Angel D. Ramos v. KILOLO KIJAKAZI, Acting Commissioner of Social Security

United States Court of Appeals
For the Seventh Circuit
Chicago, Illinois 60604
Argued June 1, 2023
Decided July 17, 2023
Before
FRANK H. EASTERBROOK, Circuit Judge
DIANE P. WOOD, Circuit Judge
DORIS L. PRYOR, Circuit Judge
No. 22-2899
ANGEL D. RAMOS,
Plaintiff-Appellant,
v.
KILOLO KIJAKAZI, Acting
Commissioner of Social Security,
Defendant-Appellee.
Appeal from the United States District
Court for the Southern District of
Indiana, Indianapolis Division.
No. 1:21-cv-02331-TAB-JRS
Tim A. Baker,
Magistrate Judge.
O R D E R
Angel Ramos applied for disability benefits under the Social Security Act on May
15, 2018. Ramos alleged a disability onset date of May 9, 2018, after being hospitalized
for depression and suicidal ideation. At a hearing before an administrative law judge
(ALJ), Ramos introduced evidence of his history of obesity and several mental im-
pairments, including major depressive disorder, an attention deficit disorder, anxiety,
bipolar I disorder, and an intellectual disorder. The ALJ acknowledged these condi-
tions but nevertheless decided that Ramos could perform work that exists in signifi-
cant numbers in the national economy and thus was not disabled. The district court
NONPRECEDENTIAL DISPOSITION
To be cited only in accordance with Fed. R. App. P. 32.1

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(acting through a magistrate judge with the parties’ consent, see 28 U.S.C. § 636(c))
upheld the ALJ’s decision, and Ramos appealed. Because we conclude that the ALJ’s
decision is supported by substantial evidence, we affirm.
I
While living in Texas in 2018, Ramos was hospitalized twice—once in March and
once in May—for depression and suicidal ideation. He filed for disability benefits in
May, just before his second hospitalization. In August 2018, police officers were
called to his home because he was having an anger episode; he was arrested after he
allegedly spat in a police officer’s face. For much of 2018, Ramos received mental
health care at Tropical Texas Behavioral Health, where care providers noted several
disorders in his then-current diagnosis, including bipolar I disorder, attention-defi-
cit/hyperactivity disorder, unspecified anxiety disorder, and major depressive disor-
der. He stopped treatment at Tropical Texas in December 2018 because of a planned
move to Indiana. He has not been hospitalized since then.
In Indiana, while his application for disability benefits was pending, Ramos re-
started mental-health treatment in January 2020, this time with Community Health
Network Gallahue. In treatment, Ramos displayed both negative (i.e. healthy) and
positive (i.e. abnormal) clinical symptoms. For example, Ramos’s clinical nurse-spe-
cialist reported that Ramos was typically able to maintain his memory, understand-
ing, concentration, and communication in his sessions—all negative findings. In con-
trast, the clinical staff also reported that Ramos had an occasionally disheveled ap-
pearance, flat affect, passive suicidal ideation, tearfulness, and feelings of worthless-
ness—all positive findings. Ramos was prescribed a mix of medications to help with
his depression and attention deficit disorder, but he had trouble managing a pill regi-
men.
Ramos’s application for disability benefits proceeded to a hearing in November
2020. In addition to Ramos’s medical records and testimony, the ALJ considered the
reports of two psychological consultants, the expert opinions of Drs. Lee Fischer and
James Brooks, and the testimony of vocational expert James Lozer. Dr. Fischer testi-
fied and opined that the record did not reveal any physical limitations.
Dr. Brooks testified about Ramos’s mental impairments. In that connection, he
was asked to assess whether Ramos could 1) “[u]nderstand, remember, or apply in-
formation”; 2) “[i]nteract with others”; 3) [c]oncentrate, persist, or maintain pace”;
and 4) “[a]dapt or manage [him]self.” See Appendix 1 to Subpart P of 20 C.F.R. § 404.

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Dr. Brooks rated Ramos as having moderate limitations in all four areas. In coming to
that conclusion, Dr. Brooks considered Ramos’s arrest, reports of irritability, and out-
bursts with his girlfriend, but the doctor gave “greatest weight in these evaluations to
cognitive functioning.” Because Ramos had “consistent mental status evaluations
within normal limits,” Dr. Brooks reported that Ramos “would be capable of at least
unskilled work and could have at least occasional contact with supervisors, cowork-
ers, and the general public.”
In his testimony, Ramos described his work history and his experience coping
with his mental health. He said that he rarely left his room; instead, he spent most of
his time watching television. He also reported avoiding interactions with others for
fear that he would have an angry outburst. His history of work was spotty, and in-
cluded getting fired from a warehouse job because he was unable to manage a full
day of work. But Ramos acknowledged having a previous position at Subway that he
was able to perform three days a week. In addition, he worked intermittently at a hot
dog stand as of the time of the hearing.
Based on all this, vocational expert Lozer offered his views on the work that Ra-
mos would be able to do. Lozer concluded that someone with similar limitations was
capable of working in jobs such as custodian, laborer, dishwasher, and food prepara-
tion jobs (like Ramos’s work at Subway).
The ALJ issued her opinion in January 2021. Following the five-step process laid
out in 20 C.F.R. § 404.1520, the ALJ determined at step one that Ramos was not en-
gaged in substantial gainful activity. At step two, the ALJ acknowledged Ramos’s
mental impairments and obesity. At step three, based on Dr. Brooks’s findings of only
moderate limitations in the four areas of mental functioning, the ALJ decided that the
record did not support a finding of disability. See Appendix 1 to Subpart P of 20
C.F.R. § 404 (directing an ALJ to find a disability based on a depressive or bipolar dis-
order where there is “[e]xtreme limitation of one, or marked limitation of two” of the
four areas of mental functioning).
Moving to step four, the ALJ had first to establish Ramos’s residual functional ca-
pacity (that is, the most that he could do given his limitations), and then to evaluate
whether Ramos could perform any relevant past work. The ALJ concluded that Ra-
mos could perform work “at all exertional levels” but with certain “non-exertional
limitations.” Ramos was restricted, the ALJ determined, to nothing more than “sim-
ple, routine, repetitive tasks, … such work having a short initial learning period of
usually 30 days or less. No tandem tasks or teamwork. … Occasional, superficial

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interaction with the general public, coworkers, and supervisors … [and] normal su-
pervisory interactions as needed … .” The ALJ explained that her decision was sup-
ported by the fact that Ramos suffered from “no more than moderate limitations in
the four broad areas of mental functioning.” She added that Ramos’s symptoms
rarely intensified to the point of requiring emergency treatment or hospitalization;
when he was in treatment and following his medication regimens, he demonstrated
improvements and “largely negative” mental-status exam findings.
Since Ramos had no relevant past work, the ALJ proceeded to step five, at which
the Commissioner bears the burden of showing that there is work that exists in signif-
icant numbers in the national economy. If so, then the applicant is not disabled. The
ALJ agreed with Lozer’s suggestions that Ramos’s limitations permitted him to work
as a custodian, laborer, or dishwasher, and that there were ample such jobs in the
economy. She accordingly denied Ramos’s application. On review, the district court
found that the ALJ’s decision was supported by substantial evidence, even though
Ramos raised “some interesting and at times close questions.”
II
As he did in the district court, Ramos asserts here that the ALJ’s decision was not
supported by substantial evidence. Substantial evidence “means … ‘such relevant ev-
idence as a reasonable mind might accept as adequate to support a conclusion.’”
Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (quoting Consolidated Edison Co. v.
NLRB, 305 U.S. 197, 229 (1938)). This is a deferential standard of review.
Ramos first attempts to meet his burden by attacking Dr. Brooks’s testimony. He
contends that Dr. Brooks over-relied on cognitive functioning when he evaluated Ra-
mos’s mental status. While a different expert might have appraised cognitive func-
tioning differently, the ALJ was entitled to deem Dr. Brooks’s testimony persuasive; it
is not our role to “reweigh evidence” for the ALJ. See Peeters v. Saul, 975 F.3d 639, 641
(7th Cir. 2020). Dr. Brooks mentioned Ramos’s arrest record, history of conflict and
irritability, occasionally disheveled appearance, work absences, suicidal ideations,
tearfulness, flat affect, and negative thought processes. Because Dr. Brooks’s opinion
accounted for the full extent of Ramos’s mental impairment evidence, Ramos’s chal-
lenge to the completeness or persuasiveness of that opinion falls short.
Second, Ramos asserts that the ALJ ignored several positive clinical findings in
the record, as well as his arrest and anger episodes. But the “ALJ’s ‘adequate discus-
sion’ of the issues need not contain ‘a complete written evaluation of every piece of

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evidence.’” Deborah M. v. Saul, 994 F.3d 785, 788 (7th Cir. 2021) (quoting Pepper v. Col-
vin, 712 F.3d 351, 362 (7th Cir. 2013)). Furthermore, the ALJ’s omission of some evi-
dence is excusable when she relies on the medical opinions of experts who did con-
sider that evidence. See Skarbek v. Barnhart, 390 F.3d 500, 504 (7th Cir. 2004) (explain-
ing that evidence may be “factored indirectly into the ALJ’s decision as part of the
doctors’ opinions”). In that way, the ALJ’s reliance on Dr. Brooks’s opinion incorpo-
rated Dr. Brooks’s consideration of Ramos’s arrest and anger episodes. This is not like
cases where the ALJ disregarded entire lines of evidence. Compare Idoranto v. Barn-
hart, 374 F.3d 470, 473–74 (7th Cir. 2004) (reversing the denial of benefits where the
ALJ failed to consider the claimant’s daily headaches and blurred vision and did not
include those limitations in the hypotheticals posed to the vocational expert).
Third, Ramos finds error in the ALJ’s list of limitations, several of which Ramos
identifies as “not clearly connected to the impairments.” But Ramos does not identify
how this alleged error affected the ALJ’s final finding of no disability. See Jozefyk v.
Berryhill, 923 F.3d 492, 498 (7th Cir. 2019) (finding no error in the ALJ’s assessment be-
cause the claimant could not hypothesize what work restrictions would better accom-
modate his “limitations in concentration, persistence, or pace”). Additionally, the ALJ
assessed additional limitations, beyond any recommended by Dr. Brooks or the psy-
chological consultants. Given that the record could have supported fewer limitations,
if the ALJ erred at all, she seems to have done so in Ramos’s favor. See Burmester v.
Berryhill, 920 F.3d 507, 510 (7th Cir. 2019) (observing that there was “reasoned consid-
eration” of claimant’s evidence where the final finding was “more limiting than that
of any state agency doctor or psychologist”).
Finally, Ramos argues that Lozer failed to account for Ramos’s limitations with
respect to supervisory contact, and that this failure affected the ALJ’s final determina-
tion. Indeed, there is some murkiness on this point. For example, the ALJ assessed
Ramos as tolerating normal supervisory interactions, “including, for example, perfor-
mance appraisals, corrections, instructions, and directives as necessary,” but she also
limited Ramos to “occasional, superficial” supervisory interactions. These two assess-
ments appear contradictory. That contradiction then affected Lozer’s own testimony
because he could not explain how someone who was limited to occasional and super-
ficial interactions with others could tolerate normal supervision. As Ramos puts it,
“there is nothing in the record to suggest that [he] possesses an especially greater
ability to interact with supervisors as compared to coworkers, family members,
friends, or police officers.”

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Like the district court, we see this as a “close question.” But this question is ulti-
mately decided by the standard of review—“[u]nder the substantial-evidence stand-
ard, … the threshold for such evidentiary sufficiency is not high.” Biestek, 139 S. Ct. at
1154. Lozer explained that being limited to occasional and superficial interactions
with supervisors does not preclude work because “it really shouldn’t take much” su-
pervisory interaction to perform the identified jobs. The apparent contradiction is re-
solved when we recall that Lozer selected work that required only minimal supervi-
sion. Overall, there was substantial evidence to support the ALJ’s decision that Ra-
mos could perform the identified jobs.
We have reviewed Ramos’s remaining arguments. None compels a finding of er-
ror in the ALJ’s decision. We note in closing, however, that though we are affirming
the district court’s decision, the proceeding before us addresses only Ramos’s ability
to work at the time that the ALJ’s decision was issued. If new evidence of Ramos’s
limitations and mental impairments arises, he is free to try his luck with a new appli-
cation for disability benefits based on an onset date that postdates the ALJ’s decision.
We offer no opinion about the prospects of any such renewed effort.
We AFFIRM the district court’s decision to uphold the ALJ’s denial of benefits.

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