Gilliam

IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF OHIO

EASTERN DIVISION

JENNIFER EILEEN GILLIAM, ) CASE NO. 1:25-CV-1287

)

Plaintiff, ) JUDGE SOLOMON OLIVER, JR.

) UNITED STATES DISTRICT JUDGE

v. )

) MAGISTRATE JUDGE

COMMISSIONER OF SOCIAL ) JENNIFER DOWDELL ARMSTRONG

SECURITY, )

) REPORT AND RECOMMENDATION

Defendant. )

I. INTRODUCTION

The Commissioner of Social Security denied Plaintiff Jennifer Eileen Gilliam’s application

for Disability Insurance Benefits (DIB). Ms. Gilliam seeks judicial review of that decision pursuant

to 42 U.S.C. §§ 405(g). (Compl., ECF No. 1.) This matter is before me pursuant to Local Rule

72.2(b). (See ECF non-document entry dated June 20, 2025.)

For the reasons set forth below, I RECOMMEND that the Court REVERSE the

Commissioner’s decision and REMAND this matter for further proceedings consistent with this

Report and Recommendation.

II. PROCEDURAL HISTORY

In June 2022, Ms. Gilliam applied to the Social Security Administration (SSA) seeking

DIB; she claimed that she became disabled on January 1, 2015. (Tr. 157.)1 She identified eleven

allegedly disabling conditions: (1) Addison’s disease; (2) secondary adrenal insufficiency;

(3) chronic pancreatitis; (4) avascular necrosis of the bones; (5) pelvic floor dysfunction;

1 The administrative transcript appears at ECF No. 7. I will refer to pages within the transcript by identifying

the Bates number printed on the bottom right-hand corner of the page (e.g., “Tr. 29”). I will refer to other

documents in the record by their CM/ECF document numbers (e.g., “ECF No. 9”) and page-identification

numbers (e.g., “PageID# 6898”).

(6) generalized muscle weakness; (7) sinus tachycardia; (8) urinary incontinence; (9) labile blood

pressure; (10) chronic complex migraines; and (11) Raynaud syndrome. (Tr. 196.)

The SSA denied Ms. Gilliam’s application initially and upon reconsideration. (Tr. 74, 82,

83.) Ms. Gilliam requested a hearing before an administrative law judge (ALJ). (Tr. 237.) The ALJ

held a hearing on July 6, 2023, at which Ms. Gilliam waived her right to representation and

proceeded pro se. (Tr. 43.) Ms. Gilliam testified, as did an independent vocational expert (VE).

(Tr. 37–73.)

On December 28, 2023, the ALJ issued a written decision finding that Ms. Gilliam is not

disabled. (Tr. 17–29.) Ms. Gilliam requested review of the ALJ’s decision, and her counsel

submitted a letter–brief regarding alleged errors in the ALJ’s decision. (Tr. 258–59.) After granting

several extensions, the Appeals Council denied review on May 9, 2025, rendering the ALJ’s

decision final. (Tr. 1.)

On June 20, 2025, Ms. Gilliam filed her Complaint, challenging the Commissioner’s final

decision that she is not disabled. (ECF No. 1.) Ms. Gilliam asserts the following assignment of

error for review:

The ALJ failed to properly evaluate the severity of Plaintiff’s impairments

prior to her date last insured. Plaintiff’s impairments and functional

restrictions establish disability as of her DLI. A remand for calculation of

benefits is therefore warranted.

(Pl.’s Merit Br. at 9, ECF No. 9, PageID# 6898.)

III. BACKGROUND

A. Personal, Educational, and Vocational Experience

Ms. Gilliam was born in October 1983 and was 39 years old on the date of her application.

(Tr. 48, 157.) Ms. Gilliam has a master’s degree in business and worked for seven years as an

import–export specialist for a government defense contractor. (See Tr. 49–51.) She last worked in

2015. (Tr. 50.) Ms. Gilliam lives with her husband. (Tr. 50.) She is currently receiving

supplemental security income (SSI). (Tr. 51–52.)

B. Relevant Hearing Testimony

1. Ms. Gilliam’s Testimony

Ms. Gilliam testified that she suffered a series of concussions and head injuries, after which

she developed post-concussion syndrome. (Tr. 52.) She suffered chronic complex migraines and

found herself in “constant pain.” (Id.) On one occasion, her legs “just gave out” when she was

walking to her car. (Tr. 52–53.) She began having more difficulty moving and exercising

“physical[] control of [her] muscles.” (Tr. 53.) She became weaker. (Id.) She began having

difficulty thinking clearly. (Id.) She was eating a lot, but she could not gain weight. (Id.) She was

constantly tired. (Id.)

She took short-term disability from her work, and she tried to go back to work when she

ran out of time off. (Tr. 55.) But she had too much difficulty working. (Id.)

Ms. Gilliam said that at some point prior to 2020, medical professionals gave her a cane

and a walker. (Tr. 56.) But she did not use them because she wanted to walk on her own. (Id.)

Ultimately, beginning in 2020, she began using a wheelchair. (Tr. 55–56.)

Ms. Gilliam said that before 2019, she could not stand for six hours at a time because her

legs “would not hold [her] for that long.” (Tr. 56.) Her body would be in “excruciating” pain to

stand for that long. (Tr. 57.) She also had pain sitting for long periods of time, and the pain

continued getting worse. (Id.)

Ms. Gilliam’s migraines were so bad that she would sometimes spend weeks in bed. (Id.)

She was having migraines every day. (Id.) Even at the time of the hearing, she was having daily

migraines despite trying several different medications and treatments over the years. (Tr. 57–58.)

Ms. Gilliam was under the care of two endocrinologists for Addison’s disease. (Tr. 60.) She

took steroids for the condition, but her understanding was that the steroids made her other physical

problems worse. (Tr. 62–63.)

Ms. Gilliam said that she had avascular necrosis in her knees, hips, and shoulders. (Tr. 69.)

She has pelvic floor dysfunction, as well as “an array of GI and urinary issues.” (Id.)

2. Vocational Experts’ Testimony

Sarah Holmes testified as a vocational expert (“VE”) at the hearing. (Tr. 63.) She classified

Ms. Gilliam’s past relevant work as that of an import–export agent (DOT 184.117-022). (Tr. 65.)

The ALJ asked the VE to assume that a hypothetical person with past relevant work as an

import–export agent was limited to work at the light exertional level with several additional

limitations. (Id.) Specifically, the person could occasionally climb ramps and stairs, stoop, kneel,

crouch, and crawl. (Id.) The person could never climb ladders, ropes, or scaffolds, and they must

avoid all exposure to hazards like unprotected heights and moving machinery. (Tr. 65–66.) They

cannot drive commercially. (Tr. 66.) They can understand, remember, and carry out simple

instructions in a routine work setting. (Id.) They can respond appropriately to supervisors,

coworkers, and work situations if the tasks performed are goal-oriented, but they cannot perform

at a production-rate pace. (Id.) Their work must require no more than superficial interaction, which

the ALJ defined as interaction that does not involve negotiating with, instructing, persuading, or

directing the work of others. (Id.)

The VE testified that such a person could not perform the work of an import–export agent

but could perform the work of an information clerk (DOT 237.367-018), cashier (DOT 211.462-

010), or merchandise marker (DOT 209.587-034).

The ALJ next asked the VE to assume that the hypothetical person was further limited, in

that they could only perform work at the sedentary exertional level. (Tr. 67.) The VE testified that

such a person could perform the work of a document preparer (DOT 249.587-018), sorter

(521.687-086), or order clerk (DOT 209.567-014). (Id.)

The VE testified that it is work-preclusive for a person to be off-task for 20 percent of the

workday or to be absent two times per month on an ongoing basis. (Tr. 67–68.)

C. State Agency Consultants

A disability examiner (Margaret Johnson), a physician (Mehr Siddiqui, M.D.), and a

psychologist (David Dietz, Ph.D.) reviewed Ms. Gilliam’s claim at the initial review level. (Tr. 74–

82.)

Dr. Siddiqui found that there was no evidence on file to evaluate Ms. Gilliam’s conditions

between the alleged onset of disability and her date last insured. (Tr. 79.)

Dr. Dietz similarly found that the records showed a history of narcotic addiction and Cluster

B personality disorders, as well as depression, but he concluded that there was insufficient

evidence to determine the severity of those conditions or opine on functional limitations. (See Tr.

80.)

The consultants noted that the medical evidence corroborated that Ms. Gilliam is “frail”

and “non-ambulatory.” (Tr. 81.)

Based on these opinions, the agency consultants determined that Ms. Gilliam is not

disabled. (Tr. 82.)

In a letter to Ms. Gilliam explaining this decision, the Agency wrote that it did not have

any records of treatment within the relevant time period. (Tr. 94.)

A disability examiner (Lauren Kulesza), physician (Abraham Mikalov, M.D.), and

psychologist (Karla Delcour, Ph.D.) reviewed Ms. Gilliam’s claim at the reconsideration level.

(Tr. 83–89.)

Dr. Mikalov affirmed the initial-level findings, opining that the additional historical

evidence was insufficient to revise the decision. (Tr. 86.)

Dr. Delcour also affirmed the initial-level findings, as written. (Tr. 87.)

But the reconsideration-level consultants found that Ms. Gilliam’s statements about the

intensity, persistence, and functionally limiting effects of her conditions were not consistent with

the medical evidence, noting that those statements were unsupported by evidence prior to the DLI.

(Tr. 87–88.)

In a letter to Ms. Gilliam explaining this decision, the Agency wrote that there was no

evidence to determine the presence and severity of any potentially disabling conditions at the time

during which she was last eligible for disability benefits. (Tr. 101.)

D. Relevant Medical Evidence

The record in this case is extensive—nearly 6,900 pages long—but many of the records

significantly postdate Ms. Gilliam’s date last insured. I will therefore focus this discussion on the

records cited by the parties as relevant to their positions on Ms. Gilliam’s sole assignment of error.

In July 2014, Marc Sharfman, M.D., submitted a letter in support of a disability application

for Ms. Gilliam. (Tr. 260.) Dr. Sharfman identified that Ms. Gilliam had been diagnosed with

refractory migraine, intractable fatigue, hypotension with tachycardia, hypothyroidism, and

“probable narcolepsy.” (Id.) He wrote that her narcolepsy causes “intractable fatigue” and her

migraine headaches cause “cognitive dysfunction.” (Id.)

In November 2015, ten months after the alleged disability-onset date, Ms. Gilliam

presented to Johnson City Medical Center in Tennessee with complaints of progressive generalized

weakness. (Tr. 806.) Ms. Gilliam described that she had developed a series of medical illnesses

over the previous decade. (Tr. 797.) She said that she had lost her appetite and could not keep food

down, leading to cachexia severe enough that she could no longer ambulate. (Id.) She presented at

five feet, seven inches tall, and she weighed 103 pounds. (See Tr. 798.)

The hospital physician noted that Ms. Gilliam’s medical history listed “a myriad of

psychosomatic issues including fibromyalgia, migraine, narcolepsy, [and] decreased appetite.”

(Id.) Ms. Gilliam and her family also reported a family history of thyroid conditions. (Id.) The

hospital physician requested a consultation with an endocrinologist and opined that Ms. Gilliam

needed further “subspecialist medical workup” that the medical center may not be equipped to

complete. (Id.)

In January 2016, R. William Taylor, D.O.—a board certified specialist in

neuromusculoskeletal medicine in Florida—wrote a letter in support of a disability application for

Ms. Gilliam. (Tr. 263.) Dr. Taylor identified that Ms. Gilliam had been diagnosed, by other

providers, with refractory migraine, central sensitization syndrome with fibromyalgia features,

autoimmune connective tissue disease, hypotension with tachycardia, hypothyroidism, proximal

colon transit delay, multiple vitamin deficiencies, transient limb paralysis, and ataxia. (Id.) Dr.

Taylor opined that recent diagnoses of colonic transit delay and vitamin deficiencies may explain

the transient limb paralysis, “lack of coordination,” and ataxia. (Id.)

Ms. Gilliam returned to Johnson City Medical Center in August 2016, complaining of falls

and increased sleepiness. (Tr. 587.) An endocrinologist noted a recent diagnosis of secondary

adrenal insufficiency and opined that there was no evidence of a current adrenal crisis. (Id.) The

endocrinologist wrote that the sleepiness and fall were likely due to medication noncompliance.

(Id.) Ms. Gilliam was started on 15 mg of hydrocortisone maintenance in the morning and 5 mg in

the evening. (Id.)

Ms. Gilliam continued receiving Botox injections to treat her chronic migraine; at a follow-

up appointment with Dr. Shawn Nelson in August 2017, Ms. Gilliam complained that she was

having more difficulty with her narcolepsy symptoms. (Tr. 1172.) She said she was “sleepy all the

time” and said she had experienced falls. (Id.) She said she believed she had a history of cataplexy.

(Id.) On examination, Ms. Gilliam weighed 122 pounds and displayed full strength, a normal

muscle tone, and normal gait. (Tr. 1174.) Dr. Nelson started Ms. Gilliam on venlafaxine, which Dr.

Nelson believed would help her narcolepsy while also providing benefits with respect to her

migraines and other neurological symptoms. (Tr. 1175.)

Records reflect that Ms. Gilliam had been prescribed hydrocortisone for adrenal

insufficiency starting in at least 2017. (See Tr. 931.)

In May 2019, Ms. Gilliam presented to a hospital complaining of increased joint swelling,

joint pain, and “uncontrollable muscle movements.” (Tr. 543.) She was observed to have difficulty

controlling her arms and legs. (Tr. 540.) During her hospital stay, a psychiatric consultation found

her to be hyperverbal and emotionally labile. (Tr. 485.) Her husband and mother admitted that they

had been obtaining narcotics to give to Ms. Gilliam to help her pain. (Tr. 485.) The psychiatrist

diagnosed Ms. Gilliam with bipolar disorder; severe opioid use disorder; severe sedative, hypnotic,

or anxiolytic use disorder; severe amphetamine-type substance use disorder; generalized anxiety

disorder; and insomnia disorder. (Tr. 486.)

Ultimately, Ms. Gilliam’s treating professionals filled out paperwork to have her

involuntarily committed at another institution, but there was difficulty transporting her after she

became extremely drowsy, to the point that she could not be awoken even to take medicine.

(Tr. 534.) Her mother and husband admitted that they had given her an injection of Emgality, but

they said a doctor had told them it was safe to administer that medicine. (Id.)

Ms. Gilliam’s family brought her back to a hospital in August 2019 because they had

observed “abnormal limb movements” and because Ms. Gilliam had elevated heart rate and blood

pressure. (Tr. 404.) The hospital physician noted that she had recently been hospitalized for

weakness, and records reflected concern about whether Ms. Gilliam truly has Addison’s disease in

light of the fact that she was “likely . . . taking too large a dose of hydrocortisone.” (Id.) It was

noted that the clinicians had recommended an extended taper of that medication, and the hospital

clinician noted that the taper may have initiated her current symptoms. (Id.) Ms. Gilliam was

stabilized on hydrocortisone and discharged, but the physician recommended a psychiatric follow

up because “[t]here may be a strong psychiatric component to all of this.” (Id.) Hospital records

reflect a discharge diagnosis of Addison’s disease. (Tr. 403.)

Ms. Gilliam’s family brought her back to the emergency department on October 15, 2019,

with concerns that she had an altered mental status and had “not been well for some time.”

(Tr. 389.) On examination, Ms. Gilliam appeared anxious, confused, and lethargic. (Id.) She was

inattentive and presented with “garbled” speech.” (Id.) Ms. Gilliam was ambulatory, but she used

a rollator or the assistance of family as needed. (Id.) Ms. Gilliam complained of an “aching,

crushing” pain. (Id.)

Ms. Gilliam and her family presented a “very convoluted” story about her history of present

illness. (See Tr. 283.) She said she had a Valium prescription and prescriptions for other pain

medications, but no such prescriptions showed in the hospital’s computer system. (Id.) The hospital

physician expressed concern that Ms. Gilliam had been using drugs that had not been prescribed

to her, and he also expressed concern over “the high doses of steroids she has been on for over a

year.” (Id.) Ms. Gilliam was apparently taking 40mg of hydrocortisone twice daily. (Id.)

Ms. Gilliam had elevated white blood cells, likely from steroid use. (Id.) The physician

noted that the high dose steroids could have caused many of her physical and mental symptoms,

and he wrote that clinicians at another facility had also expressed concern about the steroids. (Id.)

Ms. Gilliam was admitted to the hospital for several days. She displayed “chorea-like

movements” at times, was seen to exhibit severe difficulties controlling her lower extremities, and

reported that she was weak and unable to walk. (Tr. 330, 377.)

She was assessed to have systemic inflammatory response, likely secondary to steroids,

and acute encephalopathy, likely secondary to the steroids and also to the use of opioids,

amphetamine, and benzodiazepines. (Tr. 290.) The recommendation was to taper the dosage of

steroids in an inpatient setting while avoiding opioids and with an additional neurology

consultation for narcolepsy. (Id.) Ms. Gilliam refused a recommended referral for a psychiatry

consultation because she “does not trust anything that they do and either does the mother.” (Id.)

Ms. Gilliam consulted with primary care physician Mubashir Mahmood, M.D., on

November 15, 2019. (Tr. 918.) She weighed 145 pounds at the appointment. (Id.) She complained

of excessive daytime sleepiness and trouble staying asleep at night, among other things. (Tr. 922.)

Dr. Mahmood noted that she had been prescribed steroids for adrenal insufficiency, the dosage of

which had been reduced in 2017. (Id.) She said she had previously had cataplexy and bouts of

sleep paralysis, after experiencing multiple concussions with a history of post-concussion

syndrome. (Id.) On examination, Ms. Gilliam was ambulating normally and appeared healthy and

well-nourished. (Tr. 923.) She had good judgment, normal mood and affect, and she was active

and alert. (Id.) Dr. Mahmood noted that Ms. Gilliam’s chronic use of steroids had led to

hypothalamic-pituitary-adrenal axis suppression, but he said that he was unable to establish a

diagnosis and do a restudy because Ms. Gilliam was “very emotionally unstable to stop or wean

off steroids.” (Tr. 924.) Dr. Mahmood wrote that Ms. Gilliam needed to see a neurologist, a

rheumatologist, a cardiologist, and a psychiatrist. (Id.)

At a follow-up appointment on November 26, 2019, Ms. Gilliam presented with limited

ambulation and appeared to be in mild distress. (Tr. 909.) She was lethargic, anxious, and agitated,

with an abnormal affect. (Id.) Her remote memory was normal, but her recent memory was

abnormal. (Id.) She had normal muscle tone but abnormal muscle strength. (Tr. 910.) She had

limited range of motion. (Id.) Her deep tendon reflexes were abnormal, but she had a normal gait

and station. (Id.) In addition to the recommended referrals from the last appointment, Dr.

Mahmood recommended consultation with a pain specialist. (Id.)

On December 18, 2019, an MRI of Ms. Gilliam’s left knee showed multiple bone infarcts

at the femur with a large unstable osteochondral fragment at the posterior aspect of the lateral

femoral condyle. (Tr. 1131.) The radiologist could not exclude a lateral meniscal tear. (Id.)

The next day, Ms. Gilliam established care with Michelle Bullock, a certified nurse

practitioner, and James Schrenker, M.D. (Tr. 1121.) Ms. Gilliam said that she lived with others and

was not able to care for herself. (Tr. 1123.) She denied muscle weakness, weight gain, or weight

loss. (Tr. 1124.) She said that she was in a lot of pain, especially in her knees, and she said she had

experienced many falls (most recently in 2013). (Id.; Tr. 1125.) She said she was under a lot of

stress and had narcolepsy. (Id.) On examination, she appeared distressed and chronically ill; she

was confused and anxious. (Id.) She exhibited poor insight, but she was oriented to time and place.

(Id.) She had a “wide-based” gait, showed hypotonicity in her motor functions, and had a strength

of four on a scale of five. (Tr. 1125.)

Ms. Gilliam returned to Dr. Schrenker on January 3, 2020. (Tr. 1114.) She appeared

distressed, acutely ill, and chronically ill. (Tr. 1118.) She was lethargic and confused, with a flat

affect. (Id.) Her examination was positive for joint tenderness and swelling. (Id.) She presented to

the appointment in a wheelchair, with hypotonicity and strength of only one of five. (Id.) Dr.

Schrenker noted that Ms. Gilliam fell out of her wheelchair at some point in this appointment. (See

Tr. 1119.) Dr. Schrenker wrote that Ms. Gilliam was “very tangential, off point, over detailed and

nearly stup[o]rous.” (Tr. 1118.)

Ms. Gilliam followed up with Dr. Schrenker on January 20, 2020; the doctor noted that she

was not in a wheelchair but she “walks like the scarecrow in wizard of OZ and requires mod assist

of one to get up on the table.” (Tr. 1112.)

On February 7, 2020, an MRI of the cervical spine showed degenerative disc disease, most

prominent at C3–C4 levels with moderate central stenosis and bilateral neural foraminal

narrowing. (Tr.1127–28.)

Ms. Gilliam met with Dr. Schrenker again on February 20, 2020. (Tr. 1094.) Ms. Gilliam

was again “not fully alert” and “ill-appearing.” (Tr. 1095.) Her gait was unchanged from previous

appointments. (Tr. 1099.) Dr. Schrenker wrote that Ms. Gilliam “needs a wheelchair most of [the]

time.” (Id.) He expressed strong concerns about polypharmacy (Id.) He recommended centralized

medication management with the Mayo Clinic. (See id.)

Appointment notes after Ms. Gilliam’s date last insured reflect that she has used a

wheelchair and other assistive devices. (See, e.g., Tr. 3904–05.) But providers noted poor home

compliance and limited follow up. (Tr. 3904.) At an appointment on August 12, 2020, Ms. Gilliam

displayed lateral sway and unsteadiness when walking for 10 feet. (Tr. 3906.)

In June 2020, Ms. Gilliam consulted with Vahid Entezari, M.D., in a virtual appointment.

(Tr. 3980.) Dr. Entezari noted that Ms. Gilliam was “very frail and weak” and could “barely speak

with truncated sentences.” (Tr. 3980–82.) Dr. Entezari also noted that x-rays showed “a large poor

option of humeral head has gone on to avascular necrosis in both shoulders with collapse with loss

of roundness of the humeral head.” (Tr. 3982.) Dr. Entezari had been consulted because Ms.

Gilliam was at an inpatient facility and had reported a significant decline, including that she was

unable to dress or bathe herself. (See Tr. 3984–85.) She could not walk on her own and experienced

frequent falls. (Tr. 3985.)

At a physical therapy appointment on June 30, 2020, the physical therapist noted that Ms.

Gilliam was unsteady and uncoordinated even upon walking for four feet. (Tr. 3975.)

A gynecologist in August 2020 noted that Ms. Gilliam needed assistance to complete her

activities of daily living. (Tr. 3893.)

In May 2022, a doctor observed Ms. Gilliam as a “a frail appearing female in a motorized

wheelchair which she uses essentially all of the time, because of her weakness.” (Tr. 1800.)

In June 2023, Xian Wen Jin, M.D., Ph.D., provided a letter stating the opinion that Ms.

Gilliam’s “multiple chronic medical problems” have rendered her disabled since 2020. (Tr. 6855.)

Dr. Jin had been treating Ms. Gilliam since July 2020. (Id.)

IV. THE ALJ’S DECISION

The ALJ found that Ms. Gilliam met the insured status requirements of the Social Security

Act through December 31, 2019. (Tr. 22.) The ALJ next found that Ms. Gilliam had not engaged

in substantial gainful activity between the date of the alleged onset of disability (January 1, 2015)

and her date last insured. (Id.)

The ALJ next determined that Ms. Gilliam had the following severe impairments:

(1) unspecified arthropathies; (2) migraines; and (3) other disorders of the gastrointestinal system.

(Id.)

The ALJ further found that Ms. Gilliam had several non-severe impairments:

(1) personality disorders; (2) depressive disorders; and (3) drug addiction disorder. (Id.)

The ALJ determined that none of Ms. Gilliam’s impairments, whether considered singly

or in combination, met or medically equaled the severity of one of the listed impairments in 20

CFR Part 404, Subpart P, Appendix 1. (Tr. 23.)

The ALJ determined that Ms. Gilliam had the residual functional capacity (“RFC”) to

perform light work with a number of additional limitations. (Tr. 24.) Specifically, Ms. Gilliam

could only occasionally climb ramps or stairs, stoop, kneel, crouch, or crawl. (Id.) She must never

climb ladders, ropes, or scaffolds. (Id.) She must avoid all exposure to hazards like unprotected

heights and moving machinery. (Id.) She cannot drive commercially. (Id.)

The ALJ found that Ms. Gilliam was 36 years old on the date last insured and had at least

a high school education. (Tr. 28.)

The ALJ then determined that—considering Ms. Gilliam’s age, education, work

experience, and RFC—there were jobs that existed in significant numbers in the national economy

that she could perform, including work as an “information clerk” (DOT 237.367-018), “cashier”

(DOT 211.462-010), or “merchandise marker” (DOT 209.587-034). (Id.) Accordingly, the ALJ

determined that Ms. Gilliam is not disabled. (Tr. 29.)

V. LAW & ANALYSIS

A. Standard of Review

“After the Appeals Council reviews the ALJ’s decision, the determination of the council

becomes the final decision of the Secretary and is subject to review by this Court.” Olive v. Comm’r

of Soc. Sec., No. 3:06 CV 1597, 2007 WL 5403416, at *2 (N.D. Ohio Sept. 19, 2007) (citing Abbott

v. Sullivan, 905 F.2d 918, 922 (6th Cir. 1990); Mullen v. Bowen, 800 F.2d 535, 538 (6th Cir. 1986)

(en banc)). The Court’s review “is limited to determining whether the Commissioner’s decision is

supported by substantial evidence and was made pursuant to proper legal standards.” Winn v.

Comm’r of Soc. Sec., 615 Fed. Appx. 315, 320 (6th Cir. 2015) (quoting Cole v. Astrue, 661 F.3d

931, 937 (6th Cir. 2011)); see also 42 U.S.C. § 405(g).

“Under the substantial evidence standard, a court looks to an existing administrative record

and asks whether it contains ‘sufficient evidence’ to support the agency’s factual determinations.”

Biestek v. Berryhill, 587 U.S. 97, 102 (2019) (cleaned up) (quoting Consolidated Edison Co. v.

NLRB, 305 U.S. 197, 229 (1938)). The standard for “substantial evidence” is “not high.” Id. While

it requires “more than a mere scintilla,” “[i]t means—and means only—‘such relevant evidence as

a reasonable mind might accept as adequate to support a conclusion.’” Id. (quoting Consolidated

Edison, 305 U.S. at 229).

In addition to considering whether substantial evidence supports the Commissioner’s

decision, the Court must determine whether the Commissioner applied proper legal standards.

Failure of the Commissioner to apply the correct legal standards as promulgated by the regulations

is grounds for reversal. See, e.g., White v. Comm’r of Soc. Sec., 572 F.3d 272, 281 (6th Cir.

2009); Bowen v. Comm’r of Soc. Sec., 478 F.3d 742, 746 (6th Cir. 2006) (“Even if supported by

substantial evidence, . . . 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.”).

Finally, a district court cannot uphold an ALJ’s decision, even if there “is enough evidence

in the record to support the decision, [where] the reasons given by the trier of fact do not build an

accurate and logical bridge between the evidence and the result.” Fleischer v. Astrue, 774 F. Supp.

2d 875, 877 (N.D. Ohio 2011) (quoting Sarchet v. Chater, 78 F.3d 305, 307 (7th Cir. 1996))

(alteration in original).

B. Standard for Disability

Consideration of disability claims follows a five-step review process. 20 C.F.R. § 416.920.

First, the claimant must demonstrate that she is not currently engaged in “substantial gainful

activity” at the time of the disability application. 20 C.F.R. § 416.920(b). Second, the claimant

must show that she suffers from a “severe impairment” in order to warrant a finding of disability.

20 C.F.R. § 416.920(c). A “severe impairment” is one that “significantly limits . . . physical or

mental ability to do basic work activities.” Abbott v. Sullivan, 905 F.2d 918, 923 (6th Cir. 1990)

(quoting 20 C.F.R. §§ 404.1520(c) and 416.920(c)).

Third, if the claimant is not performing substantial gainful activity, has a severe impairment

that is expected to last for at least twelve months, and the impairment, or combination of

impairments, meets or medically equals a required listing under 20 CFR Part 404, Subpart P,

Appendix 1, the claimant is presumed to be disabled regardless of age, education or work

experience. See 20 C.F.R. § 416.920(d).

Before considering Step Four, the ALJ must determine the claimant’s residual functional

capacity, i.e., the claimant’s ability to do physical and mental work activities on a sustained basis

despite limitations from her impairments. 20 C.F.R. § 416.920(e). An RFC “is the most [a claimant]

can still do despite [the claimant’s] limitations.” 20 C.F.R. § 416.945(a)(1). Agency regulations

direct the ALJ to consider the functional limitations and restrictions resulting from a claimant’s

medically determinable impairment or combination of impairments, including the impact of any

related symptoms on the claimant’s ability to do sustained work-related activities. See Social

Security Ruling (“SSR”) 96-8p, 1996 WL 374184 at *5 (July 2, 1996).

“A claimant’s RFC is not a medical opinion, but an administrative determination reserved

to the Commissioner.” Golden v. Berryhill, No. 1:18CV00636, 2018 WL 7079506, at *17 (N.D.

Ohio Dec. 12, 2018), report and recommendation adopted sub nom, 2019 WL 415250 (N.D. Ohio

Feb. 1, 2019). The ALJ is “charged with the responsibility of determining the RFC based on [the

ALJ’s] evaluation of the medical and non-medical evidence.” Rudd v. Comm’r of Soc. Sec., 531 F.

App’x 719, 728 (6th Cir. 2013). “[T]he ALJ must give some indication of the evidence upon which

he is relying, and he may not ignore evidence that does not support [the ALJ’s] decision, especially

when that evidence, if accepted, would change [the ALJ’s] analysis.” Golden, 2018 WL 7079506

at *17.

At the fourth step, if the claimant’s impairment or combination of impairments does not

prevent her from doing her past relevant work, the claimant is not disabled. 20 C.F.R. §§

416.920(e)–(f). For the fifth and final step, even if the claimant’s impairment does prevent her

from doing her past relevant work, the claimant is not disabled if other work exists in the national

economy that the claimant can perform. 20 C.F.R. § 416.920(g). See Abbott, 905 F.2d at 923.

C. Analysis

In her assignment of error, Ms. Gilliam argues that the ALJ did not consider all the evidence

relevant to her condition prior to the date last insured. She contends that the ALJ flatly refused to

consider evidence postdating the DLI, even evidence that was reasonably proximate in time to the

DLI and which was relevant to a consideration of her condition in the relevant period. And she

argues that the ALJ failed to understand the link between her long history of prescribed high-dose

steroids and her subsequent development of avascular necrosis.

Ms. Gilliam argues that the ALJ erred at Step Two when he failed to find (or discuss) her

Addison’s disease or secondary adrenal insufficiency, or her complicated narcolepsy with

cataplexy and insomnia, and when the ALJ found Ms. Gilliam’s anxiety to be a non-severe

impairment. (Pl.’s Br. at 10–13, ECF No. 9, PageID# 6900–02.)

At Step Two, an ALJ must determine whether a claimant’s medically determinable

impairment is a “severe” impairment. See 20 C.F.R. § 404.1520(a)(4)(ii). A “severe” impairment

is one that “significantly limits [a claimant’s] physical or mental ability to do basic work

activities[.]” 20 C.F.R. § 404.1520(c). “Step two has been described as a ‘de minimus hurdle’; that

is, ‘an impairment can be considered not severe only if it is a slight abnormality that minimally

affects work ability regardless of age, education, and experience.’” Rogers v. Comm’r of Soc. Sec.,

486 F.3d 234, 243 n.2 (6th Cir. 2007) (quoting Higgs v. Bowen, 880 F.2d 860, 862 (6th Cir. 1988)).

But when an ALJ finds severe and non-severe impairments at Step Two and continues through the

subsequent steps in the sequential evaluation—as was the case here—any error

at Step Two is normally harmless. Maziarz v. Sec’y of Health & Human Servs., 837 F.2d 240, 244

(6th Cir. 1987); see also Floyd v. Comm’r of Soc. Sec., No. 23-2036, 2024 WL 3103757, at *2 (6th

Cir. June 24, 2024).

The Commissioner argues that any error at Step Two is harmless here. The Commissioner

asserts that, while the ALJ did not find Ms. Gilliam’s adrenal insufficiency to be a severe condition,

the ALJ nevertheless considered evidence relevant to the condition when crafting the RFC.

(Comm’r’s Br. at 6–7, 9–10, ECF No. 12, PageID# 6913–14, 6916–17.) The Commissioner further

contends that the ALJ accurately summarized the treatment record and was not required to discuss

every piece of evidence in this extensive file. (Id. at PageID# 6912, 6914.) And finally, the

Commissioner argues that the ALJ’s failure to discuss the post-DLI evidence regarding avascular

necrosis was reasonable because the state agency medical doctor reviewed that evidence and

apparently concluded that the evidence did not relate back to the relevant period. (Id. at

PageID# 6914–15 (citing Tr. 78).)

In her reply brief, Ms. Gilliam argues that the harmless-error analysis does not apply to the

ALJ’s failure at Step Two to identify several conditions, including her adrenal insufficiency or

avascular necrosis, as medically determinable impairments in the first place. (Reply Br. at 3, ECF

No. 13, PageID# 6923.)

While Ms. Gilliam does not cite caselaw in support of her position, I am aware that courts

within and outside of this circuit have distinguished between an ALJ’s finding that a medically

determinable impairment is non-severe and a finding that an alleged condition is not a medically

determinable impairment in the first place. Generally, courts have found that an ALJ’s failure to

find that a condition is medically determinable is not harmless error unless the record reflects that

the ALJ nevertheless considered the impairment in developing the RFC. See Durbin v. Comm’r of

Soc. Sec., No. 2:17-cv-896, 2020 WL 2744100, at *13–14 (S.D. Ohio May 27, 2020); Kelley v.

Comm’ r of Soc. Sec., No. 1:24-cv-506, 2025 WL 1903777, at *3 n.1 (W.D. Mich. July 10, 2025)

(collecting cases); see also Bruce v. Comm’r of Soc. Sec., 2022 WL 1555402, at *6 (N.D. Ohio

May 17, 2022).

Here, the ALJ found severe impairments of “unspecified arthropathies, migraines, and

other disorders of the gastrointestinal system,” and he found non-severe medically determinable

impairments of personality disorders, depressive disorders, and drug addiction disorder. (Tr. 22.)

In the cursory Step Two discussion, the ALJ does not even mention adrenal insufficiency, avascular

necrosis, or anxiety. (See id.)

The ALJ seems to have discounted adrenal insufficiency, avascular necrosis, and anxiety

as medically determinable impairments, despite the fact that the ALJ later specifically

acknowledged that Ms. Gilliam had been on steroids since 2016 “for a provisional diagnosis of

Addison’s disease,” which dose was tapered multiple times. (Tr. 26.) And the ALJ also

acknowledged that Ms. Gilliam had presented to the hospital in 2015 and 2019 with complaints of

progressive weakness and “significant decline,” with symptoms largely attributed to Ms. Gilliam’s

taking high-dose steroids. (Tr. 25–26.)

After careful consideration, I conclude that the ALJ committed reversible error at Step Two

and in developing the RFC.

First, it is not at all clear from the decision whether the ALJ actually considered whether

adrenal insufficiency and avascular necrosis were medically determinable impairments in the first

place. While it is possible that the ALJ did consider these conditions—an inference that would be

somewhat supported by the ALJ’s later consideration of the evidence related to high-dose

steroids—the ALJ’s failure to adequately state or explain that consideration impairs the Court’s

ability to review that condition. See Borger v. Comm’r of Soc. Sec., No. 3:20-CV-01930-JGC, 2021

WL 6297536, at *13 (N.D. Ohio Dec. 17, 2021) (“[I]t may be possible to infer that the ALJ

considered [the plaintiff’s] DVT diagnosis to be medically determinable but not severe . . . . If the

ALJ considered DVT not a medically determinable impairment, then failing to include it in the

RFC is not error. Contrariwise, if the ALJ considered DVT a medically determinable impairment,

then failing to include it in the RFC is error, whether severe or non-severe. Without clear direction

in the ALJ’s decision, this Court cannot properly review the ALJ’s decision . . . .”), report and

recommendation adopted, 2022 WL 60212 (Jan. 6, 2022). Moreover, the ALJ stated at the hearing

that “2020, 2021, all that is not stuff that I look at.” (Tr. 51.) That statement suggests that the ALJ

did not consider whether avascular necrosis, at least, was a medically determinable impairment in

the first instance.

It would be unreasonable to expect an ALJ to identify every condition in a 6,000 page

record that the ALJ considered and rejected as a medically determinable impairment. But here,

considering the evidence of adrenal insufficiency and avascular necrosis (discussed further below)

during the relevant period, the ALJ’s near total silence on these conditions casts significant doubt

upon whether and how the ALJ considered them at Step Two. For example, did the ALJ find them

to be not medically determinable? Or did the ALJ find that even if they were medically

determinable, the evidence established that Ms. Gilliam could nonetheless perform light work? In

other words, “the reasons given by the trier of fact do not build an accurate and logical bridge

between the evidence and the result.” Fleischer, 774 F. Supp. 2d at 877.

Second, the ALJ erred when crafting the RFC. The ALJ’s discussion of the effect of Ms.

Gilliam’s adrenal insufficiency and the effect of her high-dose steroids was as follows, in relevant

part:

She reported weight loss, lack of energy, and fatigue. She saw several

doctors, but medication did not help, and she felt her body was shutting

down. The claimant testified that she left [her last employer] due to chronic

migraines, and received short term disability. She has used a wheelchair

since June 2020, and before then, uses a cane and walker. She has problems

lifting. The claimant reported migraines daily. She was also treated with

steroids, but they made things worse.

. . .

[T]he claimant’s statements concerning the intensity, persistence and

limiting effects of these symptoms are not entirely consistent with the

medical evidence and other evidence in the record for the reasons explained

in this decision.

. . .

She was placed on steroids in 2016 for a provisional diagnosis of Addison’s

disease, that was tapered multiple times. At admission [in October 2019],

the claimant was taking 40mg of hydrocortisone daily. . . . Many of the

claimant’s symptoms were attributed to high dose steroids. The claimant

was diagnosed with systemic inflammatory response likely secondary to

steroids, acute encephalopathy likely due to large doses of steroids, opioids,

benzodiazepines, and amphetamine usage, and hypokalemia due to steroid

use.

. . .

In sum, the degree of limitation alleged is not fully supported by the

objective evidence prior to the date last insured. Most of the claimant’s

symptoms were attributed to pharmacology, particularly steroid use.

Despite her symptoms, records generally show intact gait, full range of

motion, and intact cognition, concentration, and attention

(Tr. 24–27) (internal record citations omitted).

The ALJ did not cite any medical records after December 2019, with the exception of Dr.

Xian Wen Jen’s 2023 opinion letter. (Tr. 6855.) The ALJ repeatedly wrote that Ms. Gilliam

presented with an intact gait and full range of motion (see Tr. 26, citing Tr. 1191 (Feb 2019

appointment), Tr. 1240 (Nov 2019 appointment)).

The Commissioner defends this discussion, arguing that it reflects that the ALJ ultimately

considered both the provisional Addison’s disease diagnosis and Ms. Gilliam’s narcolepsy when

crafting the RFC. The Commissioner argues that the ALJ accurately summarized the treatment

record, and the Commissioner points out that Dr. Siddiqui had considered some post-DLI evidence

in coming to his conclusions in the case. Finally, the Commissioner disagrees that the ALJ should

have considered more post-DLI evidence, arguing that such evidence is minimally probative.

I disagree that the ALJ accurately and completely summarized the treatment record. The

ALJ relied heavily on two findings that Ms. Gilliam had a normal gait and full range of motion in

2019. (See Tr. 26, citing Tr. 1191 (Feb 2019 appointment), Tr. 1240 (Nov 2019 appointment)). But

these appointments focused primarily on Ms. Gilliam’s migraines. The ALJ ignores

contemporaneous notes from other appointments showing that Ms. Gilliam was frail and presented

with limited ambulation, limited range of motion, and a wide gait. (See Tr. 909, 1125.)

More concerning, the ALJ does not mention the examination findings from January and

February 2020 (one fewer than five days after the DLI) that were significantly probative as to Ms.

Gilliam’s gait, strength, and ability to ambulate during the disability period. The ALJ does not

wrestle, for instance, with Dr. Schrenker’s observation on January 3, 2020, that Ms. Gilliam

presented with hypotonicity and strength of one out of five, “walk[ing] like the scarecrow in wizard

of OZ” and requiring assistance to get onto a table. (Tr. 1112, 1118.) Nor does the ALJ explain his

consideration of Dr. Schrenker’s note from February 20, 2020, that Ms. Gilliam’s gait was

unchanged and that she “needs a wheelchair most of [the] time.” (Tr. 1099).

The lack of an acknowledgement of this evidence—or any evidence postdating the DLI—

leads to ambiguity as to whether the ALJ considered this evidence in formulating the RFC. Again,

in this case and on this record, the ambiguity is such that the decision fails to “build an accurate

and logical bridge between the evidence and the result.” Fleischer, 774 F. Supp. 2d at 877. In light

of the ALJ’s statement at the hearing that he would not “look at” records from 2020 and 2021, it

seems likely that the ALJ did not consider these records at all. That also amounts to error here.

“[M]edical evidence that postdates the insured status may be, and ought to be, considered

insofar as it bears on the claimant’s condition prior to the expiration of insured status.” Carter v.

Comm’r of Soc. Sec., No. 5:12CV2321, 2013 WL 3940874 at *6 (N.D. Ohio July 30, 2013)

(internal quotation marks omitted); see also Begley v. Mathews, 544 F.2d 1345, 1354 (6th Cir.

1976) (“Medical evidence of a subsequent condition of health, reasonably proximate to a preceding

time may be used to establish the existence of the same condition at the preceding time.”)

Here, the ALJ was presented with a DLI of December 31, 2019. (Tr. 22.) A treatment record

from three days later shows significant abnormal gait and an assessment of severe adrenal

insufficiency and muscle weakness (Tr. 1118–19.) Two months after her DLI, the doctor assessed

that Ms. Gilliam had idiopathic aseptic osteonecrosis, which Dr. Schrenker sought to investigate

through an orthopedic consultation. (See Tr. 1112.) Less than six months after her DLI, Ms. Gilliam

was diagnosed with avascular necrosis in the shoulders. (Tr. 3982.) She was “very frail and weak.”

(Tr. 3980–82.) The progression continued, such that by 2022 a doctor observed Ms. Gilliam as a

“a frail appearing female in a motorized wheelchair which she uses essentially all of the time,

because of her weakness.” (Tr. 1800.)

The Commissioner’s argument that these records, especially those from 2020, are

minimally relevant is not well-taken. Reviewing the record as a whole, there is more than enough

evidence to raise the question as to whether Ms. Gilliam—during the relevant disability period—

was under a chronic progression to avascular necrosis, weakness, and frailty as a result of adrenal

insufficiency and the course of treatment for that insufficiency.

Doctors both before and after Ms. Gillian’s DLI expressed concerns that Ms. Gilliam’s

adrenal insufficiency and related regimen of high-dose steroids were contributing to her weakness

and other symptoms. See, e.g., Tr. 931 (hydrocortisone prescriptions since at least 2017); Tr. 404

(August 2019: “taking too large a dose of hydrocortisone” and noting that an extended taper likely

caused her acute symptoms); Tr. 283 (October 2019: expressing concern over the high dose of

steroids); Tr. 923–24 (November 2019: steroid use had led to hypothalamic and pituitary

suppression, but the doctor made no change to the regimen because Ms. Gilliam was opposed to

weaning); Tr. 1094 (February 2020: expressing strong concerns about polypharmacy—“she is on

way too may drugs and has way to[o] many doctors”); Tr. 3980 (June 2020: stating that steroid use

had led to avascular necrosis and even tapering had not improved her overall condition).

This is exactly the kind of progressive condition that calls for a holistic and longitudinal

review of the record evidence, including relevant evidence that postdates but is reasonably

proximate to the DLI. See Carter, 2013 WL 3940874, at *9 (“Given the progressive nature of [the

plaintiff’s] condition [liver disease], . . . post-DLI evidence which is both relevant and reasonably

proximate in time to a pre-DLI condition may be considered . . . .”)

Because the ALJ failed to consider the relevant and reasonably proximate medical records

relevant to Ms. Gilliam’s strength, gait, adrenal function, and potential avascular necrosis during

the period of alleged disability, reversal and remand is warranted. Of course, the date of the

evidence compared to the DLI is a permissible factor to be considered in assigning a relative weight

to that evidence. E.g., Sweitzer v. Astrue, No. 1:08–CV–170, 2009 WL 3064665, at *3 (E.D. Tenn.

Sept. 23, 2009); see also Higgs v. Bowen, 880 F.2d 860, 863 (6th Cir. 1988) (finding that evidence

dated after a claimant’s date of last insured may be considered but a delay of two years renders

that evidence “minimally probative”). But the ALJ erred by failing to consider this evidence at all.

I am also not persuaded that the ALJ’s failure to cite relevant and reasonably proximate

post-DLI evidence can be excused because Dr. Siddiqui reviewed that evidence during the

agency’s internal administrative review. The Commissioner directs the Court to no caselaw

supporting that position. And the ALJ here found Dr. Siddiqui’s opinion to be unpersuasive

anyway. (Tr. 26–27.)

I would expect a reasoned consideration of this matter on remand would include a

discussion of the relevant and reasonably proximate medical evidence, including a discussion of

the relevant weight assigned to this evidence as the evidence grows more remote from the DLI.

Finally, I find troubling the ALJ’s statement that “[m]ost of the claimant’s symptoms were

attributed to pharmacology, particularly steroid use.” (Tr. 26.) While it is true that medical records

reflect significant professional concern over polypharmacy, the ALJ does not explain his

consideration of this fact. Ms. Gilliam reads the decision as a critique of her as a patient, especially

in light of the ALJ’s citations to places in the record showing medication noncompliance and

doctors’ concerns about other drug use. That is not an unreasonable reading of the decision. I also

note that it seems that Ms. Gilliam has not complied with treatment recommendations related to

steroid use over the years, including recommendations to wean the dosage in an inpatient setting,

to obtain psychiatric help, and to wean the dosage to reassess her diagnosis.

But the ALJ does not significantly grapple with the fact that Ms. Gilliam’s high dose of

hydrocortisone was prescribed to her and continued by her doctors for years. I would expect a

reasoned consideration of this matter on remand would include further consideration and

explanation of the effect of polypharmacy on Ms. Gilliam’s condition during the alleged disability

period. And if the ALJ finds that noncompliance or illegal drug use is a factor relevant to the

disability decision, I would expect a fuller explanation of that conclusion.

In this matter, it is not clear whether the ALJ considered the extent to which adrenal

insufficiency and avascular necrosis are medically determinable impairments, despite significant

probative evidence raising that question. It is equally unclear whether the ALJ considered these

conditions when crafting the RFC. In crafting the RFC, the ALJ credited two findings of a normal

gait within the disability period while ignoring several contemporaneous findings of abnormal gait

and strength (again without significant explanation). More concerning, the ALJ seems to have

entirely disregarded all medical record evidence postdating the DLI, even evidence that is relevant

and reasonably proximate to the DLI such that it may be probative as to Ms. Gilliam’s condition

during the alleged disability period. Finally, it is clear that the ALJ found polypharmacy to be a

significant factor in crafting the RFC, but it is unclear from the decision how the ALJ considered

the effect of polypharmacy.

Under these circumstances, reading the decision as a whole, “the reasons given by the trier

of fact do not build an accurate and logical bridge between the evidence and the result.” Fleischer,

774 F. Supp. 2d at 877 (N.D. Ohio 2011). Thus, the ALJ’s decision should be reversed and this

matter remanded.

Because I am recommending a reversal based on the ALJ’s discussion of Ms. Gilliam’s

adrenal insufficiency and related conditions, and because I recommend a remand for further

consideration and a new decision, I do not further address Ms. Gilliam’s arguments as to

narcolepsy or anxiety.

Before concluding, I note that I am not convinced by Ms. Gilliam’s argument that the Court

should award benefits immediately. (See Pl.’s Br. at 13, ECF No. 9, PageID# 6902.) While Ms.

Gilliam is correct that the medical record related to the alleged period of disability is unlikely to

change on remand, this case raises complex and unresolved factual issues that I believe an ALJ is

in the best position to resolve in the first instance.

VI. RECOMMENDATION

Based on the foregoing, I RECOMMEND that the Court REVERSE the Commissioner’s

decision and REMAND this matter for further proceedings consistent with this Report and

Recommendation.

Dated: April 7, 2026 /s/ Jennifer Dowdell Armstrong

Jennifer Dowdell Armstrong

U.S. Magistrate Judge

VII. NOTICE TO PARTIES REGARDING OBJECTIONS

Local Rule 72.3(b) of this Court provides:

Any party may object to a Magistrate Judge’s proposed findings,

recommendations or report made pursuant to Fed. R. Civ. P. 72(b) within

fourteen (14) days after being served with a copy thereof, and failure to file

timely objections within the fourteen (14) day period shall constitute a waiver

of subsequent review, absent a showing of good cause for such failure. Such

party shall file with the Clerk of Court, and serve on the Magistrate Judge and all

parties, written objections which shall specifically identify the portions of the

proposed findings, recommendations, or report to which objection is made and the

basis for such objections. Any party may respond to another party’s objections

within fourteen (14) days after being served with a copy thereof. The District

Judge to whom the case was assigned shall make a de novo determination of those

portions of the report or specified proposed findings or recommendations to which

objection is made and may accept, reject, or modify, in whole or in part, the findings

or recommendations made by the Magistrate Judge. The District Judge need

conduct a new hearing only in such District Judge’s discretion or where required

by law, and may consider the record developed before the Magistrate Judge,

making a determination on the basis of the record. The District Judge may also

receive further evidence, recall witnesses or recommit the matter to the Magistrate

Judge with instructions.

Id. (emphasis added).

Failure to file objections within the specified time may result in the forfeiture or waiver of

the right to raise the issue on appeal either to the district judge or in a subsequent appeal to the

United States Court of Appeals, depending on how or whether the party responds to the report and

recommendation. Berkshire v. Dahl, 928 F.3d 520, 530 (6th Cir. 2019). Objections must be

specific and not merely indicate a general objection to the entirety of the report and

recommendation; a general objection has the same effect as would a failure to object. Howard v.

Sec’y of Health and Hum. Servs., 932 F.2d 505, 509 (6th Cir. 1991).

Stated differently, objections should focus on specific concerns and not merely restate the

arguments in briefs submitted to the magistrate judge. “A reexamination of the exact same

argument that was presented to the Magistrate Judge without specific objections ‘wastes judicial

resources rather than saving them, and runs contrary to the purpose of the Magistrates

Act.’” Overholt v. Green, No. 1:17-CV-00186, 2018 WL 3018175, at *2 (W.D. Ky. June 15, 2018)

(quoting Howard). The failure to assert specific objections may in rare cases be excused in the

interest of justice. See United States v. Wandahsega, 924 F.3d 868, 878–79 (6th Cir. 2019).