[DO NOT PUBLISH]

In the

United States Court of Appeals

For the Eleventh Circuit

____________________

No. 21-11794

Non-Argument Calendar

____________________

SCOTTY DEAN MILLER, 

Plaintiff-Appellant,

versus

COMMISSIONER OF SOCIAL SECURITY, 

Defendant-Appellee.

____________________

Appeal from the United States District Court

for the Middle District of Florida

D.C. Docket No. 5:20-cv-00058-PRL

____________________

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2 Opinion of the Court 21-11794

Before GRANT, LAGOA, and BRASHER, Circuit Judges.

PER CURIAM:

The Social Security Administration denied Scotty Miller’s 

claim for a period of disability and disability insurance benefits after 

deciding that he was not disabled within the meaning of the Social 

Security Act. In making that determination, the administrative law 

judge discredited the opinion of Miller’s treating physician without 

adequately explaining the reason for doing so. We therefore 

reverse the judgment of the district court upholding the denial of 

benefits with instructions to remand to the agency for further 

proceedings.

I. 

Scotty Miller applied for benefits in August 2016, claiming 

that he was unable to work because of a disabling condition he 

developed four years earlier. In his supporting paperwork, he 

explained that he was exposed to ehrlichiosis, a tick-borne illness, 

and had since suffered from chronic fatigue and pain along with 

other symptoms. Miller also submitted medical records that 

chronicled his treatment history from 2010 to 2017, when his 

disability insured status expired.

Following a hearing at which Miller and his wife testified 

about the severity of his symptoms, an ALJ determined that he was 

not entitled to disability benefits. The ALJ found that he had severe 

impairments: “Lyme disease, degenerative disc disease of the 

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21-11794 Opinion of the Court 3

cervical and lumbar spine, osteoarthritis right knee, allergic rhinitis 

and chronic pain syndrome.” The ALJ also determined that his 

impairments “could reasonably be expected to cause the alleged 

symptoms.” See 20 C.F.R. § 404.1529(b). The ALJ’s task was then 

to examine the record and “evaluate the intensity and persistence” 

of those symptoms to determine how they limited Miller’s 

“capacity for work.” See id. § 404.1529(c)(1).

When conducting that evaluation, the ALJ gave only 

“minimal weight” to the opinion of Dr. Daniel Cameron, one of 

Miller’s treating physicians. Dr. Cameron had completed a 

questionnaire in which he stated that he treated Miller for Lyme 

disease and that his prognosis was poor—Miller had been failing 

treatment, and he remained “severely ill.” The doctor described 

Miller’s pain as “intractable and virtually incapacitating,” and 

indicated that physical activity would increase the pain “to such a 

degree as to cause distraction from tasks or total abandonment of 

tasks.” He also opined that Miller could sit and stand or walk for 

less than two hours in an eight-hour workday; that he could 

occasionally lift less than 10 pounds; and that he had “significant 

limitations” in performing repetitive tasks with his hands. He 

stated that Miller’s impairments would require him to take 

unscheduled breaks and likely cause him to miss work more than 

four times a month. He reported that Miller was incapable of 

performing “even low stress jobs.”

The ALJ gave little weight to this opinion, stating that it was 

inconsistent with Dr. Cameron’s own treatment notes and the 

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4 Opinion of the Court 21-11794

other medical evidence in the record. After finding that Miller 

could perform a range of sedentary work, the ALJ determined that 

Miller was not disabled, because many jobs existed at that 

exertional level. See id. §§ 404.1520(g), 404.1567(a). The Appeals 

Council denied review, and the district court affirmed the denial of 

disability benefits. Miller now appeals.

II. 

Because the Appeals Council declined to review the ALJ’s 

decision, we review it as the Commissioner’s final decision. 

Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). We assess 

“whether the Commissioner’s decision is supported by substantial 

evidence and whether the correct legal standards were applied.” 

Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1257 (11th Cir. 2019). 

Substantial evidence is “such relevant evidence as a reasonable 

person would accept as adequate to support a conclusion.” 

Doughty, 245 F.3d at 1278 (quotation omitted).

III. 

Miller argues that the ALJ failed to adequately explain the 

reasons for discounting the opinion of Dr. Cameron, who began 

treating him in 2017. Regulations in force at the time that Miller 

applied for disability benefits required the ALJ to give “controlling 

weight” to a treating physician’s medical opinion if the opinion “is 

well-supported by medically acceptable clinical and laboratory 

diagnostic techniques and is not inconsistent with the other 

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21-11794 Opinion of the Court 5

substantial evidence” in the case record. 20 C.F.R. 

§ 404.1527(c)(2).1

This Circuit’s case law establishes that “a treating physician’s 

conclusions must be given substantial or considerable weight 

unless there is good cause to discount them.” Simon v. Comm’r, 

Soc. Sec. Admin., 7 F.4th 1094, 1104 (11th Cir. 2021) (quotations 

omitted). And good cause “exists when (1) the treating physician’s 

opinion was not bolstered by the evidence, (2) the evidence 

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

was conclusory or inconsistent with his or her own medical 

records.” Schink, 935 F.3d at 1259. If the ALJ chooses to discount 

a treating physician’s opinion, he “must clearly articulate the 

reasons” for doing so. Id.

When explaining the decision to assign only “minimal 

weight” to Dr. Cameron’s opinion, the ALJ stated that “his 

excessive limitations are not supported by his own treatment notes 

nor consistent with the rest of the medical evidence of record.” 

This justification is inadequate. The ALJ did not “clearly articulate 

what evidence led him to this conclusion.” Id. at 1263. And “no 

obvious inconsistency” exists between Dr. Cameron’s opinion and

1 This regulation only applies to disability claims filed before March 27, 2017. 

See 20 C.F.R. § 404.1527. We do not consider here how the regulation 

applicable to claims filed on or after that date “bears upon our precedents 

requiring an ALJ to give substantial or considerable weight to a treating 

physician’s opinions absent good cause to do otherwise.” Simon v. Comm’r, 

Soc. Sec. Admin., 7 F.4th 1094, 1104 n.4 (11th Cir. 2021).

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6 Opinion of the Court 21-11794

either his treatment notes or the rest of the medical evidence as 

described by the ALJ. See Simon, 7 F.4th at 1105; Schink, 935 F.3d 

at 1263.

The ALJ referred to Dr. Cameron’s treatment notes from 

Miller’s Lyme disease consultation in June 2017 and a follow-up 

visit in December 2017. As the ALJ summarized, Dr. Cameron 

conducted a physical examination during Miller’s initial visit in 

which he recorded “pain consistent with bursitis of the hips and 

shoulders.” The doctor also noted that Miller “displayed normal 

strength in all muscle groups,” “normal range of motion of all 

joints,” and “no muscle masses.” He recorded normal respiratory 

and neurologic results as well.

These observations, although “normal” in part, are not 

clearly inconsistent with Dr. Cameron’s opinion, which stated that 

Miller would have “good days” and “bad days” and that his pain 

significantly increased with activity. And Miller’s later report to 

Dr. Cameron that his medication “stabilizes his overall symptoms 

to the point that he was able to do some work” does not clearly 

show that his capabilities surpassed those that Dr. Cameron 

described in his opinion.

The ALJ also summarized other medical records from the 

years leading up to Miller’s treatment by Dr. Cameron. When he 

was hospitalized in 2012 with complaints of muscle pain, joint pain, 

fever, a mild cough, and nausea, Miller tested positive for a 

bacterial agent that causes ehrlichiosis. His primary care physician 

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21-11794 Opinion of the Court 7

diagnosed him with ehrlichiosis after he was discharged from the 

hospital.

Over the next two years, Miller continued to register 

complaints of pain with his physician, who diagnosed him with

allergic asthma, fibromyalgia, lumbar disc disorder, and fatigue, 

among other things. X-rays taken in 2015 revealed spondylitic 

changes in the cervical and lumbar spine and arthritic changes of 

the knees, which do not appear inconsistent with pain. A 

neurologic evaluation identified no “neurologic etiology of his 

diffuse pain,” but ruling out one potential cause of a symptom does 

not plainly undermine its severity—especially where a patient’s 

history indicates tick-transmitted infection as a likely cause. As the 

ALJ noted, the neurologist recorded a positive test and a negative 

test for Lyme disease, and referred Miller to an infectious disease 

specialist.

We do not see any obvious inconsistency between Dr. 

Cameron’s opinion and Miller’s treatment records. To the extent 

that the ALJ’s summary of Miller’s medical history referred to some 

“positive or neutral observations,” those are not enough to show a 

“genuine inconsistency” as required, because they “create, at most, 

a trivial and indirect tension with the treating physician’s opinion 

by proving no more than that the claimant’s impairments are not 

all-encompassing.” Simon, 7 F.4th at 1107 (quotations omitted). 

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8 Opinion of the Court 21-11794

The ALJ’s failure to clearly articulate good cause for discounting 

Dr. Cameron’s opinion requires that we remand.2 Id. at 1105.

* * *

On remand, the ALJ must reassess Miller’s testimony, giving 

appropriate weight to each medical opinion in the record. If the 

ALJ still finds Miller’s statements about the severity of his 

symptoms unpersuasive, the ALJ must specifically indicate the 

portion of the record that justifies that conclusion. See id. at 

1109–10.

We REVERSE the judgment of the district court and 

REMAND with instructionsto vacate the Commissioner’s decision 

and to remand to the Commissioner for further proceedings.

2 Miller also argues that the ALJ improperly “rejected” his own testimony 

about the severity of his impairments “solely based on the lack of objective 

medical evidence.” See 20 C.F.R. § 404.1529(c)(2); SSR 16-3p, 81 Fed. Reg. 

14166, 14169 (March 9, 2016). But the ALJ accorded some weight to Miller’s 

testimony and considered other available evidence in the record, including 

opinion evidence. The ALJ’s analysis also addressed some of the relevant 

factors listed in 20 C.F.R. § 404.1529(c)(3), such as the intensity of Miller’s pain 

and the effectiveness of treatment in controlling his symptoms. See 20 C.F.R. 

§ 404.1529(c)(3). We therefore do not remand on this basis.

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