Brenda Warnell v. Martin J. O'Malley

                               In the

    United States Court of Appeals
                 For the Seventh Circuit
                     ____________________
No. 23-1632
BRENDA K. WARNELL,
                                                  Plaintiff-Appellant,
                                 v.

MARTIN J. O’MALLEY,
Commissioner of Social Security,
                                                 Defendant-Appellee.
                     ____________________

         Appeal from the United States District Court for the
         Northern District of Indiana, Fort Wayne Division.
          No. 1:22-cv-00166-WCL — William C. Lee, Judge.
                     ____________________

     ARGUED FEBRUARY 8, 2024 — DECIDED APRIL 8, 2024
                 ____________________

   Before EASTERBROOK, SCUDDER, and ST. EVE, Circuit Judges.
    SCUDDER, Circuit Judge. Administrative law judges who
decide claims for social security disability benefits often find
themselves overloaded with work—with many more cases to
decide than hours available in a day. With so much at stake
for applicants, the responsibility brings with it a weighty ob-
ligation of diligence. So the challenge for an ALJ becomes
2                                                   No. 23-1632

combining diligence with efficiency, including in preparing
written orders of decision.
   Before us is Brenda Warnell’s challenge to an ALJ’s deter-
mination that she is not disabled and therefore not entitled to
disability benefits or supplemental security income. By any
measure, the ALJ’s written decision is clear, thorough, and
commendable. Yet Warnell claims that the ALJ needed to do
more, including by avoiding summaries of the medical evi-
dence and instead providing hyper-detailed physician-by-
physician accounts supported by fulsome pinpoint citations
to medical records. Not only is longer better, it is legally nec-
essary to withstand appellate review—or so the argument
goes.
    We reject this contention as it stands at complete odds
with what an ALJ must do to support its decision with sub-
stantial evidence, a standard that the Supreme Court has em-
phasized is light. So we decline the invitation to impose a
rigid rule of artificial completeness upon ALJ orders of deci-
sion. What the ALJ produced here was more than sufficient
and supported by substantial evidence. We affirm.
                                I
                               A
    In 2006 Brenda Warnell received a disc-removal and fu-
sion surgery in her upper spine. Twelve years later, she
sought treatment from a pain-management specialist, report-
ing severe discomfort in her head, neck, and lower back. From
2018 to 2021, Warnell met regularly with physicians who
monitored her symptoms and prescribed pain-relief medica-
tions.
No. 23-1632                                                  3

    Warnell’s medical record is mixed regarding the severity
of her condition. An MRI from 2018 revealed bone spurs in
her upper spine that pinched local nerves. But the same MRI
showed no significant vertebrae narrowing, a generally
“[u]nremarkable” spinal cord, and “[n]o acute abnormality”
in the bones. A 2019 CT scan likewise indicated “[n]o acute
osseous findings,” “[n]o destructive changes,” and no “adja-
cent inflammation.”
    Results from physical examinations were likewise mixed.
On at least three occasions, Warnell could not raise her leg
from a sitting position without pain. She also expressed ten-
derness in her neck, pain while performing physical-therapy
exercises, and consistent throbbing in her head and back. Phy-
sicians assessed Warnell with chronic pain syndrome and
chronic migraines.
    At the same time, however, Warnell performed well on
several tests designed to measure her movement capabilities.
She exhibited normal movement, muscle strength, stamina,
range of neck and hip motion, and reflexes. She also success-
fully completed walking exercises. And at least twice she
raised her leg while seated without pain, contradicting earlier
results.
    Perhaps unsurprisingly, medical experts reached differing
conclusions regarding Warnell’s condition. Three—Dr. Brian
LaMar, Dr. Daniel Roth, and Anthony Escotto, MPT—
determined that Warnell had severely limited functional ca-
pacity. But two state-agency physicians—Dr. J. Sands and Dr.
J.V. Corcoran—assessed narrower limitations, finding that
Warnell remained capable of limited physical exertion.
4                                                 No. 23-1632

                              B

    In September 2019 Warnell applied for disability insur-
ance benefits and supplemental security income under the So-
cial Security Act. She alleged that she could not work due to
debilitating migraines and chronic pain in her back, shoul-
ders, and neck.
    The ALJ disagreed. Though the judge acknowledged that
Warnell suffered from some impairments, she determined
that “a careful review of the record does not document suffi-
cient objective medical evidence to substantiate the severity
and degree of [the] functional limitations alleged by the
claimant.” The ALJ found that Warnell’s pain symptoms did
not prevent her from performing light work with moderate
noise and limited physical requirements. Based on testimony
from a vocational expert, the ALJ concluded that a significant
number of jobs matched that description. So she denied
Warnell’s claim, finding her not disabled.
    The ALJ explained her reasoning in a 17-page decision.
Summarizing the medical evidence, she emphasized several
indications that Warnell’s pain was manageable, including
the non-acute CT and MRI readings, promising internal med-
icine evaluations, and Warnell’s success during walking, leg
raising, and climbing tests. Of the five medical experts who
assessed Warnell’s functional capacity, the ALJ considered
the two state-agency examiners to be the most persuasive. The
judge rejected the conclusion reached by the three other phy-
sicians—that Warnell was more severely limited—because it
conflicted with the medical treatment records.
  After the district court affirmed the ALJ’s decision,
Warnell sought our review.
No. 23-1632                                                    5

                               II
                               A
    We affirm an ALJ’s decision denying disability benefits so
long as it is supported by substantial evidence. The threshold
for substantial evidence “is not high.” See Biestek v. Berryhill,

139 S. Ct. 1148, 1154

 (2019). “It means—and means only—
such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” 

Id.

 (internal quotation
marks omitted). When reviewing a disability decision for sub-
stantial evidence, “[w]e will not reweigh the evidence, resolve
debatable evidentiary conflicts, determine credibility, or sub-
stitute our judgment for the ALJ’s determination so long as
substantial evidence supports it.” Gedatus v. Saul, 

994 F.3d 893, 900

 (7th Cir. 2021).
    The medical record substantially supports the ALJ’s deci-
sion to reject the functional-capacity assessments of Dr. La-
Mar, Dr. Roth, and Mr. Escotto. The ALJ reasonably viewed
each physician’s opinion as contradicted by multiple lines of
evidence, including imaging test results, physical examina-
tions, and treatment sessions that documented normal
strength, stamina, and reflexes. The physicians also failed to
account for the effectiveness of Warnell’s medication, which
at various times relieved between 40% and 80% of pain with-
out side effects. Nor did they provide any explanation for the
twelve-year delay in the onset of Warnell’s alleged symp-
toms.
    The ALJ properly observed that the expert reports that
Warnell relies upon also contain important flaws. Dr. Roth,
for example, neglected to fill out a section of his report form
that asked him to “identify the particular medical or clinical
6                                                  No. 23-1632

findings … which support your assessment.” And Dr. LaMar
recorded observations that undermined his own conclusions,
noting that Warnell exhibited “normal” strength and writing
“NONE” to describe Warnell’s “inflammation, pain, swelling,
[and] stiffness.”
   In light of the medical evidence contradicting Warnell’s
experts, we have no trouble concluding that substantial evi-
dence supported the ALJ’s decision to reject them. See Dixon
v. Massanari, 

270 F.3d 1171, 1178

 (7th Cir. 2001) (stating that
“[w]hen treating and consulting physicians present conflict-
ing evidence, the ALJ may decide whom to believe, so long as
substantial evidence supports that decision”); Deborah M. v.
Saul, 

994 F.3d 785, 788

 (7th Cir. 2021) (emphasizing that we
will reverse an ALJ’s disability determination “only if the rec-
ord compels a contrary result” (cleaned up)).
    Ordinarily our opinion would end with that conclusion.
But we need to say more in response to the surprising conten-
tion Warnell presses on appeal.
                               B
    Warnell rejects the analysis above not by identifying any
substantive error of reasoning or medical judgment, but by
putting the ALJ’s written decision under a microscope and
then flyspecking it. Warnell insists, for instance, that the ALJ
failed to provide page numbers every time she cited the med-
ical record—and that her opinion does not always distinguish
between multiple supporting exhibits in the administrative
record. So, too, does Warnell fault the ALJ for only summa-
rizing the medical evidence instead of recounting it in full de-
tail physician-by-physician.
No. 23-1632                                                   7

    We are taken aback by this argument, for nothing in our
case law instructs ALJs that surviving appellate review re-
quires anything remotely resembling a mandate to type the
medical record into a written decision. Given the extraordi-
nary demands already on social security ALJs, we are disin-
clined to impose a novel make-work typing or appendix man-
date.
    The better course is to stick to our precedent, which is all
about substance and not form. Time and time again, we have
emphasized that social-security adjudicators are subject to
only the most minimal of articulation requirements. An ALJ
need not address every piece or category of evidence identi-
fied by a claimant, fully summarize the record, or cite support
for every proposition or chain of reasoning. See Schmidt v.
Barnhart, 

395 F.3d 737, 744

 (7th Cir. 2005) (explaining and em-
phasizing that an ALJ “need not provide a complete written
evaluation of every piece of testimony and evidence” (cleaned
up)); Gedatus, 

994 F.3d at 901

 (observing that a “[p]artial sum-
mary of select evidence” is appropriate and consistent with
the articulation requirement).
    All we require is that ALJs provide an explanation for how
the evidence leads to their conclusions that is “sufficient to
allow us, as a reviewing court, to assess the validity of the
agency’s ultimate findings and afford [the appellant] mean-
ingful judicial review.” Moore v. Colvin, 

743 F.3d 1118, 1121

(7th Cir. 2014); see also 

id.

 (stating that we will consider an
ALJ’s opinion to be adequately explained so long as it does
not “lack[] adequate discussion of the issues”). At times, we
have put this in the shorthand terms of saying an ALJ needs
to provide a “logical bridge from the evidence to his
8                                                   No. 23-1632

conclusion.” See, e.g., Clifford v. Apfel, 

227 F.3d 863, 872

 (7th
Cir. 2000).
    The ALJ here provided a more than sufficient explanation
for why the medical record led her to deny Warnell’s claim.
The judge devoted considerable space to addressing the per-
suasiveness of Warnell’s experts. She highlighted specific ev-
idence that contradicted their conclusions, going so far as to
cite and describe discrete examination findings. The ALJ also
acknowledged and grappled with conflicting evidence, ulti-
mately concluding that the treatment record as a whole sup-
ports a finding of non-disability. The law required no more of
the ALJ, so we AFFIRM.