Anamarie Nardelli v. Commissioner of Social Security

[DO NOT PUBLISH]
In the
United States Court of Appeals
For the Eleventh Circuit
____________________
No. 23-11581
Non-Argument Calendar
____________________
ANAMARIE NARDELLI,
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. 8:22-cv-00132-MAP
____________________
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2 Opinion of the Court 23-11581
Before R OSENBAUM , J ILL PRYOR , and B RANCH , Circuit Judges.
PER CURIAM:
Plaintiff-Appellant Anamarie Nardelli applied for Supple-
mental Security Income (“SSI”), but the Social Security Administra-
tion (“Administration”) found she was not disabled and denied her
application. Nardelli challenges that denial, claiming that the ad-
ministrative law judge (“ALJ”) improperly substituted his judgment
for that of evaluating psychological consultants. We conclude that
substantial evidence supported the ALJ’s determination that
Nardelli was not disabled and affirm the district court’s decision to
that end.
I. BACKGROUND
Plaintiff-Appellant Anamarie Nardelli applied for SSI in June
2020, alleging an onset of disability of May 7, 2012.1 Nardelli claims
she is disabled due to diabetes, high blood pressure, borderline per-
sonality disorder, depression, and anxiety.
1 Nardelli previously filed an SSI application in November 2018, which the Ad-
ministration denied after the ALJ found she was not disabled. That ALJ found
Nardelli’s depression, anxiety, and post-traumatic stress disorder to be severe
impairments but reasoned that she could still perform light work with certain
limitations. The ALJ adjudicating her 2020 application admitted the prior de-
cision, but that decision did not bind the Administration for later periods of
alleged disability. See Acquiescence Ruling 97-4(9), 62 Fed. Reg. 64038, 64039
(Dec. 3, 1997).
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23-11581 Opinion of the Court 3
A. Factual and Medical Background
Nardelli was 49 years old when she filed for SSI. She has a
high school education and previously worked as a telephone sales
representative and residence-leasing agent. Nardelli also worked
delivery for Uber Eats for a time but stopped because she was in-
volved in two car accidents in under thirty days.
Before applying for SSI, Nardelli underwent several psycho-
logical evaluations. We briefly recount the results of those evalua-
tions below, as they informed the ALJ’s disability analysis.
In April 2019, Nardelli had a consultative evaluation with Dr.
Abraham Khan, M.D. At the time, Nardelli reported having depres-
sion, post-traumatic stress disorder (“PTSD”), and borderline per-
sonality disorder, which resulted in problems sleeping, crying
spells, reduced appetite, and loss of enjoyment. Dr. Khan deter-
mined that Nardelli had PTSD, anxiety, depression, and borderline
personality disorder. In Dr. Khan’s opinion, these conditions af-
fected Nardelli’s mood, focus, and ability to be around others.
Also in April 2019, Nardelli underwent a consultative psy-
chological evaluation that Dr. Steven N. Kanakis, Psy.D., P.A., per-
formed. Nardelli’s mental status examination findings all fell
within normal limits, except for insight and judgment, which
ranged from “fair to poor.” Dr. Kanakis assessed Nardelli with can-
nabis-use disorder (moderate or severe), alcohol-use disorder (in
sustained full remission), and cocaine-use disorder (in sustained full
remission). Dr. Kanakis opined that Nardelli’s prognosis was
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4 Opinion of the Court 23-11581
guarded, but she was not at risk of decompensation in a work set-
ting.
In a June 2020 function report, Nardelli attested that she per-
forms basic tasks, such as caring for herself and her pet cat, living
with her fiancé, cooking meals, cleaning, driving, and managing
money. She stated that she could follow written instructions and
had never been fired because of problems getting along with oth-
ers. But Nardelli claimed that she does not leave the house unless
it is necessary, avoids her family, and does not handle stress or ad-
justments to her routine well.
In August 2020, during a phone consultation with Dr. Jessica
Rausch-Medina, Nardelli reported that she was very depressed and
reluctant to leave home. Later, in a June 2021 phone consultation
with Dr. Rausch-Medina, Nardelli reported anxiety symptoms (alt-
hough she said she was able to stop panic attacks before they hap-
pen), leaving the house only once or twice a week, and severe de-
pressive symptoms and feelings of worthlessness.
In October 2020, Dr. Nicholas Gehle, Psy.D., conducted a
psychological consultative evaluation of Nardelli. Dr. Gehle as-
sessed Nardelli with unspecified bipolar and related disorder, with
moderate anxious distress. He opined that Nardelli’s symptoms
“appear[ed] to be severely impacting activities of daily living, voca-
tional performance, and interpersonal interactions.” But Dr. Gehle
noted that Nardelli was able to perform basic activities, displayed
fair social skills, demonstrated adequate judgment and insight, and
appeared to have coherent and logical thought processes.
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23-11581 Opinion of the Court 5
B. Administrative Medical Findings
As part of her SSI application, Nardelli underwent psycho-
logical evaluations by state consultants, at both the initial and re-
consideration stages.
First, Dr. Brian McIntyre, Ph.D., evaluated Nardelli’s claim
in October 2020. Dr. McIntyre found that Nardelli’s depressive, bi-
polar and related disorders, anxiety or obsessive-compulsive disor-
ders and personality disorders were all severe impairments. Dr.
McIntyre relied on Dr. Gehle’s mental-status exam. In doing so,
Dr. McIntyre found that Nardelli was mildly impaired in under-
standing, remembering, or applying information; moderately im-
paired in interacting with others; moderately impaired in concen-
trating, persisting, or maintaining pace; and mildly impaired in
adapting or managing herself.2
At the reconsideration level, in January 2021, Dr. Jermaine
Robertson, Ph.D., affirmed Dr. McIntyre’s evaluation of Nardelli’s
mental impairments. But Dr. Robertson opined that Dr. Gehle’s
evaluation overestimated the severity of Nardelli’s limitations,
which indicated minimal to moderate limitations on functional ac-
tivity
2 The Administration evaluates mental impairments in the context of four
broad functional areas: (1) understanding, remembering, or applying infor-
mation; (2) interacting with others; (3) concentrating, persisting, or maintain-
ing pace; and (4) adapting or managing oneself. 20 C.F.R. § 416.920a(c)(3). In
rating the degree of limitation, the Administration employs a five-point scale:
none, mild, moderate, marked, and extreme. Id. § 416.920a(c)(4).
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6 Opinion of the Court 23-11581
The Administration denied Nardelli’s application, both ini-
tially and on reconsideration.
C. ALJ Hearing and Subsequent Procedural History
Nardelli requested a hearing before an ALJ, who again de-
nied Nardelli’s application for SSI. In reaching that determination,
the ALJ relied on the above record evidence as well as Nardelli’s
own testimony at a telephonic hearing in August 2021. Among
other things, Nardelli testified that she has trouble checking her
mood in a social environment, is either easily distracted or overly
focused, and sometimes lacks compassion and understanding.
The ALJ applied the five-step sequential framework for de-
termining whether an individual is disabled. Under that frame-
work, the Administration asks whether the claimant (1) is currently
engaged in substantial gainful activity; (2) has a severe impairment
or combination of impairments; (3) is disabled based on the con-
gruence of their impairments with listed disabilities; (4) could per-
form any of their prior work, based on their RFC; and (5) could
perform any other jobs existing in significant numbers in the na-
tional economy, based on their residual functional capacity, age, ed-
ucation, and work experience. See 20 C.F.R. § 416.920(a)(4).
First, the ALJ determined that Nardelli had not engaged in
substantial gainful activity since her application date. Second, the
ALJ found that Nardelli had the severe impairments of diabetes
mellitus, hypertension, hypothyroidism, and obesity. But the ALJ
found Nardelli’s mental impairments to be non-severe because they
did not cause more than a minimal disruption to Nardelli’s
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23-11581 Opinion of the Court 7
abilities.3 The ALJ also reasoned that Dr. Gehle, Dr. McIntyre, and
Dr. Robertson’s opinions were not persuasive because they relied
on Nardelli’s subjective reports of her symptoms and were incon-
sistent with the mental-status examination results.
At step three, the ALJ determined that Nardelli’s impair-
ments did not meet or equal the severity of one of the impairments
that would trigger an automatic disability finding. Before step four,
the ALJ found Nardelli had the residual functional capacity
(“RFC”)4 to perform the full range of light work as defined in 20
C.F.R. § 416.967(b). In doing so, the ALJ considered Nardelli’s
symptoms, medical opinions, and medical administrative findings,
including the consultants’ opinions that he found to be unpersua-
sive. The ALJ also noted that Nardelli neither sought nor “received
essentially [any] treatment during the relevant time frame,” so “the
medical evidence does not support [Nardelli’s] allegations of disa-
bling symptoms and limitations.”
3 Specifically, the ALJ found no limitation in understanding, remembering, or
applying information; mild limitation in interacting with others; mild limita-
tion in concentrating, persisting, or maintaining pace; and no limitation in
adapting or managing herself.
4 The RFC is “the most [the claimant] can still do despite [her] limitations” in
a work setting. 20 C.F.R. § 416.945(a)(1). In determining an RFC, the ALJ
must consider all impairments, including those deemed non-severe at the sec-
ond step. Id.; see also Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1268 (11th
Cir. 2019). Error at step two is harmless so long as the ALJ considers the al-
leged impairment in formulating the claimant’s RFC, and substantial evidence
supports the ALJ’s conclusion. Schink, 935 F.3d at 1268.
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8 Opinion of the Court 23-11581
Alternatively, the ALJ found that based on Nardelli’s age, ed-
ucation, work experience, and RFC, the Medical-Vocational Guide-
lines directed a finding of “not disabled.” So the ALJ found Nardelli
was not disabled.
Nardelli requested review of the ALJ’s decision, which the
Administration’s Appeals Council denied. Nardelli then filed suit
in federal district court challenging the Administration’s denial.
The parties consented to the jurisdiction of a magistrate judge,
who affirmed the ALJ’s decision. Specifically, the magistrate judge
concluded that substantial evidence in the form of mental-status
exams supported the ALJ’s determination, and the ALJ’s use of the
Medical-Vocational Guidelines was not overly mechanical.
Nardelli timely appealed.
II. STANDARD OF REVIEW
We review de novo a district court’s decision affirming the
denial of SSI or disability benefits. Buckwalter v. Acting Comm’r of
Soc. Sec., 5 F.4th 1315, 1320 (11th Cir. 2021). In doing so, we deter-
mine whether substantial evidence supports the Commissioner’s
decision and whether the Commissioner applied the correct legal
standards.5 Walker v. Soc. Sec. Admin., Comm’r, 987 F.3d 1333, 1338
(11th Cir. 2021); see also 42 U.S.C. § 405(g) (“findings of the Com-
missioner of Social Security as to any fact, if supported by
5 The Commissioner has delegated to the ALJ the responsibility of determin-
ing a claimant’s RFC and whether the claimant is disabled. See 20 C.F.R. §
404.1546(c). So “ALJ” can be substituted for “Commissioner” in this context.
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23-11581 Opinion of the Court 9
substantial evidence, shall be conclusive”). Substantial evidence
means “more than a scintilla and is such relevant evidence as a rea-
sonable person would accept as adequate to support a conclusion.”
Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004)
(per curiam) (quoting Lewis v. Callahan, 125 F.3d 1436, 1439 (11th
Cir. 1997)).
The substantial-evidence threshold “is not high.” Biestek v.
Berryhill, 139 S. Ct. 1148, 1154, 1157 (2019). Under this deferential
standard, we do not “decide the facts anew, reweigh the evidence,
or substitute our judgment for that of the Commissioner.” Mitchell
v. Comm’r, Soc. Sec. Admin., 771 F.3d 780, 782 (11th Cir. 2014) (quot-
ing Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir.
2011)). Indeed, even if a preponderance of the evidence weighs
against the Commissioner’s decision, we affirm so long as substan-
tial evidence supports it. Buckwalter, 5 F.4th at 1320. But “we will
not ‘affirm simply because some rationale might have supported
the ALJ’s conclusion.’” Id. (quoting Owens v. Heckler, 748 F.2d 1511,
1516 (11th Cir. 1984) (per curiam)).
III. DISCUSSION
On appeal, Nardelli argues that the ALJ improperly substi-
tuted his judgment for that of the state psychological consultants
when concluding that Nardelli was not disabled. We disagree.
To be entitled to SSI, a claimant must be disabled, meaning
the claimant must be “unable to engage in any substantial gainful
activity by reason of any medically determinable physical or men-
tal impairment which can be expected to result in death or which
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10 Opinion of the Court 23-11581
has lasted or can be expected to last for a continuous period of not
less than twelve months.” See 42 U.S.C. § 1382c(a)(3)(A). A “phys-
ical or mental impairment” is an “impairment that results from an-
atomical, physiological, or psychological abnormalities, which are
demonstrable by medically acceptable clinical and laboratory diag-
nostic techniques.” Id. § 1382c(a)(3)(D).
Under this framework, “the claimant bears the burden of
proving [s]he is disabled, and, consequently, [s]he is responsible for
producing evidence to support [her] claim.” Ellison v. Barnhart, 355
F.3d 1272, 1276 (11th Cir. 2003) (per curiam).6 Diagnoses alone do
not establish work-related limitations. See Moore v. Barnhart, 405
F.3d 1208, 1213 n.6 (11th Cir. 2005) (per curiam).
An ALJ bears final responsibility for assessing a claimant’s
RFC and resulting limitations, based on all the relevant medical and
other evidence in the record. See 20 C.F.R. §§ 416.945(a)(3),
416.946(c); Phillips v Barnhart, 357 F.3d 1232, 1238 (11th Cir. 2004),
superseded on other grounds by regulation, 20 C.F.R. § 404.1520c.
While an RFC determination must be based on the relevant evi-
dence, “there is no rigid requirement that the ALJ specifically refer
to every piece of evidence in his decision, so long as the ALJ’s deci-
sion . . . is not a broad rejection which is not enough to enable [a
reviewing court] to conclude that the ALJ considered [the claim-
ant’s] medical condition as a whole.” Mitchell, 771 F.3d at 782
6 At step five, the burden temporarily shifts to the Administration to show the
existence of other jobs in the national economy that the claimant can perform
even with her impairments. Buckwalter, 5 F.4th at 1321.
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23-11581 Opinion of the Court 11
(alterations in original) (quoting Dyer v. Barnhart, 395 F.3d 1206,
1211 (11th Cir. 2005)).
To determine the weight to give a medical opinion or prior
administrative medical finding, an ALJ must consider (1) the opin-
ion’s supportability or the relevance of the objective evidence to
the opinion; (2) the opinion’s consistency with the objective evi-
dence; (3) the medical professional’s relationship; (4) the profes-
sional’s specialization; and (5) other factors, such as the medical
professional’s familiarly 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 particularity the
weight given to different medical opinions and the reasons” for that
weight. Winschel, 631 F.3d at 1179.
Here, the ALJ determined that the state psychological con-
sultants’ opinions had low supportability and consistency for two
main reasons. First, Dr. McIntyre and Dr. Robertson based their
opinions on Dr. Gehle’s analysis, which in turn relied on Nardelli’s
subjective reports. Second, Dr. McIntyre and Dr. Robertson’s con-
clusions were inconsistent with Nardelli’s unremarkable mental-
status exam results and other record evidence that Nardelli demon-
strates adequate social functioning, attention, and concentration.
The ALJ did not, as Nardelli claims, improperly substitute
his medical judgment for that of the state psychological consult-
ants. The ALJ stated and explained his findings as to the reports’
supportability and consistency, finding they were “not persuasive”
because they were “clearly inconsistent with the objective medical
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12 Opinion of the Court 23-11581
evidence.” Nardelli relies heavily on Dr. Gehle’s opinion that
Nardelli’s symptoms “appear[ed] to be severely impacting [her] ac-
tivities,” but that opinion was apparently based entirely on
Nardelli’s subjective reports. So the ALJ was entitled to consider
that statement in context and weigh it accordingly. See Crawford,
363 F.3d at 1159 (finding that substantial evidence supported the
ALJ’s “decision to discount” a physician’s opinion because it was
“inconsistent with his own treatment notes, unsupported by the
medical evidence, and appear[ed] to be based primarily on [the
claimant’s] subjective complaints”); Walker, 987 F.3d at 1339 (simi-
lar, where medical opinion “conflicted with other evidence, includ-
ing several examinations”).
Nor, as Nardelli contends, was the ALJ required to order an
additional psychological evaluation once he determined that the
consultants’ opinions were unpersuasive. An ALJ must “develop
the record where appropriate but” need not “order a consultative
examination as long as the record contains sufficient evidence for
the [ALJ] to make an informed decision.” Ingram v. Comm’r of Soc.
Sec. Admin., 496 F.3d 1253, 1269 (11th Cir. 2007). That is exactly the
case here, so the ALJ did not err in declining to order an additional
evaluation.
Here, substantial evidence in the record supports the ALJ’s
finding that Nardelli was not disabled. Nardelli testified that she
can perform a range of everyday tasks notwithstanding her physi-
cal and mental impairments. Nardelli largely performed within the
range of normal outcomes on mental-status exams and presented
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23-11581 Opinion of the Court 13
in a good mood with normal affect. Medical-record evidence re-
flected that Nardelli displayed fair social skills, demonstrated ade-
quate judgment and insight, and appeared to have coherent and
logical thought processes. This is not a case in which only a “scin-
tilla” of evidence supports the ALJ’s conclusion. Rather, “a reason-
able person would accept” the evidence referenced in the ALJ’s de-
cision “as adequate.” See Crawford, 363 F.3d at 1158.
Again, it is not our role to “decide the facts anew, reweigh
the evidence, or substitute our judgment for that of the” ALJ.
Mitchell, 771 F.3d at 782 (quoting Winschel, 631 F.3d at 1178). Here,
the ALJ applied the appropriate legal framework and explained his
supportability and consistency findings. The ALJ was not required
to accept the consultants’ reports without question but rather re-
tained the ability to weigh the consultants’ opinions against other
medical evidence. And even if some evidence in the record sup-
ports Nardelli’s claim of disability, we have already determined that
substantial evidence supports the ALJ’s contrary finding. See Buck-
walter, 5 F.4th at 1320. So we conclude that the ALJ did not err in
affording low persuasive value to the consultants’ reports in reach-
ing his determination that Nardelli was not disabled.
IV. CONCLUSION
For the foregoing reasons, we affirm the district court’s de-
cision that the Administration properly denied Nardelli’s applica-
tion for Supplemental Security Income.
AFFIRMED.
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