Patricia Johnson v. Acting Commissioner of Social Security

USCA11 Case: 24-11459 Document: 19-1 Date Filed: 03/03/2025 Page: 1 of 21

[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 24-11459

Non-Argument Calendar

____________________

PATRICIA JOHNSON,

Plaintiff-Appellant,

versus

ACTING COMMISSIONER OF SOCIAL SECURITY,

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Southern District of Florida

D.C. Docket No. 1:22-cv-23717-CMA

____________________

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2 Opinion of the Court 24-11459

Before ROSENBAUM, LAGOA, AND ABUDU, Circuit Judges.

PER CURIAM:

Patricia Johnson appeals the district court’s order affirming

the denial of her applications for disability insurance benefits

(“DIB”) and supplemental security income benefits (“SSI”). John-

son raises three issues on appeal, which we address in turn. First,

she asserts that the administrative law judge (“ALJ”) failed to con-

sider whether her impairments met or medically equaled the crite-

ria of Listing 1.15, and she argues that the ALJ’s finding that her

impairments did not meet or equal any listing is not supported by

substantial evidence. Second, she argues that the ALJ’s finding that

she retains the residual functional capacity (“RFC”) to perform lim-

ited sedentary work was not supported by substantial evidence. Fi-

nally, she argues that no substantial evidence supports the ALJ’s

finding that her statements on the intensity, persistence, and limit-

ing effects of her symptoms were inconsistent with the evidence of

record. After careful review of the record, we affirm.

I.

“When an ALJ denies benefits and the Appeals Council de-

nies review, we review the ALJ’s decision as the Commissioner’s

final decision.” Samuels v. Acting Comm’r of Soc. Sec., 959 F.3d 1042,

1045 (11th Cir. 2020) (quotation marks omitted).

“[W]e review de novo the legal principles upon which the

Commissioner’s decision is based.” Moore v. Barnhart, 405 F.3d

1208, 1211 (11th Cir. 2005). “However, we review the resulting

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24-11459 Opinion of the Court 3

decision only to determine whether it is supported by substantial

evidence.” Id. “Substantial evidence is less than a preponderance,

but rather such relevant evidence as a reasonable person would ac-

cept as adequate to support a conclusion.” Id. “This limited review

precludes deciding the facts anew, making credibility determina-

tions, or re-weighing the evidence.” Id. Thus, we must affirm the

ALJ’s decision, even if the evidence may preponderate against it, so

long as it is supported by substantial evidence. Crawford v. Comm’r

of Soc. Sec., 363 F.3d 1155, 1158–59 (11th Cir. 2004).

To be eligible for DIB or SSI, the claimant must be disabled

as defined by the Social Security Act. 42 U.S.C. §§ 423(a)(1)(E),

1382c(a)(3)(A)–(B). The Commissioner engages in a five-step pro-

cess, as set out in 20 C.F.R. § 404.1520(a), 1 to determine whether a

claimant is disabled. Samuels, 959 F.3d at 1045. This process in-

cludes an analysis of whether the claimant: (1) is unable to engage

in substantial gainful activity; (2) has a severe medically determina-

ble physical or mental impairment; (3) has such an impairment that

meets or equals a listed impairment and meets the duration re-

quirements; (4) can perform her past relevant work, in light of her

RFC; and (5) can make an adjustment to other work, in light of her

RFC, age, education, and work experience. Id. at 1045–46; 20

C.F.R. § 404.1520(a). If an ALJ finds a claimant disabled or not

1 Separate regulations govern eligibility for DIB and SSI. Compare 20 C.F.R. pt.

404 (DIB), with 20 C.F.R. pt. 416 (SSI). However, “[t]he regulations for both

programs are essentially the same.” Bowen v. City of New York, 476 U.S. 467,

470 (1986).

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4 Opinion of the Court 24-11459

disabled at any given step, the ALJ does not proceed to the next

step. 20 C.F.R. § 404.1520(a)(4).

II.

Our Plaintiff-Appellant, Patricia Johnson, filed for DIB and

SSI in June 2019. In her application, she alleged disability beginning

on June 4, 2019, based on high blood pressure, a heart murmur,

spinal stenosis, and an enlarged heart. In subsequent disability re-

ports, Johnson alleged that she had back pain, left arm and shoulder

pain, and neck pain. After her claims were denied at both the initial

and reconsideration levels, Johnson requested an administrative

hearing. On November 3, 2021, Johnson, represented by counsel,

testified at a virtual hearing before an ALJ, Gracian Celaya. Regard-

ing her employment history, Johnson testified that she used to

work as a nurse assistant, waitress, and at a customer service cen-

ter, where she “did[ ] a lot of sitting and taking orders over the com-

puter.” She further testified that she was now unable to work be-

cause of back pain radiating to her left side and causing numbness.

Johnson testified that, on a scale of one to ten, her lower back pain

was a ten.

On December 1, 2021, the ALJ issued an unfavorable deci-

sion, finding that Johnson was not disabled under section

1614(a)(3)(A) of the Social Security Act. Johnson requested review

of the ALJ’s decision, but the Appeals Council denied her request,

transforming the ALJ’s decision into the Commissioner’s “final” de-

cision. Having exhausted her administrative remedies, Johnson

then filed this action in district court seeking judicial review of the

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24-11459 Opinion of the Court 5

Commissioner’s decision. Johnson and the Commissioner both

filed motions for summary judgment. On January 31, 2024, a mag-

istrate judge recommended that the district court deny Johnson’s

motion for summary judgment, grant the Commissioner’s motion

for summary judgment, and affirm the ALJ’s decision. Over John-

son’s objections, the district court adopted the magistrate judge’s

report and recommendation, affirming the Commissioner’s final

decision. This appeal follows.

III.

First, Johnson argues that the ALJ erred when he determined

that her impairments did not meet or medically equal the criteria

of Listing 1.15.

At step three of the analysis, the ALJ must determine

whether any one of the claimant’s impairments meets or equals an

impairment listed in the Listing of Impairments in Appendix 1 and,

if none does, whether the combined effect of her impairments is

medically equal to a listed impairment. Wilson v. Barnhart, 284 F.3d

1219, 1224 (11th Cir. 2002); 20 C.F.R. pt. 404, subpt. P, App. 1; see

also 20 C.F.R. §§ 404.1520(d), 404.1525, 404.1526. The ALJ’s state-

ment that a claimant’s impairments do not meet or equal a listing

constitutes evidence that the ALJ considered their combined effect.

Wilson, 284 F.3d at 1224. “While Appendix 1 must be considered

in making a disability determination,” the ALJ need not “mechani-

cally recite the evidence leading to [his] determination.” Hutchison

v. Bowen, 787 F.2d 1461, 1463 (11th Cir. 1986). “There may be an

implied finding that a claimant does not meet a listing.” Id. A

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6 Opinion of the Court 24-11459

finding that the claimant does not meet a listing, whether express

or implied, is reviewed for substantial evidence. Id. The claimant

bears the burden of proving that she meets a listing. Barron v. Sul-

livan, 924 F.2d 227, 229 (11th Cir. 1991).

To “meet” a listing, the claimant must have a “medically de-

terminable impairment(s) that satisfies all of the criteria of the list-

ing.” 20 C.F.R. § 404.1525(d); see Wilson, 284 F.3d at 1224. “An

impairment that manifests only some of those criteria, no matter

how severely, does not qualify.” Sullivan v. Zebley, 493 U.S. 521, 530

(1990). To “equal” a listing, her impairments must be “at least

equal in severity and duration to the criteria of any listed impair-

ment.” 20 C.F.R. § 404.1526(a); see Wilson, 284 F.3d at 1224. She

“must present medical findings equal in severity to all the criteria

for the one most similar impairment.” Zebley, 493 U.S. at 531.

Listing 1.15 covers “[d]isorders of the skeletal spine resulting

in compromise of a nerve root(s).” 20 C.F.R. pt. 404, subpt. P, App.

1, pt. A1, § 1.15. To meet or equal Listing 1.15, the claimant’s im-

pairment must be “documented by” the following: (A) radicular

distribution of pain, paresthesia, or muscle fatigue; (B) radicular dis-

tribution of certain neurological signs; (C) findings on medical im-

aging of the cervical or lumbosacral spine; and (D) physical limita-

tion of musculoskeletal functioning that has lasted or is expected to

last for a continuous period of at least 12 months. Id. § 1.15A-D.

“Related symptoms must be associated with, or follow the path of,

the affected nerve root(s).” Id. § 1.00F(2); see id. § 1.15A, B(2), C &

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24-11459 Opinion of the Court 7

D (requiring that evidence be impairment-related or consistent

with nerve root compromise).

To satisfy criterion B, the claimant must show radicular dis-

tribution of three neurological signs present “during physical ex-

amination” or “on a diagnostic test.” Id. § 1.15B. These signs must

include both (1) muscle weakness and (2) nerve root compromise,

and either (3) sensory changes—evidenced by (a) decreased sensa-

tion or (b) sensory nerve deficit on electrodiagnostic testing—or (4)

decreased deep tendon reflexes. Id. § 1.15B(1)-(4). Diagnostic tests

may include imaging, such as x-ray, CT, and MRI scans. Id.

§ 1.00C(3)(a).

To satisfy criterion D, the claimant must provide “medical

documentation” establishing one of three scenarios. Id. § 1.15D.

As relevant here, the second scenario has two component parts: (i)

an inability to perform work-related fine and gross movements

with one upper extremity and (ii) a medical need to hold an assis-

tive device, such as a cane, with the other upper extremity. Id.

§ 1.15D(2). The claimant’s medical need for a device must be doc-

umented in a physical examination report. Id. § 1.00C(2)(b). She

need not have a “specific prescription,” but she must provide “evi-

dence from a medical source” that supports her medical need for

the device for a continuous period of at least 12 months.

Id. § 1.00C(6)(a). That source must give a “detailed description” of

“objective clinical findings” based on “direct observations.” Id.

§ 1.00C(2). Neither subjective evidence nor findings on imaging or

other diagnostic tests is “a substitute for findings on physical

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8 Opinion of the Court 24-11459

examination.” Id. For “canes,” the SSA requires evidence from a

medical source describing how the claimant “walk[s] with the de-

vice.” Id. § 1.00C(6)(d).

For claims decided during the “pandemic period,” defined

as the period beginning April 2, 2021, and ending May 11, 2025, the

claimant’s evidentiary burden is reduced in certain ways. See id.

§ 1.00C(7)(a). The record need not establish the simultaneous pres-

ence of all the required medical criteria. Id. § 1.00C(7)(c). Instead,

“all of the relevant criteria must appear in the medical record

within a consecutive 12-month period.” Id. However, “[o]nce this

level of severity is established, the medical record must also show

that this level of severity has continued, or is expected to continue,

for a continuous period of at least 12 months.” Id.

Here, substantial evidence supports the ALJ’s step-three

finding because Johnson failed to prove that her impairments met

or equaled all of the criteria of Listing 1.15, and it is clear from his

decision that the ALJ considered those criteria as required. Specif-

ically, there was sufficient evidence to support the ALJ’s finding

that Johnson failed to satisfy criterion D of Listing 1.15. Section D

provides:

D. Impairment-related physical limitation of muscu-

loskeletal functioning that has lasted, or is expected to

last, for a continuous period of at least 12 months, and

medical documentation of at least one of the follow-

ing:

1. A documented medical need (see 1.00C6a) for a

walker, bilateral canes, or bilateral crutches (see

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24-11459 Opinion of the Court 9

1.00C6d) or a wheeled and seated mobility device in-

volving the use of both hands (see 1.00C6e(i)); or

2. An inability to use one upper extremity to inde-

pendently initiate, sustain, and complete work-re-

lated activities involving fine and gross movements

(see 1.00E4), and a documented medical need (see

1.00C6a) for a one-handed, hand-held assistive device

(see 1.00C6d) that requires the use of the other upper

extremity or a wheeled and seated mobility device in-

volving the use of one hand (see 1.00C6e(ii)); or

3. An inability to use both upper extremities to the

extent that neither can be used to independently ini-

tiate, sustain, and complete work-related activities in-

volving fine and gross movements (see 1.00E4).

§ 1.15D.

On appeal, Johnson does not argue that she uses an assistive

device involving the use of both hands or that she is unable to use

both upper extremities. Therefore, sections D(1) and D(3) do not

apply. Johnson, instead, argues that she satisfies section D(2) based

on her cervical and lumbar spine impairments and her “use of a

cane with inability to fully use her left hand.” However, the ALJ

identified ample evidence indicating that Johnson did not have an

“inability to use one upper extremity to independently initiate, sus-

tain, and complete work-related activities involving fine and gross

movements,” and that she did not have “a documented medical

need” for a one-handed cane. See § 1.15D(2).

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As to the first issue, the ALJ pointed to a report from Dr.

Clinton Bush, who, after examining Johnson, concluded that her

range of motion was “within normal limits” for all extremities, that

she had “5/5” motor strength in her upper and lower extremities,

and that she had “5/5” grip strength in both hands. Dr. Bush added

that Johnson “can turn a doorknob and manipulate small objects

with either hand.” The ALJ also found that, on September 17, 2021,

Johnson “sought emergency room treatment for back pain,” but

“[u]pon examination,” was found to have “5/5 strength in the up-

per extremities.” Johnson herself tells us that her “left-sided cervi-

cal spine radiculopathy [ ] interferes with her ability to use her left

hand”—not that she is unable to use her left hand to independently

engage in work-related activities involving fine and gross move-

ments.

As to the second issue, the ALJ considered Johnson’s testi-

mony that she uses a cane but ultimately determined that its use

was not medically necessary. As the ALJ explained—and as John-

son does not contest—there were only two references to the use of

a cane in the entire record: an August 2021 “Assessments and Treat-

ment” entry stating, “Musculoskeletal Other: Patient walks with

cane risk fall bandage applied,” and a November 2021 “Assessments

and Treatment” entry stating, “Breast Symptoms Location/De-

scription using cane.” Neither entry suggests that Johnson requires

a cane as a matter of medical necessity. Furthermore, and again as

quoted by the ALJ, Dr. Bush reported that Johnson “can stand on

either foot independently,” “can also stand without difficulty on

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24-11459 Opinion of the Court 11

heels and toes,” “ambulates with no detectable limp[,] and does not

require the use of any supportive device for ambulation.”

Johnson’s only argument on this point is that the “ALJ never

mentioned Dr. [Eliades] Carmenate’s August 2020 warning that

Johnson ‘needs to buy a medical insurance and take care of [her

lower back pain], otherwise the lumbar spine condition worsens

and she may have difficulty walking[.]’” For one thing, “there is no

rigid requirement that the ALJ specifically refer to every piece of

evidence in his decision, so long as the ALJ’s decision . . . is not a

broad rejection which is ‘not enough to enable [the district court

or this Court] to conclude that [the ALJ] considered her medical

condition as a whole.’” Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th

Cir. 2005) (quoting Foote v. Chater, 67 F.3d 1553, 1561 (11th Cir.

1995)). The ALJ considered Johnson’s medical condition as a

whole. More importantly, Dr. Carmenate’s clinical notes (which

hypothesize that Johnson may have difficulty walking in the future)

do not state that Johnson has a medical need for a cane, nor do they

describe the “circumstances for which [Johnson] need[s] to use the

assistive device,” as required under 20 C.F.R. pt. 404, subpt. P, App.

1 § 1.00(C)(6)(a). Outside of Dr. Carmenate’s notes, Johnson has

not identified anything in the record that could qualify as evidence

of a “documented medical need” for a one-handed, hand-held as-

sistive device. See Barron, 924 F.2d at 229 (“The burden was [the

claimant’s] to show that his impairments combined to meet or

equal a listed impairment in Appendix 1 of Subpart P.”).

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12 Opinion of the Court 24-11459

For these reasons, we find that there was substantial evi-

dence in the record to support the ALJ’s finding that Johnson failed

to satisfy criterion D of Listing 1.15. It is clear from his decision

that the ALJ considered Listing 1.15’s criteria as required. See Wil-

son, 284 F.3d at 1224 (holding that the ALJ’s determination—that

“the medical evidence establishes that [the claimant] had [several

injuries] which constitute a ‘severe impairment’, but that he did not

have an impairment or combination of impairments” that medi-

cally equaled a listing—was “evidence that [the ALJ] considered the

combined effects of [the claimant]’s impairments”). Having failed

to satisfy one of the criteria, Johnson does not qualify under Listing

1.15. Zebley, 493 U.S. at 530. Accordingly, we affirm as to this issue.

IV.

Second, Johnson argues that the ALJ’s “residual functional

capacity” finding was not supported by substantial evidence. In his

report, the ALJ found that Johnson had the RFC to perform seden-

tary work with “non-exertional limitations” as defined in 20 C.F.R.

§§ 404.1567(a) and 416.967(a). Based on this finding and testimony

from a vocational expert, the ALJ concluded that Johnson could

“perform her past relevant work as a telephone solicitor as actually

and generally performed.” The magistrate judge and the district

court agreed, holding that substantial evidence supported the ALJ’s

RFC finding.

Where a claimant’s impairment does not meet or equal the

criteria for a listed impairment, the ALJ must proceed to step four

of the five-step process set out in 20 C.F.R. § 404.1520(a) to

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determine the claimant’s RFC, considering whether the claimant’s

RFC permits her to perform her past relevant work. Id.

§ 404.1520(a)(4). The RFC “is an assessment, based upon all of the

relevant evidence, of a claimant’s remaining ability to do work de-

spite h[er] impairments.” Lewis v. Callahan, 125 F.3d 1436, 1440

(11th Cir. 1997); see also 20 CFR §§ 404.1545(a), (b), (c); 404.1567.

When a claimant alleges that she has several impairments,

the ALJ must “consider the impairments in combination and . . .

determine whether the combined impairments render the claimant

disabled.” Jones v. Dep’t of Health & Hum. Servs., 941 F.2d 1529, 1533

(11th Cir. 1991); see 20 C.F.R. § 404.1545(a)(2). “Consideration of

all impairments, severe and non-severe, is required when assessing

a claimant’s RFC.” Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1268

(11th Cir. 2019). However, the mere existence of an impairment

does not reveal the extent to which it limits a claimant’s ability to

work or undermine the ALJ’s determination in that regard, because

the severity of a medically ascertained disability must be measured

in terms of its effect upon ability to work. Moore, 405 F.3d at 1213

n.6 (citing McCruter v. Bowen, 791 F.2d 1544, 1547 (11th Cir. 1986)).

A claimant’s subjective symptoms, such as pain, include the

effectiveness and side effects of any medications for those symp-

toms. See 20 C.F.R. § 404.1529(c)(3)(iv). We have held that an

ALJ’s failure to inquire further into the side effects of a counseled

claimant’s medications did not deprive her of a meaningful oppor-

tunity to be heard when the only indication of side effects was her

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14 Opinion of the Court 24-11459

statement that her medication made her drowsy. See Cherry v.

Heckler, 760 F.2d 1186, 1191 n.7 (11th Cir. 1985).

In considering whether a claimant can perform her past rel-

evant work, “the ALJ must consider all the duties of that work and

evaluate her ability to perform them in spite of her impairments.”

Lucas v. Sullivan, 918 F.2d 1567, 1574 n.3 (11th Cir. 1990). The ALJ

may rely on the testimony of a vocational expert in performing this

analysis. 20 C.F.R. § 404.1560(b)(2). When a claimant cannot per-

form a full range of work at a given level of exertion, the ALJ must

rely on a vocational expert’s testimony. See Marbury v. Sullivan, 957

F.2d 837, 839 (11th Cir. 1992). “In 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 impair-

ments.” Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1180 (11th

Cir. 2011) (quotation marks omitted). If the claimant can perform

her past relevant work, she is not disabled. 20 C.F.R.

§§ 404.1520(a)(4), 404.1560(b)(3).

Here, substantial evidence supports the ALJ’s RFC finding

that Johnson could perform a reduced range of sedentary work. In

discussing Johnson’s RFC, the ALJ stated that he carefully consid-

ered “the entire record,” including medical opinions and prior ad-

ministrative medical findings, as well as “all symptoms and the ex-

tent to which these symptoms can reasonably be accepted as con-

sistent with the objective medical evidence and other evidence.”

The ALJ first acknowledged that Johnson had severe impairments

related to her back, including chronic pain. He also agreed with

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24-11459 Opinion of the Court 15

Dr. Carmenate that Johnson should avoid heavy lifting of more

than 10 pounds, standing for long periods, and long-distance walk-

ing.

The ALJ then found that x-rays taken in October 2019 and

an MRI taken in January 2020 showed mild spondylosis of the lum-

bar spine and mild degenerative changes. He noted that x-rays

taken in November 2020 revealed “no evidence of spondylolisthe-

sis on the flexion-extension views,” while a January 2021 MRI of

the lumbar spine revealed no significant changes. According to the

ALJ, Johnson was evaluated by Dr. Marimer Rensoli-Velazquez on

March 11, 2021, and Dr. Rensoli-Velazquez ascertained that John-

son had “full range of motion in her extremities, 5/5 strength in the

upper extremities, 5/5 strength in the lower extremities[,] no gross

deficit of motor or sensory function,” and no “inflammatory back

pain.” Additionally, the ALJ pointed to testimony from a voca-

tional expert, who explained that “a person of the claimant’s same

age, education, work experience, and residual functional capacity

could perform the claimant’s past work as a telephone solicitor.”

This substantial evidence supports the ALJ’s determination that

Johnson was capable of performing a reduced range of sedentary

work and capable of performing her past work as a telephone so-

licitor.

Against all this, Johnson offers three arguments: (1) The

ALJ’s RFC finding did not consider her absences for medical treat-

ment while at work; (2) The ALJ did not take into account her

chronic pain and thus failed to address her exertional and non-

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16 Opinion of the Court 24-11459

exertional limitations; and (3) The ALJ “vastly overestimated” her

capacity to handle, finger, feel, and sit for prolonged periods of time

and did not account for medication side effects that allegedly re-

duced her ability to concentrate and handle workplace changes and

stress.

We find none of these arguments persuasive. As to absen-

teeism, Johnson tells us that she went to twenty-seven medical ap-

pointments between August 2, 2019, and November 1, 2021, a span

of around twenty-seven months. Johnson avers that “there is no

reflection of the impact of Johnson’s absenteeism in the ALJ’s RFC

finding or elsewhere in his decision.” But Johnson provides no ev-

idence showing that her medical appointments had to be scheduled

during work hours or that they otherwise prevented her from

working. See Blackmon v. Comm’r of Soc. Sec., 2024 WL 3495022, at

*7 (11th Cir. July 22, 2024) (holding that “the ALJ did not err by

failing to include Blackmon’s absenteeism as a limitation” where

“nothing in the record show[ed] that Blackmon could not schedule

future appointments outside of work hours, schedule more than

one appointment per day, or schedule appointments on her off

days, which would minimize the need to miss work”).

Next, the ALJ did take into account Johnson’s chronic pain

and did address her exertional and non-exertional limitations. In-

deed, the ALJ explicitly found that “[t]he claimant has the following

severe impairments: disorders of the spine; high blood pressure;

obesity; chronic pain; and radiculopathy.” Further, he concluded

that these severe impairments “significantly limit [Johnson’s]

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24-11459 Opinion of the Court 17

ability to perform basic work activities.” He also found, based on

careful consideration of the entire record, that Johnson had the fol-

lowing “non-exertional limitations”:

[T]he claimant can occasionally kneel, crouch, crawl,

and stoop. She can occasionally climb ramps and

stairs. She can never climb ladders, ropes, or scaffolds.

The claimant can frequently reach, and she can occa-

sionally reach overhead. She can frequently handle,

finger, and feel. The claimant can never be exposed

to unprotected heights or hazards, and she can never

be exposed to extreme cold or vibration.

Thus, not only did the ALJ address Johnson’s chronic pain, but he

expressly considered it when assessing her RFC.

Lastly, Johnson has not shown that the ALJ overestimated

her capacity to handle, finger, feel, or sit for prolonged periods of

time. Specifically, Johnson contends that the ALJ “failed to alto-

gether consider her carpal tunnel syndrome as a severe or non-se-

vere impairment at step two” and failed to consider her chronic

pain. We have already explained that the ALJ addressed and ac-

counted for Johnson’s chronic pain. The ALJ also credited John-

son’s testimony that she has carpal tunnel syndrome and used a

special keyboard and mouse. To the extent that Johnson believes

the ALJ should have considered her carpal tunnel syndrome at step-

two of his analysis, the ALJ stated at the hearing that there were no

references to carpal tunnel in the record, and Johnson’s own attor-

ney responded that she did not “have those records,” and that

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18 Opinion of the Court 24-11459

Johnson had mentioned carpal tunnel only “recently.” Therefore,

we reject Johnson’s argument that the ALJ “vastly overestimated”

Johnson’s ability to reach, handle, finger, feel, or sit for prolonged

periods of time.

Accordingly, we conclude that substantial evidence supports

the ALJ’s RFC finding.

V.

Finally, Johnson argues that the ALJ erred when he con-

cluded that her statements concerning the intensity, persistence,

and limiting effects of her symptoms were inconsistent with the

evidence in the record. In his decision, the ALJ found that “the

claimant’s allegations of disabling back pain and left-sided numb-

ness are inconsistent with the MRI scan of the claimant’s lumbar

spine that does not document any significant canal or foraminal

stenosis” and “inconsistent with the physical examinations docu-

menting the claimant’s negative straight leg raising, intact/normal

sensation, normal gait, normal ranges of motion, and equal and in-

tact deep tendon reflexes.” Johnson insists, to the contrary, that

her allegations have been “remarkably consistent with the medical

evidence of record throughout the entirety of the claims process,”

and that her “self-reported symptoms and limitations are entirely

consistent” with doctors’ opinions and her own hearing testimony.

Johnson also argues that the ALJ misapplied the “pain standard”

that applies when a claimant attempts to establish disability

through her own testimony of pain or other subjective symptoms.

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24-11459 Opinion of the Court 19

We may review “unobjected-to factual and legal conclu-

sions” in a magistrate judge’s report and recommendation “for

plain error if necessary in the interests of justice.” 11th Cir. R. 3-1;

28 U.S.C. § 636(b)(1). “After a magistrate judge has issued a report

and recommendation under § 636(b)(1)(B), a party that wishes to

preserve its objection must clearly advise the district court and pin-

point the specific findings that the party disagrees with.” United

States v. Schultz, 565 F.3d 1353, 1360 (11th Cir. 2009). “Frivolous,

conclusive, or general objections need not be considered by the dis-

trict court.” Id. at 1361 (quotation marks omitted).

We have held that “pain alone can be disabling, even when

its existence is unsupported by objective evidence.” Foote, 67 F.3d

at 1561. Accordingly, “[a] claimant’s subjective testimony sup-

ported by medical evidence that satisfies the pain standard is itself

sufficient to support a finding of disability.” Id. A claimant at-

tempting to establish disability through her own testimony of sub-

jective symptoms must show: “(1) evidence of an underlying med-

ical condition; and (2) either (a) objective medical evidence con-

firming 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.” Wilson, 284 F.3d at 1225; see also 20 C.F.R.

§ 404.1529 (containing substantially similar language).

“If the ALJ discredits subjective testimony, he must articu-

late explicit and adequate reasons for doing so.” Wilson, 284 F.3d

at 1225. “Failure to articulate the reasons for discrediting subjec-

tive testimony requires, as a matter of law, that the testimony be

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20 Opinion of the Court 24-11459

accepted as true.” Id. However, “we will not disturb a clearly ar-

ticulated” finding about subjective complaints “supported by sub-

stantial evidence.” Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d

780, 782 (11th Cir. 2014). And “there is no rigid requirement that

the ALJ specifically refer to every piece of evidence in his decision,

so long as the ALJ’s decision” includes “enough to enable [us] to

conclude that [the ALJ] considered [the claimant’s] medical condi-

tion as a whole.” Dyer, 395 F.3d at 1211.

Here, we review the district court’s decision for plain error,

as Johnson waived this issue on appeal by failing to file a sufficient

objection to the magistrate judge’s report and recommendation.

Nonetheless, under any standard of review, the district court did

not err, because the ALJ made a clearly articulated credibility find-

ing and pointed to specific reasons (and objective evidence) for dis-

crediting Johnson’s subjective complaints of disabling pain. For ex-

ample, the ALJ determined (using primary care treatment notes)

that while Johnson did report lower back pain, doctors generally

treated her with pain medication and occasional steroid injections.

The ALJ noted that an MRI scan of Johnson’s cervical spine taken

on May 13, 2019, revealed only “mild degenerative changes.” X-

rays taken in November 2019 revealed no evidence of fractures,

dislocations, subluxations, erosive changes, periosteal reactions, or

soft tissue abnormalities. The ALJ identified a January 2021 MRI of

Johnson’s lumbar spine, which revealed no significant changes in

Johnson’s condition. The ALJ also cited Dr. Ian Cote’s assessment

that Johnson’s January 2021 MRI scan “did not show any significant

central canal stenosis, foraminal canal stenosis, or spondylolisthesis

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24-11459 Opinion of the Court 21

that would be causing [Johnson’s] back pain or radiculopathy.” All of

this evidence supports the ALJ’s decision to discount Johnson’s al-

legations of disabling pain.

In sum, substantial evidence supports the ALJ’s assessment

that Johnson’s statements on the intensity, persistence, and limit-

ing effects of her symptoms were inconsistent with the evidence of

record. The ALJ’s decision shows that he considered Johnson’s

medical condition as a whole. Because this Court will not disturb

a clearly articulated credibility finding supported by substantial ev-

idence, see Mitchell, 771 F.3d at 782, we affirm as to this issue.

* * *

We conclude that the Commissioner’s decision to deny

Johnson’s claims for disability insurance benefits and supplemental

security income benefits was supported by substantial evidence.

Therefore, we affirm the district court’s judgment upholding the

Commissioner’s decision.

AFFIRMED.