Andrews

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF OHIO

WESTERN DIVISION

BLANCHE A.,1 Case No. 1:24-cv-648

Plaintiff, Litkovitz, M.J.

vs.

COMMISSIONER OF ORDER

SOCIAL SECURITY,

Defendant.

Plaintiff Blanche A. brings this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) for

judicial review of the final decision of the Commissioner of Social Security (Commissioner)

denying plaintiff’s application for supplemental security income (SSI). This matter is before the

Court on plaintiff’s statement of errors (Doc. 9), the Commissioner’s response (Doc. 11), and

plaintiff’s reply (Doc. 12).

I. Procedural Background

Plaintiff protectively filed her application for SSI on December 16, 2021, alleging a

disability onset date of January 1, 2021,2 due to swollen feet, aching leg, neck cramps, and

headaches. (Tr. 174‒77, see also Tr. 10, 193). The application was denied initially and upon

reconsideration. Plaintiff, through counsel, requested and was granted a de novo telephone

hearing before administrative law judge (ALJ) Cristen Meadows. Plaintiff and a vocational

1 Pursuant to General Order 22-01, due to significant privacy concerns in social security cases, any

opinion, order, judgment or other disposition in social security cases in the Southern District of Ohio shall

refer to plaintiffs only by their first names and last initials.

2 Regardless of the actual or alleged onset of disability, an SSI claimant is not entitled to SSI benefits

prior to the date the claimant files an SSI application. Thus, the relevant period of consideration in this

case begins on December 16, 2021. See 20 C.F.R. § 416.335; Koster v. Comm’r of Soc. Sec., 643 Fed.

Appx. 466, 478 (6th Cir. 2016) (“For purposes of SSI, which is not retroactive, the relevant period here is

. . . the date [Plaintiff] filed his protective application.”).

expert (VE) appeared telephonically and testified at the ALJ hearing on May 19, 2023. (Tr. 36‒

66). On August 24, 2023, the ALJ issued a decision denying plaintiff’s application. (Tr. 7‒24).

This decision became the final decision of the Commissioner when the Appeals Council denied

review on December 13, 2022. (Tr. 1‒6).

II. Analysis

A. Legal Framework for Disability Determinations

To qualify for SSI, a claimant must suffer from a medically determinable physical or

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

last for a continuous period of not less than 12 months. 42 U.S.C. § 1382c(a)(3)(A). The

impairment must render the claimant unable to engage in the work previously performed or in

any other substantial gainful employment that exists in the national economy. 42 U.S.C. §

1382c(a)(3)(B).

Regulations promulgated by the Commissioner establish a five-step sequential evaluation

process for disability determinations:

1) If the claimant is doing substantial gainful activity, the claimant is not disabled.

2) If the claimant does not have a severe medically determinable physical or

mental impairment – i.e., an impairment that significantly limits his or her

physical or mental ability to do basic work activities – the claimant is not

disabled.

3) If the claimant has a severe impairment(s) that meets or equals one of the

listings in Appendix 1 to Subpart P of the regulations and meets the duration

requirement, the claimant is disabled.

4) If the claimant’s impairment does not prevent him or her from doing his or her

past relevant work, the claimant is not disabled.

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5) If the claimant can make an adjustment to other work, the claimant is not

disabled. If the claimant cannot make an adjustment to other work, the claimant

is disabled.

Rabbers v. Comm’r of Soc. Sec., 582 F.3d 647, 652 (6th Cir. 2009) (citing 20 C.F.R. §§

416.920(a)(4)(i)-(v), 416.920 (b)-(g)). The claimant has the burden of proof at the first four

steps of the sequential evaluation process. Id.; Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 548

(6th Cir. 2004). Once the claimant establishes a prima facie case by showing an inability to

perform the relevant previous employment, the burden shifts to the Commissioner to show that

the claimant can perform other substantial gainful employment and that such employment exists

in the national economy. Rabbers, 582 F.3d at 652; Harmon v. Apfel, 168 F.3d 289, 291 (6th

Cir. 1999).

B. The Administrative Law Judge’s Findings

The ALJ applied the sequential evaluation process and made the following findings of

fact and conclusions of law:

1. [Plaintiff] has not engaged in substantial gainful activity since December 16,

2021, the application date (20 CFR 416.971 et seq.).

2. [Plaintiff] has the following severe impairments: migraine headaches,

hypertension, degenerative disc disease of the cervical and lumbar spines,

osteoarthritis of the knees (20 CFR 416.920(c)).

3. [Plaintiff] 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 416.920(d), 416.925 and

416.926).

4. After careful consideration of the entire record, [the ALJ] find[s] that

[plaintiff] has the residual functional capacity to perform medium work as

defined in 20 CFR 416.967(c) except she could frequently climb ramps or stairs;

never climb ladders, ropes, or scaffolds; frequently stoop, kneel, crouch, crawl;

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avoid concentrated exposure to noise at more than the moderate level as defined

in the Selected Characteristics of Occupations (SCO); avoid concentrated

exposure to fumes, odors, dusts, gasses, and poor ventilation; and avoid

concentrated exposure to light brighter than a typical office.

5. [Plaintiff] has no past relevant work (20 CFR 416.965).3

6. [Plaintiff] was born [in] … 1963 and was 58 years old, which is defined as an

individual of advanced age, on the date the application was filed. [Plaintiff]

subsequently changed age category to closely approaching retirement age (20

CFR 416.963).

7. [Plaintiff] has at least a high school education (20 CFR 416.964).

8. Transferability of job skills is not an issue in this case because [plaintiff] does

not have past relevant work (20 CFR 416.968).

9. Considering [plaintiff]’s age, education, work experience, and residual

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

economy that [plaintiff] can perform (20 CFR 416.969 and 416.969a).4

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

Act, since December 16, 2021, the date the application was filed (20 CFR

416.920(g)).

(Tr. 12-20) (footnotes added).

C. Judicial Standard of Review

Judicial review of the Commissioner’s determination is limited in scope by 42 U.S.C. §

405(g) and involves a twofold inquiry: (1) whether the findings of the ALJ are supported by

substantial evidence, and (2) whether the ALJ applied the correct legal standards. See Blakley v.

3 Plaintiff had self-employment as a babysitter in 2009, 2013, and 2014, but her earnings did not meet the threshold

to qualify as past relevant work. (Tr. 19, 61-62).

4 Relying on the VE’s testimony, the ALJ found that plaintiff would be able to perform the requirements of

representative medium, unskilled occupations such as a dining room attendant (56,000 jobs in the national economy), a

kitchen helper (275,000 jobs in the national economy), or a counter supply worker (113,000 jobs in the national

e conomy). (Tr. 19-20, 63-64 ).

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Comm’r of Soc. Sec., 581 F.3d 399, 406 (6th Cir. 2009); see also Bowen v. Comm’r of Soc. Sec.,

478 F.3d 742, 745-46 (6th Cir. 2007).

The Commissioner’s findings must stand if they are supported by “such relevant evidence

as a reasonable mind might accept as adequate to support a conclusion.” Biestek v. Berryhill,

587 U.S. 97, 103 (2019) (citing Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229 (1938)).

Substantial evidence consists of “more than a scintilla of evidence but less than a preponderance.

. . .” Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). In deciding whether the

Commissioner’s findings are supported by substantial evidence, the Court considers the record as

a whole. Hephner v. Mathews, 574 F.2d 359 (6th Cir. 1978).

The Court must also determine whether the ALJ applied the correct legal standards in the

disability determination. Even if substantial evidence supports the ALJ’s conclusion that the

plaintiff is not disabled, “a decision of the Commissioner will not be upheld where the SSA fails

to follow its own regulations and where that error prejudices a claimant on the merits or deprives

the claimant of a substantial right.” Rabbers, 582 F.3d at 651 (quoting Bowen, 478 F.3d at 746).

D. Specific Errors

Plaintiff raises three assignments of error: (1) the ALJ erred in evaluating her allegations

of pain and dysfunction; (2) the ALJ’s residual functional capacity (RFC) finding is unsupported

by substantial evidence because the ALJ failed to explain how an individual with abnormal

objective findings could perform medium exertional work; and (3) the ALJ failed to evaluate the

medical source opinion of Aaron Freeman, A.P.R.N., C.N.P. (Doc. 9 at PAGEID 472‒80). The

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Commissioner counters that substantial evidence supports the ALJ’s subjective symptom analysis

and RFC finding. (Doc. 11 at PAGEID 488-95).

1. The ALJ’s subjective symptom analysis is supported by substantial

evidence.

ALJs are to “consider all of the evidence in an individual’s record” and determine

whether the individual is disabled by examining “all of the individual’s symptoms, including

pain, and the extent to which the symptoms can reasonably be accepted as consistent with the

objective medical evidence and other evidence in the individual’s record.” SSR 16‒3p, 2016

WL 1119029, at *2. ALJs also evaluate the “consistency” of a claimant’s subjective description

of symptoms with the record. See Lipanye v. Comm’r of Soc. Sec., 802 F. App’x 165, 171 n.3

(6th Cir. 2020) (citing Dooley v. Comm’r of Soc. Sec., 656 F. App’x 113, 119 n.1 (6th Cir.

2016)).

A two‒step inquiry applies to symptom evaluation. The ALJ first determines if the

record contains objective medical evidence of an underlying medically determinable impairment

that could reasonably be expected to produce the individual’s symptoms. SSR 16‒3p, 2016 WL

1119029, at *3; see also 20 C.F.R. § 416.929(a); Jones v. Comm’r of Soc. Sec., 336 F.3d 469,

475‒76 (6th Cir. 2003). Step two of symptom evaluation shifts to the severity of a claimant’s

symptoms. The ALJ must consider the intensity and persistence of the symptoms to determine

the extent to which the symptoms limit an individual’s ability to perform work‒related activities.

See 20 C.F.R. §§ 416.929(a) and (c); SSR16‒3p, 2016 WL 1119029, at *4. In making this

determination, the ALJ will consider the following:

(i) Your daily activities;

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(ii) The location, duration, frequency, and intensity of your pain or other

symptoms;

(iii) Precipitating and aggravating factors;

(iv) The type, dosage, effectiveness, and side effects of any medication you

take or have taken to alleviate your pain or other symptoms;

(v) Treatment, other than medication, you receive or have received for relief

of your pain or other symptoms;

(vi) Any measures you use or have used to relieve your pain or other

symptoms (e.g., lying flat on your back, standing for 15 to 20 minutes

every hour, sleeping on a board, etc.); and

(vii) Other factors concerning your functional limitations and restrictions due to

pain or other symptoms.

20 C.F.R. § 416.929(c)(3).

An ALJ may not consider only objective medical evidence in determining disability

unless this evidence alone supports a finding of disability. SSR 16‒3p, 2016 WL 1119029, at *5

(“If we cannot make a disability determination or decision that is fully favorable based solely on

objective medical evidence, then we carefully consider other evidence in the record in reaching a

conclusion about the intensity, persistence, and limiting effects of an individual’s symptoms.”);

20 C.F.R. § 416.929(c)(2) (“[W]e will not reject your statements about the intensity and

persistence of your pain or other symptoms or about the effect your symptoms have on your

ability to work . . . solely because the available objective medical evidence does not substantiate

your statements.”). Moreover,

[i]t is . . . not enough for our adjudicators simply to recite the factors described in

the regulations for evaluating symptoms. The determination or decision must

contain specific reasons for the weight given to the individual’s symptoms, be

consistent with and supported by the evidence, and be clearly articulated so the

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individual and any subsequent reviewer can assess how the adjudicator evaluated

the individual’s symptoms.

SSR 16‒3p, 2016 WL 1119029, at *9. See also Id. at *7 (noting that the ALJ “will discuss the

factors pertinent to the evidence of record”). At the same time, the ALJ is not required to cite or

discuss every factor used to evaluate the consistency of a plaintiff’s description of symptoms

with the record evidence. See White v. Comm’r of Soc. Sec., 572 F.3d 272, 287 (6th Cir. 2009).

In this case, the ALJ concluded that plaintiff’s medically determinable impairments could

reasonably be expected to cause the symptoms alleged but found her statements concerning the

intensity, persistence and limiting effects of these symptoms not entirely consistent with the

medical and other evidence in the record. (Tr. 17). In reaching this conclusion, the ALJ

specifically discussed the following evidence, consistent with 20 C.F.R. § 416.929(c)(3).

Plaintiff reported babysitting for an eight-year-old child three to four days per week,

attending church, walking to her sister’s home, and standing for thirty minutes without pain (Tr.

15). Although plaintiff reported edema and pain in her legs in June 2021, her medical

examination at that time revealed normal gait, no edema, and normal systems except for noting

pain in her ankles. (Tr. 16, citing Tr. 268). During her April 2022 consultative examination with

Dr. Phillip Swedberg, M.D., plaintiff reported feeling as though her legs would give out after

standing for three hours, but, on exam, her gait was normal, she required no assistive device, her

strength and neuromuscular findings were normal and without weakness. (Tr. 16, citing Tr. 293-

300). Although Dr. Swedberg noted plaintiff’s difficulty in forward bending and crepitus with

range of motion of both knees, her examination was otherwise unremarkable. (Tr. 16, citing Tr.

300).

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In May 2022, plaintiff reported headaches occurring every other day and numbness in the

big toe on her left foot. (Tr. 16, citing Tr. 309). Her medical examination was normal except for

paresthesia of her big toe. The examination of her extremities revealed no edema. (Tr. 16, citing

Tr. 311-12). Her medical provider diagnosed essential hypertension and migraine, not

intractable, and prescribed amitriptyline and recommended stretching. (Tr. 16, citing 312-313).

Plaintiff declined electromyography for further evaluation unless her symptoms worsened. (Tr.

16, citing 313).

In August 2022, plaintiff reported back pain and left ear pain that began one week earlier.

(Tr. 16, citing Tr. 362). Her physical examination revealed a dysfunction of her left eustachian

tube and pain to her paraspinal region on palpation, but her gait and spinal range of motion were

normal. (Tr. 365). Her care provider adjusted her medication for back pain, but plaintiff

declined physical therapy at that time. (Tr. 16, citing Tr. 365).

In January 2023, plaintiff again reported headaches with neck stiffness, back pain,

hyperlipidemia and hypertension. (Tr. 16, citing Tr. 378). Plaintiff was compliant with her

medications and reported no symptoms associated with hyperlipidemia or hypertension. (Tr. 16,

citing Tr. 379). Her medical examination revealed left-sided neck and lower back tenderness to

palpation, but all other findings were normal. (Tr. 16, citing Tr. 382). She ambulated with a

steady gait and required no assistive device. (Id.). After the hearing before the ALJ, plaintiff

underwent consultative diagnostic imaging of her spine and left knee. (Tr. 16, citing Tr. 433-37).

The imaging revealed mild osteoarthritis in her left knee and degenerative changes in her

cervical and lumbar spine, with grade 1 degenerative spondylolisthesis at L4-5. (Id.).

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Plaintiff contends that the ALJ “failed to provide adequate reasons for rejecting

Plaintiff’s allegations of pain and dysfunction.” (Doc. 9 at PAGEID 474). The Court disagrees.

First, the ALJ explicitly cited the reasons for finding the intensity and limiting effects of

plaintiff’s impairments not entirely consistent with the medical and other evidence in the record,

including:

1) plaintiff’s “infrequent, routine, and conservative” medical treatment (Tr. 17);

2) the consistently normal medical examinations of plaintiff’s back regarding gait

and station (Tr. 18);

3) the post-hearing diagnostic imaging that revealed only mild left knee

osteoarthritis and degenerative changes in the cervical and lumbar spin without

any indication for radicular symptoms or stenosis and spondylolisthesis that was

“noted as grade 1 and without nerve root involvement” (Tr. 18); and

4) the opinions of state agency consultant physicians Dr. Gerald Klyop and Dr. Leon

Hughes, M.D., and consultative examiner Dr. Phillip Swedberg, M.D., all of

whom concluded that plaintiff can perform medium exertional work with

additional limitations (Tr. 17-18).

Second, the ALJ did not “reject” plaintiff’s allegations of pain and dysfunction. Instead,

the ALJ—recognizing that plaintiff’s medically determinable impairments could reasonably be

expected to cause some symptoms—added greater limitations to address plaintiff’s migraine

triggers, foot numbness, and hypertension with lower extremity swelling. (Tr. 17). Specifically,

the ALJ limited plaintiff to never climbing ladders, ropes or scaffolds; avoiding concentrated

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exposure to noise at more than the moderate level; avoiding concentrated exposure to fumes,

odors, dusts, gasses, and poor ventilation; and avoiding concentrated exposure to light brighter

than a typical office. (Tr. 14, 17-18). Therefore, the ALJ’s symptom severity evaluation is

supported by substantial evidence, and plaintiff’s first statement of error will be overruled.

2. The ALJ’s RFC determination is supported by substantial evidence.

The RFC assessment is an evaluation of the most a claimant can still do despite her

limitations. 20 C.F.R. § 416.945(a)(1). The ALJ is vested with the responsibility for assessing a

claimant’s RFC based on the relevant medical and other evidence. 20 C.F.R. §§ 416.945(a)(3),

416.946(c). “[T]he threshold for such evidentiary sufficiency is not high.” O’Brien v. Comm’r

of Soc. Sec., 819 F. App’x 409, 416 (6th Cir. 2020) (quoting Biestek, 139 S. Ct. at 1154). “[T]he

decision cannot be overturned if substantial evidence, or even a preponderance of the evidence,

supports the claimant’s position, so long as substantial evidence also supports the conclusion

reached by the ALJ.” Id. (quoting Jones v. Comm’r of Soc. Sec., 336 F.3d 469, 477 (6th Cir.

2003)). The plaintiff “bears the burden of demonstrating a RFC more restrictive than that

determined by the ALJ.” Jordan v. Comm’r of Soc. Sec., 548 F.3d 417, 423 (6th Cir. 2008).

Plaintiff contends that the ALJ’s RFC determination is not supported by substantial

evidence because plaintiff’s physical examinations and diagnostic imaging showed abnormal

results, the ALJ failed to provide a narrative discussion showing how the evidence supports the

RFC finding, and the ALJ relied heavily on the medical opinions of the state agency consultants

to determine plaintiff’s RFC for medium exertional work, even though those medical consultants

did not have the benefit of plaintiff’s July 2023 diagnostic imaging results. (Doc. 9 at PAGEID

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475-77). The Commissioner counters that the ALJ considered all the evidence, including the

medical records on which plaintiff relies, and reasonably concluded that plaintiff could perform a

limited range of medium work. The Commissioner further contends that, although the state

agency physicians did not have access to the evidence submitted after the hearing date, the ALJ

specifically considered that evidence in formulating the RFC. (Doc. 11 at PAGEID 492-95).

As detailed above, the ALJ considered, discussed, and cited to many of the same medical

records plaintiff now cites in support of this alleged error. Specifically, the ALJ discussed

plaintiff’s “crepitus with range of motion in both knees” (which Dr. Swedberg diagnosed as

osteoarthritis of the knees) and her “difficulty forward bending.” (Tr. 16, citing Tr. 300). The

ALJ noted plaintiff’s ankle pain (Tr. 16, citing Tr. 268), paresthesia in her toe (Tr. 16, citing Tr.

309, 312), and edema in her ankles (Tr. 16, citing Tr. 268).5 The ALJ further discussed

plaintiff’s July 2023 diagnostic imaging which revealed “mild left knee osteoarthritis, cervical

degenerative changes most pronounced at C5-C6 levels, and degenerative changes in the lumbar

most pronounced at L3-S1 levels, with grade 1 degenerative spondylolisthesis at L4-5.” (Tr. 16,

citing Tr. 435-37). However, the ALJ explained that, despite those impairments:

Overall, [plaintiff’s] back issues have been managed conservatively and her exams

are consistently normal regarding gait and station. [Plaintiff’s] diagnostic imaging

post hearing noted only mild left knee osteoarthritis and degenerative changes in

the cervical and lumbar without any indication for radicular symptoms or stenosis.

Her imaging did show spondylolisthesis at L4-5 but noted as grade 1 and without

nerve root involvement at this time. Given her mild osteoarthritis in the left knee

confirmed on imaging and exam findings in both knees (crepitus) by the

consultative examiner, and degenerative changes in the cervical and lumbar

confirmed by imaging post-hearing, the [state agency consultative] opinions are

consistent with the record overall that shows [plaintiff] can perform medium

5 The medical record to which plaintiff cites in support of edema in her ankles specifically describes the severity of

such edema as “trace.” (Tr. 373).

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exertional work except frequently climb ramps or stairs, as well as frequently stoop,

kneel, crouch, crawl.

(Tr. 18). To accommodate plaintiff’s headaches, asymptomatic hypertension, and numbness in

her toe, the ALJ added the limitation that she never climb ladders, ropes, or scaffolds. (Tr. 17).

The ALJ also “added greater limitations, particularly to address migraine triggers,” including

avoiding concentrated exposure to noise at more than the moderate level; avoiding concentrated

exposure to fumes, odors, dusts, gasses, and poor ventilation; and avoiding concentrated

exposure to light brighter than a typical office. (Id.).

Because the ALJ both considered the specific impairments to which plaintiff now cites

and explained why she found them consistent with the RFC for medium exertional work with

additional limitations, plaintiff’s contention in essence invites the Court to reweigh the evidence

before the ALJ. See Nasser v. Comm’r of Soc. Sec., No. 22-1293, 2022 WL 17348838, at *2 (6th

Cir. Dec. 1, 2022) (Where substantial evidence supports the ALJ’s evaluation of a medical

opinion, arguments supporting a contrary opinion “are a veiled attempt to have [the Court]

reweigh the evidence.”). As explained above, the ALJ considered the relevant medical evidence

in the record and reasonably concluded that plaintiff could perform a reduced range of medium

work with additional limitations.

As for the ALJ’s reliance on the state agency physicians’ opinions, even though they did

not have access to the evidence submitted after the hearing date, the ALJ specifically considered

that evidence in formulating the RFC. The law is well-settled that:

[T]he ALJ was not required to obtain an updated medical opinion to evaluate the

new medical evidence. Instead, the ALJ was entitled to rely on the opinions of the

state agency medical and psychological consultants, even if the record contained

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later-submitted evidence, as long as the ALJ considered the later records and

accounted for any relevant differences in them. E.g., McGrew v. Comm’r of Soc.

Sec., 343 F. App’x 26, 32 (6th Cir. 2009) (“McGrew also argues that the ALJ

improperly relied on the state agency physicians’ opinions because they were out

of date and did not account for changes in her medical condition. It is clear from

the ALJ’s decision, however, that he considered the medical examinations that

occurred after [the state agency medical consultant’s] assessment, . . . including [a

treating neurologist’s] contrary assessment, and took into account any relevant

changes in McGrew’s condition.”); Ealy v. Comm’r of Soc. Sec., 594 F.3d 504, 513

(6th Cir. 2010) . . . .

Molly H. v. Comm’r of Soc. Sec., No. 3:24-cv-00181, 2025 WL 2630681, at *12 (S.D. Ohio Sept.

12, 2025). See also Nadia T. v. Comm’r of Soc. Sec., No. 3:25-cv-121, 2026 WL 45099, at *9

(S.D. Ohio Jan. 7, 2026), report and recommendation adopted, 2026 WL 173828 (Jan. 22,

2026).

Here, the ALJ discussed at some length plaintiff’s July 2023 diagnostic imaging. (Tr. 10,

16, 18).6 The ALJ discussed the degenerative changes in plaintiff’s spine but specifically noted

that there was no indication for radicular symptoms or stenosis and that plaintiff’s

spondylolisthesis was grade 1 and without nerve root involvement. (Tr. 18). In addition, rather

than being inconsistent with consultative examiner Dr. Swedberg’s opinion, the July 2023

imaging confirmed his opinion related to mild osteoarthritis in plaintiff’s left knee, and the ALJ

“accorded consideration” to “Dr. Swedberg’s finding about crepitus in both knees.” (Tr. 18)

6 In addition to plaintiff’s 2023 diagnostic imaging, plaintiff references physical therapy records from 2019 that note

decreased range of motion in her neck. (Doc. 9 at PAGEID 476, citing Tr. 409, 413, 417, 419, 423, and 426). The

ALJ held open the record for thirty days after the 2023 hearing so plaintiff could submit these 2019 records. (Tr.

10). The ALJ considered those records in her RFC, stating:

Prior to the alleged onset date, [plaintiff’s] record does show a history of acute neck pain and

decreased range of motion associated with difficulty sleeping and impaired mobility for which she

had seven physical therapy sessions in 2019 and had reported 50% improvement in her symptoms

(5F/3-4). She was transitioned to home exercises and reported ongoing headaches and neck pain

with function and disrupted sleep at that time (5F/5).

(Tr. 15).

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(Compare Dr. Swedberg’s impression of “Probably osteoarthritis, knees” (Tr. 300) with the

imaging reading physician’s impression of “Mild left knee osteoarthritis” (Tr. 434)). Therefore,

the ALJ’s RFC determination as to plaintiff’s physical impairments is supported by substantial

evidence, and plaintiff’s second statement of error will be overruled.

3. The ALJ properly evaluated the opinion of Aaron Freeman A.P.R.N.,

C.N.P

ALJs must adhere to agency regulations governing the evaluation of medical opinion

evidence. Under the regulations applicable to plaintiff’s claims, the Commissioner will “not

defer or give any specific evidentiary weight, including controlling weight, to any medical

opinion(s) or prior administrative medical finding(s), including those from your medical

sources.”7 20 C.F.R. § 416.920c(a). Rather, the Commissioner will consider “how persuasive”

the medical opinion is. 20 C.F.R. § 416.920c(b).

In determining the persuasiveness of a medical opinion, the ALJ considers five factors:

(1) supportability, (2) consistency, (3) relationship with the claimant, including length of

treatment relationship, frequency of examinations, purpose of the treatment relationship, and

examining relationship, (4) specialization, and (5) other factors that tend to support or contradict

a medical opinion. 20 C.F.R. § 416.920c(c)(1)‒(5). The most important factors the ALJ must

consider are supportability and consistency. 20 C.F.R. § 416.920c(b)(2). With respect to the

supportability factor, “[t]he more relevant the objective medical evidence8 and supporting

7 A “prior administrative medical finding” is defined as “[a] finding, other than the ultimate determination about

whether the individual is disabled, about a medical issue made by an MC [medical consultant] or PC [psychological

consultant] at a prior administrative level in the current claim.” 82 Fed. Reg. 5844-01, 2017 WL 168819, at *5850.

8 Objective medical evidence is defined as “signs, laboratory findings, or both.” 82 Fed. Reg. 5844-01, 2017 WL

168819, at *5850.

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explanations presented by a medical source are to support his or her medical opinion(s) . . . the

more persuasive the medical opinions . . . will be.” 20 C.F.R. § 416.920c(c)(1). Similarly, “[t]he

more consistent a medical opinion(s) . . . is with the evidence from other medical sources and

nonmedical sources in the claim, the more persuasive the medical opinion(s). . . .” 20 C.F.R. §

416.920c(c)(2). The ALJ is required to “explain how [he/she] considered the supportability and

consistency factors for a medical source’s medical opinions” in the written decision. 20 C.F.R. §

416.920c(b)(2). Conversely, the ALJ “may, but [is] not required to, explain” how he/she

considered the relationship, specialization, and other factors set forth in paragraphs (c)(3)

through (c)(5) of the regulation. Id. However, where two or more medical opinions or prior

administrative findings about the same issue are equally persuasive, the ALJ must articulate how

he or she “considered the other most persuasive factors in paragraphs (c)(3) through (c)(5). . . .”

20 C.F.R. § 416.920c(b)(3). Finally, the ALJ is not required to articulate how he or she

considered evidence from nonmedical sources. 20 C.F.R. § 416.920c(d).

As used in 20 C.F.R. § 416.920c, a “medical opinion” “is defined as ‘a statement from a

medical source about what you can still do despite your impairment(s) and whether you have one

or more impairment-related limitations or restrictions in [specified physical, sensory, or

environmental areas].’” Cindy S. v. Comm’r of Soc. Sec., No. 2:25-cv-293, 2026 WL 177844, at

*2 (S.D. Ohio Jan. 22, 2026) (quoting 20 C.F.R. § 416.913(a)(2)). An ALJ is not required to

perform a § 416.920c(c) assessment of routine medical treatment notes that do not meet the

definition of a “medical opinion.” Id. (Medical provider’s recommendation that a plaintiff

elevate her legs when sitting as a means of treating edema does not meet the definition of

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“medical opinion” and requires no assessment under § 416.920c(c)(1)-(5) nor explanation for

supportability and consistency.); see also Tina D. v. Comm’r of Soc. Sec., No. 3:22-cv-152, 2023

WL 2759861, at *5-6 (S.D. Ohio Apr. 3, 2023) and Bobbie N.E. v. Comm’r of Soc. Sec., No.

3:20-cv-524, 2022 WL 4151752, at *3 (S.D. Ohio Sept. 13, 2022).

In a June 2021 treatment note, plaintiff’s treating nurse practitioner, Mr. Freeman,

recommended that she elevate her legs “at night and while resting at home” for her leg pain. (Tr.

266, 335). Plaintiff argues that the ALJ failed to assess Mr. Freeman’s medical opinion under 20

C.F.R. § 416.920c. (Doc. 9 at PageID 478). In addition, plaintiff contends that her “need to

elevate her feet during the day” will prevent her from meeting the requirements for medium

exertion work and “may also” result in her being off task for 15% of the workday which,

according to the vocational expert, would preclude the performance of all work. (Doc. 9 at

PAGEID 479).

Mr. Freeman’s partial sentence treatment note recommending “elevating legs at night and

while resting at home” (Tr. 266, 335) completely fails to meet the definition of a “medical

opinion” that requires a §416.920c assessment. The treatment note does not constitute an

opinion about what plaintiff can do despite her ankle pain or edema or whether she has

impairment-related limitations or restrictions in any of the specified categories of activity.

As for plaintiff’s contention that plaintiff’s “need to elevate her feet during the day” may

result in her being off task or unable to perform medium exertion work (Doc. 9 at PAGEID 479),

even Mr. Freeman’s treatment note contains no such implication. He recommended only that

plaintiff elevate her legs “at night and while resting at home.” (Tr. 266, 335). As court’s have

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uniformly recognized, such “stray recommendations” “are too vague to constitute medical

opinions or support specific functional limitations.” Cindy S., 2026 WL 177844, at *3 (quoting

Bobbie N.E., 2022 WL 4151752, at *4). Because Mr. Freeman provided no medical source

opinion for the ALJ to assess and because his treatment note is too vague to support a functional

limitation, plaintiff's third statement of error will be overruled.

HI. Conclusion

Based on the foregoing, plaintiffs Statement of Errors (Doc. 9) is OVERRULED, and

the Commissioner’s non-disability finding is AFFIRMED. IT IS THEREFORE ORDERED

that judgment be entered in favor of the Commissioner and this case is closed on the docket of the

Court.

Date: 2/6/2026 Henn, K Rethonh-

Karen L. Litkovitz

United States Magistrate Judge

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