# Beach v. Office of Appellate Operations

> District Court, M.D. Tennessee · August 15, 2025

URL: https://www.frixlaw.com/law-library/cases/11138044

## Case

- **Court:** District Court, M.D. Tennessee
- **Decided:** August 15, 2025
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/11138044

## How later opinions describe it (automated extraction)

- explaining that this definition applies in the DIB and SSI contexts

## Opinion text

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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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/11138044. Public record. Not legal advice.