Let’s Look at this Breast Cancer Case Remanded by the Seventh Circuit

On August 26, 2024, the Seventh Circuit issued a decision in Keck v. O'Malley case.

This case highlights key issues in disability law, particularly how ALJs handle Residual Functional Capacity assessments for claimants with psychological impairments.

The plaintiff, Keck, was in her early 40s when she applied for disability insurance benefits. Following a breast cancer diagnosis in 2016, she underwent a lumpectomy and began chemotherapy, but had to discontinue treatment due to severe side effects—namely, extreme fatigue, shortness of breath, and difficulty balancing. Her medical records from this period document symptoms like chronic pain, depression, anxiety, nausea, and dizziness. These impairments persisted throughout the second half of 2015 and into 2016, leaving her unable to work.

Anxiety, depression, and pain were prominent features in her daily life, severely limiting her capacity to maintain focus or work consistently.

State agency psychologists assessed her mental capacity and determined that Keck would be off-task for up to 10% of the workday and had moderate limitations in:

Despite this evidence, the ALJ’s RFC assessment concluded that Keck could perform simple, routine work with simple decision-making and no multitasking. The ALJ also ruled that Keck could maintain a regular, non-variable pace.

However, the ALJ failed to account for the time-off-task limitation or the effects of her fatigue and mental health challenges on her ability to sustain even simple tasks over an entire workday.

On appeal, Keck’s primary argument was that the ALJ overlooked her moderate limitations in concentration, persistence, and pace (CPP). The 7th Circuit agreed, ruling that the ALJ didn’t adequately consider whether Keck could sustain even simple, routine tasks over time.

As the court cited in Crump v. Saul (2019), simply noting a claimant’s ability to perform basic tasks doesn’t address whether they can maintain those tasks consistently throughout the day. This was particularly relevant in Keck’s case, where multiple psychologists had noted her limitations in concentration and her need for frequent breaks.

The court also rejected the Commissioner’s argument that Keck could still perform jobs in the national economy, noting that the ALJ hadn’t properly incorporated Keck’s off-task limitations in the hypothetical posed to the vocational expert.

Takeaways

For practitioners, this case reinforces critical points:

Medical Records Matter: Ensure the ALJ thoroughly reviews medical records and includes all limitations (especially mental health-related) when crafting an RFC.

CPP Limitations: When claimants have moderate CPP limitations, the ability to sustain tasks over a full workday must be explicitly evaluated. It’s not enough to simply assign "simple work" without addressing whether the claimant can maintain focus and pace consistently.

Time-Off-Task Consideration: Time-off-task limitations, especially when noted by multiple psychologists, must be addressed in the RFC and considered when posing hypotheticals to vocational experts.

In Keck v. O’Malley, the court’s decision is a reminder that an RFC must reflect all of the claimant’s limitations—mental, physical, and cognitive. The result? The 7th Circuit vacated the judgment and remanded the case for further proceedings.