Stacy L. Childress, Plaintiff-Appellant,
Carolyn W. Colvin, Acting Commissioner of Social Security Defendant-Appellee.
December 13, 2016
from the United States District Court for the Central
District of Illinois. No. 2:14-CV-00297-CSB-DGB - Colin S.
Posner, Kanne, and Sykes, Circuit Judges.
POSNER, Circuit Judge.
plaintiff-appellant, Mr. Chil-dress, applied to the Social
Security Administration for disability benefits in 2008, when
he was 35. Turned down in 2010 after a hearing before an
administrative law judge, he appealed to the district court,
which initially remanded the case to the Social Security
Administration for reevaluation of the medical opinions in
the record and reconsideration of the plaintiff's
credibility. The upshot was a second hearing, held in 2013,
before the same administrative law judge, who again ruled
that Childress was not disabled; and this time the district
court affirmed, precipitating his appeal to us. He complains
that the administrative law judge again failed to give
sufficient weight to the opinions of his treating physicians
and did not accurately assess his credibility or his capacity
administrative law judge ruled in the second round that
Childress could perform only limited sedentary work (and
nothing more strenuous), because he is capable of standing
for only 25 to 30 minutes at a time and of walking 1 to 2
blocks at a time, adding up to a maximum of 2 hours a day of
either walking or standing; he is capable of sitting 45 to 60
minutes at a time, for a total of 6 hours a day; and he is
capable of carrying out workplace instructions-provided he
was given them no more than 30 days earlier. The
administrative law judge also ruled that he must avoid
strenuous work, dangerous machinery, unprotected heights, and
exposure to extreme heat.
medical evidence presented by Childress's treating
physicians was extensive. A cardiologist who had been
treating Childress for years, Dr. Theodore Addai, reported
that Childress suffers from congestive heart failure,
cardiomyo-pathy (another disease that diminishes cardiac
performance), severe asthma, COPD (chronic obstructive
pulmonary disease, actually one or more of a set of distinct
diseases, all of which however are debilitating, progressive,
and potentially fatal lung diseases), occasional chest pain,
obesity (he weighs 350 pounds yet is only 69 inches-five feet
nine inches-tall), hypertension, and dyspnea (difficult or
un- comfortable breathing, resulting in shortness of breath).
He was prescribed a number of medications: Advair,
Benazepril, Coreg, Diovan, Lanoxin, Lasix, Norvasc,
Proven-til, and Spiriva. We are not told whether any of them
have side effects that are harmful or that affect work
capacity, either in general or with specific respect to
percentage of blood pumped out of the ventricles with each
contraction of the heart (i.e., each heartbeat) is called the
"ejection fraction" (EF). The EF number helps a
health-care provider determine whether a patient has heart
disease. A normal heart has an EF of 50 to 75 percent in the
left ventricle. (The right ventricle can have a lower EF
without being abnormal, because it pumps blood only to the
lungs, whereas the left ventricle pumps blood to the rest of
2010, Childress's left-ventricle EF had fallen to 35 to
40 percent (though later in the year it rose to a normal 66
percent). The cardiologist estimated that in an eight-hour
workday Childress would be able to stand or walk for no more
than one hour and to sit for no more than two hours.
and downs continued, but the downs predominated. A stress
test in 2011 showed "poor exercise tolerance for his
age" (though he was still in his 30s). He had shortness
of breath even at home, fatigue, tingling sensations,
swelling in his feet and ankles, tightness in his chest,
flashes of light in his vision, tingling all over, and
continued diagnoses of serious heart problems. The following
year his ejection fraction fell to a dangerously low 20 to 25
percent, requiring implantation of a cardiac defibrillator.
The following year his ejection fraction rose to 30 to 35
percent, still abnormally low. Other heart problems that he
was diagnosed with in- eluded diastolic dysfunction, severely
dilated left ventricular chamber size, severely dilated left
and right atriums, and mild aortic valve insufficiency.
the ejection fraction the only evidence that Chil-dress's
left ventricle is impaired. If the left ventricle is wider
than 6 centimeters in its diastolic state (that is, when it
is expanded and full of blood), this indicates a severe
thinning of the heart muscle. See 20 C.F.R. Part 404, Subpart
P, App. 1, 4.02(A)(1). Childress's heart measurements
have consistently revealed that his left ventricle is more
than 6 centimeters wide. This was actually noted by the
administrative law judge at Childress's first hearing.
Yet at the second hearing, the one now under review, she did
not mention it, thus overlooking an important fact supportive
of his claim to be disabled.
doctor, Kari Cataldo, evaluated and treated Childress
beginning in 2008. Her diagnoses were similar to Dr.
Addai's, but with the addition of diagnosing crackles in
the lungs, bronchial markings, a hernia, acute bronchitis,
depression, a systolic heart murmur, increased lung markings,
increased dyspnea and chest pain, wheezing and coarse breath
sounds, edema (swelling) of the ankles, headaches, and pain
and swelling in the legs. In 2009 another doctor appeared on
the scene, Patrick Hartman, who diagnosed acute bronchitis
and hypertension, coarse breath sounds, shortness of breath,
coughing, fatigue, decreased exercise tolerance, severe
fatigue, congestive heart failure, chronic obstructive
pulmonary disease, obesity, etc., and an ejection fraction,
still subnormal, of 35 to 40 percent. Childress also had
painful cysts on his legs, which Dr. Hartman treated.
Hartman estimated that Childress would be able to sit for 3
hours total and stand or walk for 1 hour total in an 8-hour
workday, though he would also have to lie down for an hour
every 1 to 2 hours during the workday-which would reduce his
workday. If he lay down only every 2 hours, say at 11 a.m.
and 1 p.m. and 3 p.m., and his workday was 9 a.m. to 5 p.m.,
that would reduce the actual working part of his
"working day" to 5 hours (9 to 11 a.m., 12 to 1
p.m., 2 to 3 p.m., and 4 to 5 p.m.), rendering him
unemployable. Dr. Hartman also thought it likely that
Childress's medical symptoms would worsen in a work
environment, and he concluded that Childress is totally
disabled from gainful employment.
nonexamining state agency physicians looked at a severely
incomplete set of the plaintiff's medical records, and
concluded without any real evidence that he can walk about 6
hours a day and sit about 6 hours a day. The second such
physician summarily agreed with ...