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Cyracus v. Colvin

United States District Court, E.D. Wisconsin

March 2, 2016



William C. Griesbach, Chief Judge

Plaintiff filed this action challenging the decision of the Commissioner of Social Security denying her disability benefits. For the reasons given below, the decision of the Commissioner will be remanded for further proceedings.

I. Background

Plaintiff suffers from a number of physical conditions, including undifferentiated connective tissue disease and fibromyalgia, and these conditions cause pain, stiffness and fatigue. (R. 369, 373.) She also experienced frequent headaches. These conditions required treatment with physical therapy and periodic steroid injections, as well as a daily regimen of prescription drugs including (at various times) gabapentin, Cymbalta, Methotrexate, Effexor, and hydrocodone as needed. She also used a cane to walk, and a TENS (Transcutaneous Electrical Nerve Stimulation) unit, splints and knee braces at times to help alleviate her symptoms.

For several years the Plaintiff had seen Dr. Gowing, a rheumatologist, for pain and other symptoms, which Dr. Gowing usually attributed more to fibromyalgia than connective tissue disease. She frequently rated her pain at a 6 or 7 out of 10, and often reported pain and stiffness in the shoulders and back. In 2009 Dr. Gowing noted that her autoimmune condition (connective tissue disease) had worsened since they had taken her off methotrexate. (R. 308.) In 2010 she had problems with “full body pain with significant fatigue, ” burning in the hands and wrists, difficulty walking and grooming, turning faucets on and off, and she had difficulty getting out of bed. All of these limitations Dr. Gowing attributed to “worsening fibromyalgia.” (R. 306.) At her next visit she had severe shoulder pain to the point where she could barely lift her arm to get dressed. (R. 301.) In April 2010 Plaintiff was struggling with chronic widespread pain involving the “shoulders, the hips, knees, ankles, hands, wrists, low back.” (R. 297.) She reported that she had been unable to work the previous three weeks because of the fatigue and pain. Dr. Gowing attributed this once again to worsening fibromyalgia rather than her connective tissue disease. (Id.) By August 2010 the pain was at an 8 out of 10 and she continued to struggle with chronic fatigue, as well as neck a nd shoulder pain. (R. 291.) She still had a lot of difficulty doing things like twisting faucets, getting dressed and getting out of a car.

By November 2010 she was experiencing “increasing problems with pain involving the lower extremeties, associated numbness and burning.” (R. 287.) Dr. Gowing observed that the Effexor might be contributing to the Plaintiff’s worsening headaches, and so they planned to taper o ff that drug. In February 2011 Dr. Gowing noted that “she has not been doing well, ” had increasing problems with fatigue, and the pain was at a 9 out of 10. (R. 281.) In her May 2011 visit, she was doing “a little bit better, ” with pain down to a 6, and Dr. Gowing was going to start her on Cymbalta, a drug used to treat both fibromyalgia and depression. (R. 279.) Ultimately, in June 2012, Dr. Gowing wrote a lengthy letter indicating his belief that the Plaintiff could no longer perform gainful employment, even in a sedentary capacity, due to her deteriorated physical condition. (R. 373.) In particular, Dr. Gowing wrote that “Over the last couple of years she has shown significant functional decline and more widespread chronic pain with involvement of the neck, upper back, shoulders, and lower extremities including the knees and hips.” (Id.) Dr. Gowing also observed that Plaintiff has been a “hard worker” her whole life and gave it an honest effort to keep working, but was unable to despite its sedentary nature. (Id.) This June 2012 letter echoed a shorter statement Dr. Gowing made earlier that year to the same effect. (R. 369.)

In his decision denying benefits, the ALJ stated that he was “well aware” of Dr. Gowing’s opinion, which he discussed at some length, but found that it was inconsistent with the “clinical findings, ongoing, contemporaneous out-patient treatment records, and other objective evidence of record.” (R. 106.) Ultimately, the ALJ found that the Plaintiff’s conditions, along with obesity, were severe impairments but that they imposed no more than mild limitations on the claimant’s ability to perform normal work activities. (R. 99.) The ALJ concluded that the Plaintiff could perform light work so long as it did not involve overtly physical activities such as the use of ropes, kneeling, stooping, or frequent reaching or fingering and handling. (R. 100.) Given this residual functional capacity finding, the ALJ concluded that the Plaintiff was not disabled.

II. Analysis

The Commissioner's final decision will be upheld if the ALJ applied the correct legal standards and supported his decision with substantial evidence. 42 U.S.C. § 405(g); Jelinek v. Astrue, 662 F.3d 805, 811 (7th Cir. 2011). Substantial evidence is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Skinner v. Ast rue, 478 F.3d 836, 841 (7th Cir. 2007).

A. Medical Source Opinions

The Plaintiff first argues that the ALJ erred by giving more weight to the non-examining state agency reviewing physicians than the opinion of her treating rheumatologist, who opined that her limitations were severe enough to preclude work. (R. 373.) Generally, the ALJ must give “controlling weight” to the medical opinion of a treating physician “if it is ‘well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with other substantial evidence.’” Larson v. Astrue, 615 F.3d 744, 749 (7th Cir. 2010) (quoting 20 C.F.R. § 404.1527(c)(2)); see also Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir. 2013). If the ALJ does not ascribe controlling weight to the physician’s opinion, the ALJ must offer “good reasons” for discounting a treating physician's opinion. Larson, 615 F.3d at 749. Put another way, “[e]ven though the ALJ was not required to give [the treating physician's] opinion controlling weight, [the ALJ] was required to provide a sound explanation for his decision to reject it and instead adopt [the state agency physician's] view.” Roddy, 705 F.3d at 636 (citations omitted).

Here, although Dr. Gowing’s detaile d opinion was certainly “well-supported by medically acceptable . . . techniques, ” there was other “substantial evidence” in the record that was contrary to the treating source opinion. In particular, the state agency reviewers concluded that Plaintiff could frequently lift 10 pounds, stand or walk about 6 hours in a day, sit for 6 hours, and otherwise had no significant limitations apart from the ability to reach. (R. 343-50.) Dr. Pat Chan concluded in July 2011 that Plaintiff’s alleged limitations were only partially credible since she “indicates she is able to walk, drive and ride in the car. She is able to go shopping and help with simple household chores.” (R. 350.) That assessment was affirmed by Dr. Walcott in December 2011. These contrary views entitled the ALJ to avoid giving “controlling weight” to Dr. Gowing’s opinion. Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008) (“There was evidence—the report of the nonexamining consultant—that contradicted the reports of the treating physicians. So the presumption [of controlling weight] falls out and the checklist comes into play.”)

Of course the fact that the treating source opinion was not “controlling” does not mean it could be lightly discounted or ignored. When the treating physician's opinion no longer is controlling, it becomes “just one more piece of evidence for the [ALJ] to weigh.” Hofslien v. Barnhart, 439 F.3d 375, 376-77 (7th Cir. 2006). Accordingly, he must evaluate the opinion's weight by considering the length, nature, and extent of the claimant's treatment relationships with her physicians, the degree to which the opinion is supported by evidence, the opinion's consistency with the record as a whole, whether the doctor is a specialist, and “other factors.” 20 C.F.R. § 404.1527(c).

Here, the ALJ discounted Dr. Gowing’s opinion on the grounds that it was inconsistent with the “clinical findings, ongoing, contemporaneous out-patient treatment records, and other objective evidence of record.” (R. 106.) These reasons for discounting a treating source would be viable if the treating source had played only a small role in the claimant’s treatment, that is, if a treating source’s opinio n went against the grain of a multitude of other clinical findings and records. But Dr. Gowing was hardly a peripheral figure in the Plaintiff’s course of treatment—he was the central figure, the rheumatologist who saw her every three months over several years. Rheumatologists are experts in treating fibromyalgia and connective tissue diseases, which is what Plaintiff suffered from. Dr. Gowing examined her countless times and attempted to treat her with numerous different prescription drugs, steroid shots, and other methods. Because Dr. Gowing’s extensive opinions and records are the “clinical findings [and] contemporaneous out-patient records” in this case, it is difficult to understand how Dr. Gowing’s opinions could be “inconsistent” with ...

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