Jennifer Moore v. Carolyn Colvin , 743 F.3d 1118 ( 2014 )


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  •                               In the
    United States Court of Appeals
    For the Seventh Circuit
    No. 13-2460
    JENNIFER LEE MOORE,
    Plaintiff-Appellant,
    v.
    CAROLYN W. COLVIN, Acting
    Commissioner of Social Security,
    Defendant-Appellee.
    Appeal from the United States District Court for the
    Northern District of Illinois, Eastern Division.
    No. 11 C 6153 — Susan E. Cox, Magistrate Judge.
    ARGUED JANUARY 15, 2014 — DECIDED FEBRUARY 27, 2014
    Before FLAUM, EASTERBROOK, and ROVNER, Circuit Judges.
    ROVNER, Circuit Judge. Jennifer Lee Moore filed an applica-
    tion for disability benefits under the Social Security Act,
    alleging that she became disabled on September 6, 2007. After
    a hearing, an Administrative Law Judge (ALJ) concluded that
    Moore suffered from a number of severe impairments, but that
    she was capable of performing her past work and therefore
    2                                                    No. 13-2460
    was not entitled to disability benefits. The district court
    affirmed, and Moore appeals that determination to this court.
    When the Appeals Council denies review as it did in this
    case, the ALJ’s decision constitutes the final decision of the
    Commissioner. Villano v. Astrue, 
    556 F.3d 558
    , 561–62 (7th Cir.
    2009). Because our review of the district court’s affirmance is
    de novo, we review the ALJ’s decision directly. Pepper v. Colvin,
    
    712 F.3d 351
    , 361 (7th Cir. 2013). We will uphold the ALJ’s
    decision if it is supported by substantial evidence, that is,
    “such relevant evidence as a reasonable mind might accept as
    adequate to support a conclusion.” Richardson v. Perales, 
    402 U.S. 389
    , 401 (1971); McKinzey v. Astrue, 
    641 F.3d 884
    , 889 (7th
    Cir. 2011); Scott v. Astrue, 
    647 F.3d 734
    , 739 (7th Cir. 2011);
    Pepper, 712 F.3d at 361–62. Although we will not reweigh the
    evidence or substitute our own judgment for that of the ALJ,
    we will examine the ALJ’s decision to determine whether it
    reflects a logical bridge from the evidence to the conclusions
    sufficient to allow us, as a reviewing court, to assess the
    validity of the agency’s ultimate findings and afford Moore
    meaningful judicial review. Young v. Barnhart, 
    362 F.3d 995
    ,
    1002 (7th Cir. 2004); Roddy v. Astrue, 
    705 F.3d 631
    , 636 (7th Cir.
    2013); Pepper, 712 F.3d at 362; Villano, 
    556 F.3d at 562
    . A
    decision that lacks adequate discussion of the issues will be
    remanded. 
    Id.
    In determining whether a person is disabled, an ALJ applies
    a five-step sequential evaluation process. At step one, the ALJ
    considers whether the claimant is engaged in substantial
    gainful activity. 
    20 C.F.R. §§ 404.1520
    (b) and 416.920(b). Moore
    was not so engaged, and therefore the analysis proceeds to the
    second step, which is a consideration of whether the claimant
    No. 13-2460                                                   3
    has a medically determinable impairment, or combination of
    impairments, that is “severe.” 
    20 C.F.R. §§ 404.1520
    (c) and
    416.920(c).
    In order for an impairment to be considered severe at this
    step of the process, the impairment must significantly limit an
    individual’s ability to perform basic work activities. If the
    evidence indicates that an impairment is a slight abnormality
    that has no more than a minimal effect on an individual’s
    ability to work, then it is not considered severe for Step 2
    purposes. Here, the ALJ determined that Moore had the
    following severe impairments: migraine headaches; asthma;
    morbid obesity; and rheumatoid arthritis. The ALJ concluded
    that those impairments imposed more than minimal limita-
    tions on Moore’s ability to perform basic work-related activi-
    ties. The ALJ concluded that a number of other impairments
    impacting Moore were not severe, including irritable bowel
    syndrome, gastroesophageal reflux disease, hypertension,
    hypothyroid and prolactin irregularities, carpal tunnel syn-
    drome, depression, anxiety, and possible Crohn’s disease.
    At Step 3, the ALJ determined that those severe impair-
    ments did not meet or equal the criteria of an impairment
    listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. Accord-
    ingly, the ALJ proceeded to Step 4, at which point the claimant
    has the burden to demonstrate whether she is capable of
    performing her past relevant work. Young, 
    362 F.3d at 1000
    . At
    this stage, the ALJ first considers the claimant’s residual
    functional capacity (RFC), which is the claimant’s ability to do
    physical and mental work activities on a regular and continu-
    ing basis despite limitations from her impairments. Id.; Pepper,
    712 F.3d at 362. The ALJ concluded that Moore had the
    4                                                  No. 13-2460
    residual functional capacity to perform sedentary work as
    defined in 
    20 C.F.R. §§ 404.1567
    (a) and 416.967(a) except that
    she must avoid concentrated exposure to extreme cold,
    extreme heat, noise, fumes, odors, dusts, gases, poor ventila-
    tion, hazardous machinery, and heights. The ALJ’s calculations
    of Moore’s RFC, and the ultimate determination at Step 4 that
    Moore could perform her past relevant work as a reservation
    agent, is the focus of the challenge in this appeal.
    Moore argues on appeal that the ALJ erred at Step 4 in
    determining the limitations and restrictions imposed upon
    Moore’s work by her chronic migraines, and that the ALJ also
    erred in her credibility assessment of Moore. The ALJ’s RFC
    determination in this case, and the limitations presented to the
    vocational expert that followed from that determination, are
    conclusory and are based on findings that failed to address the
    record as a whole. Accordingly, a remand is necessary.
    The ALJ acknowledged her obligation to evaluate the
    intensity, persistence, and limiting effects of symptoms of
    Moore’s impairments including the chronic migraines, and to
    determine the degree of effect on functioning. In calculating
    that residual functional capacity, she stated that whenever
    statements concerning the intensity, persistence or functionally
    limiting effects of pain or other symptoms are not substanti-
    ated by objective medical evidence, she must make a finding
    concerning the credibility of the statements based upon the
    evidence in the record as a whole. The ALJ then noted that
    Moore maintained that her migraines are debilitating, and
    cause her to stay in bed much of the day, render her unable to
    deal with light and sound, and result in a heightened sense of
    smell that aggravates her nausea and headaches. Using
    No. 13-2460                                                     5
    “boilerplate” language often included in disability determina-
    tions, the ALJ then concluded: “[a]fter careful consideration of
    the evidence, I find that the claimant’s medically determinable
    impairments could reasonably be expected to cause the alleged
    symptoms; however, the claimant’s statements concerning the
    intensity, persistence and limiting effects of these symptoms
    are not credible to the extent they are inconsistent with the
    above residual functional capacity assessment.”
    We have repeatedly condemned the use of that boilerplate
    language because it fails to link the conclusory statements
    made with objective evidence in the record. Pepper, 712 F.3d at
    367; Bjornson v. Astrue, 
    671 F.3d 640
    , 644–45 (7th Cir. 2012);
    Filus v. Astrue, 
    694 F.3d 863
    , 868 (7th Cir. 2012); Shauger v.
    Astrue, 
    675 F.3d 690
    , 696 (7th Cir. 2012). In short, it fails to
    elucidate at all the basis for the RFC determination. Pepper, 712
    F.3d at 367. It “puts the cart before the horse, in the sense that
    the determination of capacity must be based on the evidence,
    including the claimant’s testimony, rather than forcing the
    testimony into a foregone conclusion.” Filus, 694 F.3d at 868.
    We have held, however, that the use of such boilerplate
    language will not automatically discredit the ALJ’s ultimate
    conclusion if the ALJ otherwise identifies information that
    justifies the credibility determination. Pepper, 712 F.3d at
    367–68. Here, the ALJ proceeded to engage in a more detailed
    credibility analysis, thus providing a basis for us to review that
    assessment.
    In considering Moore’s credibility, the ALJ first recited the
    history of Moore’s treatment for migraines, but the ALJ related
    only a narrow portion of that medical evidence. The ALJ noted
    that Moore was diagnosed with intractable migraines and
    6                                                  No. 13-2460
    underwent implantation of a subcutaneous occipital nerve
    stimulator at the University of Illinois Hospital at Chicago
    (“UIC Hospital”) in February 2007. The ALJ then stated that
    the surgery worked well until the battery was depleted in May
    2008, at which time the depleted battery was replaced with a
    rechargeable battery. In addition, the ALJ noted that the record
    was replete with emergency room visits, but that Moore’s own
    doctors—Dr. Leonard Robinson and Dr. Bridgette Arnett—as
    well as the emergency room physicians have questioned
    Moore’s emergency room visits as problematic or drug-
    seeking. The ALJ proceeded to detail the notations in the
    record indicating such a concern with Moore’s drug-seeking
    tendencies, including a statement that Moore’s “own parents
    have observed this behavior as potential addiction to narcotic
    pain medication.” The ALJ concluded “[w]hile the claimant’s
    noncompliant and drug-seeking behaviors do not singularly
    discount her credibility, I find persuasive the observations of
    her own treating and examining providers as well as her
    parents that the emergency room [visits] are related to medica-
    tion seeking rather than mere migraine control.”
    The ALJ did not err in considering the evidence that
    Moore’s emergency room visits may have been related to an
    addiction problem rather than evidence of debilitating mi-
    graines, but the ALJ erred in utterly failing to even acknowl-
    edge the contrary evidence or to explain the rationale for
    crediting the identified evidence over the contrary evidence.
    We have repeatedly held that although an ALJ does not need
    to discuss every piece of evidence in the record, the ALJ may
    not analyze only the evidence supporting her ultimate conclu-
    sion while ignoring the evidence that undermines it. Terry v.
    No. 13-2460                                                      7
    Astrue, 
    580 F.3d 471
    , 477 (7th Cir. 2009); Myles v. Astrue, 
    582 F.3d 672
    , 678 (7th Cir. 2009); Arnett v. Astrue, 
    676 F.3d 586
    , 592
    (7th Cir. 2012). The ALJ must confront the evidence that does
    not support her conclusion and explain why that evidence was
    rejected. Indoranto v. Barnhart, 
    374 F.3d 470
    , 474 (7th Cir. 2004).
    The ALJ in this case presented only a skewed version of the
    evidence.
    For instance, the ALJ declared that Moore’s “own parents
    have observed this behavior as potential addiction to narcotic
    pain medication.” The record indeed includes evidence that the
    parents were concerned with whether Moore was becoming
    addicted to the pain medication that she sought for treating her
    migraines. What the ALJ failed to address in relying on that,
    however, is the testimony of Moore’s mother that when she
    expressed such concerns, Moore’s doctors assured her that
    Moore was not addicted and needed the help being given.
    Moore’s mother further stated that Dr. Thomas Bartuska,
    Moore’s treating psychiatrist, made that assurance three or
    four years earlier, and that she subsequently received the same
    message from the neurosurgeon and treating neurologist at
    UIC Hospital a few months after Moore was enrolled in the
    headache study and approved for the stimulator surgery. That
    testimony was corroborated by treatment notes from Dr.
    Bartuska from that time period, which include a statement that
    “I see no evidence for opioid dependence.”
    Furthermore, the ALJ’s recitation of the medical evidence
    fails to recognize the years of records, from at least 2003
    onward, by her treating physicians relating Moore’s chronic
    painful migraines accompanied by photophobia and nausea
    and vomiting. Similarly, the ALJ detailed the concerns of
    8                                                   No. 13-2460
    emergency room physicians that she was drug-seeking, but did
    not recognize that the vast majority of emergency room visits
    in that time period reflected that she was experiencing severe
    migraine pain and provided treatment for that malady,
    without any corresponding concern of drug abuse. The ALJ
    repeatedly references Dr. Arnett’s opinion—referring to a letter
    from Dr. Arnett to Dr. Robinson in which Dr. Arnett states that
    she had received calls from emergency rooms about Moore
    seeking drug treatment there since she was thought to be drug-
    seeking by the physicians around her—as an opinion by Dr.
    Arnett that Moore’s emergency room visits are related to drug-
    seeking, not migraines. In that letter, however, after recounting
    those conversations, Dr. Arnett states as her “Impression” that
    Moore presents with migraine headaches, exacerbated by
    stress, and that Moore is under increased stress due to a need
    to care for Moore’s mother who was post-surgery for cervical
    stenosis, and her “Recommendation” is that Moore would
    benefit from a university setting with multiple studies for
    headaches because she was inadequately treating Moore’s
    “very severe headaches.” To characterize that letter as an
    opinion that her emergency room visits are not related to
    migraine pain but drug-seeking behavior fails to acknowledge
    and reconcile the actual conclusions stated. Moore subse-
    quently followed up with Dr. Daniel Hier at UIC Hospital, and
    the notes from that consultation reflect that Moore has weekly
    headaches that can include nausea, vomiting, photophobia,
    and sensitivity to smells and noises, and that the headaches can
    be precipitated by stress. Dr. Hier notes that Moore is on an
    aggressive regimen for her headaches and that there would be
    no change in the medication at that time. In an opinion
    No. 13-2460                                                   9
    submitted to the ALJ, Dr. Hier also indicated that the implanta-
    tion of the nerve stimulator did not relieve the headaches and
    that Moore was troubled by continuous unremitting head-
    aches, which the ALJ did not mention in characterizing the
    surgery as having worked well. Finally, all of the physicians
    referenced by the ALJ continued to acknowledge that Moore
    suffered from chronic migraines, and did not discontinue
    medication or diagnose her with a dependency. The ALJ
    simply cannot recite only the evidence that is supportive of her
    ultimate conclusion without acknowledging and addressing
    the significant contrary evidence in the record.
    We want to emphasize here that we are not suggesting that
    the ALJ was required to reach a certain conclusion regarding
    the nature of the emergency room visits, or the severity of
    Moore’s migraines. The error here is the failure to address all
    of the evidence and explain the reasoning behind the decision
    to credit some evidence over the contrary evidence, such that
    we could understand the ALJ’s logical bridge between the
    evidence and the conclusion. By failing to even acknowledge
    that evidence, the ALJ deprived us of any means to assess the
    validity of the reasoning process.
    We reject, however, Moore’s argument that because the
    drug being sought was pain medication and most emergency
    room physicians provided it to her as treatment for migraines,
    that necessarily indicates that her emergency room visits were
    related to the migraines and not to unrelated drug dependence.
    That argument is flawed on a number of levels. First, it would
    not be at all surprising that emergency room doctors would not
    always recognize a request for pain medicine as related to an
    addiction. Such motivation is not always easily identifiable,
    10                                                  No. 13-2460
    and factors that might aid in such a determination, such as the
    pattern and frequency of emergency room visits, may appear
    only after some time and could be manipulated by the patient’s
    use of different emergency rooms that might camouflage those
    numbers. Moreover, faced with conflicting evidence, it is
    within the province of the ALJ to make that credibility determi-
    nation. Given the nature of the impairment and the inability to
    objectively measure the pain associated with migraines, it is a
    challenge indeed to determine whether Moore’s plea for drugs
    was related to a desire to alleviate severe migraine pain or a
    need to satisfy an addiction—or both. We cannot conclude as
    a matter of law that the visits were either related to her
    migraines or to some drug-seeking. It is the province of the
    ALJ to assess all of that evidence and reach a reasoned determi-
    nation based on that evidence.
    Even if the ALJ were to again find that the emergency room
    visits reflected drug-seeking behavior, there is an added
    problem here in the conclusions that the ALJ drew from that
    finding. If the purpose of the emergency room visits is ambigu-
    ous, the ALJ could properly conclude that those visits are not
    useful in establishing the severity, persistence or frequency of
    the migraines. But a finding that at least some of those emer-
    gency room visits may be related to drug-seeking behavior
    does not support a finding that her migraines impose no
    limitations whatsoever. First, a drug addiction problem is not
    inconsistent with the presence of chronic migraines—the
    conditions are not mutually exclusive. The emergency room
    visits may be of limited utility in establishing the severity and
    frequency of her migraines given the ambiguity of purpose,
    but that simply means the ALJ must look to other evidence in
    No. 13-2460                                                    11
    the medical record for that determination. Significant medical
    evidence in the record independent of those emergency room
    visits reflects Moore’s chronic severe migraines over a long
    period of time, and the ALJ in fact found that Moore suffered
    from a severe impairment of chronic recurring migraines. The
    ALJ, however, failed to identify any limitations that would
    arise from that condition.
    In so holding, the ALJ disregarded Moore’s testimony that
    her migraines are debilitating, cause her to stay in bed much of
    the day, render her unable to deal with light and sound, and
    result in a heightened sense of smell that aggravates her
    nausea and headaches. The ALJ held that two factors weigh
    against crediting that testimony: first, the limitations cannot be
    objectively verified with any reasonable degree of certainty;
    and second, even if her activities were so limited, it would be
    difficult to attribute that to a medical condition as opposed to
    other evidence in view of the relatively weak medical evidence
    and the other factors (presumably the drug-seeking evidence)
    discussed in the decision. Inexplicably, the ALJ then states:
    “Moreover, her migraines occur once to twice weekly now;
    even if they did occur at the frequency and severity attested
    she still has a significant amount of time during which she
    would not be incapacitated.” The ALJ concludes that overall
    Moore’s reported limited daily activities are “outweighed by
    the other factors discussed in this decision.”
    Once again, there are myriad problems with the ALJ’s
    assessment of the evidence. First, the ALJ erred in rejecting
    Moore’s testimony on the basis that it cannot be objectively
    verified with any reasonable degree of certainty. An ALJ must
    consider subjective complaints of pain if a claimant has
    12                                                   No. 13-2460
    established a medically determined impairment that could
    reasonably be expected to produce the pain. Carradine v.
    Barnhart, 
    360 F.3d 751
    , 753 (7th Cir. 2004). Moore has estab-
    lished that she suffers from chronic migraines, which are the
    type of impairment that can reasonably be expected to cause
    pain. Indoranto, 
    374 F.3d at 474
    . “Further, the ALJ cannot reject
    a claimant’s testimony about limitations on her daily activities
    solely by stating that such testimony is unsupported by the
    medical evidence.” Id.; Bjornson, 671 F.3d at 646, 648; Carradine,
    
    360 F.3d at 753
    ; Villano, 
    556 F.3d at 562
    ; SSR 96-7p(4),
    www/ssa.gov/OP_Home/rulings/di/01/SSR96-07-di-01.html
    (last visited February 14, 2014) (“[a]n individual’s statements
    about the intensity and 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.”)
    That leads to the second basis for rejecting her credibility,
    which was that limitations on her activities could not be
    attributed to the migraines in light of the relatively weak
    medical evidence and the other factors. As we discussed
    earlier, this conclusion rests upon a skewed portrayal of the
    evidence that ignores extensive evidence of chronic debilitating
    migraines, including recognition of that problem by all treating
    physicians. Most significant in that evidence is that Moore
    enrolled in a migraine-specific program at UIC Hospital and
    underwent two surgical procedures for the treatment of
    migraine pain with a subcutaneous occipital nerve stimulator.
    Because it was designed to eliminate the pain and therefore the
    need for pain medication, that medical evidence is strong
    evidence that she was experiencing severe migraine pain and
    No. 13-2460                                                   13
    was not simply seeking pain medication because of an addic-
    tion. See Carradine, 
    360 F.3d at 755
     (noting the improbability
    that a claimant would undergo pain treatment procedures
    including heavy drugs and surgical implantation of a stimu-
    lator merely to strengthen the credibility of complaints of pain,
    and also the improbability that medical workers would
    prescribe drugs and other treatment for her if she was not
    experiencing those symptoms). That does not mean that the
    ALJ was required to credit Moore’s testimony. The ALJ could
    properly have considered whether Moore’s testimony was
    credible and whether the evidence supported such limitations,
    including assessing whether the migraines were less debilitat-
    ing after the stimulator implantation. The error here is the
    same failure to address the evidence in a balanced manner. See
    Myles, 
    582 F.3d at 676
    .
    The final statement made by the ALJ in assessing whether
    Moore was credible was that “her migraines occur once to
    twice weekly now; even if they did occur at the frequency and
    severity attested she still has a significant amount of time
    during which she would not be incapacitated.” If the ALJ is
    thereby agreeing that Moore experiences incapacitating
    migraines once or twice a week, then that would require a
    holding that she could not perform her past work because the
    vocational expert testified that Moore could not perform her
    past work or any work if she would be absent once or twice a
    week, and in fact stated that she could not perform her past
    work if she would miss any of the training days at all. Because
    the ALJ’s statement is unclear, however, we will not assume
    that meaning.
    14                                                    No. 13-2460
    An equally troubling aspect of that statement, however, is
    the implication that incapacitation once or twice a week would
    not be problematic because a significant amount of time
    remains in which the claimant could work. This is an even
    more extreme example of a problem we have long bemoaned,
    in which administrative law judges have equated the ability to
    engage in some activities with an ability to work full-time,
    without a recognition that full-time work does not allow for
    the flexibility to work around periods of incapacitation. See
    Roddy, 705 F.3d at 639; Carradine, 
    360 F.3d at
    755–56; Bjornson,
    671 F.3d at 647. In Bjornson, we noted that the critical difference
    between daily living activities and activities of a full-time job
    is that in the former the person has more flexibility in schedul-
    ing, can get help from others when needed, and is not held to
    a minimum standard of performance. Id. We concluded that
    “[t]he failure to recognize these differences is a recurrent, and
    deplorable, feature of opinions by administrative law judges in
    social security disability cases.” Id. Here, the ALJ appears to
    have concluded that incapacitating migraines once or twice a
    week would not be problematic because she would still have
    most of the week without such symptoms, but that essentially
    ignores the inability to schedule the incapacitating migraines.
    Absent a showing that she has a completely flexible work
    schedule in her past position as a reservation agent, the
    existence of symptom-free days adds nothing here. The ALJ
    erred in failing to account for the limitations caused by
    migraines occurring with that frequency.
    Finally, in determining Moore’s RFC, the ALJ erred in her
    treatment of opinion evidence by Dr. Hier, who was Moore’s
    treating neurologist at UIC Hospital where she had a subcuta-
    No. 13-2460                                                     15
    neous occipital nerve stimulator implanted in February 2007.
    Dr. Hier submitted an opinion to the ALJ indicating that
    Moore’s headaches are refractory to medical and surgical
    treatment including an occipital nerve stimulator, and that
    “she is troubled with continuous unremitting headaches and
    is disabled from working.” The ALJ determined that Dr. Hier’s
    opinion as treating neurologist should be given no special
    significance because, in concluding that Moore was disabled
    from working, Dr. Hier opined on an issue reserved to the
    Commissioner. The ALJ found the limited rationale problem-
    atic, stating that Dr. Hier provided very little explanation of the
    evidence relied upon as the basis for that conclusion, citing
    only subjective pain, and found it inconsistent with the
    opinions of other treating sources including Dr. Arnett and the
    emergency room physicians. That dismissive approach to the
    treating neurologist’s opinion was improper because the
    medical records submitted by all of Moore’s treating physi-
    cians including Dr. Arnett also indicated that she suffered from
    chronic migraines, and Dr. Hier’s statement that she experi-
    enced “continuous unremitting headaches” was not an opinion
    on a matter reserved to the Commissioner. In addition, Moore
    herself testified as to the limitations imposed by the migraines,
    and her mother with whom she lived testified as to that impact
    as well. The ALJ also erred in dismissing Dr. Hier’s opinion
    because it was based on Moore’s subjective pain. As the ALJ
    acknowledged, Moore suffered from a severe impairment of
    chronic migraines, and the patient’s pain level is a relevant
    consideration in determining the effectiveness of the treatment.
    The ALJ’s disregard for Moore’s allegations of pain is particu-
    larly inappropriate in the context of treatment by Dr. Hier,
    16                                                   No. 13-2460
    given that the nerve stimulator implanted at UIC Hospital was
    an effort to provide pain management not based on drugs, and
    therefore did not implicate the concern with exaggeration for
    drug-seeking purposes. See Simila v. Astrue, 
    573 F.3d 503
    , 514
    (7th Cir. 2009) (regulations 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, 
    647 F.3d at 739
     (“[a]n
    ALJ must offer ‘good reasons’ for discounting the opinion of a
    treating physician”); Young, 
    362 F.3d at 1002
    . If the ALJ was
    unable to discern the basis for the treating physician’s determi-
    nation, then the proper course would have been to solicit
    additional information from Dr. Hier. See Simila, 
    573 F.3d at
    516–17 (ALJ has a duty to solicit additional information where
    the medical support is not readily discernible); Scott, 
    647 F.3d at 741
    .
    In conclusion, significant medical and testimonial evidence
    independent of the questionable emergency room visits
    established a history of severe recurrent migraines. In light of
    that evidence, the ALJ erred in disregarding the migraines as
    a factor in determining Moore’s ability to perform her past
    work. Specifically, the ALJ should have at least included in the
    RFC determination the likelihood of missing work. The ALJ’s
    decision did not reflect any likelihood of absences or breaks at
    work related to migraines, and that is simply unsupported by
    the record. As to the limitations imposed by that severe
    impairment, the ALJ recognized in the RFC only that she
    should be limited to sedentary work in which she could avoid
    concentrated exposure to extreme cold, extreme heat, noise,
    fumes, odors, dusts, gases, poor ventilation, hazardous
    No. 13-2460                                                  17
    machinery and heights. The ALJ never related those specific
    limitations to certain impairments. It is possible to postulate
    which were related to migraines as opposed to the other severe
    or non-severe impairments such as obesity, asthma and
    rheumatoid arthritis, but the reviewing court should not have
    to speculate as to the basis for the RFC limitations. Nor is the
    basis otherwise apparent in the record. Accordingly, the case
    must be remanded for the ALJ to articulate with clarity the
    limitations related to the impairments based on an examination
    of the evidence in the record as a whole, and to present those
    limitations to the vocational expert to determine whether
    Moore is capable of performing her past relevant work. For
    these reasons, we REVERSE the district court and REMAND
    this case to the agency for further proceedings.