Thorman v. Commissioner of Social Security Administration

IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
AIMEE M. THORMAN,
Plaintiff,
vs.
COMMISSIONER OF SOCIAL
SECURITY ADMINISTRATION,
Defendant.
CASE NO. 1:25-cv-115
MAGISTRATE JUDGE
JAMES E. GRIMES JR.
MEMORANDUM OPINION
AND ORDER
Plaintiff Aimee M. Thorman filed a complaint against the Commissioner
of Social Security seeking judicial review of the Commissioner’s decision
denying her application for disability insurance benefits. Doc. 1. This Court
has jurisdiction under 42 U.S.C. §§ 405(g) and 1383(c). The parties consented
to my jurisdiction in this case. Doc. 4. Following review, and for the reasons
stated below, I affirm the Commissioner’s decision.
Procedural Background
In May 2022, Thorman filed an application for disability insurance
benefits, alleging a disability onset date1 of September 15, 2015.2 Tr. 212
1 	“Once a finding of disability is made, the [agency] must determine the
onset date of the disability.” McClanahan v. Comm’r of Soc. Sec., 193 F. App’x
422, 425 (6th Cir. 2006).
2 	Thorman’s opening brief states that she alleged that her initial onset
date was May 10, 2016. Doc. 8, at 1 (citing Tr. 192). But she notes that the
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(alleging that Thorman stopped working due to conditions on September 15,
2015); but see Tr. 192 (alleging that Thorman became unable to work due to
her conditions on May 10, 2016). In pertinent part, Thorman alleged that she
was disabled and unable to work due to the following impairments: complex
regional pain syndrome (“CRPS”),3 small fiber neuropathy, POTS,4 post-
traumatic stress disorder, anxiety, depression, autoimmune encephalitis, and
panic attacks. Tr. 212.
record at various points and the ALJ’s decision indicate an onset date of
September 15, 2015. Id. (citing Tr. 84, 95). Beyond her passing statement,
Thorman does not challenge the ALJ’s determination, and other statements—
including some made by Thorman, see Tr. 212—indicating an onset date of
September 15, 2015. So she has forfeited any issue, to the extent there could
be one, arising out of this discrepancy. See McPherson v. Kelsey, 125 F.3d 989,
995–96 	(6th 	Cir. 	1997) 	(“[I]ssues 	adverted 	to 	in 	a 	perfunctory 	manner,
unaccompanied by 	some 	effort 	at 	developed argumentation, 	are 	deemed
waived. It is not sufficient for a party to mention a possible argument in the
most skeletal way, leaving the court to . . . put flesh on its bones.”) (internal
citations omitted).
3 	“Complex regional pain syndrome (CRPS) is a form of chronic pain that
usually affects an arm or a leg. CRPS typically develops after an injury, a
surgery, a stroke or a heart attack. The pain is out of proportion to the severity
of the initial injury.” Complex Regional Pain Syndrome, Mayo Clinic Diseases
& 	Conditions, 	https://www.mayoclinic.org/diseases-conditions/crps-complex-
regional-pain-syndrome/symptoms-causes/syc-20371151
[https://perma.cc/R8PQ-9KMG ].
4 	“Postural orthostatic tachycardia syndrome (POTS) is a condition that
causes a number of symptoms when you transition from lying down to standing
up, such as a fast heart rate, dizziness and fatigue. While there’s no cure,
several treatments and lifestyle changes can help manage the symptoms of
POTS.” Postural Orthostatic Tachycardia Syndrome, Cleveland Clinic Health
Library, 	https://my.clevelandclinic.org/health/diseases/16560-postural-
orthostatic-tachycardia-syndrome-pots [https://perma.cc/P4Y8-XSMV].
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In April 2023, Thorman requested a hearing. Tr. 119. Administrative
Law Judge (“ALJ”) Catherine Ma held a telephone hearing in October 2023.
Tr. 47. Thorman appeared, testified, and was represented by counsel at the
October 2023 hearing. Tr. 47. Qualified vocational expert Allison Reno also
testified. Id. In January 2024, the ALJ issued a written decision, which found
that Thorman was not entitled to benefits. Tr. 7–26.
In January 2024, Thorman appealed the ALJ’s decision to the Appeals
Counsel. Tr. 185. In November 2024, the Appeals Counsel denied Thorman’s
appeal, making the ALJ’s January 2024 decision the final decision of the
Commissioner. Tr. 1; see 20 C.F.R. § 404.981.
Thorman timely filed this action in January 2025. Doc. 1. In her opening
brief, Thorman raises two issues:
1. 	Whether the ALJ erred in failing to assess plaintiff’s
complex 	regional 	pain 	syndrome 	under 	the
provisions of social security ruling 03-2P, which
provides the protocol for evaluating claims involving
complex regional pain syndrome.
2. 	Whether the ALJ erred in that he failed to properly
analyze plaintiff’s pain in accordance with Social
Security Ruling 16-3P.
Doc. 8, at 1.
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Evidence
Personal, Educational, and Vocational Evidence
Thorman was born in 1973 making her 46 years old on the date last
insured. Tr. 192. Thorman testified that she completed a bachelor’s degree
English and described receiving software training. Tr. 55.
Medical Evidence5
The ALJ’s uncontested summary of the medical evidence is as follows:
Around the time of the September 15, 2015 alleged
onset date, the claimant visited the Cleveland Clinic
on October 22, 2015 for a physical examination and
reported that she exercised regularly and tried to eat
healthily (Ex. 9F at 691). The claimant’s review of
symptoms was negative for back pain, joint pain,
swelling, 	or 	a 	mood 	disorder, 	she 	reported
experiencing right buttocks pain that was worse
with 	running 	and 	sitting 	and 	improved 	with
standing, and she reported receiving two injections
for 	this, 	which 	helped 	(Ex. 	9F 	at 	692). 	Upon
examination, 	the 	claimant 	was 	well 	appearing,
alert, and in no acute distress with no pain to
palpation over the spine, normal motor findings,
negative straight leg raising, and normal range of
motion of her lumbar spine, she was able to walk on
her heels and tip-toes, her abdominal examination
was normal, her extremities were normal, her gait
was normal, and her muscular strength was intact
and 	equal 	in 	her 	bilateral 	upper 	and 	lower
extremities (Ex. 9F at 693). Muhammad Ali Syed,
M.D. 	assessed 	the 	claimant 	with 	right 	sciatica,
prescribed a Medrol dose pack, gave the claimant
back exercises, and recommended regular aerobic
exercise (Ex. 9F at 693).
5 	While the parties cite some different or additional medical records in
their briefing, they do not challenge the ALJ’s summary of the medical records.
Additionally, Thorman does not claim that the ALJ erred in her recitation of
the medical evidence. Instead, as is explained below, her challenges generally
amount to a dispute over the ALJ’s weighing of evidence.
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On December 4, 2015, the claimant returned to the
Cleveland 	Clinic 	to 	follow 	up 	on 	complaints 	of
buttock pain and reported that she was an active
runner who started experiencing this pain in August
2015 after increasing her speed while running on the
treadmill (Ex. 9F at 687). The claimant also reported
a history of lower back pain since she fractured her
spine in December 2013, and Michael Schaefer, M.D.
noted that an April 2014 MRI of the claimant’s
lumbar spine showed that her fractures had healed
with no stenosis or significant disc issues (Ex. 9F at
687). Dr. Schaefer observed that the claimant was in
no acute distress with full range of motion of her
lumbar 	spine, 	negative 	facet 	loading, 	negative
sacroiliac joint maneuvers, mildly positive straight
leg raising, right hip tenderness, loss of sensation
over her right anterior/lateral leg, mild weakness in
her hamstring, and trace weakness in her right
ankle dorsiflexion, and her strength, bulk, and tone
was otherwise normal in her lower limbs bilaterally
(Ex. 	9F 	at 	688). 	Dr. 	Schaefer 	noted 	that 	the
claimant’s pain had “much improved” with two PRP
injections but then recurred, noted that the claimant
had a history of a compression fracture from a fall in
December 2013, wondered if her sciatica was a
result of a sciatic scar or fibrosis, ordered an MRI of
the claimant’s right thigh and femur, and prescribed
Lyrica (Ex. 9F at 688).
A December 29, 2015 MRI of the claimant’s right
thigh showed a normal femur and normal muscles,
fascia, and subcutaneous tissues (Ex. 9F at 1330-
1331). 	The 	claimant 	also 	received 	treatment 	at
Chagrin Valley Chiropractic and Acupuncture in
December 2019 (Ex. 13F at 1-27).
On January 19, 2016, the claimant was discharged
from Cleveland Clinic Rehabilitation and Sports
Therapy due to the claimant not following up as
recommended, as she had not returned for physical
therapy since February 2015 after attending two
physical therapy sessions (Ex. 9F at 680-681). The
claimant returned to Dr. Schaefer on January 22,
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2016, reported experiencing severe pain when trying
to run, and reported that her previous treatment for
this had included “extensive” physical therapy (Ex.
9F at 678-679). The claimant also reported that she
had stopped taking Lyrica (Ex. 9F at 680). Dr.
Schaefer recommended right piriformis and sciatic
nerve block injection, which the claimant underwent
on February 2, 2016, discussed future treatment
options that included epidural steroid injection, and
advised the claimant to try physical therapy again
(Ex. 9F at 676-678, 680).
When the claimant followed up at the Cleveland
Clinic on March 10, 2016, she reported that her pain
had worsened for two weeks after her injection and
then 	returned 	to 	pre-injection 	levels, 	and 	she
reported that her tizanidine was helping her pain
(Ex. 	9F 	at 	673). 	The 	claimant’s 	gait 	was 	non-
antalgic, 	her 	strength 	was 	full 	in 	her 	lower
extremities, and straight leg raising was negative
(Ex. 	9F 	at 	673). 	Spine 	medicine 	fellow 	Colin
Carpenter, M.D. advised the claimant to follow up
with 	neurology 	for 	further 	evaluation 	of 	her
complaints of lower extremity radiation of pain and
advised her to return in three to four months for
gradual return to therapy and jogging (Ex. 9F at
674).
The 	claimant 	visited 	general 	neurology 	at 	the
Cleveland Clinic on 	April 4, 	2016 and reported
experiencing right leg pain (Ex. 9F at 667). Upon
examination, 	the 	claimant 	was 	well 	appearing,
alert, and in no acute distress, her gait examination
was normal, her strength was normal, and she had
limitation of movement due to pain (Ex. 9F at 670).
Neurologist 	Roya 	Vakili, 	M.D. 	ordered 	further
testing and prescribed the antidepressant and nerve
pain medication Vivactil (protriptyline) (Ex. 9F at
667). When the claimant followed up with Dr. Vakili
on June 8, 2016, the claimant reported that her pain
medication was helping, and her pain had decreased
to a level of five out of ten (Ex. 9F at 655). The
claimant’s gait examination remained normal, her
strength was normal on examination, and she had
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limitation of movement due to pain (Ex. 9F at 657).
Dr. Vakili concluded that the claimant’s right leg
pain 	was 	likely 	due 	to 	small 	fiber 	neuropathy,
increased 	the 	claimant’s 	dosage 	of 	Pamelor,
continued her on Ultram, and referred her to a pain
psychologist (Ex. 9F at 655).
On July 3, 2016, the claimant visited the emergency
room with a complaint of back pain after falling in
the bathroom the night previously and reported that
she had a history of back fractures (Ex. 9F at 650).
The claimant was ambulatory and denied any leg
weakness (Ex. 9F at 650). The claimant had no acute
findings on a CT scan of her lumbar spine and
sacrum, and this testing showed a stable remote 20
percent compression fracture of the L1 superior
endplate 	(Ex. 	9F 	at 	653). 	The 	claimant 	was
discharged with pain medication and advised to
follow up with her primary care provider in one or
two days (Ex. 9F at 653).
About a month later, the claimant returned to Dr.
Vakili on August 8, 2016 and reported that Pamelor,
Ultram, and tizanidine continued to help her pain
(Ex. 9F at 644). The claimant’s gait and station
remained normal on examination, and Dr. Vakili
increased 	her 	dosage 	of 	Pamelor, 	discontinued
Tramadol, provided a short prescription for Tylenol
No. 3, which the claimant reported had previously
been helpful, and discussed relaxation techniques
(Ex. 9F at 644, 646).
The 	claimant 	subsequently 	visited 	psychologist
Kelly Huffman, Ph.D. on November 29, 2016 for a
pain 	medicine 	evaluation 	(Ex. 	9F 	at 	636). 	The
claimant reported that her current pain was at a
level of five out of ten in severity, described this as
“manageable,” and reported that stress exacerbated
her pain and medication and exercise mitigated it
(Ex. 9F at 636). The claimant also reported that she
“silver smithed” and made jewelry, she reported
volunteering for an achievement center for children
as well as for Meals on Wheels, and she reported
that she was not depressed and she was doing
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“pretty well” (Ex. 9F at 637, 639). Dr. Huffman
observed that the claimant was cooperative with
good eye contact, a euthymic affect, normal speech,
logical and relevant thoughts, normal attention span
and concentration, and good insight and judgment
and 	pain 	behavior 	was 	not 	present, 	and 	she
discussed chronic pain and its management with the
claiant, noted that the claimant’s prognosis was
good, and made no further follow up plan with the
claimant (Ex. 9F at 639).
When the claimant followed up with Dr. Vakili on
December 22, 2016, the claimant’s gait and strength
remained normal, 	and Dr. 	Vakili continued her
medications, discussed healthy lifestyle, exercise,
and diet, and advised her to follow up in six months
(Ex. 9F at 631, 634).
In January 2017, the claimant reported recently
driving back from a trip to Washington, D.C., and
upon 	examination, 	her 	gait 	and 	reflexes 	were
normal (Ex. 9F at 611-612, 626). In May 2017, the
claimant began acupuncture for right leg and foot
pain (Ex. 9F at 606). Dr. Vakili referred the claiant
to pain management at the Cleveland Clinic, and the
claimant visited pain management physician Riad
Laham, 	M.D. 	on 	June 	19, 	2017 	and 	reported
experiencing 	right 	leg 	pain 	without 	relief 	from
acupuncture (Ex. 9F at 594). The claimant was alert,
well-appearing, 	and 	in 	no 	acute 	distress 	upon
examination, she had no pain to palpation of the
lumbar spine and good range of motion of her back
without reproducible pain, straight leg raising was
negative 	bilaterally, 	she 	had 	dysesthesia 	and
allodynia 	throughout 	her 	right 	lower 	extremity
without any dermatomal distribution, her motor
strength and tone were full at a level of five out of
five throughout, her sensation was intact to light
touch all throughout, and her gait was normal (Ex.
9F at 596). Dr. Laham assessed the claiant with
complex regional pain syndrome of the right lower
extremity, prescribed Nucynta, a trial of one lumbar
epidural steroid injection, and a trial of ketamine
infusion for a couple days, continued her on Tegretol,
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Zanaflex, 	and 	nortriptyline, 	discontinued
hydrocodone, 	and 	noted 	that 	a 	spinal 	cord
stimulator and Belbuca could be further treatment
options (Ex. 9F at 596).
Dr. Vakili subsequently observed in July 2017 that
the claimant’s gait and strength remained normal on
examination 	(Ex. 	9F 	at 	590). 	The 	claimant
underwent lumbar epidural steroid injection at L4-
L5 on July 12, 2017 (Ex. 9F at 586), and she reported
no improvement with this when she returned to Dr.
Laham 	on 	July 	25, 	2017 	(Ex. 	9F 	at 	578). 	The
claimant also reported that Nucynta was helpful
initially but then this effect gradually faded (Ex. 9F
at 578). Dr. Laham observed that the claimant’s gait
was normal, her sensation was intact, and her motor
strength was full at a level of five out of five, and he
continued her on Nucynta, prescribed Baclofen, and
scheduled the claimant for ketamine infusions (Ex.
9F at 573, 580). When the claimant returned to Dr.
Laham on August 29, 2017 after completing a series
of five ketamine infusions, she reported 30 to 40
percent improvement and reported that her daily
activities and sleep had improved (Ex. 9F at 545).
The 	claimant’s 	gait, 	strength, 	and 	sensation
remained normal, and Dr. Laham continued her on
Nucynta and gabapentin, prescribed Gralise, and
noted 	that 	the 	claimant 	could 	repeat 	ketamine
infusion every couple months if needed (Ex. 9F at
547).
The claimant followed up with Dr. Laham in October
2017 and reported 50 percent improvement with
ketamine infusion with continued improvement in
her daily activities and sleep (Ex. 9F at 524). Her
gait, strength, and sensation remained normal, and
Dr. Laham continued the claimant on Nucynta and
tizanidine 	and 	noted 	that 	the 	claimant 	could
schedule additional ketamine therapy whenever she
decided (Ex. 9F at 526-527). The claimant resumed
ketamine infusions with a series of three additional
infusions in December 2017 (Ex. 9F at 508, 517).
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The claimant reported ten percent improvement
with these additional infusions when she followed
up with Dr. Laham on January 2, 2018 (Ex. 9F at
503). Her gait, strength, and sensation remained
normal, and Dr. Laham continued her on tizanidine
and Nucynta in addition to a compounded topical
medication 	(Ex. 	9F 	at 	506) 	and 	prescribed
methadone later in January 2018 (Ex 9F at 499-
500).
On February 12, 2018, the claimant returned to Dr.
Vakili and reported that she had weaned herself of
methadone 	because 	she 	preferred 	not 	to 	take
narcotic pain medication (Ex. 9Fat 493). Dr. Vakili
observed 	that 	the 	claimant’s 	gait 	and 	strength
remained normal, switched her from Pamelor to
Cymbalta 	(duloxetine), 	increased 	her 	dosage 	of
Tegretol, gave her a Toradol injection, and ordered
x-rays of her back (Ex. 9F at 493, 496), which showed
a stable and mild remote compression deformity of
L1 	with 	otherwise 	maintained 	vertebral 	body
heights and maintained disc spaces (Ex. 9F at 1274-
1275).
About six months later, the claimant visited Philip
Fischer, M.D. at Psych BC, where she had last been
seen 	seven 	years 	previously, 	for 	an 	initial
assessment on August 21, 2018 (Ex. 3F at 3). The
claimant reported symptoms of depression, anxiety,
and 	PTSD 	and 	reported 	experiencing 	family
stressors that were causing some of her symptoms
(Ex. 3F at 3). The claimant made appropriate eye
contact, her gait was normal, and she was well
groomed, attentive, friendly, and tearful with an
anxious mood, an appropriate affect, no evidence of
psychosis, good memory, above average intelligence,
good language and fund of knowledge, and good
insight and judgment (Ex. 3F at 3-4). Dr. Fischer
assessed the claimant with bipolar disorder, PTSD,
and ADHD and prescribed duloxetine, alprazolam,
and Ritalin (Ex. 3F at 5).
When the claimant followed up with Dr. Fischer on
October 16, 2018, she reported that she was under a
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lot of stress, including family and financial stressors
(Exs. 3F at 9, 4F at 4). The claimant reported no
anxiety attacks (Ex. 3F at 11). The claimant was
neatly and appropriately dressed and groomed, her
gait, speech, insight, and judgment were good, her
memory and fund of knowledge were intact, her
mood was sad and anxious, and her behavior was
within normal limits (Ex. 3F at 16-19). Dr. Fischer
concluded that the claimant’s depression, complex
regional pain syndrome, and PTSD were stable, and
he 	continued 	the 	claimant 	on 	duloxetine,
methylphenidate, and psychotherapy (Ex. 3F at 25-
27).
The claimant visited Shaker Women’s Wellness for
chiropractic treatment of lower back pain and right
leg pain in February, March, and April 2019 (Ex.
2F), 	and 	she 	reported 	that 	her 	pain 	level 	was
increased to a level of seven out of ten and her
baseline pain level was usually at a level of three out
of ten on February 4, 2019 (Ex. 2F at 12). The
claimant also returned to Dr. Fischer in February
2019 and reported that she was feeling “pretty good”
despite persistent pain (Exs. 3F at 32. 4F at 26). Dr.
Fischer concluded that the claimant’s depression
was stable, her complex regional pain syndrome had
improved 	with 	Cymbalta, 	and 	her 	PTSD 	was
improving with psychotherapy, and he continued
her on methylphenidate (Ex. 3F at 33). The claimant
reported improvement with chiropractic treatment
by March 2019 and reported that she had been doing
“a lot of kettlebell exercises” (Ex. 2F at 4).
On March 4, 2019, the claimant visited Lindsey
Szarka, 	A.P.R.N. 	at 	the 	Cleveland 	Clinic 	and
reported that she was generally feeling “pretty good”
despite 	family 	stressors, 	she 	was 	exercising
regularly, and she had right lower abdominal pain
(Ex. 9F at 477). Nurse Szarka observed that the
claimant was alert and oriented with a normal gait,
normal reflexes, right lower extremity pain, and a
possible right groin inguinal hernia on examination
(Ex. 9F at 480).
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The claimant subsequently visited the emergency
room on March 13, 2019 with complaints of right
lower quadrant pain that began in late January,
2019 after she had been “working out” (Ex. 9F at
467). The claimant’s abdomen was soft and tender
with no rigidity, rebound, or guarding, and a CT
scan showed a small fat-containing umbilical hernia
(Ex. 9F at 470-471). The claimant was assessed with
an 	umbilical 	hernia 	without 	obstruction 	or
gangrene, 	discharged 	later 	that 	day 	in 	stable
condition, and advised to follow up with general
surgery and her primary care provider (Ex. 9F at
471).
On March 20, 2019, the claimant visited orthopedic
surgeon 	Atul 	Kamath, 	M.D. 	for 	an 	orthopedic
consultation 	and 	reported 	experiencing 	three
months of acute right hip pain (Ex. 9F at 462). The
claimant reported no use of an assistive device and
reported taking over-the-counter pain medication,
and she reported that she worked as a stay-at-home
mother and had three children with one in college
(Ex. 9F at 462, 464). Dr. Kamath observed that the
claimant was well appearing, alert, and in no acute
distress with a broad and appropriate mood and
affect, a stable gait with no assistance, negative
Trendelenburg sign, hip tenderness and pain with
range of motion, normal range of motion upon knee
exam without pain, normal range of motion of her
lumbar 	spine, 	and 	negative 	straight 	leg 	raising
bilaterally (Ex. 9F at 465). Dr. Kamath ordered
additional testing, gave the claimant a right hip
injection, and prescribed physical therapy (Ex. 9F at
466).
When the claimant followed up with Dr. Fischer in
April 22, 2019, she reported that things had been
difficult because her mother had been diagnosed
with 	stage 	four 	liver 	cancer 	and 	she 	was 	her
mother’s caregiver (Ex. 3F at 35). Dr. Fischer noted
that the claimant remained stable and improved
with medication and therapy, and he prescribed
Adderall, zolpidem, and Adderall (Ex. 3F at 36).
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The 	claimant 	visited 	general 	surgeon 	James 	A.
Maglieri, M.D. on May 29, 2019 for a consultation
regarding her umbilical hernia (Ex. 9F at 459). Dr.
Maglieri observed that the claimant’s abdomen was
soft and non-tender with normal bowel sounds and a
small reducible umbilical hernia (Ex. 9F at 461). Dr.
Maglieri concluded that there was no evidence of
right lower quadrant pathology to correspond to the
claimant’s reports of intermittent pain and did not
recommend repair of the umbilical hernia because it
was “asymptomatic and small” (Ex. 9F at 461).
In June 2019, the claimant followed up with Dr.
Fischer and reported that her mother had passed
away and she felt traumatized by taking care of her
(Ex. 	3F 	at 	38). 	Dr. 	Fischer 	observed 	that 	the
claimant was neatly and appropriately dressed and
groomed, her gait, speech, insight, and judgment
were good, her memory and fund of knowledge were
intact, her mood was sad and anxious, and her
behavior was within normal limits (Ex. 3F at 39). Dr.
Fischer concluded that the claimant was stable and
improving and continued her medications (Ex. 3F at
39).
On July 15, 2019, the claimant followed up with
Nurse Szarka and reported that she was under a lot
of stress, her mother had passed away from colon
cancer, and her father had had a stroke (Ex. 9F at
453). The claiant also reported that she was down to
30 	mg 	of 	Cymbalta 	and 	trying 	to 	get 	off 	this
medication, she was exercising daily for an hour, she
was able to do water exercise and the elliptical, and
she was unable to run (Ex. 9F at 453). The claimant
also denied any anxiety or depression (Ex. 9F at
454). The claimant was alert and oriented with a
normal gait and normal range of her lumbar spine
upon examination (Ex. 9F at 454).
On 	September 	4, 	2019, 	Stephen 	Samples, 	M.D.
observed that the claimant was cogent with good
fund of knowledge, grossly intact sensation, full
strength at a level of five out of five in her upper and
lower extremities, and a normal gait, and she was
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able to walk on her heels and toes and tandem walk
(Ex. 9F at 442). After the September 30, 2019 date
last insured, Dr. Fischer continued the claimant’s
medications in November 2019 and noted that the
claimant remained stable and improving (Exs. 3F at
43, 4F at 38).
Tr. 16–22.
ALJ Decision
The ALJ made the following findings of fact and conclusions of law:
1. 	The claimant last met the insured status
requirements of the Social Security Act on
September 20, 2019.
2. 	The claimant did not engage in substantial
gainful activity during the period from her
alleged onset 	date of September 15, 2015
through her date last insured of September
30, 2019 (20 CFR 404.1571 et seq.).
3. 	Through the date last insured, the claimant
had 	the 	following 	severe 	impairments:
disorders of the skeletal spine; hernias; small
fiber sensory neuropathy; complex regional
pain 	syndrome; 	depressive, 	bipolar, 	and
related 	disorders; 	attention-
deficit/hyperactivity 	disorder 	(ADHD); 	and
trauma 	and 	stressor-related 	disorders 	(20
CFR 404.152(c)).
4. 	Through he date last insured, the claimant
did not have an impairment or combination of
impairments that met or medically equaled
the severity of one of the listed impairments
in 20 CFR Part 404, Subpart P, Appendix 1
(20 CFR 404.1520(d), 404.1525 and 404.1526).
5. 	After 	careful 	consideration 	of 	the 	entire
record, I find that, 	through the date last
insured, 	the 	claimant 	had 	the 	residual
functional capacity to perform light work as
defined in 20 CFR 404.1567(b) but with the
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following 	additional 	limitations. 	She 	could
frequently climb rams and stairs, occasionally
climb ladders, ropes, and scaffolds, frequently
stoop, 	kneel, 	and 	couch, 	and 	occasionally
crawl. She was limited to performing simple
and routine tasks with occasional interactions
with supervisors, coworkers, and the public,
and she was limited to occasional routine
workplace changes.
6. 	Through the date last insured, the claimant
was unable to perform any past relevant work
(20 CFR 404.1565).
7. 	The claimant was born February 20, 1973
(Ex. 	2D) 	and was 	46 	years 	old, 	which 	is
defined as a younger individual age 18–49, on
the date last insured (20 CFR 404.1563).
8. 	The 	claimant 	has 	at 	least 	a 	high 	school
education (Ex. 2E) (20 CFR 404.1564).
9. 	Transferability of job skills is not material to
the determination of disability because using
the Medical-Vocational Rules as a framework
supports a finding that the claimant is “not
disabled,” whether or not the claimant has
transferable job skills (See SSR 82-41 and 20
CFR Par 404, Subpart P, Appendix 2).
10. 	Through the date last insured, considering
the 	claimant’s 	age, 	education, 	work
experience, and residual functional capacity,
there were jobs that existed in significant
numbers in the national economy that the
claimant 	could 	have 	performed 	(20 	CFR
404.1569 and 404.1569a).
11. 	The clamant was not under a disability, as
defined in the Social Security Act, at any time
from September 15, 2015, the alleged onset
date, through September 30, 2019, the date
last insured (20 CFR 414.1520(g)).
See Tr. 7–26.
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Standard for Disability
Eligibility for social security benefit payments depends on the existence
of a disability. 42 U.S.C. §§ 423(a), 1382(a). “Disability” is defined as the
“inability to engage in any substantial gainful activity by reason of any
medically determinable physical or mental impairment which can be expected
to result in death or which has lasted or can be expected to last for a continuous
period of not less than 12 months[.]” 42 U.S.C. § 423(d)(1)(A); see also 42 U.S.C.
§ 1382c(a)(3)(A).
An ALJ is required to follow a five-step sequential analysis to make a
disability determination:
1. 	Is the claimant engaged in substantial gainful
activity? If so, the claimant is not disabled.
2. 	Does 	the 	claimant 	have 	a 	medically
determinable impairment, or a combination of
impairments, 	that 	is 	“severe”? 	If 	not, 	the
claimant is not disabled.
3. 	Does the claimant’s impairment meet or equal
one of the listed impairments and meet the
duration requirement? If so, the claimant is
disabled. If not, the ALJ proceeds to the next
step.
4. 	What is the claimant’s residual functional
capacity and can the claimant perform past
relevant 	work? 	If 	so, 	the 	claimant 	is 	not
disabled. If not, the ALJ proceeds to the next
step.
5. 	Can 	the 	claimant 	do 	any 	other 	work
considering the claimant’s residual functional
capacity, 	age, 	education, 	and 	work
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experience? If so, the claimant is not disabled.
If not, the claimant is disabled.
20 C.F.R. §§ 404.1520, 416.920; see Jordan v. Comm’r of Soc. Sec., 548 F.3d
417, 422 (6th Cir. 2008). Under this sequential analysis, the claimant has the
burden of proof at steps one through four. Jordan, 548 F.3d at 423. The burden
shifts to the Commissioner at step five “to prove the availability of jobs in the
national economy that the claimant is capable of performing.” Id. “The
claimant, however, retains the burden of proving her lack of residual functional
capacity.” Id. If a claimant satisfies each element of the analysis and meets the
duration requirements, the claimant is determined to be disabled. Walters
Comm’r of Soc. Sec., 127 F.3d 525, 529 (6th Cir. 1997).
Standard of Review
A reviewing court must affirm the Commissioner’s conclusions unless it
determines “that the ALJ has failed to apply the correct legal standards or has
made findings of fact unsupported by substantial evidence in the record.”
Jordan, 548 F.3d at 422. “‘[S]ubstantial evidence’ is a ‘term of art’” under which
“a court … asks whether” the “existing administrative record … contains
‘sufficien[t] evidence’ to support the agency’s factual determinations.” Biestek
v. Berryhill, 587 U.S. 97, 102 (2019) (citations omitted). The substantial
evidence standard “is not high.” Id. Substantial evidence “is ‘more than a mere
scintilla’” but it “means only[] ‘such relevant evidence as a reasonable mind
might accept as adequate to support a conclusion.’” Id. at 103 (citations
omitted). The Commissioner’s “findings … as to any fact if supported by
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substantial evidence [are] conclusive.” 42 U.S.C. § 405(g); Biestek, 587 U.S. at
99.
A court may “not try the case de novo, resolve conflicts in evidence, or
decide questions of credibility.” Bass v. McMahon, 499 F.3d 506, 509 (6th Cir.
2007). Even if substantial evidence or a preponderance of the evidence
supports 	a 	claimant’s 	position, 	a 	reviewing 	court 	cannot 	overturn 	the
Commissioner’s decision “so long as substantial evidence also supports the
conclusion reached by the ALJ.” Jones v. Comm’r of Soc. Sec., 336 F.3d 469,
477 (6th Cir. 2003). This is so because there is a “zone of choice within which”
the Commissioner can act, without fear of judicial “interference.” Lindsley v.
Comm’r of Soc. Sec., 560 F.3d 601, 605 (6th Cir. 2009) (quoting Felisky v.
Bowen, 35 F.3d 1027, 1035 (6th Cir. 1994)).
Discussion
Thorman’s first issue
Thorman’s first argument is that the ALJ failed to properly consider the
impairment of CPRS under Social Security Ruling 03-2p, 2003 WL 22399117
(SSA Oct. 20, 2003), which explains how that condition should be evaluated.
See Doc. 8, at 23. At the outset, Thorman’s assertion the ALJ should have “at
least [made] a passing reference” to Ruling 03-2p, and that her failure to do so
was an error, see id., is unfounded. Thorman cites no authority requiring the
ALJ to specifically cite that ruling when performing analysis under it. So
things are not off to a strong start. Thorman’s remaining arguments, discussed
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next, allege various instances in which she believes the ALJ improperly applied
Ruling 03-2p. For the reasons stated, those arguments are also meritless.
Under Ruling 03-2p, “because a finding that [CRPS] is a medically
determinable impairment requires the presence of chronic pain and one or
more clinically documented signs in the affected region, the adjudicator can
reliably find that pain is an expected symptom in this disorder.” 2003 WL
22399117, 	at 	*6. 	“Other 	symptoms, 	including 	such 	things 	as 	extreme
sensitivity to touch or pressure, or abnormal sensations of heat or cold, can also
be associated with this disorder.” Id. Once CRPS is established as a medically
determinable impairment, the ALJ “must evaluate the intensity, persistence,
and limiting effects of the individual's symptoms to determine the extent to
which the symptoms limit the individual's ability to do basic work activities.”
Id. at *6. Additionally, “whenever the individual's statements about the
intensity, 	persistence, 	or 	functionally 	limiting 	effects 	of 	pain 	or 	other
symptoms are not substantiated by objective medical evidence,” the ALJ is
directed to make a credibility finding by looking to the entirety of the record,
including:
medical 	signs 	and 	laboratory 	findings, 	the
individual's own statements about the symptoms,
any statements and other information provided by
treating or examining physicians or psychologists
and other persons about the symptoms and how they
affect 	the 	individual, 	and 	any 	other 	relevant
evidence in the case record.
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Id. at *6. The Ruling provides that in crafting an RFC, “all of the individual’s
symptoms must be considered in deciding how such symptoms may affect
functional capacities. Careful consideration must be given to the effects of pain
and its treatment on an individual's capacity to do sustained work-related
physical and mental activities in a work setting on a regular and continuing
basis.” Id. at *7.
In support of her argument that the ALJ failed to properly apply Ruling
03-2p, Thorman highlights certain evidence that she feels the ALJ either
improperly emphasized or ignored. For example, Thorman takes issue with the
ALJ’s discussion of her normal gait and strength and asserts her unsupported
opinion that CRPS “causes pain, not loss of strength.” Doc. 8, at 25. She further
argues that the ALJ emphasized exam findings of “normal gait and strength”
and claims that these findings “tell us nothing about the extent to which pain
interferes with [Thorman’s] activities.” Id. She also claims that the ALJ’s
discussion of Thorman’s ability to engage in activities of daily living “pick[ed]
out certain facts but ignor[ed] [her] testimony[.]” Id. Thorman then asserts that
the “ALJ’s emphasis on [her] running and exercising as being a reason to doubt
the severity of symptoms is misleading” and provides an alternative selection
of instances from the record in which she described, either to her medical
providers or during testimony, difficulty with certain forms of exercise. Id.
Thorman additionally states that the fact she exercised amounts to a “heads I
win, tails you 	lose” 	situation because exercise 	is 	part of the treatment
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recognized for CRPS. Id. at 25–26. Lastly, Thorman avers that the ALJ’s
summary of her daily activities did not address her ability to sustain those
activities. Id. at 27–28.
For starters, Thorman cites nothing to support the idea that the ALJ’s
consideration of this variety of evidence shows that she failed to comply with
Ruling 03-2p. She also does not point to any aspect of Ruling 03-2p that the
ALJ improperly applied. Instead, Thorman appears to dispute the weight the
ALJ placed on certain evidence and urges the Court to consider anew specific
evidence that she views as supporting a different outcome. See Doc. 8, at 25
(claiming that the ALJ’s identification of her normal gait and strength was a
“straw man” and asserting that the ALJ’s statements regarding Thorman’s
capacity to exercise “as being a reason to doubt the severity of her symptoms
is misleading” while pointing to medical records indicating periods of time
when she was unable to run). Thorman’s argument demonstrates that she
simply disagrees with the ALJ’s evaluation of the evidence. Such disagreement
does not support remand because weighing the record evidence is precisely
what the ALJ is tasked to do. See 20 C.F.R. § 404.1520c(a) (explaining how the
ALJ will consider and weigh medical opinions and prior administrative
medical findings); see also Rottman v. Comm’r of Soc. Sec., 817 F. App’x 192,
196 (6th Cir. 2020 (“[T]his court does not weigh evidence, assess credibility, or
resolve conflicts in 	testimony—that’s the ALJ’s job.”) (citation omitted)).
Relatedly, Thorman’s point that exercise was part of her treatment plan is
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confusing. See Doc. 8, at 26. Nothing in the ALJ’s decision contradicts the idea
that Thorman engaged in physical activity, at least in part, as a treatment for
her pain. In fact, the ALJ recognized that medical providers instructed
Thorman to pursue physical therapy and discussed exercise with her. See e.g.,
Tr. 17–22.
Additionally, 	to 	extent 	that 	Thorman 	says 	that 	the 	ALJ 	ignored
evidence, when evaluating her CRPS or otherwise, there is a difference
between not citing something and ignoring or failing to consider something.
See Kornecky v. Comm’r of Soc. Sec., 167 F. App’x 496, 508 (6th Cir. 2006) (“[a]n
ALJ can consider all the evidence without directly addressing in his written
decision every piece of evidence submitted by a party”) (quoting Loral Defense
Systems–Akron v. NLRB, 200 F.3d 436, 453 (6th Cir. 1999)). Thorman has not
shown that the ALJ failed to consider all of the evidence. The ALJ stated that
she “consider[ed] the entire record.” Tr. 15. Absent evidence to the contrary,
the Court will presume that this statement is true. See NLRB v. Newark Elec.
Corp., 14 F.4th 152, 163 (2d Cir. 2021); see also United States v. Chemical
Found., Inc., 272 U.S. 1, 14–15 (1926) (“The presumption of regularity supports
the official acts of public officers, and, in the absence of clear evidence to the
contrary, courts presume that they have properly discharged their official
duties.”); cf. Higgs v. Bowen, 880 F.2d 860, 864 (6th Cir. 1988) (noting that the
Appeals Council “state[d] that it ‘considered the entire record which was before
the administrative law judge, including the testimony at the hearing’”).
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Moreover, not mentioning a specific document or documents, particularly in an
over 3400-page record, is not error. See Thacker v. Comm’r of Soc. Sec., 99 F.
App’x 661, 665 (6th Cir. 2004) (“An ALJ need not discuss every piece of
evidence in the record for his decision to stand.”); Byler v. Kijakazi, No. 5:20-
cv-1822, 2022 WL 980099, at *9 (N.D. Ohio Jan. 21, 2022) (“with a nearly one-
thousand page record, the ALJ cannot be expected to discuss every piece of
evidence that Plaintiff believes is inconsistent with the RFC”), report and
recommendation adopted, 2022 WL 971384 (N.D. Ohio Mar. 31, 2022).
The record further belies Thorman’s claims that the ALJ ignored the
specific evidence that Thorman says was ignored. For example, Thorman
claims that the ALJ “ignore[d] large portions of [her] testimony as to her daily
activities.” Doc. 8, at 27. The ALJ didn’t ignore Thorman’s testimony. And
nothing Thorman cites shows that the ALJ failed to consider her ability to
sustain certain activities. In fact, the ALJ cited some of the evidence as to
sustainability that Thorman highlights in her briefing. Compare Doc. 8, at 27
(citing the hearing transcript and summarizing that Thorman would “make
dinner, she said, only about two times week, not daily” and “do one load of
laundry on two days out of the week”), with Tr. 16 (summarizing Thorman’s
testimony that she would “make dinner twice a week, do a load of laundry twice
a week”). So Thorman’s blanket assertion that the ALJ failed to consider her
testimony regarding sustainability of activities is belied by the ALJ’s decision.
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Likewise, the ALJ discussed Thorman’s testimony regarding her pain.
For example, the ALJ summarized that Thorman testified:
[S]he had severe pain after fracturing her spine, and
this pain worsened over time. She tried treatment
with a chiropractor, acupuncture, physical therapy,
and exercising. She stopped working due to her
symptoms in 2015, and she has not been able to work
since them. Pain caused her to become depressed
and be unable to care for herself like she used to.
Pain caused Pain caused her to become depressed
and be unable to care for herself the way she used
to. She did aquatic therapy, walked on the treadmill,
used 	the 	elliptical, 	and 	did 	core 	exercises 	to
strengthen her core. She also did Tai Chi to help
with pain. Exercising helped her more than pain
medication, and she tried to exercise for 20 minutes
a day. She had spine injections, attended physical
therapy, and saw a personal trainer. She did not get
relief 	from 	acupuncture 	or 	injections, 	and
chiropractic treatment helped her symptoms.
Tr. 16. The ALJ also detailed the pain Thorman described to her medical
providers, along with what those providers did to treat Thorman’s pain, when
the ALJ summarized the medical evidence. Id. at 17–21. After a detailed
summary of the medical evidence, the ALJ ultimately found that Thorman
“reported significant improvement in her pain treatment over the course of the
relevant period, including improvement of her pain with medications to a level
[Thorman] described as manageable … with continued improvement in her
daily activities and sleep.” Tr. 22. The ALJ continued: “[Thorman] engaged in
a range of activities of daily living over the course of the relevant period that
do not support allegations of disabling symptoms and limitations.” Id. (citing
Thorman’s reports and medical evidence showing that during the disability
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period Thorman made jewelry, worked out, drove to and from Washington, DC,
exercised regularly, and began weaning off certain pain medications).
Thorman simultaneously claims that the ALJ ignored evidence while
asserting that the myriad of evidence the ALJ did cite was “improperly
emphasized.” Doc. 8, at 25. But Thorman’s dispute over the ALJ’s “emphasis”
is irrelevant to this Court’s evaluation. As explained, it is the ALJ, not
Thorman or this Court, who is responsible for weighing the evidence. See 20
C.F.R. § 404.1520c(a). And Thorman’s citation to additional evidence that she
believes supports a different outcome does not demonstrate that the ALJ’s
decision is not supported by substantial evidence. See e.g., Key v. Callahan, 109
F.3d 270, 273 (6th Cir. 1997) (“The decision of an ALJ is not subject to reversal,
even if there is substantial evidence in the record that would have supported
an opposite conclusion, so long as substantial evidence supports the conclusion
reached by the ALJ.”). Thorman’s citation to other evidence is irrelevant unless
she shows that substantial does not support the ALJ’s decision. See Warner v.
Comm’r of Soc. Sec., 375 F.3d 387, 390 (6th Cir. 2004). At no point in her
argument does Thorman argue that the ALJ’s decision was not supported by
substantial evidence. Instead, she asserts for the first time in her conclusion
section that “[s]ubstantial evidence does not support the ALJ’s decision that
[she] is not disabled[]” and that “the ALJ’s denial of disability is premised upon
legal error and is unsupported by substantial evidence.” Doc. 8, at 30. This
conclusory statement—which appears for the first time in her conclusion—
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does not properly present any argument. McPherson, 125 F.3d at 995–96
(“[I]ssues adverted to in a perfunctory manner, unaccompanied by some effort
at developed argumentation, are deemed waived. It is not sufficient for a party
to mention a possible argument in the most skeletal way, leaving the court to
... put flesh on its bones.”).
Since Thorman’s argument solely contests how the ALJ weighed the
evidence, 	rather 	than 	attempting 	to 	show 	that 	the 	ALJ’s 	decision 	was
unsupported by substantial evidence, she has not shown that remand is
appropriate.
Thorman’s second issue
In her second issue, Thorman argues that the ALJ failed to evaluate her
symptoms of pain as required by Social Security Ruling 16-3p.
Under Ruling 16-3p, to evaluate the “intensity, persistence, and limiting
effects of an individual’s symptoms,” the ALJ must consider medical evidence,
the claimant’s statements, other information provided by medical sources, and
any other relevant evidence in the record. See Soc. Sec. Ruling 16-3p, 2017 WL
5180304, at *4 (Oct. 25, 2017); 20 C.F.R. § 404.1529. Other relevant evidence
includes: daily activities; the location, duration, frequency, and intensity of
pain or symptoms; precipitating and aggravating factors; the type, dosage,
effectiveness, 	and 	side 	effects 	of 	any 	medication; 	treatment, 	other 	than
medication, to relieve pain; any measures used to relieve pain; and “[o]ther
factors concerning … functional limitations and restrictions due to pain or
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other symptoms.” 20 C.F.R. § 404.1529(c). “The ALJ need not analyze all seven
factors, but should show that he considered the relevant evidence.” Hatcher v.
Berryhill, No. 1:18-cv-1123, 2019 WL 1382288, at *15 (N.D. Ohio Mar. 27,
2019) (citing Cross v. Comm’r of Soc. Sec., 373 F. Supp. 2d 724, 733 (N.D. Ohio
2005)).
The ALJ identified Thorman’s medically determinable impairments, Tr.
16, and she then discussed Thorman’s symptoms as described in Thorman’s
testimony and as recorded by her medical providers. See Tr. 16–21. Ultimately,
the ALJ concluded that Thorman’s medically determinable impairments could
be expected to cause the alleged symptoms but the “statements concerning the
intensity, persistence and limiting effects of these symptoms are not entirely
consistent with the medical evidence and other evidence in the record for the
reasons explained in the record.” Tr. 22.
In her argument, Thorman points to specific portions of the record that
she believes show that the ALJ failed to apply Ruling 16-3p. She then makes
the conclusory statement that the ALJ “simply fails to do the proper analysis;
SSR 16-3p is never mentioned and no pain analysis appears in the decision.”
Doc. 8, at 29–30. As with her first issue, Thorman fails to cite any authority
that required the ALJ to specifically cite Ruling 16-3p. But, more importantly,
her statement is inaccurate. The ALJ cited Ruling 16-3p. Tr. 15. Moreover, the
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ALJ did conduct a pain analysis.6 The ALJ described the two-step approach
imposed by Ruling 16-3p. Tr. 15. The ALJ then applied those two-steps. See Tr.
16 (identifying the impairments that limited Thorman before discussing the
subjective and objective record evidence); Tr. 22 (explaining that, as required
by step one, Thorman’s “medically determinable impairments could reasonably
be expected to cause the alleged symptoms” and then, as to step two, Thorman’s
“statements concerning the intensity, persistence and limiting effects of these
symptoms are not entirely consistent with the medical evidence and other
evidence in the record”). So the ALJ cited and applied the pain analysis
required by Ruling 16-3p and Thorman’s second argument provides no basis
for remand.
Conclusion
For 	the 	reasons 	explained 	above, 	the 	Commissioner’s 	decision 	is
affirmed.
IT IS SO ORDERED.
Dated: November 19, 2025 	/s/ James E. Grimes Jr.
James E. Grimes Jr.
U.S. Magistrate Judge
6 	Thorman uses the phrase “pain analysis” but does not explain what she
expected that to include. Since this argument pertains to Ruling 16-3p, the
Court interprets this statement to mean the two-step inquiry outlined in that
ruling.
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