take one of he!
her doctor’s ir
ALJ properly

one occasion,

medications. The Commissioner argues that Holland testified she was compliant with
structions while Dr. Reynolds’ notes document she was often noncompliant and thus the
onsidered this in weighing Holland’s credibility. The Commissioner also argues that on

Holland called Dr. Reynolds to complain of numbness and tingling in her arms and hands

after failing toltake her medications. Ifthis one notation is the reason for the ALJ’s conclusion, he failed

to mention it] In his decision, the ALJ did not provide such a link for his reasoning and the

Commissione!

Steele v. Barn

’s post hac rationalizations arc insufficient to cure the deficiencies in his decision. See

art, 290 F.3d 936, 941(7th Cir. 2002) (“principles of administrative law require the ALJ

to rationally articulate the grounds for her decision and confine our review to the reasons supplied by

the ALJ”). A;

must use the

ain, the ALJ has failed to provide a rational bridge for his reasoning. On remand, the ALJ

pportunity to better articulate the grounds for his credibility determination.

The ALJ also determined that Holland was not credible because she estimated that she could

probably lift five or six pounds, whereas Dr. Reynolds checked the box that she could occasionally lift

or carry at lest ten pounds. Another conflict the ALJ listed between Holland and the 2002 RFC was

that Holland testified that she had difficulty bending and stooping duc to pain in her knees, whereas Dr.

Reynolds not

inconsistenci

d that Holland could occasionally perform all types of postural maneuvers, These literal

s appcar from the cold record as differences in degree rather than persuasive justifications

for an inferenicc that Holland lacks credibility. Yet, they arc not patently wrong and as such we must

not disturb th

e AL]’s credibility determination.

TV. Hypothetical Posed to the VE

Holland argues that the ALJ did not include all of her impairments in the hypothetical hc posed

to the VE, th

s disregarding evidence favorable to her and resulting in an incomplete assessment by the

VE of her capabilitics, Holland asserts the ALJ failed to include her complaints of numbness and

19



noise, vibratidns, tempcrature extremes and the like.” Admin. R. at 12. The Commissioner argues that

it was reasondble for the ALJ to reject the portion of Dr, Reynolds’ opinion concerning environmental

limitations because that portion was not supported by the objective medical evidence and during her

testimony, H

[and did not list sensitivity to temperature as a side effect to any of her ailments.

An ALJ is entitled to consider one portion of a physician’s report less significant than others.

See, e.g., Diak v. Chater, 55 F.3d 300, 308 (7th Cir, 1995). However, the fact that the parties debated

the medical a

so obviously

curacy of such an assertion in the motions illustrates that Dr. Reynolds’ assessment is not

ff the mark that it would be clear to any reviewer why he summarily dismissed it. Nor

are the limitations so incredible that they obviate the nccd for the ALJ to adequately discuss the rationale

behind his determination. The ALJ may have determined that Dr. Reynolds’ restrictions deserved less

weight becau:

e no other assessment lists such a restriction, because the conclusion was belied by some

other piece of evidence or because Dr. Reynolds failed to provide an adequate explanation for his

restrictions.

et, there is no way to determine the sufficiency of his rationale because the ALJ failed to

provide any medical evidence or authority for his conclusion. Without more, it is difficult for this court

to conclude

ther than that the ALJ rejected the treating physician’s limitations (whose assessment he

determined was entitled to considerable weight) because they conflicted with the ALJ’s own independent

opinion as to

he aggravating factors for diabetes. Rohan cautions, however, that ALJs shall not make

their own independent medical findings. Rohan vy, Chater, 98 F.3d 966, 970 (7th Cir. 1996); see also

Clifford v. Apfel, 227 F.3d 863, 870 (7th Cir. 2000) (“An ALJ must not substitute his own judgment for

a physician’s
to articulate

treating phys:

pinion without relying on other medical cvidence or authority in the record”). By failing

hy he questioned the most recent evidence of Holland’s limitations submitted by her

cian, we are unable to discern just how the ALJ made his determination regarding the



reported he ofiginally diagnosed Holland with type H diabetes mellitus in January of 2000. He also

diagnosed Holland with obesity and he noted her compliance with treatment was poor, Dr. Reynolds

reported he had found no visual or retinal complications and no evidence of neuropathy or vascular

problems. Hd noted that Holland fatigued often but could perform sedentary tasks.

On February 6, 2001, Holland visited ophthalmologist, Robert Heindenry, M.D. Holland’s eye

examination

was normal and he rcported that there was no evidence of diabetic retinopathy. He also

reported Holland had no work-related limitations due to her vision.

A state agency physician, C.F. Aquillo, M.D., revicwed the medical evidence for Holland on

March 19, 2001, Dr. Aquillo reported that there was no evidence of neuropathy or complications, but

poor compliance with treatment. Dr. Aquillo determined that Holland had no manipulative or visual

limitations a

d retained the capacity for light work activity. Dr. Aquillo further opined that Holland

could occasionally climb stairs, but never climb ladders, ropes, or scaffolds.

On May 24, and June 4, 2001, Dr. Arcot Dwarakanathan, M.D., evaluated Holland’s diabetes.

Holland complained of fatigue, weight gain and blurred vision. She also complained of constant knee

pain and occasional nonexcrtional chest pain, shortness of breath, polyuria and muscle and joint pain.

At the time, Holland was taking Glucophage, Glucotrol, Allegra, Lasix, and Vioxx. Physical

examination

evealed that Holland was 130 pounds over ideal body weight and her pedal pulses were

diminished on both sides, Her eye examination was normal, her lungs were clear, and her cardiac

examination

XL and reco!

vas unremarkable. Dr. Dwarakanathan decreased her Glucophage, prescribed Glucotrol

nmended diet and exercise.

In June, 2001, Holland visited Dr. Reynolds complaining of right arm pain. She stated she

often was unable to hold objects and frequently dropped them. Dr. Reynolds diagnosed tendinitis.



tingling in her exiremitics and her inability to hold objects in the hypothetical posed to the VE. Holland

contends the
list them in t

likely reduce

ALJ did acknowledge that she suffers from these impairments in his opinion, but did not
le hypothetical. Holland argues because problems manipulating objects by hand would

the number of jobs available to Holland, by ignoring these limitations, the VE suggested

jobs that require significant usc of the hands. Ilolland also contends the ALJ erroneously excluded

Holland’s vishal limitations and sensitivity to temperature from the hypothetical, despite Holland’s

documented

jomplaints in the record of blurred vision, Dr. Reynolds’ notations that Holland suffers

from the early stages of diabetic retinopathy, and the environmental limitations recommended by Dr.

Reynolds in His 2002 RFC assessment form, Holland argues the ALJ must incorporate Dr. Reynolds’

findings into

he hypothetical or explain why he discounted them.

Hypothetical questions posed to VEs “ordinarily must include all the limitations that are

supported by

he medical evidence in the record.” Steele v. Barnhart, 290 F.3d 936, 942 (7th Cir. 2002).

The deficiency here, however, is that the 2002 RFC assessment made by Dr. Reynolds was completed

and submitted after the hearing; thus many of his limitations were not available for the ALJ at the time

of the hearin;

g and not included in the hypothetical posed to the VE. Given that the ALJ elicited

incomplete testimony from the VE and it is unclear whether these additional limitations would affect

his vocation:

il profile, this case should be remanded so that the VE can provide an opinion that

incorporates all limitations that are supported by the evidence in the record,

Vv. Limi

lations for the Sit/Stand Option

Holland also asserts that the ALJ erred by failing to specify cxact time limitations for her

sit/stand opti

in. As support for her argument, Holland cites an Eastern District of Wisconsin case in

which the AIJ required a sit/stand option but failed altogether to specify its frequency, which “is a

crucial comp:

nent in assessing a claimant’s ability to work.” Castrejon v. Apfel, 131 F.Supp.2d 1053,

20



Holland has nbt demonstrated she was prejudiced by some failure of the ALJ to develop the record. See

Binion v. Shalala, 13 F.3d 243, 245 (7th Cir. 1994) (“Mere conjecture or speculation that additional

evidence might have been obtained in the case is insufficient to warrant a remand”). Because this case

is being remanded for other reasons, however, Holland has the opportunity to supplement the record with

any medical evidence relevant to her limitations.

It. Credibility Determination

Holland next challenges the ALJ’s assessment of her credibility. The Seventh Circuit has made

clear that an

ALJ's credibility findings are entitled to deference and should not be disturbed on review

unless they are patently wrong. Diaz v. Chater, 55 F.3d 300, 308 (7th Cir. 1995). “However, when such

determinations rest on objective factors or fundamental implausibilities rather than subjective

considerations, appellate courts have greater freedom to review the ALJ’s decision.” Herron v. Shalala,

19 F.3d 329,

35 (7th Cir, 1994). Under the SSA regulations, an ALJ’s determination of the credibility

of the claimant is proper if it sets forth specific reasons for the finding supported by evidence and is

“sufficiently

pecific” to make clear to reviewers the weight accorded to the claimant and the reasons

for that weight. Zurawski v. Halter, 245 F.3d 881, 887 (7th Cir. 2001). Here, the ALJ found Holland

somewhat creflible but noted conflicts between her testimony at the hearing and the limitations suggested

in Dr. Reynalds’ 2002 RFC. In his decision, the ALJ provided specific reasons for his credibility

determinatio1
cannot say tl

Indeed, this

and, given the deference we must afford an ALJ’s credibility determinations, this court
at the ALJ’s determination is lacking such support so as to make it “patently wrong.”

burt recognizes that the ALJ is in the best position to obscrve witnesses and that credibility

determinatioks often involve “inarticulable clements.” Herron, 19 F.3d at 335, Although the reasons

provided by the ALI to justify his credibility determination are not patently wrong, the court does find

the inconsistencies the ALJ uses to support his determination unpersuasive.

17



Under

STANDARD OF REVIEW

1| the Social Security Act, a reviewing court must sustain the Commissioncr’s findings if

they are supparted by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is “such ‘relevant

evidenceasa

268 F.3d 513

reasonable mind might accept as adequate to support a conclusion.’” Keppel v, Massanari,

516 (7th Cir. 2001) (quoting Richardson v, Perales, 402 U.S. 389, 401, 91 S.Ct. 1420,

1427, 28 L.Bd.2d 842 (1971)). The court may not substitute its own judgment for that of the

Commissioner, reweigh evidence, resolve conflicts, or make credibility determinations. See Clifford v.

Apfel, 227 F.

4d 863, 869 (7th Cir. 2000).

DISCUSSION

Hollahd asks this court to reverse the ALJ’s denial of benefits because the ALJ: (1) ignored

relevant eviddnce; (2) failed to develop the record; (3) erred in his credibility determination; (4) failed

to include al

of Holland’s limitations in his hypothetical to the VE; (5) failed to comply with the

Commissioner’s rulings regarding VE testimony; and (6) failed to specify time limitations for the

sit/stand opti

mn.

I. Whether the ALJ Ignored Relevant Medical Evidence

A common assertion running through many of Holland’s arguments for reversal is that the ALJ

in this case impermissibly ignored scvcral impairments from which Holland suffers, including the

tingling and rumbness in her hands, fatigue and drowsiness, subjective complaints of pain, and bladder

dysfunction.

that favors hi

The Seventh Circuit has stated that an ALJ “may not select and discuss only that evidence

s ultimate conclusion, but must articulate, at some minimum level, his analysis of the

evidence to atlow the appellate court to trace the path of his reasoning.” Diaz v. Chater, 55 F.3d 300,

307 (7th Cir.

evidence sub

1995). An ALJ need not provide a written evaluation of every piece of testimony and

mitted. Jd. at 308. However, failing to consider an entire linc of evidence “falls below the



operating controls from time to time and had limitations in her far acuity, depth perception, and in her

ficld of vision due to carly stages of diabetic retinopathy. He noted that Holland should avoid

concentrated

Xposure Lo wetness, noise, vibrations, fumes, odors, gases, poor ventilation, and hazards.

He explained|he recommended these cnvironmental limitations because concentrated exposure “can

aggravate patient’s condition.” Admin, R. at 185.

M1, The Vocational Expert’s Testimony

Vocational expert (“VE”), Thomas Grzesik testified at the hearing. The ALJ asked the VE to

consider a hypothetical individual of Holland’s age, education, and work history, who was limited to

sedentary wot

k which did not require her to work around heights or moving machinery, and due to the

possible cffects of medication or pain required low degrees of concentration such as a “simple one, two

step type of

job” and allowed for her to change position at will. Admin. R. at 234, Given those

limitations, the VE determined Holland could not return to any of her previous jobs. He explained her

past employnient was at the low end of semi-skilled work and he testified none of the skills would be

transferable.

listed the pos:

[As a result, the VE concluded that Holland could perform unskilled sedentary jobs and

itions in the region as a “sorter” (3,000 jobs), “mechanical assembler” (3,500 jobs), and a

“hand packager” (3,500 jobs).

Inas

cond hypothetical, the ALJ described an individual that required time to lay down every

few hours. The VE stated that this would preclude the individual from full-time work.

Iv. The

After

ALJ’s Decision

reviewing the medical evidence and the testimony of Holland and the VE, the ALJ

determined that Holland was not disabled within the meaning of the Social Security Act. In reaching

this conclusi

regulations.

n, the ALJ conducted the five-step test as set forth in the Social Security Administration

ee 20 C.F.R. § 404.1520. First, the ALJ determined that Holland had not worked or



Another state agency physician, Young-Ja Kim, M.D., reconsidered Holland’s medical evidence
on August 9, 2001, because Holland alleged a worsening of conditions. Dr. Kim noted, however, that
no additional information or medical records had been received. Dr. Kim reported that there was no
evidence of diabctic retinopathy and determined Holland could perform light work. Dr. Kim
acknowledged this assessment was in contrast to the recommendation of Dr. Reynolds, which indicated
Holland fatigued often and could perform sedentary tasks. Dr. Kim explained Dr. Reynolds had not
provided any objective evidence to support Ho!land’s limitations.

On September 5, 2001, Holland went to the hospital reporting that she fell and hit her head, She
thought she may have lost consciousness. Holland denied blurred vision and indicated she was relatively
healthy. She displayed a full range of motion and her eye examination was normal. The CT ofher head
was negative, |and no neuromuscular or neurologic defects were noted.

Dr, Reynolds’ notes reveal that Holland called his office on September 26, 2001, complaining
of numbness and tingling in her left arm and hand after failing to take her medicine that morning. She
was advised tp take her medication, and Holland reported improvement after doing so.

In early 2002, Holland continued to complain of pain in her legs and feet. Her glucose level was
noted to be 313 on March 21, 2002, and she complained of aching “all over.” Admin. R. at 152. In
April, Holland complained of poor circulation in her legs and in May, 2002, she reported right leg and
foot pain. At{the request of the ALJ, following the administrative hearing, Dr. Reynolds completed a
residual function capacity assessment form (“2002 RFC”) in which he opined that Holland could stand
for at least two hours and sit about six hours in an eight-hour work day, lift ten pounds frequently, but
only perform limited pushing and pulling with her lower extremities. He also indicated that Holland had
moderate to severe diabetic neuropathy, particularly in her feet and legs which caused numbness and loss

of feeling injher lower extremities frequently. Dr. Reynolds noted that Holland was unable to feel



For in|

more than a c

tance, the first conflict the ALJ noted was that Holland testified that she cannot stand for

uple minutes at a time, whercas Dr. Reynolds checked the box on the RFC form that said

she can “stand and/or walk (with normal breaks) for a total of -- at least two hours in an 8-hour

workday.” Admin. R. at 112, Notwithstanding the fact that Dr. Reynolds was confined to the language

of the RFC fo!
it is possible ff
for a total of ty
requiremcnts|
conflict dema
Clifford v, Ap
explanation a
were inconsi:
and walking).

The 4
blurry vision
February, 20!
vision that the
blurred visio:
manifestatior
Admin. R. at
that the blurr¢
there are not

medical opin}

rm, these two assessments simply are not mutually exclusive. In an eight hour workday,
for Holland to stand only a couple minutes at a time, but still be able to stand and/or walk
‘o hours during the workday. Even allowing for normal breaks would accommodate her
However, the ALJ did not provide further explanation for his belicf that this apparent
instrates Holland’s lack of credibility and his failure to do so constitutes error. See, e.g.,
fel, 227 F.3d 863, 870 (7th Cir. 2000) (finding error where the ALJ did not provide any
to why the claimant’s activities which included walking six blocks and performing chores

tent with the treating physician’s opinion that claimant required limitations on standing

LI also determined Holland was not credible because she testified that she experienccs
when her blood sugar is elevated whereas Dr. Heidenry reported normal vision as of
1. Aside from the fact that there are more recent medical records assessing Holland’s
ALJ does not discuss, the ALJ concluded as part of his credibility determination that the
(along with some of the numbness and tingling) the claimant reports “is a temporary
associated with occasional noncompliance with her medication and/or diet regimens.”
12. The ALJ provided no rationale for the analytical leap he made when he determined
d vision of which Holland complains is due to noncompliance with medications. Although
tions in the record that Holland’s compliance is poor, the ALJ points to no evidence or

ion in the record to support his conclusion that blurred vision could result from failure to

18



concluded Hplland was capable of performing a wide range of sedentary work which may involve
occasionally standing and walking, lifting up to ten pounds at a time or carrying small items, and the
ability to chahge positions at will. However, the ALJ determined that she should avoid heights and
moving macHinery because of her obesity and occasional numbness and tingling in her extremities.
Given “her reported memory problems, and the fact she is currently being treated with Zoloft [Prozac]”
the ALJ determined Holland should be restricted io simple one and two-step jobs that require a low
degree of corcentration. Admin. R. at 12. Although the ALJ indicated he considered Dr, Reynolds’
restriction to only occasional climbing, balancing, stooping, kneeling, crouching, and crawling, the ALJ
found “no reason to impose those additional limitations.” Jd, He explained that sedentary work does
not usually involve such activities and only a complete restriction on stooping would erode the sedentary
work occupational base.

The ALJ acknowledged that Holland’s exertional limitations would not allow her to perform the
full range of gedentary work and given the VE’s testimony that Holland’s past relevant jobs required a
light level of exertion or more, the ALJ determined she was unable to perform her past relevant work.
Based on the testimony of the VE, the ALJ further found that none of the skills Holland acquired in her
past positions|would transfer to jobs within her residual functional capacity. The ALJ did find, however,
there were a significant number of jobs in the national economy which Holland could perform. Given
the hypotheti¢al individual’s specific work restrictions, the VE testified that Holland would be able to
adjust to other work in the region, such as a sorter, mechanical assembler or a hand packer. The ALJ

credited this testimony and therefore concluded that Holland was not under a disability as defined by

the Social Scqurity Act, at any time through the date of the decision.



oust Onder Fas (08797)

United States District Court, Northern District of Lllinois

|
]

Name of Assigned Judge Marvin Aspen Sitting Judge if Other
or Magistrate Judge than Assigned Judge
CASE NUMBER 02 C 8398 DATE 9/4/2003
CASE Tracy Holland vs. Jo Anne B. Barnhart
TITLE
[In the following box (a) indicute the party filing the motion, ¢.g.,plaintiff, defendant, 3rd party plaintiff, and (b) staie briefly the nature
MOTION: lof the mution being presented. ]
DOCKET ENTRY:
I aay Oo Filed motion of [ use listing in “Motion” box above.}
() o Brief ip support of motion due _
Q) gO Answet brief to motion due. . Reply to answer brief due___.
(4) o Ruling/Hearing on_____ set for at .
(5) oO Status hearing[held/continued to] [set for/re-set for] on __ Set for at
(6) Oo Pretrial conterence[held/continued to] [set for/re-set for] on set for at
(7) qa Trial[set for/re-sct for] on at
(8) oO {Renel/Jury tial] [Hearing] held/continued to _ at
(9} a This chse is dismissed [with/without] prejudice and without costs[by/agreement/pursuant to]
OORRCP4(m) ClLocal Rule 41.1 CIPRCP41(ay(1) OFRCP41(a)(2)
(10) a (Other dacketentry] Enter Memorandum Opinion and order: The court denics both parties’ motion
for summary judgment (16-1) but grants Holland's motion to remand. Because the ALJ’s opinioncontains
a substantial/number of omissions and errors that are material to the ALJ’s disability determination, we
remand to the agency for further procecdings. The in court hearing date of 9/11/03 is stricken.
(il) @ (Vor further detail see order attached to the original minute order,]
No notices required, aulvised in open court. Document
No notices required. umber of nies Nampsr
oY | Notices mailed by judge's stall.
Noted counsel by tepone SEP 08 2003
Docketing 10 mail ndtices. ‘ S
Mail AO 430 form. docketing deputy initials
Cony to judge/mugishrate judge,
| 1sn00
| sce oned nat
duis tiled natioe
courtrnom
GL deputy’s a
initiuls =
| . Dato/time réctived da!
canted Clerk's Office railing depty initials



However, Holland’s assertions concerning the ALJ’s treatment of other relevant evidence validly

Taises concer

s about the completeness of the ALJ’s decision in this case. First, Holland argues that the

ALJ ignored the limitations posed by the numbness and tingling Holland experiences in her hands and

impermissibl:

opinion that H

ignored an entire line of evidence that is contrary to the ruling by failing to discuss in his

lolland was wearing a brace at the hearing allegedly in order to alleviate pain in her hands.

Had the ALJ addressed her alleged hand limitations, Holland contends the number of jobs available for

her to perform would have been reduced. Holland again cites Golembiewski v. Barnhart, in which the

Seventh Circuit acknowledged that problems manipulating objects by hand reduces the number of jobs

available to alclaimant. 322 F.3d 912, 918 (7th Cir. 2003), Holland also argues the ALJ irrationally

determined that Holland should avoid heights and moving machinery because of the occasional

numbness an

In his}

records and a

fingers. The
reported was
and/or diet re
machinery be}
why heights
for his conch
points to no 1
accurate and
meaningful r¢

Cir. 2001).

tingling she experiences in her extremities and duc to her obesity.

decision, the ALJ did discuss the reports of numbness and tingling found in the medical
Hdressed Holland’s testimony concerning the numbness she experiences in her fect and
ALJ explained that it appearcd to him that some of the numbness and tingling Holland
“temporary manifestation associated with occasional noncompliance with her medication
pimes.” Admin. R. at 12, He then determined that she should avoid heights and moving
bause of her obesity and numbness and tingling in the extremitics. The ALJ did not explain
x machinery should be avoided as a result of these impairments nor provide any support
sion that noncompliance with medications would cause such an impairment. The ALT
edical evidence or opinion in the record to justify his conclusion. By failing to “build an
logical bridge” between the medical evidence and his conclusions, the ALJ has made

view of these determinations difficult. See Zurawski v. Halter, 245 F.3d 881, 887-889 (7th

11



minimal level of articulation required.” Jd, at 307, Moreover, ALJs “must not succumb to the

temptation to

966, 970 (7th

play doctor and make their own independent medical findings.” Rohan v. Chater, 98 F.3d

Cir. 1996).

To begin, Holland contends that the ALJ failed to address her bladder dysfunction. Holland

argucs that because incontinence constitutes an impairment under the SSA that must be considered in

determining
supporting di

912,917 (7th

hether an applicant is disabled, the ALJ impermissibly ignored an entire line of evidence
ability. Holland points to Golembiewski v. Barnhart, to support her position. 322 F.3d

Cir. 2003). While Golembiewski made clear that incontinence constitutes an impairment

under the SSA that must be considered in determining disability, the claimant in Golembicwski

presented evil

bladder,” thu:

submitted no

Hence that his incontinence problem was “quite disabling” and might be a “neurogenic
necessitating a discussion of his impairment by the ALJ. /d, at 917. In this case, Holland

evidence that incontinence interfered with her ability to work. While Dr. Dwarakanathan

did note that Holland reported polyuria to him in 2001, he did not diagnose a bladder problem or initiate

any sort of treatment. None of the other medical assessments submitted in the case mentioned

incontinence
Moreover, Hi
of recent me
application fe
of polyuria to
Holland mad
the ALJ’s fail

medical reco!

land Holland did not testify to any incontinence problems or symptoms at the hearing.
land did not list as a cause for her disability any sort of incontinence problem. The dearth
dical records indicating such a problem and Holland’s silence on the issue in both her
r benefits and at the hearing serve to minimize the relevance of her previous complaints
her current claim for disability benefits. Moreover, the ALJ did address the complaints
e to Dr. Dwarakanathan about polyuria in his review of the medical evidence. Therefore,
ure to thoroughly discuss Holland’s previous complaint, given its absence from recent

‘ds and Holland’s own testimony, is not reversible error.

10



engaged in substantial gainful activity since the alleged onset date of her disability, December 8, 2000.
He found her impaired by reason of diabetes mellitus and obesity and acknowledged her impairments
were “severe. Next, he credited the conclusion of the state agency’s medical consultant that Holland’s
impairments did not mect or medically equal one of the impairments listed in 20 C.F.R. Pt. 404, Subpt.
P, App. 1. Given that detcrmination, the ALJ was required then to determine Holland’s residual
functional capacity.

The ALJ discussed Holland’s testimony concerning her symptoms and reported limitations. The
ALJ found Holland “somewhat credible” in her statements, but found some of her “more extreme
limitations” conflicted with those reported in Dr. Reynolds’ 2002 RFC assessment. He provided as an
example Dr. Reynolds’ opinion that Holland can occasionally perform all types of postural maneuvers
as compared tio Holland’s testimony that she had trouble bending and stooping because of pain in her
knees. Morcover, the ALJ pointed to Holland’s testimony that she could not stand for more than a
couple of minutes at a time whereas Dr. Reynolds opined Holland can walk/stand at least two hours
during an eight hour day. The ALJ also noted that Dr. Heidenry reported normal vision in February,
2001, but Holland complained of occasional blurry vision when her glucose levels were elevated. The

ALJ concluded that “it would appear, then, that blurred vision, along with some of the numbness and

tingling claimant reports, is a temporary manifestation associated with occasional noncompliance with
her medication and/or dict regimens.” Admin. R. at 12.

The ALJ determined that Dr. Reynolds’ evaluation was entitled to considerable weight because
it was not inconsistent with other evidence and was in “general accord” with the clinical signs and
laboratory findings in the record. Nonctheless, the ALJ questioned Dr. Reynolds’ environmental
restrictions because Holland’s impairments “should not be aggravated or affected in any way by fumes,

noise, vibratiqns, temperature extremes and the like.” Admin. R. at 12. Given these findings, the ALJ



57-58 (E.D. Wis. 2001). Here, the ALJ specified that Holland required a job that would allow a change
of position at will, The ALJ staied as much to the VE when posing the hypothetical. This allowed the
VE to accommodate such a limitation in his vocational profile.
VI.‘ Whether Jobs Listed by VE Conflicted with the Dictionary of Occupational Titles

Finally, Holland argues that under SSR 00-4p, the ALJ had the duty to ask the VE about whether
the testimony|he provided conflicts with the information contained in the Dictionary of Occupational
Titles (“DOT?) but failed to do so on the record. She points out (hat the jobs the VE suggested: sorter;
hand packer; and mechanical assembler are not in the DOT. SSR 00-4p states that the ALJ “has an
affirmative rdsponsibility to ask about any possible conflict between that VE or VS evidence and
information provided in the DOT.” SSR 00-4p, 2000 WL 1898704, at *4, The Commissioner responds
that Donahue|v, Barnhart requires such an inquiry only if a claimant questions the VE’s foundation or
reasoning at the hearing or a conflict is identified by the claimant and brought to the ALJ’s attention.
279 F.3d 441] 445-7 (7th Cir, 2002). In Donahue, the court acknowledged that SSR 00-4p was not
directly appli¢able to the case before it because the ruling went into effect after the ALJ conducted the
hearing. In contrast, the hearing in this case took place well after the December 4, 2000 effective date
of SSR 00-4p! We need not interpret SSR 00-4p in the context of this case at this time because the issue
may not arisc|on remand.
CONCLUSION

Because the ALJ’s opinion contains a substantial number of omissions and errors that are
material to the ALJ’s disability determination, we remand tg the agency for further proceedings. It is

so ordered.

MARVIN E. ASPEN _-——~—_

/ United States District Judge
Dated 9 ) Y >

21



During a typical day, Holland performs few household chores and she stated she is unable to

cook or drive.| Holland testified that she often tries to sit up with her children but on some days she lays

in bed all day|because she does not feel like getting up. She explained that her aunt helps her take care

of her childreh. Holland’s husband, brother, and mother also have assisted her. She stated she sleeps

periodically throughout the day and fecls she needs to lie down constantly. Holland testified she is being

treated for de

pression and is currently taking Prozac.

Holland testified she attempts to cxercise but the pain in her legs forces her to stop. She further

testified that

receive Visito:

she tries to attend church twice a month but usually stays home to watch movies and

ts, She stated the furthest distance she walked in the last month was on the moming of the

hearing, which involved walking from the car to the courthouse. She explained pain limits her walking

to a block at 4 time. When asked about her ability to stand for periods of time, Holland explained she

is able to stand without pain for two to four minutes at a time, depending on whether she is able to shift

her weight. She believed she could not sit for longer than 45 minutes to an hour because her knees will

begin to hurt.
At th

it for carpal

hearing, Holland was wearing a splint on her right wrist and stated her doctor prescribed

lmnel syndrome and to ease the pain and numbness she experiences in her hand. When

questioned about her hand mobility, she stated she was able to make a fist with both hands and could

hold a cup of|coffee. She also testified she could probably lift five or six pounds. When asked to raise

her arms, shclexplained she could not raise her arms parallel to the ground because of pain in her right

shoulder.

Tl. Medical Evidence

Holland’s treating physician, Albert Reynolds, M.D., (Dr. Reynolds”) has treated Holland since

1996, In a 2001 questionnaire from the Bureau of Disability Determination Services, Dr. Reynolds



|
extent of Holland’s limitations (aside from substituting his own judgment for that of the treating

physician).

Holland further argues that in his decision, the ALJ ignored the fatigue and drowsiness she
experiences. | Thc Commissioner responds that the ALJ did accommodate Holland’s fatigue by
restricting her RFC to simple onc and two step jobs that require a low degree of concentration. In his
decision, the ALJ did acknowledge Holland’s testimony about the side effects of her medications, which
includes drowsiness, and he addressed that the medical records note Holland’s reports of fatigue.
Moreover, in|the second hypothetical he posed to the VE, he asked about the job prospects of a
hypothetical individual who needed to lay down cvery few hours for a period of one hour. Despite this

inquiry, and contrary to the Commissioner’s contention, however, the justification the ALJ provided in

his written defision for requiring a job with a low degree of concentration was that Holland was being
treated with an anti-depressant and reported problems with her memory, not because she experienced
fatigue. If indecd fatigue factored into his analysis, the ALJ failed to articulate it. As stated above,
although an ALJ need not evaluate in writing every piece of evidence in the record, see Diaz v. Chater,
55 F.3d 300, 308 (7th Cir. 1995), by failing to discuss Holland’s fatigue and how it might affect her job
performance precludes us from evaluating whether there is substantial evidence to support the ALJ’s
finding.

Finally, HoJland argues that the ALJ ignored her subjective complaints of pain in her legs and
hands. The ALJ did acknowledge that Holland’s complaints of pain are noted in the medical records
and discussed the testimony she gave concerning the pain she experiences and the limitations it causes
her. In his op|nion, the ALJ explained that he found Holland’s reports of difficulty stooping and bending
because of pain in her knees less credible because Dr. Reynolds determined she could occasionally

perform all types of postural maneuvers. The Commissioner argues that the ALJ nonetheless

14



As an initial matter, how much evidence to gather “is a subject on which district courts must

respect the [ALJ’s] reasoned judgment.” Kendrick v. Shalala, 998 F.24.455, 458 (7th Cir. 1993). In this

case, the ALJ

probed into the rclevant areas, focusing his questioning on her medication, symptoms,

daily activities|and physical ability to perform various tasks, He employed the services ofa VE. He

permitted Hol

land’s paralegal representative the opportunity to make an opening statement, elicit

testimony fron the claimant, and question the VE. Moreover, the ALJ left the record open to allow

Holland to obtain any additional medical records, including an RFC from her treating physician.

Specific to Holland’s depression, the ALJ questioned her about when she began taking Prozac,

why she was prescribed an anti-depressant, and whether it helped relieve her symptoms. As for the

carpal tunnel
tunnel syndro:
Holland’s clai

use her hands

(pain, numbn¢

her symptoms

of the ALI to

inability to mj

yndrome, the ALJ was initially unaware that Holland had been diagnosed with carpal
e because the diagnosis was not in the medical records or documented as part of
hn for disability, Jt was only when the ALJ asked Holland to demonstrate her ability to
that he noticed she was wearing a splint. He probed into the reason for the prescription
ss and carpal tunnel syndrome), how long she had been wearing it, whether it alleviated
, and probed into its effect on her ability to grasp objects. Holland contends the failure

elicit further information about her carpal tunnel syndrome was prejudicial because her

anipulate by hand reduces the jobs she can perform. Morcover, Holland asserts that the

superficial questioning by the ALJ at the hearing was insufficient for the ALJ to be able to accurately

assess the nat

re of her impairments. While the ALJ could have certainly probed further into the effects

of cach alleged impairment, it is important to note that Holland’s treating physician, Dr. Reynolds, who

apparently pr

hearing. No

scribed both the Prozac and the wrist splint, was asked to complete an RFC following the

here in his June 2002 assessment are depression or carpal tunnel syndrome listed as

impairments jor suggested to in any way affect her functioning in the work place. We conclude that

16



to the Social Security Appeals Council which denied Holland’s request for review, thereby making the

ALJ’s determination the final decision of the Commissioner. Admin. R. at 3. Holland then filed a

complaint requesting judicial review of the Commissioner’s final decision pursuant to 42 U.S.C. §

405(g).

FACTUAL BACKGROUND

At the time of the administrative hearing, Holland was 33 years old, 5'10" and weighed 282

pounds. Admin. R. at 194. She has completed high school and two years of college. Holland last

worked in December, 2000, as an ultrasound assistant and prior to that she held numerous short-term

jobs, including a certified nursing assistant, corrections officer, insurance sales representative, and

teaching assistant. Admin. R. at 95-97.

1 Holla

Holla
sick, her bloo
explained tha’

and later pres

nd’s Testimony

hd testified that she stopped working on December 8, 2000, because she frequently got
il sugar was constantly elevated, and her legs were swelling and becoming painful. She
in 2000, she was diagnosed with diabetes. She was initially prescribed oral medication

Tibed insulin to manage her diabetes. At the time of the hearing, Holland stated she was

taking ten prascription medications daily. She testified that she followed her physician’s instructions

Tegarding the
She explaine:

swelling, hea

imanagement of her diabetes but experienced fatigue as a side effect of the medications.
her current symptoms are pain in the legs and arms, numbness in the fingers and feet,

aches, blurry vision, and fatigue, Holland testified that her physical problems were largely

due to her weight and diabetes. She said the medication helps the pain “a very little.” She also stated

that her blood sugar did not decrease significantly as a result of her doctor’s efforts. The morning of the

hearing, Holl:

nd stated her blood sugar count was 315. She explained she is forgetful at times and she

experiences blurry vision when her blood sugar is high.



UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION
DOCKETED

TRACY D. HOLLAND, )

‘ SEP 05 2003
Plaintiff, )
)

vy. } Case No. 02 C 8398

)
JO ANNE B, BARNHART, )
Commissioner of Social Security )
)
Defendant. )
)

MEMORANDUM OPINION AND ORDER

MARVIN E, ASPEN, District Judge:

Claimant Tracy Holland (“Holland”) seeks judicial review of a final decision of the
Commissionct of Social Security (“the Commissioner”) denying her application for Disability Insurance
Benefits under Title I of the Social Security Act, 42 U.S.C, §§ 416(i) and 423. In cross-motions for
summary judgment, Holland asks the court to reverse the administrative law judge’s (“ALJ”) denial of
benefits and the Commissioner asks the court to affirm that decision. Holland has alternatively moved
to remand for further proceedings. For the reasons set forth below, the court denies both partics’ motion
for summary judgment but grants Holland’s motion to remand.

PROCEDURAL BACKGROUND

Holland applied for Disability Insurance Benefits on February 5, 2001, alleging she became
disabled by diabetes and arthritis on December 8, 2000. Administrative Record (“Admin. R.”) at 62-71.
The Social Sdeurity Administration denied her application initially and upon reconsideration. Holland
then requested review by an ALJ.

On Junc 6, 2002, the ALJ conducted a hearing. Holland was represented by a non-attorney. The

ALJ issued a written decision on July 12, 2002, finding Holland not disabled. Holland filed an appeal

Vo



More:

2002 RFC wl

limitations”

ver, in making his recommendation, the ALJ did not discuss Holland’s treating physician’s
hich addresses Holland’s limitations. Dr. Reynolds indicated under the “manipulative

ection that Holland had limited feeling in her skin receptors and that her diabetic

neuropathy rdsulted in frequent numbness and loss of feeling in her lower extremities and results in her

inability “to fpel operating contro! from time to time.” Admin, R. at 182. The ALJ also did not discuss

the fact that
assertion that

expected to a¢

pt the hearing Holland was wearing a brace to allegedly alleviate pain or address her
she had becn diagnosed with carpal tunnel syndrome. While the ALJ certainly is not

(dress each piece of evidence in his written report, by failing even to discuss these reports

of possible limitations in Holland’s manipulative ability, the ALJ did not meet the minimal articulation

required to al}

low a teviewing court to trace his reasoning. See Herron v. Shalala, 19 F.3d 329, 333-334

(7th Cir, 1994). If the ALJ discounted this evidence (rather than ignored it), he should have explained

his reasons for doing so, because all we are provided with in his decision is the ALJ’s determination that

Dr. Reynolds|
the other subj
‘evaluat[ing].
F.3d 433, 43

Addit
to ignore the
Holland’s vo
he specifical
Specifically,
Reynolds’ ey

restrictions “}

most recent evaluation is given considerable weight because it is “not inconsistent with
stantial evidence of record.” Admin. R. at 12. These omissions “preclude[] us from
.. whether substantial evidence cxisted to support the ALJ’s finding.”” Smith v. Apfel, 231
(7th Cir. 2000) (quoting Herron v. Shalala, 19 F.3d 329, 334 (7th Cir. 1994)).

ionally, Holland argues that the ALJ impermissibly made a medical judgment by choosing
ortion of Dr. Reynolds’ opinion that recommends certain environmental limitations for
ational profile. The ALJ did not ignore Dr. Reynolds’ environmental limitations; indeed,
ly addressed them in the body of his opinion. He did, however, choose to reject them.
in assessing the persuasiveness of Dr. Reynolds’ assessments, the ALJ determined that Dr.
aluation was entitled to “considerable weight” but “questioned” his environmental

ince diabetes and/or obesity should not be aggravated or affected in any way by fumes,

12



accommodated Holland’s complaints of pain and swelling in her legs and difficulty stooping by limiting
hertoa restricted tange of sedentary work that allowed her to change position at will. However, despite
his discussion jand accommodation of the pain and limitations Holland experiences in her knees, the
ALJ’s failure to consider Holland’s reports and testimony of pain in her arms and hands remains
unexplained ahd again precludes a meaningful review of the basis for the ALJ’s decision.

In sum, because the ALJ’s decision in its present form omits discussion of entire lines of relevant
evidence and at times fails to adequately articulate why he discounted other material evidence, we lack
a sufficient babs to review his disability determination. A remand is therefore in order so that the ALJ
can make additional findings, address Holland’s documented impairments fully, and provide the
requisite ani so that a reviewing court may trace his reasoning.

16 Duty to Develop the Record

An ALJ has an affirmative duty to develop a full and fair record. Smith v. Apfel, 231 F.3d 433,
437 (7th Cir. 2000). When a claimant is unassisted by counsel, the ALJ has a duty “‘scrupulously and
conscientiously [to] probe into, inquire of, and explore forall the relevant facts.” Thompson y, Sullivan,
933 F.2d 581) 585 (7th Cir. 1991) (quoting Smith v. Sec’y of Heath, Education, and Welfare, 587 F.2d
857, 860 (7th Cir. 1978)). Failure to fulfill this duty is cause for remand for the purpose of gathering
additional evidence. Id. at 586.

Holland contends the ALJ erred by failing to fully and adequately develop the record.
Specifically, Hotang argues that neither the ALJ nor Holland’s representative (a paralegal) questioned
her in any detail at the hearing about her carpal tunnel syndrome or depression. Holland suggests the

ALJ should have contacted Dr. Reynolds for further information regarding her impairments because

Holland cannot diagnose her own conditions.

15