Tara L. Crump, Plaintiff-Appellant,
Andrew M. Saul, Commissioner of Social Security, Defendant-Appellee.
July 9, 2019
from the United States District Court for the Northern
District of Indiana, South Bend Division. No. 3:17-cv-557 -
Philip P. Simon, Judge.
Kanne, Hamilton, and Scudder, Circuit Judges.
Scudder, Circuit Judge.
Crump applied for disability benefits based on numerous
mental health impairments, including bipolar disorder and
polysubstance abuse disorder. An administrative law judge
denied benefits, finding that Crump, despite her severe
impairments, could perform work limited to simple and
repetitive tasks. The district court affirmed. Because the
ALJ did not adequately account for Crump's difficulties
with concentration, persistence, or pace in the workplace, we
vacate the judgment and remand the case to the Social
Crump has a long history of mental health impairments. In
2010, she underwent hospitalization for mood swings and the
following year was diagnosed with bipolar disorder. In 2012,
after Crump reportedly experienced a mental breakdown, a
psychiatrist assessed her Global Assessment of Function
range, a measure of social functionality, at 51-60, or
"moderate" impairment of overall functioning. See
Am. Psychiatric Ass'n, Diagnostic and Statistical Manual
of Mental Disorders 34 (4th ed. 1994). (The GAF scale
"no longer is widely used," but when Crump applied
for benefits, the Social Security Administration sometimes
considered the scores. See Winsted v. Berryhill, 923
F.3d 472, 474 n.1 (7th Cir. 2019).)
symptoms continued into 2013, when a nurse practitioner
recorded her "pressured speech, flight of ideas, poor
insight, poor judgment," tangential thoughts, insomnia,
and "difficulty with focus and attention," and
assigned Crump an even lower GAF range of 41-50, signaling
"serious" impairment. See DSM IV at 34. Crump's
symptoms escalated later the same year when her family
brought her to the emergency room for "hostile" and
"aggressive" behavior. This episode led to a
diagnosis of acute psychosis, with Crump having experienced
hallucinations, bizarre behavior, disorganized speech,
insomnia, attention impairment, and decreased concentration.
Crump's behavior was so severe that the hospital obtained
a court order to extend her stay beyond 72 hours and medicate
her involuntarily. After three weeks of inpatient treatment,
the hospital discharged Crump to outpatient care.
then began a course of treatment with psychiatrist Sajja
Babu, whose observations form a large part of the medical
record that Crump relies upon in her application for
disability benefits. Dr. Babu noted from their first
appointment that Crump spoke too fast, had pressured speech,
and rapidly changed conversation topics-observing that she
was "somewhat irrational and unrealistic" and
"not able to focus well." Dr. Babu assessed Crump
with a GAF score of 40, signaling "severely"
impaired functioning. See DSM IV at 34. Crump's GAF
scores over the next two years ranged from "severe"
to "moderate." See id.
Babu's treatment notes during this time reflected mixed
observations on Crump's behavior. On the one hand, Dr.
Babu consistently observed that Crump was "[a]ble to pay
attention and concentrate" during her office visits. On
the other hand, Dr. Babu regularly noted that Crump suffered
from "hyperactivity, irritability, grandiosity, racing
thoughts as well as thoughts of helplessness and hopelessness
with crying spells and anger outbursts" as a result of
her bipolar disorder. These conditions and experiences
combined, Dr. Babu concluded, to leave Crump with an
inability to "follow through with tasks, anticipate
consequences of her decisions, interact appropriately with
others as well as establish and maintain interpersonal
this same period, from 2013 to 2015, Crump experienced other
setbacks. In 2013, for example, she was arrested for
fighting. Unable to support herself, Crump became homeless in
2014 and moved into a shelter. And in 2015 she was arrested
for shoplifting. Dr. Babu attributed each of these downturns
to Crump's ongoing struggles with mental illness.
applied for disability benefits in January 2014, claiming an
onset date of March 2012, which triggered a series of
additional assessments. In March 2014, Crump saw psychologist
Joyce Scully for a consultative examination. Dr. Scully
confirmed Crump's diagnosis of bipolar disorder with
psychosis, but also noted that she was "attentive,
persistent and focused" during the examination.
State-agency consultants separately assessed Crump's
ability to carry out short and simple instructions as
"not significantly limited," but they scored her
ability to maintain attention and concentration for extended
periods as "moderately limited."
continued seeing Dr. Babu throughout 2014 and 2015. In
September 2015, Dr. Babu prepared an assessment of
Crump's ability to work and sustain employment. He
concluded that Crump had "no useful ability to
function" in following work rules, managing stress,
maintaining attention or concentration, or fulfilling job
instructions. Dr. Babu likewise found not only that
Crump's "bipolar symptoms interfere with her
engaging in any type of work activity," but also that
her related chronic emotional impairments "diminish her
ability to follow through with tasks, anticipate the
consequences of her decisions [and] interact appropriately
with others as well as retain and process information."
Crump's initial application for disability benefits was
denied, an administrative law judge held a hearing in
February 2016. For her part, Crump testified that she has
"too many thoughts at one time" and "can't
focus" on what she is supposed to be doing. As part of
determining Crump's capacity to work, the ALJ put two
hypothetical questions to a vocational expert. The first
focused on whether work was available for someone limited to
"simple, routine, repetitive tasks" with few
workplace changes. The VE replied yes. The ALJ then posed the
same hypothetical with a critical distinction-whether work
would be available if the person would either be
off-task 20% of the time or ...