# Spiller v. Commissioner of Social Security

> District Court, S.D. Illinois · September 30, 2024

URL: https://www.frixlaw.com/law-library/cases/10646407

## Case

- **Court:** District Court, S.D. Illinois
- **Decided:** September 30, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF ILLINOIS

KELLY S.,1 )
)
Plaintiff, )
)
vs. ) Case No. 3:23-CV-383-MAB
)
COMMISSIONER OF SOCIAL )
SECURITY, )
)
Defendant. )

MEMORANDUM AND ORDER

BEATTY, Magistrate Judge:
Plaintiff Kelly S. filed applications for Disability Insurance Benefits (DIB) under
Title II of the Social Security Act and Supplemental Security Income (SSI) under Title XVI
of the Act on June 23, 2020, in which she claimed disability based on her mental health
impairments and associated symptoms. Plaintiff’s applications were ultimately denied in
a written decision by ALJ Kevin Martin issued on April 4, 2022 (Tr. 13–14). There is no
dispute that the ALJ’s decision is the final decision of the Commissioner of Social Security
(see Docs. 19, 25). Plaintiff is presently before the Court, represented by counsel, seeking
review of the Commissioner’s decision pursuant to 42 U.S.C. § 405(g). For the reasons
explained below, the ALJ’s decision is reversed.

1 In keeping with the Court’s practice, Plaintiff’s full name will not be used in this Memorandum and Order
due to privacy concerns. See FED. R. CIV. P. 5.2(c) and the Advisory Committee Notes thereto.
THE EVIDENTIARY RECORD
The evidence in the record consists primarily of Plaintiff’s medical records and
records from counseling, a Third-Party Function Report filled out by her grandfather,

and the transcript of the administrative hearing before the ALJ. The Court has reviewed
and considered the entire evidentiary record in formulating this Memorandum and
Order. The following summary of the record is presented in mostly chronological order
and is directed at the points raised by Plaintiff.
Plaintiff was born in February 1985 and was 28 years old on the alleged onset date

of June 1, 2013 (Tr. 35). The records reflect that Plaintiff has a long history of substance
abuse and other psychiatric issues. She described her childhood as a “nightmare” (Tr.
1444). She consistently reported that she started getting high with her mom, who was a
heavy drug user and “die hard addict,” around 10 years old (Tr. 39, 509, 510, 1438, 1443,
1625). She also consistently reported that her mental health symptoms started as a child

(Tr. 37, 510, 513, 1437). She remembered asking her doctor for help at age 11 and she
began having panic attacks at age 12 (Tr. 513, 1440). During her teenage years, she had at
least one psychiatric hospitalization2 and also endured a traumatic experience when she
found her mom and another man both dead from overdoses (Tr. 38, 510).
Plaintiff reported that in 2007 she overdosed on methamphetamine, was convicted

of felony drug possession, and attended inpatient substance abuse treatment (Tr. 509,

2 Details in the records varied and it was hard to tell whether Plaintiff was hospitalized more than once as
a teen (see Tr. 510 (recounting that she was taken to inpatient by her parents in Jan. 2003), 1638 (recounting
admission at age 17); 2035 (“when she was 17 she was taken to the Pavilion after finding her mother who
was killed . . . in a drug-related incident”)).
1638, 2034). Plaintiff reportedly stayed clean until 2014, when she relapsed following the
birth of her daughter (Tr. 509–10, 1438). During the time she was clean, she worked at fast

food restaurants and as a server at a steakhouse (Tr. 36; see also Tr. 240–42, 247). She
described herself as “very capable of things” at that time (Tr. 36).
Records show that Plaintiff attended substance abuse therapy—both group and
individual sessions—from June 2012 through 2013 at Centerstone of Illinois (Tr. 1541–
1616). According to Plaintiff’s testimony and the treatment records, her anxiety got worse
in 2013, which she attributed to increased stress from an abusive relationship, her job at

the steakhouse, and other personal issues (Tr. 38, 1582, 1584). Some of the notes from
counseling sessions in 2013 indicate she was tearful and upset (Tr. 1573, 1582). She often
reported being very stressed, and her dosage of Xanax was increased (Tr. 1562, 1570, 1562,
1566, 1584). At one appointment, she reported sleeping a lot, feeling “incapacitated by
depression” and “trapped,” and said she had “never before felt so much like a basket

case” (Tr. 1573). During other appointments, she needed help processing her feelings of
sadness and/or guilt (Tr. 1551, 1558, 1560). From time to time, she said things were going
“a little better” (Tr. 1545, 1547, 1553, 1574).
By January 2014, Plaintiff was pregnant, and she reported being “very stressed
out” by her partner and having a resurgence of PTSD symptoms (nightmares) (Tr. 1541).

The dosage of her anxiety medication had been increased by her doctor despite being
pregnant (Id.). Plaintiff gave birth to her daughter on March 25, 2014 (Tr. 371, 1538).
Within two months of giving birth, Plaintiff reported to both her counselor and her
primary care physician at Johnson City Community Health Center that she had been
experiencing some depression and an increase in her PTSD symptoms, including “bad
flashbacks” (Tr. 371–73, 1534; see also Tr. 1284). She also reported that her OB/GYN had

increased her dose of Xanax to 2mg (Tr. 371–73).3 In May 2014, her physician wrote that
she was “very emotionally unstable at current time” and having “significant issues” with
her partner (Id.). Her diagnoses were listed as anxiety, depression, PTSD, and postpartum
depression (Id.). She was started on venlafaxine, in addition to the Remeron and Xanax
she was already taking (Id.; see also Tr. 368). In June, the venlafaxine was doubled (Tr.
368). And in July, she switched to Zoloft (Tr. 365). It was around this same time that

Plaintiff no-showed to a counseling session, and all of her counselor’s calls in the months
that followed went unanswered (see Tr. 1530–33; see also Tr. 1281–83).
In August 2014, Plaintiff told her doctor that her symptoms were worsening and
she “had a mental break down” (Tr. 359). She said she was crying a lot, was emotionally
unstable, and was unable to leave the house (Id.) Two weeks later, she reported that she

was “doing well” but still wasn’t “where she needs to be” (Tr. 355). At a follow-up visit
in October 2014, Plaintiff reported the Zoloft “wasn’t working” (Tr. 351–53). Her doctor
noted “Agitation. Anxious. Compulsive behavior. Patient is in denial. Flight of ideas.
Hopelessness. Inappropriate affect—depressed. Increased activity. Mood swings. Poor
insight. Poor judgment. Explained that if she is bipolar she needs additional rx for

stability” (Id.). Plaintiff’s dosage of Zoloft was reduced and she was started on Abilify
(Id.). Over the next couple months, Plaintiff reported her anxiety symptoms were

3 The Court notes that there are no medical records from Plaintiff’s OB/GYN in the administrative record.
“relieved with current dosages” or “stable” (Tr. 342–46, 347).
However, in late December 2014, Plaintiff was taken to the emergency room at

Heartland Regional Hospital following a domestic dispute with her fiancé and reporting
thoughts of hopelessness (Tr. 1354–59, 1529). She was disheveled, had a depressed mood
and flat affect, and was anxious about her relationship (Tr. 1354–59). She was assigned a
GAF score of 48 (Tr. 1358), which correlates with “serious symptoms (e.g., suicidal
ideation, severe obsessional rituals, frequent shoplifting)” or “any serious impairment in
social, occupational, or school functioning (e.g., no friends, unable to keep a job).”4 Days

later, Plaintiff reported to her doctor that she was having panic attacks about twice a day
and her anxiety made her nauseous (Tr. 340). Her dosage of Zoloft was increased (Id.).
In February 2015, Plaintiff reported “improvement” in her depression symptoms
and insomnia, “but not enough” (Tr. 338). Her dosage of Zoloft was again increased (Id.).

4 The Global Assessment of Functioning (GAF) score is a numeric scale of 0 through 100 used to assess
severity of symptoms and functional level. Yurt v. Colvin, 758 F.3d 850, 853 n.2 (7th Cir. 2014) (citing Am.
Psychiatric Ass'n, Diagnostic & Statistical Manual of Mental Disorders (“DSM VI”), 32 (4th ed. text revision
2000)). The higher the number, the better a person is functioning. A score of:
• 41 to 50 reflects “serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent
shoplifting)” OR “any serious impairment in social, occupational, or school functioning (e.g., no
friends, unable to keep a job).”
• 31 to 40 reflects “some impairment in reality testing or communication (e.g., speech is at times,
illogical, obscure, or irrelevant),” OR “major impairment in several areas such as work or school,
family relations, judgment, thinking, or mood (e.g., pressed man avoids friends, neglects family,
and is unable to work).”
• 21 to 30 reflects “[b]ehavior [that] is considerably influenced by delusions or hallucinations,” OR
“serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly
inappropriately, suicidal preoccupation,” OR “inability to function in almost all areas (e.g., stays
in bed all day; no job, home, or friends).”
• 11 to 20 reflects “[s]ome danger of hurting self or others (e.g., suicide attempts without clear
expectation of death; frequently violent; manic excitement),” OR “occasionally fails to maintain
minimal personal hygiene (e.g., smears feces),” OR “gross impairment in communication (e.g.,
largely incoherent or mute).”
DSM VI, p. 34.
And in April 2015, Plaintiff reported panic attacks during which she “cannot breathe,”
she feels her body jerk, and she is “unable to remember until 2 hours later” (Tr. 333, 334).

She was referred to psychiatry and to neurology (Tr. 334).
It was around this time that Plaintiff was arrested for possession of controlled
substance (Tr. 2034; see also Tr. 332). She later admitted that she had started using drugs
again after giving birth (e.g., Tr. 509–10, 1438). Plaintiff is said to have completed a
residential drug rehabilitation program around this time (Tr. 2034), although there are no
records from the rehab program in the administrative record.

Plaintiff next saw her doctor in August 2015 (Tr. 331–32). She endorsed continued
anxiety and “black out moments.” She reported that in the last two weeks there were
“several days” where she had little interest or pleasure in doing things and she felt bad
about herself or that she was a failure or that she had let her family down (Id.). And on
“more than half the days,” she had trouble concentrating on things (e.g., reading the

newspaper or watching television) and was “moving or speaking so slowly that other
people could have noticed; or the opposite, . . . fidgety and restless” (Id.).
Following this appointment, there is a gap in the records until April 2016,5 when
Plaintiff went to the emergency department at Union County Hospital, reporting
increased depression and feeling hopeless, helpless, and worthless (Tr. 1624–39). She said

she was taking her medications as prescribed, but they were not helping (Id.). The ER

5 It appears that by late 2015, Plaintiff had switched her primary care to Dr. Aaron Newcomb at Shawnee
Health Care in Carbondale, Illinois (see Tr. 1408). However, there are no medical records from Dr.
Newcomb in the administrative record.
physician deemed Plaintiff to be an imminent danger to herself due to her depression
and suicidal ideation, and she was transferred to Harrisburg Medical Center (also

referred to as the Mulberry Center) for a psychiatric evaluation and voluntarily admitted
(Id.). She was described as “paranoid,” “guarded,” and “suspicious” but with no overt
psychotic features, and she had “difficulty staying focused and maintaining
concentration” (Tr. 1625). Her insight and judgment were “limited,” and the physician
assigned a GAF score of 20 to 30 (Id.). This corresponds with a “serious impairment in
communication or judgment,” or an “inability to function in almost all areas.” See supra

n.4. Plaintiff was diagnosed with a bipolar disorder, anxiety disorder, polysubstance
dependence, and borderline personality disorder (Tr. 1625). She was prescribed a raft of
medications during her stay, including Ambien and Restoril to help her sleep, nicotine
patches, Latuda and Depakote to stabilize her mood, Ativan for anxiety symptoms, and
Remeron for nightmares and mood symptoms (Tr. 1626, 1634). She was discharged after

four days at her request and after her suicidal ideations had abated (Tr. 1628).
There is another gap in the records from April 2016 until January 2017, when
Plaintiff re-established counseling services at Centerstone while she was in the Franklin
County Jail following her arrest in late 2016 for possession of methamphetamine and
controlled substances (Tr. 1408, 1410; see also Tr. 1404, 1496–1501). Plaintiff was released

on bond on February 22, 2017, and saw her counselor for a diagnostic assessment a couple
weeks later (Tr. 1443–46; see also Tr. 1451–53, 1492–94). Plaintiff’s counselor wrote that she
was having “a mental health crisis” and had been off drugs due to her incarceration and
was attempting to get back on her psychiatric medications before she relapsed (Tr. 1465).
Plaintiff reported that she had been so depressed she could not get out of bed and could
sleep for three or four days at a time (Tr. 1444). She endorsed agitation and anger, fatigue

and loss of energy, weight gain, feelings of worthlessness and guilt, and thoughts of death
(Tr. 1451–53). She said the depression had been present without remission since her
daughter was born two years prior, but her medications helped control some of the
symptoms (Id.). She also had periods of hypomania, which usually lasted around four
days, and then she would cycle to a depressive state for two to three weeks (Id.; see also
Tr. 1483). During her manic phases, Plaintiff was very talkative, distracted, had racing

thoughts, and was more likely to relapse (Tr. 1451–53). As for the anxiety, she said it was
there “every minute of every day.” (Id.). She said she could not go into stores, had trouble
relaxing, worried too much about things, could not control her worry, and was afraid
something awful was going to happen (Id.). The counselor noted that “the
severity/complexity of symptoms, behaviors, and functional skill deficits including

distress to [Plaintiff’s] life [was] severe” (Id.).
Plaintiff met with a clinician to develop a treatment plan and reported that her
thoughts were racing and she “felt like she was going crazy” (Tr. 1487). She was described
as “very anxious,” “unable to focus,” “tearful,” and “noticeably shaky” (Id.). The clinician
noted that Plaintiff’s “mental capacity was so decompensated that she was unable to

concentrate on communication and understand [the] full content of services being
discussed,” and they were not able to complete the treatment plan (Id.). It was further
noted that if Plaintiff was “off her medications and not using substances” then she needed
“to see the psychiatrist immediately or she [would] end up in the psychiatric hospital
very soon based on [her] presenting [state]” (Tr. 1485).
While waiting to see the psychiatrist for medications, Plaintiff attended three

individual counseling sessions (see Tr. 1485, 1487). Notes from the first session on
Tuesday, March 28th state that Plaintiff was functioning better than the previous week
(Tr. 1483). She did not cry and was able to somewhat express feelings, emotions, and
stressors (Id.). She reported that she had been in a manic state for a couple days (Id.).
At the second session the following day, Plaintiff reported that she had been
unable to sleep due to feeling manic; she finally fell asleep that morning and slept until

right before her appointment at 2:00 p.m. (Tr. 1479). When she woke up, her mood had
shifted and she “was in full panic” (Id.). She “presented with high anxiety due to the
waiting room being very full and her feeling overwhelmed” (Id.). She reported that she
was “struggling,” felt depressed, and had difficulty breathing (Id.). She said her family
was telling her to do things to “get better,” like finding a job and having a regular

schedule, but those were “not options . . . at this time” because she “[could not] even
think straight” (Id.). The clinician noted that Plaintiff was shaky and crying but her mood
became more stable once she was in the office for a while (Id.).
At the third session on Friday, March 31st, Plaintiff presented in an anxious mood
but was functioning slightly better than the two previous appointments (Tr. 1477). She

did not cry during the session and was able to use logical thinking and discuss situations
(Id.). The counselor provided encouragement for Plaintiff to remain calm over the
weekend while waiting to see the psychiatrist (Id.). Unfortunately, she not only relapsed
but was arrested for possession of drugs (see Tr. 1465, 1473, 1476).
She was incarcerated for a total of approximately 16 months in the county jail and
the Illinois Department of Corrections (Tr. 1452). Records show that Plaintiff underwent

a psychiatric diagnostic evaluation at Logan Correctional Center in September 2017 (Tr.
509–19).6 She was not taking any psychiatric medications at the time, and she reported
twice daily panic attacks where she felt dizzy and blacked out; insomnia; constant worries
that were difficult to control; racing thoughts; intrusive thoughts; being constantly on
guard; being easily startled; feeling tensed up and panicked; daily mood variations;
having good energy and feeling in “constant overdrive” some days but feeling exhausted

and “slow” other days; “horrendous” nightmares; and “locking herself in her cell due to
social anxiety” (Id.). She also endorsed having feelings of hopelessness or helplessness,
feelings of guilt or worthlessness, and low self-esteem (Id.). The clinician observed that
Plaintiff had tensed muscles, avoided eye contact, and had a euthymic affect (Id.). She
further noted that Plaintiff “presented as anxious in the beginning of the interview but

did calm down significantly” (Id.). The clinician opined that Plaintiff “clearly had signs
of PTSD” and anxiety (Id.). Plaintiff’s diagnoses were recorded as PTSD, amphetamine
use disorder, and adjustment disorder with anxiety, and she was started on Remeron
(Id.). The clinician noted she would continue to closely monitor Plaintiff for possible
generalized anxiety disorder, bipolar disorder, and personality disorder (Id.).

The following month, Plaintiff reported being “tense” and “miserable” and that

6 The records from Logan Correctional Center cover only appointments with prescribing clinicians and do
not cover any of Plaintiff’s encounters with other mental health professionals or any counseling sessions
(see Tr. 451–519).
the Remeron was not effective (Tr. 503–08). She said that she was on a manic high the
previous week, which had subsided, and she was moving toward depression (Id.). The

clinician observed that Plaintiff was tense, exhibiting psychomotor agitation, and had
rapid speech and an expansive affect (Id.). The clinician noted that Plaintiff’s thoughts
were organized overall, but she jumped topics at times, and she was irritable but able to
stay focused on the conversation (Id.). Plaintiff’s diagnosis was changed to bipolar
disorder and borderline personality disorder (Id.). The clinician discontinued Remeron
and started Plaintiff on Risperdal to stabilize her mood and Vistaril for anxiety (Id.).

By November 2017, Plaintiff’s medication had been switched from Risperdal to
Zyprexa (see Tr. 496—508). She reported “doing better,” and that her mood, sleep, and
appetite were better (Id.). She said when her anxiety got high, she would take a nap (Id.).
The clinician observed that Plaintiff was “slower,” she looked rested, and her thoughts
were organized (Id.). Plaintiff was continued on Zyprexa and Vistaril and also started on

Lamictal for mood stabilization and anxiety (Id.).
In December 2017, Plaintiff reported severe anxiety and an inability to regulate her
mood; her dosage of Zyprexa and Lamictal were both increased (Tr. 490, 494). A month
and a half later in February 2018, Plaintiff reported times where her thoughts were
“spinning” and “obsess[ive]” and she continued to report an inability to regulate her

mood (Tr. 482–89). She said she felt like her anxiety spiked after the Lamictal was
increased, she was having difficulty concentrating, and her nightmares were back (Id.).
The clinician wrote that Plaintiff’s speech was normal, her thoughts were organized, and
her insight and judgment were fair (Id.). Plaintiff was continued on Zyprexa, the Lamictal
was decreased, and she was started on prazosin for her anxiety (Id.). Two weeks later,
she reported “crippling” anxiety, and her medications were tweaked again (Tr. 474–81).

In April 2018, Plaintiff reported feeling emotionally flat and unable to cry or “have
an up or down emotion,” which she thought was due to the Lamictal (Tr. 458–65). She
reported “horrible” anxiety, which the clinician noted “seems to be baseline” but was
“not incapacitating as she [was] functioning well in the [general population] overall” (Tr.
458, 462). Plaintiff also reported feeling restless, but her mood, sleep, and appetite were
“okay” (Tr. 458). The clinician observed that Plaintiff’s speech was normal, her affect was

constricted, and her insight and judgment were fair (Tr. 460, 462). The clinician
discontinued the Lamictal and increased the Zyprexa (Tr. 462). Plaintiff presented two
weeks later with a flat affect and monotone speech (Tr. 451).
Plaintiff was released from prison in July 2018 and was referred to Centerstone for
substance abuse and mental health services as a condition of her parole (see, e.g., Tr. 751,

1452). Plaintiff reported that her mental health was very unstable, and she needed to get
her medications straightened out (Tr. 832; see also Tr. 1449–64). She said she was “not
functioning at all,” severely depressed, having anxiety “through the roof,” and
“miserable” despite being on “prison psych meds” (Tr. 1122, 1454). She reported sleeping
for 15 hours at a time and said “I’m not excited about anything. I have no ambitions. I

just exist” (Tr. 1454). She said her grandparents were on her because “I don’t talk to
anyone, I’m like a zombie” (Id.). She also reported having panic attacks every day, which
she handled by “lay[ing] down and curl[ing] up in a ball and pray[ing] . . . [for] sleep”
(Id.). She also said she considered “turning [her]self in to Mulberry for a few days” (Id.).
Shortly thereafter, Plaintiff began seeing Dr. Michael Blain for her primary care
and psychiatric medications (Tr. 574). Dr. Blaine discontinued all of the medications

Plaintiff had been prescribed while in prison and started her on new ones (Tr. 575). His
notes from August 2018 to December 2019 consistently indicate that Plaintiff was alert,
oriented, cognitively intact, cooperative and with good judgment and insight (Tr. 538–
75). However, Plaintiff continually reported anxiety and, at times, panic attacks and
insomnia, and Dr. Blaine continually tweaked her medications (Id.). But the notes rarely
said anything more about Plaintiff’s mental health (see id.).

Records from Plaintiff’s counselor during this same time period provide a clearer
picture about her mental health. After her medications were switched in August 2018,
Plaintiff reported to her counselor that she felt she was functioning and thinking more
clearly and did not feel as “slow motion” as she did on Zyprexa (Tr. 837). Her counselor
noted that Plaintiff’s “presentation was more connected and less stiff” than the previous

session, she appeared “more calm and less panicky,” and she was less fidgety and able
to sit still for the majority of the session (Id.). Plaintiff’s level of functioning continued to
improve over the next several weeks (see Tr. 842, 845, 850).
By mid-September 2018, however, Plaintiff’s mental health was slipping. On
September 19th, she “presented in a distant and depressed mood,” “stared in a blank way

during the session[n],” and “had to be engaged a few times” (Tr. 853). Plaintiff reported
that she was unable to “get motivated to do anything” and had been “distracted and
overwhelmed by ongoing feelings of sadness and irritation” (Id.). A week later, Plaintiff
was “in an anxious and apparent uncomfortable mood” and said she has been “lacking
motivation, drive, or any ambition to do anything or even get out of bed” (Tr. 858). She
did not think that Klonopin was effective because she still felt anxious and unable to focus

after taking it (Id.).
In October, Plaintiff said she felt like she had reached her breaking point (Tr. 860).
Her counselor talked of Plaintiff’s “current mental health crisis” and described her as
being in an anxious mood and “very tearful” (Id.). A mental status exam a week later
indicated that Plaintiff’s attitude was withdrawn and preoccupied, her thought process
was loose, her thought content was guarded, her mood was depressed and irritable, and

her affect was sad (Tr. 1094).
Notes from November and December indicate that Plaintiff was distracted during
one appointment and needed help processing her anxiety during another (Tr. 869, 871).
At another appointment, she presented in an anxious mood and lamented that “she
cannot get better and stay sober” while simultaneously “deal[ing] with the stress of her

home” (meaning her difficult relationships with her grandparents and aunt, with whom
she lived), and her daughter’s difficult behaviors (Tr. 878). She said she felt like she “[had]
to [choose] between being a mother and being sober because she cannot do both” (Id.).
Plaintiff also told Dr. Blaine that her anxiety was so severe she was isolating herself from
her friends and her daughter, had started clenching her jaw, and had muscle tension in

her shoulders and legs (Tr. 564).
During the first part of 2019, Plaintiff presented in an average or positive mood at
a handful of appointments but otherwise continued to struggle (Tr. 883, 886, 911–912,
915). Her counselor described her at times as in a “low mood,” in an “angry and
frustrated mood,” upset, and/or tearful (Tr. 890, 898, 909, 917–18). Plaintiff reported
feeling despair, fear, anger, incompetence, and powerlessness (Id.). She frequently talked

about her “unbearable” home life, her “emotionally overwhelming” and “hostile”
relationships with her grandparents and aunt, and the difficulty of managing her
daughter’s behavior and the emotional distress it caused her (Id.). She frequently reported
that she was struggling to maintain her sobriety (Tr. 890, 900, 909). And she began self-
medicating with marijuana after she was released from parole; she said it helped with her
mood more than any of the psychiatric medications she had tried (Tr. 909, 2269).

In May 2019, Plaintiff switched from Klonopin to Xanax, and she reported that she
was functioning better with less anxiety (Tr. 924). Her counselor noted that her behavior
and overall mood were positive (Id.). And her mental health “appeared to improve
significantly” over the next month (Tr. 929). But in July 2019, Plaintiff’s attendance at
therapy fell off, due in part to her aunt being hospitalized and her grandparents being at

the hospital, which left Plaintiff with no transportation or childcare and struggling to
manage her increased responsibilities and stress (Tr. 934–48).
Plaintiff did not return to her counselor until early December 2019 (see Tr. 950–
962). Her counselor noted that she was “very upset,” and she reported having a “very
difficult” time and wanting to re-engage in treatment (Tr. 962). Plaintiff told her counselor

(as well as her physician) that she was dealing with multiple stressors, including the
death of a close friend, her partner not being released from prison as scheduled, and her
five-year-old daughter’s “out of control” behavior (Tr. 538, 962). Plaintiff also admitted
to relapsing and using drugs (Tr. 964–65). In mid-December 2019, Plaintiff was admitted
to the ICU due to an overdose and remained in the hospital for several days (Tr. 972; see
also Tr. 974–81). After her discharge, she re-engaged with counseling services (Tr. 982–

87). She reported increased difficulties in her relationship, high levels of emotional stress,
anxiety, and substance abuse triggers (Tr. 992–95). Her counselor noted throughout
January and February 2020 that Plaintiff was “markedly” symptomatic (Tr. 982–1006).
Plaintiff looked into starting Medication-Assisted Treatment (MAT) with suboxone (Tr.
997–98),7 but the psychiatrist at Centerstone would not write her a prescription (Tr. 1650–
61; see also Tr. 1688–90).

In April 2020, Plaintiff presented at counseling sessions “very anxious and
irritable” (Tr. 1026), and “very tearful” (Tr. 1041, 1044). She discussed “mood
instabilities” at home, difficulty parenting her daughter, sadness and grief over
separating from her partner, “up and down” emotions, “high levels” of stress, feeling
overwhelmed due to her grandparents’ deteriorating health and her caregiving role,

nightmares she had been having, and a recent “break down” (Tr. 1032–33, 1036, 1041,
1252). At one point, she said her sadness and anxiety made her feel like giving up on
being a mom and being sober (Tr. 1032). Her counselor continually noted throughout
April that Plaintiff was “markedly,” and even “severely,” symptomatic (Tr. 1026–45).
In May 2020, there was one session where Plaintiff said she was “too emotionally

overwhelmed” to participate in the session; her counselor remarked that she was

7 Medication-Assisted Treatment (MAT) is the use of medications, in combination with counseling and
behavioral therapies, for the treatment of substance use disorders. SUBSTANCE ABUSE AND MENTAL HEALTH
SERVS. ADMIN., Medications for Substance Use Disorders, https://www.samhsa.gov/medications-substance-
use-disorders (last visited Sept 20, 2024).
“severely symptomatic” (Tr. 1047). Another time, she said she was having a “bad day”
and was “very tearful throughout the session” (Tr. 1052). She reported that she was “not

functioning well in any area of her life” (Tr. 683), and expressed “very high levels of
anxiety” over her relationships with her daughter, her grandparents, and her ex-partner
(Tr. 1055). She said she was dealing with “lots of stress in her living situation that [made]
her recovery difficult at times” (Tr. 1665). Plaintiff was up and down throughout the
remainder of May and June (Tr. 1061–72; 1737–44).
During a session in July, Plaintiff’s counselor noted that she was “very distracted

and upset,” and Plaintiff ended the session early because “her anxiety was increasing and
she wanted to relax and could not work on the assessment anymore” (Tr. 1077). Her
counselor remarked that she was “severely symptomatic” (Id..). Later that month,
Plaintiff obtained a medical cannabis card, allowing her to legally obtain marijuana to
help with her anxiety and PTSD symptoms (Tr. 1278). Her counselor reflected that

Plaintiff was managing her “severe ptsd and emotional problems” with mental health
counseling and medications, and “showing progress” in working toward her treatment
goals of strengthening her recovery from substances and stabilizing her mental health
(Tr. 1278, 1666) (emphasis added).
In early August 2020, Plaintiff’s 91-year-old grandfather, with whom she lived,

filled out a Third-Party Function Report (Tr. 273–80). He stated that because of Plaintiff’s
condition, her hands shake, she sweats, panics, faints, and feels nauseous. Her “moods
change easily depending on triggers.” And she oversleeps to avoid dealing with her
anxiety. In spite of her conditions, Plaintiff was able to manage her own personal care
needs (bathing, dressing, feeding, etc.). She did household chores, like laundry,
vacuuming, and cleaning. She prepared meals for herself and her daughter. And she

helped her daughter with everyday things, like bathing and schoolwork. But Plaintiff’s
grandfather said he and his wife also helped her care for her daughter and with general
daily activities due to her anxiety and panic problems. Plaintiff’s grandfather repeatedly
stated that she spent much of her time isolating herself in her room, where she watched
TV and/or scrolled Facebook. He said he only saw her at meals. She could not handle
social groups. She seldom went outside, and only went shopping when necessary. She

did not handle stress or changes in routine well. And she had trouble understanding and
following instructions and completing tasks because she had a “difficult time focusing”
and was easily overwhelmed.
It was decided in August 2020 that Plaintiff would start attending a weekly group
therapy session in addition to continuing her weekly individual sessions (Tr. 1754). That

month she appeared at sessions very upset and tearful (Tr. 1757, 1763). Once she was so
anxious and distracted that it made completing an assessment difficult (Tr. 1779–81). She
reported a recent arrest for drugs and later admitted to relapsing (Tr. 1757, 1774). But
there were also times where she was feeling better and in a positive frame of mind (Tr.
1760). Nevertheless, her counselor consistently noted that she was severely symptomatic

(Tr. 1754–75).
In September 2020, Plaintiff established care with Dr. Brent Jones at SIH
Harrisburg Primary Care to begin MAT (see Tr. 2148–49; see also Tr. 2145–48). Dr. Jones
prescribed her Suboxone and continued her prescriptions for Xanax and Seroquel (Tr.
2142–45). The following month, Plaintiff told Dr. Jones that she felt her anxiety and
bipolar disorder were “well controlled on current medications” (Tr. 2132). Plaintiff

likewise reported to her counselor that she was feeling better, less anxious, less stressed,
and in a positive mental state (Tr. 1790–1802).
Subsequent notes tell a mixed story. Dr. Jones’ notes from November and
December 2020 indicate that Plaintiff was “doing quite well” and that she felt her anxiety
and bipolar were well-controlled on current medications (Tr. 2112, 2125, 2128). However,
other notes indicate Plaintiff was experiencing significant anxiety as a result of being

investigated by DCFS for neglect (see Tr. 1812, 1815, 1820–21, 2123). One note in particular
indicates that she was “very anxious and tearful,” “in a panic,” and her counselor had to
assist her with breathing techniques to calm down (Tr. 1806–07). Another note describes
a phone call she made to Dr. Jones’s about the difficulty she was having getting her Xanax
refilled; it said, “she is really stressing out over this . . . . She said she feels like she could

have a relapse and she is really having a mental breakdown” (Tr. 2118).
In January 2021, Plaintiff reported to her counselor that her anxiety was “getting
terrible,” (Tr. 2263), and it was so high she thought she might need to be hospitalized (Tr.
2268). There was also another phone call to Dr. Jones’s; office where she was “upset and
crying” over an issue with getting her Xanax refilled; she was “sobbing and asking for

help” (Tr. 2110). And at her appointment that month with Dr. Jones, she was “very tearful
and upset” over a number of things, like the passing of her aunt, her sister being arrested,
and child custody issues (Tr. 2088). She asked for a referral to a psychiatrist to get her
dosage of Xanax increased (Tr. 2087, 2088). At that time, she was seeing three counselors:
her mental health counselor, a domestic violence counselor, and a sexual assault
counselor (see Tr. 2271; see also Tr. 2285, 2287).

In February, Plaintiff told Dr Jones she was “doing well” on the current suboxone
dosage (Tr. 2066–68). She said the same thing the next month (Tr. 2062–63). She also
reported that she had recently returned to narcotics anonymous meetings and felt like
her “bipolar and anxiety [were] doing quite well on current medications” (Id.; see also Tr.
2279). Dr. Jones wrote that Plaintiff’s bipolar disorder was “in remission” (Tr. 2062–63).
On the other hand, a March 2021 care plan from her counselor noted that Plaintiff said

she had been feeling “angry and frustrated and . . . like I have no control” (Tr. 2277). She
reported that her anxiety was “going up,” and that although she was no longer having
nightmares, she was still “very emotionally triggered” and experiencing other PTSD
symptoms (Tr. 2283, 2285). She also reported she was “having a lot of problems with her
sister again” and was in court over child custody issues with her ex-partner, which was

“very anxiety provoking for her” and gave her “major concerns for her daughter’s safety”
given that her ex was also an addict and “abusive” (Tr. 2286, 2287, 2328, 2399).
Dr. Jones’s notes from April indicate that Plaintiff continued to do well on current
suboxone dosage, but he also acknowledged “[c]omplex social factors [were] present and
complicating management” (Tr. 2058). Earlier that same day, Plaintiff had attended a

consultative examination with clinical psychologist David Warshauer (Tr. 2031–35). At
the beginning of the exam, Plaintiff was “very tearful, anxious, and extremely talkative
to the point where [Dr. Warshauer] had to ask her to slow down and eventually to stop
so that [he] could ask questions” (Tr. 2033). Dr. Warshauer noted that she was fully
oriented, had no gross psychotic symptomology, answered questions in a relevant and
coherent manner, and her intelligence was at least within normal range (Tr. 2035). He

also noted that Plaintiff was very anxious and tearful throughout much of the evaluation
but at times was able to smile appropriately (Id.). Dr. Warshauer considered her anxiety
level to be “far above what [he] would consider to be normal” (Id.).
During the agency’s initial review of Plaintiff’s disability application in April 2021,
state agency reviewing psychologist, Dr. Margaret DiFonso, opined that Plaintiff was:
• mildly limited in her ability to understand remember or apply
information;

• mildly limited in her ability to adapt or manage herself;

• moderately limited in her ability to interact with others—particularly
interacting appropriately with the general public, accepting
instructions, and responding appropriately to criticism from
supervisors—but she was not significantly limited in any other aspect
of social interaction; and

• moderately limited in her ability to maintain concentration, persistence,
and pace—particularly carrying out detailed instructions and
maintaining attention and concentration for extended periods—but she
was not significantly limited in any other aspect of sustained
concentration and persistence.

(Tr. 55–69; Tr. 70–85). In a supplemental narrative explanation, Dr. DiFonso noted that
Plaintiff performed “reasonably well” on the cognitive tasks of the mental status exam
conducted by Dr. Warshauer and that Plaintiff also “carrie[d] out a fair range of daily
activities” (Tr. 66). According to Dr. DiFonso, that suggested Plaintiff’s cognitive and
attentional skills remained intact and adequate for simple one-two step as well as multi-
step tasks even though her mental health symptoms and history of substance abuse
limited her ability to manage detailed tasks (Tr. 66). Dr. DiFonso also recommended
“moderate limitations of social expectations” due to Plaintiff’s history of personality

disorder and being self-described as socially avoidant (Id.).
Several months later at the reconsideration stage, another state agency reviewing
psychologist, Dr. Gayle Williamson, agreed with Dr. DiFonso’s opinions except Dr.
Williamson opined that Plaintiff was moderately limited in her ability to complete a
normal workday and workweek without interruptions from psychologically based
symptoms and to perform at a consistent pace without an unreasonable number and

length of rest periods (whereas Dr. DiFonso thought Plaintiff was not significantly
limited) (Tr. 88–95; Tr. 96–103). Dr. Williamson stated in a supplemental narrative:
“The [claimant] retains the mental capacity to understand, remember and
concentrate sufficiently in order to carry out one or two-step instructions
for a normal work period. The [claimant] could make simple work related
decision. the [claimant] could interact with others sufficiently in a work
setting with reduced social demands. [Claimant] would do best in a
predictable, routine work setting where employment related social
interactions are infrequent, brief and largely task-specific (vs.
collaborative).

(Tr. 94, 101).
Medical records from Dr. Jones in May 2021 continue to note that “complex social
factors [were] present and complicating management” of Plaintiff’s substance abuse (Tr.
2054). Plaintiff declined to taper off her suboxone dosage and stated she wanted to
continue her prescription for Xanax despite being warned about the increased risk of
death with concurrent use of benzodiazepines and narcotics because she felt her anxiety
“continue[d] to be well controlled on current medications” (Tr. 2054). Plaintiff’s care plan
with her counselor from May 2021 also seems to reflect that she was doing relatively well,
albeit not completely problem-free. She said she “[felt] more confident with less triggers,”

did not think about using drugs anymore, and that her mood “ha[d[ been stable for
awhile now, which is why they took away my bipolar diagnosis and now I am just trying
to manage my anxiety” (Tr. 2293, 2296). But she also reported that she continued to
experience PTSD triggers, like “when my daughter comes at me too fast or too hard with
an angry face, lots of noise, and being in a car with any male” (Tr. 2299).
In June 2021, Plaintiff reported to Dr. Jones that she had been under a lot of stress

and her craving for opiates had increased; Dr. Jones agreed that her dosage of suboxone
needed to be increased (Tr. 2050). Her anxiety, however, was “overall okay,” and her
prescription for Xanax was continued (Tr. 2050; see also Tr. 2047). A note from Plaintiff’s
counselor corroborates that she had been very stressed in recent weeks but also reported
“many healthy, sober activities . . . recently,” like going to the pool and a baseball game

with her daughter and going hiking with a friend (Tr. 2519). Plaintiff told her case
manager that she had been contemplating getting a job (Tr. 2516–17, 2525).
In July 2021, Dr. Jones wrote that Plaintiff was “doing quite a bit better” and she
felt her anxiety was “well-controlled” (Tr. 2041). She wanted to continue the current
medication regime and did not want to taper the suboxone dosage or discontinue the

Xanax (Id.). Notes from Plaintiff’s counselor similarly indicate that Plaintiff was “doing
much better mentally and emotionally” (Tr. 2499; see also Tr. 2503–04, 2509). The situation
with DCFS had been resolved in her favor, resulting in her being a lot less stressed every
day, in a better mood, with improved functioning levels (Tr. 2503–04).
Plaintiff continued doing well into the fall. She told Dr. Jones in September 2021
that “her anxiety is doing well. Things are going well with her family. Overall she feels

she is doing the best she has done in a long time” (Tr. 2600). Plaintiff’s counselor wrote
that her continued sobriety had led to improvements in her mood, functioning, and
overall happiness (Tr. 2480–81). A care plan from October 2021 indicates that although
Plaintiff’s anxiety was “still really high” and she still experienced PTSD triggers, she was
“doing a lot better” thanks to counseling (Tr. 2327, 2330). As for her substance abuse
problems, Plaintiff was stable in the MAT program on suboxone (Tr. 2324). Her counselor

continued to assess her as “moderately” and “markedly” symptomatic but also “much
improved” since she started treatment at Centerstone (Tr. 2447, 2458, 2465, 2481–82).
Dr. Jones’s notes through the end of 2021 and the beginning of 2022 indicate that
while Plaintiff had moments of feeling depressed or very stressed (e.g., Tr. 2615), she was
generally doing “okay” and managing her mental health with medication and counseling

(Tr. 2615, 2627, 2635).
At the hearing in March 2022, the ALJ asked Plaintiff what problems she was
having that impeded her ability to work (Tr. 37). Plaintiff responded that she is extremely
hypervigilant and startled easily (Tr. 37, 43–44). Her anxiety makes her nauseous and
completely overwhelmed by simple things, like checking her mailbox or filling out

paperwork (Tr. 37, 38). She said most days she stays in bed and tries to sleep longer to
avoid her anxiety (Tr. 37), which echoed what her grandfather had previously said.
Plaintiff also said “everything’s scattered” and her brain “goes about 20 different
directions” (Id.). When she tries to focus on a thought, about twenty more come at her
(Id.). Due to the trauma she’s experienced in her life, she is highly sensitive to raised
voices and people “getting offensive” or even talking in a stern voice (Id.). And she

constantly questions herself—whether she’s good enough, whether she’s overstepping
bounds, whether she made the right decision, whether she’s doing something wrong, etc.
(Tr. 38). Plaintiff also said that she has panic attacks, including a “big one” every couple
weeks, where she either throws up or passes out (Tr. 43).
The ALJ then asked Plaintiff what her typical day looked like (Tr. 39). Plaintiff said
she gets up and helps her daughter get ready for school (Id.). Once her daughter leaves,

she lays back down and tries to go back to sleep to avoid feeling her anxiety (Id.). She
makes meals for herself and her daughter, although her anxiety is so bad that she usually
cannot eat anything until about 3:00 in the afternoon (Tr. 39–40). She does housework but
her sister sometimes helps (Tr. 40). She does her own grocery shopping but not without
difficulty remembering what she needs, keeping track of her list, etc. (Id.). It usually takes

her three or four trips before she finally has everything she needs (Id.).
Plaintiff testified that for a while she would go to the gym for exercise, but after a
while “it was like I couldn’t force myself to get up and do it anymore” (Tr. 40–41). She
said it is really hard for her to keep any kind of routine, even if it is just getting out of the
house for a bit everyday (Tr. 41). She does not have any friends, and she described herself

as “extremely isolated” (Tr. 41, 42). She spends most of her time “alone, and quiet, with
Netflix” (Id.). Sometimes she scrolls Facebook because it’s a good escape from reality (Id.).
Once Plaintiff was finished testifying, the ALJ questioned the vocational expert
(“VE”) about jobs a hypothetical claimant with limitations similar to Plaintiff could
perform (Tr. 46–49). The ALJ began by asking whether jobs existed for a hypothetical
claimant who:

Was able to perform the full range of work with no exertional limitations .
. . [but was] limited to being able to understand, remember, and carry out
simple instructions for simple tasks on a sustained basis, in a predictable,
routine work setting, requiring no more than occasional brief interactions
with coworkers, supervisors, and the general public for purposes of
performing simple work tasks, and where social interaction is largely task-
specific, as opposed to collaborative.

(Tr. 46–47). The ALJ indicated that jobs existed for such a person, such as floor waxer,
industrial cleaner, and marker (Tr. 47). The same three jobs would remain even if the
hypothetical person had a greater social restriction and could tolerate no more than
incidental interaction with the general public (Tr. 48). But if the hypothetical person
would be off task approximately 15 percent of the workday, or absent from work three
or more days per month, on a sustained basis, then they were unemployable (Id.).
THE ALJ’S DECISION
To qualify for DIB or SSI, a claimant must prove that they became disabled within
the meaning of the applicable statutes and regulations. 42 U.S.C. § 423(a)(1); 42 U.S.C. §
1382(a)(1); 20 C.F.R. §§ 404.315, 416.202.8 Under the Social Security Act, a person is
disabled if she has an “inability to engage in any substantial gainful activity by reason of
any medically determinable physical or mental impairment which can be expected to

8 The statutes and regulations pertaining to DIB are found at 42 U.S.C. § 423, et seq., and 20 C.F.R. pt. 404.
The statutes and regulations pertaining to SSI are found at 42 U.S.C. §§ 1382 and 1382c, et seq., and 20 C.F.R.
pt. 416. As is relevant to this case, the DIB and SSI statutes and regulations are identical. Furthermore, 20
C.F.R. § 416.925 detailing medical considerations relevant to an SSI claim, relies on 20 C.F.R. Pt. 404, Subpt.
P, of the DIB regulations. Most citations herein are to the DIB statutes and regulations out of convenience.
result in death or which has lasted or can be expected to last for a continuous period of
not less than twelve months.” 42 U.S.C. § 423(d)(1)(a).

Here, ALJ Martin followed the familiar five-step sequential analysis to determine
that Plaintiff was not disabled (Tr. 13–24). See 20 C.F.R. §§ 404.1520 (evaluation of
disability in general); Butler v. Kijakazi, 4 F.4th 498, 501 (7th Cir. 2021) (describing the five
steps). At step one, the ALJ determined that Plaintiff had not engaged in substantial
gainful activity since her alleged onset date of June 1, 2013 (Tr. 13, 15). At step two, the
ALJ found that Plaintiff’s severe impairments included generalized anxiety disorder,

posttraumatic stress disorder, major depressive disorder, bipolar disorder, borderline
personality disorder, and substance abuse (Tr. 15).
At step three, the ALJ determined that none of Plaintiff’s impairments, either alone
or in combination, met or medically equaled a listed impairment,9 however, Plaintiff had
“moderate limitations” in all four areas of mental functioning used in a work setting: (1)

understanding, remembering, or applying information; (2) interacting with others; (3)
concentrating, persisting, or maintaining pace; and (4) adapting or managing oneself (Tr.
16–17). See 20 C.F.R. § 404.1520a(c); 20 C.F.R. Pt. 404, Subpt. P, App. 1, Pt. A2, §
12.00(A)(2)(b).
The ALJ then assessed Plaintiff’s residual functional capacity (“RFC”) and found

that, despite her limitations and psychiatric impairments, Plaintiff retained the ability to

9 The ALJ considered Listing 12.04 for depressive, bipolar and related disorders, 12.06 for anxiety and
obsessive-compulsive disorders, 12.08 for personality and impulse-control disorders, and 12.15 for trauma-
and stressor-related disorders (Tr. 16). 20 C.F.R. Pt. 404, Subpt. P, App. 1, Pt. A2, §§ 12.00(B)(3), (5), (7), (11);
12.04; 12.06; 12.08; 12.15.
perform a full range of work at all exertional levels except that she was limited to “simple
tasks on a sustained basis in a predictable, routine work setting” with only occasional,

brief, and largely task-specific interactions with co-workers, supervisors, and the general
public for purposes of performing simple work tasks (Tr. 17).
At step four, the ALJ concluded that based on her RFC, Plaintiff could no longer
perform any of her past relevant work as a fast-food worker (Tr. 22). At step five, the ALJ
determined that, based on the testimony of the VE, there were jobs that Plaintiff could
have performed, including floor waxer, industrial cleaner, and marker (Tr. 23). Therefore,

Plaintiff was not disabled.
ISSUES RAISED BY PLAINTIFF
1. Whether the ALJ erred by failing to account for Plaintiff’s moderate
limitations in concentration, persistence, and pace when assessing her RFC?

2. Whether the ALJ erred by failing to account for the moderate “check-box”
limitations found by the State Agency reviewing psychologists in accepting
instruction and responding appropriately to criticism?

3. Whether the ALJ erred by providing inadequate reasons for discounting
Plaintiff’s subjective statements about her symptoms, particularly when it
came to her daily activities?

DISCUSSION
The scope of judicial review is limited to determining whether the ALJ applied the
correct legal standard in reaching their decision, whether the ALJ’s decision is supported
by substantial evidence, and whether the ALJ “buil[t] an accurate and logical bridge from
the evidence to [their] conclusion” that the claimant is not disabled. Jeske v. Saul, 955 F.3d
583, 587 (7th Cir. 2020) (internal citations omitted). In other words, "the ALJ must explain
[their] decision in such a way that allows [the court] to determine whether [they] reached
[their] decision in a rational manner, logically based on [their] specific findings and the

evidence in the record.” McKinzey v. Astrue, 641 F.3d 884, 890 (7th Cir. 2011). The court
reviews the entire administrative record but does not reweigh evidence, resolve conflicts,
decide questions of credibility, or substitute its own judgment for that of the ALJ. Deborah
M. v. Saul, 994 F.3d 785, 788 (7th Cir. 2021). The ALJ’s decision will be reversed “only if
the record compels a contrary result.” Deborah M., 994 F.3d at 788 (internal quotation
marks and citation omitted).

All of Plaintiff’s arguments relate to the ALJ’s formulation of her RFC. A claimant's
RFC is “the maximum that a claimant can still do despite [their] mental and physical
limitations.” Craft v. Astrue, 539 F.3d 668, 675–76 (7th Cir. 2008) (citing 20 C.F.R. §
404.1545(a)(1)). The ALJ must determine the claimant’s RFC based on “all the relevant
evidence in [the] case record,” which includes objective medical evidence, statements

from medical sources, the claimant’s own statements about symptoms and limitations,
and statements from non-medical sources, like family, friends, neighbors, etc. 20 C.F.R. §
404.1545(a)(1), (3); see also Craft, 539 F.3d at 676; Social Security Ruling 96-5p, 1996 WL
374183, at *5 (July 2, 1996). And the ALJ must explain how the RFC accounts for and
accommodates the claimant’s limitations and how the evidence in the record supports

the RFC. See Martin v. Saul, 950 F.3d 369, 374 (7th Cir. 2020) (“[T]he ALJ must account for
the totality of a claimant's limitations in determining the proper RFC.”) (internal
quotation marks and citation omitted); Ghiselli v. Colvin, 837 F.3d 771, 779 (7th Cir. 2016)
(ALJ must “build a logical bridge from the medical evidence to its conclusions regarding
. . . [any] limitation attendant to its residual functional capacity determinations.”); Scott
v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011) (ALJ must “explain how she reached her

conclusions about [claimant’s] physical [and/or mental] capabilities.”) (citation omitted);
Social Security Ruling 96-8p (“SSR 96-8p”), 1996 WL 374184, at *7 (July 2, 1996) (“The RFC
assessment must include a narrative discussion describing how the evidence supports
each conclusion . . . .”).
“[A]lthough an ALJ does not need to discuss every piece of evidence in the record,
the ALJ may not analyze only the evidence supporting her ultimate conclusion while

ignoring the evidence that undermines it. The ALJ must confront the evidence that does
not support her conclusion and explain why that evidence was rejected.” Moore v. Colvin,
743 F.3d 1118, 1123 (7th Cir. 2014). See also SSR 96-8p, 1996 WL 374184, at *7.
A. Failure to Account for Moderate Limitation in Concentration, Persistence, and Pace

Plaintiff first argues that neither the hypothetical the ALJ posed to the VE nor the
ALJ’s RFC determination properly accounted for her moderate limitations in
concentration, persistence, and/or pace (Doc. 19, pp. 8–11). She contends that the
evidence shows she requires additional off-task time or unscheduled breaks, but the ALJ
rejected such a restriction without a sufficient explanation or properly considering the
evidence in the record (Id.). The Court agrees.

Concentration, persistence, or pace “refers to the abilities to focus attention on
work activities and stay on task at a sustained rate.” 20 C.F.R. Pt. 404, Subpt. P, App. 1,
Pt. A2, § 12.00(E)(3). This area of mental functioning includes, for example, “performing
a task that you understand and know how to do; working at an appropriate and
consistent pace; completing tasks in a timely manner; ignoring or avoiding distractions
while working; . . . sustaining an ordinary routine and regular attendance at work;

and working a full day without needing more than the allotted number or length of rest
periods during the day.” Id.
As a general rule, both the hypothetical posed to the VE and the RFC assessment
“must account for the ‘totality of a claimant’s limitations,’” including even moderate
limitations in concentration, persistence, or pace. Martin, 950 F.3d at 374 (citing Moreno v.
Berryhill, 882 F.3d 722, 730 (7th Cir. 2018)); Lothridge v. Saul, 984 F.3d 1227, 1233 (7th Cir.

2021) (quoting Crump v. Saul, 932 F.3d 567, 570 (7th Cir. 2019)). When posing
hypotheticals to the VE, “as a matter of form,” the ALJ need not use the precise phrase
"concentration, persistence and pace.” Crump, 932 F.3d at 570 (“[T]here is no magic words
requirement.”). But “[a]s a matter of substance . . . the ALJ must ensure that the VE is
‘apprised fully of the claimant’s limitations’ so that the VE can exclude those jobs that the

claimant would be unable to perform.” Id. (quoting Moreno, 882 F.3d at 730). The “best”
and “most effective” way to ensure that the VE knows the full extent of a claimant’s
limitations in concentration, persistence, and pace is to expressly include the limitation
in the hypothetical, but again, there is no firm requirement that the ALJ do so. Crump, 932
F.3d at 570 (citing Moreno, 882 F.3d at 730); O'Connor-Spinner v. Astrue, 627 F.3d 614, 619

(7th Cir. 2010). When it comes to the RFC finding, the Seventh Circuit has likewise
emphasized that “the ALJ generally may not rely on catch-all terms like ‘simple,
repetitive tasks’ because there is no basis to conclude that they account for problems of
concentration, persistence, or pace.” Crump, 932 F.3d at 570.
Here, at Step Three, the ALJ determined that Plaintiff’s mental impairments
caused moderate limitations in concentration, persistence, and pace (Tr. 16). In particular,

“[t]he record revealed that [Plaintiff] had demonstrated difficulties with the ability to
focus.” (Id.). The ALJ also found the state agency reviewing psychologists’ findings
“generally persuasive,” including that Plaintiff was moderately limited in her ability to
maintain concentration for extended periods as well as her ability to complete a normal
workday/week without interruptions from her symptoms and to work at a consistent
pace without taking additional breaks (Tr. 22; see also Tr. 64, 101). The ALJ seemed to

account for Plaintiff’s problems with concentration, persistence, and pace in the third
hypothetical when he asked the VE to consider a person who would be off task for 15%
of the workday (Tr. 48).10 See Winsted v. Berryhill, 923 F.3d 472, 477 (7th Cir. 2019). The VE
responded that the individual would not be able to sustain employment. But the ALJ did
not reference this opinion in his decision or impose any corresponding concession for

being off-task or taking extra breaks (see Tr. 17–22).
Rather, the ALJ’s decision relies on the first hypothetical, which asked about the
availability of work for someone who could perform “simple tasks” in “a predictable,
routine work setting” with only occasional, brief, task-oriented interactions with others
(see Tr. 17; Tr. 46–47). But the Seventh Circuit has repeatedly explained that in most cases

these exact specifications—simple, routine tasks with limited interactions with others—
will not adequately account for problems with concentration, persistence, and pace.

10 It is unclear to the Court, however how the ALJ came up with the 15% figure. See Lanigan 865 F3d at 563.
Winsted, 923 F.3d at 477 (citing O’Connor-Spinner, 627 F.3d at 620). Accord DeCamp v.
Berryhill, 916 F.3d 671, 676 (7th Cir. 2019) (“[W]e have ‘repeatedly rejected the notion that

. . . confining the claimant to simple, routine tasks and limited interactions with others
adequately captures temperamental deficiencies and limitations in concentration,
persistence, and pace.’”) (quoting Yurt v. Colvin, 758 F.3d 850, 858–59 (7th Cir. 2014)).
By way of explanation, the term “simple tasks” refers to “unskilled work,”
meaning tasks that that are not complex and do not take long to learn. Martin, 950 F.3d at
373; Varga v. Colvin, 794 F.3d 809, 814 (7th Cir. 2015); 20 C.F.R. § 404.1568 (“Unskilled

work is work which needs little or no judgment to do simple duties that can be learned
on the job in a short period of time[,]” usually within 30 days). But “the relative difficulty
of a specific job assignment does not necessarily correlate with a claimant's ability to stay
on task . . . .” Martin, 950 F.3d at 373. As the Seventh Circuit has “repeatedly cautioned . .
. ‘someone with problems concentrating might not be able to complete a task consistently

over the course of a workday, no matter how simple it may be.’” Lothridge, 984 F.3d at
1233 (quoting Martin, 950 F.3d at 373–74 (collecting cases)).11
Additionally, a “routine work setting” (meaning a workplace with few, if any,
changes) and minimal social interactions are restrictions that “dea[l] largely with
workplace adaptation, rather than concentration, pace, or persistence.” Varga, 794 F.3d at

11 Accord Crump, 932 F.3d at 570 (“observing that a person can perform simple and repetitive tasks says
nothing about whether the individual can do so on a sustained basis . . . over the course of a standard eight-
hour work shift.”); Mischler v. Berryhill, 766 Fed. Appx. 369, 376 (7th Cir. 2019) (“A task can be simple, but
a person with a poor attention span may still become distracted and stop working.”); O'Connor-Spinner,
627 F.3d at 620 (“The ability to stick with a given task over a sustained period is not the same as the ability
to learn how to do tasks of a given complexity.”).
815. See also Radosevich v. Berryhill, 759 Fed. Appx. 492, 494 (7th Cir. 2019) (restriction to
“few, if any, workplace changes” reflected claimant’s abilities to cope with changes); Yurt,

758 F.3d at 855, 859 (limitation regarding number and scope of social interactions
accounted for claimant’s difficulties in social functioning); Hofslien v. Barnhart, 172 Fed.
Appx. 116, 120 (7th Cir. 2006) (limiting social contact with supervisors, co-workers, and
the public “reflected [claimant’s] moderate restrictions in social functioning”).
In this instance, the ALJ did not articulate how limiting Plaintiff to simple tasks in
a routine setting with limited social interaction correlates with, or was meant to

accommodate, Plaintiff’s particular problems with concentration, persistence, or pace (see
Tr. 17–22). Nor is it readily apparent to the Court. It is not as if the record shows Plaintiff
only struggled to focus in response to situational stressors, like being faced with a
complex task or being around other people.12 The ALJ also did not indicate how the
evidence supported his belief that Plaintiff was able to stay on task at a sustained pace

for at least 85% of the workday and did not need additional off-task time or unscheduled
breaks (see id.). Absent from the ALJ’s decision is any explanation as to how a person with
Plaintiff’s acknowledged problems in concentration, persistence, and pace could perform

12 But see Bruno v. Saul, 817 Fed. Appx. 238, 242 (7th Cir. 2020) (holding RFC finding and hypothetical
limiting claimant to simple routine tasks and simple work-related decisions accounted for CPP problems
where the evidence showed claimant struggled to concentrate only when the assignment at hand was
complex); Jozefyk v. Berryhill, 923 F.3d 492, 498 (7th Cir. 2019) (holding hypothetical restricting claimant to
simple, routine, repetitive tasks with limited social interaction adequately accounted for CPP limitations
because medical evidence showed claimant’s psychological “impairments surface only when he [was] with
other people or in a crowd”). See also Winsted, 923 F.3d at 477 (court unable to say RFC minimizing social
interaction accounted for CPP difficulties where evidence showed claimant experienced symptoms even
when he was not around other people).
at the level described in the RFC (see Tr. 17–22). Accordingly, the ALJ did not sufficiently
connect the dots between the RFC he found and the deficits that he also acknowledged,

which leaves the Court unable to assess the validity of the ALJ’s ultimate finding.
Furthermore, because the flawed RFC was used as the basis for the first
hypothetical question to the VE, it is not clear that the VE’s testimony is reliable. The first
hypothetical question did not explicitly note that Plaintiff was moderately limited in
concentration, persistence, and pace. Nor did it describe Plaintiff’s underlying mental
conditions13 or use any alternative terminology or phrasing that could have accounted

for Plaintiff’s limitation.14 And there is no evidence that the VE had reviewed Plaintiff’s
medical records or was otherwise familiar with Plaintiff’s specific limitations. 15

13 See O'Connor-Spinner, 627 F.3d at 620 (ALJ excused from explicitly mentioning CPP limitations when
hypothetical describes claimant’s underlying mental conditions, and it is apparent and obvious those
conditions would cause CPP limitations). See also Simila v. Astrue, 573 F.3d 503, 521–22 (7th Cir. 2009)
(approving of hypothetical that omitted specific mention of CPP limitations because it stated that claimant
suffered from chronic pain syndrome and somatoform disorder, which obviously caused pain, and pain
was the root of claimant’s CPP problems).

14 See Lanigan v. Berryhill, 865 F.3d 558, 565 (7th Cir. 2017) (ALJ excused from explicitly addressing CPP
limitations when hypothetical otherwise accounts for the limitations with different terminology);
O'Connor-Spinner, 627 F.3d at 619 (“We also have let stand an ALJ's hypothetical omitting the terms
‘concentration, persistence and pace’ when it was manifest that the ALJ's alternative phrasing specifically
excluded those tasks that someone with the claimant's limitations would be unable to perform.”). See also
Winsted, 923 F.3d at 477 (explaining hypothetical about individual who would be off task 20% of workday
or would have two unscheduled absences per month seemingly “ha[d] in mind someone with ‘moderate
difficulties with concentration, persistence, and pace.’”); Sims v. Barnhart, 309 F.3d 424, 427, 431–32 (7th Cir.
2002) (finding VE's inquiry into low-stress, uncomplicated work accounted for limitations arising partly
from panic disorder); Johansen v. Barnhart, 314 F.3d 283, 285, 288–89 (7th Cir. 2002) (approving of
hypothetical limiting claimant to “repetitive, low-stress” work because that description excluded positions
likely to trigger symptoms of the panic disorder at the root of the claimant's moderate CPP limitations).

15 See Lanigan, 865 F.3d at 565 (ALJ excused from explicitly addressing CPP limitations in hypothetical when
VE has independently reviewed claimant’s medical record or heard testimony about their limitations). But
see O'Connor-Spinner, 627 F.3d at 619 (noting “[t]his exception to the general rule . . . does not apply where
. . . the ALJ poses a series of increasingly restrictive hypotheticals to the VE, because in such cases we infer
that the VE's attention is focused on the hypotheticals and not on the record.”).
Consequently, the Court cannot say whether the VE’s response to the first hypothetical
took into account Plaintiff’s limitations in concentration, persistence, or pace and

eliminated positions that she would be unable to perform. In other words, the Court is
not assured that the VE’s testimony constitutes substantial evidence of the jobs Plaintiff
could do. Therefore, the conclusion that Plaintiff could perform other work in the
economy cannot stand. O'Connor-Spinner, 627 F.3d at 620. See Crump, 932 F.3d at 570–71
(reversing where ALJ’s RFC assessment was rooted in hypothetical that “asked only
about the availability of work for someone who could perform simple, repetitive tasks

without incorporating any CPP limitations”); Winsted, 923 F.3d at 477 (same).
The Commissioner contends that the hypothetical and mental RFC were tied to
the evidence in the record—specifically medical records and the state agency reviewing
psychologists’ opinions—thereby suggesting that the ALJ’s decision was supported by
substantial evidence (Doc. 25, p. 5). However, the Court is not persuaded.

With respect to the medical records, the ALJ’s decision recites information from
the records, but it does not articulate how the records supported the ultimate
determination that Plaintiff could stay on task for an entire workday. Furthermore, only
a select portion of the records are summarized; the ALJ did not engage with large swaths
of records that would seem to undermine the conclusion that Plaintiff could stay on task

for an entire workday (see Tr. 17–22). See Lothridge, 984 F.3d at 1234 (“An ALJ need not
address every piece of evidence, but she may not ignore entire swaths of it that point
toward a finding of disability.”) (citation omitted).
To begin with, the ALJ’s discussion of Plaintiff’s medical records began with her
psychiatric hospitalization in April 2016 (see Tr. 18–22), but her alleged disability onset
date was almost three years prior. The ALJ did not engage with any of the records from

this time period from Plaintiff’s counselor at Centerstone or her primary care physician
(see Tr. 13–24). Nor is there any mention of Plaintiff’s treatment records from Centerstone
in March 2017 (see id.). All of these records contain significant information regarding
Plaintiff’s mental health issues. See supra pp. 3–6, 7–9.
With respect to Plaintiff’s psychiatric records from prison, the ALJ only discussed
the final treatment note before Plaintiff’s release from prison, when her mental status

exam was largely normal (Tr. 20; see Tr. 451–57). He did not mention any of the other
notes from Plaintiff’s (at least) eight-month course of mental health treatment, which
describe Plaintiff’s impaired mental functioning. See Larson v. Astrue, 615 F.3d 744, 751
(7th Cir. 2010) (having “symptoms that ‘wax and wane’ [is] not inconsistent with a
diagnosis of recurrent, major depression”); Bauer v. Astrue, 532 F.3d 606, 609 (7th Cir.

2008) (a claimant with a chronic disease like bipolar disorder “is likely to have better days
and worse days”); Kangail v. Barnhart, 454 F.3d 627, 629 (7th Cir. 2006) (a patient's normal
behavior during office visit does not contradict a finding of severe mental illness).
Dr. Michael Blaine prescribed Plaintiff psychotropic medications for almost two
years; but the ALJ’s decision only mentions one note from Dr. Blaine that ultimately said

very little about Plaintiff’s mental health (Tr. 20; see Tr. 534–37; see also Tr. 530–75). The
record also indicates that Plaintiff treated with a counselor at Centerstone following her
release from prison for three-and-a-half years. However, the ALJ’s decision only
discusses two records from those years of treatment notes and the two records discussed
provided little information about Plaintiff’s mental health over the course of her
treatment at Centerstone (see Tr. 17–22).

Many of the records the ALJ did not engage with appear to support Plaintiff’s
contention that she has serious trouble concentrating and remaining on task. They show
she consistently reported symptoms, including but not limited to, hypervigilance and
being easily startled; racing, scattered, and intrusive thoughts; being easily overwhelmed;
panic attacks; diminished interest in activities; and lack of motivation (e.g., Tr. 331, 333,
359, 371, 486, 503, 509, 513–14, 683, 753, 853, 858, 1005, 1624). Providers likewise

consistently observed signs such as emotional instability; anxiousness; sad or depressed
mood; distant or preoccupied mood; frustrated, angry, irritable mood; tearfulness;
psychomotor agitation; rapid speech; and extreme talkativeness (e.g., Tr. 505, 507, 509,
853, 858, 869, 890, 909, 918, 1005, 1026, 1041, 1625, 2033). And there were times where
Plaintiff could not stay focused and/or engaged for an entire appointment (e.g., Tr. 853,

1047, 1077, 1487, 1781). The ALJ’s decision did not meaningfully engage with this
evidence or reconcile it with the ultimate conclusion that Plaintiff did not require
flexibility for off-task time or unscheduled breaks. See Moore, 743 F.3d at 1123 (ALJ “must
confront the evidence that does not support her conclusion and explain why that
evidence was rejected.”).

As for the state agency reviewing psychologists’ opinions, the Commissioner
claimed the ALJ “considered” these opinions and then merely recited what the ALJ had
to say about them (Doc. 25, p. 7; see also Tr. 22). The Commissioner did not develop any
argument or cite to any case law (see Doc. 25, p. 7). Accordingly, the Court considers the
Commissioner to have waived any argument that the agency psychologists’ opinions
constitute substantial evidence sufficient to uphold the RFC assessment.

However, for the sake of completeness, the Court will briefly discuss the issues
regarding these opinions. Both of the agency psychologists opined that Plaintiff was
moderately limited in her ability to maintain attention and concentration for extended
periods (Tr. 64, 101). The agency psychologist at the reconsideration level also opined
that Plaintiff was moderately limited in her ability to complete a normal
workday/workweek without interruption from her psychological symptoms and to

perform at a consistent pace without needing additional breaks (Tr. 101). Despite
identifying these “check-box” limitations for Plaintiff, neither psychologist imposed any
restriction related to time off-task or extra breaks in their narrative RFC assessments (Tr.
64-66, 101-02). And neither psychologist provided a cogent explanation as to why such a
restriction was not needed (see id.). Consequently, the Court cannot say that the

psychologists’ narrative assessments are consistent with their check-box limitations, as
the Commissioner contends (Doc. 25, p. 8). See Varga, 794 F.3d at 816 (“ALJ may rely on
a doctor's narrative RFC, rather than the checkboxes, where that narrative adequately
encapsulates and translates those worksheet observations.”). The ALJ’s decision, which
seemed to accept the state agency psychologists’ opinions that Plaintiff can work at a

sustained pace for an entire workday as true, did not articulate why a restriction related
to time off-task or extra breaks was not necessary.
Even if it was acceptable for the ALJ to rely on the agency psychologists’ narrative
explanations in formulating Plaintiff’s RFC, when it came to posing hypotheticals to the
VE, the ALJ was still required to “adequately account for limitations identified . . . in [the]
check-box sections of standardized forms . . . .” DeCamp, 916 F.3d at 676 (citing Yurt, 758

F.3d at 859). But the first hypothetical posed to the VE incorporated only the limitations
expressly contained in the agency psychologists’ narratives and did not give the VE any
basis to evaluate Plaintiff’s impairments in concentration, persistence, and pace identified
in the “check box” portion of the forms, which warrants reversal. DeCamp, 916 F.3d at
676; Yurt, 758 F.3d at 859. See also Kasarsky v. Barnhart, 335 F.3d 539, 543 (7th Cir. 2003)
(“[T]o the extent the ALJ relies on testimony from a vocational expert, the question posed

to the expert must incorporate all relevant limitations from which the claimant suffers.”).
In sum, for all of the reasons outlined above, the ALJ’s assessment of Plaintiff’s
RFC falls short. The ALJ’s determination that jobs existed that Plaintiff could perform
likewise falls short because it relied on the VE’s response to the first hypothetical
question, which was based on the flawed RFC. Consequently, the Court concludes that

ALJ’s decision finding that Plaintiff was not disabled is not supported by sufficient
explanation or substantial evidence, and therefore must be reversed.
Although the Court need not explore in detail the remaining errors claimed by
Plaintiff, the Court will briefly discuss Plaintiff’s arguments.
B. Social Limitations Pertaining to Supervisors

In Plaintiff’s second argument, she claims that the ALJ failed to account for her
moderate limitations in accepting instructions and responding appropriately to criticism
from supervisors (Doc. 19, pp. 11–14). Specifically, both of the state agency reviewing
psychologists opined that Plaintiff was moderately limited in her ability to accept
instructions and respond appropriately to criticism from supervisors (Tr. 65, 93).

It seems as though the ALJ credited these opinions, and the ALJ imposed “more
specific social limitations” than either agency psychologist advocated for (Tr. 22), namely
that he restricted Plaintiff to occasional, brief, task-oriented interactions with supervisors
(as well as coworkers and the general public) (Tr. 17). But there is no explanation as to
how these restrictions actually accounted for and accommodated Plaintiff’s limitations in
accepting instructions and responding appropriately to criticism (see Tr. 17–22). And it is

not clear that they do; as Plaintiff said, it is entirely possible that even “occasional” and
“brief” interactions with supervisors would include some element of instruction or
criticism to which she would respond poorly (Doc. 28, p. 6). This omission is important
because “[a]s the Commissioner has explained before, even a moderate limitation on
responding appropriately to supervisors may undermine seriously a claimant's ability to

work.” O'Connor-Spinner, 627 F.3d at 621 (citing 20 C.F.R. § 404.1545(c)). See also Social
Security Ruling 85-15, 1985 WL 56857, at *6 (Jan. 1, 1985) (“[A]n individual who cannot
tolerate being supervised may not be able to work even in the absence of close
supervision; the knowledge that one's work is being judged and evaluated, even when the
supervision is remote or indirect, can be intolerable for some mentally impaired

persons.”).
Accordingly, the Court encourages the ALJ to clarify his position on remand,
although the omission, standing alone, might not have supported a remand.
C. Evaluation of Plaintiff’s Subjective Statements About Her Symptoms
In his written decision, the ALJ indicated that he believed Plaintiff’s psychological
impairments caused a variety of symptoms, but he thought that Plaintiff’s “statements

concerning the intensity, persistence, and limiting effects of these symptoms [were] not
entirely consistent with the medical evidence and other evidence in the record” (Tr. 18).
In other words, the ALJ did not believe Plaintiff’s symptoms were as bad as she said they
were. Plaintiff claims that the ALJ erred by not adequately explaining his reasons for
discounting her statements about her symptoms, particularly when it came to her daily
activities (Doc. 19, p. 14).

Once the ALJ has determined there is an underlying mental impairment that could
reasonably be expected to produce an individual's symptoms, the ALJ must then evaluate
the intensity and persistence of those symptoms to determine the extent to which they
limit the claimant’s ability to perform work-related activities. Social Security Ruling 16-
3p (“SSR 16-3p”), 2017 WL 5180304, at *4, 5 (Oct. 25, 2017); 20 C.F.R. 404.1529(c)(1). In

doing so, the ALJ must examine the entire case record, beginning with the objective medical
evidence. SSR 16-3p, 2017 WL 5180304, at *4, 5; 20 C.F.R. 404.1529(c)(1), (2), (3). If the
objective medical evidence does not fully substantiate the claimant’s subjective
statements about the severity of their symptoms, then the ALJ must consider whether the
claimant’s statements are consistent with the other medical and non-medical evidence in

the record, particularly as it relates to the claimant’s daily activities; the duration,
frequency, and intensity of the claimant’s symptoms; things that precipitate or aggravate
the symptoms; the claimant’s medications; and other treatments or measures used to
alleviate the symptoms. SSR 16-3p, 2017 WL 5180304, at *6–7, 7–8; 20 CFR 404.1529(c)(3).
An ALJ's findings concerning the intensity, persistence, and limiting effects of a
claimant's symptoms must be explained sufficiently and supported by substantial

evidence. Curvin v. Colvin, 778 F.3d 645, 651 (7th Cir. 2015); Terry v. Astrue, 580 F.3d 471,
477 (7th Cir. 2009). So long as the ALJ issues a reasoned explanation, the credibility
determination is afforded “considerable deference” and will be overturned only if it is
“patently wrong.” Ray v. Berryhill, 915 F.3d 486, 490 (7th Cir. 2019) (quoting Terry, 580
F.3d at 477). See also Getch v. Astrue, 539 F.3d 473, 483 (7th Cir. 2008) (“Reviewing courts .
. . should rarely disturb an ALJ's credibility determination, unless that finding is

unreasonable or unsupported.”). “Patently wrong is a high threshold—'only when the
ALJ's determination lacks any explanation or support . . . will [we] declare it to be patently
wrong and deserving of reversal.’” Ray v. Saul, 861 Fed. Appx. 102, 107 (7th Cir. 2021)
(quoting Elder v. Astrue, 529 F.3d 408, 413–14 (7th Cir. 2008)).
The Court agrees with Plaintiff that the ALJ did not sufficiently explain his reasons

for discounting her statements about her symptoms. As an initial matter, the Court is
unsure which of Plaintiff’s statements the ALJ was using as his basis for comparison.
There is little reference to her testimony in the decision; it simply notes that Plaintiff
testified she had previously worked at a steakhouse and as a fast-food worker, and
“alleged significantly limited activities of daily living, due to anxiety” (Tr. 18). The ALJ

also did not provide any comprehensive summary of the symptoms Plaintiff said she
experienced (see Tr. 13–24); there are only scattered references to a couple of her
symptoms (e.g., Tr. 16 (difficulty staying focused); Tr. 19 (panic attacks)).
The ALJ’s decision did not meaningfully explain the determination that Plaintiff’s
reports to physicians, and the physicians’ objective findings, were inconsistent with her
testimony about significant dysfunction (Tr. 18; see Tr. 17–22). The discussion is merely a

recitation of information from Plaintiff’s medical records and does not indicate or explain
which information supports his determination (see Tr. 18–22). While some of it appears
to support his decision, there is plenty that does not. As one example, the ALJ wrote that
“[t]he record revealed that her anxiety was well controlled,”16 but later in the same
paragraph, the ALJ recounted the consultative examiner’s opinion that Plaintiff’s
“anxiety level was far above what was considered to be normal.” (Tr. 18). There is no

explanation from the ALJ why the evidence that tended to show Plaintiff was doing well
outweighed the contrary evidence (see id.). O'Connor-Spinner, 627 F.3d at 621 (“An ALJ
must explain why he does not credit evidence that would support strongly a claim of
disability, or why he concludes that such evidence is outweighed by other evidence.”).
The ALJ’s decision does not discuss the duration, frequency, and intensity of

Plaintiff’s symptoms or the things that triggered her symptoms (see Tr. 17–22). With
regard to Plaintiff’s medications, the ALJ’s decision says only that Plaintiff was “doing
well on medications (i.e., Suboxone)” (Tr. 18). But at the time of the hearing, Plaintiff was
also prescribed Xanax to help with her anxiety and Seroquel to help her sleep at night,

16 The Court notes that the evidence the ALJ cited to in support of his statement that Plaintiff’s anxiety was
well-controlled was 16 pages of records from three appointments with her primary care physician between
late-July 2021 to early-October 2021 (Tr. 18 (citing 12F); see Tr. 2593–2608). But as the Seventh Circuit has
observed, “a person who suffers from a mental illness will have better days and worse days, so a snapshot
of any single moment says little about her overall condition.” See Punzio v. Astrue, 630 F.3d 704, 710 (7th
Cir. 2011). See also Bauer, 532 F.3d at 609 (“A person who has a chronic disease, whether physical or
psychiatric, and is under continuous treatment for it with heavy drugs, is likely to have better days and
worse days . . .” and even if she is well enough to work half of the time, “[t]hen she could not hold down a
full-time job.”).
and she used marijuana (Tr. 39). There is also no recognition that Plaintiff had spent years
cycling through numerous medications at different times and in different combinations

(including venlafaxine, Zoloft, Abilify, Remeron, Ambien, Restoril, Latuda, Depakote,
Ativan, Risperdal, Vistaril, Zyprexa, Lamictal, Prazosin, Tegratol, Klonopin, and
Seroquel) in an attempt to find something that adequately controlled her psychological
symptoms. And the ALJ did not acknowledge the numerous notes where Plaintiff
reported her medications were not working or that she had severe or worsening
symptoms in spite of the medications, sometimes to the point she had to be hospitalized

(see, e.g., Tr. 1625). Thus, there is significant evidence in the record regarding Plaintiff’s
medications that tends to support her contentions, but which the ALJ’s decision does not
confront or reconcile. Mandrell v. Kijakazi, 25 F.4th 514, 518 (7th Cir. 2022). See also SSR 16-
3p, 2017 WL 5180304, at *9 (“Persistent attempts to obtain relief of symptoms, such as
increasing dosages and changing medications, trying a variety of treatments, referrals to

specialists, or changing treatment sources may be an indication that an individual's
symptoms are a source of distress and may show that they are intense and persistent.”).
With respect to other treatment, the ALJ acknowledged that Plaintiff had required
inpatient psychiatric hospitalization on multiple occasions (Tr. 18, 19, 20). He also
acknowledged more than once that Plaintiff was in treatment with three different

counselors on a weekly basis, “which she stated was beneficial” (Tr. 18; see also Tr. 17, 19).
But it is not entirely clear what the ALJ made of Plaintiff’s treatment history as the
decision does not explain whether the ALJ thought it supported or undermined her claim
of disability.
As for her daily activities, the ALJ did not address Plaintiff’s own statements
regarding her daily activities other than to say they were “significantly limited” (Tr. 18).

The ALJ instead relied on the Third-Party Function Report filled out by Plaintiff’s
grandfather, for which he provided the following summary:
[Plaintiff] provided care for her children, showered, dressed herself,
prepared slight meals, and provided assistance with schoolwork. [She] had
no problems attending to her personal needs, preparing meals, and
perform[ing] household chores (i.e., laundry, vacuuming, and cleaning).
[She] shopped in stores and by phone. [She] managed her finances, watched
television, engaged on social media (i.e. Facebook), talked on the phone,
and was in treatment with three different counselors on a weekly basis.

(Tr. 19). The ALJ remarked that “these activities, when viewed in conjunction with the
claimant’s allegations of pain and dysfunction, further belies the persuasiveness of the
claimant’s allegations as the degree of limitation alleged is inconsistent with what is
documented in her treatment records suggested she is more functional than she is
alleging.” (Tr. 19).
From the outset, the above analysis contains several inaccuracies. Plaintiff has only
one child, but there is a reference to “children” and the ALJ references allegations of
“pain,” but Plaintiff did not testify about pain—she alleged disability due to
psychological impairments. But more importantly, the decision does not analyze how
these activities were inconsistent with Plaintiff’s reports of disabling mental symptoms
or why they suggested she was capable of competitive employment (see Tr. 13–24). See
Ghiselli, 837 F.3d at 778 (remanding where the ALJ failed to “identify a basis for his
conclusion that the life activities [the claimant] reported were inconsistent with the
physical impairments she claimed”). As the Seventh Circuit has repeatedly cautioned,
there are “critical differences between activities of daily living and activities in a full-time

job.” E.g., Id. (citation omitted); see also Stark v. Colvin, 813 F.3d 684, 688 (7th Cir. 2016)
(“[A] person performing chores has flexibility in scheduling, can receive help, and is not
held to a minimum standard of performance, unlike an employee.”) And here, there is
simply no explanation as to how Plaintiff’s daily activities undermine her claims of severe
mental health symptoms that prevent her from holding down a full-time job.17
Additionally, the ALJ also overlooked, or did not engage with, the limitations that

Plaintiff had with her daily activities. For example, her grandfather said he and his wife
helped Plaintiff care for her daughter and with general daily activities due to her anxiety
and panic problems. Plaintiff’s counseling records contain statements that she found
parenting her daughter extremely difficult and overwhelming and that she received
significant assistance from her grandparents and aunt in taking care of her daughter. See,

e.g., Craft, 539 F.3d at 680 (remanding because ALJ ignored claimant's qualifications “as
to how he carried out [daily living] activities”).
In sum, the ALJ failed to sufficiently explain and support his decision to discount
Plaintiff’s statements regarding the intensity, persistence, and limiting effects of her
symptoms and likewise failed to account for and reconcile the evidence contrary to his

17 See, e.g., Lanigan, 865 F.3d at 564 (activities like caring for pets and vacuuming the house are “wholly
irrelevant” to competitive employment); Stark, 813 F.3d at 688 (concluding that the claimant's “persistence
in struggling through household chores despite her pain does not mean, as the ALJ extrapolated, that she
can manage the requirements of the work-place”); Hill v. Colvin, 807 F.3d 862, 865, 869 (7th Cir.
2015) (warning against equating the activities of daily living—like babysitting, caring for pets, going to
church, visiting with family members, and doing household chores—with those of a full-time job).
conclusion. These errors had a material effect on the ALJ’s assessments of the Plaintiff’s
symptoms and her RFC, and therefore require reversal.

The Court wants to emphasize, however, that this Order should not be construed
as an indication that it believes the ALJ was required to reach a certain conclusion about
the credibility of Plaintiff’s testimony or the severity of her symptoms, or that Plaintiff is
entitled to benefits. On the contrary, the Court has not formed any opinions in that regard
and leaves those issues to be determined by the Commissioner after further proceedings.
The ALJ’s decision is being reversed because he failed to address all of the evidence and

sufficiently explain his determinations.
CONCLUSION
The Commissioner’s final decision denying Plaintiff Kelly S’s application for social
security Disability Insurance Benefits and Supplemental Security Income benefits is
REVERSED and REMANDED to the Commissioner, pursuant to sentence four of 42

U.S.C. §405(g), for further proceedings consistent with this Order. The Clerk of Court is
directed to enter judgment in favor of Plaintiff.
IT IS SO ORDERED.
DATED: September 30, 2024
s/ Mark A. Beatty
MARK A. BEATTY
United States Magistrate Judge

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10646407. Public record. Not legal advice.