In the

United States Court of Appeals

For the Seventh Circuit ____________

No. 05-3797

MICHELLE JOHNSON,

Plaintiff-Appellant,

v.

JO ANNE B. BARNHART, Commissioner

of Social Security,

Defendant-Appellee.

____________

Appeal from the United States District Court

for the Eastern District of Wisconsin.

No. 05-C-73—J. P. Stadtmueller, Judge.

____________

ARGUED APRIL 7, 2006—DECIDED JUNE 5, 2006

____________

Before FLAUM, Chief Judge, and POSNER and EASTERBROOK,

Circuit Judges.

POSNER, Circuit Judge. The plaintiff, who was 38 years old

at the time of her hearing and has a high-school education,

complains about being denied social security disability

benefits. She is afflicted with a mysterious malady called

sarcoidosis (see Terrence C. Demos & Patrick J. Fahey, “The

Image of Sarcoidosis,” http://www.meddean.luc.edu/

Lumen/meded/Radio/sarc/sarc.htm, visited Apr. 9, 2006),

an inflammatory condition that often affects multiple

organs, principally the lungs, eyes, and skin. She testified
2 No. 05-3797

that she has shortness of breath, blurred vision, painful skin

lesions, and pain in her joints. Although the disease is

incurable, its symptoms can be alleviated by steroids.

Johnson takes prednisone and it has proved to be an

effective medication for her skin lesions, though as a side

effect it has contributed to a substantial weight gain that has

brought her up to 211 pounds although she is only 5 feet 51⁄2

inches in height. The administrative law judge found that,

considering Johnson’s age, education, and the gravity of her

symptoms, she can do sedentary work and therefore is not

disabled, and the district court affirmed.

Sarcoidosis is one of those diseases that varies greatly

in severity from individual to individual; indeed, many

people with sarcoidosis have no symptoms at all. If one

believed everything the plaintiff said at her hearing, she is

indeed incapable of full-time gainful employment, but the

administrative law judge was not obliged to believe all her

testimony. Applicants for disability benefits have an incentive to exaggerate their symptoms, and an administrative

law judge is free to discount the applicant’s testimony on

the basis of the other evidence in the case.

The judge’s opinion is long and painstaking, and though

it is also jargon-ridden and in places opaque, we can make

out what she was driving at. But our job would be much

easier if only the administrative law judges would define

the obscure medical terms with which they pepper their

opinions, relate those terms to the claimant’s functioning—which is all that matters since “the social security

disability benefits program is not concerned with health as

such, but rather with ability to engage in full-time gainful

employment,” Gentle v. Barnhart, 430 F.3d 865, 868 (7th Cir.

2005)—and indicate the relevance of absence of symptoms.

Boiles v. Barnhart, 395 F.3d 421, 425-26 (7th Cir. 2005).
No. 05-3797 3

The medical evidence reveals that Johnson’s sarcoidosis

has less impact on her ability to work than one would

infer just from her testimony. She has 20-20 vision, and

although she has been diagnosed with an inflammation of

the eyes that causes her vision to be intermittently blurry,

there is nothing to indicate that it prevents her from reading, and it has responded well to prednisone. Her skin

lesions have also responded to medication, and they are

unsightly and irritating rather than disabling except insofar

as they cause pain (a matter we’ll take up shortly). Although

Johnson complains of shortness of breath, the physician who

diagnosed her sarcoidosis reported that “her lungs were

clear.” And after she started taking prednisone and

methotrexate regularly, her treating physician “noted that

claimant’s sarcoidosis was stable with no further reports of

shortness of breath,” which undermined Johnson’s testimony that “I try to do a little exercise, walk down the street,

but it’s like, hard for me to breathe. I have trouble breathing.”

Joint and muscle pain is another symptom of sarcoidosis.

Johnson testified that her legs hurt “all over from my

knees down to my ankles,” and they hurt “every day, all

day . . . . It’s hard for me to get up in the morning because

my leg’s so bad. It would be swollen up so bad so I’ll get up,

maybe try to take a bath but my roommate have to help me

in and out the tub.” She takes naproxen, an anti-inflammatory drug, for the pain. But medical examinations have

revealed no serious problems with her joints or difficulty in

walking and moving her limbs, which might have indicated

that the sarcoidosis had affected her joints. Her treating

physician seems to have thought that her pain was mainly

the result of the skin lesions.

The administrative law judge thought Johnson’s complaints about pain exceeded the objective medical evidence,
4 No. 05-3797

yet pain can be severe to the point of being disabling even

though it has no diagnosable cause and thus is entirely in

the patient’s mind. Sims v. Barnhart, 442 F.3d 536, 537-38 (7th

Cir. 2006); Carradine v. Barnhart, 360 F.3d 751, 753-54 (7th

Cir. 2004); Foote v. Chater, 67 F.3d 1553, 1560-61 (11th Cir.

1995) (per curiam); Latham v. Shalala, 36 F.3d 482, 484 (5th

Cir. 1994); Easter v. Bowen, 867 F.2d 1128, 1130 (8th Cir.

1989). “Medical signs and laboratory findings, established

by medically acceptable clinical or laboratory diagnostic

techniques, must show the existence of a medical impairment(s) which results from anatomical, physiological, or

psychological abnormalities and which could reasonably be

expected to produce the pain or other symptoms alleged,”

20 C.F.R. § 404.1529(b) (emphasis added), but the word we

have italicized underscores the difficulty of confirming or

refuting pain testimony.

Even when as in this case the claimant attributes her

pain to a physical rather than a psychological cause, the

administrative law judge cannot disbelieve her testimony

solely because it seems in excess of the “objective” medical

testimony. Schmidt v. Barnhart, 395 F.3d 737, 746-47 (7th Cir.

2005). The etiology of pain is not so well understood, or

people’s pain thresholds so uniform, that the severity of

pain experienced by a given individual can be “read off”

from a medical report. “[P]ain is a complex, multidimensional, subjective experience. The report of pain is related to

numerous variables, such as cultural background, past

experience, the meaning of the situation, personality

variables, attention, arousal level, emotions, and reinforcement contingencies.” Dennis C. Turk & Ronald Melzack,

“The Measurement of Pain and the Assessment of People

Experiencing Pain,” in Handbook of Pain Assessment 3, 5

(Turk & Melzack, eds., 2d ed. 2001). “[T]here is often a poor

relationship between the ‘subjective’ experience of pain and
No. 05-3797 5

‘objective’ or external referents. This may be most evident in

the case of chronic pain where apparently similar peripheral

pathology, injury, or nociceptive input [pain stimulus] can

result in markedly different presentations. Whereas patient

self-report, using verbal analogue or other rating scales, is

perhaps the most straightforward and appropriate means of

determining pain severity (or other aspects of the pain

experience), this is prone to response bias like all selfreports.” Keith Nicholson, Michael F. Martelli, & Nathan D.

Zasler, “Myths and Misconceptions about Chronic Pain: The

Problem of Mind-Body Dualism,” in Pain Management: A

Practical Guide for Clinicians 465, 465-66 (Richard S. Weiner,

ed., 6th ed. 2001); see also Kathleen McGrory, “Doctors

Struggle to Treat Mysterious and Unbearable Pain,” New

York Times, May 31, 2006, p. D5.

Despite the inherent difficulty of evaluating testimony

about pain, an administrative law judge will often have

solid grounds for disbelieving a claimant who testifies that

she has continuous, agonizing pain. The judge in Schmidt v.

Barnhart, supra, 395 F.3d at 747, found that the claimant’s

“daily living activities were not significantly restricted, that

he was not receiving any active treatment or therapy for

his conditions at the time of the hearing, that he was not

using any prescription medication, and that his alleged pain

did not prevent him from engaging in substantial gainful

activity for several months after he allegedly became

disabled.” Johnson’s skin lesions are painful—and how

painful cannot be determined from the medical evidence.

But we know that they have responded to medication, that

some of her testimony was exaggerated (the testimony

about her difficulty in breathing), and that she continued

working as a car washer for four years after being diagnosed with sarcoidosis. These circumstances justified the

administrative law judge in finding Johnson’s testimony

about pain exaggerated.
6 No. 05-3797

Johnson complains that the judge failed to explore the

possible effect of her obesity on her sarcoidosis. In Mendez

v. Barnhart, 439 F.3d 360, 363 (7th Cir. 2006), we said that

“the administrative law judge should have considered

whether [the claimant’s] difficulty in getting around

would interact with her cognitive limitations and her

psychiatric condition to make her incapable of complying

with even simple workplace directives.” See also Gentle v.

Barnhart, supra, 430 F.3d at 868. There is no evidence that

Johnson’s obesity would have a direct effect on her ability to

do sedentary work, as it might on work that involved a lot

of moving around; but obesity as a source of a

specific limitation must be distinguished from obesity as a

factor that aggravates a limitation having another cause.

Mendez’s obesity didn’t aggravate her cognitive limitations;

it created a separate impediment to her being able to work

full time. Johnson’s obesity did not create a separate impediment to her being able to work but may have aggravated the

problems with her joints because obesity places additional

stress on joints. 1 William J. Koopman & Larry W. Moreland, Arthritis and Allied Conditions: A Textbook of

Rheumatology 27-28 (15th ed. 2005). “The heavier you are, the

more stress is placed on your spine, hips, knees and ankles.

Also, heavier people tend to resist exercise, resulting in

another risk factor—weak muscles, particularly in the thigh.

Weakness in the thigh, in turn, places extra stress on the

knees.” Jane E. Brody, “Personal Health: Arthritis: Your

‘Reward’ for Wear and Tear,” New York Times, July 30, 2002,

p. F7. But there is no indication that in assessing Johnson’s

joint problems the administrative law judge gave insufficient weight to the effect on them of Johnson’s obesity,

which is anyway not extreme. Her Body Mass Index of 34.6

(211 lbs. × 703/(65.5 inches)2

) places her in obesity class 1,

the lowest class. National Institutes of Health, The Practical
No. 05-3797 7

Guide: Identification, Evaluation, and Treatment of Overweight

and Obesity in Adults, NIH Pub. No. 00-4084 (Oct. 2000), p.

1, tab. 1, http://www.nhlbi.nih.gov/guidelines/obesity/

prctgd_b.pdf.

Actually, Johnson’s lawyer is less concerned with possible

flaws in the administrative law judge’s opinion than with

the brevity of the hearing and the judge’s failure to obtain

all of Johnson’s medical records. Johnson was

not represented and her current lawyer points us to cases

which hold that the administrative law judge has a duty

in such a case to ask questions that will elicit a full picture

of the applicant’s capacity for full-time gainful employment.

Nelson v. Apfel, 131 F.3d 1228, 1235 (7th Cir. 1997); Binion v.

Shalala, 13 F.3d 243, 245-46 (7th Cir. 1994); Reefer v. Barnhart,

326 F.3d 376, 380-81 (3d Cir. 2003). The judge did ask a

number of questions, and really what Johnson’s lawyer

seems to want is that the judge have asked questions that

would have cued Johnson to exaggerate her condition. For

example, he complains that the administrative law judge

“did not ask about the severity of the blurriness [of Johnson’s vision], nor what, if any, restrictions it caused.”

Prompting Johnson to elaborate her testimony would

simply have widened the gulf between it and the medical

records.

As for the missing records (belatedly introduced in the

district court), the administrative law judge asked Johnson

at the hearing whether there were any additional documents

that should be considered, and Johnson said no. The judge

had requested all of Johnson’s medical records from Johnson’s physician and it was not the judge’s fault that the

physician failed to comply and that Johnson failed to alert

the judge to the problem. Even a pro se litigant bears some

responsibility for making a record. In any event, the missing
8 No. 05-3797

medical records, though indicating some worsening of

Johnson’s skin lesions, would have been unlikely to change

the administrative law judge’s conclusion that Johnson was

not disabled from doing sedentary work.

AFFIRMED.

A true Copy:

Teste:

 _____________________________

Clerk of the United States Court of 

Appeals for the Seventh Circuit 

USCA-02-C-0072—6-5-06