Greter Alvarez Martin v. Acting Commissioner of Social Security ( 2022 )


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  • USCA11 Case: 21-11532     Date Filed: 05/11/2022    Page: 1 of 22
    [DO NOT PUBLISH]
    In the
    United States Court of Appeals
    For the Eleventh Circuit
    ____________________
    No. 21-11532
    Non-Argument Calendar
    ____________________
    GRETER ALVAREZ MARTIN,
    Plaintiff-Appellant,
    versus
    ACTING COMMISSIONER OF SOCIAL SECURITY,
    Respondent-Appellee.
    ____________________
    Appeal from the United States District Court
    for the Southern District of Florida
    D.C. Docket No. 1:19-cv-23468-CMA
    ____________________
    USCA11 Case: 21-11532         Date Filed: 05/11/2022   Page: 2 of 22
    2                     Opinion of the Court                 21-11532
    Before BRANCH, BRASHER, and ANDERSON, Circuit Judges.
    PER CURIAM:
    Greter Alvarez Martin, through counsel, appeals the
    district court’s order affirming the Social Security Administration
    (“SSA”) Commissioner’s decision denying her application for
    disability insurance benefits (“DIB”) under 
    42 U.S.C. § 405
    (g). She
    raises three issues on appeal. First, she argues that the
    administrative law judge (“ALJ”) failed to state with particularity
    the weight accorded the medical opinion evidence and failed to
    provide good cause for discounting the medical opinion evidence
    of her treating psychiatrist. Second, she argues that substantial
    evidence does not support the ALJ’s residual functional capacity
    (“RFC”) finding. Third, she asserts that substantial evidence does
    not support the ALJ’s evaluation of her subjective complaints.
    After careful review, we affirm.
    I.       Background
    In August 2015, Alvarez Martin applied for DIB, asserting
    that her depression, anxiety, mood disorder, sadness, loss of
    interest, and insomnia limited her ability to work, and that her
    disability started on August 27, 2014. She stated that she worked
    previously in accounting, but that she had stopped working
    because of the specified medical conditions. Along with the
    application, Alvarez Martin completed a function report, which
    stated the following. She lived in an efficiency with her minor
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    21-11532                Opinion of the Court                          3
    daughter and cared for her daughter. She could not sleep at
    night, even with medication, which caused her to be sleepy and
    tired during the day. She was “always” anxious, depressed, and
    had panic attacks. She tried to live “a regular life” and to care for
    her daughter, although her conditions sometimes made that
    difficult. She recently lost interest in how she looked or dressed
    and in self-grooming. She prepared meals daily, such as
    sandwiches, frozen dinners, and “sometimes easy meals”; cleaned
    and did laundry every week or every other week; did the grocery
    shopping in-store; but went outside “only when it [was]
    necessary.” She confirmed that she could go out alone, could
    drive, pay bills, handled her bank accounts, but that she needed
    “more time” to do these tasks since the onset of her conditions.
    She denied having a social life and reported watching television as
    her only hobby. Finally, her conditions affected her memory,
    understanding, concentration, ability to follow instructions, her
    ability to complete tasks, and her ability to handle stress.
    An agency consultant for the state, Dr. Robert Hodes,
    Ph.D., reviewed Alvarez Martin’s function report and the medical
    records she submitted 1 and opined that she was not disabled.
    Specifically, he determined that her “affective disorders” resulted
    in mild limitations on activities of daily living and social
    1
    Alvarez Martin submitted records from her primary care physician, Dr.
    Juvenal Martinez, and her treating psychiatrist, Dr. Jose Lopez Escobar.
    Their records are elaborated on later in this opinion.
    USCA11 Case: 21-11532       Date Filed: 05/11/2022   Page: 4 of 22
    4                     Opinion of the Court                21-11532
    functioning and moderate limitations in maintaining
    concentration, persistence, or pace. He determined that she was
    moderately limited in her ability to understand, remember, and
    carry out detailed instructions, and her ability to maintain
    concentration for extended periods of time. He also concluded
    that her “ability to complete a normal workday and workweek
    without interruptions from psychologically based symptoms and
    to perform at a consistent pace without an unreasonable number
    and length of rest periods” was moderately limited.
    Thus, he concluded that she could understand and retain
    simple, and some detailed, work instructions, sustain her
    attention and persist at simple, routine tasks for extended periods
    of two-hour segments, sustain her work efforts with appropriate
    breaks, and maintain regular, punctual attendance. He added that
    she could relate appropriately and tolerate regular public contact,
    get along with coworkers without distracting them or exhibiting
    behavioral extremes, accept criticism and respond appropriately
    to changes, learn work rules, and adapt to demands of simple,
    routine work settings. Accordingly, Alvarez Martin’s DIB
    application was denied.
    She sought reconsideration, and a second agency
    consultant conducted an independent review and similarly
    concluded that Alvarez Martin was not disabled and identified the
    same limitations described in Dr. Hodes’s determination.
    Accordingly, her application was again denied at the
    reconsideration level.
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    21-11532                  Opinion of the Court                             5
    Thereafter, Alvarez Martin requested and received a
    hearing before an ALJ in September 2017, at which she was
    represented by counsel. The evidence included the following.
    Records from Alvarez Martin’s treating psychiatrist, Dr. Lopez
    Escobar, from March 2015 through May 2017, indicated that
    Alvarez Martin suffered from a major depressive disorder and
    anxiety. 2 Alvarez Martin’s evaluations during that time indicated
    that, while she exhibited a tense, anxious and depressed mood
    and impaired recent and immediate memory, she had an
    appropriate appearance; was cooperative and coherent; was intact
    in her thought process; was oriented to time and place; denied
    any delusions, obsessions, compulsions, or suicidal ideations; and
    had good judgment. The notes for her six visits between her
    initial appointment in March 2015 and January 2016 indicated that
    she remained depressed despite medication compliance.
    However, in her four visits between March and October 2016, Dr.
    Lopez Escobar noted that Alvarez Martin was “less depressed”
    and responding better or “well” to treatment but still had “very
    poor attention and concentration.”
    However, in May 2017, Dr. Lopez Escobar reported that
    Alvarez Martin “remain[ed] very depressed and ha[d] recently
    beg[u]n hearing voices . . . and [was] very anxious about her
    2
    Beginning in May 2015, medical records from Alvarez Martin’s primary care
    physician, Dr. Juvenal Martinez, confirmed that she suffered from
    depression, anxiety, and a sleep disorder, and she was taking medications for
    these issues.
    USCA11 Case: 21-11532        Date Filed: 05/11/2022      Page: 6 of 22
    6                       Opinion of the Court                 21-11532
    condition given her family history of schizophrenia.”3
    Nevertheless, consistent with the prior mental status
    examinations, Dr. Lopez Escobar reported that Alvarez Martin
    had an appropriate appearance; was cooperative and coherent;
    was intact in her thought process; was oriented to time and place;
    and had good judgment.
    On January 12, 2016, Dr. Lopez Escobar completed a work
    assessment related to Alvarez Martin’s application for DIB, and
    rated Alvarez Martin’s ability to do the following as “poor”—
    (1) follow work rules; (2) relate to coworkers; (3) deal with the
    public; (4) interact with supervisors; (5) deal with work stress;
    (6) function independently; (7) maintain attention or
    concentration; (8) understand, remember and carry out complex,
    detailed, or simple job instructions; (9) relate predictably in social
    situations; and (10) demonstrate reliability. He rated her use of
    judgment and ability to maintain her personal appearance and
    behave in an emotionally stable manner as fair. Dr. Lopez
    Escobar indicated that Alvarez Martin was “emotionally unstable”
    and “unable to work in any capacity.”
    Later, in August 2017, Dr. Lopez Escobar completed a
    second work assessment. In this assessment, he rated Alvarez
    Martin’s abilities as “none” in all of the identified areas, except her
    ability to use judgment and to maintain her personal appearance,
    3
    There were no treatment records submitted for the time period between
    October 2016 and May 2017.
    USCA11 Case: 21-11532       Date Filed: 05/11/2022   Page: 7 of 22
    21-11532              Opinion of the Court                       7
    which he rated as “poor.” He again stated that she was unable to
    work in any capacity.
    At the hearing before the ALJ in September 2017, Alvarez
    Martin testified that in the past 15 years, she had worked in
    accounting/bookkeeping and accounts payable and receivable.
    But she was fired from her job for “not doing [it] properly.” She
    began seeing Dr. Lopez Escobar in 2014, with complaints of
    insomnia, a lack of concentration and focus, depression, crying,
    moodiness, and a loss of interest in grooming and other
    previously enjoyable activities. She described her typical day as
    spending most of the day in bed, but stated that she gets up and
    “do[es] whatever [she can] do.” However, her sister and mother
    come over often to help. She used to have “a lot of hobbies,” but
    now she has none. She stated that she felt “terrible” because she
    was not financially contributing to the household. She asserted
    that she is unable to concentrate while using a computer or on
    television programs, she sees what is happening, but cannot
    follow the plot.
    She testified that, other than her family, she did not
    socialize with others because she did not feel comfortable, does
    not like being with “a lot of people,” and feels “very safe” in her
    home. She asserted that she experiences sudden mood changes,
    and can become very argumentative, including screaming at
    people, at any time for any reason. She denied doing cooking or
    household chores, stating that the family bought a lot of fast food
    USCA11 Case: 21-11532       Date Filed: 05/11/2022   Page: 8 of 22
    8                     Opinion of the Court                21-11532
    or frozen food and that her husband cooks, and her mother and
    sister handle the household chores.
    She confirmed that she sees Dr. Lopez Escobar every two
    months, but no other therapists. And she takes four medications
    for her conditions, which she confirmed were helping. She
    explained that, after she was fired, her emotional state started to
    deteriorate.
    The vocational expert (“VE”) testified that an individual
    with Alvarez Martin’s limitations could not perform her past
    work. But the VE testified that the individual could perform
    other jobs in the national economy—(1) a tube operator; (2) an
    addresser; and (3) a document preparer. The ALJ asked whether
    an individual could perform those jobs if they were only
    occasionally able to ignore or avoid distractions, including
    psychologically based symptoms, and the VE opined that they
    could not. Further, the VE opined that an individual who “would
    be off task ten or more minutes per hour due to concentration
    issues . . . would be unemployable.”
    Looking at Dr. Lopez Escobar’s work assessments, the ALJ
    asked the VE about the first work assessment in which Dr. Lopez
    Escobar had rated most of Alvarez Martin’s abilities as “poor.”
    The VE opined that such a person would be unemployable, as
    would a person whose abilities were rated as none in the
    identified areas.
    USCA11 Case: 21-11532            Date Filed: 05/11/2022         Page: 9 of 22
    21-11532                   Opinion of the Court                               9
    Employing the SSA’s five-step sequential evaluation
    process for determining whether a claimant is disabled, the ALJ
    denied Alvarez Martin’s application.4 The ALJ found that Alvarez
    Martin had not engaged in substantial gainful activity since
    August 27, 2014, and was severely impaired from major
    depressive and anxiety disorders. At step three, the ALJ
    determined that Alvarez Martin’s mental impairments did not
    meet or medically equal any listed impairment under §§ 12.04
    (depressive disorders) and 12.06 (anxiety disorders) of the Social
    Security regulations.5
    4
    The evaluation process involves the following five determination steps:
    (1) whether the claimant is engaged in substantial gainful activity; (2) if not,
    whether she “has a severe impairment or combination of impairments”; (3) if
    so, whether that impairment, or combination of impairments, meets or
    equals the medical listings in the regulations; (4) if not, whether the claimant
    can perform her past relevant work in light of her RFC; and (5) if
    not, whether, based on her age, education, and work experience, she can
    perform other work found in the national economy. Winschel v. Comm’r of
    Soc. Sec., 
    631 F.3d 1176
    , 1178 (11th Cir. 2011).
    5
    A claimant bears the burden of showing her impairments meet or equal a
    listing. Barron v. Sullivan, 
    924 F.2d 227
    , 229 (11th Cir. 1991). In order to
    meet listing 12.04 or 12.06, Alvarez Martin needed to show medical
    documentation of a depressive disorder (12.04) or an anxiety disorder (12.06),
    and, under paragraph B, extreme limitation in one of the following areas of
    mental function or marked limitations in two of these areas:
    (1) understanding, remembering, or applying information; (2) interacting
    with others; (3) concentrating, persisting, or maintaining pace; and adapting
    or managing oneself. See 20 C.F.R. Pt. 404, Subpt. P, App. 1, Pt. A2,
    §§ 12.04, 12.06. Alternatively, under paragraph C, Alvarez Martin could
    meet listing 12.04 or 12.06 if she showed that her mental disorder was
    USCA11 Case: 21-11532          Date Filed: 05/11/2022        Page: 10 of 22
    10                        Opinion of the Court                    21-11532
    The ALJ then determined that Alvarez Martin had the
    following RFC:
    [T]o lift and/or carry 10 pounds occasionally and
    less than 10 pounds frequently, stand and/or walk 2
    hours in an 8-hour workday, and sit 6 hours in an 8-
    hour workday. She should avoid exposure to
    hazardous machinery, mechanical parts, and
    unprotected heights. The claimant could frequently
    understand and carry out simply oral and written
    instructions. She requires limited interaction with
    others and performs best when the work deals
    primarily with objects rather than people. [She] can
    relate to, and interact, with others to the extent
    necessary to carry out simple tasks, but should avoid
    work that requires more complex interaction or
    joint efforts to achieve the work goal. She is able to
    complete simple, routine, and repetitive tasks, but
    not at a production rate or pace. [She] is able to
    perform activities within a schedule and maintain
    regular attendance while being punctual within
    customary tolerances.         She could maintain
    concentration for at least 2 hours at a time, but
    could be off task 5 minutes per hour.
    “serious and persistent,” meaning it had lasted at least two years, and there
    was evidence of both: (1) ongoing medical treatment, therapy, support, or a
    highly structured setting to diminish the symptoms and signs of the disorder;
    and (2) “minimal capacity to adapt to changes in [her] environment or to
    demands that are not already part of [her] daily life.” Id. §§ 12.04, 12.06.
    USCA11 Case: 21-11532          Date Filed: 05/11/2022       Page: 11 of 22
    21-11532                 Opinion of the Court                            11
    In reaching this conclusion, the ALJ found that Alvarez Martin’s
    “statements concerning the intensity, persistence and limiting
    effects of [her] symptoms [were] not entirely consistent with the
    medical evidence and other evidence in the record.”
    As for the medical opinion evidence, the ALJ determined
    that, in light of the factors in 
    20 C.F.R. § 404.1527
    , 6 the opinions of
    the agency consultants were
    entitled to deference over Dr. Lopez Escobar’s
    opinion because [his] opinion relies heavily on
    [Alvarez Martin’s] subjective complaints and self-
    reports and is [in]consistent with the claimant’s
    mental status examinations while the State agency
    consultants’ opinions are supported by the medical
    evidence and are consistent with the record as a
    whole. In addition, Dr. Lopez Escobar’s progress
    notes are internally inconsistent and he did not
    provide a detailed analysis regarding the limitations
    he assessed.
    6
    Section 404.1527 sets out the following factors for deciding the weight to
    give medical opinion evidence: (1) the physician’s examining relationship
    with the claimant; (2) the treatment relationship with the claimant;
    (3) whether the medical opinion is supported by other relevant evidence;
    (4) the consistency of the medical opinion with the record as a while;
    (5) whether the medical source is a specialist; and (6) “any factors [the
    claimant] or others bring to [the ALJ’s] attention, or of which [the ALJ] is
    aware, which tend to support or contradict the medical opinion. 
    20 C.F.R. § 404.1527
    (c).
    USCA11 Case: 21-11532     Date Filed: 05/11/2022   Page: 12 of 22
    12                   Opinion of the Court              21-11532
    The ALJ then detailed some of the inconsistencies identified in
    Dr. Lopez Escobar’s progress notes.
    The ALJ then found that, although Alvarez Martin was
    unable to perform any past relevant work, there were jobs in the
    national economy that she could perform—tube operator,
    addresser, and document preparer. Consequently, the ALJ found
    that Alvarez Martin was not disabled. Alvarez Martin requested
    discretionary review of the ALJ’s decision by the SSA Appeals
    Council, and her request was denied.
    Alvarez Martin subsequently filed a complaint in the
    district court, alleging that: (1) the ALJ failed to state with
    particularity the weight she afforded the different medical
    opinions, and failed to provide the necessary “good cause” for
    affording less than controlling weight to Dr. Lopez Escobar’s
    opinion; (2) the ALJ’s RFC finding was not supported by
    substantial evidence; and (3) the ALJ’s assessment of Alvarez
    Martin’s alleged symptoms and limitations was not supported by
    substantial evidence. Upon the filing of cross-motions for
    summary judgment, a magistrate judge issued a report and
    recommendation        (“R&R”),      recommending     that    the
    Commissioner’s motion for summary judgment be granted. The
    district court adopted the R&R over Alvarez Martin’s objections.
    This appeal followed.
    USCA11 Case: 21-11532      Date Filed: 05/11/2022     Page: 13 of 22
    21-11532               Opinion of the Court                      13
    II.    Standards of Review
    “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 v. Apfel, 
    245 F.3d 1274
    , 1278 (11th Cir. 2001). “[W]e review de novo the legal
    principles upon which the Commissioner’s decision is based,” and
    “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, substantial evidence is “more
    than a mere scintilla”—it “means only . . . such relevant evidence
    as a reasonable mind might accept as adequate to support a
    conclusion.” Biestek v. Berryhill, 
    139 S. Ct. 1148
    , 1154 (2019)
    (quotation omitted); see also Simon v. Comm’r, Soc. Sec. Admin.,
    
    7 F.4th 1094
    , 1103 (11th Cir. 2021) (“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.” (quotation 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) (quotation omitted). “Even if the evidence
    preponderates against the Commissioner’s findings, we must
    affirm if the decision reached is supported by substantial
    evidence.” Crawford v. Comm’r of Soc. Sec., 
    363 F.3d 1155
    ,
    1158–59 (11th Cir. 2004) (quotation omitted).
    USCA11 Case: 21-11532       Date Filed: 05/11/2022    Page: 14 of 22
    14                     Opinion of the Court                21-11532
    III.   Discussion
    1.    Whether the ALJ erred in weighing the medical opinion
    evidence
    Alvarez Martin argues that the ALJ failed to state with
    particularity the weight afforded the medical opinion evidence,
    and relatedly failed to provide good cause to accord less than
    controlling weight to Dr. Lopez Escobar’s opinion as her treating
    physician. She maintains that this error led to the ALJ’s erroneous
    finding that she was not disabled.
    To obtain social security disability benefits, the applicant
    must prove she is disabled. See Barnhart v. Thomas, 
    540 U.S. 20
    ,
    21 (2003). “Disability” 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 which has lasted or can be expected
    to last for a continuous period of not less than 12 months.” 
    42 U.S.C. § 423
    (d)(1)(A). The impairment must be “of such severity
    that [the person] is not only unable to do [her] previous work but
    cannot, considering [her] age, education, and work experience,
    engage in any other kind of substantial gainful work which exists
    in the national economy.” 
    Id.
     § 423(d)(2)(A).
    When making the disability assessment, the ALJ must give
    special attention to the medical opinions, particularly those of the
    treating physician. SSA regulations in force at the time Alvarez
    Martin filed her application required an ALJ to give “controlling
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    21-11532                 Opinion of the Court                           15
    weight” to a treating physician’s opinion if it was “well-supported
    by medically acceptable clinical and laboratory diagnostic
    techniques” and “not inconsistent with the other substantial
    evidence in [the] case record.” 
    20 C.F.R. § 404.1527
    (c)(2); 7 see
    also Winschel, 
    631 F.3d at 1179
     (“Absent ‘good cause,’ an ALJ is to
    give the medical opinions of treating physicians substantial or
    considerable weight.” (quotation omitted)). Good cause to
    discount a treating physician’s opinion exists “when the:
    (1) treating physician’s opinion was not bolstered by the evidence;
    (2) evidence supported a contrary finding; or (3) treating
    physician’s opinion was conclusory or inconsistent with the
    doctor’s own medical records.” Winschel, 
    631 F.3d at 1179
    (quotation omitted).
    “[T]he ALJ must state with particularity the weight given
    to different medical opinions and the reasons therefor.” 
    Id.
    There are no magic words to state with particularity the weight
    given to the medical opinions. Rather, the ALJ must “state with
    at least some measure of clarity the grounds for his decision.” 
    Id.
    (quotation omitted). In the absence of “at least some measure of
    clarity” for the basis of the ALJ’s decision, “we will decline to
    affirm simply because some rationale might have supported the
    ALJ’s conclusion.” 
    Id.
     (quotation omitted). The weight a medical
    opinion receives depends on, among other things, the doctor’s
    7
    In 2017, the SSA amended its regulations and removed the “controlling
    weight” requirement for all applications filed after March 27, 2017. See 
    20 C.F.R. §§ 404.1527
    , 404.1520c.
    USCA11 Case: 21-11532       Date Filed: 05/11/2022     Page: 16 of 22
    16                     Opinion of the Court                 21-11532
    examining and treating relationship with the claimant, the
    evidence the doctor presents to support their opinion, and how
    consistent that opinion is with the rest of the record. 
    20 C.F.R. § 404.1527
    (c). “We will not second guess the ALJ about the
    weight the treating physician’s opinion deserves so long as [the
    ALJ] articulates a specific justification for it.” Hunter v. Soc. Sec.
    Admin., Comm’r, 
    808 F.3d 818
    , 823 (11th Cir. 2015).
    In explaining the weight accorded to the medical opinion
    evidence, the ALJ stated that,
    in light of the factors provided in 
    20 CFR §404.1527
    ,
    the State agency consultants’ opinions [were]
    entitled to deference over Dr. Lopez Escobar’s
    opinion because Dr. Lopez Escobar’s opinion relies
    heavily on the claimant’s subjective complaints and
    self-reports . . . while the State agency consultants’
    opinions are supported by the medical evidence and
    are consistent with the record as a whole.
    Although the ALJ did not use the terms, “great weight,” “some
    weight,” or little weight” when discussing the medical opinion
    evidence, the ALJ stated “with at least some measure of clarity”
    the weight accorded the medical opinions and the grounds for her
    decision. Winschel, 
    631 F.3d at 1179
     (quotation omitted). By
    expressly affording deference to the opinions of the agency
    consultants, the ALJ necessarily did not give controlling weight to
    Dr. Lopez Escobar’s opinion and provided reasons for her
    decision. Thus, the requirement that the ALJ “state with
    USCA11 Case: 21-11532      Date Filed: 05/11/2022   Page: 17 of 22
    21-11532              Opinion of the Court                     17
    particularity” the weight accorded the medical options was
    satisfied. See 
    id.
    The ALJ also provided good cause for discounting the
    opinion of Alvarez Martin’s treating physician Dr. Lopez Escobar
    that Alvarez Martin was unable to work in any capacity.
    Specifically, the ALJ explained that, although Alvarez Martin
    suffered from depression and anxiety, Dr. Lopez Escobar’s
    records indicated that her mental status remained stable at each
    appointment—she presented as cooperated, coherent, and
    oriented with intact thought processes and good judgment. And
    although Alvarez Martin indicated on occasion that she was
    experiencing increased depression, Dr. Lopez Escobar did not
    record any significant increase in her symptoms. Further, the ALJ
    noted that “Dr. Lopez Escobar often writes that the claimant is
    responding well to treatment, which is reflected in the mental
    status, but then states that the claimant has very poor attention
    and concentration, which is not consistent with the mental status”
    recorded during examination. Similarly, the ALJ noted that,
    although Dr. Lopez Escobar noted in Alvarez Martin’s recent
    examination that she was very depressed and had begun to hear
    voices, “the mental status portion of the progress note did not
    mention hallucinations and her thought process was marked as
    intact.” Thus, the ALJ determined that “while [Alvarez Martin]
    might have some limitations, her complaints [were] not
    consistent with the evidence of record to the degree that she
    USCA11 Case: 21-11532          Date Filed: 05/11/2022        Page: 18 of 22
    18                        Opinion of the Court                    21-11532
    would be precluded from performing all work-related activity.”8
    The ALJ’s reasoning is supported by the record.
    For instance, in both of the work assessments, Dr. Lopez
    Escobar rated Alvarez Martin’s use of judgment and abilities to
    maintain her personal appearance and behave in an emotionally
    stable manner as fair or poor. But these assessments were
    inconsistent with his medical records for each of Alvarez Martin’s
    appointments between March 2015 and May 2017, in which he
    noted that she had an appropriate appearance, was cooperative
    and coherent with an intact thought process, and had good
    judgment. Furthermore, although he stated in the work
    8
    Alvarez Martin makes much of the fact that, when explaining why the
    agency consultants’ opinions were entitled to deference over Dr. Lopez
    Escobar’s, the ALJ stated that “Dr. Lopez Escobar’s opinion relies heavily on
    the claimant’s subjective complaints and self-reports consistent with the
    claimant’s mental status examinations while the State agency consultants’
    opinions are supported by the medical evidence and are consistent with the
    record as a whole.” (emphasis added). She argues that there was no basis for
    discounting Dr. Lopez Escobar’s opinions where the ALJ admitted that his
    opinions were consistent with her mental status examinations. However,
    based on the ALJ’s further explanation of her decision, we agree with the
    district court that the ALJ clearly meant that Dr. Lopez Escobar’s opinions
    were inconsistent with the mental status examinations.
    Additionally, Alvarez Martin notes that the ALJ did not mention that,
    between her first visit in 2015 and her last visit of record in 2017, her
    medications were adjusted several times. However, in light of Alvarez
    Martin’s testimony before the ALJ that her current medication regime was
    working “much better,” the number of times her medication was adjusted
    does not undermine the ALJ’s reasoning.
    USCA11 Case: 21-11532       Date Filed: 05/11/2022     Page: 19 of 22
    21-11532               Opinion of the Court                        19
    assessments that Alvarez Martin did not have the ability to
    (1) follow work rules; (2) relate to coworkers; (3) deal with the
    public; (4) interact with supervisors; (5) deal with work stress;
    (6) function independently; (7) maintain attention or
    concentration; (8) understand, remember and carry out complex,
    detailed, or simple job instructions; (9) relate predictably in social
    situations; and (10) demonstrate reliability, he left blank the
    section that asked him to “[d]escribe any limitations and include
    the medical/clinical findings that support” his ratings related to
    her “ability to adjust to a job.” And this conclusion is in direct
    tension with his own treatment records (which at best reflect mild
    to moderate limitations), as well as Alvarez Martin’s own function
    report. See Schink v. Comm’r of Soc. Sec., 
    935 F.3d 1245
    , 1262
    (11th Cir. 2019) (explaining that in order to discount a treating
    physician’s opinion, “an ALJ must identify a genuine
    inconsistency” (alteration adopted) (quotation omitted)).
    Thus, the ALJ articulated a specific, reasonable justification
    that established “good cause” for giving the treating physician’s
    opinions less than controlling weight. Winschel, 
    631 F.3d at 1179
    ;
    Hunter, 808 F.3d at 823; see also Edwards v. Sullivan, 
    937 F.2d 580
    , 583–84 (11th Cir. 1991) (concluding that good cause existed
    where the medical opinion was contradicted by other notations in
    the physician’s own record). And this rationale is supported by
    substantial evidence in the record. Accordingly, we will not
    disturb that decision. Hunter, 808 F.3d at 823.
    USCA11 Case: 21-11532      Date Filed: 05/11/2022    Page: 20 of 22
    20                    Opinion of the Court                21-11532
    2.    Whether the RFC finding is supported by substantial
    evidence
    Alvarez Martin argues that the RFC finding is not
    supported by substantial evidence due to the ALJ’s failure to
    properly evaluate the medical opinion evidence. She maintains
    that had the ALJ not discounted Dr. Lopez Escobar’s opinion, no
    reasonable person could have concluded that, despite her
    impairments, she could sustain full time work.
    Because this claim is premised on her allegation that the
    ALJ failed to properly weigh the medical opinion evidence, it fails
    necessarily for the reasons set forth previously. Moreover, we
    note that the RFC finding is consistent with the opinions of both
    of the agency consultants that, despite Alvarez Martin’s moderate
    difficulties with concentration, persistence, and pace, she was
    capable of performing simple, routine work, and maintaining
    attention and persistence for 2-hour segments. Thus, the RFC
    finding was supported by substantial evidence. See Biestek, 
    139 S. Ct. at 1154
     (explaining that, in the Social Security context,
    substantial evidence is “more than a mere scintilla”—it “means
    only . . . such relevant evidence as a reasonable mind might
    accept as adequate to support a conclusion” (quotation omitted)).
    3.     Whether the ALJ properly assessed Alvarez Martin’s
    alleged symptoms and limitations
    Alvarez Martin argues that the ALJ’s determination that
    her subjective allegations concerning the intensity, persistence,
    USCA11 Case: 21-11532      Date Filed: 05/11/2022     Page: 21 of 22
    21-11532               Opinion of the Court                      21
    and limiting effects of her symptoms were contradicted by the
    medical evidence fail to account for her deteriorating condition
    and indicate a “failure to generally appreciate the nature of mental
    impairments.”
    When, as here, the ALJ determines that the claimant’s
    medically determinable impairments could reasonably be
    expected to produce the claimant’s symptoms, the ALJ “must
    then evaluate the intensity and persistence of [the claimant’s]
    symptoms so that [the ALJ] can determine how [the claimant’s]
    symptoms limit [the claimant’s] capacity for work.” 
    20 C.F.R. § 404.1529
    (c)(1). In evaluating the intensity and persistence of the
    claimant’s symptoms, the ALJ considers “all of the available
    evidence,” from both medical and non-medical sources, and
    evaluates the claimant’s statements “in relation to” the available
    evidence. 
    Id.
     § 404.1529 (c)(1), (4).
    “[C]redibility determinations are the province of the ALJ,
    and we will not disturb a clearly articulated credibility finding
    supported by substantial evidence.” Mitchell v. Comm’r, Soc.
    Sec. Admin., 
    771 F.3d 780
    , 782 (11th Cir. 2014) (internal citations
    omitted).
    Here, the ALJ made a clearly articulated credibility finding
    and pointed to specific reasons for discounting Alvarez Martin’s
    subjective testimony concerning the intensity and severity of her
    impairments—namely, that it was inconsistent with the available
    evidence in the record. As indicated from the summary of the
    testimony detailed in this opinion, that finding was supported by
    USCA11 Case: 21-11532   Date Filed: 05/11/2022   Page: 22 of 22
    22                  Opinion of the Court             21-11532
    substantial evidence in the record. Accordingly, we will not
    disturb it.
    AFFIRMED.