REPORT AND RECOMMENDATION1

JOEL B. TOOMEY, Magistrate Judge.

THIS CAUSE is before the Court on Plaintiff's appeal of an administrative decision denying his application for a Period of Disability and Disability Insurance Benefits. A hearing was held before the assigned Administrative Law Judge ("ALJ") on September 24, 2013, at which Plaintiff was represented by an attorney. (Tr. 30-61.) In a decision dated December 4, 2013, the ALJ found that Plaintiff had not been under a disability from February 1, 2012, the alleged disability onset date, through the date of decision. (Tr. 12-25.)

Plaintiff has exhausted his available administrative remedies and the case is properly before the Court. The undersigned has reviewed the record, the briefs, and the applicable law. For the reasons stated herein, the undersigned respectfully RECOMMENDS that the Commissioner's decision be AFFIRMED.

I. Issues on Appeal

Plaintiff raises two issues on appeal. First, he argues that the "ALJ [f]ailed to [p]roperly [w]eigh the [m]edical [e]vidence." (Doc. 13 at 12.) Specifically, Plaintiff takes issue with the ALJ's analysis of the opinions of treating psychiatrist Dr. Lia Nardone and treating primary care physician Dr. Bernard Khaw. (Id. at 12-16.) Second, Plaintiff argues that the ALJ "[f]ailed to [p]roperly [e]valuate [his] [c]redibility." (Id. at 16.)

II. Standard of Review

As the Eleventh Circuit has stated:

Winschel v. Comm'r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011) (citations and quotations omitted). "With respect to the Commissioner's legal conclusions, however, our review is de novo." Lewis v. Barnhart, 285 F.3d 1329, 1330 (11th Cir. 2002).

III. The ALJ's Decision

At step two of the sequential evaluation process, the ALJ found that Plaintiff had the severe impairments of "fibromyalgia, irritable bowel syndrome, migraines, sleep apnea, insomnia, major depressive disorder, anxiety, mood disorder, and social phobia." (Tr. 14.)2 After determining that Plaintiff's impairments did not meet or equal a listing, the ALJ found that Plaintiff had the residual functional capacity ("RFC"):

(Tr. 16-17.)

At step four, the ALJ found that Plaintiff was unable to perform any past relevant work. (Tr. 24.) However, at step five, the ALJ found that there were jobs that existed in significant numbers in the national economy that Plaintiff could perform. (Tr. 24-25.) Therefore, Plaintiff was not disabled. (Tr. 25.)

IV. Analysis

A. Medical Evidence

1. Treating Physician Standard

To discount the opinions of a treating doctor, the ALJ has to provide "good cause." Phillips v. Barnhart, 357 F.3d 1232, 1240 (11th Cir. 2004). Good cause to discount a treating doctor's opinion exists when "(1) [the] treating physician's opinion was not bolstered by the evidence; (2) [the] evidence supported a contrary finding; or (3) [the] treating physician's opinion was conclusory or inconsistent with the doctor's own medical records." Id. at 1240-41.

2. Dr. Nardone

Regarding Dr. Nardone, the ALJ first reviewed her treating records:

(Tr. 20.)

The ALJ then reviewed Dr. Nardone's response to a Psychiatric/Psychological Impairment Questionnaire (Tr. 851-58). (Tr. 22.) The ALJ noted in part that Dr. Nardone opined that Plaintiff had a number of marked limitations:

(Tr. 22.)

The ALJ then stated the weight he was giving Dr. Nardone's opinions:

(Tr. 22.)

The undersigned recommends that the ALJ articulated good cause, supported by substantial evidence, to discount the opinions of Dr. Nardone. First, as noted by the ALJ, Plaintiff did not receive any treatment from a mental health professional from 2011 until April 2013. It was proper for the ALJ to consider this lack of treatment as an indication that Plaintiff's claimed psychological impairments for the period at issue were not as debilitating as Plaintiff claimed or as Dr. Nardone indicated. See Carnley v. Astrue, Case No. 5:07cv155/RS/EMT, 2008 WL 3896019, at *10 (N.D. Fla. Aug. 21, 2008) ("[A] claimant's failure to seek treatment is a proper factor for the ALJ to consider.") (citing Watson v. Heckler, 738 F.2d 1169, 1173 (11th Cir.1984)). Given that the period of disability at issue was from February 1, 2012 through December 4, 2013, Plaintiff had no treatment from a mental health professional for the majority of this time, and did not begin such treatment until approximately eight months before the period ended.

Moreover, although the ALJ could have better explained exactly how Dr. Nardone's opinions were inconsistent with the entire record and unsupported by her treatment records, the undersigned recommends that the ALJ's decision is sufficiently clear to ensure meaningful review. See Winschel, 631 F.3d at 1179 (an ALJ must "state with at least some measure of clarity the grounds for his decision"). Regarding Dr. Nardone's treatment records, the ALJ had previously described them in detail, and noted, for example, that they indicated that Plaintiff's thought process was "organized, coherent, and circumstantial," that Plaintiff "was alert and oriented times three, and there was no evidence of cognitive difficulties," and that Plaintiff's Global Assessment of Functioning ("GAF") score was 55, indicating moderate symptoms. (Tr. 20.) Further, on the visit with Dr. Nardone in May 2013, Plaintiff reported that he had plans to go to Nebraska to help care for his grandfather, and that his mood and motivation had improved. (Tr. 20.) He reported that his anxiety was less intense. (Tr. 20.) His affect "was generally euthymic," his thought process was "organized and coherent," and he was "alert and oriented times three with no gross evidence of cognitive difficulties." (Tr. 20.)

In comparing Dr. Nardone's treatment records with her opinions, the undersigned recommends that it was reasonable for the ALJ to conclude that such treatment records did not support the severe limitations indicated. Thus, this reason given by the ALJ to discount the opinions of Dr. Nardone is supported by substantial evidence.

In addition, although the ALJ did not specify how Dr. Nardone's opinions were "inconsistent with the evidence of record when considered in its entirety," he did discuss his view of the record evidence in explaining why his RFC assessment was supported. (Tr. 23-24.) In short, the ALJ relied on Plaintiff's described daily activities, the type and frequency of treatment, Plaintiff's "inconsistent and unpersuasive" description of his symptoms and limitations, and the opinions from two non-treating physicians and other State agency doctors. As discussed further herein, the undersigned recommends that all of these reasons are supported by substantial evidence. (Tr. 23-24.) Therefore, the undersigned recommends that the ALJ articulated sufficient good cause for giving the opinions of Dr. Nardone "little weight." (Tr. 22.)

Moreover, even if the ALJ should have been more explicit in specifying how Dr. Nardone's opinions were inconsistent with her treatment records and the overall evidence, the undersigned recommends that any error is harmless. See Burgin v. Comm'r of Soc. Sec., 420 F. App'x 901, 903 (11th Cir. 2011) (applying the harmless error doctrine to social security cases). As noted, substantial evidence supports the ALJ's view, the decision is adequate for meaningful review, and no purpose would be served by a remand. See Harland v. Astrue, Case No. 3:07-CV-118(CDL), 2008 WL 5137802, at *6 (M.D. Ga. Dec. 5, 2008) ("As the Eleventh Circuit has held, a remand to have the ALJ perfect the record would serve no practical purpose where it would not alter the ALJ's findings, and would be a waste of judicial and administrative resources.") (citing Graham v. Apfel, 129 F.3d 1420, 1423 (11th Cir.1997)).

3. Dr. Khaw

Regarding Dr. Khaw, the ALJ reviewed his treating records:

(Tr. 18-19.)

The ALJ also reviewed Dr. Khaw's response to a Multiple Impairment Questionnaire (Tr. 842-49):

(Tr. 18-19.)

Regarding Dr. Khaw's opinions, the ALJ stated:

(Tr. 23.)

Similar to the ALJ's discounting of Dr. Nardone's opinions, the undersigned recommends that the ALJ articulated good cause, supported by substantial evidence, to discount the opinions of Dr. Khaw. Although the ALJ could have better identified exactly how Dr. Khaw's opinions were inconsistent with his treatment notes and with Plaintiff's reported activities, the ALJ's decision is sufficiently clear to ensure meaningful review. See Winschel, 631 F.3d at 1179.

First, it was proper for the ALJ to consider that Dr. Khaw did not even see Plaintiff from March 2012 through April 2013, which encompasses the majority of the time period at issue. See Weekley v. Comm'r of Soc. Sec., 486 F. App'x 806, 808 (11th Cir. 2012) ("When a treating physician's opinion does not warrant controlling weight, the ALJ must nevertheless weigh the medical opinion based on the: (1) length of the treatment relationship and the frequency of examination . . ."). It was also reasonable for the ALJ to conclude that Dr. Khaw's opinions, which gave Plaintiff significant restrictions, were inconsistent with his treatment records. For example, as the ALJ noted, Plaintiff's physical examination in March 2012 was normal, and his examination in April 2013 was normal except for tenderness in the areas indicated. (Tr. 18-19.) Both times, Dr. Khaw advised Plaintiff to do as much aerobic exercise as possible using his upper and lower body. (Tr. 18-19.) On the first visit, Dr. Khaw noted that Plaintiff had been taking care of his grandfather who had Alzheimer's. (Tr. 18-19.) On the second visit, Dr. Khaw noted that Plaintiff was walking, doing yoga, and doing physical therapy. (Tr. 18-19.) Thus, substantial evidence supports the ALJ's view that Dr. Khaw's opined restrictions were inconsistent with his treatment records.

Similarly, substantial evidence supports the ALJ's view that Dr. Khaw's restrictions were inconsistent with Plaintiff's reported activities. As noted by the ALJ, Plaintiff reported the following activities:

(Tr. 23.)

Dr. Khaw opined, for example, that Plaintiff would have to take daily unscheduled breaks to rest at unpredictable intervals during the work day, and would then have to rest between one to five days depending on his level of pain before returning to work. (Tr. 847.) This restriction could reasonably be viewed as inconsistent with the daily activities Plaintiff described, including taking daily walks, taking care of his grandfather (and traveling to Nebraska to do so), and going to school. Thus, substantial evidence supports the ALJ's view that Dr. Khaw's opinion was inconsistent with Plaintiff's reported activities.

Moreover, even if the ALJ should have been more explicit in specifying how Dr. Khaw's opinions were inconsistent with his treatment records and with Plaintiff's reported activities, the undersigned recommends that any error is harmless. See Burgin, 420 F. App'x at 903. As noted, substantial evidence supports the ALJ's view, the decision is adequate for meaningful review, and no purpose would be served by a remand. See Harland, 2008 WL 5137802, at *6.

4. Plaintiff's Arguments

In addition to arguing that the ALJ's decision is not specific enough, which the undersigned has addressed, Plaintiff argues that the ALJ erred in relying on non-examining doctors instead of treating physicians. (Doc. 13 at 14.) "Generally, the opinions of examining or treating physicians are given more weight than non-examining, or non-treating physicians." Wainwright v. Comm'r of Soc. Sec. Admin., Case No. 06-15638, 2007 WL 708971, at *2 (11th Cir. Mar. 9, 2007). See also Wilson v. Heckler, 734 F.2d 513, 518 (11th Cir. 1984); 20 C.F.R. § 404.1527(c)(1). However, "the ALJ may reject any medical opinion if the evidence supports a contrary finding." Wainwright, 2007 WL 708971, at *2. Furthermore, "[t]he ALJ is required to consider the opinions of non-examining state agency medical and psychological consultants because they are highly qualified physicians and psychologists, who are also experts in Social Security disability evaluation." Milner v. Barnhart, 275 F. App'x 947, 948 (11th Cir. 2008). Therefore, the undersigned recommends that, having validly discounted the aforementioned treating doctors' opinions, the ALJ could reasonably give "great weight" to the opinions of Drs. James Brooks and Jose Rabelo. (Tr. 21-24.) See Flowers v. Comm'r of Soc. Sec., 441 F. App'x 735, 743 (11th Cir. 2011) ("[B]ecause the ALJ articulated good cause for discounting the opinions of [Plaintiff's] treating and examining doctors and because the consulting doctor's opinion was consistent with the medical record, . . . the ALJ did not err in giving more weight to the consulting doctor's opinion.").

Furthermore, to the extent Plaintiff argues that the ALJ erred in failing to address each specific factor listed in 20 C.F.R. § 404.1527(c), the ALJ was not required to do so. See Lawton v. Comm'r of Soc. Sec., 431 F. App'x 830, 833 (11th Cir. 2011). See also Davis-Augustin v. Colvin, Case No. 3:14CV113/EMT, 2015 WL 5042752, at *11 (N.D. Fla. Aug. 26, 2015) ("The ALJ need not separately discuss every factor that she considers in according weight to the treating source's opinion, provided she give[s] good reasons.") (internal quotation marks omitted). Therefore, the undersigned recommends that substantial evidence supports the ALJ's weighing of the medical evidence.

B. Plaintiff's Credibility

Plaintiff also argues that the ALJ "[f]ailed to [p]roperly [e]valuate [his] [c]redibility." (Doc. 13 at 16.) "If the ALJ decides not to credit a claimant's testimony as to her pain, he must articulate explicit and adequate reasons for doing so." Foote v. Chater, 67 F.3d 1553, 1561-62 (11th Cir. 1995). "A clearly articulated credibility finding with substantial supporting evidence in the record will not be disturbed by a reviewing court." Id. at 1562.

The ALJ stated that Plaintiff's "statements concerning the intensity, persistence and limiting effects of [his] symptoms are not fully supported by the record. . . . The evidence of record documents symptoms and limitations; however, they do not prevent him from performing a restricted range of light work." (Tr. 18.) As previously noted, later in the decision, the ALJ supported his RFC assessment by relying on Plaintiff's described daily activities, the significant gaps in medical treatment, Plaintiff's inconsistent and unpersuasive presentation, and the opinions of the non-examining physicians. (Tr. 23-24.) The undersigned recommends that these reasons are explicit and adequate to discount Plaintiff's credibility.

Plaintiff takes issue with each of the reasons articulated by the ALJ. Regarding Plaintiff's daily activities, he argues: "[I]t remains unclear how the ability to perform such minimal activities primarily at home and as needed can be contrary to Plaintiff's testimony on how he would be limited if in a work environment." (Doc. 13 at 17.) However, as the ALJ noted, at the hearing Plaintiff testified to extensive limitations. (Tr. 17-18.) For example, "[h]e stated that he had difficulty moving his arms, sitting for longer than 30 minutes, standing for longer than 15 minutes, walking more than 3-5 minutes, lifting more than 15 pounds, and climbing stairs. The claimant testified that he suffered from headaches 3-5 times [sic] week with the shortest one lasting four hours and the longest one being all day." (Tr. 17.) The ALJ could reasonably view these asserted limitations as inconsistent with other reports by Plaintiff that he took care of his grandfather who had Alzheimer's, he traveled to Nebraska to help care for his grandfather, he took daily walks, he did laundry, dusted, and swept, and he did yoga. (Tr. 23.)

Regarding his lengthy gaps in treatment, Plaintiff argues that the ALJ should have inquired about those gaps, as part of his duty to develop the record, and not simply assumed that the gaps were due to a lack of severity of symptoms. (Doc. 13 at 17-18.) For support, he relies on SSR 96-7p, which provides in pertinent part that "the adjudicator must not draw any inferences . . . from a failure to seek or pursue regular medical treatment without first considering any explanations that the individual may provide, or other information in the case record, that may explain infrequent or irregular medical visits. . . ." However, Plaintiff provides no explanation for these gaps in treatment, nor does he point to any other information in the record that would explain them. Thus, SSR 96-7p does not support Plaintiff's argument. Furthermore, this case is distinguishable from Henry v. Commissioner, 802 F.3d 1264, 1270 (11th Cir. 2015), in which the Eleventh Circuit recently held that the ALJ did not properly develop the record regarding a claimant's explanation that he could not afford medical treatment. There is no such issue in this case. Plaintiff is a veteran and was receiving care through the Veterans Administration. (Tr. 17.) He provided no explanation for the gaps in treatment, and the record suggested none. Therefore, the undersigned recommends that the ALJ appropriately considered this factor in discounting Plaintiff's credibility.3

Third, Plaintiff argues that the ALJ erred in relying on his observations of Plaintiff at the hearing. (Doc. 13 at 18-19.) However, the ALJ recognized: "While the hearing was short-lived and cannot be considered a conclusive indicator of the claimant's overall level of pain on a day-to-day basis, the apparent lack of discomfort during the hearing is given some slight weight in reaching the conclusion regarding the credibility of the claimant's allegations and the claimant's residual functional capacity." (Tr. 23-24.) As the ALJ stated, his observation of Plaintiff was only a slight factor, coupled with many other factors, in discounting Plaintiff's credibility. Thus, the undersigned recommends that no error occurred. See Macia v. Bowen, 829 F.2d 1009, 1011 (11th Cir. 1987) ("The ALJ is not prohibited `from considering the claimant's appearance and demeanor during the hearing.'") (quoting Norris v. Heckler, 760 F.2d 1154, 1158 (11th Cir. 1985) ("[W]e did not intend to prohibit an ALJ from considering the claimant's appearance and demeanor during the hearing. Rather, an ALJ must not impose his observations in lieu of a consideration of the medical evidence presented.")).

Finally, as previously discussed, Plaintiff argues that the ALJ erred in relying on non-examining physicians. However, for the reasons previously discussed, the undersigned recommends that the Court reject this argument as well.

V. Conclusion

The Court does not make independent factual determinations, re-weigh the evidence or substitute its decision for that of the ALJ. Thus, the question is not whether the Court would have arrived at the same decision on de novo review; rather, the Court's review is limited to determining whether the ALJ's findings are based on correct legal standards and are supported by substantial evidence. Applying this standard of review, the undersigned respectfully recommends that the Commissioner's decision be affirmed.

Accordingly, it is respectfully RECOMMENDED that: