PATRICIA A. SULLIVAN, Magistrate Judge.
Plaintiff Maria Campos claims that she has been disabled since March 1, 2002, because of kidney cancer (stage two renal cell carcinoma), abdominal and low back pain and ADHD.
This matter has been referred to me for preliminary review, findings and recommended disposition pursuant to 28 U.S.C. § 636(b)(1)(B). Having reviewed the record and mindful that an impairment is not "severe" at Step Two only if it would have no more than a minimal effect on the ability to work, SSR 85-28, 1985 WL 56856, at *2 (Jan. 1, 1985), I find that the ALJ's findings are well supported by substantial evidence. Accordingly, I recommend that Plaintiff's Motion to Reverse the Decision of the Commissioner (ECF No. 12) be DENIED and the Commissioner's Motion for an Order Affirming the Decision of the Commissioner (ECF No. 14) be GRANTED.
Plaintiff, Maria Campos, was born in 1965. Tr. 235. She was 37 as of her alleged onset date, March 1, 2002; because she has not worked since, she is insured for Social Security purposes only through March 31, 2007.
Plaintiff completed high school and has an Associate's Degree in preschool education. Tr. 111. Prior to March 2002, she worked full-time for many years as a preschool teacher, a teacher aid and a shoe sales associate. Tr. 166. She stopped working on March 1, 2002, after she was laid off by the preschool, along with two others, because the school "was overstaffed" and "from the lack of children;" she believes that part of the reason was also related to "the ADD, the ADHD." Tr. 117-18. After she was laid off, she applied for and was awarded unemployment benefits. Tr. 118. Two months after she was laid off, a health provider noted that "[s]he is doing well. . . . [s]he has recently returned from a three-week trip to Florida." Tr. 607-08. Within two years after she was laid off, she had become a full-time college student at Rhode Island College, pursuing a double major in information systems and human resource management. Tr. 113. After the first year of college, she reduced her college course load because it was hard to enroll in the classes she wanted due to prerequisites. Tr. 115. She took no classes during the fall semesters of 2008 and 2009 because of two laparoscopic surgical procedures, but continued with a reduced schedule in the spring and summer. Tr. 116. When not in school, she engaged in a wide range of activities: driving, caring for pets (walking the dog four times a day, changing the cats' litter box), preparing meals, shopping, vacuuming, laundry, mopping the floor and loading and unloading the dishwasher; pursuing hobbies and interests (crocheting, reading, horseback riding and internet research on genealogy); and socializing (movies, out to dinner, visiting her aunt and sister and watching her niece). Tr. 143, 304-11, 440. Plaintiff lives with her parents in a two-story home. Tr. 113.
Plaintiff's most significant medical diagnosis is kidney cancer, which she had in the early 1990's; after she was diagnosed with renal cell carcinoma,
Plaintiff claims that her primary disabling impairment is "adhesion related disorder," which she believes causes abdominal, back and flank pain resulting in various functional limitations. Tr. 266-73. Both her testimony and the medical record establish that this claim of disabling pain is of relatively recent vintage. From onset in 2002 until late 2007, Plaintiff concedes that her only reason for not working was ADHD.
Beginning in May 2008, the records reflect that Plaintiff began reporting pain in her abdomen and occasionally lower back, which she attributed to adhesions caused by the cancer surgery. Tr. 133, 374, 393, 718. In June 2008, a CT scan revealed bilateral hydrosalpinx (blocked fallopian tubes). Tr. 348-49. In December 2008, to evaluate the cause of the pain and to determine whether she has adhesions, Dr. Mary Catherine DeRosa performed a pelviscopy; during the surgery, she lysed the minimal adhesions she found, biopsied a nodule on the right fallopian tube and drained the right ovarian cyst. At Plaintiff's request, she did not remove the bilateral hydrosalpinx. Tr. 417-20, 902. This procedure did not result in any findings to explain Plaintiff's complaints of pain. The post-surgical report notes no endometriosis and minimal pelvic adhesions. Tr. 906.
When Plaintiff's complaints of abdominal pain persisted, on January 5, 2010, she had a second laparoscopic procedure, this time removing the bilateral hydrosalpinx, which were observed to be chronically inflamed. Tr. 691. Meanwhile, both Dr. DeRosa and the Lahey Clinic, where Plaintiff was also examined, opined that the most likely cause of the pain was "[m]inor musculoskeletal discomfort." Tr. 757, 904. Lahey recommended three weeks of Ibuprofen and sitz baths, predicting that her discomfort "should resolve spontaneously." Tr. 757, 904. At the hearing, Plaintiff testified that she deals with pain by taking Tylenol, which "works well." Tr. 151. After she continued to complain of pain to her primary care physician, Dr. Robert Ellison; he sent her for a second opinion to Dr. Gyan Pareek, who noted no abdominal pain and only left lower back and flank discomfort. Tr. 454-55. By October 2011, just before the hearing in this matter, Plaintiff told Dr. Ellison that she had no abdominal pain, but still complained of flank and back pain. Tr. 913. He did not prescribe anything for pain and scheduled her to return for her routine physical in six months. Tr. 915.
While the record includes lengthy letters from Plaintiff regarding her belief that she suffers from "adhesion related disorder," Tr. 266-73 (letter to Social Security Administration purporting to substantiate that she suffers from adhesion related disorder), Tr. 700-05 (letter to Dr. Kathleen Woodruff urging support for appeal of denial of disability benefits based on diagnosis of adhesion related disorder), no medical provider has diagnosed adhesion related disorder and Dr. DeRosa's postsurgical observations would appear to rule it out.
Plaintiff now complains that her low back pain is also a severe impairment. The record references to back pain are sparse and generally link it to her complaints of pain caused by adhesions.
Plaintiff claims that she was diagnosed with ADHD in approximately January 2001 by psychiatrist, Dr. William Kyros, who was later barred from practicing and whose records have never been produced; accordingly, there is no evidence in the record from a medically acceptable source diagnosing this mental impairment. Tr. 440, 552. The timing of the diagnosis — January 2001 — is significant to an evaluation of the impact of ADHD on Plaintiff's ability to work, in that she was employed full-time through March 2002. Further, one of the diagnostic criteria of ADHD is that several inattentive or hyperactive-impulsive symptoms have been present since at least the age of twelve; "ADHD begins in childhood." DSM-5 at 60-61. Accordingly, assuming that Plaintiff was correctly diagnosed with ADHD in January 2001, she had symptoms of ADHD, yet was unimpaired and able to work full-time from 1997 until March 2002, even though she did not begin to take Adderall until approximately 2000.
Plaintiff's ADHD diagnosis is repeatedly referenced in Dr. Ellison's treatment notes; however, these references are based on history provided by Plaintiff, not on his diagnosis. Tr. 562, 573, 581, 584-85. Although Dr. Ellison, who is not a psychiatrist, did diagnose Major Depressive Disorder in October 2010, he did not treat for it and does not refer to it in his December 2010 Physician Examination Report. Tr. 783, 908-11. The only health care professional who dealt with ADHD was Nurse Reposa, who monitored Plaintiff's medication for treatment of ADHD; Nurse Reposa saw Plaintiff quarterly and consistently renewed the prescription for Adderall, finding that Plaintiff had an "adequate med response." Tr. 435, 436, 437, 438, 636.
Nurse Reposa's treatment notes reflect one mental status examination performed on April 20, 2009, when she noted "distractibility;" on the same form, she also noted that Plaintiff otherwise either had "no abnormalities" or was "intact." For strengths, she recorded that Plaintiff likes to "read, crochet, horseback riding." Tr. 440-41. Overall, Nurse Reposa concluded that Plaintiff's ADHD was controlled by a "successful Rx for ADL (Adderall)." Tr. 439-41. In March 2010, Nurse Reposa's notes stated that Plaintiff reported that she was doing well; her assessment was that Plaintiff was "at baseline level of function." Tr. 434. In June 2010, her notes indicate, "doing ok 2 classes left — struggles — but trying." Tr. 636. In the months while Plaintiff's SSI application was pending, Nurse Reposa's notes reference "adhesion related disorder = pain" based on Plaintiff's reports to her, but consistently indicate that Plaintiff had an "adequate med response" to Adderall to treat ADD. Tr. 716-20. Plaintiff's application corroborates this conclusion; she wrote that, with Adderall, "I can concentrate for as long as needed to complete tasks." Tr. 310.
In support of her SSI/DIB application, Plaintiff presented two evaluative opinions, one from Dr. Ellison, her primary care physician, and one from Nurse Reposa.
On December 3, 2010, Dr. Ellison set out his opinion on a form prepared for the Rhode Island Department of Human Services. He concluded that the primary reason for his conclusion that Plaintiff "cannot work now or any time in [the] near future" was adhesion related disorder; as secondary reasons, he listed ADHD and low back pain. Tr. 908-11. His reference to adhesion related disorder is based on Plaintiff's report, not on any medical evidence; his reference to ADHD also comes from Plaintiff and is not a condition for which he ever provided treatment; low back pain is something Dr. Ellison discussed with Plaintiff, but which he never treated or sent her for treatment by others. Based on this flimsy foundation, Dr. Ellison opined that Plaintiff is limited to walking less than two hours in an eight-hour work day, standing less than two hours in an eight-hour work day and sitting four hours in an eight-hour work day. Tr. 910.
The limitations Dr. Ellison listed in his opinion are inconsistent with Plaintiff's daily activities (e.g., walking the dog four times a day, performing housework like vacuuming), her intellectual pursuits (e.g., college courses, internet research on genealogy) and her self-report (e.g., "I can follow written instructions quite well"). Tr. 120, 142-43, 310. They are also inconsistent with Dr. Ellison's treatment notes; for example, at Plaintiff's October 2011 appointment with Dr. Ellison, she complained of flank and back pain, as well as stress due to her parents' health issues, but he ordered no treatment or tests and prescribed no medications, apart from a flu vaccine and setting her next routine physical appointment. Tr. 915.
Nurse Reposa filled out her first "Supplemental Questionnaire as to Residual Functional Capacity" on December 28, 2010, concluding that Plaintiff had suffered from "moderately severe" and "severe" limitations in virtually every category from the age of five. Tr. 713-14. For example, with no basis for the conclusion in her treatment records and inconsistent with Plaintiff's self-description, Nurse Reposa opined that Plaintiff is severely limited in her ability to respond to customary work pressures.
On May 22, 2010, Plaintiff filed her application for DIB, and on January 3, 2011, protectively filed for SSI. Tr. 54, 172, 211-23. In connection with these applications, state agency consultant, Dr. Elizabeth Conklin, prepared a medical assessment based on a file review in June 2010; she opined that the file reflected no evidence of recurrent cancer and no evidence of any functionally limiting somatic (physical) impairment. Tr. 175. Agency psychologist, Dr. J. Litchman, performed a psychiatric review technique assessment based on a file review and opined that Plaintiff has a medically determinable impairment, ADHD, that is not severe. Tr. 175-76. On reconsideration, agency physician Dr. Youssef Georgy performed a second file review and corroborated Dr. Conklin's opinion that no physical impairment is "severe." Tr. 184-85. A second psychiatric review by psychologist Dr. Jeffrey Hughes in December 2010 corroborated Dr. Litchman's conclusion. Tr. 185-87.
Plaintiff's claims were denied both initially and upon reconsideration. Tr. 172-91. On January 7, 2011, Plaintiff filed a request for an administrative hearing, which was held before an ALJ on October 26, 2011. Tr. 103-70, 198. At the hearing, Plaintiff was represented by counsel; she, vocational expert Kenneth R. Smith and medical expert Dr. Stephen Kaplan testified. Tr. 105-70. The ALJ issued his decision on November 14, 2011, finding that Plaintiff is not disabled within the meaning of the Act. Tr. 54-63. After the Appeals Council denied Plaintiff's request for review, the ALJ's decision became the final decision of the Commissioner. Tr. 1-3.
At the hearing, Plaintiff testified about her college courses and the reasons she lost her last job. Tr. 113-18. Prior to that, from 1997 through 2002, she worked in various preschool settings, all at full-time positions. Tr. 119. Since 2002, she testified, "I've been going to school." Tr. 120. In explaining why she claims she cannot work, Plaintiff focused on the pain she believes is caused by adhesions that interfere with sleep and limit bending, squatting and lifting, as well as a "strange sensation with the sciatic nerve down the leg" that limits her ability to stand for extended periods. Tr. 121-23. She also mentioned "slight pain and discomfort across the lower back." Tr. 123. To address the pain, she testified, "[a]t this point Tylenol works well." Tr. 151. In addition, ADHD causes her to lose focus between three and six times a day for a minute or two and Adderall, which she has taken since 2000, controls this symptom though it does not eliminate it entirely. Tr. 139. Despite a claim of onset in 2002, Plaintiff said that she did not have any physical symptoms prior to 2007, Tr. 134, and that it really "started to pick up [in] 2008," Tr. 135.
Medical Expert Dr. Stephen Kaplan testified at the hearing. He testified that Plaintiff had been free of cancer for over ten years — it is not a current impairment. Tr. 152. He observed that the complaints of lower back pain are infrequent and Plaintiff denied back pain at medical appointments in 2008 and 2009.
Vocational Expert Kenneth Smith testified that Plaintiff's past relevant work as a preschool teacher, teacher aid and shoe sales associate was light and semi-skilled. Tr. 166. He responded to a hypothetical question about work available to a person who can perform work only at the sedentary level and is further limited in the ability to bend and squat, and lift more than twenty pounds. Tr. 168. Mr. Smith testified that such an individual could not perform Plaintiff's past relevant work but could perform "sedentary occupations which are sitting down and lifting up to 10 pounds" such as assembler, hand packager and inspector. Tr. 168-69. The ALJ then added the additional limitation that the person is off-task five percent of the day, and Mr. Smith testified there would be no reduction in jobs such as assembler, hand packager and inspector.
In his written decision, the ALJ first found that Plaintiff met the insured requirements of the Act through March 31, 2007. Tr. 57. He then began to proceed through the familiar five-step inquiry. After concluding that Plaintiff had not engaged in substantial gainful activity since the alleged onset date on March 1, 2002, at Step One, he proceeded to Step Two, where he considered various medically determinable impairments: renal cell carcinoma, adhesions, ovarian cysts, hydrosalpinx, history of bronchitis, high blood pressure and ADHD. In an extensive analysis of all of the evidence in the record, the ALJ examined each impairment and concluded that none separately or in combination has significantly limited or is expected to significantly limit Plaintiff's ability to work for twelve consecutive months.
The ALJ's decision focused carefully on the medical evidence, Tr. 57-60, and in examining potential mental impairments, on evidence of daily living activities, social functioning, concentration, persistence and pace and the absence of any episodes of decompensation. Tr. 61-62. In performing this evaluation, the ALJ concluded that Plaintiff's medically determinable impairments could not reasonably be expected to cause her claimed physical symptoms to the degree alleged; this adverse credibility finding was based on discrepancies between her physical complaints and the activities reflected in the medical evidence but also on the degree to which her symptoms were not reasonably related to a specific medically determinable impairment. Tr. 58.
The ALJ's findings with respect to physical impairments may be briefly summarized: cancer has been in remission since successful surgery in 1994 and the cysts are stable and benign with no correlation to any limitation,
In reaching these conclusions, the ALJ considered not only the medical evidence, but also opinion evidence from four sources. He afforded Dr. Ellison, Plaintiff's long-time primary care physician, little weight because his conclusions are principally based on Plaintiff's report of adhesion related disorder, a diagnosis that is inconsistent with the medical evidence, and because his conclusions are otherwise contrary to the objective medical evidence, including his treatment notes, which describe intact physical functioning. Tr. 60. By contrast, the ALJ afforded great weight to Dr. Conklin and Dr. Georgy; both opined that Plaintiff did not suffer from any severe physical impairment, a conclusion buttressed by Dr. Kaplan's expert testimony.
With respect to Plaintiff's mental impairments, the ALJ noted, correctly, that the record does not reflect a diagnosis of ADHD by an acceptable medical source. Nevertheless, he assumed that ADHD was established and looked further for evidence of functional consequences having more than a minimal impact on Plaintiff's capacity to work. Tr. 61. He focused on Plaintiff's testimony establishing that Adderall effectively treats her symptoms, that, at most, she zones out a few times a day for no more than two minutes, and that despite ADHD, she was able to complete college courses in a dual degree program, at times carrying a full-time load.
Noting her inconsistent treatment notes, the lack of evidence that she is an acceptable medical source and the lack of foundation for her conclusions, the ALJ afforded little weight to Nurse Reposa's responses on two "Questionnaires as to Residual Functional Capacity." Tr. 61. Instead, he afforded great weight to the two psychologists, Drs. Litchman and Hughes, both of whom concluded that ADHD does not constitute a severe mental impairment.
Plaintiff presents two arguments, which she contends establish that the decision of the Commissioner that she is not disabled within the meaning of the Act is not supported by substantial evidence in the record and is infected by legal error:
The Commissioner's findings of fact are conclusive if supported by substantial evidence. 42 U.S.C. § 405(g). Substantial evidence is more than a scintilla — that is, the evidence must do more than merely create a suspicion of the existence of a fact, and must include such relevant evidence as a reasonable person would accept as adequate to support the conclusion.
The determination of substantiality is based upon an evaluation of the record as a whole.
The law defines disability as the inability to do 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 twelve months. 42 U.S.C. §§ 416(I), 423(d)(1); 20 C.F.R. §§ 404.1505, 416.905. The impairment must be severe, making the claimant unable to do previous work, or any other substantial gainful activity which exists in the national economy. 42 U.S.C. § 423(d)(2); 20 C.F.R. §§ 404.1505-1511, 416.905-911.
Substantial weight should be given to the opinion, diagnosis and medical evidence of a treating physician unless there are good reasons to do otherwise.
Where a treating physician has merely made conclusory statements, the ALJ may afford them such weight as is supported by clinical or laboratory findings and other consistent evidence of a claimant's impairments.
A treating source who is not a licensed physician or psychologist
The ALJ is required to review all of the medical findings and other evidence that support a medical source's statement that a claimant is disabled. However, the ALJ is responsible for making the ultimate determination about whether a claimant meets the statutory definition of disability. 20 C.F.R. §§ 404.1527(d), 416.927(d). The ALJ is not required to give any special significance to the status of a physician as treating or non-treating in weighing an opinion on whether the claimant meets a listed impairment, a claimant's RFC (
The ALJ must follow five steps in evaluating a claim of disability.
In determining whether a claimant's physical and mental impairments are sufficiently severe, the ALJ must consider the combined effect of all of the claimant's impairments and must consider any medically severe combination of impairments throughout the disability determination process. 42 U.S.C. § 423(d)(2)(B). Accordingly, the ALJ must make specific and well-articulated findings as to the effect of a combination of impairments when determining whether an individual is disabled.
The claimant must prove the existence of a disability on or before the last day of insured status for the purposes of disability benefits.
The second step in the sequential evaluation requires a determination whether the medical evidence establishes an impairment or combination of impairments of such severity as to be the basis for a finding of inability to work. 20 C.F.R. §§ 404.1520(c), 416.920(c). An impairment or combination of impairments is "not severe" and a finding of "not disabled" is made at Step Two only when the medical evidence establishes a slight abnormality that would have no more than a minimal effect on an individual's ability to work. SSR 85-28 at *2. As our Circuit Court has clarified, Step Two is a screening device to eliminate applicants whose impairments are so minimal that, as a matter of common sense, they are clearly not disabled from gainful employment.
A special technique is used in evaluating the severity of mental impairments at Step Two.
While Step Two constitutes a de minimis screening device, as long as the ALJ utilizes the correct definitional framework, denial of disability benefits at Step Two is appropriate when the "medical evidence establish[es] only a slight abnormality or combination of slight abnormalities which would have no more than a minimal effect on [the claimant's] ability to work even if the individual's age, education, or work experience were specifically considered. . . ."
When an ALJ decides not to credit a claimant's testimony, the ALJ must articulate specific and adequate reasons for doing so, or the record must be obvious as to the credibility finding.
A lack of a sufficiently explicit credibility finding becomes a ground for remand when credibility is critical to the outcome of the case.
"Pain can constitute a significant non-exertional impairment."
Plaintiff challenges the ALJ's determination to afford little weight to the two opinions from Nurse Reposa. Tr. 61, 712-14, 858-59. I find no legal error.
Plaintiff's contention that the ALJ did not consider Nurse Reposa's opinions and treatment notes at all is simply wrong. The ALJ correctly classified Nurse Reposa as a provider who is "not an acceptable medical source," so that her references to a diagnosis of ADHD are insufficient to establish that condition as a medically determinable impairment. SSR 06-03p at *2. Nevertheless, the ALJ assumed the existence of ADHD, based on other evidence.
Plaintiff counters that Nurse Reposa worked closely with a physician, so her opinions are the equivalent of an opinion from an acceptable medical source. She provides no support for this argument and there is no record evidence that Nurse Reposa's notes or opinions were co-signed by a treating physician or that there was any psychiatrist or psychologist involved with Nurse Reposa in Plaintiff's treatment. In any event, even if Nurse Reposa's opinions were afforded the weight given to those of a treating physician, they are so starkly inconsistent not only with her treatment notes, but also with Plaintiff's statements about her limitations in her application and testimony, as to justify the ALJ's determination to afford them little weight.
Plaintiff also contends that the ALJ did not consider Nurse Reposa's notations referring to distractibility, Plaintiff's struggles in certain classes and her observation that Plaintiff is "doing well within her limitations (no excessive requirements or stimuli)." Tr. 434, 435, 441. This critique
I find that the ALJ properly considered both Nurse Reposa's treatment notes and opinions, and did not err in affording little weight to her opinions.
Plaintiff seizes on the ALJ's determination to end the sequential analysis at Step Two, the screening step, arguing that the standard of what is "severe" at Step Two is so low that it is error to stop there in a case where Plaintiff had cancer in the past, carries a long list of diagnoses, is constantly seeking medical treatment and is constantly complaining about pain.
Plaintiff is right that the standard at Step Two a "de minimis one."
Here, the ALJ correctly employed the evaluative standard for Step Two set out in SSR 85-28, which requires careful review of the medical findings and an informed judgment about their limiting effects on the individual's physical and mental ability to perform basic work. SSR 85-28 at *3. He also used the special technique for testing the severity of mental impairments in 20 C.F.R. § 404.1520a, which requires consideration of functioning in activities of daily living, social functioning, concentration, persistence and pace and episodes of decompensation.
Little effort is needed to confirm the legal appropriateness of the ALJ's findings with respect to Plaintiff's list of alleged physical impairments. The ALJ's careful analysis of each recites the medical evidence, more than substantial, establishing that Plaintiff's cancer was long in remission, her adhesions minimal, her "adhesion related disorder" unsupported by any medical evidence, her cysts benign and without symptoms, her hydrosalpinx removed, her leukopenia mild, her bronchitis episodic and her hypertension intermittent and benign. Tr. 58-60. In concluding that none of these medical findings are severe, the ALJ properly relied on the medical opinions of Dr. Conklin, Dr. Georgy and the expert testimony of Dr. Kaplan. Tr. 60.
That leaves Plaintiff's complaints of pain, particularly back pain,
The ALJ's determination that none of Plaintiff's mental impairments, including ADHD, constitute severe impairments is similarly well supported by substantial evidence and untainted by legal error. Plaintiff's contrary argument replays Nurse Reposa's references to distractibility, struggling with some college courses and "no excessive requirements or stimuli," as well as her opinions of Plaintiff's severe limitations. Plaintiff contends that these comments should be credited over all of the other evidence, including the evidence that ADHD is well controlled by Adderall and that Plaintiff's functioning in the four broad areas listed in 20 C.F.R. § 404.1520a is no more than minimally impacted by any mental impairment. This Court will not replow that field in the face of all of the other evidence establishing the absence of functional limitations, including Plaintiff's years of full-time work until March 2002 despite ADHD, her attendance at college full-time or nearly full-time for part of her period of disability, her wide range of activities and her testimony that, with medication, "I can concentrate for as long as needed to complete tasks."
Plaintiff tries to augment her mental impairments by focusing on Dr. Ellison's references to depression and anxiety. Tr. 585, 839, 849, 914. However, as the ALJ observed, these references do not represent a diagnosis from a psychiatrist with the training to assess and diagnose such disorders based on objective signs and tests; further, Plaintiff was never referred by Dr. Ellison to a psychiatrist for those complaints.
While adjudicators are cautioned to exercise "[g]reat care" in applying the Step Two standard to deny benefits, SSR 85-28 at *3, in this case, the ALJ got it right. There is no error in his finding that Plaintiff has no severe impairments or combination of impairments.
I recommend that Plaintiff's Motion to Reverse the Decision of the Commissioner (ECF No. 12) be DENIED and the Commissioner's Motion for an Order Affirming the Decision of the Commissioner (ECF No. 14) be GRANTED.
Any objection to this report and recommendation must be specific and must be served and filed with the Clerk of the Court within fourteen (14) days after its service on the objecting party.
