United States District Court, N.D. Illinois, Eastern Division
MEMORANDUM OPINION AND ORDER 
I. Sehenkier, United States Magistrate Judge
Sheila Denise Rice, seeks reversal and remand of the final
decision of the Acting Commissioner of Social Security
("Commissioner") denying her application for Social
Security benefits (doc. # 12: Pl.'s Mot. for Summ. J.).
After a hearing, an administrative law judge
("ALJ") denied Ms. Rice's application for
benefits, and the Appeals Council denied her request for
review of that decision, making the ALJ's decision the
final decision of the Commissioner (R, 1). The Commissioner
has filed a cross-motion asking the Court to affirm the
ALJ's decision (doc, # 14: Def.'s Mot. for Summ. J.).
For the reasons that follow, we grant Ms. Rice's motion.
Rice has been depressed most of her life (see, e.g.,
R. 579, 601, 663). She was treated for depression as early as
1994, and has taken anti-depressant medications since 2011
(R. 476-77). From 1990 through July 2013, Ms, Rice worked
full-time as an administrative assistant for Luster Products
("Luster") (R. 54), but testified that she stopped
working in July 2013 because her depression worsened to the
point she became overwhelmed and was unable to control her
frequent bouts of crying (R. 57-58, 62-63; see also
R. 601, 607).
Rice's application for Social Security disability
benefits alleged that she became disabled on July 31, 2013,
due to breast cancer, anxiety, depression, thyroid disorder,
high blood pressure, tendonitis and osteoporosis (R. 110-11).
The day before, July 30, 2013, psychiatrist, Filogonio Moises
Gaviria, M.D., conducted an IOP (intensive outpatient
program) intake evaluation of Ms. Rice (R. 425). Dr. Gaviria
noted Ms. Rice had been in the hospital for a week before her
insurance approved her for IOP treatment (Id.), He
observed that Ms. Rice "appear[ed] glum, listless,
irritable, distracted" and "severely depressed,
" and he diagnosed her with major depression and mixed
personality disorder (R. 425-26). Dr. Gaviria prescribed Ms.
Rice two antidepressants, Effexor and citalopram (R. 426). On
February 28, 2014, Dr. Gaviria filled out a mental capacity
assessment that diagnosed Ms. Rice with major depressive
disorder,  and - via checked boxes - opined that she
had moderate to marked limitations in understanding and
memory, marked to extreme limitations in sustained
adaptation, concentration and persistence, and moderate to
extreme limitations in social interaction (R. 503-05).
December 11, 2013, Ms. Rice was evaluated by Ericka Swanson,
Psy.D., for the Department of Disability Services
("DDS") (R. 475). Dr. Swanson observed Ms. Rice had
poor eye contact and was tearful throughout the meeting (R.
475, 478). She diagnosed Ms. Rice with major depressive
disorder, moderate without psychotic features and assigned
her a Global Assessment Functioning ("GAF") score
of 43 (R. 479).
9, 2014, Ms. Rice visited her primary care physician,
Mohammad Shamshuddin, M.D., for follow-up after she was seen
at urgent care for agitation and an anxiety attack (R. 540).
He observed Ms. Rice had a depressed affect, was anxious, and
complained of palpitations and dizziness (R. 542-44). Dr.
Shamshuddin prescribed an additional antidepressant,
September 22, 2014, Ms. Rice was admitted to Ingalls Memorial
Hospital because she had thoughts of killing herself and was
assessed as a high risk of harm to herself or others (R. 665,
668-70). She was tearful and depressed, with poor judgment,
insight and impulse control, and she was assessed a GAF score
of 30 (R. 663, 668-70). Ms. Rice reported that her mood had
been worsening for four to five weeks, since she
"weaned" herself off mental health medications
after she lost her insurance and could no longer afford to
see Dr. Gaviria or purchase her medications (R. 678, 663,
681). Intake notes described some of Ms. Rice's behavior
as "manic, " including buying two guitars and a
keyboard, tearing wood off her front porch, moving a 400
pound couch outside her house, cutting off all her hair, and
getting a facelift in January 2014 (R. 665-66). Her primary
diagnosis was major depression, secondary to drug abuse (she
tested positive for opioids and cannabis) (R, 677-79). While
in the hospital, Ms. Rice was given citalopram and
lamotrigine (an anticonvulsant used to treat bipolar
disorder) (R. 679). At discharge on September 27, 2014, her
GAF score was 50, she was feeling less hopeless and helpless
and sleeping and eating better, but she still had a depressed
mood and affect (R. 682).
October 1, 2014 Ms. Rice began outpatient mental health
treatment at Sertoma Centte ("Seitoma") for severe
major depressive disorder (R. 583-85). Her GAF during that
month was (7th Cir. 2018). The DSM-V, issued in 2013, is the
latest version of the Diagnostic and Statistical Manual of
Mental Disorders; in it the American Psychiatric Association
eliminated use of the GAF system. Id. at 263 n.l.
consistently assessed at 40 (see, e.g., R. 607,
624). At her appointment on October 8, 2014, Ms. Rice
reported that she felt out of control of her emotions; she
described having crying spells, feelings of hopelessness and
worthlessness, fatigue, difficulty sleeping, low motivation,
difficulty concentrating, and depression so bad that she
often had difficulty getting out of bed (R. 610-11). On
October 13, 2014, Ms. Rice said her "stress has been
especially overwhelming and difficult to manage in the last
few years;" she "kept it pretty much under control
at work until last year" when she could no longer
"deal with confrontations" and "would get
upset easily at work during meetings, would leave and
cry" (R. 601).
October 24, 2014, J.B. Goebel, Ph.D., conducted a mental
status evaluation of Ms. Rice for DDS, at which Ms. Rice was
tearful and had poor eye contact (R, 579-80). Dr. Goebel
diagnosed her with major depressive disorder and opined Ms.
Rice was mildly impaired in understanding and memory,
moderately impaired in her ability to sustain persistence and
concentration, and not limited in her ability to interact and
adapt socially (R, 581). On November 4, 2014, DDS consultant,
Russell Taylor, Ph.D., opined based on the medical record
that Ms. Rice had severe affective and anxiety disorders,
resulting in moderate impairment in concentration,
persistence, and pace; mild restriction in activities of
daily living ("ADLs") and social functioning, and
no repeated episodes of decompensation (R. 127-29, 132-33).
Rice continued receiving therapy at Sertoma over the next few
months. In November 2014, she was depressed and tearful, and
her GAF score was 40 (R, 590, 713). In December, Ms. Rice
reported struggling with feelings of sadness after attending
church for the first time in months, but later that month,
she began to feel less depressed and expressed the desire to
work again so she could provide for herself (R. 717, 721,
725). On January 6, 2015, however, Ms. Rice reported feeling
mistreated and left out by her family over the holidays (R.
731), and the next week, she was "almost immediately
depressed and in tears during [the] meeting" (R. 739).
January 21, 2015, Ms. Rice walked into Ingalls hospital,
presenting as stressed, tearful and anxious, and complaining
of headaches; she was discharged with a prescription for
Alprazolam (a sedative) (R.648, 650, 654). The next day, Ms.
Rice returned to Sertoma. She was tearful and stressed, but
she wanted to start working as a caregiver for her mother to
earn money (R. 747, 751). On January 29, 2015, Ms. Rice
reported feeling less depressed, and in February, despite
remaining a bit depressed and stressed, Ms. Rice was working
at her mother's house and applying for other jobs (R.
753-57). On February 26, 2015, however, she was stressed
because she had taken on three caregiver jobs and had been
fighting with her mother (R, 761).
March 5, 2015, Ms. Rice cried throughout her session at
Sertoma because she was frustrated with her job search and
felt she was getting "old and tired;" she became
guarded and defensive and left her session abruptly (R. 763).
On March 12, 2015, Ms. Rice was again tearful, and she became
angry at her therapist and walked out of the session (R,
769). Ms. Rice did not return to Sertoma; between March 26
and June 8, 2015, she informed staff by phone that she was
unable to meet because she had job interviews and
appointments and was too busy working (R. 772-74, 795). Ms,
Rice also said she felt better emotionally and no longer
needed services (Id.).
Rice did not receive mental health therapy over the next
year-, but notes from her rheumatologist during that time
listed citalopram and Effexor among her medications (R.
819-34). A report from her gynecologist on June 17, 2015,
also stated that Ms. Rice was on multiple antidepressants and
made a referral for her to re-establish psychiatric care (R.
873). In addition, on September 15, 2015, Ms. Rice was kept
overnight at Ingalls hospital for observation after she
complained of chest pain. Cardiac testing was unremarkable,
but she appeared anxious, depressed and tearful, and a
recommendation was made for her to change her dosages of
citaiopram and Effexor (R. 897, 927, 940-41, 1063, 1068).
February 24, 2016, Ms. Rice had an appointment with a
gynecologist and primary care doctor. She was anxious and
tearful during her appointments, and both physicians
recommended Ms, Rice seek psychotherapy (R. 703-04, 862-67).
The primary care physician prescribed clonazepam, a sedative