KENNEDY v. COLVIN

Filing 17

MEMORANDUM ORDER. The decision of the Commissioner is AFFIRMED and plaintiff's applications for Disability Insurance Benefits and Supplemental Security Income are DENIED. The clerk is directed to close the file. Signed by MAGISTRATE JUDGE CHARLES J KAHN, JR on 03/05/2015. (MB)

UNITED STATES DISTRICT COURT
NORTHERN DISTRICT OF FLORIDA
PENSACOLA DIVISION

VONDA KAY KENNEDY,
Plaintiff,
v.

Case No. 5:13cv394/CJK

CAROLYN W. COLVIN,
ACTING COMMISSIONER OF
SOCIAL SECURITY,
Defendant.
____________________________/
MEMORANDUM ORDER
This case is before the court pursuant to 42 U.S.C. § 405(g) for review of a
final determination of the Commissioner of Social Security (“Commissioner”)
denying Vonda Kay Kennedy’s application for disability insurance benefits (“DIB”)
under Title II of the Social Security Act (“Act”), 42 U.S.C. §§ 401-34, and
supplemental security income (“SSI”) under Title XVI of the Act, 42 U.S.C. §§ 13811383f. The parties have consented to Magistrate Judge jurisdiction pursuant to 28
U.S.C. § 636(c) and FEDERAL RULE OF CIVIL PROCEDURE 73 for all proceedings in
this case, including entry of final judgment. Upon review of the record before this
court, I conclude that the findings of fact and determinations of the Commissioner are
supported by substantial evidence. The decision of the Commissioner, therefore, will
be affirmed.

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ISSUES ON REVIEW
Plaintiff, who will be referred to as claimant, plaintiff, or by name, raises a
number of issues on appeal: (1) whether the ALJ failed to give sufficient weight to
the opinion of her treating physician, Dr. Valdee Harmon-Sheffield; (2) whether the
ALJ failed to give sufficient weight to the opinion of Crystal Breland, a treating
advanced registered nurse practitioner; (3) whether the ALJ failed to give sufficient
weight to the opinion of Dr. Joseph Siano, an examining physician; and (4) whether
the ALJ failed to properly assess plaintiff’s mental RFC, as required by SSRs 96-8p
and 85-15.
PROCEDURAL HISTORY
Claimant applied for DIB on November 20, 2007, and SSI on March 4, 2008,
alleging disability beginning on September 5, 2007, due to “headaches, diabetes,
gout, angina, enlarged heart, multiple sclerosis.” T. 121-21, 257-66, 294.1 Her
applications initially were denied, and the denial was upheld on reconsideration. T.
119-22, 145-50, 156-60. Claimant filed a request for a hearing. T. 161-62. Her
request was granted, and a hearing was conducted on April 15, 2010. T. 91-113. On
May 19, 2010, the administrative law judge (“ALJ”) found claimant not disabled as
defined by the Act. T. 126-34. Claimant requested review by the Appeals Council,
which granted her request and remanded the case for further administrative
proceedings on the issue of claimant’s obesity. T. 139-42. On October 4, 2011, a
second administrative hearing was held before a different ALJ at which plaintiff,

1

The administrative record, as filed by the Commissioner, consists of eleven volumes (docs.
13-1 through 13-12) and has 647 consecutively numbered pages. References to the record will be
by “T.,” for transcript, followed by the page number.
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represented by counsel, and a vocational expert appeared and testified. T. 42-90. The
ALJ issued an unfavorable decision on March 26, 2012. T. 17-41. The Appeals
Council denied plaintiff’s request for review on September 23, 2013. T. 1-6. The
ALJ’s decision thus became the final determination of the Commissioner.
FINDINGS OF THE ALJ
In his written decision, the ALJ made a number of findings relative to the
issues raised in this appeal:
•

“[C]laimant has not engaged in substantial gainful activity since
September 5, 2007, the alleged onset date (20 C.F.R. 404.1571 et seq.,
and 416.971 et seq.).” T. 22.

•

“[C]laimant has the following severe medical impairments: gout,
obesity, enlarged heart, angina, history of tobacco abuse, fibromyositis,
and diabetes mellitus with neuropathy and restless leg syndrome (20
C.F.R. 404.1520(c) and 416.920(c)).” T. 22.

•

“[C]laimant does not have an impairment or combination of impairments
that meets or medically equals the severity of one of the listed
impairments in 20 C.F.R. Part 404, Subpart P, Appendix 1 (20 C.F.R.
404.1520(d), 405.1525, 404.1526, 416.920(d), 416.925 and 416.926).”
T. 23.

•

“[C]laimant has the residual functional capacity to perform light work
as defined in 20 C.F.R. 404.1567(b) and 416.967(b) except she can
frequently2 climb ramps and stairs, balance, stoop, kneel, crouch, and

2

The context makes clear that this is a limitation of the full range of light work.

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crawl; occasionally climb ladders, ropes, or scaffolds; and can tolerate
up to frequent exposure to workplace hazards such as open machinery
or unprotected heights.” T. 26.
•

“[C]laimant is able to perform past relevant work as a Cleaner
Housekeeper, Fast Food Worker, Sewing Machine Operator,
Companion, Cashier (Convenience Store), and Job Coach, both as those
jobs are normally performed, and as performed by the claimant; and
Cook, Institutional, as performed by the claimant. (20 C.F.R. 404.1565
and 416.965). This work does not require the performance of workrelated activities precluded by the claimant’s residual functional
capacity (20 C.F.R. 404.1565 and 416.965).” T. 34.

•

“[C]laimant has not been under a disability, as defined in the Social
Security Act, from September 5, 2007, through the date of this decision
(20 C.F.R. 404.1520(g) and 416.920(g)).” T. 35.
FACT BACKGROUND AND MEDICAL HISTORY3

At the time the ALJ rendered his decision, plaintiff was forty-five years old,
had a General Equivalency Diploma, and had completed trade school for industrial
sewing. T. 49, 299. Plaintiff’s previous work included cleaner/housekeeper and fast
food worker, both of which are light, unskilled jobs; sewing machine operator
performed at the sedentary level, companion, and job coach, all of which are light,
semi-skilled jobs; convenience store cashier, which is a light, unskilled job; and
3

The recitation of medical and historical facts of this case, as set out below, is based on the
court’s independent review of the record. Although intended to be thorough and to provide an
overview of the claimant’s history of care and treatment, the synopsis of medical evidence will be
supplemented as necessary in the Analysis section.
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institutional cook, which is a skilled job performed at the medium level. T. 82-83,
316-32. Plaintiff lived at her grandmother’s house, along with her children, brother,
and nephew, and performed certain household chores, such as cleaning her room,
making her bed, and folding her laundry. T. 50-51, 336-43. She also largely cared
for her own personal needs, prepared herself meals using a microwave, rode in
vehicles, shopped in stores, and spent time with her family. T. 336-43. During the
pertinent period, plaintiff received medical care for a number of conditions, including
shingles, gout, hypertension, diabetes, and fibromyalgia pain. T. 399-410, 454-64,
482-88, 506-14, 587-616. For the most part, her treatment was routine, with repeated
references to her obesity and lack of compliance with doctors’ orders, which directed
that she take her medications, diet, exercise, and quit smoking. T. 399-410, 454-64,
482-88, 506-14, 587-616.
At the hearing, plaintiff testified that she suffers from headaches, shingles,
gout, and pain and numbness in her hands and was diagnosed with multiple sclerosis.
T. 52, 64, 67. Plaintiff claims to experience headaches daily, shingles outbreaks in
her groin twice a year, which last two to three months, and gout flare ups three to four
times a year that prevent her from placing her foot on the floor. T. 64-65, 68, 74.
Plaintiff also experiences pain in her chest. T. 73. Although plaintiff has been
prescribed numerous medications, she cannot afford them.

T. 64-65.

She

acknowledged that Lortab helped her pain but testified that she is unable to take it
due to hypertension. T. 73. Plaintiff takes Ibuprofen and Encet for pain and
Neurontin for neuropathy. T. 73, 76. Neurontin, however, causes hallucinations and
memory problems. T. 76. Claimant testified that she has used a cane since 2009 and,
at the time of the hearing, used it every day. T. 65-66. Claimant also suffers from
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anxiety and depression, which interfere with her ability to concentrate and for which
she has been prescribed Buspar and Xanax. T. 74-75, 78. Plaintiff testified that she
no longer is able to work because of pain in her hands, arms, shoulders, neck, back,
legs, and feet, which limits her ability to sit and stand. T. 64, 72.
When asked how long she can stand, plaintiff testified that she can stand for
thirty minutes. T. 69. She can sit comfortably for an hour. T. 69. She has problems
holding a book because of the numbness in her hands. T. 75. In fact, plaintiff
testified that she drops things most days and cannot pick up a coin or piece of paper.
T. 75-76. Plaintiff rated her shingles and leg pain an eight on a ten-point scale. T.
78. She rated the pain from the neuropathy with her legs a ten. T. 79. She testified
that she had been seeing Crystal Breland, an advanced registered nurse practitioner,
twice a month for the past year and had seen Dr. Valdee Harmon-Sheffield every
Saturday since February 2011 for hypertension and pain. T. 70-72. Plaintiff testified
that her daughter cooks and cleans the home and that she spends twenty hours a day
lying down. T. 78.
On September 2, 2008, claimant attended a consultative examination with
psychologist George L. Horvat, Ph.D., at the state’s request. T. 414-18. Plaintiff
reported being treated for anxiety since 2006 and taking “nerve pills” but denied a
history of inpatient treatment and suicide attempts. T. 414-15. Dr. Horvat diagnosed
generalized anxiety disorder and pain disorder and assigned plaintiff a GAF score of
65.4 T. 416. According to Dr. Horvat, there were no psychological impediments to
4

The GAF rating has two components: (1) symptom severity and (2) social and occupational
functioning. The GAF is within a particular range if either the symptom severity or the social and
occupational level of functioning falls within the range. When the individual’s symptom severity
and functioning level are discordant, the GAF rating reflects the worse of the two. The American
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plaintiff working. T. 416-17. Less than two weeks later, Dr. Samuel Ward, a general
practitioner, evaluated plaintiff at the state agency’s request. T. 419-25. Plaintiff
complained of “feet and all over body pain,” as well as gout and shingles. T. 422.
On September 24, 2008, Dr. David Guttman, a state agency physician, reviewed the
record and determined that, despite her various impairments, plaintiff retained the
RFC to lift and/or carry twenty pounds occasionally and ten pounds frequently; stand
and/or walk and sit for about six hours in an eight-hour workday; perform unlimited
pushing and/or pulling; occasionally climb ladders, ropes, or scaffolds; frequently
climb ramps or stairs; and frequently balance, stoop, kneel, crouch, and crawl. T.
427-28.

Dr. Guttman found no manipulative, visual, communicative, or

environmental limitations. T. 429-30. A state agency psychologist, Thomas Conger,
Ph.D., reviewed the record on October 9, 2008, to assess the severity of plaintiff’s
anxiety disorder. T. 434-47. According to Dr. Conger, plaintiff’s anxiety disorder
did not restrict her ability to perform activities of daily living; mildly limited her
ability to maintain social functioning; mildly limited her ability to maintain

Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (“DSM-IV-TR”) 34
(4th ed., text rev., 2000). A GAF between 51 and 60 indicates “moderate symptoms (e.g., flat affect
and circumstantial speech, occasional panic attacks) or moderate difficulty in social, occupational,
or school functioning;” a GAF between 61 and 70 indicates “mild” symptoms or “some difficulty
in social, occupational or school functioning,” but “generally functioning pretty well;” a GAF score
between 71 and 80 indicates transient and expectable reactions to psychosocial stressors and no more
than an slight impairment in social, occupational, or school functioning; a GAF score between 81
and 90 indicates no or minimal symptoms and good functioning in all areas. Id. The most recent
edition of the Diagnostic and Statistical Manual no longer recommends use of the GAF scale,
acknowledging that “[i]t was recommended that the GAF be dropped from DSM-5 for several
reasons, including its conceptual lack of clarity and questionable psychometrics in routine practice.”
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders 16 (5th
ed. 2013).
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concentration, persistence, or pace; and caused no episodes of decompensation of
extended duration. T. 444. Dr. Conger concluded that plaintiff’s anxiety disorder
was not severe. T. 434.
Crystal Breland, an advanced registered nurse practitioner who treated plaintiff,
completed a Physical Capacities Evaluation and Clinical Assessment of Pain form on
March 31, 2010. T. 515-17. On the Physical Capacities Evaluation form, Ms.
Breland indicated that plaintiff could lift and/or carry ten pounds occasionally and
five pounds frequently; sit and stand or walk for two hours each during an eight-hour
work day; rarely engage in pushing and pulling movement, climbing and balancing,
and reaching; rarely be exposed to environmental problems; occasionally bend and/or
stoop and operate motor vehicles; and frequently engage in gross and fine
manipulation. T. 516. Ms. Breland opined that claimant would be absent from work
as a result of her impairments and treatment more than four days per month. T. 516.
When asked to explain the degree and basis for the restriction she imposed, Breland
cited severe hypertension, severe neuropathy, insulin dependent diabetes, and chronic
severe fatigue. T. 516. On the Clinical Assessment of Pain form, Ms. Breland
indicated that plaintiff experienced pain “to such an extent as to be distracting to
adequate performance of daily activities or work.” T. 517. Breland also indicated
that physical activity “[g]reatly increased pain . . . to such a degree as to cause
distraction from tasks or total abandonment of task” and that drug side effects could
“be expected to be severe and to limit effectiveness due to distraction, in attention
[sic], drowsiness, etc.” T. 517.
Dr. Valdee Harmon-Sheffield, plaintiff’s treating physician, completed a
Physical Capacities Evaluation on September 20, 2011, in which she opined that
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claimant could lift and/or carry ten pounds occasionally and five pounds frequently,
sit for three hours and stand and/or walk for two hours during an eight-hour workday,
frequently engage in pushing and pulling movement, gross and fine manipulation, and
bending and/or stooping movements; frequently operate a motor vehicle; occasionally
climb and balance and reach; and never be exposed to environmental problems or
work with or around hazardous machinery. T. 618. Dr. Harmon-Sheffield indicated
that plaintiff would be absent from work three days per month due to her impairments
or treatment. T. 618. When asked to explain and describe the degree and basis for
the restriction imposed, Dr. Harmon-Sheffield stated that plaintiff was “on
medications that are sedating and has pain in shoulder and arm extremities.” T. 618.
In addition to the Physical Capacities Evaluation, Dr. Harmon-Sheffield completed
a Clinical Assessment of Pain form identical to the one completed by Breland. T.
619.
Joseph Siano, D.O., examined plaintiff at the state’s request on November 19,
2011. T. 635-47. Plaintiff identified to Dr. Siano twelve physical and mental
conditions she considered disabling, including headaches, diabetes, gout, angina,
enlarged heart, multiple sclerosis, back and hip pain, hypertension, neuropathy,
obesity, GERD, and anxiety. T. 635-36. Dr. Siano concluded plaintiff had no
functional limitations from the headaches, gout, angina, enlarged heart, hypertension,
neuropathy, GERD, and anxiety and only mild functional limitations from her
uncontrolled diabetes, multiple sclerosis, back and hip pain, and obesity. T. 639-40.
Dr. Siano also noted plaintiff’s history of noncompliance. T. 640. Nevertheless, in
a Medical Source Statement of Ability to Do Work-Related Activities (Physical), Dr.
Siano indicated that plaintiff had work-preclusive restrictions, including an inability
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to lift, carry, or perform postural activities or sit, stand, or walk more than fifteen
minutes at a time for a total of six hours during an eight-hour workday. T. 642-47.
At the hearing, the vocational expert testified that a person of plaintiff’s age,
education, and work experience, who could perform light work except only frequently
climb ramps and stairs, balance, stoop, kneel, crouch, and crawl; occasionally climb
ladders, ropes, or scaffolds; and tolerate up to frequent exposure to workplace hazards
such as open machinery or unprotected heights, could perform all of plaintiff’s
previous jobs. T. 85-86. The expert then opined that plaintiff’s jobs could be
performed if the hypothetical person were limited to frequent bilateral handling and
the jobs of companion, sewing machine operator, and cleaner/housekeeper could be
performed with the additional restriction of simple, routine work involving a specific
vocational preparation level of only one or two. T. 86-87. The vocational expert
further testified that the jobs of companion and sewing machine operator could be
performed by a person with plaintiff’s background who was limited to sedentary work
involving lifting ten pounds occasionally and five pounds frequently, sitting for up
to three hours at a time, and standing and walking for a total of two hours during an
eight-hour workday; an option to alternate between sitting and standing after a threehour interval but without the option of leaving the work station; frequent bilateral
handling and fingering; occasional reaching in all directions; occasional climbing of
stairs, ramps, ladders, ropes, and scaffolds; occasional balancing; and no exposure to
pulmonary irritants or workplace hazards. T. 87-88.
STANDARD OF REVIEW
A federal court reviews a Social Security disability case to determine whether
the Commissioner’s decision is supported by substantial evidence and whether the
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ALJ applied the correct legal standards. See Lewis v. Callahan, 125 F.3d 1436, 1439
(11th Cir. 1997); see also Carnes v. Sullivan, 936 F.2d 1215, 1218 (11th Cir. 1991)
(“[T]his Court may reverse the decision of the [Commissioner] only when convinced
that it is not supported by substantial evidence or that proper legal standards were not
applied.”). Substantial evidence is “‘such relevant evidence as a reasonable person
would accept as adequate to support a conclusion.’” Richardson v. Perales, 402 U.S.
389, 401 (1971) (quoting Consolidated Edison Co. v. NLRB, 305 U.S. 197 (1938)).
With reference to other standards of review, the Eleventh Circuit has said that
“‘[s]ubstantial evidence is more than a scintilla . . . .’” Somogy v. Comm’r of Soc.
Sec., 366 F. App’x 56, 62 (11th Cir. 2010) (quoting Lewis, 125 F.3d at1439).
Although the ALJ’s decision need not be supported by a preponderance of the
evidence, “it cannot stand with a ‘mere scintilla’ of support.” See Hillsman v. Bowen,
804 F.2d 1179, 1181 (11th Cir. 1986). Even if the evidence preponderates against the
Commissioner’s decision, the decision must be affirmed if supported by substantial
evidence. See Sewell v. Bowen, 792 F.2d 1065, 1067 (11th Cir. 1986).
When reviewing a Social Security disability case, the court “‘may not decide
the facts anew, reweigh the evidence, or substitute [its] judgment for that of the
[Commissioner] . . . .’” Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir. 1990)
(quoting Bloodsworth v. Heckler, 703 F.2d 1233, 1239 (11th Cir. 1983)). A
reviewing court also may not look “only to those parts of the record which support
the ALJ[,]” but instead “must view the entire record and take account of evidence in
the record which detracts from the evidence relied on by the ALJ.” See Tieniber v.
Heckler, 720 F.2d 1251, 1253 (11th Cir. 1983). Review is deferential to a point, but
the reviewing court conducts what has been referred to as “an independent review of
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the record.” See Flynn v. Heckler, 768 F.2d. 1273, 1273 (11th Cir. 1985); see also
Getty ex rel. Shea v. Astrue, No. 2:10–cv–725–FtM–29SPC, 2011 WL 4836220
(M.D. Fla. Oct. 12, 2011); Salisbury v. Astrue, No. 8:09-cv-2334-T-17TGW, 2011
WL 861785 (M.D. Fla. Feb. 28, 2011).5
The Social Security Act defines a disability as 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). To qualify as a disability, the physical or mental impairment must be
so severe that the plaintiff not only is unable to do her previous work, “but cannot,
considering [her] age, education, and work experience, engage in any other kind of
substantial gainful work which exists in the national economy.” Id. § 423(d)(2)(A).
Pursuant to 20 C.F.R. § 404.1520(a)-(g), the Commissioner analyzes a
disability claim in five steps:
1. If the claimant is performing substantial gainful activity, she is not disabled.
2.

If the claimant is not performing substantial gainful activity, her

impairments must be severe before she can be found disabled.
3. If the claimant is not performing substantial gainful activity and she has
severe impairments that have lasted or are expected to last for a continuous period of
at least twelve months, and if her impairments meet or medically equal the criteria of
any impairment listed in 20 C.F.R. Part 404, Subpart P, Appendix 1, the claimant is
5

The Eleventh Circuit not only speaks of an independent review of the administrative record,
but it also reminds us that it conducts a de novo review of the district court’s decision on whether
substantial evidence supports the ALJ’s decision. See Ingram v. Comm'r of Soc. Sec. Admin., 496
F.3d 1253, 1260 (11th Cir. 2007); Wilson v. Barnhart, 284 F.3d 1219, 1221 (11th Cir. 2002).
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presumed disabled without further inquiry.
4. If the claimant’s impairments do not prevent her from doing her past
relevant work, she is not disabled.6
5. Even if the claimant’s impairments prevent her from performing her past
relevant work, if other work exists in significant numbers in the national economy
that accommodates her residual functional capacity and vocational factors, she is not
disabled.
“[R]esidual functional capacity is the most [claimant] can still do despite
[claimant’s] limitations.”7 20 C.F.R. § 404.1545(1). The ALJ establishes residual
functional capacity, utilizing the impairments identified at step two, by interpretation

6

Claimant bears the burden of establishing a severe impairment that keeps her from
performing his past work. See Chester v. Bowen, 792 F. 2d 129, 131 (11th Cir. 1986).
7

In addition to this rather terse definition of residual functional capacity, the Regulations
describe how the Commissioner makes the assessment:
(3) Evidence we use to assess your residual functional capacity. We will assess your
residual functional capacity based on all of the relevant medical and other evidence.
In general, you are responsible for providing the evidence we will use to make a
finding about your residual functional capacity. (See § 404.1512(c).) However,
before we make a determination that you are not disabled, we are responsible for
developing your complete medical history, including arranging for a consultative
examination(s) if necessary, and making every reasonable effort to help you get
medical reports from your own medical sources. (See §§ 404.1512(d) through (f).)
We will consider any statements about what you can still do that have been provided
by medical sources, whether or not they are based on formal medical examinations.
(See § 404.1513.) We will also consider descriptions and observations of your
limitations from your impairment(s), including limitations that result from your
symptoms, such as pain, provided by you, your family, neighbors, friends, or other
persons. (See paragraph (e) of this section and § 404.1529.)[.]
20 C.F.R. § 404.1545(a)(3).
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of (1) the medical evidence, and (2) the claimant’s subjective complaints (generally
complaints of pain). Residual functional capacity is then used by the ALJ to make
the ultimate vocational determination required by step five.8 Often, both the medical
evidence and the accuracy of a claimant’s subjective complaints are subject to a
degree of conflict and that conflict leads, as in this case, to the points raised on
judicial review by the disappointed claimant.
ANALYSIS
As set forth above, claimant argues that the Commissioner’s decision is not
supported by substantial evidence because the ALJ failed to give sufficient weight to
the opinions of her medical providers and an examining physician and failed to
properly assess her RFC. With regard to her first assignment of error – that the ALJ
failed to give sufficient weight to the opinions of Dr. Harmon-Sheffield – plaintiff
argues that the ALJ should have given great weight to Dr. Harmon-Sheffield’s
opinions and failed to provide sufficient rationale when he declined to do so. Absent
good cause, the opinion of a claimant’s treating physician must be accorded
considerable or substantial weight by the Commissioner. Phillips v. Barnhart, 357
F.3d 1232, 1240-41 (11th Cir. 2004); Lewis v. Callahan, 125 F.3d 1436, 1440 (11th
Cir. 1997); Broughton v. Heckler, 776 F.2d 960, 960-61 (11th Cir. 1985); Jones v.
Bowen, 810 F.2d 1001, 1005 (11th Cir. 1986). “Good cause” exists when: (1) the
treating physician’s opinion was not bolstered by the evidence; (2) the evidence
supported a contrary finding; or (3) the treating physician’s opinion was conclusory

8

“Before we go from step three to step four, we assess your residual functional capacity.
(See paragraph (e) of this section.) We use this residual functional capacity assessment at both step
four and step five when we evaluate your claim at these steps.” 20 C.F.R. § 404.1520(a)(4).
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or inconsistent with the doctor’s own medical records. Phillips, 357 F.3d at 1241; see
also Lewis, 125 F.3d at 1440 (citing cases). If a treating physician’s opinion as to the
nature and severity of a claimant’s impairments is well-supported by medically
acceptable clinical and laboratory diagnostic techniques, and is not inconsistent with
other substantial evidence in the record, the ALJ is to give it controlling weight. See
20 C.F.R. § 404.1527(c)(2). Where a treating physician has merely made conclusory
statements, however, the ALJ may afford them such weight as is supported by clinical
or laboratory findings and other consistent evidence of a claimant’s impairments. See
Wheeler v. Heckler, 784 F.2d 1073, 1075 (11th Cir. 1986); see also Schnorr v.
Bowen, 816 F.2d 578, 582 (11th Cir. 1987).
The law concerning conclusory statements is particularly applied where a
doctor, even one who has treated the claimant, expresses opinions on a preprinted or
“check-off” form. Such opinion evidence will not bind the Commissioner. Indeed,
courts have found that such preprinted forms do not provide persuasive evidence of
the validity of the opinions expressed therein. See Hammersley v. Astrue, No. 5:08cv-245-Oc-10GRJ, 2009 WL 3053707, at *6 (M.D. Fla. Sept. 18, 2009) (“Check-off
forms . . . have limited probative value because they are conclusory and provide little
narrative or insight into the reasons behind the conclusions.” (citing Spencer ex rel.
Spencer v. Heckler, 765 F.2d 1090, 1094 (11th Cir. 1985); Mason v. Shalala, 994
F.2d 1058, 1065 (3d Cir. 1993))). Although such forms are admissible, “they are
entitled to little weight and do not constitute ‘substantial evidence’ on the record as
a whole.” O’Leary v. Schweiker, 710 F. 2d 1334, 1341 (8th Cir. 1983).
The ALJ gave “little weight” to Dr. Harmon-Sheffield’s opinions because he
found them unsupported by the treatment notes. T. 33. The undersigned agrees that
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Dr. Harmon-Sheffield’s opinions find little support in his treatment notes, which are
fairly unremarkable. The opinions are also conclusory in nature and expressed on
pre-printed, check-off forms and thus are entitled to little weight for that reason alone.
Accordingly, the undersigned finds no error in the ALJ’s decision to afford little
weight to the opinions of Dr. Harmon-Sheffield.
In support of her second assignment of error – that the ALJ erred by failing to
give sufficient weight to the opinions of advanced registered nurse practitioner
Crystal Breland – plaintiff makes the same argument she made regarding the opinions
of Dr. Harmon-Sheffield. The ALJ gave “little weight” to the opinions of Ms.
Breland because he found them “inconsistent with the other evidence in the record.”
T. 31. The ALJ also found that the “treatment notes from Ms. Breland’s clinic, the
Washington County Health Department, fail[ed] to reveal the type of significant
clinical and laboratory abnormalities one would expect if the claimant in fact were
disabled.” T. 31. The undersigned agrees that Ms. Breland’s opinions were entitled
to little weight. Not only are they inconsistent with and unsupported by other
evidence in the record, but like Dr. Harmon-Sheffield’s opinions, they also were
conclusory in nature and expressed on pre-printed check-off forms. Moreover, as a
nurse practitioner, Ms. Breland is not an “acceptable medical source” under the
applicable regulations and her opinions “would only be afforded weight to the extent
[they were] supported by the factors listed in 20 C.F.R. §§ 404.1527(c), and [were]
consistent with the evidence of record.” Busby v. Colvin, No. 1:13cv215/MP/GRJ,
2015 WL 333068, at *7 (N.D. Fla. Jan. 23, 2015); see also 20 C.F.R. §§ 404.1502,
404.1513(a), (d)(1); 416.902, 416.913(a)(d)(1); SSR 06-03p. The ALJ thus did not

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err in assigning little weight to Ms. Breland’s opinions.9
Turning to plaintiff’s third assignment of error – that the ALJ erred by failing
to give sufficient weight to the opinions of Dr. Joseph Siano – plaintiff argues that the
ALJ should have given great weight to those opinions of Dr. Siano favored by
plaintiff and failed to sufficiently explain his rationale for not doing so. The ALJ
gave “no weight” to Dr. Siano’s opinions, finding his examination “internally
inconsistent to a high degree” and noting the “narrative indicates the claimant has
little limitation related to her physical impairments, while the accompanying checklist
contains completely inconsistent limitations.” T. 33. Review of the record does
indeed confirm that Dr. Siano’s opinions contain significant inconsistencies and lack
support in the medical records; thus, the ALJ reasonably declined to rely on them.
Plaintiff’s fourth assignment of error – that the ALJ failed to properly assess
her mental RFC – likewise lacks merit. In support of her position, plaintiff argues
that the ALJ erroneously failed to express her pain in terms of work-related functions.
Contrary to plaintiff’s assertions, however, the ALJ plainly considered plaintiff’s
alleged mental impairment and found no significant mental work-related limitations.
T. 23-25. As the ALJ noted, plaintiff received no specialized mental health treatment
during the relevant period and had no history of inpatient psychiatric admissions or
suicide attempts. T. 414-15. Rather, plaintiff’s psychiatric treatment consisted of

9

Plaintiff cites Jackson v. Astrue, Case No. 8:06-CV-1631T26TBM, 2007 WL 2428815, at
*5 (M.D. Fla. Aug. 17, 2007), for the proposition that an ALJ errs when failing to state with
particularity the weight accorded opinions of treating practitioners in determining a claimant’s RFC.
That case is not controlling and is distinguishable because, there, the ALJ “did not discount” either
of the opinions at issue. Id. Here, the ALJ specifically considered – and expressly rejected – the
opinions at issue, explaining the weight assigned he assigned to them and the reasons for his decision
in that regard.
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medications prescribed by her primary care physician. T. 414-15. Plaintiff’s
examinations revealed no psychiatric impediments to working, as plaintiff was
consistently alert, oriented, cooperative, had a normal affect and speech, and was able
to answer questions and follow commands, although she was non-compliant with
directives regarding her medication. T. 399, 401, 403-04, 407-08, 422, 454, 458-59,
463, 483, 485, 488, 507, 509-10, 513, 588, 590-91, 593-95, 598-602, 606, 609, 612,
638-39. Plaintiff had adequate grooming and hygiene, maintained normal eye contact
and responsive facial expressions, had “distractible” attention, a normal memory, and
normal orientation.

T. 414-16.

She had anxiety that interfered with her

concentration, but she exhibited a cooperative attitude, full range and appropriate
affect, normal speech flow, appropriate thought content, average intelligence, average
fund of knowledge, concrete abstraction, commonsense judgment, normal social
judgment, and no signs of delusions. T. 415-16. Dr. Horvat, an examining
psychologist, assigned plaintiff a GAF of 65, indicating only mild symptoms and/or
functional limitations, and opined that she had no mental work-related restrictions.
T. 416-17. Reviewing state agency mental health expert Dr. Conger opined that
plaintiff’s anxiety disorder did not restrict her ability to perform activities of daily
living; mildly limited her ability to maintain social functioning; mildly limited her
ability to maintain concentration, persistence, or pace; and caused no episodes of
decompensation of extended duration. T. 444. According to Dr. Conger, plaintiff’s
anxiety disorder was not severe. T. 434. In short, the ALJ did consider plaintiff’s
mental condition and found a lack of reliable evidence that plaintiff had any

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significant mental work-related restrictions, whether caused by pain or otherwise.10
Even if the ALJ had failed to consider plaintiff’s mental restrictions, there is no
indication that the ALJ’s decision would have been different had he considered them.
Indeed, the ALJ found plaintiff capable of only unskilled work, which imposes little
mental demand.
ACCORDINGLY, it is ORDERED:
1.

The decision of the Commissioner is AFFIRMED and plaintiff’s

applications for Disability Insurance Benefits and Supplemental Security Income are
DENIED.
2. The clerk is directed to close the file.
DONE AND ORDERED this 5th day of March, 2015.

/s/

Charles J. Kahn, Jr.

CHARLES J. KAHN, JR.
UNITED STATES MAGISTRATE JUDGE

10

To the extent that Dr. Harmon-Sheffield or Ms. Breland found otherwise, the ALJ acted
within his discretion in refusing to credit their findings.
Case No. 5:13cv394/CJK