Cara LeCroy v. Commissioner of Social Security

[DO NOT PUBLISH]
In the
United States Court of Appeals
For the Eleventh Circuit
____________________
No. 23-11883
Non-Argument Calendar
____________________
CARA LECROY,
Plaintiff-Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant-Appellee.
____________________
Appeal from the United States District Court
for the Middle District of Georgia
D.C. Docket No. 3:22-cv-00059-TES-MSH
____________________
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2 Opinion of the Court 23-11883
Before LAGOA , B RASHER , and ABUDU, Circuit Judges.
PER CURIAM:
Cara LeCroy challenges the Commissioner of the Social Se-
curity Administration’s (“Commissioner”) denial of her application
for disability insurance benefits (“DIB”) and supplemental security
income (“SSI”). LeCroy argues that the administrative law judge
(“ALJ”) erroneously assessed the medical opinions in the record.
Specifically, LeCroy says the ALJ erred in finding that the opinions
from LeCroy’s treating sources were unpersuasive and the opin-
ions from a consultative examiner and reviewer were persuasive.
She also argues that the ALJ erroneously failed to consider her post-
traumatic stress disorder (“PTSD”), social phobia, and panic disor-
der; her and her friend’s subjective reports about her mental health;
and her absenteeism due to receiving mental health treatment. For
the reasons discussed below, we affirm.
I.
When the ALJ denies benefits and the Appeals Council de-
nies review, we review the ALJ’s decision as the final administrative
decision. Viverette v. Comm’r of Soc. Sec., 13 F.4th 1309, 1313 (11th
Cir. 2021). Our “review of the Commissioner’s decision is limited
to an inquiry into whether there is substantial evidence to support
the findings of the Commissioner, and whether the correct legal
standards were applied.” Wilson v. Barnhart, 284 F.3d 1219, 1221
(11th Cir. 2002); see 42 U.S.C. §§ 405(g), 1383(c)(3). Whether the
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23-11883 Opinion of the Court 3
ALJ applied the proper legal standards is reviewed de novo. Wash-
ington v. Comm’r of Soc. Sec., 906 F.3d 1353, 1358 (11th Cir. 2018).
Substantial evidence means “more than a scintilla and is such
relevant evidence as a reasonable person would accept as adequate
to support a conclusion.” Crawford v. Comm’r of Soc. Sec., 363 F.3d
1155, 1158 (11th Cir. 2004) (quotation marks omitted). The sub-
stantial-evidence threshold “is not high.” Biestek v. Berryhill, 139 S.
Ct. 1148, 1154 (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) (quotation marks
omitted). To determine whether a decision was supported by sub-
stantial evidence, the reviewing court must look at the record as a
whole, considering evidence that is favorable as well as unfavorable
to the decision. Foote v. Chater, 67 F.3d 1553, 1560 (11th Cir. 1995).
Indeed, even if a preponderance of the evidence weighs against the
Commissioner’s decision, we will affirm so long as substantial evi-
dence supports it. Buckwalter v. Acting Comm’r of Soc. Sec., 5 F.4th
1315, 1320 (11th Cir. 2021). But we will not “affirm simply because
some rationale might have supported the ALJ’s conclusion.” Id.
(quotation marks omitted).
To determine whether a claimant is disabled, the ALJ con-
siders, among other evidence, medical opinions, which are “state-
ment[s] from a medical source about what [the claimant] can still
do despite [her] impairment(s),” and prior administrative medical
findings, which are “finding[s], other than the ultimate
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4 Opinion of the Court 23-11883
determination about whether [the claimant is] disabled, about a
medical issue made by [the SSA’s] Federal and State agency medical
and psychological consultants at a prior level of review.” 20 C.F.R.
§ 416.913(a)(2), (5).1 For claims filed on or after March 27, 2017, the
ALJ will not defer or give any specific evidentiary weight to any
medical opinion or prior administrative finding. Id. § 416.920c(a).
Instead, the ALJ must determine the persuasiveness of medical
opinions and prior administrative medical findings by considering
five factors: (1) supportability; (2) consistency; (3) the provider’s
“[r]elationship with the claimant”; (4) specialization; and (5) “other
factors” including, but not limited to, the provider’s familiarity with
other evidence in the claim and the provider’s understanding of
SSA program policies. Id. § 416.920c(c)(1)-(5). Supportability and
consistency are the “most important” factors. Id. § 416.920c(b)(2).
The ALJ is required to articulate how it considered the supportabil-
ity and consistency factors, but not the remaining factors. Id. As
to supportability, the more relevant the objective medical evidence
and explanations are to the medical opinions, the more persuasive
the opinion is. Id. § 416.920c(c)(1). As to consistency, the more
1 Separate regulations govern eligibility for DIB and SSI. Compare 20 C.F.R. pt.
404 (DIB), with 20 C.F.R. pt. 416 (SSI). However, “[t]he regulations for both
programs are essentially the same.” Bowen v. City of New York, 476 U.S. 467,
470 (1986); see, e.g., 20 C.F.R. §§ 404.1520, 416.920 (setting out identical five-
step sequential evaluation processes for evaluation of disability of adults); 20
C.F.R. §§ 404.1520c, 416.920c (setting out identical regulations for how the
SSA considers medical opinions).
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23-11883 Opinion of the Court 5
consistent a medical opinion is with evidence from other sources,
the more persuasive the opinion is. Id. § 416.920c(c)(2).
Here, the ALJ properly considered the medical opinions of
the treating and non-treating sources. The ALJ complied with the
applicable regulation by articulating how he considered the sup-
portability and consistency of the medical opinions and prior ad-
ministrative medical findings, and substantial evidence supports
the ALJ’s weighing of their relative persuasiveness.
In particular, the ALJ considered the opinions of LeCroy’s
treating therapist, Janet Beasley, LPC, and concluded that Beasley’s
opinions were not persuasive because they were inconsistent with
each other, her treatment notes, and the consultative examination
findings. Beasley opined that LeCroy has abnormal recent and re-
mote memory; abnormal insight, judgment, and impulse control;
and abnormal ability to understand, remember, and carry out sim-
ple instructions. The ALJ rejected these contentions because they
were not consistent with Beasley’s treatment notes, the consulta-
tive examination findings, or Beasley’s later opinion. Beasley’s
treatment notes reported that LeCroy appeared neat, clean, and
well-groomed at her appointments, and other record evidence
showed that LeCroy’s memory and concentration abilities are in-
tact and that she is able to comprehend and answer questions and
follow instructions. The ALJ further found Beasley’s opinion un-
persuasive because Beasley stated she was not aware of LeCroy’s
ability to follow instructions or otherwise function in work situa-
tions, and that LeCroy has only a ”fair” ability to maintain her
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6 Opinion of the Court 23-11883
personal appearance and behave in an emotionally stable way—but
other evidence showed that LeCroy’s memory and concentration
abilities are intact and that she demonstrates appropriate mood and
affect. These latter observations are inconsistent with Beasley’s
opinion that LeCroy has only a fair ability to behave in an emotion-
ally stable manner.
Similarly, the ALJ considered opinions from LeCroy’s treat-
ing mental health provider, Dr. Ann Kesser, and found her unper-
suasive. Dr. Kesser opined that LeCroy has a fair-to-poor ability to
function in work situations and only a fair ability to follow simple
instructions, maintain personal appearance, and behave in an emo-
tionally stable manner. The ALJ found these opinions unpersua-
sive because LeCroy’s mental health treatment notes do not sup-
port such limitations and, instead, indicate that LeCroy maintains
a neat, clean, well-groomed appearance, and that her memory and
concentration abilities are intact. The ALJ also noted that LeCroy’s
mental health treatment appeared effective, since she had not re-
quired mental health hospitalization “for many years.”
On the other hand, the ALJ adequately explained why he
found that Dr. John Grace, Dr. Robbie Ronin, and Dr. S. Kyle’s
opinions were all more persuasive. Dr. Grace, an independent con-
sultative examiner, opined that LeCroy understands basic rules of
social convention, can take and follow instructions, can respond
adaptively to appropriate workplace criticism, and can make sim-
ple workplace decisions. He found LeCroy to be mildly impaired
in her ability to concentrate and remain attentive throughout a
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23-11883 Opinion of the Court 7
typical workday. The ALJ determined that these opinions were
persuasive because they were consistent with the consultative ex-
amination findings and LeCroy’s other records. Similarly, Dr. Ro-
nin, a state agency psychologist, found that LeCroy has the ability
to learn and remember locations and workplace procedures and to
understand and remember detailed instructions. The ALJ was like-
wise persuaded by Dr. Ronin’s opinions because LeCroy’s mental
health treatment notes and the consultative examiner's opinions
supported Ronin’s conclusions regarding LeCroy’s ability to per-
form daily activities with no more than moderate limitations. And
so too for Dr. Kyle’s opinions. Dr. Kyle, a state agency psycholo-
gist, found that LeCroy could remember locations and workplace
procedures, carry out simple instructions, and handle detailed,
complex tasks. He further found that LeCroy would be able to ad-
here to a schedule, maintain regular attendance, and sustain an or-
dinary routine without special supervision and without becoming
distracted by others around her. The ALJ found these opinions
persuasive because Dr. Kyle’s conclusions were supported by, and
consistent with, LeCroy’s mental health treatment notes, records
regarding her ability to perform activities of daily living, and the
opinions of the consultative examiner.
Substantial evidence supports the ALJ’s finding that Dr.
Kyle, Dr. Grace, and Dr. Ronin were persuasive, and that Beasley
and Dr. Kesser were not. The former three opinions were con-
sistent with each other, as they all agreed that LeCroy could per-
form daily activities despite her limitations and these conclusions
were supported by LeCroy’s medical records and the consultative
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8 Opinion of the Court 23-11883
examination. And, as the ALJ explained, the latter two opinions
were not persuasive because Beasley’s opinions were inconsistent
and neither Beasley’s nor Dr. Kesser’s opinions were supported by
the records. We, therefore, reject LeCroy’s contention that the
ALJ failed to properly assess the persuasiveness of her providers’
medical opinions.
II.
An individual claiming Social Security disability benefits
must prove that she is disabled. Moore v. Barnhart, 405 F.3d 1208,
1211 (11th Cir. 2005). The Social Security regulations establish a
five-step sequential evaluation process to determine whether a
claimant is disabled for both SSI and DIB claims. Id. First, if a
claimant is working at a substantial gainful activity, she is not disa-
bled. 20 C.F.R. § 416.920(a)(4)(i). Second, if a claimant has no im-
pairment or combination of impairments that significantly limit
her physical or mental ability to do basic work activities, then she
is not disabled. Id. § 416.920(a)(4)(ii). Third, if a claimant’s impair-
ments meet or equal an impairment listed in the Listing of Impair-
ments, she is disabled. Id. § 416.920(a)(4)(iii). Fourth, if a claim-
ant’s impairments do not prevent her from doing past relevant
work, she is not disabled. Id. § 416.920(a)(4)(iv). Fifth, if a claim-
ant’s impairments—considering her residual functional capacity
(“RFC”), age, education, and past work—prevent her from doing
other work that exists in the national economy, then the claimant
is disabled. Id. § 416.920(a)(4)(v).
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23-11883 Opinion of the Court 9
Additionally, at step four, the ALJ must determine the claim-
ant’s RFC, which is “an assessment, based upon all of the relevant
evidence, of a claimant’s remaining ability to do work despite h[er]
impairments.” Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1268
(11th Cir. 2019); 20 C.F.R. § 416.945(a)(1). In formulating the RFC,
the ALJ must account for all relevant medical evidence and other
evidence. Buckwalter, 5 F.4th at 1320; 20 C.F.R. § 416.945(a)(1). In
an RFC finding, the ALJ “must state with particularity the weight
given to different medical opinions and the reasons therefor.” Buck-
walter, 5 F.4th at 1320-21 (quotation marks omitted).
A claimant’s subjective complaints are insufficient to estab-
lish a disability on their own. 20 C.F.R. § 416.929(a). Instead, ob-
jective medical evidence must show that the claimant has a medical
impairment “which could reasonably be expected to produce the
pain or other symptoms alleged” and that, when considered with
all of the other evidence, “including statements about the intensity
and persistence of [the claimant’s] pain or other symptoms which
may reasonably be accepted as consistent with the medical signs
and laboratory findings,” would lead to a conclusion that the claim-
ant is disabled. Id. Accordingly, “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 underly-
ing medical condition; and (2) either (a) objective medical evidence
confirming the severity of the alleged pain; or (b) that the objec-
tively determined medical condition can reasonably be expected to
give rise to the claimed pain.” Wilson, 284 F.3d at 1225 (11th Cir.
2002) (citing Holt v. Sullivan, 921 F.2d 1221, 1223 (11th Cir. 1991)).
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10 Opinion of the Court 23-11883
The ALJ “has a basic obligation to develop a full and fair rec-
ord. A full and fair record not only ensures that the ALJ has fulfilled
his duty . . . to scrupulously and conscientiously probe into, inquire
of, and explore for all the relevant facts, but it also enables us on
appeal to determine whether the ultimate decision on the merits is
rational and supported by substantial evidence.” Welch v. Bowen,
854 F.2d 436, 440 (11th Cir. 1988) (internal quotation marks and ci-
tations omitted). Even still, “there is no rigid requirement that the
ALJ specifically refer to every piece of evidence in his decision, so
long as the ALJ’s decision . . . is not a broad rejection which is not
enough to enable [the reviewing court] to conclude that the ALJ
considered her medical condition as a whole.” Dyer v. Barnhart, 395
F.3d 1206, 1211 (11th Cir. 2005) (alteration adopted, quotation
marks omitted).
Here, the ALJ properly considered all of LeCroy’s mental
health limitations, the subjective reports, and absenteeism. The
ALJ applied the correct legal standards and substantial evidence
supports the ALJ’s decision that LeCroy is able to work even with
her mental health treatment and disorders. At step four, the ALJ
considered all of LeCroy’s alleged impairments, including PTSD,
social phobia, and panic disorder. When explaining the RFC find-
ing, the ALJ described how LeCroy reported suffering from panic
attacks and that she was bothered by leaving her home, spent most
of her day in bed, stopped working due to overwhelming social
anxiety and panic, and had symptoms that were exacerbated by
grief and trauma. But, as the ALJ explained, substantial evidence—
including Dr. Grace’s consultative examination, Dr. Ronin’s and
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23-11883 Opinion of the Court 11
Dr. Kyle’s opinions based on record review, and Beasley’s and Dr.
Kessen’s treatment notes—supported an RFC not further limited
by LeCroy’s reported PTSD, social phobia, and panic disorder.
The ALJ did not err in rejecting LeCroy’s subjective reports about
her own mental health, nor her friend, Antman’s subjective re-
ports. Those subjective statements were not consistent with the
medical evidence in the record, as the ALJ explained in some detail.
Indeed, as the ALJ said, the medical evidence supports a finding
that LeCroy was cooperative, demonstrated a normal mood, ap-
peared neat and clean, and was able to perform routine activities of
daily life. And, while the ALJ acknowledged that LeCroy had been
hospitalized for mental health concerns in the past, he noted that
she had not been hospitalized in many years and thus would not
need such lengthy treatment as to interfere with a work schedule.
In sum, we conclude that more than a scintilla of evidence
supports the ALJ’s decision that LeCroy was not under a disability
that prevented her from performing any work. Crawford, 363 F.3d
at 1158. Accordingly, we affirm.
AFFIRMED.
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