Ferida H. Moy v. FRANK BISIGNANO, Commissioner of Social Security

In the
United States Court of Appeals
For the Seventh Circuit
____________________
No. 24-1461
F ERIDA H. M OY ,
Plaintiff-Appellant,
v.
F RANK BISIGNANO, Commissioner of Social Security,
Defendant-Appellee.
____________________
Appeal from the United States District Court for the
Northern District of Illinois, Eastern Division.
No. 1:22-cv-06341 — Sunil R. Harjani, Judge.
____________________
A RGUED DECEMBER 6, 2024 — DECIDED J ULY 2, 2025
____________________
Before HAMILTON , S CUDDER , and L EE, Circuit Judges.
HAMILTON , Circuit Judge. Plaintiff Ferida Huskic Moy
suffers from severe post-traumatic stress disorder (PTSD)
resulting from her harrowing experiences during the brutal
wars in the 1990s as the nation of Yugoslavia was breaking
up. She applied for disability insurance benefits and
supplemental security income based on her PTSD and related
mental health issues. Moy’s application was denied after an
administrative law judge (ALJ) found that she had the

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2 No. 24-1461
residual functional capacity to perform work involving
simple, routine tasks with minimal contact with supervisors
and co-workers. That determination was upheld by the
district court, and Moy has appealed.1
When assessing Moy’s residual functional capacity, the
ALJ found that Moy had “moderate limitations in concentrat-
ing, persisting, or maintaining pace.” He then wrote that, to
“account for moderate limitations in concentrating, persisting
or maintaining pace, I provided that she can work at a con-
sistent production pace.” AR 21 (emphasis added). We see
this as a non-sequitur: to accommodate Moy’s moderate lim-
itations, the ALJ treated her as if she were unlimited in those
respects. There was no logical bridge between the noted limi-
tations and the residual functional capacity conclusion. Ac-
cordingly, we vacate the judgment and remand the case to the
Commissioner of Social Security.
I. Background
A. Factual Background
Moy grew up in what is now Bosnia and Herzegovina. She
survived the conflicts that tore Yugoslavia apart in the early
1990s and eventually made her way to the United States. She
worked various jobs in the United States before the alleged
onset of her disability in June 2020, including as a bakery as-
sistant, deli associate, line cook, server assistant, and most re-
cently as a sales associate at a Home Depot store. Until June
1 When this case was filed in the district court, the parties jointly con-
sented to have then-Magistrate Judge Harjani conduct all proceedings in
the case, including entering final judgment. See 28 U.S.C. § 636(c)(1). After
entering judgment in this case, Judge Harjani was appointed as a district
judge.

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No. 24-1461 3
2020, there was nothing unusual in Moy’s medical records, at
least as relevant to this appeal. In February 2019, she began
seeing Dr. Sonia Abraham, a primary care doctor. At that time,
Moy was “negative” for anxiety and depression.
On June 11, 2020, Moy reported to a hospital’s emergency
department complaining of dull chest pain. She was dis-
charged but returned the next day for a cardiology appoint-
ment and fainted while sitting in a chair. Medical reports in-
dicate that she had been “anxious and crying earlier in the
day” and that she was lethargic after the fainting episode. Her
cardiology exams were unremarkable, and she was again dis-
charged.
Things got worse from there. Several days later, Moy saw
Dr. Abraham to follow up on the hospital visit. Moy’s chest
pain had not returned, but she reported feeling “traumatized”
from being in concentration camps in Bosnia. Moy also told
Dr. Abraham that this experience was “causing stress” and
making her feel numb. Dr. Abraham recommended that Moy
see a psychiatrist for stress and started her on an antidepres-
sant and anti-panic medication called Alprazolam.
The next day, June 17, Moy began seeing a therapist, Dani
Avallone. Moy described hallucinations, depression, and anx-
iety related to “the war in Bosnia.” Avallone diagnosed Moy
with PTSD. The record indicates that around the time Moy
began experiencing these debilitating PTSD symptoms, she
also began to struggle at work. One note indicated that when
Moy went to work, she had panic attacks during which she
would forget some of her English. AR 514. That document
also reflected Moy’s belief that a co-worker was “trying to get
her terminated,” and another note reported that a co-worker
“betrayed her” in an incident apparently related to a forklift.

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4 No. 24-1461
AR 514, 516. Avallone’s treatment notes indicate that Moy’s
PTSD was severe: Moy was “continually getting flashbacks of
when she and her children were in a concentration camp,”
and she “keeps hearing children screaming[,] bullets fired.”
AR 518. Another noted that Moy arrived for one treatment
session “crying, sobbing, stating she had not slept because she
keeps reliving the sight of her father’s head being cut off.” AR
520. Avallone saw Moy until July 4, 2020 and consistently re-
ported that she had a depressed, anxious mood, though she
presented appropriately and was oriented to time and place.
Around the time Moy stopped seeing Avallone, she began
seeing Dr. Amr Kireem. After treating Moy for two weeks, Dr.
Kireem quickly concluded that she was “not fit physically and
mentally to bear any responsibility at her workplace effec-
tively and efficiently.” He therefore recommended that Moy
stay away from work for “at least the next two weeks.” In Oc-
tober 2020, Dr. Kireem responded to a Mental Impairment
Questionnaire in support of Moy’s disability claim. He re-
plied that Moy could not “work at all.” In a comparable report
from the same time, Dr. Abraham likewise wrote that Moy
had “extreme PTSD,” anxiety, depression, and hallucinations
that limited her ability to work.2
Moy saw Dr. Kireem for a little more than one year. Our
review of the record shows that Dr. Kireem treated Moy
2 Moy also started seeing a cardiologist, Dr. Saifullah Nasir, around
the same time she started seeing Dr. Kireem. Dr. Nasir also diagnosed
PTSD, depression, and anxiety, and he prescribed an antidepressant and
anti-anxiety medication called Escitalopram. In early September, Dr. Nasir
noted that Moy “continue[d] to have significant anxiety” but said that the
medication was helping. Nonetheless, he said that Moy would be “unable
to talk to customers” and recommended that she take time off from work.

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No. 24-1461 5
approximately 35 times between July 1, 2020 and July 31, 2021.
Several reports are of particular note. In October 2020, Dr.
Kireem submitted a separate response to the Social Security
Administration on Moy’s behalf. In that report, he wrote that
Moy was unable “to even see people in the street without hav-
ing emotional outburst, anger, and physical pain. She cannot
interact with other employees or customers in a socially rea-
sonable fashion. Besides, she consistently sees people covered
in blood.” AR 583. He noted that Moy’s PTSD symptoms were
the most severe he had ever seen. AR 588. In a later treatment
session with Dr. Kireem, Moy described “seeing a man with a
beard behind her most of the time that no one else sees.” AR
1099. She also reported feeling “scared all the times (sic) and
cannot go outside especially to crowded places.” In treatment
sessions from around the same time, Moy described sleep pa-
ralysis and auditory and visual hallucinations. On July 27,
2021—apparently the last time Moy saw him—Dr. Kireem
wrote that Moy did not show “any symptoms of improve-
ment, however, she has been attending therapy to maintain
her sanity.” AR 1132. He again said that Moy should see a
psychiatrist.
In September 2020, early in the year during which Moy did
therapy with Dr. Kireem, she returned to Dr. Abraham with a
complaint of increased depression. Treatment notes from that
appointment reflect that Moy was crying and experiencing
“memories of the war.” AR 563. Moy also said that her anti-
depressant was not working, and she reported taking double
the recommended dosage.
In early 2021, Moy received treatment for several medical
issues unrelated to her disability claim. While Moy does not
claim disability based on these other medical issues, the

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6 No. 24-1461
reports list the medications she was taking. Around June 1,
2021, Moy was taking Escitalopram, Alprazolam, Proprano-
lol, and Trazodone at least daily. These documents also re-
ported Moy’s PTSD and anxiety diagnoses but indicated that
she did not display any evidence of “emotional or behavioral
disorder.” AR 825–26; 828 (cleaned up).
B. Procedural Background
Moy filed an application seeking Social Security disability
benefits on August 5, 2020. She asserted her disability began
on June 11, 2020—the day of her initial hospital visit described
above. Moy’s claims were denied initially, on reconsideration,
and—after a telephonic (not video) hearing—in a written de-
cision. In the hearing, Moy testified through an interpreter.
She told the ALJ through an interpreter that she had been hal-
lucinating a “killer from 1992” and “blood from [her] father.”
AR 41. Moy testified that she stopped working at Home De-
pot because she “started to see blood on people.” AR 44. And
in an exchange worth reproducing in full, Moy also testified
that a killer named Milan Urusich—apparently a co-worker,
or a person she was confusing with a co-worker—was creat-
ing problems for her at work:
ALJ: Your record says that you believed some-
one was trying to get you fired.
Moy: That was the case, that someone was
pushing me from behind. That was Milan
Urusich (phonetic).
ALJ: I’m sorry. Could you repeat that?
Moy: That was when someone was pushing
me from behind. His name was Milan
Urusich.

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No. 24-1461 7
ALJ: Could she please describe what she
means by pushing her from behind?
Moy: He was pushing me from behind. I was
driving a forklift with Scott, and Milan
came and turned off my forklift. And
Scott helped me to turn this forklift back
on. And I was afraid because Milan killed
my father. He was always behind me.
AR 44. When asked about her mental health symptoms, Moy
said: “I see killer from 1992 … I see blood from my father. I
cannot fight these pictures.” She was crying during the hear-
ing.
To help determine whether Moy could work, the ALJ
posed several hypothetical questions to a vocational expert.
The ALJ first asked whether, in the expert’s opinion, a person
with Moy’s limitations and an ability to work at a “consistent
production rate” could perform any of Moy’s past jobs. The
expert responded that the only possibilities would be “dining
room attendant” or “bus person,” because those do not in-
volve “communicating with the general public.” AR 50. The
expert also opined that such a person could also work as a
scrap sorter, industrial cleaner, or dishwasher. AR 50–51. The
ALJ then asked, “what would those jobs allow in terms of ab-
sences, off-task tolerances, and breaks?” The vocational ex-
pert responded:
Certainly someone could be absent for two or
more days without medical excuse. But if this is
a regular occurrence occurring every month
where a person is absent, tardy, or leaving early
two or more days a month regularly, then

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8 No. 24-1461
they’re not a reliable worker and eventually
they’ll lose their employment. … [I]f someone is
off-task 15% of the work day, which is about
eight minutes every hour or more, … there’d be
no work for this person.
AR 51–52.
The ALJ issued a written decision applying the familiar
five-step analysis set forth in 20 C.F.R. § 404.1520(a)(4) and
concluding that Moy did not meet the stringent standard for
disability under the Social Security Act. At step one he con-
cluded that Moy had not engaged in substantial gainful activ-
ity since her alleged disability onset date. At step two he con-
cluded that Moy suffered from several severe impairments in-
cluding depression, anxiety, and PTSD. At step three, the ALJ
concluded that Moy’s impairments did not meet or equal an
automatically disabling impairment listed in 20 C.F.R. Part
404, Subpart P, App. 1; see also 20 C.F.R. § 404.1520(d).
The ALJ then determined Moy’s residual functional capac-
ity, i.e., her capacity to work notwithstanding her impair-
ments. He concluded that Moy could work at “all exertional
levels” but with limitations, including without driving, oper-
ating moving machinery, working at heights, climbing, work-
ing in direct public service, working in “crowded, hectic en-
vironments,” or engaging in “tandem” tasks. The ALJ also
concluded that, notwithstanding “moderate limitations” in
concentrating, persisting, or maintaining pace, Moy could
work at “consistent production pace.” Citing the vocational
expert’s testimony, the ALJ concluded at steps four and five
that Moy could perform her past work as a “dining room at-
tendant/bus person,” and that she could also work as a scrap
sorter, industrial cleaner, or dishwasher.

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No. 24-1461 9
The Appeals Council denied review of Moy’s claim. Moy
then sought judicial review in the Northern District of Illinois.
That court affirmed the ALJ’s denial of benefits. This appeal
followed.
II. Standard of Review
We review de novo a district court’s decision affirming an
ALJ’s denial of Social Security disability benefits, Deborah M.
v. Saul, 994 F.3d 785, 788 (7th Cir. 2021), but we review the
ALJ’s decision deferentially, affirming if its conclusions are
supported by substantial evidence. 42 U.S.C. § 405(g); Deborah
M., 994 F.3d at 788; Clifford v. Apfel, 227 F.3d 863, 873 (7th Cir.
2000) (ALJ’s residual functional capacity determination “must
be supported by substantial evidence in the record”). Sub-
stantial evidence is “such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.”
Biestek v. Berryhill, 587 U.S. 97, 103 (2019), quoting Consolidated
Edison Co. v. NLRB, 305 U.S. 197, 229 (1938). While we do not
reweigh evidence, we conduct a critical review because a de-
cision “cannot stand if it lacks evidentiary support or an ade-
quate discussion of the issues.” Lopez ex rel. Lopez v. Barnhart,
336 F.3d 535, 539 (7th Cir. 2003). In addition, an ALJ must
“build an accurate and logical bridge from the evidence to his
conclusion.” Clifford, 227 F.3d at 872. That logical bridge can
assure a reviewing court that the ALJ considered the im-
portant evidence and applied sound reasoning to it. See Hick-
man v. Apfel, 187 F.3d 683, 689 (7th Cir. 1999).
III. Analysis
We conclude that the ALJ’s determination of Moy’s resid-
ual functional capacity failed to account for her limitations re-
lated to concentration, persistence, and pace. Specifically, the

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10 No. 24-1461
ALJ wrote: “To account for moderate limitations in concen-
trating, persisting, or maintaining pace, I provided that [Moy]
can work at a consistent production pace.” AR 21. The prob-
lem is that this provision—supposedly to account for Moy’s
limitations—does not reflect any level of functional limitation.
Accordingly, we must reverse and remand.
“[O]n several occasions in recent years we have addressed
the role [concentration, persistence, and pace] limitations
must play in a proper [residual functional capacity] determi-
nation.” Crump v. Saul, 932 F.3d 567, 570 (7th Cir. 2019). We
have emphasized that “both the hypothetical posed to the [vo-
cational expert] and the ALJ’s [residual functional capacity]
assessment must incorporate all of the claimant’s limitations
supported by the medical record,” including limitations in
concentration, persistence, or pace. Varga v. Colvin, 794 F.3d
809, 813 (7th Cir. 2015), quoting Yurt v. Colvin, 758 F.3d 850,
857 (7th Cir. 2014).
Here, the ALJ first asked the vocational expert whether a
person with a wide range of limitations—including inability
to drive, operate machinery, communicate complex ideas in
English, make complicated decisions, adapt to frequent
changes in work process or product, engage with the public,
or engage in more than “brief and superficial” interaction
with co-workers—could nonetheless work. That question ex-
plicitly included an ability to work at a “consistent production
rate.” AR 49. The vocational expert testified that such a person
could work—but was later asked what the employers would
tolerate in terms of “absences, off-task tolerances, and
breaks.” The expert responded that if an employee were reg-
ularly absent or tardy or left early for two or more days per
month, that person would “lose their employment.” AR 52.

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No. 24-1461 11
He also explained that if an employee were “off-task 15% of
the work day, which is about eight minutes every hour or
more, … there’d be no work for this person.” Id.
We emphasize that the ALJ fulfilled his obligation to en-
sure the vocational expert was “apprised fully of the claim-
ant’s limitations” so the expert could offer a reliable opinion
about jobs the claimant could perform. See Crump, 932 F.3d at
570, quoting Moreno v. Berryhill, 882 F.3d 722, 730 (7th Cir.
2018); O’Connor-Spinner v. Astrue, 627 F.3d 614, 619 (7th Cir.
2010) (collecting cases: “Our cases generally have required the
ALJ to orient the [vocational expert] to the totality of a claim-
ant’s limitations.” (footnote omitted)). By first asking a hypo-
thetical question that included all the limitations the ALJ
would later incorporate into the written residual functional
capacity determination, the ALJ ensured that the vocational
expert had the information necessary to opine on Moy’s abil-
ity to work. The ALJ then asked a key follow-up question:
whether a person with Moy’s functional limitations could
work if her symptoms required her to be absent or off-task on
a regular basis. Moy’s attorney was satisfied with the expert’s
negative answer. He declined to ask any further questions
and told the ALJ that he “covered it with 15% [off-task time]
or two days absenteeism.” AR 52.
The problem, though, is that the ALJ’s residual functional
capacity determination did not adequately account for Moy’s
limitations in concentration, persistence, and pace—
limitations the vocational expert acknowledged would
impede a claimant’s ability to work. The ALJ found that Moy
had limitations in her ability to concentrate, persist, and
maintain pace, noting that Moy alleged “difficulty focusing,”
reported “flashbacks and hallucinations,” and demonstrated

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12 No. 24-1461
“distractible attention during psychotherapy visits.” AR 17.
Perhaps the ALJ might have concluded that, despite these
limitations, Moy could nonetheless stay on-task and regularly
attend work in a way that would not interfere with her
employment. But that was not his reasoning. Instead, “to
account” for Moy’s limitations, the ALJ concluded that she
could work at a “consistent production pace”—which we
understand to say that, to account for Moy’s limitations, he
imposed no additional restrictions. This reasoning fails to
build a logical bridge between the limitations found and the
residual functional capacity conclusion. See Lothridge v. Saul,
984 F.3d 1227, 1233–34 (7th Cir. 2021) (remanding when ALJ
noted limitations in concentration, persistence, and pace but
said that further residual functional capacity restrictions were
not warranted: “an internally inconsistent opinion by
an ALJ is likely to fail to build a logical bridge between the
evidence and the result”).
Because of this discrepancy, we agree with Moy that the
ALJ failed to account for her functional limitations related to
concentration, persistence, and pace. Crump illustrates why.
There, the ALJ first asked a vocational expert about the
availability of work for a person who could “perform simple,
repetitive tasks without incorporating any [concentration,
persistence, or pace] limitations.” 932 F.3d at 570–71. The ALJ
then asked whether a person who was “off-task 20% of the
time” or required two unscheduled absences per month could
work. The expert responded that such a person would be
unable to sustain employment—just as the expert testified in
this case. We ultimately reversed the ALJ’s denial of benefits.
We explained that, because the ALJ failed to incorporate the
vocational expert’s second response in his residual functional
capacity determination, that determination was “altogether

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No. 24-1461 13
uninformed by considerations of off-task time or unplanned
leave.” Id. at 570. As in this case, the ALJ rooted the residual
functional capacity determination in the vocational expert’s
first opinion—which “by its terms, did not account” for the
claimant’s limitations. Id. at 571, citing Winsted v. Berryhill, 923
F.3d 472, 477 (7th Cir. 2019) (“Because the ALJ did not include
Winsted’s difficulties with concentration, persistence, and
pace in the hypothetical he did consider, the decision cannot
stand.”). In both Crump and this case, the ALJ’s determination
of the claimant’s ability to work should have been guided by
the second hypothetical question posed by the ALJ, which
incorporated attendance and attention limitations. Accord,
Lothridge, 984 F.3d at 1233 (remanding when ALJ noted
limitations but failed to incorporate them into residual
functional capacity determination); cf. Martin v. Saul, 950 F.3d
369, 374 (7th Cir. 2020) (rejecting concentration, persistence,
and pace argument when ALJ tailored claimant’s residual
functional capacity to the noted limitations).
The Commissioner argues that we should affirm the ALJ’s
decision not to include any residual functional capacity re-
strictions despite finding persistence-related limitations be-
cause the ALJ relied on opinions from state agency medical
consultants who concluded that Moy had “no difficulty con-
centrating sufficiently for a normal work period.” AR 21. That
theory conflicts with the ALJ’s own analysis, however. The
ALJ noted that those consultants “did not have the benefit of
reviewing the record in its entirety including the claimant’s
psychotherapy notes,” and the ALJ explained that he would
add limitations beyond those found by the consultants. Id.
Quoting Thomas v. Colvin, 745 F.3d 802, 808 (7th Cir. 2014),
the Commissioner emphasizes that “a claimant’s RFC is a

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14 No. 24-1461
matter for the ALJ alone—not a treating or examining
doctor—to decide.” True enough. But again, the ALJ actually
found that Moy had “moderate limitations in concentrating,
persisting, or maintaining pace….” AR 21. The point is not
that the ALJ undervalued any particular piece of evidence but
that the ALJ’s conclusion regarding Moy’s limitations was not
reflected in the conclusion he drew about Moy’s ability to
work at a consistent production pace. See Lothridge, 984 F.3d
at 1233 (“The ALJ’s formulation here says nothing about
whether Lothridge is capable of performing work at a
sustained pace over an entire workday.”).
The Commissioner argues that moderate limitations in
concentration, persistence, and pace do not, under Agency
regulations, “connote disabling restrictions such as the
inability to sustain performance of any task over time.” But
the cited Agency regulations explain that “the spectrum of
limitation that may constitute ‘moderate’ limitation ranges
from limitations that may be close to ‘marked’ in severity to
limitations that may be close to the ‘mild’ level.” The
regulations also note that people with “moderate” limitations
may or may not qualify as disabled—a question that will be
assessed in the residual functional capacity determination.
Revised Medical Criteria for Evaluating Mental Disorders, 81
Fed. Reg. 66138, 66146–47, 2016 WL 5341732 (Sept. 26, 2016).
The Agency’s guidance makes clear that “moderate”
impairments should be considered when an ALJ calculates
the claimant’s residual ability to work, which is exactly what
the ALJ failed to do here. The Commissioner is right that a
moderate limitation in any one domain of mental function
does not always require a finding of disability, but in some
cases it may. To enable meaningful review, the ALJ must at
least describe what the moderate limitations are and how they

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No. 24-1461 15
affect the claimant’s ability to work. Lothridge, 984 F.3d at 1234
(“The ALJ’s findings about the jobs Lothridge could perform
needed to account in a meaningful way for the earlier findings
that recognized her difficulties with concentration,
completing tasks, and managing stress.”).
The Commissioner cites Pavlicek v. Saul, 994 F.3d 777, 783
(7th Cir. 2021), for the point that there is no “inherent incon-
sistency between a moderate rating in the broad area of con-
centration, persistence, or pace, and the ability to perform
simple, repetitive tasks at a consistent pace.” In Pavlicek, we
affirmed denial of benefits when an ALJ relied on a doctor’s
statement that a claimant could work at a “consistent pace
particularly if … engaged in a simple, repetitive tasks” de-
spite a checklist item marking the claimant as “moderately
limited” in concentration and pace. Id. (cleaned up). The ALJ
in Pavlicek justified the conclusion that the claimant could
work at a consistent pace by expressly incorporating the doc-
tor’s recommendation that the claimant engage in only sim-
ple, repetitive tasks (which, according to the doctor, ac-
counted for the claimant’s pace-related limitations). Id.
Here, the ALJ offered no such justification. He simply said
that, to account for Moy’s moderate limitations in concentra-
tion, persistence, and pace, he provided that Moy could work
at a consistent production pace. Without further explanation
of why the other work-related restrictions nonetheless al-
lowed Moy to work at a consistent production pace, we can-
not conclude that the ALJ’s decision was supported by sub-
stantial evidence.3
3 The Commissioner cites several other cases in support of his
argument that other restrictions can account for limitations in

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16 No. 24-1461
The Commissioner also argues that it should not matter
that the ALJ did not impose any work limitations related to
concentration, persistence, and pace because the other limita-
tions accounted for Moy’s reduced function. For example, the
Commissioner argues that the restriction to non-hazardous
work “addressed deficits in concentration,” and that the re-
striction to only occasional and minor changes in work setting
reflected deficits in persistence.
We do not think that any of the ALJ’s noted restrictions
accommodate Moy’s persistence-related limitations. The ALJ
acknowledged those deficiencies, AR 21, and they are docu-
mented extensively in the record. Recall that the vocational
expert testified that if a person were regularly absent, tardy,
or leaving early for two or more days a month, that person
would “lose their employment.” AR 52. Our review of the rec-
ord shows that Dr. Kireem alone treated Moy roughly 35
times between July 1, 2020, and July 31, 2021, just “to maintain
her sanity.” AR 1132. Over the course of 13 months, this
equates to nearly three days per month. Add to this Moy’s
concentration, persistence, and pace. Most are not precedential, and the
few that are precedential likewise support the point that for non-
persistence-related restrictions to account adequately for a claimant’s
persistence-related limitations, the evidence must show that those
restrictions will accommodate the claimant’s persistence-related
deficiencies. E.g., Jozefyk v. Berryhill, 923 F.3d 492, 498 (7th Cir. 2019)
(affirming denial of benefits when ALJ restricted claimant to “limited
interactions with others” and medical evidence showed that impairments
surfaced “only when he is with other people or in a crowd”). Several other
cited cases concluded that ALJs appropriately found no persistence-
related limitations. They do not address the issue here. E.g., Peeters v. Saul,
975 F.3d 639, 641–42 (7th Cir. 2020) (ALJ conclusion that claimant did not
have pace-related limitations was supported by substantial evidence);
Burmester v. Berryhill, 920 F.3d 507, 511–12 (7th Cir. 2019) (same).

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No. 24-1461 17
therapy treatments with Avallone, her appointments with Dr.
Abraham and Dr. Nasir, and her separate medical appoint-
ments for unrelated physical ailments in early 2021. Nothing
in the vocational expert’s testimony makes it seem likely that
a non-hazardous workplace (for example) would be any more
tolerant of those absences than a hazardous workplace would
be.
Further undermining our ability to accept the ALJ’s rea-
soning, he downplayed the extent of Moy’s treatment, saying
that she attended therapy “irregularly and infrequently” and
that Dr. Kireem’s treatment was “infrequent and conserva-
tive.” AR 20 & 22. As just explained, Moy’s treatment by Dr.
Kireem alone was frequent enough to impede her ability to
work, at least, by the vocational expert’s standards. More fun-
damental, it simply was not reasonable to characterize Moy’s
treatment as infrequent and conservative. In addition to the
extensive therapy treatment detailed above, the record shows
that Moy was taking a daily cocktail of anti-anxiety and de-
pression medications, including Escitalopram, Alprazolam,
Trazodone, and Propranolol (which is sometimes prescribed
off-label for anxiety). She began taking all of these after she
first reported to the hospital in June 2020.
This mischaracterization of the treatment record is im-
portant because a claimant’s reliance on frequent treatment
can make it difficult for her to work on a sustained basis. See
Voigt v. Colvin, 781 F.3d 871, 874 (7th Cir. 2015) (remanding:
“To miss four workdays a month would reduce one’s average
workweek from five to four days, which would not constitute
working on a sustained basis as defined by the Commis-
sion.”). While merely scheduling frequent doctor’s appoint-
ments is not enough to require a finding of disability, see

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18 No. 24-1461
Bernard L. v. King, No. 22 CV 00120, 2025 WL 296054, at *5
(N.D. Ill. Jan. 24, 2025) (collecting cases), Moy’s therapy ap-
pointments are part of a broader treatment record that indi-
cates the severity of her symptoms and the degree of interrup-
tion those symptoms cause. Moy’s extensive medication regi-
men is also significant because “a claimant’s election to un-
dergo serious treatment, such as ... taking ‘heavy doses of
strong drugs,’ indicates that the claimant’s complaints … are
likely credible,” and “the fact that physicians willingly pre-
scribed drugs … indicated that they believed the claimant’s
symptoms were real.” Scrogham v. Colvin, 765 F.3d 685, 701
(7th Cir. 2014), quoting Carradine v. Barnhart, 360 F.3d 751, 755
(7th Cir. 2004). By improperly minimizing the extent of Moy’s
treatment, the ALJ overlooked evidence that bears on Moy’s
residual ability to work.
In addition to this evidence that Moy likely could not at-
tend work consistently over the course of weeks or months,
the record also indicates that Moy would likely struggle to
persist through daily work-related activities—which the voca-
tional expert explained would also mean “no work.” AR 52.
The ALJ acknowledged several treatment records that de-
scribed Moy’s severe symptoms, including “experiencing
traumatic events on a daily basis and through her dreams as
well as sleep paralysis and hallucinations.” AR 20. As noted
above, for example, one report explained that Moy would
have panic attacks at work during which she would forget
some of her English. AR 514. Similarly, one of Dr. Kireem’s
notes explained that Moy was “seeing a man with a beard be-
hind her most of the time that no one else sees. She feels
scared all the [time] and cannot go outside especially to
crowded places.” AR 1099. And the ALJ also noted that Moy
was “crying at some counseling sessions, as well as at the

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No. 24-1461 19
hearing in this matter”—behavior that would certainly im-
pede her ability to persist through a normal workday.
It is hard for us to imagine—even under the stringent
standards of the Social Security Act—how a person could stay
on-task and serve tables or wash dishes in a professional set-
ting while consistently crying, experiencing panic attacks, and
hallucinating a killer over her shoulder. See Lothridge, 984 F.3d
at 1233 (“We have repeatedly cautioned that ‘someone with
problems concentrating might not be able to complete a task
consistently over the course of a workday, no matter how sim-
ple it may be.’” (quoting Martin, 950 F.3d at 373–74)); Spiva v.
Astrue, 628 F.3d 346, 350 (7th Cir. 2010) (“An employee who
stocks shelves at a Walmart … has to be able to interact with
customers.… A psychotic person busy trying to cope with evil
spirits and evil thoughts is not likely to be employable as a
shelf stocker in such a store.”).
The ALJ acknowledged these limitations when he noted
that Moy “exhibited distractible attention during psychother-
apy visits.” But he noted that—on the other side of the
ledger—she was able to attend medical visits, talk on the
phone, and go shopping with her husband. There is plenty of
evidence in the record indicating that Moy struggled with
these ordinary activities, and we reiterate that such activities
of daily living are not conclusive indicators of a person’s abil-
ity to work in competitive employment. See Rucker v. Kijakazi,
48 F.4th 86, 93 (2d Cir. 2022) (“[A] claimant’s regular attend-
ance at medical appointments says very little about her ability
to work during her appointments. Indeed, it would seem that
a person suffering from [significant impairments] would have
a strong interest in attending appointments and seeking relief
rather than missing appointments.” (internal quotation marks

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20 No. 24-1461
omitted, quoting Virden v. Colvin, No. 14-CV-1219, 2015 WL
5598810, at *11 (C.D. Ill. Sept. 22, 2015))); Loveless v. Colvin, 810
F.3d 502, 508 (7th Cir. 2016) (“[W]e have criticized ALJs for
equating activities of daily living with an ability to work.”);
Bjornson v. Astrue, 671 F.3d 640, 647 (7th Cir. 2012) (remanding
and noting recurring failures by ALJs to recognize differences
between activities of daily living and demands of competitive
employment); Craft v. Astrue, 539 F.3d 668, 680 (7th Cir. 2008)
(remanding because ALJ ignored claimant’s qualifications “as
to how he carried out [daily living] activities”).
The judgment is REVERSED with directions to REMAND
the case to the Social Security Administration for further con-
sideration of Moy’s application for benefits consistent with
this opinion.

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