

evidence further supports a finding that the claimant remains capable of performing 

work involving the reduced range of medium exertion described above.” [18-1] 15 

(emphasis in original). Finally, it is not clear to the Court that the inconsistency 

identified by the ALJ in plaintiff’s statements to her treaters about why she stopped 

working in fact existed or sheds any light on the credibility of plaintiff’s allegations. 

The ALJ observed that, while plaintiff testified that she stopped working because 

“mentally she could not handle it,” plaintiff had also told her primary care doctor that 

she has not been working “as her eyes cannot handle and she does not have the 

balance either.” [18-1] 15 (citing [id.] 456). Yet plaintiff also told Dr. Rubinstein that 

she could not return to work because of “fatigue” and “cognitive impairment,” which 

is consistent with her hearing testimony. [Id.] 428 (Dr. Rubinstein’s May 14, 2018 

treatment note). In addition, it is undisputed that plaintiff was referred for an 

ophthalmology evaluation–presumably to address concerns with her vision–so it is

unclear why the ALJ found it significant that plaintiff cited different reasons for not 

returning to work, especially given that MS can cause both fatigue and vision 

problems. See Milliken v. Astrue, 397 F. App’x 218, 223 (7th Cir. 2010) (“Fatigue is a 

common symptom of MS”); Milton B. v. Kijakazi, No. 20-cv-5482, 2023 WL 4134812, 

at *2 n.2 (N.D. Ill. Jun. 22, 2023) (“typical symptoms” of MS “include visual loss”).

On balance, however, these “flaws in the ALJ’s reasoning are not enough to 

undermine the ALJ’s decision that [plaintiff] was exaggerating her symptoms. Not 

all of the ALJ’s reasons must be valid as long as enough of them are[.]” Halsell v. 

Astrue, 357 F. App’x 717, 722 (7th Cir. 2009) (emphasis in original). In this case, 

enough of the ALJ’s reasons for discounting plaintiff’s allegations were valid such 

that the Court finds that the ALJ’s subjective symptom determination is supported 

by substantial evidence.

First, the ALJ found that plaintiff’s allegation that her MS caused memory and 

attention deficits was not supported by the medical record. See [18-1] 15. In support, 

the ALJ relied on notes from five of plaintiff’s doctor’s visits (which occurred between 

June 2017 and November 2018) reflecting that plaintiff had full recall and attention. 

[Id.]. Plaintiff argues that the ALJ could not rely on this evidence because these 

doctors examined plaintiff during relatively brief office visits or evaluations, and none 

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expressly considered whether plaintiff could work an eight-hour day. [19] 19. This 

argument has no merit. The ALJ was entitled to rely on these doctors’ findings 

regarding plaintiff’s memory and attention, which under the regulations are “useful 

indicator[s] to assist [the ALJ] in making reasonable conclusions about the intensity 

and persistence of [plaintiff’s] symptoms and the effect those symptoms . . . may have 

on [her] ability to work.” 20 C.F.R. § 404.1529(c)(2). Plaintiff’s argument that the ALJ 

should not have relied–or relied as heavily–on this evidence is an impermissible 

request that the Court reweigh the evidence. See Spring W. v. Saul, Case No. 20 C 

1864, 2021 WL 2529615, at *2 (N.D. Ill. Jun. 21, 2021) (“In reviewing an ALJ’s 

decision, the Court may not reweigh the evidence, resolve conflicts, decide questions 

of credibility, or substitute its own judgment for that of the ALJ.”) (internal quotation 

marks and brackets omitted).

Second, the ALJ accurately observed that plaintiff had declined to take 

prescription medication for her fatigue. [18-1] 14. In support, the ALJ cited an August 

21, 2018 treatment note from Dr. Wayne Rubinstein, plaintiff’s neurologist, which 

states that “[w]e elected not to start medications for fatigue (amantadine, modafinil 

or fluoxetine) at this time. Continue to get 7+ hours of sleep nightly and exercise 

daily.” [Id.] 435. “An ALJ is permitted to consider routine and conservative treatment 

in assessing the severity of a claimant’s subjective symptoms.” Angela G. v. Berryhill, 

No. 1:17-cv-1788-JRS-DLP, 2019 WL 1055096, at *5 (S.D. Ind. Mar. 6, 2019). 

Plaintiff’s choice, made in consultation with her neurologist, not to begin prescription 

medication for her fatigue provides a reasonable basis for the ALJ’s conclusion that 

plaintiff’s fatigue was not as severe as alleged. See Jason R. v. Saul, No. 2:19-cv-352-

JPH-MJD, 2020 WL 13555030, at *6 (S.D. Ind. Oct. 27, 2020) (ALJ reasonably relied 

on plaintiff’s decision to “prioritize[e] taking Xanax for his anxiety over being 

prescribed pain medication” in finding that plaintiff’s symptoms were not as severe 

as alleged).

Third, the ALJ reasonably observed that plaintiff’s condition was “stable” and 

had shown signs of improvement since the alleged onset date. Plaintiff was diagnosed 

with relapsing remitting multiple sclerosis [18-1] 50, 348, a form of MS “in which 

patients have relapses of MS and periods of stability between relapses. Relapses are 

episodes of new or worsening symptoms not caused by fever or infection and that last 

more than 48 hours.” Monika B. v. Saul, No. 20 CV 638, 2020 WL 7626685, at *1 n.5 

(N.D. Ill. Dec. 22, 2020). In support of her conclusion that plaintiff’s condition was 

stable or improved, the ALJ cited (1) a June 2, 2017 MRI and accompanying report 

in which neurologist John Ruge opined that, “[c]linically [plaintiff] is much improved, 

and today she is neurologically intact,” [18-1] 320; (2) treatment notes from Dr. 

Rubinstein on October 17, 2017, February 14, 2018, and May 14, 2018 noting that 

plaintiff had “stable symptoms and exam” and a stable MRI [id.] 348, 373, 430; (3) a 

November 21, 2018 treatment note from Dr. Rubinstein reflecting a “reduction in 

disease activity on DMF,” i.e., dimethyl fumarate (also known as Tecfidera), “a 

prescription medicine used to treat people with relapsing forms of multiple sclerosis,” 

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Watson v. Comm’r of Soc. Sec., Case No. 2:17-cv-11978, 2018 WL 4496650, at *3 n.2 

(E.D. Mich. Aug. 16, 2018); and (4) the opinions of Dr. Nimmagadda–the medical 

expert who reviewed the record and testified at the hearing–that plaintiff’s MS was 

“relatively stable to improving” and “remained relatively uncomplicated or stable at 

this point in time” and that “some of the plaque lesions have improved.” [18-1] 50. 

The Court also observes that a December 2017 MRI was described by Dr. Rubinstein 

as indicating “brain improved – stable lesions and smaller left post temp + right 

frontal lesions, resolution of enhancement.” [Id.] 437.

Against this evidence, plaintiff argues that “MS is not reversible” and that 

“[t]reatment only slows down progression.” [19] 17. That is true, but nothing in the 

ALJ’s decision suggests that the ALJ believed that MS was curable or could be 

reversed. To the contrary, the ALJ found–based on specific pieces of evidence, 

including treatment notes from plaintiff’s treating neurologist–that her condition was 

at least stable and that plaintiff herself and at least one MRI showed signs of 

improvement. Nor is there merit to plaintiff’s argument that the ALJ impermissibly 

cherry-picked the evidence by “[r]elying on her positive reports to the doctor, while 

discounting the symptoms she reported to the doctor.” [19] 17. In this section of her 

opinion, the ALJ focused, not on plaintiff’s subjective reports, but on the objective 

evidence in the records–doctor’s opinions, MRI results, treatment notes–and found 

that they were inconsistent with plaintiff’s allegations about the severity of her 

symptoms. Again, plaintiff points to no objective evidence that was contrary to that 

cited and discussed by the ALJ.

Fourth, the ALJ reasonably concluded that the record was inconsistent with 

plaintiff’s claim that she experienced weakness in her left arm and leg and had a 

diminished ability to walk. [18-1] 15-16. As the ALJ accurately observed, treatment 

notes consistently reflected that plaintiff had full strength in her extremities during 

exams on June 20, 2017, October 17, 2017, May 14, 2018, August 21, 2018, and 

November 21, 2018. [Id.]. Likewise, the ALJ cited evidence in support of her 

conclusion that plaintiff did not have “an uncoordinated gait, motor impairment, 

sensory deficit or impaired reflexes.” [Id.] 15. Plaintiff argues that these 

considerations should not have trumped her testimony that, before being diagnosed 

with MS, plaintiff had hiked the Grand Canyon but now had difficulty walking a mile. 

See [19] 20. But this argument is simply a request that the Court weigh the evidence 

differently than the ALJ, but such a request exceeds the scope of the Court’s review. 

See Spring W., 2021 WL 2529615, at *2.

Finally, the ALJ’s other reasons for rejecting plaintiff’s subjective allegations 

were reasonably grounded in the evidence. As the ALJ noted, plaintiff was taking 

medication for her MS that “was working well with tolerable side effects” and that 

she stopped taking Tecfidera because her “symptoms, exams and MRI” were “stable,” 

[18-1] 18. The ALJ also observed that plaintiff was able to pay attention during the 

hearing and did not appear to have trouble sitting or be in pain. [Id.] 16. While this 

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fact, standing alone, might not have supported the ALJ’s adverse credibility finding, 

the ALJ “was allowed to consider [plaintiff’s] physical appearance and demeanor at 

the hearing as one factor in assessing [her] credibility.” Burton v. Barnhart, 203 

F. App’x 737, 743 (7th Cir. 2006). Finally, while the ALJ did not elaborate on her 

conclusion that the objective evidence did not support plaintiff’s “assertion that she 

has not been able to work at any time since the alleged disability onset date,” the 

Court understands the ALJ to have meant that none of the medical evidence she 

reviewed supported plaintiff’s contention that her MS caused meaningful workrelated limitation. See Winsted v. Berryhill, 923 F.3d 472, 478 (7th Cir. 2019) (“The 

court applies a common-sense reading to the entirety of an ALJ’s decision.”).

In sum, the ALJ’s evaluation of plaintiff’s subjective symptom allegations was 

“imperfect,” but “there is substantial evidence supporting her decision to discount 

[plaintiff’s] credibility.” Halsell, 357 F. App’x at 723. A key theme in plaintiff’s brief 

is that her MS caused work-related mental limitations that prevented plaintiff from 

performing her past skilled work as a software engineer. See [19] 10, 12, 19, 21. But 

the ALJ’s subjective symptom analysis makes clear that the ALJ did not credit 

plaintiff’s claims that her fatigue, brain fog, and cognitive impairment were as severe 

as plaintiff alleged and prevented her from working. And because there was 

substantial evidence in the record that permitted the ALJ to reach that conclusion, 

the Court rejects plaintiff’s argument that the ALJ’s subjective symptom 

determination was patently erroneous.

Conclusion

For the reasons set forth above, plaintiff’s request to reverse and remand the 

SSA’s decision [19] is denied, defendant’s motion for summary judgment [20] is 

granted, and the SSA’s decision denying plaintiff’s application is affirmed.

_____________________________________

HEATHER K. McSHAIN

United States Magistrate Judge

DATE: October 18, 2023

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