ability to work, if at all. This warrants remand. See Arnett, 676 F.3d at 592 (“Although
an ALJ need not mention every snippet of evidence in the record, the ALJ must connect
the evidence to the conclusion; in so doing, he may not ignore entire lines of contrary
evidence.”).

This shortcoming ties directly into the ALJ's credibility finding. We note that the
ALJ's use of boilerplate language is at least accompanied with some reasoned
analysis.‘ See Filus v. Astrue, 694 F.3d 863, 868 (7th Cir. 2012) (noting that the
inclusion of boilerplate language may be harmless if the ALJ otherwise explains his
conclusion). However, having failed to explain why Garcia’s well documented
complaints of fatigue were incredible, we must remand on this issue for further
consideration. See Myles v. Astrue, 582 F.3d 672, 676-77 (7th Cir. 2009) (remanding
where, among other things, the ALJ failed to articulate reasons for rejecting claimant’s
allegations of fatigue).

E. The ALJ Erred at Step Four When He Determined that Garcia Could
Perform his Past Position as it was Generally Performed.

Lastly, Garcia takes issue with the ALJ's step four finding. As explained above,
ALJ Fina determined that Garcia could “perform his past relevant work as an inspector
Il [as] it [is] generally performed.” (R. 18.) According to Garcia, because his past
position at Sealy was actually a composite job, that is, a combination of the inspector II
and machine packaging positions, the ALJ’s decision at step four requires reversal. We

agree.

* Unlike Garcia, we do not view the ALJ's references to certain inconsistencies in his testimony as
a mischaracterization of the record.

20


i. LEGAL ANALYSIS

A. Standard of Review

We must affirm the ALJ's decision if it is supported by substantial evidence and
free from legal error. 42 U.S.C. § 405(g); Steele v. Barnhart, 290 F.3d 936, 940 (7th
Cir. 2002). Substantial evidence is “such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Scheck v. Barnhart, 357 F.3d 697, 699
(7th Cir. 2004) (quoting Kepple v. Massanari, 268 F.3d 513, 516 (7th Cir. 2001)). We
must consider the entire administrative record, but will not “re-weigh evidence, resolve
conflicts, decide questions of credibility, or substitute our own judgment for that of the
Commissioner.” Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003) (quoting Clifford
v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000)). And, although the ALJ is not required to
address every piece of evidence, he must “build an accurate and logical bridge” from
the evidence to his conclusion. Clifford, 227 F.3d at 872. Further, the ALJ must
sufficiently articulate his assessment of the evidence to assure us that he “considered
the important evidence” and to enable the court to “trace the path” of his reasoning.
Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002).

B. Analysis under the Social Security Act

To qualify for benefits, a claimant must be “disabled” under the Act. A person is
disabled under the Act if he or she has an “inability to engage in any substantial gainful
activity by reason of any medically determinable physical or mental impairment...which
has lasted or can be expected to last for a continuous period of not less than twelve

months.” 42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). To determine if a claimant is

14


diabetes, and hypercholesterolemia. (R. 302.) He was prescribed imdur and pepcid,
advised to stop drinking, and advised to follow up with his primary care physician at
Aunt Martha’s clinic and Dr. Hamdani. (R. 302-03.) Garcia did not require a blood
transfusion during this visit. (R. 302.)

Garcia continued to undergo treatment with Dr. Hamdani as advised. On May
19, 2009, Garcia complained of fatigue. (R. 327.) Dr. Hamdani’s physical examination
revealed normal results. (/d.) He assessed alcoholic cirrhosis of the liver, bleeding
varices, and prescribed ranitidine, an antacid. (R. 327-29.) On June 16, 2009, Dr.
Hamdani performed a follow-up endoscopy. (R. 300.) Dr. Hamdani noted that the
varices had significantly diminished since the first ligation, with very few cherry-red
spots, but were still about 8 to 9 centimeters long. (/d.) As a result, he performed an
additional ligation, during which he placed six bands. (/d.) No bleeding was noted, with
the exception of a few cubic centimeters of blood. (/d.) Dr. Hamdani increased
Garcia’s beta-blocker dosage and recommended a three week follow-up ligation. (/d.)

Garcia returned for a follow-up visit on June 23, 2009 complaining of fatigue. (R.
330.) Dr. Hamdani prescribed glyburide for his diabetes. (R. 331.)

Garcia underwent his third ligation with Dr. Hamdani on July 10, 2009. (R. 299.)
Dr. Hamdani observed persistent moderate-sized varices in the distal esophagus, with
a few cherry-red spots. (/d.) Consequently, Dr. Hamdani placed an additional seven
bands. (/d.) Dr. Hamdani noted that “[i]t was remarkable that despite 2 sessions of
ligations here the patient persists in having significant varices of medium size and very

likely requires a followup ligation in 3 weeks.” (/d.)


As a general matter, a claimant is not disabled if he maintains the RFC to
perform his past relevant work either as he actually performed it or as it is generally
performed in the national economy. SSR 82-61, 1982 WL 31387, at *2; see also 20
C.F.R. § 404.1560(b)(2). However, in the case of a “composite job,” which has
“significant elements of two or more occupations,” there is no equivalent in the
Dictionary of Occupational Titles. SSR 82-61 at *2. Instead composite jobs must be
“evaluated according to the particular facts of each individual case.” /d.

Here, the VE specifically testified that Garcia’s past relevant work at Sealy was a
combination of the inspector II position (light, semi-skilled) and the machine packager
position (medium, unskilled), supporting a finding that the position was a composite job.
He explained that Garcia performed the position at a “very heavy level,” and that he
could no longer perform the position as he performed it.

Unfortunately, the ALJ ignored the fact that Garcia appears to have had a
composite job and described his past relevant work as two separate positions. He then
concluded that Garcia could perform the inspector I! position as it is generally

performed (light level of exertion), and was thus not disabled. Like Garcia, we find the

5 As set forth in the Program Operations Manual System ("POMS"), a handbook for internal use
at the Social Security Administation, “if [the ALJ] can accurately describe the main duties of [past relevant
work] only by considering multiple DOT occupations, the claimant may have performed a composite job.
POMS DI 25005.020(B). POMS further provides that because a composite job does not have a DOT
counterpart, the ALJ should “not evaluate it at the part of step 4 considering work ‘as generally performed
in the national economy.” /d. Although POMS has no legal force and is not controlling, Parker for Lamon
v. Sullivan, 891 F.2d 185, 190 (7th Cir. 1989), some courts have at times described POMS as at least
persuasive. See e.g., Thompson v. Astrue, 11C 472, 2013 WL 393290, at *4 (N.D. Ind. Jan. 31, 2013)
(collecting cases).

21


treatment of Garcia over a year and a half period. Those records set forth Garcia's
symptoms, the treatment plan, including the banding procedures and prescribed
medications, and Dr. Hamdani’s contemporaneous recommendations as to Garcia's
abilities. The record also includes various CT scans and other laboratory results
ordered by Dr. Hamdani. How, in the face of these records, the ALJ could find Dr.
Hamdani’s opinion “conclusory” and without supporting documentation is unclear.?
Further, the ALJ does not offer any explanation as to why he concluded that the
“available objective evidence does not support [Dr Hamdani’s opinion].” See Elder v.
Astrue, 529 F.3d 408, 415 (7th Cir. 2008) (noting that at the very least, the ALJ must
“minimally articulate” his reasons for discounting a treating physician’s opinion).

Next, the ALJ states that Garcia’s testimony that his doctors told him not to lift
twenty pounds conflicts with Dr. Hamdani’s conclusion that Garcia can only lift ten
pounds. However, the fact that Garcia may have misstated Dr. Hamdani’s orders does
not necessarily render Dr. Hamdani’s flawed, especially where the contemporaneous
treatment notes reveal that Dr. Hamdani concluded on more than one occasion that
Garcia could not lift over ten pounds. More importantly, Garcia did not testify that he
could in fact lift twenty pounds. Instead, he said he does no lifting out of fear of injuring
himself further. Thus, Dr. Hamdani’s opinion does not conflict with Garcia's own
testimony regarding his abilities.

After concluding that Dr. Hamdani’s opinion was not entitled to controlling weight,

the ALJ also failed to adequately consider the factors set forth in 20 C.F.R. §

3 While we note that Dr, Hamdani’s conclusion regarding Garcia’s fine manipulative limitations
does not appear to have support in the record, this alone does not cure the ALJ's error on this issue.

18


“nuisance,” which also did not reach listing level. (R. 32-33.)

The ME then pointed out what he viewed as an inconsistency in Dr. Hamdani’s
opinion regarding Garcia’s condition and his ability to lift loads. (R. 33.) He noted that
at the April 22, 2010 visit, Dr. Hamdani stated that Garcia had small varices and could
not lift heavy loads. (R. 33.) Then, on May 24, 2010, Dr. Hamdani stated that Garcia
suffered from medium varices and could not lift more than ten pounds. (/d.) Given this
inconsistency, the ME told the ALJ that it was “up to us” to pick a level of exertion and
concluded that Garcia should be limited to the light level of exertion. (R. 34.) The ME
also opined that Garcia must avoid ladders and concentrated exposure to extreme heat
and cold. (R. 35.) ME McKenna believed that these limitations dated back to Garcia's
onset date of November 1, 2007. (/d.)

Plaintiffs counsel then asked the ME why banding procedures are performed.
(R. 36.) The ME explained that banding serves to tie off esophageal varices so that
they will no longer be present. (/d.) Plaintiff's counsel then directed the ME’s attention
to Dr. Hamdani’s December 15, 2009 opinion that Garcia may bleed again if he did any
heavy lifting and that he may not be able to work again. (R. 37.) The ME believed that
Dr. Hamdani was implying that Garcia would not be able to perform the heavy work that
he used to do. (/d.)

Next, plaintiffs counsel asked the ME to explain why Dr. Hamdani stated that
Garcia’s esophageal stricture prohibited further banding or dilation. (R. 38-39.) The
ME explained that he believed there was no absolute statement in the record that
Garcia could not be dilated, but instead, on one occasion, Dr. Hamdani noted that he

could not be dilated due to inflammation. (R. 39.) The ME also explained that Garcia’s

10


the obstruction. (/d.) He observed small varices and “the early beginnings of stricture
at 2 locations in the distal esophagus.” (/d.) Dr. Hamdani recommended interval
dilation and that Garcia be instructed on a pureed diet. (R. 349.)

As of September 8, 2009, Garcia was still very fatigued and sleeping a lot. (R.
355.) On October 2, 2009, a follow-up endoscopy showed small varices that did not
require further ligation. (R. 346-47.) A faint stricture was observed, but because of the
presence of varices, “it was felt unsafe to dilate the stricture.” (R. 347.) Biopsies were
taken of an area of mucosal inflammation in the stomach out of concern of possible H.
pylori infection or gastric cancer. (R. 346.) Dr. Hamdani advised diet modification, a
three month follow-up endoscopy, and the continuation of beta-blocker therapy. (R.
347.)

On November 2, 2009, Garcia complained that he remained tired and still had
some difficulty swallowing. (R. 358.) Dr. Hamdani noted that he was still at “high risk”
for varice bleeding. (R. 359.) By November 30, 2009, his complaints had subsided.
(R. 361-62.) He again complained of difficulty swallowing meats on December 15,
2009. (R. 364.) Dr. Hamdani commented that he was “concerned he may bleed again
if he does any heavy lifting” and that “he may not be able to work again.” (/d.)

Garcia had no complaints apart from “some fatigue” on February 22, 2010 and
Dr. Hamdani’s examination was unremarkable. (R. 399-400.) On April 22, 2010,
Garcia again complained that he had difficulty getting through the day without naps,
walking more than a mile, or doing heavy work, (R. 395.) Dr. Hamdani noted that

Garcia could not lift heavy loads due to his varices. (R. 396.) Garcia voiced similar


On July 20, 2009, Garcia told Dr, Hamdani that he was very weak and fatigued.
(R. 322.) Dr. Hamdani assessed hepatic encephalopathy, which he noted was
“refractory” (or resistant) despite Garcia having been taking lactulose in an attempt to
reduce his ammonia levels. (R. 322-23.) Dr. Hamdani further noted that Garcia's
cirrhosis was “stable but decompensated,” that he needed further ligation, and that his
diabetes was controlled with glyburide. (/d.)

On July 31, 2009, Garcia underwent a fourth ligation procedure. (R. 350-51.)
Dr. Hamdani observed that the varices were still present, but were “much shrunk in
size.” (R. 350.) A moderate degree of portal gastropathy was observed. (/d.) Seven
additional bands were successfully placed with no bleeding. (/d.) Dr. Hamdani noted
that Garcia was at low risk of bleeding because there were no more “cherry-red spots.”
(/d.) Dr. Hamdani further concluded that “at this stage, it appears that we have
successfully obliterated [Garcia's] varices.” (R. 351.) He advised Garcia to continue
taking the beta-blocker and recommended a four month follow-up endoscopy. (/d.)

At a routine visit on August 21, 2009, Garcia again complained of fatigue and
that it was “difficult to get around.” (R. 352.) Dr. Hamdani continued Garcia on
lactulose, referred him to the diabetes clinic, and noted that although his cirrhosis was
stable, he “may require transplant.” (R. 353.)

On September 6, 2009, Garcia returned to Provena complaining of difficulty
swallowing, especially hard materials such as meat. (R. 344.) Dr. Hamdani concluded,
based on the history of ligations, that Garcia most likely had post-banding strictures,
“now presenting with obstruction.” (R. 345.) Dr. Hamdani performed an endoscopy,

which revealed a large piece of meat in the esophagus. (R. 348.) Dr. Hamdani cleared

6


404.1527(c)(2), such as the frequency, length, nature, and extent of the treatment
relationship, frequency of examination, the physician's specialty, the types of tests
performed, and the consistency and supportability of the physician's opinion. See
Moss, 555 F.3d at 561. On remand, if the ALJ again concludes that Dr. Hamdani’s
opinion is not entitled to controlling weight, he must consider these factors in
determining what amount of weight to afford the opinion.

D. The ALJ Failed to Properly Consider Garcia’s Complaints of Fatigue
and Failed to Properly Assess his Credibility.

Next, Garcia argues that the ALJ failed to consider his continuous allegations of
fatigue when assessing his RFC. As Garcia points out, he complained of fatigue,
weakness, and difficulty getting through the day without naps at numerous
appointments with Dr. Hamdani. Unfortunately, the ALJ did not sufficiently address
these complaints.

The RFC is the most a claimant can still do despite his limitations. 20 C.F.R. §
404.1545(a)(1). When determining a claimant's RFC, the ALJ must consider all of the
relevant evidence in the case record, including information about symptoms that might
not be shown by objective medical evidence alone. 20 C.F.R. § 404.1545(a)(3); SSR
96-8p, 1996 WL 374184, at *5. A court will uphold an ALJ’s decision “if the evidence
supports the decision and the ALJ explains his analysis of the evidence with enough
detail and clarity to permit meaningful review.” Arnett v. Astrue, 676 F.3d 586, 592 (7th
Cir. 2012) (citing Eichstadt v. Astrue, 534 F.3d 663, 665-66 (7th Cir. 2008).

Here, although the ALJ referenced Garcia's complaints of fatigue in his step

three finding, he failed to offer any explanation as to how fatigue might affect Garcia's

19


whole, Dr. Free found that claimant's statements regarding weakness and fatigue were
“partially credible in light of the overall evidence,” but that the limitations described by
the claimant exceeded that supported by the objective medical findings. (R. 343.)

On January 4, 2010, Dr. Vidya Madala affirmed Dr. Free's RFC assessment. (R.
367-69.)

Cc. Medical Expert’s Testimony

Medical Expert (“ME”) Dr. James M. McKenna appeared telephonically at the
hearing. The ALJ first asked the ME whether the record was sufficient for him to reach
a conclusion as to Garcia’s medical condition. (R. 29.) ME McKenna responded that
the record did not include recent ammonia levels or the February 2010 endoscopy
report. (R. 29-30.) Notwithstanding this missing information, the ME stated that he
would still be able to provide a conclusion regarding Garcia's condition and proceeded
to describe his medical history. (R. 30.)

The ME explained that Garcia suffered from alcoholic induced liver disease,
namely cirrhosis, dating back to November 12, 2007, his first visit to Provena. (R. 30-
31.) He explained that Garcia suffered from both esophageal and rectal varices. (R.
31.) With respect to hepatic encephalopathy, the ME concluded that although Garcia
had elevated ammonia levels in the past, and related confusion, the problem was not
documented to persist. (/d.) The ME described Garcia's diabetes as uncontrolled, but
explained that there was no apparent end-to-end damage. (R. 32.)

ME McKenna concluded that Garcia’s esophageal bleeds and liver problems did
not meet the relevant Listings because the bleeds “were not massive bleeds” and he

maintained “pretty good liver function.” (R. 32.) He described the diabetes as a

9


IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION

DELFINO MONARREZ GARCIA,

Plaintiff,
No. 12 C 4191
v.
Magistrate Judge Michael T. Mason
CAROLYN W. COLVIN, Acting

Commissioner of Social Security,’

Defendant.

MEMORANDUM OPINION AND ORDER

Michael T. Mason, United States Magistrate Judge:

Claimant, Delfino Monarrez Garcia (“Garcia” or “claimant’), has brought a motion
for summary judgment [20] seeking judicial review of the final decision of the
Commissioner of Social Security (the “Commissioner’). The Commissioner denied
Garcia’s applications for Disability Insurance Benefits (“DIB”) and Supplemental
Security Income (“SSI”) under the Social Security Act (the “Act”), 42 U.S.C. §§ 416(i),
423(d), and 1382c(a)(3)(A). The Commissioner filed a cross-motion for summary
judgment [25] asking the court to uphold the previous decision. The court has
jurisdiction to hear this matter pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). For the
reasons set forth below, Garcia’s motion for summary judgment is granted and the
Commissioner's motion is denied.

I. BACKGROUND

' Carolyn W. Colvin became the Acting Commissioner of Social Security on February 14, 2013.
Pursuant to Rule 25(d)(1) of the Federal Rules of Civil Procedure, Carolyn W. Colvin is substituted for
Commissioner Michael J. Astrue as defendant in this sult.


not worked since 2007. (/d.)

When asked why he started bleeding in May 2009, he explained that after his
first hospital visit in 2007, he did not have any work restrictions. (R. 47.) As a result, he
was re-injured and suffered “a strain...inside.” (/d.)

= Vocational Expert’s Testimony

Vocational expert (“VE”) Thomas Gusloff also appeared at the hearing. VE
Thomas first asked Garcia to clarify his job duties at Sealy. (R. 49.) Garcia explained
to the VE that when he inspected the mattresses, he was looking for certain
imperfections, such as a tear, dirt, or inadequate filling. (/d.) He was not required to fix
such imperfections, but instead called someone to remove the mattresses. (/d.) He
clarified that part of his job was to place the mattresses on the packaging machine, but
again testified that he had assistance flipping the mattresses. (/d.) He claimed the total
load lifted by two people was about 400 pounds. (R. 50.) Garcia did not prepare
shipping information. (R. 49-50.) He stated that it took him three months to learn the
duties of the position at Sealy. (R. 50.)

The VE then classified Garcia's position at Sealy, explaining it seemed like he
did a combination of the inspector II position (light, semi-skilled) and the machine
packager position (medium, unskilled). (R. 52, 54.) However, based on Garcia’s
testimony regarding the weight of the mattresses, the VE concluded that Garcia
performed the work at a heavy level of exertion. (R. 52.) And, because Garcia spent
fifteen to twenty minutes inspecting each mattress, the VE concluded that the position

was semi-skilled. (R. 53-54.)

12


rectal varices would not further impact Garcia's ability to lift. (R. 40.)

D. Claimant’s Testimony

Garcia appeared at the hearing and testified through an interpreter as follows.
He was born on November 2, 1957, making him 52 years old at the time of the hearing.
(R. 41.) Garcia completed first grade in Mexico. (/d.) He came to the United States in
1967. (/d.) Garcia speaks only a little English and cannot read or write. (R. 42.) He
resides with his brother, but does not do any chores around the house. (R. 41, 45-46.)

Garcia testified that he last worked in “quality control” at Sealy mattress
company, where he had worked for almost thirteen years. (R. 42-43.) He explained
that he visually inspected each mattress and placed the proper sticker on each one.
(R. 42.) He did not complete written reports. (/d.) While inspecting the mattresses, he
had another person help him flip them over because they were heavy and he did not
want to strain himself. (/d.) Garcia explained that he also placed the mattresses into a
machine that would wrap them in plastic. (R. 43-44.) He never worked in the
manufacturing department. (R. 44.)

Garcia stated that he gets tired after walking a couple of blocks and feels pain on
his right side. (R. 45.) He testified that his doctor told him not to lift more than twenty
pounds because he could rupture his liver. (/d.) As a result, he does not do any lifting
because he “want[s] to be alive.” (/d.) At times, he has difficulty concentrating. (R. 47.)
He also has difficulty eating because his trachea was “reduced.” (/d.) He has not
changed his diet and eats steak sometimes. (/d.) Garcia testified that he has not

consumed alcohol since he was released from the hospital in 2007. (R. 46.) He has

11


complaints on May 24, 2010, at which time Dr. Hamdani noted that he cannot lift more
than ten pounds due to risk of varice bleeding and that he still suffered from medium
sized varices. (R. 391.) His complaints of fatigue, dizziness, and weakness continued
on June 28, July 29, and August 20, 2010. (R. 376-390.) He continued to take the
prescribed beta-blocker. (/d.) On June 28, 2010, Dr. Hamdani again advised Garcia
not to lift more than ten pounds. (R. 388.) Dr. Hamdani noted on more than one
occasion that he could not perform any more banding procedures because of the
stricture. (R. 383, 388.) Garcia voiced no complaints at his September 10, 2010 and
October 11, 2010 appointments. (R. 371-72.)

As a result of certain inconsistencies eluded to by the medical expert at the
hearing, the ALJ left the record open so that Garcia could submit an assessment from
Dr. Hamdani, which he did on December 8, 2010. (R. 404-06.) According to Dr.
Hamdani’s assessment, Garcia had the capacity to perform sedentary work. (R. 405.)
Specifically, Dr. Hamdani concluded that Garcia could sit, stand, and walk for three
hours in an eight hour workday; could carry and lift ten pounds; and could not engage in
fine manipulation, bend over, squat, or stoop. (/d.)

2. State Agency Consultants

On August 27, 2009, Dr. Barry Free completed a physical residual functional
capacity ("RFC") assessment. (R. 336-43.) Dr. Free concluded that Garcia could lift
and/or carry fifty pounds occasionally and twenty-five pounds frequently; could stand
and/or walk for six hours in an eight-hour workday and sit for six hours in an eight-hour
workday; and had no pushing or pulling limitations. (R. 337.) He found no postural,

manipulative, visual, communicative, or environmental limitations. (R. 338-40.) On the

8


case of Peterson v. Astrue, No. 09-209, 2010 WL 3219293 (N.D. Ind. Aug. 12, 2010) to
be persuasive. There, the District Court reversed the ALJ’s decision under similar
circumstances, concluding that an ALJ "may not deem a claimant capable of performing
past relevant work by dividing the demands of a composite job into two separate jobs
and finding her capable of performing the less demanding of the two jobs.” /d, at *5
(quotation omitted).

Like the Peterson court, we conclude that the ALJ's step four finding requires
reversal. We reject the Commissioner's argument that the ALJ’s step four finding is
harmless error given the VE’s testimony that Garcia could perform other work in the
national economy. Not only are there other errors requiring remand here, the ALJ did
not make a step five finding and we cannot simply “fill that gap.” Getch v. Astrue, 539
F.3d 473, 481 (7th Cir. 2008).

lll. © CONCLUSION

For the reasons set forth above, Garcia’s motion for summary judgment is

granted and the Comissioner’s motion is denied. This case is remanded to the Social

Security Administration for proceedings consistent with this Opinion. It is so ordered.

ENTERED:

-

WM hid ele —

MICHAEL T. MASON
United States Magistrate Judge

Dated: June 28, 2013

22


(R. 311.) He referred Garcia to Dr. Raza Hamdani for a gastrointestinal consult. (/d.)

Garcia told Dr. Hamdani that he stopped consuming alcohol after his last visit to
Provena in 2007. (R. 306.) Dr. Hamdani’s examination was primarily unremarkable.
(/d.) He noted that Garcia was alert and moved “all his extremities normally with normal
power.” (/d.) An abdominal ultrasound revealed gallbladder sludge and thickening of
the gallbladder wall. (R. 294.) Dr. Hamdani also assessed an upper gastrointestinal
bleed and noted that although there was “no obvious identification of cirrhosis
presently,” Garcia was at risk for it. (R. 307.)

Dr. Hamdani recommended an emergent endoscopy, which he performed on
May 9, 2009. (R. 307-09.) Upon entry, Dr. Hamdani observed extensive esophageal
varices, with multiple cherry-red spots in the distal esophagus. (R. 308.) A large
quantity of blood was observed in the stomach, but no lesions were present with the
exception of mild portal gastropathy. (/d.) The duodenum had no active bleeding
lesions and no cardiac varices were observed. (/d.) Dr. Hamdani thus concluded that
the esophageal varices were the most likely source of the bleeding. (/d.) Dr. Hamdani
then performed a ligation (or banding) procedure, and placed ten bands throughout the
esophagus. (/d.) Upon removal of the scope, the bands were well placed and no
bleeding was observed. (R. 308-09.) Dr. Hamdani noted that Garcia would benefit
from “beta blockage long term,” additional banding in three weeks, and therapy for
alcohol abuse. (R. 309.)

Garcia was discharged on May 11, 2009 with the diagnoses of acute upper

gastrointestinal bleed, liver cirrhosis, chronic alcohol abuse, non-insulin dependant


disabled, the ALJ must consider the following five step analysis: (1) whether the
claimant is currently employed; (2) whether the claimant has a severe impairment; (3)
whether the claimant's impairment is one that the Commissioner considers conclusively
disabling; (4) if the claimant does not have a conclusively disabling impairment, whether
he can perform her past relevant work; and (5) whether the claimant is capable of
performing any work in the national economy. See 20 C.F.R. §§ 404.1520(a),
416.920(a); Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). The claimant has
the burden of establishing disability at steps one through four. Zurawski v. Halter, 245
F.3d 881, 886 (7th Cir. 2001). At step five, the burden shifts to the Commissioner. /d.

ALJ Fina applied this five step analysis. At step one, he determined that Garcia
had not engaged in substantial gainful activity since November 1, 2007, the alleged
onset date. (R. 14.) At step two, the ALJ found Garcia suffered from the following
severe impairments: cirrhosis of the liver secondary to alcohol abuse, esophageal
varices secondary to alcohol abuse, and chronic alcohol abuse. (/d.) Next, at step
three, ALJ Fina concluded that Garcia does not have an impairment or combination of
impairments that meets or medically equals one of the listed impairments in 20 C.F.R.
Part 404, Subpart P, Appendix 1. (R. 14-16.)

ALJ Fina went on to assess Garcia's RFC and concluded that Garcia can
perform light work as defined in 20 C.F.R. §§ 404.1567(b) and 416.967(b), with certain

limitations.2 (R. 16-18.) Specifically, the ALJ found that Garcia can lift a maximum of

21 ight work involves lifting no more than 20 pounds at a time with frequent lifting or carrying of
objects weighing up to 10 pounds. Even though the weight lifted may be very little, a job is in this category
when it requires a good deal of walking or standing, or when it involves sitting most of the time with some
pushing and pulling of arm or leg controls. To be considered capable of performing a full or wide range of
light work, you must have the ability to do substantially all of these activities.” 20 C.F.R. §§ 404.1567(b).

15


remand.

As a general matter, the ALJ will give the opinion of a treating physician
controlling weight because treating physicians are “most able to provide a detailed,
longitudinal picture” of the claimant's medical condition. 20 C.F.R. § 404.1527(c)(2).
However, “[a] treating physician’s opinion concerning the nature and severity of a
claimant's injuries receives controlling weight only when it is ‘well-supported by
medically acceptable clinical and laboratory diagnostic techniques’ and is ‘consistent
with substantial evidence in the record.” Ketelboeter v. Astrue, 550 F.3d 620, 625 (7th
Cir. 2008) (quoting 20 C.F.R. § 404.1527(c)(2)). “If an ALJ does not give a treating
physician’s opinion controlling weight, the regulations require the ALJ to consider the
length, nature, and extent of the treatment relationship, frequency of examination, the
physician's specialty, the types of tests performed, and the consistency and
supportability of the physician's opinion” to determine what amount of weight to afford
the opinion. Moss v. Astrue, 555 F.3d 556, 561 (7th Cir. 2009) (citing 20 C.F.R. §
404.1527(c)(2)). The ALJ must always give “good reasons” for his determination as to
the amount of weight given. 20 C.F.R. § 404.1527(c)(2). The ALJ “can reject an
examining physician's opinion only for reasons supported by substantial evidence in the
record; a contradictory opinion of a non-examining physician does not, by itself, suffice.”
Gudgel v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003).

Here, we conclude that the ALJ’s proffered reasons for affording Dr. Hamdani’s
opinion “little weight” are insufficient and not supported by substantial evidence. First,
the ALJ's finding that Dr. Hamdani’s opinion was conclusory and without support cannot

stand in the face of the treatment records submitted that document Dr. Hamdani’s

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alcohol dependance, and elevated blood sugar, and referred Garcia to Dr. Rafid
Hussein in the gastroenterology department. (R. 316.)

Garcia told Dr. Hussein that he felt “nauseated, weak, and tremulous, and
generally out of sorts.” (R. 317.) Upon examination, Dr. Hussein noted hand tremors.
(/d.) Dr. Hussein recommended an urgent upper endoscopy to rule out a variceal
bleed, delirium tremens protocol, and substance abuse counseling. (R. 317-18.)

The endoscopy “was consistent with lymphoid hyperplasia with a clot in the
fundus with no active bleeding noted.” (R. 313.) Dr. Hussein found no esophageal
varices, but noted that varices can go undetected. (R. 319.) Garcia was givena
transfusion of two units of packed red blood cells. (R. 279, 313.) A subsequent CT of
the abdomen and pelvis revealed findings compatible with cirrhosis. (R. 296.) A
marked thickening of the gallbladder and possible gallbladder sludge or stones were
also observed. (/d.)

Garcia was discharged on November 16, 2007 with instructions to follow up with
his primary care physician and Dr. Hussein. (R. 313.) He was prescribed metformin to
control his blood sugar, prilosec, and iron. (/d.)

The medical records are silent until May 8, 2009, when Garcia was again
admitted to Provena after vomiting blood. (R. 310.) On admission, Garcia exhibited an
increased heart rate and borderline low blood pressure. (/d.) He denied abdominal
pain, chest pain, and shortness of breath. (/d.) A chest X-ray was unremarkable, and
an electrocardiogram showed normal sinus rhythm. (R. 295, 311.) The physician
assessed an acute upper gastrointestinal bleed, a questionable history of cirrhosis,

history of alcohol abuse, diabetes, and a questionable history of hypercholesterolemia.

3


A. Procedural History

Garcia filed for DIB and SSI on May 12, 2009, alleging disability beginning
November 1, 2007 due to liver disease, esophageal varices, and gastrointestinal
bleeding. (R. 156-69.) His claims were denied initially on September 1, 2009, and
upon reconsideration on January 6, 2010. (R. 60-68, 70-78.) Thereafter, the claimant
filed a timely request for an administrative hearing. (R. 81-82.) The hearing was held
on October 19, 2010 before Administrative Law Judge Joel G. Fina. (R. 24.) In
addition to testimony from the claimant, the ALJ heard testimony from medical expert
Dr. James M. McKenna and vocational expert Thomas A. Gusloff. (R. 24-59.)

On January 5, 2011, ALJ Fina issued a written decision finding that Garcia was
not disabled. (R. 9-19.) Garcia filed a timely request for review with the Appeals
Council, which was denied on April 13, 2012. (R. 1-3, 138.) The ALJ's decision then
became the final decision of the Commissioner. This action followed. The parties
subsequently consented to the jurisdiction of this court pursuant to 28 U.S.C. § 636(c).

B. Medical Evidence

1. Treating Physicians

On November 12, 2007, Garcia was admitted to Provena Mercy Medical Center
(“Provena’) after vomiting blood. (R. 315.) During his initial exam, Garcia admitted to
drinking a six pack of beer a day for the last thirty years. (Id.) He denied abdominal
pain and had no history of significant medical problems. (/d.) The admitting physician
noted an elevated heart rate and mild tenderness in the abdomen. (/d.) A chest x-ray

was unremarkable. (R. 298.) The physician assessed an upper gastrointestinal bleed,


The ALJ then asked the VE to consider a person of Garcia’s age, education, and
work-experience who could lift twenty pounds occasionally, ten pounds frequently,
could never climb ladders, ropes or scaffolds, and must avoid concentrated exposure to
extreme cold and heat. (R. 54.) The VE explained that such an individual would be
able to perform the inspector II position as defined in the Dictionary of Occupational
Titles and nationally, but not as Garcia performed the work. (/d.) The VE further
explained that there would be no transferable skills from the inspector II position. (/d.)
The VE concluded that the individual could perform other jobs at the light level, such as
assembler for small products, cafeteria attendant, and a hand packager, all of which
were unskilled positions. (R. 55.)

Next, the ALJ asked the VE to consider the same hypothetical individual, but with
the exertional capacity to perform only sedentary work, and asked whether the
individual would be precluded from work based on the grid rules. (R. 55.) The VE
responded that such an individual would have no transferable skills and would be
precluded from work at age 50. (/d.) If the individual were under 50, he could perform
other sedentary, unskilled positions. (/d.) The VE also concluded that such an
individual would be unable to perform claimant's past work. (R. 56.)

Lastly, the ALJ asked the VE to consider the first hypothetical individual he
described and asked whether that individual could perform work if he was incapable of
communicating in English. (R. 56.) The VE explained that the individual could perform
the light, unskilled positions he described because they did not require the ability to

communicate in English. (R. 56-57.)

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twenty pounds occasionally, and ten pounds frequently; can stand and/or walk for six
hours and sit for six hours in an eight-hour workday; can push and/or pull, including to
operate hand and foot controls as restricted by his carrying and lifting limitations; can
never climb ropes, ladders or scaffolds; and must avoid concentrated exposure to cold
and heat. (/d.) Based on this RFC, the ALJ concluded that Garcia could perform his
past relevant work in the inspector II position as it is generally performed. (R. 18.) Asa
result, the ALJ determined that Garcia was not disabled under the Act.

Garcia now. argues that the ALJ failed to properly evaluate (1) the opinion of Dr.
Hamdani; (2) his complaints of fatigue; (3) his credibility; and (4) his past relevant work.
We address each issue in turn below.

c. The ALJ Failed to Properly Consider the Opinion of the Treating
Physician.

Garcia first argues that the ALJ failed to properly assess the opinion of his
treating physician, Dr. Hamdani. Again, on December 6, 2010, Dr. Hamdani concluded
that Garcia could sit, stand, and walk for three hours in an eight hour day, could carry
and lift ten pounds, and could not engage in fine manipulation, bend over, squat, or
stoop. (R. 405.) ALJ Fina gave Dr. Hamdani’s opinion “little weight” finding it
“conclusory” because Dr. Hamdani “submitted it without any supporting documentation
and the available objective evidence does not support it.” (R. 18.) He also stated that
the lifting limitations set forth by Dr. Hamdani were contradicted by Garcia's testimony
and that the fine manipulation limitations were not supported by objective evidence.

(Id.) Like Garcia, we find the ALJ’s treatment of Dr. Hamdani’s opinion requires

and 416.967(b).

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