Jutta Spies v. Carolyn Colvin , 641 F. App'x 628 ( 2016 )


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  •                         NONPRECEDENTIAL DISPOSITION
    To be cited only in accordance with Fed. R. App. P. 32.1
    United States Court of Appeals
    For the Seventh Circuit
    Chicago, Illinois 60604
    Argued April 26, 2016
    Decided May 4, 2016
    Before
    MICHAEL S. KANNE, Circuit Judge
    DIANE S. SYKES, Circuit Judge
    DAVID F. HAMILTON, Circuit Judge
    No. 15-2578
    JUTTA SPIES,                                   Appeal from the United States District
    Plaintiff-Appellant,                      Court for the Western District of
    Wisconsin.
    v.
    No. 14-cv-568-jdp
    CAROLYN W. COLVIN,
    Acting Commissioner of Social Security,        James D. Peterson,
    Defendant-Appellee.                      Judge.
    ORDER
    Jutta Spies applied for Disability Insurance Benefits and Supplemental Security
    Income claiming that her diabetes and related neuropathy, osteoarthritis, rheumatoid
    arthritis, and headaches prevent her from working. An administrative law judge denied
    benefits, finding that Spies could perform light work with several limitations. In this
    court Spies challenges the ALJ’s adverse credibility finding and his refusal to give
    controlling weight to a treating physician’s opinion. Because the ALJ’s decision is
    supported by substantial evidence, we affirm the district court’s order upholding the
    denial of benefits.
    No. 15-2578                                                                         Page 2
    I. Background
    In 2012 at age 47, Spies applied for DIB and SSI, alleging onset in October 2008
    (later amended to October 2012) and claiming six impairments: diabetes; neuropathy in
    the feet and hands; osteoarthritis in the neck, shoulders, and arms; nerve damage in the
    neck, shoulders, and arms; rheumatoid arthritis in the lower back and knees; and
    headaches. She had applied for benefits previously in 2008, but in 2010 an ALJ had
    rejected that application. The Appeals Council upheld the denial. Afterward Spies
    initiated a challenge under 42 U.S.C. § 405(g), but later she dismissed the action
    voluntarily. Spies v. Astrue, No. 3:12-cv-00231-wmc (W.D. Wis. Aug. 31, 2012).
    Some of the evidence Spies submitted to support her current application predates
    the finding in 2010 that she was not disabled. For example, in 2009 a doctor had
    evaluated Spies after she complained of musculoskeletal pain. The doctor observed that
    Spies walked with her shoulders rounded forward and also held her head forward, but
    still he concluded that Spies’s shoulder motion was “full and pain free,” and that her
    neck motion was “nearly complete with pain-free end range” except for “rotation and
    side bending to the left.” The doctor identified trigger points in Spies’s trapezii and
    administered trigger-point injections. A back X-ray showed narrowing of disc spaces
    and some flattening of the spine, evidencing degenerative changes. Spies was prescribed
    physical therapy and gabapentin (an anticonvulsant sometimes given for nerve pain).
    A questionnaire completed in 2009 by internist Margaret Webster and a letter that
    she wrote in November 2010 are two other pieces of recycled evidence. Dr. Webster had
    first treated Spies in 2002, and in the questionnaire (completed for Spies’s former lawyer)
    she opined that Spies must elevate her feet with prolonged sitting, needed leeway to take
    unlimited breaks, and would miss more than two days of work per month. Dr. Webster
    added that she lacked information about Spies’s ability to lift weight and could not
    evaluate how long she could sit, stand, or walk continuously or in a work day. In the
    2010 letter (written in response to the same lawyer’s inquiry), Dr. Webster clarified that
    Spies experiences tingling and numbness in her legs and feet, and that elevating her feet
    would help prevent swelling. The breaks were needed, the doctor said, so that Spies
    could change position and lessen discomfort from “deconditioning” and pain in her
    upper back and neck.
    After the initial denial of benefits, Spies had continued seeing Dr. Webster for
    regular check-ups. Dr. Webster’s progress notes document treatment for Type II
    Diabetes, which was poorly controlled by Spies and prompted a referral to an
    endocrinologist. He commenced ongoing treatment in April 2011 prescribing and later
    No. 15-2578                                                                         Page 3
    adjusting the amount of insulin. During the initial consultation the endocrinologist
    noted that Spies had complained of numbness and burning in her hands and feet, which,
    he initially thought, might be partially attributable to degenerative disc disease. But a
    monofilament test (used to gauge the sensitivity of a patient’s extremities) was normal
    except for “decreased sensation at the right great toe.” The endocrinologist added, in
    commenting on Spies’s reports of diabetic peripheral neuropathy affecting her hands
    and feet, that her reported symptoms were “not particularly classic” for that impairment
    though it “could be making her other neurologic conditions worse.” A second
    monofilament test performed in September 2011 also led the endocrinologist to conclude
    that Spies’s sensation was intact. That month Spies returned to Dr. Webster for another
    regular check-up and reported continuing pain in her neck and back for which she was
    not taking medication.
    In May 2012, Spies submitted a “function report” to the Social Security
    Administration asserting that she can sit, stand, or walk only for 10 minutes at a time
    and that she must elevate her legs 75% of the time. During an entire day, Spies
    continued, she can sit at most for 8½ hours, stand for 4½ hours, and walk for 2½ hours.
    She reported difficulty lifting, bending, stooping, kneeling, and walking. Spies said that
    she cleans her house, though the task takes all day because of her need for frequent
    breaks, and she helps care for her grandson. She does laundry but cannot carry the
    clothes up or down stairs and cannot bend to vacuum. She added that she shops once a
    month for 4 to 5 hours.
    Another back X-ray in June 2012 showed mild degeneration, including some
    development of bone spurs around the thoracic and lumbar discs. That month Spies was
    examined by state-agency consulting osteopath Brian Allen and reported pain in her
    neck, shoulders, arms, back, and knees that she was treating with ibuprofen. Spies also
    reported that she could stand only for 10 minutes and walk only a block. The doctor
    found reduced range of motion in her shoulders, knees, and ankles, and swelling in her
    ankles. Spies had full strength and normal sensation in her extremities, and she could
    tandem walk, squat, and hop on each foot. The doctor concluded that her neck and back
    pain appeared to be originating from her muscles or the joints in her spine.
    The SSA initially denied benefits on June 25, 2012. Another state-agency
    consulting physician had reviewed the medical evidence and concluded that Spies could
    perform sedentary work not requiring overhead lifting. He opined that her medical
    records and daily activities suggested that Spies had exaggerated her self-reported
    functional limitations.
    No. 15-2578                                                                        Page 4
    Afterward, in July 2012 while her case was before the SSA on reconsideration,
    Spies was treated by a nurse practitioner. Spies reported intermittent pain in her neck,
    pain in her shoulders, and numbness in her hands and feet. The pain, she said, ranged
    from 3 to 9 on a 10-point scale. The nurse practitioner concluded that Spies had full
    flexion, extension, and lateral rotation in her neck though extension increased her pain.
    Her trapezii were very tight, and she was experiencing muscle spasms. Spies’s shoulder
    joints were tender, and she had pain with forward flexion, internal and external rotation,
    and thumbs up and thumbs down motions. She had full strength in her extremities but
    difficulty with tandem walking and slight swelling in her legs. Spies was prescribed an
    anti-inflammatory and muscle relaxant, and the nurse practitioner recommended a
    shoulder X-ray plus physical therapy for her neck and shoulders.
    Spies received a voucher for the physical therapy from St. Clare Health Mission,
    but after just two sessions she said that she would call if she needed further assistance.
    St. Clare also filled her prescriptions and arranged for the X-ray, which showed
    straightening of the spine and moderate enlargement along the vertebral endplates. At a
    cervical spine assessment in August 2012, Spies reported that for three months she had
    been in constant pain which hindered her daily activities. She reported that the
    anti-inflammatory had helped her pain, but she later stopped taking it and the muscle
    relaxant because they upset her stomach, instead occasionally taking ibuprofen.
    At her next appointment with Dr. Webster in September 2012, Spies again
    reported persistent back and shoulder pain that impeded her daily activities. Yet Spies
    was uninsured, so rather than treat her, Dr. Webster recommended that she continue the
    treatment she was receiving elsewhere.
    Spies then submitted another “function report” to the SSA asserting that she
    could sit, stand, or walk for only 10 minutes continuously, for a total of one hour each
    per day. With her daughter’s help she could bathe and dress, and once each month shop
    for 3 hours.
    Benefits were denied on reconsideration two months later, in March 2013. A
    different state-agency consultant, Dr. Mina Khorshidi, had concluded that Spies could
    perform light work with limited overhead lifting if she avoided hazards like machinery
    and heights. Like the previous consulting physician, she opined after reviewing the
    medical evidence and Spies’s daily activities that Spies was exaggerating her
    self-reported functional limitations.
    No. 15-2578                                                                         Page 5
    At current counsel’s request, Dr. Webster then wrote a “to whom it may concern”
    letter opining that Spies cannot perform competitive full-time work. For more than 75%
    of a typical workday, the doctor predicted, Spies’s “multiple medical conditions” would
    prevent her from performing job tasks. Those conditions, Dr. Webster added, had
    “progressed over time.” Dr. Webster apparently declined, however, to serve in the role
    of a consultative examiner.
    Spies appeared before an ALJ in November 2013. During the hearing she
    amended her alleged onset date to October 1, 2012. She testified that previously she had
    worked as a camera operator and preschool teacher, neither of which required much
    lifting. As a camera operator she alternated between sitting and standing, for about
    4 hours each in an average workday. She complained of constant pain in her neck and
    shoulders, headaches, swollen legs and ankles, random numbness in her hands and feet,
    and numbness in her arms so pronounced that several times a week she cannot lift them.
    She said that she could stand or walk for 5 minutes and sit for 10. She must alternate
    between sitting and standing, said Spies, and needed to elevate her feet 12 to 15 inches to
    prevent her ankles from swelling and her becoming stiff. Spies testified that her pain is
    progressively worsening.
    Spies lacked health insurance and testified that she relied upon financial
    assistance to see Dr. Webster. When asked by her lawyer if Dr. Webster would prefer to
    see her more than once a year, Spies simply replied that Dr. Webster performed her
    “yearly physical for diabetes,” and that she was to see the endocrinologist on a quarterly
    basis. Her attorney asked a series of questions about jobs that might have been available
    to Spies in October 2012, which prompted the ALJ to comment that Spies was answering
    counsel’s questions before he had completed them.
    A vocational expert also testified. The ALJ first asked if jobs classified as light
    work are available for a person who can occasionally stoop, crouch, kneel, and crawl;
    can occasionally climb stairs or ramps but not ladders, ropes or scaffolds; cannot be
    exposed to unprotected heights or large, open machinery; and is likely to be off task up
    to 10% of the day in addition to scheduled breaks. The VE replied that suitable
    employment is available, including Spies’s past jobs as a camera operator and preschool
    teacher, as well as jobs as an inspector or sorter, clerical cashier, and stock clerk. When
    questioned further, the VE said that the job of preschool teacher would be eliminated if
    the person also would need to sit or stand at will, but that a further restriction allowing
    for elevation of the person’s feet 75% percent of the day would not eliminate any more
    jobs. On the other hand, the VE acknowledged, all full-time employment would be
    No. 15-2578                                                                           Page 6
    precluded if the person would require unscheduled breaks at will or would be distracted
    to the extent of being off task for more than 10% of the day. Finally, the VE opined that a
    person restricted to sedentary work with the same functional limitations could be a
    production worker, information clerk, or general office clerk.
    The ALJ issued a written decision two months later finding Spies not disabled. At
    Step 1 of the 5-step analysis, see 20 C.F.R. §§ 404.1520(a), 416.920(a), the ALJ
    acknowledged that Spies had not engaged in substantial gainful activity since the
    amended onset date in October 2012. At Step 2 the ALJ identified Spies’s impairments
    (all of them severe) as peripheral neuropathy, osteoarthritis of the back and knees,
    cervical disc disease, and obesity. Excluded from this list was diabetes and rheumatoid
    arthritis. At Step 3 the ALJ concluded that the identified impairments, alone or in
    combination, did not meet a listing for presumptive disability. Spies does not dispute
    these conclusions.
    At Step 4 the ALJ partly rejected Spies’s account of disabling functional
    limitations. This adverse credibility assessment first recites boilerplate language
    rejecting as not credible Spies’s statements about the “intensity, persistence, and limiting
    effects” of her impairments. The ALJ then opined that Spies’s physical and neurological
    examinations had been “largely benign” and that X-rays had shown little beyond “mild
    degenerative changes.” He reasoned that the medical evidence contradicts Spies’s
    complaints of pain reaching 9 on a scale of 10. The ALJ accepted the view of the
    state-agency consultants that, given her daily activities and the medical evidence, Spies
    was exaggerating her limitations. Specifically, the ALJ noted, she purportedly could not
    stand or walk for more than 2 hours per day but had normal physical examinations and
    acknowledged cleaning her house, helping care for her grandson, and shopping for
    3 hours at a time. The ALJ added that during her testimony “it became evident” that
    Spies “had predetermined that her responses would be a claim of inability to perform
    any described task or activity.” Finally, he noted that Spies had said her condition was
    worsening, yet a recent cardiac stress test was favorable. Still, the ALJ included in Spies’s
    residual functional capacity that she would need to elevate her feet and switch at will
    between sitting and standing.
    The ALJ gave Dr. Webster’s opinions about Spies’s functional limitations only
    moderate weight, since the doctor had been seeing Spies typically once a year and her
    opinions were based on Spies’s self-reports instead of clinical evidence. Moreover, the
    ALJ noted, Dr. Webster had conceded in the 2009 questionnaire that she either lacked
    relevant information or could not evaluate Spies’s exertional limitations. The ALJ
    No. 15-2578                                                                            Page 7
    concluded that Dr. Webster’s views were “speculative and conclusory with regard to
    issues reserved for the Commissioner.”
    Finally, at Step 5 the ALJ found that Spies could perform her past work as a
    camera operator, as well as other available jobs.
    The Appeals Council denied review, making the ALJ’s pronouncement the final
    decision of the Commissioner. The district court upheld that decision.
    II. Analysis
    On appeal Spies first raises several challenges to the ALJ’s adverse credibility
    finding, but none shows that the credibility finding is patently wrong. See Minnick v.
    Colvin, 
    775 F.3d 929
    , 937 (7th Cir. 2015) (noting that ALJ’s credibility finding must be
    upheld unless patently wrong). Spies contends that the finding is flawed because, she
    says, it rests entirely on boilerplate frequently criticized by this court. But Spies must
    recognize her own hyperbole because, as even she acknowledges elsewhere in her brief,
    the ALJ went beyond the boilerplate and gave specific reasons for the adverse credibility
    finding. And the mere inclusion of boilerplate does not require a remand. See Loveless v.
    Colvin, 
    810 F.3d 502
    , 507–08 (7th Cir. 2016); Pepper v. Colvin, 
    712 F.3d 351
    , 367–68 (7th Cir.
    2013).
    Although greater detail would have been helpful, the ALJ touched on four
    reasons for disbelieving Spies. First, the ALJ reasoned that the medical evidence raises
    doubts about the degree of pain Spies reported because “her physical and neurological
    examinations are largely benign and x-rays show little more than mild degenerative
    changes.” Most of Spies’s attacks on the credibility finding seem to focus on this
    statement. She argues that the ALJ identified neuropathy as a severe impairment but
    then failed to acknowledge that it could have caused the pain she reported, which could
    not be confirmed by X-rays. Spies is correct that neuropathic pain need not be confirmed
    by diagnostic tests in order to be credited. See Engstrand v. Colvin, 
    788 F.3d 655
    , 660
    (7th Cir. 2015). But her contention is disingenuous: Spies complained of severe
    pain—pain that sometimes reached a 9 on a 10-point scale—in her neck and shoulders.
    She never claimed that neuropathy was causing pain in her neck or shoulders, only that
    it caused tingling, numbness, swelling, or burning in her extremities.
    Similarly, Spies argues that the ALJ could not minimize her accounts of pain
    simply because physical examinations and diagnostics provided only weak objective
    support. Spies and her doctors attributed her neck and shoulder pain to degenerative
    No. 15-2578                                                                            Page 8
    disc disease and osteoarthritis. Thus, this is not a situation where a claimant’s pain was
    from an undetermined source, making self-reports the only available evidence of
    severity. See, e.g., Adaire v. Colvin, 
    778 F.3d 685
    , 687 (7th Cir. 2015); Pierce v. Colvin,
    
    739 F.3d 1046
    , 1049–50 (7th Cir. 2014). And the ALJ did not disbelieve that Spies was
    experiencing pain, but only that the diagnosed impairments she and her doctors
    identified as the source of her pain were not severe enough to disable her to the extent
    alleged. See Mitze v. Colvin, 
    782 F.3d 879
    , 881 (7th Cir. 2015) (noting that ALJ had not
    denied that claimant was in pain but instead “didn’t believe that the pain was severe
    enough to disable her to the extent she claimed”).
    Spies also says that her own doctors believed and acted upon her reports of pain,
    and thus, she insists, the ALJ was “playing doctor” when he decided that the medical
    evidence undermines those self-reports. But all of the medical evidence Spies cites for
    this contention predates the amended onset date of October 2012, and most of it also
    predates the initial, unchallenged finding in 2010 that she was not disabled. What is
    missing from this record is evidence that Spies’s condition had deteriorated to the point
    of disability after 2010 because she cannot relitigate whether she was disabled before
    then. See Schmidt v. Astrue, 
    496 F.3d 833
    , 845 (7th Cir. 2007) (noting binding effect of
    previous, unchallenged finding that claimant was not disabled); Groves v. Apfel, 
    148 F.3d 809
    , 810–11 (7th Cir. 1998) (explaining that evidence from previous denial of benefits
    cannot by itself establish disability in later case but “still might reinforce or illuminate or
    fill gaps in the evidence developed for the second proceeding”). And the only recent
    treatment of Spies’s neck and shoulder pain was by the nurse practitioner and at
    St. Clare Health Mission. The nurse practitioner had prescribed a muscle relaxant and an
    anti-inflammatory, but Spies unilaterally discontinued both because of stomach upset
    without exploring alternatives. She likewise unilaterally stopped going to physical
    therapy at St. Clare after just two sessions. The record does not support Spies’s
    contention that her doctors acted on her complaints of pain in a way that corroborates
    her claims of its severity.
    Spies goes one step further and contends that her financial constraints obligated
    the ALJ not only to evaluate the resulting limitations on her medical treatment but also
    to order an MRI that could detect any soft tissue damage consistent with her allegations
    of disabling pain. Again, this contention is disingenuous. For one, the ALJ never faulted
    Spies for not pursuing additional treatment, so he did not need to inquire about her
    financial means. Cf. Craft v. Astrue, 
    539 F.3d 668
    , 679 (7th Cir. 2008). And on this record
    there is no reason to believe that Spies’s treatment would have been significantly
    different had she been insured. The medications she stopped using and the physical
    No. 15-2578                                                                            Page 9
    therapy she declined were being paid for by St. Clare. Moreover, at the hearing before
    the ALJ, Spies did not give her lawyer the answer he was looking for: that Dr. Webster
    would have liked to see her more than once a year. Most importantly, nowhere in Spies’s
    medical records is there mention of a need for an MRI. Spies, who was represented by
    present counsel, did not argue before the ALJ that an MRI should be ordered and did not
    highlight any potential soft-tissue damage that such a diagnostic might reveal.
    See Thomas v. Colvin, 
    745 F.3d 802
    , 807–08 (7th Cir. 2014) (noting that ALJ’s obligation to
    develop record is not limitless); Nelms v. Astrue, 
    553 F.3d 1093
    , 1098 (7th Cir. 2009)
    (explaining that even when ALJ has duty to expand record, speculation that additional
    evidence could have been obtained does not warrant remand); Skinner v. Astrue, 
    478 F.3d 836
    , 842 (7th Cir. 2007) (noting that counseled claimant is “presumed to have made his
    best case before the ALJ”).
    The ALJ’s second reason for disbelieving Spies is the disconnect between her
    medical evidence and daily activities, on the one hand, and her assertion that she cannot
    be on her feet for more than 2 hours total each day. Spies argues that the ALJ “did not
    even make an actual credibility finding, instead relying on the State Agency’s
    assessment of her daily activities.” Although the ALJ’s reference to Dr. Khorshidi’s
    opinion is perhaps poorly worded, the fair reading is that he incorporated the doctor’s
    reasoning. And that opinion was not, as Spies now insists, that her daily activities prove
    her capable of working full time. Instead, Dr. Khorshidi opined that Spies’s daily
    activities indicate exaggeration of her functional limitations. See 
    Loveless, 810 F.3d at 508
    (citing 20 C.F.R. § 404.1529(c)(3)(i)).
    The ALJ next discounted Spies’s credibility because he thought her testimony
    showed a predisposition to deny her ability to perform any task or activity posed to her.
    Spies tries to refute the ALJ’s conclusion by referring to seemingly random parts of her
    testimony, but Spies’s reading of the ALJ’s comment is unreasonable. The plausible
    reading is that the ALJ had observed Spies answering her lawyer’s questions about her
    ability to work even before the attorney had completed the questions. That the ALJ did
    not say this directly does not undermine his credibility finding. See Shideler v. Astrue, 
    688 F.3d 306
    , 312 (7th Cir. 2012) (noting that ALJ isn’t required to identify particular
    statements found not credible); Jens v. Barnhart, 
    347 F.3d 209
    , 213 (7th Cir. 2003) (rejecting
    claim that credibility finding was flawed because ALJ did not identify particular
    statements found not credible).
    Last, the ALJ discredited Spies because, he concluded, Spies had not submitted
    evidence substantiating her testimony that her condition had deteriorated significantly.
    No. 15-2578                                                                           Page 10
    The ALJ’s conclusion rests on Spies’s most-recent medical report, the results of a cardiac
    stress test. We do not understand the relevance of this report, since Spies’s alleged
    disability is unrelated to her cardiac health. But neither do we believe that this misstep
    by the ALJ undermines the credibility finding. See 
    Shideler, 688 F.3d at 312
    (upholding
    imperfect credibility determination); McKinzey v. Astrue, 
    641 F.3d 884
    , 890–91 (7th Cir.
    2011) (same). Although the ALJ does not cite this exchange, during the hearing he
    questioned Spies about the drastic difference in her reported ability to sit, stand, and
    walk between her first and second “function reports.” She initially reported being able to
    sit for 8½ hours, stand for 4½ hours, and walk for 2½ hours but then reduced each to
    1 hour. Spies has not pointed to anything that would explain this rapid deterioration. In
    this court, she asserts only that her receipt of steroid injections “during the relevant
    period” proves that her condition had deteriorated. But Spies grossly misrepresents the
    record: She received one round of trigger-point injections in 2009, before the earlier
    finding that she was not disabled. There is no other evidence of injections, much less
    steroid injections.
    Accordingly, Spies’s challenge to the ALJ’s credibility assessment is
    unpersuasive, and her remaining appellate claim is even weaker. Spies contends that the
    ALJ erred by not giving controlling weight to Dr. Webster’s views about her functional
    limitations. To start, both the 2009 questionnaire and Dr. Webster’s 2010 clarifying letter
    predate the earlier determination that Spies was not disabled, and Spies does not explain
    how they are significant to this case. Indeed, the first ALJ explicitly found these
    submissions from Dr. Webster to be unreliable. Regardless, the ALJ here discussed all of
    Dr. Webster’s opinions, and he provided good reasons for discounting them. See Schaaf
    v. Astrue, 
    602 F.3d 869
    , 874–75 (7th Cir. 2010) (noting that ALJ must give good reason for
    rejecting treating physician’s opinion that is supported by medical evidence and “not
    inconsistent” with substantial evidence in record). First, Spies typically saw Dr. Webster
    just once a year. See 20 C.F.R. § 404.1527(c)(2)(i) (explaining that SSA gives greater
    weight to treating source who has seen claimant on frequent basis); Filus v. Astrue, 
    694 F.3d 863
    , 868 (7th Cir. 2012) (acknowledging § 404.1527(c)(2)(i)). Spies now asserts that
    the infrequent contact was because of financial constraints, but she explicitly said the
    opposite at the hearing. In fact, she testified that she had been receiving financial
    assistance to pay for Dr. Webster’s treatment.
    What is more, Dr. Webster’s opinions were based on Spies’s subjective reports of
    pain instead of any clinical evidence. See Rice v. Barnhart, 
    384 F.3d 363
    , 371 (7th Cir. 2004);
    Smith v. Apfel, 
    231 F.3d 433
    , 441 (7th Cir. 2000). Dr. Webster’s progress notes document
    Spies’s reports of her symptoms and limitations, but the doctor never provided any
    No. 15-2578                                                                          Page 11
    relevant treatment. And, as the ALJ noted, Dr. Webster acknowledged that she had no
    data regarding the severity of Spies’s pain.
    And, finally, the ALJ concluded that Dr. Webster’s opinions were speculative and
    conclusory on issues that are reserved for the Commissioner. In the November 2013
    “to whom it may concern” letter, Dr. Webster asserted that Spies could not work. But
    that opinion is not a medical opinion, and thus it was entitled to no weight, even coming
    from a treating physician. See 20 C.F.R. § 404.1527(d)(1); 
    Loveless, 810 F.3d at 507
    ; Clifford
    v. Apfel, 
    227 F.3d 863
    , 870 (7th Cir. 2000).
    III. Conclusion
    We AFFIRM the district court’s judgment.