evidence supports his opinion. Golembiewski v. Barnhart, 322 F.3d 912, 917 (7th
Cir. 2003). We cannot determine from the record whether the ALJ considered
Denham’s obesity or flexion in his decision and thus, we cannot be sure that
substantial evidence supports the conclusion and must remand. Jd.

While obesity is no longer a separate listing in the C.F.R., the SSA still
requires adjudicators to consider the effects of obesity on an applicant’s disability
claim. Soc. Sec. Rul. 02-1p; see also Clifford, 227 F.3d at 873. In fact, the listings
for both musculoskeletal and respiratory impairments specifically note the potential
impact of obesity on those conditions. 20 C.F.R. § 404 App. 1 at 1.00(Q), 3.00(D.
While the issue of Denham’s obesity was not as prominent in the record as many of
her other impairments, we still find that it was sufficiently raised to alert the ALJ
that it was relevant to the inquiry. See Clifford, 227 F.3d at 873 (stating that an ALJ
should consider impairments raised by the evidence, even if not claimed in the
applicant’s disability report). Dr. Burnet diagnosed Denham’s obesity on August 21,
2000, and suggested that it aggravated her back pain. R. at 139. This diagnosis
became part of the record, as did Denham’s own hearing testimony regarding her
weight and weight gain. R. at 215. By completely excluding any mention of
obesity from his decision, the ALJ has not shown that substantial evidence supports
his conclusion regarding medical equivalency, and we therefore remand for
consideration of Denham’s obesity. Clifford, 227 F.3d at 873.

We also find that the ALJ erred by ignoring the conflicting analyses of

Denham’s flexion, particularly the conflict between Dr. Labanauskas and Dr. Kim.

13



electrical nerve stimulation (“TENS”) unit to reduce her back pain, which increased
Denham’s mobility and tolerance of daily activities.

In late September, another x-ray of Denham’s cervical spine found bilateral
cervical ribs. When Denham consulted with Dr. Jayasanker, a hand surgeon, in late
October, he found no conclusive evidence of carpal tunnel syndrome, but suggested
that her bilateral cervical ribs might be causing pressure on a nerve and producing
her pain.

Denham returned to Dr. Ellens in late September, reporting improved
mobility. Dr. Ellens diagnosed lumbar strain, hypertension, and asthma, prescribing
Flexeril again and instructing Denham to continue using her TENS unit. She
returned to Dr. Burnet in mid December 2000 and again in March 2001. At the
latter examination, Burnet again noted edema in Denham’s extremities and
recommended elastic stockings for the problem. Dr. Burnet also advised Denham to
continue using her TENS unit and Amitriptyline for her back pain.

Denham applied for Disability Insurance and Supplemental Security Income
disability benefits on May 11, 2000, but the SSA denied her claims. She requested a
hearing and appeared before an Administrative Law Judge (“ALJ”) on August 21,
2001. At the hearing, the ALJ heard testimony from Denham as well as a vocational
expert (“VE”). Denham testified that she suffers from chronic neck and back pain
with spasms, arthritis in both knees, asthma, and significant depression, resulting in
frequent crying spells and a significantly decreased ability to concentrate.

As evidence of her pain, Denham testified she is severely limited in her ability

4



analysis of the applicant’s RFC that the applicant can return to that job. E.g. Nolen
y. Sullivan, 939 F.2d 516, 518 (7th Cir. 1991). However, in this case, despite the
VE’s references to Denham’s previous jobs by their exertional classification,
substantial evidence suggests that both the VE and ALJ conducted a deeper inquiry
into the requirements of those positions. First, the VE disqualified some positions
because they required exposure to dust, fumes, odors and temperature extremes,
which requires a more detailed analysis than mere exertional categories alone would
provide. R. at 243.

In addition, while we cannot say whether substantial evidence supported the
ALJ's decision to accept Dr. Kim’s findings, we note that none of Denham’s duties
at either her jewelry sales or funeral director positions exceeded the RFC limitations
assessed by Dr. Kim. R. at 96-97 (Denham’s own description of her job duties).
We believe that the ALJ considered Denham’s job descriptions and found that
nothing therein exceeded the suggested RFC, making specific job duty questions
redundant. We do not expect an ALJ to establish in a hypothetical that an applicant
can lift a maximum of 50 pounds only to require him to ask in the next question
whether the applicant can lift 40 pounds. In short, the ALJ should ask questions
about specific job duties where the record suggests specific limitations that are
contrary to the applicant’s assessed RFC. On remand, if the ALJ finds that
Denham’s obesity, flexion, or impaired concentration call into question Denham’s
ability to perform specific job duties, he should specifically address such limitations

in his hypothetical questions to the VE.

17


the ALJ notes that a series of doctors have prescribed various treatments for
Denham’s back pain, while also noting that her objective tests were “basically
normal,” showing only a “slight curvature of the spine and L5 sacralization.” R. at
14-15, Because of this discrepancy, the ALJ notes that “no objective findings”
support the breadth of treatment prescribed by Denham’s treating physicians. /d. at
14. While Denham contends that the ALJ improperly substituted his own judgment
for a medical opinion in reaching this conclusion, we disagree. Where medical
evidence does not fully support a doctor’s diagnosis, the ALJ need not afford “great
weight” to that diagnosis. Veal v. Bowen, 833 F.2d 693, 699 (7th Cir. 1987); see
also Diaz v. Chater, 55 F.3d 300, 308 (7th Cir. 1995)(stating that an ALJ may place
less emphasis on portion of doctor’s report that is based only on applicant’s own
statements about functional restrictions).

The ALJ did not rely solely upon this assessment, however, and considered
the other factors set out in 20 C.F.R. §§ 404.1529(c), 416.929(c) as well. In his
decision, the ALJ summarizes Denham’s testimony regarding her condition,
including a detailed description of her daily activities and some discussion of her
work history following the accident. R. at 14-15. He also notes Denham’s
medications, TENS treatment, and other relief measures, including her need to prop
herself up while sitting or laying down to alleviate her pain. Jd. Finally, the ALJ
considered the functional limitations stated in a report from Dr. Young-Ja Kim, a
physician who reviewed the medical evidence in the record. R. at 15, 106-13.

Ultimately, the ALJ concluded that this evidence supported a claim of “chronic neck

9



LEGAL STANDARD
A reviewing court will uphold an ALJ's decision if it is supported by

"substantial evidence" in the record and the ALJ applied the correct legal standards.
Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000). Deference should be given to
an ALJ's determinations relating to credibility and should be reversed only if the
determinations are "patently wrong." Powers v. Apfel, 207 F.3d 431, 435 (7th Cir.
2000) (quoting Herr v. Sullivan, 912 F.2d 178, 181 (7th Cir. 1990)). However, an
ALJ must provide some explanation that would allow the parties to understand his
reasoning for his decision. See Clifford, 227 F.3d at 872 (stating that an ALJ "must

build an accurate and logical bridge from the evidence to his conclusion.").

DISCUSSION

The SSA employs a five-step process to evaluate applicants for federal
disability benefits. First, if an applicant is engaged in substantial gainful
employment, that applicant does not qualify for disability insurance. 20 C.F.R. §§
404.1520(a)(4), 416.920(a)(4). Second, if the applicant does not have a sufficiently
severe physical or mental impairment, the SSA will deny disability insurance. Jd.
Third, if the applicant’s impairment or combination of impairments satisfies or is
medically equivalent to one of a series of enumerated disability “listings,” the SSA
will find that the applicant is disabled. /d. Fourth, the SSA calculates the
applicant’s “residual functional capacity” (“RFC”) with the impairment, and if the

SSA finds that the applicant can still perform the same relevant work after the

6



to do ordinary housework and daily tasks, describing a daily routine of driving her
children to school, preparing food in the microwave, watching television, and talking
with her aunt. She testified that she could not clean vegetables or wash more than a
single dish. When sitting or laying down, Denham claims that she must prop herself
up because of her persistent pain. In addition, Denham testified that she can barely
sweep her floor and that she cannot mop at all. Finally, she estimated that she could
stand for ten minutes, sit for thirty minutes, walk one and one-half blocks, and lift
only a gallon jug without using both hands.

To support her claim of decreased concentration, Denham testified that she
has only been able to read three chapters of a 90-page book over the past three
months. In addition, she testified that she often forgets things on the stove and that
she sleeps poorly at night, resulting in feelings of tiredness and occasional napping.
Denham claims that she has crying spells every other day and that her depression
interferes with her ability to care for her children.

The ALJ denied Denham’s claim again on August 30, 2001 and the Appeals
Council thereafter denied her request for review. Denham now asks this court to

review her claim.



CONCLUSION
Based on the foregoing analysis, we deny the motions for summary judgment

and remand this case to the ALJ for proceedings in accordance with this opinion.

Qe hg —
Sak aN

United States District Court Judge

Dated: July 23, 2004

18


produce those symptoms. 20 C.F.R. §§ 404.1529(a), 416.929(a). If medical
evidence supports the applicant’s complaints, the ALJ must consider the applicant’s
subjective symptomatic claims as well. Clifford, 227 F.3d at 871. In considering
these claims, the ALJ should also consider other relevant factors, including the
applicant’s daily activities, precipitating and aggravating factors, medications and
other treatment, and functional limitations and restrictions. 20 C.F.R. §§
404.1529(c), 416.929(c). However, a discrepancy between the applicant’s claims
and the degree of impairment suggested by the medical evidence is “probative that
the witness may be exaggerating her condition.” Powers, 207 F.3d at 435-36,

At the hearing before the ALJ Denham complained about severe pain. Where
the medical evidence presented by an applicant is either internally inconsistent or
inconsistent with other evidence in the record, the ALJ may discount that medical
evidence. Knight, 55 F.3d at 314. As the ALJ notes in his decision, the objective
medical evidence in this case is conflicting at best in establishing any underlying
medical impairments that could cause Denham’s pain. In particular, the ALJ notes
that Denham’s doctors never actually found any conclusive medical evidence of
bilateral osteoarthritis in her knees or carpal tunnel syndrome in her wrists, although
she makes some claims regarding both conditions. We therefore find no error in the
ALJ’s disposition of those claims.

The ALJ treats Denham’s claims of chronic neck and back pain with greater
deference, in light of more substantial medical history for that condition, although he

still discounts the degree of pain that Denham claims from this impairment. First,

8



‘Minute v* der Form (06/97)

oa

United States District Court, Northern District of Illinois

Name of Assigned Judge 7 i Sitting Judge if Other
or Magistrate Judge Samuel Der-Yeghiayan than Assigned Judge
CASE NUMBER 03 C 3436 DATE 7/23/2004
CASE Tonia Denham vs. Barnhart
TITLE
[In the following box (a) indicate the party filing the motion, ¢.g., plaintiff, defendant, 3rd party plaintiff, and (b) state briefly the nature
MOTION: of the motion being presented.]
DOCKET ENTRY:
qd) i) Filed motion of [ use listing in “Motion” box above.]
(2) QO Brief in support of motion due
(3) a Answer brief to motion due, . Reply to answer brief due.
(4) Oo Ruling/Hearing on set for at
(5) oO Status hearing[held/continued to] [set for/re-set for] on set for at
(6) a Pretrial conference[held/continued to] [set for/re-set for] on set for at
Mm oO Trial[set for/re-set for] on at
(8) Oo [Bench/Jury trial] [Hearing] held/continued to at_
(9) a This case is dismissed [with/without] prejudice and without costs[by/agreement/pursuant to}
OOFRCP4(m) OlLocal Rule 41.1 COFRCP41(a)(1) (1 FRCP41(a)(2).
go) {Other docket entry] _ For the reasons stated in the attached memorandum opinion, the plaintiff's
and defendant’s cross-motions for summary judgment are denied and this matter is hereby remanded back
to the Commissioner for Social Security for further proceedings consistent with the Court’s opinion. All
pending dates and motions are hereby stricken as moot. Terminating case. Enter Memorandum Opinion.
(dl) (For further detail see order attached to the original minute order.]
No notices required, advised in open court.
No notices required, umber of notices
Notices mailed by judge's staff. "WL 96 2004
Notified counsel by telephone. date docketed
wv | Docketing to mail notices.
Mail AO 480 form. ay di =
Copy to judge/magistrate judge. 2

MW

not
courtroom Ate mated nosis

deputy’s
initials

Se IN 4002.

“Date/ime received iny

railing deputy initials

‘centcal Clerk's Oflick



contributed to her decreased concentration, we note that the ALJ need not address
every piece of evidence in his decision. See, e.g. Sims v. Barnhart, 309 F.3d 424,
429 (7th Cir. 2002). We find that Denham’s daily driving while taking
Amitriptyline is significant enough evidence to support the ALJ’s conclusion that
Denham’s concentration was only “mildly impaired.” R. at 15.

In addition, the ALJ twice reiterates Denham’s statements that she has no
problems getting along with others, suggesting that her social functioning is not
significantly impaired by her depression. In light of these facts, the ALJ found that
Denham suffered only from “mild depression” and a “mildly impaired” ability to
concentrate related to her chronic pain, and we do not find that this determination

was patently wrong. Id.

IL Listings and Medical Equivalence

Denham also contends that the ALJ failed at step three of the evaluation
process which requires the ALJ to determine if the applicant’s impairment or
combination of impairments satisfies or is medically equivalent to one of a series of
enumerated disability listings. Denham argues that the ALJ failed to adequately
consider her claim that her combined impairments were medically equivalent to a
listing under 20 C.F.R. § 404 App. 1. The applicant has the burden of proving
medical equivalency at step three. Maggard v. Apfel, 167 F.3d 376, 380 (7th Cir.
1999). Equivalency must be based on “medical findings,” which consist of

“symptoms” (applicant’s description of the impairment), “signs” (clinically

11



and back pain,” although not of the degree claimed by Denham, and we find no
reversible error in the ALJ’s conclusion.

Finally, the ALJ discounted several of Denham’s claims regarding her mental
State, such as her claims of frequent crying spells and a significantly impaired ability
to concentrate. The ALJ relied upon several pieces of evidence in this conclusion.
First, he notes that Denham has previously refused treatment for her depression,
claiming that she did not feel such treatment was necessary because she was “not
suicidal.” R, at 15. Where the level or frequency of treatment for a condition is
inconsistent with the applicant’s claims of symptoms, the ALJ may find those
statements discreditable, so long as the ALJ considers the applicant’s alternative
explanations for failure to seek treatment. Soc. Sec. Rul. 96-7p. Here, Denham’s
only explanation is that she did not feel her depression was severe enough to warrant
treatment. In light of her refusal of treatment, the ALJ did not err by giving less
weight to Denham’s statements.

The ALJ also felt that Denham’s daily activities suggested that her
concentration was less impaired than she claimed. These activities include driving
her children to school, driving herself to doctor’s appointments, watching television,
and attending church for two hours on Sundays. R. at 14. While we note that the
Seventh Circuit is “skeptical” that watching television indicates a significant ability
to concentrate, we agree with the ALJ that daily driving does necessitate a degree of
concentration. See Powers, 207 F.3d at 435. While Denham argues that the ALJ

erred by failing to consider expressly whether her prescribed Amitriptyline regimen

10



impairment as before, the SSA will deny benefits. Jd. Finally, using the same RFC
along with the applicant’s age, education and work experience, the SSA determines
whether the applicant can adjust to other work, in which case the SSA will deny
disability insurance. Id.

This process is structured so that if an applicant satisfies steps one through
three, the inquiry ends and the SSA finds the applicant disabled. Knight v. Chater,
55 F.3d 309, 313 (7th Cir. 1995). However, if the applicant satisfies the first two
steps but does not satisfy the third, the inquiry proceeds to the fourth and, possibly,
fifth steps. Jd. Denham claims that the ALJ in her case erred at three points in his
analysis. First, she suggests that he failed to evaluate the credibility of her testimony
accurately in light of the medical evidence presented. Second, she argues that the
ALJ did not adequately consider whether her combined impairments were medically
equivalent to a disability listing at step three. Finally, Denham also contends that the
ALJ failed to consider all of the necessary medical and vocational evidence in

calculating and applying her RFC at step four.

I. Credibility

The ALJ in Denham’s case did not find her testimony credible regarding both
the intensity of her physical pain and the severity of her mental impairment.
Applicants for disability insurance cannot rely solely upon their own claims of pain
or other symptoms to establish their disability, but must also produce medical

evidence of an underlying impairment which could “reasonably be expected” to

7



normal findings, although it also revealed that Denham’s L5 vertebrae had
anomalously fused with her sacrum, the five fused vertebrae at the base of her spine.
In early April, Denham saw Dr. Labanauskas, an orthopedic surgeon, who diagnosed
exaggerated lumbar lordosis, or abnormal inward curvature of the lower spine, as
well as limited flexion and extension due to pain. He recommended a new
lumbosacral corset, epidural steroid injections, Vioxx, and Flexeril.

Denham again saw Dr. Ellens in May 2000, who again diagnosed back pain
and asthma, prescribing a back brace, asthma medication, and continued treatment
with Vioxx and Flexeril. Upon return visits in July, Dr. Ellens also diagnosed edema
and knee strain and instructed Denham to stop taking Flexeril. In early August,
Denham again visited Dr. Labanauskas, who prescribed a cane for her swollen
knees, writing “arthritis” on the prescription slip.

Also in early August, Denham underwent an MRI of her lumbar spine, which
produced normal results. Later that month, Denham saw Dr. Burnet, who diagnosed
back pain, mild depression, obesity, controlled asthma, stable irritable bowel
syndrome, and insomnia. However, Dr. Burnet’s exam found no tenderness in
Denham’s spine or joint swelling, unlike Denham’s prior exams with Dr. Ellens. Dr.
Burnet suggested that weight reduction and other non-pharmaceutical methods might
aid with Denham’s pain. Dr. Burnet also offered to refer Denham for treatment of
her depression, but Denham declined.

From August to September 2000, Denham received another round of physical

therapy for her back pain. During this period, she received a transcutaneous

3


While the ALJ may discount contradictory evidence, he also has an “obligation” to
resolve conflicting assessments of impairments that have a significant impact on the
applicant’s claimed disability. Golembiewski, 322 F.3d at 917. In Golembiewski, as
here, the ALJ did not address conflicting doctors? reports regarding the applicant’s
ability to bend. Jd. The Seventh Circuit found this omission significant because it
bore directly upon the applicant’s ability to perform the type of work suggested in
the ALJ’s opinion. Id.

In this case, the ALJ apparently accepted Dr. Kim’s analysis as a non-treating,
non-examining physician over that of Dr. Labanauskas, who actually examined and
treated Denham. Dr. Kim found that Denham could lift 50 pounds occasionally and
25 pounds frequently, that she had unlimited push/pull ability, and that she could
stoop, kneel, crouch and crawl frequently. AR. 107-08. In contrast, Dr.
Labanauskas found that Denham had limited flexion and extension and
recommended a rigorous course of treatment for her back problems. R. at 141. The
ALJ cannot simply ignore Dr. Labanauskas’ opinion where it could have such a
substantial impact on the outcome. Golembiewski, 322 F.3d at 917, While
substantial evidence may support the ALJ’s decision to give Dr. Kim’s report
controlling weight, we cannot determine the ALI concluded so from the record
before us. Accordingly, we direct the ALJ to address this discrepancy on remand as

well.

IIL. Residual Functional Capacity

Denham also claims that the ALJ made several errors at step four of the

14


Il. Use of Hypothetical Questions

During Denham’s hearing the ALJ posed hypothetical questions to the VE.
We agree with Denham’s contention that the ALJ’s hypothetical questions to the VE
did not include all of her relevant limitations. An ALJ may use hypothetical
questions posed to a VE to ascertain an applicant’s ability to perform past relevant
work at step four of the evaluation process, but that question must incorporate all of
the applicant’s relevant limitations. Kasarsky v. Barnhart, 335 F.3d 539, 543 (7th
Cir. 2002). However, a hypothetical question need not include claims for which
there is no medical evidence, and if the VE indicates that he has reviewed the
pertinent documentary evidence in the case, omitting that evidence from the question
itself does not create reversible error. Cass v. Shalala, 8 F.3d 552, 556 (7th Cir.
1993).

Since we cannot tell from the record whether the ALJ gave appropriate
consideration to Denham’s obesity, we also cannot tell whether the RFC assessment
posed in the hypothetical to the VE is supported by substantial evidence. In
addition, the ALJ gives no attention to the effect of Denham’s “mildly impaired”
concentration on her RFC. We note that while Dr. Kim found no such mental
impairment in her report, the ALJ did, and should therefore consider its impact on
Denham’s RFC,

Denham argues that the ALJ’s hypothetical about her RFC was too general
regarding her specific job duties. We disagree. An ALJ cannot describe a job

generally by its exertional category and then conclude by merely conducting an

16


frozen food packer in 1994 and 1995, and a jewelry salesperson and office manager
from 1995 to 1998. Since her accident, Denham has held several part-time jobs,
such as a position as a phone interviewer from January to August of 2000. However,
Denham has not worked at all since August of 2000.

In the months and years following her accident, Denham has undergone
numerous medical examinations and received treatment from numerous physicians.
Immediately following her accident, Denham received roughly one month of
physical therapy for her back injury. In March and April of 1999, Denham
experienced swelling and strain in her right wrist and had a mass surgically removed
from her left thumb. In late April and early May of 1999, doctors twice diagnosed
Denham with situational depression. Then in October of 1999, her doctors
diagnosed her with asthma and fibromyalgia, a chronic condition that causes
tenderness and pain in muscle and soft tissue.

In January of 2000, Denham saw Dr. Ellens, her family physician, for a knot
in her right hand. Dr. Ellens diagnosed right hand arthralgia and back pain and
ordered more physical therapy for Denham’s right arm, hand, and back. However,
Denham made little progress in therapy and her therapist recommended referral to a
pain clinic in March of 2000. That same month, Dr. Ellens diagnosed carpal tunnel
syndrome in Denham’s right wrist and back pain and instructed Denham to wear a
brace on her right wrist. However, another test conducted the previous month had
found no such evidence of carpal tunnel syndrome.

In late March 2000, an x-ray of Denham’s lower back produced substantially

2



IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION
TONIA DENHAM, )
)
Plaintiff, )
)
Vv. ) No. 03 C 3436

)
JO ANNE BARNHART, Commissioner )
for Social Security, )
)

Defendant. y DOCKETED

JUL 2 6 2004

MEMORANDUM OPINION

SAMUEL DER-YEGHIAYAN, District Judge

This matter is before the court on Plaintiff Tonia Denham’s (“Denham”)
motion for summary judgment and on Defendant Jo Anne B. Barnhart’s (“SSA”)
motion for summary judgment. For the reasons stated below, we deny both motions
and remand this case to the Social Security Administration (“SSA”) for further

proceedings consistent with this opinion.

BACKGROUND
On September 22, 1998, Tonia Denham injured her back in an automobile
accident. Before her accident, Denham earned an associate’s degree and held

several jobs, including positions as an assistant funeral director from 1991 to 1993, a

19-



diagnosed abnormalities), and “laboratory findings” (abnormalities diagnosed by
laboratory techniques). 20 C.F.R. §§ 404.1526, 416.926, 404.1528, 416.928.

We first note that, at the hearing before the ALJ, Denham limited her assertion
of equivalency to a global statement without pointing to any particular listing or
drawing the ALJ’s attention to the particular impairments raised in her summary
judgment motion. Because the applicant has the burden of proving equivalency, a
more specific claim of equivalency would have been appropriate. In particular, we
note that if the SSA had obtained an opinion against medical equivalency, Denham’s
argument on this point would likely fail. See Steward v. Bowen, 858 F.2d 1295,

1299 (7th Cir. 1988)(stating that where consulting physicians finds against
equivalency, the ALJ may adopt consulting opinion without significant explanation
if applicant presents no contradictory medical evidence specifically supporting
equivalency). However, we find no such equivalency opinion in the record for either
party and must therefore evaluate the specific conditions that Denham raises.

We find that the ALJ erred by failing to analyze two of Denham’s alleged
impairments: 1) her obesity, and 2) her decreased flexion. Although the ALJ
considered the aggregate effect of Denham’s controlled asthma, chronic neck and
back pain, mild depression, and inability to concentrate in assessing medical
equivalency, the record makes no mention of Denham’s obesity or spinal flexion.
Even though the ALJ does not have to discuss every piece of evidence in his
decision, he “may not ignore an entire line of evidence that is contrary to the ruling”

because that prevents the reviewing court from determining whether substantial

12


evaluation process which requires the ALJ to evaluate the SSA’s calculation of the
applicant’s “residual functional capacity” (“RFC”) with the impairment. Denham
first challenges the ALJ’s finding that Denham has the RFC to perform medium
work, as Dr. Kim’s report suggested, noting that the ALJ did not consider
Denham’s obesity or possibly limited flexion. In addition, she claims that the
ALJ’s hypothetical question to the vocational expert (“VE”) at her hearing was

deficient both because it did not accurately capture her impairment and because it

did not specifically address her past employment duties.

We agree with Denham’s contention that the ALJ did not specifically consider
her obesity or possible limited flexion. On remand, the ALJ may establish
substantial evidence for giving controlling weight to Dr. Kim’s report on the flexion
dispute, but such evidence is lacking at present. In addition, it does not appear that
Dr. Kim’s report included Denham’s obesity as a factor because it predates Dr.
Burnet’s diagnosis of obesity by roughly two months and because Dr. Kim never
actually examined Denham. In addition, the record shows that Denham was gaining
weight during the relevant period, suggesting that even if Dr. Kim considered
Denham’s weight, Denham likely weighed more by the time that Dr. Burnet
examined her. Therefore, ifthe ALJ again reaches step four on remand, he should

independently consider Denham’s obesity at that step as well.

15