1 At the time she decided this case, Judge Springmann was a

magistrate judge sitting by consent of the parties. See 28 U.S.C.

§ 636(c).

In the

United States Court of Appeals

For the Seventh Circuit

____________

No. 03-3309

KIM M. INDORANTO,

Plaintiff-Appellant,

v.

JO ANNE B. BARNHART,

Commissioner of Social Security,

Defendant-Appellee.

____________

Appeal from the United States District Court

for the Northern District of Indiana, Hammond Division.

No. 2:02-CV-9—Theresa L. Springmann, Judge.

1

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ARGUED FEBRUARY 19, 2004—DECIDED JUNE 29, 2004

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Before CUDAHY, POSNER and ROVNER, Circuit Judges.

ROVNER, Circuit Judge. Kim Indoranto, a former home

care nurse, injured her back and neck in an automobile

accident. She applied for disability insurance benefits.

An administrative law judge (“ALJ”) denied her application,

determining that although she had a severe impairment,
2 No. 03-3309

she retained the residual functional capacity to do sedentary work. The district court affirmed the agency’s determination, and Indoranto appeals. We reverse and remand for

further proceedings.

In October 1998, Indoranto, then 32 years old, was driving to a patient’s home when another motorist struck her

car from behind. A few days after the accident she visited

her physician, complaining of constant headaches, dull pain

in both ears and at the top and back of her head, pain in

her back and down her shoulders, and a warm sensation in

her leg and foot. The doctor diagnosed her with cervical

strain and a cerebral concussion. Over the course of several

months she saw other doctors who diagnosed her with a

variety of ailments, including herniated discs; straightening

of the cervical spine; a bone spur; a disease of the spinal

cord and nerve roots; and a previously undetected congenital brain stem abnormality called Arnold-Chiari malformation, in which the cerebellum protrudes into the spinal

canal. She continued to experience severe pain in her neck

and back, muscle spasms, headaches, and blurred vision.

She received a variety of treatments including pain medications, massages, physical therapy, steroid injections, and

ultimately surgery. At the advice of her doctors she stopped

working and was also prescribed a handicap sticker for her

car. She was later evaluated by a psychologist, who diagnosed her with depression. Doctors also became concerned

about her heavy use of pain medication.

Indoranto applied for disability insurance benefits, alleging that she became disabled in January 1999, the date

doctors advised her to stop working. At a hearing before an

ALJ, Indoranto testified that she had experienced only

minimal improvement as a result of her surgery, and that

she continued to suffer from muscle spasms, pain in her

neck and back, difficulties in concentrating, severe headaches, and blurred vision. She also testified that her daily

activities had been dramatically curtailed because of her
No. 03-3309 3

impairments: her pain required her to change positions

from sitting to standing or lying down every 15 to 30 minutes; she could no longer do household chores except for

occasional cooking; she rarely left the house or drove; she

could walk a block or two at the most before losing her

balance and falling; and she could stand for only 10-15

minutes, sit for half an hour, and lift up to 10-15 pounds

before feeling discomfort. 

The ALJ called on a vocational expert (“VE”) to testify

about the work abilities of a hypothetical person of

Indoranto’s age, education-level, work experience, and physical condition. Specifically, the ALJ asked the VE a series

of five questions about a person who was limited in lifting,

twisting, bending, and also required a position with low

levels of concentration due to the effects of pain and medication. The VE testified that for someone with these work

restrictions, there were 3,500 cashier jobs, 3,500 handpacker jobs, and 3,000 mechanical assembler jobs available

in the region.

The ALJ subsequently issued a written decision denying

Indoranto’s claim for benefits. Based on the VE’s testimony,

the ALJ concluded that although Indoranto could not

perform her past relevant work, she retained the ability to

perform certain sedentary jobs, including approximately

10,000 jobs that existed in the Chicago metropolitan area.

He did not find her complaints of pain fully credible,

disbelieving in particular Indoranto’s testimony that her

pain required her to lie down and take up to three hot baths

during the day. The Appeals Council denied Indoranto’s

appeal. The district court concluded that the ALJ’s decision

was supported by substantial evidence and affirmed the

agency’s determination in all respects. This appeal followed.

Where, as here, the Appeals Council denies review, the

ALJ’s determination becomes the agency’s final decision. 20

C.F.R. § 404.981. We will affirm the agency’s decision if it
4 No. 03-3309

is supported by substantial evidence. 42 U.S.C. § 405(g);

Kasarsky v. Barnhart, 335 F.3d 539, 543 (7th Cir. 2003).

Evidence is considered substantial if a reasonable person

would accept it as adequate to support a conclusion. Young

v. Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004). 

We turn first to Indoranto’s strongest argument—that the

ALJ failed to consider all her impairments in concluding

that she could still perform sedentary work. Indoranto

asserts that the ALJ’s questions to the VE did not incorporate the limitations imposed by her daily headaches and

blurred vision, and that, contrary to the ALJ’s conclusion,

her combined impairments prevent her from performing the

jobs suggested by the expert. The Commissioner counters

that Indoranto improperly relies on medical evidence

submitted for the first time to the Appeals Council. Although the Commissioner is correct that the ALJ cannot

be faulted for failing to consider evidence that was not

presented to him, see Luna v. Shalala, 22 F.3d 687, 689 (7th

Cir. 1994), the record shows that the ALJ had before him

evidence pertaining to Indoranto’s headaches and blurred

vision. Indoranto testified at her hearing that she suffered

from “chronic severe headaches every day” that were

accompanied by daily episodes of blurred vision, lasting

anywhere from a few minutes to an entire day. The record

also contains a report from Dr. Cybulski, a neurosurgeon,

who opined that the Arnold-Chiari malformation had

become symptomatic because of the car accident, and noted

that Indoranto complained of headaches and blurred vision.

A doctor who examined and evaluated Indoranto for the

Social Security Administration also noted that she complained of headaches associated with episodes of blurred

vision, and other doctors noted the presence of the ArnoldChiari malformation. 

Although the ALJ need not discuss every piece of evidence

in the record, he must confront the evidence that does not

support his conclusion and explain why it was rejected.
No. 03-3309 5

Kasarsky, 335 F.3d at 543; Brindisi v. Barnhart, 315 F.3d

783, 786 (7th Cir. 2003). Notably absent from the ALJ’s

order is a discussion of how Indoranto’s headaches and

blurred vision affected her ability to work. The ALJ also

failed to include headaches or blurred vision in the list of

work-related impairments submitted to the VE. If the ALJ

relies on testimony from a vocational expert, the hypothetical question he poses to the VE must incorporate all of the

claimant’s limitations supported by medical evidence in the

record. See Young, 362 F.3d at 1003; Kasarsky, 335 F.3d at

543; Steele v. Barnhart, 290 F.3d 936, 942 (7th Cir. 2002).

The Commissioner argues that although the ALJ did not

mention headaches or blurred vision to the VE, he nonetheless incorporated these impairments into his questions by

instructing the VE to include only those jobs that allowed

for a low level of concentration. But concentration is not the

same thing as vision, and one wonders how someone with

daily episodes of blurred vision could perform the jobs

suggested by the VE, such as a cashier or an assembler,

which would require attention to visual detail. Further

proceedings are necessary so that the ALJ can give full

consideration to all of Indoranto’s documented impairments

in evaluating her claim. 

Indoranto also challenges the ALJ’s determination that

her complaints of pain were not fully credible, arguing that

the ALJ gave only “negligible explanations” for discrediting

her testimony. Specifically, the ALJ disbelieved her claim

that she lies down and takes up to three hot baths a day to

alleviate her pain and muscle spasms. The ALJ rejected

this testimony, stating only that “there is no clinical support for this extreme limitation in the record.” We review

the ALJ’s credibility determination deferentially but when,

as here, the determination rests on “objective factors or

fundamental implausibilities rather than subjective considerations [such as a claimant’s demeanor], appellate courts

have greater freedom to review the ALJ’s decision.” Clifford
6 No. 03-3309

v. Apfel, 227 F.3d 863, 872 (7th Cir. 2000). In assessing a

claimant’s credibility, the ALJ must consider subjective

complaints of pain if the claimant can establish a medically

determined impairment that could reasonably be expected

to produce the pain. See 20 C.F.R. § 404.1529; Social

Security Regulation 96-7p; Clifford, 227 F.3d at

871. Further, the ALJ cannot reject a claimant’s testimony

about limitations on her daily activities solely by stating

that such testimony is unsupported by the medical evidence. Clifford, 227 F.3d at 871. 

The ALJ’s rationale for not crediting Indoranto is not

supported by substantial evidence. The record is replete

with evidence of the severe pain Indoranto was suffering as

a result of herniated discs and numerous other ailments.

She testified in detail about how her pain severely limited

her daily activities, and there is nothing incredible or

inconsistent about her statements that she lies down and

takes baths during the day to alleviate her pain. Indoranto

never stated that her doctors told her to lie down or take

baths, merely that these home remedies helped her feel

better. And indeed, the record shows that her physical

therapist instructed her to take 30-minute hot baths for

pain relief. The ALJ’s adverse credibility finding is particularly puzzling in light of his recognition that Indoranto

experiences “significant pain and discomfort” because of her

impairments. We cannot uphold the ALJ’s decision when it

is premised on flawed logic. See Carradine v. Barnhart, 360

F.3d 751, 754-56 (7th Cir. 2004) (reversing where ALJ’s

credibility determination was based on “serious errors in

reasoning”). 

Because we remand for a new hearing, we do not reach

Indoranto’s argument that the Appeals Council erred in rejecting her request for review. We REVERSE the judgment of

the district court and REMAND the case for further proceedings consistent with this opinion.
No. 03-3309 7

A true Copy:

Teste: 

 ________________________________

Clerk of the United States Court of

Appeals for the Seventh Circuit 

USCA-02-C-0072—6-29-04