### In the 

# United States Court of Appeals For the Seventh Circuit

____________________ No. 16

- 3653
M ELISSA V ANPROOYEN , Plaintiff

- Appellant ,

v.

N ANCY A. B ERRYHILL , Acting Commissioner of S o cial

Security, Defendant

- Appellee

.

____________________ Appeal from th e United States District Court for the Norther n District of Illinois , Eastern Division. No. 14 C 6755

— Young B. Kim , Magistrate Judge

.

____________________
A RGUED J ULY 6, 2017

— D ECIDED J ULY 21, 2017

____________________

Before P OSNER , K ANNE , and S YKES , C ircuit Judges

. P OSNER , Circuit Judge

. Melissa Vanprooyen applied for Disability Insurance Benefits and Supplemental Security I ncome , claiming disability based on a litany of maladies

. An administrative law judge found her impairments to be s e-2 No. 16

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vere but not d isabling and denied benefits. The Appeals Council of the Social Security Administration denied r e view, and the district court (a magistrate judge presiding by co nsent) upheld the administrative law judge’s deci sion , pr e cipitating this appeal

. Vanprooyen in itially claimed to have become disable d in March 2010 , when she was 26 years old and fell down a flight of stairs and suffered a brain hemorrhage. She also a lleged a history of post

- traumatic stress disorder, short

- term memory loss, attention

- deficit hyper activ ity disorder, anx i ety, seizures, and f i bromyalgia. Already by March 2009 Vanprooyen’s personal phys ician, Dr. Dorothy Jones, had prescribed generic Xanax to
treat her anxiety and panic a ttacks

. In July , after she had b egun inpatient drug treatment, D r. Jones noted that she was taking a different anti

- anxiety medication and pr o nounced her “medically st able.” In October and December a psychi atrist named Harlan Alexander treated Vanprooyen for anx i ety, depression, and bipolar disorder. Du r ing one session Vanprooyen revealed a history of addiction and said her Xanax prescription kept running out b e cause she must “double it to make it work. ”

Her fall on the stairs caused a traumatic brain hemo rrhage and brain co ntusion in the left hemisphere , which r equired her hospitalization

. An EEG ( electroencephalogram) performed to rule out epileptic activity showed mild brain damage

. After a week she was di s charged from the hospital with a doctor ’ s note saying that she could resume working after her next neurosurgical a p pointment , which would be in a week or two

. She was prescribed medication , including Ultr a m , for general pain, migraine headache s, and se i zures.No. 16

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A week later Vanprooyen saw Dr. Alexander. She told him she’ d experienced strong hea d aches since the fall an d had run out of the pain medication given her by the hospital doctors. The psychiatrist prescribed her Abilify, Zoloft, Trazadone, and Xanax

. A month after her fall, Vanprooyen had a neurosurgery follow

- up by a Dr. Nassir Mansour , who declared she’d

“ made a very good recov ery.” S he was alert, her cr a nial nerves intact, had full strength , and was “ very keen to go back to her job” as a waitress . But just a week later she su ffered a tonic

- clonic (i.e., grand mal ) seizure. She had another seizure in the eme r ge ncy room and was taken to intensive

care suffering from a subdural hematoma (bleeding under the skull that can cause serious brain damage, including death)

. Dr. Jones treated her at the hospital and noted that her seizure medication had been discontinued. A neurologist obtained a CT scan (a scan for determining internal injuries) and noted that it showed softened brain tissue. He opined that Vanprooyen “may be rel a tively stable” but said she should take anti

- epileptic medic a tion for at least two years. He r uled out driving for six months , climbing to any height, using machinery, drinking alcohol, showering without assi stance, or working more than eight hours a day. Though complying with the limitations imposed by him, Va n prooyen continued to have hea d aches, and a couple of weeks later the doctor changed her anti

- seizure medic ation

— which however she stopped taking almost immed i ately b e cause it made her drowsy

. I n December 2010 she suffered another serious seizure , and the neurologist r educed her work ceiling t o six hours a day while also stressing the importance of her taking her4 No. 16

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medi cation. A few weeks later he reviewed a new EEG , which revealed abnormalities in Vanprooyen’s brain capable of causing se i zures

. In January 2011, Vanprooyen described to Dr. Alexan der, the psychiatrist, worsening anxiety, migraines, and difficulty sleeping. At her next appointment she reported that her mother had thrown out her Xanax. The Xanax had helped , so Dr. Alexander refilled the pre scription. Vanprooyen delivered a baby in Oc tober 2011. S he hadn’t suffered a seizure since December 2010 even though another physician had changed her anti

- seizure medication because of negative side effects , noting that Vanprooyen’s medical issues included the use of methadone to combat drug addi ction. Eight days after her child was born, Vanprooyen went to the emergency room after experiencing several days of pain (which she scored at 7 of 10) radiating from her lower back to her legs

. An emergency room doctor attributed the pain to f i bromyalgia

. After leaving the hospital she returned to Dr. Alexander and told him she’d been anxious throughout her pregnancy and wanted to resume taking Xanax (which a pparently she’d stopped taking while pregnant )

. Although the doctor refilled th e prescription, Vanpr ooyen’s anx i ety didn’t abate, and soon she began reporting memory loss, greater difficulty sleeping, worsening generalized pain, and hea daches. Dr. Alexander added probable PTSD and fibromya lgia to his diagnoses

. At the end of 20 11 Vanprooyen changed psych iatrists, seeing Dr. Paul Carter from then until May 2012 , which is when the medical record in this case ends. She told him thatNo. 16

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anx i ety and poor attention were her principal problems. He agreed with Dr. Alexander’s diagnoses of generalized anx i ety di s orde r, bipolar disorder, PTSD, and fibromyalgia but added opiate dependen cy. She visited two rheumatologist s in 2012 concerning her fibromyalgia. She reported having been diagnosed with the disease 10 years earlier with an average pain level of 4 or 5 out of 1 0 and greater pain in cold weather. One of the do ctors dia g nosed Vanprooyen as “diffusely tender at 18/18 points and multiple control points. ” The other su g gested that she visit a fibromyalgia clinic , but the record is silent on whether she did so

. In May 2012, Dr. Michael Stone, a state

- agency clinical psychologist, examined Vanprooyen , diagnosed genera l ized anxiety disorder with panic attacks, ADHD, PTSD, short

term memory loss, seizures, “brain damage,” and f i bromyalgia , and called her a “good informant” who could “remember a good degree of her past history. ” During the examination she had “exhibited problems maintaining a consistent level of attention and concentration.” He termed her prognosis “guarded” and said that given her “emotional adju stment and medical difficulties ” she was “unable to manage benefits [on] her own behalf at this time.”
A month later a stat e

- agency physician, Dr. Bharati Jh averi, reviewed the medical record and opined that Va n prooyen must avoid ladders, ropes, and scaffoldings b eca use of her head injury, seizures, and fibromyalgia but could sit, stand, or walk up to 6 hours each during an 8

- hour workday and also could lift 10 pounds fre quently and 20 pounds o c casionally. He concluded that she retained the ability to work.6 No. 16

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Another s tate

- agency psychologist, Dr. Ellen Rozenfeld, also reviewed the medical record and opined that, because of sustained limitations in concentration and persistence, Vanprooyen “would be moderately impaired for d etailed/complex tasks but adequate for complet ion of routine, repetitive tasks.” Likewise, i n Septemb er 2012 a second state

agency physician, Dr. Glen Pittman, having reviewed the medical record agreed with Dr. Rozenfeld regarding Va n prooyen’s limitations i n concentration and persistence

. In October 2 012, a new psychiatrist wrote that Va n prooyen’s “abi l ity to maintain focus, mental organization and memory is i m paired.” He rated as “fair” or “poor” her ability to comprehend, remember, or fol low instructions , but a s sessed most o f her social skills as “go o d.”
The same month Dr. Jones conducted a medical

- source assessment of her fibromyalgia , identifying her symptoms as multiple tender points, nonrestorative sleep, chronic fatigue, morning stiffness, frequent and severe headaches , n um bness, ti n gling, and an xiety. She wrote that Vanprooyen’s pain and muscle te n derness affected her daily , and rated her pain at 7 out of 10. She concluded that Vanprooyen must move every 20 minutes, cannot stand more than 2 hours at a time , and must take unscheduled breaks

— that s he was “i ncapable of even ‘low stress’ work” and would probably miss work more than 4 days per month. The Social Security Administration had denied benefits initially in June 2012 and did so again on reconsideration in September 2012. At a hearing before a n administrative law judge in April 201 3 , Vanprooyen described how her medical issues affect ed her da i ly life. Her fiancé was working par t

time with a varying schedule. Vanprooyen cared for theirNo. 16

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infant daughter with the assistance of her mother. A lthough she was able to change the baby’s diaper, she couldn’t hold her daughter in her arms for long because she weighed 21 pounds. After her fall down the stairs she’d r e sumed waitressing three days a week but stru g gled with balance, writing, memory, and strengt h. Her coworkers helped out, but she stopped working because “it wasn’t worth my

c o worke rs to have to carry my weight.” Vanprooyen testified at the hearing that about three times a week she suffers a migraine on the left side where she was injured in the f all. To recover from a migraine she must isolate he r self in a dark, quiet room, but when caring for her daughter she has no choice except to “deal with it.” She further testified that she experiences short

- term memory loss , that her fibromyalgia pain occur s mostly in her back and knees and is treated with nonprescription medic a tions and metha done , and that she no longer c an take prescription pain medication, other than methadone, given her history of addiction. Her fiancé testified
, corroborat ing Vanprooyen ’s account of her migraines and me m ory issues. During the hearing a vocational expert testified that Vanprooyen couldn’t perform her past work given the r esidual functional capacity described by the administrative law judge (capable of occasionally balanci ng, reaching, climbing stairs and ramps, kneeling, crouching, and craw ling; limited to assis t ing with simple, routine tasks that can be learned through short de m onstrations; and unable to work around hazardous conditions, operate a motor vehicle, or endure loud environment s ) but could work as a counter clerk, cashier, or a shipping and routing clerk

. But he

a c knowledged that she is une m ployable if she will be off8 No. 16

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task or pa ce 25% of the time , will miss 4 or more days per month , cannot sit, stand, or walk co ntinuously for at least 4 hours during an 8

- hour workday , or will require special superv i sion to su s tain an ordinary routine

. The administrative law judge rejected Vanprooyen’s a ccount of disabling limitations , stating that the med i cal record revealed a “g ood recov ery” after her fall, that her seizures were b e ing controlled with medication, that she continued to engage in a “wide range” of daily activities, and that with help from coworkers she had continued work ing at “su bstantial gai n ful activity levels” for 20 to 21 months after the fall and had stopped working only after gi v ing birth.
The administrative law judge gave “substantial” weight to the opinions of the stage

- agency physicians because, in her view, those doctors had provided “a good synopsis of
t he evidence ” and offered opinions “consi stent with the overall record.” She gave “some” weight to the ne u rologist who had predicted

— seven days before Va n prooyen ’s first seizure

— that she could return to her job and maintain a normal life despite her fall do wn the stairs , and purported to give “great” weight to the neurologist who had begun trea ting Vanprooyen after that first seizure, yet disregarded his limi t ing her to working only 6 hours a day and gave “little” weight to the medical source statement from Vanprooyen’s personal physician, Dr. Jones, because s he’d limited Va n prooyen to “less than sedentary exertional work,” a restri c tion the administrative law judge called “excessive in light of the medical evidence of record and h er activities of daily li v in g.” T he Appeals Council of the Social Security Administr a tion denied review of the administrative law judge’s dec i sion , which then was affirmed by the districtNo. 16

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court thus pr e cipitating this appeal to us. Vanprooyen points
to the admi n istrative law judge’s flawed credibility assessments of her and her f i ancé and disregard for the opinions of her treating physician s, and notes that in finding her not credible the administrative law judge had overemphasized her daily a c tivities

— and equa t ing daily activities wi th an ability to work can lead to reve r sal. See Bjornson v. Astrue , 671 F.3d 640, 647 (7th Cir. 2012). Of particular significance, Vanprooyen points out that the administrative law judge misunderstood the significance of her employment before her onset da te (that is, the date several months after her fall down the stairs when her di s abilit y compelled her to quit work)

. The fact that she worked before the onset date doesn’t negate the possibi l ity that she became di s abled by the onset. Goins v. Colvin , 764 F .3d 677, 679 (7th Cir. 2014); Sha u ger v. Astrue , 675 F.3d 690, 697 (7th Cir. 2012 ). B etween her fall in March 2010 and her onset in October 2011 she work ed only three days a week. Part

time work is not good evidence of ability to e n gage in full

time employ ment , especially as she was able to continue working part

- time only because some ma n agers gave her easier shifts and other preferential treatment . She also r eceived help from coworkers, took unscheduled breaks, and wrote everything down without abbreviatio n

— accommodations that the administrative law judge me ntion ed only in pas s ing and sometimes failed to mention at all.
She is also correct that after recounting at some length the favorable testimony of her fiancé
, the administrative law judge never explaine d why that testimony shouldn’t lead to

a favorable assessment of her credibility. It wasn’t logical for10 No. 16

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the administrative law judge to discredit Vanprooyen while di s missing without explanation a corroborating witness who supported her co n tentions. Vanproo yen further contends that the administrative law j udge improperly discounted the opinions of treating

sources in rejecti ng the views of her personal physician, ne urologist, and psychiatrist. We agree with Va n prooyen that the administrative law gave no logi cal reason for discoun ting the opinions of these doctors , such as Dr. Jones. A trea ting physician’s opinion trumps the conclusions of agency consultants

— in particular those who never exa m ined the claimant

— unless the lim i tations articulated by the treating physician are not supported by the r e cord. See Engstrand v. Colvin , 788 F.3d 655, 662 (7th Cir. 2015). While it’s true that Dr. Jones had seen Vanprooyen only once or twice a year since 2005, neither of the agency’s co n sulting physicians had

ever examined her . The administrative law judge also r e jected Dr. Jones’s opinion because it rest ed mainly on Va n prooyen’s reports of pain. That, too, was error , b e cause Dr. Jones’s medical

- source statement concerned only Va n prooyen’s fibrom yalgia , which cannot be measu red with

o b jective tests aside from a trigger

- point a s sessment . And that assessment showed that Vanprooyen was “[d]iffusely tender at 18/18 points and mu l tiple control points.” See Sarchet v. Chater , 78 F.3d 305, 30 6

– 0 7 (7th Cir. 1996) (discussing cha l leng e of diagnosing fibromyalgia and unavailability of obje c tive tests); Suleman Bhana, “ F i bromyalgia , ” American College of Rheum a tology (March 2017) , www.rheumatology.org/I

- Am

- A/Patient

- Caregiver/ Diseases

- Conditions/Fibromyalgia (noting th at causes of fibrom yalgia are unclear and diagno s tic tools lacking). An “ALJ may not discredit a claimant’s te s timony about herNo. 16

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pain and limitations solely because there is no objective medical evidence supporting it.” Villano v. A s true , 556 F.3d 558, 562 (7th Cir. 2009); Ca rradine v. Barnhart , 360 F.3d 751, 754 (7th Cir. 2004) (“Pain is always subjective in the sense of being experienced in the brain.”)

. The administrative law judge also gave little weight to the psychiatrist who opined that Va n prooyen has “fair or poor ment al abilities.” The administrative law judge d eclared that opinion inconsistent with other medical evidence, including “treatment records that generally ind i cate that the claimant’s mental status examination findings were normal and she reported improvement with medications.” Wrong ; the treatment records do not indicate a finding of “normal” mental status. The only mention of “normal” in the psychi atrist’s progress notes says that Vanprooyen’s motor skills were “within normal limits.” The administrative law judge disregarded all the psychiatrist’s other notes, covering a p eriod of six months, reporting that Vanprooyen had only fair judgment and insight and that her mood was okay at times but anxious and distraught at others. The administrative law judge also disregarded Dr. Alexander’s three years of ps ychiatric treatment without even mentioning him in the dec ision. And while Vanprooyen did report some improv e ment with medication, there were times when her medication did not improve her symptoms and she had to change medi c ation s and doses. Notably the administrative law judge failed to mention that a state consultative examiner who had given Va n prooyen a mental

- status examination concluded that she

was unable to manage her own money because of her “ em otional ad jus tment and medical difficulties. ” This omi s sion1 2 No. 16

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was especially ser i ous because at least two of the three jobs that the administrative law judge found that Va n prooye n could do

— cashier and counter clerk

— involve handling money. Instead, without any logical explanation, the admi nistrative law judge gave substantial weight to the opinions of consulting physicians who had never e xamined Va n prooyen, saying only that they had provided “a good syno p sis of the evidence” and that “their opinions are co nsistent with the overall record.” “An ALJ can reject an exa mining physician’s opinion only for reasons supported by substa n tial evidence in the record; a contradictory opi n ion of

a non

- examining physician does not, by itself, su f fice.” Gudgel v. Bar n hart , 345 F.3d 467, 470 (7th Cir. 2003).
Because of the serious deficiencies in the administrative law judge’s analysis, we reverse the decision of the district
court and remand the case to the Social Security Administr ation for further proceedings co n sistent with this opini on

. R EVERSED AND R EMANDED

.