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Gerstner v. Berryhill

United States Court of Appeals, Seventh Circuit

January 5, 2018

Ashley Gerstner, Plaintiff-Appellant,
Nancy A. Berryhill, Defendant-Appellee.

          Argued October 3, 2017

         Appeal from the United States District Court for the Eastern District of Wisconsin. No. 15-CV-1115 - Nancy Joseph, Magistrate Judge.

          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- plaints of fibromyalgia pain. We vacate the judgment and remand.


         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- 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.

         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.

          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 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.

         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 ...

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