USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 1 of 13

[DO NOT PUBLISH] In the United States Court of Appeals For the Eleventh Circuit

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No. 23-11581 Non-Argument Calendar ____________________

ANAMARIE NARDELLI, Plaintiff-Appellant, versus COMMISSIONER OF SOCIAL SECURITY,

Defendant-Appellee.

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Appeal from the United States District Court for the Middle District of Florida D.C. Docket No. 8:22-cv-00132-MAP ____________________ USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 2 of 13

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Before ROSENBAUM, JILL PRYOR, and BRANCH, Circuit Judges. PER CURIAM: Plaintiff-Appellant Anamarie Nardelli applied for Supple- mental Security Income (“SSI”), but the Social Security Administra- tion (“Administration”) found she was not disabled and denied her application. Nardelli challenges that denial, claiming that the ad- ministrative law judge (“ALJ”) improperly substituted his judgment for that of evaluating psychological consultants. We conclude that substantial evidence supported the ALJ’s determination that Nardelli was not disabled and affirm the district court’s decision to that end. I. BACKGROUND

Plaintiff-Appellant Anamarie Nardelli applied for SSI in June 2020, alleging an onset of disability of May 7, 2012. 1 Nardelli claims she is disabled due to diabetes, high blood pressure, borderline per- sonality disorder, depression, and anxiety.

1 Nardelli previously filed an SSI application in November 2018, which the Ad-

ministration denied after the ALJ found she was not disabled. That ALJ found Nardelli’s depression, anxiety, and post-traumatic stress disorder to be severe impairments but reasoned that she could still perform light work with certain limitations. The ALJ adjudicating her 2020 application admitted the prior de- cision, but that decision did not bind the Administration for later periods of alleged disability. See Acquiescence Ruling 97-4(9), 62 Fed. Reg. 64038, 64039 (Dec. 3, 1997). USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 3 of 13

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A. Factual and Medical Background

Nardelli was 49 years old when she filed for SSI. She has a high school education and previously worked as a telephone sales representative and residence-leasing agent. Nardelli also worked delivery for Uber Eats for a time but stopped because she was in- volved in two car accidents in under thirty days. Before applying for SSI, Nardelli underwent several psycho- logical evaluations. We briefly recount the results of those evalua- tions below, as they informed the ALJ’s disability analysis. In April 2019, Nardelli had a consultative evaluation with Dr. Abraham Khan, M.D. At the time, Nardelli reported having depres- sion, post-traumatic stress disorder (“PTSD”), and borderline per- sonality disorder, which resulted in problems sleeping, crying spells, reduced appetite, and loss of enjoyment. Dr. Khan deter- mined that Nardelli had PTSD, anxiety, depression, and borderline personality disorder. In Dr. Khan’s opinion, these conditions af- fected Nardelli’s mood, focus, and ability to be around others. Also in April 2019, Nardelli underwent a consultative psy- chological evaluation that Dr. Steven N. Kanakis, Psy.D., P.A., per- formed. Nardelli’s mental status examination findings all fell within normal limits, except for insight and judgment, which ranged from “fair to poor.” Dr. Kanakis assessed Nardelli with can- nabis-use disorder (moderate or severe), alcohol-use disorder (in sustained full remission), and cocaine-use disorder (in sustained full remission). Dr. Kanakis opined that Nardelli’s prognosis was USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 4 of 13

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guarded, but she was not at risk of decompensation in a work set- ting. In a June 2020 function report, Nardelli attested that she per- forms basic tasks, such as caring for herself and her pet cat, living with her fiancé, cooking meals, cleaning, driving, and managing money. She stated that she could follow written instructions and had never been fired because of problems getting along with oth- ers. But Nardelli claimed that she does not leave the house unless it is necessary, avoids her family, and does not handle stress or ad- justments to her routine well. In August 2020, during a phone consultation with Dr. Jessica Rausch-Medina, Nardelli reported that she was very depressed and reluctant to leave home. Later, in a June 2021 phone consultation with Dr. Rausch-Medina, Nardelli reported anxiety symptoms (alt- hough she said she was able to stop panic attacks before they hap- pen), leaving the house only once or twice a week, and severe de- pressive symptoms and feelings of worthlessness. In October 2020, Dr. Nicholas Gehle, Psy.D., conducted a psychological consultative evaluation of Nardelli. Dr. Gehle as- sessed Nardelli with unspecified bipolar and related disorder, with moderate anxious distress. He opined that Nardelli’s symptoms “appear[ed] to be severely impacting activities of daily living, voca- tional performance, and interpersonal interactions.” But Dr. Gehle noted that Nardelli was able to perform basic activities, displayed fair social skills, demonstrated adequate judgment and insight, and appeared to have coherent and logical thought processes. USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 5 of 13

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B. Administrative Medical Findings

As part of her SSI application, Nardelli underwent psycho- logical evaluations by state consultants, at both the initial and re- consideration stages. First, Dr. Brian McIntyre, Ph.D., evaluated Nardelli’s claim in October 2020. Dr. McIntyre found that Nardelli’s depressive, bi- polar and related disorders, anxiety or obsessive-compulsive disor- ders and personality disorders were all severe impairments. Dr. McIntyre relied on Dr. Gehle’s mental-status exam. In doing so, Dr. McIntyre found that Nardelli was mildly impaired in under- standing, remembering, or applying information; moderately im- paired in interacting with others; moderately impaired in concen- trating, persisting, or maintaining pace; and mildly impaired in adapting or managing herself.2 At the reconsideration level, in January 2021, Dr. Jermaine Robertson, Ph.D., affirmed Dr. McIntyre’s evaluation of Nardelli’s mental impairments. But Dr. Robertson opined that Dr. Gehle’s evaluation overestimated the severity of Nardelli’s limitations, which indicated minimal to moderate limitations on functional ac- tivity

2 The Administration evaluates mental impairments in the context of four

broad functional areas: (1) understanding, remembering, or applying infor- mation; (2) interacting with others; (3) concentrating, persisting, or maintain- ing pace; and (4) adapting or managing oneself. 20 C.F.R. § 416.920a(c)(3). In rating the degree of limitation, the Administration employs a five-point scale: none, mild, moderate, marked, and extreme. Id. § 416.920a(c)(4). USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 6 of 13

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The Administration denied Nardelli’s application, both ini- tially and on reconsideration. C. ALJ Hearing and Subsequent Procedural History

Nardelli requested a hearing before an ALJ, who again de- nied Nardelli’s application for SSI. In reaching that determination, the ALJ relied on the above record evidence as well as Nardelli’s own testimony at a telephonic hearing in August 2021. Among other things, Nardelli testified that she has trouble checking her mood in a social environment, is either easily distracted or overly focused, and sometimes lacks compassion and understanding. The ALJ applied the five-step sequential framework for de- termining whether an individual is disabled. Under that frame- work, the Administration asks whether the claimant (1) is currently engaged in substantial gainful activity; (2) has a severe impairment or combination of impairments; (3) is disabled based on the con- gruence of their impairments with listed disabilities; (4) could per- form any of their prior work, based on their RFC; and (5) could perform any other jobs existing in significant numbers in the na- tional economy, based on their residual functional capacity, age, ed- ucation, and work experience. See 20 C.F.R. § 416.920(a)(4). First, the ALJ determined that Nardelli had not engaged in substantial gainful activity since her application date. Second, the ALJ found that Nardelli had the severe impairments of diabetes mellitus, hypertension, hypothyroidism, and obesity. But the ALJ found Nardelli’s mental impairments to be non-severe because they did not cause more than a minimal disruption to Nardelli’s USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 7 of 13

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abilities. 3 The ALJ also reasoned that Dr. Gehle, Dr. McIntyre, and Dr. Robertson’s opinions were not persuasive because they relied on Nardelli’s subjective reports of her symptoms and were incon- sistent with the mental-status examination results. At step three, the ALJ determined that Nardelli’s impair- ments did not meet or equal the severity of one of the impairments that would trigger an automatic disability finding. Before step four, the ALJ found Nardelli had the residual functional capacity (“RFC”) 4 to perform the full range of light work as defined in 20 C.F.R. § 416.967(b). In doing so, the ALJ considered Nardelli’s symptoms, medical opinions, and medical administrative findings, including the consultants’ opinions that he found to be unpersua- sive. The ALJ also noted that Nardelli neither sought nor “received essentially [any] treatment during the relevant time frame,” so “the medical evidence does not support [Nardelli’s] allegations of disa- bling symptoms and limitations.”

3 Specifically, the ALJ found no limitation in understanding, remembering, or

applying information; mild limitation in interacting with others; mild limita- tion in concentrating, persisting, or maintaining pace; and no limitation in adapting or managing herself. 4 The RFC is “the most [the claimant] can still do despite [her] limitations” in

a work setting. 20 C.F.R. § 416.945(a)(1). In determining an RFC, the ALJ must consider all impairments, including those deemed non-severe at the sec- ond step. Id.; see also Schink v. Comm’r of Soc. Sec., 935 F.3d 1245, 1268 (11th Cir. 2019). Error at step two is harmless so long as the ALJ considers the al- leged impairment in formulating the claimant’s RFC, and substantial evidence supports the ALJ’s conclusion. Schink, 935 F.3d at 1268. USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 8 of 13

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Alternatively, the ALJ found that based on Nardelli’s age, ed- ucation, work experience, and RFC, the Medical-Vocational Guide- lines directed a finding of “not disabled.” So the ALJ found Nardelli was not disabled. Nardelli requested review of the ALJ’s decision, which the Administration’s Appeals Council denied. Nardelli then filed suit in federal district court challenging the Administration’s denial. The parties consented to the jurisdiction of a magistrate judge, who affirmed the ALJ’s decision. Specifically, the magistrate judge concluded that substantial evidence in the form of mental-status exams supported the ALJ’s determination, and the ALJ’s use of the Medical-Vocational Guidelines was not overly mechanical. Nardelli timely appealed. II. STANDARD OF REVIEW

We review de novo a district court’s decision affirming the denial of SSI or disability benefits. Buckwalter v. Acting Comm’r of Soc. Sec., 5 F.4th 1315, 1320 (11th Cir. 2021). In doing so, we deter- mine whether substantial evidence supports the Commissioner’s decision and whether the Commissioner applied the correct legal standards. 5 Walker v. Soc. Sec. Admin., Comm’r, 987 F.3d 1333, 1338 (11th Cir. 2021); see also 42 U.S.C. § 405(g) (“findings of the Com- missioner of Social Security as to any fact, if supported by

5 The Commissioner has delegated to the ALJ the responsibility of determin-

ing a claimant’s RFC and whether the claimant is disabled. See 20 C.F.R. § 404.1546(c). So “ALJ” can be substituted for “Commissioner” in this context. USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 9 of 13

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substantial evidence, shall be conclusive”). Substantial evidence means “more than a scintilla and is such relevant evidence as a rea- sonable person would accept as adequate to support a conclusion.” Crawford v. Comm’r of Soc. Sec., 363 F.3d 1155, 1158 (11th Cir. 2004) (per curiam) (quoting Lewis v. Callahan, 125 F.3d 1436, 1439 (11th Cir. 1997)). The substantial-evidence threshold “is not high.” Biestek v. Berryhill, 139 S. Ct. 1148, 1154, 1157 (2019). Under this deferential standard, we do not “decide the facts anew, reweigh the evidence, or substitute our judgment for that of the Commissioner.” Mitchell v. Comm’r, Soc. Sec. Admin., 771 F.3d 780, 782 (11th Cir. 2014) (quot- ing Winschel v. Comm’r of Soc. Sec., 631 F.3d 1176, 1178 (11th Cir. 2011)). Indeed, even if a preponderance of the evidence weighs against the Commissioner’s decision, we affirm so long as substan- tial evidence supports it. Buckwalter, 5 F.4th at 1320. But “we will not ‘affirm simply because some rationale might have supported the ALJ’s conclusion.’” Id. (quoting Owens v. Heckler, 748 F.2d 1511, 1516 (11th Cir. 1984) (per curiam)). III. DISCUSSION

On appeal, Nardelli argues that the ALJ improperly substi- tuted his judgment for that of the state psychological consultants when concluding that Nardelli was not disabled. We disagree. To be entitled to SSI, a claimant must be disabled, meaning the claimant must be “unable to engage in any substantial gainful activity by reason of any medically determinable physical or men- tal impairment which can be expected to result in death or which USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 10 of 13

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has lasted or can be expected to last for a continuous period of not less than twelve months.” See 42 U.S.C. § 1382c(a)(3)(A). A “phys- ical or mental impairment” is an “impairment that results from an- atomical, physiological, or psychological abnormalities, which are demonstrable by medically acceptable clinical and laboratory diag- nostic techniques.” Id. § 1382c(a)(3)(D). Under this framework, “the claimant bears the burden of proving [s]he is disabled, and, consequently, [s]he is responsible for producing evidence to support [her] claim.” Ellison v. Barnhart, 355 F.3d 1272, 1276 (11th Cir. 2003) (per curiam). 6 Diagnoses alone do not establish work-related limitations. See Moore v. Barnhart, 405 F.3d 1208, 1213 n.6 (11th Cir. 2005) (per curiam). An ALJ bears final responsibility for assessing a claimant’s RFC and resulting limitations, based on all the relevant medical and other evidence in the record. See 20 C.F.R. §§ 416.945(a)(3), 416.946(c); Phillips v Barnhart, 357 F.3d 1232, 1238 (11th Cir. 2004), superseded on other grounds by regulation, 20 C.F.R. § 404.1520c. While an RFC determination must be based on the relevant evi- dence, “there is no rigid requirement that the ALJ specifically refer to every piece of evidence in his decision, so long as the ALJ’s deci- sion . . . is not a broad rejection which is not enough to enable [a reviewing court] to conclude that the ALJ considered [the claim- ant’s] medical condition as a whole.” Mitchell, 771 F.3d at 782

6 At step five, the burden temporarily shifts to the Administration to show the

existence of other jobs in the national economy that the claimant can perform even with her impairments. Buckwalter, 5 F.4th at 1321. USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 11 of 13

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(alterations in original) (quoting Dyer v. Barnhart, 395 F.3d 1206, 1211 (11th Cir. 2005)). To determine the weight to give a medical opinion or prior administrative medical finding, an ALJ must consider (1) the opin- ion’s supportability or the relevance of the objective evidence to the opinion; (2) the opinion’s consistency with the objective evi- dence; (3) the medical professional’s relationship; (4) the profes- sional’s specialization; and (5) other factors, such as the medical professional’s familiarly with other record evidence. 20 C.F.R. § 416.920c(c). The first two factors are the most important. Id. § 416.920c(b)(2). And the ALJ “must state with particularity the weight given to different medical opinions and the reasons” for that weight. Winschel, 631 F.3d at 1179. Here, the ALJ determined that the state psychological con- sultants’ opinions had low supportability and consistency for two main reasons. First, Dr. McIntyre and Dr. Robertson based their opinions on Dr. Gehle’s analysis, which in turn relied on Nardelli’s subjective reports. Second, Dr. McIntyre and Dr. Robertson’s con- clusions were inconsistent with Nardelli’s unremarkable mental- status exam results and other record evidence that Nardelli demon- strates adequate social functioning, attention, and concentration. The ALJ did not, as Nardelli claims, improperly substitute his medical judgment for that of the state psychological consult- ants. The ALJ stated and explained his findings as to the reports’ supportability and consistency, finding they were “not persuasive” because they were “clearly inconsistent with the objective medical USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 12 of 13

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evidence.” Nardelli relies heavily on Dr. Gehle’s opinion that Nardelli’s symptoms “appear[ed] to be severely impacting [her] ac- tivities,” but that opinion was apparently based entirely on Nardelli’s subjective reports. So the ALJ was entitled to consider that statement in context and weigh it accordingly. See Crawford, 363 F.3d at 1159 (finding that substantial evidence supported the ALJ’s “decision to discount” a physician’s opinion because it was “inconsistent with his own treatment notes, unsupported by the medical evidence, and appear[ed] to be based primarily on [the claimant’s] subjective complaints”); Walker, 987 F.3d at 1339 (simi- lar, where medical opinion “conflicted with other evidence, includ- ing several examinations”). Nor, as Nardelli contends, was the ALJ required to order an additional psychological evaluation once he determined that the consultants’ opinions were unpersuasive. An ALJ must “develop the record where appropriate but” need not “order a consultative examination as long as the record contains sufficient evidence for the [ALJ] to make an informed decision.” Ingram v. Comm’r of Soc. Sec. Admin., 496 F.3d 1253, 1269 (11th Cir. 2007). That is exactly the case here, so the ALJ did not err in declining to order an additional evaluation. Here, substantial evidence in the record supports the ALJ’s finding that Nardelli was not disabled. Nardelli testified that she can perform a range of everyday tasks notwithstanding her physi- cal and mental impairments. Nardelli largely performed within the range of normal outcomes on mental-status exams and presented USCA11 Case: 23-11581 Document: 19-1 Date Filed: 02/13/2024 Page: 13 of 13

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in a good mood with normal affect. Medical-record evidence re- flected that Nardelli displayed fair social skills, demonstrated ade- quate judgment and insight, and appeared to have coherent and logical thought processes. This is not a case in which only a “scin- tilla” of evidence supports the ALJ’s conclusion. Rather, “a reason- able person would accept” the evidence referenced in the ALJ’s de- cision “as adequate.” See Crawford, 363 F.3d at 1158. Again, it is not our role to “decide the facts anew, reweigh the evidence, or substitute our judgment for that of the” ALJ. Mitchell, 771 F.3d at 782 (quoting Winschel, 631 F.3d at 1178). Here, the ALJ applied the appropriate legal framework and explained his supportability and consistency findings. The ALJ was not required to accept the consultants’ reports without question but rather re- tained the ability to weigh the consultants’ opinions against other medical evidence. And even if some evidence in the record sup- ports Nardelli’s claim of disability, we have already determined that substantial evidence supports the ALJ’s contrary finding. See Buck- walter, 5 F.4th at 1320. So we conclude that the ALJ did not err in affording low persuasive value to the consultants’ reports in reach- ing his determination that Nardelli was not disabled. IV. CONCLUSION

For the foregoing reasons, we affirm the district court’s de- cision that the Administration properly denied Nardelli’s applica- tion for Supplemental Security Income. AFFIRMED.