# United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Argued April 27, 2010

Decided July 14, 2010

Before

ILANA DIAMOND ROVNER, Circuit Judge

ANN CLAIRE WILLIAMS, Circuit Judge

DIANE S. SYKES, Circuit Judge

No. 09

‐ 2851

ANNETTE GOBLE,

Plaintiff

‐ Appellant,

v.

MICHAEL J. ASTRUE, Commissioner of

Social Security,

Defendant

‐ Appellee. Appeal from the United States District

Court for the Western District of

Wisconsin.

No. 08

‐ cv

‐ 529

‐ bbc

Barbara B. Crabb,

Judge

.

O R D E R

Annette Goble seeks review of the denial by an Administrative Law Judge of her

application for disability insurance benefits. Specifically, she contests the ALJ’s conclusions

that her testimony was not credible and that she retained a residual functional capacity for

light work. Because the ALJ impermissibly substituted her own judgment for that of the

treating physicians, we reverse and remand.

In November 2004, Goble applied for disability insurance benefits, claiming an

inability to work as of that date due to fibromyalgia, chronic fatigue syndrome, herniated

and degenerative discs, and chronic migraines. Goble was born in 1958, is licensed in

practical nursing, and worked as a licensed practical nurse, teacher’s assistant and 

### NONPRECEDENTIAL DISPOSITION

To be cited only in accordance with

Fed. R. App. P. 32.1No. 09

‐ 2851 Page 2

pharmacy technician. The local disability agency denied her application, and the ALJ

reconsidered the denial at a hearing in May 2007.

At the hearing Goble presented medical records from treating physicians including

Goble’s family practitioner, Dr. Dale Hadland, who first diagnosed her with fibromyalgia in

1995. Since 2004, he has prescribed Cymbalta, Skelaxin, and methadone for her

fibromyalgia and chronic back pain. He wrote a letter in 2006 stating: “I believe the patient

is unemployable. She is unable to sit, stand, bend, and/or really function mentally in any

type of employment situation secondary to her chronic pain syndrome and muscle

tightness/pain associated with the fibromyalgia.” Goble also presented medical records

from internist Dr. Okechukwu N. Iwu, who first saw her in October 2006. He noted that she

had severe fibromyalgia, fairly significant degenerative joint disease, inability to sleep, and

mild major depression. He later increased her methadone dosage. In April 2007, Dr.Iwu

wrote Goble’s lawyer saying that she was under his care “for chronic pain syndrome,

primarily due to fibromyalgia, which is fairly crippling.” Dr. Iwu said that Goble was

unable to sit or stand for more than 5 or 10 minutes without aggravating her pain and

needed assistance with activities of daily living involving arm extension.

Goble also saw several consulting physicians, including psychologist Lynne E.

Johnson, who performed a mental

‐ status evaluation in August 2005 and concluded that

Goble had developed a depressive disorder as a reaction to the pain and associated

limitations of fibromyalgia. In 2005 two state

‐ agency physicians reviewed the medical

record and agreed that Goble suffered from fibromyalgia and neck and back pain, but also

concluded that she still could lift 10 pounds frequently and 20 pounds occasionally, and

could stand, walk, or sit 6 hours in an 8

‐ hour work day.

At the hearing Goble testified that she cannot sit for more than 5 or 10 minutes at a

time, or stand for more than a minute, or walk much beyond 100 yards. She added that she

cannot raise her arms above shoulder height and drops things all the time. She also testified

that she is unable to sleep. Goble said that she can drive, feed herself, brush her teeth, and

manipulate buttons and zippers without assistance. She stated that she has difficultly

concentrating and maintaining attention. Goble recounted that she and her husband had

lived in Utah for 6 months, and when she was there, her fibromyalgia was somewhat better.

She testified that she had taken methadone for pain for four years, but it was no longer

helping. To avoid increasing her dosage again, she recently switched to morphine. She

testified that her pain prevents her from getting out of bed 2 or 3 days a week.

Three other witnesses testified at the hearing. Dr. Andrew Steiner, a specialist in

physical medicine and rehabilitation, was called by the ALJ as a neutral medical expert.No. 09

‐ 2851 Page 3

Dr. Steiner, who did not examine Goble, opined that her pain is primarily attributable to

fibromyalgia and not to degeneration of the spine. He said that he found no “objective

evidence” in her medical records supporting Goble’s testimony about experiencing

problems with reaching, gripping, grasping, and holding items, and he pronounced Goble

capable of performing light work with occasional overhead reaching and no limitation on

the use of her hands. Edward J. Utities, a vocational expert, testified that a person with the

residual functional capacity described by the ALJ could not perform Goble’s past work but

could perform one of the 8,000 jobs in Minnesota for banders

‐ and

‐ cellophaners, wrapping

machine operators, garment folders, polypackers and heat sealers, and other unskilled

wrapping and packing positions. Kent Goble, Goble’s husband, testified that her condition

had worsened in the two years preceding the hearing. He said that Goble drops things, has

memory lapses, and has difficulty staying on task.

In July 2007 the ALJ issued her decision finding Goble not disabled. Under the

five

‐ step sequential analysis, see 20 C.F.R. § 404.1520(a)(4), the ALJ found at step one that

Goble had not engaged in substantial gainful activity since November 2004. At step two,

she found that Goble suffers from multiple severe impairments: fibromyalgia or myofascial

pain, degenerative disc disease of the cervical, thoracic and lumbar spine, migraine

headaches, depression, and chronic pain syndrome. At step three, relying on the testimony

of Dr. Steiner, the ALJ concluded that these impairments do not alone or in combination

meet or medically equal a listed impairment. The ALJ found that Goble retains the residual

functional capacity to perform unskilled, light work. Jobs in this category require lifting 10

pounds frequently and 20 pounds occasionally, and standing or walking 6 hours and sitting

2 hours in an 8

‐ hour work day. The ALJ limited the work, however, to routine, repetitive 3

‐

to 4

‐ step jobs that do not require more than occasional reaching overhead. The ALJ did not

entirely credit Goble’s testimony about the intensity, duration, and limiting effect of her

symptoms. The ALJ viewed Goble’s statements as inconsistent with notes of treating

physicians describing her as alert and well oriented and with Goble’s own description of

her range of daily living activities. The ALJ also thought it significant that Goble had not

completed a recommended physical

‐ therapy program, had temporarily lived in Utah

without taking medication, and had previously held full

‐ time jobs despite her impairments

and had not sought less

‐ demanding work. Relying on the testimony of the vocational

expert, the ALJ concluded that Goble cannot perform her past work but still is employable

because there are available jobs that can be performed by someone with her residual

functional capacity. The ALJ’s decision became the final decision of the commissioner when

the Appeals Council denied Goble’s request for review on May 16, 2008.No. 09

‐ 2851 Page 4

Goble presents two main arguments: (1) the ALJ’s credibility determination is

patently wrong, and (2) the ALJ’s RFC determination is not supported by substantial

evidence.

Goble first argues that the ALJ wrongly concluded that her account of her limitations

is contradicted by objective medical evidence. She argues that not only is her pain

consistent with the objective evidence, but that no objective support is required for her

subjective assertions of pain. She cites Sarchet v. Chater

, 78 F.3d 305, 306

‐ 07 (7th Cir. 1996),

for the proposition that fibromyalgia symptoms are entirely subjective, and Bauer v. Astrue

,

532 F.3d 606, 609 (7th Cir. 2008), for the proposition that a claimant may appear to be doing

better at certain points without undermining her claim of disability.

We will not overturn an ALJ’s credibility finding unless it is “patently wrong.” Craft

v. Astrue

, 539 F.3d 668, 678 (7th Cir. 2008). An ALJ should compare the consistency of a

claimant’s statements against objective information in the medical record, SSR 96

‐ 7p, 1996

WL 374186, at *6

‐ 7, and we will disturb an ALJ’s credibility determination only if that

finding is unreasonable or unsupported, Sims v. Barnhart

, 442 F.3d 536, 538 (7th Cir. 2006).

The ALJ acted unreasonably when she rejected Goble’s subjective allegations of pain

and of medication side effects on the ground that Goble appeared “alert and oriented,

pleasant and cooperative” in the presence of treating physicians. None of the doctors who

made these observations viewed them as inconsistent with chronic pain, and in fact

continued to prescribe methadone and other medications as well as batteries of tests in

response to Goble’s complaints of pain. We have deemed it improbable that a claimant

would undergo pain

‐ treatment procedures such as heavy doses of strong drugs in order to

increase chances of obtaining disability benefits or that doctors would prescribe these

treatments if they thought she were faking. Diaz v. Prudential Ins. Co. of Am.

, 499 F.3d 640,

646 (7th Cir. 2007); Carradine v. Barnhart

, 360 F.3d 751, 755 (7th Cir. 2004). Without medical

evidence suggesting a discrepancy between Goble’s alleged chronic pain and her alert

appearance, the ALJ impermissibly substituted her own judgment for that of the physicians.

See Boiles v. Barnhart

, 395 F.3d 421, 425 (7th Cir. 2005); Clifford v. Apfel

, 227 F.3d 863, 870 (7th

Cir. 2000). No medical provider or witness, not even Dr. Steiner, the medical expert,

mentioned any inconsistency between complaining of chronic, disabling back pain and

appearing alert and pleasant during a visit to the doctor. In addition, we question the

wisdom of penalizing a claimant for cooperating during physical evaluations. In fact a

claimant’s failure to cooperate may be sufficient reason in itself to reject her testimony. See,

e.g., Thomas v. Barnhart

, 278 F.3d 947, 959 (9th Cir. 2002) (explaining that ALJ was free to

conclude that claimant’s lack of cooperation during evaluations of her physical capacity

undermined the credibility of her complaints of pain).No. 09

‐ 2851 Page 5

In addition the ALJ acted improperly when she gave no weight to Goble’s limitations

in daily living on the grounds the limitations were “due to pain or other subjective

allegations such as numbness.” A lack of objective medical evidence does not necessarily

mean that an ALJ may discredit a claimant’s subjective complaints of pain:

[T]he absence of objective medical evidence supporting an individual’s

statements about the intensity and persistence of pain or other symptoms is

only one factor that the adjudicator must consider in assessing an individual’s

credibility and must be considered in the context of all the evidence.

SSR 96

‐ 7p, 1996 WL 374186, at *6. Claims of disabling pain “based solely on the claimant’s

subjective complaints” cannot be discredited simply because of a lack of objective medical

confirmation, although the lack of confirmation can factor into the analysis. Parker v. Astrue

,

597 F.3d 920, 922

‐ 923 (7th Cir. 2010); Myles v. Astrue

, 582 F.3d 672, 677 (7th Cir. 2009); Villano

v. Astrue

, 556 F.3d 558, 562 (7th Cir. 2009); Zurawski v. Halter

, 245 F.3d 881, 887

‐ 88 (7th Cir.

2001). Pain can be severe to the point of being disabling even though it is entirely in the

claimant’s mind. Johnson v. Barnhart

, 449 F.3d 804, 806 (7th Cir. 2006); Sims

, 442 F.3d at

537

‐ 38; Carradine

, 360 F.3d at 753

‐ 54; Foote v. Chater

, 67 F.3d 1553, 1560

‐ 61 (11th Cir. 1995)

(per curiam); Latham v. Shalala

, 36 F.3d 482, 484 (5th Cir. 1994); Easter v. Bowen

, 867 F.2d

1128, 1130 (8th Cir. 1989). Goble acknowledged that she can drive short distances, cook

frozen pizza, and perform other simple tasks, but she also maintained that she cannot sit for

more than 5 to 10 minutes, stand still for more than a minute, or walk more than 100 yards.

A claimant’s ability to perform limited and sporadic tasks does not mean she is capable of

full

‐ time employment. See Carradine

, 360 F.3d at 755; Clifford, 227 F.3d at 872; Shramek v.

Apfel

, 226 F.3d 809, 813 (7th Cir. 2000). The ALJ did not refute Goble’s statements or explain

how they are compatible with the demands of a full

‐ time job.

The ALJ’s other reasons for rejecting Goble’s assertions of pain are also problematic.

The ALJ noted, for example, that Goble worked for many years after her diagnosis of

fibromyalgia. But a claimant may force herself to work for years despite suffering from

fibromyalgia, see Hawkins v. First Union Corp.

, 326 F.3d 914, 918 (7th Cir. 2003), and Goble

testified how much she loved working and how hard it was for her to give it up. The ALJ

also remarks several times that Goble’s condition improved while she was off of medication

for a few months in Utah. Goble moved to Utah at the encouragement of her doctors in the

hope that the drier climate would improve her medical condition, but she testified that she

had no insurance coverage at the time and left after a few months to be closer to her

children. It was questionable for the ALJ to conclude that her temporary improvement

implies that she does not actually require serious narcotics. The ALJ also cited a nurse’s

notation that Goble refused to set up psychotherapy or physical therapy, and a note fromNo. 09

‐ 2851 Page 6

Dr. Iwu that she was discharged from a physical therapy program after she cancelled her

appointment. The ALJ never questioned Goble about her reasons for non

‐ participation,

however, or discussed Dr. Iwu’s recommendation that she continue her physical therapy

independently in a home program. Goble asserts that she discontinued physical therapy

due to problems with insurance coverage. Without further information this non

‐ participation cannot support the ALJ’s credibility determination.

We also question a decision that casts doubt on a claimant’s disability due to her

ability to complete “multiple application and appeal forms in detail.” On remand the ALJ

may find valid reasons to impugn Goble’s credibility, but the act of applying for disability

benefits should not be among them.

Goble next contends that the ALJ’s finding of a residual functional capacity for light

work is not supported by substantial evidence. She first argues that the ALJ failed to

explain the weight given Dr. Steiner, the medical expert. She notes that, when a treating

source’s opinion is not given controlling weight, an ALJ is required to explain the weight

given to the various medical sources, see 20 C.F.R. § 404.1527(f)(2)(ii )

. In this case the ALJ

gave greatest weight to Dr. Steiner’s conclusions for the same reason that she rejected

Goble’s subjective complaints of pain—the perception that the treating physicians’

observations were inconsistent with their conclusions. Accordingly, as this reasoning is

improper in the credibility analysis, the relative weight of the physicians’ testimony in the

RFC must be reevaluated as well.

Goble also asserts that the ALJ disregarded ample clinical evidence of a correlation

between her back disorders and her arm and hand limitations. She argues that the ALJ

must consider the medical opinions in the record, see 20 C.F.R. § 404.1527(b), and that the

ALJ failed to consider evidence of her arm and hand limitations provided by Dr. Kioski,

Dr. Perra, and Dr. Tierney.

An ALJ is obligated to consider all relevant medical evidence and may not

cherry

‐ pick facts to support a finding of non

‐ disability while ignoring evidence that points

to a disability finding. Myles v. Astrue

, 582 F.3d 672, 678 (7th Cir. 2009). But an ALJ need

not mention every piece of evidence, so long she builds a logical bridge from the evidence to

her conclusion. Getch v. Astrue

, 539 F.3d 473, 480 (7th Cir. 2008).

The ALJ properly rejected Goble’s allegations of arm and hand limitations on the

ground that tests repeatedly show few neurological effects or loss of strength, grip, or range

of motion. Dr. Perra and Dr. Kioski’s notes would not change that analysis, as the notes are

mainly Goble’s self

‐ reports of her symptoms, and in any event took place in 2003, before theNo. 09

‐ 2851 Page 7

alleged period of disability. Dr. Perra, for example, noted that Goble “says she has been

having complaints recently” of a decreased grip, but upon physical examination found her

strength normal. And contrary to Goble’s assertion, the ALJ’s decision did include a

discussion of Dr. Tierney’s finding of “give way weakness of the right extremity,” even if

she did not mention Dr. Tierney by name.

Goble also argues that the ALJ selectively analyzed the record of her mental

impairments. She contends that the ALJ improperly rejected psychologist Johnson’s

conclusions that Goble would have difficulty working at a reasonable pace or tolerating

workplace stressors. Contrary to Goble’s assertion, the ALJ accepted her moderate

difficulties with pace. The ALJ appropriately accommodated the limitation by restricting

Goble to simple, unskilled work. See Simila v. Astrue

, 573 F.3d 503, 521

‐ 22 (7th Cir. 2009);

Sims v. Barnhart

, 309 F.3d 424, 431 (7th Cir. 2002).

The ALJ rejected Goble’s professed difficulty coping with workplace stressors, and

for that conclusion the ALJ failed to build a logical bridge. The ALJ reasoned that this

difficulty is “not well

‐ supported by Psychologist Johnson’s own negative mental status

examination or the assessed GAF of 58.” But Johnson did not perceive any incompatibility

with her examination, and the ALJ did not explain her disagreement. The ALJ may have

penalized Goble for appearing “pleasant and cooperative” to Johnson, but if so this

incompatibility is the same unsupported finding discussed in the credibility analysis. Goble

earlier stated in a separate functional report that she handles stress “ok” and had no

problems changing routine, but it is unclear to what extent the ALJ relied on that evidence.

Furthermore, although an ALJ is not required to determine the extent of a claimant’s

disability based on her GAF score, Denton v. Astrue

, 596 F.3d 419, 425 (7th Cir. 2010), in this

case the ALJ instead relied on a misunderstanding of the GAF score. A GAF score of 58

suggests moderate difficulties in occupational functioning, and a score below 51 indicates a

possible inability to keep a job. A M

. P SYCHIATRIC A SS ’ N

, D IAGNOSTIC & S TATISTICAL M ANUAL

OF M ENTAL D ISORDERS 32

‐ 34 (Text Revision, 4th ed. 2000). Therefore the GAF score is not

inconsistent with difficultly tolerating stress but rather suggests someone who may be

barely above the level of being able to work or live independently.

We therefore REVERSE the denial of disability benefits and REMAND for further

consideration by the agency.