### In the



# United States Court of Appeals For the Seventh Circuit

No. 13-2602

M I L D RE D T H OMA S

, Plaintiff-Appellant,

v.

C AR OL YN W. C OL VI N

, Acti ng Commi ssi oner o f So ci al Security, Defen dant-Appellee.

Appe al f ro m the Uni ted S tates Distri ct Co urt fo r the Nor thern Distri ct o f Il l i noi s, Eastern Di v i sio n. No. 1: 12 -cv-04 71 6 — She ila M. Fin nega n , Magistrate J udg e.
A RGUE D J ANUAR

Y 7, 2014

— D E C I D E D M ARC H 11, 2014

Before W O OD, Chief Judge, and P O S N E R and K ANN E, Circ uit Judges.
K AN N E, Cir cui t Judge. Mild red Thomas suffers from a numb er of potent i ally-di sabling i mpai rments, i nclu ding sci atic a, angi na, degener ativ e di sc di sease, fibromy algia, and di abetes. The So ci al Security Adminis tr ation deni ed her request for di sabi li ty i nsu rance benefi ts and supp lemental2 No. 13-2602

secu rity i ncome. The di stric t court affi r med on appeal. W e rev erse. I. B A C K G R O U N D Thomas fi l e d a n a p p l i c a ti on for d i s abi li ty i nsu rance benefi ts i n December 2009, clai ming that she suffere d from sci atic a, di abetes, angi na, a tr i gge r thumb i n her left hand, and chroni c obstructiv e pulmonar y d isease (“COPD”)

. She w as also morbid ly obese, wi th a body mass index of aro und 45. During the appli cati on process, Thomas saw a consu ltativ e exami ner

, Dr

. M. S. P atil. Dr

. P atil noted a r e d uc ed range of motion i n Tho ma s’s lumb ar spine, hi ps, and knees as w ell as moderat e di ffi culty squatti ng and get tin g on and off the exami ning table. Dr

. P atil also perfor med an x-ray of Thomas’s lumb ar spine, whi ch, a lthough sev erely li mi ted by Thomas’s obesit y , a ppeared to show narro wed di sc spac e. Later that month, a state agency do ct or , Dr

. Thomas Kenney

, rev i ew ed Thomas ’ s medic al recor ds, inc luding Dr

. P atil’s repo rt

. Based
on thi s i nformation, Dr

. Kenney determin ed that Th omas had the resi dual func tional capac i ty (“RFC”) to perfo rm li ght w or k. At t he admini strat i v e hearin g, Thomas testifi ed that her prim ary complaint w as sev ere sci atic nerv e pain that trav eled to her butt, thi ghs, and knees. She sai d she could not stand for
more than fi fteen minutes or si t for more than tw enty minutes at a tim e. She further stated that she could only w alk about half
a block and that she could not do laundry or v acuu m. And she suffered from recurr ent i nflam mati on in her left thumb. When the i nflam mati on w as bad, she could not use her left hand at all; tr eatment by i njection allow ed her to use the hand but sheNo. 13-2602 3
remain ed unabl e to bend her left thumb. Thomas also used her i nhaler four times a day to contro l her asthma. A v ocational exper t (“VE”) also testifie d about Thomas’s past relev ant w or k and th e j o bs av ai lable i n the reg i onal economy

. The VE described Thomas’s prior w or k as a phlebotomi st as he a v y

, semi ski lled w or k becau se Thomas had to li ft and mov e patien ts i n addi tion to drawi ng their blood. The VE also noted, how ev er

, that phlebotomy w as ty p ica l ly catego

rized as requiring only light exer tion. The ALJ deni ed Thomas’s clai m i n a wr it t e n opin i on. She found that Thomas ret ai ned the RFC to perfor m l ight w or k, despi te the fact that she su ff e red from ei ght sev ere i mpai r ments. She noted that the o bj ecti v e medi cal evidenc e w as

1 consi stent with Thomas’s allegation of degener ativ e di sc di sease in the lumb ar spine, but e xplai ned t hat her t r e a t ment
w as “ro utine and conserv ativ e” and thus supp or ted only a li mi tation to li ght w or k. The ALJ also consi dered Thomas’s hi stor y of di a bet es, hi gh cholesterol, hypert ensi on, stable angi na, asthma, obesi ty and COPD. She found that none of these condi tions i mp osed any li mi tations gr eater than that i mposed by her back pain. She also stated that Thomas w as no longer exper i encing tr ouble wi th her tr i gge r t hu mb

. Furt her , the ALJ found Thomas’s com p l a i nts of pain i ncredible becau se, a l though Thomas described di abetes and sci atic a as her prim ary i mpai rments, she w as taking di abetes medi cati on and had receiv ed only mini mal sci atic a tr eatm e nt

. Sim i larly , the

The ei ght sev ere i mpairments the ALJ identi fi ed are di ab etes, hyperten- 1 sio n, degenerati v e di sc di sease i n the l umb ar spine, high chol estero l , asthma, COPD, sta

b l e angina, and obesity.4 No. 13-2602 ALJ relied on the fact that t he medi cal recor d di d not show a “medi cal necess i ty” for Thomas to lay down or to abstain from doin g laundry to i nfer that Th o ma s in fact had a hi gher RFC than her dail y activi ties w ould indi cate. The Appeals Counci l deni ed re view of Thomas’s clai m, and she appealed to the di stric t cour t

. The di stric t court affi rmed the ALJ’s deci si on. II. A N AL Y S I S On appeal i n a di sabi li ty ben e fi ts case, we rev i ew the di stric t court’s deci si on de novo , resulti ng in di rect rev i ew of the ALJ’s deci si on. Elder v
. Astrue, 529 F .3d 408, 413 (7th Ci r
. 2008). Thi s di rect rev i ew i s also deferential; we wi ll uphold the ALJ’s deci si on so long a s it i s supp or ted by “sub stanti al evidenc e” and the ALJ bui lt an “accu rat e and logical bri dge” betw een the evidenc e and her conclu si on. Simi la v
. Astrue, 573 F .3d 503, 513 (7th Ci r
. 2009). Thi s deference i s lessen ed, how ev er , where the ALJ’s findings rest on an e rr or of fact or logic. Schomas v
. Colvin , 732 F .3d 702, 708 (7th Ci r . 2013). A. The ALJ improperly discredited Thomas’s testimony The ALJ found Thomas’s testim ony abo ut the sev erity of her symptoms i ncredible, noting that (1) although she testifi ed that sci atic a and di abetes w ere he r main problems, she had receiv ed effecti v e tr eatment for the di abetes and mini mal tr eatment for sci atic a; (2) the medi cal recor ds show ed that she had a normal gait, neurolog i cal testing and her Romberg si gn 2

The Ro mb erg si gn refe rs to swaying or fa l l i ng over when stan di ng with 2 eyes cl os e d an d an kle s touchi ng. It i s seen i n tab es do rsali s and other (co ntinued. ..)No. 13-2602 5

w ere normal, and she had only mi ld degener ativ e art hopathy; (3) the medi cal recor ds di d not supp or t reachi ng di ffi culti es wi th her shoulders; and (4) h er medic al recor ds di d not show a medi cal nec essi ty for laying down duri ng the day o r lim i tations on si tting and standing. First, t he ALJ r easoned that becau se Thom a s t esti fi ed that sci atic nerv e pain and d iabetes w ere her main problems, and those problems were being tr eated, Thoma s h a d gr e a te r ove ra ll func tioning capac i ty than she described. It i s tr ue that her di abetes appeared to be under contro l and w as not sev erely li mi tin g her da i l y a c tivi ties

. But Thomas testifi ed prim arily that the sci atic nerv e pain prev ented her from w al k ing more than hal f a block and doin g laundry and required her to li e down for large port i ons o f t he day

. The ALJ thought that becau se Thomas had only mini mal tr eatment for thi s pain, i t could not be as sev ere as Thomas alleged. Bu t the tr eatment records are replet e wi th notes that the pain medi cati on w a s not helping. A nd sci atic a i s not alw ays sus ceptible to more sev ere tr eat

ments; i n some cases, the caus e cannot be i denti fi ed. The Merck Manual of Medical Information 571 (Mark H. Beers et al. eds., 2d home ed. 2003). The ALJ also appears to hav e i gnor ed the medi cal evidenc e that supp or ted Thomas’s complaints of pain. An ALJ need not menti on ev ery pi ece of medi cal evidenc e i n her opinio n, but she cannot i gnor e a line of evidenc e contrar y to her conclu si on. Arnett v
. Astrue, 676 F .3 d 5 8 6 , 5 9 2 (7th Ci r
. 2012). Whi le she

( ...c onti nued) 2 di seases of the nervous system. Sign , Dorland’s Illustrated Medical Dict ionary (3 2d ed. 20 12 ).6 No. 13-2602
noted that Th om as’s gait and neurolog i cal exams w ere normal, sh e ig no red evidenc e that Thomas had di ffi culty get tin g on and off the examining table and had li mi ted ranges of motion i n her hi ps and knees. And elsewh ere in t he opini on, t he ALJ characterized Thomas’s x-ray s as normal; in fact, they showed tr ansi tional v ert ebra, narr ow ed di sc s pace, and s clerosi s. The ALJ further noted tha t t he medi cal evidenc e di d not
su pport that Thomas had any shoulder problems that w oul d li mi t her abi li ty to reach ov erhead. But Thomas had been di agnosed wi th fibr omy algia, a condi tion whose prim ary symptom is p ai n and sti ffnes s i n the mus cles and jo ints. Fibromyalgia, Dor l an d ’s Illustrated Medical Dictionary (32d ed. 2012). F inally , the ALJ found that the medi cal evidenc e did no t supp or t Thomas’s allegations of pain, noting that there w as no “medical necess i ty” for Thomas to li e down duri ng the day

. But a lack of medi cal evidenc e supp or tin g the sev erity of a clai mant’s symptoms i s i nsu ffi ci ent, standing alo ne, to di scredi t her testim ony

. V illano v
. Astrue, 556 F .3d 558, 562 (7 th Ci r
. 2009). Becaus e all of the other reasons giv en by t he ALJ

w ere i llogic al or other wi se flawed , thi s reason cannot alone supp or t the fin ding that Thomas w as incredi ble. B. The ALJ assessed Thomas’s R F C improperly by failing to consider the c ombined effec t of her ailments A di s abi li ty clai mant’s RFC describes the maxi mum she can do i n a w or k setting despi te her mental and physi cal li mi tations

. 20 C.F .R. § 404.1545(a). Whe n deter mining an i ndi vidual’s RFC, the ALJ mus t consi der all li mi tations that aris e fromNo. 13-2602 7
medi cally deter minable i mpai rments. Arnett, 676 F .3d at 592; V illano , 556 F .3d at 563. The ALJ found t hat Thomas had the RF C to perfor m light

w or k, so long as Thomas a vo ide d concentrated exposure to “dust, fum es, and gases.” In maki ng thi s deter minat io n, the ALJ consi dered each catego ry of Thomas’s i mp ai rments seriatim , finding that no single c a te go ry w ould prev ent Thomas from doin g the sli ghtly -restricted li ght w o r k i ndi cated i n the final RFC. But the ALJ di d not consi der how Thomas’s back and leg pain, combined wi th her respi rat or y symptoms, w ould i mpact her abi li ty to w or k. Th is combinati on of i mpai rments could i mpose gr ea ter restr i cti ons than any of Thomas’s i mpai rments take n singly

. For i nstance, the fact t ha t Thomas had to use her inhaler four t i mes a day , ev en wi thout great er
than-normal exposure to dust or ot he r ir ritants, w ould compound t he restr i cti ons i mposed by her back and leg pain. W i thout any evidenc e that the ALJ consi dered Thomas’s i mpai rments i n concert, w e cannot say that the ALJ bui lt the required “accu rat e and logical bri dge” be t w een the evidenc e and her conclu si on. Simi la , 573 F .3d at 513 (7th Cir . 2009). Sim i larly , the ALJ di d not consi der t he i mpai rments that she had prev i ously ruled singly non-sev ere, whi ch i nclu ded Thomas’s fibromy algia, sci atic a, left thumb i nflam mati on, and hi stor y of art hriti s. These, too , should hav e been consi dered i n concert wi th Thomas’s other i mpai rments to deter mine t he i r collecti v e effect on her abi li ty to w or k. A nd t he ALJ made a blatant factual err or when she stated that Thomas’s thumb no longer bother ed her

. In fact, Thomas testifi ed at the hearin g that she could not bend her left thumb.8 No. 13-2602
W e cannot find that these err or s w ere harmless. It seems to
us that taking all of Thomas’s i mpai rments tog eth e r w o uld result in a more restricted RFC than the ALJ formulated. And the abi li ty to us e he r left hand w as integr al to Thomas’s past
w or k as a p hlebo tomis t, and thus her clai m. As the VE testifi ed, i f Thomas w ere li mi ted to “occasi onal gr asping” wi th her left, non-dominant hand, she could no t w or k as a phlebotomi st, ev en at a li ght exer tional lev el. If Thomas could not do her past w or k, she w ould hav e been consi dered di sabled and thus eli gib le fo r benefits. 20 C.F .R. app. 2 § 404(p) (a person ov er age fi fty-fi v e who lacks tr ansferable s kill s and cannot do prev i ous relev ant w or k is consi dered dis abled). C. The ALJ was not required to order a pulmonary function test Thomas addi tionally arg ues that the ALJ err ed by fai ling to
or der a pulmonary func tion t est, whi ch Thomas r e q uested in
a pre-hearing memorandum. An ALJ i s under an obli gation to dev elop a “full and fai r recor d,” Smith v
. Ap f el , 231 F .3d 433, 437 (7th Ci r
. 2000), but t his obli gation i s not li mi tless. And i n thi s case, i t i s not clear what t he p ulmonary func tion test
w o ul d hav e added to the recor d. Although i t i s clear t ha t Th o mas suffered from some pulmonary di sorder s, i t i s no t obvious that t he exis tin g medi cal ev i dence o f t hose di sorder s
w as so scant that the ALJ should hav e or der ed addi tional testing to dete rmi ne thei r sev erity

. D. The ALJ did not err by fai l ing to obt ain the medical sour ce stat ement from Dr

. Patil. L ast, Thomas asserts that the ALJ err ed by declining t o or der a medi cal source statement fro m Dr

. P atil, the c onsultativ e exami ner

. A medi cal source statement i s a statement fromNo. 13-2602 9

a tr e a tin g or e xa mining physi ci an that explain s what a clai mant
can do despite he r i mpai rments. Illi noi s has nev er required
such statements, and the completeness of an admini strat i v e recor d i s gener ally commi tte d to the ALJ’s di s c re ti on

. Se e Nelms
v
. Astrue, 553 F .3d 1093, 1098 (7th Ci r
. 2009) (generally upholdi ng ALJ’s deter minati on that recor d w as adequate). W e do not
see any reason to i mpose such a req uir e me nt i n thi s case, particu larly consi dering that the deter minati on of a clai mant’s RFC i s a matter for the ALJ alone—not a tr eating or exami ning doctor —to deci de. 20 C.F .R § 404.1527(d) (the final responsibi li ty for deter mining y our RFC i s reserved to the commi ssi oner).

III. C O N C L U S I O N For the foreg oin g reasons, we REVERSE the deci si on of the di stric t court and REMAND to the So ci al Security Admini stration for pro ceedings consi stent wi th this opin i on.