Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-15-03220/USCOURTS-ca7-15-03220-0/pdf.json

Parties Involved:
Carolyn W. Colvin
Appellee
Erik S. Israel
Appellant

Document Text:

In the

United States Court of Appeals

For the Seventh Circuit

No. 15‐3220

ERIK S. ISRAEL,

Plaintiff‐Appellant,

v.

CAROLYN W. COLVIN, Acting

Commissioner of Social Security,

Defendant‐Appellee.

Appeal from the United States District Court for the

Eastern District of Wisconsin.

No. 2:14‐cv‐01155‐WED — William E. Duffin, Magistrate Judge.

ARGUED SEPTEMBER 8, 2016 — DECIDED OCTOBER 21, 2016

Before FLAUM, ROVNER, and SYKES, Circuit Judges.

ROVNER, Circuit Judge.    Erik Israel applied for Social

Security disability benefits in 2007, and diligently pursued his

claim through administrative review. After many years of

review, error and delay, the Acting Commissioner of the Social

Security Administration (hereafter “Commissioner” or

“Agency”)issueda finaldecisiondenying his claim.Israelfiled

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19
2 No. 15‐3220

suit in the district court to challenge that decision. The Com‐

missioner conceded in the district court that her decision was

not supported by substantial evidence and requested remand

to conduct additionalproceedings.Israel,frustrated with years

of delay, sought a direct award of benefits. The district court

remanded the case to the Agency for additional proceedings

because the record, as it stands, does not compel a finding of

disability. Israel v. Colvin, No. 14‐CV‐1155, slip op. at 6‐7

(E.D. Wisc. Aug. 28, 2015). Because the district court did not

abuse its discretion in ordering a remand, we affirm. On

remand, the Agency should expedite proceedings so that the

matter may be resolved once and for all.

I.

In 2001, Israel injured his back while digging posts for a

porch. He continued to work while receiving various treat‐

ments but his pain worsened and he stopped working in

February 2003. Later that year, he underwent a lumbar

laminectomy and diskectomy.1 The surgery did notresolve his

pain and two surgeons determined that further surgery was

1

  A laminectomy is a surgical procedure to remove the lamina, a part of the

bone that makes up a vertebra in the spine, in order to take pressure off of

spinal nerves or the spinal cord. https://medlineplus.gov/

ency/article/007389.htm (last visited October 11, 2016). Diskectomy is

surgery to remove all or part of a disk, the cushion that helps support part

of the spinal column and separate vertebrae. https://medlineplus.gov/

ency/article/007250.htm. All websites referenced in this opinion were last

visited October 11, 2016. Throughout the record, different sources uses

different spellings for the cushion separating vertebrae, some adopting

“disk” and others “disc.” We will use “disk” unless we are quoting a source

that uses the alternate spelling.

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19
No. 15‐3220 3

not an option. Under the care of various doctors and special‐

ists, Israel tried physical therapy, transcutaneous electrical

nerve stimulation (also called “TENS”),2 a dorsal column

stimulator,3 epidural injections,4 narcotic pain medications

includingMethadone andmorphine,lidocainepatches to block

nerves from sending pain signals, a muscle relaxer, an anti‐

depressant known to help with chronic pain, and drugs used

for nerve pain. Israel, who has been diagnosed with lumbar

radiculopathy5 and post‐laminectomy pain syndrome (also

calledFailedBack Surgery Syndrome), continues to experience

severely limiting pain despite these treatments. His doctor

sought approval from his insurance company to implement an

“intrathecal drug delivery system,” a pain pump that delivers

2

  A TENS unit is a small box placed over the painful area that sends mild

electrical pulses to nerves. See http://www.niams.nih.gov/

Health_Info/Back_Pain/back_pain_ff.asp.

3

   A dorsal column stimulator is a surgically implanted device used to

relieve pain by supplying a mild electric current to block nerve impulses in

the spine. See https://medlineplus.gov/ency/article/007560.htm.

4

    Epidural injections for back pain typically involve the delivery of a

steroid, a powerful anti‐inflammatory medicine, directly into the space

outside of the sac of fluid around the spinal cord.

https://medlineplus.gov/ency/article/007485.htm.

5

    “Radiculopathy is a condition caused by compression, inflammation

and/or injury to a spinal nerve root. Pressure on the nerve root results in

pain, numbness, or a tingling sensation that travels or radiates to other

areas of the body that are served by that nerve. Radiculopathy may occur

when spinal stenosis or a herniated or ruptured disc compresses the nerve

root.” http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm.

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19
4 No. 15‐3220

medication directly to the spinal cord. Despite repeated

requests, however,Israel’s insurer has refused to coverthe cost

of the device. According to Israel, he spends much of his day

trying to manage his pain by elevating his legs in bed. He has

undergone four hernia repair surgeries because he uses

abdominal muscles to compensate for his back problems. At

times, he suffers debilitating side‐effects from the many

medications he takes in an attempt to control his pain, includ‐

ing memory andconcentrationproblems,fatigue andswelling.

Israel filed applications for Disability Insurance Benefits

and Supplemental Security Income benefits on October 30,

2007. His first hearing before an administrative law judge

(“ALJ”)resulted in a denial of his claims in February 2010. The

Appeals Council vacated that ruling because it was not

supported by substantial evidence. The Appeals Council

directedtheALJ onremandto further evaluate Israel’s residual

functional capacity because the medical evidence was not

consistent with the ALJ’s finding that Israel could perform

light work. The Council also directed the ALJ to further

consider Israel’s credibility because the reasons given for

discrediting Israel’s allegations of pain were contradicted by

the record.TheALJ was furtherinstructed to update the record

with any new medical evidence; give further consideration to

the opinions of Israel’s treating doctor, nurse practitioner and

examining occupationaltherapist;reevaluate Israel’s subjective

claims of pain; obtain expert medical opinion preferably from

a pain management specialist; reconsider Israel’s residual

functional capacity; and obtain supplemental evidence from a

vocational expert.

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No. 15‐3220 5

The same ALJ conducted a second hearing and again

rejected Israel’s claim in July 2011. The Appeals Council again

vacated the decision and remanded for further proceedings,

this time finding an error of law. Apparently, the ALJ held a

video hearing at which she ordered the claimant to attend a

post‐hearing consultative medical examination. A little more

than two weeks later, before Israel could attend the scheduled

exam, the ALJ rejected his claim. Israel nevertheless kept the

appointment and the next month, the ALJ issued an amended

decision discussing the new consultative exam report and

again rejecting Israel’s claim. But there was no evidence that

Israel had received the report or that he had waived his right

to see it. Nor was there evidence that the ALJ provided the

amended decision to Israel. On remand, the Appeals Council

directed that the matter be assigned to a different ALJ; that the

new ALJ profferthe consultative exam report to Israel; that the

ALJ obtain additional evidence concerning Israel’s impair‐

ments; that the ALJreevaluate Israel’s subjective complaints of

pain;thattheALJ give further consideration to Israel’s residual

functional capacity; and that the ALJ again obtain evidence

from a vocational expert to clarify the effect of Israel’s assessed

limitations on the occupational base.

A new ALJ held a third hearing and denied Israel’s claim in

April 2014. This time, the Appeals Council denied the request

for review, and Israel filed this suit. In his brief in support of

reversing the decision of the Commissioner, Israel sought a

reversal without remand and an award of benefits. In the

alternative, he requested that the court reverse the decision of

the Commissioner and remand for a new hearing. In response,

the Commissioner conceded that the decision was not sup‐

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6 No. 15‐3220

ported by substantial evidence, and moved for remand in

orderto gather more evidence andconduct additionalproceed‐

ings. The Commissioner contended that, although Israel

produced evidence supporting his claim of disability, other

evidence in the record could be construed to undermine his

claim of disabling limitations. At that point, Israel opposed a

remand, instead seeking an immediate award of benefits. The

district court concluded that, because the record did not

compel a finding that Israel is disabled, the case should be

remandedto theAgency forfurtherproceedings.Israel, slipop.

at 6‐7.

The district court noted that there is ample evidence

supporting Israel’s claim that he is disabled, including the

opinions of his treating physician Dr. Donald Harvey (a pain

specialist) and his treating physician assistant, Ms. Dawn

Nehls. Id. at 3‐4. They opined that Israel could sit continuously

for only one hour at a time and for a total of less than two

hours in an eight‐hour work day; that he could stand continu‐

ously for only fifteen minutes and could stand or walk for a

total of less than two hours in a work day; that he could

occasionally lift ten pounds or less and could never lift twenty

pounds or more; that he would need to lie down for one to two

hours during the work day in orderto relieve pain and fatigue;

that he needs to be able to shift positions at will; that he

requires a cane; that he is not at all able to bend or twist at the

waist; that he experiences constant interference with attention

and concentration due to pain; that he is extremely limited in

his ability to deal with the normal stresses of competitive

employment; and that he would be absent from work more

than three days per month. Their opinions were consistent

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No. 15‐3220 7

with that of an examining occupational therapist, Mr.

Bergthold, and a vocational expert opined that these limita‐

tions would preclude full‐time employment.6

But the court noted that the evidence was not entirely one‐

sided. Two non‐examining physicians, Pat Chan, M.D. and

Laura Rosch, D.O., reviewed the record and concluded that

Israel could frequently lift ten pounds, sit for six hours in an

eight‐hour work day, and stand or walk for six hours in an

eight hour work day, which would enable him to perform

sedentary workunder Social Security standards.The court also

noted two MRI reports, from 2007 and 2010, that the court

characterized as “inconsistent with Israel’s disability claim”

“on their face.” Israel, slip op. at 5. The court acknowledged

thatthe opinions ofthe non‐treating physicians couldnot alone

justify summarily rejecting the opinions of the treating physi‐

cian,physicianassistant andexamining occupationaltherapist.

Because the record contained medical evidence that supported

a finding of disability and also included evidence that sup‐

ported a contrary finding, the court was persuaded that

remand was necessary to resolve the claim. Israel appeals.

II.

The district court entered the remand order under its

statutory authority “to enter,upon the pleadings andtranscript

of the record, a judgment affirming, modifying, or reversing

6

  In its Decision and Order, the district court condensed the opinions of Dr.

Harvey and Ms. Nehls. We include a more complete outline of the medical

source opinions, which can be found at pages 589‐97 of the Administrative

Record (hereafter “A.R.”).

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8 No. 15‐3220

the decision of the Commissioner of Social Security, with or

without remanding the cause for a rehearing.” 42 U.S.C.

§ 405(g). Our review at this stage is very limited. “When the

district courtremands a case to the Social Security Administra‐

tion for further proceedings, but declines to instruct the

Commissioner to calculate and award benefits, we review the

latter decision only for an abuse of discretion.” Allord v. Astrue,

631 F.3d 411, 415‐16 (7th Cir. 2011); Nelson v. Apfel, 210 F.3d

799, 801‐02 (7th Cir. 2000). We will affirm the district court’s

judgment unless no reasonable person could agree with the

decision. Allord, 631 F.3d at 416.

Israel contends that the court abused its discretion in

ordering the remand for a fourth administrative hearing rather

than awarding benefits outright. He argues that the record

contains ample evidence supporting a finding of disability and

no evidence that provides a reasonable basis to discredit that

conclusion. Israel maintains that the opinions of two non‐

treating physicians cannot overcome the well‐documented

opinions of his treating health care providers. Nor can an MRI

alone discredit his subjective claim of disabling pain because

objective medical tests such as x‐rays and MRIs cannot

establish the intensity of a person’s pain, he contends. The

Commissioner responds that the opinions of the non‐treating

physicians in combination with the MRI results, physical

examination results and the opinion of a consulting physician,

Dr. Ayaz Samadani, could warrant discounting the opinions of

the treating physician and other providers, and that there are

factual issues that must be resolved. Because the record

evidence ismixed,the Commissioner contends thatremandfor

further proceedings was a reasonable decision.

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No. 15‐3220 9

Israel is correct that a “treating physicianʹs opinion regard‐

ing the nature and severity of a medical condition is entitled to

controlling weight if it is well supported by medical findings

and not inconsistent with other substantial evidence in the

record.” Gudgel v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003). See

also Moore v. Colvin, 743 F.3d 1118, 1127 (7th Cir. 2014) (regula‐

tions require that the ALJ give the opinions of a treating

physician controlling weight as long as they are supported by

medical findings and consistent with substantial evidence in

the record); Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011)

(same). We give more weight to the opinions of treating

physicians because they are most familiar with the claimant’s

conditions and circumstances. Gudgel, 345 F.3d at 470. An ALJ

must offer good reasons for discounting the opinion of a

treating physician. Moore, 743 F.3d at 1127. See also Gudgel,

345 F.3d at 470 (an ALJ can reject an examining physicianʹs

opinion only for reasons supported by substantial evidence in

the record). A contradictory opinion of a non‐examining

physician does not, by itself, suffice as a justification for

discounting the opinion of the treating physician. Gudgel,

345 F.3d at 470. See also Beardsley v. Colvin, 758 F.3d 834, 839

(7th Cir. 2014) (an ALJ must provide a valid explanation for

preferring a record reviewerʹs analysis over that of an examin‐

ing doctor).

In the district court, the Commissioner conceded that the

ALJ failed to adequately evaluate the opinion from the treating

source, Dr. Harvey, a pain specialist, and his physician

assistant, Ms. Nehls. The Commissioner further admitted that

the reasons given by the ALJ for assigning little weight to the

opinions of Dr. Harvey and Ms. Nehls were “insufficient,” and

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10 No. 15‐3220

that the ALJ had also failed to adequately evaluate the opinion

of the examining occupational therapist, Mr. Bergthold, whose

assessment was consistent with the opinions of the treating

providers.The Commissioner also agreedbelow andagrees on

appeal that the opinions of Dr. Harvey, Ms. Nehls and Mr.

Bergthold support a finding of disability. But the Commis‐

sioner nonetheless contends that the opinions of other medical

sourcesprovide evidence that wouldsupport a contrary result.

Given that the Agency has conceded that Israel has pro‐

duced substantial evidence of disability, we turn to the

evidence that the Commissioner asserts could undermine that

conclusion. The Commissionerrelies in part on the opinions of

the non‐treating physicians, Drs. Chen and Rosch, as well as

the opinion of the consultative examining physician, Dr.

Samadani. The ALJ did not mention or rely upon the opinions

of Drs. Chen and Rosch, and the Commissioner does not

explain why these opinions are entitled to any weight let alone

more weight than that of the treating physician. See Gudgel,

345 F.3d at 470; Beardsley, 758 F.3d at 839. Moreover, we note

that Israel’s treating physician is a specialist in the area of pain

management, and the non‐examining opinions came from

internists with no special training or expertise as to pain. Social

Security regulations specify that particular weight be given to

the opinions of specialists related to their areas of expertise.

20 C.F.R. § 416.927(c)(5) (“We generally give more weight to

the opinion of a specialist about medical issues related to his or

her area of specialty than to the opinion of a source who is not

a specialist.”). That is not to say that an ALJ could not give any

weight to the opinions of the non‐treating physicians; to date,

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No. 15‐3220 11

however, the ALJ has not explained the value of the non‐

treating physician opinions, if any.

Although Drs. Chen and Rosch concluded that Israel was

capable of performing light work,7 Dr. Samadani did not offer

a definitive opinion on Israel’s ability to work. Instead, Dr.

Samadani opined that Israel suffered from post‐laminectomy

lower back pain and left lumbar radiculopathy, diagnoses

consistent with the opinions of his treating providers. In a

paragraph titled “Ability to Perform Work Functions,” Dr.

Samadani said only that Israel has “subjective limitations as

described,” but was able to “sit, stand, walk, handle objects,

see, hear, speak, and travel. He required help in ambulation.

He was walking with the cane. He was slow in his walking

pace and complained of constant pain in the lower back.”

A.R. at 656. As for the “subjective limitations,” Dr. Samadani

noted earlier in his report that Israel complained of constant

pain that is between 8 and 9 on a 0‐to‐10 scale; that he had

reported that all of his activities are restricted by his pain; that

he cannot drive a car and needs help putting on his shoes and

dressing; that his gait and station were stable but he was

“uncertain to convertregular walking to tandem walk;” that he

leaned to the side and was afraid of falling due to his lower

back pain; and that bending down or lifting his legs when

sitting or lying down caused pain in his lower back. A.R. at

654‐55. Consistent with Dr. Samadani’s report, the ALJ who

7

  The third ALJ found that Israel’s condition had declined after the agency

doctor opined that he could perform light work. The ALJ determined that

Israel was “further deconditioned to the point he would now be limited to

sedentary types of activity.” A.R. at 26.

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12 No. 15‐3220

conducted the third hearing observed that Israel “appeared

overweight and seriously deconditioned, relied heavily on a

cane to ambulate, and alternated between sitting and standing

during the proceedings.” A.R. at 25.

The Commissioner argues on appeal that Dr. Samadani’s

opinion could be read to support a finding that Israel is not

disabled because the report implies that only Israel’s ability to

walk is impaired. Regulations require consulting doctors to

report what an individual can do despite his or her impair‐

ments, the Commissioner asserts, and so Dr. Samadani

arguably would have reported additional functional limita‐

tions if he determined that Israel had them. We first note that

the district court did not rely on Dr. Samadani’s opinion in

ordering a remand, and it would be difficult to judge whether

the court abused its discretion based on evidence that the court

admittedlydidnot consider. Nevertheless,the Commissioner’s

reading of Dr. Samadani’s opinion is quite a stretch when

reading the report as a whole. First, Dr. Samadani acknowl‐

edged but did not fully list “subjective limitations as de‐

scribed,” so we may equally assume that Israel has functional

limitations not expressly included in the report. Second, the

Commissioner largely relies on the absence of information in

Dr. Samadani’s report to establish facts, when the regulations

do notrequire that a consulting physician report all limitations

to the ALJ. See Thomas v. Colvin, 745 F.3d 802, 808 (7th Cir.

2014) (ultimate responsibility for determining a claimant’s

residual functional capacity rests on the ALJ and not on an

examining doctor). Moreover, nothing in Dr. Samadani’s

report is inconsistent with the opinions of Dr. Harvey and Ms.

Nehls. And finally, Dr. Samadani’s report fails to gauge the

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No. 15‐3220 13

duration or frequency of Israel’s limitations or abilities,

rendering his opinion too vague and incomplete to be of much

use in assessing Israel’s overall limitations.

The ALJ who denied Israel’s claim after the third hearing

discounted the opinions of Dr. Harvey and Ms. Nehls because

theirfunctional assessment ofIsrael “clearly overstatedoverall

limitations.” A.R. at 25. As an example of the overstatement,

the ALJ cited what he characterized as a claim in the assess‐

ment that Israel has “little to no use of his hands/fingers,” a

finding that the ALJ asserted was unsupported in the record.

A.R. at 25. But the ALJ had misread the functional assessment:

Dr. Harvey and Ms. Nehls had said the exact opposite of this,

indicating instead that Israel had full use of his hands and

fingers. The assessment asked whether the patient had

“significant limitations in the ability to use hands and fingers

for actions in a competitive job.” A.R. at 597. Ms. Nehls (joined

by Dr. Harvey) checked the “no” box eight times, for “grasp,

twist,” “turn objects,” “fine manipulation,” and “reaching,

including overhead,” for both right and left hands. A.R. at 597.

Those responses indicated no significant limitations in those

areas. But the ALJ’s misreading of the response caused him to

believe thatMs. Nehls andDr. Harvey hadexaggeratedIsrael’s

limitations. Perhaps that is why the Commissioner agreed in

the district court that the reasons given to discount the opin‐

ions of the treating providers were “insufficient,” an under‐

statement given the nature of the error.

The Commissioner also maintains that the MRI results in

combination with the opinions of the non‐treating internists

could support a finding that Israel is not disabled, if the

opinions of non‐treating physicians are insufficient by them‐

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14 No. 15‐3220

selves to overcome the well‐supported opinion of the treating

doctor. So we turn to the MRI reports. Without citing any

medical opinion to this effect, the district court characterized

the 2007 and 2010 MRIs as inconsistent on their face with

Israel’s claim of disability. There is always a danger when

lawyers and judges attempt to interpret medical reports and

that peril is laid bare here. See Browning v. Colvin, 766 F.3d 702,

705 (7th Cir. 2014) (noting that administrative law judges are

not permitted to “play doctor”). In noting the so‐called

inconsistency, the district court cited a 2010 letter from Israel’s

lawyer as characterizing his primary impairment as “degener‐

ative disc disease, particularly at L4‐S1 vertebrate, and her‐

nias.” Israel, slip op. at 5. The letter cited actually says that

Israel “alleges disability due to degenerative disc disease with

degenerative changes at L5‐S1, status post diskectomy,

laminectomy, and fusion; L4‐5 disc bulging; and history of

repair of multiple herniadefects.”A.R. at 449.8 First,thedistrict

courtincorrectlynotedthe locationofthe claimeddegenerative

disk changes. Second, at the risk of making the same mistake

thedistrict court made,the 2007MRIreport appears consistent,

at least in part, with Israel’s claims:

There are degenerative endplate changes noted at

L5‐S1, this is the level of prior left hemilamin‐

ectomy/diskectomy. Degenerative disk disease is

present at this level but there is only mild broad‐

based disk bulging and probable mild scar tis‐

sue/fibrosis creating very minimal mass effect/

8

  Israel’s lawyer later clarified at the hearing that Israel had undergone a

laminectomy and diskectomy but not a fusion procedure.

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19
No. 15‐3220 15

stenosis. The left S1 nerve root remains mildly

enlarged with a probable mild element of stenosis.

A.R. at 520. As for L4‐5, the 2007 MRI reports a “very mild

element of broad‐based disk bulging” that haddecreasedsince

a 2005 MRI, “a minor element of ligamentum flavum thicken‐

ing and mild posterior facet sclerosis,” as well as “minimal

overall spinal stenosis,” and “no major neural foraminal

narrowing.” A.R. at 519. The 2007 MRI seemingly supports

Israel’s claim of degenerative disk disease. Similarly, the 2010

MRI notes “[s]table minimal broad‐baseddisk bulging” atL4‐5

“with associated minimal facet osteoarthritis and ligamentum

flavum hypertrophy.” A.R. at 651. At L5‐S1, the 2010 report

indicated, “[m]ild stable broad‐based disk bulging and

endplate marrow signal change ... with stable post‐operative

changes of a left L5 laminectomy. Findings result in minimal

effacement of the anterior thecal sac. There is stable minimal

bilateral neural foraminal narrowing.” A.R. at 651. Because no

physician in the record has opined on whetherthese results are

consistent with Israel’s claimofdisablingpain, andbecause the

reports are replete with technical language that does not lend

itself to summary conclusions, we cannot say whether the

results support or undermine Israel’s claim. Israel’s treating

physician was aware of these results and apparently did not

find them inconsistent with Israel’s subjective report of

disabling pain. On remand, these records should be reviewed

by a physician to determine whetherthey are in fact consistent

with Israel’s claim of disability.

But even if a physician determines that the MRIs do not

support a subjective claim of pain, we have repeatedly stated

that “an individualʹs statements about the intensity and

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16 No. 15‐3220

persistence of pain or other symptoms or about the effect the

symptoms have on his or her ability to work may not be

disregarded solely because they are not substantiated by

objective medical evidence.” Cole v. Colvin, 831 F.3d 411, 416

(7th Cir. 2016) (quoting Hall v. Colvin, 778 F.3d 688, 691 (7th

Cir. 2015)); Adaire v. Colvin, 778 F.3d 685, 687 (7th Cir. 2015)

(noting the recurrent error in decisions of Social Security ALJs

of discounting pain testimony that canʹt be attributed to

“objective” injuries or illnesses that can be revealed by x‐rays,

and collecting cases). See also Moss v. Astrue, 555 F.3d 556, 561

(7th Cir. 2009) (an ALJ cannot disregard subjective complaints

of disabling pain just because a determinable basis for pain of

that intensity does not stand out in the medical record). “If the

medical record does not corroborate the level of pain reported

by the claimant, the ALJ must develop the record and seek

information about the severity of the pain and its effects on the

applicant.” Moss, 555 F.3d at 561. And the district court itself,

after first claiming the MRI reports to be inconsistent with

Israel’s claim, noted that a medical source’s opinion was

required “to assess the extent, if any, to which this medical

evidence is inconsistent with the alleged disability.” Israel, slip

op. at 6. The Commissioner cites no such opinion, despite the

repeated orders of the Appeals Council that the reviewing ALJ

should seek additional medical evidence to clarify the nature

and severity of Israel’s impairments.

So the opinions of the non‐treating generalists may not

generally overcome those of the treating specialist unless the

specialist’s opinions are inconsistent with substantial record

evidence. And the MRIs alone are insufficient to allow an ALJ

to discount the claimant’s subjective claim of disabling pain,

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No. 15‐3220 17

especially because the MRIs have not been characterized by

any medical source as inconsistent with Israel’s claim of

disabling pain. Dr. Samadani’s opinion adds little to the

calculus because he failed to take a definitive stance on the key

issue of Israel’s abilities to perform tasks essential to work and

to his capacity to persist in those tasks in a manner that would

allow him to hold full‐time employment.

Israel has a lengthy medical history that begins with a

specific injury, continues through a failed surgery resulting in

a diagnosis consistent with persistent pain (a diagnosis

affirmed by Dr. Samadani, the State’s own doctor), and

proceeds through a lengthy series of failed attempts to control

Israel’s pain. Israel has undergone painful and risky proce‐

dures in attempts to alleviate his pain, actions that would seem

to support the credibility of his claims regarding the severity

of his pain. See Carradine v. Barnhart, 360 F.3d 751, 755 (7th Cir.

2004) (noting the improbability that a claimant would have

undergone extensive pain‐treatment procedures that included

not only heavy doses of strong drugs but also the surgical

implantation in her spine of a spinal‐cord stimulator, “merely

in order to strengthen the credibility of her complaints of pain

and so increase her chances of obtaining disability benefits”).

Yet the last ALJ to assess his claims found him “not entirely

credible,” “somewhat credible,” and “partially credible,”

vague findings based largely on documented misunderstand‐

ings of the record. See Moss, 555 F.3d at 561 (we will uphold an

ALJʹs credibility determination if the ALJ gave specific reasons

for the finding that are supported by substantial evidence).

Although Israel presents a strong claim for an award of

benefits, we cannot say that the district court abused its

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18 No. 15‐3220

discretion in remanding. The ALJ failed to gatherthe evidence

to make the findings necessary to resolve the ultimate question

of whether Israel’s pain disables him from working. Israel has

presented substantial evidence which can be read in favor of

an award of benefits, but the record also includes some

evidence that could be read to undermine his claim, including

the opinions of two non‐treating internists, MRI results that

have yet to be interpreted by a competent medical source, the

incomplete opinion of a Statedoctor, andphysical examination

findings over the years that present an unclear picture of the

effectiveness of various treatments for his persistent pain.

Because of these uncertainties in the record, we must conclude

that the district court did not abuse its discretion in remanding

for a fourth hearing.

Israel’s patience has understandably grown thin. We agree

that it should not take nine years to determine whether a

claimant’s impairments prevent him from engaging in full‐

time employment, especially a claimant who appears to have

a well‐documented and well‐supported claim for disability.

Israel believes he is entitled to a directed award of benefits at

this stage, citing Wilder v. Apfel, 153 F.3d 799 (7th Cir. 1998). But

the record in this case is not as severely lopsided as it was in

Wilder, and we do not perceive the same level of obduracy on

the part of the Agency. See Briscoe ex rel. Taylor v. Barnhart,

425 F.3d 345, 356 (7th Cir. 2005) (“Another remand for further

proceedings was unnecessary in Wilder because after two

evidentiary hearings, the ALJ had no reasonable grounds to

reject the claimantʹs claim.”). “It remains true that an award of

benefits is appropriate only if all factual issues have been

resolved and the record supports a finding of disability.”

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19
No. 15‐3220 19

Briscoe, 425 F.3d at 356. If the case returns to this court with the

Agency seeking a fifth hearing, our analysis may change. After

this remand, the Agency may not simply persist in pointing to

unexplainedMRIresults or non‐treating physician opinions as

undermining Israel’s claim. If the Agency again rejects Israel’s

claim, it must provide a logical basis, supported in the record,

to disregard the well‐founded opinions of Israel’s treating

physician, physician assistant, and the independent occupa‐

tional therapist, not to mention the extensive history of

procedures and treatments Israel has endured and his own

testimony regarding the severity of his pain. We strongly

encourage the Agency to expedite the proceedings in order to

resolve Israel’s claims once and for all.

AFFIRMED.

Case: 15-3220 Document: 37 Filed: 10/21/2016 Pages: 19