VIEIRA

v.

COMMISSIONER OF SOCIAL SECURITY

OPINION AND ORDER1

I. Status

Theresa Lima Vieira (“Plaintiff”) is appealing the Commissioner of the Social Security Administration’s (“SSA(’s)”) final decision denying her claim for disability insurance benefits (“DIB”). Plaintiff’s alleged inability to work is the result of “[o]steoarthritis,” “[b]ack injury – sciatic nerve pain,” “[d]iabetes [t]ype²,” and “[o]verweight.” Transcript of Administrative Proceedings (Doc. No. 15; “Tr.” or “administrative transcript”), filed May¹⁵, 2020, at 62, 73, 85, 212. Plaintiff filed an application for DIB on December¹, 2016,2 alleging a

and a vocational expert (“VE”). See Tr. at 32-61. At the time of the hearing, Plaintiff was 49 years old. Tr. at 34 (providing date of birth). On January 28, 2019, the ALJ issued a Decision finding Plaintiff not disabled through the date of the Decision. See Tr. at 12-22.

Thereafter, Plaintiff requested review of the Decision by the Appeals Council, Tr. at 175-76, and submitted additional evidence in the form of a brief authored by Plaintiff’s counsel, see Tr. at 4-5, 263-66 (brief). On November⁵, 2019, the Appeals Council denied Plaintiff’s request for review, Tr. at 1-3,

making the ALJ’s Decision the final decision of the Commissioner. On

Regulations (“Regulations”), determining as appropriate whether the claimant

1237 (11th Cir. 2004). The claimant bears the burden of persuasion through step four, and at step five, the burden shifts to the Commissioner. Bowen v. Yuckert, 482 U.S. 137, 146 n.5 (1987). Here, the ALJ followed the five-step inquiry. See Tr. at 14-21. At step one,

the ALJ determined that Plaintiff “has not engaged in substantial gainful activity since November¹, 2016, the alleged onset date.” Tr. at 14 (emphasis and citation omitted). At step two, the ALJ found that Plaintiff “has the following severe impairments: osteoarthritis of the left knee, diabetes mellitus,

hypothyroidism, and morbid obesity.” Tr. at 14 (emphasis and citation omitted). At step three, the ALJ found that Plaintiff “does not have an impairment or combination of impairments that meets or medically equals the severity of one of the listed impairments 20 [C.F.R.] Part 404, Subpart P, Appendix 1.” Tr. at

15 (emphasis and citations omitted). The ALJ determined that Plaintiff has the following residual functional capacity (“RFC”): “[Plaintiff can] perform light work as defined in 20 [C.F.R. §] 404.1567(b) except she is able to frequently climb ramps and stairs; occasionally climb ladders, ropes, or scaffolds; occasionally use foot controls with the left lower extremity; and occasionally kneel, crouch, and crawl.” Tr. at 16 (emphasis omitted). At step four, the ALJ relied on the VE and found that Plaintiff “is capable of performing past relevant work as an administrative clerk.” Tr. at 19 (emphasis and citations omitted).

Although the ALJ found Plaintiff can perform her past relevant work, the ALJ further made alternative findings. Tr. at 20. In the fifth and final step, after considering Plaintiff’s age (“46 years old . . . on the alleged onset date”), education (“at least a high school education”), work experience, and RFC, the

ALJ again relied on the VE and found that “there are other jobs that exist in significant numbers in the national economy that [Plaintiff] also can perform,” Tr. at 20-21, such as “Laundry Worker,” “Price Marker,” and “Information Clerk,” Tr. at 21. The ALJ concluded that Plaintiff “has not been under a disability . . . from November¹, 2016, through the date of th[e D]ecision.” Tr. at 21 (emphasis and citation omitted).

III. Standard of Review

This Court reviews the Commissioner’s final decision as to disability pursuant to 42 U.S.C. § 405(g). Although no deference is given to the ALJ’s conclusions of law, findings of fact “are conclusive if . . . supported by ‘substantial evidence.’” Doughty v. Apfel, 245 F. 3d 1274, 1278 (11th Cir. 2001) (citing Falge v. Apfel, 150 F. 3d 1320, 1322 (11th Cir. 1998)). “Substantial evidence is something ‘more than a mere scintilla, but less than a preponderance.’” Dyer v. Barnhart, 395 F. 3d 1206, 1210 (11th Cir. 2005) (quoting Hale v. Bowen, 831 F. 2d 1007, 1011 (11th Cir. 1987)). The substantial evidence standard is met when there is “such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.” Falge, 150 F. 3d at 1322 (quoting Richardson v. Perales, 402 U.S. 389, 401 (1971)); see also Biestek v. Berryhill, 139 S.Ct. 1148, 1154 (2019); Samuels v. Acting Comm’r of Soc. Sec., 959 F. 3d 1042, 1045 (11th Cir. 2020) (citation omitted). It is not for this Court to reweigh the evidence; rather, the entire record is reviewed to determine whether “the decision reached is reasonable and supported by substantial evidence.” Cornelius v. Sullivan, 936 F. 2d 1143, 1145 (11th Cir. 1991) (citation omitted). The decision reached by the Commissioner must be affirmed if it is supported by substantial evidence—even if the evidence preponderates against the Commissioner’s findings. Crawford v. Comm’r of Soc. Sec., 363 F. 3d 1155, 1158-59 (11th Cir. 2004) (per curiam).

IV. Discussion

A. Parties’ Arguments

As noted, Plaintiff argues that “the ALJ did not offer good cause for rejecting the opinion of Plaintiff’s treating physician, Dr. O’Malley-Keyes.” Pl.’s Mem. at 1, 7. Specifically, Plaintiff asserts that (1) the ALJ wrongfully ignored Dr. O’Malley-Keyes’s opinion that Plaintiff cannot ambulate without difficulty; (2) the ALJ erroneously rejected Dr. O’Malley-Keyes’s diagnosis of carpal tunnel syndrome (“CTS”); (3) the ALJ improperly faulted Dr. O’Malley-Keyes for saying Plaintiff has “extensive” osteoarthritis; (4) the ALJ mistakenly relied on Dr. O’Malley-Keyes’s clinical finding that reveals “mild swelling and tenderness;” and (5) the ALJ incorrectly disregarded Dr. O’Malley-Keyes’s opinion that Plaintiff needs an assistive device for ambulation. Id. at 9-11. Responding, Defendant asserts that “the ALJ had good cause to discount Dr. O’Malley-Keyes’[s] opinions based on their lack of support and inconsistency with other evidence, including her own treatment records.” Def.’s Mem. at 7.

B. Applicable Law6

The Regulations establish a hierarchy among medical opinions7 that provides a framework for determining the weight afforded each medical opinion. See 20 C.F.R. § 404.1527. Essentially, “the opinions of a treating physician are entitled to more weight than those of a consulting or evaluating

[any] treatment relationship”; (3) “[s]upportability”; (4) “[c]onsistency” with other medical evidence in the record; and (5) “[s]pecialization.” 20 C.F.R. § 404.1527(c)(2)-(5); see also 20 C.F.R. § 404.1527(f), Walker v. Soc. Sec. Admin., Comm’r, 987 F. 3d 1333, 1338 (11th Cir. 2021); McNamee v. Soc. Sec. Admin.,

164 F. App’x 919, 923 (11th Cir. 2006) (citation omitted) (stating that “[g]enerally, the opinions of examining physicians are given more weight than those of non-examining physicians[;] treating physicians[’ opinions] are given more weight than [non-treating physicians;] and the opinions of specialists are given more weight on issues within the area of expertise than those of nonspecialists”). With regard to a treating physician,⁸ the Regulations instruct ALJs how to properly weigh such a medical opinion. See 20 C.F.R. § 404.1527(c)(2). Because treating physicians “are likely to be the medical professionals most able to provide a detailed, longitudinal picture of [a claimant’s] medical impairment(s),” a treating physician’s medical opinion is to be afforded controlling weight if it is “well-supported by medically acceptable clinical and laboratory diagnostic techniques and is not inconsistent with the other substantial evidence” in the record. Id. When a treating physician’s medical opinion is not due controlling weight, the ALJ must determine the appropriate weight it should be given by considering the factors identified above (the length of treatment, the frequency of examination, the nature and extent of the treatment relationship, as well as the supportability of the opinion, its consistency with the other evidence, and the specialization of the physician). Id.

If an ALJ concludes the medical opinion of a treating physician should be given less than substantial or considerable weight, he or she must clearly articulate reasons showing “good cause” for discounting it. Walker, 987 F. 3d at 1338 (citation omitted); Schink, 935 F. 3d at 1259; Hargress v. Soc. Sec. Admin.,

1259; Hargress, 883 F. 3d at 1305; Phillips, 357 F. 3d at 1240-41; see also Edwards v. Sullivan, 937 F. 2d 580, 583-84 (11th Cir. 1991); Schnorr v. Bowen, 816 F. 2d 578, 582 (11th Cir. 1987) (stating that a treating physician’s medical opinion may be discounted when it is not accompanied by objective medical evidence). An ALJ is required to consider every medical opinion. See 20 C.F.R. § 404.1527(c) (stating that “[r]egardless of its source, we will evaluate every medical opinion we receive”). While “the ALJ is free to reject the opinion of any physician when the evidence supports a contrary conclusion,” Oldham v. Schweiker, 660 F. 2d 1078, 1084 (5th Cir. 1981) (citation omitted); see also 20 C.F.R. § 404.1527(c)(2), “the ALJ must state with particularity the weight given to different medical opinions and the reasons therefor,” Winschel v. Comm’r of

Soc. Sec., 631 F. 3d 1176, 1179 (11th Cir. 2011) (citing Sharfarz, 825 F. 2d at 279); Moore v. Barnhart, 405 F. 3d 1208, 1212 (11th Cir. 2005); Lewis v. Callahan, 125 F. 3d at 1440. C. Dr. O’Malley-Keyes’s Treatment and Opinions Dr. O’Malley-Keyes is Plaintiff’s primary care physician at CareHere Clinic—City of Ocala Employee Clinic (“CareHere”). Tr. at 469. Plaintiff has been a patient at CareHere since 2009, Tr. at 318, but she did not see Dr. O’Malley-Keyes for the first time until October 28, 2015, Tr. at 284. Dr. O’Malley-Keyes treated Plaintiff several times before Plaintiff filed for DIB. Tr. at 273-84 (including on October 28, 2015; August⁴, 2016; August 12, 2016; September 23, 2016; October 13, 2016; November 9, 2016; and November 29, 2016).9

Since August 2016, Dr. O’Malley-Keyes has been Plaintiff’s primary doctor. See, e.g., Tr. at 272-78, 520-21, 528, 535-36, 547, 551, 560-61.10 Dr. O’Malley-Keyes has treated Plaintiff for a number of ailments over the years, including allergic rhinitis, obesity, hypothyroidism, Type² diabetes mellitus,

osteoarthritis, anxiety, chronic elevated white blood cell count, and skin rashes. See, e.g., Tr. at 273, 277, 279, 479-86. 1. Dr. O’Malley-Keyes’s Physical Examinations of Plaintiff During almost every visit, Dr. O’Malley-Keyes has performed a Physical

Examination (“PE(s)”) of Plaintiff. See, e.g., Tr. at 480, 482, 484, 486. Dr. 9 Apparently, Dr. Jalal Kurdi and Dr. Nidal El Rimawi treated Plaintiff between November 2015 through June 2016. Tr. at 280-82. Todd Bergan, physician assistant-certified (“PA-C”), treated Plaintiff on September¹, 2016. Tr. at 278-79. 10 Mr. Bergan saw Plaintiff on September¹, 2016. O’Malley-Keyes regularly has examined Plaintiff’s head, eyes, and “general” physical state. See, e.g., Tr. at 273, 277, 480, 482, 484.11 She has documented most of Plaintiff’s PEs as “normal.” See, e.g., Tr. at 276-82, 284, 480, 482, 484, 503, 551, 560-61, 572. If something during a PE has appeared “abnormal,” Dr. O’Malley-Keyes has noted it. See, e.g., Tr. at 273 (December 12, 2016 record indicating PE was “abnormal” because Plaintiff’s left wrist was tender), 277-80 (August⁴, 2016; August 12, 2016; September¹, 2016; September 23, 2016; October 13, 2016 records indicating “skin” as “abnormal” because Plaintiff suffered from a rash during this time period).12

2. Dr. O’Malley-Keyes’s Opinions of Plaintiff’s Osteoarthritis of the Left Knee

Plaintiff saw Dr. O’Malley-Keyes on October 13, 2016 for a refill of ibuprofen that Plaintiff “use[d] occasionally for knee pain.” Tr. at 276.13 Plaintiff’s PE was “normal” for all categories, except for “skin” which was

On January 31, 2017, Dr. O’Malley-Keyes noted that Plaintiff was “in need of an ortho[pedic] appointment for chronic knee problems, but [Plaintiff] has [been] putting [the orthtopedic] off due to money.” Tr. at 485.14 She

(Continued…) indicated on Plaintiff’s PE that her “Ext.” was “abnormal,” and Plaintiff was “using [a] cane secondary to chronic knee pain.” Tr. at 485-86. Dr. O’Malley-Keyes prescribed a refill for Meloxicam on February 27, 2017 that Plaintiff was “us[ing] daily for knee pain.” Tr. at 483. Plaintiff’s PE was “normal” for all categories except “skin” that was “abnormal” due to a rash.

Tr. at 484. During Plaintiff’s visits on March 21, 2017 and May 25, 2017, Dr. O’Malley-Keyes noted “normal” for all categories of Plaintiff’s PE. Tr. at 480, 572. On May 29, 2018, Dr. O’Malley-Keyes saw Plaintiff for a follow-up and noted that Plaintiff reported she had “ongoing knee pain [that was] worsening.” Tr. at 520. It does not appear that a full PE was completed. Dr. O’Malley-Keyes ordered an X-ray of Plaintiff’s left knee, Tr. at 512, which showed moderate osteoarthritis, Tr. at 515. Allison Onkala, PA-C, reviewed Plaintiff’s X-ray of her left knee with Plaintiff on August 23, 2018 and wrote it was “significant” for osteoarthritis. Tr. at 503. Ms. Onkala noted “normal” for all categories of Plaintiff’s PE. Tr. at 503.

rel. Boyd v. Comm'r, 553 F. App’x. 914, 919 (11th Cir. 2014) (citing McClain in a Social Security appeal and noting that the appellant “fail[ed] to develop any arguments demonstrating that the ALJ erred in his conclusions...”); see also Scheduling Order (Doc. No. 17), entered May¹⁸, 2020, at 1 (directing parties to “identify with particularity the grounds upon which the administrative decision is being challenged,” advising them that “[a]ny such challenges must be supported by citation to the record of the pertinent facts and by citations of the governing legal standards,” and that “[a]ny contention for which these requirements are not met is subject to being disregarded for insufficient development”). 3. Dr. O’Malley-Keyes’s Opinions of Plaintiff’s Ambulation and the Need for an Assistive Device

On only two of Plaintiff’s visits at CareHere did Dr. O’Malley-Keyes, or another health care worker, actually characterize in the PE portion of the medical records that Plaintiff’s gait was “[a]bnormal.” Tr. at 486, 511.15 On January 31, 2017, Dr. O’Malley-Keyes indicated “[a]bnormal” (most likely referring to Plaintiff’s gait) and noted that Plaintiff was “using [a] cane secondary to chronic knee pain.” Tr. at 486. On July⁵, 2018, Ms. Onkala noted Plaintiff’s gait was “abnormal” and indicated that Plaintiff was “[a]mbulating with cane.” Tr. at 511. Dr. O’Malley-Keyes did sometimes make PE findings in the “Notes” and

History of Present Illness (“HPI”) sections of the medical records. See, e.g., 273- 77, 521. She noted on two occasions, November 9, 2016 and November 29, 2016, that Plaintiff was “limping.” Tr. at 274, 275; see also Tr. at 465, 469 (indicating on disability paperwork that Plaintiff limps). Dr. O’Malley-Keyes documented on May¹⁸, 2018 that Plaintiff was “using a cane.” Tr. at 521 (noting PE finding in the “HPI” section of the medical records). On March 21, 2017, Dr. O’Malley-Keyes noted in the “HPI” section of

566. On both applications, Dr. O’Malley-Keyes checked the box indicating an “[i]nability to walk without the use of or assistance from a brace, cane, crutch, prosthetic device, or other assistive device, or without assistance of another person.” Tr. at 565-66. Dr. O’Malley-Keyes also marked the box indicating a

“[s]evere limitation in a person’s ability to walk due to an arthritic, neurological, or orthopedic condition.” Tr. at 565-66. 4. Dr. O’Malley-Keyes’s Opinions of Plaintiff’s CTS

During Plaintiff’s visit on December 12, 2016, Dr. O’Malley-Keyes marked “abnormal” in the “Ext.” portion of the PE and indicated Plaintiff’s left wrist was “slight[ly] tender[, but] not hot/swollen/red.” Tr. at 273. Plaintiff complained of “ongoing locking of fingers on both hands, and [they] discussed treatment options for [Plaintiff’s] trigger finger.” Tr. at 273. Dr. O’Malley-Keyes also indicated that Plaintiff complained of “left wrist pain off and on” since Plaintiff injured it about six months earlier. Tr. at 273. However, Plaintiff was told that prior imaging (referring to the emergency department X-rays taken in summer 2016) of her wrist was normal. Tr. at 273. Plaintiff complained of left wrist and hand pain on January 31, 2017 and stated that “recently the pain ha[d] been worse, and extend[ed] into her left hand.” Tr. at 485. Dr. O’Malley-Keyes noted that Plaintiff had gone to the emergency room in summer 2016 and her X-ray completed then was normal. Tr. at 485. Dr. O’Malley-Keyes and Plaintiff discussed that the “pain may[ ]be secondary to [CTS].” Tr. at 485. On March 21, 2017, Dr. O’Malley-Keyes wrote in the “HPI” section of the medical records that Plaintiff “suffers from [CTS] bilaterally which affects her ability to use hands for some tasks.” Tr. at 479. On June 9, 2017, Dr. O’Malley-

Keyes noted that Plaintiff complained of “feeling swollen in her hands and feet at times, especially with heat.” Tr. at 560. Dr. O’Malley-Keyes noted on May¹⁸, 2018 that Plaintiff complained of hand pain. Tr. at 521. During a follow-up visit on May 29, 2018, Dr. O’Malley-

Keyes indicated that Plaintiff “has ongoing . . . bilateral hand pain. Her hands ache and she sa[id] her fingers get ‘stuck, pain worse with use (knitting etc.).’” Tr. at 520. The doctor requested X-rays be taken of Plaintiff’s hands. See Tr. at 512. The X-rays showed both the right and left hands had “mild osteoarthritis in the lateral carpus” and “minimally throughout the interphalangeal joints.” Tr. at 513-14. 5. The RFC Questionnaire Completed by Dr. O’Malley-Keyes On March 21, 2017, Dr. O’Malley-Keyes completed a Physical RFC Questionnaire containing opinions about Plaintiff’s impairments and their effects on her ability to perform work-related functions. Tr. at 469-73. Dr. O’Malley-Keyes opined as follows. She listed Plaintiff’s diagnoses as osteoarthritis of the left knee and CTS of the bilateral hands. Tr. at 469. She wrote that Plaintiff’s symptoms were pain in the left knee with “secondary poor balance” and CTS “bilateral hands limiting repetitive use.” Tr. at 469. Dr. O’Malley-Keyes described Plaintiff’s left knee pain as “constant 2/10 if on meds, 5/10 with walking or prolonged sitting if on meds, [and] 8/10 if not on meds.” Tr. at 469.

Dr. O’Malley-Keyes further identified the clinical findings and objective signs of Plaintiff’s diagnoses as “limping, mild swelling/tenderness, extensive [osteoarthritis] on X-ray[, and indicated Plaintiff r]equires assisted ambulation.” Tr. at 469. She also checked the “yes” box when asked if Plaintiff’s impairments were reasonably consistent with the symptoms and functional limitations described in the evaluation. Tr. at 470. Dr. O’Malley-Keyes checked the “seldom” box when asked if Plaintiff’s experiences of pain or other symptoms were severe enough to interfere with attention and concentration. Tr. at 470. As a result of Plaintiff’s impairments, Dr. O’Malley-Keyes estimated Plaintiff’s functional limitations if she were placed in a competitive work situation: Plaintiff could sit for 30 minutes and stand for 10 minutes at one time; Plaintiff could walk less than one city block; Plaintiff in an 8-hour workday could stand/walk for less than two hours and sit about two hours. Tr. at 470-71. Dr. O’Malley-Keyes further indicated Plaintiff does not need to include periods of walking around during the workday, but she noted Plaintiff would need a job that permits shifting positions at will and sometimes Plaintiff would need unscheduled breaks. Tr. at 471. She estimated that Plaintiff would need to take unscheduled breaks approximately every 30 to 60 minutes and that Plaintiff would need approximately 30 minutes to rest before returning to work. Tr. at 471.

Dr. O’Malley-Keyes also noted that Plaintiff would need to elevate her legs to a height of “chair levels with pillows” for prolonged sitting and would have to elevate her legs approximately 25% of the time during an 8-hour workday. Tr. at 471. Finally, Dr. O’Malley-Keyes marked the “yes” box indicating Plaintiff must use a cane or other assistive device while walking/standing. Tr. at 471. Dr. O’Malley-Keyes marked the boxes indicating that Plaintiff can “occasionally” lift and carry less than 10 pounds, “rarely” lift and carry 10 pounds, and “never” lift and carry above 20 pounds. Tr. at 471. Dr. O’Malley- Keyes further marked that Plaintiff can “rarely” twist or stoop (bend) and can “never” crouch or climb ladders or stairs. Tr. at 472. Dr. O’Malley-Keyes answered “no” to the question “[d]oes your patient have significant limitations in doing repetitive reaching, handing, or fingering?”

Tr. at 472. Dr. O’Malley-Keyes then opined that during an 8-hour workday Plaintiff can use her hands/fingers/arms; can use her right and left hands to grasp, turn, or twist objects only 10% of the day; use her hands for fine manipulations more than 10% but less than 25% of the day; and use both arms from a sitting position for reaching (including overhead) only 30% of the time. Tr. at 472. Dr. O’Malley-Keyes answered “no” to the question “[a]re your patient’s impairments likely to produce ‘good days’ and ‘bad days’?” Tr. at 472. Dr. O’Malley-Keyes then marked that Plaintiff would be absent from work about three days per month due to her impairments or treatment. Tr. at 472. D. The ALJ’s Findings The ALJ considered Dr. O’Malley-Keyes’s “medical opinions regarding

Plaintiff’s functioning, her ability to work, her prognosis, and need for a disabled persons parking permit,” along with Dr. O’Malley-Keyes’s opinion that Plaintiff cannot do sedentary work and requires the use of a wheelchair, walker, or cane because of her left knee osteoarthritis. Tr. at 19. He concluded that her opinions were “inconsistent with the evidence of record and her own clinical findings.” Tr. at 19. The ALJ therefore gave “little weight” to Dr. O’Malley- Keyes’s opinions. Tr. at 19. Specifically, the ALJ stated: [Dr. O’Malley-Keyes’s opinions are] inconsistent with examination findings and radiographic evidence indicating only a mild to moderate impairment. The record indicates that on examination [Plaintiff] was able to ambulate without difficulty. Dr. O’Malley-Keyes opines that [Plaintiff] has [CTS] bilaterally that limits her ability to repetitively use her hands. However, the evidence of record contains no objective imaging indicating that [Plaintiff] has [CTS]. Further, Dr. O’Malley-Keyes indicated that radiographic imaging reveals extensive osteoarthritis. However, imaging reveals that [Plaintiff] has no more than moderate osteoarthritis. Moreover, Dr. O’Malley-Keyes indicated that her clinical findings reveal that [Plaintiff] has only mild swelling and tenderness.

Tr. at 19 (citations omitted).

E. Analysis

After a thorough review of the record, the undersigned finds that the ALJ’s reasons for discounting the opinions of Dr. O’Malley-Keyes are supported by substantial evidence. The following arguments made by Plaintiff, challenging the ALJ’s handling of Dr. O’Malley-Keyes’s opinions, are closely intertwined: (1) the ALJ wrongfully ignored Dr. O’Malley-Keyes’s opinion that Plaintiff cannot ambulate without difficulty; (2) the ALJ improperly faulted Dr. O’Malley-Keyes for saying Plaintiff has “extensive” osteoarthritis; (3) the ALJ mistakenly relied on Dr. O’Malley-Keyes’s clinical finding that reveals “mild swelling and tenderness;” and (4) the ALJ incorrectly disregarded Dr. O’Malley- Keyes’s opinion that Plaintiff needs an assistive device for ambulation. See Pl.’s Mem. at 9-11. Accordingly, these arguments are addressed together. Thereafter, Plaintiff’s argument focusing on CTS is addressed.

1. Osteoarthritis, Ambulation, and Swelling/Tenderness

Substantial evidence supports the ALJ’s decision to give “little weight” to Dr. O’Malley-Keyes’s opinion that Plaintiff has “extensive” osteoarthritis and that Plaintiff needs an assistive device to ambulate. Tr. at 19. Moreover, the ALJ’s analysis of Dr. O’Malley-Keyes’s findings, regarding “mild swelling and tenderness,” is supported by substantial evidence. Tr. at 19. The ALJ correctly found that her opinions are “inconsistent with the evidence of record and her own clinical findings.” Tr. at 19. As noted, Dr. O’Malley-Keyes stated on the RFC Questionnaire that

Plaintiff has “extensive” osteoarthritis. Tr. at 469. The ALJ, however, discussed imaging that conflicted with this characterization by Dr. O’Malley-Keyes. Tr. at 19. On October 23, 2015, an X-ray of Plaintiff’s left knee showed she had “[m]ild osteoarthritis.” Tr. at 378. Another X-ray taken on November 9, 2016, of

Plaintiff’s left knee showed “‘moderate’ osteophytic spurring of the patella and tibial tubercle,” as well as “‘mild’ osteophytic spurring of the medial and lateral compartments.” Tr. at 416. “Moderate” and “mild” joint space narrowing was also found. Tr. at 416. Additional imaging on May 29, 2018 of Plaintiff’s left knee “demonstrate[d] moderate tricompartmental joint space narrowing,” “moderate osteophytic spurring of the upper and lower poles of the patella anteriorly,” “mild osteophyte formation at the periphery of the medial and lateral compartments and in the posterior upper and lower poles of the patella,” “no evidence of fracture or joint effusion,” and “moderate osteophytic spurring of the tibial tubercle.” Tr. at 515. The conclusion from this imaging was “[m]oderate osteoarthritis [of the] left knee.” Tr. at 515 (emphasis added). The undersigned could not find any treatment records in which Dr. O’Malley-Keyes noted that Plaintiff’s osteoarthritis was “extensive,” although Ms. Onkala did note that the May 2018 X-rays were “significant” for osteoarthritis. Tr. at 503. On March 21, 2017, Dr. O’Malley-Keyes noted that Plaintiff’s knee pain had “worsened,” but the X-ray completed in May 2018 (more than a year later) showed Plaintiff’s osteoarthritis was still moderate. Tr. at 479, 515. Thus, the ALJ’s rejection of Dr. O’Malley-Keyes’s characterization of “extensive” osteoarthritis in Plaintiff’s left knee is supported by substantial evidence.

Regarding the use of a hand-held assistive device, Social Security Ruling (“SSR”) 96-9p states: Medically required hand-held assistive device: To find that a hand-held assistive device is medically required, there must be medical documentation establishing the need for a hand-held assistive device to aid in walking or standing, and describing the circumstances for which it is needed (i.e., whether all the time, periodically, or only in certain situations; distance and terrain; and any other relevant information). . . .

In these situations, too, it may be especially useful to consult a vocational resource in order to make a judgment regarding the individual's ability to make an adjustment to other work.

SSR 96-9P, 1996 WL 374185, at *7 (SSA 1996). The ALJ properly relied on medical records from a July¹⁶, 2016 emergency department visit¹⁶ just four months prior to the alleged onset date and also relied on Dr. O’Malley-Keyes own records in giving “little weight” to her opinion that Plaintiff needs an assistive device to ambulate. Tr. at 19; see Tr. at 443-55 (emergency department records), 177 (onset date); see also Garrett v. Comm’r of Soc. Sec., No. 6:16-cv-01516-CEM-GJK, 2017 WL 1460733, at *3 (M.D. Fla. Mar.¹⁵, 2017) (unpublished) (recognizing that “[c]ourts within the Eleventh Circuit have found pre-onset date evidence to be significant so long as such evidence is:¹) within close proximity to the onset date; and²) relevant to a claimant’s impairments”), report and recommendation adopted, No. 6:16-cv- 1516-CEM-GJK, 2017 WL 1438321 (M.D. Fla. Apr. 24, 2017) (unpublished); Nichols v. Comm’r of Soc. Sec., No. 6:16-cv-1819-DCI, 2018 WL 746940, at *3 (M.D. Fla. Feb. 7, 2018) (unpublished) (recognizing that “even when an opinion

During many visits, instead of Dr. O’Malley-Keyes assessing Plaintiff’s gait and ambulation, it appears Plaintiff was explaining her subjective belief that she needed an assistive device for ambulation.¹⁷ See, e.g., Tr. at 273 (noting on December 12, 2016 that ongoing left knee pain now forces Plaintiff to use a cane), 274 (stating on November 29, 2016 that Plaintiff uses a walker at home), 275 (documenting on November 9, 2016 that Plaintiff is using walker at home), 483 (indicating on February 27, 2017 that Plaintiff got a wheelchair to help her get around places that would require a lot of walking), 561 (explaining on May 25, 2017 that Plaintiff continues to use a cane). Therefore, most of the documentation surrounding Plaintiff’s claim that she needs an assistive device for ambulation is based on Plaintiff’s self-reporting. Finally, there is substantial evidence supporting the ALJ’s conclusion that Dr. O’Malley-Keyes’s clinical finding that indicates Plaintiff has “mild

Plaintiff had significant edema ‘due to obesity/varicosities.’” Pl.’s Mem. at 11. Plaintiff apparently is referring to a treatment note from a visit on October 30, 2017, but Dr. O’Malley-Keyes did not indicate in the note that the edema itself was significant. Tr. at 536. Based on the foregoing, the ALJ’s decision to give “little weight” to Dr. O’Malley-Keyes’s opinions surrounding Plaintiff’s ambulation and the need for an assistive device is supported by substantial evidence. 2. The ALJ found no objective imaging confirmed Dr. O’Malley- Keyes’s diagnosis of CTS

There is substantial evidence to support the ALJ’s rejection of Dr. O’Malley-Keyes’s opinion that Plaintiff suffers from CTS bilaterally, that limits the use of her hands. As the ALJ noted, there is no objective imaging of Plaintiff’s hands that show CTS is present. Tr. at 19. The X-rays on May 29, 2018 of Plaintiff’s hands showed “mild osteoarthritis” and that the “soft tissues are normal.” Tr. at 513-14. While Dr. O’Malley-Keyes opined Plaintiff has CTS,

see, e.g., Tr. at 465, 469, 479-80, 485, the May 2018 X-rays indicate differently, Tr. at 513-14 (showing mild osteoarthritis in left and right hands). Plaintiff asserts that “[a]fter [Dr. O’Malley-Keyes] completed [her] opinion[ ], she referred Plaintiff for X-rays that revealed Plaintiff had mild osteoarthritis of the lateral carpus in both wrists as well as minimal osteoarthritis throughout the interphalangeal joints.” Pl.’s Mem. at 9-10 (emphasis added).¹⁸ Plaintiff argues that “[w]hile the imaging did not corroborate Dr. O’Malley-Keyes’s initial finding of [CTS], Plaintiff’s

V. Conclusion

After a thorough review of the entire record, the undersigned finds that the ALJ’s Decision is supported by substantial evidence. Accordingly, it is ORDERED: 1. The Clerk of Court is directed to enter judgment pursuant to sentence four of 42 U.S.C. § 405(g), AFFIRMING the Commissioner’s final decision.

2. The Clerk is further directed to close the file.

DONE AND ORDERED in Jacksonville, Florida on March 19, 2021.

amen. Roo KIC dt

JAMES R. KLINDT

United States Magistrate Judge keb Copies: Counsel of Record