In the
United States Court of Appeals
For the Seventh Circuit
No. 09-2820
S EAN T. S CHAAF,
Plaintiff-Appellant,
v.
M ICHAEL J. A STRUE,
Commissioner of Social Security,
Defendant-Appellee.
Appeal from the United States District Court
for the Western District of Wisconsin.
No. 08-cv-611—Barbara B. Crabb, Judge.
A RGUED JANUARY 26, 2010—D ECIDED A PRIL 26, 2010
Before B AUER, P OSNER, and K ANNE, Circuit Judges.
P ER C URIAM. Sean Schaaf applied for Social Security
disability benefits after he lost partial use of one arm
in a snowmobile accident, claiming that he no longer
could perform his past job as a mason or any other job.
The Social Security Administration denied his claim
after an Administrative Law Judge (ALJ) found that
Schaaf can still perform light work. The district court
2 No. 09-2820
upheld that decision. On appeal Schaaf argues that the
ALJ gave too little weight to both his treating physi-
cian’s opinion and his own testimony about his physical
limitations. We affirm the judgment.
I. B ACKGROUND
In February 2005 at age 31, Schaaf overturned his snow-
mobile and suffered a slight concussion and injuries to
his back, chest, left arm, and right knee. Most of the
injuries healed with time, but the arm and knee required
surgery. Schaaf had damaged the nerves in his left
brachial plexus, and the injury weakened the muscles in
his shoulder and arm, leaving him with the use of his
hand but unable to flex the arm or raise it in front
of him. After physical therapy did not significantly im-
prove mobility in that arm, Schaaf underwent nerve-
transfer surgery in July 2005 in an attempt to regain
more function in the muscles. Early the next year he
also had reconstructive surgery on the torn ligaments in
his right knee because, although he had regained nearly
normal functioning, the knee still hurt when he ran.
Meanwhile, just weeks after the accident, Schaaf had
applied for disability benefits, claiming that his left arm
was paralyzed and his right knee impaired to a
degree that prevented him from working. The Social
Security Administration denied his application initially
in June 2005, and, after retaining a lawyer, Schaaff re-
quested reconsideration. Reconsideration was denied,
and Schaaf requested a hearing before an ALJ.
No. 09-2820 3
The ALJ conducted the hearing in November 2007. The
evidence before the ALJ included information from
Schaaf and his mother as well as surgical records and
notes from Schaaf’s family doctor. In a Physical Activities
Questionnaire completed just 4 months after the accident,
Schaaf reported that he attended to his own personal
hygiene, did his own shopping, and occasionally went
fishing. But he complained that he was unable to rake
or sweep and could not “do much” because of the ac-
cident. He said that pain prevented him from
leaving the house more than once a day and kept him from
sleeping more than 4 to 6 hours a night. Sometimes, he
added, he napped for up to an hour a day. Schaaf
also reported that he lived alone with his 3-year-old son,
but he did not detail his caretaking responsibilities
until he updated his application in March 2006. In that
update Schaaf said that his arm injury had worsened
after the surgery in July 2005. Nonetheless, he was
getting his son ready in the morning for preschool,
driving him most days to the bus stop 15 miles away,
and preparing his breakfast and dinner. Schaaf com-
plained, however, that he was unable to “do anything
that requires two hands” and as a consequence was very
depressed. He further reported that he experienced
“constant pain—total discomfort at all times”—that
affected his sleep. Schaaf’s mother confirmed in her
report on Schaaf’s functioning that she helped him
with housework and that he complained of constant pain.
The record before the ALJ also included Schaaf’s medical
records from the time of the accident through early 2006,
shortly after his knee surgery. After the injury, doctors
4 No. 09-2820
had prescribed Neurontin, a nerve-pain drug, and
Percocet, a narcotic pain reliever. See Mayo Clinic,
Gabapentin (Oral Route), http://www.mayoclinic.com/
health/drug-information/DR600709 (last visited Apr. 19,
2010) (Neurontin); P HYSICIANS’ D ESK R EFERENCE 1127 (63d
ed. 2009) (Percocet). It is unclear how long Schaaf took
Neurontin, but the medical records document his use
of Percocet (or its generic) almost continuously after the
accident. The physical therapist’s notes detail Schaaf’s
progress until the nerve-transfer surgery. A few months
after that surgery, Schaaf was referred back to physical
therapy. But after his first evaluation in October 2005
he never returned and was discharged for noncompli-
ance. A few months later, Schaaf had reconstructive
surgery on his knee, but the record contains no post-
surgery updates.
The medical record also includes progress notes from
Dr. John Ingalls, Schaaf’s personal physician, for the
period from March 2005 through November 2007. Most
of the entries document requests to refill prescriptions
for pain medications, but in September 2005 Schaaf was
examined, complaining of pain in his left arm at a level
of 8 or 9 out of 10. Ingalls noted that Schaaf had been out
of Percocet for 6 weeks and prescribed physical therapy
(which Schaaf did not attend), more Percocet, and
Gabapentin (the generic of Neurontin). After that Schaaf
received almost monthly refills of Percocet, 90 pills at a
time. He was not seen again for pain until July 2006
when, for the first time, he also complained of insomnia.
Ingalls prescribed Benadryl for the insomnia and once
more instructed Schaaf to get physical therapy. Ingalls’s
No. 09-2820 5
treatment notes suggest that Schaaf went to physical
therapy: “Treated by Robyn M. Formanek PT, MA. Has
been trying to work. Lifting increases arm and neck
pain.” But absent from the record are notes or other
documentation from the physical therapist, so it is impos-
sible to say whether the results noted by Ingalls were
communicated to him by the therapist or by Schaaf. Ingalls
also examined Schaaf in November 2007—a few days
in advance of the hearing before the ALJ—to assess his
ability to work. At that appointment Schaaf told Ingalls
that he typically takes Percocet at bedtime and as needed
for pain, 3 pills at a time. Ingalls noted that Schaaf com-
plained of chronic pain that he said caused insomnia.
Ingalls concluded that Schaaf’s pain and loss of mobility
had led to “chronic fatigue and insomnia” and prescribed
a new pain medication, Lyrica.
The ALJ considered three assessments of Schaaf’s
residual functional capacity: a November 2007 assessment
from Dr. Ingalls and two assessments from state-agency
physicians who reviewed Schaaf’s medical records, first
in June 2005 and later in May 2006. All three physi-
cians agreed that only the arm injury affected Schaaf’s
ability to work, and only the doctor who reviewed his
file in 2006 thought that Schaaf could not use his left arm
at all. The first state-agency physician had concluded
that Schaaf could feel with his left hand, and Ingalls
gave an even more-positive assessment; he reported
that Schaaf could perform fine manipulations, limited
grasping, occasional carrying of up to 20 pounds, and
occasional reaching at or below shoulder level. Both of
the state-agency physicians concluded that Schaaf could
6 No. 09-2820
perform one-armed light work. Ingalls did not opine
about the level of work that Schaaf could perform but,
consistent with the other physicians, represented that
Schaaf was unrestricted in other areas, such as walking,
sitting, standing, bending, crouching, or operating ma-
chinery. Ingalls, though, checked yes when asked if
there would be some days during “an average month”
when Schaaf “would not be able to work at all.” Ingalls
speculated that Schaaf would miss a week or more
per month but did not elaborate. The state-agency physi-
cians used a different form that did not have this question.
At the hearing the ALJ heard testimony from Schaaf
and a vocational expert. Schaaf testified that he was
unable to work because of his arm injury, pain, and lack
of sleep and said that he relies on his mother and friends
to take care of his house. The ALJ asked Schaaf what he
does with his time, and he responded, “Not much,”
without listing any activities that he does do. In response
to his attorney’s questioning, Schaaf reported that he
is unable to sleep more than 1 to 3 hours a night because
of the pain, which he described as rating a 10 out of 10.
He said his medication does not take away the pain
but makes him relax and forget about it. Then the ALJ
asked Schaaf if he had participated in services from
the Division of Vocational Rehabilitation, Wisconsin’s job-
assistance program for people with disabilities, and
Schaaf responded that he started the process but did not
follow through because, even though the program
would pay for gas, he “didn’t have the ride.”
Next, the ALJ presented two hypotheticals to the voca-
tional expert. In one, the ALJ asked whether unskilled,
No. 09-2820 7
light-work jobs were available for someone whose use
of his left arm was limited to carrying 20 pounds, occa-
sional reaching and fine manipulation, and frequent
simple grasping. In the other, the ALJ posited no use of
the left arm. In both cases the vocational expert testified
that such a person could not perform Schaaf’s former
work as a mason. But he identified cashier as a job for
a person with restricted use of one arm and security
monitor for a person with limited to no use of one arm.
Then, in response to questions by Schaaf’s attorney,
the vocational expert acknowledged that a person with
“an impairment in concentration as a result of lack of
sleep and medication” would not be able to be a security
monitor. He also conceded that a person who missed
a week of work per month would not be employable.
The ALJ, applying the 5-step analysis for evaluating
disability, see 20 C.F.R. § 404.1520, concluded that Schaaf
had not engaged in substantial gainful activity since
the accident. The ALJ identified several severe physical
impairments, including injuries to the left brachial
plexus and thoracic nerve root, flaccid paralysis of the
left arm, right knee ligament injury, and endplate com-
pression fractures at T11 and T12, but no severe mental
impairments, despite Schaaf’s self-reported depression.
The ALJ noted that the only injury still affecting Schaaf
was the one to his arm but concluded that it was not
severe enough to qualify as a listed nerve impairment,
which requires, at a minimum, dysfunctions in two
extremities.
Accordingly, the ALJ proceeded to analyze Schaaf’s
residual functional capacity. He found that Schaaf could
8 No. 09-2820
not lift anything with his left arm but could carry up
to 20 pounds with it and occasionally perform fine ma-
nipulation, simple grasping, and reaching. He also
found that Schaaf could otherwise lift and carry up to
20 pounds occasionally and 10 pounds frequently and
could sit, stand, and walk for 6 hours of an 8-hour day.
After the ALJ concluded that Schaaf could still perform
light work with these limitations, he turned to whether
Schaaf’s reported symptoms—chronic pain and fa-
tigue—rendered him disabled.
The ALJ found that Schaaf’s medically determined
impairments could reasonably cause chronic pain and
fatigue but rejected Schaaf’s claim that the intensity and
persistence of his symptoms would limit his ability to
work. Dr. Ingalls had opined that Schaaf would miss a
week or more of work per month. But the ALJ found
Ingalls’s opinion in this respect unpersuasive because
Ingalls did not explain his reasoning and his treatment
notes did not fill in the gap. The only support the
ALJ discovered in the treatment notes was Ingalls’s
November 2007 assessment of chronic fatigue and in-
somnia, which the ALJ determined did not provide
a sufficient medical basis for the proffered limitation.
Dr. Ingalls’s opinion is based primarily on Schaaf’s
reported symptoms, and so the ALJ evaluated Schaaf’s
hearing testimony about those symptoms and refused
to fully credit his testimony because it conflicted with
other parts of the record. For example, the ALJ noted
that Schaaf testified that he does not do much during
the day, but he reported a variety of daily activities in
No. 09-2820 9
his Physical Activities Questionnaire: he is the primary
caregiver for his son 5 days a week, including the week-
end; he is able to cook, drive, shop, and take care of his
personal hygiene; and he goes fishing. Furthermore, the
ALJ found it significant that Schaaf failed to attend his
physical therapy appointments after the arm surgery
and did not pursue available services from the Division
of Vocational Rehabilitation. He questioned Schaaf’s
purported lack of transportation given that he or his
mother drives Schaaf’s son 15 miles to the bus stop every
school day. Finally, Schaaf testified that the level of pain
in his left arm was a 10 out of 10 all of the time, but the
ALJ noted that examining physicians consistently de-
scribed Schaaf as being in no acute distress, which
he found inconsistent with Schaaf experiencing constant
high-level pain. Accordingly, the ALJ concluded that
Schaaf did not credibly allege an incapacity for all sus-
tained work activity and stated that “to the extent that
he is self-limited” such limitations are not a basis for
finding disability.
The ALJ only briefly addressed the side effects from
Schaaf’s medications, concluding that “[t]here is no
evidence that Mr. Schaaf’s use of prescribed medication
is accompanied by side effects that would interfere sig-
nificantly with his ability to perform work within the
restrictions outlined in this decision.” The ALJ referred
to Dr. Ingalls’s treatment notes that showed Schaaf re-
peatedly denied memory loss, confusion, lack of con-
centration, or inability to cope with daily stresses.
Having determined Schaaf’s residual functional capacity,
the ALJ concluded that Schaaf could not perform his
10 No. 09-2820
past work as a mason but that jobs existed that Schaaf
could perform. Relying on the testimony of the vocational
expert, the ALJ found that even with his limitations
Schaaf could perform the duties of a security monitor or
cashier. The ALJ rejected Schaaf’s argument that his pain
and medication prevent him from the sustained con-
centration needed to be a security monitor, relying on
Dr. Ingalls’s treatment notes, which document Schaaf’s
repeated denials of any difficulty maintaining concentra-
tion. Accordingly, the ALJ deemed Schaaf to be not dis-
abled and denied benefits. The Appeals Council denied
review, and the district court upheld the ALJ’s decision.
II. A NALYSIS
When the Appeals Council denies review, the ALJ’s
decision becomes the final decision of the Commissioner.
Liskowitz v. Astrue, 559 F.3d 736, 739 (7th Cir. 2009). We
review the ALJ’s decision deferentially and uphold it
if supported by substantial evidence. Terry v. Astrue,
580 F.3d 471, 475 (7th Cir. 2009). Substantial evidence is
“such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Richardson
v. Perales, 402 U.S. 389, 401 (1971); see Craft v. Astrue,
539 F.3d 668, 673 (7th Cir. 2008).
Schaaf first argues that the ALJ should have granted
controlling weight to all parts of Dr. Ingalls’s report
because Ingalls is his treating physician and, in his
view, the report is well-supported and not inconsistent
with the record. Accordingly, Schaaf contends, the ALJ
was compelled to find him disabled because Ingalls
No. 09-2820 11
opined that he would miss a week or more of work a
month and the vocational expert testified that missing
so much work “would not allow for competitive em-
ployment.”
The regulations state that an ALJ must give a treating
physician’s opinion controlling weight if two condi-
tions are met: (1) the opinion is supported by “medically
acceptable clinical and laboratory diagnostic techniques[,]”
and (2) it is “not inconsistent” with substantial evidence
in the record. 20 C.F.R. § 404.1527(d)(2); see Elder v. Astrue,
529 F.3d 408, 415-16 (7th Cir. 2008); Hofslien v. Barnhart,
439 F.3d 375, 376 (7th Cir. 2006). If the opinion is unsup-
ported or inconsistent with the record, the ALJ may still
choose to accept it, but if the ALJ rejects the opinion, he
must give a good reason. 20 C.F.R. § 404.1527(d)(2);
Ketelboeter v. Astrue, 550 F.3d 620, 625 (7th Cir. 2008);
Schmidt v. Astrue, 496 F.3d 833, 842 (7th Cir. 2007).
Schaaf seemingly contends that because the ALJ did not
point to contradictory evidence (expecting, perhaps, an
opinion from a doctor saying that Schaaf could work a
full month), Dr. Ingalls’s finding must be well-supported.
But Schaaf conflates the two areas of inquiry. The ALJ
discounted Ingalls’s opinion about Schaaf missing work
because he found that Ingalls did not explain his opinion
and his treatment notes do not clarify the doctor’s rea-
soning. Although Schaaf insists that Ingalls’s opinion is
supported by substantial evidence in the record, we cannot
find any “medically acceptable clinical and laboratory
diagnostic techniques” documenting the symptoms that
supposedly would prevent Schaaf from working. See
12 No. 09-2820
20 C.F.R. § 404.1527(d)(2). In Schaaf’s best attempt to
identify objective evidence supporting Ingalls’s opinion,
he states that his own complaints provide the necessary
basis. But subjective complaints are the opposite of ob-
jective medical evidence and, while relevant, do not
compel the ALJ to accept Ingalls’s assessment. See Rice v.
Barnhart, 384 F.3d 363, 370-71 (7th Cir. 2004). Ultimately,
though, the ALJ rejected that part of Ingalls’s report for
the same reasons he rejected Schaaf’s testimony about
his symptoms: it is inconsistent with substantial
evidence in the record.
To combat the ALJ’s credibility finding, Schaaf argues
that the ALJ improperly discredited his testimony and
failed to develop a full and fair record about his pain
symptoms. We review an ALJ’s credibility determination
deferentially and uphold it unless it is patently wrong.
Simila v. Astrue, 573 F.3d 503, 517 (7th Cir. 2009). We look
to whether the ALJ’s reasons for discrediting testimony
are unreasonable or unsupported. Sims v. Barnhart, 442
F.3d 536, 538 (7th Cir. 2006).
Schaaf insists that the ALJ should have questioned
him to clear up any confusion surrounding the incon-
sistencies between his testimony and written statements.
This failure, Schaaf argues, deprived him of a full and
fair record, which the ALJ had an obligation to develop.
But this contention requires little discussion. Regardless
of any potential duty an ALJ may have to question a
claimant who is represented by counsel, see Skinner v.
Astrue, 478 F.3d 836, 842 (7th Cir. 2007); Glenn v. Sec’y of
Health & Human Servs., 814 F.2d 387, 391 (7th Cir. 1987),
No. 09-2820 13
Schaaf cannot prevail in this court unless he can show that
he was prejudiced by the ALJ’s failure to elicit more
testimony, Nelms v. Astrue, 553 F.3d 1093, 1098 (7th Cir.
2009). And Schaaf offers no hint of what further
evidence the ALJ would have elicited and thus has not
shown prejudice.
Schaaf next asserts that it is “pure conjecture” for the
ALJ to doubt that Schaaf suffers from a constant pain
level of 10 out of 10 just because his physicians noted
that he was in “no apparent distress” during appoint-
ments. Schaaf posits that, despite the excruciating pain,
he is still able to maintain his composure or else relies
on pain medication to “calm[] him enough to function.”
But the ALJ was entitled to infer that Schaaf would have
told his doctors if he was experiencing excruciating pain.
The record shows that Schaaf’s assessment of his level
of pain during doctor appointments rarely rose above
a 7 and that both times he complained of pain to
Dr. Ingalls, he had been out of Percocet. After these two
complaints, Schaaf received monthly refills of Percocet
and did not see Ingalls about pain in the year preceding
his November 2007 evaluation. Notably, this is not a
case where the ALJ ignored a claimant’s extensive
history of seeking pain-relief treatments. Cf. Parker v.
Astrue, 597 F.3d 920, 921-22 (7th Cir. 2010) (detailing
claimant’s history of pain treatments, including variety
of strong drugs and surgical procedures); Carradine v.
Barnhart, 360 F.3d 751, 755 (7th Cir. 2004) (same). Instead,
the absence of a history of seeking pain treatment
despite other doctor visits suggests that Schaaf’s current
14 No. 09-2820
treatment was effective. See Sienkiewicz v. Barnhart, 409
F.3d 798, 804 (7th Cir. 2005).
Schaaf contends, however, that the ALJ inadequately
factored his medication into the analysis, ignoring both
the amount of drugs he takes and their side effects. But
we find that the record does not support the conclu-
sions that Schaaf asks us to draw. As to the amount of
medication, although it is clear that Schaaf has been on
Percocet since the surgery, he has never testified in oral
or written form about how many he takes a day. The
record shows that Schaaf receives 90 pills about once a
month, which averages to 3 a day. And he told Dr. Ingalls
at the November 2007 visit that he usually takes 3 at once
before bed, which maybe suggests that he uses them
to sleep but also suggests that he gets by without them
during the day. Without more evidence, it would be
speculation to assume that 3 pills a day evinces ex-
treme pain, especially since the maximum daily dosage
recommended by Ingalls is 6 pills—1 pill every 4 hours
as needed for pain.
Regarding side effects, Schaaf argues that his claims
of drowsiness, fatigue, and lack of concentration “have
ample support in the record.” But our review of the
record turns up nothing regarding side effects except
for Schaaf’s complaint in his 2006 amended disability
application of “restlessness, dry mouth, [and] drowsiness”
from Percocet. (The initial 2005 application listed no
side effects.) Nor does the record contain information
about common side effects of Percocet, and it would again
be speculation to assume that Schaaf automatically
No. 09-2820 15
suffers from those side effects. Furthermore, there is no
indication in the record that Schaaf complained of side
effects to his doctors or inquired into changing pain
medication until, perhaps, November 2007. Addi-
tionally, as the ALJ points out, Ingalls’s treatment notes
indicate that Schaaf denied memory loss, confusion, lack
of concentration, and inability to cope with daily
stresses. Accordingly, the ALJ did not err in concluding
that there was no evidence that any side effects from
medications would prevent Schaaf from working.
III. C ONCLUSION
Therefore, we A FFIRM the denial of benefits.
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