Beach v. Office of Appellate Operations

UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF TENNESSEE

NASHVILLE DIVISION

TURMURIA BEACH,

Plaintiff, Case No. 3:24-cv-00915

v. Chief Judge William L. Campbell, Jr.

Magistrate Judge Alistair E. Newbern

OFFICE OF APPELLATE OPERATIONS,

Defendant.

To: The Honorable William L. Campbell, Chief District Judge

REPORT AND RECOMMENDATION

Pro se Plaintiff Turmuria Beach filed this action under 42 U.S.C. §§ 405(g) and 1383(c)(3)

seeking judicial review of the final decision of the Commissioner of the Social Security

Administration (SSA) denying her applications for disability insurance benefits (DIB) under

Title II of the Social Security Act, 42 U.S.C. §§ 401–433, and supplemental security income (SSI)

under Title XVI of the Social Security Act, 42 U.S.C. §§ 1381–1383f. (Doc. No. 1.) The Court

referred this action to the Magistrate Judge to dispose or recommend disposition of any pretrial

motions under 28 U.S.C. § 636(b)(1)(A) and (B). (Doc. No. 21.) Beach applied for and was granted

leave to proceed in forma pauperis. (Doc. Nos. 2, 10.)

Before the Court is Beach’s handwritten motion (Doc. No. 16) that the Magistrate Judge

has construed as a motion for judgment on the administrative record (Doc. No. 17), to which the

Commissioner has responded in opposition (Doc. No. 20). Having considered the parties’

arguments and the administrative record (Doc. No. 121) as a whole, and for the reasons that follow,

the Magistrate Judge will recommend that the Court deny Beach’s motion and affirm the

Commissioner’s decision.

I. Background

A. Beach’s DIB and SSI Applications

Beach applied for DIB and SSI on September 14, 2020, alleging that she has been disabled

and unable to work since December 15, 2019, as a result of bipolar disorder, post-traumatic stress

disorder (PTSD), obesity, and knee problems. (AR 324, 345.)

The Commissioner denied Beach’s applications initially and on reconsideration. (AR 366,

367, 395, 396.) At Beach’s request, an administrative law judge (ALJ) held a virtual hearing

regarding her applications on January 4, 2023. (AR 83–119, 439–42.) Beach appeared with

counsel and testified. (AR 85, 88, 92–111.) The ALJ also heard testimony from a vocational

expert. (AR 111–17.) At the hearing, Beach amended her alleged disability onset date to July 21,

2020.2 (AR 96–97.)

B. The ALJ’s Findings

On February 7, 2023, the ALJ issued a written decision finding that Beach was not disabled

within the meaning of the Social Security Act and applicable regulations and denying her claims

for DIB and SSI. (AR 52–82.) The ALJ made the following enumerated findings:

1 The transcript of the administrative record (Doc. No. 12) is referenced herein by the

abbreviation “AR.” All page numbers cited in the AR refer to the Bates stamp at the bottom right

corner of each page.

2 The record shows that Beach previously applied for DIB and SSI benefits on September

27, 2018. (AR 304.) The Commissioner denied those applications initially and on reconsideration

and, after holding a telephonic hearing on her applications at Beach’s request, an ALJ issued a

written decision denying Beach’s applications on July 20, 2020. (AR 304–316.)

1. [Beach] meets the insured status requirements of the Social Security Act

through December 31, 2022.

2. [Beach] has not engaged in substantial gainful activity since July 21, 2020,

the amended alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).

3. [Beach] has the following severe impairments: bilateral knee osteoarthritis

status post arthroscopic surgery left and right total knee replacement; degenerative

disc disease of the lumbar and cervical spine; hernia of anterior abdominal wall;

history of gastric bypass; asthma; obstructive sleep apnea; morbid obesity; post-

traumatic stress disorder (PTSD); depressive disorder; and bipolar disorder (20

CFR 404.1520(c) and 416.920(c)).

* * *

4. [Beach] does not have an impairment or combination of impairments that

meets or medically equals the severity of one of the listed impairments in 20 CFR

Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525, 404.1526,

416.920(d), 416.925 and 416.926).

* * *

5. After careful consideration of the entire record, the undersigned finds that

[Beach] has the residual functional capacity to perform light work as defined in 20

CFR 404.1567(b) and 416.967(b) except [Beach] can stand and walk for 4 hours in

an 8-hour workday, and can sit for 8 hours in an 8-hour workday. [Beach] can never

climb a ladder, rope, or scaffold or crawl. [Beach] can occasionally climb ramps

and stairs, balance, stoop, kneel, and crouch. [Beach] can perform occasional

pushing and pulling with the bilateral lower extremities. [Beach] must avoid work

at unprotected heights, must avoid work around moving mechanical parts with

vibrations and the use of vibratory tools, and must avoid concentrated exposure to

dust, fumes, odors, gases, and poor ventilation. [Beach] can understand and

remember simple instructions and can use judgment to make simple work-related

decisions. [Beach] can adapt to routine changes in the work setting that are

occasional in nature.

* * *

6. [Beach] is unable to perform any past relevant work (20 CFR 404.1565 and

416.965).

* * *

7. [Beach] was born on February 15, 1973 and was 47 years old, which is

defined as a younger individual age 18–49, on the amended alleged disability onset

date (20 CFR 404.1563 and 416.963).

8. [Beach] has a limited education (20 CFR 404.1564 and 416.964).

9. Transferability of job skills is not material to the determination of disability

because using the Medical-Vocational Rules as a framework supports a finding that

[Beach] is “not disabled,” whether or not [Beach] has transferable job skills (See

SSR 82-41 and 20 CFR Part 404, Subpart P, Appendix 2).

10. Considering [Beach]’s age, education, work experience, and residual

functional capacity, there are jobs that exist in significant numbers in the national

economy that [Beach] can perform (20 CFR 404.1569, 404.1569a, 416.969, and

416.969a).

* * *

11. [Beach] has not been under a disability, as defined in the Social Security

Act, from July 21, 2020, through the date of this decision (20 CFR 404.1520(g) and

416.920(g)).

(AR 55–75.) The Social Security Appeals Council denied Beach’s request for review on July 12,

2024, making the ALJ’s decision the final decision of the Commissioner. (AR 1–7.)

C. Appeal Under 42 U.S.C. §§ 405(g) and 1383(c)(3)

Beach filed this action for review on July 24, 2024 (Doc. No. 1), and this Court has

jurisdiction under 42 U.S.C. § 405(g). Beach argues that “[her] disability started as a child and it

[has] been going on ever[ ] since.” (Doc. No. 16, PageID# 2044.) She states that her “mental,

physical, [and] emotional illnesses” have “gotten worse” and that she “need[s] help” because she

is “not able to work how [she] did years ago.” (Id. at PageID# 2044, 2045.) Beach states that she

has “had several surgeries,” including having “both knees replaced three times in less than six

months[,] and [she is] still having issues . . . and needs to have another surgery on both knees . . . .”

(Id. at PageID# 2045.) Beach states that she “can’t stand or sit for a long time without pain.” (Id.)

She also states that “[her] blood pressure starting high is an issue for her . . . .” (Id.) Beach states

that she has “PTSD, an[xiety], . . . bipolar[,]” and “panic attacks . . . .” (Id.) She states that she

does not “think that [the ALJ] looked at all of [her] records and [she] feel[s] like they don’t even

care.” (Id.)

The Court liberally construed Beach’s motion as a motion for judgment on the

administrative record. (Doc. No. 17.) The Commissioner filed a response in opposition to Beach’s

motion, arguing that the ALJ followed applicable SSA regulations and that substantial record

evidence supports the ALJ’s determinations. (Doc. No. 20.) Beach did not file an optional reply in

support of her motion.

D. Review of the Record

The ALJ and the parties have thoroughly described and discussed the medical and

testimonial evidence in the administrative record. Accordingly, the Court will discuss those

matters only to the extent necessary to address the parties’ arguments.

II. Legal Standards

A. Standard of Review

This Court’s review of an ALJ’s decision is limited to determining (1) whether the ALJ’s

findings are supported by substantial evidence and (2) whether the ALJ applied the correct legal

standards. See 42 U.S.C. § 405(g); Miller v. Comm’r of Soc. Sec., 811 F.3d 825, 833 (6th Cir.

2016) (quoting Blakley v. Comm’r of Soc. Sec., 581 F.3d 399, 405 (6th Cir. 2009)). “Under the

substantial-evidence standard, a court looks to an existing administrative record and asks whether

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

Berryhill, 587 U.S. 97, 102 (2019) (alteration in original) (quoting Consol. Edison Co. v. NLRB,

305 U.S. 197, 229 (1938)). Substantial evidence is less than a preponderance but “more than a

mere scintilla” and means “such relevant evidence as a reasonable mind might accept as adequate

to support a conclusion.” Id. at 103 (quoting Consol. Edison Co., 305 U.S. at 229); see also Gentry

v. Comm’r of Soc. Sec., 741 F.3d 708, 722 (6th Cir. 2014) (same). Further, “[t]he Social Security

Administration has established rules for how an ALJ must evaluate a disability claim and has made

promises to disability applicants as to how their claims and medical evidence will be reviewed.”

Gentry, 741 F.3d at 723. Where an ALJ fails to follow those rules or regulations, “we find a lack

of substantial evidence, ‘even where the conclusion of the ALJ may be justified based upon the

record.’” Miller, 811 F.3d at 833 (quoting Gentry, 741 F.3d at 722).

B. Determining Disability at the Administrative Level

DIB and SSI benefits are available to individuals who are disabled, which is defined as an

“inability to engage in any substantial gainful activity by reason of any medically determinable

physical or mental impairment which can be expected to result in death or which has lasted or can

be expected to last for a continuous period of not less than 12 months[.]” 42 U.S.C. § 423(d)(1)(A);

see Colvin v. Barnhart, 475 F.3d 727, 730 (6th Cir. 2007) (explaining that this definition applies

in the DIB and SSI contexts).

ALJs must employ a “five-step sequential evaluation process” to determine whether a

claimant is disabled, proceeding through each step until a determination can be reached. 20 C.F.R.

§§ 404.1520(a)(4), 416.920(a)(4). For purposes of this case, the regulations governing disability

determination for DIB and SSI benefits are identical. See Colvin, 475 F.3d at 730 (citing 20 C.F.R.

§§ 404.1520, 416.920). At step one, the ALJ considers the claimant’s work activity. 20 C.F.R.

§§ 404.1520(a)(4)(i), 416.920(a)(4)(i). “[I]f the claimant is performing substantial gainful activity,

then the claimant is not disabled.” Miller, 811 F.3d at 834 n.6. At step two, the ALJ determines

whether the claimant suffers from “a severe medically determinable physical or mental

impairment” or “combination of impairments” that meets the 12-month durational requirement. 20

C.F.R. §§ 404.1520(a)(4)(ii), 416.920(a)(4)(ii). “If the claimant does not have a severe impairment

or combination of impairments [that meets the durational requirement], then the claimant is not

disabled.” Miller, 811 F.3d at 834 n.6. At step three, the ALJ considers whether the claimant’s

medical impairment or impairments appear on a list maintained by the SSA that “identifies and

defines impairments that are of sufficient severity as to prevent any gainful activity.” Combs v.

Comm’r of Soc. Sec., 459 F.3d 640, 643 (6th Cir. 2006); see 20 C.F.R. §§ 404.1520(a)(4)(iii),

416.920(a)(4)(iii). “If the claimant’s impairment meets or equals one of the listings, then the ALJ

will find the claimant disabled.” Miller, 811 F.3d at 834 n.6. If not, the ALJ proceeds to step four.

Combs, 459 F.3d at 643; see also Walker v. Berryhill, No. 3:16-1231, 2017 WL 6492621, at *3

(M.D. Tenn. Dec. 19, 2017) (explaining that “[a] claimant is not required to show the existence of

a listed impairment in order to be found disabled, but such showing results in an automatic finding

of disability and ends the inquiry”), report and recommendation adopted, 2018 WL 305748 (M.D.

Tenn. Jan. 5, 2018).

At step four, the ALJ evaluates the claimant’s past relevant work and “‘residual functional

capacity,’ defined as ‘the most [the claimant] can still do despite her limitations.’” Combs, 459

F.3d at 643 (alterations in original) (quoting 20 C.F.R. § 404.1545(a)(1)); see 20 C.F.R.

§§ 404.1520(a)(4)(iv), 416.920(a)(4)(iv). Past work is relevant to this analysis if the claimant

performed the work within the past 15 years, the work qualifies as substantial gainful activity, and

the work lasted long enough for the claimant to learn how to do it. 20 C.F.R. §§ 404.1560(b)(1),

416.960(b)(1). If the claimant’s residual functional capacity (RFC) permits her to perform past

relevant work, she is not disabled. Combs, 459 F.3d at 643. If a claimant cannot perform past

relevant work, the ALJ proceeds to step five and determines whether, “in light of her residual

functional capacity, age, education, and work experience,” a claimant can perform other

substantial gainful employment. Id. While the claimant bears the burden of proof during the first

four steps, at step five the burden shifts to the Commissioner to “identify a significant number of

jobs in the economy that accommodate the claimant’s residual functional capacity and vocational

profile.” Johnson v. Comm’r of Soc. Sec., 652 F.3d 646, 651 (6th Cir. 2011). “Claimants who can

perform such work are not disabled.” Combs, 459 F.3d at 643; see also 20 C.F.R.

§§ 404.1520(a)(4)(v), 416.920(a)(4)(v).

III. Analysis

Beach’s arguments, liberally construed, challenge the ALJ’s determination that she is not

disabled under SSA regulations because, despite her physical and mental impairments, Beach has

the residual functional capacity (RFC) to perform a limited range of “light work” as defined by

SSA regulations. (Doc. No. 16.)

The ALJ determined that Beach

has the residual functional capacity to perform light work as defined in 20 CFR

404.1567(b) and 416.967(b) except [Beach] can stand and walk for 4 hours in an 8-

hour workday, and can sit for 8 hours in an 8-hour workday. [Beach] can never

climb a ladder, rope, or scaffold or crawl. [Beach] can occasionally climb ramps

and stairs, balance, stoop, kneel, and crouch. [Beach] can perform occasional

pushing and pulling with the bilateral lower extremities. [Beach] must avoid work

at unprotected heights, must avoid work around moving mechanical parts with

vibrations and the use of vibratory tools, and must avoid concentrated exposure to

dust, fumes, odors, gases, and poor ventilation. [Beach] can understand and

remember simple instructions and can use judgment to make simple work-related

decisions. [Beach] can adapt to routine changes in the work setting that are

occasional in nature.

(AR 60.)

The ALJ provided more than thirteen single-spaced pages of analysis in support of this

determination, beginning by articulating the relevant standard for assessing a claimant’s symptoms

under SSA regulations:

In making this finding, the undersigned has considered all symptoms and the extent

to which these symptoms can reasonably be accepted as consistent with the

objective medical evidence and other evidence, based on the requirements of 20

CFR 404.1529 and 416.929 and SSR 16-3p. The undersigned also considered the

medical opinion(s) and prior administrative medical finding(s) in accordance with

the requirements of 20 CFR 404.1520c and 416.920c.

In considering [Beach]’s symptoms, the undersigned must follow a two-step

process in which it must first be determined whether there is an underlying

medically determinable physical or mental impairment(s)--i.e., an impairment(s)

that can be shown by medically acceptable clinical or laboratory diagnostic

techniques--that could reasonably be expected to produce [Beach]’s pain or other

symptoms.

Second, once an underlying physical or mental impairment(s) that could reasonably

be expected to produce [Beach]’s pain or other symptoms has been shown, the

undersigned must evaluate the intensity, persistence, and limiting effects of

[Beach]’s symptoms to determine the extent to which they limit [Beach]’s work-

related activities. For this purpose, whenever statements about the intensity,

persistence, or functionally limiting effects of pain or other symptoms are not

substantiated by objective medical evidence, the undersigned must consider other

evidence in the record to determine if [Beach]’s symptoms limit the ability to do

work-related activities.

[Beach] reports that she is unable to work due to persistent musculoskeletal pain,

and ongoing symptomology associated with a hernia, a history of gastric bypass

surgery, asthma, and obstructive sleep apnea. In addition to these physical

impairments, [Beach] reports ongoing mental health issues associated with post-

traumatic stress disorder (PTSD), a depressive disorder, and bipolar disorder.

(Hearing Testimony; Exhibit D3E; D4E; D8E; D9E). [Beach] has been prescribed

medications to help treat her chronic pain and mental health symptomology, and

uses a CPAP to manage her sleep apnea. (Exhibit D12E). However, she testified

that the model she uses has been recalled. [Beach] testified that she underwent a

right knee replacement, but continues to experience pain and swelling in her leg.

She uses a brace on her right knee, and a walker as needed. She also reports

worsening issues in her left knee, and states that injections are no longer working

to manage her symptomology in this extremity. [Beach] testified that she also

experiences significant pain in her back, but does not want to undergo surgery. She

also experiences pain in her abdomen related to a hernia, and has seen pain

management to help manage neuropathic symptoms. In addition to her physical

symptomology, [Beach] reports ongoing issues with PTSD, panic attacks, and

bipolar disorder. Despite medication management, she reports that she experiences

flashbacks, gets emotional, and does not socialize often with other people. (Hearing

Testimony).

The record also routinely notes that [Beach]’s weight is in the obese range. Social

Security Ruling 19-2p requires that the undersigned consider the effect obesity has

on [Beach]’s ability to perform routine movement and necessary physical activity

within the work environment. The combined effects of obesity with another

impairment may be greater than the effects of each of the impairments considered

separately. Therefore, the undersigned has considered all-work related physical

limitations, whether due to [Beach]’s obesity, other impairments, or a combination

of impairments.

After careful consideration of the evidence, the undersigned finds that [Beach]’s

medically determinable impairments could reasonably be expected to cause the

alleged symptoms; however, [Beach]’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 for the reasons explained in

this decision.

The record documents a history of treatment for the aforementioned impairments.

(Exhibit D1F; D2F; D3F; D4F; D5F; D6F; D7F; D8F; D10F; D15F; D22F; D25F).

[Beach] underwent a left knee arthroscopy with abrasion chondroplasty to the

patellofemoral joint with major synovectomy of medial, lateral, and patellofemoral

joints on October 27, 2015. (Exhibit D6F/113). She underwent a right knee

arthroscopy with partial medial meniscectomy of the anterior horn; abrasion

chondroplasty of the patellofemoral joint to bleeding bone; and synovitis of major

synovectomy medial and patellofemoral compartments on January 12, 2016.

(Exhibit D6F/114). [Beach] underwent a right knee arthroscopy with a partial

medial meniscectomy of the anterior horn, abrasion chondroplasty to bleeding bone

at the patellofemoral joint, and major synovectomy of the medial and

patellofemoral compartments on October 18, 2017. (Exhibit D6F/116). A left knee

arthroscopy with chondroplasty of the patellofemoral joint and limited

synovectomy of the medial and patellofemoral compartments were performed on

September 23, 2019. (Exhibit D6F/119; D22F/25). Electrodes for a spinal cord

stimulator were placed on October 23, 2019. (Exhibit D7F/18).

[Beach] has continued to seek orthopedic treatment during the relevant period,

reporting continued pain in her right knee in September 2020. During the objective

examination on that date, [Beach] exhibited limited range of motion, positive

patella compression, a positive medial McMurry’s, and joint swelling in the right

lower extremity. A varus deformity of about 5 degrees was noted, as well as

instability with weight-bearing. A custom medial unloader brace was requested,

and [Beach] was referred for a physical therapy evaluation. (Exhibit D5F; D6F;

D10F). [Beach] also presented to neurosurgery in September 2020, reporting lower

back pain. At this appointment, [Beach] reported that she had been fitted for a brace,

which was working well when she used it. An MRI of the lumbar spine was ordered.

(Exhibit D7F). This imaging revealed mild multi-level degenerative changes, with

minimal/mild neural foraminal narrowing at L4-L5 and L5-S1. (Exhibit D7F/12).

[Beach] was referred to pain management in September 2020. During this objective

examination, palpation of the lumbar facet revealed pain on both sides at the L3-S1

region, and pain was noted over the lumbar intervertebral disc spaces and sacroiliac

joint revealed pain. Limited extension and flexion were noted with pain. Bilateral

knee joint line tenderness was elicited upon palpation, crepitus was palpated

bilaterally, and [Beach] had positive McMurray’s bilaterally. However, [Beach]’s

gait appeared normal, straight leg raising was normal, and [Beach] had normal

strength and sensation in her extremities. Based on her history, examination, and

imaging, her main pain generators appeared to be from the SI and lumbar facet

joints, as well as osteoarthritis in her knees bilaterally. [Beach] was not interested

in injections at that time, but she was prescribed multiple medications in an attempt

to manage her symptomology. (Exhibit D18F).

[Beach] presented to neurosurgery for a follow up in October 2020, reporting

continued pain in her lower back and leg that was 8 out of 10 o the pain scale. She

stated that she did not want to undergo back surgery, so additional physical therapy

for her back was recommended. (Exhibit D7F). Bilateral knee crepitus and spinal

tenderness were noted during objective examinations in the following months, but

[Beach] was ambulatory. (Exhibit D8F). [Beach] continued to attend pain

management appointments in November and December 2020, but continued to

indicate that she was not interested in injections. (Exhibit D18F). During a

neurosurgery appointment in December 2020, [Beach] reported lower back pain

radiating to her bilateral hips, buttocks, and lower extremities, with associated

numbness and tingling. She also reported posterior neck pain at that time, which

radiated into her upper extremities with numbness in both hands. During the

objective examination, pain was noted in the lumbar spine, hips, and posterior neck,

and sensation was decreased in the L5 distribution in the bilateral lower extremities.

Sensation was also decreased in the left hand. However, strength was full in all

extremities, and [Beach]’s gait was normal. [Beach] reported that physical therapy

helped her back, though she had aches and pains in the cold. [Beach] did not want

to participate in more physical therapy at that time, however. She wanted to

continue on her current medication regimen and perform further workup of her neck

pain and bilateral hand numbness. (Exhibit D23F). [Beach] continued to participate

in pain management into 2021, with records from March noting that medications

decreased her pain from 10/10 to 8/10 and improved her ability to perform her

activities of daily living. During the objective physical examination, tenderness to

palpation, crepitus, and minimal swelling were noted in [Beach]’s knees. However,

her gait appeared to be normal. Her medications were refilled, and [Beach]

requested that injections be ordered to help her with her pain. [Beach] received

these injections during an appointment in April. Objective examination findings at

that time noted tenderness to palpation and crepitus in the bilateral knees. However,

there was no swelling, and [Beach]’s gait appeared to be normal. (Exhibit D18F).

[Beach] underwent a consultative examination in April 2021, reporting persistent

issues with pain in her knees. During the objective examination, her gait was

antalgic, but her station was normal. She got up out of the chair and got onto and

off of the examination table with difficulty, but she used no assistive device as an

aid to walking during the evaluation. Her grip grade was 5/5 bilaterally, and she

lifted 10 pounds bilaterally on a one-time basis. Her mobility and ability to grasp

and manipulate objects were normal. [Beach]’s blood pressure was elevated.

[Beach] was unable to see one finger less than 6 inches from her nose, but she did

not wear prescription glasses. Her lungs were clear to auscultation bilaterally, with

no increased AP diameter, prolonged expiration, or wheezes, rales, or rhonchi.

[Beach]’s abdomen was soft, non-distended, and non-tender. [Beach] was tender in

the lumbar spine region, and had pain with range of motion and strength testing.

Her knees were tender and swollen. However, strength was 5/5 in all major muscle

groups. Some limitations in range of motion were noted in [Beach]’s hips and

knees, but range of motion was normal in all other areas. Straight leg testing was

negative bilaterally, and Romberg testing was negative as well. [Beach] was

diagnosed with osteoarthritis, degenerative disc disease of the lumbar spine,

obesity, and migraines by history. (Exhibit D1F).

During a pain management appointment in June 2021, [Beach] reported that her

pain medication decreased her pain from 10/10 to 7/10, and improved her mobility

and ability to perform her activities of daily living. During the objective physical

examination, palpation of the lumbar facet revealed pain on both sides at L3-S1

region, and palpation of the bilateral sacroiliac joints revealed right and left-sided

pain. However, [Beach]’s gait appeared normal. [Beach]’s medications were

refilled. [Beach] reported no significant changes during a pain management

appointment in July 2021, though she remained happy with her treatment regimen.

Upon examination, palpation of the lumbar facet revealed pain on both sides at the

L3-S1 region. Extension of the lumbar spine was noted to be 25 degrees, and pain

was noted with lumbar extension. By August, [Beach] reported that her medications

were no longer helping as much as they used to. During the objective examination,

palpation of the lumbar facet revealed pain on both side at the L3-S1 region. Her

gait remained normal. [Beach]’s medication regimen was adjusted. (Exhibit D18F).

Musculoskeletal pain was noted during an annual wellness appointment in August

2021, and crepitus was noted in the bilateral knees upon examination. However,

[Beach] was ambulatory with good muscle strength and tone. (Exhibit D17F).

[Beach] reported improvement in her knee and back pain during a pain management

appointment in September 2021, stating that following the change in her

medications her pain was decreased from 10/10 to 4/10. She reported that her

medication allowed for better function and quality of life. During the objective

examination, tenderness to palpation was noted in the joint line of the knee, and

crepitus was noted. However, [Beach]’s gait again appeared to be normal. Her

medication regimen was adjusted again. [Beach] again reported that her pain was

reduced to 4/10 with medication during a pain management appointment in October

2021. She also stated that the knee injections had improved her pain for several

months, though the benefits of these injections were beginning to wear off. During

the objective examination, [Beach] had tenderness to palpation, crepitus and

minimal swelling in the knee. Injections were ordered, and [Beach]’s medication

regimen was adjusted. She received these injections in November 2021. During this

appointment, [Beach] reported no change in her chronic back pain, and reported

severe pelvic pain that was not responding to her current medication regimen.

However, her back and knee pain was reduced to 5/10 on the pain scale with

medication, and her gait continued to be normal during the objective examination.

[Beach] had tenderness to palpation of the bilateral knee joint lines, with crepitus

and minimal swelling noted. Tenderness to palpation was noted in the abdomen and

pelvic area. Further adjustments were made to her medication regimen. (Exhibit

D18F). During a primary care appointment in November 2021, crepitus was noted

in the bilateral knees, though [Beach] retained normal range of motion and good

strength and tone. She was ambulatory, with no muscular tenderness or weakness

noted. (Exhibit D17F).

Pain management records in December 2021 note that [Beach]’s back pain was

about the same, though her knee pain had improved. Overall, she continued to

report that her pain and function were improved with her medication regimen, and

stated that pain medication reduced her pain from 10/10 to 3/10. Upon examination,

tenderness and crepitus were noted in the bilateral knees, but [Beach] had only

minimal swelling and her gait remained normal. Her medication regimen was

adjusted again. Pain management records from January 2022 continued to note that

[Beach]’s pain was decreased to 3/10 with medication. though palpation of the

lumbar facet revealed pain on both sides at the L3-S1 region, [Beach]’s gait

remained normal. [Beach] continued to report knee pain in February 2022, and had

tenderness and crepitus in the bilateral knees upon objective examination.

However, she reported that medication decreased her pain to 4/10, only minimal

swelling was noted, and her gait remained normal. (Exhibit D28F). [Beach]

presented to the emergency department in March 2022 with left shoulder pain that

was worse with movement. However, she denied any radicular pain or numbness,

tingling, or weakness. Upon examination, the upper aspect of the left trapezius was

taught and tender to palpation, and range of motion of the shoulder was slightly

limited due to pain. [Beach]’s symptomology improved when [Beach] placed

pressure down on her trapezius, however, and there were no other areas of bony

tenderness in the upper extremity. Sensation was intact. Imaging revealed no

evidence of left shoulder fracture or malalignment, and relative preservation of

mineralization and joint spaces, though old calcified granulomatous disease was

noted. (Exhibit D21F). During a follow up appointment after this treatment, she

reported that she could not lift above 45 degrees, and was interested in seeing an

orthopedic specialist. During the objective examination, muscular tenderness was

present in the left shoulder, with limited range of motion. [Beach] could not lift

above 45 degrees, and pain to palpation was noted across the top of the shoulder.

There was no joint swelling or weakness. [Beach] was referred to an orthopedist.

(Exhibit D26F).

Pain management records from March 2022 report that [Beach]’s back pain was

stable, and medications decreased her pain from 8/10 to 2/10 on the pain scale.

During the objective examination, palpation of the lumbar facet revealed pain on

both sides of the L3-S1 region. Her medications were continued. No significant

changes were noted in April 2022, and [Beach] reported that medications decreased

her pain from 8/10 to 4/10 on the pain scale. During the objective examination,

palpation of the lumbar facet revealed pain on both sides of the L3-S1 region.

Palpation of the bilateral sacroiliac joint area revealed right and left-sided pain.

There was pain noted with extension and flexion, but [Beach]’s gait appeared

normal. [Beach] wanted to repeat her knee injections when due, stating they were

very helpful. [Beach] reported worsening knee pain in May 2022, and [Beach]

again indicated that she wanted to repeat her previous injections. She reported that

pain medication continued to decrease her pain from 10/10 to 4/10. Upon objective

examination, tenderness to palpation and crepitus were noted in both knees, though

there was no swelling, and her gait appeared to be normal. Injections were

administered in June 2022. [Beach] reported improvement in her knee pain

following these injections. During an appointment in July, she stated that her

prescribed medications reduced her pain from 9/10 to 6/10 on the pain scale. During

a pain management appointment in July 2022, [Beach] reported improvement in

her knee pain after her injection the previous month, and stated that her prescribed

medications decreased her pain from 9/10 to 6/10. During the objective

examination, palpation of the bilateral sacroiliac joint revealed right and left sided

pain. However, her gait remained normal. (Exhibit D28F).

[Beach] presented to pain management again in August 2022, reporting stable

chronic knee pain, and stated her pain medication decreased her pain from 9/10 to

6/10. During the objective examination, [Beach] had tenderness to palpation of the

joint line in the bilateral knees, as well as crepitus. There was no swelling noted,

and [Beach]’s gait appeared to be normal. (Exhibit D28F). During an annual

wellness visit in September 2022, [Beach] reported that her arthritis was “bad”, and

stated she was considering surgery. During the objective physical examination,

crepitus was noted in the bilateral knees, but [Beach] was ambulatory with normal

range of motion and good muscle tone and strength. (Exhibit D26F). Pain

medication records from this period indicate that [Beach]’s knee pain was stable,

and again indicated that her pain medication reduced her pain from 9/10 to 6/10.

During the objective examination, palpation of the bilateral sacroiliac joint area

revealed right and left sided pain. However, her gait continued to appear normal.

(Exhibit D28F). [Beach] presented for treatment of right knee pain in October 2022.

During the objective examination, limited range of motion, joint swelling and

tenderness, positive patella compression, and positive medial McMurry’s were

noted. However, there was no crepitus, and sensation was intact to light touch.

Imaging revealed varus deformity and bone to bone contact. [Beach] was referred

to physical therapy and pain management, and was scheduled for a right total knee

replacement. (Exhibit D27F). Continued pain was noted during a pre-operative

appointment in October 2022. During the objective examination, [Beach] had

limited range of motion, positive patella compression, joint effusion, positive

medial McMurry’s, and joint swelling in the right lower extremity. (Exhibit D22F).

Pain management records noted tenderness to palpation of the right knee joint line

with crepitus, and [Beach] was advised to talk to her orthopedic surgeon regarding

post-operative pain management. (Exhibit D28F). [Beach] underwent a right total

knee arthroplasty on October 24, 2022 (Exhibit D22F/12), and participated in

physical therapy following this surgery. (Exhibit D29F).

During a post-operative appointment at the end of October 2022, [Beach] was

recovering well. Joint swelling and tenderness were noted at the operative site, but

[Beach]’s wound was clean and dry without erythema, purulent, or serous. She was

neurovascularly intact, and sensation was intact to light touch. Imaging revealed

that [Beach]’s prosthesis was intact with good position and alignment. (Exhibit

D27F). [Beach] presented to the emergency department in early November 2022

reporting pain and swelling in the right knee, and she stated she had recently run

out of pain medications. During the objective examination, swelling and mild

warmth was noted to the right knee, with staples in place. However, her wound

appeared well-healing, and she had normal range of motion with no deformity. An

x-ray of the knee revealed intact hardware, and imaging ruled out deep vein

thrombosis. Mild elevation was noted in the inflammatory markers. She was

discharged home in stable condition. (Exhibit D30F). Pain management records

from November 2022 noted left pain, and [Beach] reported that she would

eventually need to replace that joint as well. At that time, she reported that her pain

medication decreased her pain from 10/10 to 7/10. During the objective

examination, palpation of the lumbar facet revealed pain on both sides at the L3-S1

region, as well as pain with extension and flexion. However, her gait appeared

normal. Chronic back pain was noted in December 2020, but [Beach] reported that

her pain medication decreased her pain from 10/10 to 6/10. [Beach] was noted to

be morbidly obese upon examination, but her gait appeared normal. (Exhibit

D28F). Physical therapy records from December 2022 note improvement in

[Beach]’s symptomology with physical therapy, though she still experienced some

weakness and limited range of motion and she required assistance to get leg on/off

mat table. However, [Beach] reported that she was participating in significant

activities of daily living, such as dancing. She was continued with physical therapy

to further improve her functional abilities. (Exhibit D29F).

[Beach] has also received treatment for gastrointestinal and respiratory issues

throughout the relevant period. [Beach] reported lower abdominal pain in August,

September and October 2020, which she stated had persisted since her gastric

bypass surgery. A CT scan had revealed no abnormality. At this time, she reported

that she was taking medication for weightloss, and was taking supplements for iron

and vitamin D deficiency. Tenderness was noted in [Beach]’s abdomen. [Beach]

also reported worsening asthma and fatigue during a treatment appointment in

November 2020. (Exhibit D8F). However, no significant treatment for these

conditions was noted through the first part of 2021. Records form July 2021

indicate that [Beach] had gained weight since her previous gastric bypass surgery,

but she denied abdominal pain or acid reflux. She requested revision of her gastric

bypass to allow for more weight loss. During the objective examination, she was

described as morbidly obese, with a wellhealed laparoscopic surgical incision on

her abdomen. However, other physical examination findings were largely normal.

[Beach] was scheduled for further evaluation. (Exhibit D15F; D16F). An upper GI

endoscopy was performed on July 22, 2021, which revealed a normal esophagus, a

small hiatal hernia, and a Roux-en-Y gastrojejunostomy with gastrojejunal

anastomosis characterized by healthy-appearing mucosa. (Exhibit D15F/39;

D16F/24).

During an annual wellness visit in August 2021, [Beach] reported burning with

urination, as well as ongoing issues with her abdominal hernia. Shortness of breath

and palpitations were noted as well. During the objective physical examination, no

wheezing was noted, and [Beach]’s lungs were clear to auscultation. These records

note normal cardiovascular findings as well, and while edema was present in the

extremities, there was no evidence of clubbing or cyanosis. (Exhibit D17F).

[Beach] again requested a potential surgical intervention to stimulate weight loss

during an appointment in August, and reported persistent abdominal pain. During

the objective examination, she was described as morbidly obese, and tenderness

was noted throughout the abdomen. [Beach] had a questionable bulge in her mid-

abdomen that was tender to palpation, and the abdominal wall was firm. Other

findings were largely normal. [Beach] was informed that there was not much more

that could be done surgically to facilitate weight loss, and she was referred to a

nutritionist and a plastic surgeon. [Beach] was scheduled for a CT scan to further

evaluate the hernia in her abdominal wall. (Exhibit D16F).

A CT scan performed of [Beach]’s abdomen on August 30, 2021 revealed no

radiographic evidence of a significant ventral hernia. Prior abdominal wall fascia

surgery as well as gastric and prior cholecystectomy were noted, as well as a low-

density lesion within the dome of the right lobe of the liver that were consistent

with a possible hemangioma, complex cyst, or other etiology. Increased caliber

small bowel was noted in the upper left abdomen with evidence of prior surgery,

but no localized mucosal thickening or obstructive changes were noted at that time.

(Exhibit D15F/17; D16F/31, 35). During a follow up appointment, [Beach]

reported persistent abdominal pain, nausea, and intermittent constipation. During

the objective examination, tenderness was noted in the abdomen, as well as a tender

questionable bulge in the mid abdomen and a firm abdominal wall. A second CT

scan was ordered due to the concerning liver mass, and [Beach] was prescribed

medication for nausea and vomiting. (Exhibit D16F). During an appointment with

a GI specialist in September 2021, [Beach] continued lower abdominal cramping

with no radiation. Physical examination findings were normal, with no worrying

symptoms requiring a repeat colonoscopy. [Beach] was going to attempt IBGard

for 1 month. (Exhibit D25F). A repeat CT scan was performed on October 5, 2021

revealed no acute intra-abdominal process and no evidence of hepatomegaly.

Hepatic hemangioma were noted, as well as post-operative changes in the stomach

and small bowel. However, there was no evidence of obstruction. (Exhibit

D15F/13; D16F/26, 30).

A follow up appointment in October confirmed that the findings on the CT scan

were consistent with hemangioma. [Beach] again requested surgery to assist in

weight loss, and requested referral to plastic surgery for liposuction of her thighs.

During the physical examination, [Beach] was described as morbidly obese, and

tenderness was noted in the abdomen. [Beach] had a questionable bulge in the mid-

abdomen that was tender to palpation, and the abdominal wall was firm.

Excessively large folds of skin were noted in the upper and lower extremities, as

well as an excessive panniculus. Other physical examination findings were largely

normal, and [Beach] ambulated with a normal gait. [Beach] was referred to plastic

surgery, and was again advised that a revisional surgery after a bypass might not be

helpful. (Exhibit D16F). She reported ongoing abdominal pain in November 2021,

stating this symptomology had worsened since she ran out of the medications she

had been taking for weight loss. [Beach]’s allergies were described as well-

controlled at that time. [Beach]’s physical examination noted tenderness in

[Beach]’s abdomen. (Exhibit D17F). [Beach] presented to the emergency

department for chest pain and tingling in January 2022, and during a follow up

appointment she stated that a chest x-ray revealed an enlarged cardiac silhouette.

Shealso stated that she felt that her blood pressure became elevated at times, and

she experienced dizziness when this happened. However, [Beach] was not on any

medications for hypertension. [Beach] also requested medications for weight loss.

During the physical examination, the findings were largely normal. [Beach]’s

prescribed medications were refilled, and she was prescribed medication for blood

pressure and started on a trial of weight loss medication. (Exhibit D26F).

[Beach] was treated for a urinary tract infection in January 2021 (Exhibit D26F),

and when she presented to the emergency department in May 2022 with reports of

epigastric pain, nausea, and chronic diarrhea, she was again treated for a urinary

tract infection. (Exhibit D21F; D30F). [Beach] also presented throughout 2022 to

follow up on her weight loss, and her weight was described as fluctuating. She

eventually ran out of samples of her prescribed medication, and could not afford to

get her own. [Beach] was interested in a new medication. During these

appointments, [Beach] stated she had been exercising some days, walking and line

dancing. Physical examination findings were largely normal, and her blood

pressure was described as improved. (Exhibit D26F). Appointments in May and

June 2022 note ongoing abdominal pain with a new onset of diarrhea. Further

evaluation of the colon was scheduled. (Exhibit D25F). A colonoscopy performed

on July 6, 2022 revealed diverticulosis in the sigmoid colon, but the examination

was otherwise normal. A colon biopsy performed revealed superficial colonic

mucosa with no evidence of chronic or active colitis. (Exhibit D25F/7-8). Though

[Beach] continued to report abdominal pain, shortness of breath, and wheezing

during an appointment in September 2022, physical examination findings were

normal. Her abdomen was soft and nontender, and her lungs were clear to

auscultation. (Exhibit D26F).

The record documents a history of treatment for musculoskeletal pain, with several

surgical interventions noted prior to the alleged onset date. (Exhibit D6F; D7F;

D22F). Though [Beach] has reported back pain through the relevant period,

imaging has revealed only mild findings. (Exhibit D7F) and straight leg raise testing

is routinely normal despite some notations of tenderness and pain in this area. (D1F;

D18F; D23F; D26F). Furthermore, [Beach] reported that physical therapy has

helped her back pain (Exhibit D23F), and pain medications have improved her

functional abilities. (Exhibit D18F; D28F). [Beach] has also reported pain in her

bilateral knees, and physical examination noted tenderness, limited motion, and

other abnormalities in these extremities. However, [Beach] has routinely exhibited

normal strength in all extremities on objective examinations. (Exhibit D1F; D18F;

D23F; D26F). Consultative examinations noted slow or antalgic gaits (Exhibit

D1F; D12F); however, treatment records routinely describe [Beach] as

‘ambulatory’ or indicate that her gait was normal despite other abnormalities.

(Exhibit D8F; D17F; D18F; D23F; D26F; D28F). [Beach] has also indicated on

multiple occasions that injections provided significant relief in her knee pain for a

period of time, and that her medications helped her pain and improved her ability

to perform her activities of daily living. (Exhibit D18F; D28F). [Beach] underwent

surgery on her right knee in October 2022 (Exhibit D22F), and records following

this surgery indicate that she was doing well. (Exhibit D27F). While an

exacerbation in pain was noted in November 2022, imaging showed intact hardware

(Exhibit D30F), and [Beach]’s gait was normal during pain management records

after this time. (Exhibit D28F). Physical therapy records also note improvement

despite some continued weakness and limited range of motion. (Exhibit D29F).

[Beach] also reports of abdominal pain and fatigue during the relevant period

(Exhibit D8F; D16F; D17F; D25F), with objective imaging and testing revealing

evidence of a hernia, hepatic hemangioma, and evidence of diverticulosis. (Exhibit

D8F; D15F; D16F; D25F). However, while physical examination findings

occasionally note tenderness or firm areas in the abdomen, findings in this area

normal on many other occasions. (Exhibit D8F; D15F; D16F; D17F; D25F).

[Beach] also reports respiratory issues (Exhibit D17F), though objective

examination routinely notes normal respiratory findings. (Exhibit D1F; D17F;

D26F). Furthermore, the records note that [Beach] has been capable of participating

in significant activities, such exercising and dancing, despite her impairments.

(Exhibit D26F; D29F).

The evidence outlined above supports the determination that, despite her reported

impairments, [Beach] is capable of performing a range of light work. She can stand

and walk for 4 hours in an 8-hour workday, and can sit for 8 hours in an 8-hour

workday. Though she can never climb a ladder, rope, or scaffold and can never

crawl due to her continued reports of pain, the many notations of a normal gait and

strength support the determination that [Beach] can occasionally climb ramps and

stairs, balance, stoop, kneel, and crouch. These findings also support the

determination that [Beach] can perform occasional pushing and pulling with the

bilateral lower extremities. To address the combined effect of [Beach]’s severe

impairments, [Beach] must avoid work at unprotected heights and must avoid work

around moving mechanical parts with vibrations and the use of vibratory tools. Due

to [Beach]’s respiratory issues, she must avoid concentrated exposure to dust,

fumes, odors, gases, and poor ventilation. Though [Beach] has used an assistive

device during her surgical recovery, there is no evidence that [Beach] has required

one throughout the relevant period, nor is there any evidence that she will continue

to require one after her recovery. As noted above, her gait has been described as

normal throughout the treatment records, and though [Beach] reported that she used

an assistive device during the consultative examination in April 2021, she did not

require it to ambulate during the evaluation.

In addition to the physical impairments outlined above, [Beach] also has a history

of treatment for mental health symptomology. (Exhibit D11F; D13F). [Beach]

presented to Centerstone Community Mental Health for symptomology associated

with PTSD and bipolar disorder with psychotic features, the most recent episode

depressed. [Beach] presented for individual therapy on July 21, 2020, the amended

alleged onset date, and these records note progress in discussing the nature of her

PTSD. Improvement in [Beach]’s mood was noted during a therapy appointment

in August 2020. (Exhibit D13F). Indeed, during an appointment in August 2020,

[Beach]’s affective and behavioral presentation was euthymic. [Beach] felt as

though her symptoms were well-regulated with her medications, and she had shown

progress toward an improvement in her mood and the ways in which she handled

conflict. (Exhibit D11F). [Beach] showed progress in utilizing coping skills during

an appointment in early September, and continued to show progress during

individual therapy in October 2020. By November 2020, [Beach] reported a

decrease in her negative mood symptoms. (Exhibit D13F). During an appointment

in January 2021, she reported a low stress level and mood stability, with no issues

with her prescribed medications. (Exhibit D11F).

[Beach] participated in a consultative psychological examination in April 2021, and

[Beach] reported ongoing outpatient therapy and medication management to treat

her mental health symptomology. During this evaluation, [Beach] reported a

“rocky” mood, including depression, suicidal thoughts, and worthlessness. She also

reported auditory and visual hallucinations, frequent panic attacks and crying

spells, and PTSD-related symptoms such as nightmares, intrusive thoughts,

hypervigilant, and difficulty being around others. [Beach] reported difficulty with

concentration and attention, as well as problems with her memory. [Beach]

underwent an objective mental status examination at that time, and she was well-

oriented and showed only mild difficulty with serial 3s. She could recall her date

of birth and social security number, named comment objects, and repeated tongue-

twisters without difficulty. [Beach] could follow a 3-step command, write a simple

3-word command sentence and perform the command, and could copy a design of

two overlapping shapes without difficulty. Though she had difficulties naming 5

large U.S cities, she could name 4 U.S. presidents. She could not name the U.S.

capitol, but could identify the shape of a ball and the colors of the American flag.

[Beach] demonstrated a concrete understanding of commonly-used proverbs and

showed good judgment in dealing with a situation. Overall, [Beach] interacted in a

polite, cooperative, and friendly manner. Her mood was euthymic with a mood-

congruent affect, though she had a few periods of tearfulness when sharing about

more stressful and traumatic experiences. [Beach]’s thought content was mood

congruent, and her thought process was overall logical and clear with some periods

of being tangential and circumstantial. Overall, she was alert, appeared to readily

built rapport with the examiner, and put forth good effort. She was estimated to be

of average intelligence. [Beach] was diagnosed with persistent depressive disorder

(dysthymia) and post-traumatic stress disorder, and bipolar II disorder was ruled

out. (Exhibit D12F).

[Beach] continued treatment with Centerstone Community Mental Health, and

records from May 2021 note slight improvement. These records note that [Beach]

demonstrated increased competence in managing her psychiatric symptoms, with

[Beach] reporting improvement and compliance with her medication regimen.

Records from June 2021 note an increase in mood swings and anxiety, but [Beach]

reported that she had been out of her medications for over 6 months. During this

appointment, [Beach]’s mood was stable, however. Her affect was appropriate, and

she weas described as alert and focused. Her thought process was organized and

logical, and her vocabulary and intelligence were both described as average. Her

recent and remote memory were intact. Though her insight into her psychiatric

condition was only described as fair, her judgment was intact. During an

appointment later in June, [Beach] reported progress in utilizing coping skills.

[Beach] reported a manic episode in July 2021, as well as continued PTSD-related

symptoms. During an individual therapy session in July, she was calm and

cooperative, however. (Exhibit D14F). No significant mental health treatment is

noted after that time until October 2021, and during an appointment at that time

[Beach] reported that she had been out of medications for 4 months. She was

experiencing mood swings and anxiety due to being out of medications, and stated

that she had not followed up with a therapist in several months. During an

appointment in November, [Beach] showed slight progress, as [Beach] had been

attending most of her appointments. She reported some fatigue and little interest in

activities, as well as periods of depression. (Exhibit D14F; D24F).

[Beach] again reported a manic episode and continued symptomology associated

with PTSD in December 2021. However, [Beach] had been non-complaint with her

therapy appointments. [Beach] reported depression in January 2022, but later in

January reported stability on her medication regimen. During a mental status

examination, [Beach]’s mood was euthymic and her affect appropriate. Her insight

was good and her judgment was intact, and she was oriented to person, place, and

time. Her thought processes were organized and appropriately abstract, and her

thought associations were intact. Recent and remote memory were intact as well.

[Beach] was described as alert and focused, and she was described as having

average intelligence and vocabulary. [Beach] reported no change in her mental

health symptoms in February 2022, but also stated that she forgot to take her

medications as prescribed at times. She reported a decrease in symptoms by March.

[Beach] was discharged from services in April 2022 because she did not return for

recommended services. (Exhibit D24F). Anxiety, panic attacks, and depression

were noted during treatment appointments in May and June 2022, and increased

stress was noted in September 2022. (Exhibit D26F).

Though [Beach] has reported exacerbations of symptomology during the relevant

period, the record also notes periods of non-compliance with [Beach]’s

recommended treatment records. She routinely reports notable improvement when

actively participating in treatment. (Exhibit D11F; D13F; D14F; D24F). Treatment

records describe [Beach] as alert, and focused, with an organized thought process

and average intelligence. [Beach] had an intact memory, and is routinely described

as calm and cooperative. (Exhibit D14F; D24F). Though [Beach] had some

difficulty with tasks during the consultative psychological examination, she was

well-oriented, could follow commands, and demonstrated good judgment. Her

mood was euthymic, and she interacted in a polite, cooperative, and friendly

manner. (Exhibit D12F). [Beach] also reports the ability to perform significant

activities of daily living, including cleaning her household, shopping, driving,

caring for a pet, and participating in social activities like line dancing. (Hearing

Testimony; Exhibit D4E; D8E; D9E; D26F; D29F). Therefore, the record supports

the determination that [Beach] can understand and remember simple instructions

and can use judgment to make simple work-related decisions. [Beach] can adapt to

routine changes in the work setting that are occasional in nature.

As for medical opinion(s) and prior administrative medical finding(s), the

undersigned cannot defer or give any specific evidentiary weight, including

controlling weight, to any prior administrative medical finding(s) or medical

opinion(s), including those from medical sources. The undersigned has fully

considered the medical opinions and prior administrative medical findings as

follows:

Upon initial review, the state agency medical consultant opined that [Beach] could

perform a range of light work, if limited to occasional climbing of ramps and stairs,

balancing, stooping, kneeling, crouching, and crawling. The state agency opined

that [Beach] could never climb ladders, ropes, or scaffolds, and should avoid

concentrated exposure to pulmonary irritants. (Exhibit D2A; D3A). The

undersigned finds this opinion to be partially persuasive. The determination that

[Beach] could perform light work is supported by the overwhelming objective

evidence, including imaging and response to treatment such as medication

management and surgical procedures during the relevant period. However, the state

agency was unable to support their findings with the most updated evidence, which

notes ongoing issues in the bilateral knees and back and persistent reports of

respiratory symptomology. This evidence is consistent with additional limitations

on [Beach]’s ability to stand and walk, as well as manipulative and environmental

limitations not contemplated by the state agency when they rendered this opinion.

Therefore, the undersigned can only find this opinion to be partially persuasive.

Upon reconsideration, the state agency again opined that [Beach] could perform a

range of light work, could never climb ladders, ropes, or scaffolds, and could only

occasionally climb ramps and stairs, balance, stoop, kneel, crouch, and crawl. The

state agency further opined that [Beach] should avoid concentrated exposure to

vibration, pulmonary irritants, and hazards. (Exhibit D6A; D7A; D10A; D11A).

The undersigned finds this opinion to be generally persuasive. This opinion is

supported by more updated evidence than the initial review discussed above. As

noted above, the determination that [Beach] could perform a range of light work is

consistent with [Beach]’s response to treatment and the normal strength and normal

gait routinely noted in the treatment records. However, [Beach]’s ongoing knee

problems, recovery from knee replacement, persistent reports of back pain, and

history of respiratory issues are more consistent with limiting [Beach] to no more

than 4 hours of standing and walking in a workday. Nevertheless, this opinion is

well-supported and largely consistent with the objective evidence, and the

undersigned therefore finds it to be generally persuasive.

Dr. Brian Bingham, the consultative examiner who evaluated [Beach] in April

2021, diagnosed [Beach] with osteoarthritis, degenerative disc disease of the

lumbar spine, obesity, and migraines by history. Dr. Bingham opined that [Beach]

could occasionally lift and carry less than 10 pounds, could frequently lift and carry

less than 10 pounds, and could stand and walk for less than 2 hours in an 8-hour

workday. He found no restrictions on [Beach]’s ability to sit. The diagnoses

rendered by Dr. Bingham are consistent with the findings in the objective medical

records. However, his limitation of [Beach] to a range of sedentary work is not

supported by his own examination, and is inconsistent with the record as a whole.

While his examination notes an antalgic gait, tenderness, limited range of motion,

and difficulty with tasks such getting up out of the chair or onto an examination

table, [Beach]’s strength was 5/5 in all major muscle groups, and straight leg testing

and Romberg testing were negative. [Beach] did not require an assistive device to

ambulate at that time. (Exhibit D1F). The treatment records routinely describe

[Beach] as having a normal gait (Exhibit D8F; D17F; D18F; D23F; D26F; D28F),

and [Beach] reported improvement in her functional abilities with injections,

medication management and physical therapy. (Exhibit D23F; D18F; D28F;

D29F). [Beach] has also been recovering well following her recent knee

replacement (Exhibit D22F; D27F; D28F; D30F). This evidence is more consistent

with the determination that [Beach] could perform a range of light work. As this

opinion is not supported by the objective examination at the time it was rendered

and is not consistent with the record as a whole, the undersigned can only find it

persuasive with regards to the diagnoses rendered, and not as to the functional

limitations placed on [Beach].

Upon initial review, the state agency found severe mental limitations. They opined

that [Beach] would be able to understand, remember, and carry out simple and

lower-level detailed work instructions, but no complex or executive work. The state

agency further opined that [Beach] was limited to occasional changes in a work

setting. (Exhibit D2A; D3A). The same limitations are noted upon reconsideration,

and moderate limitations were noted in [Beach]’s ability to concentrate, persist, and

maintain pace and in her ability to adapt and manage herself. Mild limitations were

noted in her ability to understand, remember, and apply information and in her

ability to interact with others. (Exhibit D6A; D7A; D10A; D11A). The undersigned

finds this opinion to be partially persuasive. Though well-supported by the evidence

available to the state agency at the time they rendered their opinion, [Beach]’s

mental health symptomology combined with her pain and fatigue are more

consistent with moderate limitations in all areas of mental functioning except for

her ability to interact with others. However, the determination that [Beach] would

be capable of performing unskilled work and adapting to occasional changes in a

work setting is consistent with the many normal findings on mental status

examinations throughout the relevant period, as well as [Beach]’s significant

reported activities of daily living. A mild limitation in interacting with others is

consistent with her routinely cooperative attitude and ability to perform significant

activities in public despite her reports of social difficulties. As these opinions are

well-supported and are largely consistent with the overall evidence, the

undersigned finds them to be partially persuasive despite the support for a moderate

limitation in understanding, remembering, and applying information in the

objective treatment records.

Dr. Shari K. Neul, the consultative psychological examiner who evaluated [Beach]

in April 2021, opined that [Beach] had mild to moderate difficulties with her mood.

Dr. Neul opined that [Beach]’s symptoms did not appear to significantly impact her

ability to engage in activities of daily living, but her symptoms may pose mild to

moderate difficulties in the workplace when certain conditions were present, such

as tensions between coworkers, unsupportive supervisors or management, work

involving moderate physical activity and stamina, and perceiving the work

environment and/or persons in the environment as dangerous or unsafe. (Exhibit

D12F). The undersigned also finds this opinion to be partially persuasive. The

diagnoses are consistent with the treatment records. Furthermore, the determination

that [Beach] has no more than moderate limitations in any area of mental

functioning is consistent with the many normal mental status examinations noted

throughout the relevant period, as well as [Beach]’s noted improvement with

treatment and her significant reported activities of daily living. However, any

limitations in interaction considered by Dr. Neul are not supported by her

cooperative, engaged attitude during the consultative examination, and are not

consistent with her ability to routinely engage with others in public for activities

like line dancing. As this opinion is not entirely supported by the objective

examination findings and is only somewhat consistent with the overall evidence,

the undersigned can only find it to be partially persuasive.

Based on the foregoing, the undersigned finds [Beach] has the above residual

functional capacity assessment, which is supported by [Beach]’s response to

treatment, the imaging and testing in the record, the objective examination findings

throughout the relevant period, and [Beach]’s reported activities of daily living. The

evidence outlined above supports the determination that [Beach] could perform a

range of light work, and could stand and walk for 4 hours in an 8-hour workday.

Though [Beach] can never climb a ladder, rope, or scaffold or crawl, she can

occasionally climb ramps and stairs, balance, stoop, kneel, and crouch. [Beach] can

also perform occasional pushing and pulling with the bilateral lower extremities.

To address the combined effect of her impairments, [Beach] must avoid work at

unprotected heights, must avoid work around moving mechanical parts with

vibrations and the use of vibratory tools, and must avoid concentrated exposure to

dust, fumes, odors, gases, and poor ventilation. Despite her mental impairments,

[Beach] can understand and remember simple instructions and can use judgment to

make simple work-related decisions. [Beach] can adapt to routine changes in the

work setting that are occasional in nature.

(AR 60–74.)

Beach states that she has a “history of [ ] mental, physical, [and] emotional illnesses” that

have “gotten worse” since she was a child. (Doc. No. 16, PageID# 2044.) She also refers to “sexual

[abuse]” that she experienced as a child. (Id.) Beach points out that she has “had several surgeries”

for her physical impairments, including knee replacement surgeries, and states that she “needs to

have another surgery on both knees now.” (Id. at PageID# 2045.) Beach states that “[her] blood

pressure starting high is an issue for [her] . . . .” (Id.) Beach further states that she has PTSD,

anxiety, and bipolar disorder and experiences panic attacks. (Id.) Beach points out that she has “to

take medicine for [her] many issues ” and that she “can’t stand or sit for a long time without

pain. . . .” (Id.)

Beach states that she “[does not] think that [the ALJ] looked at all of [her] records” in

determining whether she is disabled. (Doc. No. 16, PageID# 2045.) The SSA has promised DIB

and SSI claimants that it “will consider all evidence in [the] case record” when determining

disability claims. 20 C.F.R. §§ 404.1520(a)(3), 416.920(a)(3). However, “the ALJ need not

expressly mention every piece of evidence” he or she considered in the written opinion “so long

as the overall decision was supported by substantial evidence.” Noto v. Comm’r of Soc. Sec., 632

F. App’x 243, 250 (6th Cir. 2015) (first citing Loral Def. Sys.-Akron v. N.L.R.B., 200 F.3d 436,

453 (6th Cir. 1999); and then citing 20 C.F.R. § 404.953); see also Big Branch Res., Inc. v. Ogle,

737 F.3d 1063, 1072 (6th Cir. 2013) (“[W]e do not require the ALJ to remark on every piece of

evidence. . . . Our review is whether the ALJ’s decision rests on substantial evidence.”).

Here, the ALJ considered and discussed extensive record evidence regarding Beach’s

physical and mental impairments, including, but not limited to, her surgeries, knee problems, blood

pressure, PTSD, anxiety, bipolar disorder, and panic attacks. (AR 60–74.) The ALJ did not

expressly mention the sexual abuse that Beach survived as a child.3 But the ALJ considered and

discussed Beach’s PTSD, including Dr. Neul’s opinion and Beach’s Centerstone treatment

records. The ALJ also considered and discussed the effects of prescribed medications on Beach’s

physical and mental impairments and symptoms. (Id.) And the ALJ considered and discussed

3 The record shows that Beach told consulting psychological examiner Dr. Neul that “around

age 7 she was sexually abused by a neighbor and a family member. This abuse occurred until about

age 11.” (AR 1323.) Neul diagnosed Beach with PTSD, among other mental impairments, and

found that Beach “experience[es] PTSD symptoms related to her trauma and abuse history.”

(AR 1325.) The record also contains Beach’s treatment records from Centerstone Community

Mental Health showing that Beach experienced childhood sexual abuse and related PTSD

symptoms. (AR 1276–1320, 1327–1499, 1742–92.)

whether Beach’s testimony about her symptoms, including pain, was consistent with the overall

record evidence.

Beach has not identified any specific evidence that the ALJ failed to consider. Instead, she

“presents the same evidence the ALJ discussed and requests that this Court reach a different

outcome—an impermissible request to reweigh the evidence.” Incorvia v. Comm’r of Soc. Sec.,

Case No. 1:22-CV-01911, 2023 WL 6519152, at *9 (N.D. Ohio Sept. 20, 2023), report and

recommendation adopted, 2023 WL 6519082 (N.D. Ohio Oct. 5, 2023). Even if the evidence

Beach identifies “is considered to be substantial, it is insufficient on its own to warrant reversal.”

Shelton v. Comm’r of Soc. Sec., Case No. 2:18-cv-00093, 2020 WL 707586, at *9 (M.D. Tenn.

Feb. 12, 2020), report and recommendation adopted sub nom. Shelton v. Saul, 2020 WL 1284628

(M.D. Tenn. Mar. 18, 2020). This Court must defer to an ALJ’s finding that is supported by

substantial evidence “even if there is substantial evidence in the record that would have supported

an opposite conclusion.” Blakley, 581 F.3d at 406 (quoting Key v. Callahan, 109 F.3d 270, 273

(6th Cir. 1997)); see also id. (“The substantial-evidence standard . . . presupposes that there is a

zone of choice within which the decisionmakers can go either way, without interference by the

courts.” (alteration in original) (quoting Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir. 1986)). The

ALJ based the determination of Beach’s RFC on numerous medical records and opinions. Beach

has not shown that the ALJ’s determination lacks the support of substantial record evidence.

Beach also argues that she is “not able to work how [she] did years ago.” (Doc. No. 16,

PageID# 2045.) The ALJ agreed with Beach on this point, finding that she “is unable to perform

past relevant work as” a home health aide because of her current medically determinable

impairments. (AR 74.) However, the ALJ also found, based on vocational expert testimony, that

Beach can perform other work—specifically as a mail sorter, routing clerk, merchandise marker,

document preparer, tube operator, or printed circuit board inspector—and that these jobs exist in

significant numbers in the national economy. (AR 74-75.) Beach has not shown that this finding

lacks the support of substantial record evidence.

IV. Recommendation

For these reasons, the Magistrate Judge RECOMMENDS that Beach’s motion for

judgment on the administrative record (Doc. No. 16) be DENIED and the Commissioner’s

disability determination be AFFIRMED.

Any party has fourteen days after being served with this Report and Recommendation to

file specific written objections. Failure to file specific objections within fourteen days of receipt

of this Report and Recommendation can constitute a waiver of appeal of the matters decided.

Thomas v. Arn, 474 U.S. 140, 155 (1985); Cowherd v. Million, 380 F.3d 909, 912 (6th Cir. 2004).

A party who opposes any objections that are filed may file a response within fourteen days after

being served with the objections. Fed. R. Civ. P. 72(b)(2).

Entered this 15th day of August, 2025.

ghia noleonr

ALISTA' . NEWBERN

United States Magistrate Judge

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