Court Opinion

ID: 9353384
Source: CourtListenerOpinion
Date Created: 2023-01-11 19:01:14.518609+00
Date Added: 2024-06-11T17:07:44.324360
License: Public Domain

USCA11 Case: 21-13175    Document: 24-1      Date Filed: 01/11/2023    Page: 1 of 24

                                                    [DO NOT PUBLISH]
                                    In the
                 United States Court of Appeals
                         For the Eleventh Circuit

                           ____________________

                                 No. 21-13175
                           Non-Argument Calendar
                           ____________________

        BENJAMIN MORALES, JR.,
                                                       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. 6:20-cv-00724-GKS-DCI
                           ____________________
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        2                     Opinion of the Court                21-13175

        Before WILSON, LUCK, and HULL, Circuit Judges.
        PER CURIAM:
               Benjamin Morales, Jr., appeals the district court’s order
        affirming the Social Security Administration (“SSA”)
        Commissioner’s denial of his application for supplemental security
        income (“SSI”). After review, we affirm the district court’s order.
                             I.     BACKGROUND
        A.    Morales’s Application
               On November 29, 2016, Morales applied for SSI, alleging
        that he was disabled since January 16, 2016. He later amended the
        alleged onset date to November 29, 2016, the date of his
        application.
               After the SSA denied Morales’s claim, Morales requested a
        hearing before an administrative law judge (“ALJ”). On May 16,
        2019, the ALJ held a hearing, heard testimony from Morales, and
        reviewed extensive medical records. We outline the relevant
        evidence.
        B.    Morales’s Testimony
               Morales testified that he was an unemployed, 48-year-old
        high school graduate. Morales lived at home with his mother and
        his three-year-old son. Morales explained that he had tried to find
        work but stopped looking because he was never hired.
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        21-13175               Opinion of the Court                       3

                Morales had back problems due to his former profession as
        a break dancer, which caused stenosis, lumbar problems, and neck
        problems. Morales had a lot of back spasms with pain that spread
        to his arms and legs. He was using a walking cane for about a year
        and a half to take pressure off of his back. He took hydrocodone
        three times per day for his back pain, but it was not very effective
        because it reduced his pain from a ten to only a seven or eight on a
        ten-point scale.
               Morales woke up every morning with crying spells due to
        his depression. Morales had two or three panic attacks each day,
        even though he regularly took medication for anxiety. Because of
        his back problems and anxiety, Morales could sleep for only about
        six hours on a good night and four hours or less on a bad night. He
        got headaches about four times per week, each lasting about 30 or
        40 minutes.
                Morales could not lift his son, and his epilepsy made him
        afraid to carry his son. He did his own laundry but could not carry
        a full laundry basket. He sometimes drove, but his anxiety
        prevented him from driving much. Typically, he stayed in his
        room and watched television. Morales had friends who would visit
        him, but he would not go out to social activities. He regularly
        attended religious services with his mother, but he struggled to sit
        for long periods of time.
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        4                          Opinion of the Court                        21-13175

        C.      Vocational Expert’s (“VE”) Testimony
                The ALJ posed two hypotheticals to the VE who testified.
        First, the ALJ asked the VE whether there would be jobs in the
        national economy for a person who (1) is able to perform at the
        “light” exertional level; (2) could never climb ladders, ropes, or
        scaffolds; (3) could occasionally climb ramps or stairs; (4) could
        occasionally balance, stoop, kneel, crouch, or crawl; (5) could have
        no exposure to excessive vibration, unprotected heights, or
        hazardous machinery; (6) was limited to simple routine tasks with
        only occasional interaction with the public and coworkers; (7) had
        “no production quota” 1; (8) had only occasional supervision; and
        (9) was limited to low-stress work, with only occasional
        decision-making and occasional changes in the work setting. The
        VE responded that there would be jobs in the national economy
        with those limitations, including (1) a cafeteria attendant 2; (2) a
        cleaner/housekeeper; and (3) a folder.
               Second, the ALJ asked the VE the same hypothetical with
        the same limitations, except the ALJ reduced the exertional
        limitation to “sedentary.” The VE testified that this individual
        could perform work as (1) an address clerk; (2) a table worker; and

        1 The ALJ clarified that by “no production quota,” he meant “no strict
        production standard and no rigid production pace, such as an automated line
        outside the worker’s control.”
        2 Later, the VE clarified that, although the cafeteria attendant position required

        being in public, it did not require interaction with the public.
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        21-13175                   Opinion of the Court                               5

        (3) a sorter. The VE stated that there would be a few other jobs,
        but one or more absences per month would preclude work by the
        seventh month.
               The VE confirmed that her testimony was consistent with
        the Dictionary of Occupational Titles (“DOT”) and its companion
        publications. The VE acknowledged that the limitations for
        interactions with the public and coworkers and the “fast-paced
        production rate” were not addressed by the DOT. Thus, the VE
        had relied on her experience and training as a vocational counselor
        to identify jobs meeting the limitations in the two hypotheticals.
        D.     Medical History for Morales’s Mental Impairments
               From 2012 to 2019, Morales regularly sought mental health
        treatment from Impower providers. Morales’s June 2012 intake
        form noted a Global Assessment of Functioning (“GAF”) score of
        48 and diagnoses of depressive disorder, bipolar II disorder, and
        seizures. 3

        3 The GAF is a numeric scale (0 through 100) intended to rate the
        psychological, social, and occupational functioning of adults. See American
        Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders
        32–33 (4th ed. 2000). Scores between 51 and 60 indicate moderate difficulty in
        functioning, whereas lower scores between 41 and 50 indicate serious
        difficulty in functioning. Id. at 34.
                 As noted later, both the 2013 and 2022 versions of the fifth edition of
        the Diagnostic and Statistical Manual of Mental Disorders no longer use GAF
        scores for several reasons, including their inconsistent nature due to the lack
        of standardization. See American Psychiatric Association, Diagnostic and
        Statistical Manual of Mental Disorders 16 (5th ed. 2013); American Psychiatric
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        6                         Opinion of the Court                     21-13175

              From April to August 2016, Morales saw Impower
        psychiatrist Najib Kirmani, M.D., three times for mental health
        treatment. At the April 2016 visit, Dr. Kirmani assigned him a GAF
        score of 65. In June 2016, Dr. Kirmani reported that Morales’s
        mood had improved, and in August 2016, Dr. Kirmani noted
        Morales’s mood was stable.
              In September 2016, Morales saw an Impower counselor and
        reported struggling with being impulsive, angry, nervous, and
        anxious and having mood swings. The counselor assigned him a
        GAF score of 60.
               In June 2017, Morales saw Dr. Kirmani again after his father
        passed away. Dr. Kirmani prescribed a new medication and
        assigned a GAF score of 48.
               In July 2017, Morales saw Impower psychiatrist Kazi
        Ahmad, M.D. Morales reported feeling tense and irritable, lashing
        out, screaming, and punching walls. Dr. Ahmad diagnosed him
        with intermittent explosive disorder, added a new prescription, and
        assigned him a GAF score of 48.
               Later that month, Morales met with an Impower counselor
        about his ongoing anxiety and depression, and the counselor
        assigned him a GAF score of 60.

        Association, Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed.
        text rev. 2022).
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        21-13175               Opinion of the Court                       7

               In August 2017, Morales saw Dr. Ahmad again and reported
        feeling less anxiety and denied feeling tension, irritability, and
        depression. Despite these improvements, Dr. Ahmad assigned him
        a GAF score of 48.
               Morales was assigned a GAF score of 48 during his visits on
        the following dates: December 20, 2017; December 28, 2017;
        January 23, 2018; February 20, 2018; March 20, 2018; April 9, 2018;
        May 7, 2018; June 12, 2018; July 2, 2018; July 30, 2018; August 20,
        2018; October 19, 2018; November 12, 2018; December 4, 2018;
        December 31, 2018; January 21, 2019; February 14, 2019; March 14,
        2019; and April 11, 2019. During that same time, however, a
        counselor assigned Morales a GAF score of 60 on April 10, 2018 and
        65 on July 14, 2018.
        E.    Medical History for Morales’s Physical Impairments
               From November 2015 to January 2017, Morales regularly
        saw primary care physician Son Chau, M.D., and nurse practitioner
        Lindsay Marlene, ARNP. They assessed Morales as having chronic
        pain, prescribed pain medication, and referred Morales for physical
        therapy and to a neurosurgeon.
                In April 2016, Morales had an MRI of both his cervical spine
        (i.e., neck area) and lumbar spine (i.e., back area). For the April
        2016 cervical spine MRI, there are no results listed for C1-C2, but
        the results for the rest of the intervertebral discs and motion
        segments showed the following:
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        8                    Opinion of the Court                21-13175

             C2-C3:     No significant disc bulge or protrusion is
                        identified.        No significant facet
                        osteoarthropathy or canal or foraminal
                        stenosis is noted.
             C3-C4:     No significant disc bulge or protrusion is
                        identified. Mild left foraminal stenosis and
                        facet arthropathy. No right foraminal or
                        central canal stenosis.
             C4-C5:     Right paracentral disc protrusion and
                        subjacent thin spondylitic ridge. Moderate
                        right foraminal stenosis. No left foraminal
                        stenosis. Mild central spinal stenosis. No
                        facet abnormality.
             C5-C6:     No significant disc bulge or protrusion is
                        identified. Mild left foraminal stenosis. No
                        right foraminal or central canal stenosis.
             C6-C7:     Left medial foraminal disc protrusion.
                        Mild left foraminal stenosis. No right
                        foraminal or central canal stenosis.
             C7-T1:     No significant disc bulge or protrusion is
                        identified.        No significant facet
                        osteoarthropathy or canal or foraminal
                        stenosis is noted.
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        21-13175             Opinion of the Court                         9

        (Emphasis added.) And the April 2016 lumbar spine MRI showed
        the following:
              L1-L2:    No significant disc bulge or protrusion is
                        identified.        No significant facet
                        osteoarthropathy or canal or foraminal
                        stenosis is noted.
              L2-L3:    No significant disc bulge or protrusion is
                        identified.        No significant facet
                        osteoarthropathy or canal or foraminal
                        stenosis is noted.
              L3-L4:    Desiccation of the disc. Mild retrolisthesis.
                        Mild disc bulge. No spinal stenosis. Mild
                        bilateral foraminal stenosis. No significant
                        facet or ligamentum flavum hypertrophy.
              L4-L5:    Mild disc bulge. No spinal stenosis. Mild
                        bilateral foraminal stenosis. There is
                        bilateral facet hypertrophy.
              L5-S1:    Mild retrolisthesis. There is desiccation of
                        the disc with disc space narrowing. There
                        is a focal central protrusion encroaching
                        upon the ventral sac of the thecal sac.
                        There is mild spinal stenosis. Mild bilateral
                        foraminal stenosis. There is no significant
                        facet or ligamentum flavum hypertrophy.
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        10                     Opinion of the Court                21-13175

                In June 2017, Morales saw primary care physician Bella
        Dattani, M.D., for a consultative examination at the request of a
        State agency. Dr. Dattani reviewed Morales’s April 2016 cervical
        and lumbar spine MRIs and his treatment notes. Dr. Dattani noted
        that Morales was “generally healthy with no deficits” and had no
        stiffness, pain, or tenderness in his neck. Dr. Dattani recorded that
        (1) her examination of Morales’s cervical spine revealed no
        tenderness of the spinous process or evidence of paravertebral
        muscle spasms near the cervical spine and (2) her examination of
        Morales’s dorsolumbar spine showed no paravertebral spasms on
        the lumbar spine or tenderness over the spinous process.
              In November 2018, Morales saw Dr. Chau again about his
        neck and back pain getting worse. Dr. Chau noted that Morales
        reported his symptoms of cervical problems were getting worse,
        and Dr. Chau ordered an MRI of the cervical spine.
              In January 2019, Morales had an MRI of his cervical spine,
        which showed the following:
               C1-C2:     Mild osteoarthritis between anterior arch
                          of C1 and the odontoid process.
               C2-C3:     There is no disc protrusion. No central
                          canal stenosis. No neural foraminal
                          narrowing.
               C3-C4:     Mild concentric disc bulge measuring 1-2
                          mm in AP extent. There is no disc
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        21-13175               Opinion of the Court                       11

                          protrusion. No central canal stenosis. No
                          neural foraminal narrowing.
               C4-C5:     Mild concentric disc bulge measuring 1-2
                          mm in AP extent. There is severe right
                          neural foraminal narrowing related to
                          uncovertebral joint arthritis. Mild central
                          canal narrowing. No significant left
                          foraminal stenosis or facet arthropathy.
               C5-C6:     Mild concentric disc bulge measuring 1-2
                          mm in AP extent. Mild left foraminal
                          stenosis. No right foraminal stenosis. No
                          facet arthropathy.
               C6-C7:     There is no disc protrusion. No central
                          canal stenosis. No neural foraminal
                          narrowing.
               C7-T1:     There is no disc protrusion. No central
                          canal stenosis. No neural foraminal
                          narrowing.

        (Emphasis added.)
               The differences between the April 2016 cervical spine MRI
        and the January 2019 cervical spine MRI are twofold. First, several
        parts of Morales’s cervical spine improved. Unlike the April 2016
        cervical spine MRI, the January 2019 cervical spine MRI showed
        (1) no mild bilateral foraminal stenosis at C3-C4, (2) no spondylitis
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        12                      Opinion of the Court                 21-13175

        issues at C4-C5, (3) no mild left foraminal stenosis at C6-C7, and
        (4) no left medial foraminal disc protrusion at C6-C7. Second,
        though, it indicated new mild concentric disc bulges at C3-C4 and
        C5-C6 and the right foraminal stenosis at the C4-C5 level changed
        from moderate to severe.
                In February, March, and April 2019, Morales saw primary
        care physician, Jose Sosa, M.D., for a physical examination because
        of neck and back pain. At the first visit in February 2019, Dr. Sosa
        noted “neck pain to movement,” but he did not do so at subsequent
        visits.
              Notably, at all three visits, Dr. Sosa’s examinations revealed
        a supple neck with normal range of motion and normal
        neurological findings related to motor strength and sensation.
        F.     The ALJ’s Decision
                Eligibility for SSI benefits requires that the claimant be
        disabled. 20 C.F.R. § 416.912(a). To determine whether a claimant
        is disabled, the ALJ engages in a five-step process. Id. § 404.1520(a).
        Following the five-step process, the ALJ determined that:
        1.     Morales had not engaged in substantial gainful activity since
               his alleged onset date in November 2016;
        2.     Morales had four severe impairments: generalized anxiety
               disorder;       major        depressive     disorder/bipolar
               disorder; intermittent explosive disorder; and degenerative
               disc disease of the cervical and lumbar spine;
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        21-13175               Opinion of the Court                       13

        3.    Morales’s impairments, either alone or in combination, did
              not meet the criteria of any of the listed impairments;
        4.    Morales had the residual functional capacity (“RFC”) to
              perform a range of light work, with certain restrictions; and
        5.    Morales had no past relevant work, and considering
              Morales’s age, education, work experience, and RFC, three
              jobs—cafeteria attendant, cleaner/housekeeper, and
              folder—existed in the national economy that he could
              perform.
                 With respect to Morales’s RFC (step four, noted above), the
        ALJ found that Morales could (1) lift up to 20 pounds occasionally,
        (2) lift and carry up to 10 pounds frequently, and (3) stand and walk
        with normal breaks for about six hours in an eight-hour workday.
        The ALJ also found that Morales could never climb ladders, ropes,
        or scaffolds and could not have any exposure to excessive vibration,
        unprotected heights, or hazardous machinery, but he could
        occasionally climb ramps and stairs and occasionally balance,
        stoop, kneel, crouch, and crawl. The ALJ found that Morales could
        perform simple, routine tasks in a low-stress job and that “such
        work c[ould] have no production quota (e.g., no strict production
        standard and no rigid production pace, such as an automated line
        that the worker cannot control).”
              Also at step four, the ALJ summarized Morales’s testimony
        and found that Morales’s impairments could reasonably be
        expected to cause his alleged symptoms but that his statements
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        14                    Opinion of the Court                21-13175

        about the intensity, persistence, and limiting effects of his
        symptoms were not entirely consistent with the medical evidence
        and other evidence in the record. The ALJ reviewed Morales’s
        mental health treatment history and concluded that Morales’s
        “mental impairments, while severe, [were] largely controlled by
        psychotropic medication and therapy.”
                The ALJ stressed that in multiple examinations in 2019,
        Morales “was medication compliant without side effects, and that
        [his] anxiety was manageable, denied pain, and had good sleep and
        normal energy.” The ALJ noted that on some occasions, Morales’s
        mental health providers gave him various GAF scores. The ALJ
        gave these GAF scores little weight and explained why:
              GAF scores, as a general matter, do not describe
              specific work[-]related limitations or objective mental
              abnormalities. They consider psychological, social[,]
              and occupational functioning whereas Social Security
              is primarily concerned with occupational functioning.
              Moreover, since they reflect the individual clinician’s
              judgment, scoring can vary considerably from
              practitioner to practitioner. Further, they typically
              represent current functioning, not longitudinal
              functioning          over        12         continuous
              months. . . . Consistent with the above observations,
              the latest version of the Diagnostic and Statistical
              Manual of Mental Disorders . . . no longer utilizes
              GAF scores because of their “conceptual lack of
              clarity” and “questionable psychometric in routine
              practice.”
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        21-13175               Opinion of the Court                      15

        (Emphasis added.)
               In reviewing Morales’s medical history, the ALJ concluded
        Morales had “some spine issues, [but] his seizure disorder and
        hyperlipidemia seem[ed] relatively controlled.” To support his
        RFC determinations, the ALJ summarized the findings in Morales’s
        April 2016 MRI of his cervical and lumbar spine. The ALJ did not
        explicitly reference or discuss the January 2019 cervical spine MRI
        or its findings about Morales’s neck area. However, the ALJ
        pointed out that, as recently as April 2019, Dr. Sosa had indicated
        Morales was not in acute distress, exhibited normal range of neck
        motion with no pain noted, and had normal motor strength.
               At step five, the ALJ noted that Morales could not perform
        a full range of light work, and thus the ALJ relied on the VE’s
        testimony as to the existence of unskilled jobs—cafeteria attendant,
        cleaner/housekeeper, and folder—that an individual with
        Morales’s restrictions could perform. The ALJ “determined that
        the [VE’s] testimony [was] consistent with the information
        contained in the DOT.” The ALJ acknowledged the VE’s
        explanation that because “the DOT did not address absences or
        being off-task, interactions with co-workers and the public, or
        fast-paced production,” the VE had relied on her experience and
        training on these issues.
               Ultimately, the ALJ determined that Morales was “not
        disabled” and thus did not qualify for SSI.
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        16                      Opinion of the Court                 21-13175

        G.     Appeals Council
              Morales appealed the ALJ’s decision to the Appeals Council,
        which denied his request for review on March 2, 2020.
        H.     District Court Proceedings
               On April 27, 2020, Morales sought review of the
        Commissioner’s final decision in the district court. A magistrate
        judge recommended that the Commissioner’s decision be reversed
        and remanded. The district court rejected the magistrate judge’s
        report and recommendation and affirmed the Commissioner’s
        decision. Morales timely appealed.
                         II.    STANDARD OF REVIEW
                Our review in a social security case is the same as that of the
        district court. Martin v. Sullivan, 894 F.2d 1520, 1529 (11th Cir.
        1990). We review de novo the legal principles on which the ALJ’s
        decision was based. Simon v. Comm’r, Soc. Sec. Admin., 7 F.4th
        1094, 1103 (11th Cir. 2021). But “[w]e may not decide the facts
        anew, reweigh the evidence, or substitute our judgment for that of
        the [Commissioner].” Bloodsworth v. Heckler, 703 F.2d 1233, 1239
        (11th Cir. 1983). Rather, we must defer to the Commissioner’s
        decision if it is supported by substantial evidence. Id. “Substantial
        evidence is more than a scintilla, but less than a preponderance. It
        is such relevant evidence as a reasonable person would accept as
        adequate to support a conclusion.” Id. “If the Commissioner’s
        decision is supported by substantial evidence[,] we must affirm,
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        21-13175               Opinion of the Court                       17

        even if the proof preponderates against it.” Miles v. Chater, 84 F.3d
        1397, 1400 (11th Cir. 1996).
                               III.   DISCUSSION
              On appeal, Morales argues (1) the ALJ’s decision was not
        supported by substantial evidence because the ALJ failed to
        consider his January 2019 cervical spine MRI; (2) the ALJ
        improperly gave little weight to his GAF scores; and (3) the ALJ
        erred by failing to resolve inconsistencies between the VE’s
        testimony and the DOT. We address each argument in turn.
        A.    January 2019 Cervical Spine MRI
               Morales argues that the ALJ erred by failing to consider his
        January 2019 cervical spine MRI, which showed “severe” right
        foraminal stenosis at the C4-C5 level. Relying on Cowart v.
        Schweiker, 662 F.2d 731, 735 (11th Cir. 1981), Morales stresses that
        ALJs are required to explain the weight accorded to “obviously
        probative” exhibits. And, according to Morales, the January 2019
        cervical spine MRI is an “obviously probative” exhibit.
               On the other hand, the Commissioner emphasizes that Dyer
        v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005), says “there is no
        rigid requirement that the ALJ specifically refer to every piece of
        evidence in his decision.” So, according to the Commissioner, the
        ALJ did not err because the ALJ clearly considered Morales’s neck
        condition as a whole.
              The Commissioner also argues Cowart does not apply to the
        facts of Morales’s case.     In Cowart, the claimant was
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        18                     Opinion of the Court                 21-13175

        unrepresented, and the Court explained that, under those
        circumstances, an ALJ’s “basic obligation to develop a full and fair
        record rises to a special duty,” which “requires the ALJ to
        scrupulously and conscientiously probe into, inquire of, and
        explore for all the relevant facts.” 662 F.2d at 735 (quotation marks
        omitted). The Court concluded the ALJ in Cowart failed to fully
        and fairly develop the record, in part, by not providing and
        explaining the weight he accorded to the various testimony he
        considered. Id. The Commissioner contends that because Morales
        was represented at the administrative level, the ALJ had no special
        duty like the ALJ in Cowart to state specifically the weight
        accorded to “obviously probative” exhibits and why he reached
        that decision.
               We need not resolve this debate. We assume—without
        deciding—that (1) the January 2019 cervical spine MRI was an
        “obviously probative” exhibit and (2) the ALJ erred by not
        discussing or explaining the weight given to that MRI. But such an
        error—which, again, we are assuming to have occurred—was
        harmless in light of all the medical evidence. See Diorio v. Heckler,
        721 F.2d 726, 728 (11th Cir. 1983) (applying harmless error review
        to an ALJ’s determination that a claimant was not disabled).
               The ALJ found Morales’s severe impairments, including
        degenerative disc disease of the cervical spine, significantly limited
        his ability to perform basic work activities and, as a result, imposed
        greater limitations in determining Morales’s RFC. The ALJ
        extensively reviewed Morales’s medical records and the medical
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        21-13175                Opinion of the Court                        19

        opinion evidence, in which most of his treating medical providers’
        examinations noted normal findings of the musculoskeletal system
        and specifically that Morales had suppleness and full range of
        motion in his neck, frequently reported no neck pain, and was not
        in any acute distress. Similarly, Morales’s exam with consulting
        physician Dr. Dattani revealed full range of motion in Morales’s
        neck and no tenderness of the spinous process or evidence of
        paravertebral muscle spasms near the cervical spine.
                And, after Morales’s January 2019 cervical spine MRI, Dr.
        Sosa examined Morales in February, March, and April 2019.
        Although at two visits Morales complained of neck and back pain,
        Dr. Sosa, like Morales’s previous medical providers, noted
        generally normal examination results, including a supple neck with
        full range of motion. And Dr. Sosa noted “neck pain to movement”
        at the February 2019 visit, but he did not do so at subsequent visits.
        In other words, despite the change to the right foraminal stenosis
        at the C4-C5 level, Dr. Sosa observed substantially the same
        findings as prior medical providers had observed before the January
        2019 cervical spine MRI.
               Further, as noted above, the January 2019 cervical spine MRI
        is arguably less favorable to Morales because several of Morales’s
        conditions improved. Indeed, the only unfavorable change
        Morales specifically identified is that his right foraminal stenosis at
        the C4-C5 level had worsened from “moderate” to “severe.”
              Lastly, while the ALJ did not explicitly discuss the January
        2019 cervical spine MRI in his decision, the hearing transcript
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        20                     Opinion of the Court                 21-13175

        shows the ALJ introduced Exhibit B16F into the record, and the
        ALJ specifically referred to the January 2019 cervical spine MRI on
        page 34 of that exhibit.
               Under the totality of these circumstances, we conclude the
        January 2019 cervical spine MRI would not have altered the ALJ’s
        handling of Morales’s statements of the intensity, persistence, and
        limiting effects of his neck pain or the ALJ’s RFC determination. As
        such, any error on the ALJ’s part in failing to specifically weigh the
        January 2019 cervical spine MRI was harmless.
        B.    GAF Scores
              Next, we consider Morales’s argument that the ALJ
        improperly gave little weight to his GAF scores. According to
        Morales, the ALJ’s statement that his GAF scores were unreliable
        was boilerplate and nonspecific.
               We readily conclude the ALJ did not err in assigning
        Morales’s GAF scores “little weight.” The ALJ stated with
        particularity the reasons for giving Morales’s GAF scores little
        weight: He reasoned that GAF scores are subjective and not
        pertinent to a legal determination about disability.
              Both the SSA and this Court have recognized the subjective
        nature and unreliability of GAF scores and emphasized GAF scores
        are not dispositive when determining disability. See U.S. Soc. Sec.
        Admin., Office of Disability Programs, AM-13066, Global
        Assessment of Functioning (GAF) Evidence in Disability
        Adjudication (July 22, 2013) REV (Oct. 14, 2014) REV 2 (Mar. 27,
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        21-13175               Opinion of the Court                      21

        2017) (both the 2013 and 2017 versions highlighting multiple
        problems with using GAF scores to evaluate disability, observing
        that GAF scores lack standardization, and stating that a GAF rating
        alone is never dispositive of impairment severity); Schink v.
        Comm’r of Soc. Sec., 935 F.3d 1245, 1266 (11th Cir. 2019) (“We
        recognize that GAF scores are by no means dispositive of a
        claim . . . .”); McGriff v. Comm’r, Soc. Sec. Admin., 654 F. App’x
        469, 471 (11th Cir. 2016) (unpublished) (recognizing that “[a] GAF
        score is a subjective determination”).
                And, as the ALJ noted, the Diagnostic and Statistical Manual
        of Mental Disorders no longer uses GAF scores because of their
        “conceptual lack of clarity” and “questionable psychometrics in
        routine practice.”       See American Psychiatric Association,
        Diagnostic and Statistical Manual of Mental Disorders 16 (5th ed.
        2013); see also American Psychiatric Association, Diagnostic and
        Statistical Manual of Mental Disorders 16 (5th ed. text rev. 2022)
        (recognizing GAF scores are no longer used).
               Moreover, the ALJ’s reasons for giving little weight to
        Morales’s GAF scores were supported by the record. From 2012 to
        2019 Morales’s GAF score remained mostly at 48, even when
        mental status examinations showed normal findings and treatment
        notes detailing his progress showed improvement with medication
        and therapy. As an example, on July 31, 2017, an Impower
        counselor assigned Morales a GAF score of 60, but the next month
        on August 24, 2017, his GAF score decreased to 48 even though
        Morales (1) reported he was “doing well” and feeling less anxious
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        22                    Opinion of the Court                21-13175

        and (2) denied feeling tension, irritability, and depression.
        Similarly, between December 2017 and April 2018, Morales
        regularly received a GAF score of 48, but then on April 10, 2018, a
        provider assigned him a GAF score of 60.
               Finally, as the ALJ explained, Morales’s records of
        psychiatric treatment between 2012 and 2019 indicated that
        Morales’s mental impairment was largely controlled by medication
        and therapy. Despite Morales’s diagnoses and his reported issues
        with impulsivity, anger, anxiety, and depression, by 2019 Morales
        reported to his mental health providers that his anxiety was
        manageable, he denied having panic attacks, and he reported good
        sleep and normal energy. In light of the ALJ’s thorough
        consideration of Morales’s treatment notes from mental health
        providers showing Morales’s improvement, the ALJ did not err by
        giving Morales’s GAF scores little weight based on their subjective
        and unreliable nature.
        C.    VE’s Testimony and the DOT
                Lastly, we address Morales’s argument that the ALJ erred by
        failing to resolve inconsistencies between the VE’s testimony and
        the temperaments required of the three jobs that the ALJ found
        Morales could perform at step five. Morales contends that,
        according to the Revised Handbook for Analyzing Jobs (“RHAJ”)
        published by the U.S. Department of Labor, all three jobs have an
        “R” temperament, which indicates “[p]erforming repetitive work,
        or performing continuously the same work, according to set
        procedures, sequence, or pace.” But, according to Morales, that
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        21-13175               Opinion of the Court                      23

        temperament is inconsistent with the ALJ’s specified limitations of
        “no rigid production pace” and “no strict production standard.” So
        he says a conflict exists between the VE’s testimony and the DOT.
               According to Social Security Ruling 00-4p (“SSR 00-4p”),
        neither the VE’s testimony nor the DOT automatically trumps
        when there is a conflict between the two. SSR 00-4p, 65 Fed. Reg.
        75759-01, 75760 (Dec. 4, 2000). Instead, where a VE provides
        evidence about a job’s requirements, the ALJ has an affirmative
        duty to inquire about any possible conflict between that evidence
        and information provided in the DOT. Id. Where the VE’s
        evidence is inconsistent with the information in the DOT, the ALJ
        must resolve the conflict by eliciting a reasonable explanation from
        the VE before relying on the VE’s evidence to support a
        determination that a claimant is or is not disabled. Id. Although
        SSR 00-4p is not binding on this Court, the SSA is bound to follow
        it. Washington v. Comm’r of Soc. Sec., 906 F.3d 1353, 1361 (11th
        Cir. 2018).
               Here, Morales has pointed to no conflict between the VE’s
        testimony and the DOT. An ALJ is required to inquire and resolve
        conflicts only between VE testimony and “information in the
        [DOT], including its companion publication, the Selected
        Characteristics of Occupations [(“SCO”)] . . . , published by the
        Department of Labor.” SSR 00-4p, 65 Fed. Reg. at 75759. SSR
        00-4p does not mention the RHAJ, and there is no indication the
        DOT or SCO incorporates the RHAJ. Because Morales focuses on
        information outside the DOT and SCO, the ALJ’s duty under SSR
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        24                    Opinion of the Court                 21-13175

        00-4p was not triggered, and we need not address any alleged
        conflict between the VE’s testimony and any temperament
        requirements from the RHAJ.
                             IV.    CONCLUSION
              For these reasons, we affirm the district court’s order.
              AFFIRMED.