# United States Court of App eals F orth eSeve nt h Ci r c uit Chicago, Illin ois 60604 A rgued June 10, 20 09 Deci ded J uly13 , 20 09 B efo re IL A N A D IA M O N D R O V N E R, Cir cu i tJudg e D IA N E P . W O O D , Cir cu i tJudg e T E R E N C E T . E V A N S, Cir cu i tJudg e N o. 09
- 1135 P AT R I C K S
. MUL L I GA N, P laint if f-A ppell ant,
v. M I CHAEL J
. AS TR UE , Com m i ssi onero fS oci alS ecuri ty, D efend a nt-A pp ellee
. A pp ealfro m the U ni ted S tat es Dist ri ct Court f orthe W est er n Dis tr i ct o f W i sc o ns i n . N o. 08
- cv- 364-bbc Barbar a B. Crabb , Chie f Judg e . O R D E R A te rr ibl e l i fe- sty l e cho i ce c aught up w i th Patr i ck M ull i gan. In 200 5, atthe age o f41 , he was dia gnos ed w i th l ung cancer . Thi s s houl d com e a s no bi g s urpri se because M ull i gan sm ok ed tw o p ac ks of cig ar et te s a d ay for th e la st25 ye ar s. A t o n e t im e, th in k p os t-W or ld W arI I, sm oking was gl or i fi ed. Reca l lthe appall i ng ad: “ A ccor ding to a r ecentN ati onal su r ve y, mor e do ct o r s smok e Camel s th ana nyo th erc i g ar et te ! ” Buti n 1 98 0, whenM ul l i g an, at the a ge of16 , st ar ted l i ghti ng up, the w ar ni ng si gns were ev er ywh er e. Yetf orwh ate ver r e a s o n, h e i g n o r e d th e m. NONP RE C E DE NT I AL DI S PO S I T I ON To be ci ted o nl y in acco rdance w i th F ed. R. App. P. 32 .1

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I n 200 5 M ull i gan underwent surg er y t o re m ove m al i gnant ti ssue. The s urge rywas diffi cul t a s o ne o fhi s r ibs was br oke n i n the proce ss. He subsequentl y c ontr acte d pneum oni a. His post- oper ati ve chem othe ra py exact ed a t ol las well, l eaving M ull i gan with shor t- ter m m em or y l oss , per i pheralneuro pathy, l eg pai n, and drug- i nd uced f ati gue. That sam e y earhe a pp l i ed f orS oci alS ecuri ty disabi l i ty benefi ts and supp l em entalse curi ty i ncom e. He w as parti al l y s uccess ful. F ol l owing a hea ring, an a dm i ni str ati ve l aw j ud ge ( A LJ) deter m i ned that M ull i gan was di sabl ed fro m Februar y 5 , 20 05, to A ugust 1 1, 20 06, butno t any l o ng er . M ul l i g an ’ s he al thha d i m pr o ve d c o ns i der ab l y s i nc e hi s su r g ery a nd c h em ot h er ap y, th e A L J rea so n ed , an d h is t es tim on y re ga rd in g th e s ev er ity of h is i m pai rm ents w as not cre dibl e. The Ap peal s Counci ldeni ed M ull i gan’ s peti ti on forr evi ew so th e A L J’s d ec isio n be c am e t h e fin al d ec isio n of th e C om m iss ion er of Soc ial Se c u rit y. M ull i gan’ s peti ti on forj ud i ci alr evi ew was denie d by the di str i ct c ourtand he i s her e t oday on an ap p eal fil ed i n Jan ua ry of th is year. M ulli gan, w ho w as 42 years old at the tim e of th e A L J’ s d ecision, d rove a truc k for a livin g b efo re h e w as d iag n os ed w ith lun g c an c er in F eb ru ar y 2 00 5. T w o w ee ks aft er h is di agno si s, Dr
. Da ni elCa va na ugh pe r f o r m ed a l o be ct o m y, s ur g i ca l l y r emov i nga c an ce r o us l o be o fM ul l i g an ’ s r i g htl ung . ButM ul l i g ande ve l o ped pne um o ni a f o l l o wi ngs ur g ery, a nd hi s doct or s intubated hi m f orapproxi m ate l y a week t o sta ve offthe i l l ness. He w as eve ntual l y di schar ged, i n l ate Februar y, with pr escr i pti ons f oranti
-bacte ri alm edi cati on and pain k i l l er s. M ull i gan b ega n chem othe ra py tr eat m ent a ro und thi s t i m e, al though that to o c ame wi thc o m pl i ca ti o ns ; he was ho spi ta l i ze d, f o re xa m pl e, t wo da y s i nt o t r ea tment because o fse ver e nause a, hear tburn, and vom i ti ng. M ull i gan’ s che m othe ra py al so caused p eriph eral neu rop ath y, m an ifest as n um bn ess an d pa in i n h is feet an d l egs. Stil l, as D r. C a v a n a u g h n o t e d i n Ma r c h 2 0 0 5 , Mu l l i g a n w a s “ d o i n gv e r y w e l l ” i n l i g h to fh i s p r o b l e ms ea rlier th at m on th , an d h is ox yg en sa tu ra tio n rat e--a m ea su re of th e a m ou n t o f ox yg en in th e b l o o d s t r e a m- - wa s 9 8 %. I n Apr i l2 00 5 M ul l i g ans aw hi s tr ea tingphy si ci an, Dr
. Tho m as Lundqui st, a nd com pla i ned ofches t t i ghtnes s, wh eez i ng, sho rtness ofbr eath, and sev er e pai n i n hi s l ower ex tr em itie s (“ w h ich [M u lliga n ] rat es at8/1 0" ). Sig n ifica n tly , M u lliga n rep or te d th ath is presc ribed m or phine a nd Per coce t were “not touchi ng the pai n. ” So Dr. Lund quis t r e s p o n d e d w i th a n e w t r e a t me n tr e g i me n, i n c l u d i n gn e w d r u g s f o rth e p a i n . T h a ts a me m ont h, Dr. Bil al N aq vi, w ho w as oversee ing the che m oth erap y treatm en t, not ed M ulli gan ’s m ult i ple so urces o fpai n m edi cati on- - Dr. Cavanaugh a nd Dr. Lund quis t-
- and i nfo rm ed M ull i gan that he “shoul d get hi s nar cot i cs pr escr ibed by onl y o ne physi ci an and he deci ded to ge t t h es e fro m D r. L u n d q u ist .” D r. N aq vi a lso n ot ed th atM u lliga n w ou ld be co m p let ely di sabl ed an d unabl e to wor kdur i ngthe c o ur se o fhi s ch emothe r apyt r ea tmentb uttha t he shoul d reg ai n hi s s tr ength w i thi n f our to si x w eek s o fthe fi naltr eat m ent.

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By J uly20 05 M ull i gan c om ple ted hi s che m othe ra py tr eat m ent. Dr. Cavanaugh re port ed that he was “doi ng f ai rl y wel lnow” and that “[ h]e i s inter est ed i n go i ng ba ck to w or k, i fhe c an. ” Bu t be f or e Dr. Cavanaugh would autho ri ze a r etur n to work, he wanted to m onitor M ulli gan ’s pu lm ona ry fun ctions a l ittl e longer. For the tim e being, Dr. C a v a n a u g h p r o v i d e d Mu l l i g a n w i th a t e n t a t i v e b a c k

- t o - wo r ks l i p w i th h a l f

- t i me r es tr i ct i o ns f o rthe month o fAugus t 20 05 a nd the n ful l

- ti m e au th o r i za ti o n b eg i nning Se ptem ber1, 20 05. F urtherte sting in l ate J uly, tho ugh, sho w ed that M ull i gan had g re ate r re str i cti ons than fi rs t a nti ci pated. Dr. Cavanaugh no ted thatM ull i gan’ s for ced vi tal c ap ac ity --a m ea su re of h ow m u c h air on e c an ex h ale --w as m er ely “2 .13 liter s, w h ich is on ly 42% o fpre dict ed. ” N ordi d that m eas ure i m prove with b ro nchodil ato rs . Dr. Cavanaugh expand ed on M ull i gan’ s l i m i tat i ons: The pa ti en t be co m es v ery s ho r t o fb r ea thj us t wal k i ngup th e st ai r s an d w alk in g ou ts id e. T h e p at ien t is as kin g q u es tio n s ab ou t g oin g b ac k t o w or k. He i s a t r u c kd r i v e r, a n d Id o n o tth i n kh e i s qu a l i fi e d t o d r i v e a t r u c k
. H e al so has s om e pr obl em s with hi s m em or y s i nce he had his chem othe ra py.

. . . . Inm y s u rg ica l op in ion, Ith in k th e p at ien t is d isa b led
. I d o n otth in k h e is go in g t o b e ab le t o d o th e h ea vy ty p e o f w or k th ath e h as d on e in th e p as t. The pati ent i s a l so w or ki ng thr ough S oci alS ecuri ty. W e hav e hi m now in vo lve d in t h e o c c u p at ion al h ea lth sid e o f th in gs . A s s ta te d , in m y op in ion, I do not thi nk the pati ent i s g oi ng to be abl e t o do the type ofem plo ym ent that he has i n the past with hi s lung functi on a nd with hi s e xtre m e s hor tness o f br ea th
. Aft erDr
. Ca va na ugh l ea r ne d tha t M ul l i g anwas s ee k i ngdi sabi l i tyb en efi ts , he r efer r ed hi m t o Dr
. Er i c Car l se n, who s pec i al i ze s i n ph y si ca lmedi cine a nd r eh ab i l i ta ti o n, f oran e valuati on o fM ull i gan’ s r esi du alfuncti onalcapaci ty ( RFC). F ol l owing a J uly20 05 ex ami na ti o n, Dr
. Ca r l se n e ch o ed m any o fthe s ame obs er va ti o ns a s ha d Dr
. Ca va na ugh, expla i ni ng tha t M ull i gan “ get s s hor t o fbr eath eas i l y, ev en house hol d dist ance am bul ati on an d up o rdo wn st ai r s. He i s al so c o m pl aini ngo fs o m e numbne ss i n h i s fee t an d ha nds a nd som e s hor t t er m m em or y pr obl em s. ” “Of cour se i t i s no t S oci alS ecuri ty' s i ssue w hethero r no th e c o ul d b e g a i nful l y e mpl o y e d a th i s f o r mere mpl o y e r, ” Dr
. Ca r l s e n r e mar k e d, but wh etherhe c oul d be r eas onabl y e m plo yed in hi s a re a in other types of ca pac i ty . Ic er ta i nl y thi nktha t woul d b e f ai r l y unl i k ely, g i ve n h i s cur r en t

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prese ntati on, i ncl ud i ng chr oni c nar cot i c usag e, se ver e dyspnea [ shor tness o f bre ath] with e xert i on a nd so m e per i pheralneuro pathy. F uncti onalcapaci ty i s m ostl i kely in the sedentary t o l [ i ] ght r ange w i th al l owances f orchange o f po si ti o n. T ha t op inion j ibes som ew ha t w ith a briefl etter d ated Sept em ber 26, 2005, from Dr. Lundqui st
- - M ul l i g an ’ s tr ea tingphy si ci an - - i n whi chhe r emar k ed th atM ul l i g an“ r emai ns u n ab le t o w or k a t t h is t im e.” A year l ater, in A ug us t 2006, Dr. Cav an au gh stil l ha d reservations abou t M ulli gan ’s re turn t o w or k. He w ro te, i n re sponse to a r equest fro m M ull i gan’ s co unself ora m edi cal sta tus r epor t: M r. M u lliga n atth e p re se n t t im e a p p ea rs to slow ly b e re c ov er in g fro m h is su rg er y. H e c om p lain s o f so m e p ain in h is fe etse c on d ar y t o h is ch em oth erap y and that i s being foll ow ed by his prim ary p hy sician, D r. Lu nd quis t in Ri ce Lak e. Thi s i s a chem othe ra py- i nd uced peri pheral neuro pathy. The pat i ent i s a l so bei ng f ol l owed byhi s pri m ar y physi ci an be ca us e o fa c hr o ni c depr es si o n.

. . . . I n m y o pini on Ithi nk M r. M ull i gan has bee n dis abl ed si nce hi s o ri gi nal th or ac ot om y inFe b ru ar y 2 00 5. H is p u lm on ar y s ta tu s c on tin u es to im p ro ve . H o wev er, wi the xe r ci se he b ec o m es s ho r t- wi nde d a nd hi s o xy g ens atur at i o ns d o fa ll. It w ou ld be m y op in ion th atas of th is t im e, M r. M u lliga n is n otab le to m ai ntai n a fullwork l oad as he ha d pri orto hi s s urge ry, and that i fhe was co ns i der ed f o rs o m e ty pe o fe m pl o y m en t th i s woul d c er ta i nl y ha ve t o b e th e type ofwork that w oul d be m odi fi ed to m eethi s nee ds fro m the re si du al pu l m onar y s tatus se condaryto hi s l obe cto m y. M u lliga n ’s c ou n se l m ad e t h e s am e re q u es t o f D r. L u n d q u ist, w h o re sp on d ed in Sep tem ber 2006
. “M r. M ulli gan cont inu es to hav e significantf atigue , ” w rote D r. Lundqui st . “ H e i s unabl e to wor kf o ra ny l o ngpe r i o ds o ft i m e dur i ngthe da y wi th o ut h av in g t o lie d ow n .” D r. L u n d q u istm en tio n ed th atM u lliga n w as st ill tak in g n ar c ot ic p ain m edi cati on forthe “pai nfulneuro pathy” in hi s l egs . And , al though he get s s hor t o fbr eath w i th exer ti on, M ull i gan was “no t e xtre m el y hy poxem i c”; thati s, adequate oxyg en was g e t t i n gi n t o h i s b l o o d s t r e a m.

### No. 09-1135 Pag e 5

A fterhi s ini ti alappli cati on forS oci alS ecuri ty benefi ts w as denie d, M ull i gan requ ested a hearing be fore an A L J. A t the hearing i n N ovem ber 2005 , the A L J he ard tes ti m ony fro m M ull i gan, a m edi calexper t, and a v oca ti onalexper t. The AL Jco ncl ud ed that M ull i gan was notdi sabl ed. M ull i gan a pp eal ed that deter m i nati on, and i n A pri l20 06 the Ap peal s Counci lr em anded the case to the A LJ b ecause “[ t] he hear i ng deci si on does not c on ta ina sp ec ific fin d in g re ga rd in g th e c re d ibilit y of t h e c laim an t’s su bj ec tiv e c om p lain ts . I n a ddi ti o n, the de ci si o n do es no t addr es s whethe rthe c l ai m an t ha s anunde r l y i ng m edi cal l y dete rm i nabl e physi calo r m entali m pai rm ent that c oul d rea sonab l y b e e xpected to pr o duce the s y m pto m s al l eg ed. ” “ I n pa r ti cul ar, ” th e Appeal s Cou nc i lc o nt i nue d “ th e deci si on does notaddress the cl ai m ant’ s a l l ega ti on that he needs to l i e down f oro ne to thre e ho urs each day due to f ati gue, wh i ch the voca ti onalexper t a t the hear i ng ind i cate d w ou ld p re c lu d e a ll w or k a c tiv ity .” The s ame ALJ c o nv en ed a se co nd he ar i ngi n Aug us t 20 06 , a g ain h ea r i ngt es ti m o ny fr o m M ul l i g an, a no n- ex ami ni ng, s ta te
- ag en cyphy si ci an( Dr
. Kathe r i ne Hi duch en k o ) , a nd a vo ca ti o na le xpe r t ( Pa ulM au l ucc i )
. Unf o r tu na te l y, the r e i s no t r an sc r i pt o fthe s ec o nd hear i ng in the re cor d. The part i es ackno w l edge thi s defi ci ency but do no t a tte m pt to expla i n i t. The di str i ct c ourt, i n i ts w ri tte n deci si on, not ed the probl em as wellbut chose to draw o n the A LJ’ s wri tte n sum m ar y o fthe hear i ng be cause nei therparty obj ecte d to that po r ti o n o fthe de ci si o n. Foll ow ing the hearing the A L J con clud ed that M ulli gan w as d isabled from Febru ary 5, 20 05, to A ugust 1 2, 20 06. The AL Jbeg an, atst ep one, byfi nd i ng tha t M ull i gan had not engag ed i n any substa nti alga i nfulact i vi ty si nce F ebr uary5, 20 05. The AL Jco ncl ud ed at ste p tw o that M ull i gan s uffer ed fro m the f ol l owing seve re i m pai rm ents: “ a hi sto ryo f undi ffer en ti at ed ade no ca r cino m a [ a ty pe o fc an ce r ] o fthe r i g htl ung, s ta tu s po str i g ht up p er l obec tom y, an d che m oth erap y, w ith residu al m od erate obs tru ctive p ulm ona ry dise ase , and chem othe ra py- re l ate d senso ryper i pheralneuro pathy in the l ower extr em i ti es. ” M ull i gan had al so com pla i ned ofa ri ght- f oo t fra cture , a hi sto ryo f gas tr oes ophagea lr efl ux dise ase , and l eft- shoul der infl am m ati on, but the AL Jf ound that thos e co nd i ti ons w er e no t s eve re physi cali m pai rm ents. S i m i l ar l y, the A LJ r ej ecte d M u lliga n ’s c laim th at h is d ep re ss ion ros e t o th e le ve l of a se ve re m ed ica lly d et er m in ab le m en ta li m pai r m en t. T he r e wer e few r efer en ce s to de pr es si o n in the r ec o r d, the A LJ r em ar ked, and eve n thos e r efer ences- - e. g. , Dr. Cavanaugh no ti ng tha t Dr. Lund quis t wa s mo ni t o r i ngMul l i g a n’ s de pr e s s i o n- - di d n o tp r o v i de a nys i g ni fi c a ntde t a i l
. T he ALJ o bs er ve d, mor eo ve r, tha t “the medi ca lr ec o r d do cument s no e va l ua ti o n o rt r ea tmentb y a ny m entalheal th pro vi der. ” Perhaps m ostsi gni fi cant w as M ull i gan’ s t aci t a cknowle dgm ent a t the he ar i ng tha t, al though he w as tak i ng Pr oza c, he di d not e xperi ence any s ym ptom s o f depressi on that m i ght inter fer e with w or ki ng.

### No. 09-1135 Pag e 6

Medica l improvement, asdefined in 20 C.F .R . § § 4 04. 1594 (b)(1), 416. 994(b)(1 )(i), i s * “any decre ase in the medicalseverity of you r imp airment(s) which was prese nt atthe tim e of the mos t rece nt fav orable medicaldecision that youwer e disab led or c ontinu ed tobe dis abled. A d eter m ina ti on tha tthe reh a sb eenad ec re a s e in m ed i c a ls ev er i tymu s tb e b a s edon changes (i mpr ove me nt ) inthe symptoms, sign s and /or labor ator y fin din gs assoc iate d with your imp airment(s).” N ext, atst ep thr ee, the A LJ c oncl ud ed that fro m Februar y 5 , 20 05, to A ugust 1 1, 2006 , M ull i gan di d not hav e a n i m pai rm ent o r com bi nati on o fi m pai rm ents that m et or med i c a l l y e qu a l e d a l i s t e d i mpa i r men t . S t i l l, du r i ngtha tp e r i o d, a s the ALJn o t e d a ts t e ps f our and fi ve, M ull i gan l acke d the r esi du alfuncti onalcapaci ty to perf or m ev en se dentary

l ev elwor k
. T he ALJ s y nthe si ze d the r epo r ts o fDr
. Lundqui sta nd Dr
. Ca va na ugh a nd co nc l ude d tha t th eywer e co ns i st en t wi ththe t es ti m o ny o fDr
. Hi duch en k o , the no nexam i ni ng, st ate
- age ncy physi ci an- - w ho t est i fi ed that du ring the 18
- m onth per i od M ull i gan “ w oul d have be en unabl e t o perf or m any w or k due t o hi s r equi re d surge ry, post
su rg ica l an d ch em ot h er ap y re lat ed co m p lica tio n s, an d p ro lon ge d rec ov er y p er iod .” The A LJ’ s wri tte n deci si on i s incom ple te, however
. Und erthe bol ded headi ng “1 2. M edi cali m prove m ent o ccurr ed as ofA ugust 1 2, 20 06, the date the cl ai m ant’ s di sabi l i ty e nd e d ( 2 0 CF R 4 0 4
. 1 5 9 4 ( b ) ( 1 ) a nd 4 1 6
. 9 9 4 ( b ) ( 1 ) ( i ) ) ” the ALJwr o t e o nly “ * * [ EX PL AI N HOW * SE V E R I T Y OF IM PA I R M E N T S DE C R E A SE D I N TE R M S OF SIGN S, SYM PT O M S, A N D /OR LA B O R A T O RY FI N D I N G S]* *. ” Th is i s obvious ly an oversight by th e A L J. Else w here i n hi s deci si on, however, the A LJ t ouches on thi s no ti on o fm edi cal i m pr o ve m en t. F o re xa m pl e, the ALJ wri te s th atb eg i nningi n S ept embe r2 00 6 “the c l ai m an t has had the r esi du alfuncti onalcapaci ty to perf or m se dentaryto l i ght l eve lwork” with cer tain envi ro nm entalr est ri cti ons. In supp or t o fhi s RFC analysi s, the A LJ a l so obs er ves that “Dr. Cavanaugh, the cl ai m ant’ s t re ating sur geo n, i nd i cate d on A ugust 1 1, 20 06, that the c l ai m ant’ s pul m onar y s tatus co nti nued to i m prove , and that he would be abl e t o p er for m w or k m od ified to m ee t h is p u lm on ar y s ta tu s n ee d s.”

A l so keyto thi s no ti on o fm edi cali m prove m ent i s the A LJ’ s a dvers e cr edibi l i ty deter m i nati on. The AL Jf ound that “ the c l ai m ant’ s s tat em ents concerni ng the i ntensi ty, persi ste nce a nd l i m i ti ng effects o fthes e s ym ptom s a re notenti re l y c re dibl e be gi nning on Se ptem ber1, 20 06. ” Fori nstance , M ull i gan t est i fi ed abo ut co nstant pai n i n hi s l ower ex trem iti es an d pres su re i n h is lun gs th at p reven ted him from sitti ng or stan d ing for m ore tha n a n ho ura tat i me o rwa l k i ngmo r e tha n thr e e b l o c k s a ta t i me. B utthe me di c a lr e c o r d, the AL Jr eas oned, “docum ents onl y a m oder ate o bstructi ve pu l m onar y defect, with

### No. 09-1135 Pag e 7

si g ni fi ca ntr es po ns e to b r o nc ho di l at o rt r ea tment . ” Co m po undi ngthe ALJ ’ s do ubt s was the f act that, despi te m edi calexpecta ti ons ofi m prove m ent a s e ar l y a s 2 005, M ull i gan had r epo r te d no i m pr o ve m en t, i ns te ad demons tr at i ng“ co ns i der ab l e na r co ti c se ek i ng behavi or. . . with the cl ai m ant s peci fi cal l y r equesting Per coce t fro m m ult i ple pro vi ders f or m u ltip le s ite s o f p ain .” M ull i gan a gain so ught r evi ew befor e the A pp eal s Counci l, but thi s t i m e hi s a pp eal wa s de ni e d. As we h a v e n o t e d, the di s t r i c tc o ur tl i k e wi s e u ph e l d the de c i s i o n o fthe ALJ o n Mu l l i g a n ’ s p e t i t i o n f o rj u d i c i a lr e v i e w. I f, as i s the ca se here , the A pp eal s Counci ldecl i nes t o re vi ew the A LJ’ s deci si on, that d ec isio n be c om es th e fin al d ec isio n of th e C om m iss ion er of Soc ial Se c u rit y. Get ch v. As t r ue, 539 F.3d 473, 480 (7th Cir. 2008). W ithou t d eferenc e to the d istri ct cou rt, w e prob e the A L J’ s d ec isio n to d et er m in e w h et h er it is su p p or te d by su b st an tia l ev id en c e. See 42 U .S.C . § 40 5(g ); R ich a rdso n v . P erales , 4 02 U. S
. 3 89 , 4 01 ( 19 71 ) ( S ubs ta nt i ale vi den ce i s “s uchr el ev an t evid en ce as a reason able m ind m ight acc ep t as ad eq ua te to sup p ort a conc lusion.”);M os s v. Ast r ue, 555 F.3d 556 , 560 (7th C ir. 2009). M ulli gan first prop oses th at th e A L J reli ed i m p rop erly on th e testim ony of D r. H i duch en k o - - a no n- ex ami ni ng, s ta te
- ag en cyphy si ci an - - an d e r r ed byno t g i vingc o nt r o l l i ng w ei ght t o the m edi calo pini ons ofDr. Lund quis t-
- hi s t re ating physi ci an. In doi ng so , M u lliga n w rit es , th e A L J yield ed to th e t em p ta tio n to p lay d oc to r. M u lliga n kn ow s w ell an d r epe at s th r o ugho uthi s br i ef , a t r ea tingphy si ci an ’ s o pi ni o n i s en ti tl ed to c o nt r o l l i ng w ei ght s o l ong as i t i s s up port ed by obj ecti ve m edi calev i dence and i s co nsi ste nt with othe r su b st an tia l ev id en c e in th e re c or d
. See 20 C .F.R . § 40 4.1 52 7(d )(2) ; Baue rv. As t r ue, 53 2 F
. 3d 606, 60 8 ( 7th Ci r. 20 08)
. An A LJ who dis counts the o pini on o fthe tr eat i ng physi ci an m ust ar tic u lat e g oo d rea so n for d oin g s o. 20 C .F.R§ 40 4.1 52 7(d )(2) ; s e eSchm i dtv. As t r ue, 49 6 F
. 3d 833, 842 (7th C ir. 2007). M ul l i g an ’ s ar g um en t ha s tr ac ti o n. T he ALJ i ns i st s th r o ugho uthi s dec i si o n tha t he ha s g i ve n all ofthe m edi calr epor ts “gr eatweight, ” but that sta tem ent i s m i sl eadi ng. S o, too, is the A L J’ s assertion that the m ed ical record un eq uivoc all y sup p orts D r. H i duch en k o ’ s o pi ni o n- - th atM ul l i g anwas unabl e to wor ko nl y a fte rs ur g ery, dur i ng ch em oth erap y, an d du ring a “p rolonged recovery p eriod” en d ing in A ug us t 2006. Dr. H i duch en k o ’ s o pi ni o n c anno t be s qua r ed, f o re xa m pl e, wi thDr
. Lundqui st ’ s co nt i nui ng obs er vati ons, fi rs t co m m unica ted i n a J anuary20 06 l ett er, thatM ull i gan has “e xcessi ve d a y t i me f a t i g u e ” a s a r e s u l to fh i s c h r o n i c p a i n me d i c a t i o n a n d “ fr e q u e n t l y h a s t o l i e d o wn d uring the d ay.” D r. Lu nd qu ist rei terated thes e con cern s in his Sept em ber 2006 l etter, expla i ni ng tha t “ M ull i gan c ontinues to have si gni fi cant f ati gue. He i s unabl e t o w or k for

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any l ong peri ods o fti m e duri ng the day without having to l i e down
. ” The A LJ c hose notto countenance tho se re str i cti ons because , as to the fi rs t l ett er, “Dr. Lund quis t di d not ind i cate th at th e clai m an t w as req uired to l ie dow n on a m ed ical bas is” and , as to the sec ond l etter, “Dr. Lund quis t di d not ind i cate any m edi calneed t o l i e down f ora speci fi c per i od eac h d ay.” T he A L J su rm ised furt he r that D r. Lu nd qu ist w as m erely parroting M ulli gan ’s sel fr e p o r t i n g . H e wr o t e : “ Al th o u g h D r . L u n d q u i s th a s r e p o r t e d th a tth e c l a i ma n tl i e s d o wn fre quentl y thro ughout the day, thes e r epor ts m er el y r ei ter ate the cl ai m ant' s s ubj ecti ve co m pl aint s, a nd a r e no t co ns i st en t wi ths pec i fi c m edi ca ll i m i ta ti o ns r es ul tingfr o m a ny se ve re im p air m en t o r tr ea tm en t fo r an y s ev er e im p air m en t.” Th e m ed ica l ne ed is c ry st allin e, th ou gh : M u lliga n ’s p ain -m an ag em en t m ed ica tio n lea ve s h im ex h au st ed , as h is tr eat i ng physi ci an not ed as ear l y a s J anuary20 06. The AL J ’ s f aul ty expla nati on for disc ounti ng a port i on o fDr. Lund quis t’ s o pini on f al l s s hor t o fa “go od r eas on, ” a nd that alo n e w ar ra n ts a re m an d
. See 20 C .F.R . § 40 4.1 52 7(d )(2) ; M os s v. As t r ue, 55 5 F
. 3d 556, 56 1 (7th C ir. 2009). Bu t M ull i gan’ s s tr onge st ar gum ent c oncerns the A LJ’ s f ai l ure to expla i n the m edi cal i mpr o v e men t, i n Aug us t2 0 0 6 , tha tp ur po r t e dl y e l i mi na t e d Mul l i g a n’ s di s ab i l i ty . T he ALJ obvi ousl y intended to i ncl ud e m or e under headi ng 12 ; the Com m i ssi onerco ncedes that p oint. N everth eless, th e C om m issi one r asks us to affirm becau se, on th e w hole, th e A L J’ s d e c i s i o n a d e q u a t e l y a d d r e s s e s th e me d i c a li mp r o v e me n t
- - o rs o g o e s th e a r g u me n t . We d isagree. M ed ical im p rovem en t, as d efi ne d i n 20 C.F. R
. §§ 404.1594(b)(1), 416.994(b)(1) (i ), i s “a ny de cr ea se i n the medi ca ls ev er i tyo fy o uri m pai r m en t( s) whi chwas pr es en t atthe ti m e o fthe m ostr ecentf avo rabl e m edi caldeci si on that y ou were disabl ed orco nti nued to be di sabl ed. A deter m i nati on that there has been a decr eas e in m edi calse ver i ty m ust be base d on change s ( i m prove m ent) i n the sym ptom s, si gns a nd /o r l abor ato ryfi nd i ngs as so c iat ed w ith you r im p air m en t(s ).” W e re q u ire , m or eo ve r, th atan A L J su b st an tia te h is as se ss m en t o f a c laim an t’s res id u al fu n c tio n al c ap ac ity , s e eSte wartv. As t r ue, 56 1 F
. 3d 679, 684 ( 7th Ci r. 20 09) , a proce ss often r efer re d to as “bui l d[i ng] an a ccurat e a nd l ogi calbr i dge fro m the evi dence to the concl usi on, ” C liffo rd v . Ap fel , 227 F.3d 863 , 872 (7th C ir. 2000). The o nl y r ea ldi sc us si o n o fi m pr o ve m en t ( i n the r el ev an t ti m e fr ame) i s a sing l e l i ne i n the deci si on s tat i ng tha t “ Dr. Cavanaugh, the cl ai m ant’ s t re ating sur geo n, i nd i cate d on Augus t 11 , 2 00 6, tha t th e cl ai m an t’ s pul m o na r y s ta tu s co nt i nue d t o i m pr o ve , a nd tha t he w oul d be abl e t o perf or m work m odi fi ed to m eethi s pul m onar y s tatus needs. ” The A ugust 2006 l etter th e A L J cites is not so rosy, how ever; Dr. C avan au gh also talks abou t the “slow [] re cove r[ y] ” fro m sur gery a nd M ull i gan’ s t endency to bec om e s hor t- w i nd ed w i th exer ci se ( “and hi s o xygen saturat i ons do f al l ”)
. F urther m or e, Dr. Cavanaugh’ s ul ti m ate co ncl usi on i s m or e e quivo calthan the AL Jsugg est s. He w ri tes , “a s o fthi s t i m e, M r. M ull i gan i s no t abl e t o m ai ntai n a fullwork l oad as he ha d pri orto hi s s urge ry, and .
. . i fhe was

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con side red f or som e tim e of em p loym en t, th is w ou ld certa inly have to be th e typ e of w ork that w oul d be m odi fi ed to m eethi s nee ds fro m hi s r esi du alpulm onar y s tatus se condaryto hi s l o be ct o m y . ” W ha t i s m o r e, Dr
. Lundqui st ’ s S ept embe r2 00 6 l et te r - - whi ch, a g ain, the A LJ c hose to di sco unt f orl ack ofm edi calbas i s- - sugge sts co nt i nui ty ofM ull i gan’ s e ar l i er sym ptom s, noti m prove m ent. I t s ays , “The info rm ati on co ntai ned i n the l ett erdated Jan u ar y 2 5, 20 06 is st ill pe rt in en t. M r M u lliga n co n tin u es to h av e s ign ifica n t fa tig u e. H e is u n ab le t o w or k for an y lon g p er iod s o f tim e d u rin g th e d ay w ith ou t h av in g t o lie d ow n .” H er e, th e A L J fell sh or t o f w h atw as req u ire d
. T h e a b se n c e o f an y a c tu al a n aly sis un de rh e a de r1 2 i s a l a r mi ng - - a nd the n o t a t i o n “ * * [ EX PL AI N HOW S EV ER I TY OF I M PAI RMENTS DE CR EAS ED I N TE RMS OF S I GNS , S YMPT OMS , AND/ OR LA BO RA TO RY FI N DING S] * * ” i s no t nea rl y e nough. Nor a re the sel ecti ve re fer ences to passag es fro m m edi calpro fess i onal s who bel i eve o nl y that M ull i gan has i m prove d si nce hi s wor stda y s an d s o m eda y may be abl e to wor k, a lbe i t i n a l i m i te d f as hi o n. Fi nal l y, we note M ull i gan’ s co ntenti on that the A LJ f ai l ed to pro perl y invest i gat e an d an aly ze h is c om p lain ts of d ep re ss ion
. O n th e c on tr ar y, th e A L J d ev ot ed a siz ab le p ar ag ra p h to th e p os sib ility th at a m en ta l im p air m en t c on tr ibu te d to M u lliga n ’s d isa b ility
. B ut the A L J observ ed that the on ly m ed ical evid en ce of dep ression in th e record w as D r. Cavanaugh’s not e that Dr. Lund quis t ( a physi ci an, nota m ental

- heal th pra cti ti oner ) was m oni tor i ng M ull i gan’ s depre ssi on. Dr. Lund quis t nev erm enti oned i t in hi s r epor ts. Other th antha t, M ul l i g anment i o ne d a t th e he ar i ngtha t he was t ak i ngPr o za c, “ butr epo r te d no sym ptom s o fdepres si on that would inter fer e with hi s abi l i ty to w or k. ” M ull i gan c oncedes that ther e was sc ant e vi dence ofhi s depre ssi on in the re cor d but co unters that, o nce o n n ot ice , th e A L J w as so m eh ow ob liga te d to ord er ad d itio n al t es ts , see 20 C.F
. R. § 404. 1517, an d d ev elo p a fu ller re c or d as to h is m en ta l he alt h
. Fo r th atco n c lu sio n, he d ep en d s la rg ely on ca ses thatdi scuss the he i ghtene d du ty an A LJ has to unrepre s e nt e d c laim an ts . See ge ne ral l y Nel m s v. As t r ue, 55 3 F
. 3d 1093 , 10 98 ( 7th Ci r. 20 09)
. Cer tainl y a S oci alS ecuri ty c laim an t is en tit led to a fu ll an d fair re c or d , s e ei d. , bu t a cla im an t re p re se n te d by co u n se l, as M u lliga n w as , i s p re su m ed to h av e m ad e h is b es t c as e b efo re th e A L J, s e eSk i nne rv. Ast r ue, 478 F.3d 836 , 842 (7th C ir. 2007). Because we co ncl ud e, am ong othe r thi ngs, thatthe fi nd i ng o fa m edi cal i m prove m ent was notbas ed on s ubstanti alev i dence, the A LJ’ s deci si on i s VAC AT E D an d the m att eri s RE MANDE D to the a gencyf orfurtherpro ceedi ngs.