United States District Court, E.D. Wisconsin
DECISION AND ORDER
LYNN ADELMAN District Judge
Plaintiff Marlin Groskreutz applied for social security disability benefits, claiming that he could not work due to a variety of physical and mental impairments, but the Administrative Law Judge (“ALJ”) assigned to the case concluded that none of those impairments significantly limited plaintiff’s ability to work and thus denied the application. The Appeals Council declined review, making the ALJ’s decision the final word from the agency on plaintiff’s application. See Engstrand v. Colvin, 788 F.3d 655, 660 (7th Cir. 2015). Plaintiff now seeks judicial review of the ALJ’s decision.
The court will uphold an ALJ’s decision if he applied the correct legal standards and supported his decision with substantial evidence. Jelinek v. Astrue, 662 F.3d 805, 811 (7th Cir. 2011). Substantial evidence means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion. Richardson v. Perales, 402 U.S. 389, 401 (1971). Under this deferential standard, the court will not re-weigh the evidence or substitute its judgment for the ALJ’s. Murphy v. Colvin, 759 F.3d 811, 815 (7th Cir. 2014). Further, while the ALJ must build a logical bridge from the evidence to his conclusion, he need not provide a complete written evaluation of every piece of testimony and evidence. Id. Ultimately, the court will affirm if the ALJ’s opinion assures the court that he considered the important evidence, and the opinion enables the court to trace the path of the ALJ’s reasoning. Stephens v. Heckler, 766 F.2d 284, 287 (7th Cir. 1985). Because the ALJ satisfied these obligations in the present case, I affirm.
I. FACTS AND BACKGROUND
Plaintiff alleged disability due to anxiety, pelvic pain, and urinary dysfunction, with an onset date of December 31, 2010. He indicated that he was essentially bed-ridden from December 31, 2010, to October 1, 2011, when he began to notice improvement based on the efforts of alternative treatment providers.
The medical records document urinary and prostate problems in the years prior to the alleged disability onset, for which plaintiff received treatment from two urologists, Dr. Matthew Anderson and Dr. Robert O’Connor, as well as his primary physician, Dr. Thomas Willett. Dr. Willett also prescribed medications for anxiety and depression. Following the alleged onset date, plaintiff received treatment primarily from an acupuncturist, chiropractor, and massage therapists. After plaintiff filed his application, the agency arranged for physical and mental examinations and obtained reports from several non-examining consultants. Plaintiff presented no report from an “acceptable medical source” in support of his application. See 20 C.F.R. § 404.1513(a). Below I summarize the treatment records collected by the agency, the administrative proceedings on plaintiff’s application, and the ALJ’s decision.
B. Treatment Records
On September 26, 2008, plaintiff saw Dr. Willett for poison ivy. Plaintiff was at the time taking Flomax for chronic prostatitis and prostate hypertrophy, Alprazolam for anxiety, and Paxil for depression. Dr. Willett gave plaintiff a shot of Depo-Medrol and instructed him to use Caladryl for itching. Plaintiff also noted vitiligo of the hands, starting on the face, for which he was going to try Cortaid. (Tr. at 278.)
On March 6, 2009, plaintiff saw Dr. Anderson on an urgent basis regarding difficulty urinating. He reported inability to urinate over the past week, doing intermittent catheterization. He had known BPH with significant bladder outlet obstruction,  undergoing a transurethral incision of the prostate about 18 months previously. Dr. Anderson recommended photo-selective vaporization of the prostate. (Tr. at 290.)
On June 5, 2009, plaintiff saw Dr. Willett for an annual physical exam. His main complaint was trouble urinating, to the point where he had to catheterize himself. He had been on antibiotics for chronic prostatitis but still had more trouble. He also had neurofibromatosis affecting his face and back. He previously had vitiligo of his hands, which seemed to be better. He also had anxiety and depression associated with his problems with urination. Dr. Willett provided Darvocet for pain associated with catheterization and samples of Cialis to see if it helped with urination. (Tr. at 276.)
On June 22, 2009, Dr. Anderson performed a flexible cystoscopy,  which was suggestive of probable bladder outlet obstruction. Dr. Anderson recommended laser vaporization of the prostate to alleviate bladder outlet obstruction. (Tr. at 293.)
On July 21, 2009, Dr. Anderson performed a cystoscopy with photo-selective vaporization of the prostate. (Tr. at 269, 298.) Plaintiff returned for follow up on August 10, urinating well but with moderate to weak force of stream. His hesitancy was markedly improved. Dr. Anderson noted an excellent result from the PVP procedure with no serious complications. (Tr. at 301.)
On June 7, 2010, plaintiff saw Dr. O’Connor on referral from Dr. Anderson complaining of incomplete bladder emptying and urinary hesitancy. Dr. O’Connor recommended a flex cystoscopy. (Tr. at 310.) Plaintiff also complained of pelvic floor discomfort. (Tr. at 311.) Dr. O’Connor performed the cystoscopy on July 8, 2010. (Tr. at 313.) Dr. O’Connor recommended an InterStim trial,  but plaintiff wanted to continue with his home physical therapy. If the therapy did not work, he would consider InterStim. (Tr. at 314.)
On August 4, 2010, plaintiff saw Lindi Magnuson, PT, on referral from Dr. O’Connor, for pelvic muscle rehabilitation. (Tr. at 340.) She planned to see him for several months for neuromuscular reeducation, soft tissue mobilization, progressive therapeutic exercise, joint mobilization as needed for pelvic alignment issues, electrical stimulation as needed for pelvic floor strengthening, and education in long-term symptom management. (Tr. at 343.) According to a December 28, 2010, discharge letter, plaintiff was seen six times between August 4, 2010, and September 28, 2010, with four cancellations since his last visit in September. His objective findings were consistent with pelvic floor muscle dysfunction. He lived quite a distance from the clinic and attendance had been an issue. She provided him with clear instructions for self-management and home exercise. However, he continued to follow his own self-prescribed management program, not that of the physical therapist. Plaintiff agreed that continuation of PT would not be productive and was best discontinued. (Tr. at 336.)
In January 2011, plaintiff started seeing an acupuncturist, Barbara Bittinger, for his pelvic tension and urination problem. (Tr. at 356.) The notes generally indicate that plaintiff felt somewhat better after treatment sessions, and that progress was being made. (Tr. at 361-69.) During a January 20, 2011 session, Bittinger noted: “Displaying ocd behavior, Trying to dictate tx, Very anxious; fidgeting, expressing tension.” (Tr. at 364.) On March 22, 2011, plaintiff reported urinating on his own (Tr. at 370), but on April 15, 2011, he reported having to use a catheter again and that he had backed off walking for exercise due to pain in his right groin area (Tr. at 371). On April 27 and 29, 2011, he reported soreness that he associated with getting better. Bittinger further noted that he seemed obsessive, concerned about everything being done exactly the same way. (Tr. at 373-74.) In May 2011, plaintiff reported feeling more relaxed and less anxious (Tr. at 376) but in the summer of 2011 he reported continued groin pain (Tr. at 377-80). On September 6, 2011, Bittinger noted that plaintiff appeared to be walking normally, in good spirits, with no significant tension in the neck and back. (Tr. at 381.) On November 1, 2011, he reported voiding on his own and appeared happy and talkative. (Tr. at 383.) On December 6, 2011, Bittinger noted much progress with anxiety; plaintiff had returned to church and activities but could not sit too long. (Tr. at 385.)
Between February 9 and April 18, 2011, plaintiff saw Ethan Hagen, D.C., for 10 chiropractic treatment sessions. Plaintiff complained of muscle spasm and pain in the area of the pudendal nerve, which radiated through his pelvis bilaterally. He also reported severe difficulty urinating. Secondary complaints included thoracic spine stiffness and pain and tenderness in the cervical spine. Initial examination revealed a marked left pelvic rotation relative to the thoraces both standing and prone. He also demonstrated a ½ inch left leg length deficiency prone. He suffered with neurofibroma disease, and it was thought that this may play a significant role in some of his neurologic complaints. All other orthopedic and neurologic testing was negative. Dr. Hagen provided adjustments to reduce the left rotation of the pelvis. (Tr. at 351.)
Between June 15, 2011, and December 31, 2011, plaintiff saw a massage therapist, Janice Huth-Engel, for his complaints of pain in the pelvic and groin area and inability to urinate without catheterization. Huth-Engel noted that plaintiff exhibited a high level of anxiety that could go into depression, but he was not aware of it. She observed that his anxiety manifested in extreme hyper-tonicity throughout his body, not just in his pelvic and lumbar area. His sessions consisted of soft tissue therapy, including myofascial release therapy, deep tissue and cranial sacral therapy to help relieve tension, and structural work to release tightness in tissue. His sessions also included some recommendations of self-help techniques that he could incorporate at home, i.e., stretching, breathing, and meditating. She noted that plaintiff responded well to therapy and experienced some relief. His anxiety appeared to lessen, and he was more relaxed as the sessions progressed. (Tr. at 406, 503.)
On June 20, 2012, plaintiff saw Dr. Willett for prescription renewal, reporting no new problems. The note lists diagnoses of chronic prostatitis, vitiligo, neurofibromatosis, BPH, and anxiety/depression. (Tr. at 551.)
On August 24, 2012, Bittinger, the acupuncturist, wrote a letter indicating that plaintiff had been coming in for treatment more frequently in the past few months. This was on his own volition trying to get through his healing process quicker. He reported occasionally trying to get back to routine daily activities such as taking drives, going for a walk, or going to church, but that he usually had an exacerbation of his symptoms after. (Tr. at 429; see also Tr. at 430- 71, Bittinger’s 2012 treatment notes.) By July 2012, plaintiff reported feeling more relaxed, and that his nervous system was “letting go more.” (Tr. at 465.)
Between September 10, 2012, to September 24, 2013, plaintiff returned to Huth-Engel. She reported that plaintiff was still having issues with pulling and tightness from his sacrum up to his head. She continued to use cranio-sacral therapy to release the tension. She was able to release the tension focusing on his thoracic, neck, cranial bones, zygoma, and pterygold muscles. She realized that his pterygold muscles were extremely hyper-tonic and were stuck in a pattern that would not release easily. This created extreme tension in his mouth, which referred throughout his entire body. They had spent the last two months with that focus and continued to show increased progress. His stress level had decreased, and she continued to recommend relaxation techniques to help him at home. (Tr. at 504.)
On March 18, 2013, Bittinger wrote that plaintiff was being seen two to three times per week for ongoing complaints of general muscle tension, pain and discomfort in the perineum, choking episodes and nervousness. He had made progress in not having to use a catheter for months, but he did still complain of waking frequently every night because of bladder tension and discomfort alleviated by short voidings of urine. Plaintiff still complained of not being able to go for car rides of any long duration, sitting in one position for long, and needing to lie down frequently during the day, which kept him from activities of daily living. In general, he maintained a positive attitude about improving his condition and complied with advice, but progress was slow. (Tr. at 486; see also Tr. at 532-48, notes from Bittinger dated 3/8/13 to 5/15/14.)
On April 8, 2013, Vicki Walther, a massage therapist, provided a synopsis of the treatment she had provided since April 12, 2011. (Tr. at 498.) When plaintiff first presented he identified severe anxiety and depression, groin pain, and difficulty urinating. His behavior was consistent with someone with mental health issues; he presented as very nervous, easily distracted, and having a short attention span. The initial assessment determined that he showed signs and symptoms consistent with piriformis syndrome and weakness in the bilateral piriformis muscles. Palpations determined that his bilateral anterior hip flexors, gluteus muscles, and adductor muscles were hyper tonic. The aim of the initial treatment was to reduce these muscular imbalances, compensatory patterns, and myofascial restrictions. In November 2011, a shift in focus occurred; pressure was increased to include deep tissue and trigger point therapy as needed. Primary focus also shifted from localized treatment of musculature of the hips and abdomen to the muscular system and soft tissue in general. Plaintiff initiated a change in activities of daily living, increasing the amount of walking in the spring of 2012. Treatment then focused on re-balancing muscle groups. Walther directed plaintiff to use less force when stretching for self care in the winter of 2013. He had since been compliant with self-care and moderating the degree of stretch to lengthen his muscles. Plaintiff continued to show improvements and changes in signs and symptoms over the course of treatment and in response in activities of daily living. (Tr. at 499; see also Tr. at 500-02, treatment notes.)
On July 1, 2013, Thomas Charron, a licensed massage therapist, provided a letter indicating that he was not permitted to diagnose any medical condition or disease. Charron indicated that plaintiff first presented on March 12, 2013, with a primary complaint of abdominal pain as well as leg pain in the quadriceps and adductor muscles. In subsequent visits, he complained of pain in and around the groin and perineal areas. Plaintiff reported a variety of symptoms, mostly pain in the urogenital area, as well as difficulty urinating, for several years. Charron noted that plaintiff’s symptoms and responses to treatment varied. He often felt periods of relaxation post-session but that was usually tied to an increase in pain symptoms in the perineal area and inner thighs, generally worse on the right. From a therapeutic point of view, plaintiff carried tension in the region deep to the sacral area fairly consistently. In the most recent treatment session, they made significant headway in that area. Plaintiff also showed a tendency towards coccygeal tension, as well as tension in the abdominal area. (Tr. at 489.) He further showed a tendency towards a right-side bending of the head with soft tissue tension of the neck and flexion of the spine in general due to some extent to poor postural habits and de-conditioning, but also due to some anteriorly related tensions in the thorax and abdomen. Over the course of his treatments, Charron noted improvement in plaintiff’s ability to extend his spine, and his neck had taken a more neutral position while seated and standing. Charron had also seen a shift in points of tension from the original sessions, which was indicative of a body that had undergone a compensatory shift, consistent with the positive effects of the treatment Charron provided. However, plaintiff’s main complaint of perineal pain still existed, as did the propensity for his symptoms to increase during periods of relaxation. (Tr. at 490; see also Tr. at 491-96, treatment notes.)
According to a September 4, 2013, note from Dr. Willett, plaintiff was seen for prescription renewal and an annual checkup. The note indicated his anxiety was improved and listed diagnoses of anxiety, vitiligo, and chronic prostatitis. (Tr. at 550.)
On May 19, 2014, Charron indicated that plaintiff’s response to treatment remained similar to what was described in the previous correspondence, that being a period of relaxation often accompanied by pain. Plaintiff’s discomfort was mostly in the medial aspects of his legs, particularly on his right side, and did not include the rectal or perineal areas as much as in earlier sessions, though the area was still problematic on occasion. Plaintiff showed some postural improvement in the seated position with a lessening in the degree of side bending of the head to the right side. He continued to seek treatment from several practitioners as well as utilizing an inversion table and sacro-wedgy for home care. (Tr. at 518; see also Tr. at 519-31, treatment notes.)
C. Administrative Proceedings
1. Plaintiff’s Application and Supporting Materials
On January 17, 2012, plaintiff applied for disability insurance benefits, alleging an onset date of December 31, 2010. (Tr. at 201.) In his disability report, plaintiff indicated that he could not work due to severe anxiety, pelvic pain, nerve and muscle pain, depression, difficulty urinating, neurofibromatosis, vitiligo, and piriformis syndrome. (Tr. at 217.) Plaintiff reported that he worked as an industrial engineer from 1978 to October 2008. (Tr. at 218.) He stopped working on October 15, 2008, because of his conditions and other reasons. He indicated that his company downsized due to the economy, laying off a number of people; he believed he was one of them because he was missing a lot of work due to his conditions. (Tr. at 217.) Plaintiff reported taking Alprazolam for anxiety and insomnia, Paroxetine for anxiety, and Tramadol for pain, prescribed by Dr. Willett. (Tr. at 220.) He indicated that his problems started back in 1996, when he started having pelvic pain and difficulty urinating, which led to anxiety, muscle tension, and trouble sleeping. He started on anti-anxiety medications. From 1998 to 2007, he missed work at times. Since 2007, his condition had gotten progressively worse; after December 2010, it laid him up completely 90% of the time. He reported seeing various specialists, including urologists, neurologists, and physical therapists, who performed various tests but could not find a cause for his problems. He did note some improvement since pursuing alternative medicine treatments - acupuncture, cranial sacral and neuromuscular massage. (Tr. at 232.)
In a function report, plaintiff reported pain with sitting, which increased his anxiety. When his anxiety was bad, he had a hard time driving, sleeping, and concentrating. This in turn affected his nervous system and created tension in his muscles. He reported being dependent on drugs to get through the day and sleep at night. From December 31, 2010, to October 1, 2011, he spent 90% of his time in bed. Through alternative therapies, he had regained the ability to move about; he still had the same problems but with decreased severity. (Tr. at 233.) He reported no problem with personal care. (Tr. at 234.) From December 31, 2010, to October 1, 2011, he was unable to prepare meals or do any household chores; he was now able to cook quick meals and had eased back into chores. He lived with his father, who did the chores plaintiff could not. (Tr. at 235.) Plaintiff reported being able to drive but traffic increased his anxiety. He shopped once per week for 15-20 minutes. (Tr. at 236.) He reported hobbies of hunting, fishing, playing cards, and watching TV, but he had stopped all except TV. He reported attending church regularly before December 31, 2010; since October 1, 2011, he was slowly returning to attendance. (Tr. at 237.) He indicated that he could walk one mile, pay attention for ½ hour but not at full capacity, finish what he started, and follow instructions pretty well. (Tr. at 238.)
2. Agency Review
The agency arranged for mental and physical examinations. Following those exams, the agency obtained reports ...