REESE v. SAUL

Filing 20

ORDER - The Court REVERSES the ALJ's decision denying the Plaintiff benefits and REMANDS this matter for further proceedings pursuant to 42 U.S.C. § 405(g) (sentence four). Final judgment will issue accordingly. (SEE ORDER). Signed by Magistrate Judge Doris L. Pryor on 9/19/2022.(KAA)

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UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF INDIANA
TERRE HAUTE DIVISION
LISA M. R 1.,

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Plaintiff,
v.
KILOLO KIJAKAZI,
Defendant.

No. 2:21-cv-00148-DLP-JRS

ORDER
Plaintiff Lisa M. R. requests judicial review of the denial by the
Commissioner of the Social Security Administration ("Commissioner") of her
application for Disability Insurance Benefits ("DIB") under Title II and
Supplemental Security Income ("SSI") under Title XVI of the Social Security Act.
See 42 U.S.C. §§ 405(g); 1383(c). For the reasons set forth below, the Court hereby
REVERSES the ALJ's decision denying the Plaintiff benefits and REMANDS this
matter for further consideration.
I.

PROCEDURAL HISTORY
On October 29, 2019, Lisa protectively filed her application for Title II DIB

and on November 18, 2019, protectively filed her application for Title XVI SSI. (Dkt.
14-2 at 19, R. 18). Lisa alleged disability resulting from post-traumatic stress

In an effort to protect the privacy interests of claimants for Social Security benefits, the Southern
District of Indiana has adopted the recommendations put forth by the Court Administration and
Case Management Committee of the Administrative Office of the United States Courts regarding the
practice of using only the first name and last initial of any non-government parties in Social Security
opinions. The Undersigned has elected to implement that practice in this Order.
1

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disorder; bipolar I disorder; depression; anxiety; insomnia; a neck and back injury
with resulting pain; and severe bunions. (Dkt. 14-6 at 6, R. 221). The Social Security
Administration ("SSA") denied Lisa's claim initially on March 20, 2020, (Dkt. 14-3
at 2-3, R. 61-62), and on reconsideration on June 10, 2020. (Id. at 25-26, R. 84-85).
On June 16, 2020, Lisa filed a request for a hearing, which was granted. (Dkt. 14-4
at 37, R. 143).
On September 4, 2020, Administrative Law Judge ("ALJ") Shelette Veal
conducted a hearing from Orland Park, Illinois, with Lisa, her counsel, and
vocational expert Stephanie Archer participating by phone. (Dkt. 14-2 at 38, R. 37).
On November 4, 2020, ALJ Veal issued an unfavorable decision finding that Lisa
was not disabled. (Id. at 19-31, R. 18-30). On November 4, 2020, the SSA received
Lisa's appeal of the ALJ's decision. (Dkt. 14-4 at 79-81, R. 185-87). On January 15,
2021, the Appeals Council denied Lisa's request for review, making the ALJ's
decision final. (Dkt. 14-2 at 2-4, R. 1-3). Lisa now seeks judicial review of the ALJ's
decision denying benefits pursuant to 42 U.S.C. §§ 405(g); 1383(c).
II.

STANDARD OF REVIEW
To qualify for disability, a claimant must be disabled within the meaning of

the Social Security Act. To prove disability, a claimant must show she is unable to
"engage in any substantial gainful activity by reason of any medically determinable
physical or mental impairment which can be expected to result in death or which
has lasted or can be expected to last for a continuous period of not less than twelve
months." 42 U.S.C. § 423(d)(1)(A). To meet this definition, a claimant's impairments

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must be of such severity that she is not able to perform the works he previously
engaged in and, based on her age, education, and work experience, she cannot
engage in any other kind of substantial gainful work that exists in significant
numbers in the national economy. 42 U.S.C. § 423(d)(2)(A). The SSA has
implemented these statutory standards by, in part, prescribing a five-step
sequential evaluation process for determining disability. 20 C.F.R. §§ 416.920(a)
and 404.1520(a). 2 The ALJ must consider whether:
(1) the claimant is presently [un]employed; (2) the claimant has a
severe impairment or combination of impairments; (3) the
claimant's impairment meets or equals any impairment listed in
the regulations as being so severe as to preclude substantial
gainful activity; (4) the claimant's residual functional capacity
leaves h[er] unable to perform h[er] past relevant work; and
(5) the claimant is unable to perform any other work existing in
significant numbers in the national economy.
Briscoe ex rel. Taylor v. Barnhart, 425 F.3d 345, 351-52 (7th Cir. 2005) (citation
omitted). An affirmative answer to each step leads either to the next step or, at steps
three and five, to a finding that the claimant is disabled. 20 C.F.R. § 416.920;
Briscoe, 425 F.3d at 352. If a claimant satisfies steps one and two, but not three,
then she must satisfy step four. Once step four is satisfied, the burden shifts to the
SSA to establish that the claimant is capable of performing work in the national
economy. Knight v. Chater, 55 F.3d 309, 313 (7th Cir. 1995); see also 20 C.F.R. §

The Code of Federal Regulations contains separate, parallel sections pertaining to disability
benefits under the different titles of the Social Security Act. The parallel sections – applying to
disability insurance benefits and supplemental security income benefits – are verbatim and make no
substantive legal distinction based on the benefit type.

2

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416.920. (A negative answer at any point, other than step three and five, terminates
the inquiry and leads to a determination that the claimant is not disabled.).
After step three, but before step four, the ALJ must determine a claimant's
residual functional capacity ("RFC") by evaluating "all limitations that arise from
medically determinable impairments, even those that are not severe." Villano v.
Astrue, 556 F.3d 558, 563 (7th Cir. 2009). The RFC is an assessment of what a
claimant can do despite her limitations. Young v. Barnhart, 362 F.3d 995, 1000-01
(7th Cir. 2004). In making this assessment, the ALJ must consider all the relevant
evidence in the record. Id. at 1001. The ALJ uses the RFC at step four to determine
whether the claimant can perform her own past relevant work and if not, at step
five to determine whether the claimant can perform other work in the national
economy. See 20 C.F.R. § 416.920(a)(4)(iv)-(v).
The claimant bears the burden of proof through step four. Briscoe, 425 F.3d
at 352. If the first four steps are met, the burden shifts to the Commissioner at step
five. Id. The Commissioner must then establish that the claimant – in light of her
age, education, job experience, and residual functional capacity to work – is capable
of performing other work and that such work exists in the national economy. 42
U.S.C. § 423(d)(2); 20 C.F.R. § 416.920(f).
Judicial review of the Commissioner's denial of benefits is to determine
whether it was supported by substantial evidence or is the result of an error of law.
Dixon v. Massanari, 270 F.3d 1171, 1176 (7th Cir. 2001). This review is limited to
determining whether the ALJ's decision adequately discusses the issues and is

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based on substantial evidence. Substantial evidence "means – and means only –
such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion." Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019); Rice v. Barnhart, 384
F.3d 363, 369 (7th Cir. 2004). The standard demands more than a scintilla of
evidentiary support but does not demand a preponderance of the evidence. Wood v.
Thompson, 246 F.3d 1026, 1029 (7th Cir. 2001). Thus, the issue before the Court is
not whether Lisa is disabled, but, rather, whether the ALJ's findings were
supported by substantial evidence. Diaz v. Chater, 55 F.3d 300, 306 (7th Cir. 1995).
Under this administrative law substantial evidence standard, the Court
reviews the ALJ's decision to determine if there is a logical and accurate bridge
between the evidence and the conclusion. Roddy v. Astrue, 705 F.3d 631, 636 (7th Cir.
2013) (citing Craft v. Astrue, 539 F.3d 668, 673 (7th Cir. 2008)). In this substantial
evidence determination, the Court must consider the entire administrative record but
not "reweigh evidence, resolve conflicts, decide questions of credibility, or substitute
its own judgment for that of the Commissioner." Clifford v. Apfel, 227 F.3d 863, 869
(7th Cir. 2000), as amended (Dec. 13, 2000). Nevertheless, the Court must conduct a
critical review of the evidence before affirming the Commissioner's decision, and the
decision cannot stand if it lacks evidentiary support or an adequate discussion of the
issues. Lopez ex rel. Lopez v. Barnhart, 336 F.3d 535, 539 (7th Cir. 2003); see also
Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir. 2002).
When an ALJ denies benefits, she must build an "accurate and logical bridge
from the evidence to [her] conclusion," Clifford, 227 F.3d at 872, articulating a

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minimal, but legitimate, justification for the decision to accept or reject specific
evidence of a disability. Scheck v. Barnhart, 357 F.3d 697, 700 (7th Cir. 2004). The
ALJ need not address every piece of evidence in her decision, but she cannot ignore
a line of evidence that undermines the conclusions she made, and she must trace
the path of her reasoning and connect the evidence to her findings and conclusions.
Arnett v. Astrue, 676 F.3d 586, 592 (7th Cir. 2012); Clifford, 227 F.3d at 872.
III.

BACKGROUND

A. Factual Background
Lisa was 46 years old as of the alleged onset date of November 30, 2018. (Dkt.
14-6 at 2, R. 217). She obtained her GED. (Id. at 7, R. 222). She has past relevant
work history as an assistant manager and a security guard. (Dkt. 14-2 at 57-58, R.
56-57).
B. ALJ Decision
In determining whether Lisa qualified for benefits under the Act, the ALJ
employed the five-step sequential evaluation process set forth in 20 C.F.R. §§
404.1520(a) and 416.920(a) and concluded that Lisa was not disabled. (Dkt. 14-2 at
19-31, R. 18-30). At Step One, the ALJ found that Lisa had not engaged in
substantial gainful activity since the alleged onset date of November 30, 2018. (Id.
at 22, R. 21).
At Step Two, the ALJ found that Lisa suffered from the severe medically
impairments of right shoulder pain; bilateral bunions; tarsal tunnel bilaterally; left
bunionectomy; left tarsal tunnel release in the left ankle; anxiety; bipolar disorder;

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post-traumatic stress disorder; and alcohol use disorder. (Id.). The ALJ also found
that Lisa had the non-severe impairment of obesity. (Id.). The ALJ found that Lisa's
complaints of back pain did not constitute a medically determinable impairment.
(Id.).
At Step Three, the ALJ found that Lisa's impairments did not meet or
medically equal the severity of one of the listed impairments in 20 C.F.R. §§
404.1520(d); 404.1525; 404.1526; 416.920(d); 416.925; 416.926, specifically
considering Listings 1.02, 1.03, 12.04, 12.06, and 12.15. (Id. at 23-25, R. 22-24). As
to the "paragraph B" criteria, the ALJ found that Lisa has no limitation in
understanding, remembering, or applying information or in adapting or managing
herself, but moderate limitations in interacting with others and concentrating,
persisting, or maintaining pace. (Id. at 23-24, R. 22-23). The ALJ also found the
"paragraph C" criteria not satisfied. (Id. at 24-25, R. 23-24).
After Step Three but before Step Four, the ALJ found that Lisa had the
residual functional capacity ("RFC") to perform light work, as defined in 20 CFR
404.1567(b) and 416.967(b), with the following limitations: occasionally lift twenty
pounds and frequently lift or carry ten pounds; stand or walk for six hours and sit
for six hours per eight-hour workday; occasional climbing of ramps or stairs,
ladders, ropes, or scaffolds; frequent balancing on level surfaces; occasional
stooping, kneeling, crouching, and crawling; perform detailed, but not complex
tasks; maintain sufficient attention and concentration to perform tasks with

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reasonable pace and persistence; occasional contact with supervisors, coworkers,
and the public. (Dkt. 14-2 at 25, R. 24).
At Step Four, the ALJ determined that Lisa was able to perform her past
relevant work as a security guard. (Id. at 30, R. 29). The ALJ thus concluded that
Lisa was not disabled. (Id. at 31, R. 30).
IV.

ANALYSIS
Lisa argues that this matter should be remanded because the (1) ALJ's

decision is based on cherry-picked evidence that overlooks her difficulties in
functioning and fails to provide an accurate and logical bridge to support the critical
findings and conclusions; (2) ALJ conducted an improper Step Three analysis; (3)
ALJ inadequately considered the opinion evidence; (4) ALJ failed to build a logical
bridge from the evidence to her RFC conclusions; and (5) Commissioner's Step Five
decision was not supported. These issues are intertwined and, thus, the Court will
consider most issues together. The Undersigned will begin with the ALJ's Step
Three analysis.
A. Step Three
First, Lisa argues that the ALJ erred by failing to adequately consider the
record evidence and articulate whether Plaintiff's mental impairments met or
equaled the "paragraph B" criteria for the relevant listings under 12.00. (Dkt. 9 at
22). Specifically, Plaintiff contends that the ALJ should have found marked or
extreme limitations when considering the "paragraph B" criteria during the Step
Three analysis, which would have resulted in her meeting Listings 12.04, 12.06, or

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12.15. (Dkt. 16 at 20-26). The Commissioner maintains that the ALJ's findings were
supported by substantial evidence. (Dkt. 18 at 6-9).
At Steps Two and Three of the five-step sequential evaluation process,
mental impairments are evaluated using a "special technique" described in 20
C.F.R. § 416.920a. The first task is deciding whether the claimant has a medically
determinable mental impairment by evaluating the claimant's "pertinent
symptoms, signs, and laboratory findings." 20 C.F.R. § 416.920a(b). If the claimant
has a medically determinable impairment, the second step requires the ALJ to
determine whether the mental impairment meets or equals listing level severity at
Step Three of the sequential analysis. Leslie T. v. Saul, No. 4:19-cv-00113-SEBDML, 2020 WL 6586658, at *4 (S.D. Ind. Oct. 19, 2020). At this step, a claimant
must prove she meets the severity criteria of either paragraph B or C. 20 C.F.R. Pt.
404, Subpt. P, App. 1, §§ 12.04, 12.06.
Under Step Three of the sequential evaluation process, if a claimant has an
impairment that meets or medically equals the criteria of an impairment found in
the Listing of Impairments, 20 C.F.R. Part 404, Subpart P, Appendix 1, the
claimant is presumptively disabled and qualifies for benefits. Minnick v. Colvin, 775
F.3d 929, 935 (7th Cir. 2015); Sims v. Barnhart, 309 F.3d 424, 428 (7th Cir. 2002).
The Listings specify the criteria for impairments that are considered presumptively
disabling. Minnick, 775 F.3d at 935 (citing 20 C.F.R. § 404.1525(a)). A claimant may
also demonstrate presumptive disability by showing that her impairments are

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accompanied by symptoms that are equal in severity to those described in a specific
listing. Id. (citing 20 C.F.R. § 404.1526).
It is the claimant's burden to prove that her condition meets or equals a
listed impairment. Filus v. Astrue, 694 F.3d 863, 868 (7th Cir. 2012); Ribaudo v.
Barnhart, 458 F.3d 580, 583 (7th Cir. 2006). To meet or equal a listed impairment,
the claimant must satisfy all of the criteria of the listed impairment with medical
findings. Minnick, 775 F.3d at 935; Sims, 309 F.3d at 428; Maggard v. Apfel, 167
F.3d 376, 380 (7th Cir. 1999). Here, Listings 12.04, 12.06, and 12.15 require at least
two marked or one extreme limitation in the "paragraph B" criteria.
In this case, as noted above, at Step Two the ALJ determined that Lisa had
several mental impairments, including anxiety, bipolar disorder, and posttraumatic stress disorder. (Dkt. 14-2 at 22, R. 21). At Step Three of the sequential
evaluation process, the ALJ analyzed Listings 12.04 (depressive, bipolar, and
related disorders); 12.06 (anxiety and obsessive-compulsive disorders); and 12.15
(trauma- and stressor-related disorders) and found Lisa did not satisfy the
"paragraph B" criteria. 3 (Id. at 23-24, R. 22-23). To satisfy the "paragraph B"
criteria for these listings, the Plaintiff must show one extreme 4 or two marked 5

Listings 12.04, 12.06, and 12.15 have three paragraphs, designated A, B, and C. A claimant's
mental disorder must satisfy the requirements of both paragraph A and B, or the requirements of
both paragraphs A and C. 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 12.00(A)(2). The ALJ determined
that Lisa fails to establish the presence of the "paragraph C" criteria, and the claimant does not
contest this finding. (Dkt. 14-2 at 24-25, R. 23-24; Dkt. 9).
4 An extreme limitation means the claimant is unable to function independently, appropriately, or
effectively, and on a sustained basis. 20 C.F.R. § Pt. 404, Subpt. P, App. 1, 12.00(F).
5 A marked limitation means the claimant's ability to function independently, appropriately,
effectively, and on a sustained basis is seriously limited. 20 C.F.R. § Pt. 404, Subpt. P, App. 1,
12.00(F).
3

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limitations in the following broad areas of mental functioning: (1) understanding,
remembering or applying information; (2) interacting with others; (3) concentrating,
persisting or maintaining pace; and (4) adapting or managing oneself. 20 C.F.R. §
Pt. 404, Subpt. P, App. 1, 12.00(E).
Under the "paragraph B" criteria, reciting some of the medical history and
the claimant's statements, the ALJ determined that Lisa had no limitations in
understanding, remembering, or applying information or in adapting or managing
oneself; and moderate limitations in concentration, persistence, or maintaining pace
and interacting with others. (Dkt. 14-2 at 23-24, R. 22-23). To support these
findings, the ALJ noted 6 Plaintiff's claimed activities on her function reports; her
symptoms that she reported to her doctors at medical visits; her presentation and
performance at various psychological exams; her testimony at the hearing; and her
reported activities of daily living. (Id.).
While the Plaintiff argues that the ALJ's findings are unsupported, Lisa is
essentially asking the Court to reweigh the evidence; this, however, the Court will
not do. Prochaska v. Barnhart, 454 F.3d 731, 735 (7th Cir. 2006) (noting the court
does not reweigh evidence in reviewing an ALJ's determination). The Court is
satisfied that the ALJ minimally articulated her reasoning for finding no more than
moderate limitations in the "paragraph B" criteria areas.

To evaluate these four areas, ALJs will investigate how an impairment interferes with a claimant's
ability to function independently, appropriately, effectively, and on a sustained basis, as well as the
quality and level of overall functional performance, any episodic limitations, the amount of
supervision or assistance required, and the settings in which a claimant is able to function. 20 C.F.R.
§ 404.1520a(c)(2).
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B. Opinion Evidence
Next, Lisa argues that the ALJ erred when evaluating the medical opinions
in the record, specifically of Plaintiff's treating therapist and of the state agency
psychologists. (Dkt. 16 at 15-20; Dkt. 19 at 6-8). In response, the Commissioner
maintains that the ALJ appropriately considered each medical opinion in the
record. (Dkt. 18 at 13-14).
The ALJ considered the opinion of Plaintiff's treating therapist, Ms. Caroline
Blower, and the state agency psychological consultants, Drs. S. Hill and J. Gange.
(Dkt. 14-2 at 28-29, R. 27-28). Under the prior regulations, "more weight [was]
generally given to the opinion of a treating physician because of his greater
familiarity with the claimant's conditions and circumstances." Clifford, 227 F.3d at
870 (citations omitted); see 20 C.F.R. § 416.927(c)(2). This so called "treating
physician rule," however, was eliminated for claims, such as Lisa's, filed after
March 27, 2017. McFadden v. Berryhill, 721 F. App'x 501, 505 n.1 (7th Cir. 2018).
"Nonetheless, the ALJ must still provide a written explanation for [her] conclusion
about the treating physician's opinion, drawing a logical bridge from the evidence to
the conclusion." Varga v. Kijakazi, No. 3:20-cv-575-JPK, 2021 WL 5769016, at *3
(N.D. Ind. Dec. 6, 2021).
"Opinion evidence is now governed by 20 C.F.R. § 404.1520c. . . (2017)."
McFadden, 721 F. App'x at 505 n.1. The ALJ no longer assigns "any specific
evidentiary weight" to medical opinions, but rather evaluates the persuasiveness of
medical opinions. 20 C.F.R. § 404.1520c. When considering the persuasiveness of

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any medical opinion, an ALJ must now consider the following factors:
supportability; consistency; relationship with the claimant, including the length of
the treatment relationship, frequency of examination, purpose of the treatment
relationship, extent of the treatment relationship, and examining relations;
specialization; and any other factors that tend to support the medical opinion,
including evidence that the medical source is familiar with other medical evidence
or has an understanding of social security policies. See Inman v. Saul, No. 1:20-cv231 DRL, 2021 WL 4079293, at *2 (N.D. Ind. Sept. 7, 2021). The most important
factors are the opinion's supportability and consistency. 20 C.F.R. § 404.1520c(a).
These are the factors the ALJ must explicitly discuss, whereas the ALJ need only
consider the other factors. 20 C.F.R. § 404.1520c(b). Failure to adequately discuss
supportability and consistency requires remand. Tammy M. v. Saul, No. 2:20-cv285, 2021 WL 2451907, at *7-8 (N.D. Ind. June 16, 2021).
On August 12, 2020, Ms. Blower completed a Medical Source Statement.
(Dkt. 14-7 at 286-88, R. 590-92). Ms. Blower opined that Lisa struggles with
executive dysfunction due to mood and anxiety disorders and is likely to become
overwhelmed by multiple instructions and time expectations, which would result in
marked limitations to making simple and complex work-related decisions as well as
carrying out complex instructions; and moderate limitations to understanding and
remembering complex instructions. (Id. at 286, R. 590). Ms. Blower further opined
that Lisa has severe anxiety in social situations, often struggling to leave her home,
and that due to her PTSD she does not feel safe in public settings, which results in

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extreme limitations to interacting with the public and responding to usual work
situations and marked limitations to interacting with supervisors and co-workers.
(Id. at 287, R. 591). Ms. Blower opined that Lisa is often forgetful and easily
overwhelmed from anxiety, and that her focus is limited because of racing thoughts
and restlessness, so she would struggle to concentrate, persist, or maintain pace.
(Id.). Ms. Blower also concluded that Lisa would be off-task 25% or more of the
workday and would be absent more than four days per month. (Id. at 288, R. 592).
Ms. Blower stated that her conclusions were supported by the fact that Lisa deals
with symptoms of bipolar disorder, anxiety, and PTSD on a daily basis and that it is
difficult for her to maintain a sleep/wake routine, manage stress, and tend to her
basic needs and activities. (Id. at 287, R. 591).
The ALJ's consideration of Ms. Blower's opinion is as follows:
Caroline Blower, MSW, LSW, opined that the claimant had marked
limitations to making simple and complex work-related decisions as
well as carrying out complex instructions; moderate limitations to
understanding and remembering complex instructions; extreme
limitations to interacting with the public and responding usual work
situations; marked limitations to interacting with supervisors and coworkers; and would be absent more than four days per month (B12F).
This opinion is not found to be persuasive. Although supported by
written explanations, the opined limitations are inconsistent with the
overall exam findings. At times, she denied having any feelings of
anxiety or depression and had an appropriate mood and affect (B1F/6,
27, B5F/7, B10F/3). The claimant reported some improvement in her
panic attacks with medication and indicated that she was able to leave
the home (B9F/17). She was cooperative on exam (B1F/6, 19, B10F/3).
Her thought process was organized and circumstantial (B9F/24, 29,
B11F/6). On exam, she was able to repeat seven digits forward and five
backwards (B6F/2). The claimant reported being able to pay bills and
count change (B4E/6). On exam, she was also able to perform simple
calculations (B6F/3). Additionally, the claimant denied having any
suicidal ideation (B1F/6, 16, 19, B11F/6). Further, the claimant was
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able to work as a receptionist even after the alleged onset date (B6F/2).
Therefore, the marked or extreme level limitations and absenteeism
limitations are not consistent with the overall evidence.
(Dkt. 14-2 at 29, R. 28). Lisa argues that the ALJ improperly discounted Ms.
Blower's opinion, even though it was supported by written explanations. As noted,
the ALJ found Ms. Blower's opinion inconsistent with (1) Plaintiff's varying reports
of symptoms and (2) the overall exam findings. In response, Lisa maintain that
neither of these reasons are valid or supported by the record. The Court agrees.
The ALJ relies heavily on isolated instances throughout the record where
Lisa reported limited improvement or momentary stability, but this appears to
demonstrate the ALJ's misunderstanding of how bipolar disorder affects claimants.
See Scott v. Astrue, 647 F.3d 734, 739 (7th Cir. 2010) ("[T]he ALJ's analysis reveals
an all-too-common misunderstanding of mental illness. The 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 a 'good day' does not
imply that the condition has been treated.") Further, as the Seventh Circuit has
noted, mere "improvement" does not necessarily mean that a claimant is not
disabled, because "[t]here can be a great distance between a patient who responds
to treatment and one who is able to enter the workforce." Scott, 647 F.3d at 740. In
order to reject Lisa's allegations based on snapshots of her responses to treatment,
the ALJ must connect how this improvement has restored her ability to work.
Murphy v, Colvin, 759 F.3d 811, 818-19 (7th Cir. 2014); Scott, 647 F.3d at 740.

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As noted above, the Seventh Circuit has directed ALJs to take into account
that individuals suffering from mental illness may have "good days and bad days,
and possibly good and bad months." Bauer v. Astrue, 532 F.3d 606, 609 (7th Cir.
2008); see also Punzio v. Astrue, 630 F.3d 704, 710-711 (7th Cir. 2011). Indeed,
Social Security Rulings instruct an ALJ to consider that symptoms may fluctuate
when evaluating inconsistencies in a claimant's statements. Quinones v. Colvin, No.
15 CV 6072, 2017 WL 337993, at *4 (N.D. Ill. Jan. 23, 2017) (citing SSR 16-3p, 2016
WL 1119029, at *8 ("Symptoms may vary in their intensity, persistence, and
functional effects, or may worsen or improve with time. This may explain why an
individual's statements vary when describing the intensity, persistence, or
functional effects of symptoms")). The ALJ must consider the entire record,
including those portions of the record that do not support the ALJ's ultimate
determination. Scrogham v. Colvin, 765 F.3d 685, 697 (7th Cir. 2014). Particularly
in mental illness cases, it is important for the ALJ to evaluate the entire record, as
mental illness often fluctuates. Scott, 647 F.3d at 739. "ALJs are strictly prohibited
from making broad generalizations about the severity of bipolar disorder based on a
claimant's condition during a limited period of time." Carolyn S. v. Saul, No. 19 C
385, 2020 WL 231085, at *8 (N.D. Ill. Jan. 15, 2020).
The ALJ concludes that Ms. Blower's opinion is supported by her written
statements, but concludes that the opinion is not persuasive because it is
inconsistent with the other evidence in the record. On the Court's review, however,
the ALJ presents a limited view of the other evidence in the record and the ALJ

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failed to grapple with the significant evidence that contradicts her conclusion. First,
the ALJ does not seem to grasp the recurring and episodic nature of Plaintiff's
mental disorders, and the fact that she has good days and bad days. As pointed out
in the Plaintiff's brief, Plaintiff reported experiencing manic symptoms for a month
in October 2018; by January 2019, she noted experiencing depressive symptoms for
a month; as of November 2019, Plaintiff reported improvement in her mood due to
starting a new medication; but by December 2019 she stated that her new
medication was no longer stabilizing her mood; in April 2020, Plaintiff reported that
a medication adjustment had been helpful and allowed her to leave home; but by
May 2020, Plaintiff noted low mood and energy. (Dkt. 14-7 at 95, 122, 128, 236, 240,
245, R. 399, 426, 432, 540, 544, 549). Plaintiff even testified at the hearing that she
goes through manic and depressive stages – during her manic phase she might feel
okay, but during the depressive stage she cannot function or get out of bed until the
stage passes. (Dkt. 14-2 at 54, R. 53). The medical evidence supports this testimony.
From month to month, Plaintiff would report symptom improvement, followed by
weeks of mania and then weeks of depression – and even when she reported
improvement in some symptoms, other symptoms persisted or worsened. (Dkt. 14-7
at 95, 122, 127, 236, 240, 245, R. 399, 426, 432, 540, 544, 549). Perhaps most
importantly, Lisa treated with therapists and physicians at Hamilton Center
beginning in 2017, and no provider there deemed Plaintiff's mental disorders wellcontrolled or her recounting of the effectiveness of her treatments incorrect or
exaggerated; instead, those providers continued to treat Lisa, increase her

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medication dosage, or change her medications based on her reports. (Dkt. 14-7 at
33-146, 225-258, 267-288, R. 337-450, 529-562, 571-592).
The ALJ's citations to the record to demonstrate Plaintiff's improvement are
also unavailing. Several of the visits from May and June 2019 where Plaintiff
reported no anxiety or depression were for medical visits related to her physical
impairments (Dkt. 14-7 at 6-7, 27, R. 310-11, 331); at a primary care visit in October
2018 where Lisa reported no current suicidal ideation, she reported that her
medications were no longer helping and that she was experiencing increased
insomnia (Dkt. 14-7 at 16, R. 320); and at a therapy visit in December 2019 she
reported that her medications had plateaued and her mood had begun to fluctuate
again with a return of her depressive symptoms, that her anxiety was debilitating,
and that she continued to have panic attacks once per week. (Dkt. 14-7 at 268-271,
R. 572-75). The ALJ also cites to Lisa's report of some improvement in her panic
attacks and her ability to leave the home; the ALJ, however, fails to acknowledge
Lisa's other reports at that same therapist visit: Lisa stated that her prescription
had helped her panic attacks, but that "sometimes it doesn't feel like it's enough"
and that she still wakes up in a panic attack from nightmares 2-3 times per nights;
she noted that her mood had improved a bit, but that her mood had begun to
fluctuate again and that she is still always anxious. (Dkt. 14-7 at 240, R. 544). The
ALJ also points to Plaintiff's ability to work as a receptionist after the alleged onset
date, which was a statement Plaintiff made to the state agency psychological
consultant, but fails to mention Plaintiff's qualifying statement, which is that she

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could only work for eight hours in a week because her panic attacks would force her
to hide at work until the feeling passed. (Dkt. 14-7 at 206, R. 510). While it is true
that the ALJ need not address every piece of evidence in the decision, the ALJ is not
permitted to accept only the portions of the record that support her ultimate
conclusion and fail to confront the evidence that contradicts it. Myles v. Astrue, 582
F.3d 672, 678 (7th Cir. 2009) (ALJ erred by ignoring line of contradictory of
evidence); Denton, 596 F.3d at 425 (same); Kelly K. v. Kijakazi, No. 4:20-cv-78-JVBSLC, 2022 WL 538561, at *2 (N.D. Ind. Feb. 23, 2022) (same).
On the Court's review, the ALJ's conclusion that Ms. Blower's opinion is
inconsistent with the record is based on a limited scope of the evidence at hand and
demonstrates a misunderstanding of the episodic nature of Lisa's mental health
disorders. Even a cursory review of the medical evidence demonstrates considerable
and consistent support for Ms. Blower's conclusions. This issue is vitally important,
given that the adoption of almost any of Ms. Blower's opinions could result in a
finding that Plaintiff is unable to perform her past relevant work as a security guard.
The Court is not confident that the ALJ adequately addressed the consistency and
supportability of Ms. Blower's opinion and, therefore, this matter must be remanded
for further consideration.
C. RFC Analysis
Lisa also contends that the ALJ erred by failing to identify an evidentiary
basis for her RFC and because the RFC fails to account for all of Plaintiff's
documented mental health limitations. (Dkt. 16 at 26-30; Dkt. 19 at 10). The

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Seventh Circuit has defined the RFC as "the claimant's ability to do physical and
mental work activities on a regular and continuing basis despite limitations from
her impairments." Moore v. Colvin, 743 F.3d 1118, 1121 (7th Cir. 2014). "A regular
and continuing basis means 8 hours a day, for 5 days a week, or an equivalent work
schedule." SSR 96-8p, 1996 WL 374184, at *1.
The RFC is a function-by-function assessment based upon all of the relevant
evidence of an individual's ability to do work-related activities. Id. at *3. The
relevant evidence includes medical history; medical signs and laboratory findings;
the effects of symptoms, including pain, that are reasonably attributed to a
medically determinable impairment; evidence from attempts to work; need for a
structured living environment; and work evaluations, if available. Id. at *5. In
arriving at an RFC, the ALJ "must consider all allegations of physical and mental
limitations or restrictions and make every reasonable effort to ensure that the file
contains sufficient evidence to assess RFC." Id. An ALJ's "RFC assessment must
include a narrative discussion describing how the evidence supports each
conclusion, citing specific medical facts (e.g., laboratory findings), and nonmedical
evidence (e.g., daily activities, observations)." Id. at *7.
The ALJ assigned the following non-exertional imitations to address Lisa's
mental health disorders: can perform detailed, but not complex tasks; can maintain
sufficient attention and concentration to perform tasks with reasonable pace and
persistence; and can have occasional contact with supervisors, co-workers, and the
public. (Dkt. 14-2 at 25, R. 24). When explaining the justification for the assigned

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RFC, the ALJ pointed to the same records and findings that the ALJ used to
support his discounting of Ms. Blower's opinion. As the Undersigned has previously
noted, almost all of those records are lacking the context from which they were
found or are inaccurate portrayals of Lisa's actual allegations. Moreover, it is not
clear how those snapshots of days of better functioning lend support for the ALJ's
conclusion that these three RFC limitations adequately address Lisa's mental
health symptoms. The ALJ's categorical failure to address the medical evidence that
conflicts with her conclusions, namely the evidence that contradicts the idea that
Lisa was stable and had improved with treatment, renders the Court unable to
conduct a meaningful review as to the sufficiency of the assigned RFC limitations.
The issues regarding the evidence that the ALJ relied on to bolster her RFC
is vitally important, given Lisa's next argument. Specifically, Lisa maintains that
because the ALJ rejected all of the opinions regarding her mental limitations, the
ALJ faced an evidentiary deficit and the RFC is thus unsupported. (Dkt. 16 at 20).
As noted previously, the ALJ rejected the opinion of Plaintiff's treating therapist,
with the ALJ reasoning that the opinion was unsupported by the record and her
own treatment notes. (Dkt. 14-2 at 28, R. 27). The ALJ then rejected the opinions of
the state agency psychologists, finding that their opinions did not account for all of
Plaintiff's mental restrictions and that Plaintiff was more limited than the state
agency psychologists found. (Dkt. 14-2 at 28, R. 27). No other opinion exists in the
record regarding Plaintiff's functional imitations for her mental disorders.

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The Court does not find that the ALJ should have given evidentiary weight to
any of these opinions; however, once the ALJ rejected all opinion evidence on the
topic of Plaintiff's mental health limitations, she was left with an evidentiary record
that did not support her RFC determination. Suide v. Astrue, 371 F. App'x 684, 68990 (7th Cir. 2010) (when the ALJ rejects all physician opinion evidence, an
evidentiary deficit exists); McDavid v. Colvin, No. 15 C 8829, 2017 WL 902877, at
*5 (N.D. Ill. Mar. 7, 2017) (finding that where the ALJ discounted the only medical
opinions that set forth RFC determinations, "she was left with an evidentiary record
that did not support her RFC determination"); Daniels v. Astrue, 854 F. Supp. 2d
513, 523 (N.D. Ill. Apr. 2, 2012) (finding remand necessary due to evidentiary deficit
where ALJ rejected opinion of treating physician and did not mention or evaluate
the only other medical opinions). As it stands, it is not at all clear how the ALJ
concluded that these three RFC limitations were sufficient to address the Plaintiff's
symptoms from her mental health disorders. There is no record basis to support the
ALJ's RFC finding, and the ALJ's analysis does not assure the Court that the ALJ
properly considered the opinion evidence of Plaintiff's treating therapist. As such,
the Court concludes that remand is required as a result of the ALJ's rejection of
each opinion that included mental limitations. Accordingly, the Court finds the
ALJ's RFC analysis lacking, and remand is required to further address these issues.
Lastly, Lisa asserts that the ALJ's decision should be remanded for failure to
address both Ms. Blower's opinion and the vocational expert's testimony regarding
time off-task. (Dkt. 16 at 28-29). Because the Court has already concluded that the

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ALJ's mental RFC analysis is lacking and it is case dispositive, the Undersigned
will not address the remaining issue. The ALJ should take the opportunity on
remand to reconsider whether "off-task time " should be included in Lisa's RFC.
V.

CONCLUSION
For the reasons detailed herein, the Court REVERSES the ALJ's decision

denying the Plaintiff benefits and REMANDS this matter for further proceedings
pursuant to 42 U.S.C. § 405(g) (sentence four). Final judgment will issue
accordingly.
So ORDERED.
Date: 9/19/2022

Distribution:
All ECF-registered counsel of record via email.

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