In the
United States Court of Appeals
For the Seventh Circuit
No. 10-3340
JESSICA J. JELINEK,
Plaintiff-Appellant,
v.
M ICHAEL J. A STRUE, Commissioner of Social Security,
Defendant-Appellee.
Appeal from the United States District Court
for the Northern District of Indiana, South Bend Division.
No. 3:09-cv-368—Christopher A. Nuechterlein, Magistrate Judge.
A RGUED A UGUST 2, 2011—D ECIDED N OVEMBER 7, 2011
Before W OOD , S YKES, and H AMILTON, Circuit Judges.
H AMILTON, Circuit Judge. Jessica Jelinek’s mother
applied for supplemental security income on her daugh-
ter’s behalf shortly before Jelinek’s eighteenth birth-
day. She contended that Jelinek was disabled by a combi-
nation of mental impairments (including bipolar disorder)
and by physical impairments resulting from a 2005 car
accident. An administrative law judge found Jelinek’s
2 No. 10-3340
collective impairments severe but not disabling. On
appeal, Jelinek argues that the ALJ improperly rejected
the opinion of her treating psychiatrist and that this
mistake led to additional errors in the ALJ’s reasoning.
We reverse the judgment and remand for further pro-
ceedings.
I. Facts and Procedural Background
Jelinek, now 23 years old, was 17 in August 2005 when
her mother filed an application for supplemental security
income benefits on her behalf. Her application was
denied initially and on reconsideration. In February 2008
Jelinek appeared at a hearing before an ALJ, who later
issued a decision confirming the denial of benefits. The
Appeals Council denied review, leaving the ALJ’s deci-
sion as the Commissioner’s final word. See 20 C.F.R.
§ 416.1481; Steele v. Barnhart, 290 F.3d 936, 940 (7th Cir.
2002). Jelinek sought review in the district court, see
42 U.S.C. § 405(g), and a magistrate judge presiding by
consent under 28 U.S.C. § 636(c) upheld the decision.
This appeal followed.
A. The Medical Evidence
Jelinek received counseling at the Bowen Center (from
several medical sources) on a near-monthly basis from
October 2002 through February 2008. She was assessed
initially with depression and thoughts of suicide, precipi-
tated in part by a history of abuse inflicted by her father.
Jelinek reported a history of cutting and burning herself.
No. 10-3340 3
Early treatment notes cite a “suicidal gesture” in Janu-
ary 2002 (apparently including a plan to overdose by
taking Aleve), but staff at the Bowen Center initially
concluded that Jelinek posed a “low risk” of harm to
herself or others and showed no sign of psychosis.
Jelinek’s school records from this period show 71
absences during the 2002-03 school year and 79 absences
during the 2003-04 school year.
The diagnoses of Jelinek’s mental impairments shifted
over the course of her treatment at the Bowen Center. By
the time of her hearing before the ALJ, she was either
diagnosed with or had a history of major depression,
bipolar disorder (with manic and psychotic features),
ADHD, post-traumatic stress disorder, anxiety disorder,
and borderline personality disorder. Adding to that, she
also was obese and suffered from chronic pain. The
treatment for her mental impairments included an ever-
changing combination of medications and dosages,
among them the anti-depressants Zoloft, Prozac,
Trazodone, and Celexa; the anti-anxiety drugs Ativan,
Trazodone, and Vistaril; the stimulant Adderall; and the
anti-psychotic drugs Abilify, Geodon, Risperdal, and
Zyprexa. Treatment notes show some concern among
Jelinek’s doctors that, at least initially, her mother was
resistant to Jelinek’s medication regimen. Doctors peri-
odically assigned Jelinek a global assessment of func-
tioning (“GAF”) score, which is a psychiatric measure of
4 No. 10-3340
a patient’s overall level of functioning.1 The record shows
that Jelinek’s GAF scores tended to fluctuate between
50 and 55, numbers on the border between “moderate”
and “serious” impairment in function, with a high of
65 in April 2007 and a low of 20 during her brief hospital-
ization in December 2007.
In July 2005, Jelinek was in a car accident that left
her with fractures to her pelvis and two vertebrae. She
did not require surgery, and by October 2005 her doctors
deemed those fractures to be healed and recommended
physical therapy. Jelinek, though, continued to report
back pain. From February 2006 through December 2007,
she visited Dr. Aashish Deshpande for pain management.
Dr. Deshpande prescribed fentanyl for her pain and, by
turns, Vicodin and later Percocet for “breakthrough”
periods of additional pain.
It was the car accident that apparently precipitated
Jelinek’s application for supplemental security income
benefits, and in October 2005, soon after filing, she was
1
A GAF between 41 and 50 indicates “Serious symptoms (e.g.,
suicidal ideation, severe obsessional rituals, frequent shop-
lifting) OR any serious impairment in social, occupational, or
school functioning (e.g., no friends, unable to keep a job).” In
turn, a GAF between 51 and 60 reflects “Moderate symptoms
(e.g., flat affect and circumstantial speech, occasional panic
attacks) OR moderate difficulty in social, occupational, or
school functioning (e.g., few friends, conflicts with peers or
co-workers).” American Psychiatric Association, Diagnostic
and Statistical Manual of Mental Disorders, Text Revision
(DSM-IV-TR) 34 (4th ed. 2000).
No. 10-3340 5
examined by Dr. John Heroldt, a state-agency psycho-
logist. He noted that Jelinek reported being “bipolar
and manic,” but he opined that she did not exhibit psy-
chotic symptoms. He diagnosed her with major depres-
sion (with psychotic features) and borderline per-
sonality disorder, and assigned her a GAF score of 50.
After meeting with Jelinek, Dr. Heroldt concluded that
she was unable to handle her own finances.
In February 2006 a second state-agency psychologist,
Dr. F. Kladder, reviewed Jelinek’s treatment records to
assess her residual functional capacity. Dr. Kladder
opined that Jelinek presented several symptoms of depres-
sion, including anhedonia (the inability to experience
pleasure), appetite and sleep disturbance, and difficulty
concentrating. But he concluded that Jelinek suffered only
mild restrictions in the activities of daily living and
moderate difficulties in maintaining social functioning,
and in concentration, persistence, and pace. He opined
that Jelinek was “moderately limited” in her ability to
complete a normal workday or workweek, that she had
trouble in close relationships and would likely have
trouble taking criticism or supervision, and that her
allegations of disability were credible. He also noted that
Jelinek’s medical record showed one or two episodes
of decompensation of prolonged duration. See 20 C.F.R.
Pt. 404, Subpt. P, App. 1, § 12.00 (defining “episodes
of decompensation” as “exacerbations or temporary
increases in symptoms or signs accompanied by a loss
of adaptive functioning, as manifested by difficulties in
performing activities of daily living, maintaining social
relationships, or maintaining concentration, persistence,
6 No. 10-3340
or pace”); see also Larson v. Astrue, 615 F.3d 744, 750
(7th Cir. 2010) (explaining term).
From August 2006 through January 2008, Dr. Snieguole
Radzeviciene, a psychiatrist at the Bowen Center, over-
saw Jelinek’s psychiatric treatment. His notes from
an April 2007 evaluation identify Jelinek’s impairments
as major depressive disorder, ADHD, anxiety disorder,
PTSD, obesity, and chronic pain. Those notes also docu-
ment Jelinek’s concern that she did not have insurance
and could not afford therapy. In August 2007
Dr. Radzeviciene observed that Jelinek appeared “more
volatile” and documented her report that a recent
breakup with her boyfriend had led to an increase in
worry, depression, crying, and irritability.
In December 2007 Jelinek admitted herself to the
Bowen Center’s inpatient unit. She reported hearing
voices and said she feared that someone was trying to kill
her. The on-call psychiatrist, Dr. Barbara Eichman, was
unsure how long Jelinek had been “decompensating” and
characterized her as “very delusional.” Dr. Eichman
cited Jelinek’s breakup with her longtime boyfriend as a
possible factor and opined that Jelinek was probably
not taking all her medications. The doctor also
expressed doubt about the efficacy of the series of med-
ications (six in total, including two pain medications,
two anti-depressants, and two anti-psychotics) that
Jelinek was then prescribed.
One month later Dr. Radzeviciene completed a mental-
impairment questionnaire. He diagnosed Jelinek with
bipolar disorder with manic features, ADHD, and obesity.
No. 10-3340 7
Among Jelinek’s symptoms, Dr. Radzeviciene listed poor
memory; sleep, mood, and emotional disturbance; dif-
ficulty concentrating; oddities of thought, speech, and
behavior; manic syndrome; and general anxiety. He
noted that Jelinek’s mania had been resolved but that
she remained depressed and that her mood episodes
were likely to recur. He also noted that Jelinek’s
depression and anxiety tended to make her chronic
pain worse. He assessed Jelinek’s ability to maintain
attention for two-hour segments as “fair,” and opined
that she had poor or no ability to maintain regular atten-
dance, to perform at a regular pace without an unreason-
able number of rest periods, to deal with normal work
stress, or to deal with the stress of skilled or semi-skilled
work. He described Jelinek’s deficiencies of concentra-
tion, persistence, or pace as “frequent” and episodes of
deterioration or decompensation as “repeated.”
B. The Hearing Testimony
At her February 2008 hearing before the ALJ, Jelinek
testified that she lived across the hall from her mother,
who helped with shopping and cleaning her apartment.
Jelinek recounted problems with insomnia and bipolar
mania, and explained that she had missed a lot of school
and ultimately dropped out of high school in her sopho-
more year because of depression and anxiety. She had
gotten her GED and was then enrolled in four college
classes, but added that she had dropped three of four
classes the previous semester because of stress and the
breakup with her boyfriend. Regarding her work history,
8 No. 10-3340
Jelinek testified that she was working eight hours per
week as a library assistant at her college and had previ-
ously worked part-time as a motel clerk for about
three months.
Vocational expert Leonard Fisher also testified at the
hearing. The ALJ prompted the expert to opine whether
jobs existed in the local economy for light, unskilled
work. The expert testified that about 10,000 jobs existed
in the local four-county region for a claimant with
Jelinek’s age, education, and background of part-time
work. When the ALJ changed the hypothetical to seden-
tary, unskilled work, the expert opined that only 600 to
900 relevant jobs existed. The expert also opined,
however, that an unskilled worker with Jelinek’s profile
who missed more than one day a month (other than
vacation days, sick days, and holidays) would have
“difficulty in sustaining competitive employment.”
C. The ALJ’s Decision
In June 2008 the ALJ issued a written decision
concluding that Jelinek was not disabled. The ALJ found
that Jelinek had engaged in no substantial gainful
activity since her application was filed. Because Jelinek’s
initial application was a child application filed on her
behalf, the ALJ first examined her claims under the three-
step “child standard” for the period before her eighteenth
birthday. Under supplemental security income rules, a
child is disabled if she has a “medically determinable
physical or mental impairment, which results in marked
and severe functional limitations” that “has lasted or can
No. 10-3340 9
be expected to last for a continuous period of not less
than 12 months.” See 42 U.S.C. § 1382c(a)(3)(C)(i). This
assessment requires a three-step analysis set forth in
20 C.F.R. § 416.924(a). First, if the child is engaged
in substantial gainful activity, the ALJ will deny the
claim. Second, if the child does not have a severe
medical impairment or combination of impairments, then
she is not disabled. Third, the child’s impairments must
meet, medically equal, or functionally equal any of the
listings contained in 20 C.F.R. Pt. 404, Subpt. P, App. 1.
The ALJ found that Jelinek had the severe impairments
of ADHD, bipolar disorder, personality disorder, and
PTSD, and a history of pelvic, cervical, and thoracic
fractures. The ALJ also cited Jelinek’s poor school perfor-
mance and excessive absences. The ALJ found that none
of these impairments, alone or in combination, met,
medically equaled, or functionally equaled any listing
before Jelinek reached age 18.2 He found that Jelinek had
(1) “no limitation” in acquiring and using information,
attending and completing tasks, and caring for herself;
and (2) “less than marked limitation” in interacting or
2
To determine if an impairment is “functionally equivalent” to
a listing, an ALJ analyzes its severity in six “domains”:
(1) acquiring and using information; (2) attending and com-
pleting tasks; (3) interacting and relating with others; (4) moving
about and manipulating objects; (5) caring for oneself; and
(6) health and physical well-being. 20 C.F.R. § 416.926a(b)(1).
To functionally equal a listing, the ALJ must find an “ex-
treme” limitation in one category or a “marked” limitation
in two categories. 20 C.F.R. § 416.926a(a), (e)(2)(i).
10 No. 10-3340
relating to others, moving about and manipulating
objects, and health and physical well-being. He reasoned
that her symptoms were “reasonably controlled with
medication compliance” but noted that she sometimes
needed prompting to take her medication. On this basis,
the ALJ concluded that Jelinek had not been disabled
before her eighteenth birthday.
The ALJ then reviewed Jelinek’s application under
the five-step “adult standard” for the period after she
turned 18.3 He found that Jelinek had developed no
new impairments and found again, without additional
analysis, that Jelinek had no impairment or combination
of impairments that met or medically equaled a listing.
The ALJ acknowledged the restrictions in concentration,
persistence, and pace suggested by Dr. Radzeviciene’s
January 2008 opinion, as well as the doctor’s opinion
that she had no effective ability to maintain regular
attendance, perform at a consistent pace, or deal with
normal work stresses. But without explicit analysis, the
ALJ offset those concerns with a statement that Jelinek
“functioned well and passed the GED test, attended
college and obtained good grades, and worked selling
Avon and part-time at a hotel.” The ALJ opined that
Jelinek retained the residual functional capacity to
3
If a child claimant turns 18 after filing a disability application
but before a final decision, the ALJ uses the rules governing
child applications for the period before the claimant turned
18. For the period starting the day the claimant turns 18, the
ALJ uses the disability rules for adults who file new claims.
20 C.F.R. §§ 416.920, 416.924(f).
No. 10-3340 11
engage in light and sedentary unskilled work. In
making this determination, he concluded that Jelinek’s
statements about the intensity, persistence, and limiting
effects of her symptoms were not “entirely credible”
because progress notes often showed her to be doing
well. He reiterated that she had obtained her GED, and
he cited Dr. Radzeviciene’s April 2007 examination
as support for his conclusion that medication non-com-
pliance was often the culprit behind Jelinek’s decom-
pensation. Then, citing the vocational expert’s testimony,
the ALJ concluded that jobs existed for Jelinek in signifi-
cant numbers in the national economy. He concluded
that Jelinek was not disabled from her eighteenth
birthday to the date of the decision.
II. Discussion
On appeal Jelinek challenges several aspects of the
ALJ’s decision. Chiefly she contends that the ALJ improp-
erly discounted Dr. Radzeviciene’s assessment of her
mental impairments. This mistake led the ALJ in turn,
Jelinek argues, (1) to evaluate improperly whether her
mental impairments met the listing for “affective disor-
ders”; (2) to overstate her residual functional capacity
when questioning the vocational expert; and (3) to err in
finding her not credible. On judicial review, a court
will uphold the Commissioner’s decision if the ALJ
applied the correct legal standards and supported his
decision with substantial evidence. 42 U.S.C. § 405(g);
Castile v. Astrue, 617 F.3d 923, 926 (7th Cir. 2010); Terry
v. Astrue, 580 F.3d 471, 475 (7th Cir. 2009). A decision
12 No. 10-3340
denying benefits need not discuss every piece of evidence,
but when an ALJ fails to support her conclusions ade-
quately, remand is appropriate. Villano v. Astrue, 556 F.3d
558, 562 (7th Cir. 2009). We limit our review to the
reasons articulated by the ALJ in the written decision. See
SEC v. Chenery, 318 U.S. 80, 93-94 (1943); Spiva v. Astrue,
628 F.3d 346, 353 (7th Cir. 2010); Larson, 615 F.3d at 749.
We begin with Jelinek’s contention that the ALJ failed
to adhere to the “treating physician rule.” A treating
physician’s opinion that is consistent with the record is
generally entitled to “controlling weight.” 20 C.F.R.
§ 404.1527(d)(2); Schaaf v. Astrue, 602 F.3d 869, 875 (7th
Cir. 2010). An ALJ who chooses to reject a treating physi-
cian’s opinion must provide a sound explanation for the
rejection. 20 C.F.R. § 404.1527(d)(2); Campbell v. Astrue,
627 F.3d 299, 306 (7th Cir. 2010); Schmidt v. Astrue, 496
F.3d 833, 842 (7th Cir. 2007). Jelinek argues, and we
agree, that the ALJ did not explain satisfactorily in the
written decision his rejection of Dr. Radzeviciene’s
opinion. When an ALJ decides to favor another
medical professional’s opinion over that of a treating
physician, the ALJ must provide an account of what
value the treating physician’s opinion merits. See Scott v.
Astrue, 647 F.3d 734, 740 (7th Cir. 2011). The ALJ’s deci-
sion did not meet these requirements for rejecting
Dr. Radzeviciene’s opinion.
The ALJ’s decision does not allow us to conclude that
he weighed the merits of Dr. Radzeviciene’s opinion, let
alone engaged in the careful analysis required by the
regulations and case law. Dr. Radzeviciene’s assess-
No. 10-3340 13
ment, as reflected in the questionnaire he completed in
January 2008, addressed Jelinek’s symptoms and her
residual functional capacity and thus was highly
relevant to several parts of the ALJ’s analysis. But in a
section devoted to determining whether Jelinek’s mental
impairments met or medically equaled a listed impair-
ment under the adult five-step analysis, the ALJ limited
his comments to the following:
It is noted that . . . Dr. Radzeviciene opined in
January 2008 that the claimant has fair (seriously
limited) ability to maintain attention for two-hour
periods, sustain an ordinary routine without special
supervision; complete a normal workday and work-
week; work in coordination with others without being
unduly distracted; understand, remember, and carry
out detailed instructions; set realistic goals and
make plans independently of others; and use public
transportation; poor/no ability to maintain regular
attendance and be punctual; perform at a consistent
pace without an unreasonable number and length of
rest periods; and deal with normal work stresses.
However, the undersigned points out that the
claimant functioned well and passed the GED test,
attended college and obtained good grades, and
worked selling Avon and part-time at a hotel.
That’s it. Though the ALJ mentioned Dr. Radzeviciene’s
opinion once more in passing, the judge never linked the
activities he cited with an assessment of Dr. Radzeviciene’s
opinion or explained whether that opinion supported
a finding that Jelinek’s impairments met a listing.
14 No. 10-3340
The Commissioner does not defend the denial of
benefits by asserting that the ALJ’s discussion of
Dr. Radzeviciene’s opinion was adequate. Instead, in
his brief and at oral argument, the Commissioner has
asserted that the opinions of Dr. Kladder and Dr. Heroldt,
the two state-agency psychologists, explained the ALJ’s
rejection of Dr. Radzeviciene’s opinion. But the Commis-
sioner’s say-so is not enough.
We have made clear that what matters are the reasons
articulated by the ALJ. Spiva, 628 F.3d at 353; Larson,
615 F.3d at 749. Although the ALJ cited the opinions of
both psychologists, he did not use either opinion to
support his decision to reject Dr. Radzeviciene’s opinion.
See 20 C.F.R. § 404.1527(d)(2); Larson, 615 F.3d at 751;
Moss v. Astrue, 555 F.3d 556, 561 (7th Cir. 2009). In any
event, the ALJ would be hard-pressed to justify casting
aside Dr. Radzeviciene’s opinion in favor of these earlier
state-agency opinions. See Scott, 647 F.3d at 739-40.
By 2008, the state-agency opinions were two years old.
Dr. Radzeviciene’s opinion, on the other hand, was the
most recent professional word on Jelinek’s mental im-
pairments, by a treating psychiatrist who had seen
her repeatedly over a two-year period with full access
to her complete medical record to that point. No other
medical opinion available to the ALJ provided a
similarly comprehensive picture of Jelinek’s overall
mental health at the time of the hearing. Neither the
opinion of Dr. Heroldt nor the opinion of Dr. Kladder
fully supported the ALJ’s wholesale rejection of
Dr. Radzeviciene’s opinion. While these psychologists
No. 10-3340 15
did not think that Jelinek’s residual functional capacity
was as limited as Dr. Radzeviciene did, Dr. Heroldt
scored Jelinek’s GAF at 50, which corresponds to a
serious impairment of functioning, and Dr. Kladder
concluded, contrary to the ALJ’s decision, that Jelinek’s
claim of disability was credible.
Even if we could follow the ALJ’s reasoning from the
brief references to Jelinek’s college coursework and her
limited employment, the ALJ’s decision did not build a
logical bridge between those activities and his conclu-
sion that she had not met a listing after her eighteenth
birthday. See Clifford v. Apfel, 227 F.3d 863, 872 (7th
Cir. 2000). An ALJ may consider a claimant’s daily activi-
ties when assessing credibility, see Arnold v. Barnhart,
473 F.3d 816, 823 (7th Cir. 2007), but ALJs must explain
perceived inconsistencies between a claimant’s activities
and the medical evidence. Stewart v. Astrue, 561 F.3d
679, 684 (7th Cir. 2009); Carradine v. Barnhart, 360 F.3d 751,
755 (7th Cir. 2004); Zurawski v. Halter, 245 F.3d 881, 887
(7th Cir. 2001). The ALJ did not do so, and we are hard-
pressed to understand how Jelinek’s brief, part-time
employment supports a conclusion that she was able to
work a full-time job, week in and week out, given her
limitations. See Stewart v. Astrue, 561 F.3d 679, 684 (7th
Cir. 2009); Diaz v. Prudential Ins. Co. of Am., 499 F.3d 640,
648 (7th Cir. 2007); Zurawski, 245 F.3d at 887. The ALJ did
not ask the critical questions about Jelinek’s actual
work hours or absentee rates in the jobs she held, and
no medical provider or consultant opined that Jelinek
could hold down a full-time position. Rather, the record
suggests that Jelinek has experienced longstanding prob-
16 No. 10-3340
lem with absences. The activities the ALJ mentioned
reflected only her willingness and ability to stay
engaged in commendable but limited endeavors part-
time or at her own pace.
The remainder of the ALJ’s decision shows that the
failure to weigh Dr. Radzeviciene’s opinion appropri-
ately led to additional errors. If that opinion were fully
credited, it supports both a finding that Jelinek met
Listing 12.04 before the hearing date and that her residual
functional capacity was consistent with a finding of
disability. Dr. Radzeviciene noted that Jelinek exhibited
several symptoms of depression, including appetite and
sleep disturbance, psychomotor agitation or retarda-
tion, decreased energy, and difficulty concentrating or
thinking. Dr. Radzeviciene’s notes also reflect that Jelinek
was bipolar. A finding that she suffered from these ill-
nesses would satisfy Listing 12.04’s diagnostic “A criteria.”
See 20 C.F.R. Pt. 404, Subpt. P, App. 1 § 12.04(A); Larson,
615 F.3d at 747-48. Dr. Radzeviciene also opined that
Jelinek was experiencing “frequent” deficiencies of con-
centration, persistence, or pace and “repeated” episodes
of deterioration or decompensation in work or work-
like settings, together enough to meet Listing 12.04’s
diagnostic “B criteria.” See 20 C.F.R. Pt. 404, Subpt. P,
App. 1 § 12.04(B); Larson, 615 F.3d at 747-48; Craft v.
Astrue, 539 F.3d 668, 674-75 (7th Cir. 2008). These two
findings — that Jelinek satisfied both the A and B criteria
of Listing 12.04 — would together compel a finding that
Jelinek was disabled. See 20 C.F.R. Pt. 404, Subpt. P, App.
1 § 12.00. But the ALJ’s opinion did not mention any of
the symptoms cited in Dr. Radzeviciene’s 2008 opinion.
In fact, though the quoted text appears in the section of
No. 10-3340 17
the ALJ’s opinion devoted to whether Jelinek “met or
medically equaled” a listed impairment after the age of
eighteen, the section devoted to Dr. Radzeviciene’s
opinion cited only the portion devoted to Jelinek’s
residual functional capacity, not her symptoms or diag-
noses.
As noted, Jelinek also contends on appeal that the
ALJ’s failure to analyze Dr. Radzeviciene’s opinion led
the judge to omit key limitations when presenting his
hypothetical questions to vocational expert Fisher at
Jelinek’s hearing. As a result, Jelinek argues, the expert
could not give the ALJ an accurate picture of the jobs
available to her in the national economy. At the very
least, Jelinek contends, the ALJ should have included
hypothetical questions addressing issues of “concentra-
tion, persistence, or pace” consistent with the medical
opinions that he credited, including Dr. Kladder’s. Again,
we agree.
We have stated repeatedly that ALJs must provide
vocational experts with a complete picture of a claimant’s
residual functional capacity, and vocational experts must
consider “deficiencies of concentration, persistence, and
pace.” O’Conner-Spinner v. Astrue, 627 F.3d 614, 619 (7th
Cir. 2010); see Stewart, 561 F.3d at 684; Young v. Barnhart,
362 F.3d 995, 1004 (7th Cir. 2004); Kasarsky v. Barnhart,
335 F.3d 539, 544 (7th Cir. 2003); Steele, 290 F.3d at 942.
And though the hypothetical questions posed by an ALJ to
a vocational expert must include only the physical and
mental limitations the judge deems credible, Schmidt,
496 F.3d at 846, the ALJ did not do that in this case.
18 No. 10-3340
The ALJ limited his questioning of the expert to “seden-
tary” and “light” unskilled work. But “sedentary” and
“light” both describe a claimant’s ability to exert herself
physically over a workday or workweek. See 20 C.F.R.
§§ 404.1567, 416.967(b); Social Security Ruling (“SSR”) 83-
10, 1983 WL 31251, at *5-6 (1983); Haynes v. Barnhart, 416
F.3d 621, 627 n.2 (7th Cir. 2005). Similarly, “unskilled
work” is defined by regulation as “work which needs
little or no judgment to do simple duties that can be
learned on the job in a short period of time.” 20 C.F.R.
§ 404.1568(a). None of these terms addressed the impact
of the mental limitations reflected in Dr. Radzeviciene’s
opinion, which (as reflected in the above quotation
from the ALJ’s decision) limited Jelinek’s ability to main-
tain regular work attendance, to carry out instructions,
and to deal with the stresses of full-time employment.
What’s more, Dr. Kladder’s earlier opinion from 2006,
which the ALJ largely credited, concluded that Jelinek
was not a malingerer and that she suffered at least “mod-
erate limitations” in her abilities to concentrate, to com-
plete a normal workday or workweek, and to respond
appropriately to criticism from supervisors. At the
least, the ALJ was required to pose hypothetical questions
to the vocational expert consistent with Dr. Kladder’s
opinion (and with those of the other physicians on
whose opinions he relied) to give the expert a complete
picture of Jelinek’s residual functional capacity.
These are reasons enough to remand the matter to the
agency for further review. Nevertheless, we briefly
address as well Jelinek’s final argument — that the ALJ
No. 10-3340 19
failed to conduct a proper credibility analysis — to point
out a few additional flaws that should be avoided on
remand. Foremost among these is the ALJ’s repeated
reference to Jelinek’s “medication non-compliance” as
a reason for finding her not credible. The ALJ ap-
parently concluded that Jelinek’s symptoms would have
remained under control but for an unwillingness to
take her medications as directed. But we have often
observed that bipolar disorder, one of Jelinek’s chief
impairments, is by nature episodic and admits to
regular fluctuations even under proper treatment. ALJs
assessing claimants with bipolar disorder must consider
possible alternative explanations before concluding that
non-compliance with medication supports an adverse
credibility inference. See Punzio v. Astrue, 630 F.3d 704,
710 (7th Cir. 2010); Larson, 615 F.3d at 751; Bauer v. Astrue,
532 F.3d 606, 609 (7th Cir. 2008); Kangail v. Barnhart,
454 F.3d 627, 630-31 (7th Cir. 2006).
Here, the record shows a litany of changes to Jelinek’s
medications over the years, as well as concerns by her
doctors over side effects, ineffective drugs, costs, insur-
ance issues, and compliance issues due to both mental
illness and the potential lack of family and social sup-
port. Early notes from Jelinek’s visits to the Bowen Center
expressed concern that her mother might not have fully
supported her medication regimen. And at various times
Jelinek advised doctors that she did not have insurance
and was concerned about paying for therapy — a cost con-
cern that could have limited her access to her several
prescribed medications. Treatment notes did not al-
20 No. 10-3340
ways reflect why medication changes were made, but
several notes, including notes from as late as Decem-
ber 2007, show that doctors were concerned that Jelinek’s
medications were not optimally treating her symptoms
and that she would sometimes run out of her medica-
tions. These concerns must be addressed as part of any
consideration of Jelinek’s failure to comply with
prescribed medication.
We R EVERSE the district court’s judgment and R EMAND
to the Social Security Administration for further pro-
ceedings consistent with this opinion.
11-7-11