Hope A. Charron
Michael J. Astrue, Commissioner, Social Security Administration Opinion No. 2013 DNH 156.
MEMORANDUM AND ORDER
PAUL BARBADORO, District Judge.
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.
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. Tr. at 92. 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 22, 2011. A vocational expert ("VE") testified.
On December 30, 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 29, 2012. Accordingly, the ALJ's decision is the final decision of the Commissioner.
B. Relevant Medical History
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, " Tr. at 835; "fundi benign, conjunctiva and sclera clear, " 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,  vision grossly normal, " id. at 1357. In contrast, on December 7, 2010, orthopedic surgeon Dr. 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] injected 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 Dr. 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 82, 85.
On January 11, 2011, Dr. Timothy J. Hogan, O.D. examined Charron. Id. at 890. Dr. 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 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. Id . Dr. Hogan noted that these prior surgical procedures were "[m]ost likley [sic] strab[ismus] surgery...." 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. Dr. 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.
Nine months later, Dr. 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 amblyopia in the left eye, which he noted was "most likely stable." Id . Dr. 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 directions." Tr. at 46. She noted that she could look at a television or computer screen for five to ten minutes before her vision became blurry. Id . ...