Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca7-15-02390/USCOURTS-ca7-15-02390-0/pdf.json

Parties Involved:
Carolyn W. Colvin
Appellee
Nancy J. Thomas
Appellant

Document Text:

In the

United States Court of Appeals

For the Seventh Circuit ____________________

No. 15-2390

NANCY J. THOMAS,

Plaintiff-Appellant,

v.

CAROLYN W. COLVIN, Acting 

Commissioner of Social Security,

Defendant-Appellee.

____________________

Appeal from the United States District Court for the

Northern District of Indiana, South Bend Division.

No. 3:14-cv-00651-TLS-JEM — Theresa L. Springmann, Judge.

____________________

ARGUED MARCH 2, 2016 — DECIDED JUNE 22, 2016

____________________

Before WOOD, Chief Judge, and BAUER and KANNE, Circuit 

Judges.

PER CURIAM. Nancy Thomas applied for Supplemental 

Security Income in 2010 when she was 55 years old. An administrative law judge identified her medically determinable 

impairments as degenerative changes in her back and left 

shoulder, Graves’ disease, and dysthymic disorder (a form 

Case: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
2 No. 15-2390

of chronic depression). But the ALJ concluded that these impairments do not impose more than minimal limitations on 

Thomas’s ability to work and denied her application. Thomas disputes the ALJ’s omission of fibromyalgia from the list 

of impairments and contends that his conclusion about the 

severity of her physical impairments is not supported by 

substantial evidence. (She does not discuss the ALJ’s conclusion that she does not have a severe mental impairment.) We 

agree with both of Thomas’s contentions and remand the 

case for further proceedings. 

I. BACKGROUND

Thomas was diagnosed with Graves’ disease in 2006. 

That condition is an autoimmune disease affecting the thyroid gland. See STEDMAN’S MEDICAL DICTIONARY 515 (27th ed. 

2000). After a few follow-up visits that same year, Thomas’s

health insurance lapsed, and not until January 2010 did she 

return to her personal physician, Dr. Volker Blankenstein. At 

that time she reported experiencing several months of acute, 

unexplained pain affecting the front of her neck. 

Dr. Blankenstein observed that Thomas had a slightly decreased range of motion in her neck but was not experiencing numbness, tingling, or weakness in her extremities or 

tenderness over her cervical spine. A CT scan returned normal results. 

A month later Thomas returned to Dr. Blankenstein reporting generalized fatigue and muscle aches, which she described as affecting her shoulders and knees and, sometimes, 

her entire body. Dr. Blankenstein’s clinical examination for 

symptoms of Graves’ disease was “fairly benign,” and he 

noted the normal CT scan results from the previous month, 

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No. 15-2390 3

though he wanted Thomas to consult an endocrinologist. He 

also concluded that Thomas suffers from joint and muscle 

pain but was uncertain whether the pain resulted from her 

Graves’ disease. He posited that Thomas might suffer from 

osteoarthritis or a muscle disorder causing chronic pain but 

stated that he would wait for test results. A few days later he 

told Thomas that her bloodwork had not disclosed an “obvious answer” to her pain and fatigue.

In March 2010, Thomas saw the endocrinologist, 

Dr. Cyprian Gardine, for her Graves’ disease. At the time 

Thomas was not having neck pain but did complain about 

pain in her joints and muscles, shortness of breath, chest 

tightness, headaches, nausea, and depression. When Thomas 

next saw Dr. Gardine in August and September 2010, he 

characterized her Graves’ disease as mild. In the later visits 

Thomas reported additional symptoms, including morefrequent headaches, constant fatigue, hoarseness, intolerance 

to heat and cold, muscle weakness, a rapid heartbeat, restless sleep, and tingling in her legs after walking. The doctor 

opined that some of these symptoms could be related to 

Graves’ disease. 

Thomas applied for SSI in November 2010 alleging onset 

in June 2006. She listed as impairments Graves’ disease and 

depression. She also described suffering two to three headaches weekly since April 2008 and mentioned that she had 

gone to the emergency room for this reason in May or June

2010. She reported previous employment as a cashier and

janitor in 1999 and 2000 but no other work except for a short 

stint doing laundry and housekeeping in a nursing home in 

2007. 

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4 No. 15-2390

Dr. John Taylor, a state-agency medical consultant, examined Thomas in December 2010. He confirmed that she suffers from Graves’ disease and depression but opined that she

did not have any functional limitations. Dr. Taylor noted 

that Thomas’s grip strength, manipulative skills, range of 

motion, and ambulation all were normal. Yet despite having 

said that Thomas did not have any functional limitations, 

Dr. Taylor further concluded that she could not handle routine household chores for more than short intervals, and neither could she stand continuously for more than 15 minutes 

(or more than 2 hours total in an 8-hour day), sit continuously for more than 10 minutes, or walk much beyond a half 

block. A second state-agency medical consultant, 

Dr. M. Ruiz, reviewed the file in January 2011 and opined 

that Thomas’s affliction with Graves’ disease is not severe. 

The Social Security Administration then denied Thomas’s 

application for SSI in January 2011. The next month Thomas 

returned to Dr. Blankenstein and reported that over the previous four to six months she had experienced lower back 

pain which sometimes radiated into her legs down to her 

knees. She felt no numbness, tingling, or weakness in her extremities, however, and Dr. Blankenstein’s examination revealed that she had “fairly full” range of motion in her hips. 

He diagnosed her with lumbago—a medical term that simply means pain in the middle and lower back—and bilateral 

lower extremity radiculopathy, a condition likely to cause 

pain, numbness, or weakness in the buttocks or legs because 

of pressure on a spinal nerve root. See STEDMAN’S MEDICAL 

DICTIONARY 1034 (27th ed. 2000); Michael Rubin, Nerve Root 

Disorders (Radiculopathies), MERCK,

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No. 15-2390 5

https://www.merckmanuals.com/professional/neurologicdisorders/peripheral-nervous-system-and-motor-unitdisorders/nerve-root-disorders (last modified Mar. 2014). 

Thomas also described pain radiating from her left shoulder 

into her arm that had lasted three or four months. On examination, she had limited range of motion in her left arm and 

could not reach behind her back. Dr. Blankenstein diagnosed 

left shoulder tendonitis, possibly “a combination of rotator 

cuff and osteoarthritis issues.” X-rays revealed degenerative 

changes in the lower lumbar spine, some spurring in both 

hips, and minimal spurring of acromioclavicular joint in her 

left shoulder. Dr. Blankenstein referred her for physical therapy. Afterward Thomas asked the SSA to reconsider the denial of benefits, but another state-agency consultant, 

Dr. J. Sands, concurred with Dr. Ruiz’s review—remarking 

simply that his opinion was “affirmed, as written”—and in 

April 2011 the agency upheld the initial determination. 

Thomas immediately began seeing Dr. Asima Rashid, an 

internist who diagnosed arthritis and osteoarthritis in response to Thomas’s complaints of widespread pain. Later 

that month Thomas reported pain in her neck, left shoulder, 

left arm, and mid-back. Thomas said that she was unable to 

move her arm behind her back, and Dr. Rashid’s examination showed that Thomas had tenderness in her left shoulder 

and moderately reduced range of motion. Dr. Rashid suspected degenerative arthritis in the left shoulder, but an Xray was normal. 

Thomas started physical therapy in March 2011 but quit 

after two sessions because she thought it was not helping. At 

Dr. Blankenstein’s urging she resumed with another theraCase: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
6 No. 15-2390

pist in May. At an initial evaluation, that therapist noted a 

number of limitations on movement. Thomas was experiencing pain bending forward, backward, and side to side.

Straight leg raises also caused pain, on the right at 60 degrees and on the left at 45 degrees. She had difficulty raising 

either heel, and stretches involving extending her right knee 

and rotating her hips were painful as well. Thomas decided 

that she was not improving and quit after six sessions, 

though, according to this therapist, Thomas had “refused on 

two occasions to do more than just lying prone and applying

a moist heat pack to her back secondary to having pain all 

over and being dizzy.” The therapist told Dr. Blankenstein 

that Thomas continued to complain of severe pain but was 

not making progress. The therapist discharged Thomas in 

July 2011 after she failed to return the office’s calls.

Dr. Blankenstein then saw Thomas again. He noted that 

previous X-rays, which showed only minimal arthritic 

changes, did not explain the pain she reported. Thomas said 

that she had muscle pain affecting, at various times, her 

neck, torso, and extremities. Dr. Blankenstein detected tenderness over her entire thorax but no specific tenderness 

along her spine or any “classical rheumatoid arthritis changes.” He concluded that she “most likely suffers from a myofascial pain syndrome, such as fibromyalgia.” He remarked 

that “[s]he does not seem overly symptomatic” for Graves’ 

disease and that he could not tie her fibromyalgia-like symptoms to that condition. He prescribed Lyrica, a medication 

used to treat fibromyalgia and nerve pain, and when Thomas reported a week later that this medication was helping, he 

remarked that this means “she almost certainly has fibromyalgia ... as suspected.” See Lyrica Medication Guide, U.S.

Case: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
No. 15-2390 7

FOOD AND DRUG ADMIN., http://www.fda.gov/downloads/

Drugs/DrugSafety/UCM152825.pdf (last modified Dec. 2013)

Five weeks later, though, Thomas had a checkup with 

Dr. Rashid, the internist, and again reported pain all over 

her body and tingling, mostly on the left side. Dr. Rashid observed that touching Thomas’s left arm caused pain but that 

her range of motion was “ok.” In her progress notes Dr. Rashid wrote, “Bone/joint symptoms” and muscle pains, without further explanation. The doctor noted that Thomas reported a “moderate” activity level including walking three 

times a week for 20 minutes. Dr. Rashid also prescribed Lyrica. Another X-ray of Thomas’s left shoulder showed mild to 

moderate osteoarthritis at the acromioclavicular joint but 

nothing acute. 

In January 2012, Dr. Rashid completed a questionnaire as 

part of Thomas’s effort to obtain disability accommodations 

and services from a community college where she had been 

taking classes since 2009. Dr. Rashid stated that Thomas had 

been diagnosed with osteoarthritis and moderate fibromyalgia which were causing muscle and joint pains. She opined 

that these conditions “substantially limit” Thomas’s ability 

to walk, work, and perform manual tasks, and prevent her 

from lifting over 20 pounds. Dr. Rashid’s list of Thomas’s 

medications did not include Lyrica but mentioned Cymbalta, another medication used to treat fibromyalgia. See Cymbalta Medication Guide, U.S. FOOD AND DRUG ADMIN.,

http://www.fda.gov/downloads/Drugs/DrugSafety/ucm0885

79.pdf (last visited June 10, 2016).

There are no records of further treatment before an 

emergency-room visit in September 2012, when Thomas reCase: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
8 No. 15-2390

ported a burning sensation in her hands and from her feet

extending up to her mid-thighs. The emergency-room doctor 

diagnosed a potassium deficiency and peripheral neuropathy, a name for peripheral nerve damage that causes symptoms ranging from “numbness or tingling, to pricking sensations ... or muscle weakness.” Peripheral Neuropathy Fact 

Sheet, NAT’L INST. OF NEUROLOGICAL DISORDERS AND STROKE, 

http://www.ninds.nih.gov/disorders/peripheralneuropathy/

detail_peripheralneuropathy.htm (last modified Mar. 9, 

2016).

Thomas finally appeared before an ALJ in October 2012, 

eighteen months after her application for benefits had been 

denied on reconsideration. She testified that she last worked 

in 2007, doing laundry and housekeeping at the nursing 

home. She had hurt her knee and eventually quit, she explained, since even assignments to lighter tasks had proved

difficult to manage. Afterward she had returned to school to 

obtain a certificate in childcare but completed only a few 

classes. She was living with an adult daughter and helping 

with cooking and housework. She could manage self-care 

tasks with enough time. She described feeling numbness and 

aches in her neck, left arm, back, legs, and feet. She continued to take Cymbalta for nerve pain in her legs and an unnamed medication for muscle spasms in her neck but described her pain as still 3 to 5 on a 10-point scale even with 

her medication. She estimated that she could stand continuously for 10 minutes and walk for 10 to 15 minutes, and 

added that sitting is difficult because her legs go numb if she 

doesn’t move. She said that she could lift around 20 pounds 

depending on her pain. She also described suffering severe 

Case: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
No. 15-2390 9

headaches four to five times weekly, with pain reaching her 

ears and neck and lasting around 30 minutes.

At Steps 1 and 2 of the 5-step analysis, see 20 C.F.R. 

§ 416.920, the ALJ found that Thomas had not worked since 

applying for benefits and acknowledged that she suffers 

from Graves’ disease, degenerative changes of the left 

shoulder and lumbar spine, and dysthymic disorder. But the 

ALJ refused to accept the diagnosis of fibromyalgia from 

Dr. Blankenstein and Dr. Rashid because neither doctor is a 

rheumatologist and neither doctor had conducted a “tender 

point” analysis, in which a doctor evaluates the pain produced by pressing 18 specific points on the body. See Fibromyalgia, MAYO CLINIC (Oct. 1, 2015), 

http://www.mayoclinic.org/diseases-conditions/fibromyalgia

/basics/tests-diagnosis/con-20019243. And, the ALJ continued, the impairments that he was willing to acknowledge 

are not “severe” individually or in combination because, he 

opined, they at most cause minimal limitations on Thomas’s 

ability to perform basic work activities. The ALJ disbelieved 

Thomas’s testimony about the intensity, persistence, and 

limiting effects of her symptoms, instead focusing on the 

medical records, in particular the opinions of Dr. Ruiz and 

Dr. Sands, two of the state-agency medical consultants, that 

Thomas’s Graves’ disease is not severe. He gave little weight 

to Dr. Rashid’s statement to the community college disability 

office (describing limitations in walking, working, performing manual tasks, and lifting weights because of fibromyalgia and osteoarthritis), judging it not supported by objective 

evidence. Moreover, because the ALJ concluded that Step 2’s 

threshold requirement of a “severe” impairment was not satisfied, he denied benefits without continuing through the 

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10 No. 15-2390

three remaining steps, see 20 C.F.R. § 416.920(a)(4)(ii). The 

Appeals Council denied review, and the district court upheld the ALJ’s decision.

II. DISCUSSION

We begin with Thomas’s challenge to the ALJ’s conclusion that fibromyalgia is not among her medically determinable impairments. She argues that the ALJ disregarded the 

diagnoses given by both Dr. Blankenstein and Dr. Rashid 

and that his reasons for doing so—that neither doctor is a 

rheumatologist or performed an analysis of tender points—

are unsound.

We agree with Thomas that her doctors’ lack of specialization in rheumatology is not an acceptable basis for discounting their assessments. Although the Commissioner is 

correct that a specialist’s opinion generally merits more 

weight than that of non-specialist, see 20 C.F.R. 

§ 416.927(c)(5), all licensed medical or osteopathic doctors 

are acceptable medical sources, see id. § 416.913(a)(1); 

SSR 12-2p, 2012 WL 3104869, at *2 (July 25, 2012). And there 

is no contrary opinion from a specialist. Indeed, because 

Thomas’s doctors diagnosed fibromyalgia after her claim for 

benefits had been denied on reconsideration, the stateagency medical consultants did not even weigh in on this 

impairment. What’s more, it’s doubtful that they would be 

more qualified than Thomas’s physicians to make a judgment about whether she suffers from fibromyalgia: Neither 

Dr. Ruiz nor Dr. Sands purported to have specialized 

knowledge of the claimant’s alleged impairments.

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No. 15-2390 11

As the ALJ recognized, however, a doctor’s diagnosis of 

fibromyalgia is not alone sufficient to establish this condition 

as an impairment; the diagnosis must be supported by evidence meeting either of two sets of diagnostic criteria promulgated by the American College of Rheumatology, in 1990 

and 2010. See SSR 12-2p, 2012 WL 3104869, at *2–3. But, as 

Thomas rightly points out, and the Commissioner concedes, 

the ALJ addressed only the 1990 ACR criteria by focusing 

exclusively on the lack of analysis of tender points. The alternate 2010 ACR criteria do not require this analysis, but 

rather a history of widespread pain, repeated manifestations 

of six or more fibromyalgia symptoms, signs, or contemporaneous conditions, and evidence that alternative explanations for those symptoms, signs, or contemporaneous conditions were ruled out. See SSR 12-2p, 2012 WL 3104869, at *3.

The Commissioner insists that the ALJ’s omission of discussion of the 2010 ACR criteria was harmless “because 

Thomas has not shown that the ALJ overlooked evidence” 

that would have satisfied these criteria. This argument is unconvincing because, without any analysis from the ALJ, 

there is no basis for drawing any conclusions about what evidence he considered or overlooked. As Thomas points out 

in her opening and reply briefs, the medical evidence includes many reports of symptoms, signs, and contemporaneous conditions associated with fibromyalgia, including 

muscle aches, fatigue, and depression, see SRR 12-2p, 

2012 WL 3104869, at *3, nn. 9–10, and details tests that her 

doctors conducted while looking for explanations, such as Xrays, an ultrasound, and tests of her antinuclear antibodies 

and rheumatoid factor. Despite the Commissioner’s disclaimer in her brief, her conjecture that the ALJ would have 

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12 No. 15-2390

reached the same conclusion had he explicitly addressed the 

alternative set of criteria invokes an overly broad conception 

of harmless error of the type we have criticized previously. 

See, e.g., Roddy v. Astrue, 705 F.3d 631, 637 (7th Cir. 2013); 

see also SEC v. Chenery Corp., 318 U.S. 80, 87–88 (1943).

The Commissioner also argues that, even if the ALJ was 

wrong to omit fibromyalgia from Thomas’s impairments, the

error was harmless because he still proceeded to consider

the objective evidence of functional limitations in concluding 

that Thomas’s ability to perform work-related tasks is, at 

most, minimally affected. But this contention discounts the 

significance of Thomas’s further argument that the ALJ 

lacked substantial evidence for his conclusion that none of 

her other physical impairments is severe.

Impairments are not “severe” when they do not significantly limit the claimant’s ability to perform basic work activities, including “walking, standing, sitting, lifting, pushing, pulling, reaching, carrying, or handling.” 20 C.F.R. 

§ 416.921. The SSA has specified further that a non-severe 

impairment is “a slight abnormality (or combination of 

slight abnormalities) that has no more than a minimal effect 

on the ability to do basic work activities.” SSR 96-3p, 

1996 WL 374181, at *1 (July 2, 1996). When evaluating the severity of an impairment, the ALJ assesses its functionally 

limiting effects by evaluating the objective medical evidence 

and the claimant’s statements and other evidence regarding 

the intensity, persistence, and limiting effects of the symptoms. Id. at *2. Other circuits have described the Step 2 inquiry as a de minimis screening for groundless claims. 

See, e.g., Newell v. Comm’r of Soc. Sec., 347 F.3d 541, 546 

Case: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
No. 15-2390 13

(3d. Cir. 2003); Smolen v. Chater, 80 F.3d 1273, 1290 (9th Cir. 

1996); McDonald v. Sec. of Health and Human Servs., 795 F.2d 

1118, 1124 (1st Cir. 1986).

Thomas disputes the weight the ALJ assigned to the

medical opinions in the record, his interpretation of the objective evidence, and his adverse finding about her own 

credibility in concluding that her limitations are minimal. 

Thomas challenges the ALJ’s decision to give great weight to 

the reviews of the evidence by Dr. Ruiz and Dr. Sands, who 

concluded that her Graves’ disease was not severe, and little 

weight to Dr. Rashid’s statement to the community college 

showing more than a minimal limitation on her abilities. She 

points out that, not only was Dr. Rashid a treating physician, 

but the consulting doctors never examined her and their reviews took place in January and April 2011, before much of 

the later medical evidence showing her fibromyalgia diagnosis and degenerative changes in her left shoulder.

Thomas contends that Dr. Rashid’s statement to the 

community college about Thomas’s limitations was entitled 

to controlling weight under 20 C.F.R. § 416.927(c)(2) and that 

the ALJ discounted this opinion without an adequate reason. 

We agree. The ALJ appears to have given Dr. Rashid’s opinion little weight despite the length of her treating relationship by reasoning that Dr. Rashid had noted at one point 

that Thomas had full range of motion and because the ALJ 

thought the fibromyalgia diagnosis unfounded. But the first 

reason appears focused narrowly on the effects of the degenerative changes in Thomas’s spine and left shoulder (not on 

the disabling effects of the pain caused by fibromyalgia), and 

the second reason was erroneous for the reasons explained 

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14 No. 15-2390

previously. The ALJ also noted Thomas’s gap in treatment 

between August 2011 and September 2012, but the relevance 

of this detail to Dr. Rashid’s opinion is unclear, and, in any 

case, the ALJ did not explore the reasons for this gap. 

See Beardsley v. Colvin, 758 F.3d 834, 840 (7th Cir. 2014); Craft 

v. Astrue, 539 F.3d 668, 679 (7th Cir. 2008).

And even if Dr. Rashid’s opinion was not entitled to controlling weight, the ALJ erred by accepting Dr. Ruiz and 

Dr. Sands’s reviews of the evidence uncritically despite the 

fact that they never examined Thomas and did not have the 

benefit of much of the 2011 treatment records when they 

created their opinions. See Stage v. Colvin, 812 F.3d 1121, 1125 

(7th Cir. 2016); Goins v. Colvin, 764 F.3d 677, 680 (7th Cir. 

2014). Dr. Ruiz’s mention of Graves’ disease as Thomas’s 

sole alleged physical impairment highlights the dated nature 

of the assessment. The ALJ said that those opinions were 

consistent with a later finding of Dr. Rashid about Thomas’s 

range of motion and records showing that her Graves’ disease was in check, but he did not even attempt to compare 

the consulting doctors’ assessments with records from 

Thomas’s treatment by Dr. Blankenstein (her main doctor 

throughout 2010 and 2011) or her difficulties with physical 

therapy, even though that evidence was consistent with 

Dr. Rashid’s statement to the community college that Thomas had significant limitations.

Thomas also criticizes the ALJ’s failure to grapple with 

records from Thomas’s physical therapy sessions in his assessment of what the objective medical evidence says about 

her limitations. Even though a physical therapist is not an 

acceptable medical source for determining a claimant’s imCase: 15-2390 Document: 26 Filed: 06/22/2016 Pages: 16
No. 15-2390 15

pairments, this evidence may be used to show the severity of 

an impairment and how it affects a claimant’s ability to function. See 20 C.F.R. § 416.913(d)(1); SSR 06-03p, 2006 WL 

2329939, at *2 (Aug. 9, 2006). The second physical therapist’s 

initial evaluation and a progress note contained detailed discussions of Thomas’s pain and movement limitations, including that Thomas had difficulty with heel and straight leg 

raises and bending. The ALJ ignored those statements, however, and noted only that “a resulting progress note indicated that the claimant’s complaints of pain were rather vague” 

and that, “on at least two occasions, the claimant refused to 

do more than lay [sic] in a prone position, reportedly secondary to ‘pain all over’ and dizziness” (even though these 

are symptoms associated with fibromyalgia as well, 

see SRR 12-2p, 2012 WL 3104869, at *3, nn. 9). Although the 

ALJ was not required to mention every piece of evidence, 

providing “an accurate and logical bridge” required him to 

confront the evidence in Thomas’s favor and explain why it 

was rejected before concluding that her impairments did not 

impose more than a minimal limitation on her ability to perform basic work tasks. Roddy, 705 F.3d at 636; see Denton v. 

Astrue, 596 F.3d 419, 425 (7th Cir. 2010); Indoranto v. Barnhart, 

374 F.3d 470, 474 (7th Cir. 2004).

Finally, Thomas correctly argues that the ALJ’s credibility determination was not adequate. In finding Thomas not 

credible to the extent that she described more than minimal 

limitations, the ALJ relied on the seeming lack of objective 

evidence supporting Thomas’s subjective account of her 

symptoms, but, as discussed earlier, the ALJ skipped over 

the substantial findings of Thomas’s treating physicians and 

physical therapist that showed that her impairments indeed 

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16 No. 15-2390

would limit her ability to perform work tasks. The ALJ’s invocation of Thomas’s activities of daily living to discount her 

testimony that her limitations are more than minimal also is 

problematic because her ability to do limited chores, cooking, and self-care says little about her ability to perform the 

tasks of a full-time job, much less the Step 2 threshold that 

any limitations would be no more than minimal. See Hughes 

v. Astrue, 705 F.3d 276, 278–79 (7th Cir. 2013); Craft, 539 F.3d 

at 680. And the ALJ concluded from Thomas’s gap in treatment between August 2011 and September 2012 that her 

symptoms were not as severe as she alleged, but, as noted, 

he did not explore her reasons for not seeking treatment, another error. See Craft, 539 F.3d at 679.

III. CONCLUSION

Because the ALJ’s omission of fibromyalgia from Thomas’s medically determinable impairments and his conclusion 

that she has no severe impairments are not supported by 

substantial evidence, we REVERSE the judgment of the district court upholding the Commissioner’s decision to deny 

benefits to Thomas and REMAND for further proceedings 

consistent with this opinion. Thomas requests that this court 

direct a finding of disability, but we agree with the Commissioner that this is inappropriate because the ALJ ended his 

inquiry at Step 2, and, as a result, not all of the factual issues 

in this case have been resolved. See Allord v. Astrue, 631 F.3d 

411, 415 (7th Cir. 2011).

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