In the 

United States Court of Appeals 

For the Seventh Circuit ____________________ 

No. 16-4007 

ASHLEY GERSTNER, 

Plaintiff-Appellant, 

v.

NANCY A. BERRYHILL, 

Defendant-Appellee. 

____________________ 

Appeal from the United States District Court for the 

Eastern District of Wisconsin. 

No. 15-CV-1115 — Nancy Joseph, Magistrate Judge. 

____________________ 

ARGUED OCTOBER 3, 2017 — DECIDED JANUARY 5, 2018 

____________________ 

Before KANNE, ROVNER, and SYKES, Circuit Judges. 

ROVNER, Circuit Judge. Ashley Gerstner challenges the 

denial of her application for disability insurance benefits and 

supplemental security income. An administrative law judge 

found that she was severely impaired by anxiety, bipolar 

disorder, panic disorder, depression, and fibromyalgia, and 

that these impairments were not disabling. Gerstner contends that the ALJ erred in assigning too little weight to her 

treating psychiatrist’s opinions and in discrediting her com-
2 No. 16-4007 

plaints of fibromyalgia pain. We vacate the judgment and 

remand. 

I. 

Gerstner was 27 when she applied for disability benefits 

and supplemental security income, alleging an onset date of 

May 2011. Her mental impairments manifested during her 

high school years. She was admitted to a psychiatric hospital 

at 15 and has been treated with psychiatric and counseling 

services. Because of anxiety, she was home schooled; she later transferred to a high school where she received her degree 

by learning mostly on a computer by herself. She then 

worked as an assistant manager at Blockbuster for five years 

but quit abruptly after experiencing what she described as a 

“mental breakdown.” She moved on to work at another retail store in a managerial position that required fewer skills 

than her previous job, but quit after six months because she 

experienced another breakdown. Since May 2011, Gerstner 

has remained unemployed. 

Between mid-2011 and mid-2012, Gerstner was treated 

six times by Dr. Stephen Callaghan, M.D., a psychiatrist at 

Psychiatric Treatment Services of Racine. In those visits, 

Dr. Callaghan, who had treated Gerstner since 2006, diagnosed her with generalized anxiety disorder, depression, 

and attention deficit disorder. He prescribed Xanax and other medications, and he frequently adjusted the dosages. But 

Dr. Callaghan also noted that Gerstner appeared euthymic 

(non-depressed) with normal affect. 

In connection with Gerstner’s application for benefits, 

Dr. Callaghan completed a form assessment of Gerstner’s 

mental health in mid-2012 and opined that she was extreme-
No. 16-4007 3

ly limited socially and at work. He noted that since 2010 

Gerstner’s mental health had deteriorated, and he estimated 

that on average she could work only two to three hours per 

day and likely would miss work seven days per month. In 

response to a series of questions about “social adjustments,” 

he checked boxes indicating that she had marked-to-extreme 

limitations behaving in an emotionally stable manner, relating predictably in social situations, and demonstrating reliability. He supported this assessment with findings that she 

periodically felt suicidal and homicidal, had major problems 

with social relations, and would withdraw from stressful 

situations and not be able to function. On another part of the 

form, in a section related to “occupational adjustments,” he 

checked boxes reflecting that Gerstner had marked-toextreme limitations in her ability to deal with work stresses 

and moderate-to-marked limits in maintaining attention—

findings that he based on her severe anxiety, depression, and 

problems “handling any stress without shut[ting] down.” 

Lastly, in response to a series of questions about “performance adjustments,” he assessed Gerstner as markedly limited in her ability to understand and carry out detailed job 

instructions because she would be overwhelmed by anxiety 

and depression. 

After this assessment, Dr. Callaghan treated Gerstner 

seven more times (all within a year), added diagnoses of bipolar disorder and panic disorder with agoraphobia, prescribed medications to treat both, and noted that she had a 

dysthymic mood (depressed) each visit. On one occasion 

Dr. Callaghan noted that she had ideas of suicide and homicide. But in subsequent exams, he noted that she no longer 

had these thoughts and described her affect as normal. 
4 No. 16-4007 

Dr. David Nichols, Ph.D., a psychologist who practiced 

with Dr. Callaghan, met with Gerstner monthly (sometimes 

more frequently) for hour-long visits. Dr. Nichols diagnosed 

her in 2011 with major depressive and generalized anxiety 

disorders, and in 2013 with bipolar disorder. Gerstner, after 

filing her disability application, told Dr. Nichols that she 

continued to look for a factory job. 

Gerstner was treated in 2013 by a nurse practitioner, 

Nancy Maczka, who assessed her mental health on a form 

identical to the one completed by Dr. Callaghan. She echoed 

Dr. Callaghan’s findings that Gerstner had extreme limitations with relating “predictably in social situations” and 

“demonstrat[ing] reliability.” But unlike Dr. Callaghan, she 

found Gerstner more limited in dealing with work stresses 

and maintaining attention. 

In addition to her mental impairment, Gerstner says that 

she was prevented from working by fibromyalgia. She first 

complained of pain and weakness to Dr. Joseph Paukner, 

M.D., in September 2011, and he referred her to a neurologist, Dr. Bhupendra Khatri, M.D., of the Center for Neurological Disorders in Milwaukee. Dr. Khatri examined Gerstner in November 2011, concluded that she was “most likely” 

suffering from fibromyalgia, and repeated this diagnosis at a 

follow-up appointment in early January 2012 following an 

MRI of Gerstner’s brain. (The MRI ruled out any neurological change that might have accounted for her complaints of 

worsening pain). Soon thereafter, Dr. Tracy Brenner, M.D., a 

physician at the Milwaukee Rheumatology Center, found 

that Gerstner had fourteen of eighteen positive tender 

points, a finding that led the doctor to opine that Gerstner 

had a “high suspicion for fibromyalgia.” Dr. Brenner de-
No. 16-4007 5

ferred management of that condition to Dr. Paukner and Dr. 

Callaghan. Dr. Paukner then diagnosed Gerstner with fibromyalgia, for which he prescribed Lyrica, a pain reliever. 

The next month, in response to Gerstner’s complaints of having good and bad days, Dr. Paukner increased the dosage. 

At an appointment later that year, Gerstner rated her pain 

from fibromyalgia as a nine out of ten, and was prescribed 

a stronger pain medication—methadone. 

In June 2012, the month before Dr. Callaghan completed 

his assessment, a state-agency consultant, Dr. Craig Childs, 

Ph.D., concluded from a review of Gerstner’s medical records that she was only moderately limited in several tasks: 

completing a normal workday and workweek, maintaining 

concentration for extended periods, carrying out detailed 

instructions, and interacting with the general public. 

Gerstner lost her health insurance in 2013. She ceased 

treatment with Dr. Callaghan and went six months without 

medication for her fibromyalgia pain. 

The Agency denied Gerstner’s application for disabilityinsurance benefits and supplemental-security income, both 

initially and on reconsideration. 

At a hearing before an ALJ in 2014, Gerstner described 

how her health had deteriorated since 2010. She testified that 

she had moved back into her parents’ house and experienced trouble interacting with others, handling stress and 

pressure, sleeping, and concentrating. She added that she 

had difficulty making phone calls and leaving her house. 

She said she usually took Xanax twice daily for her anxiety, 

and she experienced shooting pain from her fibromyalgia 

that was aggravated by stress, prolonged sitting and stand-
6 No. 16-4007 

ing, and exercise. Her flare-ups lasted from one to three 

hours. She worried that working would exacerbate her pain 

the next day. Since her fibromyalgia diagnosis, she had 

gained one hundred pounds. 

The ALJ applied the standard 5-step analysis, 

see 20 C.F.R. §§ 404.1520(a), 416.920(a), and concluded that 

Gerstner was not disabled. The ALJ determined that she had 

not engaged in substantial gainful activity since her alleged 

onset date (step one); that her conditions—fibromyalgia, depressive disorder, anxiety disorder, bipolar disorder, and 

panic disorder—were severe impairments (step two); that 

these impairments did not meet a listing for presumptive 

disability, individually or in combination (step three); that 

she had the residual functional capacity to perform light, unskilled work limited to “simple, routine and repetitive 

tasks,” no interaction with the public, and “only occasional 

interaction with coworkers” (step four); and that although 

she could not perform her past work, she could work as a 

night cleaner, price marker, or call router, as a vocational expert had concluded based on the ALJ’s assessment of Gerstner’s residual functional capacity (step five). 

In deciding Gerstner’s residual functional capacity, the 

ALJ discounted her account of disabling limitations and her 

treating psychiatrist’s opinions. The ALJ found that her 

statements about the “intensity, persistence, and pace” of her 

symptoms of mental illnesses and fibromyalgia were “not 

entirely credible.” He also gave “little weight” to the mid2012 opinions of Dr. Callaghan because the limitations he 

marked were “extreme” compared to Dr. Callaghan’s own 

“findings and observations,” which the ALJ said were “relatively normal mental status examinations” with a “few ex-
No. 16-4007 7

ceptions.” By contrast, the ALJ gave “great weight” to the 

June 2012 opinion of the reviewing agency consultant, Dr. 

Childs, who concluded that Gerstner had only moderate limitations. The ALJ also purported to rely on “updated medical 

evidence” to include “somewhat greater limitations” in 

Gerstner’s residual functional capacity than what Dr. Childs 

had opined. 

After the Appeals Council denied review, a magistrate 

judge presiding by consent, see 28 U.S.C. § 636(c), affirmed 

the decision of the Commissioner. 

II. 

A. Treating Psychiatrist’s Opinions 

On appeal, Gerstner challenges the ALJ’s decision to give 

“little weight” to Dr. Callaghan’s opinions in his mid-2012 

assessment of her mental health. A treating physician's opinion on the nature and severity of a medical condition is entitled to controlling weight if it is well supported by medical 

findings and is consistent with other evidence in the record. 

20 C.F.R. § 404.1527(c)(1); Brown v. Colvin, 845 F.3d 247, 252 

(7th Cir. 2016). (This is the rule governing claims filed before 

March 27, 2017, see 20 C.F.R. §§ 404.1520c(a) (2017).) The ALJ 

declined to give Dr. Callaghan’s opinions controlling weight 

because they were “extreme compared to his own findings 

and observations. With a few exceptions, Dr. Callaghan noted relatively normal mental status examinations.” Gerstner 

argues that the ALJ cherry-picked Dr. Callaghan’s findings 

about mood and affect and disregarded his diagnoses of depression, anxiety, and other “abnormal findings.” She contends also that he failed to consider the requisite factors for 
8 No. 16-4007 

evaluating medical source opinions set forth in the applicable regulation. 

We agree with Gerstner that the ALJ fixated on select 

portions of Dr. Callaghan’s treatment notes and inadequately analyzed his opinions. First, with regard to Dr. Callaghan’s reports from six exams before August 2012, the ALJ 

focused on notes about mood and affect but ignored Dr. Callaghan’s diagnoses of depression and anxiety disorder. “An 

ALJ may not selectively discuss portions of a physician's report that support a finding of non-disability while ignoring 

other portions that suggest a disability.” Campbell v. Astrue, 

627 F.3d 299, 301 (7th Cir. 2010). Here, the ALJ did not specify which of Dr. Callaghan’s findings were “normal,” but he 

did say that Dr. Callaghan’s observations of Gerstner’s euthymic mood and normal affect were inconsistent with her 

“allegations” of “disabling affective disorders.” But 

Dr. Callaghan made these observations in the same reports 

before August 2012 in which he diagnosed her with depression and anxiety, and yet the ALJ ignored these diagnoses. 

Moreover, the affect and mood notes that the ALJ emphasized simply described how Gerstner presented on the days of 

her appointments. They were not general assessments. 

Second, the ALJ concluded from Dr. Callaghan’s notes after August 2012 that Gerstner’s mental health had improved, 

disregarding other portions of those notes that undermine 

his conclusion. After August 2012, Dr. Callaghan found during each visit that Gerstner had a normal affect, no “impaired” thoughts, and no suicidal ideations, but also that she 

reported a dysthymic mood and experienced anxiety, depression, and problems sleeping and concentrating. The ALJ 

considered only the signs of possible improvements in these 
No. 16-4007 9

notes and ignored the negative findings. But all findings in 

psychiatric notes must be considered, even if they were 

based on the patient’s own account of her mental symptoms, 

see Price v. Colvin, 794 F.3d 836, 839–40 (7th Cir. 2015) (citing 

Adaire v. Colvin, 778 F.3d 685, 688 (7th Cir. 2015)). Furthermore, every treatment note after August 2012 repeats Dr. 

Callaghan’s diagnoses and treatments; he even changed the 

medication for Gerstner’s bipolar disorder in January 2013 

and increased the dosage three months later. These unchanged diagnoses and the medication adjustments belie the 

conclusion that Gerstner’s mental health had improved. 

Third, the ALJ ignored how Dr. Callaghan’s mid-2012 

opinions of Gerstner’s limitations were supported by his repeated findings of depression and dysthymic mood. Dr. Callaghan opined that Gerstner was “extremely limited” with 

regard to such matters as emotional stability, reliability, and 

predictability. This opinion conformed to his diagnosis of 

depression since July 2011 and his observations since August 

2012 that Gerstner had a dysthymic mood; dysthymia (depression) is a condition that may “significantly interfere” 

with work and relationships, Persistent depressive disorder 

(dysthymia), MAYO CLINIC, 

http://www.mayoclinic.org/diseases-conditions/persistentdepressive-disorder/home/ovc-20166590 (visited Nov. 27, 

2017). 

Fourth, the ALJ overlooked the extent to which 

Dr. Callaghan’s opinions were consistent with the diagnoses 

and opinions of other medical sources who treated Gerstner. 

ALJs must consider psychologists’ and nurse practitioners’ 

opinions on the severity of a patient’s impairments. 

See 42 U.S.C. § 423(d)(5)(B); 20 C.F.R. §§ 404.1502(a)(2), 
10 No. 16-4007 

404.1527(a)(1),(b),(c); SSR 06-03P, 2006 WL 2329939 (Aug. 9, 

2006) (“[M]edical sources who are not ‘acceptable medical 

sources,’ such as nurse practitioners  are important and 

should be evaluated on key issues such as impairment severity and functional effects.”); see also 20 C.F.R. § 402.35(b)(1) 

(“Social Security Rulings  are binding on all components 

of the Social Security Administration.”). The ALJ failed to 

mention that Dr. Nichols diagnosed Gerstner with the same 

disorders found by Dr. Callaghan. Nor did the ALJ note that 

Dr. Callaghan’s opinion was supported by Dr. Nichols’s rating of Gerstner’s Global Assessment of Functioning (GAF), 

which measured her psychological, social, and occupational 

abilities. See AMERICAN PSYCH. ASSOC., DIAGN. & STAT. MAN.

OF MENTAL DISORDERS 34 (4th Ed., Rev. 2000) (DSM-IV). 

Gerstner’s GAF scores ranged from 40 to 55, indicating she 

had serious difficulty (41 to 50) and moderate difficulty (51 

to 60) in these abilities. Id.1 And a nurse practitioner, 

Maczka, treated Gerstner and opined that her mental abilities were limited to the same extent or more than that found 

by Dr. Callaghan, but this supporting opinion, which the 

ALJ wrongly discounted as coming from an unacceptable 

medical source, went unmentioned in the ALJ’s analysis of 

Dr. Callaghan’s opinions. 

 1 The DSM-V, the latest version of the Diagnostic and Statistical 

Manual of Mental Disorders, has abandoned the GAF. AMERICAN PSYCH.

ASSOC., DIAGN. & STAT. MAN. OF MENTAL DISORDERS 16 (5th Ed., 2013) 

(DSM-V). But the Social Security Administration still instructs ALJs to 

treat GAF scores as medical-opinion evidence. See Craig v. Colvin, 659 

F. App’x 381, 382 (9th Cir. 2016); Hughes v. Comm'r Soc. Sec., 643 F. App’x 

116, 119 n.2 (3d Cir. 2016). 
No. 16-4007 11

Fifth, even if there were sound reasons for refusing to 

give Dr. Callaghan’s opinions controlling weight, the ALJ 

still erred by assigning his opinions little weight without 

considering relevant regulatory factors under 20 C.F.R. 

§ 404.1527(c). ALJs must decide the weight of a treating physician’s non-controlling opinion by considering, to the extent 

applicable, the treatment relationship’s length, nature, and 

extent; the opinion’s consistency with other evidence; the 

explanatory support for the opinion; and any specialty of the 

treating physician. 20 C.F.R. § 404.1527(c); Moss v. Astrue, 

555 F.3d 556, 561 (7th Cir. 2009); Bauer v. Astrue, 532 F.3d 606, 

608 (7th Cir. 2008). The ALJ here did not mention that 

Dr. Callaghan is a psychiatrist, that he was the only psychiatrist who treated Gerstner, that the treatments occurred regularly for six years (sometimes monthly), or that Dr. Callaghan assessed her mental health thirteen times in the two 

years between the onset date and the date when she lost 

medical insurance. The ALJ also failed to consider the consistency of Dr. Callaghan’s opinion with the opinions of other treating, examining, and reviewing medical sources. Although the ALJ discussed the weight to afford these physicians’ opinions, he did not specify how or to what extent he 

considered these opinions when deciding to assign little 

weight to Dr. Callaghan’s opinions. 

Because of these errors, substantial evidence does not 

support the decision to afford little weight to Dr. Callaghan’s 

opinions of Gerstner’s limitations from mental impairments, 

and the case must be remanded for reconsideration of his 

opinion, see Meuser v. Colvin, 838 F.3d 905, 912 (7th Cir. 

2016); Scott v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011). 
12 No. 16-4007 

B. Adverse Credibility Determination 

Gerstner also contends that the ALJ wrongly discounted 

her testimony about the extent of her pain from fibromyalgia. The ALJ, using familiar boilerplate, said that the “claimant’s statements concerning the intensity, persistence and 

limiting effects of these symptoms are not entirely credible.” 

Gerstner argues that the ALJ discredited her complaints of 

intermittent fibromyalgia pain by overstating findings from 

examining physicians’ diagnostic tests, in which she walked, 

moved, sensed touch, and had no spasms or tenderness. She 

argues further that the ALJ wrongly discredited her pain 

complaints by misstating medical evidence from two examining physicians who recommended that she engage in unspecified physical activity. She contends also that the ALJ 

drew an unwarranted inference that her pain was not disabling because she went six months without fibromyalgia 

drugs, but the ALJ never considered the reason she offered 

for that medication gap. Lastly, Gerstner argues that the ALJ 

wrongly concluded that she could work based on a physician’s notation that she had searched for employment. 

We agree with Gerstner that the ALJ’s adverse credibility 

determination must be overturned. This court will overturn 

an ALJ’s adverse credibility finding if it is patently wrong. 

See Larson, 615 F.3d at 745; Schaaf v. Astrue, 602 F.3d 869, 875 

(7th Cir. 2010). The ALJ here overstated test results and 

treatment recommendations and drew unjustified inferences 

from Gerstner’s medication gap and job search. 

First, the ALJ overstated findings from three diagnostic 

tests to discredit Gerstner’s complaints of intermittent fibromyalgia pain. The ALJ said that Gerstner’s pain complaints were inconsistent with her abilities to sit, move, and 
No. 16-4007 13

walk for an unstated period in one exam, her normal sensation in extremities during another exam, and her lack of 

spasms and tenderness in a third exam. But these findings 

are consistent with Gerstner’s pain complaints. She never 

testified that she had constant disabling pain, or that her 

condition totally impaired the abilities tested in these exams. 

Instead, she said that her pain was triggered by prolonged sitting, standing, or activity and stress. The ALJ’s analysis reveals that he misunderstood the nature of her fibromyalgia 

pain. The extent of fibromyalgia pain cannot be measured 

with objective tests aside from a trigger-point assessment. 

See Vanprooyen, 864 F.3d at 568; Fibromyalgia, Diagnosis, 

MAYO CLINIC, http://www.mayoclinic.org/diseasesconditions/fibromyalgia/diagnosis-treatment/diagnosis/dxc20317823 (visited Nov. 27, 2017). Trigger-point testing on 

Gerstner pinpointed fibromyalgia as the source of her pain, 

and her pain complaints were consistent with her prescription for methadone, an opioid not intended for mild or acute 

pain. Methadone Hydrochloride, PRSCBR’S. DIG. REFERENCE, 

http://www.pdr.net/drug-summary/MethadoneHydrochloride-Intensol-Oral-Concentrate-methadonehydrochloride-3464 (visited Dec. 22, 2017). 

Second, the ALJ unjustifiably concluded that Gerstner’s 

pain was not disabling because an examining physician recommended that she engage in “aerobic activity several times 

a week” and a physician’s assistant who treated her was 

concerned about her “inadequate physical activity.” These 

general recommendations of physical activity do not contradict Gerstner’s alleged limits from fibromyalgia. Gerstner 

testified that she could not do “exercise,” but she did not explain what she considered exercise. Because the examining 

physician and the physician’s assistant did not elaborate on 
14 No. 16-4007 

the type, duration, or intensity of the physical activity they 

would recommend, these medical sources may have had in 

mind activity that was within Gerstner’s alleged limits—for 

instance walking a few times a week for a few minutes each 

time. Furthermore, the examining physician said her recommendation was only a “potential treatment,” probably 

because she deferred treatment of Gerstner’s fibromyalgia to 

other doctors who knew her limits. More importantly, the 

record reflects that at the time of the hearing, Gerstner was 

totally inactive, undermining any suggestion that she could 

exercise beyond her alleged limits. 

Third, the ALJ questionably concluded that Gerstner exaggerated her pain because she was able to function without 

taking fibromyalgia drugs for six months when she was uninsured. Gerstner and her attorney explained at the hearing 

that the reason for the 6-month hiatus in her pain treatment 

was her loss of health insurance. The ALJ, however, failed to 

consider her explanation before inferring that this gap 

somehow proved that her pain was not as severe as alleged. 

See Garcia v. Colvin, 741 F.3d 758, 761-62 (7th Cir. 2013); Craft 

v. Astrue, 539 F.3d 668, 679 (7th Cir. 2008). 

Lastly, the ALJ wrongly relied on psychiatric notes reflecting that Gerstner had searched for a factory job to conclude that she was able to work. The ALJ said this job search 

“suggests that she did indeed retain the ability to perform 

work-related activities,” and the Commissioner argued that 

her job search undermines her complaints of disabling pain. 

But the job search, on its own, is not evidence that she embellished her pain, because a claimant who looks for work 

after claiming a painful disability may have “a strong work 

ethic or overly-optimistic outlook rather than an exaggerated 
No. 16-4007 15

condition.” See Ghiselli v. Colvin, 837 F.3d 771, 778 (7th Cir. 

2016); Hill v. Colvin, 807 F.3d 862, 868 (7th Cir. 2015). 

III. 

The ALJ failed to substantiate and explain his decision to 

grant Dr. Callaghan’s opinion little weight, and the ALJ’s 

adverse credibility determination regarding Gerstner’s complaints of fibromyalgia pain is patently wrong. We therefore 

vacate the judgment affirming the denial of benefits and remand for further proceedings.