MANSELL v. BERRYHILL

Filing 17

MEMORANDUM OPINION AND ORDER - Considering the record as a whole, the findings of the ALJ are based upon substantial evidence in the record and the ALJ correctly followed the law. Accordingly, pursuant to 42 U.S.C § 405(g), the decision of the Commissioner to deny Plaintiffs applications for Social Security benefits is AFFIRMED. The Clerk shall enter judgment for Defendant. Signed by MAGISTRATE JUDGE CHARLES A STAMPELOS on 11/17/2017. (tdl)

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IN THE UNITED STATES DISTRICT COURT FOR THE
NORTHERN DISTRICT OF FLORIDA
GAINESVILLE DIVISION
CORRY M. MANSELL,
Plaintiff,
vs.

Case No. 1:17cv75-CAS

NANCY A. BERRYHILL,
Acting Commissioner of Social
Security,
Defendant.
/
MEMORANDUM OPINION AND ORDER
This Social Security case was referred to the undersigned upon
consent of the parties by United States District Judge Mark E. Walker.
ECF No. 9. It is now before the Court pursuant to 42 U.S.C. § 405(g) for
review of the final determination of the Acting Commissioner
(Commissioner) of the Social Security Administration (SSA) denying
Plaintiff’s Title II application for period of disability and Disability Insurance
Benefits (DIB) and Title XVI application for Supplemental Security Income
(SSI). After careful consideration of the record, the decision of the
Commissioner is affirmed.

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I. Procedural History
On or about July 31, 2012, Plaintiff, Corry M. Mansell, applied for DIB
and SSI benefits with an alleged onset date of March 5, 2010, based on
bipolar disorder and anxiety. Tr. 13, 280-87, 311, 315.1 Plaintiff’s last
date insured for DIB was March 31, 2014. Tr. 28, 281. Plaintiff’s
applications were denied initially on November 21, 2012, and upon
reconsideration on February 22, 2013. Tr. 13, 97-160.
On April 15, 2013, Plaintiff requested a hearing. Tr. 13, 162-63. On
April 2, 2015, Administrative Law Judge (ALJ) Ken B. Terry, conducted the
first of two video hearings in Jacksonville, Florida. Tr. 13, 35-57. Plaintiff
appeared without representation from Gainesville, Florida. 2
Tr. 56-89. Thereafter, Plaintiff was represented and on September 16,
2015, Plaintiff’s representative filed a brief, Tr. 366-67, and the hearing re-

1

Citations to the transcript/administrative record, ECF No. 9, shall be by the
symbol “Tr.” followed by a page number that appears in the lower right corner of each
page.
2

Plaintiff appeared at the initial hearing with his wife who was to offer testimony
and perhaps act as his representative. Tr. 37-38. The ALJ advised Plaintiff that his
wife could not testify and act as his representative. Id. Plaintiff requested a
continuance of the hearing in order to obtain representation and provide additional
information. Tr. 38-41. Nevertheless, the ALJ reviewed the existing evidence of
record with Plaintiff and asked him whether he had additional medical records. Tr. 4356. The ALJ also inquired of an attending observer regarding the status of other
medical records. Tr. 50-52.
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convened on September 28, 2015, with Plaintiff appearing by video in
Gainesville, Florida, and the ALJ appeared in Jacksonville, Florida. Tr. 13,
58-96. Plaintiff testified and was represented by Martin J. Goldberg.
Tr. 13, 58, 62-90, 233-35. Paul R. Dolan, an impartial vocational expert,
testified. Tr. 13, 58-59, 89-95, 364-65 (Resume).
On October 23, 2015, the ALJ entered a decision concluding that
Plaintiff is not disabled. Tr. 13-29. On December 16, 2015, Plaintiff filed
a request for review of the ALJ’s decision and filed a brief. Tr. 7-9, 368-69.
On January 19, 2017, the Appeals Council denied Plaintiff’s request for
review. Tr. 1-6. The ALJ’s decision stands as the final decision of the
Commissioner. See 20 C.F.R. § 404.981.
On March 16, 2017, Plaintiff filed a Complaint requesting judicial
review of the Commissioner’s final decision. ECF No. 1. Both parties
filed memoranda of law, ECF Nos. 15, 16, which have been considered.
II. Findings of the ALJ
The ALJ made several findings relative to the issues raised in this
appeal:
1. “The claimant meets the insured status requirements of the Social
Security Act through March 31, 2014.” Tr. 15.

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2. “The claimant has not engaged in substantial gainful activity
[SGA] since March 5, 2010, the alleged onset date.” Id.
3. “The claimant has the following severe impairments: bipolar
disorder and anxiety.” Id. The ALJ also considered Plaintiff’s
obesity in accordance with Social Security Ruling (SSR) 02-1p
and determined that Plaintiff’s obesity, in combination with other
impairments, is “non-severe as it does not impose significant
work-related limitations.” Tr. 15-16.
4. “The claimant does not have an impairment or combination of
impairments that meets or medically equals the severity of one of
the listed impairments in 20 CFR Part 404, Subpart P, Appendix
1.” Tr. 16. The ALJ determined that Plaintiff’s “mental
impairments, considered singly and in combination, do not meet or
medically equal the criteria of listings 12.04 and 12.06.”3 Id. The
ALJ determined that Plaintiff has mild restriction in activities of
daily living and mild difficulties in social functioning, moderate
difficulties in concentration, persistence, or pace, and no episodes
of decompensation, which have been of extended duration.
Tr. 16-17.
5.

“[T]he claimant has the residual functional capacity [RFC] to
perform a full range of light work at all exertional levels but with
the following nonexertional limitations: Mentally, he is precluded
from performing complex tasks but is capable of simple, routine
tasks consistent with unskilled work with concentration for those
tasks for 2 hour periods and normal breaks and a lunch.” Tr. 1827; see infra at n.7.

6. “The claimant is unable to perform any past relevant work” as a
sales agent, insurance and sales representative, office machines.
Tr. 27.

3

Plaintiff argued to the ALJ that Plaintiff “has documented elements of Listings
12.04 and 12.06, Tr. 62, 367, but does not argue that the ALJ’s determination at this
step of the sequential evaluation process was error. ECF No. 15.
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7. The claimant was 37 years old, which is defined as a younger
individual age 18-49, on the alleged disability onset date; he has
at least a high school education and is able to communicate in
English. Tr. 28.
8. There are jobs that exist in significant numbers in the national
economy that the claimant can perform. Id. The ALJ
determined that Plaintiff’s ability to perform at all exertional levels
has been compromised by nonexertional limitations. Id. As a
result, the vocational expert was asked whether jobs exist in the
national economy which Plaintiff can perform. The vocational
expert testified that Plaintiff was capable of performing several
representative jobs including cleaner, commercial or institutional;
warehouse worker; and router. Id. These jobs have heavy,
medium, and light exertion levels, respectively, SVP’s of 2, and
are unskilled. 4 Tr. 28, 92-93.
9. “The claimant has not been under a disability, as defined in the
Social Security Act, from March 5, 2010, through the date of this
decision.” Tr. 29.

4

“Unskilled work is work which needs little or no judgment to do simple duties
that can be learned on the job in a short period of time.” 20 C.F.R. § 404.1568(a). A
Specific Vocational Preparation (SVP) of 2 means “[a]nything beyond short
demonstration up to and including 1 month.” Dictionary of Occupational Titles (DOT)
(4th ed., rev. 1991), Appendix C: Components of the Definition Trailer, § II, SVP.
“[SVP] is defined as the amount of lapsed time required by a typical worker to learn the
techniques, acquire the information, and develop the facility needed for average
performance in a specific job-worker situation.” Id. Unskilled work corresponds to an
SVP of 1 and 2. SSR 00-4p, 2000 SSR LEXIS 8, at *8 (Dec. 4, 2000). Further,
unskilled work is work involving understanding, remembering, and carrying out simple
instructions; making simple work-related decision; dealing with changes in a routine
work setting; and responding appropriately to supervision, co-workers, and usual work
situations. SSR 85-15, 1985 SSR LEXIS 20, at *10-11 (1985). In part, “[l]ight work
involves lifting no more than 20 pounds at a time with frequent lifting or carrying objects
weighing up to 10 pounds.” 20 C.F.R. § 404.1567(b).

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III. Legal Standards Guiding Judicial Review
This Court must determine whether the Commissioner’s decision is
supported by substantial evidence in the record and premised upon correct
legal principles. 42 U.S.C. § 405(g); Chester v. Bowen, 792 F.2d 129, 131
(11th Cir. 1986). “Substantial evidence is more than a scintilla, but less
than a preponderance. It is such relevant evidence as a reasonable
person would accept as adequate to support a conclusion.” Bloodsworth
v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983) (citations omitted); accord
Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). “The
Commissioner’s factual findings are conclusive if supported by substantial
evidence.” Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002)
(citations omitted). 5
“In making an initial determination of disability, the examiner must

5

“If the Commissioner’s decision is supported by substantial evidence we must
affirm, even if the proof preponderates against it.” Phillips v. Barnhart, 357 F.3d 1232,
1240, n.8 (11th Cir. 2004) (citations omitted). “A ‘substantial evidence’ standard,
however, does not permit a court to uphold the Secretary’s decision by referring only to
those parts of the record which support the ALJ. A reviewing court must view the entire
record and take account of evidence in the record which detracts from the evidence
relied on by the ALJ.” Tieniber v. Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983).
“Unless the Secretary has analyzed all evidence and has sufficiently explained the
weight he has given to obviously probative exhibits, to say that his decision is supported
by substantial evidence approaches an abdication of the court’s ‘duty to scrutinize the
record as a whole to determine whether the conclusions reached are rational.’” Cowart
v. Schweiker, 662 F.2d 731, 735 (11th Cir. 1981) (citations omitted).
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consider four factors: ‘(1) objective medical facts or clinical findings; (2)
diagnosis of examining physicians; (3) subjective evidence of pain and
disability as testified to by the claimant and corroborated by [other
observers, including family members], and (4) the claimant’s age,
education, and work history.’” Bloodsworth, 703 F.2d at 1240 (citations
omitted). A disability is defined as a physical or mental impairment of such
severity that the claimant is not only unable to do past relevant work, “but
cannot, considering his age, education, and work experience, engage in
any other kind of substantial gainful work which exists in the national
economy.” 42 U.S.C. § 423(d)(2)(A). A disability is an “inability to
engage in any substantial gainful activity by reason of any medically
determinable physical or mental impairment which can be expected to
result in death or which has lasted or can be expected to last for a
continuous period of not less than 12 months.” 42 U.S.C. § 423(d)(1)(A);
see 20 C.F.R. § 404.1509 (duration requirement).6 Both the “impairment”
and the “inability” must be expected to last not less than 12 months.

6

The relevant DIB and SSI regulations are virtually identical. As a result,
citations will be made to the DIB regulations found at 20 C.F.R. §§ 404.1500-404.1599,
unless a SSI regulation provides otherwise. The parallel regulations are found at 20
C.F.R. §§ 416.900-416.999, corresponding to the last two digits of the DIB citations,
e.g., 20 C.F.R. § 404.1563(c) corresponds to 20 C.F.R. § 416.963(c).
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Barnhart v. Walton, 535 U.S. 212 (2002). In addition, an individual is
entitled to DIB if he is under a disability prior to the expiration of his insured
status. See 42 U.S.C. § 423(a)(1)(A); Moore v. Barnhart, 405 F.3d at
1211; Torres v. Sec’y of Health & Human Servs., 845 F.2d 1136, 1137-38
(1st Cir. 1988); Cruz Rivera v. Sec’y of Health & Human Servs., 818 F.2d
96, 97 (1st Cir. 1986).
The Commissioner analyzes a claim in five steps. 20 C.F.R.
§ 404.1520(a)(4)(i)-(v):
1. Is the individual currently engaged in substantial gainful
activity [SGA]?
2. Does the individual have any severe impairments?
3. Does the individual have any severe impairments that meet
or equal those listed in Appendix 1 of 20 C.F.R. Part 404,
Subpart P?
4. Does the individual have the RFC to perform work despite
limitations and are there any impairments which prevent past
relevant work? 7
7

An RFC is the most a claimant can still do despite limitations. 20 C.F.R.
§ 404.1545(a)(1). It is an assessment based upon all of the relevant evidence
including the claimant’s description of her limitations, observations by treating and
examining physicians or other persons, and medical records. Id. Although an ALJ
considers medical source opinions, the responsibility for determining claimant’s RFC
lies with the ALJ. 20 C.F.R. § 404.1546(c); see SSR 96-5p, 1996 SSR LEXIS 2, at *12
(July 2, 1996) (“The term “residual functional capacity assessment” describes an
adjudicator’s finding about the ability of an individual to perform work-related activities.
The assessment is based upon consideration of all relevant evidence in the case
record, including medical evidence and relevant nonmedical evidence, such as
observations of lay witnesses of an individual’s apparent symptomatology, an
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5. Do the individual’s impairments prevent other work?
A positive finding at step one or a negative finding at step two results in
disapproval of the application for benefits. A positive finding at step three
results in approval of the application for benefits. At step four, the claimant
bears the burden of establishing a severe impairment that precludes the
performance of past relevant work. Consideration is given to the
assessment of the claimant’s RFC and the claimant’s past relevant work.
If the claimant can still do past relevant work, there will be a finding that the
claimant is not disabled. If the claimant carries this burden, however, the
burden shifts to the Commissioner at step five to establish that despite the
claimant’s impairments, the claimant is able to perform other work in the
national economy in light of the claimant’s RFC, age, education, and work
experience. Phillips, 357 F.3d at 1237; Jones v. Apfel, 190 F.3d 1224,

individual’s own statement of what he or she is able or unable to do, and many other
factors that could help the adjudicator determine the most reasonable findings in light of
all the evidence.”); see also Cooper v. Astrue, 373 F. App’x 961, 962 (11th Cir. 2010)
(unpublished) (explaining claimant’s RFC determination “is within the province of the
ALJ, not a doctor”). The Court will apply the SSR in effect when the ALJ rendered her
decision. See generally Bagliere v. Colvin, No. 1:16CV109, 2017 U.S. Dist. LEXIS
8779, at *10-18, (M.D. N.C. Jan. 23, 2017), adopted, 2017 U.S. Dist. LEXIS 51917
(M.D. N.C. Feb. 23, 2017).

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1229 (11th Cir. 1999); Chester, 792 F.2d at 131; MacGregor v. Bowen, 786
F.2d 1050, 1052 (11th Cir. 1986); 20 C.F.R.
§ 404.1520(a)(4)(v). If the Commissioner carries this burden, the claimant
must prove that he or she cannot perform the work suggested by the
Commissioner. Hale v. Bowen, 831 F.2d 1007, 1011 (11th Cir. 1987).
As the finder of fact, the ALJ is charged with the duty to evaluate all
of the medical opinions of the record resolving conflicts that might appear.
20 C.F.R. § 404.1527. When considering medical opinions, the following
factors apply for determining the weight to give to any medical opinion: (1)
the frequency of examination and the length, nature, extent of the treatment
relationship; (2) the evidence in support of the opinion, such as “[t]he more
a medical source presents relevant evidence to support an opinion,
particularly medical signs and laboratory findings, the more weight” that
opinion is given; (3) the opinion’s consistency with the record as a whole;
(4) whether the opinion is from a specialist and, if it is, it will be accorded
greater weight; and (5) other relevant but unspecified factors. 20 C.F.R.
§ 404.1527(b) & (c).
The opinion of the claimant’s treating physician must be accorded
considerable weight by the Commissioner unless good cause is shown to

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the contrary. Lewis v. Callahan, 125 F.3d 1436, 1440 (11th Cir. 1997).
This is so because treating physicians “are likely to be the medical
professionals most able to provide a detailed, longitudinal picture of your
medical impairment(s) and may bring a unique perspective to the medical
evidence that cannot be obtained from the objective medical findings alone
or from reports of individual examinations, such as consultative
examinations or brief hospitalizations.” 20 C.F.R. § 404.1527(c)(2). “This
requires a relationship of both duration and frequency.” Doyal v. Barnhart,
331 F.3d 758, 762 (10th Cir. 2003).
The reasons for giving little weight to the opinion of the treating
physician must be supported by substantial evidence, Marbury v. Sullivan,
957 F.2d 837, 841 (11th Cir. 1992), and must be clearly articulated.
Phillips, 357 F.3d at 1241. “The Secretary must specify what weight is
given to a treating physician’s opinion and any reason for giving it no
weight, and failure to do so is reversible error.” MacGregor, 786 F.2d at
1053.
The ALJ may discount a treating physician’s opinion report regarding
an inability to work if it is unsupported by objective medical evidence and is
wholly conclusory. Edwards v. Sullivan, 937 F.2d 580, 583-84 (11th Cir.

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1991). Stated somewhat differently, the ALJ may discount the treating
physician’s opinion if good cause exists to do so. Hillsman v. Bowen, 804
F. 2d 1179, 1181 (11th Cir. 1986). Good cause may be found when the
opinion is “not bolstered by the evidence,” the evidence “supports a
contrary finding,” the opinion is “conclusory” or “so brief and conclusory that
it lacks persuasive weight,” the opinion is “inconsistent with [the treating
physician’s own medical records,” the statement “contains no [supporting]
clinical data or information,” the opinion “is unsubstantiated by any clinical
or laboratory findings,” or the opinion “is not accompanied by objective
medical evidence.” Lewis, 125 F.3d at 1440; Edwards, 937 F.2d at 583
(citing Schnorr v. Bowen, 816 F.2d 578, 582 (11th Cir. 1987)). Further,
where a treating physician has merely made conclusory statements, the
ALJ may afford them such weight to the extent they are supported by
clinical or laboratory findings and are consistent with other evidence as to a
claimant’s impairments. Wheeler v. Heckler, 784 F.2d 1073, 1075 (11th
Cir. 1986).
Further, when a claimant attempts to establish a disability based on
his subjective complaints, he must provide evidence of an underlying
medical condition in either objective medical evidence confirming the

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severity of the alleged symptoms or that the medical condition reasonably
could be expected to give rise to the alleged symptoms. See 20 C.F.R.
§ 404.1529(a) and (b); Wilson, 284 F.3d at 1225-26.
Plaintiff bears the burden of proving he is disabled, and consequently,
is responsible for producing evidence in support of his claim. See 20
C.F.R. § 404.1512(a); Moore, 405 F.3d at 1211.
IV. Legal Analysis
Substantial evidence supports the ALJ’s determination that
Plaintiff has the RFC to perform light work with limitations and,
as a result, is capable of performing other work.
I.
Plaintiff argues that the ALJ erred when he did not give appropriate
weight to the opinions of Sandra R. Jones, Ph.D., L.H.M.C., a treating
mental health counselor; Robert M. Licata, M.D., a staff psychiatrist with
Amen Clinic, Inc., who met with Plaintiff to review SPECHT studies and for
a full neuropsychiatric evaluation; Vicci L. Cascioli, R.N., A.P., a treating
acupuncturist, who treated Plaintiff for anxiety and depression; William E.
Benet, Ph.D., Psy.D, a psychologist, who provided a consultative
psychological exam; and Elias H. Sakris, M.D., a psychiatrist from Sarkis
Family Psychiatry, who examined and treated Plaintiff and ultimately

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provided a mental assessment form in 2015. ECF No. 15. Plaintiff
argues that each of these health care providers support his inability to work
and disability.
II.
PLAINTIFF’S PRE-HEARING AND HEARING STATEMENTS
The ALJ summarized Plaintiff’s pre-hearing and hearing statements.
At the hearing, the claimant testified that he was 42 years old. He
testified that he lives with his wife in a one-story house. He testified
that he is 5’11” and weighs 259 pounds. He stated that he has a
valid driver’s license and drives on a daily basis. He stated that he
drives to his parent’s house, doctors’ appointments and d [sic] to the
grocery store. He denied having any problems driving. He drove
himself to the hearing. He testified that he has not worked since his
alleged onset date. He stated that his wife works (and earns about
$33,00 [sic] per year) and his parents also help him pay necessary
bills. He testified that he went to a job interview but was “jumping”
out of his skin due to anxiety. He stated that he might be able to do
some self-employment but would need to be extremely flexible.
He alleged disability based upon mental issues that included anxiety
and bipolar disorder. He testified that he had a history of problems
prior to his alleged onset date with a nervous breakdown when he
was 21 years old. At the time of his alleged onset date, he stated
that [he] was “very anxious” and went into a “manic phase” after
which he lost his license with a company that he was doing business
with at the time. He testified that he was having bouts of grandeur
and spending money that he did not have (running up credit) and
ended up in the hospital twice. He stated that he got ‘‘tased” three
times. He described having some issues with the police during a
traffic stop in which he would not stop for an officer.
He testified that following this, he has been trying to get help for his
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condition. He testified that his ongoing symptoms include anxiety,
depression and paranoid thoughts (affect his ability to leave house
at times). He testified that although he has been taking
medications, ‘‘they did not get it right.” He stated that he did not
start treating with Dr. Sarkis until 2011and he feels that his
medications are more “appropriate.” He denied any more manic
episodes but stated that he has to keep things “in check”
emotionally. He alleged having a “mini breakdown” two years
ago and again last summer but admitted he was not hospitalized
either time (controlled with medications).
He testified that he [sic] for the past two weeks, he has been “real
bad.” He stated that he was not showering or shaving and was
avoiding taking care of his personal needs. He stated that on better
days, he might and go visit a friend (a mechanic) but that has been
more rare. He also talks to his siblings who live in Atlanta. He
testified that he tries to avoid social interaction, which has worsened
since 2010 due to worsening anxiety. He stated that during 2011
(and most of 2011), he would curl up in a ball and was would [sic]
be unresponsive.
The claimant also described having “emotional fatigue.” He stated
that social situations make him nervous now. He stated that on bad
days, he would send his wife in the grocery store. He stated that he
[sic] his anxiety just “varies” and is up/down. He also alleged that
his concentration has been impaired by his medications (currently
taking Lamictal and Clonazepam). He stated that he believed his
medications were also causing weight gain (30-40 pound weight
gain). He stated that any “expectation” breeds stress and that is
why he could not work. He testified having sleep issues as well.
With regard to his activities of daily living, he stated that he
sometimes is able to do household chores such as power washes
his sidewalk or help a friend (run errands for him). He testified that
[sic] might go visit his mechanic friend to help him out for a couple of
hours. He admitted that he is able to do yard work.8
8

In evaluating Plaintiff’s credibility, the ALJ may consider a claimant’s daily

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Tr. 18-19.
Plaintiff’s Work History
The ALJ considered Plaintiff’s work history
which has been sporadic and characterized by rather low earnings
over the past 15 years, which has certainly been considered in his
overall credibility determination and does not bode well. In addition,
the undersigned notes that during his consultative exam, he was
noted as vague when he was providing specifics of his alleged panic
attacks and bipolar episodes (frequency and time), which also has
been considered in part of his credibility determination. In addition,
the claimant’s testimony regarding his paranoia and depression
(severity and frequency) are simply not documented to the extent he
has alleged.
Lastly, in addition to the limited objective medical evidence and
limited treatment, the claimant has also had numerous activities that
are inconsistent with the total inability to work. The claimant lives
independently with his wife whom he married earlier this year in
February 2015. While she is at work, he stays at home by himself
during the day and does things around the house that include
cleaning, making himself a sandwich, prepare the laundry, washing
dishes and mowing the grass with the self-propelled lawnmower.
He also admitted that he is able to shop for groceries at times and
also sometimes attends his parent’s church. He testified having
“good” days and “bad” days and that he is able to do more on a good
day. On good days, he testified that he power washes sidewalks,
delivers things for his mechanic friend including picking up parts and
activities when assessing the credibility of the claimant’s complaints. Macia v. Bowen,
829 F.2d 1009, 1012 (11th Cir. 1987); 20 C.F.R. § 404.1529(c)(3)(i) (providing that daily
activities are relevant and can be considered by the ALJ when evaluating a claimant’s
symptoms); but see Lewis v. Callahan, 125 F.3d 1436, 1441 (11th Cir. 1997)
(“participation in everyday activities of short duration, such as housework or fishing”
does not disqualify a claimant from disability). A claimant’s ability to do some work,
even at a low level, “may indicate that [the claimant] is able to do more work.” Cooper
v. Comm’r of Soc. Sec., 521 F. App’x 803, 808 (11th Cir. 2013) (unpublished).
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taking them to his shop or going and getting food for his friend.
The claimant admitted that he sees his friend 2-3 times a week but
on occasion has not seen him for several weeks when he is feeling
bad.
Tr. 26.
III.
The ALJ noted “that the overall medical treatment has been rather
sparse in light of [Plaintiff’s] alleged onset date back in March 2010.”
Tr. 19. He was seen at Shands Vista Rehab in 2010 on two occasions
with two admissions. Id.
Baker Act Admissions
On June 6, 2010, Plaintiff was admitted via Baker Act after disturbing
neighbors with a laser light, walking into traffic, and pointing to neighbors
with a gun. Tr. 19. He had stopped taking Lexapro for three to four
weeks and admitted that his parents had urged him to resume Lexapro.
Id. He was given Seroquel and became more stable following treatment.
He started on Lexapro for depression. He was very apologetic upon
discharge; his paranoia had subsided; and he was psychologically stable
upon discharge on June 8, 2010, with increased Global Assessment of

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Functioning (GAF) score of 45. 9 Tr. 19-20, 382-86.
On July 18, 2010, Plaintiff was admitted under the Baker Act for the
second time. Tr. 20, 378-81. He had stopped taking Wellbutrin two days
prior to admission; his GAF score was 40. Id. It was noted that he was
irritable and hyperverbal as well as grandiose at times for which he was
given Seroquel, which helped calm him down. His mental status exam
indicated, in part, that “[h]is thought process was tangential but for the most

9

The American Psychiatric Association: Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) (4th Ed. Text Revision 2000) includes the GAF Scale
that is primarily used by mental health practitioners. The GAF Scale is used to report
“the clinician’s judgment of the individual’s overall level of functioning” (with regard to
only psychological, social, and occupational functioning) and “may be particularly useful
in tracking the clinical progress of individuals in global terms, using a single measure.”
See DSM-IV-TR 32-34. The GAF scale is divided into 10 ranges of functioning, each
with a 10-point range in the GAF scale. Id. See Nichols v. Astrue, Case No.
3:11cv409/LC/CJK, 2012 U.S. Dist. LEXIS 119347, at *26-29 (N.D. Fla. Aug. 7, 2012)
(discussing the GAF scale). A score of 31-40 is defined as manifesting “[s]ome
impairment in realty testing or communication (e.g., speech is at times illogical, obscure,
or irrelevant)” or “major impairment in several areas, such as work or school, family
relations, judgment, thinking, or mood.” DSM-IV-TR at 34. A GAF scale rating of 4150 is indicative of serious symptoms or any serious impairment in social, occupational
or school functioning. Id. A GAF scale rating of 51 to 60 indicates moderate
symptoms or moderate difficulty in social, occupational, or school functioning. Id. The
“Commissioner has declined to endorse the GAF scale for ‘use in the Social Security
and SSI disability programs,’ and has indicated that GAF scores have no ‘direct
correlation to the severity requirements of the mental disorders listings.’” Wind v.
Barnhart, 133 F. App’x 684, 692 n.5 (11th Cir. 2005) (unpublished) (citing 65 Fed. Reg.
50746, 50764-65 (Aug. 21, 2000)). In the Fifth Edition of the Diagnostic and Statistical
Manual of Mental Disorders (DSM-5) (2013), “[i]t was recommended that the GAF be
dropped from DSM-5 for several reasons, including its conceptual lack of clarity (i.e.,
including symptoms, suicide risk, and disabilities in its descriptors) and questionable
psychometrics in routine practice. In order to provide a global measure of disability, the
WHO DSM-5 (see the chapter “Assessment Measures”).” DSM-5 at 16.
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part he was logical and was directable to the point.” Tr. 381. “His content
no SI, no HI, no AVH, no delusions, psychosis. His insight and judgment
seemed poor to fair. His mini-mental status exam he got 30 out of 30.”
Id. He showed mild psychomotor retardation, intense eye contact, and
slightly pressured speech. Id. Discharge diagnoses included bipolar
disorder, type 2, most recent episode hypomanic; cluster B (most
specifically antisocial personality disorder); poor social support and coping
skills; and an assessed GAF score between of 40 and 50. Tr. 20, 378,
381 (differential diagnosis included a GAF score between 45 and 55).
The ALJ noted that at the time Plaintiff
was Baker Acted (in 2010) and other reported times of manic
behavior in the past, this usually occurred during times when he was
noncompliant with medications. For instance, during both
admissions, he admitted that he had stopped taking his Lexapro for
3-4 weeks and then for 2 days (Exhibit 2F/4, 10). When he was
evaluated in October 2011, the claimant reported that he stopped
taking his Lexapro “cold turkey” and he then experienced a manic
episode and spent an enormous amount of money in a very impulsive
manner. To stabilized [sic] his mood, he was asked to return to
Lexapro and he admitted that his mood and behavior had returned to
“normal” shortly after resuming his medications (Exhibit 9F/2). He
reported that in March 2010, he could no longer afford his medication
and discontinued it again but within four weeks, began to feel nervous
and restarted it. After one week, he had another manic episode
(Exhibit 9F/2). These prior episodes suggest that with his
medications, they certainly provided more stability as well.
Tr. 25-26.
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Sandra R. Jones, Ph.D., LHMC
Plaintiff began seeing Dr. Jones “intermittently since 2001 but more
frequently from 2006 to 2009 (although no indication that there was any
treatment in 2010 or following the claimant’s alleged onset date).” Tr. 20,
452-54. (According to her August 1, 2010, letter, she last met with Plaintiff
in 2009. Tr. 454.) The record contains two letters written by Dr. Jones,
August 1, 2010, and January 25, 2013, an addendum to the earlier letter.
Id. The ALJ noted that there were no actual therapy/treatment notes
attached to the letters and “the treatment with this provider has been rather
sporadic and irregular since the alleged onset date (Exhibit 5F/3-4).”
Tr. 23, 452-53.
On January 25, 2013, Dr. Jones wrote that in the past two years and
four months she met with Plaintiff for two sessions in 2010, one session in
2011, 10 sessions in 2012 (after 13 months since the last visit and on an
irregular basis), and one session in 2013. Tr. 23, 452. She noted “[i]n
these 14 sessions there has been little significant sustainable progress.
His progress tends to be slow and incremental. Then when he seems to
stabilize and move forward he becomes depressed again.” Tr. 452. The
ALJ noted, “that no actual therapy/treatment notes were attached [to the

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January 25, 2013, letter] but regardless as acknowledged above, the
treatment with this provider had been rather sporadic and irregular since
the alleged onset date.” Tr. 23 (citation omitted).
The ALJ gave Dr. Jones’ August 1, 2010, statement, Tr. 454, “which
was given after his two hospitalizations, limited weight. At that time, the
claimant was more unstable. However, his condition has stabilized with
treatment and after he resumed his medications as evidenced by the
conservative treatment thereafter (Exhibits 8F, 11F).” Tr. 26-27.
Plaintiff argues that the ALJ did not give proper weight to Dr. Jones’
opinion that Plaintiff had an inability to work because of severe limitations.
ECF No. 15 at 2, 5, 6. In her January 25, 2013, letter, Tr. 452-53,
Dr. Jones noted Plaintiff had been unable to acquire and hold a job, but she
did not opine that he was unable to work. Tr. 453. Dr. Jones noted:
He is intelligent but appears to be unable to implement his for [sic]
goals and plans. For example, he has been working on developing
an on-line business for two years but has not been able to get it off
the ground. He wants a job with status and free use of his time and
he avoids practical work to earn a living. He worked in insurance for
a while and was able to focus and get along with people when he got
arrested two years ago for aggressive and paranoid behavior he felt
humiliated and says he has a record and can’t get a job so focuses
on this on-line job that he cannot get off the ground.
Tr. 452. The letter also details Plaintiff’s therapeutic history and self-

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reports of symptoms. Tr. 452-53. The ALJ properly considered the
January 25, 2013, letter in evaluating the medical evidence and properly
considered Dr. Jones’ August 2010 statement in giving it “limited weight.”
Tr. 23, 26-27.
Sarkis Family Psychiatry (Sarkis)
On September 6, 2011, Plaintiff sought an evaluation from Sarkis of
his bipolar disorder.10 Tr. 20, 404. Plaintiff reported feeling depressed for
the past nine months, but also admitted feeling depressed on and off all of
his life. Id. He denied having panic attacks; reported avoiding going
anywhere due to fear that there might be a police officer as well as
hypervigilance; he reported manic episodes in 2006 and 2010 when he
stopped taking Lexapro; and he denied any paranoia. Tr. 20, 405. The
mental status examination revealed he was oriented x 4; recent memory
intact, but remote memory impaired; and he was well-groomed and put
together intact. His attention and concentration were sustained, however,
his mood was “depressed” and his affect was “blunted”; insight and
judgment were poor and eye contact was “fleeting.” He had “concrete

10

This was the first of many visits with Sarkis from September 2011 through
approximately August 2015.
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thought process.” Tr. 20, 410. He was diagnosed with bipolar disorder,
most recent episode depressed, GAD, and PTSD and assessed a GAF
score of 60. Tr. 20, 411; see supra at n.9.
Plaintiff continued to follow-up with Sarkis in 2011 (September 20,
October 4 and 28, November 7, and December 9, 2011) for treatment
consisting primarily of medication management. Tr. 20, 412-21. His
current medications were Abilify and Cymbalta. Klonopin was added on
October 4, 2011. Tr. 20, 412, 414. Generally, his mental status exam
findings were unremarkable including normal thought process and speech
and full orientation, except for down mood and flat affect and some mild
impairment in attention and concentration. He continued to deny any
panic attacks or paranoia and denied any side effects from his medications.
Tr. 20, 412-21.
His clinical global impressions severity were moderate except for
December 9, 2011, when it was noted as marked and his mood was bad;
he had a full range of emotions and avoided eye contact. Tr. 420-21. He
continued to deny any panic attacks or paranoia and denied any side
effects from his medication. Tr. 20, 411-14, 418-19. Also on December
9th, he was advised to start psychotherapy particularly due to negative

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thoughts, fear of going out and seeing people he knows and not wanting
them to know his history of manic episodes. Tr. 21, 420. He voiced
frustration that Lamictal was not working. He thought it was going to make
all his symptoms go away. He reported that his doctor who did the brain
scans told him that Lamictal was 80 to 90% effective. Id. The
assessment indicated that he was tolerating Lamictal, but his mood was
low and anxiety high. Tr. 421. He was continued on Lamictal and
Klonopin and Celexa was added. It is noted that Plaintiff refused therapy
stating: “I’ve done all that before and worked through all my problems.” Tr.
421.
Plaintiff followed up with Sarkis on January 4 and 25, February 8 and
20, March 7, April 4, June 27, August 1 and 30, and October 10, 2012. 11

11

On January 4, 2012, Plaintiff reported that he was not sleeping well; he also
admitted that he was not taking Klonopin as much (less than a couple days per week).
Lamictal was increased and he was tolerating his meds well. Tr. 22, 422. On January
25, 2012, he reported feeling afraid of everything. Tr. 22, 424. On February 8, 2012,
he reported that he talked to an old friend on the phone and also went out for coffee. It
is also noted: “Felt free for the first time.” Tr. 22, 426. In March and April 2012, it was
noted that he was not doing well and wanted to isolate. Tr. 22, 430-33. In April 2012,
his clinical global impressions severity was “severe,” whereas it was “moderate” in June
2012. Tr. 433, 435. On June 27, 2012, he reported feeling better. He was able to
work several hours on projects. Tr. 22, 434. In August 2012, he reported feeling
pretty healthy and that he had filed for social security disability. Tr. 22, 436. Later in
August 2012, he reported that he had been working part-time for a textbook company
and was working on an Internet business. Tr. 22, 438. In October 2012, it was noted
that his sleep was fair and he reported having a couple of “isolation days last week” and
admitted he took Klonopin and experienced increased anxiety. It was noted that his
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Tr. 21, 422-41. Treatment primarily consisted of medication management.
Id. Generally, his mental status exam findings were unremarkable
including normal thought process and speech in full orientation, except for
depressed mood, variable affect to flat affect to restricted affect, but
improved. Tr. 21, 423, 425, 427, 429, 431, 433, 435, 437, 439, 441. In
2012, he had mild to moderate impairment in attention and concentration;
he continued to deny any paranoia; and he continued to deny any side
effects from his medications. Tr. 425, 427, 429, 431, 433, 435, 437, 440. 12

clinical global impression of severity was moderate with marked improvement. Tr. 22,
440-41. On October 10, 2012, Elias Sarkis, M.D., completed a “Function Report –
Adult Third Party” and remarked that Plaintiff “is a highly intelligent person who is
unable to function in workplace [and] in society due to anxiety and mood [disorder].
Neuropsychological testing demonstrates great [not legible] in his ability to perform
different tasks.” Tr. 412-49. Plaintiff returned to Sarkis on November 29, 2012, and
reported that he has some good days and some bad days. Tr. 22, 492. His mental
status exam revealed he was fully oriented with normal thought process and normal
speech; he had restricted affect and mild impairment in attention and concentration; and
he continued to have moderate clinical global impression in severity, but with marked
improvement. Tr. 22, 492-93. The ALJ gave Dr. Sarkis’ 3rd party function report
noted above “little weight as this provider is not in the position to observe these
activities on a daily or even consistent basis to the extent that he is able to report on in
this capacity. Rather, these activities (or lack thereof) are more likely based upon the
claimant’s reports to his treating doctor. Thus, the undersigned gives this report little
weight.” Tr. 26; see Tr. 321-33 (Exhibit 3E), 442-49 (Exhibit 4F).
12

On February 15, 2012, Plaintiff was examined by Robert A. Erickson, M.D.,
for a comprehensive initial evaluation for long-term depression and hair loss. Tr. 22,
388-401. The ALJ reviewed the evaluation results noting in part: “He had normal
physical, neurological and psychiatric exam findings except for flat moot and affect . . .
He was given various supplements (versus medications) and dietary suggestions.”
Tr. 22 (citations omitted); see Tr. 390-91. The ALJ noted that Plaintiff “had a positive
reaction to the use of his medications at the time he was using Lexapro.” Tr. 25.
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Plaintiff continued treatment at Sarkis in January, April, August,
November, and December, 2013. Tr. 23, 481-90. On January 31, 2013,
he reported doing “better than it used to be.” Tr. 23, 490. On April 30,
2013, the assessment/plan indicated that he reported “doing well.”
Tr. 487. “In August 2013, he had improvement with normal attention
span/concentration judgment.” Tr. 23, 486 (citation omitted). The ALJ
noted that in August 2013, Plaintiff “reported he had been having seizures
(that he did not mention at the hearing). He also reported that he finished
up his business plan.” Tr. 24, 486. (citation omitted). As of December
16, 2013, it is noted he was “doing better but not great.” Tr. 24, 481.
Also, the ALJ noted that “his mental status exam findings were
unremarkable including normal thought process, fear to normal memory,
normal language, normal fund of knowledge and full orientation . . . except
for down mood . . . with restricted . . . and anxious affect . . . .” Tr. 23, 482,
484, 486, 488, 490 (citations omitted).
The ALJ considered additional treatment notes from Sarkis from 2014
and 2015. Tr. 24-25.
In 2014,the claimant continued to follow up with Sarkis Family
Psychiatry but only on 3 occasions for medication management
(May, August and November) (Exhibit 8F/ 13-18). He reported
doing okay but was still having “a hard time getting out sometimes”
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(Exhibit 8F/ 17). His mental status exam findings were
unremarkable including normal thought process , fair to normal
memory, normal language, normal fund of knowledge, normal
judgment and full orientation (Exhibit 8F/ 13, 15, 17) except for
restricted affect (Exhibit 8F/ 17). He had mild (Exhibit 8F/17)
impairment in attention/concentration.
In August 2014, he reported that he was getting married. He also
reported that Klonopin had been very effective (Exhibit 8F/ 15).
In November 2014, he returned to Sarkis Family Psychiatry and
reported that he had him problems in last 3 weeks due to people
taking advantage of him. He reported doing best with yoga.
Medication regimen continued to include Lamictal and Klonopin
(Exhibit 8F/13).
In 2015, he continued to follow up for medication management with
Sarkis Family Psychiatry for which treatment consisted of
medication management (January, February x 3, March, April, May,
June and August) (Exhibits 8F/1-12, 11F). Generally, his mental
status exam findings were unremarkable including normal thought
process, fair to normal memory, normal language, normal fund of
knowledge, normal judgment and full orientation (Exhibits 8F/4, 6,
8, 9, 11, 11F/ 1, 3, 5, 7) except for variable mood/affect from down
mood (Exhibit 8F/2, 4, 8, 9, 11F/5), irritable mood (Exhibit 11F/3),
constricted affect (Exhibits 8F/9, 11F/7) or stressed affect (Exhibit
8F/2). He had mild (Exhibit 8F/4, 6, 8) impairment in
attention/concentration. His medication regimen still did not
change as he continued to take Klonopin and Lamictal (Exhibits 8F,
11F) except Vyvance was added in June 2015 (Exhibit 11F/4).
On February 11, 2015, he reported “doing pretty good, stable” and
less agoraphobic (Exhibit 8F/6).
He returned in March 2015 and reported that things were going
well (Exhibit 8F/2).
On April 30, 2015, Dr. Sarkis completed a Medical Assessment to Do
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Work Related Activities (Mental) and opined that the claimant had
marked (defined as the limitation in the ability to function is serious.
The limitation is more than “moderate” but less than “extreme”) in the
following areas: ability to relate to coworkers; ability to deal with the
public; ability to use judgment; ability to function independently;
ability to maintain attention/concentration and ability to relate
predictably in social situations. He opined that she [sic] had
extreme limitation (defined as the limitation in the ability to function is
100%. There is no useful ability to function) in his ability to deal with
work stresses (Exhibit 10F) [Tr. 513-15].[13]
In May 2015, it was noted that he had poor compliance with
treatment (Exhibit 11F/6).
On August 4, 2015, he returned to Sarkis Family Psychiatry and
reported that he had been doing pretty good for the past couple of
weeks. He also reported that he was doing well helping down at [his]
shop (Exhibit 11F/1). Mental status exam revealed he was fully
oriented with normal language, thought process, thought content,
memory, concentration, and motor activity with appropriate judgment
and insight but restricted affect and some halting speech (Exhibit
11F/1).
Tr. 24-25; see Tr. 464-481, 513-23.
Plaintiff argues that the ALJ did not give proper weight to Dr. Sarkis’

13

The ALJ expressly referred to Exhibit 10F, Dr. Sarkis’ April 30, 2015, Medical
Assessment to do Work-Related Activities (Mental), Tr. 513-15, and gave
no weight to portion of his opinion that noted marked limitation in multiple areas
of functioning consistent with meeting listing level severity in light of the
claimant’s very own limited treatment with no hospitalizations since 2010.
Furthermore, his opinion is inconsistent with his own treatment notes, which
specifically noted that the claimant’s examinations have generally been within
normal limits with the bulk of exams showing normal memory, concentration,
judgment and insight (as discussed in detail above in Exhibits 4F, 8F, 11F).
Tr. 27.
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2015 opinion and did not identify the inconsistent evidence in the record.
See ECF No. 16 at 6, 8. As noted above, on April 30, 2015, Dr. Sarkis
completed a medical assessment and opined that Plaintiff had moderate
ability to follow work rules and interact with supervisors; marked ability to
relate to co-workers, deal with the public, use judgment, function
independently, and maintain attention and concentration; and an extreme
limitation in dealing with work stresses. Tr. 513-14. He also stated that
Plaintiff had no significant limitations in understanding, remembering, and
carrying out simple job instructions. Tr. 514. He did find, however, that
Plaintiff had a marked ability to relate predictably in social situations and a
moderate ability to maintain appearance, behave in an emotionally stable
manner, and demonstrate reliability. Tr. 515.
The ALJ gave no weight to Dr. Sarkis’ opinion. See supra at n.13.
The ALJ found that the assessment of marked limitations, indicating listing
level severity, was inconsistent with Plaintiff’s limited and conservative
treatment with medication and psychotherapy. Tr. 27. For instance, after
receiving treatment for a manic episode in 2010, Plaintiff did not seek
treatment from Dr. Sarkis until September 2011, Tr. 404, and had no more
than three sessions during that time period, August, September, and

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October 2010, and May 2011 (once), with Dr. Jones. Tr. 452-54.
The ALJ further found that Dr. Sarkis’ opinion was inconsistent with
his own treatment notes. See Crawford v. Comm’r of Soc. Sec., 363 F.3d
1155, 1159-60 (11th Cir. 2004). The ALJ explained that Dr. Sarkis’
treatment notes showed that Plaintiff’s examinations have generally been
within normal limits. Tr. 27. Although Plaintiff argues the ALJ did not
identify the inconsistencies, the ALJ provided a detailed discussion of
Plaintiff’s treatment at Sarkis. Tr. 20-27.
Furthermore, as noted above, throughout treatment with Dr. Sarkis in
2012, Plaintiff reported vacillating symptoms of depression and anxiety, but
he had fairly normal mental status examinations, other than some impaired
concentration and attention. Tr. 422-41, 491-93. Psychiatric
examinations conducted between 2013 and 2015 generally showed a
stressed and down mood; a cooperative attitude, normal orientation,
speech, thought process, association; no psychotic symptoms; normal
memory; normal to mildly reduced attention and concentration; and normal
to mildly impaired judgment. Tr. 465, 467, 469, 471-72, 474, 476, 478,
482, 484, 486, 48, 490, 516, 518, 520, 522. During this time, Plaintiff
reported symptoms of depression and anxiety with several periods of

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improvement. Tr. 464-91, 516-23. These treatment records show no
more than mildly impaired concentration at times, which supports the RFC
that Plaintiff could concentrate efficiently to perform simple tasks.
Substantial evidence supports the ALJ’s determination to give no weight to
Dr. Sarkis’ opinion.
Amen Clinics, Inc., and Robert M. Licata, M.D., a psychiatrist
On October 26, 2011, the claimant presented to Amen Clinics for
evaluation with complaints of manic episodes, depression and
anxiety (Exhibit 9F/1). Around 2006, the claimant reported that he
stopped taking his Lexapro “cold turkey” and he then experienced a
manic episode and spent an enormous amount of money in a very
impulsive manner. To stabilize his mood, he was asked to return to
Lexapro and he admitted that his mood and behavior had returned
to “normal” (Exhibit 9F/2). He reported that in March 2010, he could
no longer afford his medication and discontinued it again but within
four weeks, began to feel nervous and restarted it. After one week,
he had another manic episode (Exhibit 9F/2). During this manic
episode, he was tasered by police after an exchange of words with
another driver and had been Baker Acted. He admitted that his
paranoia had subsided with the help of Abilify but still had
depression and anxiety (Exhibit 9F/2). Mental status exam revealed
rather normal findings. He had friendly attitude and normal
behavior. He was fully oriented. Attention span was normal.
Memory was intact. Judgment and insight were good. However,
eye contact was poor and affect was flat. His mood was frustrated,
depressed and hopeless (as reported) (Exhibit 9F/6). It was noted
that brain SPECT studies were performed on 10/24/11 and
10/25/11, which revealed the most significant finding was severely
increased activity in thalamus during concentration scan; increased
activity in basal ganglia seen bilaterally most pronounced with
concentration; decreased activity in the inferior orbits of the prefrontal
corticals and the temporal lobes seen bilaterally in both areas and
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most pronounced at rest accompanied by decreased internal
cerebellar activity and irregular decreases in anterior poles in
association with decreased activity in the temporal, parietal, occipital
and posterior midline cerebellar areas that suggested trauma (Exhibit
9F/ 10-11). Robert Licata, M.D. (Staff psychiatrist) met with the
claimant to review SPECT studies and for full neuropsychiatric
evaluation. It was noted on this visit, his speech and thinking
seemed “slow.” He teared up when speaking of his shame.
Diagnoses included anxiety, depression, mood disorder, anxiety
disorder and learning disabilities (Exhibit 9F/ 12) with an assessed
GAF of 50 (Exhibit 9F/ 13). Recommendations included lab work,
nutritional supplements, mood stabilizer (Lamictal), psychotherapy
and other brain healthy strategies as well as follow up with local
professional (Exhibit 9F/13-16).
Tr. 20-21; see Tr. 496-512. 14

14

As of the October 24, 2011, evaluation, Plaintiff’s occupation was listed as
“independent insurance agent.” Tr. 496. According to the employment history, no
work-related problems are reported. Tr. 499. “Corry’s employers/supervisors would
say that he was concerned about the welfare of others, had a good work ethic, and was
friendly.” Id. see Tr. 501. The mental status examination results were generally
normal including good judgment, no reported obsessions, SI, or HI; normal attention
span and good insight, although his eye contact was poor and affect flat. Tr. 505. The
brain SPECT studies were performed on October 24 and 25, 2011. Id. Plaintiff
discontinued taking Cymbalta on October 12, 2011, and took his last Clonazepam on
October 14, 2011. He discontinued taking his supplements on October 14, 2011. Id.
The brain SPECT studies “show areas the brain that work well, areas of the brain that
worked too hard, and areas of the brain that do not work hard enough. With this
information, together with the clinical information obtained, we can develop a
comprehensive treatment program.” Id. The scan quality was good. Id. The scan
results were provided. Tr. 505-06. His GAF score was 50. Recommendations
included: “You have a good brain, but we can heal and balance it to make it better.
Make one treatment intervention or change at a time.” Tr. 508. Several laboratory
recommendations are noted. Id. Nutritional supplements and medications are
recommended. Id. The medical recommendation included: “Corry it is important that
you be patient and remember that it will take several weeks before you experience the
full impact of the treatment recommendations. Discuss with your psychiatrist any
inclinations to reduce or discontinue your medications.” Id.; see Tr. 508-11 for other
recommendations.
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On October 24, 2011, Dr. Licata conducted an evaluation of Plaintiff.
Tr. 496-512. In addition to what is reported above, Dr. Licata also
reviewed the brain SPECT imaging studies of October 24 and 25, 2011,
that examined areas of the brain for signs of increased or decreased
activity. Tr. 505-06. Dr. Licata interpreted the studies as being consistent
with low mood and executive dysfunction, anxiety, mood disturbance, and
emotional dysregulation. Tr. 507. Dr. Licata diagnosed bipolar disorder,
anxiety, and learning disabilities. Id.
Although the SPECT studies confirmed Plaintiff’s mental diagnoses, a
diagnosis alone is insufficient to establish that the condition caused specific
limitations. See generally Moore v. Barnhart, 405 F.3d at 1213 n.6. The
SPECT study is not inconsistent with the RFC findings and does not
sufficiently contradict the substantial evidence supporting the ALJ’s
decision.
Plaintiff argues the ALJ erred in not stating the weight he gave “to the
objective findings of the SPECT studies and neuropsychiatric evaluation by
Dr. Licata.” ECF 15 at 7. The SPECT studies are not medical opinions,
but objective testing. See Tr. 21; see also 20 C.F.R. § 404.1527(a)(2).
Although the ALJ did not expressly state the weight he gave to Dr. Licata’s

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opinions and the SPECT studies, the ALJ considered the salient portions of
the SPECT studies, the neuropsychiatric evaluation results, and
Dr. Licata’s opinions. There is no showing that the ALJ overlooked any
relevant evidence. No error has been shown.
Vicci L. Cascioli, R.N., A.P.
The ALJ noted that Nurse Cascioli wrote a letter and noted that
Plaintiff had been receiving acupuncture for his anxiety and depression
from January 2012 through September 2012 and January 2013. Tr. 21.
“She opined that he is unable to hold a job at this time and a good
candidate for temporary worker’s compensation. She felt that with strong
efforts, he would solve his problems and be able to work again.” Id.
(citation omitted); see Tr. 456-57. The ALJ gave Nurse Cascioli’s opinion
no weight “as this is from a non acceptable medical source,” see 20 C.F.R.
§ 404.1513(a), and further noted Nurse Cascioli provided acupuncture and
is not a specialist in the area of mental health. Tr. 26; see 20 C.F.R.
§ 404.1527(c)(3)-(5).
Nurse Cascioli outlined her acupuncture treatment provided for
Plaintiff, but did not provide any treatment notes or objective findings to
support her opinion as noted by the ALJ. Tr. 26, 456-57. Nurse

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Cascioli’s opinion that Plaintiff was unable to work concerned an issue
reserved to the ALJ. As such, the opinion was not a “medical opinion”
under the regulations and not entitled to any particular weight. See
Denomme v. Comm’r of Soc. Sec., 518 F. App’x 875, 877-78 (11th Cir.
2013) (unpublished). Furthermore, as noted by the ALJ, Nurse Cascioli is
not an acceptable medical source and her opinion is not entitled to
controlling weight. See Denomme, 518 F. App’x at 878. No error is
shown.
William E. Benet, Ph.D., Psy.D.
On February 19, 2013, Dr. Benet performed a psychological
evaluation on Plaintiff and the ALJ considered Dr. Benet’s psychological
evaluation. Tr. 23-24; see Tr. 459-63.
On February 19, 2013, the claimant presented to William Benet,
Ph.D. for a consultative psychological exam (Exhibit 7F). He
arrived in a pickup truck alone and presented ambulatory, tense and
anxious looking who was also friendly and cooperative (Exhibit 7F/2).
He reported having panic attacks since age 21 for which he had to
temporarily withdraw from college but went back to graduate with a
BA.[15] It was noted that he was vague about how often his panic
attacks, when and where they occur (Exhibit 7F/3). He alleged that
when he first started having panic attacks (age 21), “it was all I could
do to get out the door.” He also reported bipolar symptoms that
began in 2006 that included euphoric and irritable mood, racing
15

He graduated from Auburn University with a B.A. degree in interpersonal
communications. Tr. 461.
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thoughts, increased energy and activity, insomnia and decreased
need for sleep with alternating episodes of depressed mood, social
withdrawal and hypersomnia. He was also vague about the
frequency and duration of manic/hypomanic and depressive
episodes since 2006 (Exhibit 7F/3). He admitted that he had been
feeling better since June 2012 (Exhibit 7F/3). With regard to his
prior mental health history, he reported being tasered by police in
2010 at which time he was placed at Shands involuntarily under
Baker Act. He then was readmitted to Vista and saw Dr. Tran on an
outpatient basis. He started in the fall of 2011, he was seen at
Amen Clinic in Virginia for 2-3 days and then when he returned
home, he began treating with Dr. Sarkis. He also reported being
vague about his drinking but stated that he last used in 2010. He
also reported that he quit smoking cigarettes the year before and was
smoking an e-cigarette. He reported history of DUI in July 2010.
He reported one month later, he was arrested for fleeing law
enforcement officers (Exhibit 7F/3). He reported that he attended
acupuncture school in Gainesville for 1 1/2 months (Exhibit 7F/4).
He reported that he was trying to start an online jewelry business but
did not have a website. He reported that he lived in a 3 bedroom
house owned by his parents but sometimes stayed with his girlfriend
(Exhibit 7F/4). Mental status exam revealed he was fully oriented
who was casually and neatly dressed and groomed. His gait was
normal. Although he appeared tense and anxious, he was polite
and friendly and cooperative. Speech was clear.
Thinking was organized. Mood was tense and anxious. Attention
and concentration were adequate. Memory was intact. Judgment
and insight were adequate (Exhibit 7F/5). Diagnoses included
bipolar disorder without psychotic features and panic disorder
without agoraphobia (Exhibit 7F/5) with an assessed GAF of 50
(Exhibit 7F/6). Dr. Benet opined that the claimant “should be able to
perform work-related mental tasks involving understanding and
memory, but is likely to have moderate to marked difficulty
performing tasks involving sustained concentration and persistence,
social interaction and adaption” (Exhibit 7F/5).
Tr. 23-24.
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The ALJ further considered Dr. Benet’s evaluation and concluded:
As for the GAF score of 50 given by Dr. Benet noted in the
consultative exam, the undersigned gives this no significant weight
as it is based upon limited treatment and inconsistent with the noted
normal examinations by Dr. Sarkis, particularly with regard to his
more recent medical treatment. Moreover, his overall treatment has
been rather conservative as his medication regimen has remained
relatively unchanged as it has consisted of Lamictal and Klonopin for
most of 2014 and throughout 2015.
Tr. 27.
Dr. Benet was not a treating provider so his opinion was not entitled
to controlling weight. 20 C.F.R. § 404.1529(c); Denomme, 518 F. App’x at
878. Further, the stated limitation in concentration was inconsistent with
Dr. Benet’s examination of Plaintiff, Tr. 462, as well as the examinations
conducted by Dr. Sarkis and Plaintiff’s overall conservative treatment.
See, e.g., Tr. 27, 465, 467, 469, 471-72, 474, 476, 478, 482, 484, 486, 488,
490, 516, 518, 520, 522; see 20 C.F.R. § 404.1527(c)(3)-(4); Crawford, 363
F.3d at 1159-60. Substantial evidence supports the ALJ’s decision to
reject the limitations offered by Dr. Benet.
Wendy Silver, Psy.D.; Michele Quiroga, Ph.D.
“On February 22, 2013, DDS mental health specialist, Wendy Silver,
Psy.D. reviewed the available medical evidence and opined that the

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claimant’s anxiety disorder was severe as it caused moderate limitations in
concentration, persistence and pace (Exhibit 7A, duplicated at 8A).”
Tr. 24, see Tr. 117-34.
“On November 20, 2012, DDS mental health specialist, Michele
Quiroga, Ph.D. reviewed the available medical evidence and opined that
the claimant did not have any severe mental impairment as her [sic]
anxiety and affective disorders only caused mild limitation in concentration,
persistence and pace (Exhibit 1A, duplicated at 2A).” Tr. 22; see Tr. 97112.
The ALJ gave the opinions of Drs. Silver and Quiroga
significant weight as they are consistent with the overall credible
evidence of record and show that the claimant is capable of simple,
routine tasks and unskilled work. Thus, mentally, he is precluded
from the performance of complex tasks but is capable of completing
simple, routine tasks consistent with unskilled work with
concentration for those tasks for 2 hour periods and normal breaks
and a lunch.
Tr. 27.16
16

Dr. Silver opined that Plaintiff “retains the ability to perform simple, repetitive
and some higher level tasks.” Tr. 124. See Hurst v. Comm’r of Soc. Sec., 522 F.
App’x 522 (11th Cir. 2013) (unpublished) (“capable of simple, routine, repetitive tasks”);
Jacobs v. Comm’r of Soc. Sec., 520 F. App’x 948 (11th Cir. 2013) (limited to “one to
three step non-complex tasks”); Washington v. Soc. Sec. Admin., Comm’r, 503 F. App’x
881, 883 (11th Cir. 2013) (unpublished) (“limited to performing only simple, routine[,]
repetitive tasks with up to three-step demands, and only occasional changes in the work
setting, judgment, or decision making”); Scott v. Comm’r of Soc. Sec., 495 F. App’x 27,
28-29 (11th Cir. 2012) (unpublished) (“low stress, simple, unskilled; one, two, or three
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State agency consultants are highly qualified specialists who are also
experts in the Social Security disability programs and their opinions may be
entitled to great weight if the evidence supports their opinions. See 20
C.F.R. § 404.1527(e)(2)(i). The ALJ may rely on the opinions of State
agency medical consultants after discounting the opinions of other
physicians based on the record as a whole. See, e.g., Forrester v.
Comm’r of Soc. Sec., 455 F. App’x at 902-03 (holding ALJ “did not err by
relying on the opinions of the non-treating physicians, taken alone, in a way
that left [his] decision unsupported by substantial evidence” and ALJ was
not prohibited from reaching conclusion “simply because non-treating
physicians also reached it” (citation omitted)). The opinions of Drs. Silver
and Quiroga are consistent with the ALJ’s RFC finding.
IV.
Plaintiff requests this Court to re-weigh the evidence and substitute
its discretion for that of the ALJ. Bloodsworth, 703 F.2d at 1239. As

step instructions”); Rosario v. Comm’r of Social Sec., 490 F. App’x 192, 195 (11th Cir.
2012) (“simple, routine, and repetitive tasks in an environment with only brief
interactions with co-workers and public”); Forrester v. Comm’r of Soc. Sec., 455 F.
App’x 899, 903 (11th Cir. 2012) (unpublished) (“simple, routine, and unskilled work”).
In the cited cases for the most part, the administrative records reflected opinions from
state agency consulting physicians that these plaintiffs were capable of “simple routine
tasks.”
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stated above, the role of a reviewing court under 42 U.S.C. § 405(g) is
limited to determining whether substantial evidence in the record as a
whole supports the decision. As long as the ALJ’s decision is supported
by substantial evidence and based upon correct application of the law, as it
is in this case, it is entitled to deference and should be upheld.
After discussing the medical evidence, the ALJ noted the “[r]eview of the
medical evidence is rather limited.” Tr. 25. Nevertheless, the ALJ
analyzed the evidence, including objective medical evidence and limited
treatment, and provided the weight given to most of the opinions. Tr. 1826.
Although Plaintiff argues that the RFC must be based on a treating or
examining physician’s opinion, this argument has been rejected. See,
e.g., Castle v. Colvin, 557 F. App’x 849, 853-54 (11th Cir. 2014)
(unpublished) (holding the ALJ’s RFC findings are supported by substantial
evidence when he gave a physician’s opinion little weight even though the
record lacked another physician’s assessment); see also Green v. Soc.
Sec. Admin., 223 F. App’x 915, 923-24 (11th Cir. 2007) (unpublished)
(holding the ALJ’s RFC findings are supported by substantial evidence
even though he gave a physician’s opinion no weight and the only other

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evidence besides the claimant’s testimony was office visit records that did
not refute a finding that the claimant could perform light work).
Substantial evidence supports the ALJ’s RFC determination, his
consideration of the medical evidence, and Plaintiff’s credibility. No error
has been shown.
V. Conclusion
Considering the record as a whole, the findings of the ALJ are based
upon substantial evidence in the record and the ALJ correctly followed the
law. Accordingly, pursuant to 42 U.S.C § 405(g), the decision of the
Commissioner to deny Plaintiff’s applications for Social Security benefits is
AFFIRMED. The Clerk shall enter judgment for Defendant.
IN CHAMBERS at Tallahassee, Florida, on November 17, 2017.
s/ Charles A. Stampelos__________
CHARLES A. STAMPELOS
UNITED STATES MAGISTRATE JUDGE

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