Holland v. Commissioner of Social Security Administration

Filing 33

OPINION AND ORDER: The decision of the Commissioner is REVERSED, and the case is REMANDED to the Commissioner in accordance with this Opinion and Order. Judgment is entered in favor of Holland and AGAINST the Commissioner. Signed by Magistrate Judge Susan L Collins on 7/19/2016. (tc)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF INDIANA
FORT WAYNE DIVISION
DANNY C. HOLLAND,

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Plaintiff,
v.
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.

CAUSE NO. 1:15-cv-00064-SLC

OPINION AND ORDER
Plaintiff Danny Holland appeals to the district court from a final decision of the
Commissioner of Social Security (“Commissioner”) denying his application under the Social
Security Act (the “Act”) for disability insurance benefits and disabled widower’s benefits
(together, “DIB”).1 (DE 1). For the following reasons, the Commissioner’s decision will be
REVERSED, and the case will be REMANDED to the Commissioner for further proceedings in
accordance with this Opinion and Order.
I. PROCEDURAL HISTORY
Holland applied for DIB in March 2012, alleging disability as of September 20, 2008,
which he later amended to July 20, 2011.2 (DE 10 Administrative Record (“AR”) 25, 228-31,
259-62, 271). The Commissioner denied Holland’s application initially and upon
reconsideration. (AR 137, 164). After a timely request, a hearing was held on March 7, 2013,

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All parties have consented to the Magistrate Judge. (DE 13); see 28 U.S.C. § 636(c).

This is Holland’s second application for disability benefits. (AR 95). His first application, which alleged
an onset date of July 1, 2005, was denied on July 19, 2011. (AR 111-14). Holland did not seek judicial review of
that decision.

before Administrative Law Judge William D. Pierson (“the ALJ”), at which Holland, who was
represented by counsel, and a vocational expert, Amy Kutschbach (the “VE”), testified. (AR 5491). On April 15, 2013, the ALJ rendered an unfavorable decision to Holland, concluding that
he was not disabled because despite the limitations caused by his impairments, he could perform
a significant number of unskilled, light jobs in the economy. (AR 22-36). The Appeals Council
granted Holland’s request for review and issued Holland a partially favorable decision by finding
that he was disabled as of April 15, 2013, but not before that date. (AR 1-18, 358).
Holland filed a complaint with this Court on March 10, 2015, seeking relief from the
Commissioner’s decision with respect to the finding that he was not disabled before April 15,
2013. (DE 1). In doing so, Holland advances just one argument—that the ALJ failed to
adequately account for his moderate limitations in concentration, persistence, or pace when
determining his residual functional capacity (“RFC”) and when posing the hypotheticals to the
VE at step five. (DE 18 at 10-12).
II. FACTUAL BACKGROUND3
At the time of the ALJ’s decision, Holland was 54 years old (AR 266); had a fifth or sixth
grade education with no special education classes (AR 7, 61, 272); and possessed past work
experience as a machine operator and handyman (AR 321, 324). He alleges disability due to
subtle chondromalacia and subtle fissuring of the femoral articular surface and mild narrowing of
the medial compartment of the right knee, degenerative disc disease, hypertension, spondylosis
of the cervical spine, chronic kidney disease, gastroesophageal reflux disease, panic attacks,

3

In the interest of brevity, this Opinion recounts only the portions of the 733-page administrative record
necessary to the decision.

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major depressive disorder, agoraphobia, explosive disorder, personality disorder, and borderline
intellectual functioning. (DE 18 at 2). Holland does not challenge the ALJ’s consideration of
his physical impairments, and thus, the Court will focus on the evidence pertaining to his mental
impairments. (DE 18 at 3-8).
A. Holland’s Testimony at the Hearing
At the hearing, Holland testified that he is a widower and lives alone in a house. (AR
59-60, 70). He had obtained Medicaid benefits two years earlier and was on Medicaid at the
time. (AR 60). A friend had driven him to the hearing; Holland drives infrequently because he
has difficulty maintaining his right foot on the gas pedal. (AR 60-61). He stated that he had not
worked since injuring his shoulder in a fall three or four years earlier. (AR 61). Holland stated
that he cannot read or write other than to sign his name, but he can recognize some small,
familiar words, including the names of his medications. (AR 63-64). On a typical day, Holland
gets up at about 10:30 a.m., takes his medication, and then lies back down. (AR 75-76). He
spends most of his day sitting or lying down. (AR 76). Holland prepares light meals in the
microwave, but his daughter does his housework and most of his shopping and errands. (AR 7677).
Holland testified that he cannot focus, that he has an explosive temper, and that he cannot
be around people. (AR 68). He stated that he isolates himself due to his temper, reporting that
he had assaulted three people in the past, including while he was at work. (AR 68, 71). He had
not consumed alcohol in the past six months, but previously had been drinking eight beers a day.
(AR 69). Since stopping his use of alcohol, Holland has felt much better and his temper is now
mostly under control. (AR 68-71). The last time Holland had assaulted anyone was two-and-a3

half years prior to the hearing. (AR 72). He reported that his temper is triggered, at least in part,
by his constant shoulder pain. (AR 72). He indicated that his medications help to control his
temper and his pain, which he rated on a scale of one to 10 as “a six or a seven” with medication.
(AR 72-73).
B. Summary of the Relevant Medical Evidence
In September 2009, Henry Martin, Ph.D., performed a psychological evaluation and
intellectual assessment of Holland at the request of Social Security. (AR 383-87). Holland told
Dr. Martin that he had worked for Foster Forbes Glass Company for 22 years. (AR 384). He
stated that he spends most of his time at home watching television or sitting outside; a few times
each week, he drives to visit his brother or run an errand. (AR 384). He depends on his
daughter to help pay his bills, run most errands, and grocery shop. (AR 384). His mood and
affect were anxious and depressed. (AR 384). Results of the Wechsler Adult Intelligence Scale,
Fourth Edition, revealed a full scale IQ of 70, a verbal comprehension index of 70, a perceptual
reasoning index of 90, a working memory index of 69, and a processing speed index of 65. (AR
384-85). Dr. Martin’s diagnostic impression was borderline intellectual functioning and a
learning disability: verbal language deficits. (AR 385). He found that Holland was capable of
managing his own funds. (AR 386).
In June 2010, Holland was evaluated at the Grant Blackford Mental Health agency,
stating that he was seeking medications and disability benefits for his depression and other
mental health issues. (AR 388-93). A mental status exam revealed a cooperative attitude,
depressed mood, tearful affect, paranoid thought content, circumstantial thought process, normal
cognition, below average intelligence, poor insight, agitated psychomotor, no suicidal thoughts,
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and no present violent or homicidal thoughts. (AR 391). Holland reported difficulty
concentrating on tasks, poor memory recall, intermittent irritability, some difficulty making
decisions, paranoid thoughts, obsession with cleanliness, poor writing skills, limited reading
skills, and poor sleep. (AR 392). He was taking Zoloft, which was somewhat helpful. (AR
392). He reported difficulty going out in public, that he feels overwhelmed, that he has panic
attacks almost daily, and that he tends to isolate himself. (AR 391-92). During the evaluation,
Holland had difficulty focusing, became confused at times, and required redirection. (AR 392).
He was assigned a Global Assessment of Functioning (“GAF”) score of 50 and diagnosed with
adjustment disorder with mixed anxiety and depression mood, and post traumatic stress
disorder.4 (AR 391-92).
In July 2010, Holland returned to Grant Blackford Mental Health. (AR 395). He
reported having eight to 10 panic attacks a day, each lasting up to 15 minutes. (AR 395).
Holland stated that he was claustrophobic and that he had bad anxiety and a “real bad temper.”
(AR 395). He claimed to have suicidal thoughts as recently as the previous day; however, he did
not appear distressed. (AR 395). The examiner noted that Holland used passive language,
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GAF scores reflect a clinician’s judgment about the individual’s overall level of functioning. Am.
Psychiatric Ass’n, Diagnostic & Statistical Manual of Mental Disorders 32 (4th ed., Text Rev. 2000). A GAF score
of 31 to 40 reflects some impairment in reality testing or communication or major impairment in several areas, such
as work or school, family relations, judgment, thinking, or mood. Id. A GAF score of 41 to 50 reflects serious
symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) or any serious impairment in
social, occupational, or school functioning (e.g., no friends, unable to keep a job). Id. A GAF score of 51 to 60
reflects moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) or moderate
difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or co-workers). Id. A
GAF score of 61 to 70 reflects some mild symptoms or some difficulty in social, occupational, or school functioning,
but “generally functioning pretty well.” Id.
“The American Psychiatric Association no longer uses the GAF as a metric.” Spencer v. Colvin, No. 13-cv1487, 2015 WL 684545, at *17 n.5 (C.D. Ill. Feb. 17, 2015) (citing Am. Psychiatric Ass’n, Diagnostic & Statistical
Manual of Mental Disorders 16 (5th ed. 2013)). However, the medical sources of record used GAF scores in
assessing Holland, so they are relevant to the ALJ’s decision. See id. (citing Bates v. Colvin, 736 F.3d 1093, 1099
(7th Cir. 2013)).

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which indicated to the examiner that Holland was poor at taking responsibility for his emotions
and actions. (AR 398-99). Holland’s Zoloft was discontinued, and he was started on Lexapro.
(AR 399). Holland was diagnosed with panic disorder with agoraphobia, depressive disorder,
and personality disorder not otherwise specified. (AR 399).
On April 26, 2011, Sajjad Habib, M.D., examined Holland upon referral from Bridges to
Health for his hypertension. (AR 630-33). Dr. Habib performed a mental status exam as part of
the new patient exam and found that Holland’s mental status, attention span, and ability to
concentrate were all normal. (AR 632).
In May 2012, Dr. Martin saw Holland for another mental status examination at the
request of Social Security. (AR 582-86). Holland was very disorganized in his presentation of
material; he rambled and was circumstantial during the interview. (AR 584). His recall of a
sequence of events was poor; he had limited insight into the nature of his problems. (AR 584).
He was unable to recall any objects on a five-minute delayed recall; he was able to do simple
addition, but not division, multiplication, or subtraction. (AR 585). His general emotional
demeanor was unstable; several times he made vague threats that he “wasn’t afraid of whipping
someone who made him mad.” (AR 584). Dr. Martin noted that Holland took some pride in
stating that he had choked several coworkers when he was still working; Holland also stated that
he had “whipped” a neighbor a year ago and had recently “thought about whipping” a
cardiologist who had asked if he was lazy. (AR 584). Holland admitted that he had physically
attacked his daughter’s boyfriend, after which his daughter stopped helping Holland. (AR 584).
Holland told Dr. Martin: “If I lose my temper I will whip you.” (AR 584).
Holland further reported that he was having frequent panic attacks, but that he is better
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when taking his Xanax. (AR 586). Dr. Martin’s diagnostic impression on Axis I was major
depression, agoraphobia with panic attacks, and intermittent explosive disorder; on Axis II,
personality disorder and borderline intellectual functioning; on Axis IV, severe psychosocial
stressors: chronic pain and limited social support system; and on Axis V, a current GAF score of
40. (AR 586). Dr. Martin concluded by stating that during the appointment Holland was
disorganized and circumstantial in his presentation of material and his emotional and behavioral
status was very unstable and, at times, threatening. (AR 586). Dr. Martin opined that Holland
would need a payee to manage his funds. (AR 586).
In May 2012, Maura Clark, Ph.D., a state agency psychologist, reviewed Holland’s
record and completed psychiatric review technique and mental RFC forms. (AR 588-605). On
the psychiatric review technique, Dr. Clark found that Holland had moderate restrictions in
activities of daily living; in maintaining social functioning; and in maintaining concentration,
persistence, or pace; but he had no episodes of decompensation of extended duration. (AR 598).
On the mental RFC form, Dr. Clark indicated that Holland was moderately limited in
understanding, remembering, and carrying out detailed instructions; maintaining attention and
concentration for extended periods; interacting appropriately with the general public; accepting
instructions and responding appropriately to criticism from supervisors; and getting along with
coworkers or peers without distracting them or exhibiting behavioral extremes. (AR 602-03).
Holland was not significantly limited in the remaining 14 categories. (AR 602-03).
In her narrative summary, Dr. Clark summarized the mental health evaluations and
evidence of record, concluding that Holland’s presentation to Dr. Martin at the May 2012 exam
was inconsistent with the totality of the evidence of record. (AR 604). She noted that Holland
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was not currently receiving any psychiatric treatment or psychotherapy services. (AR 604). She
opined that his attention and concentration were moderately impacted. (AR 604). Dr. Clark
further concluded that Holland could manage occasional contact with the public, but that
sustained, intensive, interpersonal contact would be precluded; she stated that he would work
best alone, in semi-isolation from others or as part of a small group. (AR 604). She found that
Holland was able to maintain at least a minimal level of relationship with others, and that he
could work with a supervisor who was normally considerate and positive, but would have
problems with a supervisor who was often negative, critical, or quarrelsome. (AR 604). Dr.
Clark concluded that the totality of evidence of record suggested that Holland could understand,
carry out, and remember simple instructions; make judgments commensurate with the functions
of unskilled work; respond appropriately to brief supervision and interactions with coworkers
and work situations; and deal with changes in a routine work setting. (AR 605). Dr. Clark’s
opinion was subsequently reviewed and affirmed by Joelle Larsen, Ph.D., a second state agency
psychologist. (AR 684).
In February 2013, Dale Economan, M.D., completed a medical assessment of ability to
do work related activities (physical) form. (AR 732-33). He indicated that Holland was unable
to maintain the emotional and mental stability and concentration to work 40 hours per week.
(AR 732).
III. STANDARD OF REVIEW
Section 405(g) of the Act grants this Court “the power to enter, upon the pleadings and
transcript of the record, a judgment affirming, modifying, or reversing the decision of the
[Commissioner], with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). The
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Court’s task is limited to determining whether the ALJ’s factual findings are supported by
substantial evidence, which means “such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Schmidt v. Barnhart, 395 F.3d 737, 744 (7th Cir. 2005)
(citation omitted). The decision will be reversed only if it is not supported by substantial
evidence or if the ALJ applied an erroneous legal standard. Clifford v. Apfel, 227 F.3d 863, 869
(7th Cir. 2000) (citation omitted).
To determine if substantial evidence exists, the Court reviews the entire administrative
record but does not reweigh the evidence, resolve conflicts, decide questions of credibility, or
substitute its judgment for the Commissioner’s. Id. Rather, if the findings of the Commissioner
are supported by substantial evidence, they are conclusive. Jens v. Barnhart, 347 F.3d 209, 212
(7th Cir. 2003) (citation omitted). “In other words, so long as, in light of all the evidence,
reasonable minds could differ concerning whether [the claimant] is disabled, we must affirm the
ALJ’s decision denying benefits.” Books v. Chater, 91 F.3d 972, 978 (7th Cir. 1996).
IV. ANALYSIS
A. The Law
Under the Act, a claimant is entitled to DIB if he establishes an “inability to engage in
any substantial gainful activity by reason of any medically determinable physical or mental
impairment which can be expected to . . . last for a continuous period of not less than 12
months.” 42 U.S.C. §§ 416(i)(1), 423(d)(1)(A). A physical or mental impairment is “an
impairment that results from anatomical, physiological, or psychological abnormalities which are
demonstrable by medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C.
§ 423(d)(3).
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The Commissioner evaluates disability claims pursuant to a five-step evaluation process,
requiring consideration of the following issues, in sequence: (1) whether the claimant is currently
unemployed; (2) whether the claimant has a severe impairment; (3) whether the claimant’s
impairment meets or equals one of the impairments listed by the Commissioner, see 20 C.F.R. §
404, Subpt. P, App’x 1; (4) whether the claimant is unable to perform his past work; and (5)
whether the claimant is incapable of performing work in the national economy.5 See Dixon v.
Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001) (citations omitted); 20 C.F.R. § 404.1520. An
affirmative answer leads either to the next step or, on steps three and five, to a finding that the
claimant is disabled. Zurawski v. Halter, 245 F.3d 881, 886 (7th Cir. 2001) (citation omitted). A
negative answer at any point other than step three stops the inquiry and leads to a finding that the
claimant is not disabled. Id. (citation omitted). The burden of proof lies with the claimant at
every step except the fifth, where it shifts to the Commissioner. Clifford, 227 F.3d at 868
(citation omitted).
B. The Commissioner’s Final Decision
On January 8, 2015, the Appeals Council adopted in part the findings and conclusions
articulated by the ALJ on April 15, 2013; therefore, the ALJ’s decision, as modified by the
Appeals Council, became the Commissioner’s final decision. (AR 1-11, 22-36). The ALJ
concluded at step one of the five-step analysis that Holland had not engaged in substantial
gainful activity since July 20, 2011, his amended alleged onset date. (AR 6, 25). At step two,
the ALJ found that Holland had the following severe impairments: subtle chondromalacia and
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Before performing steps four and five, the ALJ must determine the claimant’s RFC or what tasks the
claimant can do despite his limitations. 20 C.F.R §§ 404.1520(e), 404.1545(a). The RFC is then used during steps
four and five to help determine what, if any, employment the claimant is capable of. 20 C.F.R. § 404.1520(e).

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subtle fissuring of the femoral articular surface and mild narrowing of the medial compartment
of the right knee, mild to moderate degenerative disc disease of the thoracic spine, hypertension,
mild spondylosis of the cervical spine, mild degenerative disc disease of the lumbar spine, mild
and stable chronic kidney disease, mild gastroesophageal reflux disease, panic attacks, major
depressive disorder, agoraphobia, explosive disorder, personality disorder, borderline intellectual
functioning, and degenerative joint disease. (AR 6, 25).
At step three, the ALJ concluded that Holland did not have an impairment or combination
of impairments severe enough to meet or equal a listing. (AR 25-27). Before proceeding to step
four, the ALJ determined that Holland’s symptom testimony was not entirely credible and
assigned him the following RFC:
[T]he claimant has the [RFC] to perform light work . . . except [he] can sit, stand
or walk six hours in an eight-hour workday; lift, carry, push or pull 10 pounds
frequently, 20 pounds occasionally; occasional[ly] kneel, crouch, or crawl; no
ropes, ladders or scaffolds; occasionally use the stairs and ramps; frequent
bending and stooping in addition to what is required to sit; and the claimant
would require a cane for the purpose of prolonged walking and uneven surfaces.
The claimant is limited to superficial interaction with coworkers, supervisors and
the public, superficial is defined as occasional and casual; no prolonged
conversation; contact with supervisors still involves necessary instructions; is also
limited to simple, routine, repetitive tasks, in other words the claimant can
remember simple work like procedures, can maintain sufficient concentration to
attend to simple tasks with normal work breaks; is limited to a low stress job with
occasional decision making, occasional changes in the work setting and can
tolerate predictable changes in the work environment.
(AR 6, 27-28). The ALJ found at step four that Holland had no past relevant work. (AR 6, 34).
At step five, based on the assigned RFC and the VE’s testimony, the ALJ concluded that Holland
could perform a significant number of unskilled, light jobs in the economy, including repack
room worker, laundry worker, and mail sorter; thus, he was not disabled. (AR 35-36).

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The Appeals Council, however, observed that Holland had reached the age of 55
approximately four months after the ALJ issued his decision. (AR 7). As such, the Appeals
Council chose to apply the borderline age provision, 20 C.F.R. § 404.1563(b), and considered
Holland to be of advanced age as of the date of the ALJ’s decision. (AR 8). The Appeals
Council found that an individual of advanced age with Holland’s medical and vocational factors
would be disabled pursuant to Medical-Vocational Rule 202.01. (AR 8). Therefore the Appeals
Council modified the ALJ’s decision and concluded that Holland was disabled since April 13,
2013, but not before that date. (AR 8).
C. The ALJ Failed to Adequately Account for Holland’s Moderate Deficits in
Concentration, Persistence, or Pace in the RFC and in the Hypotheticals to the VE
Holland’s sole argument on appeal is that the ALJ failed to adequately account for his
moderate deficiencies in maintaining concentration, persistence, or pace when assigning the
mental RFC and when posing the hypotheticals to the VE at step five. Holland’s argument
ultimately has merit, necessitating a remand of the Commissioner’s final decision.
As explained earlier, “RFC is what an individual can still do despite his or her
limitations.” SSR 96-8p, 1996 WL 374184, at *2 (July 2, 1996); see also 20 C.F.R. §
404.1545(a)(1). The “RFC is not the least an individual can do despite his or her limitations or
restrictions, but the most.” SSR 96-8p, 1996 WL 374184, at *1. “The RFC assessment must be
based on all of the relevant evidence in the case record . . . .” SSR 96-8p, 1996 WL 374184, at
*5; see 20 C.F.R. § 404.1545(a)(3). Cases from the Seventh Circuit Court of Appeals “generally
have required the ALJ to orient the VE to the totality of a claimant’s limitations.” O’ConnorSpinner v. Astrue, 627 F.3d 614, 619 (7th Cir. 2010) (citations omitted). “[The] cases, taken

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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 hypothetical.” Id.
More specifically, in O’Connor-Spinner, the Seventh Circuit concluded that the ALJ
erred where he found that the claimant had moderate difficulties in concentration, persistence, or
pace, but failed to specifically observe this limitation when posing hypotheticals to the VE at
step five. Id. at 620-21. In doing so, the court acknowledged that it has not insisted “on a per se
requirement that this specific terminology (‘concentration, persistence and pace’) be used in the
hypothetical in all cases.” Id. at 619. The court explained:
We also have let stand an ALJ’s hypothetical omitting the terms
‘concentration, persistence and pace’ when it was manifest that the
ALJ’s alternative phrasing specifically excluded those tasks that
someone with the claimant’s limitations would be unable to
perform. We most often have done so when a claimant’s
limitations were stress- or panic-related and the hypothetical
restricted the claimant to low-stress work.
Id. at 619 (citing Arnold v. Barnhart, 473 F.3d 816, 820 (7th Cir. 2007) (upholding a
hypothetical restricting the claimant to work involving low production standards and a low-stress
environment, where the claimant’s difficulties with concentration, persistence, or pace arose
from stress-induced headaches, frustration, and anger); Johansen v. Barnhart, 314 F.3d 283,
288-89 (7th Cir. 2002) (allowing a hypothetical formulated in terms of “repetitive, low-stress”
work to stand, where the claimant’s deficits in concentration, persistence, or pace stemmed from
a panic disorder); Sims v. Barnhart, 309 F.3d 424, 427, 431-32 (7th Cir. 2002) (finding that the
ALJ’s restricting the claimant from jobs “involving complex work processes or unusual levels of
stress” adequately accommodated the claimant’s concentration problems arising, in part, from a
panic disorder)).
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“In most cases, however, employing terms like ‘simple, repetitive tasks’ on their own
will not necessarily exclude from the VE’s consideration those positions that present significant
problems of concentration, persistence and pace.” Id. at 620 (finding that a restriction to
repetitive tasks with simple instructions did not necessarily account for the claimant’s
depression-related problems in concentration, persistence, and pace) (collecting cases); see also
Warren v. Colvin, 565 F. App’x 540, 544 (7th Cir. 2014) (finding that a limitation to “simple,
repetitive tasks” did not adequately account for the claimant’s concentration problems arising
from depression and borderline intellectual functioning); Yurt v. Colvin, 758 F.3d 850, 859 (7th
Cir. 2014) (concluding that a limitation to unskilled work did not sufficiently account for the
claimant’s concentration problems stemming from depression and a psychotic disorder). “The
ability to stick with a given task over a sustained period is not the same as the ability to learn
how to do tasks of a given complexity.” O’Connor-Spinner, 627 F.3d at 620 (citing Stewart v.
Astrue, 561 F.3d 679, 684-85 (7th Cir. 2009); Craft v. Astrue, 539 F.3d 668, 677 (7th Cir. 2008);
Kasarsky v. Barnhart, 335 F.3d 539, 544 (7th Cir. 2003); SSR 85-15, 1985 WL 56857, at *6
(Jan. 1, 1985)).
“Because 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.” SSR 85-15, 1985 WL 56857, at *6 (“The
mentally impaired may cease to function effectively when facing such demands as getting to
work regularly, having their performance supervised, and remaining in the workplace for a full
day. . . . Thus, the mentally impaired may have difficulty meeting the requirements of even so14

called ‘low-stress’ jobs.”). Accordingly, the RFC and hypotheticals “must account for both the
complexity of the tasks and the claimant’s ability to stick with a task over a sustained period.”
Warren, 565 F. App’x at 544 (emphasis added) (citations omitted); see Yurt, 758 F.3d at 858
(articulating that an RFC for unskilled work “by itself does not provide any information about
[the claimant’s] mental condition or abilities”).
Here, the ALJ concluded that Holland had moderate limitations in concentration,
persistence, or pace when considering the paragraph B criteria. (AR 26). Specifically, the ALJ
stated:
With regard to concentration, persistence, or pace, the claimant has
moderate difficulties. The evidence in the record, including the
testimony of the claimant at the hearing, shows that the claimant
has some difficulty in sustaining focus, attention and concentration
sufficiently long enough to permit the timely and appropriate
completion of tasks commonly found in work settings.
(AR 26). The ALJ, however, did not include this limitation in the RFC and the hypotheticals to
the VE. (AR 27-28, 83-87). Instead, the ALJ assigned an RFC limiting Holland, in relevant
part, to:
[S]imple, routine, repetitive tasks, in other words the claimant can remember
simple work like procedures, can maintain sufficient concentration to attend to
simple tasks with normal work breaks; is limited to a low stress job with
occasional decision making, occasional changes in the work setting and can
tolerate predictable changes in the work environment.
(AR 27-28). The ALJ then posed a hypothetical to the VE that was consistent with the RFC.
(AR 83-87).
Holland has several mental impairments which the ALJ found to be “severe” at step two:
panic attacks, major depressive disorder, agoraphobia, explosive disorder, personality disorder,

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and borderline intellectual functioning. (AR 25). The ALJ did not discuss whether Holland’s
problems with concentration, persistence, or pace stem from one of these disorders, or rather, all
of these disorders in combination. Consequently, this case does not fall neatly within the
exception noted in Johansen, where the claimant’s concentration problems stemmed from a
panic disorder and a hypothetical for “low-stress, repetitive” work was found adequate. 314
F.3d at 289. Instead, the Court must follow the O’Connor-Spinner precedent, where the
claimant’s concentration problems were depression-related and a hypothetical for “repetitive
tasks with simple instructions” was found inadequate. 627 F.3d at 620.
Additionally, there is a physical condition at issue in this case. Holland testified that his
anger problems are triggered by his chronic pain. Thus, Holland’s chronic pain may also
contribute to his problems with attention and concentration. The ALJ, however, did not mention
his chronic pain in the hypotheticals posed to the VE. Compare Simila v. Astrue, 573 F.3d 503,
521-22 (7th Cir. 2009) (finding that the claimant’s moderate deficits in concentration,
persistence, or pace, which stemmed from his chronic pain syndrome and somatoform disorder,
were adequately accounted for in a hypothetical for unskilled work where the ALJ included the
claimant’s chronic pain and somatoform in the hypothetical), with Gomez v. Colvin, 73 F. Supp.
3d 921, 932 (N.D. Ill. 2014) (finding that the ALJ’s limitation to unskilled, low-stress work did
not account for the claimant’s concentration problems, which stemmed from pain, rather than
stress), and Copeland v. Astrue, 776 F. Supp. 2d 828, 845 (N.D. Ind. 2011) (remanding case
where the ALJ did not orient the vocational expert to the claimant’s moderate deficiencies in
concentration, persistence, or pace resulting from her mental health function and chronic pain).
The Commissioner acknowledges that the ALJ did not expressly include Holland’s
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moderate difficulties in concentration, persistence, or pace in the RFC or in the hypotheticals
posed to the VE, but contends that the ALJ did not need to include these limitations in the RFC
because an ALJ’s finding of limitations when considering the paragraph B criteria is not an RFC
assessment. Rather, an RFC determination requires “a more detailed assessment.” (DE 25 at 5).
While the Court agrees that the ALJ’s findings at step two and three when considering the
paragraph B criteria are not, themselves, an RFC assessment, the ALJ’s opinion must
nevertheless be consistent within itself and build a logical bridge for the ALJ’s reasoning. See
Clifford, 227 F.3d at 872 (The ALJ “must build an accurate and logical bridge from the evidence
to his conclusion.” (citations omitted)); Rohan v. Chater, 98 F.3d 966, 971 (7th Cir. 1996)
(stating that the ALJ’s decision must demonstrate the path of her reasoning, and the evidence
must lead logically to her conclusion).
Moreover, here, the ALJ assigned significant weight to the opinion of Dr. Clark, the state
agency psychologist.6 (AR 33). Dr. Clark opined not only in Section I but also in the narrative
portion of the mental RFC assessment that Holland’s ability to maintain attention and
concentration for extended periods was moderately limited. (AR 33, 602, 604). Yet, the ALJ
did not include this limitation in the RFC or in the hypotheticals posed to the VE. Instead the
ALJ limited Holland to simple, routine, and repetitive tasks, stating that he could “maintain
sufficient concentration to attend to simple tasks with normal work breaks.” (AR 27).

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When assigning significant weight to Dr. Clark’s opinion, the ALJ stated: “The undersigned gives this
opinion significant weight, as it is consistent with and supported by the medical evidence of record and the findings
of the consultative examiner.” (AR 33). The Court is hard-pressed, however, to see how Dr. Clark’s opinion is
consistent with the findings of Dr. Martin’s May 2012 examination in which Holland was rambling and
disorganized, had poor recall, demonstrated an unstable emotional demeanor, and voiced vague threats to the
examiner. (AR 32, 582-86).

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In defending this RFC, the Commissioner argues that the ALJ properly relied on the
opinion of Dr. Clark when assigning the RFC, because Dr. Clark “translated [her] step 2 and 3
opinions [of moderate deficits in concentration, persistence, or pace] into functional capacity
assessments.” (DE 25 at 5). In doing so, the Commissioner urges that this case is analogous to
Johansen, in which the administrative law judge relied upon the opinion of a consulting
physician who “translated [his] findings into a specific RFC assessment” and the ALJ then relied
on that translation. 314 F.3d at 289.
The problem here, however, is that Dr. Clark never actually translated her finding of
moderate deficits in attention and concentration into a functional assessment. That is, Dr. Clark
never opined that Holland had the attention and concentration necessary to attend to simple tasks
with normal work breaks. Rather, Dr. Clark stated in her narrative assessment that Holland’s
attention and concentration were “moderately impacted” and that he was able to “understand,
carry out and remember simple instructions; able to make judgments commensurate with
functions of unskilled work; able to respond appropriately to brief supervision and interactions
with coworkers and work situations; [and] able to deal with changes in a routine work setting.”
(AR 605). Dr. Clark’s functional assessment, however, is silent as to Holland’s ability to “stick
with a task over a sustained period.” Warren, 565 F. App’x at 544 (citations omitted).
Consequently, the Court is not convinced that the ALJ relied on Dr. Clark’s “translation”
of Holland’s moderate deficits in concentration and attention when assigning the RFC. Rather, it
appears that the ALJ merely assumed that a limitation to simple, repetitive work automatically
accounted for Holland’s moderate deficits in concentration and attention. See Dehart v. Colvin,
No. 4:12-cv-137-WGH-TWP, 2013 WL 6440504, at *3 (S.D. Ind. Dec. 9, 2013) (emphasizing
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that an ALJ may not merely assume that a limitation to simple, repetitive work will
“automatically account” for moderate limitations in concentration, persistence, or pace (citing
Stewart, 561 F.3d at 684-85)). The Seventh Circuit has “repeatedly rejected the notion that a
hypothetical . . . ‘confining the claimant to simple, routine tasks . . . adequately captures . . .
limitations in concentration, persistence, and pace.’” Varga v. Colvin, 794 F.3d 809, 814 (7th
Cir. 2015); see also Yurt, 758 F.3d at 858-59 (“[W]e have repeatedly rejected the notion that a
hypothetical . . . confining the claimant to simple routine tasks and limited interactions with
others adequately captures temperamental deficiencies and limitations in concentration,
persistence, and pace.”) (collecting cases); Stanifer v. Colvin, No. 4:13-CV-053-JD, 2015 WL
437773, at *11 (N.D. Ind. Feb. 3, 2015) (“[T]he ALJ committed error by not explaining what
evidence supported [his] belief that the plaintiff was able to complete tasks, even if repetitive and
simple, over a sustained period of time at a competitive pace.”).
Accordingly, the Commissioner’s final decision will be remanded for the purpose of
reassessing Holland’s mental RFC with respect to his moderate limitations in maintaining
concentration, persistence, or pace.
V. CONCLUSION
For the foregoing reasons, the decision of the Commissioner is REVERSED, and the case
is REMANDED to the Commissioner in accordance with this Opinion and Order. The Clerk is
directed to enter a judgment in favor of Holland and against the Commissioner.
SO ORDERED.
Entered this 19th day of July 2016.
/s/ Susan Collins
Susan Collins,
United States Magistrate Judge
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