Duncan v. Commissioner of Social Security

Filing 11

Report and Recommendation: The Administrative Law Judge applied proper legal standards and reached a decision supported by substantial evidence. I therefore recommend that the Commissioner's final decision denying Plaintiff's applications for disability insurance benefits and supplemental security income be affirmed. Related Doc. 1 . Objections to Report & Recommendation due by 1/21/2025. Magistrate Judge Reuben J. Sheperd on 1/6/2025. (D,JJ)

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
SONYA DUNCAN,

)
)
Plaintiff,
)
)
v.
)
)
COMMISSIONER OF SOCIAL SECURITY, )
)
Defendant.
)

I.

Case No. 1:24-cv-01342
JUDGE JOHN R. ADAMS
MAGISTRATE JUDGE
REUBEN J. SHEPERD
REPORT AND RECOMMENDATION

Introduction
Plaintiff, Sonya Duncan (“Duncan”), seeks judicial review of the final decision of the

Commissioner of Social Security denying her applications for Disability Insurance Benefits
(“DIB”) under Title II of the Social Security Act and Supplemental Security Income (“SSI”)
under Title XVI of the Social Security Act. Duncan raises one issue on review of the
Administrative Law Judge’s (“ALJ”) decision, arguing that the ALJ’s finding that Duncan was
capable of a significant number of jobs was unsupported by substantial evidence as the ALJ’s
residual functional capacity finding does not include Duncan’s documented need to elevate her
legs throughout the workday. This matter is before me pursuant to 42 U.S.C. 405(g), 1383(c)(3)
and Local Rule 72.2(b). Because the Administrative Law Judge (“ALJ”) applied proper legal
standards and reached a decision supported by substantial evidence, I recommend that the
Commissioner’s final decision denying Duncan’s applications for DIB and SSI be affirmed.
II.

Procedural History
On July 21, 2023, Duncan filed applications for DIB and SSI alleging her disability
began January 1, 2021. (Tr. 171-84). The claims were denied initially and on reconsideration.

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(Tr. 73, 80, 92, 101). On December 13, 2023, she requested a hearing before an ALJ. (Tr. 123).
Duncan, with representation, and a vocational expert (“VE”) testified before the ALJ on April 3,
2024. (Tr. 43-65). At the hearing, the ALJ granted Duncan’s oral motion to amend her alleged
onset date to December 31, 2022. (Tr. 46).
On April 11, 2024, the ALJ issued a written decision finding Duncan not disabled. (Tr.
21-42). The Appeals Council denied her request for review on June 6, 2024, thereby rendering
the ALJ’s decision the final decision of the Commissioner. (Tr. 8-13). Duncan timely instituted
this action on August 5, 2024. (ECF Doc. 1).
III.

Evidence
A.

Personal, Educational and Vocational Evidence.

Duncan was 41 years old on the date her application was filed. (Tr. 151). She dropped out
of school after completing the tenth grade. (Tr. 563). She has past relevant work as a home
attendant, DOT #354.377-014, with an SVP of 3 and an exertional level of medium, although she
performed it at the very heavy level; industrial cleaner, DOT #381.687-018, with an SVP of 2
and a medium exertional level; and punch press operator, DOT #615.685-030, with an SVP of 3
and a medium exertional level. (Tr. 62).
B.

Relevant Medical Evidence

Records submitted from the Cleveland Clinic indicate that on December 26, 2022,
Duncan presented to the emergency department reporting extreme fatigue and weakness and
noting that she will “drift off” mid-conversation and slur her words. (Tr. 309). She further
indicated that she has yellowing skin and confusion. (Id.). Duncan admitted she had been
abusing heroin, fentanyl, gabapentin, and cocaine. (Tr. 311). The treating physician assistant did

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not appreciate skin yellowing and noted that Duncan suggested her lower extremity edema had
improved from her baseline. (Tr. 314).
On January 4, 2023, Duncan attended an appointment with her physician, Erick
Kauffman, M.D., complaining of leg swelling. (Tr. 459). Duncan stated she has had increasing
foot swelling and pain. (Id.). She reported that she works at a factory on her feet and after
working she will have to elevate her feet and apply ice packs throughout the night. (Id.). She has
also been using Lasix but has still been missing work more often. (Id.). Duncan claimed that she
was no longer using opioids and noted a history of cirrhosis relating to hepatitis C. (Id.). Dr.
Kauffman assessed her with salivary duct calculi, lower leg edema, and chronic hepatitis C
without hepatic coma, and indicated “severe lymphedema is preventing her from working.” (Tr.
460-61).
On June 9, 2023, Duncan presented to the emergency department with a chief complaint
of “bruising on my legs.” (Tr. 303). She reported injuring her leg several days earlier and had
since developed bright red spots on her right lower extremity and a “large purple area on the
calf.” (Tr. 303-04). Duncan stated that she was no longer injecting street drugs, but she had last
snorted “medications” a couple of weeks ago. (Tr. 304). Examination revealed no tense palpation
of the extremities, a large purpuric area on the right calf and areas of petechiae in the right lower
extremity. (Tr. 305). Her gait was normal and there was “low suspicion for cellulitis.” (Tr. 30506). Duncan left against medical advice before the treating physician assistant had completed his
assessment, but his clinical impressions included acute purpuric eruption, class 2 obesity without
serious comorbidity with BMI of 35.0-39.9, chronic hepatitis C with cirrhosis and personal
history of drug abuse. (Tr. 308).

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On July 10, 2023, Duncan appeared at the emergency department with swelling and sores
all over her left leg from the knee down. (Tr. 502). Her condition had begun a few weeks earlier,
and she had been treating with ice and Lasix, but she had recently developed blood blisters that
were draining blood and yellow fluid. (Id.). Multiple lesions had appeared on her lower leg, and
she had recently woken up with a purplish discoloration of her lateral left foot and ankle. (Id.).
Her leg felt hot and did not improve, so she came to the emergency department. (Id.). She
reported a history of compartment syndrome of the right leg five years ago, and chronic staph
infections. (Id.). A CT scan of her left lower extremity showed diffuse left leg soft tissue
swelling extending to the superficial investing fascia circumferentially, likely representing
edema and/or cellulitis. (Tr. 501). She also underwent a Lower Extremity Venous Duplex Report
which showed no evidence of acute deep vein thrombosis or superficial vein thrombosis of the
bilateral lower extremities. (Tr. 554). It did show enlarged lymph nodes in bilateral groins. (Id.).
She was admitted to the hospital, and on discharge on July 12, 2023, she was diagnosed with left
lower extremity cellulitis, wound infection, and history of intravenous drug abuse. (Tr. 521).
A note from the Neighborhood Family Practice from October 4, 2023, indicated Duncan
had relapsed with heroin. (Tr. 481). She had been injecting but was now snorting as a means of
weaning herself off of heroin. (Id.).
C.

Medical Opinion Evidence
i.

State Agency Reviewers

On July 27, 2023, state agency reviewing physician Gary Hinzman, M.D., determined
that Duncan was capable of lifting/carrying 20 pounds occasionally and 10 pounds frequently,
consistent with a light exertional level. (Tr. 71). She was limited to six hours of sitting during an
eight-hour workday but could only stand/walk for 2 hours. (Id.). She could occasionally climb

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ramps or stairs but could never climb ladders, ropes, or scaffolds. (Id.). She could frequently
balance and occasionally stoop, kneel, crouch or crawl. (Id.). She needed to avoid all exposure to
commercial driving or unprotected heights. (Tr. 72). On September 26, 2023, state agency
reviewing physician Sreenivas Venkatachala, M.D., confirmed Dr. Hinzman’s opinion. (Tr. 8889).
On November 28, 2023, state agency reviewing psychologist Kevin Lauer, Ph.D., opined
that Duncan had moderate limitation in interacting with others and adaptation but only mild
limitations understanding, remembering, and applying information and concentrating,
persistence and maintaining pace. (Tr. 86). Dr. Lauer further found that Duncan had moderate
limitations in her ability to interact appropriately with the general public and her ability to get
along with coworkers or peers without distracting them or exhibiting behavioral extremes. (Tr.
90). She was also moderately limited in her ability to respond appropriately to changes in the
work setting and set realistic goals or make plans independently of others. (Id.).
ii.

Consultative Examination Reports

On October 25, 2023, Duncan attended a consultative examination with Tom Ferrence,
Ph.D., MPH. (Tr. 562-67). Duncan reported that she considered herself widowed, although she
had never married her partner of 20 years, and she had two children. (Tr. 563). She had a tenth
grade education and had been enrolled in special education services throughout her schooling
due to learning problems. (Id.). She completed specialized vocational training to become a State
Tested Nursing Assistant. (Id.). She endorsed a history of problems with opiate pills but denied
current symptoms indicative of a substance use disorder. (Id.). She noted problems with severe
lymphedema in both legs, cellulitis of the left lower extremity, wound infection, ulcers, pressure
sores on her legs, asthma, and hepatitis C. (Id.). She had no history of mental health treatment.

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(Tr. 564). She reported depressive symptoms including fatigue/loss of energy, periods of
hypersomnia, low motivation, loss of pleasure in activities, poor concentration, poor quality
mood, and social withdrawal. (Id.). She also endorsed anxiety symptoms including heart
palpitations/rapid heartbeat, chest tightness, poor concentration, sweating, and shaking. (Id.).
Duncan further reported that she was homeless and was unable to complete household
chores due to problems with physical functioning. (Id.). She had difficulty shopping for groceries
and preparing meals due to anxiety and physical health issues. (Id.). She was able to pay bills and
manage medication, and her home activities included listening to music and using the internet.
(Id.). She had occasional contact with family and maintained generally positive relationships.
(Id.). Dr. Ferrence noted that Duncan seemed physically uncomfortable throughout the exam and
made only intermittent eye contact. (Tr. 565). Her intellectual functioning appeared to be within
normal limits. (Id.).
Based on the examination, Dr. Ferrence diagnosed Duncan with Major Depressive
Disorder, recurrent, mild, and Unspecified Anxiety Disorder. (Tr. 566). He did not find any
suggestion Duncan would have difficulty understanding, remembering, or carrying out
instructions. (Tr. 566-67). He noted that Duncan self-reported a history of problems with
concentration, persistence, and pace in work settings, but found no evidence of difficulty with
these functions during the examination. (Tr. 567). He noted that Duncan presented as depressed
which could impact her interpersonal interactions in a work setting, including limited or negative
social interactions. (Id.). Dr. Ferrence noted that Duncan appeared emotionally overwhelmed
which could impact her mood stability in a competitive work setting. (Id.). He also noted she
reported problems managing pressure in prior work settings which contributed to avoidance and
missed work. (Id.).

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iii.

Treating Source Opinions

Duncan’s physician, Dr. Kauffman, offered two opinions concerning her condition. The
first, submitted in a letter dated January 4, 2023, noted that Duncan suffered from “severe
lymphedema in both legs” and opined that she would be unable to work due to that condition.
(Tr. 295). The second opinion, dated March 26, 2024, took the form of a medical source
statement. (Tr. 575-77). Here, Dr. Kauffman diagnosed Duncan with chronic severe
lymphedema, recurrent cellulitis in her legs, and chronic leg pain, and noted symptoms including
massive leg edema bilaterally, sores on her ankles, pressure and pain in her legs, and fatigue. (Tr.
575). He opined that Duncan will have good and bad days; that she will be absent from work
more than 4 times monthly; that she can walk less than one city block; that she can sit 45 minutes
continuously and at least six hours of an eight hour workday; that she can stand 30 minutes
continuously and less than two hours of an eight hour workday; that she needs to be able to shift
positions at will while working; that she would require unscheduled 30 minute breaks every one
to two hours while working in order to elevate her legs; that she can frequently lift less than 10
pounds, occasionally lift 10 pounds and rarely lift 20 pounds; that she can rarely twist, stoop, or
climb stairs and never crouch or climb ladders; that she can handle, finger, or reach 20% of the
time bilaterally; and that will be off task more than 25% of the time while working. (Tr. 575-77).
He noted that her conditions started in February 2022 and were “rapidly progressive.” (Tr. 577).
D.

Administrative Hearing Evidence

On April 3, 2024, Duncan testified before the ALJ that she previously worked as a home
health aide (Tr. 48-50), as a cleaner for a roofing and home renovation company (Tr. 50-54), and
as a machine operator for a plating company. (Tr. 54-57). She further testified she was no longer
able to work because her legs do not allow her to move around freely and she has to “constantly

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have them elevated above the heart or they swell.” (Tr. 57). She added that once they swell, it
turns into cellulitis, and they get infected. (Id.). Her hands have also started swelling, making it
difficult to grip, hold, or open anything. (Tr. 57-58). Her legs will start swelling within in an hour
if she is standing, and she has to sit down for 20 to 30 minutes with her legs propped up to
reduce the swelling. (Tr. 58). She has a lymphatic pump that she uses for an hour in the morning
and an hour in the evening that helps reduce the swelling, and she sometimes uses it during the
day. (Id.). She takes water pills as well, and as a result, she has to use the restroom every two
hours throughout the day and night. (Tr. 59). If she sits at a desk with her legs “hanging” her legs
will also swell due to gravity. (Id.). She has experienced infections, noting that she has been on
antibiotics eight to ten times in the last year, and has had to go to the hospital for I.V. antibiotics.
(Id.).
Duncan further testified that she has a history of opioid abuse, but other than a relapse the
prior year she has been clean for a year and a half. (Tr. 60). She has pain in her legs that feels
like “Charley Horses in her calves.” (Id.). She testified that she loses her balance standing when
her legs are swollen. (Id.). She had been missing work often because after a workday her legs
would swell so much, she would take two to three days off to sit or lay with her legs elevated.
(Tr. 61). She reported some difficulty due to her mental health, but she has not received any
mental health treatment and feels she “can manage mentally at work.” (Id.). Duncan added that
the swelling in her hands had started a couple of months ago, but it is not as bad as her legs. (Id.).
She has started to try to keep her hands elevated as well. (Tr. 62).
Following Duncan’s testimony VE Jennifer Stone testified. She labeled Duncan’s past
work as a home attendant, DOT #354.377-014, with an SVP of three, generally performed at the
medium exertional level and actually performed at very heavy; as an industrial cleaner, DOT

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#381.687-018, with an SVP of two, and generally and actually performed at medium; and as a
punch press operator, DOT #615.685-030, with an SVP of two, and generally and actually
performed at medium. (Id.).
For her only hypothetical, the ALJ asked the VE to consider an individual capable of
lifting and carrying 10 pounds frequently and 20 pounds occasionally; of standing or walking
only two hours per day; of pushing/pulling occasionally with the bilateral lower extremities; of
occasionally climbing ramps or stairs but never climbing ladders, ropes or scaffolds; of
frequently balancing but only occasionally stooping, kneeling, crouching, or crawling; but who
must avoid all hazards, defined as work at unprotected heights or commercial driving. (Tr. 63).
The VE opined that this individual would be incapable of performing Duncan’s past work, but
could work as a storage facility rental clerk, DOT #295.367-026, with an SVP of two and a light
exertional level and 58,300 jobs in the national economy; as a mail clerk, DOT #209.687-026,
with an SVP of two and a light exertional level and 29,900 jobs in the national economy; and as
a routing clerk, DOT #222.687-022, with an SVP of two and light exertional level and 123,600
jobs in the national economy. (Id.).
Duncan’s counsel inquired of the VE if her answer would be affected if the individual
was going to have to elevate their legs for 30 minutes at least every two hours, and the VE
indicated that this limitation would eliminate all positions. (Id.). If, with the first hypothetical,
the individual was also limited to occasional superficial interactions with others, that would
eliminate the storage facility rental clerk position, but would not affect the individual’s ability to
work as routing clerk or mail clerk. (Tr. 64). If the individual would also be absent at least two
times per month, that would exceed tolerances in competitive employment. (Id.). Upon inquiry
from the ALJ, the VE stated that her testimony had been consistent with the DOT, except that the

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DOT does not address the need to elevate the legs or absences, and that the testimony on those
subjects was based upon her experience. (Id.).
IV.

The ALJ’s Decision
In her decision dated April 16, 2024, the ALJ made the following findings:
1.

The claimant meets the insured status requirements of the Social Security
Act through June 30, 2026.

2.

The claimant has engaged in substantial gainful activity from December
31, 2022, the alleged onset date. (20 CFR 404.1571 et seq. and 416.971 et
seq.).

3.

The claimant has the following severe impairments: lymphedema;
degenerative disc disease of the lumbar spine; and chronic hepatitis C (20
CFR 404.1520(c) and 416.920(c)).

4.

The claimant does not have an impairment or combination of impairments
that meets or medically equals the severity of one of the listed
impairments in 20 CFR Part 404, Subpart P, Appendix 1 (20 CFR
404.1520(d), 404.1525, 404.1526, 416.920(d), 416.925 and 416.926).

5.

After careful consideration of the entire record, the undersigned finds that
the claimant has the residual functional capacity to perform light work as
defined in 20 CFR 404.1567(b) and 416.967(b) except stand and/or walk
for 2 hours total in an 8-hour workday; occasionally push and/or pull with
the bilateral lower extremities; never climb ladders, ropes or scaffolds;
occasionally climb ramps and stairs; frequently balance; occasionally
stoop, kneel, crouch and crawl; and avoid all hazards defined as work in
unprotected heights and no commercial driving.

6.

The claimant is unable to perform any past relevant work (20 CFR
404.1565 and 416.965).

7.

The claimant was born on April 18, 1982, and was 38 years old, which is
defined as a younger individual age 18-49, on the alleged disability onset
date (20 CFR 404.1563 and 416.963).

8.

The claimant has at limited education (20 CFR 404.1564 and 416.964).

9.

Transferability of job skills is not material to the determination of
disability because using the Medical-Vocational Rules as a framework
supports a finding that the claimant is “not disabled” whether or not the

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claimant has transferable job skills. (See SSR 82-41 and 20 CFR Part 404,
Subpart P, Appendix 2).
10.

Considering the claimant’s age, education, work experience, and residual
functional capacity, there are jobs that exist in significant numbers in the
national economy that the claimant can perform (20 CFR 404.1569,
404.1569a, 416.969 and 416.969a).

11.

The claimant has not been under a disability, as defined in the Social
Security Act, from December 31, 2022, through the date of this decision
(20 CFR 404.1520(g) and 416.920(g)).

(Tr. 14-40).
V.

Law and Analysis
A.

Standard for Disability

Social Security regulations outline a five-step process the ALJ must use to determine
whether a claimant is entitled to benefits:
1.

whether the claimant is engaged in substantial gainful activity;

2.

if not, whether the claimant has a severe impairment or combination of
impairments;

3.

if so, whether that impairment, or combination of impairments, meets or equals
any of the listings in 20 C.F.R. Part 404, Subpart P, Appendix 1;

4.

if not, whether the claimant can perform their past relevant work in light of his
RFC; and

5.

if not, whether, based on the claimant’s age, education, and work experience, they
can perform other work found in the national economy.

20 C.F.R. § 404.1520(a)(4)(i)-(v)1; Combs v. Comm’r of Soc. Sec., 459 F.3d 640, 642-43 (6th
Cir. 2006). The Commissioner is obligated to produce evidence at Step Five, but the claimant

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The regulations governing DIB claims are found in 20 C.F.R. § 404, et seq. and the regulations
governing SSI claims are found in 20 C.F.R. § 416, et seq. Generally, these regulations are duplicates
and establish the same analytical framework. For ease of analysis, I will cite only to the relevant
regulations in 20 C.F.R. § 404, et seq. unless there is a relevant difference in the regulations.

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bears the ultimate burden to produce sufficient evidence to prove they are disabled and, thus,
entitled to benefits. 20 C.F.R. § 404.1512(a).
B.

Standard of Review

This Court reviews the Commissioner’s final decision to determine if it is supported by
substantial evidence and whether proper legal standards were applied. 42 U.S.C. § 405(g);
Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). However, the substantial
evidence standard is not a high threshold for sufficiency. Biestek v. Berryhill, 139 S. Ct. 1148,
1154 (2019). “It means – and means only – ‘such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.’” Id., quoting Consolidated Edison Co. v. NLRB,
305 U.S. 197, 229 (1938). Even if a preponderance of the evidence supports the claimant’s
position, the Commissioner’s decision cannot be overturned “so long as substantial evidence also
supports the conclusion reached by the ALJ.” Jones v. Comm’r of Soc. Sec., 336 F.3d 469, 477
(6th Cir. 2003).
Under this standard, the court cannot decide the facts anew, evaluate credibility, or reweigh the evidence. Id. at 476. And “it is not necessary that this court agree with the
Commissioner’s finding,” so long as it meets the substantial evidence standard. Rogers, 486 F.3d
at 241; see also Biestek, 880 F.3d at 783. This is so because the Commissioner enjoys a “zone of
choice” within which to decide cases without court interference. Mullen v. Bowen, 800 F.2d 535,
545 (6th Cir. 1986).
Even if substantial evidence supported the ALJ’s decision, the court will not uphold that
decision when the Commissioner failed to apply proper legal standards, unless the legal error
was harmless. Bowen v. Comm’r of Soc. Sec., 478 F.3d 742, 746 (6th Cir. 2006) (“[A] decision
. . . will not be upheld [when] the SSA fails to follow its own regulations and that error

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prejudices a claimant on the merits or deprives the claimant of a substantial right.”); Rabbers v.
Comm’r Soc. Sec. Admin., 582 F.3d 647, 654 (6th Cir. 2009) (“Generally, . . . we review
decisions of administrative agencies for harmless error.”). Furthermore, this Court will not
uphold a decision when the Commissioner’s reasoning does “not build an accurate and logical
bridge between the evidence and the result.” Fleischer v. Astrue, 774 F. Supp. 2d 875, 877 (N.D.
Ohio 2011). Requiring an accurate and logical bridge ensures that a claimant and the reviewing
court will understand the ALJ’s reasoning, because “[i]f relevant evidence is not mentioned, the
court cannot determine if it was discounted or merely overlooked.” Shrader v. Astrue, No. 1113000, 2012 WL 5383120, at *6 (E.D. Mich. Nov. 1, 2012).
VI.

Discussion
Duncan brings one issue for this Court’s review: Whether the ALJ’s finding at Step Five
that Duncan is capable of performing a significant number of jobs is unsupported by substantial
evidence when the ALJ’s residual functional capacity finding does not include Duncan’s
documented need to elevate her legs throughout the workday. (ECF Doc. 8, p. 1). Duncan argues
that her testimony describing her issues with lower extremity swelling and the need for elevation
is supported by the opinion of her treating physician, Dr. Kauffman, rendered on March 26,
2024. (Id., at 10). Dr. Kauffman opined that Duncan would need to elevate her legs for 30
minutes every one to two hours throughout the workday. (Tr. 576). The ALJ found this portion
of Dr. Kauffman’s opinion “not entirely consistent with the rest of the record.” (Tr. 35). Duncan
contends that this opinion is buttressed by an examination conducted on December 26, 2022,
where edema was found in Duncan’s bilateral lower extremities, and this condition was
described as “at baseline,” supporting the contention that it is a chronic condition. (Tr. 313).
Duncan also argues that the ALJ’s reliance on the state agency medical consultants was

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misguided, as both consultants found that Duncan suffers from chronic swelling of her lower
extremities, rendering Dr. Kauffman’s opinion regarding the need for leg elevation a “reasonable
restriction.” (ECF Doc. 8, p. 10).
The Commissioner counters that the ALJ considered Duncan’s alleged need to frequently
elevate her legs but found that restricting her to two hours standing/walking during the workday,
along with other postural limitations and avoidance of hazards, adequately accounted for her
issues with leg swelling and pain. (ECF Doc. 10, p. 5). The Commissioner notes that the ALJ
observed that there were only three documented periods of lower extremity edema, and that
Duncan was otherwise found to have normal gait, sensation, and range of motion. (Tr. 30-31; see
Tr. 305, 312-13, 320, 460, 510, 521, 565). The ALJ also took into account the opinions of the
two state agency physicians who, with the benefit of reviewing the entirety of the record, did not
indicate a need for Duncan to elevate her legs during the workday. (Tr. 71-72, 88-90). The
Commissioner contends that Duncan is merely asking this Court to reweigh the evidence, and
reconsider the ALJ’s assessment of Dr. Kauffman’s opinion, although the ALJ assessed the
opinion’s consistency and supportability as required by the regulations. (ECF Doc. 10, p. 7)
During the sequential evaluation process, an ALJ must identify the claimant’s RFC,
which “is the most [the claimant] can still do despite [her] limitations.” 20 C.F.R.
404.1545(a)(1). The RFC denotes “functional limitation and restrictions and . . . [the claimant’s]
remaining capacities for work-related activities.” SSR 96-08p, 1996 WL 374184, at *1. The ALJ
assesses “an individual’s ability to do sustained work-related physical and mental activities in a
work setting on a regular and continuing basis.” SSR 96-8p, 1996 WL 374184, *1. The ALJ
must “consider [the claimant’s] ability to meet the physical, mental, sensory, and other

14

requirements of work.” 20 C.F.R. 404154(b)(4); see also Nejat v. Comm’r of Soc. Sec., 359
F.App’x 574, 577 (6th Cir. 2009).
“A RFC determination is a legal finding, not a medical determination; thus an ‘ALJ – not
a physician – ultimately determines a claimant’s RFC.’” Peirce v. Saul, No. 3:20-CV-0248, 2021
WL 606369, at *6 (N.D. Ohio Jan. 25, 2021), report and recommendation adopted sub nom.
Peirce v. Comm’r of Soc. Sec., No. 3:20-CV-00248, 2021 WL 602979 (N.D. Ohio Feb. 16,
2021), quoting Coldiron v. Comm’r of Soc. Sec.391 F.App’x 435, 439 (6th Cir. 2010) ; see also
Nejat, 359 F.App’x at 578. (“Although physicians opine on a claimant’s residual functional
capacity to work, [the] ultimate responsibility for capacity-to-work determinations belongs to the
Commissioner.”); 20 C.F.R. 404-1546(c)(“[T]he administrative law judge . . . is responsible for
assessing your residual functional capacity.”). “[E]ven where an ALJ provides great weight to an
opinion, an ALJ is not necessarily required to adopt wholesale limitations contained therein.”
Harris v. Comm’r of Soc. Sec., No. 1:13-cv-00260, 2014 WL 346287, *11 (N.D. Ohio Jan. 30,
2014) (“[T]he regulations make clear that a claimant’s RFC is an issue reserved to the
Commissioner and the ALJ assesses a claimant’s RFC ‘based on all of the relevant medical and
other evidence’ of record.”). “‘Although the ALJ may not substitute his opinion for that of a
physician’ in fashioning an RFC, the ALJ ‘is not required to recite the medical opinion of a
physician verbatim in his [RFC] finding.’” Peirce, 2021 WL 606369, at *19; quoting Poe v.
Comm’r of Soc. Sec., 342 F.App’x 149, 157 (6th Cir. 2009).
An ALJ is not obligated to give “good reasons” for not adopting a consultant’s opinion as
written. 20 C.F.R. § 404.1527(c)(2) (stating that the Commissioner “will always give good
reasons in our notice of determination or decision for the weight we give your treating source's
medical opinion.”). Instead, the ALJ’s only articulation duty is to “explain how [they]

15

considered” the “most important factors . . . of supportability . . . and consistency.” 20 C.F.R.
§ 404.1520c(b)(2). Accordingly, it is incumbent on the ALJ to build a logical bridge, supported
by substantial evidence, between the record and the final RFC, allowing a subsequent reviewer to
follow the ALJ’s reasoning. Peirce, 2021 WL 606369, at *20; see also generally Wilson v.
Comm’r of Soc. Sec., 378 F.3d 541-544-46 (6th Cir. 2004).
The ALJ must “articulate [his] consideration of medical opinions” and “how persuasive
[he] find[s] all of the medical opinions.” 20 C.F.R. § 404.1520c, see also Gamble v. Berryhill,
No. 5:16-CV-2869, 2018 WL 1080916 at 5 (N.D. Ohio, Feb. 28, 2018). Factors to be considered
include: (1) Supportability; (2) Consistency; (3) Relationship with the claimant, including length
of treatment relationship, frequency of examinations, purpose of the treatment relationship,
extent of the treatment relationship, and examining relationship; (4) Specialization; and (5) other
factors. 20 C.F.R. 416.920c. Supportability and consistency are considered the two most
important factors; therefore, the regulations dictate that the ALJ “will explain” how the
supportability and consistency factors were considered. 20 C.F.R. § 416.920c.
Here, the ALJ cited ample evidence in support of her final residual functional capacity.
She noted that Duncan’s allegations of limitation in standing, walking, exertion, using her hands,
and the need for leg elevation are not entirely consistent with the record. (Tr. 30). The ALJ wrote
that exam findings from August 31, 2022, just prior to the alleged amended onset date, showed
no swelling and normal range of motion. (Id.). Examination notes from December 26, 2022,
noted edema in the bilateral lower extremities (baseline by report), but also showed normal range
of motion throughout, intact sensation and a stable and coordinated gait. (Tr. 31). On January 4,
2023, findings included “massive lower extremity edema, with scars on legs, but otherwise
unremarkable throughout.” (Id.). On June 9, 2023, exam findings included a normal gait, no

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sensory defects, and imaging was negative for deep vein thrombosis. (Id.). She was admitted to
the hospital from July 10 to July 12, 2023, due to a left leg infection. Her findings then included
swelling in the left lower extremity, but no swelling otherwise. (Id.). Finally, notes from a
consultative examination on October 25, 2023, included findings of ambulating without
difficulty. (Id.).
Based on the above, the ALJ wrote the following:
The claimant’s reports and exam findings demonstrate intermitting issues with leg
edema; however, the claimant’s exam findings generally demonstrated intact
sensation, gait, strength, range of motion, reflexes and coordination. This
evidence is not entirely consistent with significant, disabling limitations in
standing, walking, sitting, postural activities, as reported by the claimant. The
record does not consistently reflect edema that would necessitate the degree and
frequency of leg elevation throughout the normal workday as alleged. This does
not suggest that the claimant is incapable of sustaining physical activity consistent
with the above residual functional capacity finding.
(Id.). The ALJ has succinctly and thoughtfully built a logical bridge, supported by substantial
evidence, from the medical record to her RFC in a manner that that allows a reader to easily
follow her reasoning.
Further, the ALJ has adequately explained why she found the opinions of Dr. Kauffman
unpersuasive. The decision avers that the opinions are not consistent with Dr. Kauffman’s own
exam findings, noting that on December 26, 2022, the findings included normal breathing;
normal range of motion throughout; edema in bilateral lower extremities (baseline by report);
fluent speech; 5/5 strength in upper extremities; intact sensation; a stable and coordinated gait;
and normal behavior and thought content. (Tr. 34, 312-13) Findings from Duncan’s visit with Dr.
Kauffman on January 4, 2023, noted “massive lower extremity edema, with scars on legs” but
otherwise unremarkable findings throughout including normal breathing sound and effort, skin,
and behavior. (Tr. 34-35, 460). The ALJ’s decision notes that while these findings “might

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support prescribed leg elevation, this portion is not entirely consistent with the rest of the
record.” (Tr. 35).
The ALJ notes that in other examinations, as noted above, the exam findings included
edema in the lower extremities on one visit aside from those with Dr. Kauffman, no findings of
edema in the upper extremities, an unremarkable gait, normal sensation, normal range of motion
throughout and normal breathing effort and sounds. (Id.). The ALJ wrote, “[t]hese findings do
not suggest the claimant has greater limitations than the abilities set forth in the above residual
functional capacity findings. They are not consistent with great limitations with standing,
walking, exertion, using her hands, time off-task, absenteeism and the need for leg elevation as
opined by Dr. Kauffman.” (Id.). The ALJ further contrasted the opinions of Dr. Kauffman with
those of the state agency medical consultants, finding the less restrictive opinions of the state
agency physicians to be supported by the evidence, noting in contrast that Dr. Kauffman’s
opinion is “neither supported nor consistent with the other evidence. Accordingly, it is not
persuasive.” (Id.). This thorough assessment of the supportability and consistency of Dr.
Kauffman’s opinions well surpassed the ALJ’s onus in evaluating Dr. Kauffman’s opinions.
As the ALJ has clearly met the burden of building a logical bridge from the evidence in
the record to the RFC and has adequately discussed the supportability and consistency of the
expert opinions, I cannot recommend that this Court accept Duncan’s invitation to reweigh the
evidence. It is therefore my recommendation that the decision of the ALJ be affirmed.
VII.

Recommendation
Because the ALJ applied proper legal standards and reached a decision supported by
substantial evidence, I recommend that the Commissioner’s final decision denying Duncan’s
applications for DIB and SSI be affirmed.

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Dated: January 6, 2025

Reuben J. Sheperd
United States Magistrate Judge

________________________________________

OBJECTIONS

Objections, Review, and Appeal
Within 14 days after being served with a copy of this report and recommendation, a party
may serve and file specific written objections to the proposed findings and recommendations of
the magistrate judge. Rule 72(b)(2), Federal Rules of Civil Procedure; see also 28 U.S.C
636(b)(1); Local Rule 72.3(b). Properly asserted objections shall be reviewed de novo by the
assigned district judge.

***

Failure to file objection within the specified time may result in the forfeiture or waiver of
the right to raise the issue on appeal either to the district judge or in subsequent appeal to the
United States Court of Appeals, depending on how or whether the party responds to the report
and recommendations. Berkshire v. Dahl, 928 F.3d 520, 530 (6th Cir. 2019). Objections must be
specific and not merely indicate a general objection to the entirety of the report and
recommendation; “a general objection has the same effect as would a failure to object.” Howard
v. Sec’y of Health and Hum. Servs., 932 F.2d 505, 509 (6th Cir. 1991) Objections should focus
on specific concerns and not merely restate the arguments in briefs submitted to the magistrate
judge. “A reexamination of the exact same argument that was presented to the Magistrate Judge
without specific objections ‘wastes judicial resources rather than saving them, and runs contrary
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to the purpose of the Magistrates Act.” Overholt v. Green, No. 1:17-CV-00186, 2018 WL
3018175, 2 (W.D. Ky. June 15, 2018) quoting Howard. The failure to assert specific objections
may in rare cases be excused in the interests of justice. See United States v. Wandashega, 924
F.3d 868, 878-79 (6th Cir. 2019)

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