# Cox v. O'Malley

> District Court, S.D. West Virginia · August 22, 2024

URL: https://www.frixlaw.com/law-library/cases/10765834

## Case

- **Court:** District Court, S.D. West Virginia
- **Decided:** August 22, 2024
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

IN THE UNITED STATES DISTRICT COURT
FOR THE SOUTHERN DISTRICT OF WEST VIRGINIA

CHARLESTON DIVISION

PAULA C.,

Plaintiff,

v. CIVIL ACTION NO. 2:23-cv-00659

MARTIN J. O’MALLEY
Commissioner of Social Security,1
0F

Defendant.

PROPOSED FINDINGS & RECOMMENDATION

Plaintiff Paula C. (“Claimant”) seeks review of the final decision of the
Commissioner of Social Security (the “Commissioner”) denying her application for
Disability Insurance Benefits (“DIB”) under Title II of the Social Security Act, 42 U.S.C.
§§ 401–33. This matter was referred by standing order to the undersigned United States
Magistrate Judge to consider the pleadings and evidence and to submit proposed findings
of fact and recommendations for disposition pursuant to 28 U.S.C. § 636(b)(1)(B). (ECF
No. 2). Presently pending before this Court are Claimant’s Brief in Support of Complaint
(ECF No. 5), and the Commissioner’s Brief in Support of Defendant’s Decision (ECF No.
8). Having fully considered the record and the arguments of the parties, the undersigned

1 Commissioner O’Malley was substituted in place of Acting Commissioner Kilolo Kijakazi following
O’Malley’s appointment on December 20, 2023, and is automatically substituted as a party pursuant to
Federal Rule of Civil Procedure 25(d). See 42 U.S.C. § 405(g) (stating that action survives regardless of any
change in the person occupying the office of Commissioner of Social Security).
respectfully RECOMMENDS that the presiding District Judge DENY Claimant’s
request to reverse the Commissioner’s decision, GRANT the Commissioner’s request to
affirm his decision, AFFIRM the final decision of the Commissioner, and DISMISS this
action from the Court’s active docket.
I. BACKGROUND
A. Information about Claimant and Procedural History of Claim

Claimant was 57 years old at the time of her alleged disability onset date and 60
years old on the date of the decision by the Administrative Law Judge (“ALJ”). (Tr. 223).2
1F
Claimant has a high school education, and her work history includes a position as an
insurance clerk. (Tr. 24-25, 243). In her application for benefits, Claimant alleges that she
became disabled on October 16, 2019, due to bipolar disorder, insomnia, depression,
anxiety, fatty liver, pre-diabetes, osteoarthritis, sciatica, edema, acid reflux, and Epstein
Barr virus. (Tr. 223, 242).
Claimant filed her application for benefits on February 15, 2021. (Tr. 11, 223-26).
The claim was denied initially on September 13, 2021, and again upon reconsideration on
February 17, 2022. (Tr. 100, 111). On March 23, 2022, Claimant submitted a written
request for an administrative hearing, which was held before an ALJ on October 20, 2022.
(Tr. 81-99). Claimant was represented by counsel at the hearing, where she and a
vocational expert each testified. (Tr. 81-99). On January 26, 2023, the ALJ entered an
unfavorable decision. (Tr. 8-25). Claimant then sought review of the ALJ’s decision by the
Appeals Council on March 8, 2023. (Tr. 213-15). The Appeals Council denied Claimant’s

2 All references to “Tr.” refer to the Transcript of Proceedings filed in this action at ECF No. 4.
request for review on August 10, 2023, and the ALJ’s decision became the final decision
of the Commissioner on that date. (Tr. 1-6).
Claimant timely brought the present action on October 6, 2023, seeking judicial
review of the ALJ’s decision pursuant to 42 U.S.C. § 405(g). (ECF No. 1). The
Commissioner filed a transcript of the administrative proceedings on November 29, 2023.
(ECF No. 4). Claimant filed her Brief in Support of Complaint (ECF No. 5) on December

22, 2023, and in response the Commissioner filed his Brief in Support of Defendant’s
Decision (ECF No. 8) on February 21, 2024. Finally, Claimant filed a Reply Brief (ECF No.
9) on March 6, 2024. Each of the parties’ filings were timely; now, having been briefed in
full, this matter is ripe for adjudication.
B. Relevant Evidence
The undersigned has considered all evidence of record, including the medical
evidence, pertaining to Claimant’s arguments and summarizes the relevant portions3 here
2F
for the convenience of the United States District Judge.
1. Testimony
As part of her disability application, Claimant completed an Adult Function Report
describing her subjective symptoms. (Tr. 280-87). Therein, she stated her physical
impairments prevented her from bending, kneeling, or “being on her feet all day,” and
that her mental impairments made it difficult for her to concentrate. (Tr. 280).
Additionally, Claimant reported that she is able to engage in activities such as cooking,
shopping, and driving, as well as doing chores such as light housework, laundry, and
ironing; further, Claimant stated she was able to perform her own personal care with no

3 Claimant does not dispute the accuracy of the ALJ’s recitation of the relevant medical evidence. (ECF No.
5 at 1).
difficulty, and could manage her own finances. (Tr. 281-84). Additionally, Claimant stated
that her hobbies included sewing and playing games on her phone, and she reported being
able to follow instructions and being fine with change. See id. She reported problems with
lifting, stair climbing, squatting, bending, kneeling, memory, completing tasks, and
concentration. Id.
During the administrative hearing, the claimant testified she worked as a medical

biller. She stated her depression had worsened since her application, as she could not
concentrate, she had trouble with speech and memory, and she sometimes would forget
to take her medication. (See Tr. 81-94). Further, Claimant testified she does not sleep
well and that she takes a one-to-two-hour nap four times a week but does not feel rested.
See id. She estimated that she can sit or stand for a duration of 20 to 30 minutes, can walk
a distance of approximately 600 feet, and can carry weight up to 20 pounds. Id. Claimant
testified that generally she spends her day doing light housework and laundry. Id. Finally,
Claimant testified that she cannot handwrite long because of problems with her hands.
She has problems with her left knee especially when she goes upstairs. She has problems
bending and cannot get on her knees.
Following Claimant’s testimony, Vocational Expert (“VE”) Enjouli McGoogan
testified at the administrative hearing. (Tr. 94-99). The VE categorized Claimant’s prior
insurance-clerk position as sedentary, skilled work. (Tr. 96). The ALJ then posed a

hypothetical scenario to the VE including the following limitations:
[The] individual would be capable of performing work at the sedentary
exertional level, as defined under the Regulations, with the following
limitations. The individual could occasionally climb ramps and stairs, and
never climb ladders, ropes, or scaffolds. Could occasionally balance, stoop,
kneel, crouch, and crawl. The individual would be capable of tolerating
occasional exposure to extreme cold, heat, vibration, atmospheric
conditions . . . and any workplace hazards such as moving machinery or
unprotected heights.

(Tr. 97). The VE responded that the hypothetical individual in this scenario would be
capable of performing Claimant’s past work. (Tr. 97). The ALJ then asked the VE whether
an addition to the hypothetical requiring only simple, routine tasks would affect the ability
to do Claimant’s past work, and the VE replied that such an individual would not be able
to perform Claimant’s past work. (Tr. 97). The ALJ also asked the VE what percentage of
off-task time would be tolerated by employers, and the VE replied that anything greater
than 10% would preclude full-time employment. (Tr. 98).
2. Medical Records
Claimant’s relevant medical records begin in August 2019, when an MRI of the
thoracic spine at Roane General Hospital showed a large disc protrusion or extrusion at
T9-T10 with moderate narrowing of the central canal and moderate mass effect on the
cord. (Tr. 598-926). The following month on September 17, 2019, the claimant was seen
again at Roane General Hospital for chronic left lumbar radiculopathy and edema of both
lower extremities (Tr. 598-926). Subsequently on September 30, 2019, Claimant called
her primary-care provider to report depression, feeling anxious, and panic attacks she
attributed to her job. (Tr. 491-566). She stated she put in her two weeks’ notice and now
wants a work note to cover those two weeks. Id.
On October 14, 2019, the claimant was seen at Roane General Hospital for an
earache and headache. (Tr. 598-926). Her depression screening was negative and she
presented as cooperative, alert, oriented, and in no acute distress. Id. On October 16,
2019, the claimant underwent a nuclear medicine thyroid uptake examination, and

hypothyroidism was noted on testing Id.
On November 20, 2019, the claimant presented to at Roane General Hospital
complaining of osteoarthritis in her back and knees and stated she has been seen by pain
management and orthopedics. Id. She requested a hydrotherapy referral and stated that
injections had helped her back previously. Id. Treatment notes state that Claimant was
cooperative and comfortable with no edema and grossly normal mental status exam

findings. Id. Diagnoses included left lumbar radiculopathy, generalized osteoarthritis,
and polyosteoarthritis. Id. Later that week on November 26, 2019, the claimant was
treated for a sore throat and viral upper respiratory infection. Id. On December 12, 2019,
the claimant returned with complaints of a cough with blood tinged sputum. Id. Her
depression screening remained negative, and examination findings remained normal. Id.
On February 12, 2020, the claimant was seen again at Roane General Hospital for
dizziness, ear pain, and congestion. Id. She was noted to be in no acute distress and was
diagnosed with dysfunction of both eustachian tubes. Id.
On March 4, 2020, Claimant was seen by West Virginia Medicine where she
reported doing better now that she is no longer working. (Tr. 491-566). Further, Claimant
reported she was cleaning the house and sewing and that she made two quilts. Id.

Treatment notes show that her mood was good, and she was oriented and cooperative
with good eye contact and fair insight and judgment. Id.
On June 9, 2020, claimant was seen at Clendenin Family Medicine Primary care
for back and feet pain. (Tr. 428-490). She stated her sciatic nerve was not bothering her
any further, but that it hurt to be on her feet. Id. Exam findings note she was in no acute
distress, and she had normal mood, memory, strength, and tone. Id. Her insight was
noted to be good, and diagnoses included prediabetes and gastro-intestinal-reflux
disorder (“GERD”). Id. Claimant returned on June 23, 2020, with complaints of a rash
and tick bite. Id. She stated she was bitten while working outside. Id. Exam findings
note she was ambulating normally and in no acute distress, and there was a bullseye tick
mark on her back. Id. She had normal mental status exam findings including normal
mood, affect, and memory. Id. On August 5, 2020, the claimant returned to Clendenin
reporting the new onset of right-knee and shin pain. Id. On examination, she exhibited

tenderness over the right knee and was diagnosed with patella femoral stress syndrome.
Id. Subsequently on August 10, 2020, the claimant was diagnosed with herpes zoster. Id.
On September 9, 2020, claimant presented to West Virginia Medicine, where her
mood was noted to be stable, or “euthymic.” (Tr. 491-566). Her diagnosis was major
depressive disorder. Id.
On September 10, 2020, the claimant was seen at Roane General Hospital for right
ankle pain and right leg pain. (Tr. 598-926). She had patella pain that was worse with
ambulation; however, she was able to ambulate normally. Id. Exam findings note knee
tenderness and severe obesity. Id. Diagnoses include pain in the right knee, pain in the
right ankle, prediabetes, and peripheral edema. Id. Imaging taken that day showed
minimal degenerative changes in the right knee, as well as plantar and posterior calcaneal

spurs in the feet; however, there was no acute bony abnormality and no evidence of deep
vein thrombosis in the right lower extremity despite the presence of edema. Id.
On October 29, 2020, the claimant requested to be tested for mold. (Tr. 428-490).
She reported having headaches twice a week and stated he feels bad all the time. Id. She
reported sleeping a lot and having no energy. Id. Examination notes indicated morbid
obesity and tenderness at the medial side of the tibial plateau. Id. Diagnoses included
dysuria, chronic rhinitis, chronic fatigue syndrome, and peripheral edema. Id.
On December 9, 2020, the claimant was seen by her chiropractor at McCarter
Wellness for a monthly check-up on her complaints of fatigue, malaise, weight gain,
toxicity, irritable bowel syndrome, non-alcoholic steatohepatitis, and fatty-liver disease.
(Tr. 951). Treatment notes state that the claimant “wants to go back to work.” (Tr. 951-
61). The treatment plan called for additional diagnostic testing, as well as orders for a

healthful diet and home exercise. (Tr. 952).
On January 12, 2021, Claimant presented to Charleston Area Medical Center
Gastroenterology with complaints of abdominal fullness and discomfort with mild pain
under her rib, as well as constipation and large stools. (Tr. 1345). She had normal physical
and mental exam findings and a negative depression screening. Id. Diagnoses include
colon polyps, family history of colon cancer, irritable bowel syndrome, and abdominal
pain likely related to constipation. (Tr. 1346).
On February 25, 2021, the claimant was seen for left foot and ankle pain, with
recent onset. (Tr. 428-90). She was ambulating normally and had normal tone, strength,
and mental status exam findings. Id. There was tenderness at the medial tibial plateau
with no joint effusion. Id.

On April 5, 2021, the claimant was seen at Mountain State Rheumatology for an
evaluation of rheumatoid arthritis. (Tr. 1018-38). She reported morning stiffness and
pain in the right knee and lumbar spine joints; however, she is independent in her
activities of daily living. Id. Imaging showed osteoarthritic changes in her knee and
lumbar region. Id. Exam findings note she was in no acute distress with normal range of
motion and gait and tenderness in the right knee. Id. Diagnoses included doubtful
rheumatoid arthritis involving multiple sites with positive rheumatoid factor,
osteoarthritis in the lumbar spine, and chronic pain of the right knee. Id.
On March 10, 2021, claimant presented to West Virginia Medicine, where
treatment records note she reported sleeping more than she would like and being unable
to sit for a long duration. (Tr. 491-566). She stated her mood was okay and she thinks the
medications are working. Id. Mental status exam findings were normal. Id.
On May 6, 2021, the claimant returned to her chiropractor at McCarter Wellness,

where she reported intermittent bilateral lower lumbar pain and exhibited guarding,
spasm, and tenderness in the hip and pelvis (Tr. 951-61). She had full range of motion. Id.
On June 2, 2021, the claimant was seen for osteoarthritis in the lumbar spine
without radiation. (Tr. 598-926). She exhibited pain with range of motion in the neck and
lumbar and had negative straight leg raise testing. Id. Diagnoses included a Vitamin D
deficiency, spondylosis without myelopathy, and rotator cuff tendinitis. Id. On August 3,
2021, MRI imaging showed L3-L4 bilateral facet arthropathy and shallow broad based
disc displacement, L4-L5 non-compressive disc protrusion, and L5-S1 left paracentral
preforaminal disc protrusion. Id. On June 17, 2021, the claimant was seen at Mountain
State Rheumatology where she reported right knee pain and back pain. (Tr. 1018-38). She
continued to report being independent in her activities of daily living and had normal gait

and range of motion. Id.
On July 1, 2021, the claimant presented to her primary-care physician at Clendenin
Family Medicine with complaints of back pain and diarrhea. (Tr. 962-94). Treatment
records indicate morbid obesity and note that Claimant was ambulating normally, with
normal tone and strength. Id. Mental status exam findings remained normal and
diagnoses include GERD, prediabetes, allergies, postmenopausal state, chronic back pain,
and hypothyroidism. Id.
On July 27, 2021, Claimant was seen at Charleston Area Medical Center
Gastroenterology for a six-month follow-up appointment regarding her irritable bowel
syndrome and fatty liver. (Tr. 1157-61). She reported no concerns and explained that the
diarrhea stopped when she stopped taking Metformin. (Tr. 1162).
On August 3, 2021, an MRI of the lumbar spine showed L3-L4 bilateral facet

arthropathy and shallow broad based disc displacement, L4-L5 noncompressive disc
protrusion, and L5-S1 left paracentral preforaminal disc protrusion. (Tr. 260, 261).
On August 11, 2021, the claimant underwent an MRI and consultative examination
(Tr. 927-30; 931-36). MRI imaging showed mild degenerative disc changes at L3-L4, L4-
L5, and L5-S1, with trace grade 1 anterolisthesis at L3-L4. (Tr. 927-30). The consultative
examiner’s report notes the claimant’s chief complaints were low back pain, osteoarthritis
everywhere, and prediabetes. Id. Exam findings note her posture was straight and her gait
was normal. Id. Further exam findings indicated that the claimant was morbidly obese
with no atrophy, and that she had normal sensation and reflexes, normal gait, and normal
gait, grip strength, and fine manipulation. (Tr. 931-36). She also had normal range of
motion with the exception of lumbar flexion, and was noted to be able to get on and off

the table independently. Id.
On August 16, 2021, the claimant was seen at West Virginia Neurology for low back
pain that radiated into her buttocks bilaterally. (Tr. 937-50). Records note her symptoms
were consistent with claudication; however, her vascular study was normal. Id. Her gait
and station were antalgic, but her range of motion, strength, and sensation were normal.
Id. Further, her cranial nerves were grossly intact. Id. Diagnoses included low back pain
and degeneration of the lumbar intervertebral disc. Id.
On August 30, 2021, the claimant was seen at Mountain State Rheumatology;
treatment notes state that claimant reported taking Tylenol for her pain. (Tr. 102). She
was in no acute distress with normal mood and affect, intact judgement and insight,
normal range of motion, and tenderness in her right hand. (Tr. 103-04). Imaging from
the same date reflected mild degenerative changes with some mild joint space narrowing

and subchondral sclerosis. (Tr. 105).
On October 6. 2021, the claimant was seen at West Virginia Medicine for a
medication check. (Tr. 995-1001). She reported dizzy spells and having an appointment
to see her primary care provider in December 2021. Id. Her mood was euthymic and she
had good eye contact and fair insight and judgment. Id. Subsequently on October 26,
2021, the claimant was seen at Mountain State Rheumatology; she reported taking
Tylenol and Aleve, but her pain was not adequately controlled. (Tr. 1760). Further,
Claimant reported mild morning stiffness; however, she also reported that she remained
independent in her activities of daily living. Id. Exam findings noted bilateral wrist and
finger tenderness, intact sensation, right knee tenderness, and pain on axial compression
bilaterally; however, gait remained normal. (Tr. 1762). Diagnoses included inflammatory

arthritis, osteoarthritis in both hands, and osteoarthritis in the lumbar spine. (Tr. 1762-
63). The claimant was given an injection in her right knee. (Tr. 1764).
On December 7, 2021, Claimant was seen at Charleston Area Medical Center
Gastroenterology for a six-month follow up on her fatty-liver diagnosis. (Tr. 1142-1143).
She reported a chief complaint of black stools and indigestion. (Tr. 1142). The treatment
plan was to prescribe an antibiotic and order lab work; Claimant was directed to call in
with any increase in symptoms. Id. On December 20, 2021, the claimant followed up at
Mountain State Rheumatology; treatment notes show claimant had normal mood, range
of motion, and sensation. (Tr. 1018-38). Her gait remained normal despite pain on axial
compression. (Tr. 1727). On December 22, 2021, the claimant was seen in follow up for
reflux, GERD, fatigue, and morbid obesity (Tr. 962-94). Exam findings continue to show
normal strength and tone, no contractures, malalignment, or tenderness, and normal
movement of all extremities. Id. Diagnoses included persistent insomnia, GERD, and

prediabetes. Id.
On January 19, 2022, the claimant was seen for low back pain and covid-19 testing.
(Tr. 1390-1415). The following week on January 28, 2022, the claimant reported her
covid-19 symptoms improved except for a lingering cough. Id.
On March 23, 2022, the claimant was seen at Mountain State Rheumatology; she
reported her medication helps with osteoarthritis and that her disease was reasonably
controlled. (Tr. 1715). She continued to remain independent in her activities of daily
living. Id. Mood, range of motion, sensation, and gait were all noted to be normal (Tr.
1717-18).
Subsequently on March 29, 2022, the claimant was diagnosed with a pancreatic
cyst seen on imaging; ultimately, however, the biopsy results were negative. (Tr. 1807,

1812, 1814).
On April 13, 2022, the claimant was seen at West Virginia Medicine; she reported
struggles with sleep and racing thoughts. (Tr. 491-566). She stated she has no energy, but
her mood is not depressed. Id. Treatment notes state that Claimant’s mood was apathetic,
but that her exam findings were otherwise normal. Id.
On April 21, 2022, the claimant was seen at Foot & Ankle Center; there, she was
diagnosed with capsulitis of the toe and neuroma of the foot. (Tr. 1360-64). Claimant had
pain at the second metatarsal head and interspace pain at the second digit, and was given
an injection to help relieve her symptoms. Id.
On June 7, 2022, treatment notes show Claimant’s reported symptoms were worse,
but she remained independent in her activities of daily living. (Tr. 1367-87). She reported
increased pain and swelling in the second, third, and fourth digits. Id. On examination,

Claimant showed tenderness and swelling in the right hand and bilateral hips; however,
strength was noted to be 5/5, with a normal gait. Id. Diagnoses included inflammatory
arthritis, osteoarthritis in both hands, spondylosis in the lumbar spine, calcaneal spurs in
the bilateral feet, right leg pain, trochanteric bursitis in both hips, primary osteoarthritis
in both knees, and sprain of the right hand. Id.
Finally, on September 7, 2022, the claimant reported low back pain to her primary-
care provider at Clendenin Health Center. (Tr. 1390-1415). Additionally, Claimant
reported that her right-leg pain had resolved, and she was taking muscle relaxers and
steroids. Id. On examination, she was noted to be ambulating normally and had normal
strength, tone, and movement of all extremities. Id.
3. Prior Administrative Findings

In September 2021, Isidro Amigo, M.D., a State-agency medical consultant, found
from a review of the medial records that Claimant had a number of severe physical
impairments, including chronic-fatigue syndrome. (Tr. 105). Dr. Amigo found that
Claimant would be able to occasionally lift up to twenty pounds and frequently lift up to
ten pounds; could stand and/or walk for six hours in an eight-hour workday; could sit for
six hours in an eight-hour workday; could never climb ladders/ropes/scaffolds, and could
occasionally engage in all other postural activities; should avoid concentrated exposure to
most hazards; and had no manipulative limitations. (Tr. 107-08). On reconsideration,
State agency physician Lisa Venkataraman, M.D., affirmed Dr. Amigo’s findings as
written. (Tr. 117-18).
Regarding Claimant’s mental-health impairments, State-agency psychological
consultant Karl G. Hursey, Ph.D., found that Claimant had no limitations in all four
“paragraph B” criteria; Dr. Hursey concluded that—because Claimant reported that her
medications were working well, that her mood and anxiety were well-controlled, and that

she expected to go back to work in the next year—the medical record “does not indicate
severe functional limitations” related to Claimant’s mental impairments. (Tr. 105-06). On
reconsideration, State-agency psychological consultant James Capage, Ph.D., noted that
Claimant reported an increase in her symptoms of depression since Dr. Hursey’s initial-
level evaluation. However, Dr. Capage found this new information was “not significant
enough to change the initial determination,” and thus adopted Dr. Hursey’s findings as
written. (Tr. 115).
C. Sequential Evaluation Process
An individual unable “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” is considered to be disabled and thus eligible for benefits. 42 U.S.C. §
423(d)(1)(A). The Social Security Administration has established a five-step sequential

evaluation process to aid in this determination. 20 C.F.R. §§ 404.1520(a)(4),
416.920(a)(4); Lewis v. Berryhill, 858 F.3d 858, 861 (4th Cir. 2017). The ALJ proceeds
through each step until making a finding of either “disabled” or “not disabled”—in other
words, if no finding is made at a certain step, the ALJ’s analysis advances on to the next
step. 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). “The ultimate burden to prove disability
lies on the claimant.” Preston v. Heckler, 769 F.2d 988, 990 n.* (4th Cir. 1985); see Bird
v. Comm’r, 699 F.3d 337, 340 (4th Cir. 2012) (“To establish eligibility for . . . benefits, a
claimant must show that he became disabled before his [date last insured].”).
At the first step in the sequential evaluation process, the ALJ determines whether
the claimant is engaged in “substantial gainful activity.” 20 C.F.R. §§ 404.1520(a)(4)(i),
416.920(a)(4)(i). If the claimant is not engaged in substantial gainful activity, the ALJ

moves on to the second step. At the second step, the ALJ considers the combined severity
of the claimant’s medically determinable physical and mental impairments. Id.
§§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). The ALJ gleans this information from the
available medical evidence. See Mastro v. Apfel, 270 F.3d 171, 177 (4th Cir. 2001). An
individual impairment or combination of impairments that is not classified as “severe”
and does not satisfy the durational requirements will result in a finding of “not disabled.”
20 C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii); Mascio v. Colvin, 780 F.3d 632, 634–
35 (4th Cir. 2015). Similarly, at the third step, the ALJ determines whether the claimant’s
impairment or combination of impairments meets or is medically equal to the criteria of
an impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. See 20 C.F.R.
§§ 404.1520(a)(4)(iii), 416.920(a)(4)(iii). “A claimant is entitled to a conclusive
presumption that he is impaired if he can show that his condition ‘meets or equals the
listed impairments.’” Radford v. Colvin, 734 F.3d 288, 291 (4th Cir. 2013) (quoting

Bowen v. City of New York, 476 U.S. 467, 471 (1986)).
“If the first three steps do not lead to a conclusive determination, the ALJ then
assesses the claimant’s residual functional capacity” (“RFC”) before proceeding to the
fourth step. Mascio, 780 F.3d at 635; see 20 C.F.R. §§ 404.1520(e), 416.920(e). The
claimant’s RFC reflects “her ability to perform work despite her limitations.” Patterson v.
Comm’r, 846 F.3d 656, 659 (4th Cir. 2017); Monroe v. Colvin, 826 F.3d 176, 179 (4th Cir.
2016) (defining claimant’s RFC as “the most the claimant can still do despite physical and
mental limitations that affect his ability to work” (alterations and internal quotation
marks omitted)); see 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). The ALJ “first
identif[ies] the individual’s functional limitations or restrictions and assess[es] his or her
work-related abilities on a function-by-function basis,” then “define[s] the claimant’s RFC

in terms of the exertional levels of work.” Lewis, 858 F.3d at 862. “In determining a
claimant’s RFC, the ALJ must consider all of the claimant’s medically determinable
impairments . . . including those not labeled severe” as well as “all the claimant’s
symptoms, including pain, and the extent to which his symptoms can reasonably be
accepted as consistent with the objective medical evidence and other evidence.” Monroe,
826 F.3d at 179 (alterations and internal quotation marks omitted); see 20 C.F.R.
§§ 404.1545(a), 416.945(a).
When the claimant alleges a mental impairment, the first three steps of the
sequential evaluation process and the RFC assessment are conducted using a “special
technique” to “evaluate the severity of [the] mental impairment[].” 20 C.F.R.
§§ 404.1520a(a), 416.920a(a); see Patterson, 846 F.3d at 659. Considering the claimant’s
“pertinent symptoms, signs, and laboratory findings,” the ALJ determines whether the
claimant has “a medically determinable mental impairment(s)” and “rate[s] the degree of

functional limitation resulting from the impairment(s)” according to certain criteria. 20
C.F.R. §§ 404.1520a(b), 416.920a(b); see id. §§ 404.1520a(c), 416.920a(c). “Next, the ALJ
must determine if the mental impairment is severe, and if so, whether it qualifies as a
listed impairment.” Patterson, 846 F.3d at 659; see 20 C.F.R. §§ 404.1520a(d),
416.920a(d). “If the mental impairment is severe but is not a listed impairment, the ALJ
must assess the claimant’s RFC in light of how the impairment constrains the claimant’s
work abilities.” Patterson, 846 F.3d at 659. After assessing the claimant’s RFC, the ALJ
at the fourth step determines whether the claimant has the RFC to perform the
requirements of her past relevant work. 20 C.F.R. §§ 404.1520(a)(4)(iv),
416.920(a)(4)(iv); Monroe, 826 F.3d at 180. If she does not, then “the ALJ proceeds to
step five.” Lewis, 858 F.3d at 862.

The fifth and final step requires the ALJ to consider the claimant’s RFC, age,
education, and work experience in order to determine whether she can make an
adjustment to other work. 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). At this point,
“the burden shifts to the Commissioner to prove, by a preponderance of the evidence, that
the claimant can perform other work that ‘exists in significant numbers in the national
economy.’” Lewis, 858 F.3d at 862 (quoting Mascio, 780 F.3d at 635). “The
Commissioner typically offers this evidence through the testimony of a vocational expert
responding to a hypothetical that incorporates the claimant’s limitations.” Id. (quoting
Mascio, 780 F.3d at 635). If the claimant can perform other work, the ALJ will find her
“not disabled.” 20 C.F.R. §§ 404.1520(a)(4)(v), 416.920(a)(4)(v). If she cannot perform
other work, the ALJ will find her “disabled.” Id.
Applying the sequential evaluation process in this case, the ALJ concluded that
Claimant satisfied the insured status requirements and was insured through September

30, 2024—the date last insured—and thus qualified to apply for DIB benefits. (Tr. 13).
Turning to the first step of the sequential evaluation process, the ALJ determined that
Claimant had not engaged in substantial gainful activity since the alleged onset of her
disability. Id. Next, at step two, the ALJ determined that the following of Claimant’s
conditions constituted “severe” impairments: osteoarthritis; bursitis; degenerative-disc
disease of the lumbar spine; radiculopathy; spondylosis; chronic-liver disease; obesity;
capsulitis of the toe; neuroma of the foot; and calcaneal spurs. Id. However, the ALJ found
at step three that those impairments, or a combination thereof, failed to meet or medically
equal any of the impairments listed in 20 C.F.R. Part 404, Subpart P, Appendix 1. (Tr. 15).
Next, upon assessing Claimant’s RFC, the ALJ determined that Claimant is able “to
perform sedentary work,” subject to the following limitations:

[C]laimant can occasionally climb ramps and stairs but never climb ladders,
ropes, and scaffolds. She can occasionally balance, stoop, kneel, crouch, and
crawl. She is capable of tolerating occasional exposure to extreme cold, heat,
vibration, atmospheric conditions . . . and any workplace hazards such as
moving machinery or unprotected heights.

(Tr. 18).
Finally, at the last step of the sequential evaluation process, the ALJ enlisted a
Vocational Expert (“VE”) to aid in her findings. (Tr. 24). The ALJ found that Claimant “is
able to perform . . . [and] can return to . . . her past relevant work” as an insurance clerk—
a sedentary, skilled position—because it “does not require the performance of work-
related activities precluded by the claimant’s residual functional capacity.” (Tr. 24-25).
Based upon this finding, the ALJ determined that Claimant “has not been under a
disability” during the relevant time period. (Tr. 25).
II. LEGAL STANDARD
This Court has a narrow role in reviewing the Commissioner’s final decision to
deny benefits: it “must uphold the factual findings of the [ALJ] if they are supported by
substantial evidence and were reached through application of the correct legal standard.”
Hancock v. Astrue, 667 F.3d 470, 472 (4th Cir. 2012) (quoting Johnson v. Barnhart, 434
F.3d 650, 653 (4th Cir. 2005) (per curiam)). “Substantial evidence” is “such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion,” and it
must be “more than a mere scintilla.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154 (2019). In
other words, this Court “looks to [the] administrative record and asks whether it contains
‘sufficient evidence’ to support the agency’s factual determinations.” Id. (alteration
omitted). “[T]he threshold for such evidentiary sufficiency is not high.” Id. “In reviewing
for substantial evidence, [this Court] do[es] not undertake to reweigh conflicting
evidence, make credibility determinations, or substitute [its] judgment for that of the

[ALJ].” Johnson, 434 F.3d at 653 (quoting Craig v. Chater, 76 F.3d 585, 589 (4th Cir.
1996)). Even if “reasonable minds [could] differ as to whether a claimant is disabled,” this
Court upholds the ALJ’s decision if it is supported by substantial evidence. Id. (quoting
Craig, 76 F.3d at 589).
III. ANALYSIS
In support of this § 405(g) action, Claimant makes three assertions of error. First,
Claimant argues that the ALJ’s written determination regarding Claimant’s Residual
Functional Capacity (“RFC”) is deficient as a matter of law because “the ALJ failed to
accommodate [Claimant’s] proven mild mental limitations or explain why they were
omitted from the ALJ’s RFC assessment.” (ECF No. 5 at 2). As to Claimant’s second and
third assertions of error, she argues that remand is required because the ALJ’s RFC
determination failed to properly consider the impact caused by Claimant’s fatigue and
bilateral-hand arthritis, respectively. Id.

In response, the Commissioner argues that the ALJ did not err and that her
decision is supported by substantial evidence. He points out that the ALJ’s decision in
this case is thorough and well-supported, particularly considering the volume of medical
evidence in the record—which spans more than 1,000 pages in total. (See ECF Nos. 4; 4-
1). The Commissioner further argues that the Claimant’s arguments lack merit because
they each ignore the ALJ’s extensive discussion of each of these conditions and the basis
for her determination that Claimant’s fatigue and bilateral-hand arthritis did not impact
Claimant’s RFC. (See ECF No. 8).
In her reply brief, the Claimant reiterates her first argument that the ALJ
specifically found the Claimant had “mild” limitations in all four broad areas of mental
functioning, but failed to explain why she did not incorporate these mild limitations into

Claimant’s RFC. (ECF No. 9 at 1-3). Second, Claimant argues that the ALJ relied
improperly upon her own lay judgment and ignored medical opinions and other evidence
that Claimant’s fatigue would significantly impact her ability to perform her past skilled
work. Id. at 3-4. Lastly, Claimant reiterates that the ALJ made no actual finding regarding
the severity or non-severity of Claimant’s bilateral-hand impairment, leaving it unclear
whether she considered any work-related limitations. (ECF No. 9 at 4).
Having reviewed the parties’ submissions as well as the transcript of
administrative proceedings (the “record”), herein the undersigned takes up each of
Claimant’s three assertions of error in turn.
A. Impact of Claimant’s Mild Mental-Health Limitations on Her RFC
In support of her first assertion of error, Claimant points to the ALJ’s finding that
the medically-determinable impairment of depression caused mild limitations in all four
domains of mental functioning (i.e., understanding, remembering, or applying

information; interacting with others; concentrating, persisting, or maintaining pace; and
adapting or managing oneself). (ECF No. 5 at 4 (citing Tr. 14-15)). Claimant highlights
that the ALJ’s finding is more favorable to her than the opinions of the state-agency
physicians, who found Claimant had no mental-function limitations. (ECF No. 5 at 4
(citing Tr. 14-15, 105, 115)). Claimant does not challenge the ALJ’s determination that her
mental-function limitations were mild; as she explains in her brief, her assertion of error
“has nothing to do with how the ALJ weighed the medical evidence or what medical
opinions and other facts were considered.” (ECF No. 5 at 4 n.2). Instead, according to
Claimant, “the issue is solely whether it was legal error for the ALJ to omit Claimant’s
proven mental functional limitations from the RFC finding without explanation.” Id.
Specifically, Claimant argues that “the ALJ here included precisely zero mental functional

limitations in her RFC finding and dispositive hypothetical question to the VE (Tr. 18,
97),” despite the ALJ’s prior finding of credible mild limitations at steps two and three of
the sequential evaluation process. (ECF No. 5 at 5-6).
Claimant concedes that, “[w]ith respect to the ability to perform unskilled work,
any omission of mild mental functional limitations may likely constitute harmless error.”
Id. at 6-11. However, Claimant distinguishes the circumstances sub judice based upon the
ALJ’s determination that the Claimant can perform prior skilled work. Id. at 11 (citing Tr.
18-23). Based upon these factors, Claimant concludes that the ALJ’s written decision is
“facially defective” because the ALJ fails therein to explain why the mild mental
limitations were omitted from the discussion of her RFC determination, and fails to
otherwise identify how Claimant’s mild mental-function limitations impact her ability to
perform her skilled prior work. Id. According to Claimant, this “facial deficiency” violates
Agency policy and warrants remand. Id. at 11-13 (citing SSR 96-8p, 1996 WL 374184, *4).

In response, the Commissioner argues that the ALJ did not err because she
thoroughly explained why Claimant’s mild mental impairments did not require any work-
related limitations. (ECF No. 8 at 8). Unlike the cases Claimant cites, the ALJ here
discussed Claimant’s mental impairments many times throughout her decision—not only
at step two of the sequential evaluation process, but also during her RFC assessment. See
id. According to the Commissioner, the ALJ’s extensive discussion demonstrates her
adequate consideration of Claimant’s mild mental impairments and her reasoning for not
adding limitations related to those impairments in her RFC. Id.
In support, the Commissioner highlights the ALJ’s explanation that, although
Claimant sometimes reported feelings of anxiety and depression and trouble
concentrating, Claimant’s mental-status examinations consistently showed normal

memory, cooperative attitude, good eye contact, normal attention, normal thought
content, and “fair if not better” insight and judgment. Id. (citing Tr. 14-15, 462, 495, 819,
967, 974, 998-99, 1120-21). Furthermore, the ALJ points to Claimant’s own statements
that she engaged in a number of daily-living activities requiring relatively-unimpaired
mental functioning and concentration, such as playing games on her phone, sewing,
preparing meals, shopping, doing chores, handling her own finances, managing personal
care, and spending time with others. Id. (citing Tr. 14-15, 281-84). The Commissioner
further points out that the ALJ expressly stated in her written decision that her RFC
assessment “reflects the degree of limitation . . . found in the ‘paragraph B’ mental
function analysis.” (Tr. 19). More significant, the Commissioner explained that—unlike
the caselaw relied upon by Claimant’s brief—the ALJ did not merely confine her analysis
of Claimant’s mental-function limitations to step two of the sequential-evaluation
process. (ECF No. 8 at 9-10).

On review, the undersigned FINDS that—contrary to Claimant’s assertions—the
ALJ expressly explained the logical and evidentiary basis for her finding that Claimant’s
mild mental-function limitations did not impact her ability to perform her skilled prior
work, and that the ALJ included this explanation in the portion of the written decision
where she discusses her RFC analysis. The ALJ specifically included a detailed
explanation demonstrating the evidentiary basis and rationale she employed in her
evaluation of “the intensity, persistence, and limiting effects of the claimant’s symptoms
to determine the extent to which they limit the claimant’s work-related activities.” Id. The
ALJ expressly acknowledged Claimant’s own reports of memory and concentration
problems, and explained the basis for her determination that those limitations did not
“limit the [Claimant’s] ability to do work-related activities.” (Tr. 18). She expressly

evaluated the Claimant’s allegations and testimony—including Claimant’s allegations of
disability based upon “bipolar disorder, insomnia, depression, [and] anxiety,” and
pointed to specific evidence she weighed against these statements to support her finding
that “the claimant’s statements concerning the intensity, persistence and limiting effects
of these symptoms are not entirely consistent with the medical evidence and other
evidence in the record.” (Tr. 18-19). For instance, the ALJ noted that the Claimant
reported memory and concentration problems, but she explained that the medical records
demonstrate that, overall, Claimant had consistently normal mental-status-exam
findings. (Tr. 19-23 (citing 462, 495, 819, 967, 974, 998-99, 1120-21)).
Following her discussion of this medical evidence the ALJ summarized that the
“[m]ental health treatment records note the claimant reports her medication is effective
and that she denies symptoms of depression or anxiety when compliant . . . [and]
[f]urther, the claimant had multiple depression screenings when seen by her providers

and her mental status exam findings are normal.” (Tr. 23). The ALJ concluded that,
“[o]verall, the evidence of record does not support the alleged loss of functioning[,] [but
rather] shows that the claimant’s allegations of disabling impairments, which are found
in the claimant’s disability reports and hearing testimony, are inconsistent with objective
findings and subjective findings on examinations as well as her activities of daily living.”
(Tr. 23).
Next, the ALJ’s RFC assessment discussed the opinions of the psychological
consultants and explained why she found those opinions to be persuasive. (Tr. 23-24). As
the ALJ explained, “[t]he consultants opined the claimant has only non-severe mental
impairments and no functional limitations.” (Tr. 24). She found that the opinions were

“consistent with the evidence of record that notes normal mental status exam findings
including normal memory, attention, and behavior, a generally euthymic mood, and fair
insight and judgment.” Id. The ALJ also found it significant that Claimant “has
consistently reported she is independent in her activities of daily living.” Likewise, the
ALJ specifically discussed mental-health-treatment records from West Virginia
University Medicine where Claimant reported that her depression and anxiety improved
after she quit her job; in fact, Claimant reported that her mood was good and her
medications were working. (Tr. 22-23, 495, 497-98). Based upon this evidence, the ALJ
concluded that the record evidence “does not support [Claimant’s] alleged loss of
functioning,” because the “[m]ental health treatment records note [Claimant] reports her
medication is effective and that she denies symptoms of depression or anxiety when
compliant” with her prescribed course of medication. (Tr. 23) (emphasis added).
The undersigned agrees with the Commissioner’s characterization that the instant

action “is not a case where the ALJ failed to discuss Claimant’s mental impairments
beyond step two,” because the ALJ’s analysis “very clearly allows for meaningful review
of the ALJ’s determination that Claimant did not have any mental RFC restrictions.” (ECF
No. 8 at 10). The RFC analysis set forth in the ALJ’s written decision thoroughly explained
why she did not include a limitation for Claimant's mild mental-function impairments.
Consequently, the ALJ’s RFC analysis is distinguishable from the caselaw cited by
Claimant, all of which involved an ALJ’s omission of a claimant’s mental impairments
from the RFC discussion entirely. See Shank v. Saul, 3:20-cv-00444, 2021 WL 2767063,
at *8 (S.D. W. Va. June 11, 2021), adopted, 2021 WL 2744550, at *1 (July 1, 2021); Jones
v. Kijakazi, 5:21-cv-00634, ECF No. 18 at 19 (S.D. W. Va. Sept. 22, 2022) (“[T]he ALJ did
not discuss, or even mention, [c]laimant’s mental limitations at any subsequent steps of

the sequential evaluation.”), adopted, ECF No. 19 (Nov. 28, 2022).
In her reply brief, the Claimant reiterates her assertion of error on the grounds that
“the ALJ did not accept the state agency finding that [Claimant] had ‘no’ mental limitation
in the four broad areas of mental functioning (Tr. 24, 105, 115) . . . and instead specifically
found . . . ‘mild’ limitations in all four broad areas.” (ECF No. 9 at 2 (citing Tr. 14-15)).
Claimant asserts that “[t]his inconsistency and lack of explanation alone preclude any
meaningful judicial review, requiring remand.” Id. at 3. Claimant is correct in that the
ALJ stated that “[t]he evidence of record supports finding the claimant has no more than
mild limitations in any area of mental function and no severe mental impairments.” (Tr.
24). Claimant’s position, however, relies upon an overly-literal construction of the ALJ’s
statement and ignores the central theme of the RFC analysis, that—while finding no more
than mild mental-health limitations—the ALJ did not include any work-related mental-
function limitations in the RFC because the medical and state-agency opinion evidence

demonstrated that Claimant’s symptoms are resolved when she is compliant with her
regimen of medication. Simply put, a fair reading of the written decision demonstrates
that the ALJ provided an accurate and logical bridge between the evidence and her
conclusions—quite distinct from the line of improper decisions which frustrated judicial
review by leaving the reader “to guess about how the ALJ arrived at [her] conclusions.”
Mascio, 780 F.3d at 637.
Based upon the foregoing, the undersigned FINDS that the ALJ’s decision is
supported by substantial evidence, and Claimant has failed to demonstrate error on this
basis. Accordingly, the undersigned respectfully recommends that Claimant’s request for
remand be DENIED.

B. Impact of Claimant’s Condition of Fatigue on Her RFC
In her second assertion of error, Claimant argues the ALJ “committed legal error
in considering [Claimant’s] fatigue.” (ECF No. 5 at 13-14). Specifically, Claimant argues
that the ALJ—in finding that Claimant’s chronic-fatigue syndrome is non-severe—
improperly substituted her own lay judgment over the opinions of state-agency physicians
Isidro Amigo, M.D., and Lisa Venkataraman, M.D., who found that Claimant has severe
chronic-fatigue syndrome. (ECF No. 5 at 13-14). Claimant also argues that the ALJ
“completely ignored [the] fatigue symptoms” after determining that Claimant’s chronic-
fatigue syndrome was non-severe. (ECF Nos. 5 at 13-14; 9 at 3; Tr. 105, 116). Claimant
argues that the ALJ’s failure to consider her fatigue is not harmless in light of the ALJ’s
finding that Claimant was able to return to her past skilled work. See id.
In response, the Commissioner argues that the ALJ appropriately evaluated the
persuasiveness of the state-agency physicians’ opinions under the express provisions of

20 C.F.R. § 404.1520c. (ECF No. 8 at 12-13) (citing 20 C.F.R. § 404.1520c(a). The ALJ
determined that the physicians’ opinions as to the severity of Claimant’s chronic-fatigue
syndrome were inconsistent with the record evidence as a whole, and she explained the
evidentiary basis for this determination. (ECF No. 8 at 13-14) (citing Tr. 24, 105, 116)).
The Commissioner concludes that, because the ALJ’s written decision properly discusses
her evaluation of “the most important [persuasiveness] factors” of supportability and
consistency, the decision complies with the requirements of § 104.1520c(a) and is
therefore free of error. See id.
In reply, Claimant does not address the Commissioner’s arguments; instead, she
merely restates her argument that the ALJ improperly substituted her lay opinion to find
that Claimant’s chronic-fatigue syndrome was not severe, and then “completely ignored”

Claimant’s fatigue symptoms. (ECF No. 9 at 3-4).
Simply put, Claimant’s argument lacks merit and fails to demonstrate error. First,
it is plain that the ALJ’s severity determination did not trespass into the territory of a
medical opinion. It is undisputed that Claimant’s chronic-fatigue syndrome was a
medically-determinable impairment; in fact, the ALJ specifically found that the
impairments at issue “could reasonably be expected to cause the alleged symptoms[.]”
(Tr. 19). Rather than replacing the physicians’ diagnosis with her own lay opinion, the
ALJ appropriately considered the persuasiveness of the physicians’ opinions regarding
the severity of Claimant’s impairment in light of the evidence from other medical sources,
the objective medical evidence, and nonmedical sources in the claim. (See Tr. 19-20). In
accordance with § 404.1520c(c)(1)-(2), the ALJ assessed the factors of supportability and
consistency and explained the logical and evidentiary basis for her conclusion. (See Tr.
19-24). In particular, the ALJ explained that the opinions of Dr. Amigo and Dr. Venkataraman

were inconsistent with the record evidence as a whole. See id. For instance, the ALJ noted that, in
contrast to the physicians’ opinions and Claimant’s subjective complaints regarding the severity of
her symptoms, a diagnosis of chronic-fatigue syndrome appears only once in a sea of
medical records spanning more than a thousand pages. (Tr. 20, 438). The ALJ noted that
this finding is equivocal, because the same record states that additional testing may be
required to identify other potential etiologies for Claimant’s symptoms—including a
medication or obstructive sleep apnea. Id. Furthermore, the ALJ points extensively to
treatment records consistently indicating that Claimant’s mental-status and physical
examinations were normal and that Claimant reported being fully independent in her
activities of daily living—including activities requiring sustained concentration like
sewing, gaming, and cooking. (Tr. 20-24). Based upon this evidence, the ALJ

appropriately determined that “the claimant’s statements concerning the intensity,
persistence and limiting effects of these symptoms are not entirely consistent with the
medical evidence and other evidence in the record.” (Tr. 19).
Furthermore, Claimant’s assertion that the ALJ ignored Claimant’s other
symptoms of fatigue “once she concluded that [Claimant’s] chronic-fatigue syndrome did
not rise to the level of a severe impairment,” (see ECF No. 5 at 14), is inaccurate. It is
undisputed that Claimant reported other fatigue-related symptoms, as recognized by the
ALJ. (Tr. 23-24). The ALJ’s extensive discussion of the medical records as well as her RFC
discussion expressly acknowledge Claimant’s reported struggles with sleep, racing
thoughts, and lack of energy. (Tr. 20, 23). The ALJ explains that these reported symptoms
are simply incongruous with the record as a whole; nonetheless, the ALJ accounted for
Claimant’s non-severe fatigue-related impairments in part by adding limitations
consistent with a restriction to sedentary work into the RFC. (Tr. 23-24, 1416-1425). The

ALJ’s extensive discussion of the medical records demonstrates a traceable tether of logic
between the evidence and the ALJ’s conclusions, and the ALJ reasonably found, based on
Claimant’s generally normal exam findings and independent activities of daily living,
that the record did not support Claimant’s allegations. This is supported by substantial
evidence.
Tellingly, Claimant’s assertion of error is unsupported by any Fourth-Circuit
authority, or other persuasive caselaw setting forth circumstances similar to the instant
action; nor does Claimant’s reply brief refute any of the Commissioner’s
counterarguments and supporting authority. Instead, Claimant merely states that “the
record is replete with evidence of [Claimant’s] fatigue (Tr. 103, 114, 641-42, 653-54, 899-
900, 951, 955, 967, 1308).” (ECF No. 5 at 14; see also ECF No. 9 at 3 (repeating the same)).

Claimant fails to offer any meaningful discussion of the dozen or so listed numbers pulled
from a record spanning 1,425 pages. (See ECF Nos. 4; 4-1). The only record addressed by
Claimant’s brief is a single treatment note from a May 6, 2021 chiropractic examination.
(ECF Nos. 5 at 14; 9 at 3-4 (each citing Tr. 955)). According to the Claimant, therein her
chiropractor “characterized [Claimant’s] fatigue as ‘daily debilitating fatigue.’” Id.
Notably, the treatment note at issue does not contain a medical opinion that the
claimant has “daily debilitating fatigue,” as Claimant’s brief suggests. (ECF No. 5 at 14).
Instead, the quoted language is pulled from the patient-history section of the
chiropractor’s treatment note, summarizing Claimant’s report that she suffers from daily
debilitating fatigue in addition to her reported symptoms of joint pain, malaise,
depression, and progressive obesity, in addition to summarizing the list of the Claimant’s
current medications. (Tr. 955). In the treatment plan, the chiropractor recommends that
Claimant seek a medical evaluation and additional diagnostic testing through her

primary-care physician. (Tr. 956). The only reference to Claimant’s fatigue in this section
is the chiropractor’s addition in the Comments section of the treatment plan to “Update
exercise once fatigue is stabilized.” Id. In short, Claimant failed to demonstrate that any
of the medical records she cites in her brief support a finding that the ALJ’s determination
improperly contravenes the medical evidence or that the ALJ otherwise committed legal
error in considering Claimant’s symptoms of fatigue.
Furthermore, Claimant’s mere citation to record “evidence of [her] fatigue” fails to
demonstrate error. By simply pointing to other evidence on the record that may support
a different finding, Claimant is essentially asking the Court to re-weigh the evidence. This
is improper because it is the province of the ALJ, and not this Court, to resolve conflicts

in the evidence. See, e.g., Keene v. Berryhill, 732 Fed. App’x 174, 177 (4th Cir. 2018)
(“This court’s function is not to substitute its own judgment for that of the ALJ, but to
determine whether the ALJ’s decision is supported as a matter of fact and law. There
were a number of conflicts in the evidence here, and we do not second guess the ALJ
in resolving those conflicts.”). As set forth supra, the Court’s only role on review pursuant
to 42 U.S.C. § 405(g) is to ensure the ALJ’s decision is supported by substantial evidence,
and free of legal error.
Ultimately, Claimant may disagree with the ALJ’s determination that the record
evidence does not support the extent of fatigue-related impairments alleged by the
Claimant, but it is well-established that a claimant’s mere disagreement with the
inferences the ALJ made from the evidence, standing alone, is patently insufficient to
demonstrate error. See id. The ALJ clearly explained why she did not find the State agency
physicians’ opinions regarding the severity of Claimant’s impairments of chronic-fatigue

syndrome and other fatigue-related symptoms were persuasive in light of the record evidence
as a whole; the ALJ then grounded her explanation in support from the medical record, in a
manner that is more than sufficient to trace the path of her reasoning. The undersigned
FINDS that the ALJ appropriately considered Claimant’s subjective complaints and the
state-agency physicians’ opinions under the appropriate regulatory framework, and
substantial evidence—more than a scintilla—supports the ALJ’s fact-finding. While
Claimant, and even the Court, may have reached a different determination, the ALJ’s
decision plainly met this standard. Accordingly, the undersigned respectfully
recommends that Claimant’s request for remand be DENIED.
C. Impact of Claimant’s Bilateral-Hand Osteoarthritis on Her RFC
Finally, Claimant argues that remand is required because the ALJ failed to

appropriately consider Claimant’s impairment of bilateral osteoarthritis of the hands and
its impact upon the RFC. (ECF No. 5 at 15). Claimant highlights that x-ray images from
August 2021 “confirm bilateral degenerative changes of the hands,” and treatment
records indicate that she has been diagnosed with osteoarthritis of both hands on at least
three occasions. Id. (citing Tr. 1035, 1045, 1122, 1385). Claimant concedes that “the ALJ
recognized this evidence in the narrative portion of the decision,” but objects that the ALJ
did not make an express finding specifically as to severity. Id. (citing Tr. 22). Claimant
concludes that “[t]he ALJ’s failure to articulate her reasons for omitting . . . hand
limitations from her RFC renders this decision beyond judicial review . . . [because] it is
impossible to know, on this record, how, or even if, the ALJ considered [Claimant’s] work-
related limitations related to her bilateral osteoarthritis of the hands[.]” Id. at 15-16.

In response, the Commissioner asserts that Claimant’s argument is “demonstrably
inaccurate.” (ECF No. 8 at 15). The Commissioner points out that the ALJ’s written
decision specifically included osteoarthritis as one of Claimant’s severe impairments,
and specifically addresses Claimant’s osteoarthritis in both hands in the RFC
determination. Id. at 15-16 (citing Tr. 13). The Commissioner concludes that the ALJ’s
decision rests on application of proper legal standards and is supported by substantial
evidence. Id. at 17. In her reply brief, Claimant challenges the Commissioner’s argument
that the ALJ’s finding of severe osteoarthritis encompassed a consideration of Claimant’s
“hand limitations.” (ECF No. 9 at 4). Claimant acknowledges that the ALJ “mentioned
[the] hand impairment in the narrative portion of the decision,” but argues that, without
a finding of severity, “[i]t is impossible to know, on this record, how, or even if, the ALJ
considered [Claimant’s] work-related limitations related to her bilateral osteoarthritis of

the hands, requiring remand.” Id.4
3F
Upon review of the ALJ’s thorough and well-supported written decision,
Claimant’s assertion of error is simply not borne out by the record. At step two of the
sequential evaluation process, the ALJ expressly found “[t]he medical evidence of record
reflects that the claimant has medical signs and objective findings establishing the
diagnoses [of] osteoarthritis, and that Claimant’s osteoarthritis constituted a “severe
impairment[.]” (Tr. 13). Further, throughout the opinion, the ALJ expressly discusses the
evidence regarding to Claimant’s hand function in the context of her bilateral
osteoarthritis. In the ALJ’s narrative discussion, she describes how the medical evidence,
including results from imaging and physical examinations reflected in Claimant’s
treatment records, do not support “finding the claimant . . . is unable to independently
initiate, sustain, and complete work-related activities involving fine and gross
movements.” (Tr. 16). Specifically, in her assessment of the listed impairments under 20
C.F.R. Part 404, Subpart P, Appendix 1, the ALJ explained that, in order to qualify for
abnormality of a major joint in any extremity in accordance with Listing 1.18, Claimant
must demonstrate the following:

4 Claimant also argues in her initial and reply briefs that the Commissioner may not rely upon post-hoc
rationalization to rehabilitate the ALJ’s failure to explain her findings, and that the ALJ’s purported error
is not harmless because manipulation of the hands and fingers would be necessary to perform her past
skilled work as an insurance clerk. (See ECF No. 5). Because the undersigned finds herein that the ALJ did
not err, however, Claimant’s arguments on these points are not relevant.
documented chronic joint pain or stiffness AND abnormal motion,
instability, or immobility of the affected joint AND anatomical abnormality
of the affected joint noted on physical examination or imaging AND
impairment-related physical limitation of musculoskeletal functioning that
has lasted, or is expected to last, for a continuous period of at least 12
months, and medical documentation of at least one of the following: . . . an
inability to use both upper extremities to the extent that neither can be
used to independently initiate, sustain, and complete work-related
activities involving fine and gross movements.

(Tr. 17).
Applying this standard to the record evidence, the ALJ pointed to medical
records—with specific record citations—showing that medical examination findings and
x-ray imaging revealed “mild degenerative changes in [Claimant’s] hands bilaterally,”
but normal strength, sensation, and range of motion—with “no evidence [Claimant] is
unable to independently initiate, sustain, and complete work-related activities involving
fine and gross movements.” Id. Further, the ALJ specifically noted in her discussion of
the Claimant’s RFC that Claimant reported “increased pain in her . . . hand” in the
disability report, and testified that “[s]he cannot write long because of problems with her
hands.” (Tr. 19). The ALJ contrasted this evidence with the extensive activities of daily
living in Claimant’s function report. Id. Specifically, the Claimant “stated in her function
report that she plays games on her phone, cooks, does chores, sews, prepares meals,
drives, shops, and handles her finances . . . [and] reported no difficulty with personal
care.” Id. (citing Tr. 280-87). Finally, the ALJ further discussed Claimant’s hand-related
symptoms in medical records from her rheumatologist, as well as the opinions of the state-
agency physicians. (Tr. 21-24).
Based upon the ALJ’s extensive consideration of the evidence, she found that
Claimant’s impairments—including Claimant’s osteoarthritic impairments—could
reasonably be expected to cause the alleged symptoms; however, the claimant’s
statements concerning the intensity, persistence and limiting effects of these symptoms
are not entirely consistent with the medical evidence and other evidence in the record[.]”
Id. The ALJ provided for this finding in her RFC, stating that Claimant’s combination of
impairments, including osteoarthritis, “results in additional limitations consistent with
the finding the claimant capable of sedentary exertion with postural and environmental

limitations.” (Tr. 24). This thorough, extensive discussion throughout the ALJ’s written
decision explains the evidentiary and logical basis for the ALJ’s determination, and is
well-supported by specific record citations. As such, Claimant’s argument that “it is
impossible to know, on this record, how, or even if, the ALJ considered [Claimant’s]
work-related limitations related to her bilateral osteoarthritis of the hands,” (ECF No. 5
at 15-16), is simply not borne out by the record.
Moreover, Claimant does not highlight any specific findings from the medical
records, or point to any inaccuracies in the ALJ’s decision. In fact, she cites to only three
pages of her medical records in support of her assertion that she was “diagnosed with
osteoarthritis of both hands.” (ECF No. 5 at 15 (citing Tr. 1035, 1045, 1385)). However,
Claimant acknowledges that “the ALJ recognized this evidence.” Id. Tellingly, Claimant

fails both in her initial brief and in her reply brief to set forth any relevant authority,
either within or without the Fourth Circuit, in support of her position that the ALJ erred
under the circumstances. In fact, the sole basis for Claimant’s challenge to the
Commissioner’s argument is her own stated disagreement that the ALJ’s finding of
severe osteoarthritis “did not” encompass a finding of severity with respect to Claimant’s
bilateral osteoarthritis of the hands. (ECF No. 9 at 4 (“It did not.”)). Without any factual
or legal support, Claimant’s argument is patently insufficient to demonstrate error
pursuant to the highly deferential standard of § 405(g) review.
The undersigned FINDS that the ALJ appropriately considered Claimant’s
bilateral osteoarthritis of the hands pursuant to the appropriate regulatory framework,
and substantial evidence—more than a scintilla—supports the ALJ’s determination.
Again, while Claimant, and even the Court, may have reached a different determination,
the ALJ’s decision is supported by substantial evidence and Claimant has demonstrated

no error. Accordingly, the undersigned respectfully recommends that Claimant’s request
for remand be DENIED.
IV. CONCLUSION
For the foregoing reasons, the undersigned respectfully RECOMMENDS that the
presiding District Judge DENY Claimant’s request to reverse the Commissioner’s
decision (ECF No. 5), GRANT the Commissioner’s request to affirm his decision (ECF
No. 8), AFFIRM the final decision of the Commissioner, and DISMISS this action from
the Court’s active docket.
The parties are notified that this Proposed Findings and Recommendation is
hereby FILED and a copy will be submitted to the Honorable John T. Copenhaver, Jr.,
Senior United States District Judge. Pursuant to the provisions of 28 U.S.C.
§ 636(b)(1)(B) and Federal Rule of Civil Procedure 72(b), the parties shall have fourteen

(14) days from the date of the filing of this Proposed Findings and Recommendation to
file with the Clerk of this Court specific written objections identifying the portions of the
Proposed Findings and Recommendation to which objection is made and the basis of such
objection. Extension of this time period may be granted for good cause shown. Copies of
any objections shall be served on opposing parties and provided to Judge Copenhaver.
Failure to file written objections as set forth above shall constitute a waiver of de
novo review by the District Court and a waiver of appellate review by the Fourth Circuit
Court of Appeals. 28 U.S.C. § 636(b)(1); see Thomas v. Arn, 474 U.S. 140, 155 (1985);
Snyder v. Ridenour, 889 F.2d 1363, 1366 (4th Cir. 1989); Wright v. Collins, 766 F.2d 841,
846 (4th Cir. 1985); United States v. Schronce, 727 F.2d 91, 94 (4th Cir. 1984).
The Clerk is DIRECTED to file this Proposed Findings and Recommendation and
to transmit a copy of the same to counsel of record.
ENTERED: August 22, 2024
ae

Dwane L. Tinsley
_._ United States Magistrate Judge

36

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10765834. Public record. Not legal advice.