In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 18-2229 

DANNY J. RAY, 

Plaintiff-Appellant, 

v.

NANCY A. BERRYHILL,

Acting Commissioner of Social Security, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the 

Southern District of Indiana, Indianapolis Division 

No. 1:17-cv-01322 — Matthew P. Brookman, Magistrate Judge. 

____________________ 

ARGUED JANUARY 23, 2019 — DECIDED FEBRUARY 12, 2019 

____________________ 

Before WOOD, Chief Judge, and KANNE, and ST. EVE, Circuit 

Judges. 

PER CURIAM. Danny Ray applied for Supplemental Security Income and Disability Insurance Benefits based on a host 

of physical disorders and mental conditions. An administrative law judge found that Ray was severely impaired by most 

of his physical conditions, but she denied benefits after finding that he could perform his past relevant work as a school 
2 No. 18-2229 

bus monitor. Ray challenges that finding, arguing that the ALJ 

erroneously discredited him, failed to treat his prior job as 

“composite,” and improperly assessed his functional abilities 

compared to the job requirements for a bus monitor in the 

general economy. The district court affirmed the ALJ’s decision. We agree with Ray and vacate the judgment. 

I. BACKGROUND

Ray lives with diabetes, hypertension, obesity, kidney disease, degenerative disc disease, anxiety, and depression. 

When his conditions worsened, he began working gradually 

easier jobs, from janitor to forklift operator to bus monitor for 

children with special needs, until eventually he gave up his 

employment entirely. As a bus monitor, he would lift disabled children into their seats on the bus, strap down wheelchairs, and monitor the children’s behavior. He ultimately 

quit because it was too painful for his hands, feet, and hips. 

Ray receives medical care for his physical impairments but 

has been noncompliant with some treatments, mostly in relation to his diabetes. He struggles to remember to test his 

blood-glucose levels, eat healthfully, and take insulin. Doctors who treat Ray’s back condition also have noted that he 

takes more pain medication than the prescribed amount. 

In November 2013, Ray applied for social security benefits. During the review process, two consulting state-agency 

psychologists and an examining clinical psychologist, 

Dr. Zera, evaluated his functioning. The consulting psychologists both concluded that Ray is moderately limited in his 

ability to maintain attention and concentration for extended 

periods but is not significantly limited in any other aspect of 

concentration, persistence, or pace. Dr. Zera determined that 
No. 18-2229 3

Ray has an anxiety disorder and learning disorder, noting his 

“difficulty reading and poor math skills.” Ray also met with 

Dr. Fish, an agency physician, who determined that Ray’s major functional impairment is exertional tolerance. Dr. Fish 

noted a positive result from a supine straight-leg test, which 

reflects lumbar nerve root compression, though the less-sensitive seated test was negative.1 

The agency denied Ray’s applications initially and upon 

reconsideration, and his case proceeded to a hearing with an 

ALJ. At the hearing, Ray testified—and his mother and girlfriend corroborated with written statements—that his daily 

activities include taking his medication, making himself three 

simple meals, watching television, using the dishwasher, and 

showering (while using a shower seat). Outside of these tasks, 

he sits and watches television. Ray occasionally does laundry 

if reminded, and he had the laundry machines moved from 

the basement to the first floor of his house because the stairs 

were difficult for him. Once per week, he goes grocery shopping with the assistance of an electric cart. When he did not 

have family to drive him, the hospital provided him a bus 

pass because he is physically incapable of walking home. 

In addition to his physical impairments, Ray has limited 

intellect. He testified that he completed eight grades of special 

education, but he struggles to read and write. Although he 

will occasionally purchase a newspaper, it takes time for him 

to make sense of what he sees. Because of his limitations, his 

 1 See Alon Rabin, et al., The Sensitivity of the Seated Straight-Leg Raise 

Test Compared with the Supine Straight-Leg Raise Test in Patients Presenting 

with Magnetic Resonance Imaging Evidence of Lumbar Nerve Root Compression, 

88 PHYSICAL MED. & REHAB. 840, 842 (2007). 
4 No. 18-2229 

mother or girlfriend must write his checks and complete his 

paperwork. 

In her decision, the ALJ analyzed Ray’s application based 

on the five-step process set forth in 20 C.F.R. § 404.1520 and 

found him not disabled. She determined that he is not engaged in substantial gainful employment (step one) and that 

he has severe impairments of diabetes mellitus, obesity, degenerative disc disease, osteoarthritis of the hip, coronary artery disease, kidney disease, hypertension, and a history of 

atrial fibrillation (step two). But his impairments, she concluded, do not meet a listing (step three). 

The ALJ determined that Ray has the residual functional 

capacity (“RFC”) to perform light work (lifting ten to twenty 

pounds) and to stand or walk for six hours. She also found 

that he is able to “understand, remember, and carry out semiskilled tasks” and “attend to tasks for a sufficient period in 

order to complete tasks.” Regarding Ray’s limitations, the 

ALJ found him only “partially credible,” largely based on the 

notion that, if his symptoms were as severe as alleged, his 

daily activities would be more restricted and he would be 

more compliant with his prescribed treatments. 

The ALJ presented Ray’s RFC to the vocational expert, 

who concluded that Ray could work as a school bus monitor—not as he had performed the job, but as it is performed 

in the national economy. At the hearing, Ray questioned the 

vocational expert about the required level of language development for that position. The vocational expert confirmed 

that a requirement of the job, as it is generally performed, is 

the ability to “write compound and complex sentences, using 

cursive style, proper end punctuation, and employing adjectives and adverbs.” 
No. 18-2229 5

At the hearing and in a supplemental brief, Ray argued 

that his previous position as a bus monitor for disabled 

schoolchildren was a composite job—that is, one that combines “significant elements of two or more occupations and, 

as such, ha[s] no counterpart in the [Dictionary of Occupational Titles],” Social Security Ruling 82-61. His job, Ray argued, involved substantial activities from both the school bus 

monitor and child care attendant positions as they are described in the DOT. Ray questioned the vocational expert on 

this subject, but the testimony is transcribed as “inaudible” 

during the key responses, and Ray and the agency represent 

those portions differently. 

In her written decision, however, the ALJ dismissed Ray’s 

argument about composite jobs as “unpersuasive and unsupported” and concluded that Ray could be a bus monitor as 

that job is generally performed. She did not discuss the undisputed language-development requirements for that position. 

Ultimately, based on the vocational expert’s testimony that 

Ray could perform his past relevant work, the ALJ concluded 

that he is not disabled. 

II. ANALYSIS

We uphold an ALJ’s decision only if substantial evidence 

from the record supports her determination. Lanigan v. Berryhill, 865 F.3d 558, 563 (7th Cir. 2017). 

Ray raises four challenges in this appeal: (1) the ALJ erred 

in evaluating his daily activities and medical reports, making 

her credibility determination patently wrong; (2) the ALJ 

erred in concluding that he could perform his past relevant 

work because his bus-monitor job was a composite job, which 

precludes a finding at step four; (3) the ALJ erred in finding 
6 No. 18-2229 

that he could do the bus-monitor job as generally performed 

because he does not meet the necessary General Educational 

Development Level; and (4) the ALJ erred in assessing his 

mental impairments by finding them not severe and by not 

including any limitations on concentration, persistence, and 

pace in his RFC. 

With respect to the adverse credibility determination, this 

is the rare case in which the claimant can overcome the “considerable deference” we afford such findings unless they are 

“patently wrong,” Terry v. Astrue, 580 F.3d 471, 477 (7th Cir. 

2009). Specifically, the ALJ erroneously evaluated Ray’s 

symptoms and daily activities, misinterpreted medical evidence, and failed to ask why he skipped some appointments. 

In assessing Ray’s back and hip pain, the ALJ acknowledged that Ray had a herniating disc, degenerative disc and 

joint disease of the lower lumber spine, a herniated nucleus 

pulpous, and chronic pain syndrome. But to support her determination that these impairments “are not as limiting as he 

alleged,” she cited irrelevant records from treatment he received for a staph infection and she noted that his extremities 

were not fractured, tender, or swollen. The connection between those characteristics and Ray’s alleged pain and restricted mobility is nowhere explained. She also mischaracterized Dr. Fish’s report, writing that the straight-leg raise test 

was negative when the opposite was true. 

The ALJ also improperly emphasized Ray’s lack of followup on a recommended spine evaluation and his difficulty 

with medication compliance. Within five years, Ray missed 

two follow-up appointments, one for his heart and one for his 

spine. When the ALJ asked him about the missed cardiology 

appointment, he explained that he was uninsured at the time 
No. 18-2229 7

and could not afford it. Although the record showed that Ray 

had repeatedly lost his health insurance, the ALJ did not ask 

him about his missed spine appointment and instead assumed that he did not attend because his symptoms were not 

serious. That was reversible error; an ALJ must not draw inferences about a claimant’s lack of treatment without exploring the reasons for the inaction. Beardsley v. Colvin, 758 F.3d 

834, 840 (7th Cir. 2014). Moreover, the ALJ bolstered her presumption with evidence of Ray’s difficulty with medication 

compliance, even though, with respect to his pain (as opposed 

to his diabetes), those medical records point to Ray’s credibility. Ray’s “noncompliance” with his musculoskeletal treatment stemmed from taking pain medication too frequently, 

which does not support the ALJ’s inference that he was exaggerating his pain. 

The ALJ also overemphasized Ray’s daily living activities. 

The only evidence of those activities comes from Ray’s testimony (which apparently the ALJ credited in this aspect) and 

his family’s, and it shows that the sum of Ray’s daily routine 

involves showering while seated, fixing simple meals, and using the dishwasher. In between these activities, he sits and 

watches television. He could not walk even two hours home 

from the hospital, a stark contrast to the ALJ’s finding that he 

can stand or walk six hours every day. Ray’s minimal daily 

activities do not support the ALJ’s finding that he exaggerated 

his symptoms, nor do they support the ultimate RFC. 

See Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir. 2000). Although 

the ALJ credited him with caring for his son, his son is an 

adult, and no evidence reflects the type of “care” that Ray 

supposedly provided. Further, the struggle of living with his 

son at one point sent Ray into a suicidal decompensation. 
8 No. 18-2229 

Ray is also correct that the ALJ made two technical errors 

at step four that led to the unsupportable conclusion that he 

could perform his past relevant work as a bus monitor as that 

position exists in the national economy. First, the ALJ concluded that Ray’s former position was not a “composite” job 

and, therefore, that it could be assessed with reference to the 

Dictionary of Occupational Titles. A claimant is not disabled 

if he can do his past relevant work either in the manner he 

performed it before the impairment or in the manner it is generally performed in the national economy. See Getch v. Astrue, 

539 F.3d 473, 482 (7th Cir. 2008). But if the prior position was 

a composite job, then the ALJ may not reference it when determining whether a claimant can perform his past job as it is 

generally performed. See Programs Operation Manual System 

DI 25005.020; see also Wash. State Dep’t of Soc. & Health Servs. 

v. Keffeler, 537 U.S. 371, 385 (2003) (POMS serve as guidance 

and “warrant respect”); Cannon v. Apfel, 213 F.3d 970, 975 

(7th Cir. 2000) (same). 

Ray argues that his prior job was a composite job that combined elements of the school bus monitor and school childcare attendant positions. He cites the vocational expert’s testimony to support his position, asserting that the expert testified that his bus monitor position was a composite job. The 

agency, for its part, asserts that the expert testified to the opposite. Because key parts of the vocational expert’s testimony 

are marked as “[inaudible],” his opinion is not clear. But a review of the duties of a school child-care attendant bolsters 

Ray’s point: 

Attends to personal needs of handicapped children 

while in school to receive specialized academic and 

physical training: Wheels handicapped children to 

classes, lunchrooms, treatment rooms, and other 
No. 18-2229 9

areas of building. Secures children in equipment, such 

as chairs, slings, or stretchers, and places or hoists 

children into baths or pools. Monitors children using 

life support equipment to detect indications of malfunctioning of equipment and calls for medical assistance when needed. Helps children to walk, board 

buses, put on prosthetic appliances, eat, dress, bathe, 

and perform other physical activities as their needs 

require. 

U.S. Dep’t of Lab., 1 Dictionary of Occupational Titles 258 

(4th ed. 1991) (emphasis added). On the other hand, the duties of a school bus monitor are: 

Monitors conduct of students on school bus to maintain discipline and safety: Directs loading of students on bus to prevent congestion and unsafe conditions. Rides school bus to prevent altercations between students and damage to bus. Participates in 

school bus safety drills. May disembark from school 

bus at railroad crossings and clear bus across tracks. 

Id. at 269. 

Here, the ALJ concluded that Ray’s previous bus-monitor 

job was not a composite job because his work matched the 

DOT description “in all but the exertional requirements.” But 

Ray’s testimony (the only evidence of his job duties) demonstrates that as a bus monitor he performed significant elements of the childcare-attendant job, like assisting the students in boarding buses and securing them in their equipment 

and chairs. The DOT description of the bus-monitor job does 

not include these duties, and the vocational expert’s testimony is ambiguous. Thus, substantial evidence does not support the ALJ’s conclusion that Ray’s previous job was not a 

composite job. 
10 No. 18-2229 

Relatedly, Ray argues that the ALJ erred further by concluding that he could work as a bus monitor as the job is generally performed despite his lacking the necessary General 

Educational Development Level for that job. The bus-monitor 

position requires at least a Language Development Level 2, 

which expects that employees will be able to, among other 

things, “[w]rite compound and complex sentences, using cursive style, proper end punctuation, and employing adjectives 

and adverbs”; “[r]ead adventure stories and comic books, 

looking up unfamiliar words in dictionary for meaning, 

spelling, and pronunciation”; and “[r]ead instructions for assembling model cars and airplanes.” U.S. Dep’t of Lab., 2 Dictionary of Occupational Titles 1011 (4th ed. 1991). No evidence supports the ALJ’s implied finding that Ray has these 

skills. 

To the contrary, Ray testified that he does not fill out his 

own checks or paperwork because he misspells words and 

that he can barely read a newspaper article, a limitation confirmed in Dr. Zera’s evaluation. When a vocational expert’s 

testimony that a claimant can perform a job conflicts with the 

claimant’s ability to meet the job’s listed requirements in the 

DOT, then the ALJ must resolve that conflict before relying on 

the testimony to support her disability findings. See Social Security Ruling 00-4p; Brown v. Colvin, 845 F.3d 247, 255 (7th Cir. 

2016); Overman v. Astrue, 546 F.3d 456, 462 (7th Cir. 2008). The 

ALJ’s failure to do that here, along with the other errors at 

step four, warrants remand. See Myles v. Astrue, 582 F.3d 672, 

678 (7th Cir. 2009) (cumulative effect of multiple errors warranted remand). 

Finally, Ray argues that the ALJ erred in evaluating his 

mental limitations, first by finding them not severe at step two 
No. 18-2229 11

and later by not including any limitations on concentration, 

persistence, and pace in the RFC. To some extent, Ray is mistaken. Step two is merely a threshold inquiry; so long as one 

of a claimant’s limitations is found to be severe, error at that 

step is harmless. Arnett v. Astrue, 676 F.3d 586, 591 (7th Cir. 

2012). Either way, the ALJ must later consider the limitations 

imposed by all impairments, severe and non-severe. 20 C.F.R. 

§ 404.1523; Denton v. Astrue, 596 F.3d 419, 423 (7th Cir. 2010). 

Nevertheless, the ALJ based the RFC on her flawed credibility 

finding, which led her to discredit the opinions of the two 

agency experts who concluded that Ray had a severe mental 

impairment. Therefore, the ALJ will have to revisit her assessment of Ray’s mental impairments in any case.

Accordingly, we VACATE the judgment and REMAND to 

the district court with instructions to remand the case to the 

agency for further proceedings.