Campbell v. Astrue

In the

United States Court of Appeals

For the Seventh Circuit

No. 10-1314

C URTIS C AMPBELL,

Plaintiff-Appellant,

v.

M ICHAEL J. A STRUE,

Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District Court

for the Northern District of Illinois, Eastern Division.

No. 1:09-cv-01744—John W. Darrah, Judge.

A RGUED S EPTEMBER 9, 2010—D ECIDED D ECEMBER 6, 2010

Before W OOD , E VANS, and T INDER, Circuit Judges.

T INDER, Circuit Judge. Curtis Campbell appeals from

the district court’s judgment upholding the Social

Security Administration’s denial of his application for

disability insurance benefits and supplemental security

income. Campbell contends that the Administrative

Law Judge (“ALJ”) who denied his application erred in

discounting the opinion of his treating psychiatrist and

2 No. 10-1314

in weighing the psychiatric medical evidence. We

reverse the district court’s denial of relief and remand

with instructions to return this matter to the Commis-

sioner.

I. Background

On January 13, 2004, Campbell applied for social

security disability benefits and supplemental security

income. Although Campbell has physical impairments

and limitations, this appeal concerns his mental impair-

ments and limitations.

Campbell has a history of treatment for depression.

On March 13, 2004, Myrtle Mason, M.D., M.P.H., con-

ducted a psychiatric examination of Campbell at the

agency’s request. Campbell indicated that he had been

depressed since 1986, but was not currently being seen

by a mental health professional. He reported that his

primary care physician had prescribed medications for

depression: Zoloft, Lexapro, and Elavil. Dr. Mason con-

cluded that Campbell’s past treatment and hospitaliza-

tions had been mostly for substance abuse, not depres-

sion. Upon examination, Dr. Mason noted that Campbell

was a little guarded intermittently during the interview,

but found no evidence of any perceptual disorder or

disturbance in form or content of thought. She diagnosed

substance induced mood disorder and polysubstance

abuse. Dr. Mason rated Campbell’s current Global Assess-

ment of Functioning (GAF) Scale as 60-75, indicating

at worst some mild symptoms or some difficulty in func-

tioning, but generally functioning pretty well. See Am.

No. 10-1314 3

Psychiatric Ass’n, Diagnostic and Statistical Manual of

Mental Disorders (DSM-IV-TR) 34 (4th ed. 2000).

On April 6, 2004, Kirk Boyenga, Ph.D., a state agency

psychologist, reviewed the record and assessed

Campbell’s mental functional capacity. Boyenga opined

that Campbell was mentally capable of performing

simple and detailed tasks as well as routine and repeti-

tive tasks in settings with reduced interpersonal contact.

In August 2004, state agency psychologist Bronwyn E.

Rains and state agency psychiatrist Glen D. Pittman

reviewed the record and affirmed Dr. Boyenga’s assess-

ment.

On May 7, 2004, Campbell presented at the Community

Mental Health Council, Inc. (“CMHC”), for a mental

health assessment which was conducted by Anne Crowe,

LCPC, a clinical therapist. Campbell reported depression,

decreased sleep, decreased appetite, anhedonia,1 and a

hopeless feeling. He said that he was not active and not

motivated, but denied suicidality. He reported anxiety

and impulsivity as well as auditory and visual hallucina-

tions. He stated that he was going through a divorce

and that he was consuming alcohol daily. Crowe thought

Campbell’s affect was depressed. She recommended

a psychiatric evaluation, medication as needed, case

management services, individual therapy, and a mental

1

Anhedonia is the inability to experience pleasure in acts

that normally produce it. Merriam-Webster, MedlinePlus,

http://www.merriam-webster.com/medlineplus/anhedonia (last

visited Dec. 1, 2010).

4 No. 10-1314

health assessment. That day, a psychiatrist at CMHC also

saw Campbell. His affect was depressed and sad, but

otherwise within normal limits. The clinician diagnosed

Major Depression with psychotic features, history of

polysubstance abuse, current muscle relaxant abuse

and assessed a GAF rating of 40-45, reflecting some

impairment in reality testing or communication or

major impairment in several areas, such as work, judg-

ment, thinking, or mood. See DSMV-IV-TR 34.

On October 19, 2004, CMHC psychiatrist Traci Powell

first evaluated Campbell. She treated him regularly

through the date of the ALJ’s hearing, January 25, 2006,

and thereafter. On mental status exam, Dr. Powell noted

that Campbell had a flat affect, soft voice, fair judgment

and insight, paranoid/suspicious thought, and auditory

hallucinations. Her note states: “Reports using ETOH

[alcohol] on a daily basis and states it helps to calm him.”

Dr. Powell noted that Campbell reported symptoms of

depression and psychosis dating back ten years. She

diagnosed Major Depressive Disorder with psychotic

features and prescribed Paxil to address his depressive

symptoms and Seroquel for psychosis and sleep distur-

bance. Dr. Powell rated Campbell’s GAF at 45-50,

reflecting serious symptoms or serious impairment in

social or occupational functioning, for example, the

inability to keep a job. See DSMV-IV-TR 34.

Campbell did not see Dr. Powell again until January 4,

2005. He reported that the past two months were “terri-

ble” and that he continued to have anxiety attacks.

Dr. Powell noted that “[h]e states his ETOH use has

No. 10-1314 5

increased” and that Campbell reported using drugs once

since his last appointment. On his mental status exam,

Dr. Powell noted that Campbell’s affect was flat, his

thought content was paranoid/suspicious, and he had

auditory hallucinations. Her assessment included that

Campbell “has not been compliant with meds and con-

tinues to use ETOH.” She diagnosed Major Depressive

Disorder with psychotic features and rated him 45-50 on

the GAF Scale, again reflecting serious symptoms or

impairments in functioning. See DSMV-IV-TR 34.

Dr. Powell restarted Campbell’s medications, increasing

the dosage of Seroquel by 200 mg.

Dr. Powell saw Campbell on February 17, 2005. He

stated that things were not going well, but was not forth-

coming about what was happening. He reported using

ETOH a few times per month and denied using illegal

drugs. Based on her exam, Dr. Powell noted that Camp-

bell’s affect was flat, his thought content was para-

noid/suspicious, and he had auditory hallucinations.

She noted that he had not been fully compliant with

his medications and was “using ETOH which is likely

contributing to his presentation today.” Dr. Powell diag-

nosed Major Depressive Disorder with psychotic

features and noted the need to rule out the existence of

a learning disability. His GAF score was 45-50.

On February 22, 2005, Dr. Powell completed a mental

impairment questionnaire, assessing Campbell’s impair-

ments and functional capacity. She diagnosed Major

Depressive Disorder with psychotic features and noted

the need to rule out a learning disability. She identified

6 No. 10-1314

Campbell’s associated symptoms as sleep disturbance,

mood disturbance, anhedonia or pervasive loss of

interests, paranoia or inappropriate suspiciousness,

feelings of guilt/worthlessness, perceptual disturbance,

and flat affect. In her clinical findings, Dr. Powell noted

that Campbell’s speech was hesitant, his affect was flat,

he was positive for paranoia and auditory hallucina-

tions, and his insight and judgment were fair. Dr. Powell

noted that Campbell was not a malingerer. His prog-

nosis was fair. His medications were Seroquel and

Paxil. Dr. Powell indicated that Campbell had fair, poor,

or no ability to perform mental activities required for

even unskilled work. She found that he had the fol-

lowing functional limitations: moderate restriction in

activities of daily living; marked difficulties in main-

taining social functioning; constant deficiencies in con-

centration, persistence or pace; and repeated (three or

more) episodes of deterioration or decompensation.

She again rated his GAF score at 45-50, indicating

serious symptoms or serious impairment in functioning,

see DSM-IV-TR 34, and stated that his highest GAF

rating in the past year was 45-50.

On March 17, 2005, Dr. Powell again saw Campbell who

appeared somewhat dysphoric 2 and said he was dealing

with family stressors. He stated that he was taking

his medication, but estimated he missed it about once

2

Dysphoria is a state of feeling unwell or unhappy. Merriam-

Webster, MedlinePlus, http://www.meriam-webster.com/

medlineplus/dysphoria (last visited Dec. 1, 2010).

No. 10-1314 7

a week. He reported some improvement in symptoms.

The treatment record states that Campell continued to

drink ETOH about once per week. Dr. Powell’s findings

on Campbell’s mental status exam were essentially the

same as on the prior exam. She wrote that Campbell

continued “to have residual symptoms in the context of

ongoing ETOH use.” She rated him 45-50 on the GAF

Scale. Dr. Powell switched one of Campbell’s medica-

tions due to a recall, encouraged compliance, and en-

couraged abstinence from alcohol.

Campbell saw Dr. Powell on April 14, 2005, at which

time he reported mood swings, sleep disturbances, prob-

lems with concentration, auditory hallucinations, crying

spells, feelings of hopelessness, and alcohol use on a

weekly basis. Dr. Powell observed that Campbell re-

ported symptoms suspicious of Bipolar Disorder. She

opined that his continued alcohol use likely exacerbated

his symptoms, and noted that he took extra medication

to combat the symptoms when they worsened. This

time, Dr. Powell diagnosed Major Depressive Disorder

with psychotic features and noted the need to rule

out the existence of Bipolar Disorder with psychotic

features. Campbell again had a 45-50 on the GAF Scale.

Dr. Powell increased Campbell’s medications and en-

couraged abstinence from alcohol.

On May 15, 2005, Campbell had his next appointment

with Dr. Powell. He reported low appetite, worsening of

auditory hallucinations, paranoia, and memory prob-

lems. He did not think the higher dose of one of his

medications was helping. He stated that he continued to

8 No. 10-1314

use alcohol, but his use was very limited. Upon examina-

tion, Dr. Powell noted that Campbell’s affect was flat

and his speech was slow, but he had fair judgment and

insight. She noted that he continued to be symptomatic

despite reported compliance. Dr. Powell’s diagnoses re-

mained the same; she increased his medication and

again encouraged abstinence from alcohol. Campbell’s

GAF score was still 45-50.

When Campbell saw Dr. Powell on June 21, 2005, he

reported continued use of alcohol, but stated that his use

had decreased. He also reported sleep difficulties, poor

energy, auditory hallucinations, and paranoia. Dr. Powell

noted that Campbell had flat affect, tangential thought

process, paranoid/suspicious thought content, auditory

hallucinations, and fair judgment and insight. She ob-

served that his reported symptoms were consistent

with Bipolar Disorder and that his mood symptoms and

psychosis did not appear to be responding to his current

medications. Thus, she changed some of his medications.

Dr. Powell diagnosed Bipolar Disorder with psychotic

features and noted the need to rule out ETOH abuse and

a learning disability. She encouraged compliance and

abstinence from alcohol. Campbell’s GAF score re-

mained 45-50.

On July 6, 2005, Campbell reported to Dr. Powell that

he was experiencing physical pain that was exacerbating

his depressed mood. He claimed he had been com-

pliant with medication. Upon examination, Dr. Powell

indicated that Campbell was cooperative and his motor

activity was normal, his affect was flat, his thought

No. 10-1314 9

process was tangential, he was paranoid/suspicious, and

his memory and insight were fair. She noted that he

was having auditory hallucinations. She also indicated

that Campbell continued to report symptoms consistent

with Bipolar Disorder and that it did not appear that

his mood symptoms and psychosis were responding to

his current medication regimen. She diagnosed Bipolar

Disorder with psychotic features and again noted the

need to rule out ETOH abuse and a learning disability.

Dr. Powell’s notes for that day do not mention

Campbell’s use of alcohol. Campbell remained a 45-50

on the GAF Scale.

The next month, on August 16, 2005, Campbell admitted

to Dr. Powell that he had used alcohol once to assist

with his symptoms. He stated his mood had not been

good. He reported that he had been without medication

for two weeks and his symptoms had worsened. Dr.

Powell’s diagnosis was Bipolar Disorder with psychotic

features and she noted the need to rule out ETOH

abuse, learning disability, and narcissistic personality

disorder. She encouraged abstinence from alcohol.

In mid-September, Campbell was seen at the CMHC and

reported increased symptoms with sleep disturbance,

hallucinations, lack of energy, and anxiety. He denied use

of alcohol. His medication regime was changed.

Two weeks later, on September 28, Campbell saw

Dr. Powell. He reported some improvement, but con-

tinued to have difficulty sleeping and auditory hallucina-

tions. He denied alcohol use. The diagnosis was the

same as the month before. Dr. Powell noted some im-

10 No. 10-1314

provement, but indicated that Campbell remained symp-

tomatic. She changed his medications and recommended

continued abstinence from alcohol. Campbell’s GAF

score was 45-50.

On October 4, 2005, Dr. Powell signed off on a medical

evaluation form for Campbell, noting a diagnosis of

Bipolar Disorder with psychotic features and the need to

rule out ETOH abuse. She reported that his speech was

slow, his mood was bad, his affect was flat, and he

was positive for paranoia and auditory hallucinations.

Dr. Powell noted that Campbell suffered from depres-

sion with sleep disturbance, crying spells, appetite dis-

turbance, and passive death wishes. She indicated that

he had extreme limitations in activities of daily living;

social functioning; and concentration, persistence, and

pace; and had experienced one episode of decompensation

in the last twelve months.

Dr. Powell saw Campbell again on October 26, 2005.

He reported compliance with his medications, yet contin-

ued to have sleep difficulties, auditory hallucinations,

and depression. Dr. Powell’s treatment note does not

mention alcohol use. Her assessment remained essen-

tially the same and she recommended continued absti-

nence. Campbell’s GAF rating was again 45-50.

At his following appointment on November 23,

Campbell was not very cooperative. His mood was

“not good.” He reported continued sleep disturbance.

Dr. Powell noted that Campbell continued to have depres-

sive symptoms but was resistant to change. His affect

was sad. His speech, thought process, and thought

No. 10-1314 11

content were within normal limits, and his judgment and

insight were fair.

Dr. Powell’s treatment note for December 21, 2005,

indicates that Campbell’s affect was sad, his thought

process remained circumstantial (which we under-

stand to mean that his speech revealed “excessive atten-

tion to irrelevant and digressive details,” Merriam-

Webster, MedlinePlus, http://www.merriam-webster.com/

medlineplus/circumstantiality (last visited Dec. 1, 2010)),

and he felt paranoid. Campbell was cooperative in his

interaction with Dr. Powell. His motor activity was within

normal limits. His judgment and insight were fair.

Dr. Powell noted that Campbell appeared to have symp-

toms consistent with post traumatic stress disorder.

She did not mention any ongoing alcohol use. She

changed his medications, tapering Paxil and starting a

trial of Zoloft.

On December 22, 2005, Dr. Powell signed off on an

Adult Mental Health Assessment form that appears to

have been completed on September 14, 2005. The

form noted that Campbell had daily anxiety, some com-

pulsive behavior, daily agitation and irritation, auditory

hallucinations (nightly), decreased appetite and sleep,

and mildly impaired concentration. Campbell was co-

operative and his motor activity was normal. Upon

examination, Dr. Powell noted a flat affect, but

Campbell’s speech, thought process, thought content,

and attention were within normal limits. His memory,

judgment, and insight were considered good. His intelli-

gence was estimated as average. The assessment rated

12 No. 10-1314

Campbell 50 on the GAF Scale, continuing to reflect

serious symptoms or serious impairment in functioning.

See DSMV-IV-TR 34.

ALJ Denise McDuffie Martin held a hearing on Jan-

uary 25, 2006. Psychiatrist Robert W. Marquis testified

as a medical expert. Based on his review of the file,

Dr. Marquis stated that Campbell has a history of cocaine

abuse and dependence and was “currently using alco-

hol.” Dr. Marquis acknowledged that Campbell’s

treating psychiatrist described him as depressed, but

when questioned about the diagnosis of Bipolar

Disorder, Dr. Marquis responded that he had not

seen that in the records. The medical expert opined

that Campbell had a moderate impairment in activi-

ties of daily living; a mild to moderate impairment in

socialization; a moderate impairment in attention, con-

centration, and pace; and no decompensation. He opined

that Campbell was capable of simple, routine, repetitive

work. These opinions were made without consideration

of Dr. Powell’s February 22, 2005 assessment of Camp-

bell’s residual functional capacity. Dr. Marquis did not

receive that assessment until the morning of the hearing

and had not yet reviewed it. After he had an oppor-

tunity to review Dr. Powell’s assessment, Dr. Marquis

explained why his opinion of Campbell’s functional

capacity differed from Dr. Powell’s. He relied on

Dr. Mason’s March 13, 2004, consultative examination

which he thought was more consistent with Campbell’s

history of substance abuse treatment and hospitalizations.

Dr. Marquis stated that Campbell was “drinking cur-

rently.” He identified Dr. Powell’s treatment note for

No. 10-1314 13

October 19, 2004, which stated that Campbell “[r]eports

using ETOH on a daily basis and states it helps to

calm him,” for support. He added that there were

several notes to that effect in the record. Dr. Marquis

testified that Campbell’s psychotic features could flow

from daily drinking and that alcohol withdrawal can

cause hallucinations. Dr. Marquis stated that he could

not give an opinion about Campbell’s limitations in the

absence of drinking; he did not see a period of clear

sobriety and could not say whether Campbell would be

any better without the use of alcohol.

Campbell testified at the hearing that he had not had

a drink in six or seven months and “hadn’t really drank

before that.” He claimed that at no point since April 2004

had he been drinking every day.

On August 24, 2006, the ALJ issued her decision,

finding Campbell not disabled. In reaching that deci-

sion, the ALJ discounted Dr. Powell’s assessment of

Campbell’s mental functional limitations and found the

opinions of Dr. Marquis and the state agency medical

consultants more informed and consistent with the

record. The Appeals Council denied review. Campbell

sought judicial review in the district court, and the

court affirmed.

II. Discussion

We will uphold the Commissioner’s decision if it

applies the correct legal standard and is supported by

substantial evidence. Castile v. Astrue, 617 F.3d 923, 926

14 No. 10-1314

(7th Cir. 2010). Substantial evidence is “ ‘such relevant

evidence as a reasonable mind might accept as adequate

to support a conclusion.’ ” Id. (quoting Skinner v. Astrue,

478 F.3d 836, 841 (7th Cir. 2007)). A decision denying

benefits need not discuss every piece of evidence, but if

it lacks an adequate discussion of the issues, it will be

remanded. Villano v. Astrue, 556 F.3d 558, 562 (7th Cir.

2009). Our review is limited to the reasons articulated

by the ALJ in her decision. Larson v. Astrue, 615 F.3d

744, 749 (7th Cir. 2010).

Campbell asserts that the Commissioner’s decision

is not supported by substantial evidence. He argues

that the ALJ erred in deciding to discount Dr. Powell’s

assessment of his functional limitations and by failing to

apply the factors enumerated in 20 C.F.R. §§ 404.1527(d)

(disability insurance) and 416.927(d) (supplemental

security income) in deciding what weight to give that

assessment. We agree that the ALJ’s consideration of

Dr. Powell’s assessment is insufficient.

“A treating physician’s opinion is entitled to ‘controlling

weight’ if it is ‘well-supported by medically acceptable

clinical and laboratory diagnostic techniques and is not

inconsistent with other substantial evidence.’ ” Larson,

615 F.3d at 749 (quoting 20 C.F.R. § 404.1527(d)(2)).

An ALJ “must offer ‘good reasons’ ” for discounting

a treating physician’s opinion. Id. (citing 20 C.F.R.

§ 404.1527(d)(2)). The ALJ gave two reasons for not

giving controlling or great weight to Dr. Powell’s assess-

ment of Campbell’s functional limitations: the absence

of significant abnormal findings at the time of the Decem-

No. 10-1314 15

ber 2005 evaluation and the failure to investigate the

possible effect of alcohol on Campbell’s functioning.

Neither of these qualifies as a “good reason.”

An ALJ may not selectively discuss portions of a physi-

cian’s report that support a finding of non-disability

while ignoring other portions that suggest a disability.

Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009). The

ALJ failed to evaluate the entirety of the mental health

assessment reviewed by Dr. Powell on December 22,

2005. The ALJ focused her attention on section “V.

Mental Status,” instead of considering the six-page

report as a whole. The ALJ correctly noted that Camp-

bell’s mental status examination was within normal

limits but for a flat affect. But the ALJ ignored the sec-

tions for “Presenting Problem/Precipitants,” “Diagnostic

Formulation,” and “Diagnostic Impression” that sug-

gest greater mental limitations. The assessment relates

Campbell’s self-reported symptoms: daily anxiety, compul-

sions, daily agitation, daily irritation, and auditory hal-

lucinations that keep him up nightly. In the “Diagnostic

Formulation” section, it was noted that Campbell

reported continued symptoms of depression, including

anxiety, agitation, decreased appetite and sleep, and

poor concentration. In addition, the mental health

provider also reached his or her own conclusions about

Campbell’s mental condition. These are noted under

Diagnostic Impression as a mood disorder and a rating

of 50 on the GAF Scale, reflecting serious symptoms or

any serious impairment in functioning, for example,

being unable to keep a job. See DSMV-IV-TR 34. A GAF

rating of 50 does not represent functioning within

16 No. 10-1314

normal limits. Nor does it support a conclusion that

Campbell was mentally capable of sustaining work.

Furthermore, although Dr. Powell signed off on the

mental health assessment on December 22, 2005, it

appears the assessment was created by another mental

health provider on September 14, 2005. Dr. Powell’s

most contemporaneous treatment notes were dated

December 21, 2005. Yet the ALJ’s decision does not men-

tion them.

The Commissioner suggests that Campbell had more

significant symptoms in July 2005. At that time, his affect

was flat, his thought process was tangential, he was

paranoid or suspicious, and he reported auditory halluci-

nations. But Dr. Powell’s December 21 treatment notes

contain similar findings: Campbell’s affect was sad, his

thought process was circumstantial, and he was paranoid

or suspicious. The treatment notes show that Dr. Powell

even changed Campbell’s medications, presumably

because his current regime was not achieving the desired

result. The Commissioner suggests that Dr. Powell’s

findings from the December 21 examination were incon-

sistent with the December 22 assessment and that the

ALJ resolved that inconsistency. In doing so, the Com-

missioner advances a ground on which the ALJ did not

rely, in violation of the Chenery doctrine, see SEC v.

Chenery Corp., 318 U.S. 80, 87-88 (1943). See, e.g., Larson,

615 F.3d at 749. Neither the December 21 treatment notes

nor Dr. Powell’s other treatment notes reflect much

improvement in Campbell’s mental functional capacity.

Dr. Powell’s observations and conclusions remained

No. 10-1314 17

essentially consistent throughout the course of her treat-

ment of Campbell.

The other reason the ALJ declined to give controlling

or great weight to Dr. Powell’s assessment of Campbell’s

mental limitations was her failure to investigate the

possible effect of alcohol on his functioning. Campbell

had reported to Dr. Powell that he was using alcohol in

October 2004 and January 2005. Dr. Powell’s treatment

notes from February 17, 2005, suggested that alcohol

use may have been contributing to Campbell’s presenta-

tion that day. But her notes for February, March, and

April 2005, indicate a decline in his alcohol use that

continued through August 2005, when he reported

using alcohol only once in the prior month. The notes of

Campbell’s alcohol use are consistent with Dr. Powell’s

recommendations first of abstinence and then, be-

ginning in September 2005, continued abstinence. The

change in recommendation suggests that Dr. Powell

believed Campbell was abstaining from alcohol use.

Her earlier notes had indicated the need to rule out

alcohol abuse, but as of November 2005, she no

longer made that notation. This suggests that she had

ruled out alcohol abuse, concluding that it was no

longer a factor in Campbell’s mental health.

However, Campbell’s symptoms persisted, which

suggests that something other than alcohol use was

the cause. And in Dr. Powell’s opinion, Campbell’s

GAF rating never got higher than 50, reflecting con-

tinued serious symptoms or serious impairment in func-

tioning. Dr. Powell’s records do not reflect that she made

18 No. 10-1314

any effort to corroborate Campbell’s self-report of de-

creased and discontinued alcohol use. Nonetheless,

Dr. Powell apparently believed Campbell; her Septem-

ber 2005 note states that he denied using alcohol and

indicated “continued abstinence encouraged.” The ALJ

did not identify any reason why Dr. Powell’s assessment

of Campbell’s self-report was wrong. Nor did the ALJ

analyze Campbell’s credibility with respect to his state-

ments at the hearing that he had not had a drink in

several (six or seven) months. Although the record does

not explicitly show that Dr. Powell investigated the

possible effect of alcohol on Campbell’s functioning,

it does support a finding that she had concluded that

Campbell was abstaining from alcohol. (Of course, if

Campbell was abstaining, alcohol use would not be a

factor in his functioning.)

Even if an ALJ gives good reasons for not giving con-

trolling weight to a treating physician’s opinion, she has

to decide what weight to give that opinion. Larson, 615

F.3d at 751 (citing 20 C.F.R. § 404.1527(d)(2)). The ap-

plicable regulations guide that decision by identifying

several factors that an ALJ must consider: “the length,

nature, and extent of the treatment relationship;

frequency of examination; the physician’s specialty; the

types of tests performed; and the consistency and support

for the physician’s opinion.” Id.; see also 20 C.F.R.

§§ 404.1527(d)(2), 404.927(d)(2). Our opinion in Larson

criticized the ALJ’s decision which “said nothing

regarding this required checklist of factors.” Id.; see also

Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008) (stating

that when the treating physician’s opinion is not given

controlling weight “the checklist comes into play”). Here,

No. 10-1314 19

the ALJ’s decision indicates that she considered opinion

evidence in accordance with §§ 404.1527 and 416.927.

However, the decision does not explicitly address the

checklist of factors as applied to the medical opinion

evidence. And several of the factors support the con-

clusion that Dr. Powell’s opinion should be given great

weight: Dr. Powell treated Campbell for fifteen months;

she treated him on a monthly basis; she is a psychiatrist;

and her findings remained relatively consistent through-

out the course of her treatment. Proper consideration

of these factors may have caused the ALJ to accord

greater weight to Dr. Powell’s opinion.

The ALJ instead relied on the opinion of the non-ex-

amining medical expert whose testimony showed an

unfamiliarity with Campbell’s current condition. For

example, Dr. Marquis missed Dr. Powell’s repeated

diagnoses of Bipolar Disorder with psychotic features.

Dr. Marquis also misread Dr. Powell’s notes as

indicating that Campbell was still drinking on a daily

basis. Only the October 19, 2004 treatment notes

mention daily drinking. And apparently, Dr. Marquis

missed the repeated references in Dr. Powell’s notes

to recommend or encourage “continued abstinence.”

Another problem with Dr. Marquis’s opinion: he

did not believe that Campbell had a “period of clear

sobriety” by which to assess his functioning without

alcohol use. Nothing in the record supports that view.

To the contrary, the record indicates that Campbell

had been sober for several months. Dr. Marquis’s mis-

reading of the record and his unsupported belief that

Campbell was drinking alcohol daily undermines our

confidence in his opinion.

20 No. 10-1314

The ALJ also relied on the opinions of the state agency

psychiatrist and psychologist, but they had reviewed

only part of Campbell’s psychiatric treatment records.

They did not have the benefit of reviewing Dr. Powell’s

treatment records—the records did not exist at the time.

It seems that the mental health treatment records over

a fifteen-month period, including the diagnoses of

Major Depressive Disorder with psychotic features and

Bipolar Disorder with psychotic features and a con-

sistent GAF rating of 45-50 and never greater than 50,

would affect the state agency reviewers’ assessment of

Campbell’s mental functional capacity. Although an

ALJ may give weight to consultative opinions, here, the

ALJ did not adequately explain why the reviewers’ opin-

ions were entitled to greater weight than those of

treating psychiatrist Dr. Powell.

III. Conclusion

The district court’s denial of relief is R EVERSED and this

case is R EMANDED with instructions to return the matter

to the Social Security Administration for further pro-

ceedings consistent with this opinion.

12-6-10