In the
United States Court of Appeals
For the Seventh Circuit
No. 11-2424
L AENISE A RNETT,
Plaintiff-Appellant,
v.
M ICHAEL J. A STRUE,
Commissioner of Social Security,
Defendant-Appellee.
Appeal from the United States District Court
for the Northern District of Indiana, Fort Wayne Division.
No. 1:10-CV-226 RLM—Robert L. Miller, Jr., Judge.
A RGUED D ECEMBER 14, 2011—D ECIDED A PRIL 2, 2012
Before P OSNER, M ANION, and W OOD , Circuit Judges.
W OOD , Circuit Judge. Laenise Arnett suffers from
a number of medical problems, including peripheral
vascular disease, chronic obstructive pulmonary disease,
osteoarthritis, obesity, vascular dementia, depression,
panic disorder, and anxiety. As a result, she sought
Disability Insurance Benefits (“DIB”) from the Social
Security Administration (“SSA”), but she was unsuc-
2 No. 11-2424
cessful before the agency. After the Appeals Council
denied review of the Administrative Law Judge’s adverse
decision, she sought review in the district court pursu-
ant to 42 U.S.C. § 405(g). Once again, she did not prevail.
She now appeals to this court, seeking to persuade us
that the Administrative Law Judge (“ALJ”) failed
properly to assess her residual functional capacity. We
agree with her, and so we remand her case to the
agency for further proceedings.
I
Arnett applied for DIB in June 2004, claiming an
onset date of June 14, 2002. After the SSA denied
her application, she requested a hearing before an
ALJ. Arnett, who was 45 at the time, asserted that the
array of medical ailments we described earlier made it
impossible for her to work. Her application described
her past work as a sorter and inspector at a factory
from 1991 to 1992, as a newspaper sorter from 1994 to
1996 or 1997, as a home healthcare aide from 1998 to 1999,
and as a certified nursing assistant from 2001 to 2002.
After surgery in June 2002 and through most of 2003,
she worked eight hours per week as a certified nursing
assistant. Sometime around the end of 2003, she found
that she was unable to continue.
In December 2004 Arnett updated her application
with information about the recent removal of a vein
from one of her legs, a procedure that left her with pain
and swelling. She added that after experiencing a “mini
stroke” she also was having more difficulty with balance
and expressing her thoughts. Arnett and her husband
No. 11-2424 3
(who submitted a written statement describing how
Arnett’s medical condition impeded her daily activities)
both asserted that Arnett could care for herself and do
light housework at a slow pace, but that she sometimes
was unable to do laundry or shop for groceries. An
SSA employee interviewed her around this time and
reported that Arnett did not appear to be experiencing
any debilitating problem.
Arnett had submitted most of her medical records
from 2002 through 2004 by the time she requested a
hearing before an ALJ in May 2005. These records show
that she visited Dr. Fred Rasp, a pulmonologist, several
times in late 2001 complaining of wheezing, coughing,
and chest tightness, and that she was diagnosed with
an obstructive lung defect and early emphysema. About
a month later, Arnett went to Parkview Hospital twice;
the first time she was seen in the emergency room
for complaints of chest pain and nausea and was diag-
nosed with early emphysema and chronic obstructive
pulmonary disease (“COPD”), and during the second
visit for a cardiology consultation she complained of
chest pain and shortness of breath and was diagnosed
with peripheral vascular disease (“PVD”) and obesity.
Several months later her PVD was described as “severe.”
To address her PVD, Arnett underwent aortobifemoral
bypass surgery in June 2002. She began complaining
of swelling and cramping in her legs later that year.
In the spring of 2003 Arnett had an MRI, which
revealed degenerative disc disease in two thoracic verte-
bral discs and mild degenerative facet arthritis in her
4 No. 11-2424
lumbar vertebra. While checking up on Arnett in late
2003, Dr. Rasp confirmed the cardiologist’s opinion that
she suffers from PVD. About six months later a thoracic
surgeon noted increased stenosis in some arteries.
Shortly thereafter, in July 2004, Arnett underwent a
balloon angioplasty. A few months later she was again
dealing with stenosis and still complaining of leg pain,
which her doctors addressed with several procedures
including a second angioplasty. Arnett continued to
complain of leg cramping and weakness afterward.
Several other physicians also had submitted consulta-
tion reports by the time Arnett requested a hearing.
Dr. Galen Yordy, a consulting psychologist who met
with Arnett, diagnosed her with anxiety disorder, panic
disorder, and depressive disorder. Dr. Jaya Karnani, a
consulting physician who practices family medicine
and met with Arnett, opined that Arnett’s anxiety is
controlled effectively with medication and had not
caused her trouble concentrating or with social interac-
tions. On the negative side, he found that Arnett has
emphysema and PVD that prevent her from standing or
walking for more than two hours per day. Dr. Kenneth
Bundza, a consulting psychologist who met with Arnett,
found that she was alert but was experiencing dif-
ficulty retrieving information from memory; he diag-
nosed her with vascular dementia with depressed mood.
Dr. Yaroslev Pagorelov, a consulting family-practice
physician who had met with Arnett, opined that Arnett
suffers from emphysema, PVD, anxiety, and right-ankle
swelling and inability to walk more than five minutes
or stand more than 10 minutes at a time. Two sets of state-
No. 11-2424 5
agency physicians also evaluated Arnett’s records. The
first two opined that Arnett suffers from depres-
sive, panic, and anxiety disorders, though none of
them severe. The second two opined that Arnett has
emphysema and PVD, and that she occasionally can lift
or carry 20 pounds, can frequently lift or carry 10 pounds,
can stand or walk for at least two hours per day, and
can sit for about six hours per day.
Arnett submitted more medical records to the ALJ
in April and May 2007, mostly for treatment received
in and after 2005. One set related to her second
angioplasty in late 2004 and its failure to resolve her
problems. These records document that Arnett con-
tinued to complain of pain in her legs and began experi-
encing pain in her right arm, and that her vascular
surgeon did not believe the pain was of vascular origin
and was unsure of the cause. In late 2005, Arnett’s
arteries were again blocking up due to stenosis, and so
she underwent a third angioplasty.
Because Arnett continued to complain of pain in
2005 and 2006, her vascular surgeon referred her to a
neurologist, who diagnosed her with lumbosacral
neuritis but did not find a neurological explanation
for Arnett’s leg and arm pain. She also saw a
rheumatologist, who thought that her leg pain was not
a result of a rheumatological impairment and that her
arm pain was probably from tennis elbow. Dr. Anantha
Reddy, who specializes in physical medicine and reha-
bilitation, suggested that Arnett’s leg pain could be a
result of a spinal problem.
6 No. 11-2424
Late in 2006, Arnett complained of pain in her lower
back, hips, and right arm and hand. X-rays showed nar-
rowing of Arnett’s left and right knee joint spaces,
and Arnett’s rheumatologist diagnosed her with
osteoarthritis and stenosing tenosynovitis (a typically
painful condition that involves a finger becoming stuck
in a bent position, and later snapping back into a
straight position). Arnett was experiencing blockage
in some of her arteries again in spring 2007, and under-
went a fourth angioplasty.
Several of Arnett’s treating physicians submitted
reports of her residual functional capacity (“RFC”).
Arnett’s primary physician (until 2006) opined that Arnett
cannot lift or carry even 10 pounds, cannot stand or walk
for even two hours in an eight-hour workday, and must
periodically alternate between sitting and standing.
Dr. Don Stallman, her current primary physician, con-
cluded that Arnett can sit for up to 20 minutes at a
stretch and for two hours total during the day, stand
continuously for 15 minutes but no more than one
hour total during a day, walk 30 feet before stopping,
and carry up to five pounds frequently but not more
than 10 pounds even occasionally. Dr. Rasp, Arnett’s
treating pulmonologist, concluded that she can sit for
up to eight hours at a time, can stand continuously for
two hours and a total of four hours per day, and walk
for 15 minutes at a time and two hours total in a workday.
At the hearing before the ALJ on May 31, 2007, Arnett
and a vocational expert testified. Arnett said that her
legs cramped and she experienced difficulty breathing
No. 11-2424 7
when she had tried to work as a health aide after her
2002 aortobifemoral bypass surgery. She reported that
she still has cramping and weakness in her legs as a
result of her PVD, and this makes it difficult to stand
for more than 20 minutes at a time. The osteoarthritis
in her hips, arms, and back makes it difficult for her to
sit for very long, and she believed that her osteoarthritis
had been getting worse. Her COPD at times causes
chest pains and typically leaves her tired, light-headed,
dizzy, and short of breath. She also testified that her
hands cramp and that sometimes she has trouble con-
centrating. The vocational expert (“VE”) opined that no
job would be available for Arnett if the ALJ fully
credited her testimony. But, the VE continued, if Arnett
can perform sedentary work, with the limitation that the
job must permit alternating between sitting and standing
throughout the workday, then she can work as a food
service order clerk, a bench worker (there are several
types in the Dictionary of Occupational Titles, but the
expert did not specify which one he had in mind), or
a surveillance monitor.
The ALJ found Arnett not disabled after analyzing
the five steps in 20 C.F.R. § 404.1520. At Step 1, the
ALJ determined that Arnett had not engaged in sub-
stantial gainful activity between the claimed onset of
her disability and the date she was last insured. At
Step 2, the ALJ concluded that Arnett’s PVD and COPD
are severe, but that her anxiety, panic, and depressive
disorders are not; he did not mention her other physical
and mental impairments. At Step 3, after discussing
Listings 4.12 (PVD) and 3.02 (COPD), the ALJ found
8 No. 11-2424
that Arnett does not have an “impairment or combina-
tion of impairments” meeting or medically equaling a
listing; he did not elaborate on this conclusion or con-
sider any other specific listing.
Next, the ALJ assessed Arnett as having the RFC to
perform sedentary work with the following limitations:
carrying “up to 10 pounds occasionally and less
than 10 pounds frequently,” sitting for six hours of
an eight-hour day, walking for two hours of an
eight-hour day, and alternating between sitting and
standing throughout the day. He explained this con-
clusion as follows. First, he evaluated the writ-
ten statements submitted by Arnett and her hus-
band describing her daily activities and limitations,
as well as her husband’s statements to the SSA by tele-
phone about Arnett’s memory problems and exhaus-
tion, and Arnett’s oral testimony. But the ALJ decided
that what Arnett had said was “not entirely credible,”
and he did not address the credibility of her husband’s
statements. The ALJ discussed the opinions of several
treating or consulting physicians and explained why
he accepted or rejected each. Without explanation, how-
ever, he did not mention Dr. Bundza or Dr. Yordy,
who had diagnosed Arnett with mental impairments.
Indeed, at this stage the opinion did not mention quite
a few conditions that had been presented in the
evidence: depressive, anxiety, and panic disorders; vascu-
lar dementia; lumbosacral neuritis; osteoarthritis; de-
generative disc disease; degenerative changes in her
sacroiliac joints; or finally her obesity.
No. 11-2424 9
Finally, in concluding his analysis at Step 4, the ALJ
acknowledged that the RFC assigned to Arnett precludes
her from performing her past work. This required him
to move to Step 5, where the Commissioner bears the
burden of proof. There, the ALJ concluded that Arnett’s
RFC nevertheless allows her to perform several types
of jobs which, according to the VE, number in the hun-
dreds in northeastern Indiana.
II
On appeal to this court, Arnett takes issue with every-
thing except the ALJ’s Step 1 finding, which was in
her favor. At Step 2, she says, the ALJ failed to evaluate
the severity of each impairment. At Step 3, in her view,
the ALJ erred by failing to evaluate her impairments
collectively when he considered the listings. Third,
she argues that the ALJ’s RFC determination is flawed
because it does not incorporate all of her impairments
and limitations. Finally, she argues that the ALJ erred
at Step 5 by failing to account for all of her limitations
in the hypothetical given the VE. Arnett does not chal-
lenge the ALJ’s decisions to give some physicians’
opinions less than full weight.
Because the Appeals Council denied review, the ALJ’s
decision is the final decision of the agency. O’Connor-
Spinner v. Astrue, 627 F.3d 614, 618 (7th Cir. 2010). In
reviewing the ALJ’s decision, this court evaluates
whether substantial evidence supports it. Id. Importantly,
we must consider only the rationale offered by the
ALJ. Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011).
10 No. 11-2424
Arnett’s Step 3 claim is not properly before this court,
because she failed to raise it in the district court. Skarbek
v. Barnhart, 390 F.3d 500, 505 (7th Cir. 2004); Shramek
v. Apfel, 226 F.3d 809, 811 (7th Cir. 2000). We therefore
do not discuss it further.
All three of Arnett’s other claims assert, in one way
or the other, that the ALJ failed to consider the impact
of all of her impairments taken together. Her arguments
about Step 2 and Step 5 boil down to a contention that
the ALJ overstated her RFC by making this mistake.
But even if there were a mistake at Step 2, it does
not matter. Deciding whether impairments are severe
at Step 2 is a threshold issue only; an ALJ must continue
on to the remaining steps of the evaluation process as
long as there exists even one severe impairment. Castile
v. Astrue, 617 F.3d 923, 927-28 (7th Cir. 2010). Here, the
ALJ categorized two impairments as severe, and so
any error of omission was harmless. See id. Arnett’s
contention that at Step 5 the ALJ constructed a
hypothetical built around a flawed RFC adds nothing
to her challenge to the RFC. As Arnett herself says,
“[b]ecause the ALJ used a flawed RFC as the basis for
the hypothetical question to the Vocational Expert . . .
his hypothetical question to the VE was also flawed.”
Thus, Arnett’s appeal comes down to whether the ALJ
erred in assessing her RFC.
Arnett focuses on the ALJ’s failure to consider her
mental impairments in arriving at the RFC, as well as
his lack of attention to her lumbosacral neuritis, obesity,
osteoarthritis, degenerative disc disease, or degenera-
No. 11-2424 11
tive changes in her sacroiliac joints. She also contends
that the RFC does not reflect her need to elevate her legs.
An ALJ must evaluate all relevant evidence when
determining an applicant’s RFC, including evidence of
impairments that are not severe. 20 C.F.R. § 404.1545(a);
Craft v. Astrue, 539 F.3d 668, 676 (7th Cir. 2008). This
court upholds an ALJ’s decision if the evidence supports
the decision and the ALJ explains his analysis of the
evidence with enough detail and clarity to permit mean-
ingful review. Eichstadt v. Astrue, 534 F.3d 663, 665-66
(7th Cir. 2008). Although an ALJ need not mention
every snippet of evidence in the record, the ALJ
must connect the evidence to the conclusion; in so
doing, he may not ignore entire lines of contrary evi-
dence. Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010);
Simila v. Astrue, 573 F.3d 503, 516 (7th Cir. 2009); Zurawski
v. Halter, 245 F.3d 881, 888-89 (7th Cir. 2001). An ALJ
must also analyze a claimant’s impairments in combina-
tion. Terry v. Astrue, 580 F.3d 471, 477 (7th Cir. 2009).
The ALJ did take into account Arnett’s testimony that
she must often elevate her legs. But after referring to
her testimony, the ALJ disparaged her evidence with
the all-too-common and unhelpful “not entirely credi-
ble” remark. See Parker v. Astrue, 597 F.3d 920, 922 (7th
Cir. 2010). Arnett is not challenging the credibility
finding, which is just as well, since she did not raise
this point in the district court. See Shramek, 226 F.3d at 811.
The first significant problem that we see is the ALJ’s
failure to incorporate adequately Arnett’s mental im-
pairments into the RFC. Dr. Yordy diagnosed Arnett
12 No. 11-2424
with depressive, anxiety, and panic disorders. Dr. Bundza
diagnosed Arnett with vascular dementia, reporting
that she had some “fairly obvious cognitive problems,”
including difficulty understanding directions, slowly
responding to simple questions, a low-average or border-
line range of intelligence, and “fairly significant
retrieval problems.” The ALJ discussed Dr. Yordy’s
diagnoses at Step 2 of the analysis, and the ALJ even
says that he “translated” his Step 2 determination
“into work-related functions” in assessing Arnett’s
RFC, but the decision offers no hint about how he did
so. The ALJ never mentioned that Arnett had been diag-
nosed with vascular dementia. The Commissioner sug-
gests that these omissions are unimportant, because the
RFC is consistent with the limitations associated with
dementia. Nothing in the ALJ’s opinion explains how
that may be the case, however, and the RFC makes
no reference to any work limitations that would accom-
modate dementia. Symptoms of dementia include
an inability to learn or remember new information, an
inability to reason, and difficulty communicating. Mayo
Clinic, Dementia: symptoms, http://www.mayoclinic.com/
health/dementia/DS01131/DSECTION=symptoms (last vis-
ited March 28, 2012). Dr. Bundza’s report demonstrates
that Arnett was suffering from these symptoms as early
as two years before the hearing. An inability to learn
or remember new information could make it impossible
for Arnett to be trained for a new position, and the
inability to reason or difficulty communicating could
make simple tasks difficult and time-consuming for
Arnett to complete. Without any discussion of Arnett’s
No. 11-2424 13
dementia, this court has no idea what the ALJ thought
about this evidence. See Clifford v. Apfel, 227 F.3d 863, 873-
74 (7th Cir. 2000); Godbey v. Apfel, 238 F.3d 803, 808
(7th Cir. 2000).
The ALJ also failed to take into account several of
Arnett’s diagnosed physical impairments. An ALJ may
not ignore entire lines of evidence. See Zurawski,
245 F.3d at 888. The ALJ never mentioned Arnett’s
lumbosacral neuritis, degenerative disc disease (Arnett
also refers to this as anterior disc disease), osteoarthritis,
or degenerative changes in her sacroiliac joints. Arnett
has complained about pain in her back, knees, and
hips; this pain reduces her mobility and range of
motion and makes it difficult for her to sit for long
periods of time. The Commissioner argues that many
of these diagnoses were provisional, were made only
once, or need to be evaluated in context. But the
agency’s attorneys may not advance an explanation
the agency never made itself and may not attempt
to support the decision with evidence the agency ap-
parently did not consider. Martinez v. Astrue, 630 F.3d
693, 694 (7th Cir. 2011); Spiva v. Astrue, 628 F.3d 346,
348 (7th Cir. 2010); Parker, 597 F.3d at 922, 925.
The Commissioner also argues that Arnett waived
her claim that the ALJ failed to evaluate all of her
physical impairments because, the Commissioner says,
she has not explained how these impairments limit her
ability to work. Arnett has devoted several pages of her
brief to arguing that the ALJ did not fully evaluate all of
her impairments. This is sufficient. See Hernandez v. Cook
14 No. 11-2424
County Sheriff’s Office, 634 F.3d 906, 913 (7th Cir. 2011)
(rejecting plaintiff’s contention that defendants waived
immunity defense at summary judgment by limiting
discussion of defense to three paragraphs).
Next, the ALJ failed to take into account Arnett’s
obesity. An ALJ must factor in obesity when determining
the aggregate impact of an applicant’s impairments.
Martinez, 630 F.3d at 698-99; Clifford, 227 F.3d at 873.
The Commissioner argues that the ALJ was not re-
quired to discuss diagnoses for which Arnett failed to
provide evidence of limitations. As mentioned above,
however, an ALJ must consider all of the evidence
and must explain its decision such that it may be mean-
ingfully reviewed. 20 C.F.R. § 404.1545(a); Eichstadt, 534
F.3d at 665-66. If the ALJ thought that Arnett’s obesity
has not resulted in limitations on her ability to
work, he should have explained how he reached that
conclusion.
This error could conceivably be harmless if the ALJ
indirectly took obesity into account by adopting limita-
tions suggested by physicians who were aware of or
discussed Arnett’s obesity. Prochaska v. Barnhart, 454
F.3d 731, 736-37 (7th Cir. 2006); Skarbek, 390 F.3d at 504.
But it is not clear from the record that the limitations
the ALJ adopted met that standard. The ALJ did not
give full credit to the opinions of the physicians he men-
tioned, with the exceptions of Dr. Karnani and Dr. Rasp.
Dr. Karnani noted Arnett’s height and weight but
she never mentioned Dr. Robertson’s obesity diagnosis
or demonstrated that she took that diagnosis into ac-
No. 11-2424 15
count. Dr. Rasp characterized Arnett as mildly obese,
but referred to only Arnett’s COPD-related impairments
(and not her osteoarthritis) when assigning work limita-
tions. Several other physicians specifically discussed
Arnett’s obesity; the ALJ, however, either discounted
the opinions of these physicians or never mentioned
them. On such a record, we cannot find harmless er-
ror. See Spiva, 628 F.3d at 353.
Last, we agree with Arnett that the ALJ failed to formu-
late an RFC that is sufficiently specific as to how often
she must be able to sit and stand. The Commissioner
argues that she waived this argument. But Arnett raised
the issue of the ALJ’s RFC determination overall in
the district court, and this is sufficient. Schoenfeld v.
Apfel, 237 F.3d 788, 793 (7th Cir. 2001) (referring to the
waiver of general arguments); Ehrhart v. Sec’y of HHS,
969 F.2d 534, 537 (7th Cir. 1992) (referring to the waiver
of “issues”). An RFC must be specific about the re-
quired frequency of standing and sitting. SSR 96-9p,
1996 SSR LEXIS 6, at *18-19 (July 2, 1996). Arnett’s RFC
provides that she must be able to alternate between
sitting and standing “throughout the workday.” This
does not specify a particular frequency, and does not
require that Arnett be able to choose to sit or stand
when she feels it is necessary. See Ketelboeter v.
Astrue, 550 F.3d 620, 626 (7th Cir. 2008) (concluding
that RFC specifying applicant be able to alternate
between sitting and standing at applicant’s option was
adequate); Schmidt v. Astrue, 496 F.3d 833, 845 (7th Cir.
2007) (same).
16 No. 11-2424
For these reasons, we R EVERSE the district court’s judg-
ment and R EMAND this case to the agency for further
proceedings.
4-2-12