Kip Yurt v. Carolyn Colvin

In the

United States Court of Appeals

For the Seventh Circuit

No. 13-2964

KIP YURT,

Plaintiff-Appellant,

v.

CAROLYN W. COLVIN, Acting

Commissioner of Social Security,

Defendant-Appellee.

Appeal from the United States District Court for the

Northern District of Indiana, Fort Wayne Division.

No. 1:12 CV 00246 — Roger B. Cosbey, Magistrate Judge.

ARGUED FEBRUARY 24, 2014 — DECIDED JULY 10, 2014

Before FLAUM and ROVNER, Circuit Judges and KENDALL,

District Judge.*

ROVNER, Circuit Judge. Kip Yurt suffers from a psychotic

disorder which causes him to experience, among other things,

*

The Honorable Virginia M. Kendall, United States District Court for the

Northern District of Illinois, sitting by designation.

2 No. 13-2964

auditory hallucinations and bouts of uncontrollable rage. He

also struggles with obsessive compulsive disorder, moderately

severe chronic obstructive pulmonary disease (“COPD”), and

chronic bifrontal tension headaches. As a result, he applied for

Disability Insurance Benefits from the Social Security Adminis-

tration, but an Administrative Law Judge (“ALJ”) denied his

application. After the Appeals Council declined to review the

ALJ’s decision, Yurt sought review in the district court pursu-

ant to 42 U.S.C. § 405(g). A magistrate judge affirmed the

decision of the ALJ, and Yurt appeals, arguing principally that

the ALJ erred by failing to include many of his medical

limitations in the hypothetical that she posed to the vocational

expert (“VE”). Yurt contends that the flawed hypothetical led

the VE and the ALJ to erroneously conclude that he could be

gainfully employed. For the reasons discussed below, we

reverse the judgment of the district court and remand to the

agency for further proceedings.

I.

Yurt applied for disability in February 2011, alleging

disability beginning on August 4, 2010. The Social Security

Administration denied both Yurt’s claim and his request for

reconsideration. On his application for a hearing with an ALJ,

Yurt noted that he had worked in the past in various capacities

as a cook and a janitor.1 His final job at the “substantial gainful

activity” level effectively ended in May 2010, when he had

1

Yurt wrote in his application that his employment dates were “estimated”

and in fact some of the dates are not entirely consistent, a problem

attributed at argument to Yurt’s documented short-term memory difficul-

ties.

No. 13-2964 3

some sort of break with reality. He was taken to the emergency

room and subsequently placed on medical leave for several

months. Shortly after he returned to work in August 2010, he

threatened a coworker with a knife, which led, unsurprisingly,

to his termination.

Between the episode at the hospital in May 2010 and the

date of his hearing with the ALJ on April 3, 2012, Yurt saw a

number of different physicians and therapists and attempted

at least one other job. The May 2010 incident occurred at

Parkview Noble Hospital, where Yurt had worked in the

kitchen for several years when he was found “wandering the

halls” without any memory of how he had gotten there. After

being taken to the emergency room, he was referred to a

neurologist, Dr. Madhav Bhat, who treated him on July 1, 2010.

Dr. Bhat suggested weaning Yurt off an anti-seizure medicine

he had been taking and doubling the dosage of Prozac Yurt

was already taking for depression. Dr. Bhat recognized that

Yurt suffered from “[r]ecurrent episodes of altered awareness

of surroundings,” and diagnosed Yurt’s nearly daily recurring

bifrontal pain in his head as a chronic tension headache. He

concluded that Yurt should remain on medical leave from

work for the time being.

Yurt returned to work that August, but reported that

Parkview fired him shortly thereafter because “they were

really afraid that he might hurt other people” and because he

was accused of holding up a knife and threatening coworkers.

On August 13, 2010, Yurt saw psychiatrist Dr. Frank Shao, who

concluded that Yurt’s frequent self-described “black outs”

were difficult to diagnose precisely. Dr. Shao recommended

that Yurt obtain a second opinion and prescribed Lamictal in

4 No. 13-2964

slowly increasing dosages to help Yurt’s “mood lability and

violent behaviors.” He recognized that Yurt may have a

“certain risk of violence to himself and others” because of his

urges and history of aggression, but deemed the risk not to be

“acute.” He assigned Yurt a Global Assessment of Functioning

(“GAF”) score of 40 to 50.2 This GAF score correlates with

“[s]erious symptoms … or any serious impairment in social,

occupational, or school functioning (e.g., no friends, unable to

keep a job).” Am. Psychiatric Ass’n, Diagnostic & Statistical

Manual of Mental Disorders 32 (4th ed. text revision 2000).

Yurt then attempted to work part-time as a cook at St.

Francis School. Although the record is short on specifics, it

appears that Yurt lost this job on account of again threatening

a coworker. This likely corresponds to the beginning of

December 2010, when Yurt called Dr. Shao’s office and

reported grabbing a co-worker by the throat. He did not

remember the details because he had blacked out.

Later that same month, he was admitted to the hospital for

psychiatric evaluation. Dr. Shao reported that Yurt was

hearing voices telling him to “kill people” and that he was

afraid to go outside because the voice in his head (which he

called “Alex”) was instructing him to “randomly hurt people.”

Dr. Shao described Yurt as “disheveled” and assessed his GAF

2

The GAF score is a numeric scale of 0 through 100 used to assess severity

of symptoms and functional level. Am. Psychiatric Ass’n, Diagnostic &

Statistical Manual of Mental Disorders 32 (4th ed. text revision 2000).

Although the American Psychiatric Association recently discontinued use

of the GAF metric, it was still in use during the period Yurt’s examinations

occurred. See id. 16 (5th ed. 2013).

No. 13-2964 5

score to be between 25 to 30. This corresponds to behavior 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).” Id. Dr. Shao

recommended inpatient treatment for what he expected would

be one to two weeks. He also increased Yurt’s dosage of Celexa

(an antidepressant) and continued him on Lamictal (an

anticonvulsant used to treat both epilepsy and bipolar disor-

der) as well as Seroquel (another medication for bipolar

disorder). Despite Dr. Shao’s estimation that Yurt would need

between one and two weeks of inpatient treatment, Yurt

checked out of the hospital approximately two days later,

denying auditory hallucinations, homicidal or suicidal ide-

ations, delusions, or depression.

In January 2011, Yurt saw Dr. Kenneth Ogu for a psychiat-

ric evaluation. Dr. Ogu noted that Yurt described having

command hallucinations, sleep difficulty, racing thoughts and

obsessive compulsive thoughts. He diagnosed Yurt with

psychosis, not otherwise specified as well as “Rule out Bipolar

I Disorder” and “Rule out Intermittent Explosive Disorder.”

Yurt asked if his anti-psychotic medications (he was taking

three) could be changed because they did not seem to be

working for the voices. Dr. Ogu agreed and set out a plan for

reducing some medications and adding several others.

Yurt was again admitted for psychiatric inpatient care on

January 25, 2011. He continued to complain of auditory

hallucinations—specifically the voice of “Alex” which Yurt

described as “so strong” that he could no longer control it. This

6 No. 13-2964

time Dr. Shao recommended hospitalizing Yurt to keep him

from hurting others as a result of the auditory hallucinations.

Dr. Shao again opined that Yurt had a GAF of 25 to 30. Here

again, Yurt was released from the hospital two days later. At

that time, Dr. Shao recorded a slightly higher GAF score of 35

to 40. This corresponds to “[s]ome 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.

depressed adult avoids friends, neglects family, and is unable

to work[.])” Am. Psychiatric Ass’n, Diagnostic & Statistical

Manual of Mental Disorders 32 (4th ed. text revision 2000). After

his January 2011 stay in the hospital, Yurt was taking the

following medications on a daily basis: 40 milligrams of Prozac

for depression; 100 milligrams of Lamictal (used for treating

bipolar disorder); 500 milligrams of Depakote for mood

stabilization; 1 milligram of Klonopin (used for treating

epilepsy and panic disorders) at bedtime; 10 milligrams of

Ambien at bedtime; and an increased dosage of 2 milligrams of

Risperdal for psychosis.

In April 2011, Yurt met with the psychologist selected by

the Disability Determination Bureau, Revathi Bingi, Ed.D.

After evaluating Yurt, she concluded that he appeared to

“have great difficulty managing his symptoms” in spite of

good family support. She observed that Yurt’s “hallucinations,

paranoia and anger appear to be restricting his life” and that

his quality of life “appears to be very poor.” She assigned him

a GAF of 45, which, as described above, represents “[s]erious

symptoms … or any serious impairment in social, occupational,

or school functioning[.]” Id. That same month, Yurt began

No. 13-2964 7

meeting for therapy with Rachel DeFrancesco, M.A. She

identified Yurt’s issues as “anxiety, depression, employment,

interpersonal problems, psychosis, [and] sleep.” She character-

ized Yurt’s prognosis as “fair,” and described him as suffering

from “severe” symptoms but possessing a “strong motivation

to gain understanding.”

In May 2011, state agency psychologist Ken Lovko re-

viewed Yurt’s file for a mental residual functional capacity

assessment (“RFC”). As relevant here, Dr. Lovko checked

boxes indicating that Yurt was “moderately limited” in his

ability to: (1) understand and remember detailed instructions;

(2) carry out detailed instructions; (3) perform activities within

a schedule and maintain regular attendance; (4) perform at a

consistent pace and complete a normal workday and work-

week; (5) interact appropriately with the general public; (6) get

along with coworkers or peers; and (7) maintain socially

appropriate behavior. Dr. Lovko then opined that although

Yurt’s diagnosis was “serious and consistent with severe

impairments,” his functioning did not suggest that he had lost

the capacity for unskilled work. Dr. Lovko also noted that

Yurt’s GAF score of 60 (given by Dr. Ogu in January 2011)

indicated only “minimal impairments.” Dr. Lovko further

allowed that Yurt’s symptoms may impede his ability to work

around large numbers of people, but that Yurt could likely

work in an environment with fewer people and low levels of

stress. Dr. Lovko also thought that Yurt could relate “at least

on a superficial basis … with co-workers and supervisors.”

In April 2012, Yurt had a hearing before an ALJ. The ALJ

heard testimony from Yurt and his wife Lori as well as a

vocational expert. Yurt testified that his “rage” and inability to

8 No. 13-2964

“be around people” prevented him from holding a full-time

job. He also testified that he could not sit or stand still for more

than a few minutes at a time, and that his left hand shakes and

prevents him from using it. Finally, he testified that he re-

peated certain cleaning routines at home as many as ten times

daily and that he did not think he could get a job because he

had “a real problem around people.”

Yurt’s wife of eighteen years, Lori, testified that because of

his memory problems she needs to make sure he takes his

various medications both in the morning and again at night. As

for his level of functioning, she stated that she did not see him

“functioning that much” and that when she did see him he was

often lethargic, sleeping all day, or watching television. She

also explained that even slight changes to his medication make

it difficult for him to function and cause him to stare into space

or otherwise lose focus. Finally, she expressed her opinion that

Yurt’s memory loss would prevent him from succeeding at

even a job where he was able to work alone and avoid other

people because he would be unable to do what he was told.

The ALJ then formulated a hypothetical for the VE to assess

what jobs Yurt could perform. She described to the VE an

individual that can “remember and carry out unskilled task[s]

without special considerations … relate on at least a superficial

basis with coworkers and supervisors … attend to tasks for

sufficient periods of time to complete” and who “should not

work around large numbers of people.” When asked if such an

individual could perform any of Yurt’s past work, the VE

opined that Yurt would be capable of performing his past work

of dishwasher, janitor, and kitchen helper. She also thought

that Yurt could carry out the duties of the light, unskilled job

No. 13-2964 9

of “towel folder” or work as a cleaner/housekeeper. The VE

also stated that in competitive employment workers were

expected to be on task 80 to 85 percent of the time and could

not miss more than one or two days per month and up to

approximately ten per year. Yurt’s attorney then asked what

jobs would be eliminated if Yurt needed to avoid exposure to

pulmonary irritants such as dust and fumes (on account of his

COPD). The VE opined that such a restriction would essen-

tially eliminate any cleaning jobs. Finally, she allowed that the

kitchen helper position would be eliminated if it was necessary

to avoid any position that involved frequent exposure to

hazards.

After analyzing the five steps in 20 C.F.R. § 404.1520, the

ALJ concluded that Yurt was not disabled. At Step One, the

ALJ determined that Yurt had not engaged in substantial

gainful activity since the alleged onset date in August 2010.

The ALJ noted that Yurt initially testified that he had not

worked since the alleged onset date but that the evidence

showed that he had worked as a part-time chef from October

2010 through March 2011. Yurt attributed the discrepancy to

his alleged memory difficulties; the issue was ultimately

irrelevant because the ALJ concluded that his earnings as a

part-time chef did not represent disqualifying substantial

gainful activity. At Step Two, the ALJ concluded that Yurt’s

psychotic disorder was severe, but that his obsessive compul-

sive disorder, COPD, and hand tremors were not. At Step

Three, the ALJ determined that Yurt did not have an impair-

ment or combination of impairments that met or medically

equaled the criteria of Listing 12.03—Schizophrenic, paranoid

and other psychotic disorders. Specifically, the ALJ concluded

10 No. 13-2964

that Yurt’s mental impairment did not restrict his activities of

daily living. And although the ALJ acknowledged that Yurt

had “moderate difficulties” with social functioning and

concentration, persistence, or pace, she concluded that the

record did not support a finding of marked limitation in either

domain as required to meet the criteria of Listing 12.03. She

also determined that Yurt had not experienced any episodes of

extended decompensation or repeated episodes of decom-

pensation, which the regulations define as “exacerbations or

temporary increases in symptoms or signs accompanied by a

loss of adaptive functioning[.]” 20 C.F.R. Pt. 404, Subpt. P, App.

1, § 12.00(C)(4).

The ALJ next determined that Yurt possessed the residual

functional capacity to perform a full range of work at all

exertional levels so long as he had only brief and superficial

interaction with others and was not around large numbers of

individuals. She based this largely on Dr. Lovko’s assessment

that Yurt retained capacity to perform unskilled tasks without

special considerations as long as he was not in large groups

and had to relate only on a superficial basis. She concluded

that although Yurt’s medically determinable impairments

could be expected to cause some of his stated inability to be

around people and sit or stand still, those limitations were not

fully credible to the extent they were inconsistent with her RFC

assessment. She also noted that Yurt’s treatment records

documented improvement in his condition between his initial

psychiatric consultations in August 2010 and records from

counseling sessions in 2011 and 2012. The ALJ also made much

of Yurt’s ability to go shopping on “Black Friday” in December

2011 without incident. She generally rejected Dr. Bingi’s

No. 13-2964 11

findings as an inaccurate representation of Yurt’s overall

mental capacity. She concluded that both Dr. Ogu’s evaluation

in January 2011 and a later evaluation in May 2011 reflected

that Yurt was articulate and displayed a normal speech

pattern, findings that called into question Dr. Bingi’s GAF

score of only 45 and her assessment that Yurt had great

difficulty managing symptoms on account of his hallucina-

tions, paranoia, and anger.

At Step Four, the ALJ concluded that Yurt was capable of

performing his past work of a dishwasher and kitchen helper.

Alternatively, she found at Step Five that Yurt could also work

as an industrial janitor, cleaner, or towel folder consistent with

the VE’s testimony on that point; accordingly, she entered a

finding that Yurt was “not disabled.” The Appeals Council

denied review, rendering the ALJ's decision the Commis-

sioner's final decision subject to judicial review. 20 C.F.R.

§§ 416.1455, 416.1481. Yurt appealed to the district court, which

affirmed after finding that the ALJ's decision was supported by

substantial evidence.

II.

We review the district court’s affirmance de novo and

therefore review the ALJ’s decision directly. E.g., Thomas v.

Colvin, 745 F.3d 802, 805 (7th Cir. 2014). We review the ALJ’s

decision deferentially only to determine if it is supported by

“substantial evidence,” which we have described as “such

relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.” Moore v. Colvin, 743 F.3d

1118, 1120–21 (7th Cir. 2014) (internal quotations and citation

omitted). We neither reweigh the evidence nor substitute our

12 No. 13-2964

own judgment in place of the ALJ, but her decision must

provide enough discussion for us to afford Yurt meaningful

judicial review and assess the validity of the agency’s ultimate

conclusion. Id.

On appeal, Yurt argues that several flaws in the ALJ’s

decision undercut her conclusions at Steps Four and Five that

he could perform his past work or other jobs in the national

economy. He first claims that the ALJ’s hypothetical to the VE

is flawed because it failed to fully account for his limitations.

Relatedly, he attacks the ALJ’s failure to consider his tension

headaches at all. He also claims the ALJ did not properly

weigh the medical evidence from his treating physicians.

Finally, he asserts that the ALJ failed to build a logical bridge

between the medical evidence and her conclusion that Yurt

had not experienced any episodes of extended decompen-

sation.

We begin with the ALJ’s hypothetical question to the VE,

which, as detailed above, simply described an individual who

could perform unskilled tasks, relate superficially to small

numbers of people, and attend to tasks long enough to

complete them. Yurt notes that the hypothetical fails to

mention his headaches, his COPD, his tendency to “black out,”

the voices he hears, and significantly, the limitations outlined

in state agency psychologist Dr. Lovko’s assessment that the

ALJ expressly “adopted.”

Instead of directly defending the hypothetical, the Commis-

sioner focuses on the ALJ’s related finding regarding Yurt’s

residual functional capacity, which essentially mirrored her

hypothetical to the VE. Their dispute centers on whether the

No. 13-2964 13

ALJ was required to incorporate into her hypothetical and RFC

the “moderate” limitations Dr. Lovko noted on the Mental

Residual Functional Capacity Assessment (“MRFCA”) form

that he completed. Specifically, Yurt contends that the ALJ

ignored all six mental activity categories where Dr. Lovko

found that he was “moderately limited.” As detailed above,

these included several limitations in concentration, persistence,

and pace, including moderate limitations in the ability to carry

out detailed instructions, perform within a schedule, be

punctual, perform at a consistent pace, and to complete a

normal workday and workweek.

As a general rule, both the hypothetical posed to the VE

and the ALJ’s RFC assessment must incorporate all of the

claimant’s limitations supported by the medical record. See

O’Connor-Spinner v. Astrue, 627 F.3d 614, 619 (7th Cir. 2010)

(“Our cases, taken together, suggest that the most effective

way to ensure that the VE is apprised fully of the claimant’s

limitations is to include all of them directly in the hypotheti-

cal.”); Indoranto v. Barnhart, 374 F.3d 470, 473–74 (7th Cir. 2004)

(“If the ALJ relies on testimony from a vocational expert, the

hypothetical question he poses to the VE must incorporate all

of the claimant’s limitations supported by medical evidence in

the record.”); see also SSR 96-5p, 1996 WL 374183, at *5 (RFC

assessment “is based upon consideration of all relevant

evidence in the case record, including medical evidence and

relevant nonmedical evidence”); 20 C.F.R. § 404.1545. This

includes any deficiencies the claimant may have in concentra-

tion, persistence, or pace. O’Connor-Spinner, 627 F.3d at 619;

(“Among the limitations the VE must consider are deficiencies

of concentration, persistence and pace.”); Stewart v. Astrue, 561

14 No. 13-2964

F.3d 679, 684 (7th Cir. 2009) (hypothetical question “must

account for documented limitations of ‘concentration, persis-

tence, or pace’”) (collecting cases). Although it is not necessary

that the ALJ use this precise terminology (“concentration,

persistence and pace”), we will not assume that the VE is

apprised of such limitations unless she has independently

reviewed the medical record. There is no evidence here that the

VE reviewed Yurt’s medical history or heard testimony about

the various medical limitations that he complains were omitted

from the ALJ’s hypothetical. Thus, we would expect an

adequate hypothetical to include the limitations identified by

Dr. Lovko and Yurt’s treating physicians.

Relying on Johansen v. Barnhart, 314 F.3d 283 (7th Cir. 2002),

the Commissioner argues that we should be unconcerned here

with the failure of the ALJ to mention the six areas where

Dr. Lovko found moderate limitations because the narrative

portion of the form adequately “translated” these limitations

into a mental RFC that the ALJ could reasonably adopt. In

Johansen, we concluded that substantial evidence supported the

denial of disability benefits where the ALJ’s mental RFC

assessment and hypothetical to the VE failed to explicitly note

the three areas where one consultative physician had noted

that the claimant was “moderately limited.” Id. at 288–89. We

upheld the ALJ’s decision despite these omissions, after

observing that in addition to the finding that the claimant was

“moderately limited” in three areas, the consultative physician

“went further” and “translated” his findings into a specific

RFC assessment opining that the claimant was still able to

perform low-stress, repetitive work. Id.

No. 13-2964 15

The first and most obvious problem with the Commis-

sioner’s argument is that it focuses entirely on the ALJ’s mental

RFC when it is in fact the hypothetical she posed to the VE that

Yurt attacks. Even if we ignore this shortcoming, Johansen is not

as applicable as the Commissioner suggests. The three alleged

omissions from the hypothetical in Johansen were moderate

limitations in the claimant’s ability to (1) perform activities

within a schedule; (2) complete a normal workweek and

perform at a consistent pace; and (3) accept instructions and

respond appropriately to criticism. Id. at 286. Only one of the

limitations found by Dr. Lovko—performing activities within

a schedule—appears in Johansen. Given the additional limita-

tions Dr. Lovko found and their bearing on Yurt’s limitations

in concentration, persistence, and pace, we would be hard-

pressed to conclude that Dr. Lovko’s narrative RFC “went

further” in capturing those limitations.

Moreover, we allowed the hypothetical in Johansen to stand

despite its omissions because its description of “repetitive, low-

stress work” specifically excluded positions likely to trigger the

panic disorder that formed the basis of the claimant’s limita-

tions in concentration, persistence, and pace. See O’Connor-

Spinner, 627 F.3d at 619 (collecting and distinguishing cases,

including Johansen, where we have upheld hypotheticals that

omitted restrictions in “concentration, persistence, and pace”).

Significantly, Yurt’s hypothetical did not limit him to low stress

positions or otherwise capture his moderate difficulties

understanding and remembering instructions or performing

activities within a schedule. See Craft v. Astrue, 539 F.3d 668,

677 (7th Cir. 2008) (“In Johansen, the RFC reflected some work

requirements that were relevant to mental abilities (i.e.,

16 No. 13-2964

repetition and stress); here, the RFC was for ‘unskilled’ work,

which by itself does not provide any information about Craft’s

mental condition or abilities.”). This is true despite Dr. Lovko’s

having specifically mentioned in his narrative RFC that Yurt

could deal with an environment “where stress levels are

limited.”

Indeed, the Commissioner seems to be suggesting that the

hypothetical and the mental RFC adequately accounted for

Yurt’s limitations in concentration, persistence, and pace by

limiting Yurt to unskilled work. But we have repeatedly

rejected the notion that a hypothetical like the one here

confining the claimant to simple, routine tasks and limited

interactions with others adequately captures temperamental

deficiencies and limitations in concentration, persistence, and

pace. See generally Stewart, 561 F.3d at 685 (collecting cases); see

also Craft, 539 F.3d at 677–78 (restricting claimant to unskilled,

simple work does not account for his difficulty with memory,

concentration, and mood swings); Young v. Barnhart, 362 F.3d

995, 1004 (7th Cir. 2004); see also SSR 85-15, 1985 WL 56857 at *6

(1985) (“[B]ecause response to the demands of work is highly

individualized, the skill level of a position is not necessarily

related to the difficulty an individual will have in meeting the

demands of the job. A claimant's [mental] condition may make

performance of an unskilled job as difficult as an objectively

more demanding job.”). The ALJ specifically found at Step 4

that Yurt had “moderate difficulties … [w]ith regard to

concentration, persistence, or pace.” These limitations were

highlighted again in Dr. Lovko’s findings on the MRFCA form.

Beyond stating that Yurt could perform “unskilled task[s]

without special considerations,” the hypothetical does nothing

No. 13-2964 17

to ensure that the VE eliminated from her responses those

positions that would prove too difficult for someone with

Yurt’s depression and psychotic disorder. Nor is this a case like

Simila v. Astrue, 573 F.3d 503, 522 (7th Cir. 2009), where the

hypothetical describes the claimant’s underlying mental

diagnoses (chronic pain syndrome and somatoform disorder)

and the link between those conditions and the mental limita-

tions is clear. In short, although the ALJ’s hypothetical con-

tained several limitations accounting for Yurt’s difficulties in

social functioning, the blanket statement that he could perform

“unskilled” work fails to accurately capture Yurt’s documented

difficulties with concentration, persistence, and pace. This

failure to build an “accurate and logical bridge” between the

evidence of mental impairments and the hypothetical and the

mental RFC requires us to remand for further proceedings. See

O’Connor-Spinner, 627 F.3d at 620–21; Craft, 593 F.3d at 677–78.

There are other reasons the ALJ should not have adopted

non-examining psychologist Dr. Lovko’s RFC finding. In

concluding broadly that Yurt retained the capacity for un-

skilled work, Dr. Lovko commented that a “GAF of 60 suggests

minimal impairments.” But this conclusion fails to note that the

GAF of 60 assigned by Dr. Ogu in January 2011 was the highest

GAF assessment Yurt ever received. Notably, just two weeks

after Dr. Ogu’s assessment, Yurt was hospitalized after having

a psychotic break. At intake, his GAF was assessed at 25 to 30,

and upon his release two days later Dr. Shao recorded a GAF

score of 35 to 40. The higher score of 35 to 40 corresponds to

some impairment in reality or major impairment in several

areas (i.e., avoids friends, neglects family, and is unable to

work). This is a far cry from the sort of “minimal” impairment

18 No. 13-2964

Dr. Lovko believed could be expected with Yurt’s high-water

mark GAF of 60. Seizing upon the GAF of 60 to conclude that

Yurt was not substantially impaired is precisely the type of

cherry-picking of the medical record that we have repeatedly

forbidden. See, e.g., Bates v. Colvin, 736 F.3d 1093, 1099 (7th Cir.

2013) (“An ALJ cannot rely only on the evidence that supports

her opinion.”). The Commissioner attempts to minimize

Dr. Lovko’s reliance on Yurt’s best GAF score by pointing out

that it is the ALJ and not Dr. Lovko who is forbidden from

cherry-picking the medical evidence in support of her finding.

But such a distinction is largely irrelevant here given the ALJ’s

assertion that she credited and indeed adopted Dr. Lovko’s

opinion. And although the Commissioner is correct that the

ALJ was not required to give any weight to individual GAF

scores, see Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010), the

problem here is not the failure to individually weigh the low

GAF scores but a larger general tendency to ignore or discount

evidence favorable to Yurt’s claim, which included GAF scores

from multiple physicians suggesting a far lower level of

functioning than that captured by the ALJ’s hypothetical and

mental RFC.3 See Bates, 736 F.3d at 1100 (low GAF score alone

is insufficient to overturn ALJ’s finding of no disability but

GAF scores in context revealed ALJ’s deficient consideration of

entirety of claimant’s evidence).

We are also troubled by the ALJ’s failure to mention Yurt’s

bifrontal tension headaches, which the neurologist Dr. Bhat

3

This is true even when Dr. Binghi’s GAF estimate of 45 is excluded

pursuant to the ALJ’s finding that it was not entirely credible or consistent

with the record evidence as a whole.

No. 13-2964 19

described as having a tendency “to recur almost every day.”

The Commissioner attempts to excuse this omission because

Yurt did not mention them in his function reports or testify

about them at the hearing. Although we have recognized the

claimant’s obligation to explain why certain conditions are

disabling, Pepper v. Colvin, 721 F.3d 351, 367 (7th Cir. 2013), it

is the ALJ who carries the burden of developing the record,

Terry v. Astrue, 580 F.3d 471, 477 (7th Cir. 2009). The fact that

the headaches standing alone were not disabling is not

grounds for the ALJ to ignore them entirely—it is their impact

in combination with Yurt’s other impairments that may be

critical to his claim. See SSR 96-8P, 1996 WL 374184 at *5

(observing that when considered in combination with other

impairments a non-severe impairment may become “critical”

to the outcome of a claim); see also Indoranto, 374 F.3d at 474

(“Notably absent from the ALJ’s order is a discussion of how

Indoranto’s headaches and blurred vision affect her ability to

work.”). Although this omission standing alone probably

would not have been grounds for remand, the ALJ may clarify

on remand the effect of Yurt’s tension headaches on his claim.

See O’Connor-Spinner, 627 F.3d at 621.

Because these shortcomings are enough to require remand

to the Agency for further proceedings, we need not belabor

Yurt’s remaining arguments regarding whether the ALJ

properly weighed the evidence provided by treating physi-

cians and whether substantial evidence supports her conclu-

sion that he experienced no episodes of decompensation. Yurt

complains that the ALJ failed to properly weigh the evidence

provided by his treating physicians. He points specifically to

the assessments by Dr. Shao and Dr. Ogu as well as Rachelle

20 No. 13-2964

DeFrancesco, M.A., who worked as a therapist under

Dr. Ogu’s supervision. As for treating physicians Dr. Shao and

Dr. Ogu, we simply note that in addition to summarizing

Yurt’s visits and describing their treatment notes, the ALJ

should explicitly consider the details of the treatment relation-

ship and provide reasons for the weight given to their opin-

ions. See 20 C.F.R. § 404.1527(c)(2) (describing six factor

weighing process ALJ must perform for “every” treating

physician); see also Scott v. Astrue, 647 F.3d 734, 739 (7th Cir.

2011) (citing § 404.1527 for principle that ALJ must offer “good

reasons” for rejecting treating physicians opinion, which is

accorded controlling weight so long as it is “well supported”

and consistent with other evidence in the record) (internal

quotations and citation omitted); see also Moss v. Astrue, 555

F.3d 556, 561 (7th Cir. 2009). Likewise, on remand the ALJ

should consider DeFrancesco’s observations about the side

effects of Yurt’s medications and her assessment that Yurt’s

hallucinations and psychotic symptoms left him in “acute”

distress.

That leaves the ALJ’s perfunctory conclusion at Step 4 that

Yurt had suffered no extended episodes of decompensation, as

would be required for him to satisfy the “B criteria” for a

finding of per se disability under Listing 12.03 for psychotic

disorders. See 20 C.F.R. Pt. 404, Subpart P., App. 1, § 12.04;

Larsen v. Astrue, 615 F.3d 744, 748 (7th Cir. 2010) (describing

requirement that claimant suffering from an affective disorder

must have both a severe impairment under the “A criteria” and

at least two “B criteria”). Specifically, Listing 12.03 requires that

a claimant experience either three or more decompensation

episodes lasting at least two weeks, a lesser number of longer

No. 13-2964 21

episodes, or a greater number of shorter episodes of equivalent

severity. See 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.03(C). Here

the ALJ pointed only to Yurt’s brief hospitalizations and

concluded without elaboration that because they were both

short-lived he had not suffered from extended episodes of

decompensation. Although we reach no conclusion as to

whether Yurt has suffered from decompensation episodes of

sufficient frequency and severity to satisfy the “B criteria,” we

note that on remand the ALJ should consider that hospitaliza-

tions are not the only way a claimant can satisfy the decompen-

sation requirement. See 20 C.F.R. Pt. 404, Subpt. P, App. 1

§ 12.00(C)(4) (observing that ALJ “must use judgment” to

determine if more frequent decompensation episodes of

shorter duration or less frequent episodes of longer duration

may be used to substitute for the listed finding).

III.

For the foregoing reasons, the judgment affirming the

denial of benefits is REVERSED and the case is REMANDED

with instructions that it be returned to the SSA for further

proceedings consistent with this opinion.