Lacey Thorlton v. MICHELLE KING, Acting Commissioner of Social Security

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 24-1852
LACEY THORLTON ,
Plaintiff-Appellant,
v.
M ICHELLE K ING,
Acting Commissioner of Social Security,
Defendant-Appellee.
____________________
Appeal from the United States District Court for
the Southern District of Indiana, New Albany Division.
No. 4:23-cv-00004-KMB-TWP — Kellie M. Barr, Magistrate Judge.
____________________
A RGUED J ANUARY 29, 2025 — DECIDED F EBRUARY 11, 2025
____________________
Before BRENNAN , S CUDDER , and S T. EVE, Circuit Judges.
S CUDDER , Circuit Judge. Joshua Smitson applied for social
security disability benefits and supplemental security income,
alleging that his asthma and chronic obstructive pulmonary
disease prevented him from working. After an evidentiary
hearing, an administrative law judge denied Smitson’s appli-
cation, finding that his ailments were limiting but not disa-
bling. We affirm, as our review proceeds with a light touch—

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2 No. 24-1852
not holding ALJs to an overly demanding evidentiary stand-
ard and in turn reinforcing that claimants bear the affirmative
burden of proving their disability. The ALJ’s decision here
finds sufficient support, if just barely, in the administrative
record.
I
A
Nobody questions that Joshua Smitson’s respiratory con-
dition left him with frequent episodes of shortness of breath
and trouble walking and standing for long periods. His med-
ical records, for instance, show that he had a weeklong hospi-
tal stay in 2021 for an acute respiratory exacerbation stem-
ming in part from an accidental drug overdose.
To treat Smitson’s asthma and chronic obstructive pulmo-
nary disease, his doctors prescribed, among other medica-
tions, an inhaler and frequent nebulizer use. (A nebulizer is a
device that converts medication from a liquid to a mist so it
can be inhaled into the lungs.) Smitson’s nebulizer prescrip-
tion directed him to use the treatment four times a day. At the
evidentiary hearing before the ALJ, he testified that he used
the nebulizer upon waking up in the morning, over lunch, in
the late afternoon, and before bed, with each treatment taking
about thirty minutes. Medical records and Smitson’s own tes-
timony indicated that, after some trial and error, his medica-
tion regiment worked effectively to control his symptoms.
B
Following the evidentiary hearing, the ALJ denied bene-
fits, concluding that Smitson was not disabled. After canvass-
ing Smitson’s account of his own symptoms, his medical rec-
ords, and medical opinions offered during the administrative

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No. 24-1852 3
proceeding, the ALJ found that Smitson was able to manage
his symptoms so long as he complied with his doctors’ medi-
cal treatment recommendations. Given the improvement in
Smitson’s condition during the relevant period, the ALJ de-
termined that Smitson had a residual functional capacity, or
RFC, to perform “light work” subject to additional limitations
minimizing his exposure to triggers like prolonged walking
and allergens. Crediting testimony offered by a vocational ex-
pert, the ALJ then found jobs were available within the na-
tional economy for someone with an RFC like Smitson’s. The
district court affirmed.
Between seeking review in the district court and pursuing
this appeal, Smitson passed away. His widow, Lacey Thorl-
ton, then substituted as the appellant and urges us to con-
clude the ALJ committed error by failing to recognize Smitson
would need time off to address acute exacerbations like
asthma attacks and, relatedly, that his prescribed nebulizer
use—four times each day—prevented him from performing
not only light work but any form of employment.
II
Two principles combine and lead us to affirm the ALJ’s
decision.
First, as we have underscored time and again, a claimant
bears the burden of proving their disability. See, e.g., Punzio v.
Astrue, 630 F.3d 704, 712 (7th Cir. 2011) (“The claimant bears
the burden of submitting medical evidence establishing her
impairments and her residual functional capacity.”); Pepper v.
Colvin, 712 F.3d 351, 367 (7th Cir. 2013) (explaining that a
claimant has the burden of showing why they are disabled);

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4 No. 24-1852
see also 20 C.F.R. § 404.1512 (placing the “[r]esponsibility for
evidence” on the claimant).
Establishing the existence of an impairment is not enough.
The claimant must present evidence of limitations affecting
their capacity to work. See Gedatus v. Saul, 994 F.3d 893, 905
(7th Cir. 2021) (rejecting an appeal where the claimant failed
to “point[] to any medical opinion or evidence to show” that
the ALJ should have adopted additional “specific limita-
tions”).
Oftentimes a claimant can satisfy that burden by, for ex-
ample, asking their “doctor to lay out in plain language ex-
actly what it is that the claimant’s condition prevents” them
from doing, Punzio, 630 F.3d at 712, or presenting testimony
about the effect of their symptoms that is consistent with the
objective medical evidence. See 20 C.F.R. § 404.1529(a), (c)(3)–
(4). The administrative process, in short, provides a claimant
with ample opportunity to raise various limitations and offer
evidence to support them. See, e.g., id. § 404.1513(a)(2) (allow-
ing a claimant to provide “a statement from a medical source
about what [the claimant] can still do despite [their] impair-
ment(s)”); id. § 404.1545(a)(3) (“We will consider any state-
ments about what [the claimant] can still do that have been
provided by medical sources, whether or not they are based
on formal medical examinations.”); id. § 404.929 (providing
the opportunity to present new evidence, including their own
testimony, at a hearing before an ALJ).
Next comes our role in disability benefit appeals: we sit as
a court of review applying a very deferential standard to our
assessment of ALJ denials of benefits. We must affirm so long
as the ALJ’s decision finds support in “substantial evidence.”
No matter how that standard may read or sound, the

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No. 24-1852 5
Supreme Court has emphasized just how deferential it is as a
legal matter: “whatever the meaning of ‘substantial’ in other
contexts, the threshold for such evidentiary sufficiency is not
high” when it comes to administrative decisions. Biestek v.
Berryhill, 587 U.S. 97, 103 (2019). Put most simply, we will re-
verse an ALJ’s decision only if the record “compels a contrary
result.” Deborah M. v. Saul, 994 F.3d 785, 788 (7th Cir. 2021)
(internal quotation marks omitted) (citation omitted).
III
Substantial evidence supported the ALJ’s conclusion that
Smitson was able to perform light work. As the ALJ ex-
plained, the medical records showed that prescribed medica-
tions left Smitson’s challenges and conditions, including peri-
odic asthma attacks, well-managed, at least during the period
relevant to our review. We see no infirmity in that finding,
especially given the ALJ’s incorporation of a walking and
standing limitation in the RFC.
The harder question is whether the ALJ fell short in con-
sidering Smitson’s testimony about his use of a nebulizer four
times each day. While a claimant’s testimony about their
symptoms and related treatments “will not alone establish”
that the claimant is disabled, an ALJ must consider such tes-
timony if it “can reasonably be accepted as consistent with the
objective medical evidence and other evidence.” 20 C.F.R.
§ 404.1529(a), (c)(3)–(4); see SSR 16-3p, 2017 WL 5180304, 82
Fed. Reg. 49462, 49464 (Oct. 25, 2017) (“We will not evaluate
an individual’s symptoms based solely on objective medical
evidence unless that objective medical evidence supports a
finding that the individual is disabled.”).

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6 No. 24-1852
While under no obligation to “discuss every piece of evi-
dence in the record,” an ALJ may not “ignore a line of evi-
dence supporting a finding of disability.” Deborah M., 994 F.3d
at 788 (quoting Jones v. Astrue, 623 F.3d 1155, 1162 (7th Cir.
2010)); see also Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345,
351 (7th Cir. 2005) (“In addition to relying on substantial evi-
dence, the ALJ must also explain his analysis of the evidence
with enough detail and clarity to permit meaningful appellate
review.” (citation omitted)). We agree with Thorlton that the
ALJ would have done better to directly confront Smitson’s
testimony about his nebulizer use when deciding whether he
suffered from a disability entitling him to benefits. But, in the
end, that shortcoming does not require us to reverse. When
viewing the decision in its entirety, we are confident the ALJ
considered Smitson’s testimony and his nebulizer use. See
Zellweger v. Saul, 984 F.3d 1251, 1252 (7th Cir. 2021) (explain-
ing that we review an ALJ’s decision holistically).
The ALJ recounted much of Smitson’s testimony, relaying
a description of his symptoms and indicating that he uses in-
halers and nebulizer treatments. In discussing Smitson’s med-
ical records, the ALJ observed that Smitson’s respiratory con-
ditions were “well managed with medications when the
claimant was compliant with treatment recommendations.”
In short, this is not a case where the ALJ presented a “skewed
version of the evidence,” Moore v. Colvin, 743 F.3d 1118, 1123
(7th Cir. 2014), or failed to “minimally discuss” contrary evi-
dence, Godbey v. Apfel, 238 F.3d 803, 808 (7th Cir. 2000), so re-
versal is not warranted on this ground.
Thorlton sees the analysis differently and urges us to re-
mand to the ALJ to expressly consider Smitson’s testimony
regarding the intervals of his nebulizer use. We decline the

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No. 24-1852 7
invitation. When an ALJ rejects a claimant’s testimony as not
credible, they must articulate the reasons for that finding. See
Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539–40 (7th Cir.
2003). Failure to do so can result in reversal. See Villano v.
Astrue, 556 F.3d 558, 564 (7th Cir. 2009) (remanding case to
agency so ALJ can “give reasoned assessments of [the claim-
ant’s] credibility”). But we see no indication that the ALJ dis-
regarded or discredited Smitson’s testimony. Rather, we see
the ALJ’s RFC determination as consistent with Smitson’s tes-
timony.
Smitson testified that he took the nebulizer treatment
twice outside of an ordinary workday—once in the early
morning and another later at night. As for the remaining two
treatments, the evidence was indefinite. In his own testimony,
Smitson stopped short of explaining whether he could use the
nebulizer over a lunch break or whether his third treatment
could come in the late afternoon or early evening, just after a
standard workday. We cannot say with confidence—and es-
pecially within the confines of our deferential standard of re-
view—that Smitson’s testimony made clear that his typical
cycle of nebulizer treatments would result in an inability to
work. See Clifford v. Apfel, 227 F.3d 863, 869 (7th Cir. 2000) (“In
our substantial evidence determination, we review the entire
administrative record, but do not reweigh the evidence, re-
solve conflicts, decide questions of credibility, or substitute
our own judgment for that of the Commissioner.”).
Other evidence in the record informs our review. Neither
the medical records nor any of the opinions offered by re-
viewing consultants or physicians indicated that Smitson’s
nebulizer use would affect his ability to work or suggested
any necessary accommodation to facilitate full-time

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8 No. 24-1852
employment. Indeed, certain medical records suggested that
Smitson’s nebulizer use, at least at times during the relevant
period, was intermittent. His treating physician, for example,
observed that, in March 2021, Smitson was managing his
symptoms well with his inhaler alone.
In the final analysis, the administrative record lacked evi-
dence compelling the ALJ to find that Smitson would need a
certain amount of time off, or some other form of accommo-
dation, to address asthma attacks or permit medically neces-
sary nebulizer treatments during a workday. Could the ALJ
have done and said more? Yes, and that is what makes this
case difficult. But multiple times over “we have emphasized
that social-security adjudicators are subject to only the most
minimal of articulation requirements.” Warnell v. O’Malley, 97
F.4th 1050, 1053 (7th Cir. 2024). Under that minimal require-
ment, the ALJ said enough here to support its decision and
permit meaningful appellate review. See Gedatus, 994 F.3d at
901 (explaining that a “partial summary of select evidence” is
appropriate under the minimal articulation requirement).
So, under the generous standard of review afforded to ALJ
decisions and mindful of the evidentiary gap Smitson left
open in the administrative record, we AFFIRM.

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