Gartrell v. Commissioner of Social Security

1
IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
AMBER GARTRELL,
Plaintiff,
vs.
COMMISSIONER OF SOCIAL SECURITY,
Defendant.
CASE NO. 5:25-CV-00547-DAP
JUDGE DAN AARON POLSTER
MAGISTRATE JUDGE DARRELL A. CLAY
REPORT AND RECOMMENDATION
I NTRODUCTION
Plaintiff Amber Gartrell challenges the Commissioner of Social Security’s decision denying
disability insurance benefits (DIB). (ECF #1). The District Court has jurisdiction under 42 U.S.C.
§§ 1383(c) and 405(g). This matter was referred to me under Local Civil Rule 72.2 to prepare a
Report and Recommendation. (Non-document entry dated Mar. 20, 2025). For the reasons below,
I recommend the District Court AFFIRM the Commissioner’s decision.
PROCEDURAL B ACKGROUND
Ms. Gartrell applied for DIB on August 31, 2022, alleging she became disabled on October
14, 2021, due to fibromyalgia, back pain, osteoarthritis, vitamin D deficiency, insomnia,
depression, obesity, migraines, degenerative arthritis, and polycystic ovarian syndrome. (Tr. 221-22,
255). After the claim was denied initially and on reconsideration, Ms. Gartrell requested a hearing
before an ALJ. (Tr. 103, 114, 146-47). On January 22, 2024, Ms. Gartrell (represented by counsel)
and a vocational expert (VE) testified before the ALJ. (Tr. 48-92). On February 13, 2024, the ALJ
determined Ms. Gartrell was not disabled. (Tr. 139). The Appeals Council denied Ms. Gartrell’s
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request for review, making the hearing decision the final decision of the Commissioner. (Tr. 1-3;
see also 20 C.F.R. § 404.981). Ms. Gartrell timely filed this action on March 20, 2025. (ECF #1).
F ACTUAL B ACKGROUND
I. 	Personal and Vocational Evidence
Ms. Gartrell was 34 years old on her alleged onset date and 36 years old at the hearing. (See
Tr. 93). She graduated from high school. (Tr. 256). She has past relevant work experience,
including as an insurance agent, telemarketer, and sales floor manager. (Tr. 85).
II. 	Relevant Medical Evidence
2021. In July, during a primary care visit at the Tuscarawas Health Center of Aultman
Orrville (the health center) Ms. Gartrell complained of constant back and knee pain, among other
things. (Tr. 575). Her provider, Keely Telquist, M.D., did not examine Ms. Gartrell but
recommended ibuprofen for pain. (Tr. 576).
Ms. Gartrell returned to the health center in September and complained of continued low-
back pain, especially with sitting or standing, and described associated difficulty with walking.
(Tr. 578). Dr. Telquist prescribed prednisone for low-back pain and tizanidine HCL for muscle
spasms and recommended back stretches. 1 (Tr. 580).
During a follow-up visit at the health center on November 2, Ms. Gartrell continued to
complain of low-back pain. (Tr. 581). Dr. Telquist referred Ms. Gartrell to physical therapy to
address low-back and knee pain. (Tr. 582).
1 Prednisone is a corticosteroid prescribed to treat a variety of conditions, including
arthritis. See Prednisone, MedlinePlus, http://medlineplus.gov/druginfo/meds/a601102.html (last
accessed Nov. 25, 2025). Tizanidine is a muscle relaxant. See Tizanidine, MedlinePlus,
http://medlineplus.gov/druginfo/meds/a601121.html (last accessed Nov. 25, 2025).
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On November 9, Ms. Gartrell started physical therapy, where she reported increased pain
with standing, sitting, lifting, and walking and endorsed difficulty with performing daily activities.
(Tr. 593). The pain affects her ability to concentrate. (Tr. 594). On physical examination, she a
slightly antalgic gait with decreased cadence. (Id.). Manual muscle testing revealed some diminished
strength in the bilateral hips and knees; and Ms. Gartrell was tender to palpation of her right knee
at the anteromedial joint line and in the lumbar spine. (Id.). She attended 10 sessions through
December 9 and was discharged from physical therapy on December 15. (Tr. 588). On December
7, Ms. Gartrell reported she can perform activities of daily living but requires an occasional rest
break to ease her back pain. (Tr. 589). The therapist emphasized Ms. Gartrell’s improvement in leg
strength but noted “her symptoms remain roughly the same.” (Id.).
On December 9, Ms. Gartrell returned to the health center, reporting aching joints and
continued low-back and knee pain. (Tr. 584). Dr. Telquist ordered lumbar x-rays that showed disc
osteophytes in the lower thoracic spine, straightening of the lordosis, and minimal facet
arthropathy in the lower lumbar spine. (Tr. 585-87).
2022. Ms. Gartrell met with orthopedist Kelsey O’Connor, D.O., in January for evaluation
of lumbar pain. (Tr. 353). There, she described aching and squeezing pain in her low back that
radiates to her hips and buttocks. (Id.). Heat, lying down, and sitting provide some relief while
bending, standing, twisting, and walking aggravate her pain. (Id.). She endorsed difficulty with
prolonged standing, walking, bending, twisting, stooping, performing housework, and lifting. (Id.).
Dr. O’Connor observed Ms. Gartrell walk with a non-antalgic gait and noted intact muscle
strength and stability in the lower extremities. (Tr. 354-55). She also documented limited range of
motion in the spine and positive facet-load testing bilaterally. (Id.). Dr. O’Connor assessed Ms.
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Gartrell with lumbar radiculopathy and ordered an MRI to look for neuroforaminal stenosis, disc
bulges, and annular tears that might contribute to her back pain, especially with prolonged sitting.
(Tr. 355). Dr. O’Connor explained that “weight loss and improving her load on the axial spine as
well as knees and ankles will be of paramount importance” to address her orthopedic pain. (Id.).
The lumbar MRI was unremarkable, revealing no significant stenosis. (Tr. 357-58).
Ms. Gartrell returned to Dr. O’Connor’s office on in February, complaining of continued
low-back and knee pain aggravated by excessive use, sitting, standing, and walking. (Tr. 349). Dr.
O’Connor determined the MRI was “essentially normal” with “very trace disc bulges” at the L4-L5
and L5-S1 joints. (Id.). Ms. Gartrell endorsed discomfort with spinal range of motion testing, but
the physical examination was otherwise normal. (Tr. 350-51).
In March, Ms. Gartrell treated with Brent Ungar, D.C., and complained of cramping,
spasms, and numbness in the low back and upper gluteal regions, and neck spasms and tightness.
(Tr. 486). Ms. Gartrell reported she must rest after walking short distances and has less pain when
lying down. (Id.). On physical examination, Dr. Ungar noted “considerable” bilateral
sternocleidomastoid muscle spasms, slow ambulation, and multiple positive spinal provocation
tests. (Tr. 486-87). Ms. Gartrell had diminished cervical and lumbar range of motion and endorsed
cervical, thoracic, lumbar, and sacral pain. (Tr. 487). Imaging of Ms. Gartrell’s spine revealed mild
loss of disc height with anterior spurring at the C6-C7 joint, mild uncovertebral arthrosis at the
C5-C6 joint on the left, and moderate loss of disc height at the L5-S1 joint. (Tr. 484-85). She
received 21 chiropractic treatments between March 3 and July 25. (Tr. 489-509).
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On March 16, Ms. Gartrell returned to the health center complaining of “pain all over.”
(Tr. 596). Dr. Telquist recommended Ms. Gartrell follow up in six weeks to reassess her low-back
pain. (Tr. 597).
An MRI of Ms. Gartrell’s lumbar spine performed March 17 at Dr. Ungar’s request
showed:
• 	T11/T12: moderate loss of disc height with desiccation and anterolateral
spondylosis with type II Modic changes without bulging, spurring, or disc
herniation.
• 	T12/L1: early anterior spondylosis, normal disc height without bulging,
spurring, or disc herniation.
• 	L1/L2: early anterior spondylosis, preserved disc height without bulging,
spurring, or disc herniation.
• 	L4/L5: very mild left-sided facet arthropathy with mild thickening of the
ligamentum flavum on the left and a physiologic amount of fluid in the right
facet joint.
(Tr. 599). The interpreting radiologist determined Ms. Gartrell has moderate disc degeneration at
the T11/T12 level with early anterolateral spondylosis at the T12/L1 and L1/L2 levels, and very
mild left-sided facet arthrosis at the L4/L5 level. (Tr. 600).
Ms. Gartrell returned to the health center in May complaining of “pain all over.” (Tr. 621).
Dr. Telquist assessed Ms. Gartrell with fibromyalgia, prescribed Lyrica, 2 referred her to physical
therapy to address back pain, and ordered blood work to investigate her knee pain. (Tr. 622).
When Ms. Gartrell returned the next month, she reported that tizanidine relieved some
pain, but Lyrica was not helpful. (Tr. 646). Dr. Telquist increased the Lyrica dose. (Tr. 647).
2 Lyrica is a brand name for pregabalin, an anti-convulsant used to treat neuropathic
pain. See Pregabalin, MedlinePlus, http://medlineplus.gov/druginfo/meds/a605045.html (last
accessed Nov. 25, 2025).
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On June 28, Ms. Gartrell met with rheumatologist Johnny Su, M.D., and reported pain in
the bilateral shoulder girdle, lower arms, hips/buttocks, upper and lower legs, neck, and upper and
lower back. (Tr. 679). The physical examination showed a normal gait; full range of motion in the
neck, spine, elbows, and wrists; full strength and range of motion in the shoulders, hips, knees,
and ankles; and intact grip strength and normal hand grasp. (Tr. 679-80). Dr. Su did not observe
any deformity, swelling, or tenderness to palpation. (Id.). He ordered blood work and knee x-rays.
(Tr. 681).
Bilateral knee x-rays showed mild-to-moderate tricompartmental joint space narrowing,
mild degenerative joint change, lateral patellar margin spurring, and mild anterior soft tissue
swelling in the left knee. (Tr. 409). Right knee x-rays showed moderate-to-severe medial
compartment joint space narrowing and mild lateral and patellofemoral joint space narrowing.
(Id.).
Ms. Gartrell returned to Dr. Su’s office in August, where a physical examination showed
normal gait; full range of motion in the neck, spine, elbows, and wrists; full strength and range of
motion in the shoulders, hips, knees, and ankles; and intact grip strength and normal hand grasp.
(Tr. 675-76). She did not have any deformity, swelling, or tenderness to palpation. (Id.). Dr. Su
prescribed meloxicam3 for joint and muscle pain and ordered lab work and imaging. (Tr. 677). In
December, Dr. Su prescribed celecoxib 4 for pain. (Tr. 706).
3 Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) used to treat pain,
tenderness, swelling, and stiffness caused by arthritis. See Meloxicam, MedlinePlus,
http://medlineplus.gov/druginfo/meds/a601242.html (last accessed Nov. 25, 2025).
4 Celecoxib is a NSAID (like meloxicam) used for the same purpose, though it works
differently. See Celecoxib, MedlinePlus, http://medlineplus.gov/druginfo/meds/a699022.html (last
accessed Nov. 25, 2025).
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X-rays of the feet showed small plantar calcaneal enthesophytes bilaterally and soft tissue
swelling in the right forefoot. (Tr. 682-83). A pelvic x-ray revealed normal hip alignment and
symmetric sacroiliac joints. (Tr. 684). Bilateral hand x-rays showed negative ulnar variances, which
caused displacement of the carpal bones, more prominent in the left than right. (Tr. 716-17).
Lumbar spine x-rays showed mild facet arthropathy. (Tr. 718).
2023. On May 18, Ms. Gartrell met with rheumatologist Inderprit Singh, M.D., and
reported generalized body pain lasting for two years. (Tr. 770). She described diffuse joint pain,
morning stiffness lasting 30 minutes to an hour, and fatigue. (Id.). The physical examination
showed decreased range of motion in her cervical and lumbar spine, diffuse myofascial tenderness,
crepitus in the knees, and tender points in the suboccipital, low cervical, trapezius, supraspinatus,
greater trochanteric, second rib, lateral epicondylar, and knee medial fat pad areas. (Tr. 771). Dr.
Singh recommended Ms. Gartrell taper off Lyrica and begin taking gabapentin. 5 (Tr. 774). Cervical
x-rays from June were unremarkable. (Tr. 944).
When Ms. Gartrell returned to Dr. Singh’s office in August, she reported continued low-
back, buttock, and knee pain, constant left-sided neck pain, and worsened fatigue. (Tr. 979, 981).
She also told the doctor that gabapentin works somewhat better than Lyrica. (Tr. 979). The
physical examination showed decreased lumbar range of motion and knee crepitus. (Tr. 980). Dr.
Singh concluded Ms. Gartrell has severe fibromyalgia and osteoarthritis of the knees, both of
which are complicated by her obesity. (Tr. 981-82). He also noted that Ms. Gartrell must lose
weight before treating her knees. (Tr. 982).
5 Gabapentin is an anticonvulsant (like Lyrica) that is also used to treat neuropathic
pain. See Gabapentin, MedlinePlus, http://medlineplus.gov/druginfo/meds/a694007.html (last
accessed Nov. 25, 2025).
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III. 	Other Relevant Evidence
As part of her application for benefits, Ms. Gartrell described how her medical
impairments limit her ability to work in an Adult Function Report. (Tr. 267-75). She also testified
about her impairments at the administrative hearing. (Tr. 70-84).
Ms. Gartrell has fibromyalgia and arthritis, both of which cause pain. (Tr. 267). Her worst
pain is in her knees, hips, and low-back, and is so severe that she cannot sit longer than 20 minutes
(Tr. 70) or stand longer than 5 to 10 minutes before needing to rest (Tr. 80), and she must lie
down several times a day to alleviate her pain (Tr. 82). Ms. Gartrell cannot lift anything over ten
pounds without extreme low-back and knee pain. (Tr. 267). Pain keeps her awake at night and she
feels tired during the day. (Tr. 268). She has morning stiffness in her neck, back, knees, feet, and
hands for more than an hour after she wakes. (Tr. 268). Ms. Gartrell wears a knee brace and uses a
cane for ambulation when leaving the house. (Tr. 273). She also uses the cane at home to help rise
from a seated position. (Id.). Gabapentin eases her knee, hip, and back pain “a little” (Tr. 74), but
her medications also cause “extreme fatigue” (Tr. 267). Occasionally, she spends the day in bed
because she has no energy. (Tr. 275).
Ms. Gartrell can drive short distances but her back, hips, and knees begin to cramp and
ache after about twenty minutes in the driver’s seat. (Tr. 270). She asks her husband or sister to
drive when she cannot. (Id.; see also Tr. 55). Ms. Gartrell does most of her shopping online.
(Tr. 270). Going to the store takes a few hours because she walks slow and must take breaks to ease
her back, knee, and foot pain. (Id.). She can shower, feed herself, and use the toilet independently
but her husband helps shave her legs and dress on occasion. (Tr. 268). When she drops something
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on the floor, she usually asks her husband to pick it up because she cannot bend at the knees or
the waist. (Tr. 82).
Ms. Gartrell cooks simple meals about once a week. (Tr. 269). Typically, her husband buys
pre-made items or picks up takeout meals. (Id.). She can complete household chores but does so
very slowly. (Id.). For instance, doing dishes may take the entire day because she can wash just a few
dishes before she must lie down for half-hour to an hour to ease her pain. (Tr. 275). Carrying
laundry is painful and vacuuming and mopping cause cramping. (Id.).
Ms. Gartrell used to enjoy reading, playing video games, taking her dogs to the park,
swimming, visiting haunted houses, crafting, traveling, and painting. (Tr. 271). Now she only
watches television and reads on occasion. (Id.). She cannot paint or play video games because those
activities cause neck and back pain and cramping in her hands. (Id.). Ms. Gartrell regularly attends
doctor’s appointments and swam once a week at the YMCA when she could afford the
membership. (Id., see also Tr. 53-54). She goes out with her sister once or twice a month but is in
too much pain to spend time with friends. (Tr. 271).
The VE classified Ms. Gartrell’s past relevant work as a sales floor manager, insurance
agent, telemarketer, department store manager, and storefront sales associate. (Tr. 85-86). The VE
testified a person of Ms. Gartrell’s age, education, and experience could not perform her past
relevant work but could perform sedentary jobs (telephone information clerk, document preparer,
addresser) if subject to the ALJ’s stated restrictions. (Tr. 86-88). The VE opined a person would be
precluded from competitive employment if the person needed a ten-minute break every hour.
(Tr. 88-89). A person limited to occasional grasping, fingering, and reaching with the upper
extremities and restricted from any stooping, kneeling, crouching, crawling, and squatting cannot
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perform any sedentary work. (Tr. 90). Finally, the VE stated employers tolerate an employee being
off task no more than 10% of the workday and absent once a month. (Tr. 89).
IV. 	Medical Opinions and Prior Administrative Medical Findings
On May 23, 2022, Ms. Gartrell underwent a functional capacity evaluation (FCE) with an
occupational therapist to determine her functional abilities and limitations. (Tr. 626). Before the
evaluation, Ms. Gartrell reported increased back pain when standing or sitting for an extended
time. (Id.). At the time, Ms. Gartrell worked from home as a health insurance agent. (Tr. 627). She
reported working in one-hour shifts because sitting causes increased pain. (Id.). The occupational
therapist, Jessica Duke, MOT, OTR/L, documented some of Ms. Gartrell’s statements about what
she can and cannot do:
She has increased pain with driving. She can drive for 20 minutes before having
increased back pain. She can sit for a maximum of 20-30 minutes before readjusting
herself, but after 1 hour she needs to lie down. She stated that when she stands the
pain radiates down her legs and some of her skin becomes numb to the touch. She
stated that her knees hurt when sitting and standing. She stated that she can walk
continuously from the Walmart parking lot towards the back of the store. She stated
she cannot stand to do all the dishes. She stated she cannot do normal household
chores without rest breaks. She cannot walk her dog on a leash anymore and has to
put him on a lead outside her door when he needs to use the bathroom. She cannot
carry his dog food but can carry a gallon of milk if needed.
(Tr. 627) (cleaned up). Tests included the Purdue Pegboard; manual muscle testing; grip strength;
manual dexterity testing; postural capacities; lift, carry, push, and pull capacities; and gait testing.
(Tr. 637-43).
During pegboard testing, the therapist observed “some rushing behaviors, increased work
posture, and voiced frustration with error.” (Tr. 637). According to Ms. Duke, those observations
show Ms. Gartrell gave full physical effort during the test. (Id.). She concluded Ms. Gartrell’s fine
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motor coordination was slightly diminished bilaterally. (Id.). Ms. Gartrell reported increased back
pain and spasming when leaning forward for forward reaching. (Id.).
Manual muscle testing was largely normal with some diminished left-knee flexion. (Tr.
638). During grip testing, Ms. Duke observed fine muscle tremors and accessory muscle
recruitment indicating full physical effort. (Id.). Ms. Gartrell reported some hand-joint pain with
repetitive gripping. (Id.).
On manual dexterity testing performed while standing, Ms. Gartrell scored below the first
percentile (the lowest). (Tr. 639). During the test, Ms. Duke observed “voiced frustration with
error and competitive stance,” “demonstrated increased trunk flexion with increased standing time
and immediately sat down after testing.” (Id.). Ms. Gartrell reported increased low-back, hip, and
knee pain after standing. (Id.).
During postural testing, Ms. Gartrell reported increased back and knee pain with stooping,
crouching, and going down steps. (Tr. 641). She could not lower herself to a full squat position.
(Id.). Based on the results of postural testing, Ms. Duke determined Ms. Gartrell can occasionally
grasp and finger with both upper extremities and occasionally reach forward less than 18 inches
but she can never climb, stoop, kneel, crouch, crawl, squat, navigate a flight of stairs, or reach
forward greater than 18 inches. (Tr. 640-41). Ms. Duke also found Ms. Gartrell limited in pushing,
pulling, lifting, and carrying “due to complaints of lower back pain, knee pain, and hip pain
bilaterally.” (Tr. 642).
During a walking test, Ms. Gartrell began to hold her lower back (a sign of a painful gait)
after one minute and twenty-two seconds. (Tr. 642). She walked for three minutes and thirty-two
seconds before she needed to sit down due to pain. (Tr. 643). Ms. Duke also observed Ms. Gartrell
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sit for forty-four minutes before standing to stretch her back and stand for an average of seven
minutes before sitting down due to knee and back pain. (Tr. 642). Based on the test results, Ms.
Duke opined Ms. Gartrell cannot work because pain limits her abilities to sit, stand, walk, lift,
pull, or carry. (Tr. 643).
On January 12, 2023, Ms. Gartrell attended a consultative physical evaluation with nurse
practitioner Mary Ann Hayden, APRN, CNP. (Tr. 728-37). At the evaluation, Ms. Gartrell claimed
disability due to fibromyalgia, degenerative arthritis in the knees, lower back pain, migraines,
fatigue, hypertension, depression, arthritis in the neck and back, and polycystic ovarian syndrome.
(Id.). She reported having difficulty with stairs and using a cane for ambulation. (Tr. 729). She can
sit for 30-45 minutes before her lower back begins to cramp, stand for 5 minutes before she has
knee and lower back pain, and walk for “a very short” time before knee and back pain returns.
(Id.). The physical examination showed bilateral knee crepitus with range of motion testing and
tenderness of the shoulders, sides, legs, and calves. (Tr. 730-31). Ms. Gartrell displayed diminished
strength in her knees, ankles, hallux, and toes, but intact grip strength. (Tr. 733-34). She had some
diminished range of motion in the spine, shoulders, and elbows. (Tr. 735). Nurse Hayden
observed a slow gait and noted Ms. Gartrell could stand up from a chair with ease but (1) could
not squat and rise with ease; (2) could not walk on her heels or toes; (3) had issues with tandem
gait; and (4) could not hop or stand on one foot. (Tr. 731). Nurse Hayden concluded that Ms.
Gartrell has severe limitations with standing and walking due to back, leg, and knee pain;
significant limitations with lifting and carrying weight; and an unspecified degree of limitation
with bending, stooping, crouching, and squatting. (Tr. 732).
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On February 6, 2023, state agency medical consultant Gail Mutchler, M.D., reviewed the
available medical record and assessed Ms. Gartrell’s residual functional capacity (RFC). (Tr. 98-99).
Citing Ms. Gartrell’s morbid obesity, migraines, low-back and neck pain (supported by mild x-ray
findings and overlapping fibromyalgia), and degenerative knee changes, Dr. Mutchler determined
Ms. Gartrell can lift and carry 20 pounds occasionally and 10 pounds frequently; sit and walk for a
total of 4 hours and sit for a total of 6 hours in an 8-hour workday; occasionally climb ramps and
stairs, balance, stoop, kneel, crouch, and crawl; and must avoid concentrated exposure to extreme
temperatures, humidity, noise, and vibrations and all exposure to hazards such as dangerous
machinery and unprotected heights. (Id.).
On May 2, 2023, state agency medical consultant Jeffrey Faludi, M.D., reviewed additional
medical records and largely adopted Dr. Mutchler’s findings except he found Ms. Gartrell could
lift and carry 10 pounds occasionally (as opposed to 20) and less than 10 pounds frequently, sit
and walk for a total of 2 hours (as opposed to 4) in an 8-hour workday, and frequently balance (as
opposed to occasionally). (Tr. 109-10).
STANDARD FOR D ISABILITY
Eligibility for benefits is based on the existence of a disability. 42 U.S.C. § 423(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.” Id.
§ 1382c(a)(3)(A); see also 20 C.F.R. § 404.1505(a).
The Commissioner follows a five-step evaluation process found at 20 C.F.R. § 404.1520 to
determine whether a claimant is disabled:
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1. 	Was claimant engaged in a substantial gainful activity?
2. 	Did claimant have a medically determinable impairment, or a combination
of impairments, which is “severe,” defined as one which substantially limits
an individual’s ability to perform basic work activities?
3. 	Does the severe impairment meet one of the listed impairments?
4. 	What is claimant’s residual functional capacity and can claimant perform
past relevant work?
5. 	Can claimant do any other work considering his or her residual functional
capacity, age, education, and work experience?
Under this five-step sequential analysis, the claimant has the burden of proof in Steps One
through Four. Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997). The burden shifts
to the Commissioner at Step Five to prove whether the claimant has the residual functional
capacity (RFC) to perform available work in the national economy. Id. The ALJ considers the
claimant’s RFC, age, education, and past work experience to determine whether the claimant
could perform other work. Id. Only if a claimant satisfies each element of the analysis, including
inability to do other work, and meets the duration requirements, is the claimant deemed disabled.
20 C.F.R. § 404.1520(b)-(f); see also Walters, 127 F.3d at 529.
T HE ALJ’ S DECISION
At Step One, the ALJ determined Ms. Gartrell had not engaged in substantial gainful
activity since October 14, 2021, the alleged onset date. (Tr. 12). At Step Two, the ALJ identified
“degenerative disc disease (DDD) of the cervical spine and lumbar spine, osteoarthritis of the
bilateral knees, fibromyalgia, migraines, obesity, and depressive disorder” as severe impairments.
(Tr. 13). At Step Three, the ALJ found Ms. Gartrell’s impairments did not meet the requirements
of any listed impairment. (Tr. 13-17).
At Step Four, the ALJ determined Ms. Gartrell’s RFC as follows:
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After careful consideration of the entire record, I find the claimant has the
residual functional capacity to perform sedentary work, [6] as defined in 20
CFR 404.1567(a), except that she requires the use of a cane for ambulating,
and she is further limited in the following nonexertional respects: can never
climb ladders, ropes, or scaffolds but can occasionally climb ramps and stairs;
occasionally balance, stoop, crouch, kneel, and crawl; never work at
unprotected heights or around moving mechanical parts; can have no more
than frequent exposure to extreme cold, extreme heat, vibration, or loud
noise in the environment; can perform simple, routine, and repetitive tasks
but not at a production rate pace; and can respond appropriately to few
changes in a routine work setting with such changes explained in advance.
(Tr. 17). At Step Five, the ALJ found Ms. Gartrell could perform work in the national economy as
a telephone information clerk, document preparer, and addresser. (Tr. 34). Thus, the ALJ
concluded Ms. Gartrell was not disabled. (Tr. 35).
STANDARD OF REVIEW
In reviewing the denial of Social Security benefits, the court “must affirm the
Commissioner’s conclusions absent a determination that the Commissioner has failed to apply the
correct legal standards or has made findings of fact unsupported by substantial evidence in the
record.” Walters v. Comm’r of Soc. Sec., 127 F.3d 525, 528 (6th Cir. 1997). The Commissioner’s
findings “as to any fact if supported by substantial evidence shall be conclusive.” McClanahan v.
Comm’r of Soc. Sec., 474 F.3d 830, 833 (6th Cir. 2006) (citing 42 U.S.C. § 405(g)). “Substantial
evidence” is “more than a scintilla of evidence but less than a preponderance and is such relevant
evidence as a reasonable mind might accept as adequate to support a conclusion.” Besaw v. Sec’y of
Health & Hum. Servs., 966 F.2d 1028, 1030 (6th Cir. 1992). But “a substantiality of evidence
6 Sedentary work involves lifting no more than 10 pounds at a time and occasionally
lifting or carrying articles like docket files, ledgers, and small tools. Although a sedentary job is
defined as one which involves sitting, a certain amount of walking and standing is often necessary
in carrying out job duties. Jobs are sedentary if walking and standing are required occasionally and
other sedentary criteria are met. 20 C.F.R. § 404.1567(a).
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evaluation does not permit a selective reading of the record. Substantiality of evidence must be
based upon the record taken as a whole. Substantial evidence is not simply some evidence, or even
a great deal of evidence. Rather, the substantiality of evidence must take into account whatever in
the record fairly detracts from its weight.” Brooks v. Comm’r of Soc. Sec., 531 F.App’x 636, 641
(6th Cir. 2013) (cleaned up).
In determining whether substantial evidence supports the Commissioner’s findings, the
court does not review the evidence de novo, make credibility determinations, or weigh the
evidence. Brainard v. Sec’y of Health & Hum. Servs., 889 F.2d 679, 681 (6th Cir. 1989). Even if
substantial evidence (or indeed a preponderance of the evidence) supports a claimant’s position,
the court cannot overturn “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 because there is a
“zone of choice” within which the Commissioner can act, without fear of court interference.
Mullen v. Bowen, 800 F.2d 535, 545 (6th Cir. 1986).
Apart from considering whether substantial evidence supports the Commissioner’s
decision, the court must determine whether proper legal standards were applied. The failure to
apply correct legal standards is grounds for reversal. Walters, 127 F.3d at 528. Even if substantial
evidence supports the ALJ’s decision, the court must overturn when an agency does not observe its
own regulations and thereby prejudices or deprives the claimant of substantial rights. Wilson v.
Comm’r of Soc. Sec., 378 F.3d 541, 546-47 (6th Cir. 2004).
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
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875, 877 (N.D. Ohio 2011) (internal quotations omitted); accord Shrader v. Astrue, No. 11-13000,
2012 WL 5383120, at *6 (E.D. Mich. Nov. 1, 2012) (“If relevant evidence is not mentioned, the
Court cannot determine if it was discounted or merely overlooked.”).
D ISCUSSION
Ms. Gartrell argues the ALJ did not properly consider Ms. Duke’s opinion under 20 C.F.R.
§ 404.1520c. (ECF #10 at PageID 1130). Ms. Gartrell does not argue the ALJ did not address the
necessary persuasiveness factors in evaluating Ms. Duke’s opinion; rather she argues the reasons
the ALJ discounted the opinion—because the record did not support her findings and the opinion
was based on subjective reports of pain—are simply wrong. (Id. at PageID 1131) (“contrary to the
ALJ’s assertion, the medical record does provide ample support and consistency of her medical
opinion”). The Commissioner responds that the ALJ sufficiently evaluated the supportability and
consistency of Ms. Duke’s opinion and explained why it was not persuasive. (ECF #13 at PageID
1146).
As part of the RFC assessment, the ALJ must review all medical opinions and prior
administrative findings and explain how persuasive he finds them. See 20 C.F.R. § 404.1520c(b);
see also Reeves v. Comm’r of Soc. Sec., 618 F.App’x 267, 275 (6th Cir. 2015). The ALJ considers five
factors to determine persuasiveness: (1) supportability; (2) consistency; (3) the source’s relationship
with the claimant, including length of treatment relationship, frequency of examinations, purpose
of the treatment relationship, and examining relationship; (4) the source’s specialization; and (5)
any other factors that tend to support or contradict a medical opinion. 20 C.F.R.
§ 404.1520c(c)(1)-(5). The regulations require the ALJ to “explain how [he] considered the
supportability and consistency factors for a medical source’s medical opinions,” the two most
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important factors. See id. § 404.1520c(b)(2). Supportability is “the extent to which a medical
source’s opinion is supported by relevant objective medical evidence and the source’s supporting
explanation” and consistency is “the extent to which the opinion is consistent with evidence from
other medical sources and nonmedical sources in the claim.” Revisions to Rules Regarding the
Evaluation of Medical Evidence, 82 Fed. Reg. 5844-01, 5853, 2017 WL 168819 (Jan. 18, 2017).
The ALJ’s explanation should “generally include[] an assessment of the supporting
objective medical evidence and other medical evidence, and how consistent the medical opinion or
prior administrative medical finding is with other evidence in the claim.” Id. at 5859. The reasons
for the ALJ’s conclusions must be stated in a manner that allows the reviewing court to “trace the
path of the ALJ’s reasoning” from evidence to conclusion. Stacey v. Comm’r of Soc. Sec., 451 F.App’x
517, 519 (6th Cir. 2011). If the ALJ discusses both consistency and supportability and substantial
evidence supports the discussion, the court may not disturb the ALJ’s findings. Paradinovich v.
Comm’r of Soc. Sec., No. 1:20-cv-1888, 2021 WL 5994043, at *7 (N.D. Ohio Sept. 28, 2021), report
and recommendation adopted, 2021 WL 5119354 (N.D. Ohio Nov. 4, 2021).
Here, the ALJ explained why Ms. Duke’s opinion was not persuasive:
On May 23, 2022, Ms. Gartrell attended a functional capacity evaluation conducted
by Jessica Duke, O.T.R./L., in relation to securing payments of short-term disability
insurance benefits—i.e., and successfully so in light of the above-discussed taxable
payments shown in later year 2022 continuing into 1st-quarter 2023 (Ex. 2F/1-2).
She presented to Ms. Duke with generalized fibromyalgia joint pains including her
hips, low back, and neck, and with bilateral knee pain; rated this pain as partially
6/10 (moderate) but up to 8/10 (per rating system as “nearing hospitalization”); and
asserted that she can sit for 20-30 minutes comfortably at the most, noting there that
sitting for one-hour period would then require her to lie down due to the increased
pain, that she cannot stand to wash a load of dishes, and that she can walk from the
parking lot to the back of a large store (Walmart) but cannot walk her dog any more.
In concluding the May 2022 FCE, Ms. Duke stated that Ms. Gartrell would be unable
to work an eight-hour job or even a four-hour workday even at a sedentary work level,
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primarily due to pain in her knees and lower back that increased on FCE activities,
but also considering presentations with upper and lower extremity weakness,
weakness in grip strength, and presented limited sitting, standing, and walking.
Adding specificity, Ms. Duke concluded that Ms. Gartrell is limited to lifting and
carrying at most 15-20 pounds and cannot lift or carry any weight on an occasional
frequency in a workday; can push only 9 pounds and can do no pulling of any weight
(0 pounds); can sit for only 44 continuous minutes in a standard upright “office”
chair, and in turn needs to frequently change positions between sitting and standing
to manage pain; can only stand for seven continuous minutes; and can walk for three
and one-half minutes before needing to sit, but not even 90 seconds before showing
features of increased back pain and knee pain. Furthermore, Ms. Duke concluded
that the FCE showed no (never) abilities to climb, stoop, crouch, kneel, crawl, or use
stairs; no abilities to reach above shoulder height or forward/in front of the body for
more than 18 inches of distance, and can only occasionally reach forward for 18
inches or less of distance; and can only occasionally perform grasping and fingering
(fine motor coordination) tasks during an eight-hour workday.
Ms. Duke’s conclusions from the May 2022 FCE do constitute a medical opinion
under 20 C.F.R. 404.1513(a)(2), but they are not persuasive under 20 C.F.R.
404.1520c(b) because they are not entirely supported by her one-time observations,
and in many regards cite the claimant’s subjective reports, and because they are not
consistent with the objective medical evidence from physicians of record or with the
other medical factors discussed above, including the altogether conservative and
partially beneficial treatments for managing pain both through and after she had
evaluated the claimant. For instance, her observations of limited standing and
walking 	time, 	with 	the 	latter 	unsupported 	(“no 	equipment”) 	but 	with
antalgic/painful pattern and wide base of support, and notations of audible and
palpable crepitus in the knees and 3/5 rated strength in the lower leg muscles do
partially support in the general her opinion for significantly reduced standing and
walking abilities. But the sitting ability for 45 minutes does not persuasively support
her broad statement that the claimant could not sit for even four total hours in a
workday, and instead largely cites the claimant’s own statements as support for this
stated inability to sustain performance of even sedentary work for an eight-hour day.
I also note that Ms. Duke’s offered support for total inabilities to reach overhead and
to longer distance in front of the body, to stoop and to crouch, and to kneel and to
climb stairs largely cite her report of increased back pain on stooping and partial
squatting, and thus deeming her unsafe to test kneeling and stair climbing. Yet, this
does not appear to take into account grossly full ranges of motion in the lower
extremities, and it is not consistent with the other medical evidence showing only
modest reduction in forward flexion and other ranges of motion at the dorsolumbar
spine, and 4/5 to 5/5 strength in the lower extremities graded by physicians.
Moreover, while considering reported increases in back pain and muscle spasms on
pegboard testing for the hands, Ms. Duke’s opinion for only occasional handling,
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reaching, and other manipulative abilities is not well supported because it does not
account for her observation that the claimant rushed through this activity, because it
is not consistent with her assessment of average to only “slightly” below normal limits
of fine motor coordination abilities and noting that the claimant did not drop any
pieces, and because it is incongruent with her recording of “grossly” full limits of
bilateral upper extremity joint ranges of motion and 4+/5 wrist strength to 4/5
shoulder and forearm strength. The subsequent objective findings from the January
2023 consultative examination and from rheumatology consults with Dr. Singh are
not consistent with her opinions for only occasional manipulative abilities in most
respects, and instead show no significant functional limitations in reaching,
handling, fingering, or feeling.
Lastly, the May 2022 FCE conclusions are not persuasive for the claimant’s
maximum abilities in exertional and other physical nonexertional activities because
they are not proportionate with the conservative treatment received through it, which
included a mere one-month course of partially beneficial physical therapy and a few
months 	of 	chiropractic 	manipulation 	sessions, 	taking 	prescribed 	medications
through primary care practice group, and doing home-based pool therapy exercises
once or twice a week. They are not consistent with the later medical evidence in 2022
and 2023 for improving pain with the addition of gabapentin medication to
previously prescribed muscle relaxant, Cymbalta, and “NSAID” medications, but
again without any pursuit of advancing treatments through primary care or
rheumatology specialists.
(Tr. 27-29) (cleaned up).
At length, the ALJ addressed the supportability of Ms. Duke’s opinion, noting that some of
her observations of limited standing and walking, in combination with evidence of knee
abnormality (crepitus and decreased strength in the lower leg muscles), partially supported the
limitations concerning reduced standing and walking capabilities. (Tr. 28). Consequently, and in
consideration of her fibromyalgia and osteoarthritis, the knee x-rays, and other clinical findings,
the ALJ limited Ms. Gartrell to sedentary work. (Tr. 21, 23). The ALJ found that Ms. Duke’s one-
time observation of Ms. Gartrell sitting for 45 minutes before stretching her back and Ms.
Gartrell’s contemporaneous reports pain do not support the broader opinion that she cannot sit
for even four hours total in an eight-hour workday. (Tr. 28).
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The ALJ also discussed the consistency of Ms. Duke’s opinion. The ALJ emphasized the
incongruency between the opined manipulative limitations (occasional grasping and fine motor
control tasks) with the results of the Purdue Pegboard test (fine motor coordination assessed at
“slightly below normal” bilaterally), and the clinical findings showing grossly full range of motion
and intact strength in the upper extremities. (Tr. 28-29). Those same limitations were inconsistent
with the clinical findings documented in Nurse Hayden’s consultative examination report and Dr.
Singh’s treatment records, both of which “show no significant functional limitations in reaching,
handling, fingering, or feeling.” (Tr. 29). On the postural limitations, the ALJ emphasized that Ms.
Duke’s own clinical findings and findings from other medical records illustrate “grossly full range
of motion” and normal or slightly diminished lower-extremity muscle strength, inconsistent with
the therapist’s opinion that Ms. Gartrell has no ability to reach, stoop, crouch, kneel, or climb
stairs. (Tr. 28). The ALJ’s extensive discussion of both the supportability and the consistency of
Ms. Duke’s opinion meets the burden of articulating how the ALJ evaluated the persuasiveness of
the opinion and cited substantial evidence in doing so.
Ms. Gartrell first asserts that Ms. Duke’s observations during the FCE support her
conclusions. (ECF #10 at PageID 1134). For instance, “Ms. Duke observed her inability to sit or
stand for extended periods,” noting she could not “walk more than three and a half minutes, sit
for more than 44 minutes, and stand for more than 9 minutes, which were supported by [Ms.
Duke’s] observations of Ms. Gartrell shifting, trying to find comfortable positions, reporting pain,
and immediately sitting after doing a standing test.” (Id.). Ms. Gartrell also argues Ms. Duke’s
opined restrictions are consistent with clinical findings from 2021 documenting lumbar
tenderness and diminished extension, a 2021 x-ray showing mild lumbar facet arthropathy and
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disc osteophytes in the thoracic spine, and a clinical finding of decreased lumbar range of motion
in 2023. (Id. at PageID 1135).
Again, Ms. Gartrell does not claim the ALJ failed to apply the factors of supportability and
consistency. Rather, she extensively argues the opinion is supported by Ms. Duke’s observations
and is consistent with other evidence in the record, contrary to the ALJ’s conclusion. But even if
substantial evidence (or indeed a preponderance of the evidence) supports a claimant’s position,
the court cannot overturn “so long as substantial evidence also supports the conclusion reached by
the ALJ.” Jones, 336 F.3d at 477. To show a lack of substantial evidence, Ms. Gartrell “must
demonstrate that there is not sufficient evidence in the record that would allow a reasoning mind
to accept the ALJ’s conclusion.” Greene ex rel. Greene v. Astrue, No. 1:10-cv-414, 2010 WL 5021033,
at *4 (N.D. Ohio Dec. 3, 2010). A reasoning mind could accept the ALJ’s conclusion that some of
the opined restrictions were neither supported by Ms. Duke’s clinical findings and observations
nor consistent with the other evidence of record.
Ms. Gartrell also contends the ALJ erred by discounting Ms. Duke’s opinion because the
opined restrictions were based only on Ms. Gartrell’s contemporaneously reported pain. (ECF #10
at PageID 1134). She argues her reported pain, documented during FCE testing, was but one
factor Ms. Duke considered in reaching her conclusions, and the other factors, including her
observed maximum sitting, standing, and walking times during the assessment, support Ms.
Duke’s conclusions. (Id.). But the ALJ did not find Ms. Duke’s opinion unpersuasive solely
because it relied on Ms. Gartrell’s self-reported pain. The ALJ also noted Ms. Duke did not test
certain postural abilities, like kneeling, because Ms. Gartrell reported increased pain with other
postural testing. (Tr. 28). And the ALJ discussed how Ms. Duke’s opined limitations were not
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supported by and inconsistent with Ms. Duke’s clinical findings, including grossly full range of
motion in the lower extremities, and other clinical findings across the medical record finding
intact strength and range of motion. (Id.).
Because the ALJ properly evaluated the medical opinion using the supportability and
consistency factors and his conclusions are supported by substantial evidence, I decline to
recommend remand on this basis.
C ONCLUSION AND R ECOMMENDATION
Following review of the arguments presented, the record, and the applicable law, I
recommend the District Court AFFIRM the Commissioner’s denial of disability insurance
benefits.
Dated: November 26, 2025
O BJECTIONS , R EVIEW , AND A PPEAL
Within 	14 	days 	after 	being 	served 	with 	a 	copy 	of 	this 	Report 	and
Recommendation, a party may serve and file specific written objections to the
proposed findings and recommendations of the Magistrate Judge.
See Fed. R. Civ.
P. 72(b)(2);
see also 28 U.S.C. § 636(b)(1); Local Civ. R. 72.3(b). Properly asserted
objections shall be reviewed de novo by the assigned district judge.
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.
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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). 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-186, 2018 WL
3018175, at *2 (W.D. Ky. June 15, 2018) (quoting
Howard, 932 F.2d at 509). 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).
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