Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca11-23-12765/USCOURTS-ca11-23-12765-0/pdf.json

Parties Involved:
Commissioner, Social Security Administration
Appellee
David B. Watkins
Appellant

Document Text:

[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 23-12765

____________________

DAVID B. WATKINS, 

Plaintiff-Appellant,

versus

COMMISSIONER, SOCIAL SECURITY ADMINISTRATION, 

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Middle District of Florida

D.C. Docket No. 8:22-cv-00794-VMC-MRM

____________________

Before BRANCH, LUCK, and LAGOA, Circuit Judges.

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2 Opinion of the Court 23-12765

PER CURIAM:

David Watkins appeals the district court’s order affirming 

the Social Security Administration (“SSA”) Commissioner’s 

decision denying his application for disability insurance benefits 

(“DIB”) under 42 U.S.C. § 405(g). He argues that (1) the ALJ erred 

in weighing the medical opinion evidence; (2) the ALJ erred in 

weighing his subjective complaints; and (3) the ALJ erred in 

determining his residual functional capacity (“RFC”). After careful 

review, we affirm.

I . Background 

A. Procedural History Leading Up To The Decision On 

Review

In October 2012, Watkins, then age 57, applied for DIB with 

a disability onset date of March 24, 2012.1 He alleged that (1) he 

was ultimately terminated from his job as a chemical engineer 

because of disabling anxiety and major depression, and (2) he was 

no longer able to work because of those conditions. Watkins 

indicated in his self-prepared function report that his depression 

and anxiety affected “all facets” of his life and caused problems with 

concentration, focus, memory, and understanding and following 

instructions; caused frequent absences from work; caused crying, 

worries, constant fears, problems sleeping, and social withdrawal; 

impaired his ability to “communicate thoughts properly”; and at 

1 Watkins was represented by counsel throughout all stages of the underlying 

agency proceedings and in the proceedings that followed in the district court.

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times caused problems with personal care and grooming and the 

need for reminders to take medications or do certain tasks. He 

alleged that he was a “shut in” and did not have any interest in 

going out. When he needed to, however, he could drive and go 

out alone, and he regularly left the house for appointments and to 

shop for necessities. 

After an independent review of the application and 

supporting materials by agency consultants, the Social Security 

Administration denied Watkins’s application at the initial stage and 

on reconsideration. Watkins then requested and received a 

hearing before an administrative law judge (“ALJ”). The ALJ 

denied Watkins’s application on August 28, 2014, finding Watkins 

not disabled. Watkins requested review of the ALJ’s decision by 

the Appeals Council, but the Appeals Council denied the request. 

Thereafter, Watkins filed a complaint in the district court, 

arguing, in relevant part, that the ALJ failed to properly weigh the 

medical opinion evidence. A magistrate judge agreed, concluding 

that the ALJ had failed to support with substantial evidence his 

rejection of Watkins’s treating physician’s opinion. Accordingly, 

the magistrate judge reversed the decision of the Commissioner 

and remanded the claim for further proceedings on September 27, 

2017.2 The Appeals Council then remanded the claim to a new ALJ 

2 Watkins consented to a magistrate judge presiding over the case instead of a 

district court judge. 

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for a new hearing and decision. The new hearing took place on 

September 11, 2019. 

B. Testimony from the Second Hearing

Watkins testified that he was 64 years’ old. Between 2012 

and 2017 (the relevant time frame for his disability benefits),3 he 

experienced depression and anxiety, leading him to become 

homeless and unable to work. He was admitted into a residential 

rehabilitation program through the Department of Veterans 

Affairs (“VA”), where he stayed for approximately seven months. 

He admitted that he also had an alcohol abuse problem prior to 

losing his job, and he voluntarily participated in a 90-day rehab 

program. He stated that he was drinking heavily “up until [he] lost 

[his] job.” Since rehab, however, he has “had a couple of beers here 

and there in 2014 on the 4th of July.” Doctors considered him “an 

alcoholic by their standards,” but he did not consider himself to be 

one. He stated that he was not drinking anymore. 

Watkins testified that he most recently worked in several 

engineering roles for a chemical plant—he started as an electrical 

engineer; then he transitioned to a scheduling engineer; he then 

moved up to being the “master scheduler” in charge of 

coordinating employee, contractor, equipment, and tool 

3 Disability insurance benefits may not be paid unless the claimant was 

disabled while he met the insured status requirements of 42 U.S.C. § 423(c). 

See 42 U.S.C. § 423(a)(1)(A). Thus, the ALJ in this case examined whether 

Watkins was disabled between his alleged onset date of March 2012 and his 

date last insured of December 31, 2017. 

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schedules; and finally he was a process safety engineer in charge of 

ensuring “everything was up to code.”4 He called out “sick a lot 

because of [his] anxiety and [his] depression,” and self-medicated

with alcohol. Although Watkins was no longer drinking presently, 

his anxiety and depression were worse. 

Watkins explained that he had always struggled with anxiety 

and depression, but as he got older, he was unable to maintain the 

“mask” needed to keep working and no longer had the energy to 

fight off his fears and depression. He had been on benzodiazepines 

for 20 years off and on. However, those types of medications

would work for only a short time and ultimately caused him more 

depression and anxiety. He had also tried various anti-depressants, 

but none of them worked. He explained that he was hospitalized 

once for a panic attack, but he had since learned to recognize that 

a panic attack is not a heart attack, and that if the symptoms 

subside, he does not need to go to the hospital. He explained that

his anxiety and his medications made it difficult to focus because of

constant racing thoughts. He explained that his depression comes 

in cycles approximately three times each year and lasts for a period 

of several weeks to several months. Watkins confirmed that he 

had never attempted suicide and had not had suicidal thoughts 

since 2012. 

A vocational expert (“VE”) then testified that Watkins’s 

4 He testified that prior to his employment at the chemical plant, he had 

previous quality control engineering jobs with other companies, but he lost 

those jobs because of his anxiety and depression. 

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prior vocations were classified as light, skilled work. The VE 

opined that a hypothetical individual “limited to understanding and 

carrying out no more than simple, routine, repetitive, unskilled 

tasks” could not perform Watkins’s past relevant work. The ALJ 

then asked whether there were any jobs in the national economy 

that a hypothetical individual, approaching retirement age, with 

Watkins’s level of education could perform, where such an 

individual was “limited to medium level of exertion,” with various 

limitations including no climbing; no heights; avoidance of 

extreme temperatures; no operation of heavy machinery; and 

“limited to understanding and carrying out simple, routine, 

repetitive, unskilled tasks, with the ability to make only basic 

decisions and adjust to simple changes in a work setting, with 

interaction with others, including the general public, co-workers, 

and supervisors limited to occasional.” The VE testified that such 

a person would be able to work as a hand packager, a warehouse 

worker, or a cook’s helper, and that all of these positions were 

available in the national economy. 

The VE then testified that the same hypothetical individual 

would not be able to work any of those jobs if he would be off task 

15 percent of the time and absent from work two to three times a 

month. On further examination by Watkins’s counsel, the VE 

explained that “the baseline tolerance for time off task” at a given 

job is largely dependent on the employer, but ranges from 3 to 8 

percent. He further opined that an individual who required 

frequent supervision, “meaning up to two-thirds of the workday,” 

would likely not be able to maintain gainful employment in the 

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previous roles that the VE identified. 

C. The Relevant Medical Evidence

In addition to the testimony provided at the second hearing

before the ALJ, the relevant medical evidence included the 

following. On March 25, 2012, Watkins admitted himself to Palm 

Partners, LLC for treatment for alcohol dependency, noting that 

he had relapsed.5 At that time, he reported symptoms of insomnia, 

sweating, tremors, and that he had been suffering depression for 

the last 20 years. Watkins reported taking prescribed medications 

for anxiety, depression, and ADHD. The notes from his admission 

indicate that Watkins had a “neat/clean” appearance and was alert 

and oriented with normal speech patterns and affect. His thought 

process was logical and coherent, his short- and long-term memory 

were normal, and he was cooperative and attentive, but his 

judgment was impaired. The evaluation indicated that he had 

“severe” stressors in his life, including “[p]roblems with [p]rimary 

[s]upport,” “[p]roblems related to social environment,” and 

“[e]conomic problems.” He completed a detox program at Palm 

Partners. 

Watkins saw a general practitioner several times between 

June and July 2012 for depression and anxiety and adjustments of 

medications. He reported a concern that he was having a bad 

reaction to Seroquel, one of the depression medications that he had 

5 Records revealed that Watkins had completed a prior treatment program at 

Palm Partners for alcohol and benzodiazepine dependency in 2011. 

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been prescribed while at Palm Partners; difficulties with memory,

sleep, and concentration; and feeling depressed with intermittent 

severe episodes of anxiety. Nevertheless, activities of daily living

(“ADLs”) were normal as were his physical exams. He also denied 

suicidal ideation or any history of attempts. His doctor 

discontinued some medications and adjusted others. Watkins 

noted minor improvement with the medication adjustments at his 

visits in July 2012, and he noted that he had a pending appointment 

with a psychiatrist, Dr. Carroll. His doctor recommended that 

Watkins “stay off work at least until he [was] able to see 

psychiatrist.” 

Watkins first saw Dr. Carroll on August 14, 2012. At that 

time, Watkins indicated that he was employed but currently on 

short term disability through the end of September. He indicated 

that he did not “feel ready to return to work” and was “working to 

roll into [long term disability].” He reported no incidents of 

suicidal or homicidal ideation or risk of self-harm. Dr. Carroll 

noted that Watkins’s appearance was “disheveled”; his 

psychomotor function “restless”; his affect “tearful/sad” and 

anxious; and his mood depressed and anxious. But his judgment 

was logical and his thought process organized and relevant, and he 

was completely oriented with appropriate insight. She diagnosed 

him with alcohol dependence, major depressive disorder (severe), 

and generalized anxiety disorder. She discontinued some 

medications and began others and requested to see him again in 

three to four weeks. 

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Dr. Carroll saw Watkins again for a follow-up on September 

6, 2012. Watkins reported that he could not take one of the 

prescribed depression medications due to side effects, and she again 

adjusted his medication regime. At this visit, she documented that 

he had a normal appearance and was fully alert and oriented and 

cooperative, with clear and coherent speech, but his speech was 

slow and he exhibited retardation of psychomotor function. 

Additionally, his mood was “terrible,” and he exhibited an anxious 

affect. His memory and concentration were impaired, and his 

judgment was poor. 

Following the September 6, 2012 visit, Dr. Carroll 

completed a narrative report statement. In this statement, she 

indicated that Watkins reported prior diagnoses of, and treatment 

for, major depressive disorder, generalized anxiety disorder, and 

alcohol dependence. He had been placed on short-term disability 

“due to the severity of his symptoms.” He frequently selfmedicated with alcohol and had “experienced severe depressive 

episodes, agitation, extreme isolation, suicidal thoughts[,] and 

paralyzing anxiety attacks” over the previous two years. These 

symptoms often interfered with his ability to perform ADLs. He 

experienced the most severe symptoms during times “when he 

[was] trying to maintain employment or [was] under an inordinate 

amount of stress.” Watkins reported that his employment was “a 

large source of stress” and he felt “incapable of returning to the 

work place.” 

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Watkins saw Dr. Carroll approximately a month later for 

continuing symptoms of anxiety and depression. Watkins 

indicated during this visit that his request for long term disability 

had been denied and that he intended to apply for DIB. Dr. Carroll 

documented his appearance as normal with good eye contact and 

normal motor function. He was cooperative with logical and 

organized thoughts, and alert and fully oriented with clear and 

coherent speech. But he reported being anxious and depressed and 

Dr. Carroll documented that he had a “constricted” affect, and his 

memory and concentration were impaired. Watkins’s judgment 

improved from “poor” to “fair.” Dr. Carroll again adjusted his 

medications. 

In November 2012, Dr. Carroll completed a 

“psychiatric/psychological impairment questionnaire” in relation 

to Watkins’s application for DIB benefits. She indicated that 

Watkins suffered from alcohol dependency, major depression, and 

generalized anxiety disorder. She asserted that these diagnoses 

were supported by the following clinical findings: “poor memory”; 

“appetite disturbance with weight change”; “sleep disturbance”; 

“mood disturbance”; “social withdrawal or isolation”; “substance 

dependence”; “anhedonia or pervasive loss of interests”; 

“generalized persistent anxiety”; and “feelings of 

guilt/worthlessness.” She listed Watkins’s primary symptoms as: 

“(1) continued alcohol use”; “(2) depressed mood, fatigue, poor 

cognitive function”; and “(3) persistent generalized anxiety.” 

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Based on Watkins’s diagnoses and symptoms, Dr. Carroll 

opined that Watkins’s ability to understand and remember “worklike procedures” and “one or two step instructions” would be 

“moderately limited” as would be his ability to carry out such 

instructions. Relatedly, Watkins’s ability to understand,

remember, and carry out detailed instructions as well as his ability 

to maintain concentration for extended periods of time and 

maintain regular attendance and punctuality were “markedly 

limited.” Similarly, she opined that Watkins’s “ability to make 

simple work related decisions” and to complete a normal 

workweek without experiencing disruptions due to his 

psychological symptoms was “markedly limited.” 

Dr. Carroll also found that Watkins’s symptoms 

“moderately limited” his ability to interact with the general public 

and his coworkers and to adapt to changes in the workplace. 

Additionally, Dr. Carroll indicated that his ability to be aware of 

hazards in the workplace and respond appropriately, his ability to 

travel, and his ability to set realistic goals and plan independently 

were only “mildly limited.” Dr. Carroll noted that she was unable 

to comment on Watkins’s ability to “tolerate work stress” because 

Watkins had not worked since she began treating him. She 

acknowledged that Watkins had good days and bad days, but she 

estimated that he would likely be absent from work “more than 

three times a month” due to his conditions. Finally, Dr. Carroll

noted that Watkins “need[ed] to work to attain [and] maintain 

sobriety in order to see improvement in his mood and anxiety 

symptoms. Planning to start behavioral therapy[.]” 

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Watkins saw Dr. Carroll again on December 5, 2012, 

throughout 2013,6 and multiple times between January and May 

2014.7 At times Watkins indicated his was doing better and at other 

times worse, and he frequently requested changes to his 

medications during these visits or expressed concerns with side 

effects of current medications, and Dr. Carroll frequently adjusted 

his medications. Dr. Carroll’s observations of Watkins during 

these periods indicated appropriate grooming; fair to good eye 

contact; a cooperative attitude; logical and organized thought 

processes; alertness and proper orientation; occasional retardation

of psychomotor function, but unremarkable (i.e., normal function)

the majority of the visits; an abnormal mood and affect; clear and 

coherent but occasionally slow and soft speech; fair judgment; fair 

insight; low risk of self-harm or violence against others; no suicidal 

ideation; and impaired or poor memory and concentration. Her 

notes continuously indicated that Watkins needed to focus on 

maintaining sobriety. 

In June 2014, Dr. Carroll completed a narrative statement 

summarizing Watkins’s diagnoses, symptoms, and functional 

capacity. Her summary was virtually identical to the answers she 

provided in the November 2012 medical source statement. 

6 In 2013, Watkins saw Dr. Carroll on March 13, May 7, June 13, July 8, August 

12, September 30, October 27, November 25, and December 30. 

7 In 2014, Watkins saw Dr. Carroll on January 9, January 28, February 28, April 

7, April 30, and May 28. 

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Around this same time, Watkins’s counsel referred him for 

a psychological evaluation by Dr. Benjamin Cohen in support of 

his DIB application. Dr. Cohen evaluated Watkins by conducting 

a clinical interview and a mental status examination, reviewing 

Watkins’s treatment records from Dr. Carroll, and administering 

certain tests. Dr. Cohen’s mental status observations of Watkins 

during the evaluation included that Watkins appeared well 

groomed; was punctual; made good eye contact; had a depressed 

mood with congruent, tearful affect; had normal speech; had goaloriented thought processes; was alert and oriented to time, place, 

and situation; had average concentration and attention span; and 

had fair insight and judgment. Watkins denied suicide attempts

and ideation, but reported nervousness, memory problems, poor 

appetite, loneliness, insomnia, feelings of guilt and worthlessness, 

and chronic worry since childhood. Watkins was able to complete 

simple arithmetic in his head, spell a given word backwards and 

forwards, and “was able to complete serial 3’s from 20 with one 

mistake.” Dr. Cohen indicated that Watkins’s fund of knowledge 

was fair, he was of average intelligence, and his memory was below 

average, but not impaired. Based on his review, Dr. Cohen opined 

in his evaluation summary and recommendations that Watkins’s 

“psychological symptoms would cause mild impairment in his 

ability to perform work-related mental activities (i.e., 

concentration and memory) and moderate to severe impairment 

in his ability to socialize and adapt at work.” Further, “he would 

be at moderate risk for psychological decompensation in the future 

if subjected to job-related stressors.” 

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Dr. Cohen then completed a medical source statement, 

identifying the following symptoms as supporting Watkins’s 

diagnoses: (1) blunt affect; (2) emotional lability; (3) feelings of guilt 

or worthlessness; (4) suicidal ideation; (5) difficulty thinking or 

concentrating; (6) generalized anxiety; (7) pervasive loss of 

interests; (8) appetite disturbances/weight change; (9) fatigue; 

(10) pathological dependence; (11) psychomotor retardation; 

(12) social isolation/withdrawal; and (13) insomnia. He also noted 

that Watkins reported “bouts of depression that last[ed] for several 

weeks.” And Dr. Cohen opined that Watkins had 

“moderate‐to‐marked” limitations in his ability to: (1) perform at a 

consistent pace; (2) accept instructions and respond appropriately 

to criticism from supervisors; (3) get along with coworkers or peers 

without distracting them; (4) set realistic goals; and (5) make plans 

independently. Dr. Cohen also opined that Watkins had 

“moderate” limitations in his ability to: (1) remember locations and

work‐like procedures; (2) understand and remember detailed 

instructions; (3) carry out detailed instructions; (4) maintain 

attention and concentration for extended periods; (5) perform 

activities within a schedule and consistently be punctual; (6) sustain

an ordinary routine without supervision; (7) work with or near 

others without being distracted; (8) ask simple questions or request 

assistance; and (9) respond appropriately to workplace changes. 

Dr. Cohen estimated that Watkins would be absent from work

more than three times per month as a result of his symptoms. 

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Dr. Carroll continued to treat Watkins throughout 2014 and

2015.8 On February 9, 2015, Dr. Carroll prepared a narrative report

in support of Watkins’s request for reconsideration of the initial 

denial of his application for DIB benefits. Dr. Carroll stated that, 

over the previous five years, Watkins “experienced severe 

depressive episodes, agitation, extreme isolation, suicidal thoughts 

and paralyzing anxiety attacks at varying intervals.” She indicated 

that “[h]is most severe episodes” were triggered when he faced

“interpersonal stressors,” such as when his brother almost died due 

to a medical emergency. She maintained that Watkins struggled 

to perform ADLs due to his symptoms, and he felt “incapable of 

returning to the work place.” Dr. Carroll agreed that Watkins 

“[was] not capable of maintaining a 40 hour work week” due to his 

poor coping skills. She noted that “[a]lthough he [had] been able 

to function well at most visits with [her], he [had] spiraled and 

struggled significantly over the past year. . . . finding it harder and 

8 Although the record contains no notes from office visits between May 2014 

and July 2015, Dr. Carroll’s lengthy medication record for Watkins contains 

entries during that time period. Therefore, it is clear that she treated Watkins 

during that time frame. Office visit notes are available for July through 

October 2015. As with prior visits, Watkins frequently expressed concerns 

with his medications during these visits, and Dr. Carroll adjusted his 

medications in response. Additionally, as with prior visits, Dr. Carroll’s 

observations of Watkins during these periods indicated appropriate grooming; 

fair to good eye contact; a cooperative attitude; logical and organized thought 

processes; alert and fully oriented; retardation of motor function; an abnormal 

mood and affect; clear and coherent but occasionally slow and soft speech; fair 

or poor judgment; no suicidal ideation; low risk of self-harm or violence 

against others; and impaired memory and concentration. 

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harder to cope with life.” She maintained that his “prognosis for 

recovery [was] poor to guarded.” 

In May 2015, Dr. Carroll completed another medical source

(“mental impairment questionnaire”) statement. She checked 

many of the same signs and symptoms that supported Watkins’s 

diagnoses as she did in the November 2012 medical source 

statement. However, this time, she also indicated that Watkins 

had “suicidal ideation,” “past suicide attempt(s),” “impulsive or 

damaging behavior,” “intense and unstable interpersonal 

relationships,” and agitated psychomotor function (but not

retardation of psychomotor function). She further indicated that 

Watkins was markedly limited in many areas of function. 

Watkins also received treatment from the VA intermittently 

between 2012 and 2017. In notes from the VA regarding a visit on 

December 21, 2012, Watkins reported that his anxiety and 

depression were “getting better but [he] tend[ed] to have issues 

making new friends.” He stated he recently visited his brother and 

“felt as good as he[’]s ever felt.” He also “felt improvement with 

his Xanax and he [was] now able to engage in conversations with 

people and [had] [a] []positive point of view on life.” Progress notes 

from a June 2013 visit indicated that Watkins stated “he [had] been 

doing well” and that he was following an exercise regimen to help 

work out his anxiety. 

On June 6, 2014, Watkins saw a doctor at the VA for another 

matter and reported increased depression since the death of his 

father. He reported experiencing depressed mood, loss of interest, 

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and decreased appetite. He also stated that he was not currently 

taking any anti-depressants and did not want to take any because 

of the side effects; instead, he took only Xanax. Five days later, 

Watkins went to the VA hospital emergency room due to heart 

palpitations following two panic attacks and his consumption of 

two “airline bottles” of alcohol. He also reported experiencing 

severe depression. At a follow-up the next day, Watkins reported 

struggling with recent bouts of depression and daily panic attacks 

due to the passing of his father and his brother’s health issues. He 

also reported feeling overwhelmed with paperwork related to his 

DIB application and experiencing sleep issues. He denied any 

suicidal ideation or history of suicide attempts. He also denied 

experiencing “decreased concentration, interest, energy, appetite, 

feelings of guilt, helplessness, or hopelessness.” According to the 

notes, Watkins appeared “well groomed” with good eye contact; 

“no psychomotor retardation/agitation”; alert and fully oriented; 

normal speech pattern; logical and organized thought process; 

“grossly intact” recent and long-term memory; and adequate 

attention and concentration. 

On April 13, 2015, Watkins requested admission to a 

treatment program at the VA, reporting that he was not doing well, 

was “dangerously close to drinking again,” and that he was 

experiencing worsening anxiety and depression symptoms due to 

ineffective medications and his brother’s recent hospitalization. 

He denied any suicidal ideation or attempts. As with prior visits, 

Watkins’s mental status exam indicated that he appeared wellgroomed, made good eye contact, was cooperative, and had 

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organized thoughts. His mood was congruent, and he was 

properly oriented to time and place. “All memory functions 

appear[ed] to be grossly intact.” It was recommended that he 

participate in an outpatient substance abuse recovery program.9 

In a September 2015 psychiatric evaluation by the VA, 

Watkins reported experiencing depressed mood, loss of interest, 

sleep issues, feelings of worthlessness and guilt, and problems with 

concentration. He also reported some suicidal ideation stating that 

in June 2015 he had thoughts of “driving [his] motorcycle out to 

the desert and letting [himself] starve to death,” but he denied any 

current ideation and denied any history of attempts. His mental 

status exam indicated a depressed, anxious mood with congruent 

affect; clear, normal speech; good grooming; good eye contact;

alertness; and no psychomotor retardation or agitation. 

In November 2015, Watkins reported feeling hopeless and 

depressed, but denied any suicidal ideation. He indicated he was 

“ok,” but that he needed more therapy, assistance with substance 

abuse, and housing. He reported a life-long history of depression 

problems that “last days and weeks on end,” during which he 

experienced “sadness, anhedonia, weight gain, sleep 

disturbance . . . , low energy, feelings of worthlessness and guilt, 

and concentration problems.” However, his recent symptoms had 

not been “as intense” as in the past. He “adamantly denie[d] any 

suicidal . . . ideation[].” His mental status exam indicated “no acute 

9 It does not appear that Watkins participated in the program. 

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distress”; good eye contact; a pleasant, well-groomed appearance; 

normal psychomotor function; normal speech; “grossly intact” 

memory and concentration; no suicidal ideation; and constricted 

affect and depressed mood.10 

At a follow-up on January 22, 2016, Watkins reported a 

stable mood and mild improvement in his depression and anxiety 

symptoms due to new medications, but he expressed concerns 

about stressors surrounding the sale of his trailer and his future 

housing options given his lack of financial resources. And at a visit 

on February 8, 2016, Watkins reported that he was adjusting his 

medications as part of his treatment program, and he stated he had 

a stable mood and “denie[d] any significant depressive symptoms 

at [that] time.” His mental status exam indicated “no acute 

distress”; good eye contact; a pleasant, well-groomed appearance; 

normal psychomotor function; normal speech; “grossly intact” 

memory and concentration; no suicidal ideation; and constricted 

affect and self-reported “okay” mood. 

In the spring of 2017, Watkins entered a residential 

rehabilitation program through the VA. He was diagnosed with

benzodiazepine dependence and provided with many forms of 

treatment and counseling. He was discharged to a transitional 

housing program in October 2017, at which time he indicated the 

10 In December 2015, Watkins reached out to the VA seeking help with 

obtaining employment. 

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program had helped him develop and implement coping skills, 

“work on managing anxiety,” and maintain sobriety. 

VA records from multiple encounters in August, September, 

October, November, and December 2017 indicate that Watkins 

was stable, participating in the VA’s therapy programs, seeking 

advice on obtaining employment, and applying for jobs. He denied 

any current struggles with alcohol or suicidal ideation. He 

reported overall improvement in his moods but continued anxiety 

and panic attacks, and at times still reported depression, loss of 

interest, racing thoughts, and insomnia. 

Lastly, Watkins presented evidence that in October 2017 he 

complained of neck pain, which had been worsening over the prior 

four months. An MRI study revealed “mild lower cervical 

levocurvature,” disc degeneration at certain vertebrae in the 

cervical spine, “moderate/severe bilateral foraminal stenosis,” and 

“[m]oderate canal narrowing.” Despite these results, a physical 

exam revealed full active and passive range of motion of the 

cervical spine and shoulders without pain with full motor and grip 

strength. As a result, conservative treatment was recommended 

including applying a hot/cold wrap to the neck, a chiropractic 

consultation, physical therapy, and use of a muscle relaxer. 

D. The ALJ’s Decision

Employing the SSA’s five-step sequential evaluation process 

for determining whether a claimant is disabled, the ALJ denied 

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Watkins’s application.11 At steps one and two, the ALJ found that 

Watkins had not engaged in substantial gainful activity since March 

24, 2012, and was severely impaired by his “moderate generalized 

anxiety disorder, major depression, and long history of alcohol 

dependence.” The ALJ also found that, beginning in August 2017, 

Watkins was severely impaired by “cervical spine degenerative 

changes,” which the ALJ determined resulted in certain exertional 

and physical limitations. At step three, the ALJ determined that 

Watkins’s impairments alone or in combination did not meet or 

medically equal any listed impairment under the relevant Social 

Security regulations. At step four, the ALJ determined that:

from [Watkins’s] alleged onset date of March 24, 2012 

through July 31, 2017, the claimant had the residual 

functional capacity to perform a full range of work at 

all exertional levels, but with the following nonexertional limitations: was limited to work that is 

simple as defined in the Dictionary of Occupational 

Titles (DOT) as specific vocational preparation (SVP) 

levels 1 and 2, routine and repetitive tasks in a work 

environment free of fast-paced production 

11 The determination process involves the following five steps: (1) whether the 

claimant is engaged in substantial gainful activity; (2) if not, whether he “has a 

severe impairment or combination of impairments”; (3) if so, whether that 

impairment, or combination of impairments, meets or equals the medical 

listings in the regulations; (4) if not, whether the claimant can perform his past 

relevant work in light of his residual functional capacity (“RFC”); and (5) if 

not, whether, based on the claimant’s age, education, and work experience, 

he can perform other work found in the national economy. Winschel 

v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011).

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requirements which is defined as constant activity 

with work tasks performed sequentially in rapid 

succession; involving only simple work-related 

decisions; with few, if any, workplace changes; and no 

more than occasional interaction with the general 

public, co-workers and supervisors. In addition, 

beginning on August 1, 2017 through the date last 

insured of December 31, 2017, the claimant had the 

residual functional capacity to perform medium work 

as defined in 20 CFR 404.1567(c), except he was 

unable to climb long vertical ladders, scaffolds or 

ropes, or at open unprotected heights; he had to avoid 

extreme heat temperatures and operation of 

dangerous machinery; and was unable to work where 

alcoholic beverages were available. He was further 

limited to understanding and carrying out simple, 

routine, repetitive unskilled tasks, with the ability to 

make basic decisions and adjust to simple changes in 

the work setting, and limited to only occasional 

interaction with others, including the general public,

coworkers, and supervisors.12

In reaching the determination that Watkins had the RFC to 

perform medium-level work that is defined as simple, the ALJ 

12 The physical limitations noted by the ALJ beginning August 1, 2017 through 

December 31, 2017, appear to relate to Watkins’s neck injury. Watkins does 

not challenge the physical limitations found as part of the RFC determination. 

Instead, he focuses solely on the mental health aspects of his claim and how 

those health issues render him totally disabled. Accordingly, this opinion 

focuses on the mental health aspects as well. 

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23-12765 Opinion of the Court 23

found that Watkins’s medically determinable impairments could 

reasonably be expected to cause his alleged symptoms (problems 

with sleeping, concentration, focus, memory, excessive worry, 

fear, depression, and impairments in his ability to care for himself, 

among others), but that his “statements concerning the intensity, 

persistence and limiting effects of [his] symptoms [were] not 

entirely consistent with the medical evidence and other evidence 

in the record.” In support of this conclusion, the ALJ summarized 

the medical records from the various providers at length, noting 

that, despite Watkins’s long history of anxiety, depression, and 

alcohol dependence, his mental status exams during these visits 

indicated that he was alert and lucid with good eye contact; 

cooperative; had a well-groomed appearance; had normal speech 

activity and was coherent with logical, goal-directed thought 

processes; he did not have suicidal ideations; he was able to interact 

appropriately with doctors and staff; and had at most a mild 

impairment in concentration and memory with fair judgment and 

insight. The ALJ explained that these findings were consistent with 

his observations of Watkins’s demeanor and appearance at the 

hearing as well. 

The ALJ further noted that the records “failed to reveal any 

formal thought or psychotic disorder, and [Watkins’s] treatment 

consisted primarily of medication management along with 

counseling, with reports of improvement in his symptomatology.” 

Thus, the ALJ concluded that Watkins’s “alleged symptoms and 

restrictions are exaggerated, as they are not supported by the 

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24 Opinion of the Court 23-12765

medical signs and/or diagnostic study findings to account for the 

total level of disability alleged.” 

The ALJ gave “little weight” to Dr. Carroll’s opinions 

because, in addition to her progress notes being “mostly illegible,” 

her opinions were “unsupported and inconsistent with the overall 

medical evidence of record.” For instance, the ALJ pointed out that 

Dr. Carroll documented in treatment notes that Watkins had no 

suicidal ideations, had an appropriate appearance, was cooperative, 

had logical thought processes, and clear and coherent speech, but 

then she stated the opposite in the formal questionnaires and 

evaluations. Furthermore, her opinions were contrary to

evaluations by persons at the VA and Dr. Cohen—all of which 

indicated that Watkins was functioning at a much higher level than 

opined by Dr. Carroll. 

As for Dr. Cohen, the ALJ gave his opinion “only partial 

weight” because Dr. Cohen evaluated Watkins on only one

occasion and the evaluation did not “reveal objective findings 

supporting [the noted] signs of suicidal ideations, difficulty thinking 

or concentrating, generalized or persistent anxiety, anhedonia, 

appetite disturbances, decreased energy, psychomotor retardation,

social withdrawal, or insomnia.” Similarly, Dr. Cohen’s statement 

that Watkins had “bouts of depression that last[ed] for several 

weeks” was unsupported by objective medical findings because he 

evaluated Watkins only once, which necessarily meant that this 

statement was based on Watkins’s subjective statements. Finally, 

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the ALJ noted that Dr. Cohen’s opinion was also inconsistent with 

the records from the VA. 

Next, the ALJ determined that Watkins could not perform 

past relevant work. But, at step five, the ALJ determined that 

Watkins could perform other jobs in the national economy such as 

a hand packager, a warehouse worker, or a cook’s helper. 

Consequently, the ALJ found that Watkins was not disabled. 

Watkins requested discretionary review of the ALJ’s 

decision by the SSA’s Appeals Council, which was denied. 

E. District Court Proceedings

In April 2022, Watkins filed a complaint in the district court, 

arguing, in relevant part, that (1) the ALJ failed to properly weigh 

the medical opinion evidence of Dr. Carroll and Dr. Cohen; (2) the 

ALJ erred in determining Watkins’s RFC; and (3) the ALJ failed to 

properly evaluate Watkins’s subjective testimony. A magistrate 

judge issued a report and recommendation (“R&R”) 

recommending that the Commissioner’s decision be affirmed. The 

district court adopted the R&R over Watkins’s objections and 

affirmed the denial of benefits. Watkins timely appealed. 

II. Standard of Review

“When, as in this case, the ALJ denies benefits and the 

[Appeals Council] denies review, we review the ALJ’s decision as 

the Commissioner’s final decision.” Doughty v. Apfel, 245 F.3d 1274, 

1278 (11th Cir. 2001). “Our review of the Commissioner’s decision 

is limited to whether substantial evidence supports the decision 

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26 Opinion of the Court 23-12765

and whether the correct legal standards were applied.” Walker v. 

Soc. Sec. Admin., Comm’r, 987 F.3d 1333, 1338 (11th Cir. 2021). 

“[W]e review de novo the legal principles upon which the 

Commissioner’s decision is based,” and “we review the resulting 

decision only to determine whether it is supported by substantial 

evidence.” Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). 

“Substantial evidence is less than a preponderance, and thus we 

must affirm an ALJ’s decision even in cases where a greater portion 

of the record seems to weigh against it.” Simon v. Comm’r, Soc. Sec. 

Admin., 7 F.4th 1094, 1103 (11th Cir. 2021) (quotation omitted); see 

also Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 

2004) (“Substantial evidence is more than a scintilla and is such 

relevant evidence as a reasonable person would accept as adequate 

to support a conclusion.” (quotations omitted)).

“We may not decide the facts anew, reweigh the evidence, 

or substitute our judgment for that of the [Commissioner].” 

Winschel, 631 F.3d at 1178 (alteration in original) (quotation 

omitted). “Even if the evidence preponderates against the 

Commissioner’s findings, we must affirm if the decision reached is 

supported by substantial evidence.” Crawford, 363 F.3d at 1158–59 

(quotation omitted).

III. Discussion

Watkins argues that (A) the ALJ failed to properly weigh the 

medical opinion evidence; (B) the ALJ failed to properly evaluate 

his subjective statements; and (C) the ALJ failed to properly 

determine his mental RFC. We address each argument in turn. 

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A. Weighing of the medical opinion evidence

Watkins argues that the ALJ failed to properly weigh the 

medical opinion evidence of Dr. Carroll and Dr. Cohen. 

Specifically, he asserts that the ALJ erred in failing to give Dr. 

Carroll’s opinions controlling weight as his treating physician and 

in only giving partial weight to Dr. Cohen’s opinion. We disagree.

To obtain social security disability benefits, the applicant 

must prove he is disabled. See Barnhart v. Thomas, 540 U.S. 20, 21 

(2003). “Disability” is defined as the “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). The impairment must be “of such severity that [the 

person] is not only unable to do his previous 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 . . . .” Id. § 423(d)(2)(A).

When making the disability assessment, the ALJ must give 

special attention to the medical opinions, particularly those of the 

treating physician. SSA regulations in force at the time Watkins

filed his application required an ALJ to give “controlling weight” to 

a treating physician’s opinion if it was “well-supported by medically 

acceptable clinical and laboratory diagnostic techniques” and “not 

inconsistent with the other substantial evidence in [the] case 

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28 Opinion of the Court 23-12765

record.” 20 C.F.R. § 404.1527(c)(2).13 Good cause to discount a 

treating physician’s opinion exists “when the: (1) treating 

physician’s opinion was not bolstered by the evidence; (2) evidence 

supported a contrary finding; or (3) treating physician’s opinion 

was conclusory or inconsistent with the doctor’s own medical 

records.” Winschel, 631 F.3d at 1179 (quotation omitted). 

The Social Security regulations provide that an ALJ should 

consider many factors when weighing a medical opinion, including 

(1) the examining relationship between the physician and the 

applicant; (2) the treatment relationship, including the length and 

nature of the treatment; (3) whether the medical opinion is 

supported by the relevant evidence; (4) whether the opinion is 

consistent with the record as a whole; and (5) the specialization of 

the physician rendering the opinion. See 20 C.F.R. § 404.1527(c). 

“[T]he ALJ must state with particularity the weight given to 

different medical opinions and the reasons therefor.” Winschel, 631 

F.3d at 1179. There are no magic words to state with particularity 

the weight given to the medical opinions. Rather, the ALJ must 

“state with at least some measure of clarity the grounds for his 

decision.” Id. (quotation omitted). 

Importantly, “[a]n administrative law judge is not required 

to agree with the statement of a medical source that a claimant is 

13 In 2017, the SSA amended its regulations and removed the “controlling 

weight” requirement for all applications filed after March 27, 2017. See 20 

C.F.R. §§ 404.1527, 404.1520c. Because Watkins filed his DIB application in 

2012, the former regulations apply.

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23-12765 Opinion of the Court 29

‘disabled’ or ‘unable to work.’” Walker, 987 F.3d at 1338 (quoting 

20 C.F.R. § 404.1527(d)(1)). Rather, whether a claimant is disabled 

within the meaning of the statute is a question reserved for the ALJ 

acting on behalf of the Commissioner of Social Security. Id. at 

1338–39.

i. Dr. Carroll’s Opinions

Here, the ALJ articulated a specific justification for giving 

Dr. Carroll’s opinions less than controlling weight—her opinions 

were not consistent with her own treatment notes or the other 

medical evidence in the record. For instance, Dr. Carroll noted in 

her narrative statements14 and the medical questionnaires that 

Watkins suffered from suicidal thoughts—and, on at least one 

evaluation, Dr. Carroll also documented a history of suicide 

attempts—and agitated psychomotor function, but her treatment 

notes did not support these assessments. Rather, on each of 

Watkins’s visits, Dr. Carroll marked that Watkins did not suffer 

from suicidal ideation and he had no history of suicide attempts, 

and she also documented that he had either unremarkable 

psychomotor function or retardation of psychomotor function (not 

14 The Commissioner argues that Dr. Carroll’s narrative statements in 2012 

and 2014 that summarize Watkins’s treatment history and his subjective 

reports of symptoms and limitations are not “medical opinions” within the 

meaning of the Social Security regulations and therefore are not entitled to 

any special weight. Because the ALJ treated Dr. Carroll’s narrative statements 

as medical opinions, however, we do so as well. In considering these 

statements, we express no opinion on whether or not such narrative 

statements qualify as medical opinions for purposes of the regulations. 

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30 Opinion of the Court 23-12765

agitated). The other medical evidence in the record from other 

treating physicians also reflect findings of no suicidal ideation15 or 

attempts and unremarkable psychomotor function or retardation 

of psychomotor function.16 Thus, her assessments to the contrary 

in her medical opinions and source statements were not supported 

by the record. 

Furthermore, while Dr. Carroll opined that Watkins’s 

symptoms moderately to markedly limited his ability to maintain 

socially appropriate behavior and adhere to basic standards of 

neatness, her treatment notes (as well as the notes from other 

providers) routinely reflected that Watkins had an appropriate 

appearance, maintained good eye contact, and was cooperative 

15 In his brief on appeal, Watkins points to one instance of suicidal ideation in 

the VA records from September 2015, which he contends supports Dr. 

Carroll’s statements regarding suicidal ideation. Specifically, in September 

2015, the VA noted that Watkins reported that in June 2015, he thought about 

“driving [his] motorcycle out to the desert and letting [himself] starve to death. 

Denies any current intentions or plans.” The problem for Watkins is that Dr. 

Carroll completed the respective narrative statements and questionnaires 

noting suicidal ideation prior to June 2015. And Watkins does not allege any 

other instances of suicidal ideation nor point to any instances in the record 

prior to June 2015 in which he reported such thoughts to Dr. Carroll or anyone 

else. Thus, the record does not support Dr. Carroll’s statements. 

16 Watkins asserts that the record supports findings of psychomotor 

abnormalities, which supports Dr. Carroll’s statements. The problem for 

Watkins is that the records Watkins cites document retardation of 

psychomotor function (and in one instance “restless” psychomotor function), 

not agitation. Moreover, Dr. Carroll also documented unremarkable 

psychomotor function a majority of the time. Thus, Dr. Carroll’s statements 

otherwise are not supported by the record. 

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and able to communicate and interact appropriately with doctors 

and staff. Similarly, while Dr. Carroll opined that Watkins had 

impaired memory function, her treatment notes routinely 

indicated that Watkins had organized and logical thought 

processes. Additionally, other providers documented no issues 

with Watkins’s short- or long-term memory.

The ALJ also explained that Dr. Carroll’s narrative 

statements were due less weight because they “appeared to be 

based on the claimant’s subjective self-reports and not based on her 

own observations” or objective medical evidence. The ALJ’s 

assessment is supported by the record and constitutes good cause 

for giving Dr. Carroll’s opinions less weight.17 See Crawford, 363 

F.3d at 1159 (affirming ALJ’s discounting of treating physician’s 

opinion where it was “based primarily on [the applicant’s] 

subjective complaints of pain”). 

Accordingly, the ALJ’s stated reason for giving Dr. Carroll’s 

medical opinions less than controlling weight—because her 

opinions were inconsistent with her treatment notes and the 

17 For instance, in the September 2012 statement—after having treated 

Watkins only twice—Dr. Carroll stated that “[Watkins] sees his employment 

as a large source of his stress”; “[h]e continues to have times where it is difficult 

to get out of bed, bathe, perform ADLs and function outside of his home”; 

“[h]e has encountered considerable social and family strain due to his 

symptoms”; and “[h]e feels incapable of returning to the work place.” These 

statements were clearly based on Watkins’s subjective self-reporting and were 

not supported by Dr. Carroll’s treatment notes from her two visits with 

Watkins.

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32 Opinion of the Court 23-12765

record as a whole—was adequate, is supported by the record, and 

amounts to good cause. Raper v. Comm’r of Soc. Sec., 89 F.4th 1261, 

1275 (11th Cir. 2024); Winschel, 631 F.3d at 1179. 

Watkins resists this conclusion by arguing that the ALJ 

fundamentally misunderstood mental disorders, which are known 

to cause fluctuating symptoms, and “cherry-pick[ed]” normal 

findings from the record to support his determination that Watkins 

was not disabled. We disagree. Although the ALJ may not have 

referred to every piece of evidence in his decision, it is clear that 

the ALJ did much more than “cherry-pick[]” favorable evidence in 

the record to support his decision. Rather, the ALJ’s opinion 

contained a detailed, lengthy discussion of the evidentiary record 

and demonstrated that he clearly considered all of the evidence 

submitted and Watkins’s condition as a whole, which is all that is 

required. See Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005) 

(explaining that “there is no rigid requirement that the ALJ 

specifically refer to every piece of evidence in his decision” but 

must include enough “to enable [the district court or this Court] to 

conclude that [the ALJ] considered [the claimant’s] medical 

condition as a whole” (first and second alteration in original));

White v. Comm’r of Soc. Sec., 572 F.3d 272, 284 (6th Cir. 2009) 

(rejecting an accusation of “cherry picking” by the ALJ and 

explaining that “the same process can be described more neutrally 

as weighing the evidence”).

Watkins also points out that Dr. Carroll’s treatment notes 

supported many of her other findings—that Watkins had decreased 

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23-12765 Opinion of the Court 33

memory; weight change; sleep issues; depressed or anxious mood; 

loss of interest; feelings of guilt/worthlessness; social 

withdrawal/isolation; constricted affect; difficulty concentrating; 

decreased energy; and abnormalities of psychomotor function—

which he argues demonstrates that her opinions were consistent 

with the overall record and should have been given controlling 

weight.18 However, the ALJ was entitled to find that the 

inconsistencies discussed previously rendered Dr. Carroll’s 

opinions deserving of less weight, despite the consistency of some 

of her other findings in the record. Furthermore, even if the 

evidence Watkins cites could support his position, we cannot 

reweigh or reevaluate the evidence or otherwise substitute our 

judgment for that of the agency. Winschel, 631 F.3d at 1178; see also 

Buckwalter v. Acting Comm’r of Soc. Sec., 5 F.4th 1315, 1320 (11th Cir. 

18 Watkins argues that all of the relevant factors in 20 C.F.R. § 404.1527(c) that 

an ALJ is supposed to consider in weighing medical opinion evidence—

namely, (1) the examining relationship between the physician and the 

applicant; (2) the treatment relationship, including the length and nature of 

the treatment; (3) whether the medical opinion is supported by the relevant 

evidence; (4) whether the opinion is consistent with the record as a whole; and 

(5) the specialization of the physician rendering the opinion—weigh in favor 

of crediting Dr. Carroll’s opinions. We disagree. Although the nature and 

length of their treatment relationship and Dr. Carroll’s specialization may 

have weighed in favor of crediting her opinions, the ALJ explained that Dr. 

Carroll’s opinions were inconsistent with her own findings from mental status 

exams during Watkins’s visits as well as the records from the VA providers 

who were treating Watkins during the same time period. These 

inconsistencies weighed against crediting Dr. Carroll’s opinions. Regardless, 

nothing in the regulations requires the ALJ to explicitly discuss each of the 

factors in his decision. See generally 20 C.F.R. § 416.927.

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34 Opinion of the Court 23-12765

2021) (“We will affirm the Commissioner’s decision if it is 

supported by substantial evidence, even if the preponderance of 

the evidence weighs against it.”). Rather, as we explained 

previously, “[o]ur review of the Commissioner’s decision is limited 

to whether substantial evidence supports the decision and whether 

the correct legal standards were applied.” Walker, 987 F.3d at 1338. 

In other words, for purposes of this claim, we are limited to 

reviewing whether the ALJ articulated a specific justification for 

giving Dr. Carroll’s opinions less than controlling weight and 

determining whether that justification constituted good cause. 

When, as here, those requirements are met, “[w]e will not second 

guess the ALJ about the weight the treating physician’s opinion 

deserves.” Hunter v. Soc. Sec. Admin., Comm’r, 808 F.3d 818, 823 

(11th Cir. 2015).

ii. Dr. Cohen’s Opinion

The ALJ articulated a specific justification for giving Dr. 

Cohen’s opinion only “partial weight”—Dr. Cohen evaluated 

Watkins on only one occasion and his opinion concerning the 

severity of Watkins’s symptoms and the resulting limitations from 

said symptoms was not consistent with the treatment notes from 

the evaluation.19 For instance, as the ALJ pointed out, other than 

finding that Watkins had a depressed mood with a congruent 

affect, marked by tearfulness, Dr. Cohen otherwise found that 

19 Unlike treating physicians, the opinions of non-treating physicians, such as 

doctors who examine a claimant only once, are “not entitled to great weight.” 

Crawford, 363 F.3d at 1160. 

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Watkins’s mental status was essentially normal during the 

evaluation. Watkins was punctual to his appointment, he drove 

himself, he was well-groomed, he made good eye contact, and he 

behaved appropriately. Watkins’s speech was also normal and his 

thought process was goal-directed. He also exhibited an average 

attention span and concentration with the tests administered. Dr. 

Cohen observed that Watkins’s memory was below average, but 

not impaired. He also noted that Watkins denied suicidal ideation. 

Yet, Dr. Cohen indicated more severe symptoms in his medical 

opinion, indicating that Watkins exhibited symptoms of suicidal 

ideation, retardation of psychomotor function, and difficulty 

thinking or concentrating. As the ALJ explained, these findings 

were not supported by Dr. Cohen’s treatment notes from the onetime evaluation or the treatment notes from the numerous 

providers at the VA.20 Therefore, the ALJ provided good cause for 

20 The ALJ also noted that Dr. Cohen’s statement that Watkins had “bouts of 

depression that last[ed] for several weeks” was unsupported because he was a 

non-treating physician who only met with Watkins one time (and therefore 

this statement was clearly based on Watkins’s subjective complaints and not 

Dr. Cohen’s objective medical observations). Watkins points to this finding 

and argues that the ALJ committed reversible error because, according to 

Watkins, case law establishes that a medical opinion cannot be rejected simply 

because it is retrospective in nature as long as it is otherwise supported by 

objective medical evidence in the record. See Boyd v. Heckler, 704 F.2d 1207, 

1212 (11th Cir. 1983) (holding that the fact that a physician did not examine 

the claimant until after the expiration of the claimant’s insured status did “not 

render [the] medical opinion incompetent or irrelevant to the decision in this 

case”), superseded by statute on other grounds, 98 Stat. 1794 (1984). However, the 

ALJ did not partially reject Dr. Cohen’s opinion because it was retrospective 

in nature—indeed, Dr. Cohen examined Watkins well before his insured 

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36 Opinion of the Court 23-12765

giving Dr. Cohen’s opinion only partial weight, and we will not 

second guess that judgment.21 Winschel, 631 F.3d at 1179; Hunter, 

808 F.3d at 823.

B. Weighing of Watkins’s Subjective Statements

Watkins argues that the ALJ failed to apply the correct legal 

standards in evaluating Watkins’s subjective statements 

concerning his symptoms, and that the ALJ’s evaluation of his 

symptoms was not supported by substantial evidence. We 

disagree. 

A claimant’s subjective complaints standing alone are 

insufficient to establish a disability, but such statements are 

considered as part of the overall disability determination. 20 C.F.R. 

§ 404.1529(a) (explaining that the agency considers the claimant’s 

status expired and offered an opinion about Watkins’s current disabled state. 

Rather, the ALJ partially rejected Dr. Cohen’s opinion because it was not 

supported by the objective medical evidence in Dr. Cohen’s treatment notes 

and the record as a whole. 

21 Watkins asserts that meaningful review of his claim is precluded because it 

is impossible to tell from the record which portions of Dr. Cohen’s report the 

ALJ rejected, and which portions he credited. His argument is unpersuasive. 

To enable us to conduct a meaningful review, an ALJ must “state with 

sufficient clarity the legal rules being applied and the weight accorded the 

evidence considered.” Ryan v. Heckler, 762 F.2d 939, 941 (11th Cir. 1985). The 

ALJ did exactly that here. He explained the legal rules he applied and the 

weight he gave Dr. Cohen’s opinion. He also explained in detail the portions 

of the opinion that he found not supported by, or otherwise inconsistent with, 

the objective medical evidence. Accordingly, the ALJ’s explanation was 

sufficient to enable meaningful review. 

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23-12765 Opinion of the Court 37

subjective statements about symptoms in making the disability 

determination, but “statements about [the claimant’s] pain or other 

symptoms will not alone establish that [he is] disabled”). 

Specifically, in determining the extent to which the claimant’s 

symptoms affect his capacity to work, the ALJ will consider the 

claimant’s subjective statements “about the intensity, persistence, 

and limiting effects of [his] symptoms” and evaluate the 

“statements in relation to the objective medical evidence and other 

evidence.” Id. § 404.1529(c)(4). In doing so, the ALJ 

will consider whether there are any inconsistencies in 

the evidence and the extent to which there are any 

conflicts between [the claimant’s] statements and the 

rest of the evidence, including [the claimant’s]

history, the signs and laboratory findings, and 

statements by . . . medical sources or other persons 

about how [the claimant’s] symptoms affect [the 

claimant].

Id. When evaluating the extent to which a claimant’s symptoms 

affect his capacity to perform basic work activities, the ALJ 

considers the claimant’s daily activities; the location, duration, 

frequency, and intensity of the symptoms; precipitating and 

aggravating factors; the type, dosage, effectiveness, and side effects 

of medication taken to alleviate symptoms; treatment other than 

medication; any measures used to relieve symptoms; other factors 

concerning functional limitations and restrictions due to 

symptoms; and inconsistencies between the evidence and 

subjective statements. Id. § 404.1529(c)(3), (4). 

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After considering a claimant’s subjective complaints, the ALJ 

may reject them as not credible, which will be reviewed for 

substantial evidence. Marbury v. Sullivan, 957 F.2d 837, 839 (11th 

Cir. 1992). The ALJ must explicitly and adequately articulate his

reasons if he discredits subjective testimony. Id. “Failure to 

articulate the reasons for discrediting subjective testimony 

requires, as a matter of law, that the testimony be accepted as true.” 

Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). On the 

other hand, “[a] clearly articulated credibility finding with 

substantial supporting evidence in the record will not be disturbed 

by a reviewing court.” Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir. 

1995).

Here, the ALJ set forth the applicable legal standards for 

evaluating subjective testimony and then applied those standards 

to Watkins’s subjective complaints. The ALJ explained that 

Watkins alleged that his symptoms caused him “problems with 

concentration, focus, and memory, sleeping problems, isolation, 

crying spells, and worries. He also reported having fear, 

depression, problems with personal care, and needing reminders.” 

The ALJ found that Watkins’s mental impairments could be 

reasonably expected to cause the alleged symptoms, but that 

Watkins’s “statements concerning the intensity, persistence and 

limiting effects of these symptoms [were] not entirely consistent 

with the medical evidence and other evidence in the record . . . .” 

Accordingly, the ALJ concluded that Watkins’s “allegations of a 

total inability to work are overstated and unsupported by the 

medical evidence of record as a whole.” 

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Substantial evidence supports the ALJ’s decision. Watkins 

subjectively reported a total inability to work due to his symptoms 

and significant limitations in multiple areas of functioning. As the 

ALJ noted, however, while Dr. Carroll, Dr. Cohen, and the VA 

practitioners noted a depressed mood and constricted affect, 

Watkins was otherwise generally alert, well-groomed, exhibited 

fair eye contact, spoke clearly and coherently, and exhibited logical 

and organized thought processes with only occasionally impaired 

memory. Watkins routinely attended doctor’s appointments 

alone, was punctual and cooperative, was able to communicate 

effectively, and was compliant with doctor’s instructions. 

Furthermore, Watkins did not require hospitalization for 

psychiatric treatment and his treatment mainly consisted of 

medication management and counseling. Moreover, the ALJ 

noted that Watkins exhibited a cooperative and responsive 

demeanor at the second hearing. Specifically, the ALJ noted that, 

during the hearing,

[Watkins] was alert and aware of what went on at the 

hearing, and he paid good attention, was well 

focused, understood the questions and gave relevant 

and very detailed answers. His manner of relating, 

social skills and overall presentation seemed 

adequate; his speech was clear, intelligible, goal 

directed, logical, coherent, and he kept his trend of 

thought.

Thus, based on the objective medical evidence and other evidence 

in the record, the ALJ concluded that Watkins’s “alleged symptoms 

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40 Opinion of the Court 23-12765

and restrictions [were] exaggerated.”22 Accordingly, the ALJ 

articulated sufficient, adequate reasons for discounting Watkins’s 

subjective complaints, and these reasons were supported by 

substantial evidence. 

Watkins argues that the ALJ improperly rejected his 

subjective complaints in violation of the social security regulations 

solely because the objective medical evidence did not substantiate 

his statements. See 20 C.F.R. § 404.1529(c)(2) (“[W]e will not reject 

your statements about the intensity and persistence of your pain or 

other symptoms or about the effect your symptoms have on your 

ability to work solely because the available objective medical 

evidence does not substantiate your statements.”). This 

contention is belied by the record. The ALJ’s decision reflects that 

he considered, in addition to the objective medical evidence, the 

specifics of Watkins’s testimony at the hearing, Watkins’s 

statements concerning his daily activities and abilities, and the 

opinions of Watkins’s doctors. The ALJ then properly evaluated 

Watkins’s subjective statements in relation to the evidence in the 

record and found that Watkins’s subjective complaints were 

exaggerated and inconsistent with the evidence of record. Id.

§ 404.1529(c)(4). 

22 Watkins asserts that “the ALJ erred in suggesting that mental status findings 

cannot support a finding of disability for Plaintiff.” But the ALJ made no such 

suggestion. Rather, as discussed above, the ALJ merely concluded that 

Watkins’s subjective complaints concerning his symptoms and the resulting 

limitations of said symptoms on his ability to work were exaggerated and not 

supported by the record as a whole. 

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Next, Watkins argues that the ALJ erred in considering his

treatment records and his purported improvement with said 

treatments because psychiatric symptoms are known to “wax and 

wane,” and there was no evidence that Watkins had improved 

enough that he would be able to sustain work. Watkins’s 

argument is unpersuasive. We have held that “[t]he ALJ may 

consider the level or frequency of treatment when evaluating the 

severity of a claimant’s condition,” which is what the ALJ did here. 

Henry v. Comm’r of Soc. Sec., 802 F.3d 1264, 1267 (11th Cir. 2015); see 

also Wolfe v. Chater, 86 F.3d 1072, 1078 (11th Cir. 1996) (sustaining 

an ALJ’s finding concerning the conservative nature of the 

treatment for purposes of discrediting the claimant’s statements 

concerning the severity and limitations of his disability). 

Accordingly, there was no error. 

Finally, Watkins argues that the ALJ engaged in improper 

“sit and squirm” jurisprudence by relying on his observations of 

Watkins’s appearance and demeanor at the hearing as part of the 

disability determination. We disagree. In Freeman v. Schweiker, we 

condemned “sit and squirm” jurisprudence where “an ALJ who is 

not a medical expert . . . subjectively arrive[s] at an index of traits 

which he expects the claimant to manifest at the hearing,” and “[i]f 

the claimant falls short of the index, the claim is denied.” 681 F.2d 

727, 731 (11th Cir. 1982). However, post-Freeman, we clarified that 

Freeman stands only for the proposition that “an ALJ must not 

impose his observations in lieu of a consideration of the medical 

evidence presented.” Norris v. Heckler, 760 F.2d 1154, 1158 (11th 

Cir. 1985). We further explained that the ALJ is permitted to 

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42 Opinion of the Court 23-12765

observe and consider the claimant’s demeanor and appearance as 

part of the credibility determination. Id. Unlike “sit and squirm” 

jurisprudence, the ALJ here did not ignore medical evidence and 

impose his own subjective standards; rather, he appropriately 

considered Watkins’s demeanor and appearance at the hearing as 

one of many factors in assessing Watkins’s credibility. Thus, there 

was no error.

In sum, the evaluation of Watkins’s subjective symptoms 

and credibility belonged to the ALJ, and the ALJ supported that 

finding with substantial evidence. Accordingly, we will not disturb 

that finding. Foote, 67 F.3d at 1562.

C. The RFC Determination

Watkins argues that the ALJ failed to properly determine his 

mental RFC under Social Security Rule (“SSR”) 96-8p. The 

gravamen of his argument is that the RFC assessment is not 

supported by substantial evidence because there was no medical 

opinion evidence supporting the RFC determination or 

demonstrating that Watkins could perform full-time work on a 

sustained basis. We disagree. 

A claimant’s RFC represents the most that an individual can 

do despite his limitations or restrictions. See 20 C.F.R. 

§ 404.1545(a)(1). Under SSR 96-8p, the “RFC assessment must first 

identify the [claimant’s] functional limitations or restrictions and 

assess his . . . work-related abilities on a function-by-function basis

. . . . Only after that may RFC be expressed in terms of the 

exertional levels of work, sedentary, light, medium, heavy, and 

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very heavy.” SSR 96-8p, 61 Fed. Reg. 34,474, 34,475 (July 2, 1996). 

The rule further provides that “[t]he RFC assessment must include 

a narrative discussion describing how the evidence supports each 

conclusion, citing specific medical facts . . . and nonmedical 

evidence.” Id. at 34478. 

There is no requirement in SSR 96-8p that there be medical 

opinion evidence from a physician that matches the RFC 

determination. Rather, the regulations make clear that the task of 

determining a claimant’s RFC and ability to work is solely within 

the province of the ALJ, not the claimant’s doctors. See 20 C.F.R. 

§ 404.1546(c) (“If your case is at the administrative law judge 

hearing level or at the Appeals Council review level, the 

administrative law judge or the administrative appeals judge at the 

Appeals Council (when the Appeals Council makes a decision) is 

responsible for assessing your residual functional capacity.”); see 

also id. § 404.1527(d)(2) (“Although we consider opinions from 

medical sources on issues such as . . . your residual functional 

capacity (see §§ 404.1545 and 404.1546), . . . the final responsibility 

for deciding these issues is reserved to the Commissioner.”). And 

the ALJ is directed to assess the claimant’s RFC “based on all the 

relevant evidence in [the] record.” Id. § 404.1545(a)(1); see also SSR 

96-8p, 61 Fed. Reg. at 34,477 (providing that the RFC 

determination “must be based on all of the relevant evidence in the 

case record,” including, as relevant here, the claimant’s medical 

history; medical source statements; “[t]he effects of treatment”; 

“[r]eports of daily activities”; “[l]ay evidence”; “[r]ecorded 

observations”; and “[e]ffects of symptoms”). 

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Watkins nevertheless argues that “the absence of any 

[medical] opinion support for the RFC determination is concerning 

[when, as here,] there is no other specific medical or non-medical 

basis for the ALJ’s decision.” In support, he argues that his case is 

similar to that in Pupo v. Commissioner, Social Security Administration, 

17 F.4th 1054 (11th Cir. 2021). In Pupo, we held that the RFC 

determination that the claimant could perform medium level 

work—which required frequent lifting and carrying of objections 

weighing up to 25 pounds—was not supported by substantial 

evidence because the ALJ failed to consider the claimant’s 

significant urinary incontinence and the effect of that impairment 

on her physical abilities when making the RFC determination. Id.

at 1064–65. We also noted that because the ALJ only assigned 

“minimal weight” to the treating physician’s opinion about Pupo’s

physical abilities and limitations, and the record did not contain any 

opinion about the effect of Pupo’s incontinence on her physical 

abilities and limitations, the ALJ was left “without any medical 

opinion on that issue at all.” Id. at 1064–65. We noted that while 

medical opinion is not always necessary, in Pupo’s case, the 

absence of such evidence was

particularly concerning . . . because the ALJ also failed 

to conduct a function-by-function assessment of 

Pupo’s physical abilities and to explain how the nonopinion evidence in the record—both medical and 

nonmedical—supported his finding that Pupo could 

perform all the physical requirements for medium 

work, including lifting as much as fifty pounds at a 

time and frequently lifting up to twenty-five pounds.

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Id. at 1065. 

Watkins’s case is distinguishable from Pupo. Here, unlike in 

Pupo, the ALJ’s decision makes clear that he considered all of 

Watkins’s impairments, as well as Watkins’s medical records from 

Palm Partners, LLC, Dr. Carroll, Dr. Cohen, and the VA, Watkins’s 

subjective statements, and the ALJ’s own observation of Watkins 

at the hearing. The ALJ also explained how he resolved 

discrepancies in Dr. Carroll’s and Dr. Cohen’s medical opinions, as 

well as between Watkins’s subjective complaints and the record as 

a whole. The ALJ then found that the evidence did not support the 

level of disability that Watkins claimed as a result of his stated 

impairments, and that Watkins had the RFC to perform simple 

work of a medium exertional level. Thus, the ALJ complied with 

SSR 96-8p by first considering Watkins’s functional limitations and 

restrictions and then expressing Watkins’s residual functional 

limitations in terms of exertional and non-exertional levels. 

Moreover, the ALJ’s conclusion that Watkins retained the mental 

RFC to perform “simple, routine, repetitive unskilled tasks” 

involving only simple decisions with limited workplace changes 

and only occasional interaction with coworkers, supervisors, and 

the public, is supported by substantial evidence. For instance, the 

record demonstrated that Watkins was able to follow his various 

doctors’ instructions, perform routine tasks, and was able to 

adequately communicate with a variety of healthcare professionals 

while interacting appropriately. He was also able to complete the 

cognitive tests administered by Dr. Cohen. This evidence is just 

some of the evidence in the voluminous records that supports the 

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ALJ’s mental RFC finding. In sum, we conclude that the ALJ 

adequately analyzed and described Watkins’s RFC, and Watkins is 

not entitled to relief on this claim. 

IV. Conclusion 

For the above reasons, we affirm. 

AFFIRMED.

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