Simon v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

DEBRA YVETTE SIMON,

Plaintiff,

v. Case No. 8:20-cv-1650-SPF

KILOLO KIJAKAZI,1

Acting Commissioner of the

Social Security Administration,

Defendant.

/

ORDER

Plaintiff seeks judicial review of the denial of her claim for disability insurance

benefits (“DIB”). As the Administrative Law Judge’s (“ALJ”) decision was based on

substantial evidence and employed proper legal standards, the Commissioner’s decision

is affirmed.

I. Procedural Background

Plaintiff applied for DIB on July 17, 2017 (Tr. 211-13). The Commissioner denied

Plaintiff’s claims both initially and upon reconsideration (Tr. 96-98, 101-06). Per

Plaintiff’s request, the ALJ held a hearing at which Plaintiff appeared and testified (Tr.

32-53). Following the hearing, the ALJ issued an unfavorable decision finding Plaintiff

not disabled and accordingly denied Plaintiff’s claim for benefits (Tr. 18-26).

1 Kilolo Kijakazi became the Acting Commissioner of Social Security on July 9, 2021 and

is substituted as Defendant in this suit pursuant to Rule 25(d) of the Federal Rules of Civil

Procedure.

Subsequently, Plaintiff requested review from the Appeals Council, which the Appeals

Council denied (Tr. 1-9). Plaintiff then timely filed a complaint with this Court (Doc. 1).

The case is now ripe for review under 42 U.S.C. §§ 405(g), 1383(c)(3).

II. Factual Background and the ALJ’s Decision

Plaintiff was born in 1962 and claimed disability beginning March 10, 2016 (Tr.

211). Plaintiff graduated from college with a degree in sociology (Tr. 36). Her past

relevant work experience was as a production specialist for Standard and Poor’s, a job she

held for 21 years (Tr. 36). She described her duties as “maintaining the ratings, making

sure that all the ratings were accurate and that the ratings went out at a specific – that they

were correct and they went out at a specific time.” (Tr. 37) Plaintiff alleged disability due

to three bulging discs in her neck, sacroiliac joint dysfunction, lower back nerve pain, high

blood pressure, and arthritis in both knees (Tr. 233).

In rendering the administrative decision, the ALJ concluded that Plaintiff met the

insured status requirements through December 31, 2022 and had not engaged in

substantial gainful activity since March 10, 2016, the alleged onset date (Tr. 20). After

conducting a hearing and reviewing the evidence of record, the ALJ determined Plaintiff

had the following severe impairments: degenerative disc disease, degenerative joint

disease of the knees, chronic obstructive pulmonary disease, fibromyalgia, and obesity

(Tr. 21). Notwithstanding these impairments, the ALJ determined Plaintiff did not have

an impairment or combination of impairments that met or medically equaled one of the

listed impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (Id). The ALJ then

concluded that Plaintiff retained a residual functional capacity (“RFC”) to perform

sedentary work with limitations. Specifically,

Function by function, the claimant remains able to lift and/or carry 10

pounds occasionally and less than 10 pounds frequently, stand and/or [sic]

up to 2 hours in a workday, and sit 6 hours in a workday. She can

occasionally climb ladders, ropes, scaffolds, ramps and stairs and

occasionally balance, stoop, kneel, crouch, and crawl. She must avoid

concentrated exposure to extreme cold, hazards, and irritants such as

fumes, odors, dust, and gases.

(R. 21).

In formulating Plaintiff’s RFC, the ALJ considered Plaintiff’s subjective

complaints and determined that, although the evidence established the presence of

underlying impairments that reasonably could be expected to produce the symptoms

alleged, Plaintiff’s statements as to the intensity, persistence, and limiting effects of the

alleged symptoms were not entirely consistent with the medical evidence and other

evidence in the record (Tr. 26). Considering Plaintiff’s impairments and the assessment

of a vocational expert (“VE”), the ALJ determined Plaintiff could perform her past

relevant work (Id.). The ALJ then found Plaintiff not disabled based on Plaintiff’s age,

education, work experience, RFC, and the testimony of the VE (Id.).

III. Legal Standard

To be entitled to benefits, a claimant must be disabled, meaning she must be 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 twelve months.

42 U.S.C. §§ 423(d)(1)(A), 1382c(a)(3)(A). A “physical or mental impairment” is an

impairment that results from anatomical, physiological, or psychological abnormalities,

which are demonstrable by medically acceptable clinical and laboratory diagnostic

techniques. 42 U.S.C. §§ 423(d)(3), 1382c(a)(3)(D).

The Social Security Administration (“SSA”), to regularize the adjudicative

process, promulgated the detailed regulations currently in effect. These regulations

establish a “sequential evaluation process” to determine whether a claimant is disabled.

20 C.F.R. § 404.1520. If an individual is found disabled at any point in the sequential

review, further inquiry is unnecessary. 20 C.F.R. § 404.1520(a). Under this process, the

ALJ must determine, in sequence, the following: whether the claimant is currently

engaged in substantial gainful activity; whether the claimant has a severe impairment, i.e.,

one that significantly limits her ability to perform work-related functions; whether the

severe impairment meets or equals the medical criteria of 20 C.F.R. Part 404 Subpart P,

Appendix 1; and whether the claimant can perform her past relevant work. If the claimant

cannot perform the tasks required of her prior work, step five of the evaluation requires

the ALJ to decide if the claimant can do other work in the national economy in view of

her age, education, and work experience. 20 C.F.R. § 404.1520(a). A claimant is entitled

to benefits only if unable to perform other work. Bowen v. Yuckert, 482 U.S. 137, 140-42

(1987); 20 C.F.R. § 404.1520(g).

A determination by the Commissioner that a claimant is not disabled must be

upheld if it is supported by substantial evidence and comports with applicable legal

standards. See 42 U.S.C. §§ 405(g), 1383(c)(3). Substantial evidence is “such relevant

evidence as a reasonable mind might accept as adequate to support a conclusion.”

Richardson v. Perales, 402 U.S. 389, 401 (1971) (quoting Consol. Edison Co. v. NLRB, 305

U.S. 197, 229 (1938) (internal quotation marks omitted)); Miles v. Chater, 84 F.3d 1397,

1400 (11th Cir. 1996). While the court reviews the Commissioner’s decision with

deference to the factual findings, no such deference is given to the legal conclusions.

Keeton v. Dep’t of Health & Human Servs., 21 F.3d 1064, 1066 (11th Cir. 1994) (citations

omitted).

In reviewing the Commissioner’s decision, the court may not re-weigh the evidence

or substitute its own judgment for that of the ALJ even if it finds that the evidence

preponderates against the ALJ’s decision. Bloodsworth v. Heckler, 703 F.2d 1233, 1239

(11th Cir. 1983). The Commissioner’s failure to apply the correct law, or to give the

reviewing court sufficient reasoning for determining that he or she has conducted the

proper legal analysis, mandates reversal. Keeton, 21 F.3d at 1066. Review is thus limited

to determining whether the findings of the Commissioner are supported by substantial

evidence and whether the correct legal standards were applied. 42 U.S.C. § 405(g); Wilson

v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002).

IV. Analysis

Plaintiff raises one issue on appeal – whether the ALJ properly evaluated the

opinions of Sunil Panchal, M.D., Plaintiff’s treating pain management doctor. After a

thorough review of the record, the parties’ submissions, and the applicable regulations,

the Court concludes that Plaintiff presents no basis for reversal or remand.

Prior to March 27, 2017, SSA regulations codified the treating physician rule,

which required the ALJ to assign controlling weight to a treating physician’s opinion if it

was well supported and not inconsistent with other record evidence. See 20 C.F.R. §

404.1527(c). Under the treating physician rule, if an ALJ assigned less than controlling

weight to a treating physician’s opinion, he or she had to provide good cause for doing

so. See Winschel v. Comm'r of Soc. Sec, 631 F.3d 1176, 1178-79 (11th Cir. 2011). Good cause

existed “when the: (1) treating physician’s opinion was not bolstered by the evidence; (2)

evidence supported a contrary finding; or (3) treating physician’s opinion was conclusory

or inconsistent with the doctor’s own medical records.” Phillips v. Barnhart, 357 F.3d 1232,

1241 (11th Cir. 2004) (citation omitted).

In this case, however, revised SSA regulations (published on January 18, 2017, and

effective on March 27, 2017) apply because Plaintiff filed her claim on July 17, 2017 (see

R. 211-13). As the SSA explained, “under the old rules, courts reviewing claims tended

to focus more on whether the agency sufficiently articulated the weight we gave treating

source opinions, rather than on whether substantial evidence supports our final decision

... these courts, in reviewing final agency decisions, are reweighing evidence instead of

applying the substantial evidence standard of review, which is intended to be highly

deferential to us.” Revisions to Rules Regarding the Evaluation of Medical Evidence, 82

Fed. Reg. 5844, 5853 (Jan. 18, 2017). The new regulations require an ALJ to apply the

same factors when considering the opinions from all medical sources. 20 C.F.R. §§

404.1520c(a); 416.920c(a). As to each medical source, the ALJ must consider: (1)

supportability; (2) consistency; (3) relationship with the claimant; (4) specialization; and

(5) “other factors that tend to support or contradict a medical opinion or prior

administrative medical finding.” 20 C.F.R. § 404.1520c(c). But the first two factors are

the most important: “Under the new rule, the SSA will consider the persuasiveness of all

medical opinions and evaluate them primarily on the basis of supportability and

consistency.” Mackey v. Saul, 2020 WL 376995, at *4, n. 2 (D.S.C. Jan. 6, 2020), citing 20

C.F.R. § 404.1520c(a),(c)(1)-(2) (while there are several factors ALJ must consider, “[t]he

most important factors ... are supportability (paragraph (c)(1) of this section) and

consistency (paragraph (c)(2) of this section).”).

“Supportability” refers to the principle 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.” 20

C.F.R. § 404.1520c(c)(1). “Consistency” refers to the principle that “[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 opinion(s) or prior administrative medical finding(s) will be.” 20 C.F.R. §

404.1520c(c)(2). Put differently, the ALJ must analyze whether the medical source’s

opinion is (1) supported by the source’s own records, and (2) consistent with the other

evidence of record. See Cook v. Comm’r of Soc. Sec., No. 6:20-cv-1197-RBD-DCI, 2021 WL

1565832, at *3 (M.D. Fla. Apr. 6, 2021), report and recommendation adopted, 2021 WL

1565162 (M.D. Fla. Apr. 21, 2021).

The new regulations also change the standards an ALJ applies when articulating

his or her assessment of medical source opinions. As mentioned above, an ALJ need not

assign specific evidentiary weight to medical opinions based on their source. See Tucker v.

Saul, No. 4:19-cv-759, 2020 WL 3489427, at *6 (N.D. Ala. June 26, 2020). And while the

ALJ must explain how he or she considered the supportability and consistency factors,

the ALJ need not explain how he or she considered the other three factors.2 20 C.F.R. §

404.1520c(b)(2).

Under the new regulations, the ALJ does not need to “give good reasons” for the

weight he or she assigns to treating source opinions. Compare 20 C.F.R. § 404.1527(c)(2)

(“We will always give good reasons in our notice of determination or decision for the

weight we give your treating source's medical opinion.”) with 20 C.F.R. § 404.1520c(a)

(“We will not defer or give any specific evidentiary weight, including controlling weight,

to any medical opinion(s) or prior administrative medical finding(s), including those from

your medical sources.”). But whether these new regulations eliminate the judicially-

created treating physician rule – a longstanding requirement in this Circuit, see Winschel,

631 F.3d at 1179 – is an open question. See Beasley v. Comm’r of Soc. Sec., No. 2:20-cv-445-

JLB-MRM, 2021 WL 4059895, at * 3-4 (M.D. Fla. Sept. 7, 2021). The Eleventh Circuit

has not spoken on the issue. See Simon v. Comm’r of Soc. Sec., 7 F.4th 1094, 1104, n.4 (11th

Cir. Aug. 12, 2021) (“[W]e need not and do not consider how the new regulation bears

upon our precedents requiring an ALJ to give substantial or considerable weight to a

treating physician’s opinions absent good cause to do otherwise.”). And district courts

have diverged in their approaches. See Bevis v. Comm’r of Soc. Sec., No. 6:20-cv-579-LRH,

2 The exception is when the record contains differing but equally persuasive medical

opinions or prior administrative medical findings about the same issue. See 20 C.F.R. §

404.1520c(b)(3).

2021 WL 3418815, at *5 (M.D. Fla. Aug. 5, 2021) (collecting cases and applying good

cause standard “in the absence of binding or persuasive authority to the contrary” but

noting it was non-issue -- under both standards, ALJ’s opinion was substantially

supported)3; Miller v. Kijakazi, No. 4:20-cv-656-GMB, 2021 WL 4190632 (N.D. Ala. Sept.

14, 2021) (citing Chevron, U.S.A., Inc. v. Nat’l Res. Defense Council, Inc., 467 U.S. 837, 845

(1984), and finding treating physician rule inapplicable; plaintiff did not cite Eleventh

Circuit case stating the Act mandates it and did not argue the new regulations are

arbitrary, capricious, or otherwise invalid); Wiginton v. Comm’r of Soc. Sec., 3:20-cv-5387-

LC/MJF, 2021 WL 3684264 (N.D. Fla. Aug. 3, 2021) (applying new regulations without

discussing whether Eleventh Circuit precedent regarding the treating physician rule

applies); Devra B.B. v. Comm’r of Soc. Sec., 6:20-cv-643(BKS), 2021 WL 4168529 (N.D.N.Y.

Sept. 14, 2021) (rejecting Plaintiff’s argument that the new regulations conflict with the

treating physician rule and are therefore invalid); Carr v. Comm’r of Soc. Sec., No. 1:20-cv-

217-EPG, 2021 WL 1721692 (E.D. Cal. Apr. 30, 2021) (finding new regulations entitled

3 In finding the treating physician rule still applies, the Bevis court cited Simon v. Comm’r of

Soc. Sec., 1 F.4th 908, 912 n.4 (11th Cir. 2021) (“Simon I”), a July 9, 2021 decision the

Eleventh Circuit withdrew on rehearing on August 12, 2021, and substituted with Simon,

7 F.4th 1094 (“Simon II”), seven days after Bevis was decided. In a Simon I footnote, the

Eleventh Circuit stated that the length of a claimant’s treating relationship with her doctor

was still an important factor to consider under the new regulations. 1 F.4th at 914 n. 4;

see also Brown v. Comm’r of Soc. Sec., No. 6:20-cv-840-GJK, 2021 WL 2917562(M.D. Fla.

July 12, 2021) (citing Simon I and emphasizing that under new regulations, length of

treating relationship must still be considered). That statement was dicta, however, as

Simon I and II were decided under the old regulations. Interestingly, Simon II omits the

Simon I footnote regarding assigning weight to a treating physician’s opinion under the

new regulations, in favor of this language: “[W]e need not and do not consider how the

new regulation bears upon our precedents requiring an ALJ to give substantial or

considerable weight to a treating physician’s opinions absent good cause to do otherwise.”

7 F.4th at 1104 n.4.

to Chevron deference; treating physician rule yields to new regulations because it conflicts

with them). Here, the Commissioner argues the new regulations do away with the treating

physician rule; Plaintiff does not address the issue but acknowledges that the new

regulations apply. Because Plaintiff’s argument fails under either standard, the Court does

not reach this question. See Beasley, 2021 WL 4059895, at *4 (citing Simon II and noting

that while Eleventh Circuit has not resolved potential conflict, the court “need not read

the tea leaves today” because ALJ’s was decision substantially supported under either

standard); Grant v. Comm’r of Soc. Sec., No. 4:20-cv-802-ACA, 2021 WL 3089224 (N.D.

Ala. July 22, 2021) (leaving unanswered question of whether treating physician rule still

applies, because under either framework, the ALJ’s decision was supported by substantial

evidence).

Dr. Panchal was Plaintiff’s pain management doctor, treating her approximately

once a month from November 2016 through June 2019 for chronic neck and lower back

pain (her last appointment of record was two weeks before her administrative hearing).

After treating Plaintiff for a year, in December 2017 Dr. Panchal completed a physical

RFC form (Tr. 530-34). He noted Plaintiff’s diagnoses of lumbar and cervical facet

arthropathy, sacroiliac joint dysfunction, and nerve root compression (Tr. 530). Plaintiff’s

pain was “constant, and limits [her] duration of walking, standing, sitting. [Plaintiff]

requires use of a cane.” (Id.). Her pain would “frequently” interfere with her attention

and concentration (Tr. 531).

Dr. Panchal checked boxes indicating Plaintiff could sit for up to 10 minutes at a

time for a total of less than two hours a day, stand for up to 10 minutes at a time for a total

of less than two hours a day, and could never twist, stoop, crouch, or climb (Tr. 532-33).

Plaintiff needed to walk every 10 to 15 minutes during an eight-hour workday for

approximately 10 minutes at a time (Id.). She would need unscheduled 15-minute breaks

every hour and would miss three workdays per month due to her severe pain (Id.). Dr.

Panchal concluded that Plaintiff could frequently lift and carry less than 10 pounds,

occasionally lift and carry 10 pounds, and never lift and carry 20 pounds (Tr. 533).

The ALJ found Dr. Panchal’s RFC assessment “less persuasive”:

The assessment of Dr. Panchal is so extreme as to appear implausible and

the opinion starkly contrasts with the other medical opinions of record.

Thus, the assessment of Dr. Panchal is rendered less persuasive. That said,

the undersigned finds that the claimant’s exertional limitations are likely to

fall in the median of Dr. Panchal’s assessment that essentially precludes all

work activity and light level exertion as assessed by the medical consultants

detailed below.

(Tr. 24). His consideration of Dr. Panchal’s opinion continued one page later, when he

determined it was unsupported by the doctor’s prior treatment notes:

Turning back to the opinion of Dr. Panchal, the undersigned also notes that

his assessment is not internally consistent with his own treatment records.

A review of Dr. Panchal’s treatment records dated in June 2019 revealed

that his physical examination findings show no objective evidence of

cyanosis, clubbing, or edema at the extremities. There was no pain with

passive range of motion of the knee. The claimant endorsed pain with

palpation of the medial and lateral collateral ligaments. Her gait was noted

to be antalgic. Flexion at the lumbar spine was good with low back pain

endorsed with left lumbar facet loadings maneuvers and with palpation of

the bilateral sacroiliac joints. There was neck pain endorsed with cervical

facet loading. Sensation was intact in all four extremities with the caveat of

hyperalgesia in the left SI distribution. Motor strength was intact at 5/5 in

the bilateral upper and lower extremities. The claimant was noted to have

had an excellent response to diagnostic blocks of the lumbar facet joints and

SI joints.

(Tr. 25).

Regarding supportability, Dr. Panchal’s exam findings were similar throughout his

three-year treating relationship with Plaintiff. As the ALJ noted, Plaintiff maintained full

strength in all four extremities, her spinal range of motion was good, her deep tendon

reflexes were consistently normal, her straight leg raise test was normal in both legs, and

she had a negative Patrick’s test in both legs (see Tr. 422, 424, 426, 428, 430, 432, 434, 436,

438, 440, 443, 446, 449).4 A February 2016 lumbar spine MRI revealed mild bilateral

facet arthropathy at L3-4 and L4-5 but no disc herniation, spinal stenosis, or bony lesions

(see Tr. 421). A cervical spine MRI taken a week later revealed mild to moderate right C5

root compression, a small central disc herniation and bilateral foraminal bony productive

change at C5-6, mild bilateral C6 root compression, and a mild posterior bulging disc at

C6-7 (Id.). Dr. Panchal treated Plaintiff with diagnostic nerve blocks (a localized injection

that involves numbing a specific nerve or nerve group to locate which nerves are

responsible for a patient’s pain). In December 2016, Dr. Panchal wrote: “[Plaintiff]

returns reporting 50% relief from diagnostic bilateral SI joint block and 70% relief from

diagnostic bilateral lumber facet block. She had a limited response to SI joint steroids.”

(Tr. 425). To him, this response was “excellent.” (Id.).

In March 2017, Plaintiff underwent radiofrequency facet denervation, a minimally

invasive outpatient procedure, to treat her neck and back pain (Tr. 428). Afterwards, she

reported she had residual pain in her SI joints (Id.). Her health insurance plan did not

cover cervical facet block therapy or SI joint denervation, so as early as March 2017, Dr.

4 A Patrick’s test assesses a patient’s flexion, abduction, and external hip rotation, and is

designed to evaluate for pathology of the sacroiliac (“SI”) joint. A positive Patrick’s test

is one that reproduces a patient’s pain or limits his or her range of motion.

Panchal consistently recommended to Plaintiff that she enroll in a spinal cord stimulation

trial (“SCS trial”) rather than surgery (Tr. 428, 432, 434, 438, 443) In June 2017, Plaintiff

reported to Dr. Panchal that she got temporary relief from SI joint steroid injections (Tr.

435).

Dr. Panchal did not order spine imaging after July 2016 (although he ordered a left

shoulder MRI in May 2019, Tr. 851) and instead prescribed Plaintiff physical therapy and

gabapentin, tizanidine, and tramadol. Many of Plaintiff’s appointments were to obtain

medication refills (Tr. 448, 450, 799, 802, 811, 814, 817, 820, 826, 829, 832, 841, 844, 847,

854). In June 2019 (Plaintiff’s last appointment of record with Dr. Panchal), over two

years after recommending to Plaintiff that she try an SCS trial, the doctor reported: “She

wishes to pursue SCS Trial and had obtained a psych screen, but still needs to delay due

to her husband’s cancer treatment. She requests refill of her opioids and denies side

effects.” (Tr. 854). Overall, as the ALJ noted, Dr. Panchal treated Plaintiff’s neck and

back pain with trigger point and facet injections, muscle relaxants, and prescription pain

medications, and he recommended physical therapy, acupuncture, and chiropractic care.

Dr. Panchal’s treatment did not change much over time. Additionally, on his RFC form,

Dr. Panchal checked boxes and circles responses with very little explanation. This has

little probative value. Hammersley v. Astrue, No. 5:08-cv-245-Oc-10GRJ, 2009 WL

3053707, at *6 (M.D. Fla. Sept. 18, 2009) (discounting treating psychiatrists’ mental

health questionnaires, noting that check-off forms are “conclusory and provide little

narrative or insight into the reasons behind the conclusions” and therefore are of limited

probative value). Considering this, the ALJ properly analyzed the supportability of Dr.

Panchal’s December 2017 RFC assessment when determining its persuasiveness, as

required by 20 C.F.R. §§ 404.1520c(c); 416.920c(c).

Regarding consistency – the other key factor ALJs must consider under the new

regulations – the ALJ compared Dr. Panchal’s RFC assessment to the opinions of other

medical sources; there is substantial evidentiary support for the ALJ’s statement that it

“starkly contrasts” with other record evidence (Tr. 24). For example, the ALJ considered

Plaintiff’s September 2017 consultative physical examination with Joao Fontoura, M.D.

(Tr. 516). Plaintiff had no joint swelling, erythema, or deformity (Tr. 517). She was able

to lift, carry, and handle light objects and perform fine motor skills. She had 4 out of 5

hand strength and no palpable muscle spasms. She was “diffusely tender to palpation”

and refused to do range of motion tests (Tr. 517-18). Plaintiff was able to squat and rise

from that position and was able to rise from a sitting position without difficulty (Id.).5 Dr.

Fontoura observed that Plaintiff had “several trigger points positive consistent with

fibromyalgia and I suspect that most of her symptoms are related to her fibromyalgia.”

(Tr. 518). She had significant tenderness in her SI joints, which Dr. Fontoura associated

with fibromyalgia. But overall Dr. Fontoura was unable to assess whether Plaintiff “had

any true joint pathology” or whether her symptoms would impact her ability to work,

because her “effort associated with the exam was poor.” (Tr. 518).

The ALJ also considered the physical RFC assessment completed by state agency

consultative physician Richard Lewis, M.D. in January 2018. Dr. Lewis reviewed

5 Dr. Fontoura stated: “[Plaintiff] did have some difficulty on occasion in standing up from

her chair, although when her phone rang, the patient was able to successfully stand up by

herself without her cane and pick up the phone.” (Tr. 518).

Plaintiff’s treatment records and opined she is capable of light exertion work with

limitations, an opinion affirmed by Mary McLarnon, M.D., the state agency medical

consultant tasked with reviewing Dr. Lewis’s opinion (Tr. 87-88, 539). Next, in February

2018 – as the ALJ noted – Plaintiff was treated by Richard Cain, M.D., an orthopedist at

BayCare Medical Group, for bilateral knee pain. He found Plaintiff had osteoarthritis of

the right knee and IT band syndrome. Plaintiff walked with a cane and told Dr. Cain that

viscosupplementation injections in her knee had “offered her significant relief” in the past

(Tr. 634). She had full active range of motion in both knees (Tr. 635).

A left shoulder MRI in May 2019 showed only mild tendinosis (degeneration of

the tendons), synovitis (swollen joints), and osteoarthritis (Tr. 852). Plaintiff told Drs.

Fontoura and Panchal that her lower back pain had started “more than 19 years ago with

radiation to the hips” (Tr. 421, 517); leading the ALJ to conclude that Plaintiff, who

stopped working in March 2016, “continued to work for many years with these

conditions.” (Tr. 25). Considering the ALJ’s comprehensive assessment and summary of

the other treatment notes, the Court finds the ALJ sufficiently reviewed the evidence of

record to determine the consistency of Dr. Panchal’s opinion.

Finally, even assuming the treating physician rule still applies in this case, the ALJ

showed good cause for discounting Dr. Panchal’s opinion. As explained above, Dr.

Panchal’s check-the-box RFC assessment conflicted with his treatment notes and with the

other medical evidence. See Phillips, 357 F.3d at 1241 (finding “good cause” when the

treating physician’s opinion is not bolstered by the evidence or is inconsistent with the

physician’s own treatment notes).

The undersigned reiterates that, when reviewing an ALJ’s decision, the Court’s job

is to determine whether the administrative record contains enough evidence to support

the ALJ’s factual findings. See 42 U.S.C. § 405(g); Biestek v. Berryhill, _.- U.S. ___; 139

S.Ct. 1148, 1154 (2019). “And whatever the meaning of ‘substantial’ in other contexts,

the threshold for such evidentiary sufficiency is not high.” Jd. In other words, the Court

is not permitted to reweigh the evidence or substitute its own judgment for that of the ALJ

even if it finds the evidence preponderates against the ALJ’s decision. See Bloodsworth v.

Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983).

V. Conclusion

Accordingly, after consideration, it is hereby

ORDERED:

1. The decision of the Commissioner is affirmed.

2. The Clerk is directed to enter final judgment in favor of the Commissioner and

close the case.

ORDERED in Tampa, Florida, on September 17, 2021.

: ~L-

SEAN P. FLYNN

UNITED STATES MAGISTRATE JUDGE

16