Case Name in Social Security Case - Unavailable

UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF OHIO
EASTERN DIVISION
SANDRA J.,1 	Case No. 2:25-cv-00331
Plaintiff, 	Sargus, J.
Litkovitz, M.J.
vs.
COMMISSIONER OF 	REPORT AND
SOCIAL SECURITY, 	RECOMMENDATION
Defendant.
Plaintiff Sandra J. brings this action pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3) for
judicial review of the final decision of the Commissioner of Social Security (Commissioner)
denying plaintiff’s applications for disability insurance benefits (DIB) and supplemental security
income (SSI). This matter is before the Court on plaintiff’s Statement of Errors (Doc. 8), the
Commissioner’s response (Doc. 9), and plaintiff’s reply (Doc. 10).
I. Procedural Background
Plaintiff protectively filed her applications for DIB and SSI in February 2022, alleging
disability as of March 15, 2006, due to post traumatic stress disorder (PTSD), chronic neck pain,
migraines, elevated ALT measurement, lumbar spondylosis, degenerative disc disease, bone
spurs, and depression. (Tr. 701-714; see also Tr. 748). Her applications were denied initially
and upon reconsideration. Plaintiff, through counsel, requested and was granted a de novo
hearing again before ALJ Francine Serafin. Plaintiff and a vocational expert (VE) appeared
telephonically and testified at the ALJ hearing on February 6, 2024. (Tr. 108-35). On April 24,
2024, the ALJ issued a decision denying plaintiff’s applications. (Tr. 13-36). On January 29,
1 Pursuant to General Order 22‒01, due to significant privacy concerns in social security cases, any opinion, order,
judgment or other disposition in social security cases in the Southern District of Ohio shall refer to plaintiffs only by
their first names and last initials.
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2025, the Appeals Council denied plaintiff’s request for review, making the ALJ’s decision the
final decision of the Commissioner for purposes of judicial review. (Tr. 1-6).
II. Analysis
A. Legal Framework for Disability Determinations
To qualify for disability benefits, a claimant must suffer from a medically determinable
physical or mental impairment that can be expected to result in death or that has lasted or can be
expected to last for a continuous period of not less than 12 months. 42 U.S.C. §§ 423(d)(1)(A)
(DIB), 1382c(a)(3)(A) (SSI). The impairment must render the claimant unable to engage in the
work previously performed or in any other substantial gainful employment that exists in the
national economy. 42 U.S.C. §§ 423(d)(2), 1382c(a)(3)(B).
Regulations promulgated by the Commissioner establish a five-step sequential evaluation
process for disability determinations:
1) If the claimant is doing substantial gainful activity, the claimant is not disabled.
2) If the claimant does not have a severe medically determinable physical or
mental impairment – i.e., an impairment that significantly limits his or her
physical or mental ability to do basic work activities – the claimant is not
disabled.
3) If the claimant has a severe impairment(s) that meets or equals one of the
listings in Appendix 1 to Subpart P of the regulations and meets the duration
requirement, the claimant is disabled.
4) If the claimant’s impairment does not prevent him or her from doing his or her
past relevant work, the claimant is not disabled.
5) If the claimant can make an adjustment to other work, the claimant is not
disabled. If the claimant cannot make an adjustment to other work, the claimant
is disabled.
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Rabbers v. Comm’r of Soc. Sec., 582 F.3d 647, 652 (6th Cir. 2009) (citing 20 C.F.R. §§
404.1520(a)(4)(i)-(v), 404.1520(b)-(g)).2 The claimant has the burden of proof at the first four
steps of the sequential evaluation process. Id.; Wilson v. Comm’r of Soc. Sec., 378 F.3d 541, 548
(6th Cir. 2004). Once the claimant establishes a prima facie case by showing an inability to
perform the relevant previous employment, the burden shifts to the Commissioner to show that
the claimant can perform other substantial gainful employment and that such employment exists
in the national economy. Rabbers, 582 F.3d at 652; Harmon v. Apfel, 168 F.3d 289, 291 (6th
Cir. 1999).
B. The Administrative Law Judge’s Findings
The ALJ applied the sequential evaluation process and made the following findings of
fact and conclusions of law:
1. [Plaintiff] meets the insured status requirements of the Social Security Act
through June 30, 2007.
2. [Plaintiff] has not engaged in substantial gainful activity since March 15,
2006, the alleged onset date (20 CFR 404.1571 et seq., and 416.971 et seq.).
[Plaintiff] has the following severe impairments: degenerative disc disease of the
cervical and lumbar spine, spondylosis/radiculopathy, neuropathy, status post
cervical fusion, osteoarthritis, status post ulnar release bilaterally, status post A-1
pulley release procedure on thumb of the right upper extremity, post-traumatic
disorder, bipolar disorder, general anxiety disorder, and major depressive
disorder (20 CFR 404.1520(c) and 416.920(c)).
3. [Plaintiff] does not have an impairment or combination of impairments that
meets or medically equals the severity of one of the listed impairments in 20
CFR Part 404, Subpart P, Appendix 1 (20 CFR 404.1520(d), 404.1525,
404.1526, 416.920(d), 416.925 and 416.926).
2 “The Commissioner’s regulations governing the evaluation of disability for DIB and SSI are identical . . . and are
found at 20 C.F.R. § 404.1520, and 20 C.F.R. § 416.920 respectively.” Miller v. Comm’r of Soc. Sec., No. 3:18-cv-
281, 2019 WL 4253867, at *1 n.1 (S.D. Ohio Sept. 9, 2019) (quoting Colvin v. Barnhart, 475 F.3d 727, 730 (6th
Cir. 2007)). The Court’s references to DIB regulations should be read to incorporate the corresponding and identical
SSI regulations, and vice versa, for purposes of this Report and Recommendation.
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4. After careful consideration of the entire record, the [ALJ] finds that [plaintiff]
has the residual functional capacity to perform light work as defined in 20 CFR
404.1567(b) and 416.967(b) except she can frequently climb ramps and stairs;
she can never climb ladders, ropes and scaffolds. She can frequently balance,
stoop, kneel, crouch, but never crawl. She must avoid exposure to excessive
vibration. She should avoid exposure to any workplace hazards such as moving
machinery or unprotected heights. She is capable of frequent fingering,
handling, and feeling with the bilateral upper extremities. She is capable of
performing simple, routine, repetitive work tasks that involve one-to-three steps
that are not at an assembly line or production pace or involving any strict
production quotas. She is capable of tolerating occasional interaction with
supervisors, coworkers, and the public. She is capable of performing work tasks
that do not require any teamwork tasks or over the shoulder supervision. She is
capable of managing a few changes in the work routine defined as three to four
changes per workday or work shift.
5. [Plaintiff] has no past relevant work (20 CFR 404.1565 and 416.965).
6. [Plaintiff] was born [in]… 1977, and was 28 years old, which is defined as a
younger individual age 18-49, on the alleged disability onset date (20 CFR
404.1563 and 416.963).3
7. [Plaintiff] has at least a high school education (20 CFR 404.1564 and
416.964).
8. Transferability of job skills is not an issue because [plaintiff] does not have
past relevant work (20 CFR 404.1568 and 416.968).
9. Considering [plaintiff]’s age, education, work experience, and residual
functional capacity, there are jobs that exist in significant numbers in the national
economy that [plaintiff] can perform (20 CFR 404.1569, 404.1569a, 416.969,
and 416.969a).4
10. [Plaintiff] has not been under a disability, as defined in the Social Security
Act, from March 15, 2006, through the date of this decision (20 CFR
404.1520(g) and 416.920(g)).
(Tr. 19-31).
3 Plaintiff was 46 years old at the time of the ALJ’s decision. (Tr. 23).
4 The ALJ relied on the VE’s testimony to find that plaintiff would be able to perform the requirements of representative light,
unskilled occupations such as merchandise marker (164,000 jobs nationally), router (22,000 jobs nationally), and office helper
(6,000 jobs nationally). (Tr. 30-31, 129-30).
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A. Judicial Standard of Review
Judicial review of the Commissioner’s determination is limited in scope by 42 U.S.C. §
405(g) and involves a twofold inquiry: (1) whether the findings of the ALJ are supported by
substantial evidence, and (2) whether the ALJ applied the correct legal standards. See Blakley v.
Comm’r of Soc. Sec., 581 F.3d 399, 405 (6th Cir. 2009); see also Bowen v. Comm’r of Soc. Sec.,
478 F.3d 742, 745-46 (6th Cir. 2007).
The Commissioner’s findings must stand if they are supported by “such relevant evidence
as a reasonable mind might accept as adequate to support a conclusion.” Biestek v. Berryhill,
587 U.S. 97, 98 (2019) (quoting Consolidated Edison Co. v. N.L.R.B., 305 U.S. 197, 229
(1938)). Substantial evidence consists of “more than a scintilla of evidence but less than a
preponderance. . . .” Rogers v. Comm’r of Soc. Sec., 486 F.3d 234, 241 (6th Cir. 2007). In
deciding whether the Commissioner’s findings are supported by substantial evidence, the Court
considers the record as a whole. Hephner v. Mathews, 574 F.2d 359 (6th Cir. 1978).
The Court must also determine whether the ALJ applied the correct legal standards in the
disability determination. Even if substantial evidence supports the ALJ’s conclusion that the
plaintiff is not disabled, “a decision of the Commissioner will not be upheld where the SSA fails
to follow its own regulations and where that error prejudices a claimant on the merits or deprives
the claimant of a substantial right.” Rabbers, 582 F.3d at 651 (quoting Bowen, 478 F.3d at 746).
See also Wilson, 378 F.3d at 545–46 (reversal required even though ALJ’s decision was
otherwise supported by substantial evidence where ALJ failed to give good reasons for not
giving weight to treating physician’s opinion, thereby violating the agency’s own regulations).
B. Relevant Evidence
1. 	Plaintiff’s Testimony
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The ALJ considered plaintiff’s testimony, stating:
She has a lower back problem. After two minutes, she feels like her back is ripping
apart. She has this pain every day. If she gets up, it worsens. She has problems
stooping or bending because of pain from her lower back. She has had shock and
other modalities. She is taking medication and is in bed most of the time. She can
walk only two minutes before she has back pain. She can stand two minutes before
having to sit. She can sit three to four minutes. She has to lay flat most of the day.
She has a problem in her neck area—when she sits up or standing, it causes
migraine headaches. She goes through her pills in three days. She has headaches
three to four times a day, that lasts between four and five hours each. Her migraines
cause nausea and sensitivity to light. She has to lie down. She is on a medication
for this. She has a history of neck surgery. She has issues with range of motion –
turning side-to-side. Her neck pain travels down her arms. When it hurts, she drops
things. She has right knee problems. When she awakes, it is dislocated. She has
swelling and stiffness. She has had an MRI on her knee. She has problems bending
her knee and climbing stairs. She has problems with it locking up when bending
or stooping. She has to elevate her legs over half the day, and she wears a special
brace with metal. 	She has a history of bladder cancer, but she has continued
problems. She has been seeing blood. When she coughs, it leaks. She has to go
the restroom five more times than normally, so she tries to stay close to the
restroom. She is on a medication for this. She has had hand surgery on her right
hand—it hurts all the time and goes numb. Her trigger finger still has problems.
She has problems using her right hand and she is right-handed, and it hurts to write
her name. She suffers from anxiety—crowds, loud noises, and a bunch of talking
are triggers; she has trouble going out in public. She avoids the grocery store—she
cannot breathe; she breaks out in sweats and hives. Her panic attacks last until she
leaves the environment. She suffers from depression, and she has problems with
her concentration and memory. She has problems with her short-term memory and
needs special reminders. Her dad helps her a lot. She has problems focusing. She
gets distracted doing tasks. Her pain is distracting. She spends a lot of time in the
day to get comfortable. She has problems with her sleep –some days, she does not
sleep at all because of her pain.
(Tr. 23-24).
2. 	Treatment Records
The ALJ considered exam findings and other evidence in the record relating to plaintiff’s
severe impairments. The ALJ noted that beginning in 2019, diagnostic imaging revealed the
following spinal pathology: narrowing of the cervical spinal canal, degenerative disc disease in
the lower back, herniated cervical disc, and nerve damage affecting both arms. (Tr. 24, citing
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Exhibit 36F). A May 2018 lumbar spine MRI showed mild degeneration, most pronounced at
L5-S1, without significant stenosis at that time (Exhibit C6F). (Id.). A May 2019 CT scan
demonstrated multilevel spondylosis with a disc-spur complex at C6-7 causing mild to moderate
stenosis on the right side, while July 2018 electrodiagnostic testing confirmed moderate to severe
left ulnar neuropathy and moderate right ulnar neuropathy. (Id.).
The ALJ noted that plaintiff’s physical examinations in late 2019 and 2020 were largely
unremarkable, with normal findings across multiple body systems. (Id., citing Exhibits C1F,
C2F). However, the ALJ observed that by April 2022, plaintiff’s exams indicated that her
functional status had altered: she was using a cane for mobility, exhibited right foot drop, and
walked with a limp. (Tr. 25, citing Exhibit C5F). She reported chronic thoracic and low back
pain with muscle cramps radiating bilaterally down her legs, multiple weekly headaches, and
osteoarthritis of the knees. (Id., citing Exhibit C5F). Mental health assessment revealed
moderately severe depression and poor grooming, though her cognitive function remained intact.
(Id., citing Exhibit C13F).
The ALJ considered May 2022 imaging studies showed postsurgical changes from
cervical fusion at C6-7, mild spinal stenosis at C5-6, and a small disc herniation at L5-S1 with
focal degenerative changes. (Tr. 25-26, citing Exhibit C7F). These findings represented no
significant change from June 2020 imaging (Tr. 26, citing Exhibit C7F); however, the ALJ noted
that by November 2022, plaintiff required a spinal cord stimulator trial for chronic pain
syndrome (Id., citing Exhibit C11F).
The ALJ also considered records from 2023 and early 2024, noting additional conditions:
bladder cancer diagnosis with subsequent negative cystoscopy and urinary incontinence (Exhibit
C16F), and confirmed osteoarthritis of the right knee. (Id., citing Exhibits C17F, C18F). A
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February 2024 examination also revealed knee tenderness, though plaintiff maintained 130
degrees of flexion and could perform straight leg raises with 4/5 motor strength. (Id., citing
Exhibit C18F). The ALJ noted that plaintiff “was assessed with unilateral primary osteoarthritis
of the right knee with instructions to weight-bear, range of motion, and activity as tolerated,
elevate her legs after activity to decrease swelling, use over-the-counter NSAIDs, and perform
home stretching and strengthening.” (Id., citing Exhibit C18F).
C. Specific Errors
Plaintiff alleges four assignments of error. First, plaintiff alleges the ALJ erred in
evaluating the persuasiveness of the opinions of consultative examiners Anas Minkara, M.D.,
and Ryan R. Wagner, Psy.D. Specifically, plaintiff argues that because the ALJ found Dr.
Minkara’s opinion partially persuasive, the ALJ erred by omitting limitations on sitting,
standing, walking, reaching, and manipulative activities from the residual functional capacity
determination, and failing to adopt or explain her reasons for rejecting Dr. Minkara’s opinion
that plaintiff was limited in her ability to reach and perform overhead activities. (Doc. 8 at
PAGEID 3338-41). Plaintiff contends that the latter error was not harmless because all three
occupations identified at step five—marker, router, and office helper—require frequent reaching.
(Id.). Second, plaintiff argues that the ALJ failed to properly evaluate Dr. Wagner’s opinion
under the mandatory factors of supportability and consistency, thereby precluding meaningful
judicial review. (Id. at PageID 3343). Third, plaintiff alleges the ALJ failed to resolve a
reasoning level conflict between the vocational expert’s testimony and the Dictionary of
Occupational Titles (DOT). (Id. at PageID 3344). Fourth, plaintiff appears to preemptively
argue that the ALJ cannot rely upon Emergency Message 21065 to completely prohibit any
consideration of certain parts of the DOT, such as reasoning level. (Id. at PageID 3349).
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E. Analysis
1. 	Medical Opinions
ALJs must adhere to agency regulations governing the evaluation of medical opinion
evidence. Under the regulations applicable to plaintiff’s claims, the Commissioner will “not
defer or give any specific evidentiary weight, including controlling weight, to any medical
opinion(s) or prior administrative medical finding(s), including those from your medical
sources.” 20 C.F.R. § 404.1520c(a). Rather, the Commissioner will consider “how persuasive”
the medical opinion is. 20 C.F.R. § 404.1520c(b).
In determining the persuasiveness of a medical opinion, the ALJ considers five factors:
(1) supportability, (2) consistency, (3) relationship with the claimant, including length of
treatment relationship, frequency of examinations, purpose of the treatment relationship, and
examining relationship, (4) specialization, and (5) other factors that tend to support or contradict
a medical opinion. 20 C.F.R. § 404.1520c(c)(1)-(5). The most important factors the ALJ must
consider are supportability and consistency. 20 C.F.R. § 404.1520c(b)(2). With respect to the
supportability factor, “[t]he more relevant the objective medical evidence5 and supporting
explanations presented by a medical source are to support his or her medical opinion(s) . . . the
more persuasive the medical opinions . . . will be.” 20 C.F.R. § 404.1520c(c)(1). Similarly,
“[t]he more consistent a medical opinion(s) . . . is with the evidence from other medical sources
and nonmedical sources in the claim, the more persuasive the medical opinion(s). . . .” 20 C.F.R.
§ 404.1520c(c)(2). The ALJ is required to “explain how [he/she] considered the supportability
and consistency factors for a medical source’s medical opinions” in the written decision. 20
5 Objective medical evidence is defined as “signs, laboratory findings, or both.” 82 Fed. Reg. 5844-01, 2017 WL
168819, at *5850.
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C.F.R. § 404.1520c(b)(2) (emphasis added). Conversely, the ALJ “may, but [is] not required to,
explain” how he/she considered the relationship, specialization, and other factors set forth in
paragraphs (c)(3) through (c)(5) of the regulation. Id. However, where two or more medical
opinions or prior administrative findings about the same issue are equally persuasive, the ALJ
must articulate how he or she “considered the other most persuasive factors in paragraphs (c)(3)
through (c)(5). . . .” 20 C.F.R. § 404.1520c(b)(3). Finally, the ALJ is not required to articulate
how he or she considered evidence from nonmedical sources. 20 C.F.R. § 404.1520c(d).
a. 	Dr. Minkara
i. 	Examination and Opinion
Dr. Minkara consultatively examined plaintiff for disability purposes on September 24,
2022. (Tr. 2906-17). Plaintiff complained she was disabled due to chronic neck and back pain
with radiculopathy, depression, anxiety and PTSD. (Tr. 2906). Dr. Minkara described plaintiff’s
history of present illness, noting:
Chronic neck and back pain with radiculopathy: patient report her back pain began
in 2001. 	She reports this was a result of trauma and injury during abusive
relationships. Her symptoms include pain with singing (sic) or walking. She feels
that her lower back is “ripping apart.” Laying down improved her symptoms, while
standing, walking, and sitting worsen it. She takes meloxicam PRN for the pain.
She has undergone prior x-rays which she reports demonstrated degenerative disc
disease. 	She reports pain and numbness radiating from [] the lower back to the
buttock, bilateral thighs along the lateral aspect, anterior knee, to the dorsal feet
involving the middle 3 toes. As for her neck pain, it began in 2017 as a result of
abuse. She reports neck pain which feels like it is being “ripped off[]”, standing,
and walking horse in (sic) [worsen] it. She reports undergoing a prior neck surgery.
[S]he takes baclofen daily for her muscle spasms, and uses topical lidocaine
patches. She reports pain and numbness from the neck to the shoulder extending
to the palmar hands, including all 5 digits. 	Depression, anxiety, PTSD: patient
reports this resulted due to abusive relationships and traumas. She is currently on
aripiprazole which she takes daily.
(Tr. 2906). Dr. Minkara observed:
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With regards to her cervical pain, clinical exam today demonstrated diminished
active range of motion of the cervical spine. Her symptoms are also consistent with
cervical radiculopathy in a (sic) bilateral upper extremities. She also has a positive
Spurling sign. As for her lower back pain, her symptoms are consistent with lumbar
radiculopathy. Her history of lumbar spondylosis is corroborated by the medical
documentation 	provided. 	Additionally, 	there 	are 	symptoms 	of 	lumbar
radiculopathy in the bilateral lower extremities. This is consistent with the bilateral
positive straight leg raise. 	Patient also demonstrated antalgic gait with use of a
cane.
(Tr. 2910). Dr. Minkara opined on plaintiff’s functional limitations:
[T]he claimant had mild limitations sitting because of cervical and lumbar pain with
radiculopathy. 	The claimant has mild limitations with standing, walking, lifting,
and carrying heavy weights due to cervical and lumbar pain with radiculopathy.
The claimant does not use an assistive device with regard to short distances, long
distances, or uneven terrain.6 There were mild limitations with bending, stooping,
crouching, and squatting due to cervical and lumbar pain with radiculopathy. There
were mild limitations with reaching and overhead activities. 	There are no
limitations with grasping or handling.
Claimant has no relevant visual or communicative issues. 	There are relevant
workplace limitations due to cervical and lumbar pain with radiculopathy.
(Tr. 2910-11). The ALJ found Dr. Minkara’s opinion to be partially persuasive, briefly stating:
The examiner has an exam to support the opinion and it generally supports a light
range work restriction. 	However, a totality of the medical evidence of record is
more consistent with some manipulative limitations because of the claimant’s right
upper extremity impairment.
(Id.).
ii. 	Arguments
Plaintiff argues the ALJ erred because “despite finding persuasive Dr. Minkara’s opinion
that [plaintiff] had ‘relevant workplace limitations’ in her ability to sit, the ALJ found no
limitations on [plaintiff]’s ability to sit during the workday by, for example, allowing for a
66 It appears this statement may be a typographical error as Dr. Minkara stated, “Patient
also demonstrated antalgic gait with use of a cane.” (Tr. 2910; see also Tr. 2913).
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sit/stand option.” (Doc. 8 at PAGEID 3338, citing Tr. 22). Plaintiff further argues that the “ALJ
also failed to adopt or reject and explain her reasons for rejecting Dr. Minkara’s opinion that
[plaintiff] was limited in her ability to reach and perform overhead activities,” and the “error is
not harmless, because all three of the occupations the ALJ identified at step five, marker, router,
and office helper, require frequent reaching.” (Doc. 8 at PAGEID 3341).7
In response, the Commissioner argues that the ALJ properly evaluated and explained her
consideration of Dr. Minkara’s consultative opinion. The Commissioner emphasizes that the
ALJ found Dr. Minkara’s opinion only “partially persuasive”—not fully persuasive—and
therefore was not required to adopt every limitation Dr. Minkara assessed.
As an initial matter, the Court notes that the parties’ arguments revolve around the
interpretation of the ALJ’s brief persuasiveness analysis that Dr. Minkara “has an exam to
support the opinion and it generally supports a light range work restriction” but “the totality of
the medical evidence of record is more consistent with some manipulative limitations because of
the claimant’s right upper extremity impairment.” (Tr. 27). Plaintiff interprets the ALJ’s
statement to mean that “the ALJ found that Dr. Minkara’s opinion was persuasive apart from her
opinion that [plaintiff] had no manipulative limitations” and therefore should have explained
why she failed to adopt the other limitations upon which Dr. Minkara opined. (Doc. 10 at
PageID 3377, citing Tr. 27 (emphasis omitted)). Based on this interpretation, plaintiff argues
that the ALJ erred by failing to include limitations on sitting, standing, walking, reaching, and
overhead activities in the RFC finding. (Doc. 8 at PageID 3339, 3341). The Commissioner
counters that the ALJ found Dr. Minkara’s opinion partially persuasive “only to the extent the
7 See DOT 209.587-034 (marker), 1991 WL 67180; DOT 222.587-038 (router), 1991 WL 672123; DOT 239.567-
010 (office helper), 1991 WL 672232.
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limitations were generally consistent with light work and some manipulative limitations,” and
therefore was not required to adopt the opinion verbatim. (Doc. 9 at PageID 3363, citing Tr. 27).
The Court finds that the ALJ’s persuasiveness analysis of Dr. Minkara’s opinion is
insufficiently articulated to permit meaningful judicial review. The ALJ’s statement that Dr.
Minkara “has an exam to support the opinion and it generally supports a light range work
restriction” but “the totality of the medical evidence of record is more consistent with some
manipulative limitations because of the claimant’s right upper extremity impairment” is
ambiguous and susceptible to multiple reasonable interpretations. (Tr. 27). The phrase
“generally supports a light range work restriction” does not clearly indicate whether the ALJ
found Dr. Minkara’s opinion persuasive in its entirety except for the manipulative limitations
component, or whether the ALJ found the opinion persuasive only in the limited sense that it was
consistent with light work as a general exertional category. (Id.). Similarly, the ALJ did not
specify which particular limitations opined by Dr. Minkara she found persuasive or
unpersuasive, nor did she explain why specific limitations—such as those regarding sitting,
standing, walking, reaching and overhead activities—were or were not incorporated into the RFC
finding. Without such specificity, the Court cannot determine whether the ALJ properly
considered and accounted for Dr. Minkara’s opinion or follow the ALJ’s path of reasoning in
formulating the RFC.
The Commissioner argues that “[b]y referencing the totality of the medical evidence of
record, which she had already discussed in her decision, the ALJ specifically articulated the
consistency factor, as required by the relevant regulations.” (Doc. 9 at PageID 3363, citing Tr.
27). The Court disagrees and finds the ALJ’s consistency analysis lacking. “The more
consistent a medical opinion(s) . . . is with the evidence from other medical sources and
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nonmedical sources in the claim, the more persuasive the medical opinion(s). . . .” 20 C.F.R. §
404.1520c(c)(2). The entirety of the ALJ’s consistency analysis is as follows: “[A] a totality of
the medical evidence of record is more consistent with some manipulative limitations because of
the claimant’s right upper extremity impairment.” (Tr. 27). This does little to explain the
consistency between Dr. Minkara’s other opined limitations, aside from any manipulation
limitations, and the record evidence. The ALJ does not cite a single piece of record medical
evidence in this part of her decision demonstrating that Dr. Minkara’s opinion on, for example,
plaintiff’s ability to reach or perform overhead activities is inconsistent with the rest of the
record.
In addition, the ALJ does not adequately explain her consistency conclusion elsewhere in
the decision. See Booker R. v. Comm’r of Soc. Sec., No. 3:22-cv-00170, 2023 WL 4247312, at
*4-5 (S.D. Ohio June 29, 2023). The Court is unable to discern from the ALJ’s decision how the
medical records relating to plaintiff’s capacity to walk, stand, or sit that the ALJ highlights in her
decision are inconsistent with Dr. Minkara’s opinion. While the ALJ’s review of plaintiff’s
treatment records noted certain “normal findings” and “physical examinations in late 2019 and
2020 [that] were largely unremarkable,” imaging studies revealed “multilevel spondylosis with a
disc-spur complex,” and treatment records documented that the plaintiff experienced right foot
drop, ambulated with a limp, and occasionally required a cane for mobility. (Tr. 24). Although
the ALJ recounted these records neutrally, she made no attempt—either in this summary or in
her subsequent evaluation of the opinion evidence—to reconcile the objective findings with the
restrictions Dr. Minkara imposed or to explain why she deemed those findings inconsistent with
the stated restrictions. Cf. Daniels v. Comm’r of Soc. Sec., No. 1:13-cv-1044, 2014 WL
1304940, *12 (N.D. Ohio March 27, 2014) (“ALJ’s discussion of the medical evidence was not
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merely a rote recitation of [p]laintiff’s longitudinal history; rather the ALJ analyzed the medical
evidence and explained how it supported his ultimate RFC determination.”). In comparison,
plaintiff points to evidence in the record that supports Dr. Minkara’s opined walking limitations:
Dr. Minkara noted that a straight leg raising test was positive in the seated and
supine positions, and [plaintiff] had an antalgic gait and used a cane at her
examination (R. 2910). 	Consultative psychological examiner, Tawnee Tanner,
Psy.D., observed [plaintiff] to be using a cane (R. 2097). 	Consultative examiner
Stephen Nutter, M.D., likewise observed [plaintiff] to have a “slightly limping gait
with a cane in her right hand” (R. 2106). Consultative examiner Ryan R. Wagner,
Ph.D., noted that “[plaintiff] ambulated with difficulty” (R. 2922). 	Physical
examinations throughout the record noted that [plaintiff] had an antalgic gait and
used a cane for ambulation (R. 2132-33, 2423, 2442, 2495, 2847, 2849, 2960).
(Doc. 8 at PageID 3339).
Further, the ALJ did not identify what specific evidence contradicted the reaching and
performing overhead activity restrictions opined by Dr. Minkara, nor explain why the limitations
in an opinion she found “partially persuasive” were excluded. See Hankinson v. Comm’r of Soc.
Sec., No. 2:18-cv-58, 2020 WL 240812, at *2 (S.D. Ohio Jan. 16, 2020) (“[I]f the ALJ accepts a
medical opinion but does not include a restriction recommended by that expert in the RFC, the
ALJ must explain why he did not do so.”). Under 20 C.F.R. § 404.1520c(b)(1), the ALJ need
not discuss every statement individually, but she must articulate a clear rationale. Here, the
rationale is incomplete: the ALJ’s general reference to “the totality of the evidence” does not
allow the Court to trace the path of her reasoning, particularly where the omitted limitations
could be outcome-determinative. (Tr. 27).
The Commissioner responds that the ALJ properly accounted for the “mild” limitations
opined by Dr. Minkara “by restricting plaintiff to a reduced range of light work with [] postural,
manipulative, and environmental limitations.” (Doc. 9 at PageID 3364). Specifically, the
Commissioner points out that the ALJ restricted plaintiff to a reduced range of light work with
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the following postural, manipulative, and environmental limitations: frequently (not constantly)
climb ramps and stairs; never climb ladders, ropes, and scaffolds; frequently (not constantly)
balance, stoop, kneel, and crouch; never crawl; avoid exposure to excessive vibration; avoid
exposure to any workplace hazards such as moving machinery or unprotected heights; and
frequent (not constant) fingering, handling, and feeling with the bilateral upper extremities.
(Doc. 9 at PageID 3364, citing Tr. 22). But none of the limitations noted by the Commissioner
specifically address the limitations on standing, walking, lifting, reaching, or performing
overhead activity opined by Dr. Minkara. See SSR 83-10, at *5-6, 1983 WL 31251 (describing
jobs in the light work category as “require[ing] a good deal of walking or standing” and “off and
on, for a total of approximately 6 hours of an 8-hour workday.”). Further, while the ALJ
acknowledges Dr. Minkara’s opined limitations for reaching and overhead activity, she does not
address them further or explain how she considered them.
In sum, the ALJ’s analysis of Dr. Minkara’s opinion for persuasiveness does not permit
meaningful judicial review. In addition, the ALJ failed to properly analyze the consistency of
Dr. Minkara’s opinion. As such, the ALJ’s decision regarding this medical opinion is not based
on substantial evidence, and the decision should be reversed and remanded for re-evaluation of
Dr. Minkara’s opinion.
b. 	Dr. Wagner
i. 	Examination and Opinion
In reviewing Dr. Wagner’s opinion, the ALJ summarized:
Consultative examiner, Ryan R. Wagner, Psy.D., examined the claimant on
October 24, 2022, and upon mental status exam, found the following: “. . .
[plaintiff] was cooperative, and rapport was adequately established. 	She was
dressed casually. Her grooming and hygiene were adequate. [Plaintiff] ambulated
with difficulty but did not use an assistive device. 	She did not appear to be in
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physical discomfort. She appeared to put forth adequate effort required to complete
the evaluation process. 	Her level of understanding was adequate. 	She had
consistent eye contact during the interview . . . . She was able to track the
conversation without significant difficulty . . . displayed a rate of speech that was
within normal limits . . . not display loose associations. . . . obsession, compulsions,
delusions, or hallucinations . . . level of intellectual functioning appeared to fall
below normal . . . judgment is sufficient for her to make decisions . . . ” 	In the
functional assessment, the examiner opined that the claimant’s performance was
not suggestive of difficulty understanding instruction; her short term memory task
was not suggestive of difficulty remembering instructions; she did not have
difficulty understanding and responding to questions; the claimant reported
problems learning work task[s] including difficulty learning new information and
following instructions; she was able to follow the conversation during the interview
did not ask the regular repetition of questions; she had difficulty completing tasks
assessing attention suggestive of difficulty with concentration and focus; her level
of energy was below average; she presented is highly anxious that might impact her
mood stability in a competitive work setting; her presentation was indicative of
intellectual limitations that might negatively impact her ability to manage normal
work pressures (Exhibit 10F).
(Tr. 27). The ALJ found Dr. Wagner’s opinion to be partially persuasive, stating only:
This opinion is somewhat persuasive. 	The examiner has an exam to support the
opinion. 	However, the opinion was not expressed in the vocationally relevant
terminology.
(Id.).
ii. 	Arguments
Plaintiff argues that “[t]he ALJ’s lack of explanation in evaluating Dr. Wagner’s opinion
precludes meaningful judicial review.” (Doc. 8 at PageID 3343). Plaintiff further contends the
ALJ erred because she “did not discuss how consistent or inconsistent she found Dr. Wagner’s
opinion to be with the other record evidence, or how this factored into her finding that Dr.
Wagner’s opinion was ‘somewhat persuasive.’” (Id. at PageID 3344; Doc. 10 at PageID 3381).
The Commissioner responds by arguing that Dr. Wagner’s statements do not qualify as a medical
opinion because he did not assess what “[p]laintiff can do despite her impairments” and,
therefore, his opinion is not subject to a persuasiveness analysis. (Doc. 9 at PageID 3369-70
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(quotations omitted), citing 20 C.F.R. §§ 404.1513(a)(2), 416.913(a)(2)). The Commissioner
further argues that because the ALJ found Dr. Wagner’s opinion “was not expressed in []
vocationally relevant terminology” she was not required to include functional limitations based
on the opinion. (Doc. 9 at PageID 3374, citing Tr. 27).
Contrary to the Commissioner’s argument, the ALJ characterized Dr. Wagner’s report as
“opinion” evidence and evaluated it for persuasiveness, finding it “somewhat persuasive.” (Tr.
27). As such, the Commissioner’s opposing argument amounts to an impermissible post-hoc
rationalization of the ALJ’s determination. See Williams v. Comm’r of Soc. Sec., 227 F. App’x.
463, 464 (6th Cir. 2007) (citing SEC v. Chenery Corp., 332 U.S. 194, 196 (1947)) (a reviewing
court, in assessing the decision of an administrative agency, must judge its propriety solely by
the grounds invoked by the agency).
Further, the cases the Commissioner relies upon for this premise are distinguishable in
that the ALJs in those cases expressly stated that they found the medical opinions in question to
be “vague” and reasonably explained their reasoning for discounting them. (Doc. 9 at PageID
3371, citing Quisenberry v. Comm’r of Soc. Sec., 757 F. App’x 422, 434 (6th Cir. 2018) and
Epps v. Comm’r of Soc. Sec. Admin., 2024 WL 3184466, at *11 (N.D. Ohio June 4, 2024), report
and recommendation adopted, 2024 WL 3179664 (N.D. Ohio June 26, 2024)). That is not the
case here. The ALJ did not describe Dr. Wagner’s opinion as vague, and she did not provide any
discernible explanation indicating that she did not consider it a medical opinion. (Tr. 27).
Further, as to the ALJ’s statement that Dr. Wagner’s opinion lacked “vocationally relevant
terminology,” “it may fall to the ALJ to ‘convert[ ] and incorporate[ ]’ the limitations set forth in
a medical opinion ‘into vocationally relevant terms’—i.e., terms that are relevant and meaningful
in the DOT/SCO and/or the VE’s own vocational experience—before including those limitations
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in a hypothetical posed to a VE.” Stoodt v. Comm’r of Soc. Sec., No. 3:20-cv-2370, 2022 WL
721455, at *16 (N.D. Ohio Jan. 13, 2022) (quoting Modro v. Comm’r of Soc. Sec., No. 2:18-cv-
900, 2019 WL 1986522, at *7 (S.D. Ohio May 6, 2019)) (alterations in original), report and
recommendation adopted, 2022 WL 716105 (N.D. Ohio Mar. 10, 2022).
The Court disagrees with the Commissioner’s alternative argument that “the ALJ did more
than what was required of [her] and explained why [s]he found Dr. Wagner’s statements only
somewhat persuasive.” (Doc. 9 at PageID 3370, citing Tr. 27). While an ALJ does not commit
error simply by failing to use the terms “supportability” and “consistency” in her analysis, see
Terry Q. v. Comm’r of Soc. Sec., 2022 WL 969560, at * 5 (S.D. Ohio March 31, 2022), the Court
is simply unable to discern what part of Dr. Wagner’s opinion the ALJ found persuasive (or not)
and to what extent (if any) Dr. Wagner’s opinion was consistent with the other record evidence.
As such, the Court is unable to meaningfully review the ALJ’s assessment of Dr. Wagner’s
opinion in accordance with 20 C.F.R. § 404.1520c(c)(1) and (2).
C. Conclusion
In the absence of a sufficient explanation of supportability and consistency with the
record as a whole, the Court concludes that the ALJ’s persuasiveness analysis of Drs. Minkara
and Wagner’s opinions is not supported by substantial evidence. “The 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.” Canty v. Comm’r of Soc. Sec., No. 2:15-cv-2221, 2016 WL 5957679,
at *3 (S.D. Ohio Oct. 14, 2016) (Sargus, J.) (citing Fleischer v. Astrue, 774 F. Supp. 2d 875, 877
(N.D. Ohio 2011) (quoting Sarchet v. Chater, 78 F.3d 305, 307 (7th Cir. 1996)). Here, the ALJ
failed to build an accurate and logical bridge from the evidence to her conclusions in evaluating
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the opinions of the consultative examiners. Therefore, plaintiff’s first and second assignments of
error should be sustained and this matter reversed and remanded for further proceedings.
2. 	Vocational Expert’s Testimony and the DOT Standards
Because the ALJ’s persuasiveness analysis of the opinions of Drs. Minkara and Wagner
lacks substantial evidentiary support, the Court need not address the vocational errors identified
by plaintiff as errors three and four. As plaintiff acknowledges in her brief (Doc. 8 at PageID
3348), the remedy for these alleged vocational errors would also be a remand for further
proceedings.
IT IS THEREFORE RECOMMENDED THAT:
Plaintiff’s Statement of Specific Errors (Doc. 8) be SUSTAINED and the
Commissioner’s non- non-disability finding be REVERSED AND REMANDED FOR
FURTHER PROCEEDINGS consistent with this Report and Recommendation.
Date: _________________________ 	__________________________________
Karen L. Litkovitz
United States Magistrate Judge
11/1/2025
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UNITED STATES DISTRICT COURT
SOUTHERN DISTRICT OF OHIO
EASTERN DIVISION
SANDRA J., 	Case No. 2:25-cv-00331
Plaintiff, 	Sargus, J.
Litkovitz, M.J.
vs.
COMMISSIONER OF
SOCIAL SECURITY,
Defendant.
NOTICE TO THE PARTIES REGARDING THE FILING OF OBJECTIONS TO R&R
Pursuant to Fed. R. Civ. P. 72(b), WITHIN 14 DAYS after being served with a copy of
the recommended disposition, a party may serve and file specific written objections to the
proposed findings and recommendations. This period may be extended further by the Court on
timely motion for an extension. Such objections shall specify the portions of the Report objected
to and shall be accompanied by a memorandum of law in support of the objections. If the Report
and Recommendation is based in whole or in part upon matters occurring on the record at an oral
hearing, the objecting party shall promptly arrange for the transcription of the record, or such
portions of it as all parties may agree upon, or the Magistrate Judge deems sufficient, unless the
assigned District Judge otherwise directs. A party may respond to another party’s objections
WITHIN 14 DAYS after being served with a copy thereof. Failure to make objections in
accordance with this procedure may forfeit rights on appeal. See Thomas v. Arn, 474 U.S. 140
(1985); United States v. Walters, 638 F.2d 947 (6th Cir. 1981).
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