United States Court of Appeals 

For the Seventh Circuit 

Chicago, Illinois 60604 

Argued July 9, 2019 

Decided July 23, 2019 

Before 

MICHAEL S. KANNE, Circuit Judge 

DAVID F. HAMILTON, Circuit Judge 

MICHAEL Y. SCUDDER, Circuit Judge

No. 19-1192 

HOLLY DENISE GREEN, 

Plaintiff-Appellant, 

v. 

ANDREW M. SAUL, 

Commissioner of Social Security, 

 Defendant-Appellee.

 Appeal from the United States District 

Court for the Northern District of Indiana, 

Fort Wayne Division. 

No. 1:17-cv-318 

Susan L. Collins, 

Magistrate Judge. 

O R D E R 

Holly Green applied for Disability Insurance Benefits based on numerous 

conditions, including knee pain, fibromyalgia, neck and back pain, obesity, and anxiety. 

An administrative law judge denied benefits, finding that Green could do sedentary 

work with certain limitations. After the district court upheld this denial, Green 

appealed, arguing that the ALJ wrongly made an adverse credibility finding against 

her, improperly weighed the evidence, and did not adequately consider her sleep 

problems and neck pain. But the ALJ’s findings were supported by substantial evidence 

and properly accounted for Green’s limitations, so we affirm. 

NONPRECEDENTIAL DISPOSITION 

To be cited only in accordance with Fed. R. App. P. 32.1 
No. 19-1192 Page 2 

I. Background 

 Green was 42 years old when she applied for benefits, asserting an onset date of 

December 2012. She has an associate degree in applied science and technology and has 

worked previously as a cook, welder, and in multiple positions in quality assurance. 

She is often in pain because she suffers from fibromyalgia, degenerative disc disease, 

migraines, obesity, and arthritis in her left knee and shoulder. She treats her pain with 

medication, including opioids like hydrocodone, and has received multiple nerveblocking injections in her neck. In 2013, she had surgery on her right knee to treat a torn 

meniscus. 

Doctors have also diagnosed Green with insomnia, sleep apnea, anxiety, and 

depression. For these conditions, Green takes Ambien, Prozac, and Xanax. Dr. Dan 

Boen, a consulting psychologist who performed a mental-status evaluation in 

connection with her disability claim, assigned her a Global Assessment of Function 

(“GAF”) score of 45, indicating that she had serious impairments in social and 

occupational functioning.1 AM. PSYCHIATRIC ASS’N, DIAGNOSTIC AND STATISTICAL 

MANUAL OF MENTAL DISORDERS 32 (4th ed. 1994). Dr. Boen also opined that Green 

“could understand what she was asked to do on a job but she would not be able to 

remember it. She would have trouble concentrating and staying on task.” 

State-agency consulting psychologist Dr. Ken Lovko reviewed Green’s records 

and determined that Dr. Boen’s opinion was “not supported by exam” or daily-life 

activities. He opined that she could “understand, remember and carry-out semiskilled 

tasks” and “attend to task[s] for sufficient periods of time to complete” them. Green’s 

internist, Dr. Vijay Kamineni, noted that she had “[n]ormal concentration and social 

interaction,” and her “[r]emote and recent memory” was “intact.” 

After the Social Security Administration denied Green’s application, she had a 

hearing before an ALJ. She testified that she was unable to work primarily due to her 

left knee pain, fibromyalgia, and neck problems. Green said she that she is in 

debilitating pain about half the time and that on “bad days” she lies down and tries not 

to move. She also testified that she could stand only 15 to 20 minutes at a time. She told 

 

1 The GAF, which assesses an “individual’s overall level of functioning,” Craft 

v. Astrue, 539 F.3d 668, 676 n.7 (7th Cir. 2008), is no longer widely used by psychiatrists 

and psychologists. 
No. 19-1192 Page 3 

the ALJ that a recent MRI showed “bulging disc[s]” in her neck and back. Neck pain 

causes her “difficulty looking side-to-side,” “looking just slightly down at a computer 

screen or a table,” and “holding something and reading.” She suffers from social 

anxiety as well—she said she cannot handle being in a room with more than ten 

unfamiliar people. She also reported that some days she “just can’t ... think straight.” 

When discussing her daily routine, Green said that she reads the newspaper 

(though she usually lies down after she finishes it), watches half-hour television 

programs, and goes on Facebook every couple of days. She also enjoys fishing, though 

she has not gone for over six months. She can take care of her own hygiene, and 

although her daughter usually helps her with the cooking, Green said she does a few 

household chores, like dusting, grocery shopping, and folding laundry. Because she 

does not sleep well, Green testified that she takes “about a two hour nap” every day. 

 The ALJ consulted a vocational expert (VE) about whether a person with Green’s 

functional limitations could find work in the national economy. In his first hypothetical, 

the ALJ asked about an individual of Green’s age, education, and work history, 

“reduced to sedentary work” with the following limitations: never lifting more than ten 

pounds; sitting six hours of the work day; limited to “simple repetitive tasks,” with “no 

sudden or unpredictable workplace changes,” no “tasks requiring intense or focused 

attention for prolonged periods,” and the ability to “work at a flexible pace where the 

employee is allowed some independence in determining either the timing of different 

work activities or pace of work.” The expert said that such a person could work as an 

order clerk, change account clerk, or call-out operator. Next, the ALJ added the 

limitation of needing to alternate “between sitting and standing up to every 

30 minutes,” and the VE responded that the same jobs would be available. 

 After the hearing, Green provided additional evidence regarding her cervical 

spine issues and sleep apnea. This included the analysis of the 2015 MRI mentioned in 

Green’s testimony; it showed “[d]egenerative disc changes with” two small central disc 

protrusions. Doctors also recorded that Green’s “bilateral neck pain and spasms have 

been getting worse” and that she had “difficulty in turning her head.” 

The ALJ then conducted the Administration’s five-step analysis, see 20 C.F.R. 

§ 404.1520(a), § 416.920(a). At Step 1, he determined that Green had not engaged in 

substantial gainful activity since December 4, 2012. At Step 2, he identified Green’s 

severe impairments as fibromyalgia, bilateral knee pain due to osteoarthritis and a 

meniscal tear requiring surgery, neck (and related headache) pain and low back pain 
No. 19-1192 Page 4 

due to cervical and lumbar degenerative arthritis, rosacea, obesity, depression, and 

anxiety. At Step 3, the ALJ concluded that these severe impairments did not meet any 

listings for presumptive disability. Further, the ALJ determined, Green’s “medically 

determinable impairments could reasonably be expected to cause the alleged 

symptoms,” but her “statements concerning the intensity, persistence and limiting 

effects of these symptoms are not entirely credible.” 

Between Steps 3 and 4 the ALJ determined that Green had the Residual 

Functioning Capacity (RFC) to perform sedentary work with the limitations he had 

included in his hypothetical questions to the VE. Though the ALJ determined that 

Green’s limitations precluded her from performing her past relevant work (Step 4), at 

Step 5 he relied upon the VE’s testimony and concluded that with her RFC, Green could 

successfully find other work. 

The agency’s Appeals Council denied Green’s request for review. She then 

sought judicial review, and the parties agreed to have a magistrate judge adjudicate the 

case. See 28 U.S.C. § 636(c). The magistrate judge upheld the ALJ’s decision. 

II. Analysis 

“An ALJ’s decision will be upheld if supported by ‘substantial evidence,’ which 

means ‘such relevant evidence as a reasonable mind might accept as adequate to 

support a conclusion.’” Jozefyk v. Berryhill, 923 F.3d 492, 496 (7th Cir. 2019) (quoting 

Moore v. Colvin, 743 F.3d 1118, 1120–21 (7th Cir. 2014)). 

A. ALJ’s Credibility Determination 

Green first challenges the ALJ’s credibility determination because, she says, the 

assessment rests on an incomplete review of her daily activities, misinterprets her 

response to treatment, and is not supported by the medical evidence. Specifically, she 

argues that the ALJ illogically found that “her activities of daily living show that she is 

functioning at a higher degree than she reported,” and that the ALJ did not consider the 

daily assistance that she receives from her family. We must determine whether the 

ALJ’s credibility finding was supported by the record, recognizing that an ALJ’s 

credibility determination is entitled to “special deference.” Scheck v. Barnhart, 357 F.3d 

697, 703 (7th Cir. 2004). 
No. 19-1192 Page 5 

Here, the record supports the ALJ’s credibility determination. ALJs are tasked 

with reviewing the evidence provided and assessing whether a claimant is exaggerating 

the effects of her impairments, and reviewing daily-living activities is an important part 

of that evaluation. See 20 C.F.R. § 404.1529(c)(3)(i); Alvarado v. Colvin, 836 F.3d 744, 750 

(7th Cir. 2016); Pepper v. Colvin, 712 F.3d 351, 369 (7th Cir. 2013) (agreeing with ALJ’s 

reasoning that claimant’s daily activities undermined testimony about severity of 

symptoms). Here, there is no evidence that the ALJ overstated Green’s ability to 

perform daily activities. He noted that Green was able to do only some household 

chores (help prepare meals, fold laundry, and grocery shop). He then evaluated Green’s 

daily activities against her asserted impairments and found that she overstated the 

intensity of her symptoms. Her engagement in these activities showed that, with some 

limitations, she could do some work. See Skarbek v. Barnhart, 390 F.3d 500, 505 (7th Cir. 

2004); Powers v. Apfel, 207 F.3d 431, 435 (7th Cir. 2000). And though it is true that ALJs 

should not equate activities of daily living with an ability to engage in full-time work, 

see, e.g., Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012), there is no evidence that the 

ALJ did so here. Rather, he used what he heard from Green—that she cannot be active, 

that she needs to alternate between sitting and standing, and that she cannot lift heavy 

items (like laundry)—to tailor an RFC that fit her limitations, though not necessarily the 

intensity to which she testified. This was not “patently wrong.” Pepper, 712 F.3d at 369; 

Powers, 207 F.3d at 435. 

Green’s next argument, that it was unfair for the ALJ to find her testimony not 

credible by pointing to her positive response to treatment, is also uncompelling. The 

ALJ discredited Green’s account of her symptoms in part because the medical records 

showed that Green’s “fibromyalgia was noted for being well controlled,” and that her 

knee surgery produced “good results.” Green asserts that her testimony undermines 

this, especially because she said her pain causes her to have “bad days” about half the 

time and that her knee had been acting up recently. The medical evidence, however, 

supports the ALJ’s statements. Green repeatedly reported improvements in both her 

fibromyalgia and knee pain (records stated, “She does have fibromyalgia which is 

generally well controlled with Neurontin,” and “left knee improving since 

arthroscopy”). And an ALJ is permitted to consider the effectiveness of treatment, 

including surgery, in making his credibility determination. See 20 C.F.R. 

§ 404.1529(c)(3)(iv); Lambert v. Berryhill, 896 F.3d 768, 777 (7th Cir. 2018). 

Because the ALJ’s judgment of Green’s credibility “was tied to evidence in the 

record and was not patently wrong, we may not disturb it.” Alvarado v. Colvin, 836 F.3d 

744, 749 (7th Cir. 2016). 
No. 19-1192 Page 6 

B. ALJ’s evaluation of Dr. Boen’s opinion 

Green next argues that the ALJ gave too little weight to consulting psychologist 

Dr. Boen’s opinion. He gave “some weight” to Dr. Boen’s opinion that Green could not 

remember directions and would “have trouble concentrating and staying on task,” but 

“little weight” to his GAF assignment. 

The ALJ adequately explained his reasons for discounting Dr. Boen’s opinion. An 

ALJ may discount a doctor’s opinion for reasons that are supported by the record. See

Filus v. Astrue, 694 F.3d 863, 868 (7th Cir. 2012) (citing 20 C.F.R. § 404.1527(c)(2)-(3)). 

Here, the ALJ reviewed the entire mental-health record, finding multiple reports that 

showed that Green sometimes reported normal concentration and memory function. He 

also discussed why he did not credit the GAF score—he said that the GAF is a 

subjective test that can differ from one clinician to another, see, e.g., Price, 794 F.3d at 

839, and explained that the “objective medical evidence shows that [Green] is 

functioning at a higher level than a GAF of 45 suggests.” The ALJ instead gave “great 

weight” to Dr. Lovko’s opinion, which expressly disagreed with Dr. Boen’s, saying that 

it was “not supported by exam or” activities of daily life. When “consulting physicians 

present conflicting 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). 

And in addition to looking at the report of Dr. Kamineni (Green’s internist), the 

ALJ also discussed Green’s anxiety diagnosis and treatment, noted that medical records 

showed that she was “cooperative and calm” and had “normal behavior, judgment and 

thought content,” and credited state-agency psychological consultants’ opinions that 

she had “mild limitations with activities of daily living ... and moderate limitations 

with concentration, persistence and pace.” Substantial evidence thus supported the ALJ 

crediting other medical evidence over Dr. Boen’s opinion. See Schmidt v. Astrue, 496 F.3d 

833, 841–42 (7th Cir. 2007). 

C. ALJ’s evaluation of Green’s sleep problems and neck pain 

Last, Green argues that her RFC is incomplete because it does not account for her 

sleep apnea, cervical spine impairment, or mental-health limitations. But the ALJ 

acknowledged these impairments—albeit at different levels of specificity—and 

accounted in the RFC for the functional limitations that they could cause. This was 
No. 19-1192 Page 7 

enough; an ALJ need not discuss every piece of evidence in the record. See Rice 

v. Barnhart, 384 F.3d 363, 370 (7th Cir. 2004). 

First, it is clear that the ALJ did consider Green’s problems sleeping. Green 

contends that the ALJ did not consider her sleep apnea and other problems with sleep 

and next-day fatigue; however, the ALJ sufficiently addressed the limitations supported 

by objective medical evidence. The ALJ noted that Green had moderate difficulties with 

concentration, persistence, or pace, and discussed her difficulties with focus and 

concentration. In the RFC, he limited Green to sedentary work, with the additional 

mental limitations that Green “cannot understand or carry out detailed instructions” 

and “cannot perform tasks requiring intense/focused attention for prolonged periods.” 

The RFC does not mention that Green naps for two hours every day, but this 

requirement is not supported by evidence other than her testimony, which the ALJ did 

not credit. At most, the medical records say that she will experience “daytime sleepiness 

or drowsiness” and cautions Green from operating a motor vehicle or engaging in other 

activities that are hazardous “in the presence of diminished alertness”—limitations for 

which the RFC accounts. Moreover, Green did not elicit testimony from the VE about 

how a need to nap would affect her job prospects. Neither Green nor the record 

specifies how sleep problems impaired her ability to work beyond what was included 

in the RFC, so there is no reversible error. See Prochaska v. Barnhart, 454 F.3d 731, 736–37 

(7th Cir. 2006). 

Although the question whether the ALJ adequately considered Green’s neck pain 

is thornier, substantial evidence nonetheless supports the ALJ’s decision. As Green 

points out, significant medical evidence showed that her neck pain caused headaches 

and tingling, and one medical report, submitted after the hearing, showed that this pain 

made it difficult for her to turn her head from right to left. Green specifically notes that, 

although the RFC limits her to not lifting more than ten pounds and not sitting for more 

than six hours a day, it does not expressly include a limitation related to her inability to 

turn her head or look down. Yet the ALJ did consider Green’s neck problems: he listed 

them as a serious impairment, mentioned her testimony about her recent MRIs, and 

acknowledged her testimony that reading a newspaper or going on the computer can 

aggravate her neck pain. As required, the ALJ considered the entire record when 

creating the RFC. See Schmidt, 496 F.3d at 845. 

Finally, Green argues that in assigning mental limitations in the RFC, the ALJ 

simply “split the difference” between different mental-health professionals’ opinions. 

This is not accurate. The ALJ reviewed all the mental-health evidence, explained why he 
No. 19-1192 Page 8 

assigned different weight to the different opinions, and generated an RFC that 

adequately captured Green’s mental limitations. Green offers no specific criticisms of 

the mental RFC, so we find no reversible error. See Jozefyk, 923 F.3d at 498. 

III. Conclusion 

 Because the ALJ’s findings were adequately supported and properly accounted 

for all of Green’s limitations, we AFFIRM.