Opinion

Gauglione v. Acting Commissioner of Social Security

Court: District Court, S.D. Florida
Filed: Mar 29, 2024
Cited by: 0 cases
Authority: More cited than 20.2%

“[C]redibility determinations are the province of the ALJ, and we will not disturb a clearly articulated credibility finding supported by substantial evidence.” (internal citations omitted)

How later courts described this case

“[C]redibility determinations are the province of the ALJ, and we will not disturb a clearly articulated credibility finding supported by substantial evidence.” (internal citations omitted)
“A claimant bears the burden of establishing his RFC.” (citing Despain v. Berryhill, 926 F.3d 1024, 1027 (8th Cir. 2019))

Written by the judges who cited it.

The opinion

UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF FLORIDA

CASE NO. 23-CV-80744-STRAUSS

ALICIA MARIE GAUGLIONE,

Plaintiff,

MARTIN O’MALLEY,

Commissioner of Social Security,

Defendant.

__________________________________/

ORDER ON MOTIONS FOR SUMMARY JUDGMENT

THIS MATTER came before the Court upon Plaintiff’s Motion for Summary

Judgment/Initial Brief (“Plaintiff’s Motion”) [DE 16] and Defendant’s Cross-Motion for Summary

Judgment/Answer Brief (“Defendant’s Motion”) [DE 19]. The Court has reviewed both motions,

Plaintiff’s Reply [DE 20], the administrative record [DE 6], and all other filings in this case. For

the reasons discussed herein, Plaintiff’s Motion [DE 16] will be DENIED and Defendant’s Motion

[DE 19] will be GRANTED.

I. BACKGROUND & PROCEDURAL HISTORY

Plaintiff applied for disability insurance benefits on February 7, 2021, alleging a disability

onset date of August 2, 2020 (“Alleged Onset Date”). Tr. 17, 68-69, 75, 194-98. Plaintiff, who

was born in 1974, was 46 years old when she submitted her application for disability insurance

benefits. Her claim for benefits was denied initially and upon reconsideration. Tr. 17, 63-96.

Thereafter, Plaintiff appeared with counsel at a telephonic hearing before an Administrative Law

Judge (“ALJ”) on January 4, 2023; a vocational expert (“VE”) also appeared and testified at the

hearing. Tr. 37-62. On January 23, 2023, the ALJ issued her decision, finding that Plaintiff was

not disabled under the Social Security Act (from the Alleged Onset Date through the date of the

ALJ’s decision). Tr. 17-31. On March 27, 2023, the Appeals Council denied Plaintiff’s request

for review, thereby leaving the ALJ’s decision as the final decision of the Commissioner. Tr. 1-3.

Consequently, on May 5, 2023, Plaintiff filed this action seeking judicial review of the

Commissioner’s decision.

II. STANDARD OF REVIEW

In reviewing claims brought under the Social Security Act, a court’s role is limited.

Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). The Commissioner’s findings of

fact must be affirmed if they are based upon “substantial evidence.” See 42 U.S.C. § 405(g);

Richardson v. Perales, 402 U.S. 389, 401 (1971); Moore v. Barnhart, 405 F.3d 1208, 1211 (11th

Cir. 2005). “Substantial evidence is . . . such relevant evidence as a reasonable person would

accept as adequate to support a conclusion.” Moore, 405 F.3d at 1211 (citing Crawford v. Comm’r

of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004)). It “is something ‘more than a mere scintilla,

but less than a preponderance.’” Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (citation

omitted). “If the Commissioner’s decision is supported by substantial evidence, this Court must

affirm, even if the proof preponderates against it.” Id. (quoting Phillips v. Barnhart, 357 F.3d

1232, 1240 n.8 (11th Cir. 2004)). Courts “may not decide the facts anew, reweigh the evidence,

or substitute [their] judgment for that of the [Commissioner].” Id. (quoting Phillips, 357 F.3d at

1240 n.8); Bloodsworth, 703 F.2d at 1239. In addition to determining whether the Commissioner’s

factual findings are supported by substantial evidence, courts must determine whether the ALJ

applied the correct legal standards. Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002).

III. DISCUSSION

A. THE SEQUENTIAL EVALUATION

A “disability” is defined as an inability “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. § 1382c(a)(3)(A). In making a disability determination, “the ALJ

must consider the evidence in its entirety, including: (1) objective medical facts or clinical

findings; (2) diagnoses of examining physicians; (3) subjective evidence of pain and disability as

testified to by the claimant . . . and (4) the claimant’s age, education, and work history.” Maffia v.

Comm’r of Soc. Sec., 291 F. App’x 261, 262-63 (11th Cir. 2008) (quoting DePaepe v. Richardson,

464 F.2d 92, 94 (5th Cir.1972)); see also Walden v. Schweiker, 672 F.2d 835, 839 (11th Cir. 1982).

To arrive at a determination as to disability, the ALJ must undertake the sequential

evaluation embodied in 20 C.F.R. § 404.1520. This process requires that the ALJ first determine

whether the claimant is presently engaged in substantial gainful activity. 20 C.F.R. § 404.1520(b).

If so, a finding of “no disability” is made.

If the claimant is not engaged in such work, then the ALJ must proceed to the second step

and determine whether the claimant suffers from a “severe impairment.” An impairment is severe

if it significantly limits the claimant’s physical or mental ability to perform basic work activities.

20 C.F.R. § 404.1520(c). If no severe impairment is found, then the ALJ will conclude that there

is no disability; if a severe impairment is found, then the ALJ will proceed to the next step of the

analysis. See id.

The third step requires the ALJ to determine whether the claimant’s impairment meets or

equals those listed in Appendix 1 of the Regulations. 20 C.F.R. § 404.1520(d). If so, the ALJ will

find the claimant disabled without considering age, education, and work experience. Id. If not,

the inquiry will proceed to the next stage.

Step four requires the ALJ to determine whether the claimant has the residual functional

capacity (“RFC”) to perform past relevant work. 20 C.F.R. § 404.1520(e). The Regulations define

RFC as “the most you can still do despite your limitations.” 20 C.F.R. § 404.1545(a)(1). This

determination takes into account “all of the relevant medical and other evidence,” including the

claimant’s own testimony and the observations of others. 20 C.F.R. § 404.1545(a)(3). The ALJ

must then compare the RFC with the physical and mental demands of the claimant’s past relevant

work to determine whether the claimant is still capable of performing that kind of work. If so, the

claimant is found not disabled. 20 C.F.R. § 404.1520(f).

If the claimant establishes an inability to return to past relevant work, the inquiry turns to

step five. “At step five the burden of going forward shifts to the [Commissioner] ‘to show the

existence of other jobs in the national economy which, given the claimant’s impairments, the

claimant can perform.’” Washington v. Comm’r of Soc. Sec., 906 F.3d 1353, 1359 (11th Cir. 2018)

(quoting Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987)). If the Commissioner points to

possible alternative employment, then the burden returns to the claimant to prove an inability to

perform those jobs. Id. At this fifth and final step, the ALJ must resolve whether the claimant is

actually capable of performing other work. See 20 C.F.R. §§ 404.1520(g), 404.1560(c).

B. ALJ’S APPLICATION OF THE SEQUENTIAL EVALUATION

After considering the evidence, the ALJ found that Plaintiff was not disabled between the

Alleged Onset Date and the date of the ALJ’s decision. See Tr. 17-31. Initially, the ALJ addressed

certain preliminary issues and outlined in detail the five steps of the sequential evaluation. Tr. 17-

19. Then, addressing the first step in the sequential evaluation, the ALJ found that Plaintiff had

not engaged in substantial gainful activity since the Alleged Onset Date. Tr. 19. Next, at step two,

the ALJ found that Plaintiff had “the following combination of severe impairments: Degenerative

Changes of the Cervical Spine, Major Depressive Disorder, and Post-Traumatic Stress Disorder.”

Tr. 19. At step three, the ALJ found that Plaintiff did not have an impairment or combination of

impairments that met or medically equaled the severity of any of the impairments listed in 20

C.F.R. Part 404, Subpart P, Appendix 1. Tr. 20.

The ALJ next assessed Plaintiff’s RFC, determining based on her consideration of the

entire record that Plaintiff has the RFC

to lift and/or carry 50 pounds occasionally and 25 pounds frequently, stand and/or

walk 6 hours total in an 8-hour workday, sit 6 hours total in an 8-hour workday,

frequently climb ramps and stairs, balance, stoop, kneel, crouch, and crawl, and

occasionally climb ladders, ropes and scaffolds. [Plaintiff] is able to concentrate

and persist for simple tasks.

Tr. 23. As part of this assessment, the ALJ noted that, in accordance with 20 C.F.R. § 404.1529

and SSR 16-3p, she considered all of Plaintiff’s symptoms and the extent to which her symptoms

could reasonably be accepted as consistent with the objective medical evidence and other evidence.

Tr. 23. Additionally, the ALJ stated that she considered the medical opinion evidence and prior

administrative medical findings in accordance with 20 C.F.R. § 404.1520c. Tr. 23. She then

proceeded to discuss the evidence of record in conjunction with discussing Plaintiff’s RFC. Tr.

23-29.

After assessing Plaintiff’s RFC, the ALJ found that Plaintiff is unable to perform her past

relevant work. Tr. 29. Therefore, the ALJ considered Plaintiff’s age, education, work experience,

and RFC to determine whether a significant number of jobs, that Plaintiff could perform, exist in

the national economy. Tr. 29-31. Relying on the VE’s testimony, the ALJ determined that Plaintiff

is able to perform three unskilled, medium exertion occupations: (1) Linen Room Attendant; (2)

Cleaner, Hospital; and (3) Marker, Laundry. Tr. 30. Additionally, the ALJ determined – also

based on the VE’s testimony – that even if Plaintiff’s RFC was reduced to lifting and/or carrying

20 pounds occasionally and 10 pounds frequently (a reduction that would bring Plaintiff down to

jobs at the light exertion level), Plaintiff would still be able to perform the following three

unskilled, light exertion jobs: (1) Garment Sorter; (2) Folder; and (3) Mail Clerk. Tr. 31. As a

result, the ALJ concluded that Plaintiff is capable of making a successful adjustment to other work

existing in significant numbers in the national economy. Tr. 31. In light of this conclusion, the

ALJ found that Plaintiff was not disabled. Tr. 31.

C. ANALYSIS

Plaintiff raises several contentions of error. First, Plaintiff contends that the ALJ erred in

evaluating the medical opinions of Dr. Anthony Tereo and Dr. David Appel. However, for the

reasons discussed in Section 1 below, even if the Court were to find that the ALJ did not evaluate

Dr. Tereo’s statements in accordance with the regulation governing the evaluation of medical

opinions (20 C.F.R. § 404.1520c), the ALJ would not have erred (or at least not committed harmful

error). That is because at least certain – if not all – of Dr. Tereo’s statements were not “medical

opinions” as defined under the regulations. Meanwhile others addressed issues reserved to the

Commissioner and, in the ALJ’s reasonable view, only addressed Plaintiff’s ability to perform her

past relevant work, which the ALJ found Plaintiff did not have the ability to do at any rate. As to

Dr. Appel, as discussed in Section 2 below, the ALJ evaluated his medical opinions under the

applicable regulation and her evaluation is supported by substantial evidence.

Second, Plaintiff contends that the ALJ erred in evaluating certain evidence regarding

Plaintiff’s physical limitations. As discussed in Section 3 below, Plaintiff has failed to demonstrate

reversible error. Third, Plaintiff contends that the ALJ erred in evaluating Plaintiff’s symptoms.

As discussed in Section 4 below, the Court disagrees.

Finally, Plaintiff contends that the ALJ erred by relying on the VE’s testimony. According

to Plaintiff, the VE’s testimony did not constitute substantial evidence because the ALJ’s

hypothetical to the VE did not include all of Plaintiff’s limitations. In this regard, the Eleventh

Circuit has explained that “[i]n order for a vocational expert’s testimony to constitute substantial

evidence, the ALJ must pose a hypothetical question which comprises all of the claimant’s

impairments.” Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1180 (11th Cir. 2011) (quoting

Wilson, 284 F.3d at 1227); see also Walker, 2022 WL 1022730, at *3 (“In order for a [VE’s]

testimony to constitute substantial evidence, the ALJ must pose a hypothetical question which

comprises all of the claimant’s impairments. However, the ALJ is not required to include findings

in the hypothetical that the ALJ had properly rejected as unsupported. In other words, the

hypothetical question need not list every symptom but must provide the VE with a complete picture

of the claimant’s RFC.” (internal quotation marks and citations omitted)). Here, it is evident that

the ALJ’s hypothetical to the VE included all of the limitations that the ALJ ultimately found to

exist in Plaintiff’s RFC. Compare Tr. 23, with Tr. 58.1 Therefore, the ALJ properly relied on the

VE’s testimony.

1 Plaintiff’s argument that the ALJ’s hypothetical to the VE failed to account for all of Plaintiff’s

limitations is based on the other arguments that Plaintiff makes in her motion. In other words,

Plaintiff takes issue with the ALJ’s RFC determination for the reasons discussed in Sections 1-4

below. Because Plaintiff’s arguments – those discussed in Sections 1-4 below – fail, and because

the ALJ’s hypothetical to the VE included all limitations the ALJ found Plaintiff to have (with the

ALJ only excluding findings from the hypothetical that the ALJ properly rejected as unsupported),

Plaintiff’s argument regarding the ALJ’s reliance on the VE’s testimony fails.

1. Dr. Tereo

The ALJ did not err in her evaluation of Dr. Tereo’s alleged medical opinions. The record

contains four letters from Dr. Tereo – letters dated September 30, 2020, January 20, 2021, April

14, 2021, and October 20, 2021 – that are at issue. Tr. 340, 344-46. The first letter (from

September 2020, addressed to the CFO of United Savings Bank) states that Plaintiff was being

treated by Dr. Tereo for PTSD and that her condition rendered her “unable to perform her work-

related duties at this time.” Tr. 345. The letter noted that “[t]his will be reviewed again in sixty

days.” Tr. 345. Similarly, the second letter (from January 2021, also addressed to the bank CFO)

stated that Plaintiff “continues to be unable to perform her work-related duties at the current time”

and “will be re-evaluated in sixty days.” Tr. 346. In his third letter (from April 2021, addressed

to the Bureau of Disability Determination), Dr. Tereo, stated, inter alia, that the loss of Plaintiff’s

son “exacerbated” her conditions, and that Plaintiff’s symptoms “are beyond normal grieving, and

her suicidal ideation places her in an at-risk population.” Tr. 340. Finally, Dr. Tereo’s October

2021 letter indicates, inter alia, that Plaintiff’s PTSD “devolved into a Major Depressive

Disorder,” that Plaintiff’s depression “significantly impacted her day-to-day functioning,” and that

Plaintiff “has difficulty with concentration, completing tasks and falling and staying asleep.” Tr.

344.

After discussing the content of Dr. Tereo’s four letters, the ALJ stated that she found Dr.

Tereo’s opinions to be unpersuasive. Tr. 25-26. The ALJ explained:

First and foremost, the undersigned notes that Dr. Tereo’s statements on September

30, 2020 and January 20, 2021 seemingly relate to [Plaintiff’s] inability to engage

in past work activity. (See Exhibit 7F, Pages 2-3). Dr. Tereo’s opinion regarding

[Plaintiff’s] inability to perform her past work is actually consistent with the

conclusions reached in this decision. As for Dr. Tereo’s additional statements, the

undersigned finds they are vague as he fails to provide a function-by-function

assessment of [Plaintiff’s] mental capabilities. As discussed throughout this

Decision, [Plaintiff’s] records do support a finding that [Plaintiff] endures certain

limitations. However, the [RFC] indicated provides the most accurate assessment

of [Plaintiff’s] mental capabilities based on the totality of the evidence and the

objective findings contained therein.

Tr. 26.

Plaintiff contends that the ALJ erred in evaluating Dr. Tereo’s opinions because his

opinions find support in the record and because the ALJ cannot discount medical opinions solely

based on the form in which they were rendered. See [DE 16] at 14. However, the ALJ did not err.

First, Plaintiff has failed to show that the ALJ was unreasonable in concluding that Dr.

Tereo’s first two letters pertained to Plaintiff’s inability to perform her past work (as opposed to

any work). The letters were apparently directed at her then-employer and appeared to address her

“work-related duties” in that particular job.2 In other words, the ALJ’s characterization of Dr.

Tereo’s statements regarding Plaintiff’s ability to work was both rational and reasonable.

Therefore, it is not this Court’s place to second-guess the ALJ’s characterization. Additionally,

Dr. Tereo did not opine that Plaintiff’s condition would likely prevent her from working for at

least 12 months3 – only that she could not “perform her work-related duties” at “this time” or “the

current time” and that she would be evaluated again in 60 days.

Second, the ALJ found that Dr. Tereo’s subsequent letters contained vague statements that

failed to include any function-by-function assessment of Plaintiff’s mental capabilities. As

Defendant argues, the fact that Dr. Tereo did not address Plaintiff’s ability to perform any

particular function(s) means that Dr. Tereo did not actually provide a “medical opinion” (as

2 The ALJ even noted that Dr. Tereo’s opinion regarding Plaintiff’s inability to perform her past

work was actually consistent with the ALJ’s conclusions.

3 As noted above, a “disability” is defined as an inability “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. § 1382c(a)(3)(A) (emphasis added).

defined under the regulations). “A medical opinion is a statement from a medical source about

what you can still do despite your impairment(s) and whether you have one or more impairment-

related limitations or restrictions in the abilities” to perform various demands of work activities.

20 C.F.R. § 416.913(a)(2) (emphasis added); see also Staheli v. Comm’r, SSA, 84 F.4th 901, 906

n.2 (10th Cir. 2023) (recognizing that for a statement from a medical source to qualify as a

“medical opinion,” it must address “both what the claimant can still do despite her impairment(s)

and whether she has one or more impairment-related limitations or restrictions in specified

abilities” (cleaned up)). Such demands include mental demands of work activities, “such as

understanding; remembering; maintaining concentration, persistence, or pace; carrying out

instructions; or responding appropriately to supervision, co-workers, or work pressures in a work

setting.” 20 C.F.R. § 416.913(a)(2)(i)(B); see also Gregory v. Comm’r, Soc. Sec. Admin., No. 21-

14103, 2023 WL 4542674, at *8 n.9 (11th Cir. July 14, 2023). “Mere diagnostic statements or

‘judgments about the nature and severity of . . . impairments’ are not ‘medical opinions.’” Austin

v. Kijakazi, 52 F.4th 723, 729 n.3 (8th Cir. 2022).

Here, although Dr. Tereo noted that Plaintiff had difficulty with concentration, completing

tasks, and sleeping, he did not address what Plaintiff could still do despite her impairments or the

extent to which she was limited in any specified abilities. Nor did he address Plaintiff’s ability to

perform any specific functions in the work setting. Cf. Dye v. Comm’r of Soc. Sec., No. 5:20-CV-

459-NPM, 2022 WL 970186, at *4 (M.D. Fla. Mar. 31, 2022) (“None of the statements in

Downey’s letter assess the extent to which Dye can perform any particular function in a work

setting, and so they do not constitute ‘medical opinions’ for purposes of the applicable regulatory

regime.”). Rather, Dr. Tereo merely included several generalized – and arguably vague (as the

ALJ described them) – statements without providing the substance necessary for his statements to

qualify as “medical opinions” under the regulations. Therefore, Plaintiff has not shown that the

ALJ was required to provide any further discussion of Dr. Tereo’s statements. Moreover, contrary

to Plaintiff’s argument, the ALJ did not discount Dr. Tereo’s statements solely based on the form

in which they were rendered but rather based on their substance (or lack thereof).

Furthermore, even if Dr. Tereo’s statements regarding Plaintiff’s ability to work could

technically qualify as a “medical opinions,” the ALJ did not err in finding them unpersuasive. That

is because statements that a claimant is not “able to work” or that her RFC prevents her “from

doing past relevant work” are “[s]tatements on issues reserved to the Commissioner,” which are

“inherently neither valuable nor persuasive.” 20 C.F.R. § 404.1520b(c)(3)(i), (vi); see also Glasby

v. Soc. Sec. Admin., Comm’r, No. 21-12093, 2022 WL 1214015, at *2 (11th Cir. Apr. 25, 2022).

Therefore, the ALJ was “specifically relieved from providing any analysis about how such

evidence was considered.” Miller v. Kijakazi, No. 22-60541, 2023 WL 234773, at *2 (5th Cir.

Jan. 18, 2023) (citing 20 C.F.R. § 404.1520b(c)).

For the foregoing reasons, the ALJ did not err in evaluating Dr. Tereo’s statements.

2. Dr. Appel

The ALJ did not err in evaluating Dr. Appel’s opinion. Unlike Dr. Tereo, Dr. Appel did

provide a “medical opinion.” Therefore, the ALJ was required to evaluate his opinion in

accordance with 20 C.F.R. § 404.1520c (which applies to medical opinions for claims filed after

March 27, 2017). Under this regulation, an ALJ “will not defer or give any specific evidentiary

weight, including controlling weight, to any medical opinion(s) or prior administrative medical

finding(s).” 20 C.F.R. § 404.1520c(a); see also Planas on behalf of A.P. v. Comm’r of Soc. Sec.,

842 F. App’x 495, 498 (11th Cir. 2021) (noting that the requirement to assign weight to medical

opinions has been omitted from the revised regulation). Rather, the ALJ must evaluate the

persuasiveness of medical opinions and prior administrative medical findings based upon five

factors: “(1) supportability; (2) consistency; (3) relationship with the claimant; (4) specialization;

and (5) ‘other factors that tend to support or contradict’ the opinion” or finding. Walker v. Soc.

Sec. Admin., Comm’r, No. 21-12732, 2022 WL 1022730, at *2 (11th Cir. Apr. 5, 2022) (citing 20

C.F.R. § 404.1520c(c)(1)-(5)). Supportability and consistency are the most important factors. 20

C.F.R. § 404.1520c(a). Although an ALJ is no longer required to provide a specific weight to

medical opinions – a requirement under the prior regulation, see 20 C.F.R. § 404.1527 – the ALJ

still needs to articulate how persuasive the ALJ finds medical opinions and prior administrative

medical findings to be. 20 C.F.R. § 404.1520c(b).

Nonetheless, § 404.1520c makes clear that in doing so, an ALJ is “not required to articulate

how [the ALJ] considered each medical opinion or prior administrative medical finding from one

medical source individually.” 20 C.F.R. § 404.1520c(b)(1). In other words, if a single source

offers multiple medical opinions or multiple administrative medical findings, an ALJ only needs

to collectively address the source’s opinions or findings in a single analysis rather than including

a separate analysis for each opinion or finding. 20 C.F.R. § 404.1520c(b)(1). In doing so, the ALJ

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

is generally not required to explain how he or she considered the other three factors. 20 C.F.R. §

404.1520c(b)(2)-(3). Under the supportability factor, “[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). Under

the consistency factor, “[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).

Here, Dr. Appel completed a Mental Residual Functional Capacity Assessment. Tr. 367-

70. Therein, Dr. Appel opined that Plaintiff has “extreme” limitations in the area of understanding

and memory and in the area of sustained concentration and persistence. Tr. 368-69. Dr. Appel

also opined that Plaintiff has mostly “extreme” limitations – and a few “marked” limitations – in

the areas of social interaction and adaptation. Tr. 369-70. Additionally, Dr. Appel stated, inter

alia, that he does not believe Plaintiff “is able to work at all,” that her capacity to “leave the house

without being triggered to the point of being dysfunctional is limited,” that he did not see how she

would be able to regularly show up for work or manage simple tasks, that her capacity to focus is

significantly limited, and that her capacity to handle basic stressors is insufficient. Tr. 370.

According to Dr. Appel, Plaintiff’s impairment would substantially interfere with her ability to

work on a regular and sustained basis at least 20% of the time. Tr. 370.

After summarizing the opinions Dr. Appel provided in his assessment, the ALJ explained

that she found his opinions to be unpersuasive because “they are unsupported by and inconsistent

with the medical record as a whole.” Tr. 26. According to the ALJ, “[b]ased on the totality of the

evidence . . . there are specific and legitimate reasons to reject Dr. Appel’s unreasonably restrictive

assessment. The totality of the medical records simply fails to support Dr. Appel’s opinions . . . .”

Tr. 26. The ALJ explained:

As discussed, [Plaintiff’s] records do indicate she endures certain mental

limitations; however, the undersigned finds Dr. Appel’s opinions overstate her

limitations and are not supported by the longitudinal medical evidence of record.

In so finding, the undersigned reiterates that Dr. Appel’s treatment records from

March 16, 2022 through September 7, 2022 indicate his own mental status

examinations of [Plaintiff] consistently resulted in generally unremarkable

findings. (See Exhibit 14F, Pages 13-14, 29-30, 45-46, 61-62, 77-78, 94-95, and

111-112). The discrepancy between Dr. Appel’s opinions and his own objective

findings renders his opinions less persuasive. In addition, while Dr. Appel noted

extreme limitations in essentially all areas of functioning, which would indicate

hospitalization or institutionalization, the medical evidence of record shows

[Plaintiff] has never been hospitalized. Again, Dr. Appel’s opinions are not

supported by the longitudinal medical evidence of record.

. . .

Overall, it is evident Dr. Appel relied quite heavily on the subjective report of

symptoms and limitations provided by [Plaintiff]. He also seems to have

uncritically accepted as true most, if not all, of what [Plaintiff] reported. Yet, as

explained throughout this decision, there exist good reasons for questioning the

reliability of [Plaintiff’s] subjective complaints. Specifically, there is insufficient

medical evidence to corroborate [Plaintiff’s] assertions regarding the extent of her

alleged limitations.

Tr. 26-27.

As the foregoing discussion shows, the ALJ evaluated both the consistency and

supportability of Dr. Appel’s opinion in connection with evaluating its persuasiveness. Thus, as

an initial matter, the ALJ conducted the evaluation mandated under § 404.1520c for medical

opinions.

Nevertheless, Plaintiff argues that the ALJ erred in a few ways. First, Plaintiff notes in

passing that Dr. Appel’s opinion is consistent with Dr. Tereo’s opinion. However, as discussed in

the preceding section, the ALJ did not err with respect to her treatment of Dr. Tereo’s statements.

Moreover, the ALJ’s discussion of the evidence shows she reasonably found the other evidence of

record to be largely inconsistent with Dr. Appel’s opinions. For instance, earlier in her decision,4

the ALJ explained how Dr. Byron Pack and Dr. Barbara Lewis found no more than “mild” or

“moderate” limitations in the functional areas where Dr. Appel found mostly “extreme”

limitations. See Tr. 22. And after discussing Dr. Appel’s opinions, the ALJ further elaborated on

4 Significantly, the Eleventh Circuit and other circuits have explained that “it is proper to read the

ALJ’s decision as a whole, and . . . it would be a needless formality to have the ALJ repeat

substantially similar factual analyses.” Raper v. Comm’r of Soc. Sec., 89 F.4th 1261, 1275 (11th

Cir. 2024) (citations omitted).

the persuasiveness of Dr. Lewis’s opinions – which are clearly inconsistent with Dr. Appel’s

opinions – stating as follows:

There are very few objective medical findings that would support a finding of

disability premised on [Plaintiff’s] mental impairments. Dr. Barbara Lewis, a State

agency psychological consultant, completed a mental [RFC] assessment of

[Plaintiff] and opined that [Plaintiff’s] mental functioning did not prevent her from

performing all work activity. It was her opinion that [Plaintiff] was capable of

maintaining sufficient concentration for tasks. According to Dr. Lewis, [Plaintiff]

was able to “understand, retain, and carry out simple instructions”, “perform routine

tasks on a sustained basis”, and “adapt over time to most changes and task

demands”. Ultimately, Dr. Lewis determined that while [Plaintiff] “does suffer

from some degree of limitation from mental health issues, the symptom severity

noted would not preclude the completion of simple tasks.” (Exhibit 6A, Page 7).

To the extent consistent with the [RFC] indicated, the undersigned finds the

opinions of Dr. Lewis persuasive as they are supported by the objective medical

findings and the other substantial evidence of record.

Tr. 27.

In her decision, the ALJ also discussed a psychological consultative examination

performed by Dr. Luis Zaldivar, noting that notwithstanding Plaintiff’s complaints, she “was alert,

attentive, and cooperative” and able “to put her thoughts together and provide a background

history.” Tr. 24. Additionally, notwithstanding Plaintiff’s complaints of a lack of motivation and

being sad and teary, Dr. Zaldivar indicated that Plaintiff could communicate “in full sentences,

relate stories, and sustain a conversation.” Tr. 24. The ALJ also noted that Dr. Zaldivar reported

Plaintiff “remained ‘oriented in all spheres,’ possessed ‘adequate’ memory,” and was able to add

and subtract (albeit not multiply). Tr. 24. Moreover, the ALJ discussed Dr. Zaldivar’s notation

that Plaintiff was able to get “along with people, hold simple conversations with acquaintances,

and behave in a socially appropriate manner.” Tr. 24. Ultimately, with one limited exception, the

ALJ found that Dr. Zaldivar’s examination and report were generally supportive of the RFC the

ALJ assessed. Tr. 24.

The ALJ likewise discussed and relied on Dr. Jonathan Black’s psychological consultative

examination. The ALJ summarized Dr. Black’s examination, in part, as follows:

According to Dr. Jonathan Black, while the claimant did exhibit “some difficulty

maintaining her attention”, she “demonstrated fair task persistence” and remained

“oriented to person, place, time, and situation”. (Exhibit 9F, Pages 2 and 3). The

claimant also exhibited “fair abilities of abstraction”, a “fair fund of information”,

and the ability “to perform simple arithmetic calculations”. At this time, the

claimant also possessed “fair” insight and judgment while reporting she “manages

her own finances”. (Exhibit 9F, Page 3).

Tr. 25. And the ALJ concluded that Dr. Black’s objective medical findings supported the ALJ’s

RFC determination. Tr. 25.

Notably, Plaintiff has not argued that the ALJ erred in finding the bulk of the evidence to

be inconsistent with Dr. Appel’s opinions. Moreover, my own review indicates that the ALJ

reasonably found Dr. Appel’s opinions (that Plaintiff suffers from mostly “extreme” mental

limitations) to be largely inconsistent with the medical evidence of record regarding Plaintiff’s

mental limitations (e.g., evidence from Dr. Pack, Dr. Lewis, Dr. Zaldivar, and Dr. Black). Thus,

the ALJ’s consistency determination regarding Dr. Appel’s opinions is supported by substantial

evidence.

Plaintiff’s arguments regarding the ALJ’s treatment of Dr. Appel’s opinions seem to

implicate the supportability factor more than the consistency factor. However, the ALJ’s

supportability determination as to Dr. Appel is also supported by substantial evidence.

As to supportability, Plaintiff takes issue with three specific statements the ALJ made

regarding Dr. Appel, see [DE 16] at 15-17: (1) “Dr. Appel’s treatment records . . . indicate his own

mental status examinations of [Plaintiff] consistently resulted in generally unremarkable findings”;

(2) “while Dr. Appel noted extreme limitations in essentially all areas of functioning, which would

indicate hospitalization or institutionalization, the medical evidence of record shows [Plaintiff] has

never been hospitalized”; and (3) “Overall, it is evident Dr. Appel relied quite heavily on the

subjective report of symptoms and limitations provided by [Plaintiff].”

In connection with evaluating the foregoing statements (particularly the first and third), it

is necessary to examine Dr. Appel’s treatment records. See Tr. 371-489. As reflected therein, Dr.

Appel appears to have met with Plaintiff seven times between March 2022 and September 2022.

His records begin by summarizing information that appears to have been provided by Plaintiff –

in an HPI section and a past psychiatric history section, among other sections. See, e.g., Tr. 376-

79. Thereafter, Dr. Appel addresses Plaintiff’s appearance and behavior/psychomotor, as well as

the results of a mental status exam he performed during each appointment. With respect to

Plaintiff’s appearance, Dr. Appel noted (for all seven appointments) that Plaintiff was “healthy,

well-groomed, [and] well-dressed.” Tr. 382, 399, 415, 431, 447, 464, 481. And he noted, with

respect to behavior (for all seven appointments), that Plaintiff was “cooperative with good

grooming and eye contact.” Tr. 383, 399, 415, 431, 447, 464, 481.

The results of Plaintiff’s mental status exams were also the same for all seven

appointments, with the exception of Dr. Appel’s notations regarding Plaintiff’s “mood and affect.”

Specifically, in the mental status exam section of his reports for all seven appointments, Dr. Appel

reported the following (putting aside for a moment “mood and affect”): (1) speech – “regular rate,

rhythm and volume; (2) thought processes and content – “appropriate, logical”; (3) associations –

“linear and goal directed”; (4) abnormal or psychotic thoughts – “no S/HI, A/VH, IOR, RIS or

psychotic symptoms”; (5) judgment and insight – “fair”; (6) orientation – “alert, oriented to person,

place, time and situation”; (7) recent and remote memory – “intact”; (8) attention/concentration –

“alert, pays attention”; (9) language – “articulate, coherent”; and (10) fund of knowledge – “age

appropriate.” Tr. 383-84, 399-400, 415-16, 431-32, 447-48, 464-65, 481-82. As to “mood and

affect,” Dr. Appel noted as follows for each session: (1) March – “dythymic, ok, constricted” (Tr.

383); (2) April – “dythymic, ok, constricted, tearful at times” (Tr. 399); (3) May – “dythymic, ok,

constricted, appropriately tearful at times” (Tr. 415); (4) June – “dythymic, ‘sad,’ constricted,

appropriately tearful at times” (Tr. 431); (5) July – “dythymic, ‘sad,’ constricted, appropriately

tearful at times” (Tr. 447); (6) August – “dythymic, ‘sad,’ constricted, appropriately tearful at

times” (Tr. 464); and (7) September – “ok euthymic, fairly broad” (Tr. 481).

Plaintiff first argues that the ALJ erred in characterizing the findings from Dr. Appel’s

mental status exams as “generally unremarkable findings.” According to Plaintiff, by

characterizing the findings in this manner, the ALJ improperly focused on findings supporting her

conclusion, omitted consideration of findings to the contrary, and improperly substituted her lay

opinion for the opinion of a medical expert. The Court disagrees. The ALJ made clear that she

reviewed all of Dr. Appel’s mental status exams, see Tr. 25, 26, and as the preceding paragraph

shows, the ALJ’s conclusion that the findings were generally unremarkable is both reasonable and

rational. In fact, of the 11 categories evaluated as part of the mental status exams, only 1 category

(mood/affect) would not be “unremarkable.” But the findings for the other 10 categories were

unremarkable and reasonably support the ALJ’s conclusion that Dr. Appel’s mental status exam

observations do not support his opinion of “extreme” limitations.5

5 Plaintiff also indicates in her motion that “fair” judgment/insight is not “unremarkable.”

However, the ALJ specifically noted Dr. Appel’s finding that Plaintiff had fair judgment and

insight. Tr. 25. And even if fair judgment and insight could not be considered “unremarkable,” 9

of 11 categories were still clearly unremarkable. Moreover, the question is whether Dr. Appel’s

consistent observations of “fair” judgment (along with his other observations) support his

assessment of “extreme” mental limitations. Dr. Appel did not find that judgment and insight were

“poor.” Yet, he still assessed mostly “extreme” mental limitations. The bottom line though is, as

stated above, the ALJ reasonably and rationally found that Dr. Appel’s mental status exams

revealed generally unremarkable findings. Thus, the ALJ reasonably found that the mental status

exam findings did not support Dr. Appel’s opinions.

Nor does the ALJ’s observation that Dr. Appel appeared to rely heavily on Plaintiff’s

subjective complaints undermine the ALJ’s decision. It is true, as Plaintiff contends, that mental

health professionals may take into account a plaintiff’s subjective complaints and that it is

improper to find a psychiatrist’s medical opinion unpersuasive solely because he offers an opinion

that takes into account such complaints. The problem here though is that is difficult to conclude

how and why Dr. Appel found such extreme limitations, unless, as the ALJ concluded, Dr. Appel

“seems to have uncritically accepted as true most, if not all, of what [Plaintiff] reported.” Tr. 27.

That is because Dr. Appel’s treatment records are primarily comprised of Plaintiff’s reports and

the results of Plaintiff’s mental status exams (which the ALJ reasonably found were generally

unremarkable). Thus, without further explanation from Dr. Appel to support his opinions, it is

difficult to see how Dr. Appel’s opinions are supported by anything other than virtually wholesale

reliance on Plaintiff’s subjective complaints, particularly when his mental status exams

substantially conflict with those complaints. Regardless, the ALJ did not discount Dr. Appel’s

opinions solely because he relied on Plaintiff’s subjective complaints.6

Regarding the ALJ’s observation that Dr. Appel’s assessment of mostly extreme

limitations “would indicate hospitalization or institutionalization,” but that the evidence does not

show Plaintiff has ever been hospitalized, it is unclear without further explanation from the ALJ

6 In support of her argument regarding Dr. Appel’s reliance or lack thereof on Plaintiff’s subjective

complaints, Plaintiff contends that Dr. Appel’s treatment records “are replete with his own

observations, including uncontrollable crying, depressed mood, and constricted affect, which

support a determination that he did not exclusively rely upon [Plaintiff’s] self-report of symptoms

in assessing the marked to extreme limitations.” [DE 16] at 17 (citing Tr. 383, 415, 431). Based

on the citations Plaintiff provides, Plaintiff is evidently pointing to the mood/affect section of Dr.

Appel’s mental status exams. As discussed above, however, the mood/affect section was the only

category from Plaintiff’s mental status exams that was not “unremarkable.” Moreover, Dr. Appel

never indicated that he observed “uncontrollable crying” as Plaintiff contends. Rather, as noted

above, Dr. Appel indicated that Plaintiff was “appropriately tearful at times.” Tr. 415, 431

(emphasis added).

why Dr. Appel’s assessment “would indicate hospitalization or institutionalization.” Nonetheless,

it is evident that the ALJ primarily discounted the persuasiveness of Dr. Appel’s opinions both

because they were inconsistent with the bulk of the medical evidence of record (something Plaintiff

does not appear to dispute) and unsupported by Dr. Appel’s treatment notes. In other words, even

assuming the ALJ’s hospitalization statement was improper, it is obvious that her evaluation of

Dr. Appel’s opinions (and the ALJ’s ultimate determination) would not change in light of all of

the evidence she pointed to in support of her decision to find Dr. Appel’s opinions unpersuasive.7

And the evidence the ALJ pointed to undoubtedly qualifies as substantial evidence.

3. Plaintiff’s Physical Limitations

As noted above, in determining Plaintiff’s physical limitations, the ALJ found that Plaintiff

is capable of lifting/carrying 50 pounds occasionally and 25 pounds frequently, standing/walking

6 hours in an 8-hour workday, and sitting 6 hours in an 8-hour workday. In other words, the ALJ

found that Plaintiff is capable of performing work at the “medium” exertional level. See 20 C.F.R.

§ 404.1567(c); SSR 83-10. In addition to limiting Plaintiff to work at the medium exertional level,

the ALJ limited Plaintiff to “frequently climb[ing] ramps and stairs, balanc[ing], stoop[ing],

kneel[ing], crouch[ing], and crawl[ing], and occasionally climb[ing] ladders, ropes and scaffolds”

(the ALJ also included a non-physical limitation). Tr. 23.

Plaintiff contends that the ALJ erred in evaluating her physical limitations for two reasons:

(1) the ALJ improperly discounted objective medical evidence from Dr. Mark Rogovin reflecting

7 Cf. Malloy v. Kijakazi, No. CV 22-2133, 2024 WL 69139, at *11 (E.D. Pa. Jan. 5, 2024)

(“Plaintiff also argues that the ALJ substituted her lay opinion for that of the medical experts when

she stated that Dr. Friedman’s opinions ‘suggest the claimant should be institutionalized if she

indeed had no ability to function.’ I agree with Plaintiff that the ALJ’s statement was inappropriate

and lacking foundation. However, the isolated comment did not ‘cross the line into the ALJ

substituting [her] opinion for those of her doctors’ requiring remand.” (internal citation omitted)).

positive straight leg testing and reduced range of motion in Plaintiff’s cervical spine, shoulder, hip,

and knees; and (2) the ALJ improperly “declined to assess additional limitations because [Plaintiff]

did not undergo a new MRI” (her most recent MRI was in 2008). [DE 16] at 17-18.

However, Plaintiff has failed to show that the ALJ’s evaluation of Plaintiff’s physical

limitations is not supported by substantial evidence. With respect to Plaintiff’s MRI argument, the

ALJ did not decline to assess greater limitations due to Plaintiff not receiving a new MRI. Rather,

the ALJ explained that notwithstanding what Plaintiff’s 2008 MRI revealed – bulges at C3-C4

through C5-C6 and disc herniation at C5-C6 – Plaintiff was able to continue working until her

Alleged Onset Date (roughly 12 years after the 2008 MRI). Tr. 27. Thus, the ALJ reasonably

determined that “it is evident this impairment has not prevented work activity” and “[t]he fact that

this impairment did not prevent [Plaintiff] from working throughout that period strongly suggests

that it would not currently prevent work.” Tr. 27. And significantly, the ALJ also found, pointing

to specific medical evidence of record, that “[t]here is no evidence [Plaintiff’s] physical condition

has, in any way, deteriorated.” Tr. 27. In other words, the ALJ did not decline to assess greater

limitations merely because Plaintiff did not undergo a new MRI. Rather, the ALJ determined that

Plaintiff was physically capable of working before the Alleged Onset Date and that the record was

devoid of evidence showing that Plaintiff’s physical condition deteriorated on or after the Alleged

Onset Date.8 Therefore, Plaintiff’s MRI argument is unavailing.

8 Notably, it was Plaintiff’s burden to establish her RFC and to produce supporting evidence. See

Swink v. Saul, 931 F.3d 765, 770 (8th Cir. 2019) (“A claimant bears the burden of establishing his

RFC.” (citing Despain v. Berryhill, 926 F.3d 1024, 1027 (8th Cir. 2019))); Santos v. Soc. Sec.

Admin., Comm’r, 731 F. App’x 848, 852 (11th Cir. 2018) (“A claimant bears the burden of proof

for establishing the existence of a disability and must produce evidence in support of a claim,

including at the RFC stage.” (citing Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003); 20

C.F.R. §§ 404.1545(a)(3), 416.945(a)(3))).

Plaintiff’s first argument – that the ALJ improperly discounted certain objective medical

evidence from Dr. Rogovin – requires some further consideration, however. By way of

background, the ALJ recognized “that Dr. Rogovin’s examination did indicate decreased ranges

of motion to [Plaintiff’s] cervical spine, shoulders, hips, knees, ankles, and toes. Straight leg raise

testing was also positive.” Tr. 28. But the ALJ deemed such findings “unconvincing,” stating that

these types of findings are based primarily upon [Plaintiff’s] subjective complaints

regarding her pain and physical limitations. The objective findings referred to result

directly from [Plaintiff’s] reports of pain, for example a [plaintiff’s] complaints of

pain in performing range of motion exercises or general complaints of tenderness.

Despite [Plaintiff’s] subjective reports of pain, however, x-rays of [Plaintiff’s]

shoulders, ankles, and knees were all deemed normal. (Exhibits 11F and 12F). The

inconsistency between [Plaintiff’s] subjective complaints and the objective imaging

reports renders her complaints less persuasive.

Tr. 28.

It is questionable whether it was proper for the ALJ to consider such findings unconvincing

on the basis that they were based primarily on Plaintiff’s subjective complaints. But even if

improper, the ALJ cited a significant amount of evidence to support her physical RFC

determination.9 The plethora of evidence the ALJ pointed to undoubtedly qualifies as substantial

evidence, and Plaintiff has failed to demonstrate harmful error – even assuming the ALJ erred in

finding the results of Dr. Rogovin’s straight leg testing and range of motion testing unconvincing.

Specifically, in support of her physical RFC determination, the ALJ pointed to the

following evidence: (1) Plaintiff’s report in July 2021 “that she has no physical problems”; (2) Dr.

9 Cf. Reeve v. Kijakazi, No. 22-36018, 2023 WL 7411537, at *3 (9th Cir. Nov. 9, 2023) (“ALJ

Ross’s discounting of Dr. Liu’s pinprick and range of motion testing based on Dr. Thompson's

testimony that pinprick and range of motion tests are ‘subjective findings’ appears to run counter

to the Administration’s own regulations. . . . However, we have observed previously that even

objective medical tests may be subject to manipulation. We need not resolve whether ALJ Ross

erred in describing Dr. Liu’s testing methods as subjective because, even if we exclude all of the

improper and questionable reasons, the remaining reasons adequately support the decision to

discount Dr. Liu’s opinion.” (internal citations omitted)).

Rogovin’s statement that his May 2022 evaluation of Plaintiff revealed “no obvious clubbing,

cyanosis, or edema” to Plaintiff’s extremities; (3) “[e]xamination of [Plaintiff’s] extremities and

musculoskeletal system confirmed ‘no other sign of joint deformity,’ no ‘obvious paravertebral

spasm,’ and no ‘swelling, tenderness, increased heat, lesion, or other abnormality’”; (4) Plaintiff

“exhibited full ‘5/5’ strength throughout her upper and lower extremities and Dr. Rogovin

observed the claimant was able to get ‘up and down from the exam table independently without

complaints’ as well as ambulate ‘with a steady, independent, unremarkable gait’”; (5) “x-rays of

[Plaintiff’s] shoulders, ankles, and knees were all deemed normal”; (6) in August 2022, Plaintiff

“reported no muscle aches, cramps, weakness, joint swelling or warmth, arthritis, stiffness, gout,

bone pain, neck pain, back pain, arthralgias/joint pain, decreased motion in arms/legs, or swelling

in the extremities”; (7) no neurological symptoms or limitations were reported; (8) “examination

of [Plaintiff’s] musculoskeletal system, neurological system, and extremities [in August 2022]

resulted in unremarkable findings”;10 (9) “unremarkable objective findings were also made upon

examination” in September and October 2022; and (10) Dr. Steven Arkin’s prior administrative

medical findings, which the ALJ found to be persuasive.11 Tr. 27-28.

10 In fact, the August 2022 examination of Plaintiff’s musculoskeletal system that the ALJ pointed

to revealed, inter alia, full range of motion in Plaintiff’s cervical spine. Tr. 507.

11 Regarding Dr. Arkin, the ALJ explained:

According to Dr. Steven Arkin, [Plaintiff] retains the ability to perform medium

exertion level work (occasionally lifting and/or carrying 50 pounds, frequently

lifting and/or carrying 25 pounds, standing and/or walking for a total of about 6

hours in an 8 hour workday, sitting for a total of about 6 hours in an 8 hour workday,

and unlimited pushing and/or pulling other than as shown for lifting and/or

carrying). Furthermore, he opined that [Plaintiff] had only minimal postural

limitations with no manipulative, visual, communicative, or environmental

restrictions. (Exhibit 6A, Pages 5-6). The undersigned finds Dr. Arkin’s opinions

to be highly persuasive as they are supported by and consistent with the totality of

the evidence.

Tr. 28.

In light of all of the evidence the ALJ pointed to, the Court is hard-pressed to find that

further consideration of Dr. Rogovin’s straight leg raising and range of motion testing would

change the ALJ’s ultimate determination regarding Plaintiff’s physical limitations. Therefore,

Plaintiff has failed to satisfy her burden of establishing harmful error. See Raper, 89 F.4th at 1274

n.11 (“[T]he burden of showing that an error is harmful normally falls upon the party attacking the

agency's determination.” (citation omitted)).

4. ALJ’s Subjective Symptom Analysis

Plaintiff has failed to demonstrate reversible error with respect to the ALJ’s evaluation of

Plaintiff’s subjective complaints. When a claimant attempts to prove that she is disabled by

providing testimony regarding her pain or other symptoms, she must show: “(1) evidence of an

underlying medical condition; and (2) either (a) objective medical evidence confirming the

severity of the alleged pain; or (b) that the objectively determined medical condition can

reasonably be expected to give rise to the claimed pain.” Raper, 89 F.4th at 1277 (quoting Wilson,

284 F.3d at 1225). This standard applies to both complaints regarding subjective pain and

complaints regarding other subjective conditions. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir.

1991). If the objective medical evidence shows that a claimant’s impairment “could reasonably

be expected to produce” the pain or symptoms alleged by the claimant, “the ALJ must evaluate

the intensity and persistence of the claimant’s alleged pain and consider ‘all of the available

evidence’ from both medical and nonmedical sources.” Harvey v. Soc. Sec. Admin., Comm’r, No.

22-10281, 2022 WL 17175649, at *3 (11th Cir. Nov. 23, 2022) (citing 20 C.F.R. § 416.929(c)(1));