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[DO NOT PUBLISH] In the United States Court of Appeals For the Eleventh Circuit ____________________ No. 24-10344 Non-Argument Calendar ____________________ JILL CAPOBIANCO, Plaintiff-Appellant, versus COMMISSIONER, SOCIAL SECURITY ADMINISTRATION,

Defendant-Appellee.

____________________ Appeal from the United States District Court for the Southern District of Florida D.C. Docket No. 2:22-cv-14405-RMM ____________________ USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 2 of 13

Before ROSENBAUM, JILL PRYOR, and ABUDU, Circuit Judges.

PER CURIAM: Jill Capobianco appeals from the district court’s order affirm- ing the decision of the Commissioner of the Social Security Admin- istration denying her applications for disability insurance benefits and supplemental security income. After careful review, we affirm.

I.

Capobianco applied for disability insurance benefits and sup- plemental security income, alleging that she was disabled due to several physical and mental impairments, including chronic mi- graines. 1 An administrative law judge (“ALJ”) held multiple eviden- tiary hearings on Capobianco’s applications. 2 The record before the ALJ included medical records and testimony from Capobianco about her limitations.

The medical records reflected that neurologist Dr. Kathie Kowalczyk treated Capobianco beginning in December 2016. After treating Capobianco for four months, Kowalczyk completed a questionnaire about Capobianco’s migraine headaches. She

2 In agency proceedings, Capobianco at times was represented by counsel and at times proceeded pro se. In the district court, she was represented by counsel but is proceeding pro se in this appeal.

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24-10344 Opinion of the Court 3 reported that Capobianco experienced chronic daily headaches, which were severe enough to cause significant interference with activities throughout the day. The questionnaire asked about the frequency of headaches. Kowalczyk checked two boxes, indicating that Capobianco had headaches “1 time a week” and “2 or more times a week.” Doc. 13 at 1639. 3 Above the box for “1 time a week,” Kowalczyk added a note, stating “1-2 times.” Id. She opined that the duration of the headaches was unpredictable, but they could be expected to last more than an hour. Kowalczyk also stated that Capobianco was taking Topamax for the headaches and did not identify any side effects associated with the medication. And Kow- alczyk reported that she was unable to identify a “medical, biolog- ical, [or] psychiatric basis” for the frequency of Capobianco’s head- aches. Id. From December 2016 through March 2019, Kowalczyk saw Capobianco eight times. The only records before the ALJ concern- ing these appointments were after-visit summaries; there were no progress notes. The after-visit summaries showed that Kowalczyk administered Botox injections to Capobianco and that Capobianco took gabapentin, Topamax, and ibuprofen for her headaches. The after-visit summaries included no details about Capobianco’s symptoms or the examinations that Kowalczyk performed.

Between June 2019 and March 2021, Kowalczyk saw Capobianco four more times. The record before the ALJ included

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The ALJ also reviewed records from several magnetic reso- nance imaging (“MRI”) scans. An MRI scan of Capobianco’s brain showed “unremarkable” results. Id. at 2359. MRI scans of her cer- vical and lumbar spine showed only mild or minimal degenerative disc disease and no significant stenosis.

The ALJ issued a written decision denying Capobianco’s ap- plications. Applying the five-step sequential evaluation framework, the ALJ determined that Capobianco was not disabled during the relevant period. At the first step, he found that Capobianco had not engaged in substantial gainful activity. At the second step, he con- cluded that she suffered from several severe impairments, includ- ing cervical migraines. At the third step, he determined that she did not have an impairment or combination of impairments that met or medically equaled the severity of a listed impairment.

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24-10344 Opinion of the Court 5 The ALJ then assessed Capobianco’s residual functional ca- pacity. He concluded that she could engage in light work with cer- tain physical and mental limitations.

In assessing residual functional capacity, the ALJ considered Capobianco’s testimony that debilitating headaches prevented her from working and the medical records showing that Kowalczyk had treated Capobianco for migraines. But the ALJ noted that for most of the appointments there were no progress notes. For these appointments, the ALJ found that there was nothing that “dis- cuss[ed] [Capobianco’s] symptoms, physical examinations, test re- sults, medication management, or prognosis.” Id. at 44. And for the later appointments for which there were progress notes, the ALJ observed that these appointments generally were conducted via telemedicine without any accompanying physical examination. He also noted that the results of the MRI scans were generally unre- markable and included no “findings that would relate to [her] re- ported headaches.” Id. The ALJ thus concluded that medical rec- ords did not corroborate Capobianco’s testimony about the fre- quency, intensity, and duration of her headaches.

The ALJ also considered the migraine questionnaire that Kowalczyk completed. He noted that she filled out the question- naire four months after beginning to treat Capobianco and that it was “not accompanied by any progress notes that correspond with the statements [Kowalczyk] made regarding [Capobianco’s] symp- toms.” Id. The ALJ also found that there were “some inaccuracies in the questionnaire” because Kowalczyk indicated that USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 6 of 13

Capobianco filed an action in district court challenging the Commissioner’s decision. She raised two issues before the district court: (1) whether the ALJ properly weighed Kowalczyk’s medical opinions when assessing her residual functional capacity and (2) whether the ALJ failed to adequately develop the record after recognizing that Kowalczyk’s treatment notes for several appoint- ments were missing. 4 The district court affirmed the Commissioner’s decision. It acknowledged that the ALJ did not expressly state the weight given to Kowalczyk’s opinions. But the court concluded that it was clear from the record that the ALJ had assigned less than controlling weight to these opinions and why he decided to discount them.

4 In the district court, Capobianco also argued that the ALJ erred in giving no weight to the opinion of Dr. Kathleen Jeannot, a physician who performed a consultative examination. Because Capobianco does not raise any argument on appeal challenging the ALJ’s assessment of Jeannot’s opinions, we do not address this issue.

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24-10344 Opinion of the Court 7 The court explained that the ALJ determined there was good cause to discount the opinions because Kowalczyk had treated Capobianco for only four months when she completed the ques- tionnaire, Kowalczyk’s responses were inconsistent as she opined that Capobianco experienced headaches both two or more times a week and one to two times a week, there were no progress notes that corresponded to the opinions, and the MRI scan of Capobianco’s brain showed no abnormalities. The court further determined that substantial evidence supported the ALJ’s decision.

The district court then addressed whether the ALJ failed to adequately develop the record by not seeking additional treatment records from Kowalczyk. The court explained that a case should be remanded for failure to develop the record only when there was an evidentiary gap that resulted in unfairness or prejudice to the claim- ant. The court concluded that there was no prejudice arising from the ALJ’s failure to obtain the progress notes because the record contained ample information to allow the ALJ to make an in- formed decision. Although the ALJ had pointed to the missing notes as one basis for discounting Kowalczyk’s opinions in the questionnaire, the court noted that the ALJ also had relied on other grounds to discount the opinions. Given these other grounds, the court concluded that there was no unfairness or clear prejudice to Capobianco. Alternatively, the court determined that there was no reversible error because Capobianco’s attorney never asked the ALJ to obtain these records and at the evidentiary hearing repre- sented that the record was complete.

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II.

When, as here, an ALJ denies benefits and the Appeals Council denies review, we review the ALJ’s decision as the Com- missioner’s final decision. See Doughty v. Apfel, 245 F.3d 1274, 1278 (11th Cir. 2001). We review the Commissioner’s decision to deter- mine whether it is supported by substantial evidence, but we re- view de novo the legal principles upon which the decision is based.

Moore v. Barnhart, 405 F.3d 1208, 1211 (11th Cir. 2005). Substantial evidence refers to “such relevant evidence as a reasonable person would accept as adequate to support a conclusion.” Id. “We may not decide facts anew, reweigh the evidence, or substitute our judg- ment for that of the Commissioner.” Dyer v. Barnhart, 395 F.3d 1206, 1210 (11th Cir. 2005) (alteration adopted) (internal quotation marks omitted). We must affirm the Commissioner’s decision if it is supported by substantial evidence, “even if the proof preponder- ates against it.” Id. (internal quotation marks omitted).

III.

We liberally construe Capobianco’s appellate brief as raising eight issues. These issues are whether the ALJ: (1) abused his au- thority by making assumptions about Capobianco’s physical im- pairments and disregarding her concerns that her constitutional rights had been violated; (2) engaged in judicial misconduct by lim- iting Capobianco’s testimony, ignoring her correspondence, and commenting that her cardiologist needed money; (3) misapplied the treating physician rule by relying on the opinions of non- USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 9 of 13

24-10344 Opinion of the Court 9 treating physicians and a consulting psychiatrist over treating phy- sicians; (4) violated Capobianco’s constitutional rights as well as her rights under international law; (5) failed to develop and con- sider a complete record by asking a vague question about Capobianco’s pain level, discussing only the parts of the record that supported denying benefits, refusing to allow Capobianco to sub- mit additional evidence after she fired her attorney, and disregard- ing Kowalczyk’s opinions; (6) abused his discretion by limiting Capobianco’s testimony, not requiring a physician to answer her questions, ignoring medical evidence that was favorable to her, and questioning her credibility; (7) mischaracterized the record by cherry picking facts and ignoring evidence that showed Capobianco’s impairments were more severe; and (8) erred by fail- ing to ask the vocational expert about a hypothetical person with all of Capobianco’s limitations and relying on the vocational ex- pert’s testimony about the availability of certain jobs in the national economy.

We conclude that Capobianco forfeited all these issues ex- cept whether the ALJ erred in failing to give controlling weight to Kowalczyk’s opinions. Capobianco forfeited the other issues be- cause she did not raise them in the district court and instead raises them for the first time on appeal. We have “repeatedly held that issues not raised in an initial brief are deemed forfeited and will not be addressed absent extraordinary circumstances.” Raper v. Comm’r of Soc. Sec., 89 F.4th 1261, 1274 (11th Cir. 2024) (alteration adopted) (internal quotation marks omitted). Although we “read briefs filed USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 10 of 13

Timson v. Sampson, 518 F.3d 870, 874 (11th Cir. 2008).

It is true that in certain circumstances we will consider the merits of a forfeited issue. But we will do so only when: (1) the issue involves a pure question of law and re- fusal to consider it would result in a miscarriage of justice; (2) the party lacked an opportunity to raise the issue at the district court level; (3) the interest of substantial justice is at stake; (4) the proper resolution is beyond any doubt; or (5) the issue presents signifi- cant questions of general impact or of great public concern.

Raper, 89 F.4th at 1274 (internal quotation marks omitted). We can- not say that any of the forfeited issues fall within these exceptions.

We thus conclude that the only issue properly before us is whether the ALJ erred in failing to give greater weight to Kowalczyk’s opin- ions.

IV.

To be eligible for disability insurance benefits or supple- mental security income, a claimant must prove that she is disabled. 42 U.S.C. §§ 423(a)(1)(E), 1382(a)(1). To determine whether a claimant is disabled, an ALJ applies a five-step sequential evaluation process. In the first three steps, the ALJ considers whether (1) the claimant is currently engaged in substantial gainful activity, (2) she has a severe impairment, and (3) her impairment or combination of impairments meet the requirements of a listed impairment. If a USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 11 of 13

24-10344 Opinion of the Court 11 claimant fails to establish that she is disabled at the third step, the ALJ proceeds to step four and considers her residual functional ca- pacity to determine whether she can perform her past relevant work. 20 C.F.R. § 404.1520(a)(4); 416.920(a)(4). If a claimant estab- lishes at step four that she has an impairment that prevents her from doing the kind of work she performed in the past, the ALJ continues to step five and considers whether the claimant can ad- just to other work given her residual functional capacity, age, edu- cation, and work experience. Id. §§ 404.1520(a)(4); 416.920(a)(4).

In this case, we are concerned with the ALJ’s assessment of Capobianco’s residual functional capacity. She argues that the ALJ erred by failing to give sufficient weight to the opinions of Kow- alczyk, her treating neurologist.

To determine whether a claimant is disabled, an ALJ must consider opinions from acceptable medical sources, including phy- sicians. Id. §§ 404.1502(a)(1), 416.902(a)(1) For claims like Capobianco’s that were filed before March 27, 2017, an ALJ must give a treating physician’s opinions “substantial or considerable weight unless there is good cause to discount them.” Simon v. Comm’r, Soc. Sec. Admin., 7 F.4th 1094, 1104 (11th Cir. 2021) (inter- nal quotation marks omitted). Good cause to discount an 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 incon- sistent with the doctor’s own medical records.” Phillips v. Barnhart, 357 F.3d 1232, 1241 (11th Cir. 2004). When an ALJ disregards a USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 12 of 13

Here, Capobianco argues that the ALJ erred because he did not state the weight assigned to Kowalczyk’s opinions set forth in the headache questionnaire. She is correct that the ALJ did not ex- pressly state that he was giving the opinions little weight. But we agree with the district court that the ALJ’s thorough discussion of the questionnaire made clear that he found good cause to assign less than controlling weight to Kowalczyk’s opinions. Because an ALJ is not required to use magic words and the ALJ’s decision clearly shows the basis for why he assigned Kowalczyk’s opinions less than controlling weight, we conclude that the ALJ did not err.

See Raper, 89 F.4th at 1276 n.14.

We now turn to whether substantial evidence supports the ALJ’s decision to give Kowalczyk’s opinions little weight. As the ALJ noted, when Kowalczyk completed the headache question- naire, she had been treating Capobianco for only four months; the record did not include other medical evidence, such as progress notes, that corroborated her opinions; and Capobianco’s MRI scans were generally unremarkable. Given all of this, we conclude that substantial evidence supported the ALJ’s decision to give little USCA11 Case: 24-10344 Document: 43-1 Date Filed: 03/19/2025 Page: 13 of 13

24-10344 Opinion of the Court 13 weight to Kowalczyk’s opinions. In reaching this conclusion, we emphasize that our review is limited to whether substantial evi- dence supported the ALJ’s decision; we are not deciding whether we would have reached the same decision if we were sitting as a factfinder. See Dyer, 395 F.3d at 1210. 5 AFFIRMED.

Even assuming Capobianco had adequately raised this issue on appeal, how- ever, we would conclude that she is not entitled to relief. We agree with the district court’s treatment of the issue.