Full Opinion

In the United States Court of Appeals For the Seventh Circuit ____________________ No. 25-1328 JOHN G. LEWIS, Plaintiff-Appellant, v. FRANK BISIGNANO, Commissioner of Social Security, Defendant-Appellee. ____________________ Appeal from the United States District Court for the Eastern District of Wisconsin. No. 1:23-cv-01110 — Pamela Pepper, Chief Judge. ____________________ ARGUED DECEMBER 12, 2025 — DECIDED OCTOBER 20, 2026 ____________________ Before EASTERBROOK, JACKSON-AKIWUMI, and LEE, Circuit Judges. JACKSON-AKIWUMI, Circuit Judge. John G. Lewis applied for supplemental security income and disability insurance bene- fits, owing to depression, anxiety, and obsessive-compulsive disorder (OCD). The ALJ determined that Lewis did not meet the criteria of being disabled for any of his disorders and that medical records showed he was capable of employment. The district court affirmed the ALJ’s decision. On appeal, Lewis 2 No. 25-1328 argues that the ALJ did not adequately consider the effect of his OCD on his ability to work. Because substantial evidence supports the ALJ’s decision, we affirm. I Lewis has an associate’s degree in computer program- ming and worked in that field for nearly six years as a web designer. After receiving inpatient and outpatient care for de- pression and suicidal ideation in 2016 and 2017, Lewis ap- plied for disability benefits in 2019, at age 43. He alleged that he became disabled the year before because of depression, anxiety, and OCD. When his application was denied, Lewis requested an administrative hearing before an ALJ. The ALJ held two hearings on Lewis’s application. At the first hearing in 2020, Lewis testified that his “extreme depres- sion and anxiety” prevented him from going back to work. Specifically, he said that he could only handle being around people for a couple of hours at a time before stress forced him to sit or lie down and try to calm himself. Lewis also testified that his therapist told him that certain behaviors—picking hair out of his eyebrows and rubbing his skin to the point of irritation—were related to OCD. He added that it was “hard to exactly pinpoint what triggers” these behaviors, but he had been “plucking a lot of eyebrows out” in anticipation of the hearing. Lewis further testified that even though he was able to do some tasks independently, social interaction caused him anx- iety and high levels of stress. For example, although he was able to pick up his own prescriptions, his parents did his gro- cery shopping and cooking. And although he was supposed to do household chores, those often “pile[d] up.” He also No. 25-1328 3 recounted a time when he felt he had to leave a friend’s house about an hour after arriving because more people were there than he had expected. He explained that he left because it “was getting extremely overwhelming” to him. Lewis re- ported that he was seeing his psychiatrist once a month for medication management and a psychotherapist twice a month, and he was not experiencing any side effects from his medication aside from dry mouth. In 2022, the ALJ held a second hearing. Lewis’s testimony during this hearing was largely the same: he was unable to work because of his “extreme depression and extreme anxi- ety.” Social interaction, politics, and “anything critical” of him triggered his anxiety, which had worsened since the prior hearing. Lewis continued to pull his eyebrows when anxious, struggled to maintain his personal hygiene, and engaged in compulsive activities such as watching the same three movies repeatedly. He had “good days and bad days.” On the “bad days”—which were roughly twice a week—he did “abso- lutely nothing at all” and was unable to get out of bed in the morning or walk his dog. As to treatment, Lewis testified that he attended therapy weekly and took medication. II In 2023, the ALJ issued a 17-page decision finding Lewis not disabled. We summarize that decision now. To be found disabled, Lewis had to prove that he was “un- able to engage in any substantial gainful activity by reason of any medically determinable physical or mental 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 twelve months.” 42 U.S.C. § 1382c(a)(3)(A). The ALJ’s 4 No. 25-1328 analysis followed the five-step sequential inquiry required to determine disability status. See 20 C.F.R. § 404.1520(a)–(g). Through this process, the ALJ must decide (1) “whether the claimant is currently employed”; (2) whether the claimant has a “severe impairment or a combination of impairments that is severe”; (3) whether the impairments “meet or equal any im- pairments listed as conclusively disabling”; (4) the claimant’s “residual functional capacity” and whether the claimant can perform past work; and (5) whether the claimant is “capable of performing any work in the national economy.” Gedatus v. Saul, 994 F.3d 893, 898 (7th Cir. 2021). Lewis was unemployed when he applied for benefits, so the ALJ began his analysis at step two. There, the ALJ found that Lewis had the following severe impairments: depressive disorder, anxiety disorder, autism spectrum disorder, and at- tention deficit hyperactivity disorder, each of which signifi- cantly limited his ability to perform work activities. In making this finding, the ALJ noted that Lewis’s medical records re- flected “various mental health diagnoses, including social anxiety and obsessive compulsive disorder.” Rather than identifying those two diagnoses and others as severe impair- ments, the ALJ explained that he would address the symp- toms and limitations associated with Lewis’s mental impair- ments in the aggregate, “regardless of underlying diagnosis,” and also account for them in his residual functional capacity finding. At step three, the ALJ considered whether any of Lewis’s mental impairments, “considered singly and in combina- tion,” met or “medically equal[led]” the criteria for being dis- abled under the following disorders: depressive, bipolar and related disorders; anxiety and obsessive-compulsive No. 25-1328 5 disorders; or neurodevelopmental disorders. The ALJ as- sessed each of these disorders against four areas of mental functioning: (1) understanding, remembering, or applying in- formation; (2) interacting with others; (3) concentrating, per- sisting, or maintaining pace; and (4) adapting or managing oneself. See 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.00(A)(2)(b). To be disabled, Lewis must have demonstrated that his disor- der “result[ed] in an extreme limitation in at least one of the four areas of mental functioning, or result[ed] in marked lim- itation in at least two of the four areas of mental functioning.” Id. Despite Lewis’s testimony to the contrary, the ALJ found no such limitations in any of the four areas when compared to the treatment notes from Lewis’s care providers. The ALJ found only a mild limitation for understanding, remember- ing, or applying information, noting Lewis was able to man- age his own medication, pay bills, and use a bank account. Lewis’s functioning demonstrated moderate limitation in each of the remaining three areas. For interaction with others, the ALJ noted that Lewis “maintain[s] relationships with fam- ily members,” “spends time with others in-person and via text,” and “visits a friend about once per month to watch a movie.” Similarly, for concentrating and maintaining pace, the ALJ highlighted that none of Lewis’s medical providers noted any deficits in this area, that 2018 neuropsychological testing concluded that Lewis “rarely showed signs of distract- ibility,” and that a 2020 consultative psychological examina- tion showed Lewis “had no difficulty performing mental ca- pacity tasks requiring concentration and attention.” Finally, as to adapting and managing oneself, the ALJ found that while Lewis’s medical providers “noted deficits in 6 No. 25-1328 affect, appearance and judgment at times (irritability during medication changes, face-touching/hair pulling during peri- ods of stress),” the record reflected that Lewis “generally maintains adequate appearance and interaction (cooperative, friendly) and that any deficits in judgment have not been so concerning as to prompt more intensive mental health treat- ment.” Having found that none of Lewis’s impairments were dis- abling, the ALJ continued to steps four and five of the sequen- tial process. These steps assessed Lewis’s ability to perform his past work and to be employed in the national economy. The ALJ reviewed two buckets of evidence in his assessment: Lewis’s testimony and medical records, and the results of evaluations conducted by psychological consultants. The ALJ found that Lewis was limited to performing “sim- ple, routine, repetitive tasks” and was able to “maintain atten- tion, concentration, persistence, and pace” for such tasks for “two-hour periods throughout an eight-hour workday.” The ALJ further found that Lewis was limited to jobs involving “simple decision-making and simple changes that occur no more than occasionally” and jobs that could be performed in- dependently, with occasional interaction with supervisors and coworkers and no interaction with the public. To support this conclusion, the ALJ considered Lewis’s testimony on his symptoms, the medical records and clinical notes of Lewis’s care providers, and expert testimony. Based on his review, the ALJ found that “despite persistent anxiety and intermittent exacerbations in symptoms, [Lewis’s] longi- tudinal treatment notes reflect general stability/manageability of symptoms with therapy and psychiatric medication manage- ment.” Taken as a whole, the ALJ found, the evidence did not No. 25-1328 7 support “a finding of greater mental limitation than accom- modated in the residual functional capacity finding herein.” In fact, “the nature and scope of [Lewis’s] activities … cou- pled with provider observations,” suggested to the ALJ that Lewis had “greater mental capacity than alleged,” as demon- strated by Lewis’s ability to drive himself, handle his own money, manage his own medication, and socialize with friends and family. The ALJ then turned to prior administrative findings made by state agency psychological consultants. In July 2019 and February 2020, two consultants, Drs. Catherine Bard and Demetri Dres, assessed Lewis as having no limitation in un- derstanding, remembering, or applying information; moder- ate limitation in his ability to interact with others and concen- trate, persist, or maintain pace; and mild limitation in adapt- ing or managing himself. Then, in September 2021, a third consultant, Dr. Frank Orosz, assessed that Lewis had mild limitation in his ability to understand, remember, and apply information; moderate limitation in his ability to interact with others and concentrate, persist, or maintain pace; and mild limitation in his ability to adapt and manage himself. The ALJ determined the consultants’ evaluations of the first three functioning areas were consistent with the medical record and Lewis’s testimony, but that a finding that Lewis was moderately limited in his ability to adapt and manage was more consistent with the record. The ALJ also considered a January 2020 evaluation of Lewis by Dr. Sandra King, who opined that Lewis was “able to understand directions” but “would more than likely have moderate to severe difficulties carrying out instructions, due to severe OCD.” She further predicted that Lewis would 8 No. 25-1328 “have moderate to severe difficulties in responding appropri- ately to supervisors and co-workers” and in “withstanding routine work stress and adapting to change.” The ALJ found Dr. King’s opinions to be “of limited persuasiveness.” He faulted Dr. King for basing her opinion largely on Lewis’s subjective reports, which the ALJ found inconsistent with the overall evidence. The ALJ also noted that Dr. King’s opinions were inconsistent with the “contemporaneous observations” Dr. King made during her one-time evaluation of Lewis. Finally, the ALJ considered and discounted a December 2022 assessment of Lewis provided by Dr. Stephen Shopbell. Dr. Shopbell opined that Lewis met the criteria for disability for depressive disorder and that he had marked limitations in his ability to understand, remember, and apply information; concentrate, persist, or maintain pace; and adapt and manage himself. Dr. Shopbell also opined that Lewis would be “off task” for more than 30% of the work day and would likely be absent from work or unable to complete a full workday five days or more each month. The ALJ found Dr. Shopbell’s opin- ions to be minimally persuasive because they were “not con- sistent with [Dr. Shopbell’s] observations of [Lewis’s] mental status.” The ALJ pointed to Dr. Shopbell’s observation that Lewis had "linear and logical thought process; no impairment in memory, attention, or concentration; and good judgment.” The ALJ also referenced Dr. Shopbell’s observation that Lewis was “alert, motivated, calm, and cooperative, with appropri- ate eye contact, normal rate of speech, unremarkable motor activity, and future-oriented and goal-directed thought pro- cess.” Finally, the ALJ found that the work limitations Dr. Shopbell identified were not consistent with the 2018 neuro- psychological evaluation, “during which [Lewis] demon- strated adequate fund of knowledge, memory, and No. 25-1328 9 concentration, despite reporting anxiety.” The ALJ further noted other internal inconsistencies between Dr. Shopbell’s assessment and other observations. Based on his review of the overall record, the ALJ decided “the objective medical findings [were] not consistent with a finding of total disability. Rather, [Lewis] benefitted from treatment and retained reasonable mental function.” This meant Lewis “remained capable of performing a range of ex- ertional work with accommodations for symptoms related to his mental impairments.” Then, referencing the testimony from the vocational expert, the ALJ determined that Lewis was able to perform several jobs that exist in the national economy, including cleaner, hand packer, and routing clerk. Therefore, the ALJ concluded, Lewis was not disabled for the requested period. After the denial, Lewis filed suit in district court, arguing the ALJ had failed to consider his OCD diagnosis and to as- sess his symptoms and evidence in a manner consistent with agency regulations. The district court rejected this argument. The court “concede[d] that the ALJ mentioned [Lewis’s] OCD diagnosis only three times in his decision.” Nonetheless, the court held the ALJ “thoroughly explained” how Lewis’s med- ical records and reported activities, along with the experts’ opinions, led to his determination and supported his findings with substantial evidence. Lewis now appeals. III We review the district judge’s decision de novo and with- out deference but apply a deferential standard to the ALJ’s decision. Gedatus, 994 F.3d at 900. Under that deferential standard, “[w]e will reverse an ALJ’s decision only if it is the 10 No. 25-1328 result of an error of law or it is not supported by substantial evidence.” Jarnutowski v. Kijakazi, 48 F.4th 769, 773 (7th Cir. 2022). “The substantial evidence threshold ‘is not high’ and requires only ‘such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.’” Rabdeau v. Bisignano, 155 F.4th 908, 912 (7th Cir. 2025) (quoting Biestek v. Berryhill, 587 U.S. 97, 103 (2019)). It is not our place to “re- weigh the evidence, resolve debatable evidentiary conflicts, determine credibility, or substitute our judgment for the ALJ’s determination so long as substantial evidence supports it.” Gedatus, 994 F.3d at 900. A. On appeal, Lewis principally argues that the ALJ failed to adequately account for the limitations caused by his OCD, specifically those related to remembering, using, and apply- ing information and to concentration, persistence, and pace. Lewis explains that OCD is characterized by “ruminative thought.” He cites as support the definitions of the disorder in the Diagnostic and Statistical Manual System of Mental Health, 5th Edition (DSM-5) and in the American Psycholog- ical Association’s literature. In contrast to these definitions, Lewis argues, the ALJ treated OCD “as an amorphous mental condition without specific limitations and considerations” and overlooked medical records that show his obsessive be- havior. As Lewis sees it, this “minimal consideration” of his OCD resulted in a decision by the ALJ that “failed to address the issue[s] and ramifications of [his] condition.” We disagree with Lewis’s characterization of the ALJ’s de- cision. As we stated in Warnell v. O’Malley, “[a]n ALJ need not address every piece or category of evidence identified by a claimant, fully summarize the record, or cite support for No. 25-1328 11 every proposition or chain of reasoning.” 97 F.4th 1050, 1053 (7th Cir. 2024). Instead, “[a]ll we require is that ALJs provide an explanation for how the evidence leads to their conclusions that is ‘sufficient to allow us, as a reviewing court, to assess the validity of the agency’s ultimate findings and afford [the appellant] meaningful judicial review.’” Id. at 1054 (quoting Moore v. Colvin, 743 F.3d 1118, 1121 (7th Cir. 2014)). The ALJ’s decision meets this standard. The decision pro- vided a detailed accounting of Lewis’s treatment history, the notes and conclusions of his medical providers, and the find- ings from his psychological evaluations before applying that evidence to the standard for disability. Given this, Lewis’s ar- gument boils down to his belief that the ALJ did not properly weigh this evidence in his favor, and he asks us to do so in- stead. We decline that invitation. In Gedatus, we explained that our role is not to make fresh credibility determinations or sub- stitute our judgment for that of the ALJ, but rather to ensure that substantial evidence supports the ALJ’s decision. 994 F.3d at 900. Like the claimant in that case, Lewis “has not shown any reason to think the ALJ’s summary or determina- tions are not supported by substantial evidence.” Id. at 901. His critique of the ALJ’s treatment of the record does nothing to undermine the conclusion that substantial evidence sup- ported the ALJ’s finding that he did not meet the criteria for disability. Id. B. Lewis raises four arguments that derive from his core po- sition that the ALJ failed to adequately consider his OCD symptoms. None of these arguments are availing. 12 No. 25-1328 First, Lewis argues the ALJ erred by assessing the impact of his impairments on the four areas of mental functioning collectively rather than individually. This argument is one of form rather than substance. Recall that at step two of the agency’s five-step process, the ALJ found that Lewis had se- vere impairments for depressive disorder, anxiety disorder, autism spectrum disorder, and attention deficit hyperactivity disorder. In making that finding, the ALJ recognized that Lewis had an OCD diagnosis, but stated that “the symptoms and limitations associated with the claimant’s mental impair- ments, regardless of underlying diagnosis, are addressed be- low and accommodated in the residual functional capacity finding herein.” Accordingly, the ALJ structured his analysis as follows: Step 2: Severe impairments for depressive dis- order, anxiety disorder, autism spectrum disor- der, and attention deficit hyperactivity disor- der; Step 3: Impact of symptoms associated with these impairments on (1) understanding, re- membering, or applying information; (2) inter- acting with others; (3) concentrating, persisting, or maintaining pace; and (4) adapting or man- aging oneself. Lewis argues this approach violated agency regulations because how he experiences his symptoms and corresponding limita- tions depends on his specific mental disorders. He insists the ALJ should have identified OCD as one of Lewis’s disorders and structured the analysis to address limitations correlated with each disorder separately. In other words, he asserts that the ALJ should have structured the analysis as follows: No. 25-1328 13 Step 2(a): Severe impairment for depressive dis- order; Step 3(a): Impact of symptoms associated with this impairment on the four areas of mental functioning; Step 2(b): Severe impairment for OCD; Step 3(b): Impact of symptoms associated with this impairment on the four areas of mental functioning. Lewis cites no regulations or case law to support this argu- ment. Instead, he points to the DSM-5, which describes OCD as defined by “repetitive behaviors” and “recurrent and per- sistent thoughts.” But Lewis cites no authority requiring an ALJ to specifically consider the DSM-5 when making a disa- bility determination. Regardless, the ALJ specifically in- cluded anxiety and obsessive disorders in his analysis of whether any of Lewis’s impairments met the criteria for disa- bility. Further, even if the ALJ erred in not including OCD as an impairment, the error is not reversible. As we’ve ex- plained, step two of the five-step process “is merely a thresh- old inquiry; so long as one of a claimant’s limitations is found to be severe, error at that step is harmless” because “[e]ither way, the ALJ must later consider the limitations imposed by all impairments, severe and non-severe.” Ray v. Berryhill, 915 F.3d 486, 492 (7th Cir. 2019). The ALJ did that here. Second, Lewis takes issue with the ALJ’s engagement with the expert evaluations of his mental functioning. For example, he argues the ALJ did not discuss any of the limitations of- fered by Dr. Orosz, rejected Dr. Shopbell’s opinion that Lewis would be off task for more than 30% of the day, and failed to 14 No. 25-1328 properly assess Dr. King’s opinions. As we recounted above, the ALJ’s decision belies these assertions. Indeed, as we ex- plained in O’Connor-Spinner v. Astrue, “[a]n ALJ must explain why he does not credit evidence that would support strongly a claim of disability, or why he concludes that such evidence is outweighed by other evidence.” 627 F.3d 614, 621 (7th Cir. 2010). The ALJ’s decision here met this requirement. Third, Lewis argues that because OCD is defined by rumi- native thoughts, the ALJ should have determined Lewis’s ability to maintain concentration, persistence, and pace based on specific examples provided in the regulations. Those ex- amples include “working close to or with others without in- terrupting or distracting them; sustaining an ordinary routine and regular attendance at work; and working a full day with- out needing more than the allotted number or length of rest periods during the day.” 20 C.F.R. pt. 404, subpt. P, app. 1, § 12.00(E)(3). But the regulations include a key caveat: “These examples illustrate the nature of this area of mental function- ing. We do not require documentation of all of the examples.” Id. (emphasis added). And as we described above, the ALJ’s de- cision addressed in detail Lewis’s ability to maintain concen- tration, persistence, and pace. Fourth and finally, Lewis argues that because we have in the past criticized ALJs as being “poorly informed about men- tal illness,” the ALJ’s rejection of conclusions offered by med- ical experts here should give us pause. Spiva v. Astrue, 628 F.3d 346, 348 (7th Cir. 2010); see also Parker v. Astrue, 597 F.3d 920, 923–25 (7th Cir. 2010) (reversing ALJ denial of benefits for claimant with PTSD and depression); Martinez v. Astrue, 630 F.3d 693, 695–98 (7th Cir. 2011) (same for bipolar disorder and depression). But in Spiva and similar cases, we noted that No. 25-1328 15 the ALJ failed to mention key evidence of the claimant’s disa- bility, and critical analysis was “nowhere to be found in the administrative law judge’s opinion.” Spiva, 628 F.3d at 350. In contrast, the ALJ’s opinion here “was more than sufficient and supported by substantial evidence” and “devoted consid- erable space to addressing the persuasiveness” of the many experts who evaluated Lewis’s impairments. Warnell, 97 F.4th at 1051, 1054. IV Although we are sympathetic to the multifaceted nature of Lewis’s condition, substantial evidence supports the ALJ’s determination that Lewis is not entitled to benefits. Accord- ingly, we AFFIRM.