Court Opinion

ID: 9914531
Source: CourtListenerOpinion
Date Created: 2024-01-02 16:00:58.867942+00
Date Added: 2024-06-11T13:13:46.762087
License: Public Domain

USCA11 Case: 22-13674    Document: 31-1      Date Filed: 01/02/2024   Page: 1 of 19

                                                    [DO NOT PUBLISH]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

                           ____________________

                                 No. 22-13674
                           Non-Argument Calendar
                           ____________________

        APRIL LA REE EPPS,
                                                       Plaintiﬀ-Appellant,
        versus
        SOCIAL SECURITY ADMINISTRATION, COMMISSIONER,

                                                     Defendant-Appellee.

                           ____________________

                  Appeal from the United States District Court
                     for the Northern District of Alabama
                     D.C. Docket No. 4:20-cv-01340-CLM
                           ____________________
USCA11 Case: 22-13674      Document: 31-1     Date Filed: 01/02/2024     Page: 2 of 19

        2                      Opinion of the Court                22-13674

        Before NEWSOM, ABUDU, and HULL, Circuit Judges.
        PER CURIAM:
               April La Ree Epps appeals the district court’s order affirming
        the denial of her application for a period of disability, disability
        insurance benefits, and supplemental security income benefits. On
        appeal, Epps raises several issues relating to the Administrative
        Law Judge’s (“ALJ”) evaluation of her treating physician’s opinion
        of Epps’s physical capacities. After careful review, we find no error
        in the ALJ’s handling of this evidence and affirm.
                                I. BACKGROUND
        A.    2017 Application
               On July 26, 2017, Epps applied for benefits, alleging she
        became disabled on August 1, 2016. At the time of her hearing,
        Epps was a 38-year-old mother of five children, ages 16, 12, 7, 4,
        and 2, and lived with her boyfriend.
               For a few years leading up to her application, Epps was self-
        employed, buying items and reselling them online and at auctions.
        Epps’s application indicated she stopped working on August 1,
        2016 due to her ailments, including anxiety, panic disorder,
        obsessive-compulsive disorder, non-essential tremors, migraines,
        degenerative disc disease in her neck, crooked spine, and limited
        use of her arms.
USCA11 Case: 22-13674        Document: 31-1       Date Filed: 01/02/2024       Page: 3 of 19

        22-13674                 Opinion of the Court                             3

        B.     Medical Conditions
               Epps was in a serious car accident when she was 14 years old
        and has a long history of hip, back, and neck pain. In approximately
        2014, Epps was in another car accident that worsened those
        conditions. In 2016, Epps began suffering from what she
        considered her most severe problem, constant headaches
        accompanied by ringing in the ears and dizziness. Epps’s
        headaches sometimes lasted for days or weeks or became so painful
        that she went to the emergency room for treatment. Epps also
        suffers from anxiety, panic attacks, and depression.
              In July 2017, after she stopped working in 2016, Epps was
        diagnosed with a Baker’s cyst behind her right knee. 1 August 2018,
        Epps had Baker’s cysts behind both knees. And, in the six months
        leading up to her ALJ hearing, Epps began experiencing edema that
        caused weight gain and joint pain.
               Between 2016 and 2019, Epps’s doctors prescribed
        medications for pain, migraines, inflammation, anxiety, and
        depression. She was also prescribed Lasix and support stockings
        for her edema and physical therapy for knee pain.
              Yet, over the same period, her doctors ordered diagnostic
        imaging, including CTs, MRIs, and x-rays, of Epps’s head, lumbar

        1 Baker’s cysts are fluid-filled growths behind the knee causing a bulge and

        tightness. Baker cyst, Mayo Clinic, https://www.mayoclinic.org/diseases-
        conditions/bakers-cysts/symptoms-causes/syc-20369950 (last visited Nov. 21,
        2023).
USCA11 Case: 22-13674      Document: 31-1      Date Filed: 01/02/2024     Page: 4 of 19

        4                      Opinion of the Court                 22-13674

        spine, cervical spine, and knees, that showed no abnormal results
        apart from the small cysts in her knees and mild degenerative
        changes in the sacroiliac joints of her lumbar spine.
        C.    ALJ Hearing in 2019
              At an April 4, 2019 hearing before the ALJ, Epps and a
        vocational expert (“VE”) testified.
               Epps described her headaches as constant, rating them a 10
        (on a pain scale of 0 to 10) for 15 days in a 30-day period, with only
        one or two good days in a month. She had back and hip pain 20
        days in a month, with her back pain staying at a 3 or 4 and her right
        hip pain rising to an 8 or 9 for 10 of those 20 days. Because of her
        neck pain, lifting more than 5 pounds caused neck problems, and
        tightness in her neck made it difficult to move. The Baker’s cysts
        behind her knees made bending over to pick things up from the
        floor difficult. She had panic attacks several times in a week and
        extreme fatigue and weakness caused by her medications. Her
        anxiety made it difficult to interact with people or leave her home.
               Epps said that because of her symptoms, she could walk only
        20 or 30 steps, stand for no more than 15 minutes at a time, and sit
        for no more than 30 minutes at a time. Epps also had to lie down
        for 20 minutes before she could return to a seated or standing
        position. As a result, she had to lie down for 4 or 5 hours each work
        day. Epps said she did not take care of her personal needs, changed
        her clothes only once a week, and left most of the household chores
        and shopping for her boyfriend and her older children. When
        alone with her two youngest children, Epps said she stayed on a
USCA11 Case: 22-13674     Document: 31-1     Date Filed: 01/02/2024    Page: 5 of 19

        22-13674             Opinion of the Court                        5

        couch in the living room, where her children watched cartoons and
        played with toys. Epps denied lifting her two-year-old child.
              During the VE’s testimony, the ALJ asked the VE to
        presume the following non-exertional limitations:
              [N]o operation of foot controls. No more than
              occasional climbing stairs, never climbing ladders,
              ropes, or scaﬀolds. No kneeling, crouching, or
              crawling. Avoid all exposure to extreme heat and
              excessive vibration. Avoid concentrated exposure to
              pulmonary irritants such as fumes, odors, dusts,
              gases, poorly-ventilated areas, and to chemicals.
              Avoid unprotected heights and hazardous machinery.
              Limited to unskilled with the ability to attend and
              concentrate for two-hour periods. No more than
              occasional workplace changes, and the ability to
              make simple work-related decisions. No more than
              occasional direct interaction with the general public,
              and work that can be around coworkers throughout
              the day, but with only occasional interaction with
              coworkers.
        In one hypothetical, the ALJ asked if unskilled jobs with these
        limitations existed for an individual who had the capacity to
        perform a range of medium work activity. The VE responded that
        the hypothetical individual would be able to perform work as a
        packer and packager, assembler, or order puller.
USCA11 Case: 22-13674      Document: 31-1     Date Filed: 01/02/2024     Page: 6 of 19

        6                      Opinion of the Court                22-13674

        D.    ALJ Decision
               On May 31, 2019, in a 12-page decision, the ALJ found that
        Epps was not under a disability from August 1, 2016, through the
        date of decision.
                Specifically, applying the five-step evaluation process, the
        ALJ found that: (1) Epps met insured status requirements and had
        not engaged in substantial gainful activity since her onset date of
        August 1, 2016; (2) Epps had the severe impairments of “moderate
        Baker’s cysts right knee with mild degenerative changes, anxiety
        and depression; (3) Epps did not have an impairment or
        combination of impairments that met or equaled the severity of
        one of the listed impairments; (4) Epps had the residual functional
        capacity (“RFC”) to perform medium work with the certain
        restrictions, namely the limitations the ALJ identified to the VE
        during the hearing; and (5) considering Epps’s age, education,
        work experience, and RFC, jobs existed in the national economy
        that she could perform.
               In assessing Epps’s RFC at step four, the ALJ found Epps’s
        statements about her physical and mental limitations were “not
        persuasive” in light of objective medical evidence that indicated she
        retained “greater functioning than alleged.” The ALJ determined
        that Epps’s “statements concerning the intensity, persistence and
        limited effects of [her] symptoms are not entirely consistent with
        the medical evidence and other evidence in the record.”
              The ALJ reviewed Epps’s medical records between April
        2016 and January 2019, including treatment notes from Dr. Larry
USCA11 Case: 22-13674         Document: 31-1        Date Filed: 01/02/2024           Page: 7 of 19

        22-13674                  Opinion of the Court                                 7

        Scarborough, her primary care physician at Quality of Life Health
        Services. The ALJ also noted that Dr. Scarborough had completed
        a physical capacities evaluation as to Epps.
               On that evaluation form, Dr. Scarborough opined that:
        (1) Epps could sit upright in a standard chair for less than 30
        minutes and stand for less than 15 minutes; (2) during an eight-hour
        period, Epps would need to lie down, sleep, or sit with legs propped
        up for five hours; and (3) Epps would be off task for 79% 2 of a
        normal workday. Dr. Scarborough identified the conditions
        causing Epps’s limitations as “[h]eadache, cervicalgia, myalgia,
        [and] edema.” 3 Dr. Scarborough listed “drowsiness” as a side effect
        of Epps’s medications.
              The ALJ, however, determined that Dr. Scarborough’s
        assessment of Epps’s physical capacities was “not supported and
        not persuasive.” The ALJ first found that Epps did not seek
        treatment for the drowsiness that Dr. Scarborough indicated was a
        side effect of her medications, that Epps’s medical
        “[e]xamination[s] have not shown edema,” and that “[t]reatment
        examinations have shown normal attention span and

        2 The ALJ determined that this handwritten figure is 79%.       Epps submits that
        it is 75% but acknowledges that the discrepancy is “trivial.”
        3  Cervicalgia is neck pain. Neck Pain, Medical Dictionary Online,
        https//www.online-medical-dictionary.org/definitions-n/neck-pain/html
        (last visited Nov. 21, 2023). Myalgia is muscle pain. Myalgia, Medical
        Dictionary Online, https//www.online-medical-dictionary.org/definitions-
        m/myalgia.html (last visited Nov. 21, 2023).
USCA11 Case: 22-13674      Document: 31-1      Date Filed: 01/02/2024     Page: 8 of 19

        8                      Opinion of the Court                 22-13674

        concentration and [Epps] being in no acute distress.” The ALJ cited
        treatment notes from Epps’s May 23, 2018, visit to Cherokee
        Health Clinic as an example.
               Regarding mental impairments, the ALJ further found that
        Epps had “minimal treatment for depression and/or anxiety” and
        had not demonstrated any psychiatric abnormality since 2017. The
        ALJ highlighted that, upon examination, Epps “was cooperative
        and pleasant” and otherwise “ha[d] not exhibited any evidence of
        cognitive deficits or psychosis that would preclude substantial
        gainful activity.”
               Regarding physical ailments, the ALJ observed that,
        although Epps received treatment in emergency departments after
        complaining of headaches, “she was treated and generally
        discharged on the same day.” The ALJ found that Epps’s Baker’s
        cysts improved with injections, imaging studies of her knees “only
        showed mild degenerative changes,” and her gait and station were
        consistently normal.
                Further, the ALJ pointed out that imaging studies of her
        neck, back, and brain were generally normal. The ALJ summarized
        its finding that Epps’s “allegations are not fully consistent with the
        objective findings and she retain[ed] the capacity to perform
        substantial gainful activity.”
        E.    Appeals Council Review
              The Appeals Council granted Epps’s request for review.
        Ultimately, on August 15, 2020, the Appeals Council adopted the
USCA11 Case: 22-13674     Document: 31-1     Date Filed: 01/02/2024    Page: 9 of 19

        22-13674              Opinion of the Court                       9

        ALJ’s findings and conclusions as to Epps’s lack of disability,
        including the ALJ’s RFC-related findings at step four.
               As further background, Epps submitted new medical
        evidence to the Appeals Council, but Epps does not appeal the
        Appeals Council’s decision as to this new medical evidence. For
        completeness though, here is what happened. The Appeals
        Council initially adopted the ALJ’s findings and conclusion. After
        receiving Epps’s new medical evidence, however, the Appeals
        Council set aside its initial decision. The Appeals Council
        determined that some of the new medical evidence did not show a
        reasonable probability that it would change the outcome of the
        decision and that the rest of the new medical evidence did not
        relate to the time period at issue and therefore did not affect the
        decision. The Appeals Council again adopted the ALJ’s findings
        and conclusions that Epps was not disabled, including the RFC-
        related findings at step four.
        F.    District Court Proceedings
               On judicial review, Epps argued that the ALJ erred by
        rejecting Dr. Scarborough’s opinion “without sufficient legal
        explanation” and by failing to afford Dr. Scarborough’s opinion
        proper weight as Epps’s treating physician.
              Affirming the ALJ decision, the district court relied on this
        Court’s decision in Harner v. Social Security Administration,
        Commissioner, 38 F.4th 892 (11th Cir. 2022). In Harner, this Court
        concluded that the Social Security Administration’s new
        regulation, 20 C.F.R. § 404.1520c, validly abrogated the prior
USCA11 Case: 22-13674     Document: 31-1     Date Filed: 01/02/2024    Page: 10 of 19

        10                    Opinion of the Court                 22-13674

        treating physician rule. 38 F.4th at 894. The prior rule accorded
        significant weight to a treating physician’s opinion. Id. at 896-97.
        The new regulation requires ALJs to evaluate all medical opinions
        for persuasiveness using the same criteria. See 20 C.F.R.
        § 404.1520c. The district court concluded that the ALJ applied the
        correct legal standard in evaluating Dr. Scarborough’s opinion and
        adequately explained why she found Dr. Scarborough’s opinion
        not persuasive and that substantial evidence supported the ALJ’s
        finding as to Dr. Scarborough’s opinion.
                         II. STANDARD OF REVIEW
               “We review de novo the ALJ’s application of legal principles,
        and we review the ALJ’s resulting decision to determine whether
        it is supported by substantial evidence.” Buckwalter v. Acting
        Comm’r of Soc. Sec., 5 F.4th 1315, 1320 (11th Cir. 2021) (quotation
        marks omitted).
               “Substantial evidence is more than a scintilla and is such
        relevant evidence as a reasonable person would accept as adequate
        to support a conclusion.” Winschel v. Comm’r of Soc. Sec., 631 F.3d
        1176, 1178 (11th Cir. 2011) (quotation marks omitted). To the
        extent the ALJ commits an error, we will not reverse if the error
        did not affect the ALJ’s ultimate determination. See Diorio v.
        Heckler, 721 F.2d 726, 728 (11th Cir. 1983) (applying harmless error
        review in the social security context).
USCA11 Case: 22-13674     Document: 31-1      Date Filed: 01/02/2024     Page: 11 of 19

        22-13674               Opinion of the Court                        11

                                 III. DISCUSSION
        A.     New Regulation in 20 C.F.R. § 404.1520c
               Prior to 2017, the Courts of Appeals, including this Court,
        applied a treating physician rule, which required ALJs to give the
        opinion of a treating physician “substantial or considerable weight
        unless ‘good cause’ [was] shown to the contrary.” Phillips v.
        Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004) (quotation marks
        omitted), superseded by 20 C.F.R. § 404.1520c; see also Black & Decker
        Disability Plan v. Nord, 538 U.S. 822, 829 (2003). In 1991 the Social
        Security Administration promulgated a regulation that adopted the
        court-made rule and required ALJs generally to give more weight
        to treating physicians’ opinions absent a showing of good cause.
        See 20 C.F.R. § 404.1527(d)(2) (1992); 20 C.F.R. § 404.1527(c)(2)
        (2016) (most recent version of the treating physician rule).
               In 2017, however, the Commissioner issued a new
        regulation, 20 C.F.R. § 404.1520c, that abrogated the treating
        physician rule. Harner, 38 F.4th at 894. The new regulation
        provides that an ALJ does not “defer or give any specific evidentiary
        weight, including controlling weight, to any medical opinion(s) or
        prior administrative medical finding(s),” including a treating
        physician’s opinion. Id. § 404.1520c(a). Instead, the ALJ weighs all
        medical opinions based on their persuasiveness. 20 C.F.R.
        § 404.1520c.
               Section 404.1520c applies to all claims filed on or after March
        27, 2017. Id. Epps applied for benefits on July 26, 2017. Epps does
USCA11 Case: 22-13674          Document: 31-1       Date Filed: 01/02/2024         Page: 12 of 19

        12                          Opinion of the Court                     22-13674

        not dispute that because she filed her application after March 27,
        2017, her claim is governed by the new regulation if it is valid.
        B.      Validity of 20 C.F.R. § 404.1520c
               Epps argues the § 404.1520c regulation is invalid. 4
        Specifically, Epps contends the new regulation is in derogation of
        the text and structure of the relevant statute, 42 U.S.C.
        § 423(d)(5)(B). The § 423(d)(5)(B) statute provides that ALJs must
        “make every reasonable effort to obtain from the individual’s
        treating physician . . . all medical evidence . . . necessary” to make
        a proper disability determination. 42 U.S.C. § 423(d)(5)(B). 5 Epps
        contends: (1) the § 423(b)(5)(B) statute requires the ALJ to give
        deference or special consideration to the opinion of treating

        4 As a threshold matter, we reject the Commissioner’s claim that in the district

        court Epps did not adequately raise an issue challenging the validity of 20
        C.F.R. § 404.1520c.
        5 Section 423(d)(5)(B) states in full:

              (B) In making any determination with respect to whether an
              individual is under a disability or continues to be under a
              disability, the Commissioner of Social Security shall consider all
              evidence available in such individual’s case record, and shall
              develop a complete medical history of at least the preceding
              twelve months for any case in which a determination is made that
              the individual is not under a disability. In making any
              determination the Commissioner of Social Security shall make
              every reasonable effort to obtain from the individual’s treating
              physician (or other treating health care provider) all medical
              evidence, including diagnostic tests, necessary in order to
              properly make such determination, prior to evaluating medical
              evidence obtained from any other source on a consultative basis.
USCA11 Case: 22-13674      Document: 31-1      Date Filed: 01/02/2024      Page: 13 of 19

        22-13674                Opinion of the Court                         13

        physicians; and (2) thus, the § 404.1520c regulation, wherein the
        ALJ weighs all medical opinions based on persuasiveness, is invalid.
        We first address our decision in Harner and then Epps’s arguments
        about the new regulation.
                In Harner, the claimant argued that “our earlier precedents
        establishing and applying the treating-physician rule [were] still
        good law, notwithstanding the promulgation of [the] section
        404.1520c” regulation. 38 F.4th at 896. This Court disagreed,
        holding that “the new regulation validly abrogated” our court-
        developed treating physician rule and applied to Harner’s claim. Id.
        at 894.
               In doing so, the Harner Court concluded that the § 404.1520c
        regulation fell within the scope of the Commissioner’s rulemaking
        authority as delegated by the Congress under the Social Security
        Act. Id. at 897 (citing 42 U.S.C. § 405(a)). Our Court explained that
        42 U.S.C. § 423(d)(5)(B) “instructs administrative law judges to
        make every reasonable effort to obtain from the individual’s
        treating physician all medical evidence necessary to make a proper
        disability determination.” Id. at 897 (cleaned up). But “the [Social
        Security] Act does not specify how this evidence is to be weighed.”
        Id. Citing Chevron, the Harner Court reasoned that because the
        § 404.1520c regulation fell within Congress’s delegation of
        authority and was “not manifestly contrary to” the § 423(d)(5)(B)
        statute, the regulation did not exceed the Commissioner’s
        statutory authority. Id. (citing Chevron, U.S.A., Inc. v. Nat. Res. Def.
        Council, Inc., 467 U.S. 837, 844 (1984)).
USCA11 Case: 22-13674     Document: 31-1      Date Filed: 01/02/2024     Page: 14 of 19

        14                     Opinion of the Court                 22-13674

               The Harner Court also determined that the § 404.1520c
        regulation was not arbitrary and capricious, and, importantly for
        Epps’s argument here, that the treating physician rule was not
        “unambiguously required by the [Social Security] Act.” Id. at 897-
        98. Thus, our Court determined that the § 404.1520c regulation
        “abrogate[d] our earlier precedents applying the treating-physician
        rule.” Id. at 896. Because the new regulation applied to Harner’s
        claim, the Court concluded that the ALJ properly declined to give
        more weight to the medical opinions of Harner’s treating
        physicians. Id. at 898.
               Here, Epps argues that the § 404.1520c regulation is invalid
        because the § 423(d)(5)(B) statute unambiguously requires a
        treating physician rule that gives deference or special consideration
        to the opinion of a treating physician. The problem for Epps is that
        the question of whether the treating physician rule exists in the text
        of the Social Security Act was explicitly answered in Harner, which
        concluded that the treating physician rule was not required by the
        Act. See id. And we are bound by Harner. See United States v. Archer,
        531 F.3d 1347, 1352 (11th Cir. 2008). To the extent Epps claims her
        argument is slightly different from the claimant’s argument in
        Harner, this Court has categorically rejected an overlooked reason
        or argument exception to our prior panel precedent rule. See
        Tippitt v. Reliance Standard Life Ins. Co., 457 F.3d 1227, 1234 (11th
        Cir. 2006) (“[A] prior panel precedent cannot be circumvented or
        ignored on the basis of arguments not made to or considered by
        the prior panel.”).
USCA11 Case: 22-13674     Document: 31-1     Date Filed: 01/02/2024    Page: 15 of 19

        22-13674              Opinion of the Court                       15

               Given that Epps’s application was filed after March 27, 2017,
        the ALJ was precluded by the § 404.1520c regulation from deferring
        to or giving specific weight to any medical opinion, including to
        Dr. Scarborough’s opinion. The ALJ’s decision contains a
        statement to that effect. Accordingly, the ALJ applied the correct
        legal standard for evaluating medical opinions and did not err in
        declining to give Dr. Scarborough’s opinion special consideration
        or weight.
        C.    ALJ’s Compliance with the § 404.1520c Regulation
               Under § 404.1520c, the ALJ must consider any submitted
        medical opinion and “articulate how persuasive” the ALJ finds the
        medical opinion. 20 C.F.R. § 404.1520c(a), (b).         The ALJ
        determines the persuasiveness of a medical opinion using five
        enumerated factors: (1) supportability, (2) consistency,
        (3) relationship with claimant, (4) specialization, and (5) other
        factors. Id. § 404.1520c(a), (c).
               Because the “most important” factors are supportability and
        consistency, the ALJ must explain how it considered those factors,
        but may or may not explain the other factors. Id. § 404.1520c(b)(2).
        As to supportability, the more relevant the objective medical
        evidence and supporting explanations from the medical source, the
        more persuasive the medical opinion will be. Id. § 404.1520c(c)(1).
        As to consistency, the more consistent a medical opinion is with
        the evidence from other sources, the more persuasive the medical
        opinion will be. Id. § 404.1520c(c)(2).
USCA11 Case: 22-13674     Document: 31-1     Date Filed: 01/02/2024   Page: 16 of 19

        16                    Opinion of the Court                22-13674

               Here, the ALJ complied with the § 404.1520c regulation.
        The ALJ explicitly considered Dr. Scarborough’s opinion about
        Epps’s physical capacities. The ALJ stressed that Dr. Scarborough’s
        assessment of Epps’s physical capacities—“sitting fewer than 30
        minutes, standing fewer than 15 minutes, laying down or sitting
        with legs propped at waist level [for] 5 hours, being off tasks 79%
        of the time, and missing 15 days per month due to headache,
        cervicalgia, myalgia, edema and adverse medication due to
        drowsiness”—meant that Epps was “essentially disabled.” The ALJ
        then stated that she found Dr. Scarborough’s opinion “not
        persuasive.” See id. § 404.1520c(b) (“We will articulate in our
        determination or decision how persuasive we find all of the
        medical opinions . . . .”).
               As to the § 404.1520c(c) factors, the ALJ explained that she
        found Dr. Scarborough’s opinion was “not supported.” The ALJ
        began by noting that Epps had not sought treatment for drowsiness
        from medication, that examination had not shown edema but had
        shown “normal attention span and concentration,” and that Epps
        was “in no acute distress.” Then, over several paragraphs, the ALJ
        outlined evidence of Epps’s medical treatment (and cited exhibits
        that included Dr. Scarborough’s treatment notes) that indicated
        Epps’s symptoms were not as severe as Dr. Scarborough’s opinion
        suggested.
               For example, one of the conditions Dr. Scarborough cited as
        a cause of Epps’s limitations was headaches. The ALJ pointed out
        that (1) Epps was treated and discharged the same day when she
USCA11 Case: 22-13674      Document: 31-1      Date Filed: 01/02/2024     Page: 17 of 19

        22-13674               Opinion of the Court                         17

        went to the emergency room for headaches, (2) her headaches did
        not “frequently involve changes in vision, flashes of light, difficulty
        speaking, nausea, vomiting, or lightheadedness,” and (3) imaging
        of Epps’s brain had “revealed no acute abnormalities.”
               As to Epps’s cervicalgia (neck pain) and myalgia (muscle
        pain)—two other conditions Dr. Scarborough cited—the ALJ
        noted that (1) Epps’s Baker’s cysts improved with Kenalog
        injections, (2) imaging of Epps’s knees showed only “mild
        degenerative changes,” (3) imaging of Epps’s neck and back was
        “generally normal,” and (4) Epps had “consistently demonstrated a
        normal gait and station.” And, as a general matter, the ALJ
        observed that Epps “responded well to treatment when she was
        compliant.”
               The ALJ explained that this evidence “supported” her RFC
        finding (rather than Dr. Scarborough’s opinion) and that Epps’s
        claims about her capacities (through Dr. Scarborough’s opinion)
        were “not fully consistent” with the objective findings. Contrary
        to Epps’s claim, this explanation was sufficient to comply with the
        § 404.1520c regulation. See 20 C.F.R. § 404.1520c(b)(2) (“[W]e will
        explain how we considered the supportability and consistency
        factors for a medical source’s medical opinions.”).
               Epps correctly points out that one of the ALJ’s statements—
        that examinations of Epps showed no edema—is not supported by
        substantial evidence. While many physical examinations did not
        reveal edema, Epps testified that her swelling did not begin until
        mid-2018, just six months before her administrative hearing. By
USCA11 Case: 22-13674        Document: 31-1         Date Filed: 01/02/2024         Page: 18 of 19

        18                         Opinion of the Court                       22-13674

        that time, some physical examinations noted swelling or edema,
        particularly in her feet and ankles. But this one discrepancy does
        not undermine the ALJ’s overall evaluation of Dr. Scarborough’s
        opinion or the ALJ’s ultimate determination. See Diorio, 721 F.2d
        at 728. Epps indicated that swelling was only her third-most-severe
        ailment, behind her headaches and neck pain. Additionally,
        physical examinations between May and November 2018 showed
        that Epps had a normal gait and strength in her extremities despite
        her edema.
              Furthermore, the ALJ’s other observations are supported by
        substantial evidence. As the ALJ noted, Epps did not seek
        treatment for drowsiness (and did not frequently complain of
        drowsiness as a side effect of her medication), and clinical findings
        in her doctors’ treatment notes indicated that despite Epps’s
        complaints of pain, her strength, gait, range of motion, and sensory
        and motor skills were not significantly impaired, and that her
        mental status was not significantly altered. 6 Additionally, as the
        ALJ observed, diagnostic imaging and other tests showed no
        abnormalities beyond the small cysts behind her knees and mild
        degenerative changes in both sacroiliac joints of her lumbar spine.

        6 Epps also correctly notes that Dr. Scarborough’s opinion listed drowsiness as

        a side effect rather than as a chronic condition that limited Epps’s physical
        capacities. But the fact that Dr. Scarborough listed drowsiness as a side effect,
        despite Dr. Scarborough’s treatment notes failing to mention this side effect,
        undermines the supportability and overall persuasiveness of his opinion.
USCA11 Case: 22-13674        Document: 31-1         Date Filed: 01/02/2024         Page: 19 of 19

        22-13674                   Opinion of the Court                               19

                Epps also takes issue with the ALJ’s focus on the absence of
        acute distress during Epps’s physical examinations, pointing out
        that her conditions were chronic, not acute, and that she has good
        days and bad days. To be sure, chronic ailments are distinct from
        acute ailments. But Epps’s consistent lack of acute distress over
        many physical examinations by both primary care and emergency
        room staff supports the ALJ’s determination that the pain from her
        conditions was not so severe as to justify Dr. Scarborough’s
        significant limitations.7
               In sum, substantial evidence supports the ALJ’s
        determinations that Epps’s physical capacities were not as severely
        limited as Dr. Scarborough opined and that Dr. Scarborough’s
        opinion was unpersuasive.
                                   IV. CONCLUSION
               For these reasons, we affirm the district court’s judgment
        affirming the Commissioner’s denial of Epps’s application for
        disability insurance and supplemental security income benefits.
                AFFIRMED.

        7 Because Epps filed her application in July 2017, her claim is governed by the

        new § 404.1520c regulation. For this reason, Epps’s reliance on this Court’s
        decisions, such as Schink v. Commissioner of Social Security, 935 F.3d 1245, 1262
        (11th Cir. 2019), applying the prior version of the regulations and requiring the
        ALJ to identify “genuine inconsistencies” to discount a treating physician’s
        opinion misses the mark. Here, unlike in those cases, the ALJ was not required
        to provide substantial weight to a treating physician’s opinion absent a
        showing of good cause. Cf. Schink, 935 F.3d at 1259 & n.4, 1262-63.