Joiner v. Commissioner, Social Security Administration

IN THE UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF TEXAS
FORT WORTH DIVISION
SANDRA J., §
PLAINTIFF, §
§
V. § CASE NO. 4:24-CV-1043-BK
§
COMMISSIONER, SOCIAL SECURITY §
ADMINISTRATION, §
DEFENDANT. §
MEMORANDUM OPINION AND ORDER
Pursuant to 28 U.S.C. § 636(b) and the parties’ consent to proceed before the undersigned
United magistrate judge, Doc. 2, Doc. 7, the Court now considers this appeal of the denial of
Plaintiff’s application for Social Security disability benefits. For the reasons stated here, the
Commissioner’s decision is REVERSED, and this case is REMANDED for further proceedings
consistent with this opinion.
I. BACKGROUND
A. Procedural History
Plaintiff seeks judicial review of the Commissioner of the Social Security
Administration’s (“Commissioner”) final decision denying her application for disability
insurance benefits (“DIB”) under Title II of the Social Security Act (the “Act”). Doc. 1.
In December 2021, Plaintiff filed her application for DIB, alleging a period of disability
beginning in May 2019 due to Graves’ Disease, lupus, low vision, thyroid eye disease, and
multiple auto immune disorders. Doc. 8-1 at 115. Plaintiff’s claim was denied at all
administrative levels, and she now appeals to this Court pursuant to 42 U.S.C. § 405(g). Doc. 1.
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B. Factual History
Plaintiff, who was 46 years old at the alleged onset of her disability, has at least a high
school education and past relevant work as a school secretary and administrative assistant. Doc.
8-1 at 47, 110, 124, 265. Plaintiff’s relevant medical history, dating from 2018 to 2023, reflects
diagnoses of Graves’ disease, thyroid eye disease, hypothyroidism, and Sjogren’s syndrome. 1
Doc. 8-1 at 354, 423; Doc. 8-2 at 278. The records further show Plaintiff’s consistent reports of
diplopia (double vision) and proptosis (bulging of the eyes), among other symptoms. See, e.g.
Doc. 8-1 at 357, 501, 566.
C. Medical Opinion Evidence
In May 2019, Plaintiff presented to neuro-ophthalmologist Dr. Shannon C. Lynch, M.D.,
for a consultative examination. Doc. 8-1 at 559. Plaintiff reported worsening double vision,
particularly in her right gaze. Doc. 8-1 at 559. Upon examination, Dr. Lynch noted Plaintiff had
left hypotropia2 without diplopia and that Plaintiff’s proptosis and lid retraction were stable,
though worse than the year prior. Doc. 8-1 at 562. The following month, Dr. Lynch noted in an
email that Plaintiff would have difficulty obtaining disability based on her eye findings alone
because Plaintiff’s acuity measured “near normal” and her “[d]iplopia does not count for much
disability since it can be resolved by closing one eye.” Doc. 8-1 at 556.
1 Although Plaintiff alleged additional physical impairments related to her autoimmune
disorders, she challenges only the ALJ’s evaluation of her visual limitations. See Doc. 11 at 4-7.
Accordingly, the Court focuses on the medical records and evidence pertaining to Plaintiff’s
alleged visual impairment.
2 See https://www.merriam-webster.com/medical/hypotropia (defining hypotropia as “strabismus
in which the line of vision of one eye turns downward”) (last visited March 26, 2026).
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In June 2019, Plaintiff began orbital radiation therapy to treat her thyroid eye disease.
Doc. 8-1 at 557. Prior to initiating therapy, the oncologist noted moderate proptosis, significant
restriction of lateral gaze bilaterally, problems with downward gaze, and obvious deconjugated
gaze associated with diplopia. Doc. 8-1 at 556.
In October 2019, following completion of radiation therapy, Plaintiff reported worsening
diplopia in all gazes, including forward gaze. Doc. 8-1 at 471. Plaintiff also reported that she
could not read or work on the computer without significant eye pain and felt unable to drive
safely except for short periods. Doc. 8-1 at 471. However, she noted that she “patch[ed] her eye
occasionally . . . to drive without double vision.” Doc. 8-1 at 471.
In June 2020, Plaintiff presented to ophthalmologist Dr. Zev Shulkin, M.D., with
concerns about her double vision. Doc. 8-2 at 34. She reported that her diplopia was worse
when at work, driving, outdoors, reading, and using a computer; however, she stated that it was
present only when both eyes were open. Doc. 8-2 at 34. Plaintiff began receiving infusions of
the medication Tepezza to treat these symptoms. Doc. 8-2 at 36. Although she initially reported
improvement in her symptoms, she again reported double vision, blurred vision, proptosis and a
pressure sensation in the fall of 2021 and was prescribed a second round of Tepezza. Doc. 8-2 at
318-319, 328-32. Plaintiff reported minimal or no symptoms in March 2022, however, by
August 2022, she again reported double vision and bulging eyes. Doc. 8-2 at 328-32, 533.
In September 2021, Dr. Shulkin opined that Plaintiff could work zero days a week due to
her symptoms. Doc. 8-2 at 646. In December 2022, March 2023, and December 2023, he also
opined that Plaintiff was not able to drive. Doc. 8-2 at 393, 506, 509. In June 2023, Plaintiff
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received muscle correction surgery on her left eye. Doc. 8-2 at 579. Following the surgery,
Plaintiff continued to report double vision. Doc. 8-2 at 15.
D. Hearing Testimony
i. Plaintiff’s Testimony
At the 2024 administrative hearing, Plaintiff testified that she stopped working in 2019
because she could not see straight and had to close one eye due to her thyroid eye disease. Doc.
8-1 at 64. She also averred that she has “hardly any peripheral vision” and when she moves her
head from left to right it causes double vision and a distortion of her whole view. Doc. 8-1 at 62.
She testified that she could not see clearly enough to use a computer and that if she tries to focus
on it, she gets extreme eye strain. Doc. 8-1 at 65. She stated that, if she were focusing on
something, she would have to take a break at least once an hour to rest her eyes. Doc. 8-1 at 73.
Plaintiff further averred that glasses do not correct the problems with her vision. Doc. 8-
1 at 65-55. She stated that she has difficulty seeing the television from 20 to 25 feet away and
that she could not see the eye chart at her most recent ophthalmology appointment even while
wearing her glasses. Doc. 8-1 at 66. Plaintiff testified that, due to her poor vision, her doctors
have prohibited her from driving. Doc. 8-1 at 62.
Plaintiff also testified that, while she saw initial improvement with Tepezza treatment, it
was temporary. Doc. 8-1 at 67. She stated that after her first round of treatment, she basically
“went back to where [she] was.” Doc. 8-1 at 67. She further averred that it was unusual to be
prescribed a second round of Tepezza treatment, and that her improvement from the second
round was also “short-lived.” Doc. 8-1 at 67.
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ii. Vocational Expert Testimony
A vocational expert (“VE”) also testified at the administrative hearing. Doc. 8-1 at 74.
The VE testified that an individual with Plaintiff’s education and work experience who is limited
to sedentary work; frequent bilateral handling, fingering, and feeling; occasional climbing of
ramps or stairs, balancing, stooping, kneeling and crouching; and is precluded from climbing
ladders, ropes, or scaffolds, crawling, and driving as part of the job, could perform Plaintiff’s
past work. Doc. 8-1 at 75-76. However, the VE testified that if the same individual were further
limited to only occasional near and far visual acuity, they would be precluded from performing
Plaintiff’s past work. Doc. 8-1 at 78.
E. The ALJ’s Findings
Following the administrative hearing, the ALJ issued his Hearing Decision utilizing the
five-step sequential evaluation set forth in 20 C.F.R. § 416.920 in determining whether Plaintiff
was disabled. At step one, the ALJ found that Plaintiff met the insured status requirements of the
Social Security Act through December 31, 2024, and had not engaged in substantial gainful
activity since May 31, 2019. Doc. 8-1 at 36. At step two, the ALJ determined that Plaintiff had
severe impairments of thyroid eye disease, hypothyroidism, Sjogren’s syndrome, osteoarthritis of
the bilateral feet, knees, and hands, degenerative disc disease of the lumbar spine, and obesity.
Doc. 8-1 at 36. However, the ALJ further found that none of Plaintiff’s impairments, singularly
or in combination, met or medically equaled any listed impairment in 20 C.F.R. Part 404,
Subpart P, Appendix 1. Doc. 8-1 at 37.
At step three, the ALJ found that Plaintiff had the Residual Functional Capacity (“RFC”)
to perform “sedentary work . . . except she is limited to frequent handling, fingering and feeling
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bilaterally; occasional climbing of ramps or stairs, balancing, stooping, kneeing, and crouching;
is precluded from climbing ladders, ropes, or scaffolds and crawling; and is precluded from
driving as part of the job.” Doc. 8-1 at 38.
Relying on the VE’s testimony, the ALJ found at step four that Plaintiff could perform
her past relevant work as a school secretary. Doc. 8-1 at 47. Accordingly, the ALJ concluded
that Plaintiff was not disabled during the relevant period and denied her claim for benefits. Doc.
8-1 at 47.
II. APPLICABLE LAW
The definition of disability under the Act is 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 12 months . . . .” 42 U.S.C. § 423(d)(1)(A). To determine whether a
claimant is disabled, the Commissioner utilizes a sequential five-step inquiry: (1) whether the
claimant is engaged in substantial gainful activity; (2) whether the claimant’s impairments are
“severe”; (3) whether the claimant’s impairment “meets or equals” one of the listings in the
relevant regulations; (4) whether the claimant can still do her past relevant work; and (5) whether
the impairment prevents the claimant from doing any other available work. Webster v. Kijakazi,
19 F.4th 715, 718 (5th Cir. 2021) (citing 20 C.F.R. § 404.1520(a)(4)). The claimant bears the
burden on the first four steps. Id. (citation omitted). If the claimant meets his burden, the burden
then shifts to the Commissioner to “prove the claimant’s employability.” Id. (citation omitted).
The Court’s review “is exceedingly deferential and limited to two inquiries: whether
substantial evidence supports the ALJ’s decision, and whether the ALJ applied the proper legal
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standards when evaluating the evidence.” Taylor v. Astrue, 706 F.3d 600, 602 (5th Cir. 2012).
“And whatever the meaning of ‘substantial’ in other contexts, the threshold for such evidentiary
sufficiency is not high. Substantial evidence, [the Supreme] Court has said, is more than a mere
scintilla. It means—and means only—such relevant evidence as a reasonable mind might accept
as adequate to support a conclusion.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (internal
citations and quotation marks omitted). The Court can neither “reweigh the evidence or
substitute its judgment for the Commissioner’s.” Perez v. Barnhart, 415 F.3d 457, 461 (5th Cir.
2005). A finding that substantial evidence does not exist “is appropriate only if no credible
evidentiary choices or medical findings support the decision.” Whitehead v. Colvin, 820 F.3d
776, 779 (5th Cir. 2016) (cleaned up).
III. ANALYSIS
On appeal, Plaintiff argues that the ALJ erred by failing to include visual limitations
caused by her diplopia in the RFC and in the hypotheticals posed to the VE. Doc. 11 at 5-6. She
contends that although the ALJ recognized that she suffers from double vision—which may
require her to close or cover one eye for portions of the workday—the ALJ failed to adequately
account for this limitation at steps three and four of his analysis. Doc. 11 at 5.
Defendant responds that the RFC sufficiently accounted for this limitation because the
ALJ found that Plaintiff’s diplopia could easily be managed during the workday and therefore
only precluded her from driving. Doc 17 at 5. Because the RFC included a driving restriction,
which was incorporated in the ALJ’s first hypothetical to the VE, Defendant argues that the ALJ
properly relied on the VE’s testimony in finding that Plaintiff was not disabled. Doc. 17 at 8-10.
The RFC assessment is based on “all of the relevant evidence in the case record,”
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including, but not limited to, medical history, medical signs and laboratory findings, the effects
of treatment, reports of daily activities, lay evidence, recorded observations, medical source
statements, and work evaluations. SSR 96-8p, 61 Fed. Reg. 34,477 (July 2, 1996), 1996 WL
362207. As factfinder, the ALJ has the sole responsibility for weighing the evidence and
determining the relative weight to be given it. Chambliss v. Massanari, 269 F.3d 520, 523 (5th
Cir. 2001). The ALJ is not required to incorporate limitations into hypothetical questions posed
to the VE or into the RFC finding that he did not find to be supported by the record. Scott v.
Comm’r, Soc. Sec. Admin, No. 4:20-CV-1136, 2022 WL 4240888, at *5 (N.D. Tex. Sept. 14,
2022) (Cureton, J.) (citing Muse v. Sullivan, 925 F.2d 785, 790 (5th Cir. 1991)); Masterson v.
Barnhart, 309 F.3d 267, 273 (5th Cir. 2002). Nevertheless, in assessing a claimant’s RFC, the
ALJ “must consider limitations and restrictions imposed by all of an individual’s impairments,
even those that are not ‘severe.’” SSR 96-8p, 61 Fed. Reg. 34,477 (July 2, 1996), 1996 WL
362207.
Once an individual’s functional limitations or restrictions are identified, Social Security
Ruling 96-8p provides that such limitations “must be expressed in terms of work-related
functions.” Id. In other words, the ALJ must consider the “total limiting effects” of an
impairment on the claimant’s “ability to perform work activity on a regular and continuing
basis.” Harney v. Colvin, No. 4:12-CV-515, 2013 WL 4774128, at *13 (N.D. Tex. Sept. 5,
2013) (Means, J.) (citing 20 C.F.R. § 416.945).
Here, the record contains undisputed evidence that Plaintiff suffers from double vision as
a symptom of her thyroid eye disease. Indeed, although the ALJ explicitly rejected Plaintiff’s
complaints of light sensitivity, poor visual acuity, and ocular headaches as inconsistent with the
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objective medical evidence, he appears to credit her consistent reports of double vision, which
were repeatedly documented in the medical record. See Doc. 8-1 at 46 (noting reports of double
vision, even with some improvement with infusion treatments, use of glasses, and surgery on the
lids and eye muscles). Despite acknowledging Plaintiff’s thyroid eye disease and double vision
as a severe impairment, however, the ALJ concluded that it only precluded her from climbing
ladders, ropes, or scaffolds and from driving as part of the job. Doc. 8-1 at 45.
In reaching this conclusion, the ALJ relied on Plaintiff’s testimony that she stopped
driving due to double vision, which he found consistent with Dr Shulkin’s repeated reports that
she was unable to drive. Doc. 8-1 at 45 (citing Doc. 8-2 at 393, 506, 509). He also found that
this evidence aligned with Dr. Lynch’s note that Plaintiff’s diplopia “could be resolved by
closing one eye,” because, he reasoned, “closing one eye would be unsafe while driving.” Doc.
8-1 at 45.
Plaintiff argues that, although the ALJ implicitly acknowledged her need to close one eye
as a limitation, he failed to adequately evaluate the impact of this limitation on her functioning
during the workday. Doc. 11 at 6. The Court agrees.
Social Security Ruling 96-8p specifically provides that, “in assessing RFC for an
individual with a visual impairment, the adjudicator must consider the individual’s residual
capacity to perform such work-related functions as working with large or small objects,
following instruction, or avoiding ordinary hazards in the workplace.” 1996 WL 362207; see
also 20 C.F.R. § 404.1545(d) (recognizing that “impairment(s) of vision . . ., may cause
limitations and restrictions which affect other work-related abilities”). The ALJ did not dispute
Plaintiff’s testimony that her diplopia causes distortion which, at times, requires her to close one
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eye. Doc. 8-1 at 44, 63. Nonetheless, the ALJ’s decision wholly fails to address how this
limitation affects her ability to perform any basic work functions. Doc. 8-1 at 63. Because
visual impairments such as strabismus and diplopia may affect depth perception and the ability to
navigate a work environment, this omission was error. See, e.g., Norris v. Apfel, No. 99-6167,
2000 WL 504882, at *3 (10th Cir. Apr. 28, 2000) (holding that an ALJ erred by failing to
address strabismus, which can cause diplopia or loss of vision in the affected eye, as such
impairments “surely” affect the claimant’s ability to walk and carry things safely in the
workplace).
Defendant contends that the absence of further limitations reflects the ALJ’s finding that
Plaintiff’s diplopia imposed no additional work-related restrictions. Doc. 17 at 9. In support of
this argument, Defendant points to the fact that the ALJ rejected Dr. Shulkin’s opinion that
Plaintiff could work zero hours, while he repeatedly relied on Dr. Lynch’s statement that
Plaintiff’s diplopia did not count for much disability since it could be resolved by closing one
eye. Doc. 8-1 at 44-45. As both Defendant and the ALJ acknowledge, however, Dr. Shulkin’s
notes did not address whether Plaintiff’s diplopia resulted in any functional limitations other than
her ability to drive. Doc. 8-1 at 45; Doc. 17 at 9 (citing Doc. 8-2 at 556, 646). Nor did Dr.
Lynch opine as to whether, or to what extent, Plaintiff’s need to close one eye affects her
functional capacity.3 See Doc. 8-1 at 557. Accordingly, even if the decision is read as
3 To be sure, in the single email on which Defendant relies, Dr. Lynch notes that obtaining
disability would be difficult based on Plaintiff’s diplopia alone because “[m]ost visual disability .
. . comes from loss of acuity,” while “[d]iplopia does not count for much[.]” Doc. 8-1 at 557.
However, such statement appears to reflect a generalized observation, rather than an assessment
Plaintiff’s functional abilities. Doc. 8-1 at 566. This is underscored by Dr. Lynch’s concluding
remark that “[i]t is up to the people at the disability office to approve or deny,” indicating that
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concluding—based solely on Dr. Lynch’s statement—that Plaintiff had no additional functional
limitations, the Court cannot find a logical bridge between the evidence and that conclusion. See
Price v. Astrue, 401 F.App’x 985, 986 (5th Cir. 2010) (holding that the ALJ “must build an
accurate and logical bridge between the evidence and the final determination.”); Hickey v.
Astrue, No. 4:09-CV-280, 2010 WL 3835113, at *11 (N.D. Tex. Aug, 2, 2010) (Cureton, J.) rep.
& rec. adopted, 2010 WL 3835109 (N.D. Tex Sept. 30, 2010) (noting that while “[t]he ALJ is
permitted to draw reasonable inferences from the evidence in making his decision, . . .
presumptions, speculation, and supposition do not constitute evidence.”).
This deficiency carries through to the determination at step-four of the ALJ’s assessment.
In determining that Plaintiff was capable of performing her past relevant work, the ALJ relied
solely on the VE’s testimony that an individual of Plaintiff’s age, education, and the RFC
identified in the ALJ’s first hypothetical question, could perform work as a school secretary.
Doc. 8-1 at 47. The ALJ’s first hypothetical, like the RFC identified in his decision, included a
prohibition from driving. Doc. 8-1 at 76. However, it did not include any visual limitations
resulting from Plaintiff’s thyroid eye disease, diplopia, or any other impairment. See Doc. 8-1 at
75-76.
Although an ALJ need not rely on a VE’s testimony to reach a conclusion at step four of
the evaluation process, 20 C.F.R. § 404.1566(e), in any case in which the ALJ relies on
hypothetical questions, they must comply with the law. Piccolella v. Astrue, No. 3:09-CV-696,
2010 WL 1051045, at *5 (N.D. Tex. 2010) (Lynn, J.). To meet this standard, hypothetical
she was commenting about how such claims are evaluated, not opining that Plaintiff has no
functional limitations.
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questions must reasonably incorporate all disabilities recognized by the ALJ and supported by
the record, and the claimant must be afforded a fair opportunity to correct any deficiencies in the
hypothetical. Boyd v. Apfel, 239 F.3d 698, 707 (5th Cir. 2001). If an ALJ’s decision is based on
the VE’s answer to a defective hypothetical, “the decision is not substantially justified.”
Piccolella, 2010 WL 1051045, at *4 (citing Boyd, 239 F.3d at 708).
As outlined supra, the ALJ concluded that Plaintiff suffers from thyroid eye disease and
diplopia. Doc. 8-1 at 38, 45-46. In posing hypothetical questions to the VE, the ALJ was thus
required to reasonably include all limitations related to these disabilities. Boyd, 239 F.3d at 707.
Although the ALJ recognized Plaintiff’s occasional need to close one eye to alleviate her
diplopia, he did not include this limitation in any of his hypothetical questions to the VE and it is
not apparent that the hypothetical preclusion from driving sufficiently incorporates such
limitation. See Doc. 8-1 at 75-78. Because the ALJ failed to reasonably incorporate all
recognized limitations, the hypothetical questions were deficient. See, e.g., Eastham v. Comm’r
of Soc. Sec. Admin, No. 3:10-CV-2001, 2012 WL 691893, at *8-9 (N.D. Tex. Feb. 17, 2012)
(hypothetical question was deficient where it failed to incorporate disabilities that the ALJ had
previously recognized but did not include in the ultimate RFC determination).
Defendant argues that Plaintiff had the opportunity to cross-examine the vocational
expert on this issue, but that neither she nor her representative asked a single question about
whether closing her eye for parts of the day could impact her ability to work. Doc. 17 at 10.
However, Plaintiff’s failure to point out at the hearing any deficiencies in the hypothetical
question does not “automatically salvage[] that hypothetical as a proper basis for a determination
of non-disability.” Boyd, 239 F.3d at 707 (interpreting Bowling, 36 F.3d at 436). Indeed, “[t]he
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ALJ has a duty to develop the facts fully and fairly relating to an applicant’s claim for disability
benefits.” Ripley v. Chater, 67 F.3d 552, 557 (5th Cir. 1995). “If the ALJ does not satisfy this
duty, his decision is not substantially justified.” Boyd, 239 F.3d at 708 (quoting Newton v. Apfel,
209 F.3d 448, 458 (5th Cir. 2000)).
While the VE may have testified that an individual with occasional monocular vision
could perform the work of a school secretary, the Court “simply cannot speculate how the VE
would have responded” to a hypothetical including this limitation. Singleton v. Colvin, No. 2:15-
CV-268, 2016 WL 8674675, at *5 (N.D. Tex. Sept. 9, 2016) (Averitte, J.). “[N]or can the
[C]ourt speculate how the ALJ would have ruled if the VE’s testimony was based on a non-
defective hypothetical.” Id. Because the ALJ relied on the VE’s answers to hypothetical
questions that failed to reasonably incorporate all the limitations recognized by the ALJ and
supported by the record, his determination that Plaintiff can perform her past relevant work is not
supported by substantial evidence. Thus, remand is warranted on this issue.
IV. CONCLUSION
For the foregoing reasons, the Commissioner’s decision is REVERSED, and this case is
REMANDED for further proceedings consistent with this opinion.
SO ORDERED on March 30, 2026.
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