Johnson v. Barnhart

Decision Date05 June 2006
Docket NumberNo. 05-3797.,05-3797.
Citation449 F.3d 804
PartiesMichelle JOHNSON, Plaintiff-Appellant, v. Jo Anne B. BARNHART, Commissioner of Social Security, Defendant-Appellee.
CourtU.S. Court of Appeals — Seventh Circuit

Barry A. Schultz (argued), Evanston, IL, for Plaintiff-Appellant.

Cristine Bautista (argued), Social Security Administration Office of the General Counsel, Chicago, IL, for Defendant-Appellee.

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 highschool 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 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 5½ 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).

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, 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,"...

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