United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Argued December 18, 2019

Decided January 23, 2020

Before

DAVID F. HAMILTON, Circuit Judge

MICHAEL B. BRENNAN, Circuit Judge

MICHAEL Y. SCUDDER, Circuit Judge

No. 19-1885

MICHAEL ANTHONY GIBBONS,

Plaintiff-Appellant,

v.

ANDREW M. SAUL,

Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District 

Court for the Central District of Illinois.

No. 17-2224

Eric I. Long,

Magistrate Judge.

O R D E R

In 2011, a sheet of ice struck Michael Gibbons in the head and exacerbated a 

preexisting neck injury. By 2013, the pain in his neck, shoulders, and arms had 

worsened to the point he could no longer work. He applied for disability benefits. An 

administrative law judge determined Gibbons had several severe impairments related 

to neck and shoulder pain but nonetheless denied benefits, concluding Gibbons could

still perform light work with limitations. 

The ALJ’s findings were based on the opinion of an agency physician who 

reviewed Gibbons’s application for benefits but did not examine him. Because that

opinion had several flaws the ALJ did not address, and because the ALJ did not support 

NONPRECEDENTIAL DISPOSITION

To be cited only in accordance with Fed. R. App. P. 32.1
No. 19-1885 Page 2

her decision with other medical evidence, the ALJ’s decision was not based on 

substantial evidence. The ALJ further erred by relying on her own lay interpretation of 

medical findings to discount a treating surgeon’s opinion Gibbons could never reach 

overhead. We therefore vacate the ALJ’s decision and remand to the agency for further 

proceedings.

I. Background

Gibbons has spent almost a decade in severe pain. During that time, at least eight 

medical professionals opined on how the pain affected him. This appeal concerns four 

of them: (1) Dr. Daniel Riew, the orthopedic surgeon who performed Gibbons’s most 

recent surgery; (2) Dr. Harel Deutsch, a physician who examined Gibbons on behalf of a

worker’s compensation provider; (3) Dr. Arash Farahvar, a neurosurgeon who

examined Gibbons but did not operate on him; and (4) Dr. Richard Bilinsky, an agency 

consulting physician who reviewed Gibbons’s application for benefits but did not 

examine him.

A. Medical history

In 2003, Gibbons, then 40 years old, slipped and fell on his back. The accident 

caused extreme pain in his neck and arms, and he ultimately needed two surgeries to 

fuse three vertebrae in his neck. After the surgeries, Gibbons recovered and worked as a 

facility manager for a local church, performing building maintenance and other work 

that required heavy exertion.

In February 2011, a piece of ice fell off a building and struck Gibbons in the head

while he was at work. He suffered a concussion and experienced renewed pain in his 

neck, shoulders, and arms. A CT scan showed his vertebrae were still fused but he had 

suffered degeneration elsewhere in his spine. 

Over the next five years, Gibbons experienced increasing pain. His doctors 

cycled him through an array of different painkillers, including narcotics like Norco 

(hydrocodone and acetaminophen), Opana (oxymorphone), Oxycontin (oxycodone), 

methadone, Avinza (morphine tablets), Percocet (oxycodone and acetaminophen), and 

fentanyl. 

Shortly after the concussion, Gibbons’s doctor allowed him to return to work, but 

with orders to lift no more than 15 pounds and to avoid overhead work. Gibbons 

continued to work full time until September 2011, when his pain increased to the extent 

he could work only four hours a day, even with the limitations recommended by his 
No. 19-1885 Page 3

doctor. In December 2011, an electromyogram showed a possible injury in Gibbons’s

right long thoracic nerve (a nerve that runs from the spine through the shoulder and 

upper chest). Although Gibbons complained the pain was more serious in his left arm, 

no similar injury was discovered in his left shoulder, suggesting the pain on his left side 

originated in his spine. 

Gibbons worked part time until February 2013. A CT scan taken then showed 

mild to severe foraminal stenosis (a narrowing of the passageway through which the 

spinal nerve root runs) and facet arthrosis (arthritis of the joints between vertebrae) at 

several points in his upper vertebrae. Although Gibbons demonstrated normal strength 

and range of motion in his upper extremities, he complained of worsening headaches 

and shoulder pain radiating from his neck. He stopped working and successfully filed 

for worker’s compensation.

In May 2013, Gibbons saw orthopedic surgeon Dr. Riew for the first time, 

reporting pain in his neck, arms, and shoulders, especially on his left side. Dr. Riew 

observed Gibbons had normal reflexes and motor strength but noted Gibbons’s lefthand grip was weaker than his right, even though he was left-handed. After viewing 

Gibbons’s previous CT scan and an earlier MRI, Dr. Riew diagnosed Gibbons with a 

possible pinched nerve. That August, he operated on Gibbons and fused two more 

vertebrae in his neck. Two months later, Dr. Riew again examined Gibbons and opined 

he could return to work in two weeks, and lift up to 30 pounds, but should not perform 

overhead activity. 

In November, Gibbons returned to Dr. Riew with complaints of serious left 

shoulder pain. Gibbons had normal strength in both arms during the examination, but 

he had a positive Spurling’s sign (a physical test used to assess the presence of 

nerve-root pain). Dr. Riew recommended Gibbons refrain from work for one week and 

not lift more than 40 pounds for the next three months. A follow-up exam in January 

2014 revealed global weakness and atrophy in Gibbons’s left arm, and his left upper 

arm and forearm were 1.5 centimeters smaller than on his right. But Dr. Riew 

nonetheless opined Gibbons could return to work with the same restrictions against

lifting more than 40 pounds or reaching overhead.

In April 2014, however, Dr. Riew examined Gibbons again and changed his 

prognosis. After viewing an updated CT scan, he diagnosed Gibbons with a chronic 

pinched nerve caused by a surgical screw impinging the joint between two vertebrae at 

the base of the neck. That scan also revealed severe left foraminal stenosis near the 

vertebrae where Dr. Riew had performed surgery. Dr. Riew filled out a worker’s 
No. 19-1885 Page 4

compensation form stating Gibbons should remain off work for the next three to six 

months, and he ordered Gibbons to return for a follow-up appointment in four months.

For unexplained reasons, Gibbons did not see Dr. Riew again.

That June, Dr. Deutsch examined Gibbons on behalf of Gibbons’s employer’s 

worker’s compensation provider. Dr. Deutsch said he concurred with Dr. Riew’s earlier 

opinions that Gibbons could lift up to 40 pounds, but he did not mention Dr. Riew’s 

most recent opinion that Gibbons should remain off work. He also said he disagreed 

with the December 2011 electromyogram showing a long thoracic nerve injury on the 

right side because later electromyograms did not replicate those results.

In October, the neurosurgeon Dr. Farahvar examined Gibbons. He disagreed 

with Dr. Riew’s diagnosis regarding the cause of Gibbons’s pain. Rather than an 

impinging screw at the base of the neck, he thought a pinched nerve near the top of the

neck was the primary source of Gibbons’s pain. But he recommended delaying surgery 

until he could verify his diagnosis and determine whether conservative treatment 

would be effective. In the meantime, he ordered several tests and a neck brace for 

Gibbons to wear in the car. Dr. Farahvar then filled out a medical-source statement for 

Gibbons’s disability application, opining Gibbons could never lift any weight (even 

under 10 pounds) and never reach overhead, handle, push, or pull with either arm. He 

also stated Gibbons could not sit, stand, or walk for more than one hour per day, and 

that Gibbons needed to spend the majority of the day resting in bed. A year and a half 

later, in February 2016, Dr. Farahvar filled out a second questionnaire without 

examining Gibbons again, now opining Gibbons could occasionally lift objects less than 

10 pounds, but could not sit or stand for more than 20 minutes at a time, and could not 

walk at all. He also opined Gibbons should avoid exposure to odors, fumes, and 

pulmonary irritants, even though he cited no diagnosis that would require such a 

restriction and was not himself a pulmonologist.

B. Procedural history

Gibbons applied for disability insurance benefits, alleging he became disabled in

January 2013, around the time he stopped working. His claim was denied initially and 

on reconsideration. 

At the reconsideration level, the determination included a medical opinion from 

Dr. Bilinsky, an agency consultant who reviewed the record but did not examine 

Gibbons. Unlike Drs. Riew’s and Farahvar’s opinions, which had concluded Gibbons 

could not perform any work, Dr. Bilinsky found Gibbons could perform actions 
No. 19-1885 Page 5

consistent with light work. He opined Gibbons could occasionally lift 20 pounds and 

frequently 10 pounds, occasionally reach overhead with his right arm, and occasionally 

handle with his left hand.

At a hearing before an ALJ, Gibbons described how the pain radiating from his 

neck affected his daily life. He testified he could lift a gallon of milk with his right hand,

but not with his dominant left hand, and he had difficulty reaching for things in 

overhead cabinets, especially with his left arm. He stated he avoided driving because of 

his prescriptions for fentanyl, Percocet, and valium. He said his wife and daughter do 

all the household chores, and he shaves only once a week because of the pain in his 

arms and shoulders. Finally, he testified Dr. Farahvar does not want to perform surgery 

because his pinched nerve is located near his brain stem and scar tissue from his 

previous surgeries makes it too risky.

The ALJ found Gibbons was not disabled. She determined Gibbons’s left carpal 

tunnel, cervical radiculopathy (pinched nerve), degenerative disc disease, and right 

shoulder disorder were severe impairments. But based on Dr. Bilinsky’s opinion—the 

only opinion the ALJ assigned “great weight”—the ALJ concluded Gibbons could still 

perform light work so long as, among other restrictions, he was limited to only frequent 

handling with the left hand; occasional reaching overhead with the right arm; 

occasional head turning; and no driving. A vocational expert testified a person with 

these limitations would be able to find work as a small-products assembler or a retail 

marker.

In reaching these conclusions, the ALJ discounted Dr. Farahvar’s opinions, which 

she reasoned were inconsistent, contradicted by the record, and included opinions 

outside Dr. Farahvar’s expertise. She also discounted Dr. Riew’s opinion that Gibbons 

could never reach overhead because she said there was not sufficient evidence of a 

thoracic nerve injury. But she assigned “some weight” to Dr. Riew’s earlier opinions

that Gibbons could lift up to 40 pounds (as well as Dr. Deutsch’s concurrence with it), 

stating the suggested limitations “appear reasonable within the period of necessary 

healing for the claimant’s neck surgery.” Considering Gibbons’s more recent complaints 

of pain, however, the ALJ concluded more significant restrictions were necessary and 

adopted those suggested by Dr. Bilinsky.

Gibbons appealed the ALJ’s decision, and the Appeals Council determined the 

ALJ erred by giving great weight to Dr. Bilinsky’s opinion without adopting his 

recommendation that Gibbons be limited to only occasional handling with his left hand. 

The Appeals Council altered the ALJ’s findings to include this limitation, as well as an 
No. 19-1885 Page 6

additional limitation—unexplained—of no overhead reaching with the nondominant

right hand. Otherwise the Appeals Council adopted the ALJ’s findings. Because the 

vocational expert had testified someone with those two additional limitations could still 

find work as an usher, photo counter clerk, or furniture rental clerk, the Appeals 

Council upheld the ALJ’s determination that Gibbons was not disabled.

The district court affirmed the Appeals Council’s decision.

II. Analysis

A. Standard of review

We will uphold the agency’s final decision if supported by “substantial 

evidence,” meaning “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). Our

role is not to “reweigh evidence, resolve conflicts, decide questions of credibility, or 

substitute [our] judgment for that of the Commissioner.” Burmester v. Berryhill, 920 F.3d 

507, 510 (7th Cir. 2019) (internal citations and alterations omitted). The agency’s 

decision, however, must build a “logical bridge” from the evidence to its conclusions. 

Stephens v. Berryhill, 888 F.3d 323, 327 (7th Cir. 2018).

B. Discussion

Gibbons contends the ALJ erred by adopting Dr. Bilinsky’s opinion instead of

Dr. Farahvar’s opinions, and by failing to give weight to Dr. Riew’s opinion that 

Gibbons could not reach overhead. The Commissioner responds the ALJ was faced with 

a sea of medical opinions and took a reasonable course in weighing them.

The Commissioner is only partially correct. It is true the ALJ did not err in 

assigning little weight to Dr. Farahvar’s opinions. An ALJ may assign limited weight to 

a treating physician’s opinions if the ALJ articulates “good reasons” for doing so. 

20 C.F.R. § 404.1527(c)(2); Larson v. Astrue, 615 F.3d 744, 749 (7th Cir. 2010). And here, 

the ALJ articulated several reasons for discounting Dr. Farahvar’s opinions. For 

example, the ALJ noted Dr. Farahvar’s extreme limitations for Gibbons (including the 

inability to walk even short distances) were contradicted by evidence of Gibbons’s

consistently normal gait and ability to walk without a cane or other assistive device. 

And as the ALJ explained, Dr. Farahvar opined on subjects outside his expertise and 

gave inconsistent opinions on whether Gibbons could lift up to 10 pounds. These were 

all valid reasons to assign little weight to Dr. Farahvar’s opinions; an ALJ is not 

required to accept opinions contradicted by other medical evidence. Burmester, 920 F.3d 
No. 19-1885 Page 7

at 512, and may discount opinions that are inconsistent or fall outside the doctor’s 

expertise, Alvarado v. Colvin, 836 F.3d 744, 748 (7th Cir. 2016).

After discounting Dr. Farahvar’s opinions, however, the ALJ needed to point to 

other evidence supporting her decision. See Stephens, 888 F.3d at 327 (ALJ must build 

“logical bridge” from evidence to conclusion). Rather than adopt the opinions of one of 

the many other medical professionals who treated Gibbons, the ALJ turned to

Dr. Bilinsky. But Dr. Bilinsky did not examine Gibbons, and there are several aspects of 

his opinion that suggest he did not undertake a careful review of the medical records.

For example, Dr. Bilinsky repeatedly referred to Gibbons as “she,” even though 

Gibbons is male. And Dr. Bilinsky incorporated into his opinion a disability examiner’s 

conclusion that Gibbons was not entitled to benefits—suggesting Dr. Bilinsky already 

had this conclusion in mind when he wrote the opinion.

More critically, Dr. Bilinsky misread Dr. Riew’s April 2014 examination by 

stating the exam revealed “no atrophy.” Dr. Riew found only that there was no atrophy 

in Gibbons’s hands; he stated there was atrophy in Gibbons’s left upper arm and 

forearm (his dominant arm), which were measured 1.5 cm smaller than his right arm. 

Dr. Bilinsky then compounded this error by stating Gibbons’s grip was decreased in his 

nondominant hand, rather than his dominant left hand, as indicated by the 

examination. These errors were significant because the April 2014 examination marked

a turning point in Gibbons’s treatment. It was the examination at which, after 

repeatedly opining that Gibbons was on the cusp of returning to work with only minor 

limitations, Dr. Riew ultimately decided Gibbons could not work for at least another 

three to six months. And Dr. Bilinsky’s misunderstanding of Dr. Riew’s notes relates

directly to his assessment of Gibbons’s ability to lift, carry, and reach with his dominant 

left arm. An ALJ must consider whether a medical opinion is consistent with the record 

before assigning it weight. 20 C.F.R. § 404.1527(c)(4). Yet the ALJ did not address these 

inconsistencies; she merely stated the opinion was “consistent with the record as a 

whole” and more restrictive than Dr. Riew’s older, 40-pound lifting restriction.

The Commissioner maintains the ALJ also relied on the opinions of Dr. Riew and 

Dr. Deutsch in addition to Dr. Bilinsky. But although both those doctors opined at 

different times Gibbons could lift up to 40 pounds, the ALJ assigned their opinions only 

“some weight” and reasoned Gibbons’s testimony warranted stricter lifting restrictions.

Ultimately, she seems to have adopted the opinions only to the extent they agreed with 

Dr. Bilinsky. But even if the ALJ had meant to adopt Dr. Riew’s recommendations in 

part, she conflated Dr. Riew’s final two examinations, stating Dr. Riew had opined in 

“early 2014” that Gibbons could “lift up to 40 pounds and return to work in three to six 
No. 19-1885 Page 8

months.” These opinions were actually months apart: In January, Dr. Riew opined

Gibbons could work with modest limitations but changed his prognosis in April and 

ordered Gibbons to refrain from work pending reexamination in four months. So the

ALJ failed to appreciate the progression of Gibbons’s condition. See Lambert v. Berryhill, 

896 F.3d 768, 775 (7th Cir. 2018) (explaining that physicians may update their views 

based on a patient’s changed condition).

The ALJ also impermissibly “played doctor” when she rejected Dr. Riew’s 

proposed restrictions on overhead reaching with either arm. Although the Appeals 

Council later found Gibbons could never reach overhead with his right arm, neither the 

ALJ nor the Appeals Council placed a similar restriction on his left arm (which Gibbons 

alleged was more limited). The ALJ explained the restriction was unwarranted because 

“only [the December 2011 electromyogram] demonstrated any abnormal findings, and 

others revealed no evidence of a long thoracic nerve injury.” But Dr. Riew did not cite a 

thoracic nerve injury as the reason for his overhead-reaching restriction. And the doctor 

who examined Gibbons after his head injury in February 2011 gave similar precautions, 

almost a year before the electromyogram in question. Without relying on any medical 

evidence, the ALJ assumed a thoracic nerve injury was required for an

overhead-reaching restriction, contrary to the well-established rule that ALJs should not 

attempt to analyze the significance of medical findings without input from an expert. 

See McHenry v. Berryhill, 911 F.3d 866, 871 (7th Cir. 2018).

We are not persuaded by the Commissioner’s response that, rather than playing 

doctor, the ALJ was echoing the report of Dr. Deutsch. Although the Commissioner is 

correct that Dr. Deutsch disagreed with the diagnosis of a thoracic nerve injury on 

Gibbons’s right side, nothing in Dr. Deutsch’s report said he disagreed with Dr. Riew’s 

opinions on overhead reaching. And ultimately, whether Gibbons had a nerve injury on 

his right side is irrelevant because the Appeals Council already placed a reaching 

restriction on Gibbons’s right arm. Only Gibbons’s left arm is at issue, and doctors 

consistently found the limitations in Gibbons’s left arm were caused by pain radiating 

from his spine. No doctor suggested Gibbons also had a nerve injury on his left side; the 

ALJ simply conflated two separate impairments. See Meuser v. Colvin, 838 F.3d 905, 911 

(7th Cir. 2016) (“[T]he ALJ improperly played doctor when he ignored expert opinions 

to arrive at his own, incorrect, interpretation of the medical evidence.”).

III. Conclusion

Because the ALJ’s decision was not based on substantial evidence, we vacate the 

judgment and remand to the agency for further proceedings.