Charron v. SSA 13-NH-36-PB 11/18/13
UNITED STATES DISTRICT COURT FOR THE DISTRICT OF NEW HAMPSHIRE
Hope A . Charron
v. Civil N o . 13-cv-36-PB Opinion N o . 2013 DNH 156 Michael J. Astrue, Commissioner, Social Security Administration
MEMORANDUM AND ORDER
Hope Charron seeks judicial review of a ruling by the
Commissioner of the Social Security Administration (“SSA”)
denying her application for Supplemental Security Income
benefits (“SSI”). Charron claims that the Administrative Law
Judge (“ALJ”) lacked substantial evidence to support his finding
that she was not disabled. Charron also claims that the ALJ
made a residual functional capacity (“RFC”) determination that
failed to account for all of her non-exertional limitations and
misapplied the Medical-Vocational Guidelines as a framework for
her decision.
For the reasons set forth below, I remand the case for
further proceedings before the Commissioner. I. BACKGROUND1
A. Procedural History
Charron applied for SSI on July 6, 2010, claiming that she
began suffering from the following impairments on July 6, 2009:
depression; attention deficit hyperactivity disorder (ADHD);
knee-related problems; grand mal seizures; and diabetes. The
SSA denied Charron’s claim on December 8 , 2010. T r . at 9 2 .
Charron then supplemented the record with new medical evidence
purportedly documenting a vision impairment. Charron requested
a hearing before an ALJ, which was held on November 2 2 , 2011. A
vocational expert (“VE”) testified.
On December 3 0 , 2011, the ALJ issued a decision finding
that Charron was not disabled on or after her alleged disability
onset date. The Appeals Council denied Charron’s request for
review on November 2 9 , 2012. Accordingly, the ALJ’s decision is
the final decision of the Commissioner.
1 The background facts are presented in the parties’ Joint Statement of Material Facts (Doc. N o . 12) and are summarized here. I also rely on the Administrative Transcript (Doc. N o . 7 ) , citations to which are indicated by “Tr.”
2 B. Relevant Medical History2
Between early 2009 and late 2011, Charron made numerous
visits to a variety of healthcare providers to receive treatment
for ailments unrelated to her eyes. These providers, who were
not vision specialists, consistently noted normal vision in the
“review of systems” portion of their treatment notes.
Representative comments are as follows: “no acute changes in
vision,” T r . at 835; “fundi benign, conjunctiva and sclera
clear,”3 id. at 1028; “[d]enies vision loss,” id. at 1055; “[n]o
blurry/double vision,” id. at 1216; “conjugate gaze,” id. at
1250; “[p]upils are equal, round and reactive to light and
accommodation. Extraocular movements intact. Visual acuity
intact,” id. at 1278; and “no icterus,4 vision grossly normal,”
id. at 1357. In contrast, on December 7 , 2010, orthopedic
2 Because the ALJ’s treatment of Charron’s alleged vision impairment requires remand, I limit my discussion to Charron’s vision-related medical history. 3 The fundus is “the portion of the interior of the eyeball around the posterior pole . . . .” Stedman’s Medical Dictionary 777 (28th ed. 2006). The conjunctiva is the “mucous membrane investing the anterior surface of the eyeball and the posterior surface of the lids.” Id. at 431. The sclera is a “portion of the fibrous layer forming the outer envelope of the eyeball . . . .” Id. at 1732.
4 Icterus is the medical term for jaundice, which causes a “yellowish staining of the . . . sclerae . . . .” Id. at 943, 1010. 3 surgeon D r . Douglas J. Moran noted, without further explanation,
that Charron was “[b]lind in her left eye” during his review of
systems. Id. at 599. Additionally, an emergency room doctor
treating Charron for low back pain on September 7 , 2011 noted
that her “[l]eft eye [is] injected5 with no other abnormalities.”
Id. at 1218. Other providers treating Charron in subsequent
weeks, however, noted that there was “no injection.” Id. at
1357, 1370, 1384. Based on a review of Charron’s medical
records on December 6, 2010, state agency physician D r . John
Sadler reported that Charron had no visual limitations. He also
noted that she could cook for her children, perform household
chores, and use public transportation. Id. at 8 2 , 8 5 .
On January 1 1 , 2011, D r . Timothy J. Hogan, O.D. examined
Charron. Id. at 890. D r . Hogan’s treatment notes from this
visit are the only documentation of a detailed eye examination
in the record. Charron complained of blurry vision in her left
eye and “a decrease in all ranges with and without” prescription
over the course of the previous year. Id. Charron reported
that her last eye examination occurred three to four years
earlier, that she had undergone three surgical procedures to her
5 In this context, injected denotes “visible blood vessels distended with blood.” Id. at 978.
4 left eye as a young child, and that she subsequently wore a
patch over her right eye periodically from age three until her
early teens.6 Id. D r . Hogan noted that these prior surgical
procedures were “[m]ost likley [sic] strab[ismus] surgery . . .
.”7 Id. His examination revealed bilateral dry eye syndrome, a
tilted optic disc in the left eye, anisometropia, astigmatism,
divergent and vertical misalignment in the extraocular muscles,
and corrected left eye acuity of 20/25. 8 D r . Hogan recommended
use of warm compresses several times a day to treat Charron’s
dry eye syndrome, monitoring of Charron’s tilted optic disc,
full-time use of Charron’s prescription eyeglasses, and a return
visit in one year for further evaluation. Id.
6 Charron was 35 years old at the time she filed her SSI application and 36 years old at the time of this examination. 7 Strabismus is a “manifest lack of parallelism of the visual axes of the eyes.” Id. at 841. 8 Dry eye syndrome, also known as keratoconjunctivitis sicca, is inflammation of the conjunctiva and of the cornea associated with decreased tears. Id. at 1024. The optic disc is “an oval area of the ocular fundus [the portion of the interior of the eyeball around the posterior pole] devoid of light receptors . . . .” Id. at 549, 777. Anisometropia is a “difference in the refractive power of the two eyes.” Id. at 9 5 . Astigmatism is a “condition of unequal curvatures along the different meridians in one or more of the refractive surfaces . . . of the eye . . . .” Id. at 170.
5 Nine months later, D r . Hogan completed a vision
questionnaire. Id. at 1089. Noting that he had seen Charron
only once before, he reiterated his diagnoses of dry eye
syndrome, astigmatism, and a corrected visual acuity of 20/25 in
the left eye, while adding a diagnosis of amblyopia9 in the left
eye, which he noted was “most likely stable.” Id. D r . Hogan
reported that Charron “notes blurry vision [in her] left eye.
This however is due to congenital formation of [the] optic nerve
resulting in a form of amblyopia (lazy eye) with best corrected
vision of 20/25.” Id. He opined that Charron could perform
work activities requiring color vision on a constant basis; near
and far acuity, accommodation, and field of vision on a frequent
basis; and depth perception on a rare basis. He noted that work
involving prolonged driving or “fine near work” might pose some
difficulties for Charron.
C. Administrative Hearing - June 13, 2011
1. Charron’s Testimony
Charron testified that she has significant visual
limitations, particularly in her left eye, because her eyes
“focus in different directions or point in different
9 Amblyopia denotes “[p]oor vision caused by abnormal development of visual areas of the brain in response to abnormal visual stimulation during early development.” Id. at 5 8 . 6 directions.” T r . at 4 6 . She noted that she could look at a
television or computer screen for five to ten minutes before her
vision became blurry. Id. She also testified to lifelong
problems with her left eye that had recently worsened.
2. Vocational Expert Testimony
The ALJ asked the VE to testify to the vocational abilities
of a hypothetical individual with the same age, education, and
relevant work experience as Charron. In response to a
hypothetical containing all of the limitations in the ALJ’s
ultimate RFC assessment, the VE testified that this hypothetical
individual could perform the following jobs existing in
significant numbers in the national economy: (1) addresser; (2)
fast food worker; (3) housekeeper/cleaner; (4) charge account
clerk; and (5) small product assembler.
The ALJ then posed a second hypothetical question to the VE
including all of the first hypothetical’s limitations, plus an
additional requirement that the individual would have to avoid
performing tasks requiring depth perception. The VE testified
that the hypothetical individual would then be unable to perform
any jobs. 10 Id. at 6 8 , 7 0 .
10 The precise exchange between the ALJ and VE is as follows:
[ALJ]: So basically it [a depth perception limitation] 7 D. The ALJ’s Decision
In his decision dated December 3 0 , 2011, the ALJ followed
the five-step sequential evaluation process set forth in 20
C.F.R. § 416.920(a)(4) to determine whether an individual is
disabled. At step one, the ALJ found that Charron had not
engaged in substantial gainful activity since July 6, 2010, the
date she filed her application for SSI. At step two, the ALJ
noted that Charron had the following severe impairments:
affective disorder; obesity; left knee impairment; and a history
of seizures. In the explanation of her step two determination,
the ALJ noted that “[a]lthough the medical evidence in the
record clearly establishes that the claimant suffers from
amblyopia and astigmatism, there is no substantial medical
evidence in the record that the claimant has limitations because
of it.” T r . at 15 (citation omitted). The ALJ continued:
The claimant maintains binocular vision, including 20/20 visual acuity in her right eye and 20/25 visual acuity in her left. The claimant had a driver’s license, which she only lost because of her history of seizures and not because of a vision problem. The claimant also worked in 1998, earning $12,783 even with her vision impairment, which an examining medical
eliminates all – [ V E ] : Honestly I think s o . [ALJ]: Okay, if that’s your testimony that’s fine. [ V E ] : That’s my testimony.
Tr. at 6 8 . 8 source described as “congenital” in nature. The claimant having previously worked with her vision impairment strongly suggests that she could work today even with it. Further, the claimant watches television, including news programs and soap operas, and she uses the computer, e-mailing and communicating via Skype. There being no substantial evidence in the record indicating the claimant’s limitations from these impairments, I find that they do not create more than a minimal reduction in the ability of the claimant to perform work related activities; therefore, they are not severe.
Id. (citations omitted). This discussion is the only reference
to Charron’s claimed vision impairment in the ALJ’s decision.
At step three, the ALJ concluded that Charron did not have an
impairment or combination of impairments that met or medically
equaled one of the listed impairments in 20 C.F.R. Part 4 0 4 ,
Subpart P, Appendix 1 . At step four, the ALJ found that Charron
retained the Residual Functional Capacity (“RFC”) to perform
light work per 20 C.F.R. § 416.967(b), subject to a number of
specific limitations – but no visual limitations - that
precluded Charron from performing any of her past relevant work.
At step five, the ALJ relied on the VE’s testimony, which she
found to be “reliable, credible and convincing,” to determine
that Charron could perform jobs existing in significant numbers
in the national economy. T r . at 2 5 . The ALJ thus concluded
that Charron had not been disabled at any point since July 6,
2010, the date she filed her application. 9 I I . STANDARD OF REVIEW
Under 42 U.S.C. § 405(g), I must review the pleadings and
the administrative record and enter a judgment affirming,
modifying, or reversing the final decision of the Commissioner.
My review “is limited to determining whether the ALJ used the
proper legal standards and found facts [based] upon the proper
quantum of evidence.” Ward v . Comm’r of Soc. Sec., 211 F.3d
652, 655 (1st Cir. 2000).
The ALJ is responsible for determining issues of
credibility and for drawing inferences from evidence in the
record. Irlanda Ortiz v . Sec’y of Health & Human Servs., 955
F.2d 765, 769 (1st Cir. 1991) (per curiam) (citing Rodriguez v .
Sec’y of Health & Human Servs., 647 F.2d 2 1 8 , 222 (1st Cir.
1981)). It is the role of the ALJ, not the court, to resolve
conflicts in the evidence. Id. The ALJ’s findings of fact are
accorded deference as long as they are supported by substantial
evidence. Id. Substantial evidence to support factual findings
exists “if a reasonable mind, reviewing the evidence in the
record as a whole, could accept it as adequate to support his
conclusion.” Id. (quoting Rodriguez, 647 F.2d at 2 2 2 ) . If the
substantial evidence standard is met, factual findings are
conclusive even if the record “arguably could support a
10 different conclusion.” Id. at 770 (citing Rodriguez Pagan v .
Sec’y of Health & Human Servs., 819 F.2d 1 , 3 (1st Cir. 1987)).
Findings are not conclusive, however, if they are derived
by “ignoring evidence, misapplying the law, or judging matters
entrusted to experts.” Nguyen v . Chater, 172 F.3d 3 1 , 35 (1st
Cir. 1999) (per curiam) (citing Irlanda Ortiz, 955 F.2d at 769;
Da Rosa v . Sec’y of Health & Human Servs., 803 F.2d 2 4 , 26 (1st
Cir. 1986) (per curiam)).
III. ANALYSIS
Charron moves for reversal and remand on two main grounds.
She argues that the ALJ (1) ignored the limiting effects of her
vision impairment when developing her RFC, and (2) misapplied
the Medical-Vocational Guidelines by improperly using them as a
framework for her decision. I need not consider Charron’s
second argument because I find that her first argument has merit
and requires remand.
A. The ALJ Ignored Medical Evidence Regarding Charron’s Vision Impairment
Charron argues that D r . Hogan’s medical opinion, which
states that she can only rarely perform work requiring depth
perception, directly contradicts the ALJ’s assertion that “there
is no substantial medical evidence in the record establishing . 11 . . limitations from” Charron’s diagnosed amblyopia. Doc. N o .
8 ; T r . at 1 5 . Charron notes that the ALJ included a depth
perception limitation in the second hypothetical she posed to
the V E , who subsequently testified that this limitation would
preclude Charron from transitioning to other work in the
national economy. Despite the fact that the ALJ was clearly
aware of the functional limitations noted by D r . Hogan, Charron
argues that the ALJ simply ignored them in her decision.
Charron contends that the ALJ also erred in giving “great
weight” to D r . Sadler’s opinion, at least in so far as it
concerns her vision impairment, because D r . Sadler did not
review D r . Hogan’s treatment notes or vision questionnaire.
The Commissioner counters that D r . Hogan’s treatment notes,
which report several normal findings in addition to the above
noted abnormalities, do not support his assessed functional
limitations. Doc. N o . 11-1. He notes that the ALJ credited D r .
Hogan’s finding that Charron’s amblyopia is congenital and
contends that the ALJ took D r . Hogan’s opinion into account in
crafting Charron’s RFC, at least to the extent that Charron
“would have to avoid driving while on the job.”11 The
11 This RFC limitation is equally, if not more, likely associated with Charron’s seizure impairment, which the ALJ determined was severe and which had originally caused Charron to cease driving. 12 Commissioner also highlights the fact that D r . Hogan was an
examining source, not a treating source, and thus his opinion is
not entitled to controlling weight. See 20 C.F.R. §
416.927(c)(2).
Problematically, these arguments are made in the first
instance by the Commissioner, not the ALJ. See Morse v . U.S.
Soc. Sec. Admin., Comm'r, N o . 12-CV-446-PB, 2013 WL 5776148, at
*8 (D.N.H. Oct. 2 5 , 2013) (citing Dube v . Astrue, N o . 10–CV-179–
J L , 2011 WL 742520, at *36 n.15 (D.N.H. Feb. 2 4 , 2011)) (“The
problem with the Acting Commissioner’s argument is that it is
not the role of the Acting Commissioner or the court to fashion
a rationale under which the ALJ could have sustainably accepted
[a medical] opinion.”). The ALJ’s decision never so much as
mentions the functional limitations in D r . Hogan’s vision
questionnaire. The decision never assesses the consistency or
supportability of D r . Hogan’s opinion. See 20 C.F.R. §
416.927(c)(3-4) (requiring an ALJ to consider these factors in
determining the appropriate weight to give a medical opinion).
The ALJ never assigns a particular weight to D r . Hogan’s
opinion. See Morse, 2013 WL 5776148, at *8 (citing SSR 96–8p,
1996 WL 374184, at *7 (July 2 , 1996)) (“The ALJ was obligated to
See T r . at 1 5 . The ALJ did not explain the basis for this limitation in her decision. 13 explain the weight he gave [a medical] opinion in his RFC
assessment.”). In fact, the ALJ never mentions D r . Hogan by
name.
Although the ALJ was free to make her own credibility
determination regarding D r . Hogan’s findings, she was not free
to ignore them. See 20 C.F.R. § 416.927(c) (“Regardless of its
source, we will evaluate every medical opinion we receive.”);
id. § 416.927(e)(2)(ii) (“[T]he administrative law judge must
explain in the decision the weight given to . . . any opinions
from treating sources, nontreating sources, and other
nonexamining sources . . . . ” ) ; Nguyen, 172 F.3d at 35 (“The
ALJ’s findings . . . are not conclusive when derived by ignoring
evidence . . . . ” ) . Compounding this error, the ALJ also
neglected to make a credibility determination regarding
Charron’s testimony at the hearing regarding her vision
impairment, or even to mention her testimony on this point at
all. See Bica v . Astrue, 2011 DNH 193, 17 (“[A]n ALJ may not
ignore relevant evidence, particularly relevant evidence that
supports the claimant’s application.”).
The Commissioner argues that “the mere diagnosis of an
impairment says nothing about the severity of the condition,”
specifically highlighting Charron’s near perfect corrected
14 visual acuity in both eyes. Nonetheless, the Commissioner
ignores D r . Hogan’s assessment of the severity of Charron’s
vision impairment in the form of specific functional limitations
supported by a number of medical signs documented in his
examination. The Commissioner further contends that Charron’s
activities of daily living, the numerous comments from both
medical providers and the state agency physician that her vision
was “grossly normal,” and the relative dearth of complaints in
the record regarding vision limitations constitute substantial
evidence in support of the ALJ’s findings. Once again, the
Commissioner misses the mark. Although the evidence upon which
the ALJ relies would likely meet the substantial evidence bar in
the absence of D r . Hogan’s medical opinion, his more recent
findings call the earlier evidence into doubt and warrant an
explicit comparison of the competing evidence. This is
particularly true since no medical provider in the record other
than D r . Hogan conducted more than a cursory examination of
Charron’s eyes. All of the vision-related comments in their
treatment notes are found in a “review of systems” section that
fails to include supporting explanation, and the treatment notes
make clear that each provider was focused on a non-vision
related complaint that Charron had presented. Further, the
15 ALJ’s decision lacks support for the proposition that Charron’s
activities of daily living during the alleged disability period
are inconsistent with a disabling lack of depth perception.
The Commissioner is correct in noting that D r . Hogan and
Charron’s other providers concur that many aspects of Charron’s
vision, including her visual acuity, are “grossly normal.” But
only D r . Hogan, a vision specialist and acceptable medical
source, conducted an examination that was sufficiently extensive
to diagnose an inner eye disorder such as amblyopia. See 20
C.F.R. § 416.913(a)(3) (stating that licensed optometrists are
acceptable medical sources that may establish the existence of a
medically determinable vision impairment); id. § 416.927(c)(5)
(noting that more weight is generally given to the opinions of
specialists regarding issues within their field than to the
opinions of non-specialists). The only assessment of Charron’s
depth perception, whether positive or negative, is that of D r .
Hogan. The ALJ was not free to ignore i t . See Nguyen, 172 F.3d
at 3 5 ; Bica, 2011 DNH 193, 1 7 .
Finally, the Commissioner argues that the ALJ was warranted
in placing “great weight” on D r . Sadler’s opinion, even though
he did not review D r . Hogan’s opinion, because the “subsequent
evidence does not establish the presence of any greater
16 limitations.” Doc. N o . 11-1. That statement is simply untrue,
and more importantly, the ALJ failed to make any such finding.
Dr. Hogan’s depth perception limitation was based on a new
diagnosis of amblyopia of which D r . Sadler was unaware, and this
restriction certainly constitutes a “greater limitation” than
anything previously apparent in the record. The cases cited by
the Commissioner on this point are inapposite. C f . Ferland v .
Astrue, 2011 DNH 169, 11 (noting that an ALJ’s reliance on a
non-examining consultant’s RFC opinion that is based on a review
of an incomplete medical record may be reversible error, unless
the subsequent evidence either reveals no greater limitations or
is consistent with the consultant’s assessment); see also Wenzel
v . Astrue, 2012 DNH 1 1 7 , 12 (same).
I must review the ALJ’s decision and supporting reasoning
on its face and refrain from speculation regarding the ALJ’s
underlying reasons for rejecting D r . Hogan’s medical opinion.
Because I conclude that the ALJ ignored significant medical
evidence regarding the functional limitations of Charron’s
vision impairments, I find that the ALJ’s step five
determination is not supported by substantial evidence. See
Nguyen, 172 F.3d at 3 5 . Although the ALJ on remand must
explicitly evaluate D r . Hogan’s opinion and weigh the
17 credibility of his findings in light of the relevant regulatory
factors, see 20 C.F.R. § 416.927(c), I express no opinion
regarding the ultimate merits of Charron’s disability claim.
IV. CONCLUSION
For the foregoing reasons, I deny the Commissioner’s motion
to affirm (Doc. N o . 11) and grant Charron’s motion to reverse or
remand (Doc. N o . 8 ) . Pursuant to sentence four of 42 U.S.C. §
405(g), I remand the case to the Social Security Administration
for further proceedings consistent with this decision.
SO ORDERED.
/s/Paul Barbadoro Paul Barbadoro United States District Judge
November 1 8 , 2013
cc: Francis M . Jackson, Esq. T . David Plourde, Esq.