Hoagland v. Astrue

Filing 36

MEMORANDUM Opinion and Order Signed by the Honorable Young B. Kim on 9/18/2014. (ma,)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF ILLINOIS
EASTERN DIVISION
TIMOTHY GENE HOAGLAND,
Plaintiff,
v.
CAROLYN W. COLVIN, Acting
Commissioner, Social Security
Administration,1
Defendant.

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No. 13 CV 705
Magistrate Judge Young B. Kim

September 18, 2014

MEMORANDUM OPINION and ORDER
Timothy Hoagland seeks disability insurance benefits (“DIB”), see 42 U.S.C.
§§ 416(i), 423, and supplemental security income (“SSI”), id. §§ 1381, et seq.,
claiming that he is disabled as a result of bipolar disorder and depression. After the
Commissioner of the Social Security Administration denied his applications,
Hoagland filed this suit seeking judicial review. See 42 U.S.C. § 405(g). Before the
court are the parties’ cross-motions for summary judgment.

For the foregoing

reasons, Hoagland’s motion is granted and the Commissioner’s motion is denied:
Procedural History
Hoagland applied for DIB on May 25, 2009, and SSI on June 4, 2009,
(Administrative Record (“A.R.”) 125), claiming a disability onset date of May 19,
2009, (id. at 71).

After the Commissioner denied his claims initially and upon

Pursuant to Federal Rule of Civil Procedure 25(d), Carolyn W. Colvin—who
became the Acting Commissioner of Social Security on February 14, 2013—is
automatically substituted as the named defendant.

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reconsideration, (id. at 55, 60, 68, 72), Hoagland sought and was granted a hearing
before an administrative law judge (“ALJ”), (id. at 76, 81). A hearing was held on
May 12, 2011, at which Hoagland, a medical expert, and a vocational expert
provided testimony.

(Id. at 27-50.)

The ALJ issued a decision finding that

Hoagland is not disabled within the meaning of the Social Security Act and denying
his DIB and SSI claims.

(Id. at 17-22.)

When the Appeals Council denied

Hoagland’s request for review, (id. at 1-6), the ALJ’s denial of benefits became the
final decision of the Commissioner, see O’Connor-Spinner v. Astrue, 627 F.3d 614,
618 (7th Cir. 2010). On January 29, 2013, Hoagland filed the current suit seeking
judicial review of the Commissioner’s decision.

See 42 U.S.C. § 405(g); (R. 1,

Compl.). The parties have consented to the jurisdiction of this court. See 28 U.S.C.
§ 636(c); (R. 12).
Facts
Hoagland, who is 41 years old, suffers from depression, bipolar disorder, and
other impairments.

He held a variety of jobs, including furniture refinisher,

warehouse worker, and janitor, before applying for DIB and SSI, and last worked
for the Salvation Army in May 2009. Hoagland claims that his depression and
bipolar disorder became disabling on May 19, 2009.

He presented both

documentary and testimonial evidence in support of his claim.
A.

Medical Evidence
The relevant medical record begins in February 2009 when Hoagland sought

treatment from Dr. Eva Kurilo, a psychiatrist at the Ecker Center for Mental

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Health (“Ecker Center”), for “mood problems.” (A.R. 259-61.) Dr. Kurilo observed
that Hoagland did not appear sad and was smiling appropriately during his
interview. (Id. at 260.) She noted that his concentration was fair, although he
seemed “a little bit distractible,” and that he conveyed no suicidal or homicidal
ideations or overtly paranoid statements. (Id.) Dr. Kurilo diagnosed Hoagland with
mood disorder along with alcohol abuse and pathological gambling based on his selfreported history. (Id.) Hoagland told Dr. Kurilo that he used to take Luvox to help
with his depression, but that the medication had been less effective recently. (Id.)
She instructed Hoagland to continue taking Luvox but also prescribed Lamictal as a
mood stabilizer and recommended psychotherapy. (Id.)
Dr. Kurilo continued to see Hoagland about once a month between February
and August 2009.

(See id. at 262-69.)

During those visits Hoagland appeared

“pleasant” and “cooperative,” exhibiting good attention and fair concentration. (Id.
at 264-67.)

Dr. Kurilo’s progress notes indicate that he was tolerating his

medication well and seemed to be improving, although she increased Hoagland’s
Lamictal dosage in May 2009 when he reported that the medication was not
working as well as before. (Id. at 264-65, 267.)
In August 2009 Hoagland was treated by Dr. Syed Anwar, another
psychiatrist at the Ecker Center. (Id. at 318.) Dr. Anwar noted that Hoagland’s
mood was stable and that he was tolerating his medications well with no side
effects. (Id.) He continued to see Hoagland about once every three months between
August 2009 and January 2011. (Id. at 318, 391-92, 395-98.) Over the course of

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treatment Dr. Anwar observed that decreasing Hoagland’s medications increased
his mood swings and anxiety, and in February 2010 Dr. Anwar prescribed
Trazodone to help Hoagland sleep. (See id. at 397.) Dr. Anwar’s notes generally
indicate that Hoagland did well with his medications during that time period,
although there were instances when Hoagland’s symptoms worsened significantly.
Specifically, in July 2010, Hoagland overdosed on Lamictal in an attempt to
commit suicide after his mother’s death and was admitted to the emergency room.
(Id. at 344.)

He was described as being “initially combative and agitated” and

“crying a lot.” (Id. at 342.) Dr. Anwar observed that Hoagland was depressed and
in an “almost catatonic state.” (Id. at 345.) He was treated with antipsychotic
medications, (id.), and diagnosed with bipolar disorder and personality disorder, (id.
at 366-67).

After spending a few days in the emergency room, Hoagland was

transferred to Elgin Mental Health Center (“EMHC”) and admitted into the care of
Dr. Kurilo.

(Id. at 370.)

Dr. Kurilo completed a psychiatric evaluation noting

Hoagland’s irritability, depression, anxiety, and anger control problems.

(Id. at

368.) She diagnosed him with bipolar disorder “due to his history of impulsivity,
anger, and moodiness,” and that he had been “under a lot of stress over the last
weeks.”

(Id.)

His symptoms included racing thoughts and the “[i]nability to

complete day-to-day chores[.]” (Id. at 368.) Dr. Kurilo noted that he was “doing
fairly well on his medications” before “recent stressors, including relationship
problems and financial issues.” (Id. at 370.) Hoagland was eventually released in
stable condition after spending almost three weeks at EMHC. (See id. at 386.) But

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then in September 2010, police officers brought Hoagland back to the Ecker Center
because his former girlfriend reported that Hoagland had expressed suicidal
thoughts to her. (Id. at 393.) Although he was agitated upon arrival, Hoagland
denied suicidal ideations and was released the same day after being judged not to
be a risk of harm to himself or others. (Id.)
The record also includes psychiatric evaluations from state agency
consultants and Dr. Anwar.

In August 2009, consultant W. Nordbrock, Ph.D.,

completed a Psychiatric Review Technique form. (Id. at 287-300.) He concluded
that Hoagland’s impairment was not severe, and that he had only mild difficulties
in maintaining social function and no limitations in activities of daily living and
maintaining concentration, persistence, or pace. (Id. at 287, 297.) Dr. Nordbrock
found Hoagland to be “partially credible” because his self-described symptoms were
“somewhat more severe” than his Global Assessment Functioning (“GAF”) score of
55.2 (Id. at 299.) Dr. Nordbrock also believed that Hoagland’s symptoms were
inconsistent with his mother’s account of his activities of daily living, which
included making light meals, mowing the lawn, grooming and hygiene, taking his
medications, going outside alone, driving a car, shopping for groceries, and handling
his own finances.

(Id.)

Dr. Nordbrock concluded that Hoagland’s psychiatric

The GAF score is “a psychiatric measure of a patient’s overall level of
functioning.” See Jelinek v. Astrue, 662 F.3d 805, 807 (7th Cir. 2011). The GAF
scale ranges from zero to 100, with 100 describing “[s]uperior functioning.”
American Psychiatric Association, Diagnostic and Statistical Manual of Mental
Disorders 34 (4th ed. 2000) (“DSM-IV-TR”). A score between 51 and 60 reflects
“[m]oderate symptoms (e.g., flat affect and circumlocutory speech, occasional panic
attacks) or moderate difficulty in social, occupational, or school functioning (e.g., few
friends, conflicts with peers or co-workers).” Id.
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treatment had been “relatively short and infrequent” and that the medical record
did not support the severity of Hoagland’s complaints. (Id.)
In November 2009, Carl Hermsmeyer, Ph.D., agreed with Dr. Nordbrock’s
assessment, noting that Hoagland reported his condition was “fair” and that
medication was helping. (Id. at 330.) Dr. Hermsmeyer concluded that Hoagland
was “partially credible” and pointed out that Hoagland reported “feeling better.”
(Id.)

Neither Dr. Nordbrock nor Dr. Hermsmeyer noted any episodes of

decompensation, as both of their evaluations were completed prior to Hoagland’s
July 2010 suicide attempt.
In July 2011, Dr. Anwar completed an Affective Disorders Professional
Source Data Sheet in which he confirmed that Hoagland has bipolar disorder. (Id.
at 418-23.) He opined that Hoagland has marked difficulties in maintaining social
functioning, marked difficulties in maintaining concentration, persistence, or pace,
and repeated episodes of decompensation. (Id. at 420.) Dr. Anwar also concluded
that for RFC purposes, Hoagland is moderately limited in his ability to carry out
short and simple instructions, make simple work-related decisions, and maintain
socially appropriate behavior. (Id. at 422.) He further opined that Hoagland is
markedly limited in his ability to maintain attention and concentration for extended
periods, work with others without being distracted by them, complete a normal
workday without interruptions from his symptoms, work at a consistent pace
without an unreasonable number of rest periods, and accept instructions and
respond appropriately to criticism from supervisors. (Id.) Dr. Anwar indicated that

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“even a minimal increase in mental demands or change in the environment” would
cause Hoagland to decompensate. (Id.)
B.

Hoagland’s Testimony
During the hearing in May 2011, Hoagland described his past work history.

He testified that he last worked for the Salvation Army in May 2009 doing
“custodial and driving work” until he was terminated for getting into a fight with
his supervisor. (A.R. 31, 35-36.) He explained that his termination was part of a
“continuing pattern” and that he had been fired from numerous jobs over the past
several years for arguing with customers or employers. (See id. at 33, 36-39.) His
previous work positions included janitor, furniture refinisher, machine operator,
auto mechanic, and store manager. (Id. at 36-39.)
With respect to daily activities, Hoagland testified that he can drive, clean,
do laundry, and walk his dog. (Id. at 32, 34.) He said he mows the lawn but does
not do his own grocery shopping. (Id. at 34.) He stays in the house by himself most
of the time, (id. at 32), but goes to church on Sundays and occasionally goes to a
hobby store, (id. at 40). Hoagland testified that he visits relatives once or twice
every two to three months, and that he does not have any friends. (Id.)
Regarding his medical treatment, Hoagland said that he takes Luvox,
Lamictal, and Trazodone. (Id. at 31.) He stated that he had been seeing Dr. Anwar
for about a year and a half. (Id.) When asked whether he was getting any therapy
or counseling for anger management, Hoagland responded that he was in therapy,
but not specifically for anger management. (Id. at 34.)

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C.

Medical Expert’s Testimony
Medical Expert (“ME”) Kathleen O’Brien, Ph.D., a psychologist, testified

regarding Hoagland’s ability to engage in employment given his bipolar disorder
and depression. (A.R. 40-44.) Dr. O’Brien noted that Hoagland had an episode of
decompensation in July 2010, but that his records from before and after that
episode reflect “infrequent” and “inconsistent” visits to his psychiatrist. (Id. at 41.)
She pointed to a lack of counseling records showing that Hoagland was being
treated for anger issues, concluding that the record did not establish that
Hoagland’s anger “ha[s] much to do with [his] bipolar disorder.” (Id.) Dr. O’Brien
went on to opine that Hoagland has mild difficulties with activities of daily living,
moderate difficulties with social interaction, and moderate difficulties with
concentration, persistence, and pace. (Id. at 42.) When the ALJ asked how these
limitations would impact Hoagland’s residual functional capacity (“RFC”),
Dr. O’Brien responded that Hoagland should be limited to a job with no social
contact and only occasional contact with peers and supervisors. (Id.)
D.

Vocational Expert’s Testimony
Vocational Expert (“VE”) Lee Knutson testified regarding the kinds of jobs

someone with certain hypothetical limitations could perform. (A.R. 44-49.) The VE
first confirmed that Hoagland’s previous jobs included machine operator, furniture
refinisher, warehouse laborer, janitor, and store manager. (Id. at 46-47.) The VE
testified that Hoagland had performed these jobs at the unskilled, semiskilled, and
skilled levels, and at light, medium, and heavy exertion levels. (Id. at 47.) The ALJ

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asked the VE whether Hoagland could perform any of his past work given no
exertional limits, but no social contact and only occasional contact with peers and
supervisors.

(Id. at 48.)

The VE responded that Hoagland could perform his

previous work as a machine operator, furniture finisher, and janitor. (Id.) Then
Hoagland’s attorney asked whether Hoagland could perform any past work if he
was markedly limited in his ability to work with others without being distracted by
them, markedly limited in his ability to complete a normal workday or workweek
without interruptions from his symptoms, markedly limited in his ability to perform
at a consistent pace without “an unreasonable number” of rest periods or other
distractions, and markedly limited in the ability to accept instructions and respond
appropriately to criticism from supervisors. (Id. at 48-49.) The VE responded that
assuming “markedly limited” meant “incapable of,” Hoagland could perform past
work even if he were unable to work with others without being distracted by them.
But the VE testified that Hoagland would be unemployable if any of the other
described limitations applied. (Id. at 49.)
E.

The ALJ’s Decision
The ALJ concluded that Hoagland is not disabled under §§ 216(i), 223(d), and

1614(a)(3)(A) of the Social Security Act. (A.R. 22.) In applying the standard fivestep sequence for assessing disability, see Kastner v. Astrue, 697 F.3d 642, 646 (7th
Cir. 2012), the ALJ determined at steps one and two of the analysis that Hoagland
has not engaged in substantial gainful activity since May 19, 2009, and that his
bipolar disorder and alcohol dependence constitute severe impairments. (A.R. 19.)

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At step three, after applying the special technique for analyzing mental
impairments, the ALJ found that Hoagland’s impairments neither meet nor
medically equal any of the listings in 20 C.F.R. 404, Subpart P, Appendix 1. (Id.)
Proceeding to steps four and five of the analysis, the ALJ concluded that Hoagland
has the RFC to perform a full range of work, except that he could have no contact
with the public and no more than occasional contact with coworkers and
supervisors. (Id. at 20.) The ALJ determined that Hoagland is able to return to his
previous work as a machine operator, furniture refinisher, and janitor. (Id. at 22.)
Accordingly, the ALJ concluded that Hoagland is not disabled and denied his
applications for benefits.
Analysis
In moving for summary judgment, Hoagland argues that the ALJ committed
reversible errors in determining his RFC and assessing his credibility. This court’s
role is limited to determining whether the ALJ’s decision is supported by
substantial evidence and free of legal error. See Scheck v. Barnhart, 357 F.3d 697,
699 (7th Cir. 2004). Substantial evidence is that which “a reasonable mind might
accept as adequate to support a conclusion.” McKinzey v. Astrue, 641 F.3d 884, 889
(7th Cir. 2011) (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)).

The

substantial evidence standard requires the ALJ to build a logical bridge between
the evidence and his conclusion, but not necessarily to provide a comprehensive
written evaluation of every piece of evidence in the record. See Pepper v. Colvin,
712 F.3d 351, 362 (7th Cir. 2013).

In asking whether the ALJ’s decision has

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adequate support, this court will not reweigh the evidence or substitute its own
judgment for the ALJ’s. See Shideler v. Astrue, 688 F.3d 306, 310 (7th Cir. 2012).
A.

Credibility Analysis
The court first addresses Hoagland’s challenge to the ALJ’s credibility

analysis because an erroneous credibility determination is often reason enough to
reverse an ALJ’s decision. See Punzio v. Astrue, 630 F.3d 704, 709 (7th Cir. 2011).
Although this court will not disturb the ALJ’s credibility assessment unless it is
“unreasonable or unsupported,” see Getch v. Astrue, 539 F.3d 473, 483 (7th Cir.
2008), Hoagland meets his burden here because the ALJ’s “assessment” consists of
only one sentence describing Hoagland’s statements as “not fully credible” without
any discernible explanation why, (see A.R. 21).

When making a credibility

determination, regulations require the ALJ to “consider the entire case record and
give specific reasons for the weight given to the individual’s statements.” SSR 967p, 1996 WL 374186, at *3 (July 2, 1996); see Schmidt v. Barnhart, 395 F.3d 737,
746 (7th Cir. 2005) (ALJ must “articulate specific reasons for discounting a
claimant’s testimony as being less than credible”).

The ALJ implies from his

discussion of the medical evidence that he found Hoagland’s statements to be
inconsistent with or unsupported by the record, but the ALJ makes no reference
whatsoever to Hoagland’s hearing testimony. As an initial matter, a perceived lack
of medical evidence supporting the severity of a claimant’s symptoms is insufficient,
standing alone, to discredit his testimony. See Villano v. Astrue, 556 F.3d 558, 562
(7th Cir. 2009) (citations omitted). But even if such a basis were sufficient, for the

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reasons discussed below, the court finds the ALJ’s analysis of the medical evidence
problematic, and the ALJ offered no other reasoning to support his adverse
credibility finding.
An erroneous credibility determination mandates a remand “unless the
claimant’s testimony is incredible on its face or the ALJ explains that the decision
did not depend on the credibility finding.” Pierce v. Colvin, 739 F.3d 1046, 1051 (7th
Cir. 2014); see also Punzio, 630 F.3d at 709 (noting that an inadequate credibility
determination is “reason enough” to reverse an ALJ’s decision). Neither of those
exceptions applies here. Hoagland’s testimony is not so contradicted by medical
evidence as to be unbelievable, and it is unclear what role the ALJ’s cursory
credibility determination played in his decision. Accordingly, this case must be
remanded for a new credibility determination.
B.

RFC Assessment
Although the problems with the ALJ’s credibility analysis necessarily cast

doubt on the RFC assessment, see Pierce, 739 F.3d at 1051, in the interest of
completeness the court will address Hoagland’s RFC-specific arguments. Hoagland
first argues that the ALJ gave insufficient weight to the opinion of his treating
psychiatrist, Dr. Anwar.

(R. 19, Pl.’s Mem. at 10-17.)

As a “treating source,”

Dr. Anwar’s opinion is entitled to controlling weight provided it is “well-supported
by medically acceptable clinical and laboratory diagnostic techniques and is not
inconsistent with the other substantial evidence” in the record.

See 20 C.F.R.

§ 404.1527(c)(2); Larson v. Astrue, 615 F.3d 744, 749 (7th Cir. 2010). An ALJ may

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discredit a treating source’s opinion if it is internally inconsistent or inconsistent
with the opinion of a consulting source, provided the ALJ minimally articulates his
reason for crediting or rejecting evidence of disability. See Skarbek v. Barnhart, 390
F.3d 500, 504 (7th Cir. 2004). An ALJ may still look to the opinion even after opting
to afford it less evidentiary weight, but how much weight the ALJ affords depends
on a number of factors such as the length, nature, and extent of the physician’s and
claimant’s treatment relationship, whether the physician supported his opinions
with sufficient explanations, and whether the physician specializes in the medical
conditions at issue. See 20 C.F.R. § 416.927(d)(2)(i)-(ii), (d)(3), (d)(5).
Here, the ALJ did not sufficiently articulate his reasons for affording less
than controlling weight to Dr. Anwar’s opinion. Dr. Anwar opined that Hoagland is
markedly limited in maintaining social functioning and maintaining concentration,
persistence, or pace, and that he suffers from repeated episodes of decompensation.
(A.R. 420.) The ALJ acknowledged Dr. Anwar’s finding of marked limitations in
social functioning, but noted that Dr. Anwar also reported “only moderate
limitations” in Hoagland’s capacity for understanding, remembering, and following
simple instructions. (Id. at 21, 422.) The ALJ went on to state that Hoagland
managed to perform “a wide range of activities of daily living including lawn
maintenance, pet care, wood-burning crafts, model railroading, and church
attendance and participation.” (Id. at 21.)
First, by only highlighting Dr. Anwar’s finding of “moderate limitations” in
Hoagland’s capacity for understanding, remembering, and following simple

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instructions, the ALJ “cherry-picked” evidence to support a denial of benefits. See
Denton v. Astrue, 596 F.3d 419, 425 (7th Cir. 2010). More specifically, the ALJ
neglected to address Dr. Anwar’s other findings that Hoagland is markedly limited
in maintaining concentration for extended periods of time, markedly limited in his
ability to work with others without being distracted, and markedly limited in his
ability to complete a normal workday without interruptions from his symptoms.
(A.R. 422.) An ALJ cannot selectively consider medical reports, especially those of
treating physicians, and only focus on evidence that is favorable to his RFC
assessment. See Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009).
The ALJ’s second reason for discounting Dr. Anwar’s opinion also falls short.
The ALJ pointed to Hoagland’s ability to maintain his lawn, take care of his dog, do
wood-burning crafts and model railroading, and attend church, implying that such
activities are inconsistent with Dr. Anwar’s findings. (A.R. 21.) But solo activities
such as mowing the lawn, walking the dog, and engaging in hobbies at home do not
require social interaction, and merely attending church once a week does not
necessarily conflict with marked limitations in the ability to work with others.
These activities also do not inherently require maintaining concentration for
extended periods of time without interruption.

Accordingly, it is unclear how

Dr. Anwar’s findings are inconsistent with Hoagland’s daily activities. See Jelinek
662 F.3d at 812-13 (reversing partly because ALJ did not explain why he perceived
daily activities inconsistent with medical evidence).

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Furthermore, minimal daily activities do not establish that a person is
capable of engaging in substantial physical or mental activity. See Clifford v. Apfel,
227 F.3d 863, 872 (7th Cir. 2000). The Seventh Circuit has repeatedly warned
against citing the kind of low-level daily activities the ALJ points to here as
evidence that a claimant is not disabled. See, e.g., Hughes v. Astrue, 705 F.3d 276,
278 (7th Cir. 2013); Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012); Gentle v.
Barnhart, 430 F.3d 865, 867-68 (7th Cir. 2005); Carradine v. Barnhart, 360 F.3d
751, 755-56 (7th Cir. 2004).
Moreover, there is no indication that the ALJ considered the length, nature,
and extent of Hoagland’s treatment relationship with Dr. Anwar, the frequency of
examinations, his specialty, or the types of tests he performed, as required by 20
C.F.R. § 404.1527(c)(2). The Seventh Circuit has repeatedly criticized ALJ decisions
that discount the treating physician’s opinion but say nothing regarding these
factors.

See, e.g., Mueller v. Astrue, 493 F. App’x 772, 776-77 (7th Cir. 2012);

Larson, 615 F.3d at 751; Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008) (holding
that if the treating physician’s opinion is not given controlling weight, “the checklist
comes into play”). Some of the factors actually support giving Dr. Anwar’s opinion
more weight because Dr. Anwar is a psychiatrist who treated Hoagland for at least
17 months. Also, even if the ALJ ultimately provides good reasons for rejecting
Dr. Anwar’s opinion, he must still determine what weight the opinion is due under
the applicable regulations, which he neglected to do here. See Larson, 615 F.3d at

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751. The ALJ should discuss the required factors on remand, then specify what
weight he attributes to Dr. Anwar’s opinion.
Hoagland next challenges other aspects of the ALJ’s RFC assessment,
arguing that the ALJ failed to consider evidence supporting a finding of disability.
He points to the fact that his medication dosage increased steadily from May 2009
to July 2010, his symptoms during his July 2010 hospitalization were severe, and
that he continued to struggle with depression and external stressors after his
hospitalization.

(R. 19, Pl.’s Mem. at 13-14.)

But contrary to what Hoagland

contends the ALJ did not overlook this evidence, he simply did not attribute the
same importance to it as Hoagland does.

For example, the ALJ did note that

Hoagland needed medication adjustments, but the ALJ observed that during most
doctor visits Hoagland reported his medications were working well. (See A.R. 21,
265, 318, 391-93, 395.)

The ALJ also acknowledged Hoagland’s July 2010

hospitalization as an episode of decompensation, (id. at 20-21), but did not consider
Hoagland’s September 2010 visit to be an episode of decompensation. The record
supports the ALJ’s conclusion in this respect because when Hoagland was brought
to the Ecker Center in September 2010, he was released that same day after he
denied having suicidal or homicidal ideations, said that his medication was
working, and was judged not to be a risk of harm to himself or others. (Id. at 393.)
Just because Hoagland disagrees with the ALJ’s interpretation of the medical
record does not mean that the ALJ’s conclusions are inadequately supported.

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More persuasive, however, is Hoagland’s argument that the ALJ should have
considered the full range of Hoagland’s GAF scores. (See R. 19, Pl.’s Mem. at 1415.) The ALJ relied on the fact that Hoagland showed “a considerable increase” in
his GAF rating following his July 2010 episode in reaching his RFC determination.
(A.R. 21.)

But not only did that increase come on the heels of a three-week

hospitalization, Hoagland’s GAF score upon release was only 50, which indicates
“[s]erious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent
shoplifting)” or “serious impairment in social, occupational, or school functioning
(e.g., no friends, unable to keep a job).” See DSM-IV-TR; Campbell v. Astrue, 627
F.3d 299, 307 (7th Cir. 2010) (“A GAF rating of 50 does not represent functioning
within normal limits. Nor does it support a conclusion that [claimant] was mentally
capable of sustaining work.”). Furthermore, the ALJ neglected to mention that
Hoagland’s GAF score while he was hospitalized fell between 25 and 30, (A.R. 345,
371), signifying that his behavior was “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).” DSM-IV-TR.
As stated by the Seventh Circuit, “[t]he very nature of bipolar disorder is that
people with the disease experience fluctuations in their symptoms, so any single
notation that a patient is feeling better or has had a ‘good day’ does not imply that
the condition has been treated.” Scott v. Astrue, 647 F.3d 734, 740 (7th Cir. 2011).

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On remand, the ALJ should consider the full range of Hoagland’s GAF scores and be
mindful that “[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.” See Bauer, 532 F.3d at 609; see also Farrell v. Astrue, 692
F.3d 767, 773 (7th Cir. 2012) (claimant’s RFC should not be measured exclusively
by his best days).
Hoagland’s final argument regarding the ALJ’s RFC assessment is that the
ALJ erred in adopting the ME’s opinion. (R. 19, Pl.’s Mem. at 15-19.) This court
agrees.

Not only did the ALJ discredit Dr. Anwar’s opinion without a proper

explanation, he chose to credit Dr. O’Brien—a psychologist who had never examined
Hoagland—despite troubling oversights in her testimony.

First, Dr. O’Brien

testified at the hearing that Hoagland’s anger did not “appear to have much to do
with [his] bipolar disorder” and that anger is “normal in and of itself.” (A.R. 41.)
She went on to say that anger is an emotion “we all experience” and is “typically
under the control of the person experiencing the anger in the absence of something
like temporal lobe seizures, or brain damage, or something like that[.]” (Id. at 43.)
She ultimately was not persuaded that Hoagland’s anger is “related to a
psychological condition.” (Id.)
However, Dr. O’Brien seems to have overlooked a record replete with
evidence that Hoagland’s ongoing struggles with anger are far from “normal.” In
early 2009 and again in July 2010, Dr. Kurilo noted that Hoagland had “issues with
anger,” “problems with anger,” and trouble keeping a job “because of his anger

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issues.”

(Id. at 259-60, 368-371.)

The latter conclusion is consistent with

Hoagland’s testimony that he was terminated from several jobs due to angry
outbursts and arguments. (See id. at 33, 36-39.) But more importantly, Dr. Kurilo’s
notes explicitly state that Hoagland was diagnosed with bipolar disorder “due to his
history of impulsivity, anger, and moodiness.” (Id. at 370 (emphasis added).) It is
unclear why Dr. O’Brien found insufficient evidence linking Hoagland’s anger to his
psychological condition despite Dr. Kurilo’s findings and numerous indications that
his anger issues are far from typical. See Bates v. Colvin, 736 F.3d 1093, 1099 (7th
Cir. 2013) (noting that where a claimant diagnosed with bipolar disorder was found
to suffer from mood swings, depression, and anger issues, among other symptoms,
such findings “[we]re not ‘essentially normal,’ but reveal[ed] a claimant struggling
with serious mental health issues”).
Dr. O’Brien’s testimony was also problematic in that she found Hoagland had
moderate difficulties with concentration, persistence, and pace, yet did not
incorporate that limitation into her RFC recommendation. (See A.R. 42.) When
asked how Hoagland’s limitations would impact his RFC, Dr. O’Brien only said that
he should be restricted to no social contact and occasional contact with peers and
supervisors.

(Id.)

Without explaining why, she made no mention of limiting

Hoagland to jobs with simple instructions not requiring intense focus or
concentration for extended periods of time, or other similar restrictions used to
accommodate difficulties with concentration, persistence, or pace. See Triplett v.
Colvin, No. 12 CV 4382, 2013 WL 6169562, at *11 (N.D. Ill. Nov. 25, 2013); Jones v.

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Astrue, No. 11 CV 4827, 2012 WL 2018534, at *9, (N.D. Ill. June 5, 2012). The ALJ
then relied on the ME’s recommendation and did not incorporate any concentration,
persistence, or pace limitations into the hypothetical he posed to the VE. (Id. at 22,
48); see Young v. Barnhart, 362 F.3d 995, 1003 (7th Cir. 2004) (“Ordinarily, a
hypothetical question to the [VE] must include all limitations supported by medical
evidence in the record.”). On remand, the ALJ should revisit the ME’s testimony
and determine whether new expert testimony is necessary to accurately consider
the evidence and properly incorporates all limitations supported by the record.
Conclusion
For the foregoing reasons, Hoagland’s motion for summary judgment is
granted and the Commissioner’s is denied.

The case is remanded for further

proceedings consistent with this opinion.
ENTER:

____________________________________
Young B. Kim
United States Magistrate Judge

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