RIPPLE, Circuit Judge.
Kenneth Owen Scrogham applied for disability benefits under the Social Security Act, submitting that a variety of medical conditions — including degenerative discs, spinal stenosis, sleep apnea, hypertension, arthritis, atrial fibrillation and restless leg syndrome — constituted a qualifying disability. After his application was denied, Mr. Scrogham participated in a hearing before an administrative law judge ("ALJ") for the Social Security Administration ("Administration"). The ALJ denied Mr. Scrogham's application for benefits, and the Administration's Appeals Council denied his request for review. Accordingly, Mr. Scrogham filed a complaint in the United States District Court for the Southern District of Indiana, seeking judicial review of the ALJ's decision. The district court affirmed the denial of benefits, holding that the ALJ did not err in giving less weight to the opinion of a treating physician than to the opinions of nontreating physicians, that the ALJ permissibly found Mr. Scrogham not to be credible and that the ALJ's decision otherwise was supported by substantial evidence. Mr. Scrogham timely appealed.
We now reverse the judgment of the district court and remand for further proceedings. In our view, the ALJ's methodology was flawed in several respects. The ALJ impermissibly ignored a line of evidence demonstrating the progressive nature of Mr. Scrogham's degenerative disc disease and arthritis. As a result, the
When the Administration denied Mr. Scrogham's request for benefits, he was fifty-three years old and married with adult children. He had a high school education and, until November 2007, had been employed consistently since 1993. He had worked as a sales manager at an automotive sales company, as a landscaper and a landscape designer, as a sales representative for a building supply store and as the marketing director of a company. Most recently, he had worked from January 2007 to November 2007 in a restaurant, where he made pizzas and did some supervisory and managerial tasks, such as scheduling. Mr. Scrogham claims that he had to stop working because he had a variety of health problems, primarily back and leg pain, that made working "just entirely too rough on [him]."
The Administrative Record contains evidence of extensive treatment by both primary care physicians and specialists, as well as evidence from physicians associated with the state disability agency. Mr. Scrogham has been receiving medical attention for a number of conditions, including back and leg pain, since at least 2004. An x-ray of Mr. Scrogham's lumbar spine in 2004 revealed, among other problems, "mild to moderate spondylosis ... from L1 through L5" and "degenerative joint disease of the T10 costotransverse joints."
On April 8, 2008, Dr. Adams listed Mr. Scrogham's ailments as obstructive sleep apnea, atrial fibrillation, severe degenerative arthritis in his knees and hypertension. Dr. Adams indicated that all of these conditions were related to Mr. Scrogham's
Dr. Totten referred Mr. Scrogham to Dr. Alcorn for evaluation of his sleep apnea. In May 2008, Mr. Scrogham underwent a sleep study, after which he was instructed to use a CPAP device
On April 9, 2009, Dr. Alcorn saw Mr. Scrogham and wrote that he was having "a terrible time with his morbid obesity. He is being evaluated for morbid obesity bariatric surgery."
On June 29, 2009, Mr. Scrogham was examined by Dr. Richard Gardner, who was affiliated with Indiana's Disability Determination Bureau. Dr. Gardner recounted some of Mr. Scrogham's past employment and stated that he was "let go for performance" in November 2007 from his position as a pizzeria manager.
A month later, Dr. J. Sands, a consulting physician with the state agency, completed a residual functional capacity assessment based on the medical evidence in the record. Dr. Sands listed degenerative disc disease as Mr. Scrogham's primary diagnosis and morbid obesity as his secondary diagnosis. Dr. Sands opined that Mr. Scrogham could lift or carry twenty pounds, frequently lift or carry ten pounds, stand or walk for about six hours in an eight-hour work day and sit for about six hours in an eight-hour work day. Dr. Sands also stated that Mr. Scrogham could occasionally climb a ramp or stairs (but not a ladder or scaffold) and that he could occasionally balance, stoop, kneel, crouch and crawl. When asked to discuss whether the severity of the symptoms alleged by Mr. Scrogham was consistent with the medical and nonmedical evidence in the record, Dr. Sands wrote that it was "credible for limitations due to obesity."
The next several months of treatment reflect major ups and downs in Mr. Scrogham's condition. For example, by his visit with Dr. Alcorn on July 27, 2009, Mr. Scrogham had lost forty pounds, and Dr. Alcorn noted that Mr. Scrogham was "doing tremendous" and that his "back/spinal stenosis has improved some."
It appears that, around this time, Mr. Scrogham's condition became severe enough and his weight loss was substantial enough to consider surgery. Dr. Alcorn referred Mr. Scrogham to a surgeon, Dr. Steven James, in order to consult with him about the possibility of undergoing back surgery. Dr. James examined Mr. Scrogham and observed that he could walk on his heels, but not on his toes; that Mr. Scrogham seemed to have good strength, with mild exceptions; that he had problems with his lower extremities; and that the straight-leg raise and hip-rotation tests were negative on both sides. Dr. James noted that Mr. Scrogham was unable to walk more than fifty yards without sitting down because of his spinal stenosis and that he "really has not had gainful employment for the last few years because of his symptoms."
Mr. Scrogham's increased pain continued into early 2010. On January 29, 2010, Dr. James noted that Mr. Scrogham "still has the pain when he is up and his legs seem to want to give out. He cannot walk any distance. He cannot stand for any period of time."
Dr. James operated on Mr. Scrogham's back on April 21, 2010.
On August 19, 2010, Dr. Alcorn examined Mr. Scrogham; his notes indicate that Mr. Scrogham, despite the surgery, was still experiencing debilitating problems. Specifically, he wrote, "This patient has had serious back problems. We have been over everything. He appears to me otherwise to have no new changes."
Throughout the fall of 2010, Mr. Scrogham continued with his weight loss and walking regimen, but by early 2011, it appears that his rehabilitation efforts were slowing down. For example, on February 10, 2011, Mr. Scrogham saw Dr. Alcorn, who noted a "complex situation," in which Mr. Scrogham had experienced "marked improvement in his mobility," but only because he took Lortab, a powerful painkiller and sedative,
While undergoing the above-described treatment, Mr. Scrogham filed an application, in April 2009, for Supplemental Security Income and Disability Insurance Benefits under the Social Security Act. He stated that he became disabled as of November 11, 2007, due to the following medical conditions: degenerative discs, spinal stenosis, sleep apnea, hypertension, arthritis
Mr. Scrogham then requested a hearing before an ALJ.
The ALJ also asked Mr. Scrogham about his physical condition and his daily activities. Mr. Scrogham testified that since the alleged onset of his disability, November 2007, his wife usually drove him places, but he had driven to the doctor (a distance of fourteen miles) a couple of times. Mr. Scrogham testified that he started his day by taking pain medication and that he sat inside for most of the day because he could not do anything else given his leg and back pain. Mr. Scrogham testified that he had lost one hundred pounds at the advice of his doctors. At the time of the hearing, he recently had undergone back surgery, but he testified that it had not fixed all of his problems. Although at one point while he was recovering from surgery, Mr. Scrogham would walk over a mile twice per day, he testified that, because of his knee pain, he had reduced his walking in the three or four months prior to the hearing. He testified that, at the time of the hearing, he could stand and perform a task, such as washing dishes, for only about ten minutes before his legs and feet would go numb. He testified that he could not lift even relatively light items over an extended period of time or sit longer than twenty minutes at a time. He testified that he sometimes would mow the lawn, but it would take him all day to mow half an acre of grass because he could only use the lawnmower for about ten minutes at a time before he needed to rest. He considered himself to be mostly independent in terms of caring for himself (bathing, dressing, etc.). Mr. Scrogham testified that he attended church on Sundays from 10:15 a.m. to 11:00 a.m. Mr. Scrogham's wife also testified, primarily to explain that she did not believe that the examination by the state agency's physician, Dr. Gardner, yielded an adequate picture of Mr. Scrogham's health and abilities.
A vocational expert, Robert Breslin, also testified. He described Mr. Scrogham's prior jobs in terms of the level of physical exertion required to perform them
The ALJ denied Mr. Scrogham's request for benefits. The ALJ applied the five-step sequential evaluation process described in 20 C.F.R. § 404.1520(a)(4)(i)-(v). At step one, the ALJ held that Mr. Scrogham had not engaged in substantial gainful activity since the alleged onset of his disability. At step two, the ALJ held that Mr. Scrogham had a severe combination of impairments: (1) "spinal stenosis, status post back surgery on April 21, 2010;" (2) diabetes; and (3) obesity.
Before addressing step four, the ALJ determined that Mr. Scrogham had the residual functional capacity to perform "light work," which consists of "lifting no more than 20 pounds at a time with frequent lifting or carrying of objects weighing up to 10 pounds" and "a good deal of walking or standing," or "sitting most of the time with some pushing and pulling of arm or leg controls." 20 C.F.R. § 404.1567(b). In reaching this decision, the ALJ found that Mr. Scrogham's testimony at the hearing was not credible. In making that finding, the ALJ noted that Mr. Scrogham's testimony about his capabilities conflicted with medical reports in the record and with other statements that Mr. Scrogham had made about his daily activities. The ALJ also decided not to give Dr. Alcorn's opinion as much weight as it typically would receive because it was inconsistent with other medical evidence and with testimony presented at the hearing.
At step four, the ALJ held that because of his residual functional capacity, Mr. Scrogham was capable of performing past relevant work as a sales manager, a restaurant manager and an auto sales manager and, therefore, that he was not disabled. At step five, the ALJ found that given Mr. Scrogham's age, education, work history and residual functional capacity, there were other jobs available to him in the national economy even if he were limited to sedentary work. The ALJ ultimately concluded, "The claimant has not been under a disability, as defined in the Social Security Act, from November 11, 2007,
Having exhausted his administrative remedies, Mr. Scrogham filed a complaint in August 2011 in the United States District Court for the Southern District of Indiana, seeking judicial review of the ALJ's decision. He alleged that the ALJ had erred by not giving controlling weight to the opinion of his treating physician, Dr. Alcorn; that the ALJ's credibility determination was erroneous; and that, for various reasons, the ALJ's determination that he was not disabled was not supported by substantial evidence.
The district court affirmed the Administration's denial of benefits. It held that the "ALJ's decision to discount Dr. Alcorn's findings and grant significant weight to non-treating sources was reasonable and well-supported."
Mr. Scrogham filed a timely notice of appeal and now submits that the ALJ erred in giving more weight to nontreating physicians' opinions than to treating physicians' opinions, that the ALJ's adverse credibility determination was not supported by substantial evidence, that the ALJ failed to consider the combined effects of all of Mr. Scrogham's impairments and that the ALJ ignored the dearth of evidence from September 2009 through May 2011 supporting her conclusions. We have jurisdiction under 28 U.S.C. § 1291, and we now reverse.
Because the Administration's Appeals Council declined to review the ALJ's decision, we review the ALJ's decision as the final decision of the Administration. Schmidt v. Astrue, 496 F.3d 833, 841 (7th Cir.2007). We review the ALJ's legal conclusions de novo and her factual determinations with deference. Id. If the ALJ's decision is supported by substantial evidence, we will affirm. Id. We "conduct a critical review of the evidence, considering both the evidence that supports, as well as the evidence that detracts from, the Commissioner's decision, and the decision cannot stand if it lacks evidentiary support or an adequate discussion of the issues." Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351 (7th Cir.2005) (internal quotation marks omitted). "In addition to relying on substantial evidence, the ALJ must also explain his analysis of the evidence with enough detail and clarity to permit meaningful appellate review." Id.
Mr. Scrogham submits that the ALJ ignored the fact that his back problems were caused by a progressive disease, the severity of which increased with time. Our review of the record indicates that the ALJ failed to consider at least two periods of time when Mr. Scrogham's condition was possibly more disabling than she believed it to be: prior to his back surgery, in early 2010,
The ALJ's error in ignoring evidence in the record about how Mr. Scrogham's condition changed over time is compounded because of its apparent effect on the ALJ's decision to discredit the opinions of Mr. Scrogham's treating physicians. Under 20 C.F.R. § 404.1527(c)(1), an ALJ should "give more weight to the opinion of a source who has examined [the claimant] than to the opinion of a source who has not examined [the claimant]." Further, the applicable regulations state:
Id. § 404.1527(c)(2).
Here, the ALJ decided not to give controlling weight to Dr. Alcorn's August 2010 report because she believed that the report was "inconsistent with the weight of the objective medical evidence."
In our view, the ALJ used faulty logic when she interpreted these pieces of record evidence as inconsistencies. First, she failed to consider that, because of the progressive nature of Mr. Scrogham's disease, there might have been a legitimate difference
Additionally, the ALJ only provided reasons to discredit one report by Dr. Alcorn. The ALJ neither considered nor explained her decision not to consider the rest of Dr. Alcorn's copious records, which, upon closer review, might indicate that Mr. Scrogham was substantially more limited in his physical abilities than the ALJ initially concluded. The ALJ also appears to have ignored the treatment records of several other physicians who saw Mr. Scrogham on a regular basis: Dr. James, Dr. Vitto, Dr. Adams and Dr. Totten. Because the ALJ did not articulate her reasons for not considering the opinions of these treating physicians, we cannot engage in meaningful review of her decision.
Even when an ALJ decides not to give controlling weight to a treating physician's opinion, the ALJ is not permitted simply to discard it. Rather, the ALJ is required by regulation to consider certain factors in order to decide how much weight to give the opinion: (1) the "[l]ength of the treatment relationship and the frequency of examination," because the longer a treating physician has seen a claimant, and particularly if the treating physician has seen the claimant "long enough to have obtained a longitudinal picture" of the impairment, the more weight his opinion deserves; (2) the "[n]ature and extent of the treatment relationship"; (3) "[s]upportability," i.e., whether a physician's opinion is supported by relevant evidence, such as "medical signs and laboratory findings"; (4) consistency "with the record as a whole"; and (5) whether the treating physician was a specialist in the relevant area. 20 C.F.R. § 404.1527(c)(2)(5).
In this case, the record contained evidence about the length of Mr. Scrogham's relationship with his longstanding physicians, the nature of the treatment for his progressive disease, the consistency of the doctors' reports about Mr. Scrogham's back and knee pain and Dr. James's specialty as a surgeon. The ALJ, however, did not discuss any of these factors in her opinion, so we cannot assess whether she appropriately chose not to give much weight to the treating physicians' opinions.
We will, therefore, remand Mr. Scrogham's case because the ALJ should have taken into account evidence regarding the progressive nature of Mr. Scrogham's ailments and the views of Mr. Scrogham's treating physicians.
Even reviewing the ALJ's opinion on its own terms — looking at the evidence on which she chose to base her opinion — it appears to us that the ALJ was inappropriately selective in choosing the evidence on which she based her opinion. Specifically, the ALJ identified pieces of evidence in the record that supported her conclusion that Mr. Scrogham was not disabled, but she ignored related evidence that undermined her conclusion. This "sound-bite" approach to record evaluation is an impermissible methodology for evaluating the evidence. See Whitney v. Schweiker, 695 F.2d 784, 788 (7th Cir.1982) ("But it is equally clear that an ALJ must weigh all the evidence and may not ignore evidence that suggests an opposite conclusion."). As a result of the ALJ's failure to follow the proper methodology, we have reason to doubt the accuracy of her credibility determination and of her residual functional capacity assessments.
For example, the ALJ discredited Dr. Alcorn's residual functional capacity report in part because it conflicted with Dr. Gardner's report finding that Mr. Scrogham had a "full range of motion of the cervical spine, [and] nearly full range of motion of the lumbar spine."
Similarly, our review of the record indicates that the ALJ considered evidence about Mr. Scrogham's activities selectively,
The ALJ also wrote that Mr. Scrogham had been "exercising on a bicycle."
We also note that the ALJ discounted Mr. Scrogham's credibility because he had applied for, and received, unemployment compensation during a portion of the period for which he now claims disability payments. The case law of this circuit clearly permits the ALJ to give some consideration to such activity on the part of the applicant when assessing his credibility. Schmidt v. Barnhart, 395 F.3d 737, 746 (7th Cir.2005). But attributing a lack of credibility to such action is a step that must be taken with significant care and circumspection. All of the surrounding facts must be carefully considered. In the case of a progressive disease, it is especially possible that an applicant might, at the early stages of the disease's manifestation, be unsure of the limits of his physical capabilities and only later determine that his inability to find work was due to the fact that the physical toll taken by the disease was greater than he had thought. The decision of the ALJ in this case does not contain any discussion of these considerations. On remand, this issue ought to be revisited and the reasons for Mr. Scrogham's action explored in more depth. We express no view on the outcome of such an analysis; that determination is for the ALJ.
Finally, we also note that the record reflects that Mr. Scrogham lost, at the direction of his physicians, a great deal of weight during the time at issue. To the degree that the surrounding facts and circumstances
Even if we were confident that the ALJ had selected evidence representative of the record as a whole on which to base her opinion, to the extent that the ALJ relied on evidence of Mr. Scrogham's daily activities to determine that he was capable of returning to work, those activities do not appear to us to constitute "substantial evidence that [he] does not suffer disabling pain," and they "do not establish that [he] is capable of engaging in substantial physical activity." Clifford v. Apfel, 227 F.3d 863, 872 (7th Cir.2000). In Clifford, the claimant testified
Id. We held in Clifford that the claimant's "testimony on her daily activities d[id] not undermine or contradict her claim of disabling pain." Id.
Mr. Scrogham's activities were significantly more limited than the claimant's in Clifford. Where she could regularly perform household tasks, go shopping and lift up to twenty pounds, Mr. Scrogham testified that he could do none of those things. Apart from his walking, the activities cited by the ALJ, such as driving, mowing the lawn or working in the yard, appear to have occurred only rarely. And the "sporadic performance [of household tasks or work] does not establish that a person is capable of engaging in substantial gainful activity." Thompson v. Sullivan, 987 F.2d 1482, 1490 (10th Cir.1993) (alteration in original) (internal quotation marks omitted). Further, at least one of the activities was a precipitating event that led to one of Mr. Scrogham's doctor's visits.
Reports of Mr. Scrogham's walking simply are too thin a reed on which to rest a determination that there is substantial evidence supporting the ALJ's conclusion that he could return to full-time work. In Carradine v. Barnhart, 360 F.3d 751 (7th Cir.2004), we held that the claimant's daily activities, which included walking two miles, could not support the ALJ's conclusion that she could work. Id. at 756 ("The weight the administrative law judge gave to Carradine's ability to walk two miles was perverse: not only is it a form of therapy, but it is not a form of therapy available at work."). We also cited with approval a decision of our colleagues in the Ninth Circuit, which determined that rehabilitative efforts such as walking for an hour and swimming were "not necessarily transferable to the work setting with regard to the impact of pain." Vertigan v. Halter, 260 F.3d 1044, 1050 (9th Cir.2001). The Ninth Circuit observed that "[a] patient may do these activities despite pain for therapeutic reasons, but that does not mean she could concentrate on work despite the pain or could engage in similar activity for a longer period given the pain involved." Id.
Finally, the ALJ's finding that Mr. Scrogham's surgery and medications indicated that his symptoms were not as severe as he claimed them to be seems to us to be misguided. We previously have acknowledged that a claimant's election to undergo serious treatment, such as having surgery and taking "heavy doses of strong drugs," indicates that the claimant's complaints of pain are likely credible. Carradine, 360 F.3d at 755. Further, the fact that physicians willingly prescribed drugs and offered other invasive treatment indicated that they believed the claimant's symptoms were real. Id. Instead of showing that Mr. Scrogham's limitations were not as severe as he alleged, evidence that he was willing to undergo risky surgery and take powerful pain medication — and that physicians were willing to prescribe this course of treatment — reflects that Mr. Scrogham's symptoms caused him real problems.
We think that these three logical errors — overstating the significance of Mr. Scrogham's daily activities, overrelying on his rehabilitative efforts as proof of his fitness for full-time work and misinterpreting the significance of Mr. Scrogham's extensive treatment — had a material effect on the ALJ's credibility and residual functional capacity assessments. We emphasize, however, that we do not decide here that Mr. Scrogham is entitled to benefits. See id. at 756. It may be that he has exaggerated his symptoms or that more in-depth study of his condition would show that he could perform some work. Id. These issues are for the ALJ to decide, using the agency's expertise. Id. We reverse today only because "an administrative agency's decision cannot be upheld when the reasoning process employed by the decision maker exhibits deep logical flaws, even if those flaws might be dissipated by a fuller and more exact engagement with the facts." Id. (citations omitted).
For the foregoing reasons, we reverse the judgment of the district court and remand the case for further proceedings consistent with this opinion.
REVERSED and REMANDED
Id. at 109.
