### In the



# United States Court of Appeals

For the Seventh Circuit

____________________

No. 16

‐ 4003

K IRK W. S TEPHENS

, Plaintiff

‐ Appellant

,

v.

N ANCY A. B ERRYHILL

, Deputy

Commissioner for Operations,

Social Security Administration,

Defendant

‐ Appellee

.

____________________

Appeal from the United States District Court for the

Northern District of Indiana, Fort Wayne Division.

No. 15

‐ CV

‐ 00043

— Joseph S. Van Bokkelen

, Judge

.

____________________

A RGUED A PRIL 21, 2017

— D ECIDED A PRIL 24, 2018

____________________

Before W OOD

, Chief Judge, S YKES

, Circuit Judge

, and

C OLEMAN

, District Judge

. 

C OLEMAN

, District Judge

. Kirk W. Stephens contends that

he is disabled by diabetes, kidney disease, knee and back

 Of the Northern District of Illinois, sitting by designation.2 No. 16

‐ 4003

pain, heart disease, high blood pressure, asthma, arthritis,

and obesity. He applied for and was denied Supplement Se

‐ curity Income (“SSI”) benefits; on review the district court

reversed and remanded for a new hearing. Following the

second hearing, a different Administrative Law Judge

(“ALJ”) determined that Stephens’ impairments, although

severe, were not disabling and that he could perform rele

‐

vant past work. The district court upheld the agency’s deci

‐

sion. We affirm.

I. Background

Stephens was born in 1957 and has a ninth grade educa

‐

tion. He worked as a taxi dispatcher and a security guard in

the 15 years preceding his alleged disability. Stephens has a

family history of diabetes, hypertension, and heart disease.

Several of his family members suffered heart attacks in their

sixties.

Stephens has an extensive history of medical ailments.

He was a pack a day smoker for 20 years, quitting in June

1998. In 1999, Stephens was diagnosed with diabetes melli

‐

tus, type 2. Shortly after moving in with his mother and un

‐

cle, Stephens contracted pneumonia. In 2000, he had surgery

to resolve a problem with “redundant foreskin,” which was

not entirely successful. In 2003, Stephens was diagnosed

with hypertension and was referred for evaluation for chron

‐

ic kidney disease. Stephens was also suffering from insom

‐

nia, reflux, and renal artery disease.

By 2006, Stephens had persistent pain in his neck and

mid

‐ back. His body mass index (“BMI”) fluctuated from

38.14 to 43.7 between 2008 and 2013, the available time

frame.No. 16

‐ 4003 3

In July 2009, Stephens was having problems sleeping,

causing daytime sleepiness. Dr. Hector Perez noted “diabetic

nephrology” in August 2009. While examining Stephens for

pain in his left thumb, right shoulder, hips, and knees in July

2010, Dr. Christopher LaSalle noted the following ailments:

fecal incontinence, insomnia, night sweats, urinary retention,

and sleep apnea. Dr. William Smits diagnosed sleep apnea

and sleep disturbance in August 2010 and sent Stephens to a

sleep specialist, Dr. Sanjay Jain, who performed a CPAP

sleep study. Stephens began with a nasal mask for the CPAP

but switched to a face mask because it was uncomfortable.

By October 2010, activity aggravated Stephens’ knee pain,

which improved with rest. He continued to suffer from in

‐

somnia, shortness of breath, and urinary retention and

weakness. He also had chronic inflammation of the foreskin

tissue that was unresolved by circumcision in 2000. A second

circumcision to remove the irritated foreskin helped, though

he still had trouble urinating. In November 2010, he under

‐

went surgery for prostate issues that caused him to take up

to two minutes to void. Following the prostate surgery, his

condition improved but was not completely resolved.

Stephens had trouble adjusting to the CPAP, and his in

‐

somnia persisted without regular use of the CPAP. He suf

‐

fered from ongoing fecal incontinence, urinary retention and

weakness, and lumbar back pain. Dr. Sanjay Patel noted in

‐

termittent symptoms of Chronic Kidney Disease. By No

‐

vember 2012, Stephens used his nebulizer two to three times

a day. Dr. Guy Asher opined that Stephens’ hypertension

and diabetes were causing Chronic Kidney Disease. Dr. Ash

‐

er also noted anemia and hyperparathyroid issues.4 No. 16

‐ 4003

Stephens applied for SSI benefits, asserting a disability

onset date of January 5, 2007. The ALJ considered the appli

‐

cation and issued an unfavorable decision on October 24,

2011. The district court reversed and remanded for a new

hearing.

Stephens filed a subsequent application for SSI, and the

State Agency issued a favorable decision, finding Stephens

disabled from the date of his application on March 18, 2013.

The agency did not address the period between January 5,

2007, and March 18, 2013. On September 26, 2014, following

the remand from the district court, a different ALJ held a

second hearing. Stephens’ onset date was amended to March

31, 2010, to conform to the protective filing date.

The ALJ found that Stephens had not worked since his

March 31, 2010, onset date, and that he suffered from the fol

‐ lowing severe impairments that caused more than minimal

limitations on Stephens’ ability to work: insulin dependent

diabetes mellitus; osteoarthritis of the spine and knees; obe

‐ sity; chronic obstructive pulmonary disease (“COPD”); and

heart disease. The ALJ concluded that Stephens had the re

‐

sidual functional capacity (“RFC”) to perform past work as a

security guard or taxi dispatcher. Stephens was limited to

sedentary work with normal breaks. His limitations further

required the option to alternate between sitting and standing

approximately every 45 minutes, but the positional change

would not render him off task more than 10 percent of the

work period. He could occasionally climb ramps and stairs,

balance, stoop, crouch, kneel and crawl, but never climb

ladders, ropes, or scaffolds.

The ALJ’s unfavorable decision became final when the

Appeals Council did not review the decision. Stephens filedNo. 16

‐ 4003 5

a complaint for district court review. The district court up

‐

held the agency decision. This appeal followed.

II. Discussion

We review the district judge’s decision de novo and there

‐

fore ask whether the ALJ based her decision on substantial

evidence. Jones v. Astrue

, 623 F.3d 1155, 1160 (7th Cir. 2010).

We will reverse the Commissioner’s finding only if it is not

supported by substantial evidence or if it is the result of an

error of law. Lopez ex rel. Lopez v. Barnhart

, 336 F.3d 535, 539

(7th Cir. 2003). Substantial evidence means “such relevant

evidence as a reasonable mind might accept as adequate to

support a conclusion.” Pepper v. Colvin

, 712 F.3d 351, 361–62

(7th Cir. 2013) (quoting Richardson v. Perales

, 402 U.S. 389, 401

(1971)). In rendering a decision, the ALJ must build a logical

bridge from the evidence to her conclusion. See Steele v.

Barnhart

, 290 F.3d 936, 941 (7th Cir. 2002). Although this

Court reviews the record as a whole, it cannot substitute its

own judgment for that of the SSA by reevaluating the facts,

or reweighing the evidence to decide whether a claimant is

in fact disabled. Jens v. Barnhart

, 347 F.3d 209, 212 (7th Cir.

2003). While our review is deferential, it is not intended to be

a rubber

‐ stamp on the Commissioner’s decision. Clifford v.

Apfel

, 227 F.3d 863, 869 (7th Cir. 2000).

An individual is disabled if he is unable to engage in any

substantial gainful activity by reason of any medically de

‐

terminable physical or mental impairment which can be ex

‐ pected to result in death or which has lasted or can be ex

‐ pected to last for a continuous period of not less than twelve

months. 42 U.S.C. § 423(d)(1)(A). The Social Security Admin

‐

istration employs a five

‐ step process to determine whether

the claimant is disabled. 20 C.F.R. §§ 404.1520(a)(4),6 No. 16

‐ 4003

416.920(a)(4). Here, the ALJ concluded her inquiry at step

four: If the impairment is not one of the listed impairments,

then the ALJ reviews the claimant’s residual functional ca

‐ pacity and the physical/mental demands of past work. If the

claimant can perform past work, then he is not disabled. 20

C.F.R. § 404.1520(e).

Stephens raises three issues on appeal. First, he asserts

that the ALJ erred by improperly evaluating his obesity

when determining the aggregate impact of his impairments.

Next, he challenges the ALJ’s finding that the record lacked

medical opinion evidence as to Stephens’ hypersomnolence

or excessive sleepiness. Lastly, Stephens contends that the

ALJ failed to incorporate all of his impairments and consider

their combined impact to evaluate his residual functional

capacity. We address each issue in turn.

A. Obesity

As this Court has held, while obesity is no longer a

standalone disabling impairment, the ALJ must still consider

its impact when evaluating the severity of other impair

‐

ments. Brown v. Colvin

, 845 F.3d 247, 251 (7th Cir. 2016) (cit

‐ ing Castile v. Astrue

, 617 F.3d 923, 928 (7th Cir. 2010)). We

recognize that the combined effect(s) of obesity with other

impairments may be worse than those same impairments

without the addition of obesity. See Martinez v. Astrue

, 630

F.3d 693, 698 (7th Cir. 2011) (“It is one thing to have a bad

knee; it is another thing to have a bad knee supporting a

body mass index in excess of 40.”).

Stephens argues that the ALJ did not give enough con

‐

sideration to the effect his obesity has on his multiple im

‐ pairments and did not consider obesity as an independentNo. 16

‐ 4003 7

impairment. We disagree. The ALJ gave significant consider

‐

ation to Stephens’ obesity and its impact.

The ALJ found at step two that obesity was a severe im

‐ pairment. At step three, the ALJ began her discussion of Ste

‐ phens’ impairments by noting his weight and BMI in March

2010, the disability onset date. She further considered his

classification as Level II obese, and noted the aggravating

effects of obesity on Stephens’ other impairments. At step

four, she again noted his height and weight, and specifically

addressed the aggravating effects of Stephens’ obesity. She

noted however that the medical records did not separately

report any limitations due to obesity. The ALJ concluded that

she should not speculate on additional functional effects of

obesity unsupported by the record. Nevertheless, she found

that Stephens’ obesity enhanced the credibility of his state

‐

ments of pain. In finding Stephens limited to sedentary work

with a sit/stand option, the ALJ deferred to Stephens’ own

reported limitations. Thus, the ALJ built a logical bridge be

‐

tween the evidence and her conclusion. Stephens fails to

demonstrate that the ALJ gave insufficient consideration to

his obesity and its impact.

B. The Treating Physician Rule

Stephens challenges the ALJ’s finding that the record

lacked medical opinion evidence as to Stephens’ hyper

‐

somnolence or excessive sleepiness. “A treating physician ʹ s

opinion regarding the nature and severity of a medical con

‐

dition is entitled to controlling weight if it is well supported

by medical findings and not inconsistent with other substan

‐

tial evidence in the record.” Clifford

, 227 F.3d at 870 (citing 20

C.F.R. § 404.1527(d)(2)).8 No. 16

‐ 4003

It was not error for the ALJ to conclude that there was no

opinion from a treating or examining source. Stephens con

‐

tends that the ALJ improperly discounted Dr. Sanjay Jain’s

statement that Stephens should not drive if he has hyper

‐

somnolence. This recommendation is not a medical “opin

‐

ion” triggering the treating physician rule. Medical opinions

are statements from medical sources that reflect judgments

about the nature and severity of a claimant’s impairment. 20

C.F.R. § 416.927 (a)(1). Moreover, the ALJ considered Ste

‐ phens’ sleep apnea and fatigue as part of her evaluation of

his residual functional capacity at step four. The relevant

past work which the ALJ concluded that Stephens could per

‐

form does not involve driving. Thus, even if Stephens’ hy

‐ persomnolence imposed an additional limitation on driving,

the ALJ’s determination would be unaffected.

C. The Combined Impact of Impairments

Lastly, Stephens contends that the ALJ failed to incorpo

‐

rate all of his impairments and consider their combined im

‐

pact to evaluate his residual functional capacity. Stephens

points specifically to his urination issues, balance, and upper

extremities, as impairments that were not fully considered.

We disagree.

“The ALJ need not

... provide a ‘complete written

evaluation of every piece of testimony and evidence.’”

Haynes v. Barnhart

, 416 F.3d 621, 626 (7th Cir. 2005) (quoting

Diaz v. Chater

, 55 F.3d 300, 308 (7th Cir. 1995)). The ALJ “may

not select and discuss only that evidence that favors [her]

ultimate conclusion,” Diaz

, 55 F. 3d at 307, but “must

confront the evidence that does not support [her] conclusion

and explain why it was rejected.” Indoranto v. Barnhart, 374No. 16

‐ 4003 9

F.3d 470, 474 (7th Cir. 2004). Here, substantial evidence

supported the ALJ’s decision.

The ALJ considered the medical evidence supporting

each of these issues and found that they did not require ad

‐

ditional work

‐ related limitations. Stephens contends that the

ALJ should have included additional bathroom breaks in the

RFC. Yet, Stephens’ urinary issues were resolved and he had

no urinary complaints as of 2012 when he saw Dr. Thomas,

his urologist. The ALJ noted that the medical record showed

no urinary complaints after May 2011. Thus, the ALJ proper

‐ ly found no work

‐ related limitations of any twelve month

period relating to Stephens’ urinary issues. See 20 C.F.R. §

416.909 (“Unless your impairment is expected to result in

death, it must have lasted or must be expected to last for a

continuous period of at least 12 months.”).

The RFC provided, among other things, that Stephens

can occasionally balance. Stephens claims this determination

is illogical based on his obesity and knee problems. “Occa

‐ sionally,” though, does not mean that he must be able to bal

‐

ance for two hours and forty minutes as Stephens suggests.

“’Occasionally’ means occurring from very little up to one

‐

third of the time, and would generally total no more than

about 2 hours of an 8–hour workday.” Hodges v. Barnhart

, 509

F. Supp. 2d 726, 735 (N.D. Ill. 2007) (citing SSR 96–9p). Ste

‐ phens does not explain how his slight limp and antalgic gait

undermine the ALJ’s determination. Moreover, the ALJ con

‐

sidered Stephens’ joint and knee problems throughout her

evaluation and further relied on state agency reviewing phy

‐

sicians who concluded that Stephens can perform light work

with occasional postural movements. The RFC accounted for

these limitations.10 No. 16

‐ 4003

Stephens also argues that the ALJ improperly discounted

functional problems in his hands and should have included

manipulation limitations in the RFC. The ALJ properly

found that Stephens did not have a medically determinable

impairment of his right hand. In reaching this conclusion,

she relied on the consultative examination by Dr. Ringel on

June 8, 2010, noting some loss of fine motor control in both

hands; Stephens’ internist’s notes from July 21, 2010, show

‐ ing severe crepitation in the right thumb; a July 29, 2010,

note from a physician assistant indicating “normal” right

wrist and hand; Dr. LaSalle’s notes from May 10, 2012, also

finding Stephens’ right wrist and hand normal; and a June

2013 consultation exam finding slow and clumsy fine finger

manipulabilities. Based on these medical records, the ALJ

concluded that there was no diagnosis or treatment for right

hand impairment or evidence of ongoing functional limita

‐

tions.

Likewise, the ALJ’s evaluation of Stephens’ left hand was

supported by substantial evidence. Stephens had surgery on

his left thumb in May 2011, and the surgeon’s follow

‐ up

notes reflect that Stephens was doing “wonderfully” with a

little achiness. His physical therapist noted full range of mo

‐

tion, pain

‐ free, with no need for additional therapy. Similar

‐ ly, follow

‐ up with his surgeon in May 2012, revealed no

numbness or tingling with normal functioning of the left

wrist and hand. Thus, the ALJ properly concluded on this

evidence that any impairment of his left hand was non

‐

severe.

The ALJ’s decision to deny benefits was based on sub

‐

stantial evidence. Accordingly, the judgment of the district

court is AFFIRMED.