Case Name in Social Security Case - Unavailable

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UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF FLORIDA
TALLAHASSEE DIVISION
CASSANDRA MOORE
O/B/O R.T.B., a minor,
Plaintiff,
v. 	Case No.: 4:24cv513/TKW/ZCB
COMMISSIONER OF SOCIAL
SECURITY,
Defendant.
____________________________________/
REPORT AND RECOMMENDATION
This is a Social Security appeal filed under 42 U.S.C. § 405(g).
Plaintiff Cassandra Moore, on behalf of her minor daughter R.T.B., seeks
judicial review of the Social Security Commissioner’s decision denying
disability 	benefits. 	Because 	substantial 	evidence 	supports 	the
Commissioner’s decision, it should be affirmed.
I. 	Procedural History
Plaintiff applied for supplemental security income on behalf of her
minor child R.T.B., alleging that R.T.B. became disabled on January 1,
2018. 	(Tr. 17, 236-46).1 	The Social Security Administration denied her
1 Citations to the administrative record filed by the Commissioner are
designated as “Tr.” 	The page numbers cited are those found on the
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application. 	(Tr. 17, 117-125, 136-42). 	Plaintiff requested a hearing
before an Administrative Law Judge (ALJ), which was held on May 7,
2024. 	(Tr. 38-62). 	The ALJ issued a written decision on June 7, 2024,
finding Plaintiff was not disabled. 	(Tr. 17-31). 	The Appeals Council
denied Plaintiff’s request for review. (Tr. 1-11). Thus, the ALJ’s decision
stands as the final decision of the Commissioner. 	Plaintiff has timely
requested judicial review under 42 U.S.C. § 405(g).
II. 	The Social Security Administration’s Sequential
Evaluation Process for Childhood Disability Claims
The Social Security Administration uses a three-step sequential
process to determine if a child is disabled. 	Bryant v. Soc. Sec. Admin.,
478 F. App’x 644, 645 (11th Cir. 2012); 20 C.F.R. § 416.924. First, the
Commissioner 	must 	determine 	whether 	the 	child 	is 	engaged 	in
substantial gainful activity. 20 C.F.R. § 416.924(b). 	If so, then the child
is not disabled. 	Id. 	Second, if the child is not engaged in substantial
gainful activity, then the Commissioner will determine whether the child
has a severe impairment. Id. § 416.924(c). The child must have a severe
impairment to be disabled. 	Id. 	Third, the Commissioner determines
bottom right corner of each page of the transcript, rather than the
numbers that were assigned by the Court’s electronic docketing system.
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whether the child’s impairment or combination of impairments meets, is
medically equal to, or functionally equal to an impairment listed in
Appendix 1 or 20 C.F.R. part 404, subpart P. 	20 C.F.R. §§ 416.924(d),
416.925. 	If the answer is yes, then the child is disabled. 20 C.F.R. §
416.924(d)(1).
III. 	The ALJ’s Decision
Here, the ALJ found at step one that R.T.B. had not engaged in
substantial gainful activity since the application date. 	(Tr. 18, Finding
2). 	At step two, the ALJ found that R.T.B. suffered from the following
severe 	impairments: 	“scoliosis, 	asthma, 	depression, 	anxiety, 	and
attention deficit hyperactivity disorder (ADHD).” (Tr. 18, Finding 3).
At step three, the ALJ determined that R.T.B. did not have an
impairment or combination of impairments that met, medically equaled,
or functionally equaled the severity of one of the listed impairments in
20 C.F.R. Part 404, Subpart P, Appendix 1. 	(Tr. 19-20, Findings 4 & 5).
Based on these findings, the ALJ concluded that R.T.B. was not disabled.
(Tr. 31, Finding 6).
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IV. Standard of Review
When this Court reviews a Social Security ALJ’s decision, the
question 	is 	not 	whether 	the 	Court 	would 	have 	reached 	the 	same
conclusion had it been in the ALJ’s shoes. Instead, the Court must “give
substantial deference” to the ALJ’s decision. 	Dyer v. Barnhart, 395 F.3d
1206, 1212 (11th Cir. 2005). 	Thus, this Court’s task is limited to
determining whether the ALJ’s decision was “supported by substantial
evidence and based on proper legal standards.” 	Crawford v. Comm’r of
Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004).
The 	substantial 	evidence 	standard 	is 	“not 	high.” 	Biestek 	v.
Berryhill, 587 U.S. 97, 103 (2019). 	It requires “more than a mere
scintilla, but less than a preponderance.” Dyer, 395 F.3d at 1210 (cleaned
up). 	This means that the Court should uphold the ALJ’s decision if it is
“supported by substantial evidence . . ., even if the proof preponderates
against it.” Phillips v. Barnhart, 357 F.3d 1232, 1240 n.8 (11th Cir. 2004)
(cleaned up). 	When conducting the substantial evidence review, the
Court does not “decide the facts anew, reweigh the evidence, or substitute
[its] judgment” for that of the ALJ. 	Simon v. Comm’r, Soc. Sec. Admin.,
7 F.4th 1094, 1104 (11th Cir. 2021) (cleaned up).
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V. 	Discussion
Where—as here—an ALJ finds that a child’s impairments do not
meet or equal an impairment listed in Part 404, Subpart P, Appendix 1,
the ALJ must evaluate whether the child’s limitations functionally equal
one of the listed impairments. 	20 C.F.R. § 426.926a. 	An impairment or
combination of impairments functionally equals a listed impairment if it
results in “marked” limitations in two domains of functioning or an
“extreme” limitation in one domain. 20 C.F.R. § 426.926a(a), (d). The six
domains of functioning are: (1) acquiring and using information; (2)
attending and completing tasks; (3) interacting and relating with others;
(4) moving about and manipulating objects; (5) caring for oneself; and (6)
health and physical well-being. 20 C.F.R. § 416.926a(b)(1)(i)-(vi).
A “marked” limitation is defined as a limitation that “interferes
seriously with [the] ability to independently initiate, sustain, or complete
activities,” and is “more than moderate.” 	20 C.F.R. § 416.926a(e)(2)(i).
An “extreme” limitation is reserved for the “worst limitations” and is
defined as a limitation that “interferes very seriously with [the] ability to
independently initiate, sustain, or complete activities,” but “does not
necessarily mean a total lack or loss of ability to function.” 	20 C.F.R. §
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416.926a(e)(3)(i). In evaluating the severity of an impairment within the
six domains, the child’s independent ability to function is to be compared
with other children her age who do not have impairments. 	20 C.F.R. §
416.924a(b)(3).
In this case, the ALJ determined that R.T.B. had “less than a
marked” limitation in all six functional domains. 	(Tr. 21). 	Plaintiff
argues the ALJ erred by not properly weighing the medical opinion of
Nurse Practitioner (NP) Anderson. 	NP Anderson was a provider at
Florida 	Therapy 	Services 	who 	opined 	that 	R.T.B. 	had 	“marked”
limitations 	in 	the 	domains 	of 	attending 	and 	completing 	tasks 	and
interacting and relating with others. (Doc. 11 at 7; Tr. 919).
When determining the weight to give a medical opinion, an ALJ
must 	consider the 	following: 	(1) the 	opinion’s supportability or the
relevance of the objective evidence to the opinion; (2) the opinion’s
consistency with the objective evidence; (3) the medical professional’s
relationship with Plaintiff; (4) the professional’s specialization; and (5)
other factors, such as the medical professional’s familiarity with other
record evidence. 	20 C.F.R. § 416.920c(c). 	The first two factors are the
most important. 	Id. § 416.920c(b)(2). 	And the ALJ “must state with
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particularity the weight given to different medical opinions and the
reasons” for that weight. Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176,
1179 (11th Cir. 2011). 	An ALJ is “not required to give any specific
evidentiary weight to treating physicians’ opinions.” 	Adams v. Soc. Sec.
Admin., No. 23-11233, 2024 WL 2846726, at *2 (11th Cir. June 5, 2024).
Here, 	the 	ALJ 	determined 	that 	NP 	Anderson’s 	opinion 	was
unpersuasive. In reaching that conclusion, the ALJ found NP Anderson’s
opinion to be inconsistent with the record. (Tr. 30). Specifically, the ALJ
found NP Anderson’s opinion inconsistent “with treatment records that
reflect essentially unremarkable mental status examinations with some
instances of abnormal mood and attention, improvement with medication
adjustments, and lack of IEP for learning difficulties.” (Id.).
Contrary to Plaintiff’s argument, there is substantial evidence to
support the ALJ’s evaluation of NP Anderson’s opinion. For example,
there is evidence in the record of unremarkable findings on Plaintiff’s
mental status examinations at Florida Therapy Services. 	During her
initial intake exam, the treatment notes reflect that R.T.B.’s social
functioning, self-care functioning, motor skills, sensory skills, affective
expression, and language utilization were all in normal limits. (Tr. 1205).
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At some other follow-up appointments her mood was found to be good and
her affect stable. (Tr. 928, 951, 975, 1222, 1258, 1271, 1282, 1307, 1316,
1326). 	She 	routinely 	was 	found 	to 	be 	polite 	and 	cooperative, 	her
grooming was appropriate, and she was alert and oriented. (Tr. 894, 906,
928, 939, 940, 951, 962, 974, 975, 1222, 1234, 1246, 1258, 1271, 1282,
1294, 1307, 1316, 1325, 1326). 	Her rate of speech was consistently
normal and thought process logical. 	(Tr. 895, 907, 928, 929, 940, 951,
952, 962, 963, 975, 1223, 1235, 1247, 1259, 1271, 1272, 1283, 1295, 1307,
1308, 1316, 1326). 	She often denied delusions, hallucinations, thoughts
of self-harm, and aggression. (Tr. 895, 907, 929, 941, 952, 963, 976, 1223,
1235, 1247, 1259, 1272, 1283, 1295, 1308, 1317, 1327). 	About fifty
percent of the time, her attention and concentration were normal (Tr.
930, 942, 953, 964, 1260, 1273, 1284, 1296), while the other fifty percent
of the time she had easy distractibility or a short attention span (Tr. 896,
908, 977, 1224, 1236, 1248, 1309, 1318, 1328). Her insight and judgment
were often found to be fair or without impairment, and she could explain
recent and remote events and recall current events. 	(Tr. 896, 908, 930,
941, 942, 953, 964, 976, 977, 1224, 1236, 1248, 1260, 1273, 1284, 1296,
1309, 1318, 1328). 	Her language and fund of knowledge were routinely
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found to be normal. 	(Tr. 897, 909, 930, 942, 953, 964, 977, 1225, 1236,
1249, 1260, 1273, 1285, 1297, 1309, 1318).
There is also evidence that R.T.B.’s symptoms improved with
proper medication. 	(Tr. 922, 933, 945, 956); see also (Tr. 1312 (noting
R.T.B. 	stated 	that 	she 	saw 	improvement 	with 	mood 	when 	taking
medication as directed)). 	Finally, no individualized educational plan
(IEP) 	was 	implemented 	for 	R.T.B. 	at 	her 	school, 	which 	the 	ALJ
reasonably found inconsistent with NP Anderson’s opinion that she had
a “marked” limitation in attending and completing tasks and interacting
and relating with others. (Tr. 30, 56).
Moreover, substantial evidence in the record supports the ALJ’s
ultimate 	finding 	that 	R.T.B. 	was 	not 	disabled. 	At 	the 	initial
determination level, state agency medical consultant William Prather,
M.D., found that R.T.B. had “less than marked” limitations in the domain
health and physical wellbeing and “no limitations” in the remaining five
domains. 	(Tr. 94-95). 	At the reconsideration determination level, state
agency consultants Christine Booth, M.D., and Jessy Sadonik, Psy.D.,
found that R.T.B. had “no limitations” in moving about and manipulating
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objects and “less than marked” limitations in all other domains. (Tr. 107-
109).
Additionally, R.T.B.’s teachers did not see serious problems in her
functioning. R.T.B.’s fourth-grade teacher, J. Noble, completed a Teacher
Questionnaire where she was asked to rate the seriousness of R.T.B.’s
impairments compared to same-aged children without impairments. (Tr.
311-18). 	Ms. Noble was provided with a scale of one to five, with one
meaning the child had “no problems” and five meaning the child had “a
very serious problem.” 	(Tr. 312). 	Ms. Noble indicated that none of
R.T.B.’s impairments caused more than “an obvious problem” (a three
rating on the scale) compared to other same-aged children without
impairments.2 	(Tr. 	312-16). 	R.T.B.’s 	fifth-grade 	teacher, 	Rebecca
Gonzalez, similarly did not rate any areas of functioning as more than a
three rating or more than “an obvious problem.” 	(Tr. 339-46). 	Indeed,
2 	Plaintiff 	relies 	on 	Ms. 	Noble’s 	questionnaire, 	arguing 	that 	it 	is
consistent with NP Anderson’s opinion. 	(Doc. 11 at 10-11). 	But it is
unclear how Ms. Noble’s opinion that R.T.B. had “an obvious problem,”
but 	no 	“serious 	problems,” 	in 	attending 	and 	completing 	tasks 	and
interacting and relating with others is consistent with NP Anderson’s
opinion that R.T.B. had “marked limitations” that “interferes seriously”
with 	R.T.B.’s 	ability 	to 	function 	in 	those 	domains. 	20 	C.F.R. 	§
416.926a(e)(2)(i).
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Ms. Gonzales only found R.T.B. had “an obvious problem” (three rating)
in the area of “reading and comprehending written material.” (Tr. 340).
For all other areas of functioning, she stated R.T.B. had “no problem” (a
one rating) or only “a slight problem” (a two rating). (Tr. 340-44).
Plaintiff 	argues 	that 	the 	ALJ’s 	conclusion 	regarding 	NP
Anderson’s opinion was erroneous because the ALJ offered “no citations
to the record in support of [his] assertion, appearing instead to refer to
summaries of evidence elsewhere in the decision.” (Doc. 11 at 9). But the
ALJ was not required to repeat his previous conclusions about the
medical evidence in the paragraph discussing NP Anderson’s opinion.
See Raper v. Comm’r of Soc. Sec., 89 F.4th 1261, 1265 (11th Cir. 2024)
(“We agree with our sister circuits that it is proper to read the ALJ’s
decision as a whole, and it would be needless formality to have the ALJ
repeat substantially similar factual analyses in this circumstance.”)
(cleaned up). 	And this is not a case where the ALJ broadly rejected
evidence, preventing this Court from concluding that the ALJ failed to
consider R.T.B.’s medical condition as a whole. 	Mitchell v. Comm’r, Soc.
Sec. Admin., 771 F.3d 780, 782 (11th Cir. 2014).
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When the ALJ’s decision is read as a whole, it is evident that the
ALJ considered the relevant evidence and provided a sufficient rationale
to support his conclusions. 	See, e.g., Raper, 89 F.4th at 1265 (affirming
when the 	ALJ “articulated good cause 	for discounting the 	treating
physician’s 	opinion 	because—when 	the 	ALJ’s 	decision 	is 	read 	as 	a
whole—it is clear why the ALJ found the opinion inconsistent with the
record.”). 	The ALJ did not err by considering NP Anderson’s opinion in
context of the entire record and weighing it accordingly. See, e.g., Walker
v. Soc. Sec. Admin., Comm’r, 987 F.3d 1333, 1339 (11th Cir. 2021)
(finding 	that 	substantial 	evidence 	supported 	the 	ALJ’s 	decision 	to
discount a physician’s opinion where the medical opinion “conflicted with
other evidence, including several examinations”).
It is not this Court’s role to “decide the facts anew, reweigh the
evidence, or substitute our judgment for that of the” ALJ. 	Mitchell, 771
F.3d at 782. Here, the ALJ applied the appropriate legal framework and
adequately explained his supportability and consistency findings. 	The
ALJ was not required to accept NP Anderson’s opinion without question;
rather, the ALJ retained the ability to weigh NP Anderson’s opinion
against other medical evidence. 	Because the ALJ’s decision to assign
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little persuasive value to NP Anderson’s opinion was supported by
substantial evidence in the record, affirmance is warranted. 	See Epps v.
Soc. Sec. Admin, No. 22-13674, 2024 WL 20837, at *6 (11th Cir. Jan 2.
2024) (affirming and explaining that substantial evidence supported the
ALJ’s decision to discount physician’s opinion because it was contradicted
by other evidence in the record).
VI. 	Conclusion
For the reasons above, it is respectfully RECOMMENDED that:
1) The Commissioner’s decision be AFFIRMED.
2) The Clerk of Court be directed to enter final judgment for the
Commissioner under sentence four of 42 U.S.C. § 405(g).
At Pensacola, Florida, this 1st day of December 2025.
/s/ Zachary C. Bolitho
Zachary C. Bolitho
United States Magistrate Judge
Notice to the Parties
Objections must be filed within fourteen days of the date of the
Report and Recommendation. 	Any different deadline that may appear
on the electronic docket is for the court’s internal use only and does not
control. 	An objecting party must serve a copy of the objections on all
other parties. 	A party who fails to object to the magistrate judge’s
findings or recommendations contained in a report and recommendation
waives the right to challenge on appeal the district court’s order based on
unobjected-to factual and legal conclusions. 	See 11th Cir. Rule 3-1; 28
U.S.C. § 636.
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