United States District Court, M.D. Florida, Jacksonville Division
Patricia D. Barksdale, United States Magistrate Judge
Jane Bohannon Royal brings this action under 42 U.S.C.
§§ 405(g) and 1383(c)(3) to review a final decision
of the Commissioner of Social Security denying her
applications for benefits. Doc. 1. Under review is a decision
by an Administrative Law Judge (“ALJ”) dated
August 24, 2017. Tr. 15–30. Summaries of the law and
the administrative record are in the ALJ’s decision,
Tr. 15–30, and the parties’ briefs, Docs. 17, 18,
and not fully repeated here.
reviews the Commissioner’s factual findings for
substantial evidence. 42 U.S.C. § 405(g).
“[W]hatever the meaning of ‘substantial’ in
other contexts, the threshold for such evidentiary
sufficiency is not high.” Biestek v.
Berryhill, 139 S.Ct. 1148, 1154 (2019). “It
means-and means only-such relevant evidence as a reasonable
mind might accept as adequate to support a conclusion.”
Id. (internal quotation marks and quoted authority
omitted). A court may not decide facts anew, reweigh
evidence, make credibility determinations, or substitute its
judgment for the Commissioner’s judgment. Moore v.
Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). If
substantial evidence supports an ALJ’s decision, a
court must affirm even if other evidence preponderates
against the factual findings. Martin v. Sullivan,
894 F.2d 1520, 1529 (11th Cir. 1990). “This restrictive
standard of review applies only to findings of fact, ”
and “no similar presumption of validity attaches to the
[Commissioner’s] conclusions of law[.]” Brown
v. Sullivan, 921 F.2d 1233, 1236 (11th Cir. 1991)
(quoted authority omitted).
argues the ALJ erred in assessing opinions of Raymond Pomm,
M.D., and Advanced Registered Nurse Practitioner
(“ARNP”) Daphne Hayes, treatment providers at
River Regions Human Services, Inc. (“River
Regions”). Doc. 17 at 16–21.
Social Security Administration (“SSA”) evaluates
every medical opinion it receives. 20 C.F.R. §§
404.1527(c), 416.927(c) (2012). A “medical opinion”
is a statement from an “acceptable medical
source” that reflects judgment about the nature and
severity of a claimant’s impairment. Id.
§§ 404.1527(a)(2), 416.927(a)(2) (2012). An
“acceptable medical source” is a licensed
physician, licensed or certified psychologist, licensed
optometrist, licensed podiatrist, and qualified
speech-language pathologist. Id. §§
404.1513(a), 416.913(a) (2013). An ALJ must state with
particularity the weight given to each medical opinion and
the reasons for the weight. Winschel v. Comm’r of
Soc. Sec., 631 F.3d 1176, 1179 (11th Cir. 2011).
determine the severity of an impairment and how it affects a
claimant’s ability to work, the SSA may use evidence
from sources that are not acceptable medical sources. 20
C.F.R. §§ 404.1513(d), 416.913(d) (2012). Other
sources include nurse practitioners. Id.
§§ 404.1513(d)(1), 416.913(d)(1) (2013).
“Since there is a requirement to consider all relevant
evidence … the case record should reflect the
consideration of opinions from medical sources who are not
‘acceptable medical sources[.’]” Social
Security Ruling 06-03p, 2006 WL 2263437 (Aug. 9,
2006). “[T]he adjudicator generally should
explain the weight given to opinions from these ‘other
sources, ’ or otherwise ensure that the discussion of
the evidence in the determination or decision allows a
claimant or subsequent reviewer to follow the
adjudicator’s reasoning, when such opinions may have an
effect on the outcome of the case.” Id.
March 21, 2017, ARNP Hayes completed and signed a
“Mental Capacity Assessment” form. Tr.
635–37. She checked boxes indicating Royal has marked
limitations in twelve areas (including limitations in
the categories of “Understanding & Memory, ”
“Sustained Concentration & Persistence, ”
“Social Interaction, ” and
“Adaptation”). Tr. 365–37. She checked
boxes indicating Royal has extreme limitations in three areas
(including limitations in the categories of “Sustained
Concentration & Persistence” and
“Adaptation”). Tr. 365–37. She checked a
box indicating Royal likely would have four or more absences
in an average month. Tr. 636. The record includes another
copy of this form. Tr. 666–68. It is identical to the
first form, except it also includes a signature for Dr. Pomm.
decision, the ALJ gave “no weight” to the mental
capacity assessments by ARNP Hayes and Dr. Pomm, explaining:
The 2017 mental capacity assessments completed by ARNP Daphne
Hayes and a treating psychiatrist, Dr. Pomm, are given no
weight as they are clearly unsupported by the totality of
these medical records and statements made by the claimant to
other medical providers that her depression is under control.
Her presentations in front of her other medical providers do
not demonstrate the kind of marked and extreme limitations
that are suggested in these mental health opinions. Indeed,
it does not appear that she was even seen by this
psychiatrist on a regular basis and she did not recognize his
name when asked at the hearing on this matter. Most of the
office visits that are documented were handled by Daphne
Hayes, ARNP. The records show that ARNP Hayes usually spent
15 to 20 minutes with the claimant, which is indicative of
medication management and not any psychotherapy. The
claimant’s limitation to occasional to frequent contact
with others [in the residual functional capacity
(“RFC”) assessment)] address her allegations of
problems being around others that she claimed at the hearing
and there are no other mental impairments noted or supported
by this record.
Tr. 24 (internal citation omitted).
did not have to give ARNP Hayes’s opinion deference
because she is not an “acceptable medical
source.” 20 C.F.R. §§ 404.1513(a), 416.913(a)
(2013). Instead, he only had to consider her opinion and
generally explain the weight given to it or otherwise ensure
that his discussion would allow Royal or a reviewer to follow
his reasoning. See SSR 06-03p, 2006 WL 2263437. The
ALJ did so. Tr. 24.
evidence supports the ALJ’s findings regarding ARNP
Hayes’s opinion. The record shows only four visits with
ARNP Hayes, all of which were labeled “medication
management” visits and none of which lasted longer than
35 minutes. Tr. 645, 647, 650, 653. As summarized in the
ALJ’s decision, the record is replete with notations
contemporaneous with ARNP Hayes’s treatment of Royal
showing a lack of mental health symptoms consistent with the
marked and extreme limitations in ARNP Hayes’s opinion.
See, e.g. Tr. 463–64, 480–81,
484–85, 488, 492–93, 496, 500–01,
504–05, 512, 516, 521, 529–30, 533, 537–38,
540–42, 545–46, 549–50, 553– 54,
556–56, 561–62 (treatment notes from ARNP Faith
Snyder showing Royal was “[a]lert and oriented
x3” and had grossly normal mental status exams, as well
as normal affect and judgment despite complaints of anxiety
and depression that occasionally improved and occasionally
worsened); Tr. 606–07 (“Brief Behavioral Health
Status Exam” from River Regions with indecipherable
signature showing normal mental status exam, including
appropriate dress, realistic insight, good judgment, rational
thought processes, normal speech, and normal mood and
affect); Tr. 610 (“Assessment Rating Report” from
counselor Amy Ros at River Regions rating depression and
anxiety as “moderate” problems, a “less
than slight problem” with interpersonal relations, and
no problem with functioning in activities of daily living);
Tr. 653 (medication management note from ARNP Hayes providing
a normal mental status exam, including regular speech,
euthymic mood, thought content within normal limits, adequate
judgment and insight despite reports of family discord and
back pain); Tr. 654 (treatment note from Ros rating
depression as “slight to moderate” problem and
anxiety as “moderate” problem and noting
“no problem” with activities of daily living);
Tr. 661–62 (treatment note from Ros finding
“General Functioning/Social Adjustment” and
“Daily Living Skills/Self-Care” to be
“acceptable/within normal limits” and indicating
a normal mental status exam except for a saddened affect and
a dysphoric and anxious mood); Tr. 647 (treatment note from
ARNP Hayes showing normal mental status exam except for
contends the ALJ erred in finding ARNP Hayes saw Royal
briefly and only for medication management because the record
shows Royal’s treatment plan included hourly sessions
once a month for six months with ARNP Hayes and Royal
testified she was, at the time, seeing ARNP Hayes for therapy
an hour every two months. Doc. 17 at 17 (citing Tr. 66, 450).
The question is not, however, whether evidence could have
supported a finding that Royal saw ARNP Hayes for hourly
therapy sessions; it is whether substantial evidence supports
the ALJ’s finding that Royal saw ARNP Hayes only for
relatively brief medication management sessions. See
Martin, 894 F.2d at 829. As explained, it does. To the
extent Royal complains about the ALJ’s failure to
credit her testimony that she was seeing ARNP Hayes for an
hour every two months for therapy, the ALJ found
Royal’s testimony “not entirely consistent with
the medical evidence and other evidence in this record,
” Tr. 20, and Royal has not challenged that finding.
also contends the ALJ erred in finding ARNP Hayes’s
opinions unsupported by the totality of the medical records
because treatment providers and the state agency reviewing
physician diagnosed Royal with depression and anxiety and
because observations in notes from treatment providers are
consistent with and support ARNP Hayes’s opinion. Doc.
17 at 19–21. Royal points to portions of treatment
records from ARNP Hayes; Parveen Khanna, M.D.; Sriramulu
Aprameya, M.D.; William Hunt, M.D.; ARNP Faith ...