In the
United States Court of Appeals
For the Seventh Circuit
No. 10-1314
C URTIS C AMPBELL,
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 Illinois, Eastern Division.
No. 1:09-cv-01744—John W. Darrah, Judge.
A RGUED S EPTEMBER 9, 2010—D ECIDED D ECEMBER 6, 2010
Before W OOD , E VANS, and T INDER, Circuit Judges.
T INDER, Circuit Judge. Curtis Campbell appeals from
the district court’s judgment upholding the Social
Security Administration’s denial of his application for
disability insurance benefits and supplemental security
income. Campbell contends that the Administrative
Law Judge (“ALJ”) who denied his application erred in
discounting the opinion of his treating psychiatrist and
2 No. 10-1314
in weighing the psychiatric medical evidence. We
reverse the district court’s denial of relief and remand
with instructions to return this matter to the Commis-
sioner.
I. Background
On January 13, 2004, Campbell applied for social
security disability benefits and supplemental security
income. Although Campbell has physical impairments
and limitations, this appeal concerns his mental impair-
ments and limitations.
Campbell has a history of treatment for depression.
On March 13, 2004, Myrtle Mason, M.D., M.P.H., con-
ducted a psychiatric examination of Campbell at the
agency’s request. Campbell indicated that he had been
depressed since 1986, but was not currently being seen
by a mental health professional. He reported that his
primary care physician had prescribed medications for
depression: Zoloft, Lexapro, and Elavil. Dr. Mason con-
cluded that Campbell’s past treatment and hospitaliza-
tions had been mostly for substance abuse, not depres-
sion. Upon examination, Dr. Mason noted that Campbell
was a little guarded intermittently during the interview,
but found no evidence of any perceptual disorder or
disturbance in form or content of thought. She diagnosed
substance induced mood disorder and polysubstance
abuse. Dr. Mason rated Campbell’s current Global Assess-
ment of Functioning (GAF) Scale as 60-75, indicating
at worst some mild symptoms or some difficulty in func-
tioning, but generally functioning pretty well. See Am.
No. 10-1314 3
Psychiatric Ass’n, Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) 34 (4th ed. 2000).
On April 6, 2004, Kirk Boyenga, Ph.D., a state agency
psychologist, reviewed the record and assessed
Campbell’s mental functional capacity. Boyenga opined
that Campbell was mentally capable of performing
simple and detailed tasks as well as routine and repeti-
tive tasks in settings with reduced interpersonal contact.
In August 2004, state agency psychologist Bronwyn E.
Rains and state agency psychiatrist Glen D. Pittman
reviewed the record and affirmed Dr. Boyenga’s assess-
ment.
On May 7, 2004, Campbell presented at the Community
Mental Health Council, Inc. (“CMHC”), for a mental
health assessment which was conducted by Anne Crowe,
LCPC, a clinical therapist. Campbell reported depression,
decreased sleep, decreased appetite, anhedonia,1 and a
hopeless feeling. He said that he was not active and not
motivated, but denied suicidality. He reported anxiety
and impulsivity as well as auditory and visual hallucina-
tions. He stated that he was going through a divorce
and that he was consuming alcohol daily. Crowe thought
Campbell’s affect was depressed. She recommended
a psychiatric evaluation, medication as needed, case
management services, individual therapy, and a mental
1
Anhedonia is the inability to experience pleasure in acts
that normally produce it. Merriam-Webster, MedlinePlus,
http://www.merriam-webster.com/medlineplus/anhedonia (last
visited Dec. 1, 2010).
4 No. 10-1314
health assessment. That day, a psychiatrist at CMHC also
saw Campbell. His affect was depressed and sad, but
otherwise within normal limits. The clinician diagnosed
Major Depression with psychotic features, history of
polysubstance abuse, current muscle relaxant abuse
and assessed a GAF rating of 40-45, reflecting some
impairment in reality testing or communication or
major impairment in several areas, such as work, judg-
ment, thinking, or mood. See DSMV-IV-TR 34.
On October 19, 2004, CMHC psychiatrist Traci Powell
first evaluated Campbell. She treated him regularly
through the date of the ALJ’s hearing, January 25, 2006,
and thereafter. On mental status exam, Dr. Powell noted
that Campbell had a flat affect, soft voice, fair judgment
and insight, paranoid/suspicious thought, and auditory
hallucinations. Her note states: “Reports using ETOH
[alcohol] on a daily basis and states it helps to calm him.”
Dr. Powell noted that Campbell reported symptoms of
depression and psychosis dating back ten years. She
diagnosed Major Depressive Disorder with psychotic
features and prescribed Paxil to address his depressive
symptoms and Seroquel for psychosis and sleep distur-
bance. Dr. Powell rated Campbell’s GAF at 45-50,
reflecting serious symptoms or serious impairment in
social or occupational functioning, for example, the
inability to keep a job. See DSMV-IV-TR 34.
Campbell did not see Dr. Powell again until January 4,
2005. He reported that the past two months were “terri-
ble” and that he continued to have anxiety attacks.
Dr. Powell noted that “[h]e states his ETOH use has
No. 10-1314 5
increased” and that Campbell reported using drugs once
since his last appointment. On his mental status exam,
Dr. Powell noted that Campbell’s affect was flat, his
thought content was paranoid/suspicious, and he had
auditory hallucinations. Her assessment included that
Campbell “has not been compliant with meds and con-
tinues to use ETOH.” She diagnosed Major Depressive
Disorder with psychotic features and rated him 45-50 on
the GAF Scale, again reflecting serious symptoms or
impairments in functioning. See DSMV-IV-TR 34.
Dr. Powell restarted Campbell’s medications, increasing
the dosage of Seroquel by 200 mg.
Dr. Powell saw Campbell on February 17, 2005. He
stated that things were not going well, but was not forth-
coming about what was happening. He reported using
ETOH a few times per month and denied using illegal
drugs. Based on her exam, Dr. Powell noted that Camp-
bell’s affect was flat, his thought content was para-
noid/suspicious, and he had auditory hallucinations.
She noted that he had not been fully compliant with
his medications and was “using ETOH which is likely
contributing to his presentation today.” Dr. Powell diag-
nosed Major Depressive Disorder with psychotic
features and noted the need to rule out the existence of
a learning disability. His GAF score was 45-50.
On February 22, 2005, Dr. Powell completed a mental
impairment questionnaire, assessing Campbell’s impair-
ments and functional capacity. She diagnosed Major
Depressive Disorder with psychotic features and noted
the need to rule out a learning disability. She identified
6 No. 10-1314
Campbell’s associated symptoms as sleep disturbance,
mood disturbance, anhedonia or pervasive loss of
interests, paranoia or inappropriate suspiciousness,
feelings of guilt/worthlessness, perceptual disturbance,
and flat affect. In her clinical findings, Dr. Powell noted
that Campbell’s speech was hesitant, his affect was flat,
he was positive for paranoia and auditory hallucina-
tions, and his insight and judgment were fair. Dr. Powell
noted that Campbell was not a malingerer. His prog-
nosis was fair. His medications were Seroquel and
Paxil. Dr. Powell indicated that Campbell had fair, poor,
or no ability to perform mental activities required for
even unskilled work. She found that he had the fol-
lowing functional limitations: moderate restriction in
activities of daily living; marked difficulties in main-
taining social functioning; constant deficiencies in con-
centration, persistence or pace; and repeated (three or
more) episodes of deterioration or decompensation.
She again rated his GAF score at 45-50, indicating
serious symptoms or serious impairment in functioning,
see DSM-IV-TR 34, and stated that his highest GAF
rating in the past year was 45-50.
On March 17, 2005, Dr. Powell again saw Campbell who
appeared somewhat dysphoric 2 and said he was dealing
with family stressors. He stated that he was taking
his medication, but estimated he missed it about once
2
Dysphoria is a state of feeling unwell or unhappy. Merriam-
Webster, MedlinePlus, http://www.meriam-webster.com/
medlineplus/dysphoria (last visited Dec. 1, 2010).
No. 10-1314 7
a week. He reported some improvement in symptoms.
The treatment record states that Campell continued to
drink ETOH about once per week. Dr. Powell’s findings
on Campbell’s mental status exam were essentially the
same as on the prior exam. She wrote that Campbell
continued “to have residual symptoms in the context of
ongoing ETOH use.” She rated him 45-50 on the GAF
Scale. Dr. Powell switched one of Campbell’s medica-
tions due to a recall, encouraged compliance, and en-
couraged abstinence from alcohol.
Campbell saw Dr. Powell on April 14, 2005, at which
time he reported mood swings, sleep disturbances, prob-
lems with concentration, auditory hallucinations, crying
spells, feelings of hopelessness, and alcohol use on a
weekly basis. Dr. Powell observed that Campbell re-
ported symptoms suspicious of Bipolar Disorder. She
opined that his continued alcohol use likely exacerbated
his symptoms, and noted that he took extra medication
to combat the symptoms when they worsened. This
time, Dr. Powell diagnosed Major Depressive Disorder
with psychotic features and noted the need to rule
out the existence of Bipolar Disorder with psychotic
features. Campbell again had a 45-50 on the GAF Scale.
Dr. Powell increased Campbell’s medications and en-
couraged abstinence from alcohol.
On May 15, 2005, Campbell had his next appointment
with Dr. Powell. He reported low appetite, worsening of
auditory hallucinations, paranoia, and memory prob-
lems. He did not think the higher dose of one of his
medications was helping. He stated that he continued to
8 No. 10-1314
use alcohol, but his use was very limited. Upon examina-
tion, Dr. Powell noted that Campbell’s affect was flat
and his speech was slow, but he had fair judgment and
insight. She noted that he continued to be symptomatic
despite reported compliance. Dr. Powell’s diagnoses re-
mained the same; she increased his medication and
again encouraged abstinence from alcohol. Campbell’s
GAF score was still 45-50.
When Campbell saw Dr. Powell on June 21, 2005, he
reported continued use of alcohol, but stated that his use
had decreased. He also reported sleep difficulties, poor
energy, auditory hallucinations, and paranoia. Dr. Powell
noted that Campbell had flat affect, tangential thought
process, paranoid/suspicious thought content, auditory
hallucinations, and fair judgment and insight. She ob-
served that his reported symptoms were consistent
with Bipolar Disorder and that his mood symptoms and
psychosis did not appear to be responding to his current
medications. Thus, she changed some of his medications.
Dr. Powell diagnosed Bipolar Disorder with psychotic
features and noted the need to rule out ETOH abuse and
a learning disability. She encouraged compliance and
abstinence from alcohol. Campbell’s GAF score re-
mained 45-50.
On July 6, 2005, Campbell reported to Dr. Powell that
he was experiencing physical pain that was exacerbating
his depressed mood. He claimed he had been com-
pliant with medication. Upon examination, Dr. Powell
indicated that Campbell was cooperative and his motor
activity was normal, his affect was flat, his thought
No. 10-1314 9
process was tangential, he was paranoid/suspicious, and
his memory and insight were fair. She noted that he
was having auditory hallucinations. She also indicated
that Campbell continued to report symptoms consistent
with Bipolar Disorder and that it did not appear that
his mood symptoms and psychosis were responding to
his current medication regimen. She diagnosed Bipolar
Disorder with psychotic features and again noted the
need to rule out ETOH abuse and a learning disability.
Dr. Powell’s notes for that day do not mention
Campbell’s use of alcohol. Campbell remained a 45-50
on the GAF Scale.
The next month, on August 16, 2005, Campbell admitted
to Dr. Powell that he had used alcohol once to assist
with his symptoms. He stated his mood had not been
good. He reported that he had been without medication
for two weeks and his symptoms had worsened. Dr.
Powell’s diagnosis was Bipolar Disorder with psychotic
features and she noted the need to rule out ETOH
abuse, learning disability, and narcissistic personality
disorder. She encouraged abstinence from alcohol.
In mid-September, Campbell was seen at the CMHC and
reported increased symptoms with sleep disturbance,
hallucinations, lack of energy, and anxiety. He denied use
of alcohol. His medication regime was changed.
Two weeks later, on September 28, Campbell saw
Dr. Powell. He reported some improvement, but con-
tinued to have difficulty sleeping and auditory hallucina-
tions. He denied alcohol use. The diagnosis was the
same as the month before. Dr. Powell noted some im-
10 No. 10-1314
provement, but indicated that Campbell remained symp-
tomatic. She changed his medications and recommended
continued abstinence from alcohol. Campbell’s GAF
score was 45-50.
On October 4, 2005, Dr. Powell signed off on a medical
evaluation form for Campbell, noting a diagnosis of
Bipolar Disorder with psychotic features and the need to
rule out ETOH abuse. She reported that his speech was
slow, his mood was bad, his affect was flat, and he
was positive for paranoia and auditory hallucinations.
Dr. Powell noted that Campbell suffered from depres-
sion with sleep disturbance, crying spells, appetite dis-
turbance, and passive death wishes. She indicated that
he had extreme limitations in activities of daily living;
social functioning; and concentration, persistence, and
pace; and had experienced one episode of decompensation
in the last twelve months.
Dr. Powell saw Campbell again on October 26, 2005.
He reported compliance with his medications, yet contin-
ued to have sleep difficulties, auditory hallucinations,
and depression. Dr. Powell’s treatment note does not
mention alcohol use. Her assessment remained essen-
tially the same and she recommended continued absti-
nence. Campbell’s GAF rating was again 45-50.
At his following appointment on November 23,
Campbell was not very cooperative. His mood was
“not good.” He reported continued sleep disturbance.
Dr. Powell noted that Campbell continued to have depres-
sive symptoms but was resistant to change. His affect
was sad. His speech, thought process, and thought
No. 10-1314 11
content were within normal limits, and his judgment and
insight were fair.
Dr. Powell’s treatment note for December 21, 2005,
indicates that Campbell’s affect was sad, his thought
process remained circumstantial (which we under-
stand to mean that his speech revealed “excessive atten-
tion to irrelevant and digressive details,” Merriam-
Webster, MedlinePlus, http://www.merriam-webster.com/
medlineplus/circumstantiality (last visited Dec. 1, 2010)),
and he felt paranoid. Campbell was cooperative in his
interaction with Dr. Powell. His motor activity was within
normal limits. His judgment and insight were fair.
Dr. Powell noted that Campbell appeared to have symp-
toms consistent with post traumatic stress disorder.
She did not mention any ongoing alcohol use. She
changed his medications, tapering Paxil and starting a
trial of Zoloft.
On December 22, 2005, Dr. Powell signed off on an
Adult Mental Health Assessment form that appears to
have been completed on September 14, 2005. The
form noted that Campbell had daily anxiety, some com-
pulsive behavior, daily agitation and irritation, auditory
hallucinations (nightly), decreased appetite and sleep,
and mildly impaired concentration. Campbell was co-
operative and his motor activity was normal. Upon
examination, Dr. Powell noted a flat affect, but
Campbell’s speech, thought process, thought content,
and attention were within normal limits. His memory,
judgment, and insight were considered good. His intelli-
gence was estimated as average. The assessment rated
12 No. 10-1314
Campbell 50 on the GAF Scale, continuing to reflect
serious symptoms or serious impairment in functioning.
See DSMV-IV-TR 34.
ALJ Denise McDuffie Martin held a hearing on Jan-
uary 25, 2006. Psychiatrist Robert W. Marquis testified
as a medical expert. Based on his review of the file,
Dr. Marquis stated that Campbell has a history of cocaine
abuse and dependence and was “currently using alco-
hol.” Dr. Marquis acknowledged that Campbell’s
treating psychiatrist described him as depressed, but
when questioned about the diagnosis of Bipolar
Disorder, Dr. Marquis responded that he had not
seen that in the records. The medical expert opined
that Campbell had a moderate impairment in activi-
ties of daily living; a mild to moderate impairment in
socialization; a moderate impairment in attention, con-
centration, and pace; and no decompensation. He opined
that Campbell was capable of simple, routine, repetitive
work. These opinions were made without consideration
of Dr. Powell’s February 22, 2005 assessment of Camp-
bell’s residual functional capacity. Dr. Marquis did not
receive that assessment until the morning of the hearing
and had not yet reviewed it. After he had an oppor-
tunity to review Dr. Powell’s assessment, Dr. Marquis
explained why his opinion of Campbell’s functional
capacity differed from Dr. Powell’s. He relied on
Dr. Mason’s March 13, 2004, consultative examination
which he thought was more consistent with Campbell’s
history of substance abuse treatment and hospitalizations.
Dr. Marquis stated that Campbell was “drinking cur-
rently.” He identified Dr. Powell’s treatment note for
No. 10-1314 13
October 19, 2004, which stated that Campbell “[r]eports
using ETOH on a daily basis and states it helps to
calm him,” for support. He added that there were
several notes to that effect in the record. Dr. Marquis
testified that Campbell’s psychotic features could flow
from daily drinking and that alcohol withdrawal can
cause hallucinations. Dr. Marquis stated that he could
not give an opinion about Campbell’s limitations in the
absence of drinking; he did not see a period of clear
sobriety and could not say whether Campbell would be
any better without the use of alcohol.
Campbell testified at the hearing that he had not had
a drink in six or seven months and “hadn’t really drank
before that.” He claimed that at no point since April 2004
had he been drinking every day.
On August 24, 2006, the ALJ issued her decision,
finding Campbell not disabled. In reaching that deci-
sion, the ALJ discounted Dr. Powell’s assessment of
Campbell’s mental functional limitations and found the
opinions of Dr. Marquis and the state agency medical
consultants more informed and consistent with the
record. The Appeals Council denied review. Campbell
sought judicial review in the district court, and the
court affirmed.
II. Discussion
We will uphold the Commissioner’s decision if it
applies the correct legal standard and is supported by
substantial evidence. Castile v. Astrue, 617 F.3d 923, 926
14 No. 10-1314
(7th Cir. 2010). Substantial evidence is “ ‘such relevant
evidence as a reasonable mind might accept as adequate
to support a conclusion.’ ” Id. (quoting Skinner v. Astrue,
478 F.3d 836, 841 (7th Cir. 2007)). A decision denying
benefits need not discuss every piece of evidence, but if
it lacks an adequate discussion of the issues, it will be
remanded. Villano v. Astrue, 556 F.3d 558, 562 (7th Cir.
2009). Our review is limited to the reasons articulated
by the ALJ in her decision. Larson v. Astrue, 615 F.3d
744, 749 (7th Cir. 2010).
Campbell asserts that the Commissioner’s decision
is not supported by substantial evidence. He argues
that the ALJ erred in deciding to discount Dr. Powell’s
assessment of his functional limitations and by failing to
apply the factors enumerated in 20 C.F.R. §§ 404.1527(d)
(disability insurance) and 416.927(d) (supplemental
security income) in deciding what weight to give that
assessment. We agree that the ALJ’s consideration of
Dr. Powell’s assessment is insufficient.
“A treating physician’s opinion is entitled to ‘controlling
weight’ if it is ‘well-supported by medically acceptable
clinical and laboratory diagnostic techniques and is not
inconsistent with other substantial evidence.’ ” Larson,
615 F.3d at 749 (quoting 20 C.F.R. § 404.1527(d)(2)).
An ALJ “must offer ‘good reasons’ ” for discounting
a treating physician’s opinion. Id. (citing 20 C.F.R.
§ 404.1527(d)(2)). The ALJ gave two reasons for not
giving controlling or great weight to Dr. Powell’s assess-
ment of Campbell’s functional limitations: the absence
of significant abnormal findings at the time of the Decem-
No. 10-1314 15
ber 2005 evaluation and the failure to investigate the
possible effect of alcohol on Campbell’s functioning.
Neither of these qualifies as a “good reason.”
An ALJ may not selectively discuss portions of a physi-
cian’s report that support a finding of non-disability
while ignoring other portions that suggest a disability.
Myles v. Astrue, 582 F.3d 672, 678 (7th Cir. 2009). The
ALJ failed to evaluate the entirety of the mental health
assessment reviewed by Dr. Powell on December 22,
2005. The ALJ focused her attention on section “V.
Mental Status,” instead of considering the six-page
report as a whole. The ALJ correctly noted that Camp-
bell’s mental status examination was within normal
limits but for a flat affect. But the ALJ ignored the sec-
tions for “Presenting Problem/Precipitants,” “Diagnostic
Formulation,” and “Diagnostic Impression” that sug-
gest greater mental limitations. The assessment relates
Campbell’s self-reported symptoms: daily anxiety, compul-
sions, daily agitation, daily irritation, and auditory hal-
lucinations that keep him up nightly. In the “Diagnostic
Formulation” section, it was noted that Campbell
reported continued symptoms of depression, including
anxiety, agitation, decreased appetite and sleep, and
poor concentration. In addition, the mental health
provider also reached his or her own conclusions about
Campbell’s mental condition. These are noted under
Diagnostic Impression as a mood disorder and a rating
of 50 on the GAF Scale, reflecting serious symptoms or
any serious impairment in functioning, for example,
being unable to keep a job. See DSMV-IV-TR 34. A GAF
rating of 50 does not represent functioning within
16 No. 10-1314
normal limits. Nor does it support a conclusion that
Campbell was mentally capable of sustaining work.
Furthermore, although Dr. Powell signed off on the
mental health assessment on December 22, 2005, it
appears the assessment was created by another mental
health provider on September 14, 2005. Dr. Powell’s
most contemporaneous treatment notes were dated
December 21, 2005. Yet the ALJ’s decision does not men-
tion them.
The Commissioner suggests that Campbell had more
significant symptoms in July 2005. At that time, his affect
was flat, his thought process was tangential, he was
paranoid or suspicious, and he reported auditory halluci-
nations. But Dr. Powell’s December 21 treatment notes
contain similar findings: Campbell’s affect was sad, his
thought process was circumstantial, and he was paranoid
or suspicious. The treatment notes show that Dr. Powell
even changed Campbell’s medications, presumably
because his current regime was not achieving the desired
result. The Commissioner suggests that Dr. Powell’s
findings from the December 21 examination were incon-
sistent with the December 22 assessment and that the
ALJ resolved that inconsistency. In doing so, the Com-
missioner advances a ground on which the ALJ did not
rely, in violation of the Chenery doctrine, see SEC v.
Chenery Corp., 318 U.S. 80, 87-88 (1943). See, e.g., Larson,
615 F.3d at 749. Neither the December 21 treatment notes
nor Dr. Powell’s other treatment notes reflect much
improvement in Campbell’s mental functional capacity.
Dr. Powell’s observations and conclusions remained
No. 10-1314 17
essentially consistent throughout the course of her treat-
ment of Campbell.
The other reason the ALJ declined to give controlling
or great weight to Dr. Powell’s assessment of Campbell’s
mental limitations was her failure to investigate the
possible effect of alcohol on his functioning. Campbell
had reported to Dr. Powell that he was using alcohol in
October 2004 and January 2005. Dr. Powell’s treatment
notes from February 17, 2005, suggested that alcohol
use may have been contributing to Campbell’s presenta-
tion that day. But her notes for February, March, and
April 2005, indicate a decline in his alcohol use that
continued through August 2005, when he reported
using alcohol only once in the prior month. The notes of
Campbell’s alcohol use are consistent with Dr. Powell’s
recommendations first of abstinence and then, be-
ginning in September 2005, continued abstinence. The
change in recommendation suggests that Dr. Powell
believed Campbell was abstaining from alcohol use.
Her earlier notes had indicated the need to rule out
alcohol abuse, but as of November 2005, she no
longer made that notation. This suggests that she had
ruled out alcohol abuse, concluding that it was no
longer a factor in Campbell’s mental health.
However, Campbell’s symptoms persisted, which
suggests that something other than alcohol use was
the cause. And in Dr. Powell’s opinion, Campbell’s
GAF rating never got higher than 50, reflecting con-
tinued serious symptoms or serious impairment in func-
tioning. Dr. Powell’s records do not reflect that she made
18 No. 10-1314
any effort to corroborate Campbell’s self-report of de-
creased and discontinued alcohol use. Nonetheless,
Dr. Powell apparently believed Campbell; her Septem-
ber 2005 note states that he denied using alcohol and
indicated “continued abstinence encouraged.” The ALJ
did not identify any reason why Dr. Powell’s assessment
of Campbell’s self-report was wrong. Nor did the ALJ
analyze Campbell’s credibility with respect to his state-
ments at the hearing that he had not had a drink in
several (six or seven) months. Although the record does
not explicitly show that Dr. Powell investigated the
possible effect of alcohol on Campbell’s functioning,
it does support a finding that she had concluded that
Campbell was abstaining from alcohol. (Of course, if
Campbell was abstaining, alcohol use would not be a
factor in his functioning.)
Even if an ALJ gives good reasons for not giving con-
trolling weight to a treating physician’s opinion, she has
to decide what weight to give that opinion. Larson, 615
F.3d at 751 (citing 20 C.F.R. § 404.1527(d)(2)). The ap-
plicable regulations guide that decision by identifying
several factors that an ALJ must consider: “the length,
nature, and extent of the treatment relationship;
frequency of examination; the physician’s specialty; the
types of tests performed; and the consistency and support
for the physician’s opinion.” Id.; see also 20 C.F.R.
§§ 404.1527(d)(2), 404.927(d)(2). Our opinion in Larson
criticized the ALJ’s decision which “said nothing
regarding this required checklist of factors.” Id.; see also
Bauer v. Astrue, 532 F.3d 606, 608 (7th Cir. 2008) (stating
that when the treating physician’s opinion is not given
controlling weight “the checklist comes into play”). Here,
No. 10-1314 19
the ALJ’s decision indicates that she considered opinion
evidence in accordance with §§ 404.1527 and 416.927.
However, the decision does not explicitly address the
checklist of factors as applied to the medical opinion
evidence. And several of the factors support the con-
clusion that Dr. Powell’s opinion should be given great
weight: Dr. Powell treated Campbell for fifteen months;
she treated him on a monthly basis; she is a psychiatrist;
and her findings remained relatively consistent through-
out the course of her treatment. Proper consideration
of these factors may have caused the ALJ to accord
greater weight to Dr. Powell’s opinion.
The ALJ instead relied on the opinion of the non-ex-
amining medical expert whose testimony showed an
unfamiliarity with Campbell’s current condition. For
example, Dr. Marquis missed Dr. Powell’s repeated
diagnoses of Bipolar Disorder with psychotic features.
Dr. Marquis also misread Dr. Powell’s notes as
indicating that Campbell was still drinking on a daily
basis. Only the October 19, 2004 treatment notes
mention daily drinking. And apparently, Dr. Marquis
missed the repeated references in Dr. Powell’s notes
to recommend or encourage “continued abstinence.”
Another problem with Dr. Marquis’s opinion: he
did not believe that Campbell had a “period of clear
sobriety” by which to assess his functioning without
alcohol use. Nothing in the record supports that view.
To the contrary, the record indicates that Campbell
had been sober for several months. Dr. Marquis’s mis-
reading of the record and his unsupported belief that
Campbell was drinking alcohol daily undermines our
confidence in his opinion.
20 No. 10-1314
The ALJ also relied on the opinions of the state agency
psychiatrist and psychologist, but they had reviewed
only part of Campbell’s psychiatric treatment records.
They did not have the benefit of reviewing Dr. Powell’s
treatment records—the records did not exist at the time.
It seems that the mental health treatment records over
a fifteen-month period, including the diagnoses of
Major Depressive Disorder with psychotic features and
Bipolar Disorder with psychotic features and a con-
sistent GAF rating of 45-50 and never greater than 50,
would affect the state agency reviewers’ assessment of
Campbell’s mental functional capacity. Although an
ALJ may give weight to consultative opinions, here, the
ALJ did not adequately explain why the reviewers’ opin-
ions were entitled to greater weight than those of
treating psychiatrist Dr. Powell.
III. Conclusion
The district court’s denial of relief is R EVERSED and this
case is R EMANDED with instructions to return the matter
to the Social Security Administration for further pro-
ceedings consistent with this opinion.
12-6-10