# Howland v. Commissioner of Social Security

> District Court, M.D. Florida · September 26, 2022

URL: https://www.frixlaw.com/law-library/cases/10111138

## Case

- **Court:** District Court, M.D. Florida
- **Decided:** September 26, 2022
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

## Citator (automated)

- No negative treatment found by the automated citator. That is not the same as a confirmation that the case is good law; read the citing cases.
- Full citator and citing cases: https://www.frixlaw.com/law-library/cases/10111138

## How later opinions describe it (automated extraction)

- stating that the “ALJ must consider the applicant’s medical condition taken as a whole”

## Opinion text

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

---

Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/10111138. Public record. Not legal advice.