In the
United States Court of Appeals
For the Seventh Circuit
No. 09-3064
P ATRICIA P UNZIO ,
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. 08 C 3179—John W. Darrah, Judge.
A RGUED M ARCH 30, 2010—D ECIDED JANUARY 21, 2011
Before P OSNER, R OVNER, and T INDER, Circuit Judges.
R OVNER, Circuit Judge. Patricia Punzio has suffered
from mental illness for most of her adult life, but an
administrative law judge rejected her application for
disability benefits on the ground that her treating psy-
chiatrist’s opinion about her mental limitations con-
flicts with the other medical evidence. To the contrary,
however, the treating psychiatrist’s opinion is well sup-
2 No. 09-3064
ported not only by her own observations of Punzio
but also by the record as a whole. And because a
vocational expert confirmed that the mental limitations
identified by the psychiatrist would preclude Punzio
from working at any job, the only possible outcome
was a finding that she is disabled. We reverse the
district court’s judgment in favor of the Commissioner
of Social Security and remand the case to the agency for
an award of benefits.
I.
By any measure Punzio has led a difficult life. Her
parents were alcoholics who treated her harshly. In the
fifth grade she was sexually assaulted by her friend’s
grandfather and afterward attempted suicide. When
she was in the sixth grade she started sneaking alcohol.
In the classroom her progress was derailed by dyslexia,
but her mother, afraid of the stigma, refused to let
her be placed in a special-education program. Punzio
dropped out of school after completing the eighth grade,
although at some point she earned a GED. She drank
heavily as a young adult until, at the age of 26, she
stopped abusing alcohol after joining Alcoholics Anony-
mous, where she developed her most meaningful rela-
tionships. Still she possessed few marketable skills and
had difficulty holding down a job. Her longest tenure
was the four years she worked as a school custodian
between 1994 and 1998.
Punzio’s medical records pick up in April 1998 when,
at the age of 40, she checked herself into a psychiatric
No. 09-3064 3
facility in Illinois. She had struggled with depression her
whole life, she told her treating doctor, and recently
had been seeing a counselor at the YWCA. When she
arrived at the facility she already was taking the antide-
pressant Prozac and the mood stabilizer Depakote. But
still her mental illness was unbearable, she said, and
now she was afraid she might harm herself. She felt
increasingly hopeless, she explained, and thought that
perhaps she was “supposed to be dead.” At first she made
little progress, and during therapy sessions she was
withdrawn and disclosed little about her feelings. Within
a week, however, her suicidal thoughts subsided. Her
doctors diagnosed her with major depression and, after
determining that she was no longer a danger to herself,
decided to transition her into a partial-hospitalization
program, which would allow her to continue receiving
intensive treatment during the day while spending the
night at her home. They kept her on Depakote but
switched her antidepressant to Effexor.
Over the next three weeks, Punzio participated in
individual and group therapy sessions at the psychiatric
facility. Her doctors observed that she appeared de-
pressed and lethargic, but they also complimented her
on her coherence and insight. She shared more details
about the origins of her depression, explaining that her
parents made her feel inadequate as a child and that
now she worried about being a good mother to her son,
who was then 11 years old and living with his father
because Punzio was too depressed to take care of him.
During this time a friend in Maryland offered Punzio
a job and a place to stay, and she decided to take ad-
vantage of the opportunity to make a fresh start. Her
4 No. 09-3064
doctors approved and told her that her prognosis was
good so long as she continued taking her medications
and sought follow-up treatment in Maryland.
Yet within two months Punzio had returned to Illinois,
still crippled by her depression. In July 1998 she was
jointly evaluated by a psychiatrist and a social worker
on behalf of the DuPage County Health Department.
Her medications were ineffective, she told them, and
she felt hopeless and worthless and as a result was
unable to concentrate or sleep through the night. Nor
could she ride her bike, go dancing, or take part in any
of the other social activities that she used to enjoy.
Instead she found herself overeating and had gained
50 pounds in recent months. Her evaluators opined that
she was extremely depressed and probably bipolar. They
increased her dosage of Effexor and arranged for her
to receive counseling. In the months that followed,
Punzio met with a therapist and worked with a psychia-
trist to calibrate her dosage of Effexor. In February 1999,
however, she quit taking her medications after con-
cluding that the drugs were hindering her concentration
and making her drowsy. But she continued to see a thera-
pist at the YWCA on a weekly basis through August 2001.
Meanwhile, Punzio also was seeking treatment for
additional ailments. In November 1998 an educational
therapist diagnosed her with dyslexia and recommended
that she undergo further testing for attention-deficit
disorder. The therapist observed a number of dyslexic
behaviors, like confusing vowels, reading syllables out
of sequence, and omitting the last syllable of some words.
No. 09-3064 5
The therapist concluded that, although Punzio was intel-
ligent, her potential had been impeded by her learning
disability and emotional instability. When Punzio was
tested for attention deficit disorder, however, the ex-
amining neurologist was unable to provide a conclusive
diagnosis, explaining that the symptoms of attention-
deficit disorder mimic the symptoms of depression. On
top of it all, in October 2001 Punzio was diagnosed
with advanced carpal-tunnel syndrome in both hands,
and a few months later she had surgery to relieve the
pressure on her nerves.
Throughout this time Punzio continued to struggle
with her mental illness. For a few months at the end of
2002 she saw a licensed clinical professional counselor,
who recommended that she consult a psychiatrist to
resume her medications. The psychiatrist suggested
the mood stabilizer Lamictal, but Punzio said she was
wary of taking any medication because of a bad ex-
perience in the past; after doing some research, however,
she agreed to give Lamictal a try, gradually increasing
her dosage each week. A few weeks later the psychiatrist
supplemented the regimen with Adderall to improve
Punzio’s memory and concentration. By the beginning
of 2003, she told her counselor that both medications
seemed to be working and that she felt “encouraged” about
her progress. But soon thereafter Punzio lost her in-
surance and was unable to continue her appointments.
In July 2003 Punzio returned to the DuPage County
Health Department to consult a psychiatrist. Initially
her psychiatrist diagnosed her with bipolar disorder and
6 No. 09-3064
prescribed the antidepressant Wellbutrin. By August
Punzio reported that she was feeling better than she
had felt in years. She felt depressed only during tough
encounters with her family, she told her psychiatrist, and
at worst her symptoms lingered for only a few hours.
Her psychiatrist cautioned, however, that Punzio would
need to take her medications for the rest of her life. Indeed
in October, when Punzio missed an appointment and
ran out of her medications, her progress rapidly re-
gressed. Even so, after going back on Adderall, Lamictal,
and Wellbutrin, she showed improvement.
For at least four more years, Punzio continued to
consult psychiatrists at the DuPage County Health De-
partment, usually monthly. She did show some progress.
Her drug regimen was stable, and she told one assigned
doctor that she was active and able to function at
home and in the community. But the severity of her
symptoms continued to wax and wane with the changing
seasons. During the fall, she said, she consistently be-
came more depressed and unmotivated, although never
to the point of feeling hopeless or suicidal. And there
were more missed appointments and lapses in medica-
tions, which predictably worsened her condition. During
the summer of 2004, Punzio was overwhelmed with
worries about her son, by then a teenager, who had
attempted suicide a few months earlier and had just
been released from a rehabilitation center. To quell
Punzio’s anxiety, a psychiatrist at the county health
department prescribed Buspar. The drug seemed to
help, although the psychiatrist had to increase the
dosage when Punzio reported that she still felt quite
No. 09-3064 7
nervous around crowds and sometimes felt daunted
even by simple tasks like going to the store. In 2005 she
occasionally suffered mood swings triggered by her
inability to hold a job, but thanks to her medications
these ups-and-downs were less severe than what she
had experienced in the past. Yet she still experienced
continuous frustration dealing with the limitations im-
posed by her dyslexia, as well as chronic problems with
memory. In April 2006, for example, the county psychia-
trist then managing her care observed that Punzio felt
depressed because of her “cognitive deficits in areas of
comprehension, retention of information, short-term
memory, and dyslexia, which leads to spending an ex-
cessive amount of time on completing tasks.”
In addition, from October 2005 until October 2006
Punzio returned to the YWCA and received weekly
counseling. Her therapist attributed Punzio’s psycho-
logical problems to the trauma she had experienced
throughout her life. The therapist tried to help Punzio
cope with those scars by exploring and understanding
her past. The treatment notes reveal that Punzio spent
much time discussing dysfunction in her family
growing up. She also talked about developing healthy
relationships and examined her feelings of guilt and
anger. But the therapist lamented that poor memory and
difficulty focusing were significantly impeding Punzio’s
progress, despite her impressive self-awareness and
commitment to healing. The therapist concluded that
Punzio’s mental illness would prohibit her from
holding down a job.
8 No. 09-3064
Punzio applied for disability benefits in April 2005,
alleging an onset date of June 1997. After her applica-
tion had been denied on initial review and on reconsidera-
tion, Punzio requested a hearing. She appeared before
an administrative law judge in May 2007 and testified
that she is unable to work. Although her mental condi-
tion has improved since she was hospitalized in 1998,
she explained, there still are days when she does not
want to leave her house, especially if she must confront
a stressful social situation or will encounter a crowd of
people. If forced to face these fears, Punzio said, she
develops trouble breathing and feels like she is going
to have an anxiety attack. (Indeed, testifying at the
hearing seemed to push Punzio to the brink; the ALJ
remarked that she was in tears throughout most of the
session.) In addition, Punzio said, her depression is fed
by her dyslexia and poor memory. She is unable to re-
member the opening paragraphs of a short letter by the
time she finishes, she said, and usually she cannot even
decipher her own writing because of the misplaced
letters and phonetic spelling. She mixes up numbers too,
especially telephone numbers. During the day, Punzio
continued, she spends most of her time at home except
when attending AA meetings, which she has done regu-
larly during her 22 years of sobriety. Often she fiddles
with her computer but has difficulty staying on task. She
does little cleaning, she admitted, in part because she
lacks motivation. And she does not often shop for
groceries because she is averse to appearing in public and
overwhelmed by the cornucopia of choices. Sometimes
she drives short distances, but she has trouble finding
her away around town and remembering directions.
No. 09-3064 9
The ALJ asked a vocational expert whether Punzio
would be employable if her residual functional capacity
restricts her to one-step or two-step processes without
public contact or keyboarding but she can lift 10 pounds
frequently and 20 pounds occasionally and sit or stand
for six hours in a typical workday. The vocational
expert replied that, with that residual functional
capacity, Punzio could return to her past relevant work
as a school custodian, which the vocational expert classi-
fied as light, unskilled work. In addition, the voca-
tional expert continued, a person with this residual func-
tional capacity would be able to do assembly and
packing work in a factory. Punzio’s lawyer asked the
vocational expert whether her client could perform her
past relevant work if, in addition to the limitations listed
by the ALJ, she also has moderate restrictions in her
abilities to stay on task and to understand and remember
short instructions and was likely to miss work at least
three days a month. The lawyer defined the term “moder-
ate restriction” to mean an inability to perform the skill
in question between 20 percent and 30 percent of the
time. The vocational expert acknowledged that any one
of these moderate restrictions would be “well beyond”
what is tolerated for unskilled laborers. In fact, he said,
there are no jobs in the national economy available to
a person with these limitations.
Throughout the hearing the ALJ commented on gaps
in Punzio’s medical history and admonished her lawyer
to supplement the record. In particular the ALJ ex-
pressed skepticism that the medical evidence sup-
ported the moderate restrictions that the lawyer had
10 No. 09-3064
identified to the vocational expert. The lawyer prom-
ised to submit additional evidence to demonstrate
Punzio’s functional limitations and accordingly solicited
an opinion about Punzio’s mental residual functional
capacity from Samar Mahmood, who was then her
treating psychiatrist at the DuPage County Health De-
partment. When Dr. Mahmood assessed Punzio in
July 2007, she had been treating her for about seven
months. Dr. Mahmood based her evaluation not only on
her own treatment notes but also on the observations
of colleagues who treated Punzio at the county health
department before she took over her care in Decem-
ber 2006. Dr. Mahmood reported that Punzio’s bipolar
disorder, depression, and attention-deficit disorder were
sapping her energy and had led to diminished interest
in almost all activities, difficulty thinking and concen-
trating, impaired memory, and persistent anxiety. As a
result, Dr. Mahmood opined, Punzio had been unable
since July 2003 to meet competitive standards in three
mental abilities necessary to perform unskilled work:
remembering work procedures, understanding and
remembering detailed instructions, and carrying out
detailed instructions. In addition Dr. Mahmood opined
that Punzio’s abilities to understand and remember
short instructions and to maintain attention for a two-
hour segment were seriously limited and less than satis-
factory. Finally Dr. Mahmood opined that Punzio’s
mental impairments would cause her to miss work at
least three days each month. When Punzio submitted
Dr. Mahmood’s evaluation to the ALJ, her lawyer
offered to modify the alleged onset date to July 2003.
No. 09-3064 11
The ALJ considered the new evidence but nevertheless
found that Punzio could return to her job as a school
custodian and accordingly denied her application for
benefits. At step two the ALJ found that Punzio suffers
from bipolar disorder and carpal-tunnel syndrome, both
impairments being severe. At step three, however, the
ALJ concluded that these impairments do not meet or
medically equal a listed impairment. The ALJ further
concluded that Punzio retains the functional capacity
to perform some light work, including her former job as
a school custodian. This conclusion coincides with the
limited restrictions included in the hypothetical the ALJ
framed for the vocational expert; the ALJ ignored the
vocational expert’s testimony that no job exists for
Punzio—that she is disabled—if Dr. Mahmood’s assess-
ment of her mental residual functional capacity is ac-
curate. The ALJ explained that he gave no weight to
Dr. Mahmood’s assessment because it had been
“solicited by claimant’s attorney with the purpose of
assisting her in her pursuit of disability benefits” and, in
the ALJ’s view, was inconsistent with her earlier treat-
ment notes. The ALJ gave the same explanation for re-
jecting the YWCA therapist’s opinion that Punzio’s
mental illness precludes her from working. And in a
single sentence the ALJ rejected as “not entirely credi-
ble” Punzio’s testimony about the limitations caused by
her depression; her testimony, the ALJ offered, is not
supported by the “evidence of the record taken as a
whole.”
12 No. 09-3064
II.
Punzio raises a host of issues on appeal, among them
that the ALJ gave no explanation whatsoever for
finding her testimony not credible. On this point Punzio
is correct; to read the ALJ’s boilerplate credibility assess-
ment is enough to know that it is inadequate and not
supported by substantial evidence. That is reason
enough for us to reverse the judgment, see McClesky v.
Astrue, 606 F.3d 351, 352-53 (7th Cir. 2010); Genier v.
Astrue, 606 F.3d 46, 50 (2d Cir. 2010); Villano v. Astrue,
556 F.3d 558, 562-63 (7th Cir. 2009) (per curiam), al-
though another striking error of greater significance
compels us to soldier on: The ALJ erred in rejecting
Dr. Mahmood’s assessment of Punzio’s mental residual
functional capacity. That opinion, if credited, would
compel a finding that Punzio is disabled. Dr. Mahmood
opined that Punzio is sufficiently limited in her ability to
understand, remember, and carry out detailed instruc-
tions such that she is unable to meet competitive
standards for unskilled work. She also opined that
Punzio’s abilities to understand and remember short
instructions and to maintain attention for a two-hour
segment were seriously limited and less than satisfactory.
And she further opined that Punzio will miss at least
three days of work each month. No one contradicted
Dr. Mahmood. And the vocational expert testified that a
person with these limitations will not be able to find any
work in the national economy. See also Terry v. Astrue, 580
F.3d 471, 475 (7th Cir. 2009) (per curiam) (recounting
vocational expert’s testimony that claimant who is either
“off pace ten percent of the time” or “absent more than
No. 09-3064 13
two days per month” will not be able to perform
unskilled work).
An ALJ must give “controlling weight” to a treating
source’s opinion if it is “well-supported by medically
acceptable clinical and laboratory diagnostic techniques
and is not inconsistent with other substantial evidence.”
20 C.F.R. § 404.1527(d)(2); see also Schaaf v. Astrue, 602
F.3d 869, 875 (7th Cir. 2010) (per curiam); Poupore v.
Astrue, 566 F.3d 303, 307 (2d Cir. 2009) (per curiam);
Ketelboeter v. Astrue, 550 F.3d 620, 625 (7th Cir. 2008).
And whenever an ALJ does reject a treating source’s
opinion, a sound explanation must be given for that
decision. 20 C.F.R. § 404.1527(d)(2); Campbell v. Astrue,
No. 10-1314, 2010 WL 4923566, at *6 (7th Cir. Dec. 6,
2010); Cowan v. Astrue, 552 F.3d 1182, 1188 (10th Cir.
2008); Ryan v. Comm’r of Soc. Sec., 528 F.3d 1194, 1199
(9th Cir. 2008); Schmidt v. Astrue, 496 F.3d 833, 842 (7th
Cir. 2007). In Punzio’s case the ALJ did not cast doubt
on Dr. Mahmood’s diagnostic techniques; instead the
ALJ charged that Dr. Mahmood’s assessment of Punzio’s
mental residual functional capacity contradicted her
treatment notes and in any event could be cast aside
because Punzio’s lawyer had solicited the assessment.
Neither of these reasons is sound.
Far from being inconsistent with her treatment notes,
Dr. Mahmood’s assessment is amply supported not only
by her own experience with Punzio but also by the
medical records compiled by other treating sources
over many years. The ALJ cited two pieces of evidence
to support his contrary conclusion. When Dr. Mahmood
14 No. 09-3064
had seen Punzio in March 2007, she assigned her a GAF
score of 60; that rating, the ALJ concluded, was “inconsis-
tent with [her] current rating of claimant’s functioning,
with serious limitations noted in most areas.” But by
cherry-picking Dr. Mahmood’s file to locate a single
treatment note that purportedly undermines her overall
assessment of Punzio’s functional limitations, the ALJ
demonstrated a fundamental, but regrettably all-too-
common, misunderstanding of mental illness. See, e.g.,
Spiva v. Astrue, No. 10-2083, 2010 WL 4923563, at *1
(7th Cir. Dec. 6, 2010); Parker v. Astrue, 597 F.3d 920, 924-
25 (7th Cir. 2010); Pate-Fires v. Astrue, 564 F.3d 935, 944-
45 (8th Cir. 2009); Wilder v. Chater, 64 F.3d 335, 336-37
(7th Cir. 1995). As we have explained before, a person
who suffers from a mental illness will have better days
and worse days, so a snapshot of any single moment
says little about her overall condition. See Larson v.
Astrue, 615 F.3d 744, 751 (7th Cir. 2010); Wilson v. Astrue,
493 F.3d 965, 967-68 (8th Cir. 2007); Kangail v. Barnhart,
454 F.3d 627, 629 (7th Cir. 2006). The ALJ ought to have
analyzed whether Dr. Mahmood’s mental-residual-
functional-capacity questionnaire was consistent with
her treatment notes as a whole. Even if we accept the
March 2007 treatment note as evidence that Punzio
enjoys a few “good days,” that evidence still offers no
support for the ALJ’s finding that her mental illness
does not prevent her from holding a job. After all, the
vocational expert testified that no employer would hire
Punzio to perform unskilled work if her mental illness
limits her abilities even just 20 percent of the time—or
if she experiences as few as three “bad days” a month that
No. 09-3064 15
cause her to miss work. See Bauer v. Astrue, 532 F.3d 606,
609 (7th Cir. 2008); Watson v. Barnhart, 288 F.3d 212,
217-18 (5th Cir. 2002); Washington v. Shalala, 37 F.3d 1437,
1442-43 (10th Cir. 1994).
But in fact the ALJ’s error runs even deeper because
the March 2007 treatment note is not inconsistent with
the July 2007 assessment. A GAF score of 60 means that,
in March 2007, Punzio was either exhibiting moderate
symptoms of mental illness or experiencing moderate
difficulty in social, occupational, or school functioning.
See D IAGNOSTIC AND S TATISTICAL M ANUAL OF M ENTAL
D ISORDERS 34 (4th ed. 2000); see also Denton v. Astrue, 596
F.3d 419, 425 (7th Cir. 2010) (per curiam) (explaining that
GAF scores measure both severity of symptoms and
functional level but that the final score represents only
the worse of the two ratings). Dr. Mahmood em-
ployed a different scale, however, when she assessed
Punzio’s mental residual functional capacity in July 2007.
In evaluating Punzio’s mental abilities necessary to do
unskilled work, Dr. Mahmood was asked to assign one
of five predetermined ratings ranging from “unlimited
or very good” to “no useful ability to function.” She rated
almost all Punzio’s abilities in the middle category,
“seriously limited, but not precluded,” which, the ques-
tionnaire elaborates, means that in these areas Punzio’s
abilities are “less than satisfactory.” But remember that, at
Punzio’s hearing, her lawyer and the vocational expert
defined a moderate limitation to mean an inability to
perform to competitive standards between 20 percent
and 30 percent of the time—and that the vocational
expert explained that a moderate limitation would be
16 No. 09-3064
“well beyond what’s tolerated in unskilled work.” In other
words, Dr. Mahmood’s March 2007 assessment that
Punzio was moderately limited in occupational func-
tioning is not at odds with her July 2007 observation that,
in most of the abilities required to hold down an
unskilled job, Punzio’s performance would be “less than
satisfactory.”
The ALJ also reasoned that “the longitudinal record”
offers “no support” for Dr. Mahmood’s opinion in
July 2007 that Punzio’s mental limitations will cause
frequent absenteeism. But just three sentences earlier
the ALJ had written that Punzio “first saw Dr. Mahmood
at the Walk-In Clinic on December 1, 2006, after [she]
missed her appointment.” Indeed the psychiatric treat-
ment notes are replete with references to missed appoint-
ments. For example, two months before the missed ap-
pointment with Dr. Mahmood, Punzio had been a no-
show for an appointment with her previous psychiatrist
at the county health department. And she had missed
two additional appointments between November 2005
and February 2006, chalking it up to “forgetfulness
during the holiday season.” Even worse, between
July 2004 and October 2004 Punzio had missed two
more appointments, which caused her medications to
run out. As a result she tailspinned and was plagued
by low energy, low motivation, forgetfulness, and an
inability to concentrate. Punzio’s records from the
county health department show that her inability to keep
appointments is both a symptom of her mental illness
and an aggravating factor. Thus, Dr. Mahmood’s con-
No. 09-3064 17
clusion about her propensity for absenteeism is ade-
quately supported by her and her colleagues’ experiences.
And likewise the record adequately supports
Dr. Mahmood’s conclusion that Punzio is seriously
limited in her abilities to understand and remember
short instructions and to maintain attention for a two-
hour segment. In fact Punzio’s poor comprehension
skills appear to be part and parcel of her mental illness.
Recall that in November 1998 an educational therapist
diagnosed Punzio with dyslexia after observing her
confusing vowels, reading syllables out of sequence, and
omitting the last syllable of some words. Indeed the
educational therapist reasoned that Punzio’s dyslexia
was aggravated by her depression; more recently her
psychiatrists at the county health department reached
the same conclusion. Her therapist at the YWCA
remarked that Punzio’s poor memory and difficulty
focusing would hinder her ability to tackle her mental
illness. And then there is Punzio’s own testimony
about her difficulties staying on task and even remem-
bering what she had just read; going through these
ordeals made her even more depressed, she explained.
The ALJ declared this testimony “not entirely credible,”
but we have said already that this unexplained finding
is unsustainable. Rather than addressing Punzio’s com-
prehension skills directly, the ALJ instead surmised
that her condition has improved over the years, that she
no longer is suicidal, that her symptoms typically
persist for only a few hours, and that she is “managing
activities of daily living without significant difficulty.”
We have no way of knowing whether these observations
18 No. 09-3064
explain the ALJ’s adverse credibility finding, but we are
confident that each point is either unsupported or irrele-
vant. We cannot fathom how the ALJ determined that
Punzio experiences no significant difficulty in managing
activities of daily living. Certainly the ALJ cited no evi-
dence on this point. But even if he plucked the phrase
from one of Punzio’s treatment notes, her ability to strug-
gle through the activities of daily living does not mean
that she can manage the requirements of a modern work-
place. See Spiva, 2010 WL 4923563, at *5; Gentle v. Barnhart,
430 F.3d 865, 867 (7th Cir. 2005); Hawkins v. First Union
Corp. Long-Term Disability Plan, 326 F.3d 914, 918 (7th
Cir. 2003). In any event the ALJ’s assertion is at odds
with the medical evidence as a whole, which shows
constant bouts of anxiety wrought by even the simplest
social situations. And the fact that Punzio is no longer
suicidal and is not plagued by depression 24 hours a
day says little about her abilities to understand and
remember short instructions and to maintain attention
for a two-hour segment. See Holohan v. Massanari, 246
F.3d 1195, 1205 (9th Cir. 2001) (“That a person who
suffers from severe panic attacks, anxiety, and depression
makes some improvement does not mean that the
person’s impairments no longer seriously affect her
ability to function in a workplace.”). Concluding that the
claimant “is not a raving maniac who needs to be
locked up” is a far cry from concluding that she suffers
no limits on her ability to function. See Bauer, 532 F.3d
at 608-09.
As for the ALJ’s second reason for rejecting
Dr. Mahmood’s opinion (as well as the opinion of the
No. 09-3064 19
YWCA therapist), the fact that relevant evidence has
been solicited by the claimant or her representative is not
a sufficient justification to belittle or ignore that evi-
dence. See Moss v. Astrue, 555 F.3d 556, 560-61 (7th Cir.
2009) (per curiam); Reddick v. Chater, 157 F.3d 715, 726
(9th Cir. 1998). Quite the contrary, in fact. The claimant
bears the burden of submitting medical evidence estab-
lishing her impairments and her residual functional
capacity. 20 C.F.R. §§ 404.1512(a), (c), 404.1513(a), (b),
404.1545(a)(3). How else can she carry this burden
other than by asking her doctor to weigh in? Yet rather
than forcing the ALJ to wade through a morass of
medical records, why not ask the doctor to lay out in
plain language exactly what it is that the claimant’s
condition prevents her from doing? Indeed the regula-
tions endorse this focused inquiry. See id. § 404.1513(b)(6)
(requesting from claimant “a medical source statement
about what you can still do despite your impairment(s)”);
id. § 404.1545(a)(3) (“We will consider any statements
about what you can still do that have been provided
by medical sources . . . .”); see also id. (permitting claimant
to submit “descriptions and observations” about her
functional limitations from “family, neighbors, friends,
or other persons”). And in the “Best Practices” section of
its website, the Social Security Administration recognizes
the value of this approach by urging claimants and
their representatives to submit a doctor’s statement
that explicitly “identifies the limitations imposed by the
claimant’s impairments.” See Best Practices for Claimants’
Representatives, SOCIAL S ECURITY O NLINE, http://www.
socialsecurity.gov/appeals/best_practices.html (last visited
20 No. 09-3064
Dec. 21, 2010). Of course a treating source’s opinion can
be a mixed bag. On the one hand, the treating source
likely has spent more time with the claimant than any
other doctor and thus has a better understanding of her
condition. On the other hand, the treating source may
not be an expert on the claimant’s condition and, at
worst, may “bend over backwards to assist a patient in
obtaining benefits.” Hofslien v. Barnhart, 439 F.3d 375, 377
(7th Cir. 2006); see also Dixon v. Massanari, 270 F.3d 1171,
1177 (7th Cir. 2001); Stephens v. Heckler, 766 F.2d 284, 289
(7th Cir. 1985). But these are the very concerns that the
searching inquiry set forth in 20 C.F.R. § 404.1527(d)(2) is
designed to address. The ALJ’s examination whether
the treating source’s opinion is both well supported by
medically acceptable diagnostic techniques and consistent
with the other evidence in the record will weed out those
doctors who are either poorly versed in their patient’s
condition or unable to opine objectively. And if indeed
the treating source’s opinion passes muster under
§ 404.1527(d)(2), then “there is no basis on which the
administrative law judge, who is not a physician, could
refuse to accept it.” Hofslien, 439 F.3d at 376.
Dr. Mahmood’s assessment of Punzio’s mental residual
functional capacity is well supported and consistent with
the medical evidence, so it must carry the day. And
because the record does not contain a conflicting
opinion, we need not prolong these proceedings any
further. Given Dr. Mahmood’s assessment and the voca-
tional expert’s testimony that no jobs in the national
economy can be filled by a person with Punzio’s mental
limitations, the only possible outcome is a finding that
No. 09-3064 21
Punzio has been disabled since July 2003. See 42 U.S.C.
§ 405(g); Brownawell v. Comm’r of Soc. Sec., 554 F.3d 352,
357-58 (3d Cir. 2008); Briscoe ex rel. Taylor v. Barnhart, 425
F.3d 345, 355 (7th Cir. 2005); Benecke v. Barnhart, 379 F.3d
587, 594-96 (9th Cir. 2004). We reverse the district court’s
judgment in favor of the Commissioner and remand to
the agency for an award of benefits.
1-21-11