Case Name in Social Security Case - Unavailable

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
INDIANAPOLIS DIVISON
M ICHAEL J.,1 	)
)
Plaintiff, 	)
)
v. 	) 	No. 1:24-cv-02159-SEB-KMB
)
F RANK B ISIGNANO , 	)
Commissioner of the 	)
Social Security Administration, 	)
)
Defendant. 	)
REPORT AND RECOMMENDATION ON COMPLAINT FOR JUDICIAL REVIEW
Plaintiff Michael J. initially applied for supplemental security income from the Social
Security Administration ("SSA") on April 18, 2022, with an alleged disability onset date of
February 2, 2022. [Dkt. 8-2 at 19.] His application was denied initially on September 9, 2022,
and upon reconsideration on March 14, 2023. 	[Id.] 	The Administrative Law Judge ("ALJ")
conducted a hearing on March 4, 2024. 	[Id.] 	The ALJ issued his decision on April 23, 2024,
concluding that Michael was not entitled to receive disability benefits. [Id. at 19-31.] The Appeals
Council denied review on October 11, 2024. 	[Id. at 1-6.] 	Michael timely filed this civil action
under 42 U.S.C. § 405(g) for review of the Commissioner's decision. [Dkt. 1.] This matter was
referred to the undersigned Magistrate Judge under 28 U.S.C. § 636(b)(1)(B) and Fed. R. Civ. P.
72(b) for a Report and Recommendation as to the appropriate disposition of the pending motions.
1 To protect the privacy interests of claimants for Social Security benefits, and consistent with the
recommendation 	of 	the 	Court Administration 	and 	Case 	Management 	Committee 	of 	the
Administrative Office of the United States Courts, the Southern District of Indiana has opted to
use only the first names and last initials of non-governmental parties in its Social Security judicial
review opinions.
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I. 	STANDARD OF REVIEW
"The Social Security Administration (SSA) provides benefits to individuals who cannot
obtain work because of a physical or mental disability." Biestek v. Berryhill, 139 S. Ct. 1148, 1151
(2019). Disability is 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 twelve months."
Stephens v. Berryhill, 888 F.3d 323, 327 (7th Cir. 2018) (citing 42 U.S.C. § 423(d)(1)(A)).
When an applicant appeals an adverse benefits decision, this Court's role is limited to
ensuring that the ALJ applied the correct legal standards and that substantial evidence exists for
the ALJ's decision. 	Id. at 327. 	"[S]ubstantial evidence" is such relevant "evidence that 'a
reasonable mind might accept as adequate to support a conclusion.'" Zoch v. Saul, 981 F.3d 597,
601 (7th Cir. 2020) (quoting Biestek, 139 S. Ct. at 1154). "Although this Court reviews the record
as a whole, it cannot substitute its own judgment for that of the SSA by reevaluating the facts, or
reweighing the evidence to decide whether a claimant is in fact disabled." Stephens, 888 F.3d at
327. Reviewing courts also "do not decide questions of credibility, deferring instead to the ALJ's
conclusions unless 'patently wrong.'" Zoch, 981 F.3d at 601 (quoting Summers v. Berryhill, 864
F.3d 523, 528 (7th Cir. 2017)). 	"[E]ven under this deferential standard of review, an ALJ must
provide a logical bridge between the evidence and [his] conclusions." Jarnutowski v. Kijakazi, 48
F.4th 769, 773 (7th Cir. 2022) (internal quotation marks and citation omitted).
The SSA applies a five-step evaluation to determine whether the claimant is disabled.
Stephens, 888 F.3d at 327 (citing 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4)).2 The ALJ must
2 The Code of Federal Regulations contains separate, parallel sections concerning disability
insurance benefits and SSI, which are identical in most respects. Cases may reference the section
pertaining to disability insurance benefits, such as Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir.
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evaluate the following, in sequence:
(1) whether the claimant is currently [un]employed; (2) whether the claimant has a
severe impairment; (3) whether the claimant's impairment meets or equals one of
the impairments listed by the [Commissioner] . . . ; (4) whether the claimant can
perform [his] past work; and (5) whether the claimant is capable of performing
work in the national economy.
Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000), as amended (Dec. 13, 2000) (citation omitted).
"If a claimant satisfies steps one, two, and three, [he] will automatically be found disabled. If a
claimant satisfies steps one and two, but not three, then [he] must satisfy step four. Once step four
is satisfied, the burden shifts to the SSA to establish that the claimant is capable of performing
work in the national economy." Knight v. Chater, 55 F.3d 309, 313 (7th Cir. 1995).
After Step Three, but before Step Four, the ALJ must determine a claimant's residual
functional capacity ("RFC") by evaluating "all limitations that arise from medically determinable
impairments, even those that are not severe." Villano v. Astrue, 556 F.3d 558, 563 (7th Cir. 2009).
In doing so, the ALJ "may not dismiss a line of evidence contrary to the ruling." Id. The ALJ uses
the RFC at Step Four to determine whether the claimant can perform his own past relevant work
and if not, at Step Five to determine whether the claimant can perform other work. See 20 C.F.R.
§ 404.1520(a)(4)(iv), (v).
If the ALJ committed no legal error and substantial evidence exists to support the ALJ's
decision, the Court must affirm the denial of benefits. Stephens, 888 F.3d at 327. When an ALJ's
decision does not apply the correct legal standard, a remand for further proceedings is usually the
appropriate remedy. Karr v. Saul, 989 F.3d 508, 513 (7th Cir. 2021). Typically, a remand is also
2000), as amended (Dec. 13, 2000), which cites 20 C.F.R. § 404.1520. 	Generally, a verbatim
section exists establishing the same legal point with both types of benefits. The Court will take
care to detail any substantive differences that are applicable to this case.
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appropriate when the decision is not supported by substantial evidence. Briscoe ex rel. Taylor v.
Barnhart, 425 F.3d 345, 355 (7th Cir. 2005).
II. 	BACKGROUND
Michael was 42 years old at the alleged onset of his disability in 2022. [Dkt. 8-2 at 30.]
He has a high school education and no past relevant work experience. [Id.]
The ALJ followed the five-step sequential evaluation set forth by the SSA in 20 C.F.R. §§
404.1520(a)(4) and 416.920(a)(4) and concluded that Michael was not disabled. [Dkt. 8-2 at 19-
31.] Specifically, the ALJ found as follows:
• 	At Step One, the ALJ found that Michael had not engaged in substantial gainful
activity since his alleged onset date of April 18, 2022. [Dkt. 8-2 at 21.]
• 	At 	Step Two, 	the ALJ 	determined 	that 	Michael 	had 	the following 	severe
impairments: 	Heart 	failure, 	hypertension, 	obstructive 	sleep 	apnea, 	obesity,
schizophrenia, unspecified depressive disorder, and post-traumatic stress disorder
("PTSD"). [Id.]
• 	At Step Three, the ALJ determined that no listings were met or medically equaled.
[Id. at 22.]
• 	After Step Three but before Step Four, the ALJ found that Michael had the RFC to
"perform light work as defined in 20 CFR 416.967(b) except stand and/or walk two
hours in an eight-hour workday; occasionally climb stairs and ramps; never climb
ladders, ropes, or scaffolds; occasional balancing as defined in the Selected
Characteristics 	of 	Occupations 	of 	the 	DOT; 	occasional 	stooping, 	kneeling,
crouching, 	and 	crawling; 	must 	avoid 	concentrated 	exposure 	to 	dangerous
machinery and unprotected heights; can understand, remember, and carry out
simple instructions; no requirement to maintain a production rate pace; no customer
service related interaction with the general public; no tandem or team oriented task
requiring work in coordination with others; and occasional interaction with co-
workers and supervisors." [Id. at 24-30.]
• 	At Step Four, the ALJ determined that Michael had no past relevant work. [Id. at
30.]
• 	At Step Five, the ALJ determined that there are jobs that exist in significant
numbers in the national economy that Michael can perform. [Id.] Accordingly, the
ALJ determined that Michael was not disabled at any time between his alleged
onset date of April 18, 2022, through the date of the decision. [Id. at 31.]
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III. 	DISCUSSION
Michael contends that the ALJ committed several errors requiring reversal. First, he argues
that the ALJ impermissibly made an adverse credibility finding based on his noncompliance with
his CPAP machine and his "relatively little treatment" for other severe impairments without
questioning him regarding potential reasons for his noncompliance or lack of treatment. [Dkt. 11
at 12-14.] 	Next, Michael argues that the ALJ impermissibly ignored multiple objective instances
of hypersomnolence. 	[Id. at 15-17.] 	Finally, Michael argues that the ALJ impermissibly
discounted Michael's credibility based on his continued smoking of cigarettes and marijuana. [Id.
at 17-18.] 	The undersigned's analysis begins and ends with the first issue, as the undersigned
believes that issue alone requires reversal of the ALJ's decision.
A. The ALJ erred by failing to question Michael at the hearing as to whether there were
good reasons for his lack of medical treatment and noncompliance with medical
recommendations.
Michael argues that the ALJ erred because, "[p]rior to drawing a negative inference about
a claimant's symptoms and their functional effects from a failure to attain certain treatment, [] the
ALJ must first consider any explanations that the individual may provide or other explanatory
information in the case record." 	[Dkt. 11 at 14.] 	Michael cites SSR 16-3p in support of his
argument, which states that the ALJ "may need to contact the individual regarding the lack of
treatment, or at an administrative proceeding, ask why he or she has not complied with or sought
treatment in a manner consistent with his or her complaints." SSR 16-3p.
The Commissioner argues that "SSR 16-3p does not require an ALJ to ask a claimant about
his failure to seek treatment; rather, it provides that an ALJ must consider possible reasons for a
failure to seek treatment." [Dkt. 13 at 9 (emphasis in original).] The Commissioner contends that
an ALJ simply cannot make assumptions about the claimant's noncompliance without asking about
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the reasons for failing to comply, which the ALJ did not do. [Id. at 9-10.] The Commissioner also
argues that the ALJ did not find Michael's noncompliance to mean his symptoms were not as severe
as alleged, but rather, that noncompliance could have been a contributing factor to Michael's
symptoms. [Id. at 10.]
In his reply brief, Michael stands on the arguments made in his opening brief. [Dkt. 14 at
1.]
The Seventh Circuit Court of Appeals has held that an ALJ "may deem an individual's
statements less credible if medical reports or records show that the individual is not following the
treatment as prescribed. 	However, such evidence should not negatively affect an individual's
credibility if there are good reasons for the failure to complete the plan." Murphy v. Colvin, 759
F.3d 811, 816 (7th Cir. 2014) (citations omitted). 	"Therefore, an ALJ may need to question the
individual at the administrative proceeding to determine whether there are good reasons the
individual did not seek medical treatment or fully comply with prescribed treatment." 	Id.; see
Shauger v. Astrue, 675 F.3d 690, 696 (7th Cir. 2012) ("An ALJ may need to question the individual
at the administrative proceeding in order to determine whether there are good reasons the
individual does not seek medical treatment or does not pursue treatment in a consistent manner.”
(citation and quotation marks omitted)); Craft v. Astrue, 539 F.3d 668, 679 (7th Cir. 2008) ("The
ALJ must not draw any inferences about a claimant's condition from [infrequent treatment or
failure to follow a treatment plan] unless the ALJ has explored the claimant's explanations as to
the lack of medical care."). 	It is reversible error for an ALJ to make an adverse credibility
determination based on a lack of treatment or noncompliance with treatment without determining
whether it was justifiable. 	See Murphy, 759 F.3d at 816 (holding that "the ALJ's credibility
determination is not supported by substantial evidence" because, among other reasons, "the ALJ
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did not ask important questions to determine if [the claimant's lack of treatment and noncompliance
with treatment] were justifiable"); Shauger, 675 F.3d at 696 (agreeing with the claimant's argument
that "the ALJ could not discredit his testimony based on a perception of unexplained gaps in his
treatment history" without questioning the claimant about those gaps, which could be caused, for
example, by "an inability to afford treatment, ineffectiveness of further treatment, or intolerable
side effects").
Contrary to the Commissioner's arguments, the ALJ clearly made an adverse credibility
determination based on Michael's lack of treatment and noncompliance with recommended
treatment for his severe impairments. 	The ALJ stated, "[t]he claimant's statements about the
intensity, persistence, and limiting effects of his symptoms are inconsistent with the objective
medical evidence," and then went on to specifically document Michael's "little treatment" for
several of his severe impairments. 	[Dkt. 8-2 at 26.] 	For example, the ALJ stated that, "[o]ther
than his hospitalization in late 2022, the claimant has received relatively little treatment for his
cardiac conditions during the relevant period." [Dkt. 8-2 at 27.] But the ALJ did not ask Michael
or otherwise examine if there were "good reasons" for the lack of further treatment for his cardiac
condition, as is required. Shauger, 675 F.3d at 696.
The ALJ also discounted Michael's obstructive sleep apnea, chronic nasal sinus congestion,
and obesity because the record "reflects relatively little treatment" regarding those conditions.
[Dkt. 8-2 at 27.] But, as with his cardiac condition, the ALJ did not question Michael at the hearing
or otherwise examine whether there were "good reasons" for the lack of additional treatment for
these conditions. 3 Shauger, 675 F.3d at 696.
3 Notably, on the only occasion the ALJ explored a potential reason for Michael's noncompliance,
his assessment was flawed. The ALJ noted that evidence in the record suggested that Michael's
noncompliance with his CPAP was "difficulty using [it] due to nasal sinus congestion." [Dkt. 8-2
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In sum, the ALJ discounted Michael's credibility regarding the stated effects of his severe
impairments based on a lack of treatment or noncompliance with treatment. [Dkt. 8-2 at 27-28.]
The Seventh Circuit has held that, if an ALJ does so, the ALJ must "ask important questions to
determine if [the claimant's lack of treatment and noncompliance with treatment] were justifiable,"
Murphy, 759 F.3d at 816, due to, for example, "an inability to afford treatment, ineffectiveness of
further treatment, or intolerable side effects," Shauger, 675 F.3d at 696. See McHenry v. Berryhill,
911 F.3d 866, 873 (7th Cir. 2018) ("[A]n ALJ has the burden of inquiry [] when drawing inferences
about the severity of a condition from the failure to seek or continue medical care."). The record
is clear that the ALJ failed to ask any such questions at the hearing. [Dkt. 8-2 at 33-77.] For this
reason, 	the 	undersigned 	recommends 	that 	the 	District 	Judge 	reverse 	and 	remand 	the
Commissioner's decision in this case.
B. 	Other Arguments
The Parties disagree about the other issues set forth above. [Dkts. 11 at 15-18; 13 at 11-
20; 14 at 1-3.] Having found that it is necessary to recommend remand for the reasons detailed
above, the Court declines to substantively address the Parties' remaining arguments. Either Party
may raise those arguments on remand if appropriate to do so.
at 27; see id. at 26 (noting that "the claimant's primary care doctor 'suspect[ed] that [CPAP usage]
was made very difficult by his sinus condition'") (citation omitted) (alternations in original)).] But
instead of considering this as a legitimate basis for noncompliance, the ALJ appears to have
discounted it due to Michael's continued smoking. 	[Id. at 26-27 ("However, the claimant has
continued to smoke cigarettes daily (up to 1 pack) and marijuana throughout the relevant
period.").] 	The ALJ should not have relied on Michael's smoking as a basis to undermine his
credibility regarding an otherwise legitimate basis for noncompliance with his CPAP. See Martinez
v. Kijakazi, 71 F.4th 1076, 1082-83 (7th Cir. 2023) (noting that "a claimant's failure to quit smoking
is an unreliable basis on which to rest a credibility determination" and is "improper under [Seventh
Circuit] caselaw"); see also Penrod v. Berryhill, 900 F.3d 474, 478 (7th Cir. 2018); Shramek v.
Apfel, 226 F.3d 809, 813 (7th Cir. 2000). Even if the ALJ properly determined that there were not
good reasons for Michael's noncompliance with his CPAP, the ALJ did not do so with respect to
Michael's other severe impairments discussed above.
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IV. 	CONCLUSION
For the reasons detailed herein, the Magistrate Judge recommends that the District Judge
REVERSE and REMAND the Commissioner's decision that Michael was not disabled. 	Any
objections to this Report and Recommendation must be filed in accordance with 28 U.S.C.
§ 636(b)(1) and Fed. R. Civ. P 72(b). The failure to file objections within 14 days after service
will constitute a waiver of subsequent review absent a showing of good cause for that failure.
Counsel should not anticipate any extension of this deadline or any other related briefing deadlines.
SO RECOMMENDED.
Distribution:
All counsel electronically registered via CM/ECF
Date: 12/10/2025
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