United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER 
I. SCHENKIER United States Magistrate Judge
John Busse, has filed a motion for summary judgment seeking
reversal or remand of the final decision of the Acting
Commissioner of Social Security ("Commissioner")
denying his claim for Social Security disability benefits
(docs. #10: Pl.'sMot. for Summ. J., #11: Mem. in
Support). The Commissioner has filed a response asking the
Court to affirm its decision (doc. #18: Def.'s Resp.).
For the reasons that follow, we grant Mr. Busse's motion.
Busse applied for disability insurance benefits on May 30,
2013, alleging he became disabled on July 13, 2011 (R. 210,
212-18). His date last insured was December 31, 2017 (R. 19).
Mr. Busse's claim was denied initially (R. 100-03), and
again on reconsideration (R. 106-08). An Administrative Law
Judge ("ALJ") held a hearing on July 14, 2015 (R,
61-69), but separated from the agency before rendering an
opinion (R. 39). Another ALJ held a de novo hearing
on February 25, 2016 (Id.). On April 21, 2016, the
ALJ issued a written opinion finding Mr. Busse was not
disabled from My 13, 2011 through the date of the decision
(R. 16-30). The Appeals Council denied Mr. Busse's
request for review, making the ALJ's determination the
final decision of the Commissioner (R. 1-4, 14). 20 C.F.R.
§ 404.981; Cullinan v. Berryhill, 878 F.3d 598,
603 (7th Cir. 2017).
Busse was born on November 23, 1958 and earned a high school
diploma (R. 212, 265, 496). He began working for Caterpillar,
Inc. in September 1988 (R. 337). Mr. Busse worked as a
numerical control machine operator and set-up person through
the end of his employment in 2011 (R. 55-56).He was discharged
from Caterpillar on July 13, 2011 for not meeting the
expectations laid out in a May 9, 2011 Performance
Improvement Plan (R. 376, 379). Mr. Busse has not worked since
his termination from Caterpillar (R. 42, 71, 351).
Busse's alleged onset date is the same date that his
employment was terminated, July 13, 2011 (R. 212, 379). In
his Disability Report, dated June 17, 2013, Mr. Busse wrote
that he stopped working "[b]ecause of [his]
condition(s), " which he identified as bipolar disorder,
depression and anxiety (R. 264). In his August 20, 2013
Function Report, Mr. Busse stated that he has been
"under the care of multiple professionals in the
'mental health field' since 1994 and being on
medication to treat depression, ADHD, bipolar disorder and
anxiety for almost 20 years now has taken its toll on my
mind" (R. 287). More specifically, Mr. Busse claimed he
has "a very meager/poor 'short term memory';
[which] combined with [his] feeble concentration skills made
it difficult for [him] to process tasks from start to finish
in a single setting" (Id.). With regard to his
social activities, Mr. Busse wrote that he had become
"more of a recluse; staying home more to avoid
confrontation and large groups of people" (R. 292). In
addition, Mr. Busse noted that he "[has] problems"
with authority figures and he takes "medication for
anxiety to handle 'life, ' I don't like stress
and don't perform well under it" (R. 293). Finally,
Mr. Busse explained that since losing his job, he has gained
over 50 pounds and is "very self-aware of my larger size
and don't like it at all" (R. 294).
Mr. Busse's mental health history dates back to at least
1994, when he began medication and outpatient psychiatric
treatment (R. 43, 287, 496), this Court will focus on those
facts relevant to Mr. Busse's alleged disability
beginning with his alleged onset date in July 2011. Mr. Busse
has primarily been under the care of two doctors relevant to
his claim: a psychiatrist, John Goldin-Mertdogan, M.D., as
well as a psychologist, Timothy Buhrt, Psy.D. (R. 339).
Busse began treatment with Dr. Goldin-Mertdogan in July 2008
(R. 508). Mr. Busse saw Dr. Goldin-Mertdogan regularly, with
at least 29 visits taking place after Mr. Busse's alleged
onset date (R. 604-10). In late July 2011, Dr.
Goldin-Mertdogan diagnosed Mr. Busse with bipolar affective
disorder, attention deficit disorder with hyperactivity
("ADHD") and other personality disorders (R. 400).
Dr. Goldin-Mertdogan also prescribed Ability, Topamax,
Adderall and Lexapro during this visit (Id.). At a
follow-up visit a month later, Dr. Goldin-Mertdogan
discontinued Adderall, added Xanax and Vyvanse, and continued
Mr. Busse's other medications (R. 399). The next month,
Dr. Goldin-Mertdogan switched Mr. Busse from Vyvanse back to
Adderall (R. 398). Dr. Goldin-Mertdogan maintained the same
diagnoses and medications through mid-March 2012 (R. 395-97).
Goldin-Mertdogan's treatment records show a trend of
waxing and waning symptoms documenting both positive and
negative self-reports from Mr. Busse as well as positive and
negative observations by the doctor. For example, on June 22,
2012, Dr. Goldin-Mertdogan noted signs of insomnia and
depression, as well as a blunted affect, a mood of "35
to 40/100, " and poor energy level and motivation (R.
394). Dr. Goldin-Mertdogan increased Mr. Busse's Lexapro
dosage and refilled his remaining prescriptions
(Id.). Mr. Busse's visits on July 19, 2012,
September 13, 2012, November 15, 2012, March 8, 2013, and May
23, 2013 revealed positive observations, including an
"improved mood" and "brighter and calmer
affect" (R. 384-85, 389-92). Despite Dr.
Goldin-Mertdogan's positive observations, Mr. Busse
complained that he continued to have difficulty falling
asleep (R. 384). Dr. Goldin-Mertdogan restated his initial
diagnoses and prescribed Xanax and Ativan (Id.).
January 11, 2013 and March 1, 2013 treatment notes, Dr.
Goldin-Mertdogan observed that Mr. Busse's mood had
worsened (R. 386, 388). During their January meeting, Mr.
Busse stated his "unemployment benefits were suddenly
cut off a few weeks ago" and Dr. Goldin-Mertdogan
advised him to apply for social security disability insurance
through Medicare (R. 388). The following month, Mr. Busse
reported that he had run out of prescription medications and
could not afford many of them (R. 387). At their March 1,
2013 appointment, Mr. Busse continued to express that he was
upset his unemployment benefits had been cut off and Dr.
Goldin-Mertdogan indicated that "[patient] assistance
forms were completed and signed" (R. 386). In visits on
August 8, 2013 and October 4, 2013, Dr. Goldin-Mertdogan
observed increased anxiety, a worried, upset, and
stressed-out mood, an "agitated and nervous"
affect, and poor attention and concentration (R. 462-63). At
the August visit, Dr. Goldin-Mertdogan prescribed Strattera,
increased the Xanax prescription daily dosage, and continued
Ativan (R. 463); in October, he increased the Strattera
dosage and continued Ativan and Xanax (R. 462).
March 10, 2014, Dr. Goldin-Mertdogan opined as part of a
Non-Exertional Impairment Questionnaire that Mr. Busse was
"unable to work due to [b]ipolar [and] ADHD" (R.
515). He also completed a Psychiatric/Psychological
Impairment Questionnaire, diagnosing Mr. Busse with bipolar
disorder and ADHD, and assigning a Global Assessment
Functioning Score ("GAF") of 60 (R.
508). He noted that Mr. Busse's lowest GAF
score within that year was 40 (Id.). Dr.
Goldin-Mertdogan listed symptoms including poor focus,
inattention, labile mood swings, hopelessness, worthlessness,
anxiety, fear, paranoia, irritability, anger, amotivation,
and difficulty completing tasks as his "primary"
symptoms (R. 509-10). The doctor further found that Mr. Busse
was "markedly limited" in his "ability to set
realistic goals or make plans independently" (R. 511),
his impairments were ongoing (R. 512), and that he was
"[i]ncapable of even iow stress"'
(Id.). Finally, Dr. Goldin-Mertdogan estimated that
Mr. Busse would be absent from work more than three times per
month as a result of these impairments (R. 513).
subsequent 2014 visits again yielded both positive and
negative observations and self-reports. On March 14, 2014,
Mr. Busse reported becoming increasingly tearful with
depressed moods and feeling "extremely anxious over
small things" (R. 460). Dr. Goldin-Mertdogan's
observations at that visit, however, included "no
insomnia, decreased anxiety, no depression . . . calmer mood,
calmer and brighter affect ... no tearfulness . . . [and]
less frustrated moods;" but Dr. Goldin-Mertdogan noted
that Mr. Busse also exhibited poor attention and
concentration (Id.), On June 13, 2014, Mr. Busse
reported that "his moods have been depressed
lately" with passive suicidal thoughts, and Dr.
Goldin-Mertdogan prescribed Adderall, Ativan, Xanax, Abilify,
Celexa and Topamax (R. 502). On August 8, 2014, Mr. Busse
reported that he felt it was "highly unlikely [he could]
return to work because he has poor short term memory and
forgets regular conversations with people, " and he
couldn't finish tasks such as mowing his lawn without
distraction (R. 538). Dr. Goldin-Mertdogan also reported that
Mr. Busse's "moods have been somewhat less depressed
lately without any suicidal thoughts" (Id.).
April 10, 2015, Mr. Busse stated that he felt a lack of
motivation, and Dr. Goldin-Mertdogan increased his Adderall
dosage (R. 543). On My 10, 2015, Mr. Busse reported his mood
as anxious and his affect appeared "tense and
constricted" (R. 545). Three days later, Dr.
Goldin-Mertdogan completed a Mental Impairment Questionnaire
in which he noted multiple symptoms, identifying as marked
limitations Mr. Busse's ability to understand, remember,
and carry out detailed instructions and perform activities
within a schedule and consistently be punctual (R. 548-51).
Additionally, he estimated that Mr. Busse was likely to be
absent from work more than three times per month as a result
of these impairments (R. 551). On October 8, 2015 and January
15, 2016, Dr. Goldin-Mertdogan described Mr. Busse's mood
as "anxious and down, " with a blunted affect,
although his attitude was "cooperative and
pleasant" (R. 597, 599).
Buhrt began treating Mr. Busse at least as early as December
2008 (R. 517). Mr. Busse testified at his July 14, 2015
hearing that he saw Dr. Buhrt at least once a month, but
closer to every week or two if his life was "in
shambles" (R. 65, 604-10). On September 21, 2011, Dr.
Buhrt observed Mr. Busse to be moderately depressed, worried,
sad, deflated, annoyed, pessimistic and negative, diagnosing
him with recurrent moderate major depressive disorder (R.
577). Dr. Buhrt's observations were identical in November
2011, but his June and July 2012 and January 2013 progress
notes indicate that Mr. Busse had become severely depressed
and moderately anxious (R. 573-76). On July 3, 2013, Dr.
Buhrt observed that Mr. Busse's mood, energy, feelings of
worthlessness or guilt, and ability to think or concentrate
had worsened (R. 572). Mr. Busse reported his mood as
depressed, his affect was "dysphoric, " and his
insight and judgment as compromised (Id.). That
said, Dr. Buhrt described Mr. Busse as "cooperative,
friendly, and engaging with good eye contact and normal
attention, focus and activity levels" (Id.).
Dr. Buhrt's progress notes reiterated these negative and
positive observations through November 17, 2014, though one
progress note described his mood as irritated rather than
depressed (R, 562-71). On April 13, 2015, his mood was
described as "irritated with affect as somewhat
restricted and blunted, but context responsive" (R.
15, 2015, Dr. Buhrt completed a Mental Impairment
Questionnaire in which he reiterated his diagnosis of major
recurrent depressive disorder and also diagnosed Mr. Busse
with ADHD (R. 517-21). He assigned Mr. Busse a GAF score of
50 (R. 517). Dr. Buhrt identified Mr. Busse's most
frequent and/or severe symptoms as depressed mood, anhedonia,
weight gain, sleep difficulties, fatigue, feeling of
worthlessness, and diminished ability to think or concentrate
(R. 519). He further opined that Mr. Busse had marked
limitations in his ability to remember locations and
work-like procedures, understand and remember detailed
instructions, maintain attention and concentration for
extended periods, and perform activities within a schedule
and consistently be punctual (R. 520). Finally, he estimated
that Mr. Busse would be absent from work more than three
times per month as a result of these impairments (R. 521).
18, 2015, Mr, Busse described his mood as "O.K."
(R. 558), yet from late June to late August 2015, Dr.
Buhrt's progress notes continued to indicate Mr. Busse
was depressed, sad, or irritated with a dysphoric or anxious
affect (R. 553-57). In a letter addressed to Mr. Busse's
counsel, dated September 27, 2015, Dr. Buhrt concluded:
Given the numerous years Mr. Busse has struggled with
fluctuating levels of depression, despair, anxiety, and
agitation, he would be unable to maintain consistent
employment .... Mr. Busse has worked diligently to address
his physical and emotional difficulties through medication
and outpatient counseling. Unfortunately, the level [of]
psychological distress that ...