Howland v. Commissioner of Social Security

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

JOAN E. HOWLAND,

Plaintiff,

v. Case No. 8:21-cv-1065-AEP

KILOLO KIJAKAZI,

Acting Commissioner of Social Security,

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.

A. Procedural Background

Plaintiff filed an application for DIB on December 28, 2018 (Tr. 254-57). The

Social Security Administration (“SSA”) denied Plaintiff’s claims both initially and

upon reconsideration (Tr. 119-54, 157-76). Plaintiff then requested an

administrative hearing (Tr. 177-78). Per Plaintiff’s request, the ALJ held a hearing

at which Plaintiff appeared and testified (Tr. 82-118). Following the hearing, the

ALJ issued an unfavorable decision finding Plaintiff not disabled and accordingly

denied Plaintiff’s claims for benefits (Tr. 58-81). Subsequently, Plaintiff requested

review from the Appeals Council, which the Appeals Council denied (Tr. 1-7).

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).

B. Factual Background and the ALJ’s Decision

Plaintiff, who was born in 1966, claimed disability beginning February 24,

2017 (Tr. 254). Plaintiff completed two years of college (Tr. 281). Plaintiff’s past

relevant work experience included work as a licensed practical nurse (Tr. 113, 281).

Plaintiff alleged disability due to rheumatoid arthritis, multilevel degenerative disc

disease, leftward convex thoracolumbar scoliosis, asthma, COPD, osteopenia, and

anxiety (Tr. 280).

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 February 24, 2017, the alleged onset

date (Tr. 63). After conducting a hearing and reviewing the evidence of record, the

ALJ determined that Plaintiff had the following severe impairments: degenerative

disc disease, scoliosis, inflammatory arthritis, osteoarthritis, synovitis and

tenosynovitis of the hands, asthma, obesity, and fibromyalgia (Tr. 63).

Notwithstanding the noted impairments, the ALJ determined that 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 (Tr. 65).

The ALJ then concluded that Plaintiff retained a residual functional capacity

(“RFC”) to perform light work, except she could occasionally push and pull with

the bilateral upper extremities; occasionally balance, stoop, kneel, crouch, and

climb ramps and stairs; never crawl or climb ladders, ropes, or scaffolds;

occasionally reach overhead bilaterally; frequently reach in all other directions;

frequently handle and finger bilaterally; and have no more than occasional exposure

to atmospheric irritants, such as dust, odors, fumes, and gases, and workplace

hazards, such as unprotected heights and moving machinery (Tr. 67). 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 her

symptoms were not entirely consistent with the medical evidence and other

evidence (Tr. 68).

Considering Plaintiff’s noted impairments and the assessment of a vocational

expert (“VE”), however, the ALJ determined Plaintiff could not perform her past

relevant work (Tr. 72). Given Plaintiff’s background and RFC, the VE testified that

Plaintiff could perform other jobs existing in significant numbers in the national

economy, such as an office helper; a mail clerk, non-postal; a copy machine

operator; and a housekeeping cleaner (Tr. 74, 113-17). Accordingly, based on

Plaintiff’s age, education, work experience, RFC, and the testimony of the VE, the

ALJ found Plaintiff not disabled (Tr. 74-75).

II.

To be entitled to benefits, a claimant must be disabled, meaning the claimant

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). 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).

To regularize the adjudicative process, the SSA 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: (1) whether the claimant is currently engaged in

substantial gainful activity; (2) whether the claimant has a severe impairment, i.e.,

one that significantly limits the ability to perform work-related functions; (3)

whether the severe impairment meets or equals the medical criteria of 20 C.F.R.

Part 404, Subpart P, Appendix 1; and (4) whether the claimant can perform his or

her past relevant work. 20 C.F.R. § 404.1520(a)(4). If the claimant cannot perform

the tasks required of his or 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

his or her age, education, and work experience. 20 C.F.R. § 404.1520(a)(4)(v). 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)(1).

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). “Substantial evidence is more than a scintilla

and is such relevant evidence as a reasonable person would accept as adequate to

support a conclusion.” Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th

Cir. 2011) (citation and internal quotation marks omitted). While the court reviews

the Commissioner’s decision with deference to the factual findings, no such

deference is given to the legal conclusions. Ingram v. Comm’r of Soc. Sec., 496 F.3d

1253, 1260 (11th Cir. 2007) (citations omitted).

In reviewing the Commissioner’s decision, the court may not reweigh 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. Winschel, 631 F.3d at 1178

(citations omitted); Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)

(citations omitted). 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. Ingram, 496 F.3d at 1260

(citation omitted). The scope of 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) (per curiam) (citations omitted).

III.

Plaintiff argues that the ALJ erred by (1) improperly finding that Plaintiff’s

mental impairments and limitations were not severe; (2) improperly finding that

Plaintiff could use her hands for frequent handling and fingering; (3) failing to

properly consider Plaintiff’s subjective complaints of pain; and (4) failing to properly

consider the opinion of her treating psychiatrist, Dr. Vidyasagar Vangala. For the

following reasons, the ALJ applied the correct legal standards and the ALJ’s

decision is supported by substantial evidence.

A. Mental Impairments

Plaintiff contends that the ALJ improperly concluded that Plaintiff’s mental

impairments and limitations were not severe. At step two of the sequential analysis,

the ALJ considers the medical severity of a claimant’s impairments. 20 C.F.R. §

404.1520(a)(4)(ii). Step two operates as a threshold inquiry. McDaniel v. Bowen, 800

F.2d 1026, 1031 (11th Cir. 1986); see Gray v. Comm’r of Soc. Sec., 550 F. App’x 850,

853 (11th Cir. 2013) (per curiam).1 At step two of the sequential evaluation process,

a claimant must show that he or she suffers from an impairment or combination of

impairments that significantly limits his or her physical or mental ability to do basic

work activities. See 20 C.F.R. §§ 404.1520(a)(4)(ii), 404.1521, 404.1522(a). “An

1 Unpublished opinions are not considered binding precedent but may be cited as

impairment is not severe only if the abnormality is so slight and its effect so minimal

that it would clearly not be expected to interfere with the individual’s ability to

work, irrespective of age, education or work experience.” McDaniel, 800 F.2d at

1031; Brady v. Heckler, 724 F.2d 914, 920 (11th Cir. 1984) (per curiam). “[T]he

‘severity’ of a medically ascertained disability must be measured in terms of its effect

upon ability to work, and not simply in terms of deviation from purely medical

standards of bodily perfection or normality.” McCruter v. Bowen, 791 F.2d 1544,

1547 (11th Cir. 1986). In other words, an impairment or combination of

impairments is not considered severe where it does not significantly limit the

claimant’s physical or mental ability to perform basic work activities. Turner v.

Comm’r of Soc. Sec., 182 F. App’x 946, 948 (11th Cir. 2006) (per curiam) (citations

omitted); 20 C.F.R. § 404.1521.

Notably, however, the finding of any severe impairment, whether or not it

results from a single severe impairment or a combination or impairments that

together qualify as severe, is enough to satisfy step two. Jamison v. Bowen, 814 F.2d

585, 588 (11th Cir. 1987) (citations omitted); see Packer v. Comm’r, Soc. Sec. Admin.,

542 F. App’x 890, 892 (11th Cir. 2013) (per curiam) (“[T]he ALJ determined at step

two that at least one severe impairment existed; the threshold inquiry at step two

therefore was satisfied.”); Heatly v. Comm’r of Soc. Sec., 382 F. App’x 823, 824-25

(11th Cir. 2010) (per curiam) (noting that an ALJ’s failure to identify an impairment

as severe, where the ALJ found that the plaintiff suffered from at least one severe

impairment, constituted harmless error and was, in fact, sufficient to meet the

requirements of step two, and additionally noting that nothing requires the ALJ to

identify, at step two, all of the impairments that could be considered severe). Here,

the ALJ determined that Plaintiff had the following severe impairments:

degenerative disc disease, scoliosis, inflammatory arthritis, osteoarthritis, synovitis

and tenosynovitis of the hands, asthma, obesity, and fibromyalgia (Tr. 63).

Accordingly, since the ALJ determined that Plaintiff suffered from multiple severe

impairments at step two, and thus proceeded beyond step two in the sequential

analysis, any error in failing to find that Plaintiff suffered from other severe

impairments is rendered harmless. Gray, 550 F. App’x at 853-54; Packer, 542 F.

App’x at 892; Heatly, 382 F. App’x at 824-25.

Beyond that, however, the ALJ found that Plaintiff’s medically determinable

mental impairments of affective disorder and anxiety disorder, considered singly

and in combination, did not cause more than minimal limitation in her ability to

perform basic mental work activities and therefore, not severe (Tr. 64). The ALJ’s

determination is supported by substantial evidence.

The ALJ found that in the functional area of understanding, remembering or

applying information, Plaintiff had no more than a mild limitation (Tr. 64). The

ALJ’s finding is supported by substantial evidence. Nothing in the record indicates

that Plaintiff had significant cognitive deficits. For instance, Plaintiff reported that

she managed finances, managed her medications along with that of her husband’s

care, including his medication and doctor appointments (Tr. 289-90, 293). The ALJ

found that in the functional area of interacting with others, Plaintiff had no more

than a mild limitation (Tr. 64). The ALJ’s finding is supported by substantial

evidence. For example, Plaintiff reported that she partook in weekly social chatting

visits and went on “social friend visits [and] walks” one to three times a week (Tr.

293). Additionally, Plaintiff reported no problems getting along with family, friends,

or others (Tr. 294). The ALJ found that in the functional area of concentrating,

persisting, or maintaining pace, Plaintiff had no more than a mild limitation (Tr.

65). The ALJ’s finding is supported by substantial evidence. For example, although

Plaintiff reported depressed mood (Tr. 536, 567, 694, 700, 736, 740, 800, 805, 810,

838), her mental status exams were largely unremarkable, showing intact attention

and concentration (Tr. 314, 321, 438, 446-47, 451-52, 457, 472-73, 567, 570-71, 655,

663, 740, 800, 806, 811, 838). Lastly, the ALJ found that in the functional area of

adapting or managing oneself, Plaintiff had no more than a mild limitation (Tr. 65).

The ALJ’s finding is supported by substantial evidence. For example, although

Plaintiff reported depressed mood (Tr. 536, 567, 694, 700, 736, 740, 800, 805, 810,

838), her mental status exams were largely unremarkable, showing good insight and

judgment (Tr. 427, 447, 452, 457, 473, 567, 571, 655, 663, 740, 800, 806, 811, 838).

Plaintiff also argues that her depression screening PHQ-9 test conducted by

her psychiatrist, Dr. Vidyasagar Vangala, indicated that she had “moderate”

depression.2 However, a diagnosis does not establish that her mental impairments

2 The PHQ-2 and PHQ-9 (Patient Health Questionnaire) are a “self-administered tools for

assessing depression.” Patient Health Questionnaire (PHQ-9 & PHQ-2), Construct: Depressive

Symptoms, American Psychological Association (June 2020),

www.apa.org/pi/about/publications/caregivers/practice-

were severe or that they caused work-related limitations. See McCruter, 791 F.2d at

1547. Moreover, Dr. Vangala, who administered the PHQ-9, classified Plaintiff’s

depression as mild (Tr. 766, 802, 807, 812, 839). It is also worth noting that

Plaintiff’s reported PHQ-2 depression screening test conducted by her previous

primary care provider, Dr. Frank Fera, generally noted a score of 0 and at most 2

(Tr. 437, 442, 445, 451, 457, 467, 472, 654).3 Additionally, the ALJ did not deny

that Plaintiff had a diagnosis of depression (Tr. 64). Rather, the ALJ found that the

record did not support more than a mild limitation caused by such impairment (Tr.

64-65).

Based on the foregoing, substantial evidence supports the ALJ’s findings

classifying Plaintiff’s mental impairment as not severe.

B. RFC - Frequent Handling and Fingering

Plaintiff next argues that the ALJ improperly concluded that Plaintiff could

frequently handle and finger. At step four of the sequential evaluation process, the

ALJ assesses the claimant’s RFC and ability to perform past relevant work. See 20

C.F.R. §§ 404.1520(a)(4)(iv), 404.1545. To determine a claimant’s RFC, an ALJ

makes an assessment based on all the relevant evidence of record as to what a

claimant can do in a work setting despite any physical or mental limitations caused

3 “A PHQ-2 score ranges from 0-6. The authors identified a score of 3 as the optimal

cutpoint when using the PHQ-2 to screen for depression. If the score is 3 or greater, major

depressive disorder is likely.” https://www.hiv.uw.edu/page/mental-health-

screening/phq-

2#:~:text=A%20PHQ%2D2%20score%20ranges,major%20depressive%20disorder%20is

by the claimant’s impairments and related symptoms. 20 C.F.R. § 404.1545(a)(1).

In rendering the RFC, therefore, the ALJ must consider the medical opinions in

conjunction with all the other evidence of record and will consider all the medically

determinable impairments, including impairments that are not severe, and the total

limiting effects of each. 20 C.F.R. §§ 404.1520(e), 404.1545(a)(2) & (e); see Schink v.

Comm’r of Soc. Sec., 935 F.3d 1245, 1268 (11th Cir. 2019) (per curiam)

(“Consideration of all impairments, severe and non-severe, is required when

assessing a claimant’s RFC”); Jamison, 814 F.2d at 588 (stating that the “ALJ must

consider the applicant’s medical condition taken as a whole”). In doing so, the ALJ

considers evidence such as the claimant’s medical history; medical signs and

laboratory findings; medical source statements; daily activities; evidence from

attempts to work; lay evidence; recorded observations; the location, duration,

frequency, and intensity of the claimant’s pain or other symptoms; the type, dosage,

effectiveness, and side effects of any medication or other treatment the claimant

takes or has taken to alleviate pain or other symptoms; treatment, other than

medication, the claimant receives or has received for relief of pain or other

symptoms; any measures the claimant uses or has used to relieve pain or symptoms;

and any other factors concerning the claimant’s functional limitations and

restrictions. 20 C.F.R. §§ 404.1529(c)(3)(i)-(vii), 404.1545(a)(3); Social Security

Ruling (“SSR”) 96-8p, 1996 WL 374184 (July 2, 1996); SSR 16-3p, 2017 WL

5180304 (Oct. 25, 2017).

Here, the ALJ found that Plaintiff’s medically determinable impairments

could reasonably be expected to cause her alleged symptoms, however, her

statements concerning the intensity, persistence and limiting effects of these

symptoms were not entirely consistent with the medical evidence and other

evidence in the record (T. 68). Specifically, the ALJ found that although Plaintiff

testified that she stopped working in February 2017 due to pain in her hands (see T.

97), it was not until November 2018 that she began reporting pain and swelling in

her hands (Tr. 69). The ALJ noted that while physical examinations in November

2018 revealed tenderness at the base of the thumbs bilaterally, tenderness and

swelling in the finger joints bilaterally, and reduced range of motion in the hands

bilaterally, x-rays of the hands revealed mild degenerative joint disease in the left

hand and unremarkable findings in the right hand (Tr. 69). As a result, the ALJ

noted that Plaintiff was diagnosed with rheumatoid arthritis and osteoarthritis, and

she was prescribed medication and administered steroid injections in the hands (Tr.

69-70). Nonetheless, the ALJ found that in subsequent physical examinations,

Plaintiff demonstrated normal grip strength (Tr. 70). Moreover, the ALJ noted that

Plaintiff could perform daily activities and hobbies that and demonstrated

improvement in symptoms through the course of her treatment (Tr. 70). The ALJ

concluded that “[d]ue to the rheumatoid arthritis and osteoarthritis in the hands,

she can never crawl or climb ladders, ropes, or scaffolds and is limited to frequent

handling and fingering bilaterally” (Tr. 70).

The objective medical evidence supports the ALJ’s findings regarding

Plaintiff’s gross and fine manipulation limitations. According to the record, Plaintiff

first reported pain in her hands in November 2018 (Tr. 464). Plaintiff visited her

primary care provider, which at the time was Dr. Frank Fera, and was seen by the

nurse practitioner who observed tenderness and reduced range of motion in her

hands (Tr. 467). The nurse practitioner noted that she gave Plaintiff samples of

Duexis4 and a nonsteroidal anti-inflammatory topical gel (Tr. 467). Plaintiff was

also referred to a rheumatologist physician assistant, RPA Kaymakcian, who saw

Plaintiff that same month and noted twelve tender swollen joints (Tr. 569, 571).

Plaintiff reported that the topical gel and Duexis had helped her but she continued

to be symptomatic, therefore had been subsequently prescribed prednisone (Tr.

569). RPA Kaymakcian continued Plaintiff’s prescription for prednisone and the

topical gel, and prescribed a stronger dose of Tylenol (Tr. 572). RPA Kaymakcian

also ordered X-rays of Plaintiff’s hands, which revealed mild degenerative joint

disease at the first carpometacarpal joint in her left hand and unremarkable findings

in her right hand (Tr. 582). The X-ray report also states that there is no abnormal

soft tissue swelling detected in either hand (Tr. 582). In a subsequent visit with RPA

Kaymakcian on December 17, 2018, Plaintiff was injected with cortisone, which

she tolerated well, and prescribed Methotrexate for her rheumatoid arthritis (Tr.

568). At the next visit with RPA Kaymakcian on January 29, 2019, Plaintiff

4 “DUEXIS contains two medicines: ibuprofen, a nonsteroidal anti‐inflammatory drug

(NSAID), and famotidine, a histamine H – receptor blocker medicine.”

2

reported improvement from the cortisone injections into her left thumb (Tr. 660).

Although Plaintiff reported minimal benefit from the Methotrexate, RPA

Kaymakcian noted that Plaintiff was only six doses into the medication (Tr. 660).

RPA Kaymakcian noted that Plaintiff showed two tender and swollen joints, an

improvement from the previous visit more than a month before (Tr. 660). RPA

Kaymakcian increased the Methotrexate dosage (Tr. 664). In February 2019,

Plaintiff saw a consultative examiner, Dr. Kautilya Puri, who noted that Plaintiff’s

hand and finger dexterity was intact and her grip strength was 5/5 bilaterally (Tr.

700-703).

Plaintiff was not treated by a rheumatologist again until October 2019 when

Plaintiff began to see rheumatologist Dr. Anika Alarakhia who noted that although

Plaintiff had “some evidence of synovitis of the hands on exam,” Dr. Alarakhia did

not have any recent lab work to review (Tr. 427). Nonetheless, Dr. Alarakhia’s

physical examination of Plaintiff revealed tenderness in all hand joints with slight

swelling over the knuckles and difficulty making a fist bilaterally (Tr. 427). Plaintiff

reported that she felt that Methotrexate was not helpful (Tr. 426). Dr. Alarakhia

diagnosed Plaintiff with rheumatoid arthritis of multiple sites with negative

rheumatoid factor, osteoarthritis involving multiple joints, and fibromyalgia (Tr.

425). Dr. Alarakhia also recommended Plaintiff remain with the same dosage of

Methotrexate and restart prednisone and take Duexis5 as needed (Tr. 427). Dr.

5 It is unclear from the record when Plaintiff stopped taking Duexis before Dr. Alarakhia

Alarakhia also submitted to SSA an undated prescription note stating that Plaintiff

is “unable to use hands currently because of pain” (Tr. 727). In a March 2020 visit,

Dr. Alarakhia reported that Plaintiff was doing well on subcutaneous methotrexate

and her inflammatory markers were now normal and her pain had improved (Tr.

833).

Plaintiff was also seen by a psychiatrist, Dr. Vidyasagar Vangala (Tr. 738).

Dr. Vangala’s treatment notes state that Plaintiff reported that “doing arts and crafts

makes the anxiety better” (Tr. 738). As part of the psychiatric evaluation by the

consultative mental examiner conducted in February 2019, Dr. Jennifer Ochoa

noted that Plaintiff enjoyed reading and sewing but could no longer sew because of

her physical limitations (Tr. 696). Moreover, the consultative examiner, Dr. Puri

also noted that Plaintiff “can do some cooking, cleaning, shopping, showers, bathes,

and dresses” (Tr. 701). In her response to the Supplemental Immune System

Questionnaire completed in May 2019, Plaintiff stated that her symptoms included

pain, swelling of both hands and thumb joints and would get some relief from extra-

strength Tylenol (Tr. 273). Moreover, Plaintiff, asserted in her function report that

she takes care of her husband, who she testified is disabled (Tr. 91), manages his

medication and doctor appointments, and cooks daily (Tr. 290). In her function

report, Plaintiff also stated that she drove a car (Tr. 292), although at the hearing,

she testified that she rarely drove because of not being able to maintain grip strength

around the steering wheel (Tr. 91-92). However, physical examinations throughout

the record show normal strength and tone in all extremities (Tr. 438, 446-47, 452,

458, 655, 736, 785, 832). Moreover, while some physical examinations noted

Plaintiff’s joint tenderness, swelling, and limited grip strength in the hands (Tr. 467,

571, 702, 736, 775), other physical examination revealed no visible swelling (Tr.

438, 447-48, 452, 457-58, 473, 542, 555, 560, 634, 655).

Plaintiff also argues that the ALJ improperly considered her activities and

that she performed arts and crafts in the assessment of her RFC and the manual

limitations. According to Plaintiff, her statement to Dr. Vangala that engaging in

arts and crafts makes her anxiety better is not an indication that Plaintiff was

currently able to do arts and crafts, or if so, how extensive her activities were in that

area. However, the ALJ did not rely solely on Plaintiff’s daily activities or hobbies

in assessing Plaintiff’s ability to perform certain type of work. Rather, the ALJ

considered Plaintiff’s daily activities as part of her overall assessment of the RFC

(see 67-72).

Moreover, Plaintiff argues that the ALJ placed too much emphasis on the

previous administrative medical findings of the state agency reviewing physicians.

On reconsideration, state agency reviewing physician, Dr. Larry Meade, found that

Plaintiff was limited to frequent handling and fingering (Tr. 148). The ALJ’s

conclusion that Dr. Meade’s findings were persuasive because they were consistent

with the evidence of record is supported by substantial evidence. The ALJ

considered Dr. Meade’s opinion in combination with her full review and

consideration of the record, which supports her findings as to Plaintiff’s functional

limitations. The ALJ even noted that Plaintiff’s primary care provider, Dr. Aftab

Khan’s physician assistant submitted a medical opinion that indicated that Plaintiff

had no limitations to her fine or gross motor activity and was able to use her hands

for grasping, pushing/pulling, and fine manipulation (Tr. 728-29). However, the

ALJ found that the record and Dr. Khan’s own treatment notes supported some

manipulative limitations (Tr. 72).

Plaintiff’s treatment records showed no weakness or swelling during multiple

examinations, with normal range of motion, indicating that her allegations were not

fully supported by the evidence. Plaintiff’s symptoms generally improved as a result

of medication. The ALJ properly discounted Dr. Alarakhia’s opinion in the form of

the undated prescription notes because it was vague and does not set forth specific

functional limitations (Tr. 72). Moreover, Plaintiff’s treatment plan was consistent

and Plaintiff reported improvement of her symptoms. While, for example, some of

Plaintiff’s physical examinations suggested that Plaintiff had limited grip and

strength in her hands, the ALJ’s decision must be affirmed because it is supported

by substantial evidence in the record. See Ingram, 496 F.3d at 1260.

C. Subjective Complaints of Pain

Plaintiff additionally asserts that the ALJ failed to properly consider her

subjective complaints of pain. As indicated, in addition to the objective evidence of

record, the ALJ must consider all the claimant’s symptoms, including pain, and the

extent to which these symptoms can reasonably be accepted as consistent with the

objective evidence and other evidence.6 See 20 C.F.R. § 404.1529; SSR 16-3p, 2017

WL 5180304, at *2. A claimant’s statement as to pain or other symptoms shall not

alone be conclusive evidence of disability. 42 U.S.C. § 423(d)(5)(A). To establish a

disability based on testimony of pain and other symptoms, the claimant must show

evidence of an underlying medical condition and either (1) objective medical

evidence confirming the severity of the alleged symptoms or (2) that the objectively

determined medical condition can reasonably be expected to give rise to the alleged

symptoms. Wilson, 284 F.3d at 1225 (citing Holt v. Sullivan, 921 F.2d 1221, 1223

(11th Cir. 1991)); see 20 C.F.R. § 404.1529. Consideration of a claimant’s symptoms

thus involves a two-step process, wherein the ALJ first considers whether an

underlying medically determinable physical or mental impairment exists that could

reasonably be expected to produce the claimant’s symptoms, such as pain. 20

C.F.R. § 404.1529(b); SSR 16-3p, 2017 WL 5180304, at *3-9. If the ALJ determines

that an underlying physical or mental impairment could reasonably be expected to

produce the claimant’s symptoms, the ALJ evaluates the intensity and persistence

of those symptoms to determine the extent to which the symptoms limit the

claimant’s ability to perform work-related activities. 20 C.F.R. § 404.1529(c); SSR

6 The regulations define “objective evidence” to include evidence obtained from the

application of medically acceptable clinical diagnostic techniques and laboratory findings.

20 C.F.R. § 404.1529(c)(2). Additionally, the regulations define “other evidence” to

include evidence from medical sources, non-medical sources, and statements regarding a

claimant’s pain or other symptoms, including about treatment the claimant has received.

See 20 C.F.R. § 404.1529(c)(3). Moreover, the regulations define “symptoms” as a

claimant’s own description of his or her physical or mental impairment. 20 C.F.R. §

16-3p, 2017 WL 5180304, at *3-9. When the ALJ discredits the claimant’s

subjective testimony, the ALJ must articulate explicit and adequate reasons for

doing so. Wilson, 284 F.3d at 1225 (citation omitted). A reviewing court will not

disturb a clearly articulated finding regarding a claimant’s subjective complaints

supported by substantial evidence in the record. Mitchell v. Comm’r, Soc. Sec. Admin.,

771 F.3d 780, 782 (11th Cir. 2014); Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir.

1995) (per curiam) (citation omitted).

Notably, in considering a claimant’s subjective complaints, the ALJ

considers both inconsistencies in the evidence and the extent to which any conflicts

exist between the claimant’s statements and the rest of the evidence, including the

claimant’s history, signs and laboratory findings, and statements by treating or non-

treating sources or other persons about how the symptoms affect the claimant. 20

C.F.R. § 404.1529(c)(4). Importantly, however, the ALJ’s “determination does not

need to cite particular phrases or formulations but it cannot merely be a broad

rejection which is not enough to enable” a court to conclude that the ALJ

considered the claimant’s medical condition as a whole. Dyer v. Barnhart, 395 F.3d

1206, 1210 (11th Cir. 2005) (internal quotation marks and citation omitted); see

Sampson v. Comm’r of Soc. Sec., 694 F. App’x 727, 740 (11th Cir. 2017) (quoting Dyer).

In this instance, the ALJ found that Plaintiff’s allegations of symptoms were

not entirely consistent with the medical evidence and other evidence in the record

(Tr. 67-72). Plaintiff testified that she was unable to work due to pain in her hands

and inability to complete tasks (Tr. 95-96). She also stated that she was losing

strength and range of motion in her hands before leaving her last job (Tr. 96).

Plaintiff reported that since learning that she has rheumatoid arthritis, she had little

to no strength in her hands, little range of motion, and limited ability to grasp (Tr.

96). Specifically, Plaintiff testified that she has difficulty cooking and driving, and

cannot dial a number on a phone (Tr. 92, 100-01). Plaintiff also reported constant

shooting pain from her elbows through her fingertips and pain in her other joints

when she experiences a flare-up (Tr. 101). Moreover, Plaintiff testified that she was

only able to take Tylenol for pain due to her rheumatoid arthritis medication and

had problem walking due to her back (Tr. 101-03).

The ALJ found that Plaintiff’s medically determinable impairments could

reasonably be expected to cause the alleged symptoms, however, Plaintiff’s

statements concerning the intensity, persistence and limiting effects of these

symptoms were not entirely consistent with the medical evidence and other

evidence in the record (Tr. 68). The ALJ noted the following:

Accordingly, these statements have been found to affect the claimant’s

ability to work only to the extent they can reasonably be accepted as

consistent with the objective medical and other evidence. As a part of

this evaluation, the undersigned evaluated the consistency of the

claimant’s subjective allegations with the evidence of record. In

making this assessment, the undersigned considered the record as a

whole, including the claimant’s statements regarding the intensity,

persistence, and limiting effects of her alleged symptoms. Factors

relevant to this assessment include:

• Daily activities;

• The location, duration, frequency, and intensity of the pain or

other symptoms;

• Precipitating and aggravating factors;

• The type, dosage, effectiveness, and side effects of any

medication taken to alleviate pain or other symptoms;

• Treatment, other than medication, received for relief of pain or

other symptoms;

• Any measures, other than treatment, used to relieve the pain or

other symptoms; and

• Any other factors concerning the claimant’s functional

limitations and restrictions due to pain or other symptoms.

(Tr. 68-69).

The ALJ then recounted the medical evidence of record in order to

demonstrate that it did not support Plaintiff’s testimony (Tr. 68-72). Thus, the

record reveals that the ALJ provided an adequate basis to explain why she

discredited portions of Plaintiff’s subjective complaints where they were

contradicted by the record. The ALJ noted that Plaintiff reported that she could

perform multiple daily activities, such as cooking, cleaning, shopping, and caring

for her personal needs, although she testified that she had little strength and losing

range of motion in her hands. Plaintiff states that the daily activities cited by the

ALJ in support of her finding are at Exhibit 10F (Tr. 701), which is the consultative

examiner Dr. Puri’s evaluation. Plaintiff argues that Dr. Puri actually stated that

Plaintiff could do “some” cooking, cleaning, shopping, and caring for personal

needs, thus, Plaintiff was limited in some unspecified way in those activities.

However, Plaintiff is pointing to a distinction without a difference. In fact, Plaintiff

did not only report to Dr. Puri that she was able to do some of those daily activities,

but she also reported in her function report that she managed her medications along

with that of her husband’s care, including his medication and doctor appointments

and cooked some meals daily (Tr. 289-91, 293). Plaintiff specified that she prepared

stove top foods and microwave meals and used smaller lighter pots and pans (Tr.

291). Plaintiff also reported driving a car to travel, which she mostly did during the

day (Tr. 291). In her supplemental responses in May 2019, when asked what

difficulties she had caring for her own personal needs, she explained that she needed

help opening and squeezing bottles (Tr. 275).

As previously discussed, the ALJ did not rely solely on Plaintiff’s

participation in some daily activities when discounting her symptoms. Rather, the

ALJ provided a detailed analysis of the evidence of record, articulated the reasons

why she discounted Plaintiff’s subjective complaints, and supplied a rationale for

her findings. Contrary to Plaintiff’s argument, the ALJ did not totally discount

Plaintiff’s subjective complaints, but considered them along with the record as a

whole, including objective and other evidence, in formulating a limited RFC.

Therefore, the ALJ did not err when considering Plaintiff’s subjective complaints.

D. Dr. Vangala’s Opinion

Lastly, Plaintiff contends that the ALJ failed to properly consider Dr.

Vangala’s opinion. Previously, in the Eleventh Circuit, an ALJ was required to

afford the testimony of a treating physician substantial or considerable weight unless

“good cause” was shown to the contrary. Winschel., 631 F.3d at 1179; Crawford v.

Comm’r of Soc. Sec., 363 F.3d 1155, 1159 (11th Cir. 2004) (per curiam) (citation

omitted). Good cause existed where: (1) the treating physician’s opinion was not

bolstered by the evidence; (2) the evidence supported a contrary finding; or (3) the

treating physician’s opinion was conclusory or inconsistent with the physician’s

own medical records. Phillips v. Barnhart, 357 F.3d 1232, 1240-41 (11th Cir. 2004)

(citation omitted). However, claims filed on or after March 27, 2017 are governed

by a new regulation applying a modified standard for the handling of opinions from

treating physicians. See 20 C.F.R. § 404.1520c; see also Schink, 935 F.3d at 1259 n.4.

Of note, the new regulations remove the “controlling weight” requirement when

considering the opinions of treating physicians for applications submitted on or after

March 27, 2017. 20 C.F.R. § 404.1520c(a); Harner v. Soc. Sec. Admin., Comm’r, 38

F.4th 892, 895-98 (11th Cir. 2022); Yanes v. Comm’r of Soc. Sec., No. 20-14233, 2021

WL 2982084, at *5 n.9 (11th Cir. July 15, 2021) (per curiam).7 Indeed, the Eleventh

Circuit recently concluded that, since the new regulations fall within the scope of

the Commissioner’s authority and are not arbitrary and capricious, the new

regulations abrogate the Eleventh Circuit’s previous precedents applying the so-

called treating-physician rule. Harner, 38 F.4th at 896. Accordingly, since Plaintiff

submitted her application for benefits on December 18, 2018 (Tr. 254-55), the ALJ

properly applied the new regulation. Therefore, the ALJ was not bound by Dr.

Vangala’s opinion based on the Eleventh Circuit’s previous precedents applying the

so-called treating-physician rule.

Under the revised regulation, an ALJ will not defer or give any specific

evidentiary weight, including controlling weight, to any medical opinion or prior

administrative finding, including from a claimant’s medical source. 20 C.F.R. §

7 Unpublished opinions are not considered binding precedent but may be cited as

404.1520c(a). Rather, in assessing a medical opinion, an ALJ considers a variety of

factors, including but not limited to whether an opinion is well-supported, whether

an opinion is consistent with the record, the treatment relationship between the

medical source and the claimant, and the area of the medical source’s specialization.

20 C.F.R. § 404.1520c(c)(1)-(4). The primary factors an ALJ will consider when

evaluating the persuasiveness of a medical opinion are supportability and

consistency. 20 C.F.R. § 404.1520c(a) & (b)(2). Specifically, the more a medical

source presents objective medical evidence and supporting explanations to support

the opinion, the more persuasive the medical opinion will be. 20 C.F.R. §

404.1520c(c)(1). Further, the more consistent the medical opinion is with the

evidence from other medical sources and nonmedical sources, the more persuasive

the medical opinion will be. 20 C.F.R. § 404.1520c(c)(2). Beyond supportability and

consistency, an ALJ may also consider the relationship the medical source

maintains with the claimant, including the length of the treatment relationship, the

frequency of examinations, the purpose of the treatment relationship, the extent of

the treatment relationship, and whether the medical source examined the claimant,

in addition to other factors. 20 C.F.R. § 404.1520c(c)(3)(i)-(v) & (5).

Here, Plaintiff’s psychiatrist, Dr. Vangala, submitted a medical opinion

wherein she opined that Plaintiff had marked limitations in understanding and

memory, sustained concentration and persistence, social interaction, and

adaptation (Tr. 842-45). The ALJ did not find Dr. Vangala’s opinion persuasive

because she found it inconsistent with the record as a whole, including Dr.

Vangala’s own treatment notes (Tr. 72). Specifically, the ALJ found that mental

status and psychiatric examination throughout the record documented largely

unremarkable findings (see Tr. 314, 321, 427, 438, 446-47, 451-52, 457, 472-73, 567,

570-71, 655, 663, 740, 800, 806, 811, 838). Additionally, Dr. Vangala classified

Plaintiff’s depression as mild (Tr. 766, 802, 807, 812, 839).

Plaintiff argues that the distinction between “mild” and “moderate” criteria

for major depressive disorder is that a mild diagnosis requires one of the following

symptoms: loss of confidence or self-esteem; unreasonable feelings of self-reproach

or excessive and inappropriate guilt; recurrent thought of death or any suicidal

behavior; complaints or evidence of diminished ability to think or concentrate, such

as indecisiveness or vacillation; change in psychomotor activity with agitation or

retardation; sleep disturbance of any type; and change in appetite with

corresponding weight change; whereas a moderate diagnosis requires four of the

symptoms above along with great difficulty in continuing with ordinary activities.

Although Plaintiff attempts to characterize this as a subtle difference, a claimant

exhibiting great difficulty in continuing with ordinary activities would presumably

have significant limiting symptoms than one who does not. For instance, Plaintiff

reported that she managed finances, managed her medications along with that of

her husband’s care, including his medication and doctor appointments (Tr. 289-90,

293). The ALJ found that in the functional area of interacting with others, Plaintiff

had no more than a mild limitation (Tr. 64).

Moreover, a review of the record reveals inconsistencies with Dr. Vangala’s

opinion. For example, Plaintiff reported that she partook in weekly social chatting

visits and went on “social friend visits [and] walks” one to three times a week (Tr.

293). Additionally, Plaintiff reported no problems getting along with family, friends,

or others (Tr. 294). Furthermore, Plaintiff’s mental status exams, including Dr.

Vangala’s own treatment notes, generally showed that Plaintiff had intact attention

and concentration and good insight and judgment (Tr. 314, 321, 427, 438, 446-47,

451-52, 457, 472-73, 567, 570-71, 655, 663, 740, 800, 806, 811, 838).

Therefore, the ALJ did not err in finding Dr. Vangala’s opinion not

persuasive based on her consideration of the record. Substantial evidence supports

the ALJ’s findings regarding Plaintiff’s level of limitations as set out in the RFC.

IV.

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.

DONE AND ORDERED in Tampa, Florida, on this 26th day of September,

2022.

ANTHON E. PORCELLI

United Sfates Magistrate Judge

cc: Counsel of Record