INT HEU NITSETDA TDEISS TRCIOCUTR T FORT HEE ASTEDRINS TROIFCV TI RGINIA NorfoDlikv ision KIMBERLY A., Plaintiff, v. CasNeo2 .: 23cv563 CAROLWY.NC OLV1I, N ActCionmgm isosSfio ocnSieearcl u rity, Defendant. REPORATN DR ECOMMENDATION PlaiKnitmibAffe. (r "lPylff a'fii)ln tethdiai cst piuornst u4oan2 Ut . S§.4 C0.5 s(ege)k,i ng judirceivoaiftle h wfie n daelc iosfDi eofenn dCaanrtoW l.Cy onl vtihAnec, t Cionmgm issione oft hSeo cSieaclu Aridtmyi nis(t"rtCahotemi moins sdieonnyePirln"ag)i ,nc tliafofirfm s disaibnisluibrteaynn e(cfi"etD sIa Bn"sd)u ,p plesmeecnuitrnaiclt(o y"m SeSu In"dte)hSr eo cial SecurAictytT .h aicst wiaorsne fertrote huden derUsniigStnteeaddMt aegsi sJturd(ag"tete h e underspiugrnsteu2oda8 "Un ).t S §.6 C3.6 (b)(Fle)d(eBRr)ua-lol(efC C i)vP,ir lo ce7d2u(rbe) , EastDeirns torfVi icrtgL ionciCaail vR iull7 e2a ,n tdh Aep r2i,2l 0 0S2t,a nOdridnoegnr AssigonCfm eernMttaa tittneUo rn isSt teadMt aegsi sJturdagEteCesNF .o 6 .. PresbeenfottrlheCye o uirPstl ainbtriiifensff us p poofrr etv earnrsdea mla onftd h e Commissdieocnideserin'oybsnie nngeE fiCtNFso ,8.a , n tdh Ceo mmissbiroiinense fur p'pso rt oft hCeo mmissdieocnideserin'oysbni e nngeE fiCtFNs o,9. . A fterre vietwhbiern igte hfes ,

undermsaikgtenhseri des c ommewnidtahatho ieuoartni p nugr stuoFa endteR rualolefC ivil Proc7e8d(uabrnE)eda sDtiesrnot Vfri ircgtLi oncCiaialvR iul7l (eJ F)ot.rhfo el lorweiansgo ns, 1O nN ovem3b0e2,r0 2C4a,r oWl.yC no lvbienc atmheAe c tiCnogm missoifSo onceSirea clu rPiutrys.u ant toF edeRrualolefC ivPirlo ce2d5u(rtdeh) Ce,o usrutb stCiatruotleysCn o lWvfo.ir fon rm erC ommissioner ofS ociSaelc uMrairttyOi 'nM alilnte hymi ast ter. thuen derRsEiCgOnMeMdE NtDhtSah tfie n daelc iosfti hCoeon m misbseAi FoFnIeRrM ED, antdh tahtmi ast bteDe IrS MISWSIETDPH R EJUDICE. I.PROCEDURALBACKGROUND

Plaipnrtoitffe ficlteaidpv pelliyfoc raD t1i8ano dnS sSo In J anu9a,2r 0y2a 0l,l eging disabdiulteio tt hyfoe l lowiimnpga irdmeepnrtesbs:rs eicaoasnnt;c erp-erreilpahteerda l neurocphartophnayii;lc ny ;m pheartdhermaaol;fgm iual tjiopilcneht rsofa;nt iicgP uTeS;D ; ADHDb;o njeo,ia nntnd,e rpvaeia nn;x iaenmtdiy g;r aRi.an 7te3 s-.87 84-,28 P9l.aintiffs appliwceariteni iotdniesan olinlSe yedp te2m12b,0e 2ar0n a,dg adiennu ipeordne considerat onO cto1b22e,0r 2 R1.a. 1t 0 3-O0nD4 e.c em6b2,0e 2rP1 l,a irnetqiuffaeh setaerbdie nfogr e ana dminilsajtwur daRgt.aei1 t.v5 e18 6,0 . Ah eawraihsne gol nFd e br2u82a,0r 2ya3 wt,h iPclha ianptpiewffai rcteohdu nbseefolr e AdminiLsatJwru adJtgeieffv Jreoe ry(d "aAtnLh JeR" .a)4 t.5 7-2B.o th Panldaa nii mnptairfft ial vocateixoptneearsltt a ittfih heeed a rRi.an t5g 3.- 7O1nM. a r1c3h2, 0 2t3hA,eL iJs sau ed

decifisnidoPinln agi nnodttii sffa Rb.la e1td7 .- 3P7l.a ifinlteaird ffe qwuiettshhtAe p peals Countcroie lc ontshAieLd Jde'ersc iwshiiowcnahd,s e noinSe edp te2m22b,0e 2mr3a ,k itnhge ALJd'esc itshfiieno anl doeftc hCieos mimoins sRi.ao1 tn- e3r.. Havienxgh auhseatrde mdi nirsetmreaodtniNi eovsve,e m8b,2e 0r2P 3l,a ifinlteaid ff Complfoarji undtir ceivoaiftle h wCe o mmissdieocnieEsrCi'NFoso n1 ...I nac corwdiatnhc e thSeu ppleRmuelfonertSs ao lcS ieacluA rcittioyonM n asr,1c 3h2, 0 2P4l,a ifinltaebi drff ii enf supopfor retv eanrdrs eamloa nftd hCe o mmissdieocnieEsrCiN'Foos n8. ..O nA pr1i22l,0 24, thCeo mmisfisliaeob dnr eiirsne u fp pooftr hCteo mmissdieocnideserin'oybsnie nngeE fiCtFs .

2" Rr.e"fe trots hc ee rtiafidemdi nirsetcrtoahrwtadait fisv l eeu dn dseeroa nFl e br1u,2a2 ry0 2E4C.NF o . 5,pu rsutaoEna ts tDeirns torfVi igicrnti a CLiovRciuallSl e( saB n)7d ( CI))(. No9.. P laidnintdoi fitffl aer epblryi Beefc.a tuhmseae t itsfue lrlb yr ieifeitdrs ,i fo pre recommdeinsdpeods ition. IIR.ELEVAFNATC TUAL BACKGROUND ThRee cionrcdl tuhfodele ldo fawcitnbugaa clk gforrto huAenL dtJ ro e view: Plaiwnatfosir fft yy-etarowsloa d tt h tei omfhe e arl laemgeenddd iesda obnisdleaittt ey

ofA ug1u8s2,t0 2R0.a. 1t 7 R,.a 7t3 P.l aihnaatsh i iffsg chh doiopll Ro.am5 ta3 .S. h lei ves wihtehgr o dpaarnehdned tras u,gl hitvceleros Rs .ae5 t.4 6,3P .l ailnawtsoitrff ki 2ne0 d1 R9.. a5t4 -S5h5pe.r eviwoourskalesayd nE xecutivaeTt i Adseswiasttearn tC omam unit CommuHneiatAlydt vhi Msaonraa gtte hrAe m eriCcanacSneo rc iaentadCy l,i nSiucpaplo rt ServMiacneaasgHt ea rm pUtnoinv eRr.as5 ti5 5t,6y5 ,.7 . Plaiwnatdsii ffa gnwoistbehrd e caasntic ne2 r0 10R..a t5 08S.h uen derwent chemotahnhedar bdai plyam taesrtaelcR t.ao5 tm0 i8Se.is nt.ch ees nhh,eau sn derang uomnbee r ofa ddistuirognieanrlci leausr d,ei vniagsn iidmo pnlr aenmtor veallta hot eebrdr eaSseete.s g.. , R.a3t6 5-46473,--5 40978,1,1 6 6,0 P4l.a ianlhtsaioosff b esSieete.y Rg..a. 6 t,1 155,9 1.

A.PlainMteidff'iRsce aclo Rredlse tvoAal nlte PgheydsI imcpaali r3 ments Throutghrheeo luetpv earPniltoa dir,ne tgiusffla anwru lmyep rroouvsfoi rhd eeprrh sy sical impairimnecnlltuysdm,ip nhge ndeeumraoa,pn acdth hryop naiiancndd , y spPnleaai.an ltsioff reguslaahwre olrny c oplroogvyai ndpder ri,mc aryap rhey sician. 1.Lymphedema Plaihnaatsh i iffs ottrfoe rayt fomrel nytm phehdeeurmp apl eeierftnx treRm.ai5 tt0 y8., 716-R1.7a .t6 22P.l aitnrtehiaefftlr sy mphewdietammh ae digcarmaeln gtl,o vaneds, comprselseseiRvo.aen 6ts 2 .1 -24.

3B ecaPulsaei nmteinffitsma pla iramrneeon attit ss stuhCeeo, u droten soa td drPelsasi nmteidffisc al recorredlsat thoie mnreg n itmapla irments. Plaisnotuitgffrh eta atttm heLeny tm pheCdleimanatCi hce saRpeegaikMoeen dailc al CenotnJe ur2l 2,y0 2R0.a.6 t 2 3T.h esrhece,o mploaifi nncerdse waesleilhdnie rnrig hg ahntd , swelilhnie lnrega ft r tmi,n gilhnie finrng g erRt.ai 6tp2 s3P..l aisnttatithffela dat ts ehhleay s bederno ptphiinRng.ga 6 st2. 3 H.ep rr ovniodtseehrhde a m di nroarno gmfeo tainosdnt rength

deficRi.at 6ts2 .4 -S2h5ae.t tepnhdyestdih cearafela w pd ya lyast aentrdh,p e h ystihcearla pist appalw ireatdpho e lreu ftp peexrt rtepomr ietlvyye mnrpteh fi Rl.al6 t.2 1P.l aihnastdei vffe ral addiatpipoonianlfot rpm heynsttihsce arblau spthy e, ceaintchteehlredl muet edbo e iinloglri n paianns,dh dei ndos th ouwpt oo thsecrh eadpuploeidn Rt.am 6te2 n0t-s2.1 .o fhB eerc ause cancelalnnadot -isohPnolswa siwn,adt sii sffc hfraormpg heydst ihcearRla.a p6 ty2 .0 . Plaipnrteisffte otn hteeem de rgencyo ndS eeppatre3tm,2mb 0ee2cnr0ot ,m ploafi ning excessivRe.a 6 ts0 w7Se.hls elt iatnthgesa.dht s e a hwe prr imcaarprehy y stihcmaiotarn ni ng, whion stPrluacittnegotdo ti toffh e em ergencyt hoda eflvpueari rdet mmoeRvn.eat6 dt 0. 7 -08. Byt htei Pmlea iwnaetsvi affl tuahstewe edli,lhn ie rnrig ga hrhtma idm probvusethwd ea, ss t ill

expersiweenlcilihnine agnrb g d oamneldne gRs.a.6 t 0 8U.p opnh yseixcaamli nPaltaiionnt,i ff handoa pprescwiealtblholie eunr pg p eexrt reRm.ai6 tt1 i0Se.hsw e.a asl aenrodtr iewnittehd , intsaecnts aantndio ornmm,oa tlso trr eRn.ag6 tt1 h0T..h e em ergdeenpcayrr tmueloneuatdtn y acuotrle i fe-thcraeuafostrPee l naiinsngwt eilffalsndi din sgc hhaetrrhgfo eel dl omwoirnnign g. R.a6t1 1. Ono thoecrc atshiroonustg hrheeo lueptve arnwitho edPn,l aiwnastsei beffyn a provider buntos tp ecifofirlc yamlplhye sdhdeeem mao,n sntoor mra itneiedmd aelmS aeRe..a 6 t0 2, 750, 110102,61 44,61 95,11 55,81 64,91 96,01 96,4 3. 2.NeuropCahtrhoPyna,ii acnn ,Hd e adaches Plaianltsrioeff c erievgeutslr aera fotrmne enutr ospeactohntydo ca hreym otherap treafotrbm ernectaa sntcS eeeer. .Rg ..a,5 t 5 526,65 0,18 0,5 3. DuriaJn ugn2 e0 2t0e lehveiaswliitttaPh h h ysAiscsiiaasntSt eannttNa eruar ology,

Plaicnotmipfflo afli enuftep dpe exrt rpeamiwinet,ay k nseesnssc,oh rayna gnecdso ,n fusRi.o n. a5t 53S.hfu er tchoemrp loafaid naeihdle ya dwahcihsceth a irntt hebeda osfeh e nre cakn,d lasatldelad yR ..a 5 t5 4P.l airnatttiehpffdea oifhn e dra ihleya daacsah oe7r8s o uotf1 0R.. a5t5 4H.ep rr ovidehre mrae ddjiucRsa.att5 tei5 do9 n.. PlaintwiiffDt rthJ.r o eMhaantn esadott oh Cree nfotrAe rrt harnRidht eiusm atic Dis iSne pte2m0b2foe0rnr e uroppaaiRtn.ah.6 ti 8 c5 -D8rM6.a. n snoootre d Pnleauirnotpiaftfhsi paiinhn e fere ste emtebode h emra isno uorfpc aeia nnt,dh haatcs a uPsleadi tnofat liiltnff h e pasRt.a.6 t 8 6H.ea lnsootP elda imnutsicfuflsa rw osrywsmiepatntch ot miRsv.a i6t t8 y6D..r . MansfoouonPrdl aisnytmipfftswoe mrmseo scto nswiisattfi heb nrto myalgiRa.a tc ompon 685H.er eittehrieam tpeodro tfsa lnehceyepg ireannoegf,me o tainoadne roebxiecra csise

toleRr.aa 6tt8 e5Ad.l. t houghe nPdlosarhisonertdoti fbnff re eshaset prhh ,y seixcasamhl o wed nod yspanndte haha etrr e spirralatoteoo ckroeymd fo rtRa.ab6 tl8 e8.. Ine ar2l0y2P 1l,a intiff bweigDtarhnT. h terrJeeaasctakfom srpeo rnnot g ressive l bapcaki Unp.op nh ysical Pelxaaidmneitmnioaffnt sitorna,at cerdto hustepsi p tgerhrat pneezsisu s bilatteernadletlrnopye a,sl spi antt hileoo nwl eurm rbeagrai nomdnu ,l ttiepnpldoeei ran ctrso ss thuep panedrl owbearc Rk.a. t1 28P4l.a ihnatmdio ffd epraawitinete hx teanndsa ixoina l loadaindndig f,fi tcrualntsyfri otmis ointtitosni tgna gn Rd.ia n1tg2 8.S4 h.de i ndoh ta vpea in wihtehoe trl o wea lkbiuintwtg a ,ns o ttehsdah tae m bulattheaeds swiiostaftsh ai nncpgeol ien t canRe.a. 1t 2 8D4r.J. a ckrseofenrP rleadit naotq iuffla utmipbcha yrs tihcearalIat nMp oyt ion HarbVoire Rw.a.1 t 2 81. Att hree commeonDfdr a.t iJoPanlc akiscnootnmi,pff ls eetvseeedns soiafoq ntusha e rapy

tsot renhgebtroh dRey.an.1 t 0 7172,6P 8l.a irnetpioafftr etmepdro erdaurocyhft e pirao ainft ne r aqtuhae rtarpeya tRm.ae 1tn2 t6sH8.o. w ehveeprra ,li inm hietareb dit lcoio tmyp tlheetrea py, ansdh wea dsi schfoarvr igoeltdah cteli inangti tce'nspd oalnRic.cae1 yt 2. 6 D8rJ..a cknsootne d Plaiwnotubileaffdg oocda ndfoirda anit ned epaeqnudpaertnoitgct r aoal mlh oetwrpo a rticipat depenodnhi epnrag li env Re.al1 t.2 68. Plaiwnastsei beffyPn h ysAiscsiianAs ktsKaeenlkt tl hiSekp o Mretdsi acniOdnrt eh opedic CenBteelHrla er bioMnua rr2 c0h2fo 1rc omploafkin npetaessi tne mfrmoimanm go tvoerh icle accitdheoancttc uirnOr cetdo2 b0e2Rr0 .a. 1t 0 7W7h.i hloes pifotrat lhmieoz tevoder h icle accidentr,e cePailC vaTsei cdnao tnfhi effcr e rvsipc,iwa nhlei wcahns e gafotrfri avcet ure,

disloocsrau tbilounRx,.aa 7 tt5i 7Po.ln a.i anlhtsaioadfffu lrla nogmfeo tiihnoe nnr e acnknd o neurodleofigciRic.ata 7tsl5 . 7A .tt haep poiwnitPtm.heKA ne.tk lPilka,ie nntdiobffra scekd paianr,t hrjaolisgntitia ffnsae,nsm dsy ,a lgRi.aa t1s0 .7 P7l.a ihnatndio ffrsm eanls naot ion, detemcottweoedra knnoes swse,la lniadfun lgal,c triavnoegfm eo tiRo.an1 t.0 75. Atafo lluopaw p poiwnitDtmrheJ. na tc kDsrJo.an c,k son notweadus n tahbalte Pl toc ompalqeuttahe e rdautpeopy a wihne gne totuiotnfb g e dR..a t1 31D7r.J. a ckaslosno reviaenMw ReoIdPf l ailnutmisbfparfi swn heid,ce hm onsmtirnaimtmuealdlt dielgeevneelr ativ didsics emaislleod,w l eurm fabcaert aarntmdhi ralondst ieesrn,id opcrlh aatneRg .ae 1ts3 .2 0- 21O.thertwhfiiens deiw,ne grnseos t i gniRfi.ac1 ta3 n2tD1.rJ. .a ckrseocno mmPelnadiendt iff engiabnga esc tkr estacchreeosxi,el riacawsic es aleysls o ,ga ant da iR .ca1 ht3i 1.7 . Plaisnatnwie ffu roDlrBo.eg liasActrh aefoswrh h oe adaacnnhdee usr oAptaav t ihsyi.t iMna oy2f 0 2P1l,a idnetsicffnr uimbbeandne tdsi sn galloilvne egxr t repmaioitvnihe eernsr e, c k anbda caksw, e alshl e srh oulandkelhreassn,,ad nskd,n eRe.as 1t.2 6P1l.a ianltesinoffd orsed feeltiinrgae nwdde aakn,dd i fficwualltkyiR n.ag t1. 2 6A1s.fo rh ehre adaPclhaeisn,t iff descbriilbaehtdee ardaawlci ththehrs o anbdbs ionrgefr noemtsh bsea ocfhke nre cRk.a.1 t 2 61.

Plaisnttahitepffera d wi anas 1 0o uotf1 0i sne veanrdti htsayht,ee x perniaeunascleeowadni gt h hehre adaRc.ah t1e 2s6.D1 r.A. r aisdheon stoimfideee dc rseeansseadRt .ai t1o 2n6.H5 e. prescmreidbiecadana tddi voins edt fooPl lluaopiiw nfon tu miroff n tRh.as1 t.2 67. Plaiangtapiirffne steothn ete emde rgdeenpcayro tnJm uen1ne5t2 , 0 2R1..a t1 311. Plaiwnatesix ffp eriencsihnogu plbadiitelnhrah a tatped rr oaglr ewsosrisvoeevnleetydrh e prevtiwowoue sei knas d,d ittowio orns ennuimnbgan netdsi sn gilbni onhtgah n Rd.sa .1t 3 11. Shfuret hceorm pltahihaneltere d ft sphaoriuanld diteatorth aeend t eorhfie corhr ea snttdhb ea ck ofh enre cRk.a. 1t 3 1H1e.sr y mptwoomrssw einmteohdv emaenpndat l paRt.ai 1to3 n1.1 . Upopnh yseixcaamli nPaltaiihonacntdh,i e ffps atia nr,t hrmaylagliaganinsdae, spc ,ka iRn.a. t 131H3e.or t hseyrs tweemraselr le viaenwndee dg atRi.av 1te3 .1 S3h.he a ndod ecreased

sensaantndiom o ont woera knRe.as 1ts3 .1 T4h.ee m ergdeenpcayro trmdeelnratebR ds.a . t 131T4h.e reno dw iaasgfo nuonsadin,Psd l aiwnadtsii sffc htahsreag meeevd e nRi.an1 tg3 .1 6. Follhoewhrio nsgpv iitsPaillta ,i ntiuffpw ifoPtl.hlKA oe.wk ealdtti h kSe p oMretdsi cine anOdr thoCpeendBtieeclrH l areb oRu.ra .1t 3 4P6..KA e.k foluinknd ofo cafiln diinlnge sft shoualndtdeh urap,toe nx aminsahhteani doos ne,n slooarsnysnd, om otor wRe.aa1 tk3 n4e6s.s . FurtPhleari,n tifwfesbr aestc ynokmo prtmoamls aftearn ndfie brrvoem-tyrraeellagatitmaee dn ts R.a1t3 46. Ata fo lluopwa ppoiwnittmDherAn .rt a sihnAo u gu2s0t2P 1l,a icnotmipffl oafi ned worsehneiandgaR c.ah 1te5 s1.P5 l.a ienxtpilffta hihanether ed a dawcehrbeeis l aatnsedhr ea l rattehdea1 m 0o uotf1 0 i sne veRr.ai1 tt5 y1.P5 l.a isnttatithffnee ud m bannetdsi sn golvienrg heerx trehmanidotc tih easn Rg.ae1 td5 .1 A5p .h yseixcaamli dneamtoinosPntl raaiwtnaetsdi ff

noitrn e spidriasttaornrhedyas n dsoe , d emRa.a.1 t 5 1P5l.a idnihtdai mvffue s ctuelnard erness ansdo mdee crseeansseadRt .ai1 to5 n1S.5h .de e monsfutlsrlta rteewndig ttthhehe x, c eopft ion sompeo eofrfo orvthe erlr o weexrt redmutiepot a iieRns.a. 1 t 5 15. Plaicnotnitffti tonr uweeiadDtt rh A. r aisenha or2 l0y2R 2.a.1 t 4 9S4h.re e poarltmeods t daihleya datchhwaeetsrs ,eo metsiemveaesnr wdeo ,r sweintwehed a tchhearna gneodst her extesrntailmR u.al 1ti4 .9 P3l.a irnetpiotffrh htaeetndr e urospyamtphtwyoe mrmsea nageable buwto rsweinetexhdp otsohu eraRet. a. 1t 4 9A3d.d itisohrneea plolaryct,hel idon wgbe arc k sympttohrmaastd, it ahtreosuh gehhrioa punl tdo weexrt reRm.ai1 tt4 i9eP4sl..a iwnatrytsii nffg tod oy ogsat,r eetxcehriacnnigmds e edsi,aa thtio omnRes..a 1 t4 9A4p .h yseixcaamli nation

demonstthlreeas ftti eoddfPe l ainnteicwfkasf sws o lblunetone ,d emRa.a. 1t 4 9P9l.a intiff demonsntorrasmttaerlde w nigttthhehe x, c eopfst oimopeno eoffro orvtte hrle o weexrt remitie fropma iRn.a.1 t 4 9D9rA..r aasdhjou Psltaeidmn etdiifcfaasnit dni sotnhr eutrcfoo tl eludop w ifonu mro ntRh.as1 t.4 99. Plaivnitsihiffetp rer di mcarya prreo vNiudrePsrre,a ctSiutsiWaohnni etre huirns t-Do Ju2n0e2 T2h.e Prlea,ir netqiuaffer setfeetrrdpoa h ly stihceadrluat epco yh rpoaniiisncs wuietsh fibromybaalpcgakii kann,,pe aei anns,dh oupladiaennsr,dh r ee quaer setfeetrdpor o adli foart ry foocta rreel tahote enrde uroRp.aa1 tt5 h8yN3... WP h.i tehucrosmtm-etDnhotiasetntsdh p ea st, aqtuhae wraavspe yhr eyl foprfuP ll aisnytmipftfRos.am 1 ts5 .8P 3l.a irnetpiohffre atrse tdh ma wanso dto iwnegal nlsd h nee etduoes daer esicnuhesa elveterir mapeleds ra Ry.a.1 t 5 8O3na. physeixcaamli Pnaltaiihonanntdoe,i d ffe nmoar,rm easlp iarnradht yiatonhnhdm eh re asrotu nds wenroer mRa.al1 t.5 8P6l.a iwnastsli toffrow i frsoeam s eaptoesdia tnsidhow ena ,l skleodw ly. R.a1t5 86. Ath eirn iatpipaoli wnitttmhhepe no td iathtpero idsitna,ot trPeildsa ti ntiffs neur

examiwnaaests isoenni tnitwaailcttlthhey,e x ceopfet viiodnoe fnn ecreevn et raapbmoteuhntet tartsuanalnn ecdlo uorfts hefie b unlearrv Re.as 1t.7 2P5l.a ihnantdoie ff d eanmdan ,o rmal streannmgdut sht colineneh efere tR..a t17 25P.l ainptoidfifastr hiewsrit tc hufis tttoemd orthoRt.ai 1tc7 s1A.9t a.fo lluopaw p poinPtlmaeinntt,it ffh tarhtcee up sootrrottmeh do tics werhee lpafunsldh, we a esx perineopn aciRin.na. tg1 7 15-H1ep6rh. y seixcaasmlhs o wed Plaihnastdoi mpffea a innsd o mdee crseeanssebadut ntio ornsm,ta rle annmgdut shtc olneRe .a. t 172171 1,18 7 ,11 57 13. Ata na ppoiwnitDtmrheA. nr ta isJnhu o2n 0e2 P2l,a irnetpiowffro tresdeh neiandga ches. R.a1t4 77-11647895-,D1 r6A.8r 6a.as dhjou hsemtree ddi caadtviihosenter,rod e maacitni ve ande xeracmsiu scaehsp ossainbidln es,tP rluacittnefootdl i luffopi w fon u mro ntRh.as t1. 6 86.

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respiirnafetcootorrit yohr nee rs piprraotwcoherisiycsas h c uitnnea taunrndeo "tt ehdaw ]t i"t[h out furthewro r[k]uwopi rt haocuctteto sh wseo rktuhhpaat as l rbeeapedenyr foiirtnsm o petod s sible form et goi avp er ognRo.as5 ti9 s1D..r"H . o ffmfurtahne ars setsh"sa[ettd ] ihesev riedo efn ce signilfiycmapnhteo dfte humepa p eexrt repmairttiietcshuu,elp aplreelrefty x treamnhidet y" "coulgdea tr n eoltir aebpleeac,to anbselixesa tmeindntua tet[o iP olna ifrnetqiucfeofnustg] h ing andd ifficburletya tRh.ai5 tn9 g1.." Basoendh iesx aminDarHt.oi fofmnfoa,un n Pdl aihnattdih foffel lofuwnicntgi onal limit(a1st)hic eoo nusslt:daa npdp rox1ih moaiutanren el iyg htw-ohrok(ud2ras) yhc ;eo uslidt approx6ih moauritsnae nle yi ghtw-ohroku(dr3as )yhc ;eo ulliudftp t o5p ounfrdesq uently, betw5ea enn1d 0 p ounodcsc asiaon"ndpa rlolbyna,eb vlmeyor"rt eh a1n0p ounidnas n employsmeetnt(4ti )d n ugte;od yspsnheweao ,u hladvs ee vdeirffiec wuiltanthyyp ostural actiivnictlipuerdsoi,ln sogtn agneaddni wdna gl,k( i5dn)ugt e;do y spsnhweeoa u,l ds ehvaevree difficwuiltathnym y a nipualcattiiivnvicetl irueedsai cnhhgani dnlgfei,en lgi,gn rga,s opri ng,

fingearni(5dn )e g x;t roeftm eemsp earnardte usrpeiisrr artiwotoraucynll tdes ea xralcyeh rebra te difficiubnlr teya tRh.ai5 tn9 g2F..i naDlrHl.oy f,fmn aontt eh"daa tan s sidsetvfoiirvwc eae l king andfo ra mbulsaatfeiitmsoye n d inceaclelseysv aweryin,t [ hPilna ihnotmieRf..af"5 ts 9 ]2 . 2S.taAtgee nMcedyi Ecxaalm iners Att hien ilteiovafelrl e ovnAi uegw2u,7s 2,t0 2s0t,aa gteeen xcaym DirDn.ae vrBi rdi stow reviPelwaeidrn etciaoffnrsmdd a dfien dirneggsar hdeifurnn gc tliiomniatlRa .at 8ti3 o9,n8 s-. 100D.r. Bdreitsetromwi nheadtd h foPell laoiewnxitenirgfftl iiomniat(la1 ts)ih coeon usl:d occasliiooftncr aar lr1ly0py o unadnfrsde, q uleinofttcrl arry y l ess1 0pt ohuan(nd2 ss)hc; eo uld staonrwd a lwkin tohr bmraelfoa r2k h so u(r3ss)h;c e o usliwdti ntohr bmraelfoa r6k h so uirns ane ightw-ohrok(ud4 ra)s y hc;eo uolcdc asciloinrmaamblp slsty,a liardsda,en ordcs c,a sionall

stokonpea,en cldr a(w5sl)h;w e o uhladnv oem anipullaitmiivtaean (td6is )ohw neos u;nl edte od avociodn centratteoex dt rceeoxmlhpedeo ,aans tduh, ru em iadniwdto yu,nl edet dao voeivde n modeerxaptoets fuoum reeans d o doRr.as8 t.3 -8D5rB..r istow Pdleatienrtmbiieffn ewdo ul capaobfple er forsmeidnegwn otraRkr.a.y8 t 6 . Att hree conslideevorefral et viiooenOn wc ,t o1b12e,0r 2 D1rR,.i chard McGuffin, reviPelwaeidrn etciaffonsrmd da dfien dings Prleagiafunrntdciitffnislg oi mniatlRa .at ti ons. 115-11371,- I3nc3 o.n twriatDshrBt .r isDtroM.wc ,G uffin detecrmoiun(le1dd): Plai occasliiooftncr aa lr2lr0pyy o unadnfrsde, q uelniofttcr la yr1 r0py o und(s2s;)t aonrwda lwikt h normalfo r4b h roeuaarkns(sd;3 h )a vuen limitetdeo x etxrcpeoomlsedu ,ar nehhd ue maitd,i ty, anda vooindcl oyn ceenxtproatstfuouem rdeae sn o dd oRr.as1 t1. 5 -D1r6M..c Gudffient ermined Plaiwnotubilecffd a paobpfle er folrmiiwgnohgrtR k .a.1 t 1 5-H1eo6 t.h eargwriwesieeDthd r . Brisslt iomwi't Ra.at1 ti1 o5n-s1.6 . C.PlainTteisff'tsia mtAo LnJHy e aring Plaitnetsitffi sfihehedar set shiapdtru oabrlle elmtashot e eprdr evdiioaugson fso tsaigse

3Bt ripleb-rneecagasantatc nietdvrhr e ee ltarteeadt Rm.ae 5tn8 tS.sh s.et asthseeud ff freorms fibrompyaatilhngr ioau hgebhroo dnuyet,r p vaeim ni,g rapienreisnp,eh uerroaiplhna e htrah nyd s anfede atsw, e ilnl vhoeibrco exR ..a 5t8 -5P9l.a ienxtpilffta hihanetaer id l maeraner t ess ult ofr ecesitvriconhngeg m otRh.ea 5rt8a Ap.dy d.i tiPolnaaihlnalltsyyi m,ffp heodnte hlmeea ft ­ sidweh,im cahk iets ditffiowc ruibltetec asuhiselse e ft-haRn.ad 5te8 dT..h l ey mphedema affehcetfrrso tmh uep pcehrew sadtlo lw tnho e erl baonwcd,a ulsiemsfei etleaidnn ddgi fficulty lifthielnrega ft r mR..a 5 t9 B.e caoutfsh esi hsme,o sutslheyesr r i hganhdta nadr mR..a 6t2 . Asfo rP lainmteinhftefaaslil stshsu hesese ,ae t sh ereavpeTirusyet s adnahdya a,sn emotsiuopnpdaoolgrR .t.a 6t0 S.h fuer tshueffrfre oramss thamnaadtt, h t ei omtfeh hee aring, wadsi agwniostsehev dpe erres aissttheRmn.aat6 t. 0 C .h anigne sste haesa onnxsiw,ea tlyk,i ng,

anedn virocnomnetnatmeaixlna anctehsrea brsa ttahenm mdaa kieht a rtdboe rre aRt.ah 6te0 .- 61. Plailnitwviiehfftse h gr o dpabrudeton netosrst e caesisviefrs ottmah necRme.a. 6 t 3 H.e r daugahstsehireis rptn is c kinugpfr otmth hisent goRsr.a e6 t.3 P.l aicnabtnai toffhn he eo rw n, ansdh heaa sg rbaabir tn h bea thtbuabt hatmnpoadr t esvfa elnltiRn .ag6 t.3 S .h ieas l asbotl oe drehsesri sbnea lscfil co tRh.ai6 tn3 g.. IITIH.EA LJD'ESC ISION Tod eteirtfmh cieln aei imesal nitfog rib belneet fihAteLs cJ,o ndaufi cvtes-s setqeupe ntial evalupartoic2oe0Csn ..s FR.§ . 4 §0 4.411562.0M9,a2 s0cv;iC. oo lv7i8Fn0. , 36 d3 623,4 -(43 t5h Ci2r0.1 (5s)u mmartihzfieiv neg-s setqeupee nvtailaulaA ttsi tooennp)te .h,A e L cJo nsiders whetthhceelr a ihmaawsno tr kseidnt chaeel leognesddea tta eni,dsf o w,h etthhewarot r k constsiutbusttgeaasni tanicfuatlli § v§4i 0t4y..1 52401(6a.)9(240)A((tasi )t)t(e,w4p to) h,(e i ).

ALcJo nswihdeetrthshce elr a ihmaaassn etv pehryes oirmc eanlit mapla itrhmmaeetne ttth se durarteiqouni r§e§4m 0e4n.t1.5 204(1a6).(942)0(A(itasi )tt)(eh,4pr ) te(hAeieL,i dJ )e .t ermines whetthhceelr a ihmaaasnni tm paitrhmmaeetne ottre s q utahlsese veorfali itsyit mepda irment sefotr ti2hn0 C .FP.aR4r.0t S4 u,b pPaA,rp tp e1n.d§ i§4x 0 4.15204(1a6).(942)0((iai)i()4,) Itfh cel aidmoanenoshtt a anv iem paitrmhmeaenteto t ersq utahslees v eorafli itsiytm epda irment, thAeL wJi dlelt etrhmceil naei mraenstifu'dnsuc atlci aopnaatclhi iatystt,,h m eo stthc el aimant cadnod eshpeiirtm ep air§m§4e 0n4t.s1.54 4156(.a9A)4t,5s (tfoaeu)pr.t , hA eL cJo nsiders whetthhceelr a icmaasnnt ptie lrlf poarmrs etl ewvoargnkit vh eionsrh erre sifudnucatli onal capac§i§4t 0y4.. 15204(1a6).(942)0((iFavi))n(,aa4 lts)l t(yfiei,vpv e t),h.A e L Jc onsiders whetthhceelr a icmapannet r footrhwmeo rr§ k§4. 0 4.15204(1a6).(942)0((va)),( 4)(v).

ThAeL wJi dlelt etrmhicenl ea iimnsao dntit s aibftl:heh eday ve en gaignse udb stantial gaiancfutlai stvt ioetnpyte h;de ony o hta avnesy e viemrpea iarstmt etenwptoo sir;t f h cel aimant capne rfpoarrsmet l ewvoanratkst t foeupr S.eJ ea cksvoC.no lNvoi2.n: ,1 3c2v031W54L7 , 2859a1*t41 9(0,E .VDaJ..u 2n3e2, 0 1T4h)Ae.L wJi dlelt etrhmceil naeii mdsai nstai btflh eed claimiamnpta'imsre metethnssete veorfali itys itmepda iarstmt etenhrpte o eri,t f h cel aimant canpneortfoo rtmhw eorra kst t fievpeI .ds ;ea el Msaos c7i8Fo0. , 3a d6t 3 4-(3no5tt hiAenL gJ wiolnlld ye tertmhcieln aei mraenstifu'dnsuc atlic oanpaailctf ih fitery ts htr seteed pons o t detedrimsianbei lity). Undtehrsi esq uaennatlityahAsleLi mJsa ,dt ehfo el lofiwnidniognfaf gc astn cdo nclusions olfa w: Ats toenpte h,Ae L foJu ntdh Palta ihnantdoi etffn gaignse udb stganatiianacfultl i vity sintchaeem enadleldde igseadob nisldeiatott fAye u g1u8s2,t0 2R0.a. 1t 9 A.ts ttewpto h,e ALfoJu ntdhP alta ihnattdhifo effl losweivniegmr pea irmafefencettd sii:vs oarndxeiresty;- relat disocrhdreoprna;isi cyn n drloymmep;h esdteapmtoaubs srt e caasntca esrt;ho mbae;sa intdy ; disoorftd heleru sm sbapriR n.ae t2. 0 A.t s ttehpr tehAeeL, cJ o nsiPdleariensdte ivff'esr e

impaiarmnefodnu tntsdh Palta idnintdoih tffa vaeni mpaiorrcm oemnbti onfia mtpiaoinr ments thmaetot rm ediecqaulaltlyhse eed v eorfoi notyeft hlei sitmepda iirm2ne0 nC t..sFRP .t4 .0 4, SubPpA,tp .p1 ..R .a 2t0 -24. Aftesrt tehpr tehAeeL, dJ e tertmhiPanltea dih nattdih rffee sidual function ("RFtCpo"e )r fosrme dewnotrawkri,ytt hhfoe l lolwiimnigt ations: Shcea snt aonrwd a lnkom orteh oannhe o tuorit naan l[[ ]]8 -whoorukardn ady walnkol ontgheoarnn be l oacattk i wmiett hhae io dfa c aonrec r uSthcceha .n stannold o ntghe1ar0nm inuattaet si mSehc.ea ncnloitlm abd dreorposer,s , scaffboulstdhc sea, pn e rfoortmhp eors tmuorvaelmo enan not csc asbiaosniasl. Shiels i mtiost iemdpr loeu,ta inlndoe sw,t rteasswski slt ohsw t rdeesfisna esd requwiorrwikin ntgohm orteh oacnc ascihoanniagtnleh r seo uatniwdno ert kh at allhoewtrso a vofaisdt -ptaacssekudsc a hsa ssembjloybi-snl vionlev ing produqcutoiStohainesls .i mtiootc ecda siinotnearwlai cttthhpie uo bnSl hiiecs . limtiotfre edq ufienngte grriansghp,ai nndgal,nir dne ga cShhicenan gn.wo otr k arohuanzdas ruadcmssho vidnagn gemraocuhsia nnuednr pyr ohteeicgSthheteds . canwnooritken n virotnhwmaoetun sltudsb hjeetrceo tv meond eerxaptoets ou re respiirrartiaotneryadx n ttrtsee mmep earnahtduu mriedsi ty. R.a2t4 . Inm aktinhdgie st ermtihnAeaL ctJoi nosni,"d aselyrlme pdtan odtm hsee x ttewonh ti ch thessyem ptcoarnme sa sobneaa cbcleaypcs t oends wiisthtteheo nbtj ective medical otheevri dbeanscoeentd, hr ee quiroef2m 0Ce .nFt§.s4 R"0. 4 .a1n5§d42 196 .a9n2Sd9S 1,R6 - 3pR..a 2 t4 . Ats tfoeupr t,hA eL dJe tertmhiPanltea diw natisin ffc aopfap belref ohrempria nsgt relewvoarankast n e xecaustsiivwseht iiaccsnho t n sildiewgrohertadk na ,das no utrweoarckhe r, whiiccsho nsildiewgrohertbdk u h,te atvovy e hreya wvoyra ksa ctupaelrlfoyrR m.ae 3td5 .. WhiPllea intiff hceaprnr niootr reemtsphAuleLmo dJeye mteenratmst,it finevepted h Palta intiff coupledr footrhjmeo trbh sea xtii ssnit g ninfiucmabinetntrh n sea tieocnoanloR m.ay 3t.5 -36.

ThutshA,eL dJe tertmhiPanltea diw nantsoi dtffi safrbolmte hadel loengsededat tA eu,g1 u8s,t 202t0h,r otuhdgeah ot fhe i dse ciMsarico1hn3 2,,0 2R3.a.3 t 7 . IVS.TANDAORFRD E VIEW UndtehSreo cSieacluA rcittth,Cye o urretv'oistfe h wCe o mmissfiinodanelec rii'sssi on limtiodt eetde rwmhienttihhndeeger c iwsaissou np pboyrs tuebds teavnitdiientanh lrce ee c ord anwdh etthhceeor r lreegcsattl a nwdaaasrp dp liinee vda lutahetevi indgeS ne4ce2eU .. S.C. §405H(aygsv) S.;u ll9i0vF7a. n12,4d 5 134,5( 64C tih1r 9.9 S0u)b.s teavnitdiie"sane lcv ei dence aasr easomnianmbdil gaehc tca easpd te qtusoau tpeap c oorntc luCsriavoiC.gnh .a"t7 e6Fr .,3 d 58558,(9 4 Ctih1r 9.9 (6q)u oRtiicnhgav rP.de sroan4l 0eU2s. ,3S 8.49 0,(1 1 97"1Ic)to) n.s ists o'fm otrheaam ne rsec inotefiv lildbaeum ntac byees omelwehtsahstaa p nr epondBerriatntc e.'

vS.au8l6F,0A. p p2'5x26 6,(0 4 Ctih2r 0.2 (1q)u oCtrian7ig6Fg .,a 35td8 9T)h.Ce o ulroto ks fora n" accaunrldao tgebi rciadblge et"wt eheeevn i daenntdchA eeL Jc'osn cluWsoiovod.ns s . Berr8y8hFi8.l 63l8d,66 9,(44 Ctih2r 0.1 M8o)n;rv oC.eo l8vi2Fn6., 13 7d16 8,(9 4 Ctih2r 0.1 6); MascvCi.oo l v7i8Fn0., 63 3d62 3,(74 Ctih2r 0.1 5). Idne termwihneittnhhgCee or m missdieocniiesssriu 'opsnp b oysr utbesdt eavnitdieanlc e, thCeo udrotne os"t r e-cwoeniflgihec vtiidnmegan kcceer ,e didbeitleirtmyoi rsn uabtsitointsu,t e oujru dgfomret nhotaf tt h [eC ommissCiroa7ni6egF r,. ]a3.5td"8 9I."f c onfleivcitdienngc e allroewass omniantbddolsi e ff aestr wo h etchleari imadsa i nstat bhrleee sdp,o nfosrti hbaitl ity decifasliolontsn h [ eC ommis(sotirh[o eCn oemrm]i sdseisointgehnrAea'L tsJe]I), d.( "q uoting WalvkB.eo rw e8n3F,4. 623d65 4,(0 7 Ctih1r 9.8 7A)c)c.o rditifhn Cego lmym,i ssdieonniearl' s ofb eneifisstu sp pboyrs tuebds teavnitdaienanadlcp ep tlhiceeo sr lreegscattla ntdhaCero durt , musatf firmC otmhmei ssfiinodanelec riH'sasiy o9sn0,F.7 . a21td4 56. V.ANALYSIS

Plainatpiptfeotra hslCi osu rratia ss eisnc ghlael tloteh nAegL eJd 'esc isitohne- that ALiJm proepvearltluhyape te erds uaossfit vaaegtneeecn socsny s uelxtaamtDiirHnv.oee fr fm an's opinIidao.7tn- 1 .2 P.l aidnotneiosfft dtihtsahpAteuL tpJer opanearllytyzh seeud p portabil factboudrti, s ptuhttaheAtesL p Jr opaenralltyyh czeoe nds ifasctteEonCrcNF.yo 8 .a 1t1( noting thAeL Js'tsa ttehmtaehtmne et d iocpailnw iasosun p pboyrh tioeswd on b jeecxtafiimnv dei ngs "paessths]e[s upporptraobniIglnr"i e)tys. p tohnCeso emm,i ssairogntueheAresL a Jp ptlhiee d prorpeegru liaentv iaolnusaH toifnfmgao npD'irsn.a i ntodhn ta,htA e L Ja'nsa liysssu ipsp orted bys ubsteavnitdiEeaCnlNFc o e9..a 1t-6 29. UndtheeSr o cSieacluA rdimtiyn irsetgrual5t,ta ihtAoeiLn moJ un cssotn seiadmceehrd ical opiniintoh rnee canodrart di cuhloapwte er sutahsfieinytvd he me e diocpailnb iaosonent d h e

followfaicntgo( r1ss)u: p por(t2ac)bo inlsiit(sy3tr;)ee nlcayt;wi iothtn hscehl iapi (m4a)n t; speciaalni(dz5o a)tt hfaiecortnt o;hrt aset tn sodu popcroo rntt trhaoedp iicn§ti§4 o 0n4.. 1520c(b (c)(l4)1-6(.59)2(,0c c)((blS))u,-p (p5o)r.at nacdbo inlsiitasyrt" eet nmhcoeys i tm portant factoirnds e"t ertmhipene irnsgu aosfaim veednioecpsaisln an ido na,c cotrhAdeLi mJnu gslty , explhaoihwne o rs hceo nsitdheofarsceetd io nrt shw er idtetceins §i§4o 0n45..2 l0 c(b)(2) 416.920Wci(tbrh)e (s2pt)eos.c u tp por"t[atbm]iohlrreiee t lye,tv hanoetb jemcetdiivcea l evidanedns cuep poerxtpilnagpn raetsibeoynanm t see ddis coaualrr cete,h ""em opreer suasive thmee diocpailn iwoibnle[l§.] §4 " 0 4.152401c6(.c9)2(0Alcs)fo( ,rcc )o(nls)i'.s' t[etn]chye,

5B ecatuhsmieas t itnevro alc vleafisil mea dft eMra r2c7h2, 0 1t7hr,ee virseegdu lraetgiaotrnhdsei ng evaluoamfte idoioncp ailns iefootrn tishSn e ct4i0o4n. 1a5p2pi0ltncyh c iassU en.dt ehnree rwe gulations ALJnsol on"gdeerof grei rav nesy p eceivfiicd ewnetiigiahnrytc ,lc uodnitrnogwl eliigtnhaogtn m ,ye dical opini2o0Cn ..F"§.4 R0.4 .1520c(a). morceo nsaim setdeioncptai ln iiwosi n"t[eh]v "i frdoeomnt chmeee rd iscoaular ncndeo sn medical sourtche"esm ,op"re er sutahmseei dvioecp ailn iwoibnle[l§.] §4 " 0 4.152401c6(.c9)2(02c)(,2 ) ThAeL mJa ey xplhaoitwnh ecoyn sitdhoeetr hefaedcr t oirnsc,l tuhdmeie ndgis coaulr ce's

relatwiiottnhhcse lh aiipbm uanattro ,en rleyq utidoro se owd h ecno ntramdeidciotcpoairyln ions regartdhsiean mgie s saureee q uaslulpyp obryat necddo nsiwsitttehhnr ete co§r§d . 404.15204c1(6b.)9(220)c-I((mfb3e ))d(,io2 cp)ai-lnr( ie3og)nar.std hisena gmi es saruee eq ually suppboyar ntcdeo dn swiisttthhere ne tct ohrAedL m,Ju satr titchouetl hafaetcerta onrcdso nsider thiemiproa ntc htpe e rsuaostfi hvmeee ndeioscpsai ln i§o§4n 0s4.. 152401c6(.b9)2(03c)(,b )( Ine valuDartH.io nffgm aonp'isn tihoAenL ,Je xplatihsneue pdp orotfDa rb.i lity Hoffmaonp'isns itoatnth,ifoe nl gl owing: DrH.o ffmaonp'isna irsoeun psp boyrh tieesxd a mionfta htceil oani wmhaincth, showcelda ihmaasdni tg nidfiycsanpetnv eewani m tihn iemxaelran tdai rtoe ns t, asw ealswl h eeaznipdno gao irmr o vemseingtn,il fiycmapnhtei dnt ehumepa p er extretmeintdieierntnseh l,see hs fti spl,ao nwad n taglawgiiitutc sho e afc anaen,d difficwuilhttehyet loa,en ,td a ndwealmak np,do stmuanreaulvH eorwse.hv ee r, onelxyam itnhecedl aiomnancaten a,dtt h taitms ehh,ea adna curtees piratory proc(e1s[2sRFa . 5t 8 9-O9n3Se]e )p.t e2m0b2ee0xr as mh owcelda ihmanadon t dyspwniestaih t atnitdna glo kwrii nwtgah l kaintndag l (k2i0nF[g/R a2.1t5 0 39]). A rheumavtioislniSo teg pyt e2m0b2ae0lr ss hoo wtehsdah the a cdo mfortable respirraaattnendo od r yys p(n1e5a[F R/a.46t 8 8H]e)mr.o srte cpeunltm onary evalusahtogiwoosonr d e spifirnadtioonnreg yxs a amsw e(l4l0 [FRa .t1 639- 1646]). R.a3t3 A.sfo rt hceo nsiosftt hoeepn icnyti hAoeLn eJ,x pltahifoenl eldo wing: DrH.o ffmaans'sse sissam lensnootet n ticroenlsyiw sittlehan tetev ri dence showoinntlgry a lcyem phe(d1e8mF[a/Ra 1.t73 5 03]8;F [/R3a.2t1 60a9n]d) evidencteh sashthhe oa nwdopi anwigin ht ehoe rtl o wea lkicnogu slaidnn dg le lesgt awnictehd oiuffitc( u2l4tyF[ /Ra2.1t4 2 8R4e]l)a.t ivreelcyao lrrsdeosc ent indicatieas b ctllmoeaa inmahagepnerat (i 4n1 9F-/[14R0,a . 1t 6 5106,5 5-56]). Additisoonmoaeftl hlleyi ,m itDartH.io offmnands e scarriveba egs(u ee. g., claiwmoaunhltad v" es evdeirffiec"wu iltathnya y c tirveiqtu"yip rrionlgo nged standoiwrna gl koi"rns ge"v deirffiec"wu ilmttahyn ipualcattiivviet ies). R.a3t3 U.l timtahAteLe eJlx yp,l aihneae cdc etsphotamoetefDd r H.o ffmaonp'isn" isouncsh, atsh oisned i[cPaltaiwinongut blieldf i f]m timoto ersdee denteaxreyr-wttyoiproebkn uh"ated l i d noatc caeloplfDt r H.o ffmaans'sse s"swmhe[inwctaho,s v ]e ornapllarylt pleyr suaRs.ai tv e." 33.

A.TheA LJP ropeErvlayl utahtCeeo dn sisotfDe rnH.co yff maOnp'isn iaonnd, SubstaEnvtiidaeln ce hSiAusnp aployrstiss . ThCeo ufirntdt sht ahAteL aJd equeavtaelDluryaH. to efdfm aonp'isnb iyeo xnp laiitn ing waosn ly partibaalslienpyd a oprniet tr csso unassiwisivttteehh,ne c yo verTahlAelL Jr ecor recogtnhiDazrtHe. od ff moannel xya mPilnaeidon ntcaienff,td h AeL dJe tertmhilanatet de r evidweaniscn ec onwsiiDtsrhHt. oe fnfmtan fi'nsd iRn.ag3 ts3 .S. p ecitfihcAeaL folJul nytd,h at DrH.o ffmafinn'dsir neggsa Prldaiindngyt sipflnfyesma p,h eadbeitmlwoaia ,tlw yki thpoauitn , anadb itlmoia tnyah gepera wienir nec onwsiiltsahtet evenirtd i etnnh rceee c oRr.a3d t3. F. i rst, regarDrdH.io nffgm afinn'dsit nhgPaslt a idnetmioffn sstirgantidefiydcs apennvtee wani th miniemxaelrt thAieLo nJno ,tt ehadatt th t ei omfte h ceo nsultative heaxadamn i natio acurtees piprraotcoRe.ras yt3s3 ..H et heexnp ltahieanxtea dm insahtoiwtoehnldasa t it ne r Septe2m0b2Pe0lr,a ihnantdodi yffs pwniestaih t atnitdna glo kwrii nwtgah l kaintndag l kaindn g, ac omforrteasbplirera watitento ohdr y ys panneadad ,d ithieomrno arsletlc pyeu,nl tm oenxaarmy showgeodor de spiratoRr.a3y t3 ( ficniRdt.aii 1tnn0 gg3s6 9.8,1 8 6,3 9-46). Secoansfod r,l ymphetdheAemL aJr, e cogDnriH.zo efdfm foaunn sdi gnificant lympheidtneh umepa pe exrt rebmuidtte iteesrt,mh ieanvtei ddfr eonmlc aeet xearm inwaatsi ons

inconwsiittshhtfia entnd tai swn egl Rl.a. 3t 3 T.h AeL cJi ttewmdoe dirceaclio snru dpsop fo rt hidse termtihPnalatat iinont iffwsa nslo yatmss pe hvaeesidrw teea m dsau rhiencrgo nsultativ examinRa.at3 ti3 o n(R.c. ai7 tt5 i10n6,g0 T9h)re.e caorrfredo sPm l aionntcioff'lsoo nigeni st, Novem2b0e2tr0ho ,et hieMnra r2c0h2a 2nb,do ntohtt heua ptoe nx aminPaltaiidoninntdo,i t ff demonesdterimahnate e erx treomtihttehi"rae[ nst ,]l reaaftrc lmey mpheRd.ae7 tm5 a10.6,"0 9. ThitrhAdeL, r Je cogtnhmiaoztrer ede ceevnitd deenmcoen sPtlraaihtnaentddoip ffa in wihtehoe rtl o wea lkainncdgo ,us lidnl geslgte a wnictehd oiuffitc uRl.at 3ty3 .I.n s uppoofr t

thdiest ermitnhaAetL ciJio tanMe ,ad r 2c0h2r 1e cfroormPd l aionrttihfofDpsre J.da icskts,o n, inw hischhne o ttehasal tt hPoluagiahnm tbiufflw aitttehhase s sisotfas a inncpgeol icenan te , Plaihna"td[i nffp] aowi inht ehoe rtl o wea lkainn"dg[ "nd ]ioffi cwuilttthhyse i nlgeslgte a nce bilatRe.ar1 ta2 l8l4y.. " FinatlhAleLy eJ,x pltahiranetec dre enctod redmso nstthrPaaltta eiwdna tasib fftl oe manahgepera iRn.a.3 t 3 ( ciRt.ai1 tn6 g51 06,5 5-I5sn6u )p.op tfoh rdites t ermtihAneLa Jt ion, citreedc froormdP sl aivnitwsiiifDttfrhs A. r aisJnha on u2a0r2dy3e ,m onstthrPaaltta iinngt iff "stda]tt hesa[hti e as b tlomea nahgepera itnh,Pa"lt a ifinbtriofmfyssa ylmgpitwaoe mrosen ly worseanftiesnrhrg ea onu otf8 0m0g i bupraontfedhn Pa,lt a i"nctuirffrs eahnyetsprl a yii sn

manageRa.ab1 tl6 e51.06",5 5-56. Byu sisnpge cciifitca "tfriooomnt shm eerd iscoaulr acneedsx "p lawihnyDi rn.g Hoffmaonp'isna infiodnn dsi frnogAmsu g2u0s2wt0e irnec onwsiittshhtea evtni tdt ehnAecL eJ, adequeaxtpellwayhi Dynr eH.do ffmano'psi nwiaoisnn conwsiiotsthth eeenvrti dientn hcee recoSred§e.§ 4 04.152401c6(.c9)2(02Tc)h(,Aec L )J(s'2us)p .p oratnacdbo inlsiitsyt ency analwyasssui ffisc iaensndut b,s teavnitdsieuanplcp teoh AreLt Jso' psi ntihDoarntH. o ffman's opinwiaoosnn pl artyl pye rsuasive. Iand ditttoih AoeLn J s'pse cainfiaclo ytfsh cieos n siosDftr He.on ffcmya onp'isnt ihoen , ALJd'esc iassai w ohno plreo vaidddeists iuopnptaootlr h AteL Jd'est ermtihnDaartt. i on Hoffmaonp'isnw iaiosnn c onwsiiotsthth eeevnrit d ietnnh rceee c oArnAd L."J ' nneoertde peat herrseeglufr g[tiehet vaitdieofnnr gce ec eoacrhtd i]tm hetsa hceo nsain odpieonrniss,o l'o nags thAeL pJoin t tsos pfie ccpia orftth s erectoh rpadrt o cvoensoi irsntceonntsw iis ttthhreeeln etv ant opinsiuocthnah tt hCeo ru cta dnetnee rwmhetihseursb taneitvdieanslcpu ep tosthr eweight assigVanneesads M. v". Sa u lNo,.3 :c1v9l2209,1W L6 749a4 *t1136( ,E .VDaD..e 1c1.2, 0 19)

(quoRtoisvn. sBge rry2h0i1Wl9Ll 2 ,8 91a0t*1 6(,.E D V.aJ.a 3n ,.2 01(9c)i)Rt eidinvg. Comm'ofr S o.Sc ce.7,6F 9. 836d1 ,8 6(5t4 hC i2r0.1 r4e)p,ao nrrdte commeanoddpatteido,n 2091W L 2811(9E1.V Da J..a 2n2.2, 0 19H)e)rth.e eA ,L Jp riodvaec do mprehenns ive o thcalate rrlevyi ewaned daa nlyezveidd iennt ch reee croertldia tnogPla intdiyffssp nea, lymphedemo waa, wl ikahtbotiu lpiatiynl ,it tayn dth oea rbm iapnaaigne. Fis rti,env aluaatiinntRgiFC ,ftPh fl eAsL pJor viads eedp aanraaltyoesfth i ees v idence itn hree croleradtt i Polnagi ntipfnf eTsah .eAd LyrJse cogtnh Pialaztiendta isftfwhsam n sato alwwaeylclso-n troalnlrdee edfen rceexdea rcbaithnire osynmsp tionmlcusdg,ii nAnu g2u02s0t, them onttahthD r .H offmexaamni nPeldna ti iRf.atf. 2 7 T.hAeL eJxp lnaedi thtah esrmyp toms imprwoivaten hde bu alnidsze treoriRd.s 2,a7( t c iRt .ait6n0 g0 -60162,- a1nd 7s)h d,ei ndo t

havaen otehxearc e urnblota vitaeiy roe nlaaritn Se erp te20m2b1 Re..ar 2t 7 (c itR.ia ntg 8 )1.5 5 Despheri etxea cerin bSaetpitoe2nm00 b2t,eh rsaam tem ont shh, eha nd odypsneaw isttihnt gi and tailnokgwr ti wha lkaintnadgli n kg R.. 2 7a(ci ttRi .ant1g 30 9 T)h.AeL aJl sexop latihtna ed Plaidnid twiefflb le tweexeanc erobfah tesirmyo ptnosm asn,hde erx mainarteisounl ts demontsatrehdec rehs wtasn onetr ea,ndn sdhheac dl leua nrwg igstoh ao idern tRr.ay2 t.7( citing 12981-59596,- T 5he8A )LJ .nottehtidna J anu2a0r2 hy3re a ,stwham usnad georoc dot nr Ro.l . at2 7(ct iiRn.ag1 t 36 ) 4. SecothneAd L,pJ r voidaes de paarnaatloeyft s h ieevsi dientn hcreee croerladtt oe d lymphedRe .am 2ta7.T.h eA LaJg ariencogtnh idaurztiehndeg cor n suletxmaa wttiihDv re. HoffmPalna,i hnastdii gffn ilfiycmapnhtie bndo eutmphap eexrtr emRi.at2 ti7 eH.so .w ehvee r, nottehPdal ta ilnytmipfhfehsda hesim sat obreiemcniaa llndlad yff epcrtism haerurip lplyee rft extreRm.ai 2tt7 y(..c iRt.ai 5tn8 g9 -79126S,)h .o arftthelerycr o nsuelxtaadmtu,ir ovinene g

Septe2m0b2ee0xr aP ml,a ihnantdois ffw elilnhie unrpg p eexrt reRm.ia t2ti7 (ce istR.i. an tg 610D)e.s psiotmieen stoafsn icgensil fiycmanpth etdhAeeLm Ja ,fo und tgheante rPallaliyn demonsatmtro asmttie,nsd ot rr eannrgdat nhog fme o tdieofinc Ri.at2 ts7 (c. i tRi.an5 tg8 9-92, R.a6t2 4-R2.a51 t,3 13R-.a11 t43 ,4 6). ThitrhAdeL, cJ i teevdi dtehnrcoeuh gidhseo cuittsdo ie omno nasdtdriaettvieio dneanlc e thwaatbs o tcho nsiwsittaehnin dnt c onwsiitDshrtH .eo nffmta no'psi ntihPoalnta ihnatsi ff difficultyt owaein,ttd anh d wehamel eklai,ntn dhg sa,ht ne e eadnae sds idsetvifoivrwce ae l king iisn conwsiiotsthth eeevnrit d ientn hcee rTehcAeoL rrJde .c ogtnhicazoten ds wisiDttreh.n t Hoffmano'psi noitohenev,ri dietnn hrceee c doermdo nsPtlraaiwtnaetldiwk ffie atdnh t aglagiitc oro thgeaarib tn ormaanldi stthiuheesa saetc, d a tnaoem bulRa.at 2te6 (. c iRt.ai 4tn8 g54 5,8 ,

61705,0 H)o.w ehveel ra,t er tehxoapttlhe aexirand meesdm onsPtlraaiwtnaetldiwk ffie atd h cabnueht an dop awiinht ehoe trl o wea lkainnndgod , i fficuslitnlyge slgwte ian btcihel aterall R.at2 8( ciRt.ai 1tn2 g8 4T)hAe.L nJo ttehdPa lta iwnatliwkffie antdth a lggaibicuts t,o me recdoirnddom ste ntuisoiannna g s sidsetviiRvc.aee2 t .8 (c itRi.an1 tg2 64-M6o5sr)te. c ently, iJnan ua2r0y2o 3ne,ex asmh owPelda ihnantdosi effn soormr oyta obrn ormaanladsi tteiaedsy, gaiRt.a.2 t 8 ( ciRt.ai1 tn6 g3 5). FinatlhAleLy cJ,i teevdi dtehnrcoeuh gidhseo cuitts soiu opnph oidrset t ermination DrH.o ffmafinn'dsiw negrisen conwsiiotsthth eeevnrit d ientn hcreee cdoermdo nstrating Plaicnotumilanffda gheep ra iTnhA.eL eJx pltahiPanltea di "nbteihfhafavsnsi oa otlr w baeyesn conswiissttehev npetar iaenn s,dh hear se poirmtperdo vweimtterhne tast Rm.ae2 tn8 (tc .i"t ing R.a1t3 54-F5oe9rx) a.m tphAleLe nJ,o ttehPdal ta isnytmipfitfmospm rsao ftvfieebrdr omyalgia treaatmnegdna tb apheennrte iunr,os pyamtphtwyoe mrmsea nagmeeadbilcewa,at hsie olnp ful, anadq tuhae wraahspey l pRfu.al2 t,9 ( ciRt.ai1 tn3 g41 64,91 45,81 85,81 36,51 06,5 6). Thutsh,Ae L Jc itreedv,i eawnaednd a,l nyuzmeedrr oeucsoi rndvso lPvlianign tiffs dysplnyemap,h eadbeimtlaowi, at lwyki thpoauiatnna ,db itlomi atnyap gaeia nne,dv aluated

whetthheorrse ec woerrcdoesn swiisDttrheH. no tf fmanfi'nsd iannogdps i ndiuorhniiA nsug g ust 202c0o nsuelxtaamtiinTvaheAte Li sJoa 'nn .a lpyrsoivasid ddeist iotnhoai lds e scuitpsopi oornt finDdr H.o ffman'so noplpayir pnteilroysn ub aassoienivd tce so, n siwsitttehhrne ec cyo rd. Ins umt,hA eL pJr ovaic doemdp rerheevnoisfPei lwva ei ntiffssp aarnlesmc oosrtd t sifuxlp la goehfsi o sp inanipdor no vniudmeesrs opuesc,i fict Pocl iatiamntetidioiffncssa l reco to suthpoepp oirnTtih oAenL .pJ ro pearnlaylt yhczeoe nds iosfDt reH.no cfyfm an's opini compairwtii ontthgh er ietnvh imede edniccea la ndrdie sccoursds,i oinnts hA eLe sJl 's ewhe decipsrioovanid ddei tsiuopnpfoaorhlr ic tso nsiasntaelnBycesyci astu.hAs eLe aJ p pltiheed corlreegscattla nadnsadur bds teavnitdsieuanplcp heoi crsot nsc ltuhAseLi dJoi nnd,oe tr r.

B.PlainAtdidfif'tsi onalt hAtarhtgAe uL mJEe rnrtiesnHd i Cso nsistency Anal arneo Pte rsuasive. Plaimnatktiewffsao d diatrigoumnewanhltty hs Ae L sJp eciefircriaehnldi cls oy n sistenc analEyCsNFio s8.a. 8t - 1F2ot.rh r ee aesxopnlsba eilnnoeewdi, art ghuemrwe anrtr raenmtasn d oft hAeL sJd 'e cision. FirPslta,ia nrtgituffhet ashtA e L iJg nocreeredtv aiidnte hnwacatces o nswiisDttrhe.n t Hoffmaonp'isnE iCoNFno .8. a 1t0 P.l aicnotnittffeh nAedL "sJm anyor te jluyus ptot nh e unfaveovriadbbelunmetcu esc tia tneed x plbaoittnhhu e n favoarnafadbv loer eavbildee nce." ECNFo 8.a 1t0 P.l aipnotitincoffte sr etvaiidnie tnnh rceee c sohrcedo nttehAneLd iJsg nored­ invoslyvmipntogmof am lsa ise/fatiguefa,t idgayunsetp,aon liregm aip,cag iparweieirtdts hi ste usoefa c ananedw, h eeozris nhgo rotfbn reesast shh-aetl hlawetag cseo sn siwsitDterhn. t Hoffmano'bsj eecxtamifi vned ianngmdse diocpailn IidoT nh.Ce o mmisasrigoiunnee sr resptohntashtAee L dJi ndo cth erroyro- tphiecirkgw nitosrreee a rtemceonartndi dsnfa , c t, adopmtaenodyDf r H.o ffmano'psi nEiCoNFno s9..a 1 t7 -2149-,2 6.

HertehA,eL eJx plciictaientrddle ylu ipeo"dnfa voraanb"dlu en"fa voervaibdilenen "c e hiosp ianniddoin ndo c th errfryo-tmph rieec ckto soru dp hpiocsro tn siasntaelonyorcst yih se rwise igneovried eFnoecrxe am.p ildnei ,s cuDsrHs.oi fnfmganfi 'nsd itnhPgalsta iwnatliwkffie atd h sloawn,t aglawgiiitatc c h a annehd a ddi ffiwcaullkttiyhAn eLg aJ,c know"lo[]e tdrhgeeecrdo rds havaels shoo anwtna lggaoiiroct t hgeaarib tn ormaattli imateswis ee alssul s oefa na ssistive deviceR/.ac2 ta6 (n cei.Rt".ai 4 tn8 g54 5,68 1,70 5,0 A)sa. n otehxearmt phAleLe sJ,t attheadt Plaiansttiwhffams"sa n aoltw waeylsl -cobnuttthr eeoxnlp lletadhi,ian"htte a n dso r te suilnt ed tomoa neyx acerabnapdtr ioovnsispd,ee ccdii fitcat toti homene sd irceaclto osr udp ptohret exacerabswa etalisnlo o nrsfim nadli Rn.ag 2ts7 .(c itei.nRgg.a. 6t,0 0-60162,-1 15774-, 5 1,

15781-68314,) . Moreocvoenrtt,rPo al rayia nstsiefftrshAt eLi aJol nas,co k nowclietadengadden, da ,l yzed recionrvdosPl lvaiinsngyt mipftofomfsma sl aised/yfastppinegeruase,fai, ts itganeutneat,lo gri c impagiarwieitdtu hso efa c anaen,wd h eeozris nhgo rotfnb ersesaS tehee.., Rg ..a ,t2 2 (referreenccthoiarnPtdgl s a ihnaatsnai nfft aglagiRit.ac)2 t ;6 ( referreencctoihrnPadglts a intiff hafast igduyes,pa nnaedna t,a glaogigrita c ai btn ormRa.al2 ti7( ta ineaslr)ye;zc iionnrgvd osl ving Plainetxiaffcse robfaa sttihsomhnaos,r otfnb erseasant ddhy ,s panswe eaal,slan dn ormal findidnygssp Rn.ae 3ta2 )( ;r eferPelnaciiannntgti afglfagssiii tcg, n idfiycsapannndteu as,ia n g catnowe a lRk.a) 3t;4 ( referceonncsiinosgfat noe pnicnsyit oaPntl ianigan nttiagffla aginitdc usoefa c awnieot thh meerd irceacloN rodotsn )dl.iyt d hA eL aJc knowclieatdneagd,ne a,l yze recoirndvso tlhvseiy nmgp tPolmasic notnitffte hnAedL sJi gnotrheAedL ,Ji nclRuFdCe d limitsapteicoitnfiaoscc aclolmymt ohdosasyteme p tSoeeme.s Rg..a. 2 t,6 F.o erx amtphAleLe J, speciefixcpalltalhiy"an [ted dt] o[u Pel ainnetuirffossp]ya mtphtiionhcm e lsro weexrt remitie asw ealsfal t igcuher,po naiidcny ,s ponnee xae ratniadon nt,ag laagittiti c m. e.[s.P laciannt iffJ

staonrwda lnkom orteho annhe o tuorit anan le i ghtw-ohrokanuddraw ya lnkol ontgheoarnn e bloacattk i wmiett hhae io dfa c aonrce r utRc.ah2 t.6 "T. ot heex tPelnatia nrtgtiuhffeAe sL J dindor te fereeanrccehec Polradic notnitsffeu npdptsoh creot nss iosDftr He.on fcfmya onp'isn ion wiotthh eevri dietnnh rceee c "o[rtd],ihn seo r riegr iedq uitrhetamhtAee Ln sJtp ecirfiecfearl ly teov epryi eocefev idie[nnh cedere ]c isRieoiCndo.vm".'m or Sf o Sco.c7 .6F,9. 836d81 6,(54 th Ci2r0.1 E4v)es.no a ,ps o ionutbteyt d hC eo mmistshiAeoL ndJei irdfan, c r te tfmoea rn oytf h e recPolradiscn otnitsffeu npdptsoh creot nss iosfDt reH.no cfyfm aonp'isnE iCoNFno .9.a 2t4 . Herieitc,s l etahtrah tAe L rJe viaenwrdee dlu ipeoPdnl aimnetdiifrcfeascl oa rsawd hso,il ne , hidse cision. SecoPnlda,ic notnittffeh ntadhtAse L dJi ndor te cohnicfisin ldeti hnDagrt H. o ffman's

opinwia"oson np layrp telrys uaanshdiifi vsne d,ti"hn DagrBt .r isotpoiwnw'iass"o pne rsuasive ECNFo 8.a t1 1P.l aicnotnittffeh nbadetsc aDurBs.re i smteodwi'ficsna dliw negrasel most verbtaoDt riH.mo ffmatnh'AesL d,Ji ndo stu fficeixepnlhtail"isywn e iagshste ssImde.n t." Howeivrnee rv,i DerwB.ir nigs otpoiwn'tishAo eLn sJ,p eciefixcpalltalhiyDan rteB. dr istow's opinwiaposrn i msaruiplpybo yDr trHe.od ff macno'nss uelxtaamtiinwvaheti tictoohh ,nCe ,o urt, explwahiDynr Bs.r isutsosewid m lialnagriu hnai figsne d iSnegRes.a . t3 2T.h AeL eJx plained thDartB. r isotpoiwnw'iascos on n swiisttthheee nv ti dreencceaeitt vh ieend i lteivoaefrll e view (namDerlH.yo ,ff mafinn'dsi nbgutsth) la,at t eevri ddeenmcoen sntornafotficenaddl i ngs, managepaabwilinett rhe aantdmc elneltau,rn g gosoo,dx ysgaetnu rnaort eisopnid,ri asttorreys s, anndos ignicfiocmapnltiw ciaettdhie omRna.as. t3 2. ThAeL Jc oncltuhd"aeat[ds D Brr.i staosws'ess]is scm oennsti wsitteehvn itd ence receaittvh heeed a lreivnaegni ldss o meswuhpapto iirtpst e erds,u Ra.sai t3v 2Be.u.t t"h etnh,e

ALeJx plhaei" nfoeumdno dr sep ecainsfidoc m meo rree stricti.v.te.oa clciofomurin tta tio thceo mbeiffneeocdf[t P laiinmtpiaffisar]swm eealnsilt s ss wuientseh u rolpyamtphhye,d ema, chropnaiiacnno ,db esRi.ta yt3. 2T".h udse,s cpailtDleri B.nr gi sotpoiwn"'ipsoe nr suasive thAeL dJi ndo atd oDprBt.r isotpoiwn'wisho onl eSseaRel.a e t3. 2 R.a thjeurls,it Dk re. Hoffmatnh,Ae L aJd opstoemldei mitfraotDmir Bo.rn iss otpoiwn'aisnfoo dun n,ld i mittahtaito ns wermeo rree strtihDcartnB.i r vies otpoiwn'Siseo Ren.a . t3 2P.l ainctoinftfetsnht tahiteo n ALsJw 'e iogtfhh teo spei nionsd isffioeasmrm esah tootsfwee rm anatntidhc eisnrs,oe p ractical diffebreetnwcteehwe een i ggihvttee ona ocphi nion. AccordhienrtgehAl eLy J,p rovaic doemdp rehaennasloiyftvs heire se cocridt,i ng evidtehnsacutep ptohrbeto ettdhhc e o nsisatniednn ccoinessoi fDs rtH.eo nfcfmiaoenps'i sn ion

witthhe ev idiennt chreee coTrhdAe.L sJo 'p insiuoffinc ieexnptlltayhid ene sg orfe e persuahseig vaevtneoDe rsB.sr istow'asnD dro H.po ifnfmiaoonpn'i sna inotdnh A,eL J's reasfoornt ihnofigsn ed iTnhgAesL .bJ u ain"l atc caunrldao tgbeir cia"bdl eg tewteheeevn i dence antdhA eL Jc'osn clanudsr ieomniansnsd,o w ta rranWtoeodvd.B.s e rry8h8iF8l. l63,8d 66 9,4 (4Ctih2r 0.1 M8o)n;rv oC.eo l8v2iF6n. ,13 7d16 8,(9 4 Ctih2r 0.1 M6a)s;vc C.io ol 7v8iF0n. ,3 d 6236,7 3( 4Ctih2r 0.1 5). VIR.ECOMMENDATION Becasuusbes teanvtiidsaeulnp cpteoh Creot msm issdieocniaesnrtid'hoc seno rlreegcatl stanwdaasar pdp ltiheuedn ,d ersRiEgCnOeMdM ENtDhSat thfi en adle ciosfit ohne CommisbseAi FoFnIeRrM anEdtD h,ta htmi ast bteDe IrS MISWSIETDPH R EJUDICE. VII. REVIEW PROCEDURE By receiving a copy of this Report and Recommendation, the parties are notified that: 1. Any party may serve on the other party and file with the Clerk of the Court specific written objections to the above findings and recommendations within fourteen days from the date this Report and Recommendation is forwarded to the objecting party, see

(b)(1)(C) and Federal Rule of Civil Procedure 72(b), computed pursuant to Federal Rule of Civil Procedure Rule 6(a). A party may respond to another party’s specific written objections within fourteen days after being served with a copy thereof. See

(b)(1); Fed. R. Civ. P. 72(b). 2. A United States District Judge shall make a de novo determination of those portions of this Report and Recommendation or specified findings or recommendations to which objection is made. The parties are further notified that failure to file timely specific written objections to the above findings and recommendations will result in a waiver of the right to appeal from a judgment of this Court based on such findings and recommendations. Thomas v. Arn,

(1985); Carr v. Hutto,

(4th Cir. 1984), cert. denied,

(1985); United States v. Schronce,

(4th Cir. 1984), cert. denied,

(1984). The Clerk is DIRECTED to forward a copy of this Report and Recommendation to the counsel of record for Plaintiff and the Commissioner.

United States Magistrate Judge Norfolk, Virginia January 14, 2025

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