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Crump v. Saul

United States Court of Appeals, Seventh Circuit

July 31, 2019

Tara L. Crump, Plaintiff-Appellant,
Andrew M. Saul, Commissioner of Social Security, Defendant-Appellee.

          Argued July 9, 2019

          Appeal from the United States District Court for the Northern District of Indiana, South Bend Division. No. 3:17-cv-557 - Philip P. Simon, Judge.

          Before Kanne, Hamilton, and Scudder, Circuit Judges.

          Scudder, Circuit Judge.

         Tara 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 Security Administration.


         Tara 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).)

         Crump's 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.

         Crump 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.

         Dr. 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 relationships."

         During 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.

         Crump 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."

         Crump 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."

         After 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 ...

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