Benjamin Morales, Jr. v. Commissioner of Social Security

[DO NOT PUBLISH]
In the
United States Court of Appeals
For the Eleventh Circuit
____________________
No. 21-13175
Non-Argument Calendar
____________________
BENJAMIN MORALES, JR.,
Plaintiff-Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant-Appellee.
____________________
Appeal from the United States District Court
for the Middle District of Florida
D.C. Docket No. 6:20-cv-00724-GKS-DCI
____________________
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2 Opinion of the Court 21-13175
Before WILSON, L UCK , and H ULL , Circuit Judges.
PER CURIAM:
Benjamin Morales, Jr., appeals the district court’s order
affirming the Social Security Administration (“SSA”)
Commissioner’s denial of his application for supplemental security
income (“SSI”). After review, we affirm the district court’s order.
I. BACKGROUND
A. Morales’s Application
On November 29, 2016, Morales applied for SSI, alleging
that he was disabled since January 16, 2016. He later amended the
alleged onset date to November 29, 2016, the date of his
application.
After the SSA denied Morales’s claim, Morales requested a
hearing before an administrative law judge (“ALJ”). On May 16,
2019, the ALJ held a hearing, heard testimony from Morales, and
reviewed extensive medical records. We outline the relevant
evidence.
B. Morales’s Testimony
Morales testified that he was an unemployed, 48-year-old
high school graduate. Morales lived at home with his mother and
his three-year-old son. Morales explained that he had tried to find
work but stopped looking because he was never hired.
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21-13175 Opinion of the Court 3
Morales had back problems due to his former profession as
a break dancer, which caused stenosis, lumbar problems, and neck
problems. Morales had a lot of back spasms with pain that spread
to his arms and legs. He was using a walking cane for about a year
and a half to take pressure off of his back. He took hydrocodone
three times per day for his back pain, but it was not very effective
because it reduced his pain from a ten to only a seven or eight on a
ten-point scale.
Morales woke up every morning with crying spells due to
his depression. Morales had two or three panic attacks each day,
even though he regularly took medication for anxiety. Because of
his back problems and anxiety, Morales could sleep for only about
six hours on a good night and four hours or less on a bad night. He
got headaches about four times per week, each lasting about 30 or
40 minutes.
Morales could not lift his son, and his epilepsy made him
afraid to carry his son. He did his own laundry but could not carry
a full laundry basket. He sometimes drove, but his anxiety
prevented him from driving much. Typically, he stayed in his
room and watched television. Morales had friends who would visit
him, but he would not go out to social activities. He regularly
attended religious services with his mother, but he struggled to sit
for long periods of time.
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4 Opinion of the Court 21-13175
C. Vocational Expert’s (“VE”) Testimony
The ALJ posed two hypotheticals to the VE who testified.
First, the ALJ asked the VE whether there would be jobs in the
national economy for a person who (1) is able to perform at the
“light” exertional level; (2) could never climb ladders, ropes, or
scaffolds; (3) could occasionally climb ramps or stairs; (4) could
occasionally balance, stoop, kneel, crouch, or crawl; (5) could have
no exposure to excessive vibration, unprotected heights, or
hazardous machinery; (6) was limited to simple routine tasks with
only occasional interaction with the public and coworkers; (7) had
“no production quota”1; (8) had only occasional supervision; and
(9) was limited to low-stress work, with only occasional
decision-making and occasional changes in the work setting. The
VE responded that there would be jobs in the national economy
with those limitations, including (1) a cafeteria attendant2; (2) a
cleaner/housekeeper; and (3) a folder.
Second, the ALJ asked the VE the same hypothetical with
the same limitations, except the ALJ reduced the exertional
limitation to “sedentary.” The VE testified that this individual
could perform work as (1) an address clerk; (2) a table worker; and
1 The ALJ clarified that by “no production quota,” he meant “no strict
production standard and no rigid production pace, such as an automated line
outside the worker’s control.”
2 Later, the VE clarified that, although the cafeteria attendant position required
being in public, it did not require interaction with the public.
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21-13175 Opinion of the Court 5
(3) a sorter. The VE stated that there would be a few other jobs,
but one or more absences per month would preclude work by the
seventh month.
The VE confirmed that her testimony was consistent with
the Dictionary of Occupational Titles (“DOT”) and its companion
publications. The VE acknowledged that the limitations for
interactions with the public and coworkers and the “fast-paced
production rate” were not addressed by the DOT. Thus, the VE
had relied on her experience and training as a vocational counselor
to identify jobs meeting the limitations in the two hypotheticals.
D. Medical History for Morales’s Mental Impairments
From 2012 to 2019, Morales regularly sought mental health
treatment from Impower providers. Morales’s June 2012 intake
form noted a Global Assessment of Functioning (“GAF”) score of
48 and diagnoses of depressive disorder, bipolar II disorder, and
seizures.3
3 The GAF is a numeric scale (0 through 100) intended to rate the
psychological, social, and occupational functioning of adults.
See American
Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders
32–33 (4th ed. 2000). Scores between 51 and 60 indicate moderate difficulty in
functioning, whereas lower scores between 41 and 50 indicate serious
difficulty in functioning.
Id. at 34.
As noted later, both the 2013 and 2022 versions of the fifth edition of
the
Diagnostic and Statistical Manual of Mental Disorders no longer use GAF
scores for several reasons, including their inconsistent nature due to the lack
of standardization.
See American Psychiatric Association, Diagnostic and
Statistical Manual of Mental Disorders 16 (5th ed. 2013); American Psychiatric
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6 Opinion of the Court 21-13175
From April to August 2016, Morales saw Impower
psychiatrist Najib Kirmani, M.D., three times for mental health
treatment. At the April 2016 visit, Dr. Kirmani assigned him a GAF
score of 65. In June 2016, Dr. Kirmani reported that Morales’s
mood had improved, and in August 2016, Dr. Kirmani noted
Morales’s mood was stable.
In September 2016, Morales saw an Impower counselor and
reported struggling with being impulsive, angry, nervous, and
anxious and having mood swings. The counselor assigned him a
GAF score of 60.
In June 2017, Morales saw Dr. Kirmani again after his father
passed away. Dr. Kirmani prescribed a new medication and
assigned a GAF score of 48.
In July 2017, Morales saw Impower psychiatrist Kazi
Ahmad, M.D. Morales reported feeling tense and irritable, lashing
out, screaming, and punching walls. Dr. Ahmad diagnosed him
with intermittent explosive disorder, added a new prescription, and
assigned him a GAF score of 48.
Later that month, Morales met with an Impower counselor
about his ongoing anxiety and depression, and the counselor
assigned him a GAF score of 60.
Association, Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed.
text rev. 2022).
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21-13175 Opinion of the Court 7
In August 2017, Morales saw Dr. Ahmad again and reported
feeling less anxiety and denied feeling tension, irritability, and
depression. Despite these improvements, Dr. Ahmad assigned him
a GAF score of 48.
Morales was assigned a GAF score of 48 during his visits on
the following dates: December 20, 2017; December 28, 2017;
January 23, 2018; February 20, 2018; March 20, 2018; April 9, 2018;
May 7, 2018; June 12, 2018; July 2, 2018; July 30, 2018; August 20,
2018; October 19, 2018; November 12, 2018; December 4, 2018;
December 31, 2018; January 21, 2019; February 14, 2019; March 14,
2019; and April 11, 2019. During that same time, however, a
counselor assigned Morales a GAF score of 60 on April 10, 2018 and
65 on July 14, 2018.
E. Medical History for Morales’s Physical Impairments
From November 2015 to January 2017, Morales regularly
saw primary care physician Son Chau, M.D., and nurse practitioner
Lindsay Marlene, ARNP. They assessed Morales as having chronic
pain, prescribed pain medication, and referred Morales for physical
therapy and to a neurosurgeon.
In April 2016, Morales had an MRI of both his cervical spine
(i.e., neck area) and lumbar spine (i.e., back area). For the April
2016 cervical spine MRI, there are no results listed for C1-C2, but
the results for the rest of the intervertebral discs and motion
segments showed the following:
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8 Opinion of the Court 21-13175
C2-C3: No significant disc bulge or protrusion is
identified. No significant facet
osteoarthropathy or canal or foraminal
stenosis is noted.
C3-C4: No significant disc bulge or protrusion is
identified. Mild left foraminal stenosis and
facet arthropathy. No right foraminal or
central canal stenosis.
C4-C5: Right paracentral disc protrusion and
subjacent thin spondylitic ridge. Moderate
right foraminal stenosis. No left foraminal
stenosis. Mild central spinal stenosis. No
facet abnormality.
C5-C6: No significant disc bulge or protrusion is
identified. Mild left foraminal stenosis. No
right foraminal or central canal stenosis.
C6-C7: Left medial foraminal disc protrusion.
Mild left foraminal stenosis. No right
foraminal or central canal stenosis.
C7-T1: No significant disc bulge or protrusion is
identified. No significant facet
osteoarthropathy or canal or foraminal
stenosis is noted.
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21-13175 Opinion of the Court 9
(Emphasis added.) And the April 2016 lumbar spine MRI showed
the following:
L1-L2: No significant disc bulge or protrusion is
identified. No significant facet
osteoarthropathy or canal or foraminal
stenosis is noted.
L2-L3: No significant disc bulge or protrusion is
identified. No significant facet
osteoarthropathy or canal or foraminal
stenosis is noted.
L3-L4: Desiccation of the disc. Mild retrolisthesis.
Mild disc bulge. No spinal stenosis. Mild
bilateral foraminal stenosis. No significant
facet or ligamentum flavum hypertrophy.
L4-L5: Mild disc bulge. No spinal stenosis. Mild
bilateral foraminal stenosis. There is
bilateral facet hypertrophy.
L5-S1: Mild retrolisthesis. There is desiccation of
the disc with disc space narrowing. There
is a focal central protrusion encroaching
upon the ventral sac of the thecal sac.
There is mild spinal stenosis. Mild bilateral
foraminal stenosis. There is no significant
facet or ligamentum flavum hypertrophy.
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10 Opinion of the Court 21-13175
In June 2017, Morales saw primary care physician Bella
Dattani, M.D., for a consultative examination at the request of a
State agency. Dr. Dattani reviewed Morales’s April 2016 cervical
and lumbar spine MRIs and his treatment notes. Dr. Dattani noted
that Morales was “generally healthy with no deficits” and had no
stiffness, pain, or tenderness in his neck. Dr. Dattani recorded that
(1) her examination of Morales’s cervical spine revealed no
tenderness of the spinous process or evidence of paravertebral
muscle spasms near the cervical spine and (2) her examination of
Morales’s dorsolumbar spine showed no paravertebral spasms on
the lumbar spine or tenderness over the spinous process.
In November 2018, Morales saw Dr. Chau again about his
neck and back pain getting worse. Dr. Chau noted that Morales
reported his symptoms of cervical problems were getting worse,
and Dr. Chau ordered an MRI of the cervical spine.
In January 2019, Morales had an MRI of his cervical spine,
which showed the following:
C1-C2: Mild osteoarthritis between anterior arch
of C1 and the odontoid process.
C2-C3: There is no disc protrusion. No central
canal stenosis. No neural foraminal
narrowing.
C3-C4: Mild concentric disc bulge measuring 1-2
mm in AP extent. There is no disc
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21-13175 Opinion of the Court 11
protrusion. No central canal stenosis. No
neural foraminal narrowing.
C4-C5: Mild concentric disc bulge measuring 1-2
mm in AP extent. There is severe right
neural foraminal narrowing related to
uncovertebral joint arthritis. Mild central
canal narrowing. No significant left
foraminal stenosis or facet arthropathy.
C5-C6: Mild concentric disc bulge measuring 1-2
mm in AP extent. Mild left foraminal
stenosis. No right foraminal stenosis. No
facet arthropathy.
C6-C7: There is no disc protrusion. No central
canal stenosis. No neural foraminal
narrowing.
C7-T1: There is no disc protrusion. No central
canal stenosis. No neural foraminal
narrowing.
(Emphasis added.)
The differences between the April 2016 cervical spine MRI
and the January 2019 cervical spine MRI are twofold. First, several
parts of Morales’s cervical spine improved. Unlike the April 2016
cervical spine MRI, the January 2019 cervical spine MRI showed
(1) no mild bilateral foraminal stenosis at C3-C4, (2) no spondylitis
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12 Opinion of the Court 21-13175
issues at C4-C5, (3) no mild left foraminal stenosis at C6-C7, and
(4) no left medial foraminal disc protrusion at C6-C7. Second,
though, it indicated new mild concentric disc bulges at C3-C4 and
C5-C6 and the right foraminal stenosis at the C4-C5 level changed
from moderate to severe.
In February, March, and April 2019, Morales saw primary
care physician, Jose Sosa, M.D., for a physical examination because
of neck and back pain. At the first visit in February 2019, Dr. Sosa
noted “neck pain to movement,” but he did not do so at subsequent
visits.
Notably, at all three visits, Dr. Sosa’s examinations revealed
a supple neck with normal range of motion and normal
neurological findings related to motor strength and sensation.
F. The ALJ’s Decision
Eligibility for SSI benefits requires that the claimant be
disabled. 20 C.F.R. § 416.912(a). To determine whether a claimant
is disabled, the ALJ engages in a five-step process.
Id. § 404.1520(a).
Following the five-step process, the ALJ determined that:
1. Morales had not engaged in substantial gainful activity since
his alleged onset date in November 2016;
2. Morales had four severe impairments: generalized anxiety
disorder; major depressive disorder/bipolar
disorder; intermittent explosive disorder; and degenerative
disc disease of the cervical and lumbar spine;
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21-13175 Opinion of the Court 13
3. Morales’s impairments, either alone or in combination, did
not meet the criteria of any of the listed impairments;
4. Morales had the residual functional capacity (“RFC”) to
perform a range of light work, with certain restrictions; and
5. Morales had no past relevant work, and considering
Morales’s age, education, work experience, and RFC, three
jobs—cafeteria attendant, cleaner/housekeeper, and
folder—existed in the national economy that he could
perform.
With respect to Morales’s RFC (step four, noted above), the
ALJ found that Morales could (1) lift up to 20 pounds occasionally,
(2) lift and carry up to 10 pounds frequently, and (3) stand and walk
with normal breaks for about six hours in an eight-hour workday.
The ALJ also found that Morales could never climb ladders, ropes,
or scaffolds and could not have any exposure to excessive vibration,
unprotected heights, or hazardous machinery, but he could
occasionally climb ramps and stairs and occasionally balance,
stoop, kneel, crouch, and crawl. The ALJ found that Morales could
perform simple, routine tasks in a low-stress job and that “such
work c[ould] have no production quota (e.g., no strict production
standard and no rigid production pace, such as an automated line
that the worker cannot control).”
Also at step four, the ALJ summarized Morales’s testimony
and found that Morales’s impairments could reasonably be
expected to cause his alleged symptoms but that his statements
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14 Opinion of the Court 21-13175
about the intensity, persistence, and limiting effects of his
symptoms were not entirely consistent with the medical evidence
and other evidence in the record. The ALJ reviewed Morales’s
mental health treatment history and concluded that Morales’s
“mental impairments, while severe, [were] largely controlled by
psychotropic medication and therapy.”
The ALJ stressed that in multiple examinations in 2019,
Morales “was medication compliant without side effects, and that
[his] anxiety was manageable, denied pain, and had good sleep and
normal energy.” The ALJ noted that on some occasions, Morales’s
mental health providers gave him various GAF scores. The ALJ
gave these GAF scores little weight and explained why:
GAF scores, as a general matter, do not describe
specific work[-]related limitations or objective mental
abnormalities. They consider psychological, social[,]
and occupational functioning whereas Social Security
is primarily concerned with occupational functioning.
Moreover, since they reflect the individual clinician’s
judgment, scoring can vary considerably from
practitioner to practitioner. Further, they typically
represent current functioning, not longitudinal
functioning over 12 continuous
months. . . . Consistent with the above observations,
the latest version of the Diagnostic and Statistical
Manual of Mental Disorders . . .
no longer utilizes
GAF scores because of their “conceptual lack of
clarity” and “questionable psychometric in routine
practice.”
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21-13175 Opinion of the Court 15
(Emphasis added.)
In reviewing Morales’s medical history, the ALJ concluded
Morales had “some spine issues, [but] his seizure disorder and
hyperlipidemia seem[ed] relatively controlled.” To support his
RFC determinations, the ALJ summarized the findings in Morales’s
April 2016 MRI of his cervical and lumbar spine. The ALJ did not
explicitly reference or discuss the January 2019 cervical spine MRI
or its findings about Morales’s neck area. However, the ALJ
pointed out that, as recently as April 2019, Dr. Sosa had indicated
Morales was not in acute distress, exhibited normal range of neck
motion with no pain noted, and had normal motor strength.
At step five, the ALJ noted that Morales could not perform
a full range of light work, and thus the ALJ relied on the VE’s
testimony as to the existence of unskilled jobs—cafeteria attendant,
cleaner/housekeeper, and folder—that an individual with
Morales’s restrictions could perform. The ALJ “determined that
the [VE’s] testimony [was] consistent with the information
contained in the DOT.” The ALJ acknowledged the VE’s
explanation that because “the DOT did not address absences or
being off-task, interactions with co-workers and the public, or
fast-paced production,” the VE had relied on her experience and
training on these issues.
Ultimately, the ALJ determined that Morales was “not
disabled” and thus did not qualify for SSI.
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16 Opinion of the Court 21-13175
G. Appeals Council
Morales appealed the ALJ’s decision to the Appeals Council,
which denied his request for review on March 2, 2020.
H. District Court Proceedings
On April 27, 2020, Morales sought review of the
Commissioner’s final decision in the district court. A magistrate
judge recommended that the Commissioner’s decision be reversed
and remanded. The district court rejected the magistrate judge’s
report and recommendation and affirmed the Commissioner’s
decision. Morales timely appealed.
II. STANDARD OF REVIEW
Our review in a social security case is the same as that of the
district court.
Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir.
1990). We review de novo the legal principles on which the ALJ’s
decision was based.
Simon v. Comm’r, Soc. Sec. Admin., 7 F.4th
1094, 1103 (11th Cir. 2021). But “[w]e may not decide the facts
anew, reweigh the evidence, or substitute our judgment for that of
the [Commissioner].”
Bloodsworth v. Heckler, 703 F.2d 1233, 1239
(11th Cir. 1983). Rather, we must defer to the Commissioner’s
decision if it is supported by substantial evidence.
Id. “Substantial
evidence is more than a scintilla, but less than a preponderance. It
is such relevant evidence as a reasonable person would accept as
adequate to support a conclusion.”
Id. “If the Commissioner’s
decision is supported by substantial evidence[,] we must affirm,
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21-13175 Opinion of the Court 17
even if the proof preponderates against it.”
Miles v. Chater, 84 F.3d
1397, 1400 (11th Cir. 1996).
III. DISCUSSION
On appeal, Morales argues (1) the ALJ’s decision was not
supported by substantial evidence because the ALJ failed to
consider his January 2019 cervical spine MRI; (2) the ALJ
improperly gave little weight to his GAF scores; and (3) the ALJ
erred by failing to resolve inconsistencies between the VE’s
testimony and the DOT. We address each argument in turn.
A. January 2019 Cervical Spine MRI
Morales argues that the ALJ erred by failing to consider his
January 2019 cervical spine MRI, which showed “severe” right
foraminal stenosis at the C4-C5 level. Relying on
Cowart v.
Schweiker, 662 F.2d 731, 735 (11th Cir. 1981), Morales stresses that
ALJs are required to explain the weight accorded to “obviously
probative” exhibits. And, according to Morales, the January 2019
cervical spine MRI is an “obviously probative” exhibit.
On the other hand, the Commissioner emphasizes that
Dyer
v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005), says “there is no
rigid requirement that the ALJ specifically refer to every piece of
evidence in his decision.” So, according to the Commissioner, the
ALJ did not err because the ALJ clearly considered Morales’s neck
condition as a whole.
The Commissioner also argues
Cowart does not apply to the
facts of Morales’s case. In
Cowart, the claimant was
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18 Opinion of the Court 21-13175
unrepresented, and the Court explained that, under those
circumstances, an ALJ’s “basic obligation to develop a full and fair
record rises to a special duty,” which “requires the ALJ to
scrupulously and conscientiously probe into, inquire of, and
explore for all the relevant facts.” 662 F.2d at 735 (quotation marks
omitted). The Court concluded the ALJ in
Cowart failed to fully
and fairly develop the record, in part, by not providing and
explaining the weight he accorded to the various testimony he
considered.
Id. The Commissioner contends that because Morales
was represented at the administrative level, the ALJ had no special
duty like the ALJ in
Cowart to state specifically the weight
accorded to “obviously probative” exhibits and why he reached
that decision.
We need not resolve this debate. We assume—without
deciding—that (1) the January 2019 cervical spine MRI was an
“obviously probative” exhibit and (2) the ALJ erred by not
discussing or explaining the weight given to that MRI. But such an
error—which, again, we are assuming to have occurred—was
harmless in light of all the medical evidence.
See Diorio v. Heckler,
721 F.2d 726, 728 (11th Cir. 1983) (applying harmless error review
to an ALJ’s determination that a claimant was not disabled).
The ALJ found Morales’s severe impairments, including
degenerative disc disease of the cervical spine, significantly limited
his ability to perform basic work activities and, as a result, imposed
greater limitations in determining Morales’s RFC. The ALJ
extensively reviewed Morales’s medical records and the medical
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21-13175 Opinion of the Court 19
opinion evidence, in which most of his treating medical providers’
examinations noted normal findings of the musculoskeletal system
and specifically that Morales had suppleness and full range of
motion in his neck, frequently reported no neck pain, and was not
in any acute distress. Similarly, Morales’s exam with consulting
physician Dr. Dattani revealed full range of motion in Morales’s
neck and no tenderness of the spinous process or evidence of
paravertebral muscle spasms near the cervical spine.
And, after Morales’s January 2019 cervical spine MRI, Dr.
Sosa examined Morales in February, March, and April 2019.
Although at two visits Morales complained of neck and back pain,
Dr. Sosa, like Morales’s previous medical providers, noted
generally normal examination results, including a supple neck with
full range of motion. And Dr. Sosa noted “neck pain to movement”
at the February 2019 visit, but he did not do so at subsequent visits.
In other words, despite the change to the right foraminal stenosis
at the C4-C5 level, Dr. Sosa observed substantially the same
findings as prior medical providers had observed before the January
2019 cervical spine MRI.
Further, as noted above, the January 2019 cervical spine MRI
is arguably less favorable to Morales because several of Morales’s
conditions improved. Indeed, the only unfavorable change
Morales specifically identified is that his right foraminal stenosis at
the C4-C5 level had worsened from “moderate” to “severe.”
Lastly, while the ALJ did not explicitly discuss the January
2019 cervical spine MRI in his decision, the hearing transcript
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20 Opinion of the Court 21-13175
shows the ALJ introduced Exhibit B16F into the record, and the
ALJ specifically referred to the January 2019 cervical spine MRI on
page 34 of that exhibit.
Under the totality of these circumstances, we conclude the
January 2019 cervical spine MRI would not have altered the ALJ’s
handling of Morales’s statements of the intensity, persistence, and
limiting effects of his neck pain or the ALJ’s RFC determination. As
such, any error on the ALJ’s part in failing to specifically weigh the
January 2019 cervical spine MRI was harmless.
B. GAF Scores
Next, we consider Morales’s argument that the ALJ
improperly gave little weight to his GAF scores. According to
Morales, the ALJ’s statement that his GAF scores were unreliable
was boilerplate and nonspecific.
We readily conclude the ALJ did not err in assigning
Morales’s GAF scores “little weight.” The ALJ stated with
particularity the reasons for giving Morales’s GAF scores little
weight: He reasoned that GAF scores are subjective and not
pertinent to a legal determination about disability.
Both the SSA and this Court have recognized the subjective
nature and unreliability of GAF scores and emphasized GAF scores
are not dispositive when determining disability.
See U.S. Soc. Sec.
Admin., Office of Disability Programs, AM-13066, Global
Assessment of Functioning (GAF) Evidence in Disability
Adjudication (July 22, 2013) REV (Oct. 14, 2014) REV 2 (Mar. 27,
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21-13175 Opinion of the Court 21
2017) (both the 2013 and 2017 versions highlighting multiple
problems with using GAF scores to evaluate disability, observing
that GAF scores lack standardization, and stating that a GAF rating
alone is never dispositive of impairment severity);
Schink v.
Comm’r of Soc. Sec., 935 F.3d 1245, 1266 (11th Cir. 2019) (“We
recognize that GAF scores are by no means dispositive of a
claim . . . .”);
McGriff v. Comm’r, Soc. Sec. Admin., 654 F. App’x
469, 471 (11th Cir. 2016) (unpublished) (recognizing that “[a] GAF
score is a subjective determination”).
And, as the ALJ noted, the
Diagnostic and Statistical Manual
of Mental Disorders no longer uses GAF scores because of their
“conceptual lack of clarity” and “questionable psychometrics in
routine practice.”
See American Psychiatric Association,
Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed.
2013);
see also American Psychiatric Association, Diagnostic and
Statistical Manual of Mental Disorders 16 (5th ed. text rev. 2022)
(recognizing GAF scores are no longer used).
Moreover, the ALJ’s reasons for giving little weight to
Morales’s GAF scores were supported by the record. From 2012 to
2019 Morales’s GAF score remained mostly at 48, even when
mental status examinations showed normal findings and treatment
notes detailing his progress showed improvement with medication
and therapy. As an example, on July 31, 2017, an Impower
counselor assigned Morales a GAF score of 60, but the next month
on August 24, 2017, his GAF score decreased to 48 even though
Morales (1) reported he was “doing well” and feeling less anxious
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22 Opinion of the Court 21-13175
and (2) denied feeling tension, irritability, and depression.
Similarly, between December 2017 and April 2018, Morales
regularly received a GAF score of 48, but then on April 10, 2018, a
provider assigned him a GAF score of 60.
Finally, as the ALJ explained, Morales’s records of
psychiatric treatment between 2012 and 2019 indicated that
Morales’s mental impairment was largely controlled by medication
and therapy. Despite Morales’s diagnoses and his reported issues
with impulsivity, anger, anxiety, and depression, by 2019 Morales
reported to his mental health providers that his anxiety was
manageable, he denied having panic attacks, and he reported good
sleep and normal energy. In light of the ALJ’s thorough
consideration of Morales’s treatment notes from mental health
providers showing Morales’s improvement, the ALJ did not err by
giving Morales’s GAF scores little weight based on their subjective
and unreliable nature.
C. VE’s Testimony and the DOT
Lastly, we address Morales’s argument that the ALJ erred by
failing to resolve inconsistencies between the VE’s testimony and
the temperaments required of the three jobs that the ALJ found
Morales could perform at step five. Morales contends that,
according to the Revised Handbook for Analyzing Jobs (“RHAJ”)
published by the U.S. Department of Labor, all three jobs have an
“R” temperament, which indicates “[p]erforming repetitive work,
or performing continuously the same work, according to set
procedures, sequence, or pace.” But, according to Morales, that
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21-13175 Opinion of the Court 23
temperament is inconsistent with the ALJ’s specified limitations of
“no rigid production pace” and “no strict production standard.” So
he says a conflict exists between the VE’s testimony and the DOT.
According to Social Security Ruling 00-4p (“SSR 00-4p”),
neither the VE’s testimony nor the DOT automatically trumps
when there is a conflict between the two. SSR 00-4p, 65 Fed. Reg.
75759-01, 75760 (Dec. 4, 2000). Instead, where a VE provides
evidence about a job’s requirements, the ALJ has an affirmative
duty to inquire about any possible conflict between that evidence
and information provided in the DOT.
Id. Where the VE’s
evidence is inconsistent with the information in the DOT, the ALJ
must resolve the conflict by eliciting a reasonable explanation from
the VE before relying on the VE’s evidence to support a
determination that a claimant is or is not disabled.
Id. Although
SSR 00-4p is not binding on this Court, the SSA is bound to follow
it.
Washington v. Comm’r of Soc. Sec., 906 F.3d 1353, 1361 (11th
Cir. 2018).
Here, Morales has pointed to no conflict between the VE’s
testimony and the DOT. An ALJ is required to inquire and resolve
conflicts only between VE testimony and “information in the
[DOT], including its companion publication, the Selected
Characteristics of Occupations [(“SCO”)] . . . , published by the
Department of Labor.” SSR 00-4p, 65 Fed. Reg. at 75759. SSR
00-4p does not mention the RHAJ, and there is no indication the
DOT or SCO incorporates the RHAJ. Because Morales focuses on
information outside the DOT and SCO, the ALJ’s duty under SSR
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24 Opinion of the Court 21-13175
00-4p was not triggered, and we need not address any alleged
conflict between the VE’s testimony and any temperament
requirements from the RHAJ.
IV. CONCLUSION
For these reasons, we affirm the district court’s order.
AFFIRMED.
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