Ramos v. Commissioner of Social Security Administration

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
AUGUSTINA RAMOS,
Plaintiff,
vs.
COMMISSIONER OF SOCIAL
SECURITY ADMINISTRATION,
Defendant.
CASE NO. 1:25-cv-1015
DISTRICT JUDGE
BENITA Y. PEARSON
MAGISTRATE JUDGE
JAMES E. GRIMES JR.
REPORT &
RECOMMENDATION
Plaintiff Augustina Ramos filed a Complaint against the Commissioner
of Social Security seeking judicial review of the Commissioner’s decision
denying supplemental security income. This Court has jurisdiction under 42
U.S.C. §§ 405(g) and 1383(c). The Court referred this matter to a Magistrate
Judge 	under Local Rule 	72.2(b)(1) for the 	preparation 	of a Report 	and
Recommendation. Following review, and for the reasons stated below, I
recommend that the District Court affirm the Commissioner’s decision.
Procedural history
On October 13, 2022, Ramos filed an application for supplemental
security income, alleging a disability onset date of May 1, 2020.1 Tr. 17, 156.
In her application, Ramos claimed disability due to back problems, mental
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).
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 1 of 16. PageID #: <pageID>

2
health 	issues, 	rheumatoid 	arthritis, 	borderline 	personality 	disorder,
osteoarthritis, 	major 	depressive 	disorder, 	post-traumatic 	stress 	disorder
(PTSD), and anxiety. Tr. 184. The Social Security Administration denied
Ramos’s application and her motion for reconsideration. Tr. 75, 89. Ramos then
requested a hearing before an Administrative Law Judge (ALJ). Tr. 106.
In January 2024, an ALJ held a hearing, during which Ramos and a
vocational expert testified. Tr. 35–60. In April 2024, the ALJ issued a written
decision finding that Ramos was not disabled. Tr. 17–29. The ALJ’s decision
became final on March 19, 2025, when the Social Security Appeals Council
declined further review. Tr. 1–3; see 20 C.F.R. § 404.981.
Ramos filed this action on May 17, 2025. Doc. 1. She asserts the
following assignment of error:
Whether the ALJ erred by failing to consider how
the claimant’s continuous emergency room[] visits
and 	hospitalizations 	would 	limit 	her 	ability 	to
sustain competitive work.
Doc. 8, at 1.
Evidence
Personal and vocational evidence
Ramos was 41 years old on her disability application date. Tr. 27. She
obtained a general educational diploma and last worked in 2009. Tr. 27, 44.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 2 of 16. PageID #: <pageID>

3
Relevant medical evidence2
Ramos has several physical and mental conditions that limit the ability
to perform basic work activities, including:
small right subarticular disc protrusion at L4-5 and
left 	subarticular 	disc 	protrusion 	at 	L5-S1 	with
persistent 	severe 	canal 	stenosis 	and 	mild
progression of right subarticular recess stenosis at
L4-5 and radiculopathy; cervical spondylosis with
varying 	levels 	of 	foraminal 	impingement, 	most
evident at C4-5 and C5-6, right greater than left, and
borderline/mild cord impingement at C4-5 without
severe compression; mild right C7 radiculopathy
with no active denervation; rheumatoid arthritis;
essential 	hypertension; 	mild 	obstructive 	sleep
apnea; 	obesity; 	depression; 	anxiety; 	borderline
personality 	disorder; 	trichotillomania; 	and
posttraumatic stress disorder (PTSD).
Tr. 19.
Ramos was hospitalized from September 18, 2022, through October 4,
2022, after overdosing on muscle relaxers. Tr. 409.
On November 11, 2022, Ramos went to the emergency room complaining
of left hip and lower back pain. Tr. 565. She was assessed with left-sided lower
back pain with sciatica, treated, and discharged home. Tr. 568–69.
On January 29, 2023, Ramos went to the emergency room complaining
of a headache. Tr. 1767. She reported a history of migraines. Tr. 1767. She was
2 	Ramos only challenges the ALJ’s “fail[ure] to consider how [Ramos’s]
continuous emergency rooms visits and hospitalizations would limit her ability
to sustain competitive work.” Doc. 8, at 1. I have therefore only included in this
report and recommendation a discussion of Ramos’s emergency room visits and
hospitalizations.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 3 of 16. PageID #: <pageID>

4
treated and discharged home. Tr. 1770.
On January 31, 2023, Ramos was admitted to the hospital for depression
with a suicide attempt. Tr. 942. On February 2 she was discharged from the
mental health unit, Tr. 966, but moved to another unit due to low blood
pressure “in the setting of recent p[s]ychiatric medication changes.” Tr. 898.
The provider noted that due to an abnormal urinalysis, Ramos should remain
hospitalized for further observation. Tr. 894. Ramos was discharged home on
February 6. Tr. 893–94.
Later in February 2023, Ramos went to the hospital complaining that
she felt lightheaded. Tr. 1506. She said that she had recently re-started her
blood pressure medication and had taken an extra dose the night before her
visit to make up for a missed morning dose. Tr. 1506, 1512. Ramos also
reported a headache and said that she had run out of her migraine medication.
Tr. 1506. Ramos advised that she didn’t feel comfortable being discharged
while feeling lightheaded, so she was admitted and discharged the next day.
Tr. 1513. The provider diagnosed symptomatic bradycardia likely caused by
taking an extra dose of recently started blood pressure medication and
migraine due to having run out of medication. Tr. 1513.
In late April 2023, Ramos went to the emergency room for leg pain. Tr.
1355. The provider diagnosed likely sciatica. Tr. 1360. Ramos was admitted to
the hospital and discharged the following day. Tr. 1362.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 4 of 16. PageID #: <pageID>

5
In August 2023, a neurologist assessed Ramos with chronic bilateral
lumbosacral radiculopathy. Tr. 2052. The doctor recommended water therapy,
weight loss, continued medication, follow-up visits with Ramos’s providers, and
that Ramos “[a]void prolonged lifting standing or sitting activities.” Tr. 2052.
In late September 2023, Ramos went to the emergency room for knee
pain. Tr. 2165. She stated that she was carrying heavy objects the day before
the visit when she felt her knee pop. Tr. 2165. Ramos was fitted with a splint,
given crutches, and discharged home. Tr. 2169.
In early November 2023, Ramos went to the emergency room for back
pain. Tr. 2079. She was diagnosed with chronic midline lower back pain and
right-sided sciatica, treated, and discharged home. Tr. 2093.
State agency opinions3
In February 2023, Rohini Mendonca, M.D., reviewed Ramos’s record. Tr.
69–71. Regarding Ramos’s physical residual functional capacity (RFC),4 Dr.
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).
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 5 of 16. PageID #: <pageID>

6
Mendonca found that Ramos could perform “light” work, that is, in an eight-
hour workday she could stand and walk for no more than four hours and sit for
six hours. Tr. 69. She could lift and carry twenty pounds occasionally and ten
pounds 	frequently. 	Tr. 	69. 	Dr. 	Mendonca 	also 	assessed 	postural 	and
environmental 	limitations. 	Tr. 	70. 	He 	did 	not 	assess 	any 	absenteeism
limitations.
In June 2023, Carolyn Hildreth, M.D., reviewed Ramos’s record and
adopted Dr. Mendonca’s findings, with some postural and environmental
differences. Tr. 83–85. Dr. Hildreth did not assess any absenteeism limitations.
In March 2023, Bruce Lipetz, Psy.D., reviewed Ramos’s record. Tr. 71–
73. Regarding Ramos’s mental RFC, Dr. Lipetz generally found that Ramos
could understand and remember simple and detailed tasks. Tr. 71. She could
sustain and carry out “simple and some lower level detailed tasks … based on
skills that can be multistep, detailed,” and “learned in 1–3 months, and carried
out at a moderate pace.” Tr. 72. Ramos could have incidental contact with the
public and “social contact with co-workers and regular supervision.” Tr. 72. She
could adapt to the above-described work activity with “some limitations” due
to Ramos’s statement that her anxiety worsens in crowds. Tr. 72. Dr. Lipetz
did not assess any absenteeism limitations.
In 	June 	2023, 	Kevin 	Lauer, 	Ph.D., 	reviewed 	Ramos’s 	record 	and
generally adopted Dr. Lipetz’s findings, albeit using different language. Tr. 85–
87. Dr. Lauer did not assess any absenteeism limitations.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 6 of 16. PageID #: <pageID>

7
Hearing testimony
Ramos, who was represented by counsel, testified at the telephonic
administrative hearing held in January 2024. Ramos testified that she lives
with her grandmother. Tr. 43. Ramos has a driver’s license and drives about
two days a week. Tr. 44. She drives to doctors’ appointments or to the grocery
store. Tr. 44.
When asked what prevents her from working, Ramos stated that she
has excruciating back pain. Tr. 45. She also experiences pain in her neck,
hands, and sometimes her knees. Tr. 45. Medication helped. Tr. 45–46. Ramos
also has “anxiety, PTSD in certain situations.” Tr. 45. Due to her impairments,
she can’t lift heavy plates or write for very long. Tr. 50. Once or twice a month
Ramos loses control of her bladder or bowels. Tr. 51. She uses a shower chair
when bathing and stated that bending over to dress herself is difficult. Tr. 52.
When asked how many days in “the last year” she estimated that she
had spent admitted to a hospital or psychiatric facility, Ramos answered
“about 75.” Tr. 52.
The 	ALJ 	asked 	the 	vocational 	expert 	to 	determine 	whether 	a
hypothetical individual such as Ramos could perform any other work if the
individual had the limitations assessed in the ALJ’s RFC determination,
described 	below. 	Tr. 	56. 	The 	vocational 	expert 	answered 	that 	such 	an
individual could perform the following jobs: circuit board assembler, final
assembler, and sorter. Tr. 56. The ALJ asked the vocational expert whether
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 7 of 16. PageID #: <pageID>

8
his answer would change if the individual would also be absent two days per
month or off-task 20 percent of the day. Tr. 57. The vocational expert answered
that either of those limitations would be work-preclusive. Tr. 57.
The ALJ’s Decision
The ALJ made the following findings of fact and conclusions of law:
1. Claimant has not engaged in substantial gainful
activity since October 13, 2022, the application date
(20 CFR 416.971 et seq.).
2. Claimant has the following severe impairments:
small right subarticular disc protrusion at L4-5 and
left 	subarticular 	disc 	protrusion 	at 	L5-S1 	with
persistent 	severe 	canal 	stenosis 	and 	mild
progression of right subarticular recess stenosis at
L4-5 and radiculopathy; cervical spondylosis with
varying 	levels 	of 	foraminal 	impingement, 	most
evident at C4-5 and C5-6, right greater than left, and
borderline/mild cord impingement at C4-5 without
severe compression; mild right C7 radiculopathy
with no active denervation; rheumatoid arthritis;
essential 	hypertension; 	mild 	obstructive 	sleep
apnea; 	obesity; 	depression; 	anxiety; 	borderline
personality 	disorder; 	trichotillomania; 	and
posttraumatic 	stress 	disorder 	(PTSD) 	(20 	CFR
416.920(c)).
3. 	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
416.920(d), 416.925 and 416.926).
4. After careful consideration of the entire record,
the undersigned finds that claimant has the residual
functional capacity to perform sedentary work as
defined 	in 	20 	CFR 	416.967(a) 	except: 	can
occasionally reach overhead with the right and the
left; can frequently reach in all other directions with
the right and the left; can frequently handle with the
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 8 of 16. PageID #: <pageID>

9
right and the left; can frequently finger with the
right and the left; can occasionally climb ramps and
stairs; can never climb ladders, ropes or scaffolds;
can occasionally balance, stoop, kneel, crouch and
crawl; can never be exposed to unprotected heights,
moving 	mechanical 	parts 	or 	operating 	a 	motor
vehicle; can frequently be exposed to humidity and
wetness; has the ability to understand, remember
and carry out simple instructions; is able to use her
judgment to make simple work related decisions;
cannot perform work requiring a specific production
rate (i.e. assembly line work); is able to deal with
occasional changes in a routine work setting; and is
able 	to 	occasionally 	interact 	with 	supervisors,
coworkers and the public.
5. Claimant has no past relevant work (20 CFR
416.965).
6. Claimant was … 41 years old, which is defined as
a younger individual age 18-44, on the date the
application was filed (20 CFR 416.963).
7. Claimant has at least the equivalent of a high
school education (GED) (20 CFR 416.964).
8. Transferability of job skills is not an issue because
claimant does not have past relevant work (20 CFR
416.968).
9. 	Considering 	claimant’s 	age, 	education, 	work
experience and residual functional capacity, there
are jobs that exist in significant numbers in the
national economy that claimant can perform (20
CFR 416.969 and 416.969a).
10. Claimant has not been under a disability, as
defined in the Social Security Act, since October 13,
2022, the date the application was filed (20 CFR
416.920(g)).
Tr. 19–28.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 9 of 16. PageID #: <pageID>

10
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
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 10 of 16. PageID #: <pageID>

11
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
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 11 of 16. PageID #: <pageID>

12
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
Ramos’s sole assignment or error is that the ALJ committed reversible
error when he failed to “consider how [Ramos’s] continuous emergency room[]
visits and hospitalizations would limit her ability to sustain competitive work.”
Doc. 8, at 1, 9. Ramos contends that “[a]bsenteeism must be addressed when
determining the employability fo[r] a disability applicant.” Doc. 8, at 10 (citing
Mains v. Berryhill, No. 1:18-cv-01380, 2019 WL 1299926, at *17 (N.D. Ohio
Mar. 21, 2019)). She asserts that “the ALJ failed to undertake this required
analysis.” Id.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 12 of 16. PageID #: <pageID>

13
In Mains, the court wrote that, in addition to other errors the ALJ made
when evaluating the treating-source opinion of Dr. Warren, “the ALJ fail[ed]
to discuss Dr. Warren’s opinion that Mains’ pain symptoms would cause
absenteeism and she would require an additional, unscheduled break during
the 	workday.” 	2019 WL 	1299926, at 	*13, 17. The court 	explained that
“[b]ecause the ALJ did not provide any analysis in relation [to] Dr. Warren’s
opinion [that] Mains required an additional break and absences, this Court is
unable to discern if this portion of the opinion was discounted or overlooked.”
Id. The court vacated and remanded the Commissioner’s decision because the
ALJ “fail[ed] to set forth good reasons for discounting the opinion of Dr.
Warren.” Id.
Here, 	no 	medical 	provider 	opined 	that 	Ramos 	had 	off-task 	or
absenteeism limitations. So Mains, the only legal authority that Ramos cites
in support of her assertion, isn’t on point. See also Riggio v. Comm’r of Soc.
Sec., No. 3:22-cv-997, 2023 WL 6225093, at *2 (N.D. Ohio Sept. 26, 2023)
(rejecting the claimant’s argument that the ALJ’s RFC assessment failed to
account for absences when no medical provider opined that the claimant would
have such limitations); cf. Bell v. Comm’r of Soc. Sec., No. 1:22-cv-723, 2022
WL 18156676, at *11 (N.D. Ohio Nov. 29, 2022) (finding that the ALJ failed to
sufficiently 	explain 	why 	he 	rejected 	the 	doctors’ 	opinions 	regarding 	the
claimant’s absences), report and recommendation adopted, 2023 WL 130837
(N.D. Ohio Jan. 9, 2023).
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 13 of 16. PageID #: <pageID>

14
Later in her brief, Ramos writes that “[a]n ALJ’s unexplained failure to
include [a] medical expert’s absenteeism limitation in a residual functional
capacity (RFC) assessment has been determined to be reversible error.” Doc.
10, at 11 (citing Carter v. Comm’r of Soc. Sec., No. 3:13-cv-296, 2015 WL 791473
(S.D. Ohio Feb. 24, 2015)). But here, unlike in Carter, there was no medical
expert who assessed absenteeism (or any) limitations. Ramos submits that
ALJs must “articulate” how persuasive they find each medical opinion, Doc.
10, at 11, but this unexceptional statement doesn’t advance Ramos’s case, since
there was no medical opinion in Ramos’s record that included absenteeism or
off-task limitations.
Ramos says that an ALJ’s decision cannot be upheld “[w]here the
reasons given by the trier of fact do not build an accurate and logical bridge
between the evidence and the result.” Doc. 10, at 11 (citing White v. Comm’r of
Soc. Sec., No. 1:20-cv-588, 2021 WL 858662, at *20 (N.D. Ohio Mar. 8, 2021)).
She contends that the ALJ failed to “provide a logical explanation as to how
Ms. Ramos could sustain full-time work during a period where she was treated
at emergency rooms on at least fifteen occasions, and spending at least 20 days
as an inpatient at a hospital or psychiatric facility.”5 Doc. 8, at 11. But White
5 	As the Commissioner points out, some of the transcript pages Ramos
cites include emergency room visits and a hospitalization that occurred before
October 13, 2022. But “[f]or purposes of [supplemental security income], which
is not retroactive, the relevant period … is … the date [the claimant] filed his
protective application, to … the date of the ALJ’s decision.” Koster v. Comm’r
of Soc. Sec., 643 F. App’x 466, 478 (6th Cir. 2016) (citing 20 C.F.R. § 416.335)
And Ramos filed her application on October 13, 2022. Tr. 17, 156.
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 14 of 16. PageID #: <pageID>

15
applied this “logical bridge” test to an ALJ’s faulty evaluation of medical
opinions that contained absenteeism limitations. See White, 2021 WL 858662,
at *19–20. No medical opinions in this case contain absenteeism limitations.
So White doesn’t support Ramos’s argument.
Ramos argues that the ALJ “failed to properly consider how [] Ramos’s
extreme body pain, chronic headaches, suicidal ideation and attempts to take
her own life, would limit her capacity to be present and on-task at any job.”
Doc. 8, at 10. But the ALJ considered Ramos’s impairments and her emergency
treatment. Tr. 23–26. And, as the ALJ stated, “[t]here is no opinion in evidence
from any medically acceptable source that [Ramos] has any greater work
related physical or mental limitations” than the ALJ’s RFC. Tr. 27. Ramos has
not cited legal authority that requires an ALJ to explain why he did not include
in the RFC assessment a limitation that no medical provider assessed.
Moreover, the ALJ explained that Ramos’s headaches improved with
medication. Tr. 24. The ALJ found that Ramos’s mental health conditions
improved with medication and therapy, that her January 2023 hospitalization
was due to worsened depression from a family member’s recent death, and that
Ramos had twice been discharged from treatment for failing to return or lack
of attendance. Tr. 24–26; see Riggio, 2023 WL 6225093, at *3 (affirming the
ALJ’s decision, observing that it included evidence showing improvement and
that the claimant’s mental-health hospitalizations “often coincided with”
treatment non-compliance and external stressors). As for chronic pain, the ALJ
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 15 of 16. PageID #: <pageID>

16
discussed Ramos’s imaging results and largely normal physical exam findings
(including during emergency room visits). Tr. 23–26. The ALJ commented that
Ramos’s neurologist had three times recommended water therapy for pain
control, Tr. 24–26, which the record does not indicate Ramos followed. And the
ALJ found that Ramos’s “statements about the intensity, persistence, and
limiting 	effects 	of 	her 	symptoms” 	lacked 	“support 	in 	contemporaneous
treatment documentation or elsewhere in the record.” Tr. 23. Ramos does not
challenge any of these findings.
All told, Ramos has not shown that the ALJ erred.
Conclusion
For the reasons explained above, I recommend that the Court affirm the
Commissioner’s decision.
Dated: November 24, 2025
/s/ James E. Grimes Jr.
James E. Grimes Jr.
U.S. Magistrate Judge
OBJECTIONS
Any objections to this Report and Recommendation must be filed with
the Clerk of Court within 14 days after the party objecting has been served
with a copy of this Report and Recommendation. 28 U.S.C. § 636(b)(1). Failure
to file objections within the specified time may forfeit the right to appeal the
District Court’s order. See Berkshire v. Beauvais, 928 F.3d 520, 530–31 (6th
Cir. 2019).
Case: 1:25-cv-01015-BYP Doc #: 11 Filed: 11/24/25 16 of 16. PageID #: <pageID>