Nicholson

IN THE UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF OHIO

EASTERN DIVISION

CAROLYN M. NICHOLSON, CASE NO. 1:25-cv-2257

Plaintiff,

vs. MAGISTRATE JUDGE

JAMES E. GRIMES JR.

COMMISSIONER OF SOCIAL

SECURITY,

MEMORANDUM

Defendant. OPINION AND ORDER

Plaintiff Carolyn Nicholson filed a Complaint against the Commissioner

of Social Security seeking judicial review of the Commissioner’s decision

denying disability insurance benefits and supplemental security income. This

Court has jurisdiction under 42 U.S.C. §§ 405(g) and 1383(c). The parties

consented to my jurisdiction in this case. Doc. 9. Following review, and for the

reasons stated below, I affirm the Commissioner’s decision.

Procedural history

In July 2023, Nicholson filed applications for disability insurance

benefits and supplemental security income, alleging a disability onset date of

April 19, 2023.1 Tr. 17, 236. In her applications, Nicholson claimed disability

due to generalized anxiety disorder and post-traumatic stress disorder (PTSD).

1 “Once a finding of disability is made, the [agency] must determine the

onset date of the disability.” McClanahan v. Comm’r of Soc. Sec., 193 F. App’x

422, 425 (6th Cir. 2006).

Tr. 291. The Social Security Administration denied Nicholson’s applications

and her motion for reconsideration. Tr. 103–04, 123–24. Nicholson then

requested a hearing before an Administrative Law Judge (ALJ). Tr. 182.

In January 2025, an ALJ held a hearing, during which Nicholson and a

vocational expert testified. Tr. 38–73. In March 2025, the ALJ issued a written

decision finding that Nicholson was not disabled. Tr. 17–32. The ALJ’s decision

became final on September 8, 2025, when the Social Security Appeals Council

declined further review. Tr. 1–3; see 20 C.F.R. § 404.981.

Nicholson filed this action on October 21, 2025. Doc. 1. She asserts the

following assignments of error:

1. The ALJ’s RFC determination is unsupported by

substantial evidence due to his failure to properly

evaluate the opinions from Dr. Bell related to the

mental RFC and Dr. Yakubek related to the physical

RFC.

2. The ALJ’s Step Five determination is

unsupported by substantial evidence because given

the RFC, the VE testified Plaintiff would be

disabled.

Doc. 10, at 3.

Evidence

Personal and vocational evidence

Nicholson was 58 years old on her alleged disability onset date. Tr. 30.

She graduated from high school and last worked in April 2023 as an Amazon

warehouse worker. Tr. 48.

Relevant medical evidence

In January 2023, Nicholson saw her primary care doctor, Jerry Bell,

D.O., for a medication refill. Tr. 375. Depression screening showed a score of

zero and Nicholson denied feeling down, depressed, or hopeless. Tr. 375.

Nicholson’s physical and mental status exam findings were unremarkable. Tr.

376. Dr. Bell assessed hypothyroidism, anxiety, and rheumatoid arthritis and

refilled Nicholson’s medications. Tr. 376, 379.

The same day, Dr. Bell completed a form for Nicholson’s employer

excusing Nicholson from work for two days in early January. Tr. 420. Dr. Bell

listed Nicholson’s diagnoses as rheumatoid arthritis and anxiety. Tr. 420. He

wrote that Nicholson could not work these two days due to “office contact …

pertaining to medication, etc.” Tr. 420.

On May 15, 2023, Brown had a telemedicine appointment with Dr. Bell

for anxiety. Tr. 372. Depression screening showed a score of zero and Nicholson

denied feeling down, depressed, or hopeless. Tr. 372. Nicholson told Dr. Bell

that she was on “[w]ork leave due to anxiety and extenuating life

circumstances starting … April 19, 2023 and she will plan to return to work …

May 22, 2023.” Tr. 372. Dr. Bell wrote that Nicholson “has had extreme

situations dealing with living environment (losing her apartment, etc)

increased stress [and] increased anxiety.” Tr. 373. She “has had excessive

stress which has affected her emotionally and physically.” Tr 373. On exam,

Nicholson’s affect was anxious and Dr. Bell diagnosed anxiety. Tr. 373.

In August 2023, Nicholson followed up with Dr. Bell for “anxiety

paperwork.” Tr. 369. Depression screening showed a score of zero and

Nicholson denied feeling down, depressed, or hopeless. Tr. 369. She reported a

pain level of zero. Tr. 369. Nicholson’s affect was appropriate and she was

oriented to person, place, and time. Tr. 370. Dr. Bell diagnosed anxiety, PTSD,

hypothyroidism, and gastroesophageal reflux disease. Tr. 370. He refilled her

medications. Tr. 370.

The same day, Dr. Bell completed a form called “medical opinion—

psychological conditions” on Nicholson’s behalf. Tr. 395. Dr. Bell indicated that

he began treating Nicholson in 2016 and had treated her for anxiety, PTSD,

acid reflux, hypothyroidism, and depression. Tr. 395. He checked boxes

indicating that Nicholson’s signs of depression included anhedonia, appetite

disturbance, sleep disturbance, decreased energy, difficulty concentrating or

thinking, and thoughts of suicide. Tr. 395. Nicholson’s signs of anxiety were

“[a]pprehensive expectation” and “[r]ecurrent and intrusive recollections of a

traumatic experience, which are a source of marked distress.” Tr. 395. Dr. Bell

opined that Nicholson was “overall” “mildly limited” in her ability to

understand, remember, or apply information. Tr. 395. When asked to break

down Nicholson’s understanding and short- and long-term memory, Dr. Bell

wrote that Nicholson had no limitations “until she feels stressed or nervous.”

Tr. 395. Dr. Bell indicated that Nicholson could “understand and carry out very

short and simple instructions” and “detailed but uninvolved written or oral

instructions.” Tr. 396. When asked for examples of Nicholson’s limitations, Dr.

Bell wrote that Nicholson “has had problems with friends/family causing ‘let

down,’ mistrust. [She] [h]as problems trusting people even in day to day

environment.” Tr. 395.

Dr. Bell opined that Nicholson was markedly limited in her ability to

interact with others and that she could sometimes, but not consistently, work

with the general public, coworkers, and supervisors. Tr. 396–97. She would

need positive reinforcement from supervisors to handle stress and emotions.

Tr. 397. She “has constant stressors and problems with trust, sometimes is

focused.” Tr. 397. Nicholson was markedly limited, “when stressed,” in her

ability to concentrate, persist, or maintain pace. Tr. 397. When stressed, she

could maintain attention and concentration for 30 minutes before needing

redirection. Tr. 397. When stressed, her symptoms would cause her to be off-

task greater than 25 percent of the workday. Tr. 397. Nicholson couldn’t

maintain regular attendance and be punctual within customary tolerances,

and Dr. Bell explained that Nicholson has “severe anxiety at times.” Tr. 397.

Dr. Bell opined that Nicholson was markedly limited in her ability to

adapt or manage herself “due to anxiety (PTSD),” and that she could

sometimes, but not consistently, maintain socially appropriate behavior. Tr.

397–98. He explained that Nicholson “may become withdrawn or very

emotional due to anxiety.” Tt. 398. She could sometimes, but not consistently,

respond appropriately to changes in the work setting because of stress, anxiety,

and PTSD. Tr. 398. Finally, Dr. Bell said that because of anxiety and stress,

Nicholson would miss more than four days of work per month. Tr. 398.

In January 2024, Nicholson saw Jinhui Wang, Psy.D., for a virtual

psychological consultative exam. Tr. 434. Nicholson told Dr. Wang that she had

severe anxiety and didn’t like being “around people, a crowd of people.” Tr. 435.

She had a hard time concentrating—she had “a ton of thoughts through [her]

head” and would forget what she was doing. Tr. 435. Nicholson said that due

to her conditions, at work she couldn’t concentrate, she was hyper, she couldn’t

stand still, and she had “100 moods a day.” Tr. 436. She lashed out when coping

with work pressure and sometimes she left work. Tr. 436. She got along well

with supervisors and got along with coworkers and “just worked, stayed to

[her]self.” Tr. 436. Nicholson told Dr. Wang that she suffered from these

conditions for “all [her] life,” and that she had tried individual therapy and

medications, but neither helped. Tr. 435. At the time of the exam, Nicholson

said that she was looking for work and had applied to 40 jobs without success.

Tr. 436. At home, she performed household chores, socialized with her ex-

husband and son, and communicated with friends by telephone. Tr. 436.

Dr. Wang described Nicholson as cooperative with average social skills.

Tr. 437. She had normal speech and thought content. Tr. 437. She appeared

sad and anxious, with “[s]ome behavioral or autonomic signs of anxiety …

observed as tense facial expression, and tense vocalization.” Tr. 437. Dr. Wang

found that Nicholson was alert and responsive and had intact memory,

attention, and concentration. Tr. 437. She had satisfactory persistence,

adequate pace, and intact insight and judgment. Tr. 437–38. Dr. Wang

diagnosed Nicholson with unspecified depressive disorder and unspecified

anxiety disorder. Tr. 438. She opined that Nicholson could be “expected to be

able to understand, remember, and carry out instructions in a work setting.

Tr. 438–39. If Nicholson’s depressive and anxiety symptoms were to worsen,

“they could negatively impact” her ability to maintain concentration,

persistence, or pace “by interfering with her ability to focus and concentrate.”

Tr. 439. Nicholson “maintained [a] certain capacity” in her ability to respond

appropriately to supervision and coworkers in a work setting. Tr. 439. And

regarding Nicholson’s abilities to respond appropriately to work pressures, Dr.

Wang wrote that Nicholson “has depressive and anxiety symptoms so these

could lower her frustration tolerance and put her a bit at risk for workplace

pressure at this time.” Tr. 439.

In July 2024, Nicholson saw George Yakubek, M.D., for a physical

consultative examination. Tr. 442. Nicholson said that she experienced neck

and back pain “for years.” Tr. 443. Activity exacerbated her pain, which she

rated a six out of ten, at worst, in severity. Tr. 443. Nonsteroidal anti-

inflammatory drugs had not provided relief. Tr. 443. Nicholson had not tried

injections or physical therapy. Tr. 443. On exam, Nicholson had mild

tenderness to palpation in her thoracic spine. Tr. 445. She had full strength in

all of her muscle groups and full range of motion in all areas. Tr. 448–52. She

had normal reflexes and sensation and a normal gait. Tr. 445. Nicholson could

squat and rise from that position “with ease” and had “no difficulty getting up

and down from the exam table.” Tr. 445. She could lift and carry light objects.

Tr. 445. Nicholson had appropriate speech and eye contact, an appropriate

mood, and normal memory and concentration. Tr. 444. Dr. Yakubek opined

that “[w]ith [Nicholson’s] history of RA, back pain, ADHD, anxiety, depression,

PTSD based on the exam findings today,” she was “able to sitting couple hours

minutes, standing couple h[ou]rs, walking couple blocks, and lifting 10

pounds.”2 Tr. 446. He commented that Nicholson had no “substantial physical

limitations” and that “[h]er medical conditions seem well controlled on current

medications and there are no acute symptoms that would suggest otherwise.”

Tr. 446.

In September 2024, Nicholson saw licensed counselor Telisa Cross for

an evaluation. Tr. 523. Nicholson reported a history of depression, anxiety,

ADHD, and trauma. Tr. 523. She said that she had severe anxiety, causing her

to take a leave of absence from her job at an Amazon Warehouse. Tr. 523.

Nicholson completed a self-scoring functional impairment survey, which

indicated “high” severity in the following areas: “[d]epression/[f]unctioning”;

interpersonal relationships; self-harm; emotional lability; and psychosis. Tr.

2 Dr. Yakubek’s statement that Nicholson was “able sitting couple hours

minutes,” Tr. 446, contains some obvious scrivener’s errors. But the context

does not allow the Court to infer whether he thought that Nicholson could sit

for a couple of hours or for a couple of minutes.

525. She listed her depressive symptoms as sadness, hopelessness, thoughts of

death, low self-esteem, and social isolation and withdrawal. Tr. 526.

Nicholson’s anxiety symptoms were nervousness, hypervigilance, uneasiness,

worry, poor concentration, racing thoughts, intrusive thoughts, and avoidance.

Tr. 526. Nicholson also reported social anxiety, trauma, phobia, and attention

and hyperactive symptoms. Tr. 526. On exam, Cross found that Nicholson had

good eye contact; restless motor activity; pressured speech; a depressed,

anxious, and worried mood; and a circumstantial thought process. Tr. 528. She

had appropriate demeanor, insight, and judgment. Tr. 528. Cross diagnosed

Nicholson with major depressive disorder, recurrent, moderate; generalized

anxiety disorder; PTSD; and attention deficit hyperactivity disorder (ADHD).

Tr. 528. She referred Nicholson for individual counseling and psychiatry. Tr.

530.

Later that month, Nicholson saw Nurse Practitioner Theresa Davies.

Tr. 508. Nicholson complained of acid reflux, stated that she was out of her

hypothyroid medication, and commented that she used to receive injections for

rheumatoid arthritis. Tr. 509. She hadn’t seen her rheumatology doctor in a

few years. Tr. 465. Nicholson’s physical and mental exam findings were

normal. Tr. 511. Davies re-started Nicholson’s hypothyroid medication,

prescribed acid-reflux medication, and referred Nicholson to rheumatology. Tr.

507–08.

State agency opinions3

In January 2024, Joan Williams, Ph.D., reviewed Nicholson’s record. Tr.

88–90. Regarding Nicholson’s residual functional capacity (RFC),4 Dr.

Williams found that Nicholson could interact with coworkers, supervisors, and

the public “in situations that do not require conflict resolution or persuading

others to buy products or services.” Tr. 92. She could respond appropriately in

a work setting with consistent and predictable expectations and work duties.

Tr. 92. In April 2024, Stacy Flowers, Ph.D., reviewed Nicholson’s record and

affirmed Dr. Williams’s findings. Tr. 120.

In April 2024, W. Scott Bolz, M.D., found that Nicholson had no severe

physical impairments and, therefore, he did not set out any work-related

limitations. Tr. 127. In May 2024, King Leong, M.D., affirmed Dr. Bolz’s

findings. Tr. 144.

3 When a claimant applies for disability benefits, the State Agency creates

a record. The record includes the claimant’s medical evidence. A State Agency

disability examiner and a State Agency physician or psychologist review the

claimant’s record and determine whether and to what extent the claimant’s

condition affects his or her ability to work. If the State Agency denies the

claimant’s application, the claimant can ask for reconsideration. On

reconsideration, the State Agency updates the record and a second disability

examiner and doctor review the file and make a new determination. See, e.g.,

20 C.F.R. § 404.1615.

4 An RFC is an “‘assessment of’” a claimant’s ability to work, taking his or

her “limitations … into account.” Howard v. Comm’r of Soc. Sec., 276 F.3d 235,

239 (6th Cir. 2002) (quoting 20 C.F.R. § 416.945). Essentially, it’s the SSA’s

“description of what the claimant ‘can and cannot do.’” Webb v. Comm’r of Soc.

Sec., 368 F.3d 629, 631 (6th Cir. 2004) (quoting Howard, 276 F.3d at 239).

Hearing testimony

Nicholson, who was represented by counsel, testified at the telephonic

administrative hearing held in January 2025. Nicholson described her past job

readying items for shipment at an Amazon warehouse. Tr. 48–49. She said that

she was on her feet for entire ten-hour shifts and she lifted up to 50 pounds.

Tr. 49–50. When asked why she was unable to work, Nicholson said that her

feet cramp and “ball up” due to her rheumatoid arthritis. Tr. 50. She had to

wear steel-toed shoes at Amazon, so she would have to take her boots off “for a

minute” when her feet “cramp[ed] up” and couldn’t work during that time. Tr.

50. This made her anxious because “everything’s timed and numbered” at

Amazon. Tr. 50. When Nicholson gets irritable, she yells at people. Tr. 50. Her

joints hurt, her hands cramp, she becomes anxious about meeting “[her]

numbers,” and she leaves work. Tr. 50.

Nicholson said that she experiences pain in her feet, ankles, knees,

fingers, knuckles, wrists, hands, and neck. Tr. 51. She has degenerative disc

disease in her lower back. Tr. 51. She’s had rheumatoid arthritis for a number

of years, and she tried to work through it. Tr. 51. Nicholson estimated that she

spent 50 percent of her day in pain. Tr. 51. Her pain is bad in the morning and

at night, and she rated it a six-out-of-ten with medication and an eight-out-of-

ten without medication. Tr. 51-52. Nicholson said that she can comfortably sit

for two to three hours and stand for an hour. Tr. 52. She can walk for twenty

minutes. Tr. 52. She can lift ten pounds, and explained that she can’t lift 50

pounds anymore because she “lost all [her] body strength.” Tr. 53.

Nicholson stated that she used to receive injections for rheumatoid

arthritis, but now she only takes Ibuprofen because she lost her insurance

when she got divorced. Tr. 57. She hasn’t seen her rheumatologist since 2019,

but she had an appointment ten days after the hearing to see her again. Tr. 58.

Nicholson explained that when her anxiety and stress increase, her

rheumatoid arthritis flares up. Tr. 58. It feels like she has the flu—every

muscle and joint hurts. Tr. 58. She takes muscle relaxants for muscle cramps.

Tr. 59.

Nicholson testified that some days she can’t go outside because she is

paranoid. Tr. 57. She has problems sleeping. Tr. 57. Anxiety prevents her from

entering a room with 35 to 50 people. Tr. 60. If people line up behind her at the

grocery store, she gets panic attacks because she’s nervous that she’s holding

others up. Tr. 61. Nicholson takes medication for anxiety, but it makes her

tired. Tr. 59.

The ALJ discussed with the vocational expert Nicholson’s past work as

an order picker and order filler. Tr. 65. The ALJ asked the vocational expert to

determine whether a hypothetical individual with Nicholson’s age, education,

and work experience could perform work if the individual had the limitations

assessed in the ALJ’s RFC determination, described below. Tr. 65, 67. The

vocational expert answered that such an individual could not perform

Nicholson’s past work but could perform the following jobs: linen room

attendant, housecleaner, and cook helper. Tr. 65–67. The ALJ asked follow-up

questions regarding off-task behavior and absenteeism. Tr. 67–68.

Next, Nicholson’s attorney asked the vocational expert whether “these

jobs” would require greater than occasional interaction with supervisors and

coworkers during a training period. Tr. 68. The vocational expert explained

that there is “more interaction” during the training period because there’s

“usually a buddy system for at least two weeks” while the worker gets

acclimated to the work environment. Tr. 68. The vocational expert confirmed

that “it could be more than occasional interaction” during a training period. Tr.

68.

The ALJ’s Decision

The ALJ made the following findings of fact and conclusions of law:

1. The claimant meets the insured status

requirements of the Social Security Act through

December 31, 2028.

2. The claimant has not engaged in substantial

gainful activity since April 19, 2023, the alleged

onset date (20 CFR 404.1571 et seq., and 416.971 et

seq.).

3. The claimant has the following severe

impairments: rheumatoid arthritis, restless leg

syndrome, hypothyroidism, gastrointestinal reflux

disease, osteoporosis, depression, anxiety disorder,

post-traumatic stress disorder, attention deficit

hyperactivity disorder (20 CFR 404.1520(c) and

416.920(c)).

4. The claimant 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 the claimant has the

residual functional capacity to perform medium

work as defined in 20 CFR 404.1567(c) and

416.967(c) except she has the ability to understand,

remember and carry out simple instructions. She

can use her judgment to make simple work-related

decisions. She cannot perform work requiring a

specific production rate (for example assembly line

work). She can deal with occasional changes in a

routine work setting and [is] able to occasionally

interact with supervisors, coworkers, and the public.

6. The claimant is unable to perform any past

relevant work (20 CFR 404.1565 and 416.965).

7. The claimant was … 58 years old, which is defined

as an individual of advanced age, on the alleged

disability onset date. The claimant subsequently

changed age category to closely approaching

retirement age (20 CFR 404.1563 and 416.963).

8. The claimant has at least a high school 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 the claimant is “not disabled,”

whether or not the claimant has transferable job

skills (See SSR 82-41 and 20 CFR Part 404, Subpart

P, Appendix 2).

10. Considering the claimant’s age, education, work

experience, and residual functional capacity, there

are jobs that exist in significant numbers in the

national economy that the claimant can perform (20

CFR 404.1569, 404.1569a, 416.969, and 416.969a).

11. The claimant has not been under a disability, as

defined in the Social Security Act, from April 19,

2023, through the date of this decision (20 CFR

404.1520(g) and 416.920(g)).

Tr. 19–32.

Standard for Disability

Eligibility for social security benefit payments depends on the existence

of a disability. 42 U.S.C. §§ 423(a), 1382(a). “Disability” is defined as the

“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 also 42 U.S.C.

§ 1382c(a)(3)(A).

An ALJ is required to follow a five-step sequential analysis to make a

disability determination:

1. Is the claimant engaged in substantial gainful

activity? If so, the claimant is not disabled.

2. Does the claimant have a medically

determinable impairment, or a combination of

impairments, that is “severe”? If not, the

claimant is not disabled.

3. Does the claimant’s impairment meet or equal

one of the listed impairments and meet the

duration requirement? If so, the claimant is

disabled. If not, the ALJ proceeds to the next

step.

4. What is the claimant’s residual functional

capacity and can the claimant perform past

relevant work? If so, the claimant is not

disabled. If not, the ALJ proceeds to the next

step.

5. Can the claimant do any other work

considering the claimant’s residual functional

capacity, age, education, and work

experience? If so, the claimant is not disabled.

If not, the claimant is disabled.

20 C.F.R. §§ 404.1520, 416.920. see Jordan v. Comm’r of Soc. Sec., 548 F.3d

417, 422 (6th Cir. 2008). Under this sequential analysis, the claimant has the

burden of proof at steps one through four. Jordan, 548 F.3d at 423. The burden

shifts to the Commissioner at step five “to prove the availability of jobs in the

national economy that the claimant is capable of performing.” Id. “The

claimant, however, retains the burden of proving her lack of residual functional

capacity.” Id. If a claimant satisfies each element of the analysis and meets the

duration requirements, the claimant is determined to be disabled. Walters

Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997).

Standard of review

A reviewing court must affirm the Commissioner’s conclusions unless it

determines “that the ALJ has failed to apply the correct legal standards or has

made findings of fact unsupported by substantial evidence in the record.”

Jordan, 548 F.3d at 422. “‘[S]ubstantial evidence’ is a ‘term of art’” under which

“a court … asks whether” the “existing administrative record … contains

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

v. Berryhill, 587 U.S. 97, 102 (2019) (citations omitted). The substantial

evidence standard “is not high.” Id. at 103. Substantial evidence “is ‘more than

a mere scintilla’” but it “means only[] ‘such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.’” Id. (citations

omitted). The Commissioner’s “findings … as to any fact if supported by

substantial evidence [are] conclusive.” 42 U.S.C. § 405(g); Biestek, 587 U.S. at

99.

A court may “not try the case de novo, resolve conflicts in evidence, or

decide questions of credibility.” Bass v. McMahon, 499 F.3d 506, 509 (6th Cir.

2007). Even if substantial evidence or a preponderance of the evidence

supports a claimant’s position, a reviewing court cannot overturn the

Commissioner’s decision “so long as substantial evidence also supports the

conclusion reached by the ALJ.” Jones v. Comm’r of Soc. Sec., 336 F.3d 469,

477 (6th Cir. 2003). This is so because there is a “zone of choice within which”

the Commissioner can act, without fear of judicial “interference.” Lindsley v.

Comm’r of Soc. Sec., 560 F.3d 601, 605 (6th Cir. 2009) (quoting Felisky v.

Bowen, 35 F.3d 1027, 1035 (6th Cir. 1994)).

Discussion

1. The ALJ did not err when he evaluated the opinion evidence

Nicholson argues that the ALJ failed to properly evaluate the opinions

of Drs. Bell and Yacubek. Doc. 10, at 11.

The Commissioner is required to evaluate the persuasiveness of all

medical opinions using the following factors: supportability; consistency;

treatment relationship, including the length, frequency, purpose, and extent;

specialization; and other factors. 20 C.F.R. §§ 416.920c(a), 416.920c(c)(1)–(5).

Supportability and consistency are the most important factors. 20 C.F.R. §

416.920c(a). Supportability means that “[t]he more relevant the objective

medical evidence and supporting explanations presented by a medical source

are to support his or her medical opinion[] … the more persuasive the medical

opinions … will be.” 20 C.F.R. § 416.920c(c)(1). Consistency means “[t]he more

consistent a medical opinion[] … is with the evidence from other medical

sources and nonmedical sources in the claim, the more persuasive the medical

opinion[] … will be.” 20 C.F.R. § 416.920c(c)(2). The Commissioner must

explain the supportability and consistency factors when discussing a medical

opinion. 20 C.F.R. § 416.920c(b)(2). “[A]n ALJ need not,” however, “specifically

use the terms ‘supportability’ or ‘consistency’ in his analysis.” Cormany v.

Kijakazi, No. 5:21-cv-933, 2022 WL 4115232, at *3 (N.D. Ohio Sept. 9, 2022)

(citing cases). The Commissioner is not required to discuss the remaining

factors. Id. “A reviewing court evaluates whether the ALJ properly considered

the factors as set forth in the regulations to determine the persuasiveness of a

medical opinion.” Toennies v. Comm’r of Soc. Sec., 2020 WL 2841379, at *14

(N.D. Ohio June 1, 2020) (internal quotation marks and citation omitted).

Nicholson argues that “the ALJ completely mischaracterized the record

in Dr. Bell’s supportability and consistency analysis to improperly discount”

Dr. Bell’s opinion. Doc. 10, at 13. The ALJ detailed Dr. Bell’s August 2023

opinion, in which Dr. Bell found that Nicholson was markedly limited in three

areas of functioning due to anxiety or stress, Tr. 27–28, and explained:

The opinion from Dr. Bell was not persuasive since

the mental status evaluations performed by Dr. Bell

indicated the claimant was alert and oriented. There

was no evidence the claimant had depression or

anxiety. The claimant presented in no apparent

distress. Furthermore, the claimant did not advise

the physician that the medication was not effective

in treating her symptoms and wanted to change

medications (1F). Moreover, while the consultative

psychologist noted some anxiety and depression,

there was no evidence the claimant had significant

limitations in her functioning which was

inconsistent with the marked limitations Dr. Bell

opined (2F: 4F).

Tr. 28.

Nicholson first argues that it is “simply untrue” that Dr. Bell’s

evaluations indicated that Nicholson “was alert and oriented” with “no

evidence” of “depression or anxiety,” as the ALJ found. Doc. 10, at 15. In

support, she cites Dr. Bell’s August 2023 treatment note indicating that she

told Dr. Bell that she had anxiety and was stressed, and Dr. Bell’s January

2023 off-work statement. Id. (citing Tr. 372–73, 420). Dr. Bell’s off-work

statement didn’t list any exam findings, despite the form inviting Dr. Bell to

do so.5 Tr. 420. On this form, Dr. Bell cited Nicholson’s primary diagnosis as

arthritis and her secondary diagnosis as anxiety. Tr. 420. In support of his

statement that Nicholson had been off work for two days earlier that month,

Dr. Bell wrote that Nicholson contacted his office “pertaining to medication,

etc.” Tr. 420. So there is no indication in this note that Dr. Bell wrote that

Nicholson was off work due to anxiety, let alone any objective exam findings

supporting the off-work statement.

And Nicholson’s reference to statements that she made to Dr. Bell, Doc.

10, at 15, are not Dr. Bell’s own observations during mental exam testing. See

Kepke v. Comm’r of Soc. Sec., 636 F. App’x 625, 629 (6th Cir. 2016) (“Regardless

of any inherent subjectivity in the field of psychiatry, a doctor cannot simply

report what his patient says and re-package it as an opinion.”). Nicholson

hasn’t identified a treatment note showing that Dr. Bell found her to be not

oriented. Nicholson regularly scored a zero on her depression screenings at her

visits with Dr. Bell. Tr. 369, 372, 375. And while it is true that once in August

2023, Dr. Bell observed Nicholson to have an anxious affect, that day she was

also oriented to person, place, and time, and she was pleasant, well-appearing,

and in no acute distress, Tr. 373, as the ALJ noted, Tr. 28. In other words,

despite Nicholson’s anxious affect, she remained oriented and not distressed—

she did not present with the “marked distress” that Dr. Bell opined Nicholson

5 The ALJ separately evaluated Dr. Bell’s May 2023 off-work statement,

Tr. 27, which Nicholson does not challenge.

at times would display. Tr. 395. The ALJ acknowledged that Nicholson had

been diagnosed with anxiety, depression, PTSD, and ADHD, Tr. 20; recognized

that these impairments caused moderate, rather than marked, functional

limitations, Tr. 29; and assessed RFC limitations to accommodate Nicholson’s

moderate mental limitations, Tr. 23, 29.

Nicholson complains that the ALJ criticized her for not advising Dr. Bell

that her medication was not effective. Doc. 10, at 15–16. But Nicholson’s

treatment relationship with her primary care doctor, including the fact that

her treatment was conservative, is an appropriate factor for the ALJ to

consider. See 20 C.F.R. § 416.920c(c)(3); see also Hopkins v. Comm’r of Soc. Sec.,

No. 23-5696, 2024 WL 3688302, at *4 (6th Cir. Apr. 9, 2024) (finding that the

ALJ properly discounted a medical opinion based on “the conservative level of

treatment received”); Blacha v. Sec’y of Health & Hum. Servs., 927 F.2d 228,

231 (6th Cir. 1990) (claimant’s failure to seek treatment undercut complaints

of disabling symptoms); see also Jackson v. Saul, No. CV 6:19-272, 2020 WL

3037218, at *5 (E.D. Ky. June 5, 2020) (commenting that the doctor’s “failure

to pursue more aggressive treatment for … back pain does question the doctor’s

Medical Source Statement findings given his knowledge of the impairment.”).

And the ALJ’s comment about Nicholson’s medication regime is consistent

with his observations elsewhere in his decision that: Nicholson’s treatment for

her impairments was conservative, Tr. 24; she had gaps in treatment, Tr. 24,

28; she at times ran out of her medications, Tr. 25, 28; and there was no record

evidence that she pursued or maintained specialized treatment for rheumatoid

arthritis or mental health conditions.6 Tr. 25, 27, 29.

Nicholson submits that “Dr. Bell had a supporting explanation for

nearly every aspect of his opinion, and the ALJ completely failed to consider

his supporting explanations behind Dr. Bell’s opinions.” Doc. 10, at 16. But all

of Dr. Bell’s explanations described what Nicholson told him. Tr. 396–98. The

ALJ explained that, despite Dr. Bell’s assessed marked limitations, his opinion

was not supported by his own exam findings. Tr. 28. Nicholson hasn’t identified

treatment notes showing that Dr. Bell observed Nicholson to exhibit the

behavior he described in his opinion.

Next, Nicholson argues that the ALJ’s consistency evaluation of Dr.

Bell’s opinion, which he contrasted with Dr. Wang’s opinion, was faulty. Doc.

10, at 16–17. She claims that the ALJ “mischaracterize[ed]” Dr. Wang’s

opinion, and that Dr. Wang’s opinion “was far more significant than the ALJ

suggests” and “does in fact show significant limitations to functioning.” Id. at

17. Nicholson doesn’t challenge the ALJ’s evaluation of Dr. Wang’s opinion—

only the ALJ’s use of Dr. Wang’s evaluation to show that Dr. Bell’s opinion was

inconsistent with other evidence in the record. Id.

6 In September 2024, Nurse Davies referred Nicholson to rheumatology,

Tr. 508, and Nicholson testified at the late January 2025 hearing that she had

an upcoming rheumatology appointment in early February 2025, Tr. 58. No

treatment notes were added to Nicholson’s record, despite the ALJ’s invitation

to do so or request more time if needed. Tr. 17, 44–45.

The ALJ did not mischaracterize Dr. Wang’s opinion. The ALJ explained

that Dr. Wang wrote that Nicholson understood and remembered questions

during the consultative exam and “was expected to be able to understand,

remember and carry out instructions in the work setting.” Tr. 28, 438–39. The

ALJ noted that Dr. Wang found Nicholson’s concentration and persistence to

be “satisfactory,” that Nicholson “was able to remain on task and worked at an

adequate pace for all clinical interactions during the evaluation,” and that if

her depressive and anxiety symptoms worsened, “they could … interfere[e]

with her ability to focus and concentrate.” Tr. 28, 439. The ALJ wrote that

Nicholson showed average social skills during the exam, said that she got along

well with work supervisors, and that Dr. Wang opined that Nicholson

“maintained certain capacity in this area.” Tr. 28, 439. Finally, the ALJ

commented that Dr. Wang wrote that Nicholson had “depressive and anxiety

symptoms so these could lower her frustration tolerance and put her a bit at

risk for workplace pressure at this time.” Tr. 28, 439. Nicholson argues that

Dr. Wang observed that Nicholson “appeared sad” and “anxious, with ‘[s]ome

behavioral or autonomic signs of anxiety.’” Doc. 10, at 16. But the ALJ noted

that Nicholson during the exam with Dr. Wang displayed “depressive and

anxiety symptoms.” Tr. 28. And the ALJ recited all of the statements Dr. Wang

made that Nicholson cites. Tr. 28; Doc. 10 at 16–17 (listing Dr. Wang’s findings

that the ALJ listed above). Nicholson simply disagrees with the ALJ’s

conclusion that Dr. Wang’s exam findings described less than “significant

limitations,” id. at 17, but the ALJ’s description was accurate.

Moreover, Nicholson doesn’t specifically identify what limitations Dr.

Wang found that would be “significant.” Indeed, Dr. Wang’s opinion didn’t

contain specific functional limitations—it only described conditional, vague

limitations that Nicholson may have. Tr. 438–39. So it doesn’t amount to a

medical opinion about Nicholson’s limitations. See Francis v. Comm’r Soc. Sec.

Admin., 414 F. App’x 802, 804 (6th Cir. 2011) (finding that a doctor’s statement

wasn’t a “‘medical opinion’ at all—it merely regurgitates Francis’s self-

described symptoms”); Harden v. Comm’r of Soc. Sec., No. 16-12394, 2017 WL

4946580, at *8 (E.D. Mich. Aug. 24, 2017) (“The medical source statement’s

mere parroting of plaintiff’s reported symptoms and complaints (as dictated by

plaintiff the very day the statement was completed) oppugns its status as an

actual medical opinion under the regulatory definition”). Nicholson hasn’t

shown that the ALJ “mischaracterize[ed]” Dr. Wang’s opinion, or that he erred

when he contrasted Dr. Wang’s non-significant exam findings with Dr. Bell’s

assessed “marked” limitations, Tr. 28.

Finally, Nicholson argues that the ALJ erred when he evaluated Dr.

Yakubek’s opinion. Doc. 10, at 17. The ALJ evaluated Dr. Yakubek’s opinion

as follows:

In July 2024, the consultative physician opined the

claimant could sit a couple hours[,] stand a couple

hours and walk a couple of blocks and lift ten

pounds. She did not have any substantial physical

limitations. Her medical conditions were well

controlled on current medications and there were no

acute symptoms that would suggest otherwise (5F).

The opinion from the consultative physician was

partially persuasive since the opinion the claimant

could only stand walk sit a couple hours and lift ten

pounds was not supported by the examination that

indicated she had no limitations in range of motion

or muscle strength. She had a normal gait and

normal coordination. She had no focal deficits (5F).

The opinion the claimant had no substantial

physical limitations in her functioning and her

medical conditions were well controlled by her

current medication and no acute symptoms that

would suggest otherwise was supported by the

benign findings on the consultative examination.

Moreover, the opinion was consistent with the

examinations performed by the primary care

phys[i]cia[]n in the record (1F: 8F).

Tr. 29. Nicholson argues that the ALJ “fail[ed] to consider the supporting

explanation of Dr. Yakubek.” Doc. 10, at 18. She doesn’t identify, however,

what “supporting explanation” she’s referencing. She cites her testimony at the

administrative hearing, id., but her testimony doesn’t supply the “supporting

explanation” for Dr. Yakubek’s opinion. See 20 C.F.R. § 416.920c(c)(1).

(defining supportability as the “relevant … objective medical evidence and

supporting explanations presented by a medical source” in support of his or her

opinion). The ALJ’s explanation—that Nicholson’s normal exam findings

during Dr. Yakubeks’s exam didn’t support Dr. Yakubek’s opinion that

Nicholson could perform less than sedentary work—is proper and accurate.

2. The ALJ’s step five finding is supported by substantial evidence

Nicholson argues that the ALJ’s step five determination is unsupported

by substantial evidence. Doc. 10, at 19. She says that the RFC limited her to

occasional interaction with others, but the vocational expert testified at the

administrative hearing that the jobs he identified had a two-week training

period, during which time Nicholson “could” have more than occasional

interaction with coworkers. Id.

The following exchange occurred at the administrative hearing:

Q [Nicholson’s attorney]: So, excuse me, first would

these jobs—would the occasional interaction with

supervisors or coworkers—would … the interaction

be greater than that during the initial training

period? Whether it’s 60—

A [Vocational expert]: No.

Q: —or 90 days or what or 30 days, whatever their

introductory period, would that be—would there be

more interaction during that time?

A: It’s more interaction during the training period

because usually on a buddy system for at least two

weeks until you get familiar with the—acclimated

with the climate and—and the job duties, because

the job duties for unskilled you can learn in 30 days

… but it—a lot of times, it’s just getting acclimated

with the worker—you know, the work environment.

Q: Okay. But so you’re saying it could be more than

occasional interaction then during that time, since

she’d be working with someone else?

A: Right, during the training period, correct.

Tr. 68. Nicholson concludes that, based on this testimony, she could not

perform the jobs the vocational expert identified because the RFC limited her

to no more than occasional interaction with others. Doc. 10, at 19. She claims

that the vocational expert “essentially testified that the RFC would preclude

all jobs found at Step 5 given there would be more frequent interaction than

occasional during the training period.” Id. at 19–20. And so, Nicholson says, “it

is unclear how the ALJ determined” that Nicholson could perform the jobs

linen room attendant, house cleaner, and cook helper. Id. at 20; Tr. 31.

The Commissioner points out that the RFC “is an assessment of the

individual’s ability to do sustained mental activities on a regular and

continuing basis.” Doc. 10, at 12 (emphasis added); see 20 C.F.R. §

416.945(b),(c) (explaining that the RFC described “work activity on a regular

and continuing basis.”). “And the mere possibility of something more than

occasional, with a buddy, for approximately two weeks,” the Commissioner

contends, “is not inconsistent with only being able to interact occasionally on a

regular and continuing basis.” Doc. 11, at 12. Moreover, the Commissioner

states, this questioning was “poorly developed” by Nicholson’s counsel at the

administrative hearing:

Counsel elicited only the possibility of some amount

of additional interaction for some short period of

time, even though the hearing took place under

Social Security Ruling (SSR) 24-3p[], which explains

the agency’s expectation that counsel develop points

of contention.

Id.; see Social Security Ruling 24-3p; Titles II and XVI: Use of Occupational

Information and Vocational Specialist and Vocational Expert Evidence in

Disability Determinations and Decisions, 89 Fed. Reg. 97,158 (Dec. 6, 2024)

(effective Jan. 6, 2025), 2025 SSR LEXIS 1. Social Security Rule 24-3p

provides:

At the hearing level, when the claimant is

represented, we expect the representative to raise

any relevant questions or challenges about the VE’s

testimony at the time of the hearing and to assist in

developing the record through appropriate questions

to the VE.

2025 SSR LEXIS 1, at *8; see id. at *8 n.10 (“Raising relevant questions about

or challenges to the VE’s testimony at the time of the hearing, when the VE is

ready and available to answer them, furthers the efficient, fair, and orderly

conduct of the administrative decision-making process.”) (citing 20 C.F.R. §§

404.1740 and 416.1540).

In reply, Nicholson maintains that the vocational expert’s testimony

isn’t substantial evidence to support the ALJ’s step five finding. Doc. 12, at 2.

As for SSR 24-3p, she concedes that the ruling “explains the agency’s

expectation that counsel develop points of contention,” Doc. 12, at 2–3 (quoting

Defendant’s brief), but argues that “the government’s attempt to assert issue

preclusion by utilizing a Social Security Ruling—which lacks the safeguards

afforded by the agency’s rulemaking process, as would a regulatory change—

is improper,” id. at 3. Nicholson writes:

Plaintiff asks the Court to note that Social Security

Rulings are not offered for public consideration

under the formal notice-and-comment rulemaking

process, and that SSR 24-3p, was accordingly

published as a “Notice of Social Security Ruling,”

rather than as a “Notice of Proposed Rulemaking”

(“NPRM”).[] Fashioning such a change as reflected

here, under the guise of interpretation of established

regulatory provisions—without divulging that the

change would greatly alter substantive rights of

claimants—is impermissible.[] … Plaintiff asserts

that altering basic substantive rights of claimants—

through a purportedly interpretive ruling—must not

be allowed. As the Sixth Circuit has observed, “The

APA sets different procedural requirements for

‘legislative rules’ and ‘interpretive rules’: the former

must be promulgated pursuant to notice and-

comment rulemaking; the latter need not.”

Tennessee Hosp. Ass’n v. Azar, 908 F.3d 1029, 1042

(6th Cir. 2018). “If an agency attempts to issue a

legislative rule without abiding by the APA’s

procedural requirements, the rule is invalid.”

Tennessee Hosp. Ass’n., 908 F.3d at 1042. See also

Children’s Hosp. of the King’s Daughters, Inc. v.

Azar, 896 F.3d 615, 617 (4th Cir. 2018). A Social

Security ruling is not the appropriate tool to effect

such a change as this. It is Plaintiff’s position that—

given the manner in which the Commissioner

attempts to wield it in the case at bar—SSR 24-3p

must be properly characterized as a legislative rule,

because application of its waiver provision would

result in substantive changes both for claimants’

duties to raise issues at the administrative hearing

level and for claimants’ access to judicial review.

Doc. 13, at 3–4. Nicholson concludes that “[t]he mere presence of 24-3p in this

case should require remand.” Id. at 3.

First, Nicholson’s challenge to the ALJ’s application of SSR 24-3p is

improper because she raised it for the first time in her reply brief. See Island

Creek Coal Co. v. Wilkerson, 910 F.3d 254, 256 (6th Cir. 2018) (“Time, time,

and time again, we have reminded litigants that we will treat an ‘argument’ as

‘forfeited when it was not raised in the opening brief.’”) (citation omitted)).

Although Nicholson frames her argument as a response to the Commissioner’s

brief, the ALJ wrote that he adopted the vocational expert’s testimony “in

accordance with SSR 24-3p.” Tr. 32. So Nicholson should have raised any

challenge to the ALJ’s reliance on SSR 24-3p in her opening brief, which she

failed to do.7 She has therefore forfeited her SSR 24-3p challenge.

In any event, in light of the exemption in 5 U.S.C. § 553(b) for

“interpretative rules, general statements of policy, or rules of agency

organization, procedure, or practice,” Social Security Rulings need not be

promulgated through notice-and-comment rule making. See Taylor v. Sec’y of

Health & Hum. Servs., 922 F.2d 841 (Table), 1991 WL 1104, at *1 (6th Cir.

1991); cf. Hicks v. Comm’r of Soc. Sec., 909 F.3d 786, 810 n.12 (6th Cir. 2018)

(“As Social Security Rulings presumably lack the force of law, they do not

warrant Chevron deference.”).

Moreover, as the Commissioner says, Nicholson’s attorney did not

develop this point at the administrative hearing. Nicholson claims that the

vocational expert “essentially testified that the RFC would preclude all jobs

found at Step 5 given there would be more frequent interaction than occasional

during the training period.” Doc. 12, at 4; see id., at 2 (stating that Nicholson

“clearly would have to go through a training period on any job and the mere

possibility of over occasional interaction would preclude work according to the

7 Nicholson didn’t raise this issue when she appealed the ALJ’s decision

to the Appeals Council, either. Tr. 367–68.

RFC.”). But this is too broad a reading of the vocational expert’s testimony—

the vocational expert was not asked, nor did he state, that Nicholson couldn’t

perform any jobs or could not weather a two-week training period for the

specific jobs he identified. Nor did he say how much additional contact, and

how often, Nicholson would be expected to experience during a training

period.8 Tr. 68 (vocational expert agreeing that during a two-week training

period there “could be more than occasional interaction” with others); see, e.g.,

Dean v. Berryhill, No. 1:17-cv-01297, 2019 WL 1170479, at *5 (E.D. Cal. Mar.

13, 2019) (rejecting the claimant’s argument because “[t]he VE did not testify

that someone with a limitation to occasional interaction with supervisors could

not get past the training time for the representative jobs. Rather, the VE

suggested that during the training time, there may be more than occasional

contact with a supervisor.”).

Nicholson has not cited legal authority to support her assertion that

vocational expert testimony regarding an unidentified amount of increased

exposure to others during a two-week training period renders insubstantial the

vocational expert testimony on which an ALJ relies. Legal authority indicates

8 Counsel’s failure to pursue this point at the hearing is puzzling. See 3

Soc. Sec. Disab. Claims Prac. & Proc. § 27:83(B) Examples of when to file

posthearing briefs (2nd ed. updated Oct. 2025) (commenting that, “[f]or this

argument [regarding a probationary period preclusion] to work,” the claimant’s

representative must “focus ... on the jobs the VE identified, not all jobs in

general,” and expressly ask the vocational expert whether the hypothetical

individual could perform the identified jobs despite the probationary period,

and providing a detailed “script” for a representative to follow).

otherwise. See 20 C.F.R. § 416.945(b),(c) (explaining that the RFC describes

“work activity on a regular and continuing basis.”) (emphasis added); Wright

v. Comm’r of Soc. Sec., No. 1:12-cv-1103, 2013 WL 3873947, at *3 (N.D. Ohio

July 25, 2013) (“[U]nder Plaintiff’s theory, every single time an individual is

limited to superficial interactions with others, the result would require an ALJ

to determine that the claimant is entitled to benefits since training for a job

necessarily involves more than superficial interaction with others. Such a

result is untenable.”); see also Rebecca L. v. Comm’r of Soc. Sec., 617 F. Supp.

3d 256, 273 (D.N.J. 2022) (noting that courts in that district “routinely” reject

arguments that “an interaction level during a probationary training period

that briefly exceeds occasional undermines a plaintiff’s RFC”) (citation

omitted); see Robin S. v. Comm’r of Soc. Sec., No. 24-cv-06904, 2025 WL

1431084, at *10 (D.N.J. May 19, 2025) (“Here, the VE acknowledged that

interaction levels during training may exceed occasional, but this does not

create an apparent conflict under SSR 24-3p, … which clarifies that the DOT

reflects ‘maximum requirements of occupations as generally performed.’…

Because the potential for elevated interaction is limited to an initial

probationary period and does not conflict with the DOT’s characterization of

the job as generally performed, no further explanation was required from the

ALJ.”); Suchini v. Comm’r of Soc. Sec., No. 8:24-cv-01467, 2025 WL 913765, at

*3 (M.D. Fla. Mar. 26, 2025) (“The VE’s testimony that a supervisor might give

extra instructions for ‘maybe a week’ does not undermine the ALJ’s conclusion

that Suchini could perform work where such interaction was only occasional.”).

In sum, Nicholson didn’t develop this issue during the administrative

hearing, as Social Security Ruling 24-3p requires, and she hasn’t shown that

the ALJ’s reliance on vocational testimony at step five was not supported by

substantial evidence.

Conclusion

For the reasons explained above, I affirm the Commissioner’s decision.

Dated: May 6, 2026

/s/ James E. Grimes Jr.

James E. Grimes Jr.

U.S. Magistrate Judge