UNITED STATES DISTRICT COURT                            
                   DISTRICT OF MINNESOTA                                


Shaunquelle P.,                      Case No. 23-CV-0556 (JFD)          

              Plaintiff,                                                

v.                                          ORDER                       

Martin J. O’Malley, Commissioner of                                     
the Social Security Administration,                                     

              Defendant.                                                


   Pursuant to 

(g), Plaintiff Shaunquelle P. seeks judicial review of a 
final decision by the Commissioner of the Social Security Administration, which denied 
the Plaintiff’s applications for disability insurance benefits (“DIB”) and supplemental 
security income (“SSI”). The case is before the Court on the parties’ briefing (Dkt. Nos. 16 
and 18). Plaintiff argues that the administrative law judge (“ALJ”) who authored the 
written decision did not properly account for the total limiting effects of Plaintiff’s physical 
impairments  in  assessing  Plaintiff’s  residual  functional  capacity  (“RFC”).  Defendant 
opposes Plaintiff’s position and asks the Court to affirm the final decision. As set forth 
below, the Court concludes that the ALJ did not err and therefore denies the relief requested 
in Plaintiff’s brief, grants the relief requested in Defendant’s brief, and affirms the final 
decision.                                                                 
I.   Background                                                           
   Plaintiff applied for DIB and SSI on December 31, 2020, alleging she has been 

disabled since April 13, 2019, due to two herniated disks, chronic back and nerve pain, 
hypertension, a heart condition, and anxiety. (See Soc. Sec. Admin. R. (hereinafter “R.”) 
348, 352.)1 Her date last insured for the purpose of her DIB claim is June 30, 2021, meaning 
she must show that she was disabled on or before that date. (See Pl.’s Br. at 1.)  
   A.   Relevant Evidence2                                              
   Plaintiff had L4-S1 spinal-fusion surgery in 2016. (See R. 417.) After the surgery, 

she saw Jeffrey S. Pinto, M.D., among others, for follow-up. In April 2018, Plaintiff told 
Dr. Pinto that her pain was only 1/10 and that she had obtained 95% relief of her pre-
surgery symptoms. (R. 431.) On examination, Dr. Pinto found her strength a 5/5 in the 
lower extremities and a full range of motion in the low back, hips, knees, and ankles. (R. 
431.) A straight-leg-raising test was normal.                             

   In November 2019, saw Ryan Heisler, PA-C, for low back pain and intermittent leg 
pain. (R. 421.) On examination, Mr. Heisler observed pain with external hip rotation, 
flexion, and extension; diffuse tenderness of the L4-5 spinal segment; full strength; normal 
sensation; and no gait problems. (R. 422.)                                


1 The administrative record is filed at Dkt. No. 12. The record is consecutively paginated, 
and the Court cites to that pagination rather than ECF number and page.   

2 Plaintiff does not allege any error with respect to the ALJ’s mental RFC findings. (Pl.’s 
Br. at 3 n.4.) Accordingly, the Court summarizes only the evidence relevant to the ALJ’s 
physical  RFC  findings,  with  the  understanding  that  physical  pain  can  affect  mental 
functioning.                                                              
   In October 2020, David Strothman, M.D., recorded 5/5 strength in all motor groups 
and intact sensation. (R. 419.) A recent MRI of the lumbar spine showed satisfactory 

positioning  of  the  spinal-fusion  implants,  a  solid  fusion  from  L4  to  the  sacrum,  no 
segmental instability, no nerve root impingement, and normal disc height and hydration. 
(R. 419.)                                                                 
   In November 2020, Steven Stulc, D.O., noted that Plaintiff “has been making some 
good gains” from physical therapy and that the most recent imaging showed “essentially 
normal thoracic and lumbar” findings above the L4-S1 fusion. (R. 413.) One month later, 

in  December  2020,  Plaintiff  told  physical  therapist  Marnie  Kasinskas  that  she  was 
continuing to make progress. (R. 560.) Ms. Kasinskas wrote that Plaintiff was responding 
well  to  physical  therapy,  including  increased  range  of  motion,  decreased  pain,  and 
improved functioning and activity tolerance. (R. 561.) Also in December 2020, Jacob 
Deweerth, M.D., evaluated Plaintiff for pain management. He observed tender points and 

trigger points in her spine, and reduced range of motion with flexion, extension, and side-
bending. (R. 678.) Imaging and an MRI of the lumbar spine were normal, and Dr. Deweerth 
thoughts  Plaintiff’s  pain  was  likely  myofascial  in  nature.  (R.  679.)  Dr.  Deweerth 
recommended physical therapy, “pain psychology,” and trigger point injections. (R. 674.)  
   Plaintiff had an appointment with Hilary B. Stoffel, PsyD, LP, in February 2021 to 

determine whether Plaintiff would benefit from “pain psychology” as part of her pain 
management services. (R. 612.) Plaintiff reported worsening back pain, most severe in the 
mid-thoracic spine. (R. 612.) Her pain reportedly interfered with her relationships, quality 
of life, activities of daily living, and sleep. (R. 612.) Ms. Stoffel believed Plaintiff would 
benefit from pacing her activities, exploring concepts of radical acceptance and tolerance, 
sleep hygiene, self-soothing strategies, psychoeducation, and a regular pain management 

regimen. (R. 614.)                                                        
   On October 7, 2021, Dr. Stulc completed a medical opinion form. (R. 1105–08.) He 
described  Plaintiff’s  physical  limitations  as  “limited  lifting/carrying/sitting/standing/ 
walking/bending” and indicated she could not work more than 20 hours a week. (R. 1106.) 
Dr. Stulc provided no further details on the form.                        
   Plaintiff attended an appointment for low back pain with Brendan C. Murphy, PA-

C, on October 21, 2021. Mr. Murphy’s objective findings included full and pain-free range 
of motion in both hips; no spinal deformity or swelling; full functional strength of the head, 
neck, and spine; full strength in the hips and legs, excepting one muscle; full functional 
strength of the ankles; and a stable and well-coordinated gait. (R. 1102–03.) Dr. Stulc saw 
Plaintiff four days later, noting that an MRI from 2019 did not show any degeneration or 

nerve impingement. (R. 1100.) The progress note reflects a subjective report of continued 
low back pain but no objective findings. (R. 1100–01.)                    
   Dr. Stulc completed a Medical Source Statement form on February 14, 2022, 
providing more details than he had on the October 2021 form. (R. 1160–64.) His diagnosis 
was chronic low back pain and a “failed back surgery.” (R. 1160.) In the place on the form 

where he was asked to identify the supporting clinical findings, laboratory, and test results, 
he wrote “chronic low back pain. SIP AP fusion L4-S1.” (R. 1160.) He characterized 
Plaintiff’s pain as occurring daily and ranking a 10/10. (R. 1160.) Positive objective 
findings, according to Dr. Stulc, included decreased range of motion on flexion and 
extension, a positive straight leg raising test, tenderness, and impaired sleep. (R. 1161.) Dr. 
Stulc  opined  that  Plaintiff’s  impairments  would  interfere  with  her  attention  and 

concentration constantly. (R. 1161.) Regarding functional limitations, Dr. Stulc opined that 
Plaintiff could continuously sit for 20 minutes at a time, continuously stand for 20 minutes 
at a time, stand or walk for less than 2 hours in an 8-hour workday, and sit for about 2 hours 
in an 8-hour workday. (R. 1162.) In addition, he opined, Plaintiff would need to walk for 
about 5 minutes every 20 minutes; to shift positions at will from sitting, standing, and 
walking; to take unscheduled breaks for 5 minutes every 20 minutes; and to lie down every 

1 to 2 hours. (R. 1162–63.) She could frequently lift less than 10 pounds and occasionally 
lift 10 pounds. (R. 1163.) She could bend and twist at the waist for only 10% of the 
workday. (R. 1163.) Dr. Stulc opined that Plaintiff would have no limitations with using 
her hands or fingers but would be significantly limited with repetitive reaching, handling, 
and fingering, and she would be 50% limited in reaching overhead repeatedly. (R. 1163.) 

Finally, Dr. Stulc stated that Plaintiff would be absent from work more than three days a 
month due to pain. (R. 1164.)                                             
   B.   Procedural History                                              
   Plaintiff’s DIB and SSI applications were denied at both the initial review and 
reconsideration stages. She requested an administrative hearing before an ALJ, and the 

hearing took place on March 10, 2022. (R. 41.)                            
   Plaintiff, medical expert Joseph Gaeta, and vocational expert Mary Harris testified 
at the hearing. Relevant to the issue presented for judicial review, Plaintiff testified that she 
could not work because of back pain and trouble standing, lifting, bending, and kneeling. 
(R. 47.) She also had problems with focus, concentration, memory, muscle spasms in her 
calves and feet, and nerve pain in her legs. (R. 51, 53.) She testified she could sit for no 

more than 15 minutes at a time, stand for no more than 15 minutes at a time, walk no more 
than about 3 city blocks at a time, and lift no more than about 8 pounds. (R. 47–48.) Plaintiff 
further testified she was restricted to working from home or from bed. (R. 49.) Dr. Gaeta 
testified that Plaintiff’s physical functional limitations were light levels of activity; sitting 
for no more than 6 hours in a workday; standing and walking for 6 hours in a workday; 
lifting, carrying, pushing, and pulling 20 pounds occasionally and 10 pounds frequently; 

and occasionally using ladders and scaffolds. (R. 57–58.) Dr. Gaeta based his testimony on 
a review of Plaintiff’s medical records including her spinal-fusion surgery, the subsequent 
MRI, and Dr. Stulc’s treatment records and physical examination findings. (R. 56–57.)  
   On March 24, 2022, the ALJ issued a written decision finding Plaintiff not disabled. 
(R. 7–33.) The ALJ followed the familiar five-step sequential analysis outlined in 

 and 416.920. At each step, the ALJ considered whether Plaintiff was disabled 
based on the criteria of that step. If she was not, the ALJ proceeded to the next step. See 

(a)(4), 416.920(a)(4).                                  
   The ALJ first determined that Plaintiff had not engaged in substantial gainful 
activity since the alleged onset date. (R. 12.) At the second step of the sequential analysis, 

the ALJ found that Plaintiff had the following severe impairments: degenerative disc 
disease,  chronic  pain  syndrome,  major  depressive  disorder,  and  generalized  anxiety 
disorder. (R. 13.) At step three, the ALJ concluded that Plaintiff’s impairments did not 
meet or medically equal the severity of an impairment listed in 20 C.F.R. Part 404, Subpart 
P, Appendix I. (R. 15.)                                                   

   Before  proceeding  to  step  four,  the  ALJ  assessed  Plaintiff’s  RFC,  which  is a 
measure  of  “the  most  [she]  can  still  do  despite  [her]  limitations.”  

(a)(1), 416.945(a)(1). As part of the RFC assessment, the ALJ considered 
Plaintiff’s statements about her symptoms concerning pain in her lower back and spine; 
ability to bend, squat, kneel, climb stairs, stand, lift, carry, walk, and sit; the restriction to 
working from home or bed; drowsiness from medications; and difficulties concentrating, 

remembering, and completing tasks. (R. 20.) The ALJ found that Plaintiff’s statements 
were not consistent with the medical and other evidence of record, in particular, medical 
imaging;  a  successful  spinal-fusion  surgery;  conservative  modalities  of  treatment; 
Plaintiff’s report of 95% relief of back and spine symptoms; and examinations showing 
normal strength in the lower extremities, normal reflexes, normal sensation, full range of 

motion in the lower back and extremities, normal straight leg raises, and normal and stable 
gait. (R. 20–21.) The ALJ accepted that Plaintiff had some symptoms caused by her 
impairments, but not the extent she alleged. (R. 23.)                     
   The ALJ also considered Dr. Stulc’s opinions in assessing Plaintiff’s RFC. The ALJ 
found both opinions largely not persuasive, because most of the findings and limitations 

were neither supported by nor consistent with other evidence. (R. 29–30.) The ALJ’s 
discussion of Dr. Stulc’s October 2021 opinion follows:                   
   I considered the opinion of the claimant’s treating physician, Steven Stul[c], 
   DO (C13F). In October 2021, Dr. Stul[c]  opined that the claimant had 
   permanent limitations with lifting, carrying, sitting, standing, walking, and 
   bending. She could work for 20 hours or less during a workweek (C13F/2). 
   I do not find this opinion to be persuasive. Although Dr. Stul[c] indicated 
   that the claimant was limited in the above areas, his opinion was vague and 
   only indicated general limitations in these areas without indicating the level 
   of difficulty that the claimant experienced. Furthermore, although he was 
   more specific with regards to the amount of hours that the claimant could 
   perform on a weekly basis, Dr. Stul[c] did not offer any specific evidence or 
   corroboration for his opinion. He did not reference any treatment notes, 
   physical  examination  findings,  or  medical  imaging  to  illustrate[]  the 
   claimant’s  limitation  using  objective  medical  evidence.  Therefore,  Dr. 
   Stul[c]’s  opinion  was  not  supported  by  his  medical  opinion  (C13F/2). 
   Furthermore, to the extent that Dr. Stul[c] identified limitations with lifting, 
   carrying, sitting, standing, walking, and bending, I find these opinions to be 
   somewhat persuasive  to  the extent  that  the claimant  had  some  level  of 
   limitation in these areas. Although I considered this when evaluating the 
   claimant’s level of functioning in these areas, I did not find this opinion to 
   be persuasive in light of opinions with better supportability and consistency 
   in the record. Furthermore, the opinion found the opinion [sic] that the 
   claimant was limited to working 20 hours a week to be unpersuasive. There 
   was no support for this limitation and it was not consistent with any treatment 
   notes identified in the record. Furthermore, there was no indication from any 
   of the claimant’s treating physicians that the claimant was able to perform, 
   at most, part-time work. Therefore, his opinion appeared to be based solely 
   on  the  claimant’s  own  subjective  reports  without  a  concrete  basis  with 
   objective medical findings.                                          

(R. 29–30.)                                                               
   The ALJ’s discussion of Dr. Stulc’s February 2022 opinion reads:     
   I considered the additional opinion by Dr. Stul[c] (C16F). In February 2022, 
   Dr. Stul[c] opined that the claimant’s pain interfered with her attention and 
   concentration. She could walk three city blocks. She could sit for 20 minutes 
   at a time and sit for about 2 hours during an 8-hour workday. She could stand 
   for 20 minutes, and she could sit/stand for less than 2 hours during a workday. 
   She needed to take walking breaks every 20 minutes, which would last for 5 
   minutes. She needed the ability to transition from sitting, standing, and 
   walking at will. She would need unscheduled breaks every 20 minutes, for 5 
   minutes. She could frequently lift and carry 10 pounds and occasionally lift 
   and carry 10 pounds. She was limited to bending 10% of the workday and 
   twisting 10% of the work. She had good days and bad days. She would miss 
   more than 4 days of work (C16F). I do not find this opinion to be persuasive. 
   First,  his  opinion  noted  limitations  in  additional  areas  and  noted  more 
   restrictive limitations than identified in his prior opinion. However, despite 
   noting more limitations, he indicated that he last saw the claimant at the time 
   he made his prior opinion. Therefore, it was unclear on what basis he was 
   identifying the increase in limitations (C16F/2). In addition, like the previous 
   opinion, his opinion was not well supported. Although Dr. Stul[c] referenced 
   some treatment notes, the referenced information appeared to be based on 
   the claimant’s own subjective reports with limited concreate and objective 
   findings. He stated that the claimant had 10 out of 10 pain in her lower back. 
   Dr. Stul[c] did note that the claimant had some decreased range of motion, 
   positive straight leg raises, tenderness, and impaired sleep. However, there 
   was no mention of medical imaging or her response to treatment outside 
   these  findings.  Accordingly,  Dr.  Stul[c]’s  opinion  was  not  supported. 
   Furthermore, as noted above, his opinion was inconsistent with his own 
   opinion that was made about 4 months prior and indicated vastly increased 
   impairments and limitations, without a corresponding treatment visits to 
   indicate why there was a change in his opinion. Moreover, his opinion was 
   further inconsistent with the opinion of the medical expert that appeared at 
   the  hearing.  Specifically,  Dr.  Gaeta  testified  that  Dr.  Stul[c]’s  opinion 
   appeared to be based on subjective reports by the claimant, without objective 
   clinical information in the file (Hearing Testimony). Therefore, because Dr. 
   Stul[c]’s opinion was unsupported and inconsistent with the other evidence 
   in the record, I do not find this opinion to be persuasive.          

(R. 30.)                                                                  
   The ALJ also considered Dr. Gaeta’s hearing testimony, finding it persuasive:  
   I considered the opinion of the medical expert, Joseph Gaeta, MD (Hearing 
   Testimony).  At  the  hearing  in  March  2022,  Dr.  Gaeta  opined  that  the 
   claimant did not meet a listing, after considering 1.15 and 4.05. He stated that 
   the claimant’s cardiac impairments were nonsevere. Additionally, he noted 
   that the claimant’s spinal impairment was severe and caused limitations to 
   light  work  with  frequent  postural  movements,  except  only  occasional 
   climbing of ladders, ropes, and scaffolds (Hearing Testimony). I find the 
   opinion  of  Dr.  Gaeta  to  be  generally  persuasive.  First,  Dr.  Gaeta  is  a 
   professional in the field of medicine with more than 50 years of experience 
   (C15F). Second, he supported his findings with specific references to the 
   medical record, including the MRI of her spine that showed stable findings 
   in her spine, normal physical examination findings, and conservative levels 
   of care following the alleged onset date. Third, when asked by the claimant’s 
   representative regarding discrepancies between his opinion and the opinion 
   of the claimant’s treating physician, he was able to give a clear and cogent 
   answer in support of his findings over the opinion of Dr. Stul[c]. Specifically, 
   he identified that he based his opinions purely by the objective findings that 
   were available in the record, as noted above. Furthermore, he noted that Dr. 
   Stul[c]’s opinion appeared to be based on subjective reports and symptoms 
   reported by the claimant, which had no support from his own treatment notes 
   because he did not indicate the same level of impairment or severity of 
   findings during regular care. However, although Dr. Gaeta’s opinion was 
   well supported and explained at the hearing, I find that the claimant was 
   further limited in light of her history of multiple back surgeries and her 
   reports of chronic and persistent pain that was treated with regular opioid 
   medications. Furthermore, I find that the findings during the psychological 
   consultative examination, although not significantly corroborated with the 
   evidence in the record, I find the physical observations to be convincing and 
   demonstrated functioning consistent with the residual functional capacity as 
   identified above.                                                    

(R. 28–29.)                                                               
   Based on the ALJ’s consideration of all the evidence of record, the ALJ assessed 
Plaintiff’s RFC as follows.                                               
   [Plaintiff] has the residual functional capacity to perform sedentary work as 
   defined in 20 CFR 404.1567(a) and 416.967(a) except for the following: she 
   can never climb ladders, ropes, or scaffolds. She can occasionally climb 
   ramps and stairs. She can frequently balance and occasionally stoop, crouch, 
   crawl, and kneel. She can rarely tolerate exposure to extreme temperatures. 
   She can have no exposure to dangers of life or limb in the workplace. She 
   can rarely tolerate exposure to vibrating objects or surfaces in completing 
   tasks. She cannot be required to work in environments with high, exposed 
   places.  With  regard  to  concentration,  persistence  and  pace,  she  cannot 
   perform  work  in  excess  of  simple,  routine,  repetitive  tasks.  She  can 
   occasionally  tolerate  changes  in  work  setting.  She  can  have  no  public 
   interaction. She can perform work requiring brief and superficial interaction 
   with supervisors and coworkers . . . . She cannot perform complex decision-
   making. She cannot perform rapid, assembly-line paced work (for example, 
   she can perform jobs with daily quotas, but not hourly quotas).      

(R. 19.) With this RFC, the ALJ concluded, Plaintiff could not perform her past work as a 
childcare provider, but she could work as an addressing clerk, document preparer, or 
electronic assembly worker. (R. 31–32.) Consequently, Plaintiff was not disabled. (R. 32–
33.)                                                                      

   The Appeals Council denied Plaintiff’s request for review of the ALJ’s decision. 
(R. 1.) This made the ALJ’s decision the final decision of the Commissioner for the purpose 
of judicial review.                                                       
II.  Standard of Review                                                   
   Judicial review of the Commissioner’s denial of benefits is limited to determining 
whether substantial evidence in the record as a whole supports the decision, 

(g), or whether the ALJ committed an error of law, Nash v. Commissioner, Social 
Security Administration, 

 (8th Cir. 2018). “Substantial evidence is less 
than a preponderance but is enough that a reasonable mind would find it adequate to 
support the Commissioner’s conclusion.” Krogmeier v. Barnhart, 

 
(8th Cir. 2002) (citing Prosch v. Apfel, 

 (8th Cir. 2000)). The Court 

must  examine  “evidence  that  detracts  from  the  Commissioner’s  decision  as  well  as 
evidence that supports it.” 

 (citing Craig v. Apfel, 

 (8th Cir. 2000)). 
The Court may not reverse the ALJ’s decision simply because substantial evidence would 
support a different outcome or because the Court would have decided the case differently. 

 (citing Woolf v. Shalala, 

 (8th Cir. 1993)). In other words, if it is 

possible to reach two inconsistent positions from the evidence and one of those positions 
is that of the Commissioner, the Court must affirm the decision. Robinson v. Sullivan, 

 (8th Cir. 1992).                                            
   A claimant has the burden to prove disability. See Roth v. Shalala, 

 
(8th Cir. 1995). To meet the definition of disability for DIB and SSI, the claimant must 

establish that she is unable “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.” 

(d)(1)(A); 42 U.S.C. § 1382c(a)(3)(A). The disability, not just 
the impairment, must have lasted or be expected to last for at least twelve months. Titus v. 
Sullivan, 

 (8th Cir. 1993).                                

III.  Discussion                                                          
   Plaintiff argues that the ALJ failed to account for the total limiting effects of her 
impairments. In particular, Plaintiff contends that the ALJ erred in his consideration of Dr. 
Stulc’s opinion and his evaluation of Plaintiff’s statements concerning her symptoms and 
their resulting limitations. Plaintiff also argues that the ALJ erred in relying on Dr. Gaeta’s 

testimony.                                                                
   A.   The ALJ Did Not Err in Considering Dr. Stulc’s Opinion.         
   Title 

.1520c and 416.920c set forth the standards under which an 
ALJ considers medical opinion evidence. An ALJ considers how “persuasive” an opinion 
is according to five factors: supportability, consistency, relationship with the claimant, 

specialization,  and  any  other  relevant  factors.  

.1520c(c)(1)–(5), 
416.920c(c)(1)–(5). The “most important factors” are supportability and consistency. 

.1520c(b)(2), 416.920c(b)(2). The ALJ “may, but [is] not required to,” 
explain  how  the  remaining  factors  were  considered.  

.1520c(b)(2), 
416.920c(b)(2).                                                           

   The regulatory language pertaining to supportability provides that “[t]he more 
relevant  the  objective  medical  evidence  and  supporting  explanations  presented  by  a 
medical source are to support his or her medical opinion(s) or prior administrative medical 
finding(s),  the  more  persuasive  the medical  opinions  or  prior  administrative medical 
finding(s)  will  be.”  

.1520c(c)(1),  416.920c(c)(1).  In  evaluating 
consistency, “[t]he more consistent a medical opinion(s) or prior administrative medical 

finding(s) is with the evidence from other medical sources and nonmedical sources in the 
claim, the more persuasive the medical opinions or prior administrative medical finding(s) 
will be.” 

.1520c(c)(2), 416.920c(c)(2). In other words, supportability 
looks to how well the medical source justifies their own opinion, and consistency looks to 
how well the medical source’s opinion fits with evidence from other sources.  

   Given that the supportability and consistency factors are the most important factors 
to the persuasiveness determination, an ALJ “will explain how [the ALJ] considered the 
supportability and consistency factors for a medical source’s medical opinions . . . .” 

.1520c(b)(2), 416.920c(b)(2). “The ALJ need not use the magic words of 
‘supportability’ and ‘consistency,’ but it must be clear they were addressed.” Svendsen v. 

Kijakazi, No. 1:21-CV-1029-CBK, 

, at *8 (D.S.D. July 14, 2022). The 
ALJ’s failure to articulate how he or she considered these factors is a legal error that 
warrants remand. Susan H. v. Kijakazi, No. 21-CV-2688 (ECT/ECW), 

, 
at *3 (D. Minn. Feb. 21, 2023); Michael B. v. Kijakazi, No. 21-CV-1043 (NEB/LIB), 

, at *2 (D. Minn. Sept. 26, 2022); Joel M. B. v. Kijakazi, No. 21-CV-1660 
(PAM/ECW), 

, at *3 (D. Minn. June 1, 2022) (citing Lucus v. Saul, 

 (8th Cir. 2020)).                                         
   The  Court  finds  that  the  ALJ  properly  articulated  how  he  considered  the 
supportability and consistency of Dr. Stulc’s opinions. The ALJ explained that Dr. Stulc’s 
October  2021  opinion  was  vague,  described  only  general  functional  limitations,  and 
contained  no  supporting  explanations  or  references  to  objective  medical  evidence 
whatsoever. That description is accurate. With respect to consistency, the ALJ articulated 

that a limitation to a 20-hour workweek was not consistent with any treatment notes in the 
record, including visit summaries from Plaintiff’s medical providers. Regarding Dr. Stulc’s 
February 2022 opinion, the ALJ explained that the opinion was not supported by objective 
medical evidence, including treatment notes, medical imaging, or Plaintiff’s response to 
treatment, but was based on Plaintiff’s subjective complaints. An ALJ may reduce the 

persuasive value of an opinion that is based largely on a claimant’s subjective complaints. 
Austin v. Kijakazi, 

 (8th Cir. 2022); see Kirby v. Astrue, 

 (8th Cir. 2007) (under former regulations, giving “less weight” to an opinion based 
mostly  on  subjective  complaints).  As  to  supportability,  the  ALJ  articulated  that  the 
February  2022  opinion  contained  greater  limitations  than  the  October  2021  opinion, 

without any explanation for the discrepancies, and without Dr. Stulc having seen Plaintiff 
in the four months between the opinions. The ALJ also articulated that Dr. Stulc’s second 
opinion was not consistent with Dr. Gaeta’s testimony.3 In sum, the ALJ adequately 
articulated how he considered the supportability and consistency of Dr. Stulc’s opinions.  

   The Court now turns to Plaintiff’s argument that the ALJ’s consideration of Dr. 
Stulc’s opinions was not supported by substantial evidence. The Court acknowledges that 
there may be evidence that supports and detracts from the ALJ’s determination, but the 
Court will not reweigh the evidence. Suffice it to say, the ALJ identified substantial record 
evidence,  or  its  lack,  to  support  his  consistency  and  supportability  determinations. 
Specifically, with respect to the October 2021 opinion, the ALJ observed that Dr. Stulc did 

not refer to any of his own treatment notes, physical examination findings, or imaging (R. 
29, 1106); the limitation to a 20-hour work week was not supported by or consistent with 
any treatment notes (R. 29; e.g., R. 413–32, 674–80, 1100–04); no provider indicated that 
Plaintiff would be limited to part-time work (R. 29; e.g., R. 413–32, 674–80, 1100–04); 
and Dr. Stulc’s opinion was based on Plaintiff’s subjective reports, not objective medical 

findings (R. 30; e.g., R. 419, 421, 1102). As to the February 2022 opinion, the ALJ stated 
that Dr. Stulc did not explain the increased limitations from the October 2021 opinion (R. 
30, 1160–64); supporting treatment notes did not contain objective or concrete findings 
and were based primarily on Plaintiff’s subjective statements (R. 30, 413–14, 417–18, 
1100–01); the opinion did not acknowledge medical imaging or positive responses to 

treatment (R. 30, 1160–64); and the opinion was inconsistent with Dr. Gaeta’s testimony 



3 The Court discusses Dr. Gaeta’s testimony in Part III.C below.          
(R. 30, 54–59). Consequently, the Court finds that substantial evidence in the record 
supports the ALJ’s consideration of Dr. Stulc’s opinions.                 

   B.   The ALJ Did Not Err in Evaluating Plaintiff’s Statements Concerning 
        Her Symptoms.                                                   

   The ALJ considered Plaintiff’s testimony about her symptoms and found that her 
impairments  could  be  expected  to  cause  the  alleged  symptoms  but  that  the  claimed 
intensity, persistence, and limiting effects of her symptoms were not consistent with the 
record.                                                                   
   In  evaluating  the  intensity,  persistence,  and  limiting  effects  of  a  claimant’s 
symptoms, an ALJ considers the objective medical evidence, statements from the claimant 
and others, and the following factors:                                    
   1. Daily activities;                                                 
   2. The location, duration, frequency, and intensity of pain or other symptoms; 
   3. Factors that precipitate and aggravate the symptoms;              
   4. The type, dosage, effectiveness, and side effects of any medication an 
   individual takes or has taken to alleviate pain or other symptoms;   
   5. Treatment, other than medication, an individual receives or has received 
   for relief of pain or other symptoms;                                
   6. Any measures other than treatment an individual uses or has used to relieve 
   pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 
   20 minutes every hour, or sleeping on a board); and                  
   7. Any other factors concerning an individual’s functional limitations and 
   restrictions due to pain or other symptoms.                          
SSR 16-3p, 

, at *7 (S.S.A. Mar. 16, 2016); see 

(c),  
416.929(c). An ALJ need not discuss every factor, but only the factors relevant to assessing 
the  persistence,  intensity,  and  limiting  effects  of  a  symptom.  SSR  16-3p,  

, at *7.                                                           
   Here,  the  ALJ  considered  whether  Plaintiff’s  statements  were  consistent  with 
objective  medical  evidence.  Specifically,  the  ALJ  summarized  medical  records  that 
documented examination findings of normal strength and full range of motion, imaging 
results showing a stable spine, conservative measures of treatment, providers’ observations 
of few limitations and no observable musculoskeletal deficits, and positive responses to 

physical therapy and medication. (R. 21–23, 26.) On the other hand, the ALJ also took note 
of medical records that documented findings such as tenderness in the spine, decreased 
strength, impaired reflexes, and reduced range of motion, but found these deficits were not 
consistent with Plaintiff’s self-reports of the severity of her symptoms. (R. 21–22.) As the 
ALJ observed, no provider recommended that Plaintiff should work only from home or in 

bed. (R. 26.) The ALJ also considered that Plaintiff’s level of care generally remained the 
same, and she did not require additional surgeries, increased medication, or the use of 
assistive devices. (R. 24.) Regarding side effects of medication, the ALJ noted that Plaintiff 
often did not report drowsiness or other side effects to her providers. (R. 25.)  
   The  ALJ  accounted  for  some  intensity,  persistence,  and  limiting  effects  of 

symptoms  and  reduced  Plaintiff’s  capacity  to  do  work-related  activities  accordingly. 
Specifically, the ALJ limited Plaintiff to sedentary work to avoid triggering or exacerbating 
her pain and to accommodate her limited range of motion and abnormal gait. (R. 25.) The 
ALJ  also  added  limitations  on  climbing,  balancing,  stopping,  crouching,  crawling, 
kneeling, and on exposure to extreme temperatures, vibration, and high places, to account 
for Plaintiff’s low-back pain, limited range of motion, and spinal tenderness. (R. 25.)  

   The  Court  finds  that  the  ALJ  did  not  err  in  evaluating  Plaintiff’s  symptoms. 
Substantial evidence supports the ALJ’s conclusion that the claimed intensity, persistence, 
and limiting effects of Plaintiff’s symptoms were inconsistent with the objective medical 
evidence and other relevant evidence of record.                           
   C.   The ALJ Did Not Err in Relying on Dr. Gaeta’s Testimony.        
   Plaintiff challenges the ALJ’s reliance on Dr. Gaeta’s testimony. Plaintiff claims 

that “her argument does not depend on finding his testimony unpersuasive.” (Pl.’s Br. at 
25.) Rather, she asks the Court to find that “Dr. Stulc’s opinion is at least as persuasive as 
Dr. Gaeta’s,” and then to find that the ALJ erred by not considering the other factors of 

.1520c(c) and 416.920c(c) (relationship with the claimant, specialization, 
and any other relevant factors). Plaintiff’s argument is based on section (b)(3) of 

.1520c and 416.920c, which requires an ALJ to articulate how the ALJ considered 
the other factors in paragraphs (c)(3) through (c)(5) when the ALJ finds that “two or more 
medical opinions or prior administrative medical findings about the same issue are both 
equally well-supported . . . and consistent with the record . . . but are not exactly the same.” 

.1520c(b)(3), 416.920c(b)(3).                             

   Here, the ALJ did not find that Dr. Gaeta’s and Dr. Stulc’s opinions were equally 
persuasive, so section (b)(3) does not apply. Furthermore, the Court’s ruling that the ALJ’s 
consideration of Dr. Stulc’s opinions was not erroneous essentially forecloses Plaintiff’s 
argument. Dr. Stulc’s and Dr. Gaeta’s medical opinions are not “equally well-supported” 
or equally “consistent with the record.”                                  

   Although Plaintiff denies that she is challenging the persuasiveness of Dr. Gaeta’s 
opinion, the Court will briefly address the issue in the interest of thoroughness. The ALJ 
articulated that he found Dr. Gaeta’s testimony “generally persuasive” because Dr. Gaeta 
is an experienced medical professional; Dr. Gaeta supported his findings with references 
to the medical record including imaging, normal examination findings, and conservative 
levels of care; and Dr. Gaeta cogently explained the differences between his opinion and 

Dr. Stulc’s opinion. (R. 28–29.) The Court finds, first, that the ALJ adequately explained 
how he considered the supportability and consistency factors as they relate to Dr. Gaeta’s 
opinion, and thus committed no legal error. The Court finds, second, that substantial 
evidence  of  record  supports  those  consistency  and  supportability  determinations. 
Specifically, Dr. Gaeta is an experienced medical professional and medical expert (R. 

1156–58), and Plaintiff’s representative did not object to Dr. Gaeta testifying as a medical 
expert at the hearing (R. 53–54). Dr. Gaeta testified that he reviewed Plaintiff’s medical 
records, and he referred to her spinal-fusion surgery, subsequent imaging that showed no 
nerve impingement and satisfactory positioning of the fusion implants, Dr. Stulc’s physical 
examination records that documented no particular functional abnormalities, and generally 

“fine” range of motion, strength, and reflexes. (R. 54, 56–57.) Dr. Gaeta testified that the 
functional limitations in his opinion differed from those in Dr. Stulc’s opinion, because his 
opinion was based on objective findings, whereas Dr. Stulc’s opinion could have been 
based more on subjective symptoms. (R. 58–59.) The Court has already concluded that the 
evidence described by Dr. Gaeta constitutes substantial evidence of record. The ALJ did 
not err in deeming Dr. Gaeta’s opinion persuasive.                        

IV.  Conclusion                                                           
   Based on the foregoing, and on all of the files, records, and proceedings herein, IT 
IS HEREBY ORDERED THAT:                                                   
1.  The relief requested in Plaintiff’s Brief (Dkt. No. 16) is DENIED;  
2.  The relief requested in Defendant’s Brief (Dkt No. 18) is GRANTED, and the 
   Commissioner’s final decision is AFFIRMED.                           


LET JUDGMENT BE ENTERED ACCORDINGLY.                                      


Date: March 22, 2024            s/  John F. Docherty                    
                                JOHN F. DOCHERTY                        
                                United States Magistrate Judge          

                UNITED STATES DISTRICT COURT                            
                   DISTRICT OF MINNESOTA                                


Shaunquelle P.,                      Case No. 23-CV-0556 (JFD)          

              Plaintiff,                                                

v.                                          ORDER                       

Martin J. O’Malley, Commissioner of                                     
the Social Security Administration,                                     

              Defendant.                                                


   Pursuant to 

(g), Plaintiff Shaunquelle P. seeks judicial review of a 
final decision by the Commissioner of the Social Security Administration, which denied 
the Plaintiff’s applications for disability insurance benefits (“DIB”) and supplemental 
security income (“SSI”). The case is before the Court on the parties’ briefing (Dkt. Nos. 16 
and 18). Plaintiff argues that the administrative law judge (“ALJ”) who authored the 
written decision did not properly account for the total limiting effects of Plaintiff’s physical 
impairments  in  assessing  Plaintiff’s  residual  functional  capacity  (“RFC”).  Defendant 
opposes Plaintiff’s position and asks the Court to affirm the final decision. As set forth 
below, the Court concludes that the ALJ did not err and therefore denies the relief requested 
in Plaintiff’s brief, grants the relief requested in Defendant’s brief, and affirms the final 
decision.                                                                 
I.   Background                                                           
   Plaintiff applied for DIB and SSI on December 31, 2020, alleging she has been 

disabled since April 13, 2019, due to two herniated disks, chronic back and nerve pain, 
hypertension, a heart condition, and anxiety. (See Soc. Sec. Admin. R. (hereinafter “R.”) 
348, 352.)1 Her date last insured for the purpose of her DIB claim is June 30, 2021, meaning 
she must show that she was disabled on or before that date. (See Pl.’s Br. at 1.)  
   A.   Relevant Evidence2                                              
   Plaintiff had L4-S1 spinal-fusion surgery in 2016. (See R. 417.) After the surgery, 

she saw Jeffrey S. Pinto, M.D., among others, for follow-up. In April 2018, Plaintiff told 
Dr. Pinto that her pain was only 1/10 and that she had obtained 95% relief of her pre-
surgery symptoms. (R. 431.) On examination, Dr. Pinto found her strength a 5/5 in the 
lower extremities and a full range of motion in the low back, hips, knees, and ankles. (R. 
431.) A straight-leg-raising test was normal.                             

   In November 2019, saw Ryan Heisler, PA-C, for low back pain and intermittent leg 
pain. (R. 421.) On examination, Mr. Heisler observed pain with external hip rotation, 
flexion, and extension; diffuse tenderness of the L4-5 spinal segment; full strength; normal 
sensation; and no gait problems. (R. 422.)                                


1 The administrative record is filed at Dkt. No. 12. The record is consecutively paginated, 
and the Court cites to that pagination rather than ECF number and page.   

2 Plaintiff does not allege any error with respect to the ALJ’s mental RFC findings. (Pl.’s 
Br. at 3 n.4.) Accordingly, the Court summarizes only the evidence relevant to the ALJ’s 
physical  RFC  findings,  with  the  understanding  that  physical  pain  can  affect  mental 
functioning.                                                              
   In October 2020, David Strothman, M.D., recorded 5/5 strength in all motor groups 
and intact sensation. (R. 419.) A recent MRI of the lumbar spine showed satisfactory 

positioning  of  the  spinal-fusion  implants,  a  solid  fusion  from  L4  to  the  sacrum,  no 
segmental instability, no nerve root impingement, and normal disc height and hydration. 
(R. 419.)                                                                 
   In November 2020, Steven Stulc, D.O., noted that Plaintiff “has been making some 
good gains” from physical therapy and that the most recent imaging showed “essentially 
normal thoracic and lumbar” findings above the L4-S1 fusion. (R. 413.) One month later, 

in  December  2020,  Plaintiff  told  physical  therapist  Marnie  Kasinskas  that  she  was 
continuing to make progress. (R. 560.) Ms. Kasinskas wrote that Plaintiff was responding 
well  to  physical  therapy,  including  increased  range  of  motion,  decreased  pain,  and 
improved functioning and activity tolerance. (R. 561.) Also in December 2020, Jacob 
Deweerth, M.D., evaluated Plaintiff for pain management. He observed tender points and 

trigger points in her spine, and reduced range of motion with flexion, extension, and side-
bending. (R. 678.) Imaging and an MRI of the lumbar spine were normal, and Dr. Deweerth 
thoughts  Plaintiff’s  pain  was  likely  myofascial  in  nature.  (R.  679.)  Dr.  Deweerth 
recommended physical therapy, “pain psychology,” and trigger point injections. (R. 674.)  
   Plaintiff had an appointment with Hilary B. Stoffel, PsyD, LP, in February 2021 to 

determine whether Plaintiff would benefit from “pain psychology” as part of her pain 
management services. (R. 612.) Plaintiff reported worsening back pain, most severe in the 
mid-thoracic spine. (R. 612.) Her pain reportedly interfered with her relationships, quality 
of life, activities of daily living, and sleep. (R. 612.) Ms. Stoffel believed Plaintiff would 
benefit from pacing her activities, exploring concepts of radical acceptance and tolerance, 
sleep hygiene, self-soothing strategies, psychoeducation, and a regular pain management 

regimen. (R. 614.)                                                        
   On October 7, 2021, Dr. Stulc completed a medical opinion form. (R. 1105–08.) He 
described  Plaintiff’s  physical  limitations  as  “limited  lifting/carrying/sitting/standing/ 
walking/bending” and indicated she could not work more than 20 hours a week. (R. 1106.) 
Dr. Stulc provided no further details on the form.                        
   Plaintiff attended an appointment for low back pain with Brendan C. Murphy, PA-

C, on October 21, 2021. Mr. Murphy’s objective findings included full and pain-free range 
of motion in both hips; no spinal deformity or swelling; full functional strength of the head, 
neck, and spine; full strength in the hips and legs, excepting one muscle; full functional 
strength of the ankles; and a stable and well-coordinated gait. (R. 1102–03.) Dr. Stulc saw 
Plaintiff four days later, noting that an MRI from 2019 did not show any degeneration or 

nerve impingement. (R. 1100.) The progress note reflects a subjective report of continued 
low back pain but no objective findings. (R. 1100–01.)                    
   Dr. Stulc completed a Medical Source Statement form on February 14, 2022, 
providing more details than he had on the October 2021 form. (R. 1160–64.) His diagnosis 
was chronic low back pain and a “failed back surgery.” (R. 1160.) In the place on the form 

where he was asked to identify the supporting clinical findings, laboratory, and test results, 
he wrote “chronic low back pain. SIP AP fusion L4-S1.” (R. 1160.) He characterized 
Plaintiff’s pain as occurring daily and ranking a 10/10. (R. 1160.) Positive objective 
findings, according to Dr. Stulc, included decreased range of motion on flexion and 
extension, a positive straight leg raising test, tenderness, and impaired sleep. (R. 1161.) Dr. 
Stulc  opined  that  Plaintiff’s  impairments  would  interfere  with  her  attention  and 

concentration constantly. (R. 1161.) Regarding functional limitations, Dr. Stulc opined that 
Plaintiff could continuously sit for 20 minutes at a time, continuously stand for 20 minutes 
at a time, stand or walk for less than 2 hours in an 8-hour workday, and sit for about 2 hours 
in an 8-hour workday. (R. 1162.) In addition, he opined, Plaintiff would need to walk for 
about 5 minutes every 20 minutes; to shift positions at will from sitting, standing, and 
walking; to take unscheduled breaks for 5 minutes every 20 minutes; and to lie down every 

1 to 2 hours. (R. 1162–63.) She could frequently lift less than 10 pounds and occasionally 
lift 10 pounds. (R. 1163.) She could bend and twist at the waist for only 10% of the 
workday. (R. 1163.) Dr. Stulc opined that Plaintiff would have no limitations with using 
her hands or fingers but would be significantly limited with repetitive reaching, handling, 
and fingering, and she would be 50% limited in reaching overhead repeatedly. (R. 1163.) 

Finally, Dr. Stulc stated that Plaintiff would be absent from work more than three days a 
month due to pain. (R. 1164.)                                             
   B.   Procedural History                                              
   Plaintiff’s DIB and SSI applications were denied at both the initial review and 
reconsideration stages. She requested an administrative hearing before an ALJ, and the 

hearing took place on March 10, 2022. (R. 41.)                            
   Plaintiff, medical expert Joseph Gaeta, and vocational expert Mary Harris testified 
at the hearing. Relevant to the issue presented for judicial review, Plaintiff testified that she 
could not work because of back pain and trouble standing, lifting, bending, and kneeling. 
(R. 47.) She also had problems with focus, concentration, memory, muscle spasms in her 
calves and feet, and nerve pain in her legs. (R. 51, 53.) She testified she could sit for no 

more than 15 minutes at a time, stand for no more than 15 minutes at a time, walk no more 
than about 3 city blocks at a time, and lift no more than about 8 pounds. (R. 47–48.) Plaintiff 
further testified she was restricted to working from home or from bed. (R. 49.) Dr. Gaeta 
testified that Plaintiff’s physical functional limitations were light levels of activity; sitting 
for no more than 6 hours in a workday; standing and walking for 6 hours in a workday; 
lifting, carrying, pushing, and pulling 20 pounds occasionally and 10 pounds frequently; 

and occasionally using ladders and scaffolds. (R. 57–58.) Dr. Gaeta based his testimony on 
a review of Plaintiff’s medical records including her spinal-fusion surgery, the subsequent 
MRI, and Dr. Stulc’s treatment records and physical examination findings. (R. 56–57.)  
   On March 24, 2022, the ALJ issued a written decision finding Plaintiff not disabled. 
(R. 7–33.) The ALJ followed the familiar five-step sequential analysis outlined in 

 and 416.920. At each step, the ALJ considered whether Plaintiff was disabled 
based on the criteria of that step. If she was not, the ALJ proceeded to the next step. See 

(a)(4), 416.920(a)(4).                                  
   The ALJ first determined that Plaintiff had not engaged in substantial gainful 
activity since the alleged onset date. (R. 12.) At the second step of the sequential analysis, 

the ALJ found that Plaintiff had the following severe impairments: degenerative disc 
disease,  chronic  pain  syndrome,  major  depressive  disorder,  and  generalized  anxiety 
disorder. (R. 13.) At step three, the ALJ concluded that Plaintiff’s impairments did not 
meet or medically equal the severity of an impairment listed in 20 C.F.R. Part 404, Subpart 
P, Appendix I. (R. 15.)                                                   

   Before  proceeding  to  step  four,  the  ALJ  assessed  Plaintiff’s  RFC,  which  is a 
measure  of  “the  most  [she]  can  still  do  despite  [her]  limitations.”  

(a)(1), 416.945(a)(1). As part of the RFC assessment, the ALJ considered 
Plaintiff’s statements about her symptoms concerning pain in her lower back and spine; 
ability to bend, squat, kneel, climb stairs, stand, lift, carry, walk, and sit; the restriction to 
working from home or bed; drowsiness from medications; and difficulties concentrating, 

remembering, and completing tasks. (R. 20.) The ALJ found that Plaintiff’s statements 
were not consistent with the medical and other evidence of record, in particular, medical 
imaging;  a  successful  spinal-fusion  surgery;  conservative  modalities  of  treatment; 
Plaintiff’s report of 95% relief of back and spine symptoms; and examinations showing 
normal strength in the lower extremities, normal reflexes, normal sensation, full range of 

motion in the lower back and extremities, normal straight leg raises, and normal and stable 
gait. (R. 20–21.) The ALJ accepted that Plaintiff had some symptoms caused by her 
impairments, but not the extent she alleged. (R. 23.)                     
   The ALJ also considered Dr. Stulc’s opinions in assessing Plaintiff’s RFC. The ALJ 
found both opinions largely not persuasive, because most of the findings and limitations 

were neither supported by nor consistent with other evidence. (R. 29–30.) The ALJ’s 
discussion of Dr. Stulc’s October 2021 opinion follows:                   
   I considered the opinion of the claimant’s treating physician, Steven Stul[c], 
   DO (C13F). In October 2021, Dr. Stul[c]  opined that the claimant had 
   permanent limitations with lifting, carrying, sitting, standing, walking, and 
   bending. She could work for 20 hours or less during a workweek (C13F/2). 
   I do not find this opinion to be persuasive. Although Dr. Stul[c] indicated 
   that the claimant was limited in the above areas, his opinion was vague and 
   only indicated general limitations in these areas without indicating the level 
   of difficulty that the claimant experienced. Furthermore, although he was 
   more specific with regards to the amount of hours that the claimant could 
   perform on a weekly basis, Dr. Stul[c] did not offer any specific evidence or 
   corroboration for his opinion. He did not reference any treatment notes, 
   physical  examination  findings,  or  medical  imaging  to  illustrate[]  the 
   claimant’s  limitation  using  objective  medical  evidence.  Therefore,  Dr. 
   Stul[c]’s  opinion  was  not  supported  by  his  medical  opinion  (C13F/2). 
   Furthermore, to the extent that Dr. Stul[c] identified limitations with lifting, 
   carrying, sitting, standing, walking, and bending, I find these opinions to be 
   somewhat persuasive  to  the extent  that  the claimant  had  some  level  of 
   limitation in these areas. Although I considered this when evaluating the 
   claimant’s level of functioning in these areas, I did not find this opinion to 
   be persuasive in light of opinions with better supportability and consistency 
   in the record. Furthermore, the opinion found the opinion [sic] that the 
   claimant was limited to working 20 hours a week to be unpersuasive. There 
   was no support for this limitation and it was not consistent with any treatment 
   notes identified in the record. Furthermore, there was no indication from any 
   of the claimant’s treating physicians that the claimant was able to perform, 
   at most, part-time work. Therefore, his opinion appeared to be based solely 
   on  the  claimant’s  own  subjective  reports  without  a  concrete  basis  with 
   objective medical findings.                                          

(R. 29–30.)                                                               
   The ALJ’s discussion of Dr. Stulc’s February 2022 opinion reads:     
   I considered the additional opinion by Dr. Stul[c] (C16F). In February 2022, 
   Dr. Stul[c] opined that the claimant’s pain interfered with her attention and 
   concentration. She could walk three city blocks. She could sit for 20 minutes 
   at a time and sit for about 2 hours during an 8-hour workday. She could stand 
   for 20 minutes, and she could sit/stand for less than 2 hours during a workday. 
   She needed to take walking breaks every 20 minutes, which would last for 5 
   minutes. She needed the ability to transition from sitting, standing, and 
   walking at will. She would need unscheduled breaks every 20 minutes, for 5 
   minutes. She could frequently lift and carry 10 pounds and occasionally lift 
   and carry 10 pounds. She was limited to bending 10% of the workday and 
   twisting 10% of the work. She had good days and bad days. She would miss 
   more than 4 days of work (C16F). I do not find this opinion to be persuasive. 
   First,  his  opinion  noted  limitations  in  additional  areas  and  noted  more 
   restrictive limitations than identified in his prior opinion. However, despite 
   noting more limitations, he indicated that he last saw the claimant at the time 
   he made his prior opinion. Therefore, it was unclear on what basis he was 
   identifying the increase in limitations (C16F/2). In addition, like the previous 
   opinion, his opinion was not well supported. Although Dr. Stul[c] referenced 
   some treatment notes, the referenced information appeared to be based on 
   the claimant’s own subjective reports with limited concreate and objective 
   findings. He stated that the claimant had 10 out of 10 pain in her lower back. 
   Dr. Stul[c] did note that the claimant had some decreased range of motion, 
   positive straight leg raises, tenderness, and impaired sleep. However, there 
   was no mention of medical imaging or her response to treatment outside 
   these  findings.  Accordingly,  Dr.  Stul[c]’s  opinion  was  not  supported. 
   Furthermore, as noted above, his opinion was inconsistent with his own 
   opinion that was made about 4 months prior and indicated vastly increased 
   impairments and limitations, without a corresponding treatment visits to 
   indicate why there was a change in his opinion. Moreover, his opinion was 
   further inconsistent with the opinion of the medical expert that appeared at 
   the  hearing.  Specifically,  Dr.  Gaeta  testified  that  Dr.  Stul[c]’s  opinion 
   appeared to be based on subjective reports by the claimant, without objective 
   clinical information in the file (Hearing Testimony). Therefore, because Dr. 
   Stul[c]’s opinion was unsupported and inconsistent with the other evidence 
   in the record, I do not find this opinion to be persuasive.          

(R. 30.)                                                                  
   The ALJ also considered Dr. Gaeta’s hearing testimony, finding it persuasive:  
   I considered the opinion of the medical expert, Joseph Gaeta, MD (Hearing 
   Testimony).  At  the  hearing  in  March  2022,  Dr.  Gaeta  opined  that  the 
   claimant did not meet a listing, after considering 1.15 and 4.05. He stated that 
   the claimant’s cardiac impairments were nonsevere. Additionally, he noted 
   that the claimant’s spinal impairment was severe and caused limitations to 
   light  work  with  frequent  postural  movements,  except  only  occasional 
   climbing of ladders, ropes, and scaffolds (Hearing Testimony). I find the 
   opinion  of  Dr.  Gaeta  to  be  generally  persuasive.  First,  Dr.  Gaeta  is  a 
   professional in the field of medicine with more than 50 years of experience 
   (C15F). Second, he supported his findings with specific references to the 
   medical record, including the MRI of her spine that showed stable findings 
   in her spine, normal physical examination findings, and conservative levels 
   of care following the alleged onset date. Third, when asked by the claimant’s 
   representative regarding discrepancies between his opinion and the opinion 
   of the claimant’s treating physician, he was able to give a clear and cogent 
   answer in support of his findings over the opinion of Dr. Stul[c]. Specifically, 
   he identified that he based his opinions purely by the objective findings that 
   were available in the record, as noted above. Furthermore, he noted that Dr. 
   Stul[c]’s opinion appeared to be based on subjective reports and symptoms 
   reported by the claimant, which had no support from his own treatment notes 
   because he did not indicate the same level of impairment or severity of 
   findings during regular care. However, although Dr. Gaeta’s opinion was 
   well supported and explained at the hearing, I find that the claimant was 
   further limited in light of her history of multiple back surgeries and her 
   reports of chronic and persistent pain that was treated with regular opioid 
   medications. Furthermore, I find that the findings during the psychological 
   consultative examination, although not significantly corroborated with the 
   evidence in the record, I find the physical observations to be convincing and 
   demonstrated functioning consistent with the residual functional capacity as 
   identified above.                                                    

(R. 28–29.)                                                               
   Based on the ALJ’s consideration of all the evidence of record, the ALJ assessed 
Plaintiff’s RFC as follows.                                               
   [Plaintiff] has the residual functional capacity to perform sedentary work as 
   defined in 20 CFR 404.1567(a) and 416.967(a) except for the following: she 
   can never climb ladders, ropes, or scaffolds. She can occasionally climb 
   ramps and stairs. She can frequently balance and occasionally stoop, crouch, 
   crawl, and kneel. She can rarely tolerate exposure to extreme temperatures. 
   She can have no exposure to dangers of life or limb in the workplace. She 
   can rarely tolerate exposure to vibrating objects or surfaces in completing 
   tasks. She cannot be required to work in environments with high, exposed 
   places.  With  regard  to  concentration,  persistence  and  pace,  she  cannot 
   perform  work  in  excess  of  simple,  routine,  repetitive  tasks.  She  can 
   occasionally  tolerate  changes  in  work  setting.  She  can  have  no  public 
   interaction. She can perform work requiring brief and superficial interaction 
   with supervisors and coworkers . . . . She cannot perform complex decision-
   making. She cannot perform rapid, assembly-line paced work (for example, 
   she can perform jobs with daily quotas, but not hourly quotas).      

(R. 19.) With this RFC, the ALJ concluded, Plaintiff could not perform her past work as a 
childcare provider, but she could work as an addressing clerk, document preparer, or 
electronic assembly worker. (R. 31–32.) Consequently, Plaintiff was not disabled. (R. 32–
33.)                                                                      

   The Appeals Council denied Plaintiff’s request for review of the ALJ’s decision. 
(R. 1.) This made the ALJ’s decision the final decision of the Commissioner for the purpose 
of judicial review.                                                       
II.  Standard of Review                                                   
   Judicial review of the Commissioner’s denial of benefits is limited to determining 
whether substantial evidence in the record as a whole supports the decision, 

(g), or whether the ALJ committed an error of law, Nash v. Commissioner, Social 
Security Administration, 

 (8th Cir. 2018). “Substantial evidence is less 
than a preponderance but is enough that a reasonable mind would find it adequate to 
support the Commissioner’s conclusion.” Krogmeier v. Barnhart, 

 
(8th Cir. 2002) (citing Prosch v. Apfel, 

 (8th Cir. 2000)). The Court 

must  examine  “evidence  that  detracts  from  the  Commissioner’s  decision  as  well  as 
evidence that supports it.” 

 (citing Craig v. Apfel, 

 (8th Cir. 2000)). 
The Court may not reverse the ALJ’s decision simply because substantial evidence would 
support a different outcome or because the Court would have decided the case differently. 

 (citing Woolf v. Shalala, 

 (8th Cir. 1993)). In other words, if it is 

possible to reach two inconsistent positions from the evidence and one of those positions 
is that of the Commissioner, the Court must affirm the decision. Robinson v. Sullivan, 

 (8th Cir. 1992).                                            
   A claimant has the burden to prove disability. See Roth v. Shalala, 

 
(8th Cir. 1995). To meet the definition of disability for DIB and SSI, the claimant must 

establish that she is unable “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.” 

(d)(1)(A); 42 U.S.C. § 1382c(a)(3)(A). The disability, not just 
the impairment, must have lasted or be expected to last for at least twelve months. Titus v. 
Sullivan, 

 (8th Cir. 1993).                                

III.  Discussion                                                          
   Plaintiff argues that the ALJ failed to account for the total limiting effects of her 
impairments. In particular, Plaintiff contends that the ALJ erred in his consideration of Dr. 
Stulc’s opinion and his evaluation of Plaintiff’s statements concerning her symptoms and 
their resulting limitations. Plaintiff also argues that the ALJ erred in relying on Dr. Gaeta’s 

testimony.                                                                
   A.   The ALJ Did Not Err in Considering Dr. Stulc’s Opinion.         
   Title 

.1520c and 416.920c set forth the standards under which an 
ALJ considers medical opinion evidence. An ALJ considers how “persuasive” an opinion 
is according to five factors: supportability, consistency, relationship with the claimant, 

specialization,  and  any  other  relevant  factors.  

.1520c(c)(1)–(5), 
416.920c(c)(1)–(5). The “most important factors” are supportability and consistency. 

.1520c(b)(2), 416.920c(b)(2). The ALJ “may, but [is] not required to,” 
explain  how  the  remaining  factors  were  considered.  

.1520c(b)(2), 
416.920c(b)(2).                                                           

   The regulatory language pertaining to supportability provides that “[t]he more 
relevant  the  objective  medical  evidence  and  supporting  explanations  presented  by  a 
medical source are to support his or her medical opinion(s) or prior administrative medical 
finding(s),  the  more  persuasive  the medical  opinions  or  prior  administrative medical 
finding(s)  will  be.”  

.1520c(c)(1),  416.920c(c)(1).  In  evaluating 
consistency, “[t]he more consistent a medical opinion(s) or prior administrative medical 

finding(s) is with the evidence from other medical sources and nonmedical sources in the 
claim, the more persuasive the medical opinions or prior administrative medical finding(s) 
will be.” 

.1520c(c)(2), 416.920c(c)(2). In other words, supportability 
looks to how well the medical source justifies their own opinion, and consistency looks to 
how well the medical source’s opinion fits with evidence from other sources.  

   Given that the supportability and consistency factors are the most important factors 
to the persuasiveness determination, an ALJ “will explain how [the ALJ] considered the 
supportability and consistency factors for a medical source’s medical opinions . . . .” 

.1520c(b)(2), 416.920c(b)(2). “The ALJ need not use the magic words of 
‘supportability’ and ‘consistency,’ but it must be clear they were addressed.” Svendsen v. 

Kijakazi, No. 1:21-CV-1029-CBK, 

, at *8 (D.S.D. July 14, 2022). The 
ALJ’s failure to articulate how he or she considered these factors is a legal error that 
warrants remand. Susan H. v. Kijakazi, No. 21-CV-2688 (ECT/ECW), 

, 
at *3 (D. Minn. Feb. 21, 2023); Michael B. v. Kijakazi, No. 21-CV-1043 (NEB/LIB), 

, at *2 (D. Minn. Sept. 26, 2022); Joel M. B. v. Kijakazi, No. 21-CV-1660 
(PAM/ECW), 

, at *3 (D. Minn. June 1, 2022) (citing Lucus v. Saul, 

 (8th Cir. 2020)).                                         
   The  Court  finds  that  the  ALJ  properly  articulated  how  he  considered  the 
supportability and consistency of Dr. Stulc’s opinions. The ALJ explained that Dr. Stulc’s 
October  2021  opinion  was  vague,  described  only  general  functional  limitations,  and 
contained  no  supporting  explanations  or  references  to  objective  medical  evidence 
whatsoever. That description is accurate. With respect to consistency, the ALJ articulated 

that a limitation to a 20-hour workweek was not consistent with any treatment notes in the 
record, including visit summaries from Plaintiff’s medical providers. Regarding Dr. Stulc’s 
February 2022 opinion, the ALJ explained that the opinion was not supported by objective 
medical evidence, including treatment notes, medical imaging, or Plaintiff’s response to 
treatment, but was based on Plaintiff’s subjective complaints. An ALJ may reduce the 

persuasive value of an opinion that is based largely on a claimant’s subjective complaints. 
Austin v. Kijakazi, 

 (8th Cir. 2022); see Kirby v. Astrue, 

 (8th Cir. 2007) (under former regulations, giving “less weight” to an opinion based 
mostly  on  subjective  complaints).  As  to  supportability,  the  ALJ  articulated  that  the 
February  2022  opinion  contained  greater  limitations  than  the  October  2021  opinion, 

without any explanation for the discrepancies, and without Dr. Stulc having seen Plaintiff 
in the four months between the opinions. The ALJ also articulated that Dr. Stulc’s second 
opinion was not consistent with Dr. Gaeta’s testimony.3 In sum, the ALJ adequately 
articulated how he considered the supportability and consistency of Dr. Stulc’s opinions.  

   The Court now turns to Plaintiff’s argument that the ALJ’s consideration of Dr. 
Stulc’s opinions was not supported by substantial evidence. The Court acknowledges that 
there may be evidence that supports and detracts from the ALJ’s determination, but the 
Court will not reweigh the evidence. Suffice it to say, the ALJ identified substantial record 
evidence,  or  its  lack,  to  support  his  consistency  and  supportability  determinations. 
Specifically, with respect to the October 2021 opinion, the ALJ observed that Dr. Stulc did 

not refer to any of his own treatment notes, physical examination findings, or imaging (R. 
29, 1106); the limitation to a 20-hour work week was not supported by or consistent with 
any treatment notes (R. 29; e.g., R. 413–32, 674–80, 1100–04); no provider indicated that 
Plaintiff would be limited to part-time work (R. 29; e.g., R. 413–32, 674–80, 1100–04); 
and Dr. Stulc’s opinion was based on Plaintiff’s subjective reports, not objective medical 

findings (R. 30; e.g., R. 419, 421, 1102). As to the February 2022 opinion, the ALJ stated 
that Dr. Stulc did not explain the increased limitations from the October 2021 opinion (R. 
30, 1160–64); supporting treatment notes did not contain objective or concrete findings 
and were based primarily on Plaintiff’s subjective statements (R. 30, 413–14, 417–18, 
1100–01); the opinion did not acknowledge medical imaging or positive responses to 

treatment (R. 30, 1160–64); and the opinion was inconsistent with Dr. Gaeta’s testimony 



3 The Court discusses Dr. Gaeta’s testimony in Part III.C below.          
(R. 30, 54–59). Consequently, the Court finds that substantial evidence in the record 
supports the ALJ’s consideration of Dr. Stulc’s opinions.                 

   B.   The ALJ Did Not Err in Evaluating Plaintiff’s Statements Concerning 
        Her Symptoms.                                                   

   The ALJ considered Plaintiff’s testimony about her symptoms and found that her 
impairments  could  be  expected  to  cause  the  alleged  symptoms  but  that  the  claimed 
intensity, persistence, and limiting effects of her symptoms were not consistent with the 
record.                                                                   
   In  evaluating  the  intensity,  persistence,  and  limiting  effects  of  a  claimant’s 
symptoms, an ALJ considers the objective medical evidence, statements from the claimant 
and others, and the following factors:                                    
   1. Daily activities;                                                 
   2. The location, duration, frequency, and intensity of pain or other symptoms; 
   3. Factors that precipitate and aggravate the symptoms;              
   4. The type, dosage, effectiveness, and side effects of any medication an 
   individual takes or has taken to alleviate pain or other symptoms;   
   5. Treatment, other than medication, an individual receives or has received 
   for relief of pain or other symptoms;                                
   6. Any measures other than treatment an individual uses or has used to relieve 
   pain or other symptoms (e.g., lying flat on his or her back, standing for 15 to 
   20 minutes every hour, or sleeping on a board); and                  
   7. Any other factors concerning an individual’s functional limitations and 
   restrictions due to pain or other symptoms.                          
SSR 16-3p, 

, at *7 (S.S.A. Mar. 16, 2016); see 

(c),  
416.929(c). An ALJ need not discuss every factor, but only the factors relevant to assessing 
the  persistence,  intensity,  and  limiting  effects  of  a  symptom.  SSR  16-3p,  

, at *7.                                                           
   Here,  the  ALJ  considered  whether  Plaintiff’s  statements  were  consistent  with 
objective  medical  evidence.  Specifically,  the  ALJ  summarized  medical  records  that 
documented examination findings of normal strength and full range of motion, imaging 
results showing a stable spine, conservative measures of treatment, providers’ observations 
of few limitations and no observable musculoskeletal deficits, and positive responses to 

physical therapy and medication. (R. 21–23, 26.) On the other hand, the ALJ also took note 
of medical records that documented findings such as tenderness in the spine, decreased 
strength, impaired reflexes, and reduced range of motion, but found these deficits were not 
consistent with Plaintiff’s self-reports of the severity of her symptoms. (R. 21–22.) As the 
ALJ observed, no provider recommended that Plaintiff should work only from home or in 

bed. (R. 26.) The ALJ also considered that Plaintiff’s level of care generally remained the 
same, and she did not require additional surgeries, increased medication, or the use of 
assistive devices. (R. 24.) Regarding side effects of medication, the ALJ noted that Plaintiff 
often did not report drowsiness or other side effects to her providers. (R. 25.)  
   The  ALJ  accounted  for  some  intensity,  persistence,  and  limiting  effects  of 

symptoms  and  reduced  Plaintiff’s  capacity  to  do  work-related  activities  accordingly. 
Specifically, the ALJ limited Plaintiff to sedentary work to avoid triggering or exacerbating 
her pain and to accommodate her limited range of motion and abnormal gait. (R. 25.) The 
ALJ  also  added  limitations  on  climbing,  balancing,  stopping,  crouching,  crawling, 
kneeling, and on exposure to extreme temperatures, vibration, and high places, to account 
for Plaintiff’s low-back pain, limited range of motion, and spinal tenderness. (R. 25.)  

   The  Court  finds  that  the  ALJ  did  not  err  in  evaluating  Plaintiff’s  symptoms. 
Substantial evidence supports the ALJ’s conclusion that the claimed intensity, persistence, 
and limiting effects of Plaintiff’s symptoms were inconsistent with the objective medical 
evidence and other relevant evidence of record.                           
   C.   The ALJ Did Not Err in Relying on Dr. Gaeta’s Testimony.        
   Plaintiff challenges the ALJ’s reliance on Dr. Gaeta’s testimony. Plaintiff claims 

that “her argument does not depend on finding his testimony unpersuasive.” (Pl.’s Br. at 
25.) Rather, she asks the Court to find that “Dr. Stulc’s opinion is at least as persuasive as 
Dr. Gaeta’s,” and then to find that the ALJ erred by not considering the other factors of 

.1520c(c) and 416.920c(c) (relationship with the claimant, specialization, 
and any other relevant factors). Plaintiff’s argument is based on section (b)(3) of 

.1520c and 416.920c, which requires an ALJ to articulate how the ALJ considered 
the other factors in paragraphs (c)(3) through (c)(5) when the ALJ finds that “two or more 
medical opinions or prior administrative medical findings about the same issue are both 
equally well-supported . . . and consistent with the record . . . but are not exactly the same.” 

.1520c(b)(3), 416.920c(b)(3).                             

   Here, the ALJ did not find that Dr. Gaeta’s and Dr. Stulc’s opinions were equally 
persuasive, so section (b)(3) does not apply. Furthermore, the Court’s ruling that the ALJ’s 
consideration of Dr. Stulc’s opinions was not erroneous essentially forecloses Plaintiff’s 
argument. Dr. Stulc’s and Dr. Gaeta’s medical opinions are not “equally well-supported” 
or equally “consistent with the record.”                                  

   Although Plaintiff denies that she is challenging the persuasiveness of Dr. Gaeta’s 
opinion, the Court will briefly address the issue in the interest of thoroughness. The ALJ 
articulated that he found Dr. Gaeta’s testimony “generally persuasive” because Dr. Gaeta 
is an experienced medical professional; Dr. Gaeta supported his findings with references 
to the medical record including imaging, normal examination findings, and conservative 
levels of care; and Dr. Gaeta cogently explained the differences between his opinion and 

Dr. Stulc’s opinion. (R. 28–29.) The Court finds, first, that the ALJ adequately explained 
how he considered the supportability and consistency factors as they relate to Dr. Gaeta’s 
opinion, and thus committed no legal error. The Court finds, second, that substantial 
evidence  of  record  supports  those  consistency  and  supportability  determinations. 
Specifically, Dr. Gaeta is an experienced medical professional and medical expert (R. 

1156–58), and Plaintiff’s representative did not object to Dr. Gaeta testifying as a medical 
expert at the hearing (R. 53–54). Dr. Gaeta testified that he reviewed Plaintiff’s medical 
records, and he referred to her spinal-fusion surgery, subsequent imaging that showed no 
nerve impingement and satisfactory positioning of the fusion implants, Dr. Stulc’s physical 
examination records that documented no particular functional abnormalities, and generally 

“fine” range of motion, strength, and reflexes. (R. 54, 56–57.) Dr. Gaeta testified that the 
functional limitations in his opinion differed from those in Dr. Stulc’s opinion, because his 
opinion was based on objective findings, whereas Dr. Stulc’s opinion could have been 
based more on subjective symptoms. (R. 58–59.) The Court has already concluded that the 
evidence described by Dr. Gaeta constitutes substantial evidence of record. The ALJ did 
not err in deeming Dr. Gaeta’s opinion persuasive.                        

IV.  Conclusion                                                           
   Based on the foregoing, and on all of the files, records, and proceedings herein, IT 
IS HEREBY ORDERED THAT:                                                   
1.  The relief requested in Plaintiff’s Brief (Dkt. No. 16) is DENIED;  
2.  The relief requested in Defendant’s Brief (Dkt No. 18) is GRANTED, and the 
   Commissioner’s final decision is AFFIRMED.                           


LET JUDGMENT BE ENTERED ACCORDINGLY.                                      


Date: March 22, 2024            s/  John F. Docherty                    
                                JOHN F. DOCHERTY                        
                                United States Magistrate Judge