MEDICAL SOURCE STATEMENT AND NARRATIVE OPINION

Residual functional capacity, physical and combined impairments

Claimant: J. M. (mock claimant, all facts invented for illustration)

Date of birth: 1971 (age 54 at the date of this opinion)

Claim type: Title II (SSDI)

Alleged onset date: March 14, 2024

Date last insured: December 31, 2028

Hearing date: scheduled

Requested by: Counsel for the claimant

Prepared by: David Protaziuk, MSN, APRN, FNP-C

Date of opinion: October 2026

Exhibits reviewed: 1A through 14F (complete electronic folder as furnished by counsel, 612 pages), plus the claimant's written responses to my functional questionnaire dated October 2026 (attached as Appendix B)

I was asked to review the complete record and state, function by function, what the claimant can still do in a work setting on a regular and continuing basis, and to explain the clinical basis for each limitation with reference to the record.

I have not examined or treated the claimant. This opinion rests on a review of every page of the exhibit file listed in Appendix A and on the claimant's written answers to a structured functional questionnaire. Where the record and the questionnaire disagree, I say so and I give the record more weight.

I do not state whether the claimant is disabled or able to work. That determination is reserved to the Commissioner. My fee for this opinion is a flat fee paid by counsel. It is not contingent on the outcome of the claim, and no part of it is shared with anyone.

1. Lumbar degenerative disc disease with L4-L5 disc herniation and left L5 radiculopathy. MRI 04/2024 (Ex. 3F/14-15): 6 mm left paracentral herniation at L4-L5 contacting the descending left L5 nerve root, moderate foraminal narrowing. EMG/NCS 08/2024 (Ex. 7F/22-24): active denervation in the left L5 myotome.

2. Type 2 diabetes mellitus with peripheral neuropathy of both feet. HbA1c 8.9% 02/2025 (Ex. 9F/31); monofilament testing absent at 4 of 10 sites bilaterally (Ex. 9F/5); gabapentin 900 mg three times daily (Ex. 9F/12).

3. Obesity, BMI 38 to 40 across the period (Ex. 4F/3, 9F/5, 12F/8).

4. Major depressive disorder, moderate, treated by the primary care provider with sertraline 100 mg (Ex. 9F/18); PHQ-9 scores 16 and 18 (Ex. 9F/18, 12F/11). No specialist psychiatric treatment in the record.

Conservative care from 04/2024 to the present: physical therapy, 14 visits, discharged for plateau with persistent left leg symptoms (Ex. 6F/2-3); two lumbar epidural steroid injections with relief lasting roughly three weeks each (Ex. 8F/4, 8F/9); gabapentin, meloxicam, and tramadol (Ex. 9F/12). Surgical consultation 01/2025: microdiscectomy offered, declined by the claimant because of diabetic control and cost (Ex. 11F/6). The pain management note of 06/2025 records "failed conservative management, candidate for surgical referral, patient declines at this time" (Ex. 12F/3).

Each limitation below is followed by the clinical reasoning and the pages of the record that support it. All limits describe the claimant's capacity on a sustained basis, eight hours a day, five days a week, since the alleged onset date of March 14, 2024.

Lifting and carrying: 10 pounds occasionally, less than 10 pounds frequently.

Basis: nerve root compression confirmed on imaging and electrodiagnostics (Ex. 3F/14, 7F/22); positive straight leg raise on the left at 40 degrees at four separate visits (Ex. 4F/9, 8F/4, 11F/5, 12F/3); 4/5 strength in left ankle dorsiflexion and great toe extension (Ex. 7F/22, 11F/5). Loading the lumbar spine under these findings reproduces radicular pain and is contraindicated beyond light objects.

Standing and walking: a total of 2 hours in an 8-hour day, no more than 20 minutes at one time.

Basis: antalgic gait documented at 6 of 9 examinations where gait was recorded (Ex. 4F/9, 6F/2, 8F/4, 9F/5, 11F/5, 12F/3); diabetic sensory loss in both feet (Ex. 9F/5) which independently impairs balance and tolerance for prolonged standing; obesity adds mechanical load to the lumbar spine (Ex. 12F/8). The claimant reports needing to sit after about 15 minutes (Appendix B, item 4); the treatment record supports a limit in this range.

Sitting: a total of 4 hours in an 8-hour day, no more than 30 minutes at one time, with the option to stand for 5 minutes before sitting again.

Basis: radicular pain with sitting is the chief complaint at intake and at follow-up (Ex. 4F/7, 8F/2, 12F/2); the physical therapy discharge summary records sitting tolerance of 20 to 30 minutes (Ex. 6F/3). Seated positions increase intradiscal pressure at the level of the herniation.

Postural activities: never climb ladders, ropes, or scaffolds; occasionally climb ramps and stairs; occasionally balance; occasionally stoop; never kneel, crouch, or crawl.

Basis: left L5 motor weakness and sensory loss in both feet (Ex. 7F/22, 9F/5) make ladder work unsafe; stooping, kneeling, crouching and crawling load the herniated segment and were the movements that reproduced symptoms in therapy (Ex. 6F/2).

Manipulative activities: no limitation in reaching, handling, fingering, or feeling.

Basis: upper extremity examinations are normal throughout (Ex. 4F/9, 11F/5). The record does not support any upper extremity restriction and I do not state one.

Environmental: avoid unprotected heights and dangerous moving machinery; avoid concentrated exposure to vibration.

Basis: lower extremity weakness and sensory loss (Ex. 7F/22, 9F/5); gabapentin and tramadol, with documented drowsiness at the 09/2025 visit (Ex. 12F/5).

Elevation of the legs: not required during the workday.

Basis: the record contains no edema, venous insufficiency, or physician instruction to elevate. The claimant reports elevating her legs at home for comfort (Appendix B, item 9), but nothing in the treatment record supports a medical need to do so at work, so I do not state one.

Time off task: approximately 15 percent of the workday, in addition to normal breaks.

Basis: documented pain scores of 6 to 8 out of 10 at 11 of 14 visits (Ex. 4F through 12F, summarized in Appendix A); documented medication drowsiness (Ex. 12F/5); the need to change position roughly every 20 to 30 minutes stated above. The combination of pain, sedation, and positional change produces interruptions in attention and pace that in my clinical judgment approximate 15 percent of a workday. This is an estimate from the record, and I state it as such.

Absences: approximately 2 days per month.

Basis: 14 therapy visits, 2 injection procedures, and 9 medical visits in a 19-month period (Appendix A), which averages more than 1 appointment per month during working hours, plus flare days documented at Ex. 8F/2 and 12F/2.

Mental limitations, combined-impairment component: able to understand, remember and carry out simple and detailed instructions; able to interact appropriately with supervisors, coworkers and the public; moderate limitation in maintaining concentration, persistence and pace for complex tasks because of pain and documented depressive symptoms (PHQ-9 16 and 18, Ex. 9F/18, 12F/11).

Basis: the mental findings here come from the primary care record. There is no psychiatric specialist evidence, and I do not state limitations beyond what that record supports.

1. Normal gait is recorded at 3 of 9 examinations (Ex. 9F/12, 9F/18, 12F/11). All three are primary care visits for diabetes or mood where the note states "gait grossly normal" without a described examination; the orthopedic, pain management and therapy notes that examined gait specifically found it antalgic. I gave the specialty examinations more weight.

2. Treatment has been conservative and the claimant declined surgery (Ex. 11F/6). Declining surgery for stated reasons of cost and glycemic risk does not improve the underlying pathology; the imaging and electrodiagnostic findings are unchanged, and the pain management provider documented failure of conservative care (Ex. 12F/3).

3. A consultative examiner in 09/2024 found "no limitation in sitting" (Ex. 5F/4). That examination preceded the EMG that confirmed active denervation (Ex. 7F/22) and the therapy discharge documenting sitting tolerance (Ex. 6F/3). The consultative examiner did not have those records.

4. The claimant reported walking for exercise at the 02/2025 diabetes visit (Ex. 9F/31). She describes this as 10 minutes on flat ground with rest (Appendix B, item 6), which is consistent with the standing and walking limits stated above.

The limitations above have applied at this level since at least April 2024, when the MRI documented the herniation (Ex. 3F/14), and in my opinion since the alleged onset date of March 14, 2024, when the claimant left her warehouse position because of the same symptoms (Ex. 4F/7). They have lasted more than 12 continuous months and are expected to continue absent surgical treatment.

I have reviewed every page of the exhibits listed in Appendix A. The opinions above are my own, are stated to a reasonable degree of medical certainty, and are limited to what the record supports. I am available to answer written interrogatories from the Administrative Law Judge or counsel at no additional charge.

David Protaziuk, MSN, APRN, FNP-C

Family Nurse Practitioner, board certified (AANP)

Illinois APRN license 277002570, full practice authority

NPI 1275200149

Claimant Medical Opinions, 7501 Lemont Rd, Suite 345D, Woodridge, IL 60517

david@claimmedicalopinions.com

Appendix A: Index of records reviewed (exhibit, source, date range, pages)

Appendix B: Claimant functional questionnaire and responses

Appendix C: Credentials and licensure of the author

Appendix D: Fee disclosure