In the

United States Court of Appeals

For the Seventh Circuit

No. 11-2424

LAENISE ARNETT,

Plaintiff-Appellant,

v.

MICHAEL J. ASTRUE,

Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District Court

for the Northern District of Indiana, Fort Wayne Division.

No. 1:10-CV-226 RLM—Robert L. Miller, Jr., Judge. 

ARGUED DECEMBER 14, 2011—DECIDED APRIL 2, 2012 

Before POSNER, MANION, and WOOD, Circuit Judges.

WOOD, Circuit Judge. Laenise Arnett suffers from

a number of medical problems, including peripheral

vascular disease, chronic obstructive pulmonary disease,

osteoarthritis, obesity, vascular dementia, depression,

panic disorder, and anxiety. As a result, she sought

Disability Insurance Benefits (“DIB”) from the Social

Security Administration (“SSA”), but she was unsuc-
2 No. 11-2424

cessful before the agency. After the Appeals Council

denied review of the Administrative Law Judge’s adverse

decision, she sought review in the district court pursuant to 42 U.S.C. § 405(g). Once again, she did not prevail.

She now appeals to this court, seeking to persuade us

that the Administrative Law Judge (“ALJ”) failed

properly to assess her residual functional capacity. We

agree with her, and so we remand her case to the

agency for further proceedings.

I

Arnett applied for DIB in June 2004, claiming an

onset date of June 14, 2002. After the SSA denied

her application, she requested a hearing before an

ALJ. Arnett, who was 45 at the time, asserted that the

array of medical ailments we described earlier made it

impossible for her to work. Her application described

her past work as a sorter and inspector at a factory

from 1991 to 1992, as a newspaper sorter from 1994 to

1996 or 1997, as a home healthcare aide from 1998 to 1999,

and as a certified nursing assistant from 2001 to 2002.

After surgery in June 2002 and through most of 2003,

she worked eight hours per week as a certified nursing

assistant. Sometime around the end of 2003, she found

that she was unable to continue.

In December 2004 Arnett updated her application

with information about the recent removal of a vein

from one of her legs, a procedure that left her with pain

and swelling. She added that after experiencing a “mini

stroke” she also was having more difficulty with balance

and expressing her thoughts. Arnett and her husband
No. 11-2424 3

(who submitted a written statement describing how

Arnett’s medical condition impeded her daily activities)

both asserted that Arnett could care for herself and do

light housework at a slow pace, but that she sometimes

was unable to do laundry or shop for groceries. An

SSA employee interviewed her around this time and

reported that Arnett did not appear to be experiencing

any debilitating problem.

Arnett had submitted most of her medical records

from 2002 through 2004 by the time she requested a

hearing before an ALJ in May 2005. These records show

that she visited Dr. Fred Rasp, a pulmonologist, several

times in late 2001 complaining of wheezing, coughing,

and chest tightness, and that she was diagnosed with

an obstructive lung defect and early emphysema. About

a month later, Arnett went to Parkview Hospital twice;

the first time she was seen in the emergency room

for complaints of chest pain and nausea and was diagnosed with early emphysema and chronic obstructive

pulmonary disease (“COPD”), and during the second

visit for a cardiology consultation she complained of

chest pain and shortness of breath and was diagnosed

with peripheral vascular disease (“PVD”) and obesity.

Several months later her PVD was described as “severe.”

To address her PVD, Arnett underwent aortobifemoral

bypass surgery in June 2002. She began complaining

of swelling and cramping in her legs later that year.

In the spring of 2003 Arnett had an MRI, which

revealed degenerative disc disease in two thoracic vertebral discs and mild degenerative facet arthritis in her
4 No. 11-2424

lumbar vertebra. While checking up on Arnett in late

2003, Dr. Rasp confirmed the cardiologist’s opinion that

she suffers from PVD. About six months later a thoracic

surgeon noted increased stenosis in some arteries.

Shortly thereafter, in July 2004, Arnett underwent a

balloon angioplasty. A few months later she was again

dealing with stenosis and still complaining of leg pain,

which her doctors addressed with several procedures

including a second angioplasty. Arnett continued to

complain of leg cramping and weakness afterward.

Several other physicians also had submitted consultation reports by the time Arnett requested a hearing.

Dr. Galen Yordy, a consulting psychologist who met

with Arnett, diagnosed her with anxiety disorder, panic

disorder, and depressive disorder. Dr. Jaya Karnani, a

consulting physician who practices family medicine

and met with Arnett, opined that Arnett’s anxiety is

controlled effectively with medication and had not

caused her trouble concentrating or with social interactions. On the negative side, he found that Arnett has

emphysema and PVD that prevent her from standing or

walking for more than two hours per day. Dr. Kenneth

Bundza, a consulting psychologist who met with Arnett,

found that she was alert but was experiencing difficulty retrieving information from memory; he diagnosed her with vascular dementia with depressed mood.

Dr. Yaroslev Pagorelov, a consulting family-practice

physician who had met with Arnett, opined that Arnett

suffers from emphysema, PVD, anxiety, and right-ankle

swelling and inability to walk more than five minutes

or stand more than 10 minutes at a time. Two sets of state-
No. 11-2424 5

agency physicians also evaluated Arnett’s records. The

first two opined that Arnett suffers from depressive, panic, and anxiety disorders, though none of

them severe. The second two opined that Arnett has

emphysema and PVD, and that she occasionally can lift

or carry 20 pounds, can frequently lift or carry 10 pounds,

can stand or walk for at least two hours per day, and

can sit for about six hours per day.

Arnett submitted more medical records to the ALJ

in April and May 2007, mostly for treatment received

in and after 2005. One set related to her second

angioplasty in late 2004 and its failure to resolve her

problems. These records document that Arnett continued to complain of pain in her legs and began experiencing pain in her right arm, and that her vascular

surgeon did not believe the pain was of vascular origin

and was unsure of the cause. In late 2005, Arnett’s

arteries were again blocking up due to stenosis, and so

she underwent a third angioplasty.

Because Arnett continued to complain of pain in

2005 and 2006, her vascular surgeon referred her to a

neurologist, who diagnosed her with lumbosacral

neuritis but did not find a neurological explanation

for Arnett’s leg and arm pain. She also saw a

rheumatologist, who thought that her leg pain was not

a result of a rheumatological impairment and that her

arm pain was probably from tennis elbow. Dr. Anantha

Reddy, who specializes in physical medicine and rehabilitation, suggested that Arnett’s leg pain could be a

result of a spinal problem.
6 No. 11-2424

Late in 2006, Arnett complained of pain in her lower

back, hips, and right arm and hand. X-rays showed narrowing of Arnett’s left and right knee joint spaces,

and Arnett’s rheumatologist diagnosed her with

osteoarthritis and stenosing tenosynovitis (a typically

painful condition that involves a finger becoming stuck

in a bent position, and later snapping back into a

straight position). Arnett was experiencing blockage

in some of her arteries again in spring 2007, and underwent a fourth angioplasty.

Several of Arnett’s treating physicians submitted

reports of her residual functional capacity (“RFC”).

Arnett’s primary physician (until 2006) opined that Arnett

cannot lift or carry even 10 pounds, cannot stand or walk

for even two hours in an eight-hour workday, and must

periodically alternate between sitting and standing.

Dr. Don Stallman, her current primary physician, concluded that Arnett can sit for up to 20 minutes at a

stretch and for two hours total during the day, stand

continuously for 15 minutes but no more than one

hour total during a day, walk 30 feet before stopping,

and carry up to five pounds frequently but not more

than 10 pounds even occasionally. Dr. Rasp, Arnett’s

treating pulmonologist, concluded that she can sit for

up to eight hours at a time, can stand continuously for

two hours and a total of four hours per day, and walk

for 15 minutes at a time and two hours total in a workday.

At the hearing before the ALJ on May 31, 2007, Arnett

and a vocational expert testified. Arnett said that her

legs cramped and she experienced difficulty breathing
No. 11-2424 7

when she had tried to work as a health aide after her

2002 aortobifemoral bypass surgery. She reported that

she still has cramping and weakness in her legs as a

result of her PVD, and this makes it difficult to stand

for more than 20 minutes at a time. The osteoarthritis

in her hips, arms, and back makes it difficult for her to

sit for very long, and she believed that her osteoarthritis

had been getting worse. Her COPD at times causes

chest pains and typically leaves her tired, light-headed,

dizzy, and short of breath. She also testified that her

hands cramp and that sometimes she has trouble concentrating. The vocational expert (“VE”) opined that no

job would be available for Arnett if the ALJ fully

credited her testimony. But, the VE continued, if Arnett

can perform sedentary work, with the limitation that the

job must permit alternating between sitting and standing

throughout the workday, then she can work as a food

service order clerk, a bench worker (there are several

types in the Dictionary of Occupational Titles, but the

expert did not specify which one he had in mind), or

a surveillance monitor.

The ALJ found Arnett not disabled after analyzing

the five steps in 20 C.F.R. § 404.1520. At Step 1, the

ALJ determined that Arnett had not engaged in substantial gainful activity between the claimed onset of

her disability and the date she was last insured. At

Step 2, the ALJ concluded that Arnett’s PVD and COPD

are severe, but that her anxiety, panic, and depressive

disorders are not; he did not mention her other physical

and mental impairments. At Step 3, after discussing

Listings 4.12 (PVD) and 3.02 (COPD), the ALJ found
8 No. 11-2424

that Arnett does not have an “impairment or combination of impairments” meeting or medically equaling a

listing; he did not elaborate on this conclusion or consider any other specific listing.

Next, the ALJ assessed Arnett as having the RFC to

perform sedentary work with the following limitations:

carrying “up to 10 pounds occasionally and less

than 10 pounds frequently,” sitting for six hours of

an eight-hour day, walking for two hours of an

eight-hour day, and alternating between sitting and

standing throughout the day. He explained this conclusion as follows. First, he evaluated the written statements submitted by Arnett and her husband describing her daily activities and limitations,

as well as her husband’s statements to the SSA by telephone about Arnett’s memory problems and exhaustion, and Arnett’s oral testimony. But the ALJ decided

that what Arnett had said was “not entirely credible,”

and he did not address the credibility of her husband’s

statements. The ALJ discussed the opinions of several

treating or consulting physicians and explained why

he accepted or rejected each. Without explanation, however, he did not mention Dr. Bundza or Dr. Yordy,

who had diagnosed Arnett with mental impairments.

Indeed, at this stage the opinion did not mention quite

a few conditions that had been presented in the

evidence: depressive, anxiety, and panic disorders; vascular dementia; lumbosacral neuritis; osteoarthritis; degenerative disc disease; degenerative changes in her

sacroiliac joints; or finally her obesity.
No. 11-2424 9

Finally, in concluding his analysis at Step 4, the ALJ

acknowledged that the RFC assigned to Arnett precludes

her from performing her past work. This required him

to move to Step 5, where the Commissioner bears the

burden of proof. There, the ALJ concluded that Arnett’s

RFC nevertheless allows her to perform several types

of jobs which, according to the VE, number in the hundreds in northeastern Indiana.

II

On appeal to this court, Arnett takes issue with everything except the ALJ’s Step 1 finding, which was in

her favor. At Step 2, she says, the ALJ failed to evaluate

the severity of each impairment. At Step 3, in her view,

the ALJ erred by failing to evaluate her impairments

collectively when he considered the listings. Third,

she argues that the ALJ’s RFC determination is flawed

because it does not incorporate all of her impairments

and limitations. Finally, she argues that the ALJ erred

at Step 5 by failing to account for all of her limitations

in the hypothetical given the VE. Arnett does not challenge the ALJ’s decisions to give some physicians’

opinions less than full weight.

Because the Appeals Council denied review, the ALJ’s

decision is the final decision of the agency. O’ConnorSpinner v. Astrue, 627 F.3d 614, 618 (7th Cir. 2010). In

reviewing the ALJ’s decision, this court evaluates

whether substantial evidence supports it. Id. Importantly,

we must consider only the rationale offered by the

ALJ. Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011).
10 No. 11-2424

Arnett’s Step 3 claim is not properly before this court,

because she failed to raise it in the district court. Skarbek

v. Barnhart, 390 F.3d 500, 505 (7th Cir. 2004); Shramek

v. Apfel, 226 F.3d 809, 811 (7th Cir. 2000). We therefore

do not discuss it further.

All three of Arnett’s other claims assert, in one way

or the other, that the ALJ failed to consider the impact

of all of her impairments taken together. Her arguments

about Step 2 and Step 5 boil down to a contention that

the ALJ overstated her RFC by making this mistake.

But even if there were a mistake at Step 2, it does

not matter. Deciding whether impairments are severe

at Step 2 is a threshold issue only; an ALJ must continue

on to the remaining steps of the evaluation process as

long as there exists even one severe impairment. Castile

v. Astrue, 617 F.3d 923, 927-28 (7th Cir. 2010). Here, the

ALJ categorized two impairments as severe, and so

any error of omission was harmless. See id. Arnett’s

contention that at Step 5 the ALJ constructed a

hypothetical built around a flawed RFC adds nothing

to her challenge to the RFC. As Arnett herself says,

“[b]ecause the ALJ used a flawed RFC as the basis for

the hypothetical question to the Vocational Expert . . .

his hypothetical question to the VE was also flawed.”

Thus, Arnett’s appeal comes down to whether the ALJ

erred in assessing her RFC.

Arnett focuses on the ALJ’s failure to consider her

mental impairments in arriving at the RFC, as well as

his lack of attention to her lumbosacral neuritis, obesity,

osteoarthritis, degenerative disc disease, or degenera-
No. 11-2424 11

tive changes in her sacroiliac joints. She also contends

that the RFC does not reflect her need to elevate her legs.

An ALJ must evaluate all relevant evidence when

determining an applicant’s RFC, including evidence of

impairments that are not severe. 20 C.F.R. § 404.1545(a);

Craft v. Astrue, 539 F.3d 668, 676 (7th Cir. 2008). This

court upholds 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. Eichstadt v. Astrue, 534 F.3d 663, 665-66

(7th Cir. 2008). 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. Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010);

Simila v. Astrue, 573 F.3d 503, 516 (7th Cir. 2009); Zurawski

v. Halter, 245 F.3d 881, 888-89 (7th Cir. 2001). An ALJ

must also analyze a claimant’s impairments in combination. Terry v. Astrue, 580 F.3d 471, 477 (7th Cir. 2009).

The ALJ did take into account Arnett’s testimony that

she must often elevate her legs. But after referring to

her testimony, the ALJ disparaged her evidence with

the all-too-common and unhelpful “not entirely credible” remark. See Parker v. Astrue, 597 F.3d 920, 922 (7th

Cir. 2010). Arnett is not challenging the credibility

finding, which is just as well, since she did not raise

this point in the district court. See Shramek, 226 F.3d at 811.

The first significant problem that we see is the ALJ’s

failure to incorporate adequately Arnett’s mental impairments into the RFC. Dr. Yordy diagnosed Arnett
12 No. 11-2424

with depressive, anxiety, and panic disorders. Dr. Bundza

diagnosed Arnett with vascular dementia, reporting

that she had some “fairly obvious cognitive problems,”

including difficulty understanding directions, slowly

responding to simple questions, a low-average or borderline range of intelligence, and “fairly significant

retrieval problems.” The ALJ discussed Dr. Yordy’s

diagnoses at Step 2 of the analysis, and the ALJ even

says that he “translated” his Step 2 determination

“into work-related functions” in assessing Arnett’s

RFC, but the decision offers no hint about how he did

so. The ALJ never mentioned that Arnett had been diagnosed with vascular dementia. The Commissioner suggests that these omissions are unimportant, because the

RFC is consistent with the limitations associated with

dementia. Nothing in the ALJ’s opinion explains how

that may be the case, however, and the RFC makes

no reference to any work limitations that would accommodate dementia. Symptoms of dementia include

an inability to learn or remember new information, an

inability to reason, and difficulty communicating. Mayo

Clinic, Dementia: symptoms, http://www.mayoclinic.com/

health/dementia/DS01131/DSECTION=symptoms (last visited March 28, 2012). Dr. Bundza’s report demonstrates

that Arnett was suffering from these symptoms as early

as two years before the hearing. An inability to learn

or remember new information could make it impossible

for Arnett to be trained for a new position, and the

inability to reason or difficulty communicating could

make simple tasks difficult and time-consuming for

Arnett to complete. Without any discussion of Arnett’s
No. 11-2424 13

dementia, this court has no idea what the ALJ thought

about this evidence. See Clifford v. Apfel, 227 F.3d 863, 873-

74 (7th Cir. 2000); Godbey v. Apfel, 238 F.3d 803, 808

(7th Cir. 2000).

The ALJ also failed to take into account several of

Arnett’s diagnosed physical impairments. An ALJ may

not ignore entire lines of evidence. See Zurawski,

245 F.3d at 888. The ALJ never mentioned Arnett’s

lumbosacral neuritis, degenerative disc disease (Arnett

also refers to this as anterior disc disease), osteoarthritis,

or degenerative changes in her sacroiliac joints. Arnett

has complained about pain in her back, knees, and

hips; this pain reduces her mobility and range of

motion and makes it difficult for her to sit for long

periods of time. The Commissioner argues that many

of these diagnoses were provisional, were made only

once, or need to be evaluated in context. But the

agency’s attorneys may not advance an explanation

the agency never made itself and may not attempt

to support the decision with evidence the agency apparently did not consider. Martinez v. Astrue, 630 F.3d

693, 694 (7th Cir. 2011); Spiva v. Astrue, 628 F.3d 346,

348 (7th Cir. 2010); Parker, 597 F.3d at 922, 925.

The Commissioner also argues that Arnett waived

her claim that the ALJ failed to evaluate all of her

physical impairments because, the Commissioner says,

she has not explained how these impairments limit her

ability to work. Arnett has devoted several pages of her

brief to arguing that the ALJ did not fully evaluate all of

her impairments. This is sufficient. See Hernandez v. Cook
14 No. 11-2424

County Sheriff’s Office, 634 F.3d 906, 913 (7th Cir. 2011)

(rejecting plaintiff’s contention that defendants waived

immunity defense at summary judgment by limiting

discussion of defense to three paragraphs).

Next, the ALJ failed to take into account Arnett’s

obesity. An ALJ must factor in obesity when determining

the aggregate impact of an applicant’s impairments.

Martinez, 630 F.3d at 698-99; Clifford, 227 F.3d at 873.

The Commissioner argues that the ALJ was not required to discuss diagnoses for which Arnett failed to

provide evidence of limitations. As mentioned above,

however, an ALJ must consider all of the evidence

and must explain its decision such that it may be meaningfully reviewed. 20 C.F.R. § 404.1545(a); Eichstadt, 534

F.3d at 665-66. If the ALJ thought that Arnett’s obesity

has not resulted in limitations on her ability to

work, he should have explained how he reached that

conclusion.

This error could conceivably be harmless if the ALJ

indirectly took obesity into account by adopting limitations suggested by physicians who were aware of or

discussed Arnett’s obesity. Prochaska v. Barnhart, 454

F.3d 731, 736-37 (7th Cir. 2006); Skarbek, 390 F.3d at 504.

But it is not clear from the record that the limitations

the ALJ adopted met that standard. The ALJ did not

give full credit to the opinions of the physicians he mentioned, with the exceptions of Dr. Karnani and Dr. Rasp.

Dr. Karnani noted Arnett’s height and weight but

she never mentioned Dr. Robertson’s obesity diagnosis

or demonstrated that she took that diagnosis into ac-
No. 11-2424 15

count. Dr. Rasp characterized Arnett as mildly obese,

but referred to only Arnett’s COPD-related impairments

(and not her osteoarthritis) when assigning work limitations. Several other physicians specifically discussed

Arnett’s obesity; the ALJ, however, either discounted

the opinions of these physicians or never mentioned

them. On such a record, we cannot find harmless error. See Spiva, 628 F.3d at 353.

Last, we agree with Arnett that the ALJ failed to formulate an RFC that is sufficiently specific as to how often

she must be able to sit and stand. The Commissioner

argues that she waived this argument. But Arnett raised

the issue of the ALJ’s RFC determination overall in

the district court, and this is sufficient. Schoenfeld v.

Apfel, 237 F.3d 788, 793 (7th Cir. 2001) (referring to the

waiver of general arguments); Ehrhart v. Sec’y of HHS,

969 F.2d 534, 537 (7th Cir. 1992) (referring to the waiver

of “issues”). An RFC must be specific about the required frequency of standing and sitting. SSR 96-9p,

1996 SSR LEXIS 6, at *18-19 (July 2, 1996). Arnett’s RFC

provides that she must be able to alternate between

sitting and standing “throughout the workday.” This

does not specify a particular frequency, and does not

require that Arnett be able to choose to sit or stand

when she feels it is necessary. See Ketelboeter v.

Astrue, 550 F.3d 620, 626 (7th Cir. 2008) (concluding

that RFC specifying applicant be able to alternate

between sitting and standing at applicant’s option was

adequate); Schmidt v. Astrue, 496 F.3d 833, 845 (7th Cir.

2007) (same).
16 No. 11-2424

For these reasons, we REVERSE the district court’s judgment and REMAND this case to the agency for further

proceedings.

4-2-12