Opinion ID: 857216
Heading Depth: 2
Heading Rank: 1

Heading: Residual Function Capacity

Text: Pepper challenges the ALJ’s RFC determination on a number of grounds. At step four, the ALJ must determine the individual’s RFC, or “what an individual can still do despite his or her limitations.” S.S.R. 96-8p, 1996 SSR LEXIS 5, at . The RFC represents the maxi- 4 (...continued) ALJ’s decision, but these contentions are irrelevant to our inquiry here. No. 12-2261 21 mum a person can do—despite his limitations—on a “regular and continuing basis,” which means roughly eight hours a day for five days a week. Id. The ALJ in this case concluded that Pepper had the RFC to perform light work, with the caveat that she avoid concentrated exposure to pulmonary irritants and hazards. 20 C.F.R. § 404.1567(b) provides the definition for light work: Light work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds. Even though the weight may be very little, a job is in this category when it requires a good deal of walking or standing, or when it involves sitting most of the time with some pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of light work, you must have the ability to do substantially all of these activities. If someone can do light work, we determine that he or she can also do sedentary work, unless there are additional limiting factors such as loss of fine dexterity or inability to sit for long periods of time. We address each of Pepper’s RFC challenges in turn.
Pepper first argues that the ALJ’s RFC determination was “erroneous” as a whole because the ALJ “merely summarized some of the medical evidence without assessment or discussion specifying how the medical and other evidence supported his conclusions,” and there22 No. 12-2261 fore, it did not satisfy the requirements of S.S.R. 96-8p. We disagree. After setting forth his RFC determination, the ALJ provided a lengthy discussion of Pepper’s testimony regarding all her impairments and the information in the medical records. The ALJ described Pepper’s jaw, foot, chest, neck, and shoulder pains; her fear of nearfainting episodes; her respiratory issues; her mental impairments (mainly, depression); her migraines; her weight gain and obesity; and her vision problems. After doing so, he concluded that each of the impairments or ailments supported the light work limitation. This is consistent with our repeated assertion that “an ALJ’s ‘adequate discussion’ of the issues need not contain ‘a complete written evaluation of every piece of evidence.’ ” McKinzey, 641 F.3d at 891 (quoting Schmidt, 395 F.3d at 744). The ALJ’s discussion here was adequate. To the extent Pepper argues that the decreased range of motion in her neck and her ability to sit for only a short period of time are inconsistent with the ALJ’s RFC assessment, this argument is unconvincing. The only doctor to offer an opinion about Pepper’s abilities that arguably could be inconsistent with her capacity to do light work was Pepper’s cousin, Dr. Kafka, in 2003. But even Dr. Kafka did not explicitly opine that Pepper’s impairments, individually or in the aggregate, prevented her from completing the central tasks of “light work:” lifting, walking, standing, and pushing and pulling with one’s arms and legs. See 20 C.F.R. § 404.1567(b); see also Diaz v. Chater, 55 F.3d 300, 306-07 (7th Cir. 1995) (describing the evidence the ALJ considered in determining the claimaint had the RFC to do light and No. 12-2261 23 sedentary work, including evidence of one doctor’s opinion that the claimaint’s impairments “affected his ability to reach, push, and pull”). The ALJ has the responsibility of resolving any conflicts between the medical evidence and the claimaint’s testimony. See Shauger v. Astrue, 675 F.3d 690, 698 (7th Cir. 2012) (quoting Hacker v. Barnhart, 459 F.3d 934, 936 (8th Cir. 2006)). He did that. Our task is to determine whether substantial evidence supports the ALJ’s RFC conclusion. We believe that it does.
Pepper’s next argument is that the ALJ did not ade- quately consider her migraine headaches in determining her RFC. This argument is equally unavailing. The ALJ mentioned Dr. Fattal’s October 2005 note regarding Pepper’s complaint of migraines occurring about four times per year. The ALJ also mentioned Dr. Putman’s note that Pepper complained of migraines in 2006, in addition to his observation that Pepper complained of migraines to Dr. Brody on numerous occasions. Pepper contends this was not sufficient because her migraines “occurred several times a month and in each instance incapacitated her for at least one day.” But Pepper’s medical records do not support that contention, and an ALJ is not required to discuss every snippet of information from the medical records that might be inconsistent with the rest of the objective medical evidence. See Simila v. Astrue, 573 F.3d 503, 516 (7th Cir. 2009). The only medical record supporting Pepper’s statement is a note 24 No. 12-2261 from August 2005 by Dr. Goodner that says, “[Patient] has migraine several times monthly, though she has now gone 3 months without one.” In the diagnosis section, however, Dr. Goodner further states, “MIGRAINE—quiet for now, good relief with meds when they do occur[.]” This statement is in accordance with the rest of the medical evidence that indicates Pepper had migraine headaches approximately every few months and the symptoms were relieved with medication, which the ALJ appropriately found to be more credible than Pepper’s testimony (as we address below). See McKinzey, 641 F.3d at 890 (credibility determinations must be supported by substantial evidence). To find support for this conclusion, one need look no further than the medical record notes from the months before and after Dr. Goodner’s August 2005 note: Dr. Li wrote in her July 2005 note that Pepper said she has headaches “once every 3 to 4 month[s]”; and in October 2005, Dr. Fattal wrote that Pepper has “4 migraines per y[ea]r.” This is not a situation like Indoranto v. Barnhart, 374 F.3d 470, 473-74 (7th Cir. 2004), where the ALJ failed to discuss “chronic severe headaches every day,” or Villano v. Astrue, 556 F.3d 558, 563 (7th Cir. 2009), where the ALJ performed a cursory analysis and dismissed a line of evidence without any discussion. We believe the ALJ’s discussion sufficiently addressed Pepper’s migraine headaches and was supported by substantial evidence from the record. No. 12-2261 25
Pepper further contends the ALJ erred when dis- cussing her vision limitations by only relying on a document that post-dated Pepper’s date last insured and in not adequately explaining how Pepper’s vision impairments are addressed in the RFC. Again, we disagree. First, the document at issue was from an examination with Dr. Brody on November 12, 2008. Dr. Brody stated that Pepper’s eyesight with corrective lenses ranged from 20/20 to 20/30. This assessment is consistent with Dr. Brody’s previous eye examinations of Pepper’s eyesight from 1998 to 2007. Additionally, all but one of Pepper’s documented eye impairments were present several years before Pepper stopped working in 2002, which the ALJ noted in his written decision. These included congenital esotropia, possible glaucoma, visual obscuration, nystagmus, and the effect of migraines. Mild cataracts were noticed in 2004, but they did not change Pepper’s visual acuity. The ALJ also noted Pepper’s complaints to Dr. Brody about her difficulty seeing small print, difficulty reading, seeing black spots and flashes, and seeing yellow, all of which occurred before Pepper’s date last insured. We find no errors in the information the ALJ considered or the ALJ’s explanation when addressing Pepper’s vision limitations. Furthermore, there is no evidence of Pepper’s eye impairments substantially worsening or altering her ability to work during the relevant claim period, which could have altered the ALJ’s determination. See Eichstadt, 534 F.3d at 666 (stating that certain conditions pre26 No. 12-2261 dating the claimant’s insured status were irrelevant when evaluating the claimant’s application for benefits because the claimant “was able to engage in substantial gainful employment during and after experiencing these problems”). Despite Dr. Brody’s conclusion that Pepper had no depth perception and poor hand/eye coordination in 2008, there is no evidence of Dr. Brody ever opining that Pepper could not work due to her eye impairments. And similarly, Pepper does not direct us to any source or authority to support a contention that the effects of her vision impairments would prevent her from completing any job in the light work category. Cf. S.S.R. 85-15p, 1985 SSR LEXIS 20, at -21 (“As a general rule, even if a person’s visual impairment(s) were to eliminate all jobs that involve very good vision (such as working with small objects or reading small print), as long as he or she retains sufficient visual acuity to be able to handle and work with rather large objects (and has the visual fields to avoid ordinary hazards in a workplace), there would be a substantial number of jobs remaining across all exertional levels.”). This information leads us to easily conclude that substantial evidence supports the ALJ’s vision determination.
We move to Pepper’s contention that the ALJ violated S.S.R. 02-01p by not properly considering her obesity when formulating the RFC. See S.S.R. 02-01p, 2002 SSR LEXIS 1. The ALJ made a finding that Pepper’s obesity is severe—i.e., “significantly limits [Pepper’s] ability to No. 12-2261 27 engage in work activity.” Accordingly, the ALJ was required to discuss “any functional limitations resulting from the obesity” when formulating his RFC assessment. See id. at . We agree with Pepper that the ALJ did not specifically undertake such an analysis. We have held, however, that this type of error may be harmless when the RFC is based on limitations identified by doctors who specifically noted obesity as a contributing factor to the exacerbation of other impairments. See Prochaska v. Barnhart, 454 F.3d 731, 736-37 (7th Cir. 2006). That is what occurred here. The ALJ noted Dr. Kafka’s 2003 observation that Pepper had decreased range of motion in her lumbar spine but that Pepper was overweight and it was difficult to fully evaluate her range of motion. The ALJ also discussed Dr. Li’s 2004 assessment of Pepper’s active problems: elevated liver enzymes, hyperlipidemia, hyperglycemia, and artificial menopause. Pepper complained to Dr. Li about weight gain, and each of those conditions can be aggravated by obesity. Furthermore, the ALJ described Dr. Putman’s 2006 assessment of Pepper and her “active problems,” which also included obesity. We believe these discussions, combined with Pepper’s failure to specify how her obesity further impaired her ability to work, demonstrate that the ALJ adequately considered Pepper’s obesity. See Skarbek v. Barnhart, 390 F.3d 500, 504 (7th Cir. 2004) (concluding that the ALJ’s failure to explicitly consider the claimant’s obesity was inconsequential because the claimant did not specify how his obesity further impaired his ability to work and the ALJ addressed the limitations suggested by doctors 28 No. 12-2261 who otherwise considered the claimant’s weight). Any error was therefore harmless.
Pepper’s other arguments relating to the RFC focus on the ALJ’s treatment of her depression. Her main contention is that the ALJ erred by failing to follow the procedure for evaluating mental limitations described in 20 C.F.R. § 404.1520a, known as the “special technique.” This argument has some traction. The special technique requires the ALJ to first determine whether a claimant has a medically determinable mental impairment(s). § 404.1520a(b)(1). This is done by evaluating the claimant’s “pertinent symptoms, signs, and laboratory findings.” Id. If the claimant has a medically determinable medical impairment, the ALJ must document that finding and rate the degree of function limitation in four broad “functional areas:” activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation. § 404.1520a(c)(3); Craft v. Astrue, 539 F.3d 668, 674 (7th Cir. 2008). These areas are known as the “B criteria.” See Craft, 539 F.3d at 674 (citing 20 C.F.R. pt. 404, subpt. P, app. 1, §§ 12.00 et. seq). The first three functional areas are rated on a five-point scale: none, mild, moderate, marked, and extreme. § 404.1520a(c)(4). The final area is rated on a four-point scale: none, one or two, three, four or more. Id. The rating assigned to each functional area corresponds to No. 12-2261 29 a determination of severity of mental impairment. § 404.1520a(d)(1). If the impairment is considered severe, the ALJ must determine whether the impairment meets or is equivalent in severity to a listed mental disorder. § 404.1520a(d)(2). If the mental impairment neither meets nor is equivalent in severity to any listing, the ALJ will assess the claimant’s RFC. § 404.1520a(d)(3). The ALJ must document his use of the technique, incorporating the relevant findings and conclusions into the written decision. § 404.1520a(e)(4). The decision must adequately discuss “the significant history, including examination and laboratory findings, and the functional limitations that were considered in reaching a conclusion about the severity of the [claimant’s] mental impairment(s).” Id. The decision must include “a specific finding as to the degree of limitation in each of the functional areas[.]” Id. The ALJ did not explicitly apply the special technique when evaluating Pepper’s depression. This is clear from the written decision. The Commissioner concedes this point, instead arguing that Pepper was not harmed by this omission. Indeed, “[u]nder some circumstances, the failure to explicitly use the special technique may . . . be harmless error.” Craft, 539 F.3d at 675. We agree with the Commissioner. At step two, the ALJ made the required severe or not severe finding, concluding that Pepper’s “mental impairment of depression” was not severe. He did not, however, integrate the requisite point scales into his decision or explicitly refer to the functional areas. None30 No. 12-2261 theless, we believe the ALJ provided enough information to support the “not severe” finding. The ALJ cited the absence of psychiatric or mental medical treatment prior to the date last insured, Pepper’s good response to medication, and the aggravation of her condition by her responsibilities at home. The record medical evidence supports these assertions. For example, Hyde stated that Pepper’s depression in 2003 was stable on Paxil. See Prochaska, 454 F.3d at 737 (“[C]ontrollable conditions do ‘not entitle one to benefits or boost one’s entitlement by aggravating another medical condition.’ ” (quoting Barrett v. Barnhart, 355 F.3d 1065, 1068 (7th Cir. 2004))). In January 2004, Dr. Li noted Pepper complained of fatigue, poor memory, poor concentration, irritability, being tearful, and other symptoms; but her examination revealed no abnormalities in Pepper’s insight or judgment, orientation, memory or impairment, and mood. In October 2005, Pepper stated her mood was “fine.” Examinations by Dr. Putman in April 2006 and Dr. Li in October 2007 also revealed that Pepper had appropriate insight, judgment, mood, and affect. Even a May 2007 screening for depression was negative. The ALJ did not fully comply with the special technique at this juncture, but substantial evidence supports the ALJ’s conclusion at step two that Pepper’s mental impairment was not severe. Pepper was not harmed by the ALJ’s misstep. Likewise, as the Commissioner correctly points out, the ALJ did not stop there when analyzing Pepper’s depression. After a “not severe” finding at step two, the special technique requires the ALJ to assess the mental impairment in conjunction with the individual’s RFC No. 12-2261 31 at step four. See § 404.1520a(d)(3). The ALJ did that here, concluding that Pepper’s depression did not prevent her from completing light work. He cited Hyde’s 2003 examination and Pepper’s follow up with Dr. Li in 2004. He also referred to Pepper declining medication and counseling at her appointment with Dr. Goodner in August 2005 and failing to undergo significant depression treatment during the relevant claim period. In addition, the ALJ discussed information regarding Pepper’s mental state outside of the specific paragraph addressing Pepper’s depression medical records—Dr. Kafka’s opinion that Pepper had “low self-esteem” in 2003, Dr. Putman’s depression note in 2006, and Pepper’s testimony regarding her mental state. Again, the ALJ did not make explicit findings referencing the four functional areas, but a plain reading of the ALJ’s written decision demonstrates the ALJ generally discussed (1) Pepper’s daily activities; (2) Pepper’s mental state when around people; (3) Pepper’s difficulty focusing when completing housework; and (4) the lack of evidence of any specific, periodic episodes of decompensation (i.e., a period of exasperated symptoms). In doing so, it is apparent the ALJ considered all the relevant information and factors required. See § 404.1520a(c)(1). Substantial evidence supports the ALJ’s mental impairment finding at step four as well. The ALJ’s application of the special technique is not a model for compliance, but we will not remand a case for further specification when we are convinced that the ALJ will reach the same result. See McKinzey, 641 F.3d at 892. We believe that would occur in this case. The 32 No. 12-2261 ALJ’s failure to explicitly apply the special technique was harmless. For completeness, we briefly address Pepper’s undeveloped arguments that the ALJ erred by (1) using his “hunches” to reach his conclusion that Pepper’s depression was not severe; (2) failing to inquire as to why Pepper did not obtain treatment for her depression prior to her date last insured; and (3) ignoring the evidence of a depression diagnosis and treatment prior to Pepper’s date last insured, which is corroborated by evidence that post-dates Pepper’s date last insured. First, we have already concluded that substantial evidence supports the ALJ’s determination that Pepper’s depression did not prevent her from performing light work; we do not see how the ALJ was “playing doctor,” as Pepper insinuates. Cf. Myles v. Astrue, 582 F.3d 672, 677 (7th Cir. 2009). Next, why a claimant failed to undergo treatment is one factor to consider when assessing an impairment, but the burden was on Pepper to explain why she was disabled as a result of her depression. See Scheck v. Barnhart, 357 F.3d 697, 702 (7th Cir. 2004) (citing 20 C.F.R. § 404.1512(c); Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987)). Pepper failed to satisfy her burden. This is especially true considering Pepper was represented by counsel throughout the pendency of the proceedings. See Skinner v. Astrue, 478 F.3d 836, 842 (7th Cir. 2007) (explaining that “a claimant represented by counsel is presumed to have made his best case before the ALJ”). Lastly, as our previous discussion shows, we do not believe the ALJ ignored any pertinent information. No. 12-2261 33