Wyers v. Social Security Administration Commissioner

IN THE UNITED STATES DISTRICT COURT

WESTERN DISTRICT OF ARKANSAS

FORT SMITH DIVISION

CASSANDRA L. WYERS PLAINTIFF

v. Civil No. 2:21-cv-02031-PKH-MEF

KILOLO KIJAKAZI, Acting Commissioner,1

Social Security Administration DEFENDANT

MAGISTRATE JUDGE’S REPORT AND RECOMMENDATION

Plaintiff, Cassandra L. Wyers, brings this action under 42 U.S.C. § 405(g), seeking judicial

review of a decision of the Commissioner of Social Security Administration (the “Commissioner”)

denying her claim for a period of disability and disability insurance benefits (“DIB”) under Title

II of the Social Security Act (hereinafter “the Act”), 42 U.S.C. § 423(d)(1)(A). In this judicial

review, the Court must determine whether there is substantial evidence in the administrative record

to support the Commissioner’s decision. See 42 U.S.C. § 405(g).

I. Procedural Background

Plaintiff filed her application for benefits on October 25, 2018, alleging disability

beginning August 17, 2018, due to neuropathy, diabetes, high blood pressure, and knee problems.

(ECF No. 12-2, p. 12; ECF No. 12-6, p. 3). Plaintiff was 36 years old on the alleged disability

date, has a limited education, and is unable to perform any past relevant work. (ECF No. 12-2, p.

27-28). The Commissioner denied her applications initially and on reconsideration. (Id., p. 12).

At the Plaintiff’s request, an Administrative Law Judge (“ALJ”) held an administrative hearing on

April 21, 2020, via telephone due to the extraordinary circumstance presented by the COVID-19

1 Kilolo Kijakazi became Acting Commissioner of the Social Security Administration on July 9, 2021. Pursuant

to Rule 25(d) of the Federal Rules of Civil Procedure, Kilolo Kijakazi should be substituted as the Defendant in this

suit. No further action needs to be taken to continue this suit by reason of the last sentence of section 205(g) of the

Social Security Act, 42 U.S.C. § 405(g).

pandemic. (ECF No. 12-2, pp. 12, 34-57). Plaintiff was present and represented by counsel. (Id.,

pp. 12, 35).

On June 30, 2020, the ALJ concluded that Plaintiff’s disorder of the right knee, disorder of

the back, morbid obesity, hypertension, and diabetes mellitus with neuropathy were severe, but

then concluded they did not meet or medically equal one of the listed impairments in Appendix 1,

Subpart P, Regulation No. 4. (ECF No. 12-2, pp. 14-19). He found Plaintiff capable of performing

less than the full range of sedentary work, with occasional climbing of ramps and stairs; never

climbing of ladders, ropes, or scaffolds; occasional balancing, stooping, kneeling, crouching, or

crawling; and avoiding even moderate exposure to hazards such as dangerous machinery,

unprotected heights, operating automobiles, or carrying firearms. (Id., pp. 18-27). With the

assistance of a vocational expert (“VE”), the ALJ concluded that Plaintiff could perform work as

a document preparer, printed circuit board inspector, and cutter and paster. (Id., pp. 28-29).

Plaintiff was found not to be under a disability from her alleged onset date through the date of the

ALJ’s decision. (Id., p. 29).

The Appeals Council denied Plaintiff’s request for review on November 25, 2020. (ECF

No. 12-2, pp. 2-4). Plaintiff then filed this action. (ECF No. 1). This matter is before the

undersigned for report and recommendation. Both parties have filed appeal briefs (ECF Nos. 15,

16), and the case is ready for decision.

II. Applicable Law

This Court’s role is to determine whether substantial evidence supports the

Commissioner’s findings. Vossen v. Astrue, 612 F.3d 1011, 1015 (8th Cir. 2010). Substantial

evidence is less than a preponderance, but it is enough that a reasonable mind would find it

adequate to support the Commissioner’s decision. Biestek v. Berryhill, 139 S.Ct. 1148, 1154

(2019). We must affirm the ALJ’s decision if the record contains substantial evidence to support

it. Blackburn v. Colvin, 761 F.3d 853, 858 (8th Cir. 2014). If there is substantial evidence in the

record that supports the Commissioner’s decision, the Court may not reverse it simply because

substantial evidence exists in the record that would have supported a contrary outcome, or because

the Court would have decided the case differently. Miller v. Colvin, 784 F.3d 472, 477 (8th Cir.

2015). In other words, if after reviewing the record it is possible to draw two inconsistent positions

from the evidence and one of those positions represents the findings of the ALJ, we must affirm

the ALJ’s decision. Id.

A claimant for Social Security disability benefits has the burden of proving her disability

by establishing a physical or mental disability that has lasted at least one year and that prevents

her from engaging in any substantial gainful activity. Pearsall v. Massanari, 274 F.3d 1211, 1217

(8th Cir. 2001); see also 42 U.S.C. § 423(d)(1)(A). The Act defines “physical or mental

impairment” as “an impairment that results from anatomical, physiological, or psychological

abnormalities which are demonstrable by medically acceptable clinical and laboratory diagnostic

techniques.” 42 U.S.C. § 423(d)(3). A plaintiff must show that her disability, not simply her

impairment, has lasted for at least twelve consecutive months.

The Commissioner’s regulations require her to apply a five-step sequential evaluation

process to each claim for disability benefits: (1) whether the claimant has engaged in substantial

gainful activity since filing her claim; (2) whether the claimant has a severe physical and/or mental

impairment or combination of impairments; (3) whether the impairment(s) meet or equal an

impairment in the listings; (4) whether the impairment(s) prevent the claimant from doing past

relevant work; and, (5) whether the claimant is able to perform other work in the national economy

given her age, education, and experience. See 20 C.F.R. § 404.1520(a)(4). The fact finder only

considers a plaintiff’s age, education, and work experience in the light of her residual functional

capacity if the final stage of the analysis is reached. 20 C.F.R. § 404.1520(a)(4)(v).

III. Discussion

Plaintiff raises five issues on appeal: (1) whether the ALJ erred in failing to adjudicate a

closed period from the alleged onset date, August 17, 2018, through recovery from the right total

knee arthroplasty on October 15, 2019; (2) whether the ALJ fully and fairly developed the record;

(3) whether the ALJ erred at Step Two; (4) whether the ALJ properly evaluated Plaintiff’s

subjective complaints and applied the Polaski factors; and (5), whether the ALJ erred in his RFC

determination. After thoroughly reviewing the record, the undersigned finds that the ALJ failed

to develop the record fully and fairly, and therefore, it does not provide substantial evidence to

support the Commissioner’s decision to deny benefits in this case. Because this failure necessitates

reversal and remand, it is not necessary for the undersigned to address Plaintiff’s remaining

arguments.

A. Closed Period Evaluation

In her first issue, Plaintiff contends that the ALJ failed to adjudicate a closed period from

the alleged onset date, August 17, 2018, through recovery from the right total knee arthroplasty on

October 15, 2019. (ECF No. 15, pp. 8-10). Plaintiff anticipated that the ALJ would either disagree

with the alleged onset date or choose a closed period to evaluate, applying the medical

improvement standard. (Id. at 8). As the ALJ did neither of those things, Plaintiff insists legal

error was committed. (Id.). While Plaintiff uses the term “medical improvement,” this case is not

an “action relating to medical improvement” within the meaning of the Social Security Disability

Benefits Reform Act, 42 U.S.C.A. § 423. See Camp v. Heckler, 780 F.2d 721 (8th Cir. 1986).

Medical improvement is assessed from the last favorable decision to determine whether

improvement has occurred since the Commissioner last found Plaintiff disabled. That is not the

case here. Plaintiff did not allege a closed period of disability in her statements to the Agency.

Plaintiff appears to allege that it is the ALJ’s duty to consider the closed period potential of a case;

however, she provides no support for this argument.

The Commissioner may award Social Security disability benefits for a closed period if a

once disabling condition later ceases to be disabling. Harris v. Sec’y of Dept. of Health & Human

Servs., 959 F.2d 723, 724 (8th Cir. 1992) (“[A] claimant who is not entitled to continuing benefits

may well be eligible to receive benefits for a specific period of time.”). A disabling condition

qualifies for a closed period of disability if it lasts for at least twelve months. 42 U.S.C. §

423(d)(1)(A); Karlix v. Barnhart, 457 F.3d 742, 747 (8th Cir. 2006). A claimant may be eligible

for disability benefits for a closed period if the evidence presented shows the claimant was unable

to work for at least twelve months but recovered the ability to work before the decision on her

claim is made. Sarah B v. Saul, 2020 WL 3172466, Case No. 4:19 CV 1761 (E.D. Mo. June 15,

2020).

Here, the ALJ denied Plaintiff’s claim based on his determination that Plaintiff has the RFC

to perform work, not because the duration of Plaintiff’s alleged disability did not meet the 12-

month requirement. As the ALJ found Plaintiff not to be disabled at any time during the relevant

period, he was not required to consider a closed period of disability or present a rationale for not

awarding a closed period of disability. Accordingly, we find that the ALJ did not err by failing to

consider a closed period of disability in this case.

B. Development of the Record

Plaintiff contends that the ALJ failed to develop the record fully and fairly because he did

not order mental and physical consultative examinations. (ECF No. 15, pp. 10-14). “Well-settled

precedent confirms that the ALJ bears a responsibility to develop the record fairly and fully,

independent of the claimant’s burden to press his case.” Vossen, 612 F.3d at 1016 (quoting Snead

v. Barnhart, 360 F.3d 834, 838 (8th Cir. 2004)). “Failing to develop the record is reversible error

when it does not contain enough evidence to determine the impact of a claimant’s impairment on

[her] ability to work.” Combs v. Berryhill, 878 F.3d 642, 647 (8th Cir. 2017) (citing Byes v. Astrue,

687 F.3d 913, 915-16 (8th Cir. 2012)).

Residual functional capacity (“RFC”) is the most a person can do despite that person’s

limitations. 20 C.F.R. § 404.1545. “The ALJ determines a claimant’s RFC based on all relevant

evidence in the record, including medical records, observations of treating physicians and others,

and the claimant’s own descriptions of her limitations.” Jones v. Astrue, 619 F.3d 963, 971 (8th

Cir. 2010); Davidson v. Astrue, 578 F.3d 838, 844 (8th Cir. 2009). Limitations resulting from

symptoms such as pain are also factored into the assessment. 20 C.F.R. § 404.1545(a)(3). The

United States Court of Appeals for the Eighth Circuit has held that a “claimant’s residual functional

capacity is a medical question.” Miller v. Colvin, 784 F.3d 472, 479 (8th Cir. 2015) (citing Lauer

v. Apfel, 245 F.3d 700, 704 (8th Cir. 2001)). Therefore, an ALJ’s determination concerning a

claimant’s RFC must be supported by medical evidence that addresses the claimant’s ability to

function in the workplace. Perks v. Astrue, 687 F.3d 1086, 1092 (8th Cir. 2012).

The ALJ “bears the primary responsibility for assessing a claimant’s RFC based on all

relevant evidence.” Roberts v. Apfel, 222 F.3d 466, 469 (8th Cir. 2000). The ALJ should obtain

evidence that addresses the claimant’s “ability to function in the workplace.” Dykes v. Apfel, 223

F.3d 865, 867 (8th Cir. 2000); Nevland v. Apfel, 204 F.3d 853, 858 (8th Cir. 2000). The opinion

of a non-examining physician, standing alone, does not constitute substantial evidence in the

record in the face of a conflicting assessment of a treating physician. Jenkins v. Apfel, 196 F.3d

922, 925 (8th Cir. 1999). An ALJ may conduct an independent review of the medical evidence

and other evidence, such as motivation to return to work and daily activities, along with the non-

examining physician’s opinion. Krogmeier v. Barnhart, 294 F.3d 1019, 1024 (8th Cir. 2002). An

ALJ must not, however, substitute his opinions for those of a physician. Finch v. Astrue, 547 F.3d

933, 938 (8th Cir. 2008). In other words, an ALJ is not permitted to “play doctor.” Pates-Fires v.

Astrue, 564 F.3d 935, 946-47 (8th Cir. 2009).

While an “ALJ may consider all evidence of record, including medical records and

opinions dated prior to the alleged onset date, when there is no evidence of deterioration or

progression of symptoms,” it is improper for an ALJ to rely on an opinion rendered, which given

its timing, could not consider the subsequent medical records indicating a worsening of [a

claimant’s] symptoms and functionality. LaFrance v. Astrue, No. 09-403, 2010 WL 624202, at

*14 (D. Minn. Feb. 22, 2010) (citing Vandenboom v. Barnhart, 421 F.3d 745, 750 (8th Cir. 2005));

see also Wildman v. Astrue, 596 F.3d 959, 967 (8th Cir. 2010) (opinions of non-examining sources

are generally entitled to less weight than examining sources, especially when those opinions do

not consider all the pertinent evidence in the record). An ALJ errs in relying on his own inferences

as to the relevance of notations in the medical record when determining a claimant’s ability to

function in the workplace. See Combs v. Berryhill, 878 F.3d 642, 647 (8th Cir. 2017) (remanding

for further inquiry as to the relevance of “no acute distress” and “normal movement of all

extremities” with respect to the plaintiff’s ability to function in the workplace).

The evidence in this case indicates the ALJ determined Plaintiff’s RFC without a medical

opinion to support his assessment of the latter part of the treatment record showing a worsening

condition. In setting out Plaintiff’s RFC, the ALJ relied on the March 2019 and May 2019

assessments provided by non-examining state agency medical consultants, Jim Takach, M.D. and

Kristin Jarrard, M.D., respectively. (ECF No. 12-2, pp. 25-26; ECF No. 12-3, pp. 10-12, 24-26).

Dr. Takach initially reviewed medical evidence from June 2018 to February 2019 and assessed

that Plaintiff would be capable of sedentary work with occasional postural and hazard restrictions

by August 16, 2019, twelve months following the alleged onset date. (ECF No. 12-2, p. 25; ECF

No. 12-3, pp. 7-12). Several months later, Dr. Jarrard reviewed the initial medical evidence as

well as additional evidence showing orthopedic treatment for distal femoral medial osteochondral

defect with brace recommended. (ECF No. 12-2, p. 25; ECF No. 12-3, pp. 24-26). Dr. Jarrard

affirmed Dr. Takach’s assessment. (Id. at 26). The ALJ found the state agency consultants’

physical RFC assessments to be persuasive, noting that they were consistent with and supported

by objective findings in the medical evidence of record. (ECF No. 12-2, p. 25). While the agency

consultants reviewed medical evidence from June 2018 to May 2019, part of the medical record

occurs outside of the state agency consultants’ scope of review, including records indicating a

worsening condition.

Plaintiff’s treating physician, orthopedic surgical specialist Timothy J. Garlow, M.D., who

performed Plaintiff’s right total knee arthroplasty (ECF No. 12-10, p. 29), provided an opinion

regarding Plaintiff’s ability to function in the workplace in January 2020. (ECF No. 12-8, p. 119).

Dr. Garlow opined that Plaintiff could stand or walk for a total of 2 hours but sit for a total of 8

hours in a workday. She could sit continuously for one hour and required at least three work or

bathroom breaks. She did not need to elevate her lower extremities but must lie in a supine position

for at least 1 hour due to back pain. Dr. Garlow opined that Plaintiff could climb, squat, kneel,

crouch, bend, or stoop for less than two hours but could balance for two hours. She was also to

limit exposure to extreme temperatures; wetness or humidity; noise or vibration; fumes, odors,

dusts, gases, and poor ventilation; and hazards. (Id.).

The ALJ found Dr. Garlow’s opinion unpersuasive.2 (ECF No. 12-2, pp. 26-27). The

record does not contain additional physical consultative examinations or medical source

statements, despite Plaintiff’s specific request that the ALJ order consultative examinations as

there had been no development of examining source opinion evidence. (ECF No. 12-6, p. 100).

Without the opinion of Plaintiff’s treating orthopedic surgeon, the ALJ could rely only on his own

inferences about the more recent medical evidence showing Plaintiff’s worsening condition

because the non-examining state agency physicians did not have the opportunity to review those

records.

In June 2019, Plaintiff followed up with Patrick Walton, PA-C, for right knee pain caused

by a medial femoral condyle osteochondral lesion with arthritis in other areas. (ECF No. 12-10,

p. 5). Plaintiff reported continued pain despite wearing her unloader brace for approximately one

week and taking 600 mgs of ibuprofen twice a day. Walton noted that Plaintiff’s options were

limited as far as the NSAIDs she could take due to gastrointestinal issues. He also stated that

Plaintiff’s insurance made her ineligible for viscosupplementation3 and steroids increased her

blood sugars to about 350. Walton concluded that he was really limited in the conservative

management options he could offer Plaintiff and scheduled her for a discussion with the surgeon

regarding possible high tibial osteotomy, knee replacement, or other modalities. (Id.).

Imaging results of Plaintiff’s right knee revealed weightbearing surface irregularity off the

medial condyle and contra lateral side, subchondral sclerosis, relative narrowing of medial joint

space, early peaking of tibial spines, a large spur in the patellofemoral joint, and spurring

2 This report and recommendation does not review the ALJ’s decision to discredit the opinion of the treating physician.

3 Viscosupplementation is a treatment involving injection of hyaluronic acid into an arthritic joint, most commonly

the knee, to reduce pain and swelling. See Viscosupplementation Treatment for Arthritis, at

https://www.hopkinsmedicine.org/health/conditions-and-diseases/arthritis/viscosupplementation-treatment-for-

arthritis (last accessed July 7, 2022).

underneath the inferior and superior poles of the patella. (ECF No. 12-10, p. 7, 43). Dr. Garlow’s

examination of Plaintiff’s knee showed full motion overall without instability but definite

irritability. (ECF No. 12-10, p. 7). He assessed that Plaintiff, despite her young age, exhibited

underlying degeneration of her right knee, which had caused difficulty and evaded conservative

measures. Dr. Garlow noted that injections, anti-inflammatories, anticonvulsants, nerve pain

medications, and braces had failed. He hesitated to proceed with a large surgery or even an

arthroplasty given Plaintiff’s young age for these underlying grade four changes. (Id.).

Two months later, in August 2019, Plaintiff returned for treatment of severe right knee pain

(ECF No. 12-10, p. 10) and distress due to pain in her lower back (ECF No. 12-9, p. 62). Dr.

Garlow noted that Plaintiff had grade four lesions on her patella and condyle. He reiterated that

Plaintiff’s right knee pain evaded performance of a microfracture, administration of injections,

prescriptions for several pain medications, fitting for braces, and application of CBD oil. While

Dr. Garlow observed that Plaintiff’s tibial alignment was relatively neutral, he considered the

possibility of an arthroplasty, weighing Plaintiff’s years of moderate to severe pain against the fact

that she would be very young for such a procedure. Following a lengthy discussion about the risks,

benefits, and alternatives, Dr. Garlow and Plaintiff ultimately decided to go forward with a right

total knee arthroplasty. (Id.).

While waiting for surgery, Plaintiff continued to seek treatment from Christopher K.

Mocek, M.D., for lower back pain. (ECF No. 12-9, p. 57, 53). Dr. Mocek assessed Plaintiff with

radiculopathy of the lumbar region. While Plaintiff demonstrated a normal gait, Dr. Mocek

prescribed pain medications for moderate to severe lower back pain. (Id.). He reviewed Plaintiff’s

MRI and x-rays revealing bone spurs, arthritis in the spine, degenerative changes, and bulging

discs. (ECF No. 12-9, p. 55). Considering Plaintiff’s body habitus, Dr. Mocek assessed that

Plaintiff was not eligible for procedures that required sedation. He suggested a medial branch

nerve block as well as narcotic pain medications for Plaintiff’s low back. (Id.).

Dr. Garlow performed the surgery without complications on October 15, 2019, and

Plaintiff was discharged following an unremarkable hospital stay on October 17, 2019. (ECF No.

12-10, p. 14-17). Plaintiff reported improvement during follow-ups in November, and Dr. Garlow

noted appropriate imaging results and examinations thus far. (Id. at 26-28, 47).

In December 2019, Dr. Mocek continued to treat Plaintiff’s low back pain, noting

Plaintiff’s distress and paresthesia of the skin. (ECF No. 12-9, pp. 28, 33). The following month,

Dr. Mocek assessed Plaintiff with radiculopathy of the lumbar region, pain in the right leg and low

back, as well as intervertebral disc degeneration of the lumbar region. (Id. at 14).

Dr. Garlow continued to follow-up on the results of Plaintiff’s total right knee arthroscopy

in January 2020. (ECF No. 12-10, p. 29). He reviewed x-rays that showed well positioned knee

components with appropriate sizing and no complications. (ECF No. 12-10, p. 49). However,

Plaintiff reported swelling in the legs with half-dollar sized painful areas. (ECF No. 12-10, p. 29).

Dr. Garlow ruled out deep vein thrombosis and prescribed methylprednisolone4 with other topical

nonsteroidal anti-inflammatory drugs. Dr. Garlow also initiated physical therapy aftercare for joint

replacement surgery. (Id.). Plaintiff completed the six-week course in February 2020. (ECF No.

12-9, pp. 79-118).

While attending physical therapy three times weekly, Plaintiff also continued treatment for

low back pain with Dr. Mocek. (ECF No. 12-9, pp. 14, 19). Plaintiff demonstrated a slow gait on

examination, and Dr. Mocek refilled her pain medication prescriptions. (Id. at 19). However, in

February 2020, Plaintiff reported that the medication was no longer effective. (Id. at 9). Dr.

4 Methylprednisolone is used to treat inflammation. See Methylprednisolone, at

https://medlineplus.gov/druginfo/meds/a682795.html (last accessed July 7, 2022).

Garlow noted that Plaintiff was five days short on her pill count and appeared distressed due to the

pain. While she demonstrated a normal gait, Plaintiff’s medications were adjusted, and she was

instructed to return in four weeks for re-evaluation. (Id. at 12).

In March 2020, Plaintiff reported right leg pain, continued low back pain, and cutaneous

lupus. (ECF No. 12-9, pp. 4, 38). Dr. Mocek again noted Plaintiff’s distress due to pain, and a

physical examination revealed a positive straight leg raise test on the right. Plaintiff was scheduled

for a lumbar epidural steroid injection. (Id. at 4).

While the ALJ considered the consultative examinations predicting Plaintiff’s RFC

through August 16, 2019, there are no medical opinions, apart from Dr. Garlow’s, assessing

Plaintiff’s RFC following the deterioration of her condition resulting in major surgery in October

2019. Medical evidence demonstrates continued treatment from June 2019 to March 2020,

including an operative report for a total right knee arthroplasty. (ECF No. 12-9, pp. 4, 14, 19, 28,

33, 38, 53, 57; ECF No. 12-10, pp. 5, 7, 10, 29, 43). The medical evidence recounted here was not

reviewed by the non-examining state agency physicians in support of their assessments of

Plaintiff’s ability to function in the workplace, and the ALJ disregarded Dr. Garlow’s assessment

of the same. Notably, Dr. Garlow’s opinion was based on his interpretation of these more recent

medical records, including his own treatment notes and operative report for Plaintiff’s right knee

surgery. Because the ALJ disregarded Dr. Garlow’s assessment and no other medical opinions

assessed Plaintiff’s capacity to work during the period outside of the state agency physicians’

scope of review, including a total right knee arthroplasty and other worsening conditions, the ALJ

could only rely on his own inferences as to Plaintiff’s limitations in a work setting.

To support his RFC finding, the ALJ pointed to treatment notes following surgery in which

providers noted improved knee pain, well-positioned knee components, normal gait, and a negative

deep vein thrombosis scan. (ECF No. 12-2, pp. 22-27). However, because the RFC is a medical

question, the ALJ was not permitted to rely on his own interpretation of these treatment notes to

arrive at Plaintiff’s RFC. Our review of the record reveals that the record is incomplete as it does

not contain enough evidence to determine the impact of Plaintiff’s impairments on her ability to

work, especially when the ALJ disregarded Plaintiff’s orthopedic surgeon’s opinion and declined

to order any consultative examinations despite treatment records showing a worsening condition

during the period outside of the consulting physicians’ scope of review.

Accordingly, we cannot say the ALJ’s decision is supported by substantial evidence, and

the case must be reversed and remanded. On remand, the ALJ should be directed to obtain RFC

assessments from the Plaintiff’s treating physicians, allowing the treating physicians the

opportunity to provide an explanation for the limitations assigned should the ALJ have questions.

If those physicians are unwilling or otherwise unable to complete the RFC assessments, then the

ALJ should be directed to order a consultative examination, complete with a detailed RFC

assessment of the Plaintiff’s limitations. The ALJ should then reassess the Plaintiff’s RFC,

considering all her impairments, and conduct a thorough step four and, if necessary, step five

analysis.

IV. Conclusion

Based on the foregoing analysis, it is recommended this case be reversed and remanded to

the Commissioner for further consideration pursuant to sentence four of 42 U.S.C. § 405(g).

The parties have fourteen (14) days from receipt of our report and recommendation

in which to file written objections pursuant to 28 U.S.C. § 636(b)(1). The failure to file timely

objections may result in waiver of the right to appeal questions of fact. We remind the parties

that objections must be both timely and specific to trigger de novo review by the district

court.

DATED this 8th day of July 2022.

/s/Mark E. Ford

HONORABLE MARK E. FORD

UNITED STATES MAGISTRATE JUDGE