Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-14-02702/USCOURTS-ca7-14-02702-0/pdf.json

Parties Involved:
Carolyn W. Colvin
Appellee
Ronald Engstrand
Appellant

Document Text:

In the

United States Court of Appeals

For the Seventh Circuit ____________________

No. 14-2702

RONALD M. ENGSTRAND,

Plaintiff-Appellant,

v.

CAROLYN W. COLVIN,

Acting Commissioner of Social Security,

Defendant-Appellee.

____________________

Appeal from the United States District Court for the

Western District of Wisconsin.

No. 13-cv-436-bbc — Barbara B. Crabb, Judge.

____________________

ARGUED APRIL 28, 2015 — DECIDED JUNE 4, 2015

____________________

Before FLAUM, KANNE, and WILLIAMS, Circuit Judges.

FLAUM, Circuit Judge. Ronald Engstrand, a 52-year-old 

former dairy farmer, applied for Disability Insurance 

Benefits and Supplemental Security Insurance because of 

pain caused by his diabetic neuropathy and osteoarthritis. 

After a hearing, an administrative law judge (“ALJ”) concluded that Engstrand is not disabled. The ALJ reasoned that 

Engstrand’s account of his limitations is not credible and 

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that his treating physician is not entitled to deference. The 

Appeals Council denied review, and the district court upheld the ALJ’s decision. For the reasons set forth below, we 

reverse the district court’s judgment and remand the case to 

the agency for further proceedings.

I. Background

Engstrand applied for benefits in July 2010, when he was 

47. He alleged an onset of disability in July 2007, more than a 

year before his date last insured in September 2008.

After graduating from high school in 1981, Engstrand 

worked as a dairy farmer. Most days he worked from 6:00 

a.m. until late at night. In 2003 he was diagnosed with diabetes. By 2007 he no longer could handle the rigorous farming 

life, so he sold his cows. Since then he has not worked fulltime.

Engstrand was treated for his diabetes by 

Dr. Thomas Retzinger from 2009 to 2012. At the outset 

Dr. Retzinger noted that Engstrand could easily detect a 

10-gram monofilament1 and still had “good sensation and 

circulation” even though his diabetes previously had been 

“uncontrolled.” Dr. Retzinger prescribed several medications 

to lower Engstrand’s cholesterol and blood sugar. Then in 

2010, Engstrand’s diabetes symptoms began to multiply. 

1 A 10-gram monofilament is a soft nylon fiber used to test sensitivity to 

touch. A person who cannot feel the monofilament may have neuropathy severe enough to lead to an ulcer or gangrene. See STEDMAN’S 

MEDICAL DICTIONARY 1313 (28th ed. 2006); Diabetic Neuropathy Tests and 

Diagnosis, MAYO CLINIC, http://www.mayoclinic.org/diseases-conditions/

diabetic-neuropathy/basics/tests-diagnosis/con-20033336 (last visited May 20, 2015).

 

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No. 14-2702 3

Dr. Retzinger documented polyuria (excessive urine production), nocturia (waking up at night to urinate), polydipsia 

(excessive thirst), polyphagia (excessive hunger), weight 

loss, vision problems, and pain in Engstrand’s lower extremities. Engstrand’s sporadic use of prescription pills had not 

controlled these serious symptoms, so Dr. Retzinger decided

that regular insulin injections were necessary. According to 

Dr. Retzinger’s notes, Engstrand took the insulin and 

checked his blood sugar regularly. Dr. Retzinger later increased the insulin dosage but noted that Engstrand’s blood 

sugar remained very high. The physician also consistently 

documented Engstrand’s continuing struggle with neuropathy and noted that he experienced “diminished” and burning sensations in his feet.2 Dr. Retzinger also continued to 

note Engstrand’s ability to perceive a 10-gram monofilament. At one point Engstrand told Dr. Retzinger that his feet 

hurt so much that walking in bare feet on a smooth floor felt 

like walking on gravel, but at another appointment 

Dr. Retzinger recorded that Engstrand felt “fine” and appeared “quite well.” Engstrand also reported hip and knee 

pain, and an X-ray revealed mild osteoarthritis in his right 

hip and knee. Dr. Retzinger prescribed two painkillers; 

2 “Diabetic neuropathy” is a generic term for any diabetes-related disorder that affects the nerves, and it is the most common chronic complication of diabetes. Neuropathies can cause burning or sharp pain, a diminished capacity for physical sensation, an abnormal increase in sensitivity 

to touch, tingling skin (“falling asleep”), muscle weakness, ulcers, infections, and loss of reflexes, balance, coordination, temperature, and vibratory sense. The development of diabetic neuropathy is poorly understood, and the response to treatment is unpredictable. See STEDMAN’S 

MEDICAL DICTIONARY 1313 (28th ed. 2006); Diabetic Neuropathy Symptoms, 

MAYO CLINIC, http://www.mayoclinic.org/diseases-conditions/diabeticneuropathy/basics/symptoms/con-20033336 (last visited May 20, 2015).

 

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Engstrand took one as needed but found the other “intolerable.” Dr. Retzinger eventually discontinued certain medications since Engstrand was “not much of a pill taker” and 

“cost issues” were a concern for him.

Dr. Retzinger reported Engstrand’s residual functional 

capacity (“RFC”) on a standard Social Security 

Administration form in July 2010. Dr. Retzinger concluded

that Engstrand could lift 25 pounds frequently but only occasionally lift 50 pounds. Dr. Retzinger also concluded that 

during an eight-hour workday Engstrand could not stand or 

walk for more than two to six hours total. And, the doctor 

said, Engstrand must alternate between standing and sitting 

to relieve his pain. He also should limit using his lower extremities to push or pull and should not climb, kneel, 

crouch, crawl, or stoop, except occasionally. Finally, 

Dr. Retzinger opined, Engstrand must minimize his exposure to extreme temperatures, vibrations, humidity, and 

hazards, all of which could aggravate his neuropathy symptoms.

In September 2010 a state-agency physician, Janis Byrd, 

reviewed Engstrand’s medical records. She generally agreed 

with Dr. Retzinger’s assessment of Engstrand’s RFC, except 

that Dr. Byrd thought Engstrand could push and pull without limit. Dr. Byrd explained that both neuropathy and osteoarthritis likely would produce Engstrand’s reported symptoms, and she deemed him credible because those symptoms 

correlate to his stated limitations and Dr. Retzinger’s assessment. Yet that same day, the Social Security Administration denied Engstrand’s request for benefits. He sought reconsideration.

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No. 14-2702 5

Around this time Engstrand completed two written 

self-assessments of his level of functioning: one in August 

2010 and the other in January 2011. In each he describes a 

typical day: He drives his wife to work around 5:30 or 6:00 

a.m., lies down until helping their six children get ready for 

school beginning at 7:00 a.m., spends two or three hours at 

his parents’ farm feeding the few cattle his children raise for 

4-H (his children accompany him and perform that task during the summer), prepares lunch at home, picks up his wife 

from work in the afternoon, helps prepare dinner, and after 

dinner returns to his parents’ farm with his children to care 

for their cattle. He also drives the children to sports and 

shops for groceries two to four times a month. Engstrand recounts in these self-assessments that his joints ache, his feet 

are tender, walking is painful, and sometimes his leg pain 

keeps him awake at night. Some days are worse than others, 

and on bad days his legs “hurt like hell.” He estimates that 

he can sit continuously for two to four hours, stand continuously for two to three hours, and walk without a break for 

half an hour.

A second state-agency physician, Syd Foster, reviewed 

Engstrand’s medical records in February 2011. Unlike 

Dr. Retzinger and Dr. Byrd, Dr. Foster concluded that 

Engstrand could perform “medium” work so long as the 

jobs did not involve constant kneeling or crouching or 

significant exposure to heat, cold, and humidity. Dr. Foster 

also concluded that Engstrand could frequently lift 25 

pounds, push and pull without limit, and sit, stand, or walk 

for six hours total in an eight-hour workday. Dr. Foster 

thought it significant that Engstrand “was still able to detect 

a 10-gram filament in the feet” and purportedly walked with 

a “normal gait” despite complaining about “burning pain in 

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6 No. 14-2702

the feet and legs.” Moreover, Dr. Foster thought Engstrand 

had become better at controlling his glucose, and his neuropathy was not worsening. Dr. Foster added that, in his 

view, Engstrand’s condition actually had improved since he 

applied for benefits and his statements about his level of 

pain were inconsistent. The doctor opined that Engstrand 

lacks credibility and said he would “not give controlling 

weight to Dr. Retzinger’s opinion.” The day after Dr. Foster’s 

report, Engstrand’s request for reconsideration was denied.

Engstrand then testified before an ALJ in February 2012. 

He stated that he takes insulin three times daily as prescribed and his pain medications as needed. Still, he said, 

since 2007 he had been unable to work full-time and because 

of his pain no longer could stand continuously for more than 

30 minutes or carry more than 20 to 50 pounds. He also stated that he helps on his parents’ farm a few times a week 

(with tasks like picking up hay bales with a tractor), but his 

teenage children care for their own cattle and help him do 

any major physical work. He said that he constantly feels 

tight and stiff and always wears shoes at home because even 

a tiny crumb feels like a pin when he walks barefoot. Standing for more than 30 minutes causes pain in his legs, right 

hip, and right knee. And after 30 minutes of continuous 

sitting his right knee locks and his leg muscles cramp. To 

minimize this pain, he lies down and rubs his legs for about 

two hours every afternoon.

A vocational expert (“VE”) was the only other witness. 

The ALJ asked about work available to a high school graduate of Engstrand’s age who is capable of medium exertion 

involving infrequent kneeling or crouching in an environment free of extreme heat, cold, or humidity. The stated limiCase: 14-2702 Document: 28 Filed: 06/04/2015 Pages: 13
No. 14-2702 7

tations would rule out Engstrand’s past work, the VE replied, but still would allow for work as a security guard, 

surveillance-system monitor, ticket taker, or cashier. More 

than 86,000 of these positions, the VE added, are available in 

the “local economy.” The VE acknowledged, though, that 

only the job of surveillance-system monitor (with 1,300 positions) can be performed by someone who must avoid vibrations and unprotected heights; cannot kneel, crouch, climb, 

crawl, or stoop except occasionally; is required to alternate 

between sitting and standing; and cannot stand or walk for 

more than two hours total in an eight-hour workday. And, 

the VE conceded, a need to lie down for two hours during a 

workday would eliminate all full-time jobs.

The ALJ found Engstrand not disabled. Applying the 

requisite five-step analysis, see 20 C.F.R. §§ 404.1520(a), 

416.920(a), the ALJ found that (1) Engstrand had not engaged in substantial gainful activity since his alleged onset 

date, (2) he suffers from severe diabetes mellitus with early 

neuropathy and mild osteoarthritis of his right hip and knee, 

(3) these impairments do not meet the criteria for presumptive disability, (4) Engstrand cannot perform his past work 

but has the RFC to perform medium work with limitations, 

and (5) jobs of that type are available. In siding with 

Dr. Foster, one of the two state-agency physicians, the ALJ 

rejected the opinions of both Engstrand’s treating physician, 

Dr. Retzinger, and the other state-agency physician, 

Dr. Byrd. The ALJ gave no reason for rejecting Dr. Byrd’s 

opinion but said that Dr. Retzinger’s opinion contradicts his 

own treatment notes. The ALJ also disbelieved Engstrand’s

own account of his limitations and declared his testimony 

inconsistent with the “objective medical signs and laboratory 

findings.”

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8 No. 14-2702

The ALJ offered multiple reasons for finding Engstrand 

not credible. For example, the ALJ was critical that 

Engstrand had not undergone an EMG or nerve-conduction 

study to verify his neuropathy, and she deemed it “most 

significant” that, despite Engstrand’s testimony about foot 

pain, he could still detect a 10-gram monofilament. The ALJ 

also noted that Dr. Retzinger had attributed Engstrand’s limitations to the neuropathy, but, the ALJ declared, Engstrand 

had been filling his prescriptions for pain medication only 

for osteoarthritis, not neuropathy. Furthermore, the ALJ insisted, Engstrand had been “only partly compliant with 

treatment” and yet had not experienced episodes of hypoglycemia (low blood sugar), diabetic ketoacidosis (production of excess blood acids), or diabetic retinopathy (damage 

to blood vessels in the retina). Additionally, the ALJ asserted 

that Engstrand’s “blood glucose and overall condition” had 

become “well-controlled” with increased insulin. The ALJ 

also disbelieved that Engstrand could be experiencing significant pain or have “time for 2-hour naps” given what she 

characterized as his “rather extensive responsibilities” and 

“fairly impressive array of active daily activities.” Finally, 

the ALJ noted that at the time of the hearing Engstrand’s 

children ranged in age from six to sixteen, and she speculated that Engstrand “may have had motivations not to work 

full-time other than simply an inability to do so, and that being specifically related to childcare.”

II. Discussion

Before this court Engstrand challenges only the ALJ’s adverse credibility finding, arguing that the ALJ improperly 

discredited his testimony of disabling pain and wrongly 

equated his sporadic physical activities with the ability to 

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No. 14-2702 9

work full-time. He asserts that his testimony that he must lie 

down for two hours every day, if credited, would mean that 

he is disabled. See Craft v. Astrue, 539 F.3d 668, 680 (7th Cir. 

2008).

Because the Appeals Council denied review, we evaluate 

the ALJ’s decision as the final word of the Commissioner. 

Minnick v. Colvin, 775 F.3d 929, 935 (7th Cir. 2015). For us to 

uphold that decision, it must rest on substantial evidence, 

Pepper v. Colvin, 712 F.3d 351, 361–62 (7th Cir. 2013), untainted by an erroneous credibility finding, Murphy v. Colvin, 759 

F.3d 811, 815–16 (7th Cir. 2014). And although we defer to an 

ALJ’s credibility finding that is not patently wrong, Curvin v. 

Colvin, 778 F.3d 645, 651 (7th Cir. 2015), an ALJ still must 

competently explain an adverse-credibility finding with specific reasons “supported by the record,” Minnick, 775 F.3d at 

937. “An erroneous credibility finding requires remand unless the claimant’s testimony is incredible on its face or the 

ALJ explains that the decision did not depend on the credibility finding.” Pierce v. Colvin, 739 F.3d 1046, 1051 (7th Cir. 

2014).

After reviewing the record, we conclude that the ALJ’s

credibility finding here is patently wrong. First, as Engstrand

argues, his complaints of severe pain stemming from his 

neuropathy need not be confirmed by diagnostic tests. 

See SSR 97-6p(4); Hall v. Colvin, 778 F.3d 688, 691 (7th Cir. 

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

there is no indication that a doctor ever recommended an 

EMG or nerve-conduction study that the ALJ thought would 

have been appropriate. Moreover, the ALJ assumed that, because Engstrand could feel the 10-gram monofilament, he 

must be lying about his neuropathy, but there is no evidence 

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10 No. 14-2702

that the two are mutually exclusive. The 10-gram monofilament test is used to determine whether a person has neuropathy so severe as to cause an ulcer or gangrene, 

see STEDMAN’S MEDICAL DICTIONARY 1313 (28th ed. 2006), 

and there is no evidence in the record supporting the ALJ’s 

belief that Engstrand’s ability to feel the monofilament contradicts his complaints of pain. The test does not measure 

pain; rather, it is designed to alert a clinician that a patient 

who cannot detect the pressure of the monofilament has lost 

nerve function. See Jacquelien Dros et al., Accuracy of 

Monofilament Testing to Diagnose Peripheral Neuropathy: A 

Systematic Review, 7 ANNALS OF FAMILY MEDICINE 555, 556 

(2009); Andrew J.M. Boulton et al., Comprehensive Foot 

Examination and Risk Assessment, 31 DIABETES CARE 1679, 1680 

(2008). Dr. Retzinger regularly documented both Engstrand’s

reports of pain and his ability to detect a 10-gram monofilament, and thus the treating physician obviously did not 

think them inconsistent. And not even Dr. Foster (whose 

opinion the ALJ said she relied on) explicitly linked the 

monofilament test to a measurement of pain; he placed in 

the same sentence his observations about Engstrand’s complaints of pain and Engstrand’s ability to feel the monofilament, but he did not say that any correlation existed between these observations. Rather, the ALJ apparently assumed a connection. Thus, in deciding that the two were 

mutually exclusive, the ALJ was inappropriately “playing 

doctor.” See Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 2014) 

(rejecting ALJ’s interpretation of MRI results); Moon v. 

Colvin, 763 F.3d 718, 722 (7th Cir. 2014) (noting that ALJs 

must “rely on expert opinions instead of determining the 

significance of particular medical findings themselves”).

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No. 14-2702 11

Next, the ALJ improperly relied on Engstrand’s sporadic 

use of medications. First, the ALJ purportedly gleaned from 

“treatment notes” that Engstrand was refilling his pain medication for osteoarthritis instead of neuropathy, but we cannot find support for that conclusion in the treatment notes. 

More importantly, the ALJ does not say why this would 

matter. An ALJ must “consider an applicant’s medical problems in combination,” Goins, 764 F.3d at 681, and we cannot 

understand why Engstrand’s credibility would be diminished simply because he suffers pain from both neuropathy 

and osteoarthritis. Additionally, the ALJ concluded that 

Engstrand’s condition had improved when he complied 

with his prescribed treatment—this conclusion appears to be 

based solely on one treatment note where Engstrand reported feeling “fine”—but she did not inquire of Engstrand why

he may have been less than fully compliant. See Murphy, 759 

F.3d at 816; Garcia v. Colvin, 741 F.3d 758, 761 (7th Cir. 2013); 

Roddy v. Astrue, 705 F.3d 631, 638 (7th Cir. 2013). Indeed, 

Engstrand had told Dr. Retzinger that one of the medications 

was “intolerable,” and he stopped taking other medications 

due to “cost issues.” Engstrand also had reported that some 

days he felt worse than others, so the fact that Dr. Retzinger 

recorded that he felt “fine” at one appointment does not 

weaken the rest of his testimony about disabling pain.

Furthermore, as Engstrand contends, the ALJ wrongly 

evaluated the significance of his daily activities. First, the 

ALJ conflated Engstrand’s 2010 and 2011 self-reports of daily 

activities with his 2012 testimony, and she should have considered the possibility that his pain had worsened—and thus 

activities differed—over time. See Pierce, 739 F.3d at 1051. 

But, more significantly, Engstrand’s reported activities were 

quite consistent with his testimony that he cannot stand for 

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12 No. 14-2702

very long without pain and that he needs to frequently alternate between sitting, standing, and lying down. 

Engstrand said he drives his wife to work and his children to 

sports, and he helps with seated tasks (such as driving a 

tractor) at his parents’ farm, where his children do all of the 

significant physical tasks. The ALJ suggested that Engstrand 

is a “part-time farmer” but failed to understand that working sporadically or performing household chores are not inconsistent with being unable to engage in substantial gainful 

activity. Scrogham v. Colvin, 765 F.3d 685, 700 (7th Cir. 2014); 

see also Moore v. Colvin, 743 F.3d 1118, 1126 (7th Cir. 2014) 

(ALJs must recognize that “full-time work does not allow for 

the flexibility to work around periods of incapacitation”); 

Roddy, 705 F.3d at 638 (claimant who “pushed herself to 

work part-time and maintain some minimal level of financial 

stability, despite her pain,” was not precluded from establishing disability). Additionally, the ALJ disbelieved 

Engstrand’s testimony that, in the midst of these activities, 

he has to lie down for two hours every day, but his reports 

of functioning and his testimony left several open hours each 

afternoon during which he could indeed find time to lie 

down. And the ALJ made no attempt during the hearing to 

explore those possibilities. See Beardsley v. Colvin, 758 F.3d 

834, 838 (7th Cir. 2014). Moreover, there is no evidence in the 

record to support the ALJ’s seemingly unwarranted conjecture that Engstrand had stopped working not because of 

disability but because of “childcare,” nor did the ALJ 

attempt to question Engstrand about his motivations to stop 

working. See Murphy, 759 F.3d at 817.

Finally, although Engstrand does not challenge the ALJ’s 

refusal to give the opinion of his treating physician controlling weight, the ALJ’s flawed credibility finding hindered 

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No. 14-2702 13

her ability to appropriately weigh other favorable evidence, 

including Dr. Retzinger’s opinion. See Yurt v. Colvin, 758 F.3d 

850, 860 (7th Cir. 2014) (explaining that we have “repeatedly 

forbidden” ALJs from cherry-picking only the medical evidence that supports their conclusion); Moore, 743 F.3d at 

1124 (“The ALJ simply cannot recite only the evidence that is 

supportive of her ultimate conclusion without acknowledging and addressing the significant contrary evidence in the 

record.”). Dr. Retzinger consistently recorded Engstrand’s 

neuropathy and his reports of pain—despite his regimented 

insulin usage—and the doctor deemed that pain serious 

enough to prescribe several medications and to recommend 

that Engstrand walk or stand only a few hours total in an 

eight-hour workday. As the treating physician, 

Dr. Retzinger’s opinion should have controlled over the conclusions of the agency doctor who did not examine 

Engstrand, unless the ALJ could persuasively explain why 

Dr. Retzinger’s opinions about Engstrand’s serious limitations were not supported by the record. 

See 20 C.F.R. § 404.1527(c); Minnick, 775 F.3d at 937–38; 

Roddy, 705 F.3d at 636–37. And as we have discussed, the ALJ

neglected to do so. Moreover, the ALJ gave no explanation 

(let alone support with substantial evidence, see Scrogham, 

765 F.3d at 695) for rejecting the opinion of Dr. Byrd (an 

agency physician), which highlights her questionable dismissal of Dr. Retzinger’s opinion.

III. Conclusion

For the above reasons, we reverse the district court’s 

judgment and remand this case to the Commissioner for further proceedings.

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