# United States Court of Appeals

For the Seventh Circuit

Chicago, Illinois 60604

Argued June 2, 2020

Decided July 16, 2020

Before

J OEL M. FLAUM, Circuit Judge

MICHAEL S. KANNE, Circuit Judge

MICHAEL B. BRENNAN, Circuit Judge

No. 19

‐ 2582

AIMEE M. APKE,

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. 2:18

‐ cv

‐ 02098

‐ EIL

Eric I. Long,

M agistrate Judge

.

O R D E R

Aimee Apke, a 37

‐ year

‐ old former cashier, nurse assistant, and in

‐ home health

care provider, su ff ers from fi bromyalgia and other physical and mental health

impairments. She applied for disability insurance bene fi ts and supplemental security

income claiming she was unable to work due to chronic pain and severe symptoms

from her fi bromyalgia. The Social Security Administration denied her applications.

Apke timely sought review of the denials, and an administrative law judge determined

she was not disabled under the Social Security Act. After fi nding there was substantial

evidence supporting the ALJ’s decision, the district court a ffi rmed the denial. We fi nd

no error in the consideration of Apke’s claim, so we a ffi rm. NONPRECEDENTIAL DISPOSITION

To be cited onl y in accordance with Fed. R. A pp

. P. 32.1No. 19

‐ 2582 Page 2

I. Background

Apke was 30 years old in 2014 when she fi rst applied for disability bene fi ts

insurance and supplemental security income. She alleged her disability began in

October 2010. 1 She formerly worked as a cashier, a nurse assistant, and an in

‐ home

health care provider. Shortly after applying for bene fi ts she reported she lived at home

with her family and took care of her three children. She bathed them, cooked for them,

and a tt ended to their needs. Apke’s activities included cleaning the house, washing

clothes, washing dishes, driving, shopping in stores for groceries and household items,

paying bills, a tt ending church regularly, a tt ending her children’s sporting events, and

providing primary care for her youngest child who was not yet in school.

Additionally, Apke worked part

‐ time about 20 hours per week answering

phones and assisting customers for her father’s window business. When she felt pain or

fatigue, she was allowed to periodically sit or lay down. Since February 2016, she has

maintained a small home

‐ based baking business, working about two weekends per

month.

As part of her bene fi ts applications, Apke submi tt ed medical treatment records.

The treatment notes from 2011 show she complained of fatigue, back pain, and general

all

‐ over pain. She was treated conservatively for mild degenerative disc disease, joint

pain, and muscle spasms. In 2012, Apke was diagnosed with fi bromyalgia for which she

received multiple trigger point injections. She did not require surgery. Over the next

several years, Apke was diagnosed with headaches, which were treated with mild

medication, and borderline diabetes, which was treated through dietary restrictions.

Apke has been treated for mental impairments, including an a ff ective disorder and

anxiety. She has not required psychiatric hospitalization or inpatient care.

The Social Security Administration denied Apke’s applications initially and again

upon reconsideration. Apke, represented by counsel, requested a hearing before an ALJ.

Prior to the hearing, Apke’s counsel submi tt ed forms from three of Apke’s treating

physicians: Dr. Alao, Dr. Schue, and Dr. Joag. Each was asked to complete and sign an

“abbreviated” residual functional capacity report prepared by Apke’s a tt orney. The

report included a checklist for the physicians to complete; it did not include open

‐ ended

questions or request the physicians’ medical opinions regarding Apke’s need to

perform light work. These forms required the physicians to opine whether Apke’s

1 During her hearing before the ALJ, Apke amended the alleged onset date to July 2012. The date change

does not impact our analysis.No. 19

‐ 2582 Page 3

subjective complaints were credible. At the hearing, the ALJ heard testimony from Apke

and a vocational expert. After the hearing, the ALJ sought the objective medical opinion

of Dr. Anne Winkler, a rheumatologist who assessed Apke’s ability to perform light

work through a series of open

‐ ended questions.

At issue before the ALJ was whether Apke is entitled to disability bene fi ts

pursuant to §§ 216(i) and 223 of the Social Security Act, 42 U.S.C. §§ 416(i) and 423, as

well as supplemental security income under §§ 1602 and 1611 of the Act, 42 U.S.C.

§§ 1381a and 1382. 2 The ALJ found that Apke has severe impairments from

fi bromyalgia, borderline diabetes, headaches, spine disorder, depression, and anxiety.

But the ALJ determined that Apke does not have an impairment or combination of

impairments that meets or medically equals the severity of one of the impairments

listed in 20 C.F.R. §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 or 416.926. After

assessing Apke’s residual function capacity, the ALJ found Apke could perform light

work as de fi ned. See 20 C.F.R. §§ 404.1567(b) and 416.967(b). Although Apke is unable to

perform her previous jobs as a cashier, nurse assistant, or in

‐ home health care provider,

the ALJ determined that she can perform a signi fi cant number of jobs in the national

economy. In reaching this decision, the ALJ considered all of Apke’s symptoms and the

extent to which those symptoms could reasonably be accepted as consistent with the

objective medical and other evidence, including medical opinion evidence. To the ALJ,

Apke’s activities, examinations, and treatments were inconsistent with her allegations

of disabling symptoms. So in February 2017, the ALJ issued a decision a ffi rming the

Administration’s denials of bene fi ts to Apke.

The Social Security Appeals Council denied Apke’s request for review, making

the ALJ’s ruling the fi nal administrative decision. Apke timely sued in federal district

court seeking judicial review of the administrative decision. See 42 U.S.C. § 405(g). The

district court granted the Commissioner’s motion for summary judgment and a ffi rmed

the Administration’s denial of bene fi ts.

On appeal, Apke claims the ALJ erred in fi nding no disability. Speci fi cally, she

argues the ALJ failed to properly weigh the medical opinion evidence or consider the

severity of her subjective fi bromyalgia limitations.

2 “Disability” is defined as the inability to engage in any substantial gainful activity by reason of any

medically determinable physical or mental impairment or combination of impairments that can be

expected to result in death or that has lasted or can be expected to last for a continuous period of at least

six months. 20 C.F.R. §§ 404.1505, 416.905.No. 19

‐ 2582 Page 4

II. Analysis

We review the district court’s judgment a ffi rming the Commissioner’s decision

de novo. Shideler v. Astrue

, 688 F.3d 306, 310 (7th Cir. 2012). “We will uphold an ALJ’s

fi nal decision if the correct legal standards were applied and supported with substantial

evidence.” Burmester v. Berryhill

, 920 F.3d 507, 510 (7th Cir. 2019) (citing Jelinek v. Astrue

,

662 F.3d 805, 811 (7th Cir. 2011); 42 U.S.C. 405(g)); see also Gebauer v. Saul

, 801 Fed. Appx.

404, 408 (7th Cir. 2020) (“This court directly reviews the ALJ’s decision to determine

whether it applies the correct legal standard and is supported by substantial evidence.”)

(quoting Summers v. Berryhill

, 864 F.3d 523, 526 (7th Cir. 2017)). When reviewing the

administrative record, we do not “reweigh the evidence or substitute [our] judgment

for that of the ALJ.” Chavez v. Berryhill

, 895 F.3d 962, 968 (7th Cir. 2018); see also Lopez v.

Barnhart

, 336 F.3d 535, 539 (7th Cir. 2003) (In assessing social security decisions, this

court does not “reweigh the evidence, resolve con fl icts, decide questions of credibility,

or substitute our own judgment for that of the Commissioner.”) (quoting Cli ff

ord v.

Apfel

, 227 F.3d 863, 869 (7th Cir. 2000).

In determining whether a disability exists, the ALJ must consider the claimant’s

symptoms under a sequential, fi ve

‐ step process. See 20 C.F.R. §§ 404.1520(a), 416.920(a).

First, the ALJ must determine whether the claimant was engaged in substantial gainful

activity. 20 C.F.R. §§ 404.1520(b), 416.920(b). Second, the ALJ must assess whether the

claimant has a medically determinable impairment that is “severe” or a combination of

impairments that is “severe.” 20 C.F.R. §§ 404.1520(c), 416.920(c). Third, the ALJ must

evaluate whether the claimant’s impairment or combination of impairments is of a

severity to meet or medically equal the criteria of an impairment listed in the

regulations. 20 C.F.R. §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925, 416.926.

Before moving onto the next step, the ALJ must also consider the claimant’s residual

functional capacity, which is assessed by considering all claimed impairments including

those that are not severe. 20 C.F.R. §§ 404.1520(e), 404.1545, 416.920(e), 416.945. Next, the

ALJ must determine whether the claimant has the residual functional capacity to

perform the requirements of her past relevant work. 20 C.F.R. §§ 404.1520(f), 416.920(f).

Finally, the ALJ must assess whether the claimant is able to do any other work by

considering her residual functional capacity, age, education, and work experience. 20

C.F.R. §§ 404.1520(g), 416.920(g). If the claimant can do other work, she is not disabled.

While “the ALJ must build a logical bridge from the evidence to his conclusion, [] he

need not provide a complete wri tt en evaluation of every piece of testimony and

evidence.” Shideler

, 688 F.3d at 310 (quoting Schmidt v. Barnhart

, 395 F.3d 737, 744 (7th

Cir. 2005)).No. 19

‐ 2582 Page 5

Here, Apke does not argue the ALJ failed to complete the required fi ve

‐ step

analysis. Instead, she claims the ALJ erred by not giving enough weight to the medical

opinion evidence of her treating physicians and by failing to consider the severity of her

subjective fi bromyalgia limitations. We focus on only these claims.

A. Medical Opinion Evidence

Under federal regulations, “objective medical evidence” may establish the

presence of a medically determinable impairment for disability and social security

purposes. See SSR 12

‐ 2p. Objective medical evidence may be taken from “all of the

evidence in the case record, including the person’s daily activities, medications, and

other treatments the person uses, or has used, to alleviate symptoms; the nature and

frequency of the person’s a tt empt to obtain medical treatment for symptoms; and

statements by other people about the person’s symptoms.” SSR 12

‐ 2p(IV)(B). The ALJ

must give controlling weight to a treating physician’s opinion if it is “well supported by

medically acceptable clinical and laboratory diagnostic techniques and is not

inconsistent with other substantial evidence.” Punzio v. Astrue

, 630 F.3d 704, 710 (7th

Cir. 2011) (citing 20 C.F.R. § 404.1527(d)(2)). The regulations provide several factors the

ALJ should consider in evaluating a treating physician’s opinion: the length, nature, and

extent of the treatment relationship; the frequency of examination; the physician’s

specialty; the types of tests performed; and the consistency and support for the

physician’s opinion. 20 C.F.R. § 404.1527(c). “When treating and consulting physicians

present con fl icting evidence, the ALJ may decide whom to believe, so long as

substantial evidence supports that decision.” Dixon v. Massanari

, 270 F.3d 1171, 1178

(7th Cir. 2001).

As noted above, Apke submi tt ed medical opinion evidence from three treating

physicians: Dr. Alao, Dr. Schue, and Dr. Joag. Each completed a form provided by

Apke’s lawyer with the stated purpose of determining Apke’s ability to engage in

sedentary level work. The forms de fi ned sedentary work and asked the physician to

select a diagnosis and to indicate whether the patient’s subjective complaints were

credible. The form completed by Dr. Joag also required her to mark check boxes to

select Apke’s restrictions and predict how frequently Apke might miss work due to her

limitations.

The ALJ did not rely on the reports prepared by these three physicians because

their expressed opinions merely “rubberstamped” Apke’s subjective complaints. See

Dixon

, 270 F.3d at 1178 (“An ALJ may properly reject a doctor’s opinion if it appears to

be based on a claimant’s exaggerated subjective allegations.”). Speci fi cally, the ALJNo. 19

‐ 2582 Page 6

found the forms failed to ask open

‐ ended questions about Apke’s limitations, relied on

Apke’s reported allegations, assumed Apke would be limited to only sedentary work,

and did not include an area for the physicians to describe the type of work Apke was

capable of performing. According to the ALJ, the forms did not accurately assess Apke’s

limitations but rather re fl ected that the physicians found credible her subjective

complaints.

Instead, the ALJ gave probative weight to the opinion of Dr. Winkler, a

rheumatologist medical expert whose opinion the ALJ sought after the hearing. Dr.

Winkler opined that Apke could perform light work consistent with the limitations in

the residual functional capacity report. In giving weight to Dr. Winkler’s opinion, the

ALJ found that Dr. Winkler’s opinion was consistent with Apke’s daily activities and

was supported by objective medical fi ndings. In considering all the opinion evidence,

the ALJ decided that Dr. Winkler’s descriptive opinion warranted more weight than the

prepared forms signed by the treating physicians.

We fi nd no error with this reasoning and decision by the ALJ. An opinion is

entitled to controlling weight only if it is supported both by medical fi ndings and a

consistent record. See 20 C.F.R. § 404.1527(c)(2). “An ALJ may obtain a medical expert’s

opinion for several reasons, including to clarify and explain the evidence or help resolve

a con fl ict because the medical evidence is contradictory, inconsistent, or confusing and

to determine the claimant’s residual functioning capacity.” Gebauer

, 801 Fed. Appx. at

408. The ALJ’s reasoning and decision here favoring Dr. Winkler’s descriptive

evaluation over the “checkbox” approach of Apke’s treating physicians was within the

ALJ’s discretion, Dixon

, 270 F.3d at 1178, and appropriate. “The use of a medical expert

can help ALJs resist the temptation to ‘play doctor’

... by evaluating medical evidence

on his or her own.” Gebauer

, 801 Fed. Appx. at 408; see e.g., Myles v. Astrue

, 582 F.3d 672,

677 (7th Cir. 2009) ( fi nding the ALJ “impermissibly played doctor and reached his own

independent medical conclusion”). As this court has noted recently “[a] medical expert

may be especially helpful when evaluating the severity of a condition—like

fi bromyalgia—marked by subjective and fl uctuating symptoms.” Gebauer

, 801 Fed.

Appx. at 409.

Apke’s treating physicians provided no opinions as to her need to perform light

or sedentary work. They only completed forms based on Apke’s subjective complaints.

The physicians did not opine whether Apke had a disability for social security

purposes, and they did not rely upon outside objective medical measures including

other a tt ending, reviewing, or examining physicians. In contrast, Dr. Winkler providedNo. 19

‐ 2582 Page 7

speci fi c reasons why Apke’s impairments did not meet or equal any listed impairment,

and Dr. Winkler gave examples of speci fi c objective medical abnormalities—including

speci fi c medical signs and laboratory fi ndings—to support her assessment. Ultimately,

Dr. Winkler concluded that Apke is capable of performing light work. That conclusion

is supported by speci fi c, objective medical fi ndings and test results, as well as Apke’s

daily activities. For these reasons, the ALJ did not err in giving greater weight to Dr.

Winkler’s medical opinion than to Apke’s treating physicians.

B. Severity of Apke’s Subjective Limitations

Courts have recognized that often there is no objective medical evidence

indicating the presence or severity of fi bromyalgia. See Vanprooyen v. Berryhill

, 864 F.3d

567, 572 (7th Cir. 2017) ( fi nding that fi bromyalgia cannot be measured with objective

tests); see also Criner v. Barnhart

, 208 F. Supp. 2d 937, 951 (N.D. Ill. 2002). In the absence

of objective medical evidence, the severity of fi bromyalgia symptoms may be evaluated

based on the claimant’s subjective statements regarding the impairment. See SSR 12

‐ 2p;

SSR 16

‐ 3p. When evaluating a claimant’s subjective symptoms, the ALJ follows a two

‐

step process. See 20 C.F.R. §§ 404.1529(a), 416.929(a). First, the ALJ considers whether

the claimant’s impairments could reasonably be expected to produce the symptoms she

alleges, such as pain. 20 C.F.R. §§ 404.1529(b), 416.929(b). Second, the ALJ considers

whether the record supports the severity of the symptoms the claimant alleges, such as

debilitating pain preventing work. 20 C.F.R. §§ 404.1529(c), 416.929(c). To do so, the ALJ

will look to the claimant’s reported activity levels and treatment received. This court

will “give the ALJ’s credibility fi nding ‘special deference’ and will overturn it only if it

is ‘patently wrong.’” Summers

, 864 F.3d at 528.

The ALJ concluded that Apke’s impairments, including her fi bromyalgia and

back pain, could reasonably be expected to produce her alleged symptoms. But when

considering Apke’s allegations in light of the full record, the ALJ determined that her

symptoms and limitations were not as severe as she claimed. The ALJ adhered to the

regulations by considering Apke’s own statements regarding her fi bromyalgia

limitations. Apke’s reported daily activities— all of which she performed after her

alleged disability onset date—were considered. The ALJ also considered Apke’s

disclosed medical treatment, noting she received only minor doses of prescription

medications and injections. After weighing this evidence, the ALJ concluded that these

reported activities and treatments were inconsistent with Apke’s allegations of

debilitating pain. See e.g., Gebauer

, 801 Fed. Appx. at 410 (This court a ffi rmed the ALJ’s

evaluation of claimant’s fi bromyalgia symptoms when the ALJ relied on “a lack ofNo. 19

‐ 2582 Page 8

evidence... [of] symptoms associated with the pain that would prevent her from

performing sedentary work.”).

Apke also claims the ALJ failed to fully consider the severity of her fi bromyalgia

limitations. She points to the opinion of Dr. Darrell Snyder, a state agency consultant,

who opined that Apke had “moderate limitations” in her ability to perform activities

within a schedule, maintain regular a tt endance, and be reasonably punctual. But Dr.

Snyder concluded that Apke “could tolerate normal work expectations” so long as

additional expectations were not placed upon her. Dr. Snyder found no limitations to

Apke’s overall ability to perform a range of simple work. See e.g., Urbanek v. Saul

, 796

Fed. Appx. 910, 915 (7th Cir. 2019) (“[T]he agency doctors checked boxes stating [the

claimant] had moderate limitations in these two areas, but they concluded in their

narrative opinions that he could sustain the basic mental demands of unskilled work if

he were limited to performing simple tasks in a structured work environment.”). At any

rate, moderate limitations, on their own, do not mean a claimant is disabled. See Capman

v. Colvin

, 617 Fed. Appx. 575, 579 (7th Cir. 2015) (“A moderate limitation is not a

complete impairment.”). Because Apke has failed to show the ALJ’s credibility

determination was patently wrong, we defer to it.

We conclude the ALJ applied the correct legal standards and supported his

decision with substantial evidence. Accordingly, we AFFIRM the judgment of the

district court affirming the denial of benefits.