Young, James v. Barnhart, Jo Anne ( 2004 )


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  •                           In the
    United States Court of Appeals
    For the Seventh Circuit
    ____________
    No. 03-1545
    JAMES YOUNG,
    Plaintiff-Appellant,
    v.
    JO ANNE B. BARNHART,
    Defendant-Appellee.
    ____________
    Appeal from the United States District Court
    for the Western District of Wisconsin.
    No. 02 C 257—Barbara B. Crabb, Chief Judge.
    ____________
    ARGUED SEPTEMBER 15, 2003—DECIDED APRIL 2, 2004
    ____________
    Before POSNER, KANNE, and ROVNER, Circuit Judges.
    ROVNER, Circuit Judge. James Young applied for Social
    Security disability benefits, claiming that he suffered from
    progressively declining cognitive abilities and increasing
    personality problems which interfered completely with his
    ability to work. The Social Security Administration (“SSA”)
    denied Young’s application and upon review, the adminis-
    trative law judge (“ALJ”) determined that Young was not
    disabled. The Social Security Appeals Council denied
    Young’s request for review. Young now appeals from the
    district court’s judgment upholding the denial of benefits.
    Because we find that ALJ’s residual functional capacity
    2                                                No. 03-1545
    assessment and hypothetical question to the vocational
    expert were flawed, we reverse and remand for further
    proceedings.
    I.
    Young, a fifty-five year old veteran, applied to the SSA for
    disability insurance benefits on July 24, 1998, claiming that
    as of December 31, 1992, he was no longer able to work due
    to an adjustment disorder with mixed features, anger
    control, and personality problems. These problems, he
    asserts, stem from a 1987 motorcycle accident and the
    resultant extended coma which left him with residual brain
    injuries. At the time of the accident he was employed as a
    load master with the Air Force, but was discharged in 1990
    after the military determined that he was disabled. Since
    that time, Young has worked in many different jobs with
    very little success at maintaining employment. He was fired
    from his most recent job as a mail carrier for the U.S.
    Postal Service because of, among other things, his inability
    to understand the schedule, report to work on time, relate
    theory to task performance, and complete his deliveries in
    a timely fashion. He also has had little success
    in maintaining employment as a bartender, lawn laborer,
    or airport baggage handler. In 1996 the Department of
    Veterans Affairs (“VA”) found that although Young’s injur-
    ies were seventy percent disabling, he was 100 percent un-
    employable. Since 1997, Young has worked approximately
    thirty hours a week performing custodial duties at a bar
    that his wife, Tamara Young, owns.
    The SSA denied Young’s July 24, 1998 disability benefits
    application and his subsequent request for reconsideration.
    He fared no better before the ALJ who determined, after a
    May 5, 2000 hearing, that Young was not disabled. The
    Social Security Appeals Council declined his request for
    rehearing and the decision of the ALJ, therefore, is the final
    No. 03-1545                                                3
    decision of the Commissioner. On appeal to the United
    States District Court, Magistrate Judge Crocker affirmed
    the decision of the Commissioner. Young filed this appeal
    claiming that (1) the ALJ incorrectly dismissed the consul-
    tative examining doctor’s psychological exam and medical
    opinion, (2) the ALJ erred by using a residual functional
    capacity assessment that did not incorporate all of the
    evidence, (3) the ALJ erred in creating the list of jobs that
    Young could perform, and (4) the ALJ made an improper
    credibility assessment.
    The ALJ had a dizzying array of medical and psychologi-
    cal information to consider, including the opinions of no
    fewer than eight psychological and medical professionals
    who either examined or evaluated Young. Since we review
    the record as a whole, Jens v. Barnhart, 
    347 F.3d 209
    , 212
    (7th Cir. 2003), we briefly summarize some of the relevant
    evidence from the record here:
    In August 1990, Dr. William Hathaway, a staff neuro-
    logist for the U.S. Air Force, examined Young and de-
    termined that he had poor visual memory abilities, relied on
    inefficient mnemonic strategies, was easily distracted
    during learning tasks, but performed within the normal
    range on a host of other memory tasks. He also found that
    Young had some impaired motor functioning in his left
    hand, problems in visuospatial functioning, and had deficits
    in concept formation and conceptual flexibility. Dr.
    Hathaway also noted displays of low frustration tolerance,
    irritability, “impulsivity” and a potential for poor social
    judgment, which he concluded substantially interfered with
    Young’s daily performance. He recommended that the
    military consider Young for final medical retirement.
    In 1996, the Department of Veterans Affairs determined
    that Young was seventy percent disabled (up from thirty
    percent prior) and 100% unemployable. The change in
    disability was based on a Veterans Administration psy-
    chological exam performed in March 1995. That exam
    confirmed mild cognitive deficits, impulsivity, poor social
    4                                              No. 03-1545
    judgment and apathy, and a drop in IQ from the above
    average to normal range, irritability, and short temper. The
    examiner noted at the time that although neuro-
    psychological testing showed only a mild impairment, in
    practice it translated into a significant impairment for
    Young in his social and occupational life. The Veterans
    Administration report indicated that Young had trouble
    climbing, balancing, and working in high places or places
    with poor ventilation. He could not perform fast-paced work
    or work around cluttered or slippery floors, hazardous
    machinery or poor lighting. He also had partial restrictions
    on working alone, working with others, exacting perfor-
    mance, repetitive work, and following instructions.
    In October 1998, the state disability agency referred
    Young to Michael J. Ostrowski, Ph.D. for an evaluation. Dr.
    Ostrowski diagnosed Young with an adjustment disorder,
    finding that he had some symptoms of decreased mood and
    functioning. Dr. Ostrowski did not find pronounced memory
    deficiencies, but noted that he did not conduct formal
    memory testing. He concluded that Young would not have
    difficulty carrying out work-related activities such as
    following instructions, sustaining persistence, and adopting
    to change, but did note that Young’s temper problems might
    make it difficult for Young to relate well to coworkers.
    Dr. Robert Hodes, a consultative non-examining psycholo-
    gist completed an SSA Mental Residual Capacity Assess-
    ment on November 6, 1998, in which he concluded that
    Young was moderately limited in his ability to carry out
    detailed instructions, to interact appropriately with the
    general public, to set realistic goals, and to make plans
    independently of others. Dr. Hodes filled out the SSA
    Psychiatric Review Technique Form in which he noted the
    presence of pathological dependence, passivity or
    aggressivity and moderate difficulties maintaining social
    functioning. Dr. Hodes concluded that Young seemed
    capable of performing simple routine work.
    No. 03-1545                                                5
    Dr. Ward Jankus, a consulting, examining physician with
    the Wisconsin Department of Health and Human Services
    examined Young in early 1999 and determined that he had
    higher level memory and concentration problems and “mild
    higher level balance deficits.” His exam focused mostly on
    Young’s physical condition, which, with the exception of the
    balance problems, was largely unremarkable.
    In April 1999, Dr. Jack Spear, a non-examining, consulta-
    tive psychologist completed a Mental Residual Functional
    Capacity assessment of Young. He found some mild to
    moderate limitations in Young’s ability to understand and
    remember detailed directions, and in his ability to maintain
    attention and concentration for extended periods. He also
    determined that Young was slightly to moderately limited
    in his ability to maintain social functioning, and noted that
    Young had difficulties with concentration, persistence, and
    pace which he described as occurring seldom to often. His
    ultimate conclusion was that Young had an adjustment
    disorder and the mental residual functional capacity to
    perform unskilled work with objects, rather than people or
    data.
    Dr. Timothy Howell examined Young in July 1999, and
    determined that he had a short-term memory impairment,
    and a personality change manifested by an increased tend-
    ency to become irritable. Dr. Howell noted that Young’s
    memory problems had interfered with his past job perfor-
    mance. Howell gave Young a score of fifty on the Global
    Assessment of Functioning Scale, indicating serious symp-
    toms or functional limitations.
    Dr. Douglas Varvil-Weld, a psychologist who, in February
    2000, examined Young at the request of the ALJ, found
    significant deficits in Young’s ability to maintain attention
    and concentration and to understand, remember, and carry
    out complex job instructions. He also found some deficits in
    Young’s ability to use judgment, function independently,
    cope with work stress, and in his ability to understand,
    remember, and carry out even simple job instructions. Dr.
    6                                               No. 03-1545
    Varvil-Weld administered memory testing which revealed
    some memory deficiencies, including memory deficiencies
    affecting attention and concentration. He concluded that
    Young might have difficulty sustaining his efforts and
    persistence in a work environment. He also concluded that
    Young could be expected to have some difficulty with dis-
    tractibility, with remembering and carrying out instruc-
    tions, and with physically tolerating stress in the work-
    place. He found no evidence that he would have difficulty
    working effectively with others.
    The medical expert, Dr. Kenneth Sherry, testified at
    Young’s May 5, 2000 disability hearing. Although he could
    not explain the degradation in Young’s memory functioning
    between the 1990, 1998, and 1999 evaluations on the one
    hand and Dr. Varvil-Weld’s testing in March 2000, he did
    report that Young had problems with visual-spacial mem-
    ory, higher cognitive functioning, and some visual memory
    problems. In addition, he was able to conclude that Young
    would have problems with concentration, persistence, and
    pace—problems that might occur frequently or often.
    Although Dr. Sherry noted that Young had lost two jobs due
    to his temper and that those behavior problems might be
    part of his organic mental syndrome, he had trouble
    evaluating whether Young would suffer from deterioration
    and decompensation in work or work-like settings.
    The ALJ also heard the testimony of Young and his wife.
    Young testified that he often had trouble remembering
    things, and that these memory deficits have caused him
    great trouble in work settings. He testified that he lost his
    job with the post office because he could not remember the
    routes and procedures, and that at his wife’s bar he forgets
    to put away cleaning supplies and sometimes triggers the
    security alarm. Young testified that he was fired from two
    jobs due to physical altercations with coworkers, and that
    he can no longer work as a bartender because of his temper.
    He also testified that he generally sticks close to
    home—doing housework, playing computer games, and
    No. 03-1545                                                7
    watching television. When he does go out socially, he relies
    on his wife to keep him from offending others. Tamara
    Young corroborated her husband’s testimony, noting in
    particular her husband’s memory and temperament prob-
    lems.
    II.
    The Commissioner has set forth a five-step evaluation
    process to determine whether a claimant is disabled. Fol-
    lowing this process, the ALJ considered:
    (1) Whether Young was currently engaged in substan-
    tial gainful activity?
    (2) Whether Young had a severe impairment?
    (3) Whether Young’s impairment met or equaled one of
    the impairments listed in the SSA regulations?
    (4) Whether Young could perform his past relevant
    work?
    (5) Whether Young could make the adjustment to other
    work?
    20 C.F.R. § 404.1520(a)(4)(i)-(iv). Scheck v. Barnhart, 
    357 F.3d 697
    , 699-700 (7th Cir. 2004). The process is sequential,
    and if the ALJ can make a conclusive finding at any step
    that the claimant either is or is not disabled, then she need
    not progress to the next step. 20 C.F.R. § 404.1520(a)(4). If
    the claimant makes it past step four, the burden shifts to
    the Commissioner to demonstrate that the claimant can
    successfully perform a significant number of jobs that exist
    in the national economy. Zurawski v. Halter, 
    245 F.3d 881
    ,
    886 (7th Cir. 2001).
    In this case, the ALJ proceeded through all five steps of
    the analysis. He concluded that (1) Young had not engaged
    in substantial gainful activity during the relevant time
    8                                                No. 03-1545
    period, (SSA Decision at 7); (2) Young’s impairments were
    severe, (Id. at 2, 7);1 (3) they did not meet or equal one of
    the impairments listed in the SSA regulations, (Id. at 7-8);
    (4) Young could not perform his past relevant work, (Id. at
    8); and (5) Young could, in fact, make the adjustment to
    work at a number of jobs which exist in the national
    economy in significant numbers. (Id. at 8-9).
    At the fourth and fifth steps, the ALJ must consider an
    assessment of the claimant’s residual functional capacity
    (“RFC”). The RFC is an assessment of what work-related
    activities the claimant can perform despite her limitations.
    Dixon v. Massanari, 
    270 F.3d 1171
    , 1178 (7th Cir. 2001); 20
    C.F.R. § 404.1545(a)(1) (“Your residual functional capacity
    is the most you can still do despite your limitations.”) The
    RFC must be assessed based on all the relevant evidence in
    the record. 20 C.F.R. § 404.1545(a)(1).
    The ALJ made a determination that Young had the RFC
    to perform the nonexertional requirements of simple, rou-
    tine, repetitive, low stress work with limited contact with
    coworkers and the public. (SSA Decision at 8).
    Young argues, in his initial point, that the ALJ improp-
    erly rejected the medical evidence submitted by one of the
    medical experts, Dr. Varvil-Weld. Had he accepted the
    report of Dr. Varvil-Weld, Young argues, the ALJ would
    have found that Young’s memory and concentration diffi-
    culties were far more significant than he found. Young also
    argues that, had the ALJ parsed the medical evidence from
    the other experts, he would have found that it was not, in
    fact, conflicting but that it supported Young’s disability
    claim.
    1
    If the claimant does not have a severe impairment, then the
    ALJ must find that the claimant is not disabled and the inquiry
    ends.
    No. 03-1545                                                  9
    In reviewing the decision of the ALJ, we cannot engage in
    our own analysis of whether Young is severely impaired as
    defined by the SSA regulations. 
    Jens, 347 F.3d at 212
    . Nor
    may we reweigh evidence, resolve conflicts in the record,
    decide questions of credibility, or, in general, substitute our
    own judgment for that of the Commissioner. Lopez v.
    Barnhart, 
    336 F.3d 535
    , 539 (7th Cir. 2003). Our task is
    limited to determining whether the ALJ’s factual findings
    are supported by substantial evidence. 42 U.S.C. § 405(g);
    
    Jens, 347 F.3d at 212
    ; Stevenson v. Chater, 
    105 F.3d 1151
    ,
    1153 (7th Cir. 1997). Evidence is substantial if a reasonable
    person would accept it as adequate to support the conclu-
    sion. 
    Stevenson, 105 F.3d at 1153
    .
    Young complains that “the ALJ appears to give greater
    weight to the earlier 1990 mental status exam conducted by
    the VA, than to the recent mental status exam conducted in
    February 2000.” Appellant’s Brief at 19. Weighing conflict-
    ing evidence from medical experts, however, is exactly what
    the ALJ is required to do. See Books v. Chater, 
    91 F.3d 972
    ,
    979 (7th Cir. 1996) (pointing out that when assessing
    conflicting medical evidence, an ALJ must decide, based on
    several considerations, which doctor to believe). And we
    may not re-weigh the evidence. 
    Jens, 347 F.3d at 212
    . The
    ALJ did not ignore Dr. Varvil-Weld’s evidence as Young
    maintains, but rather considered it in light of all of the
    other evidence before him. In considering the weight to give
    to the 1990 and 2000 memory examinations, the judge
    considered the testimony of Dr. Sherry who stated that he
    could not find a medical explanation for the significant drop
    in Young’s memory function, and considered the fact that
    Young had “an incentive not do well” on the later evaluation
    since it was administered for the purpose of determining
    Young’s eligibility for benefits. This conclusion is not an
    improper medical determination, but rather is the type of
    context consideration that judges regularly make when
    assessing the weight to attribute to conflicting evidence.
    10                                              No. 03-1545
    We cannot conclude that the ALJ’s decision to disfavor
    the evidence submitted by Dr. Varvil-Weld regarding
    Young’s mental status examination scores was not sup-
    ported by substantial evidence. The ALJ evaluated the
    evidence submitted by the many medical experts in this
    case and where that evidence was conflicting, he resolved
    those conflicts by giving more weight to some evidence and
    less to others. Specifically, he concluded that Dr. Varvil-
    Weld’s conclusions that Young had poor or no capacity to
    maintain attention and concentration was inconsistent with
    other medical opinions and worthy of less weight. This is
    not a case where a treating physicians’ opinion was disre-
    garded in favor of the opinion of a consulting physician. See
    
    Books, 91 F.3d at 979
    ; 20 C.F.R. § 404.1527(d)(2). In this
    case, none of the medical experts was a treating physician.
    Nor was it a case where the ALJ improperly rejected an
    examining physician’s opinion in favor of a non-examining
    physician’s decision. Gudgel v. Barnhart, 
    345 F.3d 467
    , 470
    (7th Cir. 2003) (“An administrative law judge can reject an
    examining physician’s opinion only for reasons supported by
    substantial evidence in the record; a contradictory opinion
    of a non-examining physician does not, by itself, suffice.”)
    But in this case one examining physician’s opinion was
    contradicted by several other examining and non-examining
    physicians’ opinions. After weighing the evidence, the ALJ
    opted to believe the latter group of experts. The ALJ’s
    decision that the evidence presented by Drs. Hathaway,
    Spear, Hodes, Ostrowski, Jankus, and Howell more accu-
    rately reflected Young’s cognitive and memory problems
    was supported by substantial evidence.
    This conclusion, however, resolves only half of the story.
    In addition to the cognitive and memory problems at issue
    in the conflict between Dr. Varvil-Weld’s conclusions
    and those of the other experts, Young claims to suffer from
    problems involving his temper and poor social judgment.
    The ALJ found that Young was severely impaired by an
    adjustment disorder marked by blunted insight and judg-
    No. 03-1545                                               11
    ment, decreased mood and functioning, and an increased
    tendency to become irritable. (SSA Decision at 2-3). He also
    appears to have credited the findings of medical experts
    who found that Young is impulsive, apathetic, and has poor
    social judgment (SSA Decision at 3,4) and that he is mod-
    erately limited in his ability to carry out detailed instruc-
    tions, interact appropriately with the general public, set
    realistic goals, make plans independently of others, and
    respond to criticism from supervisors (SSA Decision at 5-6).
    After a thorough review of the record, we are unable to
    determine, however, whether the ALJ’s assessment of
    Young’s RFC adequately considers these personality dis-
    orders. The ALJ concluded that Young “had the residual
    functional capacity to perform the nonexertional require-
    ments of simple, routine, repetitive, low stress work with
    limited contact with coworkers and the public. There were
    no exertional limitations.” (SSA Decision at 8).
    Although this RFC requires that Young have limited
    contact with the public and coworkers, it says nothing
    of limiting contact with supervisors, despite the fact that
    there was substantial evidence within the record that
    Young has difficulty accepting instruction, responding ap-
    propriately to criticism, and interacting with others on the
    job. Nor does the ALJ explain how he reconciles Young’s
    two conflicting limitations—the fact that Young will have
    difficulty accepting instruction and criticism from others on
    the one hand and the fact that he has difficulty making
    plans independently and setting realistic goals on his own
    on the other hand. At oral argument the attorney for the
    Commissioner argued that the RFC accounted for all of
    these mental impairments. But we are not so convinced. If
    the ALJ meant to capture all of Young’s social and tempera-
    ment problems within this RFC, he has failed to build the
    “accurate and logical bridge from the evidence to his
    conclusion so that, as a reviewing court, we may assess the
    validity of the agency’s ultimate findings and afford a
    claimant meaningful judicial review.” Scott v. Barnhart, 297
    12                                                No. 03-1545
    F.3d 589, 595 (7th Cir. 2002); see also Steele v. Barnhart,
    
    290 F.3d 936
    , 941 (7th Cir. 2002). The ALJ has not suffi-
    ciently connected the dots between Young’s impairments,
    supported by substantial evidence in the record, and the
    RFC finding. The RFC falls short because it fails to account
    for the evidence in the record regarding Young’s problems
    accepting instruction, responding appropriately to criticism
    from supervisors, thinking independently, and setting
    realistic goals.
    Because the administrative judge used this RFC as the
    basis for his hypothetical question to the vocational expert,
    his hypothetical question also failed to include all of the
    necessary information. Ordinarily, a hypothetical question
    to the vocational expert must include all limitations sup-
    ported by medical evidence in the record. 
    Steele, 290 F.3d at 942
    . It is important for the vocational expert to understand
    the full extent of the applicant’s disability so that the expert
    does not declare the applicant capable of undertaking work
    in the national or local economy that the applicant cannot
    truly perform. 
    Id. The hypothetical
    need not include every
    physical limitation, provided that the vocational expert had
    the opportunity to learn of the applicant’s limitations
    through, for example, an independent review of the medical
    records or through other questioning at the hearing. 
    Id. Nevertheless, where
    the hypothetical does not include all of
    the applicant’s limitations, we must have some amount of
    evidence in the record indicating that the vocational expert
    knew the extent of the applicant’s limitations. 
    Id. In this
    case, the record indicates that the vocational expert testi-
    fied that he had reviewed all of the contents of the exhibits
    in this case and had heard the testimony presented at
    Young’s hearing. The exhibits included the reports of
    doctors Hathaway, Ostrowski, Hodes, Jankus, Spear,
    Howell, and Varvil-Weld along with the VA reports.
    In many cases, imputing knowledge to the vocational
    expert of everything in the exhibits and testimony from the
    hearing will be sufficient to allow an ALJ to assume that
    No. 03-1545                                                   13
    the vocational expert included all of these limitations in his
    assessment of the number of jobs that the applicant can
    perform, 
    Id. at 942;
    see also Ragsdale v. Shalala, 
    53 F.3d 816
    , 820-21 (7th Cir. 1995); Herron v. Shalala, 
    19 F.3d 329
    ,
    337 (7th Cir. 1994); Cass v. Shalala, 
    8 F.3d 552
    , 556 (7th
    Cir. 1993); Ehrhart v. Sec’y of Health and Human Servs.,
    
    969 F.2d 534
    , 540 (7th Cir. 1992), but this is not such a
    case. In this case, the ALJ took a different approach to the
    hypothetical question and decided to ask the vocational
    expert a series of hypothetical questions with increasingly
    debilitating limitations. For each question he circumscribed
    the exact limitations the vocational expert was to follow. He
    gave the following instructions:
    I want to ask you a hypothetical question. For any of
    these hypothetical questions please consider the claim-
    ant’s age, education, and work history please. For the
    first hypothetical assume an individual with no exer-
    tional limitations. I’m going to modify this about three
    times, but we’ll start off with no exertional limitations.
    (R. at 247). By the nature of the questioning, therefore, the
    vocational expert was prohibited from considering physical,
    psychological, or cognitive limitations that he may have
    absorbed either through reviewing the evidence in the
    record or by listening to the hearing testimony. He was
    instructed to stick to the particular facts of the hypothetical
    along with the claimant’s age, education, and work history.2
    2
    We make a special note that this situation differs from the one
    where a vocational expert independently learned of the other
    limitations through other questioning at the hearing or outside
    review of the record and there is evidence that he accounted for
    these limitations. See 
    Steele, 290 F.3d at 942
    ; 
    Ragsdale, 53 F.3d at 820-21
    ; 
    Herron, 19 F.3d at 337
    ; 
    Cass, 8 F.3d at 556
    , 
    Ehrhart, 969 F.2d at 540
    . We do not intend to overrule that line of cases
    which allows a reviewing court to impute to the expert knowledge
    (continued...)
    14                                                  No. 03-1545
    The vocational expert responded to six hypothetical
    questions—three from the ALJ and three from Young’s
    attorney. We can assume from the ALJ’s findings, that
    he based his conclusions about Young’s ability to work
    on the third hypothetical. We can make this assumption
    because the RFC upon which the ALJ settled in his findings
    corresponded exactly with his third hypothetical. That hy-
    pothetical asked the expert to assume that a claimant of
    Young’s age, education, and work experience could perform
    only “simple, routine, repetitive, low stress work with
    limited contact with coworkers and limited contact with the
    public.” (R. at 247-49). In response to this hypothetical
    question, the vocational expert concluded that Young was
    functionally capable of working as a sorter (light or seden-
    tary), a packager (medium, light, or sedentary), an assem-
    bler (light or sedentary) or an inspector (light or
    sedentary).3
    The hypothetical questions presented by the ALJ, like the
    flawed RFC on which they were based, made short shrift of
    Young’s social and temperamental impairments. Even
    accepting the ALJ’s decision to give limited weight to Dr.
    Varvil-Weld’s testing and evaluation, the hypothetical
    questions failed to include all of the limitations supported
    by the medical evidence in the record from the other experts
    whose assessments the ALJ did credit. For example, the
    hypothetical failed to account fully for the findings of
    almost all of the credited medical experts that Young had
    (...continued)
    of limitations that were not specifically included in the question
    but included elsewhere in the record or hearing testimony.
    3
    The ALJ subsequently concluded that, given the limitations
    listed in the RFC (which corresponded exactly to hypothetical
    question number three), Young could perform three categories of
    work in the economy—that of sorter, packager, and assembler. We
    assume that his omission of the inspector positions was simply an
    error.
    No. 03-1545                                                    15
    significant impairments in social judgment. For example,
    Dr. Hathaway found, “continued indications of impulsivity,
    poor social judgment, and interpersonal difficulties . . . .
    The fact that he has not maintained any consistent gainful
    employment since the accident suggests that these factors
    substantially interfere with his daily performance.”
    (R. at 173). The Veterans Administration report noted that
    Young had “partial restrictions on working alone, working
    around others, exacting performance, repetitive work, fol-
    lowing instructions,” and noted that “given his impairment
    in concentration, learning, and interacting with others, it is
    reasonable to conclude that his disabilities would prevent
    him from obtaining and maintaining gainful employment.”
    (R. at 121-22). Dr. Ostrowski found some symptoms of
    decreased mood and functioning, and stated that “relating
    to co-workers may prove difficult.” (R. at 127). Dr. Spear
    concluded that Young was moderately limited in his ability
    to interact with the general public, to accept instruction,
    and to respond appropriately to criticism from supervisors.
    (R. at 145). Finally, Dr. Hodes checked a box diagnosing
    Young with pathological dependence, passivity, or
    aggressivity and also found him to have moderate limita-
    tions in his ability to interact with the public and make
    plans independently of others. (R. at 137).
    For all of the same reasons that the RFC fell short, the
    hypothetical question, which was based entirely on that
    RFC did as well.4 By the time the ALJ reached the fifth step
    of the five-step disability evaluation process (see supra p. 7)
    4
    We also agree with the magistrate and district court judges be-
    low that the hypothetical question was flawed in that it purported
    to tell the vocational expert what types of work Young could
    perform rather than setting forth Young’s limitations and
    allowing the expert to conclude on his own what types of work
    Young could perform. We need not decide whether this error by
    itself is harmless, as we hold that the hypothetical was fatally
    flawed for other reasons.
    16                                               No. 03-1545
    the entire finding of disability or no disability hinged on the
    validity of the hypothetical question. When the hypothetical
    question is fundamentally flawed because it is limited to
    the facts presented in the question and does not include all
    of the limitations supported by medical evidence in the
    record, the decision of the ALJ that a claimant can adjust
    to other work in the economy cannot stand. For this reason
    we remand the case to the SSA for further proceedings
    consistent with this opinion.
    REVERSED AND REMANDED.
    A true Copy:
    Teste:
    ________________________________
    Clerk of the United States Court of
    Appeals for the Seventh Circuit
    USCA-02-C-0072—4-2-02