1

IN THE UNITED STATES DISTRICT COURT

FOR THE NORTHERN DISTRICT OF ILLINOIS

WESTERN DIVISION

Sarah O., )

 )

Plaintiff, )

 ) Case No. 3:20-cv-50229

v. )

 ) Magistrate Judge Lisa A. Jensen

Kilolo Kijakazi, )

Acting Commissioner of Social Security,1

 )

 )

Defendant. )

MEMORANDUM OPINION AND ORDER

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

of the decision denying her social security benefits.2 For the reasons set forth below, the 

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

I. Background

In September 2016, Plaintiff filed applications for disability insurance benefits and 

supplemental security income alleging a disability beginning on September 24, 2015 because of 

bipolar disorder, anxiety disorder, panic disorder, and obsessive-compulsive disorder. R. 171.

Plaintiff was 37 years old at the time she filed her applications. Plaintiff, who has been receiving 

mental health treatment intermittently since she attempted suicide in 1994, was diagnosed with 

bipolar disorder in 2008.

Between 1998 and 2015, Plaintiff held two jobs working in a factory as a conveyor feeder 

and production machine tender. At Plaintiff’s most recent job as a production machine tender, she 

1 Kilolo Kijakazi has been substituted for Andrew Marshall Saul. Fed. R. Civ. P. 25(d).

2 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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was fired on her alleged onset date because she had an issue with a coworker. Plaintiff alleged that 

after she lost her job, her mental impairments got worse, and she was unable to continue working.

Although Plaintiff worked as a driver for a delivery company for one day in November 2015, she 

quit because she could not perform her job duties due to anxiety.

Following a hearing, an administrative law judge (“ALJ”) issued a decision in March 2019, 

finding that Plaintiff was not disabled. R. 52-61. The ALJ found that Plaintiff had the severe 

impairments of bipolar disorder and anxiety. The ALJ determined that Plaintiff’s impairments did 

not meet or medically equal a listed impairment. The ALJ concluded that Plaintiff had the residual 

functional capacity (“RFC”) to perform a full range of work at all exertion levels with certain nonexertional limits and could perform her past relevant work as a conveyor feeder and production 

machine tender.

Plaintiff appeals the ALJ’s decision arguing that the ALJ made several errors in 

determining her mental RFC. Therefore, this Court will focus on the evidence relevant to the ALJ’s 

evaluation of Plaintiff’s mental functioning and RFC determination in the discussion below.

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 is “such relevant evidence as a reasonable mind might accept as adequate to 

support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (citations omitted). “An 

ALJ need not specifically address every piece of evidence, but must provide a ‘logical bridge’ 

between the evidence and his conclusions.” Butler v. Kijakazi, 4 F.4th 498, 501 (7th Cir. 2021)

(citations omitted). The reviewing court may not “reweigh the evidence, resolve debatable 

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evidentiary conflicts, determine credibility, or substitute [its] judgment for the ALJ’s 

determination so long as substantial evidence supports it.” Gedatus v. Saul, 994 F.3d 893, 900 (7th 

Cir. 2021).

III. Discussion

Plaintiff makes several arguments challenging the ALJ’s RFC determination as insufficient 

to incorporate the full extent of her mental limitations, namely limitations relating to social 

interactions and concentration, persistence, and pace. Specifically, Plaintiff argues that the ALJ: 

(1) improperly discounted the opinion of her treating psychiatrist, Dr. Desiree Rahman; (2) failed 

to incorporate all limitations identified by the state agency reviewing psychologist, Dr. M. W. 

DiFonso; and (3) improperly discounted her subjective symptoms. The Court will first address 

Plaintiff’s argument relating to Dr. DiFonso and the ALJ’s RFC determination.

A. RFC

When determining Plaintiff’s mental limitations, the ALJ considered, and partially 

rejected, three opinions contained in the record. The ALJ did not call a medical expert to testify at 

the hearing. The ALJ gave “little weight” to the opinions from Plaintiff’s treating psychiatrist, Dr. 

Rahman, and her treating therapist, Christina Bieche. The ALJ gave “fair weight” to the opinion 

from the state agency reviewing psychologist, Dr. DiFonso. 

In June 2017, Dr. DiFonso reviewed Plaintiff’s medical records and affirmed the prior 

assessments made by the psychologists in March 2017 that Plaintiff had depressive, bipolar, 

anxiety, and obsessive-compulsive disorders. R. 158. He found that Plaintiff had moderate 

limitations relating to concentration and persistence, social interaction, and adaption. R. 160-161. 

Specifically, Dr. DiFonso found moderate limitations in Plaintiff’s ability to: carry out detailed 

instructions; maintain attention and concentration for extended periods; work in coordination with 

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or in proximity to others without being distracted; complete a normal workday without 

interruptions from psychologically based symptoms and perform at a consistence pace without an 

unreasonable number and length of rest periods; interact appropriately with the general public; 

accept instructions and respond appropriately to criticism from supervisors; get along with 

coworkers; maintain socially appropriate behavior; and travel in unfamiliar places. In the narrative 

portion of the assessment, Dr. DiFonso opined that Plaintiff’s “mental status is stable” with 

treatment and treatment compliance, noting that although there are reports of breakthrough 

symptoms these were primarily related to psychosocial stressors and Plaintiff’s symptoms 

stabilized with treatment compliance. R. 162. Accordingly, Dr. DiFonso found that Plaintiff 

“retains the functional capacity to engage in reduced stress simple and routine unskilled vocational 

activities of a 1 and 2 step requirement. Limited direct and demanding social interactions with 

general public is recommended.” R. 162. 

The ALJ gave “fair weight” to Dr. DiFonso’s opinion because “it was consistent with the 

medical evidence of record.” R. 60. This was the extent of the ALJ’s evaluation of Dr. DiFonso’s 

opinion, other than to note that she “offered a more nuanced mental residual functional capacity 

due to a more complete medical record and claimant testimony.” Id. Based on this, the ALJ 

determined that Plaintiff had the RFC to perform:

a full range of work at all exertional levels but with the following nonexertional

limitations: can learn, understand, remember, and carry out simple and detailed 

work instructions with no more than occasional changes in the work; no more than 

occasional decision making; no work in a team environment or tandem task work; 

no more than occasional brief and superficial work with coworkers; no work in 

customer service or with the public; and with these abilities would adequately be 

able to sustain the concentration, persistence, and pace of the work activities in twohour increments throughout the typical workday.

R. 56.

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Plaintiff argues that the ALJ failed to provide any logical explanation for dismissing Dr. 

DiFonso’s moderate “check-box” limitations relating to concentration, social interaction, and 

adaption, as well as his narrative explanation of those limitations. The Commissioner argues that 

Plaintiff has not shown a conflict between Dr. DiFonso’s moderate checkbox limitations and the 

RFC, which the Commissioner argues exceeds the restrictions outlined in Dr. DiFonso’s narrative 

summary. However, a review of Dr. DiFonso’s narrative summary shows that the ALJ declined to 

include limitations for: reduced stress, simple, unskilled, and 1 to 2 step tasks. Yet, the ALJ’s 

decision does not sufficiently explain the reasons for excluding these limitations. Although the 

ALJ’s failure to include limitations for simple, unskilled, and 1 to 2 step tasks is arguably harmless 

because one of the jobs the ALJ identified, conveyor feeder, meets these requirements, the ALJ 

still failed to include a limitation for “reduced stress.”

A claimant’s RFC is the maximum work that she can perform despite any limitations. See

20 C.F.R. § 404.1545(a)(1); Social Security Ruling 96-8p, 1996 WL 374184, at *2. “Although the 

responsibility for the RFC assessment belongs to the ALJ, not a physician, an ALJ cannot construct 

his own RFC finding without a proper medical ground and must explain how he has reached his 

conclusions.” Amey v. Astrue, No. 09 C 2712, 2012 WL 366522, at *13 (N.D. Ill. Feb. 2, 2012).

Dr. DiFonso did not define what a “reduced stress” work environment would look like for 

Plaintiff. Accordingly, without further explanation from the ALJ, it is not clear to the Court 

whether any of the limitations the ALJ adopted were intended to provide for a reduced stress work 

environment. One limitation the ALJ included in the RFC that often deals with workplace 

adaption, and possibly workplace stress, is the limitation to “no more than occasional changes in 

the work.” R. 56. However, the ALJ explicitly stated that this limitation was included to 

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accommodate Plaintiff’s side effects from her medications, which the record reveals is mostly 

severe drowsiness. R. 59.

Tellingly, the Commissioner argues that the RFC includes limitations for “workplace 

stress,” Def.’s Resp. at 4, Dkt. 28, but erroneously states that the ALJ limited Plaintiff to “tasks 

free of fast-paced production requirements.” Def.’s Resp. at 2, Dkt. 28. Such a limitation would 

likely reduce Plaintiff’s stress at work, but no such limitation was provided here. See R. 56. This 

is significant because Dr. DiFonso found that despite Plaintiff’s mental impairments, she could 

maintain the ability to concentrate and keep pace but only in a reduced stress work environment. 

There is evidence throughout the record that Plaintiff’s is susceptible to external stressors and that 

such stress often brings on episodes of mania and depression. R. 98. Plaintiff also testified at the 

hearing that in both of her prior jobs, her roommate always worked at the same jobs as her and 

“always picked up the slack if I wasn’t able, if I was having a hard time.” R. 107. The ALJ merely 

disregarded this line of evidence, omitting to comment one way or the other on why this evidence 

did not support Dr. DiFonso’s restriction for workplace stress. If the RFC assessment conflicts 

with an opinion from a medical source, the ALJ must explain why the opinion was not adopted. 

See Social Security Ruling 96-8p, 1996 WL 374184, at *7. Here, the ALJ gave Dr. DiFonso’s 

opinion fair weight, yet provided no explanation for opting not to include his restriction for 

workplace stress. Thus, a remand is required for the ALJ to explain his reasons.

In light of this remand, the ALJ should also take the opportunity to explicitly address Dr. 

DiFonso’s limitations for work that was simple, unskilled, and only required 1 to 2 step tasks. The 

ALJ clearly did not adopt these limitations but did not explain why he opted not to incorporate 

them into the RFC. “While a mild, or even a moderate, limitation in an area of mental functioning 

does not necessarily prevent an individual from securing gainful employment, [ ] the ALJ must 

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still affirmatively evaluate the effect such mild limitations have on the claimant’s RFC.” SimonLeveque v. Colvin, 229 F. Supp. 3d 778, 787 (N.D. Ill. 2017) (emphasis in original) (internal 

citation omitted). Accordingly, on remand, the ALJ should support her reasons for not including 

any of the restrictions identified by Dr. DiFonso into the RFC. The ALJ shall then explicitly 

address all of Plaintiff’s medically supported limitations in both the RFC and in the hypothetical 

to the VE to determine whether Plaintiff can perform her past work or if there are other jobs that 

exist in significant numbers that Plaintiff can perform.

B. Subjective Symptoms

Plaintiff argues that the ALJ erred in rejecting her credibility concerning the severity of 

her mental impairments. An ALJ must justify her evaluation of a plaintiff’s subjective allegations 

with “specific reasons supported by the record.” Pepper v. Colvin, 712 F.3d 351, 367 (7th Cir. 

2013). “Because the ALJ is in the best position to determine a witness’s truthfulness,” an ALJ’s 

assessment should not be overturned “unless it is patently wrong.” Morrison v. Saul, 806 F. 

App’x 469, 474 (7th Cir. 2020) (unpublished) (citing Shideler v. Astrue, 688 F.3d 306, 310-11 

(7th Cir. 2012)). An ALJ’s assessment is patently wrong if the decision lacks any explanation or 

support. Cullinan v. Berryhill, 878 F.3d 598, 603 (7th Cir. 2017). Not all of the ALJ’s reasons 

must be valid in a subjective symptom analysis, “as long as enough of them are.” Halsell v. 

Astrue, 357 F. App’x 717, 722 (7th Cir. 2009) (unpublished) (emphasis in original).

Here, the ALJ listed several reasons to find that Plaintiff’s subjective symptoms were not 

as severe as she alleged. The ALJ identified gaps in treatment, that treatment focused on external 

stressors, Plaintiff’s ability to go on job interviews in contradiction of her reports of social 

isolation, Plaintiff’s use of medications on an “as-needed basis rather than as they were

prescribed,” and Plaintiff’s failure to present to the emergency room despite complaints of 

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worsening symptoms. The Court finds that the ALJ did not provide sufficient reasons or support 

for discrediting Plaintiff’s subjective symptoms.

Although a history of sporadic treatment can undermine a plaintiff’s subjective 

allegations, an ALJ must consider the possible reasons for the lack of treatment. Deborah M. v. 

Saul, 994 F.3d 785, 790 (7th Cir. 2021). Examples of “good reasons” may include an inability to 

afford treatment or ineffectiveness of further treatment. See Shauger v. Astrue, 675 F.3d 690, 696 

(7th Cir. 2012). None of these reasons were explored here, despite several references in the 

record to Plaintiff’s inability to meet her co-pay, fill prescriptions, or find a therapist because of 

Medicaid. See, e.g., R. 356, 398, 409, 414. As to external stressors, without further explanation 

from the ALJ, it is unclear how she used this evidence to discount Plaintiff’s symptoms where 

she did not find that such stressors were temporary or would otherwise abate such that they 

would not affect Plaintiff’s functional limitations.

The ALJ’s assessment of Plaintiff’s ability to go on job interviews is an overreach where 

there is no evidence in the record that Plaintiff was successful in her attempts. Plaintiff testified 

that she was not called back after her interviews and “started to feel very overwhelmed and shut 

down.” R. 84. Plaintiff was even prescribed medication as needed for “social anxiety for 

interviews and other anxiety provoking social situations” but was told not to drive on the 

medication or engage in other activities that require alertness, coordination, or balance. R. 379. 

As for Plaintiff’s use of medications, the ALJ misunderstood how Plaintiff uses her 

medications. Plaintiff testified, and her treatment notes confirmed, that Dr. Rahman generally 

prescribed Plaintiff Abilify on an as needed basis to combat worsening symptoms and manic 

episodes. See, e.g., R. 446-47, 449. This was in part because Plaintiff often complained that 

Abilify caused her to become extremely drowsy and unmotivated, so she only took Abilify, or an 

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increased dose of Abilify, as needed to combat increased symptoms. Without addressing this 

evidence, the ALJ characterized Plaintiff’s use of medications as “selective” or contrary to what 

was prescribed. R. 58-59. Although there is evidence in the record that Plaintiff was not always 

compliant with her medications, this alone is not enough to support the ALJ’s reasoning without 

further explanation.

Lastly, the Seventh Circuit has warned ALJs against relying on a plaintiff’s failure to 

seek emergency medical care as evidence of the severity of a symptom or condition. See Goins v. 

Colvin, 764 F.3d 677, 679-80 (7th Cir. 2014). Ms. Bieche’s treatment plan explicitly informed 

Plaintiff of appropriate use of the crisis hotline when needed and there is no other indication in 

the record that Plaintiff should have sought emergency care as opposed to seeking psychiatric 

care from her treaters. R. 433; see Pratt v. Colvin, No. 12 C 8983, 2014 WL 1612857, at *7 

(N.D. Ill. Apr. 16, 2014) (finding it improper to discount claimant’s credibility based on a lack of 

an attempt to seek certain treatment where there is no evidence that such treatment was 

recommended or would have been effective). Accordingly, it was improper for the ALJ to 

consider as evidence the fact that Plaintiff had not presented to the emergency room for her 

worsening symptoms.

Although the Court is not finding that the ALJ should have found Plaintiff’s subjective 

allegations fully credible, “[g]reater elaboration and explanation is necessary to ensure a full and 

fair review of the evidence.” Dawn P. v. Berryhill, No. 17 C 4707, 2019 WL 339603, at *7 (N.D. 

Ill. Jan. 28, 2019). On remand, the ALJ shall reevaluate Plaintiff’s subjective symptom 

allegations pursuant to Social Security Ruling 16-3p, 2017 WL 5180304, and fully explain and 

support her conclusions.

C. Treating Psychiatrist’s Opinion

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The final issue raised by Plaintiff is that that the ALJ improperly discounted Dr. Rahman’s 

opinion offered in the Mental RFC Assessment. Having found that a remand is warranted for a 

new RFC determination on the first two issues addressed, the Court finds it unnecessary to address 

this remaining argument. However, Plaintiff should raise any of her concerns with the ALJ on 

remand.

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.

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. This Court declines to order a finding 

of disability based on the record before it. It is more appropriate to remand to the ALJ to properly 

evaluate the evidence as outlined above and issue a new decision.

Date: December 13, 2021 By: ______________________

Lisa A. Jensen

United States Magistrate Judge

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