Erik S. Israel v. CAROLYN W. COLVIN , Acting Commissioner of Social Security

In the
United States Court of Appeals
For the Seventh Circuit
No. 15‐3220
ERIK S. ISRAEL ,
Plaintiff‐Appellant,
v.
C AROLYN W. C OLVIN , Acting
Commissioner of Social Security,
Defendant‐Appellee.
Appeal from the United States District Court for the
Eastern District of Wisconsin.
No. 2:14‐cv‐01155‐WED — William E. Duffin, Magistrate Judge.
A RGUED SEPTEMBER 8, 2016 — D ECIDED OCTOBER 21, 2016
Before FLAUM, R OVNER , and SYKES, Circuit Judges.
R OVNER , Circuit Judge. Erik Israel applied for Social
Security disability benefits in 2007, and diligently pursued his
claim through administrative review. After many years of
review, error and delay, the Acting Commissioner of the Social
Security Administration (hereafter “Commissioner” or
“Agency”) issued a final decision denying his claim. Israel filed

-- 1 of 19 --

2 No. 15‐3220
suit in the district court to challenge that decision. The Com‐
missioner conceded in the district court that her decision was
not supported by substantial evidence and requested remand
to conduct additional proceedings. Israel, frustrated with years
of delay, sought a direct award of benefits. The district court
remanded the case to the Agency for additional proceedings
because the record, as it stands, does not compel a finding of
disability. Israel v. Colvin, No. 14‐CV‐1155, slip op. at 6‐7
(E.D. Wisc. Aug. 28, 2015). Because the district court did not
abuse its discretion in ordering a remand, we affirm. On
remand, the Agency should expedite proceedings so that the
matter may be resolved once and for all.
I.
In 2001, Israel injured his back while digging posts for a
porch. He continued to work while receiving various treat‐
ments but his pain worsened and he stopped working in
February 2003. Later that year, he underwent a lumbar
laminectomy and diskectomy.1 The surgery did not resolve his
pain and two surgeons determined that further surgery was
1 A laminectomy is a surgical procedure to remove the lamina, a part of the
bone that makes up a vertebra in the spine, in order to take pressure off of
spinal nerves or the spinal cord. https://medlineplus.gov/
ency/article/007389.htm (last visited October 11, 2016). Diskectomy is
surgery to remove all or part of a disk, the cushion that helps support part
of the spinal column and separate vertebrae. https://medlineplus.gov/
ency/article/007250.htm. All websites referenced in this opinion were last
visited October 11, 2016. Throughout the record, different sources uses
different spellings for the cushion separating vertebrae, some adopting
“disk” and others “disc.” We will use “disk” unless we are quoting a source
that uses the alternate spelling.

-- 2 of 19 --

No. 15‐3220 3
not an option. Under the care of various doctors and special‐
ists, Israel tried physical therapy, transcutaneous electrical
nerve stimulation (also called “TENS”),2 a dorsal column
stimulator,3 epidural injections,4 narcotic pain medications
including Methadone and morphine, lidocaine patches to block
nerves from sending pain signals, a muscle relaxer, an anti‐
depressant known to help with chronic pain, and drugs used
for nerve pain. Israel, who has been diagnosed with lumbar
radiculopathy 5 and post‐laminectomy pain syndrome (also
called Failed Back Surgery Syndrome), continues to experience
severely limiting pain despite these treatments. His doctor
sought approval from his insurance company to implement an
“intrathecal drug delivery system,” a pain pump that delivers
2 A TENS unit is a small box placed over the painful area that sends mild
electrical pulses to nerves. See http://www.niams.nih.gov/
Health_Info/Back_Pain/back_pain_ff.asp.
3 A dorsal column stimulator is a surgically implanted device used to
relieve pain by supplying a mild electric current to block nerve impulses in
the spine. See https://medlineplus.gov/ency/article/007560.htm.
4 Epidural injections for back pain typically involve the delivery of a
steroid, a powerful anti‐inflammatory medicine, directly into the space
outside of the sac of fluid around the spinal cord.
https://medlineplus.gov/ency/article/007485.htm.
5 “Radiculopathy is a condition caused by compression, inflammation
and/or injury to a spinal nerve root. Pressure on the nerve root results in
pain, numbness, or a tingling sensation that travels or radiates to other
areas of the body that are served by that nerve. Radiculopathy may occur
when spinal stenosis or a herniated or ruptured disc compresses the nerve
root.” http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm.

-- 3 of 19 --

4 No. 15‐3220
medication directly to the spinal cord. Despite repeated
requests, however, Israel’s insurer has refused to cover the cost
of the device. According to Israel, he spends much of his day
trying to manage his pain by elevating his legs in bed. He has
undergone four hernia repair surgeries because he uses
abdominal muscles to compensate for his back problems. At
times, he suffers debilitating side‐effects from the many
medications he takes in an attempt to control his pain, includ‐
ing memory and concentration problems, fatigue and swelling.
Israel filed applications for Disability Insurance Benefits
and Supplemental Security Income benefits on October 30,
2007. His first hearing before an administrative law judge
(“ALJ”) resulted in a denial of his claims in February 2010. The
Appeals Council vacated that ruling because it was not
supported by substantial evidence. The Appeals Council
directed the ALJ on remand to further evaluate Israel’s residual
functional capacity because the medical evidence was not
consistent with the ALJ’s finding that Israel could perform
light work. The Council also directed the ALJ to further
consider Israel’s credibility because the reasons given for
discrediting Israel’s allegations of pain were contradicted by
the record. The ALJ was further instructed to update the record
with any new medical evidence; give further consideration to
the opinions of Israel’s treating doctor, nurse practitioner and
examining occupational therapist; reevaluate Israel’s subjective
claims of pain; obtain expert medical opinion preferably from
a pain management specialist; reconsider Israel’s residual
functional capacity; and obtain supplemental evidence from a
vocational expert.

-- 4 of 19 --

No. 15‐3220 5
The same ALJ conducted a second hearing and again
rejected Israel’s claim in July 2011. The Appeals Council again
vacated the decision and remanded for further proceedings,
this time finding an error of law. Apparently, the ALJ held a
video hearing at which she ordered the claimant to attend a
post‐hearing consultative medical examination. A little more
than two weeks later, before Israel could attend the scheduled
exam, the ALJ rejected his claim. Israel nevertheless kept the
appointment and the next month, the ALJ issued an amended
decision discussing the new consultative exam report and
again rejecting Israel’s claim. But there was no evidence that
Israel had received the report or that he had waived his right
to see it. Nor was there evidence that the ALJ provided the
amended decision to Israel. On remand, the Appeals Council
directed that the matter be assigned to a different ALJ; that the
new ALJ proffer the consultative exam report to Israel; that the
ALJ obtain additional evidence concerning Israel’s impair‐
ments; that the ALJ reevaluate Israel’s subjective complaints of
pain; that the ALJ give further consideration to Israel’s residual
functional capacity; and that the ALJ again obtain evidence
from a vocational expert to clarify the effect of Israel’s assessed
limitations on the occupational base.
A new ALJ held a third hearing and denied Israel’s claim in
April 2014. This time, the Appeals Council denied the request
for review, and Israel filed this suit. In his brief in support of
reversing the decision of the Commissioner, Israel sought a
reversal without remand and an award of benefits. In the
alternative, he requested that the court reverse the decision of
the Commissioner and remand for a new hearing. In response,
the Commissioner conceded that the decision was not sup‐

-- 5 of 19 --

6 No. 15‐3220
ported by substantial evidence, and moved for remand in
order to gather more evidence and conduct additional proceed‐
ings. The Commissioner contended that, although Israel
produced evidence supporting his claim of disability, other
evidence in the record could be construed to undermine his
claim of disabling limitations. At that point, Israel opposed a
remand, instead seeking an immediate award of benefits. The
district court concluded that, because the record did not
compel a finding that Israel is disabled, the case should be
remanded to the Agency for further proceedings. Israel, slip op.
at 6‐7.
The district court noted that there is ample evidence
supporting Israel’s claim that he is disabled, including the
opinions of his treating physician Dr. Donald Harvey (a pain
specialist) and his treating physician assistant, Ms. Dawn
Nehls. Id. at 3‐4. They opined that Israel could sit continuously
for only one hour at a time and for a total of less than two
hours in an eight‐hour work day; that he could stand continu‐
ously for only fifteen minutes and could stand or walk for a
total of less than two hours in a work day; that he could
occasionally lift ten pounds or less and could never lift twenty
pounds or more; that he would need to lie down for one to two
hours during the work day in order to relieve pain and fatigue;
that he needs to be able to shift positions at will; that he
requires a cane; that he is not at all able to bend or twist at the
waist; that he experiences constant interference with attention
and concentration due to pain; that he is extremely limited in
his ability to deal with the normal stresses of competitive
employment; and that he would be absent from work more
than three days per month. Their opinions were consistent

-- 6 of 19 --

No. 15‐3220 7
with that of an examining occupational therapist, Mr.
Bergthold, and a vocational expert opined that these limita‐
tions would preclude full‐time employment.6
But the court noted that the evidence was not entirely one‐
sided. Two non‐examining physicians, Pat Chan, M.D. and
Laura Rosch, D.O., reviewed the record and concluded that
Israel could frequently lift ten pounds, sit for six hours in an
eight‐hour work day, and stand or walk for six hours in an
eight hour work day, which would enable him to perform
sedentary work under Social Security standards. The court also
noted two MRI reports, from 2007 and 2010, that the court
characterized as “inconsistent with Israel’s disability claim”
“on their face.” Israel, slip op. at 5. The court acknowledged
that the opinions of the non‐treating physicians could not alone
justify summarily rejecting the opinions of the treating physi‐
cian, physician assistant and examining occupational therapist.
Because the record contained medical evidence that supported
a finding of disability and also included evidence that sup‐
ported a contrary finding, the court was persuaded that
remand was necessary to resolve the claim. Israel appeals.
II.
The district court entered the remand order under its
statutory authority “to enter, upon the pleadings and transcript
of the record, a judgment affirming, modifying, or reversing
6 In its Decision and Order, the district court condensed the opinions of Dr.
Harvey and Ms. Nehls. We include a more complete outline of the medical
source opinions, which can be found at pages 589‐97 of the Administrative
Record (hereafter “A.R.”).

-- 7 of 19 --

8 No. 15‐3220
the decision of the Commissioner of Social Security, with or
without remanding the cause for a rehearing.” 42 U.S.C.
§ 405(g). Our review at this stage is very limited. “When the
district court remands a case to the Social Security Administra‐
tion for further proceedings, but declines to instruct the
Commissioner to calculate and award benefits, we review the
latter decision only for an abuse of discretion.” Allord v. Astrue,
631 F.3d 411, 415‐16 (7th Cir. 2011); Nelson v. Apfel, 210 F.3d
799, 801‐02 (7th Cir. 2000). We will affirm the district court’s
judgment unless no reasonable person could agree with the
decision. Allord, 631 F.3d at 416.
Israel contends that the court abused its discretion in
ordering the remand for a fourth administrative hearing rather
than awarding benefits outright. He argues that the record
contains ample evidence supporting a finding of disability and
no evidence that provides a reasonable basis to discredit that
conclusion. Israel maintains that the opinions of two non‐
treating physicians cannot overcome the well‐documented
opinions of his treating health care providers. Nor can an MRI
alone discredit his subjective claim of disabling pain because
objective medical tests such as x‐rays and MRIs cannot
establish the intensity of a person’s pain, he contends. The
Commissioner responds that the opinions of the non‐treating
physicians in combination with the MRI results, physical
examination results and the opinion of a consulting physician,
Dr. Ayaz Samadani, could warrant discounting the opinions of
the treating physician and other providers, and that there are
factual issues that must be resolved. Because the record
evidence is mixed, the Commissioner contends that remand for
further proceedings was a reasonable decision.

-- 8 of 19 --

No. 15‐3220 9
Israel is correct that a “treating physicianʹs opinion regard‐
ing the nature and severity of a medical condition is entitled to
controlling weight if it is well supported by medical findings
and not inconsistent with other substantial evidence in the
record.” Gudgel v. Barnhart, 345 F.3d 467, 470 (7th Cir. 2003). See
also Moore v. Colvin, 743 F.3d 1118, 1127 (7th Cir. 2014) (regula‐
tions require that the ALJ give the opinions of a treating
physician controlling weight as long as they are supported by
medical findings and consistent with substantial evidence in
the record); Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2011)
(same). We give more weight to the opinions of treating
physicians because they are most familiar with the claimant’s
conditions and circumstances. Gudgel, 345 F.3d at 470. An ALJ
must offer good reasons for discounting the opinion of a
treating physician. Moore, 743 F.3d at 1127. See also Gudgel,
345 F.3d at 470 (an ALJ can reject an examining physicianʹs
opinion only for reasons supported by substantial evidence in
the record). A contradictory opinion of a non‐examining
physician does not, by itself, suffice as a justification for
discounting the opinion of the treating physician. Gudgel,
345 F.3d at 470. See also Beardsley v. Colvin, 758 F.3d 834, 839
(7th Cir. 2014) (an ALJ must provide a valid explanation for
preferring a record reviewerʹs analysis over that of an examin‐
ing doctor).
In the district court, the Commissioner conceded that the
ALJ failed to adequately evaluate the opinion from the treating
source, Dr. Harvey, a pain specialist, and his physician
assistant, Ms. Nehls. The Commissioner further admitted that
the reasons given by the ALJ for assigning little weight to the
opinions of Dr. Harvey and Ms. Nehls were “insufficient,” and

-- 9 of 19 --

10 No. 15‐3220
that the ALJ had also failed to adequately evaluate the opinion
of the examining occupational therapist, Mr. Bergthold, whose
assessment was consistent with the opinions of the treating
providers. The Commissioner also agreed below and agrees on
appeal that the opinions of Dr. Harvey, Ms. Nehls and Mr.
Bergthold support a finding of disability. But the Commis‐
sioner nonetheless contends that the opinions of other medical
sources provide evidence that would support a contrary result.
Given that the Agency has conceded that Israel has pro‐
duced substantial evidence of disability, we turn to the
evidence that the Commissioner asserts could undermine that
conclusion. The Commissioner relies in part on the opinions of
the non‐treating physicians, Drs. Chen and Rosch, as well as
the opinion of the consultative examining physician, Dr.
Samadani. The ALJ did not mention or rely upon the opinions
of Drs. Chen and Rosch, and the Commissioner does not
explain why these opinions are entitled to any weight let alone
more weight than that of the treating physician. See Gudgel,
345 F.3d at 470; Beardsley, 758 F.3d at 839. Moreover, we note
that Israel’s treating physician is a specialist in the area of pain
management, and the non‐examining opinions came from
internists with no special training or expertise as to pain. Social
Security regulations specify that particular weight be given to
the opinions of specialists related to their areas of expertise.
20 C.F.R. § 416.927(c)(5) (“We generally give more weight to
the opinion of a specialist about medical issues related to his or
her area of specialty than to the opinion of a source who is not
a specialist.”). That is not to say that an ALJ could not give any
weight to the opinions of the non‐treating physicians; to date,

-- 10 of 19 --

No. 15‐3220 11
however, the ALJ has not explained the value of the non‐
treating physician opinions, if any.
Although Drs. Chen and Rosch concluded that Israel was
capable of performing light work, 7 Dr. Samadani did not offer
a definitive opinion on Israel’s ability to work. Instead, Dr.
Samadani opined that Israel suffered from post‐laminectomy
lower back pain and left lumbar radiculopathy, diagnoses
consistent with the opinions of his treating providers. In a
paragraph titled “Ability to Perform Work Functions,” Dr.
Samadani said only that Israel has “subjective limitations as
described,” but was able to “sit, stand, walk, handle objects,
see, hear, speak, and travel. He required help in ambulation.
He was walking with the cane. He was slow in his walking
pace and complained of constant pain in the lower back.”
A.R. at 656. As for the “subjective limitations,” Dr. Samadani
noted earlier in his report that Israel complained of constant
pain that is between 8 and 9 on a 0‐to‐10 scale; that he had
reported that all of his activities are restricted by his pain; that
he cannot drive a car and needs help putting on his shoes and
dressing; that his gait and station were stable but he was
“uncertain to convert regular walking to tandem walk;” that he
leaned to the side and was afraid of falling due to his lower
back pain; and that bending down or lifting his legs when
sitting or lying down caused pain in his lower back. A.R. at
654‐55. Consistent with Dr. Samadani’s report, the ALJ who
7 The third ALJ found that Israel’s condition had declined after the agency
doctor opined that he could perform light work. The ALJ determined that
Israel was “further deconditioned to the point he would now be limited to
sedentary types of activity.” A.R. at 26.

-- 11 of 19 --

12 No. 15‐3220
conducted the third hearing observed that Israel “appeared
overweight and seriously deconditioned, relied heavily on a
cane to ambulate, and alternated between sitting and standing
during the proceedings.” A.R. at 25.
The Commissioner argues on appeal that Dr. Samadani’s
opinion could be read to support a finding that Israel is not
disabled because the report implies that only Israel’s ability to
walk is impaired. Regulations require consulting doctors to
report what an individual can do despite his or her impair‐
ments, the Commissioner asserts, and so Dr. Samadani
arguably would have reported additional functional limita‐
tions if he determined that Israel had them. We first note that
the district court did not rely on Dr. Samadani’s opinion in
ordering a remand, and it would be difficult to judge whether
the court abused its discretion based on evidence that the court
admittedly did not consider. Nevertheless, the Commissioner’s
reading of Dr. Samadani’s opinion is quite a stretch when
reading the report as a whole. First, Dr. Samadani acknowl‐
edged but did not fully list “subjective limitations as de‐
scribed,” so we may equally assume that Israel has functional
limitations not expressly included in the report. Second, the
Commissioner largely relies on the absence of information in
Dr. Samadani’s report to establish facts, when the regulations
do not require that a consulting physician report all limitations
to the ALJ. See Thomas v. Colvin, 745 F.3d 802, 808 (7th Cir.
2014) (ultimate responsibility for determining a claimant’s
residual functional capacity rests on the ALJ and not on an
examining doctor). Moreover, nothing in Dr. Samadani’s
report is inconsistent with the opinions of Dr. Harvey and Ms.
Nehls. And finally, Dr. Samadani’s report fails to gauge the

-- 12 of 19 --

No. 15‐3220 13
duration or frequency of Israel’s limitations or abilities,
rendering his opinion too vague and incomplete to be of much
use in assessing Israel’s overall limitations.
The ALJ who denied Israel’s claim after the third hearing
discounted the opinions of Dr. Harvey and Ms. Nehls because
their functional assessment of Israel “clearly overstated overall
limitations.” A.R. at 25. As an example of the overstatement,
the ALJ cited what he characterized as a claim in the assess‐
ment that Israel has “little to no use of his hands/fingers,” a
finding that the ALJ asserted was unsupported in the record.
A.R. at 25. But the ALJ had misread the functional assessment:
Dr. Harvey and Ms. Nehls had said the exact opposite of this,
indicating instead that Israel had full use of his hands and
fingers. The assessment asked whether the patient had
“significant limitations in the ability to use hands and fingers
for actions in a competitive job.” A.R. at 597. Ms. Nehls (joined
by Dr. Harvey) checked the “no” box eight times, for “grasp,
twist,” “turn objects,” “fine manipulation,” and “reaching,
including overhead,” for both right and left hands. A.R. at 597.
Those responses indicated no significant limitations in those
areas. But the ALJ’s misreading of the response caused him to
believe that Ms. Nehls and Dr. Harvey had exaggerated Israel’s
limitations. Perhaps that is why the Commissioner agreed in
the district court that the reasons given to discount the opin‐
ions of the treating providers were “insufficient,” an under‐
statement given the nature of the error.
The Commissioner also maintains that the MRI results in
combination with the opinions of the non‐treating internists
could support a finding that Israel is not disabled, if the
opinions of non‐treating physicians are insufficient by them‐

-- 13 of 19 --

14 No. 15‐3220
selves to overcome the well‐supported opinion of the treating
doctor. So we turn to the MRI reports. Without citing any
medical opinion to this effect, the district court characterized
the 2007 and 2010 MRIs as inconsistent on their face with
Israel’s claim of disability. There is always a danger when
lawyers and judges attempt to interpret medical reports and
that peril is laid bare here. See Browning v. Colvin, 766 F.3d 702,
705 (7th Cir. 2014) (noting that administrative law judges are
not permitted to “play doctor”). In noting the so‐called
inconsistency, the district court cited a 2010 letter from Israel’s
lawyer as characterizing his primary impairment as “degener‐
ative disc disease, particularly at L4‐S1 vertebrate, and her‐
nias.” Israel, slip op. at 5. The letter cited actually says that
Israel “alleges disability due to degenerative disc disease with
degenerative changes at L5‐S1, status post diskectomy,
laminectomy, and fusion; L4‐5 disc bulging; and history of
repair of multiple hernia defects.” A.R. at 449.8 First, the district
court incorrectly noted the location of the claimed degenerative
disk changes. Second, at the risk of making the same mistake
the district court made, the 2007 MRI report appears consistent,
at least in part, with Israel’s claims:
There are degenerative endplate changes noted at
L5‐S1, this is the level of prior left hemilamin‐
ectomy/diskectomy. Degenerative disk disease is
present at this level but there is only mild broad‐
based disk bulging and probable mild scar tis‐
sue/fibrosis creating very minimal mass effect/
8 Israel’s lawyer later clarified at the hearing that Israel had undergone a
laminectomy and diskectomy but not a fusion procedure.

-- 14 of 19 --

No. 15‐3220 15
stenosis. The left S1 nerve root remains mildly
enlarged with a probable mild element of stenosis.
A.R. at 520. As for L4‐5, the 2007 MRI reports a “very mild
element of broad‐based disk bulging” that had decreased since
a 2005 MRI, “a minor element of ligamentum flavum thicken‐
ing and mild posterior facet sclerosis,” as well as “minimal
overall spinal stenosis,” and “no major neural foraminal
narrowing.” A.R. at 519. The 2007 MRI seemingly supports
Israel’s claim of degenerative disk disease. Similarly, the 2010
MRI notes “[s]table minimal broad‐based disk bulging” at L4‐5
“with associated minimal facet osteoarthritis and ligamentum
flavum hypertrophy.” A.R. at 651. At L5‐S1, the 2010 report
indicated, “[m]ild stable broad‐based disk bulging and
endplate marrow signal change … with stable post‐operative
changes of a left L5 laminectomy. Findings result in minimal
effacement of the anterior thecal sac. There is stable minimal
bilateral neural foraminal narrowing.” A.R. at 651. Because no
physician in the record has opined on whether these results are
consistent with Israel’s claim of disabling pain, and because the
reports are replete with technical language that does not lend
itself to summary conclusions, we cannot say whether the
results support or undermine Israel’s claim. Israel’s treating
physician was aware of these results and apparently did not
find them inconsistent with Israel’s subjective report of
disabling pain. On remand, these records should be reviewed
by a physician to determine whether they are in fact consistent
with Israel’s claim of disability.
But even if a physician determines that the MRIs do not
support a subjective claim of pain, we have repeatedly stated
that “an individualʹs statements about the intensity and

-- 15 of 19 --

16 No. 15‐3220
persistence of pain or other symptoms or about the effect the
symptoms have on his or her ability to work may not be
disregarded solely because they are not substantiated by
objective medical evidence.” Cole v. Colvin, 831 F.3d 411, 416
(7th Cir. 2016) (quoting Hall v. Colvin, 778 F.3d 688, 691 (7th
Cir. 2015)); Adaire v. Colvin, 778 F.3d 685, 687 (7th Cir. 2015)
(noting the recurrent error in decisions of Social Security ALJs
of discounting pain testimony that canʹt be attributed to
“objective” injuries or illnesses that can be revealed by x‐rays,
and collecting cases). See also Moss v. Astrue, 555 F.3d 556, 561
(7th Cir. 2009) (an ALJ cannot disregard subjective complaints
of disabling pain just because a determinable basis for pain of
that intensity does not stand out in the medical record). “If the
medical record does not corroborate the level of pain reported
by the claimant, the ALJ must develop the record and seek
information about the severity of the pain and its effects on the
applicant.” Moss, 555 F.3d at 561. And the district court itself,
after first claiming the MRI reports to be inconsistent with
Israel’s claim, noted that a medical source’s opinion was
required “to assess the extent, if any, to which this medical
evidence is inconsistent with the alleged disability.” Israel, slip
op. at 6. The Commissioner cites no such opinion, despite the
repeated orders of the Appeals Council that the reviewing ALJ
should seek additional medical evidence to clarify the nature
and severity of Israel’s impairments.
So the opinions of the non‐treating generalists may not
generally overcome those of the treating specialist unless the
specialist’s opinions are inconsistent with substantial record
evidence. And the MRIs alone are insufficient to allow an ALJ
to discount the claimant’s subjective claim of disabling pain,

-- 16 of 19 --

No. 15‐3220 17
especially because the MRIs have not been characterized by
any medical source as inconsistent with Israel’s claim of
disabling pain. Dr. Samadani’s opinion adds little to the
calculus because he failed to take a definitive stance on the key
issue of Israel’s abilities to perform tasks essential to work and
to his capacity to persist in those tasks in a manner that would
allow him to hold full‐time employment.
Israel has a lengthy medical history that begins with a
specific injury, continues through a failed surgery resulting in
a diagnosis consistent with persistent pain (a diagnosis
affirmed by Dr. Samadani, the State’s own doctor), and
proceeds through a lengthy series of failed attempts to control
Israel’s pain. Israel has undergone painful and risky proce‐
dures in attempts to alleviate his pain, actions that would seem
to support the credibility of his claims regarding the severity
of his pain. See Carradine v. Barnhart, 360 F.3d 751, 755 (7th Cir.
2004) (noting the improbability that a claimant would have
undergone extensive pain‐treatment procedures that included
not only heavy doses of strong drugs but also the surgical
implantation in her spine of a spinal‐cord stimulator, “merely
in order to strengthen the credibility of her complaints of pain
and so increase her chances of obtaining disability benefits”).
Yet the last ALJ to assess his claims found him “not entirely
credible,” “somewhat credible,” and “partially credible,”
vague findings based largely on documented misunderstand‐
ings of the record. See Moss, 555 F.3d at 561 (we will uphold an
ALJʹs credibility determination if the ALJ gave specific reasons
for the finding that are supported by substantial evidence).
Although Israel presents a strong claim for an award of
benefits, we cannot say that the district court abused its

-- 17 of 19 --

18 No. 15‐3220
discretion in remanding. The ALJ failed to gather the evidence
to make the findings necessary to resolve the ultimate question
of whether Israel’s pain disables him from working. Israel has
presented substantial evidence which can be read in favor of
an award of benefits, but the record also includes some
evidence that could be read to undermine his claim, including
the opinions of two non‐treating internists, MRI results that
have yet to be interpreted by a competent medical source, the
incomplete opinion of a State doctor, and physical examination
findings over the years that present an unclear picture of the
effectiveness of various treatments for his persistent pain.
Because of these uncertainties in the record, we must conclude
that the district court did not abuse its discretion in remanding
for a fourth hearing.
Israel’s patience has understandably grown thin. We agree
that it should not take nine years to determine whether a
claimant’s impairments prevent him from engaging in full‐
time employment, especially a claimant who appears to have
a well‐documented and well‐supported claim for disability.
Israel believes he is entitled to a directed award of benefits at
this stage, citing Wilder v. Apfel, 153 F.3d 799 (7th Cir. 1998). But
the record in this case is not as severely lopsided as it was in
Wilder, and we do not perceive the same level of obduracy on
the part of the Agency. See Briscoe ex rel. Taylor v. Barnhart,
425 F.3d 345, 356 (7th Cir. 2005) (“Another remand for further
proceedings was unnecessary in Wilder because after two
evidentiary hearings, the ALJ had no reasonable grounds to
reject the claimantʹs claim.”). “It remains true that an award of
benefits is appropriate only if all factual issues have been
resolved and the record supports a finding of disability.”

-- 18 of 19 --

No. 15‐3220 19
Briscoe, 425 F.3d at 356. If the case returns to this court with the
Agency seeking a fifth hearing, our analysis may change. After
this remand, the Agency may not simply persist in pointing to
unexplained MRI results or non‐treating physician opinions as
undermining Israel’s claim. If the Agency again rejects Israel’s
claim, it must provide a logical basis, supported in the record,
to disregard the well‐founded opinions of Israel’s treating
physician, physician assistant, and the independent occupa‐
tional therapist, not to mention the extensive history of
procedures and treatments Israel has endured and his own
testimony regarding the severity of his pain. We strongly
encourage the Agency to expedite the proceedings in order to
resolve Israel’s claims once and for all.
AFFIRMED.

-- 19 of 19 --