## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 07

- 3682 K EV I N G. S IMI LA, Plai nt i f f

-Appe l l ant, v. M ICHAEL J. A S T RUE, Com m i ssi onero fS oci alS ecuri ty, D efend a nt-A pp ellee.

Appeal from the United States District Court fo r the Western Di stricto f Wisc onsin
. No . 07 C29

—Barb ara B. C rab b , Chief Judge .
A RG UE D M AY 29, 2008

— D ECI DE D J UL Y 22, 2009

Befo re C UDAH Y, P OSNER, a nd T INDER, C ircu it Judges. T INDER, C ircu it Judge. Once a s tr apping con structi on l abo re r, K evin Si m i l a cl ai m s that a m yst er i ous pain dis

or d er h as w ith er ed h is p h ys ica l p ro w es s a n d l e ft h im unabl e t o w or k. S i m i l a a pp l i ed forDisab i l i ty I nsurance B e n e fi t s ( “ DI B” ) a n d S u p p l e me n t a lS e c u r i ty In c o me ( “SS I ”)
. But afte r a hea ring, the adm i ni str ati ve l aw j ud ge ( “A LJ”) w as du bi ous ofthe seve ri ty ofSi m i l a’ s l i m i tat i ons.2 N o. 07

- 3682 A nd f orgo od r eas on. The r ec or d show ed that Si m i l a had go n e hunting and fi shi ng, at tended his so ns’ peewee hocke y g am es, and eve n hel ped a fri en d b u il d a l og h o me

— a l la ft e rth e t i me S i mi l a c l a i me d to h a v e b e c o me disabl ed. But no m at ter ho w fi shy acl ai m f orS oci al S e c u r i ty b e n e fi t s mi g h ts e e m, a n AL J mu s t f o l l o w th e s a me r ul es f o re ve r y case. She m us t r efr ain fr o m “ pl ay i ng do ct o r, ” pr o per l y e va l ua te the medi ca le vi den ce a nd th e cl ai m an t’ s cr edibi l i ty, a nd a cc ur at el y i nc o r po r at e th e cl ai m ant’ s l i m i tat i ons i nto any hy potheti calquesti on used to eli ci t the o pini on o fa voca ti onalexper t. Despi te S i m i l a’ s co nt en ti ons to the c o nt r ary, we th i nktha t th e AL Ja dequa te l y pe r f o r m ed th es e dut i es in thi s ca se . The m edi ca le vide nc e l en t l i tt l e su ppo r t to S i m i l a’ s ca se a nd th e AL Jha d g o o d r ea so n to do ubtS i m i l a’ s te st i m o ny . And though i m perfect, the A LJ’ s hypotheti cal q u est i ons adeq u a t e l y d e s c r ib e d S i mi l a ’ s c o n d i t i o n . We th e r e f o r e a ffi r m.

I . B a c kg r o und A. Ke v i n S i mi l a ’ s Sy mpt o ms a nd Tr e a t me nt U nti lS i m i l a’ s s ym ptom s be gan in 200 2, he work ed as a const ructi on l abor erand an o ccasi onalcar pet instal l er an d ba rt en d er . In m id -Se p te m b er of th atye ar , Si m ila we n tt o h i s p r i ma r y c a r e p h y s i c i a n, D r . E n d e r s , c o mpl aini ngo ffl u- l i k e sy m pto m s, he adac he s, a nd j o i ntpa i n. Dr. End er s, o n sta ffatthe M i del f or t Cl i ni c, exam ined Si m i l a and per f or m ed seve ra l diagnost i c tes ts. H e di d not obs er ve any a pp ar ent j oint swel l i ng, an d S i m i l a’ s t est re sul ts f orLym e Di sea se w er e neg ati ve. D u ringthi s v i si t, Sim ila a d m itt ed to h av in g a b u se d co c ain e in tr av en ou slyN o. 07

- 3682 3 i n the pa stb uts ta te d tha t he ne ve rs ha r ed ne edl es a nd had been drug- fre e forfi ftee n yea rs . Si m i l a s topped w or ki ng co nstr ucti on a ro und Octobe r 2, 2002 and re turned t o the M i del f or t Cl i ni c se ver alti m es thro ughout Octoberco m pla i ni ng o fsi m i l arsy m ptom s. Dr
. Ende r s no te d tha t S i m i l a ha d “ ar th r al gias [j o i nt p ain ] an d m ya lgia s [m u sc le p a i n ] of u n d et er m in ed et iolog y” an d p re sc rib ed V ico d into ea se th e p ain . A s fo r h is he ada ch es , a CT s ca n r ev ea l ed th atS i m i l a ha d a s i nus i nfe cti on. Dr. End er s r efer re d Si m i l a t o Dr. Bartynski, an ot ola ry n go l o g ist, w h o e x am in ed Sim ila a n d su rg ica lly drai ned his sinuses. The pro cedure d i d not a l l evi ate th e he ada ch es , tho ugh. Si m i l a’ s s ym ptom s co nti nued thr oughout the r esto f 2002
. H e co nti nued to se e a num bero fdoct or s and take pain medi ca ti o ns s ucha s Vi co di n a nd Pe r co ce t dur i ng that ti m e. H e saw two neuro l ogi sts , Dr. Chukw ud el unzu and D r. Dexter, wh o each exam i ned Si m i l a but coul d not d et er m i ne the cause o fhi s pai n. Dr. Chukw ud el unzu f ound that S i m i l a “ dem onst ra te[d ] adequate fund o f kn owl edg e, at te nt i o n, co nc en tr ation an d m em ory du ring hi sto ryand neurologi c exam i nati on, ” a nd that S i mi l a h a d n o r ma l mu s c l e s t r e n g th, c o o r d i n a t i o n, a nd re fl exes. Dr. C h u kw ud el unzu d i agno sed S i m i l a with ch ronic he ad ach es bu t note d that “Ithink th is w il l tu rn ou t to b e a ch r o ni c dai l y he ada ch e wi thpo ss ibl e su per i m po se d n a r c o t i c - i n d u c e d h e a dac he , ” r ef er en ci ng Si m i l a’ s pai n m edi cati on. Dr. Chukw ud elunzu changed Si m i l a’ s pre scr i pti on t o taperh i s Per coce t use and contr ol hi s pai n w ith otherm edi cati ons ( Si m i l a s ti l lco nti nued to4 N o. 07

- 3682 use Per coce t, tho ugh). Dr. Dexter concl ud ed si m i l ar l y. He di a g no s e d S i mi l a wi th “ di ffus e my a l g i a s a nd he a dac h e, et iolog y u n c lea r,” o b se rv in g th ath is m u sc le str ength w as nor m al, exce pt f orso m e “ gi veaway weakne ss , ” a si g n th atS i m i l a m i g htha ve b ee n e xa g g er at i ngthe effe c ts of h is p ain , see M URI EL D. L EZ AK ETAL ., N EUR O PSY CHO LOGICAL A S S ES S MENT 326 ( 4th e d. 2004 ) ( “ Ne ur o l o g i c a l exa mi ne r s r e pe a t e dl y n o t e d gi ve - away w eak ness ( pooreff or t o n str ength tes ti ng) i nd ica tin g that [ the pat i ent] was acti vel y pr ese rv i ng a disabi l i ty sta
tus. ” ( em phasi s i s o ri gi nal ) )
. In additi on, l i ke Dr. Chukw u d elu n zu , D r. D ex te r c on c lu d ed th atth e lon ge r Sim ila used narc oti c p ai n m edi cati ons, the m or e l i kely i t was that the nar cot i cs c ontr ibuted to hi s hea daches. Dr. Dexteral so note d that S i m i l a had be en “s om ew hat a cti ve” despite hi s pai n. S i m i l a had expl ai ned to Dr
. De xt ertha t he “ was abl e to g o o utde erhun ting ” an d “h as b ee n abl e to g o o ut and t ak e hi s so n t o ho ck eya nd f ather/s on h ock ey gam es, ” e ven though he experi enced disc om f or t a nd so re ness the ne xt day. Si m i l a also s aw a rheum ato l ogi st, Dr. S hel l ey, wh o, li ke oth er doc tors, foun d l ittl e exp lanation f or Si m il a’s co m pl aint s. D r. She l l eyo bs erve d tha t S i m i l a ha d no swe l l i ngi n a ny o fhi s j o i nt s, a no r m alg r i p s tr en g th, a nd a “fu ll range o fm oti on without pai n” i n hi s wri sts , elbows, sho ulder s, hi ps, knee s, ankl es, and feet
. Dr. S hel l ey d iag n os ed “a rt h ra lgia s a n d m ya lgia s o f u n c er ta inet iology ” a nd “hea daches, ” a n d n ot ed thathe di d “not see ev id en c e t o s u gg es t th e s ign ifica n c e o f an art h rit ic c on d itio n .”N o. 07

- 3682 5 Throughout thi s t i m e, S i m i l a d i d not workand drew di sabi l i tyc o m pen sa ti o n fr o m hi s uni o n. Dr
. End ers a nd Dr. Bartynskiea ch twice si gned offo n Si m i l a’ s di sabi l i ty f or m s. On the s eco nd o fDr. End er s’ s for m s, com ple ted D ecem ber 3, Dr
. Ende r s no te d tha t S i m i l a ha d b ee n c o ntin u ou sl y d i s ab led from O c to b er 2, 20 02 th ro u gh “in d efin ite .” I n 200 3, S i m i l a co nti nued se ei ng Dr. End ers a nd al so be g ant r ea tmenta t th e M ay o Cl i ni c. At May o , he r epe at ed hi s co m pl aint s o fhe ada ch es a nd ba ck, j o i nt, a nd m us cle pain, es p e c ial ly d uring ph ysical activity. Do ctors no te d tha t S i m i l a des cr ibe d ho w hi s j o i nt s hur t after h e he lp e d a friend replace a gas tank and how his fingers wou l d b e c o me n u mb wh e n h e u s e d a h a mme r o r went bowh unti ng. Se ver al tes ts gave som e expla nation f or Si m i l a’ s ba ck probl em s. In Si m i l a’s lu m barspi ne, te sts sh o wed “de g en er at i ve di skdi se as e wi ths l i g htna r r o wi ng ofthe 3r d and 4th l um bardi sks w i th br oad-base d d isk bu lge s a n d sm all a ss oc iat ed an n u l a r t ea rs ,” an d in hi s ce rv i calspi ne, te sts sh ow ed “m i l d degener ati ve ch ang es . ” H o wev er, do ct o r s no te d tha t S i m i l a’ s spine ha d a no r m alpa i n- fr ee r ange o fmot i o n wi th“ a sl i g ht i nc r ea se i n pa i n wi tha g g r es si ve pa l pat i o n o fthe r i g ht sacr oi l i ac j oint. ” D oct or s a l so f ound that S i m i l a had fu ll ran g e of p ain -fre e m ot ion in a ll fou r ex tr em itie s. In ad d iti on, l ik e t he doc tors at M idelfort, m ultiple d octors a tMay o n o t e d tha tS i mi l a wa s o v e r us ingh i s p a i n med

i cation ; t hey di d note, tho ugh, thatS i m i l a e xpresse d i nter esti n get ti ng o ffo fi t. S i m i l a co nti nued to r ecei ve d isabil ity paym en t s f r om his un ion, an d Dr. En d ers’s c o l l e a g ue , Dr
. Us he r, s i g ne d o ffo n S i mi l a ’ s u ni on d i s ab i l i ty f o r m.6 N o. 07

- 3682 Si m i l a’ s doct or s t ri ed sev er aldi ffer en t for m s o ftr eat
m ent to re du ce hi s pai n, som e of w hi ch w er e m or e s uccess ful than o th er s. P hysi calther apy was one ofthe l ess effecti ve. N oting tha t S i m i l a “enj oys hunti ng, fi shi ng, and fo ur wheel i ng an d p l aying hoc key, ” the the ra pis t devel oped a t re atm ent p lan forS i m i l a with the goa lo f re du ci ng S i m i l a’ s s ym ptom s by50

- 75%

. But Sim ila never re tu rn ed aft er th e firs t s es sio n an d w as su b se q u en tly disc harg ed. Docto rs al so tr i ed ad dit i onalm edi cati ons, w hi ch had som e t em pora rysucce ss. Dr. End er s pre scr ibed Dep ako te f orheadaches , and aftera m onth, Sim i l a r epo r t e d tha th i s h ead a c he s we r e “ muc h l e s s fr e qu e nt
. ” By M ar c h 20 03 , Sim ila re p or te d h e w as “ab ou t 9 0% be tt er .” Dr. End er s a l so presc ribed Pre dn i sone , a ste ro i d, to i m pr o ve S i m i l a’ s m us cl e an d j o i ntpa i n. The Pred niso ne wa s s o e ffe c t i v e tha ta ft e rt wo we e k s S i mi l a r e po r t e d a m arked de creas e in pa in ; Sim il a said “it is allgone.” D r. En ders note d that “ he was feel i ng so go od t h at h e has b een doingso m e f ai rly hea vy w or k forthe l astweek i nvol vi ng peel i ng l ogs and hel ping to bui l d a l og hom e. ” S im ila re port ed onl y no rm alm uscl e s or eness and sti ffness afterthatw or k. S i m i l a a l so i nstr ucted D r . E n d e r s n o t t o c o mp l e t e a n o th e ru n i o n d i s ab i l i ty f o r m, an d a r o und Apr i l2 00 3, S i m i la retur ne d t o wor ka s a co nstru ction l a b o rer. Bu t it d idn ’t l ast. Du e to Pred nison e’s si de effects , S i m i l a’ s doct or s r educed the dosa ge, after w hi ch Si m i l a co m pla i ned that hi s p ain sy m ptom s had fl a r e d b a c kup. S i mi l a s t o p p e d w o r ka g a i n s o me t i me du r i ngthe s ummero rf a l lo f2 0 0 3
. ( Al tho ugh the ALJ f o und S i m i l a to o nl y ha ve wor k ed dur i ngJ une a nd J uly, so m e m edi cal re cor ds i nd i cate thatS i m i l a was w or kin g a s la te as Sep te m b er .)N o. 07

- 3682 7 Doctor s co nti nued to try di ffer ent m ed i cati ons to tr eatS i m i l a’ s pain bu t s aw l i m i ted succe ss. They ta p er ed Sim ila off P re d n iso n e a n d st ar te d h im on E nb re l, a m edi cati on forj oint pai n tak en byi nj ecti on, wh i ch wo r k e d r e l a t i v e l y we l la tfi r s t( S i mi l a r e p o r t e d “ ab o ut 75 p er c en t im p ro ve m en t o f h is s ym p to m s” ). B u t a ga in S i mi l a ’ s c o mp l a i n t s o fp a i n r e tu r ne d , a n d i n N o v e mber20 03, Si m i l a s ought Dr. Kent, a rheum ato l ogi st, to appr o ve hi s uni o n di sabi l i tyf orm . D r. Ken t si g ne d the f or m but w ro te, “W h ile hi s m uscul osk el eta lpai n m ake s hard physi call aborextr em el y di ffi cu lt, Ise e no r eas on he co ul dn ’ tp e r f o r m cl e r i c a lwo r k, e t c . ” S i mi l a h a d a l so re turned t o usi ng nar cot i c pai n m edi cati ons, such a s Vi co di n. A t th is p oin t, S i m ila’s d oc to rs h ad be c om e in c re as in gly u n c er ta inof th e c au se of Sim ila’s p a i n . Th ey init ially tho ughti t was s po ndy l o ar th r o pathy, a n infl amm atory j oint d ise ase , but Si m i l a had no re sponse to a m edi cati on th at targete d that di s ease. Dr. K en t op ined that Si m il a’s j o i ntpa i n was m ost l i k ely r el at ed to “ ch r o ni c pain s y nd ro m e,” an d an ot h er d oc to r su gg es te d “m yo fas c ial p ain sy n d ro m e/ fibr om ya lgia ” d u e t o a lac k o fa n y ob j ec tiv ely ob s er va b le in flam m at ion . W h en D r. K en t w as ag ain as k ed to c o m pl et e S i m i l a’ s uni o n di sabi l i tyf o r m , he no te d tha t he t o l d S i m i l a “i t i s unc l ea rto m e w hy he i s t o t a l l y di s ab l e d , a n d th i s ma k e s i td i ffi c u l tf o rme th ent o fi l l outhi s f o r m s an d m ak e any pr edi ct i o ns abou t th e futu re. ” D r. K en t even tu all y signed th e form and i n d ica te d that S i m i l a was di sabl ed fro m Octobe r 15, 20 03 th ro u gh “c u rre n tly .”8 N o. 07

- 3682 I n Dec em ber20 03, Dr. M uceno, a W i sco nsi n sta te med i c a lc o ns ul t a nt, r e v i e we d S i mi l a ’ s me di c a lr e c o r ds to d eterm ine his “residu al fun ctioning cap acity.” Dr. M uceno c oncl ud ed that Si m i l a co uld lift orcar ryup to fi fty pou nd s o ccasi onal l y a nd twenty- fi ve fre quentl y; th atSim i l a c o u l d st an d , w alk, or sitfor a to ta l of six ho ur s i n a n e i g ht

- ho urwor k day ; a nd tha t S im il a ha d no po stur al, mani pul at i ve , visual, c o m m uni ca ti ve , o re nvir on m en ta l lim ita tio n s. (T h is r ep or t w as su b se q u en tly confi rm ed by anothe r state m edi calco nsul tant seve ra l m on th s la te r.) By 200 4, S i m i l a’ s doct or s a pp ear ed to have few r emedi es l eft to t r y ; Dr
. M i ch et, a r he um at o logi st at th e M ayo Cl i ni c, not ed that Si m i l a’ s t re atm ent was “a t a n i m passe. ” Dr. M i chet re com m ended three i nfusion s o f Rem i cade, a drug used t o tr eatauto i m m une dis or ders, and stat ed that i fS i m i l a had not i m prove d afterthat, “t h en w e a re goin g t o h av e t o c on c lu d e th ath e h as d ev elop ed m or e o f a fib ro m y a l g i c or m yo fas c ial c h ro n ic p ain dis or d er . . . . [ T]he next st ep f orm anaging tha t would be a chr oni c pai n re hab co nsul tat i on.” A fterthe i nfusi ons, Sim il a ha d not im p roved

. X-rays w ere taken of Sim il a’s spi ne, wh ich a ga in r ev ea l ed “m i l d degener ati ve changes

. ” S i m i l a co nti nued to ta ke Vico din r egul ar l y. I n 200 5, S i m i l a was pres c rib ed physi calther apy by do ct o r s at th e Pa i n Cl i ni c o fNor th wes te r n W i sc o ns i n, al though he sta ted that h e w as not i nter est ed i n l ongter m ther apy. A m onth l ate r the Pai n Clini c d ischarge d Si m i l a be cause a t oxi col og y scr een s how ed evi dence of coca i ne. U nti lthatt i m e, the Pai n Clini c had bee n pro-N o. 07

- 3682 9 vid in g Sim ila h is V ico d in
. A f te r h is d isc h ar ge , Sim ila ca l l e d the M i de l f o r t Cl i ni c a nd r e qu e s t e d tha t the y pre scr ibe hi m Vi codi n, expl ai ni ng tha t “ du e t o financi al re aso ns, ” he coul d no l onge r get it fro m the Pai n Clini c. Sim ila re c eiv ed a p re sc rip tio n for a refill.

B. Psycholo gi cal Eva l uati on Atthe r e qu e s to fS i mi l a ’ s a t t o r ne y, Dr
. P a ulCa i l l i er psychol ogi cal l y e xam i ned Si m i l a in Feb ruary 2006
. Dr
. Ca i l l i err ev i ewed S i m i l a’ s m edi ca lr ec o r ds an d c o nd u c te d an in-p er so n ev alu at ion, w h ich inc lu d ed Sim ila com pl et i nga M i nne so taM ul ti pha si c Pe r so na l i tyInv en tory (“M M PI-2”). Dr. Caill ier w rote a l etter to Sim il a’s att or ney, dated M ar ch 1, 20 06, in which he concl ud ed th at Sim il a ha d c hron ic p ain syn d rom e a nd a som atoform conve rs i on di sor der ( a m entalco nd i ti on th at c auses a p er so n to ex p er ien c e p h ys ica l sym p to m s o f a p u re ly p sych ologi cal ori gin). Dr
. Ca i l l i e rt a l k e d w i th S i mi l a ab o u th i s s y mp t o ms an d m ed ical history. Dr. C ail li er noted that Si m il a’s m o o d was n orm al a nd he ha d “ ade qua te a tt en ti o n a nd c on c en tr at ion to th e t as k a t h an d .” Sim ila d es c rib ed h is sy m p to m s in “d ra m at ic fa sh ion,” ex p lain in g th ath is p ain kept hi m fro m fun c ti oni ng and thatVi codi n hel ped only m inim all y. D r. Ca il li er note d Si m il a’s other d octors co ul d no t ex pl ain h i s pain a nd tha t S i m i l a was c o nc er n ed ab ou t w h et h er h is c h ild re n w ou ld d ev elo p h is sym p tom s, w hich Dr. Caill ier w rote “ w a s typ ical of M r. Si m i l a’ s dra m ati c pre senta ti on. ” In ad d i ti on, Dr. Cai l l i er i nter prete d Si m i l a’ s M M P I

- 2 r esul ts and fo und they10 N o. 07

- 3682

re veal ed a “ cl ass i calco nver sio n V pattern, ” which m eant that Si m i l a co nver ted st re ss and anxie ty i nto phy si ca lpa i n. Fr om hi s obser vati ons an d the tes t r esul ts, Dr. Cai l l i er c on c lu d ed th atSim ila’s so m at ofo rm d iso rd er an d ch ro n ic pa i n l i mi t e d h i s fun c t i o ning . Dr
. Ca i l l i e rc o mpl e t e d a “Psychi atr i c Revi ew Techniq u e” ( a s tandard S oci al Se c u rit y d isa b ility f o r m ), an d on it, he n ot ed th atSim ila had “m ar ked” r est ri cti ons ofdai l y l i vi ng ac tiv i ti es; “m oder ate ” diffi cul ti es i n m ai ntai ni ng soc i alfuncti oni ng; “mar k ed” di ffi cul ti es i n mai nt aini ngc onc en tr at i o n, per s i s t e nc e , o r pa c e ; a nd “ o ne o r t wo ” e pi s o de s o f d ecom p en s a t ion (an acu te d eterioration of a p erson ’s m entalheal th) o fexte nd ed durati on. Fr om thes e fi nd i ngs, Dr. Cai l l i erco n c l ud ed that Si m i l a’ s m ental i m pai rm ents m et the r equi re m ents ofLi sting 12
. 07, So m ato f or m Dis or ders, 20 C
. F. R. P t. 404, S ubpt. P, A pp . 1, w hi ch w oul d cl ass i fy S i m i l a a s “d isabl ed” f orS oci al Se curi ty pu rpos es. In the end, Dr. C ailli err eco m m ended that Si m i l a t ake a nti

- depressa nt m edi cati ons and rec ei ve co un seli ng . S i m i l a ha d no t so ughtc o uns el i ngb y the ti m e o fthe hear i ng and the re cor d doe s no t r eve al w hetherS i m i l a t oo k a nti

- depressa nts.

C. Si mi l a ’ s T e s t i mo ny S i mi l a t e s t i fi e d a t a he a r ing b e f o r e the ALJ o n A pri l 11 , 2006
. H e desc ribed hi s pri orem plo ym ent a s a co nstr ucti on l abor eran d h ow he w or ked as a bar tender once a w eekand car pet instal l ero ccasi onal l y. H e t est i fi ed that he would d o a li ttl e m or e ca rpet i nstal l ati on workwh en c o n s t r u c t i o n wa s s l o w.N o. 07

- 3682 11 Si m i l a tal ked m ost l y about hi s pai n, tho ugh

— how i t a ffecte d his life a nd wh at he was abl e t o do despi te i t. H e t es tifie d th ath e fe lt c on st an t p ain in h is jo i n t s , sh ou ld er s, elb ow s, n ec k, kn ee s, an kle s, a n d h ip s. H is d aily r o ut i ne was l i m i te d a nd he b ar ely g o t o ffthe c o uch

. H e te st ified thathe t ak es hi s ch i l dr ent o s ch o o li n the m or n in g b u t u p on ret u rn m u stta ke V ico d inan d lie d ow n for a fe w h ou rs . (H e te st ified t h ath e oft en h as to lie d ow n if h e s ta n d s o r sit s t oo lon g.) H ow ev er , he is ab le to dr i ve , pi ckup a gall o n o fmil kfr o m the g r o ce r y, a nd run the vac uum ; he usual l y m ake s di nner f orhi s f am i l y. Si m i l a a l so tes ti fi ed that any physical acti vi ty exacerb at es h i s p a in ; he w ill “p ay for it t h e n ex t d ay .” H e t es t i fi e d th a th e c a n n o ts h o v e ls n o w o rd o c a rmai ntenance
. But he does enga ge i n so m e physi caland re cre ati onalact iviti es. H e o ccasi onal l y hel ps fri ends w i th var i ous pr oj ects , such a s the ti m e he peeled l ogs an d c o ns truct ed a l o gho m e o rw he n he hel ped cl ea n a m oto rbo at engi ne. H owever, he t est i fi ed that, wh en bu i l di ngthe l o gho m e, he was o n P r edn i so ne a nd fee l i ng m uch bett er . ( H e a l so tes ti fi ed th at hi s s on di d m osto f the l og- hom e-bui l ding w or k; hi s s ons w oul d have be en a g e s e l e v e n a nd s i x a tthe t i me. ) In a ddi t i o n, h e a t t e nd s hi s chi l dren’ s t ra vel i ng hocke y tea m ga m es. H e t est i fi ed that he can sta nd f oro nl y tw el ve m i nutes ( one p er i od of hocke y) and m ust s i t be tw een per i ods and so m eti m es du ring per i ods. Si m i l a a l so enj oys fi shi ng and hunti ng. W hen he hunts, th o ugh, he te sti fi ed th athe c anwal ko nl y abo ut 40 0 y ar ds i nt o the w ood s b efo r e he ha s to s i t do wn, a nd12 N o. 07

- 3682 he c ans ta y s ea te d f o ron ly ab o utf o urho ur s. He we nt i ce fi shi ng in the w i nterprio r to the he ar i ng but tes ti fi ed th athe di d l ittl e wor ka nd s ati n h i s truckmos t o fthe tim e. H e also w en t fi sh ing tw o w eeks be fo r e the h eari ng. H e t est i fi ed that the a rm w i th w hi ch he castand j i gge d hi s ba i t was “pre ttym uch usel ess ” the f ol l owing day. F i nall y, Si m i l a te st i fi ed th athe s ti l lt ak es Vi co di n r egul ar l y, and a fter physi calact i vi ty, he s om eti m es “ov er eat s” hi s nar cot i c pai n m edi cati on. H e t es tifi ed that he has not b ee n to anypsycho l ogi calco unsel i ng, but i fDr. Cai l l i er re com m ended it, he woul d go.

D. Me di c a l E x pe rt ’ s T e s t i mo ny Dr
. Andr ew S te i ne r, a do ct o ro fphy si ca lmedi cine a nd r eh ab i l i ta ti o n, re vi ewe d S i m i l a’ s m edi ca lr ec o r ds an d tes ti fi ed that, i n hi s o pini on, the re w as a l ack ofo bj ecti ve evid ence that Si m i l a was di sabl ed. Dr. S teiner tes ti fi ed that the e vi dence show ed “m i l d degener ati ve diskdi sea se c h an ge s” i n t h e lu m b ar p ar t o f Sim ila’s ba c k a n d “m ild o st eo ar th r i ti c ch an g es ” i n h i s nec k

. He a l so f o und th at S i m i l a ha d so m e deg r ee o f he ar i ng l o ss i n highfre quency si tuati on s. H owever, he found no evi dence of any s i g ni fi ca ntj o i ntde f o r m i ti es , lo ss o fr an g e o fmot i o n, orgo ut. Based o n thes e fi nd i ngs, Dr. S teiner concl ud ed that Si m i l a co uld per f or m “l i ght work, ” which t ran sl ate s t o j ob s th atreq u ire liftin g u p to tw en ty p ou n d s o c c as ion ally an d te n freq u en tly ; sta n d in g a n d w a lkin g for u p to six hou r s ; a nd s i t t i ngf o ru p t o t wo . F ur the r, Dr
. S t e i ne rN o. 07

- 3682 13

o pi ne d tha t S i m i l a sh o uld b e pre cl ude d fr o m j o bs i nvol vi ng h azardous m achi neryo r unp ro tect ed hei ghts d u e t o h is h e ar in g los s. D r. Ste in er sp ec ified th ath is o pi ni o n c o nc erne d o nl y S i m i l a’ s phy si ca lc o ndi ti o n a nd n otan y p sy c h olo gic al d iso rd er s.

E . Vo c a t i o na l E x pe rt ’ s T e s t i mo ny Fi nal l y, the A LJ a ske d W i l l i am V i l l a, a voca ti onalexper t, seve ra lhypothe ti calquesti ons to deter m i ne wh ether ther e were a n y j obs thatS i m i l a co uld per f or m gi ven h is lim ita tio n s. T h e A L J firstd es c rib ed a h yp oth et ica l in w hi ch Si m i l a was l i m i ted to l i ght, unski l l ed w or k that di d no t i nv o l ve ha za r do us machine r y o rheights

. S he described Si m i l a a s hav i ng the f ol l owing ai l m ents: m yo fas c ial p ain or m u sc u los ke let al p a i n d iso rd er , m ild degen er ati ve changes i n the l um barand cer vi calspi ne, inter m i tt en t g o ut, he ada ch es , hi g h- fr eque nc y he ar i ng loss, chron ic pain syn d rom e, an d so m a toform disord er. B as ed on th is h yp ot h et ica l, V illa c on c lu d ed th atSim ila co ul d pe r f o r m a s i g ni fi ca ntnumbe ro fj obs in the nati onale c onom y. The A LJ then l i m i ted the hypothe ti cal to “se dentarywork” o nl y, and Vi l l a s ti l lco ncl ud ed that th er e w er e a sign ifica n t n u m b er of j ob s t h atSim ila c ou ld perf or m . Fi n ally, wh en the A LJ a l ter ed the hypotheti cal to de s c r ib e a p e r s o n wh o wa s u n ab l e t o s h o w u p re gul ar l y forwork, Vi l l a co ncl ud ed that ther e wou l d not be a ny j obs ava i l abl e.14 N o. 07

- 3682 F. The A LJ ’ s Op i nion The A LJ e val uated S i m i l a’ s cl ai m f ordi sabil ity und er th e m an d at or y f i v e - st ep se q u en tia l an aly sis
. See2 0 C. F
. R. §§ 404. 1520 ( a) ( 4) ( DIB) , 41 6.9 20( a) ( 4) ( SS I )
. The fi veste p anal ysi s r equi re s the A LJ t o exam i ne: (1) w hether th e c laim an t is cu rre n tly [ un]em plo yed; ( 2) wh etherthe cl ai m ant h as a seve re i m p airm en t; (3) w he th er the claim an t’s im p airm en t m eets or equ als one o f t h e im p airm en ts l i st ed bythe [ Co m m i ss i o ne r ] , s ee 2 0 C.F
. R. § 40 4, S ubpt

. P, App. 1 ; ( 4) w he th erthe c l ai m an t ca n p erfor m [ hi s] pa stwor k ; a nd ( 5) whethe rthe cl ai m an t i s ca pab l e o fpe r f o r m i ngwor ki n the nati onaleco nom y. Cli f f or d v
. Apf

el , 2 27 F. 3d 86 3, 8 68 ( 7th Ci r . 2 00 0) ( fi r sta nd se co nd a l te r at i o ns i n ori gina l )
. To de te r m i ne whethe rthe c laim an t is ab le to p er for m h is pa st w or k or is c a p a b le o fp e r f o r mi ngo the rwo r k( s t e ps f o ura nd fi v e ) , the ALJ ass ess es the c l ai m ant’ s r esi du alfuncti oni ng ca paci ty (“R FC ”). See20 C
. F.R. §§ 404
. 1520 (e), 404.1560(b)-( c), 416. 920( e) , 41 6. 960(b)

- ( c)
. A cl ai m ant’ s RFC is “the m ost [ th e cl ai m an t] c ans ti l ldo de spi te [ hi s] l i m i ta ti o ns , ” an d the A L Jd e t e r m i n e s a c l a i m a n t ’ s R F C b a s e d o n a l lth e c l a i man t’ s i m pai r m en ts and a l lthe r el ev an t ev i den ce i n the re c or d

. Id. §§ 404.1545(a), 416.945(a). A t st ep o ne, the A LJ found that S i m i l a had not en g ag ed i n s ubs tantial l y g ainfula ct i vi tya fte rthe al l ege d onseto fdi sabi li ty
. T he A L J d eem ed Si m il a’s tem pora ry em plo ym ent i n the s um m ero f20 03 an “unsucc e s s fu lwo r ka t t e mpt ” an d n o tf a t a lt o h i s c l a i m. AtN o. 07

- 3682 15 step tw o, the A L J foun d that S im ila h ad m ultiple severe i m pai r m en ts due t o muscu l o sk el et alo rmyo f as ci al pa i n, m i l d degener ati v e di s kdi s e ase , headaches , hi gh- fre quency he aring loss, chron ic pain syn d rom e, an d som atoform di so r der

. At s te p three , the ALJ c o nc l ude d tha t no ne ofS i m i l a’ s i m p airm ents, physi calo r psychol ogi cal, m et orm edi cal l y e quale d any o fthe l i ste d i m pai rm ents. Then, the AL Jf ound that Sim il a had an RFC o f“l i ght, unski l l ed w or k” base d on the obj ecti ve m edi calev i dence, Sim ila’s co u rs e o f tre at m en t, h is d aily ac tiv itie s, h is wo r kh i s t o r y, a n d th e me d i c a le x p e r t ’ s o p i n i o n . A c c o r din gly, atst ep f our, the A LJ c oncl ud ed that Si m ila coul d not per f or m hi s pastwork as a c onstructi on l abor er . H owever, atst ep fi ve, the A LJ a ccepted the vo cational ex p ert’s testim ony , conc lud ed that there w ere a s u b s t a n t i a ln u mb e ro fj o b s i n the na t i o n a le c o n o my that Sim ila coul d perf or m , and ul ti m ate l y found that S i mi l a wa s n o tdi s ab l e d.

G . Sim il a’s A p p eals Si m i l a too k hi s case to the A pp eal s Counci land subm i tted addit i onalev i denc e in the f or m o fa l ett erfro m D r. C aillie r to Sim ila’s a t t o r n ey , d at ed Ju n e 2 2, 20 06 . In thatl et te r, Dr
. Ca i l l i ere l ab o r at ed o n h i s pr ev i o us r ep ort an d r es po nde d t o the ALJ ’ s co nc erns r eg ar di ngthe se ve r i ty of Sim ila’s m en ta l d iso rd er s. T h e A p p ea ls Cou nc i lde ni ed S i m i l a’ s appe al a nd the r efo r e m ade the A L J’s o p in ionth e fin al d ec isi o n o ft h e C om m iss ion er . See Craf tv. As t r ue, 5 39 F
. 3d 66 8, 6 73 ( 7th Ci r . 2 00 8). Sim ila th enfil ed s ui t i n the di st r i ctc o ur t, whi cha ffi r m ed th e A LJ’ s deci si on a nd r ule d that Dr. Cai l l i er ’ s J une 22 l ett er16 N o. 07

- 3682

w as no t “ne w ” an d “m ateria l” eviden ce an d therefore shoul d not be i ncl ud ed as part ofthe re cor d fo r j u d icia l rev iew
. Si m i l a v. As t r ue, No
. 0 7

- C

- 0 0 2 9

- C , 2 0 0 7WL 5490 605 ( W
. D. W i s. Oct. 1, 20 07)
. S im ila then appeal ed to thi s co urt.

I I . Discussi on W e r evi ew the A LJ’s d ecis i on di re ctl y, but w e pl ay an “e x tr em ely lim ite d ” ro le. Elde rv. As t r ue, 529 F
. 3d 408, 413 ( 7th Ci r. 20 08)
. W e wil lnot“d ispl ace the AL J ’ s j ud gm en t byr ec o ns i der i ngf ac ts o re vi den ce, or bymaking i nd ependent cr edibi l i ty deter m i nati ons. ” Id. In s t e a d , we l oo k t o w hetherthe A LJ b uil t a n “acc urat e a nd l ogi cal br i dge ” fr o m the e vi den ce t o he rc o ncl us i o n tha t th e c laim an t is n o t d i sa b led

. C raft, 539 F.3d at67 3. W e w ill affi rm the A LJ’ s deci si on i fi t i s su p p or te d by s ubsta nti alev i dence , w hi ch i s “ such r el evantev i dence as a re aso nabl e m i nd m i ght a ccept a s a dequ ate to s u p porta concl usi on. ” Id. ( quoti ng B a rnett v . B a rn ha rt, 38 1 F
. 3d 664, 668 (7th Cir. 2004)). T h er efo re , “ev e n if ‘re as on ab le m i nd s co uld d ifferco ncer ni ng wh ether[ Si m i l a] i s di sabl ed, ’ ” we affi rm i fthe A LJ’ s deci si on has adequate su p p or t. E lder, 52 9 F
. 3d at 413 ( quoti ng Sc hm i dtv. As t rue, 496 F.3d 833, 842 (7th Cir. 2007)). S i m i l a r ai se s f o urpoi nt s o n appe al

. H e ar g ue s th at( 1) the AL J er r o ne o us l y r ej ec te d Dr

. Ca i l l i er ’ s co nc l us i o ns abo ut th e in te n sit y of Sim ila’s so m at ofo rm d iso rd er an d ch ro n ic p ain syn d rom e; (2) th e A L J erred i n ev aluat ing Sim il a’s cr ed ibi li ty ; ( 3) the ALJ ’ s hy po th et i ca lque st i o n t o the vo ca ti o na lexp ert o m i tt ed k eyf ac ts ; a nd ( 4) theN o. 07

- 3682 17 d istric t cou rt shou ld h ave rem an d ed becau se D r. C aillie r’s Ju n e 2 2, 20 06 let te r w as n ew an d m at er ial ev idence.

A . Th e ALJ’ s D eci s ion t o Disco un tD r . Cai l l i er ’ s Let t er ofM ar ch 1,20 06 Si m i l a fi rs t a rgues that the A LJ e rr oneo usl y d eclined to pl a c e s i g ni fi c a ntwe i g hto n Dr
. Ca i l l i e r ’ s fi nd i ngs r e g a r di ngthe i nt e ns i ty o fS i mi l a ’ s i mpa i rm en t s . T he ALJ d id n otch alle n ge th e u n d er lyin g d iag n os e s t h atSim ila had a som ato f or m di sor der a nd chr oni c pai n syndro m e. Ra th er, s he di sc o unt ed Dr
. Ca i l l i er ’ s co nc l us i o ns c o ncern ing the de gree of fun ctiona l li m itation tha t Si m il a’s ai l m ents cause, b ecause theywere “not supp or ted by th e o bj ec ti ve e vi den ce o fr ec o rd a nd [ wer e] i nc o ns i st en t w i th cl ai m ant’ s tes ti m ony. ” The A LJ i nstea d concl ud ed that Sim i l a’ s di sor ders re sul ted i n onl y m i l d r es tr i ct i o ns ofact i vi ti es ofdai l y l i vin g; m i l d di ffi cul ti es mai nt aini ng so c ial fu n c tio n in g; m o dera te di ffi cul ti es mai nt aini ng c o nc e nt r a t i o n, p e r s i s t e nc e , a nd p a c e ; a nd ze r o e pi s o des o fdecom pen sa ti o n. Co ns eque nt l y, a t st ep th r ee i n the seq ue nt ialana lysi s, th e A L J foun d that Si m il a’s i m p airm en ts d id n ot m eeto r equala “Lis ti ng Level, ” which wo ul d ha v e a ut o mat i c a l l y de c l a r e d S i mi l a di s ab l e d, 20 C.F
. R. § 404. 1520 ( a) ( 4) ( i i i ) , a n d at s teps four and fi ve, the AL J fo und thatS i m i l a had an RFC forl i ght, unski l l ed w or k, id. § 404.1520(a)(4)( iv)- (v). Befo r e we e v a l ua t e wh e the rthe ALJp r o pe r l y wei ghed Dr. Cail l i er ’ s concl usi ons, w e m ust fi rs t deter m in e w h at type of “m edi calso urce” Dr. Cai l l i eri s. I fDr. Cai l l i er18 N o. 07

- 3682 i s dee m ed a “t r ea tings o urc e, ” th enthe r egul at i o ns re quir e that the A LJ g i ve hi s o pini ons contr ol l i ng weight, as l ong as they w er e s upp or ted bym ed ica lfi nd i ngs a nd c o ns i s t e ntwi th s ub s t a nt i a le v i de nc e i n the r e c o r d. See20 C .F.R . § 40 4.1 52 7(d )(2) ; Sk a rbek v . B a rnh a rt, 39 0 F
. 3d 50 0, 5 03 ( 7th Ci r . 2 00 4)
. I fDr
. Ca i l l i eri s a “n o nt r ea ting sour ce, ” ho w eve r, th e A LJ was notr equi re d to ass i gn h is op in ion co n t r ollin g w eig h t. Whit e v. B a rnh a rt, 41 5 F. 3d 654, 65 8 ( 7th Ci r. 20 05)
. Instea d, the A LJ was per m i tted t o evaluate the o pini on’ s wei ght in l i ght o fo ther fac to rs . See20 C .F.R . § 40 4.1 52 7(d )(2) -(6) ; E lder, 529 F. 3d at 415. A nontr eat in g sourc e i s “ a physi ci an, psycho l ogi st, o r othe r acceptabl e m edi calso urce w ho has exam i ned you but does nothave , o r did noth av e, an o ngoing tr eat
m ent r el ati onshi p w ith yo u. ” 2 0 C. F. R. § 404. 1502
. D r . C a i l l i e rf a l l s s q u a r e l y wi th i n th i s d e fi n i t i o n . H e e x a mi ne d S i mi l a o nly o nc e , a nd no thing i n the r e c or d sugg es ts any th i ng“ o ng o i ng ” ab o utthe i rt r ea tmentr el at i o nsh i p. F ur th er m o r e, th e r egul at i o ns spe ci fi ca l l y defi ne a n o n t r e a t i n gs o u r c e a s a ny do c t o rw i th w h o m th e c l a i mant’ s r el ati onshi p w as “not base d on y ou r m edi calneed f ortr eat m en t orev al uati on, but sol el y o n yo ur nee d to obt ai n a r epor t in supp or t o fyo ur cl ai m f ordi sabi l i ty. ” Id. D r. Ca il li er evaluat ed Si m il a at th e beh est of Si m il a’s att or ney, ev i denced by the factthat Dr. Cai l l i er ’ s “ re port ” w as i n f act a l ett eraddress ed to th e at to rney and not to Si m i l a. A ccor dingly, Dr. Cai l l i er ’ s o pini ons w ere no t enti tl ed to co ntro l l i ng weight. Sim il a attac ks th e A L J’ s d eci si o n to discou ntDr. Caill ier’ s c on c lu sio n s o n a n u m b er ofg r o u n d s. P rim ar ily, Sim ilaN o. 07

- 3682 19 conte nd s that the A LJ i m proper l y r ej ecte d the o pini on o f th e o n l y p s y c h o l o g i s t i n th e c a s e , wh i c h l e ft th e A LJ without a n ad equate basi s t o ass ess the effect of Si m i l a’ s s om ato f or m diso rder

. I n thi s s ense, S i m i l a a rgues th at t h e AL J“pl aye d doctor, ” be cause she had no othe r psychologicalexper t o pini on in w hi ch to gr ound her fin d in gs . See B la k e s e x rel. Wo lfe v. B a rnh a rt, 33 1 F
. 3d 565, 57 0 ( 7th Ci r . 2 00 3)
. W e fi nd S i m i l a’ s vi ew o fthe ALJ ’s r o l e i n e v a l u a t i n gp s y c h o l o g i c a le v i d e n c e t o o n a r r o w. A l though a notherpsycho l ogi st’ s o pini on wo u l d have au g m en te d the ALJ ’ s an aly si s, ne i th erthe regul at i o ns noro ur pri ordeci sion s requir e the A LJ t o re l y o n such spe ci fi c ev i den ce t o r eb uta no nt r ea tingphy si ci an . “ [ T] he adm i ni str ati ve l aw j ud ge i s no t r equi re d ori nd eed per m i tted to accept m edi cal evi dence i f i t i s re futed by ot h er evi dence

— w hic h n eed no t itself be m edic a l in na ture
. . . .” Wild er v. C ha ter, 64 F.3d 33 5, 33 7 (7th C ir. 19 95 ) (em p h as is adde d)

. Ins te ad, a n ALJ i s r equi r ed to d et er m i ne the w ei ght anon tr eat i ng physi ci an’ s o pini on dese rv es bye xa m i ni ngho w w el lDr
. Ca i l l i ersuppo r te d a nd e xpl aine d hi s o pi ni o n, w he th erhi s o pi ni o n i s co ns i st en t w ith th e re c or d , w h et h er D r. C aillie r is a sp ec ialis t in pa i n dis o r de r s , a nd a nyo the rf a c t o ro fwh i c h the ALJ is aw are. 20 C
. F.R. § 404.1527(d )( 3)-( 6). This i s pre ci sel y what the A LJ di d here , decl i nin g to giv e D r. C aillie r’ s o p in ion su b st an tia l w eig h t b ec au se it lac ked co nsi ste ncy a nd supportabi l i ty. The A LJ no ted tha tDr
. Ca i l l i e rf o un d tha tS i mi l a h a d ma r k e d r est ri cti ons ofdai l y l i vi ng ac ti vi ti es. But she concl ud ed that th i s w as i nc o ns i st en t wi thS i m i l a’ s te st i m o ny tha t he re gul ar l y t oo k hi s chi l dren t o schoo l, o fte n m ad e di nner20 N o. 07

- 3682 f o rh i s f a mi l y, we nth un t i nga nd fi s hingwi th fr i e nd s and f am i l y, att ended hi s son’ s tr avel i ng hocke y team gam es, an d w orked w ith f riend s on sid e-projects. D r. Cai l l i erdi sc us se d no ne o fthe se acti vi ti es i n h i s M ar ch1 l ett er, despit e the f act that Dr. Cail l i er appeared to bas e hi s co ncl usi ons concernin g S i m i l a’ s functi onall i m i tation s o n Si m i l a’ s s ubj ecti ve com pla ints ( Dr. Cai l l i er did notcla i m that the M M PI

- 2 r esul ts

— th e o n ly a rg u ab ly obj ecti ve m eas urem ent Dr. Cai l l i erto ok

— r ev ea l ed th e i nt e ns i ty o fS i m i l a’ s m en taldi so r der )
. F ur th er m o r e, the A L J d iscoun ted D r. Ca il li er’s opinion as to Sim il a’s soc i alfuncti oni ng be cause i t, to o, was un su p port ed by an d i nc o ns i st en t wi ththe e vi d ence . Nothi ngi n the re c or d (or i n D r. C aillie r’s let te r) su gg es ts th atSim ila had probl em s g ett i ng al ong w i th hi s f am i l y o r fri en d s or w i th the cr owd s a t ho ckeyga m es. Inst ead, the A LJ pointed ou t tha t, t hrou gh ou t his m ed ical treatm en t, Sim il a’s do ct o r s co ns i st en tly de sc r ibe d hi m as “ pl ea sa nt ” an d “e nj oy ab le.” T he A L J also f ou nd l ittl e sup p o r t f or Dr. Caill ier’ s co nc lusi o ns tha t S i m i l a ha d m ar k ed di ffi cul ti es mai ntaini ng co ncentr ati on, per sist ence, o r pace, and had ex per i en ce d o ne o rtw o epi so des o fde co m pen sa ti o n. Dr
. C a i l l i e r ’ s l e t t e rme n t i o n e d S i mi l a ’ s c a p a c i ty f o rc o ncentr ati on o nl y o nce, i n w hi ch he no ted tha t S i m i l a had “adequate att enti on a nd co ncentr ati on t o the t askat hand

. ” Thi s was co nsi ste nt with w ha t D r. Chukw ud el unzu obse rv ed sev er alye ar s e ar l i erwh en he f ound that S i m i l a “demons tr at e[ d] a dequa te
. . . c o nc en tr at i o n a nd m em or y d u rin g h ist or y a n d n eu ro log ic e x am in at ion .” Si m i la argues that thi s doe s no t pr ove thatS i m i l a ca nN o. 07

- 3682 21

m aint ain a tt en ti o n a nd c onc en tr at i o n thr o ugho utthe w o r k d a y. B u t Sim ila’s arg u m en t m iss es th e p oin t. In d eterm ining w ha t w eight to give a non treating ph ysician’s op in ion, th e A L J is req u ire d to loo k for s u p p or t. Id. § 4 04. 1527 (d ) ( 3)
. A l though these obs er vati ons m ay not prove wh etherS im ila can co ncentr ate o n full

- ti m e work, they cer tainl y do not su p p or t Dr. Cai l l i er ’ s o pini on that Si m i l a i s m ar kedl y defi ci ent in that ar ea. Si m i l a a l so att acks the A LJ’ s fi nd i ng tha t Dr. Cai l l i er did notper f or m a “m entalst atus exam , ” ci ti ng the f act th atDr
. Ca i l l i erpr ef ac ed hi s o bs er va ti o ns wi ththe wor ds “o n e xa m . ” W he th erthe se t wo wo r ds pr o ve the A L J inc or re c t, w e c an n otsa y. T h os e t w o w or d s d on ’t t ell us m u ch abou t w ha t kind of ex am Dr. Caill ier w as p erf or m i ng. N onethel ess , any er ro r h ere was har m l ess g i v e n th e o th e rr e a s o n s th e AL Jc i t e d f o rd i s c o u nt i ng Dr
. Ca i l l i e r ’ s o pini o ns . We a g r e e wi th the ALJtha t Si m i l a’ s hunti ng and fi shi ng, at tendi ng trav el hocke y g ames , a nd he l pi ngfr i en ds wi thmai nt en an ce a nd c o nst r uc tion p roj ects are inc ons istentw ith D r. Ca il li er’s concl usi ons about Si m i l a’ s functi onall i m i tat i ons. Si m i l a pre sents a bar ra ge of otherar gum ents, but to no a vail. S i m i l a co ntends thatthe A LJ i gnor ed obj ecti ve ev i den ce s uppo r tingDr
. C ail l i er ’ s o pi ni o ns , s ucha s th e M M PI

- 2 r es ul ts , Dr
. M i ch et ’ s no te about S i m i l a ne eding c h ro n ic p ain reh ab , an d D r. Ste in er ’s t es tim on y th atit i s no t unusualf ordocto rs tr eat i ng a perso n w i th s o mat o f o r m t o n o tfi nd a nyp hy s i c a lc a use s . Bu tthe ALJ di d di sc us s th e M M PI

- 2, a nd a s we ment i o ne d, the re sul ts ofthat t es t s ai d nothi ng ab out the intensi ty of22 N o. 07

- 3682 Sim il a’s pa in, bu t only tha t Si m il a ha d a som atoform di so r der, whi chthe ALJ a cc ept ed as t r ue . M o r eo ve r, the A LJ i s no t r eq u ire d to di scuss eve rypi ece ofev i dence buti s i ns te ad r equi r ed to b ui l d a lo g i ca lb r i dge fr o m the ev id en c e t o h er co n c lu sio n s. C raft, 539 F.3d at67 3. A lth ou gh snip p ets o f D r. M ichet ’s notes an d Dr. Stei ne r’s tes ti m ony m i ght s up portDr. Cai l l i er ’ s o pini on s, othe r obj ecti ve evid ence i s inconsi ste nt with i t: M any o f Sim ila ’ s m ed ica l rec or d s s ta te th atSim ila h ad a n or m al, pa in-freer an g e o fmot i o n a nd no r m als tr en g th , a nd Dr. Kent w ro te that i t w as “ u ncl earto m e why [ Si m i l a] is totally d isabled ” an d he saw “no reason h e cou ldn ’t p er for m cle ric al w or k.” Si m i l a a l so ar gues that t h e A LJ e rr ed by f ai l i ng to m enti on that Dr. Cail l i er i s a ne uropsy chol ogi st w h os e o p in ion s d e s e rv e m or e w eig h t. See 20 C. F
. R. § 4 04
. 1527 ( d)( 5)
. Bu t the re gul ati ons sta te that a speci al i st’ s o pini on i s generallyenti tl ed t o m or e wei ght; it i s n o t pres um p tively so (un li ke treating p hy sicians). Id. ( em phasi s a dd ed). M enti oni ng Dr. Cai l l i er ’s speci al ty m i g hth a v e ma de the ALJ ’ s o pini o n mor e c o mp l ete , b u t in ligh t o f th e o th er ev id en c e t h e A L J c ite d , i t w oul d not hav e cha nged the outco m e. Final l y, S i m i l a a rgues that the A LJ e rr ed by not se ek i nga ddi ti o na le vi den ce b efo r e r en der i nga decis i o n. See id. § 4 0 4 .1 5 2 7 (c )(3) . “A n A L J h as a d u ty to so licit a ddi t i o na l i nfo r mat i o n t o fl e s h o ut a n o pini on f or w h i c h th e m ed ica l su p p or t is n otrea d ily d isc er n ab le.” B arnet t, 3 8 1 F
. 3 d a t 6 6 9
. S i mi l a r e l i e s o n B arnet tto con ten d that the A L J w as req uired to reconta ct D r.N o. 07

- 3682 23 Cail l i erbec ause she fou n d h i s o pini on unsupp or ted by th e r eco rd. S i m i l a r eads B arnet t too bro adly

. A n A L J is en ti tl ed to e va l ua te the e vi den ce a nd expl an at i o ns th atsu p p or t a m ed ica l sou rc e’s fin d i n gs . See 20 C. F
. R. § 40 4
. 1 5 2 7 ( d) ( 3 )
. And s he n e e d n o tr e c o nt a c tthe s o ur ce ev er y t im e s h e u n d er ta ke s s u c h a n ev alu at ion, bu t o n ly i f, a s we s ai d i n B arnet t, “the m edi calsupport is no t re adily dis ce rnabl e .” 38 1 F .3d a t 6 69 (em p h as is a d d ed ); see also Skinn e rv. As t r ue, 47 8 F
. 3d 836, 84 3 ( 7th Ci r. 20 07) (“A L Js m ay con tac t t r eating ph ysicians for furt he r inform at ion w h en th e in for m a t i o n alre ad y in th e re c or d is ‘i na d eq ua te’ to m ake a d eterm ination of disab il ity .
. . . ”). H er e, the A LJ disc er ned and di scusse d th e evi dence u p on w h ich D r . C aillie r re lied : th e M M P I-2 re su lts , his re vi ew o fS i m i l a’ s m edi calr eco rds, and S i m i l a’ s s ubj ec ti ve c o m pl aint s. Thi s r ec o r d was not“ i na dequa te
. ” The A L J sim p ly foun d that this evid en ce fail ed to sup p ort D r. Cai l l i er ’ s co nc l us i o ns , a fi ndi ngthe r egul at i o ns enti tl ed herto m ake

. I n o ne i ns ta nc e, tho ugh, the ALJ s ho uld h av e r ec o nta c te d D r. C aillie r. T h e A L J ob se rv ed th at“[I]t is un c l e a rwh e the rDr
. Ca i l l i e rh a d a c c e s s to the r e c o r ds in d ica tin g s om e c on c e r n w ith cla im an t’s n ar c ot ic u sa ge .” W e agr ee w i th Si m i l a that “uncl ear ” i s tanta m ount t o “not read il y d iscerna ble. ” H ow ever, w e beli eve th e A L J’ s e r r o rdi d n o ta ffe c tth e o ut c o me. And , a g a i n, the ALJ n ee d n otm en tio n ev er y s tr an d of ev id e n c e in h er d ec isi on but onl y e nough to bui l d an “acc urat e a nd l ogi cal b rid ge ” fro m ev id e n c e t o c on c lu sio n . C raft, 53 9 F
. 3d at 673. The ALJ ’ s di sc us si o n o fthe la cko fc o ns i st en cya nd supp or t forDr. Cai l l i er ’ s o pini on bui l t th at br i dge. A c-24 N o. 07

- 3682

cor dingly, the A LJ’ s deci si on t o disc ount that o pini on w as supp or ted bysubst anti alev i dence.

B. The A LJ ’ s Cr edibi l i ty Determ i nati on Sim ila n ex t d isp u te s t h e A L J’s fin d in g th ath is t es tim ony w as “n ot ent irel y cred ibl e.” W e rev iew an A L J’ s cre dib i l i ty de t e r mi na t i o n wi th de fe r e nc e , f o ra n ALJ, not a r evi ew i ng co urt, i s in the bestposi ti on t o evaluate cre dibi l i ty
. C raft, 539 F.3d at 678

. W e reverse th at d etermi na t i o n o nly i fi ti s s o l a c k i ngi n e xp l a na t i o n o rs up portt h at w e find i t “ patentl y wrong. ” E lder, 52 9 F
. 3d at 41 3-1 4 ( q u ot at ion om itt ed ). A n A L J m ay n ot“d isc re d it th e c l a i ma n t ’ s t e s t i mo n y a s t o s u bj e c t i v e s y mp t o ms m er el y b ecause theyar e unsupp or ted byo bj ecti ve evidence. ” Carradi ne v. B a r n h a rt, 36 0 F
. 3d 751, 75 3 ( 7th C ir. 20 04 ) (qu ot at ion om itt ed ); s e eal s o 20 C. F
. R. § 4 04. 1529 ( c) ( 2)
. To e val uate cred ibi l i ty, an AL Jm ust “c on sid er th e e n tir e c as e re c o r d a n d giv e s p ec ific re aso ns f orthe w ei ght g i ven t o the ind i vi du al ’ s s tat em ents. ” S SR 96

- 7p. In other w or ds, the A LJ sh ou l d l oo k to a num bero ff acto rs to dete rm i ne cr edibi l i ty, such a s th e o bj ec tiv e m ed ica l ev id en c e , th e c laim an t’s d aily acti vi ti es, al l ega ti ons ofpai n, ag gr avat i ng f acto rs, types oftr eat m ent r ecei ved and m edi cati on t ake n, and “functi onall i m i tat i ons. ” See 20 C
. F.R. § 404.15 29(c)(2)- (4); P roc ha s k a v . B a rnh a rt, 45 4 F
. 3d 731, 73 8 ( 7th Ci r. 20 06) (citation om itted ). In th e en d , “[a]n A L J m ay d isregard a cl ai m ant’ s a sse rt i ons ofpai n i fhe v al i dly fi nd s her i ncre dibl e. ” Prochas ka , 45 4 F
. 3d at 738.N o. 07

- 3682 25 Si m i l a a rgues that the A LJ i m proper l y di scou n ted h i s t e s t i mo n y a s to th e i n t e n s i ty o fh i s s y mp t o ms an d the l i m i tatio ns tha t st em fr o m the m . Re l y i ng pr i m ar i l y o n o uro pi ni o n in Ca r ra d i ne, 360 F. 3d at 754- 56, Si m i l a co ntends thatthe A LJ i gnor ed the psychol ogi cal nature o fhi s i l l ness, relie d too heav i l y o n obj ecti ve m edi calev i dence, m i schar act eri zed S i m i l a’ s pastm edi cal tr e a t men t, a nd i nc o r r e c t l y f o un d h i s c ur r e nta c t i v i t i es i nc o ns i st en t wi thhi s s ubj ec ti ve co m pl aint s o fpa i n. Al o ng th ese l i nes, S i m i l a a l so conte nd s that the A LJ s el ecti vely c onsi dered the ev i dence, l oo ki ng o nl y t o w hi ch ty pes o f acti vi ti es Si m i l a per for m ed but notto how he perfor m ed th e m o rt o a c t i v i t i e s h e c o u l d n o l o n g e rp e r f o r m. Though th e A LJ’ s cr edibi l i ty deter m i nati on was not fl aw l ess , i t was fa r from “pate ntl y wrong. ” The AL Jhad p len ty of rea so n to d ou b t Sim ila’s d es c rip tio n ofh is sy m p tom s a nd the extent ofthe const ra i nts they i m pose. To be gi n w i th, S i m i l a’s case i s no t qui te Carradi ne . In Ca r radi ne, we re ver sed an AL J ’ s fi nd i ng o fno disabi l i ty w here the A LJ f ai l ed to appreci ate th e psychol ogi cal nature o fthe cl ai m ant’ s s om at of or m di sor der a nd r el i ed pri m ar i l y o n the l ack ofo bj ecti ve m edi caldata to su p p or t h is c on c lu sio n s. 36 0 F .3d at75 4-5 5. T h e A L J in th a t c ase con clud ed that the claim an t’s som atoform di s o r de r“ i mpl i e s s he e xa g g e r a t e s the s e v e r i ty ofs y mptom s s he r epor ts. ” Id. a t 754
. Tha t’ s wro ng . Tha t th e cl aim an t has a som ato f or m di sor der m eans m er el y that th e pain h as a ps y ch o l o g i ca lc ause rath ertha n a p h ys ica l on e. Id.26 N o. 07

- 3682 H er e, the ALJ di dn’ t m ak e s uch a mis ta k e. Ins te ad, the A LJ had a hosto ff acts upon w hi ch to bas e her o pini on that Si m i l a o verst ated his sy m ptom s. Chie fam ong them wa s e v i de nc e o fS i mi l a ’ s a c t i v i t i e s . S i mi l a h el ped a fr i e nd p e e ll o g s a nd bui l d a l o gh o me; h e r e pl a c e d a gas ta nk; he a tte nd ed hi s s on’ s tra vel i ng hoc keyte am to ur na m en ts ; he wenthun tinga nd fi sh i ng( inc l udi ng i ce fi shi n g i n the w i nterand fi shi ng fro m a boatj ust w eek s be f or e the hear i ng)
. These ar e no t ligh t t ask s. They re quir e e xtended p hysi calexer ti on, wh i c h S i m i l a was seem ingly able to p erform

. W e d isagree w ith Sim il a’s conte nti on that these acti vi ti es ar e a ki n to the occa si onal dr i ving, s ho ppi ng, ho us ewo r k, a nd th er ape ut i c wal k i ng di sc us se d i n Carradi ne . Id. at75 5- 56. Si m i l a a rgues that the A LJ fai l ed to f ol l ow SSR 9 6- 7p by “se l ecti vel y c onsi deri ng the ev i dence” and notdi scussi ng ho w S i mi l a e ng a g e d in the s e a c t i v i t i e s . Bu tthe ALJ spe ci fi ca l l y no te d S i m i l a’ s t es ti m o ny r eg ar di ngthe l en gt h o f ti m e S i m i l a s pent doi ng ea ch act i vi ty and that su c h ac tiv itie s “ ex ac erb at e h is p ain .” T h e A L J m er ely d isc ou n t e d S im ila’s cr ed ibilit y a s t o h ow m u c h th is pain l i m i te d hi s func ti o ni ng

— Si m i la’s continuing to hu nt, fi s h, a nd g o t o h o c k e y t o urna men t s l e d the ALJ to c o nc l ude tha t S i m i l a ca n ad equa te l y de alwi tha ny i ncre ase i n hi s s ym ptom s. M or eov er, S i m i l a’ s att em pts to dow nplayhi s acti vi ti es contr adic t s eve ra lo fhi s docto r s’ r epo r ts a nd, i n s o m e i ns ta nc es , c o m m o n s en se . The re p or ts refle c t Sim ila’s on go in g parti ci pation in cer tain act i vi ti es ( e. g. , “the pati ent e nj oys hunti ng, fi shi ng, and fo ur wheel i ng and p laying hoc key ”) as o pp ose d to o ne o rtwo di sc r et e ev en ts
. And, a s we’ ve a l r ea dy m en -N o. 07

- 3682 27 ti oned, o ne physi ci an, Dr. Ke n t, openl y quest i oned Sim il a’s clai m s for d isabil ity (“I see n o reason he cou ldn ’t perf or m cl er ical w or k, et c. ”)
. Even Dr. Cai l l i ernot ed Sim ila’s te n d en c y t o d es c rib e h i s sy m p to m s in “d ra m at ic fashio n. ” M o r eo ve r, S i m i l a’ s des cr i pti o n o fho w he en gag ed i n cer tain acti vi ti es i s equal l y du bi ou s: W hen ask ed abo ut peel i ng l og s a nd bui l d ing the l og hom e, Si m i l a di dn ’ t point to the prednis one i nj ec tio n s and sa y h e fe l tg o o d e n o ug h t o w o r k

. In s t e a d , h e r e s p o n d e d , “ my so n was do i ngmos t o fthe wor k

. . . . I was the r e al o ng w ith h im .” Sim ila’s s o n s w er e e lev en an d six ye ar s o ld atth e t i me . T h o u g h we d o n ’ td o u b tth e i rs t r e n g th, p e e l i n gl o g s ( whi c h o ft e n r e q u i r e s u s i n ga c h a i n s a w) mi g htma k e e v e n Pa ulBu ny a n a l i t t l e t i r e d. I n additi on, the A LJ di scusse d the utterlac k ofo bj ecti ve m edi calev i dence thatm i ght b ol ster Sim i l a’ s co m pla i nts ofse ver e, di sabl i ng p ain
. Docto rs co nsi ste ntl y r epor ted t h a t S im ila h ad a n or m al, p ain -fre e ra n ge of m ot ion in h is lim b s a n d sp in e, m os tly n or m al s tr en gt h, an d on ly m i l d de g en er at i ve di skdi se as e in pa r t o fthe s pi ne . One physi ci an ev en not ed that Si m i l a e xhibi ted so m e “ gi veaw ay w ea kn es s,” w h ich ca n be a sig n th a t th e p at ien t is tr y in g t o d ec eiv e h is p h ys icia n by feign in g t ru e m u sc le w ea kn es s. See L EZ AK ETAL ., sup ra , at32 6; H ans E. N evi l l e e t al., Neuro m uscu la r D iseases , i n N EUROLOGY FO R TH E N ON N EUROLOGIS T 3 2 4 ( W i l l i a m J
. Weine r& Ch ri s t o ph e rG. Goetz eds. , 5th ed. 20 04) ( “[ A ] ‘g ive

- aw ay’ patte rn o f w eakn ess . . . su ggests lack of full volun tary ef fort.”); Leo na r d N
. Gr ee n, M a ling ering, D issim ula tio n a nd C o nv ers i on

—Hyste ri a , i n T RAUMA 4 3 -6-8[3] ( M atth ew Be nd er & Co. 20 03) ( “Because the dece pti ve pati ent i s unaw ar e or28 N o. 07

- 3682 uncert ai n as to how m uc h stre ngth t o exer t a nd i s no t ex er ting m ax imals tr en g tha s he o rs he i s as k ed to do , the re sul ti ng effo rtpro du ces a r atchety, i rr egul ar, sudd en
‘ g i v e - a wa y ’ fe e l i ngt o the e xa m i ne r ’ s c o un t e r a c t i o n. By c on tr as t, th e e x am i n er find s a sm oo th loss of m u sc le re sis ta n c e in a t r u ly w ea ke n ed lim b .”); cf. L EE R. R USS E TAL ., 8 A TTO RNEYS M EDICAL A D V ISOR § 74: 80 ( re i ssued ed. 20 05) ( n ot in g that “ [ e] xam i ners so m eti m es em plo y a
‘ g i ve a way wea k ne ss ’ t es t to de m o ns tr at e th ata pa ti en t i s f aking m uscl e wea kn ess, ” but express i ng so m e doubt as to applica b il i ty ofte st to pati ents w i th Refl ex S ym path etic D ystrop hy /C om p lex Re gional P a in Synd rom e). All th i s i s o n to p o f th e f ac t th at a set of go ve r nm en t m edi calexam i ners co ncl ud ed that Si m i l a co uld ca rr y o r l i f to v e r2 0 p o u n d s o c c a s i o n a l l y a n d o v e r1 0 p o un ds fre q u en tly . In sh or t, Sim ila’s m ed ica l his to ry offe rs little orno f orsupport hi s t est i m ony. Si m i l a a tta cks the AL J ’ s r el i ance o n this lac k ofo bj ecti ve eviden ce i n l i g hto fo urho l di ngi n Carradi ne . I n Carr adi ne, the A LJ pl ai nl y m i sund er sto od the psychol ogi calnatur e ofthe cl ai m ant’ s i l l ness and his heav y rel i ance o n the l ack ofan obj ecti ve m edi calexpl anati on f orthe c laim an t’s pai n contr ibuted to thater ro r. 36 0 F
. 3d at 755. But C a rrad ine does not im p l y that a n A LJ c an nev er co ns i derthe lack ofo bj ec ti ve e vi den ce i n r ej ec ting a cl ai m an t’ s su bj ect i ve c o m pl aint s. S ucha r ea di ng w oul d null i fy 2 0 C. F. R. § 404. 1529 (c) ( 2) and ( 4) , wh i ch re quir e a n A LJ to consi der the obj ecti ve m edi calev i dence. In st ea d , Carradi ne, c onsi s t e ntwi th the r e g ul a t i o ns , s t a nd s f orthe propos i ti on that a n A LJ c annot deny dis ab i l i ty
“ sole lybec ause the a vai l abl e obj ecti ve m edi calev id enceN o. 07

- 3682 29 does not substa nti ate [ th e c l ai m ant’ s] st ate m ents. ” 2 0 C. F
. R. § 4 0 4
. 1 5 2 9 ( c ) ( 2 ) ( e mpha s i s a dde d)

. He r e , the ALJ consi dered the o bj ecti ve evi dence al ong w i th a host of ot h er fac to rs n a m ed in t h e re gu lat ion s, s e ei d. § 404. 1529 ( c) ( 2)

- ( 4) , l i ke Si m i l a’ s acti vi ty l eve l s, as we ’ v e di s c us s e d. The ALJ a l so e va l ua te d S i m i l a’ s co ur se o ft r ea tmenta nd empl o y m en t hi st o r y . S he f o und S i m i l a’ s tr ea tment

— va r i o us pain m edi ca ti o ns , se ve r al i nj ec ti o ns , an d o ne physi calther apy se ssi on

— to be “ re l ati vel y c onse rv ati ve” an d inc on sis te n t w i t h Sim ila’s co m p lain ts . Sim ila a ss ails th e AL Jf o r“ pl ay i ngdo ct o r ” an d i m pr op er l y e va l ua ting the extent of hi s tr eat m ent. Si m i l a aga i n l i kens h is case to Carradi ne, i n w hich w e ob served that the claim an t’s ex te n siv e t re at m en t re g i m en ac tu ally bo lst er ed h er cr ed ibi l i ty . 3 6 0 F
. 3 d a t7 5 5
. Ho we v e r, th e r e g u l a t i o n s e xpr es sly pe r m i t th e AL Jt o c o ns i dera c l ai m an t’ s tr eat m en t hi sto ry . 20 C .F.R. § 404. 1529 ( c) ( 3) ( v)
. Giv en the defer ence w e sh ow to an A L J’s fac tu al d e t e rm in at ion s, C raft, 53 9 F. 3d at 673, w e wil lnot q uesti on the A LJ’ s fi nd i ng tha t Sim ila’s tre at m en t was “r el atively c onse rv ative ,” es p ec ially w hen com pare d w ith C ar ra d in e’s tre at m en t t h at i ncl u d ed m or phine a nd a surg i cali m pla nt i n herspi ne. See Carradi ne, 36 0 F
. 3d at 755. M or eov er , S i m i l a s eem ed to have hi s o w n i dea ofwh at ty pe oftr eat m ent he needed

— the r e c o r d s ho w s a pat te r n o fdr ug - se ek i ngb eh av i o r . M ul ti pl e phy si ci an s th ro u gh ou t th e c ou rs e o f h is t re at m en t n ot ed t h a t Sim ila w as ove rusing hi s pai n m edi cati on a nd thatsuch o ver use m igh t a c t u ally be ca u sin g s om e o f h is s ym p to m s (e .g.,30 N o. 07

- 3682 “superim p os ed n ar c ot ic-induced headache”)

. Even Sim ila ad m itt ed th at h e occ as ion ally “o ve re at s” h is p ain pi l l s. In a ddi ti o n, S i m i l a ha s a hi storyo fc o ca i ne us e, a nd i n 200 5, the Pai n Clini c o fN orth w est er n W i sco nsi n dis

charg ed Si m i l a a ftera toxi col ogyscr eeni ng sho w ed ev i den ce of coc aine . Thi s cuto ffhi s su ppl y o fVi co di n. B u t S im il a ha d to have i t. So he called th e M idelfort Clini c f ora re fi l land l i ed, te l l i ng the m he c oul dn ’ t g et a p re sc rip tio n from th e P ain C lin ic fo r “fi n a n c ial re as on s.” T h ou gh Sim ila w as su c c e s s fu l in g et tin g m or e p ills, th is i s hardl y the k i nd o fc o nd uc ttha th e l ps o ne s uc c e e d o n a d i s ab i l i ty c l a i m. N oton ly w as Sim ila a ll too ea ge r to ta ke h is n ar c ot ic pai n m edi cati on, wh i ch hi s doct or s cauti oned ag ai nst ov er u sin g, bu t h e w as rat h er u n w illing to p a r t icip at e in physi calther apy, wh i ch hi s doct or s pre scr ibed

— tw ice. Si m i la n eve r showed up afterhi s fi rs t s ess i on. W hen h is d oc to rs rec om m en d ed p h ys ica l t h er ap y a ga in, he sa id he wasn’t i nter est ed. Fur ther m or e, despi te the f act that Si m i l a l earned that the s ourc e o fhi s pai n w as psychol ogicaland despit e Dr. Cai l l i er ’ s r eco m m endati on for ther apy, S i m i l a hadn’tso ught co unsel ing bythe ti m e o f th e he ar i ng . S o a g ain we s ee a l ac ko fs i nc er i tytha t ex pla i ns the A LJ’ s doubting S i m i l a’ s t est i m ony. Fi nal l y, the A LJ found that S i m i l a’ s workhi sto ryal so und e r mi ne d h i s c r e dib i l i ty . S i mi l a c o nt e s t s thi s p o i nt, ar gui ngtha t th e AL Jmis i nt er pr eted hi s empl o y m en t r ec o r ds. S i m i l a i s co r r ec t th atthe ALJ e r r ed when sh e st at ed th at S i m i la’s ea rn in gs d ec lin ed from 19 97u n til 2003
. In f act, theydecl i ned untilo nl y 2 001, then ro seN o. 07

- 3682 31 slig h tly in 2 00 2, an d d ec l i n e d ag ain in 2 00 3. B u t th is m i nor m i sta ke w as harm l ess . I n 1996 , Si m i l a’ s earning s w er e $ 36, 980. 50 and by 20 01 w er e $ 10, 682. 29. They r ose to onl y $ 15, 909. 67 i n 200 2, l ess t h an hal fo fwh at they w er e in 199 6. A l though S i m i l a t est i fi ed that h e ba rt ended o nc e a we e ka nd o c c a s i onal l y i ns t a l l e d c a r pe t, the ALJ f ound that S i m i l a’ s d ecl i ni ng ea rni ngs pr i orto the onse t of h is a lleg ed d isa b ili t y , c o u p led w ith th e fa c t th atSim ila did notpart ici pate in a v oca ti onalr ehabi l i tat i on prog ra m , sho w ed a l ac k of eff or t t o fi nd work and, und er § 40 4. 15 29 ( c) (3), di m i ni sh ed hi s cr edibi l i ty
. S ucha find ing w as no t im p rop er. Acc o r di ng l y, we c o nc l ud e tha tthe ALJp r o pe r l y c o ns i der ed bo th S i m i l a’ s s ubj ecti ve com pla i nts a nd ev i dence unde r m ining the c r edibi l i tyo ftho se c o m pl aint s. S he ba se d he rde te r m i na ti on on m ul ti pl e f ac to r s an d the en tir e c as e re c or d , a s t h e re gu lat ion s re q u ire . Th e o n ly ev id en c e s u p p or tin g Sim ila’s c h a r ac te riz at ion of h is sy m pto ms wa s Dr
. C a i l l i er ’ s as se ss m en t o n t he “Psychi atr i c Revi ew Techni que, ” which, as we have al re ad y hel d, the AL Jpro perl y di sco unted. The o bj ecti ve m edi cal evi dence, Si m i l a’ s acti vi ty l eve l s, his c ou rs e oftr eat m en t, h is dr ug- see ki ng be havi or, and hi s e m plo ym ent hi sto ryall co unsela heal thy s kepti ci sm f or Si m i l a ’ s t e s t i mony . As s uc h, we c a nn o tc o nc l ud e that th e A L J’s c re d ibilit y d et er m in at ion w as “p at en tly w ro n g.”

C. Th e A LJ ’ s H ypot heti cal Q uesti ons f ort he V ocat i onal E xp ert Si m i l a a l so chal l enges the A LJ’ s co ncl usi on a t s tep fi ve o fthe s eque nt i al a na l y si s th atthe r e wer e a si g ni fi ca nt32 N o. 07

- 3682 numbero fj o bs tha t he c o ul d p erform

. At s te p fi ve , the A LJ evaluates the cl ai m ant’ s RFC a l ong w i th hi s a ge, educati on, and w or k ex p er i ence, to deter m i ne wh ether the c l ai m ant ca n “m ake an a dj us tm en t t o othe r w or k. ” 2 0 C .F .R
. § 404.1520(a)(4) (v). To m ake th is find ing, A L Js oft e n r e ly on the tes tim ony of a voca tional exp ert (“VE ”). Com m onl y, the A LJ wil lpose a ser i es ofhypothe ti cal que st i o ns tha t des cr ibe the cl ai m an t’ s co ndi ti o ns a nd l i m i tat i ons, and the VE wil lte sti fy t o th e n u m bero fj obs that the c l ai m ant c an per f or m bas ed on those l i m i tat i ons. This i s what the A LJ and VE di d here

. But Si m i l a a rgues th at th e VE ’s con clusion s w ere faulty beca us e the A L J’ s hypotheti calquesti ons w er e incom ple te. Ordi nari l y, an ALJ ’ s h yp o the t i c a lque s t i o ns t o a V E “ mus ti nc l ud e al ll i m it at i o ns s uppo r te d b y medi ca le vi den ce i n the re cor d.” Steele v. B a rn h a rt, 29 0 F
. 3d 936, 94 2 ( 7th Cir
. 20 02)
. S i m i l a co nt en d s th at the AL Jo m i tte d seve ra l l i m i tat i ons that w er e s upp or ted b y m edi calev i dence. M ost sa l i en t to o ura na l y si s he r e, S i m i l a ar g ue s, i s th e A LJ’ s fi nd i ng tha t S i m i l a had “m oder ate diffi cul ti es w i th co nc ent r at i o n, pe r si st en ce , a nd pa ce . ” I n a ddi ti o n, S i m i l a ar g ue s th atthe ALJ s ho uld ha ve i nc l ude d the al l ega ti ons that Si m i l a co uld s tand orsi t foro nl y a sh or t t im e, th ath e o f t e n n ee d ed to lie d ow n an d w ou ld m i ss w or kfr e qu e nt l y, a nd tha th e i n f a c th a d ma r k ed diffi cul ti es w i th co ncentr ati on, per si ste nce, and pace. W e di sag re e w i th S i m i l a r ega rdi ng the l att erse t o f l i m i tat i ons, bec ause “the A LJ i s r equi re d on ly to i ncor pora te i nto hi s hypotheti cal s those i m pai rm ents and l im itati ons that he accepts a s cr edibl e. ” Sc hm i dt, 49 6 F
. 3d at 846.N o. 07

- 3682 33 Th e ALJma de c l e a rtha ts he di d not fi nd S i mi l a ’ s s y mpt o ms t o b e a s a c ut e a s e i the r Dr
. Ca i l l i e r ’ s l e t t e rsugges ted o r Si m i l a t est i fi ed. S h e speci fi cal l y di sag re ed w i th Dr. Cai l l i er ’ s ass ess m ent that Si m i l a had “m ar ked” r est ri ctions o fc o nc en tr at i o n, pe r si st en ce , a nd pa ce , a nd s he foun d that Si m ila w as able to stan d f or up to si x h ou rs and si t up to two . Beca use we f ound that the A LJ was j u s t i fi e d i n d i s c o u n t i n g Dr
. C a i l l i e r ’ s c o n c l u s i o n s a nd Si m i l a’ s cr edibi l i ty, we al so fi nd thatshe w as not re quir ed to i ncl ud e these l i m i tat i ons i n herhypothe ti cal s. The o m i ss i o n o fthe fi r sts eto fl i m i tations

— Sim il a’s m oder ate di ffi cul ti es w i th co ncentr ati on, per si ste nce, and pace

— i s m or e tro ubl i ng. T he A LJ found these l i m i tati ons t o b e c r e dib l e , a nd un de r the o r di na r y r ul e , they w ou ld h a v e t o b e in c lu d ed . A n ex c ep tio n to th is ru le co m es i nt o pl aywhenthe r ec o r d i ndi ca te s th atthe VE “i nd ependentl y l earne d of the l i m i tat i ons ( thro ugh other que st i o ni nga t th e he ar ing or o ut si de r ev i ew o fthe m ed i c a l r e c o r d s , f o r e x a m p l e ) an d p re su m ab ly acco unted f orthem

. ” Ste el e, 29 0 F
. 3d at 94 2. Howev er, the excep tio n d oes notapplyi fthe re cor d i nd i cate s that the VE’s te sti m ony w as confi ned to t h e li m i tat i ons set for th in t h e A L J’s h yp ot h et ica l qu es tio n . Yo un g v . B a rnh a rt, 362 F.3d 995, 1003 ( 7th Cir. 2004). H er e, the hear i ng tr anscr i pt i nd i cate s t h at the VE re

vi ew ed the r ec o r d pr i o rt o t es ti fy i ng, a nd a t o r ala r g um ent, S i mi l a ’ s a t t o r ne y c o nc e de d tha t the VE was p resen t throu gh ou t the hearing and thu s hea rd Sim il a’s te st imony
. Butthe r ec o r d do es no t i ndi ca te tha t th e VE bas ed his conc lusions on anyt hin g ot h er than the A L J’ s34 N o. 07

- 3682 hy po th eti ca l s. Li k e th e AL Ji n Young, t he A LJ her e pos ed a “ se rie s o f h yp ot h et ica l qu es tio n s w ith inc re as i n gly deb i l i ta tingl i m i ta ti o ns ” an d l ai d o uts pec i fi ca l l y the fac ts u p on w h ich th e V E w as to ba se h is c on c lu sio n s. See Young, 362 F. 3d at 1003
. The VE then pref aced hi s fi rs t co m m en ts wi th , “ Gi v e n t h e el ement s o f t he h yp ot h et ica l .

. .” In n on e of his res p on se s d id th e V E rely on or even m en tion his review of th e record or Sim il a’s testim ony . Ins tead , he focu sed his testim ony on th e A L J’s hypotheti cal s, and acco rdi ngl y, we cannot ass um e that the VE base d hi s tes ti m ony on anythi ng but tho se hypotheti cal s. Our r evi ew i s thus confi ned to the questi ons the A LJ posed and w hethertho se questi ons i ncor pora ted Si m i l a’ s m oder ate diffi cul ti es w i th co ncentr ati on, per si ste nce, and pace. W e find that the A L J a d e qu ately accou nt ed f or Si m il a’s i m pai r men t s . In he rfi r s th y po the t i c a l, the ALJde s c r ibed all of Sim ila’s cr ed ible im p air m en ts , ph ys ica l an d m en ta l, i nc l ud ing S i m i l a’ s ch r o ni c pain a nd s o m at o f o r m . S he th ens ta te d tha t “b ec au se o fthe a l l eg ations o fpa i n, Iwould al so furtherl i m it it to u nski l l ed, ” a s wel las lim i t i n gth e s e c o n d h y p o th e t i c a lt o “ s e d e n t a r y le v e lw o r k.” W e ha v e h eld th at claim an ts w ho “often exp erience [ ] d efi cienc ies ofconc en tration, per s istenc e, or pac e” are c ap ab l e o f p er for m in g s em isk illed w or k, Jens v . B a rnh a rt, 347 F.3d 209, 213 (7th Cir. 2003), an d those w ho are “m i l dlyto m oder ate l y l i m i ted i n thes e a re as, ” a re abl e t o perf or m “s i m ple and re peti ti ve l i ght work, ” Si m s v. B a rnh a rt, 309 F.3d 424 , 431 (7th C ir. 2002). Sim il a’s m od erat e di ffi cu lt i es wi thc o nc en tr at i o n, pe r si st en ce , a nd pac e st emm ed fr o m hi s ch r o ni c pain s yn dr o m e an dN o. 07

- 3682 35

so m at o f o r m di so r der, whi chthe ALJ i nc l ude d i n the hy p oth etical. T he se im p airm en ts are rooted in Si m ila’s al l ega ti ons of pain. Consequentl y, byl i m i ti ng the hypotheti calto unski l l ed w or k, the A LJ incor pora ted al lo f Si m i l a’ s cr edibl e l i m i tat i ons.

D . Dr. Cai l l i er ’ s Let t erofJ un e 2 2,20 06 Fin ally , Sim ila a r g u e s t h atth e d ist ric t c ou rtsh ou ld h av e rem an d ed be c au se D r. C aillie r’s Ju n e 2 2 le tt er co n st ituted “new and m ate ria l ” e vi dence. A di str i ct c ourtm ay o r d e rth a ta d d i t i o n a le v i d e n c e b e t a k e n b e f o r e th e C o mm i ssi onerupon a s how i ng tha t there i s “ new ev i dence whi chi s m at er i ala nd tha t th er e i s g o o d c au se f orthe f ai l ur e to i nc o r po r at e su che vi den ce i nt o the reco r d i n a p rior p ro c ee d in g.” 42 U .S.C . § 40 5(g ). “N ew ” e vid en c e is th atwhi chi s “n o t ine xi st en ce o ra va i l ab l e to the c laim an t at th e tim e of th e ad m in ist ra tiv e p r oc ee d in g.” P erkin s v . C ha ter, 107 F.3d 129 0, 1296 ( 7th Cir. 1997). F ur th er, “ [ n] ew e vi den ce i s ‘ m at er i al ’ i fthe r e i s a ‘ r ea so nab l e p r o b ab i l i ty ’ tha tthe A LJ w ou l d h a v e r e a c he d a d iffer en t c on c lu sio n h ad th e e vid en c e b ee nco n sid er ed .” Sc hm idtv. B a rnh a rt, 3 9 5 F
. 3 d 73 7, 74 2 ( 7 th C i r . 2 0 0 5 )
. We re vi ew the dist ri ct c ourt ’ s deci si on notto r em and on th es e g ro u n d s d e n ov o. Jo hn son v. A pfel , 19 1 F.3d 770, 77 6 (7th C ir. 1999). Si m i l a a rgues that the J une 22 l ett er w as new and m ate
rial, becau se it w as an i m m ed iate respo ns e to the A L J’ s concerns abo ut Dr. Cai l l i er ’ s o ri gi na l r ep or t. S i m i l a r oo ts thi s ar gum ent i n hi s bel i ef that the A LJ should have re c on ta cted Dr. Cai l l i erto cl ar i fy hi s r epor t. The J une 2236 N o. 07

- 3682 l e t t e rthu s p r o v i de d the n e c ess a r y, tho ugh un s o l i c i t e d, c l a r i fi c a t i o n . He n c e , S i mi l a a r g u e s th a tth e l e t t e ri s “ n e w” be ca us e i t di d no t ex i stpr i o rt o the ALJ ’ s dec i si o n a nd is “m aterial” becau se it contrad icts th e A L J’s p riorint erpr et at i o n. But o ur pr i o r de c i s i o ns t e a c h tha t the J un e 2 2 l e t t e rwas h ar d ly “n ew ” for § 4 05 (g) p u rp os es . E.g
. , Perki ns , 10 7 F
. 3d at12 96 ; Sam ple v. Shalala , 999 F .2 d 1 138, 1144 (7th C ir. 1993 ). In st ea d , th e le tt er w as m er ely “d er iva tiv e e vid en c e,” because Dr. Cai l l i er“ba sed hi s co nc lu sio ns ent i re l y o n evi dence thathad l ong b een a vai l abl e. ” Perki ns , 10 7 F
. 3d at 1296
. Dr. Cai l l i erdi d not r eexam in e Sim i l a o r conduct n ew p sy c h olo gic al t es ts ; rat h er h e e lab or at ed on h is p revious report an d resp ond ed to Sim il a’s attorn ey’s q u est i ons about the AL J ’ s co ncer ns. Thi s was pre ci sely th e sc en ar i o we addr es se d i n Perki ns : [A ] cr itiq u e of th e A L J’s o p in ion, w h ich ob vio u sly could n ot have been done befor e the o pini on i ss ue d, do es no t amoun t to goo d c au se ; s ucha rul e wou l d am ount t o autom ati c per m i ssi on t o su ppl ementr ec o r ds wi thnew evi den ce a fte rthe A L J iss u es a d ec i s i on in t h e c as e, w h ich w ou ld ser i ousl y underm i ne the r egul ar i ty ofthe adm i ni str ati ve proce ss. Id. Se c tio n 40 5(g ) d o e s n otp ro vid e o c c as ion for a p h ys ici an to subm i t a n u n so l i ci ted cl ar i fi cati on o fhi s pri or opi ni on. The A LJ has m echani sm s t o procur e a dd i ti onal ev i den ce , i nc l udi ngr ec o nt ac tingmedi ca ls o ur ce s, i fthe ev i d e n c e w as ina d eq u at e t o re ac h a d ec isio n . See 20N o. 07

- 3682 37 C.F
. R. §§ 404. 1512 ( e) ; 404. 1527 ( c) ( 3)
. Because the ev i dence w as ad eq uate, however, the A LJ nee d not hav e i nvoke d those pro cedures here

.

I I I . Concl usio n W e A F F I RM the j ud gm ent o fthe dist ri ct c ourt
.

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