# Cain v. Social Security Administration, Commissioner

> District Court, N.D. Alabama · May 17, 2023

URL: https://www.frixlaw.com/law-library/cases/9991675

## Case

- **Court:** District Court, N.D. Alabama
- **Decided:** May 17, 2023
- **Opinion:** 100trialcourt
- **Cited by:** 0 later opinions in the Frix Law Library

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## Opinion text

UNITED STATES DISTRICT COURT
FOR THE NORTHERN DISTRICT OF ALABAMA
WESTERN DIVISION

CHRISTOPHER ALAN CAIN, )
)
Plaintiff, )
)
v. ) Case No. 7:22-cv-28-GMB
)
KILOLO KIJAKAZI, Acting )
Commissioner of Social Security, )
)
Defendant. )

MEMORANDUM OPINION

On November 28, 2018, Plaintiff Christopher Cain filed an application for a
period of disability and disability insurance benefits (“DIB”). His alleged disability
onset date is May 7, 2018. Cain’s application for benefits was denied at the initial
administrative level. He then requested a hearing before an Administrative Law
Judge (“ALJ”). The ALJ held a hearing on November 9, 2020, and denied Cain’s
claims on February 2, 2021. Cain requested a review of the ALJ’s decision by the
Appeals Council, which declined review on November 2, 2021. As a result, the
ALJ’s decision became the final decision of the Commissioner of the Social Security
Administration (the “Commissioner”) as of November 2, 2021.
Cain’s case is now before the court for review pursuant to 42 U.S.C.
§§ 405(g) and 1383(c)(3). Under 28 U.S.C. § 636(c)(1) and Rule 73 of the Federal
Rules of Civil Procedure, the parties have consented to the full jurisdiction of a
United States Magistrate Judge. Doc. 14. Based on a review of the parties’
submissions, the relevant law, and the record as a whole, the court concludes that

the decision of the Commissioner is due to be affirmed.
I. STANDARD OF REVIEW1
The court reviews a Social Security appeal to determine whether the

Commissioner’s decision “is supported by substantial evidence and based upon
proper legal standards.” Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997).
The court will reverse the Commissioner’s decision if it is convinced that the
decision was not supported by substantial evidence or that the proper legal standards

were not applied. Carnes v. Sullivan, 936 F.2d 1215, 1218 (11th Cir. 1991). The
court “may not decide the facts anew, reweigh the evidence, or substitute its
judgment for that of the Commissioner,” but rather “must defer to the

Commissioner’s decision if it is supported by substantial evidence.” Miles v. Chater,
84 F.3d 1397, 1400 (11th Cir. 1997) (citation and internal quotation marks omitted).
“Even if the evidence preponderates against the Secretary’s factual findings, [the
court] must affirm if the decision reached is supported by substantial evidence.”

Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990). Moreover, reversal is not

1 In general, the legal standards are the same whether a claimant seeks DIB or Supplemental
Security Income (“SSI”). However, separate, parallel statutes and regulations exist for DIB and
SSI claims. Therefore, citations in this opinion should be considered to reference the appropriate
parallel provision as context dictates. The same applies to citations for statutes or regulations
found in excerpted court decisions.
warranted even if the court itself would have reached a result contrary to that of the
factfinder. See Edwards v. Sullivan, 937 F.2d 580, 584 n.3 (11th Cir. 1991).

The substantial evidence standard is met “if a reasonable person would accept
the evidence in the record as adequate to support the challenged conclusion.”
Holladay v. Bowen, 848 F.2d 1206, 1208 (11th Cir. 1988) (quoting Boyd v. Heckler,

704 F.2d 1207, 1209 (11th Cir. 1983)). The requisite evidentiary showing has been
described as “more than a scintilla, but less than a preponderance.” Bloodsworth v.
Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983). The court must scrutinize the entire
record to determine the reasonableness of the decision reached and cannot “act as

[an] automaton[] in reviewing the [Commissioner’s] decision.” Hale v. Bowen, 831
F.2d 1007, 1010 (11th Cir. 1987). Thus, the court must consider evidence both
favorable and unfavorable to the Commissioner’s decision. Swindle v. Sullivan, 914

F.2d 222, 225 (11th Cir. 1990).
The court will reverse the Commissioner’s decision on plenary review if the
decision applies incorrect law or fails to provide the court with sufficient reasoning
to determine that the Commissioner properly applied the law. Grant v. Astrue, 255

F. App’x 374, 375–76 (11th Cir. 2007) (citing Keeton v. Dep’t of Health & Human
Servs., 21 F.3d 1064, 1066 (11th Cir. 1994)). There is no presumption that the
Commissioner’s conclusions of law are valid. Id.
II. STATUTORY AND REGULATORY FRAMEWORK
To qualify for disability benefits, a claimant must show 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) & 416(i). A physical or mental impairment is “an
impairment that results from anatomical, physiological, or psychological
abnormalities which are demonstrated by medically acceptable clinical and
laboratory diagnostic techniques.” 42 U.S.C. § 423(d)(3). Cain bears the burden of

proving that he is disabled and is responsible for producing evidence sufficient to
support his claim. See Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003).
A determination of disability under the Social Security Act requires a five-

step analysis. 20 C.F.R. § 404.1520(a). The Commissioner must determine in
sequence:
(1) Is the claimant presently unable to engage in substantial gainful
activity?
(2) Are the claimant’s impairments severe?
(3) Do the claimant’s impairments satisfy or medically equal one of the
specific impairments set forth in 20 C.F.R. Pt. 404, Subpt. P,
App. 1?
(4) Is the claimant unable to perform his former occupation?
(5) Is the claimant unable to perform other work given his residual
functional capacity, age, education, and work experience?

See Frame v. Comm’r, Soc. Sec. Admin., 596 F. App’x 908, 910 (11th Cir. 2015).
“An affirmative answer to any of the above questions leads either to the next
question, or, [at] steps three and five, to a finding of disability. A negative answer

to any question, other than at step three, leads to a determination of ‘not disabled.’”
McDaniel v. Bowen, 800 F.2d 1026, 1030 (11th Cir. 1986) (quoting 20 C.F.R.
§ 416.920(a)−(f)). “Once the finding is made that a claimant cannot return to prior

work the burden of proof shifts to the Secretary to show other work the claimant can
do.” Foote v. Chater, 67 F.3d 1553, 1559 (11th Cir. 1995) (citing Gibson v. Heckler,
762 F.2d 1516 (11th Cir. 1985)).
III. RELEVANT FACTUAL BACKGROUND

Cain was born on April 2, 1979, and was 39 years old on his alleged onset
date. R. 44 & 263. His primary physical complaint is back pain. R. 51. He has had
two back fusion surgeries. R. 51–52. His primary mental complaints are attention

deficit hyperactivity disorder (“ADHD”), anxiety, and Post Traumatic Stress
Disorder (“PTSD”). R. 54–56. In his disability report, Cain identified the following
medical conditions: back injury, ADHD, sleep apnea, confusional arousal disorder,
and PTSD. R. 303. Cain graduated from high school and attended trade school for

three years. R. 45. He has worked as a brick layer, electrician, front-end loader
operator, and auto parts inspector. R. 45, 48–50, 69, 302 & 304.
Cain testified at his hearing that he has severe back pain that causes his legs

to “go numb.” R. 51 & 54. Sometimes he is unable to walk because the pain shoots
from his back down to his legs and “prevents [him] from moving.” R. 53. Cain can
walk for 35 to 50 yards before having to sit down (R. 57), but if he sits for too long,

his legs go numb and he cannot stand. R. 53. It takes as little as five to ten minutes
for the numbness to occur in his legs, and he can stand for five to ten minutes before
needing to sit down. R. 53 & 57. Cain is able to walk up stairs but walking down

stairs results in radiating pain in his legs. R. 58. He estimates that he can lift only
eight to ten pounds. R. 57. He cannot bend over to pick something off the ground,
does not do laundry, and does not bend his knees to stoop or squat. R. 57–58.
As for his mental impairments, Cain testified that his PTSD affects his ability

to stay on task and to concentrate. R. 55. He takes medicine that controls some of
his PTSD symptoms. R. 55. He has anxiety and panic attacks “where [he] can’t
hardly breathe,” which are caused by circumstances “like talking to people and being

in public places.” R. 56. He worries constantly, wakes up feeling like he is under
attack, and has angry outbursts where he blacks out. R. 56. Cain sees a therapist
every two weeks. R. 56.
As to his daily activities, Cain testified that he makes simple things to eat like

sandwiches. R. 58. He does not perform any housework. R. 59. He cannot bathe
and dress himself but receives help from his wife with tasks like putting on and
removing his socks and shoes. R. 58–59. She sometimes helps him off the toilet or

to get in and out of the shower. R. 59. When asked how he spends his daytime hours,
Cain testified that he walks to his mother-in-law’s house, 35 to 50 yards away from
his own, to visit with her and also helps with his sons’ schoolwork and snacks. R.

59. He also may watch his sons play sports in the yard. R. 60. However, there are
some days his pain is so bad that he cannot get out of bed. R. 61. Those days occur
three or four times per month. R. 61.

One of Cain’s mental health treatment providers is psychologist Dr. Todd
Walborn, who diagnosed him with PTSD, ADHD, and confusional arousal. R. 699.
He explained that
Mr. Cain suffers from chronic pain in his lower back, the three
psychological conditions listed above, and an inability to be gainfully
employed. These problems are interrelated. The chronic pain is
exacerbated by the depression and anxiety of the PTSD. The
depression and anxiety lead to his attention problems (ADHD) being
more severe. His inability to work and support his family contribute to
the depression and anxiety. His inability to work is secondary to his
chronic pain, inattention, depression and anxiety.

R. 699. In a supplemental note, Dr. Walborn observed that Cain “requires
psychotherapy to deal with his emotions related to PTSD as well as the chronic pain.
His emotional response to the chronic pain is understandable but makes him unable
to function in a work environment.” R. 825–26.
The ALJ issued her decision on February 2, 2021. R. 31. Under step one of
the five-step evaluation process, she found that Cain has not engaged in substantial
gainful activity since his alleged onset date of May 7, 2018. R. 18. The ALJ
concluded that Cain suffered from the severe impairment of degenerative disc
disease of the lumbar spine status post L5-S1 and L4-5 fusions.2 R. 18. She found
Cain’s other impairments of depression, anxiety, bipolar disorder, PTSD, ADHD,

and sleep apnea to be non-severe. R. 18–24. The ALJ noted that Cain’s medically
determinable impairments cause more than minimal limitations to his ability to
perform basic work activities. R. 24–25. But she concluded at step three of the

analysis that none of Cain’s impairments satisfied or medically equaled the severity
of one of those listed in the applicable regulations. R. 24–25.
Before proceeding to the fourth step, the ALJ determined that Cain had the
residual functional capacity (“RFC”) to perform a limited range of light work. R. 51.

More specifically, she found that Cain had the following limitations with respect to
light work, as defined in 20 C.F.R. § 404.1567(b):
[H]e can occasionally climb ramps and stairs; he can never claim
ladders, ropes, or scaffolds; he can frequently balance; he can
occasionally stoop, kneel, crouch, and crawl; he can never work at
unprotected heights, with hazardous machinery, or around open bodies
of water; he is precluded from commercial driving; he can have
occasional exposure to extreme cold and vibration; and he can
understand, remember, and carry out simple instructions consistent
with unskilled work activity.

R. 25. At the fourth step, the ALJ considered Cain’s age, education, work
experience, and RFC in determining that he was not capable of performing his past
relevant work as an electrician, brick layer, front end loader, and parts inspector.

2 The ALJ found Cain’s other alleged impairments to be non-severe. R. 20. Cain does not
challenge these findings.
R. 29. However, the ALJ determined that there were other jobs existing in the
national economy that Cain could perform, including work as a ticket taker; mail

sorter, non-postal; and inspector. R. 30. Therefore, the ALJ concluded that Cain was
not disabled within the meaning of the Social Security Act from May 7, 2018,
through the date of the decision. R. 30. Based on these findings, she denied Cain’s

application for benefits. R. 31.
IV. DISCUSSION
Cain makes three3 arguments in favor of remand: (1) the ALJ improperly
assessed the credibility of his subjective complaints of pain; (2) the ALJ improperly

evaluated the opinions of his treating psychologist; and (3) the ALJ erred in framing
the hypothetical to the VE. Doc. 17 at 17–25. For the following reasons, the court
finds that substantial evidence supports the ALJ’s determinations and that she

applied the proper standards to reach her conclusions.
A. Subjective Complaints of Pain
In addressing a claimant’s subjective description of his pain and symptoms,
the law is clear that

3 Instead of clearly delineating his arguments, Cain’s brief moves from one point to the next
without any clear transitions. The court has made every attempt to address each argument Cain
fully develops in his brief in support of remand. Although Cain makes passing reference to other
potential alleged errors, the court does not address any issues unsupported by substantive
arguments containing an explanation of the asserted error, citations to the record, and supporting
case law. These arguments have been abandoned. See Access Now, Inc. v. Sw. Airlines Co., 385
F.3d 1324, 1330 (11th Cir. 2004) (“[A] legal claim or argument that has not been briefed before
the court is deemed abandoned and its merits will not be addressed.”).
to establish a disability based on testimony of pain and other symptoms,
the claimant must satisfy two parts of a three-part test 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. If the ALJ
discredits subjective testimony, he must articulate explicit and adequate
reasons for doing so.

Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002) (citations omitted); see
also 20 C.F.R. §§ 404.1529. If a claimant satisfies the first part of the test, the ALJ
must evaluate the symptoms’ intensity, persistence, and effect on the claimant’s
ability to work. See 42 U.S.C. § 423(d)(5)(A); 20 C.F.R. §§ 404.1529(c) & (d);
20 C.F.R. §§ 416.929(c) & (d). While evaluating the evidence, the ALJ must
consider whether inconsistencies exist within the evidence or between the claimant’s
statements and the evidence, including his history, medical signs and laboratory
findings, and statements by medical sources or other sources about how his
symptoms affect him. 20 C.F.R. §§ 404.1529(c)(4) & 416.929(c)(4). In determining
whether substantial evidence supports an ALJ’s credibility determination, “[t]he
question is not . . . whether the ALJ could have reasonably credited [the claimant’s]
testimony, but whether the ALJ was clearly wrong to discredit it.” Werner v. Comm’r
of Soc. Sec., 421 F. App’x 935, 939 (11th Cir. 2011). The ALJ is not required to

conduct an explicit symptom analysis, but the reasons for her findings must be clear
enough to be obvious to a reviewing court. See Foote v. Chater, 67 F.3d 1553, 1562
(11th Cir. 1995). “A clearly articulated credibility finding with substantial
supporting evidence in the record will not be disturbed by a reviewing court.” Id.
(citation omitted).

The ALJ found here that Cain’s medically determinable impairments could
reasonably be expected to produce the alleged symptoms but that his statements
regarding the intensity, persistence, and limiting effects of these symptoms were not

entirely consistent with the medical evidence and other evidence in the record.
R. 27. This determination is supported by substantial evidence.
Cain’s contention that the ALJ did not consider the evidence in its entirety or
his condition as a whole (Doc. 17 at 20–22) is incorrect. The ALJ thoroughly

examined the medical evidence in the record in determining that Cain’s subjective
complaints were not entirely credible, and she adequately articulated the reasons her
finding. R. 19–22, 25 & 27–29; see Foote, 67 F.3d at 1562. Substantial evidence

supports this finding. As to his physical impairments, Cain’s complaints of disabling
pain were inconsistent with the following medical evidence:
• In October 2018, Cain saw a new orthopedist and complained of ongoing pain
with weakness and electrical sensations in his lower extremities. A needle
electromyogram showed he had “likely resolving” lumbosacral radiculopathy
consistent with his recent surgery. Physical examination showed a moderately
reduced range of motion and positive straight leg raise testing on both sides
with generalized weakness due to pain but overall 4/5 strength. R. 429–33.

• After a car accident in November 2018, Cain reported moderate pain with
sciatica, but on examination, Cain had normal range of motion, no focal
neurological deficits, normal sensory and motor function, and normal
coordination. An x-ray showed normal alignment and appearance, and there
was no evidence of any other abnormality. R. 446–47.
• At physical therapy in December 2018, Cain was able to complete all
exercises without wincing or rest breaks, and in January 2019 his orthopedist
noted that although Cain reported some ongoing symptoms in his legs, he had
excellent strength with no weakness and was able to stand from a seated
position without assistance. R. 681 & 685.

• A May 2019 MRI of Cain’s lumbar spine showed degeneration at L4–5, but
his L5–S1 fusion remained unremarkable. Cain went to a different
orthopedist, who noted that his lower extremities were areflexic but his
sensory and motor functions were grossly intact, and he had positive straight
leg raise testing and decreased range of motion due to guarding. R. 704 & 712.
Cain underwent a myelogram, CT scan, and discogram of his lumbar spine,
where he was observed to have pain on standing with normal ambulation,
negative straight leg raise testing, normal muscle bulk and tone, and normal
gait and station. R. 694 & 705.

• After L4–5 fusion surgery in June 2019, Cain reported improvement but
discomfort in his buttock. On examination, there was no evidence of new
motor or neurological deficits, and an x-ray showed the fusion hardware was
in the correct position. R. 710.

• An October 2019 examination showed Cain was grossly neurologically intact,
and an x-ray of his lumbar spine showed his bone graft was in a good position.
R. 724.

• Cain continued to complain of pain in December 2019, but an MRI did not
show any recurrent stenosis, herniation, or neural compromise that would
cause pain or that further surgery was warranted. The doctor recommended a
functional capacity evaluation (“FCE”). R. 701–02, 777 & 780. The FCE was
invalidated due to Cain’s inconsistent and submaximal effort. R. 765.

Cain also complains that the ALJ improperly evaluated the limiting effects of
his mental impairments. The court again disagrees. Cain’s complaints of disabling
symptoms due to his mental impairments, such as panic attacks and an inability to
concentrate, are inconsistent with the following medical evidence:
• Between March 2018 and February 2019, Cain’s psychiatrist, Dr. Arnand
Schachter, repeatedly noted that he had no focus problems and was fully alert
and oriented with intact attention, concentration, and average fund of
knowledge. R. 606, 609–10, 612–13, 615–16 & 618–23.

• Treatment notes from St. Vincent’s in May and July 2018 show that Cain did
not report any mental problems, and the examination notes reflect that Cain
was cooperative and pleasant with appropriate mood and affect and normal
judgment. R. 520–21 & 564–66.

• In September 2018, treatment notes from psychologist Dr. Walborn noted that
Cain had appropriate social skills, a pleasant and cooperative demeanor,
normal or above-normal intelligence, no anxiety, no mania, no hypomania,
and appropriate eye contact. R. 420.

• In October and November 2018, Cain sometimes denied and sometimes
admitted having anxiety or depression. Examinations showed he was fully
alert and oriented, had a normal mood and appropriate affect, intact judgment
and insight, normal attention span and ability to concentrate, and a normal
mental status exam. R. 434–35, 447 & 587–88.

• In February 2019, Dr. Schachter noted Cain’s mood as manic and increased
his medications. Otherwise, Cain’s thoughts were goal-directed and he had
good insight and judgment and intact memory. R. 607.

• Later that month, Cain attended a consultative examination with Dr. John
Neville where Cain reported his mood as more stable and better concentration
with the change in medication dosage. During Dr. Neville’s examination,
Cain had a neutral mood, was alert and oriented, could do a variety of memory
and concentration tasks, was not confused, and had no abnormal thought
content, good insight and judgment, and average intellectual functioning. Dr.
Neville observed Cain as attentive and cooperative and that he followed
instructions well. R. 626–28.

• In May 2019, Cain was again observed as having a normal affect and mood
and being active, alert, cooperative, and fully oriented. R. 694.

• In October 2020, Dr. Walborn noted that Cain had appropriate social skills, a
pleasant and cooperative demeanor, and normal or above intelligence, but did
exhibit some signs of anxiety and depression. R. 825.

The ALJ also considered Cain’s daily activities and their relationship to his
alleged physical and mental symptoms. R. 22 & 25–26. For example, Cain reported
to Dr. Neville in February 2019 that he could drive, shop with his wife, perform the
vast majority of his self-care and personal hygiene activities, and accomplish

household chores. R. 627. Similarly, he reported in January 2020 that he performs
light housework, drives short distances, and does not need assistance with his self-
care activities other than putting on his socks and shoes. R. 766. He also stated in
his function report that he participated in the following social activities: assisting

with homework, watching movies, attending basketball practice, going to church,
and attending medical appointments. R. 343. These reported activities further
undermine his claim of disabling limitations. See Lynn v. Comm’r of Soc. Sec., 791

F. App’x 888, 889 (11th Cir. 2020) (determining that substantial evidence supported
the ALJ’s finding that the claimant’s subjective complaints were inconsistent with
objective medical evidence and other aspects of her testimony, including her
reported activities of operating a motor vehicle, preparing meals, performing

household chores, doing laundry, and grooming herself); Meehan v. Comm’r of Soc.
Sec., 776 F. App’x 599, 603 (11th Cir. 2019) (holding that the ALJ properly found
a subjective complaint inconsistent with a record of simple daily activities).

The ALJ also commented on Cain’s noncompliance with his medical
professionals’ recommendations in discrediting his claim of disabling pain.4 R. 20
& 28. For example, Dr. Schachter recommended psychotherapy in March 2018, and

Cain consistently met with Dr. Walborn until September 2018. R. 421, 622–23 &
668–72. Although Dr. Walborn told Cain during their September 2018 visit that he
needed continue psychotherapy (R. 421), the record shows that Cain did not return

to Dr. Walborn for regular therapy after that visit and even refused therapy on several
occasions.5 R. 607, 613 & 616. As another example, Cain’s orthopedist told him to
stop smoking because it could delay bone growth after his surgeries (R. 710–11), but
he continued to smoke. R. 724 & 777. In fact, Cain admitted that he smoked up to

half of a pack of cigarettes every day. R. 51. Cain also stopped using a bone
stimulator and did not regularly attend physical therapy after his L4-5 fusion surgery.
R. 724.

4 The ALJ did not explore Cain’s ability to pay for treatment. As a general rule, “the ALJ may not
draw an adverse inference from a claimant’s lack of medical treatment without first considering
the claimant’s explanation for his failure to seek treatment.” Brown v. Comm’r of Soc. Sec., 425
F. App’x 813, 817 (11th Cir. 2011) (citing S.S.R. 96-7). Poverty can excuse a claimant’s non-
compliance with medical treatment. Id. (citing Dawkins v. Bowen, 848 F.2d 1211, 1213 (11th Cir.
1988)). Accordingly, the ALJ ordinarily must consider whether the claimant can afford medical
treatment before denying an application for disability benefits based on a failure to comply with
prescribed medical treatment. Id. (citing Ellison v. Barnhart, 355 F.3d 1272, 1275 (11th Cir.
2003)). But where, as here, the failure to follow medical treatment is not a principal factor in the
ALJ’s decision, “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).
5 The ALJ also noted the inconsistency between Cain’s testimony at the hearing that he continued
to see a therapist every two weeks (R. 56) and the record evidence of his refusal to attend therapy
sessions and failure to visit Dr. Walborn since September 2018. R. 20, 28, 607, 613 & 616; see 20
C.F.R. § 404.1529(c)(4) (permitting an ALJ to consider conflicts between a claimant’s testimony
and the record when evaluating the severity of symptoms).
For all of these reasons, the ALJ correctly considered “the consistency of
[Cain’s] statements” with the remainder of the evidence in the record. See SSR 16-

3p, 2017 WL 5180304, at *8. The court finds that the ALJ’s determinations of
Cain’s credibility with respect to his subjective complaints are supported by
substantial evidence.

B. Mental Health Professional Opinions
Cain argues that the ALJ improperly rejected the opinions of his treating
psychologist Dr. Walborn. Doc. 17 at 23–24. The court disagrees and finds that the
ALJ properly considered and articulated his evaluation of the psychologist’s

opinions consistent with the applicable regulations such that substantial evidence
supports the ALJ’s decision.
As a threshold matter, Cain’s brief relies on an obsolete hierarchy of medical

opinions. Before March 27, 2017, the opinions of examining physicians were given
more weight than non-examining physicians, treating physicians more than non-
treating physicians, and specialists more than non-specialist physicians. 20 C.F.R.
§ 416.927(c)(1–5). Under the new regulations, however, an ALJ must “not defer or

give any specific evidentiary weight, including controlling weight, to any medical
opinion(s) or prior administrative medical finding(s), including those from [a
claimant’s] medical sources.” Id. Instead, the new regulation provides several

factors informing the ALJ’s decision on the weight to give a claimant’s proffered
medical opinions. Those factors include the supportability of the medical opinion,
its consistency with other record evidence, the physician’s relationship with the

claimant, the physician’s specialty, and other relevant information, such as the
physician’s familiarity with the other record evidence and with making a claim for
disability. 20 C.F.R. § 404.1520c(c)(1)–(5). In Harner v. Social Security

Administration, 38 F.4th 892, 897–98 (11th Cir. 2022), the Eleventh Circuit
confirmed that these new regulations eliminate the treating physician hierarchy.
Here, the new regulations apply because Cain filed his claim on November 28, 2018.
See 20 C.F.R. § 404.1520c(a) (stating that the new regulations apply to “claims filed

. . . on or after March 27, 2017”).
The new regulations also changed the standards an ALJ should apply when
articulating her assessment of medical source opinions. First, an ALJ need not

assign specific evidentiary weight to medical opinions based on their source. See
Tucker v. Saul, 2020 WL 3489427, at *6 (N.D. Ala. June 26, 2020). Second, the
ALJ does not have to “give good reasons” for the weight she assigns to treating
source opinions. Compare 20 C.F.R. § 416.927(c)(2) (“We will always give good

reasons in our notice of determination or decision for the weight we give your
treating source’s medical opinion.”), with 20 C.F.R. § 416.920c(a) (“We will not
defer or give any specific evidentiary weight, including controlling weight, to any

medical opinion(s) or prior administrative medical finding(s), including those from
your medical sources.”).
The court finds that the ALJ properly evaluated Dr. Walborn’s statements

under the new regulations. Put simply, the ALJ followed the relevant regulations
and properly analyzed Dr. Walborn’s findings. She explained how Dr. Walborn’s
opinions were not supported by or consistent with his own examinations and the

other objective medical evidence. R. 20–21. For example, throughout his own
treatment notes, Dr. Walborn noted that Cain had appropriate social skills, a pleasant
and cooperative demeanor, normal or above intelligence, unimpaired speech, no
anxiety, no mania, no hypomania, appropriate eye contact, and no psychosis or

personality disorder. R. 420 & 825. The ALJ also noted that Dr. Walborn’s
statements were inconsistent with examination findings from Dr. Schachter, Cain’s
psychiatrist. Dr. Schachter repeatedly observed that Cain was alert and oriented, had

intact concentration and an average fund of knowledge, goal-directed thoughts, good
insight and judgment, and intact memory. R. 606–23. This evidence undermines Dr.
Walborn’s assertion that Cain’s mental impairments are completely disabling. See
Matos v. Comm’r of Soc. Sec., 2022 WL 97144, at *4 (11th Cir. Jan. 10, 2022)

(finding medical statement unpersuasive where unsupported by source’s own
treatment notes and inconsistent with other medical record).
Moreover, as both the ALJ and the Commissioner argue, Dr. Walborn did not

provide a medical opinion consistent with the regulations. A medical opinion “is a
statement from a medical source about what you can still do despite your
impairment(s).” 20 C.F.R. §§ 404.1513(a)(2), 416.913(a)(2). The opinion must state

whether the claimant has limitations or restrictions in one of four ways: (1) ability
to perform physical demands of work activities; (2) ability to perform mental
demands of work activities; (3) ability to perform other demands of work; or

(4) ability to adapt to environmental conditions. Id. Dr. Walborn’s notes, diagnoses,
and statement that Cain is unable to work do not qualify under these regulations as
a medical opinion.
For these reasons, the court concludes that the ALJ applied the proper standard

in evaluating Cain’s medical evidence and did not err in evaluating Dr. Walborn’s
opinion. The ALJ clearly articulated her reasons for finding that the opinion was not
well supported or consistent with other medical records. Substantial evidence

supported this decision.
C. VE Hypothetical
Finally, Cain argues that the VE hypothetical did not include Dr. Walborn’s
proposed mental limitations. Doc. 17 at 23. An ALJ must pose a hypothetical

question to the VE that comprehensively describes the claimant’s impairments.
Pendley v. Heckler, 767 F.2d 1561, 1563 (11th Cir. 1985). However, the ALJ is not
required to include findings that she properly rejects as unsupported by the record.

Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158–59 (11th Cir. 2004).
The ALJ’s hypothetical to the VE contained all of Cain’s legitimate
limitations. First, the ALJ included Cain’s credible physical limitations in the VE’s
hypothetical. As discussed above, the ALJ properly rejected Cain’s more restrictive
subjective complaints. Second, the ALJ also properly refused to incorporate Dr.
Walborn’s mental limitations because they were not supported by his own findings
or records from other medical sources. Because the law does not require the ALJ to
include in the VE’s hypothetical any unsupported limitations, Crawford, 363 F.3d
at 1161, the ALJ here did not err in framing her hypothetical to the VE.
V. CONCLUSION
For these reasons, the Commissioner’s decision is supported by substantial
evidence and based upon the proper legal standards. Accordingly, the decision of
the Commissioner is due to be affirmed. A final judgment will be entered separately.
DONE and ORDERED on May 17, 2023.
OF on
GRAY M.BORDEN
UNITED STATES MAGISTRATE JUDGE

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Source: Frix Law Library, https://www.frixlaw.com/law-library/cases/9991675. Public record. Not legal advice.