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# United States Court of Appeals For the Seventh Circuit

No. 13-2964

K I P Y UR

T , Plaintiff-Appellant,

v.

C AR OLYN W. C OL VI N

, Acting Commi ssi oner o f Soci al Security, Defen dant-Appellee.

Appe al f ro m the Uni ted S tates Distri ct Co urt fo r the Nor thern Distri ct o f Indi ana, Fo rt Wayne Divisi on. No. 1: 12 CV 0 02 46

— Roger B. Cosb ey, Magistrate J udg e.
A RGU E D F E B R

UAR Y 24, 2014

— D E C I D E D J ULY 10, 2014

Before F LAUM and R OVN E R , Circ uit Judges and K E ND AL L, District Judge. *

R OVN E R , Cir cui t Judge. Kip Y

urt suffers from a psychoti c di sorder whi ch caus es hi m to exper i ence, among other things,

The Honor ab l e Vi rgi nia M. Kendall , U nited States Di stric t Co urt fo r the * Nor thern Distri ct o f Il l i noi s, si tting by desi gna tio n.2 No. 13-2964
audi tor y hal l ucin ations and bouts of unc ontr ollable rag e. He also strugg les wi th obsess i v e compuls i v e d i sorder , moderat ely
sev ere chroni c obstructiv e pulmonary di sease (“COPD”) , and chroni c bi frontal tensi on headaches

. As a result, he appli ed for Di sabi li ty Insurance Benefi ts from the So c i a l Security Admini str ation, but an A d min istrativ e Law Judge (“ALJ”) deni ed hi s appli cati on. After the Appeals Counci l declined to rev i ew the ALJ’s deci si on, Y

urt sought rev i ew in the di stric t court pursuant to 42 U

. S.C. § 405(g). A magi strat e judge affi rmed the deci si on of the ALJ, and Y urt appeals, arg uing prin ci pally that the ALJ err ed by fai ling to incl ud e many of hi s medi cal li mi tations in the hypothetic al that she posed to the v ocational exper t (“VE”). Y

urt contends that the flawed hypothetic al led the VE and the ALJ to err on eously conclu de that he could be gain fully employ e d. For the reasons di scu ssed below , w e rev erse the judgment of the di stric t cour t and remand to the agency for further pr oceedings. I. Y urt appli ed for di sabil i ty in Februar y 2011, allegin g di sabi li ty beginning on August 4, 2010. The So cia l Security Adminis t r ation deni ed both Y urt’s claim and hi s request for reconsi derat i on. On hi s appli cati on for a hearin g wi th an ALJ, Y urt noted that he had w or ked in the past in v arious capac i ties
as a cook and a janitor

. Hi s final jo b at the “sub stanti al gain ful 1 acti vity” lev el effectiv ely ended in May 2010, when he had

Yurt wrote i n his appli catio n tha t his empl oyment dates were “esti mat ed” 1 and i n fact some of the dates are not entir el y consi stent, a pro b l em attributed at argument to Yurt’s do cumented short-te rm memory di ffi cul

tie s.No. 13-2964 3

some sort of break wi th reality

. He w as take n to the emerge ncy ro om and sub sequently placed on medi cal leav e for several months. S hort ly after he ret urned to w or k inAugust 2010, he threat ened a cow or ker wi th a kni fe, whi ch led, uns urpris ingly , to his ter minati on. Betw een the epi sode at the hospi tal in May 2010 and the date of hi s hearin g wi th the A L J o n A p r i l 3, 2012, Y urt saw a numb er of di fferent physi ci ans and therapists and atte mpted at least one other jo b. The May 2010 inci dent occurred at P ark view Noble Hospi tal, where Y urt had w or ked in the kitch en for sev eral y ears when he w as f o un d “ w anderin g the halls” wi thout any memory of how he had got ten there

. After being take n to the emerge ncy ro om, he w as refer red to a neurolog i st, Dr

. Madhav Bhat, who tr eated hi m on July 1, 2010. Dr

. Bhat suggested weaning Y urt off an anti- sei zure medi cine he had been taking and doubling the d o sa ge of Prozac Y urt
w as alr e a d y taking for depressi on. Dr

. Bhat recog ni zed that Y urt suffered from “[r]ecurrent epi sodes of alter ed aw areness of surroundings,” and di agnosed Y urt’s nearly dai ly recurr ing bi frontal pain in hi s head a s a ch ro ni c tensi on headache. He conclu ded that Y

urt should remain on medi cal l e a ve from

w or k for the time b eing. Y urt ret urned to w or k tha t A ug ust, but repo rt ed that P ark view fi red hi m shortly there after becau se “they w ere really afr ai d that he mi ght hurtother people” an d becau se he

w as accu sed of holding up a kni fe and threat ening cow or ker s. On August 13, 2010, Y

urt saw psychi atr i st Dr

. Fr ank Shao, who conclu ded that Y

urt’s frequent self- described “ bl a ck outs”

w ere diff i cult to di agnose preci sely

. Dr

. Shao recommended that Y urt obtain a second opini on and p r e sc r ibed Lami ctal in4 No. 13-2964
slo wly increasing dosages to help Y urt’s “mood labi li ty a nd violent behavi or s.” He recog ni z e d that Y urt may hav e a “certain risk o f v i olence to hims elf and others” becaus e of hi s urges and hi stor y of aggr essi on, but deemed the ris k not to be “acute.” He assi gned Y

urt a Global Asses sment of Functi oning (“GAF”) score o f 4 0 to 50. Thi s GAF score corr elates wi th 2 “[s] erious symptoms

... or any seri ou s imp a i rment in soci al, occupati onal, or sch ool func tioning (e.g., no fri ends, unabl e to keep a j o b) .” Am. Psychiatric Ass’n, Diagnostic & Statistical Manual of Menta l Disorders 32 (4th ed. textrev i si on 2000). Y urt then atte mpted to w or k part-t i me a s a co o k at St

. Fr anci s School. Although the reco rd i s short on speci fi cs, i t appears that Y

urt lost thi s jo b on accoun t of again threat ening a cow or ker

. Thi s li kely corr esponds to the beginning of December 2010, when Y urt ca l l e d Dr

. Shao’ s offi ce and repo rt ed gr abbing a co-w or ker by the thro a t

. He di d not remember the det ai ls bec ause he h ad blac ked out

. Later that same month, he w as admi tte d to the hospi tal for p sy chi atr i c ev aluati on. Dr

. Shao repo rt ed that Y urt w a s hearin g v oic es tellin g hi m to “kill people” and that he w as afrai d to go outsi de becau se the v oice in hi s head (whi ch he called “Alex”) w as instructing hi m to “randomly hurt people.” Dr

. Shao described Y

urt as “di shev eled” and asses sed hi s GAF

The GAF scor e i s a numeric scale of 0 through 10 0 used to ass ess sev eri ty 2

o f sy mpto ms and functi onal l evel. Am. Psych iatric Ass’n, Diag nostic & Statistic al Manual of Mental Disorders 32 (4 th ed. text revisi on 20 00 ). Al though the Ameri can Psychiatric Assoc i atio n rece ntly di sconti nued use of the GAF metri c, i t was stil l i n use duri ng the peri od Yurt’s exa minatio ns occ urred

. See id. 16 (5 ed. 20 13 ). thNo. 13-2964 5

score to be betw een 25 to 30. Thi s corr esponds to behavi or that i s “consi derably influ enced by delusi ons o r halluc inati ons or seri ous i mpai rment in commu ni cati on or judgment (e.g., someti mes incoherent, acts gr ossly inappropr i ately , suicidal preo ccu pation) or inabi li ty to func tion in almost all areas (e.g., stays in bed all day; no jo b, home, or fri ends) .” Id. Dr

. Shao recommended inpati ent tr eatment for wha t he e xp e c ted w ould be one to tw o w eeks. He also increased Y urt’s dosage of Celexa (an anti depressant) and continued hi m on Lami ctal (an anti convulsant used t o tr eat both epi lepsy and bi polar di sor
der) as w ell as Ser oq ue l (another medi cati on for bi polar di sorder ). Despi te Dr

. Shao’ s esti mati on that Y urt w ould need be t w e e n one and tw o w eeks of inpati ent tr eatment, Y ur t chec ked ou t of the hospi tal approx i mately tw o days later , denying audi tor y halluc inati ons, homi ci dal or suicida l i deations, delusi ons, or depr essi on. In January 2011, Y

urt saw Dr

. Kenneth Ogu for a psychi atr ic ev aluati on. Dr

. Ogu noted that Y urt described havin g command halluc inati ons, sleep di ffi culty , racing thought s and obsess i v e compuls i v e thought s. He di agnosed Y urt wi th psychosi s, not other wi se speci fi ed as w ell as “Rule out Bi polar I Di sorder ” and “Rule out Inter mi t t e nt Explosi v e Di sorder .” Y urt asked i f hi s anti -psych otic medi cati ons (he w as taking three ) could be ch a ng ed becau se they di d not seem to be

w or king for the v oic es. Dr

. Ogu agr eed and set out a plan for reducing some medi cati ons and adding sev eral o thers. Y urt w as again admi tte d for psychi atr i c inpati ent care on January 25, 2011. He continued to complain of audi tor y halluc inati on s—speci fi cally the v oic e of “Alex” whi ch Y urt described as “so stro ng” that he could no longer contro l i t. Thi s6 No. 13-2964
tim e Dr

. Shao recom me nd e d hospi talizing Y urt to keep hi m from hurting other s as a result of the audi tor y hallucinati ons. Dr

. Shao again opin ed that Y ur t had a GAF of 25 to 30. Here aga in, Y urt w as released from the hospi tal tw o days later

. At that tim e, Dr

. Shao recorded a sli ghtly hi gher GAF score of 35 to 40. Thi s corr esponds to “[s] ome i mpai rment in reality te s ti n g or commu ni cati on (e.g. speech i s at tim es i llogic al, obscu re, or i rr elev ant) or major i mpai rment in sev eral areas, such as w or k
or sch o ol, fami ly relat i ons, j udgment, thinking, or mood (e.g. depressed adult av oids fri ends, neglects fami ly , and i s un able to w or k[.])” Am. Psychiatric Ass’n, Diagnostic & Statistical Manual of Mental Disorders 32 (4th ed. tex t rev i si on 2000). After hi s January 2011 stay in the ho sp it al, Y urt w as taking the following medi cati ons on a dai ly basi s: 40 mi lli gr ams of Prozac for depressi on; 100 mi lli gr ams of Lami ctal (us ed for tr eating bi polar di sorder ); 500 mi lli gr ams of Depakote for mood stabi li zation; 1 mi lli gr am of Klono pin (us ed for tr eating epi le p sy a nd pani c di sorder s) at bedti me; 10 mi lli gr ams of Ambi en at bedti me; and an increased dosage of 2 mi lli gr ams of Ri sperdal for psychosi s. In April 2 0 11, Y

urt met wi th the psychologis t selected by the Di sabili ty Determin ation Bureau, Rev athi Bing i, Ed.D. After ev aluating Y

urt, she conclu ded that he appeared to “hav e gr eat di ffi culty managing hi s symptoms” in spi te of goo d fami ly supp or t. She observ ed that Y urt’s “halluc inati ons, paranoia and anger appear to be restr i cting hi s li fe” and that hi s quali ty of li fe “appears to be v ery poor .” She assi gned hi m a GAF of 45, whi ch, as described above, r epresents “[s] erious
s ym p to m s
... o r any seri ous i mpai rment in soci al, occupati on a l, or sch ool func tioning[.]” Id. That same mo nt h, Y urt beganNo. 13-2964 7

me eting for therapy wi th Rachel DeFrancesco, M.A. She i denti fi ed Y

urt’s i ssu es as “anxi ety , depressi on, employment, interper sonal problems, p s ychosi s, [and] sleep.” She character

i zed Y urt’s prog nosi s as “fai r

,” and described hi m as sufferin g from “sev ere” symptoms but possess ing a “stro ng motiv ation to g ain understanding.” In May 2011, st a t e agency psychologis t Ken Lovk o reviewed Y

urt’s fi le for a mental resi dual func tional capac i ty
asses sment (“RFC”). As relev ant he re, Dr

. Lovk o chec ked boxes indi cating that Y urt w as “moderat ely li mi ted” in hi s abi li ty to: (1) understand and remember detailed instructi ons; (2) carry out detailed instructi ons; (3) perfor m acti viti es wi thin a schedule and maintain reg ular atte ndanc e; (4) p e rfor m at a consi stent pace and complete a normal w or kday and w or kw eek; (5) interact appropr i ately wi th the gener al publi c; (6) get along wit h cow or ker s or peers; and (7) maintain soci ally appropr i ate behavi or

. Dr

. Lovk o then opined that although Y urt’s di agnosi s w as “seri ous and consi stent wi th se vere i mpai rments,” hi s func tioning di d not suggest that he had lost the capac i ty for uns kill ed w o r k

. Dr

. Lovk o also noted that Y urt’s GAF score of 60 (g iven by Dr

. Ogu in January 2011) indi cated only “ mini mal i mpai rments.” Dr

. Lovk o further allow ed that Y

urt’s symptoms may i mpede hi s abi li ty to w or k
aro und large numb ers of people, but that Y ur t co uld li kely

w o r k in an environment wi th fewer people and low lev els of str ess. Dr

. Lovk o also thought that Y urt could relat e “at least on a superfi ci al basi s ... wi th co-w or ker s and s upervisors.” In April 2012, Y

urt had a he a ring before an ALJ. The ALJ heard t e st imony from Y urt and hi s wi fe Lori as w ell as a
v ocational exper t. Y

urt testifi ed that hi s “rag e” and inabi li ty to8 No. 13-2964
“be aro und people” prev ented hi m from holding a full- tim e jo b. He also testifi ed that he could not si t or stand sti ll for more than a few minutes at a tim e, and that hi s left hand shakes and pre ven t s hi m from using i t. Fin ally , he testifi ed that he repeated certain cleaning ro utines at home as many as ten tim es dai ly and that he di d not t hin k he could get a jo b becau se he had “a real pro blem around people.” Y urt’s wi fe of ei ghteen y ears, Lori, testifi ed that becau se of hi s memory problems she needs to mak e sure he take s hi s
v arious medi cati ons both in the mornin g and again at ni ght. As for hi s lev el of func tioning, she stated that she di d not see hi m “func tioning that much” and that when she di d see hi m he w as often letharg i c, sleeping all d a y , or w atching telev i si on. She also explain ed that ev en sli ght changes to hi s medi cati on make i t di ffi cult for hi m to func tion and caus e hi m to stare into spac e or other wi se lose focus

. Fin ally , she expr essed her opini on that Y urt’ s memory loss w ould prev ent hi m from suc ceeding at
e v en a jo b where he w as able to w or k alone and avo id o the r people becaus e he w ould be unab le to do what he w as told. The ALJ then formulated a hypothetic al for the VE to asses s wh a t jo bs Y

urt could perfor m. She described to the VE a n indi vidu al that can “remember and carry out uns kill ed task[s] wi thout speci al consi derat i ons
... relat e on at least a superfi ci al basi s wi th cow or ker s and supervis or s
... atte nd to tasks for suffi ci e nt periods of tim e to complete” and who “should not
w or k aro und large numb ers of people.” When asked i f such an indi vidu al could pe r fo rm any of Y urt’s past w or k, the VE opin ed that Y

urt w ould be capabl e of perfor ming hi s past w or k of di shwasher

, janitor , a nd kitch en helper

. She also thought that Y urt could carr y out the duti es o f t he l ig ht , un ski lled j obNo. 13-2964 9
of “tow el folder” or w or k as a cleaner/ho us ekeeper

. The VE also stated that in competi tiv e empl o y me nt w or ker s w ere expected to be on task 80 to 85 percent of the tim e a nd co ul d not mi ss more than one or tw o d a y s per month and up to approx i mately ten per y ear

. Y urt’s atto rney then asked what jo bs w ould be e li minated i f Y urt needed to avoi d exposure t o pulmonary i rr i tants such as dust and fum es (on accoun t of hi s C O PD). The VE opin ed that such a restr i cti on w ould essen
tiall y eli minate any cleaning jo bs. Fin ally , she allow ed that the kitch en helper posi tion w ould be eli minated i f i t w as necess ary to av oid any posi tion that inv olv ed frequent exposure to hazards. After analyzing the fi v e steps in 2 0 C

. F

. R. § 404.1520, the ALJ conclu ded that Y

urt w as not di sabled. At St ep One, the ALJ deter mine d t ha t Y urt had not engaged in sub stanti al gain ful acti vit y since the alleged onset date in August 2010. The ALJ noted that Y urt ini tiall y testifi ed that he had not
w or ked since the alle ged onset date but that the evidenc e showed that he had w or ked as a part-t i me chef from Octo ber 2 010 thro ugh Mar ch 2011. Y urt attr ibuted the di screpancy t o hi s alleged memory di ffi culti es; the i ssu e w as ulti mately i rr elev ant becau se the ALJ co nc l uded that hi s earnin gs as a part-t i me chef di d not r epresent di squali fying sub stanti al gain ful acti vity

. At St ep T

w o, the ALJ conclu ded that Y urt’s psychoti c di sorder w as sev ere, but that hi s obsess i v e compulsive d i sorder

, COPD, and hand tr emors were not. At St ep Three, the ALJ deter mined that Y urt di d not hav e an i mpai r ment or combinati on of i mpai rments that met or medi cally equaled the cri ter i a of Li sting 12.03—Schi zophrenic, paranoid and other psychoti c di sorder s. Speci fi cally , the ALJ conclu ded10 No. 13-2964
that Y urt’s mental im pai rment did not r estric t hi s activiti es of dai ly li ving. And although the ALJ acknowledged t hat Y urt had “ mo derat e di ffi culti es” wi th soci al func tioning and concentration, persi stence, or pace, she conc l uded that the
recor d di d not supp or t a finding of marked li mi tation in ei ther domain as required to meet t he cr it eria of Li sting 12.03. She also deter mined that Y

urt had not exper i enced any epi sodes of ext ended decompens ation o r repeat ed epi sodes of decompensation, whi ch the reg ulati ons define as “exacerbations or tempor ary increases in symptoms o r si g ns accompani ed by a loss of adapti v e func tioning[.]” 20 C.F .R. Pt. 404, Subpt. P , App. 1, § 12.00(C)(4)

. The ALJ next deter mined t hat Y urt possess ed the re si dual func tional capac i ty to perfor m a full range of w or k at all
exer tional lev els so long as he had only bri ef and su perfi ci al interaction wi th other s and w as not aro und larg e numb ers of indi vidu als. She b ased thi s largely on Dr

. Lovk o’s as sess ment that Y urt ret ained capac i ty to perfor m uns kill ed tasks wi thout speci al conside r a t io ns as long as he w as not in large gr oups and had to relat e only on a superfi ci al basi s. She conclu ded that although Y

urt’s medi cally deter minable i mp a i rments could be expected to cause so me o f hi s stated inabi li ty to be
aro und people and si t or stand sti ll, those li mi tations were not fully credible to the ext ent they w ere inconsi stent wi th her RFC
asses sment. She also noted that Y urt’ s tr eatment recor ds documented i mprov ement in hi s condi tion betw een hi s ini tial psychi atr i c consu ltations in A ug us t 2010 and recor ds from
couns eling sess i ons in 2011 and 2012. The ALJ also made much of Y urt’s abi li ty to go shopping on “Black Fr i day” in Decem ber 2011 wi thout inci dent. She gener a l l y rej ected Dr

. Bingi ’sNo. 13-2964 11
findings as an inaccurate repr esentation o f Y ur t’s ov erall mental capac i ty

. She conclu ded that both Dr

. Ogu’s ev aluati on in January 2011 and a later ev aluati on in May 2011 reflected that Y urt w as art i culate and d isplayed a normal speech p atte rn, findings that called into questi on Dr

. Bingi ’s GAF
score of only 45 and he r asses sment that Y urt had gr eat di ffi culty managing symptoms on acco unt of hi s halluc inations, paranoia, and an ger

. At St ep Four

, the ALJ conclu ded that Y urt w as capabl e of perfor ming hi s past w or k of a di shwasher and kitch en helper

. Alter nati v ely

, she found at St ep Fiv e that Y urt could also w or k
as an indus tr i al janitor

, cleaner , or tow el folder consi stent wi th the VE’s testim ony on that point; accordingly , she e nt ered a finding that Y

urt w as “not di sabled.” The Appeals Coun cil deni ed rev i ew

, render ing the ALJ's deci si on the Commi ssi oner' s final d e ci si on subject to judi ci al rev i ew

. 20 C.F .R. §§ 416.1455, 416.1481. Y urt appealed to the di stric t court, whi ch affi rmed after finding that the ALJ's deci si on w as supp or ted by sub stanti al evidenc e. II. W e rev i ew the d ist r i ct court’s affi rmance de nov o and there fo r e rev i ew the ALJ’s deci si on di rectly

. E.g. , Thomas v
. Colvin , 745 F .3d 802, 805 (7th Ci r
. 2014). W e rev ie w t he ALJ’s d e cis i on deferentially only to deter mine i f i t i s supp or ted by “sub stanti al evidenc e,” whi ch w e hav e described as “such

r e l e v ant evidenc e as a reasonable mind mi ght accept as adequate to supp or t a conclu si on.” Moo re v
. Colvin , 743 F .3d 1 1 1 8 , 1120–21 (7th Ci r
. 2014) (in ter nal quot ations and citati on omi tte d). W

e nei ther rew ei gh the evidenc e nor sub sti tute our12 No. 13-2964

own judgmen t in place of the ALJ, but her deci si on mus t p r ov i de enough di scu ssi on for us to afford Y urt meaningful judi ci al rev i ew and asses s the v ali di ty of the agency’s ulti mate conclu si on. Id. On appeal, Y

urt arg ues that sev eral flaws in t he ALJ’s deci si on undercut her c onclus i ons at Steps Four and Fiv e that he could perfor m hi s past w o r k or other jo bs in the nati onal economy. He fi rst clai ms that the ALJ’s hypothetic al to the VE i s fla w e d be cause i t fai led to fully accoun t for hi s li mi tations. Rel a t e d l y

, he attacks the ALJ’s fai lure to consi der hi s tensi on headaches at all. He also claims the ALJ di d not prop e rly

w ei gh the medi cal evidenc e from his t reat ing physi ci ans. Fin ally , he asserts t ha t the ALJ failed to bui ld a logical bri dge betw een the medi cal evidenc e and her conclu si on that Y urt had not exper i enced any epi sodes of ext ende d decompensati on. W e begin wi th the ALJ’s hypothetic al questi on to the VE, whi ch, as detailed abov e, si mply described an indi vidu al who could p e r fo rm uns kill ed tasks, relat e superfi ci ally to small
nu mb e r s of people, and atte nd to tasks long enough t o complete them. Y

urt notes that the hypothetic al fai ls to menti on hi s headaches, hi s COPD, hi s tendency to “black out,” the vo ices he hears, and signi fi cantly , the li mi tations o utlined in state agency psychologis t Dr

. Lovk o’s asses sment that the ALJ expressly “adopt ed.” In s te a d of d i rectly defending the hypothetic al, the C om m i s si oner focus es on the ALJ’s relat ed finding reg ardin g Y urt’s

r esi dual func tional capac i ty , whi ch essenti ally mi rr or ed her hypothetic al to the VE. Thei r di spute centers on whether theNo. 13-2964 13 ALJ w as required to incorpor ate into her hypothetic al and RFC the “moderat e” li mi tations Dr

. Lovk o note d o n the Mental Res idual Functi onal Capaci ty Asses sment (“MRFCA ”) form that he completed. Speci fi cally , Y urt conten ds that the ALJ ignor ed all si x mental acti vity catego ries where Dr

. Lo v k o found that he w a s “moderat ely li mi ted.” As detailed abov e, these inclu d e d s e ve ra l l im i ta ti on s in concentration, persi stence, and pace, inclu ding moderat e li mi tations in the abi li ty to carry out detailed instructi ons, perfor m wi thin a sch edule, be punc tual, perfor m at a consi stent pace, a nd t o complete a normal w or kday and w or kw eek. As a general r ule, both the hypothetic al posed to the VE
a nd the ALJ’s RFC asses sment mus t incorpor ate all of t he clai mant’s li mi tatio ns supp or ted by the medi cal recor d. See O’Conn or-Spinne r v
. Astrue, 627 F .3d 614, 619 (7th Ci r
. 2010) (“Our cases, take n tog ether , suggest that the most effectiv e
w ay to ensure that the VE i s appris ed fully of the clai mant’s li mi tations i s to inclu de all of them di rectly in the hy p othet i

cal.”); Indoranto v
. Barnhart, 374 F .3d 470, 473–74 (7th Ci r
. 2004) (“If the ALJ relies on testim ony from a v ocat ional exper t, the hypothetic al questi on h e poses to the VE mus t incorpor ate all of the claimant’s li mi tations supp or ted by medi cal evidenc e in the recor d.”); see also SS R 96-5p, 1996 WL 374183, at *5 (RFC
asses sment “i s based upon consi derat i on of all relev ant evidenc e in the case reco r d , including medi cal evidenc e and relev ant nonmedi cal evidence ” ); 20 C.F .R. § 404.1545. Thi s inclu des any defi ci enci es the clai mant may hav e in concentration, p e rsi stence, or pace. O’Conn or-Spinne r, 627 F .3d at 619; (“Among the li mi tations the VE mus t consi der are defi ci enci es of concentration, persi stence and pace.”); Stewart v
. Astrue, 56114 No. 13-2964
F .3d 679, 684 (7th Ci r
. 2009) (hypothet i ca l questi on “mus t
accoun t for documented li mi tations of ‘concentration, persi stence, or pace’”) (collecting cases ). Although i t i s not necess ary that the ALJ use thi s preci se ter minolog y (“conc entrat i on, persi stence and pace”), w e wi ll not assu me that the VE i s appris ed of such li mi tations unles s she has independently
rev i ew ed the medi cal recor d. There i s no evidenc e here that the VE rev i ew ed Y

urt’s m edi cal hi stor y or heard testim ony about the va ri ous medi cal li mi tations that he complains w ere omi tte d from the ALJ’s hypothetic al. Thus, w e w ould expect an adequate hypothetic al to inclu de the li mi tations i denti fi ed by Dr . Lovk o and Y

urt’s tr eating physi ci ans. Relying on Joha nsen v
. Barnhart, 314 F .3d 283 (7th Ci r
. 2002), the Commi ssi oner arg ues that w e should be unc oncerned here wit h the fai lure of the ALJ to menti on the si x areas whe r e Dr

. Lovk o found mo d e rat e li mi tations becau se the narrat i v e port i on of the form adequate l y “tr anslated” these li mi tations into a mental RFC that t he ALJ could reasonably adopt. In Joha nsen , w e conclu ded that sub st anti a l e vi d e n c e s u p p or te d the deni al of di sabi li ty benefi ts where the ALJ’ s mental RFC
asses sment and hypothetic al to the VE fai led to explic i tly note the three a reas where one consu ltativ e physi ci an had noted that t he clai mant w as “moder ately li mi ted.” Id. at 288–89. W e upheld the ALJ’s decision despi te these omi ssi ons, after observing that in addi tion to the finding that the clai mant w as “moderat ely li mi ted” in three areas, the consu ltativ e physi ci an “w ent further” and “tr anslated” hi s findings into a speci fi c RFC a ss essm ent opining that the claimant w as sti ll able to perfor m low-s tr ess, repetiti v e w or k. Id.No. 13-2964 15
The fi rst and most obvious problem wi th the Com missi oner’ s arg ument i s that i t focus es entirely on the ALJ’s mental RFC when i t i s in fact the hypothet ical she posed to the VE that Y urt attacks. Ev en i f w e i gnor e thi s shortcomin g, Joha nsen i s not
as appli cable as the Commi ssi oner suggests. The three alleged omi ssi ons from the hy p othet i cal in Joha nsen w ere moderat e li mi tations in the claimant’s abi li ty to (1) perfor m acti vit ies wi thin a sch edule; (2) complete a normal w or k w e e k and perfor m a t a consi stent pace; and (3) accept instructi ons and respond appropr i ately t o cri tic i sm. Id. at 286. Only one of the li mi tations found by Dr

. Lovk o—per formin g ac tivi ties wi thin a sch edule—appears in Joha nsen

. Gi v en the addi tional limitat io ns Dr

. Lovk o found and their bear ing on Y urt’s li mi tation s in concentration, persi stence, and pace, w e w ould be hardp r e ss e d to conclu de that Dr

. Lovk o’s narrat i v e RFC “went further” in c apturing those li mi tations. Mor eov er

, w e allow ed the hypothetic al in Joha nsen to stand despi te i ts omi ssi ons becau se i ts descri p ti on of “ re p e titi v e, lowstress w or k” speci fi cally excluded posi tion s l ike ly to tr i gg e r the pani c di sorder that formed the basi s of the clai mant ’ s li mi tations in concentration, persi stence, and pace. See O’Co n n or

Spin ner, 627 F

. 3 d at 619 (collecting and di stingui shing cases, incl uding Joha nsen , where we hav e upheld hypothetic als that omi tte d restr i cti ons in “concentration, persi stence, and pace”). Signi fi cantly

, Y urt’s hypothetic al di d not li mi t hi m to low stress posi tions or other wi se capture hi s moderat e di ffi culti es understanding and rememberin g instructi ons o r perfor ming act iv it ie s wi thin a sch edule. See Craft v
. Astrue, 539 F .3d 668, 677 (7th Ci r . 2008) (“In Joha nsen , the RFC reflected s ome w or k requirements that w ere relev ant to mental abi li ties (i .e.,16 No. 13-2964 repet i tion and stress); h ere, t he RFC w as for ‘uns kill ed’ w or k, whi ch by i tself does not prov i de any information about Craft’ s mental condi tion or abi li ties .”). Thi s i s tr ue despi te Dr

. Lovk o’s havin g speci fi cally menti oned in hi s narrat i v e RFC th at Y urt could deal wi th an environment “where stress lev els a r e li mi ted.” Indeed, the Commi ssi oner seems to be suggesting that the hy pothet i cal and the mental RFC adequately accoun ted fo r Y urt’s li mi tations in concentration, persi stence, and pace by limit ing Y

urt to uns kill ed w or k. But w e hav e repeat edly rej ected the notion that a hypothetic al li ke the on e here confining the clai mant to si mple, ro utine tas k s a nd li mi ted interactions wi th o t hers adequately captures temperamental defi ci enci es and li mi tations in concentr ation, persi stence, and pace. See generally Stewart, 561 F .3d at 685 (collecting cases ); see also Craft, 539 F .3d at 677–78 (restricting clai mant to uns kill ed, si mple w or k does notaccoun t for hi s di ffi culty wi th memory , concen t rat i on, and mood swings); Y oung v
. Barnhart, 362 F .3d 995, 1004 (7th Ci r
. 2004); see also SS R 85-15, 1985 WL 56857 at *6 (1985) (“[B]ec ause r esponse to the demands of w or k i s highly indi vidu ali ze d, the ski ll lev el of a posi tion i s not necess arily relat ed to the di ffi culty an indi vidu al wi ll hav e in meetin g the demands of the jo b. A clai mant's [mental] condi tion may make perfor manc e of an uns kill ed jo b as di ffi cult as an objectiv ely
more demanding jo b.”). The ALJ speci fi cally found at St ep 4 that Y urt had “moderat e di ffi culti es
... [w] i th reg ard to concentration, persi stence, or pace.” These li mi tations w ere hi ghli ghted again in Dr

. Lovk o’s findings on the MRF CA form. Bey ond statin g that Y ur t could perfor m “uns kill ed task[s] wi thout speci al consi de rat i ons,” the hypothetic al does nothin gNo. 13-2964 17

to ensure that the VE eli minat e d fr om her responses those posi tions that w ould prove too di ffi cult for someo ne wi th Y urt’s depressi on and psychoti c di sorder

. Nor i s thi s a case li ke Simi la v
. Astrue, 5 7 3 F .3d 503, 522 (7th Ci r
. 2009), where the hypothetic al describes the clai mant’s underlyin g menta l di agnoses (ch ro ni c pain syndrome and somatofor m di sorder ) and the link betw een those condi tions a nd the mental li mi tations i s clear

. In short, although the ALJ’s hypothetic al contain ed sev era l l imitations accoun tin g for Y urt’s di ffi culti es in soci al func tioning, the blanket statement that he could perfor m “uns kill ed” w or k fai ls to a c cu ra te ly c a p tu re Y u rt’s d ocumented di ffi culti es wi th concentration, persi stence, a nd pace. Thi s fai lure to bui ld an “accu rat e and logical bri dge” bet w e en the evidenc e of mental i mpai rments and the hypothetic al and the mental RFC requires us to remand for further proceedings. See O’Conn or-Spinne r, 627 F .3d at 620–21; Craft, 593 F .3d at 677–78. There are other reasons the ALJ should not hav e adopted non-examining psy chologis t Dr

. Lovk o’s RFC finding. In conclu ding broa d ly that Y urt ret ained the capac i ty for unski lled w or k, Dr

. Lovk o commented that a “GAF of 60 suggests mini mal i mp a i rm e nts.” But thi s conclu si on fai ls to note that the GAF of 60 assi gned by Dr

. Ogu in January 2011 w as the hi ghest GAF asses sment Y

urt ev er rece ived

. Notably , just tw o w eeks after Dr

. Ogu’s asses sment, Y urt w as hospi talized after havin g a psychoti c break. At intake, hi s GAF w as asses sed at 25 to 30, and upon hi s release tw o days later Dr

. Shao recor ded a GAF
score of 35 to 40. The hi gher score of 35 to 40 corr esponds to
some i mpai rment in reality or major i mpai rment in sev er al
areas (i .e. , a vo ids fri ends, neglects fami ly , and i s unabl e to
w or k). Thi s i s a far cry from the sort of “mini mal” i mpai rment18 No. 13-2964
Dr

. Lovk o beli ev ed could be expected wi th Y urt’s hi gh-w a t e r mark GAF of 60. Seizing u pon the G AF of 60 to conclude that Y urt w as not sub stanti ally i mpai red i s preci sely the type of cherry -pi cking of the medic al recor d that w e hav e repeat edly forbid den. See, e.g. , Bates v
. Colvin , 736 F .3d 1093, 1099 (7th Ci r
. 2013) (“An ALJ cannot rely only on the evidenc e that supp or ts her opini on.”). The Commi ssi oner atte mpts to mini mi ze Dr

. Lovk o’s relianc e on Y urt’s b est GAF s core by pointin g out that i t i s the ALJ a nd not Dr

. Lovk o who i s forbid den from cherry -pi cking the medi cal evidenc e in supp or t of her finding. But such a di stincti on i s large ly i rr elev ant here giv en the ALJ’s asserti on that she credi ted and indeed adopted Dr

. Lovk o’s opini on. And although the Com mis si oner i s corr ect that the ALJ w as no t r e qui red to giv e any w ei ght to indi vidu al GAF scores, see Denton v
. Astrue, 596 F .3d 419, 425 (7th Ci r
. 2010), the problem here i s not the fai lure t o ind i vidu ally w ei gh the low GAF scores but a large r gener al tendency to i gnor e or di scoun t evidenc e fav or able to Y urt’s clai m, whi ch inclu ded GAF scores from multi ple physi ci ans sugg esting a far low er lev el of func tioning than that captured by the ALJ’s hypo thetical and mental RFC. See Bates , 736 F .3d at 1100 (low GAF score alone

3 i s insu ffi ci ent t o o v ert urn ALJ’s finding of no di sabi li ty but GAF scores in context rev ealed ALJ’s defi ci ent consi derat i on of entirety o f clai mant’s evid ence). W e are also tr oubled by the ALJ’s fai lure to menti on Y urt’s bi frontal tensi on headaches, whi ch the neur o logist Dr

. Bhat

This i s tr u e e v en when Dr. Bi nghi’s GAF esti mat e of 45 i s exclude d 3 pursuant to the ALJ ’s fi nding tha t i t was not entir el y cred i b l e or consi stent with the r eco rd e v i dence as awhol e.No. 13-2964 19
described as havin g a tendency “to recur almost ev ery d a y .” The Commi ssi oner atte mpts to excuse thi s omi ssi on becau se Y urt di d not menti on them in hi s func tio n r e p o rt s or testif y about them at the hearin g. Although w e ha ve recog ni zed the cl a imant’ s obli gation to explain why certain condi tions are di sabling, Pepper v
. Co l v i n , 721 F .3d 351, 367 (7th Ci r
. 2013), i t i s the ALJ who carries the burden o f dev elopin g the recor d, T erry v
. Astrue, 5 8 0 F

. 3 d 4 7 1, 477 (7th Ci r
. 2009). The fact that t he headaches standing alone w ere not di sabling i s not gr ounds for the ALJ to i gnor e them entirely—i t i s their i mpact in combinati on wi th Y urt’s other i mpai rments that may be cri tic al to his claim. See SS R 96-8P , 1996 WL 374184 at *5 (observing that when consi dered in combinati on with other i mpai rments a non-sev ere i mpai rment may become “criti cal” t o t he outcome of a clai m); see also Indoranto, 374 F .3d at 474 (“Notably absent fro m t he ALJ’s o rder i s a di scu ss io n of how Indor anto’s headaches an d blurred vis i on affec t her abili ty t o
w or k.”). Although thi s omi ssi on standing a lone probably

w ould not hav e been gr ounds for remand, the ALJ may clari fy
on remand the effect of Y urt’s tensi on headaches on hi s clai m. See O’ Connor-Spin ner, 627 F .3d at 621. Becaus e these shortcomin gs are enough to require remand to the Agency for further proceedings, w e need not belabor Y urt’s remaining arg um e nts reg ardin g whether the ALJ p r o p erly w ei ghed the evidenc e prov i ded by tr eating physici ans and whether sub stanti al evidenc e suppo r t s her conclu

si on that he exper i enced no epi sodes of decompens ation. Y urt complains that the ALJ failed to proper ly w ei gh the evidenc e prov i ded by hi s t r eating physi ci ans. He points speci fi cally to the asses sments by Dr

. Shao and Dr

. Ogu as w ell as Rachelle20 No. 13-2964
De Fr ances co, M.A., who w or ked as a therapist under Dr

. Ogu’s supervis i on. As for tr eating physi ci ans Dr

. Shao and Dr

. O g u, w e si mply note that in addi tion to sum mari zing Y urt’s vis i ts and describing their tr eatment notes, the ALJ should explic i tly consi der the details of the tr eatment relat i onshi p and prov i de reas o ns for the w ei ght giv en to their opin

i ons. See 20 C.F .R. § 404.1527(c) (2) ( describing si x factor

w ei ghing process ALJ mus t p e r fo rm for “ev ery ” tr eating physi ci an); see also S cott v
. Astrue, 647 F .3d 734, 739 (7th Ci r
. 2011) (ci tin g § 404.1527 for prin ci ple that ALJ mus t offer “goo d reasons” for rej ecting tr eating phy si ci ans opini on, whi ch i s accorded contro lling w ei ght so long as i t i s “w ell supp or ted” and consi stent with other evidenc e in the recor d) (internal quotat i ons and ci tation omi tte d); see also Moss v
. Astrue, 5 5 5 F .3d 556, 561 (7th Ci r
. 2009). Li kewi se, on remand the ALJ should consi der DeFrancesco’s observ ations about t he si de
e ffects of Y

urt’s medi cati ons and her asses sment that Y urt’s halluc inati ons and psychoti c symptoms left hi m in “acute” di stress. That leav es the ALJ’s perfunctory conclu si on at St ep 4 that Y urt had suffered no ext ended epi sodes of decompens ation, as
w ould be required for hi m to sati sfy t he “B cri ter i a” for a finding of per s e di sabi li ty under Li sting 12.03 for psychoti c di sorder s. See 20 C.F .R. Pt

. 4 0 4, Subpart P ., App. 1, § 12.04; Larsen v
. As tru e, 615 F .3d 744, 748 (7th Ci r
. 2010) (desc rib ing requirement that clai mant sufferin g from an affec tiv e di sorder
mus t hav e both a sev ere i mpai rment under the “A cri ter i a” and at least tw o “B cri ter i a”). Speci fi cally , Li sting 12

. 03 requires that
a clai mant exper i ence either three or more decompens ation epi sodes lasting at least tw o weeks, a l esser number of long erNo. 13-2964 21 epi sodes, or a gr eater numb er of shorter epi sodes of equi v alent
sev erity

. See 20 C.F .R. Pt. 404, Subpt. P , App. 1 § 12.03(C). Here the ALJ pointe d only to Y urt’s bri ef hospi talizati ons and conclu ded wi thout elaborat i on that because they w ere both sh o r t-li v ed he had not suffered from ext ended epi sodes o f decompens ation. Although w e reach no conclu si on as to whether Y

urt has suffered from decompe ns a t i on epi sodes of suffi ci ent frequency and sev erity to sati sfy the “B cri ter i a,” w e note that on remand the ALJ should consi der that hospi talizations are not the only w ay a clai mant can sati sfy the decompensati on requirement. See 20 C.F .R. Pt. 404, Subpt. P , App. 1 § 12.00(C)(4) (observing that ALJ “mus t us e j udgment” to deter mine i f more frequ e nt decompens ation epi sodes of shorter duration or less frequent epi sodes of longer duration may be used to sub sti tute for the li sted finding). III. For the foreg oing reasons, the judgment affi rming the deni al of benefi ts i s REVERSED and the case i s REMANDED wi th instructi ons that i t be ret urned to the SS A for further proceedings c onsi stent wi th thisopini on.