rejecting an accusation of “cherry picking” by the ALJ and explaining that “the same process can be described more neutrally as weighing the evidence”
How later courts described this case
- rejecting an accusation of “cherry picking” by the ALJ and explaining that “the same process can be described more neutrally as weighing the evidence”
- sustaining an ALJ’s finding concerning the conservative nature of the treatment for purposes of discrediting the claimant’s statements concerning the severity and limitations of his disability
- affirming ALJ’s discounting of treating physician’s opinion where it was “based primarily on [the applicant’s] subjective complaints of pain”
- “Substantial evidence is more than a scintilla and is such relevant evidence as a reasonable person would accept as adequate to support a conclusion.” (quotations omitted)
Written by the judges who cited it.
The opinion
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[DO NOT PUBLISH]
In the
United States Court of Appeals
For the Eleventh Circuit
____________________
No. 23-12765
____________________
DAVID B. WATKINS,
Plaintiff-Appellant,
versus
COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,
Defendant-Appellee.
____________________
Appeal from the United States District Court
for the Middle District of Florida
D.C. Docket No. 8:22-cv-00794-VMC-MRM
____________________
Before BRANCH, LUCK, and LAGOA, Circuit Judges.
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2 Opinion of the Court 23-12765
PER CURIAM:
David Watkins appeals the district court’s order affirming
the Social Security Administration (“SSA”) Commissioner’s
decision denying his application for disability insurance benefits
(“DIB”) under 42 U.S.C. § 405(g). He argues that (1) the ALJ erred
in weighing the medical opinion evidence; (2) the ALJ erred in
weighing his subjective complaints; and (3) the ALJ erred in
determining his residual functional capacity (“RFC”). After careful
review, we affirm.
I. Background
A. Procedural History Leading Up To The Decision On
Review
In October 2012, Watkins, then age 57, applied for DIB with
a disability onset date of March 24, 2012. 1 He alleged that (1) he
was ultimately terminated from his job as a chemical engineer
because of disabling anxiety and major depression, and (2) he was
no longer able to work because of those conditions. Watkins
indicated in his self-prepared function report that his depression
and anxiety affected “all facets” of his life and caused problems with
concentration, focus, memory, and understanding and following
instructions; caused frequent absences from work; caused crying,
worries, constant fears, problems sleeping, and social withdrawal;
impaired his ability to “communicate thoughts properly”; and at
1 Watkins was represented by counsel throughout all stages of the underlying
agency proceedings and in the proceedings that followed in the district court.
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23-12765 Opinion of the Court 3
times caused problems with personal care and grooming and the
need for reminders to take medications or do certain tasks. He
alleged that he was a “shut in” and did not have any interest in
going out. When he needed to, however, he could drive and go
out alone, and he regularly left the house for appointments and to
shop for necessities.
After an independent review of the application and
supporting materials by agency consultants, the Social Security
Administration denied Watkins’s application at the initial stage and
on reconsideration. Watkins then requested and received a
hearing before an administrative law judge (“ALJ”). The ALJ
denied Watkins’s application on August 28, 2014, finding Watkins
not disabled. Watkins requested review of the ALJ’s decision by
the Appeals Council, but the Appeals Council denied the request.
Thereafter, Watkins filed a complaint in the district court,
arguing, in relevant part, that the ALJ failed to properly weigh the
medical opinion evidence. A magistrate judge agreed, concluding
that the ALJ had failed to support with substantial evidence his
rejection of Watkins’s treating physician’s opinion. Accordingly,
the magistrate judge reversed the decision of the Commissioner
and remanded the claim for further proceedings on September 27,
2017. 2 The Appeals Council then remanded the claim to a new ALJ
2 Watkins consented to a magistrate judge presiding over the case instead of a
district court judge.
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4 Opinion of the Court 23-12765
for a new hearing and decision. The new hearing took place on
September 11, 2019.
B. Testimony from the Second Hearing
Watkins testified that he was 64 years’ old. Between 2012
and 2017 (the relevant time frame for his disability benefits), 3 he
experienced depression and anxiety, leading him to become
homeless and unable to work. He was admitted into a residential
rehabilitation program through the Department of Veterans
Affairs (“VA”), where he stayed for approximately seven months.
He admitted that he also had an alcohol abuse problem prior to
losing his job, and he voluntarily participated in a 90-day rehab
program. He stated that he was drinking heavily “up until [he] lost
[his] job.” Since rehab, however, he has “had a couple of beers here
and there in 2014 on the 4th of July.” Doctors considered him “an
alcoholic by their standards,” but he did not consider himself to be
one. He stated that he was not drinking anymore.
Watkins testified that he most recently worked in several
engineering roles for a chemical plant—he started as an electrical
engineer; then he transitioned to a scheduling engineer; he then
moved up to being the “master scheduler” in charge of
coordinating employee, contractor, equipment, and tool
3 Disability insurance benefits may not be paid unless the claimant was
disabled while he met the insured status requirements of 42 U.S.C. § 423(c).
See 42 U.S.C. § 423(a)(1)(A). Thus, the ALJ in this case examined whether
Watkins was disabled between his alleged onset date of March 2012 and his
date last insured of December 31, 2017.
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23-12765 Opinion of the Court 5
schedules; and finally he was a process safety engineer in charge of
ensuring “everything was up to code.”4 He called out “sick a lot
because of [his] anxiety and [his] depression,” and self-medicated
with alcohol. Although Watkins was no longer drinking presently,
his anxiety and depression were worse.
Watkins explained that he had always struggled with anxiety
and depression, but as he got older, he was unable to maintain the
“mask” needed to keep working and no longer had the energy to
fight off his fears and depression. He had been on benzodiazepines
for 20 years off and on. However, those types of medications
would work for only a short time and ultimately caused him more
depression and anxiety. He had also tried various anti-depressants,
but none of them worked. He explained that he was hospitalized
once for a panic attack, but he had since learned to recognize that
a panic attack is not a heart attack, and that if the symptoms
subside, he does not need to go to the hospital. He explained that
his anxiety and his medications made it difficult to focus because of
constant racing thoughts. He explained that his depression comes
in cycles approximately three times each year and lasts for a period
of several weeks to several months. Watkins confirmed that he
had never attempted suicide and had not had suicidal thoughts
since 2012.
A vocational expert (“VE”) then testified that Watkins’s
4 He testified that prior to his employment at the chemical plant, he had
previous quality control engineering jobs with other companies, but he lost
those jobs because of his anxiety and depression.
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6 Opinion of the Court 23-12765
prior vocations were classified as light, skilled work. The VE
opined that a hypothetical individual “limited to understanding and
carrying out no more than simple, routine, repetitive, unskilled
tasks” could not perform Watkins’s past relevant work. The ALJ
then asked whether there were any jobs in the national economy
that a hypothetical individual, approaching retirement age, with
Watkins’s level of education could perform, where such an
individual was “limited to medium level of exertion,” with various
limitations including no climbing; no heights; avoidance of
extreme temperatures; no operation of heavy machinery; and
“limited to understanding and carrying out simple, routine,
repetitive, unskilled tasks, with the ability to make only basic
decisions and adjust to simple changes in a work setting, with
interaction with others, including the general public, co-workers,
and supervisors limited to occasional.” The VE testified that such
a person would be able to work as a hand packager, a warehouse
worker, or a cook’s helper, and that all of these positions were
available in the national economy.
The VE then testified that the same hypothetical individual
would not be able to work any of those jobs if he would be off task
15 percent of the time and absent from work two to three times a
month. On further examination by Watkins’s counsel, the VE
explained that “the baseline tolerance for time off task” at a given
job is largely dependent on the employer, but ranges from 3 to 8
percent. He further opined that an individual who required
frequent supervision, “meaning up to two-thirds of the workday,”
would likely not be able to maintain gainful employment in the
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23-12765 Opinion of the Court 7
previous roles that the VE identified.
C. The Relevant Medical Evidence
In addition to the testimony provided at the second hearing
before the ALJ, the relevant medical evidence included the
following. On March 25, 2012, Watkins admitted himself to Palm
Partners, LLC for treatment for alcohol dependency, noting that
he had relapsed. 5 At that time, he reported symptoms of insomnia,
sweating, tremors, and that he had been suffering depression for
the last 20 years. Watkins reported taking prescribed medications
for anxiety, depression, and ADHD. The notes from his admission
indicate that Watkins had a “neat/clean” appearance and was alert
and oriented with normal speech patterns and affect. His thought
process was logical and coherent, his short- and long-term memory
were normal, and he was cooperative and attentive, but his
judgment was impaired. The evaluation indicated that he had
“severe” stressors in his life, including “[p]roblems with [p]rimary
[s]upport,” “[p]roblems related to social environment,” and
“[e]conomic problems.” He completed a detox program at Palm
Partners.
Watkins saw a general practitioner several times between
June and July 2012 for depression and anxiety and adjustments of
medications. He reported a concern that he was having a bad
reaction to Seroquel, one of the depression medications that he had
5 Records revealed that Watkins had completed a prior treatment program at
Palm Partners for alcohol and benzodiazepine dependency in 2011.
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8 Opinion of the Court 23-12765
been prescribed while at Palm Partners; difficulties with memory,
sleep, and concentration; and feeling depressed with intermittent
severe episodes of anxiety. Nevertheless, activities of daily living
(“ADLs”) were normal as were his physical exams. He also denied
suicidal ideation or any history of attempts. His doctor
discontinued some medications and adjusted others. Watkins
noted minor improvement with the medication adjustments at his
visits in July 2012, and he noted that he had a pending appointment
with a psychiatrist, Dr. Carroll. His doctor recommended that
Watkins “stay off work at least until he [was] able to see
psychiatrist.”
Watkins first saw Dr. Carroll on August 14, 2012. At that
time, Watkins indicated that he was employed but currently on
short term disability through the end of September. He indicated
that he did not “feel ready to return to work” and was “working to
roll into [long term disability].” He reported no incidents of
suicidal or homicidal ideation or risk of self-harm. Dr. Carroll
noted that Watkins’s appearance was “disheveled”; his
psychomotor function “restless”; his affect “tearful/sad” and
anxious; and his mood depressed and anxious. But his judgment
was logical and his thought process organized and relevant, and he
was completely oriented with appropriate insight. She diagnosed
him with alcohol dependence, major depressive disorder (severe),
and generalized anxiety disorder. She discontinued some
medications and began others and requested to see him again in
three to four weeks.
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23-12765 Opinion of the Court 9
Dr. Carroll saw Watkins again for a follow-up on September
6, 2012. Watkins reported that he could not take one of the
prescribed depression medications due to side effects, and she again
adjusted his medication regime. At this visit, she documented that
he had a normal appearance and was fully alert and oriented and
cooperative, with clear and coherent speech, but his speech was
slow and he exhibited retardation of psychomotor function.
Additionally, his mood was “terrible,” and he exhibited an anxious
affect. His memory and concentration were impaired, and his
judgment was poor.
Following the September 6, 2012 visit, Dr. Carroll
completed a narrative report statement. In this statement, she
indicated that Watkins reported prior diagnoses of, and treatment
for, major depressive disorder, generalized anxiety disorder, and
alcohol dependence. He had been placed on short-term disability
“due to the severity of his symptoms.” He frequently self-
medicated with alcohol and had “experienced severe depressive
episodes, agitation, extreme isolation, suicidal thoughts[,] and
paralyzing anxiety attacks” over the previous two years. These
symptoms often interfered with his ability to perform ADLs. He
experienced the most severe symptoms during times “when he
[was] trying to maintain employment or [was] under an inordinate
amount of stress.” Watkins reported that his employment was “a
large source of stress” and he felt “incapable of returning to the
work place.”
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10 Opinion of the Court 23-12765
Watkins saw Dr. Carroll approximately a month later for
continuing symptoms of anxiety and depression. Watkins
indicated during this visit that his request for long term disability
had been denied and that he intended to apply for DIB. Dr. Carroll
documented his appearance as normal with good eye contact and
normal motor function. He was cooperative with logical and
organized thoughts, and alert and fully oriented with clear and
coherent speech. But he reported being anxious and depressed and
Dr. Carroll documented that he had a “constricted” affect, and his
memory and concentration were impaired. Watkins’s judgment
improved from “poor” to “fair.” Dr. Carroll again adjusted his
medications.
In November 2012, Dr. Carroll completed a
“psychiatric/psychological impairment questionnaire” in relation
to Watkins’s application for DIB benefits. She indicated that
Watkins suffered from alcohol dependency, major depression, and
generalized anxiety disorder. She asserted that these diagnoses
were supported by the following clinical findings: “poor memory”;
“appetite disturbance with weight change”; “sleep disturbance”;
“mood disturbance”; “social withdrawal or isolation”; “substance
dependence”; “anhedonia or pervasive loss of interests”;
“generalized persistent anxiety”; and “feelings of
guilt/worthlessness.” She listed Watkins’s primary symptoms as:
“(1) continued alcohol use”; “(2) depressed mood, fatigue, poor
cognitive function”; and “(3) persistent generalized anxiety.”
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23-12765 Opinion of the Court 11
Based on Watkins’s diagnoses and symptoms, Dr. Carroll
opined that Watkins’s ability to understand and remember “work-
like procedures” and “one or two step instructions” would be
“moderately limited” as would be his ability to carry out such
instructions. Relatedly, Watkins’s ability to understand,
remember, and carry out detailed instructions as well as his ability
to maintain concentration for extended periods of time and
maintain regular attendance and punctuality were “markedly
limited.” Similarly, she opined that Watkins’s “ability to make
simple work related decisions” and to complete a normal
workweek without experiencing disruptions due to his
psychological symptoms was “markedly limited.”
Dr. Carroll also found that Watkins’s symptoms
“moderately limited” his ability to interact with the general public
and his coworkers and to adapt to changes in the workplace.
Additionally, Dr. Carroll indicated that his ability to be aware of
hazards in the workplace and respond appropriately, his ability to
travel, and his ability to set realistic goals and plan independently
were only “mildly limited.” Dr. Carroll noted that she was unable
to comment on Watkins’s ability to “tolerate work stress” because
Watkins had not worked since she began treating him. She
acknowledged that Watkins had good days and bad days, but she
estimated that he would likely be absent from work “more than
three times a month” due to his conditions. Finally, Dr. Carroll
noted that Watkins “need[ed] to work to attain [and] maintain
sobriety in order to see improvement in his mood and anxiety
symptoms. Planning to start behavioral therapy[.]”
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12 Opinion of the Court 23-12765
Watkins saw Dr. Carroll again on December 5, 2012,
throughout 2013, 6 and multiple times between January and May
2014. 7 At times Watkins indicated his was doing better and at other
times worse, and he frequently requested changes to his
medications during these visits or expressed concerns with side
effects of current medications, and Dr. Carroll frequently adjusted
his medications. Dr. Carroll’s observations of Watkins during
these periods indicated appropriate grooming; fair to good eye
contact; a cooperative attitude; logical and organized thought
processes; alertness and proper orientation; occasional retardation
of psychomotor function, but unremarkable (i.e., normal function)
the majority of the visits; an abnormal mood and affect; clear and
coherent but occasionally slow and soft speech; fair judgment; fair
insight; low risk of self-harm or violence against others; no suicidal
ideation; and impaired or poor memory and concentration. Her
notes continuously indicated that Watkins needed to focus on
maintaining sobriety.
In June 2014, Dr. Carroll completed a narrative statement
summarizing Watkins’s diagnoses, symptoms, and functional
capacity. Her summary was virtually identical to the answers she
provided in the November 2012 medical source statement.
6 In 2013, Watkins saw Dr. Carroll on March 13, May 7, June 13, July 8, August
12, September 30, October 27, November 25, and December 30.
7 In 2014, Watkins saw Dr. Carroll on January 9, January 28, February 28, April
7, April 30, and May 28.
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23-12765 Opinion of the Court 13
Around this same time, Watkins’s counsel referred him for
a psychological evaluation by Dr. Benjamin Cohen in support of
his DIB application. Dr. Cohen evaluated Watkins by conducting
a clinical interview and a mental status examination, reviewing
Watkins’s treatment records from Dr. Carroll, and administering
certain tests. Dr. Cohen’s mental status observations of Watkins
during the evaluation included that Watkins appeared well
groomed; was punctual; made good eye contact; had a depressed
mood with congruent, tearful affect; had normal speech; had goal-
oriented thought processes; was alert and oriented to time, place,
and situation; had average concentration and attention span; and
had fair insight and judgment. Watkins denied suicide attempts
and ideation, but reported nervousness, memory problems, poor
appetite, loneliness, insomnia, feelings of guilt and worthlessness,
and chronic worry since childhood. Watkins was able to complete
simple arithmetic in his head, spell a given word backwards and
forwards, and “was able to complete serial 3’s from 20 with one
mistake.” Dr. Cohen indicated that Watkins’s fund of knowledge
was fair, he was of average intelligence, and his memory was below
average, but not impaired. Based on his review, Dr. Cohen opined
in his evaluation summary and recommendations that Watkins’s
“psychological symptoms would cause mild impairment in his
ability to perform work-related mental activities (i.e.,
concentration and memory) and moderate to severe impairment
in his ability to socialize and adapt at work.” Further, “he would
be at moderate risk for psychological decompensation in the future
if subjected to job-related stressors.”
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14 Opinion of the Court 23-12765
Dr. Cohen then completed a medical source statement,
identifying the following symptoms as supporting Watkins’s
diagnoses: (1) blunt affect; (2) emotional lability; (3) feelings of guilt
or worthlessness; (4) suicidal ideation; (5) difficulty thinking or
concentrating; (6) generalized anxiety; (7) pervasive loss of
interests; (8) appetite disturbances/weight change; (9) fatigue;
(10) pathological dependence; (11) psychomotor retardation;
(12) social isolation/withdrawal; and (13) insomnia. He also noted
that Watkins reported “bouts of depression that last[ed] for several
weeks.” And Dr. Cohen opined that Watkins had
“moderate‑to‑marked” limitations in his ability to: (1) perform at a
consistent pace; (2) accept instructions and respond appropriately
to criticism from supervisors; (3) get along with coworkers or peers
without distracting them; (4) set realistic goals; and (5) make plans
independently. Dr. Cohen also opined that Watkins had
“moderate” limitations in his ability to: (1) remember locations and
work‑like procedures; (2) understand and remember detailed
instructions; (3) carry out detailed instructions; (4) maintain
attention and concentration for extended periods; (5) perform
activities within a schedule and consistently be punctual; (6) sustain
an ordinary routine without supervision; (7) work with or near
others without being distracted; (8) ask simple questions or request
assistance; and (9) respond appropriately to workplace changes.
Dr. Cohen estimated that Watkins would be absent from work
more than three times per month as a result of his symptoms.
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23-12765 Opinion of the Court 15
Dr. Carroll continued to treat Watkins throughout 2014 and
2015. 8 On February 9, 2015, Dr. Carroll prepared a narrative report
in support of Watkins’s request for reconsideration of the initial
denial of his application for DIB benefits. Dr. Carroll stated that,
over the previous five years, Watkins “experienced severe
depressive episodes, agitation, extreme isolation, suicidal thoughts
and paralyzing anxiety attacks at varying intervals.” She indicated
that “[h]is most severe episodes” were triggered when he faced
“interpersonal stressors,” such as when his brother almost died due
to a medical emergency. She maintained that Watkins struggled
to perform ADLs due to his symptoms, and he felt “incapable of
returning to the work place.” Dr. Carroll agreed that Watkins
“[was] not capable of maintaining a 40 hour work week” due to his
poor coping skills. She noted that “[a]lthough he [had] been able
to function well at most visits with [her], he [had] spiraled and
struggled significantly over the past year. . . . finding it harder and
8 Although the record contains no notes from office visits between May 2014
and July 2015, Dr. Carroll’s lengthy medication record for Watkins contains
entries during that time period. Therefore, it is clear that she treated Watkins
during that time frame. Office visit notes are available for July through
October 2015. As with prior visits, Watkins frequently expressed concerns
with his medications during these visits, and Dr. Carroll adjusted his
medications in response. Additionally, as with prior visits, Dr. Carroll’s
observations of Watkins during these periods indicated appropriate grooming;
fair to good eye contact; a cooperative attitude; logical and organized thought
processes; alert and fully oriented; retardation of motor function; an abnormal
mood and affect; clear and coherent but occasionally slow and soft speech; fair
or poor judgment; no suicidal ideation; low risk of self-harm or violence
against others; and impaired memory and concentration.
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16 Opinion of the Court 23-12765
harder to cope with life.” She maintained that his “prognosis for
recovery [was] poor to guarded.”
In May 2015, Dr. Carroll completed another medical source
(“mental impairment questionnaire”) statement. She checked
many of the same signs and symptoms that supported Watkins’s
diagnoses as she did in the November 2012 medical source
statement. However, this time, she also indicated that Watkins
had “suicidal ideation,” “past suicide attempt(s),” “impulsive or
damaging behavior,” “intense and unstable interpersonal
relationships,” and agitated psychomotor function (but not
retardation of psychomotor function). She further indicated that
Watkins was markedly limited in many areas of function.
Watkins also received treatment from the VA intermittently
between 2012 and 2017. In notes from the VA regarding a visit on
December 21, 2012, Watkins reported that his anxiety and
depression were “getting better but [he] tend[ed] to have issues
making new friends.” He stated he recently visited his brother and
“felt as good as he[’]s ever felt.” He also “felt improvement with
his Xanax and he [was] now able to engage in conversations with
people and [had] [a] []positive point of view on life.” Progress notes
from a June 2013 visit indicated that Watkins stated “he [had] been
doing well” and that he was following an exercise regimen to help
work out his anxiety.
On June 6, 2014, Watkins saw a doctor at the VA for another
matter and reported increased depression since the death of his
father. He reported experiencing depressed mood, loss of interest,
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23-12765 Opinion of the Court 17
and decreased appetite. He also stated that he was not currently
taking any anti-depressants and did not want to take any because
of the side effects; instead, he took only Xanax. Five days later,
Watkins went to the VA hospital emergency room due to heart
palpitations following two panic attacks and his consumption of
two “airline bottles” of alcohol. He also reported experiencing
severe depression. At a follow-up the next day, Watkins reported
struggling with recent bouts of depression and daily panic attacks
due to the passing of his father and his brother’s health issues. He
also reported feeling overwhelmed with paperwork related to his
DIB application and experiencing sleep issues. He denied any
suicidal ideation or history of suicide attempts. He also denied
experiencing “decreased concentration, interest, energy, appetite,
feelings of guilt, helplessness, or hopelessness.” According to the
notes, Watkins appeared “well groomed” with good eye contact;
“no psychomotor retardation/agitation”; alert and fully oriented;
normal speech pattern; logical and organized thought process;
“grossly intact” recent and long-term memory; and adequate
attention and concentration.
On April 13, 2015, Watkins requested admission to a
treatment program at the VA, reporting that he was not doing well,
was “dangerously close to drinking again,” and that he was
experiencing worsening anxiety and depression symptoms due to
ineffective medications and his brother’s recent hospitalization.
He denied any suicidal ideation or attempts. As with prior visits,
Watkins’s mental status exam indicated that he appeared well-
groomed, made good eye contact, was cooperative, and had
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18 Opinion of the Court 23-12765
organized thoughts. His mood was congruent, and he was
properly oriented to time and place. “All memory functions
appear[ed] to be grossly intact.” It was recommended that he
participate in an outpatient substance abuse recovery program.9
In a September 2015 psychiatric evaluation by the VA,
Watkins reported experiencing depressed mood, loss of interest,
sleep issues, feelings of worthlessness and guilt, and problems with
concentration. He also reported some suicidal ideation stating that
in June 2015 he had thoughts of “driving [his] motorcycle out to
the desert and letting [himself] starve to death,” but he denied any
current ideation and denied any history of attempts. His mental
status exam indicated a depressed, anxious mood with congruent
affect; clear, normal speech; good grooming; good eye contact;
alertness; and no psychomotor retardation or agitation.
In November 2015, Watkins reported feeling hopeless and
depressed, but denied any suicidal ideation. He indicated he was
“ok,” but that he needed more therapy, assistance with substance
abuse, and housing. He reported a life-long history of depression
problems that “last days and weeks on end,” during which he
experienced “sadness, anhedonia, weight gain, sleep
disturbance . . . , low energy, feelings of worthlessness and guilt,
and concentration problems.” However, his recent symptoms had
not been “as intense” as in the past. He “adamantly denie[d] any
suicidal . . . ideation[].” His mental status exam indicated “no acute
9 It does not appear that Watkins participated in the program.
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23-12765 Opinion of the Court 19
distress”; good eye contact; a pleasant, well-groomed appearance;
normal psychomotor function; normal speech; “grossly intact”
memory and concentration; no suicidal ideation; and constricted
affect and depressed mood.10
At a follow-up on January 22, 2016, Watkins reported a
stable mood and mild improvement in his depression and anxiety
symptoms due to new medications, but he expressed concerns
about stressors surrounding the sale of his trailer and his future
housing options given his lack of financial resources. And at a visit
on February 8, 2016, Watkins reported that he was adjusting his
medications as part of his treatment program, and he stated he had
a stable mood and “denie[d] any significant depressive symptoms
at [that] time.” His mental status exam indicated “no acute
distress”; good eye contact; a pleasant, well-groomed appearance;
normal psychomotor function; normal speech; “grossly intact”
memory and concentration; no suicidal ideation; and constricted
affect and self-reported “okay” mood.
In the spring of 2017, Watkins entered a residential
rehabilitation program through the VA. He was diagnosed with
benzodiazepine dependence and provided with many forms of
treatment and counseling. He was discharged to a transitional
housing program in October 2017, at which time he indicated the
10 In December 2015, Watkins reached out to the VA seeking help with
obtaining employment.
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20 Opinion of the Court 23-12765
program had helped him develop and implement coping skills,
“work on managing anxiety,” and maintain sobriety.
VA records from multiple encounters in August, September,
October, November, and December 2017 indicate that Watkins
was stable, participating in the VA’s therapy programs, seeking
advice on obtaining employment, and applying for jobs. He denied
any current struggles with alcohol or suicidal ideation. He
reported overall improvement in his moods but continued anxiety
and panic attacks, and at times still reported depression, loss of
interest, racing thoughts, and insomnia.
Lastly, Watkins presented evidence that in October 2017 he
complained of neck pain, which had been worsening over the prior
four months. An MRI study revealed “mild lower cervical
levocurvature,” disc degeneration at certain vertebrae in the
cervical spine, “moderate/severe bilateral foraminal stenosis,” and
“[m]oderate canal narrowing.” Despite these results, a physical
exam revealed full active and passive range of motion of the
cervical spine and shoulders without pain with full motor and grip
strength. As a result, conservative treatment was recommended
including applying a hot/cold wrap to the neck, a chiropractic
consultation, physical therapy, and use of a muscle relaxer.
D. The ALJ’s Decision
Employing the SSA’s five-step sequential evaluation process
for determining whether a claimant is disabled, the ALJ denied
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23-12765 Opinion of the Court 21
Watkins’s application.11 At steps one and two, the ALJ found that
Watkins had not engaged in substantial gainful activity since March
24, 2012, and was severely impaired by his “moderate generalized
anxiety disorder, major depression, and long history of alcohol
dependence.” The ALJ also found that, beginning in August 2017,
Watkins was severely impaired by “cervical spine degenerative
changes,” which the ALJ determined resulted in certain exertional
and physical limitations. At step three, the ALJ determined that
Watkins’s impairments alone or in combination did not meet or
medically equal any listed impairment under the relevant Social
Security regulations. At step four, the ALJ determined that:
from [Watkins’s] alleged onset date of March 24, 2012
through July 31, 2017, the claimant had the residual
functional capacity to perform a full range of work at
all exertional levels, but with the following non-
exertional limitations: was limited to work that is
simple as defined in the Dictionary of Occupational
Titles (DOT) as specific vocational preparation (SVP)
levels 1 and 2, routine and repetitive tasks in a work
environment free of fast-paced production
11
The determination process involves the following five steps: (1) whether the
claimant is engaged in substantial gainful activity; (2) if not, whether he “has a
severe impairment or combination of impairments”; (3) if so, whether that
impairment, or combination of impairments, meets or equals the medical
listings in the regulations; (4) if not, whether the claimant can perform his past
relevant work in light of his residual functional capacity (“RFC”); and (5) if
not, whether, based on the claimant’s age, education, and work experience,
he can perform other work found in the national economy. Winschel
v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011).
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22 Opinion of the Court 23-12765
requirements which is defined as constant activity
with work tasks performed sequentially in rapid
succession; involving only simple work-related
decisions; with few, if any, workplace changes; and no
more than occasional interaction with the general
public, co-workers and supervisors. In addition,
beginning on August 1, 2017 through the date last
insured of December 31, 2017, the claimant had the
residual functional capacity to perform medium work
as defined in 20 CFR 404.1567(c), except he was
unable to climb long vertical ladders, scaffolds or
ropes, or at open unprotected heights; he had to avoid
extreme heat temperatures and operation of
dangerous machinery; and was unable to work where
alcoholic beverages were available. He was further
limited to understanding and carrying out simple,
routine, repetitive unskilled tasks, with the ability to
make basic decisions and adjust to simple changes in
the work setting, and limited to only occasional
interaction with others, including the general public,
coworkers, and supervisors.12
In reaching the determination that Watkins had the RFC to
perform medium-level work that is defined as simple, the ALJ
12 The physical limitations noted by the ALJ beginning August 1, 2017 through
December 31, 2017, appear to relate to Watkins’s neck injury. Watkins does
not challenge the physical limitations found as part of the RFC determination.
Instead, he focuses solely on the mental health aspects of his claim and how
those health issues render him totally disabled. Accordingly, this opinion
focuses on the mental health aspects as well.
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23-12765 Opinion of the Court 23
found that Watkins’s medically determinable impairments could
reasonably be expected to cause his alleged symptoms (problems
with sleeping, concentration, focus, memory, excessive worry,
fear, depression, and impairments in his ability to care for himself,
among others), but that his “statements concerning the intensity,
persistence and limiting effects of [his] symptoms [were] not
entirely consistent with the medical evidence and other evidence
in the record.” In support of this conclusion, the ALJ summarized
the medical records from the various providers at length, noting
that, despite Watkins’s long history of anxiety, depression, and
alcohol dependence, his mental status exams during these visits
indicated that he was alert and lucid with good eye contact;
cooperative; had a well-groomed appearance; had normal speech
activity and was coherent with logical, goal-directed thought
processes; he did not have suicidal ideations; he was able to interact
appropriately with doctors and staff; and had at most a mild
impairment in concentration and memory with fair judgment and
insight. The ALJ explained that these findings were consistent with
his observations of Watkins’s demeanor and appearance at the
hearing as well.
The ALJ further noted that the records “failed to reveal any
formal thought or psychotic disorder, and [Watkins’s] treatment
consisted primarily of medication management along with
counseling, with reports of improvement in his symptomatology.”
Thus, the ALJ concluded that Watkins’s “alleged symptoms and
restrictions are exaggerated, as they are not supported by the
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24 Opinion of the Court 23-12765
medical signs and/or diagnostic study findings to account for the
total level of disability alleged.”
The ALJ gave “little weight” to Dr. Carroll’s opinions
because, in addition to her progress notes being “mostly illegible,”
her opinions were “unsupported and inconsistent with the overall
medical evidence of record.” For instance, the ALJ pointed out that
Dr. Carroll documented in treatment notes that Watkins had no
suicidal ideations, had an appropriate appearance, was cooperative,
had logical thought processes, and clear and coherent speech, but
then she stated the opposite in the formal questionnaires and
evaluations. Furthermore, her opinions were contrary to
evaluations by persons at the VA and Dr. Cohen—all of which
indicated that Watkins was functioning at a much higher level than
opined by Dr. Carroll.
As for Dr. Cohen, the ALJ gave his opinion “only partial
weight” because Dr. Cohen evaluated Watkins on only one
occasion and the evaluation did not “reveal objective findings
supporting [the noted] signs of suicidal ideations, difficulty thinking
or concentrating, generalized or persistent anxiety, anhedonia,
appetite disturbances, decreased energy, psychomotor retardation,
social withdrawal, or insomnia.” Similarly, Dr. Cohen’s statement
that Watkins had “bouts of depression that last[ed] for several
weeks” was unsupported by objective medical findings because he
evaluated Watkins only once, which necessarily meant that this
statement was based on Watkins’s subjective statements. Finally,
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23-12765 Opinion of the Court 25
the ALJ noted that Dr. Cohen’s opinion was also inconsistent with
the records from the VA.
Next, the ALJ determined that Watkins could not perform
past relevant work. But, at step five, the ALJ determined that
Watkins could perform other jobs in the national economy such as
a hand packager, a warehouse worker, or a cook’s helper.
Consequently, the ALJ found that Watkins was not disabled.
Watkins requested discretionary review of the ALJ’s
decision by the SSA’s Appeals Council, which was denied.
E. District Court Proceedings
In April 2022, Watkins filed a complaint in the district court,
arguing, in relevant part, that (1) the ALJ failed to properly weigh
the medical opinion evidence of Dr. Carroll and Dr. Cohen; (2) the
ALJ erred in determining Watkins’s RFC; and (3) the ALJ failed to
properly evaluate Watkins’s subjective testimony. A magistrate
judge issued a report and recommendation (“R&R”)
recommending that the Commissioner’s decision be affirmed. The
district court adopted the R&R over Watkins’s objections and
affirmed the denial of benefits. Watkins timely appealed.
II. Standard of Review
“When, as in this case, the ALJ denies benefits and the
[Appeals Council] denies review, we review the ALJ’s decision as
the Commissioner’s final decision.” Doughty v. Apfel, 245 F.3d 1274,
1278 (11th Cir. 2001). “Our review of the Commissioner’s decision
is limited to whether substantial evidence supports the decision
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26 Opinion of the Court 23-12765
and whether the correct legal standards were applied.” Walker v.
Soc. Sec. Admin., Comm’r, 987 F.3d 1333, 1338 (11th Cir. 2021).
“[W]e review de novo the legal principles upon which the
Commissioner’s decision is based,” and “we review the resulting
decision only to determine whether it is supported by substantial
evidence.” Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005).
“Substantial evidence is less than a preponderance, and thus we
must affirm an ALJ’s decision even in cases where a greater portion
of the record seems to weigh against it.” Simon v. Comm’r, Soc. Sec.
Admin., 7 F.4th 1094, 1103 (11th Cir. 2021) (quotation omitted); see
also Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir.
2004) (“Substantial evidence is more than a scintilla and is such
relevant evidence as a reasonable person would accept as adequate
to support a conclusion.” (quotations omitted)).
“We may not decide the facts anew, reweigh the evidence,
or substitute our judgment for that of the [Commissioner].”
Winschel, 631 F.3d at 1178 (alteration in original) (quotation
omitted). “Even if the evidence preponderates against the
Commissioner’s findings, we must affirm if the decision reached is
supported by substantial evidence.” Crawford, 363 F.3d at 1158–59
(quotation omitted).
III. Discussion
Watkins argues that (A) the ALJ failed to properly weigh the
medical opinion evidence; (B) the ALJ failed to properly evaluate
his subjective statements; and (C) the ALJ failed to properly
determine his mental RFC. We address each argument in turn.
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23-12765 Opinion of the Court 27
A. Weighing of the medical opinion evidence
Watkins argues that the ALJ failed to properly weigh the
medical opinion evidence of Dr. Carroll and Dr. Cohen.
Specifically, he asserts that the ALJ erred in failing to give Dr.
Carroll’s opinions controlling weight as his treating physician and
in only giving partial weight to Dr. Cohen’s opinion. We disagree.
To obtain social security disability benefits, the applicant
must prove he is disabled. See Barnhart v. Thomas, 540 U.S. 20, 21
(2003). “Disability” is defined as the “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 12 months.” 42 U.S.C.
§ 423(d)(1)(A). The impairment must be “of such severity that [the
person] is not only unable to do his previous work but cannot,
considering his age, education, and work experience, engage in any
other kind of substantial gainful work which exists in the national
economy . . . .” Id. § 423(d)(2)(A).
When making the disability assessment, the ALJ must give
special attention to the medical opinions, particularly those of the
treating physician. SSA regulations in force at the time Watkins
filed his application required an ALJ to give “controlling weight” to
a treating physician’s opinion if it was “well-supported by medically
acceptable clinical and laboratory diagnostic techniques” and “not
inconsistent with the other substantial evidence in [the] case
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28 Opinion of the Court 23-12765
record.” 20 C.F.R. § 404.1527(c)(2). 13 Good cause to discount a
treating physician’s opinion exists “when the: (1) treating
physician’s opinion was not bolstered by the evidence; (2) evidence
supported a contrary finding; or (3) treating physician’s opinion
was conclusory or inconsistent with the doctor’s own medical
records.” Winschel, 631 F.3d at 1179 (quotation omitted).
The Social Security regulations provide that an ALJ should
consider many factors when weighing a medical opinion, including
(1) the examining relationship between the physician and the
applicant; (2) the treatment relationship, including the length and
nature of the treatment; (3) whether the medical opinion is
supported by the relevant evidence; (4) whether the opinion is
consistent with the record as a whole; and (5) the specialization of
the physician rendering the opinion. See 20 C.F.R. § 404.1527(c).
“[T]he ALJ must state with particularity the weight given to
different medical opinions and the reasons therefor.” Winschel, 631
F.3d at 1179. There are no magic words to state with particularity
the weight given to the medical opinions. Rather, the ALJ must
“state with at least some measure of clarity the grounds for his
decision.” Id. (quotation omitted).
Importantly, “[a]n administrative law judge is not required
to agree with the statement of a medical source that a claimant is
13 In 2017, the SSA amended its regulations and removed the “controlling
weight” requirement for all applications filed after March 27, 2017. See 20
C.F.R. §§ 404.1527, 404.1520c. Because Watkins filed his DIB application in
2012, the former regulations apply.
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23-12765 Opinion of the Court 29
‘disabled’ or ‘unable to work.’” Walker, 987 F.3d at 1338 (quoting
20 C.F.R. § 404.1527(d)(1)). Rather, whether a claimant is disabled
within the meaning of the statute is a question reserved for the ALJ
acting on behalf of the Commissioner of Social Security. Id. at
1338–39.
i. Dr. Carroll’s Opinions
Here, the ALJ articulated a specific justification for giving
Dr. Carroll’s opinions less than controlling weight—her opinions
were not consistent with her own treatment notes or the other
medical evidence in the record. For instance, Dr. Carroll noted in
her narrative statements 14 and the medical questionnaires that
Watkins suffered from suicidal thoughts—and, on at least one
evaluation, Dr. Carroll also documented a history of suicide
attempts—and agitated psychomotor function, but her treatment
notes did not support these assessments. Rather, on each of
Watkins’s visits, Dr. Carroll marked that Watkins did not suffer
from suicidal ideation and he had no history of suicide attempts,
and she also documented that he had either unremarkable
psychomotor function or retardation of psychomotor function (not
14 The Commissioner argues that Dr. Carroll’s narrative statements in 2012
and 2014 that summarize Watkins’s treatment history and his subjective
reports of symptoms and limitations are not “medical opinions” within the
meaning of the Social Security regulations and therefore are not entitled to
any special weight. Because the ALJ treated Dr. Carroll’s narrative statements
as medical opinions, however, we do so as well. In considering these
statements, we express no opinion on whether or not such narrative
statements qualify as medical opinions for purposes of the regulations.
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30 Opinion of the Court 23-12765
agitated). The other medical evidence in the record from other
treating physicians also reflect findings of no suicidal ideation 15 or
attempts and unremarkable psychomotor function or retardation
of psychomotor function.16 Thus, her assessments to the contrary
in her medical opinions and source statements were not supported
by the record.
Furthermore, while Dr. Carroll opined that Watkins’s
symptoms moderately to markedly limited his ability to maintain
socially appropriate behavior and adhere to basic standards of
neatness, her treatment notes (as well as the notes from other
providers) routinely reflected that Watkins had an appropriate
appearance, maintained good eye contact, and was cooperative
15 In his brief on appeal, Watkins points to one instance of suicidal ideation in
the VA records from September 2015, which he contends supports Dr.
Carroll’s statements regarding suicidal ideation. Specifically, in September
2015, the VA noted that Watkins reported that in June 2015, he thought about
“driving [his] motorcycle out to the desert and letting [himself] starve to death.
Denies any current intentions or plans.” The problem for Watkins is that Dr.
Carroll completed the respective narrative statements and questionnaires
noting suicidal ideation prior to June 2015. And Watkins does not allege any
other instances of suicidal ideation nor point to any instances in the record
prior to June 2015 in which he reported such thoughts to Dr. Carroll or anyone
else. Thus, the record does not support Dr. Carroll’s statements.
16 Watkins asserts that the record supports findings of psychomotor
abnormalities, which supports Dr. Carroll’s statements. The problem for
Watkins is that the records Watkins cites document retardation of
psychomotor function (and in one instance “restless” psychomotor function),
not agitation. Moreover, Dr. Carroll also documented unremarkable
psychomotor function a majority of the time. Thus, Dr. Carroll’s statements
otherwise are not supported by the record.
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23-12765 Opinion of the Court 31
and able to communicate and interact appropriately with doctors
and staff. Similarly, while Dr. Carroll opined that Watkins had
impaired memory function, her treatment notes routinely
indicated that Watkins had organized and logical thought
processes. Additionally, other providers documented no issues
with Watkins’s short- or long-term memory.
The ALJ also explained that Dr. Carroll’s narrative
statements were due less weight because they “appeared to be
based on the claimant’s subjective self-reports and not based on her
own observations” or objective medical evidence. The ALJ’s
assessment is supported by the record and constitutes good cause
for giving Dr. Carroll’s opinions less weight. 17 See Crawford, 363
F.3d at 1159 (affirming ALJ’s discounting of treating physician’s
opinion where it was “based primarily on [the applicant’s]
subjective complaints of pain”).
Accordingly, the ALJ’s stated reason for giving Dr. Carroll’s
medical opinions less than controlling weight—because her
opinions were inconsistent with her treatment notes and the
17 For instance, in the September 2012 statement—after having treated
Watkins only twice—Dr. Carroll stated that “[Watkins] sees his employment
as a large source of his stress”; “[h]e continues to have times where it is difficult
to get out of bed, bathe, perform ADLs and function outside of his home”;
“[h]e has encountered considerable social and family strain due to his
symptoms”; and “[h]e feels incapable of returning to the work place.” These
statements were clearly based on Watkins’s subjective self-reporting and were
not supported by Dr. Carroll’s treatment notes from her two visits with
Watkins.
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32 Opinion of the Court 23-12765
record as a whole—was adequate, is supported by the record, and
amounts to good cause. Raper v. Comm’r of Soc. Sec., 89 F.4th 1261,
1275 (11th Cir. 2024); Winschel, 631 F.3d at 1179.
Watkins resists this conclusion by arguing that the ALJ
fundamentally misunderstood mental disorders, which are known
to cause fluctuating symptoms, and “cherry-pick[ed]” normal
findings from the record to support his determination that Watkins
was not disabled. We disagree. Although the ALJ may not have
referred to every piece of evidence in his decision, it is clear that
the ALJ did much more than “cherry-pick[]” favorable evidence in
the record to support his decision. Rather, the ALJ’s opinion
contained a detailed, lengthy discussion of the evidentiary record
and demonstrated that he clearly considered all of the evidence
submitted and Watkins’s condition as a whole, which is all that is
required. See Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005)
(explaining that “there is no rigid requirement that the ALJ
specifically refer to every piece of evidence in his decision” but
must include enough “to enable [the district court or this Court] to
conclude that [the ALJ] considered [the claimant’s] medical
condition as a whole” (first and second alteration in original));
White v. Comm’r of Soc. Sec., 572 F.3d 272, 284 (6th Cir. 2009)
(rejecting an accusation of “cherry picking” by the ALJ and
explaining that “the same process can be described more neutrally
as weighing the evidence”).
Watkins also points out that Dr. Carroll’s treatment notes
supported many of her other findings—that Watkins had decreased
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23-12765 Opinion of the Court 33
memory; weight change; sleep issues; depressed or anxious mood;
loss of interest; feelings of guilt/worthlessness; social
withdrawal/isolation; constricted affect; difficulty concentrating;
decreased energy; and abnormalities of psychomotor function—
which he argues demonstrates that her opinions were consistent
with the overall record and should have been given controlling
weight. 18 However, the ALJ was entitled to find that the
inconsistencies discussed previously rendered Dr. Carroll’s
opinions deserving of less weight, despite the consistency of some
of her other findings in the record. Furthermore, even if the
evidence Watkins cites could support his position, we cannot
reweigh or reevaluate the evidence or otherwise substitute our
judgment for that of the agency. Winschel, 631 F.3d at 1178; see also
Buckwalter v. Acting Comm’r of Soc. Sec., 5 F.4th 1315, 1320 (11th Cir.
18 Watkins argues that all of the relevant factors in 20 C.F.R. § 404.1527(c) that
an ALJ is supposed to consider in weighing medical opinion evidence—
namely, (1) the examining relationship between the physician and the
applicant; (2) the treatment relationship, including the length and nature of
the treatment; (3) whether the medical opinion is supported by the relevant
evidence; (4) whether the opinion is consistent with the record as a whole; and
(5) the specialization of the physician rendering the opinion—weigh in favor
of crediting Dr. Carroll’s opinions. We disagree. Although the nature and
length of their treatment relationship and Dr. Carroll’s specialization may
have weighed in favor of crediting her opinions, the ALJ explained that Dr.
Carroll’s opinions were inconsistent with her own findings from mental status
exams during Watkins’s visits as well as the records from the VA providers
who were treating Watkins during the same time period. These
inconsistencies weighed against crediting Dr. Carroll’s opinions. Regardless,
nothing in the regulations requires the ALJ to explicitly discuss each of the
factors in his decision. See generally 20 C.F.R. § 416.927.
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34 Opinion of the Court 23-12765
2021) (“We will affirm the Commissioner’s decision if it is
supported by substantial evidence, even if the preponderance of
the evidence weighs against it.”). Rather, as we explained
previously, “[o]ur review of the Commissioner’s decision is limited
to whether substantial evidence supports the decision and whether
the correct legal standards were applied.” Walker, 987 F.3d at 1338.
In other words, for purposes of this claim, we are limited to
reviewing whether the ALJ articulated a specific justification for
giving Dr. Carroll’s opinions less than controlling weight and
determining whether that justification constituted good cause.
When, as here, those requirements are met, “[w]e will not second
guess the ALJ about the weight the treating physician’s opinion
deserves.” Hunter v. Soc. Sec. Admin., Comm’r, 808 F.3d 818, 823
(11th Cir. 2015).
ii. Dr. Cohen’s Opinion
The ALJ articulated a specific justification for giving Dr.
Cohen’s opinion only “partial weight”—Dr. Cohen evaluated
Watkins on only one occasion and his opinion concerning the
severity of Watkins’s symptoms and the resulting limitations from
said symptoms was not consistent with the treatment notes from
the evaluation. 19 For instance, as the ALJ pointed out, other than
finding that Watkins had a depressed mood with a congruent
affect, marked by tearfulness, Dr. Cohen otherwise found that
19 Unlike treating physicians, the opinions of non-treating physicians, such as
doctors who examine a claimant only once, are “not entitled to great weight.”
Crawford, 363 F.3d at 1160.
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23-12765 Opinion of the Court 35
Watkins’s mental status was essentially normal during the
evaluation. Watkins was punctual to his appointment, he drove
himself, he was well-groomed, he made good eye contact, and he
behaved appropriately. Watkins’s speech was also normal and his
thought process was goal-directed. He also exhibited an average
attention span and concentration with the tests administered. Dr.
Cohen observed that Watkins’s memory was below average, but
not impaired. He also noted that Watkins denied suicidal ideation.
Yet, Dr. Cohen indicated more severe symptoms in his medical
opinion, indicating that Watkins exhibited symptoms of suicidal
ideation, retardation of psychomotor function, and difficulty
thinking or concentrating. As the ALJ explained, these findings
were not supported by Dr. Cohen’s treatment notes from the one-
time evaluation or the treatment notes from the numerous
providers at the VA. 20 Therefore, the ALJ provided good cause for
20 The ALJ also noted that Dr. Cohen’s statement that Watkins had “bouts of
depression that last[ed] for several weeks” was unsupported because he was a
non-treating physician who only met with Watkins one time (and therefore
this statement was clearly based on Watkins’s subjective complaints and not
Dr. Cohen’s objective medical observations). Watkins points to this finding
and argues that the ALJ committed reversible error because, according to
Watkins, case law establishes that a medical opinion cannot be rejected simply
because it is retrospective in nature as long as it is otherwise supported by
objective medical evidence in the record. See Boyd v. Heckler, 704 F.2d 1207,
1212 (11th Cir. 1983) (holding that the fact that a physician did not examine
the claimant until after the expiration of the claimant’s insured status did “not
render [the] medical opinion incompetent or irrelevant to the decision in this
case”), superseded by statute on other grounds, 98 Stat. 1794 (1984). However, the
ALJ did not partially reject Dr. Cohen’s opinion because it was retrospective
in nature—indeed, Dr. Cohen examined Watkins well before his insured
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36 Opinion of the Court 23-12765
giving Dr. Cohen’s opinion only partial weight, and we will not
second guess that judgment.21 Winschel, 631 F.3d at 1179; Hunter,
808 F.3d at 823.
B. Weighing of Watkins’s Subjective Statements
Watkins argues that the ALJ failed to apply the correct legal
standards in evaluating Watkins’s subjective statements
concerning his symptoms, and that the ALJ’s evaluation of his
symptoms was not supported by substantial evidence. We
disagree.
A claimant’s subjective complaints standing alone are
insufficient to establish a disability, but such statements are
considered as part of the overall disability determination. 20 C.F.R.
§ 404.1529(a) (explaining that the agency considers the claimant’s
status expired and offered an opinion about Watkins’s current disabled state.
Rather, the ALJ partially rejected Dr. Cohen’s opinion because it was not
supported by the objective medical evidence in Dr. Cohen’s treatment notes
and the record as a whole.
21 Watkins asserts that meaningful review of his claim is precluded because it
is impossible to tell from the record which portions of Dr. Cohen’s report the
ALJ rejected, and which portions he credited. His argument is unpersuasive.
To enable us to conduct a meaningful review, an ALJ must “state with
sufficient clarity the legal rules being applied and the weight accorded the
evidence considered.” Ryan v. Heckler, 762 F.2d 939, 941 (11th Cir. 1985). The
ALJ did exactly that here. He explained the legal rules he applied and the
weight he gave Dr. Cohen’s opinion. He also explained in detail the portions
of the opinion that he found not supported by, or otherwise inconsistent with,
the objective medical evidence. Accordingly, the ALJ’s explanation was
sufficient to enable meaningful review.
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23-12765 Opinion of the Court 37
subjective statements about symptoms in making the disability
determination, but “statements about [the claimant’s] pain or other
symptoms will not alone establish that [he is] disabled”).
Specifically, in determining the extent to which the claimant’s
symptoms affect his capacity to work, the ALJ will consider the
claimant’s subjective statements “about the intensity, persistence,
and limiting effects of [his] symptoms” and evaluate the
“statements in relation to the objective medical evidence and other
evidence.” Id. § 404.1529(c)(4). In doing so, the ALJ
will consider whether there are any inconsistencies in
the evidence and the extent to which there are any
conflicts between [the claimant’s] statements and the
rest of the evidence, including [the claimant’s]
history, the signs and laboratory findings, and
statements by . . . medical sources or other persons
about how [the claimant’s] symptoms affect [the
claimant].
Id. When evaluating the extent to which a claimant’s symptoms
affect his capacity to perform basic work activities, the ALJ
considers the claimant’s daily activities; the location, duration,
frequency, and intensity of the symptoms; precipitating and
aggravating factors; the type, dosage, effectiveness, and side effects
of medication taken to alleviate symptoms; treatment other than
medication; any measures used to relieve symptoms; other factors
concerning functional limitations and restrictions due to
symptoms; and inconsistencies between the evidence and
subjective statements. Id. § 404.1529(c)(3), (4).
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38 Opinion of the Court 23-12765
After considering a claimant’s subjective complaints, the ALJ
may reject them as not credible, which will be reviewed for
substantial evidence. Marbury v. Sullivan, 957 F.2d 837, 839 (11th
Cir. 1992). The ALJ must explicitly and adequately articulate his
reasons if he discredits subjective testimony. Id. “Failure to
articulate the reasons for discrediting subjective testimony
requires, as a matter of law, that the testimony be accepted as true.”
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). On the
other hand, “[a] clearly articulated credibility finding with
substantial supporting evidence in the record will not be disturbed
by a reviewing court.” Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir.
1995).
Here, the ALJ set forth the applicable legal standards for
evaluating subjective testimony and then applied those standards
to Watkins’s subjective complaints. The ALJ explained that
Watkins alleged that his symptoms caused him “problems with
concentration, focus, and memory, sleeping problems, isolation,
crying spells, and worries. He also reported having fear,
depression, problems with personal care, and needing reminders.”
The ALJ found that Watkins’s mental impairments could be
reasonably expected to cause the alleged symptoms, but that
Watkins’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 . . . .”
Accordingly, the ALJ concluded that Watkins’s “allegations of a
total inability to work are overstated and unsupported by the
medical evidence of record as a whole.”
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Substantial evidence supports the ALJ’s decision. Watkins
subjectively reported a total inability to work due to his symptoms
and significant limitations in multiple areas of functioning. As the
ALJ noted, however, while Dr. Carroll, Dr. Cohen, and the VA
practitioners noted a depressed mood and constricted affect,
Watkins was otherwise generally alert, well-groomed, exhibited
fair eye contact, spoke clearly and coherently, and exhibited logical
and organized thought processes with only occasionally impaired
memory. Watkins routinely attended doctor’s appointments
alone, was punctual and cooperative, was able to communicate
effectively, and was compliant with doctor’s instructions.
Furthermore, Watkins did not require hospitalization for
psychiatric treatment and his treatment mainly consisted of
medication management and counseling. Moreover, the ALJ
noted that Watkins exhibited a cooperative and responsive
demeanor at the second hearing. Specifically, the ALJ noted that,
during the hearing,
[Watkins] was alert and aware of what went on at the
hearing, and he paid good attention, was well
focused, understood the questions and gave relevant
and very detailed answers. His manner of relating,
social skills and overall presentation seemed
adequate; his speech was clear, intelligible, goal
directed, logical, coherent, and he kept his trend of
thought.
Thus, based on the objective medical evidence and other evidence
in the record, the ALJ concluded that Watkins’s “alleged symptoms
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40 Opinion of the Court 23-12765
and restrictions [were] exaggerated.” 22 Accordingly, the ALJ
articulated sufficient, adequate reasons for discounting Watkins’s
subjective complaints, and these reasons were supported by
substantial evidence.
Watkins argues that the ALJ improperly rejected his
subjective complaints in violation of the social security regulations
solely because the objective medical evidence did not substantiate
his statements. See 20 C.F.R. § 404.1529(c)(2) (“[W]e will not reject
your statements about the intensity and persistence of your pain or
other symptoms or about the effect your symptoms have on your
ability to work solely because the available objective medical
evidence does not substantiate your statements.”). This
contention is belied by the record. The ALJ’s decision reflects that
he considered, in addition to the objective medical evidence, the
specifics of Watkins’s testimony at the hearing, Watkins’s
statements concerning his daily activities and abilities, and the
opinions of Watkins’s doctors. The ALJ then properly evaluated
Watkins’s subjective statements in relation to the evidence in the
record and found that Watkins’s subjective complaints were
exaggerated and inconsistent with the evidence of record. Id.
§ 404.1529(c)(4).
22 Watkins asserts that “the ALJ erred in suggesting that mental status findings
cannot support a finding of disability for Plaintiff.” But the ALJ made no such
suggestion. Rather, as discussed above, the ALJ merely concluded that
Watkins’s subjective complaints concerning his symptoms and the resulting
limitations of said symptoms on his ability to work were exaggerated and not
supported by the record as a whole.
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Next, Watkins argues that the ALJ erred in considering his
treatment records and his purported improvement with said
treatments because psychiatric symptoms are known to “wax and
wane,” and there was no evidence that Watkins had improved
enough that he would be able to sustain work. Watkins’s
argument is unpersuasive. We have held that “[t]he ALJ may
consider the level or frequency of treatment when evaluating the
severity of a claimant’s condition,” which is what the ALJ did here.
Henry v. Comm’r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015); see
also Wolfe v. Chater, 86 F.3d 1072, 1078 (11th Cir. 1996) (sustaining
an ALJ’s finding concerning the conservative nature of the
treatment for purposes of discrediting the claimant’s statements
concerning the severity and limitations of his disability).
Accordingly, there was no error.
Finally, Watkins argues that the ALJ engaged in improper
“sit and squirm” jurisprudence by relying on his observations of
Watkins’s appearance and demeanor at the hearing as part of the
disability determination. We disagree. In Freeman v. Schweiker, we
condemned “sit and squirm” jurisprudence where “an ALJ who is
not a medical expert . . . subjectively arrive[s] at an index of traits
which he expects the claimant to manifest at the hearing,” and “[i]f
the claimant falls short of the index, the claim is denied.” 681 F.2d
727, 731 (11th Cir. 1982). However, post-Freeman, we clarified that
Freeman stands only for the proposition that “an ALJ must not
impose his observations in lieu of a consideration of the medical
evidence presented.” Norris v. Heckler, 760 F.2d 1154, 1158 (11th
Cir. 1985). We further explained that the ALJ is permitted to
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42 Opinion of the Court 23-12765
observe and consider the claimant’s demeanor and appearance as
part of the credibility determination. Id. Unlike “sit and squirm”
jurisprudence, the ALJ here did not ignore medical evidence and
impose his own subjective standards; rather, he appropriately
considered Watkins’s demeanor and appearance at the hearing as
one of many factors in assessing Watkins’s credibility. Thus, there
was no error.
In sum, the evaluation of Watkins’s subjective symptoms
and credibility belonged to the ALJ, and the ALJ supported that
finding with substantial evidence. Accordingly, we will not disturb
that finding. Foote, 67 F.3d at 1562.
C. The RFC Determination
Watkins argues that the ALJ failed to properly determine his
mental RFC under Social Security Rule (“SSR”) 96-8p. The
gravamen of his argument is that the RFC assessment is not
supported by substantial evidence because there was no medical
opinion evidence supporting the RFC determination or
demonstrating that Watkins could perform full-time work on a
sustained basis. We disagree.
A claimant’s RFC represents the most that an individual can
do despite his limitations or restrictions. See 20 C.F.R.
§ 404.1545(a)(1). Under SSR 96-8p, the “RFC assessment must first
identify the [claimant’s] functional limitations or restrictions and
assess his . . . work-related abilities on a function-by-function basis
. . . . Only after that may RFC be expressed in terms of the
exertional levels of work, sedentary, light, medium, heavy, and
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very heavy.” SSR 96-8p, 61 Fed. Reg. 34,474, 34,475 (July 2, 1996).
The rule further provides that “[t]he RFC assessment must include
a narrative discussion describing how the evidence supports each
conclusion, citing specific medical facts . . . and nonmedical
evidence.” Id. at 34478.
There is no requirement in SSR 96-8p that there be medical
opinion evidence from a physician that matches the RFC
determination. Rather, the regulations make clear that the task of
determining a claimant’s RFC and ability to work is solely within
the province of the ALJ, not the claimant’s doctors. See 20 C.F.R.
§ 404.1546(c) (“If your case is at the administrative law judge
hearing level or at the Appeals Council review level, the
administrative law judge or the administrative appeals judge at the
Appeals Council (when the Appeals Council makes a decision) is
responsible for assessing your residual functional capacity.”); see
also id. § 404.1527(d)(2) (“Although we consider opinions from
medical sources on issues such as . . . your residual functional
capacity (see §§ 404.1545 and 404.1546), . . . the final responsibility
for deciding these issues is reserved to the Commissioner.”). And
the ALJ is directed to assess the claimant’s RFC “based on all the
relevant evidence in [the] record.” Id. § 404.1545(a)(1); see also SSR
96-8p, 61 Fed. Reg. at 34,477 (providing that the RFC
determination “must be based on all of the relevant evidence in the
case record,” including, as relevant here, the claimant’s medical
history; medical source statements; “[t]he effects of treatment”;
“[r]eports of daily activities”; “[l]ay evidence”; “[r]ecorded
observations”; and “[e]ffects of symptoms”).
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Watkins nevertheless argues that “the absence of any
[medical] opinion support for the RFC determination is concerning
[when, as here,] there is no other specific medical or non-medical
basis for the ALJ’s decision.” In support, he argues that his case is
similar to that in Pupo v. Commissioner, Social Security Administration,
17 F.4th 1054 (11th Cir. 2021). In Pupo, we held that the RFC
determination that the claimant could perform medium level
work—which required frequent lifting and carrying of objections
weighing up to 25 pounds—was not supported by substantial
evidence because the ALJ failed to consider the claimant’s
significant urinary incontinence and the effect of that impairment
on her physical abilities when making the RFC determination. Id.
at 1064–65. We also noted that because the ALJ only assigned
“minimal weight” to the treating physician’s opinion about Pupo’s
physical abilities and limitations, and the record did not contain any
opinion about the effect of Pupo’s incontinence on her physical
abilities and limitations, the ALJ was left “without any medical
opinion on that issue at all.” Id. at 1064–65. We noted that while
medical opinion is not always necessary, in Pupo’s case, the
absence of such evidence was
particularly concerning . . . because the ALJ also failed
to conduct a function-by-function assessment of
Pupo’s physical abilities and to explain how the non-
opinion evidence in the record—both medical and
nonmedical—supported his finding that Pupo could
perform all the physical requirements for medium
work, including lifting as much as fifty pounds at a
time and frequently lifting up to twenty-five pounds.
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Id. at 1065.
Watkins’s case is distinguishable from Pupo. Here, unlike in
Pupo, the ALJ’s decision makes clear that he considered all of
Watkins’s impairments, as well as Watkins’s medical records from
Palm Partners, LLC, Dr. Carroll, Dr. Cohen, and the VA, Watkins’s
subjective statements, and the ALJ’s own observation of Watkins
at the hearing. The ALJ also explained how he resolved
discrepancies in Dr. Carroll’s and Dr. Cohen’s medical opinions, as
well as between Watkins’s subjective complaints and the record as
a whole. The ALJ then found that the evidence did not support the
level of disability that Watkins claimed as a result of his stated
impairments, and that Watkins had the RFC to perform simple
work of a medium exertional level. Thus, the ALJ complied with
SSR 96-8p by first considering Watkins’s functional limitations and
restrictions and then expressing Watkins’s residual functional
limitations in terms of exertional and non-exertional levels.
Moreover, the ALJ’s conclusion that Watkins retained the mental
RFC to perform “simple, routine, repetitive unskilled tasks”
involving only simple decisions with limited workplace changes
and only occasional interaction with coworkers, supervisors, and
the public, is supported by substantial evidence. For instance, the
record demonstrated that Watkins was able to follow his various
doctors’ instructions, perform routine tasks, and was able to
adequately communicate with a variety of healthcare professionals
while interacting appropriately. He was also able to complete the
cognitive tests administered by Dr. Cohen. This evidence is just
some of the evidence in the voluminous records that supports the
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ALJ’s mental RFC finding. In sum, we conclude that the ALJ
adequately analyzed and described Watkins’s RFC, and Watkins is
not entitled to relief on this claim.
IV. Conclusion
For the above reasons, we affirm.
AFFIRMED.