# Allen v. Commissioner, Social Security Administration

> District Court, N.D. Texas · February 7, 2024

URL: https://www.frixlaw.com/law-library/cases/10671597

## Case

- **Court:** District Court, N.D. Texas
- **Decided:** February 7, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF TEXAS
DALLAS DIVISION

ANTONIO A., §
§
Plaintiff, §
§
v. § Case No. 3:23-cv-00449-BT
§
MARTIN J. O’MALLEY, §
COMMISSIONER OF SOCIAL §
SECURITY, §
§
Defendant.1 §

MEMORANDUM OPINION AND ORDER
Before the Court is Plaintiff Antonio A.’s2 civil action seeking judicial review
pursuant to 42 U.S.C. § 405(g) of a final adverse decision by the Commissioner of
Social Security. (ECF No. 1). For the reasons explained below, the Commissioner’s
decision is REVERSED.
Background
Plaintiff alleges that he is disabled due to gout, back problems, obesity,
vision loss, high blood pressure, high cholesterol, and headaches. Admin. R. 82,

1 Martin O’Malley became the Commissioner of Social Security on December 20,
2023. Pursuant to Rule 25(d) of the Federal Rules of Civil Procedure, Martin
O’Malley should be substituted for Kilolo Kijakazi as the defendant in this suit. No
further action need be taken to continue this suit by reason of the last sentence of
section 205(g) of the Social Security Act, 42 U.S.C. § 405(g).
2 The Court uses only Plaintiff’s first name and last initial as instructed by the
May 1, 2018, Memorandum Re: Privacy Concern Regarding Social Security and
Immigration Opinions issued by the Committee on Court Administration and Case
Management of the Judicial Conference of the United States.
229 (ECF No. 10-1).3 Plaintiff was born in 1981 and alleges an amended disability
onset date of December 11, 2021. Id. at 31, 48. Plaintiff has at least a high school
education. Id. at 31, 230.

On April 28, 2021, Plaintiff applied for disability insurance benefits (DIB)
and supplemental security income (SSI) under Titles II and XVI of the Social
Security Act (the “Act”). Id. at 100. His claims were denied initially and upon
reconsideration. Id. at 87, 98, 130-39, 141-46. Thereafter, Plaintiff requested a
hearing before an Administrative Law Judge (ALJ), who conducted an online video

hearing on October 6, 2022.4 Id. at 46-80.
On November 10, 2022, the ALJ issued a decision finding that Plaintiff has
not been under a disability within the meaning of the Act from his alleged amended
onset date through the date of the decision, and thus he is not entitled to DIB or
SSI. Id. at 25, 32. As an initial matter, the ALJ found that Plaintiff met the insured
status requirements under the Act though December 31, 2023. Id. at 26. Utilizing

the five-step sequential evaluation,5 the ALJ first found that Plaintiff had not

3 Citations to the record refer to the CM/ECF page numbers at the top of each page
rather than page numbers at the bottom of each filing.
4 Because of the extraordinary circumstances presented by the COVID-19
pandemic, the ALJ conducted the hearing by video.
5 “In evaluating a disability claim, the [ALJ] conducts a five-step sequential
analysis to determine whether (1) the [plaintiff] is presently working; (2) the
[plaintiff] has a severe impairment; (3) the impairment meets or equals an
impairment listed in appendix 1 of the social security regulations; (4) the
impairment prevents the [plaintiff] from doing past relevant work; and (5) the
impairment prevents the [plaintiff] from doing any other substantial gainful
activity.” Audler v. Astrue, 501 F.3d 446, 447-48 (5th Cir. 2007). The plaintiff
bears the initial burden of establishing a disability through the first four steps of
engaged in substantial gainful activity since December 11, 2021, his alleged
amended onset date. Id. at 26. At the second step, the ALJ noted that Plaintiff
experienced severe impairments of “ruptured quadriceps tendon s/p surgery;

keratoconus; and obesity.” Id. at 26. At the third step, the ALJ determined that
Plaintiff’s impairments did not meet or medically equal any listed impairment in
appendix 1 of the social security regulations. Id. at 28-29.
Before proceeding to step four, the ALJ found that Plaintiff has the RFC:
to perform less than the full range of sedentary work . . . ; he has the
ability to lift, carry, push, and/or pull 10 pounds occasionally and less
than 10 pounds frequently, stand and/or walk 2 hours of an 8-hour
day, and sit 6 hours of an 8-hour day. Claimant can less than
occasionally climb, balance, stoop, kneel, crouch, and crawl. Claimant
can perform work occasionally requiring far visual acuity and/or
visual accommodation. Claimant is able to avoid ordinary hazards.
Claimant cannot work around moving mechanical parts or
unprotected heights.

Id. at 29.
Next, the ALJ found that “[t]ransferability of job skills is not material to the
determination of disability because using the Medical-Vocational Rules as a
framework supports a finding that the claimant is ‘not disabled,’ whether or not
the claimant has transferrable job skills.” Id. at 31.

the analysis; at the fifth step, the burden shifts to the ALJ to show that there is
other substantial work in the national economy that the plaintiff can perform. Id.
at 448; Copeland v. Colvin, 771 F.3d 920, 923 (5th Cir. 2014) (citations omitted).
A finding that the plaintiff is disabled or not disabled at any point in the five-step
review is conclusive and terminates the analysis. Copeland, 771 F.3d at 923 (citing
Leggett v. Chater, 67 F.3d 558, 564 (5th Cir. 1995)); Lovelace v. Bowen, 813 F.2d
55, 58 (5th Cir. 1987) (citing Barajas v. Heckler, 738 F.2d 641, 643 (5th Cir. 1984)
(per curiam)).
Finally, relying on the testimony of a vocational expert, at step five, the ALJ
determined that Plaintiff had the ability to perform the jobs of order clerk,
document preparer, and table worker, and that such jobs existed in significant

numbers in the national economy. Id. at 32-33.
Plaintiff appealed the ALJ’s decision to the Appeals Council. Id. at 6. The
Appeals Council found that the appeal did not provide a basis for modifying the
ALJ’s decision. Id. at 6-10. Plaintiff then filed this action in federal district court.
Legal Standard

The Court’s “review of Social Security disability cases ‘is limited to two
inquiries: (1) whether the decision is supported by substantial evidence on the
record as a whole, and (2) whether the [ALJ] applied the proper legal standard.’”
Copeland v. Colvin, 771 F.3d 920, 923 (5th Cir. 2014) (quoting Perez v. Barnhart,
415 F.3d 457, 461 (5th Cir. 2005)). Substantial evidence is “more than a mere
scintilla. It means such relevant evidence as a reasonable mind might accept as

adequate to support a conclusion.” Richardson v. Perales, 402 U.S. 389, 401
(1971); see Copeland, 771 F.3d at 923 (“Substantial evidence is more than a mere
scintilla and less than a preponderance.”).
The ALJ, and not the courts, resolves conflicts in the evidence; the Court
may not “reweigh the evidence or try the issues de novo.” Martinez v. Chater, 64

F.3d 172, 174 (5th Cir. 1995) (per curiam). Hence, the Court may not substitute its
own judgment for the ALJ’s, and it may affirm only on the grounds that the
Commissioner stated to support his decision. Copeland, 771 F.3d at 923. If the
Commissioner’s findings are supported by substantial evidence, the findings are
conclusive, and the Commissioner’s decision must be affirmed. Martinez, 64 F.3d
at 173. A reviewing court must defer to the ALJ’s decision when substantial

evidence supports it, even if the court would reach a different conclusion based on
the evidence in the record. Leggett v. Chater, 67 F.3d 558, 564 (5th Cir. 1995).
Nevertheless, the substantial evidence review is not an uncritical “rubber
stamp” and requires “more than a search for evidence supporting the [ALJ’s]
findings.” Hill v. Saul, 2020 WL 6370168, at *6 (N.D. Tex. Sept. 29, 2020) (quoting

Martin v. Heckler, 748 F.2d 1027, 1031 (5th Cir. 1984)), adopted by 2020 WL
6363878 (N.D. Tex. Oct. 29, 2020) (Lindsay, J.). The Court “must scrutinize the
record and take into account whatever fairly detracts from the substantiality of the
evidence supporting” the ALJ’s decision. Id. (quoting Martin, 748 F.2d at 1031). A
no-substantial-evidence finding is appropriate only if there is a “conspicuous
absence of credible choices” or “no contrary medical evidence.” Id. (citation

omitted).
Analysis
The central issue presented is whether the ALJ’s RFC determination was
supported by substantial evidence. As his sole point of error, Plaintiff contends that
the “ALJ’s RFC determination is unsupported by substantial evidence because he

constructed the RFC out of whole cloth.” Pl.’s Brief 10 (ECF No. 16). Specifically,
Plaintiff argues that “[b]ecause the ALJ had no medical opinions in the record that
he found persuasive, and no opinions at all on Plaintiff’s visual limitations from his
keratoconus, there is effectively no evidence from which the ALJ could build a
logical bridge to determine Plaintiff’s RFC.” Id. Plaintiff further contends that “it
was incumbent that the ALJ obtain a medical expert opinion on how Plaintiff’s

keratoconus impacts his ability to work [and] the ALJ was not permitted to insert
his own guess at what Plaintiff’s RFC visual limitations require.” Id. at 14.
In response, the Commissioner contends that “substantial evidence of
record supports [the ALJ’s] decision” and the ALJ “applied proper legal standards
in reaching this decision.” Def.’s Br. 5 (ECF No. 18). The Commissioner also argues

that “[w]hat Plaintiff characterizes as the ALJ’s impermissible interpretation of
raw medical data is actually the ALJ properly interpreting the medical evidence to
determine Plaintiff’s capacity for work.” Id. at 4.
RFC is the most that a person can still do despite recognized limitations. 20
C.F.R. § 404.1545(a)(1). The RFC determination is a “combined medical
assessment of an applicant’s impairments with descriptions by physicians, the

applicant, or others of any limitations on the applicant’s ability to work.” Hill, 2020
WL 6370168, at *6 (cleaned up) (quoting Hollis v. Bowen, 837 F. 2d 1378, 1386-
87 (5th Cir. 1988) (per curiam)). It “is an assessment of an individual’s ability to
do sustained work-related physical and mental activities in a work setting on a
regular and continuing basis.” Social Security Ruling (SSR) 96-8p, 1996 WL

374184, at *1 (S.S.A. July 2, 1996). An individual’s RFC should be based on all of
the relevant evidence in the case record, including opinions submitted by treating
physicians or other acceptable medical sources. 20 C.F.R. at § 404.1545(a)(3)
(2012); SSR 96-8p, 1996 WL 374184, at *1.
The ALJ is responsible for assessing a claimant’s RFC. 20 C.F.R. §§

404.1546(c), 416.946(c). In making that assessment, the ALJ considers not only
medical opinions but all of the relevant medical and other evidence. 20 C.F.R. §§
404.1513(a), 416.945(a)(3). In this context, evidence is anything the claimant or
anyone else submits or that the ALJ obtains relating to the claim. 20 C.F.R. §§
404.1513(a), 416.913(a). The ALJ “has the authority and duty to weigh the evidence

and reach any conclusion supported by substantial evidence.” Gonzales v. Astrue,
231 F. App’x 322, 324 (5th Cir. 2007) (per curiam).
After reviewing the hearing decision and the administrative record, the
Court finds that the ALJ’s RFC determination is not supported by substantial
evidence.
Here, the ALJ determined Plaintiff to have the RFC to “perform less than the

full range of sedentary work . . . [assessed ] as the ability to lift, carry, push, and/or
pull 10 pounds occasionally and less than 10 pounds frequently, stand and/or walk
2 hours of an 8-hour day, and sit 6 hours of an 8-hour day.” Admin. R. 29. He
further limited Plaintiff’s RFC, determining he can “less than occasionally climb,
balance, stoop, kneel, crouch, and crawl.” Id. With respect to Plaintiff’s medically

determinable vision impairment, the ALJ limited Plaintiff to “work occasionally
requiring far visual acuity and/or visual accommodation.” Id. And, he found that
although Plaintiff “is able to avoid ordinary hazards[,] [he] cannot work around
moving mechanical parts or unprotected heights.” Id.
In explaining how he came to this determination, the ALJ points to

Plaintiff’s hearing testimony and objective medical evidence in the record. Id. at
29-31. He summarized the hearing testimony as follows:
At the hearing, claimant testified that he cannot really drive because
of his vision and his knee. He has double vision and his eyes blur. His
knee is still not normal. It buckles and hurts and wakes him from his
sleep. He does not use a brace or cane. He keeps his right eye closed
most of the time. He is able to avoid hazards. He drives 5 to 10 times
per week to take his roommate’s kids to school and pick them up. He
can sit 20 to 30 minutes. He can lift 50 to 70 pounds but cannot walk
very far with it and would have to rest in between doing that. His leg
just buckles when he is walking and has caused him to fall. He last fell
about 2 months ago.

Id. at 30 (citing hearing testimony).
With respect to his vision, the ALJ noted:
Claimant saw optometrist, David Dinh, in May 2022, complaining of
dirty contacts throughout the day causing him to take them out and
clean them three times per day. He was also having problems with
glare. At the conclusion of the appointment, Dr. Dinh noted that
claimant’s visual acuity with lenses was 20/20 in both eyes.

Id. at 31 (citing Exhibit 23F/5-6). He noted that Plaintiff “underwent a right
corneal transplant in August 2022.” Id. (citing Exhibit 26F/22-23). He also noted
that “[a]dditional treatment was received in August and later.” Id. at 29 (citing
Exhibit 27F). He noted that Plaintiff “testified at the hearing that this was meant
to slow the progression and his vision could possibly improve [and that] he still
drives 5 to 10 times per week, indicating that his vision is satisfactory to do so.” Id.
(citing Hearing Testimony).
The ALJ then concluded, “[a]fter careful review of the evidence,” Plaintiff’s

“medically determinable impairments could reasonably be expected to cause some
of the alleged symptoms,” but his “statements concerning the intensity,
persistence, and limiting effects of these symptoms are not entirely consistent with
the medical evidence” and other evidence in the record. Id. at 30.
Further, the ALJ determined that the state agency medical consultants’

opinions6—that Plaintiff could perform work at the light exertional level with
limitations in climbing, performing postural activities, and exposure to
environmental conditions, and with no visual limitations—were “partially
persuasive,” noting that “evidence received at the hearing level supports more
limitation.” Id. at 31. On that basis, the ALJ determined that Plaintiff’s RFC should
also include additional postural limitations and limitations arising from Plaintiff’s

vision impairment.
Under the current regulations, ALJs do “not defer or give any specific
evidentiary weight, including controlling weight, to any medical opinion(s) or prior
administrative medical finding(s).” 20 C.F.R. § 404.1520c(a); accord Winston v.
Berryhill, 755 F. App’x 395, 402 n.4 (5th Cir. 2018) (citation omitted).

6 State agency medical consultants, on initial review and reconsideration, opined
that Plaintiff could perform light work, with limitations in climbing, performing
postural activities, and exposure to environmental conditions, and had no visual
limitations. Admin. R. 94, 105, 114.
“There is no requirement that an ALJ’s RFC finding must mirror or match a
medical opinion.” Nic R. v. Kijakazi, 2023 WL 2529930, at *3 (N.D. Tex. Feb. 21,
2023) (citation omitted) (Rutherford, J.), adopted by 2023 WL 2531492 (N.D. Tex.

Mar. 15, 2023). “Even the absence of medical opinions does not necessarily render
a record inadequate to support an ALJ’s RFC determination.” Id. at *5 (citing
Ripley v. Chater, 67 F.3d 552, 557 (5th Cir. 1995) and Joseph-Jack v. Barnhart,
80 F. App’x 317, 318 (5th Cir. 2003) (per curiam)). But “as a non-medical
professional, the ALJ is not permitted to ‘draw his own medical conclusions from

some of the data, without relying on a medical expert’s help.’” Kenneth S. v. Saul,
2019 WL 3881618, at *5 (N.D. Tex. July 31, 2019) (Horan, J.) (quoting Frank v.
Barnhart, 326 F.3d 618, 621-22 (5th Cir. 2003)), adopted by 2019 WL 3859653
(N.D. Tex. Aug. 15, 2019). ALJs must resist the urge to “play[ ] doctor” and make
independent assessments of raw medical data. Id. at *7 (citation omitted). This is
because “[c]ommon sense can mislead” and “lay intuitions about medical

phenomena are often wrong.” Frank, 326 F.3d at 622 (citation omitted).
In Ripley, the Fifth Circuit observed that the record included “a vast amount
of medical evidence establishing that [the claimant] ha[d] a problem with his
back,” but it did “not clearly establish” what effect that “condition had on his ability
to work.” 67 F.3d at 557. In addition to lacking “reports from qualified medical

experts” regarding the claimant’s ability to work, “[t]he only evidence regarding
[the claimant’s] ability to work came from [his] own testimony.” Id. at 557. Thus,
substantial evidence did not support the ALJ’s RFC determination because the
court could not “determine the effects of [the claimant’s] conditions, no matter
how ‘small,’ on his ability to . . . work.” Id. at 557 & n.27. Later discussing Ripley,
the Fifth Circuit reaffirmed that “an ALJ may not—without opinions from medical

experts—derive the applicant’s [RFC] based solely on the evidence of his or her
claimed medical conditions.” Williams v. Astrue, 355 F. App’x 828, 832 n.6 (5th
Cir. 2009) (per curiam) (citation omitted). In Williams, the court held that “the
ALJ impermissibly relied on his own medical opinions as to the limitations
presented by” the claimant’s conditions because there was “no evidence supporting

the ALJ’s finding that” she “could perform light work with [those] conditions.” Id.
at 831-32.
Instead, the ALJ should request a “medical source statement” describing
types of work the claimant is still capable of performing despite his condition.
Ripley, 67 F.3d at 557. Absent such a statement, there is typically insufficient
evidence to support an RFC determination. Id. at 557-58 (remanding the case with

instructions to obtain a report from a treating physician regarding effects of the
plaintiff’s condition on his ability to work).
In this case, the ALJ determined that visual limitations were warranted. But
the record is devoid of any medical expert opinion on what those specific
limitations should be. The ALJ crafted Plaintiff’s RFC based on his own

determination of what Plaintiff’s visual impairment required. No treating,
examining, or consultative source offered any opinion on the effect Plaintiff’s
keratoconus—a complicated eye condition—had on his ability to work. The ALJ
improperly relied on his own interpretation of the raw medical data and Plaintiff’s
testimony.
While the RFC is ultimately the ALJ’s determination, under these

circumstances, there is no foundational basis for the ALJ’s RFC. An ALJ cannot
look to only the claimant’s “history of surgery, medical examinations, and
complaints of pain,” and conclude the claimant can perform sedentary work.
Ripley, 67 F.3d at 557. In doing so, “the ALJ relied on evidence that merely
describes Plaintiff’s conditions, rather than demonstrating her ability to work

despite those impairments.” Amy Y. v. Comm’r of Soc. Sec., 2023 WL 5209813, at
*7 (N.D. Tex. July 25, 2023) (finding error where, in the absence of medical
opinions and RFC assessments by state agency consultants, the ALJ made an RFC
determination based on medical conclusions he drew from the raw data), adopted
by 2023 WL 5216497 (N.D. Tex. Aug. 14, 2023); see also Cary G. T. v. Comm’r,
Soc. Sec. Admin., 2022 WL 954341, at *3 (N.D. Tex. Mar. 29, 2022) (Toliver, J.)

(concluding that although “the RFC is ultimately the ALJ’s determination,” the ALJ
erred because there was no apparent “foundational basis for that decision” where
“no treating, examining, or consultative resource reviewed the impact of
[p]laintiff’s conditions on his ability to work”); Jim S. v. Saul, 2019 WL 4694943,
at *9 (N.D. Tex. Sept. 25, 2019) (Ramirez, J.) (finding error where, despite the

voluminous progress reports, clinical notes, and lab reports in evidence, “none
[made] any explicit or implied reference to the effects these conditions h[ad] on
claimant’s ability to work” and the ALJ could not rely on that “raw medical
evidence as substantial support for” the claimant’s RFC).
Here, as in the cases cited directly above, there are no medical opinions in

the record regarding the effects of Plaintiff’s visual impairments on his ability to
work. And as in those cases cited above, here, the Court can only conclude that the
ALJ relied on his own interpretation of the medical and other evidence, which he
may not do. See Williams, 355 F. App’x at 832 n.6. (“An ALJ may not–without the
opinions from medical experts–derive the applicant’s [RFC] based solely on the

evidence of his or her claimed medical conditions, [and] an ALJ may not rely on
his own unsupported opinion as to the limitations presented by the applicant’s
medical conditions.”).
Because “[p]rocedural perfection in administrative proceedings is not
required” and a court “will not vacate a judgment unless the substantial rights of a
party have been affected,” Plaintiff must show he was prejudiced by the ALJ’s

failure to rely on medical opinion evidence in assessing his RFC. See Mays v.
Bowen, 837 F.2d 1362, 1364 (5th Cir. 1988) (per curiam). To establish prejudice,
he must show that the ALJ’s failure to rely on a medical opinion as to the effects
that his visual impairments had on his ability to work casts doubt on the existence
of substantial evidence supporting the disability determination. See McNair v.

Comm’r of Soc. Sec. Admin., 537 F. Supp. 2d 823, 837 (N.D. Tex. 2008)
(“Procedural errors in the disability determination process are considered
prejudicial when they cast doubt onto the existence of substantial evidence in
support of the ALJ’s decision.”) (citing Morris v. Bowen, 864 F.2d 333, 335 (5th
Cir. 1988)).
“Courts in the Northern District have found that the ALJ’s failure to rely on

a medical opinion concerning the claimant’s RFC necessarily casts doubt on the
disability determination.” Amy Y., 2023 WL 5209813, at *7 (collecting cases); see
also Cary G. T., 2022 WL 954341, at *4 (finding prejudice and remanding where
the administrative record revealed no treating, examining, or consultative resource
that reviewed the impact of Plaintiff’s conditions on his ability to work, and ALJ

assessed RFC based on his own lay interpretation of medical records and
claimant’s testimony); Jim S., 2019 WL 4694943, at *10 (finding prejudice and
remanding where there were no medical opinions in the record regarding the
effects Plaintiff’s mental impairments had on his ability to work, and the ALJ
appeared to have relied on his own interpretation of the medical and other
evidence); Tyria R. v. Saul, 2020 WL 10050779, at *13 (N.D. Tex. March 6, 2020)

(Ramirez, J.) (finding prejudice and reversing and remanding for further
proceedings for lack of substantial evidence because of the ALJ’s failure to rely on
a medical opinion in determining the plaintiff’s RFC), adopted by 2020 WL
1434516 (Mar. 20, 2020); Thornhill v. Colvin, 2015 WL 232844, at *11 (N.D. Tex.
Dec. 15, 2014) (finding prejudice and remanding “where the ALJ could have

obtained evidence that might have changed the result—specifically, a medical
source statement”).
As in these cases, the Court concludes that the ALJ’s error was not harmless
and remand is required on this issue.
Conclusion and Order
For the reasons stated, the Court REVERSES the Commissioner’s decision
and REMANDS the case to the Commissioner for further proceedings.
SO ORDERED.
February 7, 2024.
ai —
UNITED STATES*MAGISTRATE JUDGE

15

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10671597. Public record. Not legal advice.