# Battaglia v. Commissioner of Social Security Administration

> District Court, N.D. Ohio · June 8, 2023

URL: https://www.frixlaw.com/law-library/cases/10372159

## Case

- **Court:** District Court, N.D. Ohio
- **Decided:** June 8, 2023
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## How later opinions describe it (automated extraction)

- holding that the failure to identify good reasons affecting the weight given to an opinion “denotes a lack of substantial evidence, even whe[n] the conclusion of the ALJ may be justified based upon the record”

## Opinion text

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION

CONSTANCE BATTAGLIA, CASE NO. 1:22-CV-01459-DAC

Plaintiff, MAGISTRATE JUDGE DARRELL A. CLAY

vs. MEMORANDUM OPINION & ORDER

COMMISSIONER OF SOCIAL SECURITY
ADMINISTRATION,

Defendant.

INTRODUCTION
Plaintiff Constance Battaglia challenges the decision of the Commissioner of Social
Security denying disability insurance benefits (DIB). (ECF #1). The District Court has jurisdiction
under 42 U.S.C. §§ 1383(c) and 405(g). On August 16, 2022, pursuant to Local Civil Rule 72.2,
this matter was referred to me to prepare a Report and Recommendation. (Non-document entry of
Aug. 16, 2022). On August 24, 2022, the parties consented to my exercising jurisdiction under 28
U.S.C. § 636(c) and Rule 73 of the Federal Rules of Civil Procedure. (ECF #6). Following review,
and for the reasons stated below, I REVERSE the Commissioner’s decision and REMAND the
case for additional proceedings consistent with this opinion.
PROCEDURAL BACKGROUND
Mrs. Battaglia filed for DIB on March 13, 2017, alleging a disability onset date of
December 16, 2016. (Tr. 568). The claim was denied initially and on reconsideration. (Tr. 580,
600). Mrs. Battaglia then requested a hearing before an Administrative Law Judge. (Tr. 617-18).
Mrs. Battaglia (represented by counsel) and a vocational expert (VE) testified at a hearing before
the ALJ on December 12, 2018. (Tr. 534-567). On March 27, 2019, the ALJ issued a written

decision finding Mrs. Battaglia not disabled. (Tr. 13-34). The Appeals Council denied Mrs.
Battaglia’s request for review. (Tr. 1-7).
On April 29, 2020, Mrs. Battaglia appealed the decision to the District Court. (Tr. 1785-
95). Upon joint motion of the parties, the District Court remanded the claim to the
Commissioner for further proceedings pursuant to Sentence Four of 42 U.S.C. § 405(g). (Tr.
1796). On February 3, 2021, the Appeals Council remanded the case to the ALJ with instructions
to adequately evaluate opinion evidence, specifically the opinions of Van Warren, M.D., Jeffry

Brown, D.O., and David Knierim, M.D. (Tr. 1799-1801). Because Mrs. Battaglia filed a subsequent
claim for DIB on May 22, 2020, the Appeals Council also directed the ALJ to consolidate the
claims and issue a new decision. (Tr. 1801).
Mrs. Battaglia (represented by counsel) and a vocational expert (VE) testified at a second
hearing before the ALJ on October 15, 2021. (Tr. 1712-46). On November 12, 2021, the ALJ
issued a second written decision finding Mrs. Battaglia not disabled. (Tr. 1663-1711). The Appeals

Council denied Mrs. Battaglia’s request for review making the hearing decision the final decision
of the Commissioner. (Tr.1652-58; see 20 C.F.R. §§ 404.955 and 404.981). Mrs. Battaglia timely
filed this action on August 16, 2022. (ECF #1).
FACTUAL BACKGROUND
I. PERSONAL AND VOCATIONAL EVIDENCE
Mrs. Battaglia was 50 years old at the alleged onset date and 54 years old at the second

administrative hearing. (Tr. 1720). She completed high school. (Id.). Before her alleged onset date,
Mrs. Battaglia worked as a financial aid counselor. (Tr. 541-42).
II. RELEVANT MEDICAL EVIDENCE1
In late 2015, Mrs. Battaglia sought treatment for continued headaches with neurologist
Harold Mars, M.D. (Tr. 778-79). In December 2015, Dr. Mars noted Mrs. Battaglia’s cervical X-
rays showed loss of normal lordotic cervical curve and degenerative joint disease. (Tr. 779). He also

observed tightness to the paraspinous muscles. (Id.). Dr. Mars continued Mrs. Battaglia’s
prescriptions for Percodan and Flexeril. (Tr. 780).
On March 19, 2016, Mrs. Battaglia returned to Dr. Mars with reports of frequent
headaches, neck and back pain, and some recent pain in her right hand and elbow. (Tr. 781).
Physical examination was normal except a positive Tinel’s sign at the cubital fossa. (Id.). Dr. Mars
noted Mrs. Battaglia’s liver issues limit the kinds of medications she can take, refilled her
prescription for Percodan, and encouraged her to visit a pain management doctor. (Tr. 781-82).

On May 2, 2016, Mrs. Battaglia met with Lisa A. Brown, M.D., for chronic pain
management. (Tr. 786). Mrs. Battaglia endorsed constant, aching low back and neck pain. (Id.).
Relevant to her low back, she reported symptoms including flaring pain and stiffness without
lower extremity numbness or weakness. (Id.). She endorsed neck pain, headaches, difficulty

1 Mrs. Battaglia’s arguments pertain to the ALJ’s evaluation of her physical
impairments. (Pl.’s Br., ECF #11, PageID 4803 n.2). I therefore limit my review to the medical
records relevant to her physical impairments.
sleeping, stiffness, and upper extremity numbness, weakness, and tingling. (Tr. 787). On spinal
range of motion testing, Mrs. Battaglia had pain but was unrestricted. (Tr. 788). Motor strength,
sensation, and reflexes were normal. (Tr. 789). After diagnosing Mrs. Battaglia with neck pain,

cervical radiculitis, and narrowing of the lumbar intervertebral space, Dr. Brown ordered a cervical
MRI. (Id.). The MRI revealed bony hypertrophies at C3-C4 and C4-C5 and disc osteophyte
complex at C5-C6 and C6-C7, producing compromise of the foramen at those levels, and mild
canal stenosis at C4-C5 through C6-C7. (Tr. 783).
Mrs. Battaglia returned to Dr. Brown on May 18, 2016, complaining of neck pain and
stiffness, as well as upper extremity numbness, tingling, and weakness. (Tr. 790). She also endorsed

headaches, and difficulty walking and sleeping. (Id.). Dr. Brown reviewed the MRI, diagnosed neck
pain, cervical disc degeneration, and cervical radiculitis, and recommended an epidural injection.
(Tr. 792-93).
On June 8, 2016, Mrs. Battaglia returned to Dr. Brown and reported 30% relief from neck
and right arm pain, with feelings of weakness and jitteriness that gradually subsided. (Tr. 794). Dr.
Brown felt Mrs. Battaglia was not a good candidate for injection therapy because of the side effects
and low benefit. (Id.). In addition to neck and arm pain, Mrs. Battaglia endorsed chronic migraines

accompanied by photophobia and phonophobia. (Tr. 794-95). Resting in a quiet, dark room and
taking Percodan decreases the intensity of the headache but does not completely relieve it. (Tr.
795). Cervical spine range of motion testing reproduced neck pain and radicular symptoms with
extension, flexion, and rotation. (Tr. 797). Additionally, Mrs. Battaglia displayed tenderness to
palpation of the bilateral cervical paraspinous muscles and the right supraspinatus muscles. (Id.).
Physical examination revealed decreased strength to the right arm with resisted shoulder
abduction, biceps extension, and wrist extension. (Id.). Mrs. Battaglia also had decreased sensation
to the right arm in a C5-C6-C7 distribution with some hypertonicity of the deep-tendon reflexes,
and a positive Spurling’s test. (Id.). Dr. Brown diagnosed cervical radiculitis, cervical disorder with

radiculopathy, and cervicogenic headaches. (Tr. 798). She prescribed Percodan for the cervical
impairments and Topamax for headaches. (Id.). Dr. Brown noted the same abnormal physical
examination findings on July 6 and August 1, 2016. (Tr. 803, 809). On July 26, lab work
confirmed Mrs. Battaglia has Hashimoto’s disease. (Tr. 858).
On August 1, 2016, Dr. Brown discontinued Mrs. Battaglia’s prescription for Percodan
because her endocrinologist felt the aspirin component of that medication was contributing

negatively to Mrs. Battaglia’s thyroid function. (Tr. 806). In place of Percodan, Dr. Brown
prescribed oxycodone and limited Mrs. Battaglia to three doses per day. (Id.).
On October 3, 2016, Mrs. Battaglia returned to Dr. Brown for a refill of her medications.
(Tr. 810). There, she endorsed 50% pain relief with medication and denied any major side effects.
(Id.). She denied weakness in the upper extremities but endorsed throbbing joint pain in her knees
and hands. (Id.). Mrs. Battaglia indicated she scheduled an appointment with a rheumatologist

regarding her joint pain. (Id.). On physical examination, Mrs. Battaglia displayed normal motor
strength, sensation, and reflexes, but endorsed pain with range of motion testing. (Tr. 813). On
November 22, Mrs. Battaglia continued to endorse chronic neck pain, described as stiff, dull, and
achy, as well as daily headaches that are tolerable most of the time. (Tr. 815). Mrs. Battaglia
endorsed pain on range of motion testing; physical examination was otherwise unremarkable. (Tr.
818).
X-rays of Mrs. Battaglia’s right foot, dated December 3, 2016, show mild hallux valgus with
early bunion formation. (Tr. 898). On December 16, Mrs. Battaglia underwent a bunionectomy
for correction of the hallux valgus deformity. (Tr. 1194).

On January 23, 2017, Mrs. Battaglia met with rheumatologist Rajul Desai, M.D. for hip
and neck pain. (Tr. 913). She endorsed fatigue, red and dry eyes, dry mouth, joint pain and
swelling, morning stiffness in the joints, muscle weakness, back pain, rashes, color changes in the
skin with exposure to cold, hair loss, nail changes, headaches, numbness and tingling, allergies,
thyroid disease, and high blood pressure. (Tr. 915-16). Physical examination was normal except
Mrs. Battaglia displayed some joint line tenderness at both knees and mildly restricted cervical
range of motion. (Tr. 917-18). Dr. Desai assessed Mrs. Battaglia with pain in both hands and

chronic pain in both knees and ordered X-rays. (Tr. 919). Bilateral hand X-rays were normal. (Tr.
930). Knee X-rays revealed a small right patellar enthesophyte and were otherwise normal. (Tr.
931).
On January 25, 2017, Mrs. Battaglia returned to Dr. Brown for pain management and
complained of neck pain and radiculopathy into her right upper extremity. (Tr. 987). On
examination, Mrs. Battaglia displayed restricted cervical flexion and extension and a positive

Spurling’s test. (Tr. 990). Mrs. Battaglia noted the oxycodone was less effective than usual,
prompting Dr. Brown to prescribe a muscle relaxer. (Id.). On February 22, Mrs. Battaglia endorsed
pain with cervical rotation to the left and right. (Tr. 995). Physical examination was the same on
March 22. (Tr. 1000). Citing nervousness about taking multiple medications, Mrs. Battaglia
informed Dr. Brown that she did not start taking the muscle relaxer. (Tr. 997).
On May 16, 2017, Mrs. Battaglia met with orthopedic specialist John Feighan, M.D., to
discuss her right foot pain post-bunionectomy. (Tr. 1450). She noted her podiatrist removed a pin
from the foot on May 11, but the pain had not improved and increased with weightbearing. (Id.).

On July 10, 2017, Mrs. Battaglia met with rheumatologist Van Warren, M.D. (Tr. 1054).
Physical examination revealed moderately limited extension and mildly limited right and left
rotation of the cervical spine and slightly weakened grip strength bilaterally. (Tr. 1055). On July
14, a smooth muscle antibody screening was positive. (Tr. 760).
On August 11, 2017, Mrs. Battaglia returned to Dr. Feighan to discuss her continued pain
over the lateral forefoot with walking and some pain with motion in the big toe. (Id.). Dr. Feighan

reviewed her CT scan, dated August 4, which showed moderate degenerative changes of the
middle facet of the subtalar joint with a corticated body at the medial periphery of the joint, and
mild degenerative change of the first metatarsophalangeal joint and the hallux sesamoid
articulations. (Tr. 1074). Dr. Feighan noted the CT scan “shows healing but incomplete healing of
distal metatarsal osteotomy” and “mild 1st MTP arthrosis.” (Tr. 1447). Dr. Feighan diagnosed
acquired hallux valgus of the right foot, arthritis, and sesamoiditis. (Id.). He ordered physical
therapy for gait training, supportive footwear, and use of a bone stimulator to promote further

healing of the osteotomy. (Id.).
On November 20, 2017, Mrs. Battaglia met with Tina Barger, APRN-CNP, for pain
management. (Tr. 1312). She endorsed worsening neck pain with muscle spasms, worsening pain
with neck movement, and increasing numbness and tingling with accompanied weakness to the
left fourth and fifth fingers. (Id.). Left wrist extension increased her left elbow pain. (Id.). On
physical examination, Mrs. Battaglia displayed abnormal spinal range of motion, muscle tone, and
tremor. (Tr. 1314). CNP Barger noted painful range of motion testing, hypertonicity to the right
cervical paraspinous muscle, decreased grip strength on the left, tenderness over the left lateral
elbow, and decreased sensation to light touch to the left fourth and fifth fingers and ulnar surface

of the hand and forearm. (Tr. 1314-15). CNP Barger prescribed a five-day course of prednisone to
address her increased pain, paresthesia, and weakness; restarted Mrs. Battaglia on tizanidine;
refilled her prescription for oxycodone; and encouraged her to start gabapentin. (Tr. 1312).
In December 2017, lab work confirmed elevated liver enzymes and a positive smooth
muscle antibody panel. (Tr. 1305, 1307). On January 5, 2018, Mrs. Battaglia met with Dr. Warren
and endorsed neck, back, left arm, and right foot pain; eye dryness; and left-hand numbness. (Tr.
1308). Dr. Warren observed a dry rash on her face and dry skin over the extensor aspect of her

hands overlying the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. (Id.).
Dr. Warren also noted Mrs. Battaglia’s tests were positive for autoimmune thyroiditis and
autoimmune hepatitis. (Id.). He concluded her sicca symptoms2 and facial rash was also suggestive
of possible Sjögren’s syndrome. (Id.). He diagnosed autoimmune hepatitis and arthritis. (Tr. 1310).
On February 12, 2018, Mrs. Battaglia met with Dr. Brown for pain management and
endorsed intermittent radicular cervical symptoms. (Tr. 1504). Dr. Brown discussed changing Mrs.

Battaglia’s muscle relaxer because with poor liver function she cannot take her current medication.
(Id.). Physical examination revealed abnormal spinal range of motion but was otherwise
unremarkable.

2 Sicca symptoms include dryness of the eyes, mouth, and other body parts. See
Stedman’s Medical Dictionary, Stedmans 882100 (updated Nov. 2014).
On February 13, Mrs. Battaglia met with rheumatologist Rochelle Rosian, M.D., for a
second opinion about her Sjögren’s syndrome. (Tr. 1416). There, Mrs. Battaglia reported knee and
feet pain lasting all day, especially with weightbearing. (Id.). She endorsed excessive sweating, sicca

symptoms, daily ocular migraines, dry mouth, muscle pain in the left upper arm, telangiectasia3
over the face and chest, Raynaud’s, and numbness and tingling in the left third finger. (Tr. 1416-
17). Physical examination revealed left elbow tenderness and slight contracture, bilateral wrist
tenderness, swelling and tenderness in the bilateral MCP joints, tenderness in the bilateral PIP
joints, and tenderness to palpation of the right foot. (Tr. 1419). Dr. Rosian assessed Mrs. Battaglia
with autoimmune hepatitis, elevated liver enzymes, Raynaud’s disease without gangrene, and
inflammatory poly arthropathy with sicca complex (and not Sjögren’s syndrome) and agreed that

Plaquenil (hydroxychloroquine) may be beneficial for her liver and her joints. (Tr. 1420).
On May 8, 2018, Mrs. Battaglia met with Dr. Warren and reported pain in her head, neck,
back, bilateral knees, and bilateral feet. (Tr. 1458). Mrs. Battaglia also reported fatigue, significant
eye and mouth dryness, and dry skin over her hands and the soles of her feet. (Id.). She informed
Dr. Warren she had yet to start hydroxychloroquine because a hepatologist recommended a
baseline liver biopsy first. (Id.). Dr. Warren referred her to hepatology to evaluate and advise for

the need for any management of autoimmune hepatitis in light of her plans for initiating
hydroxychloroquine. (Tr. 1462).
On June 29, 2018, Mrs. Battaglia returned to orthopedist Dr. Feighan. (Tr. 1541). She
endorsed using the bone stimulator with resolution of the issues on the medial side of her foot.

3 Dilation of previously existing small or terminal vessels. See Stedman’s Medical
Dictionary, Stedmans 899720 (updated Nov. 2014).
(Id.). She continued to complain of pain at the joint of her small toe on the right foot, worse with
movement and improved with rest. (Id.). Physical examination of the right foot revealed good
range of motion with minimal swelling and tenderness to the lateral fifth metatarsal. (Tr. 1545).

An X-ray showed a healed bunion medially and minimal spurring at the fifth metatarsal without
significant structural issues. (Tr. 1546). Dr. Feighan discussed surgical options, including a right
bunionette correction and fifth metatarsal exostectomy. (Id.).
On August 22, 2018, Mrs. Battaglia met with Dr. Brown for pain management and
complained of a new symptom: severe burning into the left scapular region that worsens with
breathing and moving her arm and neck. (Tr. 1573). She also described shooting pain in her right

hand and index finger, issues with ocular migraines, and an overall feeling of weakness in the left
upper extremity. (Id.). Physical examination revealed pain with palpation of the left cervical spine
area, restricted cervical flexion, extension, and rotation, and global weakness in the upper left
extremity compared to the right. (Tr. 1577). Dr. Brown prescribed a course of oral steroids and
advised she would order a new cervical MRI if Mrs. Battaglia did not respond to the treatment.
(Tr. 1573). Dr. Brown referred Mrs. Battaglia to neurology for her headaches. (Tr. 1578).
On October 17, 2018, an updated cervical MRI revealed cervical spondylosis resulting in

varying severity of central canal and neural foraminal narrowing at multiple levels, worsened at C5-
C6 and C6-C7 compared to the prior study. (Tr. 1611). Mrs. Battaglia returned to Dr. Brown on
November 5, 2018 and reported very sharp neck pain radiating into the left upper extremity. (Tr.
274). Dr. Brown reviewed the updated MRI but decided not to change Mrs. Battaglia’s medication
until after she consulted with a surgeon. (Id.). Physical examination revealed painful cervical
extension and rotation. (Tr. 277).
On November 9, 2018, Mrs. Battaglia returned to Dr. Warren’s office and complained of
headaches and pain in her mid-spine and knees. (Tr. 1642). Physical examination revealed slightly
restricted cervical flexion, focal area tenderness on the lower aspect of the thoracic spine, and good

muscle strength in the upper and lower extremities except for very slight weakness of the fourth
digit of each hand and slight weakness to abduction of the left shoulder. (Id.). Dr. Warren ordered
a hepatic function panel. (Tr. 1651).
On November 20, 2018, Mrs. Battaglia consulted with orthopedic surgeon Christopher
Furey, M.D. (Tr. 2638). To Dr. Furey, Mrs. Battaglia described long-standing neck pain, daily
chronic headaches, and intermittent left arm pain and numbness without weakness or loss of

coordination. (Id.). Physical examination revealed some limited cervical spine range of motion with
intact strength in the upper and lower extremities. (Id.). On review of her spinal imaging, Dr.
Furey noted moderate degenerative changes at C5-C6 with slight focal kyphosis, mild spondylitic
changes at C5-C6 and C6-C7, and bilateral foraminal stenosis. (Id.). In the absence of severe
radicular symptoms and myelopathic features, Dr. Furey recommended non-surgical treatment.
(Id.).
On December 3, 2018, Mrs. Battaglia returned to Dr. Brown for pain management,

complaining of ongoing neck, mid-back, and low back pain. (Tr. 1627). Even with four daily doses
of oxycodone, Mrs. Battaglia stated the medication was only 50% effective for her pain. (Id.). She
reported inability to manage her daily activities without help from her husband. (Id.). On physical
examination, Mrs. Battaglia displayed pain with palpation of the facet joints of the cervical,
thoracic, and lumbar spine and pain with extension. (Tr. 1630). Dr. Brown felt her pain was most
consistent with spondylosis of the neck, mid-back, and low back. (Tr. 1627). Dr. Brown diagnosed
cervical spondylosis, cervical disc disorder with radiculopathy, narrowing of the lumbar
intervertebral disc space, and lumbar spondylosis. (Tr. 1631). Dr. Brown increased her dose of
oxycodone and recommended physical therapy and exercise. (Id.).

Mrs. Battaglia returned to pain management on January 2, 2019, reporting her muscle
spasms as well-controlled with cyclobenzaprine and experiencing 70% relief from chronic neck
pain with the increased oxycodone dose. (Tr. 2693). Medication improved her function such that
she could manage her daily activities independently. (Id.).
On March 5, 2019, Mrs. Battaglia met with Dr. Warren and complained of ocular
migraines with blurred vision; neck pain with recurrent numbness in the third, fourth, and fifth

digits of the left hand; pain in the shoulders, knees, and left ankle; and dry eyes and mouth. (Tr.
3228). Physical examination revealed focal tenderness on the posterior lateral aspect of the left
ankle, and slightly diminished muscle strength in the left upper extremity and right hip flexor.
(Id.). Dr. Warren noted Mrs. Battaglia’s positive ANA, positive anti-smooth muscle antibody, sicca
symptoms, recurrent rashes, and arthralgias suggestive of Sjögren’s syndrome. (Id.). Dr. Warren
prescribed hydroxychloroquine. (Tr. 3238).
A lumbar MRI from May 1, 2019, revealed mild multifocal degenerative changes, including

hypertrophic facet changes, diffuse disc bulges, and a posterior annular tear. (Tr. 2391). Dr. Brown
reviewed the MRI and noted Mrs. Battaglia’s complaints, including mid-back pain that worsens
with bending, twisting, and standing while doing dishes, increased left thigh pain and numbness
with standing and walking, and extreme fatigue that Dr. Brown attributed to Sjögren’s syndrome.
(Tr. 2683). Mrs. Battaglia also reported falling twice due to leg weakness. (Id.). She discontinued
Flexeril because it was not effective for her muscle spasms and started taking Topamax. (Id.).
Physical examination revealed tenderness to palpation of the thoracic spine at T11 and T12, mild
muscle hypertonicity to the right and left of the thoracic paraspinous muscles, tenderness to
palpation of the lumbar spine at L4, decreased sensation to light touch on the left thigh, and

weakness with resisted left hip flexion and left ankle dorsiflexion. (Tr. 2686-87). Dr. Brown
diagnosed cervical spondylosis, cervical radiculitis, cervical disc disorder with radiculopathy,
lumbar spondylosis, and thoracic back pain. (Tr. 2688). She ordered a thoracic MRI that showed
mild degenerative changes without significant stenosis. (Tr. 2102-03).
On July 2, 2019, Mrs. Battaglia saw Dr. Warren and complained of recurrent dry skin and
rash, finger discoloration with cold exposure, pain in the knees, neck, left arm, and left leg, and
chronic left scapular region numbness. (Tr. 3221). Dr. Warren noted a faint erythema and dry

flaky skin on Mrs. Battaglia’s face and some weakness in her neck flexors and left hip flexor. (Id.).
He determined Mrs. Battaglia’s radicular symptoms involving the left upper and lower extremities
are likely related to her cervical and lumbar radiculopathy. (Id.). Dr. Warren ordered additional lab
work. (Tr. 3226-27).
In September 2019, Mrs. Battaglia reported continued throbbing headaches despite the
oxycodone. (Tr. 2678). On October 3, 2019, she met with neurologist Stephen Samples, M.D., for

headaches that she described as constant with throbbing exacerbations, photophobia and
phonophobia, and worsened with movement. (Tr. 2921). She reported being unable to tolerate
numerous medications. (Id.). Dr. Samples noted markedly increased neck muscle tone. (Id.). He
prescribed Axert, an abortive medication, and zonegran, the only remaining oral medication for
headache relief available to Mrs. Battaglia, and strongly encouraged her to join a chronic pain
program. (Id.).
On December 11, 2019, at a pain management office visit, Mrs. Battaglia reported she
weaned herself down to one or two oxycodone tablets a day and noted a significant reduction in
headaches, but also increased joint pain. (Tr. 2805). She also reported taking hydroxychloroquine

for Sjögren’s syndrome and Topamax and Flexeril for headaches. (Id.). She received a prescription
for Celebrex to address joint pain. (Id.).
On January 15, 2020, Mrs. Battaglia met with neurologist Dr. Samples and reported being
unable to tolerate zonegran due to gastrointestinal side effects. (Tr. 2935). She also reported
decreasing her daily dose of oxycodone but endorsed continued daily headaches. (Id.). Because
insurance did not cover Axert, Dr. Samples prescribed another abortive medication Maxalt. (Id.).

He also recommended Botox injections, administered on February 18, 2020. (Id.).
During a February 2020 office visit with her family doctor, Mrs. Battaglia reported taking
hydroxychloroquine five days a week that helped clear her skin but did not relieve her pain or
fatigue. (Tr. 2862). She also reported burning pain in her legs that is relieved only by lying down.
(Id.).
On February 19, 2020, Mrs. Battaglia attended a neurological consultation with Robert

Kosmides, M.D., and reported neck and arm pain. (Tr. 2872). Physical examination was normal
except reduced sensation to pinprick at the left scapula and a slow tandem gait. (Tr. 2877). Dr.
Kosmides assessed cervical radiculopathy, for which he recommended acupuncture, and possible
small fiber neuropathy, for which he ordered lab work and prescribed alpha lipoic acid. (Tr. 2872).
On March 17, 2020, Mrs. Battaglia met with Dr. Warren and complained of a burning
sensation in her lower extremities, recurrent rash and dry skin, drooping of the left upper eyelid,
slightly blurred vision, and pain in the lateral aspect of her thigh. (Tr. 2251). Dr. Warren observed
dry, scaly skin on her forehead, palms, and hands, mild tenderness at the shoulders and thighs,
and focal tenderness at the proximal lateral aspect of the right thigh. (Id.). He noted a history of M
protein, autoimmune hepatitis, fatty liver, Sjögren’s syndrome, and paresthesias in the lower

extremities, suggestive of neuropathy. (Id.). Dr. Warren increased her dose of hydroxychloroquine
and ordered additional lab work. (Tr. 2252).
On August 20, 2020, during an appointment with pain management, Mrs. Battaglia
reported increased lateral right-sided hip pain with all movement. (Tr. 3270). Physical examination
showed right-sided hip impingement and abnormal spinal range of motion. (Tr. 3270, 3273). Hip
imaging revealed no acute process. (Tr. 3281). On November 20, Mrs. Battaglia received an

increased prescription for oxycodone and a referral to physical therapy for low back pain. (Tr.
3277).
On August 14, 2020, Mrs. Battaglia complained of generalized pain, significant fatigue,
and an inability to tolerate anti-epileptic medications, such as gabapentin, for small fiber
neuropathy pain. (Tr. 2221). Dr. Warren ordered additional lab work to determine if she can take
anti-metabolite demarcated medications. (Id.). During a telehealth visit on November 23, 2020,
Mrs. Battaglia complained of multiple joint pain. (Tr. 2192). Dr. Warren continued her

medications. (Id.).
On February 1, 2021, Mrs. Battaglia met with neurologist Dr. Kosmides and complained of
a burning sensation in her legs and pain in her shins when getting out of bed. (Tr. 2054). She
reported the medication prescribed for neuropathy made her feel nervous and discontinued it
within a few days. (Id.). A limited physical examination was normal, revealing a slow tandem gait.
(Tr. 2056). Dr. Kosmides prescribed carbamazepine pending approval of the doctor overseeing
Mrs. Battaglia’s liver disease. (Tr. 2054).
On February 5, 2021, Mrs. Battaglia reported paresthesias in her legs and, after noting

some continued problems with Mrs. Battaglia’s gait, Dr. Brown ordered an updated MRI. (Tr.
2100). At a follow-up visit on April 30, 2021, Dr. Brown continued Mrs. Battaglia’s medications.
(Tr. 2153).
A cervical spine MRI from July 14, 2021 revealed mild neuroforaminal narrowing at
multiple levels and mild facet hypertrophy at C5-C6 and mild central canal stenosis at C6-C7. (Tr.
4634). On August 2, 2021, Mrs. Battaglia met with Dr. Warren and complained of locking digits
in her right hand, increased numbness and paresthesia in the upper extremities, right more than

left, and increased gastrointestinal symptoms. (Id.). She reported decreasing her dose of
hydroxychloroquine to relieve the gastrointestinal symptoms but noticed a subsequent increase in
pain and intermittent swelling involving her hands, wrists, ankles, feet, knees, and shoulders. (Id.).
Dr. Warren prescribed azathioprine. (Tr. 4635).
III. MEDICAL OPINIONS
Upon initial assessment of Mrs. Battaglia’s claim on May 4, 2017, State agency medical

consultant Abraham Mikalov, M.D., reviewed her medical records and opined she could lift and
carry twenty pounds occasionally, ten pounds frequently; stand and walk about six hours and sit
more than six hours on a sustained basis in an eight-hour workday; never climb ladders, ropes, or
scaffolds; and frequently stoop, kneel, crouch, and crawl. (Tr. 575-76).
On reconsideration on July 13, 2017, State agency medical consultant David Knierim,
M.D., reviewed updated medical records and adopted the opinions of Dr. Mikalov, but
additionally restricted Mrs. Battaglia to frequent pushing and pulling with the right lower
extremity to account for pain in the plantar metatarsophalangeal joint while walking; frequent
overhead reaching in light of her cervical spondylosis, mild canal stenosis, and cervicalgia; frequent

handling due to elbow pain; and no exposure to hazards such as dangerous machinery and
unprotected heights. (Tr. 594-95).
The ALJ evaluated the opinions and accorded them partial weight:
They found the claimant could do light work. They found the claimant could
frequently stoop, kneel, crouch, and crawl and never climb ladders, ropes, or
scaffolds. Dr. Knierim also found the claimant could frequently push and pull with
the right lower extremity. Dr. Knierim found the claimant could frequently handle
and had limited overhead reaching. He also found the claimant should avoid all
exposure to hazards such as unprotected heights and dangerous heavy machinery.
These opinions were based on a review of the record. The record did support a
finding of limiting the claimant to light work with postural and environmental
limitations based on her ongoing treatment for pain, but with generally intact gait,
strength, and sensation on examination. However, her treatment records supported
some additional limitations with the use of the right lower extremity.

(Tr. 1689).
In June 2018, Dr. Warren completed a medical source statement and opined Mrs.
Battaglia can lift and carry ten pounds occasionally, five pounds frequently; stand and walk for a
total of four hours a day and one hour without interruption; occasionally climb; rarely balance,
stoop, kneel, crouch, and crawl; and occasionally reach, push/pull, and perform fine and gross
manipulation. (Tr. 1490-91). Additionally, Dr. Warren concluded Mrs. Battaglia should avoid
heights and temperature extremes; requires the ability to alternate between sitting and standing;
has moderate pain that would interfere with concentration, take her off task, and cause
absenteeism; and must be able to elevate her legs to 45 degrees. (Tr. 1491). On the medical source
statement, Dr. Warren supported his opinions by noting Mrs. Battaglia’s pain. (1490-91). The ALJ
gave the opinion little weight:
There was nothing in the medical record to explain why the claimant needed to be
able to elevate her legs. His opinion relied heavily on her subjective reports of pain
rather than citing to objective medical findings.

(Tr. 1692).
IV. OTHER RELEVANT EVIDENCE
On March 29, 2017, Mrs. Battaglia reported to a State agency Disability Determination
Services (DDS) representative that her daily activity is limited due to pain, and her husband does
the cooking, cleaning, and shopping for the household. (Tr. 706). She reported requiring
assistance with personal care, showering once a week, and using a walker on “really bad” days. (Id.)
She endorsed being able to sit for about an hour at a time if the chair is comfortable and stand for
about five minutes at a time. (Id.). She claimed to be able to drive sometimes, but not on days
when she cannot turn her head. (Id.). Mrs. Battaglia endorsed getting along well with others and
socializing with family and friends about twice a week. (Id.). She reported difficulty concentrating
due to headaches and pain. (Id.).
On May 31, 2017, Mrs. Battaglia reported spending most days in her adjustable bed that

helped with her neck and back pain. (Tr. 718). She affirmed her husband does the cooking,
shopping, and housework, and reported that he changed their doorknobs to handles because she
was unable to turn the knobs with her hands. (Id.). She also described difficulty opening containers
with her hands and dropping items from her grasp. (Id.). She endorsed pain in her neck that
radiates down her arm and into her hand, and pain in her elbows, knees, feet, and hips, all of
which make it difficult to do anything. (Id.).
V. ADMINISTRATIVE HEARING
At the first administrative hearing on December 12, 2018, Mrs. Battaglia testified that her
fatigue and chronic pain prevent her from working full-time. (Tr. 544). She experiences fatigue as a

result of her autoimmune conditions, including autoimmune hepatitis,4 Sjögren’s syndrome, and
Hashimoto’s disease, noting it does not take a lot of activity to tire her out. (Tr. 545, 552). Her
liver issues limit the kinds of medication she can take. (Tr. 546, 556). She has headaches and pain
in her neck, knees, ankles, feet, left arm, and right hip. (Tr. 545). The headaches stem from the
neck. (Tr. 556). Mrs. Battaglia testified she has tried physical therapy, numerous medications and
adjustments, and epidural steroid injections to relieve her pain. (Tr. 545).
Mrs. Battaglia’s husband does a lot to maintain the household, including chores, shopping,

and cooking. (Tr. 547). Her son and daughter-in-law purchased the house next door and help out
often. (Tr. 547). She tries to do some chores on good days, like loading the dishwasher and folding
laundry in her lap but must be careful not to aggravate her pain. (Tr. 547). For instance, Mrs.
Battaglia sneezed and was bed-ridden for several days, prompting her pain management doctor to
prescribe steroids. (Tr. 547). Doing anything while holding her arms out in front of her, such as
driving, standing at the counter or stove, or chopping vegetables aggravates her neck pain. (Tr. 547-

48, 552).
On a typical day, Mrs. Battaglia awakens between 8:00 a.m. and 10:00 a.m., depending on
how well she slept. (Tr. 549). She immediately takes a pill and stays in bed to let the medicine start
working. (Id.). When she gets out of bed, she goes downstairs to watch television. (Id.). If she is

4 Prior to 2006, Mrs. Battaglia received disability benefits for fifteen years based on
her autoimmune hepatitis. (Tr. 554). When the disease went into remission, she obtained a job as
a financial aid counselor. (Id.).
having a really good day, she will drive ten minutes to the drive-thru pharmacy to pick up
prescriptions, load the dishwasher, and try to do little things. (Id.). On bad days, Mrs. Battaglia
spends her time trying to find a comfortable position to relieve the pain. (Tr. 550). Often, Mrs.

Battaglia stays in her adjustable bed because it is the only place she finds any relief. (Tr. 550).
Sjögren’s syndrome causes dry and peeling skin, fatigue, and joint pain in her knees, ankles, hands,
and feet. (Tr. 556-57). On some days, her ankles and knees feel like they are on fire and ache. (Tr.
556). She experiences tingling and numbness in her left arm. (Tr. 559). Mrs. Battaglia identified
her cervical spine as the main condition preventing her from working. (Tr. 560). She has a
constant headache varying in intensity and, as a result, does not read much anymore. (Tr. 550).
VE Thomas Nimberger identified Mrs. Battaglia’s past relevant work as a composite job.

(Tr. 561). Mrs. Battaglia’s first function, financial aid/loan counselor, is classified as financial aid
counselor (DOT #169.267-018, sedentary exertion as generally performed, light exertion as
actually performed, SVP 5). (Tr. 561). The second function, manning the front desk, is classified as
front desk receptionist (DOT #237.367-038, sedentary exertion as generally and actually
performed, SVP 3). (Tr. 562). The composite job, financial aid/loan counselor front desk
receptionist, does not exist in the DOT, but Mrs. Battaglia performed this SVP 5 job at the light

exertion level. (Id.).
The ALJ asked the VE if a hypothetical individual of Mrs. Battaglia’s age, education, and
experience could perform her past relevant work if limited to light exertion and subject to the
following restrictions: never climb ladders, ropes, or scaffolds; frequently stoop, kneel, crouch, and
crawl; frequently reach overhead bilaterally; avoid all exposure to hazards such as unprotected
heights and dangerous machinery; frequently push and pull with the right lower extremity;
occasional interaction with supervisors, coworkers, and the public; and occasional routine
workplace changes. (Tr. 562-563). The VE testified the hypothetical individual could not perform
Mrs. Battaglia’s past relevant work, but identified three light exertion, SVP 2, unskilled positions,

including: office cleaner (DOT #323.687-014, 60,000 national jobs); packager (DOT #559.687-
074, 19,000 national jobs); and bench assembler (DOT #706.684-022, 79,000 jobs nationally).
If the hypothetical individual was further restricted to occasional bilateral overhead
reaching, upper extremity pushing and pulling, and grasping, gripping, and pinching, the
individual would be unable to perform any light work because the limitations diminish the light
job base and the restriction to occasional interaction with others takes away from that small job
base. (Tr. 566).

At the second administrative hearing on October 15, 2021, Mrs. Battaglia testified she
remains unable to work because of her chronic pain, anxiety, and fatigue. (Tr. 1725). Her legs
constantly feel like they are burning, her right foot hurts like a toothache all day, and she
experiences neck pain causing headaches and radiating into her arms, causing tingling and
numbing. (Id.). The tingling, numbing sensation wakes her from sleep and also occurs during the
day, causing her to drop things she is holding. (Tr. 1738). She naps at least once a day because

dealing with the pain and anxiety physically exhausts her. (Tr. 1726). Some days, she wakes up
feeling as though her nerves are jumping out of her skin. (Id.). She continues to have headaches for
which Botox injections were not effective. (Tr. 1728). Due to liver issues, Ms. Battaglia remains
unable to take medications that might otherwise be helpful. (Tr. 1726-27). There are other
medications she cannot take or can only take a limited dose because they increase her anxiety. (Tr.
1728). Mrs. Battaglia takes oxycontin to help manage her musculoskeletal pain. (Tr. 1729). A
higher dosage of oxycontin exacerbates her headache, but a lower dose does not help to control
her pain. (Tr. 1729). Mrs. Battaglia’s autoimmune disorders cause joint pain, fatigue, dry eyes and
mouth, and scaly, dry skin. (Tr. 1736).

After Mrs. Battaglia’s husband was injured in an accident, their son and daughter-in-law
began helping them with household chores, bringing them meals, and picking up groceries. (Tr.
1730). When Mrs. Battaglia wakes up with anxiety, she does not know what to do with herself and
stays in bed. (Tr. 1733). On days when she does not have as much anxiety but is in a lot of pain,
she gets up from bed and alternates between a chair with lumbar support and a chair with a stool
in front of it to elevate her legs. (Tr. 1733). She watches television without sound because the noise
hurts her head. (Tr. 1727). When she gets stiff, she moves around a bit and sits back down. (Tr.

1734). Mrs. Battaglia does not engage in hobbies or do anything else for fun because “[i]t’s hard to
have fun when you’re miserable[.]” (Tr. 1734).
The ALJ posed a hypothetical individual of Mrs. Battaglia’s age, education, and experience
with the same restrictions as those posed at the first hearing in 2018, to which the VE testified the
hypothetical individual could not perform Mrs. Battaglia’s past relevant work. (Tr. 1739-40). The
VE identified other light exertion, unskilled jobs the hypothetical individual could perform,

including officer cleaner (DOT #323.687-014, 220,000 jobs nationally), mail clerk (DOT
#209.687-026, 12,000 jobs nationally), and bench assembler (DOT #706.684-022, 320,000 jobs
nationally). (Tr. 1740-41).
If the hypothetical individual was further restricted to standing and walking no more than
four hours in an eight-hour workday and lifting no more than five pounds frequently, ten pounds
occasionally, the individual would be restricted to sedentary exertion work. (Tr. 1741).
If, based on the restrictions of the original hypothetical, the individual was further
restricted to occasional reaching in all directions, occasional pushing and pulling with the upper
extremity, and occasional performance of fine and gross manipulation, the individual would not

be able to perform any light work because the limitations themselves diminish the job base and the
restriction to occasional interaction with others eliminates the diminished job base. (Tr. 1742).
Based on the restrictions of the original hypothetical, Mrs. Battaglia’s counsel asked the VE
if the need to elevate the legs throughout the workday is work preclusive. (Tr. 1743). The VE
testified the need to elevate her legs to 45 degrees is not work preclusive, but the need to elevate
her legs to 90 degrees is work preclusive. (Tr. 1743-44). An accommodation from the employer
would be necessary if the individual required, in addition to regular breaks, extra rest periods

totaling one hour. (Tr. 1744). Finally, the VE testified an individual could not sustain work activity
if she was absent from work two or more days a month). (Tr. 1744-45).
THE ALJ’S DECISION
The ALJ’s decision included the following findings of fact and conclusions of law:
1. The claimant meets the insured status requirements of the Social Security
Act through June 30, 2022.

2. The claimant has not engaged in substantial gainful activity since the
alleged onset date, December 16, 2016 (20 CFR 404.1571 et seq.).

3. The claimant has the following severe impairments: dysfunction of major
joints, degenerative disc disease, autoimmune hepatitis, depressive disorder,
and obsessive-compulsive disorder. (20 CFR 404.1520(c)).

4. Since the alleged onset date, that claimant has not had 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, and 404.1526).
5. After careful consideration of the entire record, I find that since the alleged
onset date, the claimant had the residual functional capacity to perform
light work except frequently push and/or pull with the right lower
extremity; never climb ladders, ropes, or scaffolds; frequently stoop, kneel,
crouch, and crawl; frequent overhead reaching bilaterally; never be exposed
to hazards such as unprotected heights or dangerous machinery; occasional
interaction with supervisors, coworkers, and the public; limited to
occasional routine workplace changes.

6. Since the alleged onset date, the claimant was unable to perform any past
relevant work. (20 CFR 404.1565).

7. Prior to October 31, 2021, the claimant was closely approaching advanced
age. On October 31, 2021, the claimant’s age category changed to advanced
age. (20 CFR 404.1563).

8. The claimant has at least a high school education. (20 CFR 404.1564).

9. Prior to the alleged onset date, the claimant’s acquired job skills do not
transfer to other occupations, OR the claimant within the residual
functional capacity defined above (20 CFR 404.1568). Beginning on the
established onset date, the claimant has not been able to transfer job skills
to other occupations. (See SSR 82-41 and 20 CFR Part 404, Subpart P,
Appendix 2).

10. Prior to October 31, 2021, considering the claimant’s age, education, work
experience, and residual functional capacity, there were jobs that existed in
significant numbers in the national economy that the claimant could have
performed (20 CFR 404.1569 and 404.1569a).

11. Beginning on October 31, 2021, considering the claimant’s age, education,
work experience, and residual functional capacity, there are no jobs that
exist in significant numbers in the national economy that the claimant can
perform. (20 CFR 404.1560(c) and 404.1566).
12. The claimant was not disabled prior to October 31, 2021, but became
disabled on that date and has continued to be disabled through the date of
this decision (20 CFR 404.1520(g)).
(Tr. 1669-98).
STANDARD OF REVIEW
In reviewing the denial of Social Security benefits, 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
more than a scintilla of evidence but less than a preponderance and is such relevant evidence as a
reasonable mind might accept as adequate to support a conclusion.” Besaw v. Sec’y of Health &
Human Servs., 966 F.2d 1028, 1030 (6th Cir. 1992). The Commissioner’s findings “as to any fact if
supported by substantial evidence shall be conclusive.” McClanahan v. Comm’r of Soc. Sec., 474 F.3d
830, 833 (6th Cir. 2006) (citing 42 U.S.C. § 405(g)).

In determining whether the Commissioner’s findings are supported by substantial
evidence, the court does not review the evidence de novo, make credibility determinations, or
weigh the evidence. Brainard v. Sec’y of Health & Human Servs., 889 F.2d 679, 681 (6th Cir. 1989).
Even if substantial evidence or indeed a preponderance of the evidence supports a claimant’s
position, the court cannot overturn “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). This is so

because there is a “zone of choice” within which the Commissioner can act, without fear of court
interference. Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir. 1986) (citing Baker v. Heckler, 730 F.2d
1147, 1150 (8th Cir. 1984)).
However, “a substantiality of evidence evaluation does not permit a selective reading of the
record. Substantiality of evidence must be based upon the record taken as a whole. Substantial
evidence is not simply some evidence, or even a great deal of evidence. Rather, the substantiality of
evidence must take into account whatever in the record fairly detracts from its weight.” Brooks v.
Comm’r of Social Security, 531 F. App’x 636, 641 (6th Cir. 2013) (cleaned up).
Even if substantial evidence supports the decision, a district court will not uphold that

decision when the ALJ 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 [when] that error prejudices a claimant on
the merits or deprives the claimant of a substantial right”); Wilson v. Comm’r of Soc. Sec., 378 F.3d
541, 546–47 (6th Cir. 2004) (Even if substantial evidence supports the ALJ’s decision, the court
must overturn when an agency does not observe its own procedures and thereby prejudices or

deprives the claimant of substantial rights). Furthermore, a district court cannot uphold an ALJ’s
decision, even if there “is enough evidence in the record to support the decision, [where] the
reasons given by the trier of fact do 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) (quoting Sarchet v.
Charter, 78 F.3d 305, 307 (7th Cir. 1996)); accord Shrader v. Astrue, No. 11:13000, 2012 WL
5383120, at *6 (E.D. Mich. Nov. 1, 2012) (“If relevant evidence is not mentioned, the Court

cannot determine if it was discounted or merely overlooked.”).
STANDARD FOR DISABILITY
Eligibility for benefits is predicated on the existence of a disability. 42 U.S.C. §§ 423(a),
1382(a). “Disability” is defined as the “inability to engage in any substantial gainful activity by
reason of any medically determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for a continuous period of not less
than 12 months.” 20 C.F.R. § 404.1505(a); see also 42 U.S.C. § 1382c(a)(3)(A). The Commissioner
follows a five-step evaluation process—found at 20 C.F.R. §§ 404.1520—to determine if a claimant
is disabled:
1. Was claimant engaged in a substantial gainful activity?

2. Did claimant have a medically determinable impairment, or a combination
of impairments, that is “severe,” which is defined as one which substantially
limits an individual’s ability to perform basic work activities?

3. Does the severe impairment meet one of the listed impairments?

4. What is claimant’s residual functional capacity and can claimant perform
past relevant work?

5. Can claimant do any other work considering her residual functional
capacity, age, education, and work experience?

Under this five-step sequential analysis, the claimant has the burden of proof in Steps One
through Four. Walters, 127 F.3d at 529. The burden shifts to the Commissioner at Step Five to
establish whether the claimant has the residual functional capacity to perform available work in
the national economy. Id. The ALJ considers the claimant’s residual functional capacity, age,
education, and past work experience to determine if the claimant could perform other work. Id.
Only if a claimant satisfies each element of the analysis, including inability to do other work, and
meets the duration requirements, is she determined to be disabled. 20 C.F.R. § 404.1520(b)-(f); see
also Walters, 127 F.3d at 529.
DISCUSSION
Mrs. Battaglia claims the ALJ erred in (1) her evaluation of Dr. Warren’s opinion under
the treating physician rule and (2) erred in the assessment of her RFC, particularly by not
including more robust upper extremity limitations. (Pl.’s Br., ECF #11, PageID 4821, 4825).
Regarding Dr. Warren’s opinion, she takes issue with the ALJ’s stated rationale that the opinion
relied heavily on subjective reports of pain rather than citing to objective medical findings and
argues his opinion was entitled to controlling weight because it was well-supported by diagnostic
evidence and clinical findings and was not inconsistent with other substantial evidence in the

record. (Id. at PageID 4822-23). Mrs. Battaglia also claims the RFC assessment is not supported by
substantial evidence because the ALJ did not “look to an actual medical basis for limitations,
ignored portions of the medical and opinion evidence, and wholly devalued, without basis, the
claimant’s reported symptoms.” (Id. at PageID 4825).
In response, the Commissioner argues that when a treating physician’s opinions are merely
based on subjective complaints, as Dr. Warren’s are, the ALJ’s decision to discount the opinion is

generally upheld. (Comm’r’s Br., ECF #13, PageID 4870-71). The Commissioner also argues the
ALJ adequately explained his reasoning for giving the opinion little weight by considering the
relevant evidence and indirectly attacking both the consistency and supportability of the opinion.
(Id. at PageID 4873). As to the RFC, the Commissioner claims the ALJ’s assessment is based on a
review of all relevant evidence and is supported by substantial evidence, including objective
medical and opinion evidence. (Id. at PageID 4875-76).
For the reasons discussed below, I conclude the ALJ did not properly evaluate Dr.

Warren’s medical opinion.
Under the regulations applicable when Mrs. Battaglia first filed her claim, treating source
opinions must be given “controlling weight” if two conditions are met: (1) the opinion “is well-
supported by medically acceptable clinical and laboratory diagnostic techniques”; and (2) the
opinion “is not inconsistent with the other substantial evidence in [the] case record.” 20 C.F.R. §
404.1527(c)(2).5 If an ALJ does not accord controlling weight to a treating physician’s opinion, the
ALJ must weigh the opinion based on the length and frequency of treatment, the supportability of
the opinion, the consistency of the opinion with the record as a whole, whether the treating

physician is a specialist, the physician’s understanding of the disability program and its evidentiary
requirements, the physician’s familiarity with other information in the record, and other factors
that might be brought to the ALJ’s attention. 20 C.F.R. § 404.1527(c)(2)-(6). Nothing in the
regulations requires the ALJ to explain how she considered each of the factors. See 20 C.F.R.
§ 404.1527(c). However, to safeguard a claimant’s procedural rights and permit meaningful review,
the ALJ must at least explain the ultimate weight assigned to the opinion. Cole v. Astrue, 661 F.3d

931, 938 (6th Cir. 2011).
The ALJ must give good reasons for the weight afforded to a claimant’s treating source’s
medical opinion. 20 C.F.R. § 404.1527(c)(2). Good reasons for giving a treating source’s opinion
less-than-controlling weight include: (1) a lack of support by medically acceptable clinical and
laboratory diagnostic techniques; and (2) inconsistency with other substantial evidence in the case
record (including contrary findings in the treating source's own records). See Biestek v. Comm’r of
Soc. Sec., 880 F.3d 778, 786 (6th Cir. 2017) (“An ALJ is required to give controlling weight to a

treating physician’s opinion, so long as that opinion is supported by clinical and laboratory
diagnostic evidence [and] not inconsistent with other substantial evidence in the record.”) (citing
20 C.F.R. § 404.1527(c)(2)); Gayheart v. Comm’r of Soc. Sec., 710 F.3d 365, 376 (6th Cir. 2013).

5 Effective March 27, 2017, new regulations replaced the treating physician rule. See
20 C.F.R. § 404.150c; Revisions to Rules Regarding the Evaluation of Medical Evidence, 2017 WL
168819, 82 Fed. Reg. 5844 (Jan. 18, 2017).
In the Sixth Circuit, “it is not enough to dismiss a treating physician’s opinions as
‘incompatible’ with other evidence of record; there must be some effort to identify the specific
discrepancies and to explain why it is the treating physician’s conclusion that gets the short end of

the stick.” Friend v. Comm’r of Soc. Sec., 375 Fed. App’x 543, 552 (6th Cir. 2010). When the ALJ
does not adequately explain the weight given to a treating physician’s opinion, or otherwise fails to
provide good reasons for giving less-than-controlling weight to a treating physician’s opinion,
remand is appropriate. Cole, 661 F.3d at 939; see also Blakely v. Comm’r of Soc. Sec., 581 F.3d 399,
407 (6th Cir. 2009) (holding that the failure to identify good reasons affecting the weight given to
an opinion “denotes a lack of substantial evidence, even whe[n] the conclusion of the ALJ may be

justified based upon the record”) (internal quotation omitted); see also Patterson v. Astrue, No. 5:09-
cv-1566, 2010 WL 2232309, *13 (N.D. Ohio Jun. 2, 2010) (remanding where the ALJ does not
provide rationale beyond his conclusory statement that the opinion is inconsistent with the
objective medical evidence and appears to be based solely on subjective complaints.).
Here, the ALJ found no support in the medical record explaining a need for Mrs. Battaglia
to elevate her legs, a point she concedes. (Tr. 1692; see also Pl.’s Br., ECF #11, PageID 4823). The
absence of evidence supporting a limitation is a proper reason to discount the opinion so long as

the conclusion is supported by substantial evidence. Biestek, 880 F.3d at 786. The ALJ discounted
Dr. Warren’s other opined limitations because he relied heavily on subjective reports of pain. (Id.).
I find this to be an overly broad and conclusory finding. See Patterson, 2010 WL 2232309, at *13.
While it is accurate that Dr. Warren did not cite objective medical evidence on the medical source
statement form, Dr. Warren’s treatment records do contain objective medical evidence and clinical
findings supportive of his opinions. (See Tr. 760, 1055, 1308, 1314-15, 1458, 1642, 2221, 2251,
3221). Within her evaluation of the medical opinion, the ALJ does not cite any of these objective
findings, which include lab results confirming autoimmune issues, findings of limited range of
motion, muscle weakness, diminished grip strength, and the like.

The Commissioner correctly points out if an ALJ refers to evidence elsewhere in her
decision undercutting a medical opinion, the ALJ’s failure to refer to this evidence during the
evaluation of that medical opinion does not run afoul of the regulations. See Crum v. Comm’r of Soc.
Sec., 660 Fed. App’x 449, 457 (6th Cir. 2016). However, in this case, the objective medical
evidence and clinical findings the ALJ summarized contain findings both supportive and not
supportive of, as well as consistent and inconsistent with, Dr. Warren’s opinions. For instance, the

ALJ noted some intact range of motion testing, but also noted Mrs. Battaglia more often had
restricted range of motion. (Tr. 1682). The ALJ noted largely intact sensation but instances where
she had reduced sensation in the upper arm and left thigh. (Id.). The ALJ pointed to numerous
findings of intact strength, but also noted some instances of left sided weakness affecting strength
in Mrs. Battaglia’s arm, shoulder, fingers, and leg, and instances of neck and hip weakness. (Id.).
She noted normal grip strength findings as well as findings of weakened grip strength. (Id.). In
short, the ALJ summarized the evidence, but the summarization does not allow the Court to trace

the ALJ’s path of reasoning given the lack of indication as to how the ALJ weighed this evidence.
While the ALJ concluded the MRIs did not correlate with Mrs. Battaglia’s symptoms, the ALJ did
not offer such a conclusion related to the other clinical findings, leaving this Court to wonder
what specific evidence the ALJ relied on to determine the weight assigned to Dr. Warren’s
opinion, especially in light of the regulations, which state:
Imaging and other diagnostic tests can provide evidence of physical abnormalities;
however, these abnormalities may correlate poorly with your symptoms, including
pain, or with your musculoskeletal functioning. Accordingly, we will not use
findings on imaging or other diagnostic tests as a substitute for findings on physical
examination about your ability to function, nor can we infer severity or functional
limitations based solely on such tests.
20 C.F.R. Part 404, Subpart P, Appendix 1, 1.00C(3)(c). The ALJ’s failure to articulate her
reasoning in full regarding these findings deprives the Court of the ability to conduct a meaningful
review of the ALJ’s evaluation of Dr. Warren’s opinion. As such, I find the claim must be
remanded for additional proceedings consistent with this opinion.
In light of my decision to remand, I decline to address Mrs. Battaglia’s remaining argument
regarding the AL]’s RFC assessment. See, e.g, Maddox v. Astrue, No. 3:10CV159, 2011 WL
1990588, at *13 (S.D. Ohio May 2, 2011), report and recommendation adopted, 2011 WL 1988537
(S.D. Ohio May 23, 2011) (declining to address plaintiff's remaining arguments after finding “that
the ALJ’s decision should be reversed for failure to properly consider plaintiff's obesity consistent
with SSR 02-1p”).
CONCLUSION
Following review of the arguments presented, the record, and the applicable law, I
REVERSE the Commissioner’s decision denying disability insurance benefits and REMAND this
matter for proceedings consistent with this opinion.
Dated: June 8, 2023

; } }
DARRELLA.CLAY = —it™
UNITED STATES MAGISTRATE JUDGE

32

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10372159. Public record. Not legal advice.