Rebecca Akin v. Nancy Berryhill
887 F.3d 314
7th Cir.2018Background
- Rebecca Akin applied for Supplemental Security Income claiming disability since 2011 from fibromyalgia, chronic back/neck pain, and headaches; she underwent various treatments and multiple ER visits.
- Treating providers documented fibromyalgia tender points, variable gait/range-of-motion findings, and prescriptions including opioids, gabapentin, tizanidine, tramadol, and a fentanyl patch.
- A March 2014 MRI (added to the record later) showed moderate–severe spinal canal stenosis at T10–T11, a disk protrusion at L4–L5, and a worsening C5–6 herniation with cord impingement.
- Two state-agency physicians (August 2012 and March 2013) reviewed part of the record (before the MRI) and concluded Akin could perform sedentary work.
- The ALJ credited the state-agency opinions, discounted treating opinions (Dr. Albala, NP Voss), found Akin’s symptom statements "not entirely credible," and concluded she retained capacity for sedentary work.
- The district court affirmed; the Seventh Circuit vacated and remanded, finding errors in the ALJ’s handling of the medical evidence and credibility findings.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether ALJ properly relied on state-agency reviewers who did not see later MRI results | Akin: reviewers did not consider ~70 pages of records including MRI; their opinions are unreliable | ALJ: relied on those opinions and interpreted MRIs as consistent with his RFC | Court: Error — ALJ impermissibly relied on incomplete reviews and improperly "played doctor" by interpreting MRIs without expert opinion; remand required |
| Whether ALJ impermissibly "played doctor" by interpreting MRI findings | Akin: ALJ lacked medical expertise to interpret MRI and draw RFC-conforming conclusions | ALJ: MRIs did not support disabling limitations and were consistent with his RFC | Court: Error — ALJ cannot substitute his own medical judgment; needed updated medical opinion or consultative input; remand |
| Whether ALJ properly discounted Akin's symptom testimony | Akin: ALJ used boilerplate "not entirely credible" and relied on objective findings that poorly capture fibromyalgia and other subjective pain disorders | ALJ: inconsistent objective findings (normal gait/RoM on some days), conservative treatment, and reluctance to try injections undermined credibility | Court: ALJ’s credibility analysis was flawed — cannot discredit fibromyalgia complaints solely for lack of objective tests; must consider claimant’s reasons for limited treatment; remand to reassess credibility |
| Whether ALJ adequately evaluated headaches | Akin: headaches are severe; CT/MRIs and records support evaluation | ALJ: relied on state-agency opinions finding headaches occasional and non-disabling | Court: Remand — ALJ must reevaluate headache complaints after obtaining any needed updated medical opinions |
Key Cases Cited
- Goins v. Colvin, 764 F.3d 677 (7th Cir.) (ALJ may not impermissibly interpret medical imaging or otherwise "play doctor")
- Moon v. Colvin, 763 F.3d 718 (7th Cir.) (ALJ cannot independently interpret raw medical data to make a medical finding)
- Green v. Apfel, 204 F.3d 780 (7th Cir.) (ALJ may seek updated medical opinion when the record is incomplete)
- Summers v. Berryhill, 864 F.3d 523 (7th Cir.) (critiquing boilerplate "not entirely credible" credibility language)
- Pepper v. Colvin, 712 F.3d 351 (7th Cir.) (standards for assessing claimant testimony and treating source evidence)
- Vanprooyen v. Berryhill, 864 F.3d 567 (7th Cir.) (objective tests do not adequately capture fibromyalgia; ALJ must not demand objective confirmation to credit complaints)
- Villano v. Astrue, 556 F.3d 558 (7th Cir.) (cannot discredit pain testimony solely because of lack of objective medical evidence)
- Beardsley v. Colvin, 758 F.3d 834 (7th Cir.) (ALJ must consider claimant’s reasons for declining invasive treatment)
- Stage v. Colvin, 812 F.3d 1121 (7th Cir.) (life circumstances may justify conservative treatment choices and require explanation before using them to discredit claimant)