The opinion
UNITED STATES DISTRICT COURT
MIDDLE DISTRICT OF FLORIDA
TAMPA DIVISION
STEPHANIE HAMILTON,
Plaintiff,
v. Case No. 8:25-cv-235-CPT
FRANK BISIGNANO,
COMMISSIONER OF THE SOCIAL
SECURITY ADMINISTRATION,1
Defendant.
_________________________________/
O R D E R
The Plaintiff seeks judicial review of the Commissioner’s denial of her
application for Supplemental Security Income (SSI). For the reasons discussed below,
the Commissioner’s decision is affirmed.
I.
The Plaintiff was born in 1981, has a ninth-grade education, and has past
relevant work experience in the food service and retail industries. (R. 236, 241). In
June 2021, the Plaintiff applied for SSI, alleging disability as of July 2019 due to
1 Mr. Bisignano became the Commissioner of Social Security on May 6, 2025. Pursuant to Federal
Rule of Civil Procedure 25(d), Mr. Bisignano is substituted for the former Acting Commissioner, Mr.
Leland Dudek, as the Defendant in this suit.
migraines, neuropathy, anxiety, memory loss, back surgeries, and degenerative disc
disease. (R. 211, 240). The Social Security Administration (SSA) denied the Plaintiff’s
application both initially and on reconsideration. (Doc. 13 at 1).
At the Plaintiff’s request, an Administrative Law Judge (ALJ) conducted a
hearing on the matter in September 2023. (R. 18). The Plaintiff was accompanied by
a representative at that proceeding and testified on her own behalf. (R. 18, 47). A
vocational expert (VE) also testified. (R. 18, 60).
In a decision issued in December 2023, the ALJ determined that the Plaintiff
(1) had not engaged in any substantial gainful activity since her application date in
June 2021; (2) had the severe impairments of osteoarthritis (bilateral hips), anorexia
nervosa, migraine headaches, generalized anxiety disorder, schizoaffective disorder
(depressive type), and cervical, thoracic, and lumbar degenerative disc disease; (3) did
not, however, have an impairment or combination of impairments that met or
medically equaled the severity of any of the listings;2 (4) had the RFC to perform light
work subject to certain limitations;3 and (5) had no past relevant work but was capable
2 The listings are found at 20 C.F.R. Pt. 404, Subpt. P, App’x 1, and catalog those impairments that
the SSA considers significant enough to prevent a person from performing any gainful activity. See 20
C.F.R. § 416.920(a)(4)(iii). When a claimant’s affliction matches an impairment in the listings, the
claimant is automatically entitled to disability benefits. See id.; see also Edwards v. Heckler, 736 F.2d
625, 628 (11th Cir. 1984).
3 These limitations were that the Plaintiff could frequently crouch, kneel, balance, climb ramps, or
climb stairs; could occasionally crawl, stoop, or climb ladders, ropes, or scaffolds; should not work
around extremes of cold or heat, noise levels louder than a typical office environment, concentrated
vibration, concentrated respiratory irritants, or hazards, such as open moving machinery or
unprotected heights; could understand, remember, carry out, and exercise judgment for simple tasks;
and should work in an environment with few day-to-day changes in terms of work duties, work
settings, or work processes. (R. 25).
of making a successful adjustment to other jobs which exist in significant numbers in
the national economy. (R. 20–36). In light of these findings, the ALJ concluded that
the Plaintiff was not disabled. (R. 36).
The Appeals Council denied the Plaintiff’s request for review. (R. 5).
Accordingly, the ALJ’s decision became the final decision of the Commissioner.
Viverette v. Comm’r of Soc. Sec., 13 F.4th 1309, 1313 (11th Cir. 2021).
II.
The Social Security Act defines disability as the inability “to engage in any
substantial gainful activity by reason of any medically determinable physical or mental
impairment . . . which has lasted or can be expected to last for a continuous period of
not less than [twelve] months.” 42 U.S.C. § 1382c(a)(3)(A); see also 20 C.F.R.
§ 416.905(a).4 A physical or mental impairment under the Act “results from
anatomical, physiological, or psychological abnormalities which are demonstrable by
medically acceptable clinical and laboratory diagnostic techniques.” 42 U.S.C.
§ 1382c(a)(3)(D).
To determine whether a claimant is disabled, the Social Security Regulations
prescribe “a five-step, sequential evaluation process.” Carter v. Comm’r of Soc. Sec., 726
F. App’x 737, 739 (11th Cir. 2018) (per curiam) (citation omitted).5 Under this
process, an ALJ must assess whether the claimant: (1) is performing substantial gainful
4 Unless otherwise indicated, citations to the Code of Federal Regulations are to the version in effect
at the time of the ALJ’s decision.
5 Unpublished opinions are not considered binding precedent but may be cited as persuasive authority.
11th Cir. R. 36-2.
activity; (2) has a severe impairment; (3) has a severe impairment that meets or equals
one of the listings; (4) has the Residual Functional Capacity (RFC) to engage in her
past relevant work; and (5) can perform other jobs in the national economy given her
RFC, age, education, and work experience. Id. (citing Phillips v. Barnhart, 357 F.3d
1232, 1237 (11th Cir. 2004); 20 C.F.R. § 416.920(a)(4)). Although the claimant bears
the burden of proof through step four, the burden temporarily shifts to the
Commissioner at step five. Goode v. Comm’r of Soc. Sec., 966 F.3d 1277, 1278–79 (11th
Cir. 2020) (citation omitted); Sampson v. Comm’r of Soc. Sec., 694 F. App’x 727, 734
(11th Cir. 2017) (per curiam) (citing Jones v. Apfel, 190 F.3d 1224, 1228 (11th Cir.
1999)). If the Commissioner carries that burden, the claimant must then prove that
she cannot engage in the work identified by the Commissioner. Goode, 966 F.3d at
1279. In the end, “‘the overall burden of demonstrating the existence of a
disability . . . rests with the claimant.’” Washington v. Comm’r of Soc. Sec., 906 F.3d
1353, 1359 (11th Cir. 2018) (quoting Doughty v. Apfel, 245 F.3d 1274, 1280 (11th Cir.
2001)).
A claimant who does not prevail at the administrative level may seek judicial
review in federal court provided the Commissioner has issued a final decision
disposing of the claimant’s disability application after a hearing. 42 U.S.C. § 405(g).
Judicial review is confined to determining whether the Commissioner applied the
correct legal standards and whether the Commissioner’s decision is buttressed by
substantial evidence. Id.; Hargress v. Soc. Sec. Admin., Comm’r, 883 F.3d 1302, 1305 n.2
(11th Cir. 2018) (per curiam) (citation omitted). Substantial evidence is “more than a
mere scintilla” and is “such relevant evidence as a reasonable mind might accept as
adequate to support a conclusion.” Biestek v. Berryhill, 587 U.S. 97, 103 (2019) (internal
quotation marks and citations omitted). In evaluating whether substantial evidence
bolsters the Commissioner’s decision, a court may not decide the facts anew, reweigh
the evidence, or make credibility determinations. Viverette, 13 F.4th at 1314 (citation
omitted); Carter, 726 F. App’x at 739 (citing Moore v. Barnhart, 405 F.3d 1208, 1211
(11th Cir. 2005) (per curiam)). While a court will defer to the Commissioner’s factual
findings, it will not defer to his legal conclusions. Viverette, 13 F.4th at 1313–14; Keeton
v. Dep’t of Health & Hum. Servs., 21 F.3d 1064, 1066 (11th Cir. 1994) (citations omitted).
III.
The Plaintiff raises three challenges on appeal: (1) the ALJ’s RFC assessment
regarding the Plaintiff’s mental limitations is not supported by substantial evidence;
(2) the ALJ erred in evaluating the Plaintiff’s subjective complaints of pain and other
symptoms; and (3) the ALJ neglected to consider whether the Plaintiff’s migraine
disorder was medically equivalent to one of the listings. (Doc. 13). Each of these
challenges will be addressed in turn.
A.
Where, as here, a claimant presents a “colorable” claim of a mental impairment,
an ALJ must apply the regulatorily-mandated Psychiatric Review Technique (PRT) at
step two and/or three. See Moore, 405 F.3d at 1213–14 (citation omitted); see also
Cannon v. Astrue, 2011 WL 4346566, at *5 (M.D. Fla. Sept. 16, 2011) (observing that
the PRT can be undertaken at steps two and three) (citation omitted). This technique
requires an assessment of how a claimant’s mental impairment affects four broad
functional areas (known as the Paragraph B criteria): (1) understanding, remembering,
or applying information; (2) interacting with others; (3) concentrating, persisting, or
maintaining pace; and (4) adapting or managing oneself. 20 C.F.R. § 416.920a(c)(3).
The Regulations dictate that after applying the PRT, an ALJ must provide a specific
explanation for his determinations, including the degree of limitation found in each
area. Id. §§ 416.920a(c)(4), (e)(4).
The PRT is separate and apart from an ALJ’s RFC determination at step four,
which dictates that the ALJ gauge a claimant’s maximum ability to do work despite
her impairments, both severe and non-severe. See Schink v. Comm’r of Soc. Sec., 935
F.3d 1245, 1268–69 (11th Cir. 2019) (per curiam) (noting that “[c]onsideration of all
impairments, severe and non-severe, is required when assessing a claimant’s RFC”)
(citing Bowen v. Heckler, 748 F.2d 629, 634–35 (11th Cir. 1984)). The RFC analysis at
step four therefore represents a more detailed assessment of a claimant’s ability to
function than the one performed at the earlier stages. See Buckwalter v. Acting Comm’r
of Soc. Sec., 5 F.4th 1315, 1325 (11th Cir. 2021) (citing Winschel v. Comm’r of Soc. Sec.,
631 F.3d 1176, 1180 (11th Cir. 2011)); see also Soc. Sec. Ruling (SSR) 96-8p, 1996 WL
374184, at *4 (July 2, 1996) (stating that the criteria used to rate the severity of mental
impairments at a prior step do not equate to a step four RFC determination, which
involves a “more detailed” evaluation that obligates an ALJ to “itemiz[e] various
functions contained in the [four] broad” areas).
In this case, as noted above, the ALJ found at step two that the Plaintiff had the
severe mental impairments of anorexia nervosa, generalized anxiety disorder, and
schizoaffective disorder (depressive type). (R. 21). After applying the PRT at step
three, the ALJ determined that the Plaintiff had mild limitations in both
understanding, remembering, or applying information and interacting with others, as
well as moderate limitations in both concentrating, persisting, or maintaining pace and
adapting or managing oneself. (R. 23–24).
At step four, building on his PRT assessment, the ALJ again reviewed the
evidence pertaining to the Plaintiff’s mental condition. (R. 25–34). This evidence
spanned the period from 2019 to 2023 and included the Plaintiff’s mental health
symptoms described in function reports6 and other records; the treatment the Plaintiff
did or did not receive for her mental impairments; mental status examinations the
Plaintiff underwent; and the Plaintiff’s medication management that involved, among
other drugs, two antipsychotics. (R. 26, 30–33). After engaging in a detailed
examination of all this information, the ALJ found, inter alia, that while the Plaintiff’s
symptoms, “persistent anxiety,” and “need for a heavy regular medication regimen”
limited “her ability to concentrate, persist, and maintain pace[ ] and to adapt and
manage oneself in a work setting,” the “evidence as a whole support[ed] that she
6 Function reports outline how a claimant’s physical and mental conditions impact her ability to work,
care for herself, perform household tasks, and engage in other tasks. See (R. 26); see also Highfield v.
Saul, 2020 WL 5706120, at *11 (S.D. Fla. Sept. 24, 2020) (stating that a function report “help[s] guide”
an ALJ when conducting an RFC assessment).
would be expected to perform simple work in a fairly static work environment.” (R.
33).
Along with the above evidence and of import here, the ALJ also evaluated the
mental assessments of two state agency psychological consultants, Dr. Eric Weiner
and Dr. Mercedes DeCubas. (R. 33–34). As set forth in the ALJ’s decision, both of
these providers determined that the Plaintiff “had no more than mild limitations in
mental functioning.” (R. 33). The ALJ deemed these assessments to be unpersuasive,
however, because they were rendered early on in the process and did not account for
some of the Plaintiff’s mental restrictions. As the ALJ explained:
[Drs. Weiner and DeCubas] noted that there was little mental health
treatment documented in the record at the time of their reviews; however,
the fully developed record at the hearing level does reflect fairly
consistent behavioral health treatment since early 2022. Although
significant mental health complaints are not documented in the early
medical evidence of record, these later records do reflect mood
symptoms, anxiety, anhedonia, anergia, and hallucinations, which are
generally well controlled on a fairly high medication regimen. Given the
[Plaintiff’]s recent treatment records even with her response to
medication, the undersigned finds the record is sufficient to support
moderate limitations in concentrating, persisting, or maintaining pace
and adapting or managing oneself, and limiting the [Plaintiff] to simple
tasks in a work environment with few day-to-day changes.
(R. 33–34).
While not entirely clear, the Plaintiff now appears to contend that the ALJ
impermissibly played doctor by relying on his own “lay interpretation” of the medical
records after having rejected the opinions offered by Drs. Weiner and DeCubas. (Doc.
13 at 6–11). The Plaintiff adds that without a medical expert’s assessment regarding
the Plaintiff’s “complex” mental health impairments, the ALJ’s RFC amounts to
“nothing more than a speculative hunch.” Id. at 9–10.
It is well established that an ALJ may not arbitrarily substitute his own opinion
for that of a medical professional. See Freeman v. Schweiker, 681 F.2d 727, 731 (11th
Cir. 1982) (per curiam); see also Marbury v. Sullivan, 957 F.2d 837, 840–41 (11th Cir.
1992) (per curiam) (Johnson, J., concurring specially); Siracuse v. Acting Comm’r of Soc.
Sec. Admin., 2017 WL 2644615, at *5 n.7 (M.D. Fla. June 20, 2017) (citation omitted).
Such a scenario may occur where an ALJ “play[s] doctor” and takes it upon himself
to analyze medical evidence beyond his ken, rather than confine himself to his proper
role as “an adjudicator responsible for assessing [a claimant’s] RFC” and for
evaluating the medical opinions of record. Castle v. Colvin, 557 F. App’x 849, 853–54
(11th Cir. 2014) (per curiam); see also Rosario v. Comm’r of Soc. Sec., 2018 WL 5300202,
at *4 (M.D. Fla. Aug. 23, 2018) (deeming the ALJ to have improperly “played doctor”
when she formed her own judgment about the appropriate treatment for the claimant)
(citations omitted), report and recommendation adopted, 2018 WL 5293230 (M.D. Fla.
Oct. 25, 2018).
An ALJ does not “play doctor,” however, merely by determining a claimant’s
RFC based upon his review of the record as a whole. Castle, 557 F. App’x at 853–54.
Indeed, the pertinent regulations obligate an ALJ to render such an assessment. See
id.; see also Moore v. Soc. Sec. Admin., Comm’r, 649 F. App’x 941, 945 (11th Cir. 2016)
(per curiam).
Moreover, of significance to the Plaintiff’s challenge, there is no directive that
an ALJ must ground his RFC finding on a medical source opinion. Castle, 557 F.
App’x at 854 (ruling the district court erred in necessitating that the ALJ’s RFC
determination be predicated on a medical source opinion); Green v. Soc. Sec. Admin.,
223 F. App’x 915, 923–24 (11th Cir. 2007) (per curiam) (upholding the ALJ’s RFC
determination even though it conflicted with the only medical opinion of record,
which the ALJ discredited); Gray v. Comm’r of Soc. Sec., 2019 WL 3934441, at *9 (M.D.
Fla. Aug. 20, 2019) (“The [c]laimant has failed to cite any authority—and the [c]ourt
is unaware of any—creating a rigid requirement that the ALJ’s RFC determination
must be supported by a medical opinion.”); Falberg v. Colvin, 2015 WL 12840465, at
*5 (M.D. Fla. July 16, 2015) (dismissing the claimant’s argument that the ALJ acted
on “his own hunch” where the ALJ “made a well-reasoned determination in
accordance with his duty to assess the evidence”). Instead, all that is necessary is that
the ALJ’s RFC finding be buttressed by substantial evidence. Sims v. Comm’r of Soc.
Sec., 706 F. App’x 595, 602 (11th Cir. 2017).
It is evident from the ALJ’s decision that his mental RFC findings are
adequately substantiated by the record here. As referenced above, the ALJ evaluated
the paragraph B criteria and explained why he imposed mild limitations pertaining to
the areas of understanding, remembering, or applying information and interacting
with others, and moderate limitations relative to the domains of maintaining
concentration, persistence, or pace and adapting or managing herself. (R. 23–24). The
ALJ then detailed the Plaintiff’s self-reports and the medical evidence relating to her
mental conditions, including her demands for certain drugs, her refusal of other drugs,
and her repeated emergency department visits where no significant mental health
complaints were noted. (R. 30–33) (citing R. 324–406, 432–588, 589–626, 699–848,
862–953). The ALJ also discussed mental status observations of the Plaintiff’s
psychiatrist, including that the Plaintiff exhibited depressed and irritable mood and
affect, delusional and paranoid thought content, fair insight, and limited judgment.
(R. 31–32). The ALJ balanced those observations, however, with unremarkable
mental health-related findings in the record, such as the Plaintiff’s intact attention,
concentration, memory, and orientation. Id.
In addition, the ALJ highlighted the Plaintiff’s admitted improvement with
medication. (R. 31–32). This included the Plaintiff’s statements in mid-to-late 2022
that she was “doing a lot better” as far as her mood, appetite, insight, and judgment
were concerned, at least in part due to the drugs she was prescribed. (R. 31). It also
included evidence that by 2023 and after a further adjustment of her medication, the
Plaintiff displayed, inter alia, “intact attention, concentration, and memory” and
reported apparent progress in her mood and other symptoms. (R. 31–32).
In light of these determinations by the ALJ and his thorough consideration of
the entirety of the record, substantial evidence bolsters his mental RFC findings. The
Plaintiff’s claim that the ALJ impermissibly “played doctor” therefore fails. See Sims,
706 F. App’x at 604; Castle, 557 F. App’x at 853–54.
In an attempt to avoid this outcome, the Plaintiff relies on Brightmon v. Comm’r
of Soc. Sec. Admin., 743 F. App’x 347 (11th Cir. 2018) and Highfield v. Saul, 2020 WL
5706120 (S.D. Fla. Sept. 24, 2020). Both of these cases are readily distinguishable
from the circumstances presented here.
In Brightmon, the Eleventh Circuit ruled that the ALJ erred in assigning “great
weight” to a state agency medical consultant’s findings because the medical record
was “much more developed regarding [the claimant's] physical impairments” after the
consultant rendered his assessment. 743 F. App’x at 352–53. The court also pointed
out that no expert—apart from a subsequent consultative physician, whose opinion
the ALJ declined to credit—expressed an opinion about what these later records meant
for the claimant’s ability to work despite his impairments. Id. at 353. The court
additionally observed that because the ALJ’s RFC mirrored an RFC crafted before the
later evidence existed, it was “difficult to say that the ALJ properly ‘[took] into account
and evaluate[d] the record as a whole.’” Id. (quoting McCruter v. Bowen, 791 F.2d 1544,
1548 (11th Cir. 1986)). The court commented as well that the ALJ’s rejection of the
subsequent consultative physician’s assessment was faulty to the extent the ALJ
disregarded evidence which was consistent with that assessment and to the extent the
ALJ improperly substituted his own judgment for that of a medical expert. Id. at 353–
54.
In this case, unlike in Brightmon, it is apparent from the ALJ’s decision that he
considered the entirety of the record in making his mental RFC findings and that he
did not simply base his determinations on a narrow array of materials obtained at an
earlier juncture in the process. In fact, as recounted above, the whole rationale for the
ALJ’s rejection of the opinions of the two state agency psychological consultants, Drs.
Weiner and DeCubas, was that they were not predicated on a “fully developed record”
which post-dated the providers’ assessments. (R. 33–34). Furthermore, while the ALJ
in Brightmon was deemed to have wrongly relied on his own medical judgment instead
of that of the subsequent consultative physician, the ALJ here provided objective
grounds for not crediting Drs. Weiner and DeCubas’s opinions (R. 33), grounds with
which the Plaintiff notably agrees (Doc. 13 at 6). Brightmon is thus of no help to the
Plaintiff here.
In Highfield, the court found that the ALJ did not properly evaluate the
claimant’s post-traumatic stress disorder (PTSD) and other mental impairments, as
well as their attendant restrictions. 2020 WL 5706120, at *10–13. In support of this
conclusion, the court noted, inter alia, that the ALJ ignored evidence indicating the
claimant suffered from PTSD, that “there [wa]s no evidence that the [claimant’s
mental health issues were] being controlled by medication,” and that “there [wa]s no
information in the record as to how the [claimant’s condition] would limit [her] ability
to work on a daily basis.” Id. at 12. For the reasons set forth above, none of these
deficiencies are present here. As a result, Highfield is likewise of no help to the Plaintiff.
To stave off defeat of her first challenge, the Plaintiff seemingly suggests in the
alternative that the ALJ should have solicited additional medical opinions and/or
consultations to further develop the record. See (Doc. 13 at 8–9). To the extent the
Plaintiff makes such an argument, it too is unavailing.
A claimant seeking remand on the theory that an ALJ did not secure a
consultative examination bears the burden of demonstrating not only that the ALJ
erred in forgoing such an examination, but also that the claimant was harmed by the
ALJ’s decision on the subject. See Mosley v. Comm’r of Soc. Sec., 633 F. App’x 739, 742
(11th Cir. 2015) (per curiam) (citing Brown v. Shalala, 44 F.3d 931, 935 (11th Cir.
1995)). To establish the requisite harm, a claimant must show that there are
evidentiary gaps in the record that result in unfairness or “clear prejudice” warranting
remand. Id.; see also Goode, 966 F.3d at 1280 (observing that “[r]emand for further
factual development of the record . . . is appropriate where the record reveals
evidentiary gaps which result in unfairness or clear prejudice”) (internal quotation
marks and citation omitted); Riley v. Comm'r of Soc. Sec., 2023 WL 2894366, at *4 (M.D.
Fla. Apr. 11, 2023) (“An ALJ need not obtain additional information, seek expert
medical testimony, nor order a consultative examination when the record is sufficient
to make a disability determination.”) (citing Sarria v. Comm’r of Soc. Sec., 579 F. App’x
722, 724 (11th Cir. 2014)). If the record is complete on the other hand, the ALJ may
determine the RFC from the record. Riley, 2023 WL 2894366, at *4.
Here, at a minimum, the Plaintiff does not specify any meaningful evidentiary
gaps that would result in unfairness or clear prejudice. It is telling in this respect that,
as the Commissioner points out, the Plaintiff does not delineate what additional
restrictions the record supposedly supports or what limitations the RFC purportedly
lacks. (Doc. 15 at 8).
B.
The Plaintiff’s second claim of error—as noted above—is that the ALJ erred in
evaluating the Plaintiff’s subjective complaints of pain and other symptoms. This
challenge is meritless as well.
As discussed previously, part of the ALJ’s role at step four is to determine a
claimant’s RFC. See 20 C.F.R. §§ 416.920(a)(4)(iv), 416.945. To do so, an ALJ must
ascertain based upon all of the pertinent evidence before him what a claimant can do
in a work setting despite any physical or mental restrictions caused by her impairments
and related symptoms. Id.; § 416.945(a)(1). In making this assessment, the ALJ must
consider any medical opinions of record, all of the claimant’s medically determinable
impairments, the total limiting effects of each impairment, and the claimant’s
subjective symptoms. Id. §§ 416.920(e), 416.945(a)(3); Jamison v. Bowen, 814 F.2d 585,
588 (11th Cir. 1987).
The evaluation of a claimant’s subjective complaints is governed in the Eleventh
Circuit’s “pain standard.” Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (per
curiam). Under this standard, a claimant must show “(1) evidence of an underlying
medical condition and either (2) objective medical evidence that confirms the severity
of the alleged pain arising from the condition or (3) that the objectively determined
medical condition is of such severity that it can be reasonably expected to give rise to
the alleged pain.” Id. (quoting Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991)
(per curiam)).
If a claimant meets the pain standard, the ALJ must then assess the intensity
and persistence of the claimant’s symptoms to determine how they interfere with her
capacity to work. 20 C.F.R. § 416.929(c)(3). The considerations pertinent to this
analysis include: (1) the claimant’s daily activities; (2) the location, duration,
frequency, and intensity of the claimant’s pain or other symptoms; (3) precipitating
and aggravating factors; (4) the type, dosage, effectiveness, and side effects of any
medication the claimant takes or has taken to alleviate her pain or other symptoms;
(5) treatment (other than medication) the claimant receives or has received for relief of
her pain or other symptoms; (6) any measures the claimant uses or has used to relieve
her pain or other symptoms; and (7) other factors concerning the claimant’s functional
limitations due to pain or other symptoms. Id.
After evaluating “a claimant’s complaints of pain, the ALJ may reject them as
not creditable, and that determination will be reviewed [on appeal] for substantial
evidence.” Marbury v. Sullivan, 957 F.2d 837, 839 (11th Cir. 1992) (per curiam) (citing
Wilson v. Heckler, 734 F.2d 513, 517 (11th Cir. 1984)). In rendering this determination,
the ALJ “need not cite particular phrases or formulations,” so long as the reviewing
court can be satisfied that the ALJ “considered [the claimant’s] medical condition as
a whole.” Chatham v. Comm’r of Soc. Sec., 764 F. App’x 864, 868 (11th Cir. 2019) (per
curiam) (internal quotation marks and citation omitted); see also Stowe v. Soc. Sec.
Admin., Comm’r, 2021 WL 2912477, at *4 (11th Cir. July 12, 2021) (per curiam)
(explaining that if an ALJ does not identify specific and adequate reasons for rejecting
a claimant’s pain-related testimony, “the record must be obvious as to the [ALJ’s]
credibility finding”) (citing Foote v. Chater, 67 F.3d 1553, 1561–62 (11th Cir. 1995) (per
curiam)). A reviewing court will not disturb an ALJ’s clearly articulated credibility
finding that is buttressed by substantial evidence. Foote, 67 F.3d at 1562 (citation
omitted).
In this case, the ALJ discussed the Plaintiff’s subjective complaints, along with
the Eleventh Circuit’s pain standard and the ALJ’s duty to account for all symptoms
and the degree to which those symptoms could reasonably be accepted as conforming
to the objective medical evidence and other evidence based on the applicable legal
requirements. (R. 25) (citing 20 C.F.R. § 416.929; SSR 16-3p, 2016 WL 1119029; 20
C.F.R. § 416.920c). The ALJ also made the following express credibility finding
regarding the Plaintiff’s subjective complaints:
[T]he [Plaintiff’s] medically determinable impairments could reasonably
be expected to cause the alleged symptoms; however, the [Plaintiff’s]
statements concerning the intensity, persistence[,] and limiting effects of
[her] symptoms are not entirely consistent with the medical evidence and
other evidence in the record for the reasons explained in this decision.
(R. 27). After a lengthy review of the Plaintiff’s testimony and the relevant medical
records (R. 26–33), the ALJ concluded as part of his RFC determination that—as
described earlier—the Plaintiff could perform light work subject to certain restrictions,
including that she should limit physically exertive activities, such as crawling,
stooping, and climbing ladders; that she should not work around extreme heat, cold,
and/or “concentrated levels of vibration;” and that she should not work around noise
levels beyond that of a “typical office level,” while also avoiding “concentrated
respiratory irritants.” (R. 34).
The Plaintiff now argues that the ALJ’s placed an “undue focus on objective
medical findings” in the record in discounting the Plaintiff’s subjective complaints and
improperly downplayed the Plaintiff’s “extensive pain management.” (Doc. 13 at 15).
This contention is unavailing.
To begin, it is undisputed that in making his credibility determination, the ALJ
thoroughly recounted the Plaintiff’s subjective complaints of pain from both her
hearing testimony and in her function reports, including pain stemming from her
migraines and pain she experienced in her back and hips. (Doc. 13 at 15) (conceding
that the ALJ provided a “detailed” analysis of the Plaintiff’s testimony which was
“quite thorough[ ]”). It is also uncontested that the ALJ engaged in a robust review of
the Plaintiff’s medical treatment history and the objective medical evidence in the
record in arriving at his credibility assessment. See id. (making a similar concession
relative to the Plaintiff’s medical treatment history).
With respect to the Plaintiff’s medical treatment history, the ALJ considered the
Plaintiff’s surgeries, as well as her pain management medication and injections. See
(R. 27–28, 106, 360) (citing R. 589–626, 699–848); see also 20 C.F.R.
§§ 416.929(c)(3)(iv), (v) (explaining that the factors relevant to symptoms include the
type, dosage, effectiveness, and side effects of medications, and treatment, other than
medication, an individual receives). By way of example, the ALJ noted that the
Plaintiff underwent lumbar spinal laminectomies in 2007, 2019, and 2021 (R. 27–28)
(citing R. 432–588, 699–848, 862–953), and that she also underwent caudal epidural
injections, facet blocks, cervical rhizotomy, and a sacroiliac joint injection, all of which
provided significant, albeit temporary, improvement (R. 28–30, 1005–10) (citing R.
862–953, 1044–62, 1097–1110). The ALJ recognized as well that the Plaintiff received
pain management medication with Tylenol #3 and tizanidine. (R. 27–30).
As for the objective medical evidence, the ALJ reviewed documentation which
pre-dated the Plaintiff’s SSI application and which related to a lumbar
hemilaminectomy she received, MRI findings showing degenerative disc disease
throughout her spine, and a history of migraines. (R. 27). Closer in time to the
Plaintiff’s application date, the ALJ noted that imaging of the Plaintiff’s spine showed
degenerative and postoperative changes but that x-rays of her left hip and shoulder
were negative. (R. 28, 346, 386, 430–31, 511–13, 544, 601, 653–54, 876, 947, 1112–
14). The ALJ also acknowledged that, in July 2021, the Plaintiff reported an increase
in the frequency of her migraines (R. 28, 413). In addition, the ALJ referenced
abnormal examination findings, such as tenderness to palpation in the Plaintiff’s spine
and hips and slightly decreased bilateral hip strength. (R. 28–30, 424, 508, 659).
Of significance here, however, the ALJ pointed out that there were
unremarkable objective findings in the record too, including findings that the Plaintiff
exhibited regular strength, normal reflexes, a full range of motion, and intact sensation.
(R. 28–30, 424, 434, 442, 535, 659, 670, 1116–33). The ALJ further observed that the
Plaintiff reported to her physicians in April 2021 following a surgery that medication
was “effective in controlling” her back and leg pain. (R. 27) (citing R. 324–406, 432–
588). The ALJ also noted that, in October 2021, the Plaintiff admitted that although
she did not cook, clean, and do other household chores, it was not because she could
not do so but because “someone did these tasks for her.” (R. 28) (citing R. 627–64).
The ALJ additionally noted that, at a January 2022 appointment, the Plaintiff again
reported that her leg and back pain had improved due to medical procedures and
medication, at least temporarily. (R. 29).
Moreover, the ALJ recounted that, in 2022 and 2023, the Plaintiff underwent
further x-rays of her torso, as well as other medical tests, to probe her reports of pain
in these areas and that these procedures seemingly yielded unremarkable results. (R.
29) (citing R. 1063–87, 1097–1110, 1111–14). The ALJ observed as well that multiple
physician examinations of the Plaintiff during this time were likewise unremarkable.
(R. 29–30) (citing R. 1115–40). And lastly, the ALJ analyzed evidence from multiple
sources which reportedly reflected that the Plaintiff’s experienced “good relief from
conservative pain management procedures.” (R. 32) (citing R. 699–848, 862–953,
1063–87, 1097–1110).7
Given the foregoing, the Court finds that the ALJ’s evaluation of the Plaintiff’s
subjective complaints complied with the Eleventh Circuit’s pain standard and that the
ALJ’s credibility determination is sufficiently supported by the information before
7 The Court is aware that the ALJ covered more evidence underlying his RFC determination than that
outlined above. See, e.g., (R. 32) (discussing evidence addressing, inter alia, Plaintiff’s weight and
Chronic Obstructive Pulmonary Disease). The Court nonetheless largely confines its evidentiary
review to the items in the record that concern the Plaintiff’s leg, hip, and back pain, since those are
the areas of focus in the Plaintiff’s second challenge. (Doc. 13 at 12–17).
him. The ALJ set forth specific and adequate grounds for attributing diminished
weight to the Plaintiff’s reported symptoms and bolstered that assessment by citing to
specific evidence in the record, including objective medical tests, examination
findings, and the Plaintiff’s own self-reports of pain improvement. See Dyer, 395 F.3d
at 1210 (citing Foote, 67 F.3d at 1561–62). To the extent the Plaintiff now invites the
Court to reweigh this evidence, the Court is prohibited from doing so. Viverette, 13
F.4th at 1314 (citation omitted).
C.
The Plaintiff’s third claim of error—as mentioned earlier—is that the ALJ did
not properly evaluate whether her migraines medically equaled a listed impairment.
(Doc. 13 at 18–21). This challenge meets the same fate as the Plaintiff’s other two
challenges.
A claimant bears the burden of proving that one or more of her afflictions
“meet[ ]” or “equal[ ]” a listed impairment. See Bellew v. Acting Comm’r of Soc. Sec., 605
F. App’x 917, 920 (11th Cir. 2015) (per curiam) (citing Barron v. Sullivan, 924 F.2d 227,
229 (11th Cir. 1991)). To “meet” a listing, “a claimant must have a diagnosis included
in the Listings” and must also supply medical reports showing that her malady fulfills
“the specific criteria of the Listings and the duration requirement.” Wilson v. Barnhart,
284 F.3d 1219, 1224 (11th Cir. 2002) (per curiam) (internal quotation marks and
citation omitted). And to “equal” a listing, “the medical findings must be at least equal
in severity and duration to the listed findings.” Id. (internal quotation marks and
citation omitted). An ALJ’s determination as to whether a claimant meets a listing
may be implied from the record. Davenport v. Astrue, 403 F. App’x 352, 354 (11th Cir.
2010) (citing Hutchison v. Bowen, 787 F.2d 1461, 1463 (11th Cir. 1986)).
The listing in question here is Paragraph B of Listing 11.02 (known as Listing
11.02B), which defines a sub-category of epilepsy. According to the SSA, Listing
11.02B is the listing “most closely analogous” to the listed impairment for primary
headache disorder. See SSR 19-4p, 2019 WL 4169635, at *7. The strictures of Listing
11.02B are set forth in SSR 19-4p, which states, in relevant part:
Paragraph B of listing 11.02 requires dyscognitive seizures occurring at
least once a week for at least [three] consecutive months despite
adherence to prescribed treatment. To evaluate whether a primary
headache disorder is equal in severity and duration to the criteria in
11.02B, we consider: A detailed description from an [acceptable medical
source] of a typical headache event, including all associated phenomena
(for example, premonitory symptoms, aura, duration, intensity, and
accompanying symptoms); the frequency of headache events; adherence
to prescribed treatment; side effects of treatment (for example, many
medications used for treating a primary headache disorder can produce
drowsiness, confusion, or inattention); and limitations in functioning that
may be associated with the primary headache disorder or effects of its
treatment, such as interference with activity during the day (for example,
the need for a darkened and quiet room, having to lie down without
moving, a sleep disturbance that affects daytime activities, or other
related needs and limitations).
Id. at *7.
The Plaintiff now argues that the ALJ should have considered whether her
migraines fell within the ambit of Listing 11.02B. (Doc. 13 at 18–21). In an effort to
bolster this contention, the Plaintiff asserts that she “reported symptoms of, and
required treatment for, migraines occurring regularly for more than three consecutive
months” and that there is this a “substantial question” whether her condition equals
the listing.” (Doc. 13 at 20–21).
There are a number of flaws with the Plaintiff’s challenge. As an initial matter,
SSR 19-4p cautions that is “uncommon” for a claimant with primary headache
disorder to display equivalent signs and limitations to those detailed in Listing 11.02B.
See 2019 WL 4169635, at *7 (“While uncommon, a person with a primary headache
disorder may exhibit equivalent signs and limitations to those detailed in listing
11.02[.]”) (emphasis added). Consistent with this observation, the Plaintiff seemingly
admits—at least tacitly—that she does not satisfy the elements of Listing 11.02B,
which necessitate a migraine headache occurring at least once a week for three
consecutive months despite adherence to prescribed treatment. See 20 C.F.R. pt. 404,
subpt. P, app. 1 § 11.02B. As the Plaintiff acknowledges in this respect, she testified
at the hearing to only experiencing migraines roughly once every two weeks, which
falls short of the once-a-week for three consecutive months criterion. See (R. 59–60);
see (Doc. 13 at 20).
Putting aside this issue, the Plaintiff’s present claim that she experiences
migraines once-per-fortnight is undermined by the fact that she did not make any such
assertion to her medical providers. (R. 347, 365, 378, 413, 559). To the contrary, as
the ALJ commented, the record shows that there was no follow-up relative to the
Plaintiff’s migraines after July 2021, which was just one month after her application
date. (R. 30, 347–51, 413–18).
Moreover, to show equivalence to Listing 11.02B in accordance with SSR 19-
4p, a claimant must provide—as mentioned above—a detailed description from an
acceptable medical source of a typical headache event, including associated
phenomena, the frequency of headache events, adherence to prescribed treatment, side
effects of treatment, and limitations in functioning, such as an interference with
activities throughout the day. See 2019 WL 4169635, at *7. The Plaintiff, however,
does not point to a single statement from an acceptable medical source that could
meaningfully satisfy these demands. (Doc. 13 at 18–21).
Notwithstanding these deficiencies, the Plaintiff contends that remand is
nevertheless warranted because it cannot be discerned from the ALJ’s decision that he
actually addressed the applicability of Listing 11.02B. (Doc. 13 at 21). This contention
is similarly meritless.
While it is true that the ALJ did not explicitly compare the Plaintiff’s migraine
issues with Listing 11.02B, he was not required to do so. As discussed above, an ALJ’s
determination as to whether a claimant satisfies a listing may be implied from the
record. See Davenport, 403 F. App’x at 354 (citing Hutchison, 787 F.2d at 1463); see also
Stacy v. Comm’r, Soc. Sec. Admin., 654 F. App’x 1005, 1008 (11th Cir. 2016) (“The ALJ
need not . . . specifically enumerate the Listings under which [he] is evaluating the
claimant’s condition[,] . . . so long as the ALJ’s finding is implicit in [his] decision.”)
(citing Hutchison, 787 F.2d at 1463).
Here, in his decision, the ALJ acknowledged the Plaintiff’s testimony that she
had a migraine about once every two weeks, which—as explained above—is too
infrequent to the meet Listing 11.02B’s criteria. (R. 26, 59-60). The ALJ also
recounted the Plaintiffs treatment for migraines between 2020 and 2021 with several
medications. (R. 27-28). In addition, as described previously, the ALJ noted that the
Plaintiff had not received any further treatment for her migraines after July 2021,
which again was only a month after her filing date. (R. 30, 347-51, 413-18). And
finally, the ALJ expressly stated that the Plaintiff “d[id] not have an impairment or
combination of impairments that me[t] or medically equal[ed] the severity of one of
the listed impairments in 20 CFR Part 404, Subpart P, Appendix 1.” (R. 23). On this
record, it can be fairly implied that this determination incorporated a finding by the
ALJ that the Plaintiff's migraine impairment did not meet or medically equal Listing
11.02B. It is also evident from the whole of the ALJ’s decision that this finding is
adequately substantiated by the record.
IV.
In light of all the above, it is hereby ORDERED:
1. The Commissioner’s decision is affirmed.
2. The Clerk is directed to enter Judgment in the Defendant’s favor and to
close the case.
SO ORDERED in Tampa, Florida, this 30th day of March 2026.
Oh iste baaddaas Ack
HONORABLE CHRISTOPHER P, TUITE
United States Magistrate Judge
25
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