Opinion ID: 809804
Heading Depth: 2
Heading Rank: 1

Heading: Evidence of nerve root compression character-

Text: ized by neuro-anatomic distribution of pain, limitation of motion of the spine, motor loss (atrophy with associated muscle weakness or muscle weakness) accompanied by sensory or reflex loss and, if there is involvement of the lower back, positive straight-leg raising test (sitting and supine); or . . . . C. Lumbar spinal stenosis resulting in pseudoclaudication, established by findings on appropriate medically acceptable imaging, manifested by chronic nonradicular pain and weakness, and resulting in inability to ambulate effectively, as defined in 1.00B2b. The parties do not dispute that Kastner has satisfied the threshold requirement for a disorder of the spine. A range of physicians have repeatedly diagnosed Kastner with spondylosis, spinal stenosis, and degenerative disc disease which compromised nerve roots in his spinal cord. The ALJ also found that Kastner’s disorder of the spine constituted a severe impairment. But the ALJ determined that Kastner had not demonstrated § 1.04(A) or (C)’s additional requirements for a finding of presumptive disability. As to § 1.04(A), the ALJ stated simply that Kastner “did not display limitation of motion of the spine as 10 No. 11-1166 anticipated by section 1.04A (Ex. 2F, p. 12-14).” Kastner contends that the ALJ erred by ignoring medical evidence that his range of motion of the spine was limited. As noted above, ALJs need not address every piece of evidence presented at a disability hearing. Craft, 539 F.3d at 673. Nevertheless, we have held that “[i]n considering whether a claimant’s condition meets or equals a listed impairment, an ALJ must discuss the listing by name and offer more than a perfunctory analysis of the listing.” Barnett v. Barnhart, 381 F.3d 664, 668 (7th Cir. 2004). In this case, we conclude that the ALJ’s cursory analysis and disability determination were not supported by substantial evidence in the record. The ALJ cited one exhibit in concluding that Kastner did not meet the requirements of § 1.04A: Dr. Rupert’s initial examination of Kastner in 2005. But this examination did not include any range-of-motion evaluation. The Commissioner says that the ALJ simply made an error and intended to reference the range-of-motion examination performed by Dr. Hall. This may well be true. But the only two pieces of evidence in the record involving range-of-motion tests demonstrated that Kastner did have limited range of motion. First, in May 2005, Dr. Butler found substantial limitations to Kastner’s range of motion: 5 degrees of flexion and extension in the neck with some greater—but still limited—flexion in the back. Then, in August 2006, Dr. Hall conducted a formal range-of-motion examination and again found that Kastner could only perform 20 degrees of cervical extension versus a normal extension of 60 degrees. Similarly, Kastner was only capable No. 11-1166 11 of 70 degrees of lumbar forward flexion versus a norm of 90 degrees. Kastner had 90 degrees of flexion in the hips versus a norm of 100 degrees. Dr. Hall added the notation “pain” after each of these measurements. Because the only evidence in the record demonstrated significant limitations in Kastner’s range of motion, the ALJ’s contrary conclusion is peculiar and unexplained. An unarticulated rationale for denying disability benefits generally requires remand. In response, the Commissioner points to § 1.00(G) of Appendix 1 which provides that “[m]easurements of joint motion are based on the techniques described in the chapter on the extremities, spine, and pelvis in the current edition of the ‘Guides to the Evaluation of Permanent Impairment’ [“AMA Guides”] published by the American Medical Association.” 20 C.F.R. pt. 404, Subpt. P, App. 1 § 1.00(G). The edition of the AMA Guides in effect when Kastner was examined stated that a patient’s pain could potentially limit mobility and lead to inaccurately low or inconsistent measurement of the patient’s actual range of motion. The Commissioner contends that Dr. Hall’s “pain” notations indicate that he attributed Kastner’s limited range of motion to pain and not to a permanent impairment. This, the Commissioner argues, is what the ALJ meant when she stated that Kastner did not display the limitation of motion “anticipated by section 1.04A.” We are not persuaded by the Commissioner’s theory. First, the Commissioner gives a reason for discounting the evidence that the ALJ never relied upon. Whether 12 No. 11-1166 by accident or oversight, the ALJ never referenced Dr. Hall’s examination in her analysis of § 1.04(A). Even if we assume that she intended to, the ALJ never stated that she rejected the range-of-motion evidence due to Kastner’s pain. We have repeatedly held that an ALJ must provide a logical bridge between the evidence in the record and her conclusion. Craft, 539 F.3d at 673. Here, the Commissioner argues that by referring to motion limitations “anticipated by section 1.04A,” the ALJ meant to cross-reference both § 1.00(G) and a specific section of the AMA Guides. But this is not a logical bridge; it is a soaring inferential leap. Nothing in the ALJ’s decision indicates that this relatively obscure crossreference was the basis for the determination. Under the Chenery doctrine, the Commissioner’s lawyers cannot defend the agency’s decision on grounds that the agency itself did not embrace. See SEC v. Chenery Corp., 318 U.S. 80, 87-88 (1943); Parker v. Astrue, 597 F.3d 920, 922 (7th Cir. 2010). On appeal, the Commissioner may not generate a novel basis for the ALJ’s determination. To permit meaningful review, the ALJ was obligated to explain sufficiently what she meant by “limitation of motion of the spine as anticipated by section 1.04A.” See Steele, 290 F.3d at 940. Second, even if the ALJ had discounted Kastner’s limited motion due to his pain, that determination would not have been supported by substantial evidence. It is true that Dr. Hall included a “pain” notation next to his measurements for Kastner’s cervical, lumbar, and hip flexion. But symptoms of pain are not mutually exclusive with the limitations of motion anticipated by No. 11-1166 13 § 1.04(A). By its terms, § 1.04(A) requires a claimant to demonstrate “limitation of motion of the spine.” It does not require a claimant to prove that the motion limitation occurs without pain. To the contrary, another requirement of § 1.04(A) is “nerve root compression characterized by neuro-anatomic distribution of pain.” It would be perverse to require claimants to prove the chronic pain that typically accompanies spinal disorders while simultaneously demonstrating an absence of pain when moving their spine. The regulations explicitly anticipate that pain symptoms will “be present in combination with the other criteria” for a listed impairment. 20 C.F.R. § 404.1529. The initial section of Appendix 1, § 1.00(B)(2)(d) outlines how the regulations define loss of function under an impairment: “Pain or other symptoms may be an important factor contributing to functional loss. . . . The musculoskeletal listings that include pain or other symptoms among their criteria also include criteria for limitations in functioning as a result of the listed impairment, including limitations caused by pain” (emphasis added). There is no indication that a limitation of motion caused by persistent pain would not meet the requirement for a disorder of the spine under § 1.04(A). The AMA Guides stated that fear of injury and other factors could affect the accuracy and consistency of a range-of-motion test. The Commissioner has also noted that a patient’s lack of cooperation may affect measurements. This is true. But there is no indication in Dr. Hall’s examination or his accompanying narra14 No. 11-1166 tive account that Kastner’s motion limitations were affected by temporary pain, fear of injury, or a lack of cooperation. So there is no evidentiary support for discounting the evidence on that basis. Dr. Hall signed Kastner’s Range of Motion Chart, stating, “I attest to the fact that this individuals [sic] active mechanical range of motion was measured” (emphasis in original). Given that Kastner’s condition is characterized by chronic pain, it is unsurprising that Dr. Hall would have noted pain in measuring limitation in motion. It is also worth noting that impairment listings for disorders of the spine were revised in 2001 with the express purpose of relaxing the limitation-of-motion requirement. The earlier version of the listing had required limitation of motion of the spine to be “significant.” See Revised Medical Criteria for Determination of Disability, Musculoskeletal System and Related Criteria, 66 Fed. Reg. 58,010 (Nov. 19, 2001). The agency rejected the “significant” criterion as “imprecise” and concluded that “any limitation of motion [would be] significant if it were accompanied by the other requirements of the final listing.” Id. So, the agency has determined that any restriction on movement that a doctor considers a medical limitation of motion will satisfy this element of the listing. Even if Kastner’s pain affected the consistency and accuracy of his range-of-motion examinations, it is difficult to conclude on this record that Kastner failed to demonstrate “any limitation of motion”—the standard the agency adopted when it revised the listing. No. 11-1166 15 Next, the Commissioner contends that Kastner has provided no evidence of “motor loss (atrophy with associated muscle weakness or muscle weakness),” an additional requirement of Listing 1.04(A). This argument fails for the same reasons as before; the ALJ never referenced motor loss as a basis for the determination at step 3. The Commissioner’s theory is speculation barred by the Chenery doctrine. And in any event, the record does contain evidence of Kastner’s motor loss. The Commissioner points to Kastner’s initial examinations in 2005 where Dr. Rupert measured normal muscle strength. But this ignores the 2006 examination where Dr. Hall found reduced strength in Kastner’s left arm and stated: “He cannot lift well with his left arm.” 2 The Commissioner also references a May 9, 2006 examination with Dr. Chou where Kastner stated that his pain was getting much better since his surgery and he could lift his left arm. But this occurred three months before Dr. Hall’s examination during the period when Kastner showed initial signs of improvement after his first surgery. “An ALJ may not selectively consider medical reports . . . but must consider all relevant evidence.” Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009) (internal quotation marks and citations 2 The Commissioner also disregards other evidence including Dr. Chou’s January 7, 2005 examination where he noted that Kastner was experiencing “bilateral arm numbness” and the April 19, 2006 visit where Dr. Chou stated that Kastner “is completely weak in his left deltoids . . . and he is numb in the shoulder patch and the deltoids feel a little bit flaccid to me.” 16 No. 11-1166 omitted). Dr. Hall’s August 2006 examination may be better evidence of Kastner’s long-term condition. Furthermore, Kastner’s arm strength is not the only evidence of motor loss. Under “Examination of the Spine,” § 1.00(E)(1) of Appendix 1 states: “Inability to walk on the heels or toes, to squat, or to arise from a squatting position, when appropriate, may be considered evidence of significant motor loss.” In his examination, Dr. Hall observed that Kastner could walk on heels and toes but that he had “difficulty with tandem walking [and] squatting. He gets down but nearly cannot get back up without use of the arms.” In the January 4, 2005 examination, Dr. Butler also observed that Kastner had “trouble with standing, stooping and lifting.” This evidence supports a finding of motor loss and the ALJ never articulated any contrary conclusion. Kastner also challenges the ALJ’s determination as to Listing 1.04(C). The ALJ concluded that Kastner did not meet or equal the requirements of the listing “because he was able to ambulate effectively, which was generally well enough to perform basic activities of daily living. For example, the claimant testified that he was able to walk around his house, to clean, to bathe, attend basketball games, and perform volunteer work at school . . . .” Under § 1.00(B)(2)(b)(2) of Appendix 1, “[i]nability to ambulate effectively means an extreme limitation of the ability to walk; i.e., an impairment(s) that interferes very seriously with the individual’s ability to independently initiate, sustain, or complete activities.” This level of impairment “is defined generally No. 11-1166 17 as having insufficient lower extremity functioning . . . to permit independent ambulation without the use of a hand-held assistive device(s) that limits the functioning of both upper extremities” such as a walker, two crutches, or two canes. Id. It is not clear from this record that Kastner has demonstrated such “extreme limitation” to his ability to walk, and the ALJ correctly considered evidence of his household activities to determine whether he met the requirement. On remand, however, we would encourage the ALJ to consider and account for the medical evidence along with Kastner’s personal statements about his symptoms. See 20 C.F.R. § 404.1529(b).