Barber v. Commissioner of Social Security

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IN THE UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF OHIO
EASTERN DIVISION
RACHEL A. BARBER,
Plaintiff,
v.
COMMISSIONER OF SOCIAL SECURITY,
Defendant.
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CASE NO. 1:25-CV-02731-MJH
MICHAEL J. HENDERSHOT
UNITED STATES DISTRICT JUDGE
MAGISTRATE JUDGE
JENNIFER DOWDELL
ARMSTRONG
REPORT AND RECOMMENDATION
I. 	INTRODUCTION
Plaintiff Rachel A. Barber (“Ms. Barber”) seeks judicial review of the final decision
of the Commissioner of Social Security denying her application for Supplemental Security
Income (“SSI”). This matter is before me pursuant to 42 U.S.C. §§ 405(g), 1383(c)(3), and
Local Rule 72.2. (See ECF non-document entry dated December 16, 2025). For the reasons
set forth below, I RECOMMEND that the Court REVERSE the Commissioner’s decision and
REMAND this matter to the Commissioner for further proceedings consistent with this report
and recommendation.
II. 	PROCEDURAL HISTORY
On October 16, 2023, Ms. Barber filed her application for SSI. (Tr. 199). Ms. Barber’s
application related to her migraines, anxiety with depression, panic attacks, skin lesions and
rashes, primary osteoarthritis of both knees, numbness of the right foot, gallbladder disease,
hyperlipidemia, chronic insomnia, and abnormal spinal MRI. (Tr. 222).
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The Social Security Administration (“SSA”) denied Ms. Barber’s application initially
and 	upon 	reconsideration. 	(Tr. 	67, 	79). 	Ms. 	Barber 	requested 	a 	hearing 	before 	an
administrative law judge (“ALJ”). (Tr. 104). The ALJ held a hearing on December 16, 2024.
(Tr. 34). Ms. Barber testified, as did an independent vocational expert (“VE”). On December
18, 2024, the ALJ issued a written decision finding that Ms. Barber is not disabled. (Tr. 7).
The ALJ’s decision became final on October 17, 2025, when the Appeals Council declined
further review. (Tr. 1).
On 	December 	16, 	2025, 	Ms. 	Barber 	filed 	her 	Complaint, 	challenging 	the
Commissioner’s final decision that she was not disabled. (ECF No. 1). Ms. Barber asserts the
following assignments of error:
(1) 	The ALJ erroneously classified Ms. Barber’s migraines as a not severe [sic] at
step two of the sequential evaluation process – resulting in an inaccurate residual
functional capacity.
(2) 	The ALJ failed to adequately account for all of the limitations properly
documented in the record.
(ECF No. 7, PageID # 767).
III. 	BACKGROUND
A. 	Personal, Educational, and Vocational Experience
Ms. Barber was born in 1980 and was 43 years old on the date of her application. (Tr.
199). She has a high school diploma. (Tr. 223). Ms. Barber has never married. (Tr. 200). She
previously worked as a preschool teacher. (Tr. 223).
B. 	Relevant Hearing Testimony
1. 	Ms. Barber’s Testimony
Ms. Barber testified that she has difficulty walking and sitting because of swelling in
her legs. (Tr. 43). She also testified that she has arthritis in one knee and needs a knee
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replacement in the other, and that she needs to keep her legs elevated as a result. Id. Ms.
Barber further testified that she elevates her legs above her waist for an average of four to
five hours per day. (Tr. 47-48). She testified that the pain in her knees is constant and that she
also receives shots in her back due to back pain, which radiates through her legs to her feet.
(Tr. 48). Ms. Barber also testified that she experiences numbness in her feet, which makes it
difficult for her to wear shoes and causes her to walk with a cane. Id. She testified that she
can only walk 15 to 20 steps before she needs a break and that she can sit for 10 to 15 minutes
before she needs to change positions. (Tr. 52).
Ms. Barber also testified that she gets migraines three to four times per month. (Tr.
49). She testified that her migraines typically last two to three days, and that she stays in her
room when she gets one. Id. She also testified that her migraines give her problems with light,
noise, sounds, and smells, and that she also experiences nausea. Id.
2. 	Vocational Expert’s Testimony
The ALJ asked the VE to consider a hypothetical individual with Ms. Barber’s age,
education, and prior work experience who was able to perform light work but could never
climb ladders, ropes, or scaffolds; occasionally climb ramps or stairs; occasionally kneel or
crawl; could never be exposed to hazards; and could handle only occasional changes in the
work setting. (Tr. 44). The VE testified that the hypothetical individual could perform jobs
existing in significant numbers in the national economy, including work as a routing clerk,
cashier, or sales attendant. (Tr. 44-45).
In response to a question from Ms. Barber’s counsel, the VE testified that it would be
work preclusive if the hypothetical individual needed to elevate their legs for between four
and five hours per day. (Tr. 52-53). The VE also testified that it would be work preclusive if
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the individual required the use of a cane for standing or walking. (Tr. 54).
C. 	Relevant Opinion Evidence1
1. 	State Agency Medical Consultants
On December 27, 2023, W. Scott Bolz, M.D., a state agency medical consultant,
opined that Ms. Barber could never climb ladders, ropes, or scaffolds in light of her obesity,
chronic low back pain, and osteoarthritis of her left knee, but that she did not otherwise have
postural limitations. (Tr. 75). Dr. Bolz further opined that Ms. Barber should avoid all
hazards, machinery, unprotected heights, and commercial driving. (Tr. 76). Dr. Bolz also
noted that the medical evidence reflected that Ms. Barber had a diagnosis of migraines. (Tr.
74). On March 9, 2024, Elizabeth Das, M.D., partially concurred with Dr. Bolz’s findings on
reconsideration, but added additional postural limitations, opining that Ms. Barber could only
occasionally climb ramps or stairs, kneel, or crawl. (Tr. 84-86).
The ALJ found that the opinions of the state agency medical consultants were
persuasive, but that Dr. Das’ additional postural limitations were more persuasive. (Tr. 19).
D. 	Relevant Medical Evidence
Ms. Barber received injections for knee pain throughout the relevant period. On
October 18, 2022, she received an injection in her right knee. (Tr. 409). It was noted that she
was in no acute distress and that examination of her right knee showed no swelling, erythema,
effusion, warmth, or deformity. (Tr. 409-10). She did not display any ligament laxity and had
intact strength and sensation to light touch. (Tr. 410).
On November 11, 2022, Ms. Barber received another injection in her right knee to
1 At the administrative level, Ms. Barber alleged both physical and mental impairments. In this proceeding, she
challenges only the ALJ’s determination with respect to her migraines and alleged need to elevate her legs.
Accordingly, I summarize only evidence regarding those issues.
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treat osteoarthritis of her right patellofemoral joint. (Tr. 397). On February 17, 2023, Ms.
Barber received an injection in her left knee to treat osteoarthritis. (Tr. 372). Ms. Barber
received another injection in her left knee on August 18, 2023. (Tr. 321). She also received
bilateral knee injections on March 29, 2024 and June 25, 2024. (Tr. 645, 711). On July 22,
2024, Ms. Barber reported that a July 2, 2024 injection in her left knee had provided her with
little benefit and that she was informed she would eventually need a knee replacement. (Tr.
692). Ms. Barber received another set of injections on October 1, 2024, and treatment notes
indicate that she was to receive weekly injections. (Tr. 683).
On February 14, 2023, Ms. Barber saw her primary care provider for weight
management. (Tr. 379). She reported that she was using an elliptical machine and a bicycle
daily and that she was not having leg swelling. (Tr. 379-80).
On February 15, 2023, Ms. Barber had a follow-up visit with the Cleveland Clinic
Neurologic Institute Headache and Facial Pain Section for further evaluation of her
headaches. (Tr. 374). Aarushi Suneji, M.D. noted that Ms. Barber had a diagnosis of chronic
migraine and that she had prescriptions for several medications. Id. Ms. Barber reported that
she continued to have two or three headaches per month and inquired about rescue therapy.
(Tr. 375). In a headache questionnaire that she completed prior to her visit, Ms. Barber stated
that she experienced headaches with decreased productivity, light sensitivity, and nausea on
five days in the past month. (Tr. 377). Dr. Suneja stated that Ms. Barber met AHS criteria for
treatment of migraines with an oral small molecule CGRP antagonist because she had more
than five headaches per month lasting for four or more hours per day and accompanied by
photophobia, phonophobia, and nausea. Id. Dr. Suneja also stated that medication overuse
headaches had been ruled out and that Ms. Barber had tried and failed anti-migraine
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medications. Id. Dr. Suneja noted that Ms. Barber was stable and was doing well on her
current regimen. (Tr. 376). She was started on Ubrelvy for acute rescue therapy. Id.
On July 28, 2023, Ms. Barber saw a podiatrist, complaining of pain and numbness
in her left foot. (Tr. 338). She rated the pain as a seven out of ten and said that she used a
pillow for comfort and support. Id. On examination, she had intact light touch sensation but
decreased vibratory sensation. (Tr. 341). She was diagnosed with neuropathy, instructed on
supportive shoes and orthotics, and referred to neurology. (Tr. 341).
On August 7, 2023, Ms. Barber had a virtual visit with her primary care provider. (Tr.
501). Her provider noted that Ms. Barber was taking Topamax for migraines. (Tr. 502). She
denied leg swelling, but reported leg and foot discomfort at night. (Tr. 503).
Ms. Barber had a pain management appointment on August 10, 2023. (Tr. 324). She
reported experiencing pain in her left leg for several months, which she rated as a seven out
of ten. Id. She also reported back pain that radiated to her legs, as well as numbness in her
feet. (Tr. 326). On examination, she displayed a normal gait, grossly normal motor strength,
and no deformities, edema, or skin discoloration. (Tr. 327). She was encouraged to lose
weight and instructed to take Topamax, which she had not been taking as prescribed. (Tr.
329).
On September 8, 2023, Ms. Barber presented to the Cleveland Clinic Neuromuscular
Center for a virtual evaluation. (Tr. 315). She reported numbness in her feet and left leg. Id.
On examination, she was able to move her legs symmetrically, and it was noted that the cause
of her symptoms was difficult to determine based on the clinical description and a virtual
visit. (Tr. 316).
Ms. Barber underwent an annual physical on October 19, 2023. (Tr. 477). She was
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negative for arthralgias, gait problems, joint swelling, and myalgias. Id. Ms. Barber had
another virtual visit with her primary care provider on January 12, 2024. (Tr. 575). She
reported that she had been doing well since her prior visit. Id. She said that knee injections
had given her good relief over the previous four months, but that the pain worsened with cold.
Id.
On March 18, 2024, Ms. Barber had a follow-up visit regarding her chronic pain. (Tr.
639). She reported that knee injections had previously benefited her. (Tr. 641). She also
reported ongoing back pain. Id. On examination, Ms. Barber displayed a limited range of
motion in her back in all directions, valgus deformity of both knees, and an antalgic gait. (Tr.
642). At an April 12, 2024 weight management visit, Ms. Barber reported myalgias but denied
leg swelling. (Tr. 633).
Ms. Barber went to the Cleveland Clinic Neuromuscular Center on May 17, 2024. (Tr.
716). She reported difficulty wearing shoes. Id. An examination showed decreased pinprick
sensation in her left foot and proprioception that required full excursion of the left toe. (Tr.
717). Her treating physician noted that the examination was suggestive of possible
lumbosacral spine causes. Id. It was noted that an EMG was largely unrevealing and that an
MRI of her lumbosacral spine would be ordered. (Tr. 717-18).
On July 2, 2024, Ms. Barber had an x-ray of her left knee, which showed no acute
findings and no progression of her moderate to marked left knee osteoarthritis. (Tr. 733). On
July 5, 2024, Ms. Barber had an MRI of her lumbar spine. (Tr. 694).The MRI revealed
moderate spinal canal stenosis at L2-3 and grade 1 anterolisthesis of L5 on S1 with moderate
right-sided neural foraminal stenosis. Id. On July 22, 2024, it was noted that she may benefit
from an epidural steroid injection to treat her back pain. (Tr. 695-96).
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Ms. Barber had a follow-up visit with her primary care provider on July 11, 2024. (Tr.
703). Her provider recommended that she continue receiving knee injections and discussed
the pros and cons of surgery. (Tr. 705). She was given a referral for physical therapy. Id. It
was noted that she had discontinued gabapentin and began taking topiramate. Id.
Ms. Barber had a virtual visit with Dr. Suneja at the Cleveland Clinic Neurologic
Institute on October 17, 2024. (Tr. 674). She reported that her symptoms were stable and that
Ubrelvy was effective as a rescue medication, but that her insurance had stopped covering
her Ajovy injections. Id. She also reported that she was having more than 15 migraines per
month since she stopped receiving those injections. Id. Dr. Suneja again noted a diagnosis of
chronic migraines and stated that next steps included Botox injections and Qulipta. (Tr. 676).
Dr. Suneja further stated:
We will request precertification for Calcitonin Gene Related Peptide
Monoclonal Antibody, Fremanezumab. This patient meets ICHD-3
criteria for treatment with CGRP MAB, She has Chronic Migraine
Headache (CM), Chronic Migraine without aura, without mention
of intractable migraine without mention of status migrainosus which
occurs at least 15 days per month for at least 4 hours per day. The
FDA has approved CGRP MAB for prevention of migraine.
Specifically, the patient has 15 migraines per month, lasting 4 or
more hours/d associated with photophobia, phonophobia, nausea for
three or more months. Medication overuse headache has been ruled
out. Patient is currently taking a Gepant (Ubrelvy) for acute
treatment of her migraine.
(Tr. 676). In addition, Dr. Suneja stated that Ms. Barber had tried several preventative
medications for three or more months that did not provide benefits or that were discontinued
due to side effects, including gabapentin, topiramate, Lexapro, propranolol, verapamil,
rizatriptan, and sumatriptan. (Tr. 676-77).
At a virtual weight management visit on November 15, 2024, Ms. Barber was positive
for leg swelling and myalgias. (Tr. 668).
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IV. 	THE ALJ’S DECISION
The ALJ first determined that Ms. Barber had not engaged in substantial gainful
activity since September 21, 2023, the date of her application. (Tr. 11). The ALJ next
determined that Ms. Barber had the following severe impairments: extreme obesity,
depression, and anxiety. Id. The ALJ also determined, however, that none of Ms. Barber’s
impairments, whether considered singly or in combination, met or medically equaled the
severity of one of the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1. (Tr.
14).
The ALJ further determined that Ms. Barber had the residual functional capacity
(“RFC”) to:
perform light work as defined in 20 CFR 416.967(b), but can never
climb ladders, ropes, or scaffolds; only occasionally climb ramps or
stairs, kneel, or crawl; with no exposure to hazards; and only
occasional changes in the work setting.
(Tr. 16).
The ALJ next determined that Ms. Barber had no past relevant work. (Tr. 21).
However, 	the 	ALJ 	determined 	that, 	considering 	Ms. 	Barber’s 	age, 	education, 	work
experience, and RFC, there were jobs that existed in significant numbers in the national
economy that Ms. Barber could perform, including work as a routing clerk, cashier, or sales
attendant. Id. Accordingly, the ALJ determined that Ms. Barber was not disabled. (Tr. 22).
V. 	LAW & ANALYSIS
A. 	Standard of Review
“After the Appeals Council reviews the ALJ’s decision, the determination of the
council becomes the final decision of the Secretary and is subject to review by this Court.” Olive
v. Comm’r of Soc. Sec., No. 3:06 CV 1597, 2007 WL 5403416, at *2 (N.D. Ohio Sept. 19, 2007)
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(citing Abbott v. Sullivan, 905 F.2d 918, 922 (6th Cir. 1990); Mullen v. Bowen, 800 F.2d 535,
538 (6th Cir. 1986) (en banc)). The Court’s review “is limited to determining whether the
Commissioner’s decision is supported by substantial evidence and was made pursuant to
proper legal standards.” Winn v. Comm’r of Soc. Sec., 615 Fed. Appx. 315, 320 (6th Cir.
2015) (quoting Cole v. Astrue, 661 F.3d 931, 937 (6th Cir. 2011)); see also 42 U.S.C. §
405(g).
“Under the substantial evidence standard, a court looks to an existing administrative
record and asks whether it contains sufficien[t] evidence to support the agency’s factual
determinations.” Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019) (quotation omitted). The
standard for “substantial evidence” is “not high.” Id. While it requires “more than a mere
scintilla,” “[i]t means—and means only—such relevant evidence as a reasonable mind might
accept as adequate to support a conclusion.” Id. (quotation omitted).
In addition to considering whether substantial evidence supports the Commissioner’s
decision, the Court must determine whether the Commissioner applied proper legal standards.
Failure of the Commissioner to apply the correct legal standards as promulgated by the
regulations is grounds for reversal. See, e.g., White v. Comm’r of Soc. Sec., 572 F.3d 272, 281
(6th Cir. 2009); Bowen v. Comm’r of Soc. Sec., 478 F.3d 742, 746 (6th Cir. 2006) (“Even if
supported by substantial evidence, however, 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.”).
Finally, a district court cannot uphold an ALJ’s decision, even if there “is enough
evidence in the record to support the decision, [where] the reasons given by the trier of fact
do not build an accurate and logical bridge between the evidence and the result.” Fleischer v.
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Astrue, 774 F. Supp. 2d 875, 877 (N.D. Ohio 2011) (quoting Sarchet v. Chater, 78 F.3d 305,
307 (7th Cir. 1996)) (alteration in original).
B. 	Standard for Disability
Consideration of disability claims follows a five-step review process. 20 C.F.R. §
416.920. First, the claimant must demonstrate that she is not currently engaged in “substantial
gainful activity” at the time of the disability application. 20 C.F.R. § 416.920(b). Second, the
claimant must show that she suffers from a “severe impairment” in order to warrant a finding
of disability. 20 C.F.R. § 416.920(c). A “severe impairment” is one that “significantly limits
. . . physical or mental ability to do basic work activities.” Abbott v. Sullivan, 905 F.2d 918,
923 (6th Cir. 1990).
Third, if the claimant is not performing substantial gainful activity, has a severe
impairment that is expected to last for at least twelve months, and the impairment, or
combination of impairments, meets or medically equals a required listing under 20 CFR Part
404, Subpart P, Appendix 1, the claimant is presumed to be disabled regardless of age,
education or work experience. See 20 C.F.R. § 416.920(d).
Before considering Step Four, the ALJ must determine the claimant’s residual
functional capacity, i.e., the claimant’s ability to do physical and mental work activities on a
sustained basis despite limitations from her impairments. 20 C.F.R. § 416.920(e). At the
fourth step, if the claimant’s impairment or combination of impairments does not prevent her
from doing her past relevant work, the claimant is not disabled. 20 C.F.R. §§ 416.920(e)-(f).
For the fifth and final step, even if the claimant’s impairment does prevent her from doing
her past relevant work, the claimant is not disabled if other work exists in the national
economy that the claimant can perform. 20 C.F.R. § 416.920(g); Abbott, 905 F.2d at 923.
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C. 	Analysis
1. 	The ALJ’s Step Two Analysis
Ms. Barber first argues that the ALJ erred in determining that her headaches did not
constitute a medically determinable impairment (“MDI”). At Step Two, the ALJ must
determine whether the claimant has an MDI resulting from anatomical, physiological, or
psychological abnormalities that can be shown by acceptable clinical and laboratory
diagnostic techniques. 20 C.F.R. § 416.921. The MDI “must be established by objective
medical evidence from an acceptable medical source.” Id.
The SSA has promulgated Social Security Ruling (“SSR”) 19-4, 2019 WL 4169635
(Aug. 26, 2019), to explain how the agency will evaluate cases involving primary headache
disorders. SSR 19-4p divides headaches into two groups: (1) primary headaches, which
“occur independently and are not caused by another medical condition”; and (2) secondary
headaches, which are a symptom of another medical condition. Id. at *3. Examples of primary
headaches include migraines, tension-type headaches, and trigeminal autonomic cephalalgias.
Id. Under SSR 19-4p, only primary headache disorders, not secondary headaches, can
constitute an MDI. Id. at *5.
SSR 19-4 also issues guidance regarding how the agency will determine whether a
claimant has an MDI of a primary headache disorder. SSR 19-4p states that “physicians
diagnose a primary headache disorder only after excluding alternative medical and psychiatric
causes of a person’s symptoms.” Id. at *4. It further states that physicians diagnose a primary
headache disorder after reviewing a person’s full medical and headache history and
conducting a physical and neurological examination. Id. Headache journals, imaging, and
laboratory tests may also be of use in ruling out other medical conditions. Id.
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Under SSR 19-4p, the SSA “will not establish the existence of an MDI based only on
a diagnosis or a statement of symptoms . . . .” Id. at *6. Instead, SSR 19-4 lists four factors
that the agency will consider in determining whether a claimant has an MDI of a primary
headache disorder: (1) a primary headache disorder diagnosis from an acceptable medical
source who reviewed the claimant’s medical history, conducted a physical examination, and
“made the diagnosis of primary headache disorder only after excluding alternative medical
and psychiatric causes”; (2) an observation and detailed description of a typical headache
event, including associated phenomena; (3) remarkable or unremarkable findings on
laboratory tests; and (4) response to treatment. Id.
The ALJ expressly found at Step Two that Ms. Barber did not have an MDI of a
primary headache disorder. In reaching that conclusion, the ALJ stated as follows:
Pursuant to SSR 19-4p, the Social Security Administration may
establish only a primary headache disorder, such as migraine with
aura, as a medically determinable impairment when the evidence
documents that an acceptable medical source (AMS) made the
diagnosis of a primary headache disorder only after excluding
alternative 	medical 	and 	psychiatric 	causes 	of 	the 	person’s
symptoms. Here, there is no evidence that claimant’s medical
providers excluded all alternative medical and psychiatric causes of
claimant’s symptoms to establish the diagnosis of a primary
headache 	disorder. 	As 	such, 	claimant’s 	reported
headaches/migraines are not a medically determinable impairment.
(Tr. 14).
The ALJ’s brief analysis is insufficient to demonstrate that the ALJ properly applied
SSR 19-4p in this case. As discussed above, the ALJ was correct that the SSA will not
diagnose headaches as an MDI unless an acceptable medical source has ruled out alternative
medical and psychiatric causes. I and other courts have rejected arguments that an ALJ erred
in finding that headaches did not constitute an MDI where an acceptable medical source failed
to do so. See Dellarco v. Comm’r of Soc. Sec. Admin., No. 4:22-CV-00962-PAB, 2023 WL
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3324833, at *10 (N.D. Ohio Apr. 20, 2023), report and recommendation adopted, 2023 WL
3320142 (N.D. Ohio May 9, 2023); Wayne P.M. v. Comm’r of Soc. Sec., No. 5:24-CV-01268
(ML), 2026 WL 849934, at *4-5 (N.D.N.Y. Mar. 27, 2026); Lewis v. Soc. Sec. Admin.,
Comm’r, No. 2:23-cv-00597-NAD, 2024 WL 4116356, at *9-10 (N.D. Ala. Sept. 6, 2024)
Here, however, the ALJ did not explain why he believed Ms. Barber’s treating sources
failed to rule out alternative medical or psychiatric causes before diagnosing her with a
migraine disorder. Nor did the ALJ identify alternative medical or psychiatric causes that he
believed they failed to rule out. Instead, the ALJ’s analysis simply tracks the language of SSR
19-4p without providing any analysis of where Ms. Barber’s treating sources fell short.
The brevity of the ALJ’s analysis is concerning because the record contains treatment
notes that support multiple SSR 19-4p factors. It is undisputed that Dr. Suneja diagnosed Ms.
Barber with chronic migraines. (Tr. 676). Dr. Suneja further described the phenomena
accompanying Ms. Barber’s migraines, stating that Ms. Barber also experienced photophobia,
phonophobia, and nausea. Id. In addition, Dr. Suneja expressly discussed failed treatment
efforts, noting that Ms. Barber had tried gabapentin, topiramate, Lexapro, propranolol,
verapamil, rizatriptan, and sumatriptan, but that those medications were either ineffective or
caused side effects that led to their discontinuation. (Tr. 676-77). Finally, Dr. Suneja stated
that medication overuse had been ruled out as a cause of Ms. Barber’s headaches. (Tr. 676).
The ALJ did not discuss any of this evidence, and it is unclear whether the ALJ
considered it. Indeed, the ALJ did not mention Dr. Suneja or the relevant treatment notes at
all. Nor did the ALJ explain what conditions he believed Dr. Suneja or Ms. Barber’s other
medical sources failed to exclude before diagnosing her with a primary headache disorder.
As a result, I cannot tell whether the ALJ overlooked this evidence or whether the ALJ
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believed that Dr. Suneja’s diagnosis and supporting explanation was insufficient to rule out
other causes and, if so, why.
Nor did the ALJ provide a sufficient explanation elsewhere in the decision. When
formulating the RFC, the ALJ summarized Ms. Barber’s testimony regarding her migraines,
including that she experiences three to four migraines per week, that they typically last two
or three days, and that they are associated with vomiting and sensitivity to light, noise, and
sound. (Tr. 17). However, the ALJ never analyzed that testimony and did not explain what
conclusions he drew from it. The ALJ’s subsequent discussion of Ms. Barber’s testimony thus
was not sufficient to satisfy SSR 19-4p. See Byrd v. Comm’r of Soc. Sec., No. 3:22-cv-801,
2022 WL 18135581, at *6 (N.D. Ohio Dec. 22, 2022), report and recommendation adopted,
2023 WL 113631 (N.D. Ohio Jan. 5, 2023) (holding that ALJ’s summary of claimant’s
testimony did not rectify failure to analyze headaches at Step Two, as “while the ALJ cited
[claimant’s] testimony in which [he] complained of headaches, some headache treatment
notes from [his] neurologist, and [his] complaints of headaches in the record, the ALJ didn’t
provide any conclusions about that evidence”) (citations omitted).
It should be emphasized that this is a close case. I am cognizant that the ALJ did
discuss Ms. Barber’s migraines and expressly held that they did not constitute an MDI
because her medical sources did not rule out all other potential causes. That distinguishes this
case from Byrd, where the ALJ wholly failed to discuss the claimant’s headaches at Step Two.
Byrd, 2022 WL 18135581, at *6. In addition, neither party has identified evidence either that
Ms. Barber underwent an MRI or other imaging or that she kept a headache journal, both
factors that SSR 19-4p says medical sources should consider when diagnosing a primary
headache disorder. However, SSR 19-4p also specifically provides that “[w]hile imaging may
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be useful in ruling out other possible causes of headache symptoms, it is not required for a
primary headache disorder diagnosis.” 2019 WL 4169635, at *4. Moreover, the ALJ’s
analysis was simply too general for me to trace his reasoning or for me to determine whether
the absence of imaging or a headache journal factored into his decision. Accordingly, I
conclude that the ALJ erred in his Step Two analysis because he did not explain why he
believed Ms. Barber’s medical sources failed to exclude other potential causes of her
headaches and because it is unclear whether he considered the relevant evidence.
The Commissioner argues that, even assuming the ALJ erred at Step Two, any error
was harmless because the ALJ considered Ms. Barber’s testimony regarding her headaches
when formulating her RFC, and because the RFC was consistent with the opinions of the state
agency medical consultants. Neither argument is persuasive. As discussed above, while the
ALJ summarized Ms. Barber’s testimony regarding her headaches, he did not analyze it and
did not explain how—if at all—he factored her headaches into the RFC. Moreover, while the
ALJ’s RFC may have been consistent with the opinions of the state agency medical
consultants, he did not rely on their failure to identify Ms. Barber’s headaches as a severe
impairment when formulating the RFC. The ALJ’s Step Two error was not harmless, and I
recommend that the Court reverse the Commissioner’s final decision so that the ALJ can
properly apply SSR 19-4p and determine whether Ms. Barber’s headaches constitute an MDI.
2. 	The ALJ’s Formulation of Ms. Barber’s RFC
In her second assignment of error, Ms. Barber argues that the ALJ erred in formulating
her RFC because the ALJ failed to include a limitation that Ms. Barber would need to elevate
her legs. Ms. Barber also argues that the ALJ’s alleged error is not harmless because the VE
testified that a leg elevation limitation would be work preclusive.
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“A claimant's RFC is not a medical opinion, but an administrative determination
reserved to the Commissioner.” Golden v. Berryhill, No. 1:18CV00636, 2018 WL 7079506,
at *17 (N.D. Ohio Dec. 12, 2018), report and recommendation adopted sub nom, 2019 WL
415250 (N.D. Ohio Feb. 1, 2019). The ALJ is “charged with the responsibility of determining
the RFC based on [the ALJ’s] evaluation of the medical and non-medical evidence.” Rudd v.
Comm’r of Soc. Sec., 531 F. App’x 719, 728 (6th Cir. 2013). “[T]he ALJ must give some
indication of the evidence upon which he is relying, and he may not ignore evidence that does
not support [the ALJ’s] decision, especially when that evidence, if accepted, would change
[the ALJ’s] analysis.” Golden, 2018 WL 7079506 at *17 (quotations omitted).
Here, the ALJ considered Ms. Barber’s testimony regarding her need to elevate her
legs, but held that additional limitations were not warranted:
Regarding claimant’s allegations of leg swelling, at appointments in
July, August, and October 2023, and April 2024, claimant denied
symptoms of leg swelling. (Exhibits B3F/29, 77; B4F/13; B8F/14).
Additionally, 	at 	multiple 	appointments 	claimant’s 	providers
observed that claimant had no extremity edema. (Exhibits B3F/24,
106; B8F/18; B8F/10).
(Tr. 18).
Elsewhere in the decision, the ALJ discussed Ms. Barber’s spinal condition and left
knee osteoarthritis, noting that she had imaging results demonstrating ongoing issues but that
she displayed no swelling, erythema, effusion, warmth, deformity, problems with sensation,
or gait problems at multiple appointments. (Tr. 13).
Ms. Barber argues that substantial evidence does not support the ALJ’s conclusion
because other evidence in the record shows that she experienced leg swelling and numbness.
She accuses the ALJ of relying on out-of-date reports to her doctors while ignoring evidence
that she complained of numbness and swelling at several appointments and was positive for
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leg swelling during some examinations.
However, “the Commissioner's decision cannot be overturned if substantial evidence,
or even a preponderance of the evidence, supports the claimant's position, 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); see also Anderson v. Comm’r of Soc. Sec., No.
1:21-CV-1471, 2022 WL 4545188, at *2 (N.D. Ohio Sept. 29, 2022) (“it is also well-
established that as long as the ALJ cites substantial, legitimate evidence to support the
conclusion reached, the reviewing court may not second-guess that decision”). Substantial
evidence supports the ALJ’s conclusion not to include a leg elevation restriction in light of
medical records showing that Ms. Barber presented without leg swelling and denied such
swelling as late as April 2024. I may not second-guess the ALJ’s decision simply because
Ms. Barber cites other evidence in the record that could have supported a more restrictive
RFC. Ms. Barber’s second assignment of error is without merit.
VI. 	RECOMMENDATION
Based 	on 	the 	foregoing, 	I 	RECOMMEND 	that 	the 	Court 	REVERSE 	the
Commissioner’s final decision and REMAND this matter to the Commissioner for further
proceedings consistent with this report and recommendation.
Dated: October 16, 2026 	/s Jennifer Dowdell Armstrong
Jennifer Dowdell Armstrong
U.S. Magistrate Judge
VII. 	NOTICE TO PARTIES REGARDING OBJECTIONS
Local Rule 72.3(b) of this Court provides:
Any 	party 	may 	object 	to 	a 	Magistrate 	Judge’s 	proposed
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findings, recommendations or report made pursuant to Fed. R.
Civ. P. 72(b) within fourteen (14) days after being served with a
copy thereof, and failure to file timely objections within the
fourteen (14) day period shall constitute a waiver of subsequent
review, absent a showing of good cause for such failure. Such
party shall file with the Clerk of Court, and serve on the Magistrate
Judge and all parties, written objections which shall specifically
identify the portions of the proposed findings, recommendations, or
report to which objection is made and the basis for such objections.
Any party may respond to another party’s objections within
fourteen (14) days after being served with a copy thereof. The
District Judge to whom the case was assigned shall make a de novo
determination of those portions of the report or specified proposed
findings or recommendations to which objection is made and may
accept, reject, or modify, in whole or in part, the findings or
recommendations made by the Magistrate Judge. The District Judge
need conduct a new hearing only in such District Judge’s discretion
or where required by law, and may consider the record developed
before the Magistrate Judge, making a determination on the basis of
the record. The District Judge may also receive further evidence,
recall witnesses or recommit the matter to the Magistrate Judge with
instructions.
Id. (emphasis added).
Failure to file objections within the specified time may result in the forfeiture or
waiver of the right to raise the issue on appeal either to the district judge or in a subsequent
appeal to the United States Court of Appeals, depending on how or whether the party responds
to the report and recommendation. Berkshire v. Dahl, 928 F.3d 520, 530 (6th Cir. 2019).
Objections must be specific and not merely indicate a general objection to the entirety of the
report and recommendation; a general objection has the same effect as would a failure to
object. Howard v. Sec’y of Health and Hum. Servs., 932 F.2d 505, 509 (6th Cir. 1991).
Stated differently, objections should focus on specific concerns and not merely restate
the arguments in briefs submitted to the magistrate judge. “A reexamination of the exact same
argument that was presented to the Magistrate Judge without specific objections ‘wastes
judicial resources rather than saving them, and runs contrary to the purpose of the Magistrates
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Act.’” Overholt v. Green, No. 1:17-CV-00186, 2018 WL 3018175, *2 (W.D. Ky. June 15,
2018) (quoting Howard). The failure to assert specific objections may in rare cases be
excused in the interest of justice. See United States v. Wandahsega, 924 F.3d 868, 878-79
(6th Cir. 2019).
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