Paul Lambert v. Nancy Berryhill, 896 F.3d 768

Background

Lambert, with a long history of lumbar fusion and subsequent surgeries, applied for Social Security Disability Insurance alleging disabling chronic lower back pain with an amended onset date of Jan 1, 2013.
Neurosurgeon Dr. Kamajit Paul treated Lambert from June 2013, performed bilateral sacroiliac (SI) fusions (Oct 2013 and Apr 2014), and by July–Aug 2014 concluded Lambert’s pain had worsened and that he could not tolerate even sedentary work.
Functional testing: January 2014 testing showed improved function and light-duty clearance; July 2014 testing showed marked decline, need to change position every 15 minutes, and low-to-sedentary work tolerance.
The ALJ gave little weight to Dr. Paul’s July/August 2014 opinions, credited earlier state-agency reviewers who found capacity for sedentary work, and discredited Lambert’s subjective pain testimony (citing imaging, intermittent symptoms, and unemployment benefits before the amended onset).
The Appeals Council denied review; the district court affirmed the Commissioner. The Seventh Circuit reversed and remanded, finding the ALJ erred in discounting both the treating neurosurgeon’s opinions and Lambert’s testimony.

Issues

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether ALJ properly discounted treating neurosurgeon Dr. Paul’s July–Aug 2014 opinions	Dr. Paul’s later opinions are supported by exams and the July functional assessment and reflect deterioration after additional surgery; ALJ failed to apply treating-physician factors and mischaracterized inconsistency	ALJ reasonably discounted those opinions as inconsistent with earlier notes and objective imaging; any error harmless	Reversed: ALJ gave inadequate reasons. He improperly rejected Dr. Paul’s opinions, failed to consider regulatory factors, and relied on outdated state-reviewer opinions.
Whether ALJ permissibly rejected claimant’s testimony about pain and limitations	Lambert’s testimony is consistent with treatment records, surgeries, and functional testing showing worsening; ALJ misread records and overemphasized isolated objective findings and temporary improvements	ALJ noted lack of objective findings, some improvement with treatment, intermittent symptoms, and applicant’s unemployment benefits before amended onset as credibility problems	Reversed: ALJ’s credibility findings were not supported—he overrelied on imaging/isolated exam results, overlooked supporting evidence, and misused unemployment benefit evidence.
Whether ALJ may rely on pre‑surgery/state-agency opinions despite later medical developments	N/A (part of plaintiff’s challenge)	Agency argues state consultants’ opinions support denial and any error is harmless	Court: ALJ erred in crediting outdated reviewers without reconciling later, significant new evidence.
Whether a treating physician’s opinion that claimant cannot work is an improper legal conclusion	Dr. Paul’s statement that Lambert cannot tolerate a work situation is a medical opinion relevant to RFC	Gov’t argued such opinions are legal conclusions reserved to Commissioner	Court: Medical opinions about ability to work are relevant and must be considered; treating physician’s statement is not automatically an improper legal conclusion.

Key Cases Cited

Gerstner v. Berryhill, 879 F.3d 257 (7th Cir.) (treating-physician rule applies to claims filed prior to March 27, 2017)
Beardsley v. Colvin, 758 F.3d 834 (7th Cir.) (ALJ must build an accurate and logical bridge between evidence and conclusion)
Meuser v. Colvin, 838 F.3d 905 (7th Cir.) (ALJ cannot "play doctor" by interpreting medical evidence without expert opinion)
Stage v. Colvin, 812 F.3d 1121 (7th Cir.) (ALJ may not substitute own medical judgment for professionals')
Goins v. Colvin, 764 F.3d 677 (7th Cir.) (remand where ALJ summarized imaging without medical scrutiny)
Hill v. Colvin, 807 F.3d 862 (7th Cir.) (degenerative conditions often worsen over time)
Cole v. Colvin, 831 F.3d 411 (7th Cir.) (ALJ may not reject treating physician’s opinion simply because cause of pain is unclear)
Parker v. Astrue, 597 F.3d 920 (7th Cir.) (lack of objective findings alone cannot discredit pain complaints)
Moss v. Astrue, 555 F.3d 556 (7th Cir.) (ALJ must consider regulatory factors when weighing treating source opinions)
Bauer v. Astrue, 532 F.3d 606 (7th Cir.) (same)
Bjornson v. Astrue, 671 F.3d 640 (7th Cir.) (physician opinions about ability to work are not per se legal conclusions)
McKinzey v. Astrue, 641 F.3d 884 (7th Cir.) (harmless-error standard for agency decisions)
Ghiselli v. Colvin, 837 F.3d 771 (7th Cir.) (standard for overturning credibility findings)
Pierce v. Colvin, 739 F.3d 1046 (7th Cir.) (pain complaints cannot be discredited solely for lack of objective corroboration)
Israel v. Colvin, 840 F.3d 432 (7th Cir.) (undergoing risky treatments supports credibility of pain complaints)
Scrogham v. Colvin, 765 F.3d 685 (7th Cir.) (physicians may update opinions as conditions change)
Minnick v. Colvin, 775 F.3d 929 (7th Cir.) (ALJ must consider evidence that supports treating physician)
Moreno v. Berryhill, 882 F.3d 722 (7th Cir.) (ALJ may not rely on outdated reviewers when later evidence could change opinion)
Garcia v. Colvin, 741 F.3d 758 (7th Cir.) (distinguishing legal questions reserved to Commissioner)
Stark v. Colvin, 813 F.3d 684 (7th Cir.) (ALJ must evaluate whether ongoing treatments actually relieve symptoms)
Schmidt v. Barnhart, 395 F.3d 737 (7th Cir.) (unemployment benefits may be relevant to credibility if claimant represented ability to work)