1

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

WESTERN DIVISION

Juanita C., )

 )

Plaintiff, )

 ) Case No. 3:20-cv-50171

v. )

 ) Magistrate Judge Lisa A. Jensen

Andrew Marshall Saul, )

Commissioner of Social Security, )

 )

Defendant. )

MEMORANDUM OPINION AND ORDER

Plaintiff Juanita C. brings this action under 42 U.S.C. § 405(g) seeking reversal or a remand

of the decision denying her disability insurance benefits.

1 For the reasons set forth below, the 

Commissioner’s decision is reversed, and this case is remanded.

I. Background

On December 15, 2016, Plaintiff filed an application for disability insurance benefits

alleging that she had been unable to work since May 1, 2016 because of post-traumatic stress 

disorder, anxiety, chronic obstructive pulmonary disease (“COPD”), and dyslexia. R. 275. Plaintiff 

later indicated that she was also disabled because of an eating disorder. R. 298. Plaintiff’s work 

history consisted of working as a certified nursing assistant, with reports of working sporadically 

on a part-time basis through March 2018.

Plaintiff’s medical records consist largely of treatment for COPD and mental health issues, 

including anxiety and eating issues. Because Plaintiff’s appeal focuses on her anxiety and eating 

issues, the Court will concentrate on those records.

1 The parties have consented to the jurisdiction of a United States Magistrate Judge for all proceedings 

pursuant to 28 U.S.C. § 636(c).

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In March 2016, Dr. Kyle J. Cushing submitted a court-ordered psychological examination 

report after evaluating Plaintiff on four separate occasions between November 2015 and 

March 2016. R. 342-47. Plaintiff was examined to determine her visitation with her children as 

part of a Department of Children and Family Services investigation. According to the report, 

Plaintiff’s three younger children were removed from her care in 2010 after she was accused of 

abuse and neglect. Plaintiff stated that she attended some counseling at age seven because of

problems eating. Plaintiff stated that she was diagnosed with PTSD and reported some PTSD 

symptoms during her examination, but Dr. Cushing noted that Plaintiff did not produce 

corroborating reports of a diagnosis and did not report such symptomatology on psychological 

testing. Dr. Cushing found Plaintiff to be an unreliable historian with numerous inconsistent 

reports. He opined that Plaintiff may be suffering from Borderline Personality Disorder and/or a 

Bipolar Disorder. He further opined that Plaintiff would benefit from sustained and intensive 

individual psychotherapy and psychiatric consultation to further address her interpersonal and 

emotional instability and stabilize her mood and emotional reactivity. Dr. Cushing recommended 

supervised visitation with her children.

In May 2016, Plaintiff saw her treating physician assistant, Katherine Schenck, at Crusader 

Community Health and her BMI was 17.81. R. 380. On November 6, 2016, Plaintiff went to the 

emergency room for contusions and abrasions sustained from a domestic battery incident with her 

boyfriend. Hospital records did not reveal any broken bones and noted that Plaintiff was well 

nourished. R. 351-52. On November 15, 2016, Plaintiff saw PA Schenck for her asthma, and it 

was reported that her BMI was 15.91 and she had great difficulty with anxiety and breathing. R. 

377. She also reportedly started counseling at Remedies because of trauma related to the recent 

domestic abuse incident. In December 2016, Plaintiff saw counselor Therese Jarvi for PTSD

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related to her trauma and PA Schenck for her asthma. R. 371-75. Plaintiff’s BMI was 16.53. 

Plaintiff reported she was fearful of leaving her home and being around people. Plaintiff also 

reported a low appetite but improved mental health. PA Schenck started Plaintiff on medication 

for anxiety relating to her trauma.

In January 2017, when Plaintiff was treating for her COPD, she reported a broken jaw, 

fractured skull, and rape from the November 2016 domestic abuse incident. R. 410. Plaintiff 

reported struggling with PTSD, anxiety, a loss of appetite, nausea, and vomiting. Plaintiff’s BMI 

was 16.46. Plaintiff reported managing her weight with dietary supplements and small frequent 

meals. Plaintiff’s examination revealed she was positive for dizziness, but her strength and gait 

remained normal.

On March 2, 2017, Dr. John L. Peggau conducted a psychological consultative 

examination at the request of the Social Security Administration. R. 435-38. Plaintiff drove herself 

to the evaluation and was living at her daughter’s house. Plaintiff reported being disabled due to 

her anxiety and PTSD. She was taking medications but not was not attending therapy at time of 

the examination. Dr. Peggau noted that Plaintiff was “quite thin,” but her activity, gait, and posture 

were normal. R. 436. Plaintiff reported doing her own laundry, grocery shopping, cooking, and 

cleaning. Dr. Peggau found Plaintiff “extremely dramatic,” with “an exaggerated expression of 

emotions and was somewhat theatrical in this presentation.” R. 436-37. Dr. Peggau noted that there 

were inconsistencies between Plaintiff’s reports and the records, particularly relating to her injuries

from the domestic battery incident. Dr. Peggau found that Plaintiff demonstrated poor judgment 

and limited mental agility and was not capable of managing her finances. Dr. Peggau diagnosed 

Plaintiff with unspecified anxiety disorder and unspecified personality disorder with histrionic 

features.

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On March 16, 2017, Plaintiff saw counselor Jarvi and PA Schenck for her anxiety and 

PTSD. R. 440-44. Plaintiff reported struggling with anorexia and environmental stressors from 

leaving an abusive relationship. Her BMI was 16.64. Plaintiff’s anxiety medications were changed 

because Plaintiff reported increased anxiety and difficulty leaving the house and sleeping. 

However, Plaintiff reported some irregular use of her medications. It was recommended that 

Plaintiff seek domestic violence counseling at Remedies. Plaintiff declined the referral and instead 

sought additional counseling services at Crusader Community Health.

On April 5, 2017, state agency physicians reviewed Plaintiff’s medical records and found 

that she had the following severe impairments: COPD, anxiety, obsessive-compulsive disorders, 

and personality disorders. R. 97. The physicians noted Plaintiff’s difficulty eating, her BMI of 17.8 

and 16.5, and her reports that it was easier to eat with someone around. The physicians also noted 

Plaintiff’s history of endometriosis but no records to support the presence of a current digestive 

issue, opining that her low BMI was likely related to her psychological issues.

The physicians evaluated Listing 12.06 for anxiety and obsessive-compulsive disorders 

and Listing 12.08 for personality and impulse-control disorders but found that Plaintiff did not 

satisfy the required criteria for either Listing. In evaluating the paragraph B criteria, they found 

Plaintiff mildly limited in: (1) understanding, remembering or applying information; and (2)

adapting or managing oneself. They found Plaintiff moderately limited in: (1) interacting with 

others; and (2) concentrating, persisting or maintaining pace. The physicians found that Plaintiff 

had the capacity to perform unskilled, light work with moderate limitations in her ability to interact 

with the general public and accept instruction from supervisors, along with environmental 

limitations. 

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In April and May 2017, Plaintiff saw counselor Jarvi and PA Schenck for her anxiety. R. 

452-58. Plaintiff reported improved coping skills, spending more time with family, a better 

appetite, and her medications were helping. However, Plaintiff was still afraid to leave her house 

and had difficulty eating. Plaintiff continued to suffer from an abusive relationship and made 

conflicting reports about living with both her daughter and her abuser. See R. 452, 455.2 Plaintiff’s 

BMI was 16.97. Plaintiff was initially hesitant to seek additional counseling services that were 

being recommended, but she later informed PA Schenck that she agreed to pursue such services. 

In July 2017, Plaintiff saw counselor Jarvi for anxiety and reported stressors caused by her abuser 

and being unable to pay for her mortgage which exacerbated symptoms such as nausea, vomiting, 

and weight loss. R. 509-10. Plaintiff’s mental status exam noted a “flight of ideas” for her thought 

process. R. 509.

In May 2017, Plaintiff submitted a disability report stating that her anxiety exacerbated her 

COPD and prevented her from leaving her house, except to go to counseling and doctor 

appointments. R. 288. In June 2017, Plaintiff submitted a function report stating that her anxiety 

also prevented her from driving unless necessary because of panic attacks. R. 308. Plaintiff 

reported that she had problems concentrating, did not handle stress well, vomited most days, and 

had no strength due to her low weight. Plaintiff spent time with her daughter and granddaughter to 

become more confident in being around other people, but she reported no problems getting along 

with other people. Plaintiff was able to walk and drive alone but would usually go out with her 

daughter due to her anxiety. Her daughter helped her take care of her pets and grocery shop. 

2 R. 452 (5/17/2017 Progress Notes, counselor Jarvi: “reports environmental stressors which exacerbate sxabusive husband, living with daughter to stay safe from abuser”); R. 455 (5/17/2017 Progress Notes, PA 

Schenck: “She has continued to live with her abuser and has suffered a lot of recent trauma.”).

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However, Plaintiff was able to prepare simple meals and do household chores and yard work in 

small increments, noting that she needed to rest. Plaintiff also gardened and did crafts.

On August 3, 2017, counselor Jarvi saw Plaintiff for her anxiety and reported Plaintiff’s 

thought process as “logical and organized” with her behavior as “over[]ly dramatic.” R. 615. 

On August 24, 2017, additional state agency physicians reviewed Plaintiff’s medical 

records and affirmed the prior assessments made by the physicians in April 2017 with one 

additional consideration. R. 107-23. They evaluated Listing 12.15 for trauma and stressor-related 

disorders. However, the physicians also found that Plaintiff did not satisfy the required criteria for 

this Listing. 

On August 30, 2017, Plaintiff sought a note from PA Schenck that she could not return to 

work as a CNA. R. 606. PA Schenck noted that since last year, Plaintiff had no consistent 

counseling and was being referred to Remedies for her PTSD and domestic abuse issues. She also 

reported that Plaintiff’s anxiety relating to fear of her abuser caused Plaintiff to suffer weight loss,

poor appetite, and a fear of leaving her house. Plaintiff’s BMI was 16.09. In December 2017, 

Plaintiff reported to counselor Jarvi that she had an improved mood until she became stressed over 

her brother’s murder and custody issues with her children. R. 600. Plaintiff had been working parttime but indicated she was not strong enough.

In January 2018, PA Schenck reported that Plaintiff was gaining weight, eating better, and 

living in a different home, except for the two days a week she was working as a CNA. R. 596. Her 

BMI was 18.65. However, Plaintiff reported to counselor Jarvi that she unable to work more than 

two days per week, noting stress from her financial and domestic abuse problems. R. 593. It was 

recommended that Plaintiff seek additional counseling services. In March 2018, Plaintiff began 

counseling with social worker Christina Geiselhart for her anxiety after counselor Jarvi left the 

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clinic. R. 587. Plaintiff reported a difficulty focusing at work. Plaintiff also reported that despite 

taking her medications she had been vomiting because she did not feel safe from her abuser. R. 

584. She also reported to PA Schenck that she collapsed during a court appearance and was 

experiencing increased anxiety, which caused her to lose weight and her appetite. R. 590. Her BMI 

was 17.52. In April 2018, Plaintiff saw counselor Susan Allen for her anxiety and depression. R. 

577-80. Plaintiff reported environmental stressors that overwhelmed her, including her legal issues 

relating to her abuser and custody of her children. Counselor Allen reported Plaintiff’s thought

process as “flight of ideas, tangential, perseveration.” R. 577. In May 2018, Plaintiff saw counselor

Allen and PA Schenck for her mood. R. 561-69. Plaintiff was reportedly making progress with her 

mood and anxiety, noting that counseling was helping. However, Plaintiff reported a recent 

negative interaction with court personnel, along with weight loss and vomiting. Her BMI was 

16.64. Plaintiff was told to focus on her emotional regulation skills. 

In August 2018, Plaintiff saw counselor Allen and PA Schenck for her anxiety. R. 551-58. 

Plaintiff reported an improved mood after staying with her daughter out of town. Plaintiff was 

“doing well overall with her regime,” but had three episodes in July with a poor appetite. R. 551.

Plaintiff reported difficulty concentrating and recent episodes of dizziness, lost vision, and 

vomiting. However, Plaintiff stated she was “actively preventing” these episodes by increasing her 

calories and staying with her daughter. R. 551. Plaintiff started using Xanax when she attended 

court appearances. Plaintiff’s BMI was 17.70 and her thought process was reported as 

“perseveration, concrete thinking.” R. 556. Counselor Allen assessed Plaintiff with a mood 

disorder.

In September 2018, Plaintiff sought treatment at Alexian Brother Behavioral Health 

Hospital for anxiety, PTSD, and an eating disorder. R. 631-38. Plaintiff reported that she had not 

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eaten in three days due to a loss of appetite, nausea, and unintentional vomiting. Her BMI was 

approximately 16.83. Plaintiff reported fluctuating symptoms of anxiety, eating issues, vomiting, 

and PTSD since the domestic battery incident in November 2016. Plaintiff reported problems 

leaving her house and driving for the past two years and panic attacks daily due to her anxiety.

Plaintiff reported that medication helped her symptoms, but she had difficulty taking it without 

vomiting. Plaintiff’s thought process was reported as “impaired judgment,” but she was reportedly 

able to concentrate and focus. R. 636. The intake disposition, which was reported by a nurse aid 

after consulting with the emergency room doctor, reflected that Plaintiff’s primary disorder was 

an eating disorder and her secondary disorders were major depressive disorder and anxiety. Id. On 

the recommendation of the emergency room doctor, Plaintiff was admitted to outpatient treatment.

On November 14, 2018, Plaintiff, represented by an attorney, testified at a hearing before 

an Administrative Law Judge (“ALJ”). R. 36-91. Plaintiff was then 45 years old. In Plaintiff’s 

counsel’s opening statement at the hearing, she argued that due to Plaintiff’s significant difficulties 

in interacting with others she would meet or equal Listings 12.04 and 12.06. The ALJ noted the 

lack of acceptable medical source opinions in the record and limited information about Plaintiff’s 

functional abilities in a work setting. The ALJ emphasized the need to develop such evidence 

through Plaintiff’s testimony. 

Plaintiff testified that starting in 2016 she began falling and hitting her head because she 

would get dizzy. Plaintiff attributed it to past trauma and the lack of nutrition. Plaintiff had been 

treating at Crusader Community Health for her anxiety and explained that vertigo and anxiety 

prevented her from working a full-time job because she could not drive. Plaintiff testified that she 

was often prescribed medications, but they were difficult to take because she could not keep a 

glass of water down. Plaintiff testified that she was diagnosed with anorexia neurosis when she 

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was a child and continued to struggle with it. Plaintiff would vomit when upset. Plaintiff testified 

that she was 5’ 3” and weighed 90 pounds (BMI: 15.94). She also stated that she was “doing a lot 

better” because in 2017 she weighed only 80 pounds. R. 52. Plaintiff started living with her

daughter, which relieved her anxiety and helped her eat.

When the ALJ asked Plaintiff why she stopped working, Plaintiff explained that in 

March 2016 she was fired after her employer saw her court-ordered mental evaluation. R. 64-65. 

Plaintiff then made the contradictory statement that she was wrongfully terminated after another 

nurse’s patient fell. R. 65. Plaintiff worked full-time for approximately one month in the fall of 

2016, but she stopped working when her patient went into the hospital and she was not assigned 

another patient. In December 2017, she returned to work as a certified nursing assistant on an asneeded basis for approximately three months working 11:00 p.m. to 7:00 a.m. two times a month. 

However, Plaintiff testified that she was written up twice for failing to complete her shifts and she 

eventually quit. Plaintiff also testified that she had difficulty working because her inability to eat 

made her weak, she was often throwing up or dizzy, and she had difficulty breathing, driving to 

work, and controlling her emotions.

Plaintiff testified that she took numerous medications for her depression and anxiety. 

However, she had difficulty taking her medications as prescribed without vomiting and testified 

to episodes approximately every two weeks where she stopped taking her medications. She also 

testified that she was unable to drive while taking all her medications because they made her forget 

what she was doing.

Plaintiff testified that she went to Alexian Brothers in September 2018 for her stomach 

issues. Plaintiff testified that medications helped but not all the time. Plaintiff testified that she 

knew her stomach issues were a mental issue because she used to be able to control her stomach 

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issues by eating after she was no longer upset. However, since November 2016 Plaintiff stated that 

she was no longer able to control it. 

Following the hearing, the ALJ left the record open and received additional evidence from 

Rockford Sexual Assault Counseling and Remedies. R. 339. The records from Rockford Sexual 

Assault Counseling spanned from January 2016 through December 2018 but provided limited 

information. R. 643-64. Remedies reported that it did not have any relevant records. R. 666. On 

April 17, 2019, the ALJ issued her decision denying Plaintiff’s request for benefits. R. 16-26. The 

ALJ found that Plaintiff had the following severe impairments: anxiety and personality disorders 

and COPD. The ALJ found no severe impairments relating to Plaintiff’s low BMI by stating: “Nor 

is the claimant’s low Body Mass Index likely related to digestive issues absent any related 

diagnosis. 16F. Therefore, there are no severe impairments from this condition and the following 

RFC does not include any, absent evidence of work-related limitation of function.” R. 18.

The ALJ also determined that Plaintiff’s impairments did not meet or medically equal a 

listed impairment. The ALJ found that although Plaintiff’s anxiety and personality disorders

satisfied the paragraph A criteria for Listings 12.06 and 12.08, she did not satisfy the paragraph B 

or C criteria for the Listings. The ALJ found that Plaintiff was only moderately limited in 

understanding, remembering or applying information, interacting with others, concentrating, 

persisting or maintaining pace, and adapting or managing oneself. The ALJ then concluded that 

Plaintiff had the residual functional capacity (“RFC”) to perform light work with certain 

restrictions, including that Plaintiff “can learn, understand, remember and carry out simple work 

instructions; no work with the general public or patients; occasional, brief interactions with coworkers; no team work or tandem work.” R. 19. The ALJ found that with this RFC, Plaintiff 

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“would be able to adequately sustain the required concentration, persisten[ce] or pace in 2-hour 

increments throughout the typical workday.” R. 20.

II. Standard of Review

A reviewing court may enter judgment “affirming, modifying, or reversing the decision of 

the [Commissioner], with or without remanding the cause for a rehearing.” 42 U.S.C. § 405(g). If 

supported by substantial evidence, the Commissioner’s factual findings are conclusive. Id.

Substantial evidence consists of “such relevant evidence as a reasonable mind might accept as 

adequate to support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). Accordingly, 

the reviewing court is not to “reweigh evidence, resolve conflicts, decide questions of credibility, 

or substitute [its] judgment for that of the Commissioner.” Burmester v. Berryhill, 920 F.3d 507, 

510 (7th Cir. 2019).

However, the Seventh Circuit has emphasized that review is not merely a rubber stamp. 

Scott v. Barnhart, 297 F.3d 589, 593 (7th Cir. 2002) (a “mere scintilla” is not substantial evidence). 

A reviewing court must conduct a critical review of the evidence before affirming the 

Commissioner’s decision. Eichstadt v. Astrue, 534 F.3d 663, 665 (7th Cir. 2008). Even when 

adequate record evidence exists to support the Commissioner’s decision, the decision will not be 

affirmed if the Commissioner does not build an accurate and logical bridge from the evidence to 

the conclusion. Berger v. Astrue, 516 F.3d 539, 544 (7th Cir. 2008). Moreover, federal courts 

cannot build a logical bridge on behalf of the ALJ. See Mason v. Colvin, No. 13 C 2993, 2014 WL 

5475480, at *5-7 (N.D. Ill. Oct. 29, 2014).

III. Discussion

Plaintiff argues that the ALJ erred by failing to: (1) evaluate her eating disorder under 

Listing 12.13; (2) analyze her symptoms relating to her eating issues in the paragraph B criteria 

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contained in Listings 12.06 and 12.08; and (3) account for the effect her eating issues had on the 

limitations in her RFC. The Commissioner responds with one main argument in his six-page brief:

Plaintiff properly frames the issues as to whether substantial evidence supports the 

ALJ’s finding that plaintiff did not have a medically determinable eating disorder 

impairment. Two stage agency physicians considered plaintiff’s low body mass 

index yet did not include an eating disorder in plaintiff’s medically determinable 

impairments. Plaintiff submitted no evidence from an acceptable source, or even 

from her treating physician’s assistant, that she had an eating disorder. Lacking this 

medically determinable impairment, plaintiff’s other arguments fail.

Defendant’s Response at 1, Dkt. 16.

The Commissioner’s conclusory argument does not address the real issue with the ALJ’s 

decision. To be clear, the ALJ did not make any findings in her decision about Plaintiff’s eating 

disorder. At step two, the ALJ stated the following: “Nor is the claimant’s low Body Mass Index 

likely related to digestive issues absent any related diagnosis. 16F. Therefore, there are no severe 

impairments from this condition and the following RFC does not include any, absent evidence of 

work-related limitation of function.” R. 18.

The ALJ stated that she would not include any limitations in the RFC relating to Plaintiff’s 

low BMI but failed to address the evidence in the record that Plaintiff’s eating issues were a 

symptom of her anxiety and personality disorders, which the ALJ found to be severe mental 

impairments. Throughout the record, Plaintiff’s medical records reflect a lower BMI and greater 

difficulty with eating, vomiting, and taking medications when Plaintiff reported increased anxiety 

or difficulty coping with environmental stressors. See, e.g., R. 440-44, 509-10, 561-69, 584, 590, 

600-01, 606, 632-33. Plaintiff testified that she continued to struggle with anorexia but that 

controlling her anxiety and emotions reduced her vomiting and made it easier to eat. Additionally, 

the state agency physicians found that Plaintiff’s low BMI was likely related to her psychological 

issues. R. 101.

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Therefore, even assuming the evidence supports a finding that Plaintiff’s eating disorder 

was not a medically determinable impairment that satisfied Listing 12.13, the ALJ was required to 

consider Plaintiff’s symptoms relating to her eating issues when evaluating Plaintiff’s mental 

functioning as part of the paragraph B analysis for her anxiety and personality disorders and in the 

RFC determination. See 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.00(F)(3)(c) (requiring the ALJ 

to “consider all evidence about [Plaintiff’s] mental disorder and daily functioning before []

reach[ing] a conclusion about [Plaintiff’s] ability to work.”); Michelle R. v. Saul, No. 19 CV 50061, 

2020 WL 5530130, at *5 (N.D. Ill. Sept. 15, 2020) (“The ALJ need not base a determination as to 

the ‘B’ criteria on medical evidence alone.”); 20 C.F.R. § 404.1529(a) (“In determining whether 

you are disabled, we consider all your symptoms, including pain, and the extent to which your 

symptoms can reasonably be accepted as consistent with the objective medical evidence and other 

evidence.”). Yet, the Commissioner makes no attempt to address Plaintiff’s arguments that the 

ALJ failed to evaluate her symptoms relating to her eating issues and instead makes the broad 

assertion that “only medically determinable impairments can inform the analysis.” Defendant’s 

Response at 4, Dkt. 16; see Bonte v. U.S. Bank, N.A., 624 F.3d 461, 466 (7th Cir. 2010) (explaining 

that failing to respond to an argument in a response brief results in waiver). For the reasons 

discussed below, the Court believes that a remand is required for the ALJ to properly evaluate 

Plaintiff’s symptoms related to her eating issues in both the paragraph B criteria and in the RFC 

analysis.

A. Paragraph B Criteria

At step three, the ALJ analyzed Listings 12.06 and 12.08 for Plaintiff’s severe anxiety and 

personality disorders and found that Plaintiff did not meet either Listing because she did not satisfy 

the paragraph B criteria. To satisfy the paragraph B criteria, Plaintiff must show an extreme 

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limitation of one, or marked limitation of two, of the following areas of mental functioning: (1) 

understanding, remembering or applying information; (2) interacting with others; (3)

concentrating, persisting or maintaining pace; and (4) adapting or managing oneself. 20 C.F.R. Pt. 

404, Subpt. P, App. 1, § 12.00(E). The ALJ found that Plaintiff was only moderately limited in 

each of the four areas of mental functioning.

Plaintiff challenges the ALJ’s findings, arguing that her testimony and the medical 

evidence relating to her eating issues support that she has extreme limitations in interacting with 

others, concentrating, persisting and maintaining pace, and managing herself. The Commissioner’s 

only arguments in response are that the ALJ’s findings are supported by the uncontradicted 

opinions of the state agency reviewing physicians and Plaintiff’s low BMI alone cannot show an 

extreme functional limitation. There are several issues with the Commissioner’s argument.

The Commissioner cites to the state agency physicians’ opinions finding Plaintiff mildly 

or moderately limited in the paragraph B criteria as support for the ALJ’s determination. Although 

the ALJ gave great weight to the state agency physicians’ opinions when deciding the RFC, she 

gave no indication that she relied on these opinions when analyzing the paragraph B criteria. The 

Seventh Circuit has made clear that the Court’s review on appeal is confined to the reasons 

articulated by the ALJ in her decision. Jelinek v. Astrue, 662 F.3d 805, 812 (7th Cir. 2012).

Even if the ALJ had relied on the state agency opinions, those opinions do not indicate that 

they considered Plaintiff’s eating issues when opining on the paragraph B criteria. This is a concern 

in this case because the state agency physicians provided the only medical opinions in the record. 

Despite explicitly stating that Plaintiff’s low BMI was likely related to her psychological issues, 

the state agency physicians only referenced Plaintiff’s low BMI and resulting weakness when 

addressing exertional limitations. They also identify Plaintiff’s dizziness, fainting, and difficulty 

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eating but gave no explanation as to how these reported symptoms affected their mental 

functioning evaluation. Moreover, the state agency physicians did not review Plaintiff’s 

subsequent September 2018 visit to the emergency department where she was referred to 

outpatient treatment for her anorexia because she had been unable to eat for three days.3 Plaintiff 

reported that her treater referred her for treatment because all other resources had been exhausted, 

and she still could not keep anything down. R. 632, 637. Without an adequate explanation from 

the state agency physicians regarding how, or if, they factored Plaintiff’s eating issues into their 

opinions regarding the paragraph B criteria, the Commissioner cannot rely on the state agency 

opinions to provide support for the ALJ’s paragraph B analysis. See Jonie G. v. Saul, No. 18 CV 

50100, 2019 WL 6716610, at *4 (N.D. Ill. Dec. 10, 2019) (finding that the Commissioner could 

not rely on the state agency physicians opinions that a listing was not met where there was “no 

evidence in this record that the ALJ in fact relied upon the state agency physician opinions to 

support his findings at step three” and the opinions “provided no explanation or analysis” on the 

listing at issue).

The Commissioner specifically rejects Plaintiff’s argument that her low BMI alone is 

evidence of an extreme inability to manage oneself. The inability to manage oneself “refers to the 

abilities to regulate emotions, control behavior, and maintain well-being in a work setting.” 20 

C.F.R. Pt. 404, Subpt. P, App. 1, § 12.00(E)(4). The ALJ found a moderate limitation, noting that 

Plaintiff “had difficulty maintaining care and medication schedules, but is mostly able to perform 

self-care, grooming and hygiene and care for her granddaughter and several pets.” R. 19. But this 

3 In the RFC analysis, the ALJ gave great weight to the state agency physicians’ opinions finding them 

consistent with and supported by the medical record, noting that “evidence produced subsequent to their 

submissions is cumulative and does not alter the diagnoses or nature and severity of the impairments 

discussed above.” R. 23. However, the ALJ never directly addresses Plaintiff’s medical note from Alexian 

Brother Behavioral Health Hospital.

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analysis ignores Plaintiff’s difficulty eating and inability keep food down resulting in a consistently 

low BMI. 

The Commissioner argues that because Plaintiff does not have a physical impairment that 

identifies a low BMI as a medical sign evidencing the severity of the impairment, her low BMI 

cannot show an extreme limitation for her mental impairments. What the Commissioner ignores 

is that Plaintiff claims her low BMI is a manifestation of her anxiety. Even the state agency 

physicians attributed Plaintiff’s low BMI to her psychological issues. If on remand the ALJ 

believes that Plaintiff’s low BMI cannot be considered a symptom of her mental impairments, 

despite the state agency physicians’ opinions to the contrary, the ALJ should explain her reasons 

or call a medical expert to opine on the issue.

As written, the ALJ’s paragraph B analysis makes no mention of Plaintiff’s eating issues, 

low BMI, inability to nourish herself, or her related symptoms of dizziness, vomiting, and 

weakness and their effects on Plaintiff’s mental functioning. The ALJ briefly references Plaintiff’s 

inability to maintain her medication schedules but characterizes her limitations as moderate 

considering Plaintiff’s daily activities. The ALJ does not address the effect that Plaintiff’s inability 

to take medications for her mental impairments has on her ability to regulate her emotions and 

control her behavior, which likely exacerbate her eating issues. There is also no indication that the 

ALJ considered Plaintiff’s recent emergency department visit where she sought treatment for her 

anorexia, noting that she had exhausted all other resources. Plaintiff reported being unable to eat 

for three days and had a BMI of 16.83. Plaintiff was ultimately admitted to outpatient treatment 

for her eating disorder. Yet, the ALJ did not directly question Plaintiff about these records at the 

administrative hearing or address these records in her decision, other than to note that Plaintiff did 

not have a diagnosis for digestive issues. R. 18.

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The ALJ’s discussion fails to assure the Court that she considered Plaintiff’s eating issues 

such that this Court can determine whether her conclusions about the severity of Plaintiff’s mental 

functioning are consistent with the evidence. Accordingly, the Court finds that the ALJ’s decision 

that Plaintiff did not meet the paragraph B criteria with respect to Listings 12.06 and 12.08 was 

not supported by substantial evidence. A remand is required for the ALJ to reevaluate the 

paragraph B criteria and explicitly consider any impact Plaintiff’s eating issues had on her mental 

functioning.

B. RFC

With respect to the ALJ’s RFC determination, Plaintiff argues that the ALJ failed to 

consider her symptoms related to her eating disorder when determining her RFC. Specifically, 

Plaintiff argues that the ALJ failed to account for her inability to nourish herself and digest 

medication, along with symptoms of weakness, vomiting, and dizziness and the impact they have 

on her ability to sustain gainful employment. The Commissioner’s only arguments are that: (1) 

once the ALJ found that Plaintiff lacked a medically determinable eating disorder impairment, “it 

dropped out of the RFC analysis;” and (2) the ALJ’s subjective symptom evaluation was not 

patently wrong given “the many specific reasons the ALJ cited from the record.” Defendant’s 

Response at 6, Dkt. 16.

Again, the Commissioner’s undeveloped arguments are without merit. As discussed above, 

the state agency physicians found that Plaintiff’s low BMI were a symptom of her psychiatric 

issues. The ALJ found that Plaintiff’s psychiatric issues were severe impairments. As such, the 

ALJ was required to assess all of Plaintiff’s symptoms relating to her severe impairments and the 

extent to which those symptoms can reasonably be accepted as consistent with the objective 

medical evidence and provide a reasoned evaluation about whether Plaintiff’s eating issues did or 

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did not require any accommodation within the RFC. See 20 C.F.R. § 404.1529; Leslie T. v. Saul,

No. 419CV00113SEBDML, 2020 WL 6586658, at *6 (S.D. Ind. Oct. 19, 2020), report and 

recommendation adopted sub nom. Thomas v. Saul, No. 419CV00113SEBDML, 2020 WL 

6583088 (S.D. Ind. Nov. 10, 2020). By not independently evaluating Plaintiff’s eating issues, the 

ALJ glossed over the evidence relating to her eating issues without further explanation as to why 

they did not impact Plaintiff’s limitations. Plaintiff clearly established that she had a low BMI 

throughout the record along with an inability to digest medication, weakness, vomiting, and 

dizziness. Yet, the ALJ never addresses this evidence head on to explain why it would not affect 

Plaintiff’s limitations.

Additionally, although the Commissioner states that the ALJ gave “many specific reasons” 

for discounting Plaintiff’s subjective symptoms, the Commissioner fails to identify these reasons

and it is not otherwise apparent from the ALJ’s decision. The ALJ’s decision notes several 

instances where the record contradicted Plaintiff’s reports relating to injuries she sustained as a 

result of domestic abuse, her living situation in relation to her abuser, her ability to do household 

chores and go out of the house alone, along with reports of why she was not able to work. “As the 

Seventh Circuit has recognized, discrepancies between the objective evidence and self-reports may 

suggest symptom exaggeration.” Luigi B. v. Saul, No. 18 CV 7392, 2021 WL 83508, at *12 (N.D. 

Ill. Jan. 11, 2021) (citation omitted). But the ALJ does not explain how these discrepancies led her 

to discount Plaintiff’s symptoms relating to her eating issues or otherwise discredit objective 

reports of a low BMI. See Murphy v. Colvin, 759 F.3d 811, 816 (7th Cir. 2014), as amended (Aug. 

20, 2014) (“[T]he ALJ must explain her decision in such a way that allows us to determine whether 

she reached her decision in a rational manner, logically based on her specific findings and the 

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evidence in the record.”) (internal quotation omitted). If the ALJ did not believe that Plaintiff was 

unable to keep food down she should have explained her reasons.

Moreover, despite acknowledging that Plaintiff was unable to take her medications 

approximately every two weeks because of her stomach issues, the ALJ concluded that Plaintiff’s 

RFC “limitations also reflect the success of treatment actually received” noting that Plaintiff 

experienced periods of improvement in her anxiety with counseling and medications. R. 24. The 

ALJ makes no mention of Plaintiff’s recent emergency department visit for anorexia where 

Plaintiff was unable to keep anything down and stated that she was referred there by her treater, 

noting that all other resources, including counseling, had been exhausted. “An ALJ may rely on 

medical evidence that the condition is treated and controlled by medication.” Truelove v. Berryhill, 

753 F. App’x 393, 397 (7th Cir. 2018). However, if the ALJ found that Plaintiff’s impairments 

were controlled by counseling and medications, she needed to explain this in her decision and 

provide enough reasoning to show why Plaintiff’s inability to digest food and medications did not 

affect her limitations. See Meuser v. Colvin, 838 F.3d 905, 913 (7th Cir. 2016) (“There can be a 

great distance between a patient who responds to treatment and one who is able to enter the 

workforce.”) (internal quotation marks and citation omitted). Moreover, if the ALJ found that 

Plaintiff’s eating issues were not evidence of her anxiety, the ALJ should have clearly stated so in 

her decision. 

As the ALJ noted, there were no treating physician opinions to consider. The only medical 

opinions of records were those of the uncontradicted non-examining state agency physicians, 

whose opinions the ALJ gave great weight. R. 23. The ALJ relied on these opinions and included 

limitations for simple work instructions and limitations in social interaction to account for 

Plaintiff’s symptoms. But neither the ALJ nor the state agency physicians addressed Plaintiff’s 

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eating issues head on. Instead, they offer vague references to Plaintiff’s low BMI and medication 

management. This leaves this Court uncertain if they considered Plaintiff’s eating issues when 

determining her functional limitations. Therefore, the ALJ’s reliance on their opinions does not 

provide substantial evidence for her decision where she provided little discussion of the impact 

Plaintiff’s eating issues had on her limitations. For these reasons, the Court believes that a remand 

is warranted for the ALJ to evaluate Plaintiff’s mental functioning limitations considering all the 

evidence in the record relating to Plaintiff’s eating issues. 

C. Listing 12.13

As mentioned above, Plaintiff argues that the ALJ erred in failing to evaluate Listing 12.13 

for eating disorders. The Court is remanding the case due to a failure to evaluate the paragraph B 

criteria under Listings 12.06 and 12.08 and for further evaluation of the RFC. As such, the Court 

need not rule on this issue. However, this Court makes the following observations to provide 

additional guidance on remand.

Plaintiff argues that the ALJ erred when she did not evaluate Plaintiff’s eating disorder as 

a distinct impairment or consider Listing 12.13. The Commissioner argues that substantial 

evidence supports the ALJ’s finding that Plaintiff did not have a medically determinable eating 

disorder impairment and that without such an impairment Plaintiff cannot meet Listing 12.13.

However, the ALJ did not rule that Plaintiff did not have a medically determinable eating 

disorder. Rather, the ALJ stated: “Nor is the claimant’s low Body Mass Index likely related to 

digestive issues absent any related diagnosis. 16F. Therefore, there are no severe impairments from 

this condition and the following RFC does not include any, absent evidence of work-related 

limitation of function.” R. 18. This statement is problematic because it appears to indicate that the 

ALJ thought she could only consider Plaintiff’s low BMI a medically determinable impairment if 

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it was caused by digestive issues. Moreover, the ALJ never indicated that she considered and 

rejected Listing 12.13 for eating disorders.

On remand, the ALJ should address head on Plaintiff’s alleged eating disorder. If the ALJ 

does not believe that Plaintiff has a medically determinable eating disorder because no acceptable 

medical source made such a finding, she must state that. The ALJ should include in her analysis 

Plaintiff’s recent emergency department visit in September 2018, which addresses her continued 

struggle with eating issues. The Court notes that although only a nurse aid made the notation that 

Plaintiff suffered from an eating disorder, the record reflects that she conferred with an acceptable 

medical source, namely the emergency room physician, when making such a diagnosis. However, 

there are no other records relating to this hospital visit in the record, despite this stated consultation 

with an emergency room physician. Accordingly, on remand the ALJ should further evaluate this 

evidence and request any additional medical evidence necessary to assist the ALJ in fully 

evaluating Plaintiff’s eating issues.

In remanding this case, the Court is not indicating that the issues raised in this appeal must 

be resolved in a particular way or that they will all turn out to be material, but rather that they 

should be explored more thoroughly. All these issues should be considered in a comprehensive 

analysis on remand with more explicit analysis by the ALJ.

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IV. Conclusion

For the foregoing reasons, Plaintiff’s motion for summary judgment is granted, and the 

Commissioner’s motion is denied. The decision of the Commissioner is reversed, and the case is 

remanded for further proceeding consistent with this opinion.

Date: June 16, 2021 By: ______________________

Lisa A. Jensen

United States Magistrate Judge

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