Dunavan v. Commissioner of Social Security
OPINION and ORDER the Court SUSTAINS Defendant's objections and finds that substantial evidence supports the Commissioner's decision. As a result, the R&R 19 is REJECTED, Defendant's motion 15 for summary judgment is GRANTED, Plaintiff's motion 10 for summary judgment is DENIED, and the Commissioner's decision is AFFIRMED. Signed by District Judge Nancy G. Edmunds. (CBet)
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF MICHIGAN
BRIAN K. DUNAVAN,
Case No. 16-10455
Honorable Nancy G. Edmunds
COMMISSIONER OF SOCIAL SECURITY,
OPINION AND ORDER SUSTAINING DEFENDANT'S OBJECTIONS ,
REJECTING THE MAGISTRATE JUDGE'S REPORT AND RECOMMENDATION ,
GRANTING DEFENDANT'S MOTION FOR SUMMARY JUDGMENT , DENYING
PLAINTIFF'S MOTION FOR SUMMARY JUDGMENT , AND AFFIRMING THE
Plaintiff Brian Dunavan seeks judicial review of Defendant Commissioner of Social
Security's determination that he is not entitled to social security benefits. The Court
referred the matter to Magistrate Judge Elizabeth Stafford, and, on February 14, 2017, she
issued a Report and Recommendation (R&R) finding that the Commissioner's decision is
not supported by substantial evidence. As a result, the R&R recommends granting
Plaintiff's motion for summary judgment, denying Defendant's motion for summary
judgment, and remanding the case to the Administrative Law Judge (ALJ) for further
consideration. Defendant timely filed six objections to the R&R, which the Court considers
here. For the reasons that follow, the Court SUSTAINS Defendant's objections and finds
that substantial evidence supports the Commissioner's decision. As a result, the R&R is
REJECTED, Defendant's motion for summary judgment is GRANTED, Plaintiff's motion for
summary judgment is DENIED, and the Commissioner's decision is AFFIRMED.
Defendant does not object to either the R&R's recitation of Plaintiff's claimed
disabilities or its review of the ALJ's application of the disability framework analysis. (See
Dkt. 19, at 2-5.) Therefore, the Court adopts and incorporates those portions of the R&R.
The Court will introduce additional facts as necessary to evaluate Defendant's objections.
At the most general level, the R&R recommends remanding the case because the ALJ
violated the "treating physician rule" by "failing to give controlling weight to the opinion of
[Plaintiff's] treating physician, Dr. Ronald Coriasso." (Id. at 6.) On a more granular level,
the R&R finds that the ALJ committed the following errors: (1) the ALJ relied on his own
medical expertise to draw conclusions from raw medical data; (2) the ALJ disregarded
certain clinical findings that supported Dr. Coriasso's conclusions; (3) the ALJ did not
provide good reasons for ignoring Dr. Coriasso's opinion that Plaintiff could not work a full
day or week; (4) the ALJ disregarded the general rule that treating physicians' opinions are
given more weight than those of consultants; and (5) the ALJ used evidence related to
Plaintiff's credibility to "override" Dr. Coriasso's opinion. (Id. at 14, 19, 20, 22.) The R&R
goes on to find that, because of those errors, the ALJ's assessment of Plaintiff's residual
functional capacity (RFC) is not supported by substantial evidence. (Id. at 6.) The R&R
explains: "These [issues] are intertwined in that, if the ALJ did not provide good reasons
for giving little weight to Dr. Coriasso's opinion, the assessed RFC is unsustainable." (Id.)
Defendant has filed six objections to the R&R, and the Court sustains each of them
for the reasons below. In the process, the Court also finds that the ALJ's determination is
supported by substantial evidence, so the Court concludes that a remand is unnecessary.
1. Objections to a Magistrate Judge's R&R
When a party objects to portions of a magistrate judge's report and recommendation,
the Court reviews such portions de novo. Fed. R. Civ. P. 72(b). However, only specific
objections that pinpoint a source of error are entitled to de novo review. Mira v. Marshall,
806 F.2d 636, 637 (6th Cir. 1986). General objections, or those that merely challenge the
magistrate judge's overall determination, have "the same effects as would a failure to
object." Howard v. Sec'y of Health and Human Servs., 932 F.2d 505, 509 (6th Cir. 1991).
That is, such objections are not valid, and the Court may treat them as if they were waived.
See Bellmore-Byrne v. Comm'r of Soc. Sec., 2016 WL 5219541, at *1 (E.D. Mich. Sept. 22,
2016) (citing id.).
2. Judicial Review of an ALJ's Decision
The Court has jurisdiction to review the Commissioner's final administrative decision
pursuant to 42 U.S.C. § 405(g). The Court "must affirm the Commissioner's conclusions
absent a determination that the Commissioner has failed to apply the correct legal
standards or has made findings of fact unsupported by substantial evidence in the record."
Walters v. Comm'r of Soc. Sec., 127 F.3d 525, 528 (6th Cir. 1997). Substantial evidence
is "such relevant evidence as a reasonable mind might accept as adequate to support a
conclusion." Id. (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)). It is more than
a scintilla but less than a preponderance of the evidence. See Rogers v. Comm'r of Soc.
Sec., 486 F.3d 234, 241 (6th Cir. 2007). When reviewing the Commissioner's decision, the
Court should "not try the case de novo, resolve conflicts in evidence, or decide questions
of credibility." Bass v. McMahon, 499 F.3d 506, 509 (6th Cir. 2007). Rather, if substantial
evidence supports the Commissioner's decision, it must be affirmed regardless of whether
this Court would decide the matter differently or even if substantial evidence supports
another conclusion. See Cutlip v. Sec'y of Health and Human Servs., 25 F.3d 284, 286
(6th Cir. 1994).
1. The Application of the Treating Physician Rule to Dr. Coriasso's Opinion
Defendant first objects to the R&R's finding that the ALJ failed to comply with the
"treating physician rule" with respect to Dr. Coriasso's opinion. (Dkt. 20, at 1.) Under the
treating physician rule, an ALJ must give a treating physician's opinion controlling weight
if it is "well-supported by medically acceptable clinical and laboratory diagnostic techniques
and is not inconsistent with other substantial evidence in the case record." Gentry v.
Comm'r of Soc. Sec., 741 F.3d 708, 723 (6th Cir. 2014) (citation omitted). "When the
treating physician's opinion is not controlling, the ALJ, in determining how much weight is
appropriate, must consider a host of factors, including the length, frequency, nature, and
extent of the treatment relationship; the supportability and consistency of the physician's
conclusions; the specialization of the physician; and any other relevant factors." Rogers,
486 F.3d at 242. If an ALJ discounts a treating physician's opinion, he must provide "good
Here, Dr. Coriasso opined that Plaintiff suffers from severe degenerative disc disease
in both the thoracic and cervical spine, moderate to severe narrowing bilaterally of the
neural foramina at multiple levels of the cervical spine, bilateral impingement of the
shoulders, and cervical radiculopathy radiating down to the right arm and hand. (Dkt. 6-8,
at 169-73.) The ALJ decided to accord that opinion little weight after considering Dr.
Coriasso's specialization in family medicine (Dkt. 6-2, at 26), as well as the length,
frequency, nature, and extent of his treatment of Plaintiff. (Id. at 22-26.) The ALJ
explained that he found Dr. Coriasso's opinion "inconsistent with the evidence of record[,]
including findings on diagnostic testing that confirmed only moderate degenerative changes
in the cervical spine  and mild degenerative changes in the claimant's shoulder[.]" (Id. at
27 (internal citations omitted).) Now the R&R, reviewing the ALJ's decision, finds that the
ALJ failed to provide good reasons for giving Dr. Coriassio's opinion little weight. (Dkt. 19,
at 6-7.) And Defendant, in turn, objects to the R&R's finding.
More specifically, Defendant argues that the R&R erroneously applies the treating
physician rule,1 "transform[ing] that rule into requiring the administrative law judge  to
afford controlling weight to a treating source opinion whenever the treating source 'relied
upon objective medical evidence to render an opinion.'" (Dkt. 20, at 2 (quoting Dkt. 19, at
13, 22).) Defendant then pinpoints two particular portions of the R&R that reflect the
alleged error. For the reasons that follow, the Court agrees with Defendant that the R&R
misapplies the treating physician rule, so Defendant's first objection is sustained.2
The first error pinpointed by Defendant lies in the R&R's conclusion that the ALJ
"substituted his medical judgment for  Dr. Coriasso's to interpret raw diagnostic [testing]."
(Dkt. 20, at 2 (quoting Dkt. 19, at 14).) Defendant argues: "To the contrary, the ALJ
discussed specific relevant evidence from medical sources, whose interpretation of the
objective diagnostic testing conflicted with Dr. Coriasso's opinion." (Dkt. 20, at 2 (citing Dkt.
Contrary to Plaintiff's suggestion, Defendant never argues that the treating physician
rule does not apply in this case.
In so holding, the Court recognizes that the R&R correctly states the treating physician
rule on pages 10-11. (Dkt. 19, at 10-11.) The R&R's statement of the law is not erroneous;
the application is.
6-2, at 22-26).) Having reviewed the record de novo, the Court agrees with Defendant that
the ALJ was not "playing doctor," as the R&R suggests (see Dkt. 19, at 13); rather, the ALJ
properly decided to give Dr. Coriasso's opinion little weight after identifying substantial
inconsistent evidence from medical sources.
That evidence includes the following: First, the ALJ cited a letter sent from Dr. Henry
Hagenstein to Dr. Coriasso, in which Dr. Hagenstein discussed an electromyography
(EMG) exam that Plaintiff underwent on June 11, 2013. (Dkt. 6-2, at 24 (citing Dkt. 6-7, at
256-57).) There, Dr. Hagenstein (not the ALJ) described the results as "mildly abnormal,"
with "subtle" evidence of nerve root irritation.3 (Dkt. 6-7, at 256.) Second, the ALJ cited a
report on an MRI of Plaintiff's cervical spine performed on July 17, 2013. (Dkt. 6-2, at 24
(citing Dkt. 6-7, at 253-54).) The ALJ characterized this report as "confirm[ing] mild
degenerative change," which tracks the reporting physician's impression that the MRI
indicated "[o]verall, mild degenerative change at all levels."4 (Dkt. 6-7, at 254.) Third, the
ALJ referred to several treatment notes prepared by Dr. Siva Sripada, who reviewed
Plaintiff's MRIs and noted several findings that are inconsistent with Dr. Coriasso's opinion.
(Dkt. 6-2, at 25-26.)
Plaintiff's contention that this EMG is consistent with Dr. Coriasso's opinion misses the
mark. Plaintiff emphasizes that this evidence "confirms and supports the existence of
Plaintiff's cervical pathology." (Dkt. 21, at 4.) However, the relevant question is whether
the evidence is inconsistent with Dr. Coriasso's opinion that Plaintiff suffers from "severe
degenerative disc disease." A finding of "mildly abnormal" results is inconsistent with an
opinion of "severe" pathology.
The Court notes that Defendant's objection appears confuse Dr. George Polcano's
commentary on an August 17, 2013 X-ray (Dkt. 6-7, at 252) with Dr. George Arnold's report
on the July 17, 2013 MRI. (Dkt. 6-7, at 253-54.) Either way, the Court refers here to
impressions reported by Dr. Arnold.
For example, on September 12, 2013, Dr. Sripada noted that the MRI Plaintiff
underwent in July 2013 "is only suggestive of some mild degenerative changes" in the
cervical spine. (Dkt. 6-8, at 83.) Then, on February 20, 2014, he noted that "[r]ecent MRIs
were reviewed," and "nothing really suggested the significant pain that [Plaintiff] is having."
(Id. at 75.) Next, on March 10, 2014, he noted that "MRIs and CT myelograms of the
cervical spine failed to demonstrate any significant finding." (Id. at 73.) And on April 15,
2014, Dr. Sripada recorded that Plaintiff had a left shoulder MRI, "which shows only mild
degenerative changes." (Id. at 71.) Finally, on June 12, 2014, he noted that he reviewed
an MRI of Plaintiff's lumbar spine and found: "There is almost nothing in his MRI that
suggests the severity of his symptoms. . . . [B]ased on the almost normal MRI of his lumbar
spine, I left all of his medications exactly the same[.]" (Id. at 63.)
In light of the foregoing, the Court concludes that the record supports the ALJ's
determination that Dr. Coriasso's opinion is inconsistent with substantial evidence,
including: (1) findings of diagnostic testing that confirmed only moderate degenerative
changes in the cervical spine; (2) mild degenerative changes in the claimant's shoulder; (3)
nothing really suggestive of Plaintiff's complaints of pain; and (4) almost nothing suggesting
the severity of his symptoms. Moreover, the Court finds that the ALJ provided "good
reasons" for discounting Dr. Coriasso's opinion by referring to the evidence discussed
above. Although the ALJ did not expressly re-cite each bit of that evidence during his
summary, it was not necessary for him to do so because the reasons for his decision are
sufficiently clear. Rogers, 486 F.3d at 242 (stating that a major purpose of the "treating
physician rule" is to permit meaningful appellate review).
This brings the Court to the second alleged error in the R&R: the R&R's suggestion
that a remand is necessary because the record contains clinical findings that support Dr.
Coriasso's opinion. (See Dkt. 20, at 7 (citing Dkt. 19, at 15).) The Court agrees with
Defendant that it would be erroneous to remand the case simply because evidence
supports Dr. Coriasso's opinion, even if that evidence is substantial. As the Sixth Circuit
has explained, "the standard on review is to determine if substantial evidence supports the
ALJ's conclusion. . . . The fact that a record may also possess substantial evidence to
support a different conclusion than that reached by the ALJ or that a reviewing judge might
have decided the case differently is irrelevant." Crisp v. Sec'y of Health & Human Servs.,
790 F.2d 450, 453 n.4 (6th Cir. 1986) (emphasis added). Here, the Court has found that
substantial evidence supports the ALJ's decision to grant little weight to Dr. Coriasso's
opinion. Therefore, whether substantial evidence would support a contrary conclusion is
immaterial, and Defendant's first objection is sustained. See Cornette v. Sec'y of Health
& Human Servs., 869 F.2d 260, 263 (6th Cir. 1988) ("If it is supported by substantial
evidence, the [Commissioner's] decision must stand regardless of whether the reviewing
court would resolve the issues of fact in dispute differently.").
2. Dr. Coriasso's Treatment Notes
Defendant next objects to the R&R's finding that "Dr. Coriasso's treatment notes were
not inconsistent with his highly restrictive opinion of Plaintiff's functioning." (Dkt. 20, at 8.)
Defendant argues that this finding is erroneous because Dr. Coriasso noted on two
occasions after the alleged onset date of Plaintiff's disability that Plaintiff had "full and
painless range of motion of the neck."5 (See Dkt. 6-7, at 69; Dkt. 6-8, at 92.) The alleged
onset date of Plaintiff's disability was March 24, 2013, and the notes in question were taken
on May 24, 2013 and May 29, 2014. (See Dkt. 6-7, at 69; Dkt. 6-8, at 92.) Because the
Court agrees with Defendant that the notes are inconsistent with Dr. Coriasso's highly
restrictive opinion of Plaintiff's functioning, this objection is sustained.
The Court would be remiss, however, if it did not address the R&R's reasons for
discounting these notes. According to the R&R, Defendant impermissibly "augmented the
ALJ's reasoning" by citing to the May 2013 notes because "the only record the ALJ cited
as indicating that Dr. Coriasso found [Plaintiff] to have a full, painless range of motion was
from May 2014." (Dkt. 19, at 16.) But that analysis is misguided. A court reviewing an
ALJ's decision must base its decision on the record "as a whole," meaning the Court may
consider evidence not expressly cited in the ALJ's decision. Heston v. Comm'r of Soc.
Sec., 245 F.3d 528, 535 (6th Cir. 2001). Therefore, it is entirely appropriate when a party
points to evidence in the record that supports the ALJ's reasoning, regardless of whether
the ALJ expressly cited it. Id.
The Court also rejects the R&R's suggestion that because some evidence is
consistent with Dr. Coriasso's opinion, the Court should disturb the ALJ's opinion even if
it is supported by substantial evidence. As discussed above, the existence of substantial
evidence to support a different conclusion than the one reached by the ALJ is irrelevant.
Crisp, 790 F.2d at 453 n.4. The ALJ, not the reviewing court, is tasked with resolving
conflicts in the medical evidence. Smereczynski v. Sec'y of Health & Human Servs., 944
Defendant also points to treatment notes that preceded the alleged onset date, but the
Court agrees with the R&R that theses notes are not particularly relevant.
F.2d 296, 299 (6th Cir. 1991) ("[W]e defer to the ALJ's resolution of factual questions[.]").
Therefore, Defendant's second objection is sustained.
3. The Clinical Findings Related to Plaintiff's Subjective Complaints of Pain
Defendant's third objection contests the R&R's finding that "[w]hen the ALJ stated that
'the medical evidence of record does not contain objective signs and findings that can
account for [Plaintiff's] subjective complaints of pain,' he disregarded [certain] clinical
findings and cited only to MRIs, CT scans[,] and an EMG from November 2011." (Dkt. 19,
at 19 (citation omitted).) Defendant argues that this finding is erroneous, and the Court
agrees. First, "[i]t is well settled that: 'An ALJ can consider all the evidence without directly
addressing in his written decision every piece of evidence submitted by a party.'" Kornecky
v. Comm'r of Soc. Sec., 167 F. App'x 496, 507-08 (6th Cir. 2006) (quoting Loral Defense
Systems-Akron v. NLRB, 200 F.3d 436, 453 (6th Cir. 1999)). Second, the ALJ did directly
address clinical findings beyond the MRIs, CT scans, and an EMG from November 2011.
He cited, inter alia: (1) findings by Dr. Lisa Goyut; (2) findings by Dr. J. Steven Schultz; (3)
findings by Dr. James Culver; and (4) findings by Dr. Coriasso. (See Dkt. 6-2, at 23-24.)
Therefore, the ALJ did not disregard such evidence; he simply found that it did not support
Plaintiff's complaints of pain. Defendant's third objection is therefore sustained.
4. Dr. Coriasso's Opinion that Plaintiff Could Not Work a Full Day or Week
Defendant next objects to the R&R's finding that the ALJ erred by failing to provide
good reasons for discounting Dr. Coriasso's opinion that Plaintiff could not work a full day
or week. (Dkt. 20, at 13.) Defendant argues that the ALJ did not need to provide good
reasons for discounting that opinion because it is an opinion on an issue reserved to the
Commissioner, rather than a medical opinion. The Court agrees with Defendant.
Under the applicable regulation, "[o]pinions on some issues ... are not medical
opinions ... but are, instead, opinions on issues reserved to the Commissioner because
they are administrative findings that are dispositive of a case; i.e., that would direct the
determination or decision of disability." 20 C.F.R. § 404.1527(d). If an opinion "addresses
one of the issues reserved to the Commissioner," then it "is not a medical opinion requiring
consideration." Allen v. Comm'r of Soc. Sec., 561 F.3d 646, 652 (6th Cir. 2009); see also
20 C.F.R. § 404.1527(d)(3) ("We will not give any special significance to the source of an
opinion on issues reserved to the Commissioner[.]").
Other courts in this Circuit have routinely found that opinions regarding how often a
plaintiff might miss work are not medical opinions. See, e.g., Schacht v. Comm'r of Soc.
Sec., 2016 WL 2733140, at *5 (E.D. Mich. May 5, 2016) ("[S]tatement that Schacht would
miss work several days per week is not a valid medical opinion."), rep. & rec. adopted,
2016 WL 5219540 (E.D. Mich. Sept. 22, 2016); Ault v. Comm'r of Soc. Sec., 2016 WL
1621756, at *5 (W.D. Mich. Apr. 25, 2016) ("The doctor's opinions regarding how often
Plaintiff would miss work or be off task were not entitled to controlling weight. They are
conjectures, not a medical opinion."). Consistent with those decisions, this Court finds that
Dr. Coriasso's opinion regarding Plaintiff's ability to maintain a regular work schedule is not
a medical opinion but an opinion on an issue reserved to the Commissioner. Therefore,
the ALJ was not required to give the opinion any "special significance" or provide good
reasons for discounting it, and Defendant's fourth objection is sustained. See 20 C.F.R.
5. The Opinion Provided by a State Agency Physician
Fifth, Defendant objects to the R&R's conclusion regarding the opinion provided by
a consulting State agency physician. (Dkt. 20, at 15.) The R&R states the following:
"[Defendant argues] that the opinion of [a] consultant is further grounds for giving little
weight to Dr. Coriasso's opinion. This argument disregards the general rule that [a] treating
physician's opinions are given more weight than those from consultants." (Dkt. 19, at 20.)
Defendant argues that this analysis is erroneous, and the Court agrees.
Contrary to the R&R's suggestion, the ALJ's finding that a consultant's opinion
constitutes further grounds for giving little weight to a treating physician's opinion is not
inconsistent with the rule that treating physicians' opinions are generally given more weight
than those of consultants. Indeed, "Social Security rules and Sixth Circuit case law make
clear that a non-treating physician's opinion may receive greater weight than that of a
treating physician when supported by the record evidence." Allen v. Comm'r of Soc. Sec.,
2013 WL 5423728, at *18 (E.D. Mich. Sept. 26, 2013) (citations omitted). "In appropriate
circumstances, opinions from State agency medical and psychological consultants ... may
be entitled to greater weight than the opinions of treating or examining sources." SSR 966p, 1996 WL 374180, at *3 (July 2, 1996).
Here, the ALJ identified "appropriate
circumstances" for giving the consulting physician's opinion greater weight than Dr.
Coriasso's. He noted that the consultant's opinion was consistent with objective medical
evidence, while Dr. Coriasso's was not. Therefore, Defendant's fifth objection is sustained.
See Combs v. Comm'r of Soc. Sec., 459 F.3d 640, 652 (6th Cir. 2006) ("[T]his Court has
consistently stated that the [Commissioner] is not bound by the treating physician's
opinions, and that such opinions receive great weight only if they are supported by
sufficient clinical findings and are consistent with the evidence.").
6. The Evidence Related to Plaintiff's Credibility
Finally, Defendant objects to the R&R's analysis of the evidence related to Plaintiff's
credibility. (Dkt. 20, at 17.) The R&R states the following: "While these considerations are
ordinarily relevant, they do not override the opinion of a treating physician that is supported
by objective medical evidence[.]" (Dkt. 19, at 22.) Defendant argues that this statement
is erroneous for two reasons, and the Court agrees on both grounds.
First, the R&R errs insofar as it suggests that when a treating source opinion is
supported by objective medical evidence, it is due controlling weight, thereby stripping
"ordinarily relevant" considerations of their relevance. That is not what the "treating
physician rule" provides. Instead, as stated above, it requires the ALJ to afford controlling
weight to a treating source when the opinion is well supported by medical evidence and is
not inconsistent with other substantial evidence. Gentry, 741 F.3d at 723. And the
determination regarding an opinion's consistency with the evidence should be based on
"the record as a whole," which includes evidence related to Plaintiff's credibility. 20 C.F.R.
§ 404.1527(c)(4). Therefore, even if the opinion of a treating physician is supported by
objective medical evidence, evidence that diminishes a plaintiff's credibility remains
relevant. Id.; see also Nelson v. Comm'r of Soc. Sec., 195 F. App'x 462, 472 (6th Cir.
2006) (holding that an ALJ adequately addressed the opinions of treating physicians by
"indirectly attacking both the consistency of those opinions with the other record evidence
and their supportability").
Second, the R&R erroneously characterizes how the ALJ analyzed the factors related
to Plaintiff's credibility. The R&R proposes that the ALJ used these considerations to
"override" Dr. Coriasso's opinion. But the ALJ only considered these factors in conjunction
with the other evidence that is inconsistent with Plaintiff's alleged symptoms, which was
entirely appropriate. Siterlet v. Sec'y of Health & Human Servs., 823 F.2d 918, 920 (6th
Cir. 1987) ("[C]redibility determinations with respect to subjective complaints of pain rest
with the ALJ."); see also Walters, 127 F.3d at 531 ("[A]n ALJ's findings based on the
credibility of the applicant are to be accorded great weight and deference[.]"). As a result,
Defendant's sixth objection is sustained.
For the foregoing reasons, all six of Defendant's objections are SUSTAINED, and the
Court finds that substantial evidence supports the Commissioner's decision. Accordingly,
the R&R is REJECTED, Defendant's motion for summary judgment is GRANTED, Plaintiff's
motion for summary judgment is DENIED, the Commissioner's decision is AFFIRMED, and
the case is DISMISSED.
s/Nancy G. Edmunds
Nancy G. Edmunds
United States District Judge
Dated: March 23, 2017
I hereby certify that a copy of the foregoing document was served upon counsel of
record on March 23, 2017, by electronic and/or ordinary mail.
s/Carol J. Bethel
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