Britny N. Casten v. MARTIN J. O’MALLEY, Commissioner of Social Security

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Argued November 19, 2024
Decided November 26, 2024
Before
AMY J. ST. EVE, Circuit Judge
JOHN Z. LEE, Circuit Judge
JOSHUA P. KOLAR, Circuit Judge
No. 24-1583
BRITNY N. CASTEN,
Plaintiff-Appellant,
v.
MARTIN J. O’MALLEY, Commissioner
of Social Security,
Defendant-Appellee.
Appeal from the United States District
Court for the Central District of Illinois.
No. 22-cv-02250
Colin S. Bruce,
Judge.
O R D E R
Britny Casten, a young woman who experiences low back pain, appeals the
denial of her application for disability insurance benefits. An Administrative Law Judge
(ALJ) found that Casten did not have a disability and denied her application. Casten
sought review in the district court, which upheld the ALJ’s ruling. Because the ALJ’s
decision was supported by substantial evidence, we affirm.
In December 2019, Casten (then 29) stopped working as a customer-complaint
clerk at AT&T, and a month later she filed for disability insurance benefits. She had a
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with F ED. R. APP . P. 32.1

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wide range of medical issues, but her principal symptom was low back pain, which she
had complained about for approximately ten years. Her back pain had been attributed
to fibromyalgia, obesity, degenerative disc disease, and sacroiliac joint arthritis. The
pain worsened after a fall in 2018 and again after several falls in 2020. Doctors
prescribed her various pain medications and referred her to surgeons, specialists, and
physical therapists. In early 2021, a pain-management specialist administered
bilateral-sacroiliac-joint injections, which relieved some of her pain. She received
additional injections in early 2022.
Casten also experienced wrist and finger pain. In March 2021, she received
cubital-tunnel-release surgery, which seemed to have removed most of the discomfort.
But later that year, the pain in her right wrist returned. She reported that the pain
diminished after she received a steroid injection and completed four weeks of
immobilization.
Casten also had chronic migraines, for which she was prescribed various
medications, including an anticonvulsant, periodic trigger-point injections, and
butalbital (a barbiturate drug used to treat tension headaches). In August 2021, she
reported that her migraines had generally been “doing pretty well,” that she
experienced two to four migraines per month, and that she was satisfied with her
current medications.
In connection with Casten’s application, in July and September 2020, two state
agency physicians, Dr. Vidya Madala and Dr. Bharati Jhaveri, respectively, reviewed
Casten’s medical records, and opined that she could perform “light work” with certain
restrictions. See 20 C.F.R. § 404.1567(b).
Those opinions differed from that of a physical therapist, Madison Bayler, who
opined after a one-time evaluation in January 2021 that Casten could work only at a
sedentary level of exertion or below. Bayler conducted a physical-therapy evaluation,
which incorporated Casten’s reports of her own functional ability and pain. Bayler
concluded that Casten had limited range of motion in her spine and shoulders,
significant weakness in her upper and lower extremities, weak grip strength, and
problems with her endurance, balance, and gait. Dr. Steven Gentry, Casten’s primary
care physician, endorsed Bayler’s conclusions the following day, and relayed the
findings on a pre-printed Physical Residual Functional Capacity Questionnaire.

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An ALJ conducted a hearing in February 2021 and denied Casten’s application
for benefits. The ALJ found that Casten could perform sedentary work, and that Casten
was not disabled because she could perform her past relevant work as a customer
complaint clerk. The Appeals Council, however, remanded the case for a new hearing
because the ALJ had abused her discretion when she discounted Bayler’s opinion after
finding, without support, that Casten did not provide full effort at Bayler’s examination.
Another ALJ held a hearing on remand in January 2022 and again denied
Casten’s application. Applying the five-step disability analysis, see 20 C.F.R.
§ 416.920(a)(4), the ALJ determined that (step 1) Casten had not engaged in substantial
gainful activity during the relevant period; (step 2) her obesity, fibromyalgia, migraines,
supraventricular tachycardia, status post ablation surgery, degenerative disc disease of
the cervical and lumbar spine, and sacroiliac joint arthritis were severe impairments;
but (step 3) none of these equaled a listed impairment; (step 4) she could perform light
work with postural, manipulative, and environmental restrictions; and (step 5) she
could perform her past relevant work as a customer complaint clerk.
In finding that Casten had the residual functional capacity (RFC) to perform light
work with certain restrictions, the ALJ explained that the state physicians’ opinions
were better supported and more consistent with the medical evidence than the opinions
of Bayler and Dr. Gentry. The ALJ explained that Bayler had assessed several of
Casten’s functional abilities based on Casten’s subjective reports of pain, and Bayler’s
one-time evaluation did not reflect Casten’s longitudinal functioning. The ALJ also
found Bayler’s opinion at odds with reports from other medical providers who had
examined Casten and had not reported significantly reduced strength in her upper and
lower extremities. As for Dr. Gentry’s opinion, the ALJ found it unpersuasive because
he had used a pre-printed form and provided little narrative, relying for support only
on Bayler’s evaluation, and his opinion was inconsistent with his previous treatment
notes and other medical evidence.
This time, the Appeals Council declined further review.
Casten sought review in the district court and argued that the ALJ’s findings
regarding the medical opinions were illogical and not supported by substantial
evidence. The court upheld the ALJ’s decision, deferring to the ALJ’s stated reasons for
crediting the opinions of the state physicians’ opinions over those of Dr. Gentry and
Bayler.

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We will affirm an ALJ’s decision denying disability benefits if it is supported by
substantial evidence—a low threshold. Warnell v. O'Malley, 97 F.4th 1050, 1052 (7th Cir.
2024). “[W]e will not reweigh the evidence, resolve debatable evidentiary conflicts,
determine credibility, or substitute our judgment for the ALJ’s determination so long as
substantial evidence supports it.” Id. at 1052–53 (quoting Gedatus v. Saul, 994 F.3d 893,
900 (7th Cir. 2021)).
Casten first argues that the ALJ glossed over recent developments in her medical
record and failed to explain how they were consistent with the state agency physicians’
earlier opinions (from mid-2020). Casten points, for example, to evidence that she had
surgery on her wrist in March 2021, reported wrist pain in December 2021 and January
2022, had frequent migraines throughout 2021, and received bilateral-sacroiliac-joint
injections to treat ongoing back pain. According to Casten, the ALJ merely recited this
evidence without explaining how it could be reconciled with the earlier opinions.
This argument shortchanges the ALJ’s analysis. The ALJ explained how this
more recent evidence influenced her ultimate decision. The ALJ noted, for example, that
Casten’s low back pain improved after she received sacroiliac injections in April 2021,
and she received another round of injections a couple of weeks before the hearing in
January 2022, after she complained that her back pain had returned; her symptoms in
her right wrist had improved after her cubital tunnel release in 2021; and her migraines
were “well managed with treatment” and had improved after she began receiving
injections in October 2020. Further, in light of these recent developments, the ALJ
included additional manipulative, reaching, and environmental limitations in Casten’s
RFC. The ALJ’s analysis here was sufficient. Warnell, 97 F.4th at 1053 (ALJs “are subject
to only the most minimal of articulation requirements”).
Casten relatedly argues, for the first time, that the medical opinions from the
state agency physicians were “stale” and that the ALJ should have accounted for
subsequent developments by having them evaluated through an additional medical
opinion. We agree with the Commissioner that Casten waived this argument by failing
to raise it before the district court. See Milhem v. Kijakazi, 52 F.4th 688, 693 (7th Cir. 2022).
Regardless, the argument lacks merit because the ALJ was not required to seek an
additional medical opinion beyond those already in the record. An additional medical
opinion would be necessary only if new, significant medical diagnoses reasonably could
have changed the physicians’ medical opinions. See Pavlicek v. Saul, 994 F.3d 777, 783–84
(7th Cir. 2021). Here, the developments in the medical evidence were not new: they
concerned diagnoses and treatment for conditions—low back pain, wrist pain, and

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migraines—that Casten had experienced long before the state physicians submitted
their opinions. Further, the ALJ accounted for these developments by explaining that
Casten’s treating physicians had observed improvements in her back pain, wrist pain,
and migraine frequency that were consistent with the state agency physicians’ opinions
that she could perform light work. To the extent Casten disagrees with the ALJ’s
weighing of the state physicians’ opinions and subsequent medical evidence, we will
not reweigh the evidence or resolve debatable evidentiary conflicts. See Warnell, 97 F.4th
at 1052.
Casten next argues that the ALJ wrongly discounted Bayler’s medical opinion as
not well supported simply because it was based on a single examination and included
assessments of subjective reports of pain. But an ALJ may discount a medical opinion
that is based primarily upon a patient’s subjective complaints. Prill v. Kijakazi, 23 F.4th
738, 751 (7th Cir. 2022). And substantial evidence—namely, Bayler’s notes from her
examination—supports the ALJ’s determination to discount Bayler’s assessments of
Casten’s ability to stand, sit, or lift to the extent they were based on Casten’s subjective
reports of pain during the examination.
Casten also challenges the ALJ’s finding that Bayler’s opinion was inconsistent
with the medical evidence. The ALJ referred to exams performed by other treatment
providers showing that Casten had normal motor strength, no other neurological
abnormalities, and no deficits in her range of motion or grip strength. Casten disputes
the ALJ’s characterization of the evidence and points to select findings from the record
that she says are consistent with Bayler’s opinion.∗
Substantial evidence also supports the ALJ’s finding that Bayler’s assessment,
which showed significantly reduced motor strength in Casten’s upper and lower
extremities, was inconsistent with the medical evidence. As the ALJ explained, other
treatment providers consistently found that Casten was not as physically limited as
Bayler opined. When treating physicians present conflicting evidence, the ALJ may
∗The findings identified by Casten include diminished light touch sensation on the left side,
reduced strength in the hips and knees, pain in the back, moderate instability on left single leg stand, and
a wide-based, antalgic, slow gait in January 2019; trigger points in the back in April 2019; discomfort with
light tapping on the lumbar spine, limited ability to bend forward and backward, and discomfort while
walking in February 2020; positive provocative testing in the right cubital tunnel and at the Guyon’s canal
in May 2020; decreased range of motion of the cervical spine, tenderness in the back, and decreased range
of motion in the shoulders in August 2020; poor posture, tenderness in the spine, limited lumbar range of
motion, shaking throughout all manual motor testing, and a slow and waddling gait in September 2020.

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decide whom to credit, so long as substantial evidence supports the decision.
See Warnell, 97 F.4th at 1053. In light of the reports from other treatment providers who
contradicted Bayler’s opinion, we conclude that substantial evidence supports the ALJ’s
decision to reject it.
Casten next argues that the ALJ did not provide a logical explanation for finding
Dr. Gentry’s opinion unpersuasive. According to Casten, the ALJ should not have
devalued Dr. Gentry’s opinion merely because he used a pre-printed form and
provided “very little narrative explanation” for his opinion. In her view, the ALJ’s
reasoning was unfair because the opinions from the state agency physicians, which the
ALJ found persuasive, were similarly issued on pre-printed forms and contained
comparable narrative explanations.
Casten’s focus on the nature of the forms, however, ignores the ALJ’s broader
conclusion that Dr. Gentry’s opinion was inconsistent with his prior examination notes
that did not mention any gait abnormalities, motor-strength deficits, or range-of-motion
deficits. We will not disturb an ALJ’s decision to discount a medical opinion that is
contradicted by medical evidence in the record that the ALJ relied upon. See id. The ALJ
here appropriately explained that the record evidence consistently contradicted Dr.
Gentry’s opinion that Casten could not stand, walk, or sit for more than minutes at a
time. The ALJ also observed that Dr. Gentry’s opinion about Casten’s severely limited
ability to use her hands or reach was inconsistent with the medical evidence, which
showed no abnormalities in her hands or arms on a consistent basis other than
immediately before and after her surgery in March 2021.
AFFIRMED

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