October 3, 2017
from the United States District Court for the Eastern
District of Wisconsin. No. 15-CV-1115 - Nancy Joseph,
Kanne, Rovner, and Sykes, Circuit Judges.
ROVNER, Circuit Judge.
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-
plaints of fibromyalgia pain. We vacate the judgment and
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.
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.
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- 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-to-extreme 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.
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.
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.
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.
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
deferred 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.
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 ...