Elizabeth Ramirez v. JOANNE B. BARNHART, Commissioner of Social Security Administration. On Appeal from…

PRECEDENTIAL
UNITED STATES COURT OF
APPEALS FOR THE THIRD CIRCUIT
__________
No. 03-3313
__________
ELIZABETH RAMIREZ
Appellant,
v.
JOANNE B. BARNHART,
Commissioner of Social Security
Administration.
__________
On Appeal from the United States
District Court for the
Eastern District of Pennsylvania
(Civil Action No. 02-cv-02696)
District Judge: Hon. Eduardo C. Robreno
__________
Argued April 20, 2004
___________
Before: SCIRICA, Chief Judge,
GARTH, and BRIGHT,* Circuit Judges
(Opinion Filed June 18, 2004)
Thomas D. Sutton (argued)
Leventhal & Sutton
One Oxford Valley
Suite 317
Langhorne, PA 19047
Attorney for Appellant
David F. Chermol (argued)
Social Security Administration
OGC/Region III
P.O. Box 41777
Philadelphia, PA 19101
Attorney for Appellee
__________
OPINION
__________
Garth, Circuit Judge:
Elizabeth Ramirez appeals from
an Order of the United States District
Court for the Eastern District of
Pennsylvania affirming the decision of
the Commissioner of Social Security.
The Commissioner had denied Ramirez’s
claims for Supplemental Security Income
(“SSI”) under Title XVI of the Social
Security Act (the “Act”). 42 U.S.C.
§§ 1381-1383(f). On appeal, Ramirez
contends, as she did in the District Court,
that the hypothetical question posed by
the Administrative Law Judge (“ALJ”) to
the vocational expert failed to accurately
convey all of Ramirez’s limitations, and
that the Commissioner’s ensuing
decision is, therefore, not supported by
substantial evidence. The District Court
affirmed the ALJ’s decision and Ramirez
* Honorable Myron H. Bright, United
States Court of Appeals for the Eighth
Circuit, sitting by designation.

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timely appealed to this Court. For the
reasons set forth below, we vacate the
District Court’s order and remand for
further proceedings before the ALJ.
I.
A. Early Procedural History
Ramirez is a 47-year-old divorced
mother of two children with no significant
work experience. In August 1994, she
applied for disability insurance benefits
and SSI under the Act, claiming that she
was disabled by asthma, bad nerves and a
thyroid condition. Six months later, she
began receiving mental health treatment
for an anxiety disorder.
After the Commissioner denied
Ramirez’s application initially and on
reconsideration, she requested a hearing
before an ALJ. At Ramirez’s request, the
ALJ dismissed Ramirez’s claim for
disability benefits. The ALJ denied
Ramirez’s remaining claim for SSI,
finding that Ramirez was not disabled by
her physical or mental impairments. The
SSA Appeals Council subsequently
vacated the ALJ’s decision and remanded
with instructions to explain certain
findings and take additional evidence on
Ramirez’s mental impairments.
B. Ramirez’s Mental Health
Treatment/Evaluation
Ramirez first sought mental health
treatment in February 1995 from Dr. H.H.
Park, who diagnosed her with generalized
anxiety disorder with depression. Over the
next twenty-two months, Dr. Park
prescribed various medications with
varying degrees of success.
In December 1996, Ramirez
stopped seeing Dr. Park. She did not
resume mental health treatment until
September 1998. At the request of her
attorney, however, she underwent a
comprehensive psychological evaluation
by Dr. Craig Weiss in April 1997. Dr.
Weiss concluded that Ramirez had an
“Anxiety Disorder . . . with significant
symptoms of depression, social phobia,
o b se ss iv e -c o m pu l s iv e , a n d m o o d
i n c o n g r u e n t h a l l u c i n a t i o n s . ”
(Administrative Record (“A.R.”) at 303.)
With respect to “functional limitations,”
Dr. Weiss opined that Ramirez (1) had
moderate restriction in activities of daily
living, (2) had marked to extreme
difficulties in m aintain ing so cial
functioning, (3) experienced frequent
deficiencies of concentration, and (4)
continually experienced episodes of
deterioration.
Almost two years earlier, in 1995,
Dr. Louis Poloni, a state agency
psychologist, had completed a Psychiatric
Review Technique Form (“PRTF”) on
which he had also assessed Ramirez’s
mental impairments in four broad areas of
mental functioning. Dr. Poloni concluded
that Ramirez: (1) had no restriction in
activities of daily living, (2) had slight
diffic ulties in ma intainin g soc ial
functioning, (3) often experienced
deficiencies of concentration, persistence,
or pace, and (4) never experienced
e p i s o d e s o f d e t e r i o r a t i o n o r
decompensation in work-like settings.
Based on those findings, Dr. Poloni

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concluded that Ramirez had a severe
anxiety disorder, but that Ramirez’s
condition did not meet or equal any of the
mental impairments deemed by the SSA to
be presumptively disabling. Consequently,
Dr. Poloni proceeded to complete a Mental
Residual Functional Capacity (“MRFC”)
form, which is meant to assess a claimant’s
ability to perform either the claimant’s
previous work or other work in the
national economy. Dr. Poloni determined
that Ramirez could perform simple, routine
unskilled work.
Ramirez’s mental functioning was
also in 1998 assessed by Dr. Herman
Rudnick, a Board certified psychiatrist.
Dr. Rudnick concluded that Ramirez
suffered from anxiety-related and
personality disorders. As to the four broad
areas of mental functioning, Dr. Rudnick
found that Ramirez (1) had only
moderately limited daily activities, (2) had
moderately limited social functioning, (3)
often experienced deficiencies of
concentration, persistence, or pace, (4) and
did not experience any episodes of
deterioration or decompensation. Like Dr.
Poloni before him, Dr. Rudnick found that
Ramirez’s mental impairments did not
meet or equal the criteria of a listed
impairment. As to Ramirez’s residual
functional capacity, Dr. Rudnick opined
that Ramirez could not perform complex
or complicated work and would need to be
able to contact her home from work, but
that there was no need to limit Ramirez’s
interaction with the public or with co-
workers.
C. Procedural History After Remand
Following the remand by the SSA
Appeals Council, the ALJ held a second
hearing. The ALJ considered, among other
things, all of the evidence described above
concerning Ramirez’s mental impairments.
Near the conclusion of the second hearing
on remand, the ALJ posed the following
hypothetical question to vocational expert
Julie Stratton:
I will begin by asking you to
assume that we’re talking
about an individual of Ms.
Ramirez’s age, education
and prior work history. And
I’d like you to further
assume that this individual’s
capable of performing a
range of sedentary work.
The work should be
performed in a well
ventilated facility, with no
exposure to dust, fumes,
pets, animals, chemicals, or
temperature extremes. The
work should provide for
occasional breaks, for the
individual use of an inhaler
or pump. The work should
involve simple one to two
step tasks. The work should
not require the individual
during the course of
performing the work to
travel outside of th e
workplace. And . . . the
work setting should provide
reasonable opportunity for
the individual to make and

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receive personal phone
calls. Within the boundaries
of these limitations, . . . are
there jobs in the regional or
national economy that the
individual could perform?
(A.R. at 457-58.) It is significant that
neither Dr. Weiss’s evaluation nor his
conclusions found expression in the
hypothetical.
The purpose of the hypothetical was
to assess Ramirez’s residual functional
capacity. Stratton responded that,
notwithstanding the limitations contained
in the hypothetical, there were several jobs
in the local and national economy that the
hypothetical claimant could perform,
including assembler, hand packer, and
production inspector.
The ALJ then issued a written
decision in which she determined that
Ramirez was not disabled and therefore
she again denied Ramirez’s application for
SSI. In reaching her decision, the ALJ
relied heavily on Stratton’s testimony.
The ALJ attached to her written
decision a completed PRTF, as she was
required to do under the then-existing
Social Security Regulations. In a section
of the PRTF entitled, “Functional
Limitation and Degree of Limitation,” the
ALJ noted tha t Ramirez “often”
e x p e r i e n c e d “ d e f i c i e n c i e s o f
concentration, persistence, or pace
resulting in a failure to complete tasks in a
timely manner (in work settings or
elsewhere).” (Appendix at 93.) The
ALJ’s hypothetical, however, had not
mentioned this particular limitation.
Ramirez appealed the ALJ’s
decision, but the Appeals Council declined
to grant review. Ramirez then challenged
the ALJ’s ruling in the United States
District Court for the District of Eastern
Pennsylvania, where Ramirez and the
Commissioner filed cross-motions for
summary judgment. The District Court
referred the cross-motions to a Magistrate
Judge for a Report and Recommendation.
Although Ramirez made a number
of claims, one of her primary arguments
was that the ALJ had failed to include in
her hypothetical the finding she had made
on the PRTF that Ramirez often suffered
deficiencies in concentration, persistence,
or pace. The Magistrate Judge rejected all
of Ramirez’s arguments except for the
PRTF argument, finding that it was “not
clear whether a limitation in concentration,
persistence or pace within the hypothetical
. . . would have changed the vocational
expert’s response.” The Magistrate Judge
recommended that the District Court
remand to the ALJ to allow for further
testimony by a vocational expert.
The Commissioner objected only to
the Magistrate Judge’s finding that the
ALJ’s hypothetical was deficient. The
District Court adopted those portions of
the Magistrate’s Report to which no
objection was raised, but disapproved that
portion of the Magistrate Judge’s Report
which found the ALJ’s hypothetical to be
defective. The District Court explained
that “the standards articulated by the Third
Circuit do not mandate that the ALJ

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articulate verbatim to the vocational expert
the findings recorded on the PRTF form”
and proceeded to find that the limitations
the ALJ had included in her hypothetical
“accurately reflect[ed] the evidence
contained in the record.” (Appendix at 20,
23.) Accordingly, the District Court
entered summary judgment for the
Commissioner.
Ramirez now appeals from the
District Court’s Order. Ramirez contends
that (a) the ALJ’s hypothetical did not
adequately incorporate the PRTF finding
concerning Ramirez’s deficiencies in
concentration, persistence, or pace; and (b)
the ALJ improperly made adverse
credibility findings.
II.
We have jurisdiction to hear this
appeal pursuant to 28 U.S.C. § 1291. We
may reverse the District Court’s grant of
summary judgment to the Commissioner
only if the ALJ’s findings were not
supported by “substantial evidence.”
Burns v. Barnhart, 312 F.3d 113, 118 (3d
Cir. 2002). If, however, an ALJ poses a
hypothetical question to a vocational
expert that fails to reflect “all of a
claimant’s impairments that are supported
by the record[,] . . . it cannot be considered
substantial evidence.” Chrupcala v.
Heckler, 829 F.2d 1269, 1276 (3d Cir.
1987).
III.
We consider first Ramirez’s
argument that the ALJ’s hypothetical was
deficient.
A. Administrative Framework
Under the Act, a person who has a
“disability” is entitled to SSI payments
from the Social Security Administration
(“SSA”). The Act defines “disability” as
the “inability to engage in any substantial
gainful activity by reason of any medically
determ inable physical or m enta l
impairment which can be expected to
result in death or which has lasted or can
be expected to last for a continuous period
of not less than 12 months.” 42 U.S.C.
§ 423(d)(1)(A). The definition is
qualified, however, as follows:
An individual shall be
determined to be under a
disability only if his physical
or mental impairment or
impairment are of such
severity that he is not only
unable to do his previous
w o r k b u t c a n n o t ,
c o n s i d e r i n g h i s a g e,
e d u c a t i o n , a n d w o r k
experience, engage in any
other kind of substantial
gainful work which exists in
the national economy.
42 U.S.C. § 423(d)(2)(A). A person
seeking SSI may allege that they have
disabling physical impairments, mental
impairments, or both.
Acting pursuant to its rulemaking
authority, the SSA has promulgated
regulations establishing a five-step
sequential evaluation process to determine
if a claimant has a disability. 20 C.F.R. §
404.1520 (2003). At step one, the SSA

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will find that a claimant is not disabled
unless he demonstrates that he is not
working at a “substantial gainful activity.”
20 C.F.R. §§ 404.1520(b), 416.920(b). At
step two, the SSA will find no disability
unless the claimant shows that he has a
“severe impairment,” defined as “any
impairment or combination of impairments
which significantly limits [the claimant’s]
physical or mental ability to do basic work
activities.” 20 C.F.R. §§ 404.1520(c),
416.920(c). If the claimant successfully
demonstrates that he has a severe
impairment, the SSA determines at step
three whether the impairment is on a list of
impairments presumed severe enough by
the SSA to render one disabled; if so, the
claimant qualifies. 20 C.F.R. §§
404.1520(d), 416.920(d). If, however, the
claimant’s impairment is not on the list,
the inquiry proceeds to step four and the
SSA assesses whether the claimant has the
“residual functional capacity” to perform
his previous work. Unless he shows that
he cannot, he is determined not to be
disabled.1 If the claimant survives step
four, the fifth step requires the SSA to
consider “vocational factors” (the
claimant’s age, education, and past work
experience) and to determine whether the
claimant is capable of performing other
jobs existing in significant numbers in the
national economy. 20 C.F.R. §§
404.1520(f), 404.1560(c), 416.920(f),
416.960(c). Unlike some of the earlier
stages in the evaluation process, the
burden of proof at step five is on the
agency. Here, Ramirez was found able to
perform other jobs.
B. Evaluating Mental Impairments
In 1985, the SSA issued revised
regulations to evaluate individuals who
claimed to be disabled as a result of a
mental impairment. 20 C.F.R. § 416.920a
(1999). The revised regulations
implemented a new technique that required
the SSA to evaluate a claimant’s mental
impairments in four broad areas of
functioning: (1) activities of daily living,
(2) social functioning, (3) concentration,
persistence, or pace, and (4) deterioration
or decompensation in work or work-like
settings. 20 C.F.R. § 416.920a (1999).
The third functional area—which is of the
most concern in this appeal—was rated on
a five point scale of never, seldom, often,
frequent, and constant. 20 C.F.R. §
416.920a(b)(3) (1999).
Under the revised regulations, the
adjudicator applied the new technique by
completing a form known as the
Psychiatric Review Technique Form
(PRTF). 20 C.F.R. § 416.920a(d) (1999).
Based on the adjudicator’s findings on the
PRTF with respect to these four areas of
functioning, he would determine at step
two of the sequential evaluation process if
the claimant had a “severe mental
impairment.” 20 C.F.R. § 416.920a(c)(1)
(1999). If so, the adjudicator would
proceed to the third step and determine if
the claimant’s impairment met or equaled
1 Residual functional capacity is
defined as “what a [claimant] can still do
despite his limitations.” 20 C.F.R. §
416.945(a).

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one of the impairments found on the list of
impairments presumed severe enough to
render a person disabled. 20 C.F.R.
§ 416.920a(c)(2) (1999).
In 1996, the SSA issued Social
Security Ruling 96-8p “[t]o state the
[SSA]’s policies and policy interpretations
regarding the assessment of residual
functional capacity (RFC) in initial claims
for disability benefits under [the Act].”
Ruling 96-8p discussed the PRTF and the
role it plays in the five-step analysis:
The psychiatric review
technique described in 20
C F R 4 0 4 . 1 5 2 0 a a n d
416.920a and summarized
on the Psychiatric Review
Technique Form (PRTF)
requires adjudicators to
assess an ind ividua l’s
limitations and restrictions
from a mental impairment(s)
in categories identified in
the “paragraph B” and
“paragraph C” criteria of the
adult mental disorders
listings. The adjudicator
must remember that the
limitations identified in the
“ p a r a g r a p h B ” a n d
“paragraph C” criteria are
not an RFC assessment but
are used to rate the severity
of mental impairment(s) at
steps 2 and 3 of the
s e q u e n t ia l e v a l u a t i o n
process. The mental RFC
assessment used at steps 4
and 5 of the sequential
evaluation process requires
a more detailed assessment
b y i t e m i z i n g v a r i o u s
functions contained in the
broad categories found in
paragraphs B and C of the
adult mental disorders
listings in 12.00 of the
Listing of Impairments, and
summarized on the PRTF.
SSR 96-8p (July 2, 1996).
C. The ALJ’s Hypothetical Did Not
Adequately Convey Ramirez’s
Limitations
As we have previously noted, the
ALJ who reviewed Ramirez’s application
noted on the PRTF that Ramirez “often”
s u f f e r s f r o m “ d e f i c i e n c i e s o f
concentration, persistence, or pace
resulting in a failure to complete tasks in a
timely manner (in work settings or
elsewhere).” (Appendix at 93.) Ramirez
argues on appeal that the ALJ erred by not
including this limitation in the hypothetical
that she posed to the vocational expert. As
we explain below, we agree with Ramirez
and hold that the hypothetical did not
accurately convey all of Ramirez’s
impairments, and the limitations they
cause, and therefore the ALJ’s decision is
not supported by substantial evidence.2
2 The Commissioner frames the issue
on appeal as whether a hypothetical
question to a vocational expert in a
Social Security disability case must
include a verbatim recitation of the
findings listed on a Psychiatric Review

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We have not previously decided the
precise issue of whether certain findings
on a PRTF must be included in an ALJ’s
hypothetical. We have, however, stated in
the clearest of terms that an ALJ’s
hypothetical must include all of a
claimant’s impairments. For example, in
Chrupcala v. Heckler, 829 F.2d 1269,
1276 (3d Cir. 1987), the claimant argued
that the vocational expert’s opinion was
deficient because it failed to account for
all of the claimant’s impairments. We
agreed, noting that the ALJ’s hypothetical
question “did not reflect the fact of
constant and severe pain which [the
claimant] testified to and which we have
explained was supported by objective
medical findings in the record.” Id. We
explained that “[a] hypothetical question
must reflect all of a claimant’s
impairments that are supported by the
record; otherwise the question is deficient
and the expert’s answer to it cannot be
considered substantial evidence. Id.
(citing Podedworny v. Harris, 745 F.2d
210 (3d Cir. 1984) and Wallace v.
Secretary, 722 F.2d 1150 (3d Cir. 1983))
(emphasis added).
We recently reaffirmed this
principle in Burns v. Barnhart, 312 F.3d
113, 122 (3d Cir. 2002). There, the
claimant argued that the vocational
expert’s testimony did not provide
substantial evidence because the ALJ’s
hypothetical questions regarding the
claimant’s residual functional capacity
failed to incorporate the claimant’s
borderline intellectual functioning. The
Commissioner argued there, as it does
here, that the ALJ’s use of “simple
repetitive one, two-step tasks” in the
hypothetical was sufficiently descriptive to
encompass the findings concerning the
claimant’s limited intellectual functioning.
We disagreed, however, explaining that
the reference to simple tasks did not
“specifically convey” the claimant’s
intellectual limitations and that “greater
specificity” was required. Id. at 123.
Although we have not previously
held whether findings on a PRTF about a
claimant’s concentration, persistence, or
pace must be included in an ALJ’s
hypothetical, some of our sister Circuits
have dealt with this issue. For example, in
Howard v. Massanari, 255 F.3d 577 (8th
Cir. 2001), the claimant argued on appeal
that the ALJ had failed to convey in his
hypothetical the finding that the claimant
often suffered from deficiencies in
concentration, persistence, or pace. Id. at
581. The ALJ had, however, asked the
vocational expert to assume that the
claimant would be capable of performing
simple, routine, repetitive tasks. Id. The
Eighth Circuit Court of Appeals held that
the hypothetical “adequately capture[d]”
the claimant’s deficiencies, in part because
the state psychologist who had made the
finding also prepared a “functional
Technique Form (PRTF). However,
Ramirez does not claim that the findings
must be included verbatim in the
hypothetical; rather, Ramirez contends
that all of a claimant’s limitations must
be adequately conveyed in the
hypothetical.

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capacity assessment” in which he
concluded that the claimant could “sustain
sufficient concentration and attention to
perform at least simple, repetitive, and
routine cognitive activity without severe
restriction of function.” Id. at 582. But
see Newton v. Chater, 92 F.3d 688 (8th
Cir. 1996), infra.
The Sixth Circuit Court of Appeals
reached a similar outcome in Smith v.
Halter, 307 F.3d 377 (6th Cir. 2001). In
Smith, the ALJ also found that the
claimant often suffered from deficiencies
in concentration, persistence, or pace. In
his hypothetical, the ALJ instructed the
vocational expert to assume the claimant
had mental impairments limiting him to
jobs that were routine and low stress, and
did not involve intense interpersonal
confrontations, high quotas, unprotected
heights, or operation of dangerous
machinery. Id. at 378. On appeal, the
Sixth Circuit concluded that the ALJ
“went beyond” the simple findings
included in the PRTF and determined that
the claimant’s concentration problems
were minimal or negligible, and then
“translated [the claimant’s] condition into
the only concrete restrictions available to
him . . . and duly incorporated them into
his hypothetical . . . .” Id. at 379.
Other Courts of Appeal (or in one
case a different panel of the same Circuit)
have been less forgiving. For example, in
Kasarsky v. Barnhart, 335 F.3d 539 (7th
Cir. 2003), the ALJ noted on the PRTF
that the claimant frequently suffered from
deficiencies in concentration, persistence,
or pace. In his hypothetical, the ALJ
mentioned that the claimant’s borderline
intelligence seriously limited, but did not
preclude him from , understanding,
remembering, and carrying out detailed
instructions. Id. at 544. On appeal, the
Seventh Circuit stated that it saw “nothing
in the hypothetical that takes into account
the ALJ’s own earlier observation . . . that
[the claimant] suffered from frequent
deficiencies of concentration, persistence,
or pace.” Id. The court acknowledged
that there might be an explanation for the
omission, but it explained that it had “no
way of knowing that.” Id. Accordingly, it
remanded the case for further proceedings.
In Newton v. Chater, 92 F.3d 688
(8th Cir. 1996), the court found that a
hypothetical was defective because it
failed to adequately convey the claimant’s
deficiencies in concentration, persistence,
or pace. The ALJ’s hypothetical had
described a person with a minimal ability
to read and write, a borderline range of
intelligence, a ninth or tenth grade
education, an inability to perform highly
skilled or technical work, a capacity for
simple jobs, and a demonstrated ability to
control his drinking problem. Id. at 694.
The Commissioner argued that the
deficiencies of concentration, persistence
or pace did not have to be included in the
hypothetical because the ALJ had limited
the hypothetical to simple jobs and two
medical professionals had testified that the
c la im a n t ’ s d e f i c ie n c i e s d id n o t
significantly limit his abilities to follow
short and simple instructions and make
simple work-related decisions. Id. at 695.
The court disagreed, noting that the

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vocational expert had testified on cross-
exam i n a t io n that the cla iman t’s
concentration and persistence deficiencies
related to basic work habits needed to
maintain employment. Thus, the court
remanded for further proceedings.
Turning to the instant appeal, the
ALJ asked vocational expert Stratton to
assume a hypothetical individual with
Ramirez’s background and the following
limitations: sedentary work in a well-
ventilated environment, with no exposure
to dust, fumes, pets, animals, chemicals, or
temperature extremes; occasional breaks
necessary for the use of an inhaler or
pump; no more than simple one- or two-
step tasks; no travel outside the workplace;
and a reasonable opportunity to receive
and make personal telephone calls.3
We are not satisfied that these
limitations take into account the ALJ’s
own observation (both in her opinion and
in the PRTF) that Ramirez often suffered
from deficiencies in concentration,
persistence, or pace. The first several
limitations that the ALJ included in her
hypothetical pertain to Ramirez’s physical
impairments and therefore have no bearing
on her mental impairments. The only
limitations that relate to Ramirez’s mental
impairments are the limitations to simple
tasks, the restriction on travel, and the
phone privileges.
These limitations do not adequately
convey all of Ramirez’s limitations. The
Commissioner contends that the limitation
to one to two step tasks is sufficient, but
we agree with the Magistrate Judge that a
“a requirement that a job be limited to one
to two step tasks, as was stated in the
hypothetical relied upon by the ALJ, does
not adequately encompass a finding that
[Ramirez] ‘often’ has ‘deficiencies in
concentration, persistence, or pace, as was
noted by the ALJ both in her decision and
on the PRTF attached to the decision.”
3 We repeat the text of the
hypothetical which was presented to
Stratton, the vocational expert:
I will begin by asking you to assume that
we’re talking about an individual of Ms.
Ramirez’s age, education and prior work
history. And I’d like you to further
assume that this individual’s capable of
performing a range of sedentary work.
The work should be performed in a well
ventilated facility, with no exposure to
dust, fumes, pets, animals, chemicals, or
temperature extremes. The work should
provide for occasional breaks, for the
individual use of an inhaler or pump.
The work should involve simple one to
two step tasks. The work should not
require the individual during the course
of performing the work to travel outside
of the workplace. And . . . the work
setting should provide reasonable
opportunity for the individual to make
and receive personal phone calls. Within
the boundaries of these limitations, . . .
are there jobs in the regional or national
economy that the individual could
perform?
(A.R. at 457-58.)

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(Appendix at 72.) M ost importantly, this
limitation does not take into account
deficiencies in pace. Many employers
require a certain output level from their
employees over a given amount of time,
and an individual with deficiencies in pace
might be able to perform simple tasks, but
not over an extended period of time. If
Ramirez often suffers deficiencies in pace
and this had been included in the
hypothetical, vocational expert Stratton
may have changed her answer as to
whether there were jobs in the local or
national economy that Ramirez could
perform. In fact, the vocational expert
testified that each of the jobs suitable for
Ramirez (assembler, packer, and inspector)
would have daily production quotas and
that Ramirez would have to maintain a
certain degree of pace to maintain those
jobs.
This omission from the hypothetical
runs afoul of our directive in Chrupcala
that a “hypothetical question posed to a
vocational expert ‘must reflect all of a
clamant’s impairments,” Chrupcala, 829
F.2d at 1276, as well as our statement in
Burns that “great specificity” is required
when an ALJ incorporates a claimant’s
mental or physical limitations into a
hypothetical. Burns, 312 F.3d at 122.
Indeed, the SSA’s own ruling requires a
“more detailed assessment” of the
claimant’s mental limitations at step five
of the disability analysis. See SSR 96-8p
(July 2, 1996).
Of course, there may be a valid
explanation for this omission from the
ALJ’s hypothetical. For example, the ALJ
may have concluded that the deficiency in
pace was so minimal or negligible that,
even though Ramirez “often” suffered
from this deficiency, it would not limit her
ability to perform simple tasks under a
production quota. The record, however,
would seem to suggest otherwise. At the
second hearing, Dr. Rudnick—upon whose
testimony the ALJ relied—was asked the
following question: “What happens to
[Ramirez’s] ability to handle pace, for
example, in a work situation, where there’s
a certain amount of work that has to be
done in an eight hours or two hours or
whatever segment?” (A.R. at 451.)
Although the ALJ briefly interceded
before Dr. Rudnick could answer, Dr.
Rudick eventually replied that Ramirez’s
ability to maintain a full-time job
depended primarily on “the proximity to
where her children would be” because
Ramirez’s anxiety-disorder is in large part
attributable to her “need to feel that she
has to be reasonably protective of her
children.” While this might lead a neutral
observer to conclude that Ramirez’s
deficiencies in pace could be overcome by
finding a job close to her children, the ALJ
did not include this limitation in her
hypothetical. Instead, the ALJ provided
only for a reasonable number of personal
phone calls. If this accommodation would
not remedy Ramirez’s deficiency in
concentration and pace, the vocational
expert might have given a different answer
to the hypothetical.
Relying on Social Security Ruling
96-8p, which we reproduced in part earlier
in this opinion, the Commissioner

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contends that the “PRTF does not
document specific functional limitations
for RFC purposes, bur rather assesses
functional loss from a claimant’s mental
impairments only with respect to broad
areas of functioning.” In other words, the
Commissioner argues that the PRTF
findings are relevant only in steps two and
three of the sequential evaluation process,
before any assessment of a claimant’s
residual functional capacity is made.
We cannot concur in the
Commissioner’s evaluation of the PRTF
findings. While SSR 96-8p does state that
the PRTF findings are “not an RFC
assessment” and that step four requires a
“more detailed assessment,” it does not
follow that the findings on the PRTF play
no role in steps four and five, and SSR 96-
8p contains no such prohibition.
In conclusion, we hold that the
ALJ’s hypothetical did not adequately
capture and recite all of Ramirez’s mental
impairments and the limitations caused by
those impairments. In reaching that
holding, one factor we cannot ignore is
that the burden shifts to the Commissioner
at step five to prove that the claimant can
perform a job that exists in the national
economy. See Burns, 312 F.3d at 119 (“At
the final step—step five—the burden shifts
to the Commissioner to show that the
claimant can perform ‘other work.’”).
IV.
We have considered Ramirez’s
remaining arguments and, after reviewing
the record, are persuaded that they are
without merit.
V.
For the foregoing reasons, we will
vacate the Order of the District Court and
remand to the District Court so that it can
in turn remand to the Commissioner for
further proceedings consistent with this
Opinion.

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