Shufelt

UNITED STATES DISTRICT COURT

MIDDLE DISTRICT OF FLORIDA

TAMPA DIVISION

GINA SHUFELT,

Plaintiff,

v. Case No. 8:24-cv-2577-JRK

FRANK BISIGNANO,

Commissioner of Social Security,1

Defendant.

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OPINION AND ORDER2

I. Status

Gina Shufelt (“Plaintiff”) is appealing the Commissioner of the Social

Security Administration’s (“SSA(’s)”) final decision denying her claims for

disability insurance benefits (“DIB”) and supplemental security income (“SSI”).

Plaintiff’s alleged inability to work is the result of Buerger disease, 3

1 Frank Bisignano is now the Commissioner of Social Security. Pursuant to Rule

25(d), Federal Rules of Civil Procedure, Mr. Bisignano should be substituted as Defendant in

this suit. No further action need be taken to continue this suit by reason of the last sentence

of section 205(g) of the Social Security Act, 42 U.S.C. § 405(g).

2 The parties consented to the exercise of jurisdiction by a United States

Magistrate Judge. See Order Regarding Consent to Magistrate Judge Jurisdiction in Social

Security Appeals (Doc. No. 117), Case No. 3:21-mc-1-TJC (outlining procedures for consent

and Defendant’s generalized consent to Magistrate Judge jurisdiction in social security

appeals cases); consent by Plaintiff indicated in docket language for Complaint (Doc. No. 1).

3 “Buerger disease is a rare disease of the arteries and veins in the arms and legs.

In Buerger disease — also called thromboangiitis obliterans — blood vessels become blocked.

(Continued…)

hypertension, hypothyroidism, anxiety with panic attacks, dizziness,

depression, pre-diabetes, and generalized pain. Transcript of Administrative

Proceedings (Doc. No. 14; “Tr.” or “administrative transcript”), filed January 3,

2025, at 159-60, 169-70, 183, 201, 700.

On October 17, 2019, Plaintiff protectively filed applications for DIB and

SSI, alleging a disability onset date of August 11, 2019. Tr. at 608-09 (DIB).4

The applications were denied initially, Tr. at 159-68, 179, 181, 223-26 (DIB); Tr.

at 169-78, 180, 182, 227-29 (SSI), and upon reconsideration, Tr. at 183-200, 219,

221, 232-37 (DIB); Tr. at 201-18, 220, 222, 238-43 (SSI).

On April 13, 2021, an Administrative Law Judge (“ALJ) held a hearing,

during which Plaintiff (representing herself) testified. Tr. at 147-58. The

hearing was continued so that Plaintiff’s representative could make a proper

appearance. Tr. at 149-58. On August 24, 2021, the ALJ held a supplemental

hearing, during which she heard from Plaintiff, who appeared with a non-

lawyer representative (actually a friend/social worker who was attempting to

act as a representative). Tr. at 129-46. The hearing was continued so that

This reduces blood flow to the affected areas. Blood clots may form in the blood vessels.” Mayo

Clinic, Buerger disease, https://www.mayoclinic.org/diseases-conditions/buergers-

disease/symptoms-causes/syc-20350658 (last visited Mar. 26, 2026).

4 The SSI application was not located in the administrative transcript, although

a summary states Plaintiff had an appointment to complete it on November 13, 2019. Tr. at

602. The DIB application was actually completed on October 21, 2019. See Tr. at 608. The

protective filing date for both the applications is listed elsewhere in the administrative

transcript as October 17, 2019. Tr. at 159, 183 (DIB), 169, 201 (SSI).

Plaintiff could attempt to find a lawyer to represent her. Tr. at 143-44. On

November 2, 2022, the ALJ held a second supplemental hearing, during which

she heard from Plaintiff, who was represented by counsel, and a vocational

expert (“VE”). Tr. at 80-109. On October 16, 2023, the ALJ held a third

supplemental hearing, during which she heard from Plaintiff, who was

represented by counsel, and a VE. Tr. at 110-28. Then, on April 10, 2024, the

ALJ held a fourth supplemental hearing, during which she heard from Plaintiff,

who was represented by counsel; a VE; and a medical expert (“ME”).5 Tr. at 54-

79. On April 25, 2024, the ALJ issued a Decision finding Plaintiff not disabled

through the date of the Decision. See Tr. at 22-43.

Thereafter, Plaintiff requested review of the Decision by the Appeals

Council and submitted a brief authored by her lawyer. Tr. at 4-5 (Appeals

Council exhibit list and order), 600-01 (request for review), 889-94 (brief). On

October 3, 2024, the Appeals Council denied Plaintiff’s request for review, Tr.

at 1-3, making the ALJ’s Decision the final decision of the Commissioner. On

November 4, 2024, Plaintiff commenced this action under 42 U.S.C. §§ 405(g)

and 1383(c)(3) by timely filing a Complaint (Doc. No. 1), through counsel,

seeking judicial review of the Commissioner’s final decision.

5 All hearings were held via telephone or video conference, with Plaintiff’s

consent. Tr. at 56, 82, 113, 131-32, 290 465, 488, 528.

Plaintiff on appeal argues the ALJ erred by “failing to make findings

regarding the frequency and duration of her panic attacks and whether these

episodes would result in excessive off task behavior or absences” and in

“fail[ing] to articulate explicit and adequate reasons for rejecting [Plaintiff’s]

subjective testimony regarding her panic attacks.” Plaintiff’s Brief (Doc. No. 17;

“Pl.’s Br.”), filed March 12, 2025, at 2; see id. at 12-23. On April 11, 2025,

Defendant filed a Memorandum in Support of the Commissioner’s Decision

(Doc. No. 19; “Def.’s Mem.”) addressing Plaintiff’s arguments. Then, on April

25, 2025, Plaintiff’s Reply Brief (Doc. No. 20; “Reply”) was filed. After a

thorough review of the entire record and consideration of the parties’ respective

arguments, the undersigned finds that the Commissioner’s final decision is due

to be affirmed.

II. The ALJ’s Decision

When determining whether an individual is disabled,6 an ALJ must

follow the five-step sequential inquiry set forth in the Regulations, determining

as appropriate whether the claimant (1) is currently employed or engaging in

substantial gainful activity; (2) has a severe impairment; (3) has an impairment

6 “Disability” is defined in the Social Security Act 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),

1382c(a)(3)(A).

or combination of impairments that meets or medically equals one listed in the

Regulations; (4) can perform past relevant work; and (5) retains the ability to

perform any work in the national economy. 20 C.F.R. §§ 404.1520, 416.920; see

also Simon v. Comm’r, Soc. Sec. Admin., 7 F.4th 1094, 1101-02 (11th Cir. 2021)

(citations omitted); Phillips v. Barnhart, 357 F.3d 1232, 1237 (11th Cir. 2004).

The claimant bears the burden of persuasion through step four, and at step five,

the burden shifts to the Commissioner. Bowen v. Yuckert, 482 U.S. 137, 146 n.5

(1987).

Here, the ALJ followed the five-step inquiry. See Tr. at 25-42. At step one,

the ALJ determined that Plaintiff “has not engaged in substantial gainful

activity since August 11, 2019, the alleged onset date.” Tr. at 25 (emphasis and

citation omitted). At step two, the ALJ found that Plaintiff “has the following

severe impairments: Buerger’s disease (thromboangiitis obliterans);

hypertension; obesity; depressive disorder; anxiety disorder; panic disorder

with agoraphobia.” Tr. at 25 (emphasis and citation omitted). At step three, the

ALJ found that Plaintiff “does not have an impairment or combination of

impairments that meets or medically equals the severity of one of the listed

impairments in 20 [C.F.R.] Part 404, Subpart P, Appendix 1.” Tr. at 26

(emphasis and citation omitted).

The ALJ determined that Plaintiff has the following residual functional

capacity (“RFC”):

[Plaintiff can] perform light work as defined in 20 CFR [§§]

404.1567(b) and 416.967(b) with the following limitations:

[Plaintiff] can lift and carry 20 pounds occasionally and 10 pounds

frequently; can stand or walk six (6) hours out of an eight-hour

workday; and sit six (6) hours out of an eight-hour workday.

[Plaintiff] can never climb ladders, ropes, or scaffolds. [Plaintiff]

can frequently climb ramps and stairs, balance, stoop, kneel,

crouch, and crawl. [Plaintiff] can frequently handle, finger, and feel

with the bilateral upper extremities. [Plaintiff] should avoid all

exposure to extreme cold and avoid even moderate exposure to

unprotected heights, hazardous machinery, humidity and wetness,

extreme heat, and vibration. [Plaintiff] can only frequently operate

a motor vehicle. [Plaintiff] is able to understand, carry out, and

remember simple, routine, and repetitive tasks; involving only

simple work-related decisions. [Plaintiff] can adapt to gradual

routine workplace changes. [Plaintiff] can maintain concentration,

persistence, and pace at an acceptable level throughout a normal

workday and week. [Plaintiff] can occasionally interact with the

general public, co-workers, and supervisors.

Tr. at 29.

At step four, the ALJ relied on the VE’s hearing testimony and found that

Plaintiff “is unable to perform any past relevant work” as a “licensed practical

nurse (LPN).” Tr. at 41 (citation omitted). The ALJ then proceeded to the fifth

and final step of the sequential inquiry. Tr. at 41-42. After considering

Plaintiff’s age (“39 years old . . . on the alleged disability onset date”), education

(“at least a high school education”), work experience, and RFC, the ALJ relied

on the VE’s testimony and found “there are jobs that exist in significant

numbers in the national economy that [Plaintiff] can perform,” Tr. at 41 (some

emphasis and citation omitted), such as “bagger,” “marker,” and “routing clerk

II,” Tr. at 42. The ALJ concluded Plaintiff “has not been under a

disability . . . from August 11, 2019, through the date of th[e D]ecision.” Tr. at

42 (emphasis and citation omitted).

III. Standard of Review

This Court reviews the Commissioner’s final decision as to disability

pursuant to 42 U.S.C. §§ 405(g) and 1383(c)(3). Although no deference is given

to the ALJ’s conclusions of law, findings of fact “are conclusive if . . . supported

by ‘substantial evidence.’” Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir.

2001) (citing Falge v. Apfel, 150 F.3d 1320, 1322 (11th Cir. 1998)). “Substantial

evidence is something ‘more than a mere scintilla, but less than a

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

(quoting Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987)). The substantial

evidence standard is met when there is “such relevant evidence as a reasonable

mind might accept as adequate to support a conclusion.” Falge, 150 F.3d at 1322

(quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)); see also Biestek v.

Berryhill, 587 U.S. 97, 103 (2019); Samuels v. Acting Comm’r of Soc. Sec., 959

F.3d 1042, 1045 (11th Cir. 2020) (citation omitted). It is not for this Court to

reweigh the evidence; rather, the entire record is reviewed to determine

whether “the decision reached is reasonable and supported by substantial

evidence.” Cornelius v. Sullivan, 936 F.2d 1143, 1145 (11th Cir. 1991) (citation

omitted). The decision reached by the Commissioner must be affirmed if it is

supported by substantial evidence—even if the evidence preponderates against

the Commissioner’s findings. Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155,

1158-59 (11th Cir. 2004) (per curiam).

IV. Discussion

Plaintiff argues the ALJ erred in evaluating her subjective complaints,

particularly about her panic attacks and their frequency. Pl.’s Br. at 12-23;

Reply at 1-4. Moreover, Plaintiff contends the ALJ “failed to articulate explicit

and adequate reasons for rejecting [Plaintiff’s] subjective testimony about her

panic attacks.” Pl.’s Br. at 12 (emphasis omitted). Responding, Defendant

argues that substantial evidence supports the ALJ’s findings regarding

Plaintiff’s mental impairments, including Plaintiff’s subjective complaints.

Def.’s Mem. at 6-15.

“[T]o establish a disability based on testimony of pain and other

symptoms, the claimant must satisfy two parts of a three-part showing:

(1) evidence of an underlying medical condition; and (2) either (a) objective

medical evidence confirming the severity of the alleged pain; or (b) that the

objectively determined medical condition can reasonably be expected to give rise

to the claimed pain.” Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002)

(citing Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991)); see also Malak

v. Comm’r of Soc. Sec., 131 F.4th 1280, 1287 (11th Cir. 2025). “The claimant’s

subjective testimony supported by medical evidence that satisfies the standard

is itself sufficient to support a finding of disability.” Holt, 921 F.2d at 1223.

The Regulations provide that an ALJ “will” consider the following factors

related to symptoms such as pain:

(i) [The claimant’s] daily activities; (ii) The location,

duration, frequency, and intensity of [the claimant’s]

pain or other symptoms; (iii) Precipitating and

aggravating factors; (iv) The type, dosage,

effectiveness, and side effects of any medication [the

claimant] take[s] or ha[s] taken to alleviate [his or her]

pain or other symptoms; (v) Treatment, other than

medication, [the claimant] receive[s] or ha[s] received

for relief of [his or her] pain or other symptoms; (vi) Any

measures [the claimant] use[s] or ha[s] used to relieve

[his or her] pain or other symptoms . . .; and (vii) Other

factors concerning [the claimant’s] functional

limitations and restrictions due to pain or other

symptoms.

20 C.F.R. § 404.1529(c)(3)(i)-(vii); see Raper v. Comm’r of Soc. Sec., 89 F.4th

1261, 1277 (11th Cir. 2024). The factors must be considered “in relation to other

evidence in the record and whether the claimant’s statements conflict with

other evidence.” Raper, 89 F.4th at 1277 (citation omitted); see 20 C.F.R. §

404.1529(c)(4). To reject the claimant’s assertions of subjective symptoms,

“explicit and adequate reasons” must be articulated by the ALJ. Wilson, 284

F.3d at 1225; see also Malak, 131 F.4th at 1287; Dyer, 395 F.3d at 1210;

Marbury v. Sullivan, 957 F.2d 837, 839 (11th Cir. 1992). Moreover, “the episodic

nature of” certain mental disorders must be considered by an ALJ. Schink v.

Comm’r of Soc. Sec., 935 F.3d 1245, 1268 (11th Cir. 2019); see also, e.g., Simon

v. Commissioner, Social Security Administration, 7 F.4th 1094, 1106 (11th Cir.

2021).

The RFC assessment “is the most [a claimant] can still do despite [his or

her] limitations.” 20 C.F.R. §§ 404.1545(a)(1), 416.945(a)(1). It is used at step

four to determine whether a claimant can return to his or her past relevant

work, and if necessary, it is also used at step five to determine whether the

claimant can perform any other work that exists in significant numbers in the

national economy. 20 C.F.R. §§ 404.1545(a)(5), 416.945(a)(1). In assessing a

claimant’s RFC, the ALJ “must consider limitations and restrictions imposed

by all of an individual’s impairments, even those that are not ‘severe.’” SSR 96-

8P, 1996 WL 374184 at *5; see also Pupo v. Comm’r, Soc. Sec. Admin., 17 F.4th

1054, 1064 (11th Cir. 2021) (citing Schink, 935 F.3d at 1268); Swindle v.

Sullivan, 914 F.2d 222, 226 (11th Cir. 1990) (stating that “the ALJ must

consider a claimant’s impairments in combination”) (citing 20 C.F.R. §

404.1545; Reeves v. Heckler, 734 F.2d 519, 525 (11th Cir. 1984)).

“[B]efore denying an application based on a claimant’s failure to comply

with prescribed medical care, the ALJ must consider whether the claimant is

able to afford the medical care.” Brown v. Comm’r of Soc. Sec., 425 F. App’x 813,

817 (11th Cir. 2011) (citing Ellison v. Barnhart, 355 F.3d 1272, 1275 (11th Cir.

2003)). A claimant’s inability to afford medical care excuses his or her lack of

such care. Dawkins v. Bowen, 848 F.2d 1211, 1213 (11th Cir. 1988) (stating that

the court “agree[s] with every circuit that has considered the issue that poverty

excuses noncompliance [with prescribed medical treatment]”) (citations

omitted). “Nevertheless, if the claimant’s failure to follow medical treatment is

not one of the principal factors in the ALJ's decision, then the ALJ's failure to

consider the claimant's ability to pay will not constitute reversible error.” Id.

(citing Ellison, 355 F.3d at 1275).

Here, to be sure, Plaintiff does rather consistently allege her panic attacks

and fear of going out in public render her essentially homebound. But, the ALJ

clearly took into account Plaintiff’s subjective complaints about how she is

affected by her mental impairments, including the panic attacks and inability

to leave her house. The ALJ referred to such complaints multiple times in the

Decision. See Tr. at 28, 30, 31, 34, 35. Ultimately, the ALJ found Plaintiff’s

“medically determinable impairments could reasonably be expected to cause the

alleged symptoms; however, [Plaintiff’s] statements concerning the intensity,

persistence and limiting effects of these symptoms are not entirely consistent

with the medical evidence and other evidence in the record.” Tr. at 31.

Regarding Plaintiff’s mental impairments specifically, the ALJ found:

During the pendency of her claim, [Plaintiff] has

emphasized the increasing severity of her mental

health symptoms but the objective medical evidence of

record supports no more than moderate limitations. At

the most recent psychological evaluation, [Plaintiff]

appeared somewhat unkempt with a tense, anxious,

and depressed mood, and she was tearful. However, her

thought processes were normal, she was not inattentive

or distractable, and her memory was intact. She was

able to understand commands and follow directions. An

earlier psychological evaluation in 2020 noted similar

findings. [Plaintiff] did not request medication to

manage her anxiety until June 2020. While she

testified that she is not currently receiving mental

health treatment due to her insurance and financial

concerns, she acknowledged that her symptoms were

improved when getting treatment.

Tr. at 36 (citations omitted). Importantly, the ALJ also discussed and found

“persuasive” the opinions of the consultative examiner, Peter Bursten, Ph.D.,

about what Plaintiff can do despite her mental limitations, including the panic

disorder and agoraphobia. Tr. at 39; see Tr. at 990-91, 1015-20 (Dr. Bursten’s

opinions). Having appropriately evaluated the lack of consistency of Plaintiff’s

subjective complaints with the rest of the evidence, the ALJ was not obligated

to make specific findings about the frequency and duration of Plaintiff’s panic

attacks. In the end, the ALJ limited Plaintiff from a mental perspective to

“simple, routine, and repetitive tasks involving only simple work-related

decisions, and she can adapt to gradual workplace changes”; regarding “her

specific anxiety related to social interaction, she can occasionally interact with

the general public, co-workers, and supervisors.” Tr. at 40. The ALJ’s findings

reflect adequate consideration of the required factors and are supported by

substantial evidence. Under the deferential standard of review, this Court

cannot disturb these findings.

V. Conclusion

The ALJ’s Decision is supported by substantial evidence. In light of the

foregoing, it is

ORDERED:

1. The Clerk of Court is directed to enter judgment pursuant to

sentence four of 42 U.S.C. § 405(g), and § 1383(c)(3), AFFIRMING the

Commissioner’s final decision.

2. The Clerk is further directed to close the file.

DONE AND ORDERED in Jacksonville, Florida on March 27, 2026.

Verge Boo KAS

JAMES R. KLINDT

United States Magistrate Judge

kaw

Copies:

Counsel of Record

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