Court Opinion

ID: 9385647
Source: CourtListenerOpinion
Date Created: 2023-04-07 18:01:11.954487+00
Date Added: 2024-06-11T17:18:03.562566
License: Public Domain

USCA11 Case: 22-10842    Document: 29-1      Date Filed: 04/07/2023    Page: 1 of 26

                                                    [DO NOT PUBLISH]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

                           ____________________

                                 No. 22-10842
                           Non-Argument Calendar
                           ____________________

        NICHOLAS ALLEN GOBLE,
                                                       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. 1:21-cv-00149-CLS
                           ____________________
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        2                         Opinion of the Court                     22-10842

        Before WILSON, BRANCH, and LUCK, Circuit Judges.
        PER CURIAM:
               Nicholas Goble appeals the district court’s order affirming
        the Social Security Administration’s (“SSA”) denial of his claim for
        Social Security disability benefits. To summarize Goble’s case to
        this point: (1) Goble applied for disability insurance benefits,
        indicating that his disability began July 11, 2018, (2) the SSA denied
        his application, concluding that he did not meet the definition of
        disabled under the SSA’s rules, (3) Goble requested a hearing
        before an administrative law judge (“ALJ”), (4) the ALJ determined
        that Goble was not disabled and entered an unfavorable decision,
        (5) Goble sought review of the ALJ’s decision from the SSA’s
        Appeals Council and provided new evidence, (6) the Appeals
        Council denied Goble’s request for review, 1 (7) Goble appealed to
        the United States District Court for the Northern District of
        Alabama, and (8) the district court affirmed the decisions below.
              On appeal to this Court, Goble argues that (1) the Appeals
        Council erred in denying review of the ALJ’s decision on the
        ground that the additional evidence he brought forth did not have
        a reasonable probability of changing the outcome of the ALJ’s

        1 Once the Appeals Council denied review, “the [ALJ’s] decision [became] the
        final decision of the Commissioner of Social Security.” See generally Doughty
        v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001) (“When . . . the ALJ denies
        benefits and the [Appeals Council] denies review, we review the ALJ’s decision
        as the Commissioner’s final decision.”).
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        22-10842                   Opinion of the Court                               3

        decision and (2) the Commissioner’s decision was not based on
        substantial evidence. After review, we affirm.
                                        I.      Background
               A. Goble’s Relevant Medical History
               In 2018, Goble applied for disability insurance benefits,
        asserting that he was 35 years old, had completed high school, and
        was unable to work due to ten conditions: “Diabetes 1 & 2,
        Arthritis, [Severe] Anxiety, Depression, afib tachycardia, colitis,
        peripheral neuropathy, [autonomic] neuropathy, epilepsy, [and]
        migraines.” 2 He asserted that he stopped working on July 11, 2018
        due to these conditions. 3 He indicated that he had prior work

        2 Goble also referenced the following additional impairments in subsequent
        filings and proceedings related to his disability claim: carpal tunnel in both
        hands, chronic knee pain, congestive heart failure, diabetic neuropathy,
        dysautonomia-like syndrome, gastroesophageal reflux disease, gastroparesis,
        hypoglycemia, insomnia, a meniscus tear (left knee), a pinched nerve, and
        obesity.
        3 Goble’s mother, Rebecca Nelson, filled out a function report on Goble’s
        behalf. Nelson indicated that Goble took care of three children by doing
        “laundry [and] helping them with meals” and took care of a dog by feeding
        and “walking [it] outside.” Nelson also indicated that she helped Goble on a
        daily basis and his grandparents also helped care for the children in various
        ways—by picking them up for school and running any necessary errands.
        Finally, Nelson indicated that most physical activities are off-limits for Goble
        because they would cause a spike in his heart rate that could cause him to
        black out.
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        4                         Opinion of the Court                     22-10842

        experience as a floor finisher, skilled painter, and paint sales
        representative.
               Goble provided numerous medical records in support of his
        application.4 These records establish that Goble had colitis,
        hypothyroidism, hypertensive heart disease, hyperlipidemia,
        tachycardia,5 chronic diastolic (congestive) heart failure, type 2
        diabetes mellitus, and recurrent episodes of hypoglycemia.
                In 2010, Goble had surgeries for (1) carpal tunnel, (2) a left
        wrist fracture, 6 and (3) a meniscal tear in his right knee. Despite the
        knee surgery, Goble had recurring knee pain and reported
        significant difficulties walking in 2014, and he underwent another
        knee surgery in April 2014. During a post-surgical follow-up visit,
        Goble’s doctor found no swelling in the right knee and reported
        Goble had full range of motion. In 2017, Goble suffered a meniscal
        tear in his left knee and underwent surgery. In 2019, Goble cut
        himself with a knife and injured a nerve in his left hand. An
        orthopedist put him in a splint, noting that he did not recommend

        4 There are 52 medical records in the record on appeal. We focus only on the
        conditions critical to this appeal—taking direction from the medical events
        and records that Goble highlights in his brief.
        5From 2012 to 2019, Goble had multiple electrocardiograms (“EKGs”) which
        were occasionally abnormal.
        6 In connection with this surgery, Goble asserts that one of his severe
        impairments is status-post ORIF of his left wrist. ORIF stands for open
        reduction and internal fixation which refers to the type of surgery that Goble
        underwent.
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        22-10842              Opinion of the Court                       5

        any surgical intervention, that Goble had “excellent function and
        flexor tendons [were] spared,” and that Goble could “go about his
        activities as tolerated.”
               From August 2016 to January 2019, Goble saw
        endocrinologist Dr. Robert Chadband several times for diabetes-
        related medical care. Dr. Chadband diagnosed Goble with morbid
        obesity, type 2 diabetes mellitus with neuropathy, hypothyroidism,
        and hypertension. By February 2017, Goble—by his own
        admission—was “doing much better” with his diabetes-related
        health issues. In May 2017, Goble returned because he had had a
        seizure caused by low blood sugar. Goble “[felt] better with the
        [insulin] pump and the sensor” for his diabetes by his October 2017
        follow-up appointment. In July 2018, Goble was in a car accident
        when he ran off the road due to a low blood sugar reaction, and
        Dr. Chadband referred him for an insulin pump sensor. Goble
        received a new sensor and, at a follow-up visit in September 2018,
        Dr. Chadband reported Goble was “doing well” and “better with
        current doctors and plans.” In March 2020, at a follow-up, Dr.
        Chadband noted that Goble was “doing well at present” and that
        Goble should continue on his medications and follow up with his
        doctors as planned.
               In March 2017, Goble saw neurologist Dr. Richard Diethelm
        because Goble “had a recent seizure and [a] migraine.” Dr.
        Diethelm discussed a “migraine treatment plan” with Goble, put
        him on a seizure medication, and performed “[b]ilateral trapezius
        trigger point injections” to reduce the pain and provide a
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        6                         Opinion of the Court                      22-10842

        therapeutic effect. Because of Goble’s reported seizure, Dr.
        Diethelm ordered electroencephalogram (“EEG”) and magnetic
        resonance imaging (“MRI”) exams. Both test results were normal
        and did not show any brain abnormalities. 7 At a follow-up
        appointment in February 2018, Goble reported “no recurrent
        seizures” and a reduction in his migraine frequency, although he
        still suffered from migraines. 8 Following Goble’s July 2018 car
        accident, Dr. Diethelm increased the dosage of Goble’s seizure
        medication. A few weeks later, Dr. Diethelm changed the seizure
        medication. In April 2020, during one of Goble’s return visits, Dr.
        Diethelm noted that “[Goble] has had no seizure” and Goble “[was]
        doing much better.” During that visit, a physical exam showed no
        focal motor or sensory deficits and Goble’s “gait [was] steady.” At
        that time, Dr. Diethelm instructed Goble to stop taking his anxiety
        medication (Klonopin). However, the progress notes indicated
        that he restarted the medication in May 2020, because his anxiety
        got “worse after stopping” the medication.
             Goble visited Dr. Mohammed Shubair (a pulmonologist) in
        October 2019, complaining of asthma, chronic bronchitis, and sleep

        7 In April and May 2017, Goble visited the hospital twice for syncopal
        symptoms. At the first visit, he had collapsed at home, lost consciousness, and
        hit his head. At the second visit, his son had come home to find him seizing.
        The seizure was attributed to an episode of hypoglycemia.
        8 From May to July 2018, Goble visited the hospital multiple times
        complaining of headaches, dizziness, and syncopal events. During these visits,
        two CT scans were taken of Goble’s head, but neither showed any
        abnormalities.
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        22-10842                  Opinion of the Court                             7

        apnea. Dr. Shubair ordered a pulmonary function test and a sleep
        study. The results of the pulmonary function test showed that
        Goble had (1) “[n]ormal spirometry, however, there is significant
        improvement after bronchodilator therapy,” (2) “lung volumes
        with evidence of [mild] obesity related reduction in residual
        volume,” and (3) “normal diffusion capacity.” Following the sleep
        study, Dr. Shubair diagnosed Goble with sleep apnea and
        insomnia.
               In May 2020, Goble visited Dr. Shubair so Dr. Shubair could
        conduct a continuous positive airway pressure (“CPAP”)
        compliance report. Goble had started using a CPAP machine to
        sleep and reportedly was having “no problems with CPAP,” “no
        problems with sleep maintenance,” and his “sleep related
        symptoms ha[d] markedly improved” so that he was “wak[ing] up
        rested” without “excessive daytime sleepiness.”
               B. The SSA and ALJ Denied Goble’s Claim
               The SSA denied Goble’s claim for Social Security disability
        benefits because “[b]ased on a review of [his] health problems” he
        did not meet the SSA’s definition of disabled. The doctors that
        evaluated Goble’s medical records for the SSA both determined
        that Goble had impairments, but those impairments were not
        severe enough to render Goble disabled. 9 Dr. Holly Mussell

        9Disability for these purposes is defined as the “inability to engage in any
        substantial gainful activity by reason of any medically determinable physical
        or mental impairment which can be expected to result in death or has lasted
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        8                         Opinion of the Court                      22-10842

        determined that Goble had the following “medically determinable
        impairments”: epilepsy; cardia dysrhythmias; essential
        hypertension; diabetes mellitus; dysfunction—major joints;
        disorders of autonomic nervous system; migraine[s]; depressive
        disorders; anxiety and obsessive-compulsive disorders. The
        epilepsy, cardiac dysrhythmias, diabetes, and major joints
        dysfunction were all deemed severe medical impairments. The
        others were deemed non-severe. She further determined that the
        medically determinable impairments could be reasonably expected
        to produce some of Goble’s alleged symptoms and functional
        limitations but that his allegations about the severity, persistence,
        and functionally limiting effects of the symptoms were not
        supported by the objective medical evidence. She considered his
        allegations about the effects of the symptoms to be only “partially
        consistent” with the medical evidence. She opined that he had
        certain physical exertional limitations, but was capable of
        performing light work.
                Similarly, Dr. Robert Estock reviewed Goble’s medical
        history and determined that he had certain exertional limitations
        (i.e., Goble’s limit for occasional lifting would be 20 pounds and his
        limit for standing and/or walking would be “about 6 hours in an 8-
        hour workday”) as well as non-severe mental (psychiatric)
        impairments.

        or can be expected to last for a continuous period of not less than 12 months.”
        42 U.S.C. § 416(i)(1).
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        22-10842                     Opinion of the Court                        9

                Goble requested a hearing before an ALJ. The ALJ held a
        telephonic hearing on Goble’s claim.10 Goble was represented by
        counsel who argued that Goble “suffer[ed] from multiple
        impairments” including “diabetes, diabetic neuropathy, anxiety,
        chronic knee pain, epilepsy, migraines, gastroparesis, tachycardia,
        atrial fibrillation, dysautonomia-like syndrome, [and] insomnia.”
        According to counsel, “[t]he combination of these impairments
        cause[d] symptoms that affect [Goble’s] ability to maintain
        concentration, persistence, and pace to complete an eight-hour
        workday and 40-hour work week on a consistent basis.” Goble
        stated that he agreed with counsel’s statement, and added that he
        had “some issues with [his] legs” including “neuropathy problems”
        and blood clots as well as “carpal tunnel in both hands,” “a pinched
        nerve,” “issues with [his lungs],” and “hypoglycemia
        unawareness.” He also testified that he could only sit for 10
        minutes before needing to stand and could only stand for “[a]bout
        15 minutes” before needing to sit down. He testified that he could
        walk three minutes before needing to sit down, and that he would
        need to rest at least ten minutes before resuming walking again.
        Finally, he testified that he could lift at most five pounds on a
        frequent basis. 11

        10 The hearing was conducted by telephone “due to the extraordinary
        circumstance presented by the Coronavirus Disease 2019 (COVID-19)
        Pandemic.”
        11   Goble stated that he was “guesstimating” for this answer.
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        10                           Opinion of the Court                     22-10842

                The ALJ then examined a vocational expert (“VE”). The VE
        testified that Goble completed 12th grade and has held three semi-
        skilled jobs in the past (floor finisher, paint sales representative, and
        skilled painter). The ALJ gave the VE two hypotheticals to gauge
        which types of jobs an individual with specified restrictions would
        be able to perform. In the first hypothetical, 12 the individual had
        the age, education, and work history that Goble testified to, had

        12   The full hypothetical was:
                  Hypothetical 1, assume this gentleman is of the age, education,
                  and has the work history as [Goble] has testified. Assume I
                  should find that the claimant has pain and impairment which
                  would restrict his abilities, as follows.
                  ...
                  Physically, that this gentleman does have exertional
                  limitations. He can occasionally lift and carry 20 pounds,
                  frequently lift and carry 10 pounds. He can stand and/or walk
                  six hours; sit six hours; pushing and pulling are unlimited,
                  unless I indicate differently, as we go. There are no—he does
                  have postural limitations. He can never climb ladders, ropes
                  or scaffolding. Occasionally, he can do climbing ramps and
                  stairs; balancing occasionally, stooping occasionally, kneeling
                  occasionally, crouching occasionally, crawling occasionally.
                  He has no manipulative limitations. He has no visual
                  limitations. He has no communication limitations.
                  He does have environmental limitations. Those would be as
                  follows. Unlimited are the following: extreme cold, extreme
                  heat, wetness, humidity, noise, vibration, fumes, odors, dust,
                  gas, poor ventilation. As for hazards, machinery and heights,
                  he should avoid concentrated exposure. No unprotected
                  heights or bodies of water.
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        22-10842                 Opinion of the Court                            11

        “pain and impairment” that would restrict his abilities so that he
        could only “occasionally lift and carry 20 pounds” and “frequently
        lift and carry 10 pounds,” and could “stand and/or walk six hours
        [and] sit six hours,” among other restrictions. The VE testified that
        such an individual would be able to return to his past work as a
        paint sales representative or perform alternate light work as a
        parking lot attendant, cashier, or laundry worker. 13 In the second
        hypothetical, the individual had the same age and work history as
        before but was more limited physically—
               [h]e [could not] do an eight-hour day, five days a
               week. He [could] stand 15 minutes; he [could] sit ten
               minutes. He [could] walk one minute. After he
               walk[ed] three minutes, he would have to sit and rest
               ten minutes, before he could walk three minutes
               again. He could frequently lift five pounds.

        The VE testified that such an individual would not be able to do
        any work. Goble’s counsel stated that he “believe[d] hypothetical
        number 2 accurately describe[d] [his] client,” and he did not have
        any additional hypotheticals.

        13The VE also testified that each of these jobs were widely available in the
        national economy.
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        12                         Opinion of the Court                       22-10842

               The ALJ evaluated Goble’s claim according to the SSA’s five-
        step sequential evaluation 14 and ultimately determined that Goble
        was not disabled.
               First, the ALJ determined that Goble had not engaged in
        substantial gainful activity since July 11, 2018 (the alleged onset
        date of Goble’s disability).
               Second, the ALJ concluded that Goble “ha[d] the following
        severe impairments: obesity, diabetes mellitus, epilepsy,
        congestive heart failure, peripheral neuropathy, tachycardia,
        status-post ORIF, [and a] left knee meniscus tear.” Alongside these
        “severe” impairments, the ALJ concluded that some of Goble’s
        impairments were “non-severe” (migraines, carpal tunnel
        syndrome, sleep apnea, and hypertension) because they were being
        successfully medically managed or would “not cause more than
        minimal limitation” to his ability to work (anxiety and depression).
        The ALJ determined that Goble had mild limitations in his abilities
        to understand, remember, or apply information; concentrate,

        14 The  evaluation process involves the following five-step determinations: (1)
        whether the claimant is engaged in substantial gainful activity; (2) if not,
        whether he “has a severe impairment or combination of impairments”; (3) if
        so, “whether th[at] impairment [or combination of impairments] meets or
        equals the severity of the specified impairments” in the regulations; (4) if not,
        “whether the claimant can perform any of his . . . past relevant work” in light
        of his residual functional capacity (“RFC”); and (5) if not, “whether there are
        significant numbers of jobs in the national economy that the claimant can
        perform given the claimant’s RFC, age, education, and work experience.”
        Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011).
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        22-10842               Opinion of the Court                        13

        persist or maintain pace; manage himself, and to interact with
        others.
                Third, the ALJ assessed Goble’s severe impairments and
        determined that they did not meet the severity of the specified
        impairments listed in the regulations. Specifically, the ALJ
        explained that obesity is not a listed impairment, but that the
        functional limitations caused by obesity, alone or in combination
        with other impairments, could equal a listed impairment—but that
        it did not do so in Goble’s case. Diabetes mellitus was evaluated
        under listings for a variety of other body systems, but the evidence
        did not support a finding that Goble met or equaled the listing
        severity for any of the listed impairments. Nevertheless, the ALJ
        stated that he considered the limiting effects of the diabetes as part
        of his RFC determination. Similarly, Goble’s epilepsy did not meet
        a listing because he did not meet the requirements for recurrent
        seizures within a particular time frame. Goble’s peripheral
        neuropathy, wrist (post-ORIF), and left knee meniscal tear
        impairments also did not satisfy a listing because they did not cause
        the necessary marked limitations in physical functioning. Finally,
        Goble’s heart issues did not meet the frequency and physical
        limitations requirements for the applicable listing.
               Fourth, the ALJ concluded that Goble had a residual
        functional capacity (“RFC”) to perform “light work” with certain
        limitations. In sum, the ALJ found that Goble’s “medically
        determinable impairments could reasonably be expected to cause
        the alleged symptoms,” but “[Goble’s] statements concerning the
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        14                     Opinion of the Court               22-10842

        intensity, persistence, and limiting effects of [those] symptoms
        [were] not entirely consistent with the medical evidence and other
        evidence in the record.” The ALJ noted that Goble’s descriptions
        of his symptoms and limitations throughout the record had
        “generally been inconsistent” and were not supported by the
        objective diagnostic imaging, treatment history, and lab reports.
        The ALJ concluded that the objective medical evidence supported
        an RFC of light work.
               Fifth, relying on the VE’s testimony in response to the first
        hypothetical, the ALJ determined that, in light of his RFC, Goble
        was unable to perform his previous occupations, but found that
        Goble could perform other available jobs in the national
        economy—namely, parking lot attendant, cashier, and laundry
        worker. Accordingly, the ALJ concluded that Goble was not
        disabled.
              C. The SSA Appeals Council Denied Review
               Goble filed a request for discretionary review of the ALJ’s
        decision with the SSA’s Appeals Council arguing that the ALJ’s
        “decision to deny benefits [was] not based on substantial evidence,
        and the Judge failed to apply appropriate legal standards.”
        Alongside his request, Goble submitted additional evidence to the
        Appeals Council. This evidence included (1) “a Physical Capacities
        Form completed by Mohammed Shubair,” (2) “a Physical
        Capacities Form completed by Richard Diethelm,” and (3)
        “treatment records from Alabama Neurology Associates.”
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        22-10842                Opinion of the Court                        15

               In the first physical capacities form, Dr. Diethelm made
        several estimates regarding Goble’s work capabilities. Dr.
        Diethelm estimated that Goble’s anxiety, epilepsy, and migraines
        would limit his abilities such that he (1) could sit upright in a chair
        for only one hour at a time, (2) could stand for less than fifteen
        minutes at a time, (3) would need to lie down, sleep, or sit with his
        legs propped up for six hours out of an eight-hour day, (4) would
        be off task ninety percent of the time in an eight-hour day, and (5)
        would be expected to miss twenty days out of a thirty-day work
        period. Dr. Diethelm indicated that these limitations existed on
        July 11, 2018.
                In the second physical capacities form, Dr. Shubair answered
        the same questions with different answers. Dr. Shubair estimated
        that Goble’s asthma, sleep apnea, obesity, and blood clots in his
        legs would limit his abilities, such that he (1) could sit upright in a
        chair for four to five hours, (2) could stand for two to three hours
        at a time, (3) would need to lie down, sleep, or sit with his legs
        propped up for five to six hours of an eight-hour day, (4) would be
        off task eighty percent of the time in an eight-hour day, and (5)
        would miss work twenty-five to twenty-eight days out of a thirty-
        day period. Dr. Shubair could not opine as to whether the
        limitations existed on July 11, 2018, noting that she saw Goble for
        the first time in October 2019.
               The Alabama Neurology records were the final piece of
        additional evidence. The records were from December 2013 to
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        16                        Opinion of the Court                      22-10842

        March 2014 and documented Goble’s migraines, seizures, and
        peripheral neuropathy attributed to his diabetes mellitus.
               The Appeals Council denied Goble’s request for review,
        explaining that it “found no reason under our rules to review the
        [ALJ’s] decision.” Importantly, the Appeals Council acknowledged
        Goble’s additional evidence and stated that such evidence did not
        “show a reasonable probability that it would change the outcome
        of the decision.”
               D. The District Court Affirmed
               Goble thereafter filed suit in the Northern District of
        Alabama and alleged that “[t]he finding of the [Commissioner] that
        [Goble] was not disabled was not based upon substantial evidence
        and was not determined by proper legal standards.” He also
        alleged that the Appeals Council’s summary denial of his request
        for review implied that his new and material evidence was not read
        and considered.
              Notably, in Goble’s memorandum in support of his
        complaint, he alleged that he submitted three physical capacity
        forms to the Appeals Council, including one from Dr. Chadband.
        However, he also maintained that Dr. Chadband’s form was
        omitted from the record which is why he included it as an
        attachment to his memorandum.15

        15 Dr. Chadband only partially filled out the form. Specifically, he only
        responded to one of the questions, indicating that he would expect Goble to
        be lying down, sleeping, or sitting with his legs propped up due to his medical
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        22-10842                   Opinion of the Court                                17

                The district court concluded that “the Commissioner’s
        decision [was] supported by substantial evidence” because “[t]he
        ALJ exhaustively reviewed the medical evidence of record and,
        with the assistance of the [VE], determined that, despite claimant’s
        severe impairments, claimant retained the ability to perform light
        work” and that there were jobs available that he could perform,
        which meant he was not disabled. As to Goble’s argument that the
        Appeals Council failed to consider the newly submitted evidence,
        the district court noted that the Appeals Council “considered it and
        determined that review of the ALJ’s decision was not warranted
        because it was unlikely to change the outcome of the ALJ’s
        decision.” Furthermore, the district court noted that the Appeals
        Council’s determination that the new evidence would not have
        changed the outcome was supported because the physical
        capacities forms were “unsupported by objective medical findings”
        and the Alabama Neurology records “significantly predate[d]” the
        alleged onset of Goble’s disability (July 11, 2018). Accordingly, the
        district court affirmed the Commissioner’s decision.
                Goble now appeals to us.
                                    II.      Standard of Review

        conditions for zero minutes in an 8-hour day. Nevertheless, he identified
        Goble’s low blood sugar without warning, his need to “eat regular[ly],” check
        his blood sugar often, “doctor office visits,” and history of past seizures as the
        conditions “causing [Goble’s] limitations.”
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        18                     Opinion of the Court                22-10842

               “When, as in this case, the ALJ denies benefits and the
        [Appeals Council] denies review, we review the ALJ’s decision as
        the Commissioner’s final decision.” Doughty, 245 F.3d at 1278.
        “[W]e review de novo the legal principles upon which the
        Commissioner’s decision is based,” but “we review the resulting
        decision only to determine whether it is supported by substantial
        evidence.” Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005).
               In the Social Security context, the threshold for substantial
        evidence is “not high.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154
        (2019). It is “more than a mere scintilla” and “means only . . . such
        relevant evidence as a reasonable mind might accept as adequate
        to support a conclusion.” Id. (quotations omitted). “Substantial
        evidence is less than a preponderance, and thus we must affirm an
        ALJ’s decision even in cases where a greater portion of the record
        seems to weigh against it.” Simon v. Comm’r, Soc. Sec. Admin., 7
        F.4th 1094, 1103 (11th Cir. 2021) (quotations omitted). “We may
        not decide the facts anew, reweigh the evidence, or substitute our
        judgment for that of the [Commissioner].” Winschel, 631 F.3d at
        1178 (alteration in original) (quotations omitted).
                                    III.   Discussion
               Goble brings two arguments on appeal. First, he argues that
        the Appeals Council erred in denying review of the ALJ’s decision
        on the ground that the additional evidence submitted by Goble did
        not show a reasonable probability of changing the outcome of the
        decision. Second, he argues that the Commissioner’s decision to
        deny benefits was not based on substantial evidence in light of the
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        22-10842                   Opinion of the Court                                19

        additional evidence he submitted. We address each argument in
        turn.
                A. The Appeals Council Properly Denied Review
              Goble first argues that the Appeals Council erroneously
        denied review on the ground that the physical capacity evaluations
        from his three treating physicians (Drs. Chadband, Diethelm, and
        Shubair)—did not show a reasonable probability of changing the
        outcome reached by the ALJ.16
               Before proceeding to the operative law, we address Dr.
        Chadband’s opinion. Although Goble states in his brief that he
        submitted Dr. Chadband’s physical capacities evaluation to the
        Appeals Council, that assertion is not supported by the record. As
        stated by the Appeals Council in the “Additional Evidence” section

        16 Goble also asserts in passing in his counseled brief that “the opinion of a
        treating physician must be given substantial or considerable weight unless
        good cause is shown to the contrary.” Goble cites no authority for this
        proposition, but it appears that he is referring to an older version of the Social
        Security regulations. Under the SSA’s new regulations that apply to
        applications filed on or after March 27, 2017—like Goble’s—no special weight
        is to be given to the medical opinions of a claimant’s treating physician: “[SSA]
        will not defer or give any specific evidentiary weight, including controlling
        weight, to any medical opinion(s) . . . including those from your medical
        sources.” 20 C.F.R. § 404.1520c(a). Instead, a specified list of factors are to be
        considered when evaluating medical opinions—the most important of which
        are (1) “supportability” which is a measure of how well a medical opinion is
        supported by objective medical evidence and (2) “consistency” which is a
        measure of how consistent a medical opinion is with other objective medical
        evidence from other sources. Id. § 404.1520c(b)(2), (c)(1)–(5).
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        20                           Opinion of the Court                      22-10842

        Goble “submitted a Physical Capacities Form completed by
        Mohammed Shubair, dated September 22, 2020 (1 page); a Physical
        Capacities Form Completed by Richard Diethelm, dated October
        22, 2020 (1 page); and treatment records from Alabama Neurology
        Associates . . . .” Further, Goble has already acknowledged that
        Dr. Chadband’s form is not in the SSA record. Indeed, this fact is
        the very reason that Goble attached the form to a memorandum
        he filed in the district court.
               Although there is a process for incorporating new evidence
        into a claim—through a “sentence six” remand which is the “sole
        means for a district court to remand to the Commissioner to
        consider new evidence presented for the first time in the district
        court” 17—Goble did not argue for such a remand below or as part
        of this appeal. Accordingly, Goble has forfeited any argument
        concerning the admission of Dr. Chadband’s physical capacity
        evaluation form. 18 See Stewart v. Dep’t of Health & Hum. Servs.,

        17   As we have explained:
                  The sixth sentence of [42 U.S.C. § 405(g)] provides a federal
                  court the power to remand the application . . . to the
                  Commissioner for the taking of additional evidence upon a
                  showing that there is new evidence which is material and that
                  there is good cause for the failure to incorporate such evidence
                  into the record in a prior proceeding.
        Ingram v. Comm’r of Soc. Sec. Admin., 496 F.3d 1253, 1261 (11th Cir. 2007)
        (quotations omitted).
        18Even if we were to ignore that Goble (1) did not ask for a sentence six
        remand below, (2) does not ask for a sentence six remand in this appeal, and
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        22-10842                   Opinion of the Court                               21

        26 F.3d 115, 115 (11th Cir. 1994) (“As a general principle, this court
        will not address an argument that has not been raised in the district
        court.”); United States v. Campbell, 26 F.4th 860, 873 (11th Cir.
        2022) (en banc), cert. denied 143 S. Ct. 95 (Oct. 3, 2022) (explaining
        that an issue not raised in an appellant’s initial brief is forfeited and
        only considered in “extraordinary circumstances” that are not
        present in this case).
              Goble’s overarching argument remains, however, and we
        must consider whether the Appeals Council incorrectly
        determined that the physical capacity evaluations by Drs. Diethelm

        (3) does not lay out the standard for a sentence six remand, he would not be
        able to meet the three-part framework required for a sentence six remand.
        One element is that the evidence be “material,” but Dr. Chadband responded
        “?” to four of the nine questions (i.e., he did not answer them at all), provided
        known medical conditions that are explained elsewhere in the record as the
        conditions causing Goble’s limitations (i.e., low blood sugar and passing out
        at times), and offered only a single novel estimation (and that answer was that
        Goble would need to lie down, sleep, or sit with his legs propped up for zero
        minutes a day—which cuts against Goble’s claim that he cannot even perform
        light work). See Milano v. Bowen, 809 F.2d 763, 766 (11th Cir. 1987) (“In order
        to demonstrate that a [sentence six] remand is necessary the claimant must
        establish that . . . the evidence is material, that is, relevant and probative so
        that there is a reasonable possibility that it would change the administrative
        result . . . .” (quotations omitted & emphasis added)). Simply put, there is no
        reasonable probability that Dr. Chadband’s responses would “change the
        administrative result.” Id.
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        22                         Opinion of the Court                       22-10842

        and Shubair did not have a reasonably probability of changing the
        ALJ’s determination. 19
               “[C]laimants are permitted to present new evidence at each
        stage of [the] administrative process, including before the Appeals
        Council.” Pupo v. Comm’r, Soc. Sec. Admin., 17 F.4th 1054, (11th
        Cir, 2021). The Appeals Council will review a case if it “receives
        additional evidence that is new, material, and relates to the period
        on or before the date of the hearing decision, and there is a
        reasonable probability that the additional evidence would change
        the outcome of the decision.”             Id. (quoting 20 C.F.R.
        § 416.1470(a)(5)). “When the Appeals Council accepts additional
        evidence, considers the evidence, and then denies review, it is not
        ‘required to provide a detailed rational[e] for denying review.’”
        Washington v. Soc. Sec. Admin., Comm’r, 806 F.3d 1317, 1321 n.5
        (2015) (quoting Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d
        780, 784 (11th Cir. 2014)).

        19 The additional evidence that Goble submitted to the Appeals Council
        included “treatment records from Alabama Neurology Associates dated
        December 18, 2023 through March 26, 2014.” However, we limit our
        consideration to his other submissions (the physical capacity examinations) for
        two reasons. First, the neurology records were largely duplicative (i.e., the
        ALJ already had the majority of this information from other sources so the
        additional neurology records would not have changed the ALJ’s analysis).
        Second, we agree with the district court’s assessment that: “[T]he treatment
        records from Alabama Neurology Associates significantly predate claimant’s
        alleged onset date of disability of July 12, 2018. Thus, the determination of the
        Appeals Council that those records would not have changed the outcome of
        the ALJ’s decision has support.”
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        22-10842                   Opinion of the Court                               23

               The Appeals Council did not fail to consider the additional
        evidence submitted by Goble. Rather, it considered the evidence—
        specifically the medical opinions of Drs. Diethelm and Shubair—
        and determined that the evidence did not have a reasonable
        probability of changing the ALJ’s determination. The opinions of
        Drs. Diethelm and Shubair were unlikely to change the outcome
        of the ALJ’s decision—that Goble was not disabled and able to
        perform light work—because they were not supported by or
        consistent with the other medical evidence in this case. 20 C.F.R.
        § 404.1520c(c)(1)–(5). 20
              Much of the medical evidence in the record pointed to the
        fact that Goble’s conditions had improved alongside proper
        medical care and attention to his medication and treatments. This
        evidence contradicts the evaluations by Drs. Diethelm and Shubair
        which paint a bleak depiction of Goble’s ability to work (i.e., Dr.
        Diethelm opined that due to Goble’s anxiety, epilepsy, and
        migraines he would be off task 90 percent of the day and miss work
        twenty days a month, but in a Return Patient Note in April 2020,
        Dr. Diethelm (1) noted that Goble was “doing much better”
        regarding his seizures, (2) wrote that Goble reported success with

        20To be clear, cases like the instant case are reviewed differently than cases in
        which the Appeals Council refused to consider a claimant’s additional
        evidence at all. See Washington., 806 F.3d at 1321 n.5 (explaining that a more
        deferential review standard is applied when the Appeals Council considers a
        claimant’s additional evidence as opposed to cases where the Appeals Council
        outright refuses to consider additional evidence that has been submitted).
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        24                    Opinion of the Court                22-10842

        medication for his headaches, and in May 2020, he (3) prescribed
        medication for anxiety because Goble’s anxiety worsened after he
        stopped taking the medication). Additionally, despite conducting
        a physical exam and noting that Goble’s “[g]ait [was] steady” and
        that he had no focal motor or sensory deficiencies, Dr. Diethelm
        indicated on the physical capacities form that Goble would not be
        able to stand for even 15 minutes.
               Additionally, Dr. Shubair indicated on the physical
        capacities form that Goble’s asthma, sleep apnea, and morbid
        obesity would severely limit his ability to work, but Dr. Shubair
        also noted in October 2019 that Goble’s use of a CPAP machine
        had “markedly improved” his sleep apnea and that Goble reported
        “wak[ing] up rested” and had “no excessive daytime sleepiness
        [and] no headache” alongside other pulmonological improvements
        after “bronchodilator therapy.”
               These inconsistences call into question the supportability
        and consistency of Goble’s additional evidence. As such, the
        Appeals Council’s determination that the additional records did not
        have a reasonable probability of changing the ALJ’s thorough and
        well-reasoned decision below is supported by the record. And to
        the extent that Goble takes exception with the Appeals Council’s
        lack of extensive explanation as to why the additional evidence
        would not have changed the outcome, that is also a losing
        argument. Washington, 806 F.3d at 1321 n.5 (“When the Appeals
        Council accepts additional evidence, considers the evidence, and
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        22-10842               Opinion of the Court                       25

        then denies review, it is not required to provide a detailed
        rational[e] for denying review.” (quotations omitted)).
              B. The Commissioner’s Determinations Were Based on
                 Substantial Evidence
                Goble argues that the Commissioner’s decision was not
        based on substantial evidence for several reasons. Goble argues (1)
        “[t]he Appeals Council wrongly held the three physical evaluations
        would not change the outcome,” (2) “[t]he [ALJ’s] Unfavorable
        Decision was not based on substantial evidence,” and (3) “[t]he
        ALJ . . . relied on [VE] testimony that was not based on a correct or
        full statement of claimant’s limitations and impairments.” We
        already addressed Goble’s argument that the Appeals Council
        erred in determining that there was not a reasonable probability
        that the new evidence would have changed the outcome, but we
        address the other two arguments below.
               We start with Goble’s argument that the ALJ’s reliance on
        the VE’s testimony was misplaced. Goble’s argument is
        completely conclusory: he puts forth his argument and provides a
        short overview of the operative legal framework—but that is it.
        Goble argues that the ALJ did not account for all of the claimant’s
        limitations but does not say which limitations went unaccounted
        for or the effect that those apparent mistakes would have had on
        the VE’s assessment. Goble’s argument is devoid of substance and,
        therefore, he has abandoned his argument. Singh v. U.S. Att’y
        Gen., 561 F.3d 1275, 1278 (11th Cir. 2009) (“[A]n appellant’s simply
        stating that an issue exists, without further argument or discussion,
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        26                      Opinion of the Court                 22-10842

        constitutes abandonment of that issue and precludes our
        considering the issue on appeal.”).
               Finally, we disagree with Goble’s argument that the ALJ’s
        determination was not supported by substantial evidence. Given
        the medical records that indicated Goble’s various impairments
        were improving or could be addressed with proper medical care,
        there was sufficient evidence to find that he could still perform light
        work. See Winschel, 631 F.3d at 1178 (“We may not decide the
        facts anew, reweigh the evidence, or substitute our judgment for
        that of the [Commissioner].” (quotations omitted)); Simon, 7 F.4th
        at 1103 (“Substantial evidence is less than a preponderance, and
        thus we must affirm an ALJ’s decision even in cases where a greater
        portion of the record seems to weight against it.” (quotations
        omitted)). In addition, while Goble’s medical records were
        extensive, many of the visits led to various scans (CT scans, x-rays,
        or EKGs, etc.) that showed either no abnormalities or returned as
        “unremarkable.” Moreover, the ALJ’s RFC finding is consistent
        with the opinions of the state agency consultants. Simply put,
        substantial evidence supports the ALJ’s determination that Goble
        has impairments, but they are not so debilitating that he is unable
        to perform light work.
               AFFIRMED.