4:25-cv-00764•Pratt v. Colvin Case remanded to SSA.
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1 IN THE UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF TEXAS HOUSTON DIVISION SHEILA P., 1 Plaintiff, v. FRANK BISIGNANO, Acting Commissioner of Social Security, Defendant. § § § § § § § § No. 4:25-cv-764 JUDGE PALERMO’S REPORT AND RECOMMENDATION Plaintiff Sheila P. (“Plaintiff”) filed this suit seeking judicial review of an administrative decision. Pl.’s Compl., 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. Pl.’s MSJ, ECF No. 12; Def.’s MSJ, ECF Nos. 13, 14. Plaintiff seeks an order rendering benefits or remanding for further consideration, arguing that the ALJ’s RFC determination is 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 The district judge to whom this case is assigned referred all pretrial proceedings to the undersigned. Referral Order, ECF No. 3. United States District Court Southern District of Texas ENTERED January 08, 2026 Nathan Ochsner, Clerk Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 1 of 20
2 not supported by substantial evidence. ECF No. 12. Based on the briefing, the record, and the applicable law, the Court finds that the ALJ’s RFC determination is not based on substantial evidence because the ALJ relies on her own lay interpretation of the medical evidence. The Court recommends that Plaintiff’s motion for summary judgment be granted, Commissioner’s motion for summary judgment be denied, and the ALJ’s decision be remanded. I. BACKGROUND Plaintiff is 59 years old. R. 212, 221. 3 Plaintiff previously worked as a cashier and a home health attendant. R. 218, 225. Plaintiff alleges a disability onset date of February 15, 2023. R. 212, 215. Plaintiff claims to suffer from physical and mental limitations. R. 212, 215, 221. On November 29, 2023, Plaintiff filed an application for disability insurance benefits under Title II of the Act. 4 R. 350–53. Plaintiff based her application on depression, bipolar disorder, neck pain, anxiety, high blood pressure, high cholesterol, knee arthritis, headaches, and back pain. R. 212, 215, 221. The 3 “R.” citations refer to the electronically filed Administrative Record, ECF No. 7. 4 The parties agree that although the ALJ references Title XVI benefits, there is no Title XVI supplemental security income application in the record and Plaintiff only applied for Title II benefits. See ECF Nos. 12 at 3; 14 at n.1. For Plaintiff’s disability insurance benefits, the relevant period is February 15, 2023—Plaintiff’s alleged onset date—through March 31, 2023—Plaintiff’s last insured date. R. 137. The Court will consider medical evidence outside this period to the extent it demonstrates whether Plaintiff was under a disability during this timeframe. See Williams v. Colvin, 575 F. App’x 350, 354 (5th Cir. 2014); Loza v. Apfel, 219 F.3d 378, 396 (5th Cir. 2000). Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 2 of 20
3 Commissioner denied Plaintiff’s claim initially, R. 211–19, and on reconsideration. R. 220–26. An administrative hearing was held before an ALJ where Plaintiff was represented by an attorney. Plaintiff and a vocational expert (“VE”) testified. R. 169–91. The ALJ issued a decision finding Plaintiff not disabled and denied her request for benefits. 5 R. 132–49. The Appeals Council denied Plaintiff’s request for review, upholding the ALJ’s decision to deny benefits. R. 5–16. Plaintiff appealed the Commissioner’s ruling to this Court. ECF No. 1. 5 An ALJ must follow five steps in determining whether a claimant is disabled. 20 C.F.R. § 404.1520(a)(4). The ALJ here determined Plaintiff was not disabled at step four. R. 148. At step one, the ALJ found that Plaintiff did not engage in substantial gainful activity since her alleged onset date. R. 137 (citing 20 C.F.R. §§ 404.1571 et seq. and 416.971 et seq.). At step two, the ALJ found that Plaintiff has the following severe impairments: osteoarthritis of the bilateral knees, degenerative disc disease of the lumbar spine, migraines, obesity, major depressive disorder, generalized anxiety disorder, and bipolar disorder. R. 138 (citing 20 C.F.R. § 404.1520(c) and 416.920(c)). 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. 138 (citing 20 C.F.R. §§ 404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926). The ALJ then found that Plaintiff had the RFC to perform medium work as defined in 20 CFR 404.1567(c) and 416.967(c) except she can frequently stoop and climb ramps and stairs, occasionally kneel, crouch, and crawl, never climb ladders, ropes, and scaffolds, cannot perform tasks involving a specific production rate pace, such as assembly line work or an hourly production quota, but can deal with occasional changes in a routine work setting. R. 143. At step four, the ALJ determined that Plaintiff was able to perform past relevant work as a home health attendant and a cashier checker. R. 148 (citing 20 C.F.R. §§ 404.1565, 416.965). The ALJ concluded that Plaintiff was not disabled. R. 148. Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 3 of 20
4 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 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 v. Apfel, 219 F.3d 378, 393 (5th Cir. 2000). “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, Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 4 of 20
5 787 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) (quotation omitted). III. DISABILITY INSURANCE BENEFITS UNDER THE ACT The Act permits the payment of insurance benefits to persons who have contributed to the program and who suffer a physical or mental disability. 42 U.S.C. § 423(a)(1)(D). These payments are referred to as disability insurance benefits. Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 5 of 20
6 Applicants must prove “disability” to qualify for benefits. Id. § 423(d)(1)(A). “Disability” is defined 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 12 months.” Id. A physical or mental impairment is defined as “an impairment that results from anatomical, physiological, or psychological abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic techniques.” Id. § 423(d)(3). “The suffering of some impairment does not establish disability; a claimant is disabled only if he is ‘incapable of engaging in any substantial gainful activity.’” Anthony v. Sullivan, 954 F.2d 289, 293 (5th Cir. 1992) (quoting Milam v. Bowen, 782 F.2d 1284, 1286 (5th Cir. 1987)). IV. THE SHIFTING BURDEN OF PROOF The Act places the burden of establishing disability on the claimant. Perez v. Barnhart, 415 F.3d 457, 461 (5th Cir. 2005). To be entitled to disability insurance benefits, a claimant “must show that he was disabled on or before the last day of his insured status.” Ware v. Schweiker, 651 F.2d 408, 411 (5th Cir. 1981). The Commissioner applies a five-step sequential process to determine disability status. Torres v. Colvin, No. 4:13-cv-2571, 2014 WL 4064002, at *6 (S.D. Tex. Aug. 15, 2014). The claimant bears the burden of proof at the first four steps to Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 6 of 20
7 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. V. PLAINTIFF IS ENTITLED TO SUMMARY JUDGMENT. Plaintiff raises one issue for review, arguing that the ALJ’s RFC determination is not supported by substantial evidence. Plaintiff argues that: (1) the ALJ impermissibly relied on his own lay interpretation of the medical evidence to develop an RFC for “medium work” that is unsupported by substantial evidence; (2) the RFC fails to accommodate certain Paragraph B mental limitations found at Step Two; (3) the ALJ should have incorporated prior findings from an earlier unfavorable ALJ decision; and (4) Plaintiff’s RFC determination of “medium work” is not supported by the record. ECF No. 12. Because the Court finds remand is appropriate on Plaintiff’s first argument: that the ALJ’s physical RFC determination is not supported by substantial evidence because the ALJ relies on her own lay interpretation of the medical evidence, the Court does not address Plaintiff’s remaining arguments. A. The ALJ’s Determination of Plaintiff’s Physical RFC Is Not Supported by Substantial Evidence. The ALJ’s residual functional capacity (“RFC”) determination is the most a Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 7 of 20
8 claimant can still do despite his limitations. 20 C.F.R. § 404.1545(a)(1). In assessing RFC, the ALJ must consider all the evidence in the record, including the limiting effects of all documented impairments, regardless of whether those impairments are severe or non-severe. Id. § 404.1545(a)(1)–(3). ALJs have the “‘sole responsibility’ to make RFC determinations, and they are ‘free to reject the opinion of any physician when the evidence supports a contrary conclusion.’” Sprowl v. Comm’r of Soc. Sec., No. SA-24-CV-01125-ESC, 2025 WL 2264602, at *5 (W.D. Tex. Aug. 6, 2025) (quoting Taylor v. Astrue, 706 F.3d 600, 602–03 (5th Cir. 2012) (citing Ripley v. Chater, 67 F.3d 552, 557 (5th Cir. 1995)); citing Newton v. Apfel, 209 F.3d 448, 455 (quoting Paul v. Shalala, 29 F.3d 208, 211 (5th Cir. 1994))). “Their RFC determination need not mirror a physician’s opinion.” Id. (quoting Miller v. Kijakazi, No. 22-60541, 2023 WL 234773, at *4 (5th Cir. Jan. 18, 2023) (per curiam)). “Even the absence of medical opinions does not necessarily render a record inadequate to support an ALJ’s RFC determination.” Donna A. v. Comm’r of Soc. Sec., No. 5:22-CV-111-H-BQ, 2023 WL 5004867, at *3 (N.D. Tex. July 17, 2023), adopted sub nom. Donna A. v. Kijakazi, No. 5:22-CV-111-H-BQ, 2023 WL 5004073 (N.D. Tex. Aug. 4, 2023) (quoting Nic R. v. Kijakazi, No. 3:22-cv-00106-K-BT, 2023 WL 2529930, at *5 (N.D. Tex. Feb. 21, 2023), adopted, 2023 WL 2531492 (N.D. Tex. Mar. 15, 2023) (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))). Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 8 of 20
9 The Court’s “inquiry focuses upon whether the decision of the ALJ is supported by substantial evidence in the existing record.” Ripley, 67 F.3d at 557. “Substantial evidence requires ‘evidence of the effects the claimant’s medical conditions have on her ability to work.’” Donna A., 2023 WL 5004867, at *4 (quoting Moreno v. Astrue, No. 5:09–CV–123–BG, 2010 WL 3025525, at *3 (N.D. Tex. June 30, 2010) (citing Ripley. 67 F.3d at 557), adopted, 2010 WL 3025519 (N.D. Tex. Aug. 3, 2010)); see Ripley, 67 F.3d at 557 (reversing because “the record d[id] not clearly establish . . . the effect [the claimant’s] condition had on his ability to work”)). If “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.” Sprowl v. Comm’r of Soc. Sec., No. SA-24-CV-01125-ESC, 2025 WL 2264602, at *6 (W.D. Tex. Aug. 6, 2025) (quoting Garcia v. Berryhill, No. EP-17-cv-00263- ATB, 2018 WL 1513688, at *2 (W.D. Tex. Mar. 27, 2018) (citing Williams, 355 F. App’x at 831); citing Beachum v. Berryhill, No. 1:17-cv-00095-AWA, 2018 WL 4560214, at *4 (W.D. Tex. Sept. 21, 2018) (citing Garcia, 2018 WL 1513688, at *2) (vacating the Commissioner’s decision where the ALJ rejected all medical opinions and relied solely on “raw medical data” in crafting an RFC)); see also Fitzpatrick v. Colvin, No. 3:15-CV-3202-D, 2016 WL 1258477, at *8 (N.D. Tex. Mar. 31, 2016) (“[T]he ALJ improperly made an independent RFC finding after declining to rely on any of the medical opinions addressing the effects of [the plaintiff’s] mental Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 9 of 20
10 impairments on his ability to work.”); Thornhill v. Colvin, No. 3:14-CV-335-M, 2015 WL 232844, at *10 (N.D. Tex. Jan. 16, 2015) (“While the ALJ may choose to reject medical sources’ opinions, he cannot then independently decide the effects of Plaintiff’s mental impairments on her ability to perform work-related activities, as that is prohibited by Ripley. . . .”). Here, the ALJ determined Plaintiff’s physical RFC “to perform medium work 6 as defined in 20 CFR 404.1567(c) and 416.967(c) except she can frequently stoop and climb ramps and stairs. She can occasionally kneel, crouch, and crawl. She can never climb ladders, ropes, and scaffolds. . . .” R. 143. In determining Plaintiff’s RFC, the ALJ considered Plaintiff’s testimony, summarizing that Plaintiff testified to “difficulties managing migraine headaches, knee pain, standing for longer than 15 minutes, sitting for longer than five minutes, dealing with back pain, and managing medication side effects, including stiffness, nausea, and drowsiness.” R. 144. The ALJ also noted that Plaintiff “submitted an adult function report indicating she has difficulties with activities of daily living and functions including lifting, squatting, bending, walking, kneeling, climbing stairs, taking medications without reminders from her daughter, completing tasks, concentrating, and handling stress and change.” R. 144. The ALJ found that although Plaintiff’s medically 6 “Medium work involves lifting no more than 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds.” 20 C.F.R. § 404.1567(c). Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 10 of 20
11 determinable impairments could be expected to cause these alleged symptoms, Plaintiff’s testimony regarding the intensity, persistence, and limiting effects of her symptoms was not “entirely consistent with the medical evidence and other evidence.” R. 144. The ALJ reviewed Plaintiff’s medical records, noting Plaintiff consistently complained of knee and back pain with examinations and images showing crepitus and osteoarthritis in her knees and decreased range of motion and degenerative disc disease in her back. R. 144. The ALJ then noted that the overall record shows grossly normal findings of her knees and back, along with normal motor skills and sensation despite a painful range of motion and normal gait—all of which the ALJ concluded “indicates [Plaintiff’s] reports of pain do not affect her ability to walk or stand.” R. 144. The ALJ next noted that Plaintiff’s migraine headaches were helped with medication and her neurological examinations showed grossly normal findings. R. 145. The ALJ stated that when she decided Plaintiff’s RFC, she took Plaintiff’s orthopedic issues and migraines into account and thus: restricted her to the medium exertional range limiting the amount of exertion or weight lifted or carried. Further limitations were also afforded to the claimant limiting her ability to frequently stoop and climb ramps and stairs but only occasionally kneel, crouch, and crawl with a restriction from climbing ladders, ropes, and scaffolds, also due to the level of exertion required by such tasks, with evidence showing some range of motion issues combined with crepitus to her knees, as well as persistent pain requiring medication management. R. 145. Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 11 of 20
12 Importantly, none of the medical evidence relied on by the ALJ made any mention of Plaintiff’s lifting abilities, how long she could stand or walk, how (in)frequently she could stoop, climb, kneel, crouch, and crawl—important components to finding Plaintiff capable of medium work, which requires standing or walking for 6 out of 8 hours a day and lifting of 50 pounds with frequent carrying of 25 pounds, and the additional imposed limitations. See 20 C.F.R. § 404.1567(c). Next, the ALJ noted Plaintiff’s obesity and stated that her medical records show a BMI that qualifies Plaintiff as obese. Then, without citation to the record, the ALJ noted: an individual may have limitations in any of the exertional functions, postural functions, in the ability to manipulate objects, or to tolerate extreme heat, humidity, or hazards because of obesity. The claimant’s weight, including the impact on the ability to ambulate as well as the other body systems, has been considered within the functional limitations determined herein and specifically, her obesity has been found to contribute to her exertional and postural limitations found herein. R. 145. Again, nothing within the ALJ’s consideration of Plaintiff’s obesity included medical opinions or examination findings regarding Plaintiff’s ability to work or determinations of Plaintiff’s functional abilities—instead, the ALJ appears to rely upon her own understanding of how obesity affects functional ability. And finally, the ALJ noted of the record’s medical opinions: in November 2023, Patty Rowley, M.D., examined the evidence and opined the claimant could perform work at the light exertional level with limitations in frequently climbing ramps and stairs, balancing, and Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 12 of 20
13 stooping, but only occasionally climbing ladders, ropes, and scaffolds, kneeling, crouching, and crawling. As an initial matter, the Administrative Law Judge finds this opinion not persuasive because it is not well supported by even the citations provided, which show the claimant exhibited grossly normal findings upon examination of her gait and station, as well as normal range of motion and negative findings on SLR testing. This opinion is also inconsistent with the overall evidence. Specifically, despite a one-time finding of knee crepitus and range of motion issues to her spine, the overall record shows grossly normal findings, including a normal gait, normal motor skills, and normal sensation throughout. As such, the Administrative Law Judge is not persuaded by Dr. Rowley’s limitation to work at the light exertional level as the evidence does not support such limitations. In fact, there is no evidence to suggest the claimant would have limitations in lifting, carrying, pushing, and/or pulling to the light level when her symptoms are well managed with medication and prescription gel. Regardless, to account for the claimant’s subjective complaints and the findings of range of motion issues and crepitus to her knees, the Administrative Law Judge finds the claimant would be limited to work at the medium level, which also accounts for the claimant’s migraine headaches, which could be exacerbated by her overall exertion. This is consistent with the finding of decreased range of motion and crepitus. However, later, in January 2024, Larry Wilson, M.D., also reviewed the record but found [insufficient evidence] to make a determination (Ex. B5A). The Administrative Law Judge finds this opinion to be inherently neither valuable nor persuasive in accordance with 20 CFR 404.1520b(c) and 416.920b(c) because there were no functional limitations set forth by Dr. Wilson when, at the hearing level, there is, in fact, sufficient evidence to evaluate the severity of the claimant’s impairments. Accordingly, the Administrative Law Judge has provided the claimant physical limitations to account for the combination of her impairments and their associated symptoms, as discussed above. Finally, in June 2023, the claimant’s treating physician, Dominic Joseph, M.D., recommended the claimant, “get back to work in home health agency” and provided her with a referral to employment services. While this statement does not provide any specific functional limitations related to the claimant’s mental or physical abilities, the Administrative Law Judge has considered it. Specifically, the Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 13 of 20
14 Administrative Law Judge notes that this statement is from the claimant’s treating physician who has specific knowledge of the claimant’s mental and physical impairments and limitations. Not only that, Dr. Joseph has had the benefit of personally examining the claimant and did not find it necessary to provide her limitations, but instead recommended she return to work. R. 147–48 (internal citations omitted). The ALJ rejected both medical opinions, finding instead that her independent review of the medical examination record supported a greater level of physical work. In finding support for her higher physical RFC, she relied on a statement from Plaintiff’s treating mental health physician at the Harris Center for Mental Health, Dominic M. Joseph, M.D. On June 27, 2023, Plaintiff presented to Dr. Joseph with the chief complaint that her anxiety was worse because she was going to be homeless because she can no longer work in home healthcare. R. 669. Due to “[t]he complexity and risks of this case includ[ing] dual diagnosis and comorbid psychosocial stressors including being unemployed and fear of getting evicted over not paying rent,” Dr. Joseph counseled Plaintiff to seek housing ahead of being evicted and “to get back to work in home health agency” and seek employment at the Harris Center. R. 672. 7 Dr. Joseph performed a mental status examination on Plaintiff but did not 7 Dr. Joseph’s statement in a treatment record is arguably neither a medical opinion nor medical source statement under the regulations. See Anderson v. Berryhill, No. 4:18-CV-03058, 2019 WL 3252934, at *5 (S.D. Tex. July 19, 2019) (“A medical opinion is an opinion from an ‘acceptable medical source’ ‘about what [a claimant] can still do despite [her] impairments,’ 20 C.F.R. § 404.1527(a)(1), 20 C.F.R. §§ 404.1513(a)(2)(i-iv). A ‘medical source statement’ is a ‘medical opinion[ ] submitted by [an] acceptable medical source[ ], including treating sources, . . . about what an individual can still do despite a severe impairment(s), in particular about an individual’s Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 14 of 20
15 perform any physical examination. R. 670–71. Nothing in Dr. Joseph’s mental health treatment record touches on Plaintiff’s physical functional abilities. In rejecting all medical opinions in the record, the ALJ’s physical RFC finding rests only on the ALJ’s lay interpretation of observation and examination notes from treatment records and clinical test results—none of which address Plaintiff’s functional ability to perform the ALJ’s determined RFC. But, “[t]he problem with this approach is that an ALJ may not ‘draw [her] own medical conclusions from some of the data, without relying on a medical expert’s help.’” Donna A., 2023 WL 5004867, at *5 (quoting Frank v. Barnhart, 326 F.3d 618, 621–22 (5th Cir. 2003) (per curiam); citing Fitzpatrick v. Colvin, No. 3:15-CV-3202-D, 2016 WL 1258477, at *8 (N.D. Tex. Mar. 31, 2016) (finding error where the ALJ “attempted to compensate for” the claimant's disorder, “[b]ut other than the opinions of the two SAMCs (which the ALJ rejected), the record lack[ed] medical evidence that would support a determination that” the claimant could work despite that impairment)). “An ALJ is free to reject medical opinions provided that [she] does not ‘then independently decide the effects of a claimant’s impairments on her ability to perform work-related activities.’” Id. (quoting Greer v. Comm’r of Soc. Sec., No. 7:21-cv-00032-O-BP, 2022 WL 4239356, at *7 (N.D. Tex. Aug. 9, 2022), adopted, physical or mental abilities to perform work-related activities on a sustained basis.’ SSR 96-5p, 1996 WL 374183 at *4.”). Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 15 of 20
16 2022 WL 4240948 (N.D. Tex. Sept. 14, 2022)). The ALJ relied on evidence that merely describes Plaintiff’s conditions rather than demonstrating her ability to work despite those impairments. See id. at *6 (citing Jim S. v. Saul, No. 3:18-CV-2179-BH, 2019 WL 4694943, at *9 (N.D. Tex. Sept. 25, 2019) (finding error where the ALJ relied on medical records to assess the claimant's RFC without identifying the medical opinions that were the source of the imposed limitations); Turner v. Colvin, No. 3:13–CV–1458–B, 2014 WL 4555657, at *5 (N.D. Tex. Sept. 12, 2014) (“[E]vidence which merely describes Plaintiff’s medical conditions is insufficient to support the ALJ’s RFC determination.”)). Nothing relied upon by the ALJ addressed Plaintiff’s functional abilities like how much she can lift or how long she can walk or stand—rather, the ALJ interpreted herself that grossly normal findings of Plaintiff’s gait, station, and range of motion meant Plaintiff had the ability to lift up to 50 pounds at a time with frequent lifting or carrying of objects weighing up to 25 pounds. This is error. The record does not “clearly establish how Plaintiff’s conditions impact her ability to perform medium work and there are no medical opinions to otherwise serve as a foundation for that decision,” and “appears the ALJ relied on [her] own interpretation of the medical and other evidence, which [she] may not do.” See id. (citing Cary G. T. v. Comm’r, Soc. Sec. Admin., No. 3:20-CV-1948-BK, 2022 WL 954341, at *3 (N.D. Tex. Mar. 29, 2022) (concluding that although “the RFC is Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 16 of 20
17 ultimately the ALJ’s determination,” 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”); Alexander v. Saul, No. 7:19-CV-00127-M-BP, 2020 WL 4573847, at *4 (N.D. Tex. July 9, 2020), adopted by 2020 WL 4569034 (N.D. Tex. Aug. 7, 2020)). The ALJ erred in making a physical RFC determination without evidence in the record clearly establishing the impact of Plaintiff’s impairments on her ability to work. See Donna A., 2023 WL 5004867, at *6. 8 Likewise, the ALJ erred in making accommodations for Plaintiff’s mental impairments in the RFC without evidence establishing the impact of Plaintiff’s mental impairments on her ability to work. Thornhill, 2015 WL 232844, at *10. The ALJ cannot “independently decide the effects of Plaintiff’s mental impairments on her ability to perform work-related activities, as that is prohibited by Ripley. . . .”. Id. 8 Commissioner argues that the ALJ’s RFC determination need not mirror a medical opinion, but rather the ALJ is responsible for interpreting the medical evidence to determine Plaintiff’s RFC. ECF No. 14 at 10. But what is missing from the ALJ’s determination is any evidence in the record to establish “the effect [Plaintiff’s] condition had on [her] ability to work.” See Tiede, 770 F. Supp. 3d at 972 (emphasis in original) (quoting Ripley, 67 F.3d at 557); see also Donna A., 2023 WL 5004867, at *5–6 (RFC not supported by substantial evidence where ALJ rejected SAMCs’ opinions, but relied on the plaintiff’s testimony, clinical test results, and medical records finding normal strength, gait, and range of motion because this evidence described the plaintiff’s conditions, but did not make clear what effect the plaintiff’s condition had on the plaintiff’s ability to work). Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 17 of 20
18 B. The ALJ’s Error Was Harmful. “A court will not vacate a judgment unless the ‘substantial rights of a party have been affected.’” Giles R., 2021 WL 4502842, at *9 (quoting Mays v. Bowen, 837 F.2d 1362, 1364 (5th Cir. 1988)). Plaintiff must demonstrate that she was prejudiced from the ALJ’s errors by showing that, absent the error, the Commissioner might have reached a different conclusion. See id. (citing Jones v. Astrue, 691 F.3d 730, 735 (5th Cir. 2012) (“The party seeking to overturn the Commissioner’s decision has the burden to show that prejudice resulted from an error.”); Newton v. Apfel, 209 F.3d 448, 453 (5th Cir. 2000)). “Prejudice can be established by showing that additional evidence would have been produced if the ALJ had fully developed the record, and that the additional evidence might have led to a different decision.” Ripley, 67 F.3d at 557 n.22. Here, the ALJ determined that Plaintiff could “perform medium work, meaning she could lift up to 50 pounds and frequently lift 25 pounds, stand or walk for 6 out of 8 hours every day, “except she can frequently stoop and climb ramps and stairs” and “occasionally kneel, crouch, and crawl.” R. 143. The only other medical opinion addressing Plaintiff’s physical RFC, Dr. Rowley, stated that Plaintiff was only capable of light work, which the VE testified would prevent Plaintiff from returning to her past relevant work as a home health aide. R. 188. It is not out of the realm of possibilities that a medical opinion could have determined Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 18 of 20
19 Plaintiff incapable of the physical functions demanded of medium work and that Plaintiff would therefore be unable to perform her past relevant work. If she was limited to light work, Plaintiff is correct that, the regulations would require a finding of disabled for a person of advanced age with only a high school education and no transferable skills. 20 C.F.R. Pt. 404, Subpt. P, App. 2, Rule 201.04 & 201.06. Therefore, the ALJ’s failure to develop the record was not harmless. Remand for further proceedings is required on this issue. See Donna A., 2023 WL 5004867, at *6 (citing Kirkland v. Comm’r of Soc. Sec., No. 4:22-cv-759-O-BP, 2023 WL 3357597, at *6 (N.D. Tex. Apr. 25, 2023), adopted, 2023 WL 3362633 (N.D. Tex. May 10, 2023); Lozano v. Comm’r, Soc. Sec. Admin., No. 4:21-CV-1365-P, 2023 WL 2618132, at *6 (N.D. Tex. Mar. 2, 2023), adopted, 2023 WL 2619311 (N.D. Tex. Mar. 23, 2023); Graves v. Kijakazi, No. 3:22-CV-0107-L-BH, 2023 WL 2025247, at *17 (N.D. Tex. Jan. 31, 2023), adopted, 2023 WL 2025052 (N.D. Tex. Feb. 15, 2023); Martinez v. Kijakazi, No. 3:20-CV-3282-BH, 2022 WL 4590577, at *22 (N.D. Tex. Sept. 29, 2022). VI. CONCLUSION The Court RECOMMENDS that Plaintiff’s motion for summary judgment, ECF No. 12, be GRANTED, the Commissioner’s motion for summary judgment, ECF No. 13, be DENIED, that the Commissioner’s determination that Plaintiff is Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 19 of 20
20 not disabled be REVERSED and REMANDED to the Commissioner for further proceedings, and that the Court enter a separate final judgment. The Parties have fourteen days from service of this Report and Recommendation to file written objections. 28 U.S.C. § 636(b)(1)(C); F ED. R. C IV . P. 72(b). Failure to file timely objections will preclude review of factual findings or legal conclusions, except for plain error. Quinn v. Guerrero, 863 F.3d 353, 358 (5th Cir. 2017). Signed at Houston, Texas, on January 8, 2026. ______________________________ Dena Hanovice Palermo United States Magistrate Judge ______________________________ Dena Hanovice Palermo United States Magistrate Judge Case 4:25-cv-00764 Document 15 Filed 01/08/26 in TXSD Page 20 of 20
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