Document ID: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-ca11-15-10939/USCOURTS-ca11-15-10939-0/pdf.json

Parties Involved:
Commissioner of Social Security
Appellee
Richard William Duval
Appellant

Document Text:

[DO NOT PUBLISH]

IN THE UNITED STATES COURT OF APPEALS

FOR THE ELEVENTH CIRCUIT

________________________

No. 15-10939

Non-Argument Calendar

________________________

D.C. Docket No. 6:14-cv-00213-GKS-TBS

RICHARD WILLIAM DUVAL, 

 Plaintiff-Appellant,

 versus

COMMISSIONER OF SOCIAL SECURITY, 

 Defendant-Appellee.

________________________

Appeal from the United States District Court

for the Middle District of Florida

________________________

(December 29, 2015)

Before MARTIN, JILL PRYOR and ANDERSON, Circuit Judges.

PER CURIAM: 

Richard William Duval appeals from the district court’s decision to affirm

the Commissioner of Social Security’s denial of his applications for disability 

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insurance benefits and supplemental security income. On appeal, Mr. Duval 

argues that the administrative law judge (“ALJ”) erred in three ways. First, he 

contends that the ALJ failed to apply the proper standards when reviewing medical 

opinions from treating and non-treating physicians to determine his residual 

functional capacity and that substantial evidence does not support the ALJ’s 

evaluation of those opinions. Second, he argues that the ALJ failed to apply proper 

standards to assess his credibility, and substantial evidence does not support the 

ALJ’s conclusion that his testimony was only partially credible. Third, he claims 

that the ALJ failed to account for his mental limitations when formulating a 

hypothetical question for the vocational expert. After careful consideration, we 

affirm the district court’s judgment in favor of the Commissioner.

I. Background

Mr. Duval applied for disability insurance benefits and supplemental 

security income with the Social Security Administration. After the Commissioner 

denied his applications and reconsideration of his applications, Mr. Duval 

requested and received a hearing before an ALJ. 

A.

Before the ALJ, Mr. Duval claimed that he was no longer able to work in his 

previous jobs or any other jobs because of seizures, headaches, wrist pain, anxiety, 

and depression. First, Mr. Duval testified about the severity and frequency of his 

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seizures. He explained that he experienced his first seizure in March 2010 and that 

his seizures generally lasted two to four minutes. During the seizures, he would

convulse, bite his tongue, and drop to the floor. According to Mr. Duval, after a 

seizure it takes him approximately 20 minutes to regain full consciousness, and 

then he is exhausted for several hours. He testified that when he first began 

experiencing seizures, he would have two or more seizures per month and that in 

the two months leading up to the hearing (March and April 2012), he had four 

seizures. He offered no testimony about the frequency of his seizures in the period

between these two times.

Mr. Duval presented evidence from Dr. Ahmed Sadek, a neurologist, and

HenChai Lai, a nurse practitioner who worked with Dr. Sadek. They treated Mr. 

Duval for his seizures and saw him once every two to three months. In September 

2011, Dr. Sadek completed a Seizure Impairment Questionnaire explaining that 

Mr. Duval suffered from average of one to two seizures per month and that his 

seizures were moderately controlled but that his prognosis was unpredictable. In 

March 2012, Dr. Sadek and Ms. Lai signed a letter reporting that Mr. Duval 

continued to experience one to two seizures a month and that medication failed to 

control adequately his seizures. But treatment records from Dr. Sadek and Ms. Lai 

reflect that Mr. Duval at times throughout 2010 reported having no seizures 

between appointments or having less than one seizure per month and that 

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medication was controlling his seizures. Moreover, treatment notes from an April 

2012 appointment show Mr. Duval reported experiencing no seizures in over a 

month. 

Second, Mr. Duval testified about his headaches. He described experiencing

approximately one to two migraine headaches a month and that when he had a 

migraine, he needed to stay in a dark room for several hours. Dr. Sadek also 

treated Mr. Duval for his headaches, and Mr. Duval again relied on opinions from 

Dr. Sadek before the ALJ. In April 2012, Dr. Sadek completed a Headache 

Questionnaire in which he stated that Mr. Duval had experienced three to four 

migraine headaches a month and four to five tension headaches a week. Dr. Sadek 

explained that medication was unable to completely relieve the pain without 

unacceptable side effects and that Mr. Duval’s pain and other symptoms frequently 

interfered with his attention and concentration. Dr. Sadek further opined that 

because of his headaches and other impairments, Mr. Duval was incapable of 

performing low stress work, was precluded from performing even basic work 

activities, and would be absent from work at least three times a month. Dr. Sadek 

expected these symptoms to continue for at least 12 months. 

But Dr. Sadek’s treatment records tell a different story about the headaches. 

Treatment records from an appointment just three weeks before Dr. Sadek 

completed the Headache Questionnaire show that Mr. Duval experienced only two 

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headaches in a month and a half and that he had elected not to take his headache 

medications because the headaches were not severe enough. The treatment notes 

also indicate that Mr. Duval’s tension headaches had resolved. 

Third, Mr. Duval testified about injuries to his wrist. In April 2005, Mr. 

Duval fractured his right wrist while working. He had three surgeries on his wrist 

with the last one in 2007 or 2008. He testified that he never regained full function 

after the surgeries and continued to have problems with his wrist. He explained 

that he had difficulty holding objects in his right hand and limited movement in his 

right wrist, along with a weak grip. In February 2012, Ms. Lai completed a 

Bilateral Manual Dexterity Impairment Questionnaire, indicating that Mr. Duval

had reduced grip strength and tenderness in his right hand. She opined that he

could never lift or carry any weight and was essentially precluded from grasping, 

turning, or twisting objects, as well as from using his hands or fingers for fine 

manipulations. But treatment notes from Dr. Sadek and Ms. Lai show that Mr. 

Duval repeatedly reported normal ranges of motion and strength with no 

tenderness in his right upper extremity, which would include his wrist. 

Fourth, Mr. Duval testified about his depression and anxiety. Mr. Duval 

explained that he had experienced relatively constant depression for the past two 

years, which limited his ability to focus and concentrate, but he failed to identify

any specific instance when the depression limited him physically. He also testified 

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that he suffered from anxiety attacks every other day that lasted approximately ten 

minutes. He stated that he could sit for only 30 minutes before he began to feel 

anxious. He could stand or walk for about 45 minutes before needing to sit down,

and he would need a ten minute break before he could resume walking. He also 

reported experiencing panic attacks but failed to identify any triggers for his panic 

attacks.

Mr. Duval submitted medical records showing that Naomi Kitner, a licensed 

mental health counselor, diagnosed him in March 2012 with mixed anxiety and 

depression. After consulting with Ms. Kitner and a psychiatrist, Mr. Duval began 

to take medication for his depression and anxiety, which he reported improved and 

stabilized his mood. 

Mr. Duval described to the ALJ how his seizures, headaches, wrist pain, 

depression, and anxiety limited him on a day-to-day basis. He stated that because 

of his seizures, he had stopped driving and had his license revoked. He lived in a 

two-story townhome but stayed on one level of the house to avoid using the stairs 

because his seizures occurred without warning. He testified that he was not selfsufficient and relied on his family for assistance. He admitted that he could dress 

and bathe himself and perform housework like vacuuming and laundry, although 

the tasks took him longer than normal. He reported seeing friends at his home 

about once a month and occasionally leaving his home with family members. He 

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testified that he engaged in hobbies at home, like working with model cars, but 

reported very limited use of his right arm. 

Besides Mr. Duval’s testimony and treatment records from Dr. Sadek, Ms. 

Lai, and Ms. Kitner, the ALJ also reviewed a consultative examination report from 

William W. Austin, Psy.D. After examining Mr. Duval in January 2011, Dr. 

Austin diagnosed him with generalized anxiety disorder and major depressive 

disorder and concluded that Mr. Duval had compromised social functioning and 

moderately impaired functional abilities. 

The ALJ also considered reports from medical providers who reviewed Mr. 

Duval’s treatment records but never treated or examined him. Dr. John Rinde, an 

internist, completed a physical residual functional capacity assessment in April 

2011 and determined that Mr. Duval’s seizure disorder was fairly well controlled 

and that he faced no limitations other than to avoid work on ladders, ropes, or 

scaffolds or with machinery. Deborah Carter, Ph.D., reviewed Mr. Duval’s 

treatment records, including Dr. Austin’s consultative examination, to determine 

the limitations that Mr. Duval faced based on his mental health condition. She 

concluded that he was moderately limited in his abilities to carry out detailed 

instructions, to maintain attention and concentration for extended periods of time, 

to complete a normal workday and workweek without interruptions from his 

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psychologically based symptoms, and to interact appropriately with the general 

public.

The ALJ heard expert testimony from a vocational expert (“VE”). The ALJ 

asked the VE the following hypothetical question:

[L]et’s assume a hypothetical person of the claimant’s age, education 

and work experience who is able to lift up to 20 pounds occasionally 

and lift and carry up to ten pounds frequently. This person would be 

able to stand and walk for about six hours in an eight hour workday 

and would be able to sit for up to six hours in an eight hour workday. 

This person should never climb ladders or scaffolds. This person 

should avoid exposure to operational control of moving machinery 

and unprotected heights and also to hazardous machinery. This 

person’s work would be limited to simple, routine and repetitive tasks. 

Simple means learned with an on the job demonstration or within 30 

days. Routine means performed the same way or in a similar manner 

each time. And repetitive means performed from start to finish over 

and over throughout a workday . . . Could this individual perform any 

other job in the national or regional economy?

Hearing Tr. (Doc. 14-4 at 110–11).1

 The VE answered that this individual could 

work as a street cleaner, electronics worker, ticket taker, or produce weigher. The 

ALJ then added the limitation that the person could have only occasional 

interaction with coworkers and the public. The VE testified that this person could 

still perform the electronic worker and street cleaner positions. 

At the close of the hearing, the ALJ left open the record so that Mr. Duval 

could submit additional evidence including medical records regarding his treatment 

for bipolar disorder. Instead of treatment notes, Mr. Duval provided a Psychiatric 

 

1 Citations to “Doc.” refer to docket entries in the district court record in this case. 

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Impairment Questionnaire completed by Dr. Ramon Martinez, a psychiatrist who 

treated him. Dr. Martinez diagnosed Mr. Duval with bipolar disorder and indicated 

that he had marked limitations in areas related to understanding and memory,

sustained concentration and persistence, social interactions, and adaptation. Based 

on these limitations, Dr. Martinez opined that Mr. Duval was incapable of even 

low stress work.

B.

The ALJ issued a written decision concluding that Mr. Duval was not 

disabled within the meaning of the Social Security Act. The ALJ used the 

regulations’ five-step, sequential evaluation process to determine whether Mr. 

Duval was disabled. See 20 C.F.R. §§ 404.1520(a)(4), 416.920(a)(4). First, the 

ALJ concluded that Mr. Duval had not engaged in substantial gainful activity since 

March 1, 2010. Second, the ALJ found that Mr. Duval suffered from the following 

severe impairments: epilepsy seizure disorder, distal radioulnar joint arthrosis 

right wrist, and depression. Third, the ALJ determined that Mr. Duval did not have 

an impairment or combination of impairments that met or medically equaled the 

severity of an impairment listed in 20 C.F.R. Part 404, subpart P, appendix 1. 

Fourth, the ALJ concluded that Mr. Duval could not perform his past 

relevant work. In reaching this conclusion, the ALJ considered Mr. Duval’s 

residual functional capacity and concluded that he could perform work at the light 

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exertional level. The ALJ found that Mr. Duval could lift, carry, push, or pull up 

to twenty pounds occasionally and ten pounds frequently and that he could stand 

and walk for approximately six hours and sit for approximately six hours in an 

eight-hour workday. The ALJ recognized that Mr. Duval should never climb 

ladders or scaffolds and should avoid exposure to operational control of moving 

machinery, unprotected heights, or hazardous machinery. The ALJ determined 

that Mr. Duval’s work needed to be limited to simple, routine, and repetitive tasks 

with only occasional interaction with coworkers and the public. The ALJ rejected 

Mr. Duval’s statements about the intensity, persistence, and limiting effects of his 

symptoms to the extent they were inconsistent with the ALJ’s residual functional 

capacity assessment and unsupported by objective medical evidence. Based on 

this residual function capacity, the ALJ concluded that Mr. Duval was unable to 

perform his past work but could perform a significant number of jobs in the 

national economy, such as street cleaner or electronics assembler. Accordingly, 

the ALJ concluded that Mr. Duval was not disabled. 

Mr. Duval sought review of the ALJ’s decision by the Appeals Council and 

submitted additional evidence to the Appeals Council. The Appeals Council 

considered some new mental health records that Mr. Duval submitted but refused 

to review most of his new evidence, concluding that it concerned a later time 

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period. Because the Appeals Council determined there was no reason to review 

the ALJ’s decision, it denied his request for review.

C.

Mr. Duval then filed an action in district court seeking review of the ALJ’s 

decision denying benefits.2

 A magistrate judge entered a report and 

recommendation concluding that the Commissioner’s decision should be reversed 

and remanded for further proceedings because the ALJ failed to analyze Mr. 

Duval’s credibility properly. Although no objection was filed, the district court 

entered a one-page order rejecting the magistrate judge’s report and 

recommendation. The district court affirmed the Commissioner’s final decision 

based on its summary conclusions that “substantial evidence supports the [ALJ]’s 

findings concerning the work that Duval . . . is able to perform” and “the [ALJ] 

applied the proper legal analysis.” Order (Doc. 19). This appeal followed.

II. Standard of Review

In Social Security appeals, we review de novo the legal principles upon 

which the Commissioner’s decision is based. Moore v. Barnhart, 405 F.3d 1208, 

1211 (11th Cir. 2005). We may not decide facts anew, make credibility decisions, 

or reweigh the evidence. Id. Instead, we review the Commissioner’s decision 

“only to determine whether it is supported by substantial evidence.” Id. 

 

2 Mr. Duval did not challenge the Appeals Council’s refusal to consider some of the 

additional materials that he submitted to it. 

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“Substantial evidence is more than a mere scintilla. It means such relevant 

evidence as a reasonable mind might accept as adequate to support a conclusion.” 

Consol. Edison Co. v. NLRB, 305 U.S. 197, 229 (1938); see also Richardson v. 

Perales, 402 U.S. 389, 401 (1971) (applying substantial evidence standard to 

disability determinations under the Social Security Act). When a decision is 

supported by substantial evidence, we must affirm, “[e]ven if we find that the 

evidence preponderates against the [Commisioner’s] decision.” MacGregor v. 

Bowen, 786 F.2d 1050, 1053 (11th Cir. 1986). Similarly, we review an ALJ’s 

credibility determination concerning a claimant’s complaints of pain and other 

subjective symptoms for substantial evidence supporting the determination. 

Marbury v. Sullivan, 957 F.2d 837, 839 (11th Cir. 1992). 

III. The ALJ’s Treatment of Testimony from Medical Providers

The social security regulations establish a five-step evaluation process to 

evaluate disability claims.

3

 20 C.F.R. §§ 404.1520, 416.920. Mr. Duval’s appeal 

 

3 At step one, the ALJ determines whether the claimant is engaged in “substantial gainful 

activity.” 20 C.F.R. § 404.1520(a)(4). If not, then the claimant must show at step two that his

impairment is “severe,” meaning it “significantly limits [his] physical or mental ability to do 

basic work activities.” Id. § 404.1520(a)(4), (c). If the claimant makes that showing, then at step 

three he must show that he has an impairment that meets or equals the criteria contained in the 

listings of impairments. Id. § 404.1520(a)(4). If the claimant shows his impairment meets or 

equals a listing, then he is determined to be disabled. Id. If he fails to do so, then at step four, 

the ALJ considers the claimant’s residual functional capacity to determine whether the claimant 

could still perform his past relevant work activity. Id. If the claimant could not do so, then the 

ALJ moves to step five and determines whether, in light of the claimant’s residual functional 

capacity, age, education, and work experience, he could perform other work. If so, the claimant 

is not disabled; if not, the claimant is disabled. Id.; see also id. § 416.920(a)(4).

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focuses on step five in the evaluation process, whether he can perform other work. 

He argues that in evaluating his residual functional capacity, the ALJ erred by 

rejecting the opinions of his treating medical providers and relying on the opinions 

of medical providers who never treated or examined him. We disagree. Because 

substantial evidence supported the ALJ’s conclusion that there was good cause for 

failing to give substantial or considerable weight to the opinions of Mr. Duval’s 

treating providers, there is no error here.

A.

An ALJ must give the medical opinions of a treating physician, such as Dr. 

Sadek, “substantial or considerable weight unless good cause is shown to the 

contrary.” Phillips v. Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004) (internal 

quotation marks omitted); see 20 C.F.R. §§ 404.1527(c)(2), 416.927(c)(2). Good 

cause exists when: (1) the opinion “was not bolstered by the evidence,” (2) the 

“evidence supported a contrary finding,” or (3) the “treating physician’s opinion 

was conclusory or inconsistent with the doctor’s own medical records.” Phillips, 

357 F.3d at 1240–41. We require an ALJ to articulate clearly the reasons for 

giving less weight to the opinion of a treating physician. Id. at 1241. When 

substantial evidence supports the ALJ’s articulated reasons for assigning limited 

weight to a treating physician’s opinion, there is no reversible error. See Moore, 

405 F.3d at 1212.

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Here, the ALJ applied the correct standard in declining to give substantial or 

considerable weight to the opinions of Dr. Sadek, Ms. Lai, and Dr. Martinez

because their opinions were unsupported by progress notes or conclusory. For the 

reasons discussed below, we further conclude that substantial evidence supports 

the ALJ’s finding of good cause.

1.

Substantial evidence supports the ALJ’s conclusion that Dr. Sadek’s 

opinions were unsupported by his treatment notes. Although Dr. Sadek opined that 

Mr. Duval experienced one to two seizures per month and that mediation failed to 

adequately control his seizures, his treatment notes reflect that at times Mr. 

Duval’s seizures occurred less frequently and were controlled by medication.

4

 In 

fact, the ALJ cited to specific treatment notes showing Mr. Duval reported no 

seizures between appointments or seizures that occurred less frequently than once 

per month and that medication was controlling the seizures. Given these records, 

substantial evidence supports the ALJ’s conclusion that treatment records do not 

support Dr. Sadek’s opinions about Mr. Duval’s seizures. 

Substantial evidence also supports the ALJ’s conclusion that Dr. Sadek’s 

opinions about the severity and frequency of Mr. Duval’s headaches were not 

 

4 Mr. Duval attempts to rewrite Dr. Sadek’s opinions when he argues that the medical 

records “confirm Mr. Duval was often having 1 to 2 seizures a month.” Appellant’s Br. at 37. 

But he overlooks that in a March 2012 letter Dr. Sadek stated that Mr. Duval experienced one to 

two seizures per month, an opinion unsupported by Dr. Sadek’s treatment notes. 

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credible. In April 2012, Dr. Sadek completed a Headache Questionnaire indicating 

that Mr. Duval experienced four to five tension headaches a week and three to four 

migraines a month and that medication only moderately controlled the headaches. 

But treatment records show that Mr. Duval’s headaches occurred less frequently 

and were less severe than Dr. Sadek noted. Indeed, the treatment notes from Mr. 

Duval’s last appointment before the questionnaire show that he reported only two 

migraines in a month and a half, which were manageable; his tension headaches 

had resolved; and he had stopped taking his headache medication.

5 Because 

substantial evidence supports the ALJ’s determination that Dr. Sadek’s opinions 

were inconsistent with his treatment records, the ALJ had good cause to afford Dr. 

Sadek’s opinions less weight.

6

 

5 The ALJ concluded that progress notes throughout the record failed to support Dr. 

Sadek’s opinions about the severity of Mr. Duval’s headaches. Mr. Duval argues that we can 

consider only the evidence cited by the ALJ, meaning that we cannot look to the April 2012 

treatment notes. We disagree because “there is no rigid requirement that the ALJ specifically 

refer to every piece of evidence in his decision.” Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th 

Cir. 2005). 

6 Mr. Duval also argues that the ALJ erred by giving little credit to the opinions of Ms. 

Lai. Even assuming the ALJ was required to consider Ms. Lai’s opinions, substantial evidence 

supports the ALJ’s conclusion that treatment records fail to support her opinions for the same 

reasons discussed above for Dr. Sadek’s opinions. We recognize that Ms. Lai offered an 

additional opinion about the severity of Mr. Duval’s wrist injury. But Mr. Duval has failed to 

raise a challenge to the ALJ’s determination about the extent of his wrist limitations, meaning he 

has abandoned this argument. See Access Now, Inc. v. Sw. Airlines Co., 385 F.3d 1324, 1330 

(11th Cir. 2004) (deeming abandoned an argument the appellant failed to raise in its initial brief).

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2.

Mr. Duval also argues that the ALJ erred in summarily rejecting the opinions 

of Dr. Martinez, the psychiatrist who treated Mr. Duval. Although Dr. Martinez 

opined that Mr. Duval had marked limitations in almost all areas of mental activity, 

we conclude that substantial evidence supports the ALJ’s conclusion that these 

opinions are unsupported by Dr. Martinez’s progress notes.

Dr. Martinez treated Mr. Duval for a short period of time—only one 

month—and saw Mr. Duval twice before opining about his mental impairments. 

Dr. Martinez’s notes from Mr. Duval’s first visit reflect that he had a cooperative 

attitude, intact impulse control, a clear and coherent thought process, age 

appropriate cognition, and intact insight and judgment. Given these progress notes 

from one of the two treatment sessions, substantial evidence supports the ALJ’s 

conclusion that the progress notes did not support Dr. Martinez’s opinions. 

Accordingly, the ALJ did not err in giving Dr. Martinez’s opinions less than 

considerable or substantial weight. 

B.

Mr. Duval also argues that the ALJ erred in relying on opinions from nontreating, non-examining medical providers that he had only minor limitations based 

on his seizure disorder and psychological conditions. His argument rests on the 

premise that it is error for an ALJ to credit opinions from a non-treating, nonUSCA11 Case: 15-10939 Date Filed: 12/29/2015 Page: 16 of 22
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examining medical provider “when contradicted by the opinions from a treating 

specialist whose opinions are consistent with the underlying record.” Appellant’s 

Br. at 31. Even assuming Mr. Duval has correctly stated the law, the principle is 

inapplicable here because substantial evidence supports the ALJ’s conclusion that 

treatment records failed to support the treating medical providers’ opinions. In 

other words, there was no error in the weight the ALJ gave to opinions of the nontreating, non-examining medical providers. 

IV. The ALJ’s Treatment of Mr. Duval’s Testimony

Mr. Duval also challenges the ALJ’s determination that his testimony about

the intensity, persistence and limiting effects of his symptoms was not credible to 

the extent that it was inconsistent with the ALJ’s residual functional capacity 

assessment and unsupported by medical evidence. He argues that the ALJ failed to 

apply the proper standard and that substantial evidence does not support the 

credibility determination. We are unconvinced.

When a claimant attempts to establish a disability through his own testimony 

concerning pain or other subjective symptoms, we require “(1) evidence of an 

underlying medical condition; and (2) either (a) objective medical evidence 

confirming the severity of the alleged pain, or (b) that the objectively determined 

medical condition can reasonably be expected to give rise to the claimed pain.” 

Wilson v. Barnhart, 284 F.3d 1219, 1225 (11th Cir. 2002). If the record shows that 

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the claimant has a medically determinable impairment that could reasonably be 

expected to produce his symptoms, the ALJ must evaluate the intensity and 

persistence of the symptoms in determining how they limit the claimant’s capacity 

for work. 20 C.F.R. §§ 404.1529(c)(1), 416.927(c)(1). The ALJ is not required to 

examine every piece of evidence so long as the decision does not broadly reject the 

claimant’s case and is sufficient for a reviewing court to conclude that the ALJ 

considered the claimant’s medical condition as a whole. See Mitchell v. Comm’r, 

Soc. Sec. Admin., 771 F.3d 780, 782 (11th Cir. 2014). “If proof of disability is 

based upon subjective evidence and a credibility determination is, therefore, 

critical to the decision, the ALJ must either explicitly discredit such testimony or 

the implication must be so clear as to amount to a specific credibility finding.” 

Foote v. Chater, 67 F.3d 1553, 1562 (11th Cir. 1995) (internal quotation marks 

omitted). 

The ALJ applied the correct legal standard when reviewing Mr. Duval’s 

credibility, and substantial evidence supports the ALJ’s credibility determination. 

The ALJ applied the three-step framework for evaluating subjective testimony 

from a claimant. In evaluating the intensity and persistence of symptoms, the ALJ 

concluded there were inconsistencies between Mr. Duval’s testimony and the 

objective medical evidence. For example, after finding that the medical records 

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contradicted Mr. Duval’s assertion that he had very limited use of his right hand, 

the ALJ discounted his testimony. 

Mr. Duval claims that the ALJ failed to provide any reason for finding his

subjective testimony about seizures,

7 headaches, and mental impairments to lack 

credibility. We disagree. The ALJ explained that Mr. Duval’s testimony was not 

credible to the extent it was unsupported by the objective medical evidence and 

then discussed at length why similar opinions from Mr. Duval’s treating medical 

providers were unsupported by the record. From this discussion, we can clearly 

infer what testimony from Mr. Duval the ALJ found lacking in credibility and why 

it was discredited. For example, the ALJ discussed the medical evidence showing 

that Mr. Duval’s seizures were controlled by medication, the severity of his

headaches was overstated, and he had only mild to moderate limitations based on 

his depression and anxiety. 

Mr. Duval also argues that the ALJ used improper boilerplate language that 

tied the credibility determination to the ALJ’s residual functional capacity

assessment. But we have previously affirmed credibility determinations using that 

formula when they did not broadly reject the claimant’s testimony. See Mitchell, 

771 F.3d at 781–82. We conclude that the ALJ committed no legal error when 

 

7 We note that Mr. Duval presented limited testimony about the frequency of his seizures 

and testified only about the frequency in March 2010, March 2012, and April 2012. It appears 

that Mr. Duval made a strategic decision not to testify about the frequency of his seizures in the 

intervening period when they occurred less frequently. 

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reviewing Mr. Duval’s testimony, and substantial evidence supports the ALJ’s 

determination that Mr. Duval’s testimony was only partially credible.

V. The ALJ’s Treatment of the VE’s Testimony

As explained above, the ALJ used the five-step sequential evaluation to 

determine whether Mr. Duval was disabled. See 20 C.F.R. §§ 404.1520(a)(4), 

416.920(a)(4) . Mr. Duval contends that the Commissioner failed to carry his 

burden at step five to show that significant numbers of jobs exist in the national 

economy that he can perform based on his residual functional capacity, age, 

education, and work experience. The Commissioner may demonstrate that a 

claimant is capable of performing other work through the testimony of a VE. See 

Wilson, 284 F.3d at 1227 (referring to VE testimony as the preferred independent 

evidence of jobs that are available in the national economy). A VE’s testimony 

constitutes substantial evidence if the ALJ poses a hypothetical question that 

includes all of a claimant’s impairments. Id. Although the ALJ is required to 

include each of the claimant’s impairments in the hypothetical question, there is no 

requirement that the question include alleged symptoms without support in the 

medical record or that are alleviated by medication. Ingram v. Comm’r of Social 

Sec. Admin., 496 F.3d 1253, 1270 (11th Cir. 2007). 

An ALJ must account for a claimant’s limitations in concentration, 

persistence, or pace in a hypothetical question to the VE. Winschel v. Comm’r of 

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Soc. Sec., 631 F.3d 1176, 1180 (11th Cir. 2011). An ALJ may account for these 

limitations by limiting the hypothetical to unskilled work “when medical evidence 

demonstrates that a claimant can engage in simple, routine tasks or unskilled work 

despite limitations in concentration, persistence, and pace.” Id. In Winschel, we 

concluded that the ALJ needed to include the claimant’s limitations in 

concentration, persistence, or pace in the hypothetical question to the VE because 

there was no indication from the medical evidence that the claimant could perform 

work despite his limitations. Id. at 1181.

The ALJ posed a proper hypothetical question that included all of Mr. 

Duval’s impairments. As discussed above, the ALJ’s credibility determinations 

that influenced the hypothetical question posed to the VE were supported by 

substantial evidence. Furthermore, the ALJ accounted for Mr. Duval’s moderate 

limitations in concentration, persistence, or pace by limiting him to simple, routine, 

and repetitive tasks, which medical evidence showed he could perform. Since the 

hypothetical question was proper, and the VE informed the ALJ that Mr. Duval 

could perform other jobs in the national economy that exist in significant numbers, 

the Commissioner met her burden to show that Mr. Duval was capable of 

performing other work.

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VI. Conclusion

For the reasons set forth above, the district court’s judgment is affirmed. 

AFFIRMED.

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