## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it

N o. 11

- 2422 C HRI S TI NE B J ORNS ON, Plai nt i f f

-Appe l l ant, v. M ICHAEL J. A S T RUE, Com m i ssi onero fS oci alS ecuri ty, D efend a nt-A pp ellee.

A pp eal from the United S t ates Di strictC our t fo r the N o rthernDi stricto f Illino is, Eas tern Div isi on. No . 10 C5835

—E lai ne E . Bu cklo, Judge

. A RG UE D D ECE MBE R 14, 2011

— D ECI DE D J AN UA RY 31, 2012

Befo re P OSNER, M A NI ON, a nd W OO D , C ircu it Judges . P OSNER, Ci r c u i tJu dge

. T h i s i s a n a p p e a l fr o m a deci si on bythe dist ri ct c ou rt affi rm i ng the deni alo f soc i alse curi ty disabi l i ty benefi ts by an adm i ni str ative l aw j ud ge, wh ose d ec isi on be cam e fi nalwh en the S oci al S ec ur i tyAdm i ni st r at i o n’ s Appeal s Cou nc i l de ni ed th e appl i ca ntl ea ve t o a ppea l the Co unc i l ’ s dec i si o n. Aft era n a ut o m o bi l e ac cid en t i n 1 99 9 Chr i st i ne B j orns on be gan hav ing severe back p ains. Th ree years2 N o. 11

- 2422 lat er sh e w as d iag n os ed w ith a “C h iar i m alfo rm at ion,” w hi ch i s a pro tr usi on o fbr ai n ti ssue i nto the spinal ca na l

. The mal f o r m at i o n may h ave bee n c au se d b y the acci dent, but probabl y no t; the cau se , how eve r, i s i rr el ev a n t. A fte r th re e o p er at ion s o n h er br ain an d sp in e in 2002 , th e vision an d sp eech p roblem s th at th e C h iari m al f o r m at i o n h ad ca us ed l es se ne d s ubs ta nt i al l y b uts he dev el o ped hy dr o ce pha l us

— a bui l du p ofcer ebr ospi nal flu id in t h e b ra in

— th at req uire d t h e i ns tallati on of a sh u n t in h er br ain , to d ra inth e flu id . I t t oo k t h re e in st all at i o ns t o pl ac e th e shuntpr o per l y, the l as t i n 2 00 3. To al l evi ate the seve re headaches cause d orag gr avat ed by w hata pp e a r t o h a v e b e e n a t o t a l o fn i ne b r a i n a nd spi nal operatio ns thatshe had und er gone , she w as presc ribed a numbero fpo wer fulpa i n m edi ca ti o ns , inc l udi ng O x yC on tin , Pe rc os et, L yr ica , an d m e t h od on e, oft en in co nj unc ti o n. She hasn’ t work ed si nce the auto acc i dent. S he was las t in su re d for s oc ial se c u rit y d is ab ility be n efit s in J une 2 00 5 ( when sh e was 3 4 y ea r s ol d) , s o o nl y i fs he w as di sabl ed f r o m ful l

- ti m e wor kb y tha t dat e i s sh e el i gibl e forbene fi ts. A t the fi rs t o ftwo di sabi l i ty he ar in gs she t est i fi ed that si nce be f or e herl ast -in su re d date she has had consta nt, excruci ating hea daches f our orfi ve d ay s a week, wh i ch cause her to vom i t w h en she sta nd s up. S he ta kes her pai n m edi cati ons w hen she w ake s up and th en goes backto bed f orhou rs bec ause she “ coul d not do anythi ng el se because o fher p ain m edi cati ons. ” S he al so h as se ve re ba c k p ain , agg ra va te d by ob es i t y , b u t it d oes not ap p ear tha t t h e b a ck p ain is disabling i n itself,N o. 11

- 2422 3 though i t co m pound s the effe c ts o fthe headaches on her abi l i ty to w or k. A t th e fi rs t hea ring the adm i ni str ati ve l aw j ud ge deci ded thatBj or nson shoul d be exam i ned by a physi ci an hi re d by the I l l i noi s Depart m en t ofH um an S er vi ces, w hi ch w orks w i th the S oci alS ecuri ty A dm i ni str ati on i n deter m i ni ng el i gibi l i ty f orso ci alse curi ty disabi l i ty benefi ts. S ee I l l i noi s Depart m ent o fH um an S er vi ces, “Dis abi l i ty Deter m i nati on Ser vi ces, ” ww w . dh s. sta te. i l

. us/ page. aspx?i tem =299 79 ( vi si ted Dec. 30 , 20 11)

. Th is was done, and the physi ci an, Dr. M uham m ad Rafi q, r epor ted that Bj or nson “ get s fre quent sev er e h ea d ach es thre e t o f o urt i m es pe r wee kdur i ngwhi chs he c anno t st an d, ” an d tha ti n a n 8

- ho urda y s he c a n s i tf o r a n ho ura nd a h a l f, s t a n d f o r a n h o u r, a n d wa l k f o r h a l f a n h o ur

— the re st ofthe ti m e s he has to l i e dow n . The l i m i tat i on o n sta nd i ng m ay be c aused by her back p ai n as w el l as her headaches

— i t i s unc l ea r fr o m Ra fi q’ s r epo r t whi ch

. Othe r do c t o r s ’ r e po r t s n o t e Bj o r ns o n’ s “ c hr o ni c h e a dac h es , ne c k p ain , in te rm itt en tv isu al p ro b lem s, sw allow i ng probl em s, sl urr ed speech, and bi l ate ra l fi nger num bn es s. ” Dr

. I r a Goo dm an, a pa i n s pec i al i stwho had tre ate d Bj or nson s i nce 2 003, not ed herco m p l ai nts ofco ns t a nt he a da c he s a nd di a g no s e d he r w i th ( a mon go the r thing s ) o c c i pi t a l n e ur a l g i a , a ty pe o fh e a dache that i nvol ves pie rcing , thro bbi ng, o r “el ectr i c- shock

l i ke” chr oni c pai n i n the neck and head. H e a l so re m ar ked hercer vi calspi ne pai n, l ower-backpai n, a thre ew eekst re tch o fnonst op h ea d aches, and dayti m e s om nol ence because o fherpai n m edi cat ions. The adm i ni str a-4 N o. 11

- 2422 ti ve l aw j ud ge did not m enti on the diagnosis of oc ci pit al neural gi a. A l l the evi de n c e w e’ ve described thus f ar, exce pt f or Dr. R afi q’s , co ncer ns di agno ses and tr eat m ents that Bj or nson r ecei ved befor e J une 2005
. The r eco rd al so co nt ains a go o d de alo fe vi den ce , b es i des Ra fi q’ s, c o ncer ni ng Bj or nson’ s di agno ses and tr eat m ents si nce the n. No ne o fthi s e v i de nc e i nd i c a t e s that h e r s y mptom s hav e wors ened

— th at ifsh e is d isabled tod ay, ne verth eless s he wasn’t disabl ed bef or e herl asti nsured date. Y et th e g ov er n m en t’s br ief a rg u es th e irr ele va n c e o f all post-J une 200 5 m ed ical data, an a rg um ent t hat both i s f actual l y m i sta ken a nd vi ol ate s the C he n eryr ule , beca use the adm i ni str ati ve l aw j ud ge rul ed that postJ une 200 5 m edi caldata could b e consi dered

— and he w as right, a s t h ere w as no reason to beli eve th at B j orns on’s abi l i ty to w or k had decl i ned si nce then . R a y v . B o w en , 84 3 F .2d 99 8, 10 04 -06 (7t h C ir. 19 88 ); Pott e rv. Se cre t ary of Heal th & H um a n S ervic es , 905 F.2d 134 6, 1348 (1 0 t h Cir. 1990 ) ( per curia m ); D ousewicz v. Harris , 64 6 F

. 2d 771, 774 ( 2d Cir

. 19 81) . One ph ys ician, Dr. Chukw uem eka Ezi ke, te sti fi ed that w h il e Bj or nson has a hi sto ryo fchr oni c headaches att ributabl e t o the Chi ar i m al f or m ati on a nd has been t r e a t e d f o r “ h e a d a c h e s , n a u s e a , v o mi t i ng, a n d s o me p ar as th es ia” (n u m b n es s o r tin glin g in th e lim b s), h e “ d id not find enou gh

. . . i n th e m ed ical record s” to j us tify Dr. Rafi q’s o pini on. H e be l i eve d that he r “pai n w as not wel l s ubst an ti at ed afte r 2 00 3, ” an d he di d “ no t fi nd the ev id en c e t h at sa ys s h e c a n n otsu st ain [a] se d en ta ry j ob .”N o. 11

- 2422 5 H i s t est i m ony goe s o n a n d o n, but w hat we have quoted i s the o nly in te ll i gibl e por ti on o fi t that be ar s o n Bj o r ns o n’ s abi l i tyt o ho l d a ful l

- ti m e j o b. El se wher e he d i d s a y th a t“ b e c a u s e o fth e p e r s i s t e n c e o fth e s y mp t o ms and the f act that she was o n hi gh dose o pia tes , t h at’s not i n m y pr ofess i onalo pini on ba sed o n r eas onabl e degr ee of m ed ica l ce rt ain ty th at p h y s i c ally sh e w ou ld be u n ab le to susta i n unem plo ym ent a t that t i m e . . . . [W ]e do not have any e vi dence p h ys i cal l y. ” But we don’t know w hat thi s pass age m eans. The re st ofDr. Ezi ke’ s t est im ony, wh i ch w as co nt i nual l y a nd c o nfus i ng l y i nt er r upt ed bythe a dm i ni st r at i ve l aw j udg e, i s epi to m i ze d i n th e fol lo wi ng exchange and seem s, to the l i m i ted exte nt thati t i s e ven i ntel l i gibl e, i rr el evant : BY ADMI NI S TR ATI VE LAW J UDGE: Q Dr. A zek ee [ si c ] , ar e we i n the gener alr eal m o f w hat that c hi ar i m al f or m ati on i s? Are we al l, wh at? A Ye ah

. Ithi nk yo u ha ve the b as i c, y o u ha ve the bas ic co r r ec t patho l o g y o fthi s k i nd. J us t ba si ca l l y the b ra inis n otsu p p o s e d t o b e in th e s p in al c an al. T h at ’s a ll. Q Right. A A n y t i m e you h av e a n y p ar t o f th e b ra inw h ich in th e sp inal cana l th en you d e s c r ibe as a chiari m alf orm at i o n o fwhi chy o u ha ve f o urty pes. T ha t’ s o ne an d t wo t i m es and ty p e four

. At o ne , o fc o ur se , i s th e mos tc o mm o n, wh i c h i s wh a tthe pati enth a d o r h a d. A nd theyusual l y, theytr y t o fi rs t [ I N A U DIBLE ] they6 N o. 11

- 2422 do n’ t ha ve a ny s y m pto m s o r the y do not hav e an y ab n or m alit y. B u t w h en you h av e inj u rie s, su c h as in thi s c as e, sh e has a l um barto p, o r a l um bari dete surg er y pr oce du re thatpre ci pit ate d the, the brain to r emov e a l i tt l e bi t m o r e l o weri n the c an al, r es ul ting i n sym ptom s that s he was experi enci ng. A nd atthat poi nt, m ostdocto rs wil l r eco m m end that you have su r g ery t o , t o pr ev en t fur th erhe r ni at i o n down. The pr o bl em when br ain goe s do wn m o r e i nt o the canal, the spi nal canal, o fc ou rse, i s s m al l erthan the b ra i n. S o the m or e i t g oes dow n, the m or e y ou ha ve s tr an g ul at i o n. Q Ri g ht A The m or e y ou

— Q Igo t i t. A

— str angul ati on

— Q Ithi nk I

— A

— th en it go es from [IN A U D IB L E ] d efo rm ity is sm al l erthan the b ra i n, and i s pul l i ng dow n. Then you h av e a filter w ill colle c t a n d cu t o ff so m e o ft h e c eili ng. A nd the cei l i ng w i l l n ot re sul t in, m osto fthe ti m e, w hat i t ca uses, i t ca u ses dam age o fthe spi nal tr act, ne ck, i n the c o l um ns , o fthe s pi na l tract, so th atthe m osto fthe ti m e i t g i ves you sym ptom s o fpro bl em wi th[ I N AU DI BLE] s yn d r o me, the l o were xt r emi ty, the l ower m uscl e ner ve syndro m e the upp erextr em i ti es. Q Okay. S o i t m i ght b e r el ate d to l eft a rm weakness? Im ean i t’ s pos sibl e?N o. 11

- 2422 7 A W ell, i t’s poss ibl e, bu t it is absolutely Ithink it’s m or e i f, i fthe l eft a rm w as [IN A U DIBLE ] wh en the y g etto, if as a r es ul t o fthe s ur g ery, pa r t o fthe m alf orm ation itself

. Q Okay. W el l m aybe , from the surg er y. But so m ethi ng m i ght have gone , happ ened, wh i ch w oul d cause som e l eft a rm weakness. Ri ght? Possibl y? A M an y thing s are pos sible, You r H onor. Q W el l o kay

. One turns w ith rel i efto a N ove m ber20 08 evaluati on byDr

. Go o dm an : Ch ri stine B j or n son has be en a pati ent o fm i ne since Oc t o b e r, 2 0 0 3

. S he i s b e i ngtre a t e d fo r c hr o ni c h e a dache re l ate d t o m ult i ple sur ger i es f orChia rim al f or m ati on a s wel l as f orl ow back pai n re l ate d to degener ati ve di sk di se as e, l um ba r f ac eta r th r o pathy a nd sacr oi l i i ti s with low erextr em i ty pai n re l ate d to l um barr adic ulo pathy. S he has resp ond ed so m e t o i nter venti onaltr eat m ents and m edi calm anage m ent b ut r em ai ns unabl e t o w or k pri m ar i l y due t o no ti ce ab l e i nc r ea se s i n pa i n wi thpr o l o ng ed si tt i ng orst anding. The l astM RI o fthe l um barspi ne was perf or m ed in June 20 06 and show ed degener ati ve di skdi se as e atb oth L4- 5 an d L5

- S 1 wi thdi skpr o trusi on. S he has f ai l ed to g ain si gni fi cant i m prove m ent with I DE T and i s no t willin g to und er go a lu m b ar sp in al fu s i on atth es e le ve ls, w h ich I th in k is appr o pr i at e. I t i s m y o p i ni o n tha t sh e wi l l ne ed o ngoing treatm en t of he r p ain w ith p eriodic i nt er-8 N o. 11

- 2422

ve nt i o na l pr o ce dur es , whi ch do g i ve be ne fi t f o r up to months a t a ti m e, a s wel l a s pha r m ac o l o g i ca l manag ement
. E ven wi ththe se f o r m s o ft r ea tments he experi ences gr eatd i ffi cul ty car i ng f orherf am i l y, and I thi nk tha t functi oni ng i n a j ob on a sust ai ned b as i s w o u ld be ex tr em ely d ifficu lt if n otim p os sib le as s he c a nn o ts us t a i n o ne p o s i t i o n f o r a nyl e ngth ofti m e. B j or n so n te st ified atth e s ec on d h ea rin g, co n sis te n tly wi th he r te st i m o ny at th e fi r st, th at sh e ne eded the shu nt i n h erb r ain r epl ac ed buttha t th e ne uros ur g eo n s he ha d c o ns ul te d ha d r efus ed f o r fea r that it m i g htb r i ng b ac k h er h yd ro c ep h alu s a n d req u ire st ill an ot h er br ain su r g e r y . (H is re p or t w as co n sis te n t w ith th at te st im on y.) She tes ti fi ed that “ther e’ s no thi ng m or e they [ the doct or s] can do form e, ” a nd thatthe pai n m edi cati ons h elp “a l i ttl e” but “usual l y . . . j ust knock m e o ut and Isl eep thr o ugh the h e a da c he s . ” S he t e s t i fi e d that she s pe nd s m o sto fhe r da y l y i ngdo wn. The adm i ni str ati ve l aw j ud ge concl ud ed that Bj or nson w as capabl e o fper f or m in g s edentar y work( she had been at various tim es before h er a ccid en t a w aitress, an off

tr ac kb et tingt el l er, a nd a c l er ki n a r ea l e st at e o ff ice), albe i t wi ths o m e l i m i tati o ns

— m ain ly th at sh e b e a b le to s i t o r s ta nd whe ne ve r s he want ed to
. He a sk ed the vo c atio nal exper t ( an exper t who tes ti fi es i n dis abi l i ty hear i ngs about w hether ther e i s a substa nti al num ber of jobs in t h e loc al e c on om y t h at th e c la i m a n t is physi cal l y a n d m ental l y abl e t o perf or m ) wh ether gi ven these l i m i tat i ons Bj or nson coul d sati sfy the r equi re -N o. 11

- 2422 9

m ents ofsuch a j ob. Th e vo c atio nal exper t t est i fi ed that Bj or nson co u ld w or k a s a cl er k in a r eales tat e o ffi ce be ca us e sh e “c o ul d r emai n in a seat ed po si ti o n l o ng enough t o perf or m data entr y t asks. ” The a dm i ni str ati ve l aw j ud ge ask ed w hetherhero pin ion would change i f B j o r n s o n h a d t o l i e d o wn “ a t l e a s t a n h o ur dur i ng th e w orkd ay at irr e gu lar interva ls every day differentl y”

— to w h ich th e v oc at ion al e x p er t re p lied th at in th at ev en t “ th er e w ou ld be n o jobs [sh e] c ou ld p er for m .” And i n r es po ns e to a fur th erque st i o n fr o m the a dm i ni str ati ve l aw j ud ge

— w hat i fBj or nson had o ccasi onal bad headaches that caused herto m i ss tw o days o f wo rk ?

— th e vo c at ion al ex p er t answ er ed: thatto o “wo ul d kno ckhe r o ut o fa l l wor k

. ” N ev er th el es s th e adm i ni str ati ve l aw j ud ge co ncl ud ed that Bj or nson wa s n o tdi s ab l e d. R e a d i n gth e a d mi n i s t r a t i v e l a w j u d g e ’ s o p i ni o n, we firs t s tubbed ourto e o n a pi ece ofo paqu e bo i l er pla te ne a r the b e g i nn i ng, wh e r e , a ft e r r e c i t i ngBj o r ns o n’ s de

sc ri pti on o fherm edi calco nd i ti on, the opi ni on s tat es: “A fter careful consid eration of th e evide nc e, th e un d ersi g ne d [ admi ni st r ati ve l aw j udg e] fi nds tha t th e c laim an t’s m ed ica lly d et er m in ab le im p air m en ts w ou ld re aso nabl y b e e xpec ted to cause the al l ege d sym ptom s; ho wev er, the c l ai m an t’ s st at ement s co nc ernin gthe i ntensit y, p er sistence and l i m i ti ng effects o fthes e sy m pto m s ar e no t cr edibl e to the e xt en t th eya r e i nc o nsi ste nt with the above resi du alfuncti onalcapaci ty ass ess m ent. ” T h e gov er nm ent’ s br i efdescr ibes thi s pass age as a “ tem pla te, ” byw h ich it m eans a pass age drafted by the S oci alS ecuri ty A d m i ni str ati on f ori nser ti on into10 N o. 11

- 2422

an y ad m inistrative l aw j ud ge’s opin ion to w hich i t pe rtains. T his “tem p late” is a varian t o f one that this cou rt (an d n oton ly th is c ou rt ) h ad cr itic ize d p re vio u sly

— that “after c ons idering th e evide nc e of record , the u nd ersig n ed f i n d s t h at cla im an t’s m ed ica lly d et er m in ab le i m pai rm ents w oul d rea sonab l y b e ex p ecte d to produce the a l l ege d sym ptom s, but that the c l ai m an t’s st ate
m en t s c o n c e r n i n gth e i n t e n s i t y, p e r s i s t e n c e a n d l i mi ti ng effe c ts of th e s e s ym p to m s a re n oten tir ely cr ed ible .” In Parke rv. As t r ue, 5 9 7 F

. 3 d 9 2 0 , 9 2 2 ( 7 th C i r . 2 0 1 0 ) , we cal l ed thi s “ m eani ngl ess bo i l er pla te. T h e s tat em ent b y a t ri ero ff act that a witness’ s t est i m ony i s ‘ not ent irely cre dibl e’ yi el ds no clue to wh at w ei gh t the t ri ero f f act gave the tes ti m ony” ( em phasi s in or i gi nal ) ; se e al so Punzi o v. A str ue, 630 F.3d 704 , 709 (7th C ir. 2011); M a rt i nez v. As t r ue, 6 30 F

. 3d 69 3, 6 96

- 97( 7th Ci r . 2 01 1) ; Spi va v . As t r ue, 62 8 F

. 3d 346, 34 8 ( 7th Ci r. 20 10)

. “S uch b oile rp lat e la n gu ag e fa ils to info rm u s in a m ea n in gfu l, r ev i ewabl e way o fthe s pec i fi c ev i den ce th e ALJ co nsi dered i n deter m i ni ng tha t claim ant’ s co m pla i nts wer e no t cr edibl e. M o r e tr o ubl i ng, i t app ear s th atthe C o mmi s s i o n e r h a s r e p e a t e d l y b e e n u s i n gth i s s a me bo i l er pl at e par ag r apht o r ej ec t the t es ti m o ny o fnum er ous c l ai m ants, witho ut l i nki ng the co ncl usor y sta tem ents conta i ned ther ei n to ev i dence i n the re cor d or eve n tai l or i ng the para gr aph to the facts at hand , al m ost wi th o u tr e g a r d t o w h e th e r th e b o i l e r p l a t e p a r a g r a ph has an y re leva nce t o the c ase . ” Ha rdm a n v . B a rnh a rt, 362 F.3d 676, 679 (10th Cir. 2004) (ci tation om itted ).N o. 11

- 2422 11 The pr es en t “t empl at e, ” whi cha dds atthe e nd o fthe previ ous o ne “.

. . to the ex te n t they ar e inconsi ste nt with the above RFC a ss essm ent, ” i s e ven wors e, tho ugh the g overnm ent’ s br i efdefends i t with gr eatvi gor

— w hi l e a t the s a me t i me b o th mi s t a k e nl y de s c r ib i ngi t a s th e i denti calbo i l er pla te cri ti ci zed i n the previ ous c ase s and confusi ng it w i th f or m o rder s that the S oci alS ecuri ty A dm i ni str ati on has autho ri zed wh en an adm ini str ati ve l aw j udg e “c ho o se s to make a who l l y f av o r ab l e [ to the appli can t] o ra l deci si on a t the hear i ng. ” S oci alS ecuri ty A d m in ist ra tio n, “O ra l (B en c h ) D ec isio n P r o c ed u re s,” w w w . s s a . g o v / O P

_ H o m e / h a l l e x / I

- 0 5 / I

- 5

- 1

- 1 7
. h t m l ( vi si ted Dec. 24, 2011 ) , and “ Fi nd i ngs I ntegr ate d Tem pla tes ( FIT ), Soc ial Se c u rit y O n lin e,” w w w .ss a.g ov /a p p ea ls/fit ( vi si te d De c. 2 4, 2 01 1)

. The g o ve r nm en t r eg ar ds th e “te m pla te” as an ind i spensabl e a i d to th e So ci alS ecuri ty A dm i ni str ati on’ s o ver w or ked adm i ni str ati ve l aw j ud ges . Y et wh en we ask ed the gov er nm ent’ s l aw yerat ar g um en t whatthe “ te m pl at e” mean s, he c o nfes se d he d i d n o tkn o w. O n e p ro bl em with the bo i l er pla te i s that the as ses sm ent o fthe cl ai m ant’ s “ re si du alfuncti onalcapaci ty” ( th e b u reaucra ti c te rm f orabi l i ty to w or k) co m es l ate r in t h e ad m in ist ra tiv e law ju d ge ’s op ini on, not “abo ve”

— abov e i s j ust the f or eshadowed co ncl u sio n o fthat l at era ss es sment
. A dee perpr o bl em i s th atthe ass ess m ent o fa cl ai m ant’ s abi l i ty to w or k wil l o ften (an d in the prese nt case ) depend heavi l y on the cre d ibi l i ty ofh er st ate m ents concerni ng the “intensi ty, per si ste nc e an d l i m i ting eff ec ts ” o fhe r s y m pto m s, b utthe passag e i m pli es that abi l i ty to w ork is d ete rm i ned fi rs t12 N o. 11

- 2422 and i s then used to deter m i ne the cl ai m ant’s c re d ibi l i ty. That ge ts thi ngs b ackwards. The adm i ni str ati ve l aw j ud g e b a s e d h i s c o nc l us i o n that B j o r ns o n c a n do sedentar y worko n hi s dete rm i nati on t hat s he was exag

g er at i ngthe s ev er ity o fhe r he ada ch es . Do ubt s ab o ut cre d ibi l i ty w er e thus cr i ti calto hi s a sse ssm ent o fabi l i ty to w or k, ye t the bo i l er pla te im pli es that the det er m i natio n of cr ed ibilit y is d efe rre d u n til ab ili t y t o w or k is as se ss ed w ith ou t re ga rd to cr ed i b ility , eve n th ou gh it of tenc a n’ tb e . In thi s r e g a r d we n o t e the t e ns i o n b e tw een the “ tem pla te” and SS R 96- 7p(4 ) , ww w . ssa . g o v/OP_H om e/ rulings/d i/ 01/SSR 96-07-d i- 01.htm l (visited J an . 4, 2012), whi chs ta te s th at“ ani ndi vi dual ’ s stat ement s ab o utthe i n t e n s i t y a n d p e r s i s t e n c e o fp a i n o r o th e r s y mp t o ms or ab o ut the e ffe c t the s y mpt o ms ha v e o n hi s or her abi l i t y t o wo r kma y n o tb e di s r e g a r de d s o l e l y b e c ause th ey are n ots u b st an tia te d b y ob j ec tiv e m ed ica l ev id en c e.” The appli cant’s cre dibi l i ty thus cannotbe i gnor ed i n deter m i ni ng herabi l i ty to w or k ( her re si du alfuncti onal cap acity, in SSA -spe ak). T h e So ci alS ecuri ty A dm i ni str ati on had bet terta ke a c los e loo k a t th e ut ility an d in te lligib ility of its “t em p lat es .” The a dm i ni st r at i ve l aw j udg e ba se d hi s do ubt s ab o ut Bj or nson’ s cr edib i l i ty on hi s a sse ssm ent o fthe m edi cal re port s or tes ti m ony of the thre e doctor s w hom we’ve m enti oned, Goodm an, R afi q, and E zi ke. H e rem ar ked that D r. Go od m an ’s treatm en t note s rep ort tha t B j o r n son ’s com pla i nts about h eadaches had becom e l ess fre que nt

— th ats he ha d c o m pl aine d abo utthe m onl y f o ur ti m es i n a ni ne- m onth per i od

— and that a l though herN o. 11

- 2422 13 he ad ach es “h ave be en an ongoing p roblem since before she star ted com i ng to see m e in 2003

. . . she can dealwith that, ” a l thou gh she “m ust s i t o r l i e down se ver alti m es per day to co ntro l pai n. ” The a dm in istr ati ve l aw j ud ge appears to have overlo ok ed Bj or nson’ s t est i m ony that sh e had conc lud ed that th e m ed ical p rofession cou ldn ’t do anythi ng m or e forherhead ac hes

—b y th i s t i me she had had m ult i ple br ai n surg er i es

— except g i ve her paink i l l er s th atkno ckhe r o ut ; i fthat t es ti m o ny i s cr edi ted, it w oul d explain w hy herco m pla i nts t o docto r s ab o uthe ada ch es di m i ni sh ed o ve r t i m e. The ad m inistrative l aw j ud ge d id not m en tion D r. Go od m an ’s furtherst ate m ents that the headaches “w er e a l w ays prese nt” a nd thatBj or nson ha d com pla i ned of“no n-s top headaches” that had l ast ed f orthr ee w eek s. A nd i t was a m i sta ke to in ferfro m Goodm an’ s quot ed st at ement, a s th e adm ini st r at i ve l aw j udg e di d i n r ul i ng th at Bj o r ns o n ca n wor k as l o ng as sh e has a sit

- st an d opti on, thatsi tting down se ver alti m es a day i s a l l that sh e w ou ld h ave to do i n or der t o be abl e t o hol d a 9 to 5 j o b. Apar t f r o m the a m bi g ui tyno t ex pl o r ed bythe ad m in ist ra tiv e la w j u d ge o ft h e t er m “c on tr ol p ain ,” D r. Goodm an’ s sta tem ent that Bj or nson “m ust si t orlie do wn se ve r alt i m es pe r da y t o c o nt r o l pa in” i s co ns i st en t wi thBj o r ns o n’ s te st i m o ny tha t o fte n s he m us t l i e do wn, not sta n d o r sit dow n, to al l evi ate the pai n. One does se den ta r y wor ks i tt i ng( th e wor d “ se den ta r y ” i s f r o m the La t i n wo r d “ sedere, ” whi chmean s “t o s i t” ) , b ut notl y i ng do wn. T h e a d m in ist ra tiv e la w j u d ge rejec t e d D r. R afiq ’s e vidence ( re m em berthathe o pined thatBj or n so n co uld s i t,14 N o. 11

- 2422

w al k, o r st an d f ora tot alo fo nl y three hour s in an e i ghthour w or kday

— 9 0 mi nu t e s ( s i t t i ng ) + 6 0 mi nu t e s ( st a nd

i ng) + 30 m i n u te s (walk i ng)

— whi chmean s th ats he w ou ld h ave to be able to li e d ow n f or th e othe r five hou rs i n the w or kday) , say i ng that “thos e l i m i tat i ons are n ot su p p or te d by [D r. R afi q ’ s] o w n clin ica l ob se rv at ion s.” W el l, o bv i o us l y Dr

. Ra fi q di dn’ t co nduc t ane i g ht

- ho ur exam i nati on o fBj or nson. The adm i ni str ati ve l aw j ud ge f aul ted Rafi q f or“r el [ yi ng] o n col l at er al e vi dence i n co n c l ud i ng tha t Bj or nson’ s functi oni ng was so m ar k edl y l i m i te d. ” H e di d no t ex pl ain wha t he mean t by“ co l l at er alev i den ce , ” butpr o babl y he mean t th e oth er treatm en t notes i n th e record

— ye t D r. R afiq w ou l d have be en r em i ss nott o c o ns ul tthe m a nd to w ei gh the m i n f or m i ng hi s o w n j ud gm ent. Ou t o fthe bl ue the adm i ni str ati ve l aw j ud ge re m ar ked of Dr. Rafi q that “docto rs so m eti m es express an o pini on i n a n e ff or t t o ass i st a pati ent with w hom theysy m pathi ze. W hi l e i t i s di ffi cul t t o confi rm the prese nce ofsuch a m otive, it i s m ore l ikel y i n situ ations w he re th e o pi ni o n inque st i o n de par ts s ubs ta nt i al l y fr o m the rest ofthe evi dence ofr eco rd, as i n the curr ent c as e.” A ctual l y the docto r’s ev i dence w as consi ste nt with m osto fthe re st ofthe evi dence. A nd the sugge sti on that h is e vid en c e w as ba se d on s y m p at h y for B j or n so n is b ot h u n su p p or te d an d im p lau sib le. Sh e is n oth is pat i en t; the I l l i no i s st at e agen cy th atwor k s wi ththe So c ial Se c u rit y A d m in i s t r a tio n ret ain ed an d p aid h im to c on d u c t a sin gle ex am in at ion of a t ot al s tr an ge r. H is fi rs t m edi calr eport ( oftwo r epor ts) st ate s that Bj or nson “w as i nfo rm ed that thi s exam i nati on w as sol el y for p ro -N o. 11

- 2422 15 vidin g i nform ation to t h e B ure au of D isabil ity Dete rm i nati on Ser vic es and did not const i tute a patie n t/ p h ys icia n rela tio n sh ip .” The a dm i ni st r at ive l aw j udg e ex pr es se d do ubtabo ut B j or n so n ’s cre d ibilit y on th e fur th er gr ou n d of he r “a c tiv iti es o f d a i l y l i v i n g, ” n o t ab l y th a t s h e c a n wa l k u p t o o ne bl ock, si t o r sta nd f orup to 15 m i nutes, l i ft 1 0 pounds, b a the a nd dr e s s n o r mal l y, a nd e ven d r i v e a nd s ho p. Bu ts he h a d n e v e r t e s t i fi e d tha ts he wa s i mm o b i l i z e d, a n d i n d e e d s h e h a d t e s t i fi e d th a ts h e had o n e o r t wo goo d days ea ch w eek

— f oral l thatappears , the acti vi ti es re ci ted bythe adm i ni str ati ve l aw j ud ge ar e co nc en tr ate d in thos e d ays. Dou btless sh e d resses an d bath es m ore f r eque nt l y tha n t wi ce a wee k, b utone c anha ve a wfu l he ad ach es yet stilldres s and bath e. T he criti cal differ ences betw een a cti vi ti es ofdai l y l i vi ng and act i vi ti es i n a full

- ti m e j ob ar e that a per son has m or e fl exibi l i ty i n sc h ed u lin g t h e fo rm er th an th e la tt er , ca n ge t h elp f r om ot herpe r so ns ( i n thi s ca se , Bj o r ns o n’ s hus ba nd and otherf am i l y m em b er s) , and i s no t hel d to a m i n im um st andard ofper f or m ance, as she w oul d be by an em plo yer . The f ai l ure to re cogni ze th es e d i ffer ences i s a re curr ent, and depl or abl e, feature of opi ni ons by adm i ni str ati ve l aw j u d ge s in so ci alse curi ty disabi l i ty c a s e s . S e e P un zi o v. As t r ue, sup ra , 630 F.3d at71 2; Spi va v. Ast r ue, sup ra , 62 8 F.3d at 3 5 1 -52 ; G entle v . B a rnh a rt, 43 0 F. 3d 865, 86 7- 68 ( 7th Ci r. 20 05) ; D rap er v. B a rnh a rt, 42 5 F.3 d 11 27, 113 1 (8 th C ir. 20 05 ); Kel ley v . Cal l ahan , 13 3 F

. 3d 583, 58 8- 89 ( 8th Ci r. 19 98 ); S m o len v . Ch a ter, 80 F. 3d 1273 , 1284 n

. 7 ( 9th Cir. 1996).16 N o. 11

- 2422 The adm i ni str ati ve l aw ju d ge gav e deci si ve w ei ght t o te st im on y by D r. E zik e, ev en th ou gh h e is n ot a p ain speci al i st, l i ke Goodm an, and, unl i ke b oth Goodm an and Rafi q, had not exam i ned Bj orn so n. ( So all the evi dence Dr. Ezik e r el i ed on was “co l l ate ra l, ” unl i ke Dr. Rafi q, wh om the adm i ni str ati ve l aw j ud ge cri ti ci zed f orr el yi ng o n such ev i dence. ) H e no ted with approval Dr

. Ez i k e’ s te st i m o ny tha t th e m edi ca l e vi den ce c o nc e r ningBj o r ns o n’ s c o nd i t i o n a ft e r 2 0 0 3 “ s up po r t e d a sedentar y r esi du alfuncti onalcapaci ty finding

. ” Yet on the pr evi ous pag e o fhi s o pinion he had r ebuked D r. G oo d m an fo r s ay in g t h at B j or n so n “re m ain ed u n ab le to w or k,” rem ar kin g t h at “s ta te m en ts th at a c laim an t is di sabl ed o r unabl e to wor ka r e no t m edi ca l o pi ni o ns but ar e di sposi ti ve adm i ni str ati ve fi nd i ngs . . . r ese rv ed to th e C om m iss ion e r ” of so c ial se c u rit y. T h e re m ar k is i m prec ise
. The per ti nent r egul ati on s ays that“a st ate
m ent b y a m edi calso urce th at you ar e ‘ disabl ed’ or
‘ unabl e to wor k’ do es no t m ea n tha t we wi l l de te r m i ne th at you are d is a b led.” 20 C

. F.R. § 404.1527(e)(1). Th at’s n otth e s a m e th in g a s s ay in g th at su c h a st at em en t is i m properand ther ef or e t o be i gnor ed, as i s further m ade cl earwh en the r egul ati on g oes o n to st ate that “the f i nal r esponsibi l i ty fordeci ding” r esi du alfunctional cap acity (abil ity to w ork

— an d s o whethe r the ap p lica n t is d isa b led ) “is res er ve d to th e C om m iss ion er .” § 4 04. 1527 ( e) ( 2) ( em phasi s a dd ed). A nd “we w i l l not give any s pe ci al s i g ni fi c a nc e t o the s o ur c e o fa n o pi ni on on i ssues r ese rv ed to the Com m i ssi oner . ” § 40 4. 1527 ( e) ( 3) (em p ha sis add ed ).N o. 11

- 2422 17 The seco nd m edi calr epor t tha t Dr. Rafi q subm i tte d was a f o r m tha t th e I l l i no i s di sabi l i tyde te r m i na ti o ns age ncy had aske d him to fi l l o ut, and one ofthe questio n s w as h ow lon g B j or n so n co u ld s i t, s t an d , an d w alk and what she did w hen she coul dn ’ t do any ofth ose th in gs . W h en h e sta te d on th e form th at sh e c ou ld sit, sta n d , an d w alk for a to ta l o fo n l y t h re e h ou rs in an ei ght- h ou r w orkday, he was noti nvadingany prer o gati ve r es er ve d t o the S o ci alS ec ur i tyAdm i ni st r at i o n. B ut his statem en t inesca p ably i m p li ed th a t she can ’t w or k fu ll tim e, for w h at em p loy er w ou l d h i r e fo r a fu lltim e j ob som eon e w h o h as to li e d ow n for five hou rs du ring the workday? T h e adm i ni str ati ve l aw j ud ge not onl y for gothi s di sm i ssi ve vi ew o fphysi ci ans’ te st im ony re l ati ng to i s s u e s “ r e s e r v e d t o th e C o mmi s s i o n e r ” w h e n h e c a me to Dr. Ezi ke, but com pound ed the i nconsi ste ncy by add i ng tha t he w as “ass i gn[ i ng] subst antia l w ei ght t o Dr. Ezi ke’ s o pini ons, as he i s f am i liarwith the S oci al Se c u rit y d isa b ility p ro gr am , rev iew ed all av aila b le m edi calev i dence, l i ste ned to Bj or nson’ s t est i m ony [ at the s e c o nd a dmi ni s t r a t i v e h e a ri ng] r e g a r di ngh e r s y mpt o ms a n d fu n c t i o n a l l i mi t a t i o n s , a n d i s s u e d o p i n i o ns c on sis te n t w ith th e re st of th e m ed ica l e v id en c e re c or d .” A part f ro m the f act that D r. Ezi ke’ s t est i m ony w as not “consi ste nt w i th the restof the r eco rd, ” hi s f am i l i ar i ty w i th the s o c i a l s e c ur i t y di s ab i l i t y pr o g r a m c o uld be re l eva n t on l y i fi t per m i tte d him to o fferan o pini on concerni ng Bj or nson’ s e l i gibi l i ty

— w hi ch the adm i ni str ati ve l aw j udg e ha d j us t sai d was the pr er o g at i ve o fthe So ci alS ecuri ty A d m ini str ati on. The r egul ati on does18 N o. 11

- 2422
sta te that “the am ount of und er sta nd i ng ofou r d isabi l i ty p ro gr am s a nd thei r evi denti ar y r equi re m ents that an ac ce ptabl e m edi ca l s o ur ce has

. . . [ i s amongthe ] r el ev an t f acto rs thatwe w i l l co nsi der i n d ecidi ng the weight to g i ve t o a medi ca l o pi ni o n. ” § 40 4. 15 27 ( d) ( 6)

. Butthe adm i ni str ati ve law judge se em s t o have f or got ten th a t wh e n h e d i s mi s s e d D r . R a fi q ’ s e v i d e n c e . A n d r e me mberthati t was a si ste r go ver nm en t a gency( i n effect) o f the S oci alS ecuri ty A dm i ni str ati on tha t had hi re d D r. R afiqto ex am in e B j or n so n, w h ic h im p lies th at R afiq w as bel i eve d t o know a s m uch as he ne ed s t o kn ow about the soc i al secur i ty disabi l i ty prog ra m i n or der t o be abl e to g i ve an i nfo rm ed profess i onalo pini on about the physi calco nd i ti on of a n appli cant fordi sabi l i ty benefi ts. I t i s i m possibl e to tel l, m or eov er, w hether Dr. E zike bas ed his skep tic ism abou t the severity of B j orns on’s pai n ( her “pai n w as n ot w el l subst anti ate d after20 03”) on the abs ence ofco rr obo ra ti ng o bj ecti ve m edi cal evi dence, wh i ch i fh e d i d w oul d be i n tensi on w i th SSR 96

- 7p(4 ) ( “an ind i vi du al ’ s s tat em ents about the intensi ty an d pe r si st en ce o fpa i n o r o th ers y m pto m s o rabo ut th e effect the sym p tom s ha ve on his or he r abil ity to w ork m ay not be di sr ega rded s ole l y b ecause theyar e no t s ubst an tia te d by ob j ec tiv e m ed ica l ev id en c e” ) , o r on h is i nter preta tion o fherr epor t o fherpai n as quoted or paraphras ed i n the note s o f t h e o therdocto rs ( anothe r possibl e inter preta ti on o f“[ her] pai n w as n ot w el l substa nti ate d a fter 2 003” )

. I fthe f or m er, hi s o pini on i s bo th i m pla usibl e forther e was ple nty ofco rr obo ra ti ng m edi cal evidence

— a nd i n t e ns i o n wi th S S R 9 6

- 7 p( 4 ) , a s we s a i d;N o. 11

- 2422 19 and i f the l a t t e r i t a dds no thing t o tho s e no t e s a nd tho se d octors’ con clusion s and doe s not u nd erm ine B jor ns on’s te st im on y t h at sh e h ad ab an d o n ed h op e o f be in g a b le to deal with he r headaches othe r th an b y a co m bi nati on of p ai nki l l er s that m ade herso m nol ent with ( w hat g oes w i th so m nol ence) l ots o f ly in g d own . Dr. Ezi ke m ay have base d his te sti m ony on the f act that the o therdoctor s’ tr eat m ent no tes i nd i cate d that Bj or nson’ s co m pla i nts about headaches w er e inter m i tte nt. The So ci alSecu ri ty A dm i ni str ati on’ s a dm i ni str ati ve l aw j ud ges a re over w or ked, but i fo ne m ay j ud ge f ro m th e t ra n sc rip t in th is c as e, th e t w o h ea rin gs p ro c ee d ed in a l ei su r ely, e ve n mea nde r i ng, f as hi o n. W hate ve r the cau s e , the a dmi ni s t r a t i v e l a w j ud g e ’ s o pi ni o n f a i l ed to bui l d a b r i dge b etwee n the medi ca l ev idenc e ( al o ng w i th Bj or nson’ s t est im ony, wh i ch se em s t o have been fully c onsi ste nt with that evi dence) and the concl usi on that sh e is abl e t o w or k fullti m e in a s edentar y o ccupat i o n pr o v i de d tha ts he c a n a l t e r na t e s i t t i nga nd s t a nd

i ng. S ee Sc ot tv. As t r ue, 647 F.3d 734 , 740 (7th C ir. 2011); Terry v . Astru e, 58 0 F .3d 4 71 , 4 75 ( 7th Ci r. 20 09) ( per c u ria m ); cf. Ha rdm a n v . B a rnh a rt, sup ra , 362 F. 3d at 678- 79. The j u d g me n to fth e d i s t r i c tc o u r ti s r e v e r s e d a n d the m att err etur ned to the So ci alS ecuri ty A dm i ni str ati on f o r fur th erpr o ce eding s co ns i st en t wi ththi s o pi ni o n. R EV ER S ED AN D R EMAND ED .

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