In the

United States Court of Appeals

For the Seventh Circuit

No. 13-2602

MILDRED THOMAS,

Plaintiff-Appellant,

v.

CAROLYN W. COLVIN,

Acting Commissioner of 

Social Security,

Defendant-Appellee.

Appeal from the United States District Court for the 

Northern District of Illinois, Eastern Division.

No. 1:12-cv-04716 — Sheila M. Finnegan, Magistrate Judge.

ARGUED JANUARY 7, 2014 — DECIDED MARCH 11, 2014

Before WOOD, Chief Judge, and POSNER and KANNE, Circuit

Judges.

KANNE, Circuit Judge. Mildred Thomas suffers from a

number of potentially-disabling impairments, including

sciatica, angina, degenerative disc disease, fibromyalgia, and

diabetes. The Social Security Administration denied her

request for disability insurance benefits and supplemental
2 No. 13-2602

security income. The district court affirmed on appeal. We

reverse.

I. BACKGROUND

Thomas filedanapplicationfordisability insurance benefits

in December 2009, claiming that she suffered from sciatica,

diabetes, angina, a trigger thumb in her left hand, and chronic

obstructive pulmonary disease (“COPD”). She was also

morbidly obese, with a body mass index of around 45.

During the application process, Thomas saw a consultative

examiner, Dr. M. S. Patil. Dr. Patil noted a reduced range of

motion in Thomas’s lumbar spine, hips, and knees as well as

moderate difficulty squatting and getting on and off the

examining table. Dr. Patil also performed an x-ray of Thomas’s

lumbar spine, which, although severely limited by Thomas’s

obesity, appeared to show narrowed disc space. Later that

month, a state agency doctor, Dr. Thomas Kenney, reviewed

Thomas’s medical records, including Dr. Patil’s report. Based

on this information, Dr. Kenney determined that Thomas had

the residual functional capacity (“RFC”) to perform light work.

At the administrative hearing, Thomas testified that her

primary complaint was severe sciatic nerve pain that traveled

to her butt, thighs, and knees. She said she could not stand for

more than fifteen minutes or sit for more than twenty minutes

at a time. She further stated that she could only walk about half

a block and that she could not do laundry or vacuum. And she

suffered from recurrent inflammation in her left thumb. When

the inflammation was bad, she could not use her left hand at

all; treatment by injection allowed her to use the hand but she
No. 13-2602 3

remained unable to bend her left thumb. Thomas also used her

inhaler four times a day to control her asthma.

A vocational expert (“VE”) also testified about Thomas’s

past relevant work and the jobs available in the regional

economy. The VE described Thomas’s prior work as a phlebotomist as heavy, semiskilled work because Thomas had to lift

and move patients in addition to drawing their blood. The VE

also noted, however, that phlebotomy was typically categorized as requiring only light exertion.

The ALJ denied Thomas’s claim in a written opinion. She

found that Thomas retained the RFC to perform light work,

despite the fact that she suffered from eight severe impairments. She noted that the objective medical evidence was 1

consistent with Thomas’s allegation of degenerative disc

disease in the lumbar spine, but explained that her treatment

was “routine and conservative” and thus supported only a

limitation to light work. The ALJ also considered Thomas’s

history of diabetes, high cholesterol, hypertension, stable

angina, asthma, obesity and COPD. She found that none of

these conditions imposed any limitations greater than that

imposed by her back pain. She also stated that Thomas was no

longer experiencing trouble with her trigger thumb. Further,

the ALJ found Thomas’s complaints of pain incredible because,

although Thomas described diabetes and sciatica as her

primary impairments, she was taking diabetes medication and

had received only minimal sciatica treatment. Similarly, the

 The eight severe impairments the ALJ identified are diabetes, hyperten- 1

sion, degenerative disc disease in the lumbar spine, high cholesterol,

asthma, COPD, stable angina, and obesity.
4 No. 13-2602

ALJ relied on the fact that the medical record did not show a

“medical necessity” for Thomas to lay down orto abstain from

doing laundry to infer that Thomas in fact had a higher RFC

than her daily activities would indicate.

The Appeals Council denied review of Thomas’s claim, and

she appealed to the district court. The district court affirmed

the ALJ’s decision.

II. ANALYSIS

On appeal in a disability benefits case, we review the

district court’s decision de novo, resulting in direct review of the

ALJ’s decision. Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008).

This direct review is also deferential; we will uphold the ALJ’s

decision so long as it is supported by “substantial evidence”

and the ALJ built an “accurate and logical bridge” between the

evidence and her conclusion. Simila v. Astrue, 573 F.3d 503, 513

(7th Cir. 2009). This deference is lessened, however, where the

ALJ’s findings rest on an error of fact or logic. Schomas v.

Colvin, 732 F.3d 702, 708 (7th Cir. 2013). 

A. The ALJ improperly discredited Thomas’s testimony

The ALJ found Thomas’s testimony about the severity of

her symptoms incredible, noting that (1) although she testified

that sciatica and diabetes were her main problems, she had

received effective treatment for the diabetes and minimal

treatment for sciatica; (2) the medical records showed that she

had a normal gait, neurological testing and her Romberg sign2

 The Romberg sign refers to swaying or falling over when standing with 2

eyes closed and ankles touching. It is seen in tabes dorsalis and other

(continued...)
No. 13-2602 5

were normal, and she had only mild degenerative arthopathy;

(3) the medical records did not support reaching difficulties

with her shoulders; and (4) her medical records did not show

a medical necessity for laying down during the day or limitations on sitting and standing.

First, the ALJ reasoned that because Thomas testified that

sciatic nerve pain and diabetes were her main problems, and

those problems were being treated, Thomashadgreater overall

functioning capacity than she described. It is true that her

diabetes appeared to be under control and was not severely

limiting her daily activities. But Thomas testified primarily that

the sciatic nerve pain prevented her from walking more than

half a block and doing laundry and required her to lie down

for large portions of the day. The ALJ thought that because

Thomas had only minimal treatment for this pain, it could not

be as severe as Thomas alleged. But the treatment records are

replete with notes that the pain medication was not helping.

And sciatica is not always susceptible to more severe treatments; in some cases, the cause cannot be identified. The Merck

Manual of Medical Information 571 (Mark H. Beers et al. eds., 2d

home ed. 2003).

The ALJ also appears to have ignored the medical evidence

that supported Thomas’s complaints of pain. An ALJ need not

mention every piece of medical evidence in her opinion, but

she cannot ignore a line of evidence contrary to her conclusion.

Arnett v. Astrue, 676 F.3d 586, 592 (7th Cir. 2012). While she

 (...continued) 2

diseases of the nervous system. Sign, Dorland’s Illustrated Medical Dictionary

(32d ed. 2012). 
6 No. 13-2602

noted that Thomas’s gait and neurological exams were normal,

she ignored evidence that Thomas had difficulty getting on

and off the examining table and had limited ranges of motion

in her hips and knees. And elsewhere in the opinion, the ALJ

characterized Thomas’s x-rays as normal; in fact, they showed

transitional vertebra, narrowed disc space, and sclerosis.

The ALJ further noted that the medical evidence did not

support that Thomas had any shoulder problems that would

limit her ability to reach overhead. But Thomas had been

diagnosed with fibromyalgia, a condition whose primary

symptom is pain and stiffness in the muscles and joints.

Fibromyalgia, Dorland’s Illustrated Medical Dictionary (32d ed.

2012).

Finally, the ALJ found that the medical evidence did not

support Thomas’s allegations of pain, noting that there was no

“medical necessity” for Thomas to lie down during the day.

But a lack of medical evidence supporting the severity of a

claimant’s symptoms is insufficient, standing alone, to discredit her testimony. Villano v. Astrue, 556 F.3d 558, 562 (7th

Cir. 2009). Because all of the other reasons given by the ALJ

were illogical or otherwise flawed, this reason cannot alone

support the finding that Thomas was incredible.

B. The ALJ assessed Thomas’s RFC improperly by failing to

consider the combined effect of her ailments

A disability claimant’s RFC describes the maximumshe can

do in a work setting despite her mental and physical limitations. 20 C.F.R. § 404.1545(a). When determining an individual’s RFC, the ALJ must consider all limitations that arise from
No. 13-2602 7

medically determinable impairments. Arnett, 676 F.3d at 592;

Villano, 556 F.3d at 563.

The ALJ found that Thomas had the RFC to perform light

work, so long as Thomas avoided concentrated exposure to

“dust, fumes, and gases.” In making this determination, the

ALJ considered each category of Thomas’s impairments

seriatim, finding that no single category would prevent Thomas

from doing the slightly-restricted light work indicated in the

final RFC. But the ALJ did not consider how Thomas’s back

and leg pain, combined with her respiratory symptoms, would

impact her ability to work. This combination of impairments

could impose greater restrictions than any of Thomas’s

impairments taken singly. For instance, the fact that Thomas

had to use her inhaler four times a day, even without greaterthan-normal exposure to dust or other irritants, would compound the restrictions imposed by her back and leg pain.

Without any evidence that the ALJ considered Thomas’s

impairments in concert, we cannot say that the ALJ built the

required “accurate and logical bridge” between the evidence

and her conclusion. Simila, 573 F.3d at 513 (7th Cir. 2009).

Similarly, the ALJ did not consider the impairments that

she had previously ruled singly non-severe, which included

Thomas’s fibromyalgia, sciatica, left thumb inflammation, and

history of arthritis. These, too, should have been considered in

concert with Thomas’s other impairments to determine their

collective effect on her ability to work. And the ALJ made a

blatant factual error when she stated that Thomas’s thumb no

longer bothered her. In fact, Thomas testified at the hearing

that she could not bend her left thumb. 
8 No. 13-2602

We cannot find that these errors were harmless. It seems to

us that taking all of Thomas’s impairments together would

result in a more restricted RFC than the ALJ formulated. And

the ability to use her left hand was integral to Thomas’s past

work as a phlebotomist, and thus her claim. As the VE testified, if Thomas were limited to “occasional grasping” with her

left, non-dominant hand, she could not work as a phlebotomist, even at a light exertional level. If Thomas could not do

her past work, she would have been considered disabled and

thus eligible for benefits. 20 C.F.R. app. 2 § 404(p) (a person

over age fifty-five who lacks transferable skills and cannot do

previous relevant work is considered disabled). 

C. The ALJ was not required to order a pulmonary function test

Thomas additionally argues that the ALJ erred by failing to

order a pulmonary function test, which Thomas requested in

a pre-hearing memorandum. An ALJ is under an obligation to

develop a “full and fair record,” Smith v. Apfel, 231 F.3d 433,

437 (7th Cir. 2000), but this obligation is not limitless. And in

this case, it is not clear what the pulmonary function test

would have added to the record. Although it is clear that

Thomas suffered from some pulmonary disorders, it is not

obvious that the existing medical evidence of those disorders

was so scant that the ALJ should have ordered additional

testing to determine their severity. 

D. The ALJ did not err by failing to obtain the medical source

statement from Dr. Patil.

Last, Thomas asserts that the ALJ erred by declining to

order a medical source statement from Dr. Patil, the consultative examiner. A medical source statement is a statement from
No. 13-2602 9

a treating or examining physician that explains what a claimant

can do despite her impairments. Illinois has never required

such statements, and the completeness of an administrative

record is generally committed to the ALJ’s discretion.See Nelms

v. Astrue, 553 F.3d 1093, 1098 (7th Cir. 2009) (generally upholding ALJ’s determination that record was adequate). We do not

see any reason to impose such a requirement in this case,

particularly considering that the determination of a claimant’s

RFC is a matter for the ALJ alone—not a treating or examining

doctor—to decide. 20 C.F.R § 404.1527(d) (the final responsibility for determining your RFC is reserved to the commissioner). 

III. CONCLUSION

Forthe foregoing reasons, we REVERSE the decision of the

district court and REMAND to the Social Security Administration for proceedings consistent with this opinion.