In the

United States Court of Appeals

For the Seventh Circuit

No. 07-3682

KEVIN G. SIMILA,

Plaintiff-Appellant,

v.

MICHAEL J. ASTRUE, 

Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District Court 

for the Western District of Wisconsin.

No. 07 C 29—Barbara B. Crabb, Chief Judge.

ARGUED MAY 29, 2008—DECIDED JULY 22, 2009

Before CUDAHY, POSNER, and TINDER, Circuit Judges.

TINDER, Circuit Judge. Once a strapping construction

laborer, Kevin Simila claims that a mysterious pain disorder has withered his physical prowess and left him

unable to work. Simila applied for Disability Insurance

Benefits (“DIB”) and Supplemental Security Income

(“SSI”). But after a hearing, the administrative law judge

(“ALJ”) was dubious of the severity of Simila’s limitations.
2 No. 07-3682

And for good reason. The record showed that Simila had

gone hunting and fishing, attended his sons’ peewee

hockey games, and even helped a friend build a log

home—all after the time Simila claimed to have become

disabled. But no matter how fishy a claim for Social

Security benefits might seem, an ALJ must follow the same

rules for every case. She must refrain from “playing

doctor,” properly evaluate the medical evidence and

the claimant’s credibility, and accurately incorporate the

claimant’s limitations into any hypothetical question

used to elicit the opinion of a vocational expert. Despite

Simila’s contentions to the contrary, we think that the

ALJ adequately performed these duties in this case. The

medical evidence lent little support to Simila’s case and

the ALJ had good reason to doubt Simila’s testimony. And

though imperfect, the ALJ’s hypothetical questions adequately described Simila’s condition. We therefore affirm.

I. Background

A. Kevin Simila’s Symptoms and Treatment

Until Simila’s symptoms began in 2002, he worked as a

construction laborer and an occasional carpet installer

and bartender. In mid-September of that year, Simila

went to his primary care physician, Dr. Enders, complaining of flu-like symptoms, headaches, and joint pain.

Dr. Enders, on staff at the Midelfort Clinic, examined

Simila and performed several diagnostic tests. He did not

observe any apparent joint swelling, and Simila’s test

results for Lyme Disease were negative. During this visit,

Simila admitted to having abused cocaine intravenously
No. 07-3682 3

in the past but stated that he never shared needles and

had been drug-free for fifteen years.

Simila stopped working construction around October 2,

2002 and returned to the Midelfort Clinic several times

throughout October complaining of similar symptoms.

Dr. Enders noted that Simila had “arthralgias [joint

pain] and myalgias [muscle pain] of undetermined etiology” and prescribed Vicodin to ease the pain. As for his

headaches, a CT scan revealed that Simila had a sinus

infection. Dr. Enders referred Simila to Dr. Bartynski, an

otolaryngologist, who examined Simila and surgically

drained his sinuses. The procedure did not alleviate

the headaches, though.

Simila’s symptoms continued throughout the rest of

2002. He continued to see a number of doctors and take

pain medications such as Vicodin and Percocet during

that time. He saw two neurologists, Dr. Chukwudelunzu

and Dr. Dexter, who each examined Simila but could not

determine the cause of his pain. Dr. Chukwudelunzu

found that Simila “demonstrate[d] adequate fund of

knowledge, attention, concentration and memory

during history and neurologic examination,” and that

Simila had normal muscle strength, coordination, and

reflexes. Dr. Chukwudelunzu diagnosed Simila with

chronic headaches but noted that “I think this will turn

out to be a chronic daily headache with possible superimposed narcotic-induced headache,” referencing

Simila’s pain medication. Dr. Chukwudelunzu changed

Simila’s prescription to taper his Percocet use and control

his pain with other medications (Simila still continued to
4 No. 07-3682

use Percocet, though). Dr. Dexter concluded similarly.

He diagnosed Simila with “diffuse myalgias and headache, etiology unclear,” observing that his muscle

strength was normal, except for some “giveaway weakness,” a sign that Simila might have been exaggerating the

effects of his pain, see MURIEL D. LEZAK ET AL.,

NEUROPSYCHOLOGICAL ASSESSMENT 326 (4th ed. 2004)

(“Neurological examiners repeatedly noted give-away

weakness (poor effort on strength testing) indicating that

[the patient] was actively preserving a disability status.” (emphasis is original)). In addition, like Dr. Chukwudelunzu, Dr. Dexter concluded that the longer Simila

used narcotic pain medications, the more likely it was that

the narcotics contributed to his headaches.

Dr. Dexter also noted that Simila had been “somewhat active” despite his pain. Simila had explained to

Dr. Dexter that he “was able to go out deer hunting” and

“has been able to go out and take his son to hockey and

father/son hockey games,” even though he experienced

discomfort and soreness the next day.

Simila also saw a rheumatologist, Dr. Shelley, who,

like other doctors, found little explanation for Simila’s

complaints. Dr. Shelley observed that Simila had no

swelling in any of his joints, a normal grip strength, and

a “full range of motion without pain” in his wrists,

elbows, shoulders, hips, knees, ankles, and feet. Dr. Shelley

diagnosed “arthralgias and myalgias of uncertain etiology” and “headaches,” and noted that he did “not see

evidence to suggest the significance of an arthritic condition.”
No. 07-3682 5

Throughout this time, Simila did not work and drew

disability compensation from his union. Dr. Enders and

Dr. Bartynski each twice signed off on Simila’s disability

forms. On the second of Dr. Enders’s forms, completed

December 3, Dr. Enders noted that Simila had been continuously disabled from October 2, 2002 through “indefinite.”

In 2003, Simila continued seeing Dr. Enders and also

began treatment at the Mayo Clinic. At Mayo, he

repeated his complaints of headaches and back, joint, and

muscle pain, especially during physical activity. Doctors

noted that Simila described how his joints hurt after he

helped a friend replace a gas tank and how his fingers

would become numb when he used a hammer or went

bowhunting. Several tests gave some explanation for

Simila’s back problems. In Simila’s lumbar spine, tests

showed “degenerative disk disease with slight narrowing

of the 3rd and 4th lumbar disks with broad-based

disk bulges and small associated annular tears,” and in

his cervical spine, tests showed “mild degenerative

changes.” However, doctors noted that Simila’s spine

had a normal pain-free range of motion with “a slight

increase in pain with aggressive palpation of the right

sacroiliac joint.” Doctors also found that Simila had

full range of pain-free motion in all four extremities. In

addition, like the doctors at Midelfort, multiple doctors

at Mayo noted that Simila was overusing his pain medication; they did note, though, that Simila expressed

interest in getting off of it. Simila continued to receive

disability payments from his union, and Dr. Enders’s

colleague, Dr. Usher, signed off on Simila’s union

disability form.
6 No. 07-3682

Simila’s doctors tried several different forms of treatment to reduce his pain, some of which were more successful than others. Physical therapy was one of the less

effective. Noting that Simila “enjoys hunting, fishing,

and four wheeling and playing hockey,” the therapist

developed a treatment plan for Simila with the goal of

reducing Simila’s symptoms by 50-75%. But Simila never

returned after the first session and was subsequently

discharged. Doctors also tried additional medications,

which had some temporary success. Dr. Enders prescribed

Depakote for headaches, and after a month, Simila reported that his headaches were “much less frequent.” By

March 2003, Simila reported he was “about 90% better.”

Dr. Enders also prescribed Prednisone, a steroid, to

improve Simila’s muscle and joint pain. The Prednisone

was so effective that after two weeks Simila reported a

marked decrease in pain; Simila said “it is all gone.” Dr.

Enders noted that “he was feeling so good that he has

been doing some fairly heavy work for the last week

involving peeling logs and helping to build a log

home.” Simila reported only normal muscle soreness

and stiffness after that work. Simila also instructed

Dr. Enders not to complete another union disability form,

and around April 2003, Simila returned to work as a construction laborer. But it didn’t last. Due to Prednisone’s

side effects, Simila’s doctors reduced the dosage, after

which Simila complained that his pain symptoms had

flared back up. Simila stopped work again sometime

during the summer or fall of 2003. (Although the ALJ

found Simila to only have worked during June and

July, some medical records indicate that Simila was

working as late as September.)
No. 07-3682 7

Doctors continued to try different medications to

treat Simila’s pain but saw limited success. They

tapered Simila off Prednisone and started him on Enbrel,

a medication for joint pain taken by injection, which

worked relatively well at first (Simila reported “about

75 percent improvement of his symptoms”). But again

Simila’s complaints of pain returned, and in November 2003, Simila sought Dr. Kent, a rheumatologist, to

approve his union disability form. Dr. Kent signed the

form but wrote, “While his musculoskeletal pain makes

hard physical labor extremely difficult, I see no reason

he couldn’t perform clerical work, etc.” Simila had also

returned to using narcotic pain medications, such as

Vicodin.

At this point, Simila’s doctors had become increasingly

uncertain of the cause of Simila’s pain. They initially

thought it was spondyloarthropathy, an inflammatory

joint disease, but Simila had no response to a medication

that targeted that disease. Dr. Kent opined that Simila’s

joint pain was most likely related to “chronic pain syndrome,” and another doctor suggested “myofascial pain

syndrome/fibromyalgia” due to a lack of any objectively

observable inflammation. When Dr. Kent was again

asked to complete Simila’s union disability form, he

noted that he told Simila “it is unclear to me why he

is totally disabled, and this makes it difficult for me

then to fill out his forms and make any predictions

about the future.” Dr. Kent eventually signed the form

and indicated that Simila was disabled from October 15,

2003 through “currently.”
8 No. 07-3682

In December 2003, Dr. Muceno, a Wisconsin state

medical consultant, reviewed Simila’s medical records

to determine his “residual functioning capacity.” Dr.

Muceno concluded that Simila could lift or carry up to

fifty pounds occasionally and twenty-five frequently;

that Simila could stand, walk, or sit for a total of six

hours in an eight-hour workday; and that Simila had no

postural, manipulative, visual, communicative, or environmental limitations. (This report was subsequently

confirmed by another state medical consultant several

months later.)

By 2004, Simila’s doctors appeared to have few

remedies left to try; Dr. Michet, a rheumatologist at the

Mayo Clinic, noted that Simila’s treatment was “at an

impasse.” Dr. Michet recommended three infusions of

Remicade, a drug used to treat autoimmune disorders,

and stated that if Simila had not improved after that,

“then we are going to have to conclude that he has developed more of a fibromyalgic or myofascial chronic pain

disorder. . . . [T]he next step for managing that would be

a chronic pain rehab consultation.” After the infusions,

Simila had not improved. X-rays were taken of Simila’s

spine, which again revealed “mild degenerative

changes.” Simila continued to take Vicodin regularly.

In 2005, Simila was prescribed physical therapy by

doctors at the Pain Clinic of Northwestern Wisconsin,

although he stated that he was not interested in longterm therapy. A month later the Pain Clinic discharged

Simila because a toxicology screen showed evidence of

cocaine. Until that time, the Pain Clinic had been pro-
No. 07-3682 9

viding Simila his Vicodin. After his discharge, Simila

called the Midelfort Clinic and requested that they prescribe him Vicodin, explaining that “due to financial

reasons,” he could no longer get it from the Pain Clinic.

Simila received a prescription for a refill.

B. Psychological Evaluation

At the request of Simila’s attorney, Dr. Paul Caillier

psychologically examined Simila in February 2006.

Dr. Caillier reviewed Simila’s medical records and conducted an in-person evaluation, which included Simila

completing a Minnesota Multiphasic Personality Inventory (“MMPI-2”). Dr. Caillier wrote a letter to Simila’s

attorney, dated March 1, 2006, in which he concluded

that Simila had chronic pain syndrome and a somatoform

conversion disorder (a mental condition that causes a

person to experience physical symptoms of a purely

psychological origin).

Dr. Caillier talked with Simila about his symptoms

and medical history. Dr. Caillier noted that Simila’s

mood was normal and he had “adequate attention and

concentration to the task at hand.” Simila described his

symptoms in “dramatic fashion,” explaining that his pain

kept him from functioning and that Vicodin helped

only minimally. Dr. Caillier noted Simila’s other doctors

could not explain his pain and that Simila was concerned about whether his children would develop his

symptoms, which Dr. Caillier wrote “was typical of Mr.

Simila’s dramatic presentation.” In addition, Dr. Caillier

interpreted Simila’s MMPI-2 results and found they
10 No. 07-3682

revealed a “classical conversion V pattern,” which

meant that Simila converted stress and anxiety into

physical pain.

From his observations and the test results, Dr. Caillier

concluded that Simila’s somatoform disorder and chronic

pain limited his functioning. Dr. Caillier completed a

“Psychiatric Review Technique” (a standard Social

Security disability form), and on it, he noted that Simila

had “marked” restrictions of daily living activities;

“moderate” difficulties in maintaining social functioning;

“marked” difficulties in maintaining concentration,

persistence, or pace; and “one or two” episodes of

decompensation (an acute deterioration of a person’s

mental health) of extended duration. From these

findings, Dr. Caillier concluded that Simila’s mental

impairments met the requirements of Listing 12.07,

Somatoform Disorders, 20 C.F.R. Pt. 404, Subpt. P, App. 1,

which would classify Simila as “disabled” for Social

Security purposes. In the end, Dr. Caillier recommended

that Simila take anti-depressant medications and receive

counseling. Simila had not sought counseling by the

time of the hearing and the record does not reveal

whether Simila took anti-depressants.

C. Simila’s Testimony

Simila testified at a hearing before the ALJ on April 11,

2006. He described his prior employment as a construction laborer and how he worked as a bartender once a

week and carpet installer occasionally. He testified that

he would do a little more carpet installation work when

construction was slow.
No. 07-3682 11

Simila talked mostly about his pain, though—how

it affected his life and what he was able to do despite it.

He testified that he felt constant pain in his joints, shoulders, elbows, neck, knees, ankles, and hips. His daily

routine was limited and he barely got off the couch.

He testified that he takes his children to school in the

morning but upon return must take Vicodin and lie

down for a few hours. (He testified that he often has to lie

down if he stands or sits too long.) However, he is able

to drive, pick up a gallon of milk from the grocery, and

run the vacuum; he usually makes dinner for his family.

Simila also testified that any physical activity exacerbates his pain; he will “pay for it the next day.”

He testified that he cannot shovel snow or do car maintenance. But he does engage in some physical and recreational activities. He occasionally helps friends with

various projects, such as the time he peeled logs

and constructed a log home or when he helped clean a

motorboat engine. However, he testified that, when

building the log home, he was on Prednisone and feeling

much better. (He also testified that his son did most of

the log-home-building work; his sons would have been

ages eleven and six at the time.) In addition, he attends

his children’s traveling hockey team games. He testified

that he can stand for only twelve minutes (one period of

hockey) and must sit between periods and sometimes

during periods.

Simila also enjoys fishing and hunting. When he hunts,

though, he testified that he can walk only about

400 yards into the woods before he has to sit down, and
12 No. 07-3682

he can stay seated for only about four hours. He went

ice fishing in the winter prior to the hearing but testified

that he did little work and sat in his truck most of the

time. He also went fishing two weeks before the hearing. He testified that the arm with which he cast and jigged

his bait was “pretty much useless” the following day.

Finally, Simila testified that he still takes Vicodin regularly, and after physical activity, he sometimes “overeats”

his narcotic pain medication. He testified that he has not

been to any psychological counseling, but if Dr. Caillier

recommended it, he would go.

D. Medical Expert’s Testimony

Dr. Andrew Steiner, a doctor of physical medicine and

rehabilitation, reviewed Simila’s medical records and

testified that, in his opinion, there was a lack of objective

evidence that Simila was disabled. Dr. Steiner testified

that the evidence showed “mild degenerative disk disease

changes” in the lumbar part of Simila’s back and “mild

osteoarthritic changes” in his neck. He also found

that Simila had some degree of hearing loss in highfrequency situations. However, he found no evidence of

any significant joint deformities, loss of range of motion,

or gout.

Based on these findings, Dr. Steiner concluded that

Simila could perform “light work,” which translates to

jobs that require lifting up to twenty pounds occasionally

and ten frequently; standing and walking for up to six

hours; and sitting for up to two. Further, Dr. Steiner
No. 07-3682 13

opined that Simila should be precluded from jobs involving hazardous machinery or unprotected heights

due to his hearing loss. Dr. Steiner specified that his

opinion concerned only Simila’s physical condition and

not any psychological disorders. 

E. Vocational Expert’s Testimony

Finally, the ALJ asked William Villa, a vocational expert,

several hypothetical questions to determine whether

there were any jobs that Simila could perform given

his limitations. The ALJ first described a hypothetical in

which Simila was limited to light, unskilled work that

did not involve hazardous machinery or heights. She

described Simila as having the following ailments:

myofascial pain or musculoskeletal pain disorder, mild

degenerative changes in the lumbar and cervical spine,

intermittent gout, headaches, high-frequency hearing

loss, chronic pain syndrome, and somatoform disorder.

Based on this hypothetical, Villa concluded that Simila

could perform a significant number of jobs in the

national economy. The ALJ then limited the hypothetical

to “sedentary work” only, and Villa still concluded that

there were a significant number of jobs that Simila could

perform. Finally, when the ALJ altered the hypothetical

to describe a person who was unable to show up

regularly for work, Villa concluded that there would not

be any jobs available.
14 No. 07-3682

F. The ALJ’s Opinion

The ALJ evaluated Simila’s claim for disability under

the mandatory five-step sequential analysis. See 20 C.F.R.

§§ 404.1520(a)(4) (DIB), 416.920(a)(4) (SSI). The fivestep analysis requires the ALJ to examine:

(1) whether the claimant is currently

[un]employed; (2) whether the claimant has a

severe impairment; (3) whether the claimant’s

impairment meets or equals one of the impairments listed by the [Commissioner], see 20 C.F.R.

§ 404, Subpt. P, App. 1; (4) whether the claimant

can perform [his] past work; and (5) whether the

claimant is capable of performing work in the

national economy.

Clifford v. Apfel, 227 F.3d 863, 868 (7th Cir. 2000) (first and

second alterations in original). To determine whether the

claimant is able to perform his past work or is capable

of performing other work (steps four and five), the ALJ

assesses the claimant’s residual functioning capacity

(“RFC”). See 20 C.F.R. §§ 404.1520(e), 404.1560(b)-(c),

416.920(e), 416.960(b)-(c). A claimant’s RFC is “the most

[the claimant] can still do despite [his] limitations,” and the

ALJ determines a claimant’s RFC based on all the claimant’s impairments and all the relevant evidence in the

record. Id. §§ 404.1545(a), 416.945(a).

At step one, the ALJ found that Simila had not

engaged in substantially gainful activity after the

alleged onset of disability. The ALJ deemed Simila’s

temporary employment in the summer of 2003 an “unsuccessful work attempt” and not fatal to his claim. At
No. 07-3682 15

step two, the ALJ found that Simila had multiple severe

impairments due to musculoskeletal or myofascial pain,

mild degenerative disk disease, headaches, high-frequency

hearing loss, chronic pain syndrome, and somatoform

disorder. At step three, the ALJ concluded that none

of Simila’s impairments, physical or psychological, met

or medically equaled any of the listed impairments.

Then, the ALJ found that Simila had an RFC of “light,

unskilled work” based on the objective medical evidence,

Simila’s course of treatment, his daily activities, his

work history, and the medical expert’s opinion. Accordingly, at step four, the ALJ concluded that Simila

could not perform his past work as a construction laborer. However, at step five, the ALJ accepted the vocational expert’s testimony, concluded that there were

a substantial number of jobs in the national economy

that Simila could perform, and ultimately found that

Simila was not disabled.

G. Simila’s Appeals

Simila took his case to the Appeals Council and submitted additional evidence in the form of a letter from

Dr. Caillier to Simila’s attorney, dated June 22, 2006. In

that letter, Dr. Caillier elaborated on his previous report

and responded to the ALJ’s concerns regarding the

severity of Simila’s mental disorders. The Appeals

Council denied Simila’s appeal and therefore made the

ALJ’s opinion the final decision of the Commissioner. See

Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008). Simila

then filed suit in the district court, which affirmed the

ALJ’s decision and ruled that Dr. Caillier’s June 22 letter
16 No. 07-3682

was not “new” and “material” evidence and therefore

should not be included as part of the record for

judicial review. Simila v. Astrue, No. 07-C-0029-C, 2007 WL

5490605 (W.D. Wis. Oct. 1, 2007). Simila then appealed

to this court.

II. Discussion

We review the ALJ’s decision directly, but we play an

“extremely limited” role. Elder v. Astrue, 529 F.3d 408,

413 (7th Cir. 2008). We will not “displace the ALJ’s judgment by reconsidering facts or evidence, or by making

independent credibility determinations.” Id. Instead, we

look to whether the ALJ built an “accurate and logical

bridge” from the evidence to her conclusion that the

claimant is not disabled. Craft, 539 F.3d at 673. We will

affirm the ALJ’s decision if it is supported by substantial evidence, which is “such relevant evidence as a

reasonable mind might accept as adequate to support a

conclusion.” Id. (quoting Barnett v. Barnhart, 381 F.3d 664,

668 (7th Cir. 2004)). Therefore, “even if ‘reasonable

minds could differ concerning whether [Simila] is disabled,’ ” we affirm if the ALJ’s decision has adequate

support. Elder, 529 F.3d at 413 (quoting Schmidt v. Astrue,

496 F.3d 833, 842 (7th Cir. 2007)).

Simila raises four points on appeal. He argues that (1) the

ALJ erroneously rejected Dr. Caillier’s conclusions about

the intensity of Simila’s somatoform disorder and chronic

pain syndrome; (2) the ALJ erred in evaluating Simila’s

credibility; (3) the ALJ’s hypothetical question to the

vocational expert omitted key facts; and (4) the
No. 07-3682 17

district court should have remanded because Dr.

Caillier’s June 22, 2006 letter was new and material evidence.

A. The ALJ’s Decision to Discount Dr. Caillier’s Letter

of March 1, 2006

Simila first argues that the ALJ erroneously declined

to place significant weight on Dr. Caillier’s findings

regarding the intensity of Simila’s impairments. The ALJ

did not challenge the underlying diagnoses that Simila

had a somatoform disorder and chronic pain syndrome.

Rather, she discounted Dr. Caillier’s conclusions concerning the degree of functional limitation that Simila’s

ailments cause, because they were “not supported by

the objective evidence of record and [were] inconsistent

with claimant’s testimony.” The ALJ instead concluded

that Simila’s disorders resulted in only mild restrictions

of activities of daily living; mild difficulties maintaining

social functioning; moderate difficulties maintaining

concentration, persistence, and pace; and zero episodes

of decompensation. Consequently, at step three in the

sequential analysis, the ALJ found that Simila’s impairments did not meet or equal a “Listing Level,” which

would have automatically declared Simila disabled,

20 C.F.R. § 404.1520(a)(4)(iii), and at steps four and five,

the ALJ found that Simila had an RFC for light, unskilled

work, id. § 404.1520(a)(4)(iv)-(v).

Before we evaluate whether the ALJ properly weighed

Dr. Caillier’s conclusions, we must first determine what

type of “medical source” Dr. Caillier is. If Dr. Caillier
18 No. 07-3682

is deemed a “treating source,” then the regulations

require that the ALJ give his opinions controlling weight,

as long as they were supported by medical findings

and consistent with substantial evidence in the record.

See 20 C.F.R. § 404.1527(d)(2); Skarbek v. Barnhart, 390

F.3d 500, 503 (7th Cir. 2004). If Dr. Caillier is a “nontreating

source,” however, the ALJ was not required to assign

his opinion controlling weight. White v. Barnhart, 415

F.3d 654, 658 (7th Cir. 2005). Instead, the ALJ was permitted to evaluate the opinion’s weight in light of other

factors. See 20 C.F.R. § 404.1527(d)(2)-(6); Elder, 529 F.3d

at 415.

A nontreating source is “a physician, psychologist, or

other acceptable medical source who has examined you

but does not have, or did not have, an ongoing treatment relationship with you.” 20 C.F.R. § 404.1502.

Dr. Caillier falls squarely within this definition. He examined Simila only once, and nothing in the record suggests anything “ongoing” about their treatment relationship. Furthermore, the regulations specifically define

a nontreating source as any doctor with whom the claimant’s relationship was “not based on your medical need

for treatment or evaluation, but solely on your need to

obtain a report in support of your claim for disability.” Id.

Dr. Caillier evaluated Simila at the behest of Simila’s

attorney, evidenced by the fact that Dr. Caillier’s “report”

was in fact a letter addressed to the attorney and not

to Simila. Accordingly, Dr. Caillier’s opinions were not

entitled to controlling weight.

Simila attacks the ALJ’s decision to discount Dr. Caillier’s

conclusions on a number of grounds. Primarily, Simila
No. 07-3682 19

contends that the ALJ improperly rejected the opinion

of the only psychologist in the case, which left the

ALJ without an adequate basis to assess the effect of

Simila’s somatoform disorder. In this sense, Simila argues

that the ALJ “played doctor,” because she had no other

psychological expert opinion in which to ground her

findings. See Blakes ex rel. Wolfe v. Barnhart, 331 F.3d 565,

570 (7th Cir. 2003). We find Simila’s view of the ALJ’s

role in evaluating psychological evidence too narrow.

Although another psychologist’s opinion would have

augmented the ALJ’s analysis, neither the regulations

nor our prior decisions require the ALJ to rely on such

specific evidence to rebut a nontreating physician. “[T]he

administrative law judge is not required or indeed permitted to accept medical evidence if it is refuted by other

evidence—which need not itself be medical in nature . . . .”

Wilder v. Chater, 64 F.3d 335, 337 (7th Cir. 1995) (emphasis

added). Instead, an ALJ is required to determine the

weight a nontreating physician’s opinion deserves

by examining how well Dr. Caillier supported and explained his opinion, whether his opinion is consistent

with the record, whether Dr. Caillier is a specialist in

pain disorders, and any other factor of which the ALJ

is aware. 20 C.F.R. § 404.1527(d)(3)-(6).

This is precisely what the ALJ did here, declining to

give Dr. Caillier’s opinion substantial weight because it

lacked consistency and supportability. The ALJ noted

that Dr. Caillier found that Simila had marked restrictions of daily living activities. But she concluded that

this was inconsistent with Simila’s testimony that he

regularly took his children to school, often made dinner
20 No. 07-3682

for his family, went hunting and fishing with friends

and family, attended his son’s traveling hockey team

games, and worked with friends on side-projects. Dr.

Caillier discussed none of these activities in his March 1

letter, despite the fact that Dr. Caillier appeared to base

his conclusions concerning Simila’s functional limitations on Simila’s subjective complaints (Dr. Caillier

did not claim that the MMPI-2 results—the only arguably

objective measurement Dr. Caillier took—revealed the

intensity of Simila’s mental disorder). Furthermore, the

ALJ discounted Dr. Caillier’s opinion as to Simila’s

social functioning because it, too, was unsupported by

and inconsistent with the evidence. Nothing in the

record (or in Dr. Caillier’s letter) suggests that Simila

had problems getting along with his family or friends or

with the crowds at hockey games. Instead, the ALJ pointed

out that, throughout his medical treatment, Simila’s

doctors consistently described him as “pleasant” and

“enjoyable.”

The ALJ also found little support for Dr. Caillier’s

conclusions that Simila had marked difficulties maintaining concentration, persistence, or pace, and had

experienced one or two episodes of decompensation.

Dr. Caillier’s letter mentioned Simila’s capacity for concentration only once, in which he noted that Simila had

“adequate attention and concentration to the task at

hand.” This was consistent with what Dr. Chukwudelunzu observed several years earlier when he found that

Simila “demonstrate[d] adequate . . . concentration and

memory during history and neurologic examination.”

Simila argues that this does not prove that Simila can
No. 07-3682 21

maintain attention and concentration throughout the

workday. But Simila’s argument misses the point. In

determining what weight to give a nontreating physician’s

opinion, the ALJ is required to look for support. Id.

§ 404.1527(d)(3). Although these observations may not

prove whether Simila can concentrate on full-time work,

they certainly do not support Dr. Caillier’s opinion that

Simila is markedly deficient in that area.

Simila also attacks the ALJ’s finding that Dr. Caillier

did not perform a “mental status exam,” citing the fact

that Dr. Caillier prefaced his observations with the

words “on exam.” Whether these two words prove the

ALJ incorrect, we cannot say. Those two words don’t tell

us much about what kind of exam Dr. Caillier was performing. Nonetheless, any error here was harmless

given the other reasons the ALJ cited for discounting

Dr. Caillier’s opinions. We agree with the ALJ that

Simila’s hunting and fishing, attending travel hockey

games, and helping friends with maintenance and construction projects are inconsistent with Dr. Caillier’s

conclusions about Simila’s functional limitations.

Simila presents a barrage of other arguments, but to

no avail. Simila contends that the ALJ ignored objective

evidence supporting Dr. Caillier’s opinions, such as the

MMPI-2 results, Dr. Michet’s note about Simila needing

chronic pain rehab, and Dr. Steiner’s testimony that it

is not unusual for doctors treating a person with

somatoform to not find any physical causes. But the ALJ

did discuss the MMPI-2, and as we mentioned, the

results of that test said nothing about the intensity of
22 No. 07-3682

Simila’s pain, but only that Simila had a somatoform

disorder, which the ALJ accepted as true. Moreover, the

ALJ is not required to discuss every piece of evidence

but is instead required to build a logical bridge from the

evidence to her conclusions. Craft, 539 F.3d at 673. Although snippets of Dr. Michet’s notes and Dr. Steiner’s

testimony might support Dr. Caillier’s opinions, other

objective evidence is inconsistent with it: Many of

Simila’s medical records state that Simila had a normal,

pain-free range of motion and normal strength, and

Dr. Kent wrote that it was “unclear to me why [Simila]

is totally disabled” and he saw “no reason he couldn’t

perform clerical work.”

Simila also argues that the ALJ erred by failing to

mention that Dr. Caillier is a neuropsychologist

whose opinions deserve more weight. See 20 C.F.R.

§ 404.1527(d)(5). But the regulations state that a

specialist’s opinion is generally entitled to more weight;

it is not presumptively so (unlike treating physicians).

Id. (emphasis added). Mentioning Dr. Caillier’s specialty

might have made the ALJ’s opinion more complete,

but in light of the other evidence the ALJ cited, it

would not have changed the outcome.

Finally, Simila argues that the ALJ erred by not

seeking additional evidence before rendering a decision.

See id. § 404.1527(c)(3). “An ALJ has a duty to solicit

additional information to flesh out an opinion for

which the medical support is not readily discernable.”

Barnett, 381 F.3d at 669. Simila relies on Barnett to

contend that the ALJ was required to recontact Dr.
No. 07-3682 23

Caillier because she found his opinion unsupported by

the record. Simila reads Barnett too broadly. An ALJ is

entitled to evaluate the evidence and explanations

that support a medical source’s findings. See 20 C.F.R.

§ 404.1527(d)(3). And she need not recontact the source

every time she undertakes such an evaluation, but only

if, as we said in Barnett, “the medical support is not

readily discernable.” 381 F.3d at 669 (emphasis added); see

also Skinner v. Astrue, 478 F.3d 836, 843 (7th Cir. 2007)

(“ALJs may contact treating physicians for further information when the information already in the record is

‘inadequate’ to make a determination of disability . . . . ”).

Here, the ALJ discerned and discussed the evidence

upon which Dr. Caillier relied: the MMPI-2 results, his

review of Simila’s medical records, and Simila’s subjective complaints. This record was not “inadequate.” The

ALJ simply found that this evidence failed to support

Dr. Caillier’s conclusions, a finding the regulations

entitled her to make.

In one instance, though, the ALJ should have recontacted Dr. Caillier. The ALJ observed that “[I]t is

unclear whether Dr. Caillier had access to the records

indicating some concern with claimant’s narcotic usage.”

We agree with Simila that “unclear” is tantamount to “not

readily discernable.” However, we believe the ALJ’s

error did not affect the outcome. And, again, the ALJ

need not mention every strand of evidence in her decision but only enough to build an “accurate and logical

bridge” from evidence to conclusion. Craft, 539 F.3d at

673. The ALJ’s discussion of the lack of consistency and

support for Dr. Caillier’s opinion built that bridge. Ac-
24 No. 07-3682

cordingly, the ALJ’s decision to discount that opinion

was supported by substantial evidence.

B. The ALJ’s Credibility Determination

Simila next disputes the ALJ’s finding that his testimony was “not entirely credible.” We review an ALJ’s

credibility determination with deference, for an ALJ, not

a reviewing court, is in the best position to evaluate

credibility. Craft, 539 F.3d at 678. We reverse that determination only if it is so lacking in explanation or support that we find it “patently wrong.” Elder, 529 F.3d at

413-14 (quotation omitted). An ALJ may not “discredit

the claimant’s testimony as to subjective symptoms

merely because they are unsupported by objective evidence.” Carradine v. Barnhart, 360 F.3d 751, 753 (7th

Cir. 2004) (quotation omitted); see also 20 C.F.R.

§ 404.1529(c)(2). To evaluate credibility, an ALJ must

“consider the entire case record and give specific

reasons for the weight given to the individual’s statements.” SSR 96-7p. In other words, the ALJ should look

to a number of factors to determine credibility, such as

the objective medical evidence, the claimant’s daily

activities, allegations of pain, aggravating factors, types

of treatment received and medication taken, and “functional limitations.” See 20 C.F.R. § 404.1529(c)(2)-(4);

Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir. 2006)

(citation omitted). In the end, “[a]n ALJ may disregard

a claimant’s assertions of pain if he validly finds her

incredible.” Prochaska, 454 F.3d at 738.
No. 07-3682 25

Simila argues that the ALJ improperly discounted

his testimony as to the intensity of his symptoms

and the limitations that stem from them. Relying

primarily on our opinion in Carradine, 360 F.3d at 754-56,

Simila contends that the ALJ ignored the psychological

nature of his illness, relied too heavily on objective

medical evidence, mischaracterized Simila’s past medical

treatment, and incorrectly found his current activities

inconsistent with his subjective complaints of pain. Along

these lines, Simila also contends that the ALJ selectively

considered the evidence, looking only to which types of

activities Simila performed but not to how he performed

them or to activities he could no longer perform.

Though the ALJ’s credibility determination was not

flawless, it was far from “patently wrong.” The ALJ had

plenty of reason to doubt Simila’s description of his

symptoms and the extent of the constraints they impose.

To begin with, Simila’s case is not quite Carradine. In

Carradine, we reversed an ALJ’s finding of no disability

where the ALJ failed to appreciate the psychological

nature of the claimant’s somatoform disorder and relied

primarily on the lack of objective medical data to

support his conclusions. 360 F.3d at 754-55. The ALJ in

that case concluded that the claimant’s somatoform

disorder “implies she exaggerates the severity of symptoms she reports.” Id. at 754. That’s wrong. That the

claimant has a somatoform disorder means merely that

the pain has a psychological cause rather than a

physical one. Id.
26 No. 07-3682

Here, the ALJ didn’t make such a mistake. Instead, the

ALJ had a host of facts upon which to base her opinion

that Simila overstated his symptoms. Chief among them

was evidence of Simila’s activities. Simila helped a

friend peel logs and build a log home; he replaced a

gas tank; he attended his son’s traveling hockey team

tournaments; he went hunting and fishing (including

ice fishing in the winter and fishing from a boat just

weeks before the hearing). These are not light tasks. They

require extended physical exertion, which Simila was

seemingly able to perform. We disagree with Simila’s

contention that these activities are akin to the occasional

driving, shopping, housework, and therapeutic walking

discussed in Carradine. Id. at 755-56.

Simila argues that the ALJ failed to follow SSR 96-7p

by “selectively considering the evidence” and not discussing how Simila engaged in these activities. But the ALJ

specifically noted Simila’s testimony regarding the

length of time Simila spent doing each activity and that

such activities “exacerbate his pain.” The ALJ merely

discounted Simila’s credibility as to how much this

pain limited his functioning—Simila’s continuing to

hunt, fish, and go to hockey tournaments led the ALJ

to conclude that Simila can adequately deal with any

increase in his symptoms. Moreover, Simila’s attempts

to downplay his activities contradict several of his doctors’ reports and, in some instances, common sense. The

reports reflect Simila’s ongoing participation in

certain activities (e.g., “the patient enjoys hunting, fishing,

and four wheeling and playing hockey”) as opposed to

one or two discrete events. And, as we’ve already men-
No. 07-3682 27

tioned, one physician, Dr. Kent, openly questioned

Simila’s claims for disability (“I see no reason he couldn’t

perform clerical work, etc.”). Even Dr. Caillier noted

Simila’s tendency to describe his symptoms in “dramatic

fashion.” Moreover, Simila’s description of how he engaged in certain activities is equally dubious: When

asked about peeling logs and building the log home,

Simila didn’t point to the prednisone injections and say

he felt good enough to work. Instead, he responded, “my

son was doing most of the work. . . . I was there along

with him.” Simila’s sons were eleven and six years old

at the time. Though we don’t doubt their strength,

peeling logs (which often requires using a chainsaw)

might make even Paul Bunyan a little tired.

In addition, the ALJ discussed the utter lack of objective

medical evidence that might bolster Simila’s complaints

of severe, disabling pain. Doctors consistently reported

that Simila had a normal, pain-free range of motion in

his limbs and spine, mostly normal strength, and only

mild degenerative disk disease in part of the spine. One

physician even noted that Simila exhibited some “giveaway weakness,” which can be a sign that the patient is

trying to deceive his physician by feigning true muscle

weakness. See LEZAK ET AL.,supra, at 326; Hans E. Neville et

al., Neuromuscular Diseases, in NEUROLOGY FOR THE NONNEUROLOGIST 324 (William J. Weiner & Christopher G.

Goetz eds., 5th ed. 2004) (“[A] ‘give-away’ pattern of

weakness . . . suggests lack of full voluntary effort.”);

Leonard N. Green, Malingering, Dissimulation and Conversion—Hysteria, in TRAUMA 43-6-8[3] (Matthew Bender &

Co. 2003) (“Because the deceptive patient is unaware or
28 No. 07-3682

uncertain as to how much strength to exert and is not

exerting maximal strength as he or she is asked to do, the

resulting effort produces a ratchety, irregular, sudden

‘give-away’ feeling to the examiner’s counteraction. By

contrast, the examiner finds a smooth loss of muscle

resistance in a truly weakened limb.”); cf. LEE R. RUSS

ET AL., 8 ATTORNEYS MEDICAL ADVISOR § 74:80 (reissued

ed. 2005) (noting that “[e]xaminers sometimes employ a

‘give away weakness’ test to demonstrate that a patient

is faking muscle weakness,” but expressing some doubt

as to applicability of test to patients with Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome).

All this is on top of the fact that a set of government

medical examiners concluded that Simila could carry or

lift over 20 pounds occasionally and over 10 pounds

frequently. In short, Simila’s medical history offers little

or no for support his testimony.

Simila attacks the ALJ’s reliance on this lack of objective evidence in light of our holding in Carradine.

In Carradine, the ALJ plainly misunderstood the psychological nature of the claimant’s illness and his heavy

reliance on the lack of an objective medical explanation

for the claimant’s pain contributed to that error. 360 F.3d

at 755. But Carradine does not imply that an ALJ can

never consider the lack of objective evidence in rejecting

a claimant’s subjective complaints. Such a reading

would nullify 20 C.F.R. § 404.1529(c)(2) and (4), which

require an ALJ to consider the objective medical evidence.

Instead, Carradine, consistent with the regulations, stands

for the proposition that an ALJ cannot deny disability

“solely because the available objective medical evidence
No. 07-3682 29

does not substantiate [the claimant’s] statements.” 20

C.F.R. § 404.1529(c)(2) (emphasis added). Here, the ALJ

considered the objective evidence along with a host

of other factors named in the regulations, see id.

§ 404.1529(c)(2)-(4), like Simila’s activity levels, as

we’ve discussed.

The ALJ also evaluated Simila’s course of treatment and

employment history. She found Simila’s treatment—

various pain medications, several injections, and one

physical therapy session—to be “relatively conservative”

and inconsistent with Simila’s complaints. Simila assails

the ALJ for “playing doctor” and improperly evaluating

the extent of his treatment. Simila again likens his case

to Carradine, in which we observed that the claimant’s

extensive treatment regimen actually bolstered her credibility. 360 F.3d at 755. However, the regulations expressly permit the ALJ to consider a claimant’s treatment

history. 20 C.F.R. § 404.1529(c)(3)(v). Given the deference

we show to an ALJ’s factual determinations, Craft, 539

F.3d at 673, we will not question the ALJ’s finding that

Simila’s treatment was “relatively conservative,” especially

when compared with Carradine’s treatment that

included morphine and a surgical implant in her spine.

See Carradine, 360 F.3d at 755.

Moreover, Simila seemed to have his own idea of what

type of treatment he needed—the record shows a

pattern of drug-seeking behavior. Multiple physicians

throughout the course of his treatment noted that Simila

was overusing his pain medication and that such overuse

might actually be causing some of his symptoms (e.g.,
30 No. 07-3682

“superimposed narcotic-induced headache”). Even

Simila admitted that he occasionally “overeats” his pain

pills. In addition, Simila has a history of cocaine use, and

in 2005, the Pain Clinic of Northwestern Wisconsin discharged Simila after a toxicology screening showed

evidence of cocaine. This cut off his supply of Vicodin.

But Simila had to have it. So he called the Midelfort

Clinic for a refill and lied, telling them he couldn’t get a

prescription from the Pain Clinic for “financial reasons.”

Though Simila was successful in getting more pills, this

is hardly the kind of conduct that helps one succeed on

a disability claim.

Not only was Simila all too eager to take his narcotic

pain medication, which his doctors cautioned against

overusing, but he was rather unwilling to participate in

physical therapy, which his doctors prescribed—twice.

Simila never showed up after his first session. When

his doctors recommended physical therapy again, he said

he wasn’t interested. Furthermore, despite the fact that

Simila learned that the source of his pain was psychological and despite Dr. Caillier’s recommendation for

therapy, Simila hadn’t sought counseling by the time of

the hearing. So again we see a lack of sincerity that explains the ALJ’s doubting Simila’s testimony.

Finally, the ALJ found that Simila’s work history also

undermined his credibility. Simila contests this point,

arguing that the ALJ misinterpreted his employment

records. Simila is correct that the ALJ erred when she

stated that Simila’s earnings declined from 1997 until

2003. In fact, they declined until only 2001, then rose
No. 07-3682 31

slightly in 2002, and declined again in 2003. But this

minor mistake was harmless. In 1996, Simila’s earnings

were $36,980.50 and by 2001 were $10,682.29. They rose

to only $15,909.67 in 2002, less than half of what they

were in 1996. Although Simila testified that he bartended

once a week and occasionally installed carpet, the ALJ

found that Simila’s declining earnings prior to the onset

of his alleged disability, coupled with the fact that Simila

did not participate in a vocational rehabilitation

program, showed a lack of effort to find work and, under

§ 404.1529(c)(3), diminished his credibility. Such a

finding was not improper.

Accordingly, we conclude that the ALJ properly considered both Simila’s subjective complaints and evidence

undermining the credibility of those complaints. She

based her determination on multiple factors and the

entire case record, as the regulations require. The only

evidence supporting Simila’s characterization of his

symptoms was Dr. Caillier’s assessment on the

“Psychiatric Review Technique,” which, as we have

already held, the ALJ properly discounted. The objective medical evidence, Simila’s activity levels, his course

of treatment, his drug-seeking behavior, and his employment history all counsel a healthy skepticism for

Simila’s testimony. As such, we cannot conclude that

the ALJ’s credibility determination was “patently wrong.”

C. The ALJ’s Hypothetical Questions for the Vocational

Expert

Simila also challenges the ALJ’s conclusion at step five

of the sequential analysis that there were a significant
32 No. 07-3682

number of jobs that he could perform. At step five, the

ALJ evaluates the claimant’s RFC along with his age,

education, and work experience, to determine whether

the claimant can “make an adjustment to other work.” 20

C.F.R. § 404.1520(a)(4)(v). To make this finding, ALJs

often rely on the testimony of a vocational expert (“VE”).

Commonly, the ALJ will pose a series of hypothetical

questions that describe the claimant’s conditions and

limitations, and the VE will testify to the number of jobs

that the claimant can perform based on those limitations.

This is what the ALJ and VE did here. But Simila argues

that the VE’s conclusions were faulty because the ALJ’s

hypothetical questions were incomplete. Ordinarily, an

ALJ’s hypothetical questions to a VE “must include

all limitations supported by medical evidence in the

record.” Steele v. Barnhart, 290 F.3d 936, 942 (7th

Cir. 2002). Simila contends that the ALJ omitted several

limitations that were supported by medical evidence.

Most salient to our analysis here, Simila argues, is the

ALJ’s finding that Simila had “moderate difficulties with

concentration, persistence, and pace.” In addition,

Simila argues that the ALJ should have included the

allegations that Simila could stand or sit for only a

short time, that he often needed to lie down and would

miss work frequently, and that he in fact had marked

difficulties with concentration, persistence, and pace.

We disagree with Simila regarding the latter set of

limitations, because “the ALJ is required only to incorporate into his hypotheticals those impairments and limitations that he accepts as credible.” Schmidt, 496 F.3d at 846.
No. 07-3682 33

The ALJ made clear that she did not find Simila’s symptoms to be as acute as either Dr. Caillier’s letter suggested or Simila testified. She specifically disagreed with

Dr. Caillier’s assessment that Simila had “marked” restrictions of concentration, persistence, and pace, and she

found that Simila was able to stand for up to six hours

and sit up to two. Because we found that the ALJ was

justified in discounting Dr. Caillier’s conclusions and

Simila’s credibility, we also find that she was not

required to include these limitations in her hypotheticals.

The omission of the first set of limitations—Simila’s

moderate difficulties with concentration, persistence,

and pace—is more troubling. The ALJ found these limitations to be credible, and under the ordinary rule, they

would have to be included. An exception to this rule

comes into play when the record indicates that the VE

“independently learned of the limitations (through other

questioning at the hearing or outside review of the

medical records, for example) and presumably

accounted for them.” Steele, 290 F.3d at 942. However, the

exception does not apply if the record indicates that

the VE’s testimony was confined to the limitations set

forth in the ALJ’s hypothetical question. Young v. Barnhart,

362 F.3d 995, 1003 (7th Cir. 2004).

Here, the hearing transcript indicates that the VE reviewed the record prior to testifying, and at oral argument, Simila’s attorney conceded that the VE was

present throughout the hearing and thus heard Simila’s

testimony. But the record does not indicate that the VE

based his conclusions on anything other than the ALJ’s
34 No. 07-3682

hypotheticals. Like the ALJ in Young, the ALJ here posed

a “series of hypothetical questions with increasingly

debilitating limitations” and laid out specifically the

facts upon which the VE was to base his conclusions. See

Young, 362 F.3d at 1003. The VE then prefaced his first

comments with, “Given the elements of the

hypothetical . . .” In none of his responses did the VE rely

on or even mention his review of the record or Simila’s

testimony. Instead, he focused his testimony on the ALJ’s

hypotheticals, and accordingly, we cannot assume that

the VE based his testimony on anything but those

hypotheticals. Our review is thus confined to the questions the ALJ posed and whether those questions incorporated Simila’s moderate difficulties with concentration, persistence, and pace.

We find that the ALJ adequately accounted for Simila’s

impairments. In her first hypothetical, the ALJ described

all of Simila’s credible impairments, physical and mental,

including Simila’s chronic pain and somatoform. She

then stated that “because of the allegations of pain,

I would also further limit it to unskilled,” as well as

limiting the second hypothetical to “sedentary level work.”

We have held that claimants who “often experience[ ]

deficiencies of concentration, persistence, or pace” are

capable of performing semiskilled work, Jens v. Barnhart,

347 F.3d 209, 213 (7th Cir. 2003), and those who are

“mildly to moderately limited in these areas,” are able to

perform “simple and repetitive light work,” Sims v.

Barnhart, 309 F.3d 424, 431 (7th Cir. 2002). Simila’s moderate difficulties with concentration, persistence, and

pace stemmed from his chronic pain syndrome and
No. 07-3682 35

somatoform disorder, which the ALJ included in the

hypothetical. These impairments are rooted in Simila’s

allegations of pain. Consequently, by limiting the hypothetical to unskilled work, the ALJ incorporated all of

Simila’s credible limitations.

D. Dr. Caillier’s Letter of June 22, 2006

Finally, Simila argues that the district court should

have remanded because Dr. Caillier’s June 22 letter constituted “new and material” evidence. A district court may

order that additional evidence be taken before the Commissioner upon a showing that there is “new evidence

which is material and that there is good cause for the

failure to incorporate such evidence into the record in a

prior proceeding.” 42 U.S.C. § 405(g). “New” evidence is

that which is “not in existence or available to the

claimant at the time of the administrative proceeding.”

Perkins v. Chater, 107 F.3d 1290, 1296 (7th Cir. 1997).

Further, “[n]ew evidence is ‘material’ if there is a ‘reasonable probability’ that the ALJ would have reached a

different conclusion had the evidence been considered.”

Schmidt v. Barnhart, 395 F.3d 737, 742 (7th Cir. 2005). We

review the district court’s decision not to remand on

these grounds de novo. Johnson v. Apfel, 191 F.3d 770, 776

(7th Cir. 1999).

Simila argues that the June 22 letter was new and material, because it was an immediate response to the ALJ’s

concerns about Dr. Caillier’s original report. Simila roots

this argument in his belief that the ALJ should have

recontacted Dr. Caillier to clarify his report. The June 22
36 No. 07-3682

letter thus provided the necessary, though unsolicited,

clarification. Hence, Simila argues that the letter is “new”

because it did not exist prior to the ALJ’s decision and

is “material” because it contradicts the ALJ’s prior interpretation.

But our prior decisions teach that the June 22 letter was

hardly “new” for § 405(g) purposes. E.g., Perkins, 107 F.3d

at 1296; Sample v. Shalala, 999 F.2d 1138, 1144 (7th Cir.

1993). Instead, the letter was merely “derivative evidence,”

because Dr. Caillier “based his conclusions entirely on

evidence that had long been available.” Perkins, 107 F.3d

at 1296. Dr. Caillier did not reexamine Simila or conduct

new psychological tests; rather he elaborated on his

previous report and responded to Simila’s attorney’s

questions about the ALJ’s concerns. This was precisely

the scenario we addressed in Perkins:

[A] critique of the ALJ’s opinion, which obviously

could not have been done before the opinion

issued, does not amount to good cause; such a

rule would amount to automatic permission to

supplement records with new evidence after the

ALJ issues a decision in the case, which would

seriously undermine the regularity of the administrative process.

Id.

Section 405(g) does not provide occasion for a physician to submit an unsolicited clarification of his prior

opinion. The ALJ has mechanisms to procure additional

evidence, including recontacting medical sources, if the

evidence was inadequate to reach a decision. See 20
No. 07-3682 37

C.F.R. §§ 404.1512(e); 404.1527(c)(3). Because the evidence

was adequate, however, the ALJ need not have

invoked those procedures here.

III. Conclusion

We AFFIRM the judgment of the district court.

7-22-09