UNITED STATES DISTRICT COURT 

NORTHERN DISTRICT OF INDIANA 

SOUTH BEND DIVISION 

ANGELA CLARK, 

Plaintiff, 

 v. 

CAROLYN W. COLVIN, Acting 

Commissioner of Social Security, 

Defendant. 

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Case No. 3:13-CV-1082 JD 

OPINION AND ORDER 

 On October 7, 2013, Plaintiff Angela Clark filed a complaint in this Court, seeking 

review of the final decision of the Defendant Commissioner of Social Security 

(“Commissioner”). [DE 1.] The matter is fully briefed and ripe for decision. For the reasons 

stated below, the Court REMANDS this matter to the Commissioner for further proceedings. 

I. Procedural History 

 Ms. Clark filed an application for disability insurance benefits and supplemental security 

income in September 2007. (R. 224–29.) Her applications were denied in January 2008 and 

again on reconsideration in March 2008. (R. 106–07.) A hearing was held before Administrative 

Law Judge Sherry Thompson on April 1, 2010 (R. 85–105), after which she issued an 

unfavorable decision. (R. 111–18.) The Appeals Council granted a request for review and 

remanded Ms. Clark’s claim for further evaluation of a medical source statement. (R. 123–25.) 

After remand, the case was assigned to Administrative Law Judge Melody Paige. She 

conducted a hearing on February 22, 2012. (R. 41–84.) On March 9, 2012, ALJ Paige issued a 

decision, again denying both claims. (R. 29–40.) The Appeals Council denied a request to review 
2 

the second decision on August 14, 2013, making the ALJ’s decision the final decision of the 

Commissioner. (R. 7–9.) This suit followed. 

II. Facts

Ms. Clark was born on November 19, 1982, and was 29 years old on the date the ALJ 

rendered her decision. (R. 224.) Ms. Clark graduated from high school, and began attending 

college part-time in 2006. (R. 56–57.) Her past employment includes work as a group home 

worker, a home health care worker, and a part-time receptionist. (R. 66–69.) Ms. Clark alleges a 

disability onset date of September 10, 2007 (R. 224), and claims disability based on physical 

impairments. 

A. Medical Evidence 

Ms. Clark claims, and the ALJ found, that she suffers from Postural Orthostatic 

Tachycardia Syndrome (“POTS”), hypertension, and obesity. (R. 31–32.) POTS is a fairly rare 

condition that is classified as a form of Inappropriate Sinus Tachycardia by the National Institute 

of Neurological Disorders and Stroke. (R. 15.)1

 POTS is characterized by “a rapid increase in 

heartbeat of more than 30 beats per minute, or a heart rate that exceeds 120 beats per minute, 

within 10 minutes of rising.” NINDS Postural Tachycardia Syndrome Information Page, 

National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov/disorders/ 

postural_tachycardia_syndrome/postural_tachycardia_syndrome.htm (last visited Feb. 6, 2015). 

Medical records of Ms. Clark’s physical impairments date to late 2005, though she has 

reported similar symptoms since childhood. (R. 381; 523–24.) On December 11, 2005, Ms. Clark 

received an electrocardiography test (“EKG”) at Portage Community Hospital. The EKG 

indicated a minor sinus arrhythmia, with the rest of the EKG within normal limits. (R. 524.) 

 

1

 Tachycardia means the “rapid beating of the heart, conventionally applied to rates over 90 beats per minute.” 

Stedman’s Medical Dictionary 1931 (28th ed. 2006). 
3 

On January 27, 2006, Ms. Clark saw Gary Brigham, M.D., a cardiologist at Cardiac Care 

Associates, for evaluation of tachycardia and recurrent episodes of near syncope.2 (R. 390). Dr. 

Brigham’s notes from the consultation reference previous Holter monitor and echocardiogram 

tests, conducted when Ms. Clark was 16 or 17 years old, which showed normal results. (Id.) A 

physical examination revealed a drop in blood pressure from 112/62 to 94/60 when standing. 

(Id.) Ms. Clark underwent 24-hours of monitoring using a Holter monitor, which indicated 

substantially increased heartbeat during times of normal activity, as well as an increase in heart 

rate of 40 beats per minute while standing and ambulating. (R. 392.) Dr. Brigham’s summary of 

the monitoring states, in part, “the patient has a tendency towards a sinus tachycardia during 

minimal activity.” (Id.) Dr. Brigham ordered an Echo-Doppler Report, which appeared normal. 

(R. 393.) Ms. Clark also underwent a tilt table test. (R. 470.) 

On February 9, 2006, Dr. Brigham conducted a stress test, which was eventually halted 

because of fatigue. (R. 391.) Ms. Clark achieved a peak heart rate of 167 beats per minute and a 

total work load of 8.4 mets.3

 Dr. Brigham’s summary indicated that Ms. Clark showed 

“excessive resting tachycardia” and became symptomatic when her heart rate exceeded 160 beats 

per minute. (Id.) Later that month, Ms. Clark was prescribed medication to attempt to regulate 

her presyncope and tachycardia. (R. 403.) Throughout 2006 and 2007, adjustments were made to 

prescription dosages and a variety of medications were prescribed. (R. 396–402.) 

On March 27, 2007, Ms. Clark was admitted to the emergency department at St. Anthony 

Medical Center for lightheadedness, elevated blood pressure, shortness of breath, heart 

 

2

 Syncope means “loss of consciousness and postural tone caused by diminished cerebral blood flow.” Stedman’s 

Medical Dictionary 1887 (28th ed. 2006). 

3

 “Met” is an abbreviation for metabolic equivalent, which is a measure expressing the energy cost of physical 

activities. Stedman’s Medical Dictionary 664 (28th ed. 2006). 
4 

palpitations, and irregular heart rate. (R. 460–75.) An EKG was performed and revealed normal 

sinus rhythm and no evidence of ischemia or dysrhythmia. (R. 471.) Ms. Clark was released with 

instructions to lower the dosage of her current medication and follow-up with her primary care 

physician. (Id.) 

Ms. Clark’s condition proved resistant to medication. On November 19, 2007, Dr. 

Brigham wrote a letter to Indiana Medicaid, in which he indicated that the medications used to 

affect Ms. Clark’s condition had been poorly tolerated or ineffective. (R. 492.) Dr. Brigham 

confirmed Ms. Clark’s diagnosis of POTS and reported that Ms. Clark’s recurrent episodes of 

disabling presyncope had progressed “to the point where she is now unable to effectively work.” 

(Id.) Dr. Brigham indicated that Ms. Clark’s condition left her with limited functionality and 

noted that there was no expected date of improvement because Ms. Clark had already been 

through almost all of the usual medications, without seeing improvement. (Id.) 

On July 1, 2008, Ms. Clark presented to the emergency room at Saint Anthony Medical 

Center. (R. 505.) The Emergency Department Note states that Ms. Clark was driving home when 

her heart started to race and she started to feel lightheaded, shaky, and weak. Ms. Clark believed 

she was going to pass out. (Id.) An ambulance was called and Ms. Clark was taken to the 

hospital where an EKG was conducted. Ms. Clark’s EKG showed a sinus rhythm with a rate of 

82 and no ischemic changes. (R. 506.) Ms. Clark was released with a plan to follow up with Dr. 

Brigham. (Id.) 

On October 28, 2008, Ms. Clark underwent another stress test performed by Dr. Brigham. 

(R. 552.) Upon standing on the treadmill, Ms. Clark’s heart rate went to 115 beats per minute. 

(Id.) Ms. Clark achieved a peak heart rate of 180 beats per minute “at which point she became 

very symptomatic and required discontinuation of exercise.” (Id.) The report states in summary 
5 

that Ms. Clark had an “[a]bnormal treadmill study demonstrating a resting sinus tachycardia with 

a pronounced exacerbation during low level exercise” as well as “severely diminished functional 

capacity.” (Id.) 

In a Medical Source Statement dated on October 30, 2008, Dr. Brigham opined that Ms. 

Clark was limited to lifting less than ten pounds even occasionally, as well as less than two hours 

standing or walking in an eight-hour workday. (R. 500–503.) He opined no limitations on sitting. 

(R. 501.) Dr. Brigham wrote that Ms. Clark “has severe functional limitations that are exertional 

in nature. These were documented by treadmill testing. She is unable to lift or carry things for 

any period of time due to recurrent tachycardia and near syncope.” (Id.) At some point before 

July 2009, Dr. Brigham updated the assessment, writing “[b]ased upon her most recent 

assessment, I believe she is limited to walking < 1 hour.” (R. 548.) 

 On November 1, 2011, Dr. Brigham wrote a letter in support of Ms. Clark’s Social 

Security Disability Appeal. (R. 555.) Dr. Brigham wrote that Ms. Clark’s “has had no significant 

change in overall functional status [since 2008] despite tapering doses of medication and 

attempts at new medications.” (Id.) He further wrote: “Her control of her arrhythmias with this 

medication has been marginal at best. I don’t anticipate that this is due to any reversible cause 

and it continues to significantly limit her and result in recurrent periods of near syncope. Mrs. 

Clark’s arrhythmias have been documented extensively including during ambulatory monitoring 

as well as during provocative stress testing. I anticipate continuing Mrs. Clark on her current 

medications and don’t expect any significant change in overall functional status over the next 

several years.” (Id.) 
6 

B. Hearing Testimony 

 At the 2012 hearing, testimony was heard from Ms. Clark and Vocational Expert (“VE”) 

Lee Knutson; Ms. Clark was represented at the hearing by her attorney, Rick Gikas. (R. 47.) 

 1. Ms. Clark’s Testimony 

Ms. Clark testified that she is single and lives by herself in a duplex home. (R. 56.) She 

has a driver’s license and is able to drive. (Id.) She graduated from high school and has attended 

college classes part-time since 2006 at Indiana University Northwest. (R. 56–57.) She takes 

approximately nine credits per semester and hopes to earn a Bachelors of Fine Arts, focusing in 

photography. (R. 57.) Following graduation, she hopes to have some kind of job in photography, 

“taking pictures or working kind of on a freelance.” (Id.) She attends school two days a week. 

(R. 58.) Ms. Clark estimated that she had missed five class days in the four-to-five weeks 

immediately preceding the hearing, as well as eight or nine class days in the prior semester. (R. 

70.) The reason for missing the classes was that she was “too dizzy, or lightheaded or my heart is 

going too fast” and she is not able to get out of bed. (Id.) On some days that she attends classes, 

she lays down in between classes in order to prepare for the next class. (R. 71–72.) 

At the time of the hearing, Ms. Clark was not employed. (R. 53.) She stated that she had 

not been employed since 2007, when her cardiologist suggested that she not work anymore. (Id.) 

Prior to that time, she had worked full-time for a few years, in a variety of positions. (Id.) Her 

previous positions included being a part-time receptionist with a real estate company, working in 

the office of a home health care company, and working as a direct care professional in a group 

home with mentally handicapped adults. (R. 67.) 

Ms. Clark testified that she has “good days and bad days.” (R. 57.) Even on good days, it 

takes her “a little while to get out of bed” because she has to “get up slow.” (R. 58.) She 
7 

explained that if she gets up quickly, her “blood pressure can drop, [and] heart rate can race or go 

[too] low.” (Id.) She testified that “it’s quite a process just to get up and get ready.” (Id.) On 

school days, she has an hour-and-a-half break to relax between classes. On bad days, she said 

“there’s not much activity at all. It’s either I’m in bed or I’m laying on the couch. There’s not, 

there’s not much I do at all if it’s a bad day.” (Id.) When questioned by counsel, Ms. Clark 

estimated that she has three “bad days” in a typical week. (R. 69.) 

Ms. Clark explained that she does not always take her medicine because she builds up a 

tolerance to the medicine. (R. 62.) To combat this, she starts on lower doses, which she increases 

over time. When the dosage is maxed out, she has “to go off the medicine and be off of it for at 

least three months” before she can begin taking it again. (R. 62–63.) When she does take the 

medication, it decreases Mr. Clark’s symptoms. (R. 64.) 

Ms. Clark considers Dr. Brigham to be her treating physician and sees him approximately 

every six months. (R. 65.) The last time she had seen him before the hearing was approximately 

one month earlier. (Id.) 

Ms. Clark summarized her experience when she has an “episode” of heart racing. (R. 72.) 

When she has an episode, she focuses on relaxing and trying to “regain some kind of control 

over what’s going on.” (Id.) The episodes last anywhere from 30 seconds to 15 minutes, with an 

average time of about 5 minutes; she has such episodes at least ten times per day. (Id.) 

 2. Vocational Expert’s Testimony 

VE Knutson characterized Ms. Clark’s past work as: secretary, home health aide, and 

group home worker. (R. 78.) The work ranged from skilled to semi-skilled and was performed at 

exertional levels from medium to heavy. (Id.) 
8 

The ALJ asked the VE a series of hypotheticals regarding an individual with Ms. Clark’s 

age, education, vocational background, and the following abilities/limitations: can perform light 

exertional work; occasionally lift and/or carry 20 pounds; frequently lift and/or carry 10 pounds; 

stand and/or walk six hours in an eight-hour work day; sit for six hours in an eight-hour work 

day; would be able to frequently climb ramps, stairs, balance, stoop, kneel, crouch, and crawl, 

but never climb ladders, ropes, or scaffolds; and would need to avoid even moderate exposure to 

hazards, such as machinery and heights. (Id.) The VE stated that such an individual could 

perform Ms. Clark’s prior work as a secretary or group home worker. (R. 79.)

Next, the ALJ added an additional limitation to the hypothetical, namely that instead of 

being able to perform light work, the person was limited to sedentary work. (Id.) The VE stated 

that such an individual could perform Ms. Clark’s prior work as a secretary, as well as certain 

other sedentary jobs that existed in the economy. (R. 79–80.) 

The ALJ then added additional limitations: that the person could not lift or carry more 

than ten pounds; standing and/or walking was limited to less than two hours in an eight-hour 

work day; and the person could never climb ramps, stairs, ladders, ropes, or scaffolds, and could 

never balance; could occasionally kneel, crouch, stoop, reach in all directions; and that the 

person needs to avoid exposure to temperature extremes, dust, humidity, wetness, hazards such 

as machinery or heights, fumes, chemicals, and gasses. (R. 80–81.) The ALJ clarified that sitting 

would be unlimited. (R. 81.) The VE testified that certain sedentary jobs exist in the national 

economy that such a person could perform. (R. 81–82.) The VE testified that missing four 

unscheduled work days per month would preclude a person from sustaining competitive 

employment. (R. 82.) 
9 

Ms. Clark’s counsel questioned the VE. (R. 82–84.) The VE testified that being off task 

for 20 percent of the work day would cause a person to lose his or her job. (R. 82.) Additionally, 

the VE clarified that limiting the person in the ALJ’s final hypothetical to one hour of standing 

would not affect the VE’s opinion regarding employability. (R. 83.) 

C. ALJ’s Decision 

 On March 9, 2012, the ALJ rendered her decision, ultimately finding that Ms. Clark is 

not disabled. (R. 29–40.) At step two, she found that Ms. Clark suffered from the following 

severe impairments: POTS, hypertension, and obesity. (R. 31.) The ALJ also discussed Ms. 

Clark’s mental condition,4

 but found any limitations to be non-severe because they did not cause 

more than a minimal limitation in her ability to perform basic mental work activities. (R. 32.)

At step three, the ALJ determined that Ms. Clark did not have an impairment or 

combination of impairments that met or medically equaled any listed impairments. (R. 32–33.) 

The ALJ found that, although Ms. Clark’s counsel argued that she met Listing 4.05, the evidence 

did not support a finding of recurrent episodes of cardiac syncope or near syncope. (R. 33.) She 

further noted that those episodes of near syncope that were self-reported by Ms. Clark did not 

meet the Listing definition. (R. 33.)

The ALJ then articulated the following residual functional capacity (“RFC”) 

determination: 

 

4

 Ms. Clark did not argue before the ALJ, and does not argue in this Court, that she suffers any impairment from a 

mental condition. However, the state agency recommended a mental status examination and Ms. Clark was 

evaluated by Patrick McKian, Ph.D. (R. 411–13.) During the examination, Dr. McKian noted that Ms. Clark 

“appeared to have a very good attitude about her situation in spite of feeling concerned about her medical future” 

and that she “admits to some times [sic] getting frustrated but denied feeling particular[ly] depressed.” (R. 412.) Dr. 

McKian stated his diagnostic impression that Ms. Clark suffered from “Adjustment Reaction with mixed emotional 

features secondary to her medical problems and the impact that it has had on her life.” (R. 413.) Because Ms. Clark 

does not contend that the ALJ erred in assessing this mental condition and its effects, it does not require any further 

discussion in this opinion. 
10 

[Ms. Clark] has the residual functional capacity to lift and carry 

less than ten pounds and stand and/or walk for less than two hours 

of an eight-hour workday with no sitting limitation. [Ms. Clark] 

should never climb ramps, stairs, ladders, ropes, or scaffolds and 

should never balance; however, she can occasionally kneel, crouch 

and stoop, and reach in all directions including overhead. [Ms. 

Clark] must avoid concentrated exposure to temperature extremes, 

dust, humidity, wetness, hazards such as heights and machines, 

fumes, chemicals, and gases. 

(R. 33.) In a footnote to the RFC, the ALJ noted that she alternatively considered a situation in 

which Ms. Clark would be limited to one hour of standing and/or walking, but that even with 

such a limitation Ms. Clark would not be disabled. (R. 33 n.2.) In making the determination of 

Ms. Clark’s RFC, the ALJ conducted a credibility analysis. (R. 34–38.) 

 The ALJ found that Ms. Clark’s allegations concerning the intensity, persistence, and 

limiting effects of her symptoms were “not credible to the extent they are inconsistent with the 

above residual functional capacity assessment.” (R. 34.) While finding that the “record does 

reflect that [Ms. Clark] is limited,” the ALJ found those limitations to be non-disabling. (R. 36.) 

Specifically, the ALJ articulated three reasons to discredit Ms. Clark’s allegations: “The claimant 

has sought routine treatment, is able to perform most activities of daily living, and is currently in 

school studying for a light/medium exertional profession.” (Id.) Additionally, the ALJ wrote: 

“With respect [to] the claimant’s allegations of falling asleep, inability to focus, and headaches, 

the undersigned finds these allegations not credible. There is no significant evidence of these 

symptoms contained in the record. Furthermore, the claimant is able to successfully attend 

college classes. Finally the claimant did not testify to these symptoms at the hearing, which 

indicates that they are not severe (or non-existant).” (Id.)

 At step four, the ALJ determined that Ms. Clark was unable to perform her past work 

because the jobs exceeded the limitations set forth in the RFC. (R. 38.) At step five, the ALJ 
11 

concluded that Ms. Clark was not disabled because jobs existed in the national economy that Ms. 

Clark could perform despite the limitations in the RFC. (R. 38–39.) As a result, the ALJ 

concluded that Ms. Clark was not disabled within the meaning of the Social Security Act since 

the alleged onset date. 

III. Standard of Review 

 The ruling made by the ALJ becomes the final decision of the Commissioner when the 

Appeals Council denies review. Liskowitz v. Astrue, 559 F.3d 736, 739 (7th Cir. 2009). 

Thereafter, in its review, this Court will affirm the Commissioner’s findings of fact and denial of 

disability benefits if they are supported by substantial evidence. Craft v. Astrue, 539 F.3d 668, 

673 (7th Cir. 2008). Substantial evidence consists of “such relevant evidence as a reasonable 

mind might accept as adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 

401 (1971). This evidence must be “more than a scintilla but may be less than a preponderance.” 

Skinner v. Astrue, 478 F.3d 836, 841 (7th Cir. 2007). Thus, even if “reasonable minds could 

differ” about the disability status of the claimant, the Court must affirm the Commissioner’s 

decision as long as it is adequately supported. Elder v. Astrue, 529 F.3d 408, 413 (7th Cir. 2008). 

 In this substantial-evidence determination, the Court considers the entire administrative 

record but does not reweigh evidence, resolve conflicts, decide questions of credibility, or 

substitute the Court’s own judgment for that of the Commissioner. Lopez ex rel. Lopez v. 

Barnhart, 336 F.3d 535, 539 (7th Cir. 2003). Nevertheless, the Court conducts a “critical review 

of the evidence” before affirming the Commissioner’s decision. Id. An ALJ must evaluate both 

the evidence favoring the claimant as well as the evidence favoring the claim’s rejection and may 

not ignore an entire line of evidence that is contrary to her findings. Zurawski v. Halter, 245 F.3d 

881, 887 (7th Cir. 2001). Consequently, an ALJ’s decision cannot stand if it lacks evidentiary 
12 

support or an adequate discussion of the issues. Lopez, 336 F.3d at 539. Ultimately, while the 

ALJ is not required to address every piece of evidence or testimony presented, the ALJ must 

provide a “logical bridge” between the evidence and the conclusions. Terry v. Astrue, 580 F.3d 

471, 475 (7th Cir. 2009). 

 Furthermore, conclusions of law are not entitled to deference; so, if the Commissioner 

commits an error of law, reversal is required without regard to the volume of evidence in support 

of the factual findings. Binion v. Chater, 108 F.3d 780, 782 (7th Cir. 1997). 

IV. Analysis 

 Disability and supplemental insurance benefits are available only to those individuals 

who can establish disability under the terms of the Social Security Act. Estok v. Apfel, 152 F.3d 

636, 638 (7th Cir. 1998). Specifically, the claimant must be unable “to engage in any substantial 

gainful activity by reason of any medically determinable physical or mental impairment which 

can be expected to result in death or which has lasted or can be expected to last for a continuous 

period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A). The Social Security regulations 

create a five-step sequential evaluation process to be used in determining whether the claimant 

has established a disability. 20 C.F.R. § 404.1520(a)(4)(i)-(v). The steps are to be used in the 

following order: 

1. Whether the claimant is currently engaged in substantial gainful 

activity; 

2. Whether the claimant has a medically severe impairment; 

3. Whether the claimant's impairment meets or equals one listed in 

the regulations; 

4. Whether the claimant can still perform relevant past work; and 

5. Whether the claimant can perform other work in the community. 
13 

Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). At step three, if the ALJ determines 

that the claimant’s impairment or combination of impairments meets or equals an impairment 

listed in the regulations, disability is acknowledged by the Commissioner. 20 C.F.R. § 

404.1520(a)(4)(iii). However, if a Listing is not met or equaled, in between steps three and four, 

the ALJ must then assess the claimant’s residual functional capacity, which, in turn, is used to 

determine whether the claimant can perform her past work under step four and whether the 

claimant can perform other work in society at step five of the analysis. 20 C.F.R. § 404.1520(e). 

The claimant has the initial burden of proof in steps one through four, while the burden shifts to 

the Commissioner in step five to show that there are a significant number of jobs in the national 

economy that the claimant is capable of performing. Young v. Barnhart, 362 F.3d 995, 1000 (7th 

Cir. 2004). 

 Ms. Clark challenges the ALJ’s decision on three grounds. First, she argues that the ALJ 

erred in finding that Ms. Clark did not meet Listing 4.05 and that—at the very least—the ALJ 

should have sought a medical opinion as to whether Ms. Clark’s condition equaled Listing 4.05. 

[DE 14 at 7–10.] Second, she argues that the ALJ’s credibility determination of Ms. Clark’s 

testimony regarding her symptoms was flawed. [DE 14 at 10–22.] Finally, she argues that the 

hypothetical posed to the vocational expert failed to account for various aspects of Ms. Clark’s 

impairments. [DE 14 at 22–23.] 

 The Court begins with the second argument—regarding the credibility determination—

and finds the ALJ’s credibility determination with respect to Ms. Clark’s ability to stay on-task 

in light of her POTS symptoms was patently wrong. Because this error affected Ms. Clark’s RFC 

and the hypothetical posed to the VE, the error requires remand for further consideration.
14 

A. Ms. Clark’s Credibility 

In making a disability determination, the ALJ must consider a claimant’s statements 

about her symptoms and how her symptoms affect her daily life and ability to work. See 20 

C.F.R. § 404.1529(a). While subjective allegations of disabling symptoms alone cannot support a 

finding of disability, id., the ALJ must consider the claimant’s subjective complaints, the 

relevant objective medical evidence, and other factors relevant to a claimant’s symptoms 

including: 

(1) The individual’s daily activities; 

(2) Location, duration, frequency, and intensity of pain or other 

symptoms; 

(3) Precipitating and aggravating factors; 

(4) Type, dosage, effectiveness, and side effects of any medication; 

(5) Treatment, other than medication, for relief of pain or other 

symptoms; 

(6) Other measures taken to relieve pain or other symptoms; 

(7) Other factors concerning functional limitations due to pain or 

other symptoms. 

20 C.F.R. § 404.1529(c)(3); SSR 96-7p. 

 An ALJ is not required to give full credit to every claim made by the claimant or to find a 

disability each time a claimant states she is unable to work. Rucker v. Chater, 92 F.3d 492, 496 

(7th Cir. 1996). However, SSR 96-7p provides that a claimant’s statements regarding symptoms 

or the effect of symptoms on her ability to work “may not be disregarded solely because they are 

not substantiated by objective evidence.” SSR 96-7p. Because the ALJ is “in the best position to 

determine a witness’s truthfulness and forthrightness . . . [the] court will not overturn an ALJ’s 

credibility determination unless it is ‘patently wrong.’” Shideler v. Astrue, 688 F.3d 306, 310–11 

(7th Cir. 2012) (quoting Skarbek v. Barnhart, 390 F.3d 500, 504–05 (7th Cir. 2004)). 
15 

 Ms. Clark claims that the ALJ improperly discounted her statements regarding the 

limiting effects of her symptoms, including the significant amount of time she would need to 

spend off-task in order to regulate her symptoms. This Court agrees. 

Ms. Clark spent a significant amount of her testimony at the second hearing discussing 

the effects that POTS episodes have on her ability to function. Ms. Clark testified of the need to 

lay down when such episodes occur. (R. 71.) Moreover, she testified that she is not able to focus 

during the duration of an episode, but rather has to undergo a “meditation process, where it’s 

focusing on breathing, it’s focusing on relaxing, trying to, to regain some kind of control over 

what’s going on.” (R. 72.) She testified that such activities were not always successful. (Id.) 

Additionally, the evidence before the ALJ was that such efforts were only used to reduce the 

duration of an already-in-progress episode, rather than stopping them from occurring in the first 

place. 

Even in the face of this evidence, the RFC does not account for any potential interruption 

in pace or attention, or any potential need for more frequent breaks in order to address POTS 

symptoms. In order for this RFC to be consistent with the evidence in the record, the ALJ would 

have needed to find Ms. Clark’s testimony almost entirely incredible. 

However, the ALJ doesn’t expressly make any credibility finding on the issue of how 

often or how long Ms. Clark would be interrupted during the work day by episodes related to her 

POTS. The ALJ does say that Ms. Clark “is able to perform most activities of daily activity, and 

is currently in school studying for a light/medium exertional profession.” (R. 36.) She also states 

“[w]ith respect to the claimant’s allegation of falling asleep [and] inability to focus” the 

allegations are not credible because “[t]here is no significant evidence of these symptoms 
16 

contained in the record,” “the claimant is able to successfully attend college classes,” and “the 

claimant did not testify to these symptoms at the hearing.” (Id.). 

The last point is wrong; Ms. Clark did testify about the effects on her focus that she 

suffers while undergoing an episode of increased heart rate, attributable to her POTS. (R. 72–73.) 

And whether there is significant evidence in the record is non-dispositive. SSR 96-7p (claims of 

limitation “may not be disregarded solely because they are not substantiated by objective 

evidence.”). 

That leaves her daily activities, which included attending college part-time. With respect 

to attending college classes, the ALJ’s analysis is only that Ms. Clark can do so “successfully.” 

(R. 36.) At hearing, Ms. Clark testified to the numerous self-accommodations she makes in order 

to do so, including resting for as long as an hour-and-a-half between classes, and skipping her 

last class on days she is “not feeling well enough to go.” (R. 58, 65, 72). The ALJ makes no 

reference to these self-accommodating activities or how they impact the credibility of Ms. 

Clark’s claimed limitations. Zurawski v. Halter, 245 F.3d 881, 887 (7th Cir. 2001) (ALJ may not 

ignore an entire line of evidence that is contrary to her findings). By focusing only on the 

evidence that supports the RFC while glossing over Ms. Clark’s other limitations, the ALJ 

engaged in inappropriate “cherry-picking.” See Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 

2010) (noting that the ALJ has an obligation to consider all relevant evidence and cannot 

“cherry-pick” facts that support a finding of non-disability while ignoring evidence that points to 

a disability finding). 

Further, whether Ms. Clark’s college activities can be considered fully “successful” is not 

clear. Ms. Clark testified that she had already missed five classes during the semester in which 

the hearing was held—which was only four or five weeks old at the time. (R. 70.) The previous 
17 

semester she had missed at least eight class days. (Id.) These absences caused her to nearly fail a 

class; she was spared that fate when the instructor gave her a break because they had “made 

special arrangements” at the beginning of the semester. (Id.) The ALJ does not consider the 

extent that an employer would be willing to make similar arrangements in the face of repeated 

absences. See Hughes v. Astrue, 705 F.3d 276, 278 (7th Cir. 2013) (“The critical differences 

between activities of daily living and activities in a full-time job are that a person has more 

flexibility in scheduling the former than the latter . . . and is not held to a minimum standard of 

performance, as she would be by an employer.”). And, of course, Ms. Clark’s desire to someday 

perform photography work—the duration and intensity of which Ms. Clark testified would be 

sporadic (R. 73)—is not the same as being currently capable of sustaining full-time employment. 

Moreover, Ms. Clark testified that she has “good days and bad days.” (R. 57.) The ALJ’s 

cursory analysis only covers the good. On bad days, Ms. Clark explained that her POTS 

symptoms rendered her unable to do more than stay in bed or on the couch, (R. 57–58), and she 

estimated that she has three bad days per week, (R. 69). The ALJ did not address whether she 

found this claim credible. In doing so, she ran afoul of the rule that “an ALJ must “sufficiently 

articulate [her] assessment of the evidence to ‘assure us that the ALJ considered the important 

evidence . . . [and to enable] us to trace the path of the ALJ's reasoning.’” Carlson v. Shalala, 

999 F.2d 180, 181 (7th Cir.1993) (per curiam) (alteration in original) (quoting Stephens v. 

Heckler, 766 F.2d 284, 287 (7th Cir.1985)). 

On the whole, the ALJ’s failure to analyze the main limiting feature of Ms. Clark’s 

condition was so deficient that the Court cannot find a “logical bridge” between the evidence and 

her conclusions. Terry, 580 F.3d at 475. Here, that failure affected the RFC findings regarding 
18 

the extent of Ms. Clark’s limitations, and thus the analysis at steps four and five.5

 Accordingly, 

the Court will remand to the Commissioner for further proceedings consistent with this opinion. 

B. Medical Equivalence 

Ms. Clark argues, as she did before the ALJ, that her condition met or equaled Listing 

4.05. That Listing provides that benefits are available to claimants with the following condition: 

“Recurrent arrhythmias, not related to reversible causes, such as electrolyte abnormalities or 

digitalis glycoside or antiarrhythmic drug toxicity, resulting in uncontrolled, recurrent episodes 

of cardiac syncope or near syncope, despite prescribed treatment, and documented by resting or 

ambulatory (Holter) electrocardiography, or by other appropriate medically acceptable testing, 

coincident with the occurrence of syncope or near syncope.” The ALJ rejected that argument. 

However, the ALJ cites as her only sources documents that are silent on the matter of medical 

equivalence. (R. 33.) Further, the Commissioner cites—and the Court can find—no medical 

opinion in the record touching on the question of medical equivalence. 

To make a determination regarding equivalence, an expert would need to be consulted. 

S.S.R. 96–6p at 3 (“[L]ongstanding policy requires that the judgment of a physician (or 

psychologist) designated by the Commissioner on the issue of equivalence on the evidence 

before the administrative law judge or the Appeals Council must be received into the record as 

expert opinion evidence and given appropriate weight.”), reinstating S.S.R. 83–19; see Farrell v. 

 

5

 Admittedly, the Seventh Circuit has occasionally concluded that a VE has familiarity with the claimant's 

limitations, despite any gaps in the hypothetical, when the record shows that the VE independently reviewed the 

medical record or heard testimony directly addressing those limitations and the VE considered that evidence when 

indicating the type of work the claimant is capable of performing. O'Connor-Spinner v. Astrue, 627 F.3d 614, n. 5 

(7th Cir. 2010) (citing Simila v. Astrue, 573 F.3d 503, 521 (7th Cir. 2009); Young, 362 F.3d at 1003; Steele v. 

Barnhart, 290 F.3d 936, 942 (7th Cir. 2002); Ragsdale v. Shalala, 53 F.3d 816, 819–21 (7th Cir. 1995); Ehrhart v. 

Sec'y of Health & Human Servs., 969 F.2d 534, 540 (7th Cir. 1992)). This exception does not apply here, since the 

VE never indicated having reviewed Ms. Clark’s medical records, nor did he indicate in his responses having relied 

on those records or the hearing testimony. Rather, the VE’s attention was on the limitations of the hypothetical 

person posed by the ALJ, rather than on the record itself or the limitations of the claimant herself. Id. (citing Simila, 

573 F.3d at 521; Young, 362 F.3d at 1003). 
19 

Sullivan, 878 F.2d 985, 990 (7th Cir.1989) (concluding that ALJ complied with requirement of 

S.S.R. 83–19 that he consider a consulting physician's opinion regarding medical equivalency). 

It is error to fail to consider an expert opinion on the question of whether the medical 

evidence supports a finding of equivalency. See Minnick v. Colvin, No. 13-3626, 2015 WL 

75273, at *5–6 (7th Cir. Jan. 7, 2015) (remanding where, among other things, “the ALJ never 

sought an expert’s opinion as to whether any of the evidence could support a finding of 

equivalency”); Barnett v. Barnhart, 381 F.3d 664, 670–71 (7th Cir. 2004) (“Here, the ALJ did 

not consult an expert regarding medical equivalence. . . . Nor can we locate [any evidence] that 

would otherwise satisfy the ALJ’s duty to consider an expert’s opinion on medical equivalence. 

Yet, rather than soliciting a neurologist’s opinion on the matter, the ALJ simply assumed the 

absence of equivalency without any relevant discussion. That assumption cannot substitute for 

evidence and does not support the decision to deny benefits.”). For this additional reason, 

remand is required. 

C. Ms. Clark’s Request for a Direct Award of Benefits 

 In her reply brief, Ms. Clark requests that the Court “direct that on remand, a finding of 

disabled should be entered.” [DE 21 at 1.] Her rationale for the request is that “Ms. Clark’s claim 

has been pending before the Administration since 2007, and the evidence of record shows that 

she cannot sustain full time employment.” [Id.] Additionally, she notes that the claim “has now 

been through the administrative process twice with two ALJ’s failing to give serious 

consideration to Dr. Brigham’s opinions or functional limitations.” [Id. at 12.] The Court is 

sympathetic to Ms. Clark’s situation, but in light of the credibility issues that remain to be 

decided before any benefits may be awarded, remand without any instruction regarding the 

eventual disposition is the appropriate remedy in this case. 
20 

V. Conclusion 

 For the reasons stated above, the Court GRANTS Ms. Clark’s request to remand the 

ALJ’s decision, but DENIES her request that the Court direct an award of benefits on remand. 

The Commissioner’s decision is REMANDED for further proceedings consistent with this 

opinion. 

 SO ORDERED. 

 ENTERED: February 11, 2015 

 

 /s/ JON E. DEGUILIO 

 Judge 

 United States District Court