Prather v. Commissioner of Social Security

Filing 26

ORDER affirming the Commissioner's decision and directing the clerk to enter judgment in favor of the Commissioner and close the file. Signed by Magistrate Judge Patricia D. Barksdale on 3/31/2017. (BGK)

United States District Court
Middle District of Florida
Tampa Division
MARIE PRATHER,
ON BEHALF OF M.C.,
Plaintiff,
V.

NO. 8:16-CV-110-T-PDB

COMMISSIONER OF SOCIAL SECURITY,
Defendant.

Order Affirming Commissioner’s Decision
This is a case under 42 U.S.C. § 1383(c)(3) to review a final decision of the
Commissioner of the Social Security Administration (“SSA”) denying Marie Prather’s
claim on behalf of her minor son, M.C., for supplemental security income. 1 She seeks
reversal, Doc. 24; the Commissioner, affirmance, Doc. 25. This order adopts the
summaries of facts and law in the Administrative Law Judge’s (“ALJ’s”) decision, Tr.
10–23, and in the parties’ briefs, Docs. 24, 25.

1The

SSA uses an administrative review process a claimant ordinarily must follow to
receive benefits or judicial review of their denial. Bowen v. City of New York, 476 U.S. 467,
471−72 (1986). A state agency acting under the Commissioner’s authority makes an initial
determination. 20 C.F.R. §§ 416.1400–416.1406. If the claimant is dissatisfied with the initial
determination, she may ask for reconsideration. 20 C.F.R. §§ 416.1407−416.1422. If she is
dissatisfied with the reconsideration determination, she may ask for a hearing before an
Administrative Law Judge (“ALJ”). 20 C.F.R. §§ 416.1429−416.1443. If she is dissatisfied
with the ALJ’s decision, she may ask for review by the Appeals Council. 20 C.F.R.
§§ 416.1467−416.1482. If the Appeals Council denies review, she may file an action in federal
district court. 20 C.F.R. § 416.1481. Section 1383(c)(3), incorporating 42 U.S.C. § 405(g),
provides the basis for the court’s jurisdiction.

I.

Issues
Prather presents three issues: (1) whether substantial evidence supports the

ALJ’s finding M.C. has no impairment or combination of impairments that
functionally equals an impairment in the Listing of Impairments, 20 C.F.R. Part 404,
Subpart P, Appendix 1; (2) whether the ALJ properly evaluated Prather’s testimony;
and (3) whether the ALJ properly evaluated M.C.’s subjective complaints. Doc. 24 at
3, 10–16.
II.

Background
M.C. was born in 1997 and was an adolescent at all relevant times. Tr. 127; see

20 C.F.R. § 416.926a(g)(1)(v) 2 (defining adolescent as “age 12 to attainment of age
18”). In April 2012, Prather applied for supplemental security income on M.C.’s
behalf, alleging M.C. has been disabled since October 2011 3 due to juvenile
rheumatoid arthritis, Sjögren’s syndrome, 4 and asthma. Tr. 127, 159. She proceeded
through the administrative process, failing at each level. Tr. 1–6, 10–23, 41–59, 61–
67, 73–79. This case followed. Doc. 1.

2Unless

otherwise stated, all citations are to the regulations in effect on the date of
the ALJ’s decision.
3Because

the SSA will not pay supplemental security income for the month in which
a claimant files an application or for any month before that, the pertinent time period for
determining whether a claimant is disabled begins on the application date. See 20 C.F.R.
§ 416.335.
4Sjögren’s

syndrome is a disease often associated with rheumatoid arthritis and
characterized by dry eyes, dryness of mucous membranes, dilation of blood vessels or spots
on the face caused by hemorrhages into the skin, and enlargement of parotid glands.
STEDMAN’S MEDICAL DICTIONARY 821, 1537 (William R. Hensyl et al. eds., 25th ed. 1990).

2

III.

Evidence

A.

Medical Evidence
In April 2011, M.C. reported to his primary care physician, Dr. Amanda

Puentes, that his knees had been giving out during physical-education classes and he
had been experiencing pain in his wrists, ankles, and knees for more than a year. Tr.
303. She advised him to take ibuprofen as needed and apply heat. Tr. 304.
In August 2011, M.C. returned to Dr. Puentes complaining of right-shoulder
pain. Tr. 301. She ordered an MRI of the shoulder and recommended ibuprofen and
alternating heat and ice after school and after using the shoulder. Tr. 301–02.
In October 2011, M.C. saw Dr. Drew Warnick for evaluation of a right-shoulder
injury he had sustained a few months earlier when trying to open a cattle gate. Tr.
314–16. Dr. Warnick observed he had “full pain-free range of motion of the” shoulder,
full rotation strength, nearly full abduction strength, and “slight discomfort with the
empty drawer test.” Tr. 315. Dr. Warnick observed no swelling of other joints and
slight tenderness of the left ankle. Tr. 315. He opined M.C. had synovitis in the right
shoulder with no tear and “stressed the importance of him seeing a rheumatologist to
be placed on appropriate medication” for arthritis. Tr. 315.
In October 2011, M.C. saw Dr. Robert Nickeson for evaluation for possible
arthritis. Tr. 434–35. Dr. Nickeson observed he had mild swelling in the knees, joint
hypermobility, 5 and his small hand joints were unremarkable. Tr. 435. He started him
on piroxicam. Tr. 435.

5Joint

hypermobility refers to an “[i]ncreased range of movement of joints, joint laxity,
occurring normally in young children or as a result of disease.” STEDMAN’S MEDICAL
DICTIONARY 742 (William R. Hensyl et al. eds., 25th ed. 1990).

3

In December 2011, M.C. returned to Dr. Nickeson complaining of occasional dry
eyes and joint pain about two days a week. Tr. 433. Dr. Nickeson observed his shoulder
seemed to be a particular problem and his hand and leg joints did not show significant
swelling. Tr. 433. A few days later, Dr. Nickeson contacted another doctor about
performing a lip biopsy to test for Sjögren’s syndrome. Tr. 286.
In February 2012, M.C. returned to Dr. Puentes complaining of ongoing joint
pain “due to baseball and FHA activities.” Tr. 295. Dr. Puentes noted Prather reported
M.C.’s arthritis causes him to be tardy on days when he needs to take longer showers
to relieve pain. Tr. 295. Dr. Puentes provided a note indicating M.C. should be allowed
to be tardy “at most 2 times a week due to flare up of joint pain.” Tr. 296. She
encouraged Prather to call any time M.C. would be tardy so they could keep a record
of the frequency. Tr. 296.
In February 2012, M.C. returned to Dr. Warnick and stated “his shoulder has
completely resolved, [but] he has developed right knee, right hip, and right ankle
pain.” Tr. 311. Dr. Warnick observed M.C. had started baseball within the previous
two weeks, “which seemed to exacerbate this pain.” Tr. 311. He observed mild
tenderness to palpation but normal gait. Tr. 311. He stated, “The treatment for
[M.C.’s] knee, hip, and ankle are stretching and strengthening exercises” and advised
M.C. to continue taking medication as prescribed. Tr. 312.
About twice a week from February to April 2012 and again a few times in May
2012, M.C. participated in physical therapy. Tr. 320–69.
In October 2012, M.C. returned to Dr. Nickeson complaining of continuing joint
pain. Tr. 423–24. Dr. Nickeson observed no problems in M.C.’s arms and “2-plus”
swelling in his ankles, and he advised him to continue taking prednisone at the
current dose for another three to four weeks and reduce the dose after that. Tr. 423.
In January 2013, M.C. returned to Dr. Nickeson. Tr. 421. Dr. Nickeson observed
he continued to experience ankle, knee, and wrist swelling, had been playing “a
4

number of instruments, including piano, guitar, sax[ophone], and ukulele,” was
teaching computer skills to other people, wanted to play more baseball, and was
intermittently participating in homebound education. Tr. 421. He observed M.C.’s
arthritis was not responding well to current medication, so he introduced weekly
methotrexate injections. Tr. 421.
In September 2013, M.C. returned to Dr. Nickeson and reported “feeling better
with methotrexate” and having more pep. Tr. 419. Dr. Nickeson observed he had been
playing baseball with friends, enjoyed being in the outfield, and intended to practice
pitching. Tr. 419. He observed swelling in the elbows, small hand joints, ankles, and
right knee. Tr. 419. He concluded, “[M.C.] is doing well with methotrexate. I think we
could push the dose higher, due to his size.” Tr. 419.
In December 2013, M.C. returned to Dr. Nickeson. Tr. 415. Dr. Nickeson
observed, “Energy is good and is increased with slight raising of his methotrexate dose.
He is playing baseball and is more active. He is down 15 pounds from last year with
increase in activity. He is not complaining of nausea.” Tr. 415. He concluded,
“Assessment is good arthritis control.” Tr. 415. He reduced the prednisone dose and
left the methotrexate dose unchanged. Tr. 415.
In April 2014, M.C. returned to Dr. Nickeson reporting his right shoulder (his
“biggest problem” since October 2013) had improved over the previous month. Tr. 417.
Dr. Nickeson observed M.C. had been off methotrexate around that time because
Prather had had difficulty keeping up with refills due to a combination of
transportation and insurance problems. Tr. 417. At the time of examination, he was
taking prednisone daily, methotrexate weekly, and Tylenol as needed. Tr. 417. Dr.
Nickeson observed he had limited range of motion of the right shoulder but could
“extend both arms over his head pretty well.” Tr. 417. A joint exam showed “no
particular problems except for [mild] swelling in the right wrist” and swelling in the
knees and ankles. Tr. 417. He maintained M.C. on the same methotrexate dose and
reduced the prednisone dose. Tr. 418.
5

B.

Opinion Evidence
In June 2012, Pauline Correia, M.C.’s eighth-grade exceptional student

education (“ESE”) teacher for math and language arts, completed a questionnaire.
Tr. 165–67. She stated she sees him twice each school day, and he is on grade level
for reading, math, and written language. Tr. 165. She stated he has an unusual
absenteeism “[d]ue to his illness—Sjogrens’ [sic]; migraine headaches[;] arthritis.” Tr.
165.
For the domain of acquiring and using information, Ms. Correia opined M.C.
has an obvious problem expressing ideas in written form, stating, “Due to stiffness in
joints, difficulty holding writing instruments.” Tr. 166.
For the domain of attending and completing tasks, Ms. Correia opined M.C.
has obvious problems weekly with completing class or homework assignments and
working at a reasonable pace and finishing on time. Tr. 167. She stated, “The student
is independent, however, due to physical difficulties, [he] cannot write at an
excellerated [sic] pace and in a large amount for his grade level. For ex: can barely
write 3 full sentences during written assignments.” Tr. 167.
For the domain of moving about and manipulating objects, Ms. Correia opined
M.C. has obvious problems moving his body from one place to another and managing
the pace of physical activities or tasks. Tr. 169. She stated, “Dexterity is minimal
when grasping a pencil to write. Due to arthritis, kneeling, sitting for long periods,
standing, and crouching are painful activities.” Tr. 169.
Ms. Correia opined M.C. has no observed problems in the domains of
interacting and relating with others and caring for himself. Tr. 168, 170.
For the domain of health and physical well-being, in response to the question
asking her to describe “any chronic or episodic condition” and whether its physical
effects interfere with his functioning, she responded, “none seen at school.” Tr. 171.
6

She stated M.C. “has morning stiffness causing severe difficulties in moving with
pain. There may be some mornings when he arrives tardy as a result. Very
unpredictable and unavoidable physical state.” Tr. 171.
Later in June 2012, state-agency medical consultant Dr. Edith Davis opined
M.C. has severe impairments of inflammatory arthritis, Sjögren’s syndrome, and
asthma. Tr. 44. She opined he has less-than-marked limitations in the domains of
moving about and manipulating objects and health and physical well-being, and no
limitations in the domains of acquiring and using information, attending and
completing tasks, interacting and relating with others, and caring for himself. Tr. 44–
45. Regarding moving about and manipulating objects, she stated, “There may be
limitations due to painful joints. Teacher Questionnaire: difficulty writing at a fast
pace.” Tr. 45. On health and physical well-being, she stated:
14 yr old boy with dx of JRA, Sj[ö]gren’s Syndrome. Sinding-larsenjohnson syndrome of rt knee. Bursitis of rt hip & rt ankle stain [sic].
Responding to present treatment. OrthoPedic OV: 2/24/12: Rt shoulder
pain resolved[.] Has rt knee, rt hip, & rt [ankle] pain. PE: Tenderness
over inferior pole of patell [sic] & tendon. Mildly tenderness [sic] on rt
trochanter. Tenderness of anterior talofibular lig[a]ment. Nl gait. No
joint effusion. X-Ray of pelvis: WNL. Plan: Strengthening exercises. f/u
PRN.
12/9/11 Rhe[u]matology OV: Has dry eyes, not daily. Has tear
production. Joint pains about 2 days a week. Wt 111kg@>97%. Ht 175cm
@ 50%. PE: Joint[s] are not showing a lot of swelling in hand or lower
extremities. Less than marked.
Tr. 45.
In October 2012, state-agency medical consultant Dr. Shakra Junejo found
the same severe impairments and limitations in the functional domains. Tr. 54–55.
For the domain of health and physical well-being, besides the evidence Dr. Davis
cited, she cited new evidence from August and September 2012 concerning reports
of chest pain. Tr. 55.
7

In April 2014, Susan Noblitt, M.C.’s homebound language-arts teacher,
completed a questionnaire. Tr. 272–79. She stated she has known him for 13 months
and sees him once a week. Tr. 272. She marked he has no observed problems in the
domain of acquiring and using information, but in the narrative section, she stated,
“Because of his health issues, he is unable to function socially with his peer group.
What few activities he does are with his family.” Tr. 273.
For the domain of attending and completing tasks, Ms. Noblitt opined M.C. has
no problem refocusing to a task when necessary, carrying out single-step instructions,
waiting to take turns, changing from one activity to another without being disruptive,
organizing his own things or school materials, completing work accurately without
careless mistakes, and working without distracting himself or others; slight problems
paying attention when spoken to directly and carrying out multi-step instructions; an
obvious problem completing class or homework assignments; and very serious
problems sustaining attention during play or sports activities, focusing long enough
to finish assigned activities or tasks, and working at a reasonable pace and finishing
on time. Tr. 274. She stated, “He is unable to complete assignments in a timely manor
[sic]. I meet with him once a week and most of the time he’s not completed homework.
Many times we have to reschedule because he is ill.” Tr. 274.
For the domain of interacting and relating with others, Ms. Noblitt opined M.C.
has no problem seeking attention and asking permission appropriately, following
rules, respecting and obeying adults in authority, using language appropriate to the
situation and listener, introducing and maintaining relevant and appropriate topics
of conversation, taking turns in a conversation, and interpreting the meaning of facial
expressions, body language, hints, and sarcasm; slight problems playing
cooperatively with other children, expressing anger appropriately, relating
experiences and telling stories, and using adequate vocabulary and grammar to
express thoughts and ideas in general, everyday conversation; and a serious problem
making and keeping friends. Tr. 275. She stated, “[M.C.]’s mom is very supportive!
8

She appears to be willing to create as typical a teenage life as he wishes and can
physically handle. He doesn’t always/if rarely is physically able.” Tr. 275.
For the domain of moving about and manipulating objects, Ms. Noblitt opined
M.C. has a slight problem planning, remembering, and executing controlled motor
movements; obvious problems showing a sense of his body’s location and movement
in space and integrating sensory input with motor output; and very serious problems
moving from one place to another, moving and manipulating things, demonstrating
strength, coordination, and dexterity in activities or tasks, and managing the pace of
physical activities or tasks. Tr. 276. She stated, “He is in constent [sic] pain and does
the best he can but I can tell when he does [sic] feel well.” Tr. 276.
For the domain of caring for himself, Ms. Noblitt opined M.C. has no problem
being patient when necessary, using good judgment regarding personal safety and
dangerous circumstances, and knowing when to ask for help; slight problems
handling frustration appropriately, taking care of personal hygiene, caring for
physical needs such as dressing and eating, and responding appropriately to changes
in his mood; an obvious problem identifying and appropriately asserting his
emotional needs; and a very serious problem using appropriate coping skills to meet
the daily demands of a school environment. Tr. 277. She stated, “[M.C.] isn’t
physically able to attend a normal schedule school [sic]. The more he’s not on a regular
schedule the harder it is to return.” Tr. 277.
For the domain of health and physical well-being, Ms. Noblitt identified
“physical pain, depression[,] and antisocial behavior” as M.C.’s chronic or episodic
conditions. Tr. 278. She stated he uses glasses and an inhaler and needs but has no
assistive technology device. Tr. 278. She stated he takes medication regularly, which
affects his functioning, but she did not describe how. Tr. 278. In response to the
question, “Does this child frequently miss school due to illness?,” she responded
“DOESN’T ATTEND!! HOMEBOUND!!” Tr. 278 (emphasis in original).

9

Also in April 2014, the head of the ESE department at M.C.’s school (whose
signature is illegible) completed a questionnaire about M.C.’s functioning. Tr. 264–
71. She stated she had known him for two years, he was homebound for all subjects,
and “many medical and health issues prevent [him] from attending” school. Tr. 264.
For the domain of acquiring and using information, the department head
opined M.C. has no problems comprehending oral instructions, understanding school
and content vocabulary, reading and comprehending written material, providing
organized oral explanations and adequate descriptions, learning new material, and
recalling and applying previously learned material; a slight problem comprehending
and doing math problems; an obvious problem expressing ideas in writing; and very
serious problems understanding and participating in class discussions and applying
problem-solving skills in class discussions. Tr. 265. She clarified: “Due to student[’]s
health issues it interferes with scheduled homebound visits and prevents student
from

completing

assignments as scheduled”;

“participation and classroom

discussions—he is unable to attend with other students for discussion for over 4
years”; he “struggles with writing the material due to health issues”; and he “cannot
participate in class discussion with other students[,] for he does not attend due to
health issues.” Tr. 265.
For the domain of attending and completing tasks, the department head opined
M.C. has no problem paying attention when spoken to directly, refocusing to tasks
when necessary, carrying out instructions, waiting to take turns, changing from one
activity to another without being disruptive, completing work accurately without
careless mistakes, working without distracting himself or others, and working at a
reasonable pace and finishing on time; an obvious problem organizing his own things
or school materials; serious problems focusing long enough to finish an assigned
activity or task and completing class or homework assignments; and a very serious
problem sustaining attention during play or sports activities. Tr. 266. She clarified:

10

“due to health issues[, he] cannot participate” in play or sports, and whether he has
serious problems focusing depends on how he feels during the assignment. Tr. 266.
The department head opined M.C. has problems in the domain of interacting
and relating with others, but she did not describe the degree of his difficulties in
specific activities because, “due to health issues[,] M.C. does not attend school to be
around other students. [He] [d]oes not have any social interaction with other
students.” Tr. 267.
For the domain of moving about and manipulating objects, the department
head opined M.C. has a slight problem integrating sensory input with motor output;
obvious problems demonstrating strength, coordination, and dexterity in activities or
tasks and planning, remembering, and executing controlled motor movements; a
serious problem managing the pace of physical activities or tasks; and very serious
problems moving from one place to another and moving and manipulating things. Tr.
268. She stated, “[A]ll of these activities will be documented through medical
diagnosis.” Tr. 268.
For the domain of caring for himself, the department head opined M.C. has no
problems handling frustration appropriately, being patient when necessary, caring
for his physical needs, and using good judgment regarding personal safety and
dangerous circumstances; obvious problems taking care of personal hygiene and
cooperating in or being responsible for taking needed medications; and serious
problems identifying and appropriately asserting emotional needs, responding
appropriately to changes in his mood, and knowing when to ask for help. Tr. 269. She
clarified: “[M.C.] is dealing with a lot of pain due to medical issues which causes him
to not care.” Tr. 269.
For the domain of health and physical well-being, the department head stated
M.C. has “many medical issues”; uses glasses, an inhaler, and an assistive technology
device; and “has not attended school since 7th grade due to medical issues.” Tr. 270.
11

C.

Hearing Testimony
At an April 2014, hearing, Prather testified as follows.
M.C. “struggles day-to-day to get out of bed” and goes from the bed to the couch,

although some days he cannot get out of bed. Tr. 33–34. He is 5’11’’ and weighs about
240 pounds. Tr. 33. He was diagnosed with juvenile rheumatoid arthritis when he
was in the sixth grade but has “been sick since birth.” Tr. 34. He receives homebound
education. Tr. 34. He cannot participate some days depending on how he feels. Tr. 34.
He takes medication while in bed. Tr. 34. It makes him sick sometimes. Tr. 34–35.
The “chemo shots” 6 also make him sick. Tr. 35.
Due to pain, M.C. cannot focus and is “in tears in bed.” Tr. 35. He gets tired or
sick from medication, “especially from the chemo shots,” which make him sick several
days a week. Tr. 35. His symptoms seem to stay the same or get worse. Tr. 35.
He is in ninth grade but should be in tenth grade. Tr. 35. The 2013-to-2014
school year was his first participating in homebound schooling fulltime. Tr. 35. Dr.
Nickeson recommended homebound schooling. Tr. 36. Beginning in elementary
school and continuing through middle school, Prather must sometimes pick him up
early or take him to school late “because it takes him so long to be able to even get
going throughout the day.” Tr. 36. His grades have improved since one-on-one
instruction. Tr. 36. Sometimes he takes a long time to do school work because he
cannot focus or is in pain. Tr. 36. Sometimes he has to put work aside and return to
it when he feels better, but even then “he may only be able to do a little bit and then
come back to it and do a little bit, and sometimes he doesn’t even get to complete the
assignments.” Tr. 36–37.

6Prather

testified M.C. receives “chemo shots” to treat arthritis. Tr. 35. The Court
understands that to be a reference to methotrexate injections M.C. receives weekly as
prescribed by Dr. Nickeson. See Tr. 421.

12

M.C. has no social activities and stays in the house 24 hours a day, 7 days a
week. Tr. 37. He played baseball when he was younger, and the Little League
accommodated him. Tr. 37. He tried to play the previous year, “but it didn’t work out.”
Tr. 37.
M.C. testified as follows.
He experiences sharp pain in every joint. Tr. 38. It ranges from moderate to
severe but is more often severe. Tr. 38. He feels “[t]errible” when he wakes up. Tr. 38.
He takes medication first thing in the morning, and it takes an hour or two to reduce
pain. Tr. 38. After taking medication, his pain is about a 5 on a scale of 1 to 10. Tr.
38. His medications cause tiredness, dizziness, lightheadedness, and upset stomach.
Tr. 38. He can write only about a half page before he has wrist pain. Tr. 39. He does
not spend time with friends outside the home. Tr. 39. About twice a month, he cannot
get out of bed due to pain. Tr. 39. He can bathe himself but has problems putting on
socks and shoes. Tr. 39. When he attended school, he experienced a lot of pain and
had difficulty standing. Tr. 39. He had wrist and hand pain from writing. Tr. 39.
IV.

ALJ’s Decision
At step one, 7 the ALJ found M.C. has never engaged in substantial gainful

activity. Tr. 13.
At step two, the ALJ found M.C. suffers from severe impairments of Sjögren’s
syndrome, inflammatory arthritis, and asthma. Tr. 13.

7An

ALJ must follow a three-step sequential process to determine if a minor is
disabled. 20 C.F.R. § 416.924(a). The ALJ asks: (1) is the minor currently engaged in
substantial gainful activity; (2) does he have a severe impairment or combination of
impairments; and (3) does the impairment or combination of impairments meet, medically
equal, or functionally equal the severity of a listed impairment in 20 C.F.R. Part 404, Subpart
P, Appendix 1. Id.

13

At step three, the ALJ found M.C. has no impairment or combination of
impairments that meets or medically equals the severity of a listed impairment in 20
C.F.R. Part 404, Subpart P, Appendix 1. Tr. 13. The ALJ also found M.C. has no
impairment or combination of impairments that functionally equals the severity of a
listed impairment. Tr. 13. He found M.C. has less-than-marked limitations in moving
about and manipulating objects and health and physical well-being and no limitation
in acquiring and using information, attending and completing tasks, interacting and
relating with others, or ability to care for himself. Tr. 18–23.
The ALJ considered the medical evidence, opinion evidence, and testimony. Tr.
14–23. The ALJ gave great weight to the opinions and findings of M.C.’s medical
providers, stating:
The record contains findings and/or opinions from treating and
examining physicians that generally support the limitations reached in
this decision. Of import, the findings and/or opinions of the claimant’s
treating and examining sources reflect a longitudinal perspective of the
claimant’s impairments and are supported by the medically acceptable
clinical and diagnostic/laboratory techniques.
Tr. 17. He stated he found the opinions of the state-agency medical consultants
generally persuasive and consistent with the evidence of record as a
whole. The undersigned also notes that the State agency medical
consultants are familiar with the [SSA’s] disability listings and residual
functional capacity regulations and policies and that they had the
opportunity to review the medical evidence of record in order to offer
professional opinions both in support [of] and against disability.
Tr. 17. He gave “some weight, but not controlling, or great, weight,” to the opinions
from the teachers, observing they are not acceptable medical sources but are other
sources who may provide information about how M.C.’s impairments affect his
functioning. Tr. 17. He gave no significant weight to Prather’s statements, stating:
Since is it is not clear whether the claimant’s mother is medically
trained to make exacting observations as to dates, frequencies, types[,]
and degrees of medical signs and symptoms, or of the frequency or
14

intensity of unusual moods or mannerisms, the accuracy of her
statements is questionable. Moreover, by virtue of her relationship as
the claimant’s mother, this witness cannot be considered a disinterested
third[-]party witness whose statements would not tend to be colored by
affection for the claimant and a natural tendency to agree with the
symptoms and limitations the claimant alleges. Most importantly,
significant weight cannot be given to the witness’s statements because
they, like the claimant’s, are simply not consistent with the
preponderance of the opinions and observations by medical doctors in
this case.
Tr. 17–18.
Based on those findings, the ALJ found no disability. Tr. 23.
V.

Standard of Review
A court’s review of an ALJ’s decision is limited to determining whether the ALJ

applied the correct legal standards and whether substantial evidence supports his
findings. Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). Substantial
evidence is “less than a preponderance”; it is “such relevant evidence as a reasonable
person would accept as adequate to support a conclusion.” Id. The court may not
decide facts anew, reweigh evidence, make credibility determinations, or substitute
its judgment for the Commissioner’s judgment. Id.
VI.

Analysis

A.

Whether Substantial Evidence Supports the ALJ’s Finding M.C.’s
Impairments Do Not Functionally Equal the Severity of the Listings
Prather argues substantial evidence does not support the ALJ’s finding that

M.C.’s impairments do not functionally equal the severity of the listings. Doc. 24 at
10–14. She specifically challenges the ALJ’s findings that M.C. has no limitation in
attending and completing tasks and less-than-marked limitations in moving about
and manipulating objects and health and physical well-being, arguing the ALJ failed
to properly consider Ms. Noblitt’s and the ESE department head’s opinions in the
15

questionnaires. Doc. 24 at 12–14. The Commissioner responds substantial evidence
supports the ALJ’s findings and decision to give only some weight to those opinions.
Doc. 25 at 4–9.
At step three, an ALJ must determine whether a minor claimant’s
impairments meet, medically equal, or functionally equal the listings. 20 C.F.R.
§ 416.924(a). In determining functional equivalency, an ALJ assesses the “degree to
which the [claimant’s] limitations interfere with the [claimant’s] normal life
activities.” Shinn v. Comm’r of Soc. Sec., 391 F.3d 1276, 1279 (11th Cir. 2004). The
ALJ must consider six “major domains of life”: (1) acquiring and using information,
(2) attending and completing tasks, (3) interacting and relating with others,
(4) moving about and manipulating objects, (5) caring for oneself, and (6) health and
physical well-being. Id.; 20 C.F.R. § 416.926a(b)(1). An impairment functionally
equals the listings if it causes marked limitations in two domains or an extreme
limitation in one domain. Shinn, 391 F.3d at 1279; 20 C.F.R. § 416.926a(d).
A minor claimant has a marked limitation when his “impairment(s) interferes
seriously with [his] ability to independently initiate, sustain, or complete activities.”
20 C.F.R. § 416.926a(e)(2)(i). “‘Marked’ limitation also means a limitation that is
‘more than moderate’ but ‘less than extreme.’” Id. With respect to the domain of
health and physical well-being, a claimant has a marked limitation if he is “frequently
ill because of [his] impairment(s) or ha[s] frequent exacerbations of [his]
impairment(s) that result in significant, documented symptoms or signs.” 20 C.F.R.
§ 416.926a(e)(2)(iv). 8

8Section

416.926a(e)(2) also states the SSA considers a minor to have a marked
limitation (1) if he is under 3, has “no standard scores from standardized tests in [his] case
record,” and functions “at a level that is more than one-half but less than two-thirds of [his]
chronological age”; or (2) if he has “a valid score that is two standard deviations or more below
the mean, but less than three standard deviations, on a comprehensive standardized test
designed to measure ability or functioning in that domain, and [his] day-to-day functioning
in domain-related activities is consistent with that score.” 20 C.F.R. § 416.926a(e)(2)(ii)–(iii).

16

A minor claimant has an extreme limitation when his “impairment(s)
interferes very seriously with [his] ability to independently initiate, sustain, or
complete activities.” 20 C.F.R. § 416.926a(e)(3)(i). “‘Extreme’ limitation also means a
limitation that is ‘more than marked.’ ‘Extreme’ limitation is the rating [the SSA]
give[s] to the worst limitations. However, ‘extreme limitation’ does not necessarily
mean a total lack or loss of ability to function.” Id. Regarding the domain of health
and physical well-being, a claimant has an extreme limitation if he is
frequently ill because of [his] impairment(s) or ha[s] frequent
exacerbations of [his] impairment(s) that result in significant,
documented symptoms or signs substantially in excess of the
requirements for showing a “marked” limitation. However, if [he] ha[s]
episodes of illness or exacerbations of [his] impairment(s) that [the SSA]
would rate as “extreme” under this definition, [his] impairment(s)
should meet or medically equal the requirements of a listing in most
cases.
20 C.F.R. § 416.926a(e)(3)(iv). 9
Social Security Ruling (“SSR”) 06-03p, 2006 WL 2329939 (Aug. 9, 2006),
“clarifies how [the SSA] considers opinions and other evidence from … ‘non-medical
sources,’ such as teachers, school counselors, social workers, and others who have seen
the individual in their professional capacity.” SSR 06-03p, 2006 WL 2329939, at *4. It
states evidence from other sources may “provide insight into the severity of the
impairment(s) and how it affects [an] individual’s ability to function.” Id. at *2. It
states the SSA should evaluate opinions from non-medical sources by considering
factors such as how long the source has known the claimant, how frequently she sees
him, how consistent the opinion is with other evidence, the degree to which the source
9Section

416.926a(e)(3) also states the SSA considers a minor to have an extreme
limitation (1) if he is under 3, has “no standard scores from standardized tests in [his] case
record,” and functions “at a level that is one-half of [his] chronological age or less”; or (2) if he
has “a valid score that is three standard deviations or more below the mean on a
comprehensive standardized test designed to measure ability or functioning in that domain,
and [his] day-to-day functioning in domain-related activities is consistent with that score.”
20 C.F.R. § 416.926a(e)(3)(ii)–(iii).

17

presents evidence to support her opinions, how well she explains her opinion, whether
she has a specialization or area of expertise related to the claimant’s impairments,
and any other relevant factor. Id. at *4–5. “[T]he adjudicator generally should explain
the weight given to the opinions from these ‘other sources,’ or otherwise ensure that
the discussion of the evidence in the determination or decision allows a claimant or
subsequent reviewer to follow the adjudicator’s reasoning.” Id. at *6. An ALJ’s
determination on an issue may be implicit, but the “implication must be obvious to the
reviewing court.” Tieniber v. Heckler, 720 F.2d 1251, 1255 (11th Cir .1983).
In finding M.C. has a less-than-marked limitation in health and physical wellbeing, the ALJ observed treatment records showed M.C. received conservative
treatment with medication for Sjögren’s syndrome and arthritis. Tr. 23. He observed
joint pain and stiffness, especially in the morning, was reasonable given those
diagnoses. Tr. 23. The ALJ emphasized that, in December 2013, M.C. had reported his
energy level was good, he had been playing baseball and had lost 15 pounds because
of increased activity, there was no evidence of active arthritis on examination, and Dr.
Nickeson observed his arthritis was under good control. Tr. 23. In finding M.C. has
less-than-marked limitations in moving about and manipulating objects, the ALJ
observed his teachers had reported difficulties with writing, standing, walking, and
performing postural activities. Tr. 21. In finding M.C. has no limitation in attending
and completing tasks, the ALJ found, “The evidence of record as a whole indicates that
the claimant’s functioning in this domain is age appropriate.” Tr. 19.
Substantial evidence supports the ALJ’s findings. Considered collectively, the
medical records show M.C. developed joint pain from arthritis, which he first reported
in April 2011 and which gradually worsened. Dr. Nickeson tried different medication
combinations until M.C. responded to treatment with methotrexate and prednisone.
With medication, M.C. had more energy and less pain, could participate in sports, and
had good control of arthritis symptoms. His pain worsened when he stopped receiving
methotrexate injections but improved when he resumed. He reported no nausea from
18

the medication. Although the record contains evidence M.C. increasingly relied on
homebound education because of pain and had difficulty writing for extended periods
and completing assignments, substantial evidence supports the ALJ’s conclusion that
his impairments caused less-than-marked limitations in health and physical wellbeing and moving about and manipulating objects and no limitation in attending and
completing tasks based on his documented improvement while on medication. None of
the evidence Prather cites requires finding M.C. experienced “more than moderate”
limitations in any of those areas. See 20 C.F.R. § 416.926a(e)(2)(i) (describing a marked
limitation as “‘more than moderate’ but ‘less than extreme.’”).
Prather argues the ALJ erred in evaluating the teachers’ opinions because (1)
they saw him more frequently than his doctors did and (2) the ALJ’s rejection of their
opinions solely because they were not acceptable medical sources was contrary to SSR
06-03p. Doc. 24 at 12–14. Although the teachers identified significant limitations in
most domains, the ALJ gave their opinions only some weight because they are not
acceptable medical sources. Tr. 17. By contrast, he gave the findings and opinions of
treating and examining physicians great weight. Tr. 17. In doing so, he implicitly
found the medical opinions—which he observed “reflect[ed] a longitudinal perspective
of [M.C.]’s impairments and [we]re supported by the medically acceptable clinical and
diagnostic/laboratory techniques,” Tr. 17—provided a more accurate picture of M.C.’s
functioning than the opinions of his teachers. Substantial evidence supports the ALJ’s
decision to give more weight to the medical opinions than their opinions. That Ms.
Correia and Ms. Noblitt saw M.C. more frequently 10 could have been a reason to give
their opinions more weight, but the ALJ did not commit reversible error in choosing
to give more weight to the medical opinions instead. That evidence—showing
consistent improvement, good arthritis control, and increased activity after

10Prather

argues M.C.’s teachers saw him “on almost a daily basis,” see Doc. 24 at 12,
but the ESE department head did not indicate how frequently she saw him or whether she
taught him, see Tr. 264–71.

19

introduction of methotrexate—conflicts with the teachers’ opinions, provided just a
few months later.
Because substantial evidence supports the ALJ’s finding that M.C.’s
impairments do not functionally equal the severity of the listings, reversal and
remand for reconsideration of the evidence are unwarranted.
B.

Whether the ALJ Properly Considered Prather’s Testimony
Prather argues the ALJ improperly evaluated her testimony because he relied

on her partiality and lack of medical training—factors that “would render all
testimony, from all parents, in all child SSI claims unreliable.” Doc. 24 at 14–15. She
argues that, in relying on those factors, he did not comply with the Eleventh Circuit’s
decision in Shinn because he effectively ignored her testimony. Doc. 24 at 14–15. The
Commissioner responds the ALJ properly evaluated Prather’s testimony. Doc. 25 at
4–5, 8–9.
As discussed, evidence from non-medical sources, such as relatives, is relevant
in determining the severity of a claimant’s impairments and how they affect his
ability to function. SSR 06-03p, 2006 WL 2329939, at *2.
The ALJ did not err in relying on Prather’s perceived partiality and lack of
medical training. SSR 06-03p states an evaluator should consider several factors,
including whether a non-medical source has a specialization or area of expertise
related to the claimant’s impairments. SSR 06-03p, 2006 WL 2329939, at *4. That
the record does not indicate Prather has medical training supports the ALJ’s finding
her ability to objectively and reliably observe the severity and frequency of M.C.’s
symptoms is “questionable.” And her natural tendency to believe her son’s subjective
complaints is a relevant factor in considering the weight to give her statements,
particularly because her statements conflicted with medical evidence. Prather fails
to mention what the ALJ considered to be the “[m]ost important[ ]” factor in declining
to give significant weight to her statements: their inconsistency with the medical
20

evidence as a whole. That evidence—showing significant improvement with
medication—undermines her statements about the severity of M.C.’s impairments
and their effect on his functioning. For example, she testified methotrexate frequently
causes nausea several days a week, see Tr. 35, but Dr. Nickeson observed in December
2013 that M.C. had not complained of nausea, see Tr. 415. Prather also testified
M.C.’s condition seemed to stay the same or worsen, see Tr. 35, but Dr. Nickeson’s
treatment notes show improvement after introduction of methotrexate, see Tr. 415,
417–19.
Shinn is distinguishable. There, the ALJ, without explanation, “failed to
consider any of the testimony of [the claimant]’s mother.” See Shinn, 391 F.3d at 1280.
Here, the ALJ considered Prather’s statements and declined to give them significant
weight for reasons both legally sufficient and supported by substantial evidence.
Because the ALJ properly evaluated and considered Prather’s statements,
reversal and remand for reconsideration of them are unwarranted.
C.

Whether the ALJ Properly Considered M.C.’s Subjective Complaints
Prather argues the ALJ erred in evaluating M.C.’s subjective complaints of

pain, observing the diagnoses of juvenile rheumatoid arthritis, Sjögren’s syndrome,
and obesity “would have the very symptoms [M.C.] testified to[:] severe joint pain,
which can wax and wane.” Doc. 24 at 16. She argues Dr. Nickeson’s recommendation
of homebound schooling 11 and treatment of M.C.’s pain support his complaints. Doc.
24 at 16. She argues the ALJ summarized only the medical evidence supporting his
decision and failed to discuss other more serious evidence. Doc. 24 at 16. The
11Prather

cites a February 2012 form to support the assertion that Dr. Nickeson
recommended homebound schooling. See Doc. 24 at 8 (citing Tr. 182). The form does not
contain Dr. Nickeson’s name or signature; instead, it shows a registered nurse completed the
form. Tr. 182. Prather testified Dr. Nickeson made the recommendation, see Tr. 36, but none
of Dr. Nickeson’s treatment records indicate he ever recommended homebound schooling. See
Tr. 286–93, 414–36.

21

Commissioner responds the ALJ properly evaluated M.C.’s subjective complaints.
Doc. 25 at 4–7.
In evaluating a claimant’s subjective complaints of pain or other symptoms, an
ALJ must determine whether there is an underlying medical condition and either
(1) objective medical evidence confirming the severity of the alleged symptom arising
from that condition or (2) evidence the condition is so severe that it can be reasonably
expected to cause the alleged symptom. Holt v. Sullivan, 921 F.2d 1221, 1223 (11th
Cir. 1991). If the objective medical evidence does not confirm the alleged severity of a
claimant’s symptom, but an impairment can be reasonably expected to cause that
alleged severity, an ALJ must evaluate the intensity and persistence of his alleged
symptoms and their effect on his ability to work. 20 C.F.R. § 416.929(c)(1). In doing
so, an ALJ must consider all available evidence, including objective medical evidence
and statements from the claimant and others. 20 C.F.R. § 416.929(c)(2)–(3). An ALJ
also must consider “whether there are any inconsistencies in the evidence and the
extent to which there are any conflicts between [the claimant’s] statements and the
rest of the evidence.” 20 C.F.R. § 416.929(c)(4).
If an ALJ discredits a claimant’s testimony about the intensity, persistence,
and limiting effects of a symptom, such as pain, he must provide “explicit and
adequate reasons for doing so.” Holt, 921 F.2d at 1223. “A clearly articulated
credibility finding with substantial supporting evidence in the record will not be
disturbed by a reviewing court.” Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir. 1995).
A reviewing court should ask not whether the ALJ could have reasonably credited a
claimant’s testimony, but whether the ALJ had been clearly wrong in discrediting it.
Werner v. Comm’r of Soc. Sec., 421 F. App’x 935, 939 (11th Cir. 2011).
An ALJ must consider all relevant record evidence in making a disability
determination. 20 C.F.R. § 416.920(a)(3). But “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 Court] to
22

conclude that [the ALJ] considered [the claimant’s] medical condition as a whole.”
Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005) (internal quotation marks
omitted). “Even if the evidence preponderates against the … factual findings, we must
affirm if the decision reached is supported by substantial evidence.” Martin v.
Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990).
The ALJ provided explicit and adequate reasons, supported by substantial
evidence, for not fully crediting M.C.’s subjective statements. He found M.C.’s
impairments “could reasonably be expected to produce some of the alleged symptoms;
however, the statements concerning the intensity, persistence, and limiting effects of
these symptoms are not entirely credible for the reasons explained below.” Tr. 15. He
then discussed M.C.’s treatment, beginning in April 2011, for arthritis and Sjögren’s
syndrome. Tr. 15–17. He observed M.C. reported joint pain on several occasions but
also associated some of the increased pain with increased activity in sports. He
observed Dr. Nickeson managed M.C.’s arthritis medications and that, with
introduction of methotrexate, M.C. was more active and had good control of arthritis
symptoms. He found M.C.’s statements, like Prather’s, were “simply not consistent
with the preponderance of the opinions and observations by medical doctors.” Tr. 18.
As discussed, the medical evidence supports those findings.
To the extent Prather argues M.C.’s diagnosed impairments would cause the
symptoms about which he complained, the ALJ concluded M.C.’s impairments could
reasonably be expected to cause the reported symptoms. Tr. 15. He rejected not the
existence of the symptoms but M.C.’s report of their severity. See Tr. 15. And M.C.’s
participation in homebound schooling, although providing evidence that his pain
affected his functioning, does not change that substantial evidence supports the ALJ’s
finding that M.C.’s complaints were not entirely credible. See Martin, 894 F.2d at
1529 (“Even if the evidence preponderates against the … factual findings, we must
affirm if the decision reached is supported by substantial evidence.”). M.C.’s
participation in baseball and increased activity after attaining good control of
23

arthritis symptoms with medication conflict with his asserted inability to attend
school due to pain during the same time period. Prather fails to point to evidence the
ALJ ignored to support her assertion he mentioned only evidence supporting his
decision. The ALJ accurately summarized much of the evidence Prather describes in
her brief.
Because the ALJ properly evaluated and considered M.C.’s subjective
complaints, reversal and remand to reevaluate those complaints are unwarranted.
VII.

Conclusion
The Court affirms the Commissioner’s decision and directs the clerk to enter

judgment in favor of the Commissioner and close the file.
Ordered in Jacksonville, Florida, on March 31, 2017.

c:

Counsel of record

24