## In the



# U n ited S ta tes Co urt o f Ap p ea ls

F o rth eS e v e n th C ir cu it
N o. 10

- 3340 J ES S I CA J. J ELI NEK, Plai nt i f f

-Appe l l ant, v. M ICHAEL J. A S T RUE, Com m i ssi onero fS oci alS ecuri ty, D efend a nt-A pp ellee.
Appeal from the United States District Court fo r the N o rthernDi stricto f Indian a, S outh Bend D ivisi on. No . 3:09- cv-368

—Ch ri st oph er A . N uec hterlei n, Magis trate Judge .
A RG UE D A UGUS T 2, 2011

— D ECI DE D N OVE MBE R 7, 2011

Befo re W OO D , S YKES, a nd H A MI L T ON, C ircu it Judges. H A MI L T ON, C ircu it Judge. J ess i ca J el i nek’ s m othe r appl i ed f o rs uppl ement als ec ur i tyinc om e o n h erda ught e r ’ s b e h a l fs h o r t l y b e f o r e J e l i n e k ’ s e i g h t e e n th b i r th

d ay . Sh e c on te n d e d t h at Jelin ek w as d isa b led by a c om b ina tion of m en tal im p airm en ts (i nc lud ing bipolar d isorder) and by physi cali m pai rm en ts r esul ti ng fro m a 2005 car acc iden t. A n ad m inistrative l aw j ud ge foun d J eli ne k’s2 N o. 10

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c o l l e c t i v e i mpa i r men t s s ev e r e b utn o tdi s ab l i ng . On appeal, J el i nek a rgues that the A LJ i m proper l y rej ecte d th e o p in ion o fh er tre at in g p sy c h iat ris t a n d th at th is m i sta ke l ed to addit i onaler rors i n the A LJ’ s r eas oni ng. W e r eve rs e the j ud gm ent a nd r em and fo r furtherpro ceedi ngs.

I. Fac t s an d Pr oc e dural Backg r oun d J el i nek, now 23 y ear s o l d, w as 17 i n A ugu st 2 00 5 when her m othe r fi l ed an appl i cati on forsupplem en talse curi ty i ncom e be nefi ts on herbehal f

. H erappli cati on was denie d i ni ti al l y an d on r eco nsi derat i on. In Feb ruar y 2 008 J el i ne ka pp e a r e d a ta h e a r i ngb e f o r e a n ALJ, wh o l ate r i ss ue d a de ci si on confi r m i ngthe de ni alo fb en efi ts
. The A p p ea ls C ou n c il d en ied rev iew , l ea vin g t h e A L J’s d ec is i o n a s the Co mm i s s i o ne r ’ s fi na lwo r d. S ee 2 0 C. F
. R. § 4 16 .14 81 ; Steele v. B a rnh a rt, 290 F.3d 93 6 , 9 4 0 (7th Cir. 2002 )
. J el i ne k so ught r evi ew i n the dist ri ct c ourt, se e 42 U
. S. C. § 4 05( g) , and a m agi strat e j ud ge presi ding by co ns en t unde r2 8 U. S
. C. § 6 36 ( c) uphe l d the de ci si o n. Th i s a pp e a lf o l l o we d.

A
. The M edic al Ev idenc e J el i nek r ecei ved co unsel i ng atthe Bow en Center( fro m seve ra lm edi calso urces ) o n a ne ar -m on thl y b asi s fro m October20 02 thro ugh Februar y 2 008. S he was ass ess ed in itia lly w ith d ep re ss ion an d th ou gh ts of su icid e, p re c ip itated i n p art by a history of a b u se infl icted by her fath er. Jel inek rep orted a history of c u t t ing an d bu rning herself.N o. 10

- 3340 3 Ear l y t r ea tmentno te s ci te a “ su i ci d alg es tu r e” i n J an uar y 2 0 0 2 ( a pp a r e nt l y i nc l ud i ng a pl a n t o o v e r do se by ta kin g A lev e) , bu t s ta ff atth e B ow en C en te r in itia lly concl ud ed that J el i nek posed a “l ow r i sk” of h ar m to hers el fo r othe rs and showed no si gn o fpsycho sis. J e l i ne k ’ s s c ho o l r e c o r ds fr o m thi s pe r i o d show 71 abse nces du ring the 20 02- 03 school y ea r and 79 absence s d uring the 20 03-04 sch ool year. The diagnose s o fJ el i nek’ s m entali m pai rm ents shi fted o v e rthe c o ur s e o fh e rt r e a t men ta tthe Bo we n Ce nt e r . By the t i m e o fher h ea rin g bef or e the A LJ, she w as ei ther di agno se d wi tho rha d a hi st o r y o fm aj o rde pr es si o n, bipolar d isorder (w ith m an ic an d p s ych otic featu res), A D H D , pos t-traum atic stress d isorder, anx iety disord er, an d b o r der l i ne pe r so na l i tydi so r der

. Addi ng to tha t, s he al so was o be se an d s uffer ed fr o m c hr o ni c pain. The treatm en t for he r m en tal i m p airm e n t s i nc lud ed an eve rchangi ng co m bi nati on o fm edi cat ions and dosage s, am ong them the a nt i

- de pr e s s ants Zol of t, Pro zac, Tr az o do ne , a nd Ce l ex a; the a nt i

- an xi ety dr ug s Ati va n, Tr az o do ne , a nd Vi st ar i l ; the s ti m ulan t Ad der al l ; a nd the an ti

- psy ch o ti c dr ug s Abi l ify, Ge o do n, Ri spe r dal, a nd Zy p rexa . Tr ea tmentno te s sh o w so m e co nc ern a m o ng J el i ne k ’ s do c t o r s tha t, a t l e a s t i ni t i a l l y, he r mothe r w as re sis ta n t t o Je lin ek ’s m ed ica tio n reg im en . D o c t o rs p er iodi cal l y a ssi gned J el i nek agl obalas ses sm ent o ffuncti oni ng ( “GA F”) sco re , w h ich i s a psychi atr i c m eas ure of4 N o. 10

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A G A F b et w ee n 41 a n d 5 0 in d ic a te s “ S er io u s sy m p to m s (e.g ., 1 s uici dal i de a t i on, s e ve r e o bs e s s i on a l r i t ua l s , fr e q ue nts ho pl i ft i ng) OR an y s er i ous i m p ai rm en ti n s oc i al, oc c upat i ona l , or sc hool functi oning ( e. g ., no fr ie nd s, unab le to keep a j ob). ” In t u r n, a G A F b e t w e e n 5 1 a n d 6 0 r e fl e c t s “ Mo d e r a t e s y mp t o ms (e. g ., fl at affect and circu m stan tial spe ech , occ asio na l pa nic at t ac ks ) OR m oder at e di ffi c ul t y i n s oc i al, oc c upat i ona l , or s c hoo l func t i oni ng ( e. g. , few fri en ds , c onfl i c t s with pe er s or co-w o rk ers). ” A m erica n P sych iatric A ssociatio n, D iag no stic and S t atistic al M anu al ofM en t al Dis or der s , Te xtRevi s i on (D S M -IV -T R ) 34 (4t h ed . 20 0 0 ). a p a t i e n t ’ s o v e r a l ll e v e lo ffu n c t i o n i n g . T h e r e c o r d s h o ws 1 that J el i nek’ s GA F sco re s tended to fl uctuate b etween 50 and 55, num ber s o n the bord er betw een “ m oder ate ” an d “ s e r i o us ” i mpa i r men t i n fun c t i o n, wi th a hi gh o f 65 in A p ril 20 07 an d a low of 20 d u rin g h er br ief h os p ita li zati on in Decem ber20 07. I n J ul y 2 00 5, J el i ne kwas i n a c ara cc i den t th atl eft he rwi thfr ac tu r es t o he rpe l vi s an d t wo v er tebrae. S he d i d no t r equi r e su r g ery, a nd b y Oc tobe r2 00 5 he rdo ctors deem ed thos e fra cture s t o be he al ed and re com m ended p hy sical therap y . Jelinek, th ou gh, cont inu ed to report backpai n. Fr om Februar y 2 006 thro ug h D ecem ber20 07, she vi si ted Dr. A ashi sh Deshpand e forpai n m anage m ent. Dr. Deshpand e pr escr ibed fe ntanylf orherpai n and, by tu r ns , V ico di n a nd l at erPe r co ce t f o r“ br ea k th r o ugh” per i o ds o fa ddi ti o na lpa i n. I t w as the ca r acci dent thatapparent l y pr eci pit ate d J e l i n e k ’ s a p p l i c a t i o n f o rs u p p l e me n t a ls e c u r i t y i nc o me benefi ts, and in O c tob er20 05, so on a fterfi l i ng, she w asN o. 10

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exam i ned by Dr. J ohn H erol dt, a sta te- age ncy psyc hol ogi st. H e no ted thatJ el i nek r epor ted be i ng “b i pol ar and m ani c, ” b u t h e opi ned that she di d not e xhibi t psy
choti c sy m ptom s. H e di agno sed herwith m aj ord ep re ssion (w ith p sych otic featu res) and bord erline personal i ty diso rder, and assi gned hera GA F s cor e o f50
. A fterm eet i ng with J el i nek, Dr. H er ol dt concluded that she was unabl e t o hand l e hero w n fi nances. I n Feb ruar y 200 6 a s eco nd st ate
- age ncy psyc hol ogi st, Dr. F. Kladder, r evi ew ed J el i n ek ’s tr eat m ent r eco rds t o ass ess herr es i du alfuncti onalcapaci ty. Dr. Kladder opi ned that J el i nek prese nted sever alsym ptom s o fdepres

si on , i ncl ud i ng anhedoni a ( the inabi l i ty to experi ence pleas u re ) , appeti te and sl eep di sturbance, and diffi cul ty c on c en tr at in g. B u t he co n c lu d ed th at Jelin ek su ffer ed on ly m i l d r es tr i ct i o ns i n the a ct i vi ti es o fda i l y l i vinga nd m oder ate di ffi cul ti es in m ai ntai ni ng so ci alfuncti oni ng, an d i n conce ntra ti on, per si ste nce, and pace. H e o pined that J el i nek was “m oder ate l y l i m i ted ” in herabi l i ty to com ple te a no rm alworkday or workweek, thatshe had tr ou b l e in cl ose r el ati onshi ps and w oul d l i kely hav e tr oubl e t aking cr i ti ci sm or supervi si on, and that her al leg atio ns o fdi sabi l i ty w er e cr edibl e. H e a l so note d that J el i nek’ s m edi calr eco rd sho w ed on e or two epi sodes o fde co m pen sa ti o n o fpr o l o ng ed dur at i o n. S ee 2 0 C. F
. R. Pt. 404 , S ubpt. P, A pp . 1, § 12. 00 ( defini ng “e pis odes of dec om p en sation” as “ex acerb ations or tem p orary i ncre ase s in sym ptom s or s i gns a ccom panie d by a l oss o fa d ap tiv e fu n c tio n in g, as m an ifes te d by d ifficu ltie s in perf or m i ng ac tivit i es ofdai l y l i vi ng, m ai ntai ni ng so ci al re l ati onshi ps, o r m ai ntai ni ng c oncentr ati on, per si ste nce,6 N o. 10

- 3340 or pac e”); see al so Lars on v. A str ue, 61 5 F
. 3d 744, 75 0 (7th C ir. 2010) (exp lai nin g term ). Fr om A u gu st20 06 th ro u gh Jan u ar y 2 00 8, D r. Sn ieg u ole R ad zeviciene , a psy ch iatri st at th e B ow en Ce nt er, oversaw Je l i nek’ s psyc hi atr i c tr eat m en t. H i s no tes fro m an A pri l200 7 evaluati on i denti fy J el i nek’ s i m pai rm ents a s m aj or dep ressive d isorder, A D H D , anx iety disord er, PTS D, o be si ty, an d ch r o ni c pain. Tho se no te s al so d ocum ent J el i nek’ s co ncer n that sh e d i d not hav e insurance and coul d not a f f or d the r a py . I n A ugust 2 007 D r. Rad zeviciene observed that J eli ne k a p p eared “m ore vo l at i l e” a nd do cument ed he rr epo r t tha t a r ec en t b re ak u p w ith h er bo yfr ien d h ad led to an inc re as e in w or ry, depres si on, cr yi ng, and i rr i tabi l i ty. I n De ce m be r2 00 7 J el i ne ka dm i tte d he r se l ft o the Bo wen Ce nt er ’ s i npa ti en t uni t. S he r epo r te d he ar i ng vo ice s a n d sa id sh e fe ar ed th at so m eo n e w as try in g t o kill her. The o n-c all p sychi atr i st, Dr. Barba ra Ei chm an, was uns ur e ho w l o ngJ el i ne kha d b ee n “ dec o m pen sa ting ” an d chara cter i zed heras “ve ryd elu sio nal

. ” Dr. Ei chm an ci ted J el i nek’ s br eakup with h er l ongt i m e bo yfri end as a p os sib le fa c to r an d op in ed t h at Jelin ek w as p ro b ab ly not tak i ng al lherm edi cati ons. T h e doct oral so e xp r e s s e d d o ub tab o utthe effi c a c y o fthe s e r i e s o fme di cati ons ( si x i n to tal, i ncl ud i ng two pai n m edi cati ons, tw o anti

- depressa nts, and two anti

- psychoti cs) that J e l i ne kwa s the n pr e s c r ib e d. O n e m on th lat er D r . R ad ze vic ien e c om p let ed a m en ta li m pai rm ent questi onnai re . H e di agno sed J el i nek with bi pol ar diso rder w i th m ani c features , A DH D, and obes i ty.N o. 10

- 3340 7 A m ong J el i nek’ s s ym ptom s, Dr. Radzevi ci ene l i ste d poor m em ory; sleep , m ood , an d em otional d isturba nc e; d iffi cul tyc o ncen tr at i ng ; o ddi ti es o ftho ught, s pee ch, a nd b e h a v i o r ; ma n i c s y n d r o me ; a n d ge n e r a la n x i e t y . He note d tha t J el i nek’ s m ani a had be en r eso l ved but that she r em ai ned dep re sse d and that herm oo d ep isodes w er e l ikel y to recur. H e also noted that J eli ne k’s d ep re ss i on an d an x iet y t en d ed to m ak e h er ch ro n ic p ai n w or se. H e a sse sse d Je l i nek’ s abi l i ty to m ain ta in att enti on fortwo- hour seg m ents as “f ai r, ” a nd o pined th ats he h ad p o o ro rno abi l i tyt o mai nt ain r egul ara tt en dan c e , t o p e r f o r m a ta r e g u l a rp a c e wi th o u ta n u n r e a s o nable nu m ber of r est p eriods, to de a l w ith norm al w ork stres s, orto dealwith the st re ss ofsk i l l ed orse m i

- ski l l ed w or k. H e desc ribed Jelinek’ s defi ci enci es ofco ncentr ati on, per sis tence , o r pace as “fre quent” and epi sodes of d et er iora tio n or d ec om p en sa tio n as “re p ea te d .”

B
. The He ar i ng Tes t i m ony A t herFebruar y 2 008 hear ing be f or e the A LJ, J el i nek testifi ed that she li ved across th e hal l fr o m h er m oth er, w ho hel ped w i th sho pp i ng a n d cle ani ng herapar tm ent. J el i nek r eco unted probl em s with i nsom ni a a nd bi po lar m ani a, and expla i n ed t h at she had m i sse d a l ot ofscho ol and ult i m ate l y dro pp ed out ofhigh scho oli n herso phom or e y earbec ause of d epres si on a nd anxi ety
. S he had got ten her GE D a nd w as then enro l l ed i n f our c ollege classe s, b uta dded th ats he ha d dr o pped th r ee o ff o ur c l a s s e s th e p r e v i o u s s e me s t e rb e c a u s e o fs t r e s s a n d t he bre akup w i th herb oyfr i end. Rega rdi ng herwork hi sto ry,8 N o. 10

- 3340 J el i nek t est i fi ed that sh e w as w or ki ng ei ght ho urs per w e e k a s a libra ry as sis ta n t a t h er co lleg e a n d h ad p re vio us l y wo r k e d p a r t
- t i me a s amo t e lc l e r kf o rab o ut thre e m onths. Vo c a t i o n a l e x p e r t L e o n a r d F i s h e r a l s o t e s t i fi e d a tt he hear i ng. The A LJ pr om pted the expert to opi ne wh ether j obs exi ste d i n the l oca leco nom y forligh t, unski l l ed w or k. The exper t t est i fi ed that about 10, 000 j obs exi ste d i n the l oca lf our- county re gi on fora cla i m ant with J e l i n e k ’ s a g e , ed uc a t i o n, a n d b a c k g r o u n d o fp a r t
- t i me wor k

. W he n the ALJ c ha ng ed th e hy po th etic alt o s ede ntar y, unski l l ed w or k, the expert opi ned that only 60 0 to 9 0 0 r e l e v a ntj o b s e xi s t e d. T he ex pe r ta l s o o pi ne d, h ow ev er , th at an u n sk illed w or ke r w ith Jelin ek ’s p ro file w ho m i sse d m or e than one da y a m onth ( othe r than vacat i on days , si ck days, and hol i days) would have “d ifficu lty in s u st ain in g c om p et itiv e e m p loy m en t.”

C
. The ALJ ’s D e cis i on I n J une 200 8 the A LJ i ssued a w ri tte n deci si on co nc l ud ing tha t J el i ne kwas no t di sabl ed. The ALJ f o und th atJ el i ne kha d e ng ag ed i n n o s ubs ta nt ia lg ainful activity since h er ap p li cation w as file d . B ecau se Jel inek’s i ni ti alapplicati on was a chi l d app l i cati on fi l ed on her behal f, the A LJ fi rs t e xam i ned her cl ai m s under the three

ste p “chi l d standard” forthe peri od bef or e herei ghtee nth b irth d ay . U n d er su p p lem en ta l s e c u rit y in c om e ru les , a c h ild is d isa b led if sh e h as a “m ed ica l ly d et er m in ab le physica l o r m entali m pai rm ent, wh i ch r esul ts i n m ar ked and s eve re functi onal l i m i tat i ons” that “has l ast ed or c anN o. 10

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T o de term ine if an im p airm en t is “fun ction ally equ iv alen t” to 2 a l is ti ng, an A LJ anal yzes it s se verity in s ix “dom ains ”: ( 1 ) a c q u i r i n g a n d u s i n g i n f o r ma t i o n ; ( 2 ) a t t e n d i n g a n d c o mpl et i ng t as ks ; ( 3) int er ac t i ng and re l at i ng w i th othe rs ; ( 4) m ovi ng aboutan d m ani pul at i ng o bj ec t s ; ( 5) c ar i ng for on es el f; an d (6 ) he a lth an d p h y si c a l w el l-b ei n g . 20 C .F .R . § 4 1 6 .92 6 a (b )(1). To fu n ct io nall y equal a li st ing, the AL J m ust find an “ext re m e” lim i t at i on i n o ne c at eg or y ora “m ar ke d” l i m i t at i on in tw o ca te g o ri es . 20 C .F .R . § 4 1 6 .92 6 a (a ), (e)(2)(i). be e xpected to l astf ora cont i nuous peri od ofnotl ess th an 12 m onths. ” S ee 42 U
. S. C. § 1 382c ( a) ( 3) ( C)( i )
. Th is as se ss m en t re q u ire s a th re e-s te p an aly sis se t fo rt h in 20 C.F
. R. § 416. 924( a)
. Fi rs t, i fthe c h ild i s e ngage d i n su bst an ti alg ainfula ct i vi ty, the ALJ wi l lde ny the claim

. Secon d , i f th e ch ild d o e s not h ave a sev ere m edi cali m pai rm ent o r com bi nati on of i m pai rm ents, then she i s no t di sabl ed. Thi rd, the chi l d’s i m pa irm en ts m ust m ee t, medi ca l l y e qu al, or func ti o na l l y e qua la ny o fthe l i stings c ontained i n 20 C.F
. R. Pt. 40 4, S ubpt. P, A pp . 1. The A LJ f ound that J el i nek had the seve re im pai rm ents o fADH D, b i po l ardi so r der, pe r so na l i ty d i so r der, a nd P T SD , an d a h ist or y of p elv ic, c e r v i c a l , an d th or ac ic fractu res. T he A L J also cited Jeline k’s poor sch ool p erform an ce a nd e xc es si ve abs en ces. T he ALJ f o und tha t no ne ofthes e i m pai rm ents, alon e o r i n com bi nati on, m et, m edi ca l l y e qua l ed, o rfunc ti o na l l y equa l ed an y l i st i ng bef or e Jelin ek re ached ag e 1 8. H e found that J el i nek ha d 2 ( 1) “ no l i m i ta ti o n” i n a cqui r i nga nd usingi nf o r m at i o n, at t e n d in g and com p leti ng tasks, and caring for he rself; and (2 ) “l ess than m ar ke d li m i tat i on” i n i nter acting o r10 N o. 10

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I fa c hi l d cl ai m anttur ns 18 aft erfi l i ng a di s abi l i t y a ppl i c at i on 3 butbe f or e a fi naldec i s i on, the ALJ us es the ru l es gove rn i ng chil d ap plic ati ons f or the peri od bef ore the cl aim ant turned 18
. Forthe pe ri od s t ar t i ng the day the c l ai m anttur ns 18 , the A L J u ses the d isab ility ru les fo r a d u lts w ho file new claim s. 2 0 C .F .R . §§ 41 6 .92 0 , 41 6 .92 4 (f). r el at i ngt o o th er s, movingabo uta nd mani pul at i ng obj e c t s , a nd h e a l th a nd p hy s i c a lwe l l

-b e i ng . He r e a sone d that her sym ptom s were “r eas onabl y c on tr ol l ed w i th m edic ati on co m pli ance” but not ed that she s om eti m es needed prom pti ng to ta ke her m edi cati on. On thi s ba si s, the A LJ concl ud ed that J el i nek had no t been disabl ed bef or e herei ghtee nth bi rthd ay. The A LJ t hen r evi ew ed J el i nek’ s a pp l i cati on under th e fi ve - st ep “a dul t st an dar d” f o rthe pe r i o d a fte rs he tu r ne d 1 8. He fo und tha t J el i ne kha d deve l o ped no

3 new i m pai rm ents and fo und ag ai n, witho u t a dd i ti onal anal ysi s, that J el i nek ha d no i m pai rm ent o r com bi nati on ofi m pai rm ents that m et orm edi cal l y e quale d a l i sting. The ALJ a ckno wl edg ed th e r es tr i ct i o ns i n c o nc en tr at i o n, p ersisten ce, and pa ce su g g e s ted by D r. Rad zeviciene ’s J anuary20 08 opi ni on, as wellas the doctor ’ s op in i on that she had no effect i ve abi l i ty to m ai ntai n re gul ar attendance, per f or m ata consi ste nt pace, o r dealwith no r m alwor ks tr es se s. Butwi th o ute xpl i ci t an aly si s, the A L J o ff settho se concerns with a st ate m ent that J el i nek “functi one d w elland passed the GED te st, at tended co l l eg e an d o bt aine d g o o d g r ade s, a nd wor k ed se l l i ng A von an d p art- ti m e a t a hot el

. ” The AL J o pined that J el i nek r eta i ned the r esid ual functi onalcapaci ty toN o. 10

- 3340 11 engag e i n l i ght and s edentar y unski l l ed w ork. In m aking th is determ ination, he con clud ed that Je linek’s st at ement s ab o ut the int en si ty, pe r si st en ce , a nd l i m i ting effects o fhersy m ptom s were not “enti re l y c red ibl e” be ca us e pr o g r es s no te s o fte n s howed h ert o b e do i ng wel l

. He r ei te r at ed thats he ha d o bt aine d he rGED, a nd he c ited D r. Radzevi ci ene’ s Ap ri l20 07 exam i nati on a s s u p p o r tf o rh i s c o n c l u s i o n th a tme d i c a t i o n n o n - c o mp l i a n c e w a s o ft e n th e c u l p r i tb e h i n d J e l i n e k ’ s de c o mpe ns a t i o n. T he n, c i t i ngthe v o c a t i o na le xp e r t ’ s t e s t i m ony, th e A L J co n c lu d ed th at j ob s e x ist ed for Je lin ek in s ign if icant num ber s in the nati onaleco nom y. H e co ncl ud ed that J el i nek wa s not disabl ed fro m herei ghtee nth bi r th dayt o the da te o fthe de ci si o n.

II. D i s cu s s i on On a p p e a l J e l i n e k c h a l l e n g e s s e v e r a l a s p e c t s o ft he ALJ ’ s de c i s i o n. Chi e fl y sh e c o nt e nd s tha tthe ALJi mpr o per ly disco unted Dr. Radzevi ci ene’ s a sse ssm ent o fher m en ta li m pai r m en ts
. Thi s m i sta k e l ed th e AL Ji n tur n, J elinek ar gues, ( 1) to ev al uate i m proper l y whether her m en tal i m p airm en ts m et th e li sting for “a ff ective d isord er s” ; ( 2) to o ver sta te her re si du alfuncti onalcapaci ty w h en qu es tio n in g th e v oc at i o n al e x p er t; an d (3) to err in fi nd ing her n ot cred ibl e. O n j ud ici al r e v ie w , a court wi l lupho l d the Co mm i s s i o ne r ’ s de c i s i o n i fthe ALJ ap p lied th e c or re c t le ga l st an d ar d s a n d su p p or te d h is d ecision w ith su bsta nt ialeviden ce . 42 U
. S. C
. § 405(g); C a st i l ev. As t r ue, 617F.3d 92 3, 92 6 (7 th C ir. 20 10 ); Terry v. As t r ue, 58 0 F.3 d 471, 475 ( 7th Ci r. 20 09)
. A deci si on12 N o. 10

- 3340 denyi ng be nefi ts need not disc uss e ver y pi ece ofev i dence, but wh en an A LJ f ai l s t o supp or t herco ncl usi on s a deq u at ely , rem an d is ap p ro p ria te
. Vil l ano v. As t r ue, 55 6 F
. 3d 55 8, 5 6 2 ( 7 th C i r . 2 0 0 9 )
. We l i mi t o u r r e v i e w t o t he re aso ns arti cul ate d by the AL J i n the w ri tte n deci si on. S ee SE Cv. C hen ery, 318 U .S. 80 , 93-9 4 (1 94 3); Spi va v . As t r ue, 62 8 F .3d 34 6, 35 3 (7 th C ir. 20 10 ); Lars on , 61 5 F
. 3d at 749. W e be gi n w i th J el i nek’ s co ntenti on that the A LJ f ai l ed to a dhe r e to the “ tr ea tingphy si cian r ul e. ” A tr ea ting p h ys ic i a n ’s o p in ion th at is co n sis te n t w ith th e re c or d is g en er al l y e nt i tl ed to “ co nt r o l l i ngwei g ht

. ” 20 C. F
. R. § 4 04 .15 27 (d )(2) ; Sc haa f v. As t r ue, 60 2 F
. 3d 869, 875 ( 7th C ir. 20 10 ). A n A L J w h o c h oo se s t o r eje c t a tr ea tin g p h ys ici an’s opi ni o n mustpr o vi de a so und e xpl an at i o n fo rthe rej ec t i o n . 20 C .F.R . § 40 4.1 52 7(d )(2) ; Cam pb e l l v. As t r ue, 62 7 F .3d 29 9, 30 6 (7 th C ir. 20 10 ); S c h mi d t v . As t r ue, 49 6 F
. 3 d 8 3 3 , 8 4 2 ( 7 th C i r . 2 0 0 7 )
. J e l i n e ka r g u e s , a n d we ag r ee , tha t th e AL J di d no t ex pl ain s at i sf ac to r i l y i n the w ritten d ecision h is rej ectionof D r. Rad zeviciene ’s opi ni on. W hen an AL J deci de s to favo r anothe r m edi ca lpr o fes si o na l ’ s o pi ni o n o ve rtha t o fa t r ea ting physi ci an, the A LJ m ust pro vi de an ac count o fwh at val ue the tr eat i n g p hysi ci an’ s o pini on m er i ts. S ee Sc ot tv. Ast r ue, 647F .3d 73 4, 74 0 (7 th C ir. 20 11 ). Th e A L J’s d ec isi o n di d no t m ee t th es e r equi r ement s f o rrej ec ting Dr
. Ra dze vi ci en e’ s o pi ni o n. The A LJ’ s deci si on does not al l ow us to concl ud e t h at he w ei ghed the m er i ts of Dr. Radzevi ci ene’ s opi ni on , l et al o ne e ng ag ed i n the c ar efula na l y si s r equired by the re gul ati ons and case l aw . Dr. Rad ze vici ene’ s a sse ss-N o. 10

- 3340 13

m en t, as refle c te d in t h e q u e s t i o n n air e h e c om p let ed in J anuary2 00 8, add re sse d Je l i nek’ s s ym ptom s a nd her re sid u al fu n c tio n al c ap ac ity an d th u s w as h igh ly r el ev an t to s ev er alpa r ts o fthe A L J’ s ana l y si s. Buti n a sect i on devo ted to deter m i ni ng wh etherJ el i nek’ s m en tal im p airm en ts m et or m ed icall y equ a led a li sted i m p airm ent under the a du l t fi ve-s te p analy si s, the A LJ l i m i ted hi s co m m ents to the fol l owing: It is n ot ed th at
. . . D r. R ad ze vic ien e o p i n ed in Jan u ar y 2 0 0 8 t h at th e c laim an t h as fair (s er iou sly l i m i te d) abi l i tyt o mai nt ain a tt en ti o n fo rt wo- ho ur peri ods, sust ai n an o rdi naryr outi ne witho ut speci al supervi si on; co m ple te a no rm alworkday and w or kwee k ; wor ki n c o o r di na ti o n w i tho th er s wi th o utb eing un d uly d istracted ; un d erstan d , rem em ber, and carry o utde ta i l ed i ns truct i o ns ; s etreali st i c g o al s an d m ak e p lan s i n d e p en d en tly of ot h er s; an d u se p u b lic tr anspor tat i on; poor/no abi l i ty to m ai n ta in r egul ar at te nda nc e an d b e punc tu al ; pe r f o r m a t a co ns i st en t pace with out an unrea sonab l e num berand l ength of re st peri ods; and deal w i th nor m al w or k str es ses . H o wev er, the unde r si g ne d po i nts ou t th atthe cl aim ant functi oned w el land passed the GED te st, at te nde d c o l l eg e an d o bt aine d g ood g r ade s, a nd w or ke d se llin g A vo n an d p ar t-t im e a t a h ot el. T ha t’s i t. T hou gh the A L J m en tioned Dr. Rad zeviciene ’s o pi ni o n o nc e m o r e i n pa ss i ng, the j udg e ne ve rl i nk ed th e activities he cited w ith an asses sm en t of Dr. R ad zeviciene ’s opi ni on o r expla i ned w hetherthato pini on s up port ed a fi nd i ng tha t J el i nek’ s i m pai rm ents m et a l i sting.14 N o. 10

- 3340 The Com m i ssi onerdoe s not defe nd the denia lo f benefi ts b y a sse rt i ng tha t the A LJ’ s di scussi on o f D r. R ad ze vic ien e’s op i n ion w as ad eq u at e. Ins te ad , in hi s b r i e f a nd a t o r a l a r g ume nt, the Co mm i s s i o ner has ass er ted that the o pini ons ofDr. Kladder and D r. H er ol dt, th e tw o state- a gen cy p sych ologi sts, exp lai ne d the A L J’ s rej ecti on o fDr. Radzevi c ien e’s opi ni on. But the Com m i ssi o ne r ’ s sa y - so i s no t en o ugh. W e ha ve made cl ea rtha t whatmatt er s ar e th e r ea so ns a r t i c ul a t e d b y theALJ
. Spi va , 6 2 8 F .3 d at35 3; Lars on , 615 F
. 3 d a t 74 9
. Al tho ugh the ALJ c i t e d the o pi ni o ns o f both psychol ogi sts , he di d not use ei thero pini on t o su ppo r t hi s dec i si o n t o r ej ect D r. Ra dze vi ci en e’ s o pi ni o n. Se e 2 0 C. F. R. § 404. 1527 ( d)( 2); La rson , 61 5 F
. 3d at 751; M os s v. As t r ue, 5 55 F
. 3d 556, 5 61 ( 7th Ci r . 2 00 9)
. In a ny ev en t, the ALJ woul d b e ha r d- pr es se d t o justify c as ting asi de Dr. Radzevi ci ene’ s o p in ion in f avo r ofthes e e ar l i er sta te- age ncy o pini ons. S ee Scott, 64 7 F
. 3d at 739-4 0. By2 0 0 8 , the s t a t e - a g e nc y o pi ni o ns we r e t wo y e a r s o l d. Dr
. Ra dze vi ci en e’ s o pi ni o n, o n th e o th er ha nd, w as th e mo s tr e c e ntp r o fe s s i o n a lw o r d o n J e l i n e k ’ s me n t a li mpai rm ents, by a tr eat i ng psychi atr i st w ho had s een her re peatedl y o vera tw o- yea r peri od w i th fullacc ess to her com ple te m edi cal re c or d to that poi nt. N o othe r med i c a lo pi ni ona v a i l ab l e t o the ALJp r o v i de d a sim ilar ly c om p re h en siv e p ict u re of Jelin ek ’s o ve ra ll m en ta lhe al tha t th e ti m e o fthe he ar i ng . Nei th erthe opi ni on o f D r. H er ol dt northe opi ni on o fDr. Kladder fully s up port ed the A LJ’ s whole sal e r ej ecti on o f Dr. Radzevi ci ene’ s o pini on. W hi l e these psychol ogi stsN o. 10

- 3340 15 did notthi nk tha t J el i nek’ s r esi du alfunct ion al c apaci ty w a s a s l i mi t e d a s Dr
. R a dz e v i c i e ne di d, Dr
. He r o l dt sco re d Je l i nek’ s GA F a t 5 0, wh i ch co rrespond s t o a ser i ous i m pai rm en t of functi oni ng, and Dr. Kladder con clud ed , con trary to th e A L J’ s d ecision, th a t Je line k’s cl ai m o fdi sabi l i ty w as cre dibl e. Eve n i fwe co uld fol l o w the ALJ ’ s r ea so ni ngfr o m the bri efr efer ences to J el i nek’ s co l l ege c ours ew or k a nd her l i mi t e d e mpl o y men t, the ALJ ’ s de c i s i o n di d n o tb ui l d a l o g i ca lb r i dge b etwee n tho se acti vi ti es a nd hi s co nc l usi on that s he had not m et a l i st in g afterherei ghtee nth bi rthd ay. S ee C li

ff ord v. Apfel, 22 7 F
. 3d 863, 87 2 ( 7th C ir. 20 00 ). A n A L J m ay co n sid e r a cla im an t’s d aily ac tiv it i e s whe n a s s e s s i ng c r e dib i l i ty, se e A rno ld v . B a rnh a rt, 47 3 F.3d 81 6, 82 3 (7th C ir. 20 07 ), b u t A L Js m u s t e x p lain perce i ved i nconsi ste nci es between a c l ai m ant’ s a cti vi ti es and the m edi calev i denc e. S t e w a rt v. A strue, 56 1 F
. 3d 67 9, 68 4 (7 th C ir. 20 09 ); C a rrad ine v . B a rnh a rt, 360 F. 3d 751, 75 5 (7 th C ir. 20 04 ); Z ura w ski v. Ha lter, 24 5 F
. 3d 881, 88 7 ( 7 th Ci r . 2 0 0 1 )
. T he ALJdi d not do s o , a nd we a r e h a r dp r e s s e d t o u n d e r s t a n d h o w J e l i n e k ’ s b r i e f, p a r t
- t i me em plo ym ent s up port s a co ncl usi on that s he was abl e t o w or k a ful l

- ti m e j ob, week in and w eeko ut, gi ven her l i m i tat i ons. S ee Stew a rt v. A strue, 56 1 F
. 3d 679, 68 4 ( 7th Cir
. 20 09); D ia z v. P r u d e n t i a l In s. C o . of A m ., 49 9 F
. 3d 640, 6 4 8 (7 th C ir. 20 07 ); Z uraw ski, 245 F. 3d at 887. The A L J d id not a s kthe c r i t i c a lque s t i o ns ab o utJ e l i ne k ’ s a c t ual wor kho ur s o r abse nt ee r at es i n the j o bs s he he l d, a nd no m edi cal provi der or consul tant opi ned that Jel i nek cou ld h old d ow n a full- tim e po sitio n . Ra th er, the record sugge sts thatJ el i nek ha s e xperi enced l ongs tandi ng prob-16 N o. 10

- 3340 l em with absence s. The act ivit i es the AL J m enti oned re fl ected o nl y herwil l i ngness and abi l i ty to sta y engag ed i n com m endabl e but l i m i ted end eavor s par tti m e o r at her own pace. The r emai nde r o f th e AL J ’ s dec i si o n sh o ws th at the failu re to w eig h D r. R ad ze vic i en e’s op in ion ap p ro p riat ely le d t o a d d itio n al e rro rs . I f th at op in ion w er e fu lly cre dit ed, i t s up port s both a fi nd i ng tha t J el i nek m et List i ng 12
. 04 bef or e the heari ng d ate and that h err esi du al functi onalcapaci ty w as consi ste nt with a fi nd i ng o f disabi l i ty. Dr. R ad zevi ci ene no ted thatJ el i nek e xhibi ted se ve r als y m pto m s o fde pr es si o n, i nc lud i nga ppet i te a nd sl eep di st u rbance, psycho m oto r agi tat i on o r re tar dati on, decr eas ed ener gy, and diffi cul ty concent ra ti n g or thi nki ng. D r. Radzevi ci ene’ s no tes al so re fl ect that J el i nek w as b i p o l ar . A find in g th at sh e s u ffer ed from th es e illn es se s w ou ld sa tis fy L ist in g 12 .04 ’s d iag n os tic “ A cr ite ria .” Se e 2 0 C. F. R. Pt. 40 4, S ubpt. P, A pp . 1 § 12 .04 (A ); Lars on , 615 F. 3d at 747- 48. Dr. Radzevi ci ene a l so opi ned that J el i ne kwas e xpe r ienci ng“ fr eque nt ” defi ci en ci es o fc o ncentr ati on, per si ste nce, o r pace and “r epeate d” epi sodes ofdeter i or ati on o r decom pensation in w or k o r w or kli ke se tt i ng s, t o g ethe re no ugh t o meetLi st i ng1 2. 04 ’s di agno st i c “B cr i te r i a. ” S ee 2 0 C. F
. R. Pt. 4 04, S ubpt

. P, A p p . 1 § 12 .04 (B ); Lars on , 615 F.3d at74 7-4 8; C raf tv. Ast r ue, 5 39 F
. 3 d 6 6 8 , 6 74

- 7 5 ( 7 th C i r . 2 0 0 8 )
. T h e s e t wo fi nd i ngs — th at Jelin ek sa tis fied bo th th e A an d B cr ite ria ofLi sting 12
. 04 — w oul d t oge ther com pel a fi nd in g t h at J e l i ne kwa s di s abl ed. S e e 2 0 C. F
. R. P t
. 4 0 4 , S ub pt
. P , App
. 1 § 12
. 00. But the A LJ’ s o pini on di d not m enti on a ny o f th e sy m ptoms c i te d i n Dr
. Ra dze vi ci en e’ s 20 08 o pi ni o n. I n f act, tho ugh the quoted te xt appear s in the section ofN o. 10

- 3340 17 the AL J ’ s o pini on devo te d to w hetherJ el i nek “ m et or m edi cal l y e quale d” a l i ste d i m pai rm ent a fterthe age o f eightee n, the sec tion d evote d t o D r. Rad zeviciene ’s op in io n cited only the p ortion d evote d to J eli ne k’s re si du al functi onal capaci ty, not her sym ptom s ord iagnose s. As n oted , J el i ne ka l so c o nt en ds o n a ppea ltha t th e A LJ’ s f ai l ure to anal yze Dr. Radzevi ci ene’ s o pin ion l ed th e jud ge to om it ke y lim ita tio n s w h en p re se n t i n g h is hypotheti calquesti ons to voca ti onalexper t F i sherat Je lin ek’s hea ring. A s a result, Jel inek argu es, th e exp ert coul d not g i ve the AL J an a ccurat e picture o fthe j obs available to her i n th e nat iona l e c o nom y. A t the very leas t, J el i nek c onte nd s, the A LJ s houl d have incl ud ed hypotheti calqu es tio ns address i ng i ssues o f“co ncentr ati on, per si ste nce, o r pace” c onsi stent with the m edi cal o pi ni o ns tha t he cr edi te d, i nc l udi ngDr. K l adde r ’ s. Aga i n, w e a gr ee. W e h a v e s t a t e d r epe a t e dl ytha tALJ s mus tp r o v i de voca tional exp erts w ith a com p lete pictu re of a claim an t’s re si du alfuncti onalcapaci ty, and voc ati onal experts m ust co ns i der“ defi ci en ci es o fc o nc en tr at i o n, pe r si st en ce , a nd pace. ” O ’ Conne r - Spinne rv. As t r ue, 62 7 F
. 3d 614, 61 9 ( 7th Cir
. 20 10) ; se e Ste w art, 56 1 F .3 d a t 6 84 ; Yo un g v . B a rnh a rt, 3 6 2 F.3d 995, 1004 ( 7th Cir. 2004); Ka s ars kyv . Ba r n hart, 33 5 F .3d 53 9, 54 4 (7 th C ir. 20 03 ); S t e ele, 29 0 F
. 3d at 942. A nd tho ugh the hypotheti calquesti ons posed by an A LJ t o a v o c a t i o n a le x p e r tmu s ti n c l u d e o n l y th e p h y s i c a la nd m en ta l lim ita tio n s t h e jud ge d ee m s c re d ible , Sc hm i dt, 496 F. 3d at 846, the A LJ di d not do that i n thi s ca se.18 N o. 10

- 3340 The ALJ l i m i te d hi s que st i o ni ngofthe e xpe r t to “ se den

ta r y ” an d “ l i g ht ” uns k i l l ed wor k

. But“ se den tary” a nd “lig h t” bo th d es c rib e a cla i m a n t’s ab ility to ex er t h er se lf phy si ca l l y o ve r a wor k day o r wor k wee k

. S ee 20 C. F
. R. §§ 404
. 1567, 416.967(b); So ci alS ecuri ty Ruli ng ( “SS R”) 83

- 10 , 1 9 8 3 W L 31 25 1, at *5-6 (19 83 ); Haynes v. Ba rnhart, 41 6 F. 3d 621, 62 7 n. 2 ( 7th Ci r. 2 005)
. S i m i l ar l y, “unski l l ed wo r k ” i s de f i ne d b y r e g ul a t i o n a s “ wo r kwh i c h ne e ds l i ttl e o r no j ud gm ent t o do si m ple duti es that can be l ea r ne d o n the j o b i n a s ho r t per i o d o ft i m e. ” 20 C. F
. R. § 404. 1568 ( a)
. N one ofthes e t er m s a dd re sse d the i m pact of th e m en tal li m itations refl ecte d in D r . R ad zeviciene ’s o pi ni o n, wh i c h ( a s r e fl e c t e d in the ab o v e quo tat i on fr o m the ALJ ’ s dec i si o n) l i m i te d Jel i ne k ’ s ab i l i tyt o mai nta i n r e g ul a rwo r ka t t e nd a nc e , t o c a r r y o uti ns t r uc ti ons, and to dealwith the st re sse s o ffull

- ti m e e m plo ym ent. W hat’ s m or e, Dr. Kla d d er ’ s e ar l i ero pini on fro m 20 06, w h i ch the A LJ l ar gely c re dit ed, co ncl ud ed that J el i nek wa s n o t a ma l i ng e r e ra nd tha ts he s uffe r e d a tl e a s t“ mod

e r a t e l i mi t a t i o n s ” i n h e rab i l i t i e s t o c o n c e n t r a t e , t o c o mpl et e a no rm al wor k dayo rwor k wee k, a nd t o r es po nd appr o pr i at ely t o c r i ti ci sm fr o m su p er vi so r s. At the l ea st, the ALJ w as re qui r ed to po se hy po th et i ca lque st i o ns to the vocation al ex p ert con sisten t w ith D r. K ladd er’s opi ni on ( and w i th tho se ofthe othe r physi ci ans o n w hose o p i ni ons he r el i ed) to gi ve the e xpert a co m ple te picture ofJ el i nek’ s r esi du alfuncti onalcapaci ty. The se a r e r ea so ns e no ugh t o r emand th e m at te rt o the ag en c y for fu rt h er rev iew . N ev er th ele ss , w e b rie fly add re ss as w el lJ el i ne k’s fi nalar gum ent

— tha tthe ALJN o. 10

- 3340 19 f ai l ed to co nd uct a propercr edibi l i ty anal ysi s

— to point out a few addit i onalfl aw s that s houl d be a voi ded o n re m and. For em ostam ong these i s the A L J ’ s r epeate d re fer ence to J el i nek’ s “ m edi cati on non-co m pli ance” as a r e a s o n f o r fi n d i n g h e r n o t c r e d ib l e . T h e AL J a pparently c oncl ud ed that J el i nek’s sym ptom s would have re m ain ed und erco ntro lbut f oran unw i l l i ngness to tak e herm ed ica tio ns as di re cted. But w e hav e o ften obs er ved thatbi pol ardi sor der, one ofJ el i nek’ s chi ef i m pa irm en ts, i s bynatur e e pis odi c and adm i ts to regu lar fl uc tu ation s even un d er prop er treatm en t. A L Js ass ess i ng cl ai m ants w i th bi pol ardi sor der m ust co nsi der possibl e a l tern at i ve expla nati ons bef or e co ncl ud i ng tha t non- com pli ance with m edi cati on s up port s a n adver se cre dib ility i nfe re nce. S ee Punzi o v. As t r ue, 63 0 F
. 3d 704, 71 0 (7 th C ir. 20 10 ); Lars on , 6 15 F.3d at75 1; Baue rv. As t r ue, 53 2 F .3d 6 0 6 , 60 9 (7 th C ir. 20 08 ); Ka ng a il v. B a rnh a rt, 454 F.3d 627, 630-31 (7th Cir. 2006). H ere, th e record show s a l itany of cha ng es t o Jel inek’s m edi cati ons ove r the y ear s, as wellas co ncer ns byher d octors over sid e effects , i ne ffective d rugs , c o s t s , i ns urance i ssues , and com pli ance i ssue s d ue to bo th m ental i l l ne s s a nd the pote nt i a ll a c ko ff a mi l y a nd s o c i a ls up port
. Earl y no tes fro m J el i nek’ s v i si ts to the Bow en Center ex p re ss ed c on c er n th at h er m ot h er m igh t no t h a v e fu lly supp or ted her m edi cati on r egi m en. A nd atvar i ous ti m es J el i nek a dvis ed docto rs thats h e did nothave i nsurance and was concerned about payi ng f orther apy

— a c o stc o ncer n that coul d have l i m i ted heracc ess to herse ver al p re sc rib ed m ed ica tio n s. T re at m en t n ot es d id n otal-20 N o. 10

- 3340 way s r efl ec t why medi ca ti o n chan ges wer e m ade , b ut s e v e r a l n o t e s , i n c l u d i n g n o t e s fr o m a s l a t e a s De c e mber 2007, show th a t d octors w ere con cern ed that J eli ne k’s me d i c a t i o n s w e r e n o to p t i ma l l y t r e a t i n gh e rs y mpt o ms and that s he would so m eti m es run o ut o fherm edi cati o ns . The se c o nc erns m us t be a ddr es se d a s par t o fa ny consi derat i on o fJ el i nek’s fai l ure to com plywith pr es cr ibe d m edi ca ti o n. W e R EV ERSE the di s t r i c tc o ur t ’ s j ud gm en ta nd R EMA ND to the So ci al Se curi ty A dm i ni str ati on f or further proce eding s co ns i st en t wi ththi s o pi ni o n.

11- 7- 11