# Shirley v. Commissioner Of Social Security

> District Court, S.D. Texas · September 28, 2021

URL: https://www.frixlaw.com/law-library/cases/10674690

## Case

- **Court:** District Court, S.D. Texas
- **Decided:** September 28, 2021
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10674690

## How later opinions describe it (automated extraction)

- noting that “[s]ubsequent medical evidence is [also] relevant . . . because it may bear upon the severity of the claimant’s condition before the expiration of his or her insured status”

## Opinion text

IN THE UNITED STATES DISTRICT COURT September 28, 2021
Nathan Ochsner, Clerk
FOR THE SOUTHERN DISTRICT OF TEXAS
HOUSTON DIVISION

§
DEBORAH S.,1 §
§
Plaintiff, §
§ No. 4:20-cv-1580
v. §
§
COMMISSIONER OF SOCIAL §
SECURITY, §
§
Defendant. §
§

MEMORANDUM AND ORDER

Plaintiff Deborah S. (“Plaintiff”) filed this suit seeking judicial review of an
administrative decision. ECF No. 1. Jurisdiction is predicated upon 42 U.S.C.
§ 405(g). Plaintiff appeals from the decision of the Commissioner of the Social
Security Administration (“Commissioner”) denying Plaintiff’s claim for disability
insurance benefits under Title II of the Social Security Act (“the Act”).2 The Parties
filed cross-motions for summary judgment. ECF Nos. 17, 20. Based on the briefing

1 Pursuant to 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, the Court uses only Plaintiff’s first name and last
initial.
2 On August 24, 2020, the case was transferred to this Court to conduct all proceedings pursuant
to 28 U.S.C. § 636(c). ECF Nos. 3, 7.
and the record, the Court determines that Plaintiff’s motion for summary judgment
should be granted and Defendant’s motion for summary judgment should be denied.

I. BACKGROUND
Plaintiff is 56 years old, R. 19,3 and completed high school. R. 19, 57. Plaintiff
worked as a house worker. R. 19, 56. Plaintiff alleges a disability onset date of

August 11, 2017. R. 12, 55, 70. Plaintiff claims she suffers both physical and mental
impairments. R. 17, 59–60.
On October 3, 2017, Plaintiff filed her application for disability insurance
benefits under Title II of the Act. R. 136–37. Plaintiff based4 her application on

rheumatoid arthritis, fibromyalgia, migraines, anxiety, depression, and panic attacks.
R. 156. The Commissioner denied her claim initially, R. 101–05, and on
reconsideration. R. 107–10.

A hearing was held before an Administrative Law Judge (“ALJ”). An attorney
represented Plaintiff at the hearing. R. 50. Plaintiff and a vocational expert testified
at the hearing. R. 51. The ALJ issued a decision denying Plaintiff’s request for

3 “R.” citations refer to the electronically filed Administrative Record, ECF No. 10.
4 The relevant time period is August 11, 2017—Plaintiff’s alleged onset date—through December
31, 2017—Plaintiff’s last insured date. R. 12. The Court will consider medical evidence outside
this period to the extent it demonstrates whether Plaintiff was under a disability during the relevant
time frame. See Williams v. Colvin, 575 F. App’x 350, 354 (5th Cir. 2014); Loza v. Apfel, 219 F.3d
378, 396 (5th Cir. 2000).
benefits.5 R. 7–21. The Appeals Council denied Plaintiff’s request for review, thus
upholding the ALJ’s decision to deny disability benefits. R. 1.

Plaintiff challenges the ALJ’s analysis and asks the Court to find that Plaintiff
is entitled to disability benefits under the provisions of the Act, or, in the alternative,
remand for reconsideration of the evidence. Pl.’s MSJ Brief, ECF No. 16. Defendant

counters, arguing that the ALJ’s findings are proper and supported by substantial
evidence. Def.’s Cross-MSJ, ECF No. 20; Def.’s Resp. to Pl.’s MSJ, ECF No. 20-1.
II. STANDARD OF REVIEW
The Social Security Act provides for district court review of any final decision

of the Commissioner that was made after a hearing in which the claimant was a

5 An ALJ must follow five steps in determining whether a claimant is disabled. 20 C.F.R.
§ 416.920(a)(4). The ALJ here determined Plaintiff was not disabled at step five. R. 21. At step
one, the ALJ found that Plaintiff did not engage in substantial gainful activity during the period
from her alleged onset date through her date last insured (“DLI”). R. 12 (citing 20 C.F.R. 404.1571
et seq.). At step two, the ALJ found that Plaintiff has the following severe impairments: obesity,
migraines, fibromyalgia, and depression. R. 12. At step three, the ALJ determined that Plaintiff
did not have an impairment or combination of impairments that met or medically equaled the
severity of one of the listed impairments in the regulations that would lead to a disability finding.
R. 14 (referencing 20 C.F.R. 404.1520(d), 404.1525, and 404.1526). The ALJ found that Plaintiff
has the Residual Functional Capacity (“RFC”) to perform light work as defined in 20 CFR
§ 404.1567(b). R. 16. However, the ALJ included limitations, including that Plaintiff could lift
and/or carry 20 pounds occasionally and 10 pounds frequently, stand and/or walk for 6 hours in an
8-hour workday, and sit for 6 hours in an 8-hour workday with normal breaks; could never climb
any ladders, ropes, or scaffolds, but could occasionally climb ramps and stairs; could perform
detailed tasks at a nonproduction rate pace; and could interact frequently with the public,
coworkers, and supervisors. R. 16. At step four, the ALJ determined that through the DLI, Plaintiff
was unable to perform any past relevant work. R. 19. At step five, based on the testimony of the
vocational expert and a review of the report, the ALJ concluded that considering Plaintiff’s age,
education, work experience, and RFC, Plaintiff was capable of making a successful adjustment to
other work that exists in significant numbers in the national economy, including garment sorter,
mail sorter, and hand folder. R. 20. Therefore, the ALJ concluded that Plaintiff was not disabled.
R. 21.
party. 42 U.S.C. § 405(g). In performing that review:
The court shall have power to enter, upon the pleadings and transcript of the
record, a judgment affirming, modifying, or reversing the decision of the
Commissioner …, with or without remanding the cause for a rehearing. The
findings of the Commissioner … as to any fact, if supported by substantial
evidence, shall be conclusive[.]

Id.
Judicial review of the Commissioner’s decision denying benefits is limited to
determining whether that decision is supported by substantial evidence on the record
as a whole and whether the proper legal standards were applied. Id.; Boyd v. Apfel,
239 F.3d 698, 704 (5th Cir. 2001); Loza, 219 F.3d at 393. “Substantial evidence”
means “such relevant evidence as a reasonable mind might accept as adequate to
support a conclusion.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (quotations
omitted). It is “more than a scintilla but less than a preponderance.” Carey v. Apfel,

230 F.3d 131, 135 (5th Cir. 2000). The “threshold for such evidentiary sufficiency
is not high.” Biestek, 139 S. Ct. at 1154.
The Court weighs four factors to determine “whether there is substantial
evidence of disability: (1) objective medical facts; (2) diagnoses and opinions of

treating and examining physicians; (3) subjective evidence of pain and disability;
and (4) the claimant’s age, education, and work history.” Conley-Clinton v. Saul,
787 F. App’x 214, 216 (5th Cir. 2019) (citing Martinez v. Chater, 64 F.3d 172, 174

(5th Cir. 1995)).
A reviewing court may not reweigh the evidence in the record, try the issues de
novo, or substitute its judgment for that of the Commissioner, even if the evidence

preponderates against the Commissioner’s decision. Brown v. Apfel, 192 F.3d 492,
496 (5th Cir. 1999). Even so, judicial review must not be “so obsequious as to be
meaningless.” Id. (quotations omitted). The “substantial evidence” standard is not a

rubber stamp for the Commissioner’s decision and involves more than a search for
evidence supporting the Commissioner’s findings. Singletary v. Brown, 798 F.2d
818, 822–23 (5th Cir. 1986); Cook v. Heckler, 750 F.2d 391, 393 (5th Cir. 1985).

Rather, a reviewing court must scrutinize the record as a whole, taking into account
whatever fairly detracts from the substantiality of evidence supporting the
Commissioner’s findings. Singletary, 798 F.2d at 823. “Only where there is a
‘conspicuous absence of credible choices or no contrary medical evidence’ will we

find that the substantial evidence standard has not been met.” Qualls v. Astrue, 339
F. App’x 461, 464 (5th Cir. 2009).
III. BURDEN OF PROOF

An individual claiming entitlement to disability insurance benefits under the
Act has the burden of proving her disability. Johnson v. Bowen, 864 F.2d 340, 343–
44 (5th Cir. 1988). The Act defines disability as the “inability 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. § 423(d) (1)(A) (2000). The impairment must be proven through medically

accepted clinical and laboratory diagnostic techniques. 42 U.S.C. § 423(d)(3)
(2000). The impairment must be so severe that the claimant is “incapable of
engaging in any substantial gainful activity.” Foster v. Astrue, No. H-08-2843, 2011

WL 5509475, at *6 (S.D. Tex. Nov. 10, 2011) (citing Anthony v. Sullivan, 954 F.2d
289, 293 (5th Cir. 1992)). A claimant is eligible for benefits only if the onset of the
impairment started by the date the claimant was last insured. Id. (citing Ivy v.
Sullivan, 898 F.2d 1045, 1048 (5th Cir. 1990)).

The Commissioner applies a five-step sequential process to determine
disability status. Id. The claimant bears the burden of proof at the first four steps to
establish that a disability exists. Farr v. Astrue, No. G-10-205, 2012 WL 6020061,

at *2 (S.D. Tex. Nov. 30, 2012). The burden shifts to the Commissioner at step five
to show that the claimant can perform other work. Id. The burden then shifts back to
the claimant to rebut this finding. Id. If at any step in the process the Commissioner
determines that the claimant is or is not disabled, the evaluation ends. Id.

IV. PLAINTIFF IS ENTITLED TO SUMMARY JUDGMENT.
Plaintiff raises two issues. First, Plaintiff argues that the ALJ’s assessment of
the physical medical evidence is unsupported by substantial evidence and the RFC

determination fails to adequately reflect Plaintiff’s limitations. Pl.’s Brief in Support
of MSJ, ECF No. 17 at 10–16. Second, Plaintiff contends that the ALJ provided no
analysis of Plaintiff’s subjective complaints. Id. at 16–17. Defendant counters that

the ALJ provided a supported evaluation of Plaintiff’s impairments and their impact
on her RFC, and that the ALJ properly considered Plaintiff’s subjective complaints.
ECF No. 20-1 at 4–10. The Court finds that although the ALJ considered the medical

evidence, he substituted his opinion for the doctors’ regarding Plaintiff’s physical
and mental impairments, requiring remand.
A. The ALJ Is Required To Consider All Medical Opinions In The
Record When Formulating The RFC.
Between the third and fourth steps of the sequential analysis, the ALJ must
decide the claimant’s RFC, which is defined as “the most the claimant can still do
despite his [or her] physical and mental limitations . . . based on all relevant evidence

in the claimant’s record.” Winston v. Berryhill, 755 F. App’x 395, 399 (5th Cir.
2018) (citation omitted). The RFC determination is the “sole responsibility of the
ALJ.” Taylor v. Astrue, 706 F.3d 600, 602–03 (5th Cir. 2012) (quoting Ripley v.

Chater, 67 F.3d 552, 557 (5th Cir. 1999)).
When making the RFC determination, the ALJ must consider all medical
opinions contained in the record. Id.; 42 U.S.C. § 405(b)(1). The ALJ must

“incorporate limitations into the RFC assessment that were most supported by the
record.” Conner v. Saul, No. 4:18-CV-657, 2020 WL4734995, at *8 (S.D. Tex. Aug
15, 2020) (citing Muse v. Sullivan, 925 F.2d 785, 790 (5th Cir. 1991)). As an
administrative factfinder, the ALJ is entitled to significant deference in deciding the
appropriate weight to accord the various pieces of evidence in the record, including

the credibility of medical experts and the weight to be accorded their opinions. See
Scott v. Heckler, 770 F.2d 482, 485 (5th Cir. 1985).
1. In determining Plaintiff’s RFC, the ALJ found unpersuasive the only
medical opinions in the record, all of which were given after Plaintiff’s
DLI.
Plaintiff argues that the ALJ improperly evaluated the medical opinions of
record and relied on his own assessment of Plaintiff’s limitations when formulating
his RFC determination. ECF No. 17 at 11–15. Plaintiff contends that had the ALJ

properly evaluated the medical opinions, he would have limited Plaintiff to sedentary
work and found Plaintiff disabled. Id. at 16.
Less than four months after the DLI, on April 18, 2018, Dr. Jo Ann Formby’s
performed a psychological consultative examination. R. 18. Dr. Formby opined that

Plaintiff has adequate capacity to understand, carry out, and remember instructions
(both complex and one-two step). R. 247 (4/18/2018). She further opined that
Plaintiff likely has adequate ability to sustain concentration and persist in work-

related activity at a reasonable pace. Id. Dr. Formby also stated that, due to reported
anxiety, Plaintiff has difficulty maintaining effective social interaction on a
consistent and independent basis, with supervisors, co-workers, and the public. Id.
Finally, she found that Plaintiff is likely able to deal with normal pressures in a
competitive work setting. Id. In discounting this consulting examiner’s (“CE”)
opinion, the ALJ determined that this psychological examination occurred after

Plaintiff’s DLI and was inconsistent with medical records during the relevant time
period of August 11, 2017, the alleged onset date, and December 31, 2017, Plaintiff’s
DLI.6 R. 18. The ALJ failed to point to any record evidence that was inconsistent

with Dr. Formby’s opinion. R. 18. Moreover, the ALJ discusses little to no medical
evidence in his opinion, providing no analysis or reasoning to supporting his
decision to discount Dr. Formby’s opinion. See Jackson v. Colvin, 240 F. Supp.3d
593, 604 (E.D. Tex. 2017) (finding that where the ALJ failed to identify the medical

evidence of record he believed was inconsistent with the medical opinion in the
paragraph discounting the opinion or elsewhere, the decision was wholly
unsupported by analysis or reasoning.).

The ALJ also found unpersuasive Dr. William Culver’s internal medicine
consultative examination, R. 18, which he performed six months after the DIL, on
June 6, 2018. Dr. Culver opined that Plaintiff cannot perform all her activities of
daily living, including maintaining a home, and that she should avoid walking or

standing for long periods, working in extreme temperatures, climbing ladders or

6 The ALJ wrote in his decision that Dr. Formby’s examination occurred “prior to the date late
insured.” R. 18. As Dr. Formby’s examination occurred four months after the expiration of
Plaintiff’s insurance, the ALJ meant to find Dr. Formby’s medical opinion unpersuasive because
it occurred after the DLI.
stairs, working off ground, lifting greater than ten pounds from floor to waist and
thirty from waist to above. R. 253 (6/6/2018). Dr. Culver further opined that

Plaintiff’s primary issue is her fibromyalgia and that she fatigues quickly and
therefore would have difficulty maintaining a home or employment. Id. In finding
this CE’s opinions unpersuasive, the ALJ again determined that the examination

occurred after Plaintiff’s DLI and was inconsistent with medical records during the
relevant time period of August 11, 2017, the alleged onset date, and December 31,
2017, Plaintiff’s DLI.7 R. 18. Again, the ALJ failed to point to any record evidence
that was inconsistent with Dr. Culver’s opinion. R. 18. Moreover, because the ALJ

discusses little to no medical evidence in his opinion, the Court finds no basis to
support the ALJ’s determination that Dr. Culver’s opinion is unpersuasive. See
Jackson, 240 F. Supp.3d at 604.

The ALJ further found unpersuasive the opinions of the state agency medical
consultants (“SAMCs”). R. 18–19.8 On June 18, 20189 and November 30, 2018,10
respectively, the SAMCs opined that Plaintiff could lift or carry twenty pounds

7 The ALJ wrote in his decision that Dr. Culver’s examination occurred “prior to the date late
insured.” R. 18. As Dr. Culver’s examination occurred six months after the expiration of Plaintiff’s
insurance, the ALJ meant to find Dr. Culver’s medical opinion unpersuasive because it occurred
after the DLI.
8 The ALJ incorrectly refers to them as state agency medical examiners, but there is no evidence
that these doctors examined the Plaintiff.
9 This SAMC opinion was given before the initial determination on disability.
10 This SAMC opinion was given before the reconsideration determination.
occasionally and ten pounds frequently, stand or walk for either five or six hours in
an eight-hour workday, sit for six hours in an eight-hour workday, and push or pull

an unlimited amount. R. 76 (6/18/18); R. 89 (11/30/18). In dismissing these
opinions, the ALJ noted that the SAMCs did not consider any medical records
generated or provided after the state agency reconsideration determination on

December 11, 2018. R. 19. The Court agrees with Plaintiff’s argument that the ALJ’s
reasoning for discounting the SAMCs’ opinions is internally inconsistent. ECF
No. 17 at 15. Despite discounting the opinions of Dr. Formby and Dr. Culver for
allegedly considering evidence of Plaintiff’s health after her DLI, the ALJ

discounted the opinions of the SAMCs for not considering evidence of Plaintiff’s
health after her DLI. R. 18-19.
In discounting the SAMCs’ opinions, the ALJ further held that a different

interpretation of the earlier records justified a conclusion that was different from
what the doctors concluded. R. 19. Again, the ALJ provided no explanation of what
that different interpretation was or reference to any evidence supporting the
interpretation. R. 19. Thus, the Court finds no analysis or reasoning to support the

ALJ’s determination that the SAMCs’ opinions are unpersuasive. See Jackson, 240
F. Supp.3d at 604.
Finding the opinions of Dr. Formby, Dr. Culver, and the SAMCs to be

unpersuasive, there were no other medical source opinions on which the ALJ relied
in formulating the RFC. Nonetheless, the ALJ concluded that the objective medical
evidence supported the RFC determination. R. 19. Again, the ALJ referenced no

records and discussed no objective medical evidence in making this conclusion,
failing to provide analysis or reasoning for his determination. See Jackson, 240 F.
Supp.3d at 604.

2. The Commissioner orders consultative examinations when necessary to
render an opinion.
The Commissioner only orders consultative examinations when it is necessary
to make a disability determination. The relevant regulations state that a consultative
examination is useful to “try to resolve an inconsistency in the evidence, or when
the evidence as a whole is insufficient to allow [the ALJ] to make a determination
or decision” on the claim. 20 C.F.R. § 404.1519a(b). An ALJ is not required to order

a consultative examination if the facts do not warrant or suggest the need for it. See
Hardman v. Colvin, 820 F.3d 142, 148 (5th Cir. 2016) (“A consultative examination
is required . . . only if ‘the record establishes that such an examination is necessary

to enable the [ALJ] to make the disability decision.’” (quoting Jones v. Bowen, 829
F.2d 524, 526 (5th Cir. 1987))). Consultative examinations that do not shed light on
Plaintiff’s impairments during the period of disability do not accomplish their

purpose for the disability process. See 20 C.F.R. § 404.1519b(c) (“[W]e will not
purchase a consultative examination . . . when your insured status has expired and
there is no possibility of establishing an onset date prior to the date your insured
status expired.”); Merrell v. Comm’r, Soc. Sec. Admin., No. 6:12CV393, 2013 WL
5496783, at *7 (E.D. Tex. Oct. 1, 2013) (finding that a consultative examination

performed ten years after Plaintiff’s DLI would not provide relevant information
about Plaintiff’s past mental status).
Here, the record establishes that the Commissioner ordered both the mental

and physical consultative examinations. R. 72 (6/18/18); R. 243 (4/18/18); see 20
C.F.R. §§ 404.1519–404.1519a. Because the consultative examinations were
ordered, the Commissioner implicitly determined that further medical opinions were
necessary to make a disability determination. R. 72 (6/18/18) (noting that

consultative examinations were required because “additional evidence [was]
required to establish current severity of the individual’s impairment(s)”); see
Hardman, 820 F.3d at 148 (“A consultative examination is required . . . only if ‘the

record establishes that such an examination is necessary to enable the [ALJ] to make
the disability decision.’” (quoting Jones v. Bowen, 829 F.2d 524, 526 (5th Cir.
1987))). Once the ALJ discounted both CE opinions, he did not have sufficient
medical evidence on which to base his determination because the Commissioner

previously determined that these opinions were necessary. R. 72 (6/18/18) (noting
that consultative examinations were required because “the evidence as a whole, both
medical and non-medical, [was] not sufficient to support a decision on the claim”).
3. The ALJ erred when he rejected the retrospective consultative medical
opinions.
The ALJ erred when he discounted the medical opinions of Dr. Formby and
Dr. Culver because they occurred after Plaintiff’s DLI. Medical evaluations made
after a claimant’s insured status has expired are not automatically barred from

consideration and may be relevant to prove a disability arising before the claimant’s
DLI. Beauchamp v. Colvin, No. CIV.A. 14-01899, 2015 WL 7082506, at *4 (E.D.
La. Nov. 13, 2015) (citing Wooldridge v. Bowen, 816 F.2d 157, 160 (4th Cir. 1987));

see Jackson, 240 F. Supp. 3d at 604 (rejecting ALJ’s finding that treating physician’s
opinion was unpersuasive because it occurred after Plaintiff’s DLI). Evidence
created after a claimant’s DLI, which permits an inference of linkage between the
claimant’s post-DLI state of health and his or her pre-DLI condition, can be the

“most cogent proof” of a claimant’s pre-DLI disability. Beauchamp, 2015 WL
7082506, at *5 (quoting Bird v. Comm’r of Soc. Sec. Admin., 699 F.3d 337, 340 (4th
Cir. 2012)); see also Loza, 219 F.3d at 396 (noting that “[s]ubsequent medical

evidence is [also] relevant . . . because it may bear upon the severity of the claimant’s
condition before the expiration of his or her insured status”). The post-DLI evidence,
however, must refer clearly to the relevant period of disability and not simply

express an opinion to the claimant’s current status. Bellard v. Berryhill, No. 2:16-
CV-1711, 2018 WL 1005578, at *8 (W.D. La. Jan. 8, 2018).
Defendant argues that the ALJ properly discounted Dr. Formby’s and
Dr. Culver’s opinions because they do not refer clearly to the relevant period of

disability. ECF No. 20-1 at 8. Defendant points to the wording of Dr. Formby’s and
Dr. Culver’s opinions, contending that they couch their evaluations in current terms.
Id. The Court disagrees.

Significantly, the reason for the consultative examinations was not to treat
Plaintiff for a current impairment, but to discuss and evaluate Plaintiff’s medical
history with records from the period of disability and make an assessment on
Plaintiff’s abilities for purposes of the disability process. R. 243 (4/18/18)

(Dr. Formby’s opinion noted that, “According to DARS/DDS11 the evaluation was
requested to help determine if she qualifies for disability benefits.”); R. 249 (6/6/18)
(Dr. Culver’s report stated that, “[T]his examination was for the purpose of

evaluation only, no treatment would be rendered, and no doctor/patient relationship
would develop.”).
Nor is this a case in which a significant amount of time elapsed between
Plaintiff’s DLI and the consultative examinations. To the contrary, the consultative

examinations occurred within months of the expiration of Plaintiff’s insurance.

11 DARS means Department of Assistive and Rehabilitative Services; DDS means Disability
Determination Services.
Dr. Formby’s and Dr. Culver’s examinations occurred four and six months after
Plaintiff’s DLI, respectively. R. 243 (4/18/18); R. 249 (6/6/18). The opinions also

state that they are based on a review of the medical record and Plaintiff’s history as
recounted during the examination. R. 243 (4/18/18); R. 249 (6/6/18). Therefore, the
Court finds Defendant’s contention that Dr. Formby and Dr. Culver assessed

Plaintiff’s current impairments when formulating their opinions is without merit.
The Court further finds sufficient connection between the CEs’ opinions and the
relevant period of disability.
4. The ALJ improperly substituted his lay opinion for that of the medical
experts.
In formulating the RFC, the ALJ discounted all medical opinions in the record.
Although the ALJ is generally tasked with weighing medical opinions and

determining a plaintiff’s RFC, Taylor, 706 F.3d at 602-03, “an ALJ may not—
without opinions from medical experts—derive the applicant’s residual functional
capacity based solely on the evidence of his or her claimed medical conditions. Thus,

an ALJ may not rely on his own unsupported opinion as to the limitations presented
by the applicant’s medical conditions.” Williams v. Astrue, 355 F. App’x 828, 832
n.6 (5th Cir. 2009) (citing Ripley, 67 F.3d at 557); see also Frank v. Barnhart, 326

F.3d 618, 622 (5th Cir. 2003) (warning an ALJ “must be careful not to succumb to
the temptation to play doctor,” as “lay intuitions about medical phenomena are often
wrong”) (quotations omitted). This is particularly true in questions of mental
impairment because “[d]etermining whether a claimant is disabled because of a
mental condition under the … sequential process can be a difficult task.” Singletary,

798 F.2d at 820. “Consequently, when the ALJ rejects the only medical opinions of
record, interprets the raw medical data, and imposes a different RFC, the ALJ has
committed reversible error.” Garcia v. Berryhill, No. 17-CV-263, 2018 WL

1513688, at *2 (W.D. Tex. Mar. 27, 2018) (collecting cases); accord Allen v. Saul,
No. 4:19-cv-1575, 2020 WL 5412630, at *7 (S.D. Tex. Sept. 9, 2020); Beachum v.
Berryhill, No. 17-CV-95, 2018 WL 4560214, at *4 (W.D. Tex. Sept. 21, 2018).
Here, there were no other medical opinions the ALJ considered. In an opinion

short on discussion of the medical records, the ALJ improperly substituted his
opinion without reasoning and analysis for all four medical opinions to formulate an
RFC. See, e.g., Allen, 2020 WL 5412630, at *7 (remanding when the ALJ gave little

weight to opinions of treating psychiatrists and partial weight to the SAMCs’ who
did not review the most recent records, thereby improperly interpreting the raw
medical data to formulate the RFC); Beachum, 2018 WL 4560214, at *3–4 (noting
that the ALJ, by her own admission, dismissed the medical consultant’s opinion and

thus improperly determined the RFC based on her lay opinion); Garcia, 2018 WL
1513688, at *3 (“[T]he ALJ rejected all opining physicians, credited no ascertainable
portions of their opinions, cited raw medical data, and made judgments regarding

Plaintiff’s RFC.) (citation omitted).
“Accordingly, the Court can only conclude that the ALJ substituted his own
judgment over the medical opinions of the physicians of record.” Garcia, 2018 WL

1513688, at *3. Therefore, substantial evidence does not support the ALJ’s RFC
determination.
B. The ALJ’s Errors Harmed Plaintiff.
Reversal of an ALJ’s decision is only warranted if the claimant shows that she

was prejudiced by the ALJ’s error. Ripley, 67 F.3d at 557. A claimant establishes
prejudice by showing that the ALJ could have reached a different outcome but for
the error in question. Newton v. Apfel, 209 F.3d 448, 458 (5th Cir. 2000). The ALJ

rejected the opinions of Dr. Formby and Dr. Culver, who assigned significantly more
RFC limitations than those the ALJ included. R. 247 (4/18/18); R. 253 (6/6/18). Had
the ALJ properly considered the opinions of Dr. Formby and Dr. Culver, it is
conceivable that the ALJ would have reached a different decision. Remand is both

appropriate and necessary.
Because the Court finds that the ALJ committed harmful error when he
rejected all medical opinions of record and formulated a RFC determination based

on his own lay opinion, the Court declines to address Plaintiff’s remaining
arguments as alternative grounds for summary judgment.12 See, e.g., McNickles v.

12 Plaintiff further contends that the ALJ failed to evaluate her medical record, explain its
supportability and consistency, and articulate the facts why her symptoms are not supported by
Thaler, No. H-10-3493, 2012 WL 568069, 2012 WL 568069, at *5 (S.D. Tex. Feb.
21, 2012) (declining to address alternative summary judgment ground because

respondent was already entitled to summary judgment).
On remand, the ALJ will be required to provide a full explanation of the basis
for his determination. Under the new rule regarding RFC determinations, the ALJ is

required to consider all medical opinions and prior administrative medical findings
using specific factors:13 (1) supportability; (2) consistency; (3) the physician’s
relationships with the claimant, which includes considering the length, purpose, and
extent of the treatment relationship, the frequency of examinations, and the

examining relationship; (4) the physician’s specialization, and (5) other factors. 20
C.F.R. § 404.1520c(b). 14 The most important factors are consistency and
supportability. Id.; Garcia, 2020 WL 7417380, at *4. Under the new guidelines, the

ALJ must articulate how persuasive he finds each of the opinions in the record.
20 C.F.R. § 404.1520c(b).

objective evidence in the record. ECF No. 17 at 11–14. Plaintiff also argues that the ALJ
completely disregarded her subjective complaints. ECF No. 17 at 16–17.
13 For claims filed after March 27, 2017, the new guidelines no longer require the ALJ to defer or
give any specific evidentiary weight to any medical opinion or prior administrative finding.
20 C.F.R. § 404.1520c(a); Garcia v. Saul, No. SA-19-CV-01307-ESC, 2020 WL 7417380, at *4
(W.D. Tex. Dec. 18, 2020) (explaining that despite new regulations, previous decisions are still
relevant as supportability and consistency have always been the most important considerations.).
Because Plaintiff’s claim was filed on October 3, 2017, this new rule applies.
14 Other factors include evidence that the medical source is familiar with the other evidence, or
that the medical source understands the disability program’s policies and evidentiary policies. Id.
V. CONCLUSION.
The Court GRANTS Plaintiff's motion for summary judgment, ECF No. 16,
and DENIES the Commissioner’s motion for summary judgment, ECF No. 20. The
Commissioner’s decision denying Plaintiff benefits is VACATED. This matter is
REMANDED to the Commissioner for further proceedings. This case is
DISMISSED.
SIGNED at Houston, Texas, on September 28, 2021.

Dena Rlermer-
Dena Hanovice Palermo
United States Magistrate Judge

20

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10674690. Public record. Not legal advice.