IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

EASTERN DIVISION

MARK MAZZUCA )

)

 Plaintiff, )

) Case No. 12 C 2907

)

v. ) Magistrate Judge Daniel G. Martin

)

CAROLYN COLVIN, )

Commissioner of Social Security, )

)

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Mark Mazzuca ("Plaintiff" or "Mazzuca") seeks judicial review of a final

decision of Defendant Carolyn Colvin, the Acting Commissioner of Social Security

("Commissioner"). The Commissioner denied Plaintiff's application for disability benefits

and Supplemental Security Income benefits ("SSI") under Title II of the Social SecurityAct,

and Mazzuca filed a Motion for Summary Judgment that seeks to reverse the

Commissioner's decision. The Commissioner filed a cross-motion. The parties have

consented to have this Court conduct all proceedings in this case, including an entry of

final judgment. 28 U.S.C. § 636(e); N.D. Ill. R. 73.1(c). For the reasons stated below, both

Plaintiff's and the Commissioner’s motions are granted in part and denied in part.

I. Legal Standard

A. The Social Security Administration Standard

In order to qualify for disability benefits, a claimant must demonstrate that he is

disabled. An individual does so by showing that he cannot "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 12 months." 42 U.S.C. § 4243(d)(1)(A). Gainful

activity is defined as "the kind of work usually done for pay or profit, whether or not a profit

is realized." 20 C.F.R. § 404.1572(b). 

The Social Security Administration ("SSA") applies a five-step analysis to disability

claims. See 20 C.F.R. § 404.1520. The SSA first considers whether the claimant has

engaged in substantial gainful activity during the claimed period of disability. 20 C.F.R. §

404.1520(a)(4)(I). It then determines at Step 2 whether the claimant's physical or mental

impairment is severe and meets the twelve-month durational requirement noted above. 

20 C.F.R. § 404.1520(a)(4)(ii). At Step 3, the SSA compares the impairment (or

combination of impairments) found at Step 2 to a list of impairments identified in the

regulations ("the Listings"). The specific criteria that must be met to satisfy a Listing are

described in Appendix 1 of the regulations. See 20 C.F.R. Pt. 404, Subpt. P, App. 1. If the

claimant's impairments meet or "medically equal" a Listing, the individual is considered to

be disabled, and the analysis concludes; if a Listing is not met, the analysis proceeds to

Step 4. 20 C.F.R. § 404.1520(a)(4)(iii). 

Before addressing the fourth step, the SSA must assess a claimant's residual

functional capacity ("RFC"), which defines his exertional and non-exertional ability to work. 

The SSA then determines at the fourth step whether the claimant is able to engage in any

of his past relevant work. 20 C.F.R. § 404.1520(a)(4)(iv). If the claimant can do so, he is

not disabled. Id. If the claimant cannot undertake past work, the SSA proceeds to Step

5 to determine whether a substantial number of jobs exist that the claimant can perform

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in light of his RFC, age, education, and work experience. An individual is not disabled if

he can do work that is available under this standard. 20 C.F.R. § 404.1520(a)(4)(v). 

B. Standard of Review

A claimant who is found to be "not disabled" may challenge the Commissioner's final

decision in federal court. Judicial review of an ALJ's decision is governed by 42 U.S.C. §

405(g), which provides that "[t]he findings of the Commissioner of Social Security as to any

fact, if supported by substantial evidence, shall be conclusive." 42 U.S.C. § 405(g). 

Substantial evidence is "such evidence as a reasonable mind might accept as adequate

to support a conclusion." Richardson v. Perales, 402 U.S. 389, 401 (1971). A court

reviews the entire record, but it does not displace the ALJ's judgment by reweighing the

facts or by making independent credibility determinations. Elder v. Astrue, 529 F.3d 408,

413 (7th Cir. 2008). Instead, the court looks at whether the ALJ articulated an "accurate

and logical bridge" from the evidence to her conclusions. Craft v. Astrue, 539 F.3d 668,

673 (7th Cir. 2008). This requirement is designed to allow a reviewing court to "assess the

validity of the agency's ultimate findings and afford a claimant meaningful judicial review." 

Scott v. Barnhart, 297 F.3d 589, 595 (7th Cir. 2002). Thus, even if reasonable minds could

differ as to whether the claimant is disabled, courts will affirm a decision if the ALJ's opinion

is adequately explained and supported by substantial evidence. Elder, 529 F.3d at 413

(citation omitted). 

II. Background Facts

A. Medical History

Plaintiff began treatment with psychiatrist Dr. Melissa Chappell in October, 2005. 

3
Dr. Chappell noted that he showed a chronic “down mood” and diagnosed him with

dysthymia and depression. (R. 335, 337). She prescribed Effexor to treat Mazzuca’s

mood disorder, though her notes suggest that he had already taken Wellbutrin, Serzone,

and Adderall. (Id.). Dr. Chappell’s treatment notes imply that Mazzuca’s moods altered

significantly from one session to another. In late 2005, he reported feeling “aimless” both

at work and in his marriage. (R. 332-33). By January 2006, however, Plaintiff reported

feeling better and more motivated. (R. 329). Dr. Chappell doubled the dose of Effexor

and, in October 2006, increased it once again. (R. 315, 321). 

Dr. Chappell noted throughout 2007 that Mazzuca tolerated his medication well and

that his sleep patterns were stable. (R. 298, 300, 304, 307). By November 2007, his

insight had “greatly improved.” (R. 298). Plaintiff expressed growing anxiety by the

summer of 2008, when Dr. Chappell observed that he was too anxious to go to work and

had suddenly quit his job. (R. 292, 294). Her notes indicate a flat affect, obsession, and

some anhedonia that led her to increase his Effexor levels once again in late 2008. (R.

289, 290). By September 2009, Dr. Chappell stated that Mazzuca was having difficulty

getting out of bed at least twice a week and was ruminating “about capitalism and

socialism.” She responded by once more increasing his Effexor prescription. (R. 277).

Within a few weeks, however, Plaintiff stopped taking his medication altogether. (R.

273). He claimed that he felt better without them, but by October 21, 2009, he began

taking Prozac instead of Effexor. Dr. Chappell noted that Mazzuca had gambled away

$10,000 in 2009. (R. 270). The dosage levels of Prozac rose throughout 2010, as Dr.

Chappell noted good and bad days for Plaintiff. He reported feeling “exuberant” one day,

but feeling miserable the following week. (R. 262). Dr. Chappell changed Plaintiff’s

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medication to Pristiq. Throughout his treatment with Dr. Chappell, Mazzuca also met with

counselor Kristin Mikolite on a more frequent basis. 

Mazzuca began expressing increased doubts about the effectiveness of his

medication in late 2010. (R. 417- 20). By August and September of that year, he wrote

a series of letters to Dr. Chappell outlining his complaints about treatment. Mazzuca stated

that his medication merely “masks” things and that he planned to commit suicide once his

parents died. (R. 243). Plaintiff accused Dr. Chappell of having “the blood of Americans

on [her] hands” and encouraged her to “get out [of] the exploitation of people business.” 

(R. 245). An August 30, 2010 letter describes Mazzuca’s gambling, hoarding, spending,

and drinking sprees. He asked Dr. Chappell to treat him for bipolar disorder, which he

claimed afflicted other members of his family. (R. 238-41). Two September letters

described Mazzuca’s sleep problems in detail, as well as complaints of “[t]he tyranny of the

Capitalistic System to control, devalue, and exploit the individual through technology.” (R.

235).

Mazzuca’s growing depression resulted in psychiatric hospitalization at the Linden

Oaks Hospital in November 2010. Dr. Martins Adeoye noted on November 5 that Mazzuca

was suffering from severe depression and a generalized anxiety disorder. He expressed

suicidal thoughts, with poor insight and a Global Assessment of Functioning (“GAF”) of 25.1

GAF scores reflect a clinician’s assessment of a patient’s overall level of 1

functioning. See Am. Psychiatric Ass’n, Diagnostic & Statistical Manual of Mental

Disorders 32 (4 ed. 2000). GAF scores between 21 and 30 suggest behavior “influenced th

by delusions or hallucinations OR serious impairment in communications or judgment OR

inability to function in all areas.” Packard v. Astrue, No. 11-7323, 2012 WL 4717890, at

*3 (E.D. Pa. Oct. 4, 2012) (internal quote and citation omitted). “GAF scores are intended

to be used to make treatment decisions . . . not as a measure of the extent of an

individual’s disability.” Martinez v. Astrue, No. 9 C 3051, 2010 WL 1292491, at *9 (N.D.

5
Plaintiff was considering buying a gun and had been unsuccessful in searching the internet

for the best way to kill himself. Dr. Adeoye stated that Mazzuca had serious problems with

his sleep patterns and was experiencing “significant mental health problems.” (R. 539-40). 

Plaintiff was released on November 10 with a “guarded” prognosis. Dr. Adeoye noted that

he had shown significant improvement when Seroquel was added to the Pristiq that

Mazzuca was already taking on admission. (R. 542). 

Plaintiff continued to see Dr. Chappell for a few treatment sessions after being

released from the hospital. However, the psychiatrist noted on November 11, 2010 that

Mazzuca had stopped taking Seroquel because of nausea and that he was not taking any

other antidepressant. One week later, Plaintiff met with Dr. Evaldas Radzevicius at

Advocate Christ Medical Center for a psychiatric evaluation. Dr. Radzevicius noted that 

Mazzuca’s depression had become worse through the years and that he was having

difficulty with his sleep. The psychiatrist diagnosed Plaintiff with a major depressive

disorder. Mazzuca was reluctant to take any medication, stating that they were “a big

scam” perpetrated by pharmaceutical companies “who are drug dealers.” (R. 697). 

However, he agreed to try Lexapro at Dr. Radzevicius’ suggestion. (R. 698). Mazzuca’s

condition had improved by December 1, when he reported that he felt better and was

sleeping more normally. (R. 793). 

By March 23, 2011, the psychiatrist noted that Mazzuca was “feeling much better”

and showed logical thinking. Dr. Radzevicius also changed his diagnosis to include bipolar

disorder NOS and dysthymic disorder. (R. 830). Plaintiff continued to see Dr. Radzevicius

Ill. Mar. 29, 2010) (internal quote and citation omitted).

6
at least through July 22, 2011. The psychiatrist had changed his medication during this

treatment period from Lexapro to Remeron, and finally to Zoloft. Dr. Radzevicius’ last

treatment note in the record states that Mazzuca was “sad” and “glum,” though he believed

that his medication was working. He recommended that Mazzuca continue with the

psychotherapy sessions that he had been pursuing with social worker Elizabeth Bulmer. 

(R. 811). 

B. Consulting and State Agency Physicians

1. Dr. Melissa Chappell

Psychiatrist Dr. Melissa Chappell issued a Mental Impairment Questionnaire on May

13, 2010. Dr. Chappell assigned Mazzuca a GAF score of 60. She noted that Plaintiff had

responded to Prozac and weekly therapy. He showed improved mood, energy, and

motivation. Dr. Chappell determined that Mazzuca had a mild limitation in his activities of

daily living and a moderate restriction in social functioning. She failed to note what

limitation applied to his concentration, persistence, and pace. In addition, Mazzuca’s

psychiatrist believed that he had experienced three episodes of decompensation within a

twelve-month period, with each episode lasting at least two weeks. Plaintiff’s prognosis

was assessed as “fair - good.” (R. 383-86). The ALJ gave no weight to Dr. Chappell’s

opinion. (R. 27-28).

2. Dr. Tyrone Hollerauer

State agency psychologist Dr. Tyrone Hollerauer issued a Psychiatric Review

Technique (“PRT”) assessment of Plaintiff on April 14, 2010. Dr. Hollerauer found that

Mazzuca suffered from an affective disorder, an anxiety disorder, and a substance

7
addiction disorder, none of which were severe. Plaintiff was not found to be bipolar. 

Contrary to Dr. Chappell’s view, Dr. Hollerauer concluded that Mazzuca had not

experienced any episodes of decompensation. He also determined that Plaintiff had only

a mild limitation in all three of his functional categories of daily living, social functioning, and

concentration. (R. 359-71). 

3. Dr. Larry Kravitz

After the hearing, theALJ requested an evaluation from non-examining psychologist

Dr. Larry Kravitz. Dr. Kravitz diagnosed Mazzuca with bipolar and dysthymic disorder. 

These impairments did not meet or medically equal a Listing. Dr. Kravitz agreed with Dr.

Chappell that Mazzuca suffered from a mild limitation in activities of daily living and a

moderate limitation of social functioning. He also determined that Plaintiff had a moderate

restriction in his concentration, persistence, and pace. However, the form given to Dr.

Kravitz did not ask for the number of decompensation episodes. It only allowed the

psychologist to assess the severity of any episodes of extended duration that may have

existed. Dr. Kravitz found that Mazzuca had a moderate limitation under this functional

category. (R. 833-43). 

C. Hearing Testimony

Mazzuca appeared at the hearing before ALJ Supergan on July 11, 2011. He

testified to a series of personal and professional difficulties that he claimed stemmed from

his mental impairments. Mazzuca formerly worked as a financial planner until he was

terminated in January 2007. He stated that his production had gone from the highest in

his office to zero within the last year of his job. Mazzuca did not give reasons for the

8
decline in his productivity. However, he stated that he had serious hesitations about

encouraging clients to invest in oil companies that “started wars” and worked to “overthrow

a democracy.” (R. 56). Mazzuca further linked his work to national politics by claiming that

his participation in financial planning had caused the election of President George W.

Bush. (R. 56). Plaintiff expressed additional fears that the government might be targeting

him in some way. (R. 55).

Mazzuca stated that he found it difficult to find work because he becomes frustrated

easily and has difficulty maintaining his concentration. Plaintiff applied for a job at

Menard’s in 2008, but left because people there looked at him “funny.” (R. 48). He also 

interviewed for a position with another company, but felt the need to leave within a few

minutes because the employees were not wearing gloves. (R. 52). Plaintiff expressed

significant concerns about being contaminated by germs. (R. 52). Mazzuca did obtain a

position in 2008 as a sleep apnea technician after he received a training certificate.

However, he felt the need to walk out of that job because he felt overwhelmed. (R. 46-47).

When he was fired in January 2007, Mazzuca also stopped drinking after years of

excessive alcohol use. He regularly attends meetings of Alcoholics Anonymous (“AA”) and

has maintained sobriety. (R. 50). Plaintiff testified that he has also struggled with

compulsive gambling and spending. Mazzuca stated that his level of functioning had

diminished during the years that preceded the hearing. He stopped taking trips with his

wife and was no longer able to eat out except on rare occasions at places where he felt

safe. (R. 51-52, 580). Mazzuca stated that once a month he is completely unable to get

out of bed or to leave his house. These periods of decompensation last for several days

at a stretch. (R. 54-55). Plaintiff’s social activities are limited to attending AA and therapy

9
meetings several times a week. (R. 58). Otherwise, his daily activities are limited to

helping his wife care for their two dogs and listening to the radio over the internet. (R. 48-

49). Mazzuca also stated that he has ongoing problems with sleep. At times he wakes up

often and sleeps during the day; at other times he sleeps for long periods of time at a

stretch. (R. 60). 

Plaintiff’s wife also testified at the hearing. Mrs. Mazzuca stated that her

husband’s ability to help with chores had diminished dramatically over the past few years. 

He no longer cooks dinner, goes out, or rides bicycles. (R. 64). Mazzuca does help his

wife with laundry and prepares light meals, but he can only do so about three times a

week. (R. 64-65). Mrs. Mazzuca confirmed her husband’s statement that he often finds

it difficult to get out of bed or to leave their home. (R. 65). His relations with other people

are often contentious. (R. 65-66). She also stated that he was “very paranoid over the

government” and had “extreme” political views. (R. 67). 

D. The ALJ’s Decision

On October 7, 2011, ALJ Supergan issued a written decision finding that Plaintiff

was not disabled. The ALJ determined at Step 1 that Mazzuca had not engaged in

substantial gainful activity since his alleged onset date of July 1, 2008. Plaintiff’s severe

impairments at Step 2 included bipolar disorder, dysthymic disorder, and a history of

substance abuse. At Step 3, the ALJ applied the "special technique" required under 20

C.F.R. § 1520(a) for assessing the severity of mental disorders. She concluded that

Mazzuca had a mild restriction in his activities of daily living, and moderate restrictions in

social functioning and concentration. One to two episodes of decompensation were also

found. None of Plaintiff’s severe impairments met or medically equaled a Listing.

10
Before moving to Step 4, the ALJ assessed Mazzuca’s credibility. The ALJ gave

Plaintiff’s testimony “some weight,” she concluded that it was not credible “to the extreme

limitations” that Mazzuca claimed. The ALJ also assessed Plaintiff’s RFC, finding that

Mazzuca could perform a full range of work at all exertional levels. The ALJ accounted for

Plaintiff’s mental impairments by limiting him to unskilled work involving tasks that can be

learned by demonstration or within a limited time period. Plaintiff was also limited to only

occasional decision making, work changes, and restricted contact with supervisors or the

public. Based on this RFC, the ALJ found at Step 4 that Mazzuca could not perform his

past relevant work. The ALJ heard testimony from the VE at Step 5 and concluded that

Plaintiff was not disabled because a significant number of jobs existed that he could

perform. 

III. Discussion

Mazzuca challenges the ALJ’s decision on three grounds. He claims first that the

ALJ did not correctly weigh the medical opinion of Dr. Chappell. Mazzuca also argues that

the ALJ erred in her Step 3 discussion of Listings 12.04 (affective disorders) and 12.06

(anxiety related disorders). Third, Plaintiff contends that the ALJ improperly assessed the

credibility of the testimony he and his wife gave at the hearing. The Court addresses each

of these arguments in turn.

A. The ALJ Improperly Weighed Opinion Evidence

An ALJ is required to evaluate every medical opinion in the record. 20 C.F.R. §

404.1527(d). See Young v. Barnhart, 362 F.3d 995, 1001 (7th Cir. 2004) ("Weighing

conflicting evidence from medical experts . . . is exactly what the ALJ is required to do."). 

11
The regulations lay out six factors an ALJ should consider as part of this analysis, including

the nature and length of the treatment relationship, the medical expert's specialization, and

the degree to which a source's opinion is supported by other evidence. 20 C.F.R. §

404.1527(d)(1)-(6). The ALJ must clearly state the weight he has given to the medical

sources and the reasons that support the decision. See Ridinger v. Astrue, 589 F.

Supp.2d 995, 1006 (N.D. Ill. 2008). “A treating physician’s opinion is entitled to controlling

weight if it is well-supported by medically acceptable clinical and laboratory diagnostic

techniques and is not inconsistent with other substantial evidence.” Larson v. Astrue, 615

F.3d 744, 749 (7 Cir. 2010). th

Mazzuca argues that the ALJ violated this standard when she gave no weight to Dr.

Chappell’s Mental Impairment Questionnaire. The ALJ cited two reasons for her decision

concerning Plaintiff’s treating psychiatrist. She concluded first that the doctor’s opinion

“would be work preclusive due to the number of anticipated absences from work among

other things even though she described the claimant’s prognosis as ‘fair to good.’” (R. 27). 

Second, the ALJ noted that Dr. Chappell assigned Mazzuca a GAF of 60, which suggests

a “moderate” limitation in social and occupational functioning. The ALJ believed that this

finding was “contrary to other treatment notes in the record.” (R. 27-28).

Neither of these explanations satisfies the requirements for evaluating a treating

physician’s opinion. The Commissioner claims that the ALJ’s first reason is justified 

because Dr. Chappell’s prognosis for Mazzuca cannot reasonably be applied to a disabled

claimant. Although not entirely clear, both the Commissioner and the ALJ appear to

assume that Dr. Chappell’s report rests on a contradiction between her prognosis and a

finding that Mazzuca was disabled. 

12
The Court respectfully disagrees with this claim. An internal inconsistency can be

a ground for not giving controlling weight to the opinion of a treating physician. 20 C.F.R.

§ 404.1527(c)(2); Clifford v. Apfel, 227 F.3d 863, 871 (7 Cir. 2000). In this case, however, th

it is not clear what inconsistency exists. Dr. Chappell never gave an opinion that Mazzuca

was disabled or could not work. She only stated that Plaintiff would miss two days of work 2

each month and had a prognosis of “fair – good.” (R. 384, 386). A “prognosis” is not an

assessment of a person’s overall functional capacity; it is the “probable outcome of a

present medical condition (such as a disease).” Black’s Law Dictionary 1330 (9 ed. th

2009). 

The common-sense meaning of Dr. Chappell’s statement is that, although

Mazzuca’s current mental status would require a work absence of two days a week, there

was a reasonable probability that he would improve over time with continued treatment. 

The ALJ provided no explanation of why this finding gives rise to a contradiction that would

justify rejecting Dr. Chappell’s report in its totality. Thus, the ALJ failed to build a logical

bridge between the record and her conclusion on this issue. See Haynes v. Barnhart, 416

F.3d 621, 626 (7 Cir. 2005) (stating that an ALJ is always required to explain the basis for th

her reasoning and to draw a logical bridge between the evidence and her findings). 

The ALJ’s second reason for rejecting Dr. Chappell’s report was that “other

treatment notes” contradicted the psychiatrist’s GAF score of 60. Contradictions between

The ALJ would have been justified in rejecting any statement by Dr. Chappell that

2

Mazzuca was disabled. Such conclusions are reserved exclusively to the Commissioner. 

20 C.F.R. § 404.1527(e)(2). The ALJ’s comment seems to refer to the VE’s testimony that

if Mazzuca could not work for two days a week, as Dr. Chappell claimed, he would not be

able to perform full-time work. 

13
an expert’s report and other substantial evidence can be a basis for giving less than

controlling weight to a treating physician. 20 C.F.R. § 404.1527(c)(2). The ALJ cited many

GAF scores in the record that were inconsistent with Dr. Chappell’s. For example, Dr.

Adeoye assessed Plaintiff’s score as a 25 six months after Dr. Chappell issued her May

2010 opinion; Dr. Radzevicius assigned a score of 45 twelve days after Dr. Adeoye’s

report; and Dr. Kravitz gave Plaintiff a GAF of 50. (R. 540, 698, 830). 

The Court disagrees that these contradictions were sufficient to reject Dr. Chappell’s

report without further discussion. The ALJ assumed that scores assigned to Plaintiff at

other times provided a standard against which Dr. Chappell’s assessment of 60 could be

judged as deficient. To do so, however, the ALJ was required to account for two factors

that cast doubt on her current finding. First, the record strongly suggests that Plaintiff’s

GAF levels fluctuated over time. That is not surprising in light of Mazzuca’s bipolar

disorder. In addition, many courts have noted that “GAF scores often vacillate.” Hunt v.

Astrue, 889 F. Supp.2d 1129, 1146 (E.D. Wis. 2012). See also Herrera v. Astrue, No. CV10-362, 2012 WL 1840128, at *4 n.1 (E.D. Wash. May 21, 2012) (“[A] GAF score can

fluctuate depending on the current circumstances.”). The ALJ herself noted that Plaintiff’s

GAF improved from 25 to 40 while he was hospitalized at Linden Oaks in 2010. (R. 24). 

Before she could rely on inconsistencies between Dr. Chappell and other medical sources,

the ALJ was required to account for the fact that all the GAF scores she cited conflicted

with one another as well as with Dr. Chappell. 

Second, the ALJ did not account for what the May 2010 questionnaire actually

asked Dr. Chappell to evaluate. The questionnaire did not inquire into Mazzuca’s overall

GAF level, but only his “current” GAF score and his “highest GAF past year.” (R. 383). 

14
This language leaves open the possibility that lower scores could exist at other times

without conflicting with Dr. Chappell’s report in May 2010. 

Even if a valid inconsistency existed, moreover, the ALJ failed to provide any

justification for rejecting Dr. Chappell’s report out of hand. Dr. Chappell was a treating

medical source. Social Security Ruling 96-2p instructs ALJs that inconsistencies may be

grounds for giving less than controlling weight to treating source opinions. However, this

does not necessarily mean that an ALJ can simply reject an expert report in the way the

ALJ did in this case:

Adjudicators must remember that a finding that a treating source medical

opinion is not well-supported by medically acceptable clinical and laboratory

diagnostic techniques or is inconsistent with the other substantial evidence

in the case record means only that the opinion is not entitled to “controlling

weight,” not that the opinion should be rejected. Treating source medical

opinions are still entitled to deference and must be weighed using all of the

factors provided in 20 CFR 404.1527 and 416.927. In many cases, a

treating source’s medical opinion will be entitled to the greatest weight and

should be adopted, even if it does not meet the test for controlling weight.

SSR 96-2p. See also Moss v. Astrue, 555 F.3d 556, 561 (7 Cir. 2009) (“If an ALJ does th

not give a treating physician’s opinion controlling weight, the regulations require the ALJ

to consider the length, nature, and extent of the treatment relationship, frequency of

examination, the physician’s specialty, the types of tests performed, and the consistency

and supportability of the physician’s opinion.”).

The ALJ did not specifically discuss any of the factors referenced in SSR 96-2p or

the regulations. There is no indication, for example, that she considered the fact that Dr.

Chappell treated Mazzuca far longer than any other medical expert did. The ALJ also

misstated the nature of Plaintiff’s relationship with Dr. Chappell. The decision claims that

Plaintiff only consulted his psychiatrist for medication management. (R. 24). However, Dr.

15
Chappell’s notes repeatedly state that she saw Mazzuca for both psychotherapy and

medication. (R. 285 - 300). The Court recognizes that an ALJ is not always required to

discuss each of the criteria stated in 20 C.F.R. § 404.1527. However, it is difficult in this

case to understand how the ALJ was able to set aside the deference that is always owed

to a treating source opinion without addressing at least some of those factors. 

Finally, the Commissioner claims that the ALJ did not err because she could infer

from a score of 60 that Mazzuca was not disabled and because the RFC includes

limitations that account for Dr. Chappell’s assessment. The first of these claims is

misplaced because the ALJ did not make a disability finding based on Dr. Chappell’s score

of 60. The ALJ noted that 60 “indicates moderate symptoms or a moderate impairment

in social . . . functioning.” (R. 28). The Commissioner overlooks that Dr. Chappell agreed

with this assessment in full when she stated that Mazzuca had a “moderate” limitation in

that functional area. (R. 385). The Commissioner fails to explain how the ALJ could have

rejected Dr. Chappell’s evaluation when the ALJ agreed with the psychiatrist’s own

evaluation of Plaintiff’s social functioning. As for the RFC, the ALJ could not have

reasonably considered Dr. Chappell’s report by including significant limitations in

Mazzuca’s ability to work. An ALJ cannot logically reject a treating physician’s report and

then rely on it to support the RFC findings. 

The ALJ’s failure to note the regulatory criteria, combined with the stated reasons

for her finding, means that substantial evidence does not support her rejection of Dr.

Chappell’s report. Plaintiff’s motion is granted on this issue. 

B. Remand is Necessary at Step 3

The ALJ found at Step 3 that Mazzuca’s impairments did not meet Listing 12.04

16
(affective disorders), Listing 12.09 (substance addiction disorders), “or any of the other

listed impairments” found in Appendix 1 of the regulations. (R. 21). The Listings set out

the criteria for physical and mental impairments related to various body systems. A

claimant who demonstrates that he meets a Listing is presumed to be disabled. 20 C.F.R.

§ 404.1525(a). “In considering whether a claimant’s condition meets or equals a listed

impairment, an ALJ must discuss the listing by name and offer more than a perfunctory

analysis of the listing.” Barnett v. Barnhart, 381 F.3d 664, 668 (7 Cir. 2004). Mazzuca th

claims that the ALJ did not follow these guidelines in his analysis of Listing 12.04. Plaintiff

also argues that remand is required because the ALJ should have considered whether his

anxiety problems met Listing 12.06.

The Court agrees that the ALJ’s discussion of Listing 12.04 is insufficient. Listing

12.04 contains three sets of criteria identified as Part A, Part B, and Part C. A claimant

meets the Listing by showing either that he (1) satisfies both Part A and Part B, or (2) 

meets Part C alone. 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.04. A claimant satisfies 3

Part C when he shows, in relevant part, that he has experienced “repeated episodes of

decompensation, each of extended duration.” Id. at § 12.04(C). The regulations define

“repeated episodes” as three events within a one-year period. Id. at § 12.00. The ALJ

found that Mazzuca did not meet this requirement because he only underwent one or two

Plaintiff argues at length that his episodes of decompensation meet Part B. Part 3

B of Listing 12.04 requires a claimant to show two of the following: (1) marked limitations

in activities of daily living, (2) marked limitations in social functioning, (3) marked limitations

in concentration, or (4) repeated episodes of decompensation. The ALJ, Dr. Chappell, and

Dr. Kravitz all agreed that Mazzuca did not experience the first three of these criteria. 

Plaintiff does not challenge these findings. Thus, he has failed to demonstrate an essential

requirement for satisfying Part B. 

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periods of decompensation. (R. 22). 

Several problems stem from this finding. An episode of decompensation involves

“exacerbations or temporary increases in symptoms or signs accompanied by a loss of

adaptive functioning[.]” Id. The Seventh Circuit has noted that major changes in a

claimant’s life setting such as hospitalization would qualify as an episode, “but so would

many other scenarios.” Larson, 615 F.3d at 750. As the regulations state, episodes can

also be inferred from major changes in a claimant’s medications. 20 C.F.R. Pt. 404, Subpt.

P, App. 1, § 12.00. 

Plaintiff claims that three events in his treatment history meet these criteria: (1)

treatment at Linden Oaks and Christ Hospital, (2) worsening symptoms during the week

of April 26, 2010, and (3) deteriorations in March and April 2011. The Commissioner does

not address whether these events constitute episodes of decompensation. Instead, the

Commissioner claims that the ALJ discussed the three events in her decision and argues

that this was sufficient as long as the Court can follow the basis of the ALJ’s reasoning. 

Unfortunately, that is the problem with the Step 3 finding. The ALJ did not state

which part of Mazzuca’s psychiatric history constituted the one or two episodes of

decompensation that she believed existed. This includes his hospitalization at Linden

Oaks, which almost certainly qualifies. The ALJ noted the hospitalization, but she did

make any finding on whether it was an episode of decompensation. More problematically,

the ALJ did not consider the other two episodes that Mazzuca relies on. Dr. Chappell’s

treatment notes around the end of April 2010 concern the first anniversary of the suicide

of Mazzuca’s sister, an event that the record shows was upsetting to claimant. (R. 436). 

The psychiatrist’s entries state that Mazzuca believed his medication had stopped working,

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and that he had feelings of suicide, panic, and other distress. (R. 432-36). The ALJ also

failed to discuss Dr. Radzevicius’ notes for March 2011 indicating that Mazzuca’s condition

had worsened and that he felt suicidal on occasions. (R. 830). As a result, Dr.

Radzevicius increased Mazzuca’s level of Zoloft. (R. 830). 

In addition, the ALJ’s failure to properly consider Dr. Chappell’s report has important

implications for the Listing issue. Dr. Chappell stated that Mazzuca experienced three

episodes of decompensation in a twelve-month period. (R. 385). The ALJ might have

accepted this conclusion had she properly applied the factors for weighing Dr. Chappell’s

opinion. For these reasons, remand is necessary so that the ALJ can reconsider the 4

record on Listing 12.04 and state her reasoning on the Part C issue with greater clarity. 

Plaintiff’s motion is granted on the Listing 12.04 issue.

Mazzuca’s argument on Listing 12.06 (anxiety) is less persuasive. Like Listing

12.04, Listing 12.06 also contains Part A, Part B, and Part C. A claimant satisfies this

Listing by showing that he either meets (1) Part A and Part B, or (2) Part A and Part C. 

The Part B elements for Listing 12.06 are identical to those under Listing 12.04. Thus,

Mazzuca has not shown that he could meet Part B for the reasons stated above. Part C

requires a showing that anxiety results “in [a] complete inability to function independently

outside the area of one’s home.” 20 C.F.R. Pt. 404, Subpt. P, App. 1, § 12.06(C). The

ALJ concluded that Mazzuca could, in fact, function in this manner. (R. 22). Plaintiff does

The ALJ gave great weight to Dr. Kravitz’s report, which assessed Mazzuca’s 4

episodes of decompensation as “moderate.” (R. 839). The regulations require an ALJ to

assess decompensation on a numerical scale of “one or two, three, [or] four or more.” 20

C.F.R. § 404.1520a(c)(4). If the ALJ relies on Dr. Kravitz on remand, she should explain

how “one or two” episodes are derived from his “moderate” finding. 

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not contest this finding. As a result, he has not shown why the ALJ erred or why remand

would be likely to result in a different conclusion. The Commissioner’s motion is granted

on the Listing 12.06 issue. 

C. Substantial Evidence Does Not Support the Credibility Assessment

Mazzuca next argues that the ALJ erred in finding that his statements concerning

the limiting effects of his symptoms were not fully credible. He also objects to the

assessment of his wife’s testimony. 

If an ALJ finds that a medical impairment exists that could be expected to produce

a claimant's alleged condition, he must then assess how the individual's symptoms affect

his ability to work. SSR 96-7p. The fact that a claimant's subjective complaints are not

fully substantiated by the record is not a sufficient reason to find that he is not credible. 

The ALJ must consider the entire record and "build an accurate and logical bridge from the

evidence to his conclusion." Clifford, 227 F.3d at 872. Factors that should be considered

include the objective medical evidence, the claimant's daily activities, allegations of pain,

any aggravating factors, the types of treatment received, any medications taken, and

functional limitations. Prochaska v. Barnhart, 454 F.3d 731, 738 (7th Cir. 2006); see also

20 C.F.R. § 404.1529(c)(3); SSR 96-7p. A court reviews an ALJ's credibility decision with

deference and overturns it only when the assessment is patently wrong. Jones v. Astrue,

623 F.3d 1155, 1162 (7th Cir. 2010).

1. Mazzuca’s Credibility

The ALJ found that Mazzuca’s testimony was entitled to some credence, although

she gave no indication of what parts she accepted or rejected. (R. 27). In support, the ALJ

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accounted for a number of the factors outlined in the regulations and SSR 96-7p. She

stated that Mazzuca had been able to participate in regular AA meetings and at least some

social activities that were inconsistent with a claim of total disability. The ALJ cited a

number of medical records as counter-evidence to Mazzuca’s subjective claims. These

included Dr. Kravtiz’s report, which agreed with the ALJ’s ultimate disability finding. See

Berger v. Astrue, 516 F.3d 539, 546 (7 Cir. 2008) (discussing such medical evidence as th

support for a credibility determination). She also took careful note of Mazzuca’s medication

history and the psychotherapy he received to treat his mental impairment. 

These grounds provide some basis for the ALJ’s credibility assessment. But the

ALJ could not assess Plaintiff’s credibility on these grounds alone without first applying the

correct standards to Plaintiff’s treating physician. Dr. Chappell provided the strongest

support for Mazzuca’s statements on the limitations he experiences from depression and

bipolar disorder. The psychiatrist stated that even on 70 mg. of Prozac, Mazzuca

experienced decreased energy, persistent anxiety, and three episodes of decompensation

a year, each lasting at least two weeks. (R. 384-85). The last finding supports Mazzuca’s

claim that he experiences down cycles that prevent him from working on a regular and

sustained basis.

The ALJ’s consideration of the medical record is also undermined by other reasons

that raise serious concerns. Some are not reversible in themselves. She claimed, for

instance, that Mazzuca was less credible because a SSA field officer noted that he was

cooperative, clean, and showed no signs of any limitations. (R. 23, 205). This was not a

ground on which to discredit Mazzuca. Having a psychiatric disorder does not preclude a

person from being clean and cooperative. Indeed, Dr. Chappell noted that Mazzuca was

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“cooperative” and showed an “appropriate” appearance, even though he had recently

experienced a panic attack and felt suicidal. (R. 441). Dr. Kravitz echoed this in his report. 

(R. 843). As for limitations, Dr. Kravitz assessed numerous limitations that contradict the

field employee’s conclusion about Mazzuca.

The Court has greater concerns over the fact that the ALJ found Mazzuca to be less

credible because he could not explain what “prompted the changes” in his mental condition

after the alleged onset date of July 2008. (R. 26). A claimant is not required to explain the

origin of his disorder. That is especially true of mental impairments, which by definition

affect a person’s mind and, potentially, the ability to have the kind of insight the ALJ

sought. The ALJ should have been aware that both the regulations and SSR 96-7p

governing credibility assessments speak only of a claimant’s “symptoms.” They do not

authorize an ALJ to discount a claimant’s credibility because he cannot explain why those

symptoms began. See 20 C.F.R. § 404.1529(c)(4); SSR 96-7p. Equally important, the

ALJ never asked Mazzuca to describe either the changes he experienced around his onset

date or their cause. She only asked “What happened? What changed” in the context of

Mazzuca’s description of difficulties in getting out of bed in “2008, 2009, [and] 2010.” (R.

53). 

The ALJ laid great stress on her belief that Mazzuca’s condition had improved after

he stopped drinking in January 2007, and that this improvement continued through his

onset date. See Record at 26 (“The medical evidence demonstrated improvement in his

condition after sobriety as indicated above.”). Her discussion is far from clear, but the ALJ

appears to have thought that Mazzuca’s statements could be discounted because no

significant deterioration in his mental condition took place around the onset date of July

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2008. However, the ALJ did not account for the records that are relevant to that timeframe. 

In June 2008, Mazzuca refused to go to work, felt anxious, and engaged in thinking that

required Dr. Chappell to stress the distinction between “reality vs. fantasy.” (R. 294). The

psychiatrist’s August 2008 note states that Mazzuca had abruptly quit his job, and the

remaining notes for 2008 all indicate continuing anxiety. (R. 287-94). The ALJ was

obligated to account for this part of the record suggesting that Mazzuca experienced

something other than mere improvement.

The ALJ’s credibility decision also relied heavily on Mazzuca’s ability to work prior

to January 2007, even though he was being treated for psychiatric problems at that time. 

The ALJ believed that if Plaintiff could work then, the fact that he still had the same mental

impairments did not limit his present work capacity in the manner that Mazzuca claimed. 

This finding overlooks that Mazzuca’s mental impairment was not necessarily the same

during his disability period as it had been earlier. The diagnosis of bipolar disorder is not

shown in the record for 2007. If the ALJ intended to rely on Mazzuca’s earlier ability to

work, she was obligated to take more careful note of the possible effects this post-2007

diagnosis might have on that ability.

The ALJ did notice certain functional deteriorations Mazzuca had experienced since

his onset date, particularly his 2010 hospitalization. She found these to be of little concern,

however, because they could all be attributed to Mazzuca’s failure to take his medication

on a regular basis. The ALJ stated, for example, that Mazzuca “went for treatment for years

without any inpatient treatment or emergency room visits until his non-compliant behavior

ensued.” (R. 26). She did not draw out her conclusion in much detail, but the inference

is clear: Mazzuca could work before January 2007, so he could also work during his

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claimed disability period if he were only compliant with his medication.

The Court has grave concerns over the reasoning involved in this analysis. It is

undisputed that Mazzuca was not always consistent about taking his medication. However,

the ALJ’s reasoning overlooks the possibility that his non-compliance was a symptom of

his mental disorder, not a sign that Plaintiff was less credible because he was capable of

managing his medication regimen. The Seventh Circuit and other courts have repeatedly

stressed that “mental illness in general and bipolar disorder in particular . . . may prevent

the sufferer from taking [his] prescribed medicines or otherwise submitting to treatment.” 

Kangail v. Barnhart, 454 F.3d 627, 630 (7 Cir. 2006). See also Martinez v. Astrue, 630 th

F.3d 693, 697 (7 Cir. 2006) (stating that “people with serious psychiatric problems are th

often incapable of taking their prescribed medications consistently”); White v. Comm. of

Soc. Sec., 572 F.3d 272, 283 (6 Cir. 2009) (“For some mental disorders, the very failure th

to seek treatment is simply another symptom of the disorder itself.”); Pate-Fires v. Astrue,

564 F.3d 935, 945 (8 Cir. 2009). Mazzuca may or may not have been able to take his th

medications in the regular manner the ALJ believed would allow him to work. The problem

is that ALJ did not inquire into the matter and did not construct a logical bridge from the

record to her conclusion on this crucial issue.

The Court’s concern is heightened by the ALJ’s scant attention to the link between

Mazzuca’s anxieties and his ability to work. The ALJ noted in passing that Mazzuca quit

his job as a medical technician and that he had applied to Menard’s “without success.” (R.

23). This fails to explain that the application was unsuccessful because Mazzuca walked

out when he thought people were looking at him “funny.” The limiting effect of Plaintiff’s

symptoms is suggested throughout the record. The ALJ failed to note, for example, that

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Mazzuca was terminated from his last job in January 2007, even though he was taking

Effexor at that time. (R. 56, 298). Mazzuca himself stated that his productivity at work had

gone to “zero” before he was fired. The ALJ could not associate Mazzuca’s past ability to

hold a job with his present capacity to work without accounting for this event. Plaintiff also

described what he termed “bizarre” thoughts that he had while working, such as the belief

that his participation in financial planning was responsible for the election of George W.

Bush. (R. 56). While taking medication, Mazzuca also left an interview because the 5

people around him were not wearing gloves. The ALJ was required to account for these

facts before drawing links between Mazzuca’s credibility, his ability to work, and his

medication compliance. 

She was also obligated to consider the fact that, even when on medication,

Mazzuca’s symptoms fluctuated from time to time. Social Security Ruling 96-7p instructs

an ALJ to consider the frequency of a claimant’s symptoms when assessing his credibility.

The periodic nature of his symptoms was an important part of Mazucca’s testimony. (R.

55). The ALJ gave no consideration to this point, noting only that he showed

“improvement” after January 2007. The record – including the conflicting GAF scores

discussed earlier – plainly shows fluctuations in Mazzuca’s functioning after he became

sober in January 2007. Such changes are not surprising for a person diagnosed with a

mental impairment, particularly bipolar disorder. The Seventh Circuit has explained on

many occasions that “a person who suffers from a mental illness will have better days and

worse days[.]” Punzio v. Astrue, 630 F.3d 704, 710 (7 Cir. 2011). See also Larson, 615 th

Mazzuca stated at the hearing that he continued to believe that was the case and 5

that he might be targeted by the government. (R. 55-56). 

25
F.3d at 751; Phillips v. Astrue, 413 Fed.Appx. 878, 886 (7 Cir. 2010) (“Many mental illness th

are characterized by ‘good days and bad days,’ rapid fluctuations in mood, or recurrent

cycles of waxing and waning symptoms.”). 

The ALJ appears to have set aside these changes in Plaintiff’s functioning by

ascribing his down cycles to non-compliance with his medication regimen. For the reasons

discussed above, however, the ALJ could not discount the periodic nature of Mazzuca’s

symptoms merely by referring to his medication. The fact remains that Mazzuca was not

fully compliant, and that reality had to be more fully explored before the ALJ could discount

his credibility concerning the periodic nature of his distress. 

Certainly, the record did not obligate the ALJ to give credence to everything

Mazzuca stated. An ALJ is always entitled to discount a claimant’s credibility when the

proper grounds for doing so exist. See Johnson v. Barnhart, 449 F.3d 804, 805 (7 Cir. th

2006). In this case, the ALJ failed to consider portions of the record that were favorable

to claimant and did not draw a logical bridge between the record and her credibility finding. 

For these reasons, Plaintiff’s motion is granted on the ALJ’s assessment of his credibility. 

2. Mrs. Mazzuca’s Credibility

Plaintiff also claims that the ALJ improperly assessed the testimony his wife gave

at the hearing by giving it “little weight.” (R. 27). An ALJ considers testimony of nonmedical witnesses either by weighing it or by assessing its credibility. See SSR 06-3p;

SSR 96-7p. In either case, the ALJ should consider the nature and extent of the witness’s

relationship with the claimant, the consistency with other evidence, and other factors that

tend to support or refute the witness’s statements. SSR 06-3p.

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The ALJ’s brief consideration of Ms. Mazzuca’s testimony is troubling in this case.

The ALJ complained that no independent evidence verified the wife’s testimony concerning

Plaintiff’s activities of daily living. Without further explanation, however, it is not clear what

evidence would corroborate the day-to-day activities a claimant undertakes in the privacy

of his own home. The ALJ also relied on the fact that Mrs. Mazzuca did not personally

witness all of Plaintiff’s ongoing activities. That is undisputed, as Mrs. Mazzuca testified

that she works all day. However, SSR 06-3p requires an ALJ to account for “the nature

and extent of the relationship” between the claimant and a non-medical source like Mrs.

Mazzuca. Mr. and Mrs. Mazzuca had been married for nineteen years at the time of the

hearing. (R. 18). The ALJ was required to explain why such a long and intimate

relationship did not support Mrs. Mazzuca’s statements about what she observed. 

In addition, both husband and wife gave strikingly similar testimony. Despite this,

the ALJ gave Ms. Mazzuca “little weight,” even though she found that Plaintiff’s testimony

was partially credible. The ALJ should explain more fully why such similar testimony

should have been assessed differently. As other errors already require remand, the ALJ

should restate more fully her reasons for giving little weight to Plaintiff’s wife. Plaintiff’s

motion is granted on this point. 

IV. Conclusion

For the reasons stated above, Plaintiff's and the Commissioner’s motions for

summary judgment are granted in part and denied in part. This case is remanded to the

Social Security Administration under sentence four of 42 U.S.C. § 405(g) for further

proceedings consistent with this opinion. It is so ordered.

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ENTERED:

__________________________________

 DANIEL G. MARTIN

 United States Magistrate Judge

Dated: April 2, 2013

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