UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF INDIANA 

SOUTH BEND DIVISION 

JOHN F. STINSON, 

 PLAINTIFF, 

 VS. 

CAROLYN W. COLVIN, ACTING 

COMMISSIONER OF SOCIAL SECURITY 

ADMINISTRATION, 

 DEFENDANT. 

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CAUSE NO.: 3:14-CV-1956-RLM-CAN

OPINION and ORDER 

Plaintiff John Stinson seeks judicial review under 42 U.S.C. § 405(g) of the 

Commissioner of Social Security’s final decision denying his application for 

Supplemental Security Income and Disability Insurance Benefits. Mr. Stinson 

asks the court to set aside an Administrative Law Judge’s decision that while he 

has two severe impairments and isn’t capable of performing his past relevant 

work, he retains the capacity to perform a limited range of light work and is 

therefore not disabled. The court has jurisdiction over this action under 42 

U.S.C. §§ 405(g). For the reasons that follow, the court reverses and remands 

this case to the Social Security Administration for further proceedings consistent 

with this opinion. 

I. BACKGROUND
Mr. Stinson applied for disability benefits, claiming that he became 

disabled due to Porphyria Cutanea Tarda (“PCT”),1 Dis Porphyrin Metabolism, 

and depression. The ALJ found that Mr. Stinson suffered severe impairments 

including PCT and Chronic Obstructive Pulmonary Disease. The ALJ concluded 

that none of Mr. Stinson’s impairments met or equaled a listed impairment under 

20 C.F.R. Part 404, Subpart P, Appendix 1. After determining that Mr. Stinson 

wouldn’t be able to perform any of his past relevant work, the ALJ found that 

Mr. Stinson retained a residual functional capacity that would allow him to 

perform “less than light work” with numerous specific restrictions. Because the 

vocational expert testified that a significant number of jobs exist consistent with 

those restrictions, the ALJ concluded that Mr. Stinson wasn’t disabled. 

II. STANDARD OF REVIEW

The court must affirm the Commissioner’s determination if it is free of legal 

errors and supported by substantial evidence. See 42 U.S.C. § 405(g) (“The 

findings of the Commissioner of Social Security as to any fact, if supported by 

substantial evidence, shall be conclusive”); Scott v. Astrue, 647 F.3d 734, 739 

(7th Cir. 2011). The issue before the court isn’t whether Mr. Stinson is disabled, 

but whether substantial evidence supports the ALJ’s finding that he isn’t 

disabled. Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011). Substantial evidence 

means “such relevant evidence as a reasonable mind might accept as adequate 

 

1 PCT is a condition in which an enzyme deficiency prevents the patient’s body from converting 

porphyrins into heme. The unused porphyrins build up in the liver, plasma, and skin of the 

patient. These porphyrins are photosensitizing; when they are exposed to light they emit photons, 

which can damage surrounding tissue and result in characteristic skin blistering. (Ashwani 

Singal & Karl Anderson, Porphyria cutanea tarda and hepatoerythropoietic porphyria, in UP-TODATE (Ted Post ed., 2013), AR at 312-325). 
to support a conclusion.” Micus v. Bowen, 979 F.2d 602, 604 (7th Cir. 1992) 

(quoting Richardson v. Perales, 402 U.S. 389, 401 (1971). In deciding whether 

substantial evidence supported the ALJ’s decision, the court “reviews the entire 

record but does not substitute its judgment for that of the Commissioner by 

reconsidering facts, reweighing evidence, resolving conflicts in evidence, or 

deciding questions of credibility.” Estok v. Apfel, 152 F.3d 636, 638 (7th Cir. 

1998). In reviewing the ALJ’s conclusions, “[t]he court will conduct a critical 

review of the evidence, considering both the evidence that supports, as well as 

the evidence that detracts from, the Commissioner’s decision, and the decision 

cannot stand if it lacks evidentiary support or an adequate discussion of the 

issues.” Briscoe v. Barnhart, 425 F.3d 345, 351 (7th Cir. 2005). 

The ALJ isn’t required “to address every piece of evidence or testimony 

presented, but must provide a ‘logical bridge’ between the evidence and the 

conclusions so that [the court] can assess the validity of the agency’s ultimate 

findings and afford the claimant meaningful judicial review.” Jones v. Astrue, 

623 F.3d 1155, 1160 (7th Cir. 2010). The court can’t uphold an ALJ’s decision 

when this bridge is undermined by “contradictions or missing premises.” Parker 

v. Astrue, 597 F.3d 920, 921 (7th Cir. 2010). 

III. DISCUSSION

Mr. Stinson raises three objections to the ALJ’s decision: (1) that the ALJ 

improperly weighed the opinions of physicians in determining Mr. Stinson’s level 

of light sensitivity and his daily activity restrictions, in part because these 

opinions conflicted with the ALJ’s independent research on PCT; (2) that 
substantial evidence didn’t support the ALJ’s finding that Mr. Stinson’s 

subjective reports to physicians weren’t fully credible; and (3) that the ALJ failed 

to identify fatigue as a non-severe impairment. Because the first of these issues 

requires remand, the court doesn’t reach the credibility or fatigue issues. 

Mr. Stinson argues that the ALJ improperly conducted independent 

research on PCT, and relied on this research in rejecting the opinions of 

acceptable medical sources. He says the ALJ improperly discounted the opinions 

of Dr. Bierlein and Dr. Dwyer that Mr. Stinson’s PCT made him sensitive to all

light rather than only sunlight. Dr. Bierlein, Mr. Stinson’s primary care 

physician, wrote in a September 2013 letter that Mr. Stinson “is unable to work 

due to his diagnosis of porphyria cutanea tardia [sic]. This leaves him unable to 

be exposed to light.” Dr. Dwyer, a consultative examiner hired by the state 

disability office, examined Mr. Stinson in July 2013 and concluded that 

“Porphyria rash, which is aggravated by fluorescent and incandescent lights and 

sun, is problematic for the patient.” Mr. Stinson and his wife testified that both 

natural and artificial light aggravated his condition. 

A treating physician’s opinion is entitled to “controlling weight” if it is “well 

supported by medical findings and not inconsistent with other substantial 

evidence in the record.” Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000); see 

also 20 C.F.R. § 404.1527(d)(2). The ALJ noted the opinions of the two doctors, 

but found that Mr. Stinson’s PCT only required him to stay out of sunlight. The 

ALJ assigned the contrary opinions of Dr. Bierlein and Dr. Dwyer little weight 
because they were inconsistent with other substantial evidence for three 

reasons. 

First, both of those doctors were nonspecialists, and Dr. Bierlein admitted 

in his records that he didn’t understand PCT. More weight may be given “to the 

opinion of a specialist about medical issues related to his or her area of specialty 

than to the opinion of a source who is not a specialist.” 20 C.F.R. § 

404.1527(c)(5). The ALJ found that the non-specialists’ conclusions about Mr. 

Stinson’s light-related limitations were at odds with the findings of Dr. Bufill, a 

hematologist who treated Mr. Stinson for PCT. Dr. Bufill wrote in a January 2013 

letter to Dr. Bierlein that Mr. Stinson “linked the development of [his skin lesions] 

to sun exposure,” Dr. Bufill’s treatment notes also contained an email in which 

Dr. Bufill copied and pasted a medical article on PCT from Up-to-Date, an online 

clinical information service. This article discusses PCT in detail and states that 

“patients should avoid exposure to sunlight by wearing protective clothing.” 

Dr. Bufill’s opinion didn’t actually conflict with those of the other two 

doctors, so it was error for the ALJ to discount the opinions of the non-specialists 

on that basis. Dr. Bufill made no explicit findings about Mr. Stinson’s limitations, 

and thus never directly commented on what type of light did or didn’t aggravate 

Mr. Stinson’s PCT. The letter from Dr. Bufill to Dr. Bierlein simply reported what 

Mr. Stinson himself thought caused his symptoms, and so can’t be characterized 

as a finding by Dr. Bufill. Similarly, the email containing an Up-to-Date article 

wasn’t written by Dr. Bufill and only speaks about typical PCT cases in general 

terms, and doesn’t say anything about what symptoms Mr. Stinson in particular 
suffers. Moreover, even if either the letter or the email could be considered Dr. 

Bufill’s own findings, neither is actually inconsistent with Dr. Bierlein’s and Dr. 

Dwyer’s opinions because they don’t mention natural light at all. A finding that 

sunlight aggravates Mr. Stinson’s symptoms or a recommendation that he stay 

inside says nothing about whether artificial light might aggravate his symptoms, 

too. Because Dr. Bufill didn’t make any findings that were actually contrary to 

those of the two non-specialist examining physicians, the two pieces of Dr. 

Bufill’s records that the ALJ relied on couldn’t provide substantial evidence to 

reject them. 

The ALJ’s second justification for rejecting the opinions of the examining 

physicians is also insufficient. Dr. Nordstrom, a psychiatrist, examined Mr. 

Stinson in connection with his disability application. Dr. Nordstrom’s notes 

record that when asked about psychological factors that affect daily functioning, 

Mr. Stinson reported “I can’t go outside because I’ll blister.” (AR at 348). The ALJ 

noted that Mr. Stinson “did not report to Dr. Nordstrom that he blistered when 

he was inside under lighting.” As with Dr. Bufill’s records, Dr. Nordstrom’s report 

isn’t actually inconsistent with the findings of Dr. Bierlein and Dr. Dwyer. Mr. 

Stinson’s failure to mention artificial lighting to Dr. Nordstrom doesn’t mean that 

he wasn’t experiencing that symptom; Dr. Nordstrom is a psychiatrist, and a 

patient meeting with a psychiatrist may not see the need to explain with perfect 

precision his entirely physical symptoms. Mr. Stinson was responding to 

questions about psychological factors that limit him. That he only mentioned his 

inability to go outside may not mean that it is his only light-related limitation; it 
may simply mean that this limitation has the most notable effect on his mental 

wellbeing. Accordingly, Mr. Stinson’s statement to Dr. Nordstrom couldn’t 

reasonably outweigh the opinions of two examining physicians that Mr. Stinson 

was sensitive to artificial light. 

 The ALJ’s third and final reason for finding that Mr. Stinson need only 

avoid sunlight was that “a review of medical literature, including the Merck 

Manual and Up-To-Date, indicates only that sunlight should be avoided by 

patients with porphyria cutanea tarda, rather than all light.” (AR at 19). This was 

error. An ALJ may supplement the record by “asking detailed questions, ordering 

additional examinations, and contacting treating physicians and medical 

sources to request additional records and information,” Nelms v. Astrue, 553 

F.3d 1093, 1098 (7th Cir. 2009), but can’t make a decision based on materials 

outside the record. Rohan v. Chater, 98 F.3d 966, 970 (7th Cir. 1996) (“The 

Commissioner’s determination must be based on testimony and medical 

evidence in the record.”); see also Nelson v. Apfel, 131 F.3d 1228, 1236-1237 

(7th Cir. 1997) (holding that it was “improper for the ALJ to consider evidence 

outside the record in determining the extent of [the claimant’s] disability.”). 

The Up-to-Date entry on PCT was included in Dr. Bufill’s notes and so 

properly part of the record. But the Merck Manual wasn’t part of the record, nor 

was the other unspecified “medical literature” to which the ALJ refers. The ALJ 

erred in basing his decision at least partly on non-record evidence, and because 

the material the ALJ consulted isn’t before the court, there is no way to determine 
whether it was actually inconsistent with the opinions of Dr. Bierlein and Dr. 

Dwyer. 

Accordingly, none of the ALJ’s three articulated reasons for rejecting the 

opinions of Dr. Bierlein and Dr. Dwyer about Mr. Stinson’s reaction to artificial 

light were supported by substantial evidence. The doctors’ medical findings were 

entitled to controlling weight unless they were inconsistent with other 

substantial evidence in the record. Medical records from Dr. Bufill and Dr. 

Nordstrom aren’t actually inconsistent with these findings, and the ALJ erred to 

the extent that he consulted sources outside the record. Because the opinion of 

the two examining doctors that Mr. Stinson must stay out of all light was in fact 

unrebutted by record evidence, the ALJ’s contrary finding wasn’t supported by 

substantial evidence. The ALJ’s decision must be remanded so that the 

Commissioner can determine whether Mr. Stinson qualifies as disabled when his 

light sensitivity is appropriately taken into consideration. 

IV. CONCLUSION

For the reasons stated above, the Commissioner’s denial of benefits is 

REVERSED and this case is REMANDED with instructions to return the matter 

to the Social Security Administration for further proceeding consistent with this 

opinion. 

SO ORDERED. 

ENTERED: February 4, 2016. 

 ____/s/Robert L. Miller, Jr.____ 

 Robert L. Miller, Judge 

 United States District Court