Case: 16-16247 Date Filed: 07/21/2017 Page: 1 of 24
[DO NOT PUBLISH]
IN THE UNITED STATES COURT OF APPEALS
FOR THE ELEVENTH CIRCUIT
________________________
No. 16-16247
Non-Argument Calendar
________________________
D.C. Docket No. 1:15-cv-20845-PCH
MARIBEL LARA,
Plaintiff - Appellant,
versus
COMMISSIONER OF SOCIAL SECURITY,
Defendant - Appellee.
________________________
Appeal from the United States District Court
for the Southern District of Florida
________________________
(July 21, 2017)
Case: 16-16247 Date Filed: 07/21/2017 Page: 2 of 24
Before HULL, WILSON and JILL PRYOR, Circuit Judges.
PER CURIAM:
Maribel Lara appeals the district court’s order affirming the Commissioner
of Social Security’s decision denying her application for supplemental social
security income benefits. On appeal, Lara argues that the Commissioner
improperly denied her benefits because the Administrate Law Judge (“ALJ”) erred
by failing to assign weight to the opinions of several treating physicians found in
their notes; assigning less than controlling weight to the opinion of her treating
psychiatrist; finding her statements about the intensity, persistence, and limiting
effects of her symptoms not credible; and improperly evaluating the extent of her
limitations for purposes of determining whether her mental impairments satisfied a
listing and her residual functional capacity. After careful consideration, we affirm
the district court’s judgment in favor of the Commissioner.
I. FACTUAL BACKGROUND
In July 2011, Lara applied for benefits on the basis that she was unable to
work because of her bipolar disorder, high blood pressure, lupus, and arthritis.
Although Lara originally claimed that the onset date of her disability was
November 2010, she later amended the date to July 2011. Lara requested and
received a hearing before an ALJ.
2
Case: 16-16247 Date Filed: 07/21/2017 Page: 3 of 24
A. The ALJ Hearing
At the hearing, the ALJ heard testimony from Lara and also reviewed her
medical records.1 Lara testified that she last worked as a caregiver but was unable
to remember when she last worked or how long she had worked as a caregiver.
Lara told the ALJ that she was unable to work because she was very depressed.
She stated that because of her depression, she was unable to eat or bathe. She
described one instance when she stayed in her bed for 16 days, stating that she had
difficulty waking up and wanted only to take pills. Lara testified that her
psychiatrist prescribed medication, which did not work.
Lara described her daily routine to the ALJ. She stated that she had
forgotten how to cook and was unable to clean. She testified that all she wanted to
do was sleep but was unable to answer how much time she slept each day. She
told the ALJ that she unable to watch television or drive. She stated that her only
hobby was spending time with her daughter.
Lara was unable to answer many of the ALJ’s questions because she claimed
she could not remember. She could not remember whether she completed her
1
The ALJ also heard testimony from a vocational expert whose testimony is not relevant
to this appeal.
3
Case: 16-16247 Date Filed: 07/21/2017 Page: 4 of 24
disability forms herself, the name of her treating doctor,2 when she became a
United States citizen, or the amount of food stamps she received each month.
In addition to Lara’s testimony, the ALJ also reviewed a report of a
statement Lara gave when she applied for benefits. At that time, Lara described
her problems as primarily physical in nature. She reported that she was able to
drive but recently had received multiple tickets for not paying attention to traffic
rules. She stated that she was able to attend church, read, and watch television, and
she reported having a few friends. She indicated that she cooked several times a
week but needed assistance and was able to do laundry or wash dishes if she
divided the tasks into stages. She also reported taking three hour naps due to
fatigue and having problems concentrating because of her physical pain.
The ALJ also reviewed medical evidence regarding Lara’s mental and
physical impairments. The evidence about her mental condition included materials
from psychiatrist Dr. Berta Guerra, who treated Lara from June 2010 through
January 2013. Guerra diagnosed Lara with bipolar disorder not otherwise
specified, psychotic disorder not otherwise specified, cognitive disorder, and
generalized anxiety disorder. Guerra prescribed Lara medication and saw her once
a month for medication management appointments.
2
In contrast, when questioned by her attorney, Lara was able to identify her treating
psychiatrist.
4
Case: 16-16247 Date Filed: 07/21/2017 Page: 5 of 24
Guerra’s notes from these appointments reflect that Lara regularly reported
feeling better and less depressed and denied having mood swings or psychotic
episodes. Lara reported experiencing mild mood swings at only three
appointments. She also frequently stated to Guerra that she was sleeping well or
that her insomnia was improving. She described hearing voices at one
appointment but otherwise denied experiencing hallucinations. Guerra’s notes do
reflect that at times Lara was forgetful.
Guerra prepared two reports about Lara’s mental impairments. In a July
2011 Treating Source Mental Status Report, she opined that Lara was unable to
work because of her depression, anxiety, psychosis, and mood swings. She
described Lara’s recent memory and concentration as poor. She also reported that
Lara experienced auditory hallucinations daily.
In a February 2013 Medical Assessment of Ability to Do Work-Related
Activities (Mental) form, Guerra opined about Lara’s abilities to perform work-
related activities on a daily basis in a regular work setting. Guerra found that Lara
had no ability to follow work rules, deal with the public, use judgment, deal with
work stress, functional independently, maintain attention or concentration, carry
out simple job instructions, behave in a stable manner, relate predictably in social
situations, or demonstrate reliability. Guerra explained that Lara had these
limitations because she suffered from severe mood swings, paranoid delusions, and
5
Case: 16-16247 Date Filed: 07/21/2017 Page: 6 of 24
anxiety, which left her unable to handle stress and caused her to decompensate
easily. She also noted Lara’s poor concentration and memory. She further
indicated that Lara lacked the ability to manage her own benefits.
The record also included assessments of Lara’s residual functional capacity
from two consultative state agency examiners. After reviewing Lara’s records,
each examiner opined that Lara had limitations in her understanding and memory,
concentration and persistence, social interaction, and adaptation. But ultimately
each examiner concluded that Lara was no more than moderately limited in these
areas.
Lara also submitted medical evidence regarding her physical condition,
including evidence showing that she suffered from leukopenia, meaning she had a
reduced number of white blood cells; gallstones; a fibroid tumor in her uterus; high
blood pressure; back pain; and headaches.
The medical records showed that Lara suffered from chronic leukopenia. In
September 2010, a treating physician, after noting the diagnosis, ordered additional
testing including a bone marrow biopsy, which came back normal. In September
2011, Lara was treated by a hematologist who noted that she had a low level of
white blood cells but concluded that her condition was benign and no treatment
was needed.
6
Case: 16-16247 Date Filed: 07/21/2017 Page: 7 of 24
The medical records also reflect that Lara suffered from gallstones. In
August 2011, she complained to her physician about abdominal pain and was
diagnosed a few months later with cholelithiasis, meaning she had gallstones.
Based on this diagnosis and her ongoing intolerance to fatty foods, Lara’s
physician recommended surgery to remove her gallbladder. It is unclear from the
record whether she had this surgery.
Lara’s medical records also show that she had a fibroid tumor in her uterus
and ovarian cysts. The ultrasounds showed that the tumor increased in size over
time.
Lara was diagnosed with hypertension and went to the emergency room
complaining of high blood pressure. Examinations performed by multiple
physicians and chest x-rays showed no other problems with her heart and lungs.
Lara complained to her medical providers of back pain. X-rays of her spine
showed degenerative changes. Despite these degenerative changes, physical
examinations revealed Lara had no spinal tenderness, reduced flexibility, spinal
curvature, or joint abnormalities. These examinations showed that she could
tandem walk, walk on her heels and toes, and get in and out of a chair as well as on
and off an examination table without difficulty. Although her range of motion in
her back was limited, she had a full range of motion in her other joints.
7
Case: 16-16247 Date Filed: 07/21/2017 Page: 8 of 24
The medical records also reveal that Lara reported experiencing daily
migraine headaches. In September 2011, after she went to the emergency room
complaining of headaches, a CT scan of her brain was normal.
B. The ALJ’s Decision
After the hearing, the ALJ issued a written decision concluding, after
applying the five-step sequential evaluation process, that Lara was not disabled.
At the first step, the ALJ concluded that Lara had not engaged in substantial
gainful activity since July 6, 2011, the amended application date.
At the second step, the ALJ concluded that Lara had the severe impairments
of bipolar disorder not otherwise specified and generalized anxiety disorder. The
ALJ found that Lara’s physical impairments were not severe. Her gallstones and
fibroid tumor were not severe impairments because she was receiving no ongoing
treatment or medications for these conditions and claimed no functional limitations
resulting from these conditions. The ALJ also found that Lara’s reduced white
blood cell count was not a severe impairment because she alleged no functional
limitations based on her reduced white blood cell count and her medical providers
determined the condition needed no treatment. Although Lara claimed she had
been diagnosed with lupus, the ALJ found that she was receiving no ongoing
treatment for this diagnosis.
8
Case: 16-16247 Date Filed: 07/21/2017 Page: 9 of 24
The ALJ also discussed why Lara’s other physical impairments were not
severe. Her high blood pressure was not severe because examinations of her heart
and lungs showed results within normal limits, her chest x-rays were
unremarkable, the record documented no ongoing treatment for the condition, and
she alleged no functional limitation based on this impairment. Although there was
degenerative change in her spine, the ALJ found that this impairment was not
severe because physical examinations reflected no spinal tenderness, reduced
flexibility, spinal curvature, or evidence of bone or joint abnormalities. And the
ALJ determined that Lara’s headaches were not severe because the CT scan of her
brain was normal.
At step three of the sequential analysis, the ALJ found that Lara did not have
an impairment or combination of impairments that met or medically equaled the
severity of a listed impairment. Her mental impairments, considered singly and in
combination, did not meet or equal the criteria of Listing 12.04, covering mood
disorders, or Listing 12.06 covering anxiety disorder. The ALJ found the listings
were not satisfied because Lara had only mild restrictions in activities of daily
living; moderate difficulties in social functioning; moderate difficulties in
concentration, persistence, and pace; and no episodes of decompensation of
extended duration.
9
Case: 16-16247 Date Filed: 07/21/2017 Page: 10 of 24
The ALJ then addressed Lara’s residual functional capacity, finding that she
was at a minimum able to perform medium work with certain limitations. The ALJ
explained that she should never climb ladders, ropes, or scaffolds; she should avoid
working at unprotected heights with moving mechanical parts; and she should
avoid operating motor vehicles. The ALJ determined that she was able mentally to
perform the basic demands of unskilled work but that she required only occasional
co-worker contact and supervision with a set routine and few changes in the work
day. The ALJ found that she was able to maintain regular attendance, be punctual
with customary tolerance, and perform activities within a schedule.
In assessing Lara’s functional capacity, the ALJ found that although Lara’s
impairments could reasonably be expected to cause her alleged symptoms, her
statements concerning the intensity, persistence, and limiting effects were not
credible. The ALJ set forth several reasons for this credibility determination.
First, Lara’s description of her condition contradicted her psychiatrist’s treatment
notes. Second, she reported working through July 2011 when she applied for
disability, which indicated that her daily activities were greater than what she
generally reported. Third, she had made other inconsistent statements about her
work history, proficiency in English, and ability to keep up with doctors’
appointments. The ALJ also noted that at the hearing Lara repeatedly stated she
10
Case: 16-16247 Date Filed: 07/21/2017 Page: 11 of 24
could not remember the answers to the ALJ’s questions, but she gave articulate
answers to her attorney’s questions.
After making this credibility determination, the ALJ concluded that the
opinions of Guerra, Lara’s treating psychiatrist, contained in the two reports were
entitled to less than controlling weight. The ALJ found Guerra’s opinions were
inconsistent with her notes and Lara’s previous statements about the activities of
daily living that she could perform. The ALJ also gave some weight to the
opinions of the state agency consulting psychologists even though they had not
treated or examined Lara because their opinions were consistent with the evidence
in the record.
In light of Lara’s residual functional capacity, the ALJ concluded at step
four that she was unable to perform her past relevant work, which included jobs as
a caregiver or shampooer. But the ALJ concluded at step five that there were a
significant number of jobs in the national economy that Lara could perform,
including laundry laborer, industrial cleaner, housekeeper, maid, and garment
sorter. Accordingly, the ALJ found that Lara was not disabled.3
3
Lara requested that the Appeals Council review the ALJ’s decision, but the Appeals
Council denied her request for review. Lara raises no claim on appeal regarding the Appeals
Council’s denial of review.
11
Case: 16-16247 Date Filed: 07/21/2017 Page: 12 of 24
C. District Court Proceedings
Lara then filed an action in federal district court, asking the court to reverse
the Commissioner’s decision. Both Lara and the Commissioner filed cross
motions for summary judgment. The magistrate judge issued a report and
recommendation that the district court affirm the Commissioner’s decision, grant
the Commissioner’s summary judgment motion, and deny Lara’s summary
judgment motion. Lara objected. The district court overruled Lara’s objections,
adopted the magistrate judge’s recommendation, and affirmed the Commissioner’s
decision. This is Lara’s appeal.
II. STANDARD OF REVIEW
When, as here, an ALJ denies benefits and the Appeals Council denies
review, we review the ALJ’s decision as the Commissioner’s final decision. See
Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). We review the
Commissioner’s decision to determine whether it is supported by substantial
evidence, but we review de novo the legal principles upon which the decision is
based. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). “Even if we
find that the evidence preponderates against the [] decision, we must affirm if the
decision is supported by substantial evidence.” Barnes v. Sullivan, 932 F.2d 1356,
1358 (11th Cir. 1991). Substantial evidence refers to “such relevant evidence as a
reasonable person would accept as adequate to support a conclusion.” Moore,
12
Case: 16-16247 Date Filed: 07/21/2017 Page: 13 of 24
405 F.3d at 1211. Our limited review precludes us from “deciding the facts anew,
making credibility determinations, or re-weighing the evidence.” Id.
III. LEGAL ANALYSIS
A disabled individual may be eligible for social security income benefits.
42 U.S.C. § 1382(a)(1)-(2). To determine whether a claimant is “disabled,” an
ALJ applies a sequential evaluation process to determine whether the claimant: (1)
is engaging in substantial gainful activity; (2) has a severe and medically
determinable impairment or combination of impairments; (3) has an impairment or
combination of impairments that satisfies the criteria of a “listing”; (4) can perform
her past relevant work in light of her residual functional capacity; and (5) can
adjust to other work in light of her residual functional capacity, age, education, and
work experience. 20 C.F.R. § 416.920(a)(4).
On appeal, Lara challenges the ALJ’s application of the sequential
evaluation process and conclusion that she was not disabled. Lara argues that that
the ALJ erred in reviewing the opinions of her medical providers and her testimony
about her symptoms. More specifically, she argues that the ALJ erred by failing to
assign weight to the opinions of 10 treating physicians; failing to assign weight to
opinions contained in the notes of Guerra, her treating psychiatrist, and assigning
less than controlling weight to Guerra’s opinions in two reports; and finding Lara’s
testimony about the intensity, persistence, and limiting effects of her symptoms not
13
Case: 16-16247 Date Filed: 07/21/2017 Page: 14 of 24
credible. Lara also argues that the ALJ erred in performing the sequential analysis
by improperly assessing the severity of her mental impairments for purposes of
determining whether the mental impairments satisfied the criteria of a listing at
step three of the sequential evaluation and her residual functional capacity at steps
four and five of the sequential evaluation. We consider these arguments in turn.
A. The ALJ’s Failure to Assign Weight to Medical Records from 10 of
Lara’s Treating Providers Does Not Warrant Reversal.
The ALJ failed to specify the weight she was assigning to medical records
from 10 of Lara’s providers. Lara argues that these medical records contained
opinions, the ALJ was required to assign weight to the opinions, and reversal is
required for the ALJ to consider these opinions. We disagree. First, some of the
records Lara identified do not contain opinions, meaning the ALJ was not required
to assign weight to them. Second, although other records contained opinions, any
error was harmless and does not warrant reversal.
An ALJ must evaluate every medical opinion received and assign weight to
each opinion. 20 C.F.R. § 416.927(c); see Sharfarz v. Bowen, 825 F.2d 278, 279
(11th Cir. 1987). A medical opinion is a statement from an acceptable medical
source that “reflect[s] judgment about the nature and severity of [the claimant’s]
impairment(s), including [the claimant’s] symptoms, diagnosis and prognosis, what
[the claimant] can still do despite impairment(s), and [the claimant’s] physical or
mental restrictions.” 20 C.F.R. § 416.927(a)(1). A medical provider’s treatment
14
Case: 16-16247 Date Filed: 07/21/2017 Page: 15 of 24
notes may constitute medical opinions if the content reflects judgment about the
nature and severity of the claimant’s impairments. See Winschel v. Comm’r of Soc.
Sec., 631 F.3d 1176, 1179 (11th Cir. 2011).
Generally, a treating source’s opinion is given “substantial or considerable
weight unless good cause is shown to the contrary.” Lewis v. Callahan, 125 F.3d
1436, 1440 (11th Cir. 1997) (internal quotation marks omitted). If the ALJ gives
less than controlling weight to a treating source’s opinions, the ALJ must clearly
articulate the reasons for doing so. Good cause may exist when evidence does not
bolster the source’s opinions, the evidence supports a contrary finding, the opinion
is conclusory, or the opinion is inconsistent with the source’s own medical records.
Id. Unless a treating source’s opinion is given controlling weight, the ALJ must
consider the following when assigning weight to an opinion: (1) whether the
provider examined or treated the claimant; (2) the length, nature, and extent of the
provider’s relationship with the claimant or the frequency of examination; (3) the
amount of evidence and explanation supporting the provider’s opinion; (4) the
consistency of the opinion with the record as a whole; (5) the provider’s
specialization; and (6) other factors such as how familiar the provider is with other
evidence in the claimant’s case record. See 20 C.F.R. § 416.927(c).
In order to show that the ALJ erred, Lara must show that the medical records
she identified contain opinions. But at least some of the records contain no
15
Case: 16-16247 Date Filed: 07/21/2017 Page: 16 of 24
judgments about the nature and severity of her impairments and thus do not contain
opinions. For example, one record is a single sheet of paper that shows Dr.
Adriana Hurtado referred Lara to a rheumatologist. Because this record lacks any
indication of Hurtado’s judgment about the “nature and severity” of Lara’s
impairments, we cannot say that it qualifies as a medical opinion. Id.
§ 416.927(a)(2). The ALJ did not err by failing to assign weight to it.
To the extent that Lara has identified records from the providers that contain
medical opinions, the ALJ erred by failing to state what weight she assigned to
them. But any such error was harmless. See Schomas v. Colvin, 732 F.3d 702, 707
(7th Cir. 2013) (holding the ALJ’s error in failing to assign weight to a medical
provider’s opinion was harmless); Keyes-Zachary v. Astrue, 695 F.3d 1156, 1165
(10th Cir. 2012) (same); Bass v. McMahon, 499 F.3d 506, 510 (6th Cir. 2007)
(same). The ALJ’s decision reflects that she considered the treatment notes of
these medical sources, and her decision was consistent with the records. For
example, Lara asserts that the ALJ failed to assign weight to the records from Dr.
Tomas Braunschweig. But Braunschweig’s treatment notes show he determined
that although Lara had a low-blood cell count, her leukopenia was benign and
needed no treatment. Because the ALJ’s decision reflects that she considered these
records and her decision was consistent with the records, we conclude that any
error in failing to assign weight was harmless.
16
Case: 16-16247 Date Filed: 07/21/2017 Page: 17 of 24
B. The ALJ Did Not Err in Weighing Guerra’s Opinions.
Lara also raises two challenges to the ALJ’s review of the opinions of
Guerra, her treating psychiatrist. She argues that the ALJ erred by failing to assign
weight to the opinions Guerra offered in her treatment notes and by failing to
assign controlling weight to Guerra’s opinions set forth in the Treating Source
Mental Status Report and Mental Assessment of Ability to Do Work Related
Activities. We reject both challenges.
First, Lara is correct that the ALJ failed to identify the weight given to
Guerra’s treatment notes. But as we explained above, the ALJ was required to
assign weight to treatment notes only if they qualified as opinions, meaning they
included judgments about the “nature and severity” of Lara’s impairments.
20 C.F.R. § 416.927(a). Lara has failed to show that any of Guerra’s treatment
notes set forth Guerra’s judgments about the nature and severity of Lara’s
impairments. Accordingly, we cannot say that the ALJ was required to assign
weight to the notes. But even if we assume that the treatment notes contained
medical opinions, any error in failing to assign weight to the notes was harmless.
The ALJ discussed Guerra’s notes at length in her opinion, and her decision was
consistent with the notes.
Second, Lara argues that the ALJ erred in assigning little weight to Guerra’s
opinions set forth in the Treating Source Mental Status Report and Mental
17
Case: 16-16247 Date Filed: 07/21/2017 Page: 18 of 24
Assessment of Ability to Do Work Related Activities. But substantial evidence
supports the ALJ’s articulated reasons for assigning little weight to Guerra’s
opinions—that is, that the opinions were inconsistent with Guerra’s treatment notes
and other evidence in the record. For example, in one report, Guerra opined that
Lara suffered from daily auditory hallucinations. But her treatment notes reflect
that Lara repeatedly denied experiencing hallucinations and claimed to have
experienced auditory hallucinations at only one appointment. And although
Guerra opined that Lara was unable to work because of her severe mood swings,
her treatment notes reflect that Lara repeatedly denied experiencing mood swings.
On the few occasions that Lara reported mood swings, Guerra described them in
her notes as mild. Given these inconsistencies between Guerra’s opinions and her
treatment notes, we conclude substantial evidence supports the ALJ’s conclusion
that there was good cause for assigning Guerra’s opinions less than controlling
weight.4
C. Substantial Evidence Supports the ALJ’s Credibility Determination.
Lara also argues that the ALJ erred in finding her subjective complaints
about the intensity, persistence, and limiting effects of her symptoms not credible.
4
Because the ALJ had good cause for assigning less than controlling weigh to Guerra’s
opinions, we also reject Lara’s argument that the ALJ erred in assigning some weight to the
opinions of the state agency medical consultants about Lara’s residual mental functional
capacity. See 20 C.F.R. § 416.927(c) (recognizing that when a treating source opinion is not
given controlling weight, an ALJ must weigh each medical opinion “[r]egardless of its source”).
18
Case: 16-16247 Date Filed: 07/21/2017 Page: 19 of 24
Lara testified before the ALJ about her mental impairments, claiming that her
condition made her forgetful and that she was unable to leave her bed for weeks at
a time unable to do anything other than sleep. She also testified that medication
had not helped her psychiatric condition. Lara asserts that the ALJ erred in
rejecting her statements about the intensity, persistence, and limiting effects of her
symptoms, but we discern no error.
When a claimant attempts to establish a disability through her own
testimony concerning her symptoms, we require “(1) evidence of an underlying
medical condition; and (2) either (a) objective medical evidence confirming the
severity of the alleged [symptom]; or (b) that the objectively determined medical
condition can reasonably be expected to give rise to the claimed [symptom].”
Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). If the record shows that
the claimant has a medically determinable impairment that could reasonably be
expected to produce her symptoms, the ALJ must evaluate the intensity and
persistence of the symptoms to determine how they limit the claimant’s capacity
for work. 20 C.F.R. § 416.929(c)(1). In assessing such symptoms and their
effects, the ALJ must consider: the objective medical evidence; the claimant’s
daily activities; the location, duration, frequency, and intensity of the claimant’s
symptoms; precipitating and aggravating factors; the type, dosage, effectiveness,
and side effects of medication taken to relieve the symptoms; treatment, other than
19
Case: 16-16247 Date Filed: 07/21/2017 Page: 20 of 24
medication, for the symptoms; any other measure used to relieve the symptoms;
and any other factors concerning functional limitations and restrictions due to the
symptoms. Id. § 416.929(c)(3).5 If the ALJ determines that the claimant’s
statements about her symptoms are not credible, the ALJ must “provide[] a
detailed factual basis for [the] credibility determination,” which must be supported
by substantial evidence. Moore, 405 F.3d at 1212.
Here, substantial evidence supports the ALJ’s determination that Lara’s
statements about her symptoms were not credible because those statements were
inconsistent with the medical evidence in this case and because she had given
inconsistent statements throughout the record. First, there was substantial evidence
to support the ALJ’s conclusion that Lara’s statements were inconsistent with the
medical evidence in the case. Lara testified that her depression left her unable to
get out of bed for weeks at a time, medication had not helped, and all she wanted to
do was sleep. But Guerra’s notes tell a different story. These notes, covering more
than two years of appointments, show that Lara’s condition improved and that she
reported feeling less depressed and sleeping better. Nothing in Guerra’s notes
reflect that Lara’s depression left her unable to leave her bed for weeks at a time.
5
Lara argues that it was inappropriate for the ALJ to state that she was reviewing Lara’s
“credibility.” Lara relies on Social Security Rule 16-3p, in which the Commissioner eliminated
the use of the term “credibility” to clarify that the “subjective symptom evaluation is not an
examination of an individual’s character.” 81 Fed. Reg. 14166, 14166-67 (Mar. 16, 2016). But
SSR 16-3p became effective in March 2016—after the ALJ’s decision—and thus is inapplicable
here. See id. (implementing SSR 16-3p); 81 Fed. Reg. 15776 (Mar. 28, 2016) (amending
effective date to March 28, 2016).
20
Case: 16-16247 Date Filed: 07/21/2017 Page: 21 of 24
The ALJ also concluded that Lara’s testimony that she had memory
problems was not credible because although Lara testified she was unable to keep
up with her doctor’s appointments, the record lacked evidence showing she was
excessively tardy or missed appointments. Lara argues that the record shows she
had memory problems because it reflected that she repeatedly cancelled or missed
appointments. But all but one of the missed appointments to which Lara points
occurred prior to the period when she claimed that she was disabled, when she was
still working. Given that Lara regularly received medical care during the time
period when she claims to have been disabled and only missed one appointment,
the record contradicts her testimony that she was unable to keep up with her
doctors’ appointments. We therefore conclude that substantial evidence supports
the ALJ’s conclusion that Lara’s statements about the intensity, persistence, and
limiting effects of her symptoms were not credible.6
D. Substantial Evidence Supports the ALJ’s Conclusion that Lara’s
Mental Impairments Did Not Meet or Equal a Listing.
Lara argues that the ALJ erred in assessing her mental condition for
purposes of determining whether she suffered from a mental impairment under
Listing 12.04, which covers mood disorders, or Listing 12.06, which covers
6
Given the substantial evidence to support the ALJ’s determination that Lara was not
credible because her statements were inconsistent with her medical records and the record did
not support her claims about her memory, we need not address whether substantial evidence
supported the ALJ’s other reasons for finding her not credible.
21
Case: 16-16247 Date Filed: 07/21/2017 Page: 22 of 24
anxiety. An ALJ must use the special technique set forth in the regulations when
determining whether a claimant’s mental impairments are covered by a listing. See
20 C.F.R. § 416.920a(a), (d)(2), (e)(4), Under the special technique, an ALJ must
consider the degree of limitation a claimant experiences in activities of daily
living; social functioning; and concentration, persistence, or pace, as well as
whether the claimant had episodes of decompensation. Id. § 416.920a(c)(3). Here,
the ALJ found that Lara had mild limitations in her activities of daily living;
moderate limitations in social functioning; moderate limitations in concentration,
persistence, and pace; and no episodes of decompensation that were of extended
duration. Because Lara’s mental impairments did not cause at least two marked
limitations or one marked limitation and repeated episodes of decompensation, the
ALJ concluded that her impairments did not meet or medically equal either Listing
12.04 or Listing 12.06.
Lara argues the ALJ erred in finding that she had only mild restrictions in
activities of daily living; moderate restrictions in social functioning; and moderate
limitations in concentration, persistence, and pace. But substantial evidence
supports the ALJ’s determinations. With respect to activities of daily living, Lara
reported when she applied for benefits that her problems were primarily physical
and that she could go shopping, read, and attend church. With respect to her social
functioning, she stated that she had a few friends. Regarding concentration,
22
Case: 16-16247 Date Filed: 07/21/2017 Page: 23 of 24
persistence, and pace, medical records show that Lara had been observed to be
alert and oriented to person, place, time and situation. In addition, she had
regularly reported no mood swings or psychotic symptoms. Given this evidence,
we cannot say that the ALJ erred in assessing her limitations or concluding that her
mental impairments did not meet or equal a listing.
E. Substantial Evidence Supports the ALJ’s Residual Functional Capacity
Assessment.
Lara also argues that the ALJ erred in assessing her residual functional
capacity at steps four and five of the sequential evaluation process. Lara asserts
that the ALJ erred in assessing her residual functional capacity by failing to
consider the limitations that were the result of her gallstones, a uterine fibroid
tumor, low white blood cell counts, hypertension, and degenerative spine disease.
But Lara has offered no explanation to the ALJ or to this Court about why or how
these impairments created work-related limitations. And “the mere existence of
these impairments does not reveal the extent to which they limit her ability to work
or undermine the ALJ’s determination in that regard.” Moore, 405 F.3d at 1213
n.6. Accordingly, we cannot say that the ALJ erred in assessing Lara’s residual
functional capacity. 7
7
Lara also challenges the ALJ’s assessment of her mental impairments for purposes of
assessing her residual functional capacity. We reject her arguments for the reasons given in
Section III.D above.
23
Case: 16-16247 Date Filed: 07/21/2017 Page: 24 of 24
IV. CONCLUSION
For the reasons set forth above, we affirm the Commissioner’s decision to
deny benefits.
AFFIRMED.
24