Kevin Burns v. Commissioner, Social Security Administration

[DO NOT PUBLISH]
In the
United States Court of Appeals
For the Eleventh Circuit
____________________
No. 22-11181
Non-Argument Calendar
____________________
KEVIN BURNS,
Plaintiff-Appellant,
versus
COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,
Defendant-Appellee.
____________________
Appeal from the United States District Court
for the Northern District of Florida
D.C. Docket No. 4:20-cv-00541-WS-HTC
____________________
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2 Opinion of the Court 22-11181
Before J ORDAN , BRANCH, and ANDERSON , Circuit Judges.
PER CURIAM:
Kevin Burns appeals the district court’s affirmance of the So-
cial Security Administration’s (“SSA”) denial of his claim for child
disability insurance benefits (“CIB”). He argues that the Adminis-
trative Law Judge (“ALJ”) erred in failing to perform the Psychiat-
ric Review Technique (“PRT”) despite a colorable claim of mental
impairment. He also argues that substantial evidence did not sup-
port the ALJ’s residual functional capacity (“RFC”) finding that
Burns could perform light work with limitations when the ALJ did
not evaluate a medical opinion in the form of a Global Assessment
of Functioning (“GAF”) score1 from Nurse John Femenella.2
I.
1 A GAF score is a numeric scale meant to represent a clinician’s judgment of
an individual’s overall level of functioning. Schink v. Comm’r of Soc. Sec., 935
F.3d 1245, 1253 n.1 (11th Cir. 2019) (citing Am. Psychiatric Ass’n, Diagnostic
and Statistical Manual of Mental Disorders 32, 34 (4th ed. 2000)).
2 We do not address arguments that have not been raised in the district court.
Stewart v. Dep’t of Health & Hum. Servs., 26 F.3d 115, 115 (11th Cir. 1994). But
we may exercise our discretion to consider the issue if the proper resolution is
beyond any doubt. Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324, 1332 (11th
Cir. 2004). Here, although Burns arguably forfeited both issues by failing to
raise them in the district court, we exercise our discretion to consider them
because the resolution of both issues is beyond any doubt.
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22-11181 Opinion of the Court 3
When an ALJ denies benefits and the Appeals Council denies
review, we review the ALJ’s decision as the Commissioner’s final
decision. Viverette v. Comm’r of Soc. Sec., 13 F.4th 1309, 1313-14 (11th
Cir. 2021). We review a social security disability case to determine
whether the Commissioner’s decision is supported by substantial
evidence and review de novo whether the ALJ applied the correct
legal standards. Id. Our review is the same as that of the district
court, so we do not defer or consider errors in the district court’s
opinion. Henry v. Comm’r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir.
2015).
Substantial evidence is relevant evidence, less than a prepon-
derance but greater than a scintilla, that “a reasonable person
would accept as adequate to support a conclusion.” Viverette,
13 F.4th at 1314 (quotation marks omitted). In reviewing for sub-
stantial evidence, we “may not decide the facts anew, reweigh the
evidence, or substitute our judgment for that of the ALJ.” Id. (quo-
tation marks and brackets omitted). A decision is not based on sub-
stantial evidence if it focuses on one aspect of the evidence while
disregarding contrary evidence. McCruter v. Bowen, 791 F.2d 1544,
1548 (11th Cir. 1986). But the ALJ need not refer to every piece of
evidence in his decision, so long as a reviewing court can conclude
that the ALJ considered the claimant’s medical condition as a
whole. Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d 780, 782 (11th
Cir. 2014).
To be eligible for CIB as a child of an individual entitled to
old-age or disability insurance benefits, a claimant 18 years old or
older who is not a student must prove he became disabled prior to
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4 Opinion of the Court 22-11181
turning 22.3 42 U.S.C. § 402(d)(1)(B). A claimant is disabled if he
cannot engage in substantial gainful activity because of a medically
determinable physical or mental impairment that can be expected
to result in death or that has lasted or can be expected to last for at
least 12 months. Id. § 423(d)(1)(A).
The regulations outline a five-step evaluation process to de-
termine whether a claimant is disabled: (1) whether the claimant is
currently engaged in substantial gainful activity; (2) whether the
claimant has a severe impairment or combination of impairments;
(3) whether the impairment meets or equals the severity of the
specified impairments in the Listing of Impairments; (4) based on
an RFC assessment, whether the claimant can perform any of his
past relevant work despite the impairment; and (5) whether there
are significant numbers of jobs in the national economy that the
claimant can perform given the claimant’s RFC, age, education,
and work experience. 20 C.F.R. § 404.1520(a)(4)(i)-(v). “[T]he se-
verity of a medically ascertained disability must be measured in
terms of its effect upon ability to work, and not simply in terms of
deviation from purely medical standards of bodily perfection or
normality.” McCruter, 791 F.2d at 1547 (quotation marks omitted).
“A medical condition that can reasonably be remedied either by
3 Burns turned 22 on March 25, 2006. Thus, the relevant period of time in this
case is from July 1, 2004 (the alleged onset date of Burnes’ disability) to March
2006, when he turned 22. However, Burns did not apply for C1B until August
16, 2018.
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22-11181 Opinion of the Court 5
surgery, treatment, or medication is not disabling.” Dawkins v.
Bowen, 848 F.2d 1211, 1213 (11th Cir. 1988).
When evaluating the severity of mental impairments, the
ALJ must use a special technique called the Psychiatric Review
Technique (“PRT”). 20 C.F.R. § 404.1520a(a); Moore v. Barnhart, 405
F.3d 1208, 1213 (11th Cir. 2005). This technique requires rating how
a claimant’s mental impairments impact four broad functional ar-
eas: understanding, remembering, or applying information; inter-
acting with others; concentrating, persisting, or maintaining pace;
and adapting or managing oneself. 20 C.F.R. § 404.1520a(c)(3).
The possible ratings are none, mild, moderate, marked, or ex-
treme. Id. § 404.1520a(c)(4).
The ALJ must incorporate these results into the findings and
conclusions. Moore, 405 F.3d at 1213-14; see 20 C.F.R.
§ 404.1520a(e)(4). It must show the significant history, including
examination and laboratory findings, the functional limitations
considered in reaching a conclusion about the severity of mental
impairments, and a specific finding as to the degree of limitation in
each of the functional areas described above. 20 C.F.R.
§ 404.1520a(e)(4). We have held that “where a claimant has pre-
sented a colorable claim of mental impairment, the social security
regulations require the ALJ to complete a [PRT form] and append
it to the decision, or incorporate its mode of analysis into his find-
ings and conclusions. Failure to do so requires remand.” Moore, 405
F.3d at 1214.
The ALJ did not err in failing to perform the PRT analysis
because he discussed the PRT analysis in his findings and
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6 Opinion of the Court 22-11181
conclusions, even if he did not complete a PRT form. The ALJ
looked at examination findings to make conclusions about the de-
gree of Burns’s limitations in four functional areas: (1) understand-
ing, remembering, or applying information; (2) interacting with
others; (3) concentrating, persisting, or maintaining pace; and (4)
adapting or managing oneself. See 20 C.F.R. § 404.1520a(c)(3),
(e)(4). First, he concluded that Burns had a moderate limitation in
understanding, remembering, or applying information because alt-
hough February and June 2006 examinations showed intact
memory, a March 2006 examination showed some memory confu-
sion. Second, he concluded that Burns had a moderate limitation
in interacting with others because the January 2006 examination
reported paranoia and being easily angered, but other examina-
tions showed he made good eye contact, was cooperative, had
worked some jobs, and had moved in with friends. Third, he con-
cluded that Burns had a mild limitation in concentrating, persisting,
or maintaining pace because the February and June 2006 examina-
tions showed intact concentration and organized thoughts, but a
March 2006 examination showed poor attention and concentra-
tion. Fourth, he concluded that Burns had a moderate limitation
for adapting or managing himself because he sought consistent
treatment, had a good response to medications, and was not inap-
propriately groomed. Therefore, the ALJ performed the PRT anal-
ysis.
To the extent Burns asserts on appeal that the ALJ should
have added a PRT form to its decision, that was not required be-
cause the ALJ incorporated the PRT analysis into his findings and
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22-11181 Opinion of the Court 7
conclusions. Moore, 405 F.3d at 1214; 20 C.F.R. § 404.1520a(e)(4).
Thus, the ALJ did not err by failing to perform the PRT analysis.
II.
To determine whether a claimant is disabled, the ALJ applies
the five-step analysis outlined above. 20 C.F.R.
§ 404.1520(a)(4)(i)-(v). Before steps four and five of the process, the
ALJ must assess the claimant’s RFC. Id. § 404.1520(a)(4)(iv)-(v). A
claimant’s RFC is the most he can still do despite his limitations.
Id. § 404.1545(a)(1).
The ALJ must consider all relevant record evidence regard-
ing all the claimant’s impairments, including those that are not se-
vere. Id. § 404.1545(a)(1)-(2). The regulations specify five catego-
ries of evidence that an ALJ may consider: (1) objective medical ev-
idence, (2) medical opinion, (3) other medical evidence, (4) evi-
dence from nonmedical sources, and (5) prior administrative med-
ical findings. Id. § 404.1513(a). “Objective medical evidence” is de-
fined as “medical signs, laboratory findings, or both.” Id.
§ 404.1513(a)(1). “Other medical evidence” is evidence from a
medical source that is not objective medical evidence or a medical
opinion, and includes judgments about the severity of impair-
ments, clinical findings, and diagnoses.4 Id. § 404.1513(a)(3). A
medical opinion is a statement from a medical source about what
a claimant can still do despite his impairments and whether he has
4 For claims filed before March 27, 2017, other medical evidence does not in-
clude diagnosis, prognosis, or a judgment about the severity of an impairment.
20 C.F.R. § 404.1513(a)(3).
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8 Opinion of the Court 22-11181
one or more impairment-related limitations or restrictions.5 Id.
§ 404.1513(a)(2). The ALJ “must state with particularity the weight
given to different medical opinions and the reasons therefor.” Win-
schel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011).
We have referred to GAF scores as evidence that a mental
impairment was severe but have noted that “GAF scores are by no
means dispositive of a claim” and proceeded to point to more de-
tailed medical evidence leading to the same conclusion. Schink, 935
F.3d at 1266.
For claims filed on or after March 27, 2017,6 the ALJ will not
defer or give any specific evidentiary weight, including controlling
weight, to any medical opinion or prior administrative finding. 20
C.F.R. § 404.1520c(a). This regulation abrogated our earlier prece-
dents applying the treating-physician rule. Harner v. Soc. Sec. Ad-
min., Comm’r, 38 F.4th 892, 896 (11th Cir. 2022). In cases applying
the treating-physician rule, we had held that to discount a treating
5 For claims filed before March 27, 2017, a medical opinion includes state-
ments from a medical source that reflects judgments about the severity of im-
pairments, symptoms, diagnosis and prognosis, what a claimant can do despite
his impairments, and physical or mental restrictions. 20 C.F.R. § 1527(a)(1).
6 For claims filed before March 27, 2017, the SSA was required to give a treat-
ing physician’s opinion more weight unless there was good cause to discount
it. Harner, 38 F.4th at 896; see 20 C.F.R. § 404.1527. A “treating source” is a
physician or other medical source who has provided the claimant with medi-
cal treatment and has, or previously had, an ongoing treatment relationship
with the claimant. 20 C.F.R. § 404.1527(a)(2).
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22-11181 Opinion of the Court 9
physician’s opinion, the ALJ must clearly articulate the reasons for
doing so. Schink, 935 F.3d at 1259.
Here, substantial evidence supported the ALJ’s RFC finding
that Burns could do light work with certain limitations. Burns’s
GAF score was not a medical opinion that the ALJ was required to
consider and was outside the period where Burns alleged disability.
Additionally, medical records showed that Burns’s impairments re-
sponded well to medication and that he had adequate understand-
ing and memory skills, and opinions from medical consultants re-
inforced that finding. The ALJ was not required to refer to every
piece of evidence, so long as he considered Burns’s condition as a
whole. Mitchell, 771 F.3d at 782. And this Court has noted that the
ALJ need not list every GAF score because GAF scores do not nec-
essarily reflect a person’s ability to do work and are not dispositive
absent other medical evidence pointing to the same conclusion.
Schink, 935 F.3d at 1266.
And the record evidence as a whole supported the ALJ’s RFC
finding. Records showed Burns was involuntarily committed for a
mental health examination in 2001 pursuant to Florida’s Baker Act
after he cut his wrist when he was high. He was seen then by Nurse
Femenella, but there was a gap in medical records with no record
of consistent treatment until January 2006. Thus, for the relevant
period of disability from July 2004 to March 2006, there were only
four sets of treatment records from January through March 2006
(although the ALJ considered later records). In January 2006, Burns
was diagnosed with psychotic disorder, depressive disorder,
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10 Opinion of the Court 22-11181
polysubstance dependence, and knee pain and was prescribed
Risperdol, Wellbutrin, and Seroquel. By February 2006, the
Risperdol had helped, and he felt his suicidal thoughts had im-
proved. Burns had appropriate hygiene and grooming, good eye
contact, cooperated, had coherent thoughts, was alert, had intact
memory, and had good attention. Two weeks later, Burns reported
mood swings and paranoia but improved taking Risperdol without
Wellbutrin. He had the same good indicators at the last visit. In
March 2006, Burns was feeling more psychotic and was slightly pre-
occupied with some confusion and poor attention but still had
good eye contact, cooperated, was alert, and had intact memory.
And doctors noted his need to stay sober, suggesting that substance
abuse was contributing to his symptoms. Thus, as the ALJ noted,
the objective medical evidence suggested that Burns could perform
work during this period, since he was responding to medication
and appeared cooperative with coherent thoughts and intact
memory. See Dawkins, 848 F.2d at 1213. Moreover, evidence from
June 2006 (outside the relevant period) suggested that Burns was
doing plumbing work and considering a job with a carnival. The
only medical opinions regarding the period at issue were from Dr.
Brown and Dr. Conger and were consistent with this record evi-
dence. They asserted that Burns had adequate understanding and
memory skills to perform within a work setting, was mentally ca-
pable of performing routine tasks, was able to relate effectively
with coworkers, and had adaptation abilities to function in a work
setting. They did note moderate limitations concentrating or per-
sisting, which is why the ALJ recommended work requiring little
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22-11181 Opinion of the Court 11
to no judgment with simple duties. Therefore, substantial evidence
supported the ALJ’s RFC determination,
Accordingly, we affirm the district court’s order affirming
the ALJ’s denial of Burns’s application for CIB.
AFFIRMED.
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