White v. Commissioner of Social Security Administration

IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF OHIO

EASTERN DIVISION

TAMMY WHITE, CASE NO. 1:23-cv-1380

Plaintiff,

vs. MAGISTRATE JUDGE

JAMES E. GRIMES JR.

COMMISSIONER OF SOCIAL SECURITY

ADMINISTRATION,

MEMORANDUM OPINION

Defendant. AND ORDER

Plaintiff Tammy White filed a complaint against the Commissioner of

Social Security seeking judicial review of the Commissioner’s decision denying

disability insurance benefits and supplemental security income. This court has

jurisdiction under 42 U.S.C. §§ 405(g) and 1383(c). The parties consented to

my jurisdiction in this case. Doc. 5. Following review, and for the reasons

stated below, I affirm the Commissioner’s decision.

Procedural background

In February 2020, White filed an application for disability insurance

benefits and supplemental security income alleging a disability onset date of

December 23, 2019.1 E.g., Tr. 91, 331. In pertinent part, White claimed that

1 “Once a finding of disability is made, the [agency] must determine the

onset date of the disability.” McClanahan v. Comm’r of Soc. Sec., 193 F. App’x

422, 425 (6th Cir. 2006).

she was disabled and limited in her ability to work due to cyclic vomiting

syndrome,2 congenital heart disease, heart failure, blood clot in heart, swelling

in the lower extremities, and shortness of breath. Tr. 330. The Commissioner

denied White’s application initially and upon reconsideration. Tr. 118, 123,

129, 134.

In October 2020, White requested a hearing. Tr. 136. Administrative

Law Judge (“ALJ”) Catherine Ma initially scheduled a hearing to take place in

January 2021; however, after a series of continuances, a hearing was

ultimately held in January 2022. Tr. 37–77. White appeared, testified, and was

represented by counsel at the January 2022 hearing. Tr. 37–77. Qualified

vocational expert Deborah Lee also testified. Tr. 37–77. In February 2022, the

ALJ issued a written decision, which found that White was not entitled to

benefits. Tr. 17–36.

In March 2023, White appealed the ALJ’s decision to the Appeals

Counsel. Tr. 1–5. In May 2023, the Appeals Counsel denied White’s appeal,

making the ALJ’s February 2022 decision the final decision of the

Commissioner. Tr. 1–5; see 20 C.F.R. § 404.981.

2 Cyclic vomiting syndrome is characterized by episodes of severe

vomiting that have no apparent cause and can last for hours or days. See Cyclic

Vomiting Syndrome, Mayo Clinic, https://www.mayoclinic.org/diseases-

conditions/cyclic-vomiting-syndrome/symptoms-causes/syc-20352161

[https://perma.cc/Z3HJ-893D].

White timely filed this action in July 2023. Doc. 1. In it, she asserts the

following assignment of error:

WHETHER THE ALJ ERRED IN DETERMINING THAT

PLAINTIFF CAN PERFORM A FULL RANGE OF LIGHT

WORK DUE TO UNDERLYING ERRORS IN THE

EVALUATION OF MEDICAL OPINIONS AND LEGAL

ERROR IN THE EVALUATION OF THE OBJECTIVE

EVIDECE.

Doc. 9, at 1.

Evidence

1. Personal and Vocational Evidence

White was born in 1984, making her 35 years of age at the time of

disability onset and 37 years of age at the time of her hearing. Tr. 46. She

completed 11th grade and had relevant past work experience as a cashier II

and fast-food services manager. Tr. 46.

2. Medical Evidence3

White has a congenital heart condition called Tetralogy of Fallot4 but,

as of January 2020, had been asymptomatic for the past 15 years and had felt

3 The recitation of medical evidence is not intended to be exhaustive and

is generally limited to the evidence cited in the parties’ briefs.

4 Tetralogy of Fallot is a congenital heart condition, meaning it is present

at or before birth, that includes four problems with heart structure: (1)

narrowing of the valve between the heart and the lungs, called pulmonary

valve stenosis; (2) a hole between the bottom heart chambers, called a

ventricular septal defect; (3) shifting of the aorta to attach to the right and sit

directly above the hole in the heart wall; and (4) thickening of the right lower

chamber of the heart, called ventricular hypertrophy. Tetralogy of Fallot, Mayo

“perfectly fine during this time.” Tr. 424. However, in late January 2020, White

was hospitalized for acute congestive heart failure after experiencing shortness

of breath on exertion, fatigue, low energy, limited exercise capacity, a limited

ability to lie down, lower extremity swelling, and a 15-pound weight gain over

the course of one week. Tr. 425, 427. An X-ray taken at the time of her

admission showed cardiomegaly with a right pleural effusion and mild volume

loss in the right mid-to-lower lung zones. Tr. 423. White was started on

medication and released in stable condition approximately one week later, with

a follow-up cardiology appointment scheduled. Tr. 424–425. White’s diagnosis

at the time of discharge was acute decompensated heart failure, heart failure

with reduced left ventricular function, a blood clot in her heart, pulmonary

regurgitation,5 and subclinical hypothyroidism. Tr. 424.

In February 2020, White established care with Martin Bocks, M.D. Tr.

521. At that time, she was “doing very well from [a] cardiac standpoint,” with

an improved energy level. Tr. 521. She denied chest pain, palpitations,

shortness of breath, and dizziness. Tr. 521. However, Dr. Bocks noted that

Clinic, https://www.mayoclinic.org/diseases-conditions/tetralogy-of-

fallot/symptoms-causes/syc-20353477, [https://perma.cc/92QZ-UWJK].

5 Pulmonary regurgitation, or a leaky pulmonary valve, is a condition that

allows blood to flow back into the heart chamber before going to the lungs for

oxygen. Problem: Pulmonary Valve Regurgitation, American Heart

Association, https://www.heart.org/en/health-topics/heart-valve-problems-

and-disease/heart-valve-problems-and-causes/problem-pulmonary-valve-

regurgitation, [https://perma.cc/6Z68-XEH5].

White still required continuous therapy, should be carefully monitored, and

was thought to need a pulmonary valve replacement in the future. Tr. 527–

528. At a follow-up appointment in March 2020, White was noted as continuing

to make progress and was “asymptomatic from [a] cardiac standpoint.” Tr. 533.

She had no activity restrictions and was encouraged to exercise. Tr. 534. Still,

Dr. Bocks wanted her to proceed with the pulmonary valve replacement. Tr.

533.

In April 2020, White was admitted to the hospital at which time she

underwent valve replacement surgery and placement of an implantable

cardioverter defibrillator (“ICD”). Tr. 461, 480–486, 553. At discharge, Dr.

Bocks indicated that White “may not resume work at this time” and that she

had “activity restrictions on her left arm. No lifting more than 5 lbs.” Tr. 554.

At a June 2020 follow-up appointment, Dr. Bocks noted that White had

improved energy since the valve replacement and no significant symptoms

from a cardiac standpoint. Tr. 537. Overall, he was “very pleased with the

outcome of [the surgery] and expect[ed] to see further improvement in cardiac

chamber size and systolic function as well as valvular disease in the future.”

Tr. 537. Dr. Bocks warned White against pregnancy due to her severe

biventricular dysfunction but imposed no activity restrictions and encouraged

her to engage in routine exercise. Tr. 537.

White returned to Dr. Bocks in October 2020, at which time he noted

that her cardiac symptoms were unremarkable. Tr. 680. White, however,

reported that her defibrillator shocked her about two weeks prior, after which

she started a new medication. Tr. 680. Dr. Bocks categorized White’s condition

as Class I heart failure according to the New York Heart Association (NYHA)

classification system. Tr. 680.

Also in October 2020, White saw cardiologist Eiran Gorodeski, M.D., for

an advanced heart failure assessment and management appointment. Tr. 676,

678. He noted that White felt better with medication adjustments and

surgeries but continued to have shortness of breath with exertion. Tr. 678. Dr.

Gorodeski classified White’s symptoms as NYHA Class II or III heart failure.

Tr. 678.

In November 2020, White saw Dr. Gorodeski for a routine medication

evaluation. Tr. 671. Dr. Gorodeski noted that White had minimal symptoms on

her current regimen and advised her to continue it. Tr. 674–675.

In December 2020, White was briefly hospitalized after she was shocked

by her defibrillator due to supraventricular tachycardia.6 Tr. 579–580, 582,

601. It was noted, however, that White had forgotten to take her beta blocker

6 Supraventricular tachycardia is a type of irregular heartbeat that

causes a very fast or erratic heartbeat, and which affects the upper chambers

of the heart. Supraventricular tachycardia, Mayo Clinic,

https://www.mayoclinic.org/diseases-conditions/supraventricular-

tachycardia/symptoms-causes/syc-20355243, [https://perma.cc/7JCV-P8BQ].

the night before the shock. Tr. 579. White was discharged in stable condition

and told that she could engage in activities as tolerated. Tr. 579–580.

White returned to Dr. Bocks in January 2021. Tr. 745. She was noted as

doing “relatively well” but did not exercise regularly, which Dr. Bocks noted

was consistent with NYHA Class II heart failure. Tr. 745–746. White denied

chest pain, palpitations, or syncope but stated she had some exertional

shortness of breath when climbing stairs and on long walks. Tr. 746. Dr. Bocks

indicated that White had no activity restrictions and continued to encourage

routine exercise. Tr. 745.

In April 2021, Dr. Bocks completed a form, intended for pediatric

cardiology assessments, in which he opined that White had a marked

limitation in moving about and manipulating objects, a moderate limitation in

caring for herself, and a marked limitation in her health and physical well-

being. Tr. 751–754. Dr. Bocks also found that White may need accommodations

“particularly related to mobility and activity” if they are requested. Tr. 753.

In June 2021, White had a routine follow-up appointment with Dr.

Bocks. Tr. 880–881. White did not have any acute issues or concerns and

remained categorized by Dr. Bocks as NYHA Class II heart failure. Tr. 881.

Dr. Bocks continued to indicate that White had no activity restrictions and was

encouraged to exercise. Tr. 881.

Later in June 2021, White was hospitalized following two shocks from

her defibrillator and an adjustment was made to her medications. Tr. 843, 897,

911. At discharge, White was instructed to perform activity as tolerated. Tr.

841.

At the end of June 2021, White followed up with cardiologist Dr. Judith

Mackall, who noted that the medication change had been good for White’s

heart rhythm, with no fast heart rates since her hospital stay. Tr. 886. White

reported no present complaints and indicated that she had not been

symptomatic since her hospital discharge. Tr. 886–887. She also, however,

reported palpitations, lightheadedness, and shortness of breath at times. Tr.

887.

In September 2021, White underwent an atrial flutter ablation to

address her symptomatic supraventricular tachycardia and ICD shocks. Tr.

1061. Also in September 2021, Dr. Bocks completed an assessment in which he

opined that White could frequently lift 25 pounds, sit without restriction, stand

for four hours in an eight-hour workday and one hour without interruption,

perform occasional postural changes, occasional reaching, pushing, pulling and

fine and gross manipulation, would need an additional 30-minute break during

the day, and would need to be able to alternate between standing and sitting

at will. Tr. 921–924.

In December 2021, White remained categorized by Dr. Bocks as NYHA

Class II heart failure, but he noted that her polyvalvular disease was generally

improved. Tr. 1070–1071. White reported chronic diarrhea, weight loss,

difficulty taking deep breaths, sweating, and numbness and tingling in her legs

after sitting for 15 minutes, but she denied chest pain, palpitations, or syncope.

Tr. 1071. Dr. Bocks indicated that White had no activity restrictions, continued

her on medications, and encouraged routine exercise. Tr. 1070.

3. State Agency Opinions7

In June 2020, Dr. Leon Hughes, reviewed White’s available records and

assessed White’s physical residual functional capacity (RFC).8 Tr. 93–95. Dr.

Hughes found that White was capable of performing the full range of medium

work. Tr. 95.

7 At the end of White’s January 2022 hearing, her attorney argued that

the ALJ should obtain supplemental interrogatory responses or testimony

from a medical expert to consider evidence that had been presented since

September 2020, when the state agency consultant’s last considered White’s

claims. Tr. 75. Neither this argument nor any argument disputing the state

agency consultants’ analysis appear in White’s brief.

8 An RFC is an “‘assessment of’” a claimant’s ability to work, taking his or

her “limitations … into account.” Howard v. Comm’r of Soc. Sec., 276 F.3d 235,

239 (6th Cir. 2002) (quoting 20 C.F.R. § 416.945). Essentially, it’s the SSA’s

“description of what the claimant ‘can and cannot do.’” Webb v. Comm’r of Soc.

Sec., 368 F.3d 629, 631 (6th Cir. 2004) (quoting Howard, 276 F.3d at 239).

In September 2020, Dr. Gerald Klyop, reviewed White’s record,

including Dr. Hughes’ findings.9 Tr. 113–114. Dr. Klyop affirmed Dr. Hughes’

findings and determined that White was capable of performing the full range

of medium work. Tr. 113–114.

4. Hearing Testimony

White, who was represented by counsel, testified telephonically at an

administrative hearing in January 2022. Tr. 37–77. White testified that she

lived with her 73-year-old mother, who had thyroid cancer, but White did not

provide care for her mother. Tr. 45. She further stated that her mother was

“moving a little bit more better than I do.” Tr. 45. White testified that if she or

her mother needed assistance, she called her sisters or nieces who lived next

door. Tr. 45.

White stated that she completed 11th Grade but had not completed high

school or obtained her GED. Tr. 46. She participated in a culinary class but did

not complete that class. Tr. 46. White did not obtain any other certifications or

licenses. Tr. 46. White stated that she had a driver’s license but did not drive

9 When a claimant applies for disability benefits, the State Agency creates

a record. The record includes the claimant’s medical evidence. A State Agency

disability examiner and a State Agency physician or psychologist review the

claimant’s record and determine whether and to what extent the claimant’s

condition affects his or her ability to work. If the State Agency denies the

claimant’s application, the claimant can ask for reconsideration. On

reconsideration, the State Agency updates the record and a second disability

examiner and doctor review the file and make a new determination. See, e.g.,

20 C.F.R. § 404.1615.

long distances. Tr. 47. She confirmed that she does not have any restrictions

on her license. Tr. 47.

White stated that she is not currently working or volunteering. Tr. 47.

She testified that she does not have any form of income or assistance but

received electronic benefit transfers through the Supplemental Nutrition

Assistance Program for groceries. Tr. 48. White stated that the last time she

worked was December 23, 2019. Tr. 47.

As to her work history, White testified that her most recent employment

was as a part-time cashier at the VA. Tr. 48–49. White testified that in her role

as a cashier at the VA, she worked in the canteen, or cafeteria, of the facility

for about six months. Tr. 48. Her duties included: “ringing up customers,

making sure the tables were clean, stocking juices or whatever that was needed

in the cafeteria.” Tr. 49. She stated that she stood at all times during this

employment and that they rarely had breaks. Tr. 49. White stated that she had

to lift approximately 30 pounds, but items could be placed on a cart to be

moved. Tr. 50.

Next, White testified about a position through a company called

Compass Group. Tr. 50–51. She testified that in her role with Compass Group,

she worked in food service at Judson Park, a nursing home facility. Tr. 50–51.

She worked at Judson Park for approximately six to eight months in a part-

time position. Tr. 50. White explained her role in food service at Judson Park

included plating and providing the plated food to the nurses to be served to

residents, as well as cleaning up between meals and preparing for the next

meal service. Tr. 51, 52. White stated that she was required to be on her feet

but that she did not have to do any extreme lifting or lift a set weight because

there were other employees who would lift heavy items. Tr. 51.

White testified that in 2016 and 2017, she worked as a manager at

Jimmy Johns. Tr. 52. In that role, White explained that she made sandwiches,

cooked bread, sliced meat, and made sure delivery drivers received food on

time. Tr. 52. She also stated that she had authority to discipline employees,

but did not make hiring and firing decisions. Tr. 52. White confirmed that she

was constantly on her feet in this role and she stated that the heaviest item

she would have to lift at a given time was approximately 25 pounds. Tr. 52–53.

White testified that in 2013 and 2014, she worked at Chipotle in

multiple roles including, grill cook, prep cook, line worker, and cashier. Tr. 53.

White confirmed that she was constantly on her feet in these roles and that

she would have to lift items weighing up to 60 pounds during her shifts. Tr. 54.

White testified that she also worked at other Chipotle locations between 2006

and 2010. Tr. 54.

White expressed her belief that she has been unable to return to work

since December 2019 because of her heart. Tr. 55. She further stated:

I have a problem breathing. I couldn’t walk a certain

distance without losing my breath or to the point I’m

about to pass out and then like if I stand still for a

certain amount of time, I would feel water weight

like coming on and I can’t breathe and like I try to

not get over excited so I don’t get palpitations to my

heart and it’s just like – it’s just I don’t know. That’s

it.

Tr. 56. White also explained that she panicked when she felt like she could not

breathe or became short of breath and that wearing a mask made it worse. Tr.

56.

White testified that she took medication for her heart, had upcoming

appointments with her cardiologist and about medication, and that she had

been given certain tools to help with her breathing and regulating her lungs.

Tr. 57. White also stated that she was going to begin cardiology rehab in

February 2022, which she was “kind of excited” to begin. Tr. 57. White

confirmed that no other conditions, apart from her heart condition, limited her

ability to work. Tr. 57–58.

White stated that she took care of herself, but at a slower than usual

pace due to some of the procedures she has had. Tr. 58. For example, she stated

that her defibrillator made her arms stiff, and that the ICD caused her legs to

“lock up” if she sat for more than 10 minutes. Tr. 58. When that happened, she

had to get up slowly. Tr. 58. White also testified that she was able to vacuum

but had to sit down every 15 to 20 minutes, that she did some shopping, and

she cooked. Tr. 58. White explained that she did most of her simple house

cleaning, such as wiping up or dishes, but that her sisters or nieces came over

to do laundry because she got short of breath carrying the laundry basket up

and down the steps. Tr. 58–59. White stated that she did not do yard work. Tr.

59.

White detailed the timeline of her day and stated that she woke up

around 4:30 a.m., got out of bed around 6:30 a.m., and tried to eat something.

Tr. 59. After that she would talk to her mother, or “sit there,” or “try to do some

work around the house.” Tr. 59. She stated, however, that because of her

medication, it took a while for her to “get some juice and get up and do

something.” Tr. 59. So, she explained, it was a “slow start” and she generally

did not get up and do something until one or two in the afternoon because that

was when her medicine kicked in. Tr. 60. White stated that she often spent her

day playing games or watching movies with her mother, sister, and nieces or

by building miniature doll houses. Tr. 60–61. She spent about 30 minutes of

her day working on her doll houses. Tr. 66.

White stated that she had lost weight and now weighed approximately

113 pounds, but she typically weighed 120 pounds. Tr. 62. She also clarified

that she went grocery shopping about once a month but did not go grocery

shopping by herself. Tr. 63. White stated that while grocery shopping, she

leaned on the cart to support herself. Tr. 64.

White further explained that the stiffness in her left arm was caused by

her feeling the ICD wires when she moved and described a pressure in her

chest when she moved her arm back and forth to vacuum. Tr. 64. White

testified that she napped throughout the day but that her naps were generally

an hour or less. Tr. 65. She also explained that she had good days and bad days,

but that she typically had more good days than bad days in a given week. Tr.

65–66.

White lastly stated that she currently saw her cardiologist, Dr. Bocks,

every six months, but that she used to see him every three months, and that

Dr. Gorodeski was the doctor who placed her ICD. Tr. 67.

The ALJ’s Decision

The ALJ made 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, 2024. (Exhibit 19D).

2. The claimant has not engaged in substantial

gainful activity since December 23, 2019, the

alleged onset date. (20 C.F.R. 404.1571 et seq.,

and 416.971 et seq.).

3. The claimant has the following severe

impairments: valvular heart disease and

heart failure. (20 C.F.R. 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 of 20 CFR Part 404,

Subpart P, Appendix 1. (20 C.F.R.

404.1520(d), 404.1525, 404.1526, 416.920(d),

416.925, and 416.926).

5. After careful consideration of the entire

record, I find that the claimant has the

residual functional capacity to perform the

full range of light work as defined by 20 CFR

404.1576(b) and 416.967(b).

6. The claimant is capable of performing past

relevant work as a cashier II and fast-food

services manager. This work does not require

the performance of work-related activities

precluded by the claimant’s residual

functional capacity. (20 C.F.R. 404.1565 and

416.965).

7. The claimant has not been under a disability,

as defined by the Social Security Act, from

December 23, 2019, through the date of this

decision. (20 C.F.R. 404.1520(f) and

416.920(f)).

Tr. 20–22, 33, 35.

Standard for Disability

Eligibility for social security benefit payments depends 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[.]” 42 U.S.C. § 423(d)(1)(A); see also 42 U.S.C.

§ 1382c(a)(3)(A).

An ALJ is required to follow a five-step sequential analysis to make a

disability determination:

1. Is the claimant engaged in substantial gainful

activity? If so, the claimant is not disabled.

2. Does the claimant have a medically

determinable impairment, or a combination of

impairments, that is “severe”? If not, the

claimant is not disabled.

3. Does the claimant’s impairment meet or equal

one of the listed impairments and meet the

duration requirement? If so, the claimant is

disabled. If not, the ALJ proceeds to the next

step.

4. What is the claimant’s residual functional

capacity and can the claimant perform past

relevant work? If so, the claimant is not

disabled. If not, the ALJ proceeds to the next

step.

5. Can the claimant do any other work

considering the claimant’s residual functional

capacity, age, education, and work

experience? If so, the claimant is not disabled.

If not, the claimant is disabled.

20 C.F.R. §§ 404.1520, 416.920; see Jordan v. Comm’r of Soc. Sec., 548 F.3d

417, 422 (6th Cir. 2008). Under this sequential analysis, the claimant has the

burden of proof at steps one through four. Jordan, 548 F.3d at 423. The burden

shifts to the Commissioner at step five “to prove the availability of jobs in the

national economy that the claimant is capable of performing.” Id. “The

claimant, however, retains the burden of proving her lack of residual functional

capacity.” Id. If a claimant satisfies each element of the analysis and meets the

duration requirements, the claimant is determined to be disabled. Walters

Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997).

Standard of review

A reviewing court must affirm the Commissioner’s conclusions unless it

determines “that the ALJ has failed to apply the correct legal standards or has

made findings of fact unsupported by substantial evidence in the record.”

Jordan, 548 F.3d at 422. “‘[S]ubstantial evidence’ is a ‘term of art’” under which

“a court … asks whether” the “existing administrative record … contains

‘sufficien[t] evidence’ to support the agency’s factual determinations.” Biestek

v. Berryhill, 139 S. Ct. 1148, 1154 (2019) (citations omitted). The substantial

evidence standard “is not high.” Id. Substantial evidence “is ‘more than a mere

scintilla’” but it “means only[] ‘such relevant evidence as a reasonable mind

might accept as adequate to support a conclusion.’” Id. (citations omitted). The

Commissioner’s “findings … as to any fact if supported by substantial evidence

[are] conclusive.” 42 U.S.C. § 405(g); Biestek, 139 S. Ct. at 1152.

A court may “not try the case de novo, resolve conflicts in evidence, or

decide questions of credibility.” Bass v. McMahon, 499 F.3d 506, 509 (6th Cir.

2007). Even if substantial evidence or a preponderance of the evidence

supports a claimant’s position, a reviewing court cannot overturn the

Commissioner’s decision “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 judicial “interference.” Lindsley v.

Comm’r of Soc. Sec., 560 F.3d 601, 605 (6th Cir. 2009) (quoting Felisky v.

Bowen, 35 F.3d 1027, 1035 (6th Cir. 1994)).

Discussion

In support of her sole issue presented, White makes two salient

arguments: (1) “the ALJ failed to properly and accurately evaluate the

persuasiveness of the medical opinions of record which conflict with a light

residual functional capacity finding,” and (2) “the ALJ played doctor and failed

to draw a logical bridge between the evidence and her residual functional

capacity.” Doc. 9, at 13, 18. Both arguments are refuted by the Commissioner,

Doc. 11, at 7–13, and neither provide a sufficient basis for remand.

As to her first argument, White asserts that the ALJ failed to comply

with applicable regulations when she evaluated the medical opinions provided

by two doctors, Dr. Bocks and Dr. Gorodeski. Tr. 13. In this regard, the

Commissioner is required to evaluate the persuasiveness of all medical

opinions using the following factors: supportability; consistency; treatment

relationship, including the length, frequency, purpose, and extent;

specialization; and other factors. 20 C.F.R. §§ 416.920c(a), 416.920c(c)(1)-(5).

Supportability and consistency are the most important factors. 20 C.F.R. §

416.920c(a). Supportability means that “[t]he more relevant the objective

medical evidence and supporting explanations presented by a medical source

are to support his or her medical opinion[] … the more persuasive the medical

opinions … will be.” 20 C.F.R. § 416.920c(c)(1). Consistency means “[t]he more

consistent a medical opinion[] … is with the evidence from other medical

sources and nonmedical sources in the claim, the more persuasive the medical

opinion[] … will be.” 20 C.F.R. § 416.920c(c)(2). The Commissioner must

explain the supportability and consistency factors when discussing a medical

opinion. 20 C.F.R. § 416.920c(b)(2). “[A]n ALJ need not,” however, “specifically

use the terms ‘supportability’ or ‘consistency’ in his analysis.” Cormany v.

Kijakazi, No. 5:21-cv-933, 2022 WL 4115232, at *3 (N.D. Ohio Sept. 9, 2022)

(citing cases). The Commissioner is not required to discuss the remaining

factors. Id. “A reviewing court evaluates whether the ALJ properly considered

the factors as set forth in the regulations to determine the persuasiveness of a

medical opinion.” Toennies v. Comm’r of Soc. Sec., No. 1:19-cv-02261, 2020 WL

2841379, at *14 (N.D. Ohio June 1, 2020) (internal quotation marks and

citation omitted).

The ALJ evaluated Dr. Bocks’ medical opinions as follows:

I have considered the opinion of Dr. Martin Bocks.

After being discharged from her valve replacement

and ICD surgeries in April 2020, he indicated she

“may not resume work at this time” and that she had

activity restriction in her left arm. He indicated she

could do no lifting more than five pounds. (Exhibit

4F, page 9). This opinion is giving short-term

limitations as it related to her immediate recovery

from these surgeries that would not reflect her

functioning over the longitudinal period, as she was

asymptomatic shortly after this surgery. (Exhibit

3F, pages 70, 74). Thus, this opinion is not

persuasive.

I have considered another opinion of Dr. Martin

Bocks. In April 2021, he completed a form meant to

be used when evaluating childhood disability claims

that evaluate six functional domains. In this form,

he indicated the claimant had no limitations

acquiring and using information, attending and

completing tasks, and interacting and relating with

others. He indicated she had marked limitations

moving about and manipulating objects stating her

heart disease would limit her activity and

endurance, resulting in symptoms like shortness of

breath. He found she had moderate limitations

caring for herself, stating she had limitations related

to activities to support her daily life, like grocery

shopping, due to her health issues. He indicated she

had marked limitations in health and physical well-

being as her health would be affected by her heart

condition, which affected her ability to complete all

of her daily activities. He also provided a list of

potential side effects, but made no indication the

claimant actually had any of those side effects.

(Exhibit 8F; Exhibit 9F, pages 27–30).

Dr. Bocks was the claimant’s treating cardiologist.

Obviously completing a form meant to assess a

child’s functioning was in error, as at all times Dr.

Bocks treated the claimant the claimant was an

adult. Thus, the classifications he gave related to the

six functional domains were not particularly

relevant in evaluating her functioning as an adult.

His opinion was also not fully supported by the

record. There was no indication that her symptoms

were affecting her ability to complete all of her daily

activities as he alleged. Records showed in December

2020 that she had returned to her normal activities.

(Exhibit 5F, page 12). Dr. Bocks’ own treatment

records did sometimes document she had shortness

of breath with exertion. (Exhibit 7F, page 47).

However, his treatment records also noted she was

doing well and often noted the claimant to have no

symptoms. (Exhibit 3F, pages 58, 64, 70, 74; Exhibit

5F, pages 5, 24). While she would be expected to

have some degree of limitation based on her heart

disorder, his opinion was fairly vague and imprecise.

Thus, this opinion was not persuasive.

I have considered another opinion by Dr. Martin

Bocks. In September 2021, he completed a form

indication that the claimant could occasionally and

frequently lift and/or carry twenty-five pounds. He

indicated she could stand or walk one hour at a time

and for four hours in an eight-hour workday. He

indicated she could occasionally climb, balance,

stoop, crouch, kneel, and crawl. He indicated she

could occasionally reach, push, pull, fine

manipulate, and gross manipulate. When asked “are

there environmental restrictions that affect the

impairments” he checked “no” for heights, moving

machinery, temperature extremes, pulmonary

irritants, and noise. He indicated she would need an

additional thirty minute to an hour long break a day.

He indicated she needed to be able to shift positions

at will. (Exhibit 13F, pages 1–5). This opinion was

based on claimant’s cardiac testing and shortness of

breath on exertion. Dr. Bocks’ also cited to her

“palpitations,” though she typically denied having

palpitations. (Exhibit 1F, page 13; Exhibit 13F, page

48; Exhibit 5F, page 5; Exhibit 7F, page 47; Exhibit

11F, page 28). This opinion was not consistent with

her physical examination findings. For instance,

there was no indication in the record that she had

any focal neurological deficits or reduced range of

motion that would explain why she had limited

ability to reach, fine manipulate, or gross

manipulate objects. There was no indication that she

had any balance issues or reduced strength. There is

no explanation why he believed she needed to be able

to shift positions at will while simultaneously

stating he thought she had no limitations involving

sitting. Overall, this opinion was not well supported

or explained and was not consistent with the

treatment records. Thus, this opinion was not

persuasive.

Tr. 31–32.10

White argues that the ALJ improperly found Dr. Bocks’ April 2020

unpersuasive based on a finding that this “opinion does not reflect [White’s]

functioning over the longitudinal period, as she was asymptomatic shortly

after this surgery.” Doc. 9, at 14; Tr. 32. In support of this argument, White

admits that the record showed improved symptoms after her surgery, however,

she argues that the ALJ should have discussed additional evidence, which

demonstrated some symptoms remained post-surgery. Doc. 9, at 14. The

existence of some supporting evidence that symptoms persisted does not

negate the point recognized by the ALJ–that Dr. Bocks’ April 2020 opinion is

inconsistent with (or “does not reflect”) the broader record of medical evidence.

Tr. 32; see also Jones, 336 F.3d at 477. Although ALJ’s analysis of Dr. Bocks’

April 2020 opinion does not use the magic words “supportability” or

“consistency,” exact wording is not a requirement, and it is apparent from the

ALJ’s decision as a whole that she considered these factors. See Cormany, 2022

WL 4115232, at *3 (“[A]n ALJ need not specifically use the terms

10 The transcript places page 16 of the ALJ’s decision before page 15. The

ALJ’s decision as cited falls on pages 31 and 32 of the transcript and no

substantive issue regarding page order was raised by either party.

‘supportability’ or ‘consistency’ in [her] analysis.”). For example, by using

language such as “does not reflect” it is clear that she viewed the April 2020

opinion as inconsistent with the broader record of treatment, which

contemplated much more than the immediate post-surgery period. Tr. 32.

Likewise, it is clear from the ALJ’s decision that she evaluated Dr. Bocks’

treatment records in particular to consider whether they supported the

limitations in his April 2020 opinion. Tr. 32 (citing some of Dr. Bocks’ post-

surgery medical records). And while the ALJ could have spent more time or

gone into greater detail describing her analysis of this opinion, she was not

required to do that––it is apparent that the limitations Dr. Bocks described

were specifically related to the short-term recovery from a surgical procedure.

Tr. 32; see also Thacker v. Comm’r of Soc. Sec., 99 Fed. App’x 661, 665 (6th Cir.

2004) (“An ALJ need not discuss every piece of evidence in the record for [her]

decision to stand.”).

White also argues that the ALJ improperly rejected Dr. Bocks’ April

2021 opinion as unpersuasive. This argument also lacks merit. The ALJ

thoroughly articulated both that Dr. Bocks’ April 2021 opinion lacked

relevance because it was offered using a pediatric cardiology form and that it

was otherwise unsupported and inconsistent. Tr. 31–32. White appears to

argue that the ALJ’s finding that the April 2021 opinion lacked relevance was

improper, but she does not provide support for this contention.

Additionally, White argues that the ALJ should have considered the

substance of Dr. Bocks’ April 2021 opinion “with the record as a whole.” But

the ALJ did this. Despite finding the pediatric cardiology form to be irrelevant

to the evaluation of an adult residual functional capacity, the ALJ proceeded

to identify specific pieces of evidence and patterns of symptoms throughout

White’s treatment records that showed why the April 2021 opinion was

unpersuasive. Tr. 32. For example, as to supportability, the ALJ identified that

Dr. Bocks’ own treatment records reflected that White sometimes had

shortness of breath, sometimes was doing well, and “often noted the claimant

to have no symptoms.” Tr. 32. And, as to consistency, the ALJ articulated that

the record showed “no indication that her symptoms were affecting her ability

to complete all of her daily activities . . . and that in December 2020 she had

returned to her normal activities.” Tr. 32 (citing Exhibit 5F, page 12). By

looking to both the treatment record as a whole and to Dr. Bocks’ records in

specific to weigh the persuasiveness of his April 2021 opinion, the ALJ

complied with the applicable regulations.

White next argues that the ALJ engaged in a “selective reading of the

record” to find that Dr. Bocks’ September 2021 physical RFC assessment was

unpersuasive. Doc. 9, at 16. This argument again lacks merit. An ALJ is not

required to explicitly cite all evidence that she considered, Thacker, 99 Fed.

App’x at 665, and the threshold for the substantial evidence standard is not

high, Biestek, 139 S. Ct. at 1154. The ALJ explicitly stated that she considered

the entire record in reaching her determination. Tr. 20. Absent evidence to the

contrary, the Court will presume that this statement is true. See NLRB v.

Newark Elec. Corp., 14 F.4th 152, 163 (2d Cir. 2021); see also United States v.

Chemical Found., Inc., 272 U.S. 1, 14–15 (1926) (“The presumption of

regularity supports the official acts of public officers, and, in the absence of

clear evidence to the contrary, courts presume that they have properly

discharged their official duties.”). White, however, has not provided anything

to contradict this statement.

Additionally, the ALJ’s decision appropriately articulates substantial

evidence to support her findings related to Dr. Bocks’ September 2021 opinion.

Tr. 31. For example, the ALJ identified that the limitations in Dr. Bocks’

September 2021 opinion were based on White’s cardiac testing, shortness of

breath on exertion, and palpitations. Tr. 31. However, the limitations opined

were “not consistent with her physical examination findings.” Tr. 31. She

reasoned that no symptoms like “neurological deficits or reduced range of

motion” appeared in the record as would be expected to support Dr. Bocks’

opined “limited ability to reach, fine manipulate, or gross manipulate objects.”

Tr. 31. Additionally, the ALJ identified internal contradictions between

limitations in Dr. Bocks’ September 2021 opinion which he did not explain or

support. Tr. 31. The ALJ’s decision shows that she considered both how the

September 2021 opinion was supported with Dr. Bocks’ own records and

explanation (supportability) and how it was inconsistent with other evidence

of record (consistency). In so doing, the ALJ complied with the regulations for

evaluating medical opinion evidence.

Finally, in support of her first argument, White asserts that the ALJ’s

evaluation of Dr. Gorodeski’s “opinion” was improper in light of governing

regulations. Doc. 9, at 16–17. In response, the Commissioner argues that the

ALJ did not need to explain the persuasiveness of Dr. Gorodeski’s note because

it did not amount to a “medical opinion” as defined by the regulations. Doc. 11,

at 10. I agree with the Commissioner’s evaluation. The evidence White calls

Dr. Gorodeski’s “opinion” was not a “medical opinion” as that term is defined

in the regulations.

The applicable regulations define “medical opinion” as follows:

A medical opinion is a statement from a medical

source about what you can still do despite your

impairment(s) and whether you have one or more

impairment-related limitations or restrictions in the

following abilities: (i) your ability to perform

physical demands of work activities . . . ; (ii) your

ability to perform mental demands of work activities

. . . ; (iii) your ability to perform other demands of

work . . . ; and (iv) your ability to adapt to

environmental conditions[.]”

20 C.F.R. § 404.1513(a)(2). By contrast, “[o]ther medical evidence is evidence

from a medical source that is not objective medical evidence or a medical

opinion, including judgments about the nature and severity of your

impairments, your medical history, clinical findings, diagnosis, treatment

prescribed with response, or prognosis.” 20 C.F.R. § 404.1513(a)(3).

The cited “opinion,” as White has interpreted it, is more appropriately

classified as “other medical evidence.” See Tr. 678. That Dr. Gorodeski

memorialized her assessment does not alone convert it to a medical opinion.

White points out that Dr. Gorodeski included certain NYHA heart failure

classifications to support that her note is a medical opinion. This also is

insufficient to create a medical opinion as the regulations define that term.

Beyond citation to a certain degree of heart failure, i.e., a diagnosis, Dr.

Gorodeski does not include any statement as to what White is capable of doing

despite her condition. Nor does Dr. Gorodeski opine whether any restrictions

or limitations exist that would address White’s ability to perform the physical,

mental, or other demands of work activities or adapt to other environmental

conditions. Accordingly, the ALJ did not need to assess the supportability or

consistency of Dr. Gorodeski’s treatment note, and it was properly explained

as part of the ALJ’s description of the record of medical evidence.11

11 White cites to Palmore v. Comm’r of Soc. Sec., No. 1:20-cv-36, 2021 WL

1169099, at *4 (S.D. Ohio Mar. 29, 2021) to support the following proposition:

“When a medical opinion is consistent with and supported by the medical

record, it should be given deference.” Doc. 9, at 13–14. The cited portion of

Palmore does not entirely support this broad proposition. Palmore, rather,

articulates that the ALJ must discuss how she evaluated the factors of

consistency and supportability. Palmore, 2021 WL 1169099 at *4. It also

generally explains that the more consistent or supported an opinion is, the

more persuasive it is. Id. Palmore does not articulate circumstances in which

As to her second argument, White argues that the ALJ improperly

interpreted raw medical data, or “played doctor,” to reach her RFC

determination because no medical provider opined that she was capable of the

full range of light work. Doc. 9, at 18–19. The Commissioner disagrees, arguing

that the ALJ “fulfill[ed] her legal duty to consider the record as a whole and

weigh the evidence in assessing Plaintiff’s RFC, which is an administrative

finding.” Doc. 11, at 11.

The ALJ is not bound to findings contained within a medical source

opinion when making her RFC determination. See e.g., Reeves v. Commissioner

of Soc. Sec., 618 F. App’x 267, 264 (6th Cir. 2015). And an ALJ is not required

to rely on medical opinion evidence to craft an RFC. Tucker v. Comm’r of Soc.

Sec., 775 F. App’x 22, 226 (6th Cir. 2019) (“No bright-line rule exists in our

circuit directing that medical opinions must be the building blocks of the

residual functional capacity finding.”); Brown v. Comm’r of Soc. Sec., 602 F.

App’x 328, 331 (6th Cir. 2015) (affirming that “neither the applicable

regulations nor Sixth Circuit law limit the ALJ to consideration of direct

medical opinions on the issue of RFC”); Rudd v. Comm’r of Soc. Sec., 531 F.

App’x 719, 728 (6th Cir. 2013) (rejecting the plaintiff’s argument that the ALJ

is required “to base her RFC finding on a physician’s opinion”). “A[n] RFC

the ALJ should defer entirely to a medical opinion. In any event, Palmore is

not controlling authority, and I find that the medical opinion evidence has been

examined appropriately under the applicable regulations.

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.

3:23-cv-0248, 2021 WL 606369, at *6 (N.D. Ohio Jan. 25, 2021) (quoting

Coldiron v. Comm’r of Soc. Sec., 391 F. App’x 435, 439 (6th Cir. 2010) (citing

42 U.S.C. § 423(d)(5)(B)); see also Nejat v. Comm’r of Soc. Sec., 359 F. App’x

574, 578 (6th Cir. 2009) (“Although physicians opine on a claimant’s residual

functional capacity to work, ultimate responsibly for capacity-to-work

determinations belongs to the Commissioner.”) (citing 20 C.F.R. §

404.1527(e)(1)).

It is unclear precisely what raw medical evidence White believes the

ALJ interpreted or how the ALJ here could be construed as “playing doctor.”

Doc. 9, at 18–19. What is clear, however, is that the ALJ evaluated the entire

record to reach an RFC determination which is supported by substantial

evidence. E.g., Tr. 20, 23.

The ALJ provided a reasonable explanation of the connection between

the record of medical evidence and her ultimate RFC determination. As

detailed earlier, the ALJ considered multiple opinions regarding White’s RFC,

including from medical providers (both the state agency consultants and

White’s treating cardiologist) and the testimony of a qualified VE. Tr. 30–32,

34. The ALJ found, as she was entitled to find, that all medical providers’

opinions were unpersuasive. Tr. 30–32. She explained, rather, that the entirety

of the record showed that White could perform the full range of light work. Tr.

20, 33–35. This determination fell somewhere between the state agency’s

opinion, which found White capable of the full range of medium work, and the

opinion of White’s cardiologist, Dr. Bocks, which found greater than light work

limitations. In reaching this middle ground, the ALJ appropriately articulated

her analysis. Succinctly put, she explained that the state agency’s RFC

determination was unpersuasive because it had too few functional limitations

based on the conditions detailed in the record, Tr. 30, 32, while the Dr. Bocks’

opinions were unpersuasive because they included greater restrictions than

the record supported. Tr. 31–32.

Additionally, the ALJ explained that her RFC determination was “based

on the testimony of the qualified vocational expert who provided testimony at

the hearing indicating the claimant could perform those past two relevant

jobs.” Tr. 34. A vocational expert’s response to a hypothetical may constitute

substantial evidence, so long as that hypothetical accurately represents the

claimant’s condition. Pasco v. Comm’r of Soc. Sec., 135 F. App’x 828, 845 (N.D.

Ohio Jun. 23, 2005) (citing Varley v. Sec’y of Health & Human Servs., 820 F.2d

777, 779 (6th Cir. 1987)). And the ALJ identified specific portions of the record

which further support her RFC determination. For example, the ALJ found

that White had a conservative course of treatment and managed her condition

well with medication. Such a finding is not novel and “suggests the absence of

a disabling condition.” See Branon v. Comm’r of Soc. Sec., 539 F. App’x 675,

678 (6th Cir. 2013); see also Metz v. Kijakazi, No. 1:20-cv-2202, 2022 WL

4465699, at *8 (N.D. Ohio Sept. 26, 2022). That the ALJ considered White’s

treatment “conservative” does not amount to playing doctor and has White

provided support for such argument.

So the ALJ adequately explained her analysis of the medical evidence

and demonstrated that substantial evidence supports her RFC determination.

White has not demonstrated any flaw in the ALJ’s analysis of the facts or

compliance with applicable regulations sufficient to justify remand. White’s

challenge thus fails.

For the reasons explained above, I affirm the Commissioner’s decision.

IT IS SO ORDERED.

Dated: March 14, 2024

/s/ James E. Grimes Jr.

James E. Grimes Jr.

U.S. Magistrate Judge